Nutrition FYI

Healthy on a Lean Budget: Diabetes for Less Tami A. Ross, RD, LD, CDE, and Patti Geil, MS, RD, FADA, CDE

As the recession deepens and the Planning Pennywise Meals unemployment rate hovers at Planning pennywise meals is the first 10%,1 diabetes clinicians often find step toward taking a big bite out of themselves caring for individuals expenses. Sharing information with serious financial concerns. such as “Saving just $5 a week on Comments such as “Healthy food food—about the cost of one fast- is too expensive,” “I can’t afford food value —adds up to more to follow a diabetes diet,” and than $250 a year” with patients can “Diabetic food costs too much” are open a discussion about the effec- now commonly heard during patient tiveness of making small behavior care encounters. It is not surpris- changes to move toward the bigger ing that individuals with diabetes goal of healthy eating on a budget. have financial issues because those Because today’s diabetes nutri- with diagnosed diabetes, on aver- tion guidelines parallel the dietary age, have medical expenditures guidelines for all Americans, meal that are approximately 2.3 times planning for individuals with dia- higher than those without diabetes.2 betes incorporates the same According to the American Diabetes recommended for the entire family Association, the per capita annual to promote good health. Whether by cost of health care for people with counting carbohydrates, using the diabetes is $11,744, of which $6,649 Exchanges Lists from Choose Your (57%) is attributed to diabetes.2 Foods: Exchange Lists for Diabetes, The recent economic downturn has following a plate method, or imple- added further financial pressure. menting another diabetes nutrition The current Consumer Price Index approach, planning meals is the first Inflation Calculator estimates that step that individuals with diabetes what $100 would buy 5 years ago should take when making the transi- now costs $114.52,3 an amount tion from diabetes nutrition theory that will vary with changes in the to actually sitting down and enjoying economy. a great-tasting, good-for-you meal. It Although some individuals with may be helpful to suggest to patients diabetes may not disclose financial that meeting with a registered anxieties to their clinicians, health dietitian or diabetes educator can be care professionals should be aware a good use of both money and time that the inability to pay for food, when starting the meal-planning medications, and other aspects of process. diabetes care can pose a barrier to optimal self-management. Health Meal Planning Pays Off care professionals should be prepared Diabetes care professionals can help to assist individuals with diabetes by patients see the multiple benefits of providing guidance on pennywise planning their meals. meal planning, smart shopping, Saving time. With practice, plan- and cost-effective to help ning five evening meals for a week patients reduce their food costs with- such as those shown in Table 1 takes out sacrificing important aspects of only about 5 minutes—time that can their care. be found while waiting for a doc- 120 Diabetes Spectrum Volume 23, Number 2, 2010 DepartmentNutrition FYI

Table 1. 5-Day Meal Plan for * purchases can add $5.00–10.00 at the checkout, and if those items are Day 1 foods, they can also challenge 3 oz oven-fried chicken efforts to follow a healthy diet. ½ cup broccoli Although favorite family recipes, 1 medium ear corn on the cob with nutrition-boosting modifica- 1 tsp. light margarine tions as needed, are the heart of the ½ cup rainbow sherbet plan, incorporating at least 12 oz iced one meatless meal each week will mean lower food costs (as well as less Day 2 saturated fat and cholesterol) because 3 oz roasted turkey breast meat typically makes up the largest 1 cup roasted carrots, onions, and potatoes part of the food budget. ½ cup green beans With advance planning, it is pos- 1 whole-grain roll sible to feed a family of four at home 1 tsp. light margarine for ~$120–140 per week. Health 1 cup skim milk care professionals can direct patients Day 3 with diabetes to the U.S. Department 5 1 cup homemade turkey pot pie (incorporating “planned over” roasted of Agriculture Web site for healthy turkey from Day 2) food plans and simple recipes. 