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5.5: Conditions Related to Deficient and Excessive Carbohydrate Intake

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    Healthy means being in a state that is free from disease. What we eat can help us be healthy, and we will see the nutrients in the foods we eat can increase, and in some cases decrease, the risk of getting certain diseases. Carbohydrates, which provide energy and regulate how our bodies use fat and protein, can play a pivotal role in disease development. Excess carbohydrates can contribute to becoming overweight, especially when foods with added sugars and highly processed carbohydrates are a major part of a person's diet. As discussed in Chapter 3, increasing rates of overweight malnutrition and obesity in children and adults is a major global health concern. As you will learn throughout the book, overweight and obesity are associated with diabetes and cardiovascular disease, which are two of the leading causes of death in adults ages 18 and older in the United States.1 In this section, we will discuss health concerns associated with excess carbohydrates from added sugars. We will also consider health conditions associated with carbohydrate deficiency, particularly fiber deficiency.

    Excess Carbohydrates: Added Sugars

    The Food and Nutrition Board of the Institute of Medicine (IOM) defines added sugars as “sugars and syrups that are added to foods during processing or preparation.” The IOM states, “Major sources of added sugars include soft drinks, sports drinks, cakes, cookies, pies, fruitades, fruit punch, dairy desserts, and candy.” Processed foods, even microwaveable dinners, also contain added sugars. Added sugars do not include sugars that occur naturally in whole foods (such as an apple), but do include natural sugars such as brown sugar, corn syrup, dextrose, fructose, fruit juice concentrates, maple syrup, sucrose, and raw sugar that are then added to create other foods (such as cookies). It is helpful to read the ingredients on a nutrition label to identify the types of added sugars in the foods you eat.

    As of 2020, nutrition labels on most foods will also provide the amount of added sugars (Figure \(\PageIndex{1}\)). The 2020-2025 Dietary Guidelines for Americans recommended that no more than 10% of daily calorie intake should come from added sugars. The percent daily value is based on 50 grams of added sugars in a 2,000 Calorie diet. According to the 2025-2030 Dietary Guidelines for Americans, no amount of added sugars is recommended. However, added sugars can be difficult to avoid so each meal should have no more than 10 grams of added sugars. It is helpful to remember that 1 teaspoon is equivalent to four grams of sugars. On average, adults in America consume 17 teaspoons (68 grams) of added sugar each day, which is far exceeds the recommended amount.2 Excess sugars are associated with weight gain and oral diseases, as discussed below. Diabetes will be discussed in more detail in the next section.

    Understanding the Amount of Added Sugars in Your Foods

    Food label highlighting 23g added sugars with 46% of daily values. Measuring spoon of sugar.

    Figure \(\PageIndex{1}\): Nutrition label with added sugars. The amount of added sugars is shown below the total carbohydrates on the nutrition label (highlighted in yellow). It is helpful to remember that 4 grams of sugar is equal to one teaspoon.3,4

    Weight Gain

    Each gram of sugar contains four Calories of energy. This may not seem like a lot, but consuming excess added sugars and excess calories causes a "fat-sparing" effect as described in the previous section. As more glucose is available for energy, lipids are stored as fats. Excess fat storage can lead to weight gain, which we will discuss further in Chapter 10. Although many foods contain added sugars, sugary drinks like sodas, lemonade, sweet teas, or some energy drinks are a primary source of added sugars with no other nutritional value. For example, a 12-ounce soda contains 7-10 teaspoons of added sugars with no nutritional value. In fact, people continue to feel hungry after consuming high-calorie sugary drinks.5 In a review of studies that tracked health outcomes in people who consumed sugar-sweetened beverages, an association between consuming sugary drinks and weight gain was consistently observed. In addition, reduced consumption of these drinks was associated with weight loss.6

    It is important to remember that added sugars are also found in foods that you may consider healthy. For example, fortified cereals can have several minerals, vitamins, and even whole grains listed on the nutrient label. However, some of these cereals contain up to 16 grams of added sugar in one bowl. Other "healthy" foods that may contain excess added sugars include flavored yogurts, snack bars, and even applesauce.

    Interactive \(\PageIndex{2}\)

    The Harvard School of Public Health Nutrition Source has developed a guide called “How Sweet Is It?” that notes the calories and sugar contents of many popular beverages. Visit the site to determine drinks that are better for your oral and overall health.

