January 2010 Issue

Hurdles in the Health Food Aisle
By Maggie Moon, MS, RD
Today’s Dietitian
Vol. 12 No. 1 P. 32

Are those “all-natural” multigrain crackers truly as wholesome as they appear? Help clients recognize misleading language and understand food labels so they can become more informed shoppers.

Faced with a food that promises to be all natural and wholesome, with attractive packaging and farm-stand images to complement these claims, what would you do? As an RD, you’d probably flip that pleasant-looking box right over to take a good look at the Nutrition Facts panel. Your clients, on the other hand, may find these themes so appealing and convincing that they’ll look no further before deciding to buy.

People may be even more receptive to anything with a “health halo”—deserved or not—because it’s January, that time of year when the Google searches for “healthy eating” and “weight loss” spike. Therefore, with health and wellness high on people’s minds, the timing is perfect to equip clients with the skills to discern actually-good-for-you from sounds-good-for-you foods.

The phrase “all natural” is one of the most popular sets of buzzwords in food marketing today, and one third of new products now carry the natural claim, says Bonnie Taub-Dix, MA, RD, CDN, a national spokesperson for the American Dietetic Association and the author of a book on food labeling due out this summer.

Taub-Dix points out that although the phrase attracts people, “It’s not clearly defined, and it doesn’t reflect what’s on the Nutrition Facts panel or in the product. Natural products could very well be full of sugar, fat, and preservatives. I tell my clients not to be taken in by the word natural or a pretty package but instead to turn the package over and check out the label.”

David L. Katz, MD, MPH, FACPM, FACP, cofounder and director of the Yale-Griffin Prevention Research Center, agrees that “many products sport claims about being natural or organic, which may be true but doesn’t mean they are nutritious.”

However, not all lambs are wolves in disguise, as there are great natural products out there. And the burgeoning array of new food products and specialty markets featuring natural foods is a strong sign of a widespread and growing desire to eat healthier foods that are good for both body and planet. The tricky part is helping clients see past confusing claims so they can be prepared to make wholesome choices that not only look but also act the part of contributing to overall wellness.

Life in the Grocer’s Lane
Experts and colleagues from the growing field of supermarket RDs share their insights about life in the grocer’s lane, with perspectives on various claims, health halos, functional foods, and more.

Traffic Jam No. 1: Too many health and nutrient claims on food labels
Katz, who is also principal inventor of the Overall Nutritional Quality Index, which supports NuVal, the in-store nutrition rating system, agrees that consumers need a way to cut through the clutter. “Madison Avenue is on the front of every package. The messages there are all about marketing rather than objective health guidance,” he says.

Linda McDonald, MS, RD, LD, editor of SupermarketSavvy.com, understands that processed foods are often easier to prepare than fresh foods, but she says it’s also harder to decipher whether they’re healthful because of all of the different wellness and nutrient claims. She tells her clients to “always plan ahead, be familiar with the store layout,” and—because the unhealthiest foods are usually those bought on impulse—to “hit the aisles with a shopping list.”

Traffic Jam No. 2: Fortified functional foods
“Added vitamins, minerals, phytosterols, and probiotics are only helpful if you really need the specific nutrient and can’t get it in its natural form,” McDonald says. She offers the example of calcium, citing the calcium naturally found in milk as the best form but acknowledging that a calcium-fortified orange juice may be a good choice for people who are lactose intolerant or who don’t drink milk.

The NuVal system aims to balance the value of nutrient fortifications by looking at an overall score. “For health-conscious food shoppers,” Katz explains, “the real question of importance comes down to this: Is this product good for me and my family? NuVal aims to answer that question with a single, summative, holistic, objective look at the overall nutritional quality of the product based on all of its important nutrient levels.”

Annette Maggi, MS, RD, senior director of nutrition for NuVal LLC, adds, “The NuVal scoring process factors in more than 30 nutrients and nutrition factors, compares the nutrient levels in foods to a recommended ‘healthy’ diet, and includes a nutrient’s relationship to disease risk.”

Traffic Jam No. 3: Free roaming and free range animals
“I think it’s important for consumers to know that when they choose free roaming or free range animal products, that they are buying the assurance that the animal had access to an area to roam or range,” Taub-Dix says. “It does not mean, as some consumers may think, that these animals spend all day outdoors. It really doesn’t give a good indication of how they are raised.”

