Evaporated cane juice sounds like a healthy ingredient. Evaporated implies unprocessed, cane seems to be natural and many consumers associate juice with health. But, evaporated cane juice is a euphemism for sugar. Evaporated cane juice, cane juice, organic cane juice and organic evaporated cane juice are all terms used to hide the addition of sugar in processed foods.

The FDA issued a new guidance this month suggesting that manufacturers use the common names for sugar ingredients and avoid misleading terms, such as evaporated cane juice. Juice, as defined by the FDA, is “the aqueous liquid expressed or extracted from one or more fruits or vegetables" (1).  Although sugar cane is a plant and may be classified as a vegetable in a broader sense, the FDA does not consider it a vegetable. Sugar, as defined by the FDA, is sucrose obtained from sugar cane or sugar beets.

To create evaporated cane juice, sugar cane is crushed, the fluid extracted and then clarified. Water is evaporated and the remaining solids are filtered, crystallized and placed in a centrifuge to separate out the molasses. Although the process may vary slightly from manufacturer to manufacturer, the result is 99% to 99.8% sucrose.

The diagram to the right shows the three types of double sugars, sucrose, maltose and lactose. Table sugar is sucrose, malt sugar is maltose and milk sugar is lactose. Evaporated cane juice may vary slightly from table sugar in physical appearance, but it is nearly chemically identical to table sugar.

The new document is a guidance for the industry, not a requirement. We will likely continue to see evaporated cane juice in ingredient lists. The key is to recognize this ingredient as added sugar.

The FDA has finally updated the new Nutrition Facts label for packaged food. The process only took 9 years and 943 pages (1, 2). The label changes reflect the goal of communicating the link between diet and chronic disease to consumers (3). In the image below, the current Nutrition Facts label is shown on the left and the new Nutrition Facts label is shown on the right.

The main changes to the nutrition facts label include (3):

1. Increased font size for “Calories”, “Serving Size” and “servings per container”.
   
   
2. “Calories” will be listed in bold. This will make it easier for consumers to see how many calories are in a serving and a package.
   
   
3. Values for vitamin D, calcium, iron and potassium are required. Americans are obtaining enough vitamin A and vitamin C and these nutrients are no longer required to be listed. Americans are not obtaining enough vitamin D and potassium, and these nutrients are new requirements for the label. Vitamin D does not naturally occur in a wide variety of food sources and the values listed on the new label will most likely represent fortified sources.
   
   
4. A statement defining the % Daily Value will be included. The following statement will be added, "The % Daily Value tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice". Because the % Daily Value is based on a 2,000 calorie diet and not everyone eats a 2,000 calorie diet, it is best used for comparing product information.
   
   
5. Serving size update. Standardized serving sizes have been increased to represent the larger portion sizes people are now eating. The example used by the FDA (3) is a serving of ice cream. The old serving size was 1/2 cup. The new serving size has been increased to 2/3 cup. A serving of soda has been increased from 8 ounces to 12 ounces. In addition, a package of snacks, such as chips, that could be consumed in a single sitting or in multiple sittings, will have two columns of nutrient information. One column for calories and nutrients per serving and one column for calories and nutrients per package.
   
   
6. Calories from Fat will be removed. Total fat, saturated fat and trans fat will still be listed. The number of calories in the product from fat will no longer be required. This change was made to better reflect new research on the health effects of fat (3). The type of fat consumed is more important than the calories from all types of fat.
   
   
7. Manufacturers are required to list "Added Sugars". This is, perhaps, the most celebrated change. Manufacturers are now required to list the grams of sugar added to products.
   

The FDA states that this change reflects updated information about nutrition science (3). The 2015 Dietary Guidelines for Americans suggests no more than 10% of calories should come from added sugars (4). The American Heart Association (AHA) recommends no more than 5% of total calories from added sugars. This means the AHA recommended intakes for added sugar are as follows (5):

• Women: 6 teaspoons or 24 grams
• Men: 9 teaspoons or 36 grams
  

One 12 ounce serving of soda has, on average, 23 grams of added sugar.

