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Health, Beauty & Fashion

Count those carbs

Diabetics should track the quantity and quality of their carbohydrate sources
The Straits Times - May 1, 2014
By: Joan Chew
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Count those carbs -- ST FILE PHOTO

Diabetes need not signal the end of food jaunts for food-loving Singaporeans.

Contrary to popular belief, there is no special diet for this group of patients, who comprise about 11 per cent of adults aged between 18 and 69 in Singapore.

Dietitians say they simply need a well-balanced diet that is high in fibre but low in fat.

Type 2 diabetes develops when the body fails to produce enough insulin, a hormone that moves glucose from the blood into the cells, or is unable to use it properly.

Type 1 diabetes, often called juvenile diabetes, occurs when the pancreas does not produce insulin.

Regardless of the type of diabetes, the person should keep tabs on his intake of carbohydrates through carbohydrate counting.

Ms Ong Li Jiuen, a senior dietitian at the dietetic and food services department at Changi General Hospital, said the practice helps to manage blood sugar levels and is crucial for type 1 diabetics, who have to adjust their insulin doses according to the volume of carbohydrates they have eaten.

IT TAKES PRACTICE

To start counting carbohydrates, a person first needs to know his daily calorie allowance, which depends on his energy needs as determined by his weight and physical activity.

Ms Ong said that 50 to 60 per cent of one's daily calorie allowance is derived from carbohydrates.

For instance, a person with an acceptable weight of 50kg with low to moderate physical activity level may require 1,500 calories per day. Of these, some 750 to 900 calories would come from carbohydrates.

With 1g of carbohydrate being equivalent to 4 calories, this means he can eat between 180g and 225g of carbohydrates a day.

This can be achieved by having two slices of bread (30g) and one cup of low-fat milk (10g) for breakfast; one medium-sized orange (15g) for a snack; one bowl of rice (60g) with non-starchy side dishes for lunch; and one bowl of bee hoon soup (60g) for dinner.

But it takes practice to be able to identify carbohydrate sources, estimate the carbohydrate content and distribute this intake evenly throughout the day to prevent spikes in blood glucose levels, she added.

Someone new to this can check a food's carbohydrate content from nutrition labels or reliable websites.

Ms Bibi Chia, head dietitian at nutrition consultancy Live Wise, recommends patients to work on the quantity of their carbohydrates first, before focusing on their quality.

GO FOR LOW GI

Not all carbohydrates are made equal, so diabetics should use the glycaemic index (GI) to measure how quickly their blood glucose will peak.

Using a scale of zero to 100, a carbohydrate that scores 55 and below is considered low GI, while 70 and above is high GI.

The lower the index, the more slowly the food is digested - which means a gentler rise in blood glucose. One will, therefore, feel full for a longer time and is less likely to overeat.

The downside is that selecting food based on GI values could be challenging as most local food items have not been tested and people eat a variety of food at mealtimes, said both dietitians.

Ms Chia said there is "no good way" to calculate the GI value of combined foods as it is affected by several factors, such as acidity levels and how long the food was cooked.

It is easier to ensure a good variety of low GI foods in one's diet by replacing high GI foods. Instead of white rice, bread and pasta, try brown or basmati rice, multigrain bread, oats and skimmed milk.

Just watch out for the fat content in dishes, even those with low GI and food marketed as "diabetic-friendly".

Ms Ong also recommends getting food proportions right, with half the plate filled with vegetables, a quarter with high-protein food such as meat and the remaining quarter with carbohydrates such as rice.

If serving sizes are large because one is eating out, share the meal with another person.

"When a person eats excess calories and fat, the body creates an undesirable rise in blood glucose," she explained.

When blood glucose remains dangerously high, in what is known as hyperglycaemia, complications such as nerve, kidney and heart damage may occur, she warned.

Ms Chia said: "A diabetic diet is simply a healthy diet and patients should not feel deprived.

"A small portion of a sweet snack can be eaten occasionally if the patient's blood glucose level and diet are under control."

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