Carbohydrates

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Description and Use:

Carbohydrates are composed of carbon, hydrogen and oxygen. They are one of the three macronutrients, those nutrients needed in relatively large amounts to support normal function and health. The other two are proteins and fats. Carbohydrates come from plant sources and are found in foods in the form of sugars, starches and fiber. Plants take water from the soil and carbon dioxide from the air to create glucose and other sugars in the photosynthesis process. Plants can then store excess glucose in the form of starch. The main functions of carbohydrates in the body are to;

  • Provide energy for daily activities. They are the primary source of energy for the brain, red blood cells and nervous tissues. They are used for quick bursts of energy and in intense exercise/activity.
  • Provide fiber. Fiber is the indigestible portion of plant material that provides roughage and bulk. It supports intestinal function and health. Soluble fibers can help lower blood cholesterol levels.
Carbohydrates provide 4 kcal/gm. A typical sugar has the formula C6H12O6 (glucose, fructose etc.). With the addition of oxygen from the lungs, glucose can be easily burned (oxidized) releasing energy and the resulting by-products of carbon dioxide and water. For a short period, they can even be burned anaerobically, as can happen in intense exercise, resulting in the buildup of lactic acid and other by-products in the muscles leading to fatigue and soreness. Fats are also used for energy but require more oxygen and time to oxidize. Our bodies use a combination of the two at any given time. Light exercise/activity will burn more fat than carbs; approximately 85% from fat and 15% from carbs. Whereas intense exercise/activity burns more carbs than fat; approximately 70% from carbs and 30% from fat. The brain, red blood cells, and other nervous tissues primarily rely on glucose.

Structure of Carbohydrates:

Simple carbohydrates, or sugars, consist of monosaccharides and disaccharides. Monosaccharides consist of one sugar molecule whereas disaccharides consist of two sugar molecules joined together. There are three monosacchrides commonly found in foods;

  • Glucose - The most common sugar in our food. It is normally not found by itself but is attached to other disaccharide sugars and complex carbohydrates. Digestion breaks disaccharides and polysaccharides down to release the glucose. It is the preferred source of energy for the brain and an important source of energy for all cells.
  • Fructose - Found in fruits and vegetables, it is the sweetest sugar.
  • Galactose - Does not occur alone in foods. It joins with glucose to create lactose.

The three common disaccharides are;

  • Lactose - The sugar naturally occurring in milk. It is composed of glucose + galactose.
  • Maltose - Generally does not occur alone in foods but is a by-product of the breakdown of larger molecules. It is composed of two glucose molecules.
  • Sucrose - Common table sugar which is derived from sugar cane and sugar beets. It is composed of glucose + fructose. It is also found in maple syrup, fruits and vegetables.

Complex carbohydrates, or polysaccharides, generally consist of long chains of glucose molecules. They include starch, glycogen and fiber.

  • Starch is the storage form of glucose in plants. Typical food sources of starch include grains (rice, breads, cereals, pasta), legumes and tubers. There are two types;
    • Amylose - Is a straight chain of glucose molecules.
    • Amylopectin - Is a branched structure of glucose molecules and because it has a greater surface area, it digests more quickly thereby giving it a higher glycemic index than amylose. Glycemic index to be discussed later.
  • Glycogen is the storage form of glucose in animals, including humans. It is stored in the muscles and liver. In the muscles, it provides for quick bursts of energy. In the liver, it is used to regulate glucose levels in the blood.
  • Fiber is the indigestible part of plants that form the structural component of stems, leaves and seeds. They do not provide energy but have many health benefits. They provide roughage and bulk needed for intestinal tone and regularity. They are classified into 2 types, soluble and insoluble. Soluble types dissolve in water and form a gel. They are common food additives, used as thickening, gelling and stabilizing agents. Examples are; Pectin (used to thicken jams and yogurts) gums (guar) and mucilages (like psyllium used for a laxative). Insoluble types provide roughage which promote regularity and reduce the risk of diverticulosis. Examples are; lignins, cellulose and hemicelluloses.

