Diabetes and Carb Counting For Dummies (For Dummies (Lifestyle)) 1st Edition

Chapter 7

First Things First: Reading and Deciphering Food Labels

IN THIS CHAPTER

check Figuring out food labels, both old and new

check Understanding nutrition facts, ingredient lists, and allergy information

check Sorting out what you read at the grocery store

When learning to count carbohydrates, it makes sense to start with the basics, and the place to start is food labels. Food labels are mandatory for packaged foods in the United States. The U.S. Food and Drug Administration (FDA) is the agency that regulates and oversees label laws. Other countries may or may not offer labeling, and they may give their information in a different format. For example, some countries provide nutrition information per 100 grams of the weight of the food product. In the United States, the serving sizes are more tangible and vary depending on the food.

Periodically the Nutrition Facts food labels get a face lift — and change is soon upon us! In May 2016, the FDA approved final updates on the new Nutrition Facts food labels. The updated design is due to go live in July 2018. A grace period will allow time for all manufacturers to get onboard and comply. That means that for a while, both types of labels — old and new — may end up in your cupboard at the same time, so I explain the similarities and differences of both versions in this chapter.

Here I also walk you through all the information you find on a food label and prep you for reading labels at the grocery store.

remember Rest assured, manufacturers are held accountable for providing accurate information on their Nutrition Facts labels. Strict rules also govern what wording is allowable on the front of the package in terms of label claims. For example, you may find a label on a product containing oats that claims that soluble fiber may reduce the risk of heart disease. In order to make that particular claim, the food must be low in fat, saturated fat, and cholesterol, and specify the source and amount of the soluble fiber. Sufficient evidence proves that those properties may indeed reduce your risk of heart disease, so the claim is allowed. On the other hand, you won’t find a food label that promises to reverse the aging process or guarantees that you will shed ten pounds in a week, because those claims are simply not possible and are not backed by scientific evidence.

Finding Your Way around Food Labels

All consumers should be cognizant of the overall composition and nutritional quality of the foods they choose. Often when people with diabetes read a food label, they zero right in on the grams of total carbohydrates or the sugars and may end up ignoring other important information. While the carbohydrate information is certainly important when it comes to regulating blood-glucose levels, it doesn’t mean that you should ignore the info on calories, fats, and sodium. The information on the Nutrition Facts labels can be very useful when trying to achieve weight targets, heart health, and blood-pressure control. Labeling can also help you assure adequacy in protein, fiber, and certain key vitamins and minerals. Keep the big picture in mind and use the whole label when thinking about your overall health. (I go into detail on all the information you find on food labels in the later section “Scrutinizing the Nutrition Facts.”)

In the following sections, I point out the importance of paying attention to grams rather than percentages on all food labels, and I introduce the setup of both traditional food labels and newly designed food labels, which are set to debut in 2018.

Paying particular attention to amounts

The total fat, saturated fat, trans fat, total carbohydrate, fiber, sugar, and protein amounts on a food label are listed in grams (g), while cholesterol and sodium amounts are listed in milligrams (mg). Off to the right side of the label you find the %Daily Value in bold. The %Daily Value is sometimes abbreviated %DV. The tricky thing is that the food labels are comparing each nutrient to the %Daily Value for a person who needs 2,000 calories per day to reach weight and health targets.

remember Looking at the Total Carbohydrate amount is important because carbohydrates digest and eventually turn into glucose, which ends up in the bloodstream. Having diabetes means you should be paying attention to how much carbohydrate you’re eating. Food labels help you do just that, but you need to look for the grams of carbohydrate, not the %Daily Value. You want to focus on the grams of carb, not the %Daily Value, because insulin dosing is based on the actual grams of carb, not the percent. Carbohydrate grams and %Daily Value are listed on the same line on Nutrition Facts labels, as you can see in Figure 7-1 .

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© John Wiley & Sons, Inc.

FIGURE 7-1: Total Carbohydrate is listed in grams.

