Proposed Food Label Changes a Win With Physician

02/28/2014 02:38 pm ET | Updated Apr 30, 2014

The FDA recently announced a proposal to revise the nutrition facts label that is required on most foods. There are several paths that the potential revision may take, and it will probably be several years before the new proposal takes effect. Though the new labels are quite a ways away, they are badly needed.

As a physician who specializes in nutrition and metabolism, I am thrilled to see that changes are coming. The impetus for change is to make nutritional information easier to understand, so that consumers can pick up products on the grocery shelf and easily determine if it's a good choice for themselves and their family. As a parent, aside from my role as a weight management physician, I want that too. However, nutrition labeling is tricky for a variety of reasons.

Honest Reporting of Calories

I applaud the plan to make the designation of calories much more prominent on food labels. The whole reason we eat is to obtain energy to fuel our cells. These days, unfortunately, many of us take in too many calories on a daily basis. More importantly, is that we are eating too many calories of the wrong things. The proposed change to increase the prominence of the calorie amount is spot on, and a feature of the label that has been lacking since it's last revision in 1994. Making the calories present in an item more visible is crucial to providing consumers with the knowledge that they need to make healthy choices. I also agree, wholeheartedly, with the suggestion that new guidelines be created to regulate how food manufacturers establish serving sizes. Most 20-ounce bottles of soda currently state that there are 2.5 servings per bottle and display the calorie content for only one of those servings. This is an unfair marketing ploy and puts the consumer at a disadvantage. Presently, people may glance at the calories and see 120 calories for the soft drink, and think, "Maybe this isn't a good choice, but 120 calories over the whole day is not too bad." When they have consumed the entire bottle of soda, very few people have a clue that they've actually consumed 300 calories instead of the 120 on the label. Under the proposed revisions to food labeling, this same bottle of soda would be required to display the calories for the entire bottle, not just the single serving. Who shares a bottle of soda, or places some the remaining 1.5 servings aside for later, anyway?

So many items are packaged seemingly as stand-alone, "eat the whole thing" items, when in reality they contain multiple servings. An example of this is your standard "big cookie" that lists the calories as 225 calories a serving. "Okay, that is a splurge," you may think, "but I'm active." What you didn't notice, however, is that the wrapper actually listed two servings for a much larger indulgence of 450 calories. Those 450 calories are equivalent to a healthy meal, not a quick snack. Some of us may pick up the cookie as the label reads now and reconsider a healthier option.

I am thrilled that it is proposed to have the label include how many calories are in the whole bag of an item with multiple servings. For instance, there are typically something like eight servings in the potato chip bag. Really? Find me a real person who has ever bought a bag of chips and only consumed the suggested serving size, for eight tiny snacks. If they do exist, you won't find many.

Accounting for Added Sugar

Also proposed for the new labels is the requirement to list added sugars. In my upcoming book, The MD Factor, I have a page where I list the uncommon names for hidden added sugars in food. It takes up almost the entire page and includes over 40 alternative names for added sugar. Seeing added sugars more clearly defined will help parents who want to provide the healthiest treats, and even non-sweet foods like bread or ketchup, to their children. I am happy to see that total sugar will still be listed, followed by added sugar.

Percent Daily Value -- Why Keep it Around?

My biggest concern with the new proposal at this time is the plan to continue using the %DV which stands for "percent daily value" of specific nutrients like fat and carbohydrates. Curiously, the new labels will not include protein with percent daily value. I have read through the copious documentation of why the FDA has decided to stick with this method, and I follow the logic to a point. Making a change is a complicated thing, but if the desire is to make the nutrition labels more helpful, understandable and useful for overall health, I think the percent daily value suggestion does exactly the opposite.

The percent daily value is based upon the AMDR, or Acceptable Macronutrient Distribution Range. The AMDR is based on the amount of the macronutrient that is associated with a reduced risk of chronic disease, while providing adequate intakes of essential nutrients. It is expressed as a percentage of daily energy intake. It was decided that while a specific recommendation for calories would not be given (as it could not relate to all people because it would vary based on activity and gender), the calorie amount of 2000 per day would be used to calculate the percentage amounts of carbohydrate and fat that should be consumed. The amount of the carbohydrate or fat in the food would be listed as a percent of this total amount of carbohydrate or fat on the label. But what if you don't eat 2,000 calories a day? Confused yet?

What is so critical to understand is that the acceptable macronutrient distribution range was based upon healthy people of normal weight.

Earlier in the FDA report, it was stated that 11.3 percent of the U.S. population has diabetes and a huge 35 percent of the adult population has pre-diabetes. This means it is very likely they will develop diabetes if their do not change their diet, lose weight or both. More shocking is that 41 percent of the population is expected to be diagnosed with diabetes in their lifetime. These are very large numbers for a disease that can be impacted with diet and nutrition.

From the same document, 68 percent of adults, are overweight and 34 percent meet the medical diagnosis of significantly overweight or obese. The number for children is also a concern, as 32 percent are overweight and 17 percent are obese.

What this means in totality is that the standardized use of 2,000 calories per day, and the percentage of protein, carbohydrates and fat that appears as a percent daily value on today's food labels, is based upon information that does not relate to the majority of Americans.

The plan is to continue labeling percent daily value for carbohydrates on all labels as 300 grams per day. This is 60 percent of total daily calories. The percent daily value for fat is kept at 30 percent, and while protein is not labeled as a percentage of daily calories, it comes out to 10 percent after all the math and subtraction is done. That is simply not enough to sustain a functioning metabolism for healthy weight management. If a woman needs to lose weight and drops her calories to 1500 per day, and then consumes 10 percent of her calories from protein, she will consume 37.5 grams of protein. This consumption is below the recommended daily allowance of protein needed to prevent disease. In fact, people have a requirement for protein as it is an essential nutrient for human health and growth. This need for protein remains constant regardless of activity level, and regardless of if caloric intake is dropped.

Guidelines to Match the Population

One very important thing to share is that my medical practice specializes in the care of people who are overweight and find it hard to lose weight. Last year 89 percent of my patients, which included men, women, and children, tested positive on blood work for markers of metabolic dysfunction, more commonly known as markers of insulin resistance and pre-diabetes. So, the vast majority of people who struggle with weight -- two-thirds of the U.S. adult population -- have a metabolic condition. This metabolic condition is made worse by high carbohydrate diets. The 300 grams that will remain on the nutrition label as the percent daily value of carbohydrates is most certainly describing a diet that is high in carbohydrates. That just doesn't make sense in the face of the evidence available.

Aside from the fact that I disagree strongly with the percent daily value measure, and the established percentages for carbohydrate and fat consumption, the issue remains that the proposed new labels will still fail in their ability to be understood fully by the average consumer. For example, if a serving for a food contains 50 grams of carbohydrates from any type of carbohydrate, including sugar, it will have a designation of 16 percent of the recommended daily value. (50/300 x 100 for the percent). I think if most people would see this next to the carbohydrate amount on a serving of food, he or she would interpret it to be low in carbohydrates and go ahead and eat it. However, for many of my patients, that 50 gram serving of carbohydrate could contain 50 percent of the amount of carbohydrates that they need over the entire day. This is especially true if they want to improve their metabolic dysfunction and lose weight.

In summary, I am happy that there will be changes made to the nutrition label. More prominence for calories, true and accurate serving sizes, and labeling the amount of hidden sugar will go a long way in educating adults and children. With regards to the burden of both diabetes and obesity, which are both an epidemic in this country, we need to ensure we do not further aggravate the problem by listing percent daily values for carbohydrates that will confuse people about how much of this macronutrient they need to monitor and limit.