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  • Q&A with Australian Health Practitioners

    Do carbohydrates make you gain weight?

    A lot of my friends try to avoid eating carbs - are they bad for you? do they result in weight gain?
  • Find a professional to answer your question

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    Courtney Bates

    Dietitian, Nutritionist

    Courtney is an Accredited Practising Dietitian (APD), Accredited Nutritionist (AN) and member of the Dietitians Australia. She runs her own practice on Sydney's Northern Beaches … View Profile

    Foods are made up of 3 macronutrients - carbohydrates, proteins and fats. In terms of energy density, 1 gram of carbohydrate has 16kJ, which is the same as protein. 1 gram of fat on the other hand has 37kJ. So, carbohydrates are no more energy dense than protein, and are less energy dense than fat.

    Our diets should actually be 45-60% carbohydrate, 30% fat and 10-25% protein. Low carbohydrate diets are not nutritionally balanced and generally we cannot adhere to them longterm. The best diet for weight loss is well balanced with correct portions of carbohydrates, proteins and healthy fats. I recommend consuming low GI carbohydrates throughout the day for energy. Examples of low GI carbohydrates are oats, wholegrain bread, Vita Weats, Doongara clever rice, quinoa, fruit and yoghurt. As a general rule, aim to fill one quarter of your plate with low GI carbohydrates.

  • 13

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    Carolien Koreneff

    Counsellor, Credentialled Diabetes Educator (CDE), Diabetes Educator, Psychotherapist, Registered Nurse

    Carolien Koreneff is a Somatic (body-oriented) psychotherapist, Health Coach, Counsellor as well as a Credentialed Diabetes Educator with over 20 years experience. She currently sees … View Profile

    Courtney has provided some very important information about carbohydrates above. I would like to add though, that it is not just about the intake of energy; unless the output is matched the balance goes out and this can lead to weight gain.
    It is often thought that carbohydrates are to blame for weight gain, however they are a very important part of a balanced diet. If you want to maintain your weight, or lose weight, you want to include carbohydrates in your diet, but restrict the total caloric intake by also watching the protein and fat intake and choose carbohydrates that are lower in glycaemic index, as they tend to keep you fuller for longer.
    Remember that too much of a good thing is no longer a good thing. My grandmother always said “everything in moderation”, I think she was a wise woman and had it spot on!

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    Anonymous

    They are great answers from other health professionals, but if you'd like an answer from someone who has to battle the fat gene here's some worldly advice…

    Protein is responsible for repair and construction of every cell in your body, including your hair, nails, muscle, blood, tendons and skin.  Many health authorities recommend that we consume 10 – 15% of our daily calories in the form of protein, 65 – 75% in the form of carbohydrates, and as little fat as possible – approximately 10 – 20%.
     
    Does it make sense to you that we only take in 10% of out total calories for the purpose of repair and construction of every cell in our bodies?

    If you really want a lean and healthy body then opt more for the Paleo Diet!! 

    If Bodybuilders and Figure Competitors such as myself have to drop out carbs to get lean, then that's gotta tell you something!!!

    The Paleo diet has saved my life and made it so much easier to prevent fat gain.  I have the ‘fat gene’ and if I ate starchy carbs i'd never get on stage at 10% bodyfat.

    Just some advice from someone who lives in the real world ;)

    Pam

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    Luke Delvecchio

    Diabetes Educator, Exercise Physiologist, Nutritionist

    Specializing in the assessment and treatment of metabolism related weight disorders. View Profile

    You should remain anonymous with a nonsense answer such as this!

    please provide real scientific evidence to support such a wild hypothesis.

  • Christian O'Grady

    Nutritionist, Personal Trainer

    Body Recomposition, Fatloss, Personal Coaching Strength & Hypertrophy training  with an evidence based approach. Christian bases his clinic principles on the models of an Evidence based … View Profile

    Hi Pam, physique athletes do not heed to remove carbohydrates from there diets what so ever. If you are doing so to get lean you are doing it completley wrong because anecdotally and scientificly the evidence is against you. Look and do some reading from the following Lyle Mcdonald, Alan Aaragon, Brad Schoenfeld, Layne Norton , James Krieger ect Feel free to contact me if you would like some readings. Also What gene testing have you had to determine you have 'the fat gene'?

