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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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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