People and Carbs in the Metabolic Syndrome Era

The USDA likes pancakes!

The USDA likes pancakes!

Since the 1970’s, health institutions have advocated diets high in carbohydrates (low in fat) and carb consumption has significantly increased. The USDA recommends a low-fat diet consisting of 45 to 65 percent carbs and this is not likely to change with revisions to the 2015 dietary guidelines. I want people, especially people in my family, to know why habitually consuming this amount of carbs is unhealthy and to be skeptical of the high-carb promotions coming from institutions and the food industry. For an example of this messaging, see The USDA Likes Pancakes Topped with Fruit and a Sprinkle of Sugar. Also consider an article CSPI (Center for Science in the Public Interest) published that included…

…even for otherwise non-controversial advice, such as advice to avoid diabetes and other diseases by selecting diets high in fruits, vegetables, or whole grains.(1)

Fruits, vegetables, and whole grains are healthier than junk food. However, even ignoring issues concerning grains(2), there is much controversy regarding a high-carbohydrate diet. So I asked CSPI via Twitter:

My tweet links to the CSPI article. There hasn’t been a reply. Considering the general state of American’s health (more than 50 percent are diabetic or prediabetic) and that we have followed USDA recommendations(3), the notion that eating a low fat diet is healthy is controversial. Nevertheless, validity of the low-fat diet is the consensus of opinion among many organizations such as CSPI, ADA, AHA, and USDA. I think CSPI labels it non-controversial to dismiss other ways of eating. Of most interest to me, they have explicitly dismissed the low-carb high-fat (LCHF) diet(4).

The CSPI website describes initiatives they are working on, such as reduction of salt consumption and eliminating junk food from schools. Health profiles will get better when kids eat less junk food, but I would like to see CSPI seriously attack the metabolic syndrome epidemic in ways that will have more effect. To do that, they will need to focus on the key factors of modern chronic diseases – inflammation and insulin resistance. I believe the primary root cause of both of these maladies is habitual consumption of too much carbohydrate over the course of years. Certainly trends of metabolic syndrome are coincident with increases in carbohydrate consumption. While this doesn’t prove causation, there is convincing evidence that this problem will not be resolved until the general consumption of carbs reverts to much lower levels. CSPI is an influential advocacy group so it is unfortunate they promote the low-fat diet and dismiss alternatives that many people are discovering to be healthy(5).

Unfortunately, health professionals commonly ridicule ways of eating that do not fit low-fat dietary guidelines. Consider the following tweet that links to an info-graphic from Kaiser Permanente, which categorizes the Paleo diet as a fad. It suggests that you may have difficulty sustaining this 2.5 million year old diet of unprocessed real food and that it may leave you deficient in vitamin D and calcium. Dr. Maroon buys right into this.

Institutions and food industries use a variety of messaging to defend and promote low-fat nutrition. Modern health professionals often repeat the “artery-clogging saturated fat” phrase to advance the perception that the low-fat diet is healthy. Since this is the common view of experts, using this term gains the support of other experts, and the notion that dietary saturated fat clogs arteries is continually reinforced(6). CSPI is represented by credentialed health professionals who apparently have this consensus of opinion:

Yikes! I bring up the saturated fat issue to give an example of how health professionals work to bend the public’s perception to suit their beliefs and agendas. People are evolving and are slowly getting nutrition figured out so be wary of institutionalized myths(7).

CSPI’s categorization of diets high in fruits, vegetables, or whole grains as a non-controversial way to avoid diabetes ignores the LCHF movement. It ignores the science(8) and the experience of people who have reversed symptoms of diabetes through LCHF eating. Dismissing this is wrong and it is wrong to suggest that low-fat USDA nutritional guidelines are non-controversial(9).

Really, what’s the big deal?…

USDA's High-Carb Plate

USDA’s High-Carb Plate

A diet of fruits, vegetables, and whole grains is certainly healthy relative to many other diets so what’s the big deal? This describes the low-fat diet illustrated by the USDA MyPlate icon. Actually, the icon indicates a nearly zero-fat diet. So did I get bent out of shape over CSPI’s use of the word “non-controversial” for a good reason? To answer that, I will summarize a few facts regarding what carbs actually do. Then I will get back to why I am picking on CSPI.

