Chapter 7 — Quiz

Twenty questions. Attempt before opening.

Multiple Choice

1. The distinction the chapter argues you should use instead of "simple versus complex" is:

  • a) Fast versus slow
  • b) Natural versus artificial
  • c) Intact versus refined
  • d) High GI versus low GI
Answer **c.** The useful question is *how much structure is still around it?* — not what kind of sugar molecule it is.

2. Which of these best demonstrates the failure of "simple versus complex"?

  • a) Sugar and honey behave similarly
  • b) White bread ("complex") produces a faster glucose response than an apple ("simple")
  • c) Fiber is a carbohydrate
  • d) Starch is made of glucose units
Answer **b.** Two "complex" foods — white bread and lentils — sit at opposite ends of the response range, with a "simple" food between them. The framework is about chemistry when the thing that matters is structure.

3. Glycemic load improves on glycemic index by accounting for:

  • a) Individual variation
  • b) Cooking method
  • c) Portion size and actual carbohydrate content
  • d) Fiber content
Answer **c.** GL = (GI × grams of carbohydrate) ÷ 100. Watermelon has a high GI and low GL because a slice contains very little carbohydrate.

4. Which is NOT one of the chapter's five problems with GI as a personal system?

  • a) Values vary with variety, ripeness, cooking, and between laboratories
  • b) It is measured with foods eaten alone, fasted
  • c) Individual responses to the same food differ widely
  • d) It was never validated in any clinical setting
Answer **d.** GI and especially GL do have genuine clinical applications, particularly in diabetes care. The argument is against using it as an everyday food-selection system, not against its existence.

5. Cooking and then cooling rice or potatoes increases resistant starch. The size of this effect is:

  • a) Large enough to substantially reduce the food's calories
  • b) Real but modest — a few percent of total starch
  • c) Nonexistent
  • d) Complete — all starch becomes resistant
Answer **b.** Real, reproducible, and considerably smaller than the internet suggests. It slightly reduces available energy and slightly blunts the glucose response. It is not a mechanism for unlimited pasta.

6. The RDA for carbohydrate in adults is:

  • a) 0 g/day — there is no requirement
  • b) 130 g/day
  • c) 225 g/day
  • d) 300 g/day
Answer **b.** Based on the average minimum glucose used by the brain. Note the nuance: it describes the amount that **removes the need for your body to manufacture glucose**, not a survival threshold — which is why it coexists with the fact that there is no *essential* carbohydrate.

7. The AMDR for carbohydrate is:

  • a) 10–20% of energy
  • b) 30–40% of energy
  • c) 45–65% of energy
  • d) 70–80% of energy
Answer **c.** A population-level range, deliberately wide because the evidence doesn't support a narrow optimum. For Theo at 2,200 kcal that's 248–358 g/day — an enormous span, both ends defensible.

8. In a metabolically healthy person, a post-meal rise in blood glucose is:

  • a) Evidence of insulin resistance
  • b) Normal physiology — the system working
  • c) A sign of excessive carbohydrate intake
  • d) Damaging to blood vessels
Answer **b.** The purpose of insulin is to move glucose out of the blood. A postprandial rise is as normal as a rise in heart rate when climbing stairs. What matters is **failure to clear**, not the excursion.

9. The chapter's account of how carbohydrate became the villain identifies the key mistake as:

  • a) The low-fat era was wrong that fat is harmful
  • b) The low-fat era failed because of what replaced the fat — sugar and refined starch
  • c) Insulin doesn't promote fat storage
  • d) The obesity increase never happened
Answer **b.** Chapter 2's substitution question, wearing a different hat. Neither era was ever really about a macronutrient — both were about what got substituted in.

10. The evidence for whole grains is described as unusually good because it shows:

  • a) A single very large randomized trial with hard endpoints
  • b) Convergence across designs, dose-response, consistency across populations, and a plausible mechanism
  • c) Unanimous expert agreement with no dissent
  • d) Strong mechanistic data alone
Answer **b.** Chapter 2 §2.10's convergence criterion, met. It notably does *not* have (a), and it still carries healthy-user bias — strong by nutrition standards, which isn't the same as proven.

11. The phytate/lectin argument against grains fails primarily because:

  • a) Phytates and lectins don't exist
  • b) The mechanistic concerns are real but ordinary cooking and preparation address them, and the outcome evidence goes the other way
  • c) Nobody has studied it
  • d) Grains contain no phytate
Answer **b.** Both chemical facts are true. Phytate's effect is modest and reduced by soaking, sprouting, fermenting, and cooking; lectins are largely destroyed by cooking. And the people eating the most whole grains and legumes have better outcomes — a rung 1 mechanism losing to rung 5–6 evidence.

12. Sugar alcohols cause digestive symptoms because they:

  • a) Are toxic
  • b) Are poorly absorbed, so they draw water into the bowel osmotically and get fermented in the colon
  • c) Kill gut bacteria
  • d) Raise blood glucose sharply
Answer **b.** Which is why sugar-free confectionery carries laxative warnings. Erythritol is best tolerated because it's absorbed in the small intestine and excreted largely unchanged in urine.

13. "Net carbs" is:

  • a) A legally defined term with a standard calculation
  • b) A marketing term with no US legal definition, calculated inconsistently, and generous with sugar alcohols that are actually absorbed
  • c) The most accurate way to assess a food
  • d) Required on all Nutrition Facts panels
Answer **b.** The logic is partly sound — fiber and poorly-absorbed polyols genuinely don't become glucose — but there's no legal definition, and maltitol in particular is meaningfully absorbed while being subtracted in full.

