Research presented at the American Diabetes Association annual Scientific Sessions in 2004 showed that even educated people with Type 1 diabetes who manage their diabetes well have difficulty counting carbohydrates accurately, with a tendency to underestimate the carbohydrates consumed at breakfast, dinner, and snacks and to overestimate the carbohydrates 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 carbohydrate counters struggled to score 50% on “The Ultimate Carbohydrate Counting Test” located at my Web site, www.integrateddiabetes.com/carbtest.shtml. But by using some of the techniques described here, those same people have become highly proficient at counting carbohydrates accurately — and they don’t spend half their day obsessing over food.
Here are three simple recommendations for counting carbohydrates accurately and easily: Read labels, use resources listings, and learn to estimate portion sizes.
When it comes to carbohydrate counting, labels rule. The US Food and Drug Administration (FDA) requires the manufacturers of all packaged and processed foods to list key nutrient information and ingredients on food labels. Most industrialized nations worldwide have similar requirements. In the United States, the label must list (among other things) the grams of total carbohydrate as well as grams of sugar and dietary fiber in a single serving of the food item. Although not required, some food manufacturers also list the amount of soluble fiber, along with sugar alcohols and “other” carbohydrates (typically starches) below total carbohydrate.
Of all these items, total carbohydrate is by far the most important. The total carbohydrate includes everything in the food that is carbohydrate: starch, fiber, sugars, and sugar alcohols. Remember to look for the number next to the little “g” (which stands for 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 carbohydrate counting.
Here’s another fun fact: When counting carbohydrates, 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. You may have to make a slight adjustment if the food contains fiber or sugar alcohol. For food items that contain either of these, you should do the following:
- Subtract all the fiber grams from the total carbohydrate count since fiber does not raise blood glucose. For example, a food item containing 24 g of total carbohydrate and 6 g of fiber should be counted as 18 g carbohydrate (24 – 6 = 18). Fiber-rich foods include beans, whole-grain breads, certain cereals, and some fruits and vegetables.
- Subtract half the grams of sugar alcohols from the total carbohydrate count, since sugar alcohols affect blood glucose half as much as ordinary carbohydrates. For example, a food item containing 17 g total carbohydrate and 8 g of sugar alcohols should be counted as 13 g carbohydrate (17 – 4 = 13). Sugar alcohols are 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,” such as sorbitol, maltitol, lactitol, mannitol, and xylitol. Two sugar alcohols that do not have the –ol suffix are hydrogenated starch hydrolysates (HSH) and isomalt.