IN THIS CHAPTER
Using Exchange Lists
Solving carb counts with measures and weights
Tracking carbs in restaurants and those you drink
Keeping things simple with the plate and hand methods
Reading labels on packaged foods makes it fairly easy to count carbs. Many foods, however, don’t come with labels. It would be a shame to limit yourself to packaged foods just because the carbs are easier to count. If you would like a detailed review on deciphering food labels, see Chapter 7 .
This chapter moves beyond label reading and explains several other methods for controlling and quantifying carbs. It’s important to make healthy food choices and eat appropriate portion sizes. That means eating the right amount of carb; it doesn’t mean entirely avoiding or over-restricting healthy foods to the point of compromising nutrition.
Controlling carb intake is at the foundation of diabetes management. Carb counting is an especially important tool to learn if you have type 1 diabetes, because blood-glucose control hinges on balancing insulin with carbohydrate intake. Carb counting is also an effective method of portion control if you have type 2 diabetes. Whether carb counting is a new concept or you’re a seasoned carb counter who’s ready to take it to the next level, this chapter offers tips that will build on your skills.
Simple visual methods for carb portioning work well enough for many people with type 2 diabetes. The plate model and the hand method are two easy-to-use strategies that I explore in this chapter. The chapter begins by introducing the Exchange Lists and showing how these food composition tables can be used for counting carbs. Other topics explored in this chapter include measuring and weighing food as well as handling special carb-counting cases.
Estimating Carb Counts for Foods without Labels
A wide variety of foods, including fresh produce, breads, legumes, and grains, don’t come with a food label. Foods are also often combined into mixed dishes rather than consumed separately, which can make carb counting trickier. Whether you’re preparing meals at home or being served in restaurants, it’s important to be able to accurately estimate carb counts, and the following sections can help. Note: You’ll need a standard set of measuring cups to count carbs effectively; I discuss the use of measures and weights later in this chapter.
Relying on food composition lists
For many years food composition lists have been referred to as the Exchange Lists. The main concept is that foods are separated into groups according to their macronutrient composition: carbohydrate, protein, and fat. These lists have historically been referred to as “exchange” lists because you can pick any item within a given list and have roughly the same amount of carbohydrate, protein, fat, and calories as any other item on that list. This section identifies some of the more common foods found within each list, but be sure to review all the Exchange Lists in Appendix A .
The six separate Exchange Lists are
· Starches
· Fruits
· Milk
· Nonstarchy vegetables
· Meats and proteins
· Fats
The groups that have the most carbohydrate are the starch, fruit, and milk groups. Nonstarchy vegetables contain carbs, but in lower amounts. The protein and fat groups don’t contain carbs, or at least not much.
Foods within each Exchange List food group are adjusted in portion size to provide roughly the same amount of carb, protein, fat, and calories per serving. Choose wisely within the groups. Whole grains are healthier choices than white refined grains. For blood-glucose control, limit your intake to one serving of fruit at a time. For improved health, choose plenty of nonstarchy vegetables and opt for lean proteins and unsaturated fats.
The starch list
The starch list contains staple foods that are relatively high in carbs. This group includes breads, bagels, tortillas, biscuits, crackers, oats, cereals, noodles, rice, quinoa, millet, and barley. High-carb vegetables are also included in the starch group. Examples of the starchy vegetables included are potatoes; corn; peas; yams; winter squash; and legumes, also known as the dried bean family.
Table 8-1 shows a few examples from the starch list. Each item on the list has 15 grams of carbohydrate in the portion size listed (measured after cooking). Each starch exchange also provides about 3 grams of protein, little or no fat, and 80 calories. For example, a half-cup of cooked oatmeal provides 15 grams of carb. It doesn’t mean that you have to limit yourself to a half-cup of cooked oatmeal. The portion sizes are simply a tool to help you count carbs in foods that don’t come packaged with a label. A whole cup of oatmeal would be 30 grams of carb. A cup of cooked rice has 45 grams of carb; the entire bagel adds up to 60 grams of carb, and so on.
TABLE 8-1 Starch List: Examples = 15 Grams Carb
|
Food |
Portion Size |
|
Bagel, large |
¼ |
|
Bread, wheat or white |
1 slice |
|
Legumes (dried bean family) |
½ cup cooked |
|
Oatmeal |
½ cup cooked |
|
Pasta, spaghetti, noodles |
⅓ cup cooked |
|
Potato |
½ cup cooked |
|
Rice, white or brown |
⅓ cup cooked |
|
Tortilla, 6-inch flour or corn |
1 |
The fruit list
The fruit list includes fresh fruits, dried fruits, frozen fruits, canned fruits, and fruit juices. Each item on the list has 15 grams of carbohydrate in the portion size listed, 0 grams of protein, 0 grams of fat, and 60 calories. See Table 8-2for portion sizes.
