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Counting Carbs
Can Improve Your Control

by Lynn Bailiff

What are carbohydrates?
Carbohydrates include starch, sugars and fiber. Many years ago, people with diabetes were told to stay away from sugar, but little attention was paid to the other carbohydrates consumed. We now know that watching the total carbohydrate content of food, not just the sugar content, is more important for achieving blood sugar control.

What foods contain carbs?
Loaf of breadSometimes it is easier to start by identifying foods that do not contain carbohydrates. Protein foods such as meat, fish, eggs and cheese as well as fats such as butter, margarine, oil, olives and avocados contain minimal or no carbohydrate. Remember that adding breading or a sweet sauce like barbeque or teriyaki to meats or seafood will add carbohydrates to these foods. Bread, cereal, rice, pasta, crackers and other grain products contain carbs. Starchy vegetables like potatoes, corn, peas, and dried beans also contain carbs. And
don’t forget about milk products and fruit. They contain carbs, too. There is a diabetes myth that skipping a slice of cake and having fruit instead is better for your blood sugar. It may be, but it depends on the portion size of your dessert. A small piece of cake will have less carbohydrate than a huge apple. Read on for more details.

How much of what I eat should come from carbs?
It depends. Approximately 45-65 percent of calories should come from carbohydrates. The amount that is right for you depends on your diabetes goals, preferences and lifestyle. For example, if tests indicate that your triglycerides (a form of cholesterol in the blood) are elevated, you may benefit from eating less carbohydrate (45 percent of your calories) and eat more calories from healthy fats. Conversely, if you are from an ethnic background in which the diet is traditionally high in carbohydrates from pasta or rice, it may be more realistic for you to consume 65 percent of your calories from carbohydrates. A meeting with a registered dietitian (RD), in particular someone who is also a certified diabetes educator (CDE), can assist you with setting the carbohydrate goal that is right for you.

What about low carbohydrate, high protein diets?
Such diets are not recommended by professional organizations for people with diabetes. The Recommended Dietary Intake for carbohydrate is 130 grams or more per day for all Americans older than 1 year of age. Consuming a variety of foods including fruits, vegetables, dairy products and grains is needed to provide the body with adequate vitamins and minerals. Adequate carbohydrates are also needed to provide the body with the fuel it prefers. In particular, the brain needs carbohydrates to function well.

AppleWhat is carb counting?
The first step of carbohydrate counting is to establish a carb target for each meal. For most people it will be between 30 and 75 grams per meal and 15 to 30 grams for a snack (if snacks are eaten). Next, you add up the grams of carbohydrate you eat to be sure that you reach the target. Think of it like money. If your carb target for breakfast is 60 grams, you want to spend all 60 grams on the food that you eat. Your goal is to be within 5 grams of your goal, so for this meal you want to have between 55 and 65 grams of carb. Add up what is on your plate. If you have more than 60 grams, you have spent too much and you should put some food back or else you will go into debt. If you have not spent all 60 grams, you need more carbs.

How can carb counting improve my blood sugars?
The carbohydrate you eat affects your blood sugar level after the meal or snack. Consuming a consistent amount of carbohydrate at the same meal or snack every day will help to minimize fluctuations in your blood sugar. If you have type 1 diabetes or type 2 diabetes treated with insulin or a medication that stimulates your insulin production, your medication dose will balance a certain amount of carbohydrate. If your medication dose stays the same every day, so should your carb intake. More carbohydrate with the same amount of medication will cause your blood sugar to rise. If you eat less carbohydrate but take the same amount of medication, your blood sugar will be lower, which can lead to hypoglycemia. For individuals who have type 2 diabetes treated by diet and exercise alone, or with other medications that cannot cause hypoglycemia, it is still important to be consistent with your carbs. Eating too little carb at a meal may cause you to be hungry later in the day, which may cause you to overeat leading to high blood sugar.

How do I know the amount of carbs in my meals and snacks?
You can identify the amount of carbohydrate in foods in several ways. If there is a label on the item, that is the best place to look. If you need assistance with reading food labels, have someone assist you. Then keep the information in a format you can refer back to later. Using a recipe box to file cards with this information in Braille or large print is an easy and economical approach. You want to know the serving size (in an amount you can measure) on the label and the amount of “total carbohydrate” in grams. The “sugar” listed on the label does not matter because it is already counted in the “total carbohydrate”. So, you do not need to look at the grams of sugar. Total carbohydrate is more important. You will need to measure your portion sizes so that you can count your carbohydrates accurately. When you are at home, use measuring cups. Over time, you will be able to estimate your portions visually or by touching the food on your plate. Don’t hesitate to use your fingers.

What happened to the exchange lists?
If you are familiar with the exchange lists, you can still use them to count your carbohydrates. Items on the starch, fruit, starchy vegetable and milk lists contain 15 grams of carbohydrate (or one carb choice) per serving listed.

What about eating out?
When you are eating out, use the information you have learned at home to estimate the carbs you are eating. Also, don’t hesitate to ask your server for information about how foods are prepared. Fast food restaurants have nutrition information available online or by calling their corporate headquarters. There are also many books on the carb content of food available at your local bookstore. We are working to have some of these available in alternative formats.

How about fiber?
The RDI for fiber is 14 grams for every 1,000 calories consumed per day. This translates to approximately 21 grams/day for women and 25 grams/day for men. The vast majority of Americans eat less than 15 grams of fiber each day. Some studies have shown that eating an extremely high fiber diet (50 grams fiber or more) each day had a significant impact on glycemic control. However, such an eating pattern was found to be difficult to maintain because every food eaten had to be high in fiber, the overall diet was not very tasty and there were pronounced gastrointestinal side effects. So, it would be best to start by working towards achieving the fiber intake goals outlined in the RDI.

Lynn BaillifAbout the Author
Lynn Baillif has been a registered dietitian for 15 years and a certified diabetes educator for 7 years. She has been a member of the National Federation of the Blind since 1987 when she was a national scholarship winner.