A lot of “fad diets” (South Beach, The Zone, Mediterranean, Atkins, Paleodiet, my fav scientifically-backed Superfood diet) will have people eat certain foods – at certain portion sizes – and at certain times. But, what they all share in common is the avoidance of refined carbohydrates. They all share a diet free of high-glycemic foods:
I first heard about ‘glycemic load’ on diggnation above and about a year later I found this important excerpt from my book Transcend explaining what happens on a cellular level:
Good and Bad Calories
There are four sources of calories. The three you learned in school — carbohydrates, proteins, and fats — and the one you probably learned about after school or on weekends — alcohol. Debate has raged for years for years about how much of each of these types of calories should be consumed for optimal health and weight. Every year or so, a “new and improved” weight loss cure appears in the bookstores and rockets to the top of the bestseller list. Many of these diets advocate radical decreases in one type of calorie and greater emphasis on another. Millions have lost significant amounts of weight following the Atkins-type diet, which centers on drastic cuts in all carbohydrate foods but general acceptance of a wide variety of proteins and fats. Very low fat diets such as Pritikin are just the opposite and call for dramatic reductions in dietary fat as their mainstay. There is no question that people who follow Atkins will lose weight and show improvement in some lab tests, such as lower triglycerides (blood fats) and higher high-density lipoprotein (HDL) or good cholesterol, while very low fat diets have been shown to reduce cholesterol deposits from within the heart arteries.
But there are health risks associated with following the Atkins diet over the long term, such as eating the wrong kinds of fat, strain on the kidneys caused by consuming excessive amounts of protein (especially animal protein), and increased risk of osteoporosis — and some concern has been raised that eating so much animal-based food could increase cancer risk. Although very low fat diets have many virtues, they can be deficient in calcium, vitamin B12, and essential fats for growing children, pregnant or nursing mothers, or people who are physically very active, so supplementing with these nutrients is important when on very low fat diets. To their credit, however, both diet programs have made change in response to recent nutrition research: The Atkins diet has begun restricting saturated fat, and most very low fat diets have recommended that minimum amounts of omega-3 fats be consumed (or that EPA-DHA supplements be used).
Rates of long-term adherence are low for both of these diets. After a few months, people on Atkins get bored with eating so few carbohydrates (yes, people do get tired of just eating bacon and hamburgers) and the very low fat folks develop cravings for fat.
Although Dean Ornish is often associated with the very low fat school of thought, his Spectrum program is actually quite flexible. Like our TRANSCEND program, he recommends a personalized program that matches your specific health circumstances. For others, Dr. Ornish recommends a program similar to the one in his book that includes a range of healthy foods such as vegetables, fruits, legumes, and unrefined carbohydrates. Dr. Ornish was actually one of the first to recommend omega-3 fatty acids, which he has been doing for the past 25 years.
It’s clear that most people eat too many of their calories in the form of carbohydrates–sugary foods and refined and high-glycemic carbohydrate “white” foods such as white bread, white rice, white pasta, and white potatoes in particular–there is value in eating a wide variety of foods. We feel that all of the sources of calories have value, and that it makes sense to eat a variety of foods from each type. Rather than saying that carbs are bad and fats are good or vice versa, it’s more important to realize that carbohydrates, fats, proteins–and even alcohols– are not good or bad as a category. Instead, understand that there are good and bad varieties of carbohydrates, proteins, fats, and alcohols. Optimal health is easiest to achieve by making most of your choices from the healthy varieties of these food types.
Carbohydrates
Throughout most of the long course of human evolution, refined carbohydrates, such as refined flour products and white sugar, did not exist, while complex carbohydrates or starches such as potatoes, cereals, and grains made up a relatively small portion of our ancestors’ daily fare. Our bodies still function much as they did tens of thousands of years ago, so eating a diet lower in carbohydrates and higher in certain kinds of protein and fats is the most favorable to good health. But since the time humans first learned to harvest and grind grains, refined carbohydrates have become “staples” in our diet. Bread, pasta, white rice, cookies, cake, candies, soft drinks… the typical modern diet is now so heavily weighted toward carbohydrates, and in particular, refined sugars and starches, that it’s literally killing us. In fact, the principal cause of obesity, type 2 diabetes, and metabolic syndrome is overconsumption of these kinds of carbohydrates.
