Carb counting

In the recent Heart Scan Blog post, Can I eat quinoa, I discussed how non-wheat carbohydrate sources like quinoa, amaranth, black beans, brown rice, fruit, etc. do not exert the inflammation-provoking, appetite-increasing effects of wheat (since gliadin and gluten are not present), nor do they increase blood glucose as enthusiastically as the amylopectin A of wheat--but non-wheat grains can still increase blood sugar quite substantially.

Of course, any food that triggers blood sugar also trigger hepatic de novo lipogenesis, thereby increasing triglyceride levels and postprandial particles (e.g., chylomicron remnants), which, in turn, triggers formation of small LDL particles.

So these non-wheat carbohydrates, or what I call "intermediate carbohydrates" (for lack of a better term; low-glycemic index is falsely reassuring) still trigger all the carbohydrate phenomena of table sugar. Is it possible to obtain the fiber, B-vitamin, flavonoid benefits of these intermediate carbohydrates without triggering the undesirable carbohydrate consequences?

Yes, by using small portions. Small portions are tolerated by most people without triggering all these phenomena. Problem: Individual sensitivity varies widely. One person's perfectly safe portion size is another person's deadly dose. For instance, I've witnessed many extreme differences, such as 1-hour blood sugar after 6 oz unsweetened yogurt of 250 mg/dl in one person, 105 mg/dl in another. So checking 1-hour blood sugars is a confident means of assessing individual sensitivity to carbs.

Some people don't like the idea of checking blood sugars, however. Or, there might be times when it's inconvenient or unavailable. A useful alternative: Count carbohydrate grams. (Count "net" carbohydrate grams, of course, i.e., carbohydrates minus indigestible fiber grams to yield "net" carbs.) Most people can tolerate around 40-50 grams carbohydrates per day and deal with them effectively, provided they are spaced out throughout the day and not all at once. Only the most sensitive, e.g., diabetics, apo E2 people, those with familial hypertriglyceridemia, are intolerant to even this amount and do better with less than 30 grams per day. Then there are the genetically gifted from a carbohydrate perspective, people who can tolerate 50-60 grams, occasionally somewhat more.

People will sometimes say things like "You don't know what the hell you're talking about because I eat 200 grams carbohydrate per day and I'm normal weight and have perfect blood sugar and lipids." As in many things, the crude measures made are falsely reassuring. Glycation, for instance, from postprandial blood sugars of "only" 140 mg/dl--typical after, say, unsweetened oatmeal--still works its unhealthy magic and will lead long-term to cataracts, arthritis, and other conditions.

Humans were not meant to consume an endless supply of readily-digestible carbohydrates. Counting carbohydrates is another way to "tighten up" a carbohydrate restriction.

Comments (20) -

  • DMF

    8/4/2011 11:06:22 PM |

    I wonder if people such as the Kitavans (and other pacific islanders), Hadza in Africa and many other traditional civilizations who survive on sources of carbohydrates like tubers, yams etc walk around with blood sugar  monitoring devices?

  • Richard

    8/4/2011 11:28:31 PM |

    Another great and helpful post on blood sugar!
    As an overweight, out of shape diabetic, I'm working on this--my blog,, is my way of keeping myself honest and tracking my progress.
    My thanks for your work!

  • Fletcher

    8/5/2011 1:52:48 AM |

    Always great information!  So you are saying that for the normal healthy person, a target of 40-50 carbs a day is the max we should take in to avoid inflammation and they host of issues that go along with it?  I ask b/c if you eat enough veggies and fruit, even without sugar or wheat, it is easy to push over the 40-50 carbs.  Just wanted to make sure I understand so I can tune in my numbers.  Thank you for all of your work!

  • Might-o'chondri-AL

    8/5/2011 7:53:14 AM |

    Hyper-glycemia is able to increase the levels of matrix metallo-proteinase 9 (MMP 9), an endo-peptidase enzyme implicated in alterations of blood vessels'   walls.  It is thought to play a role in aortic aneurisms; and, since MMP 9 is made in plaque, it is also implicated in ruptures of plaque. There is a notable increase in MMP levels in individuals with  familial hyper-cholesterol and diabetics.

