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13 Get headaches if you miss a meal?
14 Need to eat frequent meals?
15 Pee a lot during the day and night?
16 Have excessive thirst?
17 Have cold hands and feet?
18 Get tired?
19 Get anxious and stressed?
20 Work harder than most people?
21 Wake up in the night feeling hungry?
22 Are you addicted to carbohydrates/sweet foods?
Total Score = /22
Interpreting the questionnaire
A high score in this questionnaire means you consume too many refined carbohydrates and this contributes to and increases your risk of Insulin Resistance. As you make changes to your diet, you should see your score reduce. Reading this chapter will help you understand why the wrong carbs are the major cause of Insulin Resistance.
Carbohydrate groups
Most foods actually contain a mixture of carbohydrates, proteins and fats; it’s rare for any food to contain only one of these macro-nutrients. Some foods are dominant in carbohydrates, some dominant in protein and some in fat. Carbohydrate dominant foods consist of cereals, grains, starchy vegetables and fruits. Legumes (beans and pulses) also contain predominantly carbohydrates even though they are often referred to as a protein food. Meats, fish, poultry and eggs have little or no carbohydrate content, whilst dairy products can contain the carbohydrate lactose (milk contains more than hard cheese) and soy products can contain carbohydrates, depending on the type (e.g. tofu, soy milk, tempeh). Nuts and seeds have little or no carbohydrate (the cashew nut contains the most, with 18 per cent of its weight as carbs). Non-starchy vegetables also contain some carbohydrates but in much smaller amounts than their starchy counterparts.
The most simple carbohydrates are known as simple sugars or monosaccharides. These are the fundamental building blocks of carbohydrates, just as the amino acid is the building block for proteins. When you eat a simple sugar or refined carbohydrate it requires little or no digestion and is absorbed quickly into the bloodstream. This elicits a rapid and excessive insulin response, and it is for this reason that refined carbs are so bad for you. The human body is not designed to handle REGULAR intake of refined carbohydrates with impunity.
Refined carbs and simple sugars require little or no digestion and provoke a rapid and excessive insulin response. This is why they are so bad for you.
A system has been devised to measure how rapidly different carbs affect your blood glucose. This is called the Glycemic Index, which is a measure of the amount of insulin the body needs to produce to lower the glucose levels after eating that food. The higher the GI the more insulin is produced.
The Glycemic Index and Load
The Glycemic Index (GI) is a numerical system of measuring how fast a carbohydrate triggers a rise in circulating blood sugar – the higher the number, the greater the blood sugar response. So a low GI food will cause a small rise, while a high GI food will trigger a dramatic spike. A GI of 70 or more is high, a GI of 56 to 69 inclusive is medium and a GI of 55 or less is low.
The Glycemic Load (GL) is a relatively new way to assess the impact of carbohydrate consumption. It takes the Glycemic Index into account, but gives a fuller picture than the Glycemic Index alone. A Glycemic Index score tells you only how rapidly a particular carbohydrate turns into sugar – but it doesn’t tell you how much of that carbohydrate is in a serving of a particular food (i.e. the GI is a qualitative measure, whereas the GL is a quantitative measure). You need to know both things to understand a food’s effect on blood sugar. The carbohydrate in watermelon, for example, has a high GI, but there isn’t a lot of it, so watermelon’s Glycemic Load is relatively low. A GL of 20 or more is high, a GL of 11 to 19 inclusive is medium and a GL of 10 or less is low. Foods that have a low GL almost always have a low GI. Foods with an intermediate or high GL range from very low to very high GI. There is a detailed table in the Resources section showing the GI and GL of common foods.
The Glycemic Index and obesity
You may be surprised to know that it is not just the number of calories you eat that results in weight loss or weight gain. This is because calorie counting does not take into account the Glycemic Index and the hormonal response to food. Calorie counting can be helpful but should certainly not be the sole focus for weight loss. The reason why a low GI carbohydrate diet helps weight control is because it helps you feel satisfied after a meal and it both minimizes insulin levels after consumption and maintains insulin sensitivity.
Case Study: Carol
Resisting sugar is not just a matter of will power, however. I believe it is also linked to biochemistry and habit. When Carol came to see me some years ago she was in her early thirties and had been a member of over-eaters anonymous for seven years. During this time she had not touched refined sugar and yet she still craved it. Sugar craving is sugar addiction, no matter which way you look at it. She was still addicted to sugar because she was having to use her will-power NOT to eat any. However, she still evidently had marked fluctuations in her blood glucose levels.
Based on her symptoms, a glucose tolerance test was recommended and the results were proof enough. Carol’s blood glucose levels went up too high at first, into the mildly diabetic range, and then plummeted into the hypoglycaemic range. She felt dreadful while the test was being performed – and remember this was after seven years of avoiding sugar. We did not measure her insulin and adrenal hormones at the time, but needless to say the insulin mounted a delayed response to the sugar shock and then was produced in high amounts, resulting in the sudden drop in blood glucose, at which time the adrenals would have kicked in to increase the level again. Carol was in stage 1 or stage 2 of Insulin Resistance, but was certainly not a full-blown case. There were also adrenal issues.
