- © 2004 Canadian Medical Association or its licensors
On Jan. 1, 2003, the Government of Canada introduced a new nutrition labelling system through amendments to regulations pertaining to the Food and Drugs Act. The regulations make nutrition labelling on most prepackaged foods mandatory and standardize the content and design of nutrition labels so that consumers will know what information to expect and where to find it. In addition, the compositional criteria for nutrient content claims (e.g., “no sugar added”) have been strengthened, and a small number of specific health food claims for foods whose consumption may reduce the risk of heart disease, osteoporosis, hypertension, dental caries and certain cancers will be permitted. The food industry has been given 3 years to comply, and small businesses 5 years. Exemptions from these regulations apply to certain food products, including those with more than 0.5% alcohol.
The hope is that, with more accessible information about food, coupled with education, Canadians will make more informed food choices and stave off diet-associated diseases such as diabetes, certain cancers, heart disease and stroke. To support the new regulations, the Canadian Diabetes Association, in collaboration with the Dietitians of Canada and an advisory committee of stakeholders, developed an interactive education program and resources known as Healthy Eating is in Store for YouTM (www.healthyeatingisinstore.ca). Tidbits from this program and from Health Canada's Nutrition Labelling Web site (www.hc-sc.gc.ca/hpfb-dgpsa/onpp-bppn/labelling-etiquetage/index_e.html) are offered here.
Physicians may wish to inform their patients about the new food labels and direct them to the 3 main components: the standardized Nutrition Facts label, the list of ingredients (all ingredients are included in order of weight) and nutrition claims. The Nutrition Facts label will provide information on a minimum of 13 core nutrients, including total calories, for a specific serving size. Before comparing like products, consumers should realize that the serving size may vary between products, may differ from portion sizes in Canada's Food Guide to Healthy Eating and may differ from the serving size they usually consume.
To allow consumers to compare the nutrient values of different food products of comparable serving size, the Nutrition Facts label lists the % Daily Value of most of the core nutrients. This value puts nutrients on a scale from 0% to 100% so that consumers will know whether there is a little or a lot of a nutrient in one serving of a packaged food. For carbohydrates and fat, the scale is based on a diet of 2000 kcal/d; for micronutrients (e.g., calcium and iron), the value is based on Recommended Nutrient Intakes, some of which are based on old values and need to be harmonized with the more current Dietary Reference Intakes.
Since caloric, vitamin and mineral needs vary between individuals (e.g., iron and vitamin A and C requirements vary by age and sex), consumers should be discouraged from using the % Daily Value as a prescriptive guide to add up their daily intake. Rather, it is designed to help them make food choices according to their need to increase or decrease particular nutrients.
Physicians should encourage their patients to compare total calories, total fat and total fibre. Fats get special mention because some choices are healthier than others (Table 1). In their natural state, fatty acids are either completely saturated with hydrogen or are unsaturated, having one or more double bonds between the carbon atoms. Unsaturated fats exist in 2 configurations (cis and trans). By virtue of their configuration, cis unsaturated fats are liquid at room temperature, whereas trans unsaturated fats are harder. Trans unsaturated fats are found naturally, in small amounts, in certain animal products such as butter, whole milk, cheese and meats. Much more common in the Canadian diet are the trans fats found in many processed foods. They are the result of a food manufacturing technique — hydrogenation — that converts liquid oils to a semi-solid form that is more spreadable and stable for shelf life.
Most trans fats, such as saturated fat, raise serum low-density lipoprotein cholesterol levels, whereas omega-3 polyunsaturated fats, found in many fish, nuts, seeds and oils, do not raise cholesterol levels but do lower triglyceride levels. The Nutrition Facts label breaks down the total amount of fat into saturated and trans fats, with the residual being unsaturated fat.
It is neither possible nor advisable to eliminate saturated fat from a typical whole-food diet. This would require extraordinary, unhealthy adjustments, since all sources of fat and oil are mixtures of fatty acids. Moreover, saturated fats are an essential component of cell walls. Depending on individual intake, many Canadians may need to reduce the amount of saturated fat in their diet, and all Canadians should reduce their intake of hydrogenated trans fats in processed foods. The Nutrition Facts label can be used to guide consumers toward healthier food purchases.
In addition to informing patients about the new Nutrition Facts label, physicians should remind them to check the ingredients list of food products, because added fats, sugars and sodium come in many guises (Table 2).
Erica Weir Associate Medical Officer of Health Marie Traynor Public Health Nutritionist Kingston, Frontenac and Lennox & Addington Health Unit Kingston, Ont. Wendy Levin Dietitian/Certified Diabetes Educator Tri-Hospital Diabetes Education Centre Sunnybrook and Women's College Health Sciences Centre Toronto, Ont.