The dreaded carbohydrates!  Don’t they make you inflamed, bloated, foggy minded, and fluffy?  For relatively healthy people, the simple answer is NO!!!  For some with medical issues, the answer is still no, but if their digestive tract isn’t functioning well, some forms of carbohydrate can present problems. 

In this week’s article, we will cover the following topics: 

• What are carbohydrates in general, and what are the different kinds of carbohydrates?

• Why do we need carbohydrates?

• How many carbs do we need?

• What happens if we eat too many or too few?

• What are healthy food sources of carbohydrates?

• Gluten - what about gluten?

• Now what?

Before we jump in, I want to let you know that this week’s article will discuss carbohydrates in general.  Next week, we will discuss fiber, which is a form of carbohydrate.  We will end this month by talking about sugar, another carbohydrate, and we will begin April by covering alcohol, which is made from carbohydrates and does provide the body with energy but no other nutrients.  I didn’t want to try and cram all of this into one article, and believe me, you wouldn’t want to try and read through all of that in one go.  I am wordy enough as it is!

What are carbohydrates?

Similar to fat molecules, carbohydrates are strings of carbon with hydrogen and oxygen attached.  Like proteins, carbohydrates are classed by how many of their subunits are lined up and how they are arranged.  Proteins are made up of amino acids and carbohydrates are made of monosaccharides - sugar molecules.  

Like fat and protein, our bodies are able to break down the carbohydrates we eat and turn them into energy for immediate use or storage.  Unlike fat and protein, our body can create all the carbohydrates we need for the function of our bodies - unless you count fiber!  While fiber isn’t often categorized as an essential nutrient, with our growing understanding of how our body works in relation to our microbiome, it is becoming increasingly clear that without fiber consumption, there are life-changing negative consequences.  Be sure to tune in next week for more on this!

As you will see below, not all carbohydrates are created equal and some are more beneficial than others. 

Monosaccharides

Monosaccharides are also known as sugars.  These are the basic building blocks of more complex carbohydrates.  In our digestive tract, carbohydrates are broken down into these tiny 5 to 6-carbon molecule structures to be absorbed into our bloodstream.  These are then converted into energy inside the mitochondria of our cells, strung back together like a beaded necklace and saved to make energy in the near future, or transformed into fat for long-term energy storage.  Glucose is the most common monosaccharide found inside the body and diabetes is a condition of improper glucose metabolism.  

Diabetes: a disease of glucose metabolism

In diabetes, insulin either doesn’t work as well as it is designed to, or the pancreas doesn’t make enough. Insulin can be thought of as the key that opens a door in each cell, shuttling glucose inside.  When this doesn’t happen, a person with diabetes isn’t able to make energy efficiently; this makes them tired and hungry.  Additionally, the blood is full of glucose, which makes it thicker like a syrup.  This causes problems, especially in the tiny blood vessels in the eyes, kidneys, and around nerves, especially in the hands, feet, and the digestive tract.  Cells there begin to die and the results can be loss of vision, kidney failure, painful neuropathy, and a lack of coordination of the intricate dance of digestion.

The body works hard to eliminate this excess sugar by moving it into fat storage, especially in the belly area.  This leads to a body shape characterized by a larger abdomen and thinner arms and legs.  Our bodies will also try to eliminate excess sugar through our urine; this is why testing for sugar in the urine is done often during pregnancy as a screen for gestational diabetes.  This increased urination leads to increased thirst, and can make someone more prone to urinary tract infections.
If you find that you are more tired, more hungry, more thirsty, and urinating more than you used to, getting screened for diabetes is a very good idea. 

Disaccharides

Disaccharides are slightly larger molecules made up of two monosaccharides.  What we call table sugar is actually a disaccharide made up of one glucose molecule and one fructose molecule.  When a person’s digestive tract is functioning well, disaccharides are easily broken down into monosaccharides and absorbed.  When there is inflammation in the digestive tract, this process can be slowed down or halted.  

Carbohydrates and Irritable Bowel Syndrome

Remember last week when I mentioned how some proteins act as enzymes?  Enzymes help our body break down and build up molecules.  In order for a disaccharide to be broken down into two monosaccharides, an enzyme is needed.  Our digestive tract makes these enzymes in the nooks and crannies of our small intestine.  When there is significant inflammation in the small intestine, the cells there will make a protective barrier of mucus - just like in our nose when we have a cold.  When this layer gets too thick, those enzymes that break disaccharides down are trapped and cannot do their job.

