Carbohydrate counting11111

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  • The red spike shows the normal effect of carbohydrates on blood sugar levels. You can see that all other components of food have less dramatic spikes.
  • Carbohydrates include all starches and sugars. Examples of starches are bread, rice, potatoes, pasta, corn, peas and beans. Carbohydrates in the form of sugar are found in fruit, milk, regular sodas, (not diet sodas), candy, lemonade, and fruit juice. In addition, carbohydrates are found in a lot of mixed dished or combinations foods like pizza and spaghetti.
  • Carbohydrates include all starches and sugars. Examples of starches are bread, rice, potatoes, pasta, corn, peas and beans. Carbohydrates in the form of sugar are found in fruit, milk, regular sodas, (not diet sodas), candy, lemonade, and fruit juice. In addition, carbohydrates are found in a lot of mixed dished or combinations foods like pizza and spaghetti.
  • Carbohydrates include all starches and sugars. Examples of starches are bread, rice, potatoes, pasta, corn, peas and beans. Carbohydrates in the form of sugar are found in fruit, milk, regular sodas, (not diet sodas), candy, lemonade, and fruit juice. In addition, carbohydrates are found in a lot of mixed dished or combinations foods like pizza and spaghetti.
  • Fiber is a carbohydrate that does not enter the blood stream and therefore does not affect blood sugar levels. It stays in the gut and helps slow the digestion of other carbohydrates. You can subtract the fiber from the total grams of carbohydrate in the food. Sugar alcohols are also carbohydrates that are manufactured to resemble sugar in taste but are not completely absorbed. Half of sugar alcohols pass through your body unabsorbed. You can subtract half the sugar alcohols from the total carbohydrate. Glycerine or glycerol also counts as a carbohydrate but does not affect blood sugar. It is similar to carbohydrate in its calorie count, but not on its effect on blood sugar.
  • Various types of carbohydrate have slightly difference effects on your blood glucose levels due to what they’re made of, how they’re processed, whether or not they’ve been cooked, and whether you eat them alone or with a meal. If your blood glucose is high before you eat, your blood glucose may increase less than it would if your blood glucose was low before a meal. It’s often difficult to predict how different carbohydrate foods affect your blood glucose because there are so many variables. Some people, however, can identify certain carbohydrate foods that have more or less effect on their blood glucose levels than others (known as the glycemic effect of foods)
  • Various types of carbohydrate have slightly difference effects on your blood glucose levels due to what they’re made of, how they’re processed, whether or not they’ve been cooked, and whether you eat them alone or with a meal. If your blood glucose is high before you eat, your blood glucose may increase less than it would if your blood glucose was low before a meal. It’s often difficult to predict how different carbohydrate foods affect your blood glucose because there are so many variables. Some people, however, can identify certain carbohydrate foods that have more or less effect on their blood glucose levels than others (known as the glycemic effect of foods)
  • Various types of carbohydrate have slightly difference effects on your blood glucose levels due to what they’re made of, how they’re processed, whether or not they’ve been cooked, and whether you eat them alone or with a meal. If your blood glucose is high before you eat, your blood glucose may increase less than it would if your blood glucose was low before a meal. It’s often difficult to predict how different carbohydrate foods affect your blood glucose because there are so many variables. Some people, however, can identify certain carbohydrate foods that have more or less effect on their blood glucose levels than others (known as the glycemic effect of foods)
  • Years ago we thought that sugars and starches had definite differences in their effect on blood glucose. Now, we have more knowledge of the effects of carbohydrate on blood glucose. Numerous research studies have shown that sugars and starches have very similar effects. Therefore, sugar is not forbidden for people with diabetes. Knowing the total carbohydrate in a food is more important than knowing how much sugar it contains. For most people, 30 grams of carbohydrate will affect their blood glucose the same, regardless of whether it is 2 slices of bread or 1 cup of ice-cream, or a small frosted brownie.
  • You can count carbs in any number of ways.
  • If you have a Food Exchange booklet, you can use the average values for carbohydrate listed - 15 grams for most portion sizes listed.