Digestion of Carbohydrates:

Digestion of carbohydrates starts in the mouth. Saliva contains the enzyme amylase which begins the breakdown of starches into the disaccharide maltose. After passing through the stomach, most the remaining digestion and absorption happens in the small intestine. There the pancreas secretes more amylase to continue the breakdown of starches into maltose. Enzymes in the small intestine, (maltase, sucrase and lactase) break the disaccharides (maltose, sucrose, lactose) into monosaccharides (glucose, fructose, galactose). The monsaccharides are then absorb into the bloodstream and sent to the liver. The liver converts most non-glucose monosaccharides (fructose, galactose) into glucose. Glucose is the final result of carbohydrate digestion.

If there are energy needs, the glucose is released into the bloodstream where it can travel to cells that need it. If there are not immediate energy needs, the glucose can be converted to glycogen and stored in the liver and muscles. Glycogen stored in the liver can be used to regulate blood sugar levels between meals. Stores in the muscles can be used for quick energy. The storage capacity of glycogen is limited, about 70 gm in the liver and 120 gm (approx 4 oz.) in the muscles. Endurance athletes, through training, can increase the glycogen storage capacity in their muscles by two to four times the normal amount. Finally, once glycogen stores have been satisfied, excess glucose can be converted to fat and stored in adipose tissue.

The indigestible carbohydrates, namely fiber, pass unchanged to the large intestine. There bacteria can ferment some of the undigested carbohydrates producing gases such as carbon dioxide, methane and hydrogen. Fiber adds bulk to the stools and promotes intestinal health and bowel regularity.

There are some over-the-counter digestive aids that provide enzymes to assist in the breakdown of indigestible carbohydrates. Raffinose and stachyose are common oligosaccharides (small chains of sugars having 3 - 10 monosaccharides) found in legumes and some vegetables (broccoli, cabbage, cauliflower, etc.). Humans do not have the enzyme to break these down. The product Beano® contains the enzyme alpha-galactosidase which assists in the breakdown of raffinose and stachyose and thus reduces the gas that can form in the large intestine. For those with lactose intolerance, there are many products containing lactase in a supplement form. Lactaid® is the most well known and the company also makes lactose-free milk products.

Effects on Health:

The amount and type of carbohydrates that we consume in our regular diet can have a significant effect on our health. Carbohydrates in whole foods, like fruits, vegetables, whole grains and legumes, come in a nutrient rich package containing vitamins, minerals, fiber and phytonutrients. Refined carbohydrates however; like sugar, syrups, candy, sodas, white flour, pastries, cakes, white rice etc. provide calories but little or no nutrients and are therefore sometimes referred to as 'empty calories'. Overemphasis of refined carbohydrates in the diet can crowd out nutrient rich foods and lead to overall poor health. Of particular concern, is the epidemic of obesity and diabetes in the U.S. over the last 20 years. Factors contributing to obesity are lack of physical activity and high calorie consumption. The caloric consumption of the average American has increased over the years and this is generally attributable to the increase of "added sugars" (including high-fructose corn syrup, HFCS) in processed foods. This high ratio of sugar consumption (vs whole food carbs) creates problems with cavities, glucose metabolism, satiety, obesity and the resulting issues of insulin resistance, diabetes, high blood pressure etc. There is an alarming trend toward increase sugar consumption.

In normal glucose metabolism, glucose levels in the blood will rise after a carbohydrate meal. The pancreas will then secrete the hormone insulin which facilitates the passage of glucose into the cells where it can then be used for energy. Insulin also triggers the liver and muscles to store excess glucose as glycogen. When glucose levels in the blood drop, the pancreas secretes another hormone, glucagon, which triggers the liver to convert some of its glycogen stores into glucose. In this way, the pancreas tries to keep blood sugar levels in a normal range. Diabetes is the disease in which the body cannot maintain glucose levels within normal limits. In type 1 diabetes, the body cannot produce enough insulin and insulin injections are required. In type 2 diabetes (approx 95% of diabetes cases), cells become insulin resistant. Insulin resistance is most often caused by obesity but age, genetics and inactivity can be factors. Type 2 can be treated by weight loss, healthy diet, regular exercise and in some cases, additional medications. In either type, since glucose cannot pass into the cells, glucose levels can get dangerously high, a condition called hyperglycemia. The body tries to compensate for this inability to use glucose by pulling energy from fat instead.

