Moving Beyond Carb Confusion

In this post we talk about the need to refresh our approach to carbohydrate rich foods; and more specifically to reduce intake of "simple" and "refined" carbs.


First, a little perspective.

Carbohydrates are not evil. They have been the backbone of humankind since the dawn of civilization. The large scale cultivation of carbohydrates (e.g. cereal grains) provided the vast amounts of energy (calories) that fueled the growth and eventual urbanization of humans. They have also been important sources of protein, fiber, vitamins, minerals and essential fatty acids.

Throughout our evolution, humans (like all herbivors) have needed sugar and other carbohydrates to survive. Funnily enough, we still do. Of course, the dominance of cereal grains as the provider of carbohydrates is a relatively new phenomenon (10-15 thousand years). And the advent and supremely high intake of refined carbohydrates is extremely recent (within the last 50 to 100 years).

With all the media attention carbs have gotten recently, you would think our grain intake had reached historics highs. Actually, we eating less grains then we did 100 years ago.

Per Capita Grain Consumption.
Source: Putnam & Allshouse. U.S. Per Capita Food Supply Trends. Food Review. Sept. 1998

So why all the bad press? The reason is that our intake of refined grains has indeed skyrocketed: see the recent upslope in the graph above (a 50% increase in grain intake since 1973), the vast majority of that increase is from refined grains.

And study after study continues to point a damming finger at people who eat the most refined grains - revealing they have higher rates of obesity, heart disease, diabetes and so on.


What is refined or processed?
Most grains come from grasses. Each stalk of grass yields numerous berries or seeds -these are the nutrient and energy dense bundles that can generate entire new grasses. Fortunately for us, they are also edible.

To a certain degree all grains require some "processing" - harvesting, removing the outer husks from the grainseed and then sprouting or cooking. Yes, some grains like corn can be eaten raw. But most become more digestible and valuable when soaked, sprouted or cooked.

However, when we talk about "refining" we're talking about processing the grain even further by removing the outer layers (the bran + germ) from the grainseeds.

Layers of a whole grain.
Image Source: http://www.nutricoach.net/Carbohydrates.html

Grains, either in whole or refined form, can also be crushed or milled into flour or ground into meal. However, refined grain flour has been stripped of so many nutrients that they sometimes add back a small handful of the vitamins and minerals lost to the end product, called enriched flour. (Depending on the grain, processing it into a flour or meal also further strips it of some protein, fiber and nutrients.)

What is wrong with refining and processing grains?

Well, as mentioned, it turns out that most of the valuable nutrients, fats, and fiber are in the outer parts of the grain. Refining leaves us mostly with starch (long chains of sugar), a bit of protein and a few nutrients - we call this package a refined carbohydrate. So if you eat only refined and processed grains then you're missing out on most of the beneficial properties of the whole grain.

In the absence of fiber, these refined "carbohydrates" are rapidly absorbed from your digestive system - giving you a blood sugar spike. Eating refined grains raises your risk for diabetes; eating more whole grains lowers it.

Because fiber is (by definition) not absorbed, fiber-free grain (i.e. refined grains) is also more energy-dense. You'll eat more calories of a bowl of white rice then you will brown rice. Eating more refined grain will make you heavier; eating more whole grain will help you stay leaner.

A brief tangent. What's the difference between simple sugar and refined carbohydrate?
Sugar can be called simple or complex depending on how it's packaged. One or two sugar molecules by themselves = simple sugar (e.g. table sugar). Many sugar molecules chained together = complex sugar (e.g. starch inside grains or potatoes). For reasons you might guess, it's not too useful to talk about simple vs. omplex sugars because complex sugars by themselves are easily broken down into simple sugars. What matters is the whether the sugar is packed in fiber and nutrients - i.e. is it refined or unrefined?

Finally, refining grains into sugar makes them more addictive. This may be true of both simple (e.g. high fructose corn syrup) and to a slightly lesser degree complex sugars (e.g white wheat flour) refined from grains. This is a controversial point, but the emerging evidence is pointing in this direction. Sugar acts on the brain in a manner similar to many drugs. And refining makes all drugs more addictive, for at least two basic reasons. First, the active ingredient is vastly more concentrated and second it gets to the brain quicker, setting up a stronger cycle of high-withdrawal-high. Think: cocaine vs whole coca leaf tea; intravenous morphine vs. opium poppy milk.