    Oral Disease

    Oral health refers not only to healthy teeth and gums but also to the health of all the supporting tissues in the mouth, such as ligaments, nerves, jawbone, chewing muscles, and salivary glands. In 2000, the Surgeon General produced its first report dedicated to oral health, stating that oral health and health in general are not separate entities. Instead, oral health is an integral part of overall health and well-being.7

    The most common oral disease in the world is tooth decay, also known as dental caries or cavities. Natural sugars and added sugars are the most important drivers of tooth decay.8 Bacteria living on and around the teeth will break down these sugars in a process known as fermentation. Glucose, fructose, and maltose are three examples of fermentable sugars. Bacteria that inhabit the mouth metabolize fermentable sugars and starches in refined grains to acids that erode tooth enamel and deeper bone tissues. The acid creates holes (cavities) in the teeth that can be extremely painful (Figure \(\PageIndex{2}\)). Gums are also damaged by bacteria produced by acids, leading to gingivitis, which is characterized by inflamed and bleeding gums. Saliva is actually a natural mouthwash that neutralizes the acids and aids in building up teeth that have been damaged.

    According to the National Institutes of Health, almost 1 in 4 preschool children have cavities, and at least 1 in 6 children aged 6-11 have at least one cavity in a permanent tooth.9 Cavities are an epidemic health problem in the United States and are associated with poor diet, but other contributors include poor dental hygiene and the inaccessibility to regular oral health care. Childhood tooth decay is more likely in low-income households, which are also more at risk for food insecurity, poor nutrition, and obesity.9

    Tooth Decay

    Picture of tooth decay or cavity.

    Figure \(\PageIndex{2}\): Dental caries.10 Gingivitis. One way to prevent tooth decay is to lower consumption of sugary drinks.

    Tools for Change

    Save your teeth and gums, and choose to drink a beverage that does not contain excess added sugars. An idea: brew some raspberry tea, add some sparkling mineral water, a raspberry or two, some ice, and a mint leaf. Then sit back and refresh. The American Heart Association also makes the recommendations below to avoid excess sugars in your diet:11

    • Skip the sugar. Cut back on the table sugar, syrup, honey, and molasses. Try cutting the amount of sugar you might add to cereal, pancakes, coffee, or tea in half. Then, reduce little by little until you are satisfied without the addition of sugar.
    • Drink less soda. Choose water first, but you can find ways to make drinks with less sugar. Try to mix juice with sparkling water or unsweetened tea.
    • Eat fruits without added sugars. Choose canned fruits in water or natural juice, and avoid canned fruits in syrup. Drain and rinse canned fruits to remove excess sugars.
    • Read food labels and choose foods with less added sugars. Dairy and fruit products naturally contain some sugars, but added sugars can be excessive in foods like yogurts or juices.
    • Cut back when you cook. Try switching out sugars with unsweetened applesauce in recipes, or cut back the sugar in cookie or cake recipes by 1/3 to 1/2. Often, the recipe will taste similar or better without the excess sugar.
    • Add flavors. Add almond, vanilla, orange, or lemon to flavor recipes instead of adding sugar. Try ginger, allspice, cinnamon, or nutmeg.

    Carbohydrate Deficiencies: Do Low-Carbohydrate Diets Affect Health?

    Since the early 1990s, marketers of low-carbohydrate diets have bombarded us with the idea that eating fewer carbohydrates promotes weight loss and that these diets are superior to others in their effects on weight loss and overall health. The most famous of these low-carbohydrate diets is the Atkin’s diet. Others include the “South Beach” diet, the “Zone” diet, and the “Earth” diet. Despite the claims these diets make, there is little scientific evidence to support that low-carbohydrate diets are significantly better than other diets in promoting long-term weight loss. For example, in a 12-month weight loss study of 609 participants, there was no significant difference in weight change between a healthy low-fat diet and a healthy low-carbohydrate diet.12 Some studies do provide evidence that in comparison with other diets, low-carbohydrate diets improve insulin levels and other risk factors for type 2 diabetes and cardiovascular disease.13 The overall scientific consensus is that consuming fewer calories in a balanced diet will promote health and stimulate weight loss, with significantly better results achieved when combined with regular exercise.

