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Health Washing: How Packaged Food Claims Obscure Health Facts

Health Washing: How Packaged Food Claims Obscure Health Facts


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A new study from Vanderbilt University found just how much package labeling influences how consumers purchase food and beverage products.

Take a walk down the aisles of the grocery store, and chances are, most boxes and bags will be prominently labeled “gluten-free,” “good source of protein,” or “made with whole grains,” among other health claims. Whether it's a sugary box of cereal or a canister of almonds, just about every product is designed to alert consumers of the nutrients they do—or don’t—contain.

Still, you might think that you're able to tell what's healthy from what isn't. But according to recent research, that advertising works better than you might think. A new study series from Vanderbilt University found these health claims on packaging really do make us see a product as healthier, even when it isn’t healthy in the slightest.

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The authors of this study noted more than 80 percent of packaged snacks make health-related claims. The FDA’s current regulation of which products are allowed to be considered healthy is pretty light. Essentially, as long as they are low in saturated fat or contain at least 10 percent of just two vitamins—Vitamin D or Potassium—the FDA considers them healthy. And as long as a food contains 10 percent or more of any nutrient, it can be considered a “good source” of that thing. (Under this notion, a Dunkin' Donuts double-chocolate donut can be considered a "good source" of iron.)

The researchers used breakfast cereals as the example for this study, which are notorious for making health claims—did you know Froot Loops are “made with whole grains?” The team created five faux brands of cornflakes with some help from a marketing research group—each box making a different health claim. Then 600 participants were given the job of picking the healthiest option for both weight loss and taste.

Courtesy of Vanderbilt University-Rotterdam School of Management

This study found “natural” claims proved more effective than scientific health claims about the products. Saying a product is “wholesome” or “organic” led more participants to believe the product was healthier than a scientific claim like “gluten-free” or “high protein.”

Interested in learning about our favorite healthy finds?

“People think organic means there’s less fat in it, less sugar, and they have association that extends beyond the actual meaning of the food,” Quentin André, lead author of the study, told Fast Company. “But organic doesn’t mean the food is healthier for you.”

However, André noted the scientific claims did have a strong pull on certain populations. For example, ”high protein” labeling appeals to those who are looking to build muscle or “gluten-free” for those with celiac disease or an apparent gluten sensitivity.

The bottom line: This study highlights the dangerous prevalence of “nutritionism,” which Michael Pollan explains in his 2007 essay, Unhappy Meals. Nutritionism differs from nutrition in that it focuses on a particular characteristic of a food rather than the food itself to determine its health status.

This ideology can easily blur the lines when it comes to processed foods, because many of them (like breakfast cereals) are fortified with a wide variety of nutrients. Just because Cheerios contain more iron than spinach doesn’t mean spinach is the lesser source here!

André (and Cooking Light!) advises ignoring the front label of any product package. Instead, go straight to the nutrition label on the back to determine if a food is healthy. The ingredients list is a sneaky gold mine, as it can show if there are hidden artificial sweeteners not divulged in the nutrition facts label and what the source of fat is for a product, for starters. Here's a quick primer on how to read nutrition labels.


Should You Wash This Food?

We get it: Raw chicken is slimy when it comes out of the package, and you want to wash it off. But according to the USDA, it’s safer to destroy bacteria when you cook it. A recent study looked at people who washed raw poultry for a meal. Sixty percent had bacteria in their sink afterward, and 26% had transferred bacteria to their salad lettuce.


No food is healthy. Not even kale.


Our beloved kale salads are not “healthy.” And we are confusing ourselves by believing that they are. (Deb Lindsey/For The Washington Post)

Not long ago, I watched a woman set a carton of Land O’ Lakes Fat-Free Half-and-Half on the conveyor belt at a supermarket.

“Can I ask you why you’re buying fat-free half-and-half?” I said. Half-and-half is defined by its fat content: about 10 percent, more than milk, less than cream.

“Because it’s fat-free?” she responded.

“Do you know what they replace the fat with?” I asked.

“Hmm,” she said, then lifted the carton and read the second ingredient on the label after skim milk: “Corn syrup.” She frowned at me. Then she set the carton back on the conveyor belt to be scanned along with the rest of her groceries.

The woman apparently hadn’t even thought to ask herself that question but had instead accepted the common belief that fat, an essential part of our diet, should be avoided whenever possible.

Then again, why should she question it, given that we allow food companies, advertisers and food researchers to do our thinking for us? In the 1970s, no one questioned whether eggs really were the heart-attack risk nutritionists warned us about. Now, of course, eggs have become such a cherished food that many people raise their own laying hens. Such examples of food confusion and misinformation abound.

“This country will never have a healthy food supply,” said Harry Balzer, an NPD Group analyst and a gleeful cynic when it comes to the American food shopper. “Never. Because the moment something becomes popular, someone will find a reason why it’s not healthy.”

Here, Balzer used the most dangerous term of all: “healthy.”

We are told by everyone, from doctors and nutritionists to food magazines and newspapers, to eat healthy food. We take for granted that a kale salad is healthy and that a Big Mac with fries is not.


In the 1970s, few questioned the prevailing opinion that eggs were a heart attack waiting to happen. Now they are among our most beloved ingredients. (Mark Gail/The Washington Post)

I submit to you that our beloved kale salads are not “healthy.” And we are confusing ourselves by believing that they are. They are not healthy they are nutritious. They may be delicious when prepared well, and the kale itself, while in the ground, may have been a healthy crop. But the kale on your plate is not healthy, and to describe it as such obscures what is most important about that kale salad: that it’s packed with nutrients your body needs. But this is not strictly about nomenclature. If all you ate was kale, you would become sick. Nomenclature rather shows us where to begin.

“ ‘Healthy’ is a bankrupt word,” Roxanne Sukol, preventive medicine specialist at the Cleveland Clinic, medical director of its Wellness Enterprise and a nutrition autodidact (“They didn’t teach us anything about nutrition in medical school”), told me as we strolled the aisles of a grocery store. “Our food isn’t healthy. We are healthy. Our food is nutritious. I’m all about the words. Words are the key to giving people the tools they need to figure out what to eat. Everyone’s so confused.”

