Carbohydrates and Type 2 Diabetes

As a diet-controlled Type 2 diabetic, I have been dealing with food issues relating to this disease for the past nine months. I will emphatically state that adequate nutrition is important to all individuals, especially diabetics. Carbohydrates (e.g. carbs) are essential to a balanced diet and in moderation can help you control the disease.

I am not familiar with the details of Dr. Vernon's treatment or her qualifications, though I am sure her intentions are well-founded. However, I think the following should be considered:

• While carbohydrates are frequently made up of sugars (that need to be closely controlled), many carbs are not and enable the slow digestive release of blood glucose components that help us avoid excessive spiking (sharp peaks and valleys) in our blood sugar levels. The carbs that help are referred to by my physician as "long-chain " carbs. These are processed slowly by our digestive system and are frequently found in certain vegetables and moderately processed grain products.
• Many Type 2 diabetics frequently suffer from other disorders. Diet extremes, such as extremely low-carbohydrate or high-protein approaches, can affect these diabetics. As an example, I am prone to gout, a disorder related to excess uric acid in the blood stream. Any significant restriction of carbohydrates may result in a relative increase of protein leading to higher uric acid concentration and, eventually, a gout attack.
• Vegetables are typically high in carbohydrates, compared to fats and proteins. Severely restricting carbs can lead to a dieter restricting good foods, like vegetables, and that is bad.

The need for weight loss often goes hand-in-hand with Type 2 diabetes. I controlled my diabetes with diet and exercise. Within six months of diagnosis, I was totally off of diabetes medication. In the process, I lost over 125 pounds. I did it while eating a balanced diet that contained a moderate level of carbs. My physician gave me some simple guidelines:

• Limit my daily caloric intake to approximately 1,000 calories less than my body uses. You can figure this out by going to www.caloriecontrol.org to find hard numbers on basic metabolism and calories burned for many common activities.
  
• We also burn a significant number of calories each day just to keep our hearts beating, our organs functioning, and our body heat at 98.6 degrees. This can be approximated by figuring around 12 calories per pound of weight. For a 150 pound person, that is about 1,800 per day. Add 600 calories of daily activity and exercise and you get 2,400 calories in your daily metabolism. A more than adequate diet of 1,400 calories of food intake per day will result in the above-mentioned 1,000 calorie differential and a weekly weight loss of 2 pounds per week! By the way, a pound of fat is roughly 3,500 calories. Therefore, when you eat 500 calories less each day than you burn, you lose weight at the rate of 1 pound per week. At 1,000 per day, then it is 2 pounds per week!
• The Doctor also suggested that for the calories I do consume, regardless of amount, they be divided into 50 percent carbohydrates (of which half are "long-chain"), 20 percent fats (limit saturated and allow no hydrogenated), and 30 percent protein. He increased the protein by 5 to 10 percent and reduced carbs by the same amount as my exercise level (and muscle building) increased.

That's how I did it and it worked! I've never felt better and all of my blood tests reveal that my overall health is excellent.

Benefits of a Bedtime Snack

Many people test their blood sugars four times a day - before meals and at bedtime. The bedtime test is to make sure that they have enough glucose on board to prevent low blood sugar during the night. Even if you don't test your blood sugar at bedtime, it is important to include a bedtime snack in your diet plan. Bedtimes snacks can:

- prevent low blood sugar during the night
- decrease midnight fridge raids
- support and stabilize your glucose
metabolism while you sleep

Some bedtime snack suggestions that will not rocket your blood sugars, include:

1. ½ sandwich made with 1 tablespoon of
peanut butter on 1 slice of whole grain
bread, with 8 ounces of low fat milk.

2. 8 ounces of low fat yogurt, with 1 slice
of whole grain toast - you can ½
tablespoon of peanut butter, too.

3. 1 package of cheese and crackers with 8
ounces of low fat milk.

4. ½ cup of fruit or vanilla ice cream with
1 large graham cracker. Avoid ice
creams with caramel, chocolate and nuts.

Making a bedtime snack doesn't have to be a production, however remember that it should contain the 3 primary fuel sources: carbs, fats, proteins.

Talk to your doctor, Nutritionist or Registered Dietician for more healthy bedtime snack ideas.

