What is the ratio rule for carbohydrates

The trick to recognizing a good whole grain: Use carb-to-fiber ratio of 10-to-1

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Whole grain has become a healthy eating buzzphrase, and food companies arent shy about using it to entice us to buy products. Browse the bread, cereal, or chip aisle of your favorite grocery store and youll see what I mean. Last year, nearly 3,400 new whole-grain products were launched, compared with just 264 in 2001. And a poll by the International Food Information Council showed that 75% of those surveyed said they were trying to eat more whole grains, while 67% said the presence of whole grains was important when buying packaged foods.

But some of the products we buy may not deliver all the healthful whole-grain goodness were expecting. If sugary Froot Loops can tout itself as a whole-grain food, theres something amiss.

Whats the best way to identify a healthful whole-grain food? I struggle with this question often while shopping. There several competing recommendations. The current Dietary Guidelines for Americans says to choose grain products that have the word whole before any grain in the ingredient list. The USDAs MyPlate recommends choosing grain products with a whole grain as the first item in the ingredient list or listing whole grain as the first item and containing no added sugars. The nonprofit Whole Grains Council promotes the Whole Grain Stamp, which a company can place on its packaging if the product contains at least eight grams of whole grains per serving.

Theres a better way. Use this rule when choosing whole-grain foods: for every 10 grams of carbohydrate there should be at least one gram of fiber. Why 10:1? Thats about the ratio of fiber to carbohydrate in a genuine whole grainunprocessed wheat. This recommendation comes from a new report from the Harvard School of Public Health published online in the journal Public Health Nutrition.

The Harvard researchers evaluated 545 grain products from two major grocery store chains, Stop & Shop and Walmart. They tallied up grams of whole grains in each product, along with the amounts of carbohydrates, fiber, added sugar, trans fat, and sodium, plus the number of calories. Foods that met the 10:1 ratio tended to have less sugar, sodium, and trans fats than those that didnt.

You arent alone if you are confused about whole-grain foods, said Rebecca Mozaffarian, a project manager for the HSPH Prevention Research Center and first author of the study. She and her colleagues started this project when they realized there was little evidence-based information for guiding consumers, schools, and other organizations about choosing healthful whole grain foods.

The drawback to using a ratio is that you need to do a little math. The advantage is that the information needed is easily found on food labels, which list both total carbohydrates and fiber (see illustration). Divide the grams of carbohydrates by 10. If the grams of fiber is at least as large as the answer, the food meets the 1:10 standard. I find this a lot easier than reading through an ingredient list, which can be long and baffling (plus there are at least 29 different whole grains that can appear in the ingredients list).

In the nutrition label shown here, for example, one serving of this whole-grain roll has 23 grams of carbohydrate. Divide that by 10 and you get 2.3. It also has 5 grams of dietary fiber, which is definitely bigger than 2.3. That signals a healthful whole-grain food.

Why bother eating whole grains? They deliver everything an intact grain has to offerfiber, vitamins, minerals, antioxidants, and other phytochemicals. As long as they arent overprocessed, the body digests them more slowly, which can delay hunger. And large, long-term studies have shown that consuming whole grains is one way to help reduce the odds of developing heart disease, diabetes, and other chronic conditions. They also taste better than processed grains.

Intact grainswheat berries, oat berries, brown rice, quinoa, and the likeare the best source of whole grains. Theyre a slam dunk, says Mozaffarian. Ground whole grains come next, as long as they still deliver a good dose of fiber and dont also deliver added sugar, trans fats, or sodium. To find those, Ill be using the 10:1 carbohydrate-to-fiber guide.

What is the 500 rule in diabetes?

What is diabetes?

Diabetes is a group of metabolic disorders where malfunctioning insulin metabolism causes high blood sugar levels that, if left untreated, can do serious long-term damage. Within this group, there are types of diabetes: Type 1, Type 2, and gestational diabetes. Insulin is a hormone which is produced in the pancreas and manages how glucose is absorbed by the body. If theres not enough insulin, the body can no longer effectively absorb glucose from the bloodstream.

