Carbohydrate Counting... Is it Effective or Necessary?

[Deleted member 596235]

I really appreciate everybody's comments here—particularly
as I'm a T2 newbie—as the field of dietary protocols and even
the medical experts' opinions seem like a minefield of varied
information and even misinformation.

Food carbohydrates are to me particularly confusing, with many
medicos saying that as long as one is eating an overall "healthy"
diet containing all the necessary daily requirements of vitamins,
proteins, minerals and fibre etc, then the carbohydrates will
effectively take care of themselves.

Then I've seen several people saying that carbohydrates are the
enemy of anyone's healthy diet—presumably including some
high-carbohydrate foods such as oats, which are described as
"an incredibly healthy whole grain and a great source of many
vitamins, minerals, and antioxidants", while being 70% carbohydrate.
(As do quinoa and buckwheat).

This prompts me to ask a simple question: does a diabetic person
maintaining a specific and successful low carbohydrate diet eat
oats, quinoa, or buckwheat? Or avoid them because of their high
carbohydrate content?

And are carbohydrates inherently the "enemy" of—in my case of
T2—a healthy diet?

 

[Grant_Vicat]

Hi and welcome
As a type 1 for 50 years i find your post fascinating and thought would you mind if i add my opinion??
Pleasantly ?

50 years ago aged just 6 i was taught in hospital that 10grams of carbohydrate was 1 line.
I could have 4 lines for breakfast 40g and the same for lunch and evening meal.

The only way to work this out was to carb count which my mum did as i was just 6 years old.

Insulins and tech has changes for the better but jog on 50 years to today and i still carb count and take insulin.

My last hba1c was 39 which is 5.7 i weigh 11 stone and am 5 ft 7 inch.

I could be in a restaurant now and pretty accurately work out the carbs at a glance of anyones plate.
Its like breathing to me.
Tedious? unnecessary?
It isn't to me ...its been integral in successful control.

I am not saying i'm right i'm just saying that is my belief and please don't think i'm criticizing'

Perhaps i shouldn't be posting but i read your post and it genuinely sent a little shiver down my spine....

I wish you well and again i don't want you to think i'm being rude

Tony

I completely agree with this @Tony337 (Good old R.D. Lawrence!).

 

[becca59]

@ausGeoff I’m a Type one. Oats and similar are my enemy too. Far too insulin heavy. In my mind if they require large doses and difficult management they cannot be doing me any good. No matter what the experts say.

 

[lovinglife]

I really appreciate everybody's comments here—particularly
as I'm a T2 newbie—as the field of dietary protocols and even
the medical experts' opinions seem like a minefield of varied
information and even misinformation.

Food carbohydrates are to me particularly confusing, with many
medicos saying that as long as one is eating an overall "healthy"
diet containing all the necessary daily requirements of vitamins,
proteins, minerals and fibre etc, then the carbohydrates will
effectively take care of themselves.

Then I've seen several people saying that carbohydrates are the
enemy of anyone's healthy diet—presumably including some
high-carbohydrate foods such as oats, which are described as
"an incredibly healthy whole grain and a great source of many
vitamins, minerals, and antioxidants", while being 70% carbohydrate.
(As do quinoa and buckwheat).

This prompts me to ask a simple question: does a diabetic person
maintaining a specific and successful low carbohydrate diet eat
oats, quinoa, or buckwheat? Or avoid them because of their high
carbohydrate content?

And are carbohydrates inherently the "enemy" of—in my case of
T2—a healthy diet?

Whilst most of us T2 here do go down the low carb/keto route, including myself, it’s all personal choice. Your diabetes is your diabetes and it’s totally your choice how you manage it. It’s a lifestyle choice and has to be sustainable very long term and it’s not for everyone and there is no right or wrong way to go about it.Theres no point in doing a keto diet if it makes you totally miserable and you struggle to stick to it.

The main thing is that as someone with T2 you keep your BG in a range that’s as near to a normal BG as possible, but also what you are personally happy with. That could be by diet only, diet and lots of exercise, with medication. However you want to do it.