The Role of Protein in the Diabetic Diet

There is no such thing as a diabetic diet, however the American Diabetes Association does recommend that you have 50% carbs, 30% fats, and 20% proteins in your daily diet.

The roles of protein include:

* to help stabilize blood sugars
throughout the day
* to provide amino acids to use as
skeletal muscle fuel
* provide a feeling of satiety at meal
times

Protein is required to help the body rebuild, and also provides needed nutrients not found in carbs and fats.

Protein comes from many sources, including:

* meats (also contains fat)
* cheeses (also contains fat)
* nuts (also contains fat)
* soy
* beans and lentils

The type of protein you choose is less important than making sure that you eat some, each day, to support healing and nutrition.

Talk to your doctor, Nutritionist or Registered Dietitian for more information about protein, and how to incorporate adequate supplies of protein into your diet.

Choosing Snack Foods

If you are a snacker and a diabetic, it can be hard to resist the quick pick-me-ups that you pass on the way to the check-out counter, or that my be lurking on your own kitchen shelves.

The average household has chips, crackers, candy, juices, soda and other fat and sugar-laden products around the house. For the diabetic, these foods can spell fluctuating blood sugars, signs and symptoms of high and low blood sugar, and increased risk for complications.

So, how do you choose the right snack foods? If you follow the guidelines of the American Diabetes Association (ADA), you can group your snacks by their category: carb, fat or protein. Knowing that it is recommended that you eat 50% of your calories in the form of complex carbohydrates, let's start here.

Some good carb snacks include:

* fresh fruit - apples, coconut or
fresh pears make a great snack and
are low in carbs
* vegies - eat all the carrots you
want, and toss in some fresh spinach,
radishes, green beans and salads, too
* whole grain breads - keep it to the
suggested serving size and you will
be fine
* 1 ounce chunks of low-fat cheese, or
yogurt or low-fat cottage cheese,
string cheese is great, too

ADA suggests 30% fats:

* cheese to the rescue, again
* 1 ounce of nuts
* olives are good too, just stick with
the serving size

They also suggest 20% proteins:

* lean slices of ham or turkey rolled
up for a quick grab
* nuts have protein, too, as does
cheese and yogurt

Keep pre-made servings of your favorite snacks in your fridge, for easy grabbing on the run. This way you don't have to think about how much to take, and this reduces your risk of overeating.

Clean out your cupboards and ditch the high fat, high calorie junk foods that tend to populate many peoples' shelves.

Add low-calorie juices, bottled water, and sparkling water to your snack shelves to encourage hydration while you snack.

Balancing Carbohydrates, Fats and Proteins

According to the American Diabetes Association, carbohydrates should comprise no more than 50% of your diet, with the remaining 50% made up of 20% proteins and 30% fats. This formula is based on the way the body processes different types of food fuels.

Carbohydrates burn quickest and include grains, legumes (peas and beans) and vegetables. These foods tend to give you the quicker pick-me-up that lasts for a short time.

Proteins take longer to process and the energy level lasts longer than with carbohydrates, though less than with fats. Proteins generally include eggs and meats. This is what carries you through from meal to meal, when combined with fats.

Fats are the longest acting fuel source and provide baseline stability for your blood sugar over the course of 24 hours.

Together, these 3 types of fuel, in the right balance, provide for consistent blood sugars throughout the day, which promotes better health and reduces the risk of complications.

Six Smalls Meals

Though there is not a specific "diabetic diet," the American Diabetes Association has guidelines that they recommend for persons with diabetes.

These guidelines include 50% carbs, 30% fats and 20% proteins. Additionally, the concept of 6 small meals has been supported. There are several reasons for this:

* maintains more consistent blood sugar
levels
* reduces the urge to binge
* promotes hydration
* decreases hunger sensations,
especially in those who are reducing
calories or intake to promote weight
loss

1. When you eat at regular 2-3 intervals
throughout the day, your blood sugar
does not have time to drop to any
significant degree. This pattern of
eating decreases the roller-coaster
effect seen with 3 meals a day.

2. Frequent meals decreases the risk that
you will binge, as you consistently have
food on board, providing feelings of
satiety.

3. When most people eat, they also drink a
beverage. More frequent eating will
then also promote better hydration, just
make sure that you are drinking water,
low calorie fruit juice or other non-
caffeinate or alcoholic beverages, as
these will dehydrate you.

