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Dealing with Carbs and Diabetes

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Get the key facts on carbs to help you take control diabetes

Carbohydrates are an important energy source for the body. But carbs can be challenging for people with diabetes because of its impact on blood sugar level. You don’t have to stop eating carbs if you have diabetes but you do have to choose wisely.

In this article, we talk about the carbs that are better for diabetes, how lowering carbs can improve blood sugar and practical ways to reduce your daily carb intake. As always, consult with your diabetes educator or care provider before making major changes to your diet.

What are carbs?

A carbohydrate is a major source of energy and one of three macronutrients in foods (the other two are protein and fat).

When we eat food, the body breaks down carbs into sugar which enters the blood. The pancreas then releases insulin, which tells the body to either use the blood sugar for energy or store it in muscles or the liver as glycogen.

There’s two main kinds of carbohydrates: simple and complex carbs.

Simple Carbohydrates

Simple carbs have simple chemical structures that includes either one sugar (monosaccharide) or two sugars (disaccharide). Examples are fructose, table sugar and lactose.  Because of their simple chemical structure, these carbs are broken down quickly and can lead to blood sugar spikes.

Complex Carbohydrates

Complex carbs have chemical structures with at least three sugars (polysaccharides) and include starches and dietary fibers.  The complex structure means these carbs take longer to digest causing a more gradual increase in blood sugars.

Carbs and Diabetes

Carbs can be challenging for a person managing diabetes. People with diabetes have a condition where their blood sugar exceeds normal levels because the body is not producing enough insulin or isn’t using insulin effectively.

High blood sugar levels over time worsens blood circulation and damages blood vessels, leading to serious health issues. Diabetes medication used to treat this condition is often meant to provide better blood sugar control such as insulin and metformin.

This is why it’s important for people with diabetes to choose their carbs wisely. Foods with high carb content, especially added sugar and refined carbs, makes it harder to keep blood glucose levels within the normal range.

And continuing to have high blood sugar levels can worsen diabetes-related conditions such as insulin resistance, obesity and hypertension.

What are good carbs for a diabetic to eat?

If you decide to eat carbs, choose complex carbs over simple carbs to minimize any increases to your blood sugar level.

The carbs you eat should also come from whole foods as possible. Many snack foods and processed foods have refined carbohydrates that cause blood sugar levels to spike. And while mealtime insulin and other medications help control blood sugar levels, simply avoiding refined carbs is just as effective.

Below is a simple guide on choosing carbs for your meal plan.

Non-starchy Vegetables

Green, leafy or cruciferous vegetables are very low in carbs and good source of fiber. These vegetables are also packed with key nutrients and vitamins. For instance cruciferous vegetables contain glucosinolates, which studies have shown to have anticancer effects.

Broccoli, cauliflower, brussels, kale, mustard greens, and turnips are cruciferous vegetables you find in many groceries. Other non-starchy vegetable options are eggplant, leafy greens, asparagus, cabbage, and beets.

Starchy Vegetables

Starchy veggies that are lower in carbs include squashes, yams, carrots, parsnips, and peas. These are better options than other starchy veggies like potatoes and corn, which have much higher carb contents.  Butternut squash has only 10 grams of carbs per serving (100g) compared to potatoes which have 20 grams of carbs per serving.

Legumes & Beans

Legumes and beans can be high in carbs so choose wisely. Stick to lower carbs types and not highly processed (e.g. “healthy” snack chips made from bean-derived flours).

brown and yellow beans

Common legumes and beans that are under 30 grams of carbs per serving are green beans, peas, lima beans, lentils, lima beans, black eyed peas, black beans, pinto beans and chickpeas.

What carbs should diabetics avoid?

Grains & Fruit

Because many grains and fruit have high glycemic load, these should make up a small amount of your meal plan. And if you have to eat them choose whole and minimally processed grains and lower carb fruit.

Real whole grains (i.e. has all three parts of the kernel) have more nutrients and slightly lower glycemic load than processed grains. Real whole grains include whole oats, wild or brown rice, and wheat berries. Quinoa is also an option but it’s actually a seed.