The Glycemic Index, GI, of a food refers to its ability to raise glucose levels in the blood. Foods are compared to white bread or glucose which is assigned an index value of 100. Roughly speaking, foods above 70 are considered high and those below 55 are considered low. A more meaningful indicator may be the glycemic load which takes into consideration the amount of carbohydrate in the food. Glycemic load = the amount of carbohydrate multiplied by the glycemic index. For example, boiled carrots have a glycemic index of 49 yet a glycemic load of 3 (below 10 is considered low) since there is very little carbohydrate in a serving of carrots. So, carrots can still be considered a healthy food. Choosing lower glycemic index/load foods makes sense for diabetics. However, for healthy individuals, there is some controversy whether glycemic index is useful for making food choices. For one, people normally eat foods together in a meal. When mixed with proteins, fiber and fats, the rise of glucose levels will tend to be moderated, so it can be difficult to determine the glycemic impact of a meal by looking at individual foods. Secondly, some feel the concepts are too complex to be practical for people to apply in their daily lives.

Regardless of the GI controversies, the goal is important; to provide a slower sustained-release supply of glucose to the blood. Quick spikes in sugar levels provoke a strong insulin response and expose the body to the toxic effects of high blood sugar and to the harmful effects of insulin. Sugar levels can then drop quickly, resulting in fatigue and triggering hunger again. Major studies have indicated that those who eat a diet of high GI carbs have the greatest risk of many chronic diseases. So, choosing low GI carbs is a healthy choice however some high GI carbs are healthy also. To slow the digestion and absorption of carbs in a meal, include a good source of protein, healthy fats and/or fiber. In general, low GI carbs are those foods which are less refined; fruits, brown rice, whole grains, legumes etc. Those with high GI are the most refined; white rice, white flour products, potatoes, corn flakes/chips and a number of breakfast cereals. To lookup the GI of various foods, see Glycemic Index

Sugars can play a role in tooth decay. Bacteria in the mouth produce acids that can erode tooth enamel for 20 minutes or more after each exposure to carbohydrates. Frequent snacking and sipping sweet drinks over periods of time can make matters worse. Also, the type of food can make a difference. Sticky snacks like dried fruit, dates, raisins, granola bars etc. can stay on the teeth much longer than other foods. It is recommended to avoid frequent snacks, and to rinse the mouth out with water or brush after eating a snack or meal.

Sugar has not been scientifically proven to cause hyperactivity in children. There is also no evidence that a diet high in sugar causes diabetes. However, over consumption of sugars can be a factor leading to obesity and obesity is the most common cause of diabetes type 2.

Is honey healthier than table sugar? Sucrose is a disaccharide that when digested is broken down into one fructose and one glucose. So it is 50% fructose, 50% glucose. Honey is about 82% carbohydrate, 17% water and 1% of many trace elements. It is already partially broken down and contains about 38% fructose, 31% glucose, 7% maltose (2 glucose molecules) and 1.5% sucrose. When digested, honey will also result in about the same 1/1 ratio of fructose/glucose that sucrose has. Since fructose is sweeter than sucrose, less honey can be used when sweetening a food or drink. It does not contain any more nutrients than sucrose, and their glycemic indexes are also similar; pure honey is 58 (raw honey will be slightly less), and sugar is 60, so honey is not considered any healthier. Other natural sugars like maple syrup, which is mostly sucrose, raw (turbinado) sugar and molasses, a by-product of sucrose manufacturing, all have similar calories and nutritional effect. The main point with sugars of any kind, is to limit the amount. The recommendation is not more than 12 tsp of "added sugars" per day. The American Heart Association recommends even less; 9 tsp for men, 6 tsp for women. The average American gets about 22 tsp per day (teens about 34), mostly from soft drinks, candy, cakes, cookies, pies, doughnuts, pastries etc. MSNBC Hold the Sugar

