Should You Cut Back on Carbohydrates?
That would seem to make sense. After all, the major types of carbohydrate--sugars and starches--both break down into glucose and are the main source of blood sugar, making them an important target of dietary control. But carbohydrates are also the body's primary source of energy, so they play a critical part of any healthy diet. According to the American Diabetes Association, carbohydrates should account for up to 60 percent of your total diet. Why so much? It's mainly a calorie issue. One gram of carbohydrate contains only four calories, while a gram of fat contains nine calories. That means, gram for gram, you can eat more than twice as much carbohydrate as fat for the same number of calories. A carb-based diet allows you to eat larger quantities of food and therefore a greater variety of foods (both nutritionally and taste-wise) even if you're restricting your total calories.
But shouldn't sugars be avoided? The answer is yes, but only because they often come in packages that are high in fat and low in vitamins and minerals: desserts, candies, and baked goods, for instance. Otherwise, there's nothing inherently wrong with sugars (sometimes called simple carbohydrates because their chemical structure consists of only a few molecules that are easily broken down during digestion). Milk contains sugar (called lactose) and so does fruit (fructose), and there's no reason to ban these foods. There's even room for sucrose (table sugar) and sweets in your diet, as long as you eat them in small amounts.
That makes starches, or complex carbohydrates, the main staple of your diet. Starches lack the sweetness of sugars but are found in some of the most nutritious foods you can eat, including beans, potatoes, pasta, rice, whole-grain breads and cereals, and vegetables like broccoli, carrots, corn, and peas. Starches not only are energy powerhouses, they're rich in vital nutrients, such as vitamins and minerals.
Counting Carbs: An Easy Solution
One of the most useful tools for controlling your caloric intake and blood sugar at the same time is carbohydrate counting. This method has recently become a favorite of dietitians since researchers discovered that all types of carbohydrates, whether sugars or starches, are converted into glucose and released into the blood at about the same rate--within an hour or so of eating. (Fat and protein are eventually broken down into glucose too, only at a much slower rate.) So the level of glucose in the blood after a meal is determined primarily by the amount (not the type) of carbohydrate consumed.
This makes following a meal plan relatively easy because you can control the amount of glucose entering your body by simply counting the grams of carbohydrate you ingest--information that's printed on every package of food you buy. This approach is particularly useful to people with type 1 diabetes or those with type 2 who must take insulin because it allows more precise matching of insulin doses to glucose intake.
To start you out on a carbohydrate-counting plan, your dietitian will first come up with the number of carbohydrates that you should eat at every meal and snack based on your individual calorie needs. Ideally, carbohydrates should make up 50 to 60 percent of your daily calorie intake. You then have flexibility in choosing the foods you like in order to hit your target. A similar program of fat-gram counting can be helpful for people with type 2 diabetes who are trying to lose weight.
Your dietitian can provide carb-counting food lists, or you can find more extensive lists in books. But a general rule of thumb is that one serving of starch, fruit, or milk contains about 15 grams of carbohydrate; vegetables, 5; and meat and fats, none. Unfortunately, that doesn't mean you can load up on meat or eat the same three carbohydrates at every meal; you still need to aim for variety and balance. Try to spread your carbohydrate intake evenly throughout the day so the amount of glucose released into your blood is fairly consistent from meal to meal.
Why You Need Fiber
Fiber, an indigestible complex carbohydrate found in plant foods, such as bran, broccoli, oatmeal, and whole grains, should be part of your diet for a number of reasons--primarily because it slows the rise of blood sugar after a meal. Soluble fiber (one of two main types, found in oats, citrus fruits, and other foods) mixes with food and water to form a gooey gel that slows digestion and makes blood sugar enter the bloodstream more gradually. In one study, people with type 2 diabetes who got 50 grams of fiber in their diet every day for six weeks (after starting with six weeks of 25 grams, the amount recommended for the general population) brought their blood-sugar levels down by about 10 percent.
