Carb Counting Tips for Diabetics Eat More Foods and Control Blood Sugar Levels

Tired of eating the same old foods just because you know how many carbohydrates they have? Is the “Exchange System” too complicated? Now, you can eat all your favorite snacks without busting your blood sugar levels. Read on to learn how to use carb counting along with gadgets and iPhone apps that help maintain your diabetes meal plan... Looking for a flexible diet that lets you eat nearly any food off the shelf yet fits into your diabetes meal plan? Welcome to carb counting – the best way for women with diabetes to track carbohydrate intake and control blood sugar, according to the American Diabetes Association (ADA). Carb counting has replaced the ADA’s old “Exchange System,” which grouped foods into six categories: starch, meat, vegetables, fruits, milk and fats. Under the exchange, foods could be swapped only with others in the same category. But carb counting focuses on carbohydrates in all foods. Why the change? “Scientists now know that foods that contain carbohydrates – including starches, fruit, vegetables, dairy foods and sweets – all raise blood sugar levels in about the same time and to about the same degree,” says Hope Warshaw, R.D., C.D.E., M.M.Sc., spokeswoman for the ADA and author of The Complete Guide to Carb Counting (American Diabetes Association). In other words, it’s the amount of carbs you eat during a meal or snack that’s important, according to a 2002 ADA study. That means you can swap a food with one carb serving (15 grams) with any other foods equaling 15 grams (g). So you could exchange a cup of milk for 1/2 cup pasta or rice, a small piece of fruit, 1/2 cup black beans, 1/2 cup ice cream or sherbet, 1 cup of soup, 1/2 cup oatmeal or 4-6 crackers. Not only is carb counting more flexible than the Exchange System, it’s also easier to learn. “You can master it in a few weeks,” Warshaw says. Here are 8 easy ways to incorporate carb counting into your diabetes diet. 1. Choose complex carbs over simple carbs “Managing diabetes means getting consistent carbs throughout the day, so your blood sugar levels remain constant,” says Lisa Moskowitz, R.D., C.D.N., a New York-based dietitian specializing in diabetes. “For most women, that’s about 45-60 grams per meal, or 250 grams daily.” But not all carbs are equal. “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 corn syrup,” Moskowitz says. Simple carbohydrates are sugars – glucose, sucrose, lactose and fructose – found in refined sugar products, such as candy, cookies, pies, cakes, chips and soda. Complex carbohydrates, found in beans, nuts, vegetables and whole grains, contain fiber and are digested more slowly, providing a steady energy source. “Whole grains and high-quality carbs – such as oatmeal, yams, whole-wheat bread and pasta, brown rice, quinoa, beans, legumes, fruits and vegetables – help control blood sugar levels,” says Connie Guttersen, R.D., Ph.D., author of The New Sonoma Diet (Sterling), a nutrition instructor at the Culinary Institute of America and a speaker for the Harvard Medical School Healthy Kitchens, Healthy Lives program. So look for easy, flavorful ways to trade bad carbs for good ones. “Swap baked sweet-potato fries or a baked potato for regular greasy fries,” suggests Robyn Webb, M.S., a Virginia-based dietitian, author of Diabetic Meals in 30 Minutes or Less (American Diabetes Association) and associate editor of Diabetes Forecast magazine, published by the ADA. “Use Stevia instead of sugar for sweetening foods, and go for whole-grain breads, couscous and rice instead of white bread and rice that have been stripped of fiber and nutrients,” she says. 2. Become a carb sleuth Having diabetes doesn’t mean you need to give up or strictly limit carbs, says Timothy Harlan, M.D., a diabetes expert and medical director at Tulane Medical School in New Orleans. “Low-carb diets often lead to eating too much heart-harming fat and may not necessarily improve your blood glucose or weight control over time,” he says. “There’s no reason to eliminate healthy carbs.” But you do need a handy way to track them. These guides will help: Complete Guide to Carb Counting, by Hope Warshaw, R.D., M.S., C.D.E. (American Diabetes Association) The Diabetes Carbohydrate & Fat Gram Guide, by Lea Holzmeister, R.D., C.D.E. (American Diabetes Association) The Doctor’s Pocket Calorie, Fat and Carb Counter, by Allan Borushek (Allan Borushek & Associates) Calories and Carbohydrates, by Barbara Kraus (Signet) The Complete Book of Food Counts, by Corrine T. Netzer (Dell) The CalorieKing Calorie, Fat & Carbohydrate Counter (Family Health Publications) What Do I Eat Now? by Patti Geil, R.D., C.D.E., and Tami Ross, R.D., C.D.E. (American Diabetes Association) Prefer getting information from a website? Check out the following sites for carb counts and other nutritional information, including calories, saturated fat, protein and fiber, Warshaw says. www.diabetes.org/my-food-advisor/ (The American Diabetes Association database of 5,000 foods, plus a carb and calorie counter and meal tracker) www.nal.usda.gov/fnic/foodcomp/search/ (The U.S. Department of Agriculture’s database of 8,000 foods) www.healthydiningfinder.com (The Healthy Dining organization and National Restaurant Association’s database of the healthiest restaurant foods) www.mypyramidtracker.gov (U.S. Government’s database. Enter one day’s worth of food and analyze it for diet quality.) www.calorieking.com (paid subscriber database of more than 50,000 foods) fatsecret.com (an online diet, nutrition and weight loss community with practical advice and a supportive network) To track carbs on the go, check out these apps and tools, Warshaw suggests. Track3: A diabetes-focused, 50,000-food database on a handheld device Food & Fitness Tracker: An iPhone food, calorie and exercise tracker Lose It! An iPhone weight-loss application Tap & Track: An iPhone calorie, weight and exercise tracker MyFitnessPal: An iPhone and Android app and online tool that remembers foods you like so you can make your own custom database GoMeals: This iPhone app lets you record entrees and adds up nutrients of foods you eat 3. Check food labels “Don’t forget to read nutrition labels for total carbohydrate grams,” warns Katherine Tallmadge, M.A., R.D., a Washington, D.C.