Carbohydrates and Insulin

Measuring the Insulin Response





Carbohydrate Intolerance

With generations of people over-consuming carbohydrates, many now have a problem I call carbohydrate intolerance, or CI. It’s now an epidemic. CI begins as a functional problem that negatively affects quality of life and gradually results in serious illness and disease. Though most people are unaware such a condition even exists in its early stages, a high percentage of the population suffers from CI in its early and later stages. The symptoms of early CI are very common and include sleepiness after meals, intestinal bloating, increased body fat, fatigue and many others listed in the survey that follows. CI is referred to by other names, but it is best viewed as one long progression of the same problem. In the early stages, the symptoms can be elusive, often associated with blood-sugar problems, fatigue, intestinal bloating and loss of concentration. In the middle stages, the worsening condition may be referred to as carbohydrate-lipid metabolism disturbance, and cause more serious conditions such as hypertension, elevations of LDL and lowering of HDL cholesterol, elevated triglycerides, excess body fat and often obesity. In the long term, CI manifests itself as various diseases, including diabetes, cancer and heart disease. These end-stage conditions are part of a set of diseases now well recognized and referred to as Syndrome X, or the Metabolic Syndrome. To make this process easy to understand, the full spectrum of these problems can simply be referred to as CI. Young people with CI are at much higher risk for disease later in life. For example, those with CI have an estimated tenfold greater risk for developing diseases such as diabetes. Some individuals who ultimately become diabetic display symptoms of carbohydrate intolerance 20 years or more before the onset of disease. Even birth weight can be a predictor of CI. Like many problems, CI is an individual one, affecting different people in different ways. Only you can determine how intolerant you are to carbohydrates, and to what degree. Blood tests will diagnose the problem only in the middle and latter stages, but the symptoms may have begun years earlier. The key to avoiding the full spectrum of CI is to be aware of it in its earliest stage, and to make the appropriate diet and lifestyle changes. This will improve quality of life immediately and prevent the onset of disease later. However, for those already in a disease state, significant immediate improvements can still be made with the proper adjustments. Following is a list of some common complaints of people with CI. Many occur immediately following a carbohydrate meal, and others are constant. While keeping in mind that these signs and symptoms may also be related to other causes, ask yourself if you have any of these problems:

* Physical fatigue. Whether you call it fatigue or exhaustion, the most common feature of CI is that it wears people out. Some are tired just in the morning or afternoon; others are exhausted all day.

* Mental fatigue. Sometimes the fatigue of CI is physical, but often it’s mental (as opposed to psychological); the inability to concentrate is the most evident symptom. Loss of creativity, poor memory, and failing or poor grades in school often accompany CI, as do various forms of “learning disabilities.” This is much more pronounced immediately after a meal, or if a meal is delayed or missed. The worker who returns to his or her job site after lunch, only to be unable to concentrate due to mental fatigue, is a very common example. Some actually fall asleep at their desk after lunch.

*Blood-sugar problems. The blood sugar may be normal until a carbohydrate meal is consumed, or if meals are not eaten on a regular schedule. Periods of erratic blood sugar, including abnormal hypoglycemia, accompanied by many of the symptoms listed here, are not normal. Feeling jittery, agitated and moody is common with CI, and is relieved almost immediately once food is eaten. Dizziness is also common, as is the craving for sweets, chocolate or caffeine. These symptoms are not necessarily associated with abnormal blood-sugar levels, but may be related to neurological stress, possibly due to the changes in blood sugar and insulin.

* Intestinal bloating. Foods that produce the most intestinal gas are complex carbohydrates, specifically starches, such as wheat products and potatoes, and other nonstarch carbohydrates such as sugar. People with CI often suffer from excessive gas production. Antacids, or other remedies for symptomatic relief, are not very successful in dealing with the problem. The gas tends to build and is worse later in the day and at night.

* Sleepiness. Many people with CI get sleepy immediately after meals containing more than their limit of carbohydrates. This is typically a pasta meal, or even a meat meal that includes bread, potatoes or dessert.

*Increased body fat. For most people, too much weight is no much fat. In males, an increase in abdominal fat is more evident and an early sign of CI (I call this the “carbo belly”). In females, it’s more prominent in the upper body compared to the thighs and legs. In the face, “chipmunk cheeks” may be a telltale sign.

* Increased triglycerides. High triglycerides in the blood are often seen in people with CI. These triglycerides are the direct result of dietary carbohydrates being converted by insulin into fat. In my experience, fasting triglyceride levels over 100 mg/dl may be an indication of a carbohydrate- intolerance problem (even though 100 is in the socalled normal range).

