One of the most common and health-undermining problems I see in my patients, especially those in middle age and older, is eating too many carbs for what their bodies can metabolize. And it’s a problem that’s hardly confined to my practice. The total amount of calories that Americans consume hasn’t appreciably gone up since the ‘80s when the national waistline began to dramatically expand. But the amount of carbs we take in, especially in the form of sugar added to the processed and junk foods we’re drowning in, has. It doesn’t take a genius to connect the dots.

But here’s the tricky part. It's different for everyone and some of my patients who are eating too many carbs for their metabolism, aren’t appreciably overweight. But they’re suffering from a host of symptoms that are driven by the systemic inflammation that a carb-heavy diet can promote – fatigue after meals, brain fog, constant hunger or cravings for sweets, skin rashes. The list goes on.

So how do you get a handle on the carb monster?

Insulin resistance – or what you don’t see in the mirror

Whether you’re overweight or not, your carb issues are likely related to what we call “insulin resistance.” The body, specifically the pancreas, produces this hormone to take sugar out of the bloodstream and deliver it to the muscles or to fat cells for storage. But if we’re constantly bombarding our systems with high-carb foods, insulin levels have to stay high to get the job done. Over time, the cells in the body begin to lose their sensitivity to insulin, to become resistant. And insulin resistance drives inflammation which can show up in symptoms popping up most anywhere, everything from brain fog to skin rashes to joint pain to PCOS (polycystic ovary syndrome). Left unchecked, high insulin levels can simply wear out the pancreas’ ability to produce enough insulin. So then your blood sugar levels creep up into the prediabetic and finally the diabetic zone. That’s an all-too-common health disaster. According to the latest CDC stats, nearly half of American adults are either prediabetic or diabetic.

Know yourself and your carb sensitivity.

People vary quite a bit in their ability to process carbs so the onus is on you to figure out where you sit on the carb spectrum. You can get a fair picture of how well or poorly your body is doing on your current diet – how carb intolerant you are – by getting a hemoglobin A1c test (HbA1c) at your next doctor’s visit. Anything over a 5.4 reading is a big red flashing light. But what mainstream doctors sometimes ignore is metabolic syndrome. In other words, your blood sugar or HbA1c levels may not be scary high but a lot of your health measurements are up in the high-normal zone: waist size, blood pressure, and triglycerides. That’s a strong suggestion your that body's working overtime to produce extra insulin to handle the carb overload and to keep your blood sugar levels in check. And while these kinds of numbers can all be useful guides, don’t forget to tune into your body to pick up the signs that too many carbs may be pushing you into the inflammation zone. I’ve mentioned some common symptoms, but in addition, here are a few more questions to ask yourself:

1. Do you tend to gain weight around the middle and in the face?
2. Do you have a hard time controlling how much carb and sugar-heavy foods you eat? Do you turn to those foods when you’re depressed, tired or anxious?
3. Do you feel like you must eat every 3-4 hours or else you get shaky or irritable?
4. Do your energy levels rise and fall in a big way throughout the day?

I think it’s pretty clear what the answer to all these ills should be -- cutting back on carbs! How aggressively you should restrict your carb intake will depend on your degree of carb intolerance.

Tried-and-true, carb-trimming tricks.

In short, just about everyone will benefit from dropping carbs down a few notches in their nutritional mix. How to do that? Start by becoming more conscious of how many carbs are in a serving of your favorite, go-to foods – the numbers may surprise you. From there take the following tips to heart:

Lose the obvious bad actors.

I don’t care what kind of metabolism you may have been blessed with. Especially as you push into middle age and beyond, ditch the added sugar (especially watch out for sugar-loaded commercial drinks, including fancy coffees), the baked goods, the bread, the processed foods. And nix to the fake sugar – the Splendas and the Sweet ‘n’ Low. Rocket science, it ain’t.

Embrace the veggies.

Every meal, including breakfast (if you eat it), should be an invitation to pile on the veggies, leafy greens and the cruciferous veggies (broccoli, etc.) especially. Low in calories, high in fiber, vitamins, minerals, phytochemicals, what’s not to like!

Love the healthy fats.

We’re talking about the fats in extra virgin olive oil, avocados and nuts and seeds -- delicious and satiating. If you choose to go ultra-low-carb, as with the keto approach, these fats can replace carbs as the body’s main energy source.

Yes to clean protein.

Choose grass-fed and finished beef; wild-caught fish and oily, bottom-of-the-food-chain fish like sardines and anchovies; local and/or certified pastured chickens and their eggs. Your body needs protein and the saturated fat that comes with the animal-food package is tasty and, in non-crazy amounts, good for you.

Be selective with fruit.

Dried fruit and fruit juices are sugar-bombs so leave well enough alone. Go with natural low-sugar fruits, for instance, in the berry family, and steer clear of high-sugar varieties like pineapple, melons and mangoes.

Trade up.

There are plenty of people don’t want or need to go super-low-carb and whose metabolisms can handle a moderate amount of carbs. They can still massively upgrade their diets by cutting back on the grains and replacing them with some legumes and starchy vegetables like sweet potato and butternut squash, as well as “ancient grains” like quinoa, wild rice and buckwheat which aren’t grains at all but rather seeds. Another bonus? You’ll lose the gluten in the process.