-based dietitian and author of Diet Simple (Lifeline). If you buy the same products frequently, you’ll soon learn their carb counts and how they affect your blood glucose. If you’re trying to decide among several products with similar calories, carbs and fat, choose one with the most fiber to slow carb absorption, Warshaw says. Also, pay attention to serving sizes, which may be more or less than you eat at one sitting, she says. “Be sure your serving size is the same size as the label serving, or calculate the carb count based on the amount of food you’ll be eating,” Warshaw says. If your serving size is half of what’s listed as a serving on the food label, divide the number of carbs in half. If you don’t know the carb count or there’s no carb count on the label, here’s how to calculate it: Buy a food scale that provides the weight of the food you’ll be eating and its carb content (see #4). You can also determine the number of carbs per food by weighing it on a food scale that provides weight in grams (not pounds and ounces). Multiply the number of grams in the food by the food’s “carb factor,” or the amount of carbs found in 1 gram of the food, for the total number of carbs. For example, if you’re eating a portion of rice that weighs 250 g, multiply it by the grain’s carb factor, or 0.24. (250 grams of rice x 0.24 = 60 grams of carbs.) Several books offer comprehensive lists of carb factors, including Using Insulin: Everything You Need for Success with Insulin (Torrey Pines Press), by John Walsh, Ruth Roberts and Chandrasekhar Varma. 4. Weigh and measure To determine the number of carbs in unlabeled or odd-sized foods, like fruits or unsliced bread, get a good scale that shows the food’s weight as well as its carb and nutritional content, advises Didi Wolter-Nitta, R.D., C.D.N., C.D.E., a dietitian specializing in diabetes at Montefiore Medical Center, the University Hospital for Albert Einstein College of Medicine in New York. A few good choices for $70 include the EatSmart Digital Nutrition Scale - Professional Food and Nutrient Calculator and the Escali Cesto Glass Nutrition Tracker Scale. 5. Learn to eyeball portions Even large portions of healthy foods, like fruits and vegetables, can tip your carb count. For example, a big apple can have 30 g of carbs, versus 15 g for a small one. Use your hand to estimate healthy portion sizes, Warshaw advises. Tip of thumb = 1 teaspoon Whole thumb = 1 tablespoon Palm of hand = 3 ounces Tight fist = 1/2 cup Loose fist or open handful = 1 cup Two fingers lengthwise = 1 ounce “To avoid buying a high-carb piece of fruit or potato, weigh produce at the supermarket, and train your eye to reach for similar sizes,” Warshaw adds. 6. Unmask hidden carbs If your blood glucose levels spike every time you eat at a Chinese, Thai or Italian restaurant, start looking for hidden carb culprits. “Marinades and sauces used in ethnic cuisine are often loaded with sugar and starches, while noodles and pasta pack a high-carb punch,” says Judith Wylie-Rosett, Ed.D., R.D., associate editor of Diabetes Care and division head for Behavioral and Nutritional Research at Albert Einstein College of Medicine in New York. To demystify ethnic meals, check out similar recipes in cookbooks or online nutrition sources, or look for comparable dishes served at chain restaurants that offer nutrition info, such as P.F. Chang’s, Panda Express, The Olive Garden, Little Caesar’s, Pizza Hut and Domino’s Pizza. 7. Build your own food database “Most people regularly eat just 50-100 foods,” Warshaw says. “Spend a few hours every month estimating the nutrient content of your favorite foods and create your own food diary for easy access.” To get started, list the foods you regularly buy by checking the fridge, freezer, pantry and your shopping lists for clues. Use measuring cups and a food scale to calculate how much of these foods you typically eat. Then look up the carb counts of these foods, and group them into meals that meet your target carb count for that meal, or 45-60 grams. 8. Get the skinny on mixed foods Nailing the carb count on one food is relatively easy. But what about when several ingredients are combined in a casserole, lasagna, soup, stew or pasta salad? If you make it often, it may be worth breaking the recipe down by ingredient, measuring the carbs for each and then adding them for a grand total, says Warshaw. If you’re dining out, count 30 grams of carbs for a cup of a starch- or starch-and-veggie-based casserole or hearty soup, such as chili with beans. Don’t forget to factor in sauces found in Asian dishes, such as sweet-and-sour sauce, as well as thick sauces and gravies made with cornstarch and other types of carbs. Add 5-10 carbs per serving, she says. For more expert advice and information, visit Lifescript's Diabetes Type 1 Health Center. Myth vs. Fact: How Much Do You Know About Diabetes? In the United States alone, 23.6 million people have diabetes. And 5.6 million of them don’t even know it.