People who eat a low carb or ketogenic diet often ask me about calculating “net carbs” and are surprised by my reply, as it differs from what they’ve read online. The commonly held advice is to subtract “fiber” from the total amount of carbohydrate on the label to arrive at “net carbs” can lead to an underestimation of nutrient intake, as well as possibly an underestimation of the effect of the food on blood glucose and insulin release when those foods are processed into other foods by grinding and/or heating.

As with other meal pattern types, a “whole foods” approach when following a low-carb lifestyle is preferable. That doesn’t mean that people shouldn’t enjoy the occasional low-carb treat, as long as they understand that a baked good prepared from almond flour is not equivalent in terms of nutrient availability to the whole almonds from which it is made.

“Net Carbs” and the Perils of Food Processing

As covered in detail in two previous articles called The Perils of Food Processing (Part 1 is here and Part 2 is here),  I showed that both the amount and type of food processing applied to a food impacts the amount of nutrients available for absorption by the body, as well as having varying effects on the body’s insulin and blood sugar response. 

“Food processing” in this context means that amount that a food undergoes cutting or grinding and/or cooking in someway, including baking. Mechanical processing, such pounding or grinding food is an ancient form of food processing which has an effect on how many nutrients are available to be digested.

That is, the nutrients available to the body when food is eaten raw and whole versus raw and pounded is significant, and this holds true whether the food is animal protein such as meat or a starchy vegetable such as sweet potato. It is also true for foods such as almonds.

The availability of carbohydrate and energy is different for whole, raw almonds versus ground almonds such as almond flour — a staple in low carb and keto baking. More on that, below.

Changes in Insulin and Blood Glucose Response Resulting from Food Processing

As covered in the first article linked to above, mechanical processing of a food doesn’t change the amount of carbohydrate that is in it. That is, when we compare 60 g of whole apple with 60 g of pureed apple or 60 g of juiced apple, there is the same amount of carbohydrate in each. The Glycemic Index of these three are very similar so this isn’t very helpful to inform about the blood glucose response to actually eating these different foods.

When these foods are eaten, the insulin response and blood glucose response 90 minutes later is significantly  different.

As can be seen by the graph on the right, in healthy individuals blood insulin level goes very high with the juiced apple and in response, blood glucose then goes very low, below baseline. The response seen with the juiced apple is typical of what is seen with ultra-processed carbohydrates. 

The same effect that is true for fruit is true when grain is ground; plasma insulin response increases the smaller the particle size of the grain.

Whole grain releases less insulin than the same amount of cracked grains, which is less than the same amount of course flour. The highest amount of insulin is released in response to eating the same amount of fine flour.

What is true for wheat is also true for rice and of interest, there isn’t a big difference between the insulin response with brown rice versus white rice.

While there is no difference in the Glycemic Index or Glycemic Load of whole wheat versus ground wheat or whole rice versus ground rice, there is a huge difference in the insulin response with difference types of mechanical processing.

Also as outlined in the previous articles (links above), the amount of fiber that was in the grain did not make a difference in the amount of insulin released, only the amount of mechanical processing of the grain. So, eating brown rice versus white rice won’t change the amount of insulin that is released.

Remember, insulin is a hormone that signals the body to store energy (calories), so increased insulin response in response to grinding food is important.

In short, it is the amount of cell disruption caused by grinding that increases insulin and glucose response; not the specific amount of carbohydrate in the whole food, nor the amount of fiber in the food.

For those with Type 2 Diabetes or pre-diabetes, applying “net carb” calculations to foods that have been ground is a problem; as it does not take into account the increased insulin release and resulting change in glucose response, as well as the change in energy availability caused by the grinding.

NOTE (June 2 2019): The fiber in the whole food and the ground food remains unchanged and is indigestible by the body, although it is digested by the gut microbiome into fatty acids. While fiber may slow the gastric emptying of the ground product (compared to the same product with the fiber removed), in and by itself the presence of fiber in the ground product compared to the whole food does not reduce the impact on insulin and glycemic response that the grinding causes. 

The Effect of Cooking on Nutrient Availability

Also as documented in the first of the two articles on food processing, cooking also has an effect on nutrient availability. When grains are cooked they become much more digestible — meaning that more of the nutrients are available to be absorbed. In the case of potatoes, there is double or triple the amount of energy (calories) available to the body when they are cooked versus when they are raw and these calories are now available to the body where they weren’t when they were raw.

