Monday, April 15, 2013

Portion Distortion

Back when I used to teach classes for diabetes and weight loss, one of the questions I would get went something like, "So, should I concentrate on what I'm eating or how much I'm eating?"  The answer would be "Yes!" if I could tell that they liked my snarky sense of humor, and "I'm sorry, but you need to watch both" if they were a more staid group of people.   I would always encourage them to measure out what they were eating at least once and read the label so they would really have an idea of how much they were eating.  If they didn't read the labels and take a serious look at how much they were actually eating they were essentially letting someone else do the thinking for them, and as a result they would probably wind up eating things that would probably not be to their benefit for losing weight and/or controlling their blood glucose levels.  (And then they would be whining in my office about how they were "eating everything you told me and I still can't control my blood sugar.").

Let's face it, there are very few of us who say "Yay!  I love to read labels and measure out my food at least once!"  Quite often that's what will sell people on a particular diet plan or diet product is that you don't have to count calories or carbohydrates, and of course I've seen some authors of diet books or "nutrition bloggers" actually go so far as to mock people who still count calories or think about their carbohydrate intake.  I will agree that being worried about eating one more gram of carbohydrate is not my idea of good quality of life.  I will also happily concede that for people who do follow a simple plan of eating a high satiety plan of adequate protein, good fats, and vegetables that they probably can do more of an amorphous "just eat until you are full and listen to your body" plan and still meet their health goals.   But does the latter approach really fit and evidence-based way of eating?

Not initially, no.  If you are a newly diagnosed diabetic/pre-diabetic, or you are attempting to follow a carbohydrate controlled plan to lose weight, you may not even know how much carbohydrate is in certain foods, let alone where they are "hiding" in foods you thought might be "safe" (like in the beef jerky I almost bought yesterday!).  So you will have to carefully read the labels for everything, at least once, to figure out what is safe for you and what is not.  And then when it comes to the carbohydrate foods that do have nutrition that you would like to include, like fruit and sweet potatoes, etc, those still contain calories and carbohydrates so eating too much can still interfere with your goals.  So you will need to measure out the berries or whatever you are eating at least one time (and test your blood sugar before and after if applicable), to see if the amount you are eating is safe for you.  

And once you've gotten a handle on what's working, are you suddenly exempt from monitoring your portion sizes?  Probably not, particularly if you a) like to try new foods and new combination of foods, b) have not perfected the "I'm going to stop eating even though this is tasty" routine, and/or c) like to eat in restaurants sometime.  As an example of "a," one time I had signed up to receive a monthly sample of snacks that were suppossed to be safe for people like me who are dairy/gluten/soy free.  One of the snacks included was a brownie made with nut flour, and when I read the label I noticed that that roughly 2 inch brownie contained about 250 calories.  I could have eaten a handful of nuts and consumed roughly half that amount of calories.  I paid for it, ate it, and enjoyed it, but I certainly wouldn't have made a habit out of it.  And that relates to "b."  Boyfriend of SkepticRD is very good at stopping when full, I am not, so I have to be careful with portioning out my plate ahead of time to make sure I don't eat too much.  This in turn, is related to "c," in which I have to ask for certain things to be left off my plate or ask for a takeout box right away so I can portion appropriately (and then I also have to remember to take my box with me!).

All this talk about portions, and how so many of us don't pay attention, was actually inspired by this article that popped up in my news feed today.    Because after I would get done reminding people about the necessity of reading and measuring (at least once!  And when you try a new food!  Or if you are having trouble losing weight!) we would talk about some of the ways people could judge their portion sizes in a restaurant, etc, and a lot of times we would use the odd hand signals that were demonstrated in a video.  But what they don't explain, and this is what I would try to explain in the classes, is that these portions are not just arbitrary, they were established to help people have some sort of standard for measurement.  I'm sure some of you who have had diabetes for a long time or who have done Weight Watchers remember the Exchange Lists and how you could have "x" number of servings from each food group, and each portion said 1/2 cup of this, and 1/3 of a cup of that?  The reason for these portion sizes is that someone had the job of taking all the different foods and making each one into a portion size that had roughly the SAME amount of calories and the SAME amount of carbohydrate.  That's it.  It's just a unit of measurement--meaning that we needed some sort of standardization so we could quickly tell how much carbohydrate we are getting.  Same thing with some of the goofy hand signals, it's just a unit of measurement.

Now, I know that some of you who dealt the exchange system are clutching your pearls and fainting, because you were probably given a plan that contained way more carbohydrate than what was safe for you, and of course the plan you were given said nothing about the quality of food you were eating.  I wish people didn't have to go through that, but I hope you can see that the real intention of all of this is to just to try to give people a way to keep track of what they were eating.  It was never meant to be a tool to chastise people.  Have we all stopped hyperventilating for a bit?  Good.

Back to the unit of measurement, this is also useful for determining how accurate someone is when they are saying "food X has more of this or less of this than food Y."  For example, I remember watching one Facebook thread where someone wondered if quinoa was actually better for people with diabetes because they thought it "didn't have as much carbohydrate."  Another person who had been diabetic for a long time said "no" and I thought (I wasn't feeling brave enough to jump in at the time), "She's asking the wrong questions!"  What would have been a better, albeit more involved series of questions, would be to ask "How much carbohydrate can I safely tolerate at a meal?" and "How much net carbohydrate is in 1 cup [1 fist sized portion]"  and "Can I handle eating that much or does the portion look too small?"  I would say "I can handle roughly about 30 grams at a meal" and "One cup will give me about 34 net grams of carb, so I'll probably do more like 1/2-3/4 of a cup" and "As long as I have my protein and vegetables mixed in with that it will be a satisfying meal."  Yes, it does take more work to go through that, and I can see why some people just leave it alone, but after you've been thinking this way for a while the right questions pop in your head easier and you answer them faster too.

Take home message--Just watching what you eat is not enough, you still have to watch how much.  You need to get an idea of how much of something you can safely eat, and use whatever technique works for you to keep track.

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