By Monique Richard MS, RDN, LDN
November is American Diabetes Month and we could discuss the staggering statistics on how many people have diabetes or pre-diabetes (having risk factors to develop full blown diabetes), but those numbers may not be very meaningful to you. What is meaningful is your family members, friends and loved ones, or your own experience dealing with the complexity of this disease on a daily basis and what it means in terms of everyday quality of life.
You may have heard of or seen lists on the Glycemic Index (GI) or Glycemic Load and wondered if you should follow that or even questioned what it means. As a registered dietitian nutritionist (RDN), I can provide examples of foods that are low on the Glycemic Index, meaning they will be less likely to promote a rapid rise or spike in blood glucose and how that relates to blood glucose (sugar) control, but since nutrition intervention is such an individualized plan, it’s important to understand the basics first.
We simply do not eat foods singly in most instances, so although the Glycemic Index and Glycemic Load can be tools in our toolbox, they do not paint the entire picture of nutritional quality, meal composition, choices, and individual needs. We also must keep in mind that these measures are very scientifically derived, and individuals, even though we all have the same components, are very unique due to many, many confounding variables. As an integrative RDN, I take into consideration bio-individuality and recognize that one client may be very sensitive to the glycemic load of pizza, while another may be more sensitive to popcorn than pizza, and I adjust dietary recommendations accordingly.
However, understanding more about carbohydrates, what foods have carbohydrates, and how carbs can impact blood glucose control is important. Regardless of having diabetes or not, everyone should learn about quality carbohydrate choices and how that can influence their health.
What are carbohydrates?
Carbohydrates are broken down by the body through a series of biochemical steps into glucose to be taken up by the cell for energy. Therefore, carbohydrates directly affect blood glucose (aka blood sugar) control more than the other two macronutrients, fat and protein. Fat and protein do affect blood glucose but in an indirect way associated with metabolic breakdown and digestion.
There are three types of carbohydrates including starches (“complex” carbohydrates—due to the complex structure of the plant; think potatoes, grains, etc.), sugar (both added sugar and natural sugars like lactose in dairy or fructose in fruit) and fiber, which is typically indigestible but very beneficial to gastrointestinal health, blood glucose control, and act as prebiotics, or food for the good bacteria in your gut.
Carbohydrate-rich foods include: fruit, starchy vegetables, grains/cereals/bread, dairy, beans/
lentils/legumes, and desserts/proprocessed snack foods. Guess what else? Non-starchy vegetables like green beans are carbohydrates as well, but have less grams per serving and are nutritious powerhouses filled with fiber and goodness. Should any of these food groups be completely eliminated, like bread? Not necessarily. There are some choices that pack more nutritional punch in a serving than others (a small apple vs. a slice of apple pie or whole rye bread vs. bread made with enriched white flour), and preparation and additives (sour cream and bacon on the potato) can alter the benefits. Avoiding carbohydrates altogether is not in anyone’s best interest, unless they have a rare inborn-error of metabolism related to carbohydrate metabolism.
Types of Sugars
Let’s take a closer look sugars since that is an area of opportunity for many people to make some pretty easy adjustments.
• Glucose: most abundant in nature, usually with another sugar or two: [like fructose-making it a di-
(two)-saccharide (sugar molecule)]. Mostly known as “blood sugar” which gives us energy. The brain needs a constant and predictable supply of glucose to thrive.
• Dextrose: Glucose produced after the breakdown of cornstarch with water.
• Fructose (also known as levulose and fruit sugar): Found naturally in fruit, honey, and even some vegetables.
• High Fructose Corn Syrup (HFCS): a manufactured version of sugar using an enzyme to change the glucose in cornstarch to fructose, hence the name high fructose corn syrup, meaning it is higher in the sugar fructose than glucose (slightly). HFCS has the sweetest taste and is inexpensive. Side Note: The makers of HFCS, The Corn Refiners Association, are petitioning the FDA for a name change to “corn sugar.” It does not change the fact it is processed from corn and is composed of fructose and glucose.
• Lactose: “milk sugar,” formed by glucose and galactose.
• Galactose: metabolized from the “milk sugar” lactose, during the digestive process.
• Sucrose: “table sugar,” cane, beet, and grape sugar made of glucose and fructose.
• Invert Sugar: unlinked fructose and glucose used in many commercial foods since the crystals are smaller and more delicate (think icings etc.). Honey is an invert sugar.
• Maltose: “malt sugar,” seldom found naturally, two glucose molecules stuck together, found in many food products.
Many, many arguments have been made blaming HFCS for the trending obesity epidemic, but the truth is, it may not be that simple. It is, however, a processed additive, and the long-term effects on human health have yet to be defined. It is categorized as Generally Regarded As Safe (GRAS) by protective agencies such as the Food and Drug Administration (FDA), but the amounts and duration are not clearly defined. Some European countries have banned HFCS due to their doubts about the safety of the product.
All sugars, whether from ‘natural’ sources or chemically manipulated sources, can carry similar health risks, especially when consumed in excess amounts. These health concerns include excess weight, which in turn can cause hypertension, cardiovascular complications, metabolic syndrome, and an increased risk for developing diabetes. When we have an excess amount of sugar to break down in our bodies (metabolize), the by-products of the process can also cause damage to our cells, leading to additional complications.
Those with diabetes are encouraged to avoid added sugars since they immediately elevate blood glucose, requiring more insulin to be produced (or manually given) and can cause damage to blood vessels in the kidneys, capillaries in the eyes, and all systemic organs. Avoidance of all carbohydrates is neither necessary nor beneficial either. Low-carb diets have been on the fad-diet bandwagon for a long time, but depending on how low you go, they can be unhealthy, unsustainable, and even dangerous. Our bodies need glucose for fuel, especially the brain, so getting enough from the right sources is a critical part of a balanced diet.
Sugar has been used for thousands of years in food preservation, as a flavor enhancer, as an additive to help with the cooking of food, and as decoration. It has many useful and desirable benefits in food but can also have some serious consequences when consumed in excess and when it goes uncontrolled within the body. I won’t sugar coat it: less, is definitely more in this case, but the right type (quality) and amount (quantity) of carbohydrates is important for overall blood glucose management.
Come see me for more specific information regarding this mysterious area of macronutrients and how we can explore dietary changes related to carbohydrates and your needs.
State of Franklin Healthcare Associates