In 1990 the U.S. Congress passed legislation establishing requirements for nutrition information, nutrient content claims, and health claims presented on food and dietary supplement labels. This legislation, called the Nutrition Labeling and Education Act, requires that almost all multiple-ingredient foods and dietary supplements be labeled with a Nutrition Facts panel (Illustration 1.9).
The act also requires that nutrient content and health claims appearing on package labels, such as “trans fat–free” and “helps prevent cancer,” qualify based on criteria established by the Food and Drug Administra-tion (FDA).
Concern about rising rates of overweight and type 2 diabetes among children and youth prompted senators in the United States to propose national menu-labeling stand-ards for fast food and other restaurants in 2009. The leg-islation would require restaurant chains with 20 or more outlets to post calories on menus and menu boards and make additional information about the fat, saturated fat, carbohydrate, sodium, protein, and fiber content available in writing upon request.
Nutrition Facts Panel
For foods, the Nutrition Facts panel must list the content of fat, saturated fat, trans fat, cholesterol, sodium, total
Illustration 1.9 Example of a Nutrition Facts panel.
Nutrition Facts
Serving Size 1 Entree Serving Per Container 1 Amount Per Serving Calories 380 Calories from Fat 170 Total Fat 19g
Saturated Fat 10g Trans Fat 2g Cholesterol 85g Sodium 810mg Total Carbohydrate 33g Dietary Fiber 3g Sugars 5g Protein 20g
29%
50%
28%
34%
11%
12%
Vitamin A 10% Vitamin C 0%
Calcium 10% Iron 15%
Percent Daily Values are based on a 2000 calorie diet. Your daily values may be higher or lower depending on your calorie needs:
Total Fat Sat Fat Cholesterol Sodium Total Carbohydrate Dietary Fiber
Calories 2000 2500 Less Than
Less Than Less Than Less Than
65g 20g 300mg 2400mg 300g 25g
80g 25g 300mg 2400mg 375g 30g
carbohydrates, fiber, sugars, protein, vitamins A and C, and calcium and iron in a standard serving. Additional nutrients may be listed on a voluntary basis. If a health claim about a particular nutrient is made for the product, the product’s
con-tent of the nutrient addressed in the claim must be shown.
Nutrition Facts panels contain a column that lists the % Daily Value (% DV) for each relevant nutrient. This in-formation helps consumers decide, for example, whether the carbohydrate content of a serving of a specific food product is a lot or a little.
Nutrient content claims made on food package labels must meet specific criteria. Products labeled “no trans fat”
or “trans fat–free,” for example, must contain less than 0.5 grams of trans fat and of saturated fat. Products la-beled “low sodium” must contain less than 140 mg so-dium per serving.
Ingredient Label
Food products must list ingredients in an “ingredient label.” The list must begin with the ingredient that con-tributes the greatest amount of weight to the product and continue with the other ingredients on a weight basis.
Dietary Supplements Any product intended to supplement the diet, including vitamin and mineral supplements, proteins, enzymes, amino acids, fish oils, fatty acids, hormones and hormone precursors, and herbs and other plant extracts. In the United States, such products must be labeled
“Dietary Supplement.”
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required for salt, it is often fortified with iodine. Fortification of these foods has contributed substantially to reductions in the incidence of dis eases related to inadequate intakes.45
Herbal Remedies
The FDA considers herbal products to be dietary sup-plements; they are taken by many people during vari-ous stages of the life cycle. Thvari-ousands of types of herbal products are available (Illustration 1.10). Some herbal remedies act like drugs and have side effects, but they are not considered to be drugs and are loosely regulated. They do not have to be shown to be safe or effective before they are marketed. Herbs vary substantially in safety and effectiveness—they can have positive, nega tive, or neutral effects on health. Knowledge of the effects of herbal rem-edies is far from complete, making it difficult to determine appropriateness of their use in many cases.
The extent to which herbs pose a risk to health de-pends on the amount taken, the duration of use, and the user’s age, stage, and health status.
Functional Foods
Also known as “neutraceuticals,” functional foods in-clude a variety of products that have theoretically been modified to enhance their contribution to a healthy diet.
