By Gary Scheiner MS, CDE
Practical approaches to accurate carbohydrate gram counting.
Let’s get this straight. There is no such thing as a “pro” when it comes to carb counting. There is no Masters or PhD in Carbohydrate Science at any major university, nor is there a course focusing on carb counting in any dietetics or nutrition science program. And I’ve yet to meet anyone at a circus or carnival who, for a mere dollar, will “guess the carbs” in your favorite food item, lest you win a valuable prize. So why would anyone with diabetes want to count carbs “like a pro”?
Simple. When it comes to keeping blood sugars in control, carb counting works better than any other system. Better than counting calories. Better than avoiding sugar. And certainly better (and simpler) than the old “exchange system.” Carbohydrate is what raises blood sugar levels abruptly after meals. Not fat or protein or vitamins or minerals. Just carbohydrate.
Counting and managing the amount of carbohydrate in your diet has important benefits. If you take multiple daily injections of insulin or use an insulin pump, carb counting allows you to match doses of mealtime rapid-acting insulin by applying insulin-to-carb ratios. This allows for almost unlimited dietary flexibility and helps to prevent post-meal highs and lows.
If you control your diabetes with diet/exercise, pills, or just one or two insulin injections a day, you can also use carb counting to improve your control. Researchers at the University of Texas School of Applied Health Sciences in Galveston found that consistent carbohydrate intake in patients with type 2 diabetes leads to improvements in blood sugar control, with or without weight loss. In their study, patients who ate consistent amounts of carbohydrate at regular intervals lowered their average blood sugar by 55 mg/dl, and lowered their average Hemoglobin A1C from 8.8% to 6.9%.
A Few Definitions
Carb counting simply means adding up the total amount of carbohydrate (in grams) in a meal or snack. Carbohydrates include sugars (simple carbohydrates) like sucrose (table sugar), fructose (fruit sugar) and lactose (milk sugar) as well as starches (complex carbohydrates) like those found in bread, rice, cereal and potatoes. When you eat something that contains complex carbohydrates, the starch is broken down into simple sugars before entering the bloodstream.
Now here’s the kicker: from the standpoint of blood sugar control, it doesn’t matter if the carbohydrates you eat are in the form of simple sugars or starches. Okay, now relax. Take a few deep breaths, then call your mom to say “I told you so.”
Both sugar and starch will raise the blood sugar by the same amount, and at about the same rate. A cup of rice containing 45 grams of starch will raise the blood sugar just as much as a can of regular, sugar-sweetened soda containing 45 grams of sugar. In other words, don’t be overly concerned about the “sugar” content of a food. Be concerned about the “total carbohydrate” content of a food.
So that’s it. Just count the carbs and life will be wonderful.
Not so fast. Accurate carb counting is what we’re after. And it better not require too much work, or nobody’s going to do it.
Research presented at the American Diabetes Association annual Scientific Sessions in 2004 showed that even well-managed, educated individuals with type 1 diabetes have difficulty counting carbs accurately, with a tendency to underestimate the carbs consumed at breakfast, dinner & snacks, and overestimate the carbs consumed at lunch. The estimation of complex meals, including restaurant food, is least precise.
At my own practice, many clients who professed to being expert carb counters struggled to score 50% on “The Ultimate Carb Counting Test” located at my website. By using some of the techniques listed below, those same patients have become highly proficient at counting carbs accurately – and they don’t spend half their day obsessing over food.
Tips From The “Pros”
Here are three simple recommendations for counting carbs accurately and easily: Read Labels, Use Resources Listings, and Become a Good Portion Estimator.
1. Read Labels
When it comes to carb counting, labels rule. The U.S. Food and Drug Administration (FDA) requires the manufacturers of all packaged and processed foods to list key nutrient information and ingredients on the food label. Most industrialized nations worldwide have similar requirements.
In the U.S., the label must list (among other things) the grams of total carbohydrate as well as sugar and dietary fiber in a single serving of the food item. Total carbohydrate (sometimes abbreviated “total carb” or simply “carb”) is always listed below the “sodium” content.
Below the Total Carbohydrate is the Dietary Fiber and Sugar content. Although not required, some food manufacturers will also list the amount of fiber, along with sugar alcohol and “other” carbohydrates (typically starches) below Total Carbohydrates.
Of all these items, “total carbohydrate” is by far the most important. The total carb includes everything in the food item that is carbohydrate – complex carbs (starch and fiber) and simple carbs (sugars and sugar alcohols). Remember to look for the number next to that little “g” (grams). The percentage (%) that follows it is the government’s estimate of how much of your daily recommended food intake is included in a serving of this food item. The percentage of daily requirements is irrelevant to the carb counting process.
