If you are already obese, you know and I know that you crave— and consume — these foods and probably avoid fats.
As studies show, you would be better off eating the fat than the carbohydrate.
Fat alone will be burned off.
A combinationof high-carbohydrate foods and fat will foster fat storage.
It is, therefore, a myth that Americans areoverweight due to exces sive fat consumption.
Americans are fat largely because of sugar, starches, and other high-carbohydrate foods.
Accordingto statistics released by the U.S.
Department of Agricul ture, added sugar consumption hit an all-time high in 1999 (the last yearforwhich statistics wereavailable), at awhopping 158 pounds per American per year, an increase of 30 percentover 1983.
The key word here is"added." This doesn't account for starches and sugars naturally present in food.
According to a report from the Oregon Health Sci encesUniversity, a 12-ounceStarbucksGrandeCaramelMocha drink contains 45 teaspoons of added sugar.
This increase in sugar consumption not coincidentallycorresponds with the timing of recommendations to eat less fat.
It was 1984 when the National Institutes of Health (NIH) began advising everyone within shouting distance to cut fat intake.
It also corresponds quite neatly with the creation of a whole new, multibillion-dollar industry in low- and nonfat foods, many of which areextremely high in sugar.
Formore than ten years, the government had planned to issue a report once and for alldamning fat asthe demon some scientists were sure it was.
The problem was, researchers couldn't"reverse engineer"the ac tual data to make the science fit the assumption.
Unfortunately, the program to indict fat was left to die a quiet death, and not so much as a press release wasissuedto say, "We were wrong." And so many of us still don't know the truth.
Theywerewrong.
No doubt the popular media have made you aware of the endless procession ofbooks and dietsand advertisements for foods alltouting the value of high"complexcarbohydrate" in the diet.
Athletes"carbo- load"beforebig games or marathons.
TV and radio commercials extol the virtues of Brand X sports drink over BrandY because it contains more "carbos." As stunning as it sounds — and unbelievable, given the popular media's recent love affairwith a high "complex carbohydrate,"low-fat diet — you can quite easily survive on a diet in which you would eat no carbohydrate.
There are essential amino acids and essential fatty acids,but there is no such thing as an essentialcarbohydrate.
Further-
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more, by sticking to a diet that contains no carbohydrate but has high levels of fat and protein, you can reduce your cardiac risk profile — serum cholesterol, triglycerides, lipoprotein(a), LDL, et cetera— though you'd deprive yourself of all the supposed "fun foods" that we cravemost.* We've allbeen trained to think that carbohydratesareour best, most benign source of food, so how can this be?
What if I, a physician, told you, a diabetic, to eat a diet that consisted of 60 percentsugar, 20 percent protein, and 20 percent fat?
More than likely, you'd think I was insane.I'dthink I was insane,and I would never make this suggestion to a diabetic (nor would I evenmake it to a nondi abetic).
But this is just the diet the ADA recommended to diabetics for decades.
On the surface, these recommendations seemed to make sense because of kidney disease, heart disease, and our abnormal Upid pro files.
But this is what is known assingle-avenue thinking.
It seemed log ical to insistthat dietaryintakeof proteinand fat be reduced,becauseno one had looked at elevated blood sugars and the high levels of insulin necessary to bring them down asthe possible culprits.
So if you eat very little fat and protein, what's left to eat?
Carbohy drate.
As I discovered in my yearsof experimentation on myself, and then in my medical training and practice, the real dietary problem for dia betics is not only fast-acting carbohydrate but also large amounts of anycarbohydrate.
In eithercase, the result is high blood sugars requir ing large amounts of insulin to try to contain them.
So what are carbohydrates?
The technical answer is that carbohydrates are chains of sugar mol ecules.
The carbohydrates we eat are mostly chains of glucose mole cules.
The shorter the chain, the sweeter the taste.
Some chains are longer and more complicated (hence, "simple" and "complex" carbo hydrates), having many links and even branches.
But simple or com plex, carbohydrates arecomposed entirely of sugar. "Sugar?" you might ask,holding up a slice of coarse-ground,seven- grainbread."This is sugar?" In a word, yes, at least after you digest it.
With a number of important exceptions, carbohydrates, or foods derived primarily from plant sources that are starches, grains, and
You'd also be missing the vitamins and other nutrients contained in low- carbohydrate vegetables, so a zero-carbohydrate diet is not in my ball game.
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fruits, have the same ultimate effect on blood glucose levels that table sugar does. (The ADA has recognized officially that, for example, bread is as fast-acting a carbohydrate as table sugar.
But instead of is suing a recommendation against eating bread, its responsehas been to saythat table sugaris thereforeokay,and can be "exchanged"for other carbohydrates.
To me, this is nonsense.)Whether you eat a pieceofthe nuttiest whole-grain bread, drink a Coke, or have mashed potatoes, the effect on blood glucose levels is essentially the same — blood sugar rises, fast, and in proportionto carbohydrate content.