Foods are made “functional” by:
Taking out potentially harmful components (e.g.,
●
cholesterol in egg yolks and lactose in milk) Increasing the amount of nutrients and beneficial
●
non-nutrients (e.g., fiber-fortified liquid meals, calcium- and vitamin C–fortified orange juice) The FDA now requires that ingredient labels note the
presence of common food allergens in products. Potential food allergens that must be listed are milk, eggs, fish, shellfish, tree nuts, wheat, peanuts, and soybeans. These eight foods account for 90% of food allergies.
Dietary Supplement Labeling
“You can call anything a dietary supplement, even something you grow in your back yard.”
Donna Porter, RD, PhD, Congressional Research Service
Dietary supplements such as herbs, amino acid pills and powders, and vitamin and mineral supplements must show a “Supplement Facts” panel that lists serving size, ingredients, and % DV of essential nutrients contained.
Because they do not have to be shown to be safe and effective before they are sold, labels on dietary supple-ments cannot claim to treat, cure, or prevent disease.
They can be labeled with standardized nutrition content claims such as “high in calcium” or “a good source of fiber.” They can also be labeled with health claims such as “may reduce the risk of heart disease” if the product qualifies based on nutrition labeling requirements. Di-etary supplements can make other claims on product labels not approved by the FDA, such as “supports the immune system” or “helps maintain mental health,” as long as the label doesn’t state or imply that the product will prevent, cure, or treat disease. If a health claim is made on a dietary supplement label, the label also must present the FDA disclaimer:
This product has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.
Enrichment and Fortification Some foods are labeled as “enriched” or “fortified.” These two terms have specific definitions developed prior to the Nutrition Labeling and Education Act. Enrichment pertains only to refined grain products and covers some of the vitamins and one of the minerals lost when grains are refined. By law, producers of bread, cornmeal, crackers, flour tortillas, white rice, and other products made with refined grains must use flours enriched with thiamin, riboflavin, niacin, and iron.
Any food can be fortified with added vitamins and min-erals, and its manufacturers most often do so on a volun-tary basis to enhance product sales. However, some foods must be fortified. Refined grain flours must be fortified with folic acid, milk with vitamin D, and low-fat and skim milk with vitamin D and vitamin A.
Although fortification is not Enrichment The replacement of thiamin,
riboflavin, niacin, and iron that are lost when grains are refined.
Fortification The addition of one or more vitamins or minerals to a food product.
Functional Foods Generally taken to mean food, fortified foods, and enhanced food products that may have health benefits beyond the effects of essential nutrients they contain.
Illustration 1.10 Herbal products are widely available on the market.
Barry Austin/Photodisc/Getty Images
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enter food products during fermentation and aging p r o c e s s e s . T h o s e t h a t survive digestive enzymes and acids may start colonies of beneficial bacteria in the digestive tract. Table 1.17 lists foods and other sources of pre- and probiotics.
Prebiotics and probiotics have been credited with im-portant benefits, such as the prevention and treatment of diarrhea and other infections in the gastrointestinal tract;
prevention of colon cancer; decreased blood levels of trig-lycerides, cholesterol, and glucose; and decreased dental caries.49 Prebiotics appear to be safe in general; however, probiotics may be harmful to individuals who may de-velop blood infections.49,50 The primary side effects as-sociated with prebiotic and probiotic use are flatulence, bloating, and constipation.49
Availability of foods containing prebiotics and probiot-ics is much more common in Japan and European countries than in Canada or the United States. However, availability of such products is increasing in these countries as research results shed light on their safety and effectiveness.51 Adding new beneficial compounds to foods (e.g.,
●
“friendly” bacteria to yogurt and other milk products)
Functional foods, such as those shown in Illustra-tion 1.11, are not regulated, and no specific standards ap-ply to them.46 Health claims, however, can be made for functional foods given they have been approved by the FDA. Increasingly, the list of functional foods is becoming infiltrated with sports bars, soups, beverages, and cereals spiked with vitamins, minerals, and herbs. Some of the products carry labels with unsubstantiated health claims and may be of little benefit or are potentially unsafe.47 For these products, the label “functional food” is a marketing term. Others, such as lactose-free milk, xylitol-sweetened gum, and iodized salt, benefit the health of some people.
