Living with Diabetes: Ingredients, Labels, Recipe Modification & Eating Out

1. Living with Diabetes:Ingredients, Labels, Recipe Modification & Eating Out Barbara Brown, Ph.D., R.D./L.D. Food Specialist Oklahoma Cooperative Extension Service Oklahoma Cooperative Extension Service

2. 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 Oklahoma Cooperative Extension Service

3. Food labels:Key points for diabetics • Ingredient list • Nutrition Facts panel • Serving size • % Daily Value • Nutrient content claims • Health claims Oklahoma Cooperative Extension Service

4. Ingredient list • In descending order by weight • Need to know terms for carbohydrates & fat Oklahoma Cooperative Extension Service

5. Several formats available Oklahoma Cooperative Extension Service

6. 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 Oklahoma Cooperative Extension Service

7. Serving size • Standardized to ease comparison of similar foods • Amounts usually eaten at 1 time • Given in household & metric measures Oklahoma Cooperative Extension Service

8. 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 Oklahoma Cooperative Extension Service

9. 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 Oklahoma Cooperative Extension Service

10. Trans fat • Required by 1/1/06 • Increases low-density lipoprotein (LDL) cholesterol levels • Raises risk of coronary heart disease Oklahoma Cooperative Extension Service

11. Unsaturated fat Trans Fat Hydrogenation changes shape H   |   -C = C-| H H  H |   | -C = C- Oklahoma Cooperative Extension Service

12. Using Trans fat information • Combine grams saturated fat & trans fat & look for lowest combined amount • Look for lowest % Daily Value for cholesterol Oklahoma Cooperative Extension Service

13. Margarine, stick Saturated Fat: 7g+ Trans Fat: 0gCombined Amt: 7g Cholesterol: 10% Saturated Fat : 2g+ Trans Fat : 3gCombined Amt: 5g Cholesterol: 0% Making the best fat choice Butter Oklahoma Cooperative Extension Service

14. Margarine, stick Margarine, tub Saturated Fat: 2g+ Trans Fat: 3gCombined Amt: 5g Cholesterol: 0% Saturated Fat: 1g+ Trans Fat: 0.5gCombined Amt: 1.5g Cholesterol: 0% Making the best fat choice Oklahoma Cooperative Extension Service

15. 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" Oklahoma Cooperative Extension Service

16. 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 Oklahoma Cooperative Extension Service

17. 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 Oklahoma Cooperative Extension Service

18. “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 Oklahoma Cooperative Extension Service

19. 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 Oklahoma Cooperative Extension Service

20. 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 Oklahoma Cooperative Extension Service

21. 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 Oklahoma Cooperative Extension Service

22. Less • Food, whether altered or not, contains 25% less of a nutrient or calories than the regular food Oklahoma Cooperative Extension Service

23. 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 Oklahoma Cooperative Extension Service

24. When label says “More” • 1 serving contains a nutrient that is at least 10% of Daily Value more than in reference food Oklahoma Cooperative Extension Service

25. Health claims • Describe how food or food component relates to a disease or health-related condition • Wording regulated by FDA Oklahoma Cooperative Extension Service

26. 3 types of health claims • Approved • Authorized • Qualified health claims Oklahoma Cooperative Extension Service

27. 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 Oklahoma Cooperative Extension Service

28. Approved health claims • Calcium & osteoporosis • Sodium & hypertension • Dietary fat & cancer • Dietary saturated fat & cholesterol & risk of coronary heart disease (CHD) Oklahoma Cooperative Extension Service

29. 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 Oklahoma Cooperative Extension Service

30. 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 Oklahoma Cooperative Extension Service

31. 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 Oklahoma Cooperative Extension Service

32. 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 Oklahoma Cooperative Extension Service

33. 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 Oklahoma Cooperative Extension Service

34. 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 Oklahoma Cooperative Extension Service

35. Ingredients of concernto diabetics • Carbohydrates • Simple—Sugars • Complex—starches • Fiber—indigestible carbohydrates • Low-calorie sweeteners • Fats • Sodium Oklahoma Cooperative Extension Service

36. Simple carbohydrates—Sugars 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 Oklahoma Cooperative Extension Service

37. Functions of sugar in foods • Sweetener • Tenderizer in baking • Caramelize under heat • Enhance growth of yeast • Control gelling process in jellies/preserves • Preservative Oklahoma Cooperative Extension Service

38. 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 Oklahoma Cooperative Extension Service

39. 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 Oklahoma Cooperative Extension Service

40. 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 Oklahoma Cooperative Extension Service

41. Sucrose Fructose Galactose Glucose High-fructose corn syrup (HFCS) Lactose Maltose Other “ose” words Ingredient label words meaning sugar Oklahoma Cooperative Extension Service

42. 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. Oklahoma Cooperative Extension Service

43. “No sugar added” • No form of sugar added during processing • No high-sugar ingredients • May still be high in carbohydrate • Read Nutrition Facts panel Oklahoma Cooperative Extension Service

44. Major sources of addedsugars in U.S. diet Source: Dietary Guidelines for Americans 2005 Oklahoma Cooperative Extension Service

45. Fructose • A monosaccharide • Added to foods in liquid or crystalline form • Crystalline form made from corn starch Oklahoma Cooperative Extension Service

46. 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) Oklahoma Cooperative Extension Service

47. 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 Oklahoma Cooperative Extension Service

48. Sugar substitutes (low-calorie sweeteners) • Don’t 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 Oklahoma Cooperative Extension Service

49. Choosing sugar-free foods:read labels carefully • Compare carb content of sugar-free with standard food • Big difference—may be reason to buy sugar-free • Little difference—base choice on taste, cost Oklahoma Cooperative Extension Service

50. 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 Oklahoma Cooperative Extension Service