Dear Carbohydrate,
I love you. I do. I’ve always loved you. From the moment I first set eyes on your chemical structure – C6H12O6 – I knew you were the one for me.
Remember all the great threesomes we had over the years? Just you, me, and some pretty darn grueling exercise.
How about the time I ate you before, during, and after climbing Mount Whitney, a 35 kilometre (22 mile) day hike?
Or on our 80 kilometre (50 mile) weekend bike rides around San Diego?
And who could forget that time surfing for five hours straight in Jeffreys Bay, South Africa?
I couldn’t have done all this without you, Carbohydrate. You were there for me and now I’m here for you when you need me most.
Macronutrient muddled media
I know it’s been a while since I’ve written you a heart-felt love letter, but I just want you to know that I’m here for you despite all the negative publicity you’ve been receiving in recent years.
I’m sure all these venomous attacks must be hard for you. They’re plastered all over the tabloids.
Donald Trump even tweeted that you’re nothing more than a “sweet poison” with no redeeming value whatsoever (#FAKE NEWS)! But why?
Maybe your old arch nemesis Protein is partly to blame for your bad reputation. I hear he’s been swanning around town like a rock star, hitting all the cool clubs, going to the best parties, towing an entourage everywhere he goes, picking up chicks, and promising to make them look like swimsuit models.
Racism is out, “carbism” is in
It just seems so unfair. Why the heck is everyone so “carbist” these days?
They discriminate against you without really understanding all the nutritional wholesomeness you bring to the table.
Maybe it’s all the popular “alternative fact” carb-bashing books written by laypeople like lawyers, journalists, and TV chefs with zero science training.
They take a little bit of information out of context and then blow it out of proportion on social media (just to make a buck and feed their egos).
They might be selling books like gluten-free hotcakes, but they don’t know you like I do.
They don’t know that you’re the preferred high octane fuel for the brain and rest of the nervous system – far more efficient and healthier than those clunky ketones spun off from high-fat, high-protein diets.
They don’t know that you come in all kinds of delicious shapes, sizes, colours, and flavours like brown rice, quinoa (I know, quinoa….so trendy, right?), wholegrain breads and, yes, your buxomly beautiful fruits and veggies!
Oh, and you’ll never believe this! The other day, I overheard some girl down at the beach tell her friend “I don’t eat any carbs at all. I just eat lots of vegetables and the rest is protein and fat.”
Yep, I know! WTF?! (and I don’t mean the World Taekwondo Federation either). She’s so brainwashed that she’s eating carbs and doesn’t even know it!
I have to confide in you, all this confusing carb controversy is turning well-intentioned eaters into carbists.
I really think they’re throwing out the proverbial carb baby with the gluten- and lactose-free bathwater.
What the heck is a carb anyway?
I think the problem is that the terms “carbohydrate” and “sugar” are used interchangeably and the general public is now confused about the difference between what constitutes good and bad carbohydrates.
High quality, nutrient-dense complex carbs, like those mentioned above, are low in calories and packed with valuable fiber, vitamins, minerals, and lots of health-promoting phytochemicals (i.e., beta-carotene, lycopene, etc).
It’s pretty hard to overeat when you’re taking in the good stuff.
In fact, this one time, at band camp, I took a bet that I could overdose on broccoli. I bought three kilograms of it, but failed miserably when I was only able to get through one stalk.
Further evidence that good carbs are the kind that fill you up without all the calories!
On the other hand, simple carbs, like the monosaccharides glucose, fructose (aka fruit sugar), and galactose are more refined, broken down versions of complex carbs and tend to be sweeter (often found in colas and junk food).
Fructose and the dark side of food fame
You know, now that I think about it, your sweet little brother Fructose might have thrown you under the bus.
Fructose was pretty cool when he only hung out in fruit, but his personality has really changed since those dodgy food company executives got a hold of him.
They told him they were gonna make him famous. You know, give him a star on Hollywood Boulevard ‘n all that sh*t – wish granted but he’s probably more infamous than anything.
They took Fructose into the lab where their food chemists pulled him apart and perverted him into dozens of different incarnations with benignly pleasant names – like nectars and syrups – just so they could hide him in processed foods without anyone knowing any better.
And what about your inbred cousin Sucrose formed from an incestuous chemical bond between Fructose and Glucose?
These days, Sucrose goes by his better-known gangsta’ rapper name Table Sugar, well-known for his greatest hits like soda, doughnuts, and candy bars.
FrankenSugar
The main problem is that your refined little brothers and inbred cousin have been chemically castrated and stripped of any real nutritional value – no fiber, no vitamins, minerals, or phytochemicals – turning them into slutty empty calories. People just can’t seem to get enough of them.
