Is there a difference between a serving and a portion on a food label?

Yes, a serving is an amount of food determined to be appropriate by the U.S. Food and Drug Administration (FDA). On nutrition labels that appear on most packaged foods, the serving size is noted, along with how many calories per serving, total fat, cholesterol, sodium, total carbohydrates, protein, and any relevant vitamins and minerals. A portion is how much food you decide to eat at one time, whether at a restaurant or at home. In many cases, our food portions do not match the serving size because many people eat a larger portion than the serving size-which is one of the possible reasons for weight gain.

How should people interpret food label claims, especially people with diabetes?

There are differences in the terms on labels, and people with diabetes who want to maintain a healthy weight and have less sugar in their diet need to understand certain label terms. The Food and Drug Administration has strict guidelines on how these food label terms can be used. Here are some of the most common claims seen on food packages-and there are many-and what they mean, as per the FDA and the American Heart Association:

Low calorie-Must have 40 calories or fewer per serving.

Low in saturated fat-Must have one gram of saturated fat or less, with not more than 15 percent of the calories from saturated fat.

Low fat-Must contain less than three grams of fat per serving.

Reduced fat-Must contain at least 25 percent less of the specified nutrient or calories than the usual product; for example, a reduced-fat mayonnaise must contain at least 25 percent less fat than regular mayonnaise.

Less-A food must contain 25 percent less of a nutrient than a certain other food; for example, a pretzel label can claim that pretzels contain 25 percent less fat than potato chips.

Good source of-Must provide at least 10 to 19 percent of the Daily Value of a particular vitamin or nutrient per serving; for example, to be a good source of calcium, the food must contain 10 to 19 percent of the daily value for calcium.

Light (or lite)-A food must have a third fewer calories or half the fat of a certain other food, or the sodium in a low-fat, low-calorie food must be reduced by 50 percent; for example, light mayonnaise must contain at least 50 percent less fat than regular mayonnaise.

Calorie-free-Must contain less than five calories per serving.

Fat-free/sugar-free-Must have less than ½ gram of fat/sugar per serving.

High in-Provides 20 percent or more of the Daily Value of a specified nutrient per serving.

High fiber-Must contain five or more grams of fiber per serving.

Good source of fiber-Must contain 2.5 to 4.9 grams of fiber per serving.

Lean meat-Must contain less than ten grams of total fat, 4.5 grams of saturated fat or less, and less than 95 milligrams of cholesterol per serving.

Extra lean-Must have less than five grams of fat, two grams of saturated fat, and 95 milligrams of cholesterol.

High protein-Must contain 20 percent (or more) of the Daily Value for protein.

Natural flavoring-The FDA standard states that foods with this label must be extracts from nonsynthetic foods, such as essential oils, spices, and so on; its function in the food is flavoring, not nutrition.

Fresh-Although this term has been misused over the years, it originally meant unprocessed, uncooked, and unfrozen foods (with washing and coating [usually wax] of fruits and vegetables allowed). Fresh-frozen is also included, meaning food that is quickly frozen; the term is usually seen in association with fresh fish.

Good source-This means a serving must contain between 10 and 19 percent of the recommended Daily Value of a certain nutrient, such as vitamin A or D.

Fortified-A fortified food must have 10 percent or more of a Daily Value per serving, but it can be used only to represent vitamins, protein, minerals, dietary fiber, and potassium; for example, most milk in the United States is fortified; thus, one cup has to have about 30 percent of the Daily Value for vitamin D.

The FDA also sets standards for health-related claims on food labels to help consumers identify foods that are rich in nutrients and may help to reduce their risk for certain diseases. For example, the manufacturers can make health claims that highlight the link between calcium and osteoporosis, heart disease and fat, and high blood pressure and sodium.

What are some other labels to be aware of if a person has diabetes?

