The nutrition facts behind revised food labeling guidelines

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

The Food and Drug Administration recently updated its definition of what packaged foods have to do in order to call themselves healthy.

Here to help explain what that means is Dr. Kaushal Nanavati. He's a doctor of family medicine and director of integrative medicine and assistant dean of wellness at Upstate.

Welcome back to "The Informed Patient," Dr. Nanavati.

Kaushal Nanavati, MD: Thank you.

Host Amber Smith: This is an update to a definition that was put in place 30 years ago that says in order to make the claim of being healthy, foods have to contain a certain amount of one or more fruits, vegetables, grains, dairy or protein. So what do the new rules do?

Kaushal Nanavati, MD: So the new rules actually relabel healthy in a little more of a stricter nutritional criteria, focusing on things like nutrient density in the food versus isolated benefits. And they emphasize whole foods, trying to reduce unhealthy components, trying to improve and increase the beneficial ones in terms of our overall health, because what we recognize is that nutrition and diet, along with physical activity or inactivity, can contribute to up to 40% of chronic disease, right? And so it's important for us to recognize that when it comes to chronic disease and kind of the leading causes of morbidity, which is sickness and mortality, death, cardiovascular disease, cancer, and then obesity as an underlying factor, diabetes, chronic lung disease, all have inflammation as a component, and also the gut microbiome, when you think about gut disorders.

So, I think they're trying to recognize that in the last 30 years we've gotten better information, which means updating the criteria and the guidelines only makes sense.

Host Amber Smith: So we have a better understanding that what we eat influences these chronic diseases now.

Kaushal Nanavati, MD: That's absolutely right. And that's been, even in food policy, but even in our Healthy People 2020, Healthy People 2030 criteria and objectives that come out. And even the WHO's guidelines, the World Health Organization's guidelines, they're recognizing the importance of nutrition, fundamental in health promotion that goes even beyond disease prevention.

Host Amber Smith: What types of foods are going to no longer count as healthy?

Kaushal Nanavati, MD: The foods that have added sugars. So when you think about processed snacks, right? Sugary cereals, some flavored yogurts that are high in sugar, high-sodium canned soups, white bread, for example, right?

Foods high in added sugar, sodium and saturated fats but low in essential nutrients will no longer qualify.

Host Amber Smith: Let me ask you about, limiting added sugars. Sugars are full of calories. Is this going to help us lose weight?

Kaushal Nanavati, MD: (Laughs) So that's a very specific question, Amber. So what I'll say with sugar is that when we consume sugar, there's natural sugar that's in fruits that our body naturally processes better and then added sugars. And what happens with added sugars is we know that we've been able to look at data and say that when people get sugar in, first of all, the body needs to release insulin to get the sugar out of the blood.

Because if sugar stays in the blood, think about an analogy where basically if you keep adding more sugar to water and keep it going, ultimately that's going to get thicker, like a syrup. And because blood is our transport medium, our taxi of oxygen to the rest of the body's tissues, if you've got thick syrup going through those arteries, it's not going to get through the smallest channels. You can't get oxygen to the tissues, and then that becomes a problem. The second thing is when the insulin's released and the body brings the sugar in, it tells the brain, "Hey, I'm bringing sugar in. I've got to store it somewhere."

Well, what store it? Those are fat cells, right? We think that by reducing added sugars, we can reduce the risk of Type 2 diabetes, lower the likelihood of heart disease, inflammation and even metabolic imbalances in the body that can lead to other chronic conditions as well.

Host Amber Smith: Why are there new limits on sodium, or salt?

Kaushal Nanavati, MD: Well, sodium, in salt, specifically, has been directly correlated with elevated blood pressure, right, which leads to cardiovascular disease, heart attack, strokes. And so limiting especially added salts, right, is what we're talking about. So natural salts in certain foods are one thing, but when you start to add salt, then that becomes a bigger issue, in terms of elevating blood pressure and then the risks that go with it. Every two points of blood pressure elevation are thought to increase the risk of heart attack or stroke by 1%. And so that can be significant over time for people.

