8 The Complexities of Carbohydrates

Carbohydrate is a major category of food, including all the fruits, vegetables, grains and starches. If you choose-as I hope you will to do Atkins for a lifetime, you must bring some exacting standards to the process of deciding what carbohydrate foods you intend to eat. And make no mistake, I'm determined to teach you how to fashion a great way to eat—long term—not simply a weight loss regimen.

When doing Atkins, you will control the number of grams of carbohydrates you eat and will focus on certain food groups rather than others. One reason you will need to do this is because not all carbohydrate found in food is created equal. Most carbohydrato is digested by your body and turned into glucose—and most nutritionists refer to this as digestible carbohydrate. However, some carbohydrate can be digested by your body but not turn into glucose (glycerin is one example), and some carbohydrate is not digestible at all, such as fiber (see "Fiber:. A Form of Carbohydrate," opposite) and is therefore eventually excreted by your body. These last two types of carbohydrate don't have an impact on your blood-sugar levels. Understanding the different behavior of carbohydrate in your body can help you make' smart food choices.

Fiber: A Form of Carbohydrate

Perhaps your grandmother called it roughage; physicians call it bulk. No matter what its called, dietary fiber is traditionally used for relieving constipation, an important consideration when changing the way you eat as you do when you start Atkins.

What exactly is fiber? Simply put, dietary fiber is the indlgasttible parts of plant cells. Although it is a carbohydrate, fiber does not convert to glucose and thus does not raise your blood-sugar level the way carbohydrates typically do

In fact, fiber actually slows the entry of glucose into the bloodstream. This in turn reduces the blood-sugar spikes that cause insulin production and encourage The body to produce and store body fat' And by slowing down food's transit time in the digestive tract, fiber helps you feel full longer, resulting in fewer food cravings.

But that's just the beginning fiber also:

·binds to cholesterol in the intestine, helping rid the body of it

·absorbs and then eliminates bacterial toxins in the intestine.

·reduces the likelihood of getting diverticulitis.

·speeds the excretion of gallstone-promoting bile.

·supports the immune system by crowding out harmful bacteria in the colon

·bulks up the stool and make it easier to pass.

Supplementing With Fiber

Fiber-rich foods include vegetables, nuts and seeds, fruits, beans and whole unrefined grains. During Induetion, your primary source of fiber will be vegetables. (In late phases you will be the other sources of fiber in the order aforementioned.).

How can you get the benefits of fiber without the carbs contained in these foods? The answer is supplementation. I recommend that you take om tablespoon of psyllium husks daily. Be sure to select a sugar-free product. You can also take one tablespoon of coarse wheat bran or flaxsoed meal. Although it's. derived from grain, coarse bran is pure fiber and therefore it too contributes zero to your carb count. PWIlium husks should be mixed with water. You can sprinkle bran over your vegetables or,blend fiaxsead meal into a shake.

Drinking the recommended eight glasses or more of water daily is also essential to avoid constipation. You need to accompany any increase in fiber intake with plenty of water.

Be aware that fiber is one place where less is more. Consuming too much can block mineral absorption because food simply doesn't stay in the digestive tract long enough for your body to extract valualble nutrients. Gas, flatulence or constipation can also result. If you haven't been eating significant amounts of fiber, increase your intake gradually to allow the intestinal tract to adjust.

But yon cannot necessarily rely on food labels. Recently (in 2001) the Food and Drug Administration (FDA) rejected a request by numerous health food manufactures to allow nondigestible and non-metabolized carbohydrates to be separately on packaging, so that diabetics and other people with glucose/insulin disaeders wonld be able to have the information upon which to make bealth decisions. I can't tell yon I agree with this de. ion, and I certainly don't agree with the apparent notion that all carbohydrates are the same and affect your the same way.

The Carbs That Count

The fact that fiber is not converted to blood sugar makes for an interesting benefit for people doing Atkins, allowing you to sneak in a few extra carbs in the form of high-fiber foods. Let me explain what I mean by "sneaking;' because it is most definitely not the same thing as cheating.

