Chapter 5


Carbohydrates are also known as saccharides, which in Greek derivation means, “sugar”. These sugars are responsible for producing energy in our bodies, however if this energy is not used immediately the excess must be stored within a fat cell, because an over abundance of sugar in our blood becomes a toxic poison. The simplest form of carbohydrates are known as monosaccharides, which can be found in hone (glucose), milk (galactose), and in fruits (fructose).

During digestion, all carbohydrates are broken down in the intestines, into their simplest form, sugar which then enters the blood. As blood sugar levels rise, the body's normal response is to increase levels of the hormone insulin in the bloodstream. Insulin, which is released by the pancreas, helps the body's cells use this sugar for energy, or store it (as fat) for later use. This, in turn, helps bring blood sugar levels down to normal levels.

The “Typical American Diet” is comprised of 300 to 400 grams of carbohydrates per day; this equates to 1200 to 1600 calories and is a whole days worth of calories, with no nutritional value. One, not even desiring to lose weight, should consume no more than 50 to 100 grams of carbohydrates per day, and the dietary basis for “A Second Opinion” calls for zero sugars and a maximum of 20 grams of carbohydrates per day.

This "Second Opinion" lifestyle alternative is especially well suited for diabetics and persons with chronic respiratory problems.

Carbon Dioxide is the cellular byproduct of metabolism. Persons with Chronic Obstructive Pulmonary Disease (COPD) tend to retain excessive amounts of Carbon Dioxide in the blood (PCO2) due to their inability to expel sufficient amounts through respiration. This causes an imbalance in the acid/ base homeostasis, making the blood overly acidic which must be compensated for by (similar to the overproduction of insulin).

Of all of the foods that we consume, the burning of carbohydrates produce the highest level of carbon dioxide, which intensifies blood acidity (most bacteria thrive in an acidic environment).

Carbohydrates and the Glycemic Index

Diets filled with high-glycemic-index foods, which cause quick and strong increases in blood sugar levels, have been linked to an increased risk for both diabetes and heart disease. A number of factors determine a food's glycemic index. One of the most important is how highly processed it’s carbohydrates are. In highly processed carbohydrates, the outer bran and inner germ layer are removed from the original kernel of grain, which causes bigger spikes in blood sugar levels than would occur with less-processed grains. Whole-grain foods tend to have a lower glycemic index than their more highly processed counterparts. For example, white rice, which is highly processed, has a higher glycemic index than brown rice, which is less highly processed. (See Fiber for more information on whole-grain foods)

A number of other factors influence how quickly the carbohydrates in food raise blood sugar levels, including:

Some foods that contain complex carbohydrates, such as potatoes, quickly raise blood sugar levels, while some foods that contain simple carbohydrates, such as whole fruit, raise blood sugar levels more slowly


Remember however, a gram of carbohydrates is a gram of carbohydrates.

               Carbohydrates and the Glycemic Index

                                                                                                        High-glycemic                  Low-glycemic

White bread
White rice
French fries
Refined breakfast cereals
White spaghetti
Soft drinks
Most Legumes
Whole fruits
Whole Wheat, Oats, Bran
Brown rice
Bulgar, Barley
Whole grain breakfast cereals

Although the fine points of the glycemic index may seem complicated, the underlying message is fairly simple: whenever possible, you should replace highly processed grains, cereals, and sugars with minimally processed whole-grain products. And potatoes--once on the complex-carbohydrate, preferred list--should only be eaten occasionally because of their high glycemic index.


High Carbohydrate/Very Low-Fat Diets


For years, you've probably heard the advice to cut back on the total amount of fat you eat and to consume more complex carbohydrates. And thousands of "low-fat" alternatives now crowd the supermarket shelves. It's easy to fall into the "low-fat trap." Because fat, gram-for-gram, has more than twice as many calories as either protein or carbohydrates, it seems logical that choosing low-fat products would help with weight loss. However, all too often the low-fat products on supermarket shelves are packed with sugar to make up for the taste that's lost when fat is removed.

