Living with Diabetes: Ingredients, Labels, Recipe Modification

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Living with DiabetesIngredients, Labels, Recipe
Modification Eating Out

• Barbara Brown, Ph.D., R.D./L.D.
• Food Specialist
• Oklahoma Cooperative Extension Service

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Today we will

• Examine features of food labels important for
  diabetics to read understand
• Look at functions of ingredients in food
  available market substitutions
• Receive tips for recipe modification
• Learn suggestions for eating out with diabetes

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Food labelsKey points for diabetics

• Ingredient list
• Nutrition Facts panel
• Serving size
• Daily Value
• Nutrient content claims
• Health claims

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Ingredient list

• In descending order by weight
• Need to know terms for carbohydrates fat

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Several formats available
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Using Nutrition Facts

• Top changes with food
• Product-specific info. (serving size, calories,
  nutrient info.
• Bottom footnote with Daily Values for 2,000
  2,500 calorie diets
• Found only on larger packages
• Does not change

 
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Serving size

• Standardized to ease comparison of similar foods
• Amounts usually eaten at 1 time
• Given in household metric measures

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Serving size vs. exchanges

• Nutrition Facts serving may not equal exchange
  serving
• Examples
• Fruit juice
• Nutrition Facts 1 c, exchange 1/2 cup
• Oatmeal
• Nutrition Facts 1
• Exchange 1/2 cup

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Daily Values

• Made of 2 dietary standards
• Daily Reference Values (DRVs)
• Reference Daily Intakes (RDIs)
• Only Daily Value appears on label
• Based on 2000 cal diet

Daily Value
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Trans fat

• Required by 1/1/06
• Increases low-density lipoprotein (LDL)
  cholesterol levels
• Raises risk of coronary heart disease

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Hydrogenation changes shape

• Unsaturated fat

• Trans Fat

H      -C C-   H
H  H   -C C-
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Using Trans fat information

• Combine grams saturated fat trans fat look
  for lowest combined amount
• Look for lowest Daily Value for cholesterol

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Making the best fat choice
Butter
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Making the best fat choice
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Nutrient content claim free

• No, only trivial or "physiologically
  inconsequential" amount of 1 or more of
• fat, saturated fat, cholesterol, sodium, sugars,
  calories
• "calorie-free" less than 5/serving
• "sugar-free" "fat-free" less than
  0.5g/serving
• Synonyms "without," "no," "zero"

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Nutrient content claim low

• Can be used on foods that can be eaten frequently
  without exceeding dietary guidelines for one or
  more of
• Fat, saturated fat, cholesterol, sodium, and
  calories

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Low descriptors

• low-fat 3g or less/serving
• low-saturated fat 1g or less/serving
• low-sodium 140mg or less/serving
• very low sodium 35mg or less/serving
• low-cholesterol 20mg or less 2g or less of
  saturated fat/serving
• low-calorie 40 calories or less/serving

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Low-carb labeling

• Net carbs, effective carbs
• No federal regulation defines
• Typically used as result when fiber certain
  sweeteners (sugar alcohols glycerin) are
  subtracted from total carbohydrate content

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Lean extra lean

• Can describe fat content of meat, poultry,
  seafood, game meats
• Lean less than 10g fat, 4.5g or less saturated
  fat, less than 95mg cholesterol/serving per
  100g
• Extra lean less than 5g fat, less than 2g
  saturated fat, less than 95mg
  cholesterol/serving per 100g

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More nutrient content claims

• High food contains 20 or more of DV for a
  particular nutrient/serving
• Good source food contains 10-19 of DVfor a
  particular nutrient/serving

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Reduced

• Nutritionally altered food contains at least 25
  less of a nutrient or calories than the regular
  food
• Claim can't be made if regular food already meets
  requirement "low" claim

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Less

• Food, whether altered or not, contains 25 less
  of a nutrient or calories than the regular food

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Meanings of Light

• 1/3 fewer calories or 1/2 fat of reference food
• Sodium content of low-calorie, low-fat food
  lowered 50
• Can describe texture /or color
• Label must explain intent

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When label says More

• 1 serving contains a nutrient that is at least
  10 of Daily Value more than in reference food

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Health claims

• Describe how food or food component relates to a
  disease or health-related condition
• Wording regulated by FDA

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3 types of health claims

• Approved
• Authorized
• Qualified health claims

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Approved health claims

• 1990 Nutrition Labeling Education Act (NLEA)
  provides for FDA to issue regulations authorizing
  health claims for foods dietary supplements
  after FDA's careful review of scientific evidence
  submitted in petitions

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Approved health claims

• Calcium osteoporosis
• Sodium hypertension
• Dietary fat cancer
• Dietary saturated fat cholesterol risk of
  coronary heart disease (CHD)

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Approved health claims

• Fiber-containing grain products, fruits,
  vegetables cancer
• Fruits, vegetables grain products that contain
  fiber, particularly soluble fiber, risk of
  CHD
• Fruits vegetables cancer

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Approved health claims

• Folate neural tube defects
• Dietary sugar alcohol dental caries
• Soluble fiber from certain foods risk of CHD
• Soy protein risk of CHD
• Plant sterol/stanol esters CHD risk

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Authorized health claims

• 1997 FDA Modernization Act (FDAMA) provides for
  health claims based on an authoritative statement
  of a scientific body of the U.S. government or
  National Academy of Sciences
• Such claims may be used after submission of
  notification to FDA

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Claims authorized based on authoritative
statements by federal scientific bodies

• Whole grain foods risk of heart disease
  certain cancers
• Potassium risk of high blood pressure stroke

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Qualified health claims

• 2003 FDA Consumer Health Information for Better
  Nutrition Initiative provides for qualified
  health claims where the quality and strength of
  scientific evidence falls below that required to
  issue an authorizing regulation
• Claims must be qualified to assure accuracy
  non-misleading presentation to consumers

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Allowed qualified health claims

• CHD risk
• Nuts, walnuts
• Omega-3 fatty acids
• B vitamins vascular disease
• Monounsaturated fatty acids from olive oil
• Neural tube defects
• 0.8mg folic acid

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Ingredients of concernto diabetics

• Carbohydrates
• SimpleSugars
• Complexstarches
• Fiberindigestible carbohydrates
• Low-calorie sweeteners
• Fats
• Sodium

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Simple carbohydratesSugars or caloric sweeteners

• Occur naturally in fruits, dairy products, some
  vegetables, honey, molasses
• Refined sugars used in processing as sweetener
• Most high sugar foods have lower nutritional value

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Functions of sugar in foods

• Sweetener
• Tenderizer in baking
• Caramelize under heat
• Enhance growth of yeast
• Control gelling process in jellies/preserves
• Preservative

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Functions of sugar in foods

• Add to smoothness of frozen desserts
• Increase consumption of nutrient-rich foods that
  would probably not be eaten
• Examples oatmeal, grapefruit, cranberries
• Incorporate air into shortening during creaming

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Functions of sugar in foods

• Stabilize egg foams
• Delay coagulation of egg proteins in custards
• Improve appearance tenderness of canned fruits
• Help retain color flavor of frozen fruits
• Enable wide variety of candies through varying
  degrees of recrystallization

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Caloric sweetener choices

• Table sugar is most common
• Contains glucose fructose
• Includes light dark brown sugar
• Other high sugar ingredients
• Honey
• Molasses
• Corn syrup
• Maple syrup

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Ingredient label words meaning sugar

• Sucrose
• Fructose
• Galactose
• Glucose
• High-fructose corn syrup (HFCS)

• Lactose
• Maltose
• Other ose words

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More label terms

• Naturally occurring sugars
• Those in food/beverages that come from
  ingredients themselves
• Fruits, vegetables, milk
• Added sugars
• Added during manufacturing, cooking, at table
• Sucrose, corn syrup, HFCS, honey, molasses, etc.

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No sugar added

• No form of sugar added during processing
• No high-sugar ingredients
• May still be high in carbohydrate
• Read Nutrition Facts panel

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Major sources of addedsugars in U.S. diet
Source Dietary Guidelines for Americans 2005
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Fructose

• A monosaccharide
• Added to foods in liquid or crystalline form
• Crystalline form made from corn starch

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Liquid form High fructose corn syrup (HFCS)

• Glucose fructose
• Made from corn syrup
• Examples
• HFCS 42 used in baking (42 fructose)
• HFCS 55 used in beverages (55 fructose)