TABLE 8-2 Fruit List: Examples = 15 Grams Carb
|
Food |
Portion Size |
|
Apple, small |
1 |
|
Banana, average |
½ |
|
Blackberries, blueberries |
¾ cup |
|
Cantaloupe, honeydew melon |
1 cup cubed |
|
Grapefruit, large |
½ |
|
Grapes, small |
17 |
|
Orange, small |
1 |
|
Peach, medium |
1 |
Fruits are concentrated sources of natural sugar. Too much fruit at one time can bump up blood-sugar levels sharply, so you may want to stick to one portion at a time. A “small” apple or orange has 15 grams of carb. Small means the size of a tennis ball. A medium peach is about the size of a baseball.
If you want to take your carb counting to the next level, you can increase precision by using a food scale. I address food scale use later in this chapter.
Note: Although avocados and tomatoes are technically fruits (if you ask a botanist), they aren’t grouped with the fruits on the Exchange Lists. Tomatoes are grouped with the nonstarchy vegetables because tomatoes are relatively low in carbs. Avocados are even lower in carbs and they are very high in fat, so they have been adopted into the fats group.
The milk list
The milk list includes milk and yogurt. See Table 8-3 for a partial list. Fat and calories vary depending on the selection, but each portion listed provides about 8 grams of protein. Appendix A has a more complete list, which separates milk and yogurt into three categories: non- and low-fat, reduced fat, and whole milk.
TABLE 8-3 Milk List: Examples = 12–15 Grams Carb
|
Food |
Portion Size |
|
Milk: Nonfat, 1%, 2%, whole |
1 cup |
|
Evaporated milk |
½ cup |
|
Yogurt, plain |
⅔ cup |
The carb in milk comes from a natural sugar called lactose. You may wonder why cheese, butter, sour cream, and cream cheese are missing from the milk list. Although they are made from milk, they have very little lactose. Milk contains three macronutrients: carbohydrate, protein, and fat. Fat, the cream, separates and rises to the top. If churned, it turns into butter (no carbs there). If the fat is cultured, it turns into sour cream (that’s fat too). Cream cheese is mostly fat. To make cheese, enzymes are added to whole milk causing fat and protein to form a curd. Cheese has only a trace of carb. The low-carb dairy foods are found in the protein and fat Exchange Lists (which I introduce later in this chapter). I discuss nondairy milk substitutes like soy milk in Chapters 11 and 13 .
The nonstarchy vegetables list
The nonstarchy vegetables list includes veggies that are low in carb. Each item on the list has about 5 grams of carbohydrate in the portion size listed, 2 grams of protein, 0 grams of fat, and 25 calories. There are advantages to eating lots of low-carb vegetables: They’re low in calories yet packed with vitamins, minerals, and fiber. They don’t raise blood-glucose levels very much, and they help you feel fuller. Salad greens have such a small amount of carb that most people consider them free foods. I’m convinced you burn as many carbs chewing lettuce as you get out of digesting it, so it sort of balances out.
There’s no need to count the carbs in mixed greens, arugula, lettuce, or endive. Whether you should bother to count the carbs in other nonstarchy veggies depends on whether you take insulin to manage your diabetes. (For a more detailed discussion, see the nearby sidebar “To count or not to count, that is the question .”)
· People with type 1 diabetes should consider all carbs when calculating insulin doses. Yet many people with type 1 have been told not to count vegetables. When children are diagnosed with type 1 diabetes at a young age, their families are regularly told not to count the carbs in vegetables. Why? Because young kids simply don’t eat large enough portions of broccoli and carrots to make a difference in their blood-glucose readings. (Frankly, some of the vegetables given to kids don’t actually get consumed. Kids slip unwanted foods to the family dog. I even had one mom tell me that she found the green beans under the couch cushions.)
Eventually these kids grow up and so do their palates. As adults they learn to love vegetables and may eat substantial amounts. When the portion size begins to make a difference to insulin needs, then it’s time to start counting the vegetables.