The most basic carbohydrates are simple sugars (monosaccharides) such as fructose found in fruit, and glucose, the critical blood sugar that provides energy to your cells. Simple sugars combine to form disaccharides (meaning “double sugars”), such as table sugar (sucrose), and polysaccharides (meaning “many sugars”), such as amylose (starch) and cellulose (the woody, indigestible structural material in plants).
If you ever wondered why you suffer a heavy energy crash when you eat candy by itself here is the explanation:
The faster a carbohydrate is digested and absorbed, the faster it releases glucose into your bloodstream. Refined-carbohydrate foods are digested and absorbed rapidly, thus, they raise your blood sugar very quickly whenever you eat them. This lies at the heart of why a diet rich in refined sugars and starches is so unhealthy. A simple monosaccharide such as glucose can be absorbed by the lining of the small intestine directly where it immediately enters the bloodstream. Disaccharides, such as sucrose (table sugar) and lactose (from milk products), can’t be absorbed directly, but are easily broken down by enzymes (sucrase and lactase, respectively) into simple sugars, which are then quickly absorbed. Even amylose, the main carbohydrate found in grains and starchy vegetables such as potatoes, is easily broken down by the enzyme amylase in saliva and pancreatic fluids into simple sugars and is quickly absorbed into the bloodstream.
Insulin: A Double-Edged Sword
The rapid digestion and absorption of refined sugars and starches triggers a rapid rise in your blood glucose level, which signals your pancreas to excrete insulin into your bloodstream. Insulin is a pancreatic hormone that moves glucose into your cells to either be burned immediately for energy or signals the conversion of glucose into glycogen and then to triglyceride (fat) to be stored for later use. Any time you eat a sugary food, insulin levels spike, which can sometimes result in a sharp drop in blood sugar a few hours later. The resulting hypoglycemia (low blood sugar) then triggers cravings for more foods high in refined sugars and starches, which leads to another spike in insulin and so on.
When this spike-and-plunge cycle continues over time, your cells lose their sensitivity to insulin and ever-increasing amounts of insulin are needed to move glucose into the cells. This is known as insulin resistance and is the primary cause of the metabolic syndrome, a serious condition associated with increased blood pressure, higher risk of coronary artery disease, and acceleration of the aging processes.
Insulin resistance can also lead to type 2 diabetes, which is a breakdown in the body’s ability to process carbohydrates. In type 2 diabetes, the pancreas can become so overworked that it eventually fails and can’t produce enough insulin to lower blood sugar levels. This crippling disease causes problems with blood circulation, dramatically increases the risk of heart attacks, and is associated with a 15-year decrease in life expectancy. Largely because of excessive consumption of simple carbohydrates and sugary foods, the number of people with type 2 diabetes in the United States has increased tenfold in the past 35 years, and as of 2008, type 2 diabetes affected over 21 million Americans. In just the 10 years between 1997 and 2007, the incidence of type 2 diabetes nearly doubled in the United States, from 4.8 to 9.1 per 1,000 people.
Excess sugar in the blood also contributes to the formation of AGEs (advanced glycation end products). These sticky conglomerations of sugar and protein molecules interfere with the work of your enzymes and accelerate aging processes. Some cases of high blood pressure (due to stiffening of the blood vessel walls from glycation) and age spots are indicators of AGE production at work.
High blood glucose levels inhibit your immune system and interfere with vitamin C’s crucial role in combating infection and building body tissues. High blood sugar stimulates growth of a broad range of pathological cells, including fungal infections such as candida (yeast) and cancer, and boosts adrenaline production, triggering the fight-or-flight stress reflex.
Consumption of refined sugars and starches is also the primary cause of weight gain and obesity. Insulin brings your blood glucose level under control by converting excess sugar into fat and moving it into fat cells for storage. The more sugary, starchy carbohydrates you eat, the more weight you gain. It’s that simple. And the craving for more sugary, starchy carbohydrates caused by cyclical drops in blood glucose level only exacerbates the problem.
Clinical research, including a study published in 2001 in the journal Nutrition Reviews, demonstrates that refined sugars and starches are addictive and that eliminating them from your diet can cause withdrawal symptoms. But eliminating such simple carbohydrates from your diet is the single most important thing you can do to reduce risk of metabolic syndrome and type 2 diabetes. It is also the best thing you can do to lose excess weight and maintain a healthy body weight. If you can completely cut out these foods, the addictive cravings will dissipate after a week or two. If you just cut back, the addiction and craving will remain.
