Nutrition and Diabetes

Smart Shopping: Supermarket Tour With DCC Registered Dietitians

Kelly Estell, RD, LDN: Hi, I'm Kelly Estell.

Megan Robinson, MS, RD, CDE, LDN: And I'm Megan Robinson.

Kelly Estell, RD, LDN: And we're registered dietitians at Children's Hospital of Philadelphia working in the Diabetes Center for Children. Today we're going to take you on a supermarket tour. Eating healthy is a big part of managing your diabetes. In the supermarket, shopping the perimeter is the best place to start to find foods in their most natural state. Our objectives today are to decode food labels and to show you the healthiest choices in each section.

Carbohydrate Counting Using a Food Label

Megan Robinson, MS, RD, CDE, LDN: Reading food labels can be confusing, but you only need to look at a few key points on the label when carbohydrate counting. The nutrition facts can be found on the side or the back of the food package. First, you need to look at the serving size, which is listed at the top of the food label. The serving size listed on this label is 1 ounce. You may be asking yourself, "What does 1 ounce look like?" You can next, look at this and find that the weight of 1 ounce or 28 grams is about 11 crisps. We all know that these crisps can be broken in the bag and it may be difficult to count out 11 crisps. So we recommend for you to use a food scale for accurate carbohydrate. If you weight the crisps on a food scale, you can weigh it either in ounces or in grams. Remember the weight in grams is not the grams of carbohydrate. Once you have weighed one ounce of crisps, you can look further down on the food label to find the total grams of carbohydrate. The grams counted here, 1 ounce of crisps equals 23 grams of carbohydrate. This bag of crisps contains 10 servings. So if you eat more than one serving, you are eating more than 23 grams of carbohydrate. For example, if you eat 2 ounces, you are eating 46 grams of carbohydrate. If you double the portion size, you need to double the total carbohydrate grams.

Olive Oil, Vegetable Oil, Canola Oil, Which Do I Choose?

Megan Robinson, MS, RD, CDE, LDN: The best type of oil to choose could be a canola oil or it could be an olive oil. These are great choices. You can try sautéing vegetables with oil or you can mix them in for a salad dressing for a great treat.

Choosing a Heart-Healthy Spread

Megan Robinson, MS, RD, CDE, LDN : A lot of dietitians get the question, "Which is better, butter or margarine?" Well, the answer is not that simple. When you look at butter and margarine, if it's in the stick form it's the least healthy for your heart. When choosing a heart healthy spread, you want to choose a tub spread. So the tub should be a light spread so it's lower in saturated fat and total fat. Other things that you want to look for is making sure that the product does not contain any hydrogenated oils. This would be found right in the ingredient list. It's important to make sure that the saturated fat is at least two grams of saturated fat or less per serving, and to make sure that it's no more than about 50 calories per tablespoon to be a heart healthy spread.

Whole Wheat Vs. Whole Grain White Bread

Kelly Estell, RD, LDN: Now we're comparing 100% whole wheat bread with the whole grain white bread. A lot of times people will think that this is a great choice because it'll say smart white bread, it has whole grains in it. But if you take a closer look at the ingredients, you'll see the first one is water and then enriched flour. Enriched flour is not a good choice because what that means is that the fiber is actually broken down and you're not getting as much nutrients.

Choosing the Best Cereal

Kelly Estell, RD, LDN: Now we're in the cereal aisle. Cereal is a popular breakfast choice, but also a great snack. There's lots of different varieties, so it's always hard to figure out which one is best to pick. Kix® and Cinnamon Toast Crunch® are good choices in that they have whole grain as the first ingredient, but you also want to look at the amount of sugar and fiber. Kix® is a great choice because it's 3 grams of sugar and 3 grams of fiber per serving. Cinnamon Toast Crunch®, however, has 9 grams of sugar and only 2 grams of fiber. When looking at your cereal, you want to look at the nutrition facts. The most important thing with diabetes is counting your carbs and taking your insulin. The serving size at the top says 1 cup. So this would be a serving for the Cheerios®. Cheerios®, if you look at the label, is only 1 gram of sugar, and 3 grams of fiber, and 20 carbs.

Navigating the Dairy Section

Megan Robinson, MS, RD, CDE, LDN: It's important to eat at least three to four servings of low-fat dairy products every single day to get the calcium and vitamin D that your body and bones need. When we look at the different type of milks, there's skim, fat-free milk all the way up to whole milk. Now, all of these contain the same amount of carbohydrates, about 12 to 13 grams of carbohydrate for every 8 ounces. But the fat and calories are going to vary compared to the fat free up to the whole milk.

When choosing milk, it's important for your children to drink low-fat or skim milk. But if you have toddlers up to the age of 2, they can still and should have whole milk every day. If your children are over the age of 2, then low-fat or skim milk are great choices.

