Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's episode of the Conquer Your Weight podcast. We are talking about carbohydrates, talking about are they good, are they bad? How do you know if it is okay to be having these in your diet? Because we are always hearing things like you shouldn't eat carbohydrates. Carbohydrates are bad for you. And then there's other people saying, I'm eating vegan, or I'm eating a plant-based diet. And those tend to be diets that are really high in carbohydrates. So are carbohydrates good? Are they bad? I am going to answer that question for you because the answer is somewhere in between and it depends. So we'll talk a little bit more about what I mean. Before we do, I want to tell you something super exciting, which is that we have made some changes in the practice recently. I have a health coach who has joined our practice and with that we are offering a new package that allows patients to see us in a way that is going to help them achieve their goals. They might be using medications to support their goals, getting nutrition counseling, and also working on that psychological piece, working on that I know what to do, but how do I implement this in my life? We are going to provide even more support so that you feel like this is a program that is customized to you, that feels totally doable. If that sounds like something you're interested in, if you want to learn more, I would love to connect with you. You can pop on over to my website. It's www.sarahstombaughmd.com. That's S-A-R-A-H-S-T-O-M-B-A-U-G-H-M-D.com. All of the information for our new membership is on there. You can learn about that. Schedule a free meet-and-greet, call with me to learn about it, ask any questions that you have. We are so excited this summer is an excellent time to lose weight. The weather is warm. We often have a little bit more flexibility in our schedules to bring in some exercise to think about how we can move our bodies to go on vacations and eat in a way that is really in line with your goals. And so if you are ready to get started, this is the time reach out and I would love to support you in your weight loss goals. And today let's dive into this topic of carbohydrates. So what are they? Are they good for you? Are they bad for you? Let's talk about it. Carbohydrates are a huge group of foods. When we think about carbohydrates, the basic definition is that it's anything that contains simply sugar molecules. So those can be complex carbohydrates, meaning that there are many strands of sugar molecules stranded together. Those complex carbohydrates or simple carbohydrates, which mean one or two strands of sugar that are very easily absorbed and used in our body for energy. So carbohydrates make up everything from fruits and vegetables to whole grains to breads and pastas to our starches and to things like candies and pastries and soda and juices. And so are they good? Are they bad? It depends. Some of those things may be right for your health goals. Other ones are going to be less in line with your health goals, I imagine. So when we think about this really big group, we think often about the definition of complex carbohydrates versus simple carbohydrates. So what that means a complex carbohydrate is these many strands of sugar molecules stranded together. There's often a lot of fiber with that. And so when our body is needing to utilize these for energy, it has to go through a pretty intensive process in order to break that down and use it for energy. So complex carbohydrates are things like fruits, they're things like vegetables, they're things like grains in their whole form. So things like farro, things like barley, things like wheat berry grains in that whole form, maybe oats, brown rice for example. Those are complex carbohydrates. We can also take those complex carbohydrates, especially when we're talking about grains and we can process them. So they're complex initially, but they become more refined. So we have them in their whole form. And then there's the refined form. And so when you think about wheat, for example, when we process wheat, that is broken down into flour. And so that is something that is though even though it was a complex carbohydrate still sort of is, it's been refined. And so our body is able to use that more readily compared to a whole wheat grain, for example. When we compare that then to a simple carbohydrate, simple carbohydrates are those that are one or two sugar molecules that are easily broken down in the body and can be used for energy readily. So these are things like glucose, fructose, galactose, these are our monosaccharides, so single sugar chains and then saccharides, which are combinations of those. There's a lot of different ones out there, but the primary ones are sucrose, which we primarily think of as table sugar. This is broken down into glucose and fructose. Then we have lactose, which we commonly think of as milk sugar that is broken down into galactose and glucose. And then maltose, which we see in certain whole grain products in beers, cereals, things like that. And that is two glucose molecules. So these are the most common ones. And a lot of these simple carbohydrates is what we're looking at and what we're finding when we think about things like sugar, when we think about things like candy, when we think about things like fruit juices and sodas, things that our body can readily use for energy. And so I got thinking about this topic because I posted a video on TikTok recently that was talking about watermelon. And the message of that video was, Hey, watermelon is really high in sugar. And so be mindful of the amount that you're consuming because it's really easy to overeat it and if you overeat it, that's a huge sugar load. And it's interesting because the message was really intended to be about mindfulness around our food, not necessarily demonizing any food or saying that we shouldn't eat watermelon. Watermelon's amazing. I love it. And I love it so much that it's easy for me to sit down and eat half of a watermelon in one