9 Tips For Traveling Abroad With Diabetes

Amalfi-italy

As any novice or expert traveler knows, planning the logistics of a trip, let alone the process of traveling, can get pretty tricky at times. This can be especially true for the adventurers with chronic medical conditions, namely those with diabetes. If you have diabetes and want to see the world but haven’t yet figured out how to balance the Colosseum with carb counting, or the Great Wall with glucose monitoring, then these tips are for you. Traveling with diabetes, whether Type 1 or 2, can certainly be a little stressful at times, but it is completely possible and should not hold you back from exploring the globe! Below is a list of 9 daily lifestyle tips for traveling with diabetes, made easy to implement in any adventure.

  1. Before you embark on your trip, if flying overseas, it’s good to know that you can order a special meal, usually up to 48 hours in advance. Visit the homepage of your airline and do a search for special menus. A review of Delta’s offerings shows that they serve 17 special menus. An overview of their diabetes menu states it’s low in sugar and avoids syrup and regular desserts. If you have high blood pressure or celiac disease, they also have a low sodium and gluten-free menu. But don’t fret. If you go with the regular menu, figure out your carb quota on the tray, so you don’t end up with a high blood glucose. Also, make sure to bring some healthy snacks, such as KIND bars, nuts, fresh fruit, and 100-calorie bags or popcorn. Keep some glucose tablets on hand in case of an emergency.
  1. Keep all medicines, syringes, inhaler and cartridges, blood sugar testing supplies, and all oral medications in your carry-on luggage. Don’t risk a checked bag getting lost or sitting in an unheated, uncooled cargo hold. If you usually carry a test kit and some exogenous source of insulin with you at all times, it may feel inconvenient to have to keep track of it during your travels. Luckily, medical equipment like test kits are available pocket-sized, and can be found at your local pharmacy. Store your insulin bottles and unopened packages of inhaled insulin between 33 F and 80 F. Don’t freeze insulin or keep it in direct sun. Once you open a package of inhaled insulin, you can keep it at room temperature safely for 10 days.
  1. Be aware of the potential language barrier in your destination country. In whatever area(s) you are traveling, certain words and phrases are critical to know and verbalize in the native language. It is too dangerous to assume that locals will be able to understand English in the event of a low blood sugar episode. Important phrases can include “I have diabetes,” “I have low blood sugar,” “I need medical assistance,” “I need a Coca-Cola” (most countries are familiar with, and carry, the iconic beverage). It is also crucial to carry an identification card or wear a medical ID bracelet that, in case of an emergency, explains your condition, which should have universal symbols that can be understood by any medical caregiver.
  1. In tandem with knowing the local language for speaking purposes, it is equally as important to be able to identify words that mean “bread,” and/or local dishes that are higher in carbohydrates. These can include pasta, potatoes, rice, pita, tortilla, or other local grains like quinoa or couscous. It’s also a good idea to practice reading nutrition labels in the local language; the word “carbohydrate” can be pretty easy to identify in some languages, but make sure you know what they are before leaving home. Also be wary that many European countries use Kilojoules instead of calories as a measurement of energy, and use commas instead of periods to designate decimals (for example, 12,5 grams as opposed to 12.5).
  1. If you are on insulin, you are probably pretty well versed on counting grams of carbohydrates. Despite your possible proficiency in carb counting, it may be helpful to refresh yourself on common exchanges of popular foods, like how 1/3 cup of rice or pasta is one exchange, and that one small slice of bread or dinner roll is one exchange. Also consider the sugar/carbohydrate content in syrups and dried fruit. It’s also a good idea to have a phone app such as HEALTHeDiabetes ($5.99 for iPhone) to check carbohydrate and sugar content of various foods. so you can quickly estimate the amount of carbohydrates in various dishes on the menu, before you order.
  1. You’ve probably heard that it is especially important to be mindful while sitting on a long plane, train, or bus ride. This is true or those with diabetes, as blood sugars tend to rise while remaining sedentary. Make sure to have your glucometer on hand at all times, and aim to test your blood glucose as needed to keep it in check. If you wear an insulin pump, you can temporarily set it to a higher basal rate during your travel, but make sure to go over those plans with your doctor or certified diabetes educator before heading out.
  1. The opposite is just as necessary to consider, as physical activity can deplete your blood sugar at an expedited rate. Make sure you have accessible forms of energy, like a granola bar or portable bottle of juice, to keep those blood sugar levels steady while you roam around Rio or traverse Tibet.
  1. In all cases, whether you’re driving a few states over or flying across the world,make sure you a card with your doctor’s name and phone number. Also keep a list of your current medications in your wallet and keep it with you at all times. And don’t forget a medical ID bracelet or card that states you have diabetes. Bring twice as many diabetic supplies as you think you need. Sometimes things just break, get stolen, or are lost in transport. Back-up supplies include an extra tube of glucose tablets for low blood sugar episodes, a back-uptest kit packed in another part of your baggage, extra insulin and/or oral diabetes medications, and extra medical condition cards in case your wallet is stolen.
  1. Last but certainly not least: eating! For many, traveling to new places is largely defined by new cuisines. Having diabetes has absolutely no hindrance on enjoying these new foods, as long as you stay mindful. If you want to sample a pizza in Florence for example, go for it (it’s practically necessary)! Keep the carb content in check by sharing the meal with a friend, or if you are alone, make sure you’re going to be exerting a lot of energy after your meal (like climbing up to the Piazzale Michelangelo). Limit the pizza to one or two slices and pair it with a salad. If you want to sample local desserts, opt for smaller sizes and try to balance it with a lower-carb meal, like a dish comprised of vegetables and a protein, like fish or a leaner meat source.