Here’s another fun fact: When counting carbs, it is not necessary to know how much sugar a food item contains. Remember, sugars are just a type of carbohydrate, and are included in the total carbohydrate listings on the label.
So that’s it, right? Almost. We may have to make a slight adjustment if the food item contains fiber or sugar alcohol. Luckily, the vast majority of foods contain little or none of either of these, so there is nothing to worry about. But for food items that contain more than three grams of either one, you should:
a) Subtract all the fiber grams from the total carb count (since fiber does not raise blood sugar). Fiber-rich foods include beans, whole-grain breads, certain cereals, and some fruits & vegetables. For example, a food item containing 24g of total carbohydrate and 6g of fiber should be counted as 18g carbohydrate (24 minus 6).
b) Subtract half the sugar alcohol from the total carb count (since sugar alcohol affects blood sugar half as much as ordinary sugar). Sugar alcohols are artificial sweeteners found in many “reduced calorie” foods such as gum, mints, yogurt, ice cream, cookies and candy. They typically go by names ending in “ol”: sorbitol, maltitol, lactitol, mannitol and xylitol. Hydrogenated starch hydrolysates (HSH) and isomalt are also sugar alcohols even though they do not have the –ol suffix. So for example, a food item containing 17g total carbohydrate and 8g of sugar alcohol should be counted as 13g carbohydrate (17 minus 4).
One other note: Be careful about serving sizes. The FDA’s opinion of what a serving should be may not be what you normally consume (I still remember when a can of soda was considered two servings). If the portion you eat is smaller or larger than the stated serving size, you will need to adjust the carbohydrate total accordingly. If a serving size is ½ cup and you have 1 cup, you will need to double the carb amount.
2. Check the Listings
As useful as food labels are, they can only help us when they are available. Unpackaged foods such as fresh fruits & vegetables, baked goods, restaurant foods and prepared foods typically do not carry a label. For these types of foods, a printed or electronic nutrient listing can really help.
Useful books include:
The Doctor’s Pocket Calorie, Fat & Carbohydrate Counter by Allan Borushek, published by Family Health Publications (949-642-8500, CalorieKing)
The Ultimate Guide to Accurate Carb Counting by (yours truly) Gary Scheiner, published by Marlowe Publishing (877-735-3648; Integrated Diabetes)
Nutrition in the Fast Lane brochure by Franklin Publishing (800-634-1993)
Bowes and Church’s Food Values of Portions Commonly Used by J. Pennington, published by Lippincott Publishing (available at most major retailers)
Guide to Healthy Restaurant Eating by Hope Warshaw, published by the American Diabetes Association (800-232-6733, ADA Shop)
Free Internet-based carb listings:
USDA Food Composition Database – Portal to the U.S. Federal Government’s comprehensive nutrient database.
For restaurants with multiple locations (including fast-food), simply type the name of the restaurant into a search engine. Most have their own web sites with nutrient listings for their current menus.
Software for PCs and PDAs:
EzManager Plus from Animas Corporation includes a database of 5000 foods. Use of the Animas insulin pump is not required. (877-937-7867, Animas Corporation)
DiabetesPilot includes a carb-specific database and summing option for meals. Available as shareware from Diabetes Pilot.
NutriGenie is an award-winning nutrition software package featuring a database with over 8,000 items. Visit NutriGenie.
Calorie King Diet & Exercise Manager on CD-ROM includes a 30,000-item food database. (949-642-8500, CalorieKing)
3. Portion Conversion
A very practical technique for counting carbs is the portion conversion method. This approach is particularly useful when having complex meals, dining out or enjoying foods that vary in size.
Portion conversion involves approximating the volume of a food by comparing it to a common object such as your fist, a can of soda or a milk carton, and then converting the volume into a carb count based on the typical carb content for that type of food.
Confused yet? Don’t be. Here’s an example that should make this very clear: If you know that one cup of pasta contains about 40 grams of carbohydrate, and you are having a portion of pasta equal to 1 ½ cups, you are having 40 X 1 ½, or 60 grams of carbohydrate.
Unless you want to carry a measuring cup around with you everywhere you go, you will need to become proficient at estimating portion sizes. Below are some common “measuring devices” that can be used to mentally calculate portions:
12 oz. Soda can = 1 ½ cups
Average adult’s fist = approx. 1 cup
Child’s fist = approx. ½ cup
Baseball = approx. 1 cup
½-Pint of milk = 1 cup
Cupped hand = approx. ½ cup
Large handful = approx. 1 cup
Deck of cards = approx. 1/3 cup
When estimating portions, it is helpful to have the measuring device right next to the food item. For instance, placing your fist next to a salad will allow you to estimate the number of “cups” of salad. Having a ½-pint of milk or a can of soda next to a piece of fruit will allow you to do the same. Be sure to count only the portion that you are actually going to eat. The rind or peel on fruit, for example, should not be counted.