· People with type 2 diabetes who aren’t on medications or who are only taking diabetes pills such as Glucophage likely don’t need to count the carbs in nonstarchy vegetables. In my many years of being a diabetes educator reviewing food and blood-glucose logs, I’ve never once seen a high blood-glucose result that could be blamed on overeating green vegetables.
Table 8-4 introduces some nonstarchy vegetables.
TABLE 8-4 Nonstarchy Vegetable List: Examples = 5 Grams Carb
|
½ cup cooked or 1 cup raw = about 5 grams carb |
|
|
Asparagus |
Greens (collard, kale) |
|
Bamboo shoots |
Mushrooms |
|
Beets |
Okra |
|
Broccoli |
Onions |
|
Brussels sprouts |
Pea pods |
|
Cabbage |
Peppers (all) |
|
Carrots |
Spinach |
|
Cauliflower |
Sprouts |
|
Celery |
Tomatoes |
|
Eggplant |
Zucchini |
TO COUNT OR NOT TO COUNT, THAT IS THE QUESTION
Many people use insulin-to-carb ratios to calculate mealtime doses (see Chapter 6 for details on these ratios). All of the carbs in the meal need to be accounted for in order to get the proper dose of insulin. A slice of tomato and lettuce on a sandwich aren’t significant, but a cup of vegetables may be. It depends on the portion size of the vegetables and the insulin-to-carb ratio. The following two scenarios illustrate the point:
Example 1: Meaghan has type 1 diabetes, and her insulin-to-carb ratio is 1:5. That means she takes 1 unit of rapid-acting insulin for every 5 grams of carb.
For dinner she plans to eat 2 cups of cooked vegetables from the nonstarchy list. Each ½ cup of cooked vegetables has approximately 5 grams of carb. Therefore, 2 cups of cooked vegetables provides 20 grams of carb.
She is supposed to take 1 unit for every 5 grams of carb consumed, so she needs 4 units of insulin for the veggies in the meal. If she doesn’t count the carbs in the veggies, she will be under-dosing by 4 units of insulin and may end up with blood-glucose levels higher than expected.
Example 2: Carter has type 1 diabetes, and his insulin-to-carb ratio is 1:20. That means he takes 1 unit of rapid-acting insulin for every 20 grams of carb.
For dinner he plans to eat ½ cup of cooked vegetables from the nonstarchy list. Each ½ cup of cooked vegetables has approximately 5 grams of carb.
With a 1:20 ratio, Carter needs only ¼ unit of insulin for the veggies, which is insignificant. An insulin pump can deliver insulin to the hundredth of a unit, but insulin syringes and insulin pens can only accurately deliver in 1-unit or ½-unit increments.
The meat and protein list
The meat and protein list includes all animal protein sources: beef, chicken, fish, lamb, pork, seafood, and turkey. Cheese has no carbs but is high in protein and fat, so it’s included on this list and not on the milk list covered earlier in this chapter. Eggs and tofu are likewise protein foods included here. Fat and calories vary depending on selections, but each ounce of meat or cheese provides about 7 grams of protein. Table 8-5 shows a few examples of lean, medium-fat, and high-fat proteins. Appendix A has a more complete list, including the calorie and fat counts.
TABLE 8-5 Meat and Protein List (No Carbs)
|
Lean |
Medium Fat |
High Fat |
|
Fish and shellfish |
Fried fish |
Bacon, sausage |
|
Skinless poultry |
Eggs |
Hot dogs, ribs |
|
Pork tenderloin |
Mozzarella cheese |
Bologna, salami |
|
Sirloin steak |
Corned beef |
Cheese |
Do your heart a favor and use the lean protein list found in Appendix A as a shopping list to pick your proteins. You may be surprised to find out that the options aren’t limited to fish and poultry.
The fat list
The fat list has both animal-based and plant-based fats:
· Animal fats tend to be solid at room temperature and are saturated fats (less heart healthy); butter is one example. Too much saturated fat in the diet can lead to blocked arteries.
· The plant-based fats that are liquid at room temperature, such as olive oil, are better for blood vessels.
All fats have the same number of calories and affect weight similarly. Each selection on the fat list in Appendix A provides 5 grams of fat and 45 calories. Other than nuts and seeds, the fat group doesn’t provide protein or an appreciable amount of carb. Nuts, seeds, and avocados are foods that are high in fat, so much so that they are listed in the fat exchange list. Table 8-6 separates fats into three categories: monounsaturated, polyunsaturated, and saturated. For more information on eating for heart health, see Chapter 16 .
