Nowadays, we hear about carbohydrate all the time. Did you know there are three main types of carbohydrate? There are starches, sugars, and fiber. You’ll also hear terms like naturally occurring sugar, added sugar, low-calorie sweeteners, sugar alcohols, reduced-calorie sweeteners, processed grains, enriched grains, complex carbohydrate, sweets, refined grains, and whole grains. No wonder knowing what kind and how much carbohydrate to eat can be confusing!

The three main types of carbohydrate are:

• Starch (also known as complex carbohydrates)
• Sugar
• Fiber

On the nutrition label, the term "total carbohydrate" includes all three types of carbohydrates. This is the number you should pay attention to if you are carbohydrate counting.

Starch

Foods high in starch include:

• Starchy vegetables like peas, corn, lima beans, and potatoes
• Dried beans, lentils, and peas such as pinto beans, kidney beans, black eyed peas, and split peas
• Grains like oats, barley, and rice. (The majority of grain products in the US are made from wheat flour. These include pasta, bread, and crackers but the variety is expanding to include other grains as well.)

The grain group can be broken down even further into whole grain or refined grain.

A grain, let’s take wheat for example, contains three parts. The parts are the bran, germ, and the endosperm. The bran is the outer hard shell of the grain. It is the part of the grain that provides the most fiber and most of the B vitamins and minerals. The germ is the next layer and is packed with nutrients including essential fatty acids and vitamin E. The endosperm is the soft part in the center of the grain. It contains the starch. Whole grain means that the entire grain kernel is in the food.

If you eat a whole grain food, it contains the bran, germ, and endosperm so you get all of the nutrients that whole grains have to offer. If you eat a refined grain food, it contains only the endosperm or the starchy part so you miss out on a lot of vitamins and minerals. Because whole grains contain the entire grain, they are much more nutritious than refined grains.

Sugar

Sugar is another type of carbohydrate. You may also hear sugar referred to as simple or fast-acting carbohydrate. There are two main types of sugar:

naturally occurring sugars such as those in milk or fruit

added sugars such as those added during processing such as fruit canned in heavy syrup or sugar added to make a cookie
On the nutrition facts label, the number of sugar grams includes both added and natural sugars.

There are many different names for sugar. Examples of common names are table sugar, brown sugar, molasses, honey, beet sugar, cane sugar, confectioner’s sugar, powdered sugar, raw sugar, turbinado, maple syrup, high-fructose corn syrup, agave nectar, and sugar cane syrup.

You may also see table sugar listed by its chemical name, sucrose. Fruit sugar is also known as fructose and the sugar in milk is called lactose. You can recognize other sugars on labels because their chemical names also end in "-ose." For example glucose (also called dextrose), fructose (also called levulose), lactose, and maltose.

Fiber

Fiber comes from plant foods so there is no fiber in animal products such as milk, eggs, meat, poultry, and fish. Fiber is the indigestible part of plant foods, including fruits, vegetables, whole grains, nuts, and legumes. When you consume dietary fiber, most of it passes through the intestines and is not digested.

For good health, adults need to try to eat 25 to 30 grams of fiber each day. Most Americans do not consume nearly enough fiber in their diet, so while it is wise to aim for this goal, any increase in fiber in your diet can be beneficial. Most of us only get about ½ what is recommended. Fiber contributes to digestive health, helps to keep you regular and helps to make you feel full and satisfied after eating. Additional health benefits, of a diet high in fiber — such as a reduction in cholesterol levels — have been suggested by some so may be an additional benefit.

Good sources of dietary fiber include:

• Beans and legumes. Think black beans, kidney beans, pintos, chick peas (garbanzos), white beans, and lentils.
• Fruits and vegetables, especially those with edible skin (for example, apples, corn and beans) and those with edible seeds (for example, berries).
• Whole grains such as:
• Whole wheat pasta
• Whole grain cereals (Look for those with three grams of dietary fiber or more per serving, including those made from whole wheat, wheat bran, and oats.)
• Whole grain breads (To be a good source of fiber, one slice of bread should have at least three grams of fiber. Another good indication: look for breads where the first ingredient is a whole grain. For example, whole whe+at or oats.) Many grain products now have "double fiber" with extra fiber added.
• Nuts — try different kinds. Peanuts, walnuts and almonds are a good source of fiber and healthy fat, but watch portion sizes, because they also contain a lot of calories in a small amount.

