Meet the Nitritionist Archive, Tuesday, April 1, 2008
The American Diabetes Association is pleased to present ADA Live! - a series of live Q&A sessions on topics related to diabetes and healthy living.
During this chat Stephanie A. Dunbar, MPH, RD, ADA Director of Nutrition and Clinical Affairs, discussed and answered questions on "Picking the best foods - Tips on shopping and reading labels."
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Forum_Moderator: Welcome to ADA Live. Today our guest is Stephanie A. Dunbar, MPH, RD, ADA Director of Nutrition and Clinical Affairs, It's a pleasure to have you here today Stephanie.
Stephanie: Thanks Bob. It's always a pleasure.
Joannie: I LOVE oatmeal but it spikes my sugar. Is there any kind that won't do that?
Stephanie: The less processed the oatmeal, the lower glycemic response. Try steel cut oats. They take about 45 minutes to cook and have a thicker chewier texture than rolled oats. Stay away from the quick oats and instant oats. Those types tend to raise blood glucose levels more than rolled oats or steel cut.
Jacko: I was diagnosed with t2 a few weeks ago. doc said to cut back on carbohydrates and fat. My wife and I stand in the store and feel like I can't eat anything.
Stephanie: First thing I would recommend is calling 1-800-342-2383 (1-800-DIABETES - the ADA call center) and request a free copy of "What Can I eat? The Diabetes Guide to Healthy Food Choices." It has 28 pages of advice for choosing foods and different meal planning tips. And it's free! Until then, remember that cutting back on carbs and fat doesn't mean not eating any. When you go to the store and you are looking at rice, or pasta, or bread - choose the ones that are whole grain. This will be brown rice, whole wheat pasta and 100% whole wheat bread. When you eat them, keep your portion small - no more than 1/4 of your plate at any meal. Load up your cart with vegetables especially the non-starchy ones like brocoli, spinach, and peppers. They can be fresh, frozen or canned. The non-starchy vegetables should be 1/2 your plate at your meals. For the last quarter of your plate, add about 3 ounces of lean meat, chicken, or fish. You can add a piece of fresh fruit or 1/2 cup of fruit salad for dessert, or even a "light" yogurt. the light yogurt is about 100 calories per 6 oz container to help you find them. Stay away from highly processed carbs like cakes, cookies, sugared cereals and sweetened drinks like soda. You can cook with the "healthy fats" like vegetable oils - you want to be cutting back on the bad fats like butter, cream, shortening and those found in full-fat dairy products and meat. Start reading labels to get familiar with the serving sizes listed and the amount of calories and grams of carbohydrate in the foods you eat. When picking between foods, look for those that are lower in carbohydrate and saturated and trans fat. And don't forget to order the book. It has most of the information you need to get your eating plan on track.
Mary_in_Manassas: Shopping for quick breakfast stuff is the worst. Either there are more carbs than I'm allowed all day or enough fat to cause a heart attack on the spot. Any suggestions?
Stephanie: You are right, breakfast can be one of the most challenging meals of the day because many of the typical quick breakfast options are higher in carbs. One thing that is helpful is preparing the night before or on the weekend. Hard boil eggs, put bran cereal in a zip lock bag, peanut butter in a small container. You also can think outside of the traditional breakfast box of pancakes and waffles. Even foods you eat other times of the day work for breakfast such as a turkey sandwich. Here are a few other ideas that are about 30 grams of carbohydrate and also contain the "healthy" fats and protein: English muffin with peanut butter; Cook steel cut oats or rolled oats the night before - simply warm up a 1/2 cup and mix with 2 Tbsp nuts and a 6 oz carton of light yogurt; 1/2 whole wheat pita stuffed with a hard boiled egg (cooked the night before) and a couple of slices of avocado. Mini bagel with hummus and fruit. And there is always good old bran cereal with milk. If you don't like the taste of the cereal by itself you can mix it with a light yogurt (sweetened with low-calorie sweeteners) sprinkle with your favorite nut - high fiber cereals are delicious this way as an alternative to cereal with milk. When you have more time on the weekend, make an egg white omlette with sauteed pepper, onions and mushrooms.
