carbs

Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity

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Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity

Abstract: A novel hypothesis of obesity is suggested by consideration of diet-related inflammation and evolutionary medicine. The obese homeostatically guard their elevated weight. In rodent models of high-fat diet-induced obesity, leptin resistance is seen initially at vagal afferents, blunting the actions of satiety mediators, then centrally, with gastrointestinal bacterial-triggered SOCS3 signaling implicated. In humans, dietary fat and fructose elevate systemic lipopolysaccharide, while dietary glucose also strongly activates SOCS3 signaling. Crucially however, in humans, low-carbohydrate diets spontaneously decrease weight in a way that low-fat diets do not. Furthermore, nutrition transition patterns and the health of those still eating diverse ancestral diets with abundant food suggest that neither glycemic index, altered fat, nor carbohydrate intake can be intrinsic causes of obesity, and that human energy homeostasis functions well without Westernized foods containing flours, sugar, and refined fats. Due to being made up of cells, virtually all “ancestral foods” have markedly lower carbohydrate densities than flour- and sugar-containing foods, a property quite independent of glycemic index. Thus the “forgotten organ” of the gastrointestinal microbiota is a prime candidate to be influenced by evolutionarily unprecedented postprandial luminal carbohydrate concentrations. The present hypothesis suggests that in parallel with the bacterial effects of sugars on dental and periodontal health, acellular flours, sugars, and processed foods produce an inflammatory microbiota via the upper gastrointestinal tract, with fat able to effect a “double hit” by increasing systemic absorption of lipopolysaccharide. This model is consistent with a broad spectrum of reported dietary phenomena. A diet of grain-free whole foods with carbohydrate from cellular tubers, leaves, and fruits may produce a gastrointestinal microbiota consistent with our evolutionary condition, potentially explaining the exceptional macronutrient-independent metabolic health of non-Westernized populations, and the apparent efficacy of the modern “Paleolithic” diet on satiety and metabolism.

Keywords: carbohydrate density, metabolic syndrome, nutrition transition, Paleolithic diet

How To: Match Insulin Reduction to Carb Reduction and Get The Best out of the Insulin Calculator

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This section is for everyone.  For the purposes of this module I am going to assume that you are currently on a high carb/ low fat diet, that you are on a basal bolus regime with a long acting insulin and a rapid acting insulin analogue. This could be in vial and syringe or pen form.

The total time that you can expect to take from going from where you are to normal blood sugars is about 3 months if you follow this programme. This can be considerably shortened if you already have a high degree of background knowledge and do not encounter any particular problems with your carb reduction and insulin adjustments.

 

THE FIRST MONTH

STEP ONE: KNOW YOUR STUFF ABOUT DIABETES, INSULIN AND DIET

This step can be expected to take 4 weeks if you allow 30 – 60 minutes a day.

Before you are ready to reduce your carbohydrate and therefore insulin it is best to do the modules appropriate for you and have a buddy to help you. Help from your diabetes team is most helpful but they may not have the time to help you or may not be happy with carbohydrate reduction. If you haven’t already joined an internet support group this could be the time to do it.

You should already have:

  • Read and understood all the course modules that have been selected for insulin users.

Reviewed thoroughly the modules:

You now know a great deal about your diabetes: the sort of insulin regime you are on, basal insulins, meal insulins, correction doses, carb sensitivity at different times of the day, how much insulin you need for most commonly eaten meals, and how much carbohydrate you are consuming for meals and snacks and the effect that exercise has on your blood sugars. You also will have an idea of what you are aiming to eat in the future compared to what you are doing now.

You may need to obtain extra testing stix, glucograph sheets, regular insulin and syringes/needles or pens. If you are already using a pen a half unit one is best. You will need one for each type of insulin you are on. Unfortunately the Autopen Classic which is used with Hypurin Pork (regular) insulin only comes in one unit pens.

 

THE SECOND MONTH

WEEK ONE

STEP TWO: SORT OUT ANY HYPOS

This step can be expected to take about a week. If you don’t have any hypos you won’t need to do this but you are likely to need to know about it once your insulin regime gets better control of your blood sugars.

Are you having regular hypos?  If so what time of day or night?

You need to cut back gradually on your insulin that governs that time of day.

Night hypos – reduce basal.

Morning hypos – reduce breakfast insulin

Afternoon hypos – reduce lunch insulin

Evening hypos – reduce lunch insulin

 

STEP THREE: GET YOUR INSULIN ACTING PREDICTABLY

In order to get the best match between insulin and food the insulin needs to be delivered in a predictable way. The key to this is the 7 units per shot rule.

BASAL

Write down how much basal you take in 24 hours.

If you are only on one injection of basal a day you can improve 24 hour coverage by changing to an injection on rising and an injection before bed. The gap between the night insulin is best to be 9 hours or less but up to a 12 hour gap may be fine if you don’t have a pronounced dawn phenomenon. The aim is to stop over dosage of basal which at some points during the day may make you need to eat to stop from going low. We also need to keep the basal high enough at other times of the day so you are not overdoing meal insulin to cover gaps that can arise in the evening if you are only on a single night dose of eg Lantus or  Detemir.

How much insulin will you need at each injection when you go to twice daily basal injections?

If this is over 7 units per shot you may need to reduce your basal slightly. You will be checking your 3 am blood sugar in this phase to check how accurate your basals are.  If your basal insulin is currently over a 24 hour total of 14 units you need to reduce the total insulin injected by 15%.

Example:  Mary is on Detemir 34 units once before bed.

This is going to need a reduction of 15% to start with. This leaves 29 units over 24 hours.

Divide this by two to find out the amount this will be when split into two injections:

14.5 units each.