Of course, we can take this comparison too far, but it is certainly possible that the addictive properties of sugar explain why so many of us have a hard time 'moderating' our intake of refined grains.

But you said sugar wasn't evil.

It's not. We all need sugar. But too much is bad. And slow-release sugar (i.e. sugar coupled with fiber and healthy fat) is arguably much better for us.

Refined grains are everywhere.
Cereal. Pasta. Bagels. Muffins. Rice. Crackers. Candies. Soda. Cakes. Pastries. Bread. The majority of these foods are made with refined grains today. Take a close look around and you will see how dominant refined grains are in the food supply.

Most of us are eating several of these foods everyday. They fill us up, preventing us from eating more nutrient dense foods. And as everyone knows, it's very easy to eat too many of them.

How to spot refined grains:

Refined grains are now the norm, so you will never see the word "refined" or "processed" in the ingredient list. Instead you need to recognize all the terms that code for refined:
-flour (or enriched flour)
-rice (or rice syrup)
-corn syrup (or high-fructose corn syrup, aka HFCS)
-corn or rice starch
-wheat
....And so on.

Another route is to realize that if the grain is still in its whole form then it will be labeled as such: the words "whole" or "unrefined" will be put in front of the grain name. e.g. whole wheat.

There are a few exceptions to know about: corn and oats are always "whole" grain. But they can be processed to one degree or another. Oat groats are much less processed than the steamed and squashed "instant oats", and therefore better for you. Whole grain rice will usually be called "brown rice" or "whole grain brown rice".

How to eat more whole grains:
1/ Start with your staples: start by looking at the foods you eat almost everyday. For example, many people eat a grain based breakfast (e.g. cereal, toast, muffins). Making sure these breakfast staples are 100% whole grain is a great start.

Likewise, many people eat rice or pasta almost every day. Switch to brown rice (I suggest investing in a rice maker). Experiment with the large variety of whole grain pastas (brown rice, quinoa, spelt, whole wheat) - some taste better than others, so keep on trying different ones until you know which you like best.

2/ Give yourself a few weeks to acquire the taste and habit. For example, some people love brown rice the instant they eat it, but for others it takes 3-4 weeks (or more) of frequent attempts before it starts tasting good. But in time, most people come to prefer brown to white rice.

3/ Create demand. We are creatures of habit and convenience. Ask for whole grains at restaurants and stores and soon enough you will start seeing them everywhere. We're already seeing this happen...


How to eat less refined and processed grains:

The first step is to switch your staple foods to whole grain varieties, as above.

Beyond that you will probably need to cut back on foods you probably shouldn't be eating on a daily basis - cookies, pastries, cakes, muffins, crackers, pancakes, waffles, crepes. These are treats, not everyday foods.

Yes, you can and should look for whole grain varieties of these foods. But chances are you will find varieties that might have some (but not all) whole grains in them. For instance, let's talk about cake:

Cake, even if made with whole wheat flour, is going to have a good amount of sugar (essentially the equivalent of maximally refined and processed grains) - otherwise it's just not a cake! Sugar comes in many forms - honey, agave, concentrated fruit juice or jam, brown rice syrup, brown sugar, molasses, cane sugar, beet sugar, high fructose corn syrup, maple syrup. Yes, some of these are slightly "better" forms of sugar than others, but they are still sugar - a touch is good, a lot is not.
In summary, whole wheat vegan double chocolate cake is a fantastic creation when made well. It should be thoroughly enjoyed, but not everyday.

Vegan Omega 3's and more

A Brief Overview of Fats
(If you know your fats well, skip to the end for the bit on Omega-3s)

Fat, also called lipid (and sometimes referred to by its liquid name "oil"), really describes a large and diverse group of substances that share a similar chemical structure of carbons linked together. Because of this similar structure, fats all are packed with energy, making them excellent storehouses for energy in the body. Fats are also a critical part of every single cell in our body and serve innumerable functions beyond that of simply providing energy.