    Diabetics have elevated urine & blood levels of MMP 9;  but also above normal levels of  it's  inhibitor  (tissue inhibitor metallo-proteinase, or TIMP). The theory is that these conflicting markers indicate there is an ongoing paradigm, in which  vascular exterior cell matrix (ECM) remodeling is aggravated, by the influence of hyper-glycemia, and this is being opposed by a body response, which tries to keep vascular walls from getting so misshapen they lose function. (To be clear this is not necessarily a narrowing of the inside of the small blood vessels; more a case where, when measured across, it is wider. And then too this is not directly causing any worsening of systolic pressure.)

    Since nothing is simple know that both too much MMP and too much of it's inhibitor TIMP are not desirable. On one hand if there is too much TIMP (ie: low MMP) then the ECM can become more fibrous from excess collagen allowed into that vessels matrix; so normal amounts of MMP is desireable. While in another context it is suggested that the way advanced glycation end products (AGE) increases oxidative stress contributes to more MMP 9; and then the high levels of vascular adhesion molecules (VAM 1),  that are notably induced by AGEs,  get to cause more monocyte adhesion to the MMP enzyme prepped vascular endothelium.

  • mrfreddy

    8/5/2011 10:43:40 AM |

    I wonder how folks who follow insane diets like Dr. Furhman's Eat to Live manage to keep their blood sugars down? According to his web site, they do manage to doso, and they keep their HDL up and their triglycerides down. There's something going on there but I'm not sure quite what it is. The diet avoids meat and fat, but it also avoids sugar and grains as well. They apparently eat a lot of beans.
    Anyway, anyone could get the same results or better without avoiding meat like it's the devil, but that's another story.

  • Gretchen

    8/5/2011 12:41:50 PM |

    The lactose content of yogurt varies a lot depending on how long it's allowed to ferment. Most people don't like sour yogurt, so most commercial yogurt producers stop the fermentation when it's still pretty sweet, even without added sweetener. The sourer the yogurt, the less milk sugar remaining. So differences in BGs after eating yogurt might stem from the level of fermentation as well as from individual differences in blood sugar control and allergies.

    Not everyone goes up to 140 after meals, even very carby ones. If you look at this chart carefully, you can see that although many people go over 160 after a carby breakfast, some start below 70 and only go up to about 90 after breakfast.

    Some people on diabetes lists have tested spouses, and many say they never go above 90, although with hearsay reports like this it's not always clear when they were testing. Nondiabetics can go up to 160 after a carby meal and be back to below 100 in an hour or two.

    One person who had tested diabetic and then lost about 100 pounds said that after the weight loss, he never went over 100 unless he really stuffed himself, and then I think he only went up to slightly over 100.

  • rhc

    8/5/2011 12:51:13 PM |

    @ mito: my husband had a major hemorrhagic stroke 10 years ago - he was not a diabetic and his cholesterol was routinely around 150 - he was a SAD eater.

    @ mcfreddy: same with the 'starch based' McDougall diet. (high carb, no added fat, no animal or dairy,  just heavy on veggies, fruits, beans, lots of sweet potatoes and potatoes - and grains as tolerated). After the initial adjustment period the majority of followers have normal stats all around.
    This whole carb thing just isn't black and white - unfortunately.

  • Might-o'chondri-AL

    8/5/2011 6:45:15 PM |

    Hi rhc,
    Would you mind telling how old  your husband was when he had his hemorrhagic stroke ?

  • cancerclasses

    8/5/2011 7:48:27 PM |

    A fasted homeostatic blood sugar level equals around1 teaspoon of sugar out of the 1000 teaspoons of blood in your body.  When analyzing food labels & tracking your carb intake the formula to remember is the 1-5-20 rule, meaning 1 teaspoon of sugar equals 5 grams which equals 20 calories.  For optimum health an honest dietitian, nutritionist or doctor will advise keeping TOTAL carb (sugar) intake to around 10 to 12 teaspoons a day MAX, others will say 10 to 12 or 15  total ADDED sugars per day.  12 teaspoons X 5 grams per equals only 60 grams & times 20 calories per teaspoon equals just 240 calories. So yes it's not much, but considering the damage done to the body by glucose from carbs, & since ALL carbs reduce to glucose, less is better.

  • rhc

    8/5/2011 8:11:15 PM |

    He was 60 - doing ok but with major right side empairment remaining and only takes one medication for blood pressure.

