Carbohydrate Counting, Glycemic Index, and Glycemic Load: Putting Them All Together

Some people prefer to count grams of carbohydrate, while others prefer to count carbohydrate “choices,” or servings. Each carbohydrate choice contains 15 grams of carbohydrate. When using this method of meal planning, it’s handy to have a resource that lists the serving sizes of various foods that contain 15 grams of carbohydrate. One example of such a resource is the booklet Choose Your Foods: Exchange Lists for Diabetes, published by the American Diabetes Association. The booklet groups carbohydrate-containing foods in categories of fruits, starches, milk, and other carbohydrates. For the purposes of carbohydrate counting, items in one list can be swapped with items in the other lists.

The right number of choices per meal depends on the person; a common range is 2–5 servings per meal and 1–2 servings for snacks. The table “Same Carbohydrate, Different Glycemic Load,” shows the portion sizes of a variety of carbohydrate foods that equal 1 carbohydrate choice, or about 15 grams of carbohydrate.

Most sweets and desserts contain carbohydrate, but typical portion sizes usually contain more than 15 grams of carbohydrate. Desserts are often high in calories and fat, and they should ideally be consumed in moderation to control not only blood glucose levels, but also weight and blood fats (cholesterol and triglycerides). See “Sweets and Desserts” for a sampling of sweets’ and desserts’ carbohydrate content.

Foods with little effect on blood glucose
Nonstarchy vegetables contain small amounts of carbohydrate (5 grams or less in half a cup cooked or 1 cup raw) and generally have no effect on blood glucose levels when eaten in typical amounts. Some examples of nonstarchy vegetables include asparagus, green or wax beans, Brussels sprouts, broccoli, celery, onions, mushrooms, greens, lettuce, peppers, okra, tomatoes, cucumber, zucchini, and cabbage.

So-called free foods are foods or beverages that contain no more than 20 calories per serving and no more than 5 grams of carbohydrate. The following are some examples of free foods. Note that the foods listed with a serving size are only “free” if no more than three servings are eaten per day.

• Nonstick cooking spray
• Artificial sweeteners
• Sugar-free soft drinks
• Sugar-free or plain teas
• Black coffee
• Sugar-free drink mixes
• Broth or bouillon
• Spices or hot pepper sauce
• Mustard
• Sugar-free gum
• 1 tablespoon of ketchup
• 2 teaspoons light jam or jelly
• 2 tablespoons sugar-free syrup
• 2 teaspoons nondairy, powdered creamer
• 1/4 cup salsa

Protein alone does not raise blood glucose, but few if any foods contain only protein. Most foods that are high in protein also contain fat, such as meat, poultry, fish, dairy products, and nuts, and some contain carbohydrate, including dairy products, nuts, and beans. Those that contain carbohydrate will have a glycemic index value; those that don’t will not.

Fat alone or in combination with protein does not raise blood glucose, so foods such as butter, margarine, oil, and meat do not have a glycemic index value. When fat is combined with carbohydrate, it tends to lower the glycemic index value of the food, since fat slows digestion. This is why potato chips have a lower glycemic index than boiled white potatoes — and this in turn is an illustration of why a food’s glycemic index value is not the only the only thing to consider when deciding what to eat. Choosing foods that are lower in saturated fat and higher in monounsaturated and polyunsaturated fatty acids is important for heart health, regardless of glycemic index. Examples of healthier fats and fatty foods include olive oil, canola oil, liquid margarine, nuts, and avocado.