What Are Carbohydrates?
Carbohydrates contain the sun’s radiant energy, captured in a form that living things can use to drive the processes of life. Carbohydrates are compounds composed of single or multiple sugars. The name means “carbon and water”. Carbohydrate-rich foods come almost exclusively from plants; milk is the only animal-derived food that contains significant amounts of carbohydrates. Carbohydrates are divided into two groups: simple carbohydrates and complex carbohydrates.

Not Just Simple Vs. Complex
Carbohydrates have been traditionally divided into two categories: simple and complex. Simple carbohydrates have been portrayed as the “nutrition bad guys,” while complex carbohydrates have been regarded as the “nutrition good guys.” This is a gross oversimplification. Not all simple carbohydrates are bad, and not all complex carbohydrates are good.

Simple carbohydrates are sugars. The simplest simple carbohydrates are glucose (sometimes called dextrose), fructose (also called fruit sugar), and galactose (a part of milk sugar). Simple carbohydrates provide us with energy and little else.

Complex carbohydrates are long chains of linked sugars. Although there are many types of complex carbohydrates in our food, the main one is starch, a long chain of glucose molecules. The human digestive system can break down complex carbohydrates like starch into their component sugars. Others are quite indigestible and pass largely unchanged through the stomach and intestines. These indigestible carbohydrates are called fiber and are an important part of our diet.

Why Carbohydrates Matter?
In the average American diet, carbohydrates contribute about half of all calories. And half of these carbohydrate calories come from just seven sources:
1-Breads 15%
2-Soft drinks and sodas 9%
3-Cakes, cookies, quick breads and doughnuts 7 %
4-Sugars, syrups and jams 6%
5-White potatoes 5%
6-Ready-to-eat cereals 5%
7-Milk 5 %
In other words, most of the carbohydrate calories come from sugars or highly refined grains.

When you eat a slice of bread, a potato, or candy, the digestible carbohydrates are rapidly absorbed into the blood stream. Because these simple sugars are the primary fuel for most of the body’s tissues, complex mechanisms are in place to make sure that the level of glucose in the bloodstream doesn’t shoot too high or drift too low.

The rise in blood sugar (glucose) is followed by a parallel rise in insulin. This hormone, produced by special cells in the pancreas, ushers glucose inside of muscle and other cells. As cells sponge up glucose, blood sugar levels fall first, followed closely by insulin levels. Once your blood sugar level hits some baseline, the liver begins releasing stored glucose to maintain a constant supply.

When you eat a snack or meal of easily digestible carbohydrates, the resulting flood of insulin drives glucose levels too low. If there isn’t any more digestible carbohydrate in the stomach or intestines, your gut and brain start sending out hunger signals to make you grab more glucose even as the liver starts releasing stored glucose.

A meal of slow digestible whole-grain carbohydrates smoothes out this glucose-insulin roller coaster. Because it takes longer for the digestive system to break these carbohydrates into sugar molecules, blood sugar and insulin levels rise more slowly and peak at lower levels. This longer process also means that it may take longer for you to get hungry again.

Are Low Carbohydrate Diets Better?
High-protein diets have recently been proposed as a “new” strategy for successful weight loss. However, variations of these diets have been popular since the 1960’s. Although these diets may not be harmful for most healthy people for a short period of time, there are no long-term scientific studies to support their overall efficacy and safety.

One hypothesis supporting the efficacy of low carbohydrate diets is that a high dietary glycemic load (the contribution of blood glucose of all foods consumed in a meal) increases the difficulty of weight control because the high intake of refined starches and sugars cause rapid swings in blood insulin and glucose levels; these, in turn, stimulate hunger between meals and lead to more snacking.

In 2004, 4 randomized trials in adults compared very-low-carbohydrate diets with low-fat diets. Although the trials differed in the target population, study design, and intensity of intervention, all 4 studies found that weight loss at 6 months was 4-6 kg greater in the low-carbohydrate group than in the low-fat group. However, the low-carbohydrate group maintained the weight loss at 6 months, whereas the low-fat group continued to lose.