  • Might-o'chondri-AL

    8/6/2011 2:53:43 AM |

    Hi rhc,
    You realize I discussed above an  aortic aneurism; this is not in the brain. As for hemorrhagic stroke there is a risk  condition one can be born with,  relatively rare to be sure, called arterio-venous malfunction; while the common sub-arachnoid hemorrhage can be either looming likewise since birth or as a rupture associated with advancing age.
    Sounds like you might be alluding to an intra-cerebral hemorrhage of some artery inside the brain. These are usually ascribed to hyper-tension's affect on brain artery.

  • Might-o'condri-AL

    8/6/2011 6:50:25 AM |

    For George Zachary ... this was blocked by Server several times when tried to send you over on Doc's 2nd post  back (ie: "The Exception to Low Carb); if anyone wants to copy and paste it there for him that would be nice.  
    PCSK9 "non sense"mutations that lower circulating LDL cholesterol:
    2% of African Americans get 40% less LDL from  these 2 in 80% of those having these:
    (a) PCSK9 variant 426C G encoding Y142X (ie: tyrosine at position 142 replaced by stop codon)
    (b) PCSK9 variant 2037CA encoding C679X (ie: cysteine at position 679 replaced by stop codon)

    3% of Caucasian Americans get 15 to 21% less LDL from:
    (a) PCSK9 sequence variant 137GT encoding R46L (ie: arginine at position 46 replaced with leucine)

    PCSK9 alleles that both can give 28% less LDL:
    (a) PCSK9 9142X allele in 0.8% of African Americans
    (b) PCSK9 9679X allele in 1.8% of African Americans

    PCSK9 9646L allele gives 15% less LDL in:
    (a) 3 % of Caucasian Americans
    (b) 0.7% of African Americans


  • Dr. William Davis

    8/6/2011 2:01:07 PM |

    One crucial difference exists between the modern American and other populations: We have been incredibly overexposed to processed carbohydrates since birth, from teething crackers, to Lucky Charms and Scooter Pies, to pizza and beer, to "healthy whole grains."

    We now arrive at later adulthood with beaten up, tired, beta cell-exhausted pancreases that make us unable to deal with the continuing flow of modern processed carbohydrates.

  • Aileen

    8/7/2011 1:54:09 AM |

    I am assuming you are directing your comments at sedentary unfit people.  Anyone who works  physically or trains as I do (I run and do heavy weight training), could not survive and train on those sorts of amounts of carbs.  If I go below about 200g/day for any length of time my ability to train drops off markedly.

  • Dr. William Davis

    8/7/2011 11:54:41 PM |

    Hi, Aileen--

    Yes, indeed. This advice is definitely not intended for people who engage in high levels of endurance training. My wife, for instance, in training for an Iron Man competition, needs to supplement carbohydrates during her training sessions, such as a 112-mile bike trip.

  • Sandra

    8/8/2011 7:08:28 PM |

    Dr. Davis, thank you really so much. Very interesting article. I believe it is also not just a a matter of the right source of carbohydrate and carb counting but also the right food combining. But what is a person has to do a lot of intelletual work? For example,  when I have to solve a lot or complicated mathematical tasks and make serious projects involving higher mathematics I just cannot do without much carbs, much more than most of my familiy members. Otherwise, it feels like the brain gets dry. On the other hand, physical  workouts never make me really hungry. IS that ok?

  • The Health Magazine

    8/10/2011 11:38:31 AM |

    I do agree sandra but please explain  I have to solve a lot or complicated mathematical tasks and make serious projects involving higher mathematics I just cannot do without much carbs

  • Dr. William Davis

    8/11/2011 12:27:46 AM |

    Hi, Sandra--

    Only people who rely on carbs need them for cerebral work.

    I wonder if something to boost acetylcholine might work better? There are a number of neat supplements you can use to achieve this, such as acetyl-L-carnitine.

  • majkinetor

    8/14/2011 12:18:46 PM |

    I suggest Piracetam.

  • William Boggs

    8/24/2011 5:48:24 PM |

    I think it is important to keep the good cholesterol foods intact in your diet.  Fruit has been getting a bad rap lately for sugar, but it is a totally different type of sugar for the body.   Apples were one of my staples when I dropped my cholesterol by 15% and weight by 45 lbs. after receiving a high cholesterol reading.    I also picked out many other good foods that contained healthy or good carbs.  Check out these other important plaque and cholesterol fighters.