4. If you are "dieting" trying to lose
weight, the 6 small meals decreases
feelings of hunger. Even if the calorie
or quantity is decreased, the act of
eating every 2-3 hours reduces hunger
pangs, and will help you be more
successful in your weight loss efforts.

Whether you opt to eat 3 meals a day and a bedtime snack, or to go with 6 small meals, each day, remember these key things:

* 50% carbs, 30% fats, 20% proteins
* hydrate with non-alcoholic and non-
caffeinated beverages to a total of
at least 1 ounce for each 2.5 pounds
of your body weight
* test your sugar at regular intervals
* keep your Food Diary
* notify your doctor for repeated high
or low values, so that you can work
together to adjust your meal plan
and/or medications.

Talk to your doctor, Nutritionist or Registered Dietitian about your meal plan; they can provide you with more information about the risks and benefits of the meal plans and the best way to help you manage your diet and your blood sugars.

Low-Calorie Sweeteners

Recent studies have shown that sugar can be included in the diabetic diet, however that does not mean that you should give up on low-calorie sweeteners.

Sugar must be figured into your carbohydrate count, however low-calorie sweeteners generally do not have any calories or carbohydrates. This makes them free foods!

Low-calorie sweeteners have a place in your diet plan:

* they make food taste sweet
* they do not count as a carbohydrate
* they are not a fat
* they can be added to your meal plan
instead of substituted
* they are FDA approved
* the American Diabetes Associates
accepts these sweeteners as safe and
part of a healthy diet

There are different types of low-calorie sweeteners, but the 4 primary types are:

1. Saccharin - Sweet N Low, Sugar Twin
2. Aspartame - NutraSweet, Equal
3. Acesulfame Potassium - Sweet One, Sunett
4. Sucralose - Splenda

These low-calorie additives will not add calories, fats or carbs to your diet, and can be enjoyed without worrying about effects on your blood sugars or your waistline.

Cooking With Low-Calorie Sweeteners

With the increased focus on reducing carbs and calories in our diets, low-calorie sweeteners are at the forefront. This is especially the case for persons with diabetes.

There are many reduced-calorie or low-calorie sweeteners currently available on the market. If you choose to cook with these sweeteners, keep these key things in mind:

* some low-calorie sweeteners lose
their sweetness when cooked at high
temperatures, or for long period of
time
* the sweetness equivalency to sugar
varies between low-cal sweeteners
* foods made with low-cal sweeteners
don't brown like those made with sugar
* low-cal sweeteners work best in
recipes where they only provide a
sweet taste, rather than bulk or
texture
* results can vary from sweetener to
sweetener, to check out the
individual product prior to including
it in your baking

When replacing sugar with a low-cal sweetener, the exchange is as follows:

Sweet One – 12 packets = 1 cup sugar
Equal – 24 packets = 1 cup sugar
Splenda – 1 cup = 1 cup sugar
Sweet N Low – 12 packets = 1 cup
sugar
Brown Sweet N Low – 4 tsps = 1 cup
brown sugar

Remember that this exchange is for the level of sweetness, not to replace bulk or add texture that you would normally get with sugar.

Talk to your nutritionist or registered dietitian about using low-calorie sweeteners for cooking.

Fad Diets and Diabetes

Every time you open a newspaper, there is another diet being touted as the best new breakthrough in losing weight.

Quick and easy schemes for losing weight may seem appealing, especially if the doctor has told you to drop pounds in order to better control your diabetes, and losing weight has not been easy for you, in the past. But what impact do these fad diets have on your body and your disease?

Some popular "new" or fad diets are:

* Atkins Diet
* Southbeach Diet
* Blood Type Diet
* Mediterranean Diet

In looking at each diet, there are both risk and benefits for the diabetic person that need to be considered, and discussed with your physician, before beginning the diet.

1. The Atkins Diet - this diet is based on the belief that our bodies do not manage carbs effectively, and we must retrain them. The diet is high protein and fat, and gradually adds carbs.

Risks: 1) High fat diets can increase cholesterol - a risk factor for developing diabetes and complications of diabetes,
2) High protein levels have been implicated in diabetes in young people, are difficult for the kidneys to process and can cause ketoacidosis - a serious complication of diabetes associated with the body using protein and fat for fuel, instead of carbs

Benefits: 1) rapid weight loss

2. Southbeach Diet - a three-phase plan that is also low-carb, high in proteins, but low in fats, in which you gradually add your carbs back in, using a list of "Foods to Enjoy" and "Foods to Avoid."