Even though it is estimated that close to 50 percent of consumers read food labels before buying, sometimes labels can be misleading. Here are some of the more common confusing labels:

Low fat-Many people on a diet look for the low-fat label. This may mean that, as per regulations, the product has three grams of fat or less. But often, when one ingredient is missing, food manufacturers add something to make up for it. In the case of “less” or “low fat,” it usually means more sugar, sodium, and calories that can cause weight gain that may lead to diabetes.

Low sugar versus reduced sugar-Many people want less sugar in their diet but should be aware of two phrases: “Reduced sugar” means that the product has 25 percent less sugar than the regular version, but “low sugar” has no standard definition.

Sugar-free-This means that the food has to have less than a half gram of sugar per serving, but the serving size may be very small. A serving size can range from a tablespoon to a cup! Sugar-free products may also cause gastrointestinal problems in people, especially those sensitive to other sugar substitutes, such as sorbitol. Overall, instead of looking at the “sugar-free” label on a package, a person with diabetes should pay more attention to the product’s total carbohydrate count.

It’s important to understand what labels such as “low fat,” “low sugar,” and “sugar free” really mean, and one needs to also consider portion size.

What are the main parts of a nutrition label on most foods?

There are standard food-nutrition labels that are based on government recommendations. The numbers, listings, and percentages are based on a 2,000-calorie diet for the “average” person, but there is a major debate about what is truly “average.” (It also means that changes are coming in the government’s recommendations; see sidebar). The following are some of the major items listed on food-nutrition labels:

Serving size-This is the number used to determine one serving of food. It is also often written in terms of grams.

Total carbohydrates-This is an important percentage for people who have diabetes (and for those who wish to limit their intake of carbohydrates). It represents the total percentage of carbohydrates in one serving, in terms of a percentage of the “average” diet.

Dietary fiber-This is also an important percentage listed under carbohydrates, usually in two forms-grams and percentage of the total in one serving.

Why and how will the government change food labels?

There has been a major problem with the government-recommended numbers and percentages on food labels that has created a great debate. In particular, the information on a label is based on an “average” person who eats 2,000 calories a day. But a great deal has changed since the Food and Drug Administration sent out guidelines for nutrition labels in 1993-especially with the American diet. The FDA label’s serving-size standards were based on the “reference amounts customarily consumed” (RACCs)-numbers based on consuming in the late 1970s and 1980s. But Americans eat more now-as evidenced by the increase in heart diseases and obesity-and instead of a third of an English muffin (the “serving size”), a person eats the entire muffin (which means more calories consumed). Now the FDA wants to emphasize this difference in serving size and give more realistic numbers; it also wants the food manufacturers to be more realistic and if most people eat the entire muffin to label the package as “one serving,” not many. These changes will not only help consumers make better decisions about how much they truly want to eat but also make more healthful choices. But when these changes will occur is another matter.

Sugars-The amount of sugar is also part of the total carbohydrate listing and can refer to both natural and added sugars. It will not list the types of sugar but only the amount (the types of sugar are often listed under the ingredients on a package).

Sugar alcohol-If applicable, the sugar alcohol may be listed or the sweeteners in the form of sugar alcohols, such as sorbitol, mannitol, and xylitol. These sugars are not listed individually on the nutrition label but may be listed in the ingredients.

Vitamins-Vitamin percentages may also be listed on nutrition labels, although they usually represent only the more “common” vitamins, such as C, A, or D. In addition, the more “common” minerals are often listed as percentages, including calcium and iron.

What are the names for sugar that a person with diabetes should understand when reading a food label?

Sugars are listed on food labels in various ways, but as most dietitians and nutritionists will tell you, sugar is sugar. The most obvious word on a label is “sugar,” but there are other words to pay attention to, including the following:

Brown sugar: refined sugar coated with molasses (the molasses is taken out, then added back in, or it can even have an artificial caramel coloring)

Corn syrup: manufactured from corn and containing various amounts of glucose, maltose, and dextrose

Dextrose: pure glucose or a sugar made of only one molecule

Fructose: sugar from fruit and maple sap

Glucose: known as dextrose, or grape sugar (it is also used in reference to a person’s blood glucose levels)

High-fructose corn syrup: concentrated corn syrup that is made mostly of fructose

Lactose: natural milk sugar

Maltodextrin: made from maltose and dextrose

Maltose: a sugar from starch, most often grains

Raw sugar: less refined white sugar with a minute amount of molasses

Sucrose: the refined, crystallized white sugar found in most sugar bowls

White grape juice: a purified version of fructose

What are some tips for people with diabetes when they go shopping for food?

Food shopping for a person with diabetes can be a challenge. Here are some tips from various organizations that specialize in helping those with diabetes:

Expand your food options, and learn about new tastes and foods. There are excellent cookbooks, cooking websites, and apps for people with diabetes who want to learn to cook or experiment with various types of foods (several of which are mentioned in this book’s “Resources, Websites, and Apps” section).

Instead of eating the same thing every day, start experimenting with new foods from the grocery. Most foods have to be labeled, making it easier to keep track of fats, sugars, and other nutrition information.

Take a list to the grocery store, and follow it. Most stores know humans can be impulsive buyers, especially when it comes to food, and stores are set up to entice people to buy things they don’t truly need to eat. Try to stick to the list.

Don’t consider any food “good” or “bad.” Even though a person has diabetes, most foods (unless the person is allergic or has an intolerance to certain foods, too) can fit into the person’s healthful-eating plan, as long as the individual adjusts for any given food (for example, balancing insulin or substituting one food for another to keep blood glucose levels balanced).


Why should processed foods be a concern, especially to a person with diabetes?

Although many processed foods are fortified with vitamins, minerals, and other nutrients, a diet that consists of all processed foods is a concern to many nutritionists. In particular, the “replacement nutrients” are in the food artificially. And, in many cases, these nutrients are not as easily absorbed into our systems as the natural nutrients found in fresh meats, fruits, and vegetables. The consumption of processed foods can be balanced. According to the Academy of Nutrition and Dietetics (AND), “processed” foods can mean anything from what a person processes in her own food processor to a packaged frozen pizza. And although some processed foods are not too bad (such as canned beans, vegetables, etc.), the AND cautions against consuming too many of the more heavily processed foods. In particular, they warn consumers who do buy processed foods to be aware of what is listed on the food labels and especially how much-such as sugars, especially for people who have type 1 and type 2 diabetes. Sugars are hidden everywhere, including as added sweeteners to ice cream, pasta sauce, etc., and also for more “hidden” things such as sugars in breads. Other things to scan labels for include fats (for flavor and to make the food last longer on the shelf) and sodium (for almost all foods for enhanced flavor and as a preservative). Too much of any of these ingredients can add on the weight that can eventually lead to certain chronic diseases, such as diabetes.

A couple issues with processed foods include: 1) chemical additives, such as preservatives, might not be healthy, and 2) the artificially added vitamins and minerals are not as easily absorbed into the body as natural vitamins and minerals.

What recent studies connected diabetes to processed foods?

There have been many recent studies of people who eat processed foods and who have diabetes. In one study from Harvard Medical School, the researchers discovered that eating processed meat (but not unprocessed red meat) caused an increase in the risk for diabetes by 19 percent and heart disease by 42 percent. In another study conducted in Finland over a 12-year period, people who ate processed meats raised their type 2 diabetes risk by 37 percent, whereas eating red meat and poultry did not.

Why should people with diabetes be aware of their intake of simulated foods?

Like processed foods, simulated (also referred to as fake) foods can be high in sugar, fats, sodium, gums, artificial flavors, dyes, and so on. For example, imitation crab meat may be cheaper than real crab, and to most people, it tastes as good. The fake crab meat is made with a type of fish called surimi. But it also has fillers, flavoring (sometimes including sugars and salt), and colored dyes, all of which make the fake crab mimic the taste, texture, and color of real crab. Although most fake crab meat is low in fat and calories, it can be extremely high in sodium, with some containing 800 milligrams of sodium or more in a three-ounce (very small) serving.