Because %Daily Value is written in bold and off to the right side of the label, and lined up neatly with the actual amount, it is easy to allow your eye to zero in on the %Daily Value rather than the actual amount in grams. However, knowing that you’re getting 26 g of carbohydrate is far more important than knowing that you’re getting 9% of the Daily Value for a person who should be eating 2,000 calories per day. (That is, unless you’re in the subset of people who happen to need exactly that many calories and therefore fall into the “reference range.”)

tip The %Daily Value on the Nutrition Facts label is useful when you’re trying to determine whether a product is high or low in a given substance. Note that 5%DV or less is considered low in that nutrient, and 20%DV or more is considered high in the nutrient. When looking at total fat, saturated fat, cholesterol, and sodium, it pays to choose foods that are low (5%DV or less). When looking at fiber, vitamin A, vitamin C, calcium, and iron, it is a good idea to aim for choices that are high (20%DV or more).

Viewing versions of traditional labels

Several versions of the Nutrition Facts labels are currently in use. The most extensive label includes additional information at the bottom of the label. This footnote section is often a source of confusion. Figure 7-2 points out the lower segment of the label, which provides the reference information in a footnote.

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© John Wiley & Sons, Inc.

FIGURE 7-2: Label reference information.

Notice that target intakes are provided for two calorie levels. One column heading is for a 2,000-calorie intake target, and another column heading is for a 2,500-calorie intake target. Total fat, saturated fat, cholesterol, sodium, total carbohydrate, and fiber daily targets are set for the two reference calorie levels.

The upside of this information is that it allows consumers to have a rough idea of what intake targets to aim for in a day. The downside is that lots of people simply don’t fall into those calorie target ranges. Many women, especially those who are older or trying to lose weight, should be aiming for a much lower calorie goal. Clearly, if you’re limiting your intake to 1,200 to 1,500 calories per day, then the nutrition information related to 2,000 and 2,500 calories is simply irrelevant and could lead to overconsumption.

An abbreviated version of the food label is also acceptable for manufacturers to use. Some food packages use a version that omits the footnote details from the bottom of the label and simply provides the key nutrition facts, such as the label in Figure 7-1 .

Taking a sneak peek at newfangled food labels

The current food label imagery (as shown in Figures 7-1 and 7-2 ) has been in use for over 20 years. The Nutrition Facts label has recently been redesigned, revamped, and improved. Changes reflect the latest scientific, nutrition, and public-health research. Health experts and the general public provided feedback, which helped shape the label transformation. The new design should make it easier for the public to make informed decisions about what they are consuming. Manufacturers have some time to gear up and get the new image rolling, but they are mandated to go live by July 2018. Smaller companies have an additional year to make the changes.

Figure 7-3 shows the old and the new, in a side-by-side view. The label on the left is the design currently in print. The label on the right is the sneak peek of the upcoming new and improved label.

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© John Wiley & Sons, Inc.

FIGURE 7-3: Current label and updated label comparison.

Here’s the scoop on what you can expect to see:

·     More realistic serving sizes: The first line on the new label specifies the number of servings in the container. Suggested serving sizes have been reconsidered on various foods. Changes have been made so that suggested serving sizes will be more likely to reflect actual intake. For example, the serving size on the new label will reflect the reality that a 20-ounce beverage is likely to be sucked down by one person, not 2.5 people. However, a 12-ounce beverage will also indicate that the container holds one serving. Let’s be honest; most of us don’t tend to share our beverages, and once the beverage is opened, it’s usually finished off in one sitting.

·     Per serving versus per package notation: Some labels will provide dual columns to show nutrition information for per serving as well as per package. For example, if you eat the whole pint of ice cream, you’ll be able to easily identify calories and nutrition facts for not only one portion but also the full container. Being more aware may help people to limit their intake to the suggested “one serving.”

·     Bigger, bolder serving-size and calorie fonts: Looking further at the new label design, on the right, you may notice how the serving size will be noted in large, bold font. The calorie level will be in even larger and bolder font. They want to make sure everyone knows that one large bag of potato chips isn’t a single-serving container.

·     No inclusion of calories from fat: The calories from fat will no longer be listed. There will still be a requirement to identify the Total Fat grams and the amount of unhealthy Saturated and Trans Fats.

