Nutritional Pearls: Carbohydrate Quality Counts
Jeffrey is a 45-year-old man who has struggled with weight loss for many years. He explains that after doing some Internet research, he has decided to follow a carbohydrate-free diet in an effort to quickly shed some extra pounds.
He tells you that he has been having a very hard time cutting out all carbohydrates, and asks you if you have any advice that could make things easier on him.
How do you advise your patient?
What is the correct answer?
(Answer and discussion on next page)
Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance.
Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen with familiar, healthy recipes. He is an assistant dean for clinical services, executive director of The Goldring Center for Culinary Medicine, associate professor of medicine at Tulane University in New Orleans, faculty chair of the all-new Certified Culinary Medicine Specialist program, and co-chair of the Cardiometabolic Risk Summit.
Now, for the first time, Dr. Gourmet is sharing nutritional pearls of wisdom with the Consultant360 audience. Sign up up today to receive an update from the literature each week.Answer: Eating better quality carbohydrates can help your patients maintain a normal weight.
I've been saying for decades that it's the quality of the calories you put in your mouth and body that really count. Since I'm an allopathic, evidence-based physician talking about health and nutrition, people assume that I'm all about weight loss. The truth is, I'm not. Yes, it's true that having a normal weight according to the body mass index means a reduced risk of many chronic illnesses. But when patients come to me for treatment, I'm far more interested in improving what they eat than in whether they need to lose weight.
One of the easiest changes for people to make when they're improving the quality of the calories in their diet is to improve the quality of the carbohydrates they're eating. I've written columns on improving your carbohydrate choices,1 but tips include choosing brown over white rice; whole wheat pasta over white pasta (or quinoa pasta over rice pasta, if you have Celiac disease), and forgoing sugary cereals in favor of oatmeal or whole-grain cereals like Total® Raisin Bran.
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The Research
Researchers in Spain made use of data gathered in an ongoing study to see if the quality of the carbohydrates people ate would actually help prevent them from gaining weight.2 They defined carbohydrate quality by looking at 4 criteria in an individual's diet: dietary fiber intake, glycemic index, ratio of whole grains to total grains, and ratio of solid carbohydrates to liquid carbohydrates. They then converted the totals into 5 levels of increasing intake and then to a score ranging from 4 to 20 (the CQI - Calorie Quality Index).
The participants included in this analysis of the study (known as the SUN Project: Seguimiento Universidad de Navarra) included only those men and women of clinically normal weight at the start of the study who filled out the study's biannual dietary and demographic questionnaires completely (about 8,700 people). After about 8 years of follow-up, the researchers looked at the CQI of those who gained weight—and how much—and compared that intake with those who gained less. (The researchers note that on average, all participants gained weight during the 8 years of follow-up.)
The Results
After taking into account age, sex, smoking status, physical activity, family history of obesity, and other variables, the small differences in yearly average weight gain between those with a high CQI score and a low score became statistically insignificant. However, when they compared the scores of those who became clinically overweight or obese with those who remained of clinically normal weight, those with the CQI scores in the top two quintiles were at least 33% less likely than those with the lowest scores to become overweight or obese in the 8 years covered in the study.
The researchers note that those with the highest CQI scores consumed a greater number of calories from carbohydrates than those with lower scores, suggesting that it was the quality of the carbohydrates that protected them from overweight or obesity.
What’s the Take-Home?
I find it concerning that the authors of this study chose to use Glycemic Index in their calculation of carbohydrate quality: the GI of a single food can be affected by what it is eaten with,3 and a yearly dietary questionnaire simply cannot provide researchers with every food combination a person consumes. That aside, this study does suggest that eating better quality carbohydrates can help your patients maintain a normal weight, and those better quality carbohydrates are likely to contain more fiber, making them more satisfying and helping them lose weight if necessary.
Here's my column on choosing better quality carbohydrates for you to share with your patients: http://www.drgourmet.com/eatinghealthy/newpantry4.shtml
References:
- http://www.drgourmet.com/eatinghealthy/newpantry4.shtml
- Santiago S, Zazpe I, Bes-Rastrollo M, et al. Carbohydrate quality, weight change and incident obesity in a Mediterranean cohort: the SUN Project. Eur J Clin Nutr. 2015;69:297-302.
- http://www.drgourmet.com/bites/2011/062211.shtml