Tag Archive for: carbohydrates

Carbs and Insulin: Diet Matters

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On Wednesday, I told you about a study of people who experienced an energy crash after eating carbs. The next study was more pragmatic: we have non-diabetic people who seem to have reactive hypoglycemia (RH), but can we treat it with diet alone? This is a concern because many believe that RH in these people may be a precursor of pre-diabetes and type 2 diabetes. This time, the researchers recruited 40 normal-weight subjects with RH symptoms to see if a dietary intervention could improve symptoms over a year. After testing all subjects, only 12 subjects actually had blood sugars below 55 mg/dl, the more-or-less agreed upon lower boundary for blood sugar.

After assessing their initial diet, subjects met with a dietician four times over the next six months. They were taught the nuances of a Low Glycemic Index Diet in private sessions with a dietician. The subjects were asked to follow that diet for the next three months, with a follow-up session with the dietician midway to fine-tune the diet. The same pattern was followed for the Mediterranean diet. The subjects were tested for RH symptoms after each diet; then for the next six months, they were told to follow any diet they chose based on what they’d learned. All subjects were tested again after 12 months.

A couple of results stood out to me. After six months, the subjects ate an average of four times per day instead of the three times before the study began. Second, they allowed more time between each meal than they had before. While they were instructed on portion sizes during the training periods on each diet, there were no limitations on how much they ate or and no counting calories.

When it comes to the symptoms associated with RH, five of the seven tested were significantly reduced. The researchers attributed it to a healthier eating pattern. After the 12-month study, 80% of the subjects leaned toward the less-complicated Mediterranean diet, which increases the number of whole grains, vegetables, beans, and nuts.

What do we know now that we didn’t know then? Two things: diet matters when it comes to hypoglycemia in non-obese, non-diabetic subjects. Further, individual attention, even just four sessions within six months, is enough to help people make better choices. Whether that lasts more than a year is unknown, but we also know this: the most powerful hormone in the body—insulin—doesn’t cause the insulin overshoot phenomenon in otherwise healthy people. The search for the cause continues.

The Insider Conference call will be next Wednesday September 16 at 9 p.m. ET, and the topic will be Sugar and Carbs—Fact or Fiction. Some of the facts and fictions covered will be:

  • Does eating sugar cause diabetes or pre-diabetes?
  • Can type 2 diabetics eat sugar?
  • Which organ wants and uses more sugar than any other?
  • What are hidden sources of sugar on nutrition labels?
  • Can overeating carbohydrates cause non-alcoholic liver disease?
  • And even more, plus answers to your questions.

The Guest Pass for this Insider Conference call will be available just like last month for $9.95. Sign up before 8 p.m. Wednesday to be included, and a replay will be available within the following week.

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What are you prepared to do today?

        Dr. Chet

Reference: Nutrients 2022. (14) 497. https://doi.org/10.3390/nu14030497

Carbohydrates and Insulin

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On a typical busy morning, a person has a fairly good dose of carbohydrates in the form of a sugary cereal, a bagel, a pastry, or a breakfast sandwich from a drive-thru. Then a couple of hours later, they seem to crash—not their car, but their energy seems to drain away. Maybe they start to sweat and even get some brain fog. If it happens with regularity, people get concerned and may even see their doctor. Is this a food problem? A metabolic problem? We’ll spend some time talking about it; let’s begin with a couple of studies.

The first study recruited a group of healthy subjects who had symptoms like I mentioned. They were tested, together with a healthy control group that had never responded that way, for a condition known as “reactive hyperinsulinemia,” also called the insulin overshoot phenomenon. In short, that means too much insulin is released and can drop the blood sugar below 55 mg/dl.

The researchers tested all subjects for problems in processing carbohydrates: oral glucose tolerance test, mixed meal tolerance test and a bunch more.

They found no specific pattern in either group of subjects:

  • Some in both groups had symptoms, but their blood sugar never went too low.
  • Some had their blood sugar go below 55 mg/dl with no apparent symptoms.
  • In subjects with glucose lower than 55 mg/dl, none had a high insulin level to cause that effect.
  • Not one subject responded with problems to the mixed meal tolerance test.

The conclusion was that a lot more research has to be done to find out why what everyone thinks is happening really isn’t happening in everyone. Fortunately, this same research group did an interesting follow-up. We’ll talk about that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: J. Pers.Med. 2021,11,276. https:// doi.org/10.3390/jpm11040276

Lectin: Hidden Danger?

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This week will be about beans and nuts, a tired ad campaign, and some exciting new research.