True / False

One-line justification.

14. Since starch digests to glucose, white rice is nutritionally equivalent to table sugar.

Answer **False.** Chemically similar, nutritionally different. The claim ignores everything in §7.3 — structure, fiber, micronutrients, eating rate, satiety, and what the food is eaten *with*. Rice eaten with beans and vegetables behaves nothing like a spoonful of sugar.

15. Whole fruit should be limited because of its fructose content.

Answer **False.** Whole fruit comes with fiber, water, volume, and intact cell structure that slow everything down, and fruit intake is associated with better outcomes essentially everywhere it's been examined. The fructose argument applies to *liquid and refined* sources — Chapter 18 handles it properly.

16. All whole-grain oats produce the same glucose response.

Answer **False.** Steel-cut, rolled, and instant oats are all genuinely whole grain — the subtraction hasn't happened — but particle size differs enormously, and finer grinding means faster enzyme access. Intact-versus-refined is a **continuum**, and "whole grain" only tells you about one end of it.

17. A person with type 2 diabetes and a metabolically healthy person should both be equally concerned about post-meal glucose excursions.

Answer **False.** Genuinely important in diabetes and prediabetes; currently unsupported as a concern in metabolically healthy people, where there's no trial evidence that flattening the curve improves any hard outcome.

18. Erythritol has been shown to cause cardiovascular events.

Answer **False**, and the honest answer is *we don't know*. The 2023 study found an association in a high-risk cohort plus mechanistic platelet findings — but people with metabolic disease are precisely the people who use sugar substitutes, and the body produces erythritol endogenously, so blood levels aren't a clean readout of intake. Verdict: 🟡.

Short Answer

19. Camila's colleague told her to cut rice because it spikes blood sugar. Write the response you'd give — accurate, brief, and not dismissive of either woman.

Answer Something close to: *"White rice does digest quickly, so she isn't wrong about the mechanism. But rice eaten with beans, vegetables, and protein behaves very differently from rice eaten alone, and cutting it costs you money, time, and a dinner Alma will actually eat — in exchange for a benefit that isn't there. If you want an easy improvement, put beans alongside it: about forty cents, more fiber and protein, and nobody has to cook anything new. And the honest answer about the tiredness is the night shifts, not the rice."* The three moves that matter: **concede the true part**, **name the real cost of the change**, and **redirect to the actual cause** rather than letting a food take the blame for a sleep problem.

20. Explain why the intact/refined axis predicts outcomes better than the simple/complex axis, using the four-food eating-rate comparison.

Answer Simple/complex classifies by **molecular chain length**; intact/refined classifies by **how much physical structure survives**. Structure is what determines enzyme access, gastric emptying rate, satiety signalling, and — critically — **how fast you can eat the food.** 300 kcal of apples is three large apples, fifteen to twenty minutes of chewing, and most people stop early. 300 kcal of apple juice is 600 ml in two minutes with no chewing. 300 kcal of steel-cut oats takes ten minutes and empties over hours; 300 kcal of cornflakes takes four minutes and leaves you hungry by ten. Same category, same energy, radically different eating rate, satiety, and subsequent intake. That's a mechanism you can verify on yourself, and it's why the axis works.

Applied Scenario

21. A patient with an HbA1c of 6.1% (prediabetes range) arrives having read that all carbohydrate must be eliminated. Their diary shows 290 g/day: white bread twice daily, a large orange juice, a sports drink at the gym, white rice most evenings, occasional fruit, and almost no legumes or whole grains. They cook for a family and have a modest budget.

What do you recommend, and — importantly — what do you not recommend?

Answer **What I would not do first: eliminate carbohydrate.** Not because low-carbohydrate approaches don't work for prediabetes — they have real evidence for glycemic control (Chapter 26) — but because this person's problem is overwhelmingly **type and form**, not quantity, and there's a much cheaper, easier, more sustainable intervention available before we ask a family to restructure how it eats. **In order of yield:** 1. **The liquid carbohydrate.** Large orange juice plus a sports drink is likely 60–90 g of rapidly absorbed sugar with essentially no satiety return, and the sports drink is being consumed by someone whose training doesn't require it. **This is the single largest and easiest win**, and it doesn't affect the family's meals at all. 2. **Swap the bread.** Twice daily white bread → a genuine wholemeal with 3 g+ fiber per slice. Same habit, same cost bracket, same convenience. 3. **Add legumes to the evening meal**, two or three nights a week, alongside the rice rather than replacing it. Roughly forty cents a serving, large fiber and protein gain, and the rest of the family eats the same dinner. 4. **Keep the rice**, and mix in brown or use brown when it's easy. Not a lifestyle change. 5. **Fruit stays.** More of it, if anything. **Then the things that aren't carbohydrate at all:** their HbA1c will respond to weight change, physical activity, and sleep, and a walk after the evening meal has better evidence for glycemic control than any of the swaps above. **Prediabetes is where diet and activity together produce the strongest results in the entire nutrition literature** (Chapter 26's DPP evidence), and treating it as purely a carbohydrate problem misses most of the effect. ⚠️ **And route them properly.** An HbA1c of 6.1% warrants ongoing monitoring with their physician, and if they later choose a low-carbohydrate approach while on any glucose-lowering medication, that needs medical supervision because doses may need adjusting.

Scoring

Score Reading
18–21 Strong. The intact/refined frame is in place.
14–17 Good. Reread §7.3 and §7.6.
10–13 Reread §7.2–§7.4 and do Exercise C2 — sorting your own diary is what makes it stick.
Under 10 Reread the chapter. Chapters 11, 18, and 22 build directly on it.