These may seem like a lot of things to keep in mind, when all you want to do is explore landmarks and experiment local cuisine like any other traveler. Visit here for more tips on traveling with diabetes. Following these tips can make your adventure run smoothly so you can get back to enjoying these amazing sights, sounds and tastes sooner. You are a traveler, and that means you are capable of dealing with anything that gets in your path on the road to new experiences. Happy travels!

Lisa Stollman, MA, RDN, CDE, CDN is based on Huntington, Long Island and New York City. She was recently honored as the 2015 Distinguished Dietitian of the Year Award by The New York State Academy of Nutrition and Dietetics. A special thanks to nutrition and writing intern Samantha Marks for her contributions to this blogpost. To find out more about Lisa, visit here.

Healthy Eating Abroad- When in Rome

rome-restaurantRome, where civilization and religion essentially began, is a place everyone should visit at least once in their lifetime. Enter a place where beauty is at every corner and one can spend hours admiring the craftsmanship put into a single building, a piece of artwork or a pasta dish that has been perfected over the years. The cuisine is something not to miss and as much a part of the experience of Rome as any other. When you experience a meal in Italy, you experience traditions that have been passed down for generations and embedded in every Italian. Meal time is family time and the typical Italian meal spans the course of 2-3 hours. There are also certain dining etiquettes one should be aware of beforehand. Check on dining etiquette in Rome. The traditional Italian meal consists of five courses. The first being an antipasti dish such as a charcuterie board or bruschetta. The main course is divided into 2 courses, the first called primo which is a pasta or rice dish, the second called secondo piatto is a meat or fish dish and contorni or side dishes may be ordered al-la cate. Dessert or dolce concludes the meal. So how does one not expand their waist line with a food culture characteristic of pizza, pasta, cheese and gelato? Here are a few tips that will allow you to enjoy the cuisine without overindulging.
1. For breakfast, order the cornetto semplice (similar to a croissant) without the fruit or cream filling. These cornettos are typically made with more sugar than croissants thus yielding a sweeter product to begin with. Biscotti are another lighter choice compared to other pastries as they typically do not contain butter. Also, opt for standing at the espresso bar to keep yourself on the go, to avoid additional charges that incur when sitting at a table and mingle with the locals.
2. Don’t feel pressured to order every course. Skip the antipasti and choose either a pasta or meat/fish course or chose to share one of each. Red sauce pastas are lighter than the cream based but there are just some dishes one must try while in Rome, Cacio e Pepe being one. Made with only butter, pecorino cheese, pepper, and pasta, the result is decadent and if done correctly the true test of Italian cuisine. Share this with your fellow diner.
3. Eat the bread with the meal not as a means to fill up before the meal arrives. Italians use the bread as an accompaniment to the meal, to scoop up the extra sauce but the bread is typically delivered to the table before the order is even placed. So you can cut an easy 200 calories by not eating 2 slices of bread before the meal.