K__Mac: My wife, 5' 7' 135 lbs. has just lost 21 lbs. using the Weight Watchers "Core" program. I am 6ft. 203 lbs. & a "type 2 " diabetic.I have tried to followed that same program, while keeping a very close eye on my levels and have only lost 6lbs. in the same time frame. My goal is to get to 190lbs. Can you recommend a diet plan that will help me to accomplish my goal.
Stephanie: The Core program with weight watchers does not limit the portion size. So eventhough you are eating primarily unprocessed foods, you are likely eating too much. If you want to follow weight watchers, you might try the point system as it helps you identify portion sizes and where you may be overeating.
Leena: When a portion of pasta is labelled as "1 cup", how does that measure, for example, in weight or pictorially for a typical noodle like a penne or spaghetti?
Stephanie: If the label says 1 cup, it is 1 measuring cup of pasta. Sometimes the label will have the number of grams or ounces in parenthesis as well. For that, you would need a food scale to measure it out exactly. Every one should invest in a set of measuring cups if you don't have them. They are cheap and a great way to know if your portion sizes need adjusting.
Leena: I have times when I feel ravenously hungry but weak and sluggish, too sluggish to want to cook. What are the best easy snack choices to give me some energy back and fill me up a bit?
Stephanie: If you're having a hard time wanting to cook, think about convenience items that you might be able to use to help with meal preparation. For example: use pre-washed salad and add canned tuna or chicken (rinse to remove salt) and other veggies. Or bring home a rotisserie chicken and microwave frozen vegetables. Even frozen dinners can work in a pinch if you are too tired to cook. For snacks, try an ounce (small handful) of nuts, a piece of fruit, a small tortilla with salsa and melted reduced-fat cheese. Also, if you are feeling sluggish all the time, you should probably make an appointment with your health care provider to make sure everything is okay. High blood glucose levels can make you feel very tired.
Jerseygirl: Please explain "net carbs". I get confused on this.
Stephanie: Net carbs have no "official" definition from FDA who regulates food labeling. So that fact that this appears on food labels is very confusing. Different food manufacturers can use different definitions since it is not standardized. There is also not a standard definition for "low carb" so you need to be careful. Buyer beware applies in these cases. I do not recommend that you rely on "net carbs" or any other version on it. Most manufacturers have subtracted all of the grams of fiber and sugar alcohols and declared that they do not impact blood glucose levels. Unfortunately, that is not always true. Some types of fiber are partially digested and some sugar alcohols cause a rise in blood glucose levels even though it is a smaller rise than sugar. The bottom line is that unless a food has more than 5 grams of fiber or 5 grams of sugar alcohol, you do not need to do anything. Use the amount on the label listed as "total carbohydrate." If a food has more than 5 grams, you can subtract 1/2 the grams of fiber or sugar alcohols from the total grams of carbohydrate. Remember, the calories remain the same as what is listed on the label.
janet: Are you an real person?
Stephanie: We always get a question similar to this so I'll answer it - to make it official. Yes, I am a real person.
Forum_Moderator: I can attest to that. Stephanie is very real.
Tommy: I look at all my labels and total everything in my head when I'm shopping before I'll buy it. I don't find that sugar alcohol calories fit into the carbs/fats/ protein counts. Does this mean that if the label states 6g of sugar and 2g sugar alcohols that there are 5g of sugar calories? I want to be able to figure out my Nutrition Labels correctly when shopping. Thanks. ---- Tommy
Stephanie: I want to clarify a couple of points. Total carbohydrate on the label includes the grams of starch, sugar, sugar alcohol and fiber in a serving of the food. The listing for sugar, is for sugar only - so it does not include the grams of sugar alcohols. If it says that it has 6 grams of sugar, then it has 6 grams of sugar. If it has 2 grams of sugar alcohols, it has 2 grams of sugar alcohols. I think you might be getting confused that sugar alcohols contain only 1/2 the calories (on average) of sugar. Please also remember that the calories for the product is accurate for the amount of sugar, fiber and sugar alcohol listed.
