Suga Suga: Dissolving the Confusion

Are you confused over nutritional health diets? If you visit food, nutrition or fitness sites, chances are you will have been confronted with bewildering acronyms like FODMAPs and SCD. In some circles such as the “Starch Solution” camp, whole food carbohydrates are celebrated while in the “Wheat Belly” and “Grain Brain” camp, carbohydrates are made out to be the caitiff. Taking a neutral stance, this post attempts to dissolve the sweet confusion surround this controversial nutrient, carbohydrates. I hope you will find it informative as much as it is unsettling how extreme fad diets can be taken if not properly informed.

Caveat: this article is lengthy and will cover seven types of carbohydrate-conscious diets or authored books. I recommend playing Suga Suga to accompany this heavy post (no pun intended).

Click to jump to individual sections:
Low FODMAP Diet
Specific Carbohydrate Diet (SCD)
Candida Program
Paleo/Primal
21 Day Sugar Detox
Wheat Belly/Grain Brain
Starch Solution

Low Fodmap Diet

FODMAP is an acronym for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols. These are a collection of short-chain sugars found in food, including lactose, fructose, fructans, galactans and polyols that are unabsorbed or poorly absorbed by some people but are instead fermented by colonic bacteria. FODMAPs are also osmotic, meaning they increase fluid delivery into the intestinal tract and are seen as the basis for symptoms of Irritable Bowel Syndrome (IBS) such as abdominal pain, bloating, flatulence, nausea and diarrhea.

The low FODMAP diet was developed by Peter Gibson and Susan Shepherd at Monash University in Melbourne1FODMAP Monash. Low FODMAP diet for Irritable Bowl Syndrome. ...continue. Research and clinical studies have shown it is useful to reduce the discomfort of IBS and to treat small intestinal bacterial overgrowth (SIBO), hypothesized to be the underlying cause of IBS for most patients2Gibson PR, Shepherd SJ (2010). Evidence-based dietary ...continue. FODMAP-containing foods are eliminated to determine the type and amount of FODMAPs able to be tolerated by the individual. The end goal for the low FODMAP diet and SIBO/IBS patient is to be satisfied with symptom management while eating a most healthy, varied diet possible.

Recommended list of high FODMAP foods to avoid on a low FODMAP diet3Sue Shepherd. FODMAPs. Online..

Specific Carbohydrate Diet (SCD)

SCD is a dietary treatment for patients of inflammatory bowel disease emcompassing Chron’s Disease (CD), ulcerative colitis (UC) and IBS and celiac disease. In the last decade, SCD approaches have been extended to patients with autism with much benefit and success. It was developed by New York physician Dr. Sidney Haas and popularized by Elaine Gottschall whose daughter was cured of UC by following Haas’ diet. Elaine went back to school to earn a master’s degree in nutritional biochemistry and then authored the books Food and the Gut Reaction (1992) – now known as Breaking the Vicious Cycle: Intestinal Health Through Diet (1994)4Gottschall EG (1994). Breaking the vicious cycle: ...continue.

The diet eliminates all complex carbohydrates – disaccharides, polysaccharides and starches – that are more difficult to digest. Disaccharides include lactose found in cheese and milk; polysaccharides include starch found in grains, sweet potatoes and other starchy vegeables. Simple carbohydrates or monosaccharides that do not require enzymatic digestion, such as glucose and fructose in fruits, certain vegetables and juices, are allowed as these are readily absorbed. Overall, this need not be a low carbohydrate but a specific simple carbohydrate diet. The conceptual basis for the diet is that it reduces fermentation of undigested carbohydrates and clinical studies have reported positive changes in intestinal mucosal physiology and gut flora of patients with CD, supporting the efficacy of SCD treatment.

Some people may be confused between a low FODMAP and SCD diet. The difference is that low FODMAP eliminates the more fermentable types of carbohydrates (the FODMAP group) which includes simple high fructose fruits, whereas SCD focuses on eliminating complex indigestible macro-carbohydrates. Ultimately, the goal is to determine the types of carbohydrate you are sensitive to, and those that you can tolerate.

Candida Program

Candida, specifically Candida albicans, is a species of yeast occurring normally as a harmless commensal inhabitant of the human intestinal tract and mucous membranes, such as eyes, lungs and vagina. Under circumstances of impaired immunity, candidiasis or overgrowth of C. albicans can result. The causes of immune dysfunction are varied but one of the biggest culprits is antibiotics overuse, excessive stress and elevated cortisol and blood sugar. Candida colonies produce root-like hyphae that penetrate intestinal walls leaving microscopic holes that allow toxic yeast metabolites such as acetaldehyde, gliotoxins and mannans, undigested food particles and other bacteria to cross into the bloodstream and stimulate immune response5Gow NA et al. (2012). Candida albicans morphogenesis and ...continue. At this stage, this condition is known as the Leaky Gut Syndrome, manifested as brain fog, headache, fatigue, skin ailments and mental illness.

