Nutrition Connection: Carbohydrates & Carb Counting

(reprinted from Dietary Manager, March 2009)

The nutrients we eat are divided into six groups: carbohydrates, lipids, proteins, vitamins, minerals, and water. Carbohydrates (CHO) are divided into two groups: simple and complex. Simple carbohydrates include glucose, sucrose, fructose, lactose, galactose, and maltose. All of the simple sugars end in “ose.” Complex carbohydrates are starches and fibers. Carbohydrates provide energy to the body in the form of glucose— also called dextrose—and glucose in the bloodstream is called blood sugar.

In the food supply, carbohydrates are found in every food group in the USDA’s MyPyramid, except oils. They are found in all varieties of grains, vegetables, and fruits; and in milk and yogurt in the milk group. While meat, poultry, fish, and eggs don’t contain carbohydrates, CHO is found in dried beans, peas, and lentils that serve as an alternate protein source.

The dietary roles of carbohydrates are to provide energy, spare protein, prevent ketosis, regulate blood glucose levels, and flavor or sweeten foods. According to the Dietary Reference Intakes (DRIs), 45-65 percent of total calories should come from carbohydrates. For a 2,000-calorie diet, that’s about 225-325 grams of carbohydrate. The minimum carbohydrate intake to spare protein and avoid ketosis is about 130 grams per day.

For a person with diabetes, regulating glucose levels is key. Over time the methods diabetics use to control blood glucose levels with foods have changed. At one time, diabetics were told to stay away from all simple sugars and a No Concentrated Sweets diet was used. Later, science learned that the total amount of CHO consumed is more important than the source of CHO. Sugar, fructose, corn syrup, and honey have no more effect on blood glucose levels than other carbohydrates. It is often recommended that portions of concentrated sweets should be kept to one CHO serving or 15 grams of CHO at a meal. Protein and fat have no effect on blood sugar levels and don’t need to be consistent day to day. However, the amount of protein and fat consumed does affect weight and possibly cardiovascular risk. Most adults need a total of six ounces of meat per day but consume much more, and thus many more calories than they need.

The diabetic exchange system has undergone changes in the number of food groups, how foods are listed, and the amount of food in an exchange. Diabetic diets with calorie levels specified are typically utilized with the exchange system. Currently the exchange system divides food into six categories: starch, fruit, vegetables, milk, meat, and fat. The serving sizes listed have similar amounts of calories, proteins, carbohydrates, and fats. There is a food list to help you see what category your food falls into. It’s called the exchange plan because it offers the flexibility to trade one food on the list for a similar food. For example, one slice of bread can be exchanged for 1/2-cup cooked oatmeal, or 3 cups popped popcorn, or 1/4-cup baked beans, since they are all equal to 1 starch serving.

Carbohydrate counting has become a popular way to provide the body with consistent amounts of carbohydrates, but allow more flexibility and variety of foods to be consumed. However, obtaining balanced nutrition can also be an issue if careful planning is not done since protein, fat, and calories are not monitored. Many vegetables contain very little carbohydrate and can be consumed in more liberal quantities before needing to be counted as a carbohydrate. Some vegetables are starches—potatoes, sweet potatoes, yams, corn, peas, pumpkin, winter squash, baked beans, cooked beans and peas, lentils, and refried beans— and will be counted as a carbohydrate when 1/4-1/2 cup is served.

In carb counting the goal is to keep the amount of carbohydrate consistent at each meal. Individuals can either count the grams of CHO or count CHO choices. CHO choices are determined by dividing the grams of CHO per serving by 15 to get CHO choices (see Table 1 below). For a 2,000-calorie diet, that’s 15-21 CHO choices per day.

Table 1

Doing this helps keep your blood sugar levels from going too low or too high. The diet is usually ordered as Consistent Carbohydrate or Carbohydrate Controlled in long-term care. Diabetics receive a meal very much like the regular diet, with the biggest difference being the portion size or number of carbohydrate foods at the meal (see Table 2 below).

Table 2

Special foods are not necessary and can be expensive for the diabetic. Sugar-free does not mean CHO-free and may have lower calories but more CHO than the regular product. Sugar-free, no sugar, reduced sugar, and lower sugar foods may be high in fat, calories, and even CHO, so read labels carefully.

Carbohydrate counting is easy with food labels, but it takes practice to be able to visualize the portions served when eating out. Some ways to make CHO counting more accurate when dining out include: practice measuring out portions of various foods at home so there is a visual of what a serving looks like; ask for rice or noodles to be served on the side instead of under or mixed into dishes so the quantity and CHO servings can be controlled; research ahead of time the CHO choices of foods commonly available at chain restaurants.

Summing it Up

In some respects the use of carbohydrates in the body is similar to the gas mileage you get in a car. The individual is driving along on cruise control and gets good mileage, or they are driving in rush hour traffic that’s stop and go and the gas mileage drops. When the body gets a consistent amount of CHO the glucose levels stay more consistent. When an individual eats a lot of CHO at once or not much CHO, the result is blood sugars that go up and down— resulting in not getting a smooth ride. The bottom line is to keep the amount of carbohydrates consistent throughout the day to keep blood sugar levels constant.

By Linda S. Eck Mills, MBA, RD, LDN, FADA

Linda S. Eck Mills, MBA, RD, LDN, FADA is a professional speaker, career coach, freelance writer, and author of the book From Mundane to Ah Ha! Effective Training Objects. Mills directs the ANFP Program at Lehigh Carbon Community College (Schnecksville, PA), and is a consulting dietitian. Contact her at LSMillsRD@aol.com or www.theconsultantsforum.com/eckmills.htm.