When foods that are high in fat (lipid) such as peanuts are cooked, the amount of energy the body is able to derive from the food, increases.

Does Food Processing Affect Almonds?

Yesterday, in preparing to write this article, I was curious if there was any information available specifically about almonds as almond flour is used in most low-carb and “keto” baked goods.

I went looking and found a September 2016 article in the International Journal of Food Science and Technology titled “A review of the impact of processing on nutrient bioaccessibility and digestion of almonds”[1] which documents the most common processing technique used on almonds and their effect on the digestion of nutrients.

In short, lab studies and animal and human studies demonstrate that there are marked differences in the way various forms of almonds (whole raw, whole roasted, blanched, milled flour) are digested and the amount of different macronutrients that are absorbed.

What is true with grinding grain, apples and peanuts holds true for almonds.

It is reasonable to assume that the body’s release of insulin and the corresponding glucose response is similarly changed by the increased bioavailablity of nutrients in those processed foods.

Ultra-processed foods, whether fruit, grains, or nuts are not treated by the body the same as whole, unprocessed foods. The macronutrient availability (i.e. amount of carbohydrate and energy) in whole, unprocessed foods is not the same as in the same foods that have been ground and/or heated, and the amount of insulin released and glucose absorbed can differ too.

Final Thoughts on “Net Carbs”

One cannot simply subtract the fiber that is contained in the whole, unprocessed food from the total carbohydrate content of the processed food and arrive at “net carbs” because the amount of macronutrient absorption of the food is increased due to the cell disruption of grinding and heating. For those with Type 2 Diabetes or pre-diabetes, one also needs to factor in the differential impact on insulin and blood glucose release that results from the food processing.

One can subtract the fiber in whole, raw almonds and arrive at “net carbs” on the assumption that the fiber is indigestible by the body and that the other nutrients listed on the label apply to the food in it’s current form, but roasting and grinding those same almonds into almond butter or grinding those almonds into almond flour and then baking (i.e. cooking) them into a host of low carb or keto ‘treats’ on the basis of their low “net carb” content can significantly underestimate their total macronutrient content. 

Should one choose to use the idea of “net carbs”, it should be applied only to whole, unprocessed (not ground or heated) foods.

Ultra-processed foods, irrespective of the carbohydrate content of the original whole, unprocessed foods from which they are made are not equivalent in nutrient availability or the body’s response to them as to whole, unprocessed foods. 

While low-carb and keto ‘treats’ may be nice as “sometimes foods”, they are not ideal as “everyday foods” if weight loss and lowering blood glucose and insulin response are goals.

More Info?

If you would like to know more about following a low carbohydrate lifestyle or to adopt it for health reasons, I can help. You can learn more about my services under the Services tab or in the Shop. If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Reference

1. Grundy MM, Lapsley K, Ellis PR. A review of the impact of processing on nutrient bioaccessibility and digestion of almonds. Int J Food Sci Technol. 2016;51(9):1937—1946. doi:10.1111/ijfs.13192          

According to Dr. David Unwin, a UK general practitioner (family doctor) and published researcher whose practice focuses on helping people put their diabetes and pre-diabetes into remission,  blood sugar (glycemic) response to carbohydrate containing foods is what matters in both diabetes and obesity, and is even more than the absolute amount of carbohydrate in those foods. For Dr. Unwin, the challenge was to represent the effect of high Glycemic Index (GI) foods on people’s blood sugar in terms that could be easily understood. This article is about some of the infographics that Dr. Unwin has developed to help people more easily understand the concept of Glycemic Load*. 

*Note: I think it is important to cover a range of ways that credible individuals view important concepts. Dr. Unwin’s view of blood sugar response as it relates to Glycemic Load (GL) is only one of the ways that glycemic response is understood. The most obvious limitation is that GI measures blood sugar response as if the food is eaten alone, which rarely occurs.

UPDATE (May 14, 2019) Findings of a lack of reliability in Glycemic Index values is outlined in the next article, which can be accessed by clicking here.

In two earlier articles, I explained what the Glycemic Index (GI) and Glycemic Load (GL) are, as well as the challenges with using them.