Host Amber Smith: How will limiting saturated fats help us?

Kaushal Nanavati, MD: So saturated fats are primarily, when you think about it, found in animal-based foods, right? And they're linked to higher cholesterol levels, increased plaque in the arteries as well. And that can lead to increased risk of heart disease. One of the primary reasons to cut back on saturated fats is because that can have an impact on the No. 1 cause of deaths in the world, in terms of chronic disease, which is cardiovascular disease.

Host Amber Smith: These new rules are meant to improve public health, so let's talk about what a healthy diet actually looks like. The dietary guidelines say that most adults should get their calories mostly from carbohydrates, but we also need protein and fats. Let's start with carbohydrates. What counts as a carbohydrate?

Kaushal Nanavati, MD: So carbohydrates, you think about sugars, starches and fiber, right? And so when you think about carbohydrates, you think about vegetables, all kinds of vegetables. And I'll put an asterisk by cruciferous vegetables (such as broccoli, kale and cabbage). They're even better. And if we have time, we can talk a little bit about that, in terms of their value for most people; certain health conditions, you have to be careful.

But you've got vegetables and fruit as fiber, even legumes as fiber. And then you've got starches like potatoes and that type of thing. And the sugars, again, we have to be very careful, but whole grains are a great source of carbohydrate as well, like brown rice, quinoa, whole wheat, for people that can tolerate them.

It's the processed carbs like white bread, sugary cereals, pastries, that we talk about that don't have the best health benefit, right? And so you think about carbs in terms of, people say, "Well, I want to go 'carb-low.' " Well, ideally, having a good amount of fiber is important and healthy in preventing chronic disease, so the vegetables and plant-based eating as a foundation is important.

And then you think about proteins, and there's vegetarian proteins and animal-based proteins, right? So the No. 1 food, according to some of the information from the "blue zones" (places with long-lived people), et cetera, are legumes, and beans, right? Great source of protein. And all kinds of beans: green beans, black beans, kidney beans, chickpeas, fava beans, cannellini, whatever you like, are great in terms of a lot of value. They do have some starch. The bigger the bean, the more the starch, and so people can weigh, literally, what they want to have in terms of the type of bean, but they're very healthy.

Animal proteins: Again, you think about fish, you think about turkey, you think about chicken, you think about red meat. And different cultures have different meats, if meat is a part of their cultural foods, and so we respect cultural norms. What we know as a big picture is that plant-based eating, meaning that the protein and the fats can become the condiment more so than the main portion of the plate, that becomes important as well, right?

And then the fats. Think about saturated fat. Think about monounsaturated and polyunsaturated fats. Saturated fat is the stuff that's solid at room temperature, right? And so that's also the stuff that can lead to more triggered cell damage in the body, more inflammation in the body, whereas monounsaturated fats tend to be optimal. And then polyunsaturated fats are also better than saturated fats.

Host Amber Smith: I want to ask you more about proteins and fats, but before we get to that, in the category of carbohydrates, if we're eating, like, fresh vegetables, we don't have to worry about added sugars and sodium, but there are some carbs that we would have to be concerned about that. Is that right?

Kaushal Nanavati, MD: Well, so you think about, like, if you're eating potatoes all day, right? That's a lot of starch. It's a carbohydrate, it's a lot of calories as well, right? Whereas if you're eating spinach, zucchini, broccoli, asparagus, right, mixed greens, those types of things, you're getting starch. It's fibrous starch, which actually has a health benefit for us as well.

And if you think about vegetables, the optimal recommendation based on (medical) literature would be to have seven-plus servings, which is even higher than the guidelines might suggest. But the value of that is that that's actually shown to reduce risk of cardiovascular disease, cancer, all causes of mortality or death.

And within the veggies, how do you get seven servings? Well, between raw, cooked and pickled, there are different ways to get vegetables onto your plate. In fact, when people have higher proteins and fats, to have some pickled vegetable actually helps to digest those foods even better, so it's easier when you think about mixing and matching.

