Be Healthy - Food Nutrition Labels

BE

Healthy ™

Sponsored by

Boston Public Health Commission

VOL. 5 • NO. 5

© March 2011

Food Nutrition Labels:

Decoding the food we eat

Understanding nutrition facts labels helps consumers make wise choices when purchasing foods. The labels are on the back of all packaged goods and beverages.

In this case, the numbers tell a surprising story. Though a recent national poll determined that the number of adults who read a book within the past year is on the decline, the percentage of people who reported checking nutrition facts labels on foods is on the rise.

According to its most recent survey in 2008, the U.S. Food and Drug Administration (FDA) found that more than 50 percent of those interviewed — a 10 percent increase in six years — indicated that they frequently check labels to determine whether they should buy or avoid certain foods.

Furthermore, 91 percent of the interviewees said they understand the link between diet and heart disease and 62 percent pointed a guilty finger at trans fat as one of the culprits for the disease.

Nutrition facts labels were mandated by the Nutrition Labeling and Education Act of 1990. Food manufacturers are required to show the facts of the nutrition of their products and include serving size, calories, nutrients and percent daily

values of those nutrients. The law applies to all packaged foods and beverages, excluding meat, poultry, fish and fresh fruits and vegetables.

Since 1994, two changes to the law have occurred. Effective Jan. 1, 2006 — thanks in part to researchers at Harvard University’s School of Public Health — the number of grams of trans fat was added, and as of Jan. 1, 2012, meat and poultry must comply with labeling guidelines.

The food labels are a boon to consumers — if they pay attention and interpret them correctly. “The food label gives consumers the power to compare foods quickly and easily so they can judge for themselves which products best fit their dietary needs,” explained Barbara Schneeman, Ph.D., the director of the FDA’s Office of Nutrition, Labeling and Dietary Supplements.

Stephanie Spaide, the director of the outpatient services in the Nutrition and Weight Management Center of Boston Medical Center, agrees. “They [food labels] give people the ability to identify what they are putting in their

Healthy? Read the fine print first It’s not just nutrition facts labels that crowd food containers. Consumers are bombarded with claims that a product is “reduced fat,” “fat free” or offers some other guarantee of good health. Even more confusing, some of these terms are used interchangeably. “Free,” “zero,” “without,” all mean supposedly the same thing.

These labels are helpful when trying to limit a particular nutrient in the diet, but the average consumer has no idea what they mean. Furthermore, many people do not believe them, according to a 2008 survey conducted by the U.S. Food and Drug Administration (FDA).

The distrust is understandable, largely because the health claims are not explained on the packaging despite the federal government’s strict definitions of these terms. In addition, the words do not always mean what they seem.

Take the labeling for trans fat. When the product indicates that there is no trans fat per serving, zero does

not always mean zero. Rather, it means that each serving contains less than one half gram of trans fat. This lack of clarity presents a problem particularly for persons with heart disease who are advised to refrain from trans fat altogether. Less than one half gram may pose little threat, but two or more servings spike the fat’s total to one or more grams — beyond the daily maximum health professionals recommend.

That’s when reading the ingredients help supplement the nutrition facts. Wording, such as “partially hydrogenated oil” signals the existence of trans fat — but no more than one half gram.

Misinterpretation abounds, especially with terms like “organic,” “natural” and “healthy,” according to Stephanie Spaide, the director of the outpatient services in the Nutrition and Weight Management Center of Boston Medical Center. Organic products are so designated by

body,” she said. “It helps to understand what’s good to eat or what to avoid.”

In addition, she explained, the labels allow a person to compare products. For instance, if one container of yogurt contains 80 calories and another 240 calories, “there’s a lot of something in that higher container,” she said.

Spaide recommends a simple and practical approach to mastering nutrition labels. “Start out with the one thing you’re focusing on.” Some may be concerned about calories, while others are trying to increase their calcium intake. “Pick one thing and start at ground zero,” she recommended.

High blood pressure is a case in point. People prone to high blood pressure should choose foods that are lower in sodium, which takes some doing given the high salt content in several foods, such as soups, salad dressings and frozen meals. “Foods that contain 400 milligrams (mg) or more of sodium per serving have a high sodium content,” said Spaide.

The nutrition facts are listed on the side or back of the packaging. Key to understanding the labels is serving size, which is typically measured in cups, grams or number of pieces. The serving size dictates the rest of the nutrition facts. For instance, if a person consumes two cups — or twice the serving size — the rest of the nutrition information is doubled as well.

That means if 150 of the calories come from fat in a single serving, 300 of the calories come from fat in two servings — a significant factor for those on a restricted fat diet.

