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A Nutritional Therapist in Birmingham is Recommending More Carbohydrates in Your Diet

The perception of carbohydrates has changed considerably in recent years. Once a staple in the British diet, particularly with our love for potatoes, carbohydrates more recently gained a negative reputation as a food group to be avoided or reduced due to their beige starchy composition, likened to sugar. Only recently has there been a slightly less confused understanding that carbohydrates are necessary as part of a healthy diet.[1] For a long time, carbohydrates have been excluded from popular diets and blamed for weight gain and blood sugar issues. Low-carbohydrate diets like Atkins and Keto[2, 3] are still trending within some fitness and health groups, which has resulted in many people avoiding carbohydrates altogether in recent years.

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Today, many nutrition experts are starting to recognise carbohydrates as the body's preferred fuel source.[4] The brain requires carbs for proper functioning, and current dietary guidelines recommend that 45-65% of total daily energy comes from carbohydrates.[5, 6] The focus has moved from simply reducing carbohydrate intake to emphasising the quality of carbohydrates consumed. Complex carbohydrates from whole grains, vegetables and fruit sources are incredibly beneficial for health.[6] Recent research shows that increased whole grains, vegetables, and fruit intake can be associated with less weight gain. People can regain weight control by replacing refined grains and sugar-sweetened beverages with healthier carb options.[6] It is important to acknowledge that the impact of quantities of carbohydrates differs based on factors like body weight and gender, so a personalised approach to carbohydrate intake should be individualized.

Recommendations for increased carbohydrates, particularly from complex sources, are widespread in my nutritional therapy practice due to their essential role in providing sustained energy, supporting digestive health, and promoting overall well-being when consumed as part of a balanced diet. This recommendation to increase complex carbohydrates is a significant shift in mindset for many people who then struggle with energy levels and brain fog because they have been depriving themselves of carbohydrates.[16] The recommendations are based on growing evidence that good-quality carbohydrates can stabilise blood sugar levels, improve insulin sensitivity, and provide vital nutrients and fibre, all contributing to better energy levels, brain function, long-term health outcomes and disease prevention. [7] People working in nutrition and health cannot ignore that the emphasis on complex carbohydrates complements the principles of the Mediterranean diet. The primary focus on whole grains, vegetables, fruit and legumes as complex, healthy carbohydrates aim to address common misconceptions about carbohydrates in general terms while promoting a more accurate understanding of carbohydrate types and their importance in maintaining optimal health. This acceptance of carbohydrates supports individuals with their health goals and will align with broader concerns about achievable and balanced eating patterns that people can sustain.[8]

Along with proteins and fats, carbohydrates are one of the three essential macronutrients for human health. They are crucial for providing energy and supporting various bodily functions. Carbohydrates are organic molecules composed of carbon, hydrogen, and oxygen atoms[4] and can be classified as simple and complex. For clarity, simple carbohydrates comprise one or two sugar molecules (monosaccharides and disaccharides). Examples include glucose, fructose, and sucrose (table sugar). These simple carbohydrates are digested quickly and absorbed, leading to a speedy increase in blood sugar levels. Complex carbohydrates are made up of long chains of sugar molecules (polysaccharides), including starches and fibre.[9] These are found in whole grains, legumes, and vegetables and are digested more slowly, providing sustained energy and better blood sugar control.

Nutritional Value of Carbohydrates

Simple carbohydrates provide four calories per gram, which makes them an important energy source for the body, while complex carbohydrates provide two per gram.[9] However, beyond essential energy provision, complex carbohydrates can offer several nutritional benefits that simple carbohydrates do not:

Sustained Blood Sugar Levels

Complex carbohydrates are superior to simple carbohydrates in providing sustained energy and are essential in naturally maintaining stable blood sugar levels. The molecular structure of complex carbohydrates requires more time for digestion and absorption; this gradual process results in a slower and more consistent release of glucose into the bloodstream.[9] Complex carbohydrates typically have a lower glycaemic index than simple carbohydrates, which means they cause a more gradual rise in blood sugar levels and avoid the rapid spikes and crashes associated with simple carbohydrates that are high-GI foods. The slow release of glucose provides a steady supply of energy over an extended period, maintaining consistent energy throughout the day. Regular consumption of complex carbohydrates can enhance insulin sensitivity, essential for efficient glucose metabolism (9). Complex carbohydrates often promote satiety, a fullness that lasts longer, aiding hunger cues and weight management.[10]

