Conquer Your Weight

Dr. Sarah Stombaugh: Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With the GLP guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today's episode, 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 this week's episode. We are talking about a concept called "No Naked Carbohydrates." Now this is something I honestly don't even remember when I first heard the phrase "No Naked Carbohydrates." You see it a lot on social media, especially where people talk about dressing up a meal, not eating carbohydrates alone. And this is advice that I give to my patients actually pretty frequently. And so we'll spend a little bit of time talking about what is the science behind why we should not eat carbohydrates alone without other things paired with them, even just what is happening when we eat a carbohydrate by itself, what happens in our body? And then when we do pair our carbohydrates with proteins, with fats, how can that be helpful from a satiety standpoint? So from feeling full, how can that be helpful in our weight loss journeys? What does that look like in terms of our energy levels throughout the day? And then how to practically implement that into your life, especially if you're someone who sort of identifies as a grazer and eats frequently throughout the day. We'll talk a little bit about how you can make a transition to eating more complex meals at once, which can be really helpful just in terms of the way our body feels and the way we feel fueled feeling sort of even energy levels throughout the day, but then also can be really helpful in our weight loss journey as well. So first, let's dive in and talk about what is a naked carbohydrate. So a naked carbohydrate is a carbohydrate eaten alone. So this can be simple carbohydrates. Complex carbohydrates. So I'm talking about everything here from a piece of toast or a cracker or a cookie or a piece of candy or a sugary beverage. Things that are more simple, carbohydrates, things that are containing really sugar and/or flour. And then thinking about even complex carbohydrates. So a piece of fruit, a whole grain, even complex carbohydrates eaten on their own do not create satiety in the same way compared to when we make a more well-rounded meal. And when we eat carbohydrates on their own, certainly it'll vary depending on whether we're talking about those simple carbohydrates or complex carbohydrates. But what happens is this insulin and glucose response by which we see sort of a spike and then a dropdown. So if you imagine someone being at their just normal blood sugar level, and then let's say they eat a piece of candy, for example, their blood sugar will spike up quickly and it will drop back down quickly. When it drops down quickly, it drops below their baseline and we feel that dropping sensation. So even let's say someone's fasting blood sugar is like 70 or 80, they eat a piece of candy, they feel their blood sugar, it goes up. We don't always feel that, but when it comes down, let's say it got up to 150 and now it's coming down and you can feel symptoms of low blood sugar even if the blood sugar's high because it's dropping so rapidly. So if someone did a finger stick and checked their blood sugar and said, Hey, what is this number right now? As they're feeling that drop, they might check and say, oh, my blood sugar is actually 100 right now. But they might feel low blood sugar, they might feel kind of dizzy, kind of shaky, kind of nauseated. They might have some emotions like feeling sort of hangry as a result of it. And you feel that drop and it feels really icky in the body. And so having a sort of true sugar like a candy or a cookie or a sweetened beverage by itself is going to create a very extreme example of that where it spikes up quickly and it drops down really significantly. But interestingly, even something like a piece of fruit, for example, can still create the sensation where it's not going to spike up as dramatically, but it can create this kind of quick up in energy, but it doesn't have that lasting satiety. So even though it's not going to feel crashy not going be like, oh my gosh, I'm nauseated, I'm dizzy, I'm going to punch someone in their face hungry. There can be this. If you had an apple by itself, for example, you might be feeling an hour later looking for the next thing, starting to feel that hunger come back. And that is because our body processes carbohydrates very readily. We can respond to those pretty quickly, certainly having fiber. So when we think about fruit, when we think about a grain in its whole form, that is going to prolong the digestion, certainly somewhat, but it doesn't create the same satiety that lasting fullness in the way that proteins and fats do. So this idea that when we have carbohydrates by themselves, especially sort of starting out the day, we can put ourselves into this almost rollercoaster of our blood sugar goes up, we feel full, we feel good, our blood sugar goes down, we're sort of looking to the next thing. And it's sometimes the case where I talk to people that even if they're eating really pretty healthy foods, they find that they're being driven to eat 5, 6, 7 times per day. Now, these aren't huge meals. A lot of times these are people who identify as grazers, but sort of all day long, they're just grazing on a few crackers here and apple there, a couple of pretzels, a granola bar, another piece of fruit, a couple of cherry tomatoes, and sort of all day long they're just finding that they need to constantly fuel their body. And this is because this response to carbohydrates can be this sort of quick up, this quick down, and we're quickly looking for that next food thing. And what happens, we're talking about the glucose response curve, is our insulin