Added sugar and other changes to the back of the pack nutrition label

     I wrote this post on May 20 -21, 2016 after the FDA announced new labeling requirements for packaged food manufacturers. The manufacturers will be required to provide additional information and modified information on the Nutrition Facts Panel (NFP). This applies to all companies, but smaller ones have longer to comply. The FDA announced July 2018 as the official effective date, but we know from past FDA associated labeling initiatives that this date could change.
     The FDA press release - which you can access here - offers highlights of the changes, and many news sources have covered the story. What I want to do is put the changes in the context of my blog re: nutrition disclosures that help us consume fewer calories across venues.
     So does this change help? Probably - or to some extent. First, the revised labels have an increased 'reference serving size'. The noted serving size may merely be a declaration to allow the nutrient content to be calculated, because people rarely (if ever) dole out cups, ounces, or grams and even if they did, it would be more cups, ounces, or grams than the label suggests. The update, a slightly larger serving size, appears to be a compromise between what people are actually eating and what they are supposed to be eating. In other words, it is probably still not realistic.  One example of a serving size change involves ice cream. Instead of a 1/2 cup, a label will say 2/3 cup. I imagine most people scoop out more than 2/3 a cup of ice cream for themselves, therefore, if a person wanted to know the actual calories or sugar they consumed, they'd have to do the math (just as before). Also people may think that the label refers to an actual cup of some sort, not a measuring cup. 
     A similar issue with serving sizes is unchanged. They are not exactly uniform across similar products - the serving sizes may all be a 1/2 cup but the weight - the precise measurement - will vary. Boxes of cereal and cartons of ice cream, as opposed to say, a can of soda, are actually figured by weight, grams usually. So a serving size might be 2/3 cup on five cartons of ice cream but the weight of each 2/3 cup could be different. So to be frugal with our calories like we are with our dollars, we  need to know the calories per unit. You don't get to see an orange shelf tag with this information but you can do the math, e.g. calories per serving divided by grams in a serving gives you the calories/gram.
     Another change on the NFP is that sugar grams will come with a % DV. I've never been much of a fan of the % daily value disclosure on a label. It is based on a 2000 calorie/day diet and the majority of women, myself included, require less, say 1500 to 1800, so again, math is required. There is a trick that can make the percentages useful. If the item on the label is a nutrient of concern (meaning we get too much of it, like calories, sugar and sodium), look for a low %DV.  Low is 10% or less. There are very few nutrients that Americans lack, but for those, look for high %DV. For example, it would be great to have products with vitamin D and calcium at 20% or higher.
    Small packages, ones that people are likely to consume all at once even if they 'technically' contain 2 or 3 servings, will now have dual labels. There will be a column with the serving size nutrient information and a column with the whole package nutrient information. For items like a 20 ounce soda, where the expectation or custom is to drink the entire bottle in one 'sitting' the nutrient and calorie content will only be for the entire package (who drinks 8 ounces of a 20 ounce soda and saves the rest for tomorrow?). BTW, that is why I go for diet sodas in 12 ounce cans, I do not need 20 ounces, its too much; and for some diet sodas, the trace calories will become meaningful beyond 12 ounces.
    There are a couple more changes, which are not as relevant to the theme of my blog. You can review them by clicking on the above link.
    I'll end with two important things the new labels do not address. The information is still on the back of the package and the rule doesn't amend the new vending machine law to include sugar grams with the point of purchase calorie disclosure. Because the Nutrition Facts Panel is still on the back of the package the prospective buyer has to pick up and turn each product around (the new rule does not mandate or standardize front of pack labels and this is a disappointment). And consequently, this rule won't help us purchase low 'added sugar' snacks from vending machines because we can't see the back of the package at the time of purchase.

Nutrition Labels: Calories and Sugar

I am a little disappointed in the scientific rigor of the two studies I mention below, especially because they address two issues of importance to me - and you; restaurant menu and food package labeling. The study designs/methods make it hard, no impossible, to make causal inferences.  We can't say x caused y, in either study - but to be fair, the second study was only meant to describe peoples perceptions.  Unfortunately, the people surveyed are not representative of the larger US population.

