Ashlee Williams, MD (Host): What's the first thing that comes to mind when you hear the word carbohydrate? Weight gain, elevated blood sugar. The truth is not all carbs are created equal and choosing the right one can make a big difference in your energy level, metabolism, and overall health. Welcome to the Healthier You podcast.

I'm Dr. Ashlee Williams, and today I'm talking with Dr. Christie Youssef, a Board Certified Family Medicine Physician here at Kaiser Permanente to explore how carbohydrates work in your body, the difference between simple and complex carbs, and how to identify the healthiest carbs to keep you energized. Dr. Youssef, thanks so much for being here.

Christie Youssef, DO: Oh, thank you so much for having me again. It's great to be here.

Host: Yeah, it's so great to have you back. So let's just start with the basics. We always like to start with the basics. Tell us what the role of carbohydrates are in your body.

Christie Youssef, DO: Sure. Carbohydrates are your body's main source of energy. So, when you eat them, they break down into glucose or blood sugar, and during digestion, your body then releases insulin. That's a hormone that helps to move glucose into your cells and use it as fuel. Glucose is super important because it powers your red blood cells, your muscles, your brain.

Any extra glucose then gets stored as glycogen in your liver and muscles, it needs to be ready for you to use in between meals for energy. How many carbs you eat can have a huge impact on your blood sugar levels.

Host: So why are carbohydrates important?

Christie Youssef, DO: Carbohydrates are necessary for cognitive and brain function, first and foremost. They influence the production of serotonin, which is a chemical in our body that regulates mood and sleep. Carbs are, are good because they contain fiber and they're especially important because they help promote good digestive health. And lastly, they support muscle function and recovery, which is especially important in athletes and people who are exercising pretty heavily.

Host: Can you talk about some good sources for carbohydrates?

Christie Youssef, DO: Sure. So carbohydrates can be found in fruits, vegetables, grains, dairy products, legumes. They all contain naturally occurring carbohydrates, and these are great, healthy sources of carbohydrates. But keep in mind carbohydrates can be found in white bread, white rice, pastries, bleached pasta, for example, sugary cereals; those all lack nutritional value.

Host: Yes, that's a great segue into my next question. Simple carbohydrates versus complex carbohydrates. What's the difference?

Christie Youssef, DO: So I get this question a lot in my practice because people don't really know the difference and so I'm glad to break it down for you guys today. There are two main types of carbohydrates like you alluded, the simple ones and the complex ones. I'm going to start with simple ones because those are the ones that mystify us the most.

Simple carbs are found in most processed foods such as sweets and white bread and soda and sugar and they contain fewer nutrients than complex carbs do. They have many nutrients removed when they're processed, making them quickly, easily to be broken down and absorbed by the body. This leads to spikes in your blood sugar levels and quick energy boosts.

However, shortly after eating them, the blood sugar levels drop and that often leaves you feeling hungry and lethargic. So we know now overeating simple carbs can lead to obesity. They can lead to Type 2 diabetes and cardiovascular disease. So it's important that we limit them completely. It's also important that I touch here on fruit because while whole fruits do contain simple carbohydrates, they're considered highly nutritious because they provide fiber, vitamins, and minerals.

So unlike processed foods that lead to rapid blood sugar spikes and crashes, the fiber in fruit helps slow down sugar absorption and that stabilizes the blood sugar levels and provides longer lasting energy. Fruits are also packed with essential nutrients like vitamins and minerals and antioxidants; that supports digestion, that reduces inflammation, and that boosts the immune system. So this combination of natural sugars and fiber makes fruit healthy and a balanced choice for energy and overall well being. So when choosing fruits, you want to go for low sugar options such as berries and green apples.

Now on to complex carbs. Complex carbs are found in vegetables, beans, sweet potatoes, whole grains, rice, pasta, and bread. These carbs are digested slowly than simple carbs and they keep energy and blood sugar levels stable because they gradually release the glucose into the bloodstream. Now foods containing complex carbs tend to be higher in minerals and vitamins and dietary fiber and they aid in digestion and help give us the feeling and the sense of fullness so we don't overeat.