As noted in the introduction to this chapter, the digestion process breaks each of the major food groups down into its basic elements, and these elements arethen utilized by the body as needed.
The basic element of most carbohydrate foods is glucose.
We usually think of simple carbohydrates as sugars and complex carbohydrates as fruits and grains and vegetables.
In reality, most fruit and grain products, and some vegetables, are what I prefer to talk about as"fast-acting" carbohydrates.
Our saliva and digestive tractcontain enzymes that can rapidly chop the chains down into free glucose.
We haven't the en zymes to break down some carbohydrates, such as cellulose, or "indi gestible fiber." Still, our saliva canbreakstarches into the shorterchains on contact and then convert those into pure glucose.
Pasta, which is often made from durum wheat flour and water (but can also be made from plain white flour and egg yolks, or other vari ants), has been touted as a dream food — particularly for runners carbo-loading before marathons — but it quickly becomes glucose, and can raiseblood sugarvery rapidly for diabetics.
In the type 2 diabetic with impaired phase I insulin response, it takes hours for the phase II insulin to catch up with the postprandial levels of glucose in the blood,and dayafter day, during that time, the high blood sugars can wreak havoc.
In the diabetic who injects insu lin, there is a tremendous amount of (rarely successful) guesswork involved in finding the proper dosage and timing of insulin to cover a carbohydrate-heavy meal, and the injected insulin not only doesn't work fast enough, it is highly unpredictable when taken in large doses in attempts to cover large amounts of carbohydrate (see Chapter 7, "The Laws of Small Numbers").
Some carbohydrate foods, like fruit, contain high levels of simple, fast-acting carbohydrates.
Maltose and fructose — malt sugar and fruit sugar — for example, are slower-acting than sucrose — table or cane sugar— but they will cause the same increase in blood sugarlev-
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els.
It may be the difference between nearlyinstant elevation and ele vation in 2 hours, but the elevation is still high, and a lot of insulin is still required to bring it into line.
And, if the insulin is injected, there's the further problem of guesswork in timing and dosage.
Despite the old admonition that an apple a day keeps the doctor away, I haven't had fruit since 1970, and I am considerably healthier for it.
Some whole-plant vegetables, that is,those that come mostly from the stalks and leaves, are of value to the diabetic and nondiabetic alike because they contain considerable amounts of vitamins, minerals, and other nutrients. (The recipe section of this book shows you a number of tasty and satisfying ways to work thesevegetables into your diet.) As noted previously, most Americans who are obese are overweight not because of dietary fat, but because of excessive dietary carbohy drate.
Much of this obesity is due to "pigging out" on carbohydrate- rich snack foods or junk foods, or even on supposedhealthy foodslike whole-grain breadand pasta.
It's my beliefthat this pigging out haslit tle to do with hunger and nothing at all to do with being a pig.
I'm convinced that people who crave carbohydrate have inherited this problem.
To some extent,we all have a natural craving for carbo hydrate — it makes us feel good.
The more people overeat carbohy drates, the more they willbecome obese, even if they exercise alot.
But certain people have a natural, ovenvhelming desire for carbohydrate that doesn't correlate to hunger.
These people in alllikelihood have a genetic predisposition toward carbohydrate craving, as well as a ge netic predisposition toward insulin resistance and diabetes. (See page 185, "The Thrifty Genotype.") This craving can be reduced for many by eliminating such foods from the diet and embarking upon a low- carbohydrate diet.
In light of the above, you might guess that I advocate a no- carbohydrate diet.
In fact, in the next chapter you'll discover that I in clude small amounts of carbohydrate in my meal plan.
Back in 1970, asI was still experimenting with blood sugarnormalization, I remem bered that during the twentieth century a new vitamin had been dis covered every fifteen years or so.
While theremay be no such thing as an essentialcarbohydrate, it seemed reasonable to conclude that, since our prehistoric ancestors consumed some plants, plant foods might well contain essential nutrients that were not yet present in vitamin supplements and had not even been discovered.
I therefore added small amounts of low-carbohydrate vegetables (not starchy or sweet) to my personal meal plan.
All of a sudden I was eating salads and
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cooked vegetables instead of the bread, fruit, cereal, skim milk, and pastathat I had been eating on my prior ADA diet.
It took a while to get used to salads, but now I relish them.
Only recently, in my lifetime, have phytochemicals (essential nutrients found in plant foods) been discovered.
Phytochemicals are now incorporated into some vitamin pills, but research on the use of isolated phytochemicals is still in its early stages.
You may haveheard of such phytochemical supplements aslutein, lycopene, and so on.
It would appear that many chemicals — large numbers of which are likely not even known about yet — work together to provide beneficial effects.
So at this point, it certainly makes senseto eatlow-carbohydrate salads and vegetables. (Although fruits contain the same phytochemicalsasvegetables, they aretoo high in fast-acting carbohydrate to be part of a restricted-carbohydrate diet, as the next chapterwill explain.)