Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 2: 0:18

Hey everybody, it's Dr. David Hilton . Welcome to episode four of season four of the podcast. Today we're gonna talk about food, and more importantly, what's on the food labels. To help me out, I have an expert in internal medicine, Dr. Aisha Galloway Gilliam . She is also the director of the Comprehensive Weight Management Center at Hennepin Healthcare, and she's gonna help us out today. Aisha , thanks for being on the show. Thanks

Speaker 3: 0:40

For having

Speaker 2: 0:41

Me. It's great to have you. And let's face it, the labels on our food are confusing. Mm-hmm <affirmative> . Yeah. Many of us might know what a few of the things listed on them might be, but what about the rest? Why are some fonts bigger than others? Uh , more than ever our diets are a major contributor to our overall health. So today we're gonna talk about that. Start us off, if you will, Dr. Galloway Gilliam . Why is understanding food labels so important?

Speaker 3: 1:05

I think of the food label as the secret de holder ring. There is so much marketing involved in our food, and that's because the food companies invest a lot of money in , uh, attracting our attention. So the front packaging will have claims, it's brightly colored, it is intended to stand out. The food label though, brings an additional element of accountability as there are some regulatory requirements from the FDA . And so when you are really trying to get to the nitty gritty of the matter regarding what is in the product that you're looking to purchase, that food label becomes important to be able to decipher.

Speaker 2: 1:53

But that's hard to do. It is. So explain, if you could, in a little more detail , why are the labels the way they are? I mean, they're hidden on the back. Some of the things must be mandatory. They're in big types , some of 'em are small little things. There's all these ingredients. Let's , why is that important to our , my family's health?

Speaker 3: 2:09

Because you need to know how the nutritional components that are in the food are potentially going to impact your health. In order to do that, of course, it's important to have some baseline understanding of what you're looking for. As you said, it , it can be confusing. There are some general tricks and tips that a person can use when they're looking at a nutritional label, but this is also part of why it's important to educate ourselves and be informed consumers. It

Speaker 2: 2:40

Struck me as that a lot of the things around the perimeter of a grocery store don't have a label at all. Mm-hmm <affirmative> . Nobody, nobody has to list it on the label, on the asparagus, do they?

Speaker 3: 2:48

Exactly. Right. Processed or ultra processed foods compared to Whole Foods. And we hear this language a lot, eat Whole Foods. Well, what does that mean? What does that mean ? What is , and what is it ? Is it, what does it mean <laugh> ? What does it mean? Right. And so one of the examples I use is exactly what you just said. If it does not require an ingredient label, you look at an apple, it's an apple. I don't need an ingredient label to tell me that it's a whole food. If it requires an ingredient label, it's probably processed to some degree. Now, all processed foods aren't bad for us, but the degree of processing matters, and that's part of where those nutritional labels and being able to interpret those labels becomes critically important. The closer a product looks to what it looked like , uh, when it came out of the ground, or as it was roaming around the, the pasture or the farm , the less processed it is.

Speaker 2: 3:45

That makes sense. That makes, I hadn't thought about it that way when I said the thing about the, the produce doesn't have a label mm-hmm <affirmative> . But you've just really hit on that. But don't come after my Snickers bar

Speaker 3: 3:55

<laugh>.

Speaker 2: 3:56

I think we're gonna be coming after my Snickers bar a little bit later in the show. Okay. So , um, let's break down a food label then. The whole label, it starts out with serving sizes and servings per container and calories. What does all that mean, and why is that important?

Speaker 3: 4:08

Yeah, so the , the serving size is one of the very first, I think, and potentially most useful areas of the label to look at. And it's why it's on the top. People don't often realize that when they are buying a packaged ingredient, it contains typically more than one serving. So when you do look at the next part of the label, which is the calorie content, you have to realize that whatever you're purchasing may have two or three servings. And so you have to amplify the number of calories you're getting.

Speaker 2: 4:45

That's a pitfall, isn't it? Because , uh, my own wife has told me that. I go, well, I just ate that one bag of Oreo cookies and look at it only has X number of calories in it. She goes, yeah, but there were six servings in that bag .

Speaker 3: 4:57

Yes,

Speaker 2: 4:57

Exactly. And that can really, that, you know , it requires some math actually.

Speaker 3: 5:02

Yes , it does.

