Carbs — in or out?

2014-08-29 00:00

TODAY we continue looking at the science behind whether carbohydrates should indeed be included in our daily diet or avoided completely.

Every social event or family gathering involving food that I have attended in the last number of months has seen a fresh wave of questions around this hot topic.

Last time we discussed results from a recent (July 2014) systematic review that critically appraised the best available research on this topic. This review included findings from all relevant clinical studies comparing low-carbohydrate diets to traditional balanced diets. It was conducted by a team comprising the Association of Dietetics in South Africa, Chronic Disease Initiative for Africa, the Heart and Stroke Foundation South Africa, the Nutrition Society of South Africa and the Professional Board for Dietetics and Nutrition of the HPCSA in the interest of advising the South African public on best practices for weight loss and improved health.

To recap what we learnt last time, the two diets have similar effect on weight loss. The key factor for weight change is total energy consumption versus energy expenditure, and not the proportions of protein, fat and carbohydrate making up the total. The appraisal also highlighted that low-carbohydrate diets should not be recommended to the public as the long-term safety beyond two years is not known.

Further findings from this critical research appraisal highlight a number of other considerations.

Weight loss may be achieved by a number of various diets, but health is only achieved by eating a balanced diet of good-quality foods.

Achieving a healthy diet is not solely dependent on the proportions and quantity of carbohydrates, proteins and fats chosen. The quality of these carbohydrate, protein and fat choices is important. Certain types of carbohydrates and fats influence heart disease and diabetes risk factors.

• Reducing saturated and trans fats in the diet, and replacing them with unsaturated fats lowers heart disease risk. In practical terms, this translates to minimising animal fats such as chicken skin, fatty red meat cuts, boerewors, cream and butter; while increasing the intake of plant oils (such as olive or canola), avocado pear, olives and nuts.

• Carbohydrates included in the diet should be from unrefined sources such as vegetables, fruits, unrefined grains such as barley and brown rice, bran-rich cereals and legumes. Refined carbohydrates such as baked confectionary products and white breads, sweets and added sugars should be avoided.

A healthy dietary pattern which combines a variety of healthful foods has consistently been linked to reduced disease risk, including diabetes, heart disease, cancers and obesity.

Foods and nutrients work in combination and health is not dependent on the presence or absence of one food, nutrient or food group in isolation.

The South African Food Based Dietary Guidelines (FBDGs) were developed to address existing public health problems in South Africa and are in line with current evidence on eating for health. The FBDGs encourage us to eat a variety of foods, plenty of vegetables and fruit, choose unrefined starchy foods, eat beans, peas and lentils regularly, have dairy products every day and use vegetable oils rather than hard fats. Fish, chicken, lean meat or eggs can be eaten daily.

Sugar, salt and foods high in these should be used sparingly. This includes highly processed foods such as cookies, cakes, pastries, chips, snack bars, ready-to-eat savoury or sweet snacks and sweetened drinks.

Diets advised to the public should be healthy, as well as affordable and sustainable. The majority of South Africans follow diets that are based on affordable carbohydrate-rich foods. Adopting a low-carbohydrate diet (which is by implication high in fat and protein), is far more costly and likely to impact negatively on household food security. In resource-scarce households, the low-carbohydrate diet is neither practical nor sustainable.

The ethical cost of producing more protein-rich foods than carbohydrate-rich staples will also burden global food supply and the environment.

It is interesting to note that although there is little difference between low-carbohydrate diets and balanced healthy diets in achieving weight loss, the overall state of health can be negatively affected by eliminating carbohydrates.

• Sharon Hultzer is a consulting

dietitian. She can be reached at

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