Practical resources and great information are key elements in managing diabetes on a 24/7 basis. I had the privilege to interview Hope Warshaw, MMSc, RD, CDE – registered dietitian and certified diabetes educator, who has provided a wealth of great information for those living with diabetes for nearly thirty-five years. She operates a consulting practice, Hope Warshaw Associates, in Northern Virginia. Today her work spans from corporate consulting to consumer and professional writing and individual diabetes education and support.
As a writer Hope has authored numerous professional articles and books. She is the author of several books for people with diabetes published by American Diabetes Association, including Eat Out, Eat Well – The Guide to Eating Healthy at Any Restaurant and Diabetes Meal Planning Made Easy . She is the contributing editor for Diabetic Living magazine and website and regularly writes for several online diabetes publications. During 2015 Hope is serving as President-elect of American Association of Diabetes Educators.
I asked Hope about her new book Eat Out, Eat Well – The Guide to Eating Healthy at Any Restaurant in hope of getting some snippets of information to share with all of you – and of course encourage you to add a new resource to your cache of info to optimize your management.
JS: The beginning of the book defines “healthy eating for diabetes.” Is this book specific to diabetes, or can the general public also follow these guidelines? Is there such a thing as a “diabetes diet” today?
HW: To your first question. The advice about healthy eating with diabetes is based on principles from the most recent American Diabetes Association nutrition recommendations. The recommendations promoted by ADA and therefore the book, which is published by ADA, build on many of the key guidelines from the Dietary Guidelines for Americans. In many respects these U.S. dietary guidelines and the ADA recommendations promote similar nutrition guidelines and reflect the current nutrition research available to date for people with diabetes (both type 1 and type 2) and the general public.
To your second question. The concept of “a diabetic diet” was thrown out by ADA at least 20 years ago. Today the ADA recommendations promote individualization and personalization. Research shows a variety of eating plans can help people achieve their glycemic, lipid and blood pressure goals. Achieving these goals is what will keep people healthy overtime. Research shows people can choose to eat vegetarian and eat healthfully or on the other extreme people enjoy an eating plan that is lower in carbohydrate and with careful food choices eat healthfully. What is at the core of the most well-researched healthy eating patterns is consuming plenty of fruits and vegetables, enjoying whole grains, legumes and low fat dairy and going light on red meats and saturated fat.
Bottom line healthy eating for diabetes and overall life-long health is about making healthy food choices and eating these foods or combinations of them in reasonable portions to maintain or get to a healthy weight and keep glucose, lipids and blood pressure under control. Easier said than done! And that’s especially true when it comes to restaurant meals.
JS: If someone has to eat out often due to work, time, travel constraints, what are the biggest pitfalls to focus on?
HW: Let’s first discuss the notion of having to eat out. Today there are many reasons people choose to eat out which range from having to eat out due to, as you mention, work, travel, etc. Today people choose to eat out for other reasons as well. Restaurant meals, whether you eat them in restaurants or take them out, have become so common because it’s how we socialize, manage our busy lives and because we want to enjoy the wide array of foods that are oh so available and accessible. Statistics I’ve included in Eat Out Eat Well note that Americans, on average, eat one-third of our calories per day and about five meals per week in restaurants. That’s a far cry from yesteryear! In the book one of the strategies I suggest is doing a personal assessment of how many restaurant meals you eat per week. Then ask yourself do you really need or want to do this? Ask yourself whether this habit is out of necessity or convenience. If you find yourself eating too many meals out and your eating habits and food choices could use some improvement it may be time to make some changes.
Now to the pitfalls of restaurant eating. In Eat Out Eat Well I discuss and go into great detail on the 10 pitfalls of restaurant eating. Here let’s focus on the top four. First on my list is PORTION Restaurant portions have grown BIG, BIGGER and BIGGEST. It’s simply hard to get reasonable portions set in front of you. Surprising to hear, but it is honestly easier to order and eat smaller portions in many fast food restaurants. American style sit-down restaurants top the list of serving HUGE portions. The SECOND pitfall is the amount of FAT in, on, around and through restaurant foods. It’s tough to dodge the fat – high fat ingredients, various fats and oils used on foods in preparation as well as fats at the table in the form of butter, salad dressing, creamy spreads and dipping oils (depending on the cuisine). The third pitfall is the challenge of eating sufficient amounts of fruits and vegetables. Fruit is typically what I call “missing in action” in restaurants. You can do a bit better with vegetables, but it’s still a challenge as is finding whole grains, legumes and low fat dairy foods. These four really make eating healthy restaurant meals a challenge. One last pitfall is that restaurant meals tend to have skyrocketing sodium content.
Running through all of these pitfalls may seem like eating healthy restaurant meals is impossible. The good news, it’s not. In Eat Out Eat Well after I run through these 10 pitfalls I provide many general skills and strategies to combat them all. Throughout the 15 chapters on the specific cuisines (from Mexican to Thai) and types of restaurants (from burger chains to family style) I provide many specific skills and strategies. Plenty of tips, tricks and tactics are at the ready for you.
JS: Using this book may be helpful for choosing healthy options, but how often do you suggest people allow “treats” or indulgences in a given week of eating? Does the book provide good suggestions?