TABLE 8-6 Fats List (No Carbs)
|
Monounsaturated |
Polyunsaturated |
Saturated |
|
Avocado |
Margarine |
Butter |
|
Nuts |
Mayonnaise |
Cream cheese |
|
Oils: olive, canola |
Oils: corn, soy |
Cream, sour cream |
|
Olives |
Seeds |
Lard |
A BRIEF HISTORY OF THE EXCHANGE LISTS
In years past, people with diabetes didn’t have as many management tools. The recommended diet was called a “diabetic diet” and was often handed out as a pre-printed diet sheet based on a calorie goal. The meal plans rigidly directed patients to eat a certain number of servings from the various Exchange Lists at mealtimes and snack times. For example, the lunch plan may have allotted 2 exchanges from the starch group, 1 fruit exchange, 1 milk exchange, 3 protein exchanges, and 2 fat exchanges. The snack assignment might have been 1 starch exchange plus 1 protein exchange. On the plus side, these plans encouraged eating from a variety of food groups. Also, if strictly followed, the plans controlled overall caloric intake and could be used for weight management.
However, these diet prescriptions left very little room for personal preferences or flexibility. Many people found them confusing and cumbersome, and simply gave up on them. The one-size-fits-all approach isn’t ideal. Not everyone needs or wants to eat the same thing day in and day out.
Having said that, I think the lists are still useful in many ways. The Exchange Lists can be used for carb counting and portion control. Quite a few people still use the lists to track numbers of “carb servings” instead of counting grams of carbohydrate. The math is easier. For example, you may aim for 3 or 4 carb exchanges per meal, yet mix and match as desired between the three main carb groups: starch, fruit, and milk.
Solving carb-counting conundrums in mixed dishes and ethnic foods
Food composition lists work great when you’re cooking single-ingredient foods such as rice, beans, spaghetti, or oatmeal. Just use your measuring cups and look up the carb count on the reference list.
Other foods aren’t so straightforward. Consider tamales, enchiladas, pot stickers, spring rolls, dim sum, ravioli, pizza, lasagna, and other mixed dishes, appetizers, and ethnic foods. One strategy for estimating carb counts in foods such as these involves going to a well-stocked grocery store and being a label detective. When you have some spare time, do a little research utilizing labels on packaged foods. If you’re trying to figure out the carb count on tamales, for example, look through the frozen food aisles until you find a similar packaged item. Check the food label for the serving size and the carb amount and write it down. Keep a running list of your carb-count estimations on an index card or on your phone. Some people snap a picture of the label and organize the information later.
Visit the canned goods, dry goods, and condiment aisles, too. You may be surprised to see the amount of carbohydrate in some of the Asian stir-fry sauces. Make note of the carbs in condiments, such as ketchup or barbeque sauce, and be sure to include the portion size in your notation. A swipe of ketchup on a bun is negligible, but ¼ of a cup of ketchup is a significant 15 grams of carb. (See the later section “Preparing your carbohydrate cheat sheet ” for more information on putting together your research.)
Nutrition information is also available online for many combination foods, mixed dishes, and ethnic foods. Chapter 9 provides guidance on how to harness the information on the Internet.
Calculating carbs in your favorite recipes
You can figure out how many grams of carb are in your recipes by adding up the carbs in the individual ingredients. Once you know the total grams of carb in the recipe, simply divide by the number of servings to get the carb count in one serving. Take cornbread, for example. If the list of ingredients totals 270 grams of carb and you cut the finished product into nine even pieces, then each piece of cornbread equals 30 grams of carb. 270 grams of carb divided by 9 servings equals 30 grams of carb per serving. Once you’ve calculated the carbs in your recipe, be sure to mark it on the recipe card. Note: Carb counts can be found on the Nutrition Facts labels for ingredients such as flour and sugar (see Chapter 7 for more about reading labels).
Here’s another example. The first step in counting carbs in recipes is to identify which ingredients contain carb. In this chili recipe, the carbs are found in the kidney beans; canned chopped tomatoes; canned tomato sauce; and sautéed onions, bell peppers, and celery. The ingredients that don’t have carbs are garlic, spices, oil, and vegetable broth. Adding ground beef or turkey, neither of which have any carbs, is optional. If you choose to use vegetarian soy crumbles (which are designed to replace the burger), the package will have a food label that you can review. Beans are especially high in fiber, and because fiber doesn’t digest, I subtract the fiber from the total carbs. Now let’s count carbs:
· 15-ounce can of kidney beans: 66 grams total carb minus 27 grams fiber = 39 grams carb
· 12-ounce can of chopped tomatoes: 14 grams carb
· 8-ounce can of tomato sauce: 12 grams carb
· ½ cup each of chopped raw onions and celery, and 1 cup diced raw bell pepper = 10 grams carb
The total amount of carb in the recipe is 75 grams. Divide into three bowls and each bowl has 25 grams of carb.