Let's compare a cookie made of white flour and sugar with a couple of fiber-rich crackers. Both contain 10 grams of carbs. But there the similarity ends. Eat the cookie and you'll send all 10 grams of carbs coursing into your blood stream. But when you chomp into the crackers (which have, say, 4 grams of fiber) only 6 of those l0 grams impact on your blood sugar. Basically, you can deduct the grams of fiber from the food's total carb count. I call the net number of grams, "The carbs that count when you do Atkins:' In the case of those crackers, you got a 4-gram free fide.

Consider the possibilities! By merely choosing fiber-rich foods over their flab-inducing, refined counterparts, you can benefit your health and get more bang for your carbohydrate buck. And determining which carbs count is simple: Check the total fiber grams listed on the food label and subtract that number from the total grams of carhohydrate listed. (For more on how to read a food label, turn to Chapter 19, pages 241-245.)

To know how many grams of carbohydrate a portion of a certain food ,contains, you will likely need a carbohydrate gram counter. And so one has been provided for yon in this book. An even more extensive version, continually updated, is available on our website at www. atkinscenter, com.

In a moment I’m going to show you how to choose foods that supply the maximum nutritional bang, while they cost you only the very smallest metabolic price. When yon combine your own personal preferences with the information in this chapter, yon will be ideally situated not only to start doing Atkins (as you will learn in detail in Part Two) but also to continue doing Atkins for life.

But first, two points:

1.A controlled carbohydrate way of eating provides you with a powerhouse of nutrients to support your newly stabilized blood-sugar levels and your freshly unburdened body (yup, the one that soon won't be carrying so much weight around!). For many years, misinformed individuals have been claiming that you just couldn't get enough nutrients doing Atkins. After they've read this chapter, I'm going to let them puzzle out how they could possibly have said that.

2.As it relates to foods containing carbohydrates, you will need to make certain tradeoffs as yon do Atkins. Once you've read this chapter, you'll have a much better understanding, both logically end intuitively, of how I came up with the lists of acceptable and unacceptable foods that you will find in Chapter 11 and the food decisions I'H be asking you to make. You'll know, for example, why a green salad is a good choice during the Induction phase and a carrot isn't.

So, let's take a quick look at the science of food.

The Glycemic Index—A Beautiful Tool

It is, too. The glycemic index is a numerical scale that tells you how fast glucose enters your bloodstream nfter a specific food is eaten. Most versions of the index, including the one I'H use (see pages 80-82), assign pure glucose the number of 100 and measure the effects of other foods in descending order from there. It's a highly effective system. Note, however, that the giycemic index doesn't tell you how much carbohydrate is in a serving of a pnrtionlar food—that is why the giycemic index works hand-in-hand with a carb gram counter. Since there is no single standard glycemic index yet, the numbers may vary in different versions, but the relative order of foods on the various indexes is pretty consistent.

So, let's take a quick look at the science of food.

The Glycemic Index—A Beautiful Tool

For someone controlling his or her intake of carbohydrates, the implication of such an index is obvious. By using it, you get to know-in advance of eating it—how a given food will affect both your blood-sugar levels and your insulin response. By choosing low-giycemic foods you can insure yourself a stable, smoothly running metabolic engine. That translates into plenty of energy and lays the foundation for both long-term health and disease prevention. The controlled carbohydrate foods you'll eat during the weight loss phases of Atkins have a good deal of overlap with the lowglycemic foods you'll see listed on the glycemic index table on the following pages.

As you can see, this is a tool for measuring only carbohydrate foods. That's because fat causes virtually no bloodsugar elevation and protein very little elevation.

It's interesting to browse through the list. Notice that a baked potato ranks exceptionally high. Starch converts to glucose in the bloodstream with great rapidity. That explains the high-giycemic index of another vegetable, the carrot. White rice, white bread and many cereals are well up there. Bananas and pasta are in the high-mid range. (Pasta lovers who intend to try to squeeze in a little once they reach the Lifetime Maintenance phase, I have a tip for you: Note that cooking your pasta al dente significantly lowers its glycemic effects. Here's why: The shorter cooking time leaves the long chains of starch that are in pasta more closely4aacked together than longer cooking time; as a result, it is harder for your body's enzymes to break down this starch so there is less of an effect on your blood-sugar levels. Of course, the best idea is to purchase one of the great-tasting controlled carbohydrate pastas now available to you.)

