Carbohydrates – How Much?

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In my field of diabetes education, I often come into close working contact with dietitians. Many have asked me, “how much carbs do you tell your patients to eat?” The above image is an example of a handout that is often given to those with diabetes. Or, if a patient meets with a dietitian, they may be given a more specific plan. Dietitians are trained to try to determine the amount of calories a person should eat, and then assign percentages of macronutrients to that calorie figure to determine how many grams of each macronutrient to tell people to eat. So say, for instance, they determine that a client needs 1500 calories, and they assign the macronutrients to be 50% carbs, 30% fat and 20% protein, they would then recommend 188g of carbs, 50g fat and 75g protein. Here are my concerns with this method:

  1. There is no way without expensive testing, to determine exactly how many calories a person is actually burning. So determining a person’s calorie needs is a guess at best.
  2. As you may be aware, I’m not a fan of calorie counting as it does not focus on the TYPES of foods being consumed (article HERE). Certain TYPES of foods will cause greater fat storage, whereas others promote fat burning. Assigning numbers without considering the QUALITY of food is not helpful.
  3. This method does not consider each person’s ability to tolerate carbohydrates in order to maintain normal blood glucose (this should be THE PRIORITY when counseling people with diabetes.)
  4. This method is no longer supported as an optimal way to control weight, blood glucose control or cardiovascular risk factors. Notice these statements by the American Diabetes Association.

“Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.”

“Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes. Therefore, collaborative goals should be developed with the individual with diabetes.”

So do I tell my clients exactly how much carbohydrate to eat? Yes, and no. I certainly don’t give them a set number to eat, as in the image above. How could I? What if I told EVERY client to eat 30g of carbs in a meal? Some would have BG readings in the low 100’s, some would be in the 400’s. What I teach clients is to determine their OWN tolerance for carbohydrates. How do they do that? By “eating to their blood glucose meter.” I have had the privilege of being associated with a brilliant health blogger who gives amazing advice to his followers when he says that we should “eat within our own pancreas’ ability to maintain normal blood glucose.” (Check out his blog called “Optimizing Nutrition, Managing Insulin” HERE). I could not explain it any better. If you are eating an amount of carbohydrates that causes unsafe rises in blood glucose, and taxing your pancreas’ ability to manage that glucose with ease, then you are eating to many carbohydrates FOR YOU. Period.*

To me, the more important question when it comes to carbs is, WHAT KIND? Focus should be given to the type of carbohydrates that are the most nutrient dense, while AT THE SAME TIME causing very little increase in blood glucose. Why is it important that both of these elements be present TOGETHER? Because some carbs that are nutrient dense will also spike blood sugar too high, like fruit, or starches (article HERE). Therefore, those nutrients may come at too great a cost to our health, especially when we can get those same nutrients in other foods that WON’T spike blood glucose. So we need to strive for nutrient dense foods with VERY LITTLE glycemic impact. This would put the focus on leafy greens and non starchy vegetables as the optimal source of healthy carbohydrates.

So while it is important to determine a safe daily number of carbs, this is something that can only be determined by an individual through experimentation, trial and error, NOT by following “one size fits all” recommendations.

There is a growing number of highly qualified dietitians now embracing individualized approaches, and considering both carb quantity AND quality, rather than using outdated standardized targets.  This at times causes them criticism from the dietitian community who are largely clinging to prior recommendations.  Kudos to these brave dietitians for embracing more up to date nutritional research and putting the needs of each individual first!