Let’s begin with the advertising retread. A retired pediatric cardiologist started talking about the dangers of lectins in foods, especially beans and nuts, years ago. They were the reason you had bloating and other digestive issues. That turns out to be partially true, but fire comes to the rescue.

Lectins are proteins found in the beans and nuts but also in a whole array of foods. These proteins bind to carbohydrates with varying results in the body. Some lectins found in beans cannot be absorbed, cause gastric distress, and may even compromise the immune system. Other lectins help boost the immune system, such as wheat lectins, and still others, like mushroom lectins, may have a positive neurological benefit.

Where does the fire come in? If the plants are cooked or roasted, the lectins become neutralized and cause little to no gastric distress. No country in the world suggests eating beans without thoroughly cooking them first. That eliminates most of the issues with lectins. That doesn’t mean that some people aren’t sensitive to them, but it’s not the gut-expanding problem the ads indicate. Time to retire that approach.

However, there is some exciting news when it comes to nuts. We’ll take a look on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1016/j.heliyon.2024.e39471

When It Comes to Carbs, Quality Matters

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You probably guessed right after reading Tuesday’s Memo that there are benefits from the quality of carbohydrates a person eats on a low-carb diet. In fact, one might say that because the carb intake is very low, every decision matters. Before getting into the results, let’s use the definition to identify the carbohydrate quality used in the study.

Good Carbs, Bad Carbs

High-quality carbohydrate diets are characterized by higher intakes of whole grains, non-starchy vegetables, whole fruits, nuts, and legumes, with correspondingly higher dietary fiber.

Lower quality carbohydrate diets are characterized by higher intakes of refined grains, sugar-sweetened beverages, baked desserts, and other sweet snacks.

The Results

While there were numerous statistical applications used, when comparing the lowest quintile of high-quality carbohydrates with the highest, as the percentage of high-quality carbohydrates increased, the markers of inflammation decreased.

When comparing the lowest quintile of low-quality carbohydrates with the highest quintile, the markers of inflammation increased as the percentage intake increased.

Understand that the high-quality carb eaters ate low-quality carbs as well, just not as much as the low-quality carb eaters. That means you don’t have to eat only one way. I’ve been developing a carb theory, one that goes along with the 80/20 rule: if you can eat well 80% of the time, you can loosen up 20% of the time, at least when it comes to carbohydrate quality.

The Bottom Line

This was not the be-all, end-all study; they used food frequency questionnaires, and I’ve talked ad nauseum about why I think they’re not much better than no info at all. But it was a practical approach to establishing that eating better most of the time can have benefits and may even reduce the risk of disease. We’ll see if there are future papers that track morbidity and mortality in the same group of subjects. Until then, eat less, eat better, and move more.

What are you prepared to do today?

        Dr. Chet

Reference: Current Developments in Nutrition. 2025. https://doi.org/10.1016/j.cdnut.2025.107479

Lower Carb Diet: Does Quality Count?

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The Framingham Study began in 1948 and focused on monitoring nutrition and cardiovascular disease among other conditions. The purpose was to monitor the dietary and health habits as well as the health outcomes of a large group of people over time. Much of what we know about diet and cardiovascular disease comes from the longitudinal data collected; that study continues today with a focus on the children whose parents were part of the original study. Study participants have regularly scheduled physicals and blood work as well as dietary intake assessed by a food frequency questionnaire.

The researchers wanted to study the effect of high-quality carbohydrate intake versus low-quality carbohydrate intake on markers of inflammation in those people following a lower carbohydrate diet. These were not hard-core ketogenic diet followers; the average carbohydrate intake was about 41% instead of the typical 50% to 60%. Subjects had similar intakes of percentage of protein and fat intake. They were compared by the quality of the carbohydrates that they ate.

The subjects were followed for over six years to see if there were any changes in inflammatory markers, because inflammation is related to an increased risk of many diseases and conditions including cardiovascular disease. Was it beneficial to eat better carbs? I’ll let you know on Saturday along with comments about the significance of this study.

Tomorrow night is the Insiders conference call. If you want to participate and get your questions answered, become an Insider by 8 p.m. ET tomorrow night; I’ll include you in the call or you can listen to the replay.

What are you prepared to do today?

        Dr. Chet

Reference: Current Developments in Nutrition. 2025. https://doi.org/10.1016/j.cdnut.2025.107479

Building a Healthy Microbiome

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After last week’s Memos on the importance of a healthy microbiome and immune health, let’s review how to have a healthy microbiome to protect your brain and boost your immune system.