There are groups of specialized fat storage cells called "adipose tissue" (when people talk about someone's fat, or love handles, or junk in the trunk, etc. they are talking about adipose!). A recent explosion in scientific research has begun to uncover Adipose tissue's hundreds of novel functions -- scientists are so impressed that they are calling for Adipose to be classified as a separate organ system.

Did I say I was going to be brief? Ok, so let's talk about fats from a vegan perspective according to the way we classify and organize fats:

Saturated Fats - saturated refers to the fact that all the carbons in these fats are full (i.e. saturated) with hydrogens. That's why I'll include partially hydrogenated and hydrogenated vegetable oils in this category. These fats are still a grouping of many types of fats, some of which are worse than others, but in general, these are the guys that raise blood cholesterol and contribute to heart disease and a very large host of atherosclerotic diseases. Yes, most saturated fat in the American diet comes from dairy and other animal foods.

But hefty amounts of saturated fat can creep their way into the vegan diet in the form of margarines, baked and processed foods (which contain hydrogenated vegetable oils, or palm oil, cocoa butter and coconut oil) and a few whole foods like avocado, chocolate, Brazil nuts or coconut.

Are all of these foods bad for us? No. For example, dark chocolate contains ample saturated oils but many studies point to the net benefit of daily intake of a small amount of dark chocolate. Similarly avocados are not enemy number one in health circuits and contain beneficial fat soluble vitamins and nutrients.

The biggest question of debate is palm oil (now gaining infamy for its role in rain forest destruction). Palm oil is ~50% saturated fat and Palm Kernal oil is ~88% saturated fat. Palm oil can be further hydrogenated or fractionated to get a more saturated fat rich product. It seems clear that hydrogenated palm, partially-hydrogenated palm and palm kernal oil are plain terrible for you and your heart. Avoid these in any quantity. So the question is about raw or unrefined palm oil, which is touted to have lots of beta-carotene, vitamin E and other antioxidants. Here studies show mixed results - some reporting a beneficial effect on blood lipids (cholesterol, etc.) and other showing detrimental effect. The differences may have to do with who was selected for the study (e.g. it may have a worse effect on men and people predisposed to bad lipids), on the type of palm oil (red palm may be better than regular palm), how "crude" or unrefined the oil is (in the same way that unfiltered extra-virgin olive oil is far superior to "light" olive oil), or on other factors that are not clear to me. Part of the argument for palm oil not being bad is that the saturated fat is mostly in the 2nd position of the 3 fatty acids on the glycerin backbone - and that this is much less bioavailable (i.e. digested/absorbed) and that palm also contains beneficial mono and polyunsaturated fats.

So in sum, my sense is the verdict is still out on unrefined palm oil. I'll chose to keep my intake small until more is known.

Trans Fats - Most often these are the news-savvy by-product of hydrogenating and modifying oils and contain a chemical structure not often found in things we eat. Until recently, about 80% of trans-fat in the US diet came from hydrogenated soy oil. There is now plenty of science revealing how toxic these critters are... thus the ban on trans-fats now in place in several cities. Do not buy anything with trans fat and be aware of products that say "now trans-fat free" - check to see if they've replaced their trans fat with palm kernal oil or other not-so-good oils.

Unsaturated Fats - we typically divide these into mono-unsaturated oils (think: olive oil, mmm) and poly-unsaturated oils (think: most vegetable-based oils). I won't talk much about mono-unsaturates, except to say they seem to be good for us.

Polyunsaturates can be further divided into categories based on their chemical structure (for you chemistry lovers: the position of the first double bond in the carbon chain), the main groups being Omega 3, Omega 6 and Omega 9.

Omega 3 and Omega 6 are the "essential fatty acids" because if you don't eat any you'll die! You'd be guessing right if you thought that both have beneficial properties. But omega-6s are in so many foods you eat that you don't have to worry about getting enough. Omega-3s are much harder to find and there is growing recognition of the theory that the balance of Omega 3's to Omega 6's in the diet is important. And that our ratio is wayyyy out of whack - we eat way way more omega 6's than 3's (roughly 10x more, rather than the 2-4x more that may be 'ideal').

Where are the Omega-3's hiding?

Well there are modest amounts in some common vegan foods, most notably tofu and other regular fat soy products (excluding soy-oil). So all of us do eat some omega 3's. But given the abundance of Omega 6's in our diet, a strong argument can be made for getting more of the 3's.

