For those on insulin -- Dietary Fiber - subtract from bolus or not?

In trying Dr. Richard Bernstein's diabetic diet I have come across a new quandry. Since he advocates eating only vegetable, protein and fat I'm left guesing at to whether or not to count the fiber in veggies. If we are only allowed 6 grams carbohydrate at breakfast, 12 at lunch and 12 at dinner, If one subtracts out the carbs when counting for boulings it means potentially eating twice as many vegetables. i.e. broccoli raab has a ton of fiber so if one subtracts one gets a whole lot more.

I'm testing my blood sugar 8-12 times a day in an effort to figure out if his diet really does help eliminate blood sugar spikes.

Well I don't do this diet (that sounds wayyyyy too restrictive for me. I used to restrict and it made me more sick than benefiting me) or anything really like it, but if something does have more than 5 grams of fiber, I subtract the fiber. It seems to work pretty well for me, but your diabetes may vary. I often don't have spikes, only when it's that time of the month.

I was told the same thing from my CDE team. Subtract anything that has more than 4g of Fiber from the total carb count as your system doesn't process it the same anyway.

Note: In the United States, labeling regulations require that fiber be listed as carbohydrate. There are different kinds of fiber, and they all behave differently. My rule of thumb is to deduct half of the stated grams of fiber from the stated grams of carbohydrate to get a general idea of how the listed carbohydrate will affect your blood sugars.

Here's the link

I don't follow Dr. Richard Bernstein's diabetic diet. But I have been counting exchanges and carbs for decades. I do not subtract the fiber and never have. I don't have spikes as a rule. Since you are testing 8-12 times a day, you will soon figure out what works for you.

I don't low carb and I do subtract out all fiber. As Karen said - you'll find out what works for you by testing. If you consistently eat about the same amount of fiber for meals then it subtracting or not subtracting won't make much difference. A plate of broccoli rabe sautéed in olive oil and garlic and a small piece of fish will take x units of insulin. If you subtract out the fiber, the total insulin you need won't change - you'll just come up with a different insulin:carbohydrate ratio,


I subtract the fiber from some foods but not from fresh vegetables. I hope the diet helps you. I found when I was on 30g per day I was a bit more stable, but I still had plenty of spikes and lows and I was also eating smaller portions then too so as not to cause glucagon bg rises due to that. I also tried bolusing for protein at first according to the weight calculations but I just ended up going hypo. I didn't follow his diet exactly though, just the 30g and I felt too hungry on that level of carbs so I increased it to 50-70g. I ended up eliminating grains/bread for the most part, all starchy veggies and anything like pizza and so on which is known to cause problems. I do some lo carb baking and pancakes now with almond flours which helps make up for a lot of the foods I don't eat now.

Oh! Do you have a recipe for almond flour pancakes?? I find almond flour (and almond milk) taste way better than the regular versions.

And to the OP: I've been told to subtract fibre from foods if it totals more than 3g of carbs. I tend to round that up to 5g. So if it's 5g or more I subtract it, otherwise I don't.

I generally only subtract for fiber totaling 5 grams or more. I figure as long as I’m consistent then my insulin to carb ratio will be approriate to how I typically eat and I don’t have to do math for small amounts of fiber every time I eat. Works for me.

I do find however that large portions of non-starchy vegetables often require that I end up subtracting the fiber however as it often brings the total fiber for a meal up high enough I do need to subtract.

Hi Jen,

Here is my recipe:

1 cup almond flour
1 cup bob's hazelnut flour
1/4 cup coconut flour
1/4-1/2 cup chia seeds
6 eggs
1/2-1 teas baking soda
1 teas vanilla
1-1.5 cup filtered water

This is double amount so you can just store the batter in the fridge and have them ready to make in the morning. It only takes about 10 minutes to fry them etc. but longer to do the batter, for me anyway.

fry in butter or sunflower oil and top with berries or unsweetened jam and sometimes cacao nibs or whatever you like. I also sometimes at some brandy or cognac for flavor to the batter.

These are so delicious, I think you'll love them and they keep me going all day for the most part. I'm working on some lo carb almond yogurt and coconut milk yogurt too and I made a great lo carb cheese cake, really delicious as well as a lo carb pumpkin pie.

ps. lately I just put chia seeds and no coconut flour, but either way it's good. The coconut flour adds a bit more carbs it's higher carb than the almond and hazelnut flours. You can also grind the flours yourself if you want to. The pancakes are around 3 g per pancake.

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YUM! Thanks for this! I'll need to pick up some of the ingredients, but hopefully I can try these soon. I've had pancakes maybe twice since I got diabetes 22+ years ago, so I can't wait!

Is the 3g with or without the coconut flour?

I consume about 50g/day CHO. I subtract all fiber out from my calculation. Avocados are high fiber, like 9g for a 12g CHO fruit. Berries also have a high fiber count. I would have to rework my other numbers if I counted all CHO including fiber.

I think you will really love them! I hear you, I haven't had anything like that since the D either so this was so great to have...I have been kind of lax about exact carbs lately because it never seems to work for me, but I will try to work it out again precisely and let you know.. it might be 4g or so with the coconut flour but not too much more..

Bernstein has at various times said that you should not subtract fiber or that you should subtract half. I believe his current position is that you should subtract half as you will be impacted by digestible fiber, but not by indigestible. He also believes that we should be vary wary of products that claim that most of their carbs are fiber as many have proven to be lying. In the end what matters to Bernstein is whether you can eat a meal which will have a minimal impact on your blood sugar.

ps. Bernstein actually doesn't recommend carb counting for bolusing, rather he recommends you count the carbs to achieve the 6-12-12 meal. The bolus is essentially constant.

I don't bother subtracting fiber. I'm at my math limit.

i subtract the fibre from most things carby, except for fruit and veg. if its got a label, then i subtract the fibre.

I've been a patient of Dr Bernstein's for almost two years now and remember asking him about "net" carbs early on (i.e., total carbs less fiber). He dismissed it as another food industry marketing gimmick. As such, I bolus for total, not net, and it seems to work for me.

The Joslin teaches its patients to subtract 100% of fiber from the carb count. Using net carbs may not be for everyone but it is more than a food industry marketing gimmick.

My understanding is that insoluble fibre passes through the digestive tract unprocessed, and so can be ignored if you are counting either carbs or calories.

Soluble fibre is fermented in the gut to fatty acids which are then absorbed into the bloodstream. These are then processed in the body just like fat and should not require insulin directly. However these fatty acids do contribute to calories consumed at about 2 calories per gram of soluble fibre. This contrasts with 4 calories per gram of non-fibre carbohydrate (i.e. starches and sugars).

In the USA and Canada carbohydrate content on food labels includes both soluble fibre, starches, and sugars. In North America "net carbohydrates" is used to mean starches + sugars, or net carbohydrates = carbohydrates - fibre . In the rest of the world carbohydrate on food labels includes only starches and sugars, i.e the same term as the USA term "net carbohydrates".

So if you are not using insulin (and so there is no problem with consuming too few carbs) you can ignore the difference. If you are using insulin there is a penalty if you underestimate your insulin needs, i.e. hypos. In this case you should count "net carbohydrates", or as the rest of the world calls them, carbohydrates.