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HFCS foods

• Amount eaten has risen in parallel with
  increasing obesity
• Does not prove HFCS causes obesity
• Proportion of total sugar in diet has remained
  constant since 1970 (15-16)
• Table sugar has gone down
• Total caloric intake rose from 3300 to
  3900/person from 1970-2000
• Based on availability data

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Sugar substitutes (low-calorie sweeteners)

• Dont affect blood sugar levels
• Some foods containing artificial sweeteners can
  still affect blood sugar because of other
  carbohydrates or proteins in the foods
• Foods containing artificial sweeteners may be
  sugar-free but may not be carbohydrate-free

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Choosing sugar-free foodsread labels carefully

• Compare carb content of sugar-free with standard
  food
• Big differencemay be reason to buy sugar-free
• Little differencebase choice on taste, cost

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Potential benefits to diabetics

• Offer way to control caloric intake
• Help with weight control weight loss
• Help reduce calorie intake therefore help lose
  weight
• Provide greater variety of low calorie foods
  beverages
• Easy to incorporated into diet

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Low-calorie sweeteners

• Sweet taste with few or no calories
• Undergo extensive safety testing
• All FDA-approved meet same safety standard
• Will not perform most of sugars functions in
  recipes

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Currently approved low-calorie sweeteners
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Currently approved low-calorie sweeteners
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Problems using low-calorie sweeteners in food

• Perform few of the functions of sugar
• Do add sweetness
• Some add bulk
• Aspartame/NutraSweet looses flavor when heated
• Saccharin becomes bitter when heated
• Use recipe formulated for product

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Sugar alcohols

• Polyols
• Chemical structure resembling both sugar
  alcohol
• Contain no ethanol like alcoholic beverages
• Most are half as sweet as sucrose
• Maltitol xylitol almost sweetness of sucrose

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Sugar alcohols calories

• Incompletely metabolized absorbed so body gets
  fewer calories
• 1.5 to 3 calories/gram
• Often combined with low-calorie sweeteners

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Occurrence of sugar alcohols

• Naturally in fruits vegetables
• Commercially produced from sucrose, glucose,
  starch

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Functions in food

• Add bulk texture
• Replace sugar 11
• Also used to replace fat
• Provide cooling effect or taste
• Inhibit browning that occurs during heating
• Retain moisture in food
• Lower calories in food

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Sugar alcohols in foods
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Sugar alcohols in foods
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Sugar alcohols in foods
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Labeling sugar alcohols

• Must include names on ingredient list
• Nutrition Facts
• Company may declare voluntarily the number of
  grams/serving
• If more than 1 in food, must use phrase sugar
  alcohol
• Required if sugar-free or no sugar added
  claim is made

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Modifying sugar in recipes

• Identify ingredient(s) to change
• Sugar, brown sugar, honey, molasses, corn syrup,
  maple syrup
• Consider function in recipe
• Options
• Leave it alone
• Reduce amount
• Replace with other sweetener
• Leave it out

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General suggestions

• Baked goods desserts cut by 1/4-1/2
• In quick bread, cookies, pie fillings, custard,
  puddings, fruit crisps
• Less desirable for some cakes
• Dont decrease sugar in plain yeast breads
• Increase sweet spices, vanilla
• Raises impression of sweetness

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General suggestions

• Decrease or eliminate sugar when canning /or
  freezing fruits
• Use unsweetened frozen fruit or fruit canned in
  juice or water

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Complex carbohydrates

• Starch
• Primary part of
• Grains (bread, rice, pasta)
• Potatoes
• Beans
• Some vegetables

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Reducing carbohydrates in traditional foods

• Has been done in breads, pasta, cereals, cookies,
  cakes, juice, soft drinks, candy

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Methods to reduce carbohydrates

• Increase amount of animal or vegetable protein
• Replacing wheat or corn flour with soy flour
• Examples soy-based chips, pasta, breads

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Methods to reduce carbohydrates

• Increasing fiber
• Example fiber such as cellulose replaces
  digestible form of carbohydrate
• Used in candy, cereals, bread, pasta

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Methods to reduce carbohydrates

• Sugar substitutes or sugar alcohols (polyols)
  used in place of traditional sweeteners
• Used in soft drinks, fruit drinks, baked goods,
  frozen desserts

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Methods to reduce carbohydrates

