from the store with my usual purchases. Should I cut out all of the starchy foods and only eat foods with fiber, like raw vegetables and salad?
DIETITIAN: Starches and fiber are recommended for all people—not just those with diabetes. There are a variety of whole-grain starches and other high-fiber foods to choose from, such as whole-wheat pasta instead of white pasta and brown or whole-grain rice instead of white rice. Therefore, whole grains and other carbohydrate foods with fiber, such as fruits and vegetables, should be the most abundant foods on your plate. I will show you how to increase your fiber intake so you will be meeting the current recommendations of 20–35 grams per day.
FERN: But I heard that carbohydrate foods, particularly starches, make you gain weight and are the main cause of diabetes—not sugar!
DIETITIAN: Starches and sugars do not cause diabetes, but weight gain may occur if an excessive amount of any food is eaten. Starch, sugar, and fiber are all types of carbohydrate. Carbohydrate is our main source of fuel, and we need to eat some with each meal. Unfortunately, many Americans eat excessive amounts of carbohydrate because they are not aware of the portion sizes that they are eating. For example, one serving of a whole-grain food could be 1/2 cup cooked oatmeal, 1/3 cup cooked whole-wheat pasta or whole-grain brown rice, one-half of a 100% whole-grain English muffin, or one slice of whole-grain bread. How often do people just eat one slice of bread? The carbohydrate from these foods can add up very quickly at a meal, especially when added to other carbohydrate foods.
FERN: But why are those high-fiber foods so high in carbohydrate?
DIETITIAN: Although fiber is a type of carbohydrate, it is considered “roughage,” so it has little impact on blood glucose levels and provides minimal calories. Therefore, dietary fiber can be deducted from the grams of Total Carbohydrate on a food label. I will be teaching you how to read food labels today. It is important to eat these high-fiber foods every day because roughage helps you feel more full after a meal, helps lower your cholesterol levels, and keeps your digestive tract healthy.
FERN: Okay, I’m ready to learn how to buy healthier foods and begin to add more fiber to my meals. I will also be mindful that it’s the quantity and quality of starches that’s important.
DIETITIAN: Although fiber is a type of carbohydrate, it is considered “roughage,” so it has little impact on blood glucose levels and provides minimal calories. Therefore, dietary fiber can be deducted from the grams of Total Carbohydrate on a food label. I will be teaching you how to read food labels today. It is important to eat these high-fiber foods every day because roughage helps you feel more full after a meal, helps lower your cholesterol levels, and keeps your digestive tract healthy.
FERN: Okay, I’m ready to learn how to buy healthier foods and begin to add more fiber to my meals. I will also be mindful that it’s the quantity and quality of starches that’s important.
WHAT’S NEXT?
Many people view starchy foods as “bad” foods and try to eliminate many of these foods from their daily intake. When these same people also think of sugar foods as “bad” foods, they end up eliminating many healthy food choices (carbohydrates) as well as good sources of fiber, vitamins, and minerals from their eating plan.
Fern learned from her dietitian that starch and sugar foods are just two of the three types of carbohydrate that belong in everyone’s food plan. Fern also learned that many carbohydrate foods also contain the third type of carbohydrate called fiber, which is the “roughage” that whole grains, fruits, and vegetables provide. Eating the recommended amount of 20–35 grams of fiber per day instead of the average American intake of 10–14 grams per day provides enough fiber to feel satisfied and full after eating a meal without adding extra calories.
Fern’s dietitian also taught her how to keep track of her carbohydrate intake with a meal-planning method called carbohydrate counting (Chapter 7). This meal-planning method gave Fern a carbohydrate allowance to spend at each meal and snack. Much to her surprise, Fern was able to incorporate many new and different foods into her meals. By monitoring how much carbohydrate and fiber she was eating throughout the day, she not only was able to improve her blood glucose levels, but also found it easier to control her weight and food cravings by adding fiber-rich foods. Fern’s last A1C revealed a significant improvement from her previous A1C.
THE OLD AND THE NEW
Before insulin was discovered in 1921, rigid restriction of carbohydrate foods was the only means of controlling blood sugar levels. However, a very small amount of carbohydrate coming from fiber was allowed in certain foods.
Foods were divided into categories based on the amount of carbohydrate and fiber they included. Vegetables such as lettuce, cucumbers, spinach, asparagus, celery, and cabbage were allowed in unlimited quantities. In Joslin’s Diabetic Manual for Doctor and Patient, Dr. Elliot Joslin stated, “These vegetables are a comfort to a diabetic because they contain so little carbohydrate that they can be eaten freely, they are satisfying because of their bulk, and they are rich in vitamins A, B, and C.” The next category included pumpkin, turnip, squash, beets, carrots, onions, and very young, fresh green peas. Then, more mature vegetables such as peas, lima beans, and parsnips were added in limited amounts. The last category was only to be used with caution. Foods such as potatoes, corn, bread, rice, macaroni, and beans were only allowed in very small quantities and had to be carefully measured.
With the discovery of insulin, carbohydrate in the form of starch was gradually increased to a small percentage of the total daily calories, although sugar in most forms, including many fruits, was still forbidden.
Over the next 50 years, as the carbohydrate increased, the percentage of calories from fat gradually decreased because of its known relationship to heart disease. It is important to note that currently, the percentage of carbohydrate is individually based on the dietitian’s nutrition assessment and each individual’s treatment goals.
Home blood glucose monitoring in the 1980s helped reveal how people with diabetes can eat a realistic amount of carbohydrate, based on factors such as blood glucose control, weight, and blood fat levels.
WHAT ARE STARCH AND FIBER?
As we learned in Chapter 2, starch and fiber are commonly known as complex carbohydrates. Starch and fiber are only found in plants, and their structure is composed of 10 or more straight or branched chains of sugar blocks called polysaccharides. Plants store their fuel as starch, so when we eat foods that come from plants, it is converted into glucose for fuel. Because starch is made up of many sugar blocks bonded together, these sugar blocks have to be broken down into their components before they can be used for fuel. The cooking, chewing, and digestive process breaks the bonds holding the sugar blocks together. A couple of hours after eating, all the starch is usually digested and is being used as fuel by the cells of the body.
The best sources of starch are grains, such as rice, wheat, corn, millet, rye, barley, and oats. Legumes (plants from the bean and pea family) and tubers such as potatoes and yams also provide starch.
WHAT IS FIBER?
Fiber is the “roughage” that comes from plant foods that cannot be digested by the human digestive system. It is considered the non-starch polysaccharide and is made up of cellulose, hemicellulose, pectins, gums, mucilages, and lignins. Fiber is what gives plants their structure and is found in all plant foods. Fiber is also the carbohydrate that gives bulk to the digestive tract. Unlike sugar and starch, fiber cannot give us fuel for energy because we cannot break the bonds that hold its sugar blocks together. Therefore,
