Carbohydrates: What You Need to Know Now
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Become a Carb Expert
Along with the diagnosis of diabetes comes a new vocabulary. One of the most frequently used -- and misunderstood -- terms is "carbohydrate."
"Confusion about carbohydrate still reigns," says Johanna Burani, R.D., CDE, author of Good Carbs, Bad Carbs: Lose Weight and Enjoy Optimum Health by Eating the Right Carbs (Da Capo Press, 2004). "People I counsel are surprised to learn milk, yogurt, and fruits contain carbohydrate and are convinced that pasta, bread, and ice cream 'turn to sugar' and shouldn't ever pass their lips again." Yet carbohydrate is essential for good diabetes nutrition, experts say. Come along as we unscramble the carb puzzle.
Foods with Carbohydrate
Think of foods as packages of various nutrients. "No one food has all the nutrients your body needs, which is why eating a variety of foods helps you meet your nutrition needs," says nutritionist Johanna Burani.
The three main nutrients are carbohydrate, fat, and protein. Most of the calories in the following foods are from carbohydrate.
- Starches: bread, cereal, pasta, whole grains
- Starchy vegetables: potatoes, corn, legumes (beans)
- Fruit and fruit juice
- Nonstarchy vegetables: green beans, tomatoes, lettuce
- Dairy: milk, yogurt
- Sweets: ice cream, chocolate, regular soda, candy
What Are "Good" Carbs
What makes a good carb? A concentration of vitamins, minerals, and fiber -- nutrient-dense foods that help you avoid empty calories. Often, similar-size servings of two carb-containing foods have about the same amounts of calories and carbohydrate, but one may be a better choice nutritionwise. For example, 1/2 cup of orange juice with pulp (fiber) and enhanced with calcium offers more nutrition than 1/2 cup of orange drink, which gets most of its calories from added corn syrup.
Your goal should be to choose carbohydrate-containing foods that offer vitamins, minerals, and fiber -- what dietitians call nutrient-dense foods. Nutritionist Johanna Burani encourages people to eat foods she calls "tricklers," which slowly raise blood glucose after eating -- whole grain, unprocessed, and fiber-filled foods rather than refined starches and sugar-added foods and drinks that contain negligible nutrients and lots of calories.
Why Carbs Matter
Why focus on carbs when you have diabetes? Because the carbohydrate in foods has the most impact on blood glucose, especially shortly after you eat. Eating carbohydrate causes your blood glucose level to increase.
"Most people with type 2 diabetes who don't take insulin can use what dietitians call basic carb counting," says Karen Bolderman, R.D., CDE, PWD type 1. "You learn the foods that contain carbohydrate and how much carb to eat each day." You want to eat enough carbohydrate to fuel your body, but not more than the insulin your body produces can handle.
"Advanced carb counting helps people who take insulin several times a day (with multiple daily injections or a pump) learn to adjust their premeal rapid-acting insulin dose based on their blood glucose level and amount of carb they're going to eat," Bolderman says.
What Is Carb Counting?
Carb counting is a method of diabetes meal planning used widely since insulin was discovered. This method doesn't prescribe a certain amount of carbohydrate to eat. It's a way to include healthful carbohydrate-containing foods, plan meals that contain sufficient carbohydrate, and fit in a wide variety of foods you enjoy (even sweets), all while you control blood glucose levels.
What's the difference between carb grams and carb choices? They're essentially the same. The concept of carb choices morphed from the diabetes exchange system, which recommends a balanced eating plan using all food groups. In that system, one starch, fruit, or milk exchange contains, on average, 15 grams of carbohydrate.
Most people, however, read food labels and use nutrient databases to count carb grams. Counting carb grams is more accurate, which is particularly important if you're determining doses of rapid-acting insulin.
How Many Carbs to Eat
Dietitians agree that the following starting points for carb grams or choices per meal work for many people. Don't severely limit or avoid carbohydrate to control blood glucose -- you'll compromise your healthful eating plan and be less likely to control your blood glucose or long-term weight. A note about the list below: If you are of average size your carb counts per day and per meal are between the small and large sizes (for example, an average size woman should eat 45-60 g carb per meal).
Carb Counts per Day
Smaller Woman: 135 g carb. or 9 carb choices
Larger Woman: 180 g carb. or 12 carb choices
Smaller Man: 180 g carb. or 12 carb choices
Larger Man: 225 g carb. or 15 carb choices
Carb Counts per Meal
Smaller Woman: 45 g carb. or 3 carb choices
Larger Woman: 60 g carb. or 4 carb choices
Smaller Man: 60 g carb. or 4 carb choices
Larger Man: 75 g carb. or 5 carb choices
1 carb choice = 15 grams of carbohydrate
Both the American Diabetes Association and the U.S. government's Dietary Guidelines suggest eating 45-65 percent of your calories from carbohydrate sources. If you eat less carbohydrate, especially if you eat fewer than 1,500 calories a day, you won't get the nutrients you need.