Serving sizes can be a bit tricky and are usually much smaller than one estimates. A serving size of ice cream is half a cup — not the heaping bowl people are more prone to dole out.

A portion of a bran muffin can be one-third of the muffin — a mere bite for some. Yet, eating the entire muffin may result in consuming 30 percent of a person’s total daily calories.

Container size can be deceiving as well. A small bag of chips, which averages about 2 ounces, often contains two servings. Many interpret the small size to be an individual portion.

Only the label will tell.

Calories count. Eating too many calories a day is one of the leading causes of overweight and obesity, but there’s a trick to understanding if the food is high or low caloric. Products that contain 40 calories or fewer per serving are considered low in calories. Serving sizes of 100 calories are considered moderate, while those containing 400 calories or more are deemed high.

Certain nutrients — fat, cholesterol and sodium — Nutrition labels, continued to page 4

In res reque ponse to a lady M st from fi r some ichelle Oba st nutrit foods now ma, i l front on facts on ist of th make packages e t the o notice m more able.

Health claims, continued to page 4 Photo courtesy of Grocery Manufacturers Association

Grains: It’s better to be whole than refined One path to better health is a wholesome diet, and one steppingstone on that path is whole grains. Whole grains are hearthealthy and may help prevent diabetes or slow its onset.

in all three layers of the seed. A few examples of whole grains are oatmeal, cracked wheat (bulgur), whole wheat, whole grain cornmeal, popcorn and brown rice. When whole grains are refined — white flour, for example, or white rice — the bran and germ are removed. That strips away fiber and a lot of healthy nutrients.

Why are whole grains a healthy food?

Whole grains deliver fiber, heart-healthy oils, essential vitamins and minerals and other beneficial substances found in plants.

Studies show that people who eat more whole grains are less likely to develop heart disease and diabetes. After tracking participants for eight years, for example, the Black Women’s Health Study noted that having one or more daily servings of whole grains cut the odds of diabetes by 31 percent compared to eating less than one weekly serving. The Physicians’ Health Study found that eating whole grain cereals once or more daily reduced risk for heart failure.

Can whole grains protect against cancer?

Studies disagree, but some evidence suggests that whole grains — not just fiber — help lower risk for colorectal cancer.

No stamps in sight?

Eating enough whole grains helps lower total cholesterol, LDL (bad) cholesterol, triglycerides (fats) and blood pressure. It also lowers blood insulin and smoothes out blood sugar spikes.

The fiber found in whole grains is good for digestive health.

By bulking up stools, it prevents constipation. And because fiber slows digestion, you wind up feeling full longer after eating.

How much should you eat?

Grains are the edible seeds of certain grasses, such as oats, corn, wheat, rye and millet. Each grain has a tough outer jacket called bran, which is rich in fiber and B vitamins, wrapped around the starchy endosperm. Packed inside these layers is the germ, a storehouse of healthy oils, vitamins B and E and essential minerals like magnesium and zinc.

Whole grains contain the complete packet of nutrients found

How can you tell if a food has whole grains?

Start by looking for two packaging symbols from the Whole Grains Council. The “100% Whole Grain” stamp identifies foods that deliver a full serving of whole grain in every serving. All the grain ingredients are whole grains. A second stamp that simply says “Whole Grain” identifies foods containing at least half a serving of whole grain per serving. Ingredients in these products may include refined grains.

Let’s say you’re aiming for three whole grain servings a day. You can meet your goal by having three servings of any food stamped “100% Whole Grain,” or six servings of any food stamped “Whole Grain.”

How might diet make a difference?

What are whole grains?

Photo courtesy of Whole Grains Council

Aim for three servings of whole grains daily for adults, recommends the U.S. Department of Agriculture (USDA). At least half of all grain servings should be whole grain. Check www. mypyramid.gov and click on MyPyramid Plan to personalize needs based on activity level.

One serving of grains — called an ounce equivalent by the USDA — is one slice of bread, one cup of most ready-to-eat cereals, or half a cup of cooked grain, pasta or cereal. It’s worth whipping out a measuring cup. You’re likely to be surprised at how little each serving is compared to the portions most restaurants — and people —d ish out. It’s not hard to eat several servings at once.

Read the ingredients on the product label with these tips in mind: • Whole grains include brown rice, oatmeal (rolled oats), whole-grain corn, whole wheat and whole wheat berries. Less common sources are bulgur (cracked wheat), hulled barley (Scotch or pearled barley may not have bran), millet and oat groats. See www.mypyramid.gov for more options.

• Steer clear of grains described as “refined,” “bleached,” “enriched,” or “degerminated.” Usually, these refer to refined grains.