In general, an excellent source of fiber contains five grams or more per serving, while a good source of fiber contains 2.5 - 4.9 grams per serving.

It is best to get your fiber from food rather than taking a supplement. In addition to the fiber, these foods have a wealth of nutrition, containing many important vitamins and minerals. In fact, they may contain nutrients that haven’t even been discovered yet!

It is also important that you increase your fiber intake gradually, to prevent stomach irritation, and that you increase your intake of water and other liquids, to prevent constipation.

Because fiber is not digested like other carbohydrates, for carbohydrate counting purposes, if a serving of a food contains more than or equal to 5 grams of dietary fiber, you can subtract half the grams of dietary fiber from the total carbohydrate serving of that food.

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Understanding the effect of carbohydrate on blood glucose levels is key to managing diabetes. The carbohydrate in food makes blood glucose levels go up.

The key to keeping blood glucose levels at your goal is to balance the food you eat with your physical activity and any pills or insulin you take. If you eat more carbohydrate than usual, you can expect your blood glucose levels to be higher than usual. Likewise, if you eat less, you can expect your blood glucose levels to be lower. Finding the balance for yourself is important so you can feel your best, do the things you enjoy, and lower your risk of diabetes complications.

There are three main types of carbohydrate in food. They are starch, sugar and dietary fiber. Starch and sugar both raise blood glucose levels so including both types in your meal plan is essential. Foods that contain carbohydrate are:

• Beans and legumes
• Grains and starchy vegetables
• Fruit
• Dairy products like milk and yogurt
• Sweets and snack foods like chips

Meal planning for diabetes is more than just cutting back on starch or sugar. There are many options that people with diabetes use to help them plan their meals. Having diabetes doesn’t have to mean eating the same foods day after day. By choosing the right meal planning tool for you, you’ll be able to try new foods and enjoy your favorites. You may want to try them all or use a combination to find out which you like the most.

Plate Method

It’s simple! Include more non-starchy vegetables and smaller portions of everything else. No special tools and nothing to count or read.

Carbohydrate Counting

Carbohydrate-containing foods raise blood glucose levels. By keeping track of how many carbohydrates you eat and setting a limit for your maximum amount to eat, you can help to keep your blood glucose levels on track.

Glycemic Index

The amount and type of carbohydrate affects blood glucose levels. Choose most of your foods with a lower glycemic response as a way to fine tune your carb counting.

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Carbohydrate counting, or "carb counting," is a meal planning technique for managing your blood glucose levels. Foods that contain carbohydrate raise blood glucose. By keeping track of how many carbohydrates you eat and setting a limit for your maximum amount to eat, you can help to keep your blood glucose levels in your target range. Finding the right amount of carbohydrate depends on many things including how active you are and what, if any, medicines you take.

How much carb?
A place to start is at about 45-60 grams of carbohydrate at a meal. You may need more or less carbohydrate at meals depending on how you manage your diabetes. You and your health care team can figure out the right amount for you. Once you know how much carb to eat at a meal, choose your food and the portion size to match.

What foods have carbohydrate?
Foods that contain carbohydrate are:

• starchy foods like bread, cereal, rice, and crackers
• fruit and juice
• milk and yogurt
• dried beans like pinto beans and soy products like veggie burgers
• starchy vegetables like potatoes and corn
• sweets and snack foods like sodas, juice drinks, cake, cookies, candy, and chips

Non-starchy vegetables have a little bit of carbohydrate but in general are very low.

How much carbohydrate is in these foods?
Reading food labels is a great way to know how much carbohydrate is in a food. For foods that do not have a label, you have to estimate how much carbohydrate is in it. Keeping general serving sizes in mind will help you estimate how much carbohydrate you are eating.