While people think that a low-fat alternative will hasten weight loss, it often has just as many calories as the full-fat version--and may even have more. In addition, many people mistakenly think that because a food is low in fat, they can eat as much of it as they want without gaining weight. But as far as the body is concerned, one calorie is the same as another, no matter where they came from.

Aside from weight loss, the popularity of low-fat food has broader implications for health. Many people are increasing the amount of carbohydrates in their diets, particularly in the form of sugars, and as we know from the discussion of the glycemic index, doing so may lead to increases in heart disease and diabetes.

Researchers have calculated that replacing a given number of calories from polyunsaturated fat with an equivalent number from carbohydrates increased the risk for heart disease by over 50 percent. And other studies have found that a low-fat, high-carbohydrate diet, particularly one high in sugars, can worsen blood cholesterol and triglycerides levels, both of which are risk factors for heart disease.

Carbohydrate Counting: As Easy As 1 - 2 - 3


There are several different ways people with diabetes can manage their food intake to keep their blood sugars as close to normal as possible. One such method is carbohydrate counting. Carbohydrate counting is a method of calculating the grams of carbohydrate you eat at meals and snacks. The reason you focus on counting grams of carbohydrate is because carbohydrates tend to have the greatest effect on your blood sugar.

When you understand how to count grams of carbohydrates, you can have a wider choice of foods in your meal plan. It is easier to fit in combination foods such as soups and frozen dinners because you look at the grams of carbohydrate listed on the package, rather than trying to calculate how that particular food fits into the more traditional exchange meal plan. Also, some people find they can control their blood sugars more precisely.

Carbohydrate counting can be used by anyone with diabetes - not just people taking insulin. This method can assure that the right amount of carbohydrate is eaten at each meal and snack. Now that foods are more clearly labeled, it is easy to find the carbohydrate content of packaged foods.

This method is also useful for people who are using more aggressive methods of adjusting insulin to control their diabetes. The amount of meal and snack carbohydrate is adjusted based on the pre-meal blood sugar reading. Depending on the reading, more or less carbohydrate may be eaten. Likewise, insulin may be adjusted based on what the person wants to eat.

Step 2: Know your Carbohydrates

Most of the carbohydrates we eat come from three food groups: starch, fruit and milk. Vegetables also contain some carbohydrates, but foods in the meat and fat groups contain very little carbohydrates. This list shows the average amount of carbohydrates in each food group per serving:


Carbohydrate Grams


Carbohydrate Grams













To make things easy, many people begin carbohydrate counting by rounding the carbohydrate values of milk up to 15. In other words, one serving of starch, fruit or milk all contains 15 grams of carbohydrates or one carbohydrate serving. Three servings of vegetable also contain 15 grams. One or two servings of vegetables do not need to be counted (except they be filled with high starch or sugar). Each meal and snack will contain a total number of grams of carbohydrates.

 Which will have the greater effect on blood sugar?

 ____ 1 tsp sugar or ____ 1/2 cup potatoes

 The potatoes will contribute about 15 grams of carbohydrates, while a level teaspoon of sugar will only give 4 grams of carbohydrates. Therefore, the potatoes will have about three times the effect on blood sugar as compared to the table sugar.



Carbohydrate Grams

1% fat milk

1 cup


Bran Chex

2/3 cup


Frosted Flakes

3/4 cup


Raisin Bran

3/4 cup



1 slice


Sugar. White table

1 teaspoon


Pancakes - 4 inches



Low-fat granola

1/2 cup


Yogurt, fruited

1 cup


Yogurt, fruit with
NutraSweet fruit juice

1 cup


Fruit juice

1/2 cup





Pancake syrup

2 tablespoons


Light pancake
sugar free syrup

2 tablespoons



                                  Sample Breakfast


Carbohydrate Grams

Fruit yogurt (with NutraSweet)