• Smaller portions
• Used for baked goods
• Breadthinner slices
• Dessertssmaller pieces or less/single serving
  container

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Dietary fiber

• Excellent source contains five grams or
  more/serving
• A good source contains 2.54.9 grams/serving

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Ingredients that indicate fiber

• Fruits vegetables, especially those with edible
  skin (apples, beans) those with edible seeds
  (berries, summer squash)
• Fresh, frozen, canned, dried

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Terms ingredients that indicate fiber in grains

• Whole wheat pasta
• Whole grain cereals (whole wheat, wheat bran,
  oats)
• Whole grain breads
• To be good source, one slice at least three
  grams fiber
• First ingredient whole grain

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Ingredients that indicate fiber

• Beans legumes
• Nuts good source of fiber healthy fat
• Watch portion sizesmany calories in a small
  amount

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Modifying recipes toincrease fiber

• Keep peel on fruits vegetables
• Add extra produce to casseroles, soups, salads
  other dishes
• Add produce to muffins, pancakes desserts
• Substitute whole-wheat flour for 1/2 of
  all-purpose flour in making breads, muffins,
  pancakes, other grain products

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Fats Functions in food

• Texture
• Crispness
• Creaminess
• Mouthfeel
• Volume
• Flavor

• Transmit heat quickly
• Juiciness
• Retain moisture
• Extends shelf life

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Most popular fat-reduced foods
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Replacing fats Systems approach

• May require more than one ingredient
• Synergistic components used to reach functional
  sensory characteristics of full-fat version

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Sources of fat replacers

• Protein-based
• Carbohydrate-based
• Fat-based

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Fat replacers protein-based

• Micropaticulated protein Simplesse
• From whey, milk or egg protein
• Digested as protein
• Modified whey protein concentrate Dairy-Lo
• Heat denatured protein
• Other K-Blazer, Ultra-Bake, Ultra-Freeze, Lita
• Use different process or base protein (corn)

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Fat replacers carbohydrate-based

• Cellulose purified ground to microparticles
  that form network with mouthfeel flow of fat
• Dextrins Amylum, N-Oil
• 4 cal/gram
• Fiber Opta, Oat Fiber, Ultracel, Z-Trim
• Gives structure, volume, holds moisture,
  adhesiveness, shelf life

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Fat replacers carbohydrate-based

• Gums Kelocgel, Keltrol, Slendid
• Guar gum, gum arabic, locust bean gum xanthan
  gum, carrageenan pectin
• Non-caloric, thicken or gel, promote creaminess
• Inulin Raftiline, Fruitafit, Fibruline
• 1-1.2 cal/gram
• Fiber bulk
• From chicory root

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Fat replacers carbohydrate-based

• Maltodextrins CyrstalLean, Lorelite, Lycadex,
  Maltrin, Paselli D-Lite, Passeli Excel, Paselli
  SA2, STAR-DRI
• 4 cal/gram
• From corn, potato, wheat tapioca
• Fat replacer, bulk, texture modifier

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Fat replacers carbohydrate-based

• Nu-Trim
• From oat barley
• Oatrim Beta-Trim, Trim Choice
• Hydrolyzed oat flour
• Fat replacer, body, texturizer
• 1-4 cal/gram

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Fat replacers carbohydrate-based

• Polydextrose Litesse, Sta-Lite
• 1 calorie/gram
• Fat replacer bulking agent
• Polyols
• 1.6-3.0 calories/gram
• Plasticizing humectant properties allow use as
  fat replacers

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Fat replacers carbohydrate-based

• Starch Modified Food Starch
• Provide body texture
• 1-4 cal/gram
• From potato, corn, wheat, oat, rice, tapioca
  starches

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Fat replacers carbohydrate-based

• Z-Trim
• From insoluble fiber
• Oat, soybean, pea rice hulls, corn or wheat bran

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Fat replacers fat-based

• Emulsifiers
• 9 calories/gram but less is used
• Salatrim
• Short long-chain acid triglyceride molecules
• Cal/gram varies
• One with 5 cal/g in use

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Fat replacers fat-based

• Lipid (Fat/Oil) Analogs
• Olestra
• Calorie-free
• 6-8 fatty acids attached to sucrose molecule
• Passes through body undigested
• Stable under high heat
• Approved in salty snacks crackers