Preparing your carbohydrate cheat sheet
Each time you make a recipe at home, take the time to calculate the carbs in the recipe. Read labels in grocery stores on combination foods, such as lasagna, and ethnic foods, such as pot stickers (as I explain in the earlier section “Solving carb-counting conundrums in mixed dishes and ethnic foods ”). Keep a running list so you can refer to it again in the future when eating those foods. Review a few new labels each time you shop. Create a cheat sheet of sorts that contains carb counts for the foods that you tend to choose. An index card is a good place to start, as the cards are easy to tuck into a purse, a backpack, or the car’s glove compartment.
Chain restaurants are required to provide nutrition information for everything they serve. Some restaurants post the info on the wall; others mark it on the menu or may leave a chart in the menu holder on the table. If you find yourself in a restaurant where the information is posted, be a carb detective and write down the details on foods that you may be eating in the future. For example, if a fast-food restaurant says a large order of fries has 500 calories and 60 grams of carb, take note because that may be shocking enough to prevent you from ordering them! Or maybe you’ll be more likely to choose the small order, which has 230 calories and 30 grams of carb. The carb counts on fries are comparable from one place to the next. It’s the portion size that matters. (I talk more about counting carbs when dining out later in this chapter.)
All chain restaurants are required to post their nutrition information online, so you can look it up on their website. See Chapter 9 for more on that topic. If the restaurants you eat at aren’t chain restaurants, then they aren’t required to provide the nutrition information.
Sizing Up Servings with Measures and Weights
The best way to hone your ability to “guesstimate” is to train your eye by measuring precisely. Increase your carb-counting accuracy by using standardized measuring cups, and consider purchasing an inexpensive food scale for the kitchen. I discuss tips in this section.
Measuring with standardized cups and spoons
When you’re counting carbs, it’s important to use standardized measuring cups and measuring spoons. They are readily available in the kitchen supplies section of many stores. When the Exchange List says “one cup” of cantaloupe has 15 grams of carb, it doesn’t mean you can use any mug in the cupboard to measure it. It means an 8-ounce measuring cup. Glass measuring cups have lines that mark the fractions of a cup, whereas stackable cups have individual cups marked as ¼ cup, ⅓ cup, ½ cup, and 1 cup. Some sets throw in additional sizes such as ⅔ cup and ¾ cup. Liquids are most easily measured using the glass cups. The stackable cups are great for measuring dry ingredients, fruits, or cooked grains. (Increase precision on measuring certain fruits by using a food scale, as I explain in the next section.)
If you plan to eat 45 grams of carb from starches at dinner, for example, you can use a measuring cup to serve the cooked starch directly from the pan to your plate. It saves a step because you’re serving and measuring all at once. Use a knife to level off the top.
Get some practice with measuring cups so that you can eventually eyeball foods more accurately. Train yourself to be able to accurately estimate portion sizes. A glass measuring cup works well for the following exercise:
1. Measure various starches and fruits in ½-cup and 1-cup portions.
Study how those portion sizes look on a plate or in a bowl. Compare the servings to your fist or palm for reference.
2. Next test yourself by putting a serving of food on your plate without using a measuring cup and guess the amount.
3. After guessing, put the food into a measuring cup to see how well you guessed.
Practicing helps.
Another strategy is to find out how much your bowls, cups, and glasses hold. Pour measured amounts of water into the various dishes and take notice of where the water line reaches. When you use that dish in the future, you can serve directly into the dish and be better able to estimate portions and carb counts. For example, if you have a rice bowl that holds exactly one cup, you can use that bowl every time you eat rice and you’ll know how much carb you’re eating. Pick appropriate-sized dishes to help manage your portions.
Studies show that people perceive being satisfied when their plate looks full, even though they may be eating less because of a reduced-size plate. Using salad-sized plates or smaller bowls typically felt acceptable as long as the dish looked full. People in the study ended up eating less just by using smaller dishes.
