August 2011 Issue

Guiding Good Choices — Shopping Strategies That Improve Diabetes Meal Planning
By Juliann Schaeffer
Today’s Dietitian
Vol. 13 No. 8 P. 26

People with type 2 diabetes can often feel overwhelmed at the time of their initial diagnosis, with one of the many thoughts to pop into their heads sure to surround food: “Will I be able to eat what everyone else in my family eats?”; “How do I know what to eat?”; “Will I ever get to eat my favorite foods again?”

Kim Kirchherr, MS, RD, LDN, CDE, a dietitian for the SuperValu family of stores, which includes Jewel-Osco, Albertsons, Shaw’s, Cub Foods, and Save-A-Lot, says these feelings are completely understandable given what patients are asked to do after such a diagnosis. “A person with diabetes faces the challenge of having to ‘relearn’ the foods they have grown up with and love in the sense that they have to know how food will affect them after every eating occasion,” she explains.

Fitting healthful foods into a daily diet can be difficult for anyone, but meal planning becomes even more challenging for people new diabetes-specific considerations into account.

“Many patients with diabetes don’t know where to begin when it comes to meal planning,” says Dawn Sherr, RD, CDE, LDN, a practice manager and spokesperson for the American Association of Diabetes Educators. “There is confusion about what to focus on when reading food labels. Is it sugar content, amount of fat, or carbohydrates? What does the food lingo mean? What is the difference between low fat [and] reduced fat?”

And they’re not afraid to tell you either, as any RD knows all too well the gripes most often heard from patients frustrated with diabetes dinner dilemmas. One such complaint: Meal planning is too hard. “Often people with diabetes believe they can’t eat their favorite foods and need to eat special diet foods,” says Sherr.

But in reality, Kirchherr says, “ Unless allergies are present, if portions are monitored, people can eat a good variety of all foods, including fruits and starchy vegetables, and indeed should be making these choices.”

Maggie Moon, MS, RD, corporate nutritionist for FreshDirect, says her grocery shopping advice for patients with diabetes isn’t very different from that given to any other American: “Start in the produce aisle and put something green in your basket. Keep filling up on veggies, then fruits. Visit the seafood counter, then make your way to the center of the store to find whole grains and beans. That should take care of most of the cart. Navigating the packaged snacks or prepared foods areas are not impossible, but [it] can be more challenging to find foods that promote good health.”

To assist patients feeling battered by an information overload and overwhelmed by the options that exist in today’s supermarkets, this shopping list of suggestions can help clients navigate toward the best foods to add to their cart, as well as those to pass by, in an effort to better manage their disease.

Produce Section
While emphasizing that, with a little planning, everything in the produce department can fit into a healthful diet for clients with diabetes, Moon says patients can conserve their carbohydrate exchanges with some careful picking.

Foods to pick up: Sprouts, greens, leafy greens, lettuces, herbs, cabbage, celery, radishes, mushrooms, blackberries, grapefruit

Why: Moon likes these produce picks because they have fewer carbs per serving than starchy or super-sweet fruits and vegetables.

Kirchherr also prefers that people with type 2 diabetes load up on choices from this department, especially “nonstarchy veggies in every color. While they count as ‘free’ foods in the exchange lists for meal planning, they are packed with nutrients, so you can have a good-sized meal without overworrying about carbohydrate count.”

Since many of these picks have nutrients that are impacted by medications, Kirchherr always recommends clients consult with an RD and/or a pharmacist to choose properly based on any additional medical conditions they may have. For example, “Produce is packed with potassium, which can be an issue if renal disease is present and/or if certain blood pressure medications are prescribed,” she says.

Foods to pick up: Romaine lettuce, fresh spinach

Why: Robin Nwankwo, MPH, RD, CDE, likes these because they’re high in vitamin A and fiber, are easy to use, and require little preparation time. They’re also “filling but won’t increase blood sugar,” she says.

Food to pick up: Peppers, all kinds

Why: “Fresh peppers are high in vitamin C and add color interest to meals and sandwiches, pizza, and wraps,” says Nwankwo.

In general, Sherr guides clients toward fruits and vegetables that are deep and rich in color. “Darker produce tends to have a higher vitamin and mineral content,” she says.

Foods to avoid: Potatoes, corn, peas, carrots, bananas, dates, mangoes, pineapples

Why: “Remember that all healthful foods can fit,” says Moon, “but it’s just as important to be aware that these produce [items] pack a heavier carbohydrate load, and therefore patients with type 2 diabetes will want to monitor their intake of them.”

Dairy Aisle
Foods to pick up: Skim or 1% milk, low-fat half-and-half

Why: “Milk is a great source of protein and minerals, including calcium, which helps build strong bones,” says Sherr. “By choosing a light or low-fat option, people with diabetes can limit the type [saturated, trans] and amount of fat they are consuming.”