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    Arlene is a registered practising dietitian, with a private practice in the Eastern Suburbs of Sydney, and has built a strong business over the last … View Profile

    Carbohydrates don't make you gain weight if you eat the correct portions and select unrefined, unprocessed carbohydrates. Never blacklist individual foods or entire food groups from your diet, unless you have a food intolerance or allergy. Forget fad diets that omit certain food groups such as carbohydrates. The most important part of successful weight loss is balance, and when you eliminate an entire food group, your body misses out on important nutrients. Moreover you are likely to feel deprived, increasing the risk of bingeing. You can eat everything you want provided you moderate your choices and keep your portions small. Weight loss should not be your only concern when making food choices; it is imperative to enjoy a wide variety of food to optimise your intake of nutrients. You should pay attention to portion sizes!!!

  • Christian O'Grady

    Nutritionist, Personal Trainer

    Body Recomposition, Fatloss, Personal Coaching Strength & Hypertrophy training  with an evidence based approach. Christian bases his clinic principles on the models of an Evidence based … View Profile

    Refined or processed carbohydrates also do not make you gain weight. 

    It is down to the context of the individual granted both diets are isocaloric and have the same macronutrient and micronutrient composition. 

  • 2

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    Anonymous

    Keep in mind too that the Paleo Diet is not a fad… its the way we were designed to eat.  Are there any essential carbohydrates?  Yes, vegetables!!

    Grains are essentially nutrient deficient foods with an abundance of anti nutrient qualities. The sooner the masses realize that the better.

    That is the number one dietary reason in addition to consuming polyunsaturated fats why western society are suffering an epidemic of physical and mental disease. The delivered historical model of the traditional food pyramid with 6 serves of grains at the bottom is a tragic case of distorted convention wisdom.

    The best book on the planet regarding this subject is called The BLOOD SUGAR SOLUTION by Dr Mark Hyman. If that does not make the hairs on the back of your neck stand up… Nothing will.

  • Christian O'Grady

    Nutritionist, Personal Trainer

    Body Recomposition, Fatloss, Personal Coaching Strength & Hypertrophy training  with an evidence based approach. Christian bases his clinic principles on the models of an Evidence based … View Profile

    The Paleo diet is most definetley a fad favourited by quacks and celebrity chefs. The evidence is clear we do not and can not eat like our ancestors, and even if we could why would we want to?

    You have made an error in assuming that people actually follow the guidelines this is total rubbish, the guidlines have not made anyone obese or overweight. 

    Mark Hyman is a self professed expert and his ideas are designed to sell books to people like yourself. He makes money by making wild claims he is no different to foodboob or mercola. 

    I suggest you look into the actual evidence for yourself and by evidence i mean exactly that, not a book on amazon, not blogs or youtube videos actual evidence.
     

    http://ajcn.nutrition.org/content/76/3/535.full

    http://www.ncbi.nlm.nih.gov/pubmed/25559238

    http://www.ncbi.nlm.nih.gov/pubmed/21147364

    http://www.ncbi.nlm.nih.gov/pubmed/17760498

     

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    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    Re: Dr Mark Hyman

    I have visited his site (http://drhyman.com/) and a number of things about it concern me;

    (1) It is linked to a site (http://www.ultrawellnesscenter.com/) which Dr Hyman seems to have a beneficial interest in. The cutsie title (“ultrawellnesscenter”) is a big red-flag warning for me.

    (2) http://drhyman.com/ is a “.com” site which means that it is intended to make money for Dr Hyman and his associates.

    (3) Consistent with (2), a prominent part of it is http://store.drhyman.com/, in which visitors are invited to buy books that Dr Hyman has written.  I conjecture that Dr Hyman will turn a profit from every such sale.

    I can find nothing relevant in PubMed concerning Dr Hyman. PubMed is the primary database for the *peer-reviewed*  biomedical research literature. Dr Hyman's absence from this database is consistent with the view that none of his views on nutrition and related topics have been assessed as being worthy of publication by his professional colleagues.

    I would be very cautious here - my inclination would be to seek advice from an *evidence-based* Australian health professional before placing much credence on Dr Hymn's views.