Last March, the Food and Drug Administration sent the nut-bar maker Kind a letter saying their use of the word “healthy” on their packaging was a violation (too much fat in the almonds). Kind responded with a citizens’ petition asking the FDA to reevaluate its definition of the word.

If I may rephrase the doctor’s words: Our food is not healthy we will be healthy if we eat nutritious food. Words matter. And those that we apply to food matter more than ever.

Kraft cheese slices cannot be called cheese but must be labeled “cheese food” or a “cheese product.” Pringles cannot be called “chips” but rather “crisps.” Yet packaged foods can be labeled “natural” or “all-natural” — what exactly is the difference between the two, anyway? — with little regulation.


Pork rinds are an indulgence, sure, but are they “unhealthy”? They’re practically pure protein. (Kate Patterson/For The Washington Post)

Here is a word we think we understand: protein. Protein is good, yes? Builds strong muscles, has positive health connotations. That’s why “protein shakes” are a multibillion-dollar business. Pork cracklings do not have positive health connotations because we think of them as having a high fat content. But pork cracklings are little more than strips of fried pig skin. Skin is one of the many forms of connective tissue in all animal bodies and is composed almost entirely of protein, typically undergirded by a layer of fat. When these strips of pig skin are fried, most of the fat is rendered out and the connective tissue puffs, resulting in a delectable, crunchy, salty crackling. I therefore recommend them to you as a “protein snack” during your on-the-go day.

Given the infinitely malleable language of food, it’s no wonder American food shoppers are confused.

What is “mechanically separated meat,” a standard ingredient in the turkey bacon and chicken sausages popularized because of our low-fat love? “Do you know what that is?” a grocery store owner asked me. “They basically put poultry carcasses in a giant salad spinner.” Whatever winds up on the walls of the spinner in addition to meat — bits of cartilage (protein!), nerves (I have enough of my own, thank you), vessels, bone fragments — is scraped off and added to the mixing bowl. “Mechanically separated meat” engages our imagination only when someone attaches new words to it, such as “pink slime.”


The label might tell you it’s “enriched,” but it doesn’t tell you that the bread’s ingredients were first stripped of their natural benefits. (PAUL J. RICHARDS/Agence France-Presse/Getty Images)

“Refined” is another critical food word. Generally, refined means elegant and cultured in appearance, manner or taste, or with impurities removed. Yet that is what food companies have been calling wheat from which the germ and bran have been removed, leaving what is in effect pure starch, devoid of the fiber, oils, iron and vitamins that make wheat nutritious.

That’s not refined, Sukol said, “that’s stripped.” Flour stripped of the nutrition that makes it valuable to our bodies but reduces shelf life.

Because it has been stripped, we must “enrich” it. “Enriched.” “Fortified.” Good, yes? To make rich, to make strong. Food companies added the iron they took out during the refining process, but not enough of what we need. “Refined flour — this resulted in B vitamin and iron deficiencies,” Sukol said, “so they added vitamins and iron. And what do they call that? Enriched and fortified. But they forgot to add folate, vitamin B9, until the 1990s.”

What we don’t know, Sukol said, is how those additions, not to mention the diglycerides and sulphates, combined with the lack of fiber, will affect our metabolism in the long run. So far, she said, “it has resulted in diabetes and metabolic syndrome.”

We will be healthy if we eat nutritious food. Our food is either nutritious or not. We are healthy or we are not. If we eat nutritious food, we may enhance what health we possess.

This is not a judgment on what you choose to eat. If you hunger for a cheese product grilled between bread that’s been stripped of its nutrition, along with a bowl of Campbell’s tomato soup (made with tomato paste, corn syrup and potassium chloride), fine. It was one of my favorite childhood meals. Just be aware. Buy fat-free half-and-half if that’s what you like just know what it is you’re putting in your body and why.

Because, and this is the judgment call, fat isn’t bad stupid is bad. And until we have better information and clearer shared language defining our food, smart choices will be ever harder to make.

Ruhlman is the author of many books, including “Ruhlman’s How to Roast” and the recent collection of novellas “In Short Measure.” He blogs and can be reached at ruhlman.com. He will join Wednesday’s Free Range chat at noon at live.washingtonpost.com.

Correction: A previous version of this article mistakenly said that refined wheat has had the endosperm and bran removed. In fact, the germ and bran have been removed, and the endosperm remains.


Authorized Health Claims That Meet the Significant Scientific Agreement (SSA) Standard

Authorized health claims in food labeling are claims that have been reviewed by FDA and are allowed on food products or dietary supplements to show that a food or food component may reduce the risk of a disease or a health-related condition. Such claims are supported by scientific evidence and may be used on conventional foods and on dietary supplements to characterize a relationship between a substance (a specific food component or a specific food) and a disease or health-related condition (e.g., high blood pressure). The Nutrition Labeling and Education Act of 1990 (NLEA) directed FDA to issue regulations providing for the use of health claims. All health claims must undergo review by the FDA through a petition process.

To be approved by the FDA as an authorized health claim, there must be significant scientific agreement (SSA) among qualified experts that the claim is supported by the totality of publicly available scientific evidence for a substance/disease relationship. The SSA standard is intended to be a strong standard that provides a high level of confidence in the validity of the substance/disease relationship.

To learn more about authorized health claims and qualified health claims, visit Questions and Answers: Authorized and Qualified Health Claims in Food Labeling.

Guidance

Electronic Submissions

Approved Health Claims

Calcium, Vitamin D, and Osteoporosis

Dietary Lipids (Fat) and Cancer

Dietary Saturated Fat and Cholesterol and Risk of Coronary Heart Disease

Dietary Non-cariogenic Carbohydrate Sweeteners and Dental Caries

Fiber-containing Grain Products, Fruits and Vegetables and Cancer

Folic Acid and Neural Tube Defects

Fruits and Vegetables and Cancer

Fruits, Vegetables and Grain Products that contain Fiber, particularly Soluble fiber, and Risk of Coronary Heart Disease

Sodium and Hypertension

Soluble Fiber from Certain Foods and Risk of Coronary Heart Disease


2. Pass the Salt, Again and Again and Again

Most of the sodium in our diet comes from salt added to processed and restaurant foods. But our testing revealed that there’s loads of sodium hiding in the dishes you find in the prepared meals department, Keating says.