The first study (from the University of Glasgow in Scotland) compared the average weight gain of two different groups of college students - during two different years.  The first group may or may not have eaten at the cafeteria when no calorie labels were present and the second group may or may not have eaten at the cafeteria when calorie labels were present.  The first group gained 8 pounds during 36 weeks (perhaps a semester) and the second group gained 4 pounds during the 36 weeks they were assessed.  There is absolutely no way to say that the calorie labels were responsible for the weight gain differences - none.  And I am 100% pro labeling. However, during the second year when calorie labels were on the menus, the customers did purchase less calories than when the labels were not on the menus - during this one time period.  That is important.

The second study - a very small, internet survey- strove to answer the question of whether or not Americans would be confused by the addition of an added sugar declaration on the Nutrition Facts Panel (the panel on the back of packaged foods).  The rationale for this study was the assertion by anti- added sugar labeling folks that consumers would not find the additional nutrition information helpful - on the contrary, naysayers say - added sugar information will confuse the public.

The assertion that more information is bad really gets under my skin, because again, I am pro labeling.  However, there is evidence from studies on nutrition information that suggests we cannot apply available nutrition information in the context of our personal, daily needs.  That is why the IOM and others have recommended more intuitive labels, ones that highlight a few nutrients of concern, like salt, sugar and overall calories- in color coded front of the package schemas.

But the FDA is considering changes to the Nutrition Facts Panel(NFP) on the back, including an added sugar declaration - read more here.  Ted Kyle and his colleague surveyed a small group of internet users, a couple hundred, and asked them if the added sugar section of the NFP was helpful or confusing.  The survey respondents looked at a make believe label before answering the question.  Most of the people who participated said that the additional information was helpful.  I think this is probably right, however, the survey doesn't really tell us anything about what people will do when the labels actually contain this information, we need a different kind of study for that.

You can read a popular press write up about the Glasgow study here, and an over view of the added sugar survey results can be found here.  The ConscienHealth blog written/maintained by Ted Kyle focuses on more rigorous studies than the added sugar survey  and is one of my favorites.

Ah, Sugar, Sugar -

Earlier this month, a research team representing the CDC and 2 schools of Public Health (Emory and Harvard) published results from a study that examined the association between consumption of added sugar and the risk of dying from heart disease.  You can read the entire study here.

Briefly, this study consisted of a secondary data analysis.  A large sample of Americans participated in a continuous survey (NHANES III) that assessed behavior, including dietary intake, from 1988 to 1994. The researchers matched the participant IDs to an existing mortality data file that tracked deaths to the year 2006.  Researchers followed the survey participants until they died or until the study period ended (2006).  The researchers used statistical methods to set aside (control for) other factors that can cause heart disease death (e.g., smoking, weight) and focused on how sugar intake influenced death from heart disease.  They found that as sugar intake increased so did death from heart disease – regardless of what someone weighed.   

Because I trust that the association between sugar intake and heart disease death is real, it’s important to talk about 1) what ‘excess’ means – i.e., at what level does sugar intake become harmful, 2) how you (and I) can determine sugar intake, and 3) ways to reduce sugar intake. 

Dietary guidance on sugar intake varies.  The World Health Organization suggests that people consume less than 10% of their total DAYS worth of calories from sugar; the USDA/DHHS Dietary Guidelines for Americans combines solid fat and added sugar into one category and recommends that we consume less than 25% of total DAILY calories from solid fats and added sugar; and the American Heart Association (whose mission is preventing heart disease and heart disease deaths) suggest the lowest intake.  The AHA recommends that women (who generally need less overall calories and macronutrients than men) consume no more than 100 calories a day from added sugar and men no more than 150 calories from added sugar. 

In the research study, the people who consumed less than 10% of their daily calories from added sugar had the least number of heart attack deaths.  (I eat ~ 1800 cals a day so that translates to 180 sugar calories a day for me, at the 10% level.  I want to keep my max level between 100 and 180 cals a day, which is the American Heart Association and World Health Organization recs combined. 

Before I present some package labels, I want to clarify a few terms: added sugar, calories per gram, and sugar grams.  The research linking sugar to heart disease death is specific to added sugar, not the kind you find naturally in fruit and vegetables (fructose) or in milk products (lactose); however, products made from fruits, vegetables and milk often do have added sugar. (By the way, there is no natural sugar in almond milk, so any sugar grams you see listed on the label is added.  My almond milk has 0 grams of sugar).

