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Scott Benner 0:00
Hello friends, and welcome to episode 668 of the Juicebox Podcast.

On today's episode of The Juicebox Podcast, Jenny Smith and I are going to define carb absorption and digestion. There's no more to it than that. That's what we're gonna do. I mean, there's way more to it than that. But as far as the explanation prior to the conversation, that's all I've got for you. Please remember while you're listening, that my voice sounds terrific today, and that you should always look and that you should always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Are you a US resident who has type one diabetes, or is the caregiver of someone with type one, because if you are, you can support the T one D exchange and research for type one diabetes by going to T one D exchange.org. Forward slash juicebox. When you get there, join the registry fill out the survey the whole thing takes fewer than 10 minutes and you are going to help people with type one, you're also going to support the Juicebox Podcast. I don't even want to stop talking now. My voice sounds amazing in my ears. T one D exchange.org forward slash juicebox. This episode of The Juicebox Podcast is sponsored by us med. US med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor from the pod dash, the number one fastest growing tandem distributor and the number one rated distributor index. com customer satisfaction surveys. US med is a place where you get your diabetes supplies from most of us use them right? Most of us are using some sort of an online Wait a minute, are you not getting your supplies online? Okay, hold on. First of all, it's super easy to get your supplies online. You just are you're not doing this. Alright, hold on a second. Let me get a sip of water I gotta explain this whole thing to you. So we used to use another company, we've actually used a couple of them. And in the past they've been you know, spotty, let's say spotty in their customer service. But us med prides themselves on their white glove treatment of their customers. US med has an A plus rating with the Better Business Bureau and they want you to get better service and better care than you're accustomed to getting now. US med always provides 90 days worth of supplies and fast free shipping. You can get a free benefits check right now at us med.com forward slash juicebox or by calling 888721151. For us Medicare is everything from insulin pumps and diabetes testing supplies to the latest CGM including libre two and Dexcom G six. They accept Medicare nationwide and over 800 private insurers. This 888 Number is dedicated for Juicebox Podcast listeners. Call now 888-721-1514 Get the service you deserve. Get your supplies without a big hassle. US met us med.com forward slash juicebox look everybody these supplies are going to be common forever and ever. I'd love it if you had it set up so that it just happened and you didn't have to think about it. That's how we have it here. And it is a real it's a weight lifted. It's another thing you don't have to think about. Let us med think about that. You go live your life

okay, so we fixed your computer.

Jennifer Smith, CDE 4:08
We did thankfully Yeah. Good for us.

Scott Benner 4:12
Do you want to start with carb absorption and digestion as the defining or antibodies? I let it be ladies choice as I'm going to have very little to add on one of them for sure.

Jennifer Smith, CDE 4:28
How about we do carb absorption.

Scott Benner 4:31
Okay. Well then, in fact, Jenny, we are going to define carb absorption and digestion talked about that. Okay, can I tell you that the first time I want to be honest. The first time you said to me that the body digests things in an order. I had never heard anybody say that before. I knew

Jennifer Smith, CDE 4:57
I remember telling you that. You told Utah in order.

Scott Benner 5:02
So I'll tell you what I remember,

Jennifer Smith, CDE 5:04
I might have to clarify, because I don't even remember

Scott Benner 5:07
what it is like, please don't put that on me I never said. So what I recall is that we were talking about pizza as an example. And right, and we were talking about how, in people's minds, pizza is an example could be a is a food. But if you really stop and deconstructed pizzas cheese, it's sauce, it's salt, it's oregano, it's flour, right? It's all these things, if you put sausage on its protein, if you put, you know pepperoni on it, it's protein, that's sort of an idea. If you put pineapple on it, it's a simple sugar, like getting these things, right. And you were describing why people get low blood sugars from pizza, because they look at the slice. And they, Oh, it's 35 carbs, they Bolus these 35 carbs, they hooked down this pizza, the, because that's how I eat it. If the rest of the first slice goes fast, and and then of course, the the insulin is working, working, working. But because of how digestion works, the pizza, the impactful parts of the pizza aren't being absorbed by your body right away. And you I if I'm wrong, stop me. But you said that the cheese is the most difficult part. For the body to break down, it starts with that it takes a long time, it's not pulling out carbs do I remember all this correctly,

