People with type 1 diabetes are known to develop certain eating disorders.
In fact, it is thought that women with type 1 diabetes are more than twice as likely to develop an eating disorder than women of the same age who do not have diabetes.
Some researchers suggest that there are signs that a person with diabetes has an eating disorder.
They include an unexplained rise in the person’s A1c values; the person’s expressing extreme concerns about his or her weight and body shape; a change in eating habits; unusual patterns of intense exercise (this often occurs with bouts of hypoglycemia; for more about hypoglycemia, see the chapter “Type 1 Diabetes”); and for women, skipping their monthly periods (called amenorrhea).
The Handy Diabetes Answer Book
SHOPPING FOR FOOD AND EATING OUT
SHOPPING AND READING LABELS
Is there a difference between a serving and a portion on a food label?
Yes, a serving is an amount of food determined to be appropriate by the U.S.
Food and Drug Administration (FDA).
On nutrition labels that appear on most packaged foods, the serving size is noted, along with how many calories per serving, total fat, cholesterol, sodium, total carbohydrates, protein, and any relevant vitamins and minerals.
A portion is how much food you decide to eat at one time, whether at a restaurant or at home.
In many cases, our food portions do not match the serving size because many people eat a larger portion than the serving size, which is one of the possible reasons for weight gain.
How should people interpret food label claims, especially people with diabetes?
There are differences in the terms on labels, and people with diabetes who want to maintain a healthy weight and have less sugar in their diet need to understand certain label terms. The Food and Drug Administration has strict guidelines on how these food label terms can be used. Here are some of the most common claims seen on food packages, and there are many, and what they mean, as per the FDA and the American Heart Association:
Low calorie , Must have 40 calories or fewer per serving.
Low in saturated fat , Must have one gram of saturated fat or less, with not more than 15 percent of the calories from saturated fat.
Low fat , Must contain less than three grams of fat per serving.
Reduced fat , Must contain at least 25 percent less of the specified nutrient or calories than the usual product; for example, a reduced-fat mayonnaise must contain at least 25 percent less fat than regular mayonnaise.
Less , A food must contain 25 percent less of a nutrient than a certain other food; for example, a pretzel label can claim that pretzels contain 25 percent less fat than potato chips.
Good source of , Must provide at least 10 to 19 percent of the Daily Value of a particular vitamin or nutrient per serving; for example, to be a good source of calcium, the food must contain 10 to 19 percent of the daily value for calcium.
Light (or lite) , A food must have a third fewer calories or half the fat of a certain other food, or the sodium in a low-fat, low-calorie food must be reduced by 50 percent; for example, light mayonnaise must contain at least 50 percent less fat than regular mayonnaise.
Calorie-free , Must contain less than five calories per serving.
Fat-free/sugar-free , Must have less than ½ gram of fat/sugar per serving.
High in , Provides 20 percent or more of the Daily Value of a specified nutrient per serving.
High fiber , Must contain five or more grams of fiber per serving.
Good source of fiber , Must contain 2.5 to 4.9 grams of fiber per serving.
Lean meat , Must contain less than ten grams of total fat, 4.5 grams of saturated fat or less, and less than 95 milligrams of cholesterol per serving.
Extra lean , Must have less than five grams of fat, two grams of saturated fat, and 95 milligrams of cholesterol.
High protein , Must contain 20 percent (or more) of the Daily Value for protein.
Natural flavoring , The FDA standard states that foods with this label must be extracts from nonsynthetic foods, such as essential oils, spices, and so on; its function in the food is flavoring, not nutrition.
Fresh , Although this term has been misused over the years, it originally meant unprocessed, uncooked, and unfrozen foods (with washing and coating [usually wax] of fruits and vegetables allowed). Fresh-frozen is also included, meaning food that is quickly frozen; the term is usually seen in association with fresh fish.
Good source , This means a serving must contain between 10 and 19 percent of the recommended Daily Value of a certain nutrient, such as vitamin A or D.
Fortified , A fortified food must have 10 percent or more of a Daily Value per serving, but it can be used only to represent vitamins, protein, minerals, dietary fiber, and potassium; for example, most milk in the United States is fortified; thus, one cup has to have about 30 percent of the Daily Value for vitamin D.
The FDA also sets standards for health-related claims on food labels to help consumers identify foods that are rich in nutrients and may help to reduce their risk for certain diseases. For example, the manufacturers can make health claims that highlight the link between calcium and osteoporosis, heart disease and fat, and high blood pressure and sodium.
What are some other labels to be aware of if a person has diabetes?
Even though it is estimated that close to 50 percent of consumers read food labels before buying, sometimes labels can be misleading. Here are some of the more common confusing labels:
Low fat , Many people on a diet look for the low-fat label. This may mean that, as per regulations, the product has three grams of fat or less. But often, when one ingredient is missing, food manufacturers add something to make up for it. In the case of “less” or “low fat,” it usually means more sugar, sodium, and calories that can cause weight gain that may lead to diabetes.
