Healthful Carbohydrates — Insights From the Healthy Kitchens, Healthy Lives Conference
By Madhu Gadia, MS, RD, CDE
In an ideal medical model, physicians would preach prevention, discuss diet and lifestyle habits, and if patients needed changes, refer them to a dietitian.
“Even though physicians may only have about two minutes, they should do exactly that—strike up a conversation with their patients on weight and health choices,” said Helen Delichatsios, MD, SM, of Massachusetts General Hospital and Harvard Medical School to an audience of dietitians, physicians, and other health professionals at the Healthy Kitchens, Healthy Lives conference, which took place in March at The Culinary Institute of America (CIA) at Greystone in Napa Valley, Calif.
David Eisenberg, creator of Healthy Kitchens, Healthy Lives and director of research and education in complementary and integrative medical therapies at the Harvard Medical School, urged physicians, “If necessary, write a lifestyle prescription or hand out a healthy recipe.”
Healthy Kitchens, Healthy Lives is a collaboration of the Harvard School of Medicine and the CIA. Harvard physicians present the latest science on diet and nutrition, and the CIA chefs cook it up. One important take-away message from the conference is that healthful food must taste great. “If we’re going to get people to eat better, we have to realize that taste trumps nutrition science every time,” said Eisenberg as he whipped up whole wheat couscous salad.
The conference focuses on healthy and tasty solutions to the obesity epidemic and grim health statistics. At this year’s conference, health professionals and chefs presented sessions such as “Exploring a World of Healthy Flavors”; “Deconstructing Popular Weight Loss Diets”; “Munching With Mindfulness”; and “A Focus on Healthy Carbohydrates.” Some highlights of the conference were to eat healthful fats, increase fruit and vegetable intake, make whole grain choices, and eat mindfully. The attendees enjoyed hands-on experience with chefs, cooking up healthful, easy, and delicious whole grains, proteins, legumes, and vegetables.
Today, health experts, including dietitians, are focusing more on the quality and less on the quantity of carbohydrates. Delichatsios, Eisenberg, and Kathy McManus, MS, RD, LDN, director of nutrition at Brigham and Women’s Hospital, presented “A Focus on Healthy Carbohydrates.” Delichatsios focused on translating the science of glycemic index and glycemic load, McManus discussed helping patients choose healthful carbohydrates, and Eisenberg inspired attendees by cooking up a whole grain recipe.
One popular method of classifying healthful carbohydrates is by using the glycemic index and glycemic load of foods, as McManus presented. Foods with a low glycemic index may prevent chronic disease and aid weight loss.
Preventing Chronic Disease
Delichatsios summarized the results of several studies using glycemic index and glycemic load in relation to the risk of developing certain chronic diseases.
The glycemic index was originally developed as a tool to manage blood glucose levels in people with diabetes. Although some studies have reported improvement in glycemic control for people with type 1 and type 2 diabetes who incorporated low-glycemic-index foods into their diet, other studies have showed no difference in long-term glycemic control or insulin requirements.
A meta-analysis of 37 cohort studies by Barclay et al that appeared in the American Journal of Clinical Nutrition in August 2008 analyzed the effect of glycemic index on certain diseases. It indicated that although there is some evidence to support that low glycemic index and/or low glycemic load may be independently associated with a reduced risk of certain chronic diseases, especially type 2 diabetes, the overall results were inconclusive. For diabetes and heart disease, the results indicated that low-glycemic -index/glycemic-load foods and whole grain and high-fiber foods offered comparable protection.
Aiding Weight Loss
Several weight-loss books using the glycemic index—South Beach, The Zone, Glucose Revolution, and Ending the Food Fight—have emerged and gained popularity over the years. These diets are fueled by the claim that low-glycemic-index foods are digested more slowly, keep people feeling full longer, and help control appetite, thus aiding weight loss, said Delichatsios. She continued by presenting a randomized controlled trial by Pittas et al published in Diabetes Care in December 2005 that reported no differential effect on weight loss when healthy overweight women and men were assigned to a low-glycemic-load diet, although individuals who have relatively high insulin secretion may find that reducing glycemic load may aid weight loss.
Make It Practical and Easy to Follow
“Following the glycemic index and calculating the glycemic load can be complicated,” said McManus. Many factors affect a food’s glycemic index, such as the degree of processing, cooking method, length of cooking, ripeness of food, and the amount of ingredients it contains. Following the glycemic index can also prove to be difficult and confusing for consumers; for example, wheat bread and white bread have a similar glycemic index, and ice cream has a lower glycemic index than wheat bread.
McManus clarified that the good news is that the primary foundation of a low-glycemic diet is consistent with current nutrition recommendations: increase fruit, vegetable, whole grain, and legume intake.
The average American diet consists of 50% to 60% kcal from carbohydrates. Delichatsios reported that one half of these carbohydrate calories come from only seven sources: bread (15%); soft drinks and sodas (9%); cakes, cookies, and donuts (7%); sugars, syrups, and jams (6%); white potatoes (5%); ready-to-eat cereals (5%); and milk (5%). Most of these foods are highly processed and low in dietary fiber. Dietitians should encourage their patients to choose more whole grains, legumes, vegetables, and fruits and eat fewer refined carbohydrates, such as white flour, sugary cereals, concentrated sweets, and soft drinks.
As Delichatsios noted, “Changing the type of carbohydrates we eat routinely can have a significant impact on our health, weight, and disease progression.”
— Madhu Gadia, MS, RD, CDE, is a nutrition and diabetes consultant, health writer, and speaker. She is the author of The Indian Vegan Kitchen and New Indian Home Cooking.