And because they’re already broken down to their simplest forms, they pass through the digestive tract very quickly, leaving their loyal disciples feeling unsatisfied and therefore likely to eat more and more.
Cha-ching! Every day is Christmas bonus time for multinational food company execs!
CSI Carbohydrate
I can’t tell you how many times I hear people say “Oh myyy, carbs are fattening.”
Yeah, ok, it’s true that people are eating massive quantities of refined carbohydrate (sugar) and they are getting fatter and fatter.
But while sugar is at the scene of the crime, does that make it wholly culpable or just an innocent bystander who witnessed the crime?
The answer to this is, probably a little of both.
Firstly, from the excess calories = obesity argument, it is far easier to eat too many calories when they’re in the form of two-litre bottles of soda, doughnuts, and ice cream than brown rice and veggies.
I don’t think the bog-standard calories in vs. calories out mantra accounts for everything, but it still accounts for a significant part of the obesity epidemic.
And let’s not forget, we’re unfit and out of shape.
Physical activity levels are lower than ever since the technological revolution left us legless in the office tethered to a computer (or tablet) playing Candy Crush – I know, good carb pun, eh?
Lucky we don’t live on the African savannah ’cause even a hyena with two broken legs could easily run us down for dinner!
Public health experts and government officials keep looking at the stats, scratching their balls, and wondering why our waistlines continue to expand.
Well don’t piss on my head and tell me it’s raining. Isn’t it obvious we’re not burning off all the junk calories we’re eating? Plus we’re extremely deconditioned and metabolically unfit.
Second, aside from the “eat too much, move too little” argument, we also know that fructose is metabolised differently in the body than other sugars and may contribute to fat formation in ways not explained by the calories in vs. calories out gospel.
Plus refined sugar can wreak havoc on our blood chemistry in ways that leave us susceptible to metabolic diseases like type 2 diabetes and hyperlipidemia (high blood fats).
Reduce sugar intake, not common sense
So my dear Carbohydrate, I fully support people limiting their refined sugar intake – especially since Fructose and Sucrose “think they all that and a bag o’ chips,” what with their big fat egos.
Unfortunately, the FEAR SUGAR campaign has backfired in ways that have left people scared shitless of sugar with no real consideration for the quality or quantity of carbohydrate they’re eating.
Sugar: The devil is in the dose
No matter which side of the carb fence you’re on, everyone still agrees the devil is in the dose (though the sugar-bashing brigade frequently tends to downplay and gloss over this fact because it goes against biases).
If people make consistently healthy food choices but have a small cup of ice cream once in a while at a birthday party, you know what will happen to them?
Absolutely nothing. True story!
If they eat three big containers of ice cream each day washed down with two-litres of cola, then you can bet they’re in for a world of hurt, sooner than later.
Did you hear that people are now cutting fruit out of their diets? What is this world coming to when people deny themselves nature’s candy?
Yes, fruit contains fructose, but does this mean it’ll have the same effect in the body as the FrankenFructose found in our children’s cereals? No.
Natural fructose found in fruit comes packed with fiber, phytochemicals, vitamins, and minerals, not to mention it tends to be much lower in calories than energy-dense, low-nutrient refined junk food.
Therefore, the digestive profile of fruit is different than a glass of refined fruit juice.
Related article: Is Fruit Sugar Bad For You?
Carbohysteria and food anxiety
All this carbohysteria has created a climate of food anxiety.
People are terrified of you, Carbohydrate. They’re afraid to sit down for a meal at a restaurant unless they have a full accounting of each and every carb molecule.
Everywhere I turn, it’s low-carb this, gluten-free that, or “Oh, I’m lactose intolerant“. We’re turning into a bunch of food sissies, I tell ya. Forget the sugar, a scoop of concrete in their coffees oughta harden ‘em the <bleep> up!
Hug a carbohydrate today
If Martin Luther King Jr. was around today and saw such hatred towards his carbohydrate brethren, his I Have a Dream speech would have sounded something this:
“I have a dream that one day, this world, with all its vicious “carbists,” with their lips dripping with the words of interposition and nullification, will release the people from the tyranny of this carbohysteria, so they’ll be able to join hands with white sourdough and dark pumpernickel bread without fear of prejudice!
Well my beloved Carbohydrate, I just want you to know that, no matter how this turns out, I love you. And when the smoke clears and the flour dust settles, I’ll still be right here by your side.
