The recent Lancet study reporting association of increased risk of mortality and low carb diets has stirred up something of a storm.  Publication was swiftly followed by a series of headline-grabbing misinterpretations, coupled with endless pictures of highly refined highly processed carbohydrate based foods – otherwise known as ‘bad carbs’.

Somewhere amidst all the hype surrounding what’s good and what’s not, we risk missing the point entirely.  The question shouldn’t be about whether carbs collectively are good or bad.  The real question should be about whether we are consuming good quality carbs (real whole foods) and avoiding bad quality carbs (fake refined foods).

The Lancet study looked at carbs as a whole – lumping consumption of highly processed and refined bread, pasta, cakes and biscuits in the same category as healthy wholegrains, vegetables and fruits.  In which case, how do we know what those in the ‘low carb’ group were really eating?  How do we know they weren’t all eating relatively low quantities of vegetables, fruits and wholegrains, and relatively high quantities of commercially-produced bread, pasta, cakes and biscuits?  What’s more, the ‘low carb’ groups that provided the analysis for plant versus animal protein outcomes comprised carbohydrate at 38% of total daily energy intake.  This is not low carb.  That aside, observational studies such as this are subject to distortion by unexamined confounding factors.  This means we can’t draw any real conclusions about cause and effect.

The problem with media portrayal of nutrition studies is that they tend to encourage avoidance of entire food groups, regardless of quality.  Focusing on food groups misses the point entirely.  We don’t eat macronutrients.  We eat food.  Imagine a restaurant menu offering only varying quantities of carbohydrate, protein and fat.  Not exactly appetising is it?  Food is so much more than just the sum of its parts.  Food is meant to be savoured and enjoyed, in its natural form.

The food frenzy of recent decades has been the low fat diet, a movement that gained momentum in the early eighties when adopted by UK national dietary guidelines.  The British media were quick to jump on the bandwagon, along with the food industry.  This has led to increased consumption of highly processed and refined, ‘low fat’ foods, despite no original supporting RCT evidence demonstrating reduced risk of all-cause mortality from reduced fat in the diet [1].  We’re now facing an epidemic of diabetes and obesity.  And so manifests the new ‘enemy’: carbs. Which includes highly processed and refined carbs (the real enemy).

The real problem


Western diets have become increasingly energy dense and nutrient deplete, despite delicious nutritious food being more available to us than ever before.

What’s changed?

The answer has to do with choice.  We now have more choice than ever before.  But more choice leaves us open to poor choice.  With this almost limitless choice on offer, it’s more important than ever that we receive proper education about what constitutes good food, be wary of mass media scaremongering and food industry marketing, and make sensible, healthful, whole food choices.

Do we benefit from low carb?

Our bodies need energy in order to survive.  But more than that, in order to thrive, we need good quality whole foods that contain plenty of vitamins and minerals.  We gain our energy from nutrients in food, in varying quantities, depending on our individual and cultural eating habits.  Nutrients are comprised of macronutrients (carbohydrate, protein, fat) and micronutrients (vitamins and minerals).  It is the combination of high quality macro and micro nutrients, derived from whole foods, acting in synergy, that allows us to perform at our best, both mentally and physically.  It’s not about demonizing food groups, but enjoying good quality and delicious real whole foods.

What are carbs?

Carbohydrate is a macronutrient.  This means it’s a source of energy, typically consumed in gram rather than milligram quantities.  Other macronutrients are protein and fat.  Carbohydrate is composed of three key elements, in varying structural forms.

At their simplest, carbohydrates consist of three single units (glucose, fructose, galactose), which combine in various combinations of pairs to produce what we know as sugars (sucrose, maltose, lactose), and in varying repetitions of single and branched chains to produce what we know as oligosaccharides (found in vegetables such as artichoke, chicory, asparagus, onion, & leeks) and polysaccharides (found in all other vegetables, fruits, and grains).  In their natural form, good quality carbohydrates are a valuable source of energy, as well as providing us with essential health-boosting micronutrients, phytochemicals, and fibre.


Carbohydrate is broken down into glucose in the body, which in turn provides our brain and red blood cells with essential energy.  Good quality carbs come from real, whole, non-refined foods, including leafy vegetables, root vegetables, fruits, nuts, seeds, legumes, and wholegrains.  Poor quality carbs come from highly processed and refined foods, such as bread, pasta, white rice, cereals, cakes and biscuits.  Good quality real whole foods naturally have a low to medium carb content (<20g/100g), whereas poor quality refined packaged foods usually have a high carb content (>25g/100g).

What are wholegrains?

The term wholegrain means the original grains retain their inner and outer parts – the germ and the bran.  These contain all the goodness – fibre, vitamins, minerals, and antioxidants.  Fibre aids digestive transit and can help lower cholesterol.  Vitamins and minerals support numerous metabolic and physiological functions.  Antioxidants defend against harmful molecules called free radicals, which can damage the cells of our body.