The total number of injections to cover basal will therefore be expected to be 7u x 2 separate injections both night and morning. This does leave a deficit of 0.5 units but  as this is quite a small amount it would be okay to see how this regime goes. If this regime is tried for three nights and the 2-4 am blood sugar is 4.4-5.6 this would be satisfactory. If the readings were higher the additional half units or progressively more insulin could slowly be added. It is best not to change basals more than every 3 days as it takes a while for insulin levels to balance out. If hypos occur through the night and you are certain it is not the effect of two much meal insulin beforehand you would need to reduce the amount of insulin given at your basal injections eg to 6 units x 2 morning and night and gradually adjust upwards for fine control.

Within one to two weeks I would expect your basals to be much more stable. You are now ready to proceed to sorting out your meal insulins.

STEP FOUR: STOP SNACKING

The first step to sorting your meal insulins is to know what effect the insulin you gave yourself for the last meal actually had. You have little chance of getting this right till you stop snacking.

If you have a hypo and usually snack you need to change what you do when you have a hypo. The best thing is to have a small quantity of pure glucose in liquid or gel form and be careful not to overtreat.  Over correction of hypos is hard to prevent if less than very rapidly acting carb is taken as it acts too slowly to get you feeling better fast enough.

If you have a hypo due to exercise and this is a regular thing the best way of dealing with it is to have the snack – which could in this instance be a food item – before or during the particular exercise.  Getting this right can take some practice.  This is fine for regular activities eg twice weekly supermarket shop, a weekly game of tennis.  If the exercise is not a regular thing can you put it off till you have finished this run in phase? It will only take a few weeks.

Hunger and a need for snacks can also be due to basal insulin being too high. Is this well under control now?

You now have got the hang of the 7 shot rule, no snacking and have sorted out your basals and hypos.

 

WEEK TWO

STEP FIVE: SORT OUT YOUR BREAKFAST

REDUCE BREAKFAST CARB BY HALF

Breakfast is usually eaten at home. It is beneficial to eat a high protein meal to reduce the tendency to snack from hunger late on.  The lower amounts of carb usually eaten at this meal to help deal with the dawn phenomenon.  For the purposes of all your meal experiments in this second month  however we are going to aim for the following plan meanwhile.

Plan out the minimum amount of protein you need for the day.  This is your ideal body weight in kilograms divided by six.  Eat no less than one third of this in ounces of lean protein for breakfast.  Do the same for  lunch and dinner.

Lets assume you are a bit overweight but ideally are 60kg. You would be looking at 10oz of protein a day and would want to eat at least 4oz of protein at breakfast.

E.g. three egg omelette with some ham chopped into it.

It is amazing how filling this sort of breakfast is compared to a high carb one.

For carbohydrates you will already know the approximate carb count for what you eat.

Banana  30g

Glass of milk 15g

2 slices of toast 40g

Marmalade 5g

Breakfast cereal 40g

Coffee 0g

The total is 130g.

To start with reduce your carbohydrate by half of what you are on or to 30g whatever is the highest.

What of these foods could you do without?

Work it out.

Say you go for 65 g and go for the breakfast cereal, milk and a half slice of toast with butter instead of marmalade.

Give yourself the insulin you would normally give in proportion to the carb you intend to eat.

Eg  If you normally give 13 units for the 130g breakfast give yourself 6.5 units for the 65 g breakfast.

If the insulin injection is more than 7 units then you need to split the insulin into more than one shot.

STEP SIX: COVER BREAKFAST PROTEIN WITH REGULAR INSULIN

You may need to have obtained regular insulin in syringe and vial or pen form. In the UK pen regular insulin is only available in pork or beef versions from Wokhardt Pharmaceuticals. This is able to be imported to other countries however.

Use 2 units of regular insulin for each 3oz portion of lean protein you are eating. This is a starting dose to use till you start to profile your meals and fine tune them with different proportions of different insulins. Ideally inject this 15 minutes before eating. Alternatively you can use a small amount eg 1- 1.5 units of rapid acting insulin to cover protein but inject this 1.5 – 2  hours after eating.

STEP SEVEN: CUT BACK TO 30g of CARB FOR BREAKFAST

The next step is to cut back your breakfast carbs to 30g or less. Again adjust your insulin accordingly. At this stage you are aiming to have your blood sugar before your next meal within your target range. It is unlikely that you won’t spike at one or two hours on this amount of carb without running low before your next meal. The goal however at this stage is simply to work your way down gradually and particularly to avoid hypos.

WEEK THREE

STEP EIGHT:  SORT OUT YOUR LUNCH

 

Follow the same steps for your breakfast.

Your insulin sensitivity is likely to be best at this time of day.  You may well be able to cut insulin doses somewhat.

STEP NINE:  SORT OUT YOUR EVENING MEAL

Follow the same steps as your previous meals. Your insulin sensitivity will be a bit lower than at lunch but usually not quite as high as at breakfast.

WEEK FOUR

STEP TEN: SORT OUT YOUR BEDTIME SNACK

Follow the same steps as your previous meals. If you don’t usually have a bedtime snack you don’t need to have one just for the sake of it.

Your final level for this phase is a bedtime snack of 15g or less.

You should now be on three meals a day of 30g carb and an optional bedtime snack of 15g maximum of carb.  You may also be having some extra carb to cover planned daily exercise.   Your insulin doses should be much less than usual and your predictability should be much improved. You may have had hypos in this reduction phase and you should have been adjusting your insulin doses downwards to sort this out. The main blood sugars that are of most concern right now are the fasting, pre-meal and 3am blood sugars that you can expect to be around target by now.

THE THIRD MONTH

WEEK ONE

STEP ELEVEN:  FINE CONTROL OF CARB INTAKE

How low in total carbs would you be happy to go for each meal?

Can you reduce higher glycaemic carbs that you may have been eating?

