Meet the Nutritionist Archive, Thursday May 6, 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 Hope S. Warshaw, MMSc, RD, CDE, BC-ADM, will answer your questions on eating away from home. Hope is the author of "Guide to Healthy Restaurant Eating" published by ADA and will discuss the complicated world of eating out when you are trying to manage your diabetes.
Forum_Moderator: Today our guest today is Hope S. Warshaw, MMSc, RD, CDE, BC-ADM, will answer your questions on eating away from home. The world of eating out can seem complicated when you are trying to manage your diabetes. Welcome Hope!
Hope: Thank you. It's a pleasure to be here.u
Forum_Moderator: Hope is the author of "Guide to Healthy Restaurant Eating" published by ADA - you can purchase it at a special discount by clicking "Guide to Healthy Restaurant Eating" and using the code MAYCHAT when you check out.
Hope: Thanks Bob. This book can take a lot of the mystery out of eating out and make it the enjoyable experience it's meant to be - even for people with diabetes.
Mary: Do people with diabetes have to follow different guidelines in restaurants than people interested in eating healthier?
Hope: No! Today the eating guidelines for people with diabetes are in sync with the healthy eating guidelines for everyone. This is true from the push to eat more fruits and vegetables to limiting sweets and sugary foods and beverages. It’s important, particularly if you eat restaurant meals several times a week, to attempt to eat healthy when you eat restaurant foods. Keep in mind that any steps in the right direction are commendable, such as opting for green salad vs. French fries, a sandwich made on whole grain bread vs. croissant, mustard vs. mayonnaise, salad dressing on the side, etc.
John: What are the biggest challenges to healthier restaurant eating?
Hope: 1. Your food is in someone else's control. You are not in the kitchen and therefore can't oversee what goes in your food and how it's prepared. To exert control you'll need to speak up and make special requests as well as learn to outsmart the menu.
Hope: 4. Portions are out of control…and getting bigger. Two for ones, meal deals, all you can eat buffets, bigger than ever burgers and more, have escalated portions (and therefore calories) out of control. Change the value proposition in your mind - think better food rather than more food.
Hope: 2. Fat is melted, spread and poured. From the high fat ingredients cheese, sour cream, and oil; to fat laden preparations, such as, battered and fried, topped with cheese or cheese sauce; the fat content of foods can quickly top one day's allotment. Learn the words and menu preparations that mean high fat and control what's melted, spread and poured on your foods to trim and skim the fats.
Hope: The 4 main challenges to healthy restaurant eating are:
Hope: 3. Sodium is sky high from salt and high sodium ingredients. Restaurant foods provide a larger portion of our sodium intake than ever...and our sodium intake is several times higher than the desired 2,300 milligrams a day. One fast food meal can deliver that dose of sodium. Salt is used to enhance the taste of foods and sodium-ladened prepared or partially prepared foods served in fast food and sit-down chain restaurants raise the sodium content. Steering clear of high sodium ingredients and toppings and keeping your hands off the salt shaker can help you lighten up on sodium.
Michelle: What are the best strategies for healthier restaurant eating?
Hope: #1: Don't treat restaurant meals as a special occasion. Years ago restaurant meals were special occasions, so a splurge on these occasions was fine. Today, people eat out, on average, 6 times a week. These are hardly all special occasions. So to combat the battle of the bulge and the large portions of restaurant meals, you've got to change your attitude and approach. Learn to find a balance between enjoying what you eat at restaurants and not overeating or over indulging each time you eat out.
Hope: #2: Become a fat sleuth. Fats, whether found in fried foods or in spoonfuls of thick salad dressing, will quickly raise your calorie count and lower the health quotient of the meal. Limit fat dense ingredients, such as cheese, butter, cream cheese, or cream sauce. Search out lower fat and calorie preparations, such as light wine sauce, marinara or tomato sauce, grilled, or blackened, and limit cooking techniques that add fat, such as fried, cream or cheese sauce, or crispy golden brown.
Hope: #3: Practice portion control from the start. Huge and growing portions are our nemesis in restaurants today. You've got to outsmart the menu to get smaller portions. Make this happen by practicing portion control from the start. Order less to eat less! Put these practices into action: Split and share menu items. Avoid large portions by looking for these menu descriptors - jumbo, extra large, supreme, triple, double, and grande. Search for the words that mean smaller portions - small, regular size, petite, junior, or appetizer size. Lastly take advantage of those take-home containers. If you've got to order more than you know you should eat, put half away when your meal is delivered.
