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CARBS: How They Came To Be The Enemy

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outcountedRon Perry, 57, a mortgage banker in Lawrence, Kan., never counted calories, fat grams, points or anything else when it came to his diet. Until now.

For the past year, he has been keeping track of the carbohydrates in everything he eats, from vegetables to low-carb cereal.

Perry, who lost 12 pounds in 12 months on the meat-lovers' Atkins diet, expects to do this the rest of his life ''because it's second nature now.'' Even the mad cow scare hasn't frightened him away from beef.

Carbohydrates, which are found in bread, rice, pasta, beans, fruits and vegetables, have taken a beating in recent years. Once the darling of nutritionists and marathon runners, they now are being placed on some dieters' no-no lists.

How did carbs come to such a dismal state? And are they really the enemy, or are they just misunderstood?

The trend toward counting and limiting carbohydrates began about 30 years ago, when the late cardiologist Robert Atkins came up with his diet that pushed meat, pork, fish, butter and other high-fat foods and drastically slashed sweets, potatoes, pasta, starchy vegetables and many fruits.

Despite the skepticism of nutritionists, the Atkins diet from the start had a core group of dedicated followers who swore it succeeded where traditional diets failed. And recently, after several studies suggested that the regimen might work for some dieters without raising their overall cholesterol and even lowering some other heart-disease risk factors, the diet has gained popularity along with South Beach and other carb-limiting diets.

Millions of people have either tried a low-carb diet or are on one now. Many more, even those who are not following the diets, are cutting carbs.

The marketplace is responding: More than 600 low-carb products, from protein bars to breads and beer, were introduced in 2003, according to Productscan Online, a market research company in Naples, N.Y.

Still, carb-limiting diets are the subject of heated debate among weight-loss researchers who don't agree on whether this is a realistic or healthy way to manage weight over the long term.

Critics say the success experienced by low-carb dieters comes from eating fewer calories, not limiting carbs. They say people often don't stick with these programs, because a life devoid of pasta and potatoes creates diet boredom. In fact, a group of folks who have been dubbed ''low-carb refugees'' have found this to be the case.

No large, long-term study has documented all the health consequences of the programs, but new government-sponsored research is examining the diet's effect on weight, arteries, cholesterol, body composition, bones and kidneys.

''A lot of the questions about these diets remain unanswered,'' says Gary Foster, lead researcher of the new study and clinical director of the Weight and Eating Disorders Program at the University of Pennsylvania School of Medicine. ''In the short term (up to one year), there don't seem to be any ill effects, but more studies are needed before we make public health recommendations.''

What are carbs, anyway?

Carbohydrates are the starches, fiber and sugars in foods. All plant foods such as fruits, vegetables, whole grains and beans have carbs, which are converted by the body into blood sugar, mostly glucose, and used for fuel. If people eat too much of them, they get stored as fat, just as too much fat or protein does.

But ''not all carbs are the same, any more than all fats are the same,'' says Keith Ayoob, a spokesman for the American Dietetic Association. There are basically two types:

* Complex carbohydrates are generally considered by nutritionists to be ''good carbs.'' They are found in whole grains, beans and vegetables. These foods are often rich in fiber, vitamins, minerals and other nutrients and lower the risk of cancer and other diseases. Most major health groups and dietitians say Americans should eat more of these foods.

Complex carbs that have been refined, such as white flour and white rice, have most of the fiber taken out of them and are not considered as nutritious, Ayoob says.

* Simple carbohydrates, often considered the ''not-so-good carbs,'' are found in sugar, syrup, milk, fruits and some vegetables. Table sugar and syrups such as high-fructose corn syrup don't pack any nutrient punch, Ayoob says. However, some simple sugars, like those found in fruits and vegetables, keep really good company, because the produce has fiber and other nutrients, he says.

Many processed foods such as pastries, cookies, cake and candy contain a lot of sugar, refined carbs and fat, Ayoob says. They often are very low in nutrients and high in calories, which is why nutritionists advise limiting them. Bill Phillips, author of Eating for Life, calls them ''crummy carbohydrates.''

The Atkins program and the South Beach diet eliminate most processed and simple carbs.

Atkins dieters also avoid some complex carb foods like whole-grain bread and many starchy vegetables, especially in the initial weight-loss phase, which is called the induction phase. During that phase, dieters eat only about 20 grams of carbs a day, which usually amounts to a salad and a vegetable along with their meat. The number of carbs allowed goes up during the diet's weight-loss and maintenance phases.

South Beach dieters don't officially count carbs, but during the first two weeks they stop eating most of them except for vegetables. They also eat lean meats, fish, cheese and fats like olive oil.

After the first two weeks on the South Beach diet, dieters are encouraged to start eating more ''good carbs,'' such as beans, 100% whole-grain bread, oatmeal and fruits, says Marie Almon, a nutritionist in Arthur Agatston's cardiology practice in Miami Beach.

Sounds simple enough, but here's where it gets more complex.

Atkins dieters are advised to avoid some foods generally considered ''good carbs,'' including potatoes, sweet potatoes, pasta, rice and bananas. That's because these foods rate high on a scale called the glycemic index, a system devised by scientists to tell dieters how fast glucose enters the bloodstream after food is eaten.

Atkins' nutritionists and others say foods high on this scale cause blood sugar and the hormone insulin to rise and fall sharply. They say that this isn't healthy and that it prompts more hunger three or four hours later.

Searching for middle ground

Most high-fiber foods, including lots of vegetables and many fruits, are low to moderate on the glycemic index scale and are acceptable on the Atkins diet, especially in the later phases, because they don't cause the spike in blood sugar, says Colette Heimowitz, a nutritionist with the Atkins companies.

Many nutritionists don't buy the glycemic index theory. ''People tend to eat foods in combination with each other, which changes the glycemic index of the foods,'' Ayoob says. ''There are plenty of people on high-carbohydrate diets who are quite normal weights -- like those living in Asia.

''I have no problem with people eating less white flour and white rice, but cutting out potatoes, carrots and whole wheat bread isn't necessary,'' he says.

Ayoob is part of the camp that says dieters who lose weight on Atkins do so because they cut calories, not because there is anything special about carbs.

He says the carb-cutting craze is sure to wane. ''Just like we went to extreme with eating too many carbs (during the low-fat days), now we're going to the other extreme with low carbs.

''I hope when all this is said and done, we'll end up somewhere in the middle.''

But Heimowitz says the Atkins diet is here to stay. ''It's already passed the test of time, being embraced by the consumers for the last 30 years.''

It works for Perry of Lawrence, Kan., and he plans to stick with it the rest of his life. He says he feels better than ever. He doesn't eat candy bars and other junk food anymore, although he does sometimes have a low-carb protein bar.

Some nutritionists say one good thing the carb-cutting craze has accomplished is it is making people more aware of the junk foods and empty calories in their diets.

People are developing a ''carbohydrate awareness and a respect for carbohydrates,'' Heimowitz says. ''If all they do is cut out some bread, sugar, white pasta and sodas, that's a wonderful thing.''

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