response will mimic that almost identically. Now there's not continuous insulin monitors, so we can't see that when it's happening. But what happens is insulin is our energy storage hormone. So particularly when we have carbohydrates, and to some extent when we have protein, insulin is released in order to take that energy and store it away for later. And so what happens is that when we're storing energy, we cannot be simultaneously burning energy. So we are either in a place of energy storage or we are at a place of energy burning and we can't be doing those two things at the same time. So even the person who is grazing throughout the day and defines that they're constantly fueling their body with a couple of bites here, a couple of bites there, an apple here, a few crackers there. That person is finding themselves in a state that really the entire day they're sort of storing energy. So if they're doing that and also having excess storage of fat on their body, maybe they have overweight or they have obesity and they're trying to lose weight, but they're simultaneously putting their body in a place where they're storing energy all day long. It just doesn't give our body the opportunity to then come to a fasted state, to come to a stable energy level, fuel satiety for a period of time and not have to have this constant fuel goes in, food goes in insulin response, storing energy, and then this cycle that can repeat all day long. So when we think about adjusting that and transitioning someone to a more complex meal, we talk about dressing up their carbohydrates with proteins and or fats. Now the reason why is that protein and fats create more lasting satiety. When we look at the way that our body experiences fullness, it's the absorption of food and those macronutrients that get broken down. So carbohydrates, proteins, fats as those are broken down, absorbed into our bloodstream, proteins and fats in particular trigger in our brain to say, yes, I am full. And that fullness actually can take a little bit of time to kick in. So a lot of times the satiety from fats and proteins can take about 20 minutes, 15 to 30 minutes kind of on average from when you start eating to when that signal starts to reach the brain of those proteins, those fats signaling in the brain to say, Hey, I am full. I should stop eating. And when we get those, particularly when they're paired together in this complex meal, so you've got some carbohydrates, you've got some proteins, maybe a little bit of fat in it as well, it ends up creating this complex meal that has fiber to help it digest slowly. It has proteins, it has fats that signal in the bloodstream trigger in the brain to say, yes, I'm full. And then that fullness can last for a while, often on the order of 3, 4, 5, 6 hours and beyond depending on the meal and certainly depending on lots of other factors like their movement, their day and what their day-to-day energy burning looks like anyway. But these fats, these proteins help us to feel full for longer. And then we look at the glucose response curve. If someone was wearing a continuous glucose monitor, we looked at what does their blood sugar do? And if we look at saying eating an apple by itself versus eating an apple with a slice of cheese or an apple with some peanut butter or a handful of nuts or something, we've got protein, we've got some fats, and we looked at what happens on that person's blood sugar response. What we would see is that the apple creates more of a spike where the apple paired with protein paired with fat is going to create this more well-rounded glucose response. And we can feel that in the way that our body feels. So it feels like this sort of lasting energy. It feels good, our energy level feels really good, we don't have that sort of crashy or nausea sensation that can come up. And it ends up creating also a situation where our body can not have to eat as often and not find that it's constantly looking for the next carbohydrate to fuel the next burst of energy that then has to get stored away for later. So when we start pairing a simple carbohydrate or even a complex carbohydrate with that fat, with that protein, what ends up happening is we feel full for longer periods of time. And for someone who was grazing and eating multiple times per day, we may find that they're able to eat two or three times per day rather than eating five or seven times per day. And so making this transition can be really helpful in finding that, for one, you're just not spending as much time eating for two, the body feels better, fuels more even energy levels throughout the day, and then for three can actually be really helpful in the weight loss journey as well. Now, certainly we think about the roles of different macronutrients. So we have carbohydrates, we have proteins, we have fats, and each of those play a really important role in our body as well. So it's not, I'll say not uncommon, but it happens from time to time that I encounter someone who is really fueling their body with carbohydrates all day long. And commonly, these may even be people who aren't eating huge amounts. They may be eating really healthy carbohydrates. So they're eating fruits, they're eating vegetables, they're eating hummus, they're eating the things that are, we'd put on a health food list, for example, but may not be having a lot of protein or fat alongside of it. So we start looking at the other pieces of the weight loss journey and how different foods signal to our body, how to use them. So when we think about glucose, when we think about any sort of carbohydrate, I use glucose and carbohydrate a lot of times interchangeably because our body, anytime we eat a carbohydrate, it's going to break it down into glucose that we can use for