Glycemic Index

Food Glycemic Index (glucose=100)

Bsdtery products

Muffins

Apple made without sugar 48

Blueberry 59

Bran 60

Com 49

Breads and pastry

Bagel, plain, frozen 72

Croissant 67

Hamburger bun 61

Melba toast 70

Pita bread 57

Pumpernickel 41

Waffles 76

White bread 70

Breakfast cereals

All-Bran 42

Com Flakes 84

Grape-Nuts 67

Muesli 66

Puffed Wheat 74

Shredded Wheat 69

Barley 25

Couscous 65

Rice, brown 55

Rice, instant 91

Rice, white, low-amylose 88

Fruits

Apple 36

Banana, ripe 52

Cherries 22

Grapefruit 25

Crapes 43

Orange 43

Peach 28

Pear 33

Pineapple 66

Plum 24

Watermelon 72

Legumes

Baked beans 48

Chickpeas 33

Kidney beans 27

Lentils 29

Pasta

Linguine 46

Macaroni and cheese, boxed 64

Spaghetti 41

Spaghetti, boiled 5 minutes (al dente) 37

Snack foods and candy

Corn chips 73

Jelly beans 80

Peanuts 14

Popcom 55

Oatmeal 55

Shortbread 64

Vanilla wafer 77

Vegetables

Carrots 71

Peas, green 48

Potato, baked 85

Sweet corn 55

Sweet potato 54

Source: Women's Health Watch—Harvard Health Online.

One of the latest installments of the famed Harvard Nurses Study conducted for almost two decades (it started in 1984) by Simin Liu and Walter Willett and their associates—-confirms the importance of the glycemic index. Researchers tracked the dietary habits and the health of 75,521 nurses for ten years. The research team discovered that the consumption of carbohydrates with a high-glycemic index was strongly associated with an increased risk of heart disease. They also discovered, although the data was not as strong, that "total carbohydrate intake, representing the replacement of fat with carbohydrate, appeared to be positively related to CHD [coronary heart disease] risk"

The Harvard researchers concluded, in my view quite correctly, that eating foods high on the glycemic index leads to elevatated blood-sugar and insulin levels, which in turn leads to hypertension, undesirable cholesterol and triglyceride levels and other risk factors for heart disease. Since this is the largest long-term epidemiological study being condncted in America, these conclusions will not go unnoted in the scientific community?

This is a good lime for me to disabuse you of the long-held notion that there was some enormous difference between socalled "simple" and "complex" carbohydrates. That theory held that simple carbs such as sugar and white flour sent glucose into your blood stream faster than complex carbs much as fruits, potatoes and whole grains.But, Lin and Willett and the other researchers found that two foods that contribute to elevating blood sugar to an excessive level (called the "glycemie load") are baked potatoes and cold breakfast als. These foods were traditionally classified as complex, as opposed to simple, carhohydrates. However, they behaved just as simple do. So the glycemic index appears to be a better gauge of the impact of various cadbothydrates on your blood sugar. As research continues to associate to pay closer attention not only to the amount of carbohydrates consmned, but also to their position on the glycemic index.

Choosing your carbohydrate foods from the lower.end of the glycemic index is fundamental common sense, and, for a person doing Atkins, an important building block for permanent weight loss.

In addition to being helpful for weight loss, the glycemic index has enormous potential as a tool for minimizing the risk factors associated with certain diseases. As the message spreads that hyperinsulimsm is a factor in certain illnesses and disease—and it has spread like wildfire in the medical establishment over the last five or six years '.he glycemic index becomes an ever more important tool for selecting foods. In my practice most of my patients have symptoms of rotatable blood sugar (you may know it as hypog/ycemia). Time and time again i have found this condition dramatically clears up when a diet inducing a lower glycemic reslponse is followed. Also, doctors who specialize in diabetes are learning not only how important it is to control their paticats' intake of carbohydrates, but how the glycemic index can help their patients do that intelligently.

