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Carbs: A friend or a foe?

Updated: May 18

Carbohydrates (carbs) are one of the most hotly debated topics in the nutrition world. You have all heard of the no carb diets such as keto and low carb diets such at Atkins. And then there is the ubiquitous all American high carb diet which I proudly took part for many years. But thankfully we now have actual scientist instead of self made nutrition experts to guide us. Disclaimer, I am neither of those people. I simply have used my medical knowledge and personal interest to read through the medical literature to finally understand, based on actual science and research, what are carbs all about. I drastically changed my own All American diet more than 10 years ago, lost 30 pounds and feel lighter, more energetic and faster at the age of 45 than I ever did in my 20s and 3os. So, here we go.

Carbs are one of the three major macronutrients, meaning your body needs them in large quantities on a daily basis (fats and proteins being the other two). Carbs are essential for various body functions. For example, simple carbs (glucose) are the main source of fuel for our brain cells. In fact there is good evidence that evolutionary our brain started to grow and separate from our primate ancestors once carbs were introduced into our diet, providing our brain with the adequate nutrient to grow and evolve. Carbs are also an important source of energy, cell signaling and various other body functions. So. you absolutely need carbs to live a healthy life. You may lose a quick few pounds on a low or no carb diet, but your body will not function well, you wont feel good, and eventually you will go back to old habits. But we also know that carbs are the major source of the obesity epidemic and diabetes. So, it is not that whether you should eat carbs or not, you definitely should, but much more importantly, what matters is what kind of carbs you eat.

To really learn carbs for once and all, we need to revisit some basic high school or perhaps college chemistry. I will make it childproof, don't panic.

Carbs are made of carbons, hydrogens and oxygen molecules attached to each other in a three dimensional structure. Just like everything else in life, carbs can be simple or complex. Simple carbs are made of 1 (mono) or 2 (di) molecules of carbohydrates (saccharides). Complex carbs are made of many (poly) carbs attached to each other (many simple carbs attached to each other). Both simple and complex carbs are found in nature and are healthy for you.

Examples of simple carbs: Glucose, fructose, Lactose.

Examples of Complex carbs: Sucrose, Cellulose and Fiber.

A little physiology:

The most common way of looking at carbs is the glycemic index or load. But instead of going into a whole carb accounting detail, let me reassure you that you do not need to pull out a complex chart of numbers before you decide if you should take a bite of a watermelon. There is a much easier and intuitive way.

Simply put: ALL carbs in their natural form, regardless of simple or complex, are very healthy for you. MOST carbs in their processed form are unhealthy.

Now the details: What makes some carbs unhealthy is the rate of absorption. Our digestive system first has to break down all carbs to the simple form before we can absorb them, This occurs mostly in the stomach and early parts of small intestine. In fact, the most simple carbs can even be absorbed in the mouth (table sugar). Once absorbed, carbs stimulate the pancreas to release insulin. Insulin is the main hormone that regulates the update of glucose from blood stream into the cells for storage and use as needed. The liver and fat (adipose) tissues are the major organs that deposit the dietary glucose. This storage is then used as needed by the our muscles and other organs when they need fuel. The amount of insulin released directly correlates with the level of simple carbs in our blood stream.

To summarize: carbs in food get digested to simple carbs, simple carbs are absorbed in to the blood stream. This in turn stimulates the pancreas to release Insulin. Insulin is the key that unlocks the door for simple carbs to enter in our organs and exit the blood stream.

Now, here is the catch: The faster we digest and absorb carbs, the faster and larger the amount of insulin released. Insulin, although a natural and essential hormone, has also been shown to cause increase appetite, fat storage, and overall weight gain when released at unnaturally high levels. So, when we eat too much or too frequent simple carbs, we get too much and too frequent large loads of insulin. The over stimulation of insulin is now thought to be a major contributor to various changes in our brain, metabolism and fat storage that ultimately leads to obesity. Insulin is essential for proper digestion of carbs, but too much insulin is deleterious for our health.

On the other hand, complex carbs are digested slowly, leading to a slow and more prolonged absorption period. This leads to a smaller insulin surge which does not cause changes mentioned above.

Ok, that was probably a lot of nerdy talk. Now you understand the basic physiology of carbs. So, lets use this knowledge and see how you can translate it to practical use.

Healthy vs unhealthy carbs:

So, now that you understand how carbs lead to obesity, lets talk more practical advice. How to distinguish between healthy vs unhealthy carbs using your knowledge, and without doing any carb counting, indexing or looking at the pretty picture of the athletes on cereal boxes for a hint (which by the way is usually misleading).