Glycemic Index, Glycemic Load . . . and How to Keep Your Blood From Turning into “Pink Cream”
Not all carbohydrate foods are unhealthy. In fact, many are highly desirable, containing crucial vitamins, minerals, fiber, and other valuable nutrients. To help you determine whether a particular food falls into the “good carbs” group, you need to know its glycemic load, and that is determined, in part, by its glycemic index. This may sound complicated, but let us explain.
The speed at which a particular food is converted into glucose in the blood, and thus how fast it boosts your insulin level, is called its glycemic index. Because glucose is the primary blood sugar and needs no processing to enter the bloodstream, scientists have assigned glucose a glycemic index of 100. The glycemic index for any particular food is determined as a function of how fast it turns into sugar in the bloodstream as compared to glucose itself. For example, corn flakes have a relatively high glycemic index of 92, very close to glucose, while peanuts are quite low at 14. Two slices of white bread have a glycemic index of 73, while two slices of whole grain bread have a glycemic index of 55. This is because the fiber content of the whole-grain bread slows the digestive process and the speed at which the carbohydrates are converted to glucose, so it has a lower glycemic index. Foods made from whole grain are also better for you because they still contain all the nutrients that the refining or milling process strips away. Similarly, a piece of fruit with all its fiber and other nutrients intact has a lower glycemic index and is better for you than a glass of juice squeezed from that fruit.
And here is the important part to imprint in your memory:
Any time you eat a high-glycemic food, there is a sudden rush of sugar or glucose into your bloodstream. The body has minimal ability to store glucose, so the only options are: (a) burn it as fuel immediately or (b) turn it into triglycerides and store it as fat. Unless you happen to be running a marathon or doing some other type of extreme physical exertion, you don’t burn very much sugar at any one time, so most of the sugar in high-glycemic foods you eat is converted into triglycerides and eventually stored as fat. If you consume a high-glycemic food such as a candy bar or sugary soft drink and have a sample of your blood drawn 60 minutes later–unless you’re doing something physically very strenuous and burning all the sugar as soon as you eat it–you’ll find your blood sample filled with triglycerides or fat particles. There will be so much fat floating in your bloodstream, in fact, that it will look like pink cream. The same thing happens any time you eat any high-glycemic food. Drink a glass of orange juice, and 60 minutes later, your blood looks like pink cream; a sugary breakfast cereal with skim milk and a banana–same thing. A bowl of white spaghetti, a sandwich on white bread, white potatoes–your blood changes from red to pink because it has so much fat in it. The pink color lasts only a few hours (unless you have diabetes) as the fat particles gradually are cleared from your bloodstream and enter your fat cells –adding to your weight and waistline, If you have undiagnosed and, thus, untreated type 2 diabetes, which is true of 6 million Americans, or are one of the 57 million with prediabetes (also called metabolic syndrome), the fat remains in your bloodstream for many hours, or in more severe cases, your blood simple stays pink–that is, filled with fat–all the time.
In general, foods with a lower glycemic index are better for you than those with a higher glycemic index, but that’s not always the case. That’s why a food’s glycemic load is a much more useful indicator. The glycemic load for a serving of food represents the approximate amount of insulin needed to process it based on both the speed at which it is converted to glucose (its glycemic index) and the total amount of sugar it has, a factor determined by the total amount of carbohydrates in the serving. For example, a serving of green peas with a glycemic index of 75 appears to be worse than white bread with a glycemic index of 73. But when you factor in the total number of grams of carbohydrates contained in a serving of peas compared with that in a serving of bread, the actual “load” on your system–and the amount of insulin needed–is much lower with the peas. Glycemic load is calculated by multiplying the number of grams of carbohydrates in the serving by the glycemic index of that food. Thus, the glycemic load for two slices of white bread is 28 grams (total carbs) x 73 percent (glycemic index) = 20. A serving of peas with 7.5 grams of carbs and a glycemic index of 75 would have a much lower glycemic load of only 5.5 The amount of insulin released into your bloodstream is directly related to the glycemic load of the meal, so a serving of bread creates a much greater overall impact on insulin levels than a serving of green peas.