Mini turkey meatloaves from The Fresh Market were mini salt licks: 891 milligrams in 6 ounces. And who would guess that a cup of the chain’s delicate lemon orzo was a salt bomb, with 938 milligrams per serving? That’s about 40 percent of the daily recommended limit of 2,300 milligrams per day. How about the vegetarian eggplant rollatini (635 milligrams) or spicy tuna rolls (834 milligrams in 6 ounces)?

The health consequences of overdosing on sodium are serious. Too much boosts the risk of high blood pressure, which in turn raises the risk of heart disease and stroke. To get a sense of the amount of sodium in a healthful-sounding entrée, download a nutrition information app such as Calorieking.com, Buch suggests. You won’t find data for specific dishes, but the estimates for items like meatloaf or Asian noodles will at least be in the right ballpark, she says.


A claim that a food is low in energy, and any claim likely to have the same meaning for the consumer, may only be made where the product does not contain more than 40 kcal (170 kJ)/100 g for solids or more than 20 kcal (80 kJ)/100 ml for liquids. For table-top sweeteners the limit of 4 kcal (17 kJ)/portion, with equivalent sweetening properties to 6 g of sucrose (approximately 1 teaspoon of sucrose), applies.

ENERGY-REDUCED

A claim that a food is energy-reduced, and any claim likely to have the same meaning for the consumer, may only be made where the energy value is reduced by at least 30%, with an indication of the characteristic(s) which make(s) the food reduced in its total energy value.

A claim that a food is energy-free, and any claim likely to have the same meaning for the consumer, may only be made where the product does not contain more than 4 kcal (17 kJ)/100 ml. For table-top sweeteners the limit of 0,4 kcal (1,7 kJ)/portion, with equivalent sweetening properties to 6 g of sucrose (approximately 1 teaspoon of sucrose), applies.

A claim that a food is low in fat, and any claim likely to have the same meaning for the consumer, may only be made where the product contains no more than 3 g of fat per 100 g for solids or 1,5 g of fat per 100 ml for liquids (1,8 g of fat per 100 ml for semi-skimmed milk).

A claim that a food is fat-free, and any claim likely to have the same meaning for the consumer, may only be made where the product contains no more than 0,5 g of fat per 100 g or 100 ml. However, claims expressed as 'X % fat-free' shall be prohibited.

LOW SATURATED FAT

A claim that a food is low in saturated fat, and any claim likely to have the same meaning for the consumer, may only be made if the sum of saturated fatty acids and trans-fatty acids in the product does not exceed 1,5 g per 100 g for solids or 0,75 g/100 ml for liquids and in either case the sum of saturated fatty acids and trans-fatty acids must not provide more than 10% of energy.

SATURATED FAT-FREE

A claim that a food does not contain saturated fat, and any claim likely to have the same meaning for the consumer, may only be made where the sum of saturated fat and trans-fatty acids does not exceed 0,1 g of saturated fat per 100 g or 100 ml.

A claim that a food is low in sugars, and any claim likely to have the same meaning for the consumer, may only be made where the product contains no more than 5 g of sugars per 100 g for solids or 2,5 g of sugars per 100 ml for liquids.

A claim that a food is sugars-free, and any claim likely to have the same meaning for the consumer, may only be made where the product contains no more than 0,5 g of sugars per 100 g or 100 ml.

WITH NO ADDED SUGARS

A claim stating that sugars have not been added to a food, and any claim likely to have the same meaning for the consumer, may only be made where the product does not contain any added mono- or disaccharides or any other food used for its sweetening properties. If sugars are naturally present in the food, the following indication should also appear on the label: 'CONTAINS NATURALLY OCCURRING SUGARS'.

LOW SODIUM/SALT

A claim that a food is low in sodium/salt, and any claim likely to have the same meaning for the consumer, may only be made where the product contains no more than 0,12 g of sodium, or the equivalent value for salt, per 100 g or per 100 ml. For waters, other than natural mineral waters falling within the scope of Directive 80/777/EEC, this value should not exceed 2 mg of sodium per 100 ml.

VERY LOW SODIUM/SALT

A claim that a food is very low in sodium/salt, and any claim likely to have the same meaning for the consumer, may only be made where the product contains no more than 0,04 g of sodium, or the equivalent value for salt, per 100 g or per 100 ml. This claim shall not be used for natural mineral waters and other waters.

SODIUM-FREE or SALT-FREE

A claim that a food is sodium-free or salt-free, and any claim likely to have the same meaning for the consumer, may only be made where the product contains no more than 0,005 g of sodium, or the equivalent value for salt, per 100 g.

NO ADDED SODIUM/SALT

A claim stating that sodium/salt has not been added to a food and any claim likely to have the same meaning for the consumer may only be made where the product does not contain any added sodium/salt or any other ingredient containing added sodium/salt and the product contains no more than 0,12 g sodium, or the equivalent value for salt, per 100 g or 100 ml.

SOURCE OF FIBRE

A claim that a food is a source of fibre, and any claim likely to have the same meaning for the consumer, may only be made where the product contains at least 3 g of fibre per 100 g or at least 1,5 g of fibre per 100 kcal.

A claim that a food is high in fibre, and any claim likely to have the same meaning for the consumer, may only be made where the product contains at least 6 g of fibre per 100 g or at least 3 g of fibre per 100 kcal.

SOURCE OF PROTEIN

A claim that a food is a source of protein, and any claim likely to have the same meaning for the consumer, may only be made where at least 12% of the energy value of the food is provided by protein.

HIGH PROTEIN

A claim that a food is high in protein, and any claim likely to have the same meaning for the consumer, may only be made where at least 20% of the energy value of the food is provided by protein.

