How to recognize labeling tricks that make foods seem healthier than they are

Can you trust the ingredient panel on food packaging? I’m a doctor and I don’t.

Misleading information on food packaging is one of the things I am most passionate about and one of the reasons that I started Step One Foods.

I also spearheaded an effort within the American College of Cardiology to send a letter to the FDA asking them, among other requests, to stop the practice of ingredient list manipulation. It was only one letter — but it did come from an organization representing over 52,000 health care professionals.

Food labeling has become nothing but a ruse and deceptive labeling is one of the major factors that has led to the epidemic of chronic disease in the United States.

My patients, and millions around the country are trying to make the right choices, but often fall prey to clever marketing.

At best, people are being led to believe that what they’re eating is better for them than it actually is. At worst, they are being completely manipulated and duped. Even by the most regulated section of a food’s packaging — the ingredient panel.

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What’s an ingredient panel/label?

The ingredient panel/label is a highly standardized list of ingredients found on the side or back of a food’s package. It is presented in accordance with FDA guidelines that cover everything from which ingredient names should be used to the font size of the print.

And the FDA is not kidding around. Failure to list an ingredient or failure to list it properly places a food company at risk of facing serious sanctions and stiff fines. So, if you’re going to find truth anywhere on the package, it should be here.

Many of us have heard the advice to always look at the ingredient list, especially the first five ingredients, to assess the quality of the foods we are purchasing.

Unfortunately, despite the FDA’s best intentions, even the ingredient list is being manipulated by manufacturers.

But before you can recognize the deception, you need to know something about the rules.

According to FDA rule 21 CFR 101.4(a), ingredients must be listed “in descending order of predominance by weight”, meaning that “the ingredient that weighs the most is listed first, and the ingredient that weighs the least is listed last.”

What is ingredient splitting?

Here’s the list of ingredients for Planters Honey Roasted Peanuts:

PEANUTS, SUGAR, HONEY, CORN SYRUP, PEANUT AND/OR COTTONSEED OIL, SALT, FRUCTOSE, CORNSTARCH, XANTHAN GUM

The list tells you that when you’re eating these peanuts, you’re ingesting more nuts than xanthan gum. So far so good.

But unless you were paying attention, you probably missed the fact that Planters employed ingredient “splitting” to manipulate the appearance of the list.

Related: When it comes to food, be wary of definitions

Look back at Planter’s ingredient list again. It contains 4 separate added sugars (sugar, honey, corn syrup, and fructose). These sugars may technically be distinct, and each was obviously used to make the product, but their only role is to add sweetness and from a nutrition perspective they are basically interchangeable.

So why did Planters use four sugars not one?  To ensure that an added sweetener didn’t end up ahead of the peanuts in the ingredient panel.

What is ingredient combining?

There’s even more to FDA rule 21 CFR 101.4(a). If an ingredient has sub-ingredients, those sub-ingredients are listed in parentheses, and also in descending order of predominance by weight for the ingredient’s composition.

This is meant to help deal with standard ingredient items such as chocolate or dried cranberries which naturally contain more than one component.

Now take a look at the list of ingredients for Kind Cinnamon Oat Clusters With Flax Seeds:

WHOLE GRAIN BLEND (OATS, BROWN RICE, BUCKWHEAT, AMARANTH, MILLET, QUINOA), DRIED CANE SYRUP, FLAX SEEDS, CHICORY ROOT FIBER, CANOLA OIL, MOLASSES, CINNAMON, SEA SALT, BROWN RICE SYRUP, VITAMIN E (TO MAINTAIN FRESHNESS).

The cereal is made mostly out of a blend of whole grains, and the blend is made up of more oats than quinoa. Again, fairly straightforward.

Or is it?

Something made of many things will weigh more than any one of its components alone – and manufacturers use this to their advantage. In essence, they create novel multi-ingredient items that were never envisioned by the FDA. Known as ingredient “combining,” this allows more desirable-sounding items to float to the top of the list.

Take a look at KIND’s ingredient list again. “Whole grain blend” definitely sounds healthy and it makes you feel good to find it as the first item listed.

