Sugar limit for diabetics

Contents

Let’s Talk About How Much Sugar You Eat & Prediabetes

I know you get it. Cut down on sugar. Then, you won’t be obese and get diabetes. But do you know how much sugar you are eating? When I have clients come in for nutrition consultations, they are always shocked by how much more sugar they are eating than they should. Let’s review the numbers and tips on how to make sure your sugar intake is sweet, not bittersweet.

National surveys have found that the average American consumes around 85 grams of sugar every day. According to the new USDA guidelines, we should really be eating a fraction of that amount. The recommended sugar intake for adult women is 22 grams of sugar per day, for adult men, it’s 36 grams daily, and for children, it’s 12 grams a day.

Over time, consistently taking in more sugar will lead to insulin resistance disease, otherwise known as diabetes. What’s alarming is that many people do not realize they are on the road to diabetes. This epidemic of “on the way to diabetes” is called prediabetes. Type 2 diabetes doesn’t appear all of a sudden and the slow, long and invisible road there is prediabetes, which is where blood sugar levels are consistently higher than normal over a long time slowly affecting insulin signaling.

Many people focus on calories rather than sugar since diabetics are supposed to look at sugar not you and me. But unfortunately, a new report from the Center for Disease Control and Prevention shows that among Americans age 20 and older, as many as 73 million Americans have prediabetes, which is about 1 in 3 Americans! That’s a lot of missed opportunities to prevent diabetes by cutting down on sugar intake.

You can check with your doctor if you have prediabetes, which is a fasting glucose level of 100-125 mg/dL. Being prediabetic is a serious game changer since it is much easier to prevent diabetes than to reverse it and the prediabetic point is the last chance one has to make significant lifestyle changes. However, we all know cutting down one’s sugar intake is not easy especially given a recent article in the British Medical Journal, which described sugar “as dangerous as tobacco”, with its ability to produce morphine-like chemicals in the brain that produce a natural high, making it very hard for us to resist. Nonetheless, it is possible to create habits that can keep prediabetes and diabetes far from your timeline. Just like it’s a slow road to get diabetes, there’s also another slow but steady road you can choose which is taking small steps in reducing your sugar intake with these tips:

1) Eliminate all sugary beverages. Beverages are particularly harmful since they are high-glycemic and generally empty calories. Eliminating sugary beverages is especially important if you are over the age of 40, which is a time to get serious about sugar intake.

2) Don’t go “natural” sugar crazy. Note fruit, honey and other natural sugars are still sugars and can contribute to diabetes if eaten in excess. Both natural sugars and processed sugars are all broken down to glucose in the body. Once glucose is in the blood, it stimulates insulin, which can contribute to diabetes in excess.

3) Walk! Nothing gets sugar out of the blood quicker than using it for energy through physical activity. A brief 20-minute walk can help stabilize blood sugar levels.

4) Avoid fast and processed food. Fast and processed food manufacturers add sugar to encourage you to want more. About three-four teaspoons of sugar is added to processed food.

5) Pick low or no sugar options. Everything you love and crave such as cereal, yogurt, popcorn, has a brand or version with less sugar so be aware of and opt for those. For example) whole grain cereal, non-flavored yogurt, plain popcorn.

I Tried to Eat Only 25 Grams of Sugar a Day, Here’s What I Learned

Sugar is so delicious, isn’t it? I mean, not straight up or anything, but mixed into things, like chocolate chips and chocolate cake and chocolate bars and…well, I guess you can tell I like chocolate.

It’s not just in things like baked goods and candy, though, it’s in tons of beverages, coffee drinks, tomato sauces, ketchup, yogurt, salad dressings, and more.

How much sugar should you eat per day?

In recent years the recommendation for total grams of added sugar had been lowered; the World Health Organization used to say that no more than 10% of your daily calories should come from it, and then they lowered it down to 5%. For most women, that means about 25 grams of sugar per day, which equals 6 teaspoons. (Guys get about 9 teaspoons. Lucky.)

Although I’m actually a big fan of fruits and veggies and whole grains and all that jazz, I do love me some baked goods. However, I am not a soda-drinker, and I don’t eat sweetened yogurts, so I thought keeping my intake to 25 grams or less per day would be pretty easy.

It wasn’t.

Tips to reduce the amount of sugar you eat daily

I don’t want to mislead you—it wasn’t torture and it wasn’t impossible, but it was a real challenge and I had to be super conscious of my choices all the time, which was honestly quite annoying. I did achieve my goal on most days, but certainly not all of them. If you’d like to keep your sugar intake low, too, here’s what I learned:

Never drink sweetened beverages

You probably already know this, but they add so many calories to your diet and, of course, to your sugar intake.

Watch out for condiments

I don’t eat ketchup all that often, but if I make home fries or sweet potato rounds, I like to dip them in ketchup, and the sugar in that little delicious red blob adds up quickly. It’s easy to think you’re just squirting out a serving when really you’ve got three or four on there. Which is why you should.

Measure everything

Let’s talk about maple syrup. I’m a New England girl, so we only buy the real stuff, and I freaking love it. However, I know it’s all sugar, and if I pour it on my waffle or pancake I’ll use way too much. Even if I put it in a dipping container to control my portion, if I don’t measure, it’s almost certain I’ll overestimate how much I’m about to consume. If you really want to stick to a limit, measuring will have to be part of your life.

Learn to love dark chocolate

One of the things that helped get me through the month with my sanity intact was 85% dark chocolate bars by Lindt. I know that’s too strong for some people, but a one-ounce serving only has 2.5 grams of sugar. Which means I can eat 10 oz of chocolate a day, right? Right?

