Understanding the FDA's Nutrition Labels, Part 2

Nielsen’s survey suggests that consumers are vulnerable to advertising when it comes to food. While 26 percent of global shoppers look at nutrition labels and scrutinize foods that they perceive as being “nonhealthy,” they do not examine the foods that they consider to be “healthy” in the same way.

Worldwide, Americans are the most likely to understand the information on the Nutrition Facts panel (67 percent as compared with the global average of 45 percent, according to Nielsen’s survey). But American consumers also appear to be the least inclined to use that information to their benefit. And while the sales of many health and wellness products may be on the rise in America — particularly those that boast “no trans or saturated fats” or claim to contain flax, hemp seed, or probiotics — obesity is also still on the rise.

Getting the Most Out of the Nutrition Facts Panel
Despite any perceived failings in the FDA’s nutrition-labeling system, it remains the primary system in the US. The FDA and USDA, along with the HHS and other governmental regulatory agencies, will continue to update the Nutrition Facts panel and other dietary guidelines for Americans and to regulate health claims based on scientific research and consensus panels.
The following are a few tips for getting the most out of the FDA’s Nutrition Facts panel:

• Pay attention to portions, and make sure you’re eating the right amount based on the actual serving size.
• Count calories to help manage your weight; make sure not to take in more calories than your body burns or you will gain weight.
• Limit saturated and trans fats, cholesterol, and sodium to reduce your risk of chronic diseases.
• Be sure you’re getting enough dietary fiber, vitamin A, vitamin C, calcium, and iron in your diet — daily.
• Use the Percent Daily Value (%DV) to determine how much the nutrients per serving are contributing to your total daily diet. You can also compare %DVs of similar products to see which is higher or lower in nutrients and, therefore, which one is better for you (for instance, if one cereal has 40%DV of iron while another has 100%DV).
• Read the ingredients list to learn more about what the package contains. For instance, you may want to choose foods that contain fewer preservatives or you may be seeking more whole grains. The ingredient listing is also important if you or someone in your family has food allergies.

For more information on the Nutrition Facts panel, you can visit the FDA’s Labeling and Nutrition section or you can sign up for updates on FDA-regulated products on the FDA’s Consumer Updates page.

Understanding the FDA's Nutrition Labels

Decoding food labels and product health claims can be a challenge. Here's the key to choosing the most nutritious foods and beverages.

When shopping the grocery store for healthy foods, the Nutrition Facts panel and other health claims on packaged food can be helpful tools. But how do you know these labels are guiding you to make the healthiest and most nutritious choices for you and your family?

Government Regulation of Nutrition Facts and Claims in America
The Food and Drug Administration (FDA), along with the US Department of Agriculture (USDA) and the Department of Health and Human Services (HHS), is responsible for setting the guidelines for healthy eating in America. This includes the regulation of the FDA's Nutrition Facts panel and of any nutrition claims that manufacturers display on the packaging of food and beverages sold in the US.

The Nutrition Facts panel was initially developed by the FDA to make consumers aware of the nutrients and calories in the foods and beverages they buy and, ultimately, to help shoppers make more-healthful choices for themselves and their families. The panel is required to list the amount of calories, fats, cholesterol, sodium, carbohydrates, fiber, sugars, protein, vitamins, and minerals per serving, as well as the serving size and number of servings per container. Still, food labeling at the FDA and USDA remains a work in progress, with revisions being made as scientists uncover important nutritional revelations.

Revising Nutrition Facts
To help protect consumers from misleading claims, the FDA and USDA made a significant change to the Nutrition Facts panel requirements in 1994. The departments created guidelines for the use of such terms as “healthy,” “light,” “reduced sodium,” and “low fat” (and variations on these terms) as part of the Nutrition Labeling and Education Act. Before this provision, a food or drink that contained no fat or sodium could have been labeled as “healthy” — even jelly beans or soda.

In 1994, the FDA declared that in order to be deemed “healthy,” a food or beverage must be low in fat (including saturated fat), sodium, and cholesterol, and also contain at least 10 percent of the recommended daily value of either vitamin A, vitamin C, iron, calcium, protein, or fiber. Even big brands with the word “healthy” in their names, such as Healthy Choice, were obliged to conform to the FDA’s new labeling laws. The FDA also currently regulates terms — including "low," "reduced," "high," "free," "lean," "extra lean," "good source," "less," "light," and "more" — that may be used to describe a given nutrient.

