Diabetes mellitus is a metabolic condition requiring a comprehensive approach to treatment. The primary goal for individuals with type 1 and type 2 diabetes is maintaining optimal blood sugar control. Most treatments, including insulin, other injections, oral medications, dietary adjustments, and physical activity, are directed toward achieving this objective. One dietary strategy that allows for greater control without burdensome restrictions is the consistent carbohydrate diet (CCHO diet).
What is the CCHO Diet?
The consistent (or controlled) carbohydrate diet (CCHO diet) is a dietary approach designed to help individuals with diabetes maintain stable carbohydrate consumption across all meals and snacks. This consistency helps prevent drastic fluctuations in blood sugar levels, avoiding both spikes and dips. The core idea behind the CCHO diet is to carefully monitor and regulate carbohydrate intake to minimize these fluctuations.
How the CCHO Diet Works
The CCHO diet aims to keep your carbohydrate intake consistent throughout the day, every day of the week. This consistency, combined with taking medications at the same times each day and maintaining a regular exercise schedule, promotes smoother blood sugar control.
Instead of meticulously counting grams of carbohydrates, the CCHO diet uses a system of "choices" to represent food portions. Approximately 15 grams of carbohydrates equals one carb "choice." For instance, a half-cup of rice contains about 22 grams of carbohydrates, which would be equivalent to 1 1/2 carb "choices." Similarly, one slice of bread, containing 12 to 15 grams of carbs, equals one "choice."
Planning menus and setting limits on the total number of carb choices per meal can help stabilize carb intake and blood sugar levels. The CCHO diet may be easier to follow than tracking individual carbs or food groups to adjust insulin dosages at each meal. Once familiar with common exchanges, individuals can navigate restaurant menus or plan weekly meals effectively, as long as portion sizes remain consistent.
Read also: The Hoxsey Diet
Carb Counting: A Deeper Dive
When you eat or drink foods that have carbohydrate-also known as carbs-your body breaks those carbs down into glucose (a type of sugar), which then raises the level of glucose in your blood. Your body uses that glucose for fuel to keep you going throughout the day. When it comes to managing diabetes, the carbs you eat play an important role. After your body breaks down those carbs into glucose, your pancreas releases insulin to help your cells absorb that glucose.
When someone’s blood glucose is too high, it is called hyperglycemia. There are a few causes for “highs,” including not having enough insulin in your body to process the glucose in the blood or the cells in your body not effectively reacting to the insulin that is released, leaving extra glucose in the blood. A low blood glucose is known as hypoglycemia. “Lows” can sometimes be caused by not consuming enough carbohydrates, or an imbalance in medications. In short, the carbs we consume impact our blood glucose-so balance is key!
There are three main types of carbohydrates in food-starches, sugar, and fiber. As you’ll see on the nutrition labels for the food you buy, the term “total carbohydrate” refers to all three of these types. The goal is to choose carbs that are nutrient-dense, which means they are rich in fiber, vitamins and minerals, and low in added sugars, sodium, and unhealthy fats.
Carbohydrate Sources
Carbohydrates come in three primary forms: sugars, starches, and dietary fiber. While it's common to associate carbs with foods like pasta and rice, they are also present in dairy products, fruits, fruit juices, starchy vegetables, and whole grains.
While carbs with minimal nutritional value, such as white rice and sugary candy, may not be ideal for a healthy diet, the carbs found in plant-based foods are often accompanied by essential vitamins and minerals. Additionally, these foods are excellent sources of fiber, a nutrient that supports a healthy digestive system.
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The easiest way to determine the carbohydrate content of a food is by checking the nutrition label. For foods without labels, the U.S. Department of Agriculture (USDA) maintains a searchable Food Composition Database with information on both generic and brand-name foods.
Determining Your Ideal Carbohydrate Intake
An ideal carbohydrate goal or "choice" number is not one-size-fits-all. A healthcare provider can help establish a personalized goal based on individual factors, including:
- Health status
- Weight
- Activity level
- Average blood sugar levels
A doctor may recommend consulting a registered dietitian or diabetes educator. These professionals can assist in creating menus that align with your carb choice goals while accommodating individual preferences.
The Role of a Dietitian or Nutritionist
A dietitian or nutritionist is a trained expert who can provide care for individuals with specific dietary needs or concerns. The American Diabetes Association advises people with diabetes to consult with these providers. Working together with a dietitian or nutritionist and the healthcare team can help determine appropriate carb goals, monitor blood sugar levels, and make necessary adjustments to achieve the right carbohydrate intake.