2 cups of lettuce, tomatoes, cucumbers, and carrots Saving energy. Planning meals 2 Tbsp. oil and vinegar dressing ahead and buying all the necessary ½ cup mandarin oranges with light whipped topping ingredients at one time saves not only 8 oz sugar-free lemonade the shopper’s personal energy by reducing the need for multiple quick Day 4 trips to the store, but it also saves 2 cups crockpot vegetable (incorporating leftover vegetables from environmental energy and mental previous meals) energy. There’s no more wondering, 6 whole-grain crackers “What’s for dinner?” ½ medium banana 1 cup skim milk Planning for “Planned Overs” No one wants to eat the same foods Day 5 day after day, but “planned overs” : are a smart ’s best friend. 1 small (8-oz) chili with 6 crackers Planned overs are planned left- 1 side salad with 1 packet light dressing overs—key ingredients deliberately 1 small diet soda prepared in larger quantities with the *Each menu includes ~ 55–60 g of carbohydrate and costs < $1.80 per plan to use them in several different person, except for the fast-food meal, which is < $3.25 (based on January ways. For example, by grilling a few 2010 prices in Lexington, Ky.). adapted from Geil PB, Ross TA: extra chicken breasts while prepar- Diabetes Meals on $7 a Day – or Less! 2nd ed. Alexandria, Va., American ing tonight’s chicken dinner, you can Diabetes Association, 2007 then use some of the extra chicken for a green salad with chicken strips tor’s appointment, waiting for a pot Saving money. Planning meals in tomorrow’s and put extra of water to boil, or sitting in traffic. and shopping from a list also diced chicken in the freezer for use That initial 5-minute time invest- translates into cost savings at the in a future chicken and broccoli ment will then pay off by simplifying checkout. According to a CNN casserole. the process of making a shopping report, shoppers spend between 50 Using planned overs means more list and going to the grocery store. cents and $1 for every minute over than just eating tonight’s leftovers Following a quickly written list of one-half hour they are in the super- for lunch tomorrow. Deliberately ingredients needed to prepare the market.4 Getting through the store cooking and baking in larger quanti- planned meals, individuals can make faster by following a shopping list ties and using planned overs for their way through the grocery store means spending less money. additional meals makes the most of a cook’s time, energy, and ingredients. more efficiently, eliminating the need Planning ahead and shopping to spend time later making extra with a list can also help ensure that Smart Shopping trips to buy forgotten items. Further, the shopping cart will be filled with Savvy supermarket shopping is when the menu is planned in advance only foods that are needed, in the one sure way for individuals with and the pantry and refrigerator are proper package size, resulting in diabetes to spend less and eat more well stocked, healthy meals are only less wasted food and fewer impulse healthfully. With food prices rising minutes away. purchases. Just one or two impulse at a pace not seen in almost 20 years, Diabetes Spectrum Volume 23, Number 2, 2010 121 Nutrition FYI

Table 2. Sample Staples That few items. When the basket gets popular coupon Web sites such Can Be Purchased in Bulk heavy, shoppers should be ready as www.coupons.com or received for checkout. A cart makes it via text messages and down- • Baking powder easier to continue buying impulse loaded to supermarket rewards • Baking soda items. cards for scanning at checkout. • Bouillon cubes • Stick to the perimeter. Foods • Fresh isn’t always best. Fruits and • Cocoa with the most nutritional value vegetables that are “in season” • Cooking spray are typically found on the store’s are a best buy. Consumers may • Corn starch perimeter. That’s where produce, want to buy extras and freeze • Cornmeal fresh meats, dairy, and breads them to use throughout the • Extracts can be found. High-traffic areas year. Economical and nutritious • Evaporated milk are typically located in the back choices in the winter months • Flour of the store, so shoppers are include apples, cabbage, carrots, • Oil more likely to pass through the oranges, tangerines, and turnips. • Powdered milk inner aisles where processed and • Sugar convenience foods are found, Although many think that “fresh • Sugar substitute encouraging impulse buys. is best” when it comes to fruits and • Look high and low for the best vegetables, canned and frozen ver- people are adjusting their shopping sions often