Fibre Content and Digestive Health

Complex carbohydrates are typically rich in dietary fibre, which is vital in digestive health. Fibre adds bulk to your stool, promoting regular bowel movements and preventing constipation.[4] Certain types of fibre (prebiotics) serve as food for beneficial gut bacteria; this is crucial for a healthy gut microbiome. High-fibre intake is now associated with a lower risk of digestive issues such as diverticulitis, haemorrhoids, and colon cancer. Soluble fibre in many complex carbohydrates can help lower LDL (harmful) cholesterol levels, contributing to heart health. Fibre also slows the absorption of sugar, which helps prevent rapid spikes in blood glucose levels.[11] Fibre-rich foods often require more chewing and take longer to eat, promoting satiety and potentially reducing overall calorie intake.

Complex carbohydrates are often found in nutrient-dense foods that provide a wide array of essential vitamins, minerals, and phytonutrients:

Vitamins

Whole grains, fruits, and vegetables are excellent sources of B vitamins, E, and C, which are crucial for various bodily functions, including energy metabolism and immune support.[12]

Minerals

Complex carbohydrate sources often contain essential minerals such as magnesium, potassium, and selenium, necessary for numerous physiological processes.[4]

Antioxidants

Many plant-based complex carbohydrates are rich in antioxidants, which help protect cells from oxidative stress and may reduce the risk of chronic diseases.[11]

Phytochemicals

These plant compounds found in fruits, vegetables, and whole grains have various health-promoting properties, including anti-inflammatory and anti-cancer effects.[11]

Protein

Some complex carbohydrate sources, particularly legumes and whole grains, also provide significant amounts of plant-based protein.

Healthy Fats

It is accepted that many plant-based complex carbohydrate foods, such as quinoa and oats, contain small amounts of healthy fats, including omega-3 fatty acids.

Examples of nutrient-dense complex carbohydrate sources include:

• Whole grains (e.g., brown rice, quinoa, oats)
• Legumes (e.g., lentils, chickpeas, black beans)
• Starchy vegetables (e.g., sweet potatoes, squash)
• Non-starchy vegetables (e.g., broccoli, spinach, carrots)
• Fruits (e.g., apples, berries, citrus fruits)

By incorporating these nutrient-dense complex carbohydrates into the diet, individuals can benefit from a wide range of essential nutrients while enjoying sustained energy and improved digestive health.[6]

The benefits of complex carbohydrates go beyond energy provision. Their ability to sustain blood sugar levels, support digestive health through fibre content, and provide a wealth of essential nutrients makes them a crucial component of a healthy, balanced diet.[10] As nutritional therapists increasingly recognise these benefits, they emphasise complex carbohydrates from whole food sources to support overall health and well-being.

Carbohydrates and Blood Sugar Management

Understanding how carbohydrates affect blood sugar levels is crucial for overall health (14), especially for individuals managing or at risk of diabetes. The concepts of glycaemic index and glycaemic load and the role of complex carbohydrates in blood sugar stabilisation are essential to diabetes management and prevention.[13]

Glycaemic Index and Glycaemic Load

Glycaemic Index (GI):

The glycaemic index measures how quickly a carbohydrate-containing food raises blood glucose levels. Foods are ranked on a scale from 0 to 100, with pure glucose given a value of 100:

Low-GI foods (55 or less) are slowly digested and absorbed, causing a gradual rise in blood sugar levels.

Medium GI foods (56-69) can cause a moderate rise in blood sugar.

High-GI foods (70 or above) are rapidly digested and absorbed, causing a quick spike in blood sugar levels.

