DR. LOUAY LABBANDEPARTMENT OF

NUTRITIONUNIVERSITY OF

KALAMOON

Carbohydrate Counting is a meal planning approach based on the following ideas :

•Carbohydrates is the main nutrient affecting post-prandial glycemic response

•Total amount of carbohydrates is more important than source of carbohydrates

Carb counting began receiving attention in 1990 as method of controlling blood sugar

1994 ADA used science behind carb counting to make nutrition recommendations

Getting the best of from your insulin regimen

Good glycemic controlFreedom to eat when you want toFreedom to eat as little or as much

as you wishFreedom to eat traditionally

‘forbidden’ food without feeling guilty

Not difficult but you need to invest time & effort in getting it right

It is possible that you may gain weight if : You eat the high calorie foods you

previously avoided Have larger portions because you can

give extra insulin Concentrate on only CHO and forget

about other aspects of a healthy diet

• Understand how foods affect your blood sugar

• Carbohydrates have largest effect on blood sugar

• Allows flexibility in meal planning• No “good” foods or “bad” foods

Meal 1 Hr 2 Hrs 3 Hrs 4 Hrs 5 Hrs 6 Hrs 7 Hrs 8 Hrs

Carbohydrate…. rapid digestion, total absorption/conversion to glucose (100%) Sugar Alcohols.. moderate digestion, partial absorption as glucose (50%) Protein…………… slow digestion, partial conversion to glucose* (~40%)  Fat…………………. slow digestion, little conversion to glucose** (<20%)

* In absence of dietary carbs ** may cause insulin resistance in large qty

Glucose Fructose (fruit

sugar) Galactose Dextrose Lactose (milk sugar) Sucrose (table

sugar)

“flavored” simple sugars:

• Maltose• High-Fructose Corn Syrup• Molasses• Brown Sugar• Honey

Fruit Fruit Juice Candy Regular Soda Punch

Muffins Milk Ice Cream Yogurt Sport Drinks Table Sugar

Chocolate Cookies & Cakes Pies & Pastries Raisins/Dried Fruit Syrup Jelly

• Potatoes• Rice• Noodles/Pasta• Cereal• Oatmeal• Bread

• Tortillas• Pancakes• Waffles• Crackers• Bagels• Pizza

• Beans• Corn• Pretzels• Chips• Popcorn• Sweet potatoes

(disount 100%!)

(discount 50%!)

Sorbitol / Maltitol / Lactitol/ Mannitol / Xylitol

(Rare… can ignore!)

 

Simple Carbohydrates

(sugars)

Complex Carbohydrates

(starches)

BloodGlucose

All carbs (except fiber) convert All carbs (except fiber) convert to blood glucose eventuallyto blood glucose eventually

G.I. Reflects the magnitude of G.I. Reflects the magnitude of blood glucose rise for the first blood glucose rise for the first 2 hours following ingestion2 hours following ingestion

G.I. Number is % or rise G.I. Number is % or rise relative to pure glucose (100% relative to pure glucose (100% of glucose is in bloodstream of glucose is in bloodstream within 2 hours)within 2 hours)

Example:Example:

SpaghettiSpaghettiGI = 37GI = 37 Only 37% of

spaghetti’s carbs turn into blood glucose in the first 2 hours.

The rest will convert to blood glucose over the next several hours.

Glycemic Index (contd.)Glycemic Index (contd.)

Slow Stuff Average Stuff

Fast Stuff

PastaLegumes

Salad VeggiesDairy

FruitJuicePizzaSoupCake

Breads/CrackersSalty Snacks

PotatoesRice

CerealsSugary Candies

== =

The “Exchange” systemFood package labelsResource listingsPortion estimationCarb factors

Foods with common nutrient values are grouped together.

1 Fat

1 Meat

1 Vegetable

1 Milk

1 Fruit

1 Starch

0 5 10 15

Groups/ Lists Carb.

Protein

Fat Calories

Carbohydrate GroupStarch 15 3 1 or

less80

Fruit 15 ___ ___ 60

Milk Skim Low-fat Whole

121212

888

0-358

90120150

Other carbohydrates 15 varies varies varies

Vegetables 5 2 ___ 25

Meat and Substitute Group Very lean Lean Medium-fat High-fat

____________

7777

0-1358

355575

100

Fat Group ___ ___ 5 45

Labels are the best resource for carbohydrate counting

Pay attention to: Serving Size Total Carbohydrate Fiber & Sugar Alcohol (if

any)

Labels are the best resource for carbohydrate counting

Pay attention to: Serving Size Total Carbohydrate Fiber & Sugar Alcohol (if

any)

Included in total carbohydrateDoes not convert to glucoseSubtract fiber from the Total

Carbohydrate

For example:13 g Total Carb- 3 g dietary fiber

Count as 10 grams carbohydrate

Artificial SweetenersFound in chewing gum, mints,

yogurt, ice cream, cookies and candy

Digest slowly and partially ( 50%)

Can cause diarrhea

Fat Lengthens time your stomach takes to

empty Delays rise in blood glucose May cause temporary insulin resistance

•Protein– Very little effect on blood glucose

(unless carb diet)

– Usually combined with fat

1 ounce of cheese is about the size of your thumb

A teaspoon of margarine is about the size of your thumb tip

1 cup of milk, yogurt or chopped fresh greens is about the size of a small hand holding a tennis ball

1 oz nuts or small candies:About one handful

1 cup: About the size of a man's fist

One piece fruit or potato:About the size of a regular(60 watt) light bulb

One-half cup of vegetablesis the size of a light bulb

One cup of pasta is the sizeof a tennis ball

3/4 cup:About the size of a tennis ball

1 fruit serving = ½ cup cannedor 1 medium fruitis about the size of a tennis ball

Is the weight of serving of a particular food divided by its content of carbohydrates

Weigh a portion of foodMultiply the weight by its carb

factor*Get total carb count

*A carb factor is the percentage of the food’s weight that is carbohydrate. The rest is water, protein, fat, minerals

Carb Factor Examples:

Apple: .13Apple Pie: .32Bagel: .51Carrot (raw): .06Chocolate Cake: .51Cornbread: .45Pancake: .28

For carb factors for more than 6000 foods (in Excel spreadsheet format), go to: www.friendswithdiabetes.org/files/Carb factor.xls

Pizza (cheese): .32Potato, baked: .22Potato Salad: .09Rice: .27Spaghetti: .26Vanilla Ice Cream: .23Watermelon: .06