The Ultimate Guide to Accurate Carb Counting

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The most comprehensive on accurate carb counting-a must-have for the more than 20 million people with diabetes, the 42 million with prediabetes, as well as millions of other carb-conscious eaters.

Whether you’re following a diet plan that requires carb-counting, you have diabetes, or simply because you are conscious of the quantity of carbs you consume, The Ultimate Guide to Accurate Carb Counting is the all-in-one resource for practically and effectively managing your carb intake. Certified diabetes educator, type 1 diabetic, and Think Like a Pancreas author Gary Scheiner focuses on carb counting in a real-world context, and his explanations and advice-in addition to being complete and thoroughly accurate-are geared towards the most common foods and eating habits.

The Ultimate Guide to Accurate Carb Counting tells you everything you need to accurately keep track of your carb intake, including: The basic rationale for and the theory behind carb-counting, as well as explanations of simple to advanced techniques. There is also a comprehensive listing of exchanges, carb factors, and glycemic index values, as well as the carb and fiber values for 2,500 foods.

The Marlowe Diabetes Library Good control is in your hands.

SINCE 1999, Marlowe & Company has established itself as the nation's leading independent publisher of books on diabetes. Now, the Marlowe Diabetes Library, launched in 2007, comprises an ever-expanding list of books on how to thrive while living with diabetes or prediabetes. Authors include world-renowned authorities on diabetes and the glycemic index, medical doctors and research scientists, certified diabetes educators, registered dietitians and other professional clinicians, as well as individuals living and thriving with prediabetes, type 1 or type 2 diabetes. See page 241 for the complete list of Marlowe Diabetes Library titles.

Gary Scheiner, MS, CDE, is a certified diabetes educator, exercise physiologist, and nutrition consultant who has written dozens of articles and two books on diabetes, fitness, and motivation. He serves on the board of directors of the Diabetes Exercise and Sports Association, and volunteers for the Juvenile Diabetes Research Foundation, American Diabetes Association, and Setebaid Diabetes Camping Services. Drawing upon both his professional skills and personal experience with type 1 diabetes, he teaches the art and science of carbohydrate gram counting and diabetes management to clients throughout the world from his private practice, Integrated Diabetes Services, in Wynnewood, Pennsylvania and through his Web site, www.integrateddiabetes.com.

ALSO BY GARY SCHEINER

Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin

To MJ, Bumblebee, Spiderman and the Princess; and Debbodil, who makes everything possible.

INTRODUCTION

WHEN I WAS a kid, my favorite TV character was "the Count" from Sesame Street. Sure, his Romanian accent and entourage of bats were pretty neat. But what I really liked was how he made numbers so much fun. Who else could find such joy in counting pumpkins or claps of thunder or whatever else happened to be around? Simply put, the Count made counting cool.

When we become grown-ups, counting is serious business. Why else would we need so many accountants? We count how much money we have (or owe), how many miles we get per gallon, how many minutes have passed since the last contraction (as a father of four, I've been there!), how much we weigh, and even the occasional blessing.

There are many counting systems that allow us to monitor and manage our food intake: Calorie counting, fat gram counting, point systems, exchange systems, and so on. Today, one of the most popular counting system is carbohydrate gram counting, or carb counting for short. And for good reason. Carb counting is important for people with diabetes. It helps those with Type 2 diabetes to control their after-meal blood sugar levels, and it allows those with Type 1 diabetes to match their insulin doses to the amount of carbohydrates consumed. It also has the potential to promote both short-term and long-term weight loss. Many diet plans, including the Atkins, South Beach, and Zone diets, require careful control of carbohydrate intake. Carb counting is important for those who suffer from (reactive) hypoglycemia to help minimize the frequency and severity of low-blood-sugar events. Athletes often count carbs to prepare for and excel in competitive events, and managing carb intake has been shown to improve cholesterol and triglyceride levels.

With so many important uses for carb counting, it seems that everyone should be born with an innate ability to count carbs . . . or at least a guidebook on how to do it right. That's the purpose of this book. It's not to promote any particular approach to managing weight, blood sugars, cholesterol, or energy levels. You and your health-care team are intelligent enough to figure that out. The purpose of this book is to help you to become a more accurate and intelligent carb counter. The tools presented in the pages that follow will make carb counting a practical and effective process.

Research presented at the American Diabetes Association annual Scientific Sessions in 2004 showed that even well-managed individuals with type 1 diabetes have difficulty counting carbs accurately, with a tendency to underestimate the carbs consumed at breakfast, dinner, and snacks, and overestimate the carbs consumed at lunch. A major reason for this is our inability to accurately assess our ever-changing portion sizes. The estimation of complex meals, including restaurant food, is the least precise. Also, meals prepared from scratch using fresh, nonlabeled ingredients can be particularly challenging.