·     Specification of “added” sugar: One significant change coming to the new label relates to sugar. Current labels already list the amount of sugar in the product, but the new food label will add more clarity. It will not only list the total amount of sugar per serving, but it will also tell you how much of the sugar is “added” versus naturally present in the food. In the example of the updated label shown in Figure 7-3 , there are 12 total grams of sugar, but of the 12 grams, 10 grams have been added during manufacturing and processing. You can deduce that 2 grams of sugar were naturally occurring, such as the sugars found in milk or fruit.

warning Added sugars are going to be identified on the new labels to help consumers be more aware. Added sugars, honey, syrup, and other processed sweeteners tend to add too many “empty calories.” Those calories, if not kept in check, can lead to unwanted weight gain and a rash of other health concerns, not to mention the impact on blood-glucose control if you have diabetes.

·     Updated %Daily Value targets: Daily values for nutrients like sodium, fiber, and vitamin D are being updated based on newer scientific evidence from the Institute of Medicine and other reports such as that from the 2015 Dietary Guidelines Advisory Committee. In Figure 7-3 , for example, 8 grams of Total Fat is listed as 12% of Daily Value on the label on the left (the original label), but the same amount of fat is listed as 10% of Daily Value on the label on the right (the revised label). The difference is due to the newly established targets.

·     Inclusion of micrograms and milligrams for vitamins and minerals: Old labels fall short, as they currently list only the %Daily Value for vitamins A and C and for the minerals calcium and iron. Current labels don’t indicate exactly how many milligrams of calcium, for example, are provided. The new labels will continue to list information on calcium and iron, and will start to list the specific amounts in milligrams in addition to the %Daily Value.

·     Addition of vitamin D and potassium info: Another notable change will be the addition of vitamin D and potassium information:

o   Many folks fall short in the vitamin D department. Vitamin D is critical for bone health, and lab results are showing that many of the people who are being screened have low blood levels of this crucial vitamin. Vitamin D content will be listed in micrograms and in %Daily Value.

o   Listing potassium on the new label will bring more attention to this important mineral, which, among other things, helps with blood-pressure regulation. Potassium content will be listed in milligrams, which will be useful for individuals with kidney failure who need to limit or track their intake of potassium. The %Daily Value will also be listed.

·     Omission of vitamins A and C: New labels will no longer be mandated to include details on vitamin C and vitamin A. You may wonder why those two nutrients are being booted off the new label. It’s simply because deficiencies are far less frequent these days as most individuals have adequate intakes for both vitamins A and C.

Scrutinizing the Nutrition Facts

When it comes to scrutinizing the Nutrition Facts food label, I start at the top of the label and work my way down. I’ll be focusing on the current labels as they exist now, since the new label design won’t be out until the summer of 2018. Refer to Figure 7-4 as you read through this section. Key content is identified in bold font throughout the label and includes Calories, Total Fat, Cholesterol, Sodium, Total Carbohydrate, and Protein.

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© John Wiley & Sons, Inc.

FIGURE 7-4: Sample Nutrition Facts label.

Sorting out serving sizes and servings per container

The very first line tells you what is considered to be one serving. Next to the serving size, in parentheses, you find the weight of the product. For example, if the label says Serving Size 1 cup (55 g), it means that one serving, or 1 cup, weighs 55 grams on a food scale.

The next line down tells you how many servings are in the container. In Figure 7-4 , the serving size is 1 cup and there are 4 servings in the container, so the full container has 4 cups.

tip Sometimes it’s easier to measure a serving using the Servings Per Container information. For example, a frozen lasagna may say the Serving Size is 1 cup, and Servings Per Container 6. Using a measuring cup to serve lasagna would end up being a sloppy mess. Instead, take the lasagna out of the oven and cut it into six even pieces. It will look a lot nicer served with a spatula. Each piece is about a cup.

remember All the nutrition information provided on the label is correct only for exactly one serving. Be sure to note what’s identified as the serving size. If you eat more or less than the specified serving size, do the math. If you eat two portions, you should double all the information on the label as you manage your carbs.