Hope: Learn more strategies for healthier restaurant eating in my book Guide to Healthy Restaurant Eating and Guide to Healthy Fast Food Eating
David: What beverages (non-alcoholic) are best to order?
Hope: As most people with pre-diabetes and type 2 diabetes need to monitor calories carefully, it’s best to "spend" your calories on foods and not "waste" them on beverages. Additionally, so many beverages in restaurants are loaded with added sugars, from regularly sweetened soda to fruit drinks and punch, to sweetened ice tea, hot and cold fancy coffee and tea drinks. So, limit your calories from beverages by opting for water, sparkling water, diet soda, unsweetened tea, low- or fat-free milk, 100% fruit juice (but limit serving size). When it comes to coffee and tea drinks, take advantage of the sugar-free syrups, low- or fat-free milk and sugar substitutes that are now available.
Beverly: What are a few portion control tips to use in any restaurant?
Hope: Portion control strategies:
Hope: * Watch for the words that mean smaller portions: small, regular, junior, petite vs. large portions: jumbo, supreme, grande, giant, BIG.
Hope: * Practice portion control from the start. Take care to order small portions, split and share menu items and more so you don't get more food in front of you than you should be eating...most of the time you can eat more than you should.
Hope: * Split items. Often ordering one dish is enough for two. Example: order one personal pizza and share a salad. Splitting works well for desserts too. Sometimes you need four spoons or forks.
Hope: * Share. Order items that complement each other and help you eat more balanced meals. Example: in an Italian restaurant, one person order pasta the other a veal or chicken entrée. Then split them down the middle.
Hope: * Choose from salads, appetizers, soups and/or a la carte menu items. Request that one, such as a salad, be served as an appetizer (if your dining partners are eating appetizers) and another, such as soup or an appetizer, is served as a main course.
Hope: * Don't forget those take home containers aka "doggie bags" for leftovers. A word to the wise-put away your leftovers before you dig in.
Hope: Learn more portion control tips for healthier restaurant eating in my book Guide to Healthy Restaurant Eating and Guide to Healthy Fast Food Eating.
Jasmine: Are certain ethnic cuisines healthier to eat than others?
Hope: I'm often asked this question. People jump to the conclusion that several Asian cuisines, such as Chinese, Japanese or Thai are the healthiest cuisines, whereas Mexican, Middle Eastern and Italian are less healthy. I don't believe this is true. What I believe is true is that it is possible for you to choose to eat healthy at nearly any type of restaurant.
Hope: The key element is to know what to order to keep the fat and sodium count down and limiting portions. Bottomline: you can choose to eat healthy in almost any restaurant. The operative three words are you can choose. It's all about your choices and the amounts of foods you eat.
noty: I am newly diagnosed. I am confused. For years I heard they couldn't eat sweets nor bread. Now I am hearing "moderation". Is there a chart showing the correct answer? Is there a maximum amount of __________ I should have a day? When I did other diets, I would avoid food with high carbs, for example. Now I don't know what the limits should be...nor what to avoid. Please advise.
Hope: You are right that things have changed a lot over the years in diabetes management. That includes what to eat. If you're new to diabetes, or if you just need more information and food and nutrition, I would recommend you contact the American Diabetes Association at 1-800-DIABETES. The ADA has a lot of information for free that they will mail to you. In particular, a new booklet called "What Can I Eat? The Diabetes Guide to Healthy Food Choices" is a good place to get started with making changes to your diet.
Joseph: Where can I find the calorie, carbohydrate and other information about restaurant foods?
Hope: Thanks to books like Guide to Healthy Restaurant Eating and Guide to Healthy Fast Food Eating you have access to nutrition information for many national chain restaurants at your fingertips. There is way more nutrition information available from what I call walk up and order chain restaurants than there is from sit-down chain and, particularly, chain restaurants. If you want information from a particular national or large chain restaurant, check their website. If there's no nutrition information, consider calling the headquarters of the restaurant. While they may not be willing to publish their information on the internet, they may be willing to tell you the nutrient counts for a few of your favorite restaurants. Another new resource online is Healthy Dining Finder – brought to us by the National Restauarant Association and CDC (www.healthydiningfinder.com). Lastly, if you are in favor of restaurants having to provide nutrition information on menus, support state-based and federal initiatives to make this happen.
Helen: What's the best way to handle the delayed timing of restaurant meals if you take a blood glucose lowering medication that can cause hypoglycemia?