At my own practice, patients who are already experienced carb counters struggle to come up with correct answers to half of the self-test questions scattered throughout this book. With additional training and education, those same patients become proficient at counting carbs accurately.

So let's not waste any more time. Take things at your own pace, enjoy the learning process, and above all, let's make The Count proud!

MEET THE CARBS

IT'S TIME FOR some introductions! Carbohydrates (or "carbs" for short) are carbon-based molecules that serve as the primary energy source for our body's cells. Simple sugars, starches, and fiber are all types of carbohydrates, just like cars, buses, and planes are all forms of transportation.

—simple sugars—

Simple sugars are like passenger cars on a highway—they are relatively small, fast-moving, and can be quite stylish (or in this case, tasty!). Most cars on the highway also have only one or two passengers on board. Similarly, simple sugars contain only one or two sugar molecules and are digested easily. Simple sugars include:

* Glucose (a building block for starches and other complex carbohydrates), also used in syrups and baking sweeteners. It is present in most fruits.

* Fructose (fruit sugar), found in vegetables and fruit, as well as honey and other plant-based sweeteners.

* Galactose (combined with glucose to form lactose), rarely found on its own.

* Dextrose (also known as corn sugar), used in many cookies, candies, sports drinks, crispy snacks (including dried vegetable chips), and low blood sugar treatments.

* Lactose (milk sugar, also found in some plants), present in all cow's milk products and derivatives (milk, butter and most margarines, cheese, condensed and evaporated milk, cream and sour cream, yogurt, ice cream and sherbet, whey) as well as in foods whose ingredients include milk products, such as cream-style soups, most baked goods, and most chocolates. "Lactose-free" soy products are technically dairy lactose free yet may contain the plant form of lactose. Traces of lactose are also found in sourdough breads, soy sauce and miso, green olives, sauerkraut, packaged quick-cook Asian noodles, and salad dressings, as well as some jams and jellies.

* Sucrose (derived from cane and/or beets), also known as "table sugar." Aside from being the granulated or cube sugar commonly stirred into beverages, it is used in countless products to add sweetness, color, moisture, and/or tenderness.

* Maltose (malt sugar, derived from barley), found in beer, malt whiskey, and other malt beverages, as well as sweetened "natural" foods, malted milk and malted milk-flavored candies, most brands of pretzels, and in the glaze of some Asian dishes.

Sometimes, simple sugars are found in or combined with other substances or flavors, and are listed on ingredient labels as:

* High-fructose corn syrup

* Invert sugar syrup

* Molasses, treacle, and other cane syrup

* Barley malt

* Brown sugar

* Honey

* Maple syrup (also known as pancake or table syrup) and maple sugar

* Sorghum syrup

* Palm sugar

* Agave syrup

* Date sugar

* Brown rice syrup

* Sucanet (as its name suggests, this is largely sucrose)

Even foods you don't think of as being sweet may contain these additives. Some breads contain honey, and most contain some high-fructose corn syrup.

You may have noticed that many "natural," and "sugar-free" products and recipes include these sweeteners. "Natural" though they may be, as compared with highly processed table sugar, they are still sugar. Maple syrup, for example, is sucrose, plus a little fructose. Honey may contain nearly two dozen kinds of sugar, with fructose and glucose leading the list. (There are some genuinely sugar-free sweeteners, which I'll get into later. If you can't wait, jump to page 223.)

But we're not done yet—there is also a group of simple sugars called "sugar alcohols," which are simple sugars with a slightly different chemical structure. Some fruits contain trace amounts of sugar alcohol naturally. In most cases, sugar alcohols are synthetic substances produced by food manufacturers to add sweetness to reduced-calorie foods. They do not have the same characteristics as alcoholic beverages, and will not make you drunk! However, they can have a laxative effect, especially when consumed in large quantities. The benefit of sugar alcohols is that they have a sweet taste but digest more slowly and less completely than other simple sugars, providing fewer calories and having less impact upon blood glucose levels than the sugars listed previously. They include:

* Sorbitol (derived from certain fruits; also found in seaweed and algae)

* Maltitol (a modified version of maltose)

* Lactitol (a modified version of lactose)

* Mannitol (derived from algae and fungi such as mushrooms)

* Xylitol (derived from vegetables and fruits)

* Erythritol (derived from fruits)

* Isomalt (a modified version of sucrose)

* Hydrogenated starch hydrosylates (HSH) (converted from starch)

Them's a lot of simple sugars to try to remember! The important thing to keep in mind is this:

Simple sugars are converted into glucose during the digestive process.

Think of glucose as the gas that drives your car. There are many types of fossil fuel, but we can't take crude oil out of the ground and put it into our cars. It must first be refined and turned into a form that can be accepted and used by an engine. Glucose is the form of energy that is preferred by our body's cells.

