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Dr. Ayala

Dr. Ayala
Philadelphia, Pennsylvania, USA
V.P. Product Development
Herbal Water
I’m a physician (Pediatrics and Medical Genetics), artist, and mother of 3 school age active kids. I recently co-founded Herbal Water Inc. (www.herbalwater.com) with my husband, Albert. I am a serious home cook, and love to entertain. My expertise is vegetarian food (I have been a vegetarian all my life). I strongly believe that eating healthy and enjoying good food go hand in hand. My main interests are science, nutrition and art, and I am overall a very curious person that tries to learn something new every day. Dr. Ayala (Ayala Laufer-Cahana M.D.)


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DECEMBER 14, 2009 10:32AM

What would you change about the Nutrition Facts Panel?

Rate: 6 Flag

Nutrition Facts labels became law in the US some 15 years ago, and the familiar panel we all know and strain our eyes over—the one that provides some key nutrition information, an ingredient list and allergen declarations—continues to evolve.
Nutrition label for blog
Do you read it? All of it? Do you understand it? Are you looking for your reading glasses?

In all fairness, not all labels are as detailed as the one I’ve included here—some are shorter and simpler. This is a cereal label, which I chose because I think it’s a good example. Breakfast cereals are a staple in most homes (that’s what my kids eat most school days), there are dozens of cereals to choose from, and this is a fine example of a purchase situation in which we’d like some good, clearly presented information to help us with the selection process before the day is over.

Well, if you’re baffled by the label, you’re not alone. The FDA feels your pain and is re-examining the Nutrition Facts Panel and will consider modifications to the label in order to help consumers make more informed food choices

Consumer attitudes towards the Nutrition Facts Panel

A recent paper in Nutrition Reviews looked at consumer attitudes and perceptions of nutrition labels around the world. Most of the data on US consumers was from the International Food Information Council (IFIC) research, and shows that, although almost 60 percent of consumers say they use the Nutrition Facts Panel, only a quarter of them find it easy to use.

The calorie information on the Nutritional Facts Panel gets a glance from 75 percent of consumers, yet most consumers cannot put the calorie count in context: A quarter of people asked are unaware how many calories they should consume, and about half overestimate their daily suggested intake.

The percent daily values, typically located above the actual ingredients, are either ignored or poorly understood by most.

The paper gathered key consumer recommendations for improving the Nutrition Facts Panel, and here are some of them:

Readability: Increase the font size (Duh!); use bold face text for serving size

Usability: Maintain standard serving size across similar products

Ensure information on serving size is easily interpretable

Clarity: Clarify the meaning of “percent daily value”

Visibility: Move key information to a small panel on the front of the package.


I’d say all these recommendations are pretty obvious. Apparent as they may seem, I hope that the FDA takes especially seriously the benefits of standardizing the serving size across similar products. Check out your cereal cabinet and you’ll see that serving sizes range from ¾ to 1 cup and from 30 to 55 grams a serving—the savvy consumer needs not only a magnifying glass but also a calculator and a something to write on to compare any nutritional attribute across products.

CSPI’s proposed makeover

The Center for Science in the Public Interest (CSPI) proposed its ideas for a makeover for packaged foods’ nutrition labelling with some compelling graphics to make its case.

The CSPI addresses two needs: improved clarity of information and workarounds for marketers’ and food manufacturers’ tricky ways of intentionally emphasizing and de-emphasizing parts of the label, which make consumers believe their product is better than the sum of its ingredients actually suggests.

Take a look at the CSPI’s re-imagined (and I think better) label:
To summarize the key changes in the CSPI proposal:

Calories—Loud and clear.

Added sugar—This is a dramatic change. The FDA doesn’t require food labels to disclose the amount of added sugar in products separately, and the naturally occurring sugar in milk or fruit is listed in much the same way as the added high fructose corn syrup in sodas.

The American Heart Association recently published its guidelines, calling for a dramatic cut in added sugar in the American diet and has petitioned the FDA to create a label requiring that added sugar be listed as such.

The CSPI concurs, as do many health experts.

Sugar has as many calories whether it’s naturally occurring or added, but the health impact is very different.

The other major change CSPI proposing is lumping all sugars together, and then detailing which specific sugars are in the product. The trick many manufacturers use is that by including several kinds of sweeteners, each sugar’s relative contribution is rather small, and since ingredients are listed by concentration, sugar isn’t the first ingredient listed. Take another look at your cereal cabinet. If you have some of the sugary cereals at home you’ll see that sometimes because there are a bunch of sweeteners in the product even though sugar is the main ingredient in them it’s not first on the list.

I like this proposed change! The first thing we need to know as consumers is how much sugar is added, and the secondary question is which ones.

Fiber—CSPI: “Only fiber from whole grains, beans, fruits, and vegetables, and not faux fibers such as polydextrose and maltodextrin, would be considered to be fiber on the nutrition label.”

Whole grains—If the food contains grains, the label should convey what percent of the grains are whole grains. “Contains whole grains” just isn’t useful.

Ingredients—CSPI called for a clearer format, plain-spoken ingredients without hyped names, percentages of key ingredients, a hierarchy—with major ingredients listed separately from minor ingredients—and allergy information getting a place of its own.

Get rid of what doesn’t work—The CSPI label edited out the footnote section with the percent daily values for fat, cholesterol, sodium, carbs and fiber. (There is an exemption from this footnote under current law for smaller-size labels anyway). CSPI thinks this isn’t useful for most consumers. Eliminating it made room for bigger fonts and a clearer label. The same goes for calories from fat--information overload.

Couldn’t agree more. The time and place for a nutrition lesson isn’t at the point of purchase.