cost less and require less habits and frequenting a combination buys. Point out to patients that the more expensive brands and preparation. Furthermore, the nutri- of stores to stretch their food dollars. ent value is as good as or better than Smart shoppers may want to con- impulse buys are at eye level, whereas store brands and betters fresh food and less food is wasted sider visiting a warehouse club once during preparation. Canned and fro- a month to stock up on nonperish- buys are often located on the top and bottom shelves. zen fruits and vegetables are picked able staples in bulk (Table 2), a super at their peak ripeness, whereas center type store for best everyday • Take advantage of store specials. If blueberries are on the shopping produce sold fresh is often harvested prices, and a regular supermarket to before it is fully ripe, which may list but the store circular shows save time or pick up low-fat milk or compromise its nutritional value. grapes to be a better buy, encour- fresh produce as needed. No-frills Patients who are concerned about age patients to consider making a discount groceries and bakery outlets the syrups in canned fruits can easily switch to save money. boast a 40–50% savings and are drain and rinse them to reduce the • Buy store brands. More consum- growing in popularity. New to the carbohydrate content. Some canned ers are switching to store brands grocery shopping scene are “dollar vegetables are available in “no salt or generics to save 20–30% on stores,” many of which are expand- added” versions. Those that are not their food bill. ing their food offerings to meet the can be drained and rinsed to remove needs of penny-pinching consumers. • Skip “special” foods. Special a significant amount of sodium. “dietetic” and “diabetic” food Smart Shopping Tips to Share items are not necessarily lower Cost-Effective Cooking Diabetes care professionals can help in carbohydrates and typically Relearning the lost art of cooking their patients in their quest for low- are higher priced than regular is key for individuals with diabetes cost healthful food by sharing the versions of the same foods. For who want to get the most from less following shopping tips. example, a piece of regular red costly and more healthful meals. • Shop alone, and don’t head in to and white peppermint hard candy Traditional meals have become the store hungry. Having extra costs 2 cents, whereas a piece of a casualty of our time-obsessed people along (especially kids!) or sugar-free red and white pep- society. Today, the average American a growling stomach means extra permint hard candy costs 8 cents spends a mere 31 minutes per day on food in the cart and extra money (based on January 2010 prices in food preparation and cleanup.6 spent at checkout. Lexington, Ky.). Both contain 5 g Expensive and often nutrient- • Be a list lover; don’t leave home of carbohydrate. poor convenience and ready-to-eat without it. Shopping lists help • Cut costs with coupons. Coupons foods have taken on a central role in shoppers stay focused and resist can save individuals with diabetes meals prepared at home. Consumers high-price, low-nutrition impulse money on routine purchases and pay premium prices for foods that buys. Advise your patients to add extra savings if double or have been grated, chopped, pre- organize their lists aisle by aisle triple coupon days are available cooked, pre-sliced, or individually to realize additional cost and time in their area stores. Using just five packaged. For example, shredded savings. 50-cents-off coupons per week carrots by the pound cost more than • Grab a basket, not a cart. To can create a savings of $130 each three times more than whole carrots, control purchases, suggest that year. Coupons have gone high which can be shredded in moments patients grab a handheld basket tech, so it is no longer necessary in the . Individuals with dia- rather than a cart when head- to hassle with clipping them. betes who are willing to invest time ing into the store to pick up a Coupons can be printed from in food preparation will reap savings, 122 Diabetes Spectrum Volume 23, Number 2, 2010 DepartmentNutrition FYI