For example there is about 15 grams of carbohydrate in:

• 1 small piece of fresh fruit (4 oz)
• 1/2 cup of canned or frozen fruit
• 1 slice of bread (1 oz) or 1 (6 inch) tortilla
• 1/2 cup of oatmeal
• 1/3 cup of pasta or rice
• 4-6 crackers
• 1/2 English muffin or hamburger bun
• 1/2 cup of black beans or starchy vegetable
• 1/4 of a large baked potato (3 oz)
• 2/3 cup of plain fat-free yogurt or sweetened with sugar substitutes
• 2 small cookies
• 2 inch square brownie or cake without frosting
• 1/2 cup ice cream or sherbet
• 1 Tbsp syrup, jam, jelly, sugar or honey
• 2 Tbsp light syrup
• 6 chicken nuggets
• 1/2 cup of casserole
• 1 cup of soup
• 1/4 serving of a medium french fry

Protein and Fat
With carbohydrate counting, it is easy to forget about the protein and fat in meals. Always include a source of protein and fat to balance out your meal.

Using Food Labels
Carbohydrate counting is easier when food labels are available. You can look at how much carbohydrate is in the foods you want to eat and decide how much of the food you can eat. The two most important lines with carbohydrate counting are the serving size and the total carbohydrate amount.

1. Look at the serving size. All the information on the label is about this serving of food. If you will be eating a larger serving, then you will need to double or triple the information on the label.

2. Look at the grams of total carbohydrate.
Total carbohydrate on the label includes sugar, starch, and fiber.
Know the amount of carb you can eat, figure out the portion size to match.

Other important label information:
3. If you are trying to lose weight, look at the calories. Comparing products can be helpful to find those lower in calories per serving.

4.To cut risk of heart disease and stroke, look at saturated and trans fats. Look for products with the lowest amount of saturated and trans fats per serving.

5. For people with high blood pressure, look at the sodium. Look for foods with less sodium.

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Often, when people are diagnosed with diabetes, they don’t know where to begin. One way is to change the amount of food you are already eating. Focus on filling your plate with non-starchy vegetables and having smaller portions of starchy foods and meats. Creating your plate is an easy way to get started with managing blood glucose levels.

You don’t need any special tools or have to do any counting. It’s simple and effective — draw an imaginary line on your plate, select your foods, and enjoy your meal! You may have heard of this as the “Plate Method.” Once you’ve changed your portion sizes, you can work on making healthier food choices from each food group.

The easiest way to get started with managing your diabetes is to create your plate.
It’s simple and effective for both managing diabetes and losing weight. Creating your plate let’s you still choose the foods you want, but changes the portion sizes so you are getting larger portions of non-starchy vegetables and a smaller portion of starchy foods. When you are ready, you can try new foods within each food category.

Try these 6 simple steps to get started:

1. Using your dinner plate, put a line down the middle of the plate.

2. Then on one side, cut it again so you will have 3 sections on your plate.

3. Fill the largest section with non-starchy vegetables such as:

• spinach, carrots, lettuce, greens, cabbage, bok choy
• green beans, broccoli, cauliflower, tomatoes,
• vegetable juice, salsa, onion, cucumber, beets, okra,
• mushrooms, peppers, turnip

4. Now in one of the small sections, put starchy foods such as:

• whole grain breads, such as whole wheat or rye
• whole grain, high-fiber cereal
• cooked cereal such as oatmeal, grits, hominy, or cream of wheat
• rice, pasta, dal, tortillas
• cooked beans and peas, such as pinto beans or black-eyed peas
• potatoes, green peas, corn, lima beans, sweet potatoes, winter squash
• low-fat crackers and snack chips, pretzels, and fat-free popcorn

5. And then on the other small section, put your meat or meat substitutes such as:

• chicken or turkey without the skin
• fish such as tuna, salmon, cod, or catfish
• other seafood such as shrimp, clams, oysters, crab, or mussels
• lean cuts of beef and pork such as sirloin or pork loin
• tofu, eggs, low-fat cheese

6. Add an 8 oz glass of non-fat or low-fat milk. If you don’t drink milk, you can add another small serving of carb such as a 6 oz. container of light yogurt or a small roll.