And while we’re at it

A few other suggestions I’d like to add:

Vitamins: Much like the CSPI's fiber suggestion above, I’d advise that only naturally occurring vitamins—those that are an integral part of the food—be listed in the Nutrition Facts Panel. Why?

Foods that are rich in vitamins—such as fruits and vegetables—are an important part of a healthy diet, but there’s really no evidence that foods with added isolated and lab-produced vitamins add anything to health. While it’s true that fortification of some processed foods with the vitamins they were stripped of during processing may have prevented vitamin deficiencies in our age of high consumption of highly processed foods, it hardly makes sense to fortify every processed junk with a bunch of vitamins and have the Nutrition Facts Panel endorse its “wholeness“ (or as the manufacturers would prefer, its “holiness”).This also feeds into the false notion that we should be counting our vitamins and further encourages our obsession with these micronutrients--eating well isn't about getting enough vitamins.

The ability to put the added vitamins on the nutrition panel has been a boon for the makers of some of the worst junk out there. Take a look again in the cereal aisle or the vitamin drink section and you’ll see what I mean. Having a bunch of vitamins sprinkled in does not a health food make.

Serving size: Let’s make it simple: A small package is one serving. Take a close look at today’s labels and see how they express serving size: Whom are we kidding?

How many people actually consume only half a candy bar, 40 percent of a single-serve bottle or a quarter of an individual pack of chips? “Serving size” has historically been a loophole to enable food marketers to make their products look better—lower in calories fat sugar and sodium—than they are.

What changes would you like to see in the Nutrition Panel Label?

Dr. Ayala

For an FDA tutorial on how to read the Nutrition Facts label go here.

Full disclosure: My familiarity with the food label panel is not only as a consumer and pediatrician, but also as a VP of product development for Herbal Water, an organic herb-infused water that has zero calories and no sugar or artificial ingredients. While bringing Herbal Water to market I studied the many aspects of the label guidelines.

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Yes, as you say, I do need my reading glasses. The CSPI model is a damn sight better. I would just highlight the sodium, too, so you have sugar, salt & fat in marquee letters. Maybe they should be bunched up at the top in extra bold. Great post.
Dr. Ayala,
Thank you for this terrific post. The Nutrition Facts panel has needed an overhaul for a long time - and not just because of how it makes so many of us squint and seek for better lighting.

I wholeheartedly agree that information on sugars should be formatted in much the same way as information on fats is.

To know the amount of total fat or total calories from fat is helpful - but being able to see what percentage of that fat is saturated or trans fat is where much of the truth lies in regard to health.

The same is also so true of sugars.

A standardized serving size is an outstanding idea. It’s easy to hide many things within a varying serving size.

I have also hoped for some time that Nutritional labels would be required to reveal if any percentage of animal products were used in the preparation of the product.

If the “crunch” of a cereal of cracker is derived from frying in fats with any percentage of animal products it would be a service to many to reveal that information.

I really appreciate your columns. You offer information that is not only helpful but educational. Thank you.

Rated and appreciated.

Steve: The CSPI recommendation actually addresses sodium and calls for a reduction in daily amounts to 1,500 mg/day, from the current 2,400 mg/day, which they think is too high.

Dennis: I'd love an animal products declaration. You know my bias:)
Ever since Michael Pollan, I've understood that everything I need to know comes down to one thing: the ingredients list. For example, if I don't know what something is, if I've never heard of it, and/or it is something that would never appear on any of grandma's shelves, then I shouldn't eat it; it's not food.
I would appreciate all confirmed and potential carcinogens italicised or underlined on the label. Also, I would like to add a separate category for Melamine content. That would be useful.
Indeed, great post! As Steve indicated, I would highlight the sodium. I always"try" read information about sodium content on labels.
The stupid serving sizes are the worst thing about American food labels. I remember a bag of chips that had 1.2 servings per packet. All that told me was that the calorie information was worthless.

If you ditch added vitamins on the label, then perhaps companies will stop adding vitamins. You might think this makes Lucky Charms more obviously a tasteless breakfast candy, but many staple are fortified, like milk and cereal and Vitamin D in milk is a significant source of Vitamin D for many children. For people in the North, who don't expose much skin to the weak winter sun for several months a year, vitamin D supplements are a must (if you aren't getting it in milk).

Naturally occurring sugars are important for diabetics to track. I remember a doctor once complaining that many of her patients thought if sugar wasn't added, it wasn't there. They drank juice instead of Coke.

Most of your labels came out too fuzzy for me to read.
Some irony in the fact that over half of people overestimate how much they should consume - and the fact that over half the population is overweight and have metabolism disorders.

Keeping marketing off the labels and making them easier to read and understand would be a good start.
@Irma Arkus: You really don’t expect much of processed foods:)
@Malusinka: The CSPI proposal isn’t suggesting to take off total sugars from the label, but rather to also give further information as to how much of the total sugar is added refined sugars.

Regarding vitamins: The added vitamins are listed in the ingredients. Giving them extra real estate on the already crowded Nutrition Facts is what I think is redundant and a marketing tool overused by food makers.

Milk and refined flour are required by law to add vitamins—a public health decision. The idea to add vitamins to everything—from candy to cereal to sugary drinks—is a marketing idea that has taken off and a boon to highly processed foods. It’s based on no evidence of benefits.
Yes, and yes. I love how the new label makes it easier to understand what exactly is in the product.
@Will: I like the origin of ingredients idea. I think there's not even the slightest chance food makers could or would provide it :(
Great post. And incredibly important topic.

Couldn't help thinking of this thought-provoking New Scientist article from this summer, about how our calorie calculations might actually be oversimplified and inaccurate: