Treatment without prevention is simply unsustainable.”
– Bill Gates

Nutrition: Carbohydrates


See also:

Nutrition and Supplements

Nutrition: Amino Acids

Diet & Dopamine

Diet & Depression






Definitions and Terms Related to Pain

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Carbohydrates are one of the 3 main food groups other than proteins and fats. Carbohydrates are classified as “simple” (sugars) or “complex” (starches). Simple sugars are smaller molecules, consisting of monosaccharides and disaccharides. There are 3 major monosaccharide (one unit) sugars: glucose, fructose and galactose.  Monosaccharides are the building blocks of disaccharides (two unit sugars). There are 3 major discaccharides: sucrose, lactose and maltose.  Starches are multiple unit carbohydrates made up of many monosaccharids and disaccharides.


Functions of Carbohydrates

Our bodies cannot function without carbohydrates (carbs). Carbohydrates are the main source of energy for metabolism throughout the body and especially the brain which relies solely on carbohydrates for its metabolism.. It is generally recommended that more than half of our calories should be come in the form of carbs. Some carbs are used immediately for cellular processes and muscle activity, while excess carbs are stored in the form of glycogen, a starch manufactured in the liver and muscle. Other excess carbs are converted into fat and are stored in fat cells.

Glycemic Index

The glycemic index of a carbohydrate refers to the impact of different carbohydrate-rich foods and fluids on blood leels of glucose and insulin.  The glycemic index ranks foods from 0 to 100 with values less than 30 to 40 being considered ‘low glycemic’, 40 to 70 ‘moderate glycemic’ and anything greater than 70 considered ‘high glycemic’.  Low glycemic index foods raise blood glucose and insulin levels more slowly than higher glycemic index foods.

Glycemic index can also be influenced by other factors.  Foods consisting of larger particles overall take longer to fully digest so usually have lower glycemic index values.  As an example, instant oatmeal is more finely ground so it will cook faster compared to regular oatmeal but it will also be digested and absorbed faster so it will have a higher glycemic index.  The higher the fiber content of a food, the slower digestion and lower glycemic index.   Soluble fibers (e.g., oats, barley, beans) take longer to digest compared to insoluble fibers that merely pass through the digestive system.  Like high fiber content, high fat content slows digestive time and results in lower glycemic index values of the foods or meals consumed.

Health Impact of Glycemic Index

Research suggests that the magnitude of increase of glucose levels, the rate at which this increase in glucose occurs and the overall insulin response to food ingestion, all increase the risk for obesity, cardiovascular disease and high blood pressure. Thus high glycemic foods are generally considered less healthy. Another problem with high glycemic index foods is they tend to be high in fat and calorics and also taste very good so they tend to be over-eaten.

For individuals wishing to lose weight, low to moderate glycemic index foods as well as a lower overall intake of carbohydrates are recommended to reduce the release of insulin which drives carbohydrates into cells for conversion to fat.

Low to moderate glycemic index foods are also recommended as part of the dopamine diet, recommended to maintain or increase dopamine levels in the brain. The dopamine diet is recommended for individuals with severe stress, chronic pain and/or reward deficiency syndrome (See Reward Deficiency Syndrome).

Sse Dopamine Diet


Exercise and Performance

Alternatively, individuals focused upon performance should consider high-glycemic foods at predetermined times.  Higher glycemic index foods are advised to eat just prior exercise because of its ability to rapidly digest and provide valuable glucose for muscle fuel.  High glycemic index foods are also recommended after an exhaustive exercise session to rapidly replace depleted fuel stores, especially if another round of exercise will begin within a few hours, because they have been shown to promote a faster rebuilding of lost muscle glycogen.

Glycemic Load

The glycemic index of foods tells only part of the story because it does not indicate how much carbohydrate is in an individual serving.  A separate value called “glycemic load” gives a more accurate portrayal of a food’s impact on blood sugar because it takes into account serving size. The glycemic load is determined by multiplying the grams of a carbohydrate in a serving by the glycemic index, then dividing by 100.

A glycemic load of 10 or below is considered low; 20 or above is considered high. Watermelon, for example, has a high glycemic index (80). But a serving of watermelon has so little carbohydrate (6 grams) that its glycemic load is only 5.

 See Glycemic Index & Glycemic Load Index For 100+ Foods



Types of Carbohydrates

Simple Sugars – Monosaccharides


Glucose is nutritonally the most important sugar because it is the body’s preferred energy source, especially the brain. Most  carbohydrates foods are processed by the body into glucose which is either used immediately for energy or stored in the liver or muscle for later use. Glucose is stored in the form of glycogen, a polysaccharide made up of many glucose units. Glucose circulates in the blood (“blood sugar”) and the levels are maintained in a normal range.