Calling out calories

remember Calories matter. If you eat more calories than you need, no matter what the source, you will gain weight. If you eat fewer calories than your body requires for its day-to-day functioning, then you will lose weight. Be sure to take the time to look at calories and compare products. Use this information as part of your decision-making process when shopping.

The product in Figure 7-4 has 216 calories per serving. If you eat two servings, you end up with 432 calories. Eating the whole container would be four servings with a total intake of 864 calories. Next to the calories, on the same line, the current food label lets you know how many of the calories come from fat. The new food labels will do away with that notation and will just focus on the total number of calories.

Finding the fat

The total amount of fat per serving is given in both grams and %Daily Value. Providing information on the unhealthy types of fat is required. Labels must tell you the amount of saturated fat and trans fat per serving. Labels are not required to list the details on the heart-healthy types of fats, known as unsaturated fats. Some manufacturers proudly choose to do so, so you may end up with a label that does show you how many grams of monounsaturated fat and polyunsaturated fat are provided per serving. That info is optional.

Toting up the total fat

The sample label in Figure 7-4 shows 8 grams of Total Fat, 12% of Daily Value. Indented below the Total Fat you always find the information on the Saturated Fat and the Trans Fat. The goal is to eat as little saturated fat and trans fat as possible. Both types are linked to raising LDL cholesterol, which is the bad kind of cholesterol in your blood.

remember While some fats are good for your heart and others are not so good, all fats have the same effect on your hips because they have the same number of calories. Flip to Chapter 16 for tips on eating smart for both weight and heart.

Breaking out the saturated fat

Saturated fats are not heart healthy. Look for this number to be as low as possible when reviewing labels; the example in Figure 7-4 shows 1 gram of saturated fat (5% of Daily Value). Saturated fats occur naturally in many different foods, predominantly animal products such as fatty meats and full-fat dairy products. It pays to compare labels and aim to lower your intake of saturated fats. One thing to be aware of is that a label can say 0 g of saturated fat as long as a serving provides under 0.5 grams per serving.

Tallying trans fats

Trans fats are especially bad for your health. Trans fats are a double whammy. They not only raise the LDL, which is the bad kind of cholesterol in your blood, but they also lower the HDL, which is the good kind of cholesterol in your blood. There has been a big push to reduce the amount of trans fat in our food sources. Manufacturers have responded by reformulating many products to reduce trans fat.

You should definitely compare labels and look for items with zero grams of trans fat (like the one in Figure 7-4 ). The label can say 0 g trans fat as long as a serving provides less than 0.5 grams per serving.

Noting the cholesterol content

Cholesterol content is listed in milligrams (mg). Expert opinion has shifted somewhat in terms of the recommendations on intake of dietary cholesterol. The focus has shifted away from the cholesterol in the foods we eat, and the attention is zeroing in on the type of fat. New recommendations are allowing for more cholesterol than previously allowed. The attention is focused on limiting saturated and trans fats. Prior guidelines set an upper limit at 300 milligrams of dietary cholesterol per day. The current guidelines say, “While adequate evidence is not available for a quantitative limit for dietary cholesterol in the 2015–2020 Dietary Guidelines, cholesterol is still important to consider when building a healthy eating style .” It’s a good idea not to go overboard. The product in Figure 7-4 provides 5 mg of cholesterol per serving, which isn’t much.

Surveying the sodium

Salt is a significant source of sodium. Common table salt is made from sodium and chloride. Sodium intake is linked to high blood pressure, so if you have hypertension, you should take note of the amount of sodium you eat. Packaged foods make it easy by listing the milligrams per serving.

Guidelines for Americans encourage keeping sodium intake to under 2,300 mg/day. Depending on your overall health, doctors may suggest that you keep your intake below 1,500 mg/day. The product in Figure 7-4 has 490 mg of sodium, which is considered high. Anytime the %Daily Value is 20 percent or more, it’s considered high.

For more information on making heart-healthy choices and further details on sodium, dietary fats, and cholesterol, see Chapter 16 .

Focusing on total carbohydrate

The Total Carbohydrate grams represent the lump-sum total from all carbohydrate sources, including the starch, the fiber, the sugars, and any and all other types of carb, such as sugar alcohol.