Low carb is anything under 130g carb. Some people can have more carbs than others, I used to be 100g carb a day & take medication but found gradually I was eating less and less carbs and having hypos so took the decision to come off the meds with the support of my HCP team.

This is why having a meter is the most valuable tool you can have. Testing will tell you if YOU can tolerate some carbs and can keep them in your diet. Don’t always go by what others say they can & cannot eat. Just because an apple raises Joe Blogs BG too much doesn’t mean it necessarily will raise yours. Many here would run a mile from an apple but even on keto I can eat half of a small green apple combined with say some cheese or in a slaw with mayo and it has no effect on my BG. It’s all about portion size and knowledge of how a certain food affects you personally.

You’re not in competition with anyone but yourself and there is no shame in taking meds if you need them or choose to have more carbs in your diet to make life liveable. You’re the one living your life, no one else. If you want to eat the oats, buckwheat, quinoa, no one can tell you not to, it’s your choice but be guided by your meter, who knows you may be able to tolerate a small portion, you may not. But test test test is my advice here as in my experience even on meds they were just too carb heavy

Having said all that in my personal opinion this is forum is THE best place to gain the knowledge you need to become an expert in yourself. It has great members who have between us vast experience that we love to pass on and share, so ask questions, read around the forum, take in info and digest it and then use that knowledge to create a lifestyle that’s best for you and your diabetes.

 

[KennyA]

I really appreciate everybody's comments here—particularly
as I'm a T2 newbie—as the field of dietary protocols and even
the medical experts' opinions seem like a minefield of varied
information and even misinformation.

Food carbohydrates are to me particularly confusing, with many
medicos saying that as long as one is eating an overall "healthy"
diet containing all the necessary daily requirements of vitamins,
proteins, minerals and fibre etc, then the carbohydrates will
effectively take care of themselves.

Then I've seen several people saying that carbohydrates are the
enemy of anyone's healthy diet—presumably including some
high-carbohydrate foods such as oats, which are described as
"an incredibly healthy whole grain and a great source of many
vitamins, minerals, and antioxidants", while being 70% carbohydrate.
(As do quinoa and buckwheat).

This prompts me to ask a simple question: does a diabetic person
maintaining a specific and successful low carbohydrate diet eat
oats, quinoa, or buckwheat? Or avoid them because of their high
carbohydrate content?

And are carbohydrates inherently the "enemy" of—in my case of
T2—a healthy diet?

Hi. This is an answer for myself, not a "you should...." or "everyone should...." type of answer. Unfortunately anything that says "food X is an incredibly healthy food" is giving an over-simplified one size fits all answer. In my opinion.

This particular T2 diabetic person does not generally eat oats, quinoa or buckwheat. A small exception would be for things like black pudding or haggis, which are made using oatmeal. I don't eat either of these very often and not in any great quantity. I'd expect 14-15g carb from 100g black pudding, so 100g black pudding would be OK for me in the context of no more than 10g carb intake from other sources that day. In practical terms this usually means having black pudding or haggis as part of a big fry-up as my meal that day.

Up to around 1980 the standard medical advice for anyone wanting to lose weight (there was no blood glucose component to this advice, because BG couldn't be readily measured, and there was no obvious T2 issue - T2 did not really exist as a concept) was to avoid starches and sugars in the diet. Those are digested to glucose, and excess glucose is stored as bodyfat. That advice is what we would easily recognise today as a low-carb diet.

The 1980s was when governments started getting involved in telling people what to eat. The standard advice was to boost the consumption of starches - as cheap food, they had an appeal on cost. Food manufacturers quickly picked up on this as a way of producing cheap food with a long shelf life. It helped to be able to describe factory-made food as "healthy" - there is absolutely no definition of what "healthy" means in this context, so advertisers are free to use it as they wish. There's usually an implication that it will "make you healthy" with no evidence offered. There are often weasel words attached such as "...in the context of a balanced diet", which again means very little. Milk is marketed as a "healthy" food. Is milk still "healthy" for anyone who is lactose-intolerant? Equally, are carbs "healthy" for anyone who has trouble tolerating the resulting glucose?