The following table will help you determine which foods are to be avoided and which can be included in a healthy diet. Unrefined, high-fiber, low-glycemic load foods are best, and your mother was right when she told you to eat your vegetables–nonstarchy vegetables are not only ver low in glycemic load but are loaded with many valuable nutrients, such as vitamins and phytochemicals.
[Table showing list of foods and their glycemic index and glycemic load]
Recommendations for Carbohydrate Consumption
Our recommendations regarding dietary carbohydrate consumption are based on your current state of health. For most people, we recommend that carbohydrates make up 33 to 40 percent of total calories. This may represent a significant reduction for some, as many people consume 60 percent or more of their daily calories in the form of carbohydrates. We also recommend that the majority be of the low-glycemic variety.
Our recommendations for a moderate-carbohydrate diet include
- Eat moderate amounts of legumes (peas, beans, lentils, peanuts, etc.) and nuts (walnuts, cashews, almonds, etc.).
- Eat very small amounts of low-glycemic-load fruits (e.g., melons, berries).
- Steer clear of grains and fruit juices
- Speak with your health provider about using a starch blocker (a medication or supplement designed to deactivate the enzyme amylase that digests starch). We recommend starch blockers in addition to reducing carbohydrates, not as substitute for reducing carbohydrates.
- Eat unlimited amounts of low-starch above ground vegetables (cabbage, Brussels sprouts, broccoli, kale, mustard greens, Swiss chard, collard greens, spinach, lettuce, peppers of all colors, Chinese cabbage, bok choy, snow peas, celery, cauliflower, zucchini, cucumbers, etc.), preferably fresh and lightly cooked.
- Cut all high glycemic-load foods from your diet, including anything that contains sugar or refined starch (breads, pastries, pasta, candy, soft drinks, etc.) and all high-starch vegetables (potatoes, corn, etc.). In recent years, many new low-carbohydrate breads, desserts, and pastas have come on the market, making it easier to eat the kinds of foods you enjoy without the high glycemic load of refined sugars and starches.
A lot of people think it’s eating fat that makes us fat, but really, it’s our juices, sodas and sweet tea. Oprah’s Doctor Oz bans them from his household:
And that’s the trick: don’t make simple carbohydrates an option in your refrigerator. Don’t just cut back –cut out completely– and this will stop cravings after 1-2 weeks (you’ll notice a difference on day 1 in my experience), and disease-causing pink-cream spikes will stop immediately. It starts at the grocery store.
You can look up foods on nutritiondata.com‘s food search. Anything below 10 is a low-glycemic food, and anything between 10-20 is midrange (don’t eat too much of it) and anything over 20 should generally be avoided. If you eat something that spikes your blood sugar (say a cake or coke on a special occasion) make sure you blunt the effects with an additional food high in fiber, fat, protein, or you can even ingest some cinnamon if you plan ahead. It’s kind of like that Mitch Hedberg joke:
That would be cool if you could eat a good food with a bad food and the good food would cover for the bad food when it got to your stomach. Like you could eat a carrot with an onion ring and they would travel down to your stomach, then they would get there, and the carrot would say, “It’s cool, he’s with me.”
Here are two videos that explain some common blood-sugar traps people fall into:
Some words on diet sodas and artificial sweeteners, from Transcend (or you can see this video):
A Few Words about Sweeteners
Sugar is bad for you!
Well, maybe a few more words are called for because this point can’t be stressed enough. We feel sugar is so bad that we call it the “White Satan.” There is overwhelming clinical evidence linking consumption of high-glycemic-load carbohydrates to increased risk of type 2 diabetes, cardiovascular disease, cancer, obesity, AGEs, and the metabolic syndrome. And without doubt, refined sugar in its many forms (cane sugar, beet sugar, high-fructose corn syrup, etc.) tops the list of most dangerous high-glycemic-load carbohydrates. At the beginning of the 20th century. Americans averaged about 5 pounds of sugar each year. Today, estimated annual consumption of sugar in the United States is more than 150 pounds for every man, woman, and child. Much of this sugar is consumed in the form of soft drinks, averaging 53 gallons per person per years. Of course, these averages include a lot of people who consume little or no refined sugars, which leaves many others putting away enormous quantities indeed. And all that soda pop is turning these people’s blood into pink cream. And then there are all the other prepared foods that are loaded with refined sugars, from the obvious breakfast cereals, cakes, cookies, and candies to not-so-obvious items such as frozen microwavable entrees–more pink cream. The alarming rise in obesity rates in recent years, including among children, is directly related to this glut of sugar in our diet.