In January 2006, in an effort to help consumers make more heart-healthy choices, the FDA began requiring manufacturers to list trans fat — that is, trans fatty acids — on the Nutrition Facts (and some Supplements Facts) panels. This addition was the result of scientific research showing that consuming trans fat can increase the risk of coronary heart disease by raising low-density lipoprotein (LDL) levels, often referred to as “bad cholesterol.” Saturated fat and dietary cholesterol also increase LDL, but they have been listed on food labels since 1993.

Global Nutrition Labels
In a September 2008 Consumers and Nutrition Labeling global report by the Nielsen Company, Deepak Varma, senior vice president of Nielsen Customized Research, concluded that both the rise in obesity and the fact that heart disease is the number-one killer worldwide puts increasing pressure on governments and the food industry to better educate people about what they’re eating. “The urgent need for clear and educational labeling has become one of the most debated and controversial topics in recent years,” says Varma.

To be continued...

People playing the odds on health care over costs

Call it a health care gamble: the decision by some people to opt out of health insurance, paying cash for routine care while playing the odds that an accident or catastrophic illness won't plunge them into financial ruin.
President Barack Obama's goal of requiring everyone to carry health insurance has drawn a great deal of skepticism from this group. Many pay far less for health care than they would on premiums, and doubt that insurance would even cover them if they needed it.
It's not known how many of the nearly 50 million people in the United States voluntarily go without coverage. Researchers at the Kaiser Family Foundation, which studies the uninsured, said most are young, generally healthy adults who are self-employed or are in relatively low-wage jobs that do not offer insurance coverage and don't pay enough for workers to afford individual policies.
"Income is key and most of the uninsured have low incomes," foundation researcher Karyn Schwartz said. "If you look at your budget and think you can't afford it or can afford it if you eat only ramen noodles, you may choose not to get it."
All the health care plans that have emerged from the Democratic-controlled Congress would require everyone to have insurance, the way drivers in nearly every state must purchase auto insurance. Proponents say that by bringing everyone into the system, medical risk is spread over a broader population, bringing costs down.
Those who opt out voluntarily might have to pay a penalty. Sen. Max Baucus, D-Mont., who drafted the Senate Finance Committee's plan, set the penalty at $3,800 for a family but cut it to $1,900 amid complaints that the original level was too high.
Republicans have called the insurance mandate a new tax on the middle class. Obama disputes that, saying that whatever plan emerges from Congress must offer subsidies to lower income people that will make coverage affordable.
In exchange for the requirement that everyone buys coverage, Obama wants a guarantee from insurers that they no longer will deny coverage based on an individual's health or drop coverage when a person gets sick. The insurance industry has signaled it will accept that trade-off, but need to convince skeptical consumers that it actually means it.
Doubts about what insurers will cover — coupled with the exploding costs of premiums — are what has driven some to opt out and take their chances.
Krista Neher, who's starting her own social media and marketing venture, is one.
The 30-year-old from Cincinnati recently left Proctor and Gamble, where she was covered by the company's health care plan. After researching the costs of an individual policy, she decided to remain uninsured.
"I want to have health coverage, I think it's important. It bothers me that I could be hit by a car," Neher said. "But I have really low confidence that any insurance company would even cover me in that case, even after I paid all the high premiums. It just seems like a lose-lose situation."
Many people who go without coverage have found that health care providers often will cut the price of a procedure if they know they'll be paid in cash rather than through insurance.
Jason Jepson, a self-employed communications consultant based in Southern California, decided against buying an individual policy he said would have cost twice as much as his $1,250 monthly rent. He pays out of pocket for all medical treatment, saving money even after being treated for a broken ankle and severe strep throat.
"If you pay with cash, they do give you a discount — it's the big secret of not having insurance," Jepson, 35, said.
But Jepson said his lack of insurance has meant lifestyle adjustments, such as driving less and staying off freeways to avoid accidents. He says he supports Obama's requirement that everyone carry insurance if it can be made affordable.
"I would pay for it. I'm just not sure it will really cover everything," Jepson said.
To ease fears of an unexpected medical crisis, registered nurse Mary Pitman of Vero Beach, Fla., refuses health insurance and takes the extra cash in her paycheck. Pitman, 54, puts $3,000 per year into a pretax flexible spending account for routine care and another $300 per month in an emergency fund in the event of a major illness.
"I have more control over my money this way, and there's a tax advantage," she said.
As skeptical as many are about insurers, some are equally doubtful about government's ability to do a better job managing health care.
Laura Silverthorn of Tampa, Fla., left a nursing job to start her own business designing and selling temporary tattoos. She has gone without health coverage for nearly two years for herself and her toddler son.
While Silverthorn, 36, said she wishes she could afford insurance — "Just one accident and you're done," as she put it — she's also grown disillusioned with government-run programs after working part time reviewing medical charts for Medicaid.
"I don't know if I want the government running health care when I see how they run Medicaid — there is so much fraud," she said.
The only test case for Obama's plan to bring everyone into the health insurance system is Massachusetts. In 2006, it enacted a program to cover all state residents. Those who opt out must pay a $912 annual tax penalty.
Michael Widmer, president of the nonpartisan Massachusetts Taxpayer Foundation, which has researched the effectiveness of the state's health insurance mandate, said most people had chosen to buy insurance rather than pay the penalty — even those who are "young, healthy and immortal."
"Most are saying, 'If I'm going to have to pay this much in any case, I should be covered,'" he said.
While about 65,000 people in Massachusetts were allowed for financial reasons to opt out of the mandate last year, the state now has the lowest rate of uninsured residents in the country — 4.1 percent, according to the latest census data.

