BF Basics: Carb Confusion (Part Five)

Making it all work on YOUR plan



One of the most common questions I see new post-ops ask is “how many carbs a day should I eat?”

The tricky thing about this is that it’s not a “one size fits all” question. The number of carbs YOU should eat a day and the number I should eat can (and probably will) be completely different.

What I would like to point out to you, my dear fellow post-ops, is that while protein is of the highest priority in our food plans, carbs are important too. You should not attempt to cut carbs out of your life post-op (nor do I even think that’s humanly possible).

As you get further post-op, and your pouch capacities expand, you should integrate carbs into your plan for the benefit of the energy, satiety and fiber they give.

But for those who absolutely MUST have some parameters, I will say this. Many post-ops who are really into planning their food in a food journal usually pay more attention to the total percentage of their daily calories that come from carbs than how many grams they eat.

(“Huh?”)

Let me explain.

A carbohydrate has 4 calories. So if you eat a meal and that meal is 300 calories with 20g of carbs, 80 of those calories, or 26%, were from carbs. Looking at your day’s calories, if you take in 1000 calories and you ate 100g of carbs, 400 calories, or 40% of your daily calories, came from carbs.

There are various schools of thought on the ideal balance of protein:carbs:fat. The most common one I’ve heard is 40/35/25 (protein/carbs/fat). Most online food journals have a pie chart function that easily tells you how your daily calories are distributed.

Paying attention to this, of course, involves meal planning, which some seem to think is a dirty phrase. I won’t argue for or against here, but you should know that it is very easy to consume too much of anything if you aren’t paying attention. Knowledge is power and having some conception of the make-up of your daily caloric intake can help you along the way.

The one thing I find is missing from many post-op plans I see, however, is balance. If the goal of our surgeries is to eventually eat like a healthy human, we need balance. Your meals should be composed of protein, carbohydrates and fat — preferably the most beneficial and appropriate kinds of each that you have access to.

But different meals require different nutrient balances. As I stated before, before a workout you need carbs to sustain you. Other times you need protein to keep you sated until your next meal. You always need fiber. It can be a bit overwhelming. So here are some tips:

For the most part, choose more complex carbohydrates like vegetables and fruits. And, as much as you are able, eat them in their most natural form. Canned/frozen fruits and veggies aren’t bad, but the fresher the better!

When considering starches, choose whole grains with a decent amount of fiber per serving. Anything with more than 2g of fiber per serving is usually a decent choice, however, if you have to take 50g of total carbs to get that 2g of fiber? You might want to re-think your choices. I’ve attached a list of my favorite starch products at the end of this post to give you an idea of some better options.

In general, always eat a carb with protein. Post-ops suffering from reactive hypoglycemia know this is important in keeping blood sugar stable. In general, however, the practice will keep you from becoming hungry again too soon.

It’s up to you how your carbs are distributed throughout your day, but think about how your day will go when planning your food. If you have a family dinner at an Italian restaurant, you might want to go lighter on your carb consumption earlier in the day. Small decisions like this are what success is made of!

And as promised, here is a list of my preferred “starchy carbs.” There really are some good products on the market that give you a good balance of carbs and fiber. For your convenience I’ve broken this out into things you can find or request in your local store and things you need to order from the internet.

Stuff you can probably find at your local store:

• Ak-Mak whole grain crackers
• Wasa whole grain crisps
• Flatout Multi-Grain wraps
• Spelt cakes (like a rice cake, except it's whole grain)
• And of course...Fiber One original cereal!

Stuff you'll probably need to get off the internet:

• P-28 Protein Bread
• Atkins Baking Mix
• Carbquik Baking Mix
• Kay's Naturals Protein Pretzels

Well…that about wraps up this little series. It is by no means exhaustive. There’s plenty more to know about carbs and I empower you to research! If you have any questions, hit us up. You know we’re always happy to help!

<< Part Four: Carbs & Fiber: YOU do the math

Now that you've read the enire series, you can download it as a pdf for free (Adobe Acrobat required) by clicking here!

And as a reminder, if you enjoyed this series and feel so inclined, I'd love to count you among my supporters in my goal to walk the Susan G. Komen 3-Day for the Cure. My widget is in the right hand navigation bar. If not, no worries. We're still cool!

BF Basics: Carb Confusion (Part Four)

Carbs and Fiber: YOU do the math...