Type 2 is by far the most common, accounting for 90% of global diabetes cases. It develops when the bodys cells can no longer receive and respond to insulin, a condition called insulin resistance. Type 2 diabetes cannot usually be cured, but it can be managed with a healthy lifestyle (a balanced, low-sugar diet and regular physical exercise) and with medications like insulin sensitizers.

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Type 1 diabetes is much less common, making up about 8-10% of diabetes, globally. It is an incurable and lifelong condition. The disease typically develops in childhood, due to an autoimmune disorder, and results in the pancreas not producing sufficient insulin. Type 1 diabetes can be effectively managed with insulin injections or pumps that make up for the insulin no longer produced by the pancreas. Instead of scheduled injections, its becoming increasingly popular to continuously monitor glucose levels and have insulin delivered automatically using a pump.

Almost 10% of the worlds population suffers from diabetes or pre-diabetes. In particular, the disease is becoming a problem in more affluent countries like the United States, where obesity and a sedentary lifestyle are widespread. Currently, around 13% of American adults are diabetic, including 8 million who have not yet been diagnosed.As per an estimate by the US Center for Disease Control. Every year, around 300,000 Americans die from complications of diabetes.

What is the 500 rule?

The 500 rule (sometimes also called the 450 rule) is a widely used method for type 1 diabetes patients to estimate how many carbohydrates will be covered by one unit of fast-acting, or bolus insulin. This is called the insulin-to-carb ratio or simply, the carb factor. Knowing this ratio allows you to plan ahead for how much insulin you need to cover the carbohydrates in your meals,and keep your blood sugar levels under control.

Bolus insulin is specifically designed for fast action and thus ideal to be used after meals or during times when blood sugar levels are unusually high and require an immediate reduction. Fast-acting insulin takes effect within 15 minutes, peaks after one hour and remains effective for 2-4 hours afterwards.

The volume of bolus insulin used needs to correspond tothe number of carbs a person eats during a meal. So it is essential that a person with diabetes knows how many carbohydrates they are taking in during a meal. For accurate calculation you also need to take into account the basal insulin you use this is the set amount of long-acting insulin you inject or pump every day.

The 500 rule is based on the simple assumption that the average adult consumes 500 grams of carbs every day, including any carbs produced in the liver. So, to get your normal insulin-to-carb ratio (ICR) you divide 500 by the units of insulin you take on a typical day (both basal and bolus) with stable blood sugar levels. For example, lets say that normally you take 20 units of insulin, then your ICR is 1:25 (500/20=25).

Heres a table of common ICRs:

Based on your ICR, you can then roughly calculate how much bolus insulin youll need to cover the carbs of any meal. Of course, youll need to have an idea of how many carbs actually are in the meal. It takes some practice at first, but over time youll get a good sense of how many carbs are in your favourite foods.

What is the downside of the 500 rule?

The 500 rule is simple to use, but it comes at the expense of accuracy. After all, not all people eat exactly 500 grams of carb every day. Depending on body weight, age, sex, dietary preferences and many other factors, carb intake can vary widely.

With the 500 rule, overweight people tend to lowball their mealtime insulin needs, while leaner people will use too much. Therefore, more and more people are using a calculation that takes bodyweight into account. This approach also requires some trial & error and fine-tuning.

To learn more about the 500 rule and alternative ways of estimating mealtime insulin needs, talk to your primary doctor or an endocrinologist (a diabetes specialist).

References

1. Symptoms & Causes of Diabetes | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases, Mar. 2019, www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes. Accessed 25 Aug. 2020.
2. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes2018. Diabetes Care, vol. 41, no. Supplement 1, 5 Aug. 2018, pp. S13S27, 10.2337/dc18-s002. Accessed 25 Aug. 2020.
3. Scheiner, Gary. Insulin-to-Carb Ratios Made Easy. Integrated Diabetes LCC, 11 Mar.2017.https://integrateddiabetes.com/Articles/insu/carb%20ratio%20article%20for%20mendosa.pdfAccessed 25 Aug. 2020.