Can you substitute lower glycaemic  options eg avocados at breakfast instead of bananas?

The optimal is 6g for breakfast  and 12g of carb for each other meal. This is based on Dr Bernsteins work which aims to give no blood sugar spikes at all and highly consistent blood sugars 24 hours a day.

It is perfectly acceptable to have higher amounts than this. The important thing is that you reckon you can be consistent about what you are going to do.

STEP TWELVE: FINE CONTROL OF PROTEIN INTAKE

You know how much protein is considered a minimum for you and you’ve been eating this for a few weeks. Is this completely satisfying for you?

If you are hungry before your next meal is due perhaps you could do with more? Some of us need a lot more!

Alternatively you may have delayed stomach emptying and need to reduce your dinner portion of protein?

You will now have good experience of varying your regular insulin to your protein at various times of day and you can adapt what you have found out to sorting out the right dose for the protein you prefer to consume.

STEP THIRTEEN: FINE CONTROL OF FAT INTAKE

The good news for variations in your fat intake is that you don’t need insulin to cover fat.

How is your weight doing?

Have you lost weight on this regime? Have you gained?

You need to adjust your fat intake to reflect the calorie balance you want to have. This is easier than previous adjustments. Eat enough fat to make your meals enjoyable as a reasonable minimum and up the fat as needed to keep your weight at a level that is ideal for you.

WEEK TWO

STEP FOURTEEN:  PROFILING YOUR MEALS

Now you are eating your ideal or near ideal diet regarding carb/ protein and fat proportions it is time to again fine tune your insulin.

For each actual meal that you are going to profile you need to:

Eat the same  food in the same proportions each time at around the same temperature and the same time of day.  Eat it at around the same speed.

Weigh or measure your portions. You may as well have the portion size you really want to eat.

You need to have a blood sugar in your target range, you need to avoid unusual exercise and you need to be well ie not coming down with a cold or have a gum infection for instance.

Take the insulin you think you should take at the time you should take it and then eat the meal when you plan to.  Check the bs every half hour – one hour after finishing the meal until the next meal is due.

You can see several patterns.

No hypos till next meal. Well done. You have not overdone the insulin.

Hypo in the first two hours after eating.  You need to reduce the rapid acting insulin for that meal.

Hypo in the 2.5- 5 hour mark after the meal. You need to reduced the regular acting insulin for that meal.

Spikes in the first 2 hours after the meal.  You need to increase the time interval between giving the rapid acting insulin and eating OR you need to up the dose.

Spikes in the 2.5 – 5 hours after the meal.  You need to increase the regular insulin for the protein or carbohydrate component of the meal.

Hypos in the early post meal period and spikes in the later post meal period may indicate that the meal is best covered by a higher proportion of regular insulin than rapid acting insulin. This is common for high fat meals as carbohydrate absorption is delayed. This phenomenon is called the “Pizza Effect”. It is discussed more in the insulin calculator section which follows.

Once you have hit the right dose for that meal put a note of it in your favourites list. You can add this to your insulin calculator should you choose to use this.

WEEK THREE

STEP FIFTEEN:  WHAT DO YOU REALLY MISS? CAN YOU SUBSTITUTE IT?

You are now almost at the end of the course. The next three sections are all about making life a bit easier for you.

What do you really miss, or know that you would like to eat sometimes?

Have a good look at the carb cooking and baking modules again. This is the time for you to experiment with something you haven’t tried so far. If you can find a good substitute and you won’t miss that item eg cauliflower mash instead of mashed potatoes or low carb muffins/ cheesecake you simply have to organise yourself to have a regular cooking/ baking day and prepare packed lunches for when you need them.

STEP SIXTEEN:  WHAT DO YOU STILL REALLY MISS? CAN YOU CARB WEIGHT IT?

If there is an item that you think you must have eg pizza, a burger bun or so forth you need to review the carb weighting technique section again. To do your experiments on this it is best to do these at lunch time and when you have company to help if you over do the insulin and have a hypo.

WEEK FOUR

STEP SEVENTEEN: PROGRAMMING YOUR PORTABLE INSULIN CALCULATOR.

There are two versions of the insulin calculator available. One is for downloading onto your pc and the other is a more sophisticated programme for a palm top which has the advantage of greater portability.

The insulin calculators have background tables that you programme yourself. What you are doing is putting in your particular information into several of these background tables. When you are using the calculator you will usually be putting in the carb values of the food you intend to eat, the particular meal involved and your current blood sugar.  The machine calculates the amount of insulin you need to take. As there are differences between the calculators I will explain them separately. For using either of them is essential that you have done all your experiments to find out the correction factors, carb sensitivities and weightings that work for YOU. It also helps to understand more about the “Pizza Effect” so that you can adjust the proportion of rapid acting and regular insulin for the type of meal you are having.

The Pizza Effect is the pattern of blood sugars you get when you use the correct carb sensitivity for the total carb content of the food but don’t take into consideration the effects of delayed glucose absorption when high amounts of fat or protein are also in the meal. It isn’t just pizza that can do this !

If you use a single injection of rapid acting insulin to cover these types of  meal you will end up with low blood sugars soon after eating the meal and a delayed rise in blood sugars after the meal. To counteract this you need to be prepared to allocate some of your total insulin dose to regular insulin taken at the same time as your pre-meal insulin or another separate injection of rapid acting insulin some time after eating the meal.  A pragmatic way of doing this is to allocate 50% of the carb allowance to rapid acting insulin and 50% to regular insulin. You then can see what results you get and vary the doses for that meal in the future accordingly. Some meals eg toast and jam are likely to need all rapid insulin. Others eg thin crust pepperoni pizza or a meaty lasagne are likely to need all regular insulin. Mixed meals like fish and chips could well be a 50: 50 split between the types.