When glucose levels get too low, glycogen stores in the liver are broken down into glucose and released into the blood. If the glycogen stores in the liver become depleted, glucose can be manufactured by the body from muscle protein or stored fat, a process called gluconeogenesis. When blood glucose levels get too high, insulin is released from the pancreas which functions to drive glucose into cells for storage as glycogen or conversion to fat.


Glucose is 70-80% as sweet as sucrose. The glycemic index of 25 grams of glucose is 100.



Fructose is the sugar found naturally in many fruits and vegetables. It is widely used commercially, added to various beverages such as soda and other foods and condiments including foods not usually thought of as sweet such as salad dressings, ketchup and many other items. Fructose is very different from other sugars because it has a different metabolic pathway and is not a preferred energy source for muscles or the brain. Fructose is only metabolized in the liver and is more lipogenic, or fat-producing, than glucose.

Unlike glucose, fructose does not stimulate release of insulin or stimulate production of leptin, a key hormone for regulating energy intake and expenditure. These properties of fructose raise concerns about chronically high intakes of dietary fructose because it appears to behave more like fat in the body than other carbohydrates. High dietary fructose intake may induce insulin resistance, hyperinsulinemia and hypertriglyceridemia and could contribute to risk for obesity and diabetes. However, a moderate dose (≤ 50 g/day) of added dietary fructose has no detrimental effect on fasting and triglycerides, glucose control, insulin resistance or hypertension.


Beneficial effects of moderate amounts of fructose have been demonstrated:

1. Fructose seems to decrease appetite when ingested before a meal,

2. Fructose seems to lower plasma glucose responses to ingested glucose,

3. While pre-exercise and exercise ingestion of glucose and fructose are of equal values in delaying exercise-induced exhaustion, ingestion of fructose before and during the exercise provide a more constant supply of available glucose to the exercising muscle.

4. Indirect benefits of eating fructose occur due to the fact that most fructos food sources, frutis and vegetables, also have healthful fiber, antioxidants and NRF2 activators.

Fructose is 120-190% sweeter than sucrose. The glycemic index of 25 grams of fructose is 11.

Fructose Content of Different Fruits

High Fructose Corn Syrup (HFCS)

There is some confusion about the difference between fructose and high fructose corn syrup (HFCS). HFCS is produced by enzymatically converting corn starch to glucose, and then adding a second enzyme that converts part of the glucose to fructose. The HFCS usually used in food production is about 55% fructose and 45% glucose. HFCS is more similar to sucrose (50% fructose and 50% glucose) than to pure fructose.

Fructose and Gout

Research also shows that that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men and women. Furthermore, fructose rich fruits and fruit juices may also increase the risk. Diet soft drinks were not associated with the risk of gout.

Fructose and Increased Risk for Cardiovascular Disease

Recently there has been speculation that fructose, especially HFCS, is a causative factor in obesity and/or diabetes. Given the fact that fructose has been an important part of the human diet from prehistoric times, it seems unlikely that fructose alone is the problem, rather overconsumption of carbohydrates is far more likely to be the problem. Of particular concern is the overwhelming use by the food industry of high fructose corn syrup (HFCS). In fact, it is difficult to find commercial food products that don’t have HFCS listed as an ingredient.


What is clear, however, is that too much added sugar of any kind — not just high-fructose corn syrup — can contribute unneeded calories that are linked to health problems, such as weight gain, type 2 diabetes, metabolic syndrome, high triglyceride levels and risk of heart disease. More studies are needed, but current medical literature does not indicate that a normal consumption of fructose (approximately 50–60 g/day – Fructose Content of Different Fruits) increases the risk of atherosclerosis, type 2 diabetes, or obesity more than consumption of other sugars. However, a high intake of fructose may have negative health effects by increasing triglycerides and low density lipids (LDLs), leading to increased systemic inflammation.



The American Heart Association recommends that most women get no more than 100 calories a day of added sugar from any source, and that most men get no more than 150 calories a day of added sugar. That’s about 6 teaspoons of added sugar for women and 9 teaspoons for men. A 12-ounce can of Coca Cola cotains 140 calories, and the same size Pepsi has 150 calories. The World Health Organization has recommended that people limit their consumption of added sugars to 10% of their caloric intake, but typical consumption of these empty calories in the United States is nearly twice that amount.


In the human body, most ingested galactose is converted to glucose. The most common food source of galactose is milk and dairy products, formed from the metabolism of lactose.


Galactose is 30% as sweet as sucrose. The glycemic index of galactose is uncertain but less than glucose.