  • Christian O'Grady

    Nutritionist, Personal Trainer

    Body Recomposition, Fatloss, Personal Coaching Strength & Hypertrophy training  with an evidence based approach. Christian bases his clinic principles on the models of an Evidence based … View Profile

    Mark Hyman has aligned himself with the 'foodbabe' this says it all.

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    Anonymous

    No doubt.  Just quoting one interesting book.

    I would rather stick to my own research as an Aust health professional, I still believe and other evidence proves that 75% of the population are carb intolerant.

    I would never suggest to my clients that they will definately burn fat in the presence of sugar (carbs).

  • 1

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    Christian O'Grady

    Nutritionist, Personal Trainer

    Body Recomposition, Fatloss, Personal Coaching Strength & Hypertrophy training  with an evidence based approach. Christian bases his clinic principles on the models of an Evidence based … View Profile

    A health professional that can not understand basic physiology? Please provide this evidence...
     

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    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    In the interest of continuing this conversation, which may be of interest to others who read along here…

    "
    other evidence PROVES that 75% of the population are carb intolerant. “

    Two questions:

    (1) *What* ”evidence“ are you alluding to - PubMed links would be nice :-) ?

    (2) I am not sure what you mean by ”carb intolerant". From my knowledge, (I am a biomedical research scientist (PhD, not MB BS) and so know a fair bit about metabolism and related areas), there seem to be a number of possibilities here. 

    Can you be more explicit?

  • Anonymous

    Google that info with world renoun Charles Poliquin.  That will explain everything to you

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    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    Thank you for your kind suggestion.
     
    I have.
     
    The second Google hit, (http://en.wikipedia.org/wiki/Charles_Poliquin),  notes that "This article relies on references to primary sources or sources affiliated with the subject, rather than references from independent authors and third-party publications. Please add citations from reliable sources.).''

    That is Wiki code which, subject to the laws of libel, encourages viewers to consider that it might not be wise to place undue credence on the veracity of that information.
     
     
    The first Google hit (http://www.charlespoliquin.com/) is another commercial site. Prominent in it is the “Shop Online” part, where Poliquin is hoping to make money by selling various things.
     
    This is the same style as the Hyman site that we have discussed above.
     
    Do you think that there might be a message here for sceptical readers?

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    Anonymous

    Yeah I think the message is that when people suggest to eat lots of carbs and especially grains then the person making the suggestion should accept responsibility for further health problems.

    Charles Poliquin is an exception coach.  I will accept his research.  I put into practice his knowledge everyday… his intelligence has saved my life. 

  • Courtney Hargrave

    Exercise Physiologist, Nutritionist

    Dual qualified Accredited Exercise Physiologist and Nutritionist with undergraduate and postgraduate degrees in the fields of Sports Science, Exercise Physiology and Nutrition. Also I am … View Profile

    Pam in your first post above you write:

    “Many health authorities recommend that we consume 10 – 15% of our daily calories in the form of protein, 65 – 75% in the form of carbohydrates, and as little fat as possible – approximately 10 – 20%.”

    Can you please highlight these health authorities and where these recommendations are being promoted to the general public?

  • Anonymous

    That's a quote by Donna Aston.  Perhaps you could ask her

  • 3

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    Anonymous

    Pam, If you are quoting others you should reference or acknowledge that source or else it can be termed plagarism, however unfortunately in this case both Donna Aston and yourself are quoting incorrect information with respect to these supposed dietary guidelines that are being promoted by ‘health authorities’. 

    Healthshare is meant to be a point of accurate and resourceful information provided by appropriately qualified health professionals. I would recommend that dietary questions be answered by those with tertiary qualifications in the areas of nutrition and dietetics. 


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    Courtney Hargrave

    Exercise Physiologist, Nutritionist

    Dual qualified Accredited Exercise Physiologist and Nutritionist with undergraduate and postgraduate degrees in the fields of Sports Science, Exercise Physiology and Nutrition. Also I am … View Profile

    Thanks Pam. I think Donna Aston has got this one wrong. I am unaware of any health authorities that are promoting a diet with "10 – 15% of our daily calories in the form of protein, 65 – 75% in the form of carbohydrates, and as little fat as possible – approximately 10 – 20%.”