    Health Benefits of Whole Grains in the Diet

    Although excessive consumption of fast-releasing carbohydrates is potentially bad for your health, consuming more slow-releasing carbohydrates is extremely beneficial to health. There is a wealth of scientific evidence supporting that replacing refined grains with whole grains decreases the risk of obesity, type 2 diabetes, and cardiovascular disease. Whole grains are great dietary sources of fiber, vitamins, minerals, healthy fats, and a vast amount of beneficial plant chemicals, all of which contribute to the effects of whole grains on health. The 2020-2025 Dietary Guidelines for Americans recommended that at least half of the daily grains a person eats are whole grains. The most recent version of the Dietary Guidelines for Americans furthers recommends that whole grains should be prioritized in a healthy diet. However, most Americans do not get the recommended amount of whole grains, which means they are not getting the fiber and health benefits of whole grains. Based on a survey conducted from 2013 to 2016 by the US Department of Health and Human Services, the average adult in America gets about 16% of the daily grains as whole grains. This is much lower than the recommended amount, but data from 2005-2006 show that Americans have increased the amount of whole grains in their diets.14

    Diets high in whole grains have repeatedly been shown to have health benefits. A large group of studies all support that consuming more than two servings of whole grains per day reduces one’s chances of getting type 2 diabetes by 21%.15 The Nurses’ Health Study found that women who consumed two to three servings of whole grain products daily were 30% less likely to have a heart attack.16 In a review of studies conducted across several countries with thousands of participants, researchers found that individuals who consumed more whole grains had reduced overall mortality rates, cancer mortality, and heart disease.17 These studies, and many more, demonstrate the benefit of maintaining a diet sufficient in beneficial carbohydrates.

    Colon Health

    A substantial health benefit of whole grain foods is that fiber actively supports digestion and optimizes colon health. This health benefit can be more specifically attributed to the insoluble fiber content of whole grains, which aids in digestion. There is good evidence supporting that insoluble fiber prevents the irritating problem of constipation and the development of diverticulosis and diverticulitis. Diverticulosis is a benign condition characterized by out-pocketing of the colon. Diverticulitis occurs when the out-pocketings in the lining of the colon become inflamed. Interestingly, diverticulitis did not make its medical debut until the early 1900s, and in 1971 was defined as a deficiency of whole-grain fiber. According to the National Digestive Diseases Information Clearinghouse, more than 30% of Americans over between the age of 50 and 59 have diverticulosis, and 70% of people over the age of eighty have the disorder.18 Less than 5% of people who have diverticulosis go on to develop diverticulitis.18 Symptoms include lower abdominal pain, nausea, and alternating between constipation and diarrhea.

    Diverticulitis

    Diverticulits shows pockets in the lining of the colon.

    Figure \(\PageIndex{3}\): Diverticulitis in the colon.19 Out-pockets of the colon and inflammation can cause pain and other digestive issues.

    The chances of developing diverticulosis can be reduced with fiber intake because of what the breakdown products of the fiber do for the colon. The bacterial breakdown of fiber in the large intestine releases short-chain fatty acids. These molecules have been found to nourish colonic cells, inhibit colonic inflammation, and stimulate the immune system, thereby protecting the colon from harmful substances. Additionally, the bacterial-indigestible fiber, mostly insoluble, increases stool bulk and softness, increasing transit time in the large intestine and facilitating feces elimination. One phenomenon of consuming foods high in fiber is increased gas because the byproducts of bacterial digestion of fiber are gases.

    Some studies have found a link between high dietary fiber intake and a decreased risk for colon cancer. However, an analysis of several studies published in the American Journal of Clinical Nutrition did not find that dietary fiber intake was associated with reduced colon cancer risk. Still, high dietary fiber was associated with a reduced risk of mortality from cardiovascular disease.20 There is some evidence that specific fiber types (such as inulin) may protect against colon cancer, but more studies are needed to determine conclusively how certain fiber types (and at what dose) inhibit colon cancer development.

    Attributions

    References

    Wiese, Melissa. Sugar. Flickr, uploaded 29 Apr. 2008, https://www.flickr.com/photos/93587218@N00/2452033439. Accessed 10 Feb. 2026.