Speaker 2: 5:02

Yes. Okay. So that's a, that's a pitfall. Mm-hmm <affirmative>. Dr. Gallie , Gilliam , what's a calorie? Yeah.

Speaker 3: 5:07

Uh , a calorie is a measurement of energy contained in a food. Right? So when we think about what are called macronutrients, and those are broad-based categories for food, so that's fats, proteins, and carbohydrates. And so it just, it's a , a numerical measurement for how much energy is released from this food item.

Speaker 2: 5:33

So you've brought up those three big ones, fats, proteins, carbohydrates. And over the years in my practice, our ideas of those have changed mm-hmm <affirmative> . And I remember fats was bad, bad, bad, bad, bad, bad, bad. Proteins was a neutral. And carbohydrates were , um, okay. That isn't the way it is anymore, is it? Mm-hmm <affirmative> . But it's probably not true that just one thing is good and one thing is bad. Mm-hmm <affirmative> . It's not that, that clear. Yeah . Could you talk us through those three macronutrients and what they mean for our diet?

Speaker 3: 6:03

So it is complicated , um, and it is important, as you pointed out, to try to avoid concrete thinking , uh, though that there are some areas that we know either promote or work against our health. So when we're thinking about carbohydrate, this is the, the one that comes up most often , uh, for me in, in the exam room with patients,

Speaker 2: 6:27

Hearing a lot about carbs. Now,

Speaker 3: 6:28

What is a carbohydrate? Yeah. When , when , when we think about carbohydrates, often people are thinking about like flour based products, breads, pastas. They aren't often thinking about fruits and vegetables. They, they aren't often thinking about the , the fact that those are carbohydrate containing food items as well. Um , and so when I am providing guidance to patients on carbohydrates, I say, get your carbohydrates from fruits and vegetables. Those are going to be your healthiest sources, followed by whole grains. The items that are more highly processed, as we talked about earlier, tend to be the types of carbohydrates we really wanna minimize in our diet. We know that ultra processed foods definitely contribute to chronic disease risk. So as we process down the carbohydrates, again, the less they look like what they look like when they were sort of pulled out of the ground, the more processed they are. So there's a full spectrum of carbohydrate to consider as we're thinking about how much of these items should I be including in my diet.

Speaker 2: 7:41

Okay. So you talked about carbs, and it's not so simple. Mm-hmm <affirmative> . There's complex, simple, there's a gamut of carbs. Mm-hmm <affirmative> . Uh , what about, what's the role of proteins in our diet?

Speaker 3: 7:50

Protein is really, really important in our diet. Um, when we think about where protein lives in our bodies , of course, one of the major areas is in our muscles. Um, and , uh, our muscles are really, really important. Health of our muscles are really, really important for, of course, our strength fall reduction for our metabolic health. So we want to eat and consume healthy sources of protein. Now, most people aren't overindulging on protein. That's why the FDA does not require a daily value, quantity to be declared on the food ingredient label, because that's not an area where there's a , a perceived significant risk to health. Sources of protein can come from Most classic form is animals. People know, okay, when I'm talking to patients about protein, yeah, I, I get my protein from chicken or Turkey or fish, you know, or red meat. And sort of the , this conversation around red meat comes up often, but people often don't realize is that they could also get pretty good quality protein from plants. Now it's harder to get as much in one serving, but , um, there are really nice, well-rounded plant-based sources of protein like tofu or Tempe, which are considered a complete and a whole protein,

Speaker 2: 9:12

Proteins, carbs. Before we move on to other things like sugars and fiber and all that, let's talk about fats.

Speaker 3: 9:18

So this is another area, as you mentioned, where we've had some evolution over the past 10, 15 years. And part of how we got into a position where our foods were so have become so heavily inundated with sugar is that fat was targeted in the late seventies, early eighties because of the concern of an association with heart disease. And so there was a big push to reduce fat. So from the low fat push, sprang up a high sugar sort of industry. And it was after that that we really started to see things emerge, like the obesity epidemic and , um, this increased incidence of , uh, diabetes.

Speaker 2: 10:04

So we're not gonna talk epidemiology here, but do you think, I mean , just a little aside, is it was obesity and the epidemic largely due to the rise of sugars.

Speaker 3: 10:14

The epidemiological data suggests that highly, based on my interpretation. Yeah. When you look at some of the graphs where the degree of sugar , uh, that was introduced into the American diet, the , the timeframe where that started really matches quite closely the line for the obesity epidemic.