Fruit with low sugar include berries, avocados, grapefruit, some apples, and kiwi.

Refined Sugars

Added sugars, sweeteners and syrups should be avoided as much as possible. These refined sugars are sure to raise blood sugar levels, making it unnecessarily harder to manage diabetes. Added sugars are found in a lot of packaged foods so pay attention to their food label.

How many carbs should a diabetic have a day?

The USDA Dietary Guidelines (found here) recommends that carbohydrates make up 45% – 65% of daily calories for adults. However these recommendations are most likely too high for people with diabetes.  These Guidelines apply to the general public – not specifically for people managing diabetes and have high blood sugar levels.

There is no ideal carb intake amount for people with diabetes because individual situations will vary. But studies continue to show that eating fewer carbs reduces hemoglobin A1C.

For instance, this 2018 review of carb restricted eating patterns found that greater carb restriction let to greater reductions in A1C, particularly within 6 months.  And this study comparing a low carb diet to a low fat diet found that low carb eating saw more improvement to A1C.

While there is no single definition for low carb diets, the studies above defined low carb as making up 26% – 45% of daily calories and very low carb makes up less than 26% daily calories.

Below is a reference table converting calories (%) into to grams of carbs.

This table gives you an idea how many carbohydrates in a day you should be eating. You’ll also need to know the total daily calories your body needs, which you can estimate using online calculators.

How do I lower my carbs?

Now that you know a low carb diet is better for diabetes disease control, there’s a few ways to start limiting carbs in your meal plan.

Carb Counting

A common and accurate way to lower daily carb intake is by carb counting.  Carb counting involves tracking the amount of carbs in each meal and making sure the total carbs consumed in a day is within your daily target.

sample nutrition label
Image source: usda.gov

But you’ll need to know how many carbs are in the foods you eat. This can be found in the nutrition food label on packaged foods (pictured right).

Or if you’re eating whole foods (which you should), you can search online food nutrition databases such as USDA’s database or MyFoodDiary.com.

When you count carbs, it does take time and effort at first. But don’t worry, it gets easier since you’ll remember the total carbohydrate of many foods you regularly eat.

Modified Plate Method

A simpler (but less accurate) way to reduce carbs is usng a modified version of the diabetes plate method. The American Diabetes Association plate method starts with a 9” plate and is filled with 50% nonstarchy vegetables, 25% proteins and 25% carbs (which includes grains, legumes and fruit).

Our modified plate method (see below) avoids grains and fruit in the carb portion since since the goal is to lower carb intake. Instead, replace with starchy vegetables, legumes or beans.

We also suggest reducing the amount of carbs (%) while increasing other portions.  A good starting point could be a plate with 50% nonstarchy veggies, 35% proteins, and 15% carbs.

We also suggest animal-based protein (over plant-based) in our plate method. Animal based proteins are more energy dense and contain a lot of essential amino acids. Lean protein is always a safe option but you can also eat proteins with moderate fat, as long as you watch the calories (higher fat = more calories).

Monitor Your Blood Sugar

Regularly monitor blood glucose when you lower carb intake. As blood sugar levels fall your medication may need to be changed and should be discussed with your care provider. For instance, mealtime insulin dose may need to be lowered to prevent blood sugar levels from falling too low.

If you experience very low blood sugar (glucometer reading below 70 mg/dL), quickly eat at least 15g of fast-absorbing carbohydrates. Recheck blood glucose after 15 minutes to see if it’s above 70 mg/dL. Repeat this until readings are above 70 mg/dL and then eat a meal or complex carb to keep blood sugar from dipping.

Don’t Forget About Your Energy

Count carbs but don’t forget about counting calories too. Lowering your calories from carbohydrates can make you feel less energetic.

Make sure you get enough calories (energy) from protein and fat, especially if you’re staying active. Remember, carbs and protein have 4 calories per gram while fat has 9 calories per gram.

