Saturday, January 19, 2013

The Nutrition Debate #84: Carbohydrate Intolerance – the new ‘buzz’ words

Authors Jeff Volek and Stephen Phinney use the phrase “carbohydrate intolerance” seven times in their introduction to “The Art and Science of Low Carbohydrate Living.”  They’re telling us something. They’re want to replace the medical term Impaired Glucose Tolerance (IGT) with “carbohydrate intolerance” to make it more “accessible,” and I approve.

IGT involves hormones, enzymes and cell receptors, and unless you’re a molecular biologist, these terms make the eyes glaze over. Besides, the biological actions that occur within the body are autonomic, whereas we eat food consciously, for the most part. And we don’t eat glucose. We eat carbs. Our digestive system breaks down  all carbs, including all simple sugars and all complex carbohydrates (starches), into single molecules, most of them glucose.

So, “carbohydrate intolerance” is an excellent way to describe some people’s metabolic response to eating ALL carbs. I am stressing all carbs because of the popularity of distinguishing between simple sugars (mono and disaccharides) from complex carbs, or polysaccharides (starches).  And to differentiate “natural sugars” (as in fruits) from “added” sugars. Sure, they contain some small amounts of indigestible fiber, but they’re all the same, folks! They’re all glucose.

It is true that the common simple disaccharide sugar, sucrose, breaks down to 50% glucose and 50% fructose, and fructose is metabolized differently than glucose. (It is diverted to the liver where it is detoxified and turned into fat.) But all complex carbohydrates (the starches) break down and are absorbed into the blood as glucose. All glucose will raise blood sugar by the same total amount, and some complex carbohydrates will raise blood sugar more and more quickly that sucrose, e.g. a slice of bread vs. a hard candy or watermelon, or even popcorn.

Another extreme example of misinformation about nutrition is a statement I read recently in a magazine: “The complex carbohydrates in apples give your body a longer, more even energy boost compared to high-sugar snacks.” That is false. Utter nonsense. There are no complex carbohydrates in an apple. An apple is 86% water, 3% (indigestible) fiber and 11% simple sugars (67% fructose/33%glucose). An apple is, in fact, just a delicious “high-sugar, high-fructose snack.”

So I applaud the initiative of Volek and Phinney to create a user-friendly “buzz word” to describe the condition that affects a large and rapidly growing “cohort” of the population – those of us who have eaten a “Western Diet” and have succumbed (perhaps due to  genetic predisposition) to one of the most common diseases of Western Civilization, Metabolic Syndrome. See the Nutrition Debate #9 here for the indications. But here I want to focus on understanding that we are, many of us, carbohydrate intolerant. We must accept that and learn what we can do about it.

We are the obese. Okay, a more user-friendly term: we are the overweight. This applies to all of us from a little overweight to the morbidly obese. Our mechanism of fat synthesis and metabolism is a little or a lot broken. We are also the hypertensive. Our blood pressures rise as we gain weight (and drop when we lose it). We are also the ones with “high cholesterol,” often misdiagnosed as high Total Cholesterol and high LDL lipoproteins (which can be manipulated easily with a statin); instead, we have a more difficult-to-treat form of dyslipidemia characterized by low HLD lipoproteins and high triglycerides. See the Nutrition Debate #25, #27, #67, #68 and #72 for what to do about that.

The first step is to recognize ourselves – to know that we are members of this “cohort” that has an association with being obese or overweight, and has high blood sugar, high blood pressure and “high cholesterol.” And that having all these indications puts us at much higher risk of death or another “morbid” outcome. Are you motivated yet? Will you reject the failed treatment protocols of taking more pills and being constantly hectored to lose weight? Remember the old aphorism: “The definition of insanity is doing the same thing over and over again and expecting different results.”

A reasoned approach, on the other hand, would be a different diet. If you are a Type 2 or even prediabetic, and you and your doctor know that carbohydrates raise your blood sugar unnaturally, then why in heaven’s name would your doctor advise you to eat carbohydrates? YOU ARE CARBOHYDRATE INTOLERANT! Accept it, and then do something about it!  

You’re in good company. Many kinds of intolerances are now recognized as detrimental to health: Fructose intolerance, FODMAPs, salicylates, gluten, casein, etc. The consequences, short and long term, vary, but in general individuals who recognize, accept, and deal with intolerances report greatly improved health and day to day quality of life.

Sorry for all my “shouting.” Learn what carbohydrate foods are. Then, try a Low Carbohydrate diet. For this, you’re on your own; I can’t do everything for you. Just kidding. Start with one of my favorites at The Nutrition Debate #19 here.

© Dan Brown 1/19/13

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