Vindicating Carbohydrates

Thirteen years after Dr. Atkins suffered a near fatal heart attack, we're still talking carbs. 

In the beginning of the diabetes class I teach, I ask the participants what comes to mind when they hear the word carbohydrate.  The most frequent responses:

"Sugar"

"Starch"

"All the good stuff"

"Everything I like but can't have"

Poor guys.  Even Lindsay Lohan has a better reputation.

I'm on a mission to restore carbohydrates good name!  Rachael vs. South Beach.  Luckily, the low carb diet craze has fizzled, but the carbohydrate name has never been restored. I still see foods marketed as low carb lining grocery store shelves.  My clients consistently list carbohydrates as a food they struggle with, even though carbohydrates aren't a food group, rather a nutrient found in  most foods.  I even see health care providers still prescribing low carb diets to patients!  It takes most my self control to hold back the urge to call their office and say “Ummm excuse  me, but your diet advice is sooooo 2001.” 

Much of the confusion over carbohydrates in our diet is due to the fact that most people don't know what a carbohydrate is in the first place.  Carbohydrates are one of the three main macronutrients, or nutrients that provide energy (i.e. calories).  Fat and protein are the other two.  Alcohol also provides calories, but unless you live in a frat house, it’s not an essential nutrient.  

There are three main types of carbohydrate found in foods: sugar, starch and fiber. Although sugary and starchy are two adjectives commonly used to describe an unhealthy food, sugar and starch aren’t necessarily bad for you. All foods that contain carbohydrate also contain sugar and/or starch. What determines if a carbohydrate containing food is healthy or not is the degree it has been processed, which usually removed fiber and nutrients.

There are three main beliefs about carbohydrates that seem to have permeated our understanding of nutrition.  So lets get all mythbusters and set the record straight!

High carbohydrate foods are generally unhealthy.

Quite the opposite!  In fact, compared to fat and protein, carbohydrates should provide the greatest percent of our caloric intake.  Carbohydrates are found in all plant based foods, so a plant-based diet is by default, a higher carbohydrate diet.  Most health organizations in the Unites States recommend that 45-65% of calories come from carbohydrates, while most international organizations recommend 55-75%.  Personally, I agree with the latter.  Why the discrepancy?  The slightly lower recommendations are closer to our typical meat and dairy heavy diet, which increases the percentage of fat and protein in our diet and arguably, keeps the powerful meat and dairy industries happy.  Developing countries, which have much lower rates of chronic disease like diabetes, heart disease and cancer (also called diseases of affluence or Western disease) consume about 65% of their calories from carbohydrates, typically unprocessed carbohydrate foods. 

Low carb diets are effective for weight loss.

Low carb diets are effective for rapid, but short term weight loss.  Let's say your high school reunion is next month and you’re looking to drop a few pounds and you couldn't care less about long term health consequences you just really want that kid who rejected your prom invite to think "Dang!  What was I thinking?!"  Then go low carb.  But if you'd like to keep the weight off, which I assume most people do, steer clear.  Studies indicate low carbohydrate diets are most effective in the first 6 months, but by 12 months, they are as effective (or ineffective?) as any other diet.  

Low carb diets produce rapid weight loss by putting our body into a state of ketosis.  Ketosis also occurs during starvation or in uncontrolled diabetes.  Most people need at least 100-130 grams of carbohydrate for fuel.  If you do not eat this amount, your body simply makes it's own glucose, but from fat rather than carbohydrates.  Ketones are a byproduct of this reaction.  Ketones are acidic so as your body attempts to maintain normal blood pH levels, you shed fluids.  So as lovely as it is to see those pounds melting away, keep in mind, most of it is water weight.  Any actual weight lost on a low carb diet can be attributed to a calorie deficit, something you can produce without depriving yourself of healthy and delicious carb foods!

All carbs turn to sugar.

Technically, this is true, but it doesn't mean carbs are bad for blood sugar control or cause diabetes.  Let me explain.  Glucose, often called sugar, is the breakdown product of carbohydrate.  Glucose in our bloodstream is not the same as table sugar.  Glucose is a fuel source, and the only energy source our brain can utilize. 

The problem isn't that carbs break down into glucose. The issue is that some carbohydrate containing foods, specifically processed carbs, break down rapidly, causing a spike in blood glucose levels. Our body just isn't made to handle the massive rush of sugar. I like to think of it like this - imagine your boss kept handing you huge projects to complete in just a short amount of time. You probably woudn't do a very good job, and over time, you'd likely give up and quit. Similar thing happens to our body. Over time, repeated blood sugar spikes lead to insulin resistance, impaired glucose tolerance and eventually diabetes. 

Unprocessed carb foods do not cause this blood glucose spike.  Basically all unprocessed carbohydrate foods have a built in mechanism that prevents glucose from entering the bloodstream too rapidly.  Fruits, vegetables, beans and whole grains all contain fiber, which slows down the digestive process and allows sugars from these foods to slowly be released into the bloodstream.  Milk and yogurt contain lactose, a natural sugar, and although they do not have fiber, they contain fat and protein, which similarly slows down the rise in blood glucose. 

So up till now, I've been talking mostly nutrients, not food, something I hate to do!  So what are these "healthy" and "unhealthy" carbs?  A good rule of thumb is the less processed it is, the healthier it is. 

Green Light: You can purchase these foods without thinking twice! 
Whole grains (brown rice, barley, wild rice, quinoa, farro, bulgur, etc)
100% whole grain pasta
Whole grain flours
Any vegetable (even starchy vegetables!)
Any fruit
Beans
Organic dairy
Unsweetened dairy alternatives

Yellow Light: Be a prudent label reader (both ingredients & nutrition facts) with these foods. 
100% whole grain bread - sometimes even 100% whole grain breads are made with significant amounts of added sugar
Breads, pastas, and snack foods labeled as whole grain, whole wheat, wheat, or multigrain - may be 100% whole grain, but more than likely, it's not
Granola bars
Flavored yogurts
Breakfast cereal
Smoothies

Red Light: Limit these foods. 
Sweets
Sugar
Refined flours and foods made with refined flours (this includes white bread, white rice, white pasta, and most snack foods)
White rice
High sugar beverages like soda, sports drinks, punches and sweet tea
Fruit juice

Fellow carb lovers, rejoice! Here's a round up of my favorite carb-centric recipes:

Baked Oatmeal with Berries and Bananas
Lentil and Brown Rice Salad with Tahini Dressing
Eggplant, Chickpea and Wheatberry Salad
Quinoa Chili
Lentil Sloppy Joes
Dairy Free Macaroni and Cheese
Brown Rice, Chickpea, and Roasted Broccoli Bowl
Chorizo Tempeh and Potato Tacos