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HEART Insight:
doi: 10.1097/01.HEARTI.0000285627.30997.06
Departments: Nutrition Know-Hows

Making Sense Of Food Nutrition Labels

Papazian, Ruth

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It's Not Easy—But It's Worth the Effort By Ruth Papazian

Joy K. admits that she reads food labels “more closely than most people.” She has to. She is diabetic, has high blood pressure, and needed a stent three years ago.

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She considers herself “pretty knowledgeable” about the ins and outs of food labels. “My focus isn't on calories—although if a product is crazy high for the portion size, I won't buy it,” she says. Instead, she zeroes in on those nutrients that concern her the most —calcium, fiber, saturated and trans fats, cholesterol and sodium. But there is one thing about food labels that complicates her efforts to eat a healthy diet: portion sizes.

“I have a problem with portion sizes when the package looks like a single portion, but is really more than one portion. Like a bag of potato chips that I think is one portion, but turns out to be two or three. If I don't read the label first, then I end up eating more than I should,” says Joy, who gets ticked off when she eats more calories, sodium, saturated or trans fat than she intended to.

If the number of calories on the label is too good to be true, beware, warns Judith Wylie-Rosett, Ed.D., R.D., who heads the Division of Behavioral and Nutrition Research at Albert Einstein College of Medicine in The Bronx, New York.

“If you see a number you like, you might get lulled into forgetting to check the label to see how many servings are in the package for that number of calories,”she explains.

The American Heart Association's most recent diet and lifestyle recommendations advise you to read the nutrition facts panel and ingredients list when shopping, and offer practical tips on applying this information to choose heart-healthy foods.

Wylie-Rosett, a member of the AHA Nutrition Committee that researched and wrote the recommendations, notes vending machines are notorious for serving up packages of snacks that look like a single serving but are at least double that. “You could get a two-ounce bag with nutrition info for a one-ounce serving.”

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Cutting Through The Clutter At The Supermarket

“There's a lot of information on nutrition labels, because of government regulations and because people on therapeutic diets to manage chronic conditions like high blood pressure or diabetes need information specific to them on the label,” says Penny Kris-Etherton, R.D., Ph.D., F.A.H.A., Distinguished Professor of Nutrition at Penn State, University Park, PA.

Even people who don't need to worry about limiting intake of certain nutrients should pay attention to food labels, because “we can prevent diabetes, heart disease, metabolic syndrome and weight gain by eating a healthy diet,” she adds.

“Health claims on food packages are confusing, and it's sometimes hard to reconcile the information on the front of the package with what's on the nutrition facts panel on the back of the package—and food manufacturers know that many people will only read the front of the package,” explains Kris-Etherton, who is also a member of the AHA Nutrition Committee.

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Grocery store shelves are stocked with thousands of products. Many of them are “brand extensions”—the same cereal or snack food, but with the package and nutritional profile tweaked so that one version appeals to shoppers interested in fat-free products and another version appeals to those limiting carbohydrate intake.

Adding another level of complexity, manufacturers often tout health claims on the front of the package. Health claims authorized by the Food and Drug Administration (FDA) are meant to alert shoppers that certain foods, nutrients or ingredients—as part of an overall healthy diet—may reduce the risk of a specific disease.

But the science behind some health claims is stronger than others, and understanding those subtle differences is complicated. Qualifying language around the description of the relationship between the food and the disease is the FDA's way of trying to help consumers see that the science is still developing in that area.

For instance, the link between heart disease risk and dietary saturated fat and cholesterol is on solid ground, according to the FDA. Therefore, the agency allows the front of the package to include such language as: “Diets low in saturated fat and cholesterol may reduce the risk of heart disease.”

In comparison, the evidence on including folic acid, Vitamin B6 and Vitamin B12 to reduce the risk of cardiovascular disease is still emerging, so the statement the FDA allows manufacturers to state on the label is riddled with caveats: “As part of a well-balanced diet that is low in saturated fat and cholesterol, Folic Acid, Vitamin B6 and Vitamin B12 may reduce the risk of vascular disease.”

