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Emily Loghmani and Christopher Saudek, M.D.
02-03-2011
Trinidad and Tobago Information Authors: June Holdip, MS, RD and Alison White, BSc, RdN
- In Trinidad and Tobago and the rest of the Caribbean, carbohydrate counting is not widely used as much as the Exchange system.
- According to Exchange system developed for use in the Caribbean, portions are based on calories - presenting substitutions using the Caribbean Food Groups.
- Values differ for some carbohydrate-containing foods based on the portion size used in Trinidad and Tobago.
- Applying the Carbohydrate counting system to the Caribbean Six Food Groups, the following can be used:
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Staples: Approx 15 g carbohydrate i.e. one carb exchange: ½ hops bread, 1 slice bread/toast, ¼ thin 8 inch sada roti, ¼ large bagel, 1 oz roast bake, ¾ cup unsweetened flaked cereal, ½ cup cooked cereal/porridge, ½ cup cooked pasta, ½ cup cooked rice, ½ cup whole kernel corn, ½ only (6 inch long) corn-on-the-cob, ½ cup mashed potatoes, 6 crackers (e.g. 'Crix'), 3 cups popcorn, ¾ oz potato/tortilla chips, 2 oz cooked provision, 1 medium green banana, 2 inch piece boiled plantain.
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Legumes/Nuts: Approx 14 g carbohydrate i.e. one carb exchange: ¼ cup cooked channa/chick peas, or any other dried peas or beans such as pigeon peas, red beans, black eye peas, lentils, split peas, gub gub; ½ cup medium consistency dahl, 16 only peanuts, 7 cashew nuts,10 shelled almonds
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Vegetables: Approx 7 g carbohydrate i.e. ½ carb exchange: ½ cup beetroot, pumpkin/squash, carrots, chow mein, ¾ cup bodi/string beans, 1/3 cup canned mixed vegetables. Note: Green leafy and other low calorie vegetables are 'free' when eaten raw in salads or no more than 1 cup when cooked.
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Fruits: Approx. 10 g carb: Examples: 20 West Indian cherries, 1 medium guava, ½ medium banana, 1 small silk fig, 2 sucrier (see-key-e) figs, ¾ cup coconut water, 1 small mango, 1 medium portugal, 1 medium pommecythre, 1 medium pommerac, 1/3 cup soursop juice, 1 medium sapodilla, 1 slice pineapple (½ inch thick), ½ cup canned fruit in natural juice/liquid, ½ cup fresh or unsweetened canned orange/grapefruit juice, 2 tablespoons dried fruit, 14 medium grapes, 1 cup watermelon, ½ cup paw paw, 10 small/6 medium local plums.
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Food from Animals: Approx. 6 grams carb, that is ½ carb exchange Milk: ½ cup liquid milk, 2 tablespoons powdered milk, ¼ cup evaporated milk, ¼ cup plain yogurt (preferably low fat or skimmed). Meats, fish and poultry are not included in the carbohydrate counting system.
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Fats and Oils: Foods in this group are not included in the carbohydrate counting system
- A method for estimating carbohydrate (carb) intake, either in total grams of carb or in 15-gram servings.
- Important because carb is the primary nutrient affecting postprandial blood glucose levels (Sheard)
- For people with diabetes on oral medications or fixed insulin doses, carb counting promotes consistent carb intake; for weight loss, helps control overall calories; for those using insulin:carb ratios, helps match premeal insulin dose to amount of carb eaten.
- Carb counting allows flexibility in food choices and helps promote glycemic control (Chiesa).
- Other methods for estimating carb intake are the exchange system and experience-based estimations (Wheeler 2008a).
- Carbs include starch, fiber, sugar alcohols (such as sorbitol) and/or simple sugar (such as sucrose or fructose, either natural or added). (Wheeler 2008)
- 1 carb serving is defined as 15 grams of carb.
- Using exchanges, the starch/grain, fruit and milk groups all contain carb.
- 1 carb serving = 1 starch/grain or 1 fruit or 1 milk each have 15 gm carb
- Healthy meals include carbs from whole grains, dried beans and legumes, low-fat dairy products and fruit. (See Overview of Nutrition)
- Recommended Dietary Allowance for carb is at least 130 g/day (8-9 servings) for adults and children, 45% to 65% of energy (IOM 2005).