*High blood pressure. Most people with hypertension have CI. There is often a direct relationship between insulin levels and blood pressure — as average insulin levels elevate, so does blood pressure. For some, regardless of whether the blood pressure is elevated, sodium sensitivity is common and eating too much sodium causes water retention along with elevated blood pressure.









*Depression . Because can be a natural “downer,” depression is common among people who have CI. Carbohydrates do this by adversely affecting levels of neurotransmitters made in the brain, producing feelings of depression. Many people have been taught that sugar is stimulating, but actually the opposite can be true. Some people have a short, initial burst of energy after eating sugar, but it does not last. This is a significant consideration for children or adults trying to function optimally at school, home or work. . Because carbohydrates can be a natural “downer,” depression is common among people who have CI. Carbohydrates do this by adversely affecting levels of neurotransmitters made in the brain, producing feelings of depression. Many people have been taught that sugar is stimulating, but actually the opposite can be true. Some people have a short, initial burst of energy after eating sugar, but it does not last. This is a significant consideration for children or adults trying to function optimally at school, home or work.

In addition to the signs and symptoms listed above, carbohydrates, especially sugar, can be addicting. Some people have trouble accepting that notion as there are no clear scientific studies to demonstrate the claim. Many professionals have struggled trying to help patients who could not reduce or eliminate sugar despite its unhealthy hold on them. We still don’t have a clear scientific study that shows sugar or other refined carbohydrate foods can be addicting. However, some studies do show that certain foods, like sugar, can trigger the brain’s reward centers — the same brain areas stimulated by cocaine, nicotine and other well-accepted addicting substances. The fact that food can be addicting is well accepted — and even proven — by the very companies who use addiction as a powerful tool to sell these products. Food advertisers, who spend billions of dollars each year, know very well about addiction, and how to tease you with foods that can kill you. These ad campaigns are especially successful with children, and they are not unlike those used by the tobacco industry for so many decades. If society placed sugar in the same category as cigarettes, there would be a revolution. State, city and even federal government agencies would ban sugar and refined carbohydrate foods due to the

astronomical cost of health care associated with its addiction. Companies that make cereals, candies, cookies and sugar itself would be sued, much like the tobacco class-action lawsuits of recent history.

I can imagine the secret after-school cookie deals, sugar at $650 a pound, or by prescription only, and the growth of sugar addiction clinics where the treatment of choice would be artificial sweeteners. Well, things may be heading that way. With some countries banning sugar food ads on children’s TV, banning of soda in schools, restaurants being required to post calories in their meals, and other restrictions, the war has begun. Science is catching up too. But let’s not rely on the government, science or anything or anyone else to get us to act. Like other addictions we are the responsible parties. There is help if we need it, but after a long time in clinical practice it’s clear to me that each of us holds the key to control or eliminate (depending on the definitions) addiction despite the ongoing propaganda from big corporations who continue to peddle their deadly foods. Not only can carbohydrates be addictive, but CI is a prevalent problem in persons addicted to alcohol, caffeine, cigarettes or other drugs. Often, the drug is the secondary problem, with CI being the primary one. Treating this primary problem should obviously be a major focus of any addiction therapy, which can make recovering from other drugs more successful. Other groups of people are very vulnerable to CI, including those who are inactive, under stress, taking estrogen, dark skinned and those with a family history of diabetes and other diseases of the metabolic syndrome. In addition, aging is frequently accompanied by increased carbohydrate intolerance.

The Metabolic Syndrome

If CI is not corrected in the early stages, your signs and symptoms, and your overall health can easily worsen and even lead to disease. There is a whole complex of related diseases that include some of the biggest killers of today: heart disease, cancer, stroke, diabetes and others. These diseases kill more people in the United States each year than died in all of our wars combined. This disease complex is referred to as the Metabolic Syndrome (or Syndrome X). The specific

disorders include: • Hyperinsulinemia • Diabetes (type 2) • Hypertension • Obesity • Polycystic ovary • Stroke • Breast cancer • Coronary heart disease • Hyperlipidemia (high blood cholesterol and triglycerides)

These problems don’t necessarily all develop or even evolve in this order. But all are related to CI. Unfortunately, once some of these diseases develop, many of the changes are more difficult to treat conservatively, and more extreme care may be needed. However, even these conditions can improve with the right dietary control, which includes solving the problem of excess carbohydrate intake. How do you adjust your lifestyle so that carbohydrate intolerance is not a problem? Before you do anything, you need to know just how sensitive you are to carbohydrates. Your doctor may do some tests, including checking insulin and glucose levels, to see if the problem can be detected. You could just follow a low-carbohydrate diet, but the better choice is to determine your own specific needs. Finding your optimal level of carbohydrate intake is the first step to balancing the rest of your diet. In the mid 1980s I developed an effective method of finding the optimal level of carbohydrate intake. It’s called the Two-Week Test and is detailed in the following chapter.