Other examples include fake cheeses, most of which contain fillers, oils, and emulsifiers (called “processed cheese” by most producers); frozen dairy desserts that only have to contain at least 10 percent milk fat but are also high in corn syrup, gums (like guar gum) and whey; and even fake, dehydrated potato flakes that also come with preservatives, emulsifiers, artificial flavorings, and trans fat. For a person with diabetes, adding such sugars and fats to the daily diet may add on weight and also cause blood glucose levels to fluctuate. Therefore, most health care professionals recommend that simulated foods be a small part of the person’s daily diet.

What are the most common food additives?

The most common modern food additives are sugar, corn syrup, other sweeteners, and salt. They are all used to enhance flavor and/or prevent the food from spoiling. Still other food additives are used as preservatives, colorings, antioxidants (to prevent foods from going rancid), flavor enhancers, emulsifiers, thickeners, and stabilizers.

Which additives should a person with diabetes be aware of consuming?

According to several recent studies, people with diabetes should be aware of consuming certain additives. In particular, one study on a simulated human gut showed that emulsifiers found in most processed foods seem to be connected to obesity, inflammatory bowel disorders, and diabetes (mostly type 2). Another study warns of ingesting aspartame and monosodium glutamate (MSG). In the case of aspartame, not only does it often cause headaches in many people, but it can also cause an increase in fasting blood glucose levels. When aspartame and MSG are combined, they cause even more of an increase in glucose levels.

What are some of the more interesting additives used in foods?

O ne of the more interesting “scary-sounding” additives is carnauba wax, which is usually associated with polishing a car, not with food. This ingredient is listed first in the ubiquitous marshmallow treats most associated with the Easter holiday (used for the eyes of the candy animal). Another interesting ingredient is shellac. It is a secretion from the female lac bug in India, and in terms of food, it is called “confectioner’s glaze.” This additive is used to give the glossy covering to such foods as jelly beans and other candies and is mainly used to stop the food from drying out. According to research done on both additives, there seem to be no adverse effects. Thus, they are approved for use in foods by the Food and Drug Administration.


What should a person with diabetes look for on a restaurant menu?

Eating out at any restaurant can be a challenge for people with diabetes. Depending on their eating habits to maintain their blood glucose levels, they may have to curb fatty and sugary foods. Doing so becomes difficult as many restaurants, diners, and dinner clubs offer large portions packed with calories, saturated fats, and sugar. And because people with diabetes have to pay more attention to their intake of carbohydrates, they must be more diligent when looking for something to eat on the restaurant menu. Below are some hints for ordering:

Don’t be afraid to ask how an entrée (or anything on the menu) is prepared. Try to avoid dishes served with heavy sauces or gravy, fried foods, and certain dairy products, such as heavy cream and thick cheeses. If everything on the menu includes such items, then eat only a reasonable proportion of the food and, if possible, take the rest home.

Most restaurants are aware that many people have certain dietary restrictions and are thus used to dealing with special diets. Ask whether the foods can be prepared in a certain way, such as steaming vegetables, or ask for skinless chicken, fish, or lean meat that is broiled, poached, baked, or grilled.

If a meat or vegetable is accompanied by a fattening sauce or butter, then ask whether that can be served on the side-and use it sparingly, if desired. Similarly, many restaurants will provide salad dressings on the side, allowing the customer to add as much of the dressing as desired.

No rule states that a person has to clean his or her plate. If only a portion of the food is eaten, then ask for a container to take the remainder home.

Get the server’s advice as to low-fat or low-sugar meals. Usually servers will be more than happy to help with dietary requests.

If the person with diabetes is on insulin and knows that a certain restaurant is usually slower than others when it comes to serving, then time the injection appropriately. If the service is slow, then some diabetics can slowly eat a roll or piece of fruit until the full meal is served. Some people always bring certain food items along with them-for example, crackers-just in case a meal is delayed.

Not everyone with diabetes can or will have dessert. But if a person wants to have a dessert, then share one. That way, the person won’t be tempted to eat the entire dessert, which may cause blood sugar to become unbalanced.