energy, and that energy is going to circulate around the bloodstream. And if we need it right, then great, our body can utilize that. But if we have more than our body needs, then it will take it and store it as glycogen, which is an intermediate storage form, or it will store it as fat, which is a more long-term storage form. But when we think about the other foods, when we think about proteins, for example, protein is broken down into amino acids. And amino acids are some of the most important building blocks, certainly for our muscles, but for other enzymes and other hormones in our bodies, for example, fats also play a really important role in hormones in our cell structure. And so each of these things plays a very important role. And one thing that I find is that for the person who is fueling their body with simple carbohydrates all day long is a lot of times I talk to people who are eating very little, if any protein in their diet. Certainly we're all getting some, it's hard to get zero protein in your diet, but if you're having fruits, if you're having vegetables, if you're having crackers or granola bars or things like that, that by the end of the day, a lot of times we're talking about maybe a little bit of cheese, maybe a tiny bit of deli meat, and someone, I frequently talk to people who are getting 20 or 30 grams of protein over the course of their entire day when we sit down and really calculate it out. And when we think about the weight loss journey, when we are losing weight, we want to make sure that we're getting adequate protein so that our body has all of the protein that it needs for all of the cellular functions while also having enough to maintain our muscles. And so those numbers will look different for different people, but what that does mean is we want to make sure that we're getting protein, we're getting it consistently throughout the day, and the insulin response to protein is not as significant as it is to carbohydrates. Then interestingly, when we look at fats, fats can play a really important role. Fats are really calorically dense, so we do have to be careful with them. You don't want to eat a huge amount of nut butters or avocados or just sort of every meal all day long having huge amounts of fat that is very calorically dense. And there's certainly people who, even if they're eating healthy fats, can realize that they're having too many calories and sea weight gain from that. But fat has this really interesting role in our body where it is absorbed directly, so it's broken down, it's absorbed directly through the bloodstream, and it doesn't require any insulin, for example, in order to store that away. And so when we can eat fat, say both signal satiety, so we get that fullness signal from eating fats as well as creating this response where our body can be, doesn't have to tip into this energy storage state. And so we're able to continue to fuel an energy burning state, for example, rather than being in an energy storage state. So practically, when we take all of this information and think about what does day-to-day eating look like for me, if I realize that I am eating carbohydrates, even like I said, an apple here, a couple of cherry tomatoes there, when I'm doing that type of thing, am I inadvertently creating a problem by which my body just sort of all day long is processing this food and sort of all day long find itself in a place where it's processing and storing energy rather than having the ability to dip into my fat stores and burn it? So may think about what day-to-day this looks like. I would encourage you to check in at what's happening in the morning. Are you hungry? A lot of times there are people who eat breakfast first thing in the morning, even if they're not hungry, they are used to eating because it's the time of day because they're getting ready to walk out the door because they need to eat before their workday. And all of those may be perfectly reasonable reasons to eat. But I would like to encourage to ask, am I hungry right now? And if you're not hungry, I'd like to trial even if it's just for a couple of days, what would it look like pushing off my meal for a couple of hours? Now, what you can do is actually have a fat early in the morning. So what this could look like is having a cup of coffee and adding a little bit of heavy whipping cream, for example, having a tea and adding a little bit of whipping cream. And because that fat does not require insulin in order to store that energy away, you can keep yourself in this sort of pseudo fasted state and keep your energy levels very equal or very even and that sort of even keeled feeling. And so ask yourself, am I hungry? If yes, you absolutely can and should eat, if no though, I'm going to encourage you. What would it look like to push back your eating by a couple of hours and just to wait until my body is asking for food? What would that look like? Is that doable for me? Can I bring in this coffee or this tea paired with a little bit of cream, for example, to give myself that fat to keep myself in a fasted state, give myself some energy, but not set myself into this sort of up and down energy rollercoaster. Now, when your body starts to get hungry asking, okay, do I need a full meal versus is this something where I'm going to eat a smaller meal right now? So either way, when we eat, making sure that every single time that you're going to eat that you've included some source of protein and or some source of fat with that. So this can look like when you're eating breakfast instead of having a bowl of oatmeal, to have a bowl of oatmeal that maybe has a scoop of protein powder in it that maybe has some nuts and seeds sprinkled on top. Maybe you've got some berries for a little bit of additional