As companies began refining healthy foods, making them sweeter and increasing shelf life, sometimes to months and years, the nutritional quality of these foods diminished significantly. This is true of carbohydrate foods more than any other. This includes the mass productionof sugar that has grown dramatically as its use in many foods continues to increase. The result is that over the past few generations most people consume too much carbohydrate. Today, one obviousresult is that overfat people now make up the majority! One reason is the fact that a significant portion of carbohydrate foods turns to fat inthe body.The trend in carbohydrate overconsumption continues today, propelled by companies selling refined carbohydrates and sugar. They’ve been so successful that the newest epidemic includes obesebabies. This is due to the promotion of highly refined baby cereals, which are actually worse for babies than pure sugar.For many generations, the common recommendations have been to eat a large amount of carbohydrates. And, if you’ve followed the USDA food pyramids through the years most of your diet is carbohydrate, and you’ve gotten fat. The problem goes beyond being fat —highly refined carbohydrate diets are unhealthy on all levels, significantly reducing human performance. Today, the term “carbohydrate” is almost always synonymous with “refined carbohydrate.” One reason for this imbalance is that the human body has notadapted to processing this amount of carbohydrates, especially in refined forms. For 99.6 percent of our existence on earth, humans consumed diets that were relatively low in almost all carbohydrates but higher in fat, protein and vegetables. During most of evolutionary history,humans lived near the sea and consumed significant amounts of fish, seafood, and other land-animal proteins. More importantly, significant amounts of plant foods were also consumed. These included vegetables, fruits, nuts and seeds, which help protect against the potential effects of high intakes of saturated fat. In addition, our ancestors were very active physically. Only in the last 5,000 years has this changed. The Agricultural Revolution brought a dramatic increase incarbohydrate foods, and the Industrial Revolution brought highly refined carbohydrates to the table. The intake of carbohydrates by humans has never been so dramatically high as it has been in just thelast 100 years. This relatively short period of significant dietary change has contributed to many problems leading to heart disease, cancer, obesity and other diseases.For most people, eating such a high-carbohydrate diet can reduce fat-burning and energy production, increase body-fat storage, significantly reduce overall health, and greatly diminish human performance.Common foods including breads and other items made with flour such as rolls, muffins, pancakes, waffles, cereals and pasta are among the highest in carbohydrates. Also included in this category are al sweets, including the hidden sugars found in many foods. One of the main problems associated with eating carbohydrates has to do with insulin.Insulin is a hormone made by the pancreas. When you eat carbohydrate foods, they are digested and the carbohydrate is absorbed into the blood as glucose (blood sugar). This stimulates the release ofinsulin, which has many different jobs. Three key actions of insulin on blood sugar include the following:• About 50 percent of the carbohydrate you eat is quickly used for energy in the body’s cells. (Earlier we talked about getting energy from both sugar and fat — this is the part that comes from sugar.)• About 10 percent of the carbohydrate you eat is converted to and stored as glycogen, a reserved form of sugar. When blood sugar is low, glycogen stored in the muscles and liver is converted back to glucose and used for energy.(Muscle glycogen is used for energy by the muscles containing it, and liver glycogen is used mostly to maintainblood-sugar levels between meals and during nighttimesleep.)• About 40 percent of the carbohydrate you eat is convertedto fat and stored.Insulin production occurs as a normal process each and every time you eat a meal containing carbohydrates. Small amounts of insulin may also be produced if you consume a protein-only meal, and in some people, a high-protein meal can stimulate significant amounts of insulin. But for most people, it’s predominantly carbohydrates that trigger the insulin mechanism. The more carbohydrates consumed, the more insulin produced. For many people — especially those who are overfat and those who have consumed a high carbohydrate diet for a long time — eating carbohydrates results in production of too much insulin. This leads to a condition referred to as insulin resistance, and it’s associated with the inability of insulin to efficiently fuel the cells, especially the muscle cells, with glucose. As a result, the cells do not get all the glucose they need for energy. When these people eat carbohydrates, the brain can get the message that the cells don’t have enough sugar and it tells thepancreas to make more insulin. Finally, insulin is produced beyond normal limits, a condition referred to as hyperinsulinism — too much insulin. While it takes more insulin to get glucose into the insulinresistant cells efficiently, this hormone still performs its other tasks, including converting carbohydrates to fat. As mentioned previously, in a normal person, 40 percent of the carbohydrates eaten is converted to fat. In a person who produces