Understanding The Most Important Concept In Medicine Today

The most important public health issue in American health is in your kitchen cabinet and not your medicine cabinet.  Pills and surgery may be the back bone of modern medicine in most Americans minds but for the majority of the population health and wellness will be intimately tied with lifestyle.  Among the most critical components of lifestyle medicine is how the body metabolizes a class of food known as carbohydrate.

A study released today in the Journal of American Medicine touts the importance of not only how much we eat but the composition of what we eat. The study suggested that when it comes to maintaining weight loss among diets with the same amount of calories, calories higher in healthy carbohydrates may offer an advantage over  diets filled with unhealthy carbohydrate

“From a metabolic perspective, all calories are not alike,” said study senior author Dr. David Ludwig,“The quality of the calories going in affects the quantity of the calories going out.”

In order to understand not only this study but arguably the most important public health issue in the history of mankind ( namely the American epidemic of obesity and cardiovascular disease) Americans need to understand how the body breaks down carbohydrate and the closely related concept of the glycemic index.  

 For the vast majority of Americans, the biological mechanisms that provide the foundation for the glycemic index will be far more important to the quality and quantity of their life than anything else.     And it turns out the choices we make on our dinner plate are a major factor in this process.

Carbohydrates are a type of nutrient found heavily in the human diet.  They are basically rings of carbon, hydrogen and oxygen and human beings can break down the chemical bonds in the rings and harvest energy from them to be used.  Carbohydrates or “carbs” are found in breads, grains, pasta, rice and “starches.”

The bottom line is that there are some kinds of carbohydrate that are very healthy for human beings to consume and others that are literally poisonous to consume.   What distinguishes a healthy carb from an unhealthy carb comes down to not so much the chemical structure of the carbohydrate itself but how the carbohydrate is packaged.

When carbs are packaged in a way that makes them easy to digest they are harmful to human physiology, whereas carbs that are physically harder to digest are beneficial.  The reason for this is that when the body absorbs carbohydrate the pancreas makes a hormone called “Insulin.”  Insulin helps deliver carbs to your cells so the carbs can be used as energy.   But insulin is a hormone and it has many, many other functions on other organ systems besides delivering carbohydrates to cells.  For example, Insulin is made during times when food is available and therefore a second task of the hormone besides delivering carbohydrate to cells for energy is to promote cell growth and replication.  Insulin also  exerts direct effects on the kidneys, the liver, the brain, the endocrine system and most importantly of all the inside walls of your blood vessels.

Your body will secrete insulin based on how quickly you are able to absorb the carbohydrate you eat.  Some carbs like simple sugars found in soda or candy are easy to digest and they cause a spike or surge in insulin.   Other carbs that are wrapped in bulky fiber molecules are more difficult to digest and they cause a slower, more moderate release in insulin.   High insulin spikes brought on by easy to digest carbs for energy are quite harmful to multiple organ systems because of the many other effects of insulin.  


Further complicating this is that if a person repeatedly eats carbohydrate that makes their insulin spike high eventually the muscle and tissue cells that use carbohydrate for energy will grow less sensitive to insulin and become “insulin resistant”.  This means your pancreas will have to make more and more insulin every time to break down the same amount of bad carbohydrate.

But here is the real catch:  just because in terms of energy metabolism a person becomes insulin resistant does not mean that insulin’s other effects in the body will also become desensitized.   Remember we said before that helping your body breakdown sugar was only one of insulin’s many effects in the body.  So your kidneys, liver, brain and blood vessels will still be quite sensitive to the effects of insulin as you make more and more of it to facilitate energy metabolism in insulin resistant cells .  Furthermore, insulin will still have the same effects of promoting cell growth and differentiation throughout the body.

This is what I mean when I say some kinds of carbohydrates are poisonous.   These easy to digest carbohydrates cause a natural and necessary hormone made by your body (insulin) to spike and reach toxic and damaging levels to critical organ systems, especially the inside walls of blood vessels.  Your body is not meant to eat food like this day in, day out and in excess and this process is causing more disease than anything else in the western world.

The distinction between “good carbs” and “bad carbs” can be made by a scale known as the glycemic index.  The glycemic index is a measure of your bodies insulin response to certain foods.  Foods that are processed, loaded with refined sugar and “white” foods tend to be easy to digest, causing dangerously high insulin spikes and therefore high on the glycemic index.   Foods that are natural, high in soluble fiber and “brown” (brown breads, sweet potatoes, brown rice) tend to keep insulin levels more moderate, be low glycemic and therefore extremely healthy.

The danger is that American diet is based on foods that are high glycemic.  The typical western diet is based on foods that cause Americans insulin levels to spike up and down like a yo-yo all day, with deleterious effects on the body and the mind (insulin spikes lead to counter regulatory surges in several important stress hormones like adrenaline).  Even many foods that are considered healthier options are in fact high glycemic and therefore unhealthy.

The top two causes of death in America now are cardiovascular disease and cancer.  Insulin is a hormone that promotes cell growth and differentiation and is likely oncogenic in levels seen in repeated insulin spikes in unhealthy eaters.  Insulin also damages to inside of blood vessel walls and is likely pro-inflammatory and contributing to the process of plaque build up in arteries that is the basis of all vascular disease (strokes, heart attacks, erectile dysfunction).


When it comes to nutrition it is important for Americans to make the distinction between obesity and insulin dys-regulation.   The two are closely related, but regardless of body weight the way the body breaks down carbohydrate via insulin is a critical factor in the development of many diseases and especially cardiovascular disease.  As cardiovascular disease continues to rise to epic levels in  the United States (we crack open about 400,000 chests per year) one of the best and most profound solutions is the type of carbohydrate we serve on our dinner plates.