carbohydrate intake. You are not a bad person for enjoying all foods. You are a normal person who happens to have diabetes and who has to live in the real world.
SUMMARY
Although it has been many years since nutrition guidelines for diabetes have become more realistic, people with diabetes still believe that avoiding sugar is the main goal of nutrition therapy. After years of educating people with diabetes about the dangers of sugar and giving them lists of “good” and “bad” foods, we now know that sugar is just a form of carbohydrate. With proper education from a registered dietitian, you can learn how to choose your carbohydrates wisely.
YOUR TURN
Now it’s your turn to recall some key points from this chapter. Let’s see how you do!
1. Natural sugars found in fruits, vegetables, and milk make up about one-half of the sugar intake in the U.S. Added sugars such as those in cookies, soda, cakes, and candy make up the other half. True or false?
2. The primary naturally occurring sugar found in milk is called ____________ and is often called milk sugar.
3. Three examples of “empty-calorie foods” include:
_____________________
_____________________
_____________________
4. You are “cheating” on your meal plan if you eat foods that have added sugar in them. True or false?
See APPENDIX A for the answers.
FERN: I recently read an article that said Americans should be adding more fiber to their diets and that fiber was also good for blood sugar and weight control. I wanted to start doing this, but I found that most high-fiber foods are also high in carbohydrate. I ended up coming home from the store with my usual purchases. Should I cut out all of the starchy foods and only eat foods with fiber, like raw vegetables and salad?
DIETITIAN: Starches and fiber are recommended for all people—not just those with diabetes. There are a variety of whole-grain starches and other high-fiber foods to choose from, such as whole-wheat pasta instead of white pasta and brown or whole-grain rice instead of white rice. Therefore, whole grains and other carbohydrate foods with fiber, such as fruits and vegetables, should be the most abundant foods on your plate. I will show you how to increase your fiber intake so you will be meeting the current recommendations of 20–35 grams per day.
FERN: But I heard that carbohydrate foods, particularly starches, make you gain weight and are the main cause of diabetes—not sugar!
DIETITIAN: Starches and sugars do not cause diabetes, but weight gain may occur if an excessive amount of any food is eaten. Starch, sugar, and fiber are all types of carbohydrate. Carbohydrate is our main source of fuel, and we need to eat some with each meal. Unfortunately, many Americans eat excessive amounts of carbohydrate because they are not aware of the portion sizes that they are eating. For example, one serving of a whole-grain food could be 1/2 cup cooked oatmeal, 1/3 cup cooked whole-wheat pasta or whole-grain brown rice, one-half of a 100% whole-grain English muffin, or one slice of whole-grain bread. How often do people just eat one slice of bread? The carbohydrate from these foods can add up very quickly at a meal, especially when added to other carbohydrate foods.
FERN: But why are those high-fiber foods so high in carbohydrate?
DIETITIAN: Although fiber is a type of carbohydrate, it is considered “roughage,” so it has little impact on blood glucose levels and provides minimal calories. Therefore, dietary fiber can be deducted from the grams of Total Carbohydrate on a food label. I will be teaching you how to read food labels today. It is important to eat these high-fiber foods every day because roughage helps you feel more full after a meal, helps lower your cholesterol levels, and keeps your digestive tract healthy.
FERN: Okay, I’m ready to learn how to buy healthier foods and begin to add more fiber to my meals. I will also be mindful that it’s the quantity and quality of starches that’s important.
DIETITIAN: Although fiber is a type of carbohydrate, it is considered “roughage,” so it has little impact on blood glucose levels and provides minimal calories. Therefore, dietary fiber can be deducted from the grams of Total Carbohydrate on a food label. I will be teaching you how to read food labels today. It is important to eat these high-fiber foods every day because roughage helps you feel more full after a meal, helps lower your cholesterol levels, and keeps your digestive tract healthy.
FERN: Okay, I’m ready to learn how to buy healthier foods and begin to add more fiber to my meals. I will also be mindful that it’s the quantity and quality of starches that’s important.
WHAT’S NEXT?
Many people view starchy foods as “bad” foods and try to eliminate many of these foods from their daily intake. When these same people also think of sugar foods as “bad” foods, they end up eliminating many healthy food choices (carbohydrates) as well as good sources of fiber, vitamins, and minerals from their eating plan.
Fern learned from her dietitian that starch and sugar foods are just two of the three types of carbohydrate that belong in everyone’s food plan. Fern also learned that many carbohydrate foods also contain the third type of carbohydrate called fiber, which is the “roughage” that whole grains, fruits, and vegetables provide. Eating the recommended amount of 20–35 grams of fiber per day instead of the average American intake of 10–14 grams per day provides enough fiber to feel satisfied and full after eating a meal without adding extra calories.
Fern’s dietitian also taught her how to keep track of her carbohydrate intake with a meal-planning method called carbohydrate counting (Chapter 7). This meal-planning method gave Fern a carbohydrate allowance to spend at each meal and snack. Much to her surprise, Fern was able to incorporate many new and different foods into her meals. By monitoring how much carbohydrate and fiber she was eating throughout the day, she not only was able to improve her blood glucose levels, but also found it easier to control her weight and food cravings by adding fiber-rich foods. Fern’s last A1C revealed a significant improvement from her previous A1C.
THE OLD AND THE NEW
Before insulin was discovered in 1921, rigid restriction of carbohydrate foods was the only means of controlling blood sugar levels. However, a very small amount of carbohydrate coming from fiber was allowed in certain foods.
Foods were divided into categories based on the amount of carbohydrate and fiber they included. Vegetables such as lettuce, cucumbers, spinach, asparagus, celery, and cabbage were allowed in unlimited quantities. In Joslin’s Diabetic Manual for Doctor and Patient, Dr. Elliot Joslin stated, “These vegetables are a comfort to a diabetic because they contain so little carbohydrate that they can be eaten freely, they are satisfying because of their bulk, and they are rich in vitamins A, B, and C.” The next category included pumpkin, turnip, squash, beets, carrots, onions, and very young, fresh green peas. Then, more mature vegetables such as peas, lima beans, and parsnips were added in limited amounts. The last category was only to be used with caution. Foods such as potatoes, corn, bread, rice, macaroni, and beans were only allowed in very small quantities and had to be carefully measured.
With the discovery of insulin, carbohydrate in the form of starch was gradually