Carbohydrates have become the ugly stepsister in the family photo album of healthy eating. Standing in the grocery aisle, consumers study ingredients and food labels, counting and analyzing the carb content of their foods. In the last decade, the popularity of low carb diets rose to dramatic heights as Americans gravitated toward the South Beach, Atkins, and Zone diets. Fruits were forsaken for plates piled high with steak and eggs.
People with diabetes have been counting carbs for years, and many adhere passionately to the philosophy of doctors like Dr. Bernstein, whose advice (six grams of carbs for breakfast, 12 at lunch and dinner) differs from the ADA recommendations (45 to 60 grams per meal) for a healthy diet. But something gets lost in the fervor over carbohydrates, and that is the reality that even ugly stepsisters have redeeming qualities.
There are two basic types of carbohydrates: simple (bad) and complex (good). “Good” complex carbs are found in the following:
Oatmeal and oat bran
Nuts and seeds
Most fruits (for example, strawberries, blueberries, pears, and apples)
Dry beans and peas
Whole wheat bread and wheat bran
Barley, brown rice, couscous, bulgur, and whole grain cereals
“Bad” carbs include sugars found naturally in foods such as fruits, vegetables, milk, and milk products. Simple carbohydrates also include sugars added during food processing and refining, refined grains like white bread and white rice, processed foods such as cake, cookies, chips, certain lunch meats, and hotdogs, and soft drinks and alcohol.
Here’s where it can get a little confusing. It’s not just about the carbohydrate content of foods that matters for managing blood sugars. The glycemic index (GI) needs to be considered as well.
The glycemic index ranks carbohydrates on a scale from 0 to 100 according to the extent to which they raise blood sugar levels after eating. Foods with a high GI are rapidly digested and absorbed, resulting in marked fluctuations in blood sugar levels. Low GI foods, by virtue of their slow digestion and absorption, produce gradual rises in blood sugar and insulin levels and have proven benefits for health.
Low GI diets have been shown to improve both glucose and lipid levels in people with diabetes (type 1 and type 2). They have benefits for weight control because they help control appetite and delay hunger. Low GI diets also reduce insulin levels and insulin resistance.
Low glycemic index foods tend to be complex carbohydrates like whole grains, non-starchy vegetables, beans, nuts, yogurt, whole wheat pasta, and many fruits. They contain less calories, sugar, and fat, are more filling, and don’t set off cravings for fat, sugar, and salt the way high GI foods do.
According to the Glycemic Index Foundation (http://www.glycemicindex.com/), a low GI diet (under 50) is beneficial because it helps people lose and manage weight and increases the body’s sensitivity to insulin. Low GI carbs also improve diabetes management, reduce the risk of heart disease, improve blood cholesterol levels, reduce hunger and keep you fuller longer, and prolong physical endurance.
Riva Greenberg has lived with type 1 diabetes since 1972. After graduating from college and moving back to her native New York City, she ate the standard New York diet of bagels, muffins, scones, and pretzels. She says that she used to think she ate a fairly low carb diet. It wasn’t until she read Dr. Bernstein’s Diabetes Solution that she began to change the way she ate. She gave up the bagels and pretzels, but took liberties with the rigid Bernstein diet.
Greenberg continued to read the latest research on various meal plans and had an “ah-ha” moment when she realized that she was using the term “low carb” incorrectly. “I thought I was eating a low carb diet, but every day, oatmeal, veggies, fruit, nuts, and beans made up the bulk of my diet, and those all have carbs in them,” she says. She realized that she was following a higher carb diet than she thought, yet it was low glycemic index, and it was working.
Greenberg says routine helps. “If you can eat the same way most days, your blood sugars are more predictable.” Usually, her meals consist of the following:
Breakfast: steel-cut oatmeal with flaxseed, sunflower seeds, berries, a spoonful of nonfat Greek yogurt, and cottage cheese and peanut butter
Lunch: leftover veggies, chick peas and turkey, chicken, and hummus or feta cheese
Dinner: chicken or fish, non-starchy vegetables, beans, and a glass of red wine
Snacks: dark chocolate, fruit, and nuts
Greenberg notes, “I’m not saying I never eat pancakes, fried calamari, or the occasional dessert, and I do always dunk the bread crusts in olive oil when I’m out to dinner. But pretty much the way I eat now is simple and really clean. Eating this way, I’ve been able to maintain my lowest weight without much effort. I also don’t feel deprived. I like what I eat. I don’t miss bagels at all.”
Greenberg believes that when you change your eating habits over time, your taste buds change. She adds, “I also think that when you shift your mindset from feeling deprived to wanting to be healthy, then it doesn’t feel like giving up processed foods and refined carbohydrates is a sacrifice.
Food is a complex issue for people with diabetes. What we eat affects how we feel physically and emotionally. Everyone is different, and what works for one may not work for another. What’s most important when making food choices is to be informed, know the difference between good and bad carbs, and choose what works best for you.