What Are Carbohydrates?

First, a brief rundown: Carbohydrates are found in the grocery store in one of two forms—refined and whole. Although refined carbs represent only a subset of carbohydrate-rich foods, they’re what most people think of when they hear the word “carb”: white breads, pretzels, pastries, refined cereals, and other highly processed snack foods. We recommend staying clear of refined carbohydrates, as they can increase your risk for fatty liver disease, insulin resistance, prediabetes, and type 2 diabetes; lead to unwanted weight gain; and increase triglyceride levels. 

In sharp contrast to foods containing refined carbohydrates, whole carbohydrate–rich foods such as fruits, vegetables, beans, lentils, peas, and whole grains are some of the most nutrient-dense foods on the planet. For a deep dive into the differences between refined carbs and the carbs found in whole plant foods, see How Carbs Became a Dietary Supervillain by Sofia Pineda Ochoa, MD. 

What Is Carb Cycling?

“Carb cycling” refers not to a specific diet but a general strategy of manipulating the amount of carbohydrates consumed in an effort to achieve a desired outcome. The practice has been fairly common among endurance athletes for years, but recently it has drawn attention from the general public as a potential weight-loss strategy.

The general idea is to eat a high-carb diet on training days to increase glycogen stores in the muscles and liver; then restrict carbohydrate intake to burn more fat on rest days. In this way, carb cyclers are attempting to switch between days of ”carb burning” and days of “fat burning,” effectively flipping a metabolic switch from one to the other. Some carb-cycling proponents advocate taking one day every week or two to “re-feed” by overeating and exceeding one’s daily caloric requirements, in order to overcome the negative effects of being in a caloric deficit.

Periods of “carb loading” can increase glycogen stores in the liver, providing an extra fuel supply during exercise, which is why it’s common for endurance athletes to eat a large carbohydrate-rich meal the night before a competition. However, this approach overlooks an important point: Because glycogen stores in both the liver and muscle are influenced by one’s total carbohydrate intake, eating a healthful high-carbohydrate diet every day is a simpler way to ensure that your glycogen stores are maximized on a daily basis, not only in the days prior to a competition. 

Short-Term Results, Long-Term Risks

One of the main benefits that people report when carb cycling is changing their body composition, losing fat and gaining muscle. In the short term, low-carb diets can indeed be effective for weight loss and can lower fasting blood glucose, post-meal blood glucose, and A1C value. However, in the long term, low-carbohydrate diets dramatically increase your risk of insulin resistance—which, more than any other condition, is the strongest predictor of chronic disease, underlying type 2 diabetes, type 1 diabetes, type 1.5 diabetes, gestational diabetes, coronary artery disease, atherosclerosis, cancer, high cholesterol, high blood pressure, obesity, polycystic ovary syndrome (PCOS), peripheral neuropathy, retinopathy, Alzheimer’s disease, chronic kidney disease, and fatty liver disease. (We go into extensive detail about the mechanisms behind insulin resistance and chronic diseases in our book Mastering Diabetes.)

Additionally, research has found that limiting carb intake can negatively impact athletic performance. And randomized controlled trials have found that low-fat, high-carbohydrate diets can promote weight loss as effectively as a low-carbohydrate diet, especially when whole carbohydrates make up the majority of all carbohydrate energy. So in effect, both low-carbohydrate and high-carbohydrate diets can promote weight loss.

The Bottom Line

For healthy individuals who avoid processed foods and maintain an appropriate calorie balance, short periods of carb cycling will likely not pose serious health risks. However, one concern with any low-carb dietary strategy (including carb cycling) is that eating high-fat, high-protein meals can significantly increase your risk for insulin resistance. 

If you’re looking to lose weight, reduce your risk of type 2 diabetes and cardiovascular disease, and promote better metabolic health overall, consider centering your diet on whole plant foods. 

World-class athletes find that eating a low-fat, plant-based, whole-food diet is an exceptionally effective way to train and compete, without the need for carbohydrate manipulation. 

To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.

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In today’s world, an increasing number of people are overweight or obese. According to the Centers for Disease Control, in 2017 more than 42 percent of adults in the United States were classified as obese. Obesity is associated with early death and chronic health issues. 

What Is Obesity?

