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Proposed changes to nutrition labels will help consumers make health choices

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Winnipeg Health Region
Wave, November / December 2014

Like many people, Dorothy Buchanan didn't pay too much attention to the nutritional information on the labels of the packaged foods she purchased at the local grocer.

But when the Winnipeg woman was diagnosed with diabetes and started to experience some challenges with her blood sugar, she decided to take in a few nutrition classes at NorWest Co-op to see what she could learn.

The classes covered a variety of topics, including how to read the nutrition facts table and the ingredients list that are on the label of every packaged food product. "She (the dietitian) explained to us what the nutrition facts meant and how to read it, and what was important to watch for," she says.

That's when Buchanan started to realize that there are some very important differences in the foods she was buying, particularly when it came to sugar and the effect it could have on her blood sugar levels.

"It blows me away," Buchanan says. "When you read the (labels), there is all this stuff . . . I had a hard time finding products that were lower in sugar, and I really had to pay attention."

She was especially surprised to find sugar in some products that she thought were sugar-free. "When I started to read the labels, I was really surprised by the things you didn't expect it (sugar) to be in," she says, referring to the fact that sugar can be found in a variety of products ranging from bread to ketchup.

Now that she is paying more attention to the nutrition information on the labels, Buchanan says she is able to make better choices at the grocery store. In fact, she has told her friends about the label-reading classes at NorWest and the importance of knowing what is in the food they buy. "They went through the classes. They were very informative and helpful." 

The fact that consumers can make better choices if they know what is in their food is not lost on Health Canada. That's why it recently announced a series of proposals designed to enhance the reporting of nutrition information on food products.

Dietitians say it is a step in the right direction. Specifically, they applaud plans for redesigned labels that increase awareness of added sugars in many prepared and packaged foods. And they like aspects of the redesign that will make it easier to compare foods as sources of fibre and of nutrients such as vitamin D and potassium.

"The biggest benefit is improving the consumer's understanding of what the labels actually mean," says Amanda Nash, a registered dietitian who handles community nutrition and northern outreach for the Heart and Stroke Foundation in Manitoba. "There's still a high percentage of consumers who don't understand what labels are saying."

While the nutrition facts table and ingredients list on food product labels will have largely the same appearance as in the past, there are several key changes in the information presented.

One of the most visible is that total calories will now be in a bold and slightly larger font at the top of the nutrition facts table. Another significant change concerns the reorganization of nutrient categories. Just below calories will be a listing of fat, cholesterol, sodium and carbohydrates - essentially grouping together the components that Canadians should be aware of in their diets.

Below this group of nutrients will be those nutrients that Canadians may be trying to get more of: fibre, protein, vitamin D, calcium, iron, and potassium. Here the big changes are the addition of vitamin D and potassium and the elimination of vitamin C and vitamin A. Removal of the latter two is not expected to be a significant matter, as there's no indication that vitamin C and A deficiency is a concern in Canada.

Nutrient content for the vitamins and minerals will be listed both in absolute terms - the number of grams or milligrams of the substance in a serving - and as a percentage of the daily value of that nutrient in an average healthy diet.

Another significant change is an explanatory note at the bottom of the new labels that will put "percentage of daily value" (%DV) in context by explaining that five per cent or less of a daily value in one serving is "a little" and 15 per cent or more is "a lot."

Perhaps one of the more significant changes involves sugar.

Under carbohydrates, the new nutrition facts table will list the amount of total sugar and also the amount of added sugar, whereas previously the table only listed total sugars.

This is important because many dietitians and other health experts worry that Canadians are consuming too much sugar, often without even realizing it.  

This poses a problem because, as outlined in a recent position statement issued by the Heart and Stroke Foundation, there is emerging evidence to suggest that excess sugar consumption is associated with a range of health issues, including obesity, diabetes, high blood cholesterol, heart disease, stroke, cancer and tooth decay.

At the heart of the issue, says Nash, is the difference in how the body digests naturally occurring sugar and added sugar.

"Remember, sugar itself is not evil. It's a carbohydrate that provides energy to the body. It's excess (or added) sugar that can contribute to negative health."

As she explains, naturally occurring sugar is found in a wide range of foods, including fruit, dairy products, grains and some vegetables. It does not pose the same health issue as added sugar because it is accompanied by other nutrients such as fibre and protein that ensure it is digested into the body relatively slowly.

That's not the case with added sugar. Because it is not accompanied by other nutrients, it is digested relatively quickly, causing blood sugar levels to spike, a development that is associated with obesity, heart disease, diabetes and other health conditions.

The issue of added sugar comes into play with many processed or manufactured food products.

Take a tub of plain yogurt. It will have a certain amount of naturally occurring sugar, which is perfectly fine, says Nash.

"You're getting a good source of protein and a good source of calcium, so that's a beneficial food to eat. We want to make sure we include those types of foods in our diet."

But some manufacturers can't resist adding sugar to the yogurt to make it more appealing to consumers.