The temptations of eating out, whether at a restaurant or at a holiday or other party, can test anyone’s self-control. Don’t hesitate to talk to a dinner host about your special dietary needs.

What are some ways to measure and count carbohydrates while eating out?

In most social situations, a person with diabetes cannot get out a scale and determine size and approximations of carbohydrates when eating out. But there are simple ways to estimate sizes of servings and count carbohydrates. The following list is one way of estimating the measure of a handful (large, medium, and small), and the index finger and thumb positions (not touching, just touching, and overlapping) to determine amounts:

Large (not touching)-This is approximately equal to two (30 grams) of non-sugar carbohydrate servings (for example, breads, potato, rice, barley, pasta, grits, oatmeal, non-sugary cereals, corn, peas, winter squash, pretzels, crackers, fruit, and popcorn); four servings (60 grams) of sugar-carbohydrate desserts (cake, pie, cookies, doughnuts, pastries, muffins, frozen yogurt, ice cream, pudding, sherbet, and custard); and eight servings (120 grams) of candy carbohydrates (chocolate, caramels, hard candy, marshmallows, honey, syrup, jams, and jellies).

Medium (just touching)-This is approximately equal to one (15 grams) of non-sugar carbohydrate servings; two servings (30 grams) of sugar-carbohydrate desserts, and four servings (60 grams) of candy carbohydrates.

Small (overlapping)-This is approximately equal to 1/2 (eight grams) of non-sugar carbohydrate servings; one serving (15 grams) of sugar-carbohydrate desserts, and two servings (30 grams) of candy carbohydrates.

Why are holiday parties and special celebrations often a challenge for a person with diabetes?

Holiday parties and special celebrations are especially difficult if the host/hostess does not have diabetes, has never known anyone with the disease, and no other guests have diabetes. There are still many misconceptions about the disease, and as with many other conditions, many people don’t understand it if they have never experienced some of the frustrations. This does not mean a person with diabetes should stop going to parties and celebrations. It means that the person may have to be more diligent about what he or she chooses to eat or drink. Attentive eating includes asking the host/hostess about the foods offered, being careful about food choices offered, and even bringing one’s own food to the party. (See below for other suggestions.)

How can people with diabetes measure smaller quantities when eating out?

There are other ways to estimate portions if people with diabetes are eating out or even if they need to know about a portion size while eating at home. The following is modified from Harvard Medical School and the Academy of Nutrition and Dietetics:

The tip of the thumb = one teaspoon of peanut butter, sugar, or butter

A golf ball = two tablespoons of peanut butter

One finger length or a tube of lipstick = one ounce of cheese

One fist = a cup of cereal, pasta, or vegetables

One handful = one ounce of nuts or raisins

One palm (woman’s) or deck of playing cards = three ounces of cooked meat (any type), poultry, or fish

Two handfuls = two ounces of pretzels

How can a person with diabetes cope with eating at holiday parties?

There are some ways for people with diabetes to help themselves cope at a holiday-or any other-party. The following are some suggestions (note: not all suggestions can be fulfilled before or during a party, but most understanding hosts/hostesses will try to make the person with diabetes more comfortable):

If the party or celebration will include a dinner at a certain time, a person with diabetes can call and ask when the meal will be served. This way, if the person is taking insulin, then he or she can plan on when to administer an injection before eating.

Eat a regular meal before attending the party or grab a snack. This can include foods that are high in fiber and low in sugar and fat, such as crackers, soup, a vegetable salad, or yogurt. This way, the person with diabetes will not be hungry and/or tempted to eat snacks and sweets that may make the blood glucose levels fluctuate. It is also not a good idea to skip a meal the day of a party in order to “save up” for overeating at the party. This, too, will more often than not cause a dramatic fluctuation in blood glucose levels.

Eat slowly in order to keep from consuming more than needed-or enough to make blood glucose levels become imbalanced.