Either give up baked goods or make your own low or lower sugar versions

It stinks, but you can’t just go to a restaurant or store and buy a brownie and eat it all, because it probably has well over your total daily limit for sugar. Boom! Over the limit in one snack. The best way to avoid this is to just give up baked goods except for really special occasions, but another option is to start baking your own stuff. Honestly, many recipes still taste good with 1/3 less sugar than the recipe calls for; you can also try sweetening with applesauce, dates, or a sugar substitute like Stevia.

Since the month ended I admit I haven’t been counting my sugar grams, and I’ve probably gone over on multiple occasions. However, just writing this article makes me realize I need to get back into gear and keep an eye on my sugar intake, so maybe reading this article will do the same for you.

How Much Is Too Much?

The growing concern over too much added sugar in our diets

For most people, experts agree that some added sugar in the diet is fine. But the truth is, most Americans are consuming way too much — on average, nearly 57 pounds of added sugar per person, every year. This could be affecting us in ways that make us prone to craving more sugar and to obesity.

How much is okay?

Expert panels worldwide have made consistent recommendations on daily sugar intake. The American Heart Association (AHA) recommends no more than 6 teaspoons (25 grams) of added sugar per day for women and 9 teaspoons (38 grams) for men.1 The AHA limits for children vary depending on their age and caloric needs, but range between 3-6 teaspoons (12 – 25 grams) per day.

That is in line with the World Health Organization’s (WHO) recommendation that no more than 10% of an adult’s calories – and ideally less than 5% – should come from added sugar or from natural sugars in honey, syrups and fruit juice. For a 2,000-calorie diet, 5% would be 25 grams.

Limit daily sugar to 6 tsps (25 g) for women, 9 tsps (38 g) for men.

Yet, the average American consumes 17 teaspoons (71.14 grams) every day.2 That translates into about 57 pounds of added sugar consumed each year, per person.3

Children and teens are particularly at risk. The U.S. Dietary Guidelines for Americans recommend limiting total intake of discretionary calories, including both added sugars and fats, to 5% –15% per day. Yet children and adolescents in America obtain about 16% of their total caloric intake from added sugars alone.4

Sugar leaves us craving more

It’s easy to exceed those limits. With as many as 11 teaspoons (46.2 grams) of added sugar in one 12 oz. soda, a single serving is close to double most people’s daily sugar allowance.5 But sugar also is pervasive in our food supply. A leading brand of yogurt, for example, has 7 teaspoons (29 grams) of total sugars in a single serving, most of it added.

The sugar in one 12-oz soda is as much as in 1 orange + 16 strawberries + 2 plums.

Research also shows that, for some people, eating sugar produces characteristics of craving and withdrawal, along with chemical changes in the brain’s reward center, the limbic region.

Using brain-scanning technology, scientists at the U.S. National Institute on Drug Abuse were among the first to show that sugar causes changes in peoples’ brains similar to those in people addicted to drugs such as cocaine and alcohol.6,7 These changes are linked to a heightened craving for more sugar.8 This important evidence has set off a flood of research on the potentially addictive properties of sugar.9

Natural changes lead to weight gain

Consuming too much added sugar over long periods of time also can affect the natural balance of hormones that drive critical functions in the body. Eating sugar increases levels of glucose in the bloodstream, which leads the pancreas to release insulin. Higher levels of insulin, in turn, cause the body to store more food calories as fat.

Insulin also affects a hormone called leptin, which is our natural appetite suppressant that tells our brains we are full and can stop eating. Imbalanced insulin levels, along with high consumption of certain sugars, such as fructose, has been linked to a condition called leptin resistance,10 in which the brain no longer “hears” the message to stop eating, thus promoting weight gain and obesity.

Leptin resistance enabled our ancestors to survive long periods of limited food supply by encouraging them to overeat during times of plenty and enabling them to conserve more calories as fat. In the modern world, that’s not a benefit. To make matters worse, people with leptin resistance also tend to feel sluggish, making it difficult to be active and contributing to further weight gain.

World Health Organization

The World Health Organization (WHO) is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends. Website: http://www.who.int

SugarScience Glossary

Added sugar

Any sugar added in preparation of foods, either at the table, in the kitchen or in the processing plant. This may include sucrose, high fructose corn syrup and others.

SugarScience Glossary

Fruit juice

This is a drink that is made entirely (100%) from the liquid which comes from squeezing or grinding up the part of the fruit we would normally eat. Sugar is not added to this drink. The drink will have the sugars that come from the food itself. The juice will likely have less fiber than the fruit. Fiber serves to decrease the speed and amount of sugars absorbed from sugary foods.

SugarScience Glossary

Sugars

Sugars are chemicals made of carbon, hydrogen, and oxygen found which taste sweet and are found in food. They are an important part of what we eat and drink and of our bodies. On this site, sugar is used to mean simple sugars (monosaccharides) like fructose or glucose, and disaccharides like table sugar (sucrose). Sucrose is two simple sugars stuck together for example (see Table sugar). Sugars are a type of carbohydrate. Carbohydrates are energy sources for our bodies Sugars enter the blood stream very quickly after being eaten.

SugarScience Glossary

Glucose

Glucose is a sugar we eat. It is found in starch. It is the main fuel for our bodies. It is the sugar measured when we have a blood test to measure the blood sugar.

SugarScience Glossary

Pancreas

The pancreas is an internal organ that helps us digest our food by making insulin and other chemicals.

SugarScience Glossary

Fat

One of the three major groups of nutrients we eat. Much of this website is related to problems associated with too much fat storage in the body. Each gram of fat produces 9 calories of energy if burned by the body as fuel. Fat can be stored in many places in the body. We generally think of fat as under the skin (subcutaneous), but the fat that may be most damaging to us is the fat stored in the liver and around the organs of the abdomen (intrahepatic and visceral or abdominal or intra-abdominal)

SugarScience Glossary

Fructose

A sugar that we eat. Also called fruit sugar. Most fructose comes in sucrose (table sugar, cane sugar, beet sugar), or from high-fructose corn syrup.