The USDA nutritional guidelines recommends a diet of 45 to 65 percent carbohydrates and is therefore an extreme diet. It is extreme from a historical perspective and it is extreme because of the demands it imposes on the body. People have become so accustomed to an abundance of breads and other processed high-carbohydrate foods that they are typically not aware of how unusual it is to eat so much of this. A target of less than 20 percent carbohydrates is more reasonable(10). It certainly makes no sense to recommend that half your intake should be from a nonessential macronutrient.

Consider the quarter of the MyPlate icon devoted to grains. The USDA actively supports grain consumption and suggests making at least half of your grains whole. I disagree with the USDA’s zealous promotion of grains because even whole grains are high-carb and grains are not particularly nutrient dense(11). They recommend 410 calories of grains per day for a person that consumes 2000 calories per day. This equates to six slices of 100 percent whole wheat bread and a single slice of this has 12 grams of carbohydrates and one gram of added sugars(12). If you followed the USDA recommendation with 100 percent whole wheat, you would be consuming 78 grams of carbohydrates per day just from the grains. The body breaks down all carbohydrates into simple sugars. There are approximately five grams of sugar per one teaspoon so your body will need to process 15.6 teaspoons of sugars just from the whole wheat. Fortunately, the fiber and the more complex carbohydrates in the whole wheat slows the process, preventing the type of blood sugar spike you can get from junk food. Still, the sugar from just one slice of whole wheat bread is in excess of the body’s requirement(13) and imposes an unnecessary glycemic load, considering that less than one teaspoon of sugar is in a normal person’s bloodstream(14).

Other foods have higher concentrations of carbs. For instance, the simple sugar component of the carbohydrate in just a medium order of fast food fries is about 10 teaspoons. Dr. Malcolm Kendrick’s article, What happens to the Carbs?, is an excellent discussion of how the body processes more carbs than can be used.

None of this information proves that eating six slices of whole wheat bread a day is unhealthy. We do not know the optimum macronutrient ratio and we never will because there are too many variables that continually change (insulin resistance, level of exercise, etc.). However, what is known about the effects of excess blood sugar reinforces my conclusion that a 45 plus percent ratio is potentially damaging.

Of course, “extreme” is a matter of degree. Would you think drinking 12 ounces of Coca-Cola Classic per day is excessive carbohydrate consumption? This piles on 39 grams of simple sugars per day to process – all in excess of requirements. After one year, you will have consumed more than 31 pounds of sugar. Swapping the soda with sports drinks or “natural” fruit juices will bring essentially the same result. What if you eat six slices of whole wheat bread per day? Is this excessive? While the 78 grams of carbohydrates in the bread is converted to simple sugars, your blood sugar level will not be spiked as it is with the sugar from Coke. Nevertheless, I believe this is excessive as well. While tolerance to carbs varies, excessive habitual carb intake results in the inflammation and insulin resistance that is driving metabolic syndrome. Fat and protein do not significantly affect inflammation(15) and insulin production. Carbohydrates do. To avoid diabetes, lower the proportion of calories that require insulin production. An occasional carb binge is not going to significantly harm anyone with normal tolerance, but there are consequences.

If you do eat grains, at least follow CSPI’s advice to eat whole grains. This is important because the glycemic load from a serving of white bread is almost as much as it is for a soft drink (16 for the drink and 14 for the bread). Unfortunately, most of the grain-based processed foods that fill our grocery stores do not consist of whole grains.

The insulinogenic index is probably a better way to assess whether foods will stress your system and increase chances for diabetes. It factors in protein. fiber, and fat(16). Avocados are nutrient-dense and include a lot of fiber, making a calorie from avocado more than five times less insulinogenic that a calorie of 100 percent whole wheat. There are better foods to eat than whole grains to avoid diabetes.

You may believe that the correlation of low-fat diet and metabolic syndrome trends do not point to the cause of generally poor health. After all, health conditions have clearly been exacerbated by refined sugar consumption, mostly from sugary soda, sports drinks, and fruit drinks. These quickly metabolizing sugars result in more impact to health than complex carbohydrate foods that include fiber. Assessing nutrition is also complicated by the fact that everyone’s tolerance to carbs differs and exercise has effects as well. Low-fat diet advice is not completely to blame for chronic metabolic diseases. However, an excess of carbohydrates over a long period of time does result in

  • fatty liver disease
  • visceral fat
  • diabetes
  • obesity(17)
  • oral health dysfunction
  • inflammation (affecting cardiovascular health)
  • high triglycerides and more…

Atherosclerosis is influenced by elevated blood glucose(18) so don’t elevate your blood glucose. The only way to significantly elevate blood sugar is to guzzle carbs. I don’t think there is a reason for concern, unless your carb intake approaches or exceeds USDA dietary recommendations.