• If the first ingredient says “whole” (whole wheat, whole oats, whole rye), odds are good that the product is mostly whole grain, according to the Whole Grains Council.

• Watch out for multigrain and seven grain products. It’s hard to know just how much of the product is whole grains, especially if refined flour is listed among the ingredients. Similarly, “made with whole grains” just means the ingredients include whole grains.

How can you eat more whole grains?

• Start the morning with whole grain cereal. Old-fashioned oats or quick oats taste great sprinkled with cinnamon, nuts and dried fruit for a nutritious boost.

• Substitute whole grains or whole grain products when possible. Eat brown rice instead of white rice (hint: quick cooking varieties count as whole grain). Try whole wheat pasta, bagels, crackers or couscous, or whole grain corn or whole wheat tortillas. When recipes require flour, try making one-third to half the amount whole grain flour.

• For picky eaters, try sandwiches with a slice of whole wheat bread and a slice of white bread.

• Sample a new whole grain or whole grain recipe each week. See home recipes for whole grains and other healthy eats at www.hsph.harvard.edu/nutritionsource/recipes/home-cooking, the Nutrition Source website at Harvard School of Public Health.

• Add whole grains — brown rice or barley, perhaps — to soups and stews, suggests the American Dietetic Association.

Or turn extra cooked grains into a hearty salad by tossing with dressing and raw or cooked vegetables.

Whole grains are an important part of a healthy diet. So the next time you make a trip to the grocery store, plan ahead and make a list of the items you eat (pasta, bread, muffins, rice, etc.) that may have whole grain substitutions.

2 BE Healthy • http://behealthy.baystatebanner.com

Questions & Answers 1. Since the percent daily values on nutrition labels are based on a 2,000 calorie diet, how should a person determine the correct daily values for a diet of a different calorie intake?

Each person’s calorie needs are different. An Vivien Morris, M.S., R.D., M.P.H., L.D.N. active person will need Dietitian and Director of Community more calories than a Initiatives person that is not active.

Generally, men need more Nutrition and Fitness for Life Program Boston Medical Center calories than women.

And each person’s calorie needs vary day by day. The reference 2,000 calorie diet used on food nutrition labels is designed to give consumers a bench mark to use when assessing whether their nutrient needs would be more than or less than the reference amount. For example, if a person believes that their calorie needs are 1,600 calories per day, then their percent daily values from the food item would be 25 percent greater (2000 /1600 = 1.25) than the person who needs 2,000 calories.

2. If a food advertises that it is fat-free, does that mean it is low in calories?

While fat contains more calories per gram than the other key nutrients (carbohydrate and protein), being fat free does not necessarily mean being low in calories. A soda is fat free, but at 150 calories per 12 ounce serving, it is considered high in calories.

3. In general, what is the maximum amount of fat a person should consume each day?

It is recommended that adults ages 19 and older consume from 20 to 35 percent of their total calories as fat. Healthy fats (for example, monounsaturated fats like canola oil or olive oil) are needed in small amounts for good health. Consuming less than 10 percent of calories from saturated fats (e.g. shortening or margarine) and replacing them with monounsaturated fats and polyunsaturated fats (e.g. vegetable oils) is associated with lower blood cholesterol levels and therefore lower risk of heart disease. People should also keep their intake of trans fats as low as possible by avoiding foods that include partially hydrogenated oils or other fats that are solid at room temperature.

A CLOSER LOOK Where you least expect it The words “calcium carbonate” in the list of ingredients give it away. If the labels don’t tell you the entire story, the ingredients can fill in the blanks. Ingredients are listed in descending order by weight, which means the first ingredient makes up the largest proportion of the food.

This is actually a supplement that contains calcium and vitamin D — both recommended for strong bones and overall good health.

The chews contain more sugar than either calcium or vitamin D. And the words “hydrogenated coconut oil” may indicate a small amount of trans fat, one of the leading contributors to cardiovascular disease. In addition, although some oils, such as olive and safflower are recognized as healthy fats, coconut oil does not make the list.

The bottom line is: Read all nutrition facts — even on medicines and supplements, and decide what works best for you.

ndy Is it ca tary e or a di ent? m supple

What’s in a name?

Many nutrients go by several different names. Learn to spot the “hidden” ingredients.

SUGARS • Words ending in “ose,” such as fructose and sucrose • Molasses • Honey • Maple syrup and corn syrup • Fruit juice concentrate

SALT • Sodium • Baking soda • Monosodium glutamate (MSG) • Sodium bicarbonate • Sodium phosphate

4. Does the order of the list of ingredients of a product have significance?

Yes. Ingredients are listed by order of weight or volume. For example, if sugar is listed as the first ingredient, then the product has more sugar than any other ingredient.

