By Belinda O’Connell, MS, RD, CDE, and Laura Hieronymus, MSEd, APRN, BC-ADM, CDE
Eating healthfully and following a meal plan are key components of good diabetes care whether you use oral medicines, insulin, or diet and exercise to manage your diabetes. Knowing how to read a food label can help you choose healthful foods, figure out portion sizes, count carbohydrates, limit sodium or fat, and keep track of calories. Understanding how to use the information found on food labels can also help you to choose foods that meet your vitamin and mineral requirements. In short, being “label-able” can take the guesswork out of healthful eating.
A majority of the prepared foods you find in your local grocery store are required to have a nutrition label. Nutrition labeling of most foods is regulated by the Food and Drug Administration (FDA), under the Nutrition Labeling and Education Act of 1990, which identifies the nutrients that must be listed on food labels, other nutrients that may be listed, allowed health claims, and standard portion sizes. The Act also defines terminology commonly used on labels such as “light,” “low-fat,” and “sodium free.”
Raw, unprocessed fruits and vegetables, meat, fish, and poultry are not required to have nutrition labels, though voluntary labeling is strongly encouraged, and 70% of U.S. food stores provide this information, either by posting it near fresh food displays or by labeling foods such as meats that are packaged in the store. Other foods that are not required to bear nutrition labels include food prepared for immediate consumption such as restaurant, cafeteria, and airplane food; ready-to-eat food prepared primarily on-site, such as bakery store items; foods prepared by some small businesses; and medical foods (special foods prescribed by a physician to manage a disease or health condition). Restaurants that make health claims for certain foods on their menus or in advertising are required to provide nutrition information for those foods.
Nutritional and herbal supplements have Nutrition Facts labels similar to those on packaged foods, but they are regulated by the FDA under a different set of guidelines, the Dietary Supplement Health and Education Act of 1994. Under this act, supplement manufacturers are responsible for making sure dietary supplements are safe before they are marketed and that label information is truthful and not misleading. The FDA has strict guidelines that regulate the types of information and health or nutrition claims allowed on supplement labels.
Nutrition information on food labels can be found in several locations. These include the Nutrition Facts panel, the ingredients list, and other areas of the label where health claims may be displayed.
Your best source of nutrition information is the Nutrition Facts panel, where manufacturers provide serving size information, quantities of specific nutrients, and percent Daily Values (%DV). Nutrient information required on all food labels includes total calories, calories from fat, total fat, saturated fat, cholesterol, sodium, total carbohydrate, dietary fiber, sugars, protein, vitamin A, vitamin C, calcium, and iron. Starting in 2006, disclosure of trans fatty acid (a type of fat) content is required on food labels, though it may not show up on all food products right away.
Nutrient information allowed but not required on nutrition labels includes calories from saturated fat, polyunsaturated fat, monounsaturated fat, potassium, soluble fiber, insoluble fiber, sugar alcohols and other carbohydrates, percent of vitamin A present as beta-carotene (a nutrient found in plant foods that is converted to vitamin A in the body), and other essential vitamins and minerals (those the body cannot make at all or in sufficient quantities to meet its daily needs). If a health claim is made anywhere on the food package about a nutrient that is allowed but not required, that nutrient must be included in the Nutrition Facts panel. No nutrients other than those specifically required or allowed are permitted on the Nutrition Facts panel.
Serving size. The serving size is the portion size for which all of the nutrition information on the food label is based. In the past, serving sizes on labels were determined by individual manufacturers, and they varied a great deal. Today, serving sizes are standardized, and all manufacturers are required to use the same standard portion sizes. Standard serving sizes are based on amounts people typically eat in a single sitting, and they must be provided in both common household measures, such as cups, tablespoons, or slices, and as a weight in grams (g) or volume in milliliters (ml).
If you look at these sample food labels for pizza, you can see that the serving size for the vegetarian pizza is 1 pizza (170 g), while the serving size for the meat pizza is 2 slices (154 g). Even though the pizzas themselves are different sizes, because the nutrition values are calculated for a similar amount of pizza, you can easily compare the fat, calories, and other nutrients in the two products.
Not all foods fit neatly into standard serving size categories, however, so the FDA allows manufacturers to adjust serving sizes and to round off values based on specific guidelines. This means that if you need very precise nutrition information about foods, it is most accurate to weigh foods on a food scale yourself.