The subsets indented below the Total Carbohydrate identify the specific amount of carbohydrate coming from fiber and from sugar. The sample label in Figure 7-4 has 30 grams of Total Carbohydrate, of which 4 grams come from fiber and 2 grams come from sugar. Nutrition Facts labels don’t list how much of the Total Carbohydrate comes from starch, but it’s pretty easy to figure out. Because fiber and sugar are providing 4 g and 2 g respectively, the remainder must be from other carbohydrates, which is generally the starch. In this case, add 4 grams of fiber and 2 grams of sugar to get 6 grams, and then subtract 6 from 30 grams of total carb; your answer is 24 grams of starch.

remember Carbohydrates from starch and sugars are digested and eventually turn into the individual sugar molecules that are absorbed into the bloodstream. The sugar in the bloodstream is called blood glucose, abbreviated BG. Carbohydrate foods provide the glucose that the body needs to function normally. Having diabetes doesn’t mean that you should over-restrict, or avoid, carbohydrates. Managing diabetes does mean that you should learn to identify which foods have carbs and how much of those foods you should eat. Portion size matters. Take note, though, that not all carbohydrates affect the blood-glucose levels in the same way.

The following sections delve deeper into the two types of carbs called out on food labels: fiber and sugar.

tip Find out which foods have carbohydrates in Chapter 3 . For more details on how carbs fuel the body, see Chapter 4 . Get an idea of how much carb you need by delving into Chapter 5 . For more about digestion rates and how food composition can impact your blood-glucose readings, see Chapter 10 .

Accounting for fiber

Fiber is unique because it is a form of carbohydrate that doesn’t digest. Fiber comes from plant foods such as whole grains, legumes, fruits, and vegetables. (Meats, dairy products, fats, and oils don’t have any dietary fiber.) Dietary fiber is what remains after digestion; it’s the indigestible part of the plant. Fiber makes its way all the way through the intestine, pushing things along as it goes, which helps promote regularity in bowel movements. Fiber is important for intestinal health. Fiber is made out of glucose molecules all linked tightly together. It doesn’t break down into individual glucose molecules in the same way that starch does.

remember Bottom line: When counting carbs, you don’t need to count fiber since it doesn’t end up raising your blood-glucose levels. You can subtract the grams of fiber from the grams of Total Carbohydrate. In Figure 7-4, 30 grams of Total Carbohydrate minus 4 grams of fiber leaves you with 26 grams of digestible carbs.

tip If you inject insulin, you should definitely subtract the fiber if it is going to make a difference to your insulin dose. However, if you have diet-controlled Type 2 diabetes, you really don’t need to worry about subtracting the fiber.

When adjusting insulin doses to the amount of carbohydrate eaten, precision is important. Calculating your own doses of insulin allows for flexibility in what you eat, but getting the proper dose of insulin relies on you counting the carbohydrates accurately. Consider the two tortilla labels shown in Figure 7-5 .

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© John Wiley & Sons, Inc.

FIGURE 7-5: Fiber comparison.

The label on the left shows that the total carbohydrate count is 13 grams and the fiber is a mere 1 gram. If you subtracted the gram of fiber and counted the carbs as 12 grams, you would be very unlikely to change your dose of insulin on that basis. For example, if your doctor recommended that you take 1 unit of rapid-acting insulin for every 12 grams of carb you eat, you would end up taking just 1 unit of insulin regardless of whether you counted this tortilla as 13 grams of carb or as 12 grams of carb.

warning The insulin-dosing examples used in this book are only to make a point. Individual insulin requirements vary significantly. Do not make changes to your insulin plan without conferring with your doctor.