5. Is it necessary to evaluate the nutrition labels of beverages as well as foods?

Absolutely. Beverages make up a significant percentage of calories consumed. Often we are unaware of those beverage calories. Most people would shy away from eating a food that had 18 teaspoons of sugar; yet a 24 ounce orange soda has 88 grams of carbohydrate, the equivalent of 18 teaspoons of sugar. On the other hand, beverages like skim milk have important nutrients like protein, calcium and vitamin D that positively contribute to our health.

6. How can a person determine the nutrition facts of foods that are not packaged, such as fresh fruits and vegetables?

Food nutrition labels are not required by the government for non-packaged foods like fruits and vegetables. One can find out basic nutrition facts for these and other foods by going to the website: www. nal.usda.gov/fnic/foodcomp/search.

7. Is it necessary to limit the intake of healthful fats such as nuts and olive oil?

Healthful fats found in olive oil and nuts are high in monounsaturated fatty acids (MUFAs). MUFA rich foods aid in preventing heart disease by lowering total blood cholesterol and low density lipoprotein cholesterol (LDL) — especially when they are eaten instead of saturated fats and trans fats. Yet, healthful fats have the same number of calories per gram as unhealthy fats (9 calories per gram). So unlimited intake of all fats will lead to unwanted weight gain if those calories are not burned off with physical activity.

8. If people are advised to limit their daily amount of sugar, does that include naturally occurring sugars, such as fruits and milk?

For most people, naturally occurring sugars, such as those found in fruits, some vegetables and milk, are a pleasant bonus for healthful eating. A healthy diet that contains these foods in the amounts needed for energy and growth is recommended. Persons with diabetes are encouraged to count the grams of carbohydrate in their diets, including the carbohydrate in naturally occurring sugars in fruits, starchy vegetables, grains and dairy products.

The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician.

We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors and make timely visits to your primary care physician.

BE Healthy • http://behealthy.baystatebanner.com 3

Nutrition labels, continued from page 1

sodium, remain unchanged in their percent daily values regardless of calories, while total fat and should be limited in consumption, but the nutrition labels do not indicate this. The vitamins and minerals vary. As an example, if American Heart Association (AHA) recomthe product lists that the serving contains 30 mends limiting total fat each day to about 30 percent of the daily value of total fat, it means percent of total calories and saturated fats to that each serving contains roughly 20 grams of 7 percent of total calories. Cholesterol intake fat. Two servings of the product would bring should not exceed 200 mg — particularly for the percentage to 60 percent and 40 grams of people with cardiovascular disease. Currently, fat. That also means that the remainder of the no upper limit of trans fat has been determined. food you consume that day should not exceed Most health providers 24 grams of total fat to meet the recommenrecommend abstaining completely. dation of less than 65 Too much sodium grams each day. can be harmful to those There is a simple with hypertension, rule of thumb to heart disease or stroke. use whether you are Doctors suggest a trying to limit or limit of 2,300 mg a day increase nutrients. A — about a teaspoon of serving that contains salt. But the Centers for 5 percent or less of Disease Control and the nutrient is considPrevention recommend ered low — a good a daily maximum of thing for sodium; 20 1,500 mg of salt for percent or greater is those with high blood high — a desirable pressure, those over 40 reading for calcium. and all African AmeriPeople tend to can adults. Labels do overlook beverages, not reflect this measure- Stephanie Spaide, M.S., R.D., L.D.N. which are subject to nutrition facts as well. ment, forcing consum- Director, Outpatient Nutritional Services ers to do the math.

It’s almost as though Boston Medical Center calories don’t count if Some nutrients, they are drunk instead on the other hand, are of eaten. It’s often assumed that juices can highly recommended. Experts recommend at be consumed without caution. “Drinking too least 25 grams of dietary fiber each day. Fiber much juice is not a good thing,” Spaide said. is the undigested part of plant foods and helps “It is 100 percent natural and can be a good regulate the gastrointestinal tract. Serving sizes of 5 grams or more of fiber are considered high source of vitamin C, but it is still high in caloin fiber, while good sources of fiber contain 2.5 ries.” She also explained that the popularity of sports drinks doesn’t make them healthier to 4.9 grams. alternatives. “You don’t need a sports drink to In addition to fiber, vitamins, proteins and hydrate,” she said, acknowledging that water calcium are recommended in varying quantity will do just fine. based on age and gender.

