CARBOHYDRATES AND DIABETES Brenda Davis, RD
Why are Carbohydrates Needed? Primary source of fuel for all body cells Proper functioning of central nervous system, kidneys, brain, and muscles Maintenance of a healthy intestinal tract and protective microbiome
Position Statement 2013 Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes. For good health, carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products should be advised over intake from other carbohydrate sources, especially those that contain added fats, sugars, or sodium. Evert AB. Diabetes Care. 2013; 36:3821-42.
Quantity vs Quality Both amount and type of carbohydrates matter. Sources of carbohydrates matter more than the percentage of calories from carbohydrate. When carbohydrates come predominately from whole plant foods, and energy needs are not exceeded, excellent health can be maintained over a relatively wide range of carbohydrate intakes. vs
Aren t Carbohydrates Bad for People with Diabetes?
It all depends on their source. When carbohydrates come from whole foods they are consistently protective. Blue Zone intakes range from 50-80% of total calories.
Refined Carbohydrates are Bad News
Diets Rich in Refined Carbohydrates Promote overeating and obesity Increase inflammation Impair immunity Increase risk of Diabetes, prediabetes and metabolic syndrome Heart disease GI diseases, including cancers Nonalcoholic fatty liver disease
What are Refined Carbohydrates? High carbohydrate foods that have been stripped of their nutrients by food processing techniques. Simple Refined CHO Sugars - sugar, honey, syrup, jam, jelly, candy and sweetened beverages Complex Refined CHO Starches - white flour products, white rice, and concentrated starches
Refining Grains Whole Grain vs. White Grain Bran The fiber-rich outer layer that protects the seed and contains B vitamins and trace minerals. Endosperm The middle layer that contains carbohydrates and proteins. Germ The small nutrient-rich core that contains antioxidants, including vitamin E, B vitamins and healthy fats. Typical losses: 80-90% of the fiber 70-80% of the vitamins and minerals 95% of the phytochemicals
About 90% of the grains we consume are refined.
Whole Grains are Protective! Large volumes of peer-reviewed evidence demonstrate that higher intakes of whole grains are associated with a reduced risk of diabetes, heart disease and some cancers.
All Whole Grains are NOT Equal!
Whole Grain Hierarchy Intact whole grains e.g. kamut berries, quinoa, brown rice, barley, oat groats Broken whole grains e.g. 12 grain cereal, bulgur Rolled whole grains e.g. rolled oats, barley, rye Shredded whole grains e.g. shredded wheat Ground whole grains e.g. whole wheat flour products Flaked whole grains e.g. cold flaked cereals Puffed whole grains e.g. puffed wheat, rice, millet
Intact Grains are Delicious!
Optimal Intakes of Grains and Starchy Vegetables???
Varies with Energy Needs Once recommended intakes of vegetables, fruits, legumes, nuts and seeds are met, add grains and starchy vegetables to meet energy requirements. Portion control is important for people with diabetes.
Sugar Shock Recommended maximums: Men - 9 tsp/day Women 6 tsp/day Actual Intakes: 22-30 tsp/day FOOD SUGAR (TSP) Slush, 32 oz. 28 Fruitopia, 20 oz. 18 Vanilla shake, 20 oz. 12 Soda, 12 oz. 10-13 Cinnamon bun, 1 large 12 Fruit pie, 1/6 th of pie 11 Low-fat fruit yogurt, 8 oz. 9 Chocolate bar 4-7 AHA. Circulation 2009, 120:1011-1020 1 tsp ~ 4 grams sugar
Sources of Added Sugars (As a % of calories from added sugars) 14% 6% 10% 7% 50% Sweet beverages Grain-based desserts Dairy desserts Candy, sugar and honey RTE cereal and bread Other 13% 21 Data: HANES 2005-2006
Fructose Folly Fructose is metabolized only by liver cells. Excess is turned into fat some is turned into triglycerides and some is stored in the liver may contribute to nonalcoholic fatty liver disease (NAFLD). Adverse effects of too much sugar are even more pronounced with fructose than with glucose. Tappy L. Physiol Rev. 2010;90:23-46. Takeuchi M. Lab Invest. 2010;90(7):1117-27. Basaranoglu M. 2015;4(2):109-16.
What about the sugar in fruit? The body is well equipped to handle fructose when eaten in small quantities, as in fruit. When added to beverages and processed foods, the body s capacity to handle fructose is quickly overwhelmed. Added sugars increase risk of death and disease; fruit is consistently protective. WHY? Phytochemicals + antioxidants Micronutrients Fiber Gan Y. Int J Cardiol. 2015;183:129-37. Hu D, Stroke. 2014; 45(6):1613-9. Li M. BMJ Open. 2014;4(11);e005497.
