Saturday, April 25, 2009

Are Carbs Really Necessary?

I wrote about the The Diabetes Diet Wars and the continuing controversy over low-fat versus low-carbohydrate late last year. Although I do not consider myself to be following a low carbohydrate way of eating I certainly eat less carbs than I did pre-diagnosis and a lot less than the average type 2 diabetic in a Western country.

I spend the first couple of hours each day reading and posting on several diabetes forums. Daily I see newly diagnosed type 2s reporting the advice they have received from dieticians, diabetes educators or doctors. Far too often that advice is to eat to a formula. The formula is usually 45 to 60 grams of carbohydrate at each of the three main daily meals and 15 grams for snacks. That gives 180 to 225 grams of carbohydrate daily as a minimum level. I have discussed the problems inherent in that advice in several previous posts. However, when I, or others, suggest to new people that they could benefit from eating less carbs we find they have been told horror stories of the dangers of inadequate carbohydrate input.

The most common warning is the need to eat a minimum of 130 grams of carbohydrate per day or the brain will lack sufficient energy to function, but there are others such as the dangers of fatigue from lack of energy or just the generalised warning "but your body NEEDS carbs!"

This is just one of many examples: What Should I Eat? New ADA Guidelines Can Help
"ADA does not recommend a specific mix of carbohydrates, fats, and protein. Rather, it refers people to the guidelines of the Institute of Medicine. These recommend that healthy adults get 45 to 65 percent of their calories from carbohydrates, 20 to 35 percent from fats, and 10 to 35 percent from protein.
[snip]
ADA discourages low-carb diets (diets that limit carbohydrate to fewer than 130 grams per day). Carbohydrates are major sources of fiber, vitamins, minerals, and phytochemicals (health-promoting chemicals in plants). People who overly restrict carbohydrates can miss out on these benefits as well as the good flavors of carbohydrate foods".

Despite statements like that, whether or not carbohydrates are essential is still a matter of differing opinions. Far too many health authorities accept that "carbohydrates are a necessary dietary component" is a given fact that needs no support. I can only offer my own opinion, supported by reading, personal experience and discussions with many people on the web and the net.

Carbohydrates are not essential to energy or cognition. Before I go on, I want to stress that although I eat carbohydrates myself my point is that I don't need carbohydrates for good health.

To meet our energy and cognition needs there is nothing that carbohydrates provide that can not be provided by protein or fat via gluconeogenesis, aided by glycogen storage in the liver and muscles. The oft-repeated need for a minimum intake of 130gms of carb per day for brain energy is nonsense. Ask a traditional Inuit. Or read Vilhjalmur Stefansson's story.

The issue is confused by the other factors mentioned in that ADA quote: fibre, vitamins, minerals, and phytochemicals. That is correct, the body needs all those and other micronutrients and flavonoids for good health. Some of those things, especially fibre, are available in most abundance in starchy foods like grains and root vegetables, so people tend to presume that is the best way to get them. Unfortunately it's not necessarily the best and certainly not the only way, it's just a convenient way. Adequate fibre is available in other, non-starchy vegetables; fibre is also readily available as a supplement in natural forms such as psyllium husk. The same logic applies to fruits; flavonoids, vitamins and other micronutrients are available from other vegetable sources with less effect on blood glucose levels. Again, note that I eat fruit, but with care and in small portions. Not because I have to but because I choose to.

There is no doubt that carbs provide quick energy. There is definitely a use for higher carbohydrate input before exercise or heavy activity for an athlete or a worker in a highly active job. But for the rest of us that does not usually apply. I have no energy problems in the mornings despite a simple breakfast that never exceeds 10gms carb; nor do I have energy problems after lunch despite rarely having eaten more than 25 gms total by that time.

Many people lead long, productive and healthy lives on ultra-low-carb diets. It may not be the way you would choose, but you only need to drop in on the Bernstein forum to meet a lot of people who do.

Personally I choose a middle ground. I used my meter to find, over time, how much I needed to reduce carbs at different meals to meet my blood glucose goals. But within those limits I include a significant level of carbs (by my standards) to add variety and flavour. My main focus is blood glucose control; for the micronutrients I consciously try for maximum variety in my vegetable input to try to cover the field.

To me carbohydrates are not essential, they are a luxury food that I treat similar to chocolate or scotch. Nice to eat and beneficial in moderation, but with specific limits which I should not exceed.

But, of course, if you believe the experts my brain will die before dinner from the lack of carbs. I had dire warnings from the dieticians seven years ago that one day I would hear a little voice in the back of my mind...

"I'm afraid. I'm afraid, Alan. Alan, my mind is going. I can feel it. I can feel it. My mind is going. There is no question about it. I can feel it. I can feel it. I can feel it. I'm a... fraid. Alan, please eat more carbs..."

I'm still waiting for that little voice (apologies to HAL 9000)

Cheers, Alan
Everything in Moderation - Except Laughter

4 comments:

Toma Grubb said...

Hi Alan,

I came across your blog at the ADA site. I would like to correspond with you to learn a bit more about you about possible mutual links. I maintain www.Diabetic-Diet-Secrets.com

What I have is quite a bit different than what is on ADA. On the site I write about type 2 diabetes also from the standpoint of a type 2 diabetic. I was very bad when I was diagnosed and necrosis was already present in the emergency room. I have learned how to do what I call an optimized diabetic diet and have had blood glucose and A1C in normal range without medications for 4 years now.

My email is toma (at) diabetic-diet-secrets.com

I hope to hear from you

Trinkwasser said...

Here's a great paper from Eric Westman

http://www.ajcn.org/cgi/content/full/75/5/951-a

Mark Sissions has some good stuff also

http://www.marksdailyapple.com/the-primal-carbohydrate-continuum/

I worked out my carb consumption pragmatically by using my meter, and curiously (or not) mine is within the 50 - 100g range, which gives me more and far more controllable energy and keeps my lipids better than many nondiabetics.

Your actual specific level will depend on how far your pancreas has disintegrated, how well it still communicates with your liver, how much cardio level exercise you do (endurance can be fuelled very well on fats) and of course time of day/level of insulin resistance.

But once you find your sweet spot, wherever it is, you can expect to find many factors improve. I've been doing this for a fair few years now and I'm still tweaking. Currently I'm finding I can walk much further and garden more without so much need for snacking, by adding more of those instantly lethal saturated fats. I always carry some form of fast carbs as a potential hypostop but haven't hit them for months now, the exact opposite of what used to happen on the Heart Healthy diet.

Electronic Medical Records said...

I have often heard that the white carbs and starches like sugar flour white bread is to be avoided...what are your thoughts for the same in case of a diabetic?

Robert Miles said...

Looks like you might want to add something on research finding that your liver can normally convert proteins into glucose more than fast enough to supply those portions of the brain that cannot switch to using fats for energy instead.