4. Add in a hefty serving of vegetables. Artichokes and tomatoes in Rome are delicious! Order a salad and choose vegetable side dishes to accompany the main course. Or have them as your meal. For pizza and pasta, choose vegetarian.
5. Skip the dessert at lunch and dinner but enjoy single serving of gelato during the day when you are more active. Gelato is often enjoyed on-the-go by Italians. So have your sweet treat mid-day as you are walking around the city.
6. Engage in the Italian approach to mealtime. Italians eat leisurely, enjoying both the food and company. As a result they eat more slowly and allow themselves to experience the feeling of satiety before they over eat. It takes about 20 minutes for our brains to actually register that we are full. So, when you eat slowly, you will likely eat less.
And above all else, enjoy the Italian cuisine as it is not one to miss. Just keep portion sizes and moderation in mind. Buon appetito!
Lisa Stollman, MA, RDN. CDE, CDN is a nationally-renowned teen and adult weight management expert with offices in Huntington, NY and the Upper East Side of Manhattan. Lisa is the author of The Trim Traveler: How to Eat Healthy and Stay Fit While Traveling Abroad (Nirvana Press 2014) and The Teen Eating Manifesto: The Ten Essential Steps to Losing Weight, Looking Great and Getting Healthy (Nirvana Press 2012), the premier guide on healthy eating and weight management for teens. She loves to share her enthusiasm of eating healthy, traveling and staying fit. To find out more about Lisa, visit her website.

Eating Vegan While Traveling Abroad

IMG_2605Following a vegetarian, vegan or plant-based lifestyle has become extremely popular in today’s culture. Whether for health, sustainability of the planet or animal rights, the number of people adapting a plant-based diet is at an all time high. If you are a vegetarian, it is usually not difficult to consume a nutritious diet as you can omit the meat in restaurants, but still include dairy foods, such as milk, cheese and yogurt and eggs. If you adhere to a vegan diet, it can be a little tricky to meet your nutritional needs, especially when traveling, without some careful planning. People that are vegan do not consume any foods derived from animals. That means no meat, dairy or eggs. Many vegans also exclude honey from their diets.

If you follow a vegan diet and enjoy eating in restaurants, you may become familiar with the various establishments in your locale that offer vegan menu options or will oblige special requests and modify dishes to meet your needs. However, when you travel abroad you may find it difficult to find restaurants that will satisfy your vegan preferences. Google websites for vegan restaurants where you are traveling. You should find this quite helpful. Also be aware that you can order a vegan or vegetarian meal for your flight, but do so at least 48 hours in advance. You should be able to do this on the airline’s website.

If you follow a vegan diet exclusively, you should be aware that there are a handful of nutrients that you need to pay special attention to so you don’t develop a deficiency. These nutrients include protein, Vitamin B12, zinc, iron and calcium. Almost all foods except for alcohol, fruit, sugar, and fat provide some protein.

Protein’s role in the diet is to repair cells and make new ones. Protein is also important for growth and development in children, teens, and pregnant women.Vegan protein sources include: lentils, chickpeas, tofu, peas, peanut and other nut butters, soy milk and protein-fortified almond milk, almonds and other nuts, peas, seitan (wheat gluten), edamame and tempeh.