Risks: 1) Low carbs and high proteins can cause ketoacidosis - a serious complication of diabetes

Benefits: 1) Three meals + six snacks each day decreases cravings and roller-coaster blood sugars, 2) Uses Glycemic Index (the rate at which a food raises the blood sugar) to help make food choices - leans toward whole grains, fresh fruits and veggies.

3. The Blood Type Diet - touts that different blood types need different types of nutrients, and that eating the "wrong" food their their blood type would cause serious injury to the body.

Risks: 1) Not based on scientific fact, the information in the diet may frighten or mislead the readers, into unnecessarily limiting intake, 2) Limits foods for certain blood types, that have known health benefits, which may result in high cholesterol, ketoacidosis, anemia, and malnutrition.

Benefits: 1) None identified.

4) The Mediterranean Diet - based on intake of a wide variety of grains, fruits and vegetables, moderate protein, unsaturate fats and seafood.

Risks: 1) Suggests wine in moderation - causes blood sugar fluctuations and can contribute to mood swings.

Benefits: 1) Low in red meats and animal fats, touting fish and unsaturated fats can decrease cholesterol, 2) Balanced diet including all food types, to provide core nutrients, 3) High in essential fatty acids and antioxidants - touted as cancer preventatives

Each diet listed above has both risks and benefits, with some demonstrating greater potential risks for complications for persons with diabetes, due to the complex needs of your body.

Obtain information about the diet you are considering, and then meet with your physician, Nutritionist or Diabetes Educator to discuss the risks and benefits of the diet, and it's potential impact on you.

Keeping Your Carbohydrates in Check

When you think of carbohydrates, what comes to mind? Bread, pasta or rice? Jelly, honey or sugar? Fruits and vegetables? Well, ALL of these are carbohydrates!

All of these foods must be figured into your diabetic meal plan, in conjunction with fats and proteins, to stabilize your blood sugar and reduce the risk for complications associated with high or low blood sugar.

One key to keeping your blood glucose on target is to balance your carbs throughout the day. It's a good rule of thumb to average between 45-60 grams at each main meal, though this can vary depending on your weight and whether you are trying to lose weight.

Serving sizes are another important part of managing your carbs. Check the container for the recommended serving size, i.e. one small apple is one serving, or 1/2 cup of applesauce, or 1 slice of bread. Keeping within the recommended portions gives you more room to add variety to your daily carb selections, while keeping your numbers in line.

Be creative and think outside the box. If you want to sweeten up your snack or meal, check the carbs and make a "trade." If you want cookies at lunch, try adding chicken to a green salad, instead of having a chicken salad sandwich. With this, you are trading the bread portion for the cookies, and still staying within your meal plan.

In the diet recommended by the American Diabetes Association, carbohydrates should make up approximately 50% of your daily dietary intake. By setting a carb goal for your meals and snacks, keeping to the suggested serving sizing and being creative, your can keep your carbohydrates in check.

Different Kinds of Carbohydrates

Carbohydrates come in many different forms from potatos, vegetables and legumes, to breads, rice and pasta.

Vegetables, unless packaged with sauces are included within many pre-packaged, pre-seasoned foods are a good source of carbohydrates. Vegetables contain water and fiber, which promotes bowel health and hydration, and they tend to be low in calories. Lacking high quantities of simple sugars, you will not get the rapid rise and subsequent rapid fall as you do with other types of carbohydrates.

Potatoes, breads, rice and pasta are also carbohydrates, however they are high in starches, break down rapidly into simple sugars and tend to be higher in calories. This can result in significant fluctuations in blood sugar levels, causing symptoms of high or low blood sugar. This does not mean that these foods are bad for a diabetic, however understanding how the body processes these types of carbohydrates is important to avoid they symptoms of blood sugar fluctuation.

Choosing whole grains and brown rice over white bread and rice reduces simple sugars and offers more fiber and higher nutrition. Additional, many whole grain breads contain nuts or seeds - members of the fats family - which provide for longer lasting stability in blood sugars.