Research these issues for yourself. If everyone had an understanding of all facts regarding nutrition, the diet advice given by institutions would be of no consequence. However, people are getting information from institutions that they are believing and following and some of this advice is making them sick. The information seems believable because it is repeated over and over. Some of it is just believable anyway. For instance, doesn’t it seem logical that eating sticky saturated fat could clog your arteries? And why wouldn’t it be healthy for humans to start consuming a diet with one fourth of calories coming from grains?  The low-fat high-grain diet is enshrined in icon’s, repeated in textbooks, and it is alluded to as “non-controversial”. Medical doctors who deviate from low-fat dogma are attacked for any inconsistency or any issues that can be found. They are publicly derided and they are sometimes referred to a quacks. Watch for this and look for the evidence to decide what is credible.

Nutrition is complex and it has been afflicted with poorly executed and biased science. There are many variables and there is much that is unknown. People’s tolerance to carbohydrates varies widely and can change over time as insulin resistance changes so there is no single diet that fits everyone. It is too soon to dismiss anything just because it is not USDA approved.


Jeff’s Non-USDA Approved Plate

With no sugars and no grains, what’s there to eat?

There’s lots of really tasty choices, even when you limit yourself to real, unprocessed food. The photo shows one of my plates consisting of:

  • hamburger (unfortunately not grass-fed)
  • cheese
  • mustard (no sugar in this)
  • bacon
  • pickle
  • celery
  • carrot
  • lettuce
  • tomato
  • onion

I entered the type and amounts of these foods into the USDA’s SuperTracker and clicked the Nutrient Intake Report link. From that I learned his meal is 486 calories with nine percent carbs. Had I included a white hamburger bun, calories would have gone to 606 and the carb content would have been 22 percent. A couple of years ago, I would have included the bun and sugary ketchup, skipped the bacon, and there would have been fries instead of veggies. Interestingly, if the bun was 100 percent whole wheat, calories would have been 600 with the total carbs at 22 percent. So adding a wheat bun would more than double the carbs, but there is little difference in carb content between the white bread and whole wheat. Adding the 100 percent whole wheat bun would have increased fiber consumption by three grams along with the 114 additional calories.

This is a typical dinner for me. Eating this way, I find that I am sometimes not hungry in the morning so I skip breakfast. Later in the day, after about 15 hours of fasting, I will go running and I don’t bonk. This is a common experience for fat-adapted runners. There’s no way that would have happened in my past as a carb-loading runner(19).

I think it is worth the effort to criticize CSPI because they can influence health trends positively. CSPI is a strong advocacy group that has demonstrated capability to change when it is warranted. It will be awhile before USDA reduces the grain portion of the plate icon due to powerful special interests. CSPI can help with this. Better advice for them to give for avoiding diabetes would be:

Don’t eat sugar. Don’t eat grains.

The body makes glucose as needed without dietary carbohydrates so it would be better if CSPI recommended avoiding foods that have to be ultimately processed as simple sugars. My guess is that CSPI does not follow Jeff’s Health Notes so I will invite them to comment on this via Twitter.

Some of my comments are opinions supported only by my experience, reported experience of others, and my interpretation of research. However, there is enough science regarding what carbs do to know that an average of more than 45 percent is excessive and there is much other evidence. Look around – you will find a few people from health and food industries recommending carbs, lots of people eating carbs, and lots of people burdening the health care system with chronic diseases. Long-term LCHF eaters are not participating in this.

Notes and References:

1. This is quoted from CSPI’s article, Nation’s Health Groups Oppose Appropriations Riders Aimed at Gutting Dietary Guidelines for Americans. The author probably means “and whole grains” instead of “or whole grains”.

2. See the lecture, Wheatlessness: A 21st Century Health Strategy, by cardiologist Dr. William Davis.

3. See Jeff’s Health Notes: Eating Trends Follow Guidelines and information from the CDC:

Also, we have been eating a lot of wheat during the metabolic syndrome era…

4. Jeff’s Health Notes: Nutrition Action Debunks Low-Carb Diets???.

5. The LCHF movement is supported by science, although more is needed. Passion for it is based on the stories of millions who have experienced LCHF health, including improved blood lipid metrics, weight loss, and reversals of type 2 diabetes symptoms. There is much collective experience throughout social media.