I tell my patients, if you think about your lunch and dinner plate as basically a salad, and you can put your healthy fats and proteins on top of it, versus having a salad on the side and then filling the plate with a bunch of other stuff. Now, suddenly, you're eating two plates' worth of food, right?

So the idea is to keep that one plate, but make the base plant-based, and then have your other portions be more like condiment-sized portions for healthy fats and healthy proteins.

Host Amber Smith: You're listening to Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with Dr. Kaushal Nanavati, the assistant dean of wellness at Upstate, about healthy foods.

So let me ask you about protein. Are Americans in general getting enough protein, and are we eating the right kinds of protein?

Kaushal Nanavati, MD: So, that is a great question. in general, Americans get an adequate amount of protein, although what happens often is a lot of people rely on processed meats, which tend to be higher in sodium and saturated fats. Think about bacon and sausage, that type of stuff, instead of lean or plant-based sources. So, if you think about how much the recommendations are for protein for the sedentary person, 0.8 grams per kilogram of body weight is what's recommended.

So for the average weight, it would be about 46 grams of protein for women, 56 grams for men. However, when people are more active, they actually need more protein. So, like, endurance athletes might get 1.2 to 1.4 grams per kilogram. Strength athletes may get 1.6 to 2.2 grams, and actually older adults need to get a little bit more, so people over 65, the recommendation would be around one to 1.2 grams per kilogram.

Just because we know protein has an impact on not only muscle, that's what we usually associate protein with, but it's also immune function, metabolic function, right? So it's a matter of keeping your body healthy, but it's a great, great source of energy and nutrient base.

Host Amber Smith: Let me ask you about the type of protein. Food sources is one thing, but the additive protein powders, those have become pretty popular.

Are they as good as food?

Kaushal Nanavati, MD: So, I would say that in terms of protein, optimally, if you were thinking about it, vegetarian-based sources of protein, such as beans, lentils, tofu, quinoa, nuts, seeds, that kind of stuff, even tempeh, some people use, are actually good. And when you take plant proteins and combine them with rice or quinoa, you actually get the full amino acid or what we call essential amino acid profile.

So, there are certain components, that we don't make in our own body, we get from food sources. And with plant-based proteins, in many cases, those amino acids are kind of in a locked form. And when you add rice or quinoa, that actually activates, or unlocks, it so that it's more user-friendly in the body.

So you look at all cultures around the world, like, rice and beans have been a staple, right, along with vegetables. So that's actually like a complete meal in and of itself. Then you think about animal proteins and lean meats, and that's where fish, especially with omega-3, which is a healthy fat, becomes a good source. With fish, we think about cold-water, freshwater, wild-caught fish versus shellfish. Shellfish doesn't necessarily have the greatest profile in terms of cholesterol and for heart health, whereas cold-water, freshwater, wild-caught fish like salmon, tuna, mackerel, those fish tend to have better value if you're going to have animal-based proteins.

And then protein powders: For athletes it can be good as an add-on. But I always think about protein powders as a "complement to," right, not a "replacement for." And that's very important to realize because a lot of people like to drink their calories. And the problem with that is that that actually has an impact on how we absorb nutrients because the stomach has a role to play in breaking foods down. The intestines have a role to play. And when you have liquid calories, that kind of actually bypasses some of the processing that the body does that actually allows for us to be able to absorb nutrients better. So I always say, if you're going to use protein powders, use them as a complement to rather than a substitute for.

Host Amber Smith: Are there saturated fats that we need to look out for in the animal proteins?

Kaushal Nanavati, MD: Yeah, so specifically in red meats, processed meats, and even some dairy, you can have high saturated fat, high sodium and even some sugars. Sometimes you look at yogurts, and sometimes the lower-fat yogurts might actually have more sugar content, right?

And so you have to be careful about that as well. Generally, you think about lean meat. So like with chicken, chicken breasts tend to be less fatty than chicken thighs or bone-in or chicken wings. And I do joke with some people about this, that if you want to have chicken wings Super Bowl Sunday or for Syracuse, when SU makes the Final Four, then you can have some.

