23/05/2024

Care Health

Prioritize Healthy life

Label reading for heart health in Canada: The definitive guide

Label reading for heart health in Canada: The definitive guide

Introduction

There is so much nutrition information on packaged food, people often struggle to make sense of it all. Even if you’ve been reading labels for years, you may be misunderstanding some lines.

Some lines have percentages, some don’t. The claims on the front of the package look legit, but how much of that is just marketing? How much is that too much cholesterol? And what about ingredients that sound like they came from a lab?

If you know what you’re looking for, a quick look at the label can be extremely helpful. Let’s take a look at where to focus if heart health is your priority.

What are we looking for?

We choose foods for a variety of good reasons, from taste to convenience, from tradition to cost. I’ll talk here about label-reading with a heart health focus, but that doesn’t mean cardiac nutrition is the only – or even most important – consideration.

But with that goal in mind, what we’re looking for is more plant foods — vegetables, fruit, whole grains, legumes, nuts, and seeds — as well as fish and other lean animal protein foods if you like. 

It also means healthier fats and fewer refined grains, sodium, added sugars, processed meat, and alcohol.

How can label reading help us with all of that? First let’s look at what you’ll find on the front of the package.

Front of the package

This may be the first thing you’ll see, but take what’s written there with a healthy dose of skepticism. While some terms are regulated, they can still be misleading. 

For example, this granola uses words like “organic,” “dark chocolate,” and “red berries” to imply that it’s a healthy choice, but a close look at the Nutrition Facts table reveals 21 grams of sugar per cup, or about 5 teaspoons, not ideal at breakfast.

This Lipton noodle soup mix is marked “25% less salt,” and the package has a subtle heart-shaped bowl on the front. That’s pretty bold considering a whole packet of it is still 1410 mg of sodium, a pretty big chunk of the 2000 mg max recommended by Hypertension Canada! 

(Not much nutrition in there either. Pretty much just salt, noodles made with white flour, and “powdered cooked chicken,” which contributes to the paltry two grams of protein per serving.)

Like Lipton’s heart-shaped bowl, companies sometimes use subtle imagery and words like “super” to get around the rules for words like “healthy” or  “nutritious.”

There are even more regulatory requirements for much of the information on the front of food packages. By 2026 foods that are high in sodium, sugars, or saturated fat will be required to display a Health Canada warning symbol on the front of their packages.

Meanwhile, the back or side is where you’ll get the whole picture, so if the front passes your sniff test, let’s take a look at the Nutrition Facts table.

Nutrition Facts

These tables are where people usually look for nutrition information, and that’s the best place to start. What to look for?

Start with the serving size! 

The serving size is important and easily overlooked. It just tells you how much of the food the numbers in the table reflect. 

It should be given in grams or milliliters and a more common household measure like cups or teaspoons. Note that it isn’t a “recommended” amount!

If you’re comparing two products, the serving sizes might not be the same. These No Name brand canned lentils, for example, have 300 mg sodium per serving, which sure seems like more than these Tamam brand lentils at 160 mg. 

What you might easily miss is that the serving size for the No Name is 125 mL (½ cup), and the Tamam lentils are 250 mL (1 cup). So actually the No Name lentils have more sodium per cup. More than twice as much! 

Another of my pet peeves is this Bragg’s Liquid Soy Seasoning, “soy sauce alternative,” which has only 310 mg sodium per serving. Sounds good right? Compare that to the reduced-sodium soy sauces, which pack about 600 mg per serving, or the regular ones, which have about 1000 mg. 

Hopefully by now you’re thinking of checking the serving size! The Bragg’s is one teaspoon, while the soy sauces are all one tablespoon, which is three teaspoons. So if we do the math, the Bragg’s packs 930 mg sodium per serving, about as much as regular soy sauce. 

I’m sorry to start off with math, but we need to know if the Nutrition Facts table is referring to a teaspoon or a tablespoon, a half-cup or a cup, one slice of bread or two, and so on. That way you’re comparing apples to apples!

Understanding Percent Daily Values (% DV)

The Percent Daily Value isn’t available for every nutrient, but when we have it, it’s a quick and easy number to use. 

If you don’t spend a lot of time on nutrition, you might not know, is 7 grams of saturated fat a lot? Is 12 grams of sugar a lot? How about 400 mg of sodium?

The percentages you see on the right, called Percent Daily Values (% DV), give you a quick answer to that question. The rule of thumb generally is that 5% is a little, more than 15% is a lot. You don’t need to remember more than that!

I always like to add a little nuance to that (as I do), because if you eat a complete balanced meal with 16% sodium, I’m not as worried as a handful of potato chips giving you 16% sodium. 

But either way, that’s the quick and easy way to read those percentages. 

Note that there is just one % DV for both saturated and trans fats. So for these peanuts, the % DV is 10%, with none coming from trans fats. Pretty good!

(Some people wonder what the percentage is referring to exactly. The Daily Value for each nutrient is basically how much of that nutrient we need in a day. Of course some people need more and some less, but it’s a number that covers most people.

The Percent Daily Value refers to how much the food has compared to the Daily Value. So if the Daily Value for sodium is max 2300 mg, and a food contains 230 mg per serving, then the Percent Daily Value will be 10%.)

Required Nutrients

Nutrition fact tables in Canada must include 13 nutrients: Fat, saturated fat, trans fat, cholesterol, sodium, carbohydrate, fibre, sugars, protein, vitamin A, vitamin C, calcium, and iron. 

However, as of December 15, 2022, food manufacturers were supposed to have changed their labels in numerous ways, including showing potassium instead of vitamins A and C, as more Canadians are at risk for not getting enough of this blood-pressure maintaining mineral.

Manufacturers might choose to list more than that, so don’t be surprised if you see something else like monounsaturated fat or magnesium. Those are just optional.

Which nutrients matter most for heart health?

Before I answer this, I want to caution against taking any nutrient in isolation too seriously. Something might be high in saturated fat, for example, but if the food is otherwise nutritious, we might choose it anyhow. (Higher fat yogurts or cheese, for example.) 

The idea is to look at the big picture. 

Anyhow, with respect to where to focus on the Nutrition Facts table, this is an area of great debate, but I would put my money on the following.

Five nutrients to focus on:

  1. Saturated and trans fat
  2. Fibre and sugars
  3. Sodium
  4. Protein
  5. Potassium (if shown)

(I’ve combined a couple where they work together to tell us what we need to know.)

1. Saturated and trans fat

First we’d like to know if most of the fat in the food is heart-healthy fat or not. 

The type of fats that tend to contribute to blocked arteries are saturated and trans fats, and they’re both required on every label. 

The heart-healthier fats (monounsaturated and polyunsaturated) aren’t normally there, but it’s easy to figure out. Just compare the total fat to the saturated and trans fat

For example, a 2 tsp serving of this olive oil has 9 grams of fat in total, but just 1.7 grams of that are saturated fats, and there’s no trans fat. So you can see that most of what’s in there is healthy fat.

With this butter, on the other hand, 5 of the 8 grams of fat in a 2 tsp link are saturated, so not as much of a heart-healthy choice, even though it’s organic.

2. Fibre and Sugars (for carbohydrate quality)

Next we’d like to know if the carbohydrates in a food are heart-healthy or not. Carbohydrates include all the starch, fibre, and sugar in a food, so they can come from soda pop or blueberries or something in between. Wouldn’t it be nice if the label gave us some clues?

So take a look at the lines that say fibre and sugar. More fibre and less sugar helps us identify a heart-healthier food. That’s more useful than just looking at the carbohydrate line.

Really what we don’t want too much of is “free sugars,” sugars that aren’t naturally part of a whole food. Free sugars include sugar that’s added by manufacturers, but also natural sources of concentrated sugars like maple syrup, honey, and juice. 

Canadian labels don’t specify free sugars, but I would assume that if you see a high number on the Sugars line, you’re seeing mostly free sugars unless the food is plain milk, yogurt, or whole fruit. That’s a small list of exceptions.

Traditionally we haven’t had a Daily Value for Sugars, so there was no % DV. However, this is part of Canada’s new Nutrition Facts table, so you should be seeing it on more and more foods.  

3. Sodium

Unless you’ve been told otherwise, most of us are wise to avoid higher sodium foods. Too much sodium can cause high blood pressure, one of the major risk factors for heart disease and stroke. Even if you don’t have high blood pressure, we’d like to keep it that way. Excess sodium can also contribute to osteoporosis and stomach cancer.

A quick glance at the Sodium line might surprise you. You’ll find it in cereal, pasta sauce, ketchup, and other everyday foods you might not expect. See if you can compare products and choose lower sodium alternatives. 

But again, let’s not get carried away with this. Just cooking your meals yourself goes a long way towards reducing sodium intake, compared to letting most restaurants do the cooking. The idea isn’t to avoid sodium altogether, but rather to avoid excessive amounts.

4. Protein

Protein isn’t traditionally a big consideration for heart health, but it should be! Eating enough protein at every meal can help you feel full, making you less likely to eat more than you wish to later in the day. It can also help steady your blood sugar, which is good for your arteries. (Prediabetes and diabetes are both risk