Glucose is absorbed into the bloodstream through the walls of the small intestine. Once in the bloodstream, glucose has one of three fates, depending on the body's immediate energy needs: it can (with the assistance of insulin) enter bodily cells to be burned for energy, enter muscle or liver cells for storage (in a dense form called "glycogen"), or enter fat cells for conversion to fat (see figure 1).

Simple sugars are only one of the sources of glucose for fueling our body's cells. Let's turn our attention to another important energy source: Starch.

—starch—

Starch is like a bus—it is fairly large and carries many individual passengers that can easily get off when they reach their destinations. Starches are made up of clusters of glucose molecules, loosely linked together. Because of the complexity of their structure, they are called complex carbohydrates.

Enzymes in the saliva and small intestine break the links holding starches together to produce batches of individual glucose molecules. As was the case with simple sugars, the glucose molecules then absorb through the intestines and circulate in the bloodstream until being taken up by the body's cells.

Some complex carbohydrates/starches are "straight chains" of glucose molecules, like the line of cars that make up a train (see below):

Straight-chain starches are found in many forms of pasta, long-grain rice, and legumes (beans, peas, lentils, peanuts, sprouts, and soy). They break down into glucose slowly because they pack together tightly in bunches.

Others "branch out" at odd angles like the limbs on a tree (see below):

Branched-chain starches are found in most cereals, breads, potatoes, and sticky rice. Because they don't pack together tightly, digestive enzymes have easy access to them. As a result, branched-chain starches convert to individual glucose molecules rather quickly.

Major sources of starches include:

* Wheat

* Rice (all varieties)

* Corn

* Oats

* Rye

* Barley

* Buckwheat

* Millet

* Teff

* Quinoa

* Amaranth

* Triticale

* Kamut

* Spelt

* Sorghum

* Seeds and nuts

* Bananas and plantains

* White potatoes, sweet potatoes, and yams

* Parsnips and carrots

* Carob

* Jerusalem artichoke (also known as sunchoke)

* Cassava (also known as yucca or manioc)

* Jicama (believe it or not, in the bean family)

* Taro (used in Asian/Asian-style cooking and some varieties of Terra snack chips)

* Arrowroot (usually used as a thickener, and in some Asian noodles)

* Tapioca (dried cassava) and sago (used in desserts and drinks)

* The following gelling/thickening agents: agar (from seaweed), carrageenan (from algae), kudzu (from a starchy root), guar gum (from the cluster bean), locust bean gum, gum tragacanth (also legume-derived), and xanthan gum (made from corn sugar)

* Legumes (beans, peas, lentils, soy, peanuts, sprouts)

Be aware that the ever-versatile soy may turn up in foods in the form of tofu, miso, tempeh, soy sauce (which may also contain wheat) and tamari, edamame, soy milk, and other nondairy milklike products such as margarines and cheeses, and soy flours. If you are heavily into natural or Asian foods, you may be consuming way more carbohydrates than you realize!

—simple vs. complex carbs—

How can you tell if a food is rich in simple or complex carbohydrates? Which foods contain both? Be careful when reading only the large print on packaging: some may claim to be "low-sugar" or "low-carb," but such terms may not give you the entire picture. For example, a beer may have a low malt content and yet contain corn or other starchy grains to make up for it.

Again, keep in mind that virtually every sugar or starch in a food or beverage will be converted by your body to glucose.

Foods rich in sugar (simple carbohydrates)

Foods rich in starch (complex carbohydrates)

Fruit Fruit juice, drinks, and punch Raisins/other dried fruit Carrots, beets, and parsnips Regular soda Cake, pie, pastries, muffins, and cookies Candy and chocolate Milk and milk products Ice cream, ices, frozen yogurt, and nondairy frozen confections Yogurt Beer, malt drinks, and malt whiskey Wine Sports drinks Granulated, cubed, and powdered sugar Brown sugar and molasses Honey Maple and other syrups Jelly, jam, and preserves Puddings

Bananas and plantains Potatoes, sweet potatoes, and yams Corn Rice Noodles/pasta Cereal Oats Bread, bagels, and rolls Soybeans and soy products Crackers Crunchy snacks such as pretzels, chips, and popcorn Pizza Tortillas and wraps Pancakes and waffles Legumes (peas, beans, and peanuts) Seeds and nuts Beer Aspics, jelled desserts, and puddings

—The "Fate" of Dietary Carbohydrates—

FIGURE 1: Simple and complex carbohydrates are converted into glucose, which is used for energy or stored for future use.

—fiber—

Fiber is a special type of complex carbohydrate. Unlike starches, which break down into simple sugar molecules, the links that hold fiber together are very strong and cannot be broken by the body's digestive enzymes and acids. Think of fiber as a plane: once you get on, you are packed in with lots of other passengers, and you don't get off the plane until you arrive at the final destination. With fiber, that final destination is . . . how shall I put this . . . the toilet. That's right. Fiber passes clear through your digestive system unchanged and is simply pooped away. Its calorie content and contribution to blood sugar levels is insignificant.

Fiber comes in two forms: soluble fiber, found in many fruits and vegetables, which dissolves during digestion but remains thick and gummy, and insoluble fiber, found in whole grains and legumes, which does not digest at all.

Dietary fiber has a number of important benefits. Because it retains its "bulk" as it moves through the digestive system, it creates a sense of fullness and satiety. This can be very helpful to those who want to control their appetite. In the large intestine, fiber helps make bowel movements softer and bulkier. Fiber tends to absorb toxins that build up in the large intestine, and carries them out of the body. This reduces the risk of several forms of cancer. The same thing happens with cholesterol—fiber prevents the body from absorbing some dietary cholesterol. Fiber also slows the digestive process. This can be helpful in the management of blood glucose levels after meals, since blood sugars rise more slowly when fiber is present.

Unfortunately, the majority of foods in our modern diet have little or no fiber. Processed foods tend to have less fiber than fresh foods. The effect of cooking on the fiber content of foods is unclear; some foods will lose fiber content during the cooking process, whereas others may actually increase. Good fiber sources include:

* Whole-grain cereals

* Whole-grain breads

* Beans and peas

* Oats

* Barley

* Whole, fresh fruit

* Raw vegetables

* Nuts and seeds

Techniques for factoring fiber into carb counts will be discussed in detail in chapter 2. I have also gone to painstaking means to include the fiber content along with the carb listings in Tool Kit 4, so make good use of them!

—glycerine—

Glycerine is kind of like a flying saucer. It's there, but not really.

Also known as glycerin or glycerol, glycerine is derived from triglycerides and is found in some processed diet foods. Although glycerine contains 4 calories per gram, the same as carbohydrates, it does not affect blood sugar levels. However, because glycerine has many of the same chemical properties as carbohydrates, it is included in the total grams of carbohydrates on food labels. If you are counting carbs for weight control, glycerine counts as much as any carbohydrate. But if you are counting carbs purely for blood sugar control, you can take the government's approach to UFOs and act as though glycerine just doesn't exist.

test your carb basics skills

Q: True or False: Sugar alcohols do not raise blood sugar. A: False—Don't be fooled by misleading product labels. All sugar alcohols raise blood sugar, just not as much as ordinary sugars and more slowly than most other types of carbohydrates.

Q: True or False: Sugar usually has a similar impact on the body as starch.

A: Yes, indeedy. Sugars (simple carbohydrates) and starches (complex carbohydrates) have the same calorie content per gram, raise blood sugars equally per gram, and digest at similarly quick rates.

Q: Carbohydrates include:

a. Sugars, fats, and starch

b. Sugar alcohols, starch, and protein

c. Sugars, fiber, and starch

d. Sugar, fat, and protein

A: c.—Fat and protein are not carbohydrates. To complete the list, in addition to sugars, fiber, and starch, carbohydrates also include sugar alcohols and glycerine/glycerol.

BASIC CARB-COUNTING TECHNIQUES

I LOVE THE TV show Seinfeld. In one of my favorite episodes, Jerry Seinfeld is at the airport and goes to pick up a car he reserved at a rental car company. Unfortunately, the company has rented out all of their cars, and Jerry is stuck with nothing to drive. "But I had a reservation," he pleads to the woman at the counter. "I should have a car. That's what reservations are for."

"I know why we have reservations," the woman says.

"I don't think you do," replies Jerry. "If you did, I would have a car. Anyone can take reservations. That's easy. What you didn't do is hold the reservation, and that's really the most important part of the reservation. Anyone can take them."

Now, think of Jerry's dilemma in carb-counting terms. Anyone can count carbs. (Hey!—there goes one. Here comes another—that makes two!) But not everyone can count carbs accurately. And accuracy is really the most important part of the carb-counting process. It is what makes your dietary plan work for you.

So how do we go from being a carb-counting guesser (a reservation "taker") to a carb-counting

Genre:

On Sale: Dec 11, 2006
Page Count: 256 pages
Publisher: Da Capo Lifelong Books
ISBN-13: 9781569242742

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Gary Scheiner, MS, CDCES

About the Author

Gary Scheiner, MS, CDE,&nbsp is a certified diabetes educator, insulin-pump user and trainer, and exercise physiologist. He is the author of six books and serves on the board of directors of the Juvenile Diabetes Research Foundation. He lives in Pennsylvania.

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