The debate continues; setting the record straight about carbs and protein

As a nutrition writer, I rarely get a lot of feedback from my readers. However, I recently got bombarded with responses to an article I wrote about carbohydrates ("Carbohydrate Confusion" in the January/February 2003 issue). Dr. Atkins' fans turned out in full-force to bash carbohydrates and praise protein. Clearly, I failed to clarify the carbohydrate confusion that abounds among today's dieters. Here is further information about this complex topic.

Reader's comment: "The obesity epidemic coincided with the advent of the high-carb, low-fat American diet. Plain and simple, overconsumption of carbs causes obesity ..."

My response: Obesity is a very complex problem, related not only to food but person's lifestyle. Hence, we need to look at the whole picture, not just carbs. Lack of exercise is an important part of the obesity picture. Our society generally lacks sidewalks for walking to school, paths for biking to work and safe neighborhoods for children to play outside. We use too many escalators, ride-on lawn mowers and watch too much TV. The American lifestyle's abundance of inactivity has caught up with adults and children alike.

Today's family lifestyle also takes its toll. Working parents who are tired, stressed and lack time to cook wholesome meals appreciate the convenience of take-out meals and comfort of mindless eating in front of the TV. Big portions add (momentary) pleasure, thus food can all too easily become a (fattening) de-stresser.

Reader's comment: "Most fat people believe they are overweight because they are weak willed and eat chocolates. Actually, they are overweight because they eat pasta, rice and bread. These carbs create an insulin reaction that drives their blood sugar low and forces them to eat more ... "

My response: Most fat people are overweight because they eat more calories than they burn. People who eat pasta, rice and potatoes are not destined to gain weight. If carbs caused obesity, then why are rice-eating Asians living in their native countries not fat? Because they get plenty of exercise in their daily lives! Why are pasta-eating marathoners not fat? Because they also get plenty of exercise. Activity, not carbohydrate intake, makes a critical difference between obesity and health.

Reader's comment: "I have had success on the Atkins Diet and NEVER could have lost weight with the low-fat approach. My blood sugar swings so wildly on a high-carb diet that there was no way I could lose weight. That's biology ..."

My response: Yes, each person is metabolically unique and we need to respect differences in reactions to foods. For example, some people are sensitive to caffeine and avoid coffee in the evening; others can drink coffee at night and sleep just fine. Some people can handle three beers; others get drunk on half a can. Some people can enjoy candy bars and soda pop; others feel a sugar surge followed by a "crash." However, does this mean coffee, alcohol and sugar are evil? No.

Before anyone bashes the general category of "carbs," I recommend they separate carbs into positive and negative groupings:

* Carbs with fiber--such as whole grain bread, bran cereal, oatmeal, apples, broccoli and other wholesome fruits, vegetables and unrefined grain foods--are an important part of a balanced diet. They offer an assortment of vitamins, minerals and phytochemicals which protect your health and rarely cause "sugar crashes."

* Refined carbs--such as white flour and sugar, are the main culprits in triggering a strong insulin response. Yet, eating refined carbs with protein and fat buffers this insulin response. That is, if you put peanut butter (instead of jelly) on a piece of white toast, your blood sugar will rise less. Hence, carb bashers should look at the whole diet, not just a single food.

Reader's comment: "Americans are fatter than ever because nutritionists have told them to eat more carbs and cut the fat. This makes logical sense, but in reality, doesn't work."

My response: When the "cut the fat" movement started, nutrition messages not only failed to acknowledge dietary fat benefits (e.g., satiety and flavor) but also put too little focus on the type of fat. Just as we need to look at the kinds of carbs we eat (e.g., fruits, vegetables and whole grains vs. refined sugar and flour), we also need to look at the kinds of fat we eat. We now know more about the health benefits of fats from plants (e.g., olive oil, canola oil, walnuts and flaxseed) and fish (e.g., tuna, swordfish, salmon and lox). These plant and fish oils are associated with a lower risk of heart disease and diabetes than diets abundant in animal fats (e.g., greasy burgers, bacon and many fast-foods).

Today's nutrition message should be "cut the bad fat"--donuts, Big Macs and cookies. However, we can and should enjoy the enhanced flavor and satiety that comes with having some (health-protective) oils, seeds and nuts in our diets. Almonds and peanuts are no longer taboo.