Phillipa Gee
Tuesday 4th of September 2018
Hi Bill, thanks for your articles; great to get an informed point of view! I have hypoglycaemia and was wondering what carbs you would recommend? I eat oats, whole meal/egg pasta, whole meal breads, use lower GI flours in cooking etc. I now limit fruit to berries and the occasional apple/orange/pineapple as even half an orange in the evening can have me waking at 6am hungry! Over the years before I found out what I had, I carried crackers with me always as I couldn’t predict when I would have a debilitating episode; shaking, lightheaded, vision effected. I agree that carbs have been demonised but lowering them (refined) for me and cutting out caffeine, has been a life changer :-)
Dr Bill Sukala
Tuesday 4th of September 2018
Hi Phillipa, I think you've answered your own question. As I pointed out in my article, many people paint all carbohydrates with the same brush and equate refined sugar (fizzy drinks and candies) with the good stuff like oats and wholemeal products. Good quality carbohydrates like the ones you're eating will leave your stomach a lot slower and give you an ongoing and stable blood sugar level as opposed to refined junk which will be digested quickly and leave you feeling hungrier sooner. Remember that fruit has lots of nutrient density including fibre, so they can fit into a healthy and varied diet. If you only eat a half an orange at night and no other food, you'll be hungry in the morning not because you at an orange but because you had such little food. If you eat an orange with other foods, then it will be digested differently than if eaten alone. For specifics, I would suggest working with a qualified dietitian who can help you tailor your approach. Check out Dietitians NZ here: https://dietitians.org.nz/find-a-dietitian/. Kind regards
Andrew McIntyre
Friday 10th of February 2017
I don't think I am blaming dieticians, but blaming the guidelines which did lead to a huge increase in the % of carbohydrate in our diet, particularly added sugar and thats something that is hard to deny. I have seen information from the nineties even saying that sugar is harmless and won't make you fat. The food companies complied with the recommendations and produced low fat food and its hard to blame them as there was no outcry from the guideline people. People, including myself just went with the recommendations and I don't think the people responsible for the guidelines can revise history to suggest they never intended this to happen. Dieticians have been taught this stuff as well, and cannot be blamed as such.
The rubbish food you mention is usually extremely high in sugar, including fructose and there is good evidence of fructose causing fatty liver, which has become epidemic and precedes diabetes. I don't think clinicians would be as obsessive as to not call something Metabolic syndrome just because it did not precisely fit some criteria. Some diabetics do not get obese, that is well known, but they still get all the other features.
The recent evidence does strongly support Low carbohydrate diets as better for weight loss and better for diabetes and fatty liver. To label it is as a FAD diet is simply unscientific as it has good evidence of superior effectiveness in people with insulin resistance and in reality the Dietary Guidelines are the modern FAD diet, introduced without solid evidence and they have failed to acquire positive evidence. The eyeball test and the data says they are a failure with a %600 increase in diabetes and huge rates of obesity. Trying something like a Low Carb diet, which has scientific evidence of superior results for obesity is not something that should be opposed by dieticians. I do not understand why it generates such opposition.
Dr Bill Sukala
Saturday 11th of February 2017
Hi Andrew, I think we could go back and forth all day and I'm sure neither of us has the time nor patience to do so. But I'm sure we can agree that: 1) Yes, people do need to eat less refined rubbish. There is no debate over that. 2) People need to increase both exercise time and incidental movement (inactivity physiology research supports this). 3) Food companies do have an ethical duty to provide healthy foods and sadly many of them fail, including many companies jumping on the "healthy" bandwagon selling sugar-laden "organic" or "paleo" foods. Here's another article I wrote along these lines on this topic: https://drbillsukala.com/fibbing-food-labels-fattening/ 4) Regarding low carb, I have supported its use where warranted, but have not seen any compelling evidence that this is the end-all-be-all for everyone on Earth. In the many years I have followed this debate, I have seen a lot of cherry picking data to serve agendas (on both sides, unfortunately). If you only look at pro-LCHF information sources, they do not provide a clear and balanced view on both sides of the debate. I see at lot of emotional talk of conspiracies etc. While there are many people who would say low carb is THE gospel and only solution, I can also show papers that will show short-term weight loss for lower carb/higher protein is slightly greater at 6 months, but by 12 months, there is a convergence of results where a higher carbohydrate diet resulted in the same amount of weight loss as a lower carbohydrate diet. The biggest factor in weight loss and long-term weight loss maintenance is actually adherence. If you have a person who was eating rubbish food, not exercising, and doing no incidental movement and then put them on any diet that is nutrient-dense and moderate in energy intake they will lose weight (and keep it off if it's sustained).
