Pat Coyle, of Rockville, Md., is a 67-year-old woman with
diabetes, vitamin B12-deficiency anemia, and osteoporosis. So she
has to pay attention to her diet. But ask her what she likes most
about the new food label, and you won't hear much about serving
sizes, names of nutrients, and %Daily Values. Instead, you'll get
rave reviews about the print size and background color.
The nutrition information on the new label is in bigger type,
and FDA requires the information to appear on a white or other
neutral contrasting background, when practical.
Those are benefits for Coyle because she has diabetic
retinopathy, an eye condition that can lead to blindness. She
already has had two surgeries to correct poor eyesight. Before the
surgeries, she had trouble reading food labels.
"I needed a magnifying glass to read [the nutrition
information]," she recalls, referring to the small type and shaded
backgrounds on the old labels. "I'm looking forward to not having
to read the teeny tiny print."
For people with diabetes, easily readable labeling information
is vital because diet is important in managing diabetes.
New food labeling regulations that went into effect May 1994 now
require labels on most packaged foods to provide nutrition
information. That previously was voluntary and appeared on only
about 60 percent of such foods.
Also, nutrition information for fresh fruits and vegetables and
raw meat and fish may appear at the point of purchase.
The nutrition information is now more complete. Labels continue
to provide information about calories, fat, carbohydrate, sodium,
protein, iron, calcium, and vitamins A and C. But now they also
contain additional information about saturated fat and cholesterol.
These two nutrients are important to people with diabetes because
diabetes increases the risk of heart disease, and heart disease is
also linked to high intakes of saturated fat and cholesterol.
How beneficial the new label will be for people with diabetes
depends on the type of meal plan they follow. Today, diabetes
experts no longer recommend a single diet for all people with
diabetes. Instead, they advocate dietary regimes that are flexible
and take into account a person's lifestyle and particular health
The American Diabetes Association (ADA) described some common
options in a 1994 position paper. A first step, for example, is to
encourage people with diabetes to follow the government's Dietary
Guidelines for Americans and Food Guide Pyramid.
According to Phyllis Barrier, a registered dietitian and
director of council affairs for ADA, this step alone may be enough
to maintain normal blood glucose, or sugar, levels. Maintaining
these levels helps reduce the risks of retinopathy and other
diabetes-related complications, such as kidney and heart
Other people use the Exchange Lists for Meal Planning, she said.
This system, established by the American Dietetic and American
Diabetes associations, separates foods into six categories based on
their nutritional makeup. People following this plan choose a set
amount of servings from each category daily, depending on their
A more sophisticated method of meal planning is "carbohydrate
counting," in which grams of carbohydrate consumed are monitored
and adjusted daily according to blood glucose levels. Some people
count protein and fat grams, too. These two nutrients also can
affect blood sugar levels, although to a lesser extent.
Whatever method used, ADA recommends these general dietary
guidelines for people with diabetes:
- Limit fat to 30 percent or less of daily calories.
- Limit saturated fat to 10 percent or less of daily
- Limit protein to 10 to 20 percent of daily calories. For those
with initial signs of diabetes-induced kidney disease, restrict
protein to 10 percent of daily calories.
- Limit cholesterol to 300 milligrams or less daily.
- Consume about 20 to 35 grams of fiber daily.
Most of these guidelines are a good idea for the general
population, as well.
Those who are overweight also may moderately restrict calories.
ADA recommends a calorie reduction of 250 to 500 calories less than
normally eaten per day. That should result in a weight loss of
about 0.2 to 0.5 kilograms (one-half to 1 pound) a week, ADA's
Barrier said. The calorie restriction, along with increased
exercise, should help an overweight person achieve a weight loss of
5 to 10 kilograms (11 to 22 pounds) in about six months to one
year. The weight loss, although moderate, can help improve diabetes
Carbohydrate intake can vary, but, contrary to popular belief,
the type of carbohydrate is not a factor. As ADA points out in its
position paper, people with diabetes have for years been told to
avoid "simple" sugars, such as table sugar and those found in
sugary snacks, because they were thought to elevate blood glucose
more quickly and more severely than other carbohydrates.
