by Barbara Berkeley, MD
The short answer: it depends.
Do you want to lose the extra weight that is bothering you? Do you want to get rid of, or greatly reduce, the medicines you take for blood pressure, diabetes, and cholesterol? Do you want to finally keep the weight off without having to deal with soul-crushing bouts of regain? If so, an understanding of how your body reacts to carbohydrate is essential.
Let's begin here: Weight warriors, I love you. I also deeply respect you. Battling weight repeatedly over the years is an incredibly tough task, yet you do it---always with the hope of creating better health and always with optimism about your chances of finally "getting it right".
When I go to the message boards that share my articles, I often see comments that call me strict or harsh. Honestly, I'm really not!!! But what I do try to do is to is help you succeed by sharing what I've observed. I have the benefit of thousands of hours of experience with thousands of foot soldiers in the weight war. While each individual is slightly different, there are certain themes that can help all of us. More importantly, I always want you to know that I am not inflexible or some kind of absolutist. I believe in what works. And if your diet is working for you and keeping you healthy, I'm fine with it...even if all you eat is Pizza and Snickers (with one caveat: that diet may come back to bite you later, so stay very wary).
When you are trying to lose weight, it is extremely helpful and may even be necessary to lower carb intake. The reason is that carb intake is tied to the release of insulin, the fat storage hormone. Insulin essentially directs the body as to whether it should store fat or burn it off. If there is insulin in the blood stream, you are in storage mode. If insulin is low, burning mode. For this reason, it's hard to lose weight when insulin is turned on, even by smallish amounts of carbs. But you don't have to go as low as you might think. In our clinic, we get excellent weight loss with a diet of about 1200 calories that has approximately 100 grams of carbohydrate. We don't count the carbs from vegetables and we allow one serving of non tropical fruit (no banana, pineapple, mango, papaya) daily during the weight loss period. We have found that we don't have to "do an Atkins" to get super weight losses, and we certainly don't need to get patients into ketosis. You can ditch those little tester sticks.
But what about for the rest of your life when you want to maintain weight? The idea of giving up bread, pasta, pizza crust, tacos, cake, cookies, potatoes, rice, corn, cereal, candy, whole grains and so on is simply too much for most of us. We've been raised in Carb World. And boy, does it taste good.
Before giving my answer to the question that burns brightly for all maintainers, let me back up for a bit. In fact, let me back up about 1 million years.
Human beings have been around on the planet for about 2.5 million years, and we've undergone a slow process of change and adaptation during that time. For the vast majority of our existence, we've had to exist on what we could get from Earth, and we've lived under uncertain food conditions. A terrible winter was always possible. A migration of our primary food source could occur. A disease might sweep through our tribe. In order to give us an edge against prolonged periods without food, we were designed with a system that would store a portable supply of food on our frame. Think of it as a backpack of extra calories we could carry. Under conditions of starvation, our body would open the back pack and eat out of it. That back pack is our fat.
In those days, there just wasn't enough fattening food for anyone to become obese. The back pack could never get big enough to cripple our knees or create diabetes. Because it wasn't possible to be truly overweight, the body never evolved systems to deal with obesity. A world with too much food was never anticipated, and that's the reason why we can't get the fat off now. Our body gives us no help because it simply doesn't know what to do with it.
During most of our existence, we would fill our backpack by eating foods that caused fat storage. These were primarily the foods that stimulated insulin....the hormone that fills the fat cells. Fruit in the summer, honey, starchy tubers and roots---these were carbs that brought insulin into the bloodstream. Insulin would then transform the blood sugars into fats and store them away. But in order to insure that we loaded up when we could, insulin would also start an inexorable wheel turning in the brain. This wheel made the food taste really good and increased our hunger and cravings. In those days, loading up on as much honey and fruit as we could find was insurance for our existence.
Fast forward to today. We live in a honey pot. We are bathed in carbohydrates, both sugars and starches (which become sugar in the bloodstream), and thus we have a constant, relentless wheel turning in our brain. Eat more! Want more! Eat more! Want more! We store fat when we certainly don't need to. And we don't ever burn it, because the constant presence of insulin in the blood tells the body to remain in fat storage mode and never to slip into burning mode.
That wheel!!!! That wheel is the reason that I have to replace the box of tissues in my office once every few weeks. That wheel, once such a beautiful biological design, causes such tears and misery.
So, now to answer the question. Do I HAVE to give up carbs?
I would say that it depends on the strength of your wheel. Thousands of patient encounters have led me to observe that there are two ends of the maintenance spectrum (and probably many gradations in between). On one end, we have people who can eat a slice of bread or a piece of pizza and stop. They are able to go back to their default primal diet directly afterwards. They are satisfied with half of their husband's dessert. They can stop at one Christmas cookie. On the other end, we have people who are overwhelmed by a relentless and rapidly spinning carb wheel as soon as they taste chocolate or have a bagel. They immediately fall out of control and start carb binging. It is not they that are out of control. It is their biological wheel.
Understanding where you fall on this spectrum answers the question of whether or not you must give up carbs in maintenance and to what degree. The reason that my advice is often interpreted as harsh is that I have found that there are more weight battlers on the addictive end of the wheel spectrum than on the I-can-live-without-it end. You probably already know where you fall, but if you are uncertain, try this:
- Carefully observe your reaction to eating carbohydrates over a week. If you notice that eating carbs makes you suddenly hungrier and you find yourself searching for more carbs or increasing your intake (or WANTING to increase your intake), you are on the addictive side of the spectrum. You should carefully watch carb intake and cut back as soon as you notice that wheel starting to turn. Be careful! The wheel is strong and will overwhelm your resolve unless you catch it early.
- If you find that you are ok with just having a little and stopping, you are probably on the other end of the spectrum. For you, it's important to figure out which carbs might move the needle in the other direction. Most people have specific foods that will cause the wheel to turn, while others may not. I can't eat pasta or doritos or chips or bread without starting off a response that I have to contend with for weeks. But I'm ok with one sweet thing here or there. Figure it out for yourself and be careful to avoid the wheel-turners.
- Watch your weight daily and if it starts to climb, look to the carbs. Have you increased intake without even knowing it? Most likely.
All my best to all of you in the New Year. Always know that I respect and honor your continued efforts to live cleanly in our very problematic food environment. Stay healthy my friends!!