setting. And in talking with friends and family, I was sharing that and it came up over and over again that it is a food that is readily over eaten because it's so refreshing. We're really enjoying it. It feels sometimes like this special treat because we can only get it during the summertime and even though it is a fruit. So even though it's fruit, it is still something that can be a really high sugar load. So the comments on that video were wild. People were thinking about, oh my gosh, should people be drinking soda instead? How dare you tell people not to eat watermelon? So I want to talk a little bit about what is fruit sugar? Is it a simple carbohydrate? Is it a complex carbohydrate? How do we navigate this? Especially when people are always talking about good for you, bad for you, sort of categorizing foods into should have, shouldn't have. And one of the messages that I preach all of the time is that there are no foods that are off limits. So foods are things that we need to learn how to enjoy responsibly, how to enjoy them in a way that is going to serve our health goals, serve our weight goals. And when we take foods and just demonize them, it often almost puts them on this pedestal. That restriction drives us to want it more and more. So when you say you can't have something, there's this natural rebellion that comes up in all of us where as soon as we're told we can't, we just think about it and we want it more and more. And so it's not necessarily labeling any foods as should have or should not have. But thinking about are there foods which may be less in line with your health goals that may spike your blood sugar, be more likely to contribute to health conditions that you have, particularly if you're working in your weight loss journey. So let's talk about it. Let's first start and talk about watermelon since that was such a hot topic recently. But then we'll explore some of these other foods and talk about what they are, what that means from a carbohydrate standpoint, what that means with your blood sugar and how that can impact our health and our weight. So interestingly, watermelon has about 10 grams of sugar in a cup. So if you take a cup of bald or cubed watermelon and measure that out, put it into a bowl, it's an okay serving size, but I'll tell you what, I could easily eat three or four cups of that in one setting, if not more. So 10 grams of sugar. What does it mean when we say sugar? So sugar is a really broad term that we use a lot of times to encompass all of these things. Interestingly, when we think about fruit, people typically think about fructose, which is what we think of as fruit sugar. And so in watermelon we do have fructose. Interestingly, we do also have glucose and we do also have sucrose that disaccharide that once it's processed is broken down into fructose and glucose. So watermelon has different simple, excuse me, monosaccharides and that disaccharide that can be absorbed into our system really quickly and used for energy. In general, when we think about fruits and vegetables, there's a lot of fiber that comes with those that really slows down the absorption of those so that you don't get this wild spike of glucose in your bloodstream. So what happens with fruit juice, for example? So if you imagine juicing a watermelon and having watermelon juice without any fiber, that would hit your bloodstream more quickly compared to eating whole watermelon. But interestingly, watermelon in and of itself is actually a fairly low fiber fruit. And so of all of the fruit options, it is lower fiber. And so that is while we can eat it, we can really enjoy it. We should also be mindful because it can end up being a pretty significant sugar load without having a lot of fiber paired with it. So typically maybe a little bit less than one gram of fiber in that same cup of watermelon that we're eating. So again, you can enjoy it and be really mindful of the amount that you're eating. So a lot of fruits are similar in that they have sugar, but they also have fiber with them. So that slows down the absorption of that sugar. It allows our body to take longer to digest it. And so if we were to look at a continuous glucose monitor for example, we may see a more well-rounded curve because of that fiber that slows everything down. So in general, when we're eating fruit, that can be a really good thing. However, there are some fruits that are lower in fiber. There are also some fruits that are high in sugar. And again, doesn't mean that you shouldn't have those, but just being mindful of the portion size because it may make sense to have a cup of grapes, for example, which are another fruit that are pretty high in sugar. But you do want to be mindful of that amount. I think about some of my patients who have type two diabetes for example, and it's hard sometimes people are counseled about increasing fruits and vegetables, and I had a patient who was eating really like a huge bundle of grapes every morning and feeling really happy about that health choice. And while that may be a step in the right direction compared to previous health choices, it also wasn't improving his blood sugar that much. We were seeing that that still really spiked his blood sugar. And whether you have type two diabetes or not, we really do need to be mindful of spiking our blood sugar because what happens is that decrease. So once we've spiked up and we're coming back down, that down sensation feels really crashy like you can feel kind of nausea, you can feel kind of hangry, you can feel almost dizzy or hypoglycemic. And interestingly, some people do actually get hypoglycemic or low blood sugar when they're coming down. A lot of people though, they just feel that sharp decrease in their blood sugar and it feels hypoglycemic even if it's not actually getting low. They just feel that rapid decrease in their sugar. So having things that are really fiber rich is valuable for us in order to support that delayed absorption. So with fruit, some fruits are more fiber rich than others. So things like apples, for example, are