Friday, June 27, 2014

How to include cereal in your diet

Earlier this week I caught a segment on CNBC in which the hosts were discussing falling prices for cereal stocks.  The analysts mentioned General Mills and Kellogg by name and noted that the companies were seeking to expand their market share by introducing new products to their portfolios.  One of the analysts, originally from the UK, recalled his surprise at the American’s reliance on cold cereal as a breakfast staple.  He then opined about the changing preferences of Americans - turning away from “all that sugar and those carbs.”  He added a dig about the use of the term ‘all natural’ to indicate that people were less likely to be fooled into thinking that anything in a box was natural.  I found little to disagree with, but there was this one thing… it is not carbs that are the problem but the type of carbs found in cold cereal.  Try as cereal producers may with the ‘whole grain’ caveat, breakfast cereals are packed full of refined carbs, mostly sugar, and thus are calorie dense, nutrient poor, and not very satiating.  Tasty?  Oh YES, filling, no.

So do I eat cereal?  You betcha!   I LOVE cereal.  It reminds me of a happy sugar, laden childhood.  But I am a nutrition savvy grown up now and I have found that when there is something I like so much I want it often, then it has to be a low calorie food or a calorically safe dose (for my own calorie vs nutrient needs) of a high calorie food.  Every night I have maybe a  ¼ cup of almond milk and cereal combined; it’s a tiny serving, maybe three teaspoons full.  Sounds crazy right?  Maybe not.  What if I told you that it was chocolate that I loved and craved every day?  I have a friend who does and she buys a package of Hershey miniatures and has one piece as a treat, every day.  That Hershey miniature has around 45 calories, and my itty-bitty cereal bowl has about the same.  

My educated understanding of energy balance and dietary guidance is that each person has energy needs (calorie amounts) unique to himself/herself and the unique amount is very complicated to calculate.  If your weight has been stable for some time and you can accurately track your calorie intake, you might figure out what your daily energy requirement is - to maintain your weight.  That is not my area of expertise and not the point I wish to make.  Meaning, I am digressing.

Within a person’s unique amount of necessary calories, there are nutritional requirements for optimum health leaving little room for discretionary calories (like chocolates and refined carbs).  I never preach ‘everything in moderation’ because 1) I don’t believe it and 2) I don’t think I can do it.  But, I do tell people when they ask about me, that I consider my overall needs, which change based on my activity level, when deciding what to eat.  Within those needs I make space for my wants and cravings.  One of those wants is a little bit of cereal - only at night and only as a snack. (Ok, not true, sometimes I sprinkle a little All Bran or Kashi on my ice cream or yogurt (oh, you know that they are light versions!)).   

It would take multiple normal size bowls of cold cereal for me to feel like I had breakfast, but that would give me about 200 more calories than usual and they would be nutrient poor calories at that.  (Note, I am referring to cold cereals.  I do have loose oat bran (cooked in water) with almond milk for breakfast at least once a week.) 

All that being said, breakfast cereals are neither the main source nor even a top source of sugar in the diet.  Click here to see information from the RUDD Center on sources of added sugar in the diet.

Saturday, June 21, 2014

Popcorn - Nutrition Labels and SES

In a study currently published in the journal Appetite, researchers Crockett, Jebb, Hankins and Marteau (2014) tested the effect of a low fat and a high fat label placed on a bucket of popcorn and the amount of calories consumed.  In other words, will the amount of popcorn calories be different based on whether a person has a low fat, high fat or no label?  In the study, the researchers also tested to see if there was a relationship between a persons’ BMI; concern about their weight (either they said that they were dieting to lose weight or that they were trying to maintain their weight); or their socioeconomic status (a combined measure of educational attainment and income, which in this case was ascertained by zip code, so more of a neighborhood SES).  The researchers looked at two way (e.g., did the effect of the label play out differently based on whether or not someone was concerned about their weight) and three way (e.g., did the outcome depend on whether a person was concerned about their weight, but only if that person was also low SES (i.e., poor)) interactions. 

The study took place in the UK, and though the researchers did what they could to mask the experiment (i.e., they told people that they were assessing how emotion affects taste), it was still unnatural (i.e., 1) they knew they were in a study and that researchers were going to collect the popcorn buckets at the end, and 2) they had to fill out a questionnaire at 3 time  points during their stay at the cinema).  Nonetheless, and taken with a little popcorn salt, the findings were interesting.

