Carbohydrates are all around us – they are present in common foods like fruit, vegetables, dairy, legumes, whole grains, and sweeteners, as well as processed foods and ingredients like flour-based products and sugar. If one is not careful, it's easy to fall into a Standard American Diet (SAD) eating pattern that includes high carbohydrate intake and chock full of both: processed foods and added sugars. This style of eating has consistently been shown to increase risk of lifestyle-related diseases like diabetes, heart disease, fatty liver disease, cancer and obesity.
Carbohydrates role in health & disease
Carbohydrates are a primary fuel source for the body, especially for high intensity activity. Metabolic dysfunction and weight gain arise when high carbohydrate intake is paired with a sedentary lifestyle, especially as we age. While some individuals thrive with very little carbohydrate in their diets, such as under 60g a day, others do best with a more moderate amount.
Whether you are looking to reduce carbohydrates and/or optimize your health and disease risk by choosing healthier carbohydrates, there are some important factors to consider – because not all carbs are created equal.
Simple vs. complex
Simply put, simple carbs are digested more quickly. Complex carbs are longer chains of starches and take longer for the body to digest and extract energy. Except whole fruits, research shows simple carbs such as sucrose (sugar) and fructose have a greater potential of leading to non-alcoholic fatty liver disease, diabetes and metabolic dysfunction through chronic inflammation, accumulation of fat in the liver, repeated blood sugar spikes and insulin-demanding strain on the pancreas.
Examples of simple carbs: fruit juice, sugar, soda, caloric sweeteners, white flour, milk, fruit.
Examples of complex carbs: legumes, whole grains, and vegetables.
Processing and ingredient lists
An easy rule of thumb to remember is the longer the ingredient list, the more processed and faster digested the product will be. This is more likely to spike blood sugar, leading to a blood sugar crash later, and the “I need a nap” feeling. Look for products with less than five ingredients, and whole foods ingredients, or ingredients you would have in your own home.
Added sugars and fiber
Truth is the majority of people eat too much sugar and too little fiber. Public health agencies recommend a maximum daily added sugar intake (24g for women, 36g for men, or less than 10% of calories) and a minimum daily fiber intake (14g per 1000 calories) to lower disease risk. Unfortunately, the average American eats twice the sugar and half the fiber.
Avoiding added sugar, especially in liquid form, and eating fiber-rich foods such as vegetables, some fruits, beans and nuts is a great step in the right direction.
Check serving size and total carb grams
Just because a carb has little to no added sugar and is minimally processed doesn’t mean we can eat unlimited amounts of it. Check the serving size of what you are eating (on the package or in a tracking app) to know the total grams of carbohydrates you are eating or will eat in the future.
Carb counting works well for some to promote weight loss and improve blood sugars, but may not be as effective for others. Tracking your total carbs at meals and snacks with corresponding blood sugar levels via blood sugar meter is a combined tool that can help you determine if this approach is helpful for you – whether you have diabetes, prediabetes, or not. One serving of carbs is around 15 grams (or 12 grams for milk).
Glycemic index and load
The glycemic index (GI) ranks foods from 1 to 100 based on how they impact blood sugars, with 1 being the lowest impact and 100 (pure glucose) being the highest.
The glycemic load (GL) factors in the glycemic index plus the actual grams of carbohydrate in a typical serving size to provide a more accurate blood sugar response prediction based on how much an individual is actually eating. The glycemic load’s scale ranges from 1-20. Choosing low GL carbs (when you do eat carbs) will help you avoid and minimize processed carbs. Reducing intake of processed foods is associated with better management of weight, blood sugar, hunger, mood and disease risk.
Use this equation to calculate the GL of food you are eating and aim for both low GI and low GL foods:
GL = (GI / 100) x grams of carbs in a serving
All carbs are not created equal. Reduce processed carbs containing added sugars, and choose more whole food, higher fiber carb choices. Being more intentional about the types of carbohydrates you are including in your diet may help you reach your personal health goals, possibly without having to reduce your overall carb intake.