Vitamin B12  is required for the formation red blood cells, neurological function, and DNA synthesis. Vitamin B12 is predominately found in animal foods. It can be difficult to get sufficient amounts from plant-based foods. If you are traveling, it may be wise to bring a package of Red Star nutritional yeast that you can add to foods for protein and Vitamin B12. Two tablespoons of nutritional yeast contains only 45 calories, but has 6 grams of protein and 100% of the RDA for Vitamin B12. If you bring a small container of it to restaurants, you can add it to soups, pasta, rice and stews.

Zinc has many important functions in the body.  It’s needed to maintain the body’s immune system. Zinc is also required for cell division, cell growth, wound healing and the digestion of carbohydrates. Zinc is also essential for both smell and taste. During pregnancy, infancy, and childhood the body needs zinc to grow and develop properly. Plant-based food sources of zinc include white beans, kidney beans, and chickpeas, zinc-fortified breakfast cereals, wheat germ and pumpkin seeds. While traveling, try to  order entrees which include beans when dining in restaurants.

Iron’s role in the body is to carry oxygen to all of the cells. Iron sources for vegetarians and vegans include iron-fortified breakfast cereals, spinach, kidney beans, black-eyed peas, lentils, turnip greens, molasses, whole wheat breads, peas, and some dried fruits (dried apricots, prunes, raisins). For vegetarians, egg yolk is also a good source of iron.

Calcium is the most plentiful mineral found in the human body. The majority of calcium is found in the teeth and bones. Nerve cells, body tissues, blood, and other body fluids contain the rest of the calcium.  In addition to building strong bones and teeth, calcium also helps blood to clot, sends and receives nerve signals, and maintains a normal heartbeat. Calcium food sources for vegans include calcium-fortified soymilk, calcium-fortified breakfast cereals and orange juice, almonds, tofu made with calcium sulfate, and dark-green leafy vegetables, including broccoli, collard, turnip and mustard greens, bok choy. Vegetarians can get adequate calcium from milk, cheese and yogurt.

If you are a vegan and traveling, don’t forget to bring a multiple vitamin/mineral supplement that is 100% of the Daily Value (DV). Taking a daily multiple vitamin/mineral supplement that provides sufficient amounts of Vitamin B12, calcium, zinc and iron is a good way to ensure adequate nutrition while you travel.

Some helpful tips for ordering vegan meals in restaurants abroad include:

1. If the restaurant doesn’t have a vegan option, request a vegetable plate.
If there is a salad that includes meat or cheese, and no vegan option, request that the meal and cheese be omitted. Ask for beans and/or avocado to be added.
2. Bring packets of oatmeal, bags of nuts and vegan protein bars from home when you travel.
3. Download Happy Cow, the free app for iPhone, to find vegetarian and vegan restaurants around the globe.

Lisa Stollman, MA, RDN, CDE, CDN is the author of the new ebook The Trim Traveler: How to Eat Healthy and Stay Fit While Traveling Abroad (Nirvana Press 2014) and The Teen Eating Manifesto (Nirvana Press 2012). She is a nationally-recognized Registered Dietitian Nutritionist with a specialty in teen and adult weight management and diabetes. Lisa received her B.S. in Food and Nutrition and her M.A. in Clinical Nutrition from New York University. She consults with clients in Huntington, New York and on the Upper East Side of Manhattan. To find out more about Lisa or to book an appointment, please visit: http://www.lisastollmanrd.com