High-fructose corn syrup, HFCS, has primarily replaced sucrose as a sweetener in the U.S. food industry. Reasons are costs. The U.S. sets domestic production quotas on sucrose, has tariffs on imports and subsidizes the corn industry. As a result U.S. sugar prices are higher than most the world and corn syrup is cheap. Corn syrup is primarliy maltose (2 glucose molecules) and does not taste very sweet. By converting some of the glucose to fructose, the sweetness can be increased to be similar to sucrose. HFCS was introduced in 1975 and its use grew rapidly in processed foods and soft drinks. There are 3 types, HFCS 42 (42% fructose, 53% glucose), used in foods, HFCS 55 (55% fructose, 42% glucose), used in soft drinks and HFCS 90 used in special cases. Some blame HFCS for the obesity epidemic since the rate of obesity has paralleled along with the increase in HFCS usage. This is partly true, since the overall increased consumption of "added sugars" is a main factor in the obesity epidemic. However, HFCS is not worse than sucrose; it is about the same as most sugars. Remember sucrose is 50/50 fructose glucose so HFCS 42 actually has less fructose, HFCS 55 a little bit more. But since it is in the monosaccharide format like honey, it tastes sweeter so less can be used. HFCS is not on the "Avoid" list but like sucrose is definitely on the "Cut Back" list.

Fructose has received a lot of attention lately, in particular, for its possible role in the obesity and diabetes type 2 epidemic. Fructose is metabolized differently than glucose. Glucose is regulated by various hormones in the body, insulin when levels are high, glucagon when levels are low and insulin-regulated leptin which reduces appetite when enough calories have been consumed. Fructose is not regulated, it does not stimulate insulin or leptin production. It comes to the liver and is quickly metabolized. In small amounts it has positive effects, and actually decreases the glycemic response to glucose loads, and improves glucose tolerance. However, in excessive quantities (when sugars are > 25% of calories) it can have several harmful effects; causing glucose and fructose malabsorption, raising triglyceride and LDL cholesterol levels (leading to heart disease, insulin resistance) increasing visceral abdominal fat and uric acid (a factor in gout). For thousands of years humans consumed fructose amounting to 16-20 grams per day, largely from fresh fruits. Westernization of diets has resulted in significant increases in added fructose, leading to typical daily consumptions amounting to 46-72 grams of fructose per day. The body is not adapted to process these new high levels of fructose. For further details, see Fructose Metabolism. In summary;

  • Fructose as found naturally in fruits and vegetables is not a problem. It is at low and healthy levels.
  • However, keep the overall calorie intake from simple sugars to less than 25% and from "added sugars" (half fructose) to less than 10%. Soft drinks and sweetened fruit/sport drinks are the major source of "added sugars". It is better to get your calories from food. Starches are generally the preferred fuel as they convert mostly to glucose.
  • Do not use fructose or Agave Nectar (56-92% fructose) as substitutes for sucrose.

Lastly, a word about fiber. A fiber rich diet has many health benefits. It may reduce the risk of colon cancer, help in preventing hemorrhoids, constipation and diverticulosis. It can be a factor in reducing heart disease by lowering LDL. It adds to the feeling of fullness in a meal which can help with weight loss. It promotes intestinal health by keeping stools soft, moist and giving the gut muscles something to push on. It slows digestion and therefore helps to moderate the rise of glucose in the blood. It is better to get fiber from foods rather than from supplements. Foods rich in fiber include fruits, vegetables, legumes and whole grains.

Interesting historical and cultural notes:

In the past, refining some carbohydrates led to vitamin deficiency diseases. Once the cause was found, the solution was to fortify the refined carb with the missing vitamins. This was an unusual approach, to first strip the vitamins and other nutrients out, then selectively try to add them back in. Will the refined and fortified food have the same value as the original whole food? Here are a few fortification stories;

  • Beriberi - is a thiamin, B1, deficiency disease characterized by severe lethargy and fatigue, together with complications affecting the cardiovascular, nervous, muscular, and gastrointestinal systems. In severe cases, it can lead to heart failure and death. Prior to the 1900's it was common in areas of Asia where polished white rice was the main staple. Around 1901 it was identified as a deficiency disease. About 1910, extract of rice bran was established as a treatment for it.
  • Pellagra - is a niacin, B3, deficiency disease characterized by the 3 D's": diarrhea, dermatitis and dementia. Untreated, sufferers can die in 4 to 5 years. In the early 1900s, pellagra reached epidemic proportions in the American South. There were 1,306 reported pellagra deaths in South Carolina during the first ten months of 1915; 100,000 Southerners were affected in 1916. It was also common is some parts of Europe where, like in the South, corn was the main staple. By 1926 it was determined a balanced diet or a little brewer's yeast cured it. In 1937, niacin was identified as the missing nutrient. Interestingly, Native and South Americans who also had a diet high in corn did not suffer from pellagra. It was discovered that the way they used lime in the cooking process (nixtamalization) made the niacin available.