Speaker 2: 10:36

I strongly remember the push for low fats mm-hmm <affirmative> . In the eighties. Yeah. I strongly remember that was the diet. You wanna be healthy, low fat folks. That was 20 years or 40 years ago. Mm-hmm <affirmative> . We're in a different place now. Yeah.

Speaker 3: 10:47

So when we talk about fats, you have to be careful about the type of fat. There are really healthy forms of fat. Our bodies need fat to survive. And the healthy forms of fat are traditionally considered what are called monounsaturated fats. So think about your olive oil, think about your avocados and polyunsaturated fats. Uh , I am gonna call out specifically on this omega threes. Think about your salmon. Your certain highly fatty fish are really packed with omega threes. And then you have of course, your saturated fat. That's a little complicated too. It's, it's, it's a little , uh, more complicated than we once thought it was. But traditionally, we want to be careful about how much saturated fat we are consuming. And that's for a variety of reasons, but maybe not as much as what we once thought.

Speaker 2: 11:48

So you shouldn't probably eat a whole stick of butter that , that's what I think of what I think of century .

Speaker 3: 11:52

That's probably not a good

Speaker 2: 11:53

Idea. So thanks, Aisha . We've talked about the macronutrients and some of the things that are at the top of the label. We're gonna take a quick break. I'm gonna get a little healthy snack. And when we come back, we're gonna talk about what's on that label, what does that ingredient list mean, and what are some of those other little micronutrients? And I'm hoping you could tell me what riboflavin is because I've never known. So stay with us listeners. We'll be right back.

Speaker 4: 12:15

When Hennepin Healthcare says We are here for life. They mean here for you, your life, and all that it brings. Hennepin Healthcare has a hospital, HCMC, and a network of clinics both downtown and across the West Metro. They provide all the primary care and specialty care you would expect to find, but did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis? Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 12:53

We're back talking with Dr. Aisha Galloway Gilliam about food labels and nutrition. And I'm gonna start off the second half with what is riboflavin?

Speaker 3: 13:01

Riboflavin is a , um, B vitamin. It's vitamin B two. And it's something that our bodies use , basically like in biochemical reactions. And , um, it's, it's a part of our , uh, energy cycle.

Speaker 2: 13:14

Literally, somebody has asked me, and I , you know, what is ribo flam ? I go, I don't know. I must have been sick that day in med school. Maybe I knew that at one point. I think maybe they didn't teach me that in med school, so thank you. It's one of the B vitamins. You're welcome. I wanted to clear the air on that. Let's talk about some other words people see on the label. Uh, they see words like trans fat . They see words like fiber, sodium. Let's talk about those three if we could in order what is a trans fat ?

Speaker 3: 13:40

So trans fat is , uh, partially hydrogenated oil. And some of these occur naturally in our food, but most often they are manufactured and produced historically. Now we know that things are not always neat about food and that it , it's important to some degree to try to avoid concrete thinking around food. But in this area, there is a definitive association with trans fats and increased risk for cardiovascular disease. So much so that the federal government said these must be removed from our food supply. Um, and so they , they really are no longer allowed to add trans fats specifically to foods, but they still may be included if a certain food product has less than 0.5 grams of transects , that food label can say zero transect . Mm-hmm . So this goes back to the serving size part . Right . So knowing that you may be getting more trans fat if you are eating more than one serving of that particular food. I

Speaker 2: 14:58

Know . I didn't know that. Okay. So that one I think listeners can take to the bank, minimize trans fat , right? Preferably none of 'em .

Speaker 3: 15:04

That's right. Okay.

Speaker 2: 15:05

What is fiber? Fiber

Speaker 3: 15:07

Does a few things. It helps to prevent a higher degree of blood sugar spikes when our bodies are digesting that. It helps us to feel fuller longer. It's healthy for our digestive tracts can help prevent and and treat constipation. It can help to reduce the amount of , uh, saturated fats absorbed into the bloodstream. So that's why you see , uh, fiber associated with cholesterol benefits. And so it, it really is a really healthy part of the diet that we often don't get enough of

Speaker 2: 15:39

Trans fat's, bad fiber's generally something you should seek

Speaker 3: 15:43

Out. That's correct.