Great Travel Snacks

travel_agentsTraveling makes healthy eating a bit more challenging. Whether you go by car, train or plane, when you aren’t in your normal environment it’s just easier to get off track and forget about your meal routine. And while you shouldn’t try to lose weight when on vacation, you don’t want to back track either. So taking a few minutes to pack snacks for your trip will help prevent you from stopping at the corner stop for a candy bar or pulling into the fast food lane for a milkshake. That being said some convenient stores and airport vendors do have healthy snacks to choose from, you just have to choose wisely. Here are a few suggestions for healthy snacks to bring along on your trip. Nuts Full of healthy fats, fiber and plant proteins- nuts are also calorie dense so just a small handful can be pretty satisfying and hold off your hunger for your next meal. Choose any kind you want- roasted peanuts, almonds, walnuts, pistachios, sunflower seeds, etc or make a variety pack. Fresh fruit Choose less perishable fruit such as bananas, oranges, apples, plums, apricots. Fruit is hydrating, full of nutrients and low in calories so it can be a good way to satisfy the munchies that pop up during a long trip. Raw veggies Great for a road trip. If you can bring along a cooler, pre-wash and cut veggies such as radishes, carrots or celery, place all in a plastic bag and put on ice. These make a great dipper for hummus or homemade ranch using plain Greek yogurt instead of sour cream. Crackers Choose whole grain crackers which are more filling and contain more fiber than the “enriched” counterpart. Choose those with 5 or less ingredients. Triscuits are a great choice and offered in a variety of different flavors. Pair with hummus, natural peanut butter or cheese. Popcorn Popcorn is actually a whole grain, just be sure to choose unbuttered, unsalted to avoid unnecessary processed ingredients, trans fats and sodium. Flavor it yourself with garlic powder, onion powder, oregano, pepper, sea salt or even hot sauce for a kick. Popcorn lets you “volume eat” since you get a three-cup serving for only 100 calories. Trail mix
Make your own! Mix together a whole grain cereal such as Wheat Chex or Cheerios, nuts, dried fruit and dark chocolate pieces. Place in individual baggies.. The snack doesn’t require refrigeration so can last the length of your trip. Energy Bars Choose those with few ingredients, low in added sugar (less than 6 grams), contain some protein (more than 3 grams) and fiber (at least 2 grams)per serving. Kind Bars and Lara Bars are excellent choices because they are satisfying, tasty and contain more “whole food” ingredients. If you don’t pack ahead, good news! Most of the aforementioned items can be found at most convenient stores or airport vendors. Happy snacking!

Lisa Stollman, MA, RDN, CDE, CDN is the author of the new ebook The Trim Traveler: How to Eat Healthy and Stay Fit While Traveling Abroad (Nirvana Press 2014) and The Teen Eating Manifesto (Nirvana Press 2012.). She is a nationally-recognized Registered Dietitian Nutritionist with a specialty in teen and adult weight management and diabetes. Lisa received her B.S. in Food and Nutrition and her M.A. in Clinical Nutrition from New York University. She consults with clients in Huntington, New York and on the Upper East Side of Manhattan. To find out more about Lisa or to book an appointment, please visit: www.lisastollmanrd.com

Traveling Abroad Gluten-Free

086506a45643d61bb38d1ee16ac3738cTraveling abroad with celiac disease or gluten sensitivity may pose a challenge at first. But once you do your homework you may find it quite manageable. The key is to do your research so you are not left starving or unsure if what you are eating is in fact gluten-free. Make sure you are well-versed in avoiding cross-contamination with gluten. Don’t let your diet restriction stop you from enjoying this amazing experience on which you are about to embark!

Remember these three areas to familiarize yourself with: the food customs, language and the new surroundings.

1. Food customs: have an understanding of how traditional dishes are prepared and the ingredients used so you know what is gluten-free, what to avoid and what can be modified.

2. Language: be able to communicate your needs and identify key words that indicate sources of gluten. Have a smart phone? Download a translation application to ease the language barrier. Google Translate is a user friendly app. Although English may be spoken as a second language in your city of travel, it is unlikely the word gluten or celiac is understood so know the translation in the area’s primary language. An excellent resource for gluten-free dining out is the app GF Card (free for iPhone or iPad) which contains gluten-free dining cards in fifty languages. Simply show your iPhone to your server. If you don’t have an iPhone, visit www.TriumphDining.com to order gluten-free dining cards.

