Carbohydrate Quality: What Do I Tell My Patients?
Obesity and diabetes have reached epidemic proportions and are projected to increase over the next decade with important consequences for cardiometabolic complications. As the ultimate role of fat in this dual epidemic has been questioned, carbohydrates are increasingly being indicted as the main culprit. Much of the concern has focused on sugars but traditional carbohydrate staples like cereal grains, pulses, and pasta are also under scrutiny.
Dr Sievenpiper reviews the available evidence suggesting that not all sources of carbohydrates behave similarly. High quality systematic reviews and meta-analyses show that high carbohydrate diets that are low in glycemic index, high in fiber, or emphasize specific foods (eg, whole grains, pulses, fruit) decrease cardiometabolic risk factors in randomized controlled trials, and are associated with decreased weight gain, diabetes incidence, and cardiovascular disease incidence and mortality in prospective cohort studies. These data reflect the current shifts in dietary guidance that focus on quality over quantity, and dietary patterns over single nutrients.
JOHN L. SIEVENPIPER, MD, MSC, PHD, FRCPC
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