Speaker 2: 15:44

In general, you know, nothing's absolute in the mm-hmm <affirmative> . In the world, but in general. Okay. The third thing I talked about, they often talk about sodium. Is salt bad in our diet? Yeah,

Speaker 3: 15:52

We get too much of it. It does have an association with a number of , uh, you know, health conditions , um, blood pressure, people who have certain heart conditions and, and so we definitely want to be mindful of how much we're getting in our diets generally less than, you know, 2000 milligrams, 1500 milligrams in a day. And most of us get much, much more than that.

Speaker 2: 16:18

Read your labels. That's something that you can see on the label. Yeah . And , uh, it's everywhere, sort of like sugars. It's another one of those things we have to look out for. Okay. So thank you for those. Now I wanna talk about buzzwords. People here, and it's maybe not always on the nutrition facts, but it's often on the labels of foods like natural or organic. Mm-hmm <affirmative> . This is a diet or this is a healthy product. Could you speak a little bit to those words that are may or may not be true, but they are generally marketing terms. Yeah , but they're on our packages.

Speaker 3: 16:50

Mm-hmm <affirmative> . And that's exactly right. So that goes back to the marketing terms like natural are really confusing. I, there , there really isn't sort of a strict definition for what that means. There's a loose definition, which is that this product doesn't have any synthetic or artificial ingredients, but that doesn't mean a whole lot because you can use synthetic ingredients in producing that food. Uh, it doesn't mean that there aren't preservatives. Really interpret that with a great degree of caution and front of the box labeling in general with some caution. Now organic is separate. That terminology is definitely regulated by the USDA, if there's a stamp on the product.

Speaker 2: 17:42

Like USDA

Speaker 3: 17:43

Organic Yeah . US D organic. Um, and there are some standards that do have to be followed. You know, when , when we're talking about an organic product and generally organic means that , uh, 95% of the ingredients that are in that product are organic. If it's 100% organic, then 100% of the ingredients are , uh, organic. And now these products are supposed to be without , uh, artificial or synthetic ingredients. There are some natural pesticides that are allowed, but no synthetic pesticides. And then there are some sort of farming regulations , uh, around organic foods. And then it also is important to call out that sometimes folks are farming organically, but just don't have the money to stamp their product as organic. So this is where shopping really close to the farm and , uh, you know, co-ops and things like that can be helpful for you to , uh, get a, get a good sense of where your came

Speaker 2: 18:41

From, the organic . That makes sense to me. And I know there's a reality for many people that they're , they can be more expensive sometimes, but, but you can go to farmer's markets Yeah . And buy directly from the person that grew it and ask them mm-hmm . To just spray a bunch chemicals on these. Yeah . You know, so there are ways to do it mm-hmm <affirmative> . But it does make some sense to me. Mm-hmm <affirmative> . What about natural sugars versus synthetic sugars? And I always think of some popular colas. When you buy that cola in another country, it's made with natural sugar mm-hmm <affirmative> . Cane sugar or something. And when you buy that cola in the United States, it's made with high fructose corn syrup. Mm-hmm <affirmative> . So that's what I always think of . Yeah . Is there a difference between those sugars? Yeah.

Speaker 3: 19:19

Sugar is sugar <laugh> , uh, you know, to to, to just keep it simple. Uh , people come in and ask, okay, well I used honey or I used agave syrup. Um, and so is that better than just using, you know, my run of the mill granulated table sugar? And the answer is, then your body's gonna see it the same way. It's sugar. Now there , there is some nuanced territory with high fructose corn syrup because of the way fructose is processed within our bodies compared to , uh, glucose. And I don't know that we need to get down that rabbit hole, but, but, but that potentially has some different metabolic consequences associated with it. Natural sugar. So that, that's also a little bit nuanced when we're thinking about sugars on the ingredient label versus added sugars. So natural sugars, sort of sugars that are just natural to the actual products versus sugars, extra sugars that are added to the product. So like

Speaker 2: 20:19

An apple has sugar.

Speaker 3: 20:20

Yeah, exactly. That part of the ingredient label is important to look at too. How much sugar was actually added in addition to what's naturally occurring.

Speaker 2: 20:29

So what , let's talk about the ingredient list. Now we've got through some of the top parts of the food label. We've talked about the package on the front of it. Now down to the nitty gritty, the ingredients. When you are reading an ingredient list, what are you looking for?