7. And a piece of fruit or a 1/2 cup fruit salad and you have your meal planned. Examples are fresh, frozen, or canned in juice or frozen in light syrup or fresh fruit.

Breakfast
Your plate will look different at breakfast but the idea is the same. If you use a plate or bowl for breakfast, keep your portions small. Use half your plate for starchy foods. You can ad fruit in the small part and a meat or meat substitute in the other.

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What is the glycemic index?
The glycemic index, or GI, measures how a carbohydrate-containing food raises blood glucose. Foods are ranked based on how they compare to a reference food– either glucose or white bread. A food with a high GI raises blood glucose more than a food with a medium or low GI.

Meal planning with the GI involves choosing foods that have a low or medium GI. If eating a food with a high GI, you can combine it with low GI foods to help balance the meal. Examples of carbohydrate-containing foods with a low GI include dried beans and legumes (like kidney beans and lentils), all non-starchy vegetables and some starchy vegetables, most fruit, and many whole grain breads and cereals (like barley, whole wheat bread, rye bread, and all-bran cereal). Meats and fats don’t have a GI because they do not contain carbohydrate.

What affects the GI of a food?
Fat and fiber tend to lower the GI of a food. As a general rule, the more cooked or processed a food, the higher the GI; however, this is not always true.

Below are a few specific examples of other factors that can affect the GI of a food:

• Ripeness and storage time – the more ripe a fruit or vegetable is, the higher the GI
• Processing – juice has a higher GI than whole fruit; mashed potato has a higher GI than a whole baked potato, stone ground whole wheat bread has a lower GI than whole wheat bread.
• Cooking method: how long a food is cooked (al dente pasta has a lower GI than soft-cooked pasta)
• Variety: converted long-grain white rice has a lower GI than brown rice but short-grain white rice has a higher GI than brown rice.

Other things to consider if using the GI:

• The GI value represents the type of carbohydrate in a food but says nothing about the amount of carbohydrate typically eaten. Portion sizes are still relevant for managing blood glucose and for losing or maintaining weight.
• The GI of a food is different when eaten alone than it is when combined with other foods. When eating a high GI food, you can combine it with other low GI foods to balance out the effect on blood glucose levels.
• Many nutritious foods have a higher GI than foods with little nutritional value. For example, oatmeal has a higher GI than chocolate. Use of the GI needs to be balanced with basic nutrition principles of variety for healthful foods and moderation of foods with few nutrients.

Is the GI a better tool than carbohydrate counting?
There is no one diet or meal plan that works for everyone with diabetes. The important thing is to follow a meal plan that is tailored to personal preferences and lifestyle and helps achieve goals for blood glucose, cholesterol and triglycerides levels, blood pressure, and weight management.

Research shows that both the amount and the type of carbohydrate in food affect blood glucose levels. Studies also show that the total amount of carbohydrate in food, in general, is a stronger predictor of blood glucose response than the GI.

Based on the research, for most people with diabetes, the first tool for managing blood glucose is some type of carbohydrate counting. Balancing total carbohydrate intake with physical activity and diabetes pills or insulin (if needed) is key to managing blood glucose levels.

Because the type of carbohydrate does have an affect on blood glucose, using the GI may be helpful in “fine-tuning” blood glucose management. In other words, combined with carbohydrate counting, it may provide an additional benefit for achieving blood glucose goals for individuals who can and want to put extra effort into monitoring their food choices.

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The Diabetes Food Pyramid is another meal planning option that some people use. It is less popular compared to both carbohydrate counting and the plate method for diabetes management.

The Diabetes Food Pyramid divides food into six groups. These groups or sections on the pyramid vary in size. The largest group – grains, beans, and starchy vegetables – is on the bottom. This means that you should eat more servings of grains, beans, and starchy vegetables than of any of the other foods. The smallest group – fats, sweets, and alcohol – is at the top of the pyramid. This tells you to eat very few servings from these food groups.

