Food Friday: Better Carbs 

Authorities agree that we consume too many carbohydrates and that this has contributed to the obesity epidemic. However it’s easy to eat plenty of carbs, lose weight, and have lots of energy if you just shift the way you think about them. 

When most people think about carbs (carbohydrates) they think of starches like white potatoes, grains like rice, and of course wheat products like bread, tortillas and pasta. But carbohydrates also comprise sugar, honey, maple syrup, corn syrup, etc, and all the products which feature them prominently, like conventional soda, frappes, and lattes. These sorts of carbohydrates are unhealthy because they jet sugar into your bloodstream much faster than you can utilize it and it ends up being stored as fat. The fat ends up having a variety of toxic effects down the line. Even the white flours, pastas, rices and white potatoes do this. The white flour and white rice have been denatured of their fibrous structure and because of this breakdown very quickly into sugar. 

Whole wheat flour and brown rice are commonly thought of as better carbs, and they are, but not as much as you might think. Their glycemic index (rate at which they break down into sugar) is not that much better than their white counterparts. These should be utilized by people of normal weight and body composition with high energy requirements. This would include adolescents and athletes.

It has been shown that consumption of 2-3 servings of whole grains per day reduces risk of diabetes, high blood pressure, colon cancer and obesity, compared to rates in those that don’t eat these. The precise reason for this is unclear, though it may well be because of the fiber and additional nutrients that whole grains contain compared to refined (denatured) grains.  It is a sad commentary that the presence of 2-3 servings of whole grains per day constitutes a measurably higher caliber of diet than our general population’s diet.

Certainly whole grains are not the only readily available dietary source of fiber and nutrients. What if, in an imaginary prospective research study, conventional eaters were compared to those with 2-3 servings of whole grains per day, AND against those with an equivalent amount of fiber, BUT in the form of vegetables and fruits? I suspect that the third group that took their carbs as fruits and vegetables would do even better. I feel confident in speculating like this because, as a rule, produce (vegetables and fruits) is considerably more nutrient dense than whole grains. Depending on the particulars, they have fiber, vitamins, minerals, but also other types of nutrient such as healthy fats and antioxidants. Moreover, they have even lower glycemic indices. 

So, I propose that we learn to take most of our carbs as produce. What ? No bread at dinner ? No pancakes or cereal at breakfast ? No bread for sandwiches at lunch ? People are sure they will starve. What they will do is lose some of their belly fat. They will lower their blood sugars. Pregnant women will gain less excess weight, and be less likely to have gestational diabetes. They will also spend more money and time on food. But, they could also be spending money on treatments for obesity, diabetes, heart disease and worse. 

There are other differences that should go along with this approach. Portion sizes usually need to be larger. Additionally, there should is more emphasis on healthy fats such as coconut oil for high heat and olive oil for low heat and dressings. Also, from a culinary standpoint, there should be a greater utilization of flavors such as spices, garlic, lemon, chili and so on.  Healthy sauces and dressings figure more prominently. and Finally, there is more emphasis on lean meats, poultry and cold water fish. 

I wanted to take this post and show you how this might look. I think that while you will find it completely different, you will find it rather appealing. 


Breakfast idea: 


I would pair this with a small bowl of fresh fruit. 





Stiff leaves of romaine make a crunchy manageable container for savory contents, much like a taco shell. 









These are cauliflower mashed “ potatoes”, also known as “faux”  potatoes, which can be served as a side dish at dinner, drizzled with olive oil or butter.




These are zucchini noodles which just need a hearty meat sauce.





Dinner is in some ways the easiest, since you still have your “main dish” and your salad. All you need is another cooked vegetable, like these vegetable fries, and perhaps some fresh fruit. 




There are an infinity of substitutions like this. When families are transitioning from conventional diets to more of a paleo style diet like this, they may find it politic to try to make their new healthier dishes resemble old conventional ones. Eventually, this pretense can be abandoned, as more exciting approaches to healthy cooking are discovered. Check out any number of the new Paleo cookbooks out there. For more information, see the last four Food Friday blog posts on food inspiration. 

Food Friday: Carbohydrate Intolerance

“ Hey wait, I thought food Friday was supposed to be a celebration of good food and eating !” Of course it still is. I just want to talk a little bit about how to understand your own metabolism and to leverage it for your health and for your enjoyment. Bear with me for a little science.

Carbohydrate or carbs is a term we hear frequently in popular media. But what exactly are they? A carbohydrate is a compound that contains carbon, hydrogen and oxygen. These molecules are linked together in such a way as to store energy. In their simplest form, they are sugars like glucose. When they are linked together like Legos they become starch, which is really just a storage form of glucose. 

Glucose is the body's principal energy source, its fundamental fuel. But as with most things,too little or too much is a problem. A young, healthy, non-pregnant body will manage its fuel very efficiently. The silent internal workings of the body's physiology will keep circulating levels of glucose within a close ideal range, even during periods of dietary excess and periods of dietary scarcity. The main regulators here are insulin and glucagon. Insulin is a pancreatic hormone that brings glucose from the circulation into the cell where it can be used for fuel. Glucagon has the opposite effect. When blood sugar levels go low, though lack or food or periods of high demand, glucagon goes into action and mobilizes stored starch to be broken down releasing glucose into the bloodstream. 