In short, the Glycemic Index (GI) ranks the carbohydrate content of food in terms of their effect on blood sugar compared to a meal of pure glucose (which is counted as 100).

Using the Glycemic Index often causes confusion because it fails to compensate for the density of each carbohydrate in a particular portion of food. That is why Glycemic Load (GL) was created, which is given as grams of glucose for a specified portion of a food. The problem is, most people have no understanding of glucose and it’s metabolic effects and as Dr. David Unwin, a General Practitioner explained in the paper below (1), many healthcare professionals also have misconceptions about the effect of food-based carbohydrates on blood sugar, as compared to glucose.

Blood Sugar Response as a Patient tool

Dr. Unwin thought that in order to best use Glycemic Load to explain blood sugar response, that it would be more helpful for patients with pre-diabetes or diabetes to be able to understand the effect on blood sugar of eating specific by comparing them to the more familiar sugar, ordinary table sugar.  Dr. Unwin developed some infographics that explain glycemic response in comparison to one (4 g) teaspoon of table sugar.

While table sugar is made up of both glucose and fructose, patients are able to understand the table sugar analogy without being confused by what glucose is (the standard used in the Glycemic Index and Glycemic Load). 

Glycemic Load translated to Blood Sugar Response as a tool for Healthcare Practioners

Dr. Unwin’s and his colleagues had noted that healthcare professionals were making decisions based on Glycemic Index (GI) and assumed that carbohydrate-based foods have a lower GI than table sugar, which is not necessarily the case.

For example, the GI of table sugar is 65, but foods such as basmati rice (GI 69), whole wheat bread (GI 74) and baked potato (GI 86) have higher GIs. This incorrect assumption about many carb-based foods by healthcare professional affected food choices being recommended by them and which were then adopted by their patients, adversely impacting their blood sugar levels.

While Dr. Unwin expressed that health practitioners would be better to refer to Glycemic Load (GL) which takes into account the carbohydrate content of the food in terms of a likely portion size for that food, the concept of GL is not easily understood by their patients. That is where Dr. Unwin’s infographics may play a role.

Blood Sugar Response – a tool for people with diabetes and pre-diabetes

Below is one of the infographics developed by Dr. Unwin to explain Glycemic Index in terms of standard serving sizes (i.e. Glycemic Load) with a corresponding explanation of how that quantity of common foods affects blood sugar compared to one (4g) teaspoon of ordinary table sugar.

In the infographic below, I’ve taken just 3 of the foods above and represented these three foods (1) visually (2) in imperial quantities and (3) in metric quantities.

In my experience people rarely eat the common portion size of foods, whether it is the recommended portion size listed in national food guides or in the Glycemic Index.

Common Portion Sizes rather than Normal Portion Sizes

As a Dietitian, I’ve come to realize that while the standard portion for cooked rice is given as a 1 cup (150 g) serving, many people eat more than 1 cup of rice at a time. In fact, the standard portion of rice in the old Canada’s Food Guide (which had recommended portions) was 1/2 cup (125 ml), which is half this amount!

The standard portion of spaghetti in the old Canada’s Food Guide was 1/2 cup (125 ml) which is half the amount listed in the GI portions and one has to ask how many people really limit their servings to 1 cups of spaghetti?  It is my experience that most people who are not restricting portions often eat 2 cups of spaghetti or more; which raises blood sugar as much as 13.2 tsp of sugar; and that is not yet counting the sauce that goes on the spaghetti!

Some adults eat only 3 small boiled baby potatoes at a time too but even if they do, that raises blood sugar as much as 9.1 tsp of table sugar!

Below are some other infographics developed by Dr. Unwin that demonstrate ordinary foods in terms of their effect on blood sugar compared to a teaspoons (4g) of ordinary table sugar.

I find the similarity between white bread and brown bread interesting. Not much difference, and if one makes a sandwich or 2 pieces of toast for breakfast, whether its white or brown bread, it raises blood sugar as much as 6- 1/2  and 7- 1/2 tsp of sugar…and that is before putting anything on the bread! 

Below is an infographic for servings of cereal, but again how many people limit themselves to 30g (1/2 cup) of cereal for breakfast? In my experience, most adults eat 1 cup of cereal as a serving, often more.

Below is one of Dr. Unwin’s infographics with respect to fruit.