Weighing in on whether to weigh foods
Food scales provide an option for increased precision when measuring foods. For example, the Exchange List says that a “small” apple has 15 grams of carb. What you consider small may not be what they consider small. That’s why in parentheses the Exchange List specifies that a small apple weighs 4 ounces. It means 4 ounces on a food scale, not 4 ounces in a measuring cup. Ounces of liquid and ounces of weight are entirely different things:
· Measuring cups measure liquid ounces. There are 16 tablespoons to 1 cup, 2 cups to 1 pint, 2 pints to 1 quart, and 4 quarts to 1 gallon.
· A food scale measures weight in grams or ounces. There are 28 grams to 1 ounce, 16 ounces to 1 pound, and 2.2 pounds to 1 kilogram.
Precision carb counting matters most when using insulin-to-carb ratios (see Chapter 6 for more about these ratios). You can use food scales to weigh fruits (if they’re not easy to measure in a cup, as I explain in the preceding section), snack foods, or a slice of bread that you cut off of an unsliced loaf. Have you ever opened a bag of pita chips that says the serving size is eight pita chips, but the chips are all broken into smaller pieces? Food labels tell you the weight of one serving. In the case of the pita chips, the serving size says eight pieces, but in parentheses to the right of the serving size, it notes that the weight of a serving is 28 grams. You can use the food scale to weigh out 28 grams, which is one ounce, to get an accurate portion of the pita chips for a precise carb count.
The following sections go into more detail on using a food scale and counting carbs with a food’s weight.
Using a food scale
If you purchase a food scale, make sure that it measures in increments of grams and ounces. Some food scales are designed for heavier items and weigh in increments of pounds. Food scales are available for less than ten dollars, but you can choose to spend more. Some versions have a dial that lines up with markings indicating the weight in grams or ounces, while others are digital. Scales have either a flat weighing surface or a bowl to contain the food. Compact travel scales are also available.
If you buy snack foods in multi-serve containers, weigh out individual portions and put the measured portions into zip-lock baggies or reusable containers. Mark the carb count on the bag with a permanent marker or write it on a label if using reusable containers.
The Exchange Lists in Appendix A note the weight next to some of the fruits. Use your food scale to compare your fruit to the reference size. For example, the list says that a small (4-ounce) apple has 15 grams of carb. It’s unlikely your apple weighs exactly 4 ounces. Most don’t. If your fruit weighs 6, 7, 8, or 9 ounces, then you’re looking at doing some math, which can get tedious. To simplify, I’ve created a list of common foods that shows the carb count “per ounce” of the food. See the next section for more on that.
Counting carbs with a food’s weight
Table 8-7 is useful because it’s designed for you to weigh the fruit with the peel on. Weigh the entire fruit. Don’t cut, core, or peel it until after it has been weighed. The inedible waste has been factored in, and the math has been adjusted to account for the part of the fruit that isn’t consumed. Fiber grams have already been subtracted from the total carbs.
TABLE 8-7 Grams of Carb per Ounce of Food
|
Fruits |
Grams of Carb per Ounce of Fruit (Skin On) |
Starchy Foods |
Grams of Carb per Ounce of Food |
|
Apple |
2.9 |
Dinner roll |
14.0 |
|
Apricots |
2.5 |
Kaiser roll |
14.2 |
|
Banana |
3.7 |
French baguette |
14.5 |
|
Cantaloupe |
1.3 |
Croissant |
12.1 |
|
Cherries |
3.6 |
Whole-wheat bread |
13.0 |
|
Figs, fresh |
4.6 |
Cornbread |
12.3 |
|
Grapefruit |
1.0 |
Challah bread |
14.0 |
|
Grapes |
4.8 |
Baked sweet potato |
5.0 |
|
Honeydew melon |
1.2 |
Baked russet potato |
5.4 |
|
Kiwi |
2.5 |
French fries |
7.0 |
|
Mango |
2.8 |
Sweet potato fries |
7.3 |
|
Nectarine |
2.3 |
Corn on the cob |
5.6 |
|
Orange |
2.0 |
Potato chips |
15.0 |
|
Papaya |
1.5 |
Oyster crackers |
20.3 |
|
Peach |
2.3 |
Tortilla chips |
18.0 |
|
Pear |
3.2 |
Pita chips |
19.0 |
|
Plum |
2.6 |
Pretzels |
22.0 |
|
Tangerines |
2.4 |
Angel food cake |
16.0 |
|
Watermelon |
2.0 |
Biscotti, almond |
17.0 |
The benefit of using this particular list is that you can weigh all of the bananas in the bunch, one at a time, and get the carb counts figured out in advance. Use a pen to write the carb count in small numbers directly on the peel. Then, a day or two later when you have another banana, the carb counting has already been done. Write on the peel of the orange too. For apples or other fruits that have a sticker, write on the sticker. Office supply stores sell stickers that can be used to mark carb counts.
