Читать книгу Complete Guide to Carb Counting - Hope S. Warshaw - Страница 3

Chapter 1:

What Is Carb Counting?

In This Chapter, You’ll Learn:

• Basic facts about carbohydrate

• Which foods contain carbohydrate

• How carbohydrate affects blood glucose

• About the meal planning approach called carbohydrate counting

Would you like to have a better sense of when your blood glucose is going to rise and be able to predict how high it might go today, tomorrow, or the next day? If your answer is YES, then carbohydrate counting—“carb counting” for short—might be an approach to planning your meals that works for you.

Carb counting is not a one-size-fits-all meal planning method. It is simply a method to help you plan and eat balanced meals and control your blood glucose level along with the other elements of your diabetes care plan, such as medications and exercise.

Why Count Carbs?

Foods contain varying amounts of carbohydrate, protein, fat, vitamins, minerals, and water. When you use carb counting, you focus on the carbohydrate in foods. Why is that? Because carbohydrate raises your blood glucose more—and more quickly—than the two other nutrients that provide calories—protein and fat (excluding alcohol).

Adding up the amount of carbohydrate in each meal and snack that you eat each day can help you keep your blood glucose at a steady level, adjust your insulin as needed (if you take it), and feel your best.

Variety: The Spice of Life

Carb counting also allows you to enjoy a wide variety of foods, as long as you eat about the same amount of carbohydrate at each meal and snack each day. The foods don’t need to remain the same, but the amount of carbohydrate should. When you eat about the same amount of carbohydrate at each meal, day in and day out, your blood glucose levels are more likely to fall into a steady pattern. That means better blood glucose control for you.

Carb Counting May Not Be Right for Everyone

As you learn more about carb counting in the pages ahead, ask yourself whether you think this approach will fit your needs and lifestyle. In Chapter 2 you’ll do a self-assessment to determine whether carb counting is right for you. There’s another self-assessment in Chapter 11 to help you determine whether you want or need to progress from basic to advanced carb counting. We’ll explain more as we go along—for now, it’s time to learn which foods contain carbohydrate.

Which Foods Contain Carbohydrate?

Most people tend to equate carbohydrate with starches. Starches, such as potatoes, breads, and pasta, do contain carbohydrate, but they’re not the only foods under the “carbohydrate umbrella.” Here is a complete list of the food groups whose calories come mainly from carbohydrate:

• Starches—bread, cereal, crackers, rice, and pasta

• Starchy vegetables—peas, beans, lentils, potatoes, and corn

• Fruit and fruit juice

• Nonstarchy vegetables—tomatoes, cauliflower, and carrots

• Dairy foods—milk, yogurt, and other dairy foods

• Sugary drinks—regular soda, fruit punch, sports drinks, and flavored waters

• Sweets—candy, cakes, cookies, and pies

After reading this list, you might wonder which foods do not contain carbohydrate. There are a few:

• meats (red meat, poultry, seafood, and eggs)

• fats (oil, butter, and nuts)

Although these foods that don’t contain carbohydrate won’t be part of your daily carb counting totals, you still need to pay attention to them. They contain calories and other nutrients that are also important to a healthy eating plan. You will learn more about protein and fats and how they affect eating plans in Chapter 4.

How Much Carbohydrate Is in These Foods?

The list of foods above includes general groups of foods that contain carbohydrate. But within each food group, there can be a wide range in the actual amount of carbohydrate in each food. For example, the amount of carbohydrate in dairy foods varies quite a bit. On average, 8 ounces of most cheeses contains about 8 grams of carbohydrate, whereas 8 ounces of milk contains 12 grams of carbohydrate.

You can see more examples of this in Table 1-1, and in Appendix 1 at the back of the book. As you learn more, and start using carb counting in your meal planning, you’ll rely on resources like these to help you determine the carb count in everything from apples to zucchini. For now, focus on the some common, simple foods and how they affect your blood glucose.

How Does Carb Counting Help with Blood Glucose Control?

Your blood glucose levels are related to the amount of carbohydrate you eat. If you regularly track the amount of carbohydrate you eat at a meal and check your blood glucose levels one to two hours after that meal, you’ll hopefully detect patterns. That’s what carb counting is all about. Monitoring the amount of carbohydrate you eat, and eating about the same amount at each meal, will help you keep your blood glucose levels on target throughout the day. This will help you feel your best and allow you to manage your blood glucose medication effectively.