The Candida Program attempts to rebuild the immune system and reestablish good enteric bacteria through a diet low in carbohydrate and fermented foods, but high in quality protein and good saturated fats. Refined sugar, alcohol and antibiotics are disallowed as these substances spur great Candida growth. In the early phases, carbohydrate intake can be limited to 30-50 grams per day. In later phases, carbohydrate limit is raised and probiotics may be introduced to restore healthy bacteria. The Candida Program though apparently restrictive can be nutrient-dense, and is very similar to the Paleo/Primal Diet (see next section).

Paleo/Primal

Proponents of the Paleo diet base their eating habits on our hunter-gatherer ancestors in the Paleolithic period, circa 2.5 million and 10,000 years ago. The mental imagery “paleo” evokes is wild hominids hunting on steppes with flint-tipped spears, surviving on “free-range” meat and fish supplemented with foraged roots, berries, fruits and vegetables. Grains, legumes, potatoes, dairy and sugar were not a staple and hence off the menu for the modern paleo human. Overall, the macronutrient ratio veers toward high fat-low carb.

Gastroenterologist Walter Voegtlin earns credit as the father of the Paelo movement with its beginnings in 1970s. The premise for such constraint is that the human body is still evolutionarily designed for life in the prehistoric era; our genetics and anatomy are incompatible with our contemporary way of eating. Today outspoken proponents of Paleoism include Chriss Kesser, Mark Sission, Kurt Harris and Robb Wolf (notably men) who promote paleo as as lifestyle to keep fit and energetic and as a disease-prevention method.

For all the zealous endorsement by Paleo-pushers, the Paleo diet fails in several ways. First, it idolizes one particular slice of our evolutionary history based on assumptions about what early man ate while denying the benefits of some nutritional and affordable foods available to modern man such as whole grains and legumes. Second, it insists that we are biologically identical to stone age humans – a gargantuas genomic project would be required to quantify the extent. Third, the arguments for paleo tend to ignore the moral standards of the animal industry.

The polemic and polarities of the sugar debate; a guide for the perplexed. Image created by easel.ly.

21 Day Sugar Detox

The 21 Day Sugar Detox is a nutritional program developed by nutritionist Diane Sanfillipo, also author of the book Practical Paleo (2012). It takes a paleo-like approach that eliminates all form of sugars including grains, beans, fruit, sweet vegetables and sweeteners for three weeks to find “food freedom.”

Why is sugar so bad? The first reason is explained by the insulin response. Increased glucose in the bloodstream induces metabolic mechanisms to remove excess glucose into cells via insulin. While this is normal, constant hyperglycemia and elevated insulin, coupled with a sedentary lifestyle, can cause cells to become desensitized to insulin, leading to type 2 diabetes and weight gain. In the long run, insulin resistant cells become starved and die off – the slow start of ageing. Second, digestion of gluten releases peptides (exorphins) with opioid activity in the brain and can induce a feeling of mild euphoria or obsessive compulsive symptoms6Lister J et al. (2015) Behavioral effects of food-derived ...continue. This may explain the addictive nature of bread and pasta and initial withdrawal symptoms when eliminating such foods.

By refocusing on whole, nutrient-dense foods with minimal sugars, the body and brain is given a chance to reset and break addictions. The 21-day sugar detox program is recommended for those looking to lose weight, regulate their carbohydrate intake and blood sugar, and improve mental clarity.

Wheat Belly / Grain Brain

Wheat Belly (2014) and Grain Brain (2013) are anti-carbohydrate books by cardiologist Dr. William Davis and neurologist David Perlmutter respectively. In particular, wheat is singled out as the “bad guy” in Wheat Belly whose as title proposes, causes big belly.

“Wheat is the most destructive thing you could put on your plate, no question,” declares Davis. Both Davis and Perlmutter echo the Paleo notion that that modern wheat is unsuitable for human consumption as it is genetically transformed through hybridization and breeding. From the cardiologist’s perspective, Davis asserts consumption of wheat as the cause of present-day ailments such as obesity, diabetes and heart disease. Perlmutter takes his argument beyond wheat and includes all cereal grains, fruit, and vegetables with high glucose and fructose. Citing patient evidence from his clinical practice as well as studies from medical journals, Perlmutter explicates that glucose is inflammatory, promotes glycation and formation of Advanced Glycation Endproducts (AGEs), protein aggregation, induces insulin resistance and ultimately cause reduced cognitive capacity, brain dysfunction and neurological conditions such as Alzheimer’s Disease, mild cognitive impariment (MCI), dementia, depression, and epilepsy among others. Perlmutter advocates a high fat low carb diet with no more than 60 grams of carbohydrates a day compared to the standard average of 100-150 grams7Perlmutter D (2013). Grain Brain: The Surprising Truth ...continue.