Time-pressed shoppers have the AHA on their side to cut through the health claim clutter on food labels quickly.

Just look on the label for a red heart with a white check mark. This means the product complies with the AHA's specific Food Certification Program standards for heart-healthy levels of fat (3g or less), saturated fat (1g or less), sodium (480mg or less) and cholesterol (20mg or less) for healthy people over age two.

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The AHA also helps you create a shopping list of heart-healthy foods with an interactive tool on its website at: You can choose your favorite foods by manufacturer or category (bread, snacks, deli meat, for instance), then type the quantity you need, and add it to your list with a click of the mouse.

A really neat feature of the shopping tool is that you can add non-food items to the list, such as laundry detergent and plastic wrap, so everything you want to buy is on a single piece of paper when you head out the door.

The overall AHA recommendations are as follows:

▪Cut back on high calorie bakery products like cake, cookies, doughnuts and muffins, and eat whole (fresh, frozen or canned) fruit instead.

▪When buying frozen and canned fruit and vegetables, choose those without high-calorie sauces or syrups, or added salt and sugars (such as corn syrup, dextrose, fructose, glucose, maltose, and sucrose).

▪Choose whole fruits and vegetables instead of juices, most often.

▪Increase fiber intake by eating beans (legumes), whole grain products (such as barley, brown rice, bulger, corn, oats/oatmeal, popcorn, rye, whole wheat bread), fruits and vegetables.

▪Use liquid vegetable oils in place of solid fats.

▪Limit foods and beverages high in added sugars.

▪Buy fat-free or low-fat milk and dairy products.

▪Reduce salt intake by comparing labels of similar products to see which one is lowest, or by choosing reduced salt products.

▪Buy lean cuts of meat, and limit intake of processed (or deli) meats that are high in salt and fat; also, when possible, choose vegetable-based meat substitutes.

The recommendations “encourage people to cook more of their own food, and to stay away from prepared or processed food as much as possible,” says Wylie-Rosett.

But when harried shoppers can't cook from scratch, the best way to use nutrition information at the supermarket is to “compare like items side by side to find the one that is more nutrient dense for the same number of calories,” says Kris-Etherton. HI

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Why Don't They Make Single-Serving Packages?

A study by Vanderbilt University published in the November 2006 issue of the American Journal of Preventive Medicine backs up Joy's pet peeve on portions-per-package. Researchers found that most people are unable to figure out how to calculate the amount of calories, fat or other important information when the package contains more than one serving—especially if the additional amount is a fractional serving.

Participants in the study—more than 40 percent of whom had diabetes, high blood pressure or another illness that requires dietary restrictions—were asked to figure out the carbohydrate or caloric content of a specific amount of food.

They were also asked to choose which of two foods had more or less of a certain nutrient. Half the questions involved packaging that boasted being “reduced carb,” “low carb,” or meant for those on “a low-carb diet.”

Overall, the participants in the study got a “C,” correctly answering 69 percent of the questions. More often than not, it was simple arithmetic that was the problem—especially fractions.

For example, only one-third of those in the study (32 percent) were able to correctly calculate the amount of calories in a 20-ounce bottle of soda that had 2.5 servings in the bottle. And just four out of 10 could figure out the calories in half a bagel, based on a serving size of a whole bagel.

What's notable about this study is that 68 percent of the participants had at least some college education—but their math skills were less than 9th-grade level, according to the Vanderbilt researchers.

“In the U.S., we do not teach Base-10 math [that is, the decimal system]. Europeans, who use the metric system, are much better in math,” Wylie-Rosett says.

Another advantage of the metric system, she says, is that the unit of measurement—grams—is uniform. In contrast, portion sizes in the U.S. are measured in ounces, teaspoons or quarts, but nutrition information is measured in grams. “This is all very confusing to consumers.”

Kris-Etherton says she would like to see the total number of calories contained in the package “on a large banner on the front.” The study suggests food is not packaged in a user-friendly way, and the FDA really needs to simplify nutrition labels so people don't have to do any math at all, she adds.

© 2007 American Heart Association, Inc.