When Is It Appropriate To Subtract Fiber Or Sugar Alcohols From Total Carbs
Looking at my patients pump download on CareLink, I realized when she ate the low carb bar, her blood sugar dropped. She asked, What do I do to prevent these lows? If you notice a low after eating high fiber foods , there are rules set forth by the ADA:
- If a meal has more than five grams of total fiber, you can subtract half the total fiber from the total carbohydrate
- If a food contains sugar alcohols, you can subtract half the total sugar alcohol from the total carbohydrate
Fiber Does Not Affect Your Blood Sugar Levels
Fiber is a type of carbohydrate that your body cant digest, so you should subtract the grams of fiber from the total carbohydrate.
On Nutrition Facts food labels, the grams of dietary fiber are already included in the total carbohydrate count. But because fiber is a type of carbohydrate that your body cant digest, it does not affect your blood sugar levels. You should subtract the grams of fiber from the total carbohydrate.
How To Calculate Net Carbs
Net carbs are total number of carbs minus non-active carbs.
In non-processed, whole foods the formula is: Net Carbs = Total Carbs – Fiber
For example, one cup of raspberries contains 7 grams of net carbs through 15 grams total carbs minus 8 grams of fiber.
In processed, packaged foods the formula is: Net Carbs = Total Carbs – Fiber – Sugar Alcohols
For example, a popular protein bar contains 4 grams of net carbs through 21 grams total carbs minus 14 grams of fiber minus 3g sugar alcohols.
Read our advanced guide on How to Calculate Net Carbs.
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Beware Of Sugar Alcohols
Sugar alcohols are both confusing and annoying. For one thing, they arent sugar. For another, they arent alcohol.
They are compounds similar in structure to sugar and taste sweet to varying levels, but are not completely absorbed and therefore, do not have the same degree of impact on blood sugar.
But thats the catch: some sugar alcohols have no impact on blood glucose whereas others have almost the same impact as sugar itself. And unfortunately, when you look at the nutrition facts label, all of these sugar alcohols are lumped into the same category and manufacturers get away with subtracting all of them from the carb count, even when its not accurate and could in fact be harmful to people!
For example, erythritol has zero calories and a glycemic index of zero. Whereas xylitol has 2.4 calories per gram and a glycemic index of 12, which will certainly still impact blood glucose to some degree.
Heres the sugar alcohol shortlist :
- Erythritol C: 0-0.2, GI: 0, IE: 2
- Xylitol C: 2.4, GI: 13, IE: 11
- Sorbitol C: 2.6, GI: 9, IE: 11
- Mannitol C: 1.6, GI: 0, IE: 0
- Isomalt C: 2.0, GI: 9, IE: 6
- Lactitol C: 2.0, GI: 6, IE: 4
- Maltitol C: 2.1, GI: 35, IE: 27
- Polyglycitol C: 3, GI: 39, IE: 23
So in terms of carb counting, what are you to do about sugar alcohols then?
What’s The Connection Between Carbs Insulin And Blood Sugar
You might be wondering why your care team is so concerned about carb counting, and why it’s important to space out the carbs you eat over the day. Here’s why: When you eat foods with carbohydrates, the carbohydrate is broken down into glucose , which enters your bloodstream, raising the amount of sugar in your blood. This signals the pancreas to release insulin. Insulin then takes the sugar from your blood to your cells to be used for energy. Subsequently, the amount of sugar in your blood comes down. The next time you eat, this process happens again.
If you have diabetes, your body doesn’t use insulin properly, making it hard for your body to regulate the amount of sugar in your bloodstream. Because carbohydrates cause your blood sugar to rise, controlling your intake of carbohydrates helps control your blood sugar as well.
But here’s a little tip: While there are three types of carbohydrates-sugar, fiber and starch-they are not all digested the same.
Nonstarchy vegetables contain mostly fiber and little to no sugar, so they don’t raise your blood sugar very high and therefore, not as much insulin needs to be released.