Cinnamon-sugar toast - 

1 slice with 1 teaspoon sugar and one teaspoon margarine


Milk, 1/2 cup



Carbohydrate total =





"A Second Opinion friendly Breakfast" Carbohydrate


3 extra jumbo eggs 3
3 pieces of  standard bacon 0.1
3 pieces of Canadian Bacon 0.9
6 oz of ham 0.0
6 oz. pork chop 0.0
1 oz. of American Cheese 1.0
Black Coffee or Tea

(artificially Sweetened)

Total Carbohydrates  

5.0 grams



A slice of white cake with chocolate icing (1/12 of a cake or 80 gram weight) will give you about 300 calories, 45 grams of carbohydrates and 12 grams of fat. That is three starch servings and over 2 fat servings.


i26 Fit,  "A Second Opinion's" recommended meal replacement, "snack shake", and exercise recovery drink contains a full serving of i26, 20 grams of protein, 5 grams of fiber, 8 grams of carbohydrates (3 grams of net carbs), less than 1 gram of sugar, and a wide variety of vitamins, and minerals.



I am not a tremendous advocate of the consumption of alcohol, however there are zero carbohydrates in distilled spirits:

So drinks such as brandy, cognac, whiskey, scotch, bourbon, rum, gin, vodka, vermouth, aquavit, and the like can be consumed (straight or with a none sugar mix) with no restriction (although moderation is certainly encouraged)

The Carbohydrate gram count on other alcohols are as follows:

Carbs in Beer (12 oz. Serving)
  • Regular Beer: 13 grams
  • Light Beer: 4.5 grams
  • Ale: 7 grams
  • Stout: 20 grams
Carbs in Malt Liquor (8.5 oz. Serving)
  • Malt Liquor: 8 grams
Carbs in Table Wine (5 oz. Serving)
  • Dry White (e.g. Sauvignon Blanc, Chardonnay): 3 grams
  • Off Dry (e.g. Reisling, Chenin Blanc): 5 grams
  • Muscat: 8 grams
  • Dry Red (e.g. Syrah, Pinot Noir, Cabernet Sauvignon): 4 grams
  • Red Bordeaux: 4.5 grams
  • Red Burgundy: 5.5 grams
  • Red Zinfindel: 4 grams
Carbs in Champagne or Sparkling Wine (5 oz. serving)
  • Dry Champagne or Sparkling Wine (e.g. Extra Brut, Brut): 4.5 grams
  • Sweet Champagne or Sparkling Wine (e.g. Asti Spumante): 10 grams
Carbs in Dessert Wines
  • Dry Sherry: 12 grams (fortified, 3.5 oz. serving)
  • Port: 14 grams (fortified, 3.5 oz. serving)
  • Sweet Late Harvest Wine: 20 grams (unfortified, with 13% alcohol by volume minimum, a standard drink is close to 5 oz.)
Carbs in Liqueurs (2.5 oz. serving)
  • Amaretto: 42 grams
  • Bailey's Irish Cream: 18 grams
  • B & B Benedictine: 13 grams
  • Campari: 20 grams
  • Coffee Liqueur (e.g. Kahlua): 40 grams
  • Cointreau: 25 grams
  • Creme de Cacao: 37 grams
  • Creme de Cassis: 28 grams
  • Creme de Menthe: 35 grams
  • Grand Marnier: 17 grams
  • Kirsch: 15 grams
  • Ouzo: 27 grams
  • Sambuca: 28 grams
  • Triple Sec: 27 grams
There are zero carbs in Brandy / 80 proof Gin, Vodka, Whiskey etc. (1.5 oz serving)
  • All distilled spirits contain zero carbohydrate grams.



Controlling all carbohydrates

It is important to realize that sugar is not the only carbohydrate that you have to "control." The body will convert all carbohydrates to glucose - so eating extra servings of rice, pasta, bread, fruit or other carbohydrate filled foods will make the blood sugar rise. Just because something doesn't have sugar in it doesn't mean you can eat as much as you want. Remember your “Second Opinion” calls for the ingestion of zero grams of sugar and no more than 20 grams of carbohydrates.



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