Because most carb-heavy food is fairly bland, various flavour enhancers got added, and food that was packaged became increasingly processed. You could add things like corn syrup, a "healthy" vegetable product. Some of this had to do with the size of the USA - if you could centralise production, you didn't need a factory in every state, and your packaged food could last the longer travel and be on supermarket shelves for weeks.

So we've been encouraged to eat increasing amounts of processed carbs for the last forty to fifty years, and obesity rates have soared, T2 is forecast to take up a third of the NHS' resource by 2035, and the British Heart Foundation says that since 1993, the estimated number of people living with heart and circulatory diseases globally has doubled. So although as a population we seem to be getting much less healthy, we are still being encouraged to eat the same "healthy" food that's been associated with the decline in health. There's a much fuller description of this in Gary Taubes' book "Rethinking Diabetes".

I have no idea what caused or triggered my T2. I was at the time eating the recommended "healthy diet" with a lot of carbs - pasta, rice, cereal, potatoes, fruit etc, but very little white sugar. Work was stressful, particularly around 2008, and I noticed my first diabetic symptom (oedema in my feet, although it wasn't recognised as a diabetic symptom) in 2009 or so. I also started to gain weight really quickly, without anything else having changed. I think, based on countback, that my BG went out of normal range about the same time - can't be sure, because my medical records don't include that information.

Roll forward about ten years of weight gain and increasingly painful and distressing symtoms and I was eventually diagnosed in late 2019. Reduce carbs to 20g/day, eat natural, non-processed food with this being mainly fresh meat, dairy, and green veg. Result, bloods normal inside four months and by 2023/4 I'd lost all the gained weight plus some, around 90lbs in total.

Personally, I would ban any use of the word "healthy" in connection with food. What is or is not healthy depends so much on the person, other food eaten, related medical conditions, physical activity, age, etc.

 

[AndBreathe]

I'm not keto and never have been long term, although I have had the odd phase where it was simpler to be so - for example when staying with friends, where if I was having some carbs, their cries of "one won't hurt", or "that's never a portion" were easier to avoid. I have also had a couple of brief forays into carnivore eating, but those were simply when feeding prior to long haul journeys, where airline food can be mixed, at best. On those occasions, I just fasted.

There seem to be lots of T2 folks on here now using the Libre or Dexcom almost full time. Heck, in the dark ages when I was diagnosed such things really didn't exist, and for a time could not be sourced by T2s, so to learn about my blood sugars I did finger prick testing. That was a major tool in my personal T2 diabetes education experience, because, frankly, if my aim was to keep my postprandial blood sugar blood sugar under X, then troughing on cake or pasta showed me that was tricky.

On that basis, I could conclude that any food or drink giving my stratospheric blood glucose scores, or slightly lower, but very extended rises (for me, that was pasta), I knew portions needed to be either smaller or ditched - at least for some time.

Once I found a way that worked for me - backed up by lab results, I just stuck with it.

Over time, I have learned I can eat more carbs than around diagnosis. Sometimes I do, and sometimes I don't bother. I feel no loss from not eating bread, or risotto, because I have found other things and ways of enjoying my food just as much.

Honestly, we can help you a lot on here, but a lot of what you need to learn is personal.

 

[Antje77]

This prompts me to ask a simple question: does a diabetic person
maintaining a specific and successful low carbohydrate diet eat
oats, quinoa, or buckwheat? Or avoid them because of their high
carbohydrate content?

I avoid them as a rule, with the occasional exception.
Not because of their high carb content but because my meter/sensor clearly shows me that those things are not healthy for me. Unless in very small amounts, they'll make my bg rise well over 10 before dropping again, no matter how I time my insulin doses. I like my feet, eyesight and kidneys much more than I like oats so I try to keep my levels in the normal range and avoid foods I know will make me spike.
To my thinking, keeping mostly in the normal range gives me some leeway for occasional high bg with some special meal.

