The New Food Label

Better Information for Special Diets

by Paula Kurtzweil

(This is the fifth and last in a series of articles telling how to
use the new food label to meet specific dietary needs.)
       The right diet is important for everyone, but for Tony
Robinson of Orlando, Fla., it truly is his lifeblood.
       Robinson has end-stage renal disease. Three times a week, he
goes to a local medical center, where a dialysis machine does what
his kidneys no longer can: purify his blood.
       Between treatments, he's careful about what he eats because
some nutrients can cause harmful--sometimes deadly--levels of
substances to build up in his blood. He eats a diet low in protein,
sodium and potassium to keep those dangerous substances minimal,
and high in calories to maintain his weight.
       Until recently, he and his wife, who does most of the cooking,
kept mainly to foods listed in a brochure of "foods to eat" and
"foods to avoid" for people with end-stage renal disease. But now
they're using the new food label as another source of information.
       "The new label adds to what we already know," Robinson said.
"And mandatory nutrition labeling gives us the information we need
to choose from a wider range of food products."

Label Benefits
       Under the Nutrition Labeling and Education Act of 1990 and
regulations from the Food and Drug Administration and the U.S.

Department of Agriculture, virtually all food labels must now give
information about a food's nutritional content.
       That wasn't always the case. Until 1994, nutrition information
was voluntary. Manufacturers had to provide it only when a food
contained added nutrients or when nutrition claims appeared on the
label. Nearly 40 percent of products didn't carry nutrition
information.
       "Just to have the information on the label is a big plus for
consumers on therapeutic diets," said Camille Brewer, a registered
dietitian and nutritionist in FDA's Office of Food Labeling.
       Another group the regulations help is people with food
sensitivities. Every product with two or more ingredients must now
list the ingredients on the label. That includes standardized
foods, such as peanut butter, and some baked goods. These foods
previously were exempt from ingredient labeling because at one
time, most Americans were familiar with the recipes since they were
foods routinely prepared at home.
       Also, the source of some ingredients (for example, hydrolyzed
soy protein) must now be identified.

Get the Nutrition Facts
       Consumers looking for nutrition information about a food
should first look at "Nutrition Facts," usually on the side or back
of the package.
       For many people on special diets, the amount of the nutrient
in grams or milligrams is most important because their diets are
based on a set amount of one or more nutrients a day specific to 
their needs--for example, 60 grams (g) of protein, 2,000 milligrams
(mg) of sodium a day. Special dieters can find the amount by weight
of nutrients listed in the top part of the Nutrition Facts panel.
       Some important points about the Nutrition Facts panel: The
values listed for total carbohydrate include all carbohydrates,

including dietary fiber and sugars listed below it.
       The sugars include naturally present sugars, such as lactose
in milk and fructose in fruits, as well as those added to the food,
such as table sugar, corn syrup, and dextrose. The label can claim
"no sugar added" but still have naturally occurring sugar. An
example is fruit juice.
       Also, potassium may be listed voluntarily with the nutrients
listed on the top part of the panel, just below sodium. Its %Daily
Value is based on a recommended intake of 3,500 mg a day.
       Other vitamins and minerals may be listed on the Nutrition
Facts panel, along with vitamins A and C, iron, and calcium.
       Amounts of vitamins and minerals are only presented as
percentages of the Daily Value.
       Calorie information appears at the top of the Nutrition Facts
panel, following serving size information. This information is
important for those needing to increase or decrease their calories.

Serving Size
       The serving size information gives the amount of food to which
all the other numbers on the Nutrition Facts panel apply.
       Now serving sizes are more uniform among similar products and
are designed to reflect the amounts people actually eat. Also,
serving sizes must be about the same for the same types of
products--for example, different brands of frozen yogurt--and for
similar products within a food category--for example, ice cream,
ice milk, and sherbet within the category frozen dairy-type
desserts.
       Having more uniform serving sizes makes it easier to compare
the nutritional values of related foods.
       People who follow special diets should be aware that the
serving size on the label may not be the same as that recommended
for their specific needs. For example, the label serving size for
cooked fish is 3 ounces (84 g). A person following a 60-gram
protein diet may be allowed only 1 ounce (28 g) of fish at a meal.
So, in this case, the nutrient values would have to be divided by
3 to determine the nutritional content of the 1-ounce portion
eaten.

Ingredients
       The ingredient list is a source of information especially
useful for people with food sensitivities. (See Ingredient
Labeling: What's in a Food?" in the April 1993 FDA Consumer.) Some
new requirements that provide more information in the list are:
~      Listing protein hydrolysates by source--instead of "hydrolyzed
vegetable protein," the list must state the type of vegetable (for
example, "hydrolyzed corn protein").
~      Stating FDA food-certified color additives by name--for
example, "FD&C Blue No. 1~ and ~FD&C Yellow No. 6.~ Before, they 
could be listed simply as "colorings."
~      Declaring caseinate as a milk derivative in foods that claim
to be non-dairy, such as coffee whiteners.
       On some labels, the ingredient list may state the source of
sweeteners, too, although this is voluntary. For example, instead
of "dextrose" or "dextrose monohydrate," the ingredient may be
listed as "corn sugar monohydrate."

