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Finally … the Revised Nutrition Facts Label! by Jeanne Rosner, MD

Navigating your way through the aisles in the supermarket can be challenging. Did you know that whenever you purchase a processed food item, it is required to have two labels on the exterior of its package: the ingredient list and the Nutrition Facts Label (NFL)? These labels are meant to inform consumers about the food they are purchasing and eating. Click here to read the SI post where I addressed understanding the ingredient lists on processed food items. In May 2016, the FDA published final rules on the new NFL for packaged foods. Manufacturers with $10 million or more in annual sales were required to switch to the new label by January 1, 2020; manufacturers with less than $10 million in annual food sales have until January 1, 2021, to comply. The new labeling is meant to reflect current scientific information, including the link between diet and chronic diseases such as obesity and heart disease. Today I want to delve more deeply into understanding the Nutrition Facts Label. Here is a brief history of how the NFL came to be Prior to 1973, there was a limited amount of processed food on the market and most people were preparing meals at home with whole ingredients. That all began to change in the second half of the 20th century as an increasing number of processed foods started to appear on the market. Consumers began asking for information about what was in those processed foods. In 1973, the Food and Drug Administration (FDA) finalized regulations which specified that when nutrition labeling was present on labels of FDA-regulated foods, it was to include: the number of calories, the grams of protein, carbohydrate and fat, and the percent of the US Recommended Daily Allowance (US RDA) of protein, vitamins A and C, thiamin, riboflavin, niacin, calcium and iron. Sodium, saturated fatty acids and polyunsaturated fatty acids could also be included at the manufacturer’s discretion. All were to be reported on the basis of an average, or usual, serving size.  As scientific knowledge grew concerning the relationship between diet and health, consumers wanted even more information on food labels. Concurrently, many food manufacturers were using the labels for dubious marketing purposes: they were making health claims on their food packages that weren’t scientifically tested. This despite the fact that the FDA has prohibited the explicit discussion of disease or health on food labels since the 1938 passage of the Food Drug and Cosmetic (FD&C) Act. These competing interests both influenced the contents of the new Nutrition Facts Label. Let’s look at the label in detail, starting at the top.

Serving Size: (larger and bolded) This now reflects what people are actually eating and drinking, not the recommended amount people should eat. It’s interesting to note that the quantity of food and drink people consume has changed since the previous serving size requirements were published in 1993. The serving sizes are now bigger, reflecting what people are eating today. As examples, before, one serving of ice cream was ½ cup, now it is ⅔ cup. With respect to soda, one serving was eight ounces; now it is 12 ounces. Realize that everything listed on the NFL is based upon a single (1) serving. This is an important point. Servings per container: Pay attention to the number of servings in the entire can or container. There may be multiple servings. Calories: (larger and bolded) This indicates the total number of calories or energy that is supplied in one serving of the food. % Daily Value: This number represents the percent of the daily value of a given nutrient that is present per serving. The % Daily Value tells you how much a nutrient in a serving of food contributes to a daily diet of 2,000 calories. The daily values on the new labels have been updated to reflect new scientific evidence. Generally, 5% DV, or less, of a given nutrient/serving is considered low. Twenty percent DV, or greater, of a given nutrient/serving is considered high. Added sugar: There is now a separate line item for added sugar. YAY! In the previous NFL, sugars were listed; however, you didn’t know if they were added or natural sugars. To determine the difference, you were required to review the ingredient lists to determine what type of sugar it was. What exactly is an added sugar? An added sugar includes sugars that are included when foods are processed as well as those that are packaged as pure sugar. Sugars from syrups, honey and those from concentrated fruit or vegetable juices are all included. Aim for less than 10% of your total daily calories from added sugars. Vitamin D and potassium: These are now included because many Americans do not get the recommended amount of these nutrients. Vitamins A and C are no longer listed on the label because it is rare for people to be deficient in these vitamins. Aim to get 20% or more of these nutrients: fiber, vitamin D, calcium, iron and potassium. Diets higher in these nutrients can reduce your risk of developing a variety of health conditions such as high blood pressure, cardiovascular disease, osteoporosis and anemia. You can learn more about the health benefits of dietary fiber in this SI post and about the blood pressure benefits of potassium in this SI post. Aim for 5% or less of these nutrients: saturated fat, trans fat, sodium and added sugar. Diets higher in these nutrients are associated with chronic health issues such as high blood pressure and cardiovascular disease.

Image credit: Bernice Wong

Everywhere we look, we are bombarded with processed food images and advertising, from our TVs to billboards, social media, grocery stores and sports games. Here is some advice about how to navigate through the processed food jungle:

  1. Aim to eat more whole food, close to nature. Limit your consumption of processed food.

  2. It is unrealistic to eliminate all processed food; however, be deliberate about what you choose to eat (by reading the labels) and consider the amount of food you eat.

  3. Pay attention to the new “added sugar” line. The current recommendation for women and children 18 years or younger is no more than 25 grams/day. For men, it's 36 grams/day.

  4. Cook more frequently at home using real ingredients.

  5. Keep wholesome, minimally processed snacks handy, such as nuts, fruit and cut vegetables.

  6. Avoid sugar-sweetened beverages. Drink mostly water.

  7. Avoid food items with artificial coloring (e.g., food that can turn your fingers orange [Cheetos] and lips blue [Gatorade]).

  8. When grocery shopping, stay on the perimeter of the store. Most of the processed food items are in the middle of the market.

In general, we should strive to eat the way we did before the latter half of the 20th century—before the era of nutrition labeling. Making whole-food, home-cooked meals the mainstay of our diet would help eliminate the need for food labeling.


Jeanne Rosner, MD

Jeanne Rosner is a board-certified anesthesiologist who practiced pediatric anesthesia at Stanford Medical Center for nearly 20 years. In 2011, she began teaching nutrition classes in her son’s 5th-grade science class. It was an “aha” moment for her. She realized that learning and teaching about nutrition, health and wellness in her community was her destiny.  Since retiring from anesthesia, she has been a nutrition educator at local middle and high schools throughout the Bay Area. She teaches students about the importance of eating food closest to the source, making good food choices and eating in a balanced and moderate way.  Jeanne started SOUL (seasonal, organic, unprocessed, local) Food Salon in 2014. SOUL Food Salon’s mission is to educate and empower people to be healthier. She holds small gatherings (salons) at which experts in the health and wellness community share their knowledge on how to lead a healthier life. Instagram: @soulfoodsalon

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