In Chapter 3, we’ll talk more about the data you need to record, how to record it, and how to use your results.

What’s So Important about Controlling Blood Glucose Levels?

When you get and keep your blood glucose levels in your target ranges, you feel better. You also can help prevent and/or delay the complications of diabetes, such as heart, eye, and kidney problems. Think of blood glucose control like walking on a balance beam—you don’t want to fall off on either side. There are dangers associated with both high blood glucose and low blood glucose (if you are on certain diabetes medications), so you want to stay right in the middle. Hypoglycemia is another word for low blood glucose. Hyperglycemia is another word for high blood glucose.

Table 1-2 gives you the target blood glucose levels that the American Diabetes Association (ADA) recommends. Ask your health care provider what your target levels should be; yours may be different from the ones in the table for a variety of reasons. For example, a pregnant woman may have lower target levels and an older person at risk for hypoglycemia may have higher target levels.

Basic Facts about Carbohydrate

When you eat any type of carbohydrate, the body breaks it down into glucose (sugar) and releases the glucose into your bloodstream. With the help of the hormone insulin, the cells of your body then use that glucose as fuel for all the different types of work they have to do.

There are three categories of carbohydrate: starches, sugars, and fiber. Starches and sugars are the main contributors of carbohydrate to our foods. Fiber is also carbohydrate, but its impact on blood glucose can be different than that of other types of carb. There are many types of fiber. (For more information on fiber, see Fiber and Blood Glucose, later in this chapter.)

You may have heard the terms “simple carbohydrates” and “complex carbohydrates” before. These categories were used for many years to try to explain how various types of carbohydrate affected blood glucose in different ways. These terms are no longer used because recent research suggests that that our old understanding wasn’t accurate. We now know that once carbohydrate is broken down, the body doesn’t know whether the resulting glucose came from the carbohydrate in mashed potatoes or a piece of apple pie. All carbohydrate becomes glucose—the body’s preferred and primary source of energy.

If Carbohydrate Raises Blood Glucose, Should I Follow a Low-Carb Eating Plan?

Once you realize that carbohydrate is the nutrient in foods that raises blood glucose the most, you might jump to the conclusion that people with diabetes should steer clear of foods that contain carbohydrate. But that’s incorrect. For starters, any eating plan that drastically restricts a particular food or food group is not realistic in the long term. Restricting carbohydrate would limit foods like fruits, vegetables, and whole grains, which are essential for good nutrition. And your body still needs carbohydrate for energy.

In general, the ADA recommends an eating plan in which about 45–65% of your total daily calories come from carbohydrate. The exact grams of carbohydrate you eat will vary depending on your total calorie goal and a number of other factors.

There’s been a lot of talk in recent years about using low-carb meal plans to lose weight. Most of these plans restrict carbohydrate intake to the point where less than 40% of your total daily calories come from carbohydrate. The results from research on these low-carb weight-loss plans have been mixed, and the long-term effectiveness of low-carb eating plans hasn’t been shown. At this point, many diabetes experts conclude that there’s insufficient evidence to recommend low-carb diets, especially to people with type 2 diabetes. Beyond the question of long-term effectiveness, there are safety concerns about following such a plan over the long term, such as concerns about the progression of heart and kidney problems.

It is most important to consider the total calories that you eat every day if you are considering weight loss, so it can be counterproductive to focus on only whether the calories come from carbohydrate or protein or fat. Therefore, it is best to choose healthy carbohydrate sources, like fruits, vegetables, whole grains, and nonfat and low-fat dairy foods. You do want to limit the not-so-healthy carbohydrate sources, like foods that contain added sugars and sweets, because they contribute concentrated amounts of calories and fats and add little in the way of essential vitamins and minerals.

The best advice? Find a sensible and realistic healthy eating plan for you that is based on sound science. The eating plan should help you lose weight (if you need to) and, even more importantly, keep weight off the rest of your life.

What about Sugars?

First, let’s get a few facts straight. Note the plural on “sugars” in the header. The sources of sugars we eat number far more than just the white granular stuff. There are sugars that occur naturally in foods, such as the fructose in fruit and the lactose in milk. Other sugars—such as granulated sugar, brown sugar, and high-fructose corn syrup—are added to foods when they are baked, cooked, prepared, or processed. The most important thing to remember about sugars is that they are carbohydrate and will raise your blood glucose.

If I have diabetes, can I eat sugary foods and sweets?

