Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Carbohydrate-Counting Diet

by Maria Adams, MS, MPH, RD and Rebecca J. Stahl, MA

What Is Carbohydrate Counting?

Carbohydrate counting is a method of keeping track of the number of carbohydrates you eat at each meal. Carbohydrates from your food get digested and absorbed as glucose (sugar) into your blood. Counting carbohydrates allows you to be aware of how food will affect your blood glucose (also known as blood sugar) This is important if you need to manage your blood sugar levels.

Why Should I Use the Carbohydrate-Counting Method?

Carbohydrate counting is particularly useful for people who take insulin shots since it allows you to balance food intake with insulin. The more carbohydrates you eat, the higher your blood sugar will be, and the more insulin you will need. Of course, always ask your doctor before adjusting insulin doses on your own.

Carbohydrate-Counting Basics

When you eat carbohydrates, your body turns them into sugar, or glucose. The foods that raise blood sugar the most are those that are high in carbohydrates (eg, starches, milk, fruit, and sweets).

Carbohydrates are often classified as simple or complex:

Complex carbohydrates, or starches, include whole grains, starchy vegetables, and legumes.
Simple carbohydrates, or “sugars,” include table sugar, honey, high fructose corn syrup, and the sugars found in milk and fruit.

Types of Carbohydrates	Healthy Choices	Foods to Limit or Avoid
Simple Carbohydrates (Sugars)	Fruits Low-fat milk and milk products Vegetables	Foods high in added sugars (eg, candy, cookies, ice cream) High fructose corn syrup—This is found in soda and juice drinks. It is often added to processed foods, as well. Read the list of ingredients. Honey Table sugar (eg, cane sugar, sucrose)
Complex Carbohydrates (Starches)	Beans Lentils Starchy vegetables Whole grains	Refined starches (eg, white flour, foods made from white flour, and white rice)

How Much Is One Serving of Carbohydrates?

One carbohydrate serving is equal to 15 grams of carbohydrate. This is about the amount of carbohydrate in one slice of bread, ¾ cup dry, unsweetened cereal, ½ cup of pasta, one cup of milk, or one small piece of fresh fruit.

Since they have similar effects on your blood sugar, they can also be “exchanged.” This is because these foods are generally considered “carbohydrate servings.” For example, you may trade one starch serving for one fruit or milk serving.

The table below gives examples of foods that have approximately 15 grams of carbohydrates per serving.

Food Group	Serving Size and Type of Food
Fruits	1 small piece of fresh fruit 4 ounces of juice ½ cup of canned or frozen fruit
Starchy Vegetables (eg, potatoes, sweet potatoes, corn, green peas, green lima beans)	¼ of a large baked potato ½ cup mashed potatoes ½ cup of peas or beans
Grains	1 slice of bread 1/3 bagel 1/3 cup rice 3 cups popcorn ¼ cup granola ¾ cup unsweetened cereal
Protein	6 chicken nuggets ½ cup beans
Dairy	1 cup milk 2/3 cup of plain fat-free yogurt ½ cup ice cream
Other	1 medium sugar cookie

Meats and fats generally contain little or no carbohydrate, while non-starchy vegetables contain only five grams per serving (one serving equals 1 cup raw vegetables or ½ cup cooked). Examples of non-starchy vegetables include:

Artichoke hearts
Asparagus
Broccoli
Celery
Cucumbers
Dark green leafy lettuce or spinach
Eggplant

There are books that provide comprehensive carbohydrate count lists. In addition, most packaged foods have labels with the carbohydrate amount.

How Much Carbohydrate Can I Eat?

Most people with diabetes should consume between 45%-65% of their calories as carbohydrates (and the rest from fat and protein).

There are four calories in every gram of carbohydrate. So, for example, if you are on a 2,000-calorie diet with 50% of your calories coming from carbohydrates, you can have a total of 16 servings of carbohydrate per day.

Calculating Carbohydrate Servings (2,000 Calorie Diet)
50% of calories from carbohydrates = 1,000 calories
1,000 calories divided by 4 calories per gram of carbohydrate = 250 grams
250 grams divided by 15 grams carbohydrate per serving = 16.66 servings

How you distribute these servings will affect your blood sugar. The bottom line is that you should space out your carbohydrate servings into at least three meals per day, ideally with a snack in between. This frequent and steady intake of carbohydrates will keep your blood sugar steady (as opposed to a huge meal of carbohydrates and then no more carbs for the rest of the day). In addition, the more fiber the carbohydrates contain, the better the effect on your blood sugar.