SugarScience Glossary

Insulin

Insulin is a messenger released from the pancreas after eating, which shunts energy (glucose or triglycerides) from the blood into fat cells for storage. Insulin is given to some people with diabetes to lower the blood glucose; it leaves the blood and enters the fat cell for storage.

SugarScience Glossary

Hormone

A chemical created by the body and released into the blood stream. Upon reaching another part of the body or organ, a hormone effects the function of that bodily part or organ.

SugarScience Glossary

Leptin

A hormone produced mostly in fat cells in response to eating and to how much energy is stored in the body. It effects the brain and tells us we have eaten enough and to stop eating.

SugarScience Glossary

Recommended sugar intake: How much should you have per day?

People can reduce their intake of added sugar by:

Avoiding liquid sugar

Share on PinterestJuices and smoothies can be high in sugar

Liquid sugar is in soft drinks and juices. The body digests it more quickly than the sugar in foods, and as a result, liquid sugar causes a greater spike in blood glucose levels.

If a person drinks sugary liquids on a regular basis, the repeated spikes in blood glucose can overload the pancreas and liver, causing health problems.

Sodas tend to contain the highest amounts of liquid sugar. A 12-ounce can of soda contains about 8 tsp of sugar, or 130 empty calories.

The following drinks may also contain liquid sugar:

  • fruit juices and smoothies
  • high-energy drinks or sports drinks
  • chocolate or flavored milk

Avoiding packaged foods

Research suggests that about 75 percent of packaged foods in supermarkets contain added sweeteners.

Examples of packaged foods that may contain added sugar include:

  • candies and chocolate
  • desserts
  • breakfast bars
  • breakfast cereals
  • yogurt
  • savory snacks
  • sauces and salad dressings
  • milk and soy beverages
  • canned, frozen, and dried fruit

Swapping added sugars for natural alternatives

The following tips can help a person replace the added sugar in their diet with more healthful alternatives:

  • Try adding mint leaves, cucumber, berries, or citrus fruit to plain or sparkling water.
  • Swap sweets and desserts for fruit, but avoid canned fruit in syrup.
  • Prepare homemade sauces and salad dressings.
  • Replace store-bought granola and snack mixes with homemade varieties that include unsweetened dried fruits and non-frosted wholegrain cereals.
  • When cooking or baking, use unsweetened applesauce or mashed bananas instead of sugar.
  • Stop using sugar in tea and coffee or reduce the amount.
  • Use herbs and spices instead of sauces that contain added sugar.

Trying sugar alternatives

Non-nutritive sweeteners (NNSs) contain few or no calories.

Researchers have investigated whether replacing sugary foods and drinks with sugar-free options containing NNSs may help people consume fewer calories and maintain a healthy weight. They have reached differing conclusions.

The Food and Drug Administration (FDA) have approved the following NNSs for use in food:

  • acesulfame K, such as Sweet One
  • advantame
  • aspartame, such as NutraSweet and Equal
  • neotame
  • saccharin, such as Sweet’N Low
  • sucralose, such as Splenda

Stevia is another type of NNS that the FDA consider to be “generally recognized as safe.” This means that experts agree that recommended amounts are safe to use.

It is best to limit the intake of NNSs and pay attention to overall calories consumed per day, as NNSs can lead to cravings and overeating.

Emerging research suggests that artificial sweeteners may have negative effects on metabolism, gut health, and cravings, but confirming these findings will require more research.

How Many Carbs Should You Eat If You Have Diabetes?

Many studies support the use of carb restriction in people with diabetes.

Very low-carb, ketogenic diets

Very-low-carb diets typically induce mild to moderate ketosis, a state in which your body uses ketones and fat, rather than sugar, as its main energy sources.

Ketosis usually occurs at a daily intake of fewer than 50 or 30 grams of total or digestible carbs (total carbs minus fiber), respectively. This equates to no more than 10% of calories on a 2,000-calorie diet.

Very-low-carb, ketogenic diets have been prescribed for people with diabetes even before insulin was discovered in 1921 (7).

Several studies indicate that restricting carb intake to 20–50 grams of carbs per day can significantly reduce blood sugar levels, promote weight loss, and improve heart health in people with diabetes (8, 9, 10, 11, 12, 13, 14, 15, 16, 17).

In addition, these improvements often occur very quickly.

For instance, in a study in obese people with diabetes, limiting carbs to 21 grams per day for 2 weeks led to a spontaneous decrease in calorie intake, lower blood sugar levels, and a 75% increase in insulin sensitivity (16).

In a small, 3-month study, people consumed a calorie-restricted, low-fat diet or a low-carb diet containing up to 50 grams of carbs per day.

The low-carb group averaged a 0.6% decrease in HbA1c and lost over twice as much weight as the low-fat group. What’s more, 44% of them discontinued at least one diabetes medication, compared with 11% of the low-fat group (17).

In fact, in several studies, insulin and other diabetes medications have been reduced or discontinued due to improvements in blood sugar control (8, 10, 12, 13, 15, 17).

Diets containing 20–50 grams of carbs have also been shown to lower blood sugar levels and reduce the risk of disease in people with prediabetes (17, 18, 19).

In a small, 12-week study, obese men with prediabetes ate a Mediterranean diet limited to 30 grams of carbs per day. Their fasting blood sugar dropped to 90 mg/dL (5 mmol/L), on average, which is well within the normal range (19).

In addition, the men lost an impressive 32 pounds (14.5 kg), on average, and experienced significant reductions in triglycerides, cholesterol, and blood pressure, among other benefits (19).

Importantly, these men no longer met the criteria for metabolic syndrome due to reductions in blood sugar, weight, and other health markers.

Although concerns have been raised that higher protein intake on low-carb diets may lead to kidney problems, a recent 12-month study found that very-low-carb intake did not increase the risk of kidney disease (20).

