Maintaining a kidney-friendly diet really is the cornerstone of improving your kidney health but working out exactly what is contained in your food can be really tricky and may seem overwhelming- if you feel this way, please know that you are not alone! Have a read of this article to help you on your way to understanding exactly what’s in the food that you’re eating.
Reading food labels can be confusing, especially because some food manufacturers use misleading tricks to convince people to buy highly processed and unhealthy products under the guise that they are in fact healthy.
Food labeling regulations are also complex, making it harder for consumers to understand them.
So here are some tips to help you read and understand food labels and what you should be paying particular attention to if you have CKD.
What information must be included on food labels?
The information that must be included on food labels varies from country to country. Information that is typically required on food labels includes:
- Serving size
- Number of serves per package
- Number of calories or kilojoules per serving
- Total fat, Saturated fat, and in some countries trans fat
- Total carbohydrates
These are the nutrients that are typically included across the board and then different countries have different guidelines. For example, a recent change was made in the US that means vitamin D, and potassium now need to be included on food labels.
Depending on the food or beverage, other vitamins and minerals may be included on food labels, but this is up to the discretion of the manufacturer
Reading Food Labels
Not all foods require a nutrition label, for example in most countries’ foods sold unpackaged (eg. fruit and vegetables), foods made and packaged at the point of sale (eg. bread made and sold in a bakers) and other foods such as herbs, spices, packaged water, tea, and coffee do not require a nutrition label.
For those foods that do contain a nutrition label, here’s an example of what they generally look like and the information they usually contain- there are however some differences between countries.
Now I want to take you through the different sections of the nutrition label and explain some of them in a bit more detail so the next time you go to the supermarket, you can make a more informed choice about what you are purchasing.
Nutrient labels state how many calories and nutrients are in a standard amount of the product- often a suggested single serving.
When looking at the nutrition facts label, first take a look at the number of servings in the package (servings per package or servings per container) and the serving size. Serving sizes are standardized to make it easier to compare similar foods; they are provided in familiar units, such as cups or pieces, followed by the metric amount, eg. the number of grams (g).
However, these serving sizes are frequently much smaller than what most people consume in one sitting. Many people are unaware of this serving size scheme, assuming that the entire container or package is a single serving, which in truth it may consist of two, three, or more servings.
It’s important to realize that all the nutrient amounts are shown on the label, including the number of calories or kilojoules, which refer to the size of the serving. Pay attention to the serving size, especially how many servings there are in the food package
On the example label, there are 8 servings per container and each serving size is 2/3 cup (55g), if you were to eat two serves of this food or 1 1/3 cups (110g) you need to double the nutrient and calorie/kilojoule amount, the amount of each nutrient, as well as the %DV, to see what you are actually eating.
Calories and kilojoules provide a measure of how much energy you get from a serving of this food. In this example, there are 230 calories per serving. What if you ate two servings? Then, you would consume 460 calories.
To achieve or maintain healthy body weight, you need to balance the number of calories/kilojoules you eat and drink with the number of calories your body uses. 2,000 calories a day is often used as a general guide for nutrition advice but your calorie needs may be higher or lower and vary depending on your age, sex, height, weight, and physical activity levels so you might need more or less than this amount.
Remember: The number of servings you consume determines the number of calories you actually eat.
This section shows you some key nutrients that impact your health. You can use the label to support your personal dietary needs- look for foods that contain more of the nutrients you want to get more of and less of the nutrients you may want to limit.
All information found on food labels is useful but there are a few things people with kidney disease may need to pay particular attention to.
Protein in grams is listed on the nutrition label. The amount of protein recommended varies depending on the stage of kidney disease and should be calculated based on someone’s weight. Protein is one of the macronutrients that people with kidney disease should be monitoring and calculating because reducing protein intake has a number of benefits for people with kidney disease.
If you are interested in finding out how much protein you should be eating, have a read of our article that outlines this.
Dietary sodium intake among people worldwide often exceeds recommended limits. There is lots of evidence in human studies showing indirect and direct negative consequences of high dietary sodium intake on the kidney. In people with CKD, dietary sodium can have effects on proteinuria (protein loss in the urine), the effectiveness of medication aimed at reducing proteinuria, blood pressure control, edema or swelling, and immunosuppressant therapy.
Increased blood pressure and proteinuria both contribute to kidney damage and progression of kidney disease and there is also evidence that high sodium intake can affect the kidneys and vascular systems directly resulting in a decline in kidney function.
The KDIGO (Kidney Disease Improving Global Outcomes) recommends reducing salt intake to less than 2gm per day of sodium in adults with CKD unless contraindicated. To give you an idea of who much that is, 1 teaspoon of salt = approximately 2,300mg sodium.
For those who need to follow a low potassium diet- remember, not everyone with CKD does need to follow a low potassium diet- potassium is another nutrient to pay attention to.
Recently, the US has mandated that potassium must be included on the nutrition label, this occurred because potassium offers numerous health benefits, and it was recognized that many people in the US (just like the rest of the world) do not get enough potassium in their diet. This is super helpful for those of you living in the US but unfortunately, not all countries require that potassium is listed on the nutrient facts label so just because it’s not listed, doesn’t mean the food contains no potassium.
For those following a low potassium diet, beware of added potassium in the ingredient list. Sometimes, low-sodium or low-salt packaged foods have potassium chloride salt instead of sodium chloride salt. Potassium chloride can add potassium to low-sodium foods so be sure to check the ingredient list for added potassium.