There are a few things to remember:

  1. Rapid acting insulin has x 1.5 the potency of Regular insulin.

Say your carb content of the meal is 30g and you wish to give half of this to rapid insulin and half to regular insulin. Your sensitivity happens to be one unit of rapid for each 15g of carb. You would therefore need to give one unit of rapid acting insulin and 1.5 units of regular insulin.

  1. Correction doses are always rapid acting insulin.
  2. Protein cover is always regular acting insulin.
Personal Computer Insulin Calculator Version

This is the basic programme.  The background tables are needed for your:

Correction doses.

Insulin sensitivity for breakfast, lunch, dinner and bedtime snack.

Carb weighting values.

When you use the programme you will enter:

Current blood sugar.

Breakfast, lunch, dinner or bedtime snack.

Total carb count of the meal.

You will receive an insulin dose based on any correction dose needed, carb sensitivity you have registered for that particular meal and any additional carb needed for carb weighting factors. This will be the total  rapid acting insulin dose equivalent.

You then need to:

Consider how much of the total dose may need to be split between rapid and regular insulin if this applies to the type of meal you are having.

Calculate the conversion factor ( 1.5 ) to change rapid to regular insulin.

Visually estimate your protein amount in the meal and add this to the amount of regular you are going to inject. The sum is approximately 2 units of regular for each 3oz size of lean protein. This is the size of a pack of cards.

You should then have the total amounts of rapid and regular insulin you are likely to need. You need to profile each meal. Are you happy with the results? Feel free to adjust your insulin for that meal. From time to time you may also need to adjust the background tables. Remember the maximum your are going to inject is 7 units per shot.

Portable Palm Insulin Calculator Version

This programme has some extra features that are not available on the pc version.

The same background tables are filled in for correction doses, insulin sensitivities for different meals and carb weighting values.

When you use the programme you enter the same data regarding blood sugar, time of meal and total carb count of the meal.

These features are all exactly the same as the pc version.

The difference with this calculator is that additionally you have another programme in which you can:

  1. Add your estimate the amount of protein for your meals. The insulin needed to cover this is automatically added to the amount of regular insulin total.
  2. Decide how much of a percentage of the carb count should be allocated between rapid acting and regular insulin.
  3. Put your profiled meals on a favourites list. When you are going to eat any of these meals the calculator will adjust the doses according to the time of day you intend to eat it.

Things to be aware of:

  1. You do need to calculate any pre-meal correction doses separately when you use the protein calculator. A pop up box reminds you of this when this applies.
  2. When putting in the protein value from nutritional information on a meal packet you multiply the protein amount in grams for the portion you are eating by 4.6 and put this total in the protein box.
  3. When putting in the protein value from a visual estimate or measured amount of lean protein that does not have nutritional information you need to estimate the amount in ounces, multiply by 30 and put this total in the protein box.

The palm version offers the advantage of portability, a favourites list and calculates the protein insulin for you.  It is a bit more complex to use and programming the protein is not quite as straightforward as programming the carbs. It can be helpful to use to get specific meals sorted out. I would recommend that for most meals you start with a 50:50 rapid: regular split to avoid the worst of the  “Pizza Effect” and adjust according to your results from there.

Neither insulin calculator is a necessary feature of good meal profiling and manual collection of information is just as good. What they do is make the sums that you would be doing as a matter of course for new meals easier. This particularly applies to larger meals and processed ready meals that contain nutritional information.

Reference Info:

Where to Next:

We have now completed one of the toughest parts of this course. Well done. Congratulations to our helpers too.

To complete our journey I would like to read you a little story. There is no quiz in the next section.

Please all continue to the Endings and New Beginnings page.

How To: Count Carbohydrates

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This section is necessary for everyone to read at least once. When you understand the complexities of carb counting you need to ask yourself if you need to learn it or not.

If you are an insulin user who wants to eat higher carb meals even just sometimes you do have to learn and become highly proficient at this skill.

If you are not on insulin you may prefer to have a “done it for you” sort of diet such as Dr Annika’s, the Life without bread diet or coming later in the How To: Follow Dr. Bernstein's Dietary Plan section.

If you are an insulin user who would prefer not to carb count you will still need to have some idea of what sorts of relative amounts of carb different foods have. Whether you choose Dr Annika’s, LWB or Dr Bernstein’s diet you are still going to have to cut your carbs gradually and be very consistent particularly in the run in phase when insulin doses are reducing. You need to give this carb counting a very good effort. When you are eventually stable on a low carb eating plan that suits you it is entirely possible to keep to doing what you know works and hardly carb count after that point.

There are several methods of carbohydrate counting that are commonly used.

1. Lists.

2. Exchange method.

3. Carb factors.

4. Nutritional labels.

5. Nutritional scales.

6. Eyeballing.

These all have their pros and cons. You need equipment or information sources for some of them. No matter how accurate you try to be you are likely to end up with an approximation of the carb content. The more of these methods you become comfortable with the more versatility you will have under different circumstances. In all cases you need to make the best estimate you can and notice the results you get. What would you change next time if your post meal blood sugars are not within your particular target range? By giving it your best guess and then testing you can build up a profile of how your body, medication doses,  and insulin can cope with that particular meal at that particular time of day.

 

HOW TO LOOK UP CARB LISTS.

Carb lists of food items can come from various sources. There are published books, web based resources and chain restaurants will often publish leaflets to give you an idea of the carb count or have the information on a web site.

One of the difficulties however is knowing what portion size they have actually measured. Sometimes a food is listed by the amount of carb in 100g which is a little over 3 ounces. Other times cups, tablespoons, handfuls or  the number of items eg grapes are listed with carb count. The most accurate way is when you have a standardised and individually packaged portion.