Sally83: My dad has been diabetic for 2 years, recently he had a heart attack, due to a block in the LAD and underwent an angioplasty. He has been recommended the Dean Ornish diet for reversal of heart disease, which demands that he eat 75% carbs. Isn't that bad for a diabetic, to have a diet of 75% carb?
Stephanie: There is research to support many different types of diets for managing diabetes. Some people manage diabetes with very high carbohydrate vegan diets (100% plant foods - no dairy, eggs or meats, fish etc.) and some manage diabetes with a low carbohydrate diet that is the exact opposite. The Ornish diet is very low fat and focuses on beans or legumes, fruit, vegetables, and whole grains. The only animal product allowed is some dairy. All fats are to be avoided. Depending on what your father eats currently, the Ornish diet could work for him if overall he is eating fewer calories and getting more fiber (which he definately would be!). Many people with diabetes could have trouble with blood glucose levels with this level of carbohydrate and it can be a difficult diet to follow to the letter. He can try it for a few days and check his blood glucose levels, report those to his doctor and work from there. If he can't follow it, he should be honest with his doctor. It would also be a good idea for him to have an appointment with a Registered Dietitian (RD) who specializes in diabetes so he can work out a meal plan that will work for him.
Leni: I recently was checked for diabetes & the test came back normal, but I was not given the test to check after drinking a glucose rich beverage. I have been having strange symptoms that sound like pre-diabetes...increased thirst & urination at night, numbness /tingling in my feet & hands, and most troubling severe dizziness & blurred vision whenever I eat something sugary and/or starchy. Further, I have gained weight & am having trouble losing. I am trying to eat to avoid these symptoms which are clearly associated with sugars, but it is difficult since I have also been told that my cholesterol is elevated. I can't eat vegetables for every meal & I don't know what to eat at this point. If I eat brown rice & wheat pastas, won't they convert to sugar & give me the same reaction? I'm very confused about what to eat!
Stephanie: It sounds as though you had a fasting blood sugar test which is the most commonly used test to check for diabetes. The test for after drinking the glucose drink is called an oral glucose tolerance test. It can also be used to diagnose diabetes, but is used less often. I would suggest that you try using a simple method to make sure your portions of food are smaller to help you lose weight. It is called the plate method. I referenced it earlier in the chat - and it is useful even if you don't have diabetes. Many people use it to lose weight to avoid diabetes. It includes half your plate as non-starchy vegetables with a small portion of starch (1/4 of plate) and 1/4 of plate as lean meal, chicken or fish. Make sure too that you are being physically active. Whatever you are doing now, step it up a notch. Try taking a short walk after meals and see if that helps you feel better. Losing weight and being physically active are the best ways to prevent diabetes. Even if you don't have diabetes, call our 1-800-Diabetes call center to get a free copy of the What Can I eat booklet? It can be used for following a healthful diet even when you don't have diabetes!
dandyann: Please help me to understand the label on the Dreamfields pasta products. How do they figure those carb values? I was told you can subtract one half of the grams of fiber over 5 grams. My own nutritionist said she had called the company and she was even confused. Can you help us figure out how many carb grams is really represented in that product? Thank you so much! MB
Stephanie: I can't answer your question exactly. How you respond to the product will be different than someone else. I would not follow the "digestible carb" numbers as they are. I would suggest that you start off by subtracting 1/2 the grams of fiber from the total amount and check your blood glucose levels. It's the only way to see how the product will affect you.
Barry: My son is 8 years old with Type 1. Please explain the difference on his glucose level if he eats 30 gm of carbohydrates in a cupcake or in crackers. He has not particpated in class parties because we are trying not to allow him sweets.
Stephanie: It is absolutely okay for your son to participate in the party - including having a cupcake. If he substitutes equal amounts of carb in a cupcake for the carb in crackers, you may not see much of a difference at all in his blood glucose levels. If there is more carb in the cupcake, his blood glucose levels may be higher. From the parties I've witnessed, there is usually extra activity as well - even if it is just the kids running around and bouncing off the walls! I feel strongly that children with type 1 diabetes should be allowed to have sweets on special occasions and birthday parties definitly qualify. If you find that his blood glucose levels are higher after the cupcake or the serving was larger than you expected, ask your physician or educator how you should adjust his insulin. Check out our website specifically for kids. There is information on how to handle special celebrations at http://tracker.diabetes.org/celebration.php . I hope your son enjoys his next party!
edie: My question is about the total Carbs. Do you add the sugar grams to the total carb grams or is the sugar grams included in the TOTAL CARBS.