Low-carb diets

Many low-carb diets restrict carbs to 50–100 grams, or 10–20% of calories, per day.

Although there are very few studies on carb restriction in people with type 1 diabetes, those that exist have reported impressive results (21, 22, 23).

In a long-term study in people with type 1 diabetes who restricted carbs to 70 grams per day, participants saw their HbA1c drop from 7.7% to 6.4%, on average. What’s more, their HbA1c levels remained the same 4 years later (22).

A 1.3% reduction in HbA1c is a significant change to maintain over several years, particularly in those with type 1 diabetes.

One of the biggest concerns for people with type 1 diabetes is hypoglycemia, or blood sugar that drops to dangerously low levels.

In a 12-month study, adults with type 1 diabetes who restricted daily carb intake to fewer than 90 grams had 82% fewer episodes of low blood sugar than before they started the diet (23).

People with type 2 diabetes may also benefit from limiting their daily carb intake (24, 25, 26).

In a small, 5-week study, men with type 2 diabetes who consumed a high-protein, high-fiber diet with 20% of its calories from carbs experienced a 29% reduction in fasting blood sugar, on average (25).

Moderate-carb diets

A more moderate-carb diet may provide 100–150 grams of digestible carbs, or 20–35% of calories, per day.

A few studies examining such diets have reported good results in people with diabetes (27, 28).

In a 12-month study in 259 people with type 2 diabetes, those who followed a Mediterranean diet providing 35% or fewer calories from carbs experienced a significant reduction in HbA1c — from 8.3% to 6.3% — on average (28).

Finding the right range

Research has confirmed that many levels of carb restriction effectively lower blood sugar levels.

Since carbs raise blood sugar, reducing them to any extent can help control your levels.

For instance, if you’re currently consuming about 250 grams of carbs per day, reducing your intake to 150 grams should result in significantly lower blood sugar after meals.

That said, a severely restricted intake of 20–50 grams of carbs per day appears to produce the most dramatic results, going so far as to reduce or even eliminate the need for insulin or diabetes medication.

SUMMARY Studies demonstrate that restricting carbs may benefit people with diabetes. The lower your carb intake, the greater the impact on your blood sugar levels and other health markers.

How to prevent (and even reverse) prediabetes

More than 25.8 million children and adults in the United States live with type 1 and type 2 diabetes, and experts say as many as 79 million more have prediabetes—a condition where elevated blood glucose levels raise your risk of developing type 2 diabetes.

So how can you avoid or reverse prediabetes? Start by asking your doctor for fasting plasma glucose (FPG), A1C, and oral glucose tolerance tests (OGTT); then follow these expert recommendations for staying diabetes-free.

Diabetes lifestyle educator

Get moving.
If you are overweight, have high cholesterol, or have a family history of diabetes, you’re at risk. You can lower that risk by up to 58 percent by losing 7 percent of your body weight, which means exercise is essential. Start with 30 minutes of brisk walking five to six times per week; then try low-impact workouts like biking or swimming.

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Eat better.
Reduce sugar intake to less than 6 teaspoons (24 grams) daily for women and less than 9 teaspoons (36 grams) per day for men. People at risk for prediabetes should follow a reduced-calorie and reduced-fat diet. Avoid trans fats and regulate high-caloric healthy fats like olive oil, nuts, and avocado.

Make measureable changes.
Wear a pedometer to calculate daily movement, start a food journal, and download online applications that track your weight-loss successes with graphs.

–Jennifer Pells, PhD, Wellspring at Structure House, Durham, North Carolina

Integrative physician

Reduce stress.
Chronic stress taxes the pancreas (the insulin-producing organ) and increases prediabetes risk. Honokiol, a magnolia bark extract, reduces stress and supports the pancreas by taming inflammation and oxidative stress. Take 250 mg twice per day with meals, for long-term use.

Choose the right fiber.
Fiber slows sugar’s release into the bloodstream, allowing your body to use less insulin. Modified citrus pectin is a high-fiber, easily absorbed carbohydrate. Studies show it blocks the inflammatory compound galectin-3, which people predisposed to diabetes release when they eat sugar. Take 5 grams modified citrus pectin once daily.

Support immunity with mushrooms.
People at risk for prediabetes have low immune function; plus, diabetes risk can increase with certain infections and diseases like pancreatitis (inflammation of the pancreas). Medicinal mushrooms safely support immunity; look for a supplement blend of maitake, cordyceps and reishi. Take 2,000 to 3,000 mg daily for two months, and then reduce your intake to 1,000 mg per day for the long term.

–Isaac Eliaz, PhD, Amitabha Medical Clinic, Sebastopol, California

Wellness Coach

Preserve vegetables’ nutrients.
Overcooking vegetables can deplete theiressential vitamins, minerals, and fiber—nutrients that help slow sugar’s release into the bloodstream. Preserve nutrients by cooking them rapidly. Cut vegetables into small pieces, boil a pot of water, and blanch for three to five minutes, until slightly tender. Drain; then submerge in ice water to stop cooking. Or use a high-powered electric wok with 1 tablespoon safflower oil; the high heat sears the vegetables in minutes.

Use sugar alternatives.
When baking, reduce the amount of sugar by half and replace the other half with natural, rich-texture alternatives like frozen fruit concentrates, date paste, or fruit purées. These contain fructose, which doesn’t stimulate insulin production, as glucose does. Avoid artificial sweeteners like sucralose (Splenda).

Arrange your plate.
For prediabetes prevention and even reversal, fill half your plate at every meal with low-sugar, high-fiber fruit like berries or with nutrient-dense vegetables such as kale, carrots, or broccoli. Divide the other half between a complex carbohydrate like brown rice and lean protein such as chicken, tofu, or fish. Additionally, include one fruit or vegetable with every snack. If you fill up on healthful foods, you won’t be as likely to snack on carbohydrates and sweets.

–Jackie Keller, board certified wellness coach, founding director, NutriFit, Los Angeles

Note: If you have just found out you have prediabetes then make sure to .

Prediabetes is a very early form of diabetes. The first thing you should know about prediabetes is that it is reversible and does not have to lead to full blown diabetes. The second thing you should know about prediabetes is that you –and really only you—have the power to reverse it. How can you do that? By incorporating some significant dietary and lifestyle changes into your life—these are significant changes, but not terribly difficult ones. But first, some basic information so that you understand why these changes can change a prediabetic condition to a non-diabetic condition.

The Basics of Prediabetes

A person with prediabetes has levels of blood sugar that is higher than normal, but the levels of blood glucose (sugar) are not quite high enough to be confidently diagnosed as diabetes. But, anyone with consistently higher levels of fasting blood glucose has a higher risk of developing Type 2 Diabetes (T2D)—about 15-30% of people with prediabetes develop Type-2 diabetes. In prediabetes, the cells of the body do not respond effectively to insulin– they are resistant to the insulin. Because the cells of the body are resistant, they don’t absorb sugar from the blood– these cells are essentially “ignoring” the signals from insulin.

How Prediabetes Can Develop

Every cell in our body uses glucose (sugar) for producing the energy needed for the cells to do their jobs. This glucose is derived from the foods we eat, primarily from carbohydrates.

Carbohydrates are one of the main groups of nutrients—the other are fats and proteins. Carbohydrates are molecules composed of chains of various different sugars, including glucose. The glucose is derived as a digestive breakdown product from carbohydrates and is absorbed by the digestive system into the blood. At this point, the glucose is commonly known as “blood sugar” and is the substance measured to determine your blood sugar levels. To understand prediabetes, you first should understand about the different types of carbohydrates and about insulin.

There are essentially two classes of carbohydrates1:

  • Complex carbohydrates have many chains and often consist of many branches of sugars linked together. Complex carbohydrates are found in unprocessed whole grains, fruits, vegetables, beans and legumes. The fact that they are unprocessed is important because processing breaks down complex carbohydrates into simple carbohydrates—basically, processing can be thought of as an industrial “pre-digestive” step. Complex carbohydrates are also called starches—the indigestible carbohydrates are known as fiber. Complex carbohydrates take longer to be digested (chemically broken down to the simple carbohydrates) but provide more potential for energy over a longer period of time, resulting in fewer highs or lows in blood sugar.
  • Simple carbohydrates have shorter, unbranched chains of sugars linked together. Table sugar (sucrose) is a simple sugar made up of one molecule of glucose and one molecule of fructose. Lactose or milk sugar is also made up of two units—glucose and galactose. These simple carbohydrates are fast sources of energy because they are easily and rapidly digested. High Fructose Corn Syrup (HFCS) is a simple sugar and is added to a great number of processed foods. Recently, the ingestion of HFCS (by consuming soft drinks and other beverages with HFCS added) has, like the over-ingestion of sugar, been associated with increased risk of insulin resistance, Type 2 Diabetes, cardiovascular disease and obesity2. Simple sugars can cause high levels of blood glucose.

While diabetes has been known for thousands of years, the rate of diabetes has risen dramatically in the last 200 years. This rise in the rate of prediabetes and diabetes essentially parallels the rise in the industrialization of food and the amount of processed foods that we eat. Processing adds simple sugars to our foods and the theory is that the greater the amount of simple sugars that we ingest, the greater the risk of prediabetes. In fact, there are many scientists, doctors and researchers who believe that the simple sugars act as a drug—they show certain drug characteristics such as addiction and tolerance development4,5.

What is Insulin? How Does Insulin Affect Blood Sugar?

Hormones are chemical “messengers” that are produced by endocrine glands. Insulin is a hormone that is produced by the pancreas. Insulin is the primary chemical messenger, signaling the cells to absorb the glucose into the cells. If the cells respond to insulin correctly, they begin to transport glucose into their interior and the levels of glucose in the blood—your blood sugar or blood glucose levels—should begin to decrease.

In addition, our bodies tend to use its chemical messengers to send many different messages at the same time. At the same time that insulin is telling the cells of the body to take up glucose, it is also involved in signaling the liver to take the glucose from the blood. Liver cells then transform it into glycogen, the storage form of glucose. Insulin is involved in a number of other functions including the metabolism of fats and proteins. For example, insulin can increase the production of fatty acids in the liver and slows down the breakdown of fat in fatty tissues.

When the Message from Insulin is “Ignored”

Prediabetic cells become insulin resistant and don’t pay attention to or can’t react to the signal from insulin. This is the beginning of the long process that can eventually lead to prediabetes and then, potentially diabetes, metabolic syndrome, heart disease and obesity.

At first, some cells begin to ignore the insulin signals. Then, more and more cells ignore the insulin. This ends up causing even more insulin to be secreted from the pancreas because the signal for insulin release is the level of blood sugar. High levels of blood sugar tell the pancreas it needs to produce insulin. So, more and more insulin ends up being secreted but fewer and fewer cells are responding properly. This results in an increased level of glucose in the blood. The pancreas will then respond by producing more and more insulin, in an effort to “push” the sugar molecules into the cells. A sort of vicious cycle has begun—the pancreas keeps getting the signal to produce more insulin to try and push the sugar from the blood into the cells of the body—the cells won’t take up the glucose and the pancreas keeps producing even more insulin.

Since, as mentioned, insulin has a number of functions, the high insulin levels end up stimulating the conversion of the high levels of blood glucose in the blood into fatty acids and then fat. On the level of the whole body, this insulin resistance can show up in early symptoms of prediabetes, though, for most people, there are no obvious symptoms of prediabetes. The following are at least some ways that symptoms of prediabetes can appear.