Young adults and healthcare. Who cares?

Young adults are the least likely among all age groups to get outpatient medical care even though there is plenty of evidence that seeing a doctor once a year or so would benefit people ages 20 to 29 just as much as older or younger folks.

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A study published in the September issue of the Annals of Internal Medicine used national survey data from 1996 to 2006 to show that annual visits for healthcare drops sharply between peaks of heavy usage in childhood and middle age. Young men, especially, are unlikely to get regular healthcare, as are people without insurance. About one-third of young adults are uninsured, according to the researchers from the University of Rochester School of Medicine and Dentistry. Young adults are also less likely to have a primary care doctor.

People in their 20s often appear to be in good health, which may lead many to conclude that they don't need healthcare. But numerous studies show that many health problems peak in early adulthood, including homicide, accidents, sexually transmitted diseases and substance abuse disorders. Rates of suicide, smoking, HIV infection and psychiatric disorders are also higher in this age group than in several other age groups. A large portion of young adults are overweight or obese or sedentary.

"In contrast to adolescents, young adults garner relatively little attention from researchers, advocacy groups, or policymakers," the authors wrote. "Our findings emphasize the need for a national agenda to improve access to care and preventive services for all young adults."

Menopause and Acne: Causes and Control

Acne in adulthood can often be an unexpected menopause symptom

Hot flashes, night sweats, weight gain: These are menopause symptoms that are all too familiar to most of us. And yet acne — the bane of our teenage years — is also associated with menopause.

Why Does Acne Appear in Menopause?
Whether you are 17 or 47, acne outbreaks have the same root cause: Changes in hormone levels affect the way your skin protects and regenerates itself, sometimes with unpleasant results.
At the onset of menopause, or more accurately, the phase that leads into it, called perimenopause, levels of the female hormones, including estrogen, drop. But androgen levels, the male sex hormones that each woman has as well, remain constant. This situation in effect causes the body to experience a relative increase in the effect of these "male" hormones.
One of the strongest of the androgens, testosterone, often triggers skin conditions that result in menopausal acne. As testosterone levels rise, the skin's sebaceous glands go into overdrive, producing excess sebum, an oily substance that can block pores. The problem is further exacerbated by the slowed-down cell regeneration in older skin. As excess skin cells build up, they block pores already clogged with sebum, resulting in inflammation and infection. The body's immune response causes a buildup of white blood cells in the infected area, and the result is a blemish or zit.
Medical Treatments for Adult Acne
If a pimple or even more widespread acne develops, "don't panic!" recommends Jerilynn Prior, MD, founder of the Centre for Menstrual Cycle and Ovulation Research. "Women in perimenopause rarely experience severe acne." Dr. Prior also points out that stress hormones are linked to acne as well, so stressing out about zits is the last thing you want to do.
Typically, menopausal acne is a temporary condition that goes away once a woman settles into postmenopausal hormone levels. But sometimes the discomfort and cosmetic impact of acne is severe enough to prompt a woman to seek medical attention. Among the most popular options are:

• Hormone therapy. Women who participate in hormone replacement therapy (HRT) often cite an improved complexion as one of its benefits. Supplemental estrogen provided by HRT not only helps your skin retain the elasticity and softness of its younger days, it can also help ward off blemishes and acne. On the other hand, in some women HRT may actually trigger an acne problem. It is rare for doctors to prescribe hormones for dermatological issues alone, as HRT is typically undertaken to address a suite of menopausal symptoms. Furthermore, any potential dermatological benefits are highly unlikely to outweigh HRT's significant risk factors, including those for heart disease, stroke, and breast cancer.
• Topical treatments. Skin-care specialists often recommend over-the-counter topical medications such as benzoyl peroxide to target blemishes and/or a topical antimicrobial gel like the prescription antibiotic erythromycin (Benzamycin) to combat acne-causing bacteria. Retinoids, a vitamin-A derivative, are another effective class of topical medications prescribed to help treat blackheads or small blemishes. Retinol increases the skin's sensitivity to sunlight, so daily sunscreen application is critical when using these products.
• Oral medications. In addition to topical treatments, doctors may also prescribe oral medications such as antibiotics, low-dose oral isotretinoin (an acne treatment commonly known by the brand name Accutane), or spironolactone, an anti-androgen diuretic.