However, this “whole grain blend” is a completely made up term, and it is reasonable to expect that if each of the components in the “whole grain blend” were enumerated separately, dried cane syrup (a sneaky name for sugar) could float to the top.

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The result

Ingredient splitting and combining is a rampant industry practice. And it makes knowing what you’re eating almost impossible to figure out – by design.

Just look at the ingredient list in Kellogg’s® Special K® Strawberry Protein Meal Bar:

COATING (SUGAR, PALM KERNEL AND PALM OIL, MILK PROTEIN ISOLATE, NONFAT YOGURT POWDER [CULTURED WHEY PROTEIN CONCENTRATE, CULTURED SKIM MILK, YOGURT CULTURES; HEAT-TREATED AFTER CULTURING], COLOR ADDED, SOY LECITHIN, NATURAL AND ARTIFICIAL FLAVOR), SOY PROTEIN ISOLATE, SOLUBLE CORN FIBER, STRAWBERRY FLAVORED FRUIT PIECES (SUGAR, CRANBERRIES, CITRIC ACID, NATURAL STRAWBERRY FLAVOR WITH OTHER NATURAL FLAVORS, ELDERBERRY JUICE CONCENTRATE FOR COLOR, SUNFLOWER OIL), CORN SYRUP, FRUCTOSE, INULIN, SUGAR, RICE, WHOLE GRAIN WHEAT, SOYBEAN AND PALM OIL WITH TBHQ FOR FRESHNESS, CONTAINS 2% OR LESS OF DEXTROSE, CALCIUM CARBONATE, GLYCERIN, SORBITOL, WHEAT BRAN, SALT, SOLUBLE WHEAT FIBER, SOY LECITHIN, VITAMIN C (ASCORBIC ACID), MALT FLAVOR, CITRIC ACID, STRAWBERRY JUICE CONCENTRATE, VITAMIN E (ALPHA TOCOPHEROL ACETATE), XANTHAN GUM, NIACINAMIDE, BHT FOR FRESHNESS, ZINC OXIDE, REDUCED IRON, NATURAL AND ARTIFICIAL FLAVOR, VITAMIN B6 (PYRIDOXINE HYDROCHLORIDE), VITAMIN B1 (THIAMIN HYDROCHLORIDE, THIAMIN MONONITRATE), VITAMIN A PALMITATE, VITAMIN B2 (RIBOFLAVIN), WHEAT STARCH, PARTIALLY DEFATTED PEANUT FLOUR, ALMOND FLOUR, VITAMIN B12, FOLIC ACID, VITAMIN D3.

If you missed the fact that added sugars are listed 6 times, and that there are no actual strawberries in the bars, don’t feel bad.

That’s the point.

Hopefully this makes it clear why it’s so important to choose foods from trusted sources or, better yet, choose real whole foods — there’s no label needed on a sweet potato.

For more information on healthy nutrition, visit Step One Foods.

Dr. Elizabeth Klodas MD, FACC

By Dr. Elizabeth Klodas MD, FACC

"Diet is a major driver of high cholesterol, but instead of changing the food, we prescribe medications. This never seemed logical to me.” Dr. Klodas has dedicated her career to preventive cardiology. Trained at Mayo Clinic and Johns Hopkins, she is the founder and Chief Medical Officer for Step One Foods. Dr. Klodas is a nationally sought out speaker and has an active role at the American College of Cardiology. Her clinical interests include prevention of heart disease and non-invasive cardiac imaging and she has published dozens of scientific articles throughout her career. Dr. Klodas has been featured on CNN Health for her mission to change how heart disease is treated. An independent study performed at leading medical institutions affirmed the ability of Step One Foods to deliver measurable and meaningful cholesterol-reduction benefits in the real world. The results of the trial were presented at the 2018 American Heart Association’s Scientific Sessions. Dr. Klodas has also authored a book for patients, "Slay the Giant: The Power of Prevention in Defeating Heart Disease," and served as founding Editor-in-Chief of the patient education effort of the American College of Cardiology. In addition to her practice and her duties at Step One Foods, she also serves as medical editor for webMD.

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