And the point is 90/10, right? Majority of the time, if you get the leaner meats, it's better for you. The saturated fats and red meats, processed meats, and even some dairy, can, be detrimental over time with overconsumption.

Host Amber Smith: The FDA says that three-quarters of Americans don't get enough dairy.

Why do you think it's hard for us to get enough dairy? Is dairy just being demonized?

Kaushal Nanavati, MD: So I'm smiling as you say that, and I'll get a few phone calls either way I answer this question. But the point is with dairy, again, what is the value of dairy?

Well, there's healthy fats. There's good calories. Generally it's vitamin D fortified. It's a good source of protein as well. And so from that perspective, we think, "Well, great, it's good for us," right? At the same time, for many people, as we grow older, lactose intolerance is a real thing. So if you consume dairy and you either get gassy or bloated or your bowel movements, you can either get constipated or looser stools, then you have to think, right?

And so you can easily try to eliminate (dairy) for anywhere from one to four weeks and then reintroduce it and see how differently you feel, right? So when we think about the benefits of dairy for protein, vitamin D, healthy fats, there are also alternative sources for that, including calories.

So it's become a discussion piece. We have a big dairy industry in New York state, and a lot of friends and local community members who, that's their livelihood. And for many people that tolerate it, it's a great source of protein and calories and vitamin D and even calcium, right?

But if you have any kind of health issues related to it, then that's something. In the United States, that's part of the issue. Some avoid dairy because of concerns of fat content or digestive issues or based on the information that they've seen.

Host Amber Smith: Now, as for fats, can you help us understand which fats are healthy compared with the saturated fats that are not?

Kaushal Nanavati, MD: Yeah, so healthy fats, I would say would be like the unsaturated, so mono- or polyunsaturated fats. Think about, olive oil, right? And again, know, we use, olive oil for cooking and we use extra virgin olive oil, like on salads and stuff. Depending on how much heat, you can use that for cooking as well.

Avocados, nuts, seeds. And then the cold-water, freshwater, wild-caught fish. Great sources of omega-3, and between omega-3, omega-6 and omega-9, which are all healthy fats, omega-3 and -9, actually help reduce inflammation, whereas omega-6 is pro-inflammatory, but that can be protective if you have an injury.

So there's value to fats, especially because they help to stabilize the cell wall in our body for our cells. So it's not that fats are bad, but the right kinds of fats are healthier. Unhealthy fats like saturated fats from red meat, even butter, full-fat dairy and processed foods, those we have to limit because they can put us at a higher risk.

And then there are trans fats, right? They're found in fried foods, hydrogenated oils, and those really trigger inflammation, cell damage, trauma to the body at the cellular level. And those are the things that we should try to avoid. And I think, over the last decade in society, in many places, people have been much more conscious of trans fats and trying to avoid that, even in things that are sold, there's less and less of trans fats that we're getting.

Host Amber Smith: Why are these unsaturated fats necessary in our diets? What do they do for our body?

Kaushal Nanavati, MD: So fats, actually, are a great source of energy, and so they support cell function. They actually, in our hormone cycle and our hormone cascade (a series of reactions), they're very essential for hormone production. And it can also help us with nutrient absorption. So like, there are fat-soluble vitamins, so vitamins A, D, E and K, which actually help with energy, with mood, with metabolism, skin, hair, nails, our circulation, and even with mentation (thinking) and brain health. They're fat soluble, which means they actually require fat to be absorbed, right?

Fats also provide longer-lasting energy. and so that's important as well. and things like, nuts, walnuts, almonds, they actually help with the good cholesterol, what we call the HDL or healthy cholesterol, to do better and are a great source of protein as well.

Host Amber Smith: Well, Dr. Nanavati, I appreciate you making time to talk to us about healthy eating. Thank you.

Kaushal Nanavati, MD: I sincerely appreciate this conversation. Thank you.

Host Amber Smith: My guest has been Dr. Kaushal Nanavati, an assistant professor of family medicine, the director of integrative medicine and assistant dean of wellness at Upstate.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

Find our archive of previous episodes at upstate.edu/informed.

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