While the glycaemic index provides information about the speed at which carbohydrates affect blood sugar, it does not account for the quantity of carbohydrates in a serving; this is the glycaemic load. GL takes into account both the quality (GI) and amount of carbohydrates in a portion of food:

GL = (GI x grams of carbohydrate) / 100

A GL of 20 or more is considered high, 11-19 is medium, and 10 or less is low.

Diabetes Management and Prevention

Understanding and managing carbohydrate intake is crucial for both diabetes management and prevention. For individuals with diabetes, choosing complex carbohydrates with a lower glycaemic index can help maintain more stable blood sugar levels throughout the day. This can reduce the need for insulin or other diabetes medications. Complex carbohydrates often promote feelings of fullness and satiety, which can aid in weight management – a critical factor in preventing and managing type 2 diabetes;[10]. Diets rich in low-GI complex carbohydrates are associated with a lower risk of developing type 2 diabetes. Improved Insulin Sensitivity: Regular consumption of complex carbohydrates, significantly those high in fibre, may improve insulin sensitivity over time.[13]

Understanding the concepts of glycaemic index and load and choosing complex carbohydrates over simple ones can significantly impact blood sugar management.[13] For individuals with diabetes or those at risk, this knowledge can be a powerful tool in maintaining stable blood sugar levels, reducing the risk of complications, and potentially preventing the onset of type 2 diabetes. The current dietary guidelines recommend that 45-65% of daily caloric intake come from carbohydrates, emphasising complex carbohydrates from whole food sources. A balanced approach ensures the body receives energy and nutrients while promoting overall health and well-being(5). Complex carbohydrates offer numerous health benefits that make them essential to a balanced diet. Their unique properties contribute to sustained energy, improved digestive health, and enhanced overall nutrition.[8]  

Debunking Carbohydrate Myths

In recent years, carbohydrates have been the subject of numerous misconceptions, leading to confusion about their role in a healthy diet. Many common myths surround carbohydrates, and it is essential to clarify their importance in a balanced nutritional approach.[15]

1. Carbohydrates Make You Fat

Reality: Weight gain is primarily caused by consuming more calories than you burn, regardless of whether those calories come from carbohydrates, proteins, or fats. Carbohydrates contain four calories per gram, the same as protein and less than fat (nine calories per gram). When consumed in a balanced diet and appropriate portions, carbohydrates do not inherently lead to weight gain.[10]

2. Low-carbohydrate diets Are Superior for Weight Loss

Reality: Low-carbohydrate diets can lead to initial weight loss, but research shows they are less effective long-term than other balanced dietary approaches. A systematic review found that low-carbohydrate and isoenergetic balanced diets resulted in similar weight loss over time.

3. All Carbohydrates Are Created Equal

Reality: There is a significant difference between simple and complex carbohydrates. Complex carbohydrates from whole grains, fruits, and vegetables provide essential nutrients and fibre, aiding weight management by promoting satiety and regulating blood sugar levels. [10]

4. Carbohydrates Are Addictive

Reality: While some people may crave carbohydrate-rich foods, there is no scientific evidence that carbohydrates are addictive in the same way as drugs or alcohol. Cravings are often related to emotional or psychological factors rather than physical addiction.[13]

Recommendations

Focus on complex carbohydrates from whole food sources to optimise health benefits. The table below is a list of healthy complex carbohydrate foods, along with suggested portion sizes and daily intake recommendations.[5,6,9] The Dietary Guidelines recommend that 45-65% of daily calories should come from carbohydrates (6). A 2,000-calorie diet translates to about 225-325 grams of daily carbohydrates. Here are some suggested portion sizes for different carbohydrate food groups:

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Again, it is important to note that individual needs may be different based on age, sex, weight, and activity level.[5] The recommended intake of 200-300 grams of carbohydrates daily is a general guideline for healthy adults.[5]

To ensure a balanced intake of complex carbohydrates:

• Make at least half of your grain intake whole grains
• Vary your vegetable choices throughout the week
• Always choose whole fruits over fruit juices
• Include legumes in your meals several times a week

It is also crucial to maintain a balanced diet that includes adequate protein and healthy fats.