For best results when considering carbohydrates, choose lower fat, whole grains, fiber and texture over simple sugars, processed breads and rice, to better sustain your blood sugars, obtain more nutritive value and promote optimum blood sugar control without the side effects of blood sugar fluctuations.

Low-Sugar Jams and Jellies

There is a wide variety of low-sugar and sugar-free jams, jellies and preserves on the market. Many people also like to can their own, but diabetics must be cautious of their sugar and carb intake. If you are a home-canner and wish to try your hand at low-sugar or sugar-free recipes, here are some things to keep in mind:

* In addition to adding sweetness, sugar
also helps in gel formation, and
reducing the risk for spoilage.
Lowering your sugar content can impact
gelling and preservation.
* Low-calorie sweeteners have different
stability when heated, with some losing
some of their sweetness with cooking.
* Jellies and jams that are made without
heat processing will need to be
refrigerated to prevent spoilage.

Making your own low sugar jams and jellies can be fun, and you can have more variety in your flavors if you mix and match your favorite fruits.

Contact the company that makes your canning jars for recipes.

The Role of the Nutritionist

A nutritionist is a person who has education and training on diets and nutrition, and who can advise you on healthy eating and nutritional topics.

A nutritionist is not a Registered Dietitian or licensed as a healthcare practitioner. They may have a degree in nutrition, but this is not required, in order to be a nutritionist.

When you have diabetes, there are many questions, including:

* What should I eat?
* What can't I eat?
* Is there a special diet I should
follow?
* Why do I need to eat a bedtime snack?

A nutritionist can help to answer these questions, while also providing:

* information on eating properly
* nutritional information regarding
different types of foods
* weight loss suggestions/ideas
* support during your diet challenges
* coaching for meal problem-solving

When you have diabetes, you don't have to tread the diet and nutrition waters alone. Talk to your doctor about a referral to a nutritionist or registered dietitian to help you develop appropriate meal plans, and to problem-solve your nutritional needs and concerns.

The "Sugar-Free" Dilemma

May products are now touting "sugar-free," "low fat," "low carbs," and more. Does something being sugar-free or low in fat make it safe for a diabetic to eat? Actually, a simple carbohydrate is a simple carbohydrate, in terms of your disease, however sometimes the difference is in how the body processes the carb.

In foods that contain simple sugars, the body processes the sugar-fuel very rapidly, causing a spike in your blood sugar. Often you then have a boomerang effect of a sudden drop in blood sugar, leaving you feeling dizzy, nauseated and weak.

In "sugar-free" foods, frequently the sugar-substitute is actually another naturally-occurring "sugar" like fructose or lactose. In foods containing lactose, maltose, fructose or honey, the only thing that makes them "sugar-free" is the lack of cane sugar. They DO contain another natural form of sugar, and you can anticipate a similar rise and fall of blood sugars, though due to the increased complexity of the molecule, the effect is generally less dramatic.

Today's most popular artificial sweetener -- Aspartame -- is actually sugar-based, but it's molecules have been modified to remove the sugar-base structure that is problematic in simple sugars, with those who have diabetes. However, sugar-free does not mean that you can eat all you want.

Be smart about your diet plan. Get a referral to a Registered Dietitician or Nutritionist to help you take the "fat" out of nutrition labels. Being smart about your diet will help you better control your disease and reduce the risks of complications

Carbohydrate Choices on the Diabetic Meal Plan

According to the American Diabetes Association, there is no such thing as a "diabetic diet." Instead, they promote a healthy diet with a combination of 50% carbohydrates, 20% proteins and 30% fats.

In terms of carbohydrates, one fruit exchange is equal to one carbohydrate, such as one small apple, or 1/2 cup of orange juice.

One starch exchange is one carbohydrate, such as one slice of bread, 1/2 cup cooked cereal, or 1/2 of a medium baked potato.

Vegetables are lower in carbohydrates, and 1/2 cup of most non-starchy vegetables will be about 5 grams of carbohydrate, so 1 1/2 cups of broccoli would equal one carbohydrate choice, for example.

Eight ounces of low fat milk or sugar free yogurt is also one carbohydrate choice.

Learning to use "exchanges" allows to you go into any dining setting and make good choices regarding your carbohydrate. Ask your physician for a referral to a Nutritionist or Registered Dietitian, or contact your local chapter of the American Diabetes Association for more information about food exchanges and your diabetic meal plan.