    Might be worth reading the NHMRC's Australian Dietary Guidelines, which have just been revised and are due to public release shortly. 

    Cheers,
    Courtney

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    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    Re: Donna Aston

    A quick Google pulls up this; http://www.donnaaston.com/index.php .

    Ms Aston describes herself as a “Fitness Therapist” whatever, if anything, that may mean. I can not find anything on her site which provides *independent* evidence as to her professional qualifications if such there may be.

    Whether she is (in HealthCare terminology) entitled to call herself a “Health Professional” is a question which I will leave to others to address.

    On the other hand, a prominent part of her Web site is “Shop Online”

    I guess that she is hoping to make money by selling things.

    Gosh, life is full of surprises…


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    Jarrod Wilson

    Exercise Physiologist

    I have been an Exercise Physiologist in Tasmania commencing private practice (Coastal Physiotherapy) in Burnie Tasmania in 2010. Prior to this I completed a Bachelor … View Profile

    I strongly agree with the first two comments. For a balanced diet, the recommendations are as listed in these answers. They are recommendations for a reason. I educate most of my clients about staple foods and how carbohydrates are essential for proper nutrition. I often make example of diets hundreds of years back where we as humans relied on grains, wheats, fruits and such carbohydrate enriched food that we SHOULD be eating. As brought up too, energy balance is so important. The energy (kJ) from CHO's will of course lead to weight gain if the output from work and physical activity/exercise does not match the total intake of energy from food. Simple. So these low CHO/high Pr diets are just a joke and I cannot understand the popularity of them considering the lack of professional scientific research to back them up.

  • Kirsty Woods

    Exercise Physiologist

    Hi I’m Kirsty Woods,I would like to use my experience, expertise and passion to help you reach your weight, energy and health goalsI have been … View Profile

    Carbohydrates have been a hot topic recently especially with the release of such articles such as R.H. Lustigs article ‘The Toxic Truth About Sugar’ in February's edition of Nature (http://www.connectwell.biz/pdf/comment_truth_about_sugar.pdf). There is also new evidence showing that reduced carbohydrate diets are not only effective in weight loss but do not have the detrimental  effect on cardiovascular health as once thought (http://www.ajcn.org/content/86/2/276.full).

    What is known is that insulin mediates fat burining, and that diets high in carbohydrates will increase insulin secretion, perhaps chronically, leading to insulin resistance. This makes it difficult to use fat as a fuel and may also cause additional fat storage through lipogenesis. So it is possible that diets high in CHO may indirectly lead to weight gain, through inhibition of fat utilisation and promotion of fat storage (http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/pancreas/insulin_phys.html)

    One thing is for certain and that is that everybody has a metabolism as unique as their personality. So depending on activity levels, hormonal function, stress, insulin resistance and body composition holds the answer as to the question ‘Do carbohydrates make you gain weight?’ At METS we offer the technology to assess your current metabolism to help you better understand how YOUR body works and what nutrition and exercise/activity strategies are right for YOU.'



  • Christian O'Grady

    Nutritionist, Personal Trainer

    Body Recomposition, Fatloss, Personal Coaching Strength & Hypertrophy training  with an evidence based approach. Christian bases his clinic principles on the models of an Evidence based … View Profile

    Lustigs rubbish has been thouroughly debunked. It is as credible as the poliquen rubbish posted above. 

  • 1

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    Anonymous

    If you say insulin mediates fat burning then you should lose weight on a high carbohydrate diet if this increases insulin secretion? shouldn't it??

  • Christian O'Grady

    Nutritionist, Personal Trainer

    Body Recomposition, Fatloss, Personal Coaching Strength & Hypertrophy training  with an evidence based approach. Christian bases his clinic principles on the models of an Evidence based … View Profile

    What is the definition of high carbohydrate. If by high you mean that it results in excess calories then no. If by high you mean in proportion to fat compared to a no- low carbohydrate diet where protein is kept the same you bet! I dont have in hand but research shows no difference in long term outcome between low carb and high carb granted isocaloric state and protein is matched. Low carb wins initially with weightloss due to fluid balance, that is all.