    1. Ahmad FB, Cisewski JA, Anderson RN. Provisional Mortality Data - United States, 2021. MMWR Morb Mortal Wkly Rep. 2022;71(17):597-600. Published 2022 Apr 29. doi:10.15585/mmwr.mm7117e1.
    2. Get the Facts: Added Sugars. Center for Disease Control and Prevention. Updated January 5, 2024. Accessed August 8, 2023. https://www.cdc.gov/nutrition/php/data-research/added-sugars.html?CDC_AAref_Val=https://www.cdc.gov/nutrition/data-statistics/added-sugars.html.
    3. Added sugars on the Nutrition Facts Label. US Food & Drug Administration. Updated March 5, 2024. Accessed August 3, 2023. https://www.fda.gov/food/new-nutrition-facts-label/added-sugars-new-nutrition-facts-label.
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    5. Pan A, Hu FB. Effects of carbohydrates on satiety: differences between liquid and solid food. Curr. Opin. Nutr. Metab. Care. 2011;14(4):385-390.           doi:10.1097/MCO.0b013e328346df36.
    6. Nguyen M, Jarvis SE, Tinajero MG, et al. Sugar-sweetened beverage consumption and weight gain in children and adults: a systemic review and meta-analysis of prospective cohort studies and randomized controlled trials. Am. J. Clin. Nutr. 2023;117(1):160-174. doi:10.1016/j.ajcnut.2022.11.008.
    7. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Published 2000. Accessed August 2, 2023. https://www.google.com/books/edition/Oral_Health_in_America/W9ZpAAAAMAAJ?hl=en&gbpv=1&printsec=frontcover.
    8. Nutrition and Oral Health. American Dental Association. Updated October 11, 2021. Accessed August 10, 2023.                       https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/nutrition-and-oral-health.
    9. National Institutes of Health. Oral Health in America: Advances and Challenges. Published 2021. Accessed August 10, 2023.         https://www.nidcr.nih.gov/research/oralhealthinamerica.
    10. "File:Dental Caries Cavity 2.JPG." Wikimedia Commons. 23 Nov 2025, 21:14 UTC. <https://commons.wikimedia.org/w/index.php?title=File:Dental_Caries_Cavity_2.JPG&oldid=1120467716> 10 Feb 2026, 19:31.
    11. American Heart Association. Tips for Cutting Down on Sugar. AHA. Updated April 17, 2018. Accessed August 10, 2023.                             https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/tips-for-cutting-down-on-sugar.
    12. Gardner CD, Trepanowski JF, Del Gobbo LC, et al. Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: The DIETFITS randomized clinical trial. JAMA. 2018;319(7):667-669. doi:10.1001/jama.2018.0245.
    13. Sievenpiper JL. Low-carbohydrate diets and cardiometabolic health: the importance of carbohydrate quality over quantity. Nutr. Rev. 2020;78(Supplement_1):69-77. doi:10.1093/nutrit/nuz082.
    14. Ahluwalia N, Herrick KA, Terry AL, Hughes JP. Contribution of whole grains to total grains intake among adults aged 20 and over: United States, 2013-2016. NCHS Data Brief. 2019;no.341. https://www.cdc.gov/nchs/data/databriefs/db341-h.pdf. Accessed August 4, 2023.
    15. de Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: A prospective cohort study and systematic review. PLoS Med. 2007;4(8):e261. doi:10.1371/journal.med.0040261.
    16. Liu S, Stampfer MJ, Hu FB, et al. Whole-grain consumption and risk of coronary heart disease: results from the Nurses' Health Study. Am. J. Clin. Nutr. 1999;70(3):412-419. doi:10.1093/ajcn/70.3.412.
    17. Zong G, Gao A, Hu FB, Sun Q. Whole grain intake and mortality from all causes, cardiovascular disease, and cancer: A meta-analysis of prospective cohort studies. Circulation. 2016;133(24):2370-2380. doi:10.1161/circulationaha.115.021101.
    18. Definition & Facts for Diverticular Disease. National Institute of Diabetes and Digestive and Kidney Diseases. Updated August 2021. Accessed August 7, 2023. https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis/definition-facts.
    19. "File:Diverticulitis complete hariadhi.svg." Wikimedia Commons. 16 Oct 2025, 16:46 UTC. <https://commons.wikimedia.org/w/index.php?title=File:Diverticulitis_complete_hariadhi.svg&oldid=1100352573> 10 Feb 2026, 19:34.
    20. Veronese N, Solmi M, Caruso MG, et al. Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analysis. Am. J. Clin. Nutr. 2018;107(3):436-  444. doi:10.1093/ajcn/nqx082.

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