Fructose in Fruit Fruit Fructose Content (g) Grapes, 1 cup 12.4 Apple, 1 medium 10.7 Cherries, 1 cup 7.5 Blueberries, 1 cup 7.4 Banana, 1 medium 7.1 Watermelon, 1 cup 6 Peach, 1 medium 5.9 Figs, fresh, 3 4.5 Strawberries, 1 cup 3.8 Orange, 1 medium 3.7 Kiwi, 1 medium 3.1 Apricots, 1 medium 1.4 FOR COMPARISON 20 oz Pepsi = 36 grams fructose Source: USDA Nutrition Database
What about dried fruit? Dried fruit is more concentrated in sugar so can increase blood sugar more rapidly than fresh fruit It is higher in fiber It is healthful, but should be used in moderation Great replacement for sugar in desserts and snacks
What About Fruit Juices? Fruit juices (even 100% fruit juice) are best minimized or avoided eat whole fruit instead For a fancy drink, mix a splash of fresh squeezed juice or antioxidant-rich juice with soda water or freeze as ice cubes
What about Frozen or Canned Fruit? Frozen is better than canned No added sugar in either
Fruit is Protective! 2014 meta-analysis (10 studies) found an inverse association with fruit intake 7% risk reduction for one serving Li M. BMJ Open. 2014;4(11):e005497.
Boost Fiber
Benefits of Fiber Stabilizes blood sugar Promotes regularity Improves gut flora Increases satiety and reduces cravings Reduces cholesterol levels Reduces risk of GI disorders Reduces risk of colorectal cancer Enhances immune function Lessens hormonal imbalances
Aim for at least 12-20+ grams of fiber per meal from a variety of whole plant foods.
What are the highest fiber foods? FOOD FIBER (gms) Beans, 1 cup cooked 10-20 Avocado, 1 x 200 g fruit 13.5 Grains, most, 1 cup cooked 5-10 Berries, most, 1 cup 3-8 Vegetables and fruit, most, 1 cup raw 2-5 Nuts and seeds, ¼ cup 2-5 Source: USDA Nutrient Database 27 ONLY PLANT FOODS CONTAIN FIBER
Focus on Viscous Fiber Viscous fiber helps to reduce blood sugar after meals and blood cholesterol levels Best sources - legumes, barley, oats, flaxseeds, passion fruit, avocado, figs, citrus fruits, sweet potatoes, Brussels sprouts, asparagus, turnips, pears, apricots, collards and other greens, peas
Aim for Low Glycemic Load Focus on foods that don t cause a rapid rise in blood sugar.
GI and GL Definitions GI = measure of how food affects blood sugar GL = amount of carbohydrate in a food x GI (%) GL is more practical tool as the AMOUNT of carbohydrates consumed is taken into consideration. Some foods have a high GI but generally a very low GL because the total carbohydrate content is low. Watermelon (120 g) GI = 72 GL = 4 (0.72 x 6)
GL and Type 2 Diabetes Risk 24 prospective cohort studies consistent, strong relationship between GL and T2D risk RR of T2D was 1.45 for every 100 g increment of GL 100 g of GL equals: 100 g CHO with a GI of 100 200 g CHO with a GI of 50 300 g CHO with a GI of 33. Livesey et al. Am J Clin Nutr. 2013: 97(3):584-96.
GI of Selected Grains Food Glycemic Index Serving Size Glycemic Load Cornflakes 81 1 oz 20 White rice 64 5 oz 23 White bread 75 1 oz 11 100% whole wheat bread 74 1 oz 9 White table sugar 68 2 tsp 7 Rice, brown 55 5 oz 18 Oatmeal 55 8 oz 13 Heavy specialty grain bread 53 1 oz 7 White spaghetti 49 6 oz 24 Whole wheat spaghetti 48 6 oz 18 Bulgur, boiled 48 5 oz 13 Wheat berries 41 1.75 oz dry 14 Rye berries 34 1.75 oz dry 13 Barley 25 5 oz 10 Key: Low Medium High
GI of Other Foods Food Glycemic Index Serving Size Glycemic Load Potato, boiled 78 5 oz 21 Raisins 64 2 oz 28 Sweet potato 61 5 oz 17 Corn 54 5 oz 9 Banana 51 4 oz 13 Carrots, boiled 47 3 oz 3 Apple, raw 38 4 oz 6 Chocolate bar, milk 43 1.76 oz 12 Orange, raw 42 4 oz 5 Beans (average) 29 5 oz 5 Cashews 22 1.75 oz 3 Soybeans 18 5 oz 1 Carrots, raw 16 3 oz 1 Peanuts 14 1.75 oz 1 Key: Low Medium High
Factors Affecting Glycemic Impact Type of sugars and starches present (fructose vs glucose; amylose vs amylopectin) Particle size Food Processing Gelatinization Fiber Cooking Ripeness Density Acidity Speed of eating vs vs vs
Carb-Commonsense Rely on vegetables, fruits, legumes and whole grains as your primary carbohydrate sources Minimize products rich in refined carbohydrates (e.g. white flour, sugar) Avoid beverages containing sugar
The Solution is Simple. Whole Foods, Plant-based Diet!
Questions?