Next, look at the label on the right. That’s a different story. There are 10 grams of carb per tortilla, but 7 of those grams come from fiber. Keep in mind that fiber doesn’t digest. Subtract the fiber: 10 grams of carb minus 7 grams of fiber leaves you with just 3 grams of digestible carb. That means only 3 grams will turn into glucose and enter your bloodstream. Anyone calculating insulin-to-carb ratios would want to subtract the fiber in order to calculate the right dose of insulin. If a person took insulin to cover 10 grams but digested only 3 grams, then that person might end up with low blood glucose as a result of taking too much insulin. Eating two high-fiber tortillas amplifies the discrepancy.

tip A food label can say it’s a “good” source of fiber if it provides 10 percent of the Daily Value for fiber, or at least 2.5 grams per serving. An excellent source of fiber provides at least 5 grams of fiber per serving, or 20 percent of the Daily Value.

Sizing up the sugar content

remember The grams of sugar are already included in the Total Carbohydrate count. First and foremost, look at the labels for the Total Carbohydrate count. The number of grams of sugar noted on the Nutrition Facts label is a number that includes all forms of sugar in the product. That means the grams of naturally occurring sugars in milk and fruit are counted together with the grams of added sugars (for example, from honey, syrups, white sugar, or any other sugar). Don’t panic when you notice your milk carton shows 13 grams of sugar. That is from the naturally occurring sugar in milk, lactose. If fruit is packaged, you see the same thing: The carbs that are found in fruit are technically sugars.

There are no arbitrary rules on how many grams of sugar to choose or avoid. When you count carbs, look at the total grams of carb and consider the fiber as mentioned in the previous section. Consider the health properties of food rather than the grams of sugar on the label. In the case of breakfast cereals, it won’t hurt to compare labels and choose cereals with less sugar. Choose wholesome whole-grain cereals rather than sugary refined breakfast cereals.

KEEPING NATURAL SUGARS IN MIND

Madelyn, newly diagnosed with type 2 diabetes, came to see me for nutrition counseling. She brought a list of questions with her, and one was related to label reading. She explained that she “just couldn’t find a single carton of yogurt that didn’t have sugar.” She was frustrated that even plain yogurt had sugar, as did the yogurts sweetened with aspartame or sucralose.

When looking at the Nutrition Facts labels, Madelyn had been looking at the grams of sugar rather than the grams of Total Carbohydrate. I explained that yogurt and milk have a natural sugar called lactose and that lactose was, by definition, a form of sugar. I reassured her that the goal was to eat the right amount of carbohydrate and that it was fine to include milk, yogurt, and fruit even though they had natural sugars. We agreed that it made sense in her case to choose a yogurt with fewer than 20 grams of carbohydrate per serving. Some versions of yogurt have upward of 30–45 grams of carb per serving, or even more. The excess added sugars, in addition to the naturally occurring sugars, would make it harder for her to control blood-glucose levels.

Pinpointing the protein

Labels indicate the amount of protein per serving. Figure 7-4 shows that one serving of this product (1 cup) provides 6 grams of protein. Protein needs vary significantly based on age, gender, and other factors, so the food labels don’t provide information regarding the %Daily Value for protein. Most Americans have no problems meeting their protein needs; in fact, most people get a lot more than what the body requires. Chapter 8 provides tips on portioning and planning balanced meals.

Taking note of other valuable nutrients

Currently, food labels provide information on vitamin A, vitamin C, calcium, and iron. (This will change with the labels debuting in 2018, as I note in the earlier section “Taking a sneak peek at newfangled food labels .”) However, only the %Daily Value is provided. Labels do not specifically tell you how many micrograms or milligrams are provided.

Figure 7-4 shows that one serving provides 4 percent of the Daily Value for vitamin A, 8 percent for vitamin C, and 10 percent for iron, but it does not provide any calcium at all. As I note in the earlier section “Paying particular attention to amounts ,” 5%DV or less is considered low in the nutrient, and 20%DV or more is high in the nutrient.

Investigating the ingredients

Food labels must include an ingredients list. Ingredients are listed in descending order by weight. That means that the ingredient that weighs the most is listed first, and the ingredient that weighs the least is listed last. Everyone benefits from eating wholesome foods, so look for whole grains, as I describe later in this chapter. For heart health, steer clear of hydrogenated oils, as I discuss further in Chapter 16 .