When this happens, disaccharides that normally would have been absorbed into our blood now make it down into the large intestine where there are many microbes who will happily eat them.   Those microbes who prefer to eat the disaccharides tend to produce more inflammatory substances, and when they eat the disaccharides, their population grows out of balance.  This can create a vicious cycle that leads to bloating, constipation, diarrhea, cramping, and gas.  In some cases, it can lead to small intestinal bacterial overgrowth (SIBO) where those happy sugar loving bacteria follow their preferred food to its source, the small intestine, where they create more inflammation, which leads to fewer disaccharides being broken down and more food for them and their babies.  This is a painful condition and is difficult to diagnose and treat.  It is a vicious cycle indeed!

Starch

Starch is a long string of monosaccharides in a digestible arrangement.  Our bodies love this stuff!  We can break starches down very easily.  However, when we don’t pair starches with fiber, fat, and protein, our blood sugar rises and falls very quickly.  This is why eating sugary snacks or refined carbohydrates like white rice leave us hungry again soon after.  Low blood sugar triggers hunger, and we are back to looking for another meal within a couple hours or even waking in the middle of the night for a snack.  When this pattern becomes our norm, we experience hangry episodes and develop insulin resistance.  This increases our risk of developing diabetes.

Starch is also the body’s preferred way of storing energy for use in the near future.  If we ignore our hunger signals, we will release the stored carbohydrates (now called glycogen) to fuel our body and break down some of our stored fat to form replacement glycogen.

Fiber

Fiber is defined as carbohydrates that we as humans cannot digest.  There is one thing that makes fiber different from other carbohydrates: its branches!  These branches slow down the breakdown of these carbohydrates.  At each branch, a different enzyme is needed to release the monosaccharides for use.  We as humans do not make the enzymes needed to break these branches down - this is why we cannot eat grass for energy.

You know who can break these branches?  Microbes!   Fibers that we classify as “soluble” are fibers that our gut microbes can break down into short chain fatty acids which are then absorbed through our large intestine and have many anti-inflammatory roles.  Fibers that cannot be broken down by our gut microbes are referred to as insoluble fiber and help us form stools that are easy to pass and bind to substances we have queued up for elimination, such as the breakdown products of hormone, medication, and cholesterol metabolism. 

What does this mean for us? 

We do not break fiber down into energy.  Our gut microbes break fiber down into nutrients we need to function optimally.  When we take care of our microbes, they take care of us.  The presence of fiber in our food helps our digestion slow down and avoid spikes in our blood sugar and sugar crashes.  Additionally, eating foods full of fiber helps us feel satisfied sooner and longer, so we eat fewer calories and don’t get as hungry between meals. 

Why do we need carbohydrates?

Simply put, we need carbohydrates for energy, to feed our gut microbes, and to help us eliminate waste products.  

More specifically, we need carbohydrates to run our brains and fuel our immediate energy needs.  We can break fat down into energy for our muscles and to replace used up glycogen (stored carbs) quite efficiently for sustained effort, but nothing can replace the efficacy of carbohydrates for immediate energy production.

In cases of starvation, we can break fat down into ketone bodies to fuel our brains, but this is not a healthy state to be in long-term, and it creates harmful byproducts that our body needs to eliminate.  When we break glucose down into energy to fuel our brains, the byproducts are heat, water, and carbon dioxide, which are much easier for our body to process. 

How many carbs do I need?

This is a much less specific answer than for fat and protein.  Basically, the amount of carbohydrate needed depends on how many calories you need in your daily life.  In general, a healthy ratio is: 

• 20-35% fat calories

• 15% protein calories

• 65-50% carbohydrate calories

 As you can see, we need more carbohydrates than fat or protein. 

Remember, this is a measure of net carbohydrates which doesn’t include our fiber intake.  You get to subtract fiber from your carbohydrate total gram for gram.  Say you eat a cup of brown rice that contains 51.7 grams of carbohydrates.  That brown rice also has 3.3 grams of fiber.  Your net carbohydrate consumption is actually 48.4 grams.  That is a difference of 13.2 calories.

This brings us to fiber.  The great thing about fiber is that there is no upper limit.  You could eat 100 grams of fiber daily if you wanted!  A good minimum fiber intake to shoot for is around 35 grams daily. 

Where do I find carbohydrates?

Carbohydrates are found in all whole foods with the exception of meat, poultry, and seafood.  They are particularly rich in: 

• Legumes (beans, peas, lentils)

• Whole grains such as whole wheat, brown rice, oats, barley, kamut, quinoa, wild rice, buckwheat, teff, amaranth, sorghum, corn, etc.

• Vegetables - especially root vegetables and squashes

• Fruits

• Some nuts and seeds like pumpkin seeds and cashews 

Refined carbohydrates

Refined carbohydrates are foods that have had most of the fiber and other nutrients removed.  Think white flour, white rice, and the things made from them: bread, pasta, crackers, and baked goods.  White sugar is another example of a refined carbohydrate.  These foods generally increase blood sugar quickly, deliver energy without other necessary nutrients, are low in essential fats and proteins, and can quickly result in fat storage and blood sugar spikes/crashes.  

