A Pharmacist in Every Pharmacy and a Dietician in Every Grocery Store

December 5, 2013

As a consumer, I find nutritional labels confusing. Even with a health background and a propensity to read the fine print, it seems I have a difficult time getting the information I want out of the labels. Take a look at these 3 examples from the cereal aisle.

cereals

We begin at the top with serving size. With Cheerios and Raisin Bran, I see that I’m comparing the information for 1-cup serving sizes. Already for me, that’s not very helpful. I would have thought that serving size (at least when it comes to grains) should correlate to some degree of satiation — how “full” you feel afterwards. Here, however, one serving is 27g and the other 55g, a two-fold difference! To compare these products any further, I’m going to have to be constantly multiplying and dividing by 2. To make it more confusing, the Honey Nut Cheerios is measured in a 3/4 cup serving size. So multiply this column by four-thirds if I want to compare 1 cup serving sizes, or leave it at 29g if I want to base it on how filling it is. We’re off to a bad start.

Now, I would have suspected that serving sizes are used to comply with the Canada Food Guide. Turns out, that’s not true.

All the information on the Nutrition Facts table is based on a specific amount of food. This amount may be different than one Food Guide Serving.

To that end, I’m not sure what a “serving” really is. Health Canada doesn’t provide me with a concrete definition, just a set of examples which are broken up into “whole grain” and “non-whole grain”, where even that doesn’t seem to make a difference (see, slice of bread). As it turns out, 1 serving of cereal is 30g so it seems the Raisin Bran is totally off. At least it explains why the two Cheerios-brand cereals have different cup amount but similar weights. Still, it’s very confusing while standing in the middle of the cereal aisle.

What do I make of the cholesterol number? There isn’t a percent-daily-value (%DV) for cholesterol (even when it’s non-zero) and there’s no information as to how much is high or low.[1] Even if I was watching my cholesterol, milligrams of cholesterol is a meaningless value since my doctor adjusts the medication based on lab values. Most patients will know there’s “good cholesterol” and “bad cholesterol”, but the label doesn’t make clear that even cholesterol from otherwise healthy foods can raise a person’s blood levels. Once again, the information is not easily digestable in the middle of the grocery aisle.

Moving on to sodium: The amount of daily sodium is changing, but %DV is calculated on the maximum daily value, not a recommended daily value. That’s not immediately obvious from the label, and I would have preferred a more conservative labeling rule that indicates the percentage intake based on recommended amounts. I might be more cautious when I see a sodium amount that has 20% of my recommended daily intake instead of 10% of my maximum daily intake.

I don’t pretend that pre-packaged foods are healthy, but I want to be able to pick products that are at least less harmful. And I suspect I’m not alone. The point of consumer labels is to inform, but the more interpretation that is required the less useful they become. That’s why more spurious indicators like Health Check,[2] Sensible Solutions, Blue Menu, Health Signature, and Smart Spot are more attractive because they provide a shortcut to indicating “healthier” foods. My confusion over nutrition labels in the grocery reminds me of Jerry Seinfeld’s confusion with reading medication labels in the OTC aisle.

The difference between nutrition labels and OTC labels is that in the pharmacy a pharmacist is readily available to help you interpret those medication labels and choose the product that is best for you. Some products cannot be sold without a pharmacist being on duty. Why not have the same requirement for dieticians and grocery chains? While medications can be harmful in the short or long term, unhealthy food is really only harmful in the long term.[3] But the harm nevertheless exists, and the purpose of labels is to help inform the uneducated consumer to make better choices. Is it wishful thinking? If we really are committed to improving chronic health problems like heart disease and obesity, we need to make dieticians more accessible, just as we’ve done for pharmacists. Requiring grocery stores to have an on-hand dietician — at least during peak hours — seems like the next step for healthier Canadians.[4]


  1. At least with %DV, Health Canada states you should look for foods between 5–15%.  ↩

  2. Though Health Check is sponsored by a non-profit, the Heart and Stroke Foundation, Dr. Yoni Freedhoff provides a critical view of the program.  ↩

  3. I guess, in the extreme, unhealthy food can be harmful in the short term.  ↩

  4. Perhaps a great resource for Ontarians is Eat Right Ontario which allows anyone to speak to a registered dietician for free at any time. But there’s still something to be said for the convenience of in-person assistance right at the time of shopping.  ↩