Identifying allergens

The Food Allergen Labeling and Consumer Protection Act requires that packaged foods clearly identify the eight most common food allergens. While many foods can elicit an allergic response in a sensitive individual, just eight main foods account for 90 percent of all food allergies. If a packaged food contains milk, eggs, fish, crustacean shellfish (such as shrimp, crab, or lobster), tree nuts, peanuts, soybeans, or wheat, it must be clearly noted on the label.

Allergens may be noted in the actual ingredient list, but if the ingredient isn’t a commonly known source of the allergen, then the source must be listed in parentheses. The allergen may or may not be written in bold font, so look closely at each label. For example:

Ingredients: wheat flour, corn oil, eggs, honey, whey (milk ), vanilla, lecithin (soy ), salt.

It is obvious that the product contains wheat and eggs. It is less obvious that whey indicates a milk product or that lecithin is made from soy. To clarify, the common words “milk” and “soy” must be noted in parentheses to clarify the less-common ingredient names.

An alternate way to note the allergens is to do so below the ingredient list, by saying “contains” and then listing the allergens. For example:

·        Ingredients: wheat flour, corn oil, eggs, honey, whey, vanilla, lecithin, salt.

·        Contains: wheat, eggs, milk, soy

Heading to the Grocery Store

Make use of the information on the Nutrition Facts food labels when you go to the grocery store. Take some time to compare products. Go shopping in off-peak hours so you can feel relaxed about browsing the aisles. It’s easy to become a creature of habit and always grab the same items as you dash in and out of the store. New products are frequently introduced, and many great choices are available. Some not-so-great items are also available (if not abundant), so take yourself on a grocery store tour and be your own tour guide. For tips on choosing foods wisely, see Chapter 13 .

The following sections cover label claims to watch for, help you prepare a shopping cheat sheet, and encourage you to read labels faithfully.

Being skeptical about label claims

Manufacturers want to catch your attention as you browse the grocery aisles. This section clarifies some of the terminology you may see on packaging.

Net carbs

Manufacturers try to get your attention by using terms like net carbs, impact carbs, or active carbs. Manufacturers may subtract the grams of carb that come from fiber, sugar alcohol, and glycerin, claiming that those things don’t impact blood-glucose levels that much, if at all.

remember The problem is that most sugar alcohols do digest, at least in part, and do contribute some glucose to the bloodstream. If you’re using insulin-to-carb ratios, trying to figure out just how much insulin you should take gets tricky. Fiber doesn’t digest, so subtracting fiber grams from the Total Carbohydrate is fine (see the earlier section “Accounting for fiber ” for details). However, it’s estimated that roughly half of the sugar alcohol in a product will likely be digested. If a product contains sugar alcohol, it will be listed under the Total Carbohydrates below the grams of fiber and sugar. For example, if there are 10 grams of sugar alcohol per serving, about 5 grams of that will probably be digested, enter the bloodstream, and require insulin. Adjust your dose accordingly. Keep in mind that the remaining sugar alcohol that is not digested may cause gas and bloating. Complicating matters further, there are quite a few different forms of sugar alcohol, and some are more digestible than others.

Zero trans fat

A package is allowed to say the product contains zero trans fat if it has less than 0.5 grams of trans fat per serving. If you’re having multiple servings, or if you’re having several items throughout the day, they could add up to a significant amount of trans fat. In other words, a product just has to have slightly less than a half of a gram of trans fat per serving to say “0”; this doesn’t guarantee that there is none whatsoever.

Whole grain

The term “whole grain” means the product contains all three portions of the wheat — the germ, bran, and endosperm — and has at least 51 percent whole-grain ingredients by weight per serving. Look for products that claim to contain 100 percent whole grain. Items are listed in descending order by weight on ingredients lists. An item may contain more than one kind of grain, so choose items that have “whole grain” listed at, or near, the top of the ingredient list.

warning Keep an eye out for the following products and terms:

·     Cereals may have three or four different kinds of sugar added. If manufacturers keep the weight of each individual type of sugar lower than the weight of the whole grain, then they can still list whole grain first on the ingredient list — even if combining all the sugars together may actually outweigh the grain! Yikes! Check those cereal boxes carefully.