Stephanie: No, you do not add the sugar grams to the grams of total carbohydrate. The number of grams for total carbohydrate includes ALL types of carbohydrate. (Sugar, sugar alchohls, dietary fiber, and starch - which is not listed on the label.
Sal-o-mondo_2: Just diagnosed with type 2. Where do I start? What is the best place to find nutrition information for all foods?
Stephanie: The best place to start is by calling 1-800- DIABETES. You can get information on food and nutrition as well as other aspects of managing diabetes.
katikat_s_mom: Well, I just noticed who sponsored this chat, but I am going to ask my question anyway. Is it ok to drink veggie drinks or are the absorbed too quickly?
Stephanie: Glad you still asked. Yes, it is okay to drink vegetable juice. Portion size, as with all things, is the key. 1/2 cup (4 oz) has about 5 grams of carbohydrate and counts as 1 serving of vegetables. I think if you want a quick snack or drink juice with breakfast, it is easier to fit into your meal plan than fruit juice. I would suggest to anyone with diabetes wanting to drink vegetable juice to choose the low sodium version.
chashuch: I am confused on sugar alcohol. Are they okay to eat or not?
Stephanie: They are okay to eat if you are not sensitive to them. Some people, particularly if they are sensitive or eat too much, can experience GI side effects such as stomach cramping, gas and diarrhea.
Wilbur: I've had type I diabetes for 21 years, wear an insulin pump and have no complications. After having labs done last year, my doctor wanted me to try and lower my cholesterol and I added 'Flax-seed meal' to my morning breakfast and I have been doing this for about a year and is the only addition to my diet. My ratio of carbs to insulin has changed over the last year, and I'm just not sure why. My ratio was, before last year, about 1 unit for every 12 grams of carbs. Now, my ratio is about 1 unit for every 15 grams of carbs. My insulin requirements have lowered, and I'm asking if you know if 'flax-seed' could be a reason? Thank you.
Stephanie: I've never heard of flax seed lowering insulin requirements. I don't know how much you are adding, but it seems the small amount of fat and fiber that would be added, wouldn't be enough to change insulin requirements throughout the day. I'm wondering if your activity changed at all or something else is at play. Either way, flax seed is a good source of healthy fatty acids - omega 3 and 6 and fiber - so it's a good addition!
Forum_Moderator: We're close to the end of our time here today. Do you have any thoughts you'd like to leave us with Stephanie?
Stephanie: Thanks for having me Bob and all the great questions. One thing that we didn't touch on is where to find the most nutritious foods in the store. I'll remind everyone that you find the processed foods down the aisles and at the end of each aisle. Marketing professionals are experts at making you want to buy their products as impulse purchases. Other tips:
* Make a list before you go and stick to it.
* Avoid shopping when you are hungry so you can stick to your list.
* Don't go down the aisle with tempting foods if you can't resist.
Most of us buy the same brands and foods over and over again. Set up a shopping list on your home computer of everything you buy, and all you have to do is check it off when you are getting low. Leave space for any add-on items. It takes a few minutes to set it up, but saves you a lot of time in the end. Stash your coupons near by and you will always be ready to head to the store and not have to go back for a forgotten item.
Forum_Moderator: That's it for today. Thanks so much for taking the time to be here Stephanie. Thanks to all of you who joined us by asking great questions or by just tuning in. If you wish to continue any of today's discussions please feel free to visit the ADA Message Boards.
Keep up to date with all the ADA Live events and reference the archives here. We hope you found this interesting and informative and that you'll join us again next time here at ADA Live. Our guest will be Rite Aid Pharmacists and diabetes experts, will discuss and answer your questions on all aspects of diabetes at 1:00 p.m. EDT Thursday, May 1, 2008. See you then.
Stephanie: Have a great day everyone!
