The Carb Conundrum

Many of you are aware that I have had weight loss surgery (vertical gastric sleeve). I am on a support group on Facebook for people who have had wls. One thing I have learned is that just about every surgeon has a different nutritional program. Many, maybe most, of them involve counting things: calories, carbs, protein, fat. People are constantly asking questions about how much of this or that should they have. Many people try to eliminate almost all carbs, regardless of source.

My plan is quite different. Instead of counting, we are supposed to focus on certain types of foods in certain orders. Eat all the fresh fruits and vegetables you want. Eat lesser amounts of nuts and whole grains. Lean meats, such as fish and chicken, healthy oils such as olive oil, and then red meat (beef, pork, and lamb).

This is not only different in that there is nothing to count, but also in terms of restricting carb intake. Given how different this is, I have been doing some reading up on the so-called good and bad carbs,

You’ll get radically different answers from people on the number of carbs people should be consuming. Certainly, this depends on a well as factors, including weight and severity of diabetes and metabolic syndrome, people often lose sight of what types and sources of carbs should be consumed.

My recommended diet (Mediterranean) is intentionally high in carbs, but it is the source of those carbs that is important. Here’s a good reference I found discussing the differences: https://www.healthline.com/nutrition/good-carbs-bad-carbs

A few quotes from the article, as well as some of my commentary, follow:

Dietary carbohydrates can be split into three main categories:

Sugars: Sweet, short-chain carbohydrates found in foods. Examples are glucose, fructose, galactose and sucrose.
Starches: Long chains of glucose molecules, which eventually get broken down into glucose in the digestive system.
Fiber: Humans cannot digest fiber, although the bacteria in the digestive system can make use of some of them.

The main purpose of carbohydrates in the diet is to provide energy. Most carbs get broken down or transformed into glucose, which can be used as energy. Carbs can also be turned into fat (stored energy) for later use.

Fiber is an exception. It does not provide energy directly, but it does feed the friendly bacteria in the digestive system. These bacteria can use the fiber to produce fatty acids that some of our cells can use as energy.

Sugar alcohols are also classified as carbohydrates. They taste sweet, but usually don’t provide many calories.

“Not all carbs are created equal.” Something I’ve been starting to say. The same is true of fats.

“Although carbs are often referred to as “simple” vs “complex,” I personally find “whole” vs “refined” to make more sense.” This statement matches what my surgeon told me a couple of weeks ago, as well as what we heard in my nutrition classes.

Whole carbs are unprocessed and contain the fiber found naturally in the food, while refined carbs have been processed and had the natural fiber stripped out.

Examples of whole carbs include vegetables, whole fruit, legumes, potatoes and whole grains. These foods are generally healthy.

On the other hand, refined carbs include sugar-sweetened beverages, fruit juices, pastries, white bread, white pasta, white rice and others.

Numerous studies show that refined carbohydrate consumption is associated with health problems like obesity and type 2 diabetes (1, 2, 3).

They tend to cause major spikes in blood sugar levels, which leads to a subsequent crash that can trigger hunger and cravings for more high-carb foods (4, 5).”

However, it makes no sense to demonize all carbohydrate-containing foods because of the health effects of their processed counterparts.

Whole food sources of carbohydrates are loaded with nutrients and fiber, and don’t cause the same spikes and dips in blood sugar levels.

Hundreds of studies on high-fiber carbohydrates, including vegetables, fruits, legumes and whole grains show that eating them is linked to improved metabolic health and a lower risk of disease (10, 11, 12, 13, 14).

On the subject of low carb diets:

Over 23 studies have now shown that low-carb diets are much more effective than the standard “low-fat” diet that has been recommended for the past few decades.

These studies show that low-carb diets cause more weight loss and lead to greater improvement in various health markers, including HDL (the “good”) cholesterol, blood triglycerides, blood sugar, blood pressure and others (15, 16, 17, 18, 19).

For people who are obese, or have metabolic syndrome and/or type 2 diabetes, low-carb diets can have life-saving benefits.

Restricting carbs can often (at least partly) reverse obesity.

However, this does not mean that the carbs were what caused the obesity in the first place.

This is actually a myth, and there is a ton of evidence against it.

While it is true that added sugars and refined carbs are linked to increased obesity, the same is not true of fiber-rich, whole-food sources of carbohydrates.

Humans have been eating carbs for thousands of years, in some form or another. The obesity epidemic started around 1980, and the type 2 diabetes epidemic followed soon after.

Keep in mind that many populations have remained in excellent health while eating a high-carb diet, such as the Okinawans, Kitavans and Asian rice eaters.

What they all had in common was that they ate real, unprocessed foods.”

Brown and wild rice are not bad for you. It’s the white rice, so common in Western cuisine, that is.

On the subject of the quantity of carbs that are required, or if they are at all:

Many carb-containing foods are healthy and nutritious, such as vegetables and fruits. These foods have all sorts of beneficial compounds and provide a variety of health benefits.

Although it is possible to survive even on a zero-carb diet, it is probably not an optimal choice because you’re missing out on plant foods that science has shown to be beneficial.

And now, the tie in to the Mediterranean diet, which I mentioned earlier is intentionally high in carbs:

Good Carbs:

Vegetables: All of them. It is best to eat a variety of vegetables every day.
Whole fruits: Apples, bananas, strawberries, etc.
Legumes: Lentils, kidney beans, peas, etc.
Nuts: Almonds, walnuts, hazelnuts, macadamia nuts, peanuts, etc.
Seeds: Chia seeds, pumpkin seeds.
Whole grains: Choose grains that are truly whole, as in pure oats, quinoa, brown rice, etc.
Tubers: Potatoes, sweet potatoes, etc.

And now for the carbs to avoid or minimize:

Sugary drinks: Coca cola, Pepsi, Vitaminwater, etc. Sugary drinks are some of the unhealthiest things you can put into your body.
Fruit juices: Unfortunately, fruit juices may have similar metabolic effects as sugar-sweetened beverages.
White bread: These are refined carbohydrates that are low in essential nutrients and bad for metabolic health. This applies to most commercially available breads.
Pastries, cookies and cakes: These tend to be very high in sugar and refined wheat.
Ice cream: Most types of ice cream are very high in sugar, although there are exceptions.
Candies and chocolates: If you’re going to eat chocolate, choose quality dark chocolate.
French fries and potato chips: Whole potatoes are healthy, but french fries and potato chips are not.

In closing:

The “optimal” carbohydrate intake depends on numerous factors, such as age, gender, metabolic health, physical activity, food culture and personal preference.

If you have a lot of weight to lose, or have health problems like metabolic syndrome and/or type 2 diabetes, then you are probably carbohydrate sensitive.

My surgeon recommends this diet because, according to him, research has shown that is has a higher rate of long-term compliance than other types of diets.