  • The Nutrition Facts label is the most reliable resource for carbohydrate information. It includes two things you need to know to do carbohydrate counting – the Serving Size and the Total Carbohydrate. The amount of carbohydrate you are eating is calculated by multiplying the serving size by the total carbohydrate.
  • The Nutrition Facts label is the most reliable resource for carbohydrate information. It includes two things you need to know to do carbohydrate counting – the Serving Size and the Total Carbohydrate. The amount of carbohydrate you are eating is calculated by multiplying the serving size by the total carbohydrate.
  • Here is an example of a Nutrition Facts Label. Note where the Serving Size and Total Carbohydrate information are listed. You also see sugar on the label. You do not have to count sugar separately from carbohydrate. Sugar is a type of carbohydrate and is already included in the total. All carbohydrates list under total carbohydrate should add up to the total. Sometimes manufacturer’s leave out some information – like how much starch is in a food. Then the numbers don’t add up. On this label you can assume that the 7 grams of missing carbs are starch (13 – 3 – 3 = 7).
  • Although fiber is included in the total carbohydrate on a food label, it does not increase the blood glucose. So, if you eat a high-fiber food, it won’t increase your blood glucose as much as a food with the same amount of carbohydrate that’s low in fiber. If your blood glucose fluctuates a lot due to variations in the amount of fiber you consume, you can do the following: For foods with more than 5 grams of insoluble fiber per serving, subtract the amount of fiber from the Total Carbohydrate.
  • For example, a breakfast cereal containing 30 grams of total carbohydrate per serving with 7 grams of insoluble dietary fiber would actually be counted as 23 grams of carbohydrate.
  • These artificial sweeteners do contain carbohydrates but they digest more slowly and some of them don’t ever find their way into the blood. About ½ of the sugar alcohols remain unabsorbed, so you can subtract 50% of them from the total carbohydrate. They tend to cause stomach distress and diarrhea, especially if eaten in large quantities. Keep in mind that sugar-free foods can contain sugar alcohol and other carb-rich elements.
  • Fat and protein have very little effect on blood glucose levels. That’s why we focus on carbohydrate. However, a high fat meal takes longer to be digested. Therefore, the rise in blood glucose following the meal may be delayed. For example, your blood glucose may still be high at bedtime after a high fat dinner.
  • There are books and websites devoted to finding the carb factors of food. You can also calculate your own carb factors if you have complete nutrition information, including the weight of a portion of the food, on any food.
  • There are books and websites devoted to finding the carb factors of food. You can also calculate your own carb factors if you have complete nutrition information, including the weight of a portion of the food, on any food.
  • Carbohydrate counting11111

    1. 1. DR. LOUAY LABBAN DEPARTMENT OF NUTRITION UNIVERSITY OF KALAMOON
    2. 2. <ul><ul><li>Carbohydrate Counting is a meal planning approach based on the following ideas : </li></ul></ul><ul><ul><ul><li>Carbohydrates is the main nutrient affecting post-prandial glycemic response </li></ul></ul></ul><ul><ul><ul><li>Total amount of carbohydrates is more important than source of carbohydrates </li></ul></ul></ul>
