Carbohydrates: Quality vs. Quantity
by Chelsea Johns RD,LDN
Picture this scenario:
Anne, a patient with type 2 diabetes, comes into your office
Monday morning for a follow up appointment. She is currently managing her
diabetes through lifestyle changes and her personal health goals include
lowering her A1c and managing her weight. When you ask her how she’s doing, she
says that she has been counting her carbohydrates, but feels frustrated. She
has followed the individualized carbohydrate counting guidelines you provided,
reading labels and measuring portions at each meal, but has still been
experiencing blood sugar readings in the 200’s after each meal. She also states
that she hasn’t seen any change in her weight, despite her reduction in
carbohydrate intake.
While Anne explains her frustration, you wonder to yourself,
“Why isn’t the plan working for her?” Upon further examination of her current
eating plan, you find that while she is keeping her carbohydrate portions to
the size you discussed, she gets most of her carbohydrates from the following
sources: a Toaster Strudel for breakfast, potato chips with lunch, white pasta
at dinner, and ½ cup of ice cream as a snack in the evening.
As you can see, Anne’s problem of post-meal hyperglycemia
and unsuccessful weight management isn’t caused by large carbohydrate portions,
but rather the quality of the carbohydrates that she is eating. The American
Diabetes Association (ADA) 2014 Standard of Medical Care in Diabetes states
that there is not an ideal percent of calories from carbohydrates, protein, and
fat. While monitoring carbohydrate intake is important, the ADA states that it
is crucial to focus not only on carbohydrate quantity, but also on quality.
Think about it: 45 grams of carbohydrates from a meal
including salmon, sweet potato, and a salad is not the same as 45 grams from a
meal of 2 glazed Krispy Kreme donuts. While this may seem like common sense to
us, sometimes it may not be as evident to our patients.
Encouraging patients like Anne to substitute the
nutrient-poor sources of carbohydrates for more nutrient-dense sources such as vegetables,
fruit, whole grains, legumes, and dairy may help prevent post-meal
hyperglycemia, aid weight management, and prevent future complications.
Here are some practical ways that patients can increase the
nutrient density of their meals:
- Instead of flavored yogurt, choose plain yogurt
and add fresh or frozen berries
- Instead of potato chips, choose carrots and celery sticks with hummus
- Instead of white pasta, choose roasted spaghetti squash
- Instead of sugary cereals, choose steel-cut oats
Resources:
American Diabetes Association. Standards of Medical Care in
Diabetes-2014. Diabetes Care. 2014;
37(1): S14-S80.
Did you miss Chelsea’s television début? Please follow the link:
http://www.frequency.com/video/did-you-miss-chelsea-johns-on-good-day/154975216/-/5-12384