In conclusion, the evolving understanding of carbohydrates highlights their essential role in a balanced diet. As scientific evidence shifts us away from outdated beliefs that demonize carbohydrates, it becomes clear that incorporating complex carbohydrates every day can significantly enhance our health. When focusing on whole food sources rich in nutrients and fibre, individuals can achieve sustained energy, improved digestive health, and better blood sugar management. This whole food approach not only supports personal health goals but also promotes a more accurate perception of why carbohydrates are such a vital component of a nutrient-dense diet.

References

1. Okburan, Gozde, and Ceren Gezer. “Carbohydrates as nutritional components for health and longevity.”Healthy Ageing and Longevity, 2021, pp. 39–52, https://doi.org/10.1007/978-3-030-83017-5_2.  
2. Wepman, Dennis. “Atkins, Robert (1930-2003), physician and Diet Specialist.”American National Biography Online, Oct. 2013, https://doi.org/10.1093/anb/9780198606697.article.1302683 . 
3. Dowis, Kathryn, and Simran Banga. “The potential health benefits of the ketogenic diet: A narrative review.”Nutrients, vol. 13, no. 5, 13 May 2021, p. 1654, https://doi.org/10.3390/nu13051654 . 
4. Reynolds, Andrew, and Jim Mann. “Carbohydrates.”Essentials of Human Nutrition, 15 Sept. 2023, https://doi.org/10.1093/hesc/9780198866671.003.0004 . 
5. “Who Updates Guidelines on Fats and Carbohydrates.”World Health Organization, World Health Organization, who.int/news/item/17-07-2023-who-updates-guidelines-on-fats-and-carbohydrates . Accessed 24 Oct. 2024. 
6. “Carbohydrates.”British Dietetic Association (BDA), 27 July 2023, www.bda.uk.com/resource/carbohydrates.html . 
7. Clemente-Suárez, Vicente Javier, et al. “The Burden of Carbohydrates in Health and Disease.”Nutrients, U.S. National Library of Medicine, 15 Sept. 2022.         https://pmc.ncbi.nlm.nih.gov/articles/PMC9505863/   .
8. “The evidence base for the Mediterranean diet.”Implementing the Mediterranean Diet, 7 Oct. 2022, pp. 1–1, https://doi.org/10.1002/9781119826743.part1 . 
9. Jenkins, David J.A., et al. “Simple and complex carbohydrates.”Nutrition Reviews, vol. 44, no. 2, 27 Apr. 2009, pp. 44–49, https://doi.org/10.1111/j.1753-4887.1986.tb07585.x.
10. Poppitt, S.D. “Carbohydrates and satiety *.”Satiation, Satiety and the Control of Food Intake, 2013, pp. 166–181, https://doi.org/10.1533/9780857098719.3.166 . 
11. Pluschke, Anton.The Impact of Soluble Dietary Fibre on Elements of Digestive Physiology, https://doi.org/10.14264/uql.2015.659 . 
12. “What to Eat and Drink to Boost Your Immune System.”Healthline, Healthline Media, www.healthline.com/health/food-nutrition/foods-that-boost-the-immune-system. Accessed 24 Oct. 2024. 
13. Seery, Conor. “Normal and Diabetic Blood Sugar Level Ranges.”Diabetes, 22 Nov. 2022, diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html . 
14. Debra Manzella, RN. “How the Glycemic Index Chart Can Help Manage Blood Sugar.”Verywell Health, Verywell Health, 2 Oct. 2024, verywellhealth.com/glycemic-index-chart-for-common-foods-1087476.  
15. “Busting the Top 10 Carb Myths - Today’s Dietitian Magazine.”Today’s Dietitian, todaysdietitian.com/newarchives/0416p30.shtml . Accessed 24 Oct. 2024. 
16. Orlando, Alex. “Why Does the Keto Diet Cause Brain Fog?”Discover Magazine, Discover Magazine, 25 Mar. 2024, discovermagazine.com/health/why-does-the-keto-diet-cause-brain-fog.