When we become overweight or pregnant or older, this process works less well. In particular, the cells do not respond as well to insulin. I am not speaking of diabetics here. This tendency is true of everyone. When we do not process our blood glucose efficiently, specifically when we become less sensitive to our own insulin, we are said to be carbohydrate intolerant.

A vicious cycle can then ensue. When we cannot bring glucose from the bloodstream into the cell by the action of our insulin, the concentrations of glucose in the bloodstream becomes abnormally high. This leads to the formation of fat in our tissues and in particular our arteries. This of course, leads to cardiovascular disease.

Under these circumstances, our insulin levels also become chronically high in an attempt to bring the blood sugar down. This is called hyperinsulinemia, and it is thought to be a precursor of type 2 diabetes. Moreover, hyperinsulinemia alone is associated with “ Metabolic Syndrome” , the unholy quartet of hypertension, obesity, high cholesterol ( or triglycerides) and glucose intolerance. 

How can you short-circuit this vicious cycle? Well, no one can avoid aging if they're lucky, and many people choose to become pregnant. Avoiding obesity is the best way to avoid carbohydrate intolerance because, as you have no doubt gathered by now, obesity leads to carbohydrate intolerance, and carbohydrate intolerance leads to more obesity, a vicious cycle. That is one of the reasons why it is so hard for people to lose weight once they have become obese. It is far easier to avoid obesity in the first place than it is to correct it after the fact.

But there are many obese people who are intent on losing their weight and getting healthy. Here's the good news for them, and for the rest of us wanting to prevent these problems. If we minimize sugars and simple carbohydrates (like starch) in our diet and keep a steady intake of meals and snacks with high quality fruits, vegetables, proteins and fiber, our blood sugar levels will trend toward the steady and normal, both necessary to avoid the development of carbohydrate intolerance.

If we add steady increasing levels of physical activity every day and, as a result develop increased exercise tolerance and increased muscle mass, we will have synergistically increased our metabolic rate. We will feel more energetic, and as a result be more active. A virtuous cycle will set in! 

Here's the real newsflash: I am asking all my patients to pay more attention to food. In fact, I am almost certainly asking them to eat better food, in greater quantities, more frequently. In fact I would be thrilled if all of my patients made healthy food a lifelong hobby. Sourcing high quality food, searching for recipes, trying new things, and entertaining with healthy recipes is a lot of fun.

So with the holidays approaching, do not worry. Get excited about finding some great healthy recipes. And maybe plan a frosty family walk outside on your Thanksgiving morning, or between dinner and pie. 



Big Soda versus Milk


I love a cold carbonated drink. Who doesn't ? But I am on a mission to get my patients off of soda. Why pick on one particular junk food and not them all ? Soda pop is a special concern to me since I care for girls and women. 

I have tried to educate my patients, young and old, about carbohydrate metabolism. Carbohydrates are the starches and sugars in our diet. We need them for energy, but we can only absorb them at a certain rate. The modern food industry has altered natural food materials in such as ways to make them taste good and not spoil. In short, they have processed the food, and that basically means the food is already partially broken down and relieved of its perishable nutrients. It is also filled with strategic additives to recolor, reflavor, or stabilize. When we eat processed carbohydrate, it jets right into our bloodstream since there is little breakdown left to do. The gratification is quick and the effect is almost addictive. Of course this is by design on the part of the food industry. 

Soda pop is the epitome of this phenomenon. I think of it as a sugar water IV. Even a young non diabetic person will raise their blood sugar beyond what it should be. What does the body do with excess sugar that it can't burn ? It stores it as fat. 

So many of us work hard to keep the waistline trim, and it turns out that is worthy goal. Truncal or waistline obesity is associated with cardiovascular disease. I have seen patients who drink large amounts of soda reduce their waistline and weight by just quitting that one thing. 

There's a special concern about girls, women and soda pop, and that is that it displaces milk as a common go-to beverage. It is consummately uncool to drink milk. I want that to change. You see, women are living longer than ever and in their older years, bone thinning is becoming a bigger and bigger problem. We women only have until the mid thirties to build are bone density. After that it's all downhill. It's just a question of how fast downhill, and from what height. 

So it is very important for girls and women to drink milk to build bone. Milk is rich in protein, Calcium, vitamin D and water. They need not be concerned about taking in too much fat, since skim or nonfat options are available everywhere. Furthermore, those with lactose intolerance can now find lactose free varieties on every street corner. 

It is worth mentioning that claims that soy, coconut, rice, almond, or hemp milk are superior are unfounded. None of them contain complete protein. They are essentially a complex carbohydrate and their role in a diet should factor that in. If as a lactose intolerant person I order a latte where there is no lactose free milk, I am happy to get one of these substitutes as the mood suits, but they are not a dietary substitute for milk from mammals such as cows or goats. 

So how am I going to get my fix for an ice cold carbonated drink ? Easy. I am going to buy one the newer elegant low sugar natural fruit based sodas. Or, even better, I am going to go home and mix plain club soda with crushed ice, a small splash of real fruit juice and a twist of lime. 

For more information about Big Soda, go to The Center for Science in the Public Interest.