    3. 3. <ul><li>Carb counting began receiving attention in 1990 as method of controlling blood sugar </li></ul>
    4. 4. <ul><li>1994 ADA used science behind carb counting to make nutrition recommendations </li></ul>
    5. 5. <ul><li>Getting the best of from your insulin regimen </li></ul><ul><li>Good glycemic control </li></ul><ul><li>Freedom to eat when you want to </li></ul><ul><li>Freedom to eat as little or as much as you wish </li></ul><ul><li>Freedom to eat traditionally ‘forbidden’ food without feeling guilty </li></ul>
    6. 6. <ul><li>Not difficult but you need to invest time & effort in getting it right </li></ul><ul><li>It is possible that you may gain weight if : </li></ul><ul><ul><li>You eat the high calorie foods you previously avoided </li></ul></ul><ul><ul><li>Have larger portions because you can give extra insulin </li></ul></ul><ul><ul><li>Concentrate on only CHO and forget about other aspects of a healthy diet </li></ul></ul>
    7. 7. <ul><li>• Understand how foods affect your blood sugar </li></ul><ul><li>• Carbohydrates have largest effect on blood sugar </li></ul><ul><li>• Allows flexibility in meal planning </li></ul><ul><li>• No “good” foods or “bad” foods </li></ul>
    8. 8. 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
    9. 10. <ul><li>Glucose </li></ul><ul><li>Fructose (fruit sugar) </li></ul><ul><li>Galactose </li></ul><ul><li>Dextrose </li></ul><ul><li>Lactose (milk sugar) </li></ul><ul><li>Sucrose (table sugar) </li></ul>Sugars (aka &quot;simple&quot; carbohydrates) <ul><li>“ flavored” simple sugars: </li></ul><ul><li>Maltose </li></ul><ul><li>High-Fructose Corn Syrup </li></ul><ul><li>Molasses </li></ul><ul><li>Brown Sugar </li></ul><ul><li>Honey </li></ul>
    10. 11. <ul><li>Fruit </li></ul><ul><li>Fruit Juice </li></ul><ul><li>Candy </li></ul><ul><li>Regular Soda </li></ul><ul><li>Punch </li></ul>Sugars (aka &quot;simple&quot; carbohydrates) <ul><li>Muffins </li></ul><ul><li>Milk </li></ul><ul><li>Ice Cream </li></ul><ul><li>Yogurt </li></ul><ul><li>Sport Drinks </li></ul><ul><li>Table Sugar </li></ul><ul><li>Chocolate </li></ul><ul><li>Cookies & Cakes </li></ul><ul><li>Pies & Pastries </li></ul><ul><li>Raisins/Dried Fruit </li></ul><ul><li>Syrup </li></ul><ul><li>Jelly </li></ul>
    11. 12. Starches (aka &quot;complex&quot; carbohydrates) <ul><li>Potatoes </li></ul><ul><li>Rice </li></ul><ul><li>Noodles/Pasta </li></ul><ul><li>Cereal </li></ul><ul><li>Oatmeal </li></ul><ul><li>Bread </li></ul><ul><li>Tortillas </li></ul><ul><li>Pancakes </li></ul><ul><li>Waffles </li></ul><ul><li>Crackers </li></ul><ul><li>Bagels </li></ul><ul><li>Pizza </li></ul><ul><li>Beans </li></ul><ul><li>Corn </li></ul><ul><li>Pretzels </li></ul><ul><li>Chips </li></ul><ul><li>Popcorn </li></ul><ul><li>Sweet potatoes </li></ul>
    12. 13. Fiber Glycerine Sugar Alcohol (disount 100%!) (discount 50%!) Sorbitol / Maltitol / Lactitol/ Mannitol / Xylitol (Rare… can ignore!)
    13. 14.   Simple Carbohydrates (sugars) Complex Carbohydrates (starches)     Blood Glucose
    14. 15. <ul><li>All carbs (except fiber) convert to blood glucose eventually </li></ul><ul><li>G.I. Reflects the magnitude of blood glucose rise for the first 2 hours following ingestion </li></ul><ul><li>G.I. Number is % or rise relative to pure glucose (100% of glucose is in bloodstream within 2 hours) </li></ul>
    15. 16. <ul><li>Example: </li></ul><ul><li>Spaghetti </li></ul><ul><li>GI = 37 </li></ul><ul><li>Only 37% of spaghetti’s carbs turn into blood glucose in the first 2 hours. </li></ul><ul><li>The rest will convert to blood glucose over the next several hours. </li></ul>Glycemic Index (contd.)