The table below shows examples of different ways that these 16 carbohydrates servings could be distributed:

Breakfast	4	4	2	3	4	3	0
AM Snack	0	2	2	2	2	1	3
Lunch	5	4	4	3	5	4	3
PM Snack	0	2	2	2	2	2	3
Dinner	5	4	4	4	3	4	4
Evening Snack	2	0	2	2	0	2	3
TOTAL CARBS	16	16	16	16	16	16	16

Meal Planning

A registered dietician can help you master carbohydrate counting and come up with an individualized meal plan for you. The dietician will take into consideration a number of factors, like how well you are managing your diabetes, how physically active you are, how much you weigh, and how old you are.

What Should I Consider When Planning My Meal?

Count Your Carbs

Learn which types of foods contain carbohydrates and the amount per serving. A quick search online will turn up a range of reference books to help you count carbohydrates and plan diabetic meals.

When grocery shopping, remember to read the food label. This will tell you the portion size and the total carbohydrate amount. For example, one granola bar can have a total of 22 grams of carbs.

To be more precise with your counting, use measuring cups and spoons, as well as a food scale. For example, an apple weighing 4 ounces has about 15 grams of carbohydrates.

Use a worksheet to keep track of your meals, drinks, and snacks. Share this information with your dietician so that she can check on your progress. Carb counting software programs are also available to help you stick to your meal plan.

Be Aware of Foods That Are Carb-Free

Not all foods contain carbohydrates! For example, a 6-ounce serving of ground beef contains 0 carbohydrates, but has over 500 calories. And one teaspoon of corn oil also has 0 carbohydrates, but has 40 calories.

With this in mind, choose your proteins and fats in moderation. If they are eaten in excess, you may exceed your target calorie level and gain weight. Foods that are high in fat and cholesterol should also be limited to decrease your risk of developing cardiovascular disease.

Don’t Forget About Fiber

Fiber is a carbohydrate. But, because the body cannot break it down, it does not affect blood sugar. If you eat many high-fiber foods, you may want to talk to a dietitian about label reading to learn how to subtract the “dietary fiber” grams from the “total carbohydrate” grams. This subtraction gives you a more accurate estimate of the carbohydrates that will affect your blood sugar.

Make Healthy Choices

Eat a variety of healthy foods everyday by choosing:

Healthy fats, like olive and canola oil, peanuts, avocado, and fish oil.
Lean sources of protein, like lean cuts of beef and pork, poultry, fish, beans, and legumes
Unprocessed, unrefined sources of carbohydrate (eg, whole grains, fruits and vegetables, beans, and lentils)

The United States Department of Agriculture’s ChooseMyPlate offers more tips, like:

Be aware of the sodium amounts, especially in soup, bread, and frozen foods. Choose lower sodium products.
Drink fat-free or low-fat (1%) milk.
Fill half you plate with fruits and veggies.
Instead of drinking sugary drinks, have plain water instead.
Watch your portion sizes!

Sample Meal

Are you wondering what it would be like to eat a carb-friendly dinner? Here is just one example, but keep in mind that a dietician can create a personalized meal plan for you.

Food	Grams of Carbohydrates
Small raw apple	15
Baked chicken (6 ounces)	0
Pasta (½ cup)	18
Cooked zucchini (½ cup)	5
Bread (1 slice)	15
Non-fat milk (1 cup)	15
Total Amount of Carbohydrates	68

Last reviewed: August 2011 by Dianne Scheinberg MS, RD, LDN.

RESOURCES:

American Diabetes Association
http://www.diabetes.org/
ChooseMyPlate.gov
http://www.choosemyplate.gov/

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca/
Dietitians of Canada
http://www.dietitians.ca/

References:

American Diabetes Association website. Available at: http://www.diabetes.org . Accessed December 29, 2009.
Carbohydrate counting. American Diabetes Association website. Available at: http://www.diabetes.org/food-and-fitness/food/planning-meals/carb-counting/. Accessed August 4, 2011.
Carbohydrate counting. Canadian Diabetes Association website. Available at: http://www.diabetes.ca/Section_About/carbcount.asp . Accessed December 29, 2009.
Carbohydrate counting 101. Joslin Diabetes Center website. Available at: http://www.joslin.org/info/Carbohydrate_Counting_101.html. Accessed August 4, 2011.
Carbohydrate counting with chronic kidney disease. National Kidney Foundation website. Available at: http://www.kidney.org/atoz/atozItem.cfm?id=51 . Accessed December 29, 2009.
ChooseMyPlate.gov website. Available at: http://www.choosemyplate.gov/index.html. Accessed August 4, 2011.
Diabetes diet: create your healthy-eating plan. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/diabetes-diet/DA00027. Accessed August 4, 2011.
Kulkarni KD. Carbohydrate counting: a practical meal-planning option for people with diabetes. Clinical Diabetes . 2005; 23:120-122.
Powers M. American Dietetic Association Guide to Eating Right When You Have Diabetes . Hoboken, NJ: John Wiley & Sons, Inc; 2003.
United States Department of Agriculture. My Food-a-Pedia website. Available at: http://www.myfoodapedia.gov/Default.aspx. Accessed August 4, 2011.