Traffic Jam No. 4: Low-fat trade-offs
Maggi warns to take a closer look at low-fat salad dressings. “While they are lower in fat, they can have close to 500 mg of sodium in a 2-T serving. That’s 20% of the sodium you should have in an entire day.”

Cheryl Forberg, RD, nutritionist for The Biggest Loser, agrees: “Low-fat and fat-free products aren’t always the best choice. Removing fat from products takes away texture and flavor, which is often replaced with salt and/or sugar. The fat grams may drop, but total calories could end up even higher than in the original version. I encourage my clients to check the label.”

Traffic Jam No. 5: Beverages
Designer beverages aren’t always worth their price tag. “Expensive beverages with pomegranate, green tea, açaí, etc usually contain ample sugars or artificial sweeteners and very little nutrition at a premium price,” says Brooke Baker, MS, RD, LD, extension specialist with West Virginia’s Family Nutrition Program. “We don’t know how well these nutrients work alone, which is how they’re added to a food that didn’t originally contain them. We do know, however, that nutrients work best the way they’re packaged in nature. I recommend that my clients buy the original food. An entire pomegranate in season is going to be less expensive than the bottle of its juice.”

“Fruit juices can seem like good choices when they’re labeled with appealing terms like all natural,” adds Marie Feldman, RD, CDE, research manager at The Medical Group of Encino in California. However, some contain added sugar, and they don’t offer much in the way of fiber. Instead, Feldman recommends that her clients choose fresh fruit and convinces them with comparisons of calories and fiber: “A small apple or orange contains 30% fewer calories than a cup of juice and has 60% more fiber, which helps to make it more filling and satisfying.”

Diane Welland, MS, RD, author of The Complete Idiot’s Guide to Eating Clean, shares that she loves soy milk, “But I only buy brands that say no sugar added. Even natural plain soy milk and low-fat soy milks may have sugar added. I tell my clients to check the label.”

Traffic Jam No. 6: When simple isn’t always the solution
Carolyn O’Neil, MS, RD, coauthor of The Dish on Eating Healthy and Being Fabulous! is “not a huge fan of simplistic advice to look for foods with less than three or less than five ingredients. Some of the most delicious and nutritious foods in the world have lots of ingredients. It’s not about the quantity of ingredients; it’s about the quality.”

Case in point: Potato chips that are nothing but potatoes, oil, and salt don’t contribute many positive nutrients. And while 1 oz of plain potato chips can be a good source of vitamin C, there are plenty of fresh fruit and vegetable sources for this nutrient, sans oil or salt.

“Well-meaning health professionals often recommend shopping the perimeter of the grocery store for the most healthful choices,” says Jessica Walls, RD, CD, corporate dietitian for Affiliated Foods Midwest. “I appreciate the simplicity of the message, but I also know that many healthful (and more budget-friendly) choices are found in the center of the store.”

Walls explains: “Some of these often-overlooked pantry picks include fortified (and fiber-filled) cereals and pastas, canned and frozen fruits and vegetables, peanut butter and nuts packed full of healthful fats, canned tuna and salmon for brain-boosting omega-3s, and the nutrition powerhouse, the humble bean.” She guides customers to search out healthful choices in all sections of the grocery store and encourages people to check the calories; cut the saturated/trans fats, cholesterol, and sodium; and look for protein, fiber, vitamins, and minerals.

Traffic Jam No. 7: The multigrain halo
Welland suggests taking a closer look at multigrain foods. “Many people think multigrain crackers are great sources of fiber, but if you read the label, you’ll find that some of them contain less than 1 g of fiber per serving. That’s not that much different than the 0 g of fiber listed on the plain white cracker. Furthermore, if you read the ingredient list, enriched white flour is often still the first ingredient on these multigrain products,” she says.

The Wolves
Unfortunately, we live in a world where we must educate our clients about the misleading claims on foods, or the so-called wolves in sheep’s clothing. The following are some common examples to share with clients.