And don’t forget, if you are eating more than one serving of a product, you may be getting more potassium than you have calculated.
Your doctor will be able to tell from a blood test whether you have high phosphorus levels and whether you need to limit it in your diet. Unfortunately, the amount of phosphorus in food is rarely included on the food label so you will need to read the ingredient list.
Even if the food itself doesn’t contain phosphorus, it is added to many foods in the form of an additive or preservative. It’s found in foods such as fast foods, ready-to-eat foods, canned and bottled drinks, processed meats, and most processed foods.
This added phosphorus is even more problematic than foods with a naturally high phosphorus content because this type of phosphorus is almost completely absorbed by the gut so is highly bioavailable.
Elevated phosphorus levels can cause damage to the body and increase the risk of heart attack and stroke and studies have shown an increased risk of mortality between CKD and phosphorus levels and it is also linked to faster progression of kidney disease.
For this reason, avoiding foods that contain phosphate additives is really important for your overall health and your kidney health and to reduce the amount of phosphorus you are getting from your diet.
Check the ingredient list for phosphorus, or for words with PHOS such as phosphoric acid, sodium aluminum phosphate, pyrophosphate, polyphosphate, and calcium phosphate. Sometimes food additives are listed as numbers (which makes things even harder!). Common phosphorus additive numbers are: 101, 339, 340, 341, 342, 343, 450, 451, 452, 541, 542, 1410, 1412, 1413, 1414 and 1442.
Don’t forget that ingredients are listed in order of weight, so the higher a food/additive is on an ingredient list, the more is contained within the product.
The Percent Daily Value (%DV)
The % Daily Value (%DV) is the percentage of the Daily Value for each nutrient in a serving of food. The Daily Values are reference amounts of nutrients to consume or not to exceed each day.
The %DV shows you how much a nutrient in a serving of food contributes to a total daily diet and can help you determine if a serving of food is high or low in a nutrient. This % DV is generally calculated based on around a 2,000-calorie daily diet and as I mentioned earlier this is just a general guide for nutrition advice but your calorie needs may be higher or lower which will alter your % daily value.
Study the Ingredients List
Ingredients are listed by quantity- from highest to lowest amount. This means that the first ingredient is what the manufacturer used the most.
A good rule of thumb is to scan the first three ingredients, as they make up the largest part of what you’re eating. If the first ingredients include refined grains, a type of sugar, or hydrogenated oils, you can assume the product isn’t healthy. Instead, try choosing items that have whole foods listed as the first three ingredients.
Also, the longer the ingredient list, the more processed the product.
Don’t Let the Claims on the Front Fool You
One of the best tips may be to completely ignore claims on the front of the packaging. Front labels try to lure you into purchasing products by making health claims.
Research shows that adding health claims to labels, makes people believe a product is healthier than the same product that doesn’t list health claims.
Manufacturers are often dishonest in the way they use these labels. They tend to use health claims that are misleading and, in some cases, downright false.
Health claims on packaged foods are designed to catch your attention and convince you that the product is healthy (when it actually might not be). Which claims are allowed (and what they can mean) does vary between countries. Here are some of the most common claims- and what they mean:
- Light or Lite- light products are processed to reduce calories, fat, sugar, or salt. Check carefully to see if anything has been added instead- for example, sugar to a food that contains less fat. Also, the word ‘lite’ doesn’t necessarily mean the product is lower in fat or sugar. A company can use the word ‘lite’ or ‘light’ to indicate it has a reduced color, a muted taste, or even a softer texture.
- Multigrain- this sounds very healthy but only means that a product contains more than one type of grain. These are more likely refined grains- unless the product is marked as whole grain.
- Natural- in most countries, there are no actual guidelines for use of the term ‘natural’ so this doesn’t necessarily mean that the product resembles anything natural.
- Organic- this label says very little about whether a product is healthy. For example, organic sugar is still sugar.
- No added sugar- some products are naturally high in sugar. The fact that they don’t have added sugar doesn’t mean they’re healthy or low in sugar.
- Low-calorie– low-calorie products have to be one-third fewer calories than the brand’s original product. Yet one brand’s low-calorie version may have similar calories as another brand’s original.
- Low-fat- this label usually means that the fat has been reduced at the cost of adding more sugar. Be very careful and read the ingredients list.
- Low-carb- processed foods that are labeled low-carb are usually still processed junk foods, similar to processed low-fat foods.
- Made with whole grains- the product may contain very little whole grains. Check the ingredients list- if whole grains aren’t in the first three ingredients, the amount is negligible.
- Fortified or enriched- this means that some nutrients have been added to the product. Yet just because something is fortified doesn’t make it healthy
- Fruit flavored- many processed foods have a name that refers to a natural flavor, such as strawberry yogurt. However, the product may not contain any fruit- only chemicals designed to taste like fruit.
Despite these cautionary words, many truly healthy foods are organic, whole grain, or natural. Still, just because a label makes certain claims, doesn’t guarantee that it’s healthy.
Reading and understanding food labels can take a bit of time and practice but hopefully, these tips here have given you a better understanding of what you’re looking at and how to read a food label correctly. And don’t forget, don’t believe the claims on food packaging without having a closer look at the nutrition facts and ingredients.
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