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    Christina Turner

    Dietitian, Nutritionist

    Christina is an Accredited Practising Dietitian who specialises in working with community members living with Eating Disorders. She currently provides online consultations. www.solnutrition.com.au View Profile

    A lot of interesting and thoughtful answers for this one. Just a couple of things I'd like to add. In my exerience, in those people that have reduced their carbs and lost weight, it is usually because a lot of the carbs they previously ate had other things (usually quite high in calories) added to them. E.g. bread + butter, pasta +sauce. So when you remove these foods from your diet you are bound to lose weight.

    I have tried the Paleo Diet. I struggled big time. Mainly because without grains I couldn't seem to fuel my body for hard exercise. Although I don't agree with the science behind the Paleo Diet (I can't seem to see any long term studies proving no grains or root vegetables is beneficial), if you take on some of it's philosphies you will cut a lot of processed foods from your diet. For many people in Australia this is a good thing. Great care is needed though. Your diet may not be nutritionally balanced - see a professional for advice.

    :)

  • Rebecca Charlotte Reynolds, PhD (Dr Bec) Personable and ethical registered nutritionist (RNutr) and lecturer at UNSW Australia in lifestyle and health. Regular consultant to the … View Profile

    "Anonymous", if you had improved your dietary habits sufficiently in a more evidence-based way (e.g. still consuming "good" carbs), you could have acheived the same result. You might currently be spruiking the Australian Dietary Guidelines if these had worked for you instead of a strict paleo eating pattern - if you had in fact followed them (https://www.nhmrc.gov.au/guidelines-publications/n55). There is no need to be so black-and-white about improving health. Although I understand that it is easier (not healthier) for some people to conceptualise and follow such yes:no eating patterns. 

  • Christian O'Grady

    Nutritionist, Personal Trainer

    Body Recomposition, Fatloss, Personal Coaching Strength & Hypertrophy training  with an evidence based approach. Christian bases his clinic principles on the models of an Evidence based … View Profile

    I also have a bunch of anecdotes that are direct opposite to this. However n=1 is of no relevance really so we must look at the literiture. It currently is on the side of my anecdotes.

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    Chris Fonda

    Dietitian, Nutritionist, Sports Dietitian

    As an Accredited Sports Dietitian, APD and athlete (springboard diver), Chris has both professional and personal experience in sport at the sub-elite and elite level.Chris … View Profile

    Quite a contentious topic. I would like to add that I agree with most of the health professionals that have commented above. As this site is supposed to be one of credible information from health professionals I feel that I need to sum up everything my fellow colleagues have written.

    The recommended intakes of the macronutrients from the NHMRC are 45-65% of energy from carbohydrates, 15-25% of energy from protein, and 20-35% of energy from fat.

    There are many benefits that whole-grain breads, cereals, pasta, rice, quinoa and others can provide our bodies. They are a great source of dietary fibre needed to keep our digestive system regular and functioning optimally, an excellent source of iron for those who are vegan or follow a vegetarian diet, good source of thiamin (a vitamin needed to release the energy from our food) and so much more!

    In regards to “carbohydrates making people fat”, obviously if you consume too much of any food, you will gain weight and foods often contain a mixture of all three macronutrients PLUS vitamins and minerals so it's rather difficult to eliminate carbohydrates completely. 

    There is plenty of research out there that shows that diets containing whole-grain, high fibre carbohydrates actually reduce the risk of common lifestyle diseases.

    Simple or processed carbohydrates such as cakes, biscuits, white bread, pastries, confectionary etc are generally nutrient poor food choices often high in saturated fat and added sugars and definately  cause a greater rise in blood glucose levels compared to their whole-grain, high fibre counterparts. This greater rise in blood glucose levels leads to more insulin bein released which in the long-term can lead to insulin sensitivity problems like insulin resistance.

    The idea is NOT to cut out carbohydrate based foods all together, just choosing the right types in the right amounts (or portions) and to consume as part of a healthy diet with plenty of fruits and vegetables, lean meats, poultry and low-fat dairy.

    In terms of chronic disease conditions such as diabetes, it is a common misconception that these people need to cut out carbohydrates, however, this is not true. People with diabetes or insulin resistant even PCOS need to consider the type and portions of whole-grain, high fibre carbohydrates as part of a well-balanced diet.