First, eat a mostly plant-based diet: some raw, some cooked, some fermented. The raw will give you probiotics and fiber. The cooked, especially whole grains and beans, will give you fiber. The fermented such as sauerkraut and yogurt will give you even more probiotics.

Second, fast once in a while. I covered this in Memos from June, so you can re-read the Memos on fasting and microbiome health.

Third, reduce your refined carbohydrate and sugar intake. Simply put, they provide the bad microbes with the food they need to overtake the good bacteria. Good bacteria need fiber from foods or supplements, so make sure you’re getting 25–30 grams per day.

My knee replacement surgery is scheduled in six days, so I’ve been working on preparing my body to defend against staph infections. I’ll talk about that in Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

“What the Health”: False Sugar Claims

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“Sugar doesn’t cause diabetes!” So says just about every expert in the film “What the Health.” Of all the misstatements in the film, this one is the worst and most dangerous. It isn’t because the statement is false; it’s because of the way it’s presented. Expert after expert looks into the camera and says that excess sugar intake does not cause type 2 diabetes. On top of that, the explanations that they give to justify their position are misleading.

One expert said that sugar will be stored as glycogen in the liver and the muscles and the rest used for energy. That’s correct. Another talked about the Duke University Diet which included rice, sugar, and some fruit and fruit juices; one physician used it to help many people who were too sick for other treatments. All the experts filmed agreed that neither sugar nor carbohydrate caused type 2 diabetes. It just couldn’t.

They are stopping short of telling the truth or intentionally misleading the audience. Sugar doesn’t cause type 2 diabetes if the person does not overeat. The statement about glycogen? True, as I said, but when a person overeats carbohydrates, the liver stores as much glycogen as it can and then converts the rest to fat.

Excess carbohydrates lead to insulin resistance and eventually, type 2 diabetes. The Duke University Diet? That was from the 1940s. It was an ultra low-fat diet with no salt, and was used to treat the sickest patients but only under the care of a physician.

The section on sugar and diabetes was by far the worst. It intentionally misleads people to think that overeating is fine as long as it’s carbohydrates. But there was one study that was cited over and over that’s even worse in my opinion. I’ll cover that on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: What the Health. Directed by K. Andersen and K. Kune. 2017.

 

The Bottom Line on Veggies and Carbs

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Go ahead and finish your oatmeal and drink your protein-kale smoothie—you do need those veggies. Meanwhile I’ll put the PURE study in perspective.

This is a large study that looks at the economics of food as well as the health benefits. In a separate publication, the analysis of the data focused on the cost of fruit and vegetable intake as a percentage of monthly income. They specifically collected data from low-, middle-, and high-income communities from 18 different countries. Researchers actually went to grocery markets in those countries to collect the cost data. As you might expect, the lower the income, the higher the percentage of monthly revenue spent on vegetables and fruits.

I think that explains part of the reason the second study on vegetable intake and mortality said there was no additional benefit beyond three or four servings per day: if people can’t afford more, it’s wrong to teach them that more is better if it might not be. But that doesn’t justify the headlines because the message that Americans hear is “I don’t have to eat those darn vegetables!”

Yes, you do. Here are the issues with each of the studies.

 

Do Carbs Kill?

In the first study on carbohydrate intake and mortality, researchers used a simple percentage of caloric intake in their analysis. Basically we have a math problem: if someone in a poor country eats 80% of their diet as carbohydrates from root vegetables but they only get 1,000 calories per day that’s a completely different situation from a person who eats 3,000 calories per day but 50% of their calories are from refined carbohydrates and sugars.

As I’ve said many times, while we should eat fewer refined carbohydrates, carbohydrates are not inherently bad; it is the overconsumption that’s the problem. If researchers didn’t analyze the total caloric intake from carbohydrates, protein, and fats, we don’t have the complete answer. The PURE study used a food frequency questionnaire. I’ll leave it at that because I rant too much about the FFQs.

Finally, the researchers simply jumped the gun by recommending that health education should now focus on increasing fat intake while reducing carbohydrates. All types of vegetables and fruits are carbohydrates. Because researchers did not parse out different sources of carbohydrates in their analysis, their recommendations are meaningless.

 

Don’t Bother with More Veggies?

PURE is an observational study; it cannot determine cause and effect. Also it can tell you a lot about a large group of people but nothing about an individual.

The lead researcher actually provided the perspective on vegetables and fruit during an interview: if the research shows that the benefit of eating more plant-based food is a 20% reduction in mortality, and the mortality rate of the population is just 1%, that means the reduction goes from 10 out of 1,000 to 8 out of 1,000. It’s virtually meaningless to an individual.