The website resources section in the metabolic syndrome section has some carb counting sites to help you get started. In addition here is list from some fast food and other restaurants.  To put these figures into context the Atkins diet ranges from 20-120g of carb a day.

Burger King
Whopper 48g
Cajun Chicken deli wrap 48g
Large fries 53g
Sachet ketchup 4g
Chocolate ice cream sundae 26g

McDonalds
Big Mac 44g
French fries regular 28g
BBQ dip 12g
Apple pie 27g
Regular vanilla milkshake 63g

Kentuky Fried Chicken
Original recipe chicken drumstick (one) 7g
Chicken fillet burger 36g
Corn 11g
Crispy strip (one) 6g

Pizza
One medium slice Italian pizza 27-38g
Portion of lasagne 63g
One slice of garlic bread 11g

Indian 
One portion of boiled basmati rice 110g
Chicken tandoori 2g
Chicken korma 16g
Vegetable curry 15g
Beef curry 6g
Naan bread 80g

Canteen/Bar food
Baked potato 70g
Chicken pie for one 32g
Meat pie for one 33g
Shepherds pie for one 37g
Battered fish 21g
Sweet and sour pork 34g
Chips/Fries small 31g
Chips/Fries medium 50g
Chips/Fries Large 73g

 

HOW TO USE THE EXCHANGE METHOD OF CARB COUNTING

The exchange method of carb counting was used for many years. Diabetics and their carers were taught what quantity of a carbohydrate containing food amounted to 10g, 12g or 15g of carbohydrate.  The Life Without Bread Diet which I have described in the Metabolic section uses a certain number of 12g carb portions a day.

In general this method can be more accurate than the list method. For instance a third of a cup of cooked rice is around 15g versus about 110g for your average Indian restaurant rice portion. It is still subject to some error of course.

The American Diabetes Association have come up with a rough quantity guide to help you. This is for a woman’s hand.

one clenched fistful = one cup

palms sized quantity = 3 oz

thumb tip = one teaspoon

handful = 1 or 2 oz of snackfood

whole thumb size = 1 oz

With all the inbuilt imprecision that this method of counting has you will always have to compare what you think you ate versus the results you got. When you do have such items as nutritional scales or relatively accurate portioned control amounts it is helpful to compare what they look like versus your usual portion size to improve your eyeballing accuracy.

American cup sizes are used throughout.

All of these portion sizes amount to about 15g of carbohydrate unless stated otherwise.

Easy Averages

1/2 cup beans
one small slice bread
1/2 cup cereal
one cup milk = 10g
1/2 cup cooked pasta
1/3 cup cooked rice

one large apple
5 small apricots
6 apricot halves in juice drained

one small banana
half a large banana
20 blackberries or blueberries

32 cherries
3 medium clementines or satsumas

3/4 cup fruit salad

one medium grapefruit
ten large grapes or 20 small grapes

2.5 kiwi fruit

3/4 of a medium mango
2 slices of melon

one large nectarine

one large orange

2 medium peaches
7 slices of canned peaches in juice drained
one medium pear
3 pear halves in juice drained
3 slices of pineapple
3 medium plums
4 dried prunes

1.5 tablespoons of raisins
1/2 cup raspberries

one tablespoon sultanas

One medium slice of bread 24g
one slice of french bread 1.5 cm in length

1.5 bridge rolls
1/2 medium sized roll

one slice currant or raisin bread

1/4 cup breadcrumbs

1/2 medium chapati

one toasted crumpet
1/2 currant bun
1/2 English muffin

2 small slices garlic bread
one medium hamburger bun 24g
one large hamburger bun 42g

1/2 hot cross bun

1/5 naan bread

1/2 sweet pancake 15cm diameter

2 large poppadoms
one pitta bread

one small scone

2 taco shells
1/2 corn or flour tortilla

For most breads a 30g serving has 15g of carb

2 tablespoons canned sweetcorn
one small corn on the cob
120g roast parsnips
1/2 cup frozen peas

1/2 small baked potato
one very small boiled potato
10 crisps
2 tablespoons mashed potato

For most vegetables

1/2 cooked = one cup raw = 5g carb
1 and a half cooked = 3 cups raw = 15g carb

1/2 cup of cornflakes, fruit and fibre or rice krispies

2 tablespoons muesli
1 cup puffed cereal
1/2 cup rolled oats made with water
one biscuit of weetabix

For most cereals a 20g serving has 15g of carb

Apple juice 150mls
drinking chocolate powder 20g
unsweetened grapefruit juce 180mls
Lucozade 85mls
unsweetened orange juice 170mls
unsweetened pineapple juice 150mls
soft drink 140mls

1/2 cooked barley
1/3 cup bulgar wheat
1 and a half teaspoons cornflour
1/3 cup couscous
2 and a half tablespoons wholewheat flour
2 tablespoons white flour
1/2 cup pasta
1/3 cup cooked rice
1 and a half tablespoons dried rice
1/2 cup tinned spaghetti

3 tablespoons baked beans
1/2 cup kidney beans
2 heaped tablespoons lentils or split peas

3/4 cup custard
3/4 cup evaporated milk
1 and a half cups milk
1/2 cup vanilla ice cream
2 heaped teaspoons sweetened yoghurt

1/2 standard bounty bar
25g bar of chocolate
1/3 standard mars bar
1.5 small milky way
1/2 snickers bar
3 fingers of kit kat
one finger of twix

3 cream crackers
3 crispbread

120g peanuts
3 cups cooked popcorn
25g packet of crisps

one penguin biscuit
two ginger nuts
one 9g shortbread biscuit

one 5cm square cake without icing
one 2.5 cm square cake with icing
one mr kipling french fancy 19g
one choc chip cookie 8g
one small slice chocolate cake

2/3 large croissant
one danish pastry
1/2 jam donut

1/2 slice fruit cake
one jaffa cake 9g

3 level teaspoons jam

one small slice madeira cake
1/2 an individual jam tart
1/2 mince pie

2 oatcakes

3 level teaspoons sugar

one small slice swiss roll
one small waffle

For most dry biscuits and cakes a 25-30g serving will have 15g of carb

For most sweets a 10-20g serving will have 15g of carb.