You ever notice we WLS folk have NO problem talking about poo? Seriously. It’s an acceptable topic of conversation no matter where you are or what you are doing. So long as you are talking to other post-ops that is. It can (and has been) even discussed around the dinner table.

Why are we so obsessed with poo? Mainly because it is sort of a luxury to be “regular” post-op. I am proud to say that I am and I credit that mainly to the fact that I make sure to get adequate fiber every day.

Dietary Fiber
This is the term you’ll see on food packages. But what is Fiber? Again, we turn to our friends at Wikipedia:

“Dietary fiber or Dietary fibre or sometimes roughage is the indigestible portion of plant foods having two main components:

• soluble (prebiotic, viscous) fiber that is readily fermented in the colon into gases and physiologically active byproducts, and
•  insoluble fiber that is metabolically inert, absorbing water throughout the digestive system and easing defecation.”

Here’s what’s important to you. Dietary fiber is found in carbohydrates. Since our bodies cannot digest dietary fiber, it cannot be turned into glucose or glycogen or converted into fat.

Because of all this, there is a piece of terminology that I am sure you all are familiar with: net carbs. When looking at a food label, you’ll see the total amount of carbohydrates. Then, under that, there’s the amount of fiber, sugar, etc. The net carbs are the total number of carbohydrates grams minus the total number of dietary fiber grams. So if a food has 20g of total carbohydrates and 2g of dietary fiber, the net carbs would be 18g of carbohydrates.

The American Dietary Association recommends we get at least 25g of fiber every day. Why? Look at bullet point #2 above. Fiber absorbs water in the digestive system and sort of “scrubs out” the intestines, carrying out waste (poo). You like to poo? Eat your fiber!

Now, in order to get your fiber you have to take in carbohydrates, this goes without saying. The trick, then, is choosing the right foods to get a good balance of carbohydrates and other nutrients. Fresh fruits and veggies (when you are cleared for them) are obviously a good choice. And there are many grain products that give good fiber (100% whole wheat bread, quinoa, etc.). Beans are also an excellent source of fiber (hence the popular school rhyme. You know the one…”Beans, beans…good for the heart. The more you eat the more you…” well you get the point.)

Fiber Supplements


Because of the reduced amount of food we can eat post-op, it might be necessary for some of us to use fiber supplements (much in the way that we use protein supplements) to get some of our fiber. I just want to highlight that there’s nothing wrong with that (or nothing that I could find wrong with it). Fiber supplements tend to be low calorie and if they have any more carbs than the fiber they give, it’s usually very little.

Having said that, as you get further out from surgery, the other benefits of fiber (satiety and regulation of blood sugar) may prompt you to find more ways to get fiber from your food.
I’ve said it several times before but it bears repeating: you cannot get fiber without consuming carbohydrates. You NEED fiber for several purposes (some that I’ve outlined and others that I have not). Therefore, it stands to reason that you HAVE to eat some carbohydrates (and preferably ones that are good sources of fiber) in order to maintain the proper intake of…fiber!

The food industry and whole grain products

Food companies are notorious for trying to confuse us with packaging. There are some phrases that are meant to make you think you are getting a lot of fiber when may not be.

For instance, when a package says “5g of whole grains per serving.” That isn’t the same as fiber. That 5g of whole grains might only have 2g of fiber. While it’s great that the product is made with whole grains, you really do need to check the nutrition label to get a complete picture of what you are eating.

Also beware of bread packaging. Some loaves of bread will simply say “wheat bread” while some say “100% whole wheat.” Some might even say “enriched wheat bread.” These have very distinct meanings and those meanings do impact you.

So what does this all mean and how can you tell what you’re getting?

If you see a package that simply says “wheat bread” or “enriched wheat bread,” go straight to the nutrition information and look at the ingredients list. If whole wheat flour is not listed, what you probably have is white bread with some wheat germ added for the lovely brown color.

If a package says 100% whole wheat bread, you are probably getting bread that really was made with whole wheat flour, but it’s good to check the label just to make sure.

