Understanding The Nutrition Label: A Nutritionist Q&A

Whether you’re a cancer patient or not, what should you be paying attention to on the Nutrition Facts label found on packaged food and beverages in the United States? How you can take this information and adapt it to your specific needs?

In this podcast, we dig into these questions and more with Stacy Kennedy MPH, RD/LDN, CSO, senior nutritionist at Dana-Farber Cancer Institute.

Austin Fontanella: Why is it important to read the nutritional facts label on a package?

Stacy Kennedy, MPH, RD, CSO: The nutritional facts panel, and importantly, the ingredient list are required parts of a packaged food that can be really informative; but as you mentioned, they can also be really overwhelming too. So it’s great to talk through what are the points to pay attention to, how do you know what’s relevant, and how to know what you’re eating.

When you’re cooking from scratch, you’re shopping for ingredients, you’re putting them together, you know exactly what’s in there. When you’re buying something that’s in a package at the store, or even ordering from a restaurant that provides the nutrition information, you’re not really sure what’s in there, and so this is your way of taking a lens to know what’s inside of that food that I’m about to be eating.

Fontanella: When someone picks up a container, what’s the first line their eye should go to?

Kennedy: Turn it over and go first to the ingredient list, honestly, so you can have a good sense of what are the actual foods inside my food, and how much not food or things that are hard to pronounce are in my food too. There’s also allergen statements, so if you’re dealing with a food sensitivity or you’re dealing with an allergy, that’s an important part too.

Then, look at the facts panel, and think about what it is that your goals are. For example, for a patient going through treatment, getting enough protein might be your goal. If that’s your goal, then I would recommend, after you do a quick read of the ingredients and get a sense of “you know, do I need a chemistry degree to read this or not,” then you might go straight to the protein grams because that’s really your focus right now.

Fontanella: In terms of that ingredient list, why are they in the order that they’re in?

Kennedy: Another requirement on labels is that the ingredients start with the most prevalent item in that food. So, the thing that’s listed first is in the greatest quantity within the package, the thing listed last would be in the least.

Fontanella: Okay, and to kind of go off of that, are there any giveaways that what you just picked up is good for you or bad for you just by quickly looking at the label?

Kennedy: It’s really relative. That’s another one of those kind of internet things that can be really confusing for people is that foods are often pitched as being absolutes. This is a good food, this is a bad food, and it’s all relative to you and your personal situation. There certainly are healthier choices than others, but it is context and frequency above all else.

Fontanella: Now, when you look at the back, you’ll see things like sodium, cholesterol, maybe fat. This might kind of scare you if you’re reading it and see what the numbers are, but are there guidelines you should be following for some of these major categories?

Kennedy: Yes, there are absolutely general healthy guidelines. For cancer patients going through treatment, you might have specialized needs, and this is actually something that comes up quite a bit. For example, while eating a lower sodium diet is an important public health recommendation for heart disease and high blood pressure, for patients in treatment, certain treatments might actually cause your body to be low in sodium, which can affect your energy level and blood pressure —  if your blood pressure is low enough it can be really serious and concerning.

So, during treatment, we actually have to help patients overcome the good learning they did for their general low-sodium diet and recommend that they purposefully include foods with some sodium if, for example, their blood sodium level is low. So yes, in general we should be limiting things like cholesterol, excess amounts of saturated fat, and sodium, but don’t be surprised during treatment if you get a more personalized recommendation. Trans-fats are artificial fats that are now mandated to be out of foods, so thankfully, this conversation is quickly going away, but that’s certainly something that has no health value and can really detract from an overall healthy diet.

Fontanella: Switching gears, in 2016 the U.S. Food and Drug Administration (FDA) approved a series of changes to the nutrition label. Are there any notable updates people should be aware of?

Kennedy: There are a couple really great things about this new food label. One is the inclusion of added sugar. So, this is a big question that comes up, especially when you start reading online about sugar and cancer and people have a lot of questions about this. When you look at food right now, the sugar includes natural sugar like from fruit as well as table sugar that’s added to a product. Meaning, the consumer really can’t distinguish between these things.

A good example we use all the time is with yogurt. You might see a plain yogurt has 0 added sugar and it has, you know, maybe 12 or 14 grams of sugar. Some of that sugar is the naturally occurring sugar that’s found in dairy, like lactose. Without knowing that there’s no added sugar, you have no way of knowing what’s the natural and what’s the added. If you look at a flavored yogurt, even if it’s vanilla, you might see instead of 12 grams of sugar, there’s 24 grams of sugar. So right now, in your head, if you’re someone with a nutrition degree, you would be standing there in the grocery store doing some math and saying, “Oh, well that means this flavored one has added sugar,” right? Because I’m comparing it against the plain. All of that’s going to get much easier, because on the label, the companies will have to list the amount of added sugar which is something you do want to try to limit.

Fontanella: What are the most common questions you get about sugar, and added sugar?

Kennedy: Again, like when we talked about the good and evil food thing, sugar kind of gets lumped in that category too. There is some research showing that excessive intake of added sugar, sugar sweetened beverages, and a high processed sugar type of a diet may contribute to your risk of developing cancer, but it’s not directly a causal effect of the sugar itself. Often because people who tend to follow those types of diets tend to be overweight or obese, and there are links between obesity and cancer-risk.