3. The surroundings: know where you can stop in to purchase packaged snacks or fresh fruits to fuel your travels. If you are staying in a place with a kitchen it may be a good idea to stock up on gluten-free dried pastas, bread, cereal, quinoa, crackers and rice to break up the meals eaten out.

Pack gluten-free snacks to avoid searching aimlessly for gluten-free options, taking away from valuable sightseeing time. Airports are also a great spot to stock up packaged snack foods. KIND bars, NuGo Free Dark Chocolate Trail Mix protein bars, dried fruit and nuts are some examples. Dehydrated rice noodles, bean soups and gluten-free oatmeal packets are easy to carry along and just require hot water, easy to come across in most hotels, cafés or corner stops. Look for gluten free wraps you can carry along so you can simply request the sandwich fillings be made in your wraps and even bring along plastic gloves just in case. Know that continental breakfasts will unlikely have gluten free breads/cereals and the risk for contamination is likely going to be quite high. Yogurt, cheese, eggs and fresh fruit are good options for breakfast when dining out.

Before booking a hotel, it would be wise to ask if special arrangements can be made depending on your length of stay. Request to have a small refrigerator in your room.  Stock up on inexpensive grab-n-go breakfast food such as gluten free granola bars, dried fruit and rice cakes with a nut butter spread.
 For eating out, research the area beforehand to find those restaurants which will accommodate the gluten-free traveler. Look on the Internet for restaurants which serve gluten-free dishes. Choose those places that understand risk of cross-contamination. –

When ordering here are a few requests you might need to ensure cross-contamination is avoided:

1. Make sure your meat is cooked on a clean surface, meaning not the same grill where bread/buns are toasted.

2. Make sure the vegetables have not been cut on the same cutting board as any flour products.

3. Gluten free pizzas need to be cooked on clean surfaces and gluten free pasta needs to be boiled in clean water, not the same water previously used to cook wheat pasta and the same thing goes for any fry order

4. Tip generously especially if the restaurant or café makes special plates and is very accommodating. This will only encourage similar behavior for the next traveler.

By Country:

Italy: the land of bread, pasta and pizza, is very conducive to the gluten free traveler. The Italian Coeliac Society certifies restaurants claiming gluten-free on their menu to assure the consumer there will be no risk for cross-contamination. Florence is home to several restaurants offering gluten free pasta and there is always the option for a Caprese salad, freshly sliced meats, antipastos and risotto.

France: Many restaurants and bakeries offer gluten-free fare. The Chambelland Boulangerie in Paris is a gluten-free bakery located in the 11th Arrondissement.

Spain: The Attic Restaurant in Barcelona offers selections specific for those with celiac disease. Menu options included pastas, fries, and other gluten-free selections.

A terrific website is www.glutenfreepassport.com for finding info on restaurants, traveling tips, travel language guides and a variety of gluten-free and food allergy apps. Take the time to review it before you embark on your trip. For more specifics by country: if you are traveling to Mallorca, France, Indonesia, Bolivia, Chile, Easter Island, Thailand, Finland, Australia, Montreal, Abu Dhabi, Sweden, Italy, Columbia or Sri Lanka just to name a few, follow this link for stories from gluten-free travelers. http://www.celiactravel.com/stories/

 

Lisa Stollman, MA, RDN, CDE, CDN is the author of the new ebook The Trim Traveler: How to Eat Healthy and Stay Fit While Traveling Abroad (Nirvana Press 2014) and The Teen Eating Manifesto (Nirvana Press 2012.). She is a nationally-recognized Registered Dietitian Nutritionist with a specialty in teen and adult weight management and diabetes. Lisa received her B.S. in Food and Nutrition and her M.A. in Clinical Nutrition from New York University. She consults with clients in Huntington, New York and on the Upper East Side of Manhattan. To find out more about Lisa or to book an appointment, please visit: http://www.lisastollmanrd.com