Carbs and Type 2 Diabetes – understanding and using carbs

carbs breadIt is important to understand carbs and Type 2 Diabetes. How much and what kind of carbohydrates can you eat? How does our consumption of carbs affect the balance between how much insulin we produce and our blood sugar levels?

We’ll look at the different types of carbs, the glycaemic Index and Type 2 Diabetes, should we avoid carbs and finally, how to introduce good carbs into our diet and how to count them.

So, let’s dive in…

Types of Carbohydrates – discovering the 3 types

Did you know that our food contains three main types of carbohydrate? These are:

  • Starches (also known as complex carbohydrates)
  • Sugars
  • Fibre

Let’s look at each of these in turn:

Starch – foods high in starch include the following main groups:

  • Starchy vegetables like peas, potatoes, corn and lima beans
  • Bread, pasta, breakfast cereals and couscous
  • Dried beans, lentils and beans such as pinto beans, kidney beans and black eyed peas
  • Grains such as oats, barley, wheat and rice

The grains can be broken down into whole grain or refined grain. Grains consist of the outer shell or husk, known as bran which contains the most fibre and B vitamins and minerals; the germ which is packed with nutrients including Vitamin E as well as essential fatty acids; the endosperm which is the soft part in the centre of the grain and contains the starch.

Whole grains include all three parts so if you eat these you are getting the full package of nutrients and starch. Eating a refined grain food means you are missing out a lot of vitamins and minerals as these only contain the starchy endosperm.

Sugar – there are two types of sugar, naturally occurring sugars such as those found in milk and fruit and refined or added sugars such as those found in sweets, chocolate, sugary drinks and desserts.

You will find many names for sugar such table sugar, brown sugar, honey, confectioner’s sugar, cane sugar and so on. You can also recognize sugars from their chemical names which all end in ‘ose’ such as sucrose, fructose (sugar in fruit) and lactose (in milk and other dairy products).

Fibre – is a type of carbohydrate that you can’t digest.

There are two types of fibre:

  • Insoluble fibre found in foods such as wholemeal bread, brown rice and wholemeal cereals. Insoluble fibre helps to keep the digestive system healthy
  • Soluble fibre, found in foods like bananas, apples, potatoes, oats and barley helps to keep our cholesterol and blood sugar levels under control

We should ensure that we eat both types of fibre regularly. Fruit and vegetables, nuts and seeds, oats, wholegrain breads and pulses are all good sources of fibre.

For good health, adults should aim to eat between 25 and 30 grams of fibre daily. Most of us only eat around half that so any increase in our fibre intake will be good for us.

Glycaemic index and diabetes – understanding GI

The glycaemic index (GI) tells us whether a food raises blood glucose levels quickly, moderately or slowly. This means it can be useful to help you manage your diabetes. Different carbohydrates are digested and absorbed at different rates, and GI is a ranking of how quickly each carbohydrate-based food and drink makes blood glucose levels rise after eating them.

Research has shown that choosing foods with a low GI can particularly help manage glucose levels in people with Type 2 diabetes. There is less evidence to suggest it can help with blood glucose control in people with Type 1 diabetes.

Unfortunately, not all low-GI foods are healthy choices – chocolate, for example, has a low-GI because of its fat content, which slows down the absorption of carbohydrate. (I love chocolate so have to limit myself on this one!)

If you create a meal using foods with different GIs this alters the overall GI of a meal. You can maximize the benefit of GI by switching to a low GI option with each meal or snack. As I just mentioned, go easy on lower GI foods like chocolate, which is high in fat and calories, especially if you are trying to lose weight. Save them for occasional treats.

Eating to control your diabetes isn’t just about GI ratings. Think of the bigger picture and choose foods low in saturated fat, salt and sugar as part of a healthy, balanced diet.

Other factors affect the GI too! For instance, frying, boiling and baking; how ripe your fruit and veg are; eating high-fibre foods (they act as a physical barrier slowing down the absorption of the carbohydrate), fat content also lowers the GI (enough about chocolate?), protein lowers the GI of food, milk and other dairy products have low GIs because they are high in protein and contain fat. Meat has no GI as it contains no carbohydrate.

You can obtain books that give a long list of GI values for many foods but this kind of list does have its limitations. The GI value relates to the food eaten on its own and in practice we usually eat foods in combination as meals. Bread, for example is usually eaten with butter or margarine; potatoes could be eaten with meat and vegetables and fried, boiled or baked.

One other additional problem is that GI compares the glycaemic effect of an amount of food containing 50g of carbohydrate but in real life we eat different amounts of food containing different amounts of carbohydrate.

The amount of carbohydrate you eat has a bigger effect on blood glucose levels than GI alone, so watch your portion sizes.

Should we avoid carbs? – Not entirely!

Current evidence does suggest that a low-carb diet can be safe and effective for people with Type 2 diabetes. They can help to reduce the risk of cardiovascular disease as well as helping with weight loss and blood sugar control.

I have been on a low-carb, high fat (LCHF) diet and lost weight and brought my blood sugar levels down to normal. However, I would like to make clear the following points:

I do NOT recommend low-carb diets for Type 1 diabetics. There is no clear evidence to suggest that a low-carb diet is safe or effective for people with Type 1 diabetes.

I do NOT recommend low-carb diets for children. Evidence would suggest that low-carb diets in children can lead to adverse effects such as an increased risk of cardiovascular disease, poor growth rates and psychological problems.

We are all different! What works for me may not work for you. We are individuals with different bodies and different nutritional requirements. You should work with your family, friends and medical team to find what best works for you.

We should all be encouraged to eat more fruit and vegetables, whole grains, seafood, pulses and nuts and to eat less red meat, processed meats, sugary drinks, foods with added sugar, and refined grains such as white bread.

Introduce good carbs into our diet – let’s hear it for wholefoods!

We can all introduce good carbs into our diets by choosing wholegrain products such as wholemeal bread and cereals and using brown rice.

Eating whole fruit rather than drinking fruit. Did you know that eating a whole apple, with the skin on, provides more fibre than drinking a glass of apple juice?

Try alternatives such as quinoa or couscous instead of pasta. One of my particular favourites is cauliflower ‘rice’.

Counting the carbs – does it add up?

A good place to start is to figure out how many carbs you are eating now. Then you can use that as a basis for reducing your carb intake. Measuring your blood sugar levels before meals and 2 hours after eating for a few days will help you figure out how your carbs are affecting your blood sugar levels before you embark on any low carb diet.

If you do want to count the carbs then check the food labels on the packages. The amount of starch, sugar and fibre should be clearly indicated but it is the total amount of carbohydrate that is the important figure. Just add up the amounts – simple! But what about your fruit and veg that don’t come packaged? A quick search on the internet will provide you with some great online tools which will give you the nutritional information you need.

If you are buying prepackaged foods with labels then you need to look for the serving size too. This will also be on the label. Remember, if you are eating the whole pack yourself then you will need to multiply the number of servings by the total amount of carbohydrate!

Protein and fat in meals are also a consideration although they have less impact on blood sugar levels. If you are eating lots of protein and find your blood sugar levels remain high then you should consult your doctor or dietitian.

Whatever you do – enjoy it!

There are a whole variety of wholemeal grains, cereals, fruit, vegetables, nuts, seeds and so on to keep you going for months, if not years, without getting bored with your diet. Just be careful to monitor your intake of carbohydrates and don’t overdo it. All colours of the rainbow can be found in the grocery store or supermarket these days – enjoy cooking and eating them all.

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