In contrast, fruit juice, soda and refined grains , contain little to no fiber, so they spike your blood sugar and more insulin is released. The glycemic index further explains the effect that different foods have on your blood sugar level, but eating a healthy, low-carb, vegetable-packed diet is a good place to start.
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The Skinny On Sugar Alcohols
But researchers say the impact of sugar alcohols on blood sugar levels and the body is not fully understood, and they may also cause problems in some people.
“There are some sugar alcohols that can raise your blood sugar,” says Karmally. “Certain sugar alcohols do have a higher glycemic index, and they still are not counted as carbohydrates by these companies.”
“When you tell a person ‘net carbs’ or ‘impact carbs,’ it’s very confusing,” says Karmally. “A person with diabetes may think, ‘It’s fine for me to have as much as I want.'”
People with diabetes are advised to closely monitor their intake of carbohydrates because their bodies can’t produce enough insulin to keep blood sugar levels within a safe range.
“I think we should not misguide people and make them aware that these sugar alcohols also contribute calories,” says Karmally. “Too much of them can actually have a bad effect, and some of them can also have a laxative effect.”
Although sugar alcohols have been used in small amounts in items like chewing gums for years, researchers say little is known about the long-term effects of consuming large amounts of these substances.
Registered dietitian Jackie Berning, PhD, says she steers her patients against products containing sugar alcohols for those reasons.
Which Would Should You Count If You Have Gestational Diabetes
If you have gestational diabetes, your doctor will likely recommend that you follow a diet with limited amounts of carbs, like keto.
But what are net carbs and why are they important?
Understanding the difference between net carbs and total carbs could help you make better food choices to manage your gestational diabetes.
Lets take a look at their differences, as well as how each impacts your gestational diabetes.
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What Is Sugar Content
The sugar content of food, also known as the total carbohydrate count, is made up of both fiber and the actual carbs found in complex carbohydrates such as sugar, starches, and digestible cellulose.
Insoluble fiber is eliminated from this equation due to the fact that it does not dissolve in water, so it doesnt have any impact on carbs.
On the other hand, glycerol has a limited effect on your blood sugar levels and remains relatively constant once you ingest it.
This is why you will often see an insoluble fiber and sugar alcohol line item on food labels.
Consequently, the amount of net carbs/total carbs is typically much lower than the total carb count itself due to the fact that both fiber and glycerol are excluded from this measurement.
Using The Glycemic Index As A Guide
The glycemic index is a system that ranks foods based on how quickly they cause your blood sugar to rise.
Foods with a high GI, like refined carbs, make your blood sugar rise faster than foods with a low GI, like complex carbs.
If you do eat something with a higher GI, combine it with a lower GI food. This will help lessen its effect on your blood sugar.
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What If You’re Making Healthy Choices And Still Have High Blood Sugar
According to American Diabetes Association guidelines, most people with type 2 diabetes should start taking a blood glucose-lowering medication, typically metformin , as soon as they are diagnosed.
Most people diagnosed with type 2 diabetes have had blood sugar levels in the diabetes range for months if not years before diagnosis. Don’t think of taking blood glucose-lowering medication as failing. Type 2 diabetes, with prediabetes as its starting point, is a progressive disease during which people slowly lose their insulin-making capabilities over time. It’s of no health value to severely restrict the amount of carbs you eat to manage your blood sugar levels and/or to delay medication. The recommended course of action to stay healthy with type 2 diabetes is to get blood glucose, cholesterol and blood pressure numbers under control soon after the time of diagnosis-and maintain target goals-adjusting diet and medication as needed.
Pro: Possibly Eat A Higher Fiber Diet
At the very top, Kathleen said: I eat a lot of veggies, which increases my total carbs to over 100 grams per day, but my net carbs are usually 40-60
In this instance where Kathleen is obviously eating lots of natural whole food sources that are beneficial to her health, this would be acceptable because anything under 120 grams per day total carbs is technically considered low carb. And she is consuming 40 to 60 grams of natural plant fiber, which also has huge benefits, including better blood glucose and A1c control.
Counting net carbs can be used as a method to tease out the carb-heavy foods that are completely off limits from the nutrient-dense vegetables and fruits that will nourish your body while keeping your blood sugar stable.