First, the use of labels in general, a RED high fat or a GREEN low fat did not change consumption.  Whether a person got a bucket of popcorn with no label, a red label or a green, they ate on average 549 calories if it was toffee flavored and 242 calories if it was salt flavored (from this I am guessing butter was not involved!).  There was not an interaction between label and BMI or label and weight concern.  So for the basic question of whether labeling led to a difference in the amount of calories consumed, segmenting people based on BMI or weight concern didn’t change the outcome - there was no effect.

However, when looking at 3 way interactions, the researchers found some interesting paradoxes ~ though not necessarily new ones.  SES does seem to matter when you also consider weight concern.  Interestingly, a person who was concerned about their weight and was more affluent ate more popcorn when they had a low fat label than a similar person who was not concerned about their weight.  The higher SES person who was concerned about their weight ate MORE with a low fat label; on the other hand, a low SES person who was concerned about their weight ate less popcorn whether the label said low fat or high fat.  In other words, when they had a popcorn with a label on it, they ate LESS than if they had a popcorn without a label.  The researchers expect that the label is a prompt - a reminder that calories matter. 

What does all this mean?  Well, you have to answer that question for yourself and do read the study if you are so inclined, because I am not sure that I interpreted everything correctly.  My thought, much in line with the researchers, is that nutrition labeling can work, but we need to understand more about how it works and for whom.  I also think that the type of label is of utmost importance.  I did not like these  because low or high fat doesn't tell you anything about calories.

Friday, June 13, 2014

Will the Supreme Court Do What the FDA Won't? Legitimize Food Labels.

POM Wonderful, LLC the maker of POM pomegranate juice has been trying to sue Coca Cola for false advertising because its Minute Maid drink called Pomegranate Blueberry Flavored Blend of 5 juices (really that is the name) only contains a trace amount of pomegranate and blueberry juice, in fact less than 1%.   POM Wonderful sells juice blends and 100% juices; it sells 100% blueberry POM and 100% pomegranate POM, and a pomegranate blueberry blend.  The label for the blend clearly notes that it is 85% pomegranate and 15% blueberry.  Thus, the company wants to sue because they believe that Coca Cola is -by way of their label - drawing customers away from the POM blend. There is nothing on the Pomegranate Blueberry Flavored Blend of 5 juices label that indicates how much of the blend is pomegranate and how much is blueberry, but clearly most of it is something else.  I think POM has a fair point.

You can see the court brief here.  The concern about the law suit is whether its the FDA that is supposed to do something - is Coca Cola breaking any label laws under their jurisdiction (no) - because if so, then the private company cannot, or if it isn't the FDA's responsibility then can a private company sue another under the Lanham Act even if this seems like an FDA related labeling issue.  The decision by the US Supreme Court, which is being talked about a lot today, was that POM Wonderful can go ahead and sue Coca Cola.  

I think that is good.

I understand also that POM has an FTC labeling issue to contend with - a 'false' health claim - and that same issue is likely to hit Coca Cola whose juice drink label purports "brain nourishment".

Some public health advocates, consumer activists and business attorneys consider the courts decision to be a potential game changer.  Me, too.  I have bemoaned the, capricious at best, actions of the FDA on food labeling for years.  Two examples are 1) The FDA is not moving forward with restaurant menu labeling which was passed 4 years ago and 2) they are not putting any teeth into definitions for food labels, such as All Natural.  That is why I see this as a game changer.  If companies or activist organizations like CSPI can sue over label issues - false, misleading, opaque - then companies in their cross hairs will CHANGE.  I imagine that big businesses have the resources and motivations necessary to go after their competitors, and I expect that consumers want to be told the truth.  There is a huge difference between 85% pomegranate juice and 0.3% pomegranate juice.

Now, lest you think I have had a change of heart about juice, I assure you I have not.  Many of the juices sold by Coca Cola/Minute Maid are only 25% juice and contain calorically dense high fructose corn syrup; but even 100% juice is high in calories and light on fiber/substance.  Though I am 100% in favor of FRUIT and 0% in favor of fruit juices, I am 110% in favor of truth in labeling.

Friday, June 6, 2014

What does a sunscreen label tell you?

In preparation for discussing the new sunscreen labels, I reviewed a post I wrote a year ago - here - and found that I really don't have new news. The labels do contain new language and unresolved issues are still unresolved.  But at least the labels are now on the products.

