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So What’s Low Carb? Chapter 4 – Part 6

Sep 16, 2015

The Diabetes Diet
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 6 of Chapter 4
So What’s Low Carb?

Or, What’s in What You Eat?

The single most widely recognizable graphic in the United States isn’t a corporate logo like the Nike “swoosh” or a brand symbol like the cursive Coca-Cola name, it’s a plain and unremarkable little box: the nutrition facts label. On virtually all packaged food and drink products, the graphic is ubiquitous in the United States.

The label can be a valuable source of information, but it can also be misleading or just dead wrong, depending on how the numbers were derived.

I rely heavily on food labels, and I encourage my patients — and you — to become an educated nutrition facts reader. Even though you can’t always rely solely on nutrition labels, they are really the only source of information we have about many products. They can be inaccurate in a number of ways, starting with the numbers not adding up (a clue that the label may be unreliable), although sometimes the reason the numbers don’t add up is due not to inaccuracy but to the way regulations require carbohydrate to be listed. It’s mandatory that total carbohydrate be listed, as well as dietary fiber and sugar, but listing of sugar alcohols is optional. And since these numbers are all averages, there may be a margin of error; so if you add up all the smaller
numbers under the total number, you may get a slightly different figure.

In addition, there are exceptions to the rules for the labels: small packages get an exemption and can use an abbreviated label; so can foods intended for children younger than four years and “medical foods, such as those used to address the nutritional needs of patients with certain diseases.” Manufacturers can also “customize” their labels by using footnotes.

Of course there are also just plain mistakes and even outright misrepresentations. I’ve seen strawberry preserves that are labeled as zero carbohydrate when it is obvious, from the berries in the jar, that there is plenty of carbohydrate. Mistakes can also happen with respect to foods that originate in the European Union and have had labels (with differing regulatory requirements) “translated” into American nutrition facts labels. And then there are good old typos — numbers that are incorrect or have misplaced decimal points.

The good news is that FDA spot checks have supposedly shown that overall, better than 90 percent of the time, the labels are accurate.

The Nutrition Labeling and Education Act of 1990 established standards for the information included on these labels.* Interestingly, the labels were in part a government response to the low-fat craze. The two most prominent numbers are for carbohydrate and fat, which have overall totals, but also have a breakdown — fiber and sugars, and saturated and unsaturated fats.

Manufacturers are required to measure several categories: protein, fat, carbohydrate, particular nutrients (select vitamins, as well as iron and calcium), and calories. The tricky thing about these labels is that there are different ways the information can be assembled. The maker can send the product off to the lab for an actual (averaged) measurement of protein, fat, and carbohydrate (see below), or it can estimate based on the ingredients in the recipe (as we do in creating meal plans).

Neither method is absolutely precise, but since every person can react to foods differently, and exact measurements would likely be quite expensive, absolutely precise measurements aren’t necessary.

There are standards for lab analyses of the different categories of nutrients in foods. There may be more than one approved method, and one method may be more precise than another. Each, however, has its limitations. One manufacturer of chicken soup, for example, may analyze the product in a lab. Another may use the recipe. The latter could, for example, use a proprietary database of nutrition information, or it could use a public resource like the U.S. Department of Agriculture’s National Nutrient Database. Since there is no single bible of nutritional information from which the data are derived, there will be variations depending on the source.

Say you’re shopping for breakfast sausage. You look at three different products. All have exactly the same ingredients except for salt and their special blend of spices. Two use their own labs to test their products and the other uses the recipe method. The likelihood of discrepancy is high.

That doesn’t necessarily mean, however, that the differences will be enormous, or even noticeable. Chances are good that the nutrition analyses are going to be very similar. If they aren’t — if the labels list significantly different amounts of protein, carbohydrate, or fat — a simple mistake, rather than the methodology, is likely to be the cause.

*A very comprehensive explanation of nutrition facts labeling can be found on the FDA’s Web site. Look on and search for information on nutrition facts labeling.

We would like to thank the publisher Little Brown and Company and Dr. Richard K. Bernstein, for allowing us to provide excerpts from The Diabetes Diet.

Copyright © 2005 by Richard K. Bernstein, M.D. All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.

Author’s Note:
This book is not intended as a substitute for professional medical care. The reader should regularly consult a physician for all health-related problems and routine care.

For more information on Dr. Bernstein’s and to purchase his books, CD’s or get access to his free monthly webinars, visit his website at