Are carbs as ‘amazing’ as Elon Musk says in his tweet? Why Indians should take this with a pinch of salt

‘Chief Twit’ Elon Musk may have set the ball rolling with his tweet, “Finally, the truth that carbs are amazing can be said on this platform! #FreeSpeech,” but it does prod some deep thinking. With all conversations around a world more prone to diabetes and obesity, making the carb look like a monster, and social media full of posts on different low-carb diets, we might end up thinking that carbohydrates are bad for us. On the contrary, they are a key pillar of our energy.
The minimum carbohydrate requirement for adults is 130 grams or 45 per cent of daily calories. While getting enough carbohydrates is important, with Indians prone to diabetes, there is a need for regulating their intake and smart management of the type you include in your diet. Yes, unknown to many we need to switch over to complex carbohydrates, which take time to be broken down and, therefore, do not cause either a sudden sugar rush or drop, a worrying concern for diabetics.

LOOK FOR THE RIGHT CARBOHYDRATES
There are plenty of healthy carbohydrates which are nutrient-rich that are good for overall balance. These include leafy greens, cruciferous vegetables like broccoli and cauliflower, some tubers like sweet potato, berries, oats, beans and legumes. All of them contain fibres which go well with lean meats and healthy fats.
Photo At the recent Cardiometabolic Health Congress,
Alison Evert, manager of the nutrition and diabetes education programmes at the University of Washington Neighbourhood Clinics, said there are multiple types of eating patterns recommended for people with diabetes, “but approaches that target glucose, weight management and cardiovascular risk reduction through changes in both quantity and quality of carbohydrates may have the most therapeutic advantages.”

News reports quoted her as saying that providers should focus on “reducing carbohydrate intake in people with diabetes cutting out sugar-sweetened beverages and reducing the portion sizes of starchy foods, as well as improve carbohydrate quality creating an eating pattern featuring more non-starchy vegetables and whole foods, and less added sugars and refined grains.”
NOT EVERYTHING IS BAD NEWS WITH PORTION CONTROL
“Replacing simple/refined carbs with fibre-rich complex carbs and trans-or saturated fats with good fats from nuts like walnuts and almonds is recommended. Adding protein to our carbohydrate-rich Indian diets helps. In case there are days when one cannot find dedicated time for exercise, increasing daily activities can make a difference too – for example climbing the stairs (instead of using the elevator) or walking for daily chores. It helps to avoid sitting for prolonged periods. Getting up from the desk every 30-60 minutes to walk to a colleague’s desk or just stretching the body makes a difference. And it’s never too late to quit smoking and reduce alcohol intake. Just do it,” says Dr Ambrish Mithal, Chairman and Head, Endocrinology and Diabetes, Max Healthcare.
Dr Mithal urges a relook at fruits since this is the season for them, of course not the processed, canned or juiced variety. “They are an important part of our diet since they are packed with numerous vitamins, minerals and antioxidants like polyphenolic flavonoids, vitamin C and anthocyanins. These compounds not only protect the human body from the oxidative stress of free radicals but also boost the immunity level of the body. Many fruits are rich in fibre, which plays an important role in managing our sugar levels. A diet high in soluble fibre slows sugar absorption. Besides, fibre makes us feel full, so we eat less. Fruits have a lot of water, which improves hydration. Both fibre and water in the fruit help in battling constipation, a common problem in people with diabetes. Diets which contain adequate amounts of vegetables and fruits reduce the risk of obesity, high blood pressure, heart attack, stroke and cancer.”

Which fruit and how much is advisable for people with diabetes? “That depends on the glycaemic index (GI) of all foods, not just fruits. Examples of low GI fruits (GI 20-49) include apples, avocados, cherries, guava, peaches, pears, and strawberries. Medium GI fruits (GI 50-69) include figs, grapes and oranges. Fully ripe bananas and dates are examples of high GI fruits,” explains Dr Mithal.
The key to fruit consumption in diabetes is incorporating them into the daily carbohydrate allowance, which means cutting back on other carbs. “For people with diabetes, one serving of fruit should contain 15 grams of carbohydrates and the total daily intake should not exceed 30 gm. So one can have a 15 gm carb serving of fruit in one sitting, and a total of two fruit servings in a day. Eating fruits as a snack consumed mid-morning or mid-evening is preferable to having them as dessert after meals since they add to the carbohydrate load. Rather than consuming large portion sizes of fruits, it is best to combine them with protein-rich foods like dairy products or nuts. Since fruits lack proteins, this makes the snack more nutritious and filling,” he adds.
REINVENT THE FOOD PYRAMID AND MEAL PATTERNS
Dr Anuja Agarwala, former Senior Dietitian at AIIMS, has been researching and reinventing the food pyramid for a better carb balance. “Imagine your plate to be a pie chart. We need half of it to be full of fruits and vegetables, basically plant foods. One fourth part should be protein and the remaining quarter should be carbohydrates. We usually tend to reserve the bigger chunk for rice and wheat, thinking the meal would not have satiety value. It’s the same reason why despite having an omelette made of two eggs (good protein with high satiety value) people will always team it with bread. Even the rice-eating Japanese have double the vegetables in their bowl. Millets, wholegrains, legumes and pulses include as many complex carbohydrates as possible as they take time to be broken down. Hydration is also very important. Junk that flavoured or sparkling water and go for plain water that’s boiled. Even RO takes away most of the healthy minerals from the water.”

Dr Priyanka Rohatgi, Chief Nutrition, Indraprastha Apollo Hospitals, New Delhi, suggests changing meal patterns and making a habit of small and frequent portions with controlled intake. “Eat non-starchy vegetables and fruits, lean meats, healthy fats, less root vegetables and whole grains. Should you have a sweet craving after meals, you can have a slice or two of tropical fruits as they tend to have a lower glycaemic index than typical desserts. Try out unbroken grains like our millets, wheat and brown rice. Cut out breads. Avoid processed foods of all kinds. If you are a fruit juice addict, cut down or stop it immediately, have the whole fruit instead. Drink plenty of water to kill the thirst for other drinks,” she says. She suggests smarty tweaks in our lifestyle as follows:
• Keep fixed meal timings. Many studies on mice have shown that time-restricted eating can improve blood glucose levels, even when they have a diet high in fats.
• In case the individual is overweight, losing five to 10 per cent of excess body weight can make a huge difference. Also working backwards, try to keep all your body markers on the lower side of a normal range. That way you can escape the galloping sugar tendency.
• Exercise: Muscle-strengthening resance training helps. If 30 minutes are recommended for everybody else, you should push it up to 60 minutes. Losing five to 10 per cent of body fat can improve your blood sugar level and reverse pre-diabetes.

DIABETICS MUST PRACTISE CARB COUNTING
Carb counting means counting the number of grams of carbohydrate in a meal and matching that to your dose of insulin. “For example, before a meal, you must account for each carbohydrate gram you eat and your insulin based on it. You can use what’s known as an insulin-to-carb ratio to calculate how much insulin you should take in order to manage your blood sugars after eating. You also have to factor in protein and the fat component in foods as they have a key role in satiety and how quickly the body absorbs carbohydrates. Carbohydrate counting, though it has been known for several decades, is hardly practised in the management of diabetes in our country with the strictness and vigilance it should,” says diabetolog Dr Jothydev Kesavadev, who runs Jothydev Diabetes Research Centre.