I will proceed with the post because as someone who can barely function on cloudy days, sun protection is very important to me.  It is also important because my job as a health educator is to remind people to be safe and smart about their time in the sun.  Evidence does support a link between sun exposure, especially sun burn, and skin cancer and early skin aging.*  (FYI: shoe hide skin is not becoming and your skin will become shoe hide like if you don't protect it.)

When you spend time in the sun:

wear sunscreen, and
make sure that the label says both of these things:
  • broad spectrum
  • SPF 30 (or more)
It is also good if the sunscreen has a seal from the Skin Cancer Foundation,** of which there are several types:
  • Daily Use
  • Active
  • International
  • Traditional
Click here to get the definitions straight from the source, but in case you don't click, I'll provide a brief rundown: the daily use is for people who are exposed to the sun for short bursts of time in their everyday life, for example, going from the car to a store, checking the mail, etc.  Active use is the seal I look for and it is for extended periods of sun exposure while engaging in outdoor recreation, like running, cycling, walking the beach. The international seal is for outside the US and is a little different than the daily and active seal I just described, but it is undergoing a revision so I don't have more details.  Lastly, the traditional seal is for products that block the sun (e.g., glasses, hats) that are not sunscreen.  All products which carry the Skin Cancer Foundation (SCF) seal have undergone rigorous testing (the manufacturer submits data to the scientific advisory committee at SCF). Not all of the products that have passed the 'test' have the seal on their label.  You can search for recommended products, by category here.  Although in my store visit yesterday, I did not see any spray-on products with the seal, I did see some on the SCF website. 

The new label on sunscreen - where the manufacturer uses terms like broad spectrum and includes the SPF factor - may also say that the product protects against skin cancer and early skin aging.  The reason the manufacturers can make this claim (as long as its SPF greater that 15 and broad spectrum) is because the company has to provide scientific evidence to the FDA that the product offers broad spectrum protection and spf 15 or higher, and those two factors have been empirically tested in regards to the protection they offer against skin cancer and early skin aging (think wrinkles). 

In addition, the label will now tell you how long you can wear the sunscreen while swimming or sweating before the sunscreen needs to be reapplied.  In other words, the sunscreen can be water resistant, but that declaration has to come with a time frame that has been tested.

The issue of  whether or not SPF protection over 50 is possible, has not been resolved, nor has the issue about spray-on sunscreens (they may not cover the body completely and may have toxic fumes).  However, any sunscreen with SPF under 15 has to have a warning that it does NOT protect you from either sun damage or skin cancer.  

I echo the sentiments of many others when I say, use lotion not spray, choose between SPF 30 and 50 and reapply every two hours, but I add this caveat.. . unless you are employed as an outside worker, 2 hours of direct sun a day is bordering on too much.  You need more than sunscreen  - long sleeves, hats, sunglasses for example.

I ran out of my sunscreen last weekend.  I had the spray-on kind, but after reading that the concerns about the fumes and full body protection continue, I opted for a lotion this time.  I agree that SPF 30 is sufficient.  I did choose a product with the SCF Recommendation Active.  Here are photos of my label.  Notice the information about how long this lotion is expected to protect me.

You can see the broad spectrum and SPF declarations and that this lotion is water resistant with the 80 minutes in parenthesis.  I have read that it might be a good idea to avoid oxybenzone, so I like that this product is free of it.  (Oxybenzone may have endocrine effects (related to hormone secretion/disruption)).  I later noticed that this compound is in the sunscreen lotion I recently purchased for my face. This  bothers me.  However, there is no scientific consensus on oxybenzone risks and               many dermatologist still                                                                       recommend it.  Read more here and here.)

The SCF seal is on the back of the bottle.  In the section that begins, Sun Protection Measures, is the language about sun exposure and risk for cancer and early skin aging and how products with broad spectrum and spf + 15 can protect against this risk.

*Epstein, J. H. (1983). Photocarcinogenesis, skin cancer, and aging. Journal of the American Academy of Dermatology, 9(4), 487-502.

**I read in a newspaper article that the companies who wish to submit their product information for a test to receive the SCF seal, must pay a fee or make a donation.  I do not know if that is true, but I have emailed a contact person at the SCF to find out. Meanwhile, the other information about broad spectrum and SPF language is by law and regulated by the FDA.