 

[Outlier]

I like my feet, eyesight and kidneys much more than I like oats so I try to keep my levels in the normal range

That's my take on it too. There is nothing so delicious that I would sacrifice my long-term welfare over. There are plenty of yummy things I am still able to eat - just not anything with carbs and sugars.

BUT we are all different and are at liberty to make our own choices.

 

[NoMoreBeerAnymore]

As a newly diagnosed Type 2 diabetic I've noticed many people here
putting a lot of stead on carbohydrate counting (BCC) as an important
(even critical) part of their BG levels, some as part of a sole dietary
therapy, and some as an adjunct only to their medication. It would
seem from the usually very positive and detailed comments posted
on these forums that carb counting is highly regarded in the diabetic
"community".

Personally, I see carb counting as tedious and overly involving, and
even unnecessary—assuming of course one's medication is working
satisfactorily to control one's BG levels in the first instance.

Anyway... a little bit of research brought up THIS site, which in part
suggests that "despite the impact of the total carbohydrate intake in a
meal on the postprandial glucose response, there remains a scarcity of
evidence regarding the effectiveness of basic carbohydrate counting as
a dietary approach for enhancing glycaemic control."

Compared with the standard dietary care group, [they] observed no
treatment effects of the BCC intervention on HbA1c from baseline to
end-of-treatment. Both groups (subject and control) experienced
comparable reductions in HbA1c and MAGE (mean amplitude of
glycemic excursions) from baseline to end-of-treatment at 6 months.

[They] found that BCC as add-on to standard dietary care did not reduce
HbA1c or MAGE, compared with standard dietary care in individuals
with T2 diabetes.

—I'm guessing BBC could be a hot topic on diabetes
forums, so I'm interested in hearing peoples' opinions
on this topic, whether from a pro or a con perspective.

PS: I'm very new to this condition, so I'm hardly an expert, that's for sure.

I am a type II, working in an office, not a doctor, and no expert, but this is what "works" for me.

I was A1C of 120 last year, I am down to a sort of alright 56 now. It's a bit pants, but I will get there.

Type II is by definition: a real damned nuisance, party-pooper, etc etc. Counting the carbs sounds like a new level of purgatory.

If you want to eat carb (and who doesn't), stick to wholemeal, the Hovis-type bread with lots of roughage in it, this seems to be digested slower and I find my BG doesn't race off in the wrong direction. I know this because if I eat something new or different, I test my BG with a meter after 2-3 hours, and that tells me what breakfast, lunch, dinner did to me. If I eat the same thing again, I don't bother testing because I bet it will be the same outcome.

Bagels seems to mess with me. Whole-oats cooked in the microwave for 1 minute are brilliant, but you need to be some kind of human-ruminant chimera to chew them.

I do deliberately cook tatties and leave them overnight, they taste weird but my BG is alright (under 7) 3 hours later. I like All-bran but it is clarted with sugar, and you might as well go for a delicious donut (9.5)

So to answer your question, we are probably supposed to be counting, but the heck am I doing that, it's a no from me.

My entirely unqualified view on the matter is: you need to get a BG monitor and do some edible experiments. Test after a couple of hours of eating and if its all gone wrong, don't eat that again.

 

[paulcw16]

Age 73. Chronic fatigue which limits exercise. My first ever A1C was 6.7 six months ago. I've averaged 80g/day net carbs since. Today it was 6.5. I expected (hoped for) a larger drop. Products like Choczero, and Quest Protein bars utilize monk fruit and allulose, which have zero glycemic index according to web/AI search (not product websites). Quality keto breads the same.. So I'm either Type 2 FOR REAL, or the 'net carb' marker isn't applicable for whatever reason. Or I should just try total carbs, say under 100, and see what happens. Thoughts? Thank you in advance.