Bottom line from my perspective, whilst everyone is splitting hairs and fighting a pointless emotional battle over whose diet is best, I step back and say get the right eating pattern (I hate the word "diet") for the job. There is no one size fits all approach that is right for everyone. Lower carbohydrate diets DO have merit and can be therapeutically useful in certain clinical situations. But to play devil's advocate against myself, even if everyone at a little less carbohydrate, so what? We have gluconeogenesis to fix that. But I think it is useful to point out that by making protein and fat intake too high at the expense of carbohydrate, this does reduce the intake of important fibres and phytonutrients which have valuable health properties for the body independent of weight loss (i.e., think gut microbiome and its role in health).
As I said, dietitians do not arbitrarily oppose the use of lower carbohydrate regimens, but they are a useful tool to be applied when relevant.
In response to your final line regarding not understanding why the low-carb diets generate such opposition, in my view, it's not necessarily the diet alone that is garnering flack, but also the militant nature of it's promoters. In my 27 years working in the health industry, I've watched the evolution of nutrition the science and its slow perversion into a religion. The debate (if we even want to call it that) has become so emotional for some promoters (and their followers) that there will not be any meeting of the minds. Moreover, I see many people just parroting back what their guru wrote in a book.
Regarding it's classification as a fad, I think it's important to note that a lower carb regimen is not a single diet. It has been hijacked by many self-styled nutritionist who put their own spin on it and pervert it into a cult. THAT is where it's gone wrong. Many "gurus" will push extreme regimens and make up all kinds of bat-shite crazy theories that have no merit, cite a bunch of "case studies" of their satisfied users (who would have lost weight anyway by simply giving up Maccas and KFC every day).
But as I said up front, it's an emotional debate that, in this post-truth Trump era of "alternative facts," is really just a waste of time unless people are open to a civil debate and are willing to acknowledge that there are pros and cons for every eating pattern and there is evidence which can be cherry picked in either direction. I believe it's best to look at the preponderance of evidence that is neither 100% in favour of either side of the fence and say, "hey, these are our tools. Let's apply them when the situation merits this diet or that diet." And aside from all that, as I said above, it's also about adherence. High carb diets are shit for adherence, some people calling them cardboard diets. People eating lots of protein and fat sometimes get constipated. Point is, if someone can't stick with a diet, no matter what it is, then perhaps it's time to try something else.
Balance in views and judicious application of evidence where warranted (and no to everyone and their agendas, on either side of the table).
Andrew McIntyre
Friday 10th of February 2017
Non processed carbs are fine if you do not have insulin resistance from years of xs Sugar intake, which unfortunately much of the adult population of the west been exposed to by following guidelines. Once you have insulin resistance, avoiding majority of carbs does appear to help reverse metabolic syndrome. Populations that thrived on high amounts of non processed carbs usually had minimal fructose exposure. The advice needs to be tailored to age and metabolic damage that has happened in the past. Your advice is perfect for teenagers that were not brought up on soft drink, fruit juice and low fat products. These days even teenagers can have metabolic syndrome and in that state they should minimise all carbs. Advice needs to be adjusted based on metabolic status.
Dr Bill Sukala
Friday 10th of February 2017
Hi Andrew, Thanks for your comment. 1) On the first point, I would politely disagree that the excess sugar intake is a direct result of following dietary guidelines. I trained as a dietitian nearly 25 years ago (before moving into exercise physiology) and even then, the recommendations encouraged people to eat real food, not too little and not too much, not supplements, not meal replacements (i.e., brown rice, quinoa, lots of fruits and veggies, lean cuts of meat, fish, poultry, and good quality fats). When we talk about sugar intake in particular, the argument is not a simple dichotomous line down the middle of good guys vs bad guys. I have no kindling love affair with any government health agency or any particular dietitian's groups, but I will call bullshit where I see it. And the argument that "dietitians are making people fat" is unfair and unfounded. During my research for my PhD in diabetes, I dug really deep into the scientific literature on this topic. The truth is, there are many factors and meta-factors that are attributed to excess refined food intake (not just sugar, but also excess fat and the corresponding calories). You must account for socioeconomic demographics like level of education, income, geographic location, quality food availability/accessibility, information sources on nutrition, not to mention institutionalised racism in impoverished minority sections of the country (Australia, NZ, US, Canada, UK, etc). All of these things are real and they can and do influence what people put into their mouths. So while superficial social media conversations might sound intuitively logical on the surface, the actual causative factors of why people eat too much refined rubbish food is more intricate.