Food to pick up: Fat-free or low-fat yogurt

Why: Kirchherr likes this item because of its versatility. “It’s easy to eat for a busy professional on the go and easy to prepare for seniors cooking at home,” she says. “Be aware of total carb count here, [as it] can vary tremendously. So label reading is key.”

Food to pick up: Reduced-fat or fat-free cheese

Why: Lighter cheeses are great paired with fruit or grains to add a protein component (and a bit of fat) for a more satisfying snack than just carbohydrate alone, says Kirchherr.

“Be careful with the type chosen and portions so you don’t negate the good part of this choice by overdoing it,” she adds. “And don’t forget: Milk and yogurt have carbohydrate, but cheese counts [toward] protein.”

Foods to avoid: Whole milk, regular cheese, regular sour cream, regular cottage cheese, butter

Why: It stands to reason then that people with diabetes should steer clear of the full-fat varieties of dairy foods, which often hide higher levels of sodium as well. “These foods tend to be high in fat, particularly saturated fat,” says Sherr. “Too much saturated fat in the diet increases blood cholesterol, a risk factor for heart disease.

“Excess sodium consumption is strongly associated with the development and worsening of high blood pressure and an increased risk of heart attack, stroke, and kidney disease,” she continues. “New guidelines from the American Heart Association on sodium recommend daily sodium intake of less than 1,500 mg. By selecting low-sodium cheese or margarine [instead of butter], you can meet this goal.”

Food to avoid: Whipped yogurt

Why: Nwankwo also advises clients against this type of yogurt because of its low calcium and protein content per serving and the extra sugar typically added.

Meat and Seafood Section
Foods to pick up: Lean meat, skinless chicken

Why: “Protein helps sustain carbohydrates,” says Kirchherr, “and a mixed meal, meaning carbohydrate, protein, and a bit of heart-smart fat, is more satisfying overall plus aids with stable blood sugars when these types of meals are eaten.”

Food to pick up: Fatty fish such as wild Alaskan salmon

Why: Moon explains that eating seafood twice per week is recommended for heart health and overall health, “but eating a variety of fish and shellfish is recommended.”

Food to avoid: Lobster

Why: While apologizing to lobster lovers, Moon recommends against any fish that those with diabetes might be tempted to eat with butter.

Frozen Foods Aisle
Food to pick up: Vegetables

Why: Their easy preparation makes them the frozen section’s best pick for Nwankwo, who adds that frozen vegetables’ nutrients are often better preserved than their canned or processed varieties.

Foods to avoid: Desserts, pizza, or frozen entrées with more than 10 g of fat per serving

Why: Choices such as these are plentiful in the frozen foods section, but clients are better off avoiding these high-fat items that can hinder weight management, says Nwankwo.

Baking Needs Aisle
Foods to pick up: Stevia, Splenda

Why: “Both are nonnutritive sweeteners that won’t raise blood sugar the way sugar will,” says Moon, adding that clients should know to look out for any of sugar’s code names, such as evaporated cane juice, honey, agave, corn syrup, or high-fructose corn syrup. “Clients who prefer a more natural lifestyle may prefer Stevia,” she says.

Food to pick up: Agave nectar

Why: Agave nectar has a lower glycemic load per portion, says Nwankwo, and its sweet flavor can be substituted for sugar in a variety of instances.

Food to pick up: Whole wheat or whole grain flours

Why: Their increased fiber content compared with white or bleached flour makes these a great baking substitute for patients who want to continue baking cookies and cakes following their diabetes diagnosis, according to Nwankwo.

Foods to pick up: Olive and canola oils, nuts
Why: When it comes to types of fats, Kirchherr says, “Liquid oils are typically heart smarter than solid fats, with the exception of items like nuts and avocado—solid at room temperature—which are packed with smart fats. Since heart disease is a bigger risk for people with diabetes, type of fat is important. [These] are great choices.”

Item to pick up: Single-serving (1/2 to 1 cup) storage containers

Why: If clients pick these up, “Leftovers can be stored in single servings and ready for subsequent meals, like lunch or tomorrow’s dinner,” says Nwankwo.

Kirchherr also recommends that in addition to storage containers, patients with diabetes pick up measuring cups and spoons, nonfat cooking spray, and any other items that might make them more likely to cook meals at home. “Having the proper tools and equipment is essential for culinary success. Making it easier to make good choices and better dishes sets you up for success,” she says.

Canned Goods Aisle
Foods to pick up: Lower-sodium canned veggies, fruits packed in natural juices or water, canned beans

Why: These count toward fruit and veggie servings for the day and limit added sodium and sugar, says Kirchherr. “For people who rely on family or public transportation for stocking up at the store, frozen and canned goods really extend the ability to make nutritious meals between trips to the store,” she explains.