In the past, manufacturers were only required to list total grams of sugar. This would include naturally occurring sugar in plant food and lactose from milk, as well as added sugar. The consumer has been left to guess, or guesstimate, the amount of sugar added to a product.

Last year, Roberto Ferdman exposed the sugar industry in a Washington Post article. Documents, dating back to the 1950s, showed the industry’s use of political influence to skew government medical research on sugar’s role in the development of tooth decay (6). In addition, The American Beverage Association, spent almost $40 million in 2009 battling a possible federal tax on sugar sweetened drinks (6).

Not surprisingly, The Sugar Association expressed their disappointment of the ruling to require added sugars on the label, citing a lack of scientific justification. The association brazenly claimed that this unprecedented action by the FDA could “deter us from our shared goal of a healthier America” (7).

As seen in the chart above, from the 2015 Dietary Guidelines, most Americans are exceeding the recommended upper limit for added sugar (9). What might be most disturbing is the added sugar intake in young children. Evidence suggests that limiting added sugars, in conjunction with a healthy eating pattern, is associated with a reduced risk of heart disease, obesity, type 2 diabetes and some types of cancer (8). Most health organizations recommend limiting added sugar intake. More information on sugar.

Manufacturers will need to comply with the new Nutrition Facts panel regulations by July 26, 2018 (3).

It’s easy get overwhelmed when looking for yogurt at the grocery store. Dozens of brands line the shelves in the refrigerated section. We can choose from light, whipped or creamy styles. We have options for whole, low-fat and nonfat varieties. Flavors include strawberry, blueberry, apple-cinnamon and lemon custard. We can enjoy authentic Greek nonfat yogurt with dark chocolate chunks, coffee bean bliss or salted caramel crunch. The number of choices for yogurt is mind blowing. In Marion Nestle’s book, What To Eat, she describes finding 400 different varieties of yogurt in one medium-sized Supermarket in New York  (1).

Yogurt is a food produced by the fermentation of milk. The beneficial bacteria in yogurt make it a probiotic and the live microorganisms contained in yogurt can benefit our health (2, 3, 4). Yogurt is high in calcium, iodine, phosphorus, vitamin B12 and riboflavin and is a good source of zinc, potassium and protein (5, 6). These features create a yogurt health halo. 

Traditional plain yogurt is thick and has a sour taste which is why many of us prefer added fruit and flavors. With these additions, yogurt has gradually morphed from a health food into a dessert. It’s difficult to find plain yogurt among the cleverly packaged, colorful cups of sugar infused, creatively flavored concoctions marketed as yogurt.

Yogurt has amazingly maintained its healthy status, despite what has been added. It’s easier to find yogurt with Oreo cookies, M&Ms and Whoopers than yogurt without anything added. Most of us know that the addition of M&Ms to yogurt makes it more like a snack food than a health food. Yet, few of us would equate a breakfast of  strawberry yogurt & granola to ice cream & cookies. Strawberry yogurt with granola may have fewer calories and fat than most brands of ice cream, but it's likely to have as much added sugar and more food additives.

Let's take a look at Chocolate Haze Craze yogurt shown below. What about this product tells us it's healthy? It contains calcium, it’s an excellent source of protein, it is low-fat and wears the yogurt health halo. If we look at the ingredients we see low-fat yogurt as the first ingredient. But, the second ingredient is evaporated cane juice. Evaporated cane juice is code for sugar. The next two ingredients are water and hazelnuts and the 5th ingredient is sugar, followed by chocolate liquor and cocoa butter. The remaining nine ingredients are mostly food additives.

Let’s compare our chocolate yogurt with Ben & Jerry’s Chocolate Therapy® ice cream.

Chocolate yogurt ingredients
Low-fat yogurt (nonfat milk, cream and live and active cultures) evaporated cane juice, water, hazelnuts, sugar, chocolate liquor, cocoa butter, milk, cocoa powder, natural flavor, pectin, locust bean gum, guar gum, organic soy lecithin, salt, vanilla.

Chocolate ice cream ingredients
Cream, liquid sugar, skim milk, water, cocoa, wheat flour, sugar, soybean oil, egg yolks, chocolate liquor, brown sugar, cocoa, honey, guar gum, vanilla extract, natural flavors, salt, sodium bicarbonate, cocoa butter, carrageenan, soy lecithin (7).

Let's start with the differences between these two products. The data for the comparison is from the USDA Nutrient Database (8) and the serving size used for yogurt is 150 grams, similar to the 6 ounce serving at the grocery store. The serving of ice cream used is 100 grams, which is like an extra large scoop. Although these are the serving sizes used, it's important to keep in mind that this makes the comparison between the two somewhat unbalanced.

The first ingredient in the yogurt is low-fat yogurt and it has live and active cultures. The ice cream does not. There is less fat in the yogurt. The yogurt has 10 grams per serving, while the ice cream has 14 grams per serving. There is less saturated fat in the yogurt as well. There are 12 grams of protein in the yogurt, but only 5 grams in the ice cream. Although the ice cream actually has double the amount of fiber than the yogurt, it's only 2 grams compared with the yogurt's 1 gram. The yogurt comes in a small container that makes it easy to stop eating. The larger container of Ben & Jerry's makes it easy to eat more than a single serving.

The second ingredient in both the ice cream and the yogurt is sugar. Remember, evaporated cane juice is sugar. If we look through the ingredients, we can find 13 similar ingredients. The similar ingredients are highlighted in red, the cane juice, which is sugar, is highlighted in blue. Sugar, cream, chocolate liquor, cocoa butter, natural flavor, guar gum, soy lecithin, salt and vanilla are all in both products. What is one of the most striking similarities is the amount of sugar.

Keep in mind the standardized serving sizes for yogurt and ice cream are different, 150 to 100 grams respectively, but this is a striking similarity. Both have naturally occurring sugar, lactose in the milk and cream, so it’s difficult to know exactly how much added sugar is in each product.

Although yogurt may have edged out ice cream in regards to health in the comparison above, the two are similar in many respects. Their core ingredients are the same, they have similar amounts of sugar and the same types of food additives. Most yogurts on the market are closer to dessert foods than health foods.  Most yogurts have no real fruit, only fruit flavors. Some yogurts have real fruit, but they will generally have more sugar than fruit (1).

There are about 6 grams of naturally occurring sugar in a 6 ounce container of yogurt. The remaining sugar is added. If the yogurt has been heat-treated, the microorganisms in the yogurt will not survive and will have no health benefit. These brands should carry the label “heat-treated after culturing”, as determined by the FDA (9).

When you choose yogurt, look for plain yogurt without added sugars, artificial sweeteners or flavors. Look for brands with "live and active cultures". Add whole, fresh fruit, nuts or seeds to plain yogurt and enjoy a delicious treat while obtaining all the health benefits. If you want to eat ice cream ... eat ice cream. Treat it like a dessert, eat it occasionally and enjoy it!

In a study published in JAMA Pediatrics, investigators found an association between the consumption of artificially sweetened beverages during pregnancy and infant weight (1). The study evaluated artificially sweetened and sugar sweetened beverage consumption in 3,033 healthy, pregnant women. The weight of the infant, as measured by body mass index (BMI), was evaluated at one year of age. Almost 30% of the women consumed artificially sweetened drinks at some point during their pregnancy.

Daily consumption of artificially sweetened beverages was associated with a 2-fold higher risk of the infant being overweight by one year of age. The investigators considered factors such as the weight of the mother, the quality of her diet, the number of calories consumed and common obesity risk factors.

Although this is the first study to assess the impact of artificially sweetened beverages during pregnancy and their effect on infant weight, the concept is not new. There is a growing body of evidence to support the link between artificially sweetened drinks, weight gain and even diabetes. What is really interesting about this study is that there was no association between increased infant weight and sugar sweetened drinks. This is surprising because there is a clear link between the consumption of added sugar and weight gain (2).

Despite this new research, a causal relationship has not been established. There is not enough evidence to prove that diet sodas consumed during pregnancy cause weight gain in infants. The authors concluded that further research is warranted to confirm their findings. For expecting mothers, caution should be exercised and it might be wise to avoid artificially sweetened beverages during pregnancy.

Crackers are wonderful snacks. They go great with dips, cheese, fruit and spreads.  They're salty and crunchy and according to Snack Works (1), "there’s a variety to fit every mood, every occasion and every appetite".  When trying to choose a healthy snack, it's easy to grab a 100% whole grain variety of crackers.

The cracker shown below has fire roasted tomatoes and olive oil. It's baked with 100% whole grain wheat. In addition, "it may help reduce the risk of heart disease".  If the crackers can be crunchy, salty, snackable and prevent heart disease, that gives us good reason to throw the box in the shopping cart.

If we take a closer look we immediately spot "natural flavor". Natural flavors are manufactured in a lab, at a chemical plant. Although a natural flavor can be derived only from naturally occurring ingredients, the resulting chemical flavor, whether it is made from artificial ingredients or natural ingredients, is exactly the same. Natural flavors can represent an undetermined number of flavors, as long as they occur in the FDA's list (2).

"Calling any of these flavors natural requires a flexible attitude toward the English language and a fair amount of irony.”  - Eric Schlosser, Fast Food Nation (3)

Although whole grain wheat tops the ingredient list, it is followed by 21 other ingredients, mostly food additives. There may be 100% whole grain wheat in the product, but the crackers are not 100% whole grain.

Ingredients: Whole grain wheat, vegetable oil, maltodextrin, salt, tomato powder, onion powder, spices, sundried tomatoes, garlic powder, citric acid, malic acid, malted barley flour, hydrolyzed corn protein, olive oil, disodium guanylate, disodium inosinate (flavor enhancers), natural flavor, paprika extract, artificial color, red 40, yellow 5 and blue 1.

Let's take a look at the health claim on the front of the package:

Diets rich is whole grains are associated with lower risks of heart disease, which is why the FDA allows this health claim (4). It's important to note that this statement refers to soluble fiber from whole grain foods in a diet that consists of other plant food and low in saturated fat. This product has 3 grams of fiber per serving, which does make it a good source of fiber, but it's not high-in fiber. True "whole" grains include wild rice, quinoa, barley, millet and oats. Lastly, the FDA requires the manufacturers to write "may reduce the risk of heart disease", as opposed to "treats heart disease" or "prevents heart disease".

Crackers are wonderful snack foods on occasion, but will not improve our health or decrease our risk of heart disease.

Researchers at Cornell University's Food and Brand Lab found that diners will eat almost 20% more food if the color of their food matches the color of their plate (1). To study the effect of plate color on food consumption, sixty Cornell alumni were invited to dine on a free pasta lunch. The unsuspecting diners were given a white plate or a red plate and directed to a buffet of pasta with Alfredo sauce or a buffet of pasta with marinara sauce. Their plates were secretly weighed after eating.

When diners served themselves white pasta on a white plate, or red pasta on a red plate, they consumed 18% more than diners eating pasta that contrasted their plate color.  Diners consistently served themselves more pasta when there was less contrast between the color of their food and their plate.

Although the amount eaten was not assessed in this study, another study by Dr. Brian Wansink found adults eat most of the meal they are served. In a variety of eating conditions studied, researchers found that adults consume about 92% of what is on their plates at meal time (2). If we serve ourselves more, we eat more.

Simple changes to our eating environment can change our eating behavior (3). It's much easier to change our food environment than change our eating habits.