  • Since the glucose isn’t going into the cells as it is supposed to, the cells aren’t getting enough energy and the body as a whole reads this as “I’m hungry and I need to eat!” This translates as one of the symptoms of prediabetes—a sense of increased hunger.
  • Another symptom of prediabetes is losing weight even while you are hungrier and eating more—this may be because while you are eating, your cells are not actually getting the fuel they need, so they start using the stored fat as a source of energy. However, fat tends to be inflammatory and also tends to increase your body’s resistance to insulin. All this can set up a state of chronic inflammation and disorders such as T2D, obesity, metabolic syndrome and heart disease.
  • Other symptoms of prediabetes include:
    • Increased thirst and increased frequency of urination
    • Increased fatigue (possibly because the cells of your body are not getting the fuel (glucose) that they need).

Risk Factors for Prediabetes

There are a number of unanswered questions about prediabetes and how, exactly, it progresses to diabetes. We do know that there are certain risk factors for developing prediabetes. These include6:

    • Weight: People who are heavier—especially heavier around the midsection or waist—tend to have a higher risk for prediabetes. One simple way of determining this is to measure the waist (in inches). The risk of prediabetes is increased in women with a waist measurement of > 35 inches and in men with a waist measurement of > 40 inches.
    • Physical Inactivity: People who tend to do little physical activity tend to be heavier and this has long been thought to be an indirect way that low levels of physical activity put a person at risk for prediabetes. But, since exercise has been shown to reduce inflammation and since inflammation is always a part of prediabetes, the lack of physical activity may increase the risk of prediabetes more directly by increasing the amount of inflammation in the body.
    • Genetics or Family History: Your heredity can be very important as a risk factor. If a close family member had or has prediabetes or diabetes, you have a greater risk of prediabetes yourself.
    • Ethnic Background: People of African, Hispanic, North American Native and Asian backgrounds have a higher risk of prediabetes.
    • Age: After the age of 45, your risk of prediabetes begins to increase. After the age of 65, the risk starts increasing more dramatically.
    • Medical History: Your personal medical history can increase your risk of prediabetes. For example, if you have a history of high blood pressure, high levels of LDL-cholesterol (or low levels of HDL-Cholesterol), a history of polycystic ovary syndrome (PCOS) or have had gestational diabetes, your risk of prediabetes is increased.

Lab Tests for Prediabetes

Quite often, there are no clear symptoms of prediabetes. If you see a physician regularly and have your blood tested, your physician may notice that your blood sugars tend to be on the high side (but not high enough to diagnose T2D). Prediabetes can be diagnosed, however, using either the A1c test, a fasting blood glucose test or an oral glucose tolerance test (OGTT).4

  • Fasting blood sugar levels between 100-125 mg/dL are suggestive of prediabetes.
  • Another blood test, the A1c test, measures how your body has been handling sugars for the past 3 months and can be used to diagnose prediabetes.
    • The A1c level for insulin resistance and prediabetes is generally considered to be between 5.7- 6.4%.
      • Type 2Diabetes is usually diagnosed if the A1c is greater than 6.5%.
  • An oral glucose tolerance test (OGTT) can be used to diagnose prediabetes. In this test, first, you have your blood drawn to measure blood sugar levels. You will then be given a beverage that is very sweet. After 2 hours, your blood is drawn again and the blood sugar is measured again. This test determines how well your body handles sugars. (The blood sugar levels should go down within 2 hours. If they do not go down significantly, this can be a sign that you may be insulin resistant or prediabetic. In prediabetes, the blood sugar levels will be between 140-199 mg/dL. In people without prediabetes, the blood sugar levels will be less than 139mg/dL).

What can YOU do to Prevent or Reverse Prediabetes

The answer to this question is straightforward and may be simple for some—however, putting this answer to work for you requires some commitment and dedication because you are likely to have to change some habits, and that, honestly, can be sometimes difficult.

Most simply put, prediabetes can be reversed by losing weight by changing the way you eat and by increasing you level of exercise. 6,7

Controlling Prediabetes with Diet

Food is not what it used to be. Until recently, many of us grew much of our own food or bought it from the farmer down the road. Today, the food that one buys may have come from another continent or from another part of the country. Most food that is available on most grocery shelves is boxed, packaged, processed and preserved. The meats contain antibiotics, hormones and the animals from which these meats are derived do not eat their natural foods and do not get to roam freely and may not be completely healthy. Crops may be grown in depleted soils, forced to grow by the use of fertilizers and soil additives. To put it simply, our food just ain’t what it used to be! On the more individual level, many people don’t eat many fruits and vegetables, or eat a limited number. Many people have little time to cook and use prepared or fast foods. Large food manufacturers and processors add all sorts of additive, preservatives and sugars to foods—this extra sugar tastes good to many people and the foods are often easier to prepare.

Prediabetes has been recognized only in the last few decades, but it is believed that prediabetes is associated with too many simple sugars in the diet and can be reversed with diet, nutrition and exercise.

To reverse prediabetes, dietary approaches emphasize whole foods (organic when at all possible), complex carbohydrates and high density nutrients including proteins and healthy fats. These guidelines are essentially part of an anti-inflammatory diet which is gaining more and more acceptance with physicians– nutritionists have been “on board” for a much longer time.2 Following the dietary rules below can help you reverse prediabetes resistance and, as a bonus, it is very likely that it will help you lose extra weight!

