Food Label: Coping With Diabetes

by Food and Drug Administration (FDA)

Pat Coyle, of Rockville, Md., is a 67-year-old woman with diabetes, vitamin B12-deficiency anemia, and osteoporosis. So she has to pay attention to her diet. But ask her what she likes most about the new food label, and you won't hear much about serving sizes, names of nutrients, and %Daily Values. Instead, you'll get rave reviews about the print size and background color.

The nutrition information on the new label is in bigger type, and FDA requires the information to appear on a white or other neutral contrasting background, when practical.

Those are benefits for Coyle because she has diabetic retinopathy, an eye condition that can lead to blindness. She already has had two surgeries to correct poor eyesight. Before the surgeries, she had trouble reading food labels.

"I needed a magnifying glass to read [the nutrition information]," she recalls, referring to the small type and shaded backgrounds on the old labels. "I'm looking forward to not having to read the teeny tiny print."

For people with diabetes, easily readable labeling information is vital because diet is important in managing diabetes.

Other Label Benefits

New food labeling regulations that went into effect May 1994 now require labels on most packaged foods to provide nutrition information. That previously was voluntary and appeared on only about 60 percent of such foods.

Also, nutrition information for fresh fruits and vegetables and raw meat and fish may appear at the point of purchase. (See Nutrition Info Available for Raw Fruits, Vegetables, Fish in the FDA Consumer Special Report "Focus on Food Labeling.")

The nutrition information is now more complete. Labels continue to provide information about calories, fat, carbohydrate, sodium, protein, iron, calcium, and vitamins A and C. But now they also contain additional information about saturated fat and cholesterol. These two nutrients are important to people with diabetes because diabetes increases the risk of heart disease, and heart disease is also linked to high intakes of saturated fat and cholesterol.

Diet for Diabetes

How beneficial the new label will be for people with diabetes depends on the type of meal plan they follow. Today, diabetes experts no longer recommend a single diet for all people with diabetes. Instead, they advocate dietary regimes that are flexible and take into account a person's lifestyle and particular health needs.

The American Diabetes Association (ADA) described some common options in a 1994 position paper. A first step, for example, is to encourage people with diabetes to follow the government's Dietary Guidelines for Americans and Food Guide Pyramid.

According to Phyllis Barrier, a registered dietitian and director of council affairs for ADA, this step alone may be enough to maintain normal blood glucose, or sugar, levels. Maintaining these levels helps reduce the risks of retinopathy and other diabetes-related complications, such as kidney and heart disease.

Other people use the Exchange Lists for Meal Planning, she said. This system, established by the American Dietetic and American Diabetes associations, separates foods into six categories based on their nutritional makeup. People following this plan choose a set amount of servings from each category daily, depending on their nutritional needs.

A more sophisticated method of meal planning is "carbohydrate counting," in which grams of carbohydrate consumed are monitored and adjusted daily according to blood glucose levels. Some people count protein and fat grams, too. These two nutrients also can affect blood sugar levels, although to a lesser extent.

Whatever method used, ADA recommends these general dietary guidelines for people with diabetes:

• Limit fat to 30 percent or less of daily calories.
• Limit saturated fat to 10 percent or less of daily calories.
• Limit protein to 10 to 20 percent of daily calories. For those with initial signs of diabetes-induced kidney disease, restrict protein to 10 percent of daily calories.
• Limit cholesterol to 300 milligrams or less daily.
• Consume about 20 to 35 grams of fiber daily.

Most of these guidelines are a good idea for the general population, as well.

Those who are overweight also may moderately restrict calories. ADA recommends a calorie reduction of 250 to 500 calories less than normally eaten per day. That should result in a weight loss of about 0.2 to 0.5 kilograms (one-half to 1 pound) a week, ADA's Barrier said. The calorie restriction, along with increased exercise, should help an overweight person achieve a weight loss of 5 to 10 kilograms (11 to 22 pounds) in about six months to one year. The weight loss, although moderate, can help improve diabetes control.

Carbohydrate intake can vary, but, contrary to popular belief, the type of carbohydrate is not a factor. As ADA points out in its position paper, people with diabetes have for years been told to avoid "simple" sugars, such as table sugar and those found in sugary snacks, because they were thought to elevate blood glucose more quickly and more severely than other carbohydrates.

"There is, however, very little scientific evidence that supports this assumption," ADA wrote in its position paper. The organization recommended that the focus be on total carbohydrate--not source of carbohydrate. If sugar and sugar-containing foods are eaten, the amounts must be figured into the daily allotment of carbohydrate.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.