To use Table 8-7 , locate the fruit or starchy food that you want to weigh. The number listed directly to the right of the food indicates the amount of carbohydrate contained in 1 ounce of that food.
Note: Carb content of foods may vary. Data in Table 8-7 was obtained cross-referencing and averaging information from the following two websites:
· Calorie King: www.calorieking.com
· USDA National Nutrient Database: https://ndb.nal.usda.gov/ndb/foods
So what kind of calculations do you need to make with this table? Using a food scale, weigh the food (for an entire fruit, include the peel, core, pit, and rind). Be sure to measure in ounces, and multiply the ounces by the number in the next column of the table. For example:
· For an orange that weighs 10 ounces, multiply 10 by 2 for a total of 20 grams of carb.
· For an apple that weighs 8 ounces, multiply 8 by 2.9 for a total of 23.2 grams of carb (you can round down to 23).
· For a baked sweet potato that weighs 3 ounces, multiply 3 by 5 for a total of 15 grams of carb.
Fruits come in a wide range of sizes. Weighing fruit allows for a more accurate carb count. You don’t have to weigh every fruit from here on out, but by going through the motions and weighing periodically, you refine your ability to guess correctly. After weighing a few oranges, you’ll get pretty good at guessing the carb counts in the future.
Weighing food is something that a family member, friend, or roommate can do for the person with diabetes. Pre-weighing and marking carb counts saves time in the long run, and everyone learns to estimate carbs more accurately. When kids with diabetes repeatedly see the carb counts on foods, they learn to estimate better themselves.
Dealing with Special Cases
This section provides guidance on managing carbs when you’re dining away from home. Some restaurants, primarily chain establishments, provide nutrition information and carb counts either in the restaurant or on a website. Chapter 9 provides details on how to zero in on resources that assist with quantifying carbs. Use your carb-counting cheat sheet too, as I discuss earlier in this chapter.
Controlling carb intake when eating out
Getting down to the nitty-gritty of carb counting in a restaurant may be a bit tougher because most of us aren’t going to whip out our handy-dandy measuring cups. Using measuring cups at home improves your ability to recognize serving sizes when you’re out, as I explain in the earlier section “Measuring with standardized cups and spoons .” The hand method of portioning is also useful and discussed in more detail later in this chapter. An average woman’s tightly clenched fist is about 1 cup.
Here are some additional pointers for watching your carbs when you eat out:
· Some restaurants serve big portions, which makes it easy to overeat. Ask for a to-go container as soon as the food is served. The best time to pack your leftovers is before you even take your first bite. Leave an appropriate amount on your plate to savor, but pack the rest and take it home to enjoy for tomorrow’s lunch.
· Start your meal with a green salad and order an extra side of vegetables to accompany your entrée if you want a larger volume of food. Salad and vegetables are usually lower in calories and carbs than most other selections; just go light on the salad dressing.
· Another strategy for controlling intake in restaurants is to share an entrée. You can also create your own meal from a combination of smaller appetizers and side dishes.
· Desserts in restaurants can be deceptively high in carbs and best to avoid. A couple forkfuls of a shared dessert may be the second-best approach.
One key to controlling carbs and calories is to choose the small-sized offerings. Over the years portions have grown, and so have our collective waistlines. Does anyone remember when a soda was in a 6.5-ounce bottle? That same soda is now sold in a 20-ounce bottle. Movie theaters and convenience stores sell buckets of soda with refills. Portion distortion is plaguing the United States. Years ago an order of fries was 210 calories. Today’s large order is more than 600 calories. A small hamburger is close to 300 calories, but deluxe versions range from 600 to more than 1,000 calories.