"There is, however, very little scientific evidence that
supports this assumption," ADA wrote in its position paper. The
organization recommended that the focus be on total
carbohydrate--not source of carbohydrate. If sugar and
sugar-containing foods are eaten, the amounts must be figured into
the daily allotment of carbohydrate.
Considering these factors, how should people with diabetes go
about using the new food label?
They can begin with the Nutrition Facts panel, usually on the
side or back of the package. A column headed % Daily Values shows
whether a food is high or low in many of the nutrients listed.
People with diabetes should check the % Daily Values for fat,
saturated fat, and cholesterol. As a rule of thumb, if the number
is 5 or less, the food may be considered low in that nutrient.
The goal for most people with diabetes is to pick foods that
have low % Daily Values for fat, saturated fat, and cholesterol and
high % Daily Values for fiber. Other label nutrition information
can help people with diabetes see if and how a food fits into their
The serving size information gives the amount of food to which
all other numbers on the Nutrition Facts panel apply.
Serving sizes now are more uniform among similar products and
reflect the amounts people actually eat. For example, the reference
amount for a serving of snack crackers is 30 g. Thus, the serving
size for soda crackers is 10 crackers and for Goldfish Tiny
Crackers, 55, because these are the amounts that come closest to
The similarity makes it easier to compare the nutritional
qualities of related foods.
People who use the Exchange Lists should be aware that the
serving size on the label may not be the same as that in the
Exchange Lists. For example, the label serving size for orange
juice is 8 fluid ounces (240 milliliters). In the exchange lists,
the serving size is 4 ounces (one-half cup) or 120 mL. So, a person
who drinks one cup of orange juice has used two fruit
The Nutrition Facts panel also gives total calories and calories
from fat per serving of food. This is helpful for people who count
calories and monitor their daily percentage of calories from
Here's how to use calories from fat information: At the end of
the day, add up total calories and then calories from fat eaten.
Divide calories from fat by total calories. The answer gives the
percentage of calories from fat eaten that day. For example, 450
calories from fat divided by 1,800 total calories = 0.25 (25
percent), an amount within the recommended level of not more than
30 percent calories from fat.
The label also gives grams of total carbohydrate, protein and
fat, which can be used for carbohydrate counting.
The values listed for total carbohydrate include all
carbohydrate, including dietary fiber and sugars listed below it.
Not singled out is complex carbohydrates, such as starches.
The sugars include naturally present sugars, such as lactose in
milk and fructose in fruits, and those added to the food, such as
table sugar, corn syrup, and dextrose.
The listing of grams of protein also is helpful for those
restricting their protein intake, either to reduce their risk of
kidney disease or to manage the kidney disease they have
Elsewhere on the label, consumers may find claims about the
food's nutritional benefits. Often, they appear on the front of the
package, where shoppers can readily see them. These claims signal
that the food contains desirable levels of certain nutrients.
Some claims, such as "low-fat," "no saturated fat," and
"high-fiber," describe nutrient levels. (See "A Little 'Lite'
Reading," in the June 1993 FDA Consumer.) Some of these are
particularly interesting to people with diabetes because they
highlight foods containing nutrients at beneficial levels.
Other claims, called health claims, show a relationship between
a nutrient or food and a disease or health condition. FDA has
authorized eight such claims; they are the only ones about which
there is significant scientific agreement. (See "Starting This
Month: Look for 'Legit' Health Claims on Foods" in the May 1993 FDA
Two that relate to heart disease are of particular interest to
people with diabetes:
- A diet low in saturated fat and cholesterol may help reduce the
risk of coronary heart disease.