Despite overwhelming evidence of the terrible health consequences of our national sugar addiction, public health authorities and most physicians in the United States have yet to fully raise the alarm. This is due in part to the power of the sugar industry, which, just as was seen in the past with the tobacco industry, has managed to thwart efforts by government health agencies to issue any official warnings about sugar consumption. Even on an international level, it wasn’t until 2003 that the World Health Organization included recommendations in its health guidelines that people cut total calories consumed in the form of refined sugars to less than 10 percent–an amount that is still far too high. However, there’s no need for you to wait for an official warning to take the initiative in your own life and eliminate or greatly reduce your consumption of sugar.
“But,” you may be saying, “I love my sweets. What about sugar substitutes?” In our experience, the best course is to train your tastebuds to be happy without the regular stimulation of sweet foods, but if that’s not possible, here are our recommendations:
- Saccharin was linked to bladder cancer in laboratory animals, and despite recent efforts by producers to have warnings to that effect removed from labels, we feel the evidence is still persuasive enough to recommend against its use.
- Aspartame (Nutrasweet and Equal) is also to be avoided because of a host of health concerns raised by several studies, such as one reported in 1991 in the journal Pharmacology and Toxicology liniking it to significant imbalance of amino acids and neurotransmitters in the brain, including lowered serotonin levels.
- Acesulfame-K (Sunett, acesulfame potassium) is not recommended in light of studies linking it to possible genetic damage and stimulation of insulin production.
- Sucralose (Splenda) has yet to be definitively linked to any specific health risks. It is a modified form of sugar that passes through the digestive tract without being absorbed into the bloodstream, so it appears to be a better alternative than saccharin, aspartame, or acesulfame-K, but we advise caution until more research is done.
- Stevia is the only calorie-free sugar substitute that we do recommend–in small quantities. Stevia, derived from a South American shrub (Yerba dulce) is more than 100 times sweeter than table sugar. It has been used for at least 1,500 years for culinary and medicinal purposes in South America, and is widely used in Japan today. Stevia is not available as sweetener in the United States, Canada, or the European Community; rather it is marketed as a nutritional supplement. It is not “generally regarded as safe” by the FDA as animal experiments have shown that high doses can lead to reduced sperm production and could cause infertility in rodents. Research in humans thus far has not linked moderate stevia consumption with any harmful effects. In fact, numerous studies have demonstrated important health benefits, including lowered blood pressure and blood sugar levels, increased energy and mental activity, reduced tobacco and alcohol cravings, and antibacterial effects in the mouth. We feel the best course is to get used to not sweetening foods and beverages but feel that low or moderate amounts are stevia are acceptable.
For those with a sweet tooth I recommend low-glycemic load fruit. Fruit tastes like candy but is full of fiber so your energy stays level. I blend green smoothies and because the whole plants are blended it still retains the filling effects of fiber (and the water I added) along with the beneficial phytonutrients. Put them in a 40oz stainless steel bottle and you can easily transport it for on-the-go eating –that does not even require you to chew since it’s liquid. Drink the portions (that you didn’t pour in a bottle) as breakfast along with some oatmeal or broccoli with protein-rich black beans. Breakfast, the first, most important meal of the day (when your blood sugar is low) is crucial for sustained energy. So avoid the coffee/bagel combo — Dr. Perricone explains:
Here’s my secret 
for snacking (when you’re in a bind and don’t have a meal ready). Try mixing 0-glycemic load, anti-inflammatory, monounsatured-fat, cholesterol-lowering, hunger-satiating raw nuts (walnuts are good too) with raw, unsalted sunflower seeds and your favorite type of dried fruit. It makes for a complex flavor infusion on your tongue. And if you eat a handful, wait a bit for it to digest some, it will satiate your hunger. This will keep you from turning into pink cream 
and crashing 
– instead it will tide you over until your next nutrition-packed meal. Or you could eat animal products which typically have 0-carbohydrates (and 0 sugar) — this is why Atkins diets work. 
So I suggest we all prepare ahead when at the grocery store … my 2 
.