Again, the serving size here is much smaller than what is a “usual” serving in my experience.  For example, most people I’ve worked with eat a whole large banana, which is double this serving (and has the same blood glucose response as 11- 1/2 tsp of sugar).

Th fruit infographic below will also help explain why I recommend berries such as strawberries in 1/2 cup servings (which only affect blood glucose as much as a little over a tsp of table sugar).

Some final thoughts…

As mentioned above, there are different views regarding how different carb-containing foods impact blood glucose levels. Dr. Unwin’s infographics are certainly helpful for people to better understand the concept of Glycemic Load.

If you have been recently diagnosed as having pre-diabetes or as having type 2 diabetes (T2D) and would like to work on reversing the symptoms by adopting a low carbohydrate lifestyle, I can help.

You can learn more about my services including individual hourly appointments and sessions as well as packages above under the Services tab or in the Shop.

If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.

To your good health!

Joy

About Dr. Unwin

Dr. David Unwin, MD, is a UK general practitioner (family doctor) known for pioneering a low-carb approach to managing diabetes in the UK who won the prestigious NHS Innovator of the Year award in 2016 for his work with diabetes patients. He serves as medical advisor to the Low Carb Program which is an online platform approved by the NHS and aimed and helping individuals put type 2 diabetes and prediabetes into remission.

In 2017-2018, Dr. Unwin’s practice saved £57,000 ($99,445 CDN / $74,077 USD) on drugs for type 2 diabetes, hypertension and other conditions by offering patients a dietary alternative to medications.

In 2018, Dr. Unwin was named the 9th most influential General Practitioner (GP) in the UK by GP magazine and has written several peer-reviewed papers related to low-carbohydrate diets.

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Reference

Unwin D, Haslam D, Livesey G. It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited. Journal of Insulin Resistance. 2016;1(1), a8. http://dx.doi.org/10.4102/jir.v1i1.8

An analogy is a comparison between similar ideas to help illustrate one of them. The featured photo for this post are sugar crystals on a string and the reason for this will become clear.

The idea for this article came when someone I follow on social media (Dr. RD Dikeman*) posted the graphic below, which shows complex carbohydrates as long strings of glucose, which starches are. But there are also other types of complex carbohydrates that are long strings of different sugar molecules that can impact blood glucose differently. I thought a simple explanation of what “complex carbohydrates” are, how they are digested and how these can affect blood sugar differently might be helpful, so that is what this article is about.

graphic from RD Dikeman, Typeonegrit

*Dr. RD Dikeman holds a PhD in Theoretic and Mathematical Physics and has become very knowledgeable in carbohydrate metabolism as a result of his son having been diagnosed in 2013 with Type 1 Diabetes. His son was eating 40-60 g of carbohydrate per meal and was experiencing a “roller-coaster ride” of high and low blood sugars, including an incidence of “ketoacidosis”; which is a life-threatening condition when the body produces high levels of ketones due to an insufficiency of insulin. This should not be confused with “ketosis” where the body switches to using fat stores for energy, such as after an overnight fast. Five years ago, Dr. Dikeman’s son began to follow the low carbohydrate protocol of Dr. Richard Bernstein MD (outlined in his book “Diabetes Solution”) and since that time has been able to maintain normal normal blood sugar levels with the minimum required doses of insulin. 

I liked the analogy of Dr. Dikeman’s graphic and wanted to use it as a ‘jumping off point’ for this article.

Glucose Explain Simply

Glucose (also called dextrose) is the type of sugar found in the blood which is why the common term “blood sugar” and the more clinical term “blood glucose” refer to the same thing.

Glucose is one of the two sources of energy (along with ketones) that are used to fuel the body’s cells. Even people that don’t eat “low carb” will make ketones after a night’s sleep, so the body of healthy people runs on both glucose and ketones.

The carb-containing foods that we eat are broken down into glucose for energy or the body makes the glucose it needs for the brain and red blood cells from other substances in a process called gluconeogenesis.

The Glucose-Complex Carb Analogy

In the graphic above, Dr. Dikeman questions whether people such as Diabetics that have trouble metabolizing glucose should be eating complex carbohydrates that are essentially just long strings of glucose molecules strung together like beads on a chain.