Jennifer Smith, CDE 6:30
kind of it's sort of yes, in a way. Because, right, the fat in the cheese, and the protein and the cheese and whatever else you might have also put on top of it. I mean, it could be, you know, the Italian sausage and whatever. And the multiple cheeses that might actually be on top of it, right. But the body sort of breaks things down in a general sense to completely like process, right, almost like a blender, if you will. But if you have like the pineapple, if you only put the pineapple in your stomach, simple carb or simple sugar, so it's going to break that down really fast. Whereas when you start mixing that with the other macronutrients, like fat and protein, such as in cheese, you're really going to get a slowdown of the carbs, that you really only see the pizza as being or anything really that you've identified as a carbohydrate, you're gonna see it, you're gonna count the carbs, you're gonna say, Okay, I'm just gonna go ahead and give my insulin right now. And that insulin, it's meant to work. The way that you know, rapid insulin specifically is sort of designed is to work with carbohydrate digestion, it's got this in out sort of bell curve of action, which is kind of how carbs get digested and carb decarb. Even those are a little bit different, depending on the kind of carpet is right. But pizza, for example, being Yes, it might have carbs in it, but those carbs really get slowed down when everything gets blended together. And the body is trying to also work on, I guess, simple way to say it is a harder to process,

Scott Benner 8:13
right? The macronutrient. So if so, if we took the slice of pizza as an example, and it just had, I don't know sausage and cheese on it, and we eat, we eat it, our body processes it in one bell curve that we could see. But if we rip the cheese off it and eat it, the bell curve completely changes.

Jennifer Smith, CDE 8:33
Right? That's a great way to describe it. Absolutely. In fact, something like the pizza crust with just the sauce, which pretty much that's just all carb unless you've added fat and whatnot to the crust, then yes, that's going to be a faster digesting type of food or meal because you really have added nothing to slow down. So you have a typical carbohydrate bell curve and in kind of out within, let's say about three ish hours, right? Whereas when you start adding those other macronutrients, they take proteins and fats take longer for the body to process you might actually have sort of a double humped kind of felt curve maybe, right, it might go up a little bit, or it might actually remain pretty smooth and steady. Especially if you've dosed your insulin in a split type of fashion, or extended your Bolus out. You might actually see something that's pretty stable for a while before it slowly starts to go up later, where things like fat and protein, those may be the end result of all of a rise up later. Not necessarily truly just carbohydrate,

Scott Benner 9:43
right? I just not that. I mean, I just think we should so bell curve. If you think about a spike that you see on your CGM where you're going along, you know, okay at 90 and then all of a sudden you go up to 140. It hangs there for a little while and it curves and it comes back down to 90 Again, if you can picture that in your head, it sort of looks like the outline of a bell. Yes. So the carbs, it's an impact of the carbs, the carbs start the impact, they impact heavier and heavier and hit harder and harder and harder. The bell at the top of the bell gets formed, the carbs start to be digested, so less impact. And at the same time, if you're lucky, there's another bell curve going on, which is the insulin. Yep. All right. But the insulin and the insulin is not working as hard at first, it starts to work harder and harder and harder, which is why you always hear me say something like, you know, you got to, it's all about timing and amount, you have to put in the right amount at the right time, you have to line up the impact of the carbs with the action of the insulin. However, I don't know I've said it, like 1000 different ways at this point. But those impacts have to be fighting the fight at the same time. Correct, right. But aside of that, just just sort of keep in mind that if you Hey, it's Scott, I know I put the ad at the beginning of the episode today, I trick you a little bit. But I still need to pop in and tell you that US med offers a free benefits check. And you can get it at us med.com forward slash juice box, or by calling a special number just for Juicebox Podcast listeners 888-721-1514 us med carries everything from your insulin pumps, to your diabetes testing supplies, go check them out. All right, sorry, I have ordered a new computer.

Jennifer Smith, CDE 11:30
Oh, that wasn't my fault. I did nothing.

Scott Benner 11:37
So but but what we're saying is, is that if you so if you eat the pizza, and it doesn't have cheese on it, your body can get right to breaking down the dough. And so you're gonna start seeing an impact sooner. But if you mix the cheese in with it, fat and protein slow down the digestion process, and your body sort of focuses on the things that are more difficult to break down first. So it's breaking down stuff that doesn't have carbs in it necessarily. So is there's less than

Jennifer Smith, CDE 12:07
breaking it down all at one time. But because the carbs get mixed in with these foods that are harder, and it's breaking everything down, the whole slow the whole process down really

Scott Benner 12:19
significantly slow it down. And significantly

Jennifer Smith, CDE 12:21
slow it down exactly which again, as your example when you then take a Bolus all up front for something like like pizza, or the other foods that would fit into that, you know, same category, you're really going to most likely get a low blood sugar, and up needing to treat the low blood sugar, that treatment might even be a little bit slower. Because you have this food that's a heavier type of food already in your stomach. And then you end up going up later, not only from treating the low, which you needed to do, but also now the food is actually hitting, and you got impact of insulin more upfront where you actually needed it stretched out over the course of how long that was taking to digest.

