Carb Confusion: Net Carbs vs Total Carbs

February 26, 2020

The history of tracking the macronutrient breakdown of our food dates back to the early 1970s when obesity rates rose significantly from 14% to 30% in a matter of a few short years. By this time, the healthcare community was also recognizing the benefit of encouraging patients to track their intake for improved awareness of consumption and be able to accurately make recommendations to increase weight loss and manage eating behavior. Thus the trend of understanding macronutrients and how they affect our weight loss was born.

In the 1990s, Dr. Atkins introduced an even finer concept of actually manipulating these macronutrients to reduce inflammation and, in some cases, also manage diseases such as reflux or diabetes.

Today, experts all over the world continue to fuel the debate on the best ratio of these nutrients for optimal health and better quality of life.

Net Carbs vs Total Carbs - What Should We Focus On?

What are Macronutrients?

So what exactly are ‘macronutrients’? Many have heard this term, but sometimes little is shared about what they truly are and why they are referenced. Macronutrient (also referenced as "macros" for short) is the scientific term used to categorize the components in our food. On labels in the United States, the four most popular groups are:

• Carbohydrates (common sources: bread, pasta, rice)
• Protein (common sources: fish, eggs, chicken, a variety of plants)
• Fats (common sources: butter, avocado, coconut oil, olive oil)
• Fiber (a form of carbohydrate that is now considered it’s our group due to the increasing known benefits of consuming it consistently in the diet).

What's in the Macronutrient Sub-Groups?

Just as the fiber group is technically part of the carbohydrate category, there are many varieties of sub-categories that can be found on labels. Some examples include:

• Soluble and Insoluble Fiber (Carbohydrate category)
• Sugar (Carbohydrate category)
• Polyunsaturated Fats (Fat category)
• Medium Chain Triglyceride or “MCT” (Fat category)

These sub-categories can also help define the chemical properties of how the food is behaving once digested. One excellent example is the sub-category of fat known as “trans-fat” which is man-made and nationally recognized as harmful in the body due to the limited ability of the body to break it down, thus continuous circulation in the bloodstream potentially raising cholesterol and contributing to the risk of heart disease in adults consuming this dietary component. Experts today may even argue it is not a dietary (or “food”) component at all.

This is why the process of continually working to categorize our food is vital to sharing accurate and honest information with the public. Furthermore, testing current knowledge of macronutrients and food composition against well-known household products is equally important to challenge food companies to keep integrity in our food.

Net Carbs vs Total Carbs

This brings us to today’s topic: Net carbohydrates vs total carbohydrates, how should we view this, and how do we track them?

For those managing their health without the tool of bariatric surgery, it may be appropriate to incorporate higher amounts of carbohydrates if the individual chooses to do so.

After bariatric surgery, it is well recognized in the bariatric community to reduce carbohydrates to approximately 50 grams,  depending on each clinic and patients' needs. Not only does reducing and tracking carbohydrates ensure higher chances for long-term weight loss, but it may also limit the possibility of weight regain and possibly even certain gastrointestinal manifestations after surgery such as reflux or bowel inflammation. By doing so, you increase your body’s ability to absorb more nutrient-dense foods as well as intake adequate protein (individually determined by your practice and healthcare provider).

The Difference Between Net Carbs vs Total Carbs

As a registered and licensed dietitian and whole foods advocate, I have thousands of patients who have experienced great success after weight loss surgery who are counting the Net Carbs only.

Total Carbs:  Tracking total carbs is tracking every carbohydrate you eat (including fiber in the final total). This is not necessary to receive the benefits of a low carb diet and, if managed poorly, can lead to minimal fiber intake, ultimately causing symptoms such as constipation, weight stalling, and reduced bowel health.

Net Carbs: The net carbohydrate is only counting the carbohydrates after the two important sub-categories of fiber and sugar alcohol(s) have been deducted.

When counting net carbs, many healthcare professionals will agree to subtract fiber from this equation. However, there is still debatable research to suggest we can deduct 100% of sugar alcohols (artificially created non-nutritive sweeteners such as sorbitol, mannitol, sucralose, and aspartame). Natural sweeteners such as erythritol and allulose are considered to be fully non-nutritive, and therefore, 100% of their total can be subtracted to calculate net carbs.

Dietitian Tips

• Never count non-starchy vegetables (any vegetable aside from corn, peas potatoes) as part of your carb total when counting net carbs. These foods play an especially vital role in gut health, antioxidant consumption, and healthy microflora and should be treated as a valuable piece of your daily routine.
• Include up to one cup of berries, kiwi, fresh peaches, or plums without counting the carbs! Similar to the vegetables, this is to achieve and maintain the benefits gained from antioxidants found in these special foods without the feeling you over-consuming on your low carb goals.
• Don’t add the foods listed above to apps that don’t consider Net Carbs. Although some tracking apps are designed to subtract fiber and the other sub-categories of carbs to give you an accurate net carb count, other apps are not. Adding the side salad with cucumbers to your tracker may make it appear that you are consuming more carbohydrates on your low-carb diet than the net carb reality.

Final Notes

The purpose of following a low-carb diet is to maintain your weight loss and improve the nutritional quality of your food to achieve overall better health.

If you find the concept too complicated, frustrating, or leave you feeling that you have limited options, NEVER hesitate to meet with your obesity care professional, dietitian, or surgeon. Eating should be fun, flavorful, and guilt-free by choosing a variety of nutrient and fiber dense foods. Keep setting goals and sharing your journey with others you trust to ensure a healthy approach to a whole food, low carb lifestyle.

ABOUT THE AUTHOR Linzi Cruz is a Registered and Licensed Dietitian in the state of Texas. She graduated with two degrees from the University of Florida, the first in Marketing and a second in Nutrition and Dietetics before pursuing her credentials as a RD. She is the owner and lead RD of Whole Cruzine Nutrition in Austin, TX. She has been a member of the Academy of Nutrition and Dietetics on the Weight Management Dietetic Group since 2012. Linzi is experienced and passionate about obesity and bariatrics.

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