- A diet rich in fruits, vegetables and grain products that
contain fiber, particularly soluble fiber, and are low in saturated
fat and cholesterol may help reduce the risk of coronary heart
Both claims also must state that heart disease depends on many
Nutrient and health claims can be used only under certain
circumstances, such as when the food contains appropriate levels of
the stated nutrients. So now, when consumers see the claims, they
can believe them.
The intent, though, is not just to ensure the label information
is truthful, but also to enable the consumer to use it to choose
healthier foods. For people with diabetes, that's especially
important because of the increased risk of other chronic diseases.
Pat Coyle is one person with diabetes who realizes this.
"I'm looking forward to greater health because I won't have any
excuses," she says. "The information is right there." And, she
adds, "I especially like the large print."
less than 0.5 grams (g) fat per serving
3 g or less per serving and, if the serving size is
30 g or less or 2 tablespoons or less, per 50 g of the food
Reduced or less fat:
at least 25 percent less per serving
than reference food
Saturated fat free:
less than 0.5 g and less than 0.5 g
of trans fatty acids per serving
Low saturated fat:
1 g or less per serving and not more than
15 percent of calories from saturated fatty acids
Reduced or less saturated fat:
at least 25 percent less per
serving than reference food
less than 2 milligrams (mg) and 2 g or
less of saturated fat per serving
20 mg or less and 2 g or less of saturated
fat per serving and, if the serving is 30 g or less or 2
tablespoons or less, per 50 g of the food
Reduced or less cholesterol:
at least 25 percent less than
reference food and 2 g or less of saturated fat per serving
The following claims can be used to describe meat, poultry,
seafood, and game meats:
less than 10 g fat, 4.5 g or less saturated fat,
and less than 95 mg cholesterol per serving and per 100 g
less than 5 g fat, less than 2 g saturated fat,
and less than 95 mg cholesterol per serving and per 100 g
- "low fat," "low saturated fat," with 60 mg or less cholesterol
per serving (or, if raw meat, poultry and fish, "extra lean")
- at least 10 percent of Daily Value for one or more of vitamins
A and C, iron, calcium, protein, and fiber per serving
- 480 mg or less sodium per serving, and, if the serving is 30 g
or less or 2 tablespoons or less, per 50 g of the food. (After Jan.
1, 1998, maximum sodium levels drop to 360 mg.)
fewer than 5 calories per serving
40 or fewer calories per serving and, if the
serving size is 30 g or less or 2 tablespoons or less, per 50 g of
Reduced or fewer calories:
at least 25 percent fewer
calories per serving than the reference food
- one-third fewer calories or half the fat of the reference
food--if the food derives 50 percent or more of its calories from
fat, the reduction must be 50 percent of the fat
- a "low-calorie," "low-fat" food whose sodium content has been
reduced by 50 percent from the reference food
("Light in sodium" means the food has 50 percent or less sodium
than the reference food and may be used on foods that are not
"low-calorie" and "low-fat.")
5 g or more per serving
Good source of fiber:
2.5 g to 4.9 g per serving
More or added fiber:
at least 2.5 g more per serving than
the reference food. (Label will say 10 percent more of the Daily
Value for fiber.)
Foods making claims about increased fiber content also must meet
the definition for "low-fat" or the amount of total fat per serving
must appear next to the claim.
less than 0.5 g per serving
No added sugar, without added sugar, no sugar added:
- no sugar or ingredients that functionally substitute for sugar
(for example, fruit juices) added during processing or packing
- no ingredients made with added sugars, such as jams, jellies,
or concentrated fruit juice
("Sugar-free" and "No added sugar" signal a reduction in
calories from sugars only, not from fat, protein and other
carbohydrates. If the total calories are not reduced or the food is
not "low-calorie," a statement will appear next to the "sugar-free"
claim explaining that the food is "not low-calorie," "not reduced
calorie," or "not for weight control." If the total calories are
reduced, the claim must be accompanied by a "low-calorie" or
Reduced sugar: at least 25 percent less sugar than the reference