As in Dr. Dikeman’s illustration, some complex carbohydrates such as starch are just long chains of glucose molecules, however other complex carbohydrates are made up of other sugars such as galactose and fructose, along with glucose. Because of that I wanted to expand on Dr. Dikeman’s illustration.

Simple and Complex Carbs

One way that carbs are sometimes classified is as “simple” or “complex”; with starch and fiber being categorized as complex carbs and all sugars being categorized as simple carbs.

Simple Sugars

There are two types of simple sugars; monosaccharides and disaccharides.

Mono means “one” and saccharides means “sugar” so a monosaccharide is just a single sugar molecule. Di means “two”, so a disaccharide is two sugar molecules joined together.

Monosaccharides

As mentioned above, monosaccharides are made up of only a single sugar molecule and examples of these are glucose, fructose and galactose. All three monosaccharides have 6 carbons and the same chemical formula but look entirely different from each other. For example, glucose and galactose are 6-ring sugars and fructose is a 5-ring sugar.

Glucose is usually found in food bound either to other glucose molecules, as in Dr. Dikeman’s illustration above, or may be bound to other types of sugar molecules in a disaccharide (2 sugar molecules) or a starch or fiber (long chain of sugar molecules).

Fructose is the sugar found in fruit and since it is a 5-ring sugar, it can’t simply be broken down into glucose, which is a 6 ring sugar.

Galactose is a six ring sugar that rarely exists on its own in food but that can be broken down in the body through digestion. It is usually found bound to glucose to form lactose, the sugar found in milk and dairy products.

Disaccharides

Disaccharides are two monosaccharide sugar molecules bound together.

Sucrose is ordinary table sugar and made up of glucose-fructose.

Lactose is the sugar in milk and milk products and is glucuse-galactose

Maltose which rarely occurs naturally in foods, is glucose-glucose. Maltose is used in food processing such as the shiny glaze on Chinese roast duck.

complex carbohydrates

Complex carbohydrates are made up of more than two monosaccharides (sugar molecules). Oligosaccharides (where oligo means “scant” or “few”) are made up of 3-10 sugar molecules, whereas polysaccharides are made up of hundred or even thousands of monosaccharides (sugar molecules).

Oligosaccharides

Oligosaccharides are made up of 3-10 sugar molecules and the two most common are some of the complex carbohydrates found in dried beans, peas and lentils[1].

Raffinose is an oligosaccharide made from 3 sugar molecules: galactose-glucose-fructose and stachyose is an oligosaccharide made from 4 sugar molecules: galactose-galactose-glucose-fructose.

The body can’t break down either raffinose or stachyose, but this is done by the bacteria in the intestine.

Polysaccharides

Polysaccharides are made up of hundreds or thousands of sugar molecules linked together. When those sugar molecules are only glucose, the polysaccharide is called “starch”.

Some polysaccharides form long straight chains while others are branched like a tree. These structural difference affect how these carbohydrates behave when they’re heated or put in water.

The way the monosaccharides are linked together makes the polysaccharides either digestible as in starch, or indigestible as in fiber.

Polysaccharides found in plant foods such as fiber, cellulose, hemicellulose, gums and mucilages (such as psyllium) are indigestible by the body so won’t be covered in this article, but it should be noted that they can slow down the absorption of digestible carbohydrate.

Starch

Starches are long chains of glucose molecules strung together like beads on a string and are the ones illustrated in Dr. Dikeman’s illustration, above.

Starches are found in grains such as wheat, corn, rice, oats, millet and barley as well as in legumes such as peas, beans and lentils* and tubers such as potatoes, yams and cassava.

*Recall as mentioned above that peas, beans and lentils also have the complex carbohydrates called oligosaccharides which are not broken down by the body, but by the bacteria of the gut.

There are two types of starches; the long unbranched chains called amylose and the long branched chain ones call amylopectin. What is important in this context is that the long branched chain starches called amylopectin are more easily digested.

The body digests most starches very easily, although those with a high percentage of amylopectin (such as cornstarch) are digested much more easily than those with a high amount of amylose, such as wheat starch [1].

Since starches are just glucose molecules linked together and they are easily broken down to individual glucose molecules, starches can quickly affect the blood sugar of those who are pre-diabetic or have Diabetes.