This is a lot of information, we know. But it’s important! So about fiber, here’s the breakdown of what you should know:

• Dietary fiber can only be found in carbohydrates, therefore you have to eat carbohydrates to get them
• Our bodies can’t digest fiber and can’t convert them into glucose or glycogen or fat for energy storage
• Our bodies CAN use dietary fiber to clean out our digestive systems and for excretion (poo-ing)
• Because dietary fiber can’t be digested, the amount of dietary fiber in food does not count toward the net amount of carbohydrates in the food we eat
• The American Dietary Association recommends healthy people get at least 25g of fiber a day for good health
• Vegetables, whole grains and beans are all excellent sources of fiber
• Beware the packaging on bread products that say whole wheat. Always look at the ingredients to make sure that whole wheat flour is used.

 Part Three: A Time for Every Carb

BF Basics: Carb Confusion (Part three)

A Time for Every Carb...



Let me tell you a little story about one of my first post-op experiences in the gym. I was on the treadmill. I was walking fast (or fast for me at the time). There was wind in my hair, sweat on my face and then all of a sudden…the room got very, very dim and started spinning. I felt like someone had stuck a spigot in my back and drained all my energy.

Thankfully, I gripped the handles of the treadmill and pulled the emergency stop plug (if this ever happens to you PLEASE do the same!). I was cold. I was shaky. I was tired. I was carb deprived.

This was in the midst of my “all carbs are evil” post-op phase (it’s really a phase…seriously!) and I hadn’t given my body the fuel it needed for sustained activity. So it gave out on me. Traitor!

The Glucose/Glycogen Factor
OBLIGATORY DISCLAIMER: this is an extremely simplified account of how your body uses carbs. For more in-depth information, I suggest independent research!

For all the non-chemists in the house...this would be the chemical structure of a glucose molecule.

Carbs are important for a variety of reasons, but especially if you are planning to get active. They provide your body with the energy you need to get going and stay going through your workout.

When the body stores carbs as an energy source, it does so by first converting it into glucose, or blood sugar. Glucose is an extremely simple sugar that’s easy to burn, making it a good source of energy for your body in a pinch.

If there is “left over” glucose that your body doesn’t need, it first stores it in your muscles and liver as a molecule called glycogen. Now when your body doesn’t need all that energy to maintain your activity levels, it turns it into body fat for longer-term storage.

But when you DO need it – mainly when you are doing exercise that sustains your heart rate an elevated level for a prolonged period of time – your body will use both glucose and glycogen to get you through. But your body only has a limited supply of the stuff readily available so when that runs out and your body is still burning calories at an elevated rate (true fact, your body continues to burn many calories even after you stop exercising), your body must turn to burning fat.

Anecdotally, I can say that I can feel when my glycogen stores run out. I can feel a temporary dip in my energy level, a feeling of weakness, maybe a little light-headedness. Then your body gets into gear and you recover. This critical moment is the point where many weight loss gurus tell you to “dig deep and find something within you to keep you going.” It is my most sincere hope that that something ends up being my Buddha belly. Just sayin…

So what does this all mean to you?



This means that if you plan to take on exercise, you should not endeavor to cut all carbs out of your life. You shouldn’t even endeavor to cut all simpler carbs out of your life.

Many exercise experts advise that before a strenuous workout, you should have a snack made up of carbohydrates and some protein. They advise against eating a lot of fiber before a workout, however (we’ll talk about fiber tomorrow). That leaves you at the simpler end of the carb continuum. Now why is that? Well, the body can’t access more complex carbs as quickly and the energy it takes your body to burn more complex carbs diverts energy you need to…you know…not DIE on the treadmill.

Now, just because you work out does NOT mean you have an open license to eat potato chips before you go to the gym. But having some yogurt with fruit in it (especially a no-sugar added and lowfat variety) is not a terrible thing. My personal favorite pre-workout snack is a banana with some peanut butter (surprise, surprise). Especially when I am doing strength training that gives me the carbs, fat and protein I need to get through the whole thing (we’ll talk about how fat factors into the equation in our next series).

...And a time for whole grains & more complex carbs

There is also a time for whole grains & more complex carbs (like vegetables), although you already knew that. It's a good idea to eat whole grains, along with some protein for snacks. Why? For newbies, the hunger is sometimes completely absent but for us "veterans" hunger between meals can be an issue. To stave it off (and prevent dips in blood sugar and other types of glorious post-op metabolism wonkiness), a good complex carb with some protein can help. Roasted soy beans are good as are fruit with yogurt or peanut butter (although note that peanut butter is primarily a source of fat with high protein content so...moderation!).