Here are some “rules” to follow:

  • Buy whole foods (whole grains, fresh fruits and vegetables) as opposed to processed foods.
    • The reasoning is that processing removes nutrients, adds preservatives and additives and sometimes huge amounts of sugars. For example, 1 teaspoon of sugar is equal to about 4 grams of sugar. One 6 ounce serving of low-fat yogurt has 28 grams or 7 teaspoons of sugar. On the other hand, one tablespoon of pure honey has 16 grams of sugar.
  • Cook fresh food from scratch as much as possible—this helps preserve the nutrients.
  • Include organic foods as much as possible. Here, the rationale is that many chemicals are though to cause inflammation. Since inflammation is always linked to prediabetes, you want to limit that inflammation as much as possible.
  • 90-95% of the carbohydrates you eat should be complex carbohydrates:
    • Complex carbohydrates are found in whole, unprocessed foods such as whole grains, peas, lentils, beans, fruits and vegetables.
    • A good rule of thumb to follow is “No white foods” – no white bread, white pasta or white rice. You should also avoid candies, cookies, cakes and other pastries.
  • Increase the amount of fiber in your diet. Try to include, for example, a tablespoon of ground flaxseeds at every meal. You can add ground flaxseeds to salads, vegetables, side dishes or soups.
  • Limit red meats and increase the amounts of fish and skinless poultry you eat.
    • Look for wild-caught fish such as salmon, cod, haddock and tuna– these fish are good sources of omega-3 fatty acids. The omega-3 fatty acids are essential for health and are anti-inflammatory foods.
  • Increase the amounts and varieties of fruits and vegetables that you eat.
    • The sugars in fruit are combined with the fiber– and this means that the absorption of sugars from the fruit are slowed down.

Exercise

Increasing your physical activity level just a relatively moderate amount can help reverse prediabetes. There is no need to train for a marathon! All you really have to do is to start walking more, climbing more stairs, doing more outdoor activities, hiking, gardening, aerobics, Tai chi, yoga, using an elliptical, rowing machine or using a stationary bicycle. This can be as simple as parking at the far end of a parking lot or using the stairs instead of an elevator or escalator. You goal should be 30 minutes of moderate activity (mixing the activities if you want) for at least 5 days a week. It is important to find some activity that YOU like and that YOU can commit to! Start slowly and work your way into greater activity. Don’t forget to stretch and warm up, especially if you are trying to jump right into it! You can also think about joining a gym and getting a personal trainer. Finally, make certain you know and understand any physical conditions that may limit your activity.

Last Updated: Thursday, December 26, 2019 Last Reviewed: Saturday, May 7, 2016

Carbohydrate Counting & Diabetes

What is carbohydrate counting?

Carbohydrate counting, also called carb counting, is a meal planning tool for people with type 1 or type 2 diabetes. Carbohydrate counting involves keeping track of the amount of carbohydrate in the foods you eat each day.

Carbohydrates are one of the main nutrients found in food and drinks. Protein and fat are the other main nutrients. Carbohydrates include sugars, starches, and fiber. Carbohydrate counting can help you control your blood glucose, also called blood sugar, levels because carbohydrates affect your blood glucose more than other nutrients.

Healthy carbohydrates, such as whole grains, fruits, and vegetables, are an important part of a healthy eating plan because they can provide both energy and nutrients, such as vitamins and minerals, and fiber. Fiber can help you prevent constipation, lower your cholesterol levels, and control your weight.

Unhealthy carbohydrates are often food and drinks with added sugars. Although unhealthy carbohydrates can also provide energy, they have little to no nutrients. More information about which carbohydrates provide nutrients for good health and which carbohydrates do not is provided in the NIDDK health topic, Diabetes Diet, Eating, & Physical Activity.

The amount of carbohydrate in foods is measured in grams. To count grams of carbohydrate in foods you eat, you’ll need to

  • know which foods contain carbohydrates
  • learn to estimate the number of grams of carbohydrate in the foods you eat
  • add up the number of grams of carbohydrate from each food you eat to get your total for the day

Your doctor can refer you to a dietitian or diabetes educator who can help you develop a healthy eating plan based on carbohydrate counting.

Which foods contain carbohydrates?

Foods that contain carbohydrates include

  • grains, such as bread, noodles, pasta, crackers, cereals, and rice
  • fruits, such as apples, bananas, berries, mangoes, melons, and oranges
  • dairy products, such as milk and yogurt
  • legumes, including dried beans, lentils, and peas
  • snack foods and sweets, such as cakes, cookies, candy, and other desserts
  • juices, soft drinks, fruit drinks, sports drinks, and energy drinks that contain sugars
  • vegetables, especially “starchy” vegetables such as potatoes, corn, and peas

Potatoes, peas, and corn are called starchy vegetables because they are high in starch. These vegetables have more carbohydrates per serving than nonstarchy vegetables.

Examples of nonstarchy vegetables are asparagus, broccoli, carrots, celery, green beans, lettuce and other salad greens, peppers, spinach, tomatoes, and zucchini.

Foods that do not contain carbohydrates include meat, fish, and poultry; most types of cheese; nuts; and oils and other fats.

Foods that contain carbohydrates include grains,fruits, dairy products, vegetables, and legumes.

What happens when I eat foods containing carbohydrates?

When you eat foods containing carbohydrates, your digestive system breaks down the sugars and starches into glucose. Glucose is one of the simplest forms of sugar. Glucose then enters your bloodstream from your digestive tract and raises your blood glucose levels. The hormone insulin, which comes from the pancreas or from insulin shots, helps cells throughout your body absorb glucose and use it for energy. Once glucose moves out of the blood into cells, your blood glucose levels go back down.

How can carbohydrate counting help me?

Carbohydrate counting can help keep your blood glucose levels close to normal. Keeping your blood glucose levels as close to normal as possible may help you

  • stay healthy longer
  • prevent or delay diabetes problems such as kidney disease, blindness, nerve damage, and blood vessel disease that can lead to heart attacks, strokes, and amputations—surgery to remove a body part
  • feel better and more energetic

You may also need to take diabetes medicines or have insulin shots to control your blood glucose levels. Discuss your blood glucose targets with your doctor. Targets are numbers you aim for. To meet your targets, you will need to balance your carbohydrate intake with physical activity and diabetes medicines or insulin shots.