Since 1941, fortification of white flour-based products with some of the nutrients lost in milling, like thiamin, riboflavin, niacin, and iron was mandated by the US government in response to the vast nutrient deficiencies seen in US military recruits at the start of World War II. This fortification led to nearly universal eradication of deficiency diseases in the US, such as pellagra and beriberi.

B vitamins are the essential catalysts needed in order to metabolize/burn carbohydrate (glucose). Some use the analogy of a candle; carbs are the wax, B vitamins the wick. In nature, carbs come in a whole food package whether it is simple sugars (dates, raisins, fruit) or complex carbs (whole grains). This package almost always contains enough B vitamins to process the corresponding amount of carbs found in the same package. The refining process to make white flour, white rice, removes B vitamins, fiber (bran), oil (germ) and other micronutrients. The goal is to increase shelf life and improve taste/texture. Fortification can prevent disease symptoms, but it is no substitute for simply eating the original whole food. Brown rice, whole wheat flour and whole grain products are the healthier choice. They provide B vitamins, fiber and other micronutrients.

Alternative Sweeteners:

Artificial sweeteners are common in many "diet" processed foods and provide an alternative to natural sugars. Reasons for choosing them may be to reduce calories (weight watchers), reduce glycemic response (diabetics) or to reduce the risk of dental caries (chewing gums). There are two types; nutritive and non-nutritive.

Nutritive sweeteners still contribute some calories but fewer than regular carbs; 2-3 kcal/gm as oppose to 4 kcal/gm. These include the sugar alcohols; erythritol, isomalt, mannitol, sorbitol and xylitol. They are not as sweet as sugar, not absorbed well by the body, and do not promote tooth decay. However, large amounts may have a laxative effect and even cause diarrhea.

Non-nutritive sweeteners are synthetically produced. They contribute little or no calories. Those currently approved by the FDA include:

  • Acesulfame-K - sold as Sunette and Sweet One. It is not metabolized by the body so it is excreted by the kidneys unchanged. It leaves no aftertaste and has zero calories.
  • Aspartame - sold as NutraSweet and Equal. It consists of 2 amino acids and like protein has 4 kcal/gm. Since it is 200 times sweeter than sucrose, much less can be used. It is the most common sweetener used in diet sodas. Heat destroys the taste. It should not be consumed by people with PKU disease.
  • Neotame - similar to and made by the same company as aspartame. It is 7,000-13,000 times sweeter than sucrose, heat resistant and safe for people with PKU disease. It has the characteristic aftertaste common to artificial sweeteners.
  • Saccharin - sold as Sweet n' Low. Often criticized for having a chemical aftertaste. It was controversial for a while due to evidence that it could cause bladder cancer in laboratory rats. It has since been cleared and is considered safe by US govt.
  • Sucralose - sold as Splenda. It is made from the chlorination of sucrose. Most of it passes through the digestive tract unchanged. However, 11-27% is absorbed of which 70-80% is eliminated by the kidneys. It is heat resistant.

Stevia is a zero calorie sweetener derived from the leafy green foliage of the Stevia plant. Relatively new in the West, it was approved by the FDA in 2008. Japan however, has been using it for decades. It is a natural alternative to the often-controversial synthetic sweeteners. Since it is new, there are still some concerns and there is ongoing testing. It is sold as Truvia, PureVia, SweetLeaf, Stevia in the Raw.

The FDA maintains that these sweeteners are safe when consumed within the Acceptable Daily Intake, ADI. The ADI is the mg/kg of body weight considered safe, with a 100-fold safety factor. There are ongoing controversies about a number of these and the web has many testimonials. The Center for Science in the Public Interest, CSPI, only considers neotame as "Safe" and recommends to "Avoid" acesulfame-k, aspartame, saccharin and sucralose. Regarding the sugar alcohols, erythritol is ranked as "Safe", the other 4, isomalt, mannitol, sorbitol and xylitol get a "Cut Back" rating. Stevia is given a "Caution" rating until further testing is done. CSPI Ratings on Food Additives

Recommended Intakes:

A good recommendation for the total amount of carbohydrate in the diet is about 55-70% of total kcal. This assumes approx 10-15% is protein and 15-25% is fat. The AMDR (Acceptable Macronutrient Distribution Range) allows a broader range of carbohydrates at 45-65%. Athletes, particularly endurance athletes, will be at the higher end of this range 60-70%.