The short answer is yes. People with diabetes can eat sweets, as long as you account for them in your eating plan and adjust your medications to respond to the extra carbohydrate. Carb counting can help you do this, and you’ll learn how in this book. (This may be a surprise—for many years people with diabetes were told to avoid sugar. But now we know that the total amount of carbohydrate in a food or meal is the most important factor.)

This doesn’t mean that you should regularly eat candy, cake, and cookies. Realize that even a small serving of these types of foods contain a lot of carbohydrate. Cake and cookies also contain a lot of calories and fat. So you’ll want to limit them to special occasions and indulge in small portions, in addition to counting the carbs in your overall carb counting records.

Tips for Eating Fewer Sweets

• Choose a few favorite desserts and decide how often to eat them.

• Satisfy your sweet tooth with a bite or two of your favorite sweet rather than eating the whole thing.

• If you have a difficult time eating smaller portions or how often you eat sweets, it is best not to bring large portions of sweets into your home. You might only order dessert at restaurants or just purchase a small quantity at a time.

• Split a dessert with a dining companion in a restaurant. Ask for several forks or spoons to share the treat.

• Take advantage of smaller portions—kiddie, small, or regular—at ice cream shops or in the supermarket.

Easy Ways to Eat Less Sugar

• Instead of regular soda, go for diet soda, seltzer water, or, even better, water.

• When you order or buy iced tea, make sure it is unsweetened or sweetened with a low-calorie sweetener.

• When you buy fruit drinks or flavored seltzers, read the Nutrition Facts label. Make sure the calories, carbohydrate, and sugars are near zero. In general, it’s better to drink water and eat fresh fruit.

• Trade canned fruit packed in heavy syrup for fruit packed in its own juice or light syrup.

• Use low-calorie sweeteners instead of sugar.

• Use low- or no-sugar jelly or jam instead of regular.

Fiber and Blood Glucose

As explained earlier, fiber is a type of carbohydrate. There are hundres of different types of fibers in our foods. Depending on which type you eat, fiber can affect blood glucose differently than other carbohydrates. Some fibers can slow down the absorption of glucose, resulting in lower rises in blood glucose after eating. Some fibers are also helpful for weight loss because they make you feel full and satisfied. Fiber has no calories. Fiber is an essential part of a healthy eating plan.

Easy Tips to Fit in Fiber

The U.S. Food and Drug Administration (FDA) defines foods with more than 5 grams of dietary fiber per serving as “excellent” sources, whereas foods that provide between 2.5 and 4.9 grams per serving are considered “good” sources.

Look for these items and check the Nutrition Facts label to see how much fiber a food contains.

• whole-grain cereals, breads, and crackers

• whole grains, such as barley, bulgur, and buckwheat

• beans and peas—these types of foods, called legumes, are great sources of fiber

• fruits and vegetables that are high in fiber, such as acorn and butternut squash, broccoli, carrots, zucchini, berries, plum, prunes, and apples

• nuts and seeds

What Is the Glycemic Index and Should I Use It with Carb Counting?

The glycemic index (GI) is a list of foods that details how various foods affect blood glucose levels. It was developed in the early 1980s by researchers who studied how quickly or slowly various carbohydrate-containing foods raised blood glucose—bread, corn, pasta, beans, fruit, and others. The GI research helped show that not all carbohydrates raise blood glucose levels the same amount. They showed, for instance, that potatoes raised blood glucose more quickly than fruit and that legumes raised blood glucose quite slowly.

This is valuable information, but it can be difficult for people with diabetes to use the GI for blood glucose control. That’s because the GI only evaluates one food at a time. Most people eat several foods in a meal, and some are high in carbohydrate and others are high in protein or fat. The combination of foods in a meal is what determines the effect on blood glucose. In addition, a number of other factors affect how quickly foods raise blood glucose, such as:

• How much blood glucose–lowering medication you take and the type of medication you take

• The fiber content of the foods you eat

• The ripeness of the fruit or vegetable you eat

• Whether the food is cooked or raw

• How quickly or slowly you eat

• The level of blood glucose before a meal (when the starting point is low, blood glucose rises faster after a meal)

• The time of your last dose of diabetes medication and the time you eat

Although the GI may not account for all of this, it can be another tool in your meal planning toolbox. As you progress with carb counting, you may develop your own personal GI. Your records may show that the carbohydrate in certain foods affects your blood glucose more than others. This information can help you fine-tune your blood glucose management.