Diving into our second series of Q & A’s is the all-too-common questions regarding carbohydrate consumption. To refrain from being to long-winded, I’ve only detailed three, though I think these are pretty common among individuals I come across and can relate to a wide range of the population. Let’s dive in!
How much carbohydrate should I eat?
Carbohydrates are the only macro nutrients without an established minimum requirement. Although many populations have thrived with carbohydrates as their main source of energy, others have done so with few little carbohydrate-containing foods throughout much of the year. If carbohydrates are not necessary for survival, questions are raised about the amount and type of this macro nutrient needed for optimal health, longevity, and sustainability. This really boils down to food preference and activity level. It becomes your choice of how much of your diet is made up from carbohydrates to satisfy your needs.
In a 2019 series of systematic reviews and meta-analysis, the findings linked to relatively high intakes of whole grains and dietary fiber were complementary, and links to a number of non-communicable diseases may be causal. Human health is thought to improve overall with the adoption in increasing dietary fiber consumption and switching to whole grains from refined grains. We may probably all agree that processed diets devoid of nutrients are not good for human health. Opting for high quality, whole grains while simultaneously increasing your fiber content, is a win-win overall. Carbohydrates, though, are nearly essential for all athletes in one way or another.
Regarding Athletes:
The International Society of Sports Nutrition (ISSN) latest guidelines state:
Endogenous glycogen stores are maximized by following a high-carbohydrate diet (8–12 g of carbohydrate/kg/day [g/kg/day]); moreover, these stores are depleted most by high volume exercise.
If rapid restoration of glycogen is required (< 4 h of recovery time) then the following strategies should be considered:
aggressive carbohydrate re-feeding (1.2 g/kg/h) with a preference towards carbohydrate sources that have a high (> 70) glycemic index
The addition of caffeine (3–8 mg/kg)
Combining carbohydrates (0.8 g/kg/h) with protein (0.2–0.4 g/kg/h)
How is blood sugar regulated by the carbohydrates i eat?
I get this question a lot and it’s usually revolving around eating carbohydrates and concerns about a high blood sugar/glucose response.
This answer is going to be broken up into three different ways/scenarios of answering this question.
Type 1 Diabetes: Both Type 1 and Type 2 diabetes are categorized as issues with glucose sensing and utilization, but really have drastically different etiologies and ways to manage the condition. Type 1 diabetics regulate their carbohydrate intake through the use of exogenous insulin to balance and mitigate the rise in glucose from the carbohydrates they’ve eaten due to the pancreas being unable to regulate this itself. Because carbohydrates are of specific concerns for those with T1D, a very individualized approach should be handled and understood by both the person and clinician they see.
Type 2 Diabetes: In those with T2D, the pancreas is still functioning but not at an optimal level regarding the sensing of glucose or the ability to efficiently transport it where it needs to go in the body. Glucose control is important for those with T2D and remission of this condition has now been studied and confirmed as something that patients and clinicians alike can shoot for as a goal. Previously thought to be a condition of the over-consumption of carbohydrates, it really boils down to the over-consumption of calories in general, causing metabolic damage throughout the body if not recognized in its infancy. How to handle carbohydrates? This is a good question as it can be managed in multiple ways. Once a person acknowledges that their condition is not driven by dietary carbohydrates, but an excess in overall consumption, they can then focus their attention purely on the amount eaten and consumed on a daily basis. Organizing a diet should prioritize protein first, while dietary fat and carbohydrates can make up the rest depending on the person's dietary preference. If someone feels better, more satiated when eating more dietary fat, those calories can be calculated into their total daily calorie allotment with carbohydrates making up the rest. The same goes on the flip side 100%. Weight loss completely on its own through the composition of multiple types of food preferences have shown to reverse and put in remission the condition of T2D.
Those without Diabetes: Individuals without diabetes do not typically experience dangerously low blood glucose levels because of counterregulatory hormonal regulation of glycemia. From here, it’s mainly a choice of preference as well. Composing your daily nutrition around foods you like to eat, are enjoyable and leave you feeling good are important factors for each person when establishing what a good diet might look like. We have many different studies being published all the time confirming weight loss with both low carb diets, as well as higher carb diets.
Would cutting out carbs help with gut issues?
Ahh. One of my favorite topics. GUT HEALTH! So many different rabbit holes to travel down when individuals inquire about gut health/microbiome topics. To start us off here, I think I’ll have some pretty solid backing when I say that we really don't have much of an idea what is REALLY going on regarding ingested food and the entire metabolic fate that follows in a positive or negative way. What I think we have at least a decent understanding of, is that certain foods can without a doubt cause a negative reaction to our gut lining and digestive tract when consumed. So to answer the question. YES!... Maybe?
We know that certain diagnosed inflammatory bowel diseases such as celiac disease, crohn’s disease and diverticulitis require immediate intervention for one’s nutrition to attempt to regain their quality of life and is importantly defined as an immune system reaction. For other disorders of the gastrointestinal tract, it can truly be a game of trial and error with removing possible food triggers and tracking symptoms associated with alterations. As such, conditions like Irritable Bowel Syndrome can be extremely hard to actually diagnose, although new criteria do seem to be emerging helping clinicians to isolate conditions like these from other more serious or not so.
It is well-known that patients with a higher degree of self-reported food intolerance show more severe IBS symptoms. It’s possible you’ve heard of the FODMAP diet (LFD). FODMAP’s consist of fermentable oligo-, di- and monosaccharides, and polyols. It’s important to state that All FODMAPs are potential triggers, but, fortunately, not all FODMAPs exacerbate abdominal symptoms in the same IBS patient.
What’s been really important for me to learn throughout my graduate studies pertaining to gastrointestinal disorders but IBS, and a low FODMAP diet in particular is that a LFD is not only a gluten/lactose-free diet. It is a more of a global restriction, which has a greater and more consistent effect than a more limited diet. Therefore, for example, a single pear may not cause an IBS flare up, but consuming some slices of bread, half an onion, a pear, and a glass of milk during the same meal may cause the onset of IBS symptoms.
The low-FODMAP diet is more than just a "avoidance diet." Additionally, it can be used as a diagnostic tool to determine a person's tolerance to particular meals, allowing them to completely cut out these foods from their diets and drastically alter their lifestyles. A LFD entails eliminating all FODMAPs from the diet for four to eight weeks, then gradually reintroducing them as tolerated by the individual. This makes it possible to tailor the diet and carry it out over time.
If you do feel like you have certain intolerance to food which could manifest in a multitude of ways (headache, stomach discomfort, brain fog) it could definitely be beneficial to discuss that with your PCP or gastrointestinal specialist.