Obesity is defined by a body mass index (BMI) of greater than 30. BMI is a simple metric that calculates your weight-to-height ratio (kg/m2). Though BMI has its limitations (it doesn’t measure body fat or consider weight distribution), it offers a frame of reference for estimating whether you are underweight, normal weight, overweight, obese, or severely obese, using the following scale. 

• Underweight: Your BMI is less than 18.5
• Normal weight: Your BMI is between 18.5 and 25
• Overweight: Your BMI is between 25 and 30
• Class 1 Obesity: Your BMI is between 30 and 35
• Class 2 Obesity: Your BMI is between 35 and 40
• Class 3 “Severe” Obesity: Your BMI is greater than 40

To calculate your BMI, simply enter your height and weight into this free online BMI calculator. 

GET OUR FREE 20-PAGE ULTIMATE PLANT-BASED BEGINNER’S GUIDE

Morbid Obesity

Morbid obesity is defined as being 100 pounds or more above your ideal body weight, having a BMI greater than 35 with at least one serious obesity-related condition, or having a BMI greater than 40. Those with a BMI greater than 40 are also referred to as living with extreme obesity. 

Childhood Obesity

A growing number of children worldwide are overweight or obese, which not only increases the risk for being obese as an adult but also increases the risk of developing type 2 diabetes, cancer, and coronary heart disease. (See more on the health risks of obesity below.)

Researchers have identified many risk factors evident in the first 1,000 days of a child’s life that are strongly associated with childhood obesity. These risk factors include:

• Being born to a mother who is overweight, obese, or living with gestational diabetes
• Being exposed to tobacco smoke in utero
• High birth weight
• Accelerated weight gain as an infant
• Poor sleep as an infant
• The introduction of solid food before the age of 4 months
• Repeated exposure of the infant to antibiotics 

Children impacted by these risk factors will not necessarily become obese, and they can influence their body weight and body composition throughout life by eating healthful diets. And a notable aside: The majority of obesity-related deaths occur in adults who were a healthy weight in childhood.

Health Risks Associated with Obesity

One of the main concerns about obesity is that it doesn’t always travel alone: People who are obese are at a significantly higher risk for many chronic diseases. Because most data regarding obesity and disease risk comes from observational studies, it’s not possible to definitively conclude if obesity itself increases risk for certain diseases, if obese individuals are more likely to have other risk factors, or if there is some other explanation for the association. 

What Causes Obesity?

Obesity is a complex metabolic condition with no single cause. It’s important to understand that multiple environmental, dietary, lifestyle, and genetic factors can influence one’s risk for developing obesity both as a child and as an adult.

Can Diet Alone Cure Obesity?

If you are overweight and have managed to lose weight by dieting only to regain it all back, you are not alone. A 2018 meta-analysis of 29 long-term weight-loss studies found that more than half of all weight lost was regained within two years, and more than 80 percent was regained by the five-year mark. It’s common for dieters to gain back even more weight than they lost. More research is needed to understand why it’s so difficult to maintain weight loss. It may be that as we gain extra pounds, the body registers a higher “set point” and will attempt to stay at that weight, through mechanisms such as a slowed metabolism or increased appetite.

While dietary changes may not resolve obesity for everyone, people who eat a plant-based diet tend to be leaner than those who don’t. Rather than calorie-counting and portion control, Forks Over Knives recommends eating a diet of whole plant foods. Whole grains, vegetables, fruits, and legumes contain significant fiber and water, a combination known as bulk. Barbara Rolls, MD, one of the leading obesity experts, says that bulk is key to satiety. These whole plant foods are much lower in calorie density than animal products and highly processed foods, and are a phenomenal way to stay full without eating excess calories. Animal-based foods such as meat, cheese, fish, and eggs contain zero fiber, making it easy to exceed your calorie requirements without feeling full. Whole plant foods have also been shown to boost after-meal metabolism.

Because this way of eating doesn’t require calorie counting or portion control, some have found it more sustainable than weight-loss diets. Forks Over Knives has published a number of first-hand accounts from people who, after years of yo-yo dieting, have maintained weight loss after going whole-food, plant-based. Read more: 

• How I Kicked Cheese and Sugar Addiction, Lost 150 Pounds on a Plant-Based Diet
• What Giving Up Meat, Dairy, and Processed Foods Did for My BMI, Blood Pressure, and Cholesterol
• I Cut My Weight in Half on a Plant-Based Diet
• I Went From Obese to the Best Shape of My Life on a Plant-Based Diet
• We’ve Lost a Combined 195 Pounds Since Going Plant-Based
• After Decades of Failed Diets, I Went Plant-Based and Lost 140 Pounds in 2 Years
• From Hot Dog King to Whole-Food, Plant-Based: My 210-Pound Weight-Loss Journey
• I Went Plant-Based, Said Goodbye to 100 Pounds, Prediabetes, and My CPAP Machine

Ready to get started? Check out our Plant-Based Primer to learn more about adopting a whole-food, plant-based diet.