Prebiotics and Probiotics The terms prebiotics and probiotics were derived from antibiotics due to their probable effects on increasing resistance to various diseases. Prebiotics and probiotics are in a class of functional foods by themselves. Prebiotics are fiberlike, indigestible carbohydrates that are broken down by bacteria in the colon. The breakdown products foster the growth of beneficial bacteria. The digestive tract generally contains over 500 species of microorganisms and 100 trillion bacteria.48 Some species of bacteria such as E. coli may cause disease; others, such as strains of lactobacillus and bifidobacteria, prevent certain diseases.49 Because they foster the growth of beneficial bacteria, prebiotics are consid ered “intestinal fertilizer.” Probiotic is the term for live, beneficial (“friendly”) bacteria that
Prebiotics Certain fiberlike forms of indigestible carbohydrates that support the growth of beneficial bacteria in the lower intestine. Nicknamed “intestinal fertilizer.”
Probiotics Strains of lactobacillus and bifidobacteria that have beneficial effects on the body. Also called “friendly bacteria.”
Table 1.17 Food and other sources of prebiotics and probiotics
Probiotics
Fermented or aged milk and milk products Yogurt with live culture
•
Buttermilk
• Kefir
•
Cottage cheese
•
Dairy spreads with added inulin
•
Other fermented products Soy sauce
• Tempeh
•
Fresh sauerkraut
• Miso
• Breast milk
Probiotic tablets, powders, and nutritional beverages Prebiotics
Chicory
Jerusalem artichokes Wheat
Barley Rye Onions Garlic Leeks
Prebiotic tablets, powders, and nutritional beverages Illustration 1.11 Examples of functional foods.
Andy Crawford/Dorling Kindersley/Getty Images
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Sometimes diets of native populations change when their numbers become overwhelmed by other population groups. A primary example of this phenomenon is repre-sented by changes in traditional dietary practices of Native Americans. In general, traditional diets of Indians in the United States consisted of foods such as buffalo, deer, wild berries and other fruits, corn, turnips, squash, wild potato, and wild rice. Loss of land and buffalo, discrimination, pov-erty, and food programs that offered refined flour, sugar, salt pork, and other high-fat meats drastically changed what Indians ate, how they lived, and their health status. Activi-ties aimed at bringing back traditional foods and dietary practices are under way among many Indian groups.55
Food preferences of African Americans vary widely but may stem from their cultural food heritage. Histori-cally important foods include corn bread, pork, buttermilk, rice, sweet potatoes, greens, cabbage, salt pork, and fried fish. “Soul foods” make less of the African American diet now than in the past but remain foods of choice for special occasions and are the foods most likely to be revered.56
Dietary Considerations Based on Religion
Many religions have special dietary laws and practices.
For example:
Hindus may not consume foods such as garlic
●
and onions, which are believed to hinder spiritual development.
Buddhists in certain countries tend to be vegetarian
●
or to eat fish as their only choice of meat. In coun-tries such as Tibet and Japan, vegetarianism is rare among Buddhists.
Alcohol is prohibited as part of Sikhism, and meat
●
prepared by kosher or halal methods is avoided.
The Church of Latter Day Saints, or the Mormon
●
Church, prohibits alcohol and discourages consumption of caffeine. Mormons may eat meat and prize wheat.
Seventh-Day Adventists tend to follow a strict
lacto-●
ovo vegetarian diet and exclude alcohol and caffeine.
Whole grains, vegetables, and fruits are considered to be the base of diets, and dried beans, low-fat dairy products, and eggs may be consumed infrequently.
Jewish dietary laws require that foods consumed
●
must be kosher, or fit to eat according to Judaic law.
Organizations are certified as supplying foods that are kosher. The Jewish calendar includes six fasting days that call for total abstinence from food or drink.
The Muslim religion has dietary laws that require
●
foods to be halal, or permitted for consumption by Muslims. Pork consumption is not allowed, nor is the consumption of animals slaughtered in the name of any god other than Allah. Slaughterhouses must be under the supervision of a halal certifier in order for meat to be considered fit to eat, although