both by using fewer of these conve- • Buy cold food last, and refrigerate 2American Diabetes Association: Economic nience products and by cutting down fast. Bacteria that cause food- costs of diabetes in the U.S. in 2007. Diabetes on pricy fast-food drive-through borne illnesses grow rapidly at Care 31:596–615, 2008 fare, home-delivered meals, and room temperature. 3U.S. Department of Labor: CPI inflation splurges. • Start clean, and keep it clean. calculator [article online]. Available from It is not necessary for patients www.bls.gov/data/inflation_calculator.htm. Wash hands, utensils, and cutting Accessed 10 January 2010 to cook at the level of Julia Child boards before and after contact or be a “Top ” to save money. 4CNN: Is the grocery store ripping you off? with raw meat, poultry, seafood, [article online]. Available from www.cnn. A good basic is the place and eggs. com/2008/LIVING/personal/07/09/food.bill/ to start, with recipes that are quick • Separate, don’t cross-contami- index.html. Accessed 2 March 2010 to assemble, feature few ingredi- nate. Keep raw meat, poultry, and 5U.S. Department of Agriculture. Recipes ents, and emphasize simple cooking seafood apart from foods that and tips for healthy, thrifty meals [article techniques. The American Diabetes will not be cooked. online] Available from http://www. Association publishes several • Cook safely. Use a food ther- cnpp.usda.gov/Publications/FoodPlans/ budget-friendly , such as mometer to ensure that food is MiscPubs/FoodPlansRecipeBook. Diabetes Meals on $7 a Day— or pdf#xml=http://65.216.150.153/texis/search/ thoroughly and appropriately pdfhi.txt?query=recipes+and+tips+for+healt Less! and The 4-Ingredient Diabetes cooked. 7 hy+thrifty+meals&pr=CNPP&prox=page& Cookbook. • Remember the cool rules. Chill rorder=500&rprox=500&rdfreq=500&rwf Clever, cost-conscious cooks can leftovers and takeout foods req=500&rlead=500&rdepth=0&sufs=2& also save time and money by using within 2 hours in a refrigerator order=r&cq=&id=4b8442007. Accessed 10 January 2010 techniques such as batch cooking, that is < 40°F. which means cooking and baking in 6U.S. Department of Labor: American time large quantities and freezing portions Conclusion use survey, 2008 [article online]. Available for future use. For example, a person As incomes drop and food budgets from http://www.bls.gov/news.release/pdf/ can cook a large batch of waffles on shrink, strategies for eating right atus.pdf. Accessed 10 January 2010 a Sunday morning, serve a few for when money is tight are a neces- 7American Diabetes Association: Books for that day’s , and then freeze sity for individuals with diabetes. healthy living. Available online from http:// store.diabetes.org/products/product_details. the rest to pop into the toaster on Diabetes clinicians should be aware busy weekday mornings, saving both jsp?PRODUCT%3C%3Eprd_id=84552444 of their patients’ financial concerns 1764104&FOLDER%3C%3Efolder_id=253 time and money. and help them make the changes 4374302024139&bmUID=1267292492395. they need in terms of meal plan- Accessed 10 January 2010. Handle With Care 8 Economical eating does require ning, shopping, and cooking to U.S. Department of Health and Human enjoy healthy eating even on a lean Services: Food Safety.gov: your gateway to special attention to food safety, par- federal food safety information [Web site]. ticularly when storing large amounts budget. Offering practical strate- gies such as grocery shopping tours, www.foodsafety.gov. Accessed 10 January of food or using “planned overs” or 2010 batch cooking. For people with dia- cost-conscious cooking classes, and betes, food-borne illness is not only label-reading lessons is another way unpleasant, but its accompanying to help patients make the most of Tami A. Ross, RD, LD, CDE, nausea, diarrhea, and vomiting can their available options. Healthy dia- provides diabetes education for a have serious effects on blood glucose betes nutrition need not be sacrificed large internal medicine practice, and control. Resources available from in an unhealthy economy. Patti Geil, MS, RD, FADA, CDE, the U.S. Department of Health and is the president of Geil Nutrition Human Services8 provide patients References Communications in Lexington, Ky. They are co-authors of Diabetes with tips on proper food storage, 1 U.S. Department of Labor: Labor force nd cooking, and handling. statistics from the current population survey Meals on $7 a Day – or Less! 2 ed. Health care providers can share [article online]. Available from www.bls.gov/ Alexandria, Va., American Diabetes the following safety tips with patients. cps. Accessed on 12 January 2010 Association, 2007

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