Hope: The biggest concern in delaying meals is low blood glucose. If you take a blood glucose lowering medication that can cause your blood glucose to get too low you'll need to make adjustments. Use the tips below based on the blood glucose lowering medication(s) you take:
Hope: * If you take a rapid-acting insulin (lispro (Humalog), aspart (Novolog), or glulisine (Apidra) take these rapid-acting medications a few minutes before you start to eat rather than at your usual meal time.
Hope: * If you take the oral pills Prandin and Starlix, which lower blood glucose after you eat, then you should take these rapid-acting medications a few minutes before you start to eat rather than at your usual meal time.
Hope: * If you take a pre-mixed combination of insulin, such as 70/30 or 75/25, or just take insulin twice a day, such as a mixture of NPH or Lente and regular, it becomes more important for you to eat on time to prevent low blood glucose. (Note: A disadvantage of these insulin regimens is that they do not allow much flexibility in meal times. If you regularly need more flexibility in your schedule, talk to your health care providers about your needs and discuss your medication options.
sean: someone told my wife that if she eats too much fruit while she is pregnant, she can cause the baby to have diabetes. Is this true?
Hope: This is not true. Eating fruit does not cause diabetes.
Steven: Can fast food restaurants (walk up and order types) actually help me eat healthier - I hope!?
Hope: Fast food eating is associated with unhealthy meals – too much food, too much fat and too much sodium. Interestingly, there are aspects about fast food restaurant that actually can help you eat healthier – that is if you make healthier choices and help you eat less!
Hope: * Reason 1: No nibbles are at the table as you wait for your food.
Hope: * Reason 2: There's no wait for your food. It's order and eat.
Hope: * Reason 3: A variety of portion sizes are available and small, regular, junior are among the small ones. (There aren't a variety of portion sizes in most sit down restaurants - are there?)
Hope: * Reason 4: It's no sweat to split and share food items because no one is looking!
Joan: Is it possible to eat subs and pizza healthier?
Hope: Here are a few tips and tactics to eat subs and pizza healthier?
Hope: Take advantage of those 6" subs. That's portion control at work.
Hope: Subs are made to order. Watch the preparer carefully and tell them what you want and what you don't want. For example: Leave off mayonnaise, oil, dressing. Add on more lettuce, tomato, onion, pickles, peppers, vinegar, and/or mustard.
Hope: Split that bag of chips or skip it and enjoy a salad or, more commonly available now, bag of carrots.
Hope: Pizza - go heavy on the healthier vegetable toppings. Go light on the meat and extra cheese topping. Then stop at 2 to 3 pieces.
Hope: Get a salad with pizza to fill you up.
Guy: What are some healthier items on Chinese restaurant menus?
Hope: Here are a few healthier items you'll find on most Chinese menus whether the restaurant lives at a mall or airport food court or is your neighborhood favorite independent restaurant.
Hope: Appetizers: Teriyaki Chicken or Beef, Steamed Peking Dumplings (raviolis), Vegetarian Dumpling (raviolis) or Roast Pork Strips
Hope: Soups: Hot and Sour, Wonton, Egg Drop and Chicken and Corn (all Chinese soups are broth based, order a bowl to fill you up especially if others are dining on high fat fried appetizers)
Hope: Entrees: Moo Goo Gai Pan, Moo Shi (with vegetables, pork, chicken or shrimp), Shrimp, pork or chicken with Chinese vegetables, Velvet Chicken, Tofu (request that it not be fried) with Chinese vegetables, Szechuan green beans, Lo-Mein (with vegetables, pork, chicken or shrimp), Chow Mein or Chop Suey.
Anne: Should I try to avoid sweets and sugary foods when I eat in restaurants?
Hope: Sugars and sweets are no longer off-limits for people with diabetes and haven't been off-limits since 1994. If you enjoy sugary foods and sweets, you’ll need to learn how to split and share a dessert on occasion with restaurant meals. The amount of sugary foods and sweets you eat with restaurant meals should depend on your weight, blood glucose and blood fat levels, and nutrition and diabetes goals. Sugary foods and sweets are concentrated sources of carbohydrate and can raise blood glucose. Plus, sweets such as cheesecake and regular ice cream may be high in total fat, especially the unhealthy saturated fats – butter, cream, sour cream, etc. Finally, because sugars and sweets usually offer little in the way of nutrition, everyone who wants to eat healthier should limit the amount of sugars and sweets they eat.
Harry: Got any tips to limit sweets when you eat restaurant meals?