    16. 17. Slow Stuff Average Stuff Fast Stuff Pasta Legumes Salad Veggies Dairy Fruit Juice Pizza Soup Cake Breads/Crackers Salty Snacks Potatoes Rice Cereals Sugary Candies
    17. 18. = = =
    18. 19. <ul><li>The “Exchange” system </li></ul><ul><li>Food package labels </li></ul><ul><li>Resource listings </li></ul><ul><li>Portion estimation </li></ul><ul><li>Carb factors </li></ul>
    19. 20. <ul><li>Foods with common nutrient values are grouped together. </li></ul>
    20. 21. Groups/ Lists Carb. Protein Fat Calories Carbohydrate Group Starch 15 3 1 or less 80 Fruit 15 ___ ___ 60 Milk Skim Low-fat Whole 12 12 12 8 8 8 0-3 5 8 90 120 150 Other carbohydrates 15 varies varies varies Vegetables 5 2 ___ 25 Meat and Substitute Group Very lean Lean Medium-fat High-fat ___ ___ ___ ___ 7 7 7 7 0-1 3 5 8 35 55 75 100 Fat Group ___ ___ 5 45
    21. 22. <ul><li>Labels are the best resource for carbohydrate counting </li></ul><ul><li>Pay attention to: </li></ul><ul><ul><li>Serving Size </li></ul></ul><ul><ul><li>Total Carbohydrate </li></ul></ul><ul><ul><li>Fiber & Sugar Alcohol (if any) </li></ul></ul>
    22. 23. <ul><li>Labels are the best resource for carbohydrate counting </li></ul><ul><li>Pay attention to: </li></ul><ul><ul><li>Serving Size </li></ul></ul><ul><ul><li>Total Carbohydrate </li></ul></ul><ul><ul><li>Fiber & Sugar Alcohol (if any) </li></ul></ul>
    23. 25. <ul><li>Included in total carbohydrate </li></ul><ul><li>Does not convert to glucose </li></ul><ul><li>Subtract fiber from the Total Carbohydrate </li></ul>
    24. 26. <ul><li>For example: </li></ul><ul><li>13 g Total Carb </li></ul><ul><li>- 3 g dietary fiber </li></ul><ul><li>Count as 10 grams </li></ul><ul><li>carbohydrate </li></ul>
    25. 27. <ul><li>Artificial Sweeteners </li></ul><ul><li>Found in chewing gum, mints, yogurt, ice cream, cookies and candy </li></ul><ul><li>Digest slowly and partially (  50%) </li></ul><ul><li>Can cause diarrhea </li></ul>
    26. 28. <ul><li>Fat </li></ul><ul><ul><li>Lengthens time your stomach takes to empty </li></ul></ul><ul><ul><li>Delays rise in blood glucose </li></ul></ul><ul><ul><li>May cause temporary insulin resistance </li></ul></ul><ul><li>Protein </li></ul><ul><ul><li>Very little effect on blood glucose (unless  carb diet) </li></ul></ul><ul><ul><li>Usually combined with fat </li></ul></ul>
    27. 31. <ul><li>1 ounce of cheese is about the size of your thumb </li></ul><ul><li>A teaspoon of margarine is about the size of your thumb tip </li></ul>
    28. 32. <ul><li>1 cup of milk, yogurt or chopped fresh greens is about the size of a small hand holding a tennis ball </li></ul>
    29. 33. <ul><li>1 oz nuts or small candies: About one handful </li></ul>
    30. 34. <ul><li>1 cup: About the size of a man's fist </li></ul>
    31. 35. <ul><li>One piece fruit or potato: About the size of a regular (60 watt) light bulb </li></ul><ul><li>One-half cup of vegetables is the size of a light bulb </li></ul>
    32. 36. <ul><li>One cup of pasta is the size of a tennis ball </li></ul><ul><li>3/4 cup: About the size of a tennis ball </li></ul><ul><li>1 fruit serving = ½ cup canned or 1 medium fruit is about the size of a tennis ball </li></ul>
    33. 37. <ul><li>Is the weight of serving of a particular food divided by its content of carbohydrates </li></ul>
    34. 38. <ul><li>Weigh a portion of food </li></ul><ul><li>Multiply the weight by its carb factor* </li></ul><ul><li>Get total carb count </li></ul><ul><li>*A carb factor is the percentage of the food’s weight that is carbohydrate. The rest is water, protein, fat, minerals </li></ul>
    35. 39. Carb Factor Examples: Apple: .13 Apple Pie: .32 Bagel: .51 Carrot (raw): .06 Chocolate Cake: .51 Cornbread: .45 Pancake: .28 For carb factors for more than 6000 foods (in Excel spreadsheet format), go to: www.friendswithdiabetes.org/files/Carb factor.xls Pizza (cheese): .32 Potato, baked: .22 Potato Salad: .09 Rice: .27 Spaghetti: .26 Vanilla Ice Cream: .23 Watermelon: .06

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