That is the “point” behind Dr. Dikeman’s illustration, above which I have modified slightly, below.

adapted from graphic by RD Dikeman by Joy Y. Kiddie, MSc, RD

Those who are Diabetic (or pre-diabetic) already have challenges with their blood glucose (“blood sugar”), so does eating foods that are nothing more than long strings of glucose such as starches really make sense?

Note: While the fiber content of whole grain pasta will slow down its digestion compared to refined pasta, it is still long strings of glucose molecules. Think of whole wheat pasta as a string of pearls with in addition to the pearls, in this case fiber.

Digestion of Carbohydrates

Carbohydrate digestion begins in the mouth where an enzyme in saliva called amylase breaks starch down into shorter polysaccharides and maltose.

The acidity of the stomach temporarily stops the effect of the salivary amylase, but the digestion of carbohydrate starts up again in the small intestine where most carbohydrate digestion takes place. Digestion of carbohydrates begins again when the pancreas secretes pancreatic amylase into the small intestine.

In the small intestine, starch is broken down in to many, many individual units of the disaccharide maltose, which are simply two glucose molecules linked together. Then, enzymes located to the brush border of the small intestine break the alpha bond which holds the two glucose molecules together.

It’s easy to understand how starch, which is simply long chains of glucose molecules strung together are so easily broken down when digestion already starts in the mouth and is completed in the small intestine where the disaccharide (maltose) is broken down into 2 glucose molecules.

In the small intestine, other enzymes split other disaccharides into monosaccharides; so for example, the enzyme sucrase splits the disaccharide sucrose into glucose and fructose and the enzyme lactase splits the disaccharide lactose into glucose and galactose.  Note that these other disaccharides are only 1/2 glucose.

Absorption of Carbohydrates

Monosaccharides are absorbed into the mucosal cells of the small intestine and travel to the liver, where galactose and fructose are converted to glucose and the glucose is stored in the liver as glycogen.

Glycogen is long, highly branched chains of glucose molecules (similar to amylopectin, but much more highly branched). When needed, the liver can break down glycogen into glucose at a rate of 100 mg to 150 mg of glucose per minute for up to 12 hours [2].

When glycogen stores of the liver are already full, the glucose from the broken down carbohydrate with the help of the hormone insulin converts the excess glucose into fat and sends to other parts of the body to be stored in adipose tissue.

Carbohydrate-based Foods in the Diet

As covered in previous articles including this one , there is NO requirement for people to eat carbohydrate-based food” provided that adequate amounts of protein and fat are consumed“[3] which are used to provide essential glucose for the brain via gluconeogenesis. This does not mean that I recommend people don’t eat any carbohydrate-based food!

Which carbohydrate-based food people are able to eat and in what quantity without it affecting their blood sugar to any large degree varies considerably from person to person[4], whether or not they are Diabetic.  For those who already have Type 2 Diabetes or are pre-diabetic, a personalized nutrition approach is needed.  This is often called “eating to your meter“; testing a specific quantity of a food by itself, to see how your blood sugar responds. 

Based on research, some people with Type 2 Diabetes can do well eating certain types of legumes (pulses) including black beans, white navy beans, pinto beans, red and white kidney beans, chickpeas and fava beans [5] which is helpful for those who follow a plant-based vegetarian diet. Once people have lowered their HbA1C and fasting blood glucose levels and achieved remission of Type 2 Diabetes symptoms, I work can work with them in determining which foods they can re-introduce into their diet and in what quantities and how often, so as not to adversely impact their blood sugar. Some do better than others.

Over the last 4 years of my clinical practice, I have found that many people with pre-diabetes or Type 2 Diabetes can often manage their blood glucose well while including small servings (1/2 cup / 125 ml) of whole-food starchy vegetables such as winter squash (butternut, acorn, kobacha, etc.), as well as small servings of other starchy whole-food vegetables such as orange or purple yam, or peas. For those eating a moderately-low level of carbs (non-ketogenic) or want to keep eating these foods, I encourage them to choose these more often over starch-based foods such as pasta, rice and bread.

That doesn’t mean that people with Type 2 Diabetes shouldn’t ever eat whole, unmilled brown rice or quinoa but that avoiding refined starches such as white bread, pasta and rice is best preferable.

I hope that you found this article helpful to understand what complex carbohydrates are, and why certain types of complex carbs are more of a challenge to those with Type 2 Diabetes or pre-diabetes.

