Carbohydrate: How Low Should You Go?

When it comes to food and diabetes carbohydrate takes center stage. That’s because carbohydrate impacts your blood glucose – also called blood sugar, levels more than any other nutrient. However, the ideal amount of carbohydrate in the management of diabetes is unclear.

Expert advice on recommended carbohydrate intake has gone through several cycles over the years—ranging from low to high carbohydrate. Many people with diabetes believe that total carbohydrate restriction is the only way to manage diabetes. Results of a new review study suggest that moderate carbohydrate intake may be the best way to manage diabetes.

When individuals in the study followed a low to moderate carbohydrate diet with 57 grams to 198 grams (g) carbohydrate, they had a lower A1C compared to those who followed a high carbohydrate diet with 133 g to 205 g of carbohydrate. Moreover, the greater the carbohydrate restriction, the more significant the glucose-lowering effect. The A1C test tells what your average blood glucose level has been every day for the past 90 days.

Experts agree that there is no ‘one-size-fits-all’ when it comes to carbohydrate and it’s the total amount of carbohydrate – sugar, starch, or fiber at the meal that affects your blood glucose levels. It’s reasonable for most adults to eat 45 g to 60 g of carbohydrate per meal or a total of 135 g to 180 g carbohydrate per day.

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Adults on low-calorie diets and adults who are physically inactive may want to aim for the lower end of that range. To determine how much carbohydrate is best for you, check your blood glucose levels two hours after the start of your meal. According to the American Diabetes Association, a blood glucose level less than 180 mg/dl is an indicator of good diabetes control.

Before attempting to follow a low carbohydrate diet with less than 130 g carbohydrate, you should…

…see a registered dietitian nutritionist or certified diabetes educator, particularly if you take insulin or oral medications for diabetes that stimulate insulin secretion. You may need a redistribution of carbohydrate or an adjustment in your medication.

Carbohydrate restriction is not the only way to control blood glucose. Plant-based diets work well even though the amount of carbohydrate is greater than a low-carbohydrate diet. Plant-based diets are high in fibrous foods like beans and whole grains that slow the conversion of sugar or starch into glucose, keeping the blood glucose more stable after meals.

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High fiber foods also tend to have a low glycemic index which may provide additional benefit in the management of diabetes. The GI is a measurement of how fast a particular carbohydrate raises blood glucose. Foods with a high GI will raise your blood glucose quickly, while a low GI food, which is absorbed more slowly, will raise your blood glucose more slowly.

The following guidelines will help you choose your carbohydrate wisely.

• Low to moderate carbohydrate diets have a greater effect on blood glucose control in diabetes compared with high-carbohydrate diets.
• Food containing carbohydrates from whole grains; minimally processed fruits and vegetables; and low-fat milk and yogurt; should be included in a healthy diet.
• The total amount of carbohydrates in meals and snacks is more important than the source or type.
• Sugar counts as carbohydrate sources in a meal, but low-calorie sweeteners don’t have to be counted as carbohydrates in your meal plan.
• A healthy fiber intake is 20 to 35 grams daily or 14 grams per 1,000 calories.

Constance Brown-Riggs, MSEd, RD, CDE, CDN is a registered dietitian, certified diabetes educator, national speaker and author of The African American Guide to Living Well with Diabetes. She is a Dannon One Yogurt Every Day Nutrition Advisor.