HW: If there’s one characteristic that describes me as a dietitian and diabetes educator it is to be “practical and realistic”. (Yes, I pride myself on this trait!) I believe food is to be enjoyed and can be successfully balanced with good diabetes management. Eating and enjoying restaurant food is very important for many of us so if we can enjoy as well as get the job of eating done at the same time it’s a win-win. If you feel this is true for you, then it is important that you figure out how to do this while also achieving your diabetes goals. Make sense?
Along with this premise is certainly allowing for treats or indulgences and this is discussed in detail in Eat Out Eat Well. There’s a whole chapter on diabetes dining dilemmas. It includes how to manage alcohol, sweets and desserts and delayed meals.
I believe that people need to individually develop guidelines for themselves about what treats or indulgences they can enjoy while also achieving their health and diabetes goals. This is for sure a balancing act and one that we need to establish and refine over time.
While I don’t have diabetes I certainly have my own personal indulgence guidelines. I can’t enjoy an alcoholic beverage (or two) or dessert every time I eat a restaurant meal. Therefore, when it comes to desserts my guideline is split a dessert once in a while and make sure it’s going to be absolutely fantastically delicious.
JS: If someone has no access to information before entering a restaurant, what is the best way to choose a healthy, balanced meal optimal for diabetes management? Plate Method, etc?
HW: I’ll take issue with your comment about people not having access to nutrition info before entering a restaurant. The reality today is that we’re surrounded by more nutrition information than ever before and much of it is at our fingertips at the ready. In regards to restaurant nutrition information, most regional and large walk up and order (my term for the get it fast ilk of restaurants) provide their nutrition information online. Today more sit-down chains are also becoming open books about their nutrition information. Come late 2015 restaurant chains with more than 20 locations which serve the same menu will have to share their information due to a regulation being put into effect by FDA in accordance with the Affordable Care Act. And with our smart phones in hand the websites of restaurants are just a few clicks away.
I’ll give a plug here to the companion app, Eat Out Well, to my book. This free app is downloadable from both iTunes and Google Play. The app contains nutrition data for most menu items for many of the top chain restaurants across the country. The app uses GPS to locate restaurants around you at the time. It also allows you to look an item up once and save it in your favorites. Link to the app on my website here. Please check it out.
One tip. Access to all this data including the data from the Nutrition Facts labels and more can be overwhelming. Yet most of us eat the same foods and meals over and over…even in restaurants albeit with some exceptions. For this reason I encourage you to make a list of the restaurant meals you eat pretty regularly. Then gather the nutritional data. Keep a record of it either in the favorites of my Eat Out Well app or in some place you can easily access in your travels. This tip can help with your carbohydrate counting accuracy as well as making the task of carbohydrate counting (or other approach to meal planning) easier.
JS: Often people choose a “salad” assuming it is a good “low carb”, low fat and high nutrient option. How can you avoid salad pitfalls?
HW: Salads are an easy way to find sources of vegetables at restaurants. Most American-style restaurants, from walk up and order to sit-down fare offer both side and entrée salads. Though salads are certainly healthy they can quickly become fat and calorie loaded from non-vegetable ingredients and toppers and dressing. Let’s address each one. When reviewing salad toppers keep your focus on added vegetables like peppers, mushrooms, onions, spinach and more. Other healthy items are avocado and nuts. Steer clear of or ask for small amounts of fried items like breaded chicken, shrimp, crispy noodles or onions. Watch the cheese. Skip it, or ask for it on the side so you control the amount you use.
Watch salad dressing which can be the undoing of a healthy salad. Here are a few tips: Always order dressing on the side so you can control the amount you use and don’t end up with a drowned salad. If you enjoy a creamier dressing and have the fat grams and calories to spare then enjoy it. One way to spread this further and use less is to get a few lemon wedges on the side or ask for some vinegar. Most sit-down restaurants will always have at least one or more types of vinegar.
JS: Most people drink a beverage with food, especially when eating out. What are optimal choices for both calorie containing and non-caloric drinks?
HW: Calories and grams of carbohydrate from beverages, whether alcoholic or non-alcoholic can add up quickly so you’ve got to be strategic with your beverage choices. Again, consider your restaurant eating guidelines and where and when you can and want to splurge. That’s especially relevant with alcohol. If you do choose to drink some alcohol figure out at what point of a meal you enjoy it most. Always make sure you have a non-alcoholic and non-caloric beverage along with the alcohol. Of course, water is a healthy choice (and most often free of charge). Other non-caloric beverages are sparkling water, club soda, ice tea or coffee (with nothing added or a non-nutritive sweetener). Diet soda is another regularly available choice.
No doubt our restaurants, especially those walk up and order types, and supermarkets are loaded with high calorie, low nutrient sugary beverages. Other categories of calorie-containing beverages we see are coffee and tea drinks along with fruit and vegetable smoothies. My advice is to be wise to the calories and grams of carbohydrate these contain before you start to sip and slurp.
If you found these small tips helpful, imagine what you’ll find inside the rest of Hope’s book!! It’s a wonderful wealth of info for all people who want to successfully manage their diabetes while enjoying a quick meal on the run or a luxurious evening dinner out.