A cup of steamed white rice typically contains: 

• 44.5 grams of total carbohydrate

• Less than 1 gram of fat

• 4 grams of protein

• Less than half a gram of fiber

• Few vitamins and minerals (unless it is an enriched variety like golden rice)

Refined carbohydrates are frequently enriched, meaning some of the vitamins and minerals that were removed are added back in.  These vitamins are in a synthetic form and not all of the original nutrients are added back.  When we talk of empty calories, we are referring to foods that provide energy without the other needed nutrients.  Refined carbohydrates that have not been enriched fit into this category, as do sugar and alcohol. 

Complex carbohydrates

Complex carbohydrates are left in their original form or ground as whole grains, leaving their fiber, protein, vitamins, and minerals intact and removing the need to enrich the final product.

In comparison to the white rice above, a cup of steamed brown rice contains on average: 

• 51.7 grams of total carbohydrate

• 2 grams of fat

• 5.5 grams of protein

• 3.3 grams of fiber

• One third of your daily recommended vitamins B1 and B3

• Over 100% of your daily recommended manganese

• And is a significant source (15% or more of your daily need) of: 

  • B5

  • B6

  • Copper

  • Magnesium

  • Phosphorus

  • Selenium

  • Zinc

  • And several essential amino acids

Removing whole grains from the diet quickly makes supplementation necessary in order to obtain our basic nutritional needs.   Unfortunately, supplementation can never provide the same level of nutrition that whole foods do. 

Gluten: 

Gluten isn’t a carbohydrate, it is a protein found in certain grains that people with celiac disease are allergic to.  If you suspect that you might have celiac disease, please take the time to go through a diagnostic evaluation.  There is more to this condition than avoiding gluten, and if you have already cut gluten out of your diet, you will need to add it back in for testing to be accurate. 

There are people who do not meet the diagnostic criteria for a diagnosis of celiac disease who still have troubles with gluten.  These people are said to have a hypersensitivity to gluten.  Basically this means that their immune system sees gluten and then acts as if it is a harmful substance.  This isn’t an allergy as it is a different type of immune response, but it still causes significant troubles in the form of a generalized inflammatory response that can trigger other inflammatory diseases.  

This is why integrative practitioners such as Naturopathic Physicians often recommend an elimination of gluten from a person’s diet for 2-6 weeks followed by a reintroduction to see what their response is.  Often gluten will make other issues significantly worse and avoiding it can take some stress off your body while you work on healing your digestive tract and incorporating other lifestyle changes.  It doesn’t always mean giving up gluten forever.

And, even if you are gluten-free, there are so many other non-glutinous grains and foods you can eat to provide you with all the great fiber, B vitamins, carbohydrates, and other nutrients you need.  

Applications

You’ve heard me say it before, and you will hear it again: the best way to support our health through nutrition is to eat a whole-food-plant-based diet.  This means incorporating whole grains and eating nutritious foods in a way that comes naturally to us.  Restrictive eating patterns deny our bodies the nutrients they need to function optimally, and we cannot supplement our way to good health. 

Now that we have reviewed the major macronutrients that our bodies need, let’s take a look at a good goal for a baseline whole-food-plant-based eating pattern.  Your individual needs will vary depending on your activity level, your desired health goals, and any specific medical conditions you have.  I’m not listing the amounts of each food to eat, but I am listing categories to include.  You should talk with a nutritionist, dietician, or other healthcare professional well trained in nutrition about creating a plan unique to you.  

This list doesn’t include animal products; that doesn’t mean you cannot have them.  It just means they would be in addition to these foods listed below. 

• Water 

• Whole grains 

• Legumes 

• Green leafy vegetables 

• Broccoli family vegetables 

• Other vegetables 

• Fruit 

• Herbs and spices 

• Nuts and seeds

Next Week

Next week we will focus on all things fiber!  I love this family of nutrients for all of their many, many health benefits.  If I could convince people to focus on one nutrient to increase in their diet, it would be fiber in the form of whole foods.  Next week, I’ll tell you more.

References

1. Institute of Medicine 2005. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press. https://doi.org/10.17226/10490.

2. USDA, “Dietary Guidelines for Americans 2020-2025: Make Every Bite Count With the Dietary Guidelines - Ninth Edition”, www.dietaryguidelines.gov, Accessed 2/15/2021

3. Ferrier, D. Lippincott Illustrated Reviews: Biochemistry: Seventh Edition, Wolters Kluwer, 2017