The post Understanding the Risks and Causes of Obesity appeared first on Forks Over Knives.

What Is Insulin and Why Is It Important?­

Insulin is a hormone that is manufactured and secreted by the pancreas in response to rising blood glucose. When you consume carbohydrates, the glucose that enters the bloodstream signals the beta cells to make insulin. Insulin communicates with tissues all over your body and signals tissues that glucose is available. In effect, insulin says, “Knock knock. If you want to uptake glucose, this is your chance.”

Without insulin, cells in the liver, muscle, and fat have a difficult time importing glucose from the blood. These tissues can transport only a small percentage (5 to 10 percent) of the glucos­e in circulation without the help of insulin. When insulin is present, it increases the amount of glucose that can be transported into tissues, allowing them to be properly fed, and keeping the amount of glucose in the blood in the normal range.

This process of transporting glucose into your muscle and liver is important because every cell in your body uses glucose for energy. (Besides glucose transport, insulin also escorts amino acids and fatty acids into cells.) The system looks like this:

What Is Insulin Resistance and Why Is It Important?

Insulin resistance is a condition in which multiple tissues in the human body become resistant to the effects of insulin. In our New York Times best-selling book Mastering Diabetes, we take a deep dive into this subject and demonstrate how insulin resistance underlies almost all chronic diseases, including cardiovascular disease, fatty liver disease, chronic kidney disease, and Alzheimer’s disease.

Simply stated, insulin resistance occurs when tissues become “blind” to insulin. As a result, the pancreas is forced to secrete increasing amounts of insulin, resulting in a condition known as hyperinsulinemia. Hyperinsulinemia is a dangerous condition for many tissues, simply because elevated insulin concentrations in the blood act as potent signals for cell growth. More insulin means more tissue growth, resulting in increased body fat, increased cell replication rates, and a significantly increased risk for cancer. 

Many studies have now begun to uncover the link between insulin resistance and cancer. One study states the following:

“Insulin resistance is common in individuals with obesity or type 2 diabetes (T2D), in which circulating insulin levels are frequently increased. Recent epidemiological and clinical evidence points to a link between insulin resistance and cancer. The mechanisms for this association are unknown, but hyperinsulinaemia (a hallmark of insulin resistance) and the increase in bioavailable insulin-like growth factor I (IGF-I) appear to have a role in tumor initiation and progression in insulin-resistant patients.”

How Much Do Scientists Know About the Causes of Insulin Resistance?

There is a significant amount of confusion about what actually causes insulin resistance, and I witness it every day in our work coaching people with diabetes as well as in my career as a nutritional biochemist.

A large gap exists between the scientific research on insulin resistance and what the general public understands about it. Most health professionals were never taught the basic biochemistry of insulin resistance, and are unaware of the latest research. Unfortunately, excellent research does no good if the information is not put in the hands of those who need it. This is certainly the case with insulin resistance.

This gap exists for a number of reasons and is heavily influenced by economic forces that profit on lifelong chronic diseases like diabetes. The practice of educating doctors improperly is what keeps life-saving information out of the hands of those who need it.

The Major Cause = Lipid Overload

Researchers debate the causal mechanisms of insulin resistance tirelessly, day after day, and travel thousands of miles to attend large conferences to flex their scientific muscles. They propose every mechanism you can imagine, and blame every tissue you can think of, from the pancreas to the muscle to the liver to the brain to your blood.

To say that insulin resistance has a single cause is an oversimplification. To say that it is a complex metabolic condition with many causes is much more accurate.

Despite this, however, researchers in the laboratory environment can induce insulin resistance in people incredibly easily. Regardless of the endless intellectual debate, almost every laboratory on the planet that studies insulin resistance utilizes one simple technique to consistently induce insulin resistance: a diet high in fat. Not a diet high in carbohydrates.

