I love pasta, and I cannot lie. For the most part, that’s why I eat it.
I absolutely do think it’s good for me, too, and that figures in my personal choices - and did before the new study put the health- or at least weight- benefits of pasta in the headlines.
That study, published in the British Medical Journal, is a meta-analysis of prior studies examining the effects of pasta consumption on weight, and related measures of body composition. The researchers expressed an interest in reviewing studies of pasta alone, as well as studies of pasta in dietary context.
Unsurprisingly, they were unable to find any studies of pasta in isolation. This is important not only in reaching conclusions about pasta, but in understanding all of nutritional epidemiology. Much as our oversimplified preoccupations and hyperbolic headlines tend to focus on one nutrient savior or scapegoat at a time, the reality is that isolating nutrient and food effects from diet is nearly impossible.
Feeding people nothing but pasta, for example, for weeks would be awkward, uncomfortable, and perhaps unethical. Even then, it would not really answer questions about just pasta, because there would still be other salient influences: the effects of dietary monotony; the effects of excluding all other foods; and as ever, the importance of the comparison diet. If weight were lost on only pasta compared to a balanced, healthful diet- would it really tell us about the effects of pasta, or would it be all about the effects of massively restricted choice? If pasta outperformed junk food, would that be because pasta is good, or because junk food is bad, or both?
For these and related reasons, the researchers found no studies of pasta alone, and were left to analyze the more than 30 studies of pasta effects on weight in the context of overall diet. Here, too, they were constrained by what research has been done before. All of these intervention trials examined pasta in the context of low-glycemic dietary patterns.
As the authors detail in the discussion of their paper, pasta, itself, is a low glycemic food. This is in part due to the varieties of wheat used, and in part due to the extrusion process intrinsic to pasta production. While there are health advantages to whole grain as compared to refined grain pasta, even standard (refined) pasta is low-glycemic, and higher in nutrients as compared to other applications of the same ingredients in products such as bread.
The contention that low-glycemic diets may be high, or low, in carbohydrate is not new. More than a decade ago, a randomized trial, published in the Archives of Internal Medicine, compared high and low carbohydrate, high and low glycemic diets, with regard to weight, and measures of cardiometabolic risk. The low-glycemic diets were better for weight loss, whether high or low in total carbohydrate (i.e., plant foods). But the net effects on both weight and cardiovascular risk reduction were best for the high carbohydrate, low glycemic diet- the very kind of diet in which pasta might figure.
The findings of the new meta-analysis aligned with such prior research, including sub-group analysis suggesting that weight outcomes were better for pasta in the context of high-carbohydrate than high-protein diets. Overall, the inclusion of pasta in low-glycemic diets was associated with moderately greater weight loss, and general improvement in measures of body composition. The clearest implication of this is not that eating pasta unrestrainedly will cause weight loss, but that weight-consciousness is not a reason to avoid pasta as part of a sensible diet.
Personally, I eat pasta routinely, mostly because, as I mentioned, I love it. I eat whole grain pasta preferentially. I probably did this at first for health benefit, but that was many years ago. I do it now because I prefer it. When it comes to taste buds, familiarity breeds not contempt, but preference.
Pasta figures famously in some variants of the traditional Mediterranean diet, which in turn figure among the diets practiced by the longest-lived, most vital populations known. As diverse studies continue to highlight the health benefits of traditional Mediterranean dietary patterns, enthusiasm for them among experts in nutrition is predictably strong and widespread.
My conclusion about the new meta-analysis is that the exact benefits of pasta may be hard to isolate. But arguments against it because it is a “carbohydrate” are misguided, and misleading.
As fate would have it, my wife and I are just back from leading a culinary tour through Sicily. We ate a fair amount of excellent pasta, as the Sicilians tend to do. Despite their annoying penchant for smoking, Sicilians are known for healthy aging, and enjoy generally better health and greater life expectancy than we do in the U.S.
So, should you eat pasta? Inevitably, as with all matters of nutrition, our culture pushes for a single, summative, oversimplified answer. The contribution of pasta to your diet depends slightly on what kind of pasta it is; whole grain is, as ever, better than refined. The addition of whole grain pasta is apt to enhance the quality of modern diets, often deficient in whole grains and the fiber it provides.
It depends more on what you eat with your pasta. There is, obviously, a big nutritional difference between pasta fagiole (a traditional, vegan dish of pasta and beans; we experienced it in Sicily with fava beans in particular) or pasta primavera (pasta with a mix of vegetables), and fettuccine Alfredo (a dish of fettuccine pasta, cheese, and butter). Aesop advised us that we are to some extent judged by the company we keep, and we may to some extent judge our pasta consumption that way, too. (For those so inclined, here’s the recipefor the Katz Family favorite shown above.)
And, of course, it depends on the always important but routinely neglected “instead of what?” question. I suppose somebody, somewhere might be choosing between whole grain pasta and, say, whole grain couscous or bulgur wheat. Acknowledging the potential glycemic advantages of pasta, this is basically a lateral move. Somebody somewhere might eat more pasta, fewer hot dogs, and would certainly be trading up. Pasta in lieu of vegetables, beans, legumes, or highly nutritious grains like quinoa would make little sense.
And, as ever, dose matters. Wholesome, real, simple, minimally processed, mostly plant foods are required to make up a wholesome, healthful diet. But so, too, is balance and sense in the overall assembly. The right place and proportions for pasta in an ideal diet are conveyed nicely by variants on the Mediterranean diet theme that have stood the test of time.
I would be remiss not to mention that pasta is traditionally made from wheat, and thus contains gluten. All of the same considerations pertain, however, to those choosing alternative, gluten-free formulations.
The new study notwithstanding, diet need not include pasta to be ideal for health and weight control. Ideal diets, however, certainly can and do include pasta, and even benefit from it. For those of us who love it, that’s more than enough reason to land on: why on earth wouldn’t we?
The answer, courtesy of low-carb zealotry run amok, is something like: because it’s carbs, and carbs will kill you! The evidence against this summary judgment of a macronutrient is much more than required to make it plain silly as well as wrong. Whole grains are consistently associated with health advantage.
If, however, we did need any help getting past the “carbs will be the death of you” argument, we might turn to the Sicilians, who as noted, eat pasta routinely. Even despite their smoking, they live longer, leaner, and generally healthier than we do. You know what they say: never go in against a Sicilian when death is on the line. Feel free to dine accordingly.
David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.