“Granola is often marketed as all natural, made from whole grain rolled oats, but it is also high in sugar, fat, and calories,” Feldman says. “A mere quarter-cup portion is often over 200 kcal per serving. Instead, go straight to the source: The key ingredient is oats. An instant packet of plain oatmeal is only 100 kcal, regular stove-top oatmeal is about 150 kcal, and both are a good source of fiber with no added sugar. I like to recommend topping it off with fresh fruit or nuts to add flavor and, of course, nutrients.”

Katz singles out reduced-fat peanut butter, calling it “less nutritious overall compared to regular because while a bit of fat is taken out, sugar and salt are added.” The story on sugar-reduced cereals is similar, and they may even be “less nutritious than the original,” according to Katz, because the trade-off for less sugar is sometimes more salt and fat and less fiber. He says, “Some breakfast cereals have a higher concentration of salt than potato chips, [and] some pasta sauces have higher concentrations of added sugar than ice cream toppings.”

Maggi finds pretzels and sorbet noteworthy because “while both products are low in fat or fat free, the majority of calories in sorbet come from sugar and from refined flour in pretzels. Neither product has positive nutrition attributes to offer.”

Welland recommends that her clients stay away from products labeled as being light or reduced sugar. “Most of these products simply add artificial sweeteners. I often suggest buying nonfat or low-fat plain yogurt or plain oatmeal, then adding (preferably fresh) fruit. I highlight that they’ll save calories and get more fiber, too.”

When to Say Yes
In addition to giving clients general guidance and noting foods to avoid, it’s also important to be prepared to recommend specific foods. While we want to teach our clients to “fish” by providing general advice, oftentimes it’s helpful to get them started with a few pointed suggestions. Get to know your local natural food markets (or the dedicated shelf space in the conventional grocery store) and keep track of the items whose nutrition profiles impress you. The demand for these products is rising, and it’s smart to have insights into foods that satisfy consumer demand and our nutritional standards.

In the dairy case, look for Chobani, a line of Greek yogurts, including many nonfat varieties. They provide protein (36% of the Daily Value [DV]) and are an excellent source of calcium (20% DV), contain no artificial flavors or preservatives and no synthetic growth hormones, and are gluten free. And a portion of the proceeds from sales is donated to various charities.

For snacks, bulk dried fruits and nuts help satisfy sweet and savory food hankerings. A specific product that stands out is Wonderful brand pistachios, which are grown using environmentally friendly farming practices. They offer the safety of a sealed package but are available in fairly large sizes (24 oz), so there isn’t an excess of wasted packaging. Pistachios are one of the lowest calorie, lowest fat nuts, and the fats they do contain are heart healthy.

All-natural frozen food options can be all over the place nutritionally, especially when it comes to sodium. Kashi, a brand associated with natural foods, offers some good choices. Kashi has a sweet and sour chicken entrée with no artificial ingredients that contains 320 kcal, 3.5 g total fat, 0.5 g saturated fat, 380 mg sodium, and 600 mg potassium (17% DV). It also provides an excellent source of fiber (24% DV). A vegetarian choice by Kashi is the black bean and mango dish with whole grain pilaf, which provides 340 kcal, 8 g total fat, 1 g saturated fat, 430 mg sodium, a good amount of fiber (28% DV), and plenty of vitamin C (100% DV) and vitamin A (150% DV). Both of these options are also good sources of iron (10% DV).

Guidance is necessarily general when it comes to perishables because regional sources come into play. For produce, finding something local and seasonal often outweighs the benefits of organic in terms of taste, price, and sustainable agriculture. For meat and poultry, an antibiotic-free label is not as meaningful as one that says “raised without antibiotics.”

RDs to the Rescue
It would be nice if we could tell our clients that all foods labeled as natural, simple, organic, or wholesome were great choices, knowing that they face 45,000-plus items during the average food shopping experience. But as nutrition experts, we know that minefields exist even in the health food aisle.

We can assist clients by helping them recognize healthier options and then strategize with them on how to incorporate these foods into the usual diet. Providing concrete examples of “wolves” may also help clients feel more confident as they make their way through a natural food market or even just their conventional grocery store’s health food section.

Katz believes RDs can help clients learn to incorporate nutritious foods into meals at home quickly and conveniently. “There is a whole skill involved in getting the food you love to love you and your family back,” he says. “Dietitians are, and need to be, in the vanguard of imparting that skill set.”

— Maggie Moon, MS, RD, is a nutrition writer and dietitian based in New York City.