In the 2 studies that lasted for 1 year, the differences in weight loss had narrowed to 2 kg by 1 year and were no longer statistically significant. This occurred because the low-carbohydrate group regained weight.

The low-carbohydrate diet had similar effects on blood lipid levels in the 4 studies. The low-carbohydrate diets minimally changed LDL cholesterol (bad cholesterol) levels, slightly increased HDL cholesterol (good cholesterol) levels, and markedly decreased fasting triglyceride levels. The changes in HDL cholesterol and triglyceride levels are consistent with the known effects of reducing carbohydrate intake and body fat. The small effects on total and LDL cholesterol probably result in part from greater weight loss, which reduces total and LDL cholesterol levels, thereby offsetting the effects of a higher intake of saturated fat. The low-carbohydrate diet did not, on average, harm blood lipid levels.
The take-home message is that although people are encouraged by health care professionals to experiment with various methods for weight control, the emphasis should still be on following a healthy diet and incorporating regular exercise. It is important for you to focus on finding ways to eat that can be maintained indefinitely rather than seeking “diets” that promote permanently eliminating certain food groups.

The first few months after surgery, you are on a “diet,” in the sense that you may not be able to eat from all the different food groups. This restriction is mainly due to the small pouch size and the need to meet protein needs to prevent lean body mass (muscle) loss. But as you reach goal and start to work on maintenance, it is important to work with your dietitian in fine-tuning your eating habits and knowledge of nutrition. If you do not change your eating habits and lifestyle, weight gain will be inevitable!

What are Sugar Alcohols?

Sugar alcohol is neither a sugar nor an alcohol. It comes from fruits, trees, and other plants. It is formed when its sugar source is hydrogenated. An enzyme changes the link between glucose and fructose in sucrose (sugar) and an alcohol group is attached to the sucrose molecule.

Sugar alcohol is considered a “nutritive sweetener”. Non-nutritive sweeteners include Equal, Sweet'n Low, and Splenda, and basically have no calories.
The FDA considers these food products safe.

Sugar alcohols generally have half the sweetness and half the calories of sugar. This is the main reason why they are frequently used by the food industry to sweeten foods. They also may reduce the risk for dental caries.

Sugar has 4 calories per gram and sugar alcohols have about 2 calories per gram. Sugar alcohols are low-digestible carbohydrates and are absorbed slowly and incompletely, having a smaller effect on blood glucose (sugar).

However, consuming large amounts can add up and affect both your blood glucose and calorie intake. It is generally agreed that if a food has about 5 or less grams of sugar per serving, the effect on blood glucose is minimal.

The total grams of carbohydrate on the food label include sugar and sugar alcohol. The serving size is at the top of the label. If a food contains just one sugar alcohol, then it is listed individually on the food label, but if there is more than one sugar alcohol, the label will say, “sugar alcohols”.

The following are sugar alcohols:

It may be helpful to remember the following about sugar alcohols:

1. The relationship to sugar …when reading the food label, take the number of grams of sugar alcohol and divide in half. For example, if a food label has no sugar but has 18 grams of sugar alcohol, this is actually equal to about 9 grams of sugar.
Go easy, the food still has about twice the recommended sugar per food serving. Remember, we recommended about 5 or less grams of sugar per serving. So in this case, if the food serving is “4 pieces of candy”, you may want to only have “2 pieces of candy” so that the actual sugar equivalent is closer to the recommended 5 grams. If the food label also shows sugar, this has to be counted, too.

2. The relationship to carbohydrate …if all the grams of carbohydrate come from sugar alcohol and the grams of sugar alcohol are less than 10, it can be considered a low sugar food.
If the grams of sugar alcohol are greater than 10, subtract half of the sugar alcohol grams from the total carbohydrate grams and count the remaining grams as actual carbohydrate.
For example, if the label shows 14 grams of sugar alcohol and 30 grams of total carbohydrate (14 – 7 = 7 and 30 – 7 = 23), there are 23 grams of actual carbohydrate.

3. The absorption of sugar alcohols …sugar alcohols are absorbed slowly and incompletely and large amounts may cause abdominal swelling, bloating, or diarrhea.

Hopefully, this will be helpful as you navigate the food labels!