Papa Omega 3 and the important fine print of omega 3s:

The parent of the omega 3 family is a fat called alpha-linolenic acid (LNA). The main vegan sources of omega 3 (such as flax oil, canola oil, tofu, walnuts) are mostly alpha-linolenic acid. From LNA our bodies can make some other omega-3s special kiddies called EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). EPA and DHA are the omega 3's most well studied that lower the risk of dying from heart disease. It's thought that large amounts of omega 6 can suppress our ability to convert LNA to DHA and EPA, which may be a particular disadvantage to the common vegan diet at present. So the major question still unanswered is can we make enough EPA and DHA by eating predominantly LNA? And if not, how much does this matter?

I'll skirt these questions by saying this: My hunch is that the modern vegan will get meaningful benefits from improving fat intake - through the combination of reducing harmful fats, increasing omega 3s (especially by replacing omega 6 dominant oils with omega 3s) and likely added benefit from supplementing with DHA (vegan EPA can be extracted from some plant seeds but is still hard to come by right now, and our bodies likely find it easy to convert DHA to EPA...so the main issue is getting or making enough DHA).

Who should pay particular attention to omega 3's?

Those at risk for heart disease and stroke (ok that's most of us); those with depression and women during their childbearing-potential years, especially if you are pregnant or breast-feeding (omega-3s are critical for normal development of the brain).

How to get your omega 3s & improve your balance of 3 to 6:

1. have a daily source of concentrated omega 3s, e.g. 1-3 tablespoons of Flax oil. Flax meal (ground flax seeds) is also an excellent choice because you get the other benefits of the seed, but obviously you need to eat more to get the same amount of omega-3s in the oil. NOTE: whole flax seeds will pass straight through you so are not a viable source (watch out for this in products that claim to have omega-3s from flax).

2. for cooking and baking - switch from generic vegetable oils to canola or extra-virgin olive oil. Do not use shortening or margarine at all. Experiment with flax meal+water as an egg replacer in baking. Pay close attention to the ingredients in those vegan baked goods we love so much.

3. for spreads - again throw out the typical margarine. Use an oil like olive, canola or flax. Or look for specialty margarine-like spreads that boast omega 3s, or at least no hydrogenated, partially hydrogenated oils or palm kernal oils (and thus don't have trans fat or excess saturated fat).

4. Consider a daily source of vegan DHA. These are typically made from algae (precisely where the fishees get theirs) and come in supplement form (e.g. Omega Zen, Health from the Sea and Neuromins (if you don't mind gelatin)) and are now being added to some soymilks (e.g. Silk special formula).

5. Read your labels. Most of us eat an extraordinary amount of packaged and processed foods - try to minimize the junk - stuff with refined grains, hefty sugar helpings and bad oils...

6. Look for fun foods - e.g. refrigerated dark chocolate truffles made with omega-3 rich oil.

7. Focus on the minor sources too. There are plenty of vegan foods that have small amounts of omega-3 (like leafy greens) and or decent amounts but we don't eat them often (like walnuts, hemp and pumpkin seeds). Of course, there are lots of other good reasons to eat these foods too. A recent study on walnuts suggest that daily intake of ~2 ounces offers the same cardiovascular protection as fish.

8. Keep your eye open for more plant based EPA and DHA. These compounds are being discovered in a decent handful of plants (often in the seeds of plants we don't commonly eat) and are sure to make their way to us in functional foods or supplements in the near future...

Vegan must-knows on Vitamin B12

As you are reading these sections please keep in mind that the science of measurement and definitions of normal vs. optimal levels for these substances is still evolving. Plus there is incomplete standardization of these tests in the US - meaning the reference normal range may be different from one lab to the other. But these few paragraphs will give you a good background with which to interpret new discoveries and opinions as they emerge!

Vitamin B12
 
One of my favorites (such a complex and hotly debated vitamin). There are only a few essentials you need to know - but they are important to understand fully. The active forms have a variety of ___-cobalamin names, but you will mostly hear about B12 as "cyanocobalamin". Now we know why we call it B12 for short.