SOURCE OF [NAME OF VITAMIN/S] AND/OR [NAME OF MINERAL/S]

A claim that a food is a source of vitamins and/or minerals, and any claim likely to have the same meaning for the consumer, may only be made where the product contains at least a significant amount as defined in the Annex to Directive 90/496/EEC or an amount provided for by derogations granted according to Article 6 of Regulation (EC) No 1925/2006 of the European Parliament and of the Council of 20 December 2006 on the addition of vitamins and minerals and of certain other substances to foods[1].

HIGH [NAME OF VITAMIN/S] AND/OR [NAME OF MINERAL/S]

A claim that a food is high in vitamins and/or minerals, and any claim likely to have the same meaning for the consumer, may only be made where the product contains at least twice the value of ‘source of [NAME OF VITAMIN/S] and/or [NAME OF MINERAL/S]’.

CONTAINS [NAME OF THE NUTRIENT OR OTHER SUBSTANCE]

A claim that a food contains a nutrient or another substance, for which specific conditions are not laid down in this Regulation, or any claim likely to have the same meaning for the consumer, may only be made where the product complies with all the applicable provisions of this Regulation, and in particular Article 5. For vitamins and minerals the conditions of the claim 'source of' shall apply.

INCREASED [NAME OF THE NUTRIENT]

A claim stating that the content in one or more nutrients, other than vitamins and minerals, has been increased, and any claim likely to have the same meaning for the consumer, may only be made where the product meets the conditions for the claim ‘source of’ and the increase in content is at least 30% compared to a similar product.

REDUCED [NAME OF THE NUTRIENT]

A claim stating that the content in one or more nutrients has been reduced, and any claim likely to have the same meaning for the consumer, may only be made where the reduction in content is at least 30% compared to a similar product, except for micronutrients, where a 10 % difference in the reference values as set in Directive 90/496/EEC shall be acceptable, and for sodium, or the equivalent value for salt, where a 25% difference shall be acceptable.

The claim "reduced saturated fat", and any claim likely to have the same meaning for the consumer, may only be made:

(a) if the sum of saturated fatty acids and of trans-fatty acids in the product bearing the claim is at least 30% less than the sum of saturated fatty acids and of trans-fatty acids in a similar product and

(b) if the content in trans-fatty acids in the product bearing the claim is equal to or less than in a similar product.

The claim "reduced sugars", and any claim likely to have the same meaning for the consumer, may only be made if the amount of energy of the product bearing the claim is equal to or less than the amount of energy in a similar product.

A claim stating that a product is ‘light’ or ‘lite’, and any claim likely to have the same meaning for the consumer, shall follow the same conditions as those set for the term ‘reduced’ the claim shall also be accompanied by an indication of the characteristic(s) which make(s) the food 'light' or 'lite'.

NATURALLY/NATURAL

Where a food naturally meets the condition(s) laid down in this Annex for the use of a nutritional claim, the term 'naturally/natural' may be used as a prefix to the claim.

SOURCE OF OMEGA-3 FATTY ACIDS

A claim that a food is a source of omega-3 fatty acids, and any claim likely to have the same meaning for the consumer, may only be made where the product contains at least 0,3 g alpha-linolenic acid per 100g and per 100kcal, or at least 40mg of the sum of eicosapentaenoic acid and docosahexaenoic acid per 100g and per 100kcal.

HIGH OMEGA-3 FATTY ACIDS

A claim that a food is high in omega-3 fatty acids, and any claim likely to have the same meaning for the consumer, may only be made where the product contains at least 0,6 g alpha-linolenic acid per 100 g and per 100 kcal, or at least 80 mg of the sum of eicosapentaenoic acid and docosahexaenoic acid per 100 g and per 100 kcal.

HIGH MONOUNSATURATED FAT

A claim that a food is high in monounsaturated fat, and any claim likely to have the same meaning for the consumer, may only be made where at least 45% of the fatty acids present in the product derive from monounsaturated fat under the condition that monounsaturated fat provides more than 20% of energy of the product.

HIGH POLYUNSATURATED FAT

A claim that a food is high in polyunsaturated fat, and any claim likely to have the same meaning for the consumer, may only be made where at least 45% of the fatty acids present in the product derive from polyunsaturated fat under the condition that polyunsaturated fat provides more than 20% of energy of the product.

HIGH UNSATURATED FAT

A claim that a food is high in unsaturated fat, and any claim likely to have the same meaning for the consumer may only be made where at least 70% of the fatty acids present in the product derive from unsaturated fat under the condition that unsaturated fat provides more than 20% of energy of the product.


Pasta Sauce

Winner: The Silver Palate Low Sodium Marinara. Even though both products mention sodium in their names, the Prego sauce, with 360 mg, has more than twice the amount in The Silver Palate’s Marinara, which has 115 mg.

This is an example of how sodium claims can be confusing. “Lower sodium” means only that the food has 25 percent less sodium than a similar food, such as the company’s regular version. “Low sodium” is a government-defined standard: 140 mg or less per serving. And though The Silver Palate sauce may be low in sodium, it's not low in flavor. In CR’s recent pasta sauce tests, our sensory panelists (who test for taste and texture) found that it tasted of fresh tomato and garlic, with hints of onion, fresh basil, and olive oil. Prego’s smooth, thick sauce is highly cooked, and its slightly sweet taste includes notes of dried oregano and hints of onion and garlic.


Food Labels

The nutrition facts label on your favorite breakfast cereal tells you it's full of vitamins and minerals. So it must be healthy, right?

Just because a food is high in vitamins doesn't mean it's healthy overall. Sure, it's great that your favorite cereal gives you a shot of vitamins and minerals. But what if it's also loaded with sugar?

Eating healthy means choosing lots of different types of food throughout the day to get all the nutrients you need, such as vitamins, minerals, carbohydrates, fiber, and &mdash yes &mdash even fat.

So how do you figure all this out? Thank goodness for food labels!