The researchers hesitated to tell people with very low incomes to spend more on additional servings of plant-based food if there was not a meaningful benefit. But for most of you, the cost of fruit and vegetables is not a hardship, so buy ’em and eat ’em.

 

The Bottom Line

These will not be the last headlines we hear from the PURE study because the data continues to be analyzed. One issue for me is that there’s no data from the U.S. included so the ability to generalize to the U.S. population is very limited. We lead the world in obesity and overweight and our food consumption patterns are different even from other Westernized countries.

One thing remains clear to me: we should all eat more vegetables and fruit and reduce refined carbohydrates. The recommendation never changes: eat less, eat better, move more.

What are you prepared to do today?

Dr. Chet

Reminder to Insiders: The next Insider Conference Call will be Tuesday at 9 p.m. Not an Insider? Join now to participate in this call and get your questions answered.

 

References:
1. DOI: http://dx.doi.org/10.1016/S0140-6736(17)32252-3.
2. DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8.

 

PURE Headline 1: Do Carbs Kill?

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Never a dull moment when it comes to health news: now they’re asking if you should choose fat rather than carbs.

The research study was called PURE: Prospective Urban Rural Epidemiology, and you’ll be hearing more about it. Over 150,000 people from five continents, 18 countries, and 613 different communities were included in the study. Researchers collected data on demographics, smoking habits, and health questionnaires including a semi-quantitative food frequency questionnaire (FFQ).

In the first paper, researchers examined the relationship between macronutrient intake, specifically fats and carbohydrates, and total mortality including cardiovascular events. Higher fat intake was associated with a decreased risk of total mortality while high carbohydrate intake was associated with a higher risk of mortality. There was no specific relationship between either macronutrient and heart disease.

Should you put down that rice? How about the bread? What about that cabbage and broccoli? Before you decide, let’s check out the second headline grabber on Thursday.

What are you prepared to do today?

Dr. Chet

Insider Update: The next Conference Call will be next Tuesday September 25 at 9 p.m. If you’re not an Insider yet, join now to participate in this information-packed call and get your questions answered.

 

Reference: DOI: http://dx.doi.org/10.1016/S2213-8587(17)30283-8

 

How to Limit Your Processed Food

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There are two strategies that you can use to control your intake of processed foods.

The first is the simplest yet the most difficult, especially if it’s something you really love to eat: Don’t buy it. If it’s not in the house, you can’t eat it. Whenever I tell that to someone, the next words out of their mouth are usually something like “That’s not going to happen!”

I understand completely, but for me, it’s the only way I can reduce my intake of chips and peanuts. If they’re in the house, I will eat them and I won’t stop. Some types of nuts such as almonds or walnuts are easier to control. I have yet to find something to substitute for any type of chip. You can put salt on carrots and celery, but it isn’t the same. You can dip broccoli or cauliflower in olive oil or balsamic vinegar and it doesn’t come close. It’s the combination of processing combined with the fat and salt that makes these foods difficult to resist for me.

Can you walk away from the pantry as you let one square of chocolate dissolve in your mouth? Can you eat two Oreos and put the package away? We all have our Achilles heel of foods; Paula almost finished a box of deluxe ice cream sandwiches the day we bought them, so we never bought them again. For you, it may be bread or donuts or chocolate or jelly beans. If you can’t walk away, just don’t buy it.

The second approach, and one that may be more reasonable for some, is to portion out a serving and don’t eat any more. In my opinion, there are no foods that you can never eat as long as you control the amount and the frequency. If you can control your portions, that works just fine. If you can’t, you have no alternative other than to not purchase them.

Here is a bonus third way: Eat your vegetables first. Research shows that vegetables contribute to satiety. If you eat them first, it may be easier to control the processed foods you desire. Drinking a glass of tomato juice instead of a milkshake may not be as rewarding emotionally, but it may satisfy you physically.

This is something to work on at home with your children. Based on recent changes to the guidelines for school lunches, the upper levels of sodium may be suspended for school districts that request it. It seems innocent enough but in effect, your kids probably will be exposed to high levels of salt, learning to become dependent on the same nutritionally deficient foods we have problems with today. Schools can also opt out of the whole-grain requirement, so expect to see cheaper white bread. Best bet is to fix healthy lunches for your children every day and teach the kids to fix them, too.

I hope this helps. For me, it’s a never-ending battle and I know it is for others as well. Find which strategy works best for you—abstinence or control—and stick to it.

What are you prepared to do today?

Dr. Chet