Complex carbs play a vital role in regulating cholesterol as well. So when looking at grains, make sure you choose whole grains such as brown rice and pasta and cereal made from whole grain flour instead of white rice, white bread, and white pasta.

Host: Yeah. So trends of low carb diet, especially the keto diet have been really, really popular. Can you talk about why it's important to have carbohydrates in our diet?

Christie Youssef, DO: Some diets such as ketogenic diet focuses on severely restricting carbs down to around 50 grams of carbs a day or lower sometimes. Eating a low carb diet can lead to weight loss, it can. When the body does not have a sufficient sugar, such as glucose, available from carbohydrates as a source of energy, it goes to the next available energy source, which is fat.

And the liver turns the fat into ketones, which is an acid our cells use for fuel. This is called ketogenesis. However, people following a keto diet tend to gravitate towards eating foods that are higher in saturated fat. These fats are converted in the bloodstream into bad cholesterol, which can cause cardiovascular disease.

So, you want to be very careful because this increases your risk for cardiovascular heart attacks, strokes, and things of that nature. When people don't eat enough high fiber foods, such as foods containing complex carbs; they're doing their gut a disservice. Low fiber diets have been linked to constipation, diverticulitis, and other gastrointestinal conditions.

Many people find that restrictively low carb diets also are unsustainable, which is another reason I encourage everyone to learn to identify healthy complex carbs and eat a balanced diet instead of restricting your carbohydrate intake. Now, one thing we do know that is a diet without enough carbs, can lead to headaches, fatigue, weakness, lack of focus and concentration, nausea, constipation, and some vitamin deficiencies as well.

Host: I'm always telling my patients, it's so important to make sure that we're reading labels on our food sources. Can you tell us a little bit about what we should be looking for on our food labels?

Christie Youssef, DO: Oh, this is my favorite part when counseling people because I like to show them exactly where they can get their knowledge. So when you're looking at a label, first thing first, look at the serving size because many packaged foods can include two or three servings just in that package. All the numbers on the label, calories, carbs, sugar, they're based on this amount.

So, next thing, let your eyes scroll down to the line that says Total Carbohydrates. But don't stop there. Pay attention to things like the dietary fiber. Because we want to aim for at least three to five grams of fiber per serving. And then after the level of fiber, look at the amount of added sugar.

On the label, you're going to see total sugars and a line below it that shows total number of added sugars. The lower, the better. Ideally keep added sugars under 25 grams per day for women and 36 grams for men.

Host: Okay, those are great numbers to keep in mind. How do you counsel your patients on choosing healthy carbohydrates?

Christie Youssef, DO: Oh, yes, absolutely. So we focus a lot on the plate method. And when choosing the right carbohydrates, you want to look one at portion control, but you also want to look at balanced eating. So, when you have your plate method in front of you, you want to say 50 percent of that plate should come from non starchy vegetables.

That's going to be your, your green leafy vegetables, non starchy. And the other quarter of it's going to be protein, and then there's a quarter left that can be considered open for carbohydrates. That's when you're going to want to reach for your complex carbs like, whole grain pasta, brown rice, whole wheat, beans, legumes, lentils.

That's going to be a good source of complex carbs. So keep it all balanced and you should be able to make choices that are more whole wheat based, instead of refined sugar based.

Host: Well, Dr. Youssef, thank you so much for this great information. We learned a lot about carbohydrates and how they affect our body's health and function. Here are the top takeaways. One, carbohydrates break down into energy for your body. And there are two types of carbohydrates, simple carbs and complex carbs.

Simple carbs are found in many processed foods and contain few nutrients, while complex carbs are digested slower and help keep your energy and blood sugar levels stable. Carbohydrates can lead to obesity, diabetes, and cardiovascular disease. But when eaten properly, they have many health benefits, including blood sugar regulation, and improved brain function.

Diets without enough carbohydrates can lead to fatigue and vitamin deficiencies. Check the food labels, particularly serving sizes. And lastly, choose whole, nutrient dense carbs, focus on fiber, and avoid refined options. And balance your meals using the plate method. For further information about lifestyle medicine from our experts, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to share it with others who may find it helpful. Thank you and from all of us at Kaiser Permanente, be well.