Your Cheat Sheet to Good Eats

Labels give you information that can help you decide what to choose as part of an overall healthy eating plan. For example, it may be OK to eat a sugary cereal if you make up for it by not eating much sugary stuff for the rest of the day. Checking the labels on foods can alert you when a food is high in something like sugar so you can be prepared to make tradeoffs.

Food labels provide more than just nutrition facts, though. They also tell you what's in a packaged food (i.e., the ingredients). Some food labels also state which country the food came from, whether the food is organic, and certain health claims.

So who decides what information goes on a food label? In the United States, it's the Food and Drug Administration (FDA) and the Department of Agriculture (USDA). These agencies require that all food labels show the same nutrition and health information. This allows consumers to compare different foods and make the choices that are right for them.

The FDA and USDA regulate any health claims that companies make on their food labels. When a food says "light" ("lite") or "low fat" on the label, it must meet strict government definitions in order to make that claim. Foods that are labeled "USDA organic" are required to have at least 95% organic ingredients.

Making Food Labels Work for You

The first step in making food labels work for you is to look at the entire label. If you focus on only one part &mdash like calories or vitamins &mdash you may not be getting the full story, like how much sugar or fat is in the product. (Check out our mac and cheese example below to see why the full story is important.)

Serving Size

Always start with the serving size amount. That's because all the information on the rest of the label &mdash from calories to vitamins &mdash is based on that amount.

Take note of how much a serving is (e.g., 1 cup, 8 oz). Sometimes a serving size will be way less than you're used to eating &mdash like only half a cup of cereal. So make sure you check what it is!

The label will also list how many servings are in the package. Even things that seem like they'd be a single serving, such as a bottle of juice or packet of chips, may contain more than one serving. If you eat or drink the whole thing, you're getting more vitamins and minerals but you're also getting way more calories, sugar, fat, and other stuff that you might not want.

Calories

A calorie is a way to measure how much energy a food provides to your body. The number on the food label shows how many calories are in one serving of that food. To get a rough idea of how many calories you need to eat each day, check out the personalized plan calculator on the U.S. government's ChooseMyPlate website.

The calories from fat number tells you how many calories in that serving come from fat. For most people, about 30% of all the calories they eat in a day should come from fat. So if you eat 2,000 calories a day, about 600 of these calories should come from fat.

More Stats to Know

Percent Daily Value

These percentages show the amounts of nutrients an average person will get from eating one serving of that food. For the purposes of food labels, the government chose an "average" person as someone who needs 2,000 calories a day. So if the label on a particular food shows it provides 25% of vitamin D, that 25% is for a person who eats 2,000 calories a day.

The percent daily value information can be complicated. But one thing it makes easy is showing at a glance if a food is high or low in a particular nutrient. Here's how:

  • If a food has a daily value of 5% or less of a nutrient, it is considered to be low in that nutrient.
  • A food is a good source of a nutrient if the percent daily value is between 10% and 19%.
  • If the food has 20% or more of the daily value, it is considered an excellent source of that nutrient.

Total fat shows how much fat is in a single serving of food. Although eating too much fat can lead to obesity and health problems, our bodies do need some fat every day. Fats are an important source of energy and provide insulation and cushioning for the skin, bones, and internal organs. Fat also distributes and helps the body store certain vitamins.

Fat is usually measured in grams. A good rule of thumb for keeping to the 30% calories from fat rule is to check the label and choose foods that have less than 3 grams of fat or less for every 100 calories in a serving.

Some fats are better than others. Unsaturated fats, which are found in vegetable oils, nuts, and fish, are often called "good fats." That's because they don't raise cholesterol levels like saturated fats and trans fats do. Both saturated and trans fats are considered "bad" because they can increase a person's risk for developing heart disease. These types of fat are solid at room temperature (picture them clogging your arteries).

Saturated fats usually come from animal products like cheese, meats, and ice cream. Trans fats are naturally found in these foods too, but they are also in vegetable oils that have been specially treated (hydrogenated) so they are solid at room temperature &mdash like shortening. The amount of saturated and trans fats that are in a food are shown below total fat on the nutrition facts label. Less than 10% of calories should come from saturated fats and try to keep trans fats as low as possible.

Cholesterol

Cholesterol isn't entirely bad for you &mdash it's important to production of vitamin D and some hormones, and to building many other substances in the body. The liver manufactures most of the cholesterol a person needs, but cholesterol is also found in the foods we eat.

Blood cholesterol comes in two major types: HDL (the "good" kind) and LDL (the "bad" kind). Too much LDL cholesterol in a person's blood increases the risk of heart disease. So it's a good idea for even teens to watch how much cholesterol they eat, along with saturated and trans fats, which tend to raise levels of LDL cholesterol in the blood.

More Stats to Know (continued)

Sodium

Sodium is a component of salt. Almost all foods contain sodium because it adds flavor and helps preserve food. Processed, packaged, and canned foods usually have more sodium than freshly made foods.

Small amounts of sodium keep proper body fluid balance. Sodium also helps the body transmit electrical signals through nerves. But too much sodium can increase water retention and blood pressure in people who are sensitive to it.

Total Carbohydrate

This amount covers all carbohydrates, including fiber and sugar. The best sources of carbohydrates are fruits and vegetables, along with whole-grain foods like cereals, breads, pasta, and brown rice. Most of your daily calorie intake should come from carbohydrates.

Sugars are found in most foods. When a food contains lots of sugar, the calories can add up quickly. Soda, snack foods and other foods that are high in added sugar are considered "empty calories" because they usually don't offer a lot of other nutrients.

Sugars are listed separately under Total Carbohydrates. Checking sugar quantities on labels can be really eye opening. Often there's way more than you'd expect. For example, sometimes manufacturers cut back on fat but add sugar to keep a food tasting good. With a little label study, you may notice that some low-fat foods have nearly as many calories as their regular versions.

Fiber

Fiber is not digested and helps keep your digestive system healthy. Fiber can also help reduce cholesterol levels. Best of all, fiber has no calories and it can help you feel full. So check the label and pick foods that have at least 3 grams of fiber per serving.