  • Wholegrains include whole oats, brown rice, quinoa, millet, cracked wheat, buckwheat, barley and rye. Most commercially produced breads, even those marketed as ‘wholemeal’ or ‘wholegrain’, do not count as wholegrain.
  • Consuming healthy wholegrains may lead to numerfous long term health benefits, including reduced risk of heart disease, stroke [2], colorectal cancer [3], cardiovascular disease, cancer, and all-cause mortality [4][5][6] .
  • Refined carbohydrates, such as bread, white rice and pasta, are not wholegrains.  They contain only the middle endosperm layer of the grain. This is devoid of all the goodness in the grain – the micronutrients, antioxidants and fibre.
  • Refined carbohydrates also tend to have a higher glycaemic index, which means they produce higher amounts of glucose in the bloodstream shortly after eating.

Why is good carb more important than low carb?

Poor quality carbs provide us with a whole lot of glucose and not much else.  But good quality real food sources of carbs give us so much more than this.  Good quality carbs also provide a number of essential health boosting components, micronutrients and phytochemicals, including:

Vitamin C:

  • Important for collagen synthesis, wound healing, immune function, iron absorption, and provision of antioxidant activity.

B Vitamins:

  • Collectively important for the production of DNA, metabolism of carbohydrates, fats and proteins, production of ATP (energy), synthesis of neurotransmitters, synthesis of red blood cells, and normal cell division.
  • Vitamin B9 (Folic acid) helps prevent neural tube defects.

Carotenoids, including: 

  • Beta carotene: Precursor to Vitamin A, important for vision, immune function, skin health and gene transcription.
  • Lutein: May help slow progression of age related macular degeneration (ARMD).


  • Soluble fibre feeds healthy gut bacteria, helps maintain gut transit and prevent constipation.
  • Regular consumption of fibre rich foods may also help with weight loss, reducing cholesterol, and lowering colorectal cancer risk.

So cutting out or drastically reducing healthy carbohydrates risks missing out a wide variety of important dietary components vital for maintaining long term health and well-being.

What should we be eating?

If you are unsure, seek help from a qualified nutrition professional. One of the best dietary guides I have seen comes from the British Association for Nutrition and Lifestyle Medicine (BANT).  The guide highlights the importance of healthy whole food sources of carbohydrate, among other lifestyle factors conducive to achieving and maintaining good health.

BANT-dietary-guidelines-including low carb options

1. Eat plenty of leafy / non starchy vegetables and some fruit

  • Aim for at least 5 portions of different vegetables per day and 1-3 portions of fruit. A portion of vegetables equates to about 3 heaped tablespoons.  For fruit, a portion is a single piece of fruit / handful of berries.  Avoid juices and smoothies – they tend to be a concentrated source of glucose and may lack the health benefits of added fibre found in intact whole fruits.
  • Eating a variety of vegetables has countless benefits. They contain plenty of fibre, which in its soluble form can lower cholesterol and blood glucose, as well as aiding digestive transit.  They are also a valuable source of essential vitamins and minerals, vital for optimum physiological function and prevention of some deficiency associated diseases.
  • There are so many delicious fruits and vegetables available to us. Try to aim for a variety of colours.

2. Replace bread, pasta & white rice with wholegrains and root vegetables

starchy carbs_wholegrains

3. Include dairy or alternatives as low carb sources of calcium and protein.

low carb dietary sources of calcium - cheese eggs milk
  • Calcium is essential for teeth and bone health and plays a role in muscle and nervous system function.
  • Non-dairy sources of calcium include leafy green vegetables, tinned fish (bones included), seaweed, almonds, and eggs.
  • Dairy sources of calcium include whole milk, whole yoghurt, and natural cheese.

4. Eat healthy fats, naturally low carb

low carb healthy fats
  • Fats must be consumed in the diet for provision of essential fatty acids, such as omega-3 and omega-6, which cannot be made by the body.
  • It’s a myth that fats are unhealthy. Consumed in their natural form as part of a balanced diet, fats are healthful, nutritious and tasty.  Fatty acids are vital not only as a valuable source of energy, but for insulation, hormone synthesis, cell membrane integrity, and facilitating absorption of fat soluble vitamins.  Fat soluble vitamins are essential for numerous physiological functions, including vision, immunity, antioxidant capacity, blood clotting, bone health and cell growth.
  • Aim to include plenty of omega 3 sources in your diet (including oily fish, walnuts, flaxseed, chia seeds, and cod liver oil).

Low carb – take home message

Our bodies thrive on real whole foods, eaten in balance and in moderation.  Our bodies do not thrive on fake refined foods, of any macronutrient group.  Not only is a real whole food diet more likely to lean towards being low carb, it will also provide essential nutrients for health and optimum function.  A low carb diet full of refined processed foods will not.  This may not be the attention-grabbing stuff of front page news, but it’s certainly a message we could all do with hearing a little more often.

Author: Dr Rebecca Healey