There are several controversies I would like to address. First, the argument that modern wheat is very different from early wheat is supported by recent comparative biochemical research studies, but not in the way we expect. A study by Colomba and Gregorini (2012) showed that the ancient wheats Graziella Ra and Kamut have greater amounts of total and α-gliadin than modern accessions and α-gliadins from such ancient wheats show strong immunogeneticity in antibodiy assays8Colomba MS and Gregorini A (2012). Are ancient durum wheats ...continue. However animal studies showed that rats fed a ancient kamut-khorasan diet had strong protective effects against doxorubican-induced oxidation and inflammation, whereas rats fed a modern whole wheat pasta diet showed abnormal characteristics at the intestinal mucosa and inflammation at the spleen and lymph nodes resembling the features of non-celiac wheat sensitivities9Carnevali A et al. (2014). Role of Kamut brand khorasan ...continue. The incongruity between biochemical assays suggesting high potential immunogenecity and toxicity of all wheat types and histological assays showing the potential benefits of ancient wheat over modern wheat remains to be investigated by scientists.

Second, if it were correct that grains and carbohydrates were cardiotoxic and neurotoxic, civilization would have been debilitated many years ago. Populations with carbohydrate-based diets like those from rural Africa, Japan, Korea, and China have much lower incidence of obesity, diabetes, neurodegeneration and heart disease, clearly a refute against the hard carbohydrate-slamming argument.

Starch Solution

Starch Solution (2012) is a book by Dr. John McDougall that advocates a plant and starch-based diet comprising at leat 70 percent. Starchy foods are high in complex carbohydrates and includes grains like oats and rice, and starchy vegetables like potatoes and sweet potatoes. He lauds starch as the “gold medal” for carbohydrate as it provides sustained energy and satiety10McDougall J and McDougall M (2012). The Starch Solution: ...continue. Interestingly, research based on archaeological, genetic and anatomical data suggests that carbohydrate consumption, in particular starch, was fuel for evolution of the extraordinary human brain11Perry GH et al. (2007). Diet and the evolution of human ...continue,12Hardy K et al. (2015). The important of dietary ...continue, implicating humans as evolutionarily designed for it. This diet, however, does not take into consideration those with digestive disorders and gut dysbiosis who may not be able to tolerate complex carbohydrates.

My Experience and Conclusion

The conclusion I have reached is that everyone got it right and also got it wrong. Each doctor, scientist or researcher has figured out a piece of the puzzle, but none like to admit they might have part of it wrong. By making a living off of their purported version of the truth and caught in the political web of affiliations, they can not just retract and concede they had parts of the story wrong. Everyone agrees on the eating of greens and veggies, Davis and Perlmutter fed us with fat, Paleopushers wild meat and eggs, McDougall supplied us with starch, and biochemists raised the red flags to specific carbohydrate groups such as FODMAPs.

Diets are as personal as each individual’s unique biochemical and genetic makeup, which even changes based on age, environment and external stressors. The only way to find your sweet balance, pun aside, is to experiment, track and reflect. Personally, with the help of Cronometer app, I have come to understand that my body thrives best on a macro ratio of 60-30-10 (carbohydrate-fat-protein). My preferred sources of carbohydrates are a good mix of vegetables, fruits and roots, and occasionally gluten-free grains and pseudograins.

Lest we border on nutritionism, the reductive focus on the nutrient composition of food13Scrinis G (2008). On the ideology of nutritionism. ...continue, let us not forget that food and feeding is merely one aspect of a holistic happy life. Here is a adage I will conclude with:

Eat responsibly and sustainably for the health of your body and earth; Respect the source; Appreciate the nourishment of food and its connection to people and planet.

References   [ + ]

1. FODMAP Monash. Low FODMAP diet for Irritable Bowl Syndrome. Blog.
2. Gibson PR, Shepherd SJ (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 25:252-258.
3. Sue Shepherd. FODMAPs. Online.
4. Gottschall EG (1994). Breaking the vicious cycle: Intestinal health through diet. Kirkton Press, Kirkton ON. Website.
5. Gow NA et al. (2012). Candida albicans morphogenesis and host defence: discriminating invasion from colonization. Nat Rev Microbiol. 10:112–122.
6. Lister J et al. (2015) Behavioral effects of food-derived opioid-like peptides in rodents: Implications for schizophrenia? Pharmacol Biochem Behav. 134:70-78.
7. Perlmutter D (2013). Grain Brain: The Surprising Truth about Wheat, Carbs and Sugar – Your Brain’s Silent Killers. Little, Brown and Company.
8. Colomba MS and Gregorini A (2012). Are ancient durum wheats less toxic to celiac patients? A study of α-gliadin from graziella ra and kamut. The Scientific World Journal 2012.
9. Carnevali A et al. (2014). Role of Kamut brand khorasan wheat in the counteraction of non-celiac wheat sensitivity and oxidative damage. Food Research Intl. 63:218-226.
10. McDougall J and McDougall M (2012). The Starch Solution: Eat the Foods You Love, Regain Your Health, and Lose Weight for Good. Rodale, New York.
11. Perry GH et al. (2007). Diet and the evolution of human amylase gene copy number variation. Nat Genet. 39:1256-1260.
12. Hardy K et al. (2015). The important of dietary carbohydrate in human evolution. Q Rev Biol. 90:251-268.
13. Scrinis G (2008). On the ideology of nutritionism. Gastronomica 8: 39-48. PDF
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