B12 is only made by bacteria and fungi, which explains why we have a hard time finding it in our modern antiseptic foods. Ruminants like cows have b12 because bacteria in their gut make it for them (and thus eating or drinking cows provides b12). Our intestinal bacteria also make B12, BUT these little guys live away from the place in our intestines where we are able to absorb B12...this is why we must eat B12.

Take B12 seriously - B12 deficiency is not rare. A prolonged deficiency of B12 has serious yet reversible effects (such as anemia - low red blood cell levels) and even more serious but irreversible effects (such as subacute degeneration of the dorsal columns - permanent damage to nerves that enable you to feel the floor and stay balanced, which is something I have a hard time doing even with normal dorsal columns).

Low B12 levels are also associated with depression and other neurological conditions.

Here's the good news - B12 is cheap, it has little if any side-effects, you need very little of it (around 2-3 micrograms/day) and you (well your liver) can hoard stores of b12 for one or more years (you'll hear ranges from 1-7 years, but NOTE: you will eventually run out if you don't eat any b12). Your liver, at least, understands how important this vitamin is!
 
Now here's the thing - B12 deficiency is more common than we'd like in both non-vegans and vegans. Why? Because most b12 deficiency is not from eating too little, but rather from being unable to absorb it (for reasons I wont get into here)...This said, vegans do consistently have lower levels of B12 than non-vegans.

So here's what you should do:
 
1/ make sure you have a reliable daily source of b12. These include a multivitamin, B12 supplement or fortified soy or rice milk, fortified cereals and "cliff" bars (or similar).

Yes you might be able to get B12 from a few dietary sources (e.g. Red Star Brand nutritional yeast, marmite). And there are some folks who claim other sources have b12 (traditionally made tempeh, your gut bacteria, blue-green algae, nori, etc.) but it is highly unlikely that these sources provide adequate amounts of B12 for all people. And frankly it is foolish to bet our nerves and blood on it. To complicate matters some of these other "sources" have "inactive" B12 analogues which can compete for absorption in your gut with active B12 thereby worsening your real B12 levels - another reason not to count on these less reliable sources.

I realize some people think there is something "unnatural" and bad about taking supplements, but it is the price we must pay for eating less dirt, feces and insects than our primate ancestors.

2/ being vegan gets you a free b12 level lab test. Actually it may get you as many as you want! This is because doctors are classically conditioned to associate the word vegan with the word b12 deficiency. It's part of the fun training we get. So get your b12 level checked and find out where you stand.

The B12 blood test your doctor will do is not a perfect test (like most tests we use), so the result may need some interpretation. For instance, if it comes back in the upper half of normal (often >400 pg/mL) - rock on, it's normal. Recheck once in about 2 years. And keep eating a reliable daily source as per above. If it comes back "normal" but it's at the very low end (say below 300/350) then you should request a more specific test (e.g. methylmalonic acid and homocysteine) to make sure all is kosher. Talk to your doctor about this. Assuming the confirmation test is normal, you still need to be extra diligent about taking in b12 at least once per day and consider a repeat lab in 3-6 months . If a confirmation test or your initial test comes back "deficient", then you have some important work to do with your doc. (Note: an alternative strategy for a low-normal B12 is aggressive supplementation for a few months and then recheck with the standard test. Also note that labs may use different units such as pmol/L).

Look for updates on the topic of what the optimal b12 range is. If indeed it is optimal to be above 300-350 pg/ml, than that would mean a huge proportion of people around the world have deficient B12 levels. Yes this may seem extreme, but it is not an impossibility in our modern sanitized world - which has eliminated our 'natural' exposure to B12.

B12 Summary - find a daily reliable source, get your B12 level checked - it's simple.

For the clinically/medically minded see this article in the AAFP for a good B12 review.

For a nice informal review of B12 studies relating to vegan diets see this article from the 35th World Vegetarian Congress



As always, this blog does not provide individualized medical advice - for that you should find a good doctor.
If any of the above is unclear, please feel free to post related questions.

The fears of a suspecting vegan. Answered.

Maybe you're a touch freaked out about becoming vegan...about abandoning the dietary staples that billions of dollars in marketing have told you are essential to a happy successful productive and fertile life?

You're asking yourself: "But, where will I get my protein?!!!"