If you have questions about how I can help you eat in a way to lower your blood sugar levels, please send me a note through the Contact Me form above and for information about the types of services I offer, please have a look under the Services tab or in the Shop.

To your good health,

Joy

You can follow me on:

Twitter: https://twitter.com/lchfRD
Facebook: https://www.facebook.com/lchfRD/
Instagram: https://www.instagram.com/lchf_rd

Copyright ©2019 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

References

1. Chapter 4, Carbohydrates: Simple sugars and Complex Chains, http://samples.jbpub.com/9781284064650/9781284086379_CH04_Disco.pdf
2. Rappaport B, Metabolic factors limiting performance in marathon runners. PLoS Comput Biol. 2010; 6(10). doi: 10.1371/journal.pebi.1000960
3. National Academies Press, Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (2005), Chapter 6 Dietary Carbohydrates: Sugars and Starches”, pages 265-275
4. Zeevi D, Korem T, Zmora N, et al. Personalized Nutrition by Prediction of Glycemic Responses. Cell. 2015 Nov 19;163(5):1079-1094.
5. Sievenpiper, J.L., Kendall, C.W.C., Esfahani, A. et al. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diabetologia (2009) 52: 1479.

A study that is due to be published on July 3, 2018 in the scientific journal Cell Metabolism is the first to demonstrate that compared to foods high in carbs or fat, foods with both carbs and fats together result in much more dopamine being released from the striatum, which is the reward-center of our brain [1]. Dopamine is the same neurotransmitter that is released during sex and that is involved in the addictive “runner’s high” familiar to athletes. This is one powerful neurotransmitter!

It is thought that there are separate areas of the brain that evaluate carb-based foods and fat-based foods and both are involved in the release of dopamine, but when carbs and fat appear in the same food together, this results in what the researchers called a “supra-additive effect”. That is, both areas of the brain get activated at the same time, resulting in much more dopamine being released and a much bigger feeling of “reward” being produced.

This combination of carbs and fat in the same food is why we find foods such as French fries, donuts and potato chips irresistible.

In fact, the study found that people were willing to pay more for foods that combine both carbs and fat than for foods that were only high in carbs but not fat such as candy, or only high in fat but not carbs, such as cheese.

This powerful reward-system involving dopamine is why we will choose the fries over the baked potato and why we have no difficulty wolfing back a few donuts, even when we’ve just eaten a meal.

This “supra-additive effect” on the pleasure center of our brain, along with the fact that more insulin is released when both carbs and fat are eaten together[2] may help explain the roots of the current obesity epidemic and the metabolic diseases such as Type 2 Diabetes that go along with it.

Carbohydrate intake was high in the early 1900s and gradually decreased until about 1954, leveled off, then began to increase again[3]. What caused that to occur? At that time, ultra-refined carbohydrates began appearing in the market and these by their very nature were devoid of the whole, unprocessed grain that slows the release of insulin [3] (for more information on the mechanism, please see this article).  Excess release of insulin made worse by the constant eating of ultra-refined carbohydrate foods underlies the process of how insulin resistance develops and in time, how Type 2 Diabetes develops [3].

The early 1950’s was also when the ”diet-heart hypothesis” proposed by Ancel Keys took root, along with the recommendation that Americans (and later, Canadians) reduce their consumption of saturated fat (more in this article).  With the recommendation to decrease saturated fat was the necessity to create fats to replace them, which is when and why both soybean oil and later, canola oil were created (see this article for more information). These industrial seed oils began to replace natural fats such as butter, lard and tallow in home and restaurant cooking, frying and baking.

With the creation of “polyunsaturated vegetable oils”, French fries were now a healthy food – after all, they were vegetables fried in “healthy polyunsaturated fat”. What could possibly go wrong?

This new study provides the missing link as to the mechanism by which the “perfect storm” was created. That “perfect storm” was the simultaneous appearance in the late 1950s and early 1960s of ultra-refined carbohydrates and industrial seed oils (promoted as “heart healthy” by the American and Canadian Dietary Guidelines) that literally hijacked the reward system of our brain!

Is there little wonder why rates of overweight and obesity began rising at in the early 1960s and have continued to rise dramatically ever since?