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How To Count Carbs
Carbohydrates are a great source of energy for your body, but they affect your blood sugar too. If you have diabetes, keep track of how many you eat with a few simple tricks.
Know your carbs. It’s a lot more than just pasta and bread. All starchy foods, sugars, fruit, milk, and yogurt are rich in carbs, too. Make sure you count them all, not just the obvious ones.
Put together a meal plan. Figure out the amount of carbs, protein, and fat you can eat at meals and snacks throughout the day to keep your blood sugar levels steady. Most adults with diabetes aim for 45-60 grams of carbs per meal and 15-20 grams per snack. That number may go up or down, depending on how active you are and the medicines you take, so check with your doctor or a registered dietitian.
Look at labels. They make counting carbs easy. Find the “Total Carbohydrate” number listed on a package’s “Nutrition Facts” panel. Then, check the serving size and confirm the amount you can eat. Repeat this step with other foods you plan to eat. When you add all the grams of carbs, the total should stay within your meal budget.
Starch, fruit, or milk = 15. Fresh foods don’t come with a label. You may have to guess the number of carbs they have. A good rule of thumb: Each serving of fruit, milk, or starch has about 15 grams. Vegetables don’t have a lot, so you can eat more of them. Two or three servings of veggies usually equal 15 grams of carbs.
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The Bottom Line: Should You Count Net Carbs
Net carbs are essentially the carbohydrates that your body is able to digest and use as fuel.
When calculating net carbs, one subtracts the fiber and sugar alcohols from the total carb count, since these are not considered digestible carbs.
There are advantages and disadvantages to counting net carbs, but ultimately, the choice is up to you. If you are already counting carbs, you may now choose to count net carbs as it allows you to consume a greater variety of foods and higher amounts of fiber.
For some, counting net carbs may lead to higher blood sugar levels than expected. If this is the case, and especially if you have diabetes, you may decide that tracking total carbohydrates makes more sense for you. If you are taking any medication or insulin to manage diabetes, be sure to talk to your diabetes care team to determine the best way for you to count carbohydrates for your treatment goals.
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Why Choose Carbohydrates With Fiber Rather Than Sugar
Pictured Recipe: Strawberry & Tuna Spinach Salad
Remember that carbohydrates can be further broken down into fiber and sugar. Research shows Americans eat too much added sugar and not enough fruits, vegetables, whole grains and low-fat dairy foods. Added sugar is anything that’s not plain dairy or fruit. The American Heart Association recommends women eat less than 24 grams of added sugar per day and men consume no more than 36 grams per day .
Instead, try to prioritize carbohydrates that provide fiber. Aim to get 25-35 grams of feel-full fiber each day. Focus on the quality of carbs you eat, aiming to make half your plate nonstarchy vegetables, a quarter of your plate whole grains and a quarter of your plate protein at most meals. Reduce your consumption of low-fiber, sugary foods and beverages, including desserts, muffins, soda, sugary coffee beverages, fruit juice, ice cream and baked goods, which add carbs without much nutrition.
The above recipe for Strawberry & Tuna Spinach Salad provides 20 grams of protein and 10 grams of fiber for a healthy, satisfying meal that’s also diabetes-friendly.
Why Measure Total Carbs
Its easier to measure total carbs no subtraction necessary!
The benefit of measuring total carbs is most evident when it comes to manufactured or packaged products.
The effect of the natural insoluble fiber found in fruit and veggies is well known and has been well-studied. Its called insoluble fiber because your body doesnt absorb it at all.5
Naturally-occurring soluble fiber is a little different. Soluble fiber forms a gel and increases the viscosity of the digested food. While some soluble fiber may get absorbed, it is more likely that it gets fermented by gut bacteria. Therefore, soluble fiber can contribute a small number of calories, but it doesnt usually impact blood sugar and insulin significantly.
However, the fiber added to packaged food products is often the kind of soluble fiber that can contribute to increases in blood sugar and insulin.