Improve Your Carb-Counting Accuracy
A few tried-and-true suggestions from the experts -- dietitians and people with diabetes (PWDs):
- Check the carb count on the nutrition facts label against the serving size. Is this the amount you eat? "When I began to focus on portion control, I realized my portions were huge," says Kelly Cupp, 44, PWD type 2, who has lost 50 pounds.
- Visualize, visualize, visualize. "At home, weigh and measure the common items you eat -- potatoes, rice, dry or cooked cereal. Then you'll better recognize the right portions at home and when you eat out," says author Karen Bolderman, R.D., CDE, PWD type 1.
- Write it down. Use a permanent marker to note the serving sizes and carb counts on the sides of boxes and cans in your pantry. "You'll see at a glance how much to count," says Kelly Rawlings, PWD type 1, editor of Diabetic Living magazine.
The Low-Carb Diet Debate
Research on low-carb diets has revealed no benefits for controlling weight, blood lipids, or blood glucose, especially when followed for longer than six months. Still, there's much debate about carbohydrate's role in diabetes eating plans. Advocates span the carbohydrate continuum -- from the low side, such as an Atkins diet, to a higher-carb, no-animal-products approach, such as veganism.
But one thing shouldn't be ignored: "Studies show that when people with diabetes cut back on carbohydrate, they eat more fat, often the unhealthy saturated fat, which has been shown to contribute to insulin resistance and less-well-controlled diabetes," says Marion Franz, R.D., CDE, a nutrition and diabetes consultant from Minneapolis.
Weight loss studies also discount low-carb diets (under 135 grams of carbohydrate daily). The food plan shown to truly work for weight control is eating less fat and getting about half of your total daily calories from carbohydrate.
"The American Diabetes Association reinforces the importance of zeroing in on an amount of carbohydrate that is healthy and meshes well with your food preferences and eating style for the long haul," Franz says.
Why Low-Carb Isn't a Wonder Cure
Following a healthy meal plan is essential for living well with diabetes. However, it might not be enough to keep you from needing blood glucose-lowering medications. Because of the natural progression of both pre-diabetes and type 2 diabetes, by the time most people are diagnosed with type 2, they've been losing insulin production progressively for five to 10 years and less than half of their insulin-producing cells are working. Eating fewer carbs does nothing to halt this process, and eventually blood glucose-lowering medications are required.
In fact, the American Diabetes Association now recommends that people diagnosed with type 2 diabetes begin taking at least one medication right away. To avoid complications, immediate control of blood glucose levels is key. "Studies show it's the total amount of carb you eat mixed with your available insulin that impacts your after-meal blood glucose levels," nutritionist Marion Franz says.
Carb-Counting Resource: Nutrition Labels
The most accurate information is at your fingertips -- and it's free. Read the food package for the total carbohydrate grams (pay no attention to the grams of sugars because they're factored into the grams of carbohydrate). If the fiber count is higher than 5 grams per serving, subtract half the number of fiber grams from the total carbohydrate grams to get your carb count.
Carb-Counting Resource: Books
Books can be very helpful to have with you all the time, or at least in your kitchen. A variety is available to help with carb counting and provide nutrition values for restaurant foods.
Start with these books:
- The Diabetes Carbohydrate & Fat Gram Guide by Lea Ann Holzmeister, R.D., CDE (American Diabetes Association, 2006)
- The Doctor's Pocket Calorie, Fat & Carbohydrate Counter by Allan Borushek (Family Health Publications, 2001)
- Guide to Healthy Restaurant Eating, fourth edition, by Hope S. Warshaw, R.D., CDE (American Diabetes Association, 2009)
- Nutrition in the Fast Lane: The Fast-Food Dining Guide (Franklin Publishing, 2006)
Carb-Counting Resource: Web Sites and Applications
The Internet can be your first source for any information you seek. Try these helpful carb-counting Web sites and applications.
- Search the U.S. Department of Agriculture's nutrient database of 8,000 foods: nal.usda.gov/fnic/foodcomp/search
- Search a database of more than 50,000 foods: calorieking.com
- Enter one day's worth of food and analyze it for diet quality, and find links to nutrient information: www.mypyramidtracker.gov
- Find healthier substitutes for favorite foods in the 5,000-food database from the American Diabetes Association: diabetes.org/myfoodadvisor
- See restaurants that offer better-for-you menu items: healthydiningfinder.com
- Track3 is a diabetes-focused, 50,000-food database on a handheld device ($80): track3DMD.com; buy at dmd.coheso.com
- Food & Fitness Tracker iPhone food, calorie, and exercise tracker (free): sparkpeople.com; download at itunes.com
- Lose It! iPhone weight loss application (free): fitnow.com; download at itunes.com
- Tap & Track iPhone calorie, weight, and exercise tracker ($2.99): nanobitsoftware.com; buy at itunes.com