Sample CCHO Menu Plans
The following sample menus, including choice counts, can serve as inspiration for daily food choices. Feel free to mix and match to create variety or streamline the process by eating the same foods each day. Be mindful of potential boredom or burnout, which can lead to unhealthy binges. Substituting foods with similar carb content can help maintain interest.
Read also: Weight Loss with Low-FODMAP
Day 1
- Breakfast: 1 cup oatmeal (2 choices); 1 slice thin whole-wheat toast (1 choice) with 2 tablespoons peanut butter (0 choice); coffee (0 choice); unsweetened half-and-half creamer (0 choice)
- Morning snack: fresh orange (1 choice); unsweetened iced or hot tea (0 choice)
- Lunch: 1/2 chicken breast (0 choice); 1/2 cooked wheat berries (1 choice); three cups spinach (0 choice); 1 cup strawberry halves (1 choice); 1 ounce toasted walnuts (0 choice); balsamic vinaigrette (0 choice); 1 dinner roll (1 choice); unsweetened iced tea (0 choice)
- Afternoon snack: 4 cups air-popped popcorn (1 choice)
- Dinner: salmon fillet (0 choice), 1/2 cup mashed sweet potatoes (1 choice), 1 cup steamed broccoli (0 choice); 1 dinner roll (1 choice); water (0 choice); 1 cup raspberries (1 choice)
Day 2
- Breakfast: 2 over-medium eggs (0 choice); 1 slice thin whole-wheat toast (1 choice); 1 tablespoon fruit preserves (1 choice); 1/2 banana (1 choice); coffee (0 choice); unsweetened half-and-half creamer (0 choice)
- Morning snack: 1 small pear (1 choice); 1 ounce of cheese (0 choice)
- Lunch: 1 cup chicken salad (0 choice); 6 crackers (1 choice); 1/2 cup grapes (1 choice); water (0 choice)
- Afternoon snack: 3/4 ounce pretzels (1 choice); low-fat mozzarella cheese stick (0 choice)
- Dinner: 1/2 cup cooked black beans (1 choice); 1/2 cup brown rice (1 choice); 1/2 cup corn kernels (1 choice); 1/2 cup cooked ground beef (0 choice); shredded lettuce (0 choice); shredded cheese (0 choice); 1/4 cup fresh salsa (0 choice); dollop of sour cream (0 choice); unsweetened iced tea (0 choice)
Day 3
- Breakfast: low-fat vanilla Greek yogurt (1 choice); 3/4 cup fresh blueberries (1 choice); 1/2 cup fresh orange juice (1 choice)
- Morning snack: 1/2 cup applesauce (1 choice); 1 cup milk (1 choice)
- Lunch: 2 slices thin whole-wheat toast (2 choices); 3 ounces sliced turkey breast (0 choice); 1 tablespoon mayonnaise (0 choice); 1 slice tomato (0 choice); 1 cup carrot sticks (1 choice); water (0 choice)
- Afternoon snack: hard-boiled egg (0 choice); small apple (1 choice)
- Dinner: 1 cup beef-and-bean chili (2 choices); dinner roll (1 choice); 1 small apple (1 choice); green salad, tomatoes, and cucumbers with vinaigrette dressing (0 choice)
Potential Benefits of the CCHO Diet
A well-balanced diet like the CCHO diet can be a healthy way to manage blood sugar levels and weight. It may also help lower the risk of diabetes-related complications, such as heart disease, stroke, and nerve damage. While the body needs carbohydrates for energy, excessive intake can pose challenges for individuals with type 2 diabetes.
Other Names for the CCHO Diet
Healthcare providers or nutritionists may refer to the CCHO diet by alternative names, such as the "constant carbohydrate" or "controlled carbohydrate" diet.
Types of Carbohydrates
There are three main kinds of carbohydrates:
- Sugar: A "simple" carbohydrate that the digestive system breaks down quickly. Sugars can occur naturally, like fructose in fruit, or be processed, like white table sugar.
- Starch: A "complex" carbohydrate that digests slowly. Examples include lima beans, potatoes, and whole grains.
- Fiber: Also a complex carbohydrate, found in foods like apples, celery, and chickpeas.
Carbohydrate Recommendations
On a CCHO diet, an individual might be allowed to consume around 185 carbohydrates each day, though this amount can vary based on a doctor's recommendations. For example, a person might divide their carbs this way into three meals:
- Breakfast: 65 carbohydrates
- Lunch: 60 carbohydrates
- Dinner: 60 carbohydrates
Potential Benefits
Studies suggest that limiting carbohydrates can be an effective strategy for managing blood sugar levels, potentially reducing the need for insulin or even eliminating it altogether. Unlike some medications for type 2 diabetes, the CCHO diet typically has no side effects.
