Carb Counting Basics

5 Nov

Be prepared for information overload in this post…

I am a huge sucker for health documentaries, even though almost all of them start out with the same shocking statistic: 1/3 of all children born in the year 2000 are expected to develop diabetes during their lifetime.  For minority children, the estimate is as high as 1/2!  UnitedHealth group concluded a study with the prediction that 1 out of every 2 Americans will be pre-diabetic or diabetic by the year 2020.  According to the 2011 National Diabetes Fact Sheet, ~8.3% of Americans have diabetes with 7 million undiagnosed.  I’d be shocked if you didn’t know at least 1 person with diabetes.

Only 5% of diabetics have Type 1 diabetes.  This type is often diagnosed in childhood and is the result of a faulty pancreas that does not have the ability to make insulin.  Therefore, Type 1 diabetics are dependent on insulin injections to maintain their blood sugar levels.

Type 2 diabetes is far more common and stems from 2 possible factors: not enough insulin produced or the body cells becoming resistant to insulin’s effects.  A person with Type 2 diabetes may/may not need to receive insulin injections.  Sometimes, a medication is prescribed that helps with insulin resistance.  I believe Metformin is the most commonly prescribed.

Whereas diet and exercise can alleviate and even reverse Type II diabetes, a person with Type 1 diabetes must be careful to coordinate their meals and exercise with their insulin injections.  Too many carbs and not enough insulin = hyperglycemia.  Too much exercise, too much insulin/not enough carbs = hypoglycemia.

Hyperglycemia is when the body has more sugar than it can handle.  Neuropathy (nerve damage) and nephropathy (kidney damage) are common consequences.  In some parts of the world, diabetes is the most common cause of blindness and kidney failure.   Serious business folks!

Hypoglycemia is when the brain does not receive enough glucose (which it REQUIRES to function).  Mild hypoglycemia can generally be treated at home with sugar pills or a glass of orange juice.  More severe cases can result in coma or even death.  Even more serious business folks!

For the entire month of November, I am on my version of a “diabetic diet”.  The day after Thanksgiving, I will be starting my mini-Paleo experiment (Good timing, eh? ;-))  as there will be exactly 1 week left of November starting on Black Friday.

My cat was recently diagnosed with diabetes 😦  which has prompted some early research into the matter as well as the acquisition of some useful tools including a blood sugar monitor.  Everyone with diabetes is different in terms of how often they need to check their blood sugar.  Those with Type 1 diabetes and Type 2 diabetics who are insulin dependent, should check their blood sugar more often.  Holy crap is it expensive!!!  I bought a box of 25 test strips, and it cost me about $25.  That’s $1.00 per strip!  Not to mention the other costs: insulin: $120 per 10ml vial, flimsy syringes & lancets designed to be used only 1 time, lancet pen, blood sugar monitor, etc.  And here’s the real kicker: some of the glucose monitors are more sensitive than others.  If you don’t do it perfectly, you’ll receive an error message and need to use another $1.00 strip to get a different reading.  YIKES!!!

Originally, I had planned on taking my blood sugar at least once a day.  I wanted to see what it felt like to have to prick myself multiple times per day just to keep tabs on my homeostasis.  Unfortunately, I can’t afford to take my blood sugar everyday in the name of science, so now I’m just planning to test my blood sugar at least a few times during the month.

In my dietetics courses, we were taught the exchange system.  The exchange system is based on keeping track of your macronutrient intakes.  Macronutrients consists of carbohydrates, protein, and fat.  The premise of the program is to make sure you are getting the desired percentage of each.  For example, if you wanted to limit your carbohydrate content to 50%, your protein content to 20%, and your fat content to 30%, there is a method one can adopt in attempting to do so.  However, following the exchange system can be a bit overwhelming, especially for the newly diagnosed.  For those who are less interested in dietary perfectionism and more interested in following a less strict but highly effective method, I would encourage carb counting.  Once you’ve got a handle on it, this is a much simpler approach that more people may be comfortable introducing into their daily lives.

Here is how carb counting works:

The first step is identifying caloric needs based on resting metabolic rate and activity level.  From there, a person must choose how many carbohydrates they wish to consume in a day.  According to the USDA, 45-65% of calories should come from carbohydrates.  I strongly disagree.  This is way too many carbs, especially for a person with diabetes.  I am more comfortable with a range of 30-50%.  Many of us (myself obviously included) are carb addicts, so a higher percentage may be appropriate in certain people who do not like the idea of “low carb” or wish to follow a plant-based diet.  However, my personal and professional opinion is that a lower carb diet is more appropriate for most people with diabetes.  For my experiment, I am aiming for no more than 50% of calories coming from carbs.  We can use my numbers as an example:

I need about 1492 calories per day (based on my height, weight, and activity level).  50% of 1492 = 746.  This means that 746 of my calories will be coming from carbs.  Then, divide that number (746) by 4, because there are 4 calories per gram of carbohydrate.  This leaves us with 186.5 grams of carbs per day.

Still with me?

Next, divide by 15, because 1 choice in carb counting is about 15 grams of carbohydrate.  This gives me 12.4 total choices per day.  If I divide this up into 3 meals, I am allowed 4 choices per meal.  Phew!  I hope that all makes sense.  If not, don’t worry.  That’s what dietitians are for. 😉

I have an official “Choose Your Foods: Exchange Lists for Diabetes” reference guide that divides each category of food up into different categories.  As a general rule, 1 serving of starch = 1 choice(15 grams of carb); 1 serving of fruit also = 1 choice(15 grams of carb); milk = a tad more than 3/4 of choice(12 grams of carb).  It’s important to note that all dairy products are not considered equal.  Some hard cheeses are pure protein and therefore, do not contain any carbohydrate.  This is where the reference guide and/or a background knowledge in nutrition comes in handy!  A guide is best for those just starting out, but 1 can branch out by learning and internalizing the general rules of carb counting.

This is the label from a can of black beans.  You’ll notice that it has 20 grams of total carbohydrate & 7.5 grams of fiber.  From this information, we can figure out net carbs.  Don’t worry!  This is much simpler than the hooplah found above. 😉  To get net carbs, we just subtract the grams of fiber from total carbs.  In this case: 20-7.5 = 12.5.  Since fiber is indigestible by definition, we do not have to include it in our carb counting choices.  Therefore, 1/2 cup of black beans has 12.5 grams of carbohydrate.  Using the rules mentioned above, we know that a serving of black beans would = ~3/4 choice since 1 choice = 15 grams of carb.

Here’s another example:

I can have up to 4 carb choices at breakfast.  As stated above, each choice = 15 grams of carbohydrate.

Let’s say I want to have a bowl of oatmeal.  My reference guide tells me that 1/2 cup of cooked oatmeal = 1 choice.  If I eat 1 cup of oatmeal, this will = 2 choices.  To this, I will add 3/4 cup of blueberries (1 choice) and an extra small banana cut into slices (1 choice).  At this point, I have reached my 4 allowed carb choices for breakfast.  I could also add some butter or shredded coconut, but since these are mostly fat, they wouldn’t factor into my allowed carb choices.

I could exchange 1 TBSP of sugar for the banana, as that would also represent 1 carb choice.  A common misperception among people is that a person with diabetes can not have any sugar.  This is not true.  An argument for choosing a slice of whole grain bread over 1 TBSP sugar for nutritional purposes can certainly be made.  However, the fact of the matter is that both will raise blood sugar.  So a sugar really is a sugar is a sugar (& this includes “healthy” starches).  It is often shocking to people that 2 slices of whole wheat bread can spike blood sugar more than a TBSP sugar, but that’s what brainwashing will do to a nation.

Is that enough brain stretching for 1 day?  Let’s wrap it up with my November 1st menu.

What I ate my first day on my diabetic diet:

Breakfast: Smoothie made with 1 cup of soymilk, 1/2 cup of blueberries, 1 banana, collard green leaf, romain lettuce leaves, and cinnamon.  Approximate CHO (carbohydrate) count: 3 choices

Lunch: Brown rice tortilla with 1 oz pepperjack cheese, spinach, lettuce, & red pepper + a handful of almonds

Approximate CHO count: 2 choices

Snack: 1 fun-sized Kit Kat bar & 1 Reese’s peanut butter cup (Soy lecithin!  How I missed you!)

Approximate CHO count: 1 1/2 choices

Supper: Spaghetti with buckwheat noodles, tomato sauce with chopped collard greens, kale, and red pepper, & 4 meatballs; salad with lettuce, spinach, carrots, strawberries, olive oil, and balsamic vinegar

Approximate CHO count: 4

I only used10 1/2 total carb choices on this day rather than the allowed maximum of 12.  My appetite was still quelled from my carb binge the day before (see previous post: “Soyless Joyless Halloween” – What I ate my last day with a soy and egg allergy).  By the way, you can’t eat meat all day and then splurge on 6 frosted cupcakes (the equivalent of 12 carb choices) at the end of the day.  You need to space your carb choices out!

Sources:

http://www.diabetes.org/diabetes-basics/diabetes-statistics/?cr=redcpcggfreediabetesstatistics&gclid=CM7QuumfuLMCFcKPPAodzV4Aaw

http://www.nlm.nih.gov/medlineplus/magazine/issues/summer08/articles/summer08pg14-15.html

http://phys.org/news/2010-11-americans-diabetic-pre-diabetic.html

http://reboot.fcc.gov/parents/media-and-childhood-obesity

http://www.renalinfo.com/uk/how_kidneys_work_and_fail/kidney_failure/causes_of_kidney_failure/diabetes_mellitus.html

 

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