If your child decides to drink flavored milk, that's okay because they're still getting the calcium-rich and vitamin D nutrients. But remember, the chocolate or flavored milks are going to have almost up to 30 grams of carbohydrate per serving compared to only 12 grams in a non-flavored milk.

If your child is allergic to milk, it's important to still make sure that they get enough calcium and vitamin D for their bones. So when looking and trying different types of milk products, you can see you have soy milk, coconut milk and almond milk. Now, the soy milk is a great choice because it is calcium rich, it's fortified with vitamin D, and it does have adequate protein. But when you compare that to the almond milk or coconut milk, they will not have appropriate vitamin D and calcium as well as for protein.

When you're in the dairy aisle, it's also important to get calcium and vitamin D through yogurt. And yogurt is a great snack because you can have it with your school lunches or you can have it after school. But it's important to choose the right type of yogurt. Many kids love the flavored yogurts with the crunchies on top, but it's loaded with extra carbohydrates and sugar. For one of these containers, it's 32 grams of carbohydrate compared to when you have a light yogurt that's only maybe about 15 to 16 grams of carbohydrate. Another great choice would maybe even be the new Greek yogurts. And they do make them in kid flavors, which even have double the protein and the same amount of carbohydrates as a light yogurt. So it's a great choice for snacks and for school lunches.

Smart Snacking

Megan Robinson, MS, RD, CDE, LDN: Kids get at least a third of their calories coming from snacks. Now, many kids eat tons of different types of snacks, such as chips, pretzels, popcorn. But a lot of them even eat candy and cakes and cookies. A treat is okay once in a while, but you want to make sure that you choose snacks that are nutrient rich. Other snacks are important to choose that are high in fiber and low in saturated fat. So here we have a few examples. If we compare SunChips® to regular classic potato chips, the SunChips® are going to have more whole grains and they're going to be lower in saturated fat compared to the regular potato chips, which do not have whole grains in them at all.

And another example of a really great snack is popcorn. Now, some people think popcorn laden with butter and cheese are a great, healthy option. Not so. You want to choose just plain popcorn or you can even make your own popcorn using a little bit of oil. But it's important to choose the right type of snack so your child stays healthy.

When you think about carb counting with diabetes, it's really important to make sure you look at the food label on the back of the package. When looking at the package, it's important to focus on the serving size and the total grams of carbohydrate. For example, when you have a large bag like this, most kids will just go in and grab a handful of popcorn. But remember to take out your measuring cup to measure it first. So you can either individually measure out the serving and put it in little baggies, or pre-measure it and tell your child what a typical handful would be. For example, a serving size for this popcorn is three cups of popcorn. So you would measure out three cups of popcorn and that would be equivalent to only 18 grams of carbohydrate.

Ground Meat: Which One Is the Best?

Kelly Estell, RD, LDN: When looking at ground meat, ground turkey breast is the best. You can see that this ground beef, they only have 73% lean. You would want to pick at least 90% or higher. This ground turkey breast, again, is 99% lean, so this would be the best choice.
So when eating protein, what counts as a serving? About the size of a deck of cards, the width and the thickness, is what counts as one serving. This is about three ounces. As you can see with these steaks, this is way bigger than a serving size. You can see the length and the thickness is a lot bigger, so at least half of this would count as a serving.

Fresh Fruits and Vegetables: Serving Size and Carbs

Megan Robinson, MS, RD, CDE, LDN: Here we are in the fresh fruits and vegetables section. And it's important to eat at least five servings of fresh fruits and vegetables every day. But what counts as a serving? So here we are in an area of vegetables. And it's really important to try eating a variety of vegetables every day. So, for instance, choosing more of the dark green leafy vegetables compared to something like using an iceberg lettuce.

It's important to eat at least five servings of fresh fruits and vegetables every day. But what counts as a serving? A good way of looking at what a serving is, is by looking at everyday things you have in the house. For example, a tennis ball is about equivalent to the size of a serving for fruit. But another way to determine a serving size is by using a food scale. Now, you can use a food scale at home or you can use the food scale right at the grocery store. What is important, though, is to remember when you look at the food scale at the grocery store, 1 pound is equivalent to 16 ounces.

Now, how do you determine the number of grams of carbohydrate based on the serving? You can use products such as the CalorieKing™ book or you can also use their website, which is calorieking.com. So let's first look at the serving size and how to weigh and measure to determine the grams of carbohydrate in the fruit. First, we have this apple. Let's compare this to this apple. How many grams of carbohydrate are in each fruit? Most of us would look at a piece of fruit and estimate that it'd be about 15 grams of carbohydrate. But that's not the same for this. This is a much larger apple and that would be more than 15 grams of carbohydrate. So we're going to weigh this one to determine how many grams it is. So when you weigh the fruit, you weigh it on the scale. And for this apple it is approximately 9 ounces. So when we look in the CalorieKing™ book, a 9 ounce apple would be equivalent to about 32 grams of carbohydrate.