How to Navigate Carbs When You Have High a1c (like me).

I thought quitting sugar would be hard. But it's far easier to control and delete from your diet, believe it or not, than those darned carbs!

Engin Akyurt

When the physician's assistant first told me, many years ago and after blood test results came in, I would have to cut sugar out of my diet, I replied weakly, "All sugar?"

"Most of it," he said, in that clinical voice medical professionals use so well.

I tried not to think about it. I didn't believe it was possible. No more sugar? In coffee? In desserts? I experienced this wave of shock, not unlike when you learn a friend or relative has died. Sugar was a friend. And it had just died in my life.

I remember thinking "Yesterday I ate my last chocolate chip brownie." And I didn't even mark the occasion. How shortsighted of me.

I did it, though. Quitting sugar was tough, and I didn't quit all sugar. I still ate the occasional cookie. Sometimes more than the occasional cookie. Yes, I slipped.

Anastasiia Chepinska

But I'm not here to confess my sins. My point is that sugar turned out to be relatively easy to contain. You just don't buy sweets. No more desserts. No more sugary drinks. Sure, there's sugar hiding in places you don't think of—condiments, protein bars, salad dressings—but those are generally small amounts that I can get away with so long as I keep it under control.

Carbohydrates, on the other hand...

Carbs turned out to be so much tougher. If you'd told me that originally I would have doubted you. But carbs are the fly in the ointment, because they're tough to weed out, so embedded in many recipes they are, often without satisfactory substitutes. While you can avoid so much sugar—especially processed sugar—by avoiding certain aisles in the supermarket, it's not so easy with carbohydrates.

How do you avoid carbs in Italian meals? Pizza? (Perhaps not technically an Italian meal so I'm listing it separately.) Mexican and Asian have some alternatives—Burrito bowls rather than wraps—but Italian is tricky. There are recipes on the internet, but while I haven't tried all of them, the ones I have tried have left me wanting.

Carissa Gan

You can substitute spaghetti squash for pasta, for example. If your taste buds are dead you won't notice the difference. Instead I just opt for wheat pasta and smaller servings to cut back on the carbs. With Italian, I feel "eating less" is the best low-carb solution. Carbs are just so much a part of Italian cooking, at least southern Italian cooking, which is the kind most popular among Americans, that I find they can't pleasingly be separated from the dish. Prove me wrong, someone!

I've found a solution for burgers, and it's not the substitute of lettuce for bread, which works for me about as well as spaghetti squash. I like thinly-sliced avocado on my burger in lieu of bread. You'll need a knife and fork to eat this burger and yes, it looks a little weird, but it tastes good, even with ketchup (just a little—it's full of sugar) on it. Then there's the technique of using large grilled or baked portobello mushrooms in place of bread. I have not tried this but I am curious. As for the fries...you're on your own. Sweet potato fries when air-fried or baked, are healthier, but they don't satisfy me the way they do "unhealthy" fries. Ah well...

Filipp Romanovski

Asian food—another tough one. It's my favorite cuisine overall, and it's all about the rice. Sashimi works for raw fish and poke bowls can substitute mixed greens for rice (or combine the two, cutting down on the quantity of rice). Personally, for Thai and Vietnamese I can do brown rice or forbidden or purple rice because these cuisines are hearty and hold up well to the denser, chewier rice, but for me both Chinese and Japanese cry out for more delicate, less nutritious white rice. ("Bad palate!")

Here I just bite the bullet and eat the white rice, though I don't eat as much as I used to. I'm not recommending this for you, but as with much Italian food I don't have a lot of substitutes that work for me. The light taste of Japanese and much Chinese food just accepts no substitute for white rice, unless you just forgo rice altogether, which may be the way to go. (Notice I call this "How to Navigate Carbs," not avoid them completely.)

How about bread? Fortunately, there are some very good substitutes—and some outright breads—you can have. Cauliflower wraps are a popular alternative to traditional tortillas, especially for those seeking low-carb, gluten-free options. They're made from finely chopped cauliflower (often "riced" in a food processor), mixed with eggs and sometimes cheese or other binders, and baked into thin, pliable rounds. You can sub them for traditional tortillas for tacos, burritos and quesadillas, or as a base for personal-sized pizzas. (So there is a way around the carbs in pizza, so long as you go for the personal size!) And they taste delicious.

Meg von Haartman

Other low-carb alternatives to bread include Almond or coconut flour bread/tortilla. These options are higher in fiber and healthy fats. And there's low-carb tortillas or keto bread. I'm not a fan of the latter, but some people are. And don't forget my favorite solution, whole grain crackers or flatbreads! Choose varieties without added sugars and pair them with protein-rich spreads.

And finally, keep in mind not all carbs are evil. Complex carbs, found in whole, unprocessed foods such as the above-mentioned whole grain crackers, are rich in fiber, vitamins, and minerals.

Coupled with a steady but not overwhelming regimen of exercise (you DO have to get in at least 130 minutes of exercise a week; you DON'T have to lift free weights or train for an Ironman Triathlon; brisk walking is fine) you stand a good chance of lowering your blood sugar to decent levels. The trick is to not fall off the wagon and revert to your old ways; it's harder than you think, and I'll talk about that in my next post.