A common mistake people make when reading food labels is to confuse the weight of the entire serving of food for the amount of carbohydrate in the food. For example, the total weight of the vegetarian pizza is listed as 170 grams, but only 47 grams are carbohydrate. If you want to know how much carbohydrate is in a serving of a food, be sure to look for “Total Carbohydrate” on the label.
Another common mistake is to assume that the nutrition information listed on the label is for the entire package of food. Sometimes, it is, but often, it is not. To find out how many portions of food a package contains, look at the “Servings Per Container.” If this number is 1, the nutrition information provided is for the whole package, but if this number is greater than 1 and you intend to eat the entire package, you must multiply the amount of fat, cholesterol, sodium, etc., by the number of servings per container to find out how much of these nutrients you will be consuming.
For example, the “Serving Size” for the meat pizza on the sample label is 1/4 pizza, 2 slices (154 g). If you were going to eat the whole pizza, you would be eating four servings, so to figure out the amount of nutrients in your actual serving, you would multiply the nutrition information provided by 4. In this case, one serving has 510 calories and 43 grams of carbohydrate. If you were to eat the entire package, you would be consuming 2,040 calories (4 x 510) and 172 grams of carbohydrate (4 x 43 grams).
Percent Daily Value (%DV). Major nutrients on food labels, such as fat, cholesterol, sodium, carbohydrate, and protein, must be listed as a quantity, in grams or milligrams, and as a percent Daily Value. Percent Daily Values are reference values designed to help people see how a food fits into their overall diet. For example, the amount of fat in one serving of the vegetarian pizza is 9 grams, and the %DV is 14%. This means that one serving of this food provides about one-seventh of a typical person’s recommended maximum daily fat intake, and seven servings would provide 100%. One serving of the meat pizza has 26 grams of fat and provides 40% of a typical person’s daily fat intake, so just 2 1/2 servings would supply an entire day’s recommended maximum fat intake.
The percent Daily Value also provides context for interpreting the quantities of nutrients in a food. For example, you could mistakenly think the meat pizza is a low-fat food, because 26 grams is a relatively small number, but when you look at the %DV, you see that it is actually a high-fat food, since one serving provides 40% of your day’s fat intake. Alternatively, you might think that the vegetarian pizza is a high-sodium food because it has 360 milligrams of sodium, a fairly large number, but when you look at the %DV, you see that one serving provides only 15% of the average person’s recommended daily maximum.
Most of the percent Daily Values on food labels are calculated for someone who needs 2,000 calories a day. (Exceptions are cholesterol, sodium, and vitamin and mineral values, which are the same for all healthy adults, no matter how many calories they eat.) Since you may have higher or lower calorie needs, the percent Daily Values on food labels may not be exactly correct for you. You can still use them to compare foods and to quickly determine the general nutritional quality of a food, but to find your personal nutrient values see “Personalizing the Percent Daily Value.”
Calories. The “Calorie” information tells you the number of calories in one standard serving of the food. (The standard serving size is listed on the label under Serving Size.) Remember, the number of calories in your serving of food will depend on the portion size you actually eat, which may or may not be the same as the standard serving size. To determine the number of calories in your serving of food, measure how much you are eating and compare this to the standard serving size from the food label. If your portion is larger than the standard serving from the food label, you will need to adjust the calories from the food label up to account for your larger portion. If your portion of food is smaller than that listed on the label, you will need to adjust the calories down to account for your smaller portion.
Fat and cholesterol. This section tells you the amount of total fat, saturated fat, and cholesterol provided by one standard serving of food. (Again, if your portion is larger or smaller, you will need to adjust these values accordingly.) On some products, polyunsaturated fat, trans fat, and monounsaturated fat are listed as well. The American Diabetes Association (ADA) recommends that people with diabetes limit their fat intake to less than 30% of calories from fat and less than 10% of calories from saturated fat. (Because trans fats have similar health effects to saturated fats, your combined intake of trans and saturated fats should be less than 10% of your daily calorie intake.)
For example, if your daily calorie needs are 2,000 calories, your daily fat intake should be under 65 grams per day (30% of calories from fat). To figure out how much fat and saturated fat is OK for you, see “Personalizing the Percent Daily Value.”