Interestingly, it has also been shown that reducing your glycemic load appears to diminish your risk of developing eolo-rectal cancer. One likely reason is that cancer cells food off sugar. Another possibility is that sugar may compromise the integrity of the intestinal tract. Moreover, hyperinsulinism, in response to a high-glycemic load, may increase the risk of cancer. Furthermore, recent studies on women who have had breast cancer have shown that women with lower insulin production have a better survival rate and a decreased incidence of recurrence than women with higher insulin levels.

Two other recent studies have shown that hyperinsulinism has also been associated with higher risk for polycystic ovarian syndrome.6-? It all goes back to lesson one in eating for health: Avoid glycemic load. Don't cause your metabolism to straggle incessantly with high insulin levels, weight gain and looming cardiovascular and other health tragedies.

Now let's look at another, equally exciting way to rate carbohydrate foods.

The Promise of the Positive

Let us sing a song of veggies. Such beautiful, healthenhancing, varied foods. Adaptable to every cuisine worldwide, nothing in the world of cooking has more variety of taste and texture. I am waxing rhapsodic about vegetables, but their virtues are firmly grounded in scientific research.

Vegetables, if you choose the fight ones, are very highpowered nutrient packages. These advantages come once again if you choose your vegetables carefully—at a relatively low metabolic cost. That means that you are getting high fiber and phytochemicals with relatively low numbers of calories and carbohydrates.

So if some misguided individual tells you that you won't eat vegetables when you do Atkins, wave hhis chapter (with a stalk of celery, for good measure) at him or her. You will And, it's just possible, if you are a typical American, that you will eat more vegetables than you ever ate before. Because despite what Mom, and countless other mothers before her, advised, most people do not eat nearly the amount of vegetables riley should.

But let's look at the other side of the coin. In encouraging you to eat your vegetables, I certainly have no intentiou of compromising rite basic weight loss principles of Atkins. Yes, I want you to consume plenty of nutrients, but you must do so without eating so many carbohydrates that you saborage your weight loss efforts. Each person has a Critical Cat.hydrate Level for Losing (CCLL), and if you stay below that highly individual numbet you will lose weight However, if you exceed that level—even with all healthy foods—your body will not switch to burning fat as the primary source of fuel. We need a way to focus on health-promoting vitanutrients that also provide blood-sugar stability and weight loss,

Fortunately, we're in luck. Nature dovetails with the Atkins plan beautifully, and the vegetables densest in nutrients happen to be those lowest in carbs. Salad greens and other leafy greens—-escarole, spinach, parsley, watercress, arugula, Boston and romaine lettuce—-am nutrient powerhouses that are low on the glycemic index.

Some other excellent health choices include asparagus, bamboo shoots, broccoli, cabbage, cauliflower, collard greens, eggplant, kale, kohlrabi, leeks, okra, onions, pumpkin, scallions, snow peas, spaghetti squash, string or wax beans, Swiss chard, tomato, turnips, water chestnuts and zucchini.

Even during Induction, the first phase of Atkins, and the one which is most restrictive of carbohydrates, most of you will be able to eat one cup of those vegetables daily, as well as two cups of salad vegetable, s (or just three cups of salad vegetables). As your memtablism permits, most of you will add more vegetables during the increasingly liberal phases that follow. By the time you are in the Lifetime Maintenance phase, you may well be able to eat most every vegetable, although some in moderation or only rarely. Still, it is always a good idea to make the high-nutrient/lower-carhohydrate ones your primary choices.

Nuts and Seeds:

The Original Functional Foods

Nuts and seeds have been an Important component of the human diet since the days when mankind survived as hunter-gatherers. I suspect that nuts and seeds were the original dessert in caveman days. The two combine protein,fat and carbohydrate in one tidy package. The protein content of nuts ranges from ten percent in walnuts to seventeen percent in almonds; the fat content ranges from about thirty-five percent in coconuts to over seventy percent in macadamla nuts; the remainder is carbohydrate, including a significant amount of fiber. Obviously, the higher the fat content, the lower the carb count, which is one mason my personai favorite is the macadamla nut.