And as I said before, complex carbs contain fiber, which keeps you regular. Regularity is a blessing after surgery. I'm sure you'll all agree.

One important thing to note is that the recommended daily intake of fiber is about 25g a day for women, 30g a day for men. In order to get that much fiber you HAVE to take in a decent amount of carbs. Because our bodies can't absorb fiber, they don't count in our net carb count for the day. Simply put, there is no way to fiber but through carbs. And trust me when I say you WANT to get an adequate amount of fiber.

So…in summary, there is a time for every carb because:

• The body converts carbs into glucose that can be burned quickly for energy
• Excess glucose gets turned into glycogen that is stored in the muscles but your body can still use it if it needs it
• Excess glycogen is stored as fat. Your body burns fat when you sustain your heart rate long enough to go through your stores of glycogen
• It’s good to have a healthy carb/protein snack (not refined carbs no matter how healthy they claim to be) before a workout
• More complex carbs can keep you sated and keep your blood sugar levels sustained for longer periods of time, making them an ideal part of a good snack
• More complex carbs contain fiber, which is essential in staying regular

<< Part two: Simple vs. Complex Carbs: why it's not that simple...

BF Basics: Carb Confusion (Part two)

Simple vs. Complex: Why it's not that simple...

Most sources will tell you that there are two different kinds of carbohydrates — simple and complex. I don’t like that explanation, mainly because it sets us up with an “either/or” method of thinking that has led to some characterizing carbs as “good” (complex) versus “bad” (simple). Folks, it’s just not that black and white.

Instead let’s imagine all the carbohydrates in the world standing in straight line. One extreme end of that line would be simplest of carbs, the other would be the most complex. All carbs fall somewhere on that line. Some are more complex or simple than others. Make sense? Lovely! Moving on…

Refined Carbs

Like I said yesterday, somewhere along the way, carbs got a bad reputation. I personally blame MTV (kidding). Hence, you’ll hear a lot of people talk about “good” and “bad” carbs. I'm not generally a fan of deeming any food good or bad. It’s just food. Some choices are more beneficial than others. All have their rightful place in a well-balanced eating plan.

But, within that, there is a distinction of carbs that I think we can all agree are less beneficial than others and should be consumed in extreme moderation. That would be “refined carbs.”

Refined carbs are carbohydrates that have been largely stripped of their fiber and nutrients. They are easy to identify because they are mostly “white” carbs (yep…it’s a white thing…). White bread, white pasta, potato chips, refined sugar (the white kind that comes in the bag…yep…that’s the one). Most refined carbs have a non-refined counterpart: whole wheat bread and pasta, whole grain chips, raw sugar, etc.

I call out refined carbs for two reasons. First, because if we were going to label any carb “bad” (and I wouldn’t, but still...) they would be it. They give you a lot of calories, with packaged foods they are often prepared using less than stellar methods (frying in trans fats, with a boatload of sodium, etc.) and in return they give you very little nutrition. And because your body can easily convert refined carbs to blood sugar (see below), you get a big spike followed by an even bigger crash.

Think of refined carbs like that ex-boyfriend or girlfriend you were once so ga-ga about...they seemed like the best thing ever...but in reality they were are just no good for you! The post-op WLS patient should only consume refined carbs in extreme (meaning not very often at all) moderation.

Whole Grains and Other Complex Carbs

Increasingly, you’ll see the term “whole grain” on food packaging. But what is it?

This is one of those instances where what it sounds like is basically what it is. A whole grain utilizes all parts of the grain (the whole grain), including the bran (the hull), endosperm and wheat germ. These all have nutritional benefits. The bran is fibrous and helps keep us regular. Whole grains also contain essential nutrients that are either largely absent in their refined counterparts or, because of the removal of the other parts of the grain, our bodies (our bodies meaning any human body) don't absorb those nutrients effectively.

How the Body uses Carbs: a basic primer

Carbs are rated from the simplest of the simple to the most complex of the complex based on how fast your body can convert them into energy. The simplest carbohydrates can be quickly converted and can enter your blood system very fast, causing your blood sugar level to rise and then eventually fall again. More complex carbohydrates (ones that contain fiber, which we’ll talk about Thursday) take longer to break down and thus keep your blood sugar at a sustained level for a longer period of time.

What does this all mean to you? Well the simplest sugars will give you quick energy but when your blood sugar level quickly falls, your body will crave more carbs to get that level up again (hence the adage, “carbs beget carbs”). More complex carbs take longer to burn and don’t cause that same reaction.