fiber and sweetness coming from berries rather than needing to add sugar on it, for example. And then what you'll find if you're comparing, let's say a bowl of instant oatmeal to a bowl of rolled oatmeal with that protein powder with those nuts and seeds with the little berries on it that all of a sudden you've made this much more complex meal. And the important piece here is that realizing that may stick with you for a lot longer. So if you're used to eating breakfast at a certain time and then two hours later turning to a small snack, you might find that now, okay, I've added protein. I'm adding fat. This meal is going to stick with me for three, four or five, six hours. It ends up sticking with me for a much longer period of time. So even though I've created a meal that has a lot more calories in it, and in theory if you're not careful, you could gain weight because if you just add protein and fat to every eating opportunity, you're just going to add a significant amount of calories throughout your day. But if you think about, okay, this is going to create a more long lasting fullness for me. Let me keep checking in on what my fullness looks like. You might find that meal that used to last two hours all of a sudden is lasting four hours, five hours, six hours and beyond, for example. Or if you're going to have an apple, you're like, okay, checking in. I'm recognizing I'm hungry. Like I said, pairing it with a nut butter, pairing it with a slice of cheese, something that's going to make it a little bit more complex. When we think about having toast, are you adding some sort of fat like an avocado or an egg or some nut butter on it? How can you create a more complex meal? Sometimes this can look like a really simple, I'm having a apple right now, and so I'm going to have a protein shake alongside of it. It doesn't always have to be something put on top of it or something paired exactly with it, but foods that are consumed sort of at the same time or together with one another to create this more long lasting effect, now they don't have to be done exactly at the same time. It can be something I usually say within an hour of eating that having those foods will end up sort of creating a meal together. What can be important is thinking about our food order. So particularly if we start with vegetables, things that are very high in fiber, but otherwise low in calories, this is going to slow down the absorption of everything that comes behind it. And then we have some proteins, maybe we have some fat, so that can look like maybe the meat or whatever protein you're having for the meal then to end the meal with any sort of more processed carbohydrate or more starchy carbohydrate or a dessert if you're having that, to have that as the end part of our meal. Now, even in this concept of no naked carbohydrates, one thing I will often encourage patients to do is to have their dessert almost immediately following the meal or within an hour of the meal ending. So what this does is allows it to be part of the meal. We can check into how hungry am I for this dessert? So separating it out by many hours, we're probably actually getting hungry again. So how can we bring it in as part of the meal if we're going to have dessert to pair it with a meal can help actually with both the amount that we eat, but then also how our body responds to it. It's absorbed more slowly, for example. So that can be something that's really helpful. And so thinking about really any time that we're eating, how are we going to create a more complex meal, creating something that's going to stick with us? That's something to help us last longer that gives us pauses in our day such that we're not finding, we have to constantly turn to fuel, but rather we can eat meals that help us stay satiated for longer. And if you are someone who identifies as a grazer and you're trying to make this change, really paying close attention to that hunger and to that satiety piece as well. Because if you were eating 5, 6, 7 times per day with just a little bit of carbohydrate here and there, adding protein and fat to it is going to make those meals feel heavier. They're going to stick with you longer. And so you do want to make sure that you're adequately compensating by eating less frequently then and waiting until your body is asking for food again. So let me know what you think. No naked carbohydrates is a rule that can be very, very helpful in creating meals, recognizing, am I actually hungry right now? If you're walking by the break room and see a cookie, for example, if you're going to have that, partnering it with the rest of a meal can help our body's response to it. And then helping define ourselves in a place where we're adequately getting the protein needs that our body has, making sure that we're feeling adequately fueled and even energy levels throughout the day, and no naked carbohydrates is one of the best ways that we can do that. My patients who've implemented it just feel really good. They don't feel that crashy sensation of, oh my gosh, sort of always looking for food. It helps our body to feel really, really good and can be supportive of their weight loss goals as well. If you were interested in learning more about something like this or working with a doctor who can help you implement these type of nutrition changes into your health goals, I would absolutely love to help you with that. You can see me online at www.sarahstombaughmd.com. We see patients in person in Charlottesville, Virginia, and then by telemedicine throughout the states of Virginia, Illinois, and Tennessee, reach out. We would love to connect with you and help support you on your weight loss goals. Thank you for joining us for today's podcast. We'll see you all next time.