These little powerhouses are also' densely packed with nutrients. Almonds are a rich source of calcium. Almonds, sunflower kernels and hazelnuts are particularly good sources of vitamin E. Nuts also provide a long list of other nutrients, Including niacin, vitamin B6, folk= acid, magnesium, zinc, copper and potassium, plus a number of phytochemicals,inducing many antioxidants.

After the first two weeks of Inducllon, whon you can Introduce nuts and seeds Into your menuS, you will find they make excellent m and often an unexpected and tasty lngredient in an entree or vegetable dish.You can also use ground nuts and re'In lieu of breeding before baking or sauteing chicken breasts,veal scallops or fish ffillets.Like all good nuts and seeds should be eaten in moderation.An ounce of most nuts or seeds contains roughly 5 grams of carbs.

Tasty and nutritious as they are, nuts and seeds should be a component any healthy nutritional regiman. Numerous studies have shown that regular consumptoin of nuts and sesde minimizes your risks of coronary heart diseese. A number of epidemiological studies (studies of populations over time) have shown that people who eat nuts regularly are less likely to have a heart attack than people who do not consume nuts and oil-containing eeeds. Moreover, the greater the frequency of consumption, the lower the incidence of heart attack. Ugnans in seeds and nuts lower LDL (bad) cholesterol, as do the heart-protective vitamin E, betaine and argintne.

People on Low-fat diets often eliminate nuts and with them a powerful source of omega-6 fatty acids and other nutrients. When you do Atkins, one of the many culinary pleasures is being able to enjoy the multiplicity of fat-rich and nutrien-dense nuts and seeds.

Giving It a Number

One way to look at nutrient value is to measure the concentration of anfioxidants in food. Antioxidants are a spocial group of vitamins and phytochemicals that protect your cells from the ravages of environmental pollution, stress, disease and aging. Researches at Tufts University School of Mediciue in Boston studied the antioxidant capacity of common vegetables and assigned each vegetable an antioxidant score. I've taken that score and divided it by the number of grams of carbohydrate in the same-size serving of each vegetable or fruit and thus computed what I now call the Atkins Ratio.

The higher the number, the mom antioxidant protection you get per gram of carbohydrate. Talk about bang for your buck. If you used this tool to maximize your nutrient intake and simultaneously exercised regularly and controlled your carbohydrates by following Atkins, I would defy you not to be an outstanding physical specimen.

Look at the numbers in the Atkins Ratio below. As you can see, garlic is in a class by itself. The cruciferous vegetables broccoli, cauliflower, kale, Brussels sprouts and cabbage—which extensive research has shown to be a group of potent cancer fighters, are well up there. Onions also play a starring role. From this already rich list, let's identify some vegetable all-stars.

Atkins Ratio

Garlic (1 clove) 23.2

Lear Lettuce (1 leaf) 8.2

Kale (1/2 cup raw) 6.5

Onion (1 tablespoon) 6.2

Spinach (1/2 cup raw) 5.0

Broccoli (1/2 cup raw) 3.2

Red Bell Pepper (1/2 cup raw) 2.5

The world of vegetables is filled with natural chemicals that help protect you from illness. Scientists now call these defenders phytonutrients—phyto being Greek for plant. Here, for instance, are three phytonutrients that have been shown to lower the risk of cancer. Bear in mind that a complete list would be long enough to fill an entire book.

1.Beta carotene: You'll find a rich supply in green vegetables such as spinach, kale, broccoli, Brussels sprouts and beans, as well as in squash, peppers and yams.

2.Lycopene: The king of this nutrient hill is the tomato, and there is very good reason to think it will help protect you from prostate cancer. Note, however, that fresh tomatoes contain less lycopene or tomato juice.

3.Lutein: This carotenoid has been identified with reduced breast cancer risk, and it can be found in kale, collard greens, spinach and yellow squash.

How (and When) to Eat Your Veggles

Choose a good lineup of vegetables, then follow these five tips:

1.Consume vegetables little by little throughout the day. H you save up your carb aUowance for a giant reggie splurge, it might produce a surge in your blood sugar.

2.When you eat higher-carb vegetables, such as yarns or winter squash, do so along with proteins and fats. They will slow the passage of carbs through your digestive system and minimize their impact on your blood sugar.