Assuming the average person has about 2000 kcal/day, this would mean 1100-1400 kcal should be from carbohydrates. At 4 kcal/gm this is about 275-350 gms. It is recommended that not more than 25% of total kcal should be from simple sugars. This could be from sugars naturally occurring in foods, like fruits or from added sugars. Less than 10% should be from added sugars. This translates to .1 * 2000 kcal/day = 200 kcal/day or 200 kcal / 4 kcal/gm = 50 gm. Table sugar is about 4.2 gm/tsp so this means not more than 12 tsp of sugar, syrup, honey etc. per day. This may seem like a lot but added sugars are prevalent in so many processed foods and the daily intake can really add up. Here are a few examples;

 Instant Oatmeal packet3 tsp
 Honey Nut Cheerios, ¾ cup   2 tsp
 Coke, 12 oz. can 10 tsp
 Coke, 20 oz. bottle 16 tsp
 Yoplait yogurt, 6 oz 6 tsp
 Granola bar, 1 bar 3 tsp
 Nutri-Grain bar 3 tsp
 M&M's, ¼ cup 7 tsp
 Ketchup, 1 Tbsp 1 tsp
 Pop-Tart, 1 4 tsp
 Spaghetti sauce, ½ cup 2 tsp
 Ice cream, ½ cup 3 tsp

Deficiency symptoms:
Short term effects can be felt in as little as the time between meals, you may feel tired, irritable and shaky. If over time, the carbohydrate intake is insufficient to meet energy needs, the body will try to derive its energy from fats or proteins. Proteins can be broken down into glucose in the process of glucogenesis. Protein when used for fuel, does not burn as cleanly as carbs or fats and puts and added strain on the liver and kidneys.

The brain primarily requires glucose but if necessary, fats can be broken down in the process of ketosis to create ketones, an alternative fuel. This is different than normal fat metabolism. This can be dangerous since excessive ketones in the blood cause it to become acidic leading to ketoacidosis. Ketoacidosis can lead to coma and death in cases of untreated diabetes.

Excess symptoms:
Too many calories from carbohydrates (or any source) can lead to obesity and all the problems associated with it. Too much of the wrong kind of carbohydrates, refined flour/rice, added sugars etc. can lead to tooth decay, vitamin imbalance, spiking of blood sugar levels, rise of LDL and with lack of fiber, poor intestinal health.

Summary:

Based on the above information, here are some general guidelines;