Summary

Carbs are an important energy source but can be problematic for people with diabetes. because it raises blood sugar, especially added sugar found in a lot of food today.

Managing diabetes doesn’t stop you from eating carbs but you do have to choose wisely. We talked about how choosing complex carbs and lowering carb intake can greatly improve blood sugar levels. And we showed ways to reduce daily carb intake by carb counting or using a modified version of the plate method.

Keep your meal plan simple! No need to worry if your meals fit into labels like “low carb diets” or the “ketogenic diet.” Just focus on eating fewer calories from carbohydrates and whole, minimally processed foods.

Lastly, staying active and exercise is important for long-term diabetes management. A healthy diet combined with active living will promote weight loss and improve other diabetes-related conditions.

What the Mayo Clinic Diabetes Diet Gets Wrong

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The Mayo Clinic Diabetes Diet comes from a trusted source but may not be the best for your diabetes

If you have Type 2 diabetes (T2DM), you may have heard of the Mayo Clinic Diabetes Diet. The Mayo Clinic is a trusted name so it’s easy to think the Diet works. But we found problems with the Diet and show why it may actually work against your goal of taking control of T2DM.

The Mayo Clinic Diabetes Diet

If you searched searched online for ‘best diets for diabetes,’ one that pops up is the Mayo Clinic Diabetes Diet. The Mayo Clinic is a respected name with their award winning hospitals, doctors, and medical education and research centers. Here’s the basics of the Diet:

  • Healthy Carbohydrates: including fruits, vegetables, legumes. These same foods are recommended under fiber-rich foods.
  • Heart-healthy fish: those with high omega-3 fatty acid.
  • Good fats: sources with high monounsaturated (MUFA) and polyunsaturated fats (PUFA) such as avocados, nuts and oils like canola, olive and peanut.

Foods to Avoid

  • Saturated Fats: certain dairy and animal proteins including hot dogs and sausages.
  • Trans fat: in processed snacks and baked goods.
  • Cholesterol: including high-fat dairy and animal proteins.

To put it all together they recommend to develop meal plans such as the ADA plate method (for portion sizes) or carb counting.

What the Mayo Clinic Diet Gets Wrong

So now we know the Mayo Clinic Diabetes Diet recommends “healthy” carbohydrates and “good” fats. Great! That sounds like healthy eating and good nutrition. And since it’s for diabetes it should help with blood glucose and weight loss, right?

But taking a closer look and we see a diet that can actually make it harder to control T2DM. We find 4 things the Mayo Clinic gets wrong.

The Staple Foods Are Mostly Carbs

The first problem with the Mayo Clinic Diabetes Diet is that the staple foods are whole grains, fruits and legumes (such as beans). But these include many foods high in carbohydrates!

We took their sample menu and used nutritiondata.self.com to calculate the amount of carbohydrates and glycemic load (GL) of the staple foods. Here are the results:

  • Breakfast: 285 calories (cal.) with 242 of those from carbs and a total 31 on GL. This is the whole wheat bread, jelly, shredded wheat cereal and fruit (orange).
  • Lunch: 328 cal. with 182 from carbs and total 15 GL. This is the sandwich bread and medium apple.
  • Dinner: 244 cal. with 205 from carbs and 27 GL. This is the small baked potato, green beans and medium white dinner roll.
  • Snack: 75 cal. with 63 from carbs and 7.5 GL from the popcorn.

That totals to 932 calories with 692 coming from carbs and a total GL of 80. That’s at least 74% of your energy coming from carbs in one day. And note that food with a glycemic index of 70 or higher is considered bad according to Healthline.

You’re Likely to Overeat Carbs

The second problem with the Mayo Clinic Diabetes Diet is that you’ll end up overeating. And most likely on carbohydrates which is terrible for your diabetes.

Their sample menu is for 1,200 to 1,600 cal. in a day. However, that’s actually on the low-end for calories needed for the average person.

You can find daily caloric needs by using online calculators like this. For a 5’10” male, age 55, 230 pounds with a sedentary activity level, 2,750 cals. are needed per day.