Now, I do believe that you're genuinely concerned about your amino acid pool, though I think what you're really asking is: how easy is it for me to screw this vegan business up and end up a crippled wreck? What do I really need to worry about? And what can I chill out about?

Important questions. Here is my answer:

If you're vegan, there are 5 major concerns you should address:

Pssst. don't tell anyone, but you should concern yourself with these things even if you're not vegan. Oh, and I have a much longer list for non-vegans, but I'll spare you that for now.

From easiest to tackle to hardest:
1. Vitamin B12
2. Vitamin D
3. Omega 3 Fatty Acids
4. Befriending refined Carbs
5. Getting cozy with isolation
 

Notice that protein isn't on this list. But it does get an honorable mention in my rant on carbs...so read on! If I had to list a number 6, it would probably be Iron (mostly for women) and 7 might be getting enough calories (though this would only apply to maybe 10-20% of us at most)...

Update: This blog will provide a BRIEF overview of the above worry list and I will wax philo-medical on each topic in more detail in separate blogs. If you're interested in topics 6 or 7 let me know and I'll happily offer a spiel!

1. Vitamin B12 - the vitamin that makes doctors and scientists alike wave their big wobbly index finger at us crazy vegans. And they are right (but they conveniently forgot to wave it at themselves as well) - you need to hunt out little bits of this vital substance and get your B12 level checked periodically. Read why and how by clicking here.

2. Vitamin D - the sunshine vitamin. Understanding this master vitamin will give you a new found respect for that golden globe that warms our spirits. Vitamin D deficiency runs surprisingly rampant in us northerners and it's so easy to prevent. In the least, take a supplement in the fall and winter. Read why and how by clicking here.

3. Omega-3 - the rarest of the "essential fatty acids". It's the fat you need in your diet for your heart, brain and maybe more. But omega-3s are a little tricky to find in good quantities unless you're a regular fish eater (which I'm guessing you're not). Read why and how to get vegan sources by clicking here.

4. Refined carbs - unlike D, B12, and omega-3s the problem here is that these little devils are just too easy to find and they are awfully tasty. We all (vegan or not) need to crack the whip and get these foods off the everyday menu. But they are everywhere. Like mosquitoes ruining a good sunset picnic. Take a hard look at what you eat and you'll be surprised. Read about your options for switching to whole grains, and why that's important, here.

5. Avoiding isolation - say what?! I don't eat isolation. Thank goodness you don't, because being vegan can be a good recipe for adding isolation into your life.

Let me rewind for a second. I've often asked myself: if eating animal foods is so damn harmful and eating plant foods so protective, why doesn't the medical literature abound with data that blows the efforts of our friendly meat and dairy lobby groups to smithereens? (Don't get me wrong - it does support the benefits of a whole food vegan diet).

Well, one answer (of many) may be that people who choose to buck society and become vegan are different. Maybe (and for good reason) they are more often depressed about the world they see around them. Maybe (and for good reason) they feel different and more isolated from the average Joe or Jane. Maybe there is an unspoken psychological toll that befalls those of use who care deeply about what we eat and what we don't. No, I'm not advocating ignorance - just that as a community we need to start thinking and talking about this. I'll muse on this more, tell you why I think it deserves a place on the top 5 list and offer a few suggestions on the topic if you click here 

The unofficial 6th worry: keeping it in context.

I want to be clear - eating a whole-foods vegan diet is a great way to help maximize your health and make the earth a better place. It's a great way to bring purpose and meaning into your life, to minimize cruelty to animals, to lessen your environmental foot-print and hey, it may even help you stay lean in America.

But let's face it, eating vegan doesn't cure malaria or prevent SUVs from running you over. Being Vegan = one important piece of the puzzle, but it rarely stands alone. There are many other important determinants of health and well-being. But we can muse more on that later.

Oh, and worrying IS bad for you. So take action on these concerns, but don't let them cause undue stress!
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Note: take everything you read on The Internet with a grain of salt. My writings do not constitute individual medical advice - for there is no advice that applies to everyone. These are just my informed opinions and I hope they can provide some guidance in your quest for wellness. In short: Please don't sue me. I'm Canadian.

One final disclaimer: my views do not represent the views of my employers or the academic centers I have been fortunate to attend.

Thanks for reading this. Feel free to comment, or offer suggestions on further blogs...