Diabetes

Helping Patients With Diabetes Embrace Carbohydrates

I teach carbohydrate counting to most of my patients with type 2 diabetes. For some, the simple plate method of meal planning is all they need. However, most benefit from combining various meal planning techniques. And that means quantifying the amount of carbohydrates in various foods.

I struggle to help them grasp that one food isn’t better than another just because it has fewer grams of carbohydrates in a serving. And I struggle to teach limits on carbohydrates without making them carb-phobic. So many already come to me with the belief that all things carbohydrate are bad or forbidden. It’s easy for me to see that lentils and lollipops have little in common. Yet to many with diabetes, they’re the same: carbs, bad, forbidden.

I’d like to learn what strategies you use, so please share some thoughts in the comment section below. Here’s what I teach to help my clients with diabetes fear less, know more, and embrace wholesome foods with carbohydrates.

1. The underlying problem with type 2 diabetes isn’t dysglycemia. Rather, high blood sugar is a symptom of insulin resistance, the true underlying problem. Carbohydrate avoidance will help manage blood sugar levels, but it does nothing to help insulin resistance. Though I’m careful how I address other problems associated with insulin resistance, I do explain that it affects lipids, blood pressure, fatty liver, cardiovascular risk, and cancer risk. If we address only blood sugar management, then we’re leaving the patient at high risk of other health problems. It’s helpful to look at each of insulin’s roles, not simply its role in shuttling glucose from the bloodstream into various cells.

2. Having diabetes doesn’t change the definition of a healthful diet. Such a diet should be tasty, livable, affordable, and culturally appropriate. It should help to maintain or achieve body weight goals and reduce cardiovascular and cancer risks.

3. There are many ways to a healthful plate. A variety of diet types work well to manage all aspects of diabetes. Even higher-carbohydrate vegetarian and vegan diets are suitable for people with diabetes, as are many other types of diets and distributions of macronutrients.

4. Some carb-rich foods are especially beneficial to people with diabetes or insulin resistance. I encourage these foods while emphasizing portion control and overall meal balance.

  • Barley and oats: Both contain the soluble fiber beta-glucan, which appears to improve insulin action and lower blood sugar levels. Beta-glucan also sweeps cholesterol from the digestive tract, keeping it from the bloodstream.
  • Pulses (dry beans, peas, and lentils): Studies show that diets rich in pulses have beneficial effects on both short-term and long-term fasting blood sugar levels and can lower blood sugar as well as some diabetes medications. Not only are they full of plant protein but they also contain potassium, magnesium, B vitamins, and dietary fiber, including resistant starch. Resistant starches make their way to the colon where they feed gut bacteria. In the process, the beneficial bacteria produce short-chain fatty acids, which improve the way our bodies respond to insulin. I heard researcher John Sievenpiper, MD, PhD, FRCPC, of the University of Toronto speak at a sponsored conference. Sievenpiper shared data suggesting that pulses help mitigate other abnormalities associated with insulin resistance and diabetes, too, specifically body weight, blood pressure, and lipids.
  • Whole grains: According to the Dietary Guidelines for Americans Committee, healthful eating patterns that include whole grains may be associated with lower risk of type 2 diabetes.
  • Yogurt: Though studies are mixed, many suggest that yogurt has a protective effect against type 2 diabetes.
  • Berries: A Finnish study found that middle-aged and older men who consumed the most berries had a 35% lower risk of developing type 2 diabetes. In fact, while they’re high in carbohydrates, fruits in general are associated with less chronic disease, not more. I explain to my patients that fruits—like other edible plants—contain phytonutrients, many of which improve insulin sensitivity and glucose metabolism.

It’s so common for people with diabetes to focus most of their diet energies onto avoiding carbohydrates. While understandable, this strategy is misguided because it treats only the elevated blood sugar level. Instead, eating a variety of healthful carbohydrates such as fruits, vegetables, pulses, and whole grains, can help clients manage diabetes and prevent further health problems.

— Jill Weisenberger, MS, RDN, CDE, FAND, CHWC, is a freelance writer and a nutrition and diabetes consultant to the food industry, including Dow AgroSciences and Egg Nutrition Center. She has a private practice in Newport News, Virginia, and is the author of several books, including Diabetes Weight Loss — Week by Week.

2 Comment

  1. I do what you do – we are on the same page with what we teach, in other words. I embrace testing. My goal is for them to see that nothing is forbidden, and nothing is free when it comes to carbohydrates. Testing before and again 2 hours after a meal with different types of carbohydrates will help them see for themselves, that not all carbs are the same.

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