Are Carbs The Enemy?


When it comes to diabetes, there may be no topic more fraught with controversy than carbohydrates. Sure, everyone agrees that the body uses carbs for energy in the form of glucose. But how much carbohydrate should people with diabetes really eat?
That question has divided researchers, doctors, dietitians—and people with diabetes themselves. Some insulin users in particular find that their blood glucose is far easier to control when they limit the carbs in their diet. Others think people with diabetes deserve to eat (and enjoy) the same healthy diet recommended for all Americans. All are deeply passionate on the subject. And, in a sense, they may all be right.

Today, most people with diabetes are encouraged to eat a balanced diet of lean meats and dairy, whole grains, healthy fats, and fruits and vegetables. This concept is backed by the American Diabetes Association (ADA) as well as the American Heart Association and American Dietetic Association, and it incorporates recommendations from agencies like the Department of Agriculture and the Department of Health and Human Services. While the ADA does not specify exact grams or percentages of calories from carbohydrate, the approach is generally moderate in carbs. According to Marion J. Franz, MS, RD, CDE, a registered dietitian and nutrition/health consultant in Minneapolis, studies have shown that people with diabetes generally get about 40 to 45 percent of their calories from carbs.

The moderate-carb approach stresses that grains should come in the form of whole grains instead of refined grains (like white flour), which have been stripped of important vitamins and minerals. Research has shown that eating a moderate-carb, high-fiber diet (like one that includes whole grains) may improve post-meal glucose levels and lower the risk for cardiovascular disease.

Indeed, a lot of those newly diagnosed with diabetes are happy to find out that they can still have most of their favorite foods, in moderation—as long as they lower their blood glucose with medication and exercise. (People who control their diabetes without medication or who take oral drugs will need to watch how carbs affect their glucose levels and then work with their doctor to determine the right number of carbs and amount of medication needed to stay in good glucose control.) Gone are the days of “diabetic diets” that were meager and confining. Today, the idea is that people with diabetes can eat everything recommended to those without the disease. “If we look at what’s important for all of us,” says Franz, “it’s important to eat healthy foods in the right portion sizes.”

People with diabetes looking for a one-size-fits-all “right” way to eat are going to come up short. There probably is no one way to eat that works for everyone. For some, all but nixing carbs is the ideal way to normalize blood glucose levels. For others, eating a higher-carb diet and covering the carbs with insulin or oral medications wins. This is all part of the reason that the American Diabetes Association stresses that meal plans should be geared to fit each person’s individual lifestyle.

So what should you do if you have diabetes and you’re trying to eat healthfully? First of all, keep in mind that what works for someone else may not necessarily work for you—and vice versa. You may need to experiment a bit to see how different methods affect your blood glucose levels. Consider making an appointment with a registered dietitian, who can review your individual needs and circumstances and help you tailor a nutrition plan that’s right for you. In the end, the best diet is the healthy one you’re able to follow.

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