Carb Confusion? What should I be eating?

If there’s one thing the internet is good for, it’s confusing people. This is primarily because anyone can post anything, and if you do a good job with it, EVEN IF IT’S INCORRECT, it will still look good enough to fool people. And we get this “fake news” problem in nutrition all the time.

Part of this is because a lot of nutrition studies are inherently flawed, but when you read an article about a vitamin or herb that makes it sound fantastic, what you DON’T hear is that the study was in a Petri dish, or on mice, or had 15 people in the study, or that that they tallied the information from questionnaires (and who tells the truth on those?). So you end up with articles that I laughingly call “The Goji Berry Effect” where you end up thinking that if you eat enough goji berries, it’ll improve every single aspect of your health, no effort needed on your part other than to just eat them.  

The issue of carbohydrates in your diet is DEFINITELY confusing. The old food pyramid recommended 6-11 servings of carbs per day (resulting in the diabetes epidemic, but more on that another time). American Dietetic Association recommends a starch with each meal, and patients often come to me saying they were told that it’s unhealthy to NOT have a starch with each meal. This does, of course, come as a surprise to the Inuit Eskimos, who, before modern foods were introduced, had a ketogenic diet, since the permafrost prevented any planting of anything like vegetables or fruits or grains. 

The problem is this: we, as most human beings (not even just Americans!) have blown it in terms of carbs. I describe it like this: we were given a certain amount of “points” for carbs in our lifetime, and most people are done with those points by the time they’re 35. Actually, for the younger people now, it’s by age 30. And how did we all do that? We “used” up our points on things with sugar, and soda, and fruit juice, and smoothies, and cereal. We ate plates of pasta, Cinnabon, and watched as ice cream servings went into bowls and extra big waffle cones, because no one ate just one scoop anymore. We started having sugar every day — sometimes just a little in our coffee, sometimes as dessert after dinner, and sometimes like a patient of mine, who had dessert after every meal (leading to my question, “What do you EAT for dessert after breakfast?!?” She shrugged and said, “You know, a cookie or something.”). And we were confused by carbohydrates — good vs. bad, the conversation about “sugar in moderation” (because EXACTLY what is that?), added sugar versus carbs, and the concept of fat-free. 

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What’s true here? One thing to consider is that EVERYONE is broken in terms of carbohydrates. It is estimated that as of this writing, 50% of the population is considered diabetic or pre-diabetic. This is EVERYONE put together — kids to elders. If we just look at people over the age of 65, it’s 77% of that population. That’s why it’s reasonable to assume that, depending on your age, you’re probably out of points. Even infants are in trouble — if the mother has high blood sugar while she’s pregnant (gestational diabetes), the baby comes into this world already having a problem with carbs and insulin. There are documented cases of toddlers being diagnosed with Type 2 diabetes now, stemming from having developed in a sugar-laden environment in the womb. 

Going with the assumption that your system is “broken”  (and it’s probably a good idea to assume that, given the statistics), then what’s happening is called “carbohydrate intolerance”, meaning that your system can’t manage carbs, and tries to compensate by releasing excess insulin. Here is where the confusion begins. People are often given advice to eat “good carbs” like whole grain bread, oatmeal, and brown rice. While it’s absolutely accurate to say that those things have more fiber and more nutrients than their refined versions, when someone is carb intolerant, they can’t manage those healthy carbs either. Brown rice is still a carb, just a carb with more nutrients and fiber. When your system is “broken” because we used up all our points, it means you can’t tolerate “good carbs” either. 

Glycemic Index is another place where people get confused. The glycemic index basically rates foods by how fast they go into your bloodstream as sugar — the more fiber something has, the slower it gets absorbed.  The problem with GI, though, is that that rate of absorption varies if the food is eaten with fat, if it’s more ripe (think a green banana versus the sweetness of an overripe banana), and even the type (different kinds of potatoes have different GI ratings). The biggest issue with glycemic index is that it confers the idea that a lower GI food is fine, even healthy, for anyone. But remember? When someone’s system is broken, they can’t tolerate even carbs that are a little slower with releasing their sugar into the bloodstream. It’s still a carb, and that carb is still causing your body to release excess insulin . Additionally, there’s no concept of serving sizes here — you might be eating a low glycemic index brown rice, but if you’re eating more than ⅓ cup of it, you’re having more than a single serving. 

Fruits are also a place of confusion. One thing that people often don’t know is that fructose, the main sugar in fruit, turns into fat faster than any other type of sugar.  We would have been able to limit our intake if we only had access to fruit during its growing season, or we didn’t juice them, thereby concentrating the sugar. But we have access to nearly all fruits, all year, and juice bars everywhere. The other problem with fructose is that when it’s taken in in large amounts, it damages the liver because it metabolizes in the same pathways as alcohol. So if you drink a lot of alcohol, you get fatty liver disease, and if you eat a lot of fructose, you get non-alcoholic fatty liver disease. “I don’t do fruit juice, or soda, or high-fructose anything!” say some of my patients. Except what they don’t know is that table sugar (white or brown, doesn’t matter), is half fructose. So even if you use organic raw sugar, make your own desserts, only buy organic cane-sugar soda from Whole Foods… it doesn’t matter. It’s highly concentrated fructose. Which is why people with blood sugar problems often have to limit their fruit intake as well — because even though they’ve been told that eating “fruitsandvegetables” are healthy, people who like carbs will tend to eat the fruit because it’s sweeter, and can easily overeat them. Our general rule is to eat twice as many vegetables as fruit. 

But where will I get my fiber? is a question that I’ve been asked multiple times, and I gently remind you, dear reader, that vegetables have fiber as well. In fact, with all of the dissolvable fiber out there, it would be easy to supplement fiber in your diet without having to increase your carb load.

You want to check to see if you have a blood sugar problem? Run some blood tests and apply the narrower ranges that we do. Check your Hemoglobin A1c — that’s a 3-month average of your blood sugar. We start suspecting a problem if the number is 5.5% or higher. Or your triglycerides — we don’t wait for them to get over 150; we start talking to people when they’re over 100, since higher numbers are commonly caused by carbohydrate overload. The most important test is one your doctor doesn’t run often, but should — fasting insulin. This is the first marker to go awry when there are blood sugar problems. It’s an indication that your body is having to produce more insulin to deal with the higher amounts of carbohydrates being eaten. We want that number to be under 6, yet we commonly see it in the teens, 20’s, even occasionally in the 30’s (once I saw a fasting insulin of 36 in an 8-year old).

We have a clear and proven system for getting people’s blood sugar back into a normal range, and having it be EASY. Like, no deprivation. Not even any “forbidden” foods. Just a solid methodology to being able to make good choices, not have sugar cravings, get your energy back, sleep deeply and solidly, and lose weight as a convenient side effect. If you’re having trouble figuring out what works and what doesn’t, and what’s effective and what’s not in the realm of conflicting advice, we’ll get you straightened out, no problem. You can schedule an appointment by clicking here.