 

[NoMoreBeerAnymore]

Age 73. Chronic fatigue which limits exercise. My first ever A1C was 6.7 six months ago. I've averaged 80g/day net carbs since. Today it was 6.5. I expected (hoped for) a larger drop. Products like Choczero, and Quest Protein bars utilize monk fruit and allulose, which have zero glycemic index according to web/AI search (not product websites). Quality keto breads the same.. So I'm either Type 2 FOR REAL, or the 'net carb' marker isn't applicable for whatever reason. Or I should just try total carbs, say under 100, and see what happens. Thoughts? Thank you in advance.

This sounds good. a) do they taste good, b) this all sounds a chemical experiment not food. if a) is yes, and b) it is a bit factory-ish but it is healthy, I want to know more, educate us !! A1c of 6.5 is OK, NHS things mine is great at 8.6% apparently. What is allulose and why should we care? Keto bread, is that made of meat ? Tell us more please !!

 

[NoMoreBeerAnymore]

Quinoa. This is the stuff. Like a kind of bird seed. I did like it, I was expecting it to be gritty. Is it digested slowly to keep my BG from going into low earth orbit.

 

[Resurgam]

@NoMoreBeerAnymore I'm quite convinced that anything labelled as 'healthy' should be fed to birds or ruminants able to cope with it.
These days I listen intently when anyone is hammering on about whole grain and not eating meat or fat and then smile and say 'What a pity it doesn't work for a lot of Humans.'
Like many type 2's in remission I can actually cope with more carbs than I eat these days, but my weight immediately begins to increase and my waistbands become tighter.
Claims that carbs are treats and all round good things really make me feel slightly unwell - I watched my grandmother dying slowly from the complications of type 2 and when faced with eating carbs or nothing, I eat nothing.

 

[KennyA]

This sounds good. a) do they taste good, b) this all sounds a chemical experiment not food. if a) is yes, and b) it is a bit factory-ish but it is healthy, I want to know more, educate us !! A1c of 6.5 is OK, NHS things mine is great at 8.6% apparently. What is allulose and why should we care? Keto bread, is that made of meat ? Tell us more please !!

An A1c of 6.5% is equivalent to 48mmol/mol in the UK, at which point you'd automatically be diagnosed with T2 diabetes. 8.6% translates to 70mmol/mol. "Normal BG" is, for the vast majority of non-diabetic people, somewhere between 36 and 42mmol/mol.

The problem with GI is that for many of us, and I'm one, it makes no difference at all. For me it's a useless idea. There are an increasing number of low-carb items around these days, and several firms are making and selling low carb bread. I get rolls from SRSLY at about 2g carb each. They're a fair bit more expensive than standard bread but it means I can have a bacon sandwich without going over my daily carb target.

[Edited to add both "normal" BG values as comparison and the graph]

 

[EllieM]

I suspect that a lot of the dietary advice given to T2s is based on advice given to T1s who can inject for their carbs and often (but not always) don't have any insulin resistance. So it's a question of matching the carb absorption to the profile of injected insulin, and low gi is definitely easier to cope with for this T1.

Just a personal opinion, based on my interactions with dieticians, and quite possibly overly cynical (and incorrect).

 

[Melgar]

I eat carbs. I'm also insulin sensitive. I'm careful with carbs though, but I do eat them. I personally choose exercise over a highly restricted diet (It's already restricted due to my gluten and lactose intolerances) to help control my blood sugars. I do feel that the current demonization of carbs is similar to the demonization of fats that took place several decades ago. Our dietary advice is confusing and conflicted. In my opinion, the real enemy in all this are highly/ultra processed foods , fast foods and the prohibitory pricing of fresh foods - veggies, fruits and meats. If people are struggling financially or/and are at work all day , cheap takeouts and UP ready meals are a draw, and kids love them. Their pallets become accustomed to salty , highly flavoured additives , with man made chemical flavours. And people who consume foods that are highly processed etc likely find healthy, cooked from scratch meals don't have the same flavour profiles. Just my personal view point.