Percent daily values describe how much or Think about it. “If you drink a 250 calohow little the nutrients contribute to each servrie drink each day, that results in 25 pounds a ing. There’s a catch though. The values are based year,” she said. on a 2,000 calorie a day diet and require adjustSpaide recognizes that people can bement to accommodate each person’s individual come too zealous in their approach to healthy daily calorie intake. eating. “Too much of a good thing is not Some nutrients, such as cholesterol and always good,” she said. “Calories still count.”

SIZE MATTERS The serving size controls the nutrition facts labels. Cut the serving size in half and the percentage daily values are halved; double it and the percentage daily values are twice as much.

The big trick, however, is recognizing what entails a serving size. More often than not, it does not correspond to the amount of food consumers typically dole out as a serving. It is usually much less.

READ THE LABELS CAREFULLY This raisin bran muffin has 180 calories in each serving. The serving size is one third of the muffin. Eat the whole muffin, add a tablespoon of butter and a glass of orange juice and the calories mount to 854 — more than half of a 1500-calorie a day diet.

BRAN MUFFIN

CANDY BAR

CHIPS Small bags of chips are another case in point. People assume that, because of its size, the entire bag is one serving. Actually, it often contains two or more servings.

This “King Size” candy bar is good enough to eat in one gulp and many people do. But the entire bar contains three servings and a hefty 510 calories, almost half of which is fat.

March is National

Nutrition Month 4 BE Healthy • http://behealthy.baystatebanner.com

A Step-By-Step Approach

1. SERVING SIZE

4. GET ENOUGH OF THESE NUTRIENTS

A serving size of this food is one cup. So all the nutrition information on the label is based upon one cup. There are two servings per container. If you eat two servings the nutrients are doubled.

Eat foods with fiber, vitamin A, vitamin C, calcium and iron to improve overall health and reduce the risk of certain diseases and conditions, such as osteoporosis and anemia.

2. AMOUNT OF CALORIES

This section indicates how the nutrients contribute to your total daily diet based on a 2,000 calorie a day diet.

• Low level of nutrients — 5 percent or less of the daily value. Low levels are good for sodium but bad for fiber.

• High level of nutrient — 20 percent or more.

High values are good for vitamin A but bad for cholesterol.

The 250 calories listed are for one serving, and 110 — or 44 percent — of the calories are from fat.

3. LIMIT THESE NUTRIENTS Don’t eat too much of these nutrients. Fat — especially saturated fat and trans fat — cholesterol and sodium may increase your risk of heart disease, stroke, high blood pressure and some cancers.

Suggested recommendations per day • Total fat — 25 to 35 percent of total calories • Saturated fat — Less than 7 percent of total calories • Trans fat — as little as possible • Cholesterol — Less than 200 milligrams • Sodium — less than 2,400 milligrams a day for most healthy people; less than 1,500 for those with high blood pressure and African American adults

Health claims, continued from page 1

the National Organic Program and must meet standards set by the U.S. Department of Agriculture (DOA). Organic processed products must contain at least 70 percent organic ingredients and list the certifying agent.

According to FDA policy, “natural” products cannot contain synthetic or artificial ingredients. “Healthy” limits the amounts of fat and sodium and requires minimum amounts of vitamins and minerals. Organic products, on the other hand, do not claim to be more nutritious than conventional foods.

That’s where the problem arises. People assume organic or natural is inherently healthy. Not so. Both can be very high in fat or saturated fat, thus failing to meet the standards set by the FDA. Spaide advises to not read too much into such labeling. Claims like natural or healthy often have little merit. “Arsenic is natural,”

5. PERCENT DAILY VALUE

SNAPSHOT OF THIS SERVING What’s bad?

• Low in dietary fiber, vitamin A, vitamin C and iron • High in sodium and calories from fat • Contains saturated and trans fats What’s good?

• High in calcium and potassium • Moderate in number of calories Image courtesy of U.S. Food and Drug Administration

she said.

And low-fat does not mean healthy or lower calories. When a product is lower in one area, it typically means it is higher in another area. “Low fat usually is higher in sugar,” she said.

Another change in nutrition fact labels is underway. In response to a request from first lady Michele Obama, the Grocery Manufacturers Association and the Food Marketing Institute announced the industry’s new “Nutrition Keys,” which will prominently display on the front of packages four basic icons for calories, saturated fat, sodium and sugar.

Spaide said she is all for more information, but warns consumers to read the entire nutrition fact listing that will still appear on the side or back of the package.

“People read what they want to read,” she said.

And sometimes, that might not be good enough.

For more information on health claims, visit www.diabetes.org/food-and-fitness/food/ what-can-i-eat/nutrient-content-claim-and-percentage.htm.l

Comments on Be Healthy? Contact Health Editor Karen Miller at kmiller@bannerpub.com.