Carbohydrates and Diabetes

Here’s a great question we received recently about carbohydrates as part of a diabetes diet.

Q – We know the body is a biochemical factory. Food is chemically broken down and absorbed. The body recognizes only chemicals, not the source of the chemicals. So why do I hear stuff from so-called experts about how we should never eat chocolate or sweet snacks every day, but only on rare special occasions? If our A1c is in line, our cholesterol numbers are okay, and we are not overweight, isn’t it okay to eat such things, as long as they are included in our daily carb count? If one eats a bowl of rice containing 60g of carbs, the body doesn’t know if it was rice or apples or chocolate that was eaten. All it knows is that 60g of carbs must be processed. So, why do the experts continue to scare us into nearly never eating certain foods, always neglecting to mention that if all our statistics are okay and we eat healthy food at almost every meal, it shouldn’t make a difference? – George –

A – There is no longer a single diabetes diet that will suit everyone. The overall approach is based on the US Dietary Guidelines for healthy eating for all Americans, and includes the following:

  • Limit fats. Avoid saturated fats (found in animal products) and trans-fatty acids (hard margarine, commercial products, fast foods). In selecting fats or oils, choose monounsaturated fats (virgin olive oil, canola oil), although you may also include polyunsaturated oils (sunflower, rapeseed). Of note, a 2001 report suggested that trans-fatty acids were a risk factor for diabetes type 2 while polyunsaturated were protective.
  • Limit dietary cholesterol.
  • Consume plenty of fiber-rich foods in the form of whole grains and fresh fruits and vegetables. Includes a daily choice of nuts, seeds, or legumes.
  • When choosing foods with sugar, choose fresh fruits, but do so in moderation.
  • Limit protein. In selecting proteins, eat in moderation and choose fish or poultry not meat. (Avoid, in any case, high-fat meats.)
  • Reduce salt.

People with diabetes should ideally meet with a professional dietitian to plan an individualized diet within the general guidelines that takes into consideration their own health needs and preferences. There is no single diet that meets all the needs of everyone with diabetes.

A simple heart-healthy diet with weight control may be sufficient for people with type 2 diabetes. One study of people with type 2 diabetes compared several diet plans: a high-carbohydrate/high-fiber diet, a low-fat diet, and a weight management diet. After 18 months all groups experienced similar and improved glycolated hemoglobin and cholesterol levels. The researchers concluded that the positive benefits of the diets were derived not from the specific regimens, but because the people in the study were attentive and focused. In other words, any healthy diet works if patients work at it.

Intricate dietary methods are available for control of blood sugar in type 1 and more severe type 2 diabetes. Methods include exchanges (though that is being used less and less) counting carbohydrate grams and using the glycemic index to determine the impact of carbohydrates on blood sugar.

If one of these approaches works in controlling glucose levels, there is no reason to choose another. Each of them can be effective, but because regulating diabetes is an individual situation, everyone with this condition should get help from a dietary professional in selecting the best method for them.