 

[HSSS]

I eat carbs. I'm also insulin sensitive. I'm careful with carbs though, but I do eat them. I personally choose exercise over a highly restricted diet (It's already restricted due to my gluten and lactose intolerances) to help control my blood sugars. I do feel that the current demonization of carbs is similar to the demonization of fats that took place several decades ago. Our dietary advice is confusing and conflicted. In my opinion, the real enemy in all this are highly/ultra processed foods , fast foods and the prohibitory pricing of fresh foods - veggies, fruits and meats. If people are struggling financially or/and are at work all day , cheap takeouts and UP ready meals are a draw, and kids love them. Their pallets become accustomed to salty , highly flavoured additives , with man made chemical flavours. And people who consume foods that are highly processed etc likely find healthy, cooked from scratch meals don't have the same flavour profiles. Just my personal view point.

Totally agree about the upf. Exercise is a great choice if you can do it but not everyone can do enough to maintain control that way alone, and eat the carbs at the same time

However carbs are undoubtedly an issue for those of us who are not insulin sensitive - as is the case for most true type 2. Did carbs make us that way or are they merely the result of insulin resistance or a mix of both I’m not sure but the reality is to have ended up in this forum for the type 2’s the problem already exists however we got there and we now have to manage it.

 

[Antje77]

I do feel that the current demonization of carbs is similar to the demonization of fats that took place several decades ago. Our dietary advice is confusing and conflicted. In my opinion, the real enemy in all this are highly/ultra processed foods , fast foods and the prohibitory pricing of fresh foods - veggies, fruits and meats.

I think there has been very little demonisation of carbs on here. Mainly the advice to use a meter to see how your own diabetes behaves on different foods.
I do not agree thet the 'real enemy' with diabetes is highly processed foods. I can eat a highly processed slice of low carb bread without getting blood glucose to the point of potentially doing damage, but I can't eat a decent portion of fully unprocessed mango (much as I'd like to) without rising to the mid to high teens, even with insulin.
I put my money on the processed bread being healthier for me than the unprocessed fruit, but that's only after using my meter to see what it does to my BG.

 

[Bcgirl]

Such a great conversation! As others have mentioned, everyone is different. You must use yourself as a Guinea pig….test often, use a CGM for a month or two…know what your triggers are.
i have half a functioning pancreas so what I do is far different than someone who is insulin resistant (I am not). Sadly I must keep my carbs well below 10 daily, usually less. This works for me…but only keeps me in the prediabetic category. My intent is to not be medicated for as long as possible. I just don’t do well with medications. My doctor is so happy with my numbers, which have been steady since diagnosis (almost three years). She also said that there are not many people who would do it….
so, for me, carb counting is a must….but honestly when eating a near carnivore diet there is no counting to do. I’m having steak for supper….and maybe if I’m still hungry I’ll have a quarter of an apple with some almond butter..

i wish you well as you figure out your own reactions to all the foods….keep us posted.

 

[Deleted member 596235]

I do not agree that the 'real enemy' with diabetes is highly processed foods...

Yep... I have to agree.

So-called "ultra-processed" foodstuffs are too often made out to
be the demon they're not under closer examination. According to
the Australian government's HealthDirect site, ready-made meals
are ultra-processed—which is an absurdity in many cases.

Yesterday for lunch, I ate a ready-made meal of beef tortellini from the
Aussie "Lean Cuisine" brand.

Nutritionally, it had the following dietary values:

295 calories,
36.8g carbohydrates,
11.7g protein,
3g saturated fat,
781mg salt,
6.4g sugar,
1.5 serves (@75g ea) vegetables,
4.7g fibre.

(Its only chemical additives were 160c, natural
colour, and 635, flavour enhancer.)

My opinion is that this meal is not "ultra-processed" and
in fact is perfectly suitable for a meal—maybe of course not
three times a day every day, but it doesn't deserve its bad
rap as a typical food to avoid.