high in sugar, but they are really fiber rich. So that's going to slow down that absorption where there are some fruits like melons in particular, bananas aren't particularly high in fiber. Papaya for example, there are things that don't really have a lot of fiber in them. So we really want to be intentional about the amount that we're consuming. And then one other trick that we can use is when we are consuming, even if it's fruit, carbohydrates, I have a rule that I describe with my patients called no naked carbohydrates. So when we are eating a carbohydrate, especially ones that are less complex, when we're able to pair that with a fiber, when we're able to pair that with protein, when we're able to pair that with fat and maybe some combination of all of those things, it helps to create this much more well-balanced sugar response and it creates a staying power so that food gives us some satiety and that satiety will stick with us for hours to come. So that's a little bit about this fruit component. One thing I want to be really clear of though is that when you're thinking about the choices that you're making when you're eating fruit in place of donuts you used to have, if you're eating fruit in place of a soda that you used to have; in place of a pastry, that is certainly a wonderful choice. A lot of times people will say to me, Hey, is this a good choice? And it's like, well, instead of what are grapes healthier than a donut? Of course. So are grapes healthier than a bowl of low fat and unflavored Greek yogurt with nuts and seeds and berries on top? Well, maybe not. And so when we think about not just what is the food, but instead of what else would you be doing and is this an improvement in the way that you're choosing to provide foods for your body that are going to fuel your body in the most effective way? So fruits are a phenomenal choice and we may want to be careful about the portion size and making sure we're pairing them with other things. And then there are things like sweets, like candies, candies and pastries and sodas and some of these dessert type foods. And those are things that, again, I don't believe anything should be off limits for our diet. And there are some things that are serving our goals better than others. So recognizing that some of these foods may be less in line with our goals they may be causing, they may not promote as much satiety. So when we think about sugars, for example, sugar or flour, something that has been very highly processed, our body can use that very quickly for energy. And so it doesn't have a lot of staying power. So when we eat things like a brownie or when we drink a soda, there isn't that same satiety that's created compared to if we had a much more complex meal. And interestingly, when we drink our calories, so in the case of a soda or fruit juice or a sugary and sweetened beverage, like some of the coffee beverages or tea beverages, liquid does not create the same satiety at all compared to anything that is whole and substantive. And so any sweetened beverage really, those calories are not recognized in the same way, which is why if we were to have a meal, even a healthy meal, right? Let's say we were to have chicken and Brussels sprouts on the side, let's say if you paired that with a soda, even though the soda would have a lot of calories with it, it wouldn't change the amount of food that you needed to consume at dinner in order to create satiety because that liquid just does not do the same thing from satiety standpoint as eating the same volume of a real food or a food-like item. So that's something to think about is these sugary sweetened beverages, whether it's soda, whether it's the coffee drinks, whether it's the fruit drinks, those are absorbed very readily and don't do anything for us in terms of satiety. So when we think about sugars, we think about desserts, we think about candies, we think about sodas. Those sugars are often in the form of glucose fructose or most commonly sucrose, which is a disaccharide easily broken down into that glucose and fructose. And so our body utilizes those very readily for energy, which is why if we were tracking on a continuous glucose monitor for example, we would see that really sharp spike and that would sort of crash down afterwards. Again, when we're eating these foods, there's things that we can do to minimize the impact that they have on that glucose response, which ends up minimizing the impact that it has in terms of weight, for example. So if we're thinking about dessert, interestingly, if you pair your dessert with a meal or you eat it sort of right immediately after a meal as opposed to waiting a few hours later, what happens is that that becomes part of the meal. Any of the fiber, protein, fat that you consumed during the dinner is going to help to slow down the absorption of the dessert so that it doesn't have the same impact on our blood sugar compared to if a couple of hours had gone by and you consumed that sweet on its own. So one thing you can think about is pairing those sweets with your meal. You're also less likely to overeat it a lot of times after a meal or feeling more satiety. And so we may be able to eat some dessert, but oftentimes having a few bites is enough that it feels like it sort of satisfies that sweet tooth where if a couple of hours have gone by, we may actually be starting to get hungry again. And so we may be eating a larger quantity of it. The other thing is that no naked carbohydrates. So we can think about that just with pairing it, but just in general, if you're going to be eating something, can you pair even a brownie paired with a glass of whole milk, for example, maybe more supportive of your goals compared to having that sugar spike in and of itself. But then, so these type of things should be really intentionally planned and chosen in a way that's really in line with your goals. Again, I think eliminating some of these things from your diet completely saying, I can't have that ends up creating this place where we feel really restricted and we almost desire