The Diabetes Pyramid gives a range of servings. If you follow the minimum number of servings in each group, you would eat about 1600 calories and if you eat at the upper end of the range, it would be about 2800 calories. Most women, would eat at the lower end of the range and many men would eat in the middle to high end of the range if they are very active. The exact number of servings you need depends on your diabetes goals, calorie and nutrition needs, your lifestyle, and the foods you like to eat. Divide the number of servings you should eat among the meals and snacks you eat each day.

The Diabetes Food Pyramid is a little different than the USDA Food Guide Pyramid because it groups foods based on their carbohydrate and protein content instead of their classification as a food. To have about the same carbohydrate content in each serving, the portion sizes are a little different too. For example: you will find potatoes and other starchy vegetables in the grains, beans and starchy vegetables group instead of the vegetables group. Cheese is in the meat group instead of the milk group. A serving of pasta or rice is 1/3 cup in the Diabetes Food Pyramid and ½ cup in the USDA pyramid. Fruit juice is ½ cup in the Diabetes Food Pyramid and ¾ cup in the USDA pyramid. This difference is to make the carbohydrate about the same in all the servings listed.

Following is a description of each group and the recommended range of servings of each group.

Grains and Starches
At the base of the pyramid are bread, cereal, rice, and pasta. These foods contain mostly carbohydrates. The foods in this group are made mostly of grains, such as wheat, rye, and oats. Starchy vegetables like potatoes, peas, and corn also belong to this group, along with dry beans such as black eyed peas and pinto beans. Starchy vegetables and beans are in this group because they have about as much carbohydrate in one serving as a slice of bread. So, you should count them as carbohydrates for your meal plan. More

Choose 6-11 servings per day. Remember, not many people would eat the maximum number of servings. Most people are toward the lower end of the range.
Serving sizes are:

• 1 slice of bread
• ¼ of a bagel (1 ounce)
• ½ an English muffin or pita bread
• 1, 6 inch tortilla
• ¾ cup dry cereal
• ½ cup cooked cereal
• ½ cup potato, yam, peas, corn, or cooked beans
• 1 cup winter squash
• 1/3 cup of rice or pasta

Vegetables
All vegetables are naturally low in fat and good choices to include often in your meals or have them as a low calorie snack. Vegetables are full of vitamins, minerals and fiber. This group includes spinach, chicory, sorrel, Swiss chard, broccoli, cabbage, bok choy, brussels sprouts, cauliflower, and kale, carrots, tomatoes, cucumbers, and lettuce. Starchy vegetables such as potatoes, corn, peas, and lima beans are counted in the starch and grain group for diabetes meal planning. More

Choose at least 3-5 servings per day.

A serving is:
1 cup raw
½ cup cooked

Fruit
The next layer of the pyramid is fruits, which also contain carbohydrates. They have plenty of vitamins, minerals, and fiber. This group includes blackberries, cantaloupe, strawberries, oranges, apples, bananas, peaches, pears, apricots, and grapes. More

Choose 2-4 servings per day

A serving is:
½ cup canned fruit
1 small fresh fruit
2 tbs dried fruit
1 cup of melon or raspberries
1 ¼ cup of whole strawberries

Milk & Dairy
Milk products contain a lot of protein and calcium as well as many other vitamins. Choose non-fat or low-fat dairy products for the great taste and nutrition without the saturated fat. More

Choose 2-3 servings per day

A serving is:
1 cup non-fat or low-fat milk
1 cup of yogurt

Meat and Meat Substitutes
The meat group includes beef, chicken, turkey, fish, eggs, tofu, dried beans, cheese, cottage cheese and peanut butter. Meat and meat substitutes are great sources of protein and many vitamins and minerals.

Choose from lean meats, poultry and fish and cut all the visible fat off meat. Keep your portion sizes small. Three ounces is about the size of a deck of cards. You only need 4-6 ounces for the whole day. More

Choose 4-6 oz per day divided between meals

Equal to 1 oz of meat:

¼ cup cottage cheese
1 egg
1 Tbsp peanut butter
½ cup tofu

Fats, Sweets, and Alcohol
Things like potato chips, candy, cookies, cakes, crackers, and fried foods contain a lot of fat or sugar. They aren’t as nutritious as vegetables or grains. Keep your servings small and save them for a special treat. More

Serving sizes include:

• ½ cup ice cream
• 1 small cupcake or muffin
• 2 small cookies

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How can food choices help keep my heart and blood vessels healthy?