2) I would agree that for individuals with insulin resistance, if they simply cut out all of the rubbish food they were eating that caused their obesity (and resultant insulin resistance/diabetes), then they would fare much better (that much I have seen first hand in clinical practice and it's supported by evidence). There is evidence that for some patients, they can benefit from having fewer carbohydrates and more protein, but again this is something that must be taken on a case by case basis by the endocrinologist/clinical dietitian.
2a) On a side note, regarding metabolic syndrome, I would encourage you to check out Khan's work on this topic: http://care.diabetesjournals.org/content/28/9/2289 This idea of metabolic syndrome as a clinical entity is a bit misguided. The criteria that the patient must tick 3 of 5 boxes can be misleading. What if someone has high blood pressure and elevated plasma glucose, but nothing else. They tick 2 out of 5 boxes. That means they don't have "metabolic syndrome" per se, and they might leave the doc's office thinking, "whew, dodged a bullet there!" But in reality, both elevated BP and BG are still clinically meaningful and are cause for alarm. Do we not treat the person? Are they not at increased risk for cardiovascular disease? So we do have to use clinical judgment when evaluating patients on an individual basis instead of using a carpet bombing approach to classifying people with/without metabolic syndrome. But that's a separate story (don't get me started!).
3) Fructose. It's true that fructose can have adverse effects on the liver, but those who would demonise fructose as a molecule and who buy into Lustig's alarmist self-promotion often neglect the fact that for someone who is eating very healthy, if they have the occasional piece of candy against a backdrop of a healthy lifestyle (exercise, healthy eating, etc), it is not realistic to think that would cause any lasting damage. The devil is in the dose. Do I think society as a whole needs to reduce fructose intake? Of course, but not for the reasons that the alarmist camp would have everyone believe. It's because eating too much refined junk in general crowds out good quality nutrient-dense foods and provides a LARGE number of excess calories. Partner this up with excessively high levels of INACTIVITY and you have a perfect metabolic storm. Again, as I mentioned in point 1 above, the great sugar debate is, in actual fact, far more complex than a naive fructose = fat/unhealthy = insulin resistance. Here are two other articles on my site which discuss this topic: https://drbillsukala.com/is-sugar-bad-for-you/ and https://drbillsukala.com/is-fruit-sugar-bad/
4) One thing we can agree on is that, yes, advice should be evidence-based and tailored to the individual.
Joanne Murphy
Wednesday 8th of July 2015
Where are the carbohydrates in the Australian bush?
The carbohydrates are everywhere, in the forms of lerp, honeydew/ nectar, & manna. Australian native plants are carbohydrate factories, because of our combined high sunshine levels & poor soils. The high light levels encourage rapid photosynthesis. However, the plants can't convert all the sugars they produce into physical structures (wood, seeds, leaves), because there are insufficient essential minerals in the old soils. The plants have to get rid of the excess carbs somehow, so they "sweat it out" in the form of nectar/ honeydew, or in some cases manna. They are also assisted by psyllid larvae which suck carbohydrates from the plants, & themselves excrete it to form lerp.
I get this information from an excellent book called Where Song Began: Australia's Birds & How They Changed the World by Tim Low (Penguin Group (Australia), 2014). I was most surprised to learn that Australian native peoples traditionally ate diets very high in refined carbohydrates. I had assumed the opposite was the case, & was the reason for the high levels of diabetes found in Indigenous Australian populations today.
Also, Indigenous Australians in southern regions obtained carbs from eating the roots of Microseris lanceolata (also known as murnong & native daisy). However, obviously, gathering this destroys the plant.
Hope this information is useful & interesting to your readers Bill!
Jon
Sunday 5th of April 2015
Thanks again, Bill. Yes, I know about Dr O'Day's work. I find it fascinating that her work hasn't become a cornerstone for future research. From memory she hinted at a potential remission of diabetes based on a traditional diet. Also my memory tells me that the diet was Ketogenic and next to no carbohydrates (5%). I'm trying to equate that conclusion with the recommended dietary guidelines. That was where I was hoping for advice. Similarly was the work of Steffanson in the 1930s living with the Inuits. And then there is the example of my wife's ancestors - the Sami (aka Lapplanders) - colloquially referred to as the Inuits of Europe as they reside within the Arctice Cirlce of Scandanavia. Both the Sami and the Inuit have diets almost void of grains and carbohydrates. I don't understand how they are able to function and I was left stumped when asked to explain in the context of NHMRC recommendations. Please help.
Dr Bill Sukala
Sunday 5th of April 2015
Thanks Jon. All very interesting questions. Unfortunately, I don't have time to dig into researching your thesis topic but would be interested to read your report and recommendations when finished. I'd suggest contacting full-time academics who are working in the area and get their take on these questions. Kind regards