Sodium. This tells you the amount of sodium in one standard serving of a food. The ADA recommends that people with diabetes keep their daily total sodium intake under 2400 milligrams per day, and, conveniently, the percent Daily Value for sodium is based on 2400 milligrams per day, so it can help you see if a food is a high-sodium or low-sodium food and how easily it will fit into your diet. For example, 1/2 cup of regular chicken noodle soup may have up to 940 mg of sodium, which uses up 39% of your daily sodium intake. Reduced-sodium chicken noodle soup, however, may have only 450 mg of sodium, or 19% of your daily recommended maximum intake, so it is a healthier choice.
Carbohydrate. Understanding how to use carbohydrate information from food labels is particularly important for people with diabetes. The most important number for you to look at in this section is “Total Carbohydrate.” It is listed in bold letters and tells you the amount of carbohydrate, in grams, found in one standard serving of a food. If you count carbohydrates, “Total Carbohydrate” is the number you should use to calculate carbohydrate choices. This is because research shows that most forms of carbohydrate (including starches, processed sugars, sugar from fruit, and sugars in milk) increase blood glucose levels similarly when they are eaten in equal portions. (The exceptions are dietary fiber, “resistant” starches, and sugar alcohols, which have less of an effect on blood glucose than other carbohydrates.) For more on using food labels to determine carbohydrate choices, see “Calculating Carbohydrate Choices.”
Listed under “Total Carbohydrate” are the amounts of the different types of carbohydrate present in the food. These may include Dietary Fiber, Sugars, Sugar Alcohols, and Other Carbohydrates.
Many people are concerned about the amount of sugar they are getting. The amount of “Sugars” on a food label can give you important clues about how generally healthy a food is: Foods that contain a great deal of sugar are generally not good sources of fiber, vitamins, or minerals and may be high in total fat or saturated fat as well. Nonetheless, the number of grams of “Sugars” listed on the food label is not the most important factor to consider when evaluating how a food will affect your blood glucose level. “Total Carbohydrate” will give you a more accurate picture of how a serving of a particular food will affect your blood glucose level.
The “Dietary Fiber” listing on food labels can be used to identify healthier entrées, breads, grains, cereals, sweets, and snack foods. The percent Daily Value for fiber is 25 grams for a 2,000-calorie diet, but most Americans do not get that much fiber on a daily basis. To increase your fiber intake, try to choose breads, grains, and snack foods that provide at least 3 grams of fiber per serving and cereals and entrées that provide 5 or more grams of fiber per serving.
If you are eating a food with more than 5 grams per serving, you can subtract the grams of “Dietary Fiber” from the grams of “Total Carbohydrate” before you calculate the number of carbohydrate choices in your meal. This is done because dietary fiber is not digested and does not increase blood glucose levels.
Many sweets marketed to people with diabetes contain sugar alcohols, such as xylitol, mannitol, and sorbitol. Sugar alcohols have a lower caloric value and raise blood glucose levels less than other forms of carbohydrate, but foods made with sugar alcohols are not necessarily “healthier” or even lower in carbohydrate than foods sweetened with sugar. To determine how a food fits into your meal plan, look at the number of calories and amounts of “Total Carbohydrate,” “Total Fat,” and “Saturated Fat” the food contains. If the food has fewer calories and less carbohydrate and fat than other, similar products, it is probably a better choice, but in many cases, the amounts of “Total Carbohydrate,” “Total Fat,” or other nutrients are not significantly different for foods containing sugar alcohols than for other, similar foods. For example, if you compare the nutrition information for Murray Sugar-Free Fudge Dipped Shortbread Cookies made with sugar alcohols and a grocery store brand of Regular Fudge Dipped Shortbread Cookies made with sugar, you can see the sugar-free version is not necessarily a better choice.
MURRAY SUGAR-FREE FUDGE DIPPED SHORTBREAD COOKIES
(Made with sorbitol)
Serving Size: 5 cookies (29 g)
Total Fat: 7 g
Total Carbohydrate: 20 g
Sugars: 0 g
Sugar Alcohol: 9 g
Number of Carbohydrate Choices: 1
REGULAR FUDGE DIPPED SHORTBREAD COOKIES
(Made with sugar)
Serving Size: 2 cookies (25 g)
Total Fat: 6 g
Total Carbohydrate: 17 g
Sugars: 8 g
Sugar Alcohol: 0 g
Number of Carbohydrate Choices: 1
Since sugar alcohols have a lower caloric value (2–3 calories per gram versus 4 calories per gram for other carbohydrates) and cause a somewhat lower blood glucose response, they are counted somewhat differently from other carbohydrates. If a food contains 5 grams of sugar alcohols or more per serving, you can subtract half the grams of “Sugar Alcohols” from the “Total Carbohydrate” value before calculating the carbohydrate choices in your meal or snack.