3.Look for recipes in which a variety of vegetables are included with meat, fish or fowl as part of a complete entree, such as stews and dishes based on Asian cuisine.

4.Don't drink your vegetables. Juicing removes the fiber, which has the double merit of helping you feel full and maintaining a healthy digestive system. Juices also concentrate the sugars from vegetables, increasing the risk that they'll spike your blood sugar.

5.Cook carefully. Vegetables are usually most nutritious when crisp not overcooked. An exception to this recommendation and to #4, above, is the tomato; its cancer-fighting chemical lycopene becomes more bioavailable when heat breaks down the 4omato's cell walls or even when it is served as juice.

A Message to My Friends,the Die-Hard Carnivores

Of course, there are lots of people who start Atkins more than a little pleased with the fact that I certainly won't discourage them from eating meat, fish and fowl. l'm a carnivore, too. But l'm also an omnivoro—meaning I eat anything that's healthy.

I know there are some people who simply don't like vegetables. Or, at least, they don't like the ones they've eaten so far. The funny thing is that a lot of folks who do Atkins eventually find vegetables they can love. Perhaps it's because many people who follow the program end up trying many recipes and dishes they have never eaten before. They are making all sorts of healthy changes in their eating habits, smd, in that context, sampling new foods doesn't seem particularly revolutionary. If you've always been a grudging consumer of vegetables, I hope you'll become a vegetableeating convert.

Berries Are Bestl

One important lesson learned from the Tufts study previously mentioned is that, as evaluated by the Atkins Ratio, the lumping together of fruits and vegetables as being essentially equal in benefits is not true. Relatively speaking, vegetables have considderably more antioxidam value per carbohydrate gram than fruits and thus represem a much more valuable dietary choice.

Even so, alter the In.lion phase of Atkins, you may use some of your daity carb ration to add the more valuable frutts to your menu. Berries, inducding blueberries, raspberries,blackberries and strawberries,are the fruits highest in antioxidant value. Berries are also lower in carbs than other fruit and are re4atively low on the glycamic index scale. Moreover, the phytonutrients in certain fruits can slow pre-cancerous growths.

Look at the recipe section in the back of this book. Pick out a few vegetable concoctions that sound at least tolerable to your carnivorous personality, How surprised you will be if you like some of them. Then try a few more. Vegetables don't have to become your favorite food, but if you can lure yourself into dietary habits that put more of them on your plate than most Americans eat, you will be doing your noble, hard-working body an immense favor.

Think of all the things your body does for you. I'm sure you'll agree that it's payback time.

KEY POINTS!

·All fruits, vegetables, grains and starches contain carbohydrates.

·The more carbohydrate an individual consumes, the less body fat he or she will lose. That's why low-fat diets usually don't work.

·All carbohydrates are not created equal. The glycemic index measures the relative rate at which glucose enters the blood stream after a specific carbohydrate food is eaten.

·Low-glycemic vegetables contain relatively less sugar. Choosing foods that are low in carb grams, have a lowglycemic index value and are high in antioxidants is your passport to weight loss, increased energy and improved overall health.

A FREQUENTLY ASKED QUESTION:

What is the difference between a carbohydrate gram counter and a glycemic Index? A carbohydrate gram counter typically lists the total carbohydrate value of a food item. (The carbohydrate gram counter starling on page 49'2 also lists the level of digestible carbohydrates you should count when doing Atkins.) The glyeemie index is a measure of a given earbohydrate's effect on your blood-sugar levels. You can use the glycemic index to choose carbohydrate foods that will have a relatively low impact on your blood sugar. But remember, when doing Atkins your total carbohydrate intake is of ultimate importance.

TIPS:

·Keep a carbohydrate gram counter and a glycemic index on your refrigerator (and use the electronic versions at www. atkinscenter, com).

·Eat whole vegetables instead of drinking juices. Overcooking vegetables destroys nutrients.

·Adding some fat and/or protein to a salad minimizes the impact of the carbs on your blood-sugar level.

·Vegetables most dense in nutrients are lowest in sugar and should be your primary choices.

·When you think fruit, think berries.

·A pocket-size carb counter, such as the one hound into the front of this book, comes in handy at the supermarket and in restaurants.