For instance, isomaltooligosaccharide significantly raises blood sugar and insulin levels.6 Food manufacturers often count IMO as fiber and subtract it from total carbs to market a low-net-carb product. Unfortunately, your body will not agree.
Other examples of added fibers are inulin, xanthan gum, tapioca fiber, and chicory root. While none of these will likely cause the same adverse reaction as IMO, we still recommend caution as many of these added fibers have not been extensively studied.
Pro tip
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Crash Course In Carbs
Foods that contain carbohydrates include:
- Grains, such as breads, cereals, pasta, and rice
- Fruits and fruit juices
- Starchy vegetables, such as potatoes and corn
- Dried beans and peas
- Dairy foods, such as milk and yogurt
- Sweets, such as cookies, pastries, cakes and candy
- Snack foods, such as potato chips
To find the carb content of a food, check the amount of total carbohydrate on the food label. Be sure to look at the serving amount as well. If youre eating twice as much as the listed serving, youll need to double the total carbs. If a food doesnt have a label, there are many apps and books available to help you track carbs. One great free tool is MyFoodAdvisor from the American Diabetes Association. At first, you may need to look up almost everything. But with time, youll start to learn how many carbs are in your favorite foods and dishes.
Net Carbs Vs Total Carbs For Gestational Diabetes
If youve been diagnosed with gestational diabetes, you should track net carbs. Tracking net carbs can help you keep your carb intake low while still eating fiber-rich foods. If youre doing a keto diet to manage your gestational diabetes, I recommend eating under 40 grams of net carbs per day.
Eating fiber is good for you, so dont eliminate it out of your low-carb diet because youre tracking total carbs instead of net carbs.
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Use Evidence To Debunk Myths About Net Carbs Artificial Sweeteners Low
Chomko M. 2-BM-MS02. Presented at: American Diabetes Association Scientific Sessions June 3-7, 2022 New Orleans .
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NEW ORLEANS Providers should use evidence-based recommendations to educate people with diabetes on misconceptions surrounding net carbohydrates, artificial sweeteners and very low-carbohydrate diets, according to a speaker.
Maureen Chomko, RDN, CDCES, a dietitian and diabetes care and education specialist at Neighborcare Health in Seattle, said methods for calculating net carbohydrates, the effects of artificial sweeteners on health, and safety concerns with very low-carbohydrate eating patterns are common areas where people with diabetes have questions for providers. Chomko discussed those three nutritional topics during a presentation at the American Diabetes Association Scientific Sessions.
Stop counting net carbohydrates
Counting net carbohydrates was a concept popularized by the Atkins diet about 20 years ago, according to Chomko. The Atkins diet encourages people to track net carbohydrates by subtracting the amount of fiber and sugar alcohol consumed from total carbohydrates.
However, all fiber is not equal, according to Chomko. Insoluble fiber does not contribute carbohydrate or calories, and no definitive evidence demonstrates how many carbohydrates and calories are digested from soluble fibers.
References:
How Many Carbs Should A Person With Diabetes Have In A Day
Studies have shown that many different levels of carb intake may help manage blood sugar, and the optimal amount of carbs varies by individual.
The American Diabetes Association used to recommend that people with diabetes get around 45% of their calories from carbs.
However, the ADA now promotes an individualized approach in which your ideal carb intake should take into account your dietary preferences and metabolic goals .
Its important to eat the number of carbs at which you feel best and that you can realistically maintain in the long term.
The typical American diet provides around 2,200 calories per day, with 50% of them coming from carbs. This is equivalent to 275 grams of carbs per day .
A severely restricted intake of less than 50 grams of carbs per day appears to produce the most dramatic results and may reduce or even eliminate the need for insulin or diabetes medication. This represents 910% of daily calories on a 2,0002,200-calorie diet .
When tracking carb intake, experts sometimes recommend focusing on your net carbs instead of the total amount of carbs you eat. Net carbs is total grams of carbs minus grams of fiber .
People with diabetes can also benefit from diets that allow up to 26% of their daily calories to come from carbs. For people who eat 2,0002,200 calories a day, this is equivalent to 130143 grams of carbs .
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