Self-Care Strategies for Menopausal Acne
Maintaining a good self-care regimen is necessary for skin health throughout your life, but it is especially important for women experiencing the dual challenges of delicate skin and breakouts during menopause. Dermatologists recommend:

• Daily cleansing. Wash your face twice a day with a gentle, nondrying cleanser followed by a light moisturizer.
• Gentle approach. Harsh products and vigorous scrubbing are a definite no-no for mature skin that can be easily irritated or damaged.
• No picking. Squeezing or picking at pimples must be avoided completely since skin, which becomes more fragile at menopause, may scar more easily.

In addition to proper skin care, Prior encourages women to reevaluate their cosmetics collection. "Oil-based cosmetics can exacerbate the problems for skin that is already clogged with excess oil." Look for water-based or mineral cosmetics to replace oily products and "take extra care to remove all traces of makeup when you wash your face," she says.

 

Teeth Whitening at Home

Want to whiten your teeth using over-the-counter products?

There are many to choose from — find out which work best.

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Walk into the dental health section of any drugstore, and it’s likely you’ll be overwhelmed by the sheer number of teeth-whitening products. Everything from teeth-whitening strips to gels to trays to toothpastes promise gleaming white teeth. So how do you know which to choose? And do any of them actually work?

Sorting Through Teeth-Whitening Products
Here’s an overview of teeth-whitening products currently on the market.

Teeth-Whitening Strips

• How they work: Teeth-whitening strips are thin, almost invisible pieces of plastic coated with a whitening solution (usually a low concentration of hydrogen peroxide). The strips are applied directly to your teeth for 5 to 30 minutes once or twice daily for 5 to 14 days (depending on the product). Generally, strips that are designed to be worn for shorter periods of time have higher concentrations of the whitening solution.
• Cost: $20-$40

Teeth-Whitening Gels

• How they work: Designed to be painted directly on the teeth using a small brush or pen, teeth-whitening gels are typically peroxide-based. The gel is usually applied before you go to bed and left on overnight. The process is repeated for two weeks or longer.
• Cost: $12-$15

Teeth-Whitening Trays

• How they work: Tray-based whitening systems involve filling a mouthpiece-like tray with a peroxide-based whitening gel. The tray is worn for a certain time period each day or night for one to four weeks or longer.
• Cost: $8-$45

Light-Based Kits

• How they work: After using an acid rinse, you paint a whitening gel on your teeth with an applicator and hold a special light (included in the kit) up to your teeth to accelerate lightening. The process can be repeated multiple times.
• Cost: $35-$60

Teeth-Whitening Toothpastes

• How they work: Toothpastes with whitening agents don’t actually bleach or change the color of teeth. Instead, they help remove surface stains using polishing or chemical agents and mild abrasives. This may make the teeth look slightly whiter over time.
• Cost: $3-$8

Do Teeth Whitening Products Work?
Most over-the-counter teeth whitening products will work to some degree if you use them long enough, says Kimberly Harms, DDS, a spokesperson and consumer advisor for the American Dental Association’s (ADA). Over-the-counter teeth whitening products contain much lower concentrations of whitening agents than professional tooth-whitening products used under the supervision of a dentist. “The biggest problem with these store-bought whiteners is that people give up too soon,” says Dr. Harms. “In most cases, you need to use them for weeks and weeks and weeks before you’ll see any change in the whiteness of your teeth.” In a recent study published in the journal General Dentistry, people who used whitening strips for 30 minutes twice daily showed significant improvements in yellowness and lightness/brightness. But all the patients in the study used the strips for 44 consecutive days.
Are Teeth-Whitening Products Safe?
Whitening your teeth using over-the-counter teeth whitening products is considered safe but some people may experience mild tooth sensitivity or gum irritation. If you experience these side effects, stop using the product for a few days, says Harms.
Teeth-Whitening Tips
The following recommendations will help you get the most out of over-the-counter tooth-whitening products.

