The Great Carbohydrate Debate

For quite some time carbohydrates (otherwise known as carbs) have been largely debated. What are good carbs? What are bad carbs? How much carbs do we need? The debate stems even further when you are dealing with diabetes. When it comes to carbohydrates you’ve probably heard it all. Carbs are good, carbs are bad, eat complex carbs, avoid simple carbs, eat more whole grains, eat low glycemic carbs, or eat a low carb diet. So what is more important when it comes to carbohydrates, quality or quantity?

 

For many years, if you had diabetes the focus was on counting your carbs and likely cutting back in order to achieve good blood sugar control. We know that carbohydrates are what contribute most to the rise in blood sugar levels after meals. So it makes sense to think that cutting your carb intake will lower your blood sugar levels. This theory of eating less carbs is even further promoted with the promise of quick weight loss and even reversal of diabetes by some healthcare professionals and self proclaimed “nutrition experts”. It’s no wonder why this topic is so heavily debated and therefore becoming more and more confusing. The good news: research tells us otherwise.

 

There have been numerous studies over that last decade on people with both type 1 and type 2 diabetes evaluating the effects of very low carb to moderate carb to high carb diets. The American Diabetes Association recently reviewed these studies through a systematic review process. What they found was that for people with diabetes, whether or not they followed a low carb diet (30-40% of total calories) or a high carb diet (over 65% of total calories), they were still able to improve their A1C (average blood glucose control) as well as improve their risk of heart disease. What they reveal is that it’s not just the carbs that matter. Other factors such as weight loss and other components of the diet such as amount and type of fats come into play as well.

 

Both high and low carb diets are difficult to sustain for most people and, let’s face it, it’s difficult for anyone to make any dramatic changes in their eating habits. For a person with type 2 diabetes, we know that even just a modest amount of weight loss (7% of total body weight) will significantly improve insulin resistance and therefore improve blood sugar levels.

Achieving a modest amount of weight loss through eating fewer calories and getting regular physical activity is more important than the amount of carbohydrates a person with diabetes consumes. Research also tells us that we need to focus more on improving lipid levels (specifically LDL cholesterol), blood pressure, and weight control as lipid and blood pressure control can reduce the risk of cardiovascular disease by 20-50% in a person with diabetes. This control is achieved through weight loss and healthy eating. Therefore when it comes to carbs, the answer is quality over quantity.

The problem with many of our carbohydrate choices today is that they are very nutrient poor: lacking in many important vitamins, minerals, and fiber. We are consuming too much added sugars and not enough fruits, vegetables, whole grains, and fiber. We have heard this all before.

 

So now let’s look at the current recommendations. The 2010 Dietary Guidelines recommend that 45-65% of one’s total calories should come from carbohydrates. This recommendation is to ensure that we meet our bodies’ needs for those vitamins, minerals, and fiber that our current intake is lacking. The recommendation for fiber is 25 grams per day which a very small percentage of people actually meet. It’s also important to note that it is very hard to meet this recommendation when a person follows a low carb eating pattern. The American Diabetes Association does not recommend one specific mix of macronutrients (carbs, protein, and fat) or amount of carbohydrates that everyone with diabetes should follow. Their position is that each person with diabetes should follow an individualized eating plan.

 

Basically, there is not one specific type of “diet” or way of eating to best control your diabetes. Instead switch your focus on healthy eating overall through better carbohydrate choices, increased intake of fruits and vegetables, lean meats, low fat dairy, and healthy fats for improved overall health. Find out what works best for you and your lifestyle. In conclusion, blood sugar control is not the only goal for a person with diabetes. There is no benefit in achieving good blood sugar control in lieu of healthy eating and it’s not just about the carbs.

 © By: Alyssa Werner MS, RD, LD, CDE

 

References:

 

American Diabetes Association. Nutrition Recommendations and Interventions for Diabetes. A position statement of the American Diabetes Association. Diabetes Care. 2008; 31:S61-S77.

 

American Diabetes Association. Standards of Medical Care in Diabetes-2012. Diabetes Care.2012; 35:S11-S25.

 

Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

 

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans 2010. 7th Edition, Washington DC: U.S. Government Printing Office, December 2010.

 

Wheeler et al. Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes: A Systematic Review of the Literature, 2010. Diabetes Care. 2012; 35:434-445.

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