Nutrient Claims
       Elsewhere on the label, consumers may find claims about the
food's nutrient content. Often, these claims 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-sodium" "high in calcium," or "good
source of fiber," describe nutrient levels. (See "A Little 'Lite'
Reading," in the June 1993 FDA Consumer.) Some, but not all,
highlight foods containing beneficial amounts of nutrients for some
people with special dietary needs. The same claim may warn other
consumers, for whom the nutrient is detrimental, to avoid the
product. For example, a product claiming to be an "excellent source
of potassium" is not a wise buy for a person following a low-
potassium diet. (See "Nutrient Claims Guide for Individual Foods.")

Health Claims
       Health claims describe a relationship between a nutrient or
food and a disease or health-related condition. FDA has authorized
eight such claims; they are the only ones that can be used in a
label. The claims may show a link between:
~      calcium and a lower risk of osteoporosis
~      fat and a greater risk of cancer
~      saturated fat and cholesterol and a greater risk of coronary
heart disease
~      fiber-containing grain products, fruits and vegetables and a
reduced risk of cancer
~      fruits, vegetables and grain products that contain fiber and
a reduced risk of coronary heart disease
~      sodium and a greater risk of high blood pressure
~      fruits and vegetables and a reduced risk of cancer
~      folic acid and a decreased risk of neural tube defect-affected
pregnancy.
       Nutrient and health claims can be used only under certain
circumstances, such as when the food contains appropriate levels of
the stated nutrients.
       The intent of the new food label is not just to ensure that
label information is truthful but to provide more complete and
useful nutrition and ingredient information for consumers' use.
People with special dietary needs will likely find the labeling
changes a welcome bonus.

Paula Kurtzweil is a member of FDA's public affairs staff.


Special Diets
       Label information can help individuals select foods
appropriate for their special dietary needs, determined by a
physician, registered dietitian, or nutritionist. Some medical
conditions that require special attention to diet are:
~      Kidney disease
       For many people whose kidneys have failed or are failing,
protein, potassium and sodium are restricted. The nutrient
phosphorus also may be restricted.
       People undergoing dialysis may be encouraged to eat 20 to 25
grams (g) of fiber daily because fluid restrictions, lack of
exercise, and some kidney medications can cause constipation. The
Daily Value for fiber, which is based on a 2,000-calorie diet, is
25 g.
       Daily Values are reference numbers based on recommended
dietary intakes to help consumers use label information to plan a
healthy diet. (See "'Daily Values' Encourage Healthy Diet" in the
May 1993 FDA Consumer.)
~      Liver disorders
       People with hepatitis, cirrhosis, and other liver diseases
often need a high-calorie, low-protein diet to help rejuvenate the
damaged liver and maintain adequate nutrition. They also may need
to increase their intake of vitamins--particularly folic acid,
vitamin B12, and thiamin--and minerals.
~      Food sensitivities
       According to the Food Allergy Network (a national nonprofit
organization), the most common food allergens are milk, eggs, wheat,
peanuts and other nuts, and soy. The treatment: avoiding the food or foods
containing them.
~      Celiac disease
       This is a genetic disorder in which the body cannot tolerate
gliadin, the protein component of the gluten in wheat, barley, rye,
and oats. So, people with celiac disease must avoid all products
containing these grains--even foods that may contain only small
amounts of the protein, such as vinegar, bouillon, and alcohol-
containing flavorings. The intolerance leads to malabsorption--not
only of the offending food but virtually all nutrients.
~      Cancer
       Because weight loss is common during cancer treatment, many
cancer patients need to increase their calories and protein intake.
       In the case of bowel obstruction--either from surgery,
radiation or the tumor--cancer patients may need to eat less fiber.
But, they may need more if they become constipated.
       To help reduce their risk of developing cancer again,
following treatment, patients may want to choose foods and
nutrients whose role in reducing cancer risk has been borne out by
significant scientific evidence. (See "Look for 'Legit' Health
Claims on Foods" in the May 1993 FDA Consumer.)
~      Bowel Disease
       Increased fiber is often recommended for people with chronic
constipation, irritable bowel syndrome, and diverticulosis. Low-
fiber diets may be called for during flare-ups of these and other
bowel diseases, such as Crohn's disease and ulcerative colitis.
 ~     Osteoporosis
       In osteoporosis, bone mass decreases, causing bones to become
brittle and easily broken, especially in later life. A low-calcium
intake throughout life is thought to be a major risk factor. The
Daily Value for calcium, based on calcium needs for all ages, is
1,000 milligrams. Vitamin D also is important because it aids
calcium absorption. The Daily Value for vitamin D is 400
International Units.

--P.K.

Nutrient Claims Guide
For Individual Foods

Fiber
High-fiber: 5 grams (g) or more per serving
Good source of fiber: at least 2.5 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.)

Protein
High-protein: 10 g or more of high-quality protein per serving
Good source of protein: at least 5 g of high-quality protein per
serving
More protein: at least 5 g more of high-quality protein per serving
than reference food. (Label will say 10 percent more of the Daily
Value for protein.)

Calcium
High-calcium: 200 milligrams (mg) or more per serving
Good source of calcium: at least 100 mg per serving
More calcium: at least 100 mg more than reference food. (Label will
say 10 percent more of the Daily Value for calcium.)

Vitamin D
High in vitamin D: 80 International Units (IU) or more per serving
Good source of vitamin D: at least 40 IU per serving
More or fortified with vitamin D: at least 40 IU more than
reference food. (Label will say 10 percent more of the Daily Value
for vitamin D.)

Special Report
       Articles cited in this story are among those included in the
in-depth and easy-to-understand FDA Consumer special report, Focus
on Food Labeling. Copies cost $5 each. To order, write to:
Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-
7954. Ask for stock number S/N 017-012-00360-5.