    For members of the public who are following these posts I would suggest seeking “expert” dietary advice from an Accredited Practising Dietitian (APD). APDs are tertiary trained experts in the field of nutrition and dietetics with background in the biochemistry and intimate workings of how the body digests, absorbs and uses the nutrients we get from our food. APDs can create an individual plan that is tailored to your needs or condition without the need for cutting out entire food groups. You can find an APD at www.daa.asn.au 

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    Arlene is a registered practising dietitian, with a private practice in the Eastern Suburbs of Sydney, and has built a strong business over the last … View Profile

    Don’t think of carbohydrates as your rival. They are a major fuel source in your body, after all. In addition, many nutrients, vitamins and mineral are obtained from carbohydrates. But carbohydrates are known to increase weight gain in some cases. Carbohydrates can make you gain water weight and even fat, although as long as you’re consuming the correct quantities and types -- and sticking to your daily calorie allowance -- this shouldn’t be a major issue. If you eat more calories as carbohydrates than you burn you will obviously gain weight. 1 gram of carbohydrate has 4 calories, 1 gram of protein has four calories, and 1 gram of fat has 9 calories. If you eat too many calories in any form you will gain weight. It is just exceptionally easy to eat large amounts of carbohydrates eg bowl of rice or pasta, whereas you would not eat a chicken.

     

    Water Retention

    After your body converts carbohydrates into glucose, any leftover fuel gets converted into a polysaccharide carbohydrate called glycogen. Your liver and muscles store glycogen as energy and quickly turn it back into glucose as needed. The issue is that glycogen tends to make muscle tissues hold on to extra water, ultimately making the number on the scale go up. This is why when you severely cut back on carbs, you might lose weight rather quickly. You’re just using up all of your glycogen storage, forcing your body to release extra water which is stored with the glycogen, and it appears on the scale as a huge weight loss.

     

     

    Insulin Response

     

     

    With the exception of fibre, all carbohydrates are converted into glucos. When glucose passes into your blood, your pancreas secretes the hormone insulin -- unless you are diabetic and have to inject it yourself. Insulin helps with glucose conversion into glycogen, but you only have room to store so much. Once your glycogen stores are full, the extra converted carbs get stored as fat, making you gain weight over time.

     

     

    Poor Carb Choices

     

     

    The difference between starch and sugar digestion and satiety could make you eat more, causing weight gain. Sugars from junk highly processed foods digest fast, giving you a sugar rush. You may feel hungry again not long after munching something sweet. Sugar from fruits, grains and vegetables digests similarly, although these foods also have fibre. Ultimately fibre, especially soluble fiber, slows down sugar absorption, lessening peaking glucose levels, and hence insulin peaks. Alternatively, starch from vegetables and grains takes longer to convert into glucose since it’s made up of multiple bonded strands. When your sugar levels stabilize, your appetite should be satisfied minimizing binge eating.

     

     

    Optimal Carb Intakes

     

     

    You need to leave enough room in your diet for protein and fat, rather than just filling up on carbohydrates. Adhere to a moderate carbohydrate intake to prevent weight gain. Focus on unprocessed carbohydrates and watch your portions - whole grains, fresh fruits, beans, legumes and vegetables to help you get a healthy dose of slow-digesting starch carbohydrates (low Glycaemic Index) , as well as fibre.

     

     

     

    It is important to eat a balanced diet to satisfy your nutrient requirements – protein, carbohydrates and fats.

     

  • 2

    Agrees

    Rebecca Charlotte Reynolds, PhD (Dr Bec) Personable and ethical registered nutritionist (RNutr) and lecturer at UNSW Australia in lifestyle and health. Regular consultant to the … View Profile

    Dietary fads are NOT usually based on scientific evidence:

    http://theconversation.com/quit-sugar-go-paleo-embrace-clean-food-the-power-of-celebrity-nutrition-38822

    Please be wary of the "demonising carb hype" spruiked by "Anonymous".

     

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    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    Thanks for that link Dr Reynolds.

    I think that the comments from the many different kinds of health professionals in it are very informative.

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