Food to pick up: Low-sodium canned or boxed broth

Why: “The broth makes it easy to cook smarter, as you can sauté in broth and make your own soup,” Kirchherr adds.

Food to avoid: Jarred fruit

Why: In addition to being expensive, says Nwankwo, as a carbohydrate source, this pick is also easily consumed in large quantities. Plus, “Vitamins are depleted with time and exposure,” she says.

Cereals, Chips, and Other Packaged Goods Aisle
Foods to pick up: Baked snacks, 100% whole grain crackers, air-popped or calorie-controlled popcorn

Why: In addition to these items being good sources of fiber, they provide healthful snack options to avoid excess weight gain, according to Sherr.

Foods to pick up: Whole grain cereals with minimal added sugars, brown rice, black or red quinoa

Why: Unlike what some may believe, controlling carbohydrate intake doesn’t mean eliminating them completely, says Moon. “Any healthful diet will include complex carbohydrates from whole foods that also contain vitamins, minerals, and fiber. Complex carbs will be absorbed more slowly,” she explains.

Beverages Aisle
Drinks to pick up: Water (unflavored, flavored, sparkling), unsweetened tea, diet soda

Why: “Water is one of the best fluids to drink because it contains no calories, no artificial flavors or colors, and no sugar,” says Sherr of her No. 1 beverage choice. Close behind comes artificially sweetened teas, lemonades, and sodas that are also calorie free “and are preferred over sugary drinks like soda, fruit punches, and regular lemonades.”

Drinks to pick up: Unsweetened seltzer water, 100% juice in smaller portions

Why: “The seltzer can be combined with a portion-controlled amount of 100% juice, which counts as a fruit serving, to create a more nutritious beverage vs. regular soda or punch/cocktail,” says Kirchherr.

Drinks to avoid: High-fat, high-calorie drinks; energy drinks

Why: “Not just for diabetes but in general, people tend to forget that calories we drink count too,” Kirchherr adds. “So it’s important to keep track of entire intake and not use up calories for the day on choices that don’t also provide nutrients we need for everyday health.”

Condiments Aisle
Foods to pick up: Mustard, apple cider vinegar

Why: Moon says these are smart picks for adding a ton of flavor with only a bit of sugar. Nwankwo adds that vinegar may also inhibit the digestion of starch in the gut.

Foods to avoid: Ketchup, hoisin, teriyaki sauce

Why: Moon says with added sugars and sodium, there’s not a lot of nutrition in these types of condiments, so people with diabetes will do best to bypass them.

Food to pick up: Favorite foods in smart portions

Why: “This is a lifelong eating plan, so it is essential that we work to fit in foods that we love,” says Kirchherr of one important factor to note when counseling clients. “It’s not realistic to think people won’t enjoy a classic favorite that might not be all about health goals. We eat for social, emotional, and all kinds of reasons, so learning how to do it in the context of an overall healthful meal/day is going to lead to long-term success and better overall blood sugar management/health/quality of life.”

More Tips
Recommending specific foods is helpful, but offering clients some more general suggestions will help guide them toward a better (and more healthful) grocery shopping experience.

Sherr likes to recommend that those with diabetes make a list ahead of time “so you’re less likely to forget to buy items that you need or end up buying foods on impulse.”
She also finds that starting portion control at the store can lead to smarter shopping. “If your healthy eating plan calls for 4-oz apples, buy only 4-oz apples. That way, when you’re ready to eat one, you can grab it and go with no extra weighing and measuring,” she says.

“Be open to trying new foods,” Nwankwo advises her clients with diabetes. “It takes several trials to begin to enjoy some of the foods with higher fiber, like whole wheat pasta or brown rice,” she says, noting that new spice combinations are best attempted in small portions to see whether the flavor gained is worth trying again. “Lean meats are better with marinades and spice rubs to flavor the meats.”

Nwankwo also tells those with diabetes to take advantage of store sales when they’re ready to try new foods. “Very fresh produce can last for a week,” she explains. “By trying new vegetables and fruits, you can expand to more appealing menus. Think of combinations like berry and yogurt smoothies, shredded vegetables, avocado and deli turkey wraps, or a spinach layered pasta dish.”

And always remember to illustrate how clients can fit into their diet both “everyday” healthy foods and “sometimes” favorite foods from their past, as clients can shut down if they think that they’re on a path to a flavorless future.

“Asking them to think if food selections are most often supporting their health goals is important, but we also must teach them how they can fit in an appropriate-sized slice of birthday cake on their birthday,” says Kirchherr. “Managing everyday eating occasions and strategizing for on the road or in social settings will arm patients with the confidence and tools they need to manage every time there is food offered.”

— Juliann Schaeffer is an associate editor at Great Valley Publishing Company and a regular contributor to Today’s Dietitian.