6. While cholesterol  amassed to repair an inflammation can clog arteries, dietary saturated fat does not. The 2015 Dietary Guidelines Advisory Committee made statements pointing out that dietary saturated fat is not a significant concern based on science. For instance, from their report…

…recent meta-analyses of prospective observational studies did not find a significant association between higher saturated fat intake and risk of CVD in large populations.

In some conflicting statements, the committee also noted that Americans are eating less saturated fat and they believe we should eat even less.

7. There is a need for unbiased nutrition science. The following article by Stephan Guyenet, PhD discusses the weak association between habitual saturated fat intake and blood cholesterol and the lack of science that, according to popular belief, demonstrates that dietary saturated fat is “artery-clogging”: Does Dietary Saturated Fat Increase Blood Cholesterol? An Informal Review of Observational Studies. Then there is the issue of whether you really want low cholesterol. Both total and LDL cholesterol metrics are not good predictors of mortality and low LDL is associated with risk for dementia. There is more about this in Jeff’s Basic Health Notes and Comments for the 2015 Dietary Guidelines. Also see Zoë Harcombe’s article Saturated fat & CHD in Europe.

8. A great deal of science has demonstrated effects of excessive carbohydrate intake and much more needs to happen. Groups such as The Noakes Foundation work to advance science related to metabolic syndrome. See the References section of this website and review citations provided by the referenced sources. Some of the authors of the references, such as Dr. Joseph Mercola, have been the subject of vitriolic rhetoric from people and organizations that do not agree with his views. Ignore this and objectively review the information provided and what is cited as evidence. Special agendas often result in very skewed conclusions that get published regarding nutrition. See Interesting Low-Carb Science where scientists discover they can reverse symptoms of diabetes in rats by feeding them a low-carb diet. Also see My Five-Star Rating and Comments on The Big Fat Surprise. Read the book and review the references. There is also much information that points to LCHF benefits that is from experience. For instance, Dr. Sarah Hallberg reverses symptoms of metabolic syndrome in her clinic through the prescription of LCHF, as opposed to using high-carb ADA nutritional guidelines. Her TEDx talk, “Reversing Type 2 diabetes starts with ignoring the guidelines”, is published on YouTube:

9. For my admittedly controversial views on the USDA dietary guidelines, see Comments for the 2015 Dietary Guidelines. Also see Food Guidelines Are Broken. Why Aren’t They Being Fixed? by Jeff S. Volek, PhD, RD. which states:

The excessive consumption of carbohydrates is the primary cause of obesity and diabetes—and it’s not a stretch to implicate the dietary guidelines in these epidemics plaguing our country.  

10. Jeff’s Health Notes: More About Macronutrient Targets.

11. Zoë Harcombe: ‘Healthy whole grains’ – really?!

12. The amount of carbohydrates in whole wheat bread is almost the same as the amount in white bread. There is twice as much fiber in whole wheat. A slice of 100 percent whole wheat bread includes two grams of fiber. However, there are more concentrated fiber sources, such as from avocados. One green avocado provides 20 grams of fiber.

13. As there is no nutritional requirement for carbohydrates, any amount is excessive by definition, although the extent to which carb consumption matters is widely variable. Eliminating carbs would be impractical and unnecessary. However, because our bodies produce glucose as needed from the essential macronutrients (protein and fat), I believe habitually consuming over 45 percent of your diet in carbs is extreme. This is based on known effects of elevated blood sugar and some of my own experiences with the health consequences.

14. Micheal R. Eades, M.D.: A spoonful of sugar

15. Inflammation results when the small and dense type of LDL cholesterol particles become lodged in artery walls. This type of LDL is more prevalent in people who eat low-fat high-carb diets. For a well-referenced article regarding this by cardiologist Dr. William Davis, see New Blood Test Better Predicts Heart Attack Risk. Also see Advice to follow a low-carbohydrate diet has a favorable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet, Annals of Medicine.


17. Unless someone is extremely gluttonous and slothful, the only way an otherwise healthy person can become overweight is by habitually eating an amount of carbs that are excessive for their physiology. Few people are overweight due to gluttony or sloth.

18. See section 4.3 of Scientific Advisory Committee on Nutrition – 2015 (UK), Carbohydrates and Health.

19. Endurance athletes improve performance once they become fat-adapted.