"With the example of yogurt, some have a lot of extra sugar added - sometimes one serving will have up to two or three teaspoons or more. When we are adding additional sugars, that can be harmful to our health because it is an excess amount," says Nash.

So how much sugar is too much?

It is estimated that the average Canadian gets 21 per cent of their average daily calories from sugar, including 13 per cent from added sugar.

The Heart and Stroke Foundation's position statement suggests Canadians should derive no more than 10 per cent of their daily calories from added sugar. That means the average person consuming 2,000 calories a day would take in about 200 calories from added sugar. That would be the equivalent of 12 teaspoons or 48 grams of sugar, which is only about two teaspoons or eight grams of sugar more than found in a single can of many soft drinks.

"People who consume more than 25 per cent of their daily calories from added sugar have nearly triple the risk of heart disease," says Nash.

At the same time as Health Canada is proposing changes to the nutrition facts table, it is also proposing a new standard for the product ingredient list.

In part, the change is about making the lists easier to read - switching to black ink on a white background and using upper and lower case letters instead of the current all-capitals approach. But the more important change to the ingredients label will be a requirement to list all forms of sugar together, in order to give consumers a better idea of the amount of sugar in a product.

Currently, ingredients are listed from the most plentiful to the least plentiful, but since some prepared foods might have several different kinds of sugar in them, an ingredient list could include separate entries for each of molasses, brown sugar, fructose, and other sugars. By having them all combined together in the ingredient list, consumers will be able to see that in some prepared foods sugars add up to the largest single ingredient.

"The proposed changes to the ingredient list are really good changes," says Coralee Hill, the Clinical Lead Dietitian with Manitoba's Dial-a-Dietitian program, who also says listing the added sugar on the label is a positive change.

"Maybe now that this information is on the label, manufacturers will reformulate their products when people see how much added sugar there is," says Hill.

Adding vitamin D and potassium to the nutrition facts table may increase awareness of the importance of these nutrients. Vitamin D is essential to building and maintaining healthy bones.

"We know that, in most cases, Canadians aren't getting enough vitamin D," says Nash. "According to the Canadian Consumer Health Survey, 75 to 97 per cent of Canadians have vitamin D intake from food alone that is less than the recommended amount."

While most people know sunshine is a natural source of vitamin D, Canada's northern location means that for much of the year, the sun's rays are not direct enough to provide us with the vitamin D we need. Added to that, of course, is that for much of the year Manitobans keep most of their skin covered up to stay warm, resulting in limited exposure to vitamin D.

"If we look at Manitoba, from October to May the sun isn't strong enough," notes Nash.

Potassium is another valuable nutrient that is under-represented in many of our diets. Fewer than 20 per cent of Canadians have potassium intakes above the adequate level, says Nash.

Getting adequate amounts of potassium can reduce high blood pressure and help to reduce the adverse effects of sodium. It can also help to prevent kidney stones. Potassium is naturally found in many fruits, vegetables and dairy products.

In addition to these changes, the nutrition facts table will also include a footnote explaining how to interpret the daily values, which indicate whether the amount of a given nutrient is considered a healthy maximum or minimum, for an individual with a 2,000-calorie daily diet. The explanatory note at the bottom is useful, says Hill, because "some people are really numbers oriented. They want to know, ‘Is two grams of fat a lot or a little?' ‘Is 140 grams of sodium a lot or a little?'" The %DV is most useful for helping consumers compare products.

Based on a 2,000-calorie daily diet, the %DVs flow from Canadian recommendations to limit fat consumption to 65 grams per day, cholesterol to 300 milligrams per day and sodium to 2,400 milligrams per day.

On the other hand, the daily values listed for fibre, sodium and potassium are minimums; you want to consume at least 25 grams of fibre, 3,500 milligrams of potassium, and for most people between the ages of one and 70, 600 international units of vitamin D. (Children under one need 400 IU of vitamin D, whereas people over 70 and pregnant or breast-feeding women need 800 IU.)

Dietitians do express some concerns that the proposed changes could be interpreted by consumers in a misleading way. For example, bold-typing calories may convey to some label-readers the idea that it is most important to select products that are lower in calories, and could encourage people to avoid some nutrient-rich foods, such as nuts, that pack a lot of good nutrition along with calories. "People might select lower calories as a priority over nutrient density," says Hill.

Placing protein along with the other nutrients that consumers may need more of could also convey an impression that consumers need to seek out more protein, she adds. In reality, most Canadians don't have a problem getting enough protein in their diet.

Highlighting vitamin D in a similar way on the label could have unintended consequences.

Hill points out that most foods do not naturally contain vitamin D, so some food manufacturers could find that adding the nutrient to an otherwise not very nutritious product has the effect of making consumers think a particular food is a better choice than it really is.

"Focusing on the overall food and meal quality would be the better approach for consumers," says Hill. "You don't eat food for the nutrients alone. A healthy diet is not about which nutrients you eat or which nutrients you exclude but how you put them all together in the foods you enjoy."

Bob Armstrong is a Winnipeg writer.


About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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