Carol was not eating enough protein by any means, with none whatsoever at breakfast. In addition, her diet as a whole was relatively high in carbohydrates, though these had a relatively medium to low Glycemic Index. I addressed her lack of protein by getting her to eat high BV protein for breakfast, lunch and dinner. She continued to eat some carbohydrates as well, so it was by no means a low or no carbohydrate diet at all. When she got into the habit of eating the protein foods her craving virtually disappeared. Her will-power enabled her to implement the new programme, but it was the new programme that gave her new-found freedom from her cravings. She has a motto, which I often use myself, ‘discipline equals freedom’. The discipline to follow a programme allows you to derive the benefits from that programme.
It is not how many calories you eat, but rather the type of calories you eat that causes weight gain.
What’s the difference between simple sugars and starches?
Glucose (aka dextrose) is the best-known simple sugar. Sugars composed of two monosaccharide units are called double sugars or disaccharides, and these are found extensively in nature. Sucrose, also known as table sugar, is the best-known double sugar. When you eat sucrose, the enzyme sucrase splits it into the simple sugars glucose and fructose, which are then quickly absorbed into the body. More complex sugars, or polysaccharides, contain links of many simple sugars. Starch, for instance, contains polysaccharides, and are therefore known as complex carbohydrates. Plant starch requires much greater digestion and hence is absorbed much more slowly than less complex sugars like sucrose or glucose. As a consequence, starchy vegetables have a medium to low Glycemic Index.
Starchy vegetables
Some examples of starchy vegetables are given below:
Cooking transforms more complex carbs into more simple carbs. This means that the GI of raw starches is almost always lower than cooked starches.
Fibre foods
Just as starch slows down digestion, so too does fibre. Fibre makes you feel more full, which helps reduce appetite and slows the release of sugar into the bloodstream. It feeds friendly bacteria, carries toxins out of the gut, so unwanted bugs are less able to flourish.
Essentially, there are two kinds of fibre, soluble and insoluble. Soluble fibre absorbs much more water, toxins and even cholesterol than insoluble fibre, and carries them all through the colon for elimination; insoluble fibre provides bulk but can irritate the gut lining, especially when eaten in excess. For example, oat bran, which is a rich source of soluble fibre, can lower cholesterol levels whereas wheat bran, a rich source of insoluble fibre, does not.
Legumes – which contain plenty of soluble fibre – are a particularly useful source of carbohydrate in the diet. This is because they have a low Glycemic Index and are very insulin-friendly. Unfortunately, some people may find that legumes can cause excess wind, so introduce them gradually into your diet. If, however, the problem persists it may be due to a lack of digestive enzymes and you may need to either avoid them altogether or reduce the volume of legumes eaten and instead consume more starchy vegetables.
In some countries legumes are a staple; however, in the West they are not as common – with the exception of tinned baked beans. So, instead of opting for de-natured, often sugar-loaded, baked beans why not try some of the following:
Grains
Starchy vegetables, legumes and grains are the three main foods groups from which we derive the bulk of our carbohydrates. Fruit is also a high carbohydrate food. Of these groups it is grains that are most often refined and processed – and it is food processing that is largely to blame for the huge increase in refined, high Glycemic Index foods. The main staple foods around the world are wheat and rice. However, there is more to grains than just the big two. Below is a list of grains and, where appropriate, the sorts of foods that are made from them. Where possible, opt for the unrefined product – wholemeal breads, whole-wheat pasta, unrefined breakfast cereals, brown rice, quinoa, millet grains and so on.
Fruit
While fruit contains many beneficial nutrients, such as antioxidants, vitamins, minerals, fibre and water, as a food group, fruit is higher in carbohydrates and lower in protein and fat than any other. Fructose is the main carbohydrate in fruit, which is absorbed more slowly than glucose but still more quickly than complex carbs found in whole grains and legumes. For this reason you should be careful about how much fruit you eat. For the archetypal fit and lean individual, fruit will not be an issue, but the more insulin resistant you are, the more likely it is that you need to limit your fruit intake. If you have full-blown Insulin Resistance, you should only eat the lowest Glycemic Index fruits.
Limit carbohydrates, don’t avoid them
If you have Insulin Resistance you should limit all carbohydrates, but not avoid them. However, you should avoid all high Glycemic Index foods. You can eat moderate to low Glycemic Index foods, such as many of the above grains in their whole form and in small amounts, although the more insulin resistant you are the fewer you should eat. Some people consider grains to be a primary cause of the Insulin Resistance phenomenon, and recommend an avoidance of all grains, both whole and refined. However, this is not practical for most people and can also cause health problems in the longer term. Instead of cutting out carbs altogether, concentrate on cutting out refined carbs from your diet and choose instead starchy vegetables and legumes as your main source of carbohydrate and whole grains as a limited source – this cannot be emphasized enough.
Main sources of carbohydrate
Try to limit your carb intake to 40 per cent of your diet, and within this 40 per cent the following proportions:
Why shouldn’t I cut out carbs altogether?
Don’t make the mistake of thinking that if low GI is good, no GI (i.e. eating no carbs at all) is better. Whatever degree of Insulin Resistance you have, it’s made worse if you eat no carbs at all. Eating a very low carb diet for more than a couple of weeks can reduce the activity of your thyroid hormones, in particular the most active thyroid hormone, T3, or tri-iodo-thyronine. A low level of T3 can lead to fatigue, weight gain and poor circulation. What’s more, a low carb diet will also cause your blood glucose to drop and, when this happens, your brain stimulates the adrenals to raise blood glucose with cortisol, resulting in high cortisol levels. Independently of eating a low carb diet, high cortisol levels will actually reduce the thyroid hormone T3 and also increase Insulin Resistance (see chapter 9 (#litres_trial_promo)
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