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Reviewed by Dr Roy Kedem, MD

Information last reviewed 12/06/21

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Follow the 5-to-1 Rule for Packaged Foods

When people think fiber, they think constipation. And its true: If we could get Americans to eat just the minimum recommended daily intake of fiber-containing foods, we could save our country $80 billionand thats just from the effects on constipation alone. But thats not all. Accumulating evidence indicates that greater dietary fiber intakes reduce risk for type 2 diabetes, cardiovascular disease, certain cancers, weight gain, obesity, and diverticular disease, as well as functional constipation. So, we need to eat more fiber-rich foods, which means eating more whole grains, vegetables, fruits, and legumes (beans, split peas, chickpeas, and lentils).

As fiber intake goes up, the risk of metabolic syndrome appears to go down, with less inflammation and an apparent step-wise drop in obesity risk. Its therefore no surprise that greater dietary fiber intake is associated with a lower risk of heart disease: There is a 9 percent lower risk for every additional 7 grams a day of total fiber consumed, which is just some rice and beans or a few servings of fruits and veggies.

How does fiber do its magic? What are the mechanisms by which dietary fiber may extend our lifespan? It helps get rid of excess bile, feeds our good bacteria, and changes our gut hormones, which collectively helps control our cholesterol, body weight, blood sugar, and blood pressure, thereby reducing the risk for cardiovascular disease. Reducing inflammation is a whole other mechanism by which fiber may help prevent chronic disease.

An accompanying editorial to a fiber and heart disease meta-analysis implored doctors to enthusiastically and skil[l]fully recommend that patients consume more dietary fibrewhich means a lot of whole plant foods. If we do buy something packaged, however, the first word in the ingredients list should be whole. But, even if it is, the rest of the ingredients could be junk.A second strategy is to look at the ratio of grams of carbohydrates to grams of dietary fiber. Were looking for about 5 to 1 or less. For example, whole-wheat Wonder Bread passes the first test: The first word in its ingredients list is whole. However, it then includes corn syrup and the contents of a chemistry set. So, lets see if it passes the 5-to-1 rule.

In my video The 5-to-1 Fiber Rule. I show examples of some Nutrition Facts labels. The whole-wheat Wonder Bread lists 20 grams of carbs and 2.7 grams of dietary fiber per serving. Dividing the carbohydrates by the dietary fiber, 20 divided by 2.7, is about 7, which is obviously more than 5, so back it goes onto the shelf. Its better than white Wonder Bread, though, which comes in at over 18. Ezekiel sprouted grain bread, however, makes the cut: 15 divided by 3 equals 5.

You can do the same thing with breakfast cereal. Multi-Grain Cheerios sounds healthy but has a ratio over 7. Uncle Sam original cereal is an example of one that makes the cut, sliding in under 4.

The editorial concluded that the recommendation to consume diets with adequate amounts of dietary fibre may turn out to be the most important nutritional recommendation of all.

I love producing videos about practical, day-to-day decision-making. Next time you go to the grocery store, look for products that fit the 5-to-1 ratio rule. They arent easy to find!

Eating fiber-rich foods is more than just a way to avoid constipation. For example, watch my videos Fiber vs. Breast Cancer and How to Prevent a Stroke.

Theres a misconception that we cant digest fiber. We cant do it alone, but we can with a little help from our gut flora friends. See Prebiotics: Tending Our Inner Garden and Gut Microbiome: Strike It Rich with Whole Grains.

This isnt to downplay all the suffering caused by constipation. Check out How Many Bowel Movements Should You Have Every Day? and Should You Sit, Squat, or Lean During a Bowel Movement? to learn more.

Isnt this talk of fiber reductionist? Good question! So good, in fact, that I created an entire video about it. See Is the Fiber Theory Wrong?.

In health,Michael Greger, M.D.

PS: If you havent yet, you can subscribe to my free videoshereand watch my live, year-in-review presentations: