If you are diabetic, you have probably already heard, at the very least, that you need to limit or avoid starchy carbohydrates, especially the “white” things, like white rice, white bread, pasta and potatoes. The traditional approach to diabetes care relies on a balanced diet that includes a limited amount of carbohydrates (about 250 grams a day, as explained below).
There is an entirely different school of thought that suggests drastically limiting carbohydrates and replacing those foods primarily with healthy fats, and even some that are saturated. Several studies have documented very significant blood glucose reductions and even a reduced need for medications for Type 2 diabetes with a so-called “LCHF” (low carb high fat) approach. This approach has some similarities to a very strict Keto diet.
We include links to a number of resources on our Resources page, including LCHF resources. We are not here to tell you which approach is best for you. We try to limit our use of grains, and avoid starchy/refined carbs, and we will tag our recipes that are Keto friendly. This and other nutritional issues on which the professional community appears divided will be the subject of future blog posts.
Whatever treatment you embrace, it is clear that the typical Western diet relies too much on starchy/refined carbs and too little on the many green, orange and red vegetables that nourish our bodies and enrich our choices. How many restaurants have you been to where the only food outside of meats, breads and potatoes is Cole slaw?
Sometimes it is a lot easier to follow instructions when you know what is actually going on with a substance in your body. We all know we should eat better and exercise more, but once you know what the things you consume are doing inside your body, how they produce energy and what happens if the energy is not used as motion, it becomes easier to try to change things.
First, a quick lesson on terminology: not all carbohydrates are starchy or harmful ones. In fact, our energy is supplied by just three food substances: protein, carbohydrates and fats. Virtually all fruits and vegetables are in the category of carbohydrates (an example of a slight exception would be that avocados contain monounsaturated fats, widely viewed as healthy). So, to say that you want to avoid carbs is probably incorrect; in many cases, people mean that they want to avoid starchy and refined, simple carbs.
The world of carbohydrates can be divided two ways; carbs can be simple or complex, and they can be refined or unrefined.
Simple or complex refers to the molecular structure of the food.
- Simple carbs: these digest quickly and are found in sugar and honey, as well as occurring naturally in some products like fruits and some dairy products. They are quickly absorbed into the blood, because they are small molecules, so they raise blood sugar and provide quick energy. When simple carbs are not used by the body as energy, they are converted into fat. Simple carbs include both healthy foods (like fruits and vegetables) and unhealthy ones, like pastries, candy and sweetened drinks. The important thing is what happens to the carbs as they are digested: fruits and vegetables contain fiber that slows down the digestion process. The impact of fruits and vegetables on your body is more like that of complex carbs.
- Complex carbs: these take longer to digest, because they are larger molecules. The body has to break them down into simple carbs before they can enter the bloodstream, so they digest more slowly and do not spike blood sugar as much. That also means a longer-acting source of energy. Complex carbs include whole grains, legumes (beans, lentils), potatoes and corn.
There are foods in both the simple and complex categories that can be considered healthy (depending on the approach to diabetes treatment). This makes it important to consider a different distinction, refined or unrefined carbs. Refining refers to what has been done to it before it gets to your plate.
- I Refined means the food has been highly processed, stripping away fiber and bran. This results in the body processing the food much more quickly. A complex carb can function in the body like a simple carb as a result of heavy processing. The list of examples of foods that are refined runs the gamut of common convenience foods, including sugars in many forms, most junk foods and snack products, cookies, cakes, pancakes, pizza, instant cereal, crackers, etc.
- Unrefined means the carbohydrate has been left in its natural state, regaining the bran and germ of the natural grain. When the carbohydrate is a grain, these are also referred to as whole grains. They contain fiber, vitamins and minerals that would be stripped out by processing. Fiber slows the digestion process and, as we saw with complex carbs, slower digestion means a longer, steadier source of energy (and less spiking of blood sugar). Note that grains, as well as certain root vegetables still raise blood sugar and are prohibited in a strict LCHF treatment approach.
One of the more traditional ways of managing food as a diabetic is carb counting. For diabetic patients eating about 2,000 calories per day, a suggested carb intake (according to the ADA) might be 250 grams of complex carbohydrates, or about 45-60 per meal plus a couple of snacks at 30-50 grams. LCHF proponents criticize this as too high, and suggest that it fails to address the root cause of high blood sugar, which is a key characteristic of Type 2 diabetes.
Another traditional way of managing carbs is the “plate method” in which you think of your plate as having four quarters, and limit your starchy carbs to ¼ of the plate. Another quarter would contain protein, with the remaining half being nonstarchy vegetables.
The LCHF approach limits carbohydrates significantly (I.e.,to 50 or even 30 grams per day), replacing the missing carbs with healthy fats, protein and even intermittent fasting
Foods that are high in refined carbohydrates are a health threat to both diabetic and heart patients. Diabetic patients are usually warned to avoid them because of their tendency to spike blood sugar. Emerging research suggests that refined carbs may be even more harmful to heart health than saturated fat. In an effort to promote low fat diets, traditional advice for heart patients has sometimes ignored the impact of refined carbohydrates. And LCHF proponents argue that the traditional approaches to Type 2 diabetes treatment do little to actually reduce blood glucose, particularly without medication. What is a patient to do?
- Talk to your doctor about his or her recommended limits for starches, like potatoes, white rice and pasta. At the very least, your new strategies can minimize the impact of these in your daily life.
- Expand your resources to include more information on the LCHF approach to Type 2 diabetes.
- If you do choose to include bread or pasta in your meal, use whole grain and high fiber products.
- If you include potatoes in a meal, choose dishes and recipes that allow you to minimize sodium and saturated fat, and avoid potatoes in highly processed forms.
- As much as possible, eliminate junk food and refined carbs from your daily routine. If you focus on very healthy core meals and healthy snacks, the temptation to indulge in junk will be reduced.