Simple Sugars – Disaccharides


Sucrose, commonly known as table sugar, is the disaccharide glucose-fructose and is usually derived from sugar cane or sugar beets. When ingested, sucrose is broken down into glucose and fructose.


Sucrose is more sweet than glucose but less sweet than fructose. The glycemic index of 25 grams of sucrose is 58-84.



Lactose, the disaccharide glucose-galactose, is the sugar found in milk and milk products. When ingested, lactose is broken down to glucose and galactose which is then converted to glucose. Lactose is not as sweet as glucose, fructose or sucrose. It’s dietary significance is largely related to the common condition of “lactose intolerance,” in which people are deficient in the gut enzyme lactase, which metabolizes lactose. Elevated levels of undigested lactose in the gut gives rise to symptoms of bloating, abdominal cramps and diarrhea.


Lactose is 20% as sweet as sucrose. The glycemic index of 25 grams of lactose is 48.



Maltose, the disaccharide glucose-glucose, is the sugar found in sweet potatoes and grains such as barley, brown rice and corn. Maltose is commercially manufactured into barley, corn and rice syrmps and may be found in beers and other malt beverages and ciders.


Maltose is 50% as sweet as sucrose. The glycemic index of 25 grams of maltose is 55.


Complex Carbohydrates

Starches are complex carbohydrate found in flours and grains, including bread, pasta and rice. They take longer to digest and absorb into the blood than simple sugars  so the rise is blood sugar is slower and the glycemic index is lower. However, the more refined and processed the grains are, the more rapid they are digested and absorbed. Whole grain foods also contain more fiber than processed grain and fiber further slows absorption so are perceived as more filling than simple sugars.



This is my favorite online resource for nutritional information. It provides excellent breakdowns of the nutrional value of natural foods, raw and cooked, as well as commercial food products. It offers a web-based app that allows you to track and analyze your diet and monitor your exercise. It has a wealth of educational information on topics from food additives, glycemic index, food processing, individual nutrients and pretty much anything of interest to the person motivated to learn more about diet and nutrition. There are even recipes!   ( provides easy access to vetted food and nutrition information from across the federal government. It serves as a gateway to reliable information on nutrition, healthy eating, physical activity, and food safety for consumers.


Providing science-based dietary guidance is critical to enhance the public’s ability to make healthy choices in the effort to reduce obesity and other food related diseases. Since dietary needs change throughout the lifespan, specialized nutrition information is provided about infants, children, teens, adult women and men, and seniors.


Users can find practical information on healthy eating, dietary supplements, fitness and how to keep food safe. The site is kept fresh with the latest news and features links to interesting sites.


Evidence based information about nutrient effects and side effects.

“Dopamine for Dinner”

by Joan Borsten, 2014
Available online at Kindle subscriber: free;  Kindle book: $9.95  Paperback: $149.00


“Dopamine for Dinner,” is the first Malibu Beach Recovery Diet Cookbook, based on their famous low-glycemic diet. The recipes developed by four accomplished chefs are both pleasant eating as well as healthy. Based on the use of low glycemic index foods, the recipes emphasize nutritious eating in a manner that promotes maintaining high brain levels of dopamine and serotonin as a means of supporting healthy brain chemistry.




Carbohydrates – Overviews

  1. Carbohydrates: MedlinePlus
  2. Total_Carbohydrate
  3. Glycemic Index & Glycemic Load Index For 100+ Foods


Carbohydrates – Fructose

  1. Health implications of fructose consumption – A review of recent data – 2010
  2. Fructose Metabolism and Relation to Atherosclerosis, Type 2 Diabetes, and Obesity – 2015
  3. Consumption of Honey, Sucrose, and High-Fructose Corn Syrup Produces Similar Metabolic Effects in Glucose Tolerant and Intolerant Individuals – 2015
  4. Energy and Fructose From Beverages Sweetened With Sugar or High-Fructose Corn Syrup Pose a Health Risk for Some People – 2013
  5. Fructose – “It’s “Alcohol Without the Buzz” -2013


Carbohydrates – Fructose and Gout

  1. Soft drinks, fructose consumption, and the risk of gout in men – prospective cohort study – 2008
  2. Fructose-Rich Beverages and the Risk of Gout in Women – 2010


Carbohydrates – Sugar Consumption

  1. Consumption of Honey, Sucrose, and High-Fructose Corn Syrup Produces Similar Metabolic Effects in Glucose Tolerant and Intolerant Individuals – 2015
  2. Sugar consumption, metabolic disease and obesity – The state of the controversy – 2016
  3. Resolved – There is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases – 2013
  4. Guidance for Industry. Evidence-based review system for the scientific evaluation of health claims.US Food and Drug Administration 2007



Emphasis on Education


Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.


For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.


Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.


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