• Talk to your dentist before getting started. The ADA recommends that you consult with your dentist before using a bleaching product, even an over-the-counter one. The reason: Whitening can be uncomfortable or ineffective for people with worn tooth enamel, gum disease, sensitive teeth, tooth-colored fillings, or crowns.
• Buy well-known brands. Harms recommends choosing major brands that have been around for awhile when selecting an over-the-counter product.
• Look for the ADA seal. Whitening toothpastes that display the ADA Seal of Acceptance have met the ADA’s standards for safety and effectiveness. Harms says that no over-the-counter whitening strips, gels, trays, or light-based systems currently carry the ADA seal, although several bleaches dispensed by dentists do.
• If you use the tray-based system, choose a tray with a flexible mouthpiece. Some mouthpiece trays can be molded to your mouth to some degree. “It’s better than an inflexible mouthpiece that may not fit snugly around your teeth,” says Harms. If the mouthpiece doesn’t uniformly make contact with your teeth, whitening can be uneven. Plus, the solution may leak out, irritating your gums.
• Avoid staining beverages. Your whitening will last longer if you avoid coffee, tea, and red wine. Also avoid smoking, which can stain the teeth.
• Wait to whiten if you’re pregnant or nursing. It’s recommended that pregnant and nursing women avoid teeth whitening because the effects of whitening agents on fetuses and babies are unknown.

Though you shouldn't expect dramatic results from over-the-counter teeth-whitening products, over time, a store-bought teeth whitener can make your teeth several shades lighter. Slightly yellow teeth are the easiest to whiten, and new stains are easier to remove than old ones. Gray or black stains are more difficult, and may require professional whitening or another cosmetic dentistry procedure, such as veneers.

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A 16-Year-Old Boy With a Fever of Unknown Origin

A 16-year-old boy is presented to the emergency department (ED) with an 11-day history of low-grade fever. He complains of decreased appetite and a 7-lb weight loss during approximately the past 11 days. He denies any recent travel or unusual exposures. His symptoms began with an erythematous rash on his feet, bilateral ankle swelling, and pain while walking. The symptoms partially improved with the use of ice packs and bed rest. The patient was seen in his pediatrician's office with the same complaints 3 days ago; he was prescribed amoxicillin/clavulanate at that time, but he has not experienced any further improvement. The patient has no significant previous medical or surgical history, and he denies using alcohol, cigarettes, or other drugs. He lives in a residential urban home with his parents and sibling.

On the initial physical examination, he has a temperature of 100.9°F (38.3°C), but otherwise his vital signs are normal. His weight is noted to be in the third percentile for his age. Shoddy, deep cervical lymphadenopathy is present bilaterally, and asymmetrically enlarged, tender anterior cervical and submental lymph nodes are detected (more prominently on the left than right). He is noted to have a slightly scaly erythematous macular rash on his face and involving the bridge of the nose, with sparing of the nasolabial folds (see Figure 1; the image shown is not of the actual patient, but it exhibits the same findings as described in this case). The rash has sharp edges and is not pruritic. His physical examination is otherwise unremarkable.

The initial laboratory results reveal pancytopenia, with a white blood cell (WBC) count of 1.6 × 10³/µL (1.6 × 10⁹/L), a hemoglobin of 10.4 g/dL (104 gL), a hematocrit of 30%, and a platelet count of 71 × 10³/µL (71 × 10⁹/L). His erythrocyte sedimentation rate (ESR) is elevated at 80 mm/h. The patient is admitted to the hospital for fever of unknown origin. Cultures of blood, urine, and sputum are obtained, and he is subsequently started on broad-spectrum antibiotics. Serology tests for tick-borne illnesses, HIV, systemic lupus erythematosus (SLE), and Epstein-Barr virus (EBV) are sent. While awaiting the laboratory results, he is given 1 dose of intravenous immunoglobulin empirically for atypical Kawasaki disease, with no response. He is sent for bone marrow aspiration and biopsy, which shows hypocellular bone marrow for his age, with all 3 cell line elements present and without evidence of malignancy. Computed tomography (CT) imaging reveals bilateral axillary, anterior mediastinal, retroperitoneal, external iliac, supraclavicular, and inguinal lymphadenopathy (images not available). Biopsies of the left cervical and submandibular lymph node are performed, but they are not consistent with lymphoma or other malignancy.

Throat, urine, and blood cultures remain negative after 4 days. Antinuclear antibody (ANA) titers are positive, with a titer of 1:640 and a speckled appearance. The patient is scheduled for a second lymph node biopsy because of the incongruence of the radiographic and histologic studies. Prior to the procedure, bilateral small pleural effusions are discovered on the chest radiographs. As a result of his anemia and thrombocytopenia, he is transfused packed red blood cells and platelets, without marked improvement in these indices. A second bone marrow biopsy and left axillary lymph node biopsy are performed, but the results are unchanged from the prior biopsy results.