·     Beware, the following terms do not necessarily mean that you are getting whole grain: wheat flour, 100 percent wheat, bran, seven grain, multigrain, enriched, or stoneground. None of those terms indicate 100 percent whole grain. Saying that the product is made with whole grains doesn’t cut it either.

remember When reading label claims and ingredients lists, look for the word “whole” in front of the word indicating the grain. Examples include “whole wheat” and “whole grain.”

The Whole Grains Council is helping to clear up confusion in the supermarket. They’ve developed a stamp of approval for whole-grain products. See Figure 7-6 . If a product has the “100% whole grain” stamp, it means all the grain ingredients in the product are whole grain and that a serving provides a minimum of 16 grams of whole grain. The basic stamp indicates the product has at least 8 grams of whole grain but may also contain refined grains.

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Courtesy Oldways and the Whole Grains Council, wholegrainscouncil.org

FIGURE 7-6: The whole grain stamp.

tip Have you seen white whole-wheat bread and wondered whether it really was whole grain? Well, the answer is that white whole-wheat flour does contain all three components of the wheat — the bran, germ, and endosperm — so yes, it really counts as a whole grain. This light-colored whole wheat has a milder flavor, so fans of white bread should find it very palatable.

No sugar added

This term simply means that no sugars have been added in manufacturing or processing. The product may contain naturally occurring sugars, however. Yogurt is made from milk, and milk contains lactose, which is technically a form of sugar. You can’t find a yogurt that says “sugar-free,” but you can find one that says “no sugar added.” The same holds true if you look at no-sugar-added applesauce. It is still going to look like it is 100 percent sugar when you check the grams of sugar on the Nutrition Facts food label. Milk sugar and fruit sugar both show up on the label as grams of sugar. (Check out the earlier section “Sizing up the sugar content ” for more information.)

Sugar-free

A product can make the claim “sugar-free” if it has fewer than 0.5 grams of sugar per serving. Be aware that products that are sweetened with sugar alcohol are allowed to say sugar-free on the front of the package but may have a surprising amount of carbohydrate. When you look at the Nutrition Facts label on sugar-free products, the sugar grams are indeed zero. Total Carbohydrates are not necessarily zero, because sugar alcohol is a form of carbohydrate. Some candies have a regular version and a sugar-free version. Both usually end up having the same number of calories, fats, and carbs. The only difference is that the carbs are being counted as sugar alcohol instead of sugar. Always look at the total carbohydrates. (Find out more about sugars and various sweeteners in Chapter 12 .)

Preparing your carbohydrate cheat sheet

tip The Exchange Lists in Appendix A provide information on single foods but not mixed dishes. You can create a cheat sheet by doing a little investigative work at your local market. Take a note pad or index card (or keep notes on your phone) and head to the supermarket when you have some spare time. You can discover a thing or two about the carb counts in mixed dishes and ethnic foods. Think about some of the foods that you eat but are unsure about how to count. Do you count tamales, pizza, calzones, or ravioli? How about egg rolls, pot stickers, or Indian foods? Head to the frozen foods section in the store and look for foods similar to those that you eat in restaurants or make at home. Glance at the food label and make note of the portion size and the carb count. You can at least get an idea of how much carb is in quiche or lasagna if you look at a label on a similar item. Keep a running list of carb counts on mixed dishes and ethnic foods that you can refer to in the future when you next eat those foods.

Developing supermarket savvy

Next time you’re shopping, take a look at labels. Choose with health in mind. Try new foods. Look at the upper and lower shelves. Keep in mind that just because an item is at eye level on the supermarket shelf, it doesn’t mean it’s the best choice. Check out your options and read labels carefully; the more you practice, the easier it’ll be. Eating healthfully pays off.

remember While it is fairly easy to count carbs using food labels on packaged foods, don’t be afraid to buy fresh foods or produce just because they lack a label. Some of your best choices will be in the perimeter of the store. Produce, reduced-fat dairy products, lean meats, poultry, fish, and whole-grain breads are usually in the outer perimeter. See Chapter 8 for details on how to count carbs in foods that don’t have a food label, such as bulk foods and produce.