Protein

Most of the body &mdash including muscles, skin, and the immune system &mdash is made up of protein. If the body doesn't get enough fat and carbohydrates, it can use protein for energy. So be sure the foods you eat give you some protein.

Vitamins and Minerals

It goes without saying that you want to choose foods that are high in a variety of vitamins and minerals. The FDA requires food manufacturers to include information about vitamin A, vitamin C, calcium and iron. Sometimes you'll see other important vitamins and minerals listed on the label, especially if the product contains significant amounts. Some vitamins &mdash like vitamin C &mdash are water soluble, which means that the body can't store them so they need to be consumed daily.

Food labels can't tell you what foods to eat &mdash that's your decision! But they can help you find foods that taste good and treat your body right.


Functional Foods

Magazine articles and news reports tout the benefits of "functional foods," which they claim can do everything, from reducing cholesterol to preventing cancer. At the grocery store, you'll find plenty of foods and beverages with similar health benefits advertised on their packaging - but what is a functional food exactly?

Most foods are functional. Food may provide protein for muscle repair, carbohydrates for energy or vitamins and minerals for cell function. But in the 1980s, the Japanese government created a class of "functional foods" that included additional health benefits beyond those covered by basic nutrition.

In the United States, the Food and Drug Administration, or FDA, regulates functional foods and label claims that appear on foods and beverages. Examples of claims include those promoting the role of dietary fiber for heart health or advertisements that a product is &ldquolite&rdquo or reduced in sodium or fat. Although the FDA defines terms, such as &ldquoreduced sodium&rdquo and &ldquolow-fat,&rdquo there is currently no legal definition for functional food. This leaves American consumers to evaluate the claim on their own. Focusing on the Nutrition Facts Label and ingredients list can help you determine if a food is a healthful choice.

Functional foods cover a variety of foods. Minimally processed, whole foods along with fortified, enriched or enhanced foods, can all be functional foods. Generally, these foods have a potentially beneficial effect on health when consumed on a regular basis and at certain levels.

Another area that is often questioned is food fortification &mdash when products include added vitamins and other nutrients. Fortified foods can have a place in a healthy eating plan. Some may help to provide nutrients that might be low or missing. For example, there are only a few foods that naturally contain vitamin D, so products that are fortified with it, such as milk, are a main source of vitamin D for many people. Other foods and beverages may be fortified with nutrients that are easier to obtain. Some fortified products may also contain high amounts of added sugars or sodium, so be sure to review the Nutrition Facts Label.

When possible, consider focusing on minimally processed, functional foods to provide a variety of nutrients to help meet your needs. Some examples might include.

  1. Fish
    Fatty fish, like salmon, sardines, trout and herring, are among some of the best choices. They are lower in mercury and have higher amounts of omega-3 fatty acids, which may help lower risk of heart disease and improve infant health when consumed by women during pregnancy or while breastfeeding. About eight ounces of seafood a week is a good goal for adults, which amounts to two meals per week.
  2. Unsalted Nuts
    They make a great snack, help you feel full and may help promote heart health. Bonus: most unsalted nuts, including cashews and almonds, are good sources of magnesium, which plays a role in managing blood pressure.
  3. Whole Grains
    Oatmeal receives plenty of recognition for its dietary fiber, an under consumed nutrient of public health concern in the United States. It may help lower cholesterol and assist with blood sugar control. Other whole grains, such as whole barley, farro and buckwheat, also offer a variety of health benefits.
  4. Beans
    Beans provide dietary fiber, as well as protein, potassium and folate. While canned beans are fine, look for those with no salt added. If you do choose beans with salt added, rinse and drain them before use, which reduces sodium significantly.
  5. Berries
    Whether you opt for strawberries, cranberries, blueberries, raspberries or blackberries - berries are wonderful functional foods. Not only are they low in calories, their anthocyanin pigments, which give them color, may offer health benefits. If you can't get fresh berries, frozen unsweetened berries are a healthful choice, too.

A healthful eating style, which includes a variety of foods from each food group, prepared in a healthful way, can help you meet your nutrient needs and reduce your risk for various chronic diseases. Focus on fruits and vegetables, whole grains, lean protein foods and low-fat or fat-free dairy products. For more information on functional foods or developing an eating plan that is right for you, find a registered dietitian nutritionist in your area.


Achievements in Public Health, 1900-1999: Safer and Healthier Foods

During the early 20th century, contaminated food, milk, and water caused many foodborne infections, including typhoid fever, tuberculosis, botulism, and scarlet fever. In 1906, Upton Sinclair described in his novel The Jungle the unwholesome working environment in the Chicago meat-packing industry and the unsanitary conditions under which food was produced. Public awareness dramatically increased and led to the passage of the Pure Food and Drug Act (1). Once the sources and characteristics of foodborne diseases were identified--long before vaccines or antibiotics--they could be controlled by handwashing, sanitation, refrigeration, pasteurization, and pesticide application. Healthier animal care, feeding, and processing also improved food supply safety. In 1900, the incidence of typhoid fever was approximately 100 per 100,000 population by 1920, it had decreased to 33.8, and by 1950, to 1.7 (Figure 1). During the 1940s, studies of autopsied muscle samples showed that 16% of persons in the United States had trichinellosis 300-400 cases were diagnosed every year, and 10-20 deaths occurred (2). Since then, the rate of infection has declined markedly from 1991 through 1996, three deaths and an average of 38 cases per year were reported (3).

Nutritional sciences also were in their infancy at the start of the century. Unknown was the concept that minerals and vitamins were necessary to prevent diseases caused by dietary deficiencies. Recurring nutritional deficiency diseases, including rickets, scurvy, beri-beri, and pellagra were thought to be infectious diseases. By 1900, biochemists and physiologists had identified protein, fat, and carbohydrates as the basic nutrients in food. By 1916, new data had led to the discovery that food contained vitamins, and the lack of "vital amines" could cause disease. These scientific discoveries and the resulting public health policies, such as food fortification programs, led to substantial reductions in nutritional deficiency diseases during the first half of the century. The focus of nutrition programs shifted in the second half of the century from disease prevention to control of chronic conditions, such as cardiovascular disease and obesity.