In nature, carbs come in two forms: simple and complex. You already know that complex carbs are digested slowly and are healthy. But what about the simple carbs found in nature?

Fruits: If you asked dietitians and diabetes educators just a few years ago, they would have advised against eating fruits, the main source of simple carbs in nature. But research now shows that fruits in fact lower risk of diabetes and heart disease. Here is

the catch: fruits do have simple carbs, but the amount of simple carbs per serving of fruit is very small (hence, a negligible spike in insulin) . On the other hand, fruits are rich in another kind of carb: fiber. Fiber is an undigestible complex carb that has many health benefits including lowering your cholesterol, risk of heart disease and diabetes. . So, a serving of fruit gives you a small dose of simple carbs, with no health risk, and lots of health benefits with fiber and vitamins.

What makes fruits unhealthy is juicing. Juicing essentially removes all the fiber and concentrates the simple carbs. Try this: squeeze an orange into a cup. You get at most 1/4th cup of liquid. But we all pour ourselves a whole glass of juice. So, you either have to juice about 4-5 oranges at home or add water and sugar to get a sweet cup of juice (basically most of what you buy as juice in stores). This is why ALL commercial juices are unhealthy. No matter what the bottle says: organic, made from real fruits, no additives... . Juice is essential water plus sugar. If you really like a juice, try home juicing: make sure you add all the fiber back in (all those gunky stuff you usually throw away) and limit your juice to 1-2 fruits. Smoothies are another way of eating fruits. They are perfectly healthy as long as you add whole fruits and keep it to 1-3 servings of fruits. Try to avoid the store bought smoothies, most have artificial ingredients and added sugar.

Other sources of natural carbs are vegetables, legumes and grains.

Vegetables and legumes are rich in complex carbs, vitamins, minerals and in case of legumes protein. They are fantastic for you and should be part of your every day meals. There is really little way you can eat them in an unhealthy way (deep frying or buying flavored forms are the only bad ways). As a distance runner I need lots of carbs and protein, so for lunch I always make a homemade salad with greens, some veggies, an apple, and 1-2 cups of home made legumes like black or garbanzo beans. The legumes add lots of healthy complex carbs, protein and vitamins and minerals. The fruits add extra layer of healthy carbs.

Most vegetables also have either complex or a small amount of simple carbs. Examples include carrots, squash and beans. Potatoes are also rich in starch, a complex carb that is very healthy. Unlike popular belief, there is really no significant difference between various types of potaties (sweet potato is very healthy). In fact vegetables are a great substitution for processed grains and bread for your meals.

Grains are a whole different story. In fact this is where most of the bad reputation for carbs originates.

In nature Grains are made of an inner layer simple carb that is surrounded by two layers of proteins, fats and minerals. So, even though the carb is simple, but because it is surrounded by fats and protein, the digestion is slow and healthy. Whole grains are also rich in some vitamins. But, all that fat and protein make grain unstable as a product, meaning short shelf life. So, the little geniuses at food companies realized that if they simply remove the outer fat and protein layers and just have simple carbs as the final result, the shelf life is much longer. Profits go up. Only problem being that now the product is a processed pure simple carb and devoid of all its other nutrients. What are the examples of these highly processed simple grains?

  • white rice

  • white bread

  • All purpose flower (meaning most of pastries, most of waffles and pancakes)

  • regular pasta

  • most cereals

What are the unprocessed healthy options:

  • brown rice or wild rice

  • whole wheat bread

  • whole wheat flour

  • whole grain pasta

  • oats, rolled or steel cut (avoid flavored ones, lots of added sugar)

Other sources of healthy grains you can use in place of rice:

  • buckwheat

  • quinoa

  • barely

  • farrow

For baking, you may replace All Purpose flour with oat flour (great for pancakes), buckwheat, almond (great for cookies), and whole wheat.

Healthy grains are also rich in fiber and protein. So you can even cut down on your meat intake if you simply replace your unhealthy grains with healthy grains.

Rolled outs or cooked quinoa are great replacement for cereal. They are full of healthy carbs, protein and vitamins (trust me on the quinoa, with a little banana, tea spoon of maple syrup, walnuts and fruits it is fantastic). And When I am tired of beans in my salad, I simply replace it with quinoa, couscous or barley.


