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Today, another myth-busting session of our diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois:




Don from Florida, type 1, asks: Can you tell me about "net carbs" vs. "total carbs?" To me, a sugar alcohol is a carb to be counted, as are fiber grams. If I would just take insulin for net carbs, I'd really have trouble, I think.


Wil@Ask D'Mine answers: You bet I can! Total carbs, in a nutshell, are numbers that can predict the blood sugar impact of any given food on your body—but other elements of the same food can reduce that impact at the same time.

Fiber is a good example. If you ate both the nut and the shell.... just kidding. But seriously, fiber reduces the net effect of the carbs in a food. So you need to subtract fiber, not add it in. If you were to take insulin based solely on total carbs, and the food you're eating had a lot of fiber, you'd take too much insulin for the meal and could go low.

The concept of the "net carbs" that we see on many food labels today is a legacy of the Atkins Diet era. For those of you who weren't born yet... oh wait a sec. It was only a few years ago, wasn't it? Funny how your sense of time gets warped when you have a 24-7-365 chronic illness!

So back in 2004 the low-carb diet approach pioneered by outside-the-box physician Robert Atkins (way back in 1972) reached its feverish peak. Dr. Atkins advocated for low-carb, high-fat, high-protein diets. The long-term health risks of this approach are widely disputed, but people do lose a boatload of weight on this diet, and keep it off as long as they stay on the diet. Oops. Once people drop the diet and go back to eating the way that made them fat in the first place, they get really fat again. Really quickly. Well, that's true of most diets.

Low-carb diets are hard to sustain for most folks, as everyone's favorite comfort foods tend to be high-carb, and we live in a virtual Garden of Eden filled with high-carb apple trees and snakes.

Atkins diets weren't designed for PWDs, but we all owe a debt of gratitude to Dr. Atkins. Before everyfrickinbody was on Atkins, the major manufacturers of stuff to eat paid very little attention to the diabetes population. Sugar-free (or corn syrup-free) foods were rare and nasty tasting. But the Atkins craze got so big so quickly (with about 9% of the population on it in '04 and sales of pasta, rice, and Krispy Kreme doughnuts plummeting), that the big producers of food had to sit up and take notice. Soda makers had to make sugar-free drinks that tasted good to shore up slumping sales; while other food kings saw opportunities to gain or create new market share.

This was because, for dieters, the food had to taste good. Unlike us, it wasn't a matter of life and death.

Anyway, hard-core Atkins folks had carb limits on how much they could eat at a given meal. Dr. Atkins realized that fiber-reduced carb impact, so for Atkins dieters, fiber was subtracted from the carb count. But he didn't stop there. Sugar alcohols, a sugar substitute, were also subtracted. As far as the Atkins folks were concerned, sugar alcohols had no impact on weight. This is where the "net carbs" thing came from. It's total carbs minus fiber, minus sugar alcohol. This sleight of hand might let someone advertise, say, a breakfast bar, that was packed full of fiber and loaded with sugar alcohol as having only 2 net carbs when the total carbs could be as high as 25 or 30.

The problem for us PWDs is that, whether or not sugar alcohols have any effect on weight, they sure as hell have an impact on blood sugar. In fact, they have almost exactly half the impact of regular sugar. You are right, Don, if you just take insulin for the net carbs, you'll be in trouble. High trouble.

And while our taste buds have a lot to be thankful for from the Atkins craze and its long-term fallout, net carbs are not for us. You still need to do some data mining on the food label. Sugar alcohols are listed under sugar, which is found under the Total Carbohydrate section of the label. To calculate a proper bolus of insulin for any food with sugar alcohol you need to take the total carbs, subtract the fiber (next on the label), then subtract half of the sugar alcohol. This is your bolusable carb count, and it'll be much higher than the "net carb" count on the front of the box!


... while we're on the subject of eating...


Mallory from Tennessee, type 2, writes: I'm a 27-yr-old who's had type 2 diabetes for one year. I'm on oral meds and insulin. I find it very hard to cope, especially with eating. I don't like to eat early in the day, but tend to overeat as the day goes on.  Why do people say it's so important to eat breakfast? If I force myself to eat in the morning, would that really help me do better?

Wil@Ask D'Mine answers: Oh dear. I can hear the registered dietitians and nutritionists sharpening their pitch-forks as I write this, but...

I don't thinking "forcing" yourself to eat breakfast is a good idea.

But breakfast really is the most important meal of the day. So frankly, I'd rather you ate a Butterfinger bar than skip breakfast altogether. Was that the sound of torches being lit?

OK, here's the deal. Breakfast is important for two reasons: one, it sets up your metabolic rate for the day; and two, as you've noticed in yourself—people who skip breakfast tend to eat too much later in the day. Oh, yeah, and there's a third reason too: calories consumed early in the day tend to get burned off during the day.

On the whole metabolic thing, your body seeks clues early in the day about access to fuel. If you don't eat early, your body assumes you are lost in the Sahara (hey, it could happen), and shifts into fat-storing mode. Things you eat later in the day are stored at a higher rate than burned. If you eat in the morning, even something bad, then your body shifts into fuel-burning mode and you tend to store less fat.

Of course, the biggest issue is the if-you-wait-unit-you-are-hungry-you-will-eat-more problem. Even a super-small breakfast makes a difference. I've seen dozens of people at our clinic who've lost weight simply by adding breakfast. People freak out at first, saying, "I'm already fat, if I eat more I'll get even bigger!" But what happens is that eating breakfast reduces hunger later in the day, which reduces the volume you eat as the day goes on. And as we already pointed out, the later in the day you eat something, the less chance you have to burn it off, in the perfect world we'd have huge steak-and-eggs breakfasts, modest lunches, and small dinners.

But we do the opposite in our society. No breakfast, small lunch, huge late dinner followed by sitting on the couch watching TV because your wife is hogging the computer.

So like I said, forcing yourself to do something is a bad idea in my playbook. It'll make you miserable and it probably isn't sustainable. But, yeah, breakfast probably will help you do better. Why don't you think outside the box? Instead of a traditional breakfast, is there something you could eat early in the day? Could you drink a protein shake? Eat a couple pieces of beef jerky? What about a slice of bologna with a chunk of cream cheese wrapped up in it?

And if all else fails, reach for the Butterfinger. But not the King-sized one, please.





This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.





Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.