Perishable foods contain nutrients that pathogenic microorganisms require to reproduce. Bacteria such as Salmonella sp., Clostridium sp., and Staphylococcus sp. can multiply quickly to sufficient numbers to cause illness. Prompt refrigeration slows bacterial growth and keeps food fresh and edible.

At the turn of the 20th century, consumers kept food fresh by placing it on a block of ice or, in cold weather, burying it in the yard or storing it on a window sill outside. During the 1920s, refrigerators with freezer compartments became available for household use. Another process that reduced the incidence of disease was invented by Louis Pasteur--pasteurization. Although the process was applied first in wine preservation, when milk producers adopted the process, pasteurization eliminated a substantial vector of foodborne disease (see box, page 907). In 1924, the Public Health Service created a document to assist Alabama in developing a statewide milk sanitation program. This document evolved into the Grade A Pasteurized Milk Ordinance, a voluntary agreement that established uniform sanitation standards for the interstate shipment of Grade A milk and now serves as the basis of milk safety laws in the 50 states and Puerto Rico (4).

Along with improved crop varieties, insecticides and herbicides have increased crop yields, decreased food costs, and enhanced the appearance of food. Without proper controls, however, the residues of some pesticides that remain on foods can create potential health risks (5). Before 1910, no legislation existed to ensure the safety of food and feed crops that were sprayed and dusted with pesticides. In 1910, the first pesticide legislation was designed to protect consumers from impure or improperly labeled products. During the 1950s and 1960s, pesticide regulation evolved to require maximum allowable residue levels of pesticides on foods and to deny registrations for unsafe or ineffective products. During the 1970s, acting under these strengthened laws, the newly formed Environmental Protection Agency (EPA) removed DDT and several other highly persistent pesticides from the marketplace. In 1996, the Food Quality Protection Act set a stricter safety standard and required the review of older allowable residue levels to determine whether they were safe. In 1999, federal and state laws required that pesticides meet specific safety standards the EPA reviews and registers each product before it can be used and sets levels and restrictions on each product intended for food or feed crops.

Newly recognized foodborne pathogens have emerged in the United States since the late 1970s contributing factors include changes in agricultural practices and food processing operations, and the globalization of the food supply (Table 1). Seemingly healthy food animals can be reservoirs of human pathogens. During the 1980s, for example, an epidemic of egg-associated Salmonella serotype Enteritidis infection spread to an estimated 45% of the nation's egg-laying flocks, which resulted in a large increase in egg-associated foodborne illness within the United States (6,7). Escherichia coli O157:H7, which can cause severe infections and death in humans, produces no signs of illness in its nonhuman hosts (8). In 1993, a severe outbreak of E. coli O157:H7 infections attributed to consumption of undercooked ground beef (9) resulted in 501 cases of illness, 151 hospitalizations, and three deaths, and led to a restructuring of the meat inspection process. The most common foodborne infectious agent may be the calicivirus (a Norwalk-like virus), which can pass from the unwashed hands of an infected foodhandler to the meal of a consumer. Animal husbandry and meat production improvements that have contributed to reducing pathogens in the food supply include pathogen eradication campaigns, the Hazard Analysis and Critical Control Point (HACCP) programs (10), better animal feeding regulations (11), the use of uncontaminated water in food processing (12), more effective food preservatives (13), improved antimicrobial products for sanitizing food processing equipment and facilities, and adequate surveillance of foodhandling and preparation methods (14). HACCP programs also are mandatory for the seafood industry (15).

Improved surveillance, applied research, and outbreak investigations have elucidated the mechanisms of contamination that are leading to new control measures for foodborne pathogens. In meat-processing plants (16), the incidence of Salmonella and Campylobacter infections has decreased. However, in 1998, apparently unrelated cases of Listeria infections were linked when an epidemiologic investigation indicated that isolates from all cases shared the same genetic DNA fingerprint approximately 100 cases and 22 deaths were traced to eating hot dogs and deli meats produced in a single manufacturing plant (17). In 1998, a multistate outbreak of shigellosis was traced to imported parsley (18). During 1997-1998 in the United States, outbreaks of cyclosporiasis were associated with mesclun mix lettuce, basil/basil-containing products, and Guatemalan raspberries (19). These instances highlight the need for measures that prevent food contamination closer to its point of production, particularly if the food is eaten raw or is difficult to wash (20).

Any 21st century improvement will be accelerated by new diagnostic techniques and the rapid exchange of information through use of electronic networks and the Internet. PulseNet, for example, is a network of laboratories in state health departments, CDC, and food regulatory agencies. In this network, the genetic DNA fingerprints of specific pathogens can be identified and shared electronically among laboratories, enhancing the ability to detect, investigate, and control geographically distant yet related outbreaks. Another example of technology is DPDx, a computer network that identifies parasitic pathogens. By combining PulseNet and DPDx with field epidemiologic investigations, the public health system can rapidly identify and control outbreaks. CDC, the Food and Drug Administration, the U.S. Department of Agriculture (USDA), other federal agencies, and private organizations are enhancing food safety by collaborating in education, training, research, technology, and transfer of information and by considering food safety as a whole--from farm to table.

The discovery of essential nutrients and their roles in disease prevention has been instrumental in almost eliminating nutritional deficiency diseases such as goiter, rickets, and pellagra in the United States. During 1922-1927, with the implementation of a statewide prevention program, the goiter rate in Michigan fell from 38.6% to 9.0 % (21). In 1921, rickets was considered the most common nutritional disease of children, affecting approximately 75% of infants in New York City (22). In the 1940s, the fortification of milk with vitamin D was a critical step in rickets control.

Because of food restrictions and shortages during the first world war, scientific discoveries in nutrition were translated quickly into public health policy in 1917, USDA issued the first dietary recommendations based on five food groups in 1924, iodine was added to salt to prevent goiter. The 1921-1929 Maternal and Infancy Act enabled state health departments to employ nutritionists, and during the 1930s, the federal government developed food relief and food commodity distribution programs, including school feeding and nutrition education programs, and national food consumption surveys.