In addition to lowering blood sugar, soluble fiber helps lower cholesterol, reducing your risk of cardiovascular disease. Insoluble fiber (the other type) improves overall digestive function by helping waste move through your system. What's more, fiber adds bulk to food, which makes you feel full without adding a single calorie.
Factoring in Fat
Fat is usually seen as a dietary evil, mainly because it's so dense in calories and a known contributor to heart disease. But fat also has important roles to play in the body, such as helping to form cell membranes, distributing fat-soluble vitamins, and insulating the body against heat loss. And there's an upside to fat for diabetics: It slows the digestion process, which means that glucose enters the blood more gradually. As a result, fat should play a bigger role in your diet than you might assume--making up as much as 25 to 30 percent of total calories.
But watch out--there's a caveat. The type of fat you eat makes a difference. According to the American Diabetes Association's 2002 dietary recommendations, less than 10 percent of your diet should consist of the kind of fat we're likely to eat most--saturated fat. Found in animal-based foods like meat and eggs and in dairy products like butter, saturated fat tends to raise levels of LDL ("bad") cholesterol and is associated with an increased risk of cardiovascular disease, thus magnifying the metabolic problems that worsen diabetes. What's more, foods that contain saturated fat are often loaded with cholesterol, which can also raise LDL levels.
But if you eat only small amounts of saturated fat (easily recognized because it usually stays solid at room temperature), where should the rest of your fat calories come from?
The answer is monounsaturated and polyunsaturated fats, neither of which raise your levels of bad cholesterol. Monounsaturated fat is especially recommended because it actually raises levels of good cholesterol, making it the best source of fat in your diet. (Polyunsaturated fat, found in such foods as corn oil, safflower oil, and mayonnaise, ranks second because it's been shown to lower levels of good cholesterol.)
According to the ADA, monounsaturated fat may also reduce insulin resistance. These fats are so good for you that the ADA says either monounsaturated fat or carbohydrates can be eaten in place of saturated fat. In fact, either one can make up as much as 60 to 70 percent of your total calories. This allows you even more latitude when planning your meals, especially if you eat an ethnic diet. For example, a person who eats an Asian diet may prefer a diet high in carbohydrates like rice, while someone who eats a Mediterranean diet may want more calories from foods like olive oil. Both are allowed. But remember: Even monounsaturated fat is rich in calories, so don't go overboard, especially if you're trying to lose weight.
Last and Perhaps Least: Protein
Getting the right amount of protein isn't difficult if you're already controlling your fat and carbohydrate balance--protein will account for the rest of your calories. You need protein to build and repair tissues and ensure the proper functioning of hormones, immune-system cells, and hardworking enzymes throughout the body. But it doesn't have to be the major dietary staple many people assume it should be. In fact, for most people with diabetes, only 10 to 20 percent of calories should come from protein. You can easily get all you need in just a few servings of protein-rich foods, such as meats, fish, dairy items, and plant foods like beans, nuts, and soy products. Smaller amounts are also found in vegetables and grains.
Most Americans already get far more protein than necessary, which raises issues when you have diabetes. One concern is that because the body excretes excess protein, eating more than you need makes your kidneys work harder. Diabetes already increases your risk of kidney damage, and some doctors believe that eating too much protein can lead more quickly to kidney complications. A number of studies have suggested that this is the case, but a large study reported in The New England Journal of Medicine in 1994 found that a high-protein diet didn't impair
kidney function any faster than a low-protein diet. Because the kidney question remains unresolved, doctors and dietitians are cautious about your taking in more than the recommended amount of protein.
When you do eat protein, about a third to half of it is converted to glucose for energy--far less than carbohydrates but more than fat. Protein is digested slowly compared to carbohydrates, causing a more gradual rise in blood sugar.
From Reader's Digest Stopping Diabetes in its Tracks. Buy this and other books at the Reader's Digest Store.
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