Hope: Choose a few favorite restaurant desserts and decide how often to eat them in light of your diabetes goals.
Hope: Satisfy your sweet tooth with a small portion of your favorite sweet. Create small portions by splitting and sharing desserts. Keep in mind it's the first few bites that do the trick.
Hope: Order small portions when they’re available – like kid's servings of ice cream.
Hope: When you eat a sweet, check your blood glucose 1 to 2 hours afterward to see its effect. Let this information help you decide which sweets to eat and when.
Hope: Satisfy your sweet tooth with a coffee drink sweetened with a sugar substitute.
Hope: Try fresh berries with a liqueur.
Larry: How do you estimate restaurant portions?
Hope: It's one thing to have measuring equipment at home – spoons, cups and a food scale - but you aren’t going to carry these to restaurants. The good news is you always travel with two excellent portion control tools - your eyes and hands. (They also work well at home too once you have correct portions nailed down.)
Hope: Eyes: train your eyes well by using measuring equipment at home. The more you use these items at home, the better you’ll be at estimating restaurant portions. But do keep your eyes honest!
Hope: Hands: Thumb tip (from tip of finger to first knuckle) = 1 teaspoon. Example: 1 tsp mayonnaise or margarine
Hope: Thumb (from tip of finger to second knuckle) = 1 tablespoon. Example: 1 Tbsp salad dressing, cream cheese
Hope: Two fingers lengthwise = 1 ounce. Example: 1 oz cheese or meat
Hope: Palm of hand = 3 ounces. Example: 3 oz cooked meat (boneless). A regular-sized deck of cards or bar of soap are also good examples of 3 ounces.
Hope: Tight fist = 1/2 cup. Example: 1 serving of noodles or rice, 1 serving of canned fruit
Hope: Loose fist or cupped hand = 1 cup. Example: 1 cup vegetables or pasta
Hope: Note: These guidelines hold true for most women's hands, but some men's hands are much larger. Check out the size of your hands in relation to various portions.
Maurice: I would like to enjoy a glass of wine, beer or a cocktail when I dine out, is this safe?
Hope: With diabetes there are reasons to drink alcohol and reasons to avoid it. You will need to work with your health care provider to figure out whether you can safely enjoy alcohol on occasion or should simply avoid it.
Hope: As you make your decision about whether to drink alcohol or not, keep in mind that alcohol is high in calories (unhealthy calories with no nutrition). It can cause low blood glucose if you take an oral diabetes medication or insulin that can cause low blood glucose. On the converse it can cause an elevation in blood glucose. Alcohol, if you consume a lot, can slow your responses which may impact your ability to manage your diabetes.
Hope: Here are a few tips to sip by:
Hope: Don't drink when your blood glucose is below 70 mg/dl or you have symptoms of hypoglycemia.
Hope: Remember that alcohol can cause low blood glucose soon after you drink it (if your blood glucose lowering medication is working hardest and/or you need to eat). Alcohol can continue to cause low blood glucose 8–12 hours after you drink it, especially if you drink in excess, take too much medicine, or don't eat enough. If you drink more than usual in the evening or night, check your blood glucose more frequently and if you are low before bed, eat something.
Hope: Don't drink on an empty stomach if you take a blood glucose lowering medication that can cause low blood glucose. Either munch on a carbohydrate source (popcorn or pretzels) as you drink or wait to drink until you get your meal.
Hope: Alcohol can also make blood glucose too high. This is true for anyone with diabetes, no matter how they control it. High blood glucose can be caused by the calories from carbohydrate in the alcoholic beverage, such as wine or beer, or in a mixer, such as orange juice.
Hope: Avoid mixers that add lots of carbohydrates and calories—tonic water, regular soda, syrups, juices, and liqueurs.
Hope: Check your blood glucose to help you decide whether you should drink and when you need to eat something.
Hope: Wear identification that states you have diabetes.
Hope: Sip a drink to make it last.
Hope: At a meal have a noncaloric, nonalcoholic beverage by your side to quench your thirst. Try water, club soda, or diet soda.
Hope: Never drink and drive to keep you and others safe.
Forum_Moderator: That's it for today. Thanks so much for taking the time to be here Hope. Don't forget, if you would like more info about restaurant eating at restaurants with nutritional info for many popular chains, click on th image above and don't forget to use the promo code MAYCHAT when checking out of the ADA online store. 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.
Hope: Thanks for having me. I do hope this was informative and know that the book "Guide to Healthy Restaurant Eating" will help lots of folks.