 

HOW TO COUNT CARBS USING CARB FACTORS 

The carb factor is the percentage of carbohydrate present in a food. If an apple has a carb factor of 0.13 this means that 13% of the weight of that apple is carbohydrate. If your apple weighs exactly 100g this would contain 13g of carb.

To use this method you need a list of carb factors and a set of scales to measure out the weight of your food portion. Nutritional scales have the carb and other factors built into them but you can use any scale provided it is sensitive enough.  Digital scales may therefore be preferable to analogue scales.

John Walsh and Ruth Roberts book, “Pumping Insulin” has a list of about 300 foods at the back.

The site Friends with Diabetes is a site for diabetics who wish to follow a kosher diet. There is lots of helpful information of help to everyone else too.

Also, this site www.medexplorer.com/nutrition/nutrition.dbm gives you carb content and other nutritional information too.

 

HOW TO COUNT CARBS FROM NUTRITIONAL LABELS

When you pick up many items of processed food you will find nutritional labels on them. How do you know how much carb is in the portion you intend to eat?

For the purposes of illustration lets say I decide to have a meal of a half can of lobster bisque soup, 3/4 of a can of spaghetti bolognese and half a can of mandarin oranges in light syrup with a dollop of tinned heavy cream.

I look at the lobster bisque. It lists :

Per  100g
Energy  51 kcal
Protein 3.4g
Carbohydrate 4.7g
(of which sugars 1.2g
Fat 2.1g
(of which saturates 1.2g)
Fibre 0.2g
Sodium 0.5g

I want to eat half a can and fortunately the figures for this are listed too.

How to I know how much carb to count? In this case it is easy because it is on the tin. Carbohydrate 9.8g per half tin (of which sugars 3.5g).

The important thing to remember is that it is the carb count and not just the sugar count that matters.

Now for the main course. Tinned spaghetti bolognese. The tin weighs 400g.

I pick up this can and go straight to the carb count.

It says carbohydrate 13.2 per 100g with sugars being 2.4g of this.
Per half can serving there is 26.3g  with sugars being 4.8g of this.

Ignoring the sugar content as usual I see that if I want 3/4 of the can I will need to do a little sum.

Although this is an easy sum to do I would like to go though what your old school teacher called “the working” so that it is easier to do this cross multiplication technique with more awkward amounts.

If 100g weight = 13.2 carbs  what does 300g weight contain?

Write it like this   100g = 13.2
300g = X

Now cross multiply like this:

100g x X = 13.2 x 300g

From algebra you may remember that if you want to know what X is you need to move the 100g to the other side of the equal sign. When you do this it has to go below the 13.2 x 300g sum to indicate that this  is  now going to be divided.

So  you get:

X = 13.2 x 300g
100

Using a calculator the answer is:

39.6

This cross multiplication technique can be used not only for counting how much carb is in a certain weight of food if you have the carb factor or carb count from a list but how much of a certain food you can have to stay within a certain carbohyrate limit.

Now dessert. Mandarin orange segments in light syrup. The can weighs 312g and the drained weight of the can is 170g.

Per 100g for the fruit and the syrup the carb count is  14g of which sugars is 14g.
For half a can the carb weight is 22g of which sugars is 22g. The fibre content is 1g.

This fibre content is pretty low so can be ignored in this calculation.  For certain foods with a significant fibre level you may be best to deduct it from the total carb count. Fibre affects the bulkiness of the meal but as it passes throught the gut without being absorbed you don’t need insulin to cover it. Because bulk can affect blood sugars through the effect of glucagon released from gut distention Dr Bernstein suggests a compromise by deducting half of the fibre from any given meal.

In this case we can find out how much carb is in half a can just by looking at the label. But what if this information was not supplied? What if the can contents had been shared out and you really had no idea what proportion of the can you had been given?

Lets go back to the carb factor information. 14g of the weight of the 100g of this food is carbohydrate.  If you weigh your portion on an accurate scale and it comes to 156g how much carb is this.

Cross multiply:

100g = 14g carb

156g = X carb

100 x X = 14 x 156

X = 14 x 156
100

X =  21.84g carb

Now lets add the cream.  Per 100g the carb count is 3.6g.  For a 50g serving size the carb count is 1.8g.  The can contains 283g so a serving size is  283/50 = 5.66th of the tin. A good couple of tablespoons by the look of this for a very low carb count.

Now add up your meal carb content:

Lobster bisque  9.8
Spaghetti bolognese 39.6
Mandarin oranges 22
Cream   1.8

Total = 73g

Now, you won’t be surprised to hear after what we’ve been telling you  about high amounts of carbohydrate messing up your blood sugar control, weight and metabolism that this menu is for carb counting lessons only. You want to eat much healthier meals that this canned rubbish don’t you?

 

HOW TO COUNT CARBS USING NUTRITIONAL SCALES

Nutritional scales come in two main types. The cheaper type has a booklet with food lists and you enter the code of what you are weighing into the machine. More expensive models have an inbuilt computer with the foods listed and you click on the food you are weighing. These tend to have a larger database and can be used without having to have a booklet.

The nutritional scales give you the calorie, salt, protein, fat, cholesterol, fibre and carbohydrate counts for any given weight of food. There are memory features too.

The Salter nutritional scale that I have has 800 foods listed from the USDA database. It cost me £32 from Amazon. If you go onto the USDA site to find an even larger range of foods and have an accurate enough scale you do not really need to have nutritional scales.  I have found it a convenient and useful method and our family even have guessing  games about how many carbs a particular food portion contains. I have even taken it into restaurants to carb count food!