Sorting out added versus natural sugar in some products can be tricky and might require some label sleuthing.  One thing to keep in mind is that very few juices are 100%  juice.  IF you have a 100% fruit product – i.e., no other ingredients listed, then you are safe to disregard the sugar grams on the label (but not the calories!).  IF you eat a fresh (unpackaged) apple, a cup of broccoli, a tomato, etc.. you are good to go.  Usually canned vegetables are also free of added sugar, but you should double check. A can of tomato sauce with no added sugar will have ~ 2 grams of sugar per serving, but a can of spaghetti sauce will often have added sugar that you won’t detect unless you read and understand the ingredient list. The nutrition facts panel doesn’t currently separate the added sugar from the naturally occurring sugar. 

The ‘back of pack’ nutrition facts panel lists sugar, in grams, under the category carbohydrate.  A gram of sugar contains 4 calories.  IF you are trying to stay at 150 calories from sugar (a day) that is 37 grams (or 9 teaspoons) – quite a lot!   Until front of pack labeling becomes standardized and mandatory on all products, you will have to read your labels carefully to choose the product with the lowest amount of sugar in any particular category of food.  Take cereal for example.  To make the best choice, read the labels and the serving sizes across boxes (use the nutrition facts panel) and choose the one that is lowest. It is easier to watch your grams throughout the day.  For me that means I need to keep mine at 48 or below, and below is better - to meet my goal of no more than 180 sugar calories per day.

One way to lighten up on sugar is to avoid drinking it – forgo fruit juices and sports drinks – they almost always have added sugar. Another place to make a lighter choice – peanut butter.  Some brands/types, like Smucker’s All Natural, have no added sugar.  I know this because the label says one gram of sugar and the ingredients list does not name anything that could be code for sugar. 

Here let me show you:

There is 1 gram of sugar and the ingredients are peanuts and salt.

 

There are 8 grams of sugar in a half a cup of no sugar added applesauce, and as you can see from the ingredients list, the product only contains apples, water and a preservative.  Hence, none of these 8 grams of sugar or 32 calories of sugar (8g x 4) counts towards your daily limit.

Now here are examples where all of the sugar grams and the associated calories would count towards your added sugar total.

First is the dreaded sports drink.  There is nothing in the ingredient list that leads me to believe this drink contains ANY fruit juice.  Note also that ingredients are listed in order of amount.  The first ingredient is water and the second is high fructose corn syrup – aka – added sugar.  A 12-ounce serving of this beverage has a whopping 21 grams of sugar or 21g x 4 = 84 sugar calories.  Ah, this is a great example of fuzzy math because the label claims only 80 calories per serving.  They have rounded DOWN.  I find this ghastly.  Anyways, one glass of this and you’re about done with added sugar for the day.  

Here is another example of excess sugar.  This is a box of Cracklin Oat Bran.  One serving has as much added sugar as a serving of Oreo cookies: 14 grams or 56 sugar calories.

The next examples are from my Mom’s snack jar.  Some surprises.

My favorite packaged cookies in the world, Marinela Suavicremas have less sugar grams per serving than Nature Valley crunchy OatsnHoney and a Fiber One 90 calorie lemon bar – which by the way is the smallest of the three snacks, in weight.  My cookies, 4 cookies per serving have 6 grams or 24 sugar calories, the 2 bar OatsnHoney serving has 12 grams or 48 sugar calories and the (tiny) Fiber One bar has 8 grams or 32 calories from sugar. 

In the examples I provided, cereal had the most sugar.  Other things to watch for include dairy desserts – in the research study any sugar in a dairy dessert was considered added sugar; and soda, which is the leading source of added sugar in the American diet. A single serve bottle of soda has about 39 grams of sugar or 156 sugar calories per serving.

So there you go.  Regardless of weight or any other physical or health characteristic, sugar intake at or above 10% of daily calorie intake increases the risk of death from heart disease.  The researchers provide numbers for the absolute risk differences in their article.  It is also important to know that the risk increases according to the ‘dose’ of sugar.  By this I mean, a person who eats around 200 calories of sugar a day (50 grams) has a higher risk than someone who eats 100 calories of sugar a day (25 grams), but less than someone who consumes 300 calories of sugar a day (75 grams).

Just FYI, this is a front of pack label that can be helpful for same product comparison because it includes the serving size.