  • Obtain most your energy requirements from healthy carbs; fruits, vegetables, starchy roots, whole grains and legumes. These are nutrient rich with vitamins, minerals, fiber and phytonutrients.
  • 55-70% of calories should come from carbs. Carbs are not evil as some diet books may suggest. They provide essential energy for the body and are the primary fuel for the brain, red blood cells and nervous system. However, the type of carbs used on a regular basis can have a significant effect on one's overall health. Choose whole food carbs and cut back on or avoid altogether highly refined, processed and "empty calorie" carbs.
  • The staple of most meals should be a low glycemic index carb. These include whole grains, cereals, pastas, breads, tortillas, sweet potato, corn, brown rice etc. White potatoes have a high GI and are fine on an occasional basis but are not the best choice for a daily staple.
  • Limit "added sugars" to 12 tsp per day. This does not mean the sugars naturally found in fruits, vegetables and dairy but the sugar added in drinks and processed foods. Do not use fructose or Agave Nectar as substitutes for sugar.
  • Buy fresh fruits and vegetables when available or frozen when they are not. Be careful with canned fruits and vegetables; they are not as fresh and can have added sugar and sodium. Choose the "no sugar added" or "Light syrup" fruit cups/cans. Pass on the heavy syrup. Always rinse canned legumes (black, kidney, garbanzo, etc.) before using. This will remove some of the sodium and gas making properties.
  • Leave skins on apples, pears and potatoes. Much of the fiber and nutrients are in the skin.
  • Select whole grain breads and cereals with < 10% added sugar. Breads which are dense, chewy and grainy are best. Experiment with new whole grains; barley, bulgur, millet, quinoa, spelt, wild rice.
  • Brown rice is a healthier choice over white rice. It has fiber and B vitamins. Brown, basmati and long grain white rice are preferred over short grain white rice. They have a significantly lower GI, 55-58 compared to 72.
  • Pasta made from whole grain, multi-grain (sometimes includes legume flours) or blended mixes is better than white.
  • Legumes make an excellent addition to one's daily diet. In addition to protein, they provide needed fiber.
  • Avoid soft drinks and sweetened fruit/fruit flavored drinks. They are one of the major sources of added sugars in the American diet. Beyond the water and sugar, they have little or no nutritional value; they are the definition of "empty calories". Choose water, carbonated/flavored mineral water, unsweetened fruit juice, carbonated fruit juice (like Crystal Geyser) or natural juices (like Naked), green/herbal tea etc. instead. If caffeine is the need, tea or coffee in moderation are better choices. You can control the amount of sugar added.
  • Sport drinks are designed for intense athletic activity where a lot of water is being lost through sweat. In that role, they can be useful to provide carbs and replenish fluids and electrolytes. However, because of the added sugars, they are not a good choice for a regular drink when not being intensely active.
  • Choose fruit juices that are 100% juice without added sugar. Drink juices in moderation. This means about one glass a day.
  • Cut back on or avoid altogether white flour products; pastries, doughnuts, cakes, pies, commercial cookies and muffins. We all indulge a little on special occasions, but these should not be regular items in the daily diet. Bake more of your own foods at home where you can control the ingredients. Make healthy substitutions; some whole wheat flour for white, healthy oils for butter and reduce the sugar.
  • Buy plain/vanilla yogurt or plain breakfast cereals and then add your own fresh fruit rather than relying on the fruits/syrups added in yogurts and the dried/sugared fruits added in cereals. Dried fruits in cereals are usually as hard as rocks. Fresh raisins, chopped dates, dried cranberries, apricots etc. are always more delicious and satisfying.
  • No scientific evidence supports any link between the intake of sugars and hyperactivity. If parents observe kids going hyper, consider if caffeinated sodas or the excitement of special treats (cake) and a party environment could be factors.
  • Sugars and other carbohydrates do not cause diabetes. The most common factors for the onset of type 2 diabetes are being overweight and inactivity. Other factors such as genetics, illness or simply getting older can also be a trigger. While food choices don't cause diabetes, diet is part of the strategy for managing it; along with physical activity and perhaps medication.
  • When looking for a sweet snack, consider healthy choices; a juicy navel orange, an apple, a hand full of figs, a banana perhaps with a few dates, a bowl of grapes, a mango, some yogurt with fresh blueberries or raspberries thrown in, or a slice of cantaloupe.

Disclaimer:

The contents of this Web site are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Web site.

References:

  1. Thompson, Janice L., Melinda M. Manore and Linda A. Vaughn. "Carbohydrates: Bountiful Sources of Energy and Nutrients" The Science of Nutrition San Francisco, CA : Pearson Benjamin Cummings 2008
  2. Duyff, Roberta L. "Carbs: Simply Complex" American Dietetic Association Complete Food and Nutrition Guide Hoboken, NJ : Wiley 2006
  3. Weil, Andrew. "Carbohydrates Revisited: Staff of Life or Stuff of Sickness?" Eating Well for Optimum Health New York : Quill 2001
  4. Willet, Walter C. "Carbohydrates for Better and Worse" Eat Drink and Be Healthy New York : Free Press 2001
  5. Melina, Vesanto, and Brenda Davis. "Energy Plus...goodness from grains " Becoming Vegetarian Summertown, TN : BPC 2003
  6. Craig, Winston J. "Facts About Fiber", "Satisfying Your Sweet Tooth" Nutrition and Wellness Berrien Springs, MI : Golden Harvest Books 2008
  7. "Sugar Overload, Curbing America's Sweet Tooth" Nutrition Action Healthletter, Jan/Feb 2010 issue, Washington, DC: CSPI 2010
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