Also, when we aren’t using the energy from carbohydrates, our body converts them fat and stores it. The simpler the carb, the easier it is for the body to convert the carb to fat. Now if we want to demonize anything in this process, let’s demonize body fat. Body fat is the ENEMY. We don’t want it! We don’t need it! BOOOOOO!!! HISSSSSSS!!! (That felt good.)

The Inevitable Caveat

Even with simpler carbs, the body will treat different kinds differtly. Your body doesn’t see a banana (a very simple carb among fruits) the same way it sees a piece of white bread or a snack cake.

Believe it or not, there is a use for natural simpler carbs in the body. And I'm going to tell you what that use is…tomorrow! (Red Herring! How dare she!)

So, in summary, here’s what you need to know about the simplicity and complexity of carbs:

• Try not to think of carbs as “simple vs. complex” but rather on a scale from the most simple to the most complex
• Refined carbs are foods like white bread and pasta, white sugar and some types of snack foods like potato chips and cakes
• Refined carbs should only be consumed in extreme moderation
• Simpler carbs are easiest for your body to convert to both energy and fat and they cause a rapid rise in your blood sugar level, followed by a quick lowering (or crash)
• Complex carbs give your body energy but raise your blood sugar more slowly and steadily
• The body reacts differently to natural, simpler carbs like fruits and vegetables than it does to refined carbs

Stay tuned tomorrow to learn how a banana can actually be your friend!

<< Part one: What the Hell is a Carb Anyway?

BF Basics: Carb Confusion (Part One)

So What the Hell is a Carb Anyway?



Ok, do you want the textbook definition or the practical one? Let’s start with the former. Here are the two best definitions I could find on what a carbohydrate is:

• A carbohydrate is an organic compound with the general formula Cm(H2O)n, that is, consisting only of carbon, hydrogen and oxygen, the last two in the 2:1 atom ratio. Carbohydrates can be viewed as hydrates of carbon, hence their name. (en.wikipedia.org/wiki/Carbohydrate)
• an essential structural component of living cells and source of energy for animals; includes simple sugars with small molecules as well as macromolecular substances; are classified according to the number of monosaccharide groups they contain (wordnetweb.princeton.edu/perl/webwn)

Yeah…I thought the same thing.

So in practical terms, when we speak of carbs we’re speaking of a few different types of foods, mainly:

• Starches like bread, pasta, chips, etc.
• Legumes and beans
• Vegetables
• Foods that contain natural sugars (fruit, milk)

But remember, these foods are sources of carbohydrates, not carbohydrates in and of themselves. This is an important distinction because we often demonize foods as "carbs" and overlook the other important health benefits of the food, such as vitamins, minerals and phytonutrients.

Carbs are abundant in foods and with good reason. Depending on the complexity of the carb (or, by the scientific definition, the number of monosaccharide groups they contain), your body can use carbs quickly to generate energy.

Our very first food as little humans is carb heavy. Whether you drank formula or your mother’s milk, it was mainly a source of a fairly simple carbohydrate (we’ll discuss simple vs. complex carbs tomorrow) – milk sugar. And when you began to drink cow’s milk that is also mainly a source of carbohydrates (True fact: milk has 50% more carbs than protein).

Our bodies need those carbs as “youngins” because we’re growing quickly and we need a LOT of energy to do so. While our need for carbohydrates (especially simple ones) reduces as we get older, we still need them for brain function and energy, to name a few uses.

But somewhere along the line carbs got a bad reputation, didn’t they? We became all about the Atkins diet and the South Beach diet, all campaigning for limited amounts of only complex carbohydrates.

Yet, we find that in countries whose diets center mainly on carbs like rice and fruit, there is nowhere near the level of obesity as in the United States. I’m not going to begin to theorize on that but will say that carbs alone are not the problem nor is limiting them the sole solution.

So, in summary, here’s what you need to know about what carbohydrates are:

• They are a quick and essential source of energy and cell structure
• They are found in starchy foods (like bread and pasta), legumes and beans and foods that contain natural sugars and fiber, like milk (containing lactose) , fruits (containing fructose) and vegetables
• All humans need some carbohydrates for our bodies to function normally

Tomorrow we’ll discuss simple vs. complex sugars and why that isn’t such a simple matter.