Low sugar versus reduced sugar , Many people want less sugar in their diet but should be aware of two phrases: “Reduced sugar” means that the product has 25 percent less sugar than the regular version, but “low sugar” has no standard definition.
Sugar-free , This means that the food has to have less than a half gram of sugar per serving, but the serving size may be very small. A serving size can range from a tablespoon to a cup! Sugar-free products may also cause gastrointestinal problems in people, especially those sensitive to other sugar substitutes, such as sorbitol. Overall, instead of looking at the “sugar-free” label on a package, a person with diabetes should pay more attention to the product’s total carbohydrate count.
It’s important to understand what labels such as “low fat,” “low sugar,” and “sugar free” really mean, and one needs to also consider portion size.
What are the main parts of a nutrition label on most foods?
There are standard food-nutrition labels that are based on government recommendations. The numbers, listings, and percentages are based on a 2,000-calorie diet for the “average” person, but there is a major debate about what is truly “average.” (It also means that changes are coming in the government’s recommendations; see sidebar). The following are some of the major items listed on food-nutrition labels:
Serving size , This is the number used to determine one serving of food. It is also often written in terms of grams.
Total carbohydrates , This is an important percentage for people who have diabetes (and for those who wish to limit their intake of carbohydrates). It represents the total percentage of carbohydrates in one serving, in terms of a percentage of the “average” diet.
Dietary fiber , This is also an important percentage listed under carbohydrates, usually in two forms, grams and percentage of the total in one serving.
Why and how will the government change food labels?
T here has been a major problem with the government-recommended numbers and percentages on food labels that has created a great debate.
In particular, the information on a label is based on an “average” person who eats 2,000 calories a day.
But a great deal has changed since the Food and Drug Administration sent out guidelines for nutrition labels in 1993, especially with the American diet.
The FDA label’s serving-size standards were based on the “reference amounts customarily consumed” (RACCs), numbers based on consuming in the late 1970s and 1980s.
But Americans eat more now, as evidenced by the increase in heart diseases and obesity, and instead of a third of an English muffin (the “serving size”), a person eats the entire muffin (which means more calories consumed).
Now the FDA wants to emphasize this difference in serving size and give more realistic numbers; it also wants the food manufacturers to be more realistic and if most people eat the entire muffin to label the package as “one serving,” not many.
These changes will not only help consumers make better decisions about how much they truly want to eat but also make more healthful choices.
But when these changes will occur is another matter.
Sugars , The amount of sugar is also part of the total carbohydrate listing and can refer to both natural and added sugars. It will not list the types of sugar but only the amount (the types of sugar are often listed under the ingredients on a package).
Sugar alcohol , If applicable, the sugar alcohol may be listed or the sweeteners in the form of sugar alcohols, such as sorbitol, mannitol, and xylitol. These sugars are not listed individually on the nutrition label but may be listed in the ingredients.
Vitamins , Vitamin percentages may also be listed on nutrition labels, although they usually represent only the more “common” vitamins, such as C, A, or D. In addition, the more “common” minerals are often listed as percentages, including calcium and iron.
What are the names for sugar that a person with diabetes should understand when reading a food label?
Sugars are listed on food labels in various ways, but as most dietitians and nutritionists will tell you, sugar is sugar. The most obvious word on a label is “sugar,” but there are other words to pay attention to, including the following:
• Brown sugar: refined sugar coated with molasses (the molasses is taken out, then added back in, or it can even have an artificial caramel coloring)
• Corn syrup: manufactured from corn and containing various amounts of glucose, maltose, and dextrose
• Dextrose: pure glucose or a sugar made of only one molecule
• Fructose: sugar from fruit and maple sap
• Glucose: known as dextrose, or grape sugar (it is also used in reference to a person’s blood glucose levels)
• High-fructose corn syrup: concentrated corn syrup that is made mostly of fructose
• Lactose: natural milk sugar
• Maltodextrin: made from maltose and dextrose
• Maltose: a sugar from starch, most often grains
• Raw sugar: less refined white sugar with a minute amount of molasses
• Sucrose: the refined, crystallized white sugar found in most sugar bowls
• White grape juice: a purified version of fructose
What are some tips for people with diabetes when they go shopping for food?
Food shopping for a person with diabetes can be a challenge. Here are some tips from various organizations that specialize in helping those with diabetes:
• Expand your food options, and learn about new tastes and foods. There are excellent cookbooks, cooking websites, and apps for people with diabetes who want to learn to cook or experiment with various types of foods (several of which are mentioned in this book’s “Resources, Websites, and Apps” section).
• Instead of eating the same thing every day, start experimenting with new foods from the grocery. Most foods have to be labeled, making it easier to keep track of fats, sugars, and other nutrition information.