If you typically inject insulin at mealtime, be sure to bring your insulin with you when going out to a restaurant to eat. Rapid-acting insulins such as Humalog, NovoLog, and Apidra are commonly used to cover the carbs at mealtime, and they are designed to be injected within a few minutes of the meal. Follow your doctor’s advice on when to inject. If you have been told to take your insulin 5 to 15 minutes before the meal, then you need to do that with restaurant meals as well. If you take “regular” insulin, then the typical timing is to inject it 30 minutes before the meal. Do not take your injection at home and then drive to the restaurant. If you take your insulin earlier than you should, you stand the risk of having your blood glucose drop too low. What if there is traffic, or you get to the restaurant and there is a waiting list to be seated, or someone bumps the plate out of the waiter’s hand as he is delivering your meal? There are no guarantees, so wait to inject your rapid-acting insulin until the food is in front of you. Regular insulin is supposed to be injected 30 minutes prior to eating, which means making your best guess on injection timing when it comes to restaurant meals. Be sure to have carbohydrate foods handy in case the meal you ordered is delayed. Flip to Chapter 6 for more information on timing insulin.
Keeping track of the carbs you drink
For the most part, eating your carbs is better than drinking them. There are a few exceptions. For example, milk is a nutritious beverage and can be consumed without derailing your blood-glucose control.
Just keep in mind that liquids are rapidly digested and absorbed, so liquid carbs get into the bloodstream quickly. Sugar-sweetened beverages should be avoided. Keep a cautious eye on juice too. Juice isn’t necessarily the best way to start your day if you have diabetes.
For more information on best-bet beverages, see Chapter 11 .
Guesstimating: When Carb Counts Aren’t Critical
For many people with type 2 diabetes, blood-glucose levels can be controlled with simpler portioning guidelines. Certainly carb counting is an option, but it may not be necessary. If you want to keep things simple or if you don’t like math, charts, and measuring, then the two options covered in the following sections are great alternatives to carb counting. Manage portions and plan a balanced meal with the plate model. You can also learn to use your own hand as a measuring device with the hand method.
Type 2 diabetes means your insulin is having a hard time helping you to properly use the glucose from the foods you eat. The more you eat at one time, the harder it is to control blood-glucose levels. The first step is to distribute food among three main meals, with optional snacks if needed. Keep the snack portions controlled. See Chapters 19 , 20 , and 21 for main meal menu ideas and Chapter 22 for tips on reasonable snacks.
Balancing your plate with the plate model
Policy makers and health experts try to guide Americans to eat healthier. For many years the Food Pyramid was used to guide nutrition, but now the pyramid has been replaced with the Choose MyPlate image. The plate image is visually simple to understand. The idea is to choose from a variety of food groups and to control portion sizes. Simply fill your plate in the manner shown in Figure 8-1 . Imagine a line down the middle of your plate. Half the plate goes to grains and proteins with a little over one-fourth of the plate going to starch and the remainder allotted to protein. The other half of the plate is for fruits and vegetables, with the vegetable portion a little bit bigger than the fruit portion. A serving of milk is included if desired. (If you aren’t a milk drinker, see Chapter 11 for tips on best-bet beverages.)
Source: U.S. Department of Agriculture
FIGURE 8-1: The Choose MyPlate image created by the U.S. Department of Agriculture.
ChooseMyPlate.gov is a great place to find information on how to choose healthy options within each food group. You can find tips geared specifically to preschoolers, school-aged children, teens, college-aged students, adults, and for pregnancy. The educational materials and online tools are well worth exploring.
When using the MyPlate method to manage portions with diabetes, use vegetables from the nonstarchy vegetable list to fill the “vegetable” section. The starchy vegetables and legumes should be counted in the grains group because they are similar in carb composition.
It is fine to modify your plate to include even more vegetables than the Choose MyPlate model encourages. See Figure 8-2 for a meal-planning alternative that allows for more vegetables. Feel free to fill half of your plate with nonstarchy vegetables and add a leafy green salad if desired. When learning to cut back on other foods, salads and vegetables are the perfect foods to fill the void. Fruit can be consumed with the meal or as a between-meal snack. Use the Exchange Lists in Appendix A to identify fruit portions that are equal to 15 grams of carb. Fruit served at the end of the meal may satisfy your sweet tooth and make it easier to skip dessert. A little whipped topping over berries feels decadent but doesn’t add that many extra calories, carbs, or fat.
© John Wiley & Sons, Inc.
FIGURE 8-2: High-vegetable meal plan.
Handling portions with the hand model
Portion control is literally at your fingertips. If you want to keep things simple, you can use your own hands to visually guide serving sizes. Hands are certainly convenient, as you never leave home without them!
· Cooked starches: Serve the size of your tightly clenched fist.
· Protein: Serve the size and thickness of the palm of your hand.
· Vegetables: Serve enough to fill your two cupped hands.
· Fruit: Serve the size of your tightly clenched fist.
· Fat: Limit serving to the size of your thumb.