Oh, those refined carbs. New research finds that there are healthy carbs and then there are not so healthy carbs — aka refined carbs. Bottom line, it's the type of carbohydrate that is important in optimal health. The refined carbs — such as white bread, sugary beverages, snack foods and baked items — have been linked to health problems. Studies have found that higher intake of such carbohydrates is linked with a great risk of Type 2 diabetes and ischemic heart disease, while diets high in minimally processed carbohydrate sources, such as whole grains, vegetables, fruits and legumes, have been linked with a lower risk.

In a 2010 Danish study of more than 53,000 participants, published in the American Journal of Clinical Nutrition, replacement of saturated fat with high glycemic index carbohydrates (refined) significantly increased the risk of heart attack, whereas replacement with low glycemic index (minimally processed) carbs showed a lower risk.

We used to qualify "good" and "bad" carbs in terms of "complex" (which included starches like potatoes and bread) and "simple" meaning sugars, such as sucrose. But those descriptions don't fully portray the qualities of carbs. More useful indicators include the amount and type of fiber, the amount of processing and the glycemic load.

The best choices for carbohydrates are the whole foods or minimally processed — fruits, vegetables, beans and lentils, barley, wheat berries and quinoa. Try to make room for three servings of dairy, at least 2 cups of fruits, 1 1/2 cups of vegetables and three servings of whole grains every day, suggests Sharon Palmer, a registered dietitian with Environmental Nutrition. That allows an occasional refined serving of carbs to fit into a daily plan.

Here are some other recommendations from Environmental Nutrition newsletter:

1. Look for whole grains on labels for breads, crackers and cereals.

2. Try different whole grains such as barley, wheat berries and quinoa.

3. Eat a couple of pieces of whole fruit every day. Try to choose different types in various colors.

4. Limit highly processed foods such as baked goods, candies and sugary beverages.

5. Read food labels carefully to determine whether grains are refined and if sugars are added.

6. Try to include legumes — beans, lentils, peas and soy — on your menu at least a few times per week.

Q and A

Q: I heard that some people with "normal" weight or BMI actually have too much body fat that puts them at risk for chronic disease. Is that true, and if so, how would you know?

A: Yes, it is true. Some people have weight that falls within recommended ranges for body mass index, but a healthy BMI for any particular height often covers a range of about 30 pounds. So it is possible to be in the healthy range but have too much of that weight as body fat, especially if you've lost muscle with age, illness or inactivity. Emerging research shows that this problem, called metabolically obese normal weight or normal weight obesity, affects at least 25 percent of U.S. adults who have normal BMI. Although these people do not face health risks as great as people who are classified as obese, their rate of heart disease deaths and overall mortality rate are increased compared to people with a healthier body composition.

People with excess body fat in the abdomen seem especially at increased risk, because this fat is most metabolically active. It is linked with insulin resistance and promoting a chronic, low-grade inflammation throughout the body. In a recent study that followed about 3,000 women for five years, those with more fat deep in the abdomen (visceral fat) were more likely to have a heart attack or stroke or to develop cancer compared to the women with less visceral fat. These women all received computed tomography scans, a specialized type of X-ray that provides more detailed images of body structures than standard X-rays. Outside of scans like this, it's difficult to identify excess visceral fat specifically, but one simple indicator of abdominal fat is your waist size. Use a tape measure and compare your measurement to the American Institute for Cancer Research and the World Health Organization recommendation to aim for waist size no larger than 37 inches in men or 31.5 inches in women. If despite a normal BMI you've been gaining weight or if blood tests show elevations of triglycerides, blood sugar or high-sensitivity C-reactive protein, excess body fat may be at least partly responsible.

Discuss with your health care provider whether a check of your body-fat level with a health care or fitness professional trained in measuring body composition might be helpful. If you do have a waist measure above the healthy range or other signs of excess body fat, focus on getting moderate physical activity every day and use strength-training exercise to minimize loss of muscle tissue. At the same time, cut back on calorie-laden beverages; eat healthfully with meals centered around vegetables, fruits, whole grains and beans; and make sure that portion sizes satisfy hunger but don't leave you stuffed. These steps may add up to help you lose a few pounds and waistline inches. After four to six weeks, measure your waist and check to see if blood sugar and triglycerides have improved.

Information courtesy of the American Institute for Cancer Research.

Recipe

These Greek-Seasoned Steak Sandwiches, from Cooking Light magazine, include plenty of veggies as well as a yogurt-based sauce to keep the calories down and protein up.

Greek-Seasoned Steak Sandwiches

—3 tablespoons red wine vinegar, divided

—4 teaspoon extra-virgin olive oil, divided

—1 tablespoon minced garlic

—1 teaspoon dried oregano

—12 ounces flank steak, trimmed

—1/2 teaspoon kosher salt, divided

—3/8 teaspoon freshly ground black pepper, divided

—Cooking spray

—2 tablespoons plain fat-free Greek yogurt

—1/4 teaspoon Dijon mustard

—4 (6-inch) whole-wheat pitas

—Romaine lettuce leaves

—4 thin red onion slices

—1 cucumber, peeled and thinly sliced

—1 tomato, cut into 8 slices

Combine 2 tablespoons vinegar, 1 teaspoon oil, garlic and oregano in a large-zip-top plastic bag Add steak to bag; seal. Let stand at room temperature for 20 minutes, turning once. Heat a grill pan over medium-high heat. Remove steak from bag; discard marinade. Sprinkle 3/8 teaspoon pepper evenly over both sides of steak. Coat pan with cooking spray. Place steak in pan; grill 5 minutes on each side. Remove steak from pan; let stand 10 minutes. Cut steak across the grain into thin slices. Combine remaining 1 tablespoon vinegar, 1 tablespoon oil; 1/8 teaspoon salt; 1/8 teaspoon pepper, yogurt and mustard in a bowl, stirring with a whisk. Cut off one-third of each pita and discard. Arrange 1 lettuce leaf, 1 onion slice, 1/4 of cucumber slices, 2 tomato slices and 1/4 of steak in each pita; top each sandwich with 1 tablespoon yogurt mixture. Serves four, serving size, one sandwich.

Per serving: 313 calories, 23.3 g protein, 29 g carbohydrate,51 mg cholesterol, 4.5 g fiber, 517 mg sodium.

Charlyn Fargo is a registered dietitian from Springfield, Ill. For comments or questions, contact her at [email protected] or follow her on Twitter @NutritionRD. To find out more about Charlyn Fargo and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.