of this writing, the direct link for food and nutrition labeling information is www.cfsan.fda.gov/label.html.
The following are teaching points about the Nutrition Facts panel in regard to Basic Carbohydrate Counting:
• The Nutrition Facts provide information based on one serving of the food. People need to take note of the panel serving and consider the portion they eat to correctly figure their carbohydrate count. Serving sizes on food labels are uniform and defined by the FDA. For example, one serving of bread is 30 grams and one serving of juice is 8 ounces. Servings must be noted in grams as well as household servings. For example, one slice, ten crackers, 8 ounces, etc. This makes the amounts easier to understand.
• Food label serving sizes are not necessarily the same as diabetes (or exchange/choice) servings. Table 3-4 (page 27) provides examples of how the servings can be the same or different.
• The total carbohydrate count includes all the components under total carbohydrate, including dietary fiber, sugars, and polyols (sugar alcohols). There is no need for people to pay special attention to sugars, as they are counted as part of total carbohydrate. “Sugars” are defined by the FDA as both naturally occurring sugars and added sugars or all mono- and disaccharides (U.S. Food and Drug Administration 2004). Educators should explain that the word “sugars” on the food label is not just added sugars. This is often a point of confusion for people learning carbohydrate counting.
• Make sure that if people are doing meal planning according to servings that they know how to translate the grams of carbohydrate from a Nutrition Facts panel into a serving of food in their eating plan.
• The nutrition claims: sugar free, reduced sugars, and no added sugar or no sugar added do not mean the food is carbohydrate or calorie free. People still need to look at the amount of total carbohydrate and count it. (Chapter 10 provides additional information on polyols and how to teach people to fit these into their eating plan.)
Have and know how to use measuring equipment
and other portion control tools
Teaching people what measuring equipment and portion control tools to have and how to use them is a critical aspect of teaching carbohydrate counting. Consider using the online tool from National Institutes of Health, called the Portion Distortion Quiz (http://hp2010.nhlbihin.net/portion/ as of the time of this writing) to raise consciousness about the portions a person is currently eating.
The following is the measuring equipment that people should have at home and be encouraged to use regularly:
• Measuring cups for both liquids and solids
• Measuring spoons (a set)
• Food scale
Most will have the first two items, but not the scale. Encourage people to purchase an inexpensive scale ($10 to $15), particularly to measure foods that don’t come with a Nutrition Facts panel, such as fresh fruit, fresh vegetables, bagels, and raw or cooked meats. More expensive food scales ($40 to $100) are also available. These scales may provide features such as the gram weight of the food and the grams of carbohydrate pulled from a database for several hundreds to thousands of common foods. The Diabetes Mall at www.diabetesnet.com or 800-988-4772 is a good resource for information on several of these scales. Additionally, the EatSmart Nutrition Scale (www.eatsmartscales.com) is a good choice.
Portion control tools are not just limited to measuring utensils. The following are additional portion control tools:
• Nutrition Facts panel on food labels. Encourage people to read the serving sizes on a food’s Nutrition Facts panel. Make sure they realize that the nutrition information provided is for one reasonable serving of the food for most Americans. Have them think about the quantity they eat in comparison to the food label portion. If willing, have them measure out this portion with measuring equipment, then put it into a serving item to see how the quantity looks.
• Eyes. Help people train their eyes to judge portions. Teach them that their eyes are always with them in the supermarket, at the bakery, or at restaurants. Tell people that the more they use measuring equipment at home, the better they will be at estimating portions when they eat out.
• Hands. Many educators find it helpful to teach the hand guides found in Table 4-1 to help people eat foods in proper portions. These can be particularly helpful for meals eaten away from home.
Additional portion control tips
While it is important to encourage people to use measuring equipment at home when possible, especially as they start to count carbohydrate, it is unrealistic to expect people to continue using these tools long term. For this reason it is important to provide additional portion control tips for eating at home and away from home.
Portion control tips for purchasing food and eating food at home:
• Keep measuring equipment—spoons, cups, and a scale—in an easy-to-use location. Consider weighing and measuring foods once a week. A reasonable suggestion may be to do it over the weekend, when a person may have more time.
• Use smaller plates and bowls. Less food looks like more food on smaller plates. People are less likely to overfill smaller plates.
• Encourage people not to serve family style. Putting bowls or platters of food on the table makes it easier to overeat.
• Put the leftovers (or what should be leftovers) away before eating.
• When buying produce—fruits, vegetables, and starches—buy the small pieces or plan to cut larger ones in half.
• When buying meat, fish, or poultry, purchase the amount needed for the meal, rather than too much. Give people examples. For instance, if a person is making hamburgers for four and wants 3-ounce cooked hamburgers, then only buy 16 ounces (1 pound) of meat. Or, if a person is buying turkey at the deli to make four sandwiches with 2 ounces of meat each, then buy as close to 1/2 pound as possible and make each sandwich with an equal amount of turkey.
Portion control tips for eating foods at a restaurant:
• Educate people about the words on menus or menu boards that mean large portions: giant, grande, supreme, extra large, jumbo, double, triple, double-decker, king size, and super.
• Educate people to seek out portion descriptors that mean small portions: junior, single, queen, petite, kiddie, and regular.
• Encourage people not to “super-size” or purchase meal deals, as these can promote overeating unless people are sharing parts of the meal, such as French fries. Teach that value equals being able to eat a healthy, reasonably portioned meal.
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