In some studies, researchers use a diet high in both fat and sucrose (white table sugar), to ensure that both the muscle and the liver become insulin resistant. The reason for this is simple: dietary fat causes lipid overload in muscle and liver, resulting in a reduced ability of insulin to import glucose. 

Considerable scientific evidence clearly indicates that excess fatty acids are a potent cause of both muscular and liver insulin resistance. A recent review and meta-analysis of the medical literature states: “Prolonged exposure of skeletal muscle and myocytes to high levels of fatty acids leads to severe insulin resistance. Among the different types of fatty acids, saturated long-chain fatty acids such as palmitic and stearic acids were demonstrated to be potent inducers of insulin resistance.”

Researchers have shed light on the ability of excess fatty acids (dietary or structural, meaning body fat) to induce low-grade inflammation, which acts as an initial step in a series of events leading to damaged blood vessels, liver disease, heart disease and hypertension:

“Elevated free fatty acid levels (due to obesity or to high-fat feeding) cause insulin resistance in skeletal muscle and liver, which contributes to the development of type 2 diabetes mellitus (T2DM), and produce low-grade inflammation, which contributes to the development of atherosclerotic vascular diseases and NAFLD (non-alcoholic fatty liver disease).”

Too often, we blame carbohydrates for insulin resistance, despite significant evidence that excessive fat consumption results in excessive fat storage that ultimately creates whole-body insulin resistance.

Saturated Fat in Particular

Saturated fatty acids, in particular, are the most potent influencers of insulin resistance. Saturated fatty acids are derived mainly from animal sources, and have direct negative effects on the muscle and liver.

High concentrations of saturated fatty acids are found in the following animal foods:

• Meat (e.g., beef, chicken, pork, turkey, duck, and venison).
• Seafood (e.g., trout, cod, herring, salmon, sardines, shrimp, and crab).
• Dairy products from cows, goats, and sheep (e.g., milk, butter, sour cream, cream cheese, and cheese).

In addition, high concentrations of saturated fats are found in some plant foods like coconut-derived products (including coconut meat, milk, cream, butter, and oil).

Some of the direct detrimental effects of saturated fatty acid intake on muscle and liver tissue include:

• Mitochondrial dysfunction.
• Production of free radicals.
• Cellular inflammation.

Other Causes 

Besides dietary fat, insulin resistance is also affected by a diet containing a significant amount of highly processed foods. This includes candy, donuts, many packaged goods, and frozen pre-made meals. To improve insulin sensitivity, aim to eat whole plant foods, which come prepackaged with a host of vitamins, minerals, antioxidants, phytonutrients, fiber, and water. These foods have untold health benefits, and are required for optimal health, athletic performance, athletic recovery, and protection against lipid overload.

Insufficient exercise is also a cause of insulin resistance. Exercise stimulates the muscle tissue to burn stored fat and to accept glucose from the blood. Adopting a regular exercise regimen is effective in improving insulin sensitivity.

Take-Home Message

It is important to recognize that insulin resistance affects everyone, even those who show no symptoms of high blood sugar. In order to ensure that you remain insulin sensitive, regardless of your current health status (diabetic or nondiabetic), follow these three steps:

• Consume a plant-based diet containing less than 30 grams of fat per day to improve your insulin sensitivity.
• Minimize or eliminate your consumption of highly refined, processed foods.
• Maintain a consistent exercise regimen with three to four sessions of cardiovascular exercise per week.

Check out our Plant-Based Primer to learn more about adopting a whole-food, plant-based diet.

This article was originally published on March 22, 2016, and has been updated.

The post Everything You Need to Know About Insulin Resistance and Diet appeared first on Forks Over Knives.

For the past 50 years, people diagnosed with all forms of diabetes have been advised to eat low-carb diets high in fat and protein, and to avoid eating high-carbohydrate foods like fruits, potatoes, squash, corn, beans, lentils, and whole grains.

Despite this popular opinion, more than 85 years of scientific research clearly demonstrates that a low-fat, plant-based whole foods diet is the single most effective dietary approach for managing type 1 and type 2 diabetes. This means that a low-fat diet—not a low-carb diet—has been shown across the board to minimize oral medication and insulin use, stabilize blood glucose, and dramatically reduce long-term disease risk in people with diabetes.