As far as our brains are concerned, French fries are much more desirable than a baked potato and donuts and pastry much more desirable than toast because they literally make us feel good!  Eating French fries and pastry results in considerably more dopamine being released than eating baked potato or plain toast. Eating these foods produce something comparable to a “runner’s high” in people that have never run a block or have even gotten off the couch!

While discovery of the dopamine-centered mechanism is new to this study, the food industry has known for some time that processed foods containing both carbohydrate and fat will result in people coming back and buying more and more of their product. Carbs and fat is why Lays® chips could boast “betcha can’t eat just one!“, but it’s not just Lays®. This combination of carbs and fat is in all processed foods; from so-called “junk food” such as chips and Cheezies® to foods that are perceived as “healthy foods”, such as granola bars and commercial peanut butter.

Carbs and fats together are the essence of “fast food” – from Big Macs® dripping with cheese and mayo sandwiched between several buns, to French fries of all types, super-sized or not.  People may joke about “junk food being addictive”, however understanding the “supra-additive” effect of carbohydrate combined with fat makes these foods as addictive to our brains as a “runner’s high” is to an athlete, or what makes people seek out sex. Addictive? Maybe not in the truest sense of the word except in cases of food addiction, but certainly in the rest of us there is a powerful draw to want to eat them.

Knowing and understanding this mechanism is of no small consequence! It should inform our food choices.

We need to be aware of foods that we eat that “hijack” our appetites. They could be “healthy foods” like cashews that are both high in fat and high in carbohydrate.  Given what we know about the triggering of the reward system in the brain, should those of us with current or past weight problems have them around?

Another way this knowledge should inform our food choices is around the concept of “cheat days”.  People who see me seeking weight loss often ask me about whether they can have one day a week, or one day a month where they eat “cheat foods”.  Knowing the very potent chemically-mediated reward system involved with eating foods such as pizza or French fries or ice cream, do you think these are foods that are helpful to eat once a week or once a month? How much will eating those foods cause you to crave them later, after your “cheat day”? Is it worth it?

From a purely academic perspective, knowing the mechanism also helps explains why metabolically healthy people can lose weight either following a low-fat diet or a low-carb diet, because it is the combination of both carbs and fats that stimulate the reward centers.

Note: a low-carb approach is preferable for people who have have already become insulin resistant or diagnosed with Type 2 Diabetes because they are no longer able to handle more than small amounts of carbohydrate at a time without it significantly impacting their blood sugar (and insulin) levels.

So, knowing that eating carbs and fat together result in a huge release of dopamine and light up the reward-centers of our brain, how should we choose foods differently? What do we do if we eat carbs and fat at the same meal; does it matter which we eat first? Does how we process and prepare our carb-based foods make a difference on our blood sugar?

The answer to these questions is easy.  Yes, based in this study and many others, how we eat meals that have carbs, fat and protein (called “mixed meals”) matters and how quickly or slowly our blood sugar rises depends on when we eat them as well as how we process and prepare them.

This is where I can help.

I can explain in a very easy to understand way how to eat in such as ways as to minimize the impact on blood sugar, and beyond that, how to lower insulin release and insulin resistance which keeps blood sugar levels high.

If you would like information about my services or about having me design a Meal Plan for you, please send me a note using the “Contact Me” tab above and I will reply as shortly.

To our good health,

Joy

You can follow me at;

 https://twitter.com/lchfRD

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References

1. Di Feliceantonio et al., 2018, Supra-Additive Effects of Combining
   Fat and Carbohydrate on Food Reward, Cell Metabolism 28, 1—12
2. Carrel, G., L. Egli, C. Tran, P. Schneiter, V. Giusti, D. D’Alessio, and L. Tappy. ”Contributions of Fat and Protein to the Incretin Effect of a Mixed Meal.” American Journal of Clinical Nutrition 94, no. 4 (2011):997—1003.
3. Gross, Lee S., Li Li, Earl S. Ford, and Simin Liu. ”Increased Consumption of Refined Carbohydrates and the Epidemic of Type 2 Diabetes in the United States: An Ecologic Assessment.” The American Journal of Clinical Nutrition 79, no. 5 (2004): 774—779.
4. O’Dea, K., Nestel, P.J., and Antonoff, L. ”Physical Factors Influencing Postprandial Glucose and Insulin Responses to Starch” 33, no. 4 (April 1, 1980): 760—65. https://doi.org/10.1093/ajcn/33.4.760.

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