In the photo above, we can estimate the volume of the fruit (not including the rind) by comparing it to an adult’s fist. Since it appears to be slightly larger than a fist, and a fist equals 1 cup, then the food item measures about 1¼ cups.
The best way to fine-tune your portion estimation skills is through practice. Estimate the volume of a food item using your fist or another item of known volume for comparison and then either look up the exact volume on the food’s label or place it in a measuring cup. Doing this repeatedly will train your eye to estimate portions more accurately.
Great. Now you can figure out exactly how many cups there are in a serving of your Aunt Betty’s famous Blueberry Pie. Where do we go from there? We turn it into grams of carb!
Below are approximate carb counts for standard portion sizes of many common foods:
Food Type
Approx. Carb Content in 1 Cup (Prepared)
Potato
40g
Pasta
40g
Rice
50g
“Sticky” Rice
75g
Vegetables (raw)
5g
Vegetables (cooked)
10g
Corn & Peas
30g
Beans
40g
Soft Breads
25g
Dense Breads
50g
Pancakes/Waffles
25g
Fruit
20g
Pastry
50g
Pretzels
25g
Chips
15g
Popcorn
5g
Ice Cream
35g
Dry Cereal
25g
Milk
12g
Juice
30g
Sauce
20g
Soft drinks
30g
Sport drinks
15g
Grams of carb per cup X number of cups = Carb Count
Using this approach with the piece of cantaloupe pictured above, at 20g per cup, a 1 ¼ cup portion has about 25 grams of carbohydrate. Three large handfuls of popcorn would have 5g/cup X 3 cups, or 15g carb, and half a baseball of peas has 30g/cup x ½ cup, or 15 g carb.
Note that this approach allows you to estimate the carb count of a food item if no other means are available. Again, it is best to practice this method with some packaged food items (where a label is available) so that you can hone your estimation skills.
The Type-A Way
If you’re looking for a more scientific, precise (albeit somewhat less practical) method of carb counting, carb factors are for you. This technique involves weighing a portion of food on a scale and then multiplying the weight of the food (in grams) by its carb factor (which represents the percentage of the food’s weight that is carbohydrate). Doing so will produce a fairly precise carb count for that portion of food.
Food Weight (in grams) X Carb Factor = Carb Count
For example, apples have a carb factor of .13, which means that 13% of an average apple’s weight is carbohydrate. If an apple weighs 120 grams, the carb count is 120 x .13, or 15.6 grams.
As was the case with portion guestimation, carb factors should only take into account the food portion that will actually be consumed. Foods should be weighed without the peel, rind, skin, seeds, packaging, crust, or any other part that will not actually be eaten. The apple measurement, for instance, may slightly overestimate the carb count since the core is not usually eaten.
Below are examples of carb factors for some common foods:
Bagel .51
Apple pie .32
Ice cream (chocolate) .27
Apple .13
Spaghetti (cooked) .26
Cheese Pizza .32
Carrot (raw) .06
Baked potato .22
For an alphabetized list of carb factors, go to Carbohydrate Factor Reference List. Condensed lists can also be found in my book (The Ultimate Guide to Accurate Carb Counting) and Pumping Insulin by John Walsh and Ruth Roberts.
Personalized Help
Registered Dietitians (RDs) who are also Certified Diabetes Educators (CDEs) take great pride in helping people with diabetes learn to count carbs. Many use food models and other hands-on techniques to teach the types of methods described above. To find a diabetes/nutrition expert near you, contact the American Dietetic Association Nutrition Hotline (1-800-366-1655) or American Association of Diabetes Educators referral service: 1-800-TEAM-UP-4 (832-6874).
Now, if your current career doesn’t work out, you can always take that job as “carb guesser” at the circus!
Editor’s note: Gary Scheiner is owner and clinical director of Integrated Diabetes Services (www.integrateddiabetes.com; 610-642-6055), a private practice specializing in advanced training and management of children and adults on intensive insulin therapy. His team of CDEs (all of whom have Type-1 diabetes) provides consultations worldwide via phone and the internet. Gary is author of several books including “Think Like A Pancreas” and was named 2014 Diabetes Educator of the Year by the American Association of Diabetes Educators. Feel free to submit questions and comments to gary@integrateddiabetes.com.
Photo Credit: Gary Scheiner, Adobe Stock Photos, FDA
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