Scott Benner 13:10
And that's why Chinese food can be difficult, right? Because it can be a mixture of a slow and a fast impact. Yes, you can almost have what you do have, you'll have two bell curves, you'll have quicker faster ones and slower, more drawn out ones. And you have to hit both of those differently with insulin differently. Yep, yeah. So. So now that we've kind of like walked through it, pizza is a great example. Because it makes the point but so if you have anything now, like, just think about all the different foods you're eating, if you eat them singularly, they have an impact, you know, across this curve, when you start mixing them together on a plate, you're now we were talking about this in another episode, you have different lines of I don't know reality happening, you have the bell pepper reality and the mashed potato reality and the meatloaf reality all kind of happening at the same time. Now, it's not. I mean, I have to say, like anecdotally from managing art, and it's not like there are these three different crazy, I don't know, things happening, they kind of blend together a little bit, you kind of almost can't see it with the naked eye. But it is true that it's working that way. It's different foods differently.

Jennifer Smith, CDE 14:21
And if you have paid enough attention, I've said it before, if you've paid enough attention to the 80% of time food that you eat, right what you've eaten over and over and over. If you've paid enough attention to that, you can get your timing down. Yeah, pretty pretty well, right? And in most mixed meals setting something like a you know, brown rice and I don't know broccoli and grilled chicken, right? I mean, that's still unless your portions are exorbitant or you've had them slathered in butter or some type of other fatty kind of, you know, dressing You are going to have the pretty typical bell curve of action. It's just when things get heavier in fact, especially and or heavier in protein and maybe lower in carbohydrate at the same time or lower glycemic. I mean, it brings in a whole carbohydrate to carbohydrate. Not all carbs are sort of digested by the body the same way, right? A good example being plain old white bread versus something like a sprouted grain like in Ezekiel bread, for example, right? Very unprocessed, versus really, really broken down. There's nothing left in that white bread. It's kind of like eating sugar. Really, right.

Scott Benner 15:50
It's funny, because I find it if you choose a whitebread that doesn't have high fructose corn syrup in it. I find it easier to Bolus for because I know what it doesn't right away and it takes a lot of insulin, but it doesn't it's not like these real kind of like, like the grains don't take more time. It doesn't stretch out the process like No, not at all. It's but it's a ton of it's a ton of insulin like you're making me think about, like I just I Googled, this is one of my favorite things and I'm not sure it's real in the world or not, but that there's that there's silicone in McDonald's french fries. So I Oh, is there silicone in McDonald's fries, the chemical sharing a link between finding a cure for baldness and fast food french fries is di meth low poly Ciloxan, which is a is reportedly found in the silicone that is added to the oil McDonald's cooks is famous French fries, and it's from 2018. So not not really my bigger point. My bigger point is that when you start looking at processed foods versus natural foods, this is a big deal. Because these foods are generally speaking going to be higher carbs. And there are things in them that your body is not really supposed to be dealing with. You know, you wouldn't, you don't I'm saying like deep frying is a great example to me. Because if anybody's ever like deep fried something on their own, you fill the you know, you fill the pot up or whatever, and you fry it. And when you're done, the pot has much less oil on it, but you don't think about it that you're the one eating the oil. Right? It's over.

Jennifer Smith, CDE 17:27
It's like it magically just just went someplace. It's like when you boil water and the water like sort of evaporates, right? You kind of think, well, they must have just like evaporated educated

Scott Benner 17:37
did by the way, it's up in the air now, right? Like it's still there, this oil is still it still exists on the world in the world, it's been absorbed into your food. And so if you go back to the pizza explanation, where fat slows down digestion, then fried foods are going to slow down digestion too, because you're gonna be taking in oil. And in a in most settings, it's not going to be like real expensive, cold pressed olive oil that they're making your french fries. And it's going to be whatever, like, you know, Jack's easy to buy, you know, stuff that these companies can use for their oil. So you're getting that in there, you're getting whatever is in French fries, you know, and I'm using this as an example because it's here's this from a 20 2015 article. Let's see if it shows you how McDonald's fries are made. There are real potatoes in it. That's nice.

Jennifer Smith, CDE 18:32
hatefully Oh my goodness.