How much carbohydrate do I need each day?

The daily amount of carbohydrate, protein, and fat for people with diabetes has not been defined—what is best for one person may not be best for another. Everyone needs to get enough carbohydrate to meet the body’s needs for energy, vitamins and minerals, and fiber.

Experts suggest that carbohydrate intake for most people should be between 45 and 65 percent of total calories. People on low-calorie diets and people who are physically inactive may want to aim for the lower end of that range.

One gram of carbohydrate provides about 4 calories, so you’ll have to divide the number of calories you want to get from carbohydrates by 4 to get the number of grams. For example, if you want to eat 1,800 total calories per day and get 45 percent of your calories from carbohydrates, you would aim for about 200 grams of carbohydrate daily. You would calculate that amount as follows:

  • .45 x 1,800 calories = 810 calories
  • 810 ÷ 4 = 202.5 grams of carbohydrate

You’ll need to spread out your carbohydrate intake throughout the day. A dietitian or diabetes educator can help you learn what foods to eat, how much to eat, and when to eat based on your weight, activity level, medicines, and blood glucose targets.

How can I find out how much carbohydrate is in the foods I eat?

You will need to learn to estimate the amount of carbohydrate in foods you typically eat. For example, the following amounts of carbohydrate-rich foods each contain about 15 grams of carbohydrate:

  • one slice of bread
  • one 6-inch tortilla
  • 1/3 cup of pasta
  • 1/3 cup of rice
  • 1/2 cup of canned or fresh fruit or fruit juice or one small piece of fresh fruit, such as a small apple or orange
  • 1/2 cup of pinto beans
  • 1/2 cup of starchy vegetables such as mashed potatoes, cooked corn, peas, or lima beans
  • 3/4 cup of dry cereal or 1/2 cup cooked cereal
  • 1 tablespoon of jelly

Some foods are so low in carbohydrates that you may not have to count them unless you eat large amounts. For example, most nonstarchy vegetables are low in carbohydrates. A 1/2-cup serving of cooked nonstarchy vegetables or a cup of raw vegetables has only about 5 grams of carbohydrate.

As you become familiar with which foods contain carbohydrates and how many grams of carbohydrate are in food you eat, carbohydrate counting will be easier.

Nutrition Labels

You can find out how many grams of carbohydrate are in the foods you eat by checking the nutrition labels on food packages. Following is an example of a nutrition label:

Nutrition labels tell you the total grams of carbohydrate per serving, along with other nutrition information.

Nutrition labels tell you

  • the food’s serving size––such as one slice or 1/2 cup
  • the total grams of carbohydrate per serving
  • other nutrition information, including calories and the amount of protein and fat per serving

If you have two servings instead of one, such as one cup of pinto beans instead of 1/2 cup, you multiply the number of grams of carbohydrate in one serving—for example, 15—by two to get the total number of grams of carbohydrate—30.

15 x 2 = 30

Cooking at Home

To find out the amount of carbohydrate in homemade foods, you’ll need to estimate and add up the grams of carbohydrate from the ingredients. You can use books or websites that list the typical carbohydrate content of homemade items to estimate the amount of carbohydrate in a serving.

You can also weigh foods with a scale or measure amounts with measuring cups or spoons to estimate the amount of carbohydrate. For example, if a nutrition label shows that 1 1/2 cups of cereal contain 45 grams of carbohydrate, then 1/2 cup will have 15 grams of carbohydrate and 1 cup will have 30 grams of carbohydrate.

Eating Out

Some restaurants provide nutrition information that lists grams of carbohydrate. You can also use carbohydrate counting food lists to estimate the amount of carbohydrate in restaurant meals.

Can I eat sweets and other foods and drinks with added sugars?

Yes, you can eat sweets and other foods and drinks with added sugars. However, you should limit your intake of these high-carbohydrate foods and drinks because they are often high in calories and low in vitamins, minerals, and fiber. Fiber-rich whole grains, fruits, vegetables, and beans are wiser choices.

Instead of eating sweets every day, try eating them in small amounts once in a while so you don’t fill up on foods that are low in nutrition. Ask your dietitian or diabetes educator about including sweets in your eating plan.

How can I tell whether carbohydrate counting is working for me?

Checking your blood glucose levels can help you tell whether carbohydrate counting is working for you. You can check your blood glucose levels using a glucose meter.

You should also have an A1C blood test at least twice a year. The A1C test reflects the average amount of glucose in your blood during the past 3 months.

If your blood glucose levels are too high, you may need to make changes in your eating plan or other lifestyle changes. For example, you may need to make wiser food choices, be more physically active, or make changes to your diabetes medicines. Talk with your doctor about what changes you need to make to control your blood glucose levels.

If you use an insulin pump or take more than one daily insulin shot, ask your doctor how to adjust your insulin when you eat something that isn’t in your usual eating plan.

Can I use carbohydrate counting if I am pregnant?

You can use carbohydrate counting to help control your blood glucose levels when you are pregnant. Meeting your blood glucose targets during pregnancy is important for your and your baby’s health. High blood glucose during pregnancy can harm the baby and increase the baby’s chances of having type 2 diabetes later in life.

Women diagnosed with gestational diabetes—a type of diabetes that develops only during pregnancy—can also use carbohydrate counting to help control their blood glucose levels.

Talk with your doctor about using carbohydrate counting to help meet your blood glucose targets during your pregnancy.

Where can I find more help with carbohydrate counting?

The Internet has carbohydrate counting tools that let you enter a type of food and find out what nutrients the food contains, including carbohydrates. Try visiting these sites:

  • www.diabetes.org/mfa-recipes/—a calorie and carbohydrate counting tool from the American Diabetes Association (ADA)
  • www.nal.usda.gov/fnic/foodcomp/search—an online database from the U.S. Department of Agriculture Nutrient Data Lab

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

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