Pellagra is a good example of the translation of scientific understanding to public health action to prevent nutritional deficiency. Pellagra, a classic dietary deficiency disease caused by insufficient niacin, was noted in the South after the Civil War. Then considered infectious, it was known as the disease of the four Ds: diarrhea, dermatitis, dementia, and death. The first outbreak was reported in 1907. In 1909, more than 1000 cases were estimated based on reports from 13 states. One year later, approximately 3000 cases were suspected nationwide based on estimates from 30 states and the District of Columbia. By the end of 1911, pellagra had been reported in all but nine states, and prevalence estimates had increased nearly ninefold (23). During 1906-1940, approximately 3 million cases and approximately 100,000 deaths were attributed to pellagra (24). From 1914 until his death in 1929, Joseph Goldberger, a Public Health Service physician, conducted groundbreaking studies that demonstrated that pellagra was not infectious but was associated with poverty and poor diet. Despite compelling evidence, his hypothesis remained controversial and unconfirmed until 1937. The near elimination of pellagra by the end of the 1940s (Figure 2) has been attributed to improved diet and health associated with economic recovery during the 1940s and to the enrichment of flour with niacin. Today, most physicians in the United States have never seen pellagra although outbreaks continue to occur, particularly among refugees and during emergencies in developing countries (25).

The growth of publicly funded nutrition programs was accelerated during the early 1940s because of reports that 25% of draftees showed evidence of past or present malnutrition a frequent cause of rejection from military service was tooth decay or loss. In 1941, President Franklin D. Roosevelt convened the National Nutrition Conference for Defense, which led to the first recommended dietary allowances of nutrients, and resulted in issuance of War Order Number One, a program to enrich wheat flour with vitamins and iron. In 1998, the most recent food fortification program was initiated folic acid, a water-soluble vitamin, was added to cereal and grain products to prevent neural tube defects.

While the first half of the century was devoted to preventing and controlling nutritional deficiency disease, the focus of the second half has been on preventing chronic disease with initiation of the Framingham Heart Study in 1949. This landmark study identified the contribution of diet and sedentary lifestyles to the development of cardiovascular disease, and the effect of elevated serum cholesterol on the risk for coronary heart disease. With increased awareness, public health nutrition programs have sought strategies to improve diets. By the 1970s, food and nutrition labeling and other consumer information programs stimulated the development of products low in fat, saturated fat, and cholesterol. Since then, persons in the United States have significantly decreased their dietary intakes of total fat from approximately 40% of total calorie intake in 1977-1978 to 33% in 1994-1996, approaching the recommended 30% (26) saturated fat intake and serum cholesterol levels also have decreased (27). Prevention efforts, including changes in diet (28) and lifestyle and early detection and improved treatment, have contributed to impressive declines in mortality from heart disease and stroke (29).

Populations with diets rich in fruits and vegetables have a substantially lower risk for many types of cancer. In 1991, the National Cancer Institute and the Produce for Better Health Foundation launched a program to encourage eating at least five servings of fruits and vegetables daily. Although public awareness of the "5 A Day" message has increased, only approximately 36% of persons in the United States aged greater than or equal to 2 years achieved the daily goal of five or more servings of fruits and vegetables (28). A diet rich in fruits and vegetables that provide vitamins, antioxidants (including carotenoids), other phytochemicals, and fiber is associated with additional health benefits, including decreased risk for cardiovascular disease.

The most urgent challenge to nutritional health during the 21st century will be obesity. In the United States, with an abundant, inexpensive food supply and a largely sedentary population, overnutrition has become an important contributor to morbidity and mortality in adults. As early as 1902, USDA's W.O. Atwater linked dietary intake to health, noting that "the evils of overeating may not be felt at once, but sooner or later they are sure to appear--perhaps in an excessive amount of fatty tissue, perhaps in general debility, perhaps in actual disease" (30). In U.S. adults, overweight (body mass index [BMI] of greater than or equal to 25 kg/m2) and obesity (BMI greater than or equal to 30 kg/m2) have increased markedly, especially since the 1970s. In the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), the crude prevalence of overweight for adults aged greater than or equal to 20 years was 54.9%. From 1976-1980 (NHANES II) to 1988-1994 (NHANES III), the prevalence of obesity increased from 14.5% to 22.5% (31).

Overweight and obesity increase risk for and complications of hypertension, hyperlipidemia, diabetes, coronary heart disease, osteoarthritis, and other chronic disorders total costs attributable to obesity are an estimated $100 billion annually (32). Obesity also is a growing problem in developing countries where it is associated with substantial morbidity and where malnutrition, particularly deficiencies of iron, iodine, and vitamin A, affects approximately 2 billion people. Increasing physical activity in the U.S. population is an important step (33), but effective prevention and control of overweight and obesity will require concerted public health action.

As the U.S. population ages, attention to both nutrition and food safety will become increasingly important. Challenges will include maintaining and improving nutritional status, because nutrient needs change with aging, and assuring food quality and safety, which is important to an older, more vulnerable population. Continuing challenges for public health action include reducing iron deficiency, especially in infants, young children, and women of childbearing age improving initiation and duration of breastfeeding improving folate status for women of childbearing age and applying emerging knowledge about nutrition on dietary patterns and behavior that promote health and reduce risk for chronic disease. Behavioral research indicates that successful nutrition promotion activities focus on specific behaviors, have a strong consumer orientation, segment and target consumers, use multiple reinforcing channels, and continually refine the messages (34). These techniques form a paradigm to achieve public health goals and to communicate and motivate consumers to change their behavior.

Reported by: Environmental Protection Agency. United States Department of Agriculture. Center for Food Safety and Applied Nutrition, Food and Drug Administration. Div of Nutrition Research Coordination, National Institutes of Health. National Center for Health Statistics National Center for Environmental Health National Center for Infectious Diseases National Center for Chronic Disease Prevention and Health Promotion, CDC.

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TABLE 1. Newly recognized pathogens identified as predominantly foodborne