For years, the American Diabetes Association told people with diabetes that they should be eating 55 to 60 percent of their calories as carbohydrate. Many experts disagree. The ADA has now modified its recommendation so that it says in the Clinical Practice Recommendations for 1998: "The percent of carbohydrate will vary and is individualized based on the individual's eating habits and glucose and lipid (fat) goals." Below are suggestions for carbohydrate in your diet based on medical literature and the clinical experience of experts. But you should use whatever level of carbohydrate you like as long as it helps to promote low blood glucose without increasing blood fats or weight.
Carbohydrates are the source of energy that starts with glucose, the sugar in your bloodstream that is one sugar molecule, and includes substances containing many sugar molecules called complex carbohydrates, starches, cellulose, and gums. Some of the common sources of carbohydrate are bread, potatoes, grains, cereals, and rice.
Physicians know a lot of information about carbohydrate in the body:
- Carbohydrate is the primary source of energy for muscles.
- Glucose is the carbohydrate that causes the pancreas to release insulin.
- Carbohydrate causes the triglyceride (fat) level to rise in the blood.
- When insulin is not present or is ineffective, more carbohydrate raises the blood glucose higher.
- If simple sugars are in the diet in increased amounts, they are not harmful as long as the total calorie count is satisfactory.
Because carbohydrate is the food that raises the blood glucose, which is responsible for the complications of diabetes, it seems right to recommend a diet that is lower in carbohydrate than previously suggested. Furthermore, a major source of coronary artery disease in diabetes is the insulin resistance syndrome. Because increased carbohydrate triggers increased triglyceride, which is the beginning of a number of abnormalities that lead to increased coronary artery disease, recommending less carbohydrate on this basis as well seems prudent.
Therefore, a man on a diet of 1,700 kcalories should eat about 680 calories as carbohydrate. Because each gram of carbohydrate is 4 calories, he eats about 170 grams of carbohydrate a day. Translating this into the foods you know, this is the same as 11 slices of white bread a day or 6 cups of cereal a day or 4 cups of rice a day.
Diabetes and the glycemic index
All carbohydrates are not alike in the degree to which they raise the blood glucose. This fact was recognized some years ago, and a measurement called the glycemic index was created to quantify it. The glycemic index (GI) uses white bread as the indicator food and assigns it a value of 100. Another carbohydrate of equal calories is compared to white bread in its ability to raise the blood glucose and assigned a value in comparison to white bread. A food that raises glucose half as much as white bread has a GI of 50, while a food that raises glucose 1-1/2 times as much has a GI of 150. The point is to select carbohydrates with low GI levels to try to keep the glucose response as low as possible.
Evaluation of the diet of people who develop diabetes compared with those who don't shows that, all other things being equal, the people with the highest GI diet most often developed diabetes. Once diabetes is present, those who eat the lowest GI carbohydrates have the lowest levels of blood glucose. Patients in these studies have not had great difficulty changing to a low GI diet. The other thing that happens when low GI food is incorporated into a diet is that the levels of triglycerides and LDL (or "bad" cholesterol) fall in both type 1 and type 2 diabetes.
Switching to low GI carbohydrates can be very beneficial for controlling your glucose. You can easily make some simple substitutions in your diet, as shown in Table 1.
Table 1: Simple Diet Substitutions
Because bread and breakfast cereal are major daily sources of carbohydrates, these simple changes can make a major difference in lowering your glycemic index. Foods that are excellent sources of carbohydrate but have a low GI include legumes, such as peas or beans, pasta, grains like barley, parboiled rice and bulgar, and whole grain breads.
Even though a food has a low GI, it may not be appropriate because it is too high in fat. You need to evaluate each food's fat content before assuming that all low GI foods are good for a person with diabetes.
Fiber and diabetes
Fiber is the part of the carbohydrate that is not digestible and therefore adds no calories. Fiber is found in most fruits, grains, and vegetables. Fiber comes in two forms:
- Soluble fiber: This form of fiber can dissolve in water and has a lowering effect on blood glucose and fat levels, particularly cholesterol.
- Insoluble fiber: This form of fiber cannot dissolve in water and remains in the intestine. It absorbs water and stimulates movement in the intestine. Insoluble fiber also helps prevent constipation and possibly colon cancer. This is the fiber called bulk or roughage.
Because too much fiber causes diarrhea and gas, you need to increase the fiber level in your diet fairly slowly. The recommendation for daily fiber is 20 to 30 grams. Most Americans eat only about 15 grams daily.
Many of the foods listed as having a low glycemic index contain a lot of fiber and that helps to reduce the blood glucose.
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