too much insulin, that number may be much higher, perhaps 50 to 60 percent. In many people, this excess production of insulin may be amplified due to genetics, or it may be a normal response to eating too much carbohydrate. If you have a family history of diabetes, heart disease, high blood pressure or stroke, the odds are greater that you have less tolerance for carbohydrate consumption. Lifestyle also contributes to this problem, including poor dietary habits such as eating too much carbohydrate, too little protein, lack of exercise and stress.But even if diabetes runs in your family, you still may be able to control the problem with the proper lifestyle factors. In addition to causing even more carbohydrates to convert and store as fat, excess insulin can lower the blood sugar too drastically. Since the brain exclusively relies on glucose for fuel, this can result in impaired mental function, including loss of memory, reduced concentration and other cognitive function. Low blood sugar also often results in hunger, sometimes only a couple of hours, or less, after the meal. Cravings, often for sweets, are frequently part of this cycle, andresorting to snacking on more carbohydrates maintains the cycle. And if you don’t eat, you just feel worse. Eventually, the fat-storage deposits get bigger.High insulin levels also suppress two important hormones: glucagon and growth hormone. Glucagon has the opposite effect of insulin and is produced following protein consumption. While insulin promotes storage, glucagon promotes the utilization of fat and sugar for energy. Growth hormone is also important for sugar- and fat-burning, the regulation of minerals, and amino-acid action onmuscle development.If your goal is to burn more body fat, improve your health and increase human performance, you must eliminate refined carbohydrates, and determine how much natural carbohydrate your body can effectively metabolize. This will vary from person to person. Before discussing how that is accomplished, let’s look at some other important aspects of carbohydrates and insulin.The glycemic index (GI) is an indicator of how much your blood sugar increases after eating specific carbohydrate foods. However, it must be noted that glycemic index is only a very general measure ofresponses to food, and individual variation is not considered in studies of foods and their glycemic effects. High-GI foods, which produce the greatest glucose response, include bagels, breads, potatoes, sweets and other foods that contain refined flour and sugar. Many processed cereals, especially those containing the sugar maltose, which has a very high GI, produce an even stronger glucose response. Even foods you may think are good for you can trigger high amounts of insulinincluding fruit juice and bananas. The biggest problems in most dietsmay be wheat products, potatoes, fruit juice and sugar or sugar-containingproducts.Carbohydrates with a lower GI include some fruits, such as grapefruits and cherries, and legumes such as lentils. Non-carbohydrate foods, proteins and fats, usually don’t cause a glycemic problem,although in some people even meals high in protein and/or fat can trigger an abnormal insulin response. In these situations, eating smaller and more frequent low-glycemic meals often solves the problem, as discussed later.Most vegetables contain only small amounts of carbohydrates (except very starchy ones like potatoes and corn). Carrots were at one time believed to be a high-glycemic food, but studies have shown theglycemic effect of this root vegetable to be relatively low. By moderating carbohydrate intake to control insulin production, you can increase your ability to burn fat as an optimal and efficientsource of almost unlimited energy. Rather than using the glycemic index as a guide, which has become more common, especially among diabetics, all individuals should learn which foods and food combinations work best for their individual needs. This is most easily accomplishedby performing the Two-Week Test, along with proper followup, as discussed in the next chapter. Insulin responses to carbohydrate intake and the ensuing bloodsugar rise can vary greatly fro person to person. But generally, more refined carbohydrates evoke a stronger and more rapid production ofinsulin. One reason for this, as discussed earlier, is that humans are not adapted to diets high in carbohydrates, so our metabolism is not meant to process these foods. Another reason is that refined carbohydrates lack the natural fiber that helps moderate thecarbohydrate/glucose and insulin responses. Consumption of natural fiber with carbohydrates can reduce the dietary stress associatedwith high-carbohydrate meals. In practical terms, this means that eating refined foods like a cookie or piece of cake will cause more problems than eating a piece of fruit or whole-grain crackers with the same amount of carbohydrate and calories. Low-fat foods or low-fat meals containing carbohydrateshave a relatively higher glycemic index. This is due to quicker digestion and absorption of sugar when less fat is present. Eating carbohydrate foods in combination with some fats, such asolive oil or butter, slows digestion and absorption, thus moderating the insulin response. Moderate protein levels in a meal also can lower the glycemic index of the meal. Artificial sweeteners should also be avoided as even these foods can trick the brain and cause insulin responses through what is known as the cephalic phase of digestion.