that food more. So being really intentional, okay, what is the amount that I can enjoy and still meet my health and weight goals? Can I be intentional about the ones that I choose? Can I be really picky about if I'm going to have a cupcake that I'm only going to have it from this really delicious bakery where I'm really going to enjoy it as opposed to the cheap pre-made cupcake that I bought from the local grocery store at a kid's birthday party? Those two things may be much more or less enjoyable. And so getting to choose the ones that you're really going to enjoy as much can be a way that really supports your health goals. So choosing those and in a very intentional way. And then I want to take a minute and talk about complex carbohydrates because so often we hear people talk about low carbohydrate diets, but I'll tell you what, broccoli is primarily a carbohydrate. And so sometimes it leaves us a little bit confused because when we say low carbohydrate, what do we actually mean? And are there carbohydrates that you consume that are actually good for you? And the answer is of course. So when we think about certain diets like a plant-based diet, someone who is vegan and minimizes or doesn't eat at all animal type products, that is naturally a diet that may be lower in some proteins, lower in some fats, and there are only three macronutrients. There are fats, there are proteins, and there are carbohydrates. So if there is less fat, if there is slightly less protein, there's going to be more carbohydrate. And is that a bad thing? Not necessarily. It depends on where your carbohydrate is coming from. So when we think about those really complex carbohydrates, we think about grains in their whole form. We think about fruits, we think about vegetables, we think about nuts and seeds and legumes like beans and peanut butter. We think about certain protein sources like soy for example, and edamame and tofu and that those are foods that may be predominantly carbohydrate, but they're really complex. And so that complexity comes from the fact that there's fiber paired with it and it's going to take your body a lot of energy to break that down in order to utilize those energies. Additionally, all of the foods that I named have other parts in them. So if you think about nuts for example, nuts are actually a really interesting balance of protein and fat and carbohydrate. And the carbohydrate is very fiber rich. And so when you look at the way your body responds to eating a nut versus eating candy, those are very different things. When you think about vegetables, for example, like I said, broccoli is primarily a carbohydrate. It does have a tiny bit of protein in it, but some of these things are carbohydrates. That doesn't mean it's bad for you, it's got a lot of fiber in it. It's really has a high volume. So it provides satiety because of the volume of the food. And so when you think about eating a diet that may be very plant-based, if you imagine a dish that has a whole grain, let's say there's quinoa on it, and then you've got a lot of vegetables, like maybe you've got potatoes or sweet potatoes and you've got roasted mushrooms and onions and peppers, and you can imagine this really rich dish that's maybe got some oil drizzled over it, maybe it's paired with meat, maybe it's eaten on its own. You could imagine just this sort of mound of food that is going to be primarily carbohydrate, and it's also a really healthy option. So unfortunately over the last decade or so, I feel like carbohydrates have gotten a really bad reputation. And the reality is many carbohydrates are really, really good for us, especially when we think about these complex carbohydrates especially we think about things that are rich in fiber and then may have those other components like protein, like fat. Can we consume these? Of course. Absolutely. Of course. It's hard to convince me. We think about the Atkins diet, for example, and people who are eating just bacon, bacon, bacon. I can't be convinced that eating pounds of bacon compared to this huge rich plant-based diet would necessarily be better for you. I think that both of those foods could fit into a diet plan if it was in line with your health goals. And so that's where you have to think about what are your preferences, what are your health goals? And then working with someone like myself, an obesity medicine physician, working with a dietician or nutritionist in order to understand a little bit better about some of these different foods, how they may serve your goals, and how you can put them into a food plan that's going to make the most sense for you. And everybody's different. There are people who have insulin resistance and need to make different decisions compared to a person who maybe has heart disease or a person who has another health condition. And so everyone's health condition, everyone's preferences, everyone's cultural preferences, everyone's availability in terms of what food is easy for them to access. All of these things make a difference. And ultimately, what we consume day to day. And so there's not going to be any one size fits all program, and so we get to sort of create what makes the most sense for you. And carbohydrates for most people are absolutely going to be part of that plan. Even the simple carbohydrates like the sweet treats when planned in an intentional way and consumed and really enjoyed with intentionality, can also be part of that plan as well. So I want to invite you to just pause and question the food choices that you're making right now. Are they in line with your health goals? Are they not? If they're not, is that something that I could help you with? I would love to see you as a patient in my clinic. If you're not in Illinois or Virginia where I'm licensed to practice medicine, reach out. I'd love to learn how I can support you, maybe connect you with someone who is local to you. There are so many great options here, and carbohydrates may be a part of the picture. Thank you so much for joining me today. I'll see you all next week. Bye-Bye.