Eating meals that only give you 1,600 cals. is clearly not enough. Thus, this will cause you to increase your meal sizes to get needed energy but the staple foods are still high in carbs!

The primary goal for patients with Type 2 diabetes is to lower blood sugar levels. And weight loss is just as important with doctors likely to recommend as a primary treatment goal for diabetes, based on recent studies.

But the meals under this Diet end up working against your goals. You’ll have to exercise more to lose or maintain weight. Or you’ll try to find for more “healthy” recipes when your glucose doesn’t improve.

This can all get tiring, fatigue kicks in and eventually people lose motivation.

Recommends Oils High in Omega-6

The Mayo Clinic recommends eating “good fats” that contain monounsaturated (MUFA) and poly unsaturated (PUFA) fats. We don’t disagree that MUFA/PUFA are healthy and studies show they can improve key markers for Type 2 diabetes.

The Diabetes Care Journal published this review of studies comparing diets high in MUFA to ones with high carbohydrates. They found benefits of the MUFA diet over the high-carb diet including significant reductions in fasting plasma glucose, triglycerides, body weight and blood pressure.

However the problem is that the “good fats” include seed oils that have high omega-6 fatty acid content.

While there’s nothing wrong with omega-6 per se, there’s a desired ratio of omega-6 to omega-3 to maintain overall health. This study in PubMed.gov showed the importance of consuming a low ratio of omega-6/omega-3 (roughly 2:1) in reducing the risk of many chronic diseases.

Peanut oil has a 32:1 omega-6/omega-3 ratio! Making it very easy to exceed the ideal ratio.

Mischaracterizes Animal Protein

Finally, the Diet recommends avoiding animal proteins and lumps in highly processed meat like hot dogs, sausages and bacon. This is misleading because processed meat is clearly different from minimally processed meat such as a steak with salt and pepper.

We can all agree that processed food is poor nutrition and bad for health. Highly processed foods are stripped from vital nutrients, include chemical stabilizers and most have added sugar. No doubt people with diabetes should avoid these and stick to minimally processed foods and recipes.

Yet this mischaracterization of animal protein has been done for years by mainstream health authorities. We often see studies trying to link overall poor health and nutrition with eating red meats.

Take this recent research published in JAMA looking at associations of animal protein intake with certain diseases. They concluded that eating over two servings of red meat, processed meat or poultry is linked to a 3% to 7% increased risk of cardiovascular disease (CVD). The percentage increase is quite small but note the “or” used to lump in processed meat with red meat and poultry.

And the actual results show a clear distinction between the two meats. The study found that the 30-year absolute risk for CVD was much higher for processed meat (at 1.74%) than red meat (at 0.62%). More than double, actually.

Summary

The Mayo Clinic is known for medical education and research so it’s easy to assume their Diet is good for health, nutrition and improving Type 2 diabetes. But the Mayo Clinic Diabetes Diet has problems that we think will make it harder to lower blood sugar and lose weight.

The diet includes many carb-heavy foods and can leave you hungry, causing overeating with more carbs. The diet also recommends seed oil but doesn’t caution again their high omega-6 content. And the Mayo Clinic lumps in hot dogs and sausage with minimally processed animal proteins, despite the clear differences in nutrition.

Bottom Line

We think this diet will make you work harder to control Type 2 diabetes naturally. A meal with carb-heavy foods makes it harder to lower blood sugar. And you’ll likely overeat, which results in excess calories and will require more exercise to lose weight.

Ultimately, frustration kicks in when you don’t see results and it’s easy to lose motivation.

So what diet should I eat?  Stay tuned, we’ll be posting a separate article going in depth on this issue since there’s a lot of important context and information. But for now, you can get a preview of our preferred diet in our post on meal planning hacks for diabetics.

Meal Planning Hacks

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Meal planning is important for managing diabetes but can be a lot of work. These simple hacks will help Type 2 diabetics make meal planning more convenient and time saving, without limiting too variety.