Patients will often feel for every cookie they eat, a certain number of cancer cells might grow, and there isn’t a direct effect like that. Overall, we want to keep our sugar intake to be more natural like fruit. We don’t want to see people eliminating fruit in an effort to cut down on sugar to help reduce their risk of cancer or reduce their risk of recurrence because there isn’t the evidence to support that at all. In fact, only one out of every ten Americans is getting the recommended amount of fruits and vegetables in their diet. So, if 90% of people aren’t eating enough fruit in the first place, it’s unlikely to be contributing to any of the concerns that we have. When it comes to that kind of a topic, we want to just get back to trying to streamline. Get rid of those excess added sugars, but understand, keeping things in moderation can be fine.

Fontanella: On that note, I know on the back there’s the percentage daily value. What does that mean, where did that number come from, and how do you work that in to your daily routine?

Kennedy: That’s a really great question, because everybody as an individual is going to have an individual nutrition need depending on their age, weight, activity level, medications, etc. When we see percentages, it can feel like it applies to each of us, but it doesn’t necessarily. The way those numbers come about is more from a public health perspective. Essentially, what’s the minimum amount of nutrition that somebody needs to prevent developing a deficiency, clinical concern, or an illness. It doesn’t mean that that is the optimal level.

The daily value for protein is 50g a day. The percent daily value if you see it on the label is benchmarked off of that. That doesn’t mean that every single person has 50g of protein as their goal. Many people need more than that, for some people that might be the right amount. So, those percentages are kind of a ball park general guidance, they’re not really specific for each person. It can be helpful for something like sodium. If you are trying to keep your sodium intake lower, under 5% of the daily value is the technical definition for low sodium.

Fontanella: So, let’s say you’re not a patient now but you’re a caregiver who’s perhaps buying food on a patient’s behalf. Is there something as a caregiver you should be more aware of or you should look closely for as you make these purchases?

Kennedy: It depends again on the goal. A lot of caregivers, when they’re shopping for patients, might have the mind set of, “My loved one doesn’t have an appetite and so we want to make every bite count.” It’s important to be looking for what we call nutrient dense foods. The calories might feel kind of high, but if you see healthy fats (not the saturated fat but the kind of healthy fat like from avocado or nuts or seeds) that might be higher, protein might be higher, fiber is something that’s really important too. If you look for some of those key nutrients, and comparatively look for them to be greater than maybe other products they’re next to, that might be helpful because then the patient can have a very small amount and get a lot of nutrition in.

Fontanella: In terms of fats and you just kind of mentioned that, it seems that has its own sub-category. What is the difference between all of the ones I’m reading on the back?

Kennedy: We kind of lump them in, we don’t like the terms good and bad, and then of course we lump them into this category because it’s easy to understand. The quote on quote good fats are essentially heart-healthy fats, fats that are more what you would call anti-inflammatory, like plant-based fats. Those tend to be healthier overall. Things like nuts and seeds, nut butters like peanut butter or almond butter, avocados, omega-3 fats that come from fish like salmon or sardines, also come from plant-based foods like walnuts or chia seeds. Omega-3 fats are important fats that our body needs, and ones we can’t make on our own. We literally have to eat it in order to have those foundational building blocks. Those are the kinds of fats we tend to call healthier fats that should make up more of that part of your diet.

Fontanella: And just quickly then, what are some of the fats if you see on the back you should probably avoid?

Kennedy: Those are typically common-sense things like saturated fat. You know, having some butter on your toast can certainly be fine. Things like lard or, there are other kinds of even plant-based fats that tend to be more promoting of inflammation in excess amounts. Excessive amounts of soy bean oil and corn oil, and some of those highly processed ingredients, are not going to be quite as healthy as some of the mono-unsaturated fats like we mentioned before.

Fontanella: And just to confirm, you mentioned the percent daily value usually changes per person. Is that the same thing with the serving sizes?

Kennedy: The other really great parts about this new food label have to do with serving size and knowing how many calories are in an item. Those are very connected. For example, if you go to buy a bottled smoothie or juice or a drink, right now the requirement on the food labels is on the recommended amount which is basically based off a standard serving size. For a beverage, that’s 8oz. But, let’s say the bottle you’re buying is 16oz. Right now the food label might say 80 calories, and in really small letters you see there are two servings. So, what is the likelihood that you’re going to drink half and save the other half for later? You might, right? But most people are going finish the whole container. It looks like it’s for a single serving. So, the new food labels require companies to label foods intended for a single serving to be labeled as such. So now, the calories will say in bigger letters where it’s easier to see, 160. Because you can manipulate a lot right now.

Fontanella: And just to finish up here, Stacy, is there anything else that maybe we haven’t covered today that people, especially cancer patients, should keep in mind when looking at these food labels?

Kennedy: You know, we’re talking about how to kind of pick it apart and scour it for ingredients you may not want to include in your diet. I think the flip side of that is being overly concerned and stressed about every little thing on the label that may not make sense. It’s important to look at it as a whole. You can have a quote on quote clean label that is a bit manipulated or that becomes stressful. If all of a sudden eating is a really stressful experience, stress is not good for our immune system either. So, we want to kind of take things with a grain of salt, no pun intended, when we’re looking at food labels, and really know the big picture.

Again, the benefit of eating a minimally processed plant-based diet is that the apple doesn’t have or require a food label. You know that’s it’s healthy. A banana doesn’t need a food label. A carrot doesn’t need a food label. So, make sure that you’re including some of these foods that don’t have food labels, too.