- For wt loss: women need 30-45 grams/meal (2-3 servings), 15 grams/snack; men need 45-60 grams/meal (3-4 servings), 15-30 grams/snack.
- Read food labels for the manufacturer's serving size and total grams of carb/serving; adjust based on amount eaten. The "serving" listed on the nutrition label reflects the amount of the food normally eaten, not necessarily a 15-gram carb serving.
- A "serving" (amount usually eaten) therefore does not necessarily equal a "portion" (15 g).
- Labels may be misleading. For instance, a package that is normally eaten at one time, may be listed as "2 servings", e.g. a candy bar with "2 servings", 150 calories each, has 300 calories for the whole bar.
- Starch/grain group: 1/4 large bagel, 1slice bread, 1 6inch tortilla, 3/4 cup unsweetened cold cereal, 1/2 cooked cereal, 1/3 cup pasta, 1/3 c rice, 1 cup soup, 1/2 cup corn, 1/2 cup mashed potatoes, 5 crackers, 3 cups popcorn, 3/4 oz potato/tortilla chips, 1/2 cup cooked beans or lentils
- Fruit group: 1 small fresh fruit, 1/2 banana, 1/2 canned fruit in light syrup, 2 Tbs. dried fruit, 17 small grapes, 1 cup melon, 3/4-1 cup berries
- Milk group: 1 cup white milk, 1/2 cup chocolate milk, 1 cup soy milk, 1 cup plain yogurt
- Sweets: 2 inch square piece of cake or brownie without icing, 2 small cookies, 5 vanilla wafers, 1/2 cup sugar-free pudding, 1 Tbsp sugar or honey, 1/2 cup plain ice cream, 1/4 cup sherbert/sorbet
- Combination foods: 1/2 cup casserole, 1/2 sandwich, 1 cup meat stew with vegetables, 1 small taco
- Individual patients may have different levels of knowledge and practice, from general carb awareness to careful carb counting or even consideration of glycemic index.
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Carb awareness:
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1.) Know which foods contain carb.
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2.) Choose healthy, consistent portion sizes.
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3.) Avoid sweets and sweetened beverages.
- Promotes consistency of carb intake
- Understand effect of food, medication and physical activity on blood glucose levels and identify patterns.
- Use food labels and carb counting resources to obtain carb information
- Estimate the number of servings (or half-servings) in food to be ingested.
- In addition to above, adds precision to actual grams ingested.
- Calculate grams of carb more accurately (e.g. +/- 5 gm) rather than just as servings.
- Know and quantitate less obvious sources of carb (nonstarchy vegetables, dairy products, etc.).
- Use insulin-to-carbohydrate ratio to calculate dose of fast-acting insulin.
- Adjust for foods high in fat or fiber.
- Adjust for individual glycemic index (GI).
- Be aware that high fat intake slows absorption of carbohydrate.
- GI may provide additional benefit over tracking total carb alone, but research has shown mixed results (Sheard).
- Monitoring carb intake is a key strategy in meeting glycemic goals (Am Diabetes Assoc).
- For type 1 diabetes, the goal is to match premeal insulin to carb intake, premeal blood glucose level and exercise.
- For type 2 diabetes, the goal is to fit carb intake into a generally healthy, often hypocaloric, meal plan.
- Carb counting can help patients monitor overall food intake for both consistency and weight loss.
- There are many published and on-line sources of reliable information describing the carb content of various foods. Examples: Choose Your Foods: Exchange Lists for Diabetes, Diabetes Carbohydrate and Fat Gram Guide, www.calorieking.com, www.acaloriecounter.com
- Levels of carb counting must be tailored to the the individual, his/her readiness to learn, ability with numbers, and many other factors.
- It is useless to try to teach advanced carb counting to someone unwilling or unable to learn it.
- Levels of carb counting can be improved gradually.
- Many people wrongly think that carb restriction is the recommended approach to managing diabetes. (See Overview of Nutrition)
- In our practice, we rarely address GI as such. While scientifically sound, many factors influence the postprandial response to carb, such as amount ingested ("glycemic load"), type of carb, speed of absorption, fat and protein content of the meal, degree of processing, cooking method, etc. Frequently, an experiential approach is more practical. Individuals can test blood glucose 2 hours after eating and learn which foods raise their blood glucose to a surprisingly high level.
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