What types of carbohydrates should diabetics eat

For people with diabetes, carbohydrates play a key role. For this reason, choosing the right carbohydrate and specialized products is one of the best strategies to manage the disease.

In general, when carbohydrates or carbohydrates (HCO) are named, immediately reference is made to “sugars” and in most cases, it is associated with a negative connotation. While excess consumption can have negative health consequences, HCOs are indispensable and not all are equal to each other.

HCOs represent the main source of energy for the population and within a correct diet, they represent from 40 to 65% of the daily energy to be able to perform most of the functions of the body (for example heart, brain, liver, kidney and muscles).

One of the main keys to success for people with diabetes is learning to choose the quality and quantity of carbohydrates to be consumed to support the control of blood glucose in conjunction with a diet and exercise plan. The scientific evidence supports that the inadequate intake of carbohydrates can negatively affect the main organs and tissues of the body (whether it increases blood glucose, lowers or is very variable). Conversely, when foods or products that have the right quality and quantity are consumed, it can help to reduce glycemic variability and control blood glucose levels.

To better understand the type of products recommended for the patient with diabetes, it is important to understand a little about the classification of carbohydrates. According to their size (chemical structure), HCOs can be classified as:

• Starches (also known as complex carbohydrates or polysaccharides). These are found naturally in cereals such as corn, rice, potatoes, oats.
• Fiber – (carbohydrates of complex or intermediate chains such as pectins, modified maltodextrins or oligosaccharides). They are found naturally in vegetables, fruits and cereals and/or as prebiotics in food. In a recommended diet it is suggested to consume 25 to 30 grams daily and is usually classified according to their solubility, fermentation, and degree of digestion.
• Sugars (also known as simple carbohydrates). Of which 2 types are known:
– Those that are naturally found in foods such as fruits and milk
– The “added sugars” that are added to food as part of their process. Axis: the fruit in syrup to which sucrose or the muscovado sugar has been added in a cookie or bread product.

WHAT TO CHOOSE?

For practical purposes, when it comes to diabetes, the following points should be considered:

• Prefer carbohydrates from complex structures such as starches, modified maltodextrins, fructo-oligosaccharides. These HCOs are also known as slow-digesting carbohydrates that not only have a lower impact on postprandial glucose and insulin in people with diabetes but also often confer benefits to digestive health by stimulating the growth of beneficial intestinal bacteria.

• Prefer products with low glycemic index (GI) carbohydrates. The glycemic index is the measure by which foods can raise blood glucose after ingestion due to the type of carbohydrates they contain. The consumption of a food with a high glycemic index raises blood glucose faster than foods with a medium or low glycemic index.

For a patient with Diabetes it is important to prefer foods that have a low or medium Glycemic Index; and if you eat foods with a high GI it is recommended to combine them with low GI foods to balance the food. Examples of food with a high glycemic index are bread products such as waffles, hot cakes or sweets such as jam and honey. Examples of foods with low glycemic index are vegetables such as nopales and carrots; fruits like kiwi or strawberries and oilseeds like nuts.

SPECIALIZED FOODS TO SUPPORT THE NUTRITION OF PEOPLE WITH DIABETES

There is a growing field of research that revolves around the most recommendable type of carbohydrates to consume in order to support the control of postprandial glucose levels, postprandial blood insulin, glycemic variability and glycosylated hemoglobin (HbA1c) as an integral part of diet and exercise. For these purposes, the European Nutrition Society (ESPEN 2017 and 2018) suggests that patients with diabetes use specific specialized feeding formulas and that they have the following characteristics:

They contain slow-digesting carbohydrates and fiber
They contain healthy fats such as monounsaturated
Are low glycemic index
Are rich in vitamins and minerals
Provide protein

As with any other feeding decision, the individual characteristics of the patient or subject will determine the quantity and use of these specific formulas. The reported evidence supports its short and long-term benefits to support glycemic control and blood lipids of people with diabetes when it is part of a diet and exercise plan.

EYE WITH PRODUCTS WITH “LESS SUGAR”
This legend is only an indication that the product in question has “less sugar content” compared to its original version. It is not necessarily allusive to the desirable characteristics that were previously mentioned. For people with diabetes, the key to success when it comes to choosing carbohydrates is not precisely about “having less” content but having “better”.

PRACTICAL RECOMMENDATIONS
• Carbohydrates are crucial for the diet, but inadequate intake can cause hyperglycemia, hypoglycemia and glycemic fluctuations that are harmful to health.
• The carbohydrates that are recommended to restrict are those called as added sugars or simple sugars. Some examples are corn glucose syrup, sugar cane or sucrose, honey, high fructose syrup, and dextrose.

• The recommended carbohydrates are fiber and slow-digesting HCOs, thanks to their proven benefits in the management of blood glucose and glycosylated hemoglobin (HbA1c) in people with diabetes.

SUBSTITUTES OF FOOD
In today’s hectic world, trying to eat healthily can be extremely difficult, but choosing bad foods and skipping meals can undermine efforts to control diabetes and weight. Meal substitutes can be a useful option as part of a diabetes management plan because they are practical, easy to carry and provide complete nutrition.

Meal replacements provide a known number of calories with specific micro and macronutrient levels, which help to avoid guessing in complex meal planning. No need to measure, weigh or count calories and nutrients. Substitutes are designed specifically for people with diabetes to help them control the response of blood sugar levels and can be used as meal replacements.

In other words, these are foods that you can eat or drink as an alternative to, or as part of, meals. They are a quick and easy way to get the nutrition that people with diabetes need. Other examples of meal replacements include pre-packaged meals, such as frozen dishes and powders ready to prepare.

According to the American Diabetes Association, using meal replacements once or twice a day to replace the usual meal can result in significant weight loss, but they must contain the correct types of carbohydrates, such as low glycemic index carbohydrates.

How to use them? Instead of 1 or 2 meals or as part of a meal, at snack times or as a snack. They can also be combined with other foods such as fruits, vegetables, whole grain crackers, nuts, skim milk, and light yogurt. It is the health professional who can best determine how to incorporate food substitutes into a dietary plan for diabetes control.

Bibliographic reference and sources:

1. American Diabetes Association. Diabetes care. 2004; 27: s36-s36.