A young woman approached me during an annual diabetes fair at the community hospital where I work. She told me she recently found out she had diabetes, but that she started “watching” her diet closely and had her blood sugars “under control.” So, with curiosity and eagerness to offer her education in our diabetes program, I asked her what diet changes she had made. She proceeded to recite the guidelines of the paleo diet and told me that she “avoids all sugar and got rid of the carbs,” proudly stating she only eats 30 grams of carbs per day in total.

At this point, my mind is searching for a way to help this person understand diabetes management while not offending her.

I chose to congratulate her on her efforts to get control of her diabetes, encouraged her to continue, and also told her that the science-based recommendations call for at least 130 grams of carbohydrates each day for good health, even for people with diabetes. After further conversation, she appreciated my concern and made an appointment with a diabetes educator, which I encourage anyone to do if they have prediabetes or diabetes.

I understand someone wanting to get their blood sugar and diabetes under control and even prevent diabetes. I am all for it, and part of my job is helping people attain those self-management skills for long-term blood sugar and weight control for good health. However, food and carbs are not the enemy.

Food is part of the most significant moments and celebrations in our lives.

Food brings us pleasure and satisfaction. I do not want to take that away from anyone. I would never tell someone not to eat carbs because they have diabetes. This is a red flag when a diet trend eliminates an entire food group and deems it as evil. Carbohydrates and sugar do not cause diabetes. The main risk factors for type 2 diabetes are being overweight, eating excess calories, weight gain, and an inactive lifestyle. If you have prediabetes or diabetes, you have to watch your intake of carbohydrates, not eliminate them entirely.

A healthy diet consists of the right balance of complex carbohydrates, lean protein, and healthy fats.

Carbohydrates are the body’s preferred form of fuel. We need them every day to give us energy. The National Academy of Science’s Institute of Medicine recommends that 45 to 65 percent of our total calories come from carbohydrates. The idea is not to eliminate carbs, but to incorporate the right balance of the three main nutrients to meet our individual needs. This translates into a minimum of 130 grams of carbohydrates a day for people ages one and older, 175 grams of carbs for pregnant women, and 210 grams of carbs each day women who are nursing. We need glucose from carbs as energy for our brains and other body cells.

“When and how should I count carbs?”

I always tell patients that when it comes to carbs, look at how much, what kind, how often, and when—and this is where carbohydrate counting becomes invaluable as a way to meal plan. It helps maintain blood sugar levels by managing portions, carbohydrate intake, overall energy, or caloric intake with a complete meal plan. People with diabetes often have the misconception that they have to follow a special diet or live a deprived life to achieve blood sugar control and weight management. This is not true. Balancing your carbs, fat, and protein, and looking at the quality of your choices, as I have explained in previous Breadsense posts[KP1]  , brings lasting compliance and outcomes.

Or in other words, pursue good nutrition. Skipping the carbs initially may help bring down weight and numbers. That is only natural. When you delete an entire food group or eliminate calories from your diet, of course the weight will drop. However, that may be a short-lived result for some people. What will work for you as a lifestyle? What will enhance your overall health long-term? The answer is a balanced diet that takes into account portion sizes, the timing of meals and snacks, and the carbohydrate content of carbohydrate servings.

“What exactly is a carbohydrate?”

A carbohydrate in simple terms is a starch, fruit, or milk. One serving of a carbohydrate is equal to 15 grams of carbs. A dietitian or certified diabetes educator can teach you how many carbs to include for all meals and snacks, how to read labels, determine serving sizes, and discuss timing of the meals.  

Carbohydrates basically come in two forms. Simple carbs are found in fruits, non-starchy vegetables, sugars, and dairy products. Complex carbs show up in grains, legumes, and starchy vegetables like potatoes and corn. The idea is not to eliminate carbs, but to eat fewer refined carbs, as usually refined carbs also contain added fats and extra calories. These foods include things like syrup, candy, soda, and table sugar. Refined sugars provide little nutrition and are therefore often referred to as empty calories. Replace them with healthier carbohydrates such as fruits, vegetables, whole grain breads, low fat dairy, and legumes. Along with their calories, these carbs have fiber, vitamins, and minerals to give you energy while helping you feel satisfied.

“What’s the bottom line?”

Carbs are a main fuel source for your body so make them part of your daily diet. When it comes to carbohydrates and diabetes, the majority of your choices should be high quality carbohydrates, while avoiding refined carbohydrates as much as possible.  Following a low carb diet can result in improved blood sugar control for some people, but diabetes is an individualized disease, so what may work for one person, may not work for another. Long-term adherence can be an issue with following low carb diets. Perhaps a more effective approach, while still being able to enjoy your favorite foods and get enough fiber in your diet, would be to consume as many whole foods (consisting of lean proteins, whole grain breads and cereals, fruits, vegetables, legumes, and healthy fats) as possible while reducing the intake of refined simple sugars.


Lela Iliopoulos is a Registered Dietitian and Certified Diabetes Educator and an expert in nutrition therapy, health promotion, and education. She is passionate about impacting nutritional health through the practical application of science-based information

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