DIABETES CARE

RICE AND THE MANAGEMENT OF DIABETES
Due in part at least to the current popularity of “low carb” diets, people with diabetes are often advised to at the very least severely limit, if not completely avoid rice. This is of course a major issue for people who traditionally eat rice for all of their main meals (breakfast, lunch and dinner), like many people from South and East Asia. For these people, complete avoidance is not really a long-term strategy for success, as it goes against their cultural and personal food preferences. What are the alternatives, if any? 

Portion caution
Cooked rice is indeed a concentrated source of starchy carbohydrate. As can be seen in this month’s “Your GI Shopping Guide”, a quarter of a Cup of most cooked rices provides around one carbohydrate exchange (12-18g carbohydrate per serve). While everyone with diabetes should see a dietitian for personalised advice, as a general guide, the carbohydrate recommendations for main meals for adults are: 

Men 45 – 60 grams of carbohydrate, or 3 – 4 exchanges 

Women 30 – 45 grams of carbohydrate, or 2 – 3 exchanges 

So, if you are going to continue to enjoy rice for breakfast, lunch and dinner, aim to have less than 1 cooked Cup at each meal. Bulk the meal out with non-starchy vegetables (e.g., alfalfa sprouts, asparagus, bean sprouts, bok choy, broccoli, Brussel’s sprouts, cabbage, capsicum, cauliflower, celery, chives, cucumber, eggplant, endive, garlic, green beans, kale, lettuce, leeks, marrow, mushrooms, okra, onions, radish, rocket, shallots, silverbeet, spinach, squash, tomatoes, watercress, and zucchini) and some lean protein (e.g., eggs, lean meat, seafood, skinless poultry or tofu). 

Swap it, don’t stop it
There are literally thousands of varieties of rice grown around the world. We have measured the GI of only a small portion of them. While many varieties have a high GI (>70), not all varieties do. Lower GI varieties are becoming increasingly available in both South and East Asia, to suit the culinary needs of the local population. See this month’s “Your GI Shopping Guide” for some more common examples and ideas. 

Glycemic load counts
The glycemic load (GL) is the amount of available carbohydrate (grams) in a serve of food, multiplied by its GI value (which is a percentage): 

GL = available carbohydrate per serve X GI value ÷ 100. 

Each unit of GL is equivalent to 1 gram of pure glucose – the sugar people measure in their blood with their home blood glucose meter when they have diabetes. So, by choosing the lower GI variety of your favourite rice, and eating it in smaller portions, you can potentially cut the glycemic impact of the rice you eat in half. 

Long-term success
For those people who have enjoyed eating rice for their main meals for most of their life, complete avoidance or severe restriction is not a recipe for long-term success. As the scientific evidence base shows us, many people can adhere to a “low carb” diet for 6 months, but most can’t for 12 months or more. It is therefore arguably better to enjoy a smaller amount of high-quality rice on a regular basis, than to try to avoid it. 

Read more: 

• Diabetes Australia: What should I eat 
• National Diabetes Services Scheme: Carbohydrate counting and diabetes 
• Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis

Alan Barclay, PhD is a consultant dietitian and chef (Cert III). He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).
Contact: You can follow him on Twitter, LinkedIn or check out his website.