After eating a plate of food at a party, wait around 20 minutes before going back for more (or don’t go back at all). This is because it takes at least 20 minutes for the brain to know that a person has eaten enough to make him or her feel full. If after 20 minutes a person is still hungry, then he or she could go back for one more serving of one type of food instead of filling the plate again.

It may be a good idea to stand away from the food tables, especially the appetizers and desserts. That way, the temptation to graze or eat before a meal (or after) will not be as great. Depending on the party, a person with diabetes can keep far from the food table by engaging in conversations, sharing stories, watching movies, or participating in activities, such as badminton or lawn darts.

Drink plenty of water before the party. It makes a person feel full and consequently eat less. (Drinking alcohol and sugary beverages will only add calories and can cause problems with blood sugar levels.)

Don’t be afraid to ask the host/hostess about the types of foods and drinks that will be served-and be sure to ask before the party. (Preferably ask days before, not the day before or day of the party!) After all, it is better to ask than to have a bad hypoglycemic or hyperglycemic episode.

If, after asking the host/hostess what will be served, the person with diabetes finds nothing to eat, then he or she may want to suggest bringing some of his or her own food and drink to the party, especially low-fat and/or low-sugar dishes. Not only will it help to control portions, but the person will not be tempted to eat foods that may be unhealthful to consume.

After eating, keep moving, if possible. Not only will it keep one’s mind off food, but light physical activity, such as a stroll or playing games such as badminton, also speeds up metabolism, burns calories, helps with blood glucose, and is good for digestion.

Know that not everyone understands what life with diabetes entails. Don’t be tempted to eat something at a party that may send blood glucose levels too high (or low). If someone asks the person with diabetes to eat something that will cause a blood glucose problem, then the person should gently refuse and explain about blood sugar. It may be a chance for the person without diabetes to better understand the challenges faced by a person with diabetes!

How can a party host help a person with diabetes, especially in terms of food and drinks?

If a host/hostess knows that someone with diabetes is attending the party, then he or she can help in several ways-and most of the foods and drinks won’t be that much different from what is usually offered at parties. The following lists a few of the ways to help if a person with diabetes attends a celebration or special party:

Ask whether the person with diabetes can bring some of his or her own foods, especially any low-fat foods and/or low-sugar desserts. Most parties include high-fat, high-sugar desserts that can wreak havoc with a diabetic’s blood glucose levels. Also be sure to let other guests know which dishes do not have sugar if it is not obvious.

Ask what foods would be best to offer the person who has diabetes. Most people with diabetes would be grateful to know that they won’t have to guess at what to eat when they get to a party. It may also help if the host/hostess explains how some of the foods are prepared-for example, if they are steamed or fried-especially if the foods are high in fat or sugar.

Be careful when showing people with diabetes the foods they can or cannot eat at the party. Some people do not believe it is anyone’s business that they have diabetes, mainly because they do not want to be treated “differently.” Others will be fine with its being known that they have diabetes and may even want to educate others as to the challenges of having diabetes.

Have water, tea, and coffee-non-sugar drinks-available. Some people with diabetes also drink sugar-free beverages, so have some of those on hand, too (or ask the person what types of drinks he or she prefers).

Offer low-fat and low-sugar foods such as fruits (grapes, apple wedges, or strawberries), vegetables (carrots, cauliflower, cherry tomatoes, celery, cucumbers, or summer squash sticks), some breads and starches (low-fat offerings are best, and if purchased, those with lower carbohydrates listed on the label), and dips (such as tomato salsas or black bean dips).

The host/hostess may also want to ask the person with diabetes for meat preferences (low fat, such as turkey, lean roast beef, or chicken) if it will be offered.

If the host/hostess’s house is large enough, then have a nearby room or room extension away from food tables where people can gather.

If a guest has diabetes and needs to take insulin before a meal, plan on telling the person when food will be served. This is important in order to keep the diabetic’s blood glucose levels balanced. (In addition, the host/hostess may want to know whether the person with diabetes, especially someone taking insulin injections, has a glucagon kit in case of a hypoglycemic episode at the party.)