Speaker 3: 20:42

First? I'm looking for how many ingredients are on the list. Right. So again, thinking about how processed is this item? If, if this is an ultra processed food item, I'm really gonna be thinking twice about whether it's something I wanna buy. Thinking about the ingredient list in terms of how ingredients are listed, the order in which they are listed is important as well, because

Speaker 2: 21:08

It does matter.

Speaker 3: 21:09

It matters. They're listed from heaviest weight to least. Right. So what is first on the ingredient label takes up most of that product. And so I'm going to be looking if it's a sort of a processed item for whole grains to be listed first and then kind of reading from there. I'm also gonna be looking for how much synthetic chemicals are added. Are there a bunch of names? I don't recognize what, what, what are these things? That's gonna be something I'm gonna think twice about, is it something I really, really wanna do? And the answer may be, yeah. 'cause I want a Snickers bar <laugh> . Exactly. Uh , but I, at least I have the information that I need to really , um, make an informed decision about that in that moment. Um, and be a , uh, an informed consumer. And that's the , the power that interpreting ingredient level gives.

Speaker 2: 22:03

Yeah . I went to and read a thing by somebody, a famous , uh, author on food. He said, if your great grandmother or your grandmother wouldn't recognize those things mm-hmm . On that list, maybe give it a

Speaker 3: 22:14

Pass. Yeah . Yes. Exactly. Or if you don't recognize

Speaker 2: 22:17

The thing on that list. Exactly . It's got too many syllables. It's a word you don't understand. It looks like something from a chemistry lab. Yeah,

Speaker 3: 22:23

Exactly. You

Speaker 2: 22:24

Might wanna think, think about it. You might wanna think twice. Think twice. Okay. Before we wrap up, Dr. Galloway Gilliam , I wanna ask you about , um, some tips for people in managing their food intake. Um, there are things like daily requirements. Where do those come from and should people be monitoring their or their progress toward the daily requirements? Or what, what tips would you give people

Speaker 3: 22:43

When a person is looking at the percent daily value? This is complicated because math can be involved, but a good way to generally interpret those numbers is that if it is 5% or less of the percent daily value, it's considered low. So if you've got a , uh, item that has 5% or less , um, total fat, it would be considered low. If it is 20% or higher of whatever the micronutrient is, it would be considered high. And so when you are thinking about your own individualized needs, 'cause this is gonna differ depending upon the person, and that's part of what makes it complicated, looking at the label with that in mind, if I know that I'm trying to follow a low fat diet, then I'm gonna need to be looking for things that are less

Speaker 2: 23:42

Than five . If it says 20, 30, 40% of you fat ,

Speaker 3: 23:45

You're getting a lot in that product . Product . That's exactly , yeah, that's exactly right.

Speaker 2: 23:48

So in your practice, you, you literally run our comprehensive weight management clinic. We don't call it weight loss, we don't call it this, that , or anything . We call it weight management. In your practice, you probably talk to people all the time about their nutrition. What tips do you give them and that you could leave our listeners with mm-hmm

Speaker 3: 24:06

<affirmative> . Yeah. So as you pointed out earlier, one of the tips for sure is shopping at the perimeter of the store. That is where you're going to be most likely to encounter some of those less ultra processed food items. The ultra processed foods tend to live in the center of the store, and those are the things that are in boxes and have a long ingredient label. Uh, the other thing is, when you're shopping, go in prepared. You know, have a a list, know what you're going in for. And then of course, as we have all heard, but it's really important, don't shop hungry because our hunger hormones are powerful. It it , this is not about willpower. Those hormones send a very powerful and potent message to our brains. So you wanna have a game plan, go in and follow the play that helps you to be able to be really intentional about what you're purchasing,

Speaker 2: 25:06

What great advice for people next time you go grocery shopping, or next time you're planning your family's food for the week. I think we've picked up a lot of great tips today from you, Dr. Galloway Gilliam . So thank you for being on the show .

Speaker 3: 25:19

Thank you for having me.

Speaker 2: 25:20

And I encourage listeners to , you know, compare the labels and hopefully you've learned something today to help you when you do compare those labels. We've been talking with Dr. Aisha Galloway Gim . She is the director of the Comprehensive Weight Management Center at Hennepin Healthcare. And a friend and colleague of mine here, listeners, thanks for joining us and I hope you'll join us in two weeks time for our next episode. And in the meantime, be healthy. Be well.

Speaker 1: 25:44

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive Producers are Jonathan , CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.