Stock up on essential spices and herbs

Since every good meal starts with the right seasonings, stock up your pantry with essential spices and herbs. This gives you more options for recipes so that meal planning doesn’t get boring.  Also, most spices and herbs are fairly inexpensive and can last months so buy the larger sizes, when you can.

But what are the “essentials”? You can always stock up on your favorites (they should be low sugar) but below are seasonings we see used in many popular recipes.

  • Powders: garlic, onion, chili, paprika, cumin, cayenne, and chili flakes.
  • Herbs: bay leaves, basil, oregano, parsley, and thyme.

Bonus tip: make your own seasoning blends and store in containers.  You’ll save time with meal prep plus you can make low-sugar or low-salt versions of popular blends.

For example, BBQ seasoning is usually salt, pepper, garlic, onion, chili, paprika and cayenne along with brown sugar.  Just remove the brown sugar (or limit to a small amount) and now you have a BBQ rub that’s better suited for your diet.

Quick note on Oils

You’ll want to have oils in stock and we suggest olive, coconut, or avocado oils. Clarified butter is also a good option and is easy to make at home (CulinaryHill.com has a quick tutorial).

We suggest avoiding vegetable and seed oils (like canola, corn, etc.) because of the high amounts of omega-6 fatty acids. Eating more omega-6 makes it easier to exceed the desired ratio of omega-6 to omega-3 fatty acids, which helps reduce risks of chronic diseases, based on this summary from PubMed.gov.

Buy proteins in bulk, portion and freeze

Go to your local wholesale club store and buy a variety of poultry, meat and fish. Portion them to freeze using plastic storage bags or wrap.  We suggest portions of at least 4 servings, which should cover meals for most the week.  Just anticipate giving a day and a half to set out to defrost.

Added tip: when using the oven, cook two (or three) proteins together even if they’re for different dishes.  A lot of recipes actually say to cook meat or poultry at around 350 degrees but differ in cook times.

Cooking different proteins together is a simple meal planning hack that can double the number of meals you can make with little added time.

Our opinion on proteins

Proteins are important for a balanced diet. And they typically have lower glycemic loads than carbohydrates, which is important for keeping your hemoglobin A1C in range.

In fact a study published by the American Diabetes Association showed that dietary proteins had a small contribution to endogenous glucose production. In other words the proteins resulted only in a small increase in blood sugar, which is a key goal for keeping your A1C within range.

We also suggest animal-based protein over plant-based. And we prefer proteins with moderate amounts of fat such as pork shoulder, chicken thighs (skin on) or beef chuck. This is because they generally have higher energy density per serving, giving you more energy with less volume consumed.

Animal-based protein also contain many essential amino acids, which are at the core of many vital processes (per Healthline). For example, the nutrition data of just 6 oz. of chicken breast contains all 9 essential amino acids.

But mod- to high-fat proteins should not be paired with refined or starchy carbohydrates like grains, corn or white potatoes. Doing so creates a meal with high calorie, high glycemic load. Something to avoid since it will spike your A1C and create excess calories, which can then turn into body fat.

Use appliances to make things efficient

Investing in a slow-cooker or pressure cooker is a popular meal planning hack.  You can make large portions and the timed cooking is very convenient. And they can save you money by being able to cook tougher cuts of meat, which tend to cost less (especially if you buy in bulk). Making hearty stews and soups are perfect for these cookers – just toss all the ingredients together and set it aside to cook.

You should also invest in food storage containers of different sizes. You’ll be cooking a lot of food so you’ll want to store them into portions for a single meal, family servings or snack sizes. And look into containers with dividers inside to help take a lot of the guesswork out of portioning meals.

Summary

Planning meals is important for managing Type 2 diabetes. But we know it can take a lot effort.  With these meal planning hacks, you can make a variety of tasty dishes while saving some time and effort.

And if you still feel overwhelmed to start meal planning, just keep it simple! There’s already a lot to do for proper diabetes self-care (which we wrote about here) and why keeping it simple is all you need to get started.