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Olestra

• May reduce absorption of fat soluble vitamin
  carotenoids eaten at same time as olestra
  containing food
• Label cautions
• Some people may experience temporary digestive
  effects
• Vitamins A, D, E, K have been added

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Substituting fat ingredients with lower fat
options

• Cream, whole milk evaporated fat-free milk or
  chicken broth thickened with cornstarch or flour
• Butter soft tub margarine
• Cheese non-fat or low fat cheeses or 1/2
  original cheese ½ low fat or replace with
  reduced amount of sharper cheese
• Meat use lower fat cut or meat, or replace with
  soy-based substitute

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Substituting fat ingredients with lower fat
options

• Ice cream lowfat or fat-free versions
• Whole eggs 2 egg whites for each whole egg or
  egg substitutes
• Sour cream mix nonfat yogurt with light sour
  cream, or nonfat sour cream or plain lowfat or
  nonfat yogurt
• Whipped cream nonfat or lowfat versions of
  commercial products

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Low fat guidelines for recipes

• For recipe to be low fat, 1 serving should have
  10g fat or less for main dish, 5g or less for
  dessert, side dish, snack 
• 1 teaspoon fat 5g so look at total oil or
  margarine in recipe number of servings
• 1 cup of oil 48 teaspoons
• To be low fat recipe with 1 cup oil needs to
  serve 48 as side dish, 24 as main dish

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Low fat guidelines for recipes

• Recipes with more than 1/2 cup fat are probably
  too high in fat to bother trying to modify
• Take recipe with 1/2 cup or less cut fat by
  half
• May need additional liquid
• Use skim milk, water, fruit juices as appropriate

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Low fat guidelines for recipes

• If cutting fat in 1/2 worked well, next time cut
  fat a little more, until product has right amount
  of fat per serving still tastes good 

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Fat modified recipe problems?

• Replace only 1 source of fat at a time
• Reduce fat slowly to level where changes are
  unacceptable
• Choices if changes are unsatisfactory
• Have favorite recipe less often
• Cut down on serving size
• Serve dish with lowfat foods

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Supermarkets health trendsfrom the Center for
Science in the Public Interest

• Health trends caused by
• Pressure to sell health
• Obesity, trans fat, whole grains
• Replacing carbs
• FDA allows more health claims on foods
• scientific evidence suggests

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1. More whole grains

• General Mills All GM Cereals are made with WHOLE
  GRAIN!
• Example Trix
• Means some, not all flour, flour is whole grain
• Still high in sugar

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2. Less sugar

• Sugar-free Milanos, SnackWells Sugar-Free Fudge
  Brownie oatmeal cookies label not for weight
  control
• Ask
• Is it lower in calories?
• Has the serving size changed?
• Does it use only Splenda?
• Is it nutrient dense?

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3. No trans fat

• Hersheys Chocolate Dipped cookies have no trans
  fat but 5g saturated fat/serving
• Ask
• Did it ever have any?
• Is it high in saturate fat?
• Is it really trans-free?
• free 0.5g or less
• If 0.49/serving x 3 1.47g

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4. More functional fiber

• Fiber in Dannon yogurt fiber from
  maltodextrin3g/1/2 cup
• Breyers CarbSmart ice cream fiber from
  polydextrose
• Many breads raise fiber with cellulose from oat
  hull fiber, wheat fiber, pea fiber, soy fiber,
  cottonseed fiber, wood pulp
• Most are low in phyotchemicals

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4. Functional fiber

• Ask
• How much fiber?
• Is it naturally occurring fiber?
• Studies on benefits generally use dietary, not
  functional
• Could it cause cramps or diarrhea?
• Sugar alcohols may

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5. Weaker claims

• FDA allows qualified claims scientific evidence
  suggests, not proves
• Claims based on weaker evidence
• Example Kashi Heart to Heart
• Ask
• Weak claim words supports, maintains,
  promotes, evidence suggests

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6. More omega-3 fats

• Added to pasta from ground flaxseed
• Example Barilla Plus pasta
• Also found in margarine spreads, breads, eggs,
  bars
• Other ALA sources include walnuts, canola soy
  oils

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6. More omega-3 fats

• Problem flaxseed high in alpha-linolenic (ALA)
  acid not a longer-chain omega-3s
  eicosapentaenoic acid (EPA) docosahexaenoic
  acid (DHA)
• Not clear if ALA lowers sudden death heart attack
  risk like EPA, DHA

