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 needs.
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 disease.
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 nutritional needs.
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:
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 control.
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 meal plan.
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 30g.
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 exchanges.
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 fat.
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 developed.
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 Consumer.)
Two that relate to heart disease are of particular interest to people with diabetes:
Both claims also must state that heart disease depends on many factors.
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."
Fat-free:
less than 0.5 grams (g) fat per serving
Low-fat:
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
Cholesterol-free:
less than 2 milligrams (mg) and 2 g or
less of saturated fat per serving
Low-cholesterol:
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:
Lean:
less than 10 g fat, 4.5 g or less saturated fat,
and less than 95 mg cholesterol per serving and per 100 g
Extra lean:
less than 5 g fat, less than 2 g saturated fat,
and less than 95 mg cholesterol per serving and per 100 g
Calorie-free:
fewer than 5 calories per serving
Low-calorie:
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
the food
Reduced or fewer calories:
at least 25 percent fewer
calories per serving than 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.")
High-fiber:
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.
Sugar-free:
less than 0.5 g per serving
No added sugar, without added sugar, no sugar added:
("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-calorie" claim.)
Reduced sugar: at least 25 percent less sugar than the reference food
Source:
Adapted from US Food and Drug Administration, 1/00
Last reviewed January 2000 by EBSCO Publishing Editorial Staff
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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