FDA Consumer November 1994
 
The New Food Label: Coping with Diabetes
by Paula Kurtzweil
 
This is the third in a series of articles telling how to use the
new food label to meet specific dietary needs.
 
     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.
 
Other Label Benefits
     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. (See
"Nutrition Info Available for Raw Fruits, Vegetables, Fish" in the
January-February 1993 FDA Consumer.)
     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.
 
Diet for Diabetes
     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:
~    Limit fat to 30 percent or less of daily calories.
~    Limit saturated fat to 10 percent or less of daily calories.
~    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
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.
 
Get the Nutrition Facts
     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.
 
Serving Sizes
     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.
 
Calorie and Other Information
     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.
 
Front Label Info
     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. (See "Nutrient Claims
Guide.")
     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:
 
~    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
disease.
     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." n
 
Paula Kurtzweil is a member of FDA's public affairs staff.
 
Nutrient Claims Guide
For Individual Foods
 
Fat
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
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
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
 
Healthy
~    "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.)
 
Calories
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 (two meanings)
~    one-third fewer calories or half the fat of the reference
food--if the food derives 50 percent or more of its calories from
 
More? (yes or no):
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.")
 
Fiber
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
Sugar-free: 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-calorie" claim.)
Reduced sugar: at least 25 percent less sugar than the reference
food
 
--P.K.
 
Special Report
 
     The articles cited in this story, plus others giving in-depth
and easy-to-understand information about the new food label, are
included in an FDA Consumer special report, Focus on Food Labeling.
Copies cost $5 each. To order, send check to: Superintendent of
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Ask for
stock number S/N 017-012-00360-5. n