Eating Right: How to Read Nutrition Labels

A young boy comes into clinic, concerned about his weight. He's above the 95%ile for weight, so qualifies as being obese. His mother is thin as a rail, so there is likely some genetic component from Dad's side playing in, but he wanted to know ways to reduce his weight. Other than giving him the general schpiel about good nutrition, his mom wanted me to talk about how to read a nutrition label.

When I first heard this request, I was a little confused. After all, I had learned how to read a nutrition label way back in elementary school. I usually don't unless I'm directly comparing two products, but I know how. Have things really changed so much that this isn't taught anymore?

Compounding this, you may have heard the news from a couple months ago that the FDA is considering a change in how nutrition labels are organized. Personally, I think the new recommendations are great: they put greater emphasis on things that a lot of people have difficulty with with the current label.

If you haven't had experience with this, I'll try to start basic. If you have, then skip down a bit to read some of the common pitfalls people have when reading labels. Those are useful to review even if you read the labels themselves all the time.

Let's look at a basic label now:



The first thing listed on any nutrition label will be the serving size. This determines how the rest of the label is read, and is the source of problem with most Americans. See, we don't really have a good concept of a serving size. An easy example is bread: one slice of bread is a serving size, but most people will have two at any given time (a sandwich), and consider that to be one serving. A serving of chicken is about the size of a deck of cards. The serving is not a glass of milk, it's 8 oz. Most adult glasses fit at least 16 oz. So, pay attention to this size, and when in doubt, measure it out.

The next line reports servings per container. This is useful to helping determine the serving size if you aren't able to measure it out. A Gatorade bottle, for instance, typically contains 2.5 servings of Gatorade.

Next up is what a lot of people get hung up on: the calories. Scientifically speaking, a calorie is a measure of how much energy something provides. We know that carbohydrates, like sugar and flour, give us 4 calories per gram, as does protein like chicken or steak. Fat, on the other hand, provides 9 calories per gram. Alcohol, for those interested, falls somewhere in the middle at 7 calories per gram.

Calories are a great way of measuring how much you eat. It allows you to compare foods, and eat better by having less calorie dense foods. But they are not the be-all-end-all to weight management.

Below the solid line, the food gets broken up even more. We start to see a column for % Daily Value, essentially how much of what it recommended daily is contained within this one food. In the case of fat, sodium, cholesterol, and sugar, we want that percentage to be low. Keep in mind, you still need some of these things to function properly, so I am absolutely not advocating only eating non-fat or non-sugar foods. Just to keep them low. One person has suggested less than 5%, but this may not always be possible. Definitely, you should keep these below 20% in one serving.

Some things, though, are actually good for you, and you may want to increase your intake of them. Fiber is the most commonly listed in this category--you need fiber to help keep your digestion regular, and most Americans don't get enough fiber in their diets. This is one that it'd be impressive if there were 20% or more of your % DV.

Lower down, there is usually a list of vitamins. Labels present these in different ways, some listing the actual amount per serving and others only listing the %DV, but again, these are ones you want a high value of. It's not necessary to get 300% of a certain vitamin, but 20% is great for a serving.

Now, some of the things that labels can trick you about.

1) Low fat foods
- Be wary and really look at the label when you see this presented on a package. Most often, the food will be manufactured to include more sugar to make up for the lack in fat, which may actually be worse for you than the fat in the first place.

2) Whole grain!
- I was reading a label the other day, trying to decide between what was essentially regular Wheat Thins, and ones made with 'whole wheat'. The fiber content is what is really affected by using whole vs. processed wheat, but there was only 1 extra gram of fiber per serving with the whole wheat variety. What was different was the amount of sodium (salt) was nearly triple what the regular wheat ones were! Not worth it.

Those are the two most common ones I see. Do you know of any others? Tell me about them in the comments below!

I hope this was a useful exercise for some of you. Hopefully, the FDA's proposed label changes will go through and make it easier for everyone to interpret these labels.

Expressive Writing

I'm at a Medical Humanities Conference this weekend, so I felt it was appropriate to talk a little bit about what I've learned. It's' been a lot of things like Yoga and self-reflection, and mainly focused on student wellness, but we've also talked about expressive and narrative writing, and how to go about this. My favorite session was by Nancy Morgan, from the Georgetown Lombardi Cancer Center, who talked about the effects of expressive writing in cancer patients. It made me think about whether the same effects would be seen in pediatric patients, and I think if it hasn't been studied yet, that might be a project I work on.

So, for this post, I'm going to delve a little more into expressive writing: what it is, and what benefits have been reported.

In a nutshell, expressive writing is the writing of emotions. It is intensely deep and personal, and focuses much more on feelings rather than facts. Basically, it's what people think of when they consider a diary or a journal of some type.

Expressive writing has been studied extensively in the past 20 years or so. The pioneer of this research is considered to be James Pennebaker, who has focused his research on traumatic experiences and expressive writing.

Since it is an emotion-based activity, the short-term effects of the writing often include heightened distress, increase in negative mood symptoms, and a decrease in positive mood symptoms. However, the long-term effects can include fewer doctor's visits, improved lung and liver function, reduced blood pressure, improved mood, reduced absences, better working memory, etc.

However, it should be noted that the act of writing itself is not what causes the benefit. Expressiveness was determined to be the deciding factor on whether it was beneficial, with individuals with high expression benefiting more than individuals with low expression. This study concluded that having patients not likely to express their emotions naturally take place in this exercise may actually be harmful, but this is something that may be hard to assess in someone who hasn't written in the past.

Of course, most of these studies looked at 1) traumatic events, and 2) controlled environment with 15-20 minute writing exercises for 3-5 sessions. Nancy Morgan, though, decided to push the conclusions a bit--she had cancer patients write for 20 minutes in a clinic setting--with interruptions and everything included. Essentially, she wanted to look more at real-life scenarios. Participants only did one writing exercise, and were evaluated before and after the exercise. Under these circumstances, patients reported an improvement in perceived quality of life, indicating that it'd be a very useful exercise for these patients, and their caregivers.

Anecdotally, she also reports that the same effects can be seen even if the patients themselves are not the ones writing. In patients who are illiterate, whose stories she is copying down, they have the same overall benefits of the expression than those who are able to write.

So, if you're feeling a little stressed, turns out writing it out in a journal may actually be a good thing to do.