Considerations for High-Carbohydrate Diets
In patients with type 2 diabetes mellitus (T2DM), whether dietary carbohydrates have beneficial or detrimental effects on cardiometabolic risk factors has drawn attention. Although a high-carbohydrate (HC) diet and a low-carbohydrate (LC) diet have gained popularity for several decades, there is scarce review focusing on the effects of HC diet on glucose, lipids and body weight in patients with T2DM. In this review, we examined recently-published literature on the effects of HC diets on metabolic parameters in T2DM. HC diets are at least as effective as LC diets, leading to significant weight loss and a reduction in plasma glucose, HbA1c and low density lipoprotein-cholesterol (LDL-C) levels. The major concern is that HC diets may raise serum triglyceride levels and reduce high density lipoprotein-cholesterol (HDL-C) levels, increasing the risk of cardiovascular disease. However, these untoward effects were not a persistent consequence and may be ameliorated with the consumption of a low glycemic index (GI)/low glycemic load (GL) and high fiber.
Sample CCHO Meal Recipes
Here are some recipes that can be incorporated into a CCHO meal plan:
Oatmeal with Strawberries and Almonds
- 1 cup old-fashioned rolled oats (not quick cooking, gluten-free)
- 2 cups water
- 1/4 teaspoon salt
- 1/4 cup raspberry fruit spread
- 1/2 teaspoon almond extract
- 2 cups strawberries, quartered
- 1 ounce slivered almonds, toasted
Total carbs: 33
Combine water, oats, and salt in a medium-size pan. Bring to a boil, reduce heat, and simmer 10 minutes uncovered. Remove from heat and let stand 2 minutes. Place the fruit spread in a small microwave-safe bowl and cook on high setting for 15 seconds or until slightly melted. Remove from heat and stir in the extract. Spoon equal amounts of the oatmeal in four bowls. Top with 1 tablespoon fruit spread, 1/2 cup berries, and 1 tablespoon toasted almonds.
Ham, Cheese, and Avocado Lettuce Wrap
- 1 teaspoon lime juice
- 1/2 ounce reduced-fat Colby jack cheese
- 1/4 avocado, mashed
- 1 1/2 ounces low-sodium deli ham
- 1 large Bibb lettuce leaf
- 1 teaspoon chili powder
- 2 hard-boiled egg whites
- 12 roasted almonds, unsalted
- 1 green apple
- 3 baby carrots
Put the ham, cheese, and avocado on the lettuce leaf, then roll it tightly and wrap in plastic wrap. Serve it with the egg whites, almonds, green apple, and baby carrots.
Total carbs: 35
Chicken and Mushroom Dish
- 1 pound boneless, skinless chicken breasts
- 1 tablespoon olive oil
- 1/4 cup all-purpose flour
- 1 tablespoon margarine (trans fat-free)
- 10 ounces white (button) mushrooms, sliced
- 1/4 teaspoon black pepper
- 1/3 cup balsamic vinegar
- 1/2 cup low-sodium, fat-free chicken broth
Place the chicken breast in a plastic bag and pound it thin with a mallet. Heat olive oil over medium-high heat in a skillet. Dredge the chicken in flour and coat it on both sides. Add the chicken to the pan and sauté 5 minutes per side. Remove the chicken from the pan and set aside. Melt the margarine in the pan. Add the mushrooms and pepper and cook for 5 minutes. Add the balsamic vinegar to the pan and bring it to a boil to reduce the liquid. Add the chicken broth to the pan and simmer 2 minutes.
CCHO Diet vs. Low-Fat Diets (LCD vs. LFD)
Numerous studies were performed to compare the effects on metabolic risk factors and weight loss in overweight and obese adults between LCD and LFD. However, the studies showed inconsistent results. Some meta-analysis showed different effects on metabolic risk factors and weight loss in adults with overweight or obese between LCD and LFD. Compared with LFD, subjects on LCD had a greater reduction in TG, DBP, weight loss, and greater increases in HDL-C. However, participants on LFD had more decreases in LDL-C and TC. LCD was more beneficial for improving TG and HDL-C.
Important Considerations
- Restrictiveness: The CCHO diet is restrictive and requires eating the same number of carbohydrates every day.
- Individual Needs: There is no single ideal number of carbohydrates for each meal, as individual needs vary.
- Medication: People with type 1 diabetes and some people with type 2 diabetes need to adjust their insulin doses based on what they are eating.
- Professional Guidance: Anyone with diabetes should speak with a healthcare professional about the benefits of changing the diet. The American Diabetes Association recommends that everyone with diabetes receives an individualized nutrition plan.
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