Carbohydrates, Part 1

On our healthy eating journey, we're going to look specifically at different types of nutrients.  Essentially, foods can be broken down into three categories: carbohydrates, proteins and fats.  Most foods will have some combination of these three constituents.  At different times, each of these components has received intense scientific and lay press attention.  As is common with many health topics, one cannot isolate specific entities and expect to learn the whole story.  Thus, a healthy diet involves much more than focusing solely on these nutrients.  I refer you back to the Themes article to keep a broad focus on overall dietary goals.  Nutrient content, however, is certainly an important aspect and learning about what we eat can help dramatically.  Currently, there is no topic in nutrition that receives more attention than carbohydrates and that is where we will start our discussion.

One quick caveat...the issues discussed below are meant to provide general information and pertain to a broad group of patients.  There may be instances where eating something that appears intrinsically beneficial may not be right for an individual.  These unique issues are obviously best dealt one-on-one with me.

Without becoming an organic chemistry text, I think it's important to review some basic definitions.  The ones with most pertinence are bolded.

Carbohydrate: Quite simply, an organic compound composed of carbon, hydrogen and oxygen.  A synonym for carbohydrates is saccharides.  This is the most inclusive category.  Carbohydrates are made of blocks that can form chains.  The simplest carbohydrates contain 1 or 2 blocks whereas others can contain in the thousands.  Interestingly, despite being our primary energy source, eating carbohydrates is not necessary.  Humans can make carbohydrates from protein and fat intake.  Carbohydrates an important source of energy for your body, however.  Your digestive system changes carbohydrates into glucose (blood sugar).  Your body uses this sugar for energy for your cells, tissues and organs.  It stores any extra sugar in your liver and muscles for when it is needed. 

Mono-saccharides: These are the simplest carbohydrates and contain a single block.  For our purposes, there are 3 of importance.  Glucose is the primary source of energy for our cells and the main carbohydrate in the blood.  Nearly all food we eat is eventually converted to glucose by our body.  Other mono-saccharides include fructose which is found in fruit and galactose which is found in milk and dairy products. 

Di-saccharides: These are carbohydrates containing two blocks. The most common of these is sucrose which contains 1 block of glucose and 1 block of fructose joinded together.  Sucrose is table sugar.  Lactose is a combination of glucose and galactose and found in dairy products.   Maltose is a combination of 2 glucose blocks and found in malt beverages such as beer. 

Simple Sugars: This term generally involves all the mono and d-saccharides.  We'll use this term when discussing dietary recommendations.  Simple carbohydrates thus include the sugars found naturally in foods such as fruits, vegetables, milk and milk products (natural sugars).  They also include sugars added during food processing and refining (added sugars). 

Poly-saccharides: Carbohydrates containing long chains of blocks.  Poly-saccharides are also called complex carbohydrates.  These are the carbohydrates commonly found in plants (including grains) and make up the bulk of carbohydrates eaten by the average American.  For our purposes the poly-saccharides we care about are starch and fiber.  Poly-saccharides are also called complex carbohydrates. 

Starch: Poly-saccharides which are long chains of glucose blocks.  The body has specific methods in which it can break down starch and absorb it for energy. 

Fiber: Also poly-saccharides which are long chains of glucose but constructed in way that humans cannot effectively break it down for absorption.  We'll have much more detail able fiber in future articles. 

Grains: Also called cereal grains which are grasses that are cultivated for consumption.  It is the seed that we eat.  The most common grain eaten in America is wheat. Other grains include maize, rice, barley, rye, buckwheat, quinoa, and barley. 

Whole Grains: The grain seed that we eat is composed of 3 layers.  There is an outer protective shell called the bran made primarily of fiber, a large middle chamber called endosperm which is primarily starch, and a small inner core called the germ which contains nutrients and oils.  Whole grain products are made from grinding the entire seed, including all 3 components. 

Refined (processed) Grains: The is when the whole grain is modified and only parts are included in the flour.  Generally the fiber-rich bran and nutrient-rich germ are removed and only the starchy endosperm remains.

We're going to go in greater detail below about how to think of these components in our diet and try to cut though some of the confusing claims made by food manufacturers. 

If I've already bored you and you cannot take anymore, I'm going to shrink all my opinions down to a single sentence... 

When eating carbohydrates, try to get all your simple sugars from naturally occurring foods (i.e no added sugars) and your complex carbohydrates from whole grains.  

Nobody is perfect but if you were to achieve the following 80-100% of the time, eating carbohydrates in proper balance with fat and protein, you will likely not be overweight, not development diabetes or other metabolic problems, reduce your likelihood of cancer and heart disease, and overall life a longer and healthier life.   

How do you ensure you are following these rules?  Growing all your own produce and making all your own breads is one way, though not terribly realistic.  Thus, for the masses, the best way to ensure you are doing things correctly is reading ingredient labels.  For anyone buying grocery items, reading the ingredients is the only way to ensure you are getting what you want and avoiding additives you do not.  So what do you look for?  First, the fewer ingredients the better.  Second, look for things that actually sound like food.  When trying to identify whole-grains, look for some of the terms below.  Additionally, try to avoid some of the added sugars that are often hidden in the ingredient list.

Notice some of the phrases that are not on the whole grain list: wheat flour, oat flour, enriched wheat flour, bleached flour, and multi-grain flour.  When it comes to complex carbohydrates, you can see that the most important word is "whole."  If they are not listing "whole-grain" flour then it doesn't contain whole grains.  Obviously any whole grain is better than none but try to find products that contain 100% whole grains.

When it comes to the simple sugars, obviously avoidance of added ingredients is best.  When purchasing products, buy things as plain as possible and add your own sugar naturally.  Yogurt is a great example.  An ingredient list for strawberry yogurt from a common brand is listed here: Cultured Pasteurized Grade A Low Fat Milk, Sugar, Strawberries, Modified Corn Starch, High Fructose Corn Syrup, Nonfat Milk, Kosher Gelatin, Citric Acid, Tricalcium Phosphate, Natural Flavor, Pectin, Colored with Carmine, Vitamin A Acetate, Vitamin D3.  Bolded are two different added sugars.  A better way would be buying plain yogurt and simply adding strawberries.  Not only are you avoiding the added simple sugars, but some other unnecessary chemicals as well.  The ingredient list for plain yogurt from another brand is listed here: cultured pasturized nonfat milk, cream (it also lists the specific probiotic strains).  Now take the latter yogurt and add strawberries and voila!  You've got strawberry yogurt and have avoided not only added refined sugar, but also some unnecessary chemicals  Additionally, you also got additional fiber content from using the whole fruit.  

While reading and deciphering labels may be a daunting task, it is definitely worth it.  Once you have gotten in the habit, you can pick certain products that meet the criteria we are discussing and then not think about it as much.  Every time you go to the store, pick 2 or 3 food categories and find the products that are most ideal.  Next time move onto different categories.  Within a few trips to the store, you've got your core items down pat.  Then you just recheck labels periodically to ensure the manufacturers are not lowering the quality of their products.

There are other catbohydrate topics into which we'll delve later.  Discussions of fiber, types of whole grains, the importance of glycemic index/load and how much carbohydrates you really need are all important.  However, they all take a back seat to avoiding added simple sugars and refined grains.  Just remember the word whole:  whole grains, whole fruits and whole vegetables and you can't go wrong.