Scott Benner 18:35
Do you add any type of flavor guests so they put in flavors and oil blends be flavoring? Like there's all kinds of stuff? What kind of oil do you use, we use an oil blend made from four different kinds of oil, canola, corn, soybean, hydrogenated soybean, those are four oils, I wouldn't eat. And I am not nearly the healthiest person in the world. And so I'm assuming there's salt. You know, a lot in

Jennifer Smith, CDE 19:02
thankfully, salt is like one of the least dangerous things on the whole list. Fries,

Scott Benner 19:08
Chinese, like maybe you'll get some iodine. Exactly knock your thyroid down. They use the right kind of salt. But I just think that when I watch people online speaking and talking about the problems, they have bolusing for their meals, they only ever think of it as the number on the carb count. Like the the rest of it just usually doesn't come into play for them. And I mean, I just think I don't think you should eat any certain way and I'm not telling anybody how to eat. I enjoy McDonald's french fry. But you have to understand it. You can't just blindly look at this meal and go McDonald's says that this is the 86 carbs and dial it up and think that's going to work out for you because it very likely is not going to

Jennifer Smith, CDE 19:53
right i mean it brings in a bigger a definite bigger piece of it. The lack of detail in education that's provided, because majority of people diagnosed are sent home and told, count your carbs, take your insulin, maybe they're told to Pre-Bolus by 10 minutes. And it's sort of left at that. Most places unfortunately, don't even go into use of potential split Bolus ideas, or whether you're on multiple daily injections or have the use of a pump with extended Bolus and those types of things. There is there's no definition to these type, this type of carbohydrate, or these types of carbohydrate are these groups here, you can expect quick impact, sort of moderate impact, really slow impact that gets into glycemic index. And from the get go, if we're not giving this information. That's where the confusion starts to come in. But if I was just told the count carbohydrate and that every single apple out there was 12 grams of carbohydrate, well, great, fabulous. So then I go and get my big old honey, crisp apple, and it's 12 grams of carbon.

Scott Benner 21:11
Not really. And I say good luck using a 12 gram count for a big apple because you're gonna be in trouble. All right, where you send your kid to a pizza party, and the kid has three slices of pizza and you're like, well, that's 90 carbs, you give your kid 90 carbs worth of insulin, that insulin is going to crush them long before the pizza catches up. Some other stuff, we know that

Jennifer Smith, CDE 21:31
most kids are not sitting at a birthday party, right? I mean, it's a trampoline park or something. Right? Yeah,

Scott Benner 21:38
the balance of the timing and the amount is just it's more important in different situations. It's also Alright, hold on. So from online, how are carbohydrates digested absorbed? During digestion, starches and sugars are broken down both mechanically through chewing, and chemically by enzymes into the single units glucose, fructose, and or galactose. That sounds like a transformer, which are absorbed into the bloodstream and transported for use as energy throughout the body. Which, if you listen closely to that sentence, what it means is, is sugar gets put into your blood. So yes, and so this happens at a different time. The end here, very quick googling How soon after eating our carbs absorbed, the denser the food, meaning the more protein or fat it has, the longer it takes to digest notes, Dr. Li simple carbohydrates such as plain rice pasta, or simple sugars, average between 30 and 60 minutes in the stomach. So you put your insulin in at noon, it starts working really well. 20 minutes, it starts working 20 minutes later starts working really well at 45 minutes, this pasta, except this stuff might not even be impacting you yet, or not impacting you enough to combat this.

Jennifer Smith, CDE 22:51
And it's, you know, these are the pieces of science education, I guess, that? No, I mean, unless you really Google something yourself. Most people wouldn't know, unless they've gone for some type of a, you know, nutritional biology degree or something that they get the understanding. I mean, most people don't even know that starches essentially start to get digested in your mouth, right? I mean, one of the enzymes is amylase, it's like a salivary based thing that starts to kind of break things down. Thus, a really good reason, then even if you don't remember any of that, it's a really good reason to Pre-Bolus Most things that are simple carbers, right, baseline carbohydrates, and then, you know, other other types of carbohydrates actually, kind of get moved further down. And in your small intestine, you actually have a whole bunch of other enzymes, which, at this point, I would have to look them up, I would have to go back to my nutrition physiology books to look exactly which one they are up, but majority of their those kind of come in through the small intestine. And so we have, we have to wait out this process, right? Your stomach is like a big turning place, and absorption gets done in your digestive tract. Right, so the more things that you put in with carbohydrate, that are longer in terms of the body breaking them down, such as fats, the more drawn out that whole process gets,

Scott Benner 24:26
I wonder, and this is just me wondering if you're constipated. Does your body slow down digestion? Does it say it didn't come out? So we're not going to worry about it right now. We're just digestion just keep happening and the constipation just keeps being forced from what's in your stomach. Right?