Protein. The amount of protein you need is based on your size, calorie needs, and stage of life. The ADA recommends that adults with diabetes get about 10% to 20% of their daily calorie requirement from protein. Most labels do not list a percent Daily Value for protein because most Americans get adequate amounts of protein and it is not considered a nutritional concern, so it does not need to be highlighted on the food label. In general, men need about 60 grams of protein per day, and women need about 45–50 grams of protein per day.
Vitamins and minerals. Labels are required to list vitamin A, vitamin C, calcium, and iron and are allowed to list information about other essential vitamins and minerals. This information is provided only as a percent Daily Value and is the same for all healthy adults. This information can help you make sure you meet the guidelines for intake of these important nutrients. For example, when choosing fruit juice, you can use the percent Daily Values to help you choose the juice that provides the greatest amounts of vitamins and minerals if you don’t get enough of these nutrients elsewhere in your diet. If you look at the two apple juice labels below you can see that Apple Juice A is regular apple juice and has no calcium or vitamin C, but Apple Juice B has been fortified with these nutrients, and one 4-ounce serving provides 100% of the daily vitamin C requirement and 20% of the daily calcium requirement.
APPLE JUICE A
Serving Size: 8 fl oz (240 ml)
Servings Per Container: 8
Total Fat: 0 g
Sodium: 25 mg
Total Carbohydrate: 29 g
Sugars: 26 g
Protein: 0 g
% Daily Value*
Vitamin A: 0%
Vitamin C: 0%
* Percent Daily Values are based on a 2,000 calorie diet.
APPLE JUICE B
Serving Size: 8 fl oz (240 ml)
Servings Per Container: 8
Total Fat: 0 g
Sodium: 40 mg
Total Carbohydrate: 30 g
Sugars: 26 g
Protein: 0 g
% Daily Value*
Vitamin A 0%
Vitamin C 100%
* Percent Daily Values are based on a 2,000 calorie diet.
Additional information about a packaged food can be gleaned from its ingredients list. Ingredients are listed in order of predominance by weight, so the ingredient that makes up the greatest proportion of the food is listed first, and other ingredients are listed in descending order. Reading the ingredients list can be helpful when comparing two products with similar names. For example, you can’t tell from the names of the following two breads which is healthier, but when you look at the ingredients lists, you can see Bread A has whole wheat flour as the first ingredient, and Bread B has wheat flour as the first ingredient. Wheat flour is simply another term for refined white flour, which contains very little fiber. Whole-grain flours, such as whole wheat, are a better choice because they are higher in fiber.
BREAD A: Whole Wheat Bread
Ingredients: 100% stone ground whole wheat flour, water, brown sugar, wheat bran…
BREAD B: Hearty Classic Health Nut Bread
Ingredients: Enriched wheat flour, water, high fructose corn syrup, walnuts, whole wheat flour…
Ingredients lists are particularly useful for people with food allergies. Common allergens such as wheat, milk products, nuts, and eggs are now highlighted in food ingredients lists or noted in a separate statement to simplify identification for consumers.
The Nutrition Facts panel provides information on the quantity of nutrients in foods, such as calories, fat, and fiber, that play a role in major health concerns in the United States. Food manufacturers often attempt to draw consumers’ attention to the amount of fat, sodium, or other nutrients in a food with prominent wording declaring, for example, “Low fat!” To protect consumers from misleading claims, the FDA regulates the way terms such as “low calorie” or “fat free” can be used on labels. These terms have specific definitions to ensure that all manufacturers use them in the same manner. (See “Label Terms” for a list of these terms and their official definitions.)
The FDA also regulates the use of health- or disease-related claims on food labels. A health claim is a statement about the role of a specific nutrient in maintaining health or preventing disease. Since these statements are commonly used by consumers to help them select more healthful foods, only health claims approved by the FDA are allowed on food labels. Foods that carry a health-related claim are required to contain specified levels of nutrients believed to be adequate to bring about the health result described in the claim. (See “Health Claims” for a list of these claims.)
By regulating what and how information is presented on food labels, the FDA has made following a balanced, healthy diet a much more manageable feat. Although individual dietary needs also have to be taken into account, the information on food labels can serve as a valuable tool in helping to determine what to eat and how much of it to eat at a time. So the next time you’re at the grocery store, just remember — you can judge a food by its label.
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