Diabetes increases your chances of having a heart attack or a stroke. But you can protect your heart and blood vessels by

• eating less of the foods that raise your blood cholesterol and your chances of heart disease
• eating more of the foods that lower your cholesterol and your chances of heart disease

Choosing foods wisely can also help you lose weight and keep your blood glucose (sugar) levels on target.  

How can I make wise food choices?

Try these steps to help protect your heart and blood vessels:

Eat less fat, especially saturated fat and trans fats, and fewer high-cholesterol foods. Saturated fat is found in meat, poultry skin, butter, 2% or whole milk, ice cream, cheese, lard, and shortening. You’ll also want to cut back on foods that contain palm oil or coconut oil.

Trans fats are produced when liquid oils are turned into solids. This process is called hydrogenation. Cut back on foods that list hydrogenated or partially hydrogenated oils on the labels. This type of fat is found in crackers and snack foods, baked goods like cookies and donuts, french fries, and stick margarine. Use a soft margarine in place of butter or stick margarine. Look for soft margarine in a tub that lists a liquid oil such as corn, safflower, soybean, or canola oil as the first ingredient.

Egg yolks and organ meats such as liver are high in cholesterol. Check the Nutrition Facts and the list of ingredients on food labels.

Choose the kinds of fat that can help lower your cholesterol. If you use cooking oil, choose olive oil or canola oil. Nuts have a healthy type of fat as well. Corn oil, sunflower oil, and safflower oil also protect your heart. However, all oils, nuts, and fats are high in calories. If you’re trying to lose weight, you’ll want to keep servings small.

Have fish 2 or 3 times a week. Albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon are high in omega-3 fatty acids, a type of fat that may help lower blood fat levels and prevent clogging of the arteries.

Use special cholesterol-lowering margarine. Having 2 to 3 tablespoons of a cholesterol-lowering margarine every day can lower your cholesterol. These margarines contain plant stanols or plant sterols, ingredients that keep cholesterol from being absorbed. You’ll find several types at the grocery store in the margarine section.

Cook with less fat. You can cut down on total fat by broiling, microwaving, baking, roasting, steaming, or grilling foods. Using nonstick pans and cooking sprays instead of cooking with fat also helps.

Eat more foods that are high in fiber. Foods high in fiber may help lower blood cholesterol. Fiber also can prevent problems with the digestive system such as constipation. Oatmeal, oat bran, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are good sources of fiber.

Include more soy protein in your meals and snacks. Replacing foods high in saturated fat with soy-containing foods may help lower your cholesterol. Foods with soy protein include soybeans, tofu, miso, tempeh, soy nuts, soy milk, textured soy protein, soy protein powder, and items that are made from soybeans, such as burgers.

Limit your alcoholic beverage consumption. Drinking light to moderate amounts of alcohol is associated with a low risk of heart disease, perhaps by raising HDL (good) cholesterol levels. There isn’t enough information to recommend that people who don’t drink should start drinking alcohol to reduce heart risk. But, for those who do drink alcohol, 1 serving daily for women and up to 2 servings daily for men have been associated with good health. Drinking more than 1 to 2 drinks per day isn’t helpful; it contributes unnecessary calories and may actually raise your blood pressure and triglycerides. In addition, it can cause other health problems. It’s best to discuss drinking alcohol with your health care provider to find out whether it may be helpful for you.

A Day of Heart-Healthy Meals 

Breakfast

Fresh orange sections
Oatmeal with 1% milk and raisins
Toast with cholesterol-lowering margarine
Coffee with 1% milk

Lunch

Sliced turkey on whole wheat bread with lettuce and mustard
Carrot sticks
Cherry tomatoes
Fresh apple

Dinner

Baked chicken
Baked potato with cholesterol-lowering margarine and low-fat sour cream
Steamed green beans
Tossed salad with low-fat salad dressing
Low-fat frozen yogurt

Between-meal Snacks

Dried fruit air-popped popcorn rice cakes with peanut butter

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