Jennifer Smith, CDE 24:44
I mean, constipation is usually there are many reasons for obviously too many to kind of get into and discuss but your body is still breaking down and it's still absorbing. But I've had quite a number of people who've definitely said As soon as I go to the bathroom my blood sugar's seem to even out a lot better who have who have said that, you know, I have trouble with constipation or a lot of the people that I work with through pregnancy, essentially, that's a typical thing in pregnancy is constipation.

Scott Benner 25:18
I remember saying it once, too. And you looked at me a little weird, but I swear to God, I knew what I was looking at. Like, if Arden gets constipated, then she disappears in the bathroom and comes back. You're like her blood sugar is gonna, sticky blood sugar is gonna start going down. Yeah, I mean, that's one of those things I can't prove.

Jennifer Smith, CDE 25:35
But I bet you have hindsight. Yeah,

Scott Benner 25:37
I would, if you made me bet. I'd bet in that direction for certain. Yes. So have we done justice to this idea?

Jennifer Smith, CDE 25:45
I think so. I mean, in a general sense, it's yes, I think so. Yeah,

Scott Benner 25:50
I just want people to understand that the time it takes for food to go through your body impacts where you're going to need your insulin. I mean, I think in very simple terms, I think that's important to understand, you can't just have this blind idea that, you know, it's gone out of sight, out of mind with the food, it must be doing exactly what it's going to do right now. And because, you know, on the flip side of that, you have to understand how insulin works to an insulin, really, you're in the same problem as it just doesn't start happening immediately at full speed, you know, the foods not impacting you right away at full speed. And, either is the and so on. And so you just have to, I mean, you said it earlier, but it bears repeating, you have to eat these things, you have to watch it happen. And then next time believe this is about how it's gonna go. You know,

Jennifer Smith, CDE 26:44
that's exactly right. And again, sometimes those normal things that you eat over and over can then give a little bit of insight to something that you may choose at a restaurant or a friend's house that you haven't necessarily had before. But if you're looking at them, you can gain a little bit of perspective from what you've done and say, Ah, this looks kind of like something I've had at home. And I would have probably done this type of a Bolus strategy for it. So I mean, the best that you can do is give it a try, which is kind of what we all do.

Scott Benner 27:13
Right? Exactly. I always tell people, somebody asked recently, can you do a pro tip on eating in a restaurant? And I said, it doesn't eat a pro tip, the better it tastes, the more insulin it needs.

Jennifer Smith, CDE 27:26
Possibly a drawn out

Scott Benner 27:27
fashion. Yeah. Yeah, cuz that's probably going to be butter that's making you happy. Yeah. All right. Well, I appreciate you doing this with me. Thanks. Yeah, absolutely. Want to thank Jenny for being here. Don't forget that Jenny works at integrated diabetes.com. If you'd like to hire her, you can. I like to thank our sponsor today us med get your diabetes supplies, easily. It doesn't need to be a big hassle. And with us med it won't be check them out and get your free benefits check at us med.com forward slash juice box or by calling 888-721-1514. There are links to us Med and all the sponsors in the shownotes of your podcast player and at juicebox podcast.com. And don't forget to go take that survey AT T one D exchange.org. Forward slash juice box. When you support the sponsors, you're supporting the show. At this point, I don't even remember how many defined diabetes episodes there are. But there's got to be more than 40. If you're enjoying them, you can find them at juicebox podcast.com diabetes pro tip.com, or by joining the private Facebook group Juicebox Podcast type one diabetes, and then heading up to the top I want to call it the I always want to use the wrong word. And then I hold on a second, I'll tell you what it's called when you get the the Facebook page is a private group. It's really terrific. I think it's got like 24 25,000 members in it right now. And at the top. Not here this, there's a feature tab. So you have to answer a couple of questions to get in. But once you're in there, go to that feature tab. And there's a list of all the defining diabetes episodes, all the variables, all the how we eats the Quickstart guides. If you're just starting with the show, the Pro Tip series is a list of popular requested episodes popularly requested episodes if I'm going to use English, special episodes, Scott and Jenny's where they're called ask Scott and Jenny, people send in questions and Jenny and I answer them a whole bunch of stuff on how to Bolus for fat and protein. I mean, there's a ton here anyway, it's all in that private Facebook group up under the feature tab. This is the part where I say thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Please subscribe and your apps Subscribe and follow follow and subscribe.