Myth #1: You Develop Type 2 Diabetes From Eating Too Much Sugar

Eating sweets is not a direct cause of type 2 diabetes. People develop type 2 diabetes over time by slowly developing a resistance to insulin, the hormone that escorts glucose out of your blood and into tissues like your muscle and liver. I like to think of type 2 diabetes as a very advanced form of insulin resistance in which glucose remains trapped in your blood because your body cannot use insulin properly. In this way, elevated blood glucose is a symptom of diabetes, and NOT the root cause.

The real cause of insulin resistance is dietary fat. We discussed it at length in this article. People with both type 1 and type 2 diabetes are told to eat foods that are low in carbohydrates and high in fat and protein simply because they don’t create an immediate need for insulin. But in the hours and days after a meal high in fat and protein, your insulin needs increase significantly, because both fat and protein make insulin less powerful over time.

Think of it this way: Imagine the cells in your bodies are all locked behind closed doors. Insulin is the key that unlocks the doors to allow glucose to enter (and fuel) your body’s tissues. Fat gums up the locks so that insulin can’t do its job—leaving glucose outside in the bloodstream, knocking at the door. The problem isn’t the glucose, but the fat preventing insulin from bringing glucose into the body’s cells.

Myth #2: Fruits and Starchy Vegetables Will Spike Your Blood Glucose

This is both true and false. Many people with diabetes have experienced a high blood glucose immediately after eating fruits or starchy vegetables. In this situation it’s easy to blame carbohydrates, because it’s the most logical culprit.

The truth is that your blood glucose spikes not because of the carbohydrate, but because the quantity of fat in your diet was high to begin with. The more fat there is in the diet, the harder it is for insulin to get glucose into your cells and out of your bloodstream. Considerable scientific evidence shows that eating a medium-fat or high-fat diet causes large blood glucose swings after eating foods containing carbohydrates (1-17). (We categorize a medium-fat diet as one with greater than 30 grams of fat per day and a high-fat diet as one with greater than 60 grams of fat per day.On average, Americans eat over 70 grams of fat per day.)

People who adopt a truly low-fat diet (less than 30 grams of fat per day) are able to eat significantly more carbohydrate without blood glucose spikes, because the amount of fat in their muscles, liver, and blood is very low. By adopting a truly low-fat, plant-based whole foods diet, your insulin sensitivity will increase considerably since you will gain the ability to metabolize carbohydrates.

So the next time your blood glucose is running abnormally high and you’re inclined to blame the fruits or starchy vegetables, ask yourself a simple question: how much fat have I been eating over the past 24-72 hours? If your fat intake was medium or high, then you are likely pointing your finger at the the wrong culprit.

Myth #3: Fruits and Starchy Vegetables are all “Just Sugar” and Should Be Avoided

The confusion starts with the word sugar.

Most people use the term sugar to refer to compounds found in fruits and starchy vegetables as well as man-made sweeteners found in packaged and processed foods. To differentiate between the two, I use the words refined sugar for man-made sweeteners, and natural sugar for fruits and starchy vegetables.

Fruits and starchy root vegetables that contain natural sugar are nutritional powerhouses and should be eaten more of, not less. This is because they come prepackaged with five classes of micronutrients, including water, antioxidants, vitamins, fiber and minerals (WAV-FM). These micronutrients act as behind-the-scenes cast members that affect how we digest, process and use the nutrients we eat.

In the same way that blueprints are the instruction manual for building a house, micronutrients are instructions that actually dictate how carbohydrates, fat and protein are digested, absorbed, transported, uptaken and burned for energy. These micronutrients relay critically important messages such as:

Uptake this.
Don’t uptake this.
Read this sequence of DNA.
Express this gene.
Make this protein.
Release this hormone.
Store this fuel.
Stop this process.
Start this process.
Degrade this protein.
Burn this molecule.

Foods containing refined sugars like sucrose, dextrose, high fructose corn syrup and maltodextrin have only a fraction of the micronutrients as fruits and vegetables, and are processed extremely quickly because they are also low in fiber content. As a result, refined sugars spike blood glucose while natural sugars keep blood glucose in the normal range.

Without these WAV-FM instructions, your digestive system has a difficult time understanding how to metabolize carbohydrate, fat and protein properly, and this can result in large swings in blood glucose. This is also true of many refined and processed carbohydrates like white bread and most breakfast cereals.

Take a look at the table below to understand what foods contain natural sugars and which foods contain refined sugar. This is a very important distinction that simply cannot be overlooked!

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