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7. Self-styled symbols

• Companies highlight healthier products
• Example Life cereal
• Smart Choices Made Easy logo
• Kraft products may have Sensible Solution logo
• Kelloggs Healthy Beginnings program has 5
  logos
• Problem companies develop own criteria for
  healthy foods

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8. More phytosterols

• Natural compounds in small amounts in fruits,
  vegetables, nuts beans
• At high levels can lower LDL cholesterol about
  10
• Example Yoplait
• Ask
• How much per serving? (at least 0.8g)
• Over 3/day, no increased effect

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9. Added vitamins minerals

• Added liberally to cereals, breakfast bars
• Example Kelloggs Smart Start
• Ask
• Do you need it?
• Are you getting too much?
• Is it nutrient dense?

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10. Repackaging

• Smaller servings of foods
• Pre-portioned packs inside a large container
• Example Oreo Thin Crisps
• Ask
• Is it nutrient dense?
• How much does packaging cost?
• Is this environmentally friendly?

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11. Low-glycemic foods

• Next big fad???
• Glycemic index measures speed carbohydrate is
  digested raised blood sugar
• Refined grains/sugars are high
• Whole grains are low
• New products introduced
• 2 in 1999
• 175 in 2004

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Eating out with diabetes

• Requires planning, wise choices
• Work with health care team to identify goals
• Know how to make changes in meal plan if
  restaurant doesnt have what you want

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How to order at restaurants

• Phone ahead
• Ask to see menuwhat fits plan
• Are changes possible?
• Be assertive, ask questions about food,
  ingredients, preparation
• Try to eat same portions as at home
• Share, to-go container, leave on plate

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How to order at restaurants

• Get meat fish
• Broiled without added fat
• No breaded friedpeel off if cant avoid
• Order baked potatoes plain add
• 1 tsp. margarine or low-cal sour cream and/or
  vegetable from salad bar or menu

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How to order at restaurants

• Ask for no added salt
• On the sidesauces, dressings, gravies
• Read menu creatively
• Fruit cup for appetizer
• Breakfast melon for dessert
• Combine salad with low fat appetizer as entrée

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How to order at restaurants

• Substitute or omit double vegetables instead of
  fries or ask for no fries
• Ask for low fat version of dressing, margarine,
  milk
• Limit alcohol to cut calories

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Eat on time

• Ask others to eat at your regular time
• Plan to avoid waiting for a table
• Be on time for reservation
• Do special dishes take extra time?

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Eat on time

• If late lunch eat fruit or starch serving from
  that meal at usual time
• For very late dinner eat bedtime snack at usual
  dinner time
• May need to adjust insulin

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Fast food in America

• 47 of money spent on food will be spent at
  restaurants in 2005
• Healthy food is not trend at fast food
  restaurantshealthy is for home
• Taste important to 93.6
• Healthy important to 69.1

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Fast food in America

• Fried chicken fastest-growing food category in
  2004

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Burger King

• Enormous Omelet Sandwich
• 2 eggs, 2 slices cheese, 3 strips bacon, 1
  sausage patty
• 730 calories, 47g fat

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Pizza Hut3Cheese Stuffed Crust Pizza

• Pepperoni/slice 360 cal, 14g fat, 7g saturated
  fat, 990mg sodium,

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KFC Ben Jerrys

• KFC Considering returning to full name
• Ben Jerryswider cone holds 2 scoops, not 1,
  no more low carb choices

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Carls Jr.Monster Thick Burger

• 2/3 pound beef
• 3 slices cheese
• Bacon
• Mayonnaise-based sauce

1,420 calories
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Fast food

• Know nutritional value of foods ordered
• Fast food only once a day
• Order grilled, broiled, lean without fat-based
  toppings breading

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Ordering fast food

• Choose fat-free milk, sugar-free beverages
• Watch for big words or double
• Choose buns, bread, English muffins

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Ordering fast food

• Choose thin crust pizza with veggies
• Limit dressings on salads high-fat salad bar
  items
• Limit cheese

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Today you

• Examined features of food labels important for
  diabetics to read understand
• Looked at functions of ingredients in food
  substitutions available on the market
• Received tips for recipe modification
• Learned suggestions for eating out with diabetes

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