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Carbohydrates. Yes, I said the "C" word. I'm amazed at the anger and
frustration that Americans have towards carbohydrates these days.
Perhaps they feel duped by nutrition experts for telling them to
replace fat with an abundance of carbs, a recommendation that may be
one of the causes for the recent increase in our waistlines.
In fact, the Centers for Disease Control and Prevention (CDC) found
calorie intake increased markedly between 1971 and 2000 (22% for women
and 8% for men), mainly from eating more carbohydrates (e.g., rice,
bread and pasta). The CDC holds accountable the consumption of pizza,
salty snacks and takeout foods, as well as bigger portions.
If
carbs are so bad, then why were we told to eat more in the first place?
Recent diet books have been emphasizing the "good" carbs, with
astonishing success. But how do we know which are the right carbs to
eat? And is this really the healthier path in the first place?
GOOD VERSUS BAD
The
concept of "good" versus "bad" carbs actually comes from the outdated
concept of complex (starches) versus simple carbs (sugars). The idea
was that smaller, simple sugars digest quickly, and the longer-chain
complex carbs take longer to digest and therefore keep you full.
However, a complex carbohydrate can be refined (e.g., white bread,
white rice, and pasta), which strips away much of the good stuff like
fiber, vitamins, and minerals. At the same time, there are many simple
carbohydrates that are unrefined (e.g., fruits and vegetables) and
therefore still contain fiber, vitamins and minerals. So dividing carbs
this way is too simplistic to guide your food choices.
That's
where the glycemic index (GI) comes in. Created as a research tool to
determine the actual effect carbohydrates have on blood sugar, GI
measures how quickly a food that contains carbohydrate raises a fasting
person's blood sugar levels and subsequent insulin in two hours.
(Insulin is the hormone that activates cells to absorb sugar from the
bloodstream, thus reducing blood sugar levels.)
"The glycemic
index cuts across some traditionally accepted boundaries of 'healthy'
and 'unhealthy' foods. Some starches with a healthy reputation are
surprisingly high, and some foods that you wouldn't think are
nutritious have a low GI," explains Susan Roberts, Ph.D., of the Jean
Mayer USDA Human Nutrition Research Center on Aging at Tufts University
in Boston. High GI foods include white bread, white potatoes, pasta,
doughnuts, and bagels, but also watermelon and carrots. Low GI includes
most vegetables, low-fat yogurt, lentils, and peanuts, but also whole
milk and pound cake.
Why is it important to know a food's GI value?
Foods
with a high GI value raise the body's blood sugar levels very quickly,
which signals a corresponding rapid release of insulin into the
bloodstream; this quick rush of insulin then lowers blood sugars
levels. "When your body takes in carbohydrates, or any food, there is a
mechanism that switches from the feeling of being 'famished' to being
'fed,'" explains David Ludwig, M.D., Ph.D., director of the Obesity
Center at Boston Children's Hospital and Harvard Medical School.
"High
GI foods create a slower and more difficult transition from the fasted
to fed state and studies have shown that this causes hunger," says
Ludwig. "Typically, foods that are high on the glycemic index are
highly processed foods, and we are not physiologically programmed to
handle this."
In contrast, low GI meals cause a slower release
of sugars into the bloodstream. So instead of spikes of insulin, a
steady, moderate insulin release allows for the sensible metabolism of
sugars both into and out of their storage.
CONTROVERSY OVER GI
Experts disagree about the use of glycemic
index and its benefits. "There aren't any conclusive studies. The
majority of, but not all, one-day studies show low GI foods suppress
hunger, but no relevant long-term studies have been completed," says
Christine Pelkman, Ph.D., professor of nutrition at the University at
Buffalo in New York. "Not only that, there's no proof that following a
low GI diet will aid in weight loss."
GI is based on blood sugar
response after fasting, and in real life, we eat several times a day.
Your earlier meal or snack can affect your current meal's GI. Many
other variables affect a food's GI too: fiber or fat content, acidity,
food combinations, preparation method, and even ripeness.
And
it's not easy to follow a low GI diet. For starters, GI is based on a
50-gram carbohydrate portion of food. This is nowhere near the size of
a typical serving of many foods. For example, carrots have a high GI
(92), which is much higher than many other vegetables. But this is a
little misleading because a 50-gram carbohydrate portion of carrots is
about one and a half pounds, much more than most people would consume.
GLYCEMIC LOAD
To
take the serving size into account, the glycemic load (GL) was
introduced in 1997. The GL of a portion of food is equal to that food's
GI value multiplied by the number of carbohydrate grams in the portion
of food, divided by 100. For example, carrots (GI of 92) take on a GL
of between 3 and 4, once portion size is taken into account. Another
example is Shredded Wheat with a GI of 95 and a GL of 36. (For GI/GL
values: www.glycemicindex.com)
STILL NOT PERFECT
Both the GI and GL fail to account for
calories. Take ice cream for example -- a half cup has a GI of 42 (16g
carbs) and a GL of 7, making it seem almost healthy when it's loaded
with calories and fat! When people are trying to lose weight, study
after study shows a calorie deficit and satiety (not being hungry) are
what's needed. "If you look at the GI/GL all on its own, it might not
lead to a healthier or more satisfying (less hunger) diet," says
Pelkman. In her study, she found no difference in hunger levels between
participants fed a high GI and GL diet for six weeks. "Soda has a lower
GI than carrots, so if you were just using GI, you would choose soda
over carrots -- these are not choices that would lead to weight loss,"
cautions Pelkman.
Another problem is the fact that we
rarely eat carbohydrates alone, which means other hormones besides
insulin work to satisfy feelings of hunger. "We need to focus on the
net effect of food intake and satiety," says Pelkman.
SO WHAT SHOULD YOU EAT?
Many
nutrition experts advise eating a diet rich in whole grains, legumes,
vegetables, fruit, and nuts, de-emphasizing processed foods. But if you
look at foods such as whole wheat bread compared to white bread, they
are both high glycemic foods.
"You can't just say that any
foods that are whole wheat are low on the GI," says Pelkman. "Eating
whole grains and fiber doesn't necessarily keep you from getting
hungry." The research out there shows that foods high in fiber promote
weight loss, NOT the fiber itself. Foods high in fiber also tend to be
bulky foods that have lower calorie densities. "You need to look for
low energy, low density foods that will satisfy you," says Pelkman.
BOTTOM LINE
Glycemic
index and glycemic load should be used for what they are -- tools. They
can help you choose healthier carbohydrates, but should not be the only
gauge you're using to evaluate your foods. When faced with two high GI
foods, choose the item that offers more nutrients and more bulk for
fewer calories -- this is often the food that is the least processed.
Eat
your carbs in combination with fat and/or protein to decrease the
impact on blood sugar (e.g., toast with peanut butter, or rice and
beans).
Finally, keep this in mind. It's not just the GI
that defines a "good" or "bad" carb. Good carbs also carry other
nutrients or phytochemicals, have lower total calorie content, and are
eaten with other nutrient-dense foods.
CHARLES STUART PLATKIN
JD MPH is a nutrition and public health advocate, author of the best
seller Breaking the Pattern (Plume, 2005), Breaking the FAT Pattern
(Plume, 2006) and Lighten Up (Penguin USA/Razorbill, 2006) and founder
of Integrated Wellness Solutions. Copyright 2006 by Charles Stuart
Platkin. Sign up for the free The Diet Detective newsletter at www.dietdetective.com
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