Ok, most of us like some sweetness in our lives. But we also know that sugar is bad for you. So, should you just ensue a bitter life? Not totally. Here is a simple guide:

  • ALL sugars are bad, that includes the cane sugar, corn syrup, brown, coconut and the sugar alternatives like Stivia (which is converted to sugar in your body). Your body processes simple sugars the same way, regardless of the name or packaging. Get rid of them all.

  • For added sweetness get yourself a teddy bear. Or add 1-2 tea spoons of REAL honey or maple syrup. By real I mean natural, unprocessed from a farm, farmers market or grocery store. Most commercial brands are highly processed and unhealthy with artificial sweeteners. Honey and maple syrup are still simple sugar and not really healthy, but at least they have the added benefit of having minerals in addition to their simple sugar. Use 1-2 tea spoon for your tea/coffee/oats or bread.

  • Crush a ripe banana: adds sweetness and has lots of benefits with little added simple sugar. That's how I get sweetness in my morning oats or smoothies.

  • Add natural fruits: want a fruit yogurt? Skip the flavored commercial brands, they have little real fruit and lots of added sugar (about 7-10g per serving). Instead buy plain and add your own real fruits. This goes for smoothies as well. Don't buy the highly processed protein shakes, instead make your own using real fruits and natural ingredients.

I think we are all "over carbed " by now. So I am going to end this blog here. I know when I first started eating healthy carbs I had a hard time even pronouncing the word Quinoa, let alone cook it. I will be adding recipes to Emerald website in the coming days, so if you need some ideas on how to incorporate healthy carbs in your snacks and meals stay tuned. If you have a recipe that you would like to share send it to me and I will add it.

And lastly, always keep moderation. Eating occasional ice cream, cake or whatever else unhealthy food is your poison, enjoy it, but be mindful of how often you are eating unhealthy and portion size. I wont be ordering double scoops at Mitchells any more, tasters single scoop for me. I had to put this in case any of you see me chowing down at Mitchell's!

Extra credit for the super nerds:

What is diabetes: Diabetes simply means your body has lost its ability to absorb the dietary carbs into the cells. What you eat remains in your blood stream for a long time instead of being gobbled up by your cells. Elevated carbs in blood stream eventaully deposit in the lining of small blood vessels, leading to poor blood flow and tissue damage. Your heart, kidneys and eyes are particularly sensitive and one of the first ones to go. In addition, small nerves in your fingers and toes start getting damaged, leading to "diabetic neuropathy."

Type I Diabetes: Your pancreas does not produce insulin. Insulin is the key that allows glucose to go inside your cells. Without insulin, glucose is locked out and remains in the blood stream. Most type I diabetes are genetic and usually manifest in early childhood. Your body produces antibodies that attack the insulin producing cells, gradually leading to insulin deficiency.

Type II Diabetes: You are born totally normal. But after years of eating all the delicious sugars, your glucose machinery essentially burns out. First your cells lose their sensitivity to glucose, they simply reject it. This is like that annoying person that is always in your face (lets call him/her sugar), so you start to ignore Sugar to keep your sanity. Its your cells defense mechanism against too much sugar. But your pancreas keep putting out more insulin to force the cells back into obedience. This is the "prediabetes" period, your body is not happy and your blood sugar may be a little high, but insulin is still going strong and keeping the storm at bay. Keep at it for long and your pancreas eventually burns out, insulin levels drop and now your blood sugar sky rockets, hello diabetes. The good news is that in most people, with drastic lifestyle changes the damage is reversible. My favorite story is a patient I saw while I was in Colorado. I diagnosed him severe diabetes (average blood glucose of 300), he promised me he is going to drastically change his lifestyle with my help, 6 months later, without ever taking a diabetic medication he was back to normal.

Double Nerdy point: What is A1c? Most of you have had this test done. Wat does it actually measure? Hemoglobin (Hgb), the main oxygen transporter in our blood is produced in bone marrow and released into the blood stream where it carries oxygen. Each Hgb lives about 3 months before it is degraded by the spleen. It turns out that during this time the free glucose in blood gradually accumulates on Hgb. By looking at a sample of Hgb and measuring how much glucose is on each Hgb, we can correlate that with what are the daily average blood sugars. That is also why it takes about 3 months for A1C to change.

Normal A1c: less than 5.6 (5.6% of Hgb surface is glycosylated).

Prediabetes (where your cells are getting annoyed from too much glucose and not picking up as much): 5.7-6.4

Diabetes (where insulin is giving up): 6.5

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