 

HOW TO EYEBALL PORTIONS OF CARB CONTAINING FOOD

Out of all the carb counting methods I have discussed this is the method subject to the most error and yet it is the most commonly used.

To get success with this you have to practice and practice with the other more accurate methods of weighing out small portions of food and using packaging information, charts or nutritional scales to come to what still is an approximation of the amount.

It has been shown that eyeballing is reasonably effective up to about 30g of carb portions but once the portions get bigger the estimates get considerably less accurate. For this reason you are better to look at your food and even  move it about in your plate a bit try to replicate the portions you use at home with a known carb count and then add them up.

It always amazes me just how much carb potatoes have compared to for instance cauliflower, broccoli and green beans. Some  eye ballings rules are that a golf ball size of mashed potato is 10g of carb and a woman’s fist size of cooked low starch vegetable is 5g.

The lower the carb count of your meal the easier it is in general to figure out the carbs. There is less room for error with what you think is one golf ball size of mash compared to say six such estimated portions which is not unusual in some restaurant meals.  This goes of course for rice, bread, pasta, chips, cakes and sugary sauces too.

Partly for these reasons of difficulty in  carb estimation and also because of the variability in the absorption and effect of insulin injections it is far less troublesome to simply keep these food items to a minimum for insulin users.

Type 2s who don’t use insulin also find that their sugars spike with anything other than modest portions of these items because they don’t have a supply of immediately releasable stored insulin in their pancreases.

 

Quick Quiz:
Carb counting is not an exact thing. Different breads are sliced to different widths for instance. Cup sizes vary too. In the carb comparison questions one option will have at least twice or half of the relative amounts of the other three options.

1. 12g of carbohydrate is present in all of these except…
a one thin slice of bread.
b one cup of broccoli.
c one cup of rice.
d half a grapefruit.

2. 15g is present in all of these except…
a Half a cup of beans.
b Half a cup of cereal.
c Half a medium roll.
d One hamburger bun.

3. 15g of carb is present in all of these except…
a One large banana.
b One medium pear.
c Three pear halves in juice.
d 3 medium satsumas.

4. 15g of carb is present in all of these except..
a Half of a small baked potato.
b A packet of crisps.
c A small portion of Burger King chips.
d Two tablespoons of mashed potato.

5. 15g of carb is present in all of these except…
a Three fingers of kit kat.
b Half a standard bounty bar.
c One standard snickers bar.
d One finger of twix.

6. 30g of carb is present in all of these except…
a A slice of pizza (the size of the ones with a thin base served at the buffet in Pizza hut)
b A donut.
c Two oatcakes.
d An individual jam tart.

Have you got it?
1. C. A cup of rice is about 30g. More than twice the carb count of the others.

2. D. A small hamburger bun is around 24g and a large one 48g. The others are about half the carb count.

3. A. A large banana is about 30g.

4. C. A small portion of Burger King chips is about 32g. Even then the consistency between these small portions varies a lot. I know. I’ve sat counting chips to find out.

5. C. A standard snickers bar is 34g.

6. C. Two oatcakes at 7g each are around 15g.

Reference Info:
Jo Sutton an Australian Dietician compiled the carb lists that I have used here.

 

Where to Next?
We are all now going to move onto the  How To: Do the Atkins Diet diet section.  What? Did I hear this right? Surely everyone in the developed world knows how to do Atkins?  They all think they do! That’s for sure. For a different take on the most famous diet in history I’ll see you there.

 

 

How To: Cover a Strict Low Carb, Moderate Low Carb, and High Carb Diet with Insulin

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This section is for everyone.

HOW DO I COVER A STRICT LOW CARB REGIME WITH INSULIN?

Dr  Richard Bernstein, Dr Annika Dalquhist’s, and  Dr Atkins diet have been described in previous sections. They can all take you to the strict low carbing end of things amounting to about 30-42g a day of carbohydrate.
I have chosen this level of carb for your meals to differentiate a strict low carb diet from a typical low carb diet. All of these diets in this strict  range  will give you the possibility of entirely normal blood sugars.

Dr Bernstein’s diet is more specific about what sorts of macronutrients you eat and in what amounts. For simplicity of eating and insulin regime combined with effectiveness it is my opinion that this is the “Gold Standard.”

If you are eating faster digesting carbs even within the  12g total carb limit you would need to experiment to see if a single insulin type covers your meals to entirely normal blood sugar standards or not.  The levels you may be aiming for have been described previously. If you get what you want this is perfect and if you don’t you may wish to try the specific insulin regime for the typical section which follows.

Dr Bernstein recommends using regular insulin to cover meals. These are of no more than 12g of non starchy vegetables three times a day with 6g allowed for breakfast because of the effect the dawn phenomenon has on insulin resistance at this time of day.

The regular insulin is best injected 45 minutes before eating. Because you are having such small amounts of carb and therefore insulin at each meal you don’t really need a separate insulin for the carb and protein. Just a little more regular  such as actrapid to cover your protein.  The usual formula for most people is 2 units regular insulin to cover 3oz lean protein or meat the size of a deck of cards.

The protein amount and consistency depends on your goals concerning weight gain or loss.  For people with delayed gastric emptying they may be on quite small portions of protein at their evening meal such as 2oz.  With guess and test you will quickly learn what works best for you.

Rapid acting insulin analogues are used for correction doses.

HOW DO I COVER A TYPICAL LOW CARB REGIME WITH INSULIN?

I have chosen Dr Jovanovich’s carbohydrate limits as the border between what could still be considered low carb and what is out with that range.  Dr Atkins and Drs Allen and Lutz diet’s have been described previously and fall in this range.  If you are  on another diet such as Protein Power, South Beach or Barry Groves “Eat fat and Stay Slim” diet you are in this range.

Once you get to higher carbohydrate levels of 13-30 g a meal of carb you increasingly need a bit more oomph with your insulin to deal with more rapidly rising  blood sugar levels.  At the same time protein continues to digest slowly so you need techniques to deal with that.

The most accurate technique that I know of was perfected by Dave (Iceman) from Alaska.  Sadly he died of cardiovascular complications of his longstanding diabetes. For all our benefits he passed his method throught the Bernie forum onto Adam (Adam DMer) who graciously passed it onto me. It is a beautifully simple technique that can also be used at lower and higher carb levels than I am describing in this section if desired.

Use rapid acting analogues to cover carb. This can be done according to your individual carb sensitivity for that time of day.

Use regular insulin to cover protein. This is to the tune of 2 units of regular insulin for each portion of lean protein which is a deck of card in size.

Both are optimally injected 15 minutes before eating.

HOW DO I COVER A HIGHER CARB REGIME WITH INSULIN?

The higher carb your meals the harder it is to get perfect  or even acceptable blood sugar control.  You can usually get an improvement from what you have been getting however,from the techniques I will be describing.

Although I much prefer to eat a typical low carb diet myself I was aware that my son Steven did miss the occasional treat. What was more important was that the meals provided at school emphasised high carb /low fat dishes in keeping with the ubiquitous “healthy eating” guidelines. The odd high sugar due to either of these reasons didn’t bother us at first because it was so infrequent.

For almost 18 months from diagnosis Steven did excellently on a typical low carb diet and twice daily mixtard combinations. Due to his lower carb diet and lengthy honeymoon his hbaic was 4.8.

Then his growth spurt and reduction in endogenous insulin became obvious. We continued mixtard but started on novorapid for lunch coverage in a half unit increment pen.

After 4 months on this we started an intensive insulin regime on levemir and novorapid.  By this time he was growing faster than our high fat/mod/protein/ low carb diet could sustain and his bmi was just under 16.  This is the bmi of eg Liz Hurley the actress who is indeed slim.

The dietician and diabetologist started threatening me. “Feed your kid a high carb/low fat diet and he will fatten up. Or else.” Presumably child protection procedures.

They did have a point.  Indeed I had never seen a skinny diabetic  on a high carb/ low fat diet.  It did seem to work like magic to fatten people up.

The problem was that Steven was just not hungry.  Effectively reducing hunger is  a major reason for the success of low carb diets in weight loss . But it is a disadvantage if you are hitting adolescent growth spurts.

I increased the carb in his diet knowing that he needed to have more carb for weight gain but also knowing that this would play havoc with his beautiful blood sugar pattern.

I decided to go for it and fatten him up like a goose destined for pate de fois gras. “Have what you like Steven. We have to learn how to control whatever effect it has on your bloods sugars. You could eat a bit more bread and potatoes than that couldn’t you? Please.”

I started this intensive fattening regime while on holiday abroad when we had almost unrestricted access to foods of all types and while I could monitor his sugars day and night.

To start with it seemed quite fun to Steven. “You mean I can eat a whopper with fries?”

“You certainly can. You must.”

Soon the wildly fluctuating blood sugars and blurred vision got us both down. “Please mum. Can’t I go back to low carbing? ”

“Please, Steven. Just keep going with this a bit longer. I am getting nearer and nearer to perfecting the carb weighting figures.”

We had a three month period of hellish sugars.  We did loads of blood sugar measurements including most nights between 2-4 am.  I could hardly sleep with anxiety.

This is what your average mother with an average kid with type one diabetes goes through all the time. It was bloody awful. I had no idea how bloody awful till I did it myself.

Fortunately I had some ideas about why Dr Bernstein strongly advised limiting carbs. The reason is to stop any spikes after meals that normal people don’t have.

And why does Dr Jovanovich limit a meal to 30g of carb? The reason I figured out is that linear doses of insulin based on reliable carb insulin sensitivities become increasingly unreliable above this level.

The more carb you eat the higher your blood sugar goes.

The higher your blood sugar goes the more insulin resistant you become.

The more insulin resistant you become the more insulin you need.

There is no longer a linear relationship between carb and insulin dosage after 30g.

There is an exponential curve.

Figuring out the sweep of that curve will vary from person to person.

To do this you MUST do extensive self experimentation.

Your carb counting skills must be well developed.

You must increase your carb counts above 30g in a progressive way.

You must keep meticulous records.

Give yourself a break every so often.  It is best only to do these experiments when you have help around and you are able to monitor day and night.

Unless you absolutely have to, you are much, much better off on a typical and preferably strict low carb regime. Low carbing is extremely efficient at curbing your appetite. This is a major benefit for most diabetics but I can see where it can be a problem for skinny toddlers and teenagers. If you need to resume a higher carb diet I hope our experiences and learning of techniques can help you through this process.

I know that for many diabetics the hectic blood sugar patterns that they simply accept as the package deal that comes with diabetes is actually due to the high carb diet.

I found the high carbing process extremely traumatic.  Steven was unhappy. I was unhappy. Yet, no matter how much fat I added to his diet I could not fatten him up. He is not as much as a carnivore as me and carb seemed the only answer. The high carb diet has worked and now Steven has a healthy bmi at 18. Teenagers have lower bmis than adults but your dietician won’t know this. They don’t know a lot about a lot of things you no doubt are finding out.

Quick Quiz:
There is no quiz for this section.

Reference Info:
Acknowledgements to Dr Bernstein, Dave (Iceman) and Adam (AdamDMer) from the Bernstein Forum and my son Steven.

Where to Next?
Please continue onto the How To: Do Dr. Morrison's Carb Weighting System section.