Living with Diabetes...

with Dr. Tia Rains

It's All in the Carbs

Confused about carbs, net carbs, counting carbs and what it all means? Nutritionist, Dr. Tia Rains, answers your questions about how carbs factor into diets for both people with diabetes and health-conscious individuals…

Carbohydrate management is essential for maintaining optimal blood glucose regulation in people with diabetes.* Both the amount (grams) of carbohydrate and the type of carbohydrate consumed are important considerations. I get many questions about the role carbs play in the diabetic diet.

Why Count Carbs?

The total amount (grams) of carbohydrate consumed is a strong predictor of blood glucose levels. As such, keeping track of carbohydrate intake during the day is important. There are several strategies for tracking carbohydrate intake. Carbohydrate (or carb) counting is one approach whereby the grams of carbohydrate eaten throughout the day are tracked and compared to a daily carb goal.* The Nutrition Facts Panel on food labels prominently displays the total grams of carbohydrate per serving. The total carbohydrate number includes starches, sugar, fiber, and sugar alcohols. For foods that have more than 5 g of fiber per serving, the American Diabetes Association¹ recommends subtracting out the fiber from the total carbohydrate count for a more accurate estimate of the product's carbohydrate content. Though fiber is considered a carb for labeling purposes, it does not increase blood glucose levels like other carbohydrates.

Another approach to counting carbs is the Diabetes Food Pyramid² , (similar to the Diabetes Exchange Diet), which groups foods into categories, including grains, bean, and starchy vegetables (carbohydrates), fruits, vegetables, milk, meats, and fats. It differs from the USDA My Pyramid in that foods are grouped into the categories based on carbohydrate and protein content, instead of just food classification. But like the USDA Pyramid, the number of servings recommended for food group will vary person to person based on diet and health needs.

Is There a Difference Between Carbs?

Yes. All carbs are not created equal. The type of carbohydrate can also influence blood sugar levels. Foods containing carbohydrates that are rapidly digested and absorbed affect blood sugar to a much greater degree than carbohydrates that are slowly digested and absorbed. However, this approach to carbohydrate management is not as black and white as just counting carbs. Although scientists agree that different carbohydrates affect blood sugar to different extents, techniques to accurately measure these differences in humans are debated as are how to communicate these differences. As such, the regular Nutrition Facts Panel does not include information on the types of carbohydrates in the product, other than listing out “sugars.”

What Does the Term “Net Carbs” mean?

The term “net carbs” is one tool that has been used to differentiate carbohydrates. The “net carb” count is calculated by taking the total carbohydrates in grams and subtracting the grams of fiber and sugar alcohols. This calculation is based on research showing that both sugar alcohols and fiber produce smaller increases in blood sugar than most other carbohydrates (such as glucose). While this does not mean that the product is lower in calories or healthier than other foods, it is a good tool for consideration in carbohydrate management, particularly when comparing two foods.For example, a regular oatmeal raisin cookie may provide 21 g of net carbs (23 g total carbohydrates) per serving versus a Hill & Valley cookie that provides approximately 8 g of net carbs (17 g total carbohydrates). If your meal plan allows for a sweet treat, you may decide to choose the cookie that has a lower net carb content.

Can Counting Carbs Benefit Non-Diabetics or Health-Conscious Individuals?

Yes. Although each person is different, there are studies showing that reducing the amount (grams) of carbohydrate consumed during the day and choosing carbohydrates that produce a smaller increase in blood sugar levels may be advantageous for weight loss³. There is also preliminary evidence that the amount and type of carbohydrate may affect future risk for developing diabetes and cardiovascular disease⁴ , although more studies are needed to better understand these relationships.

The Bottom Line

There are many tools available that make carbohydrate management easier, and it is always important to remember that the blood glucose response to any food can vary person to person. Whether counting carbs, using the Diabetes Food Pyramid, or another technique, the ultimate goal is finding out what works best for you in order to achieve and maintain optimal blood glucose levels.

*Please see a healthcare professional for determining the optimal level and type of carbohydrates for your healthy diet and meal plan.

¹http://www.diabetes.org/nutrition-and-recipes/nutrition/types-of-carb.jsp
²http://www.diabetes.org/food-nutrition-lifestyle/nutrition/meal-planning/diabetes-food-pyramid.jsp
³Maki KC, Rains TM, Kaden VN, Raneri KR, Davidson MH. Effects of a reduced-glycemic-load diet on body weight, body composition, and cardiovascular disease risk markers in overweight and obese adults. Am J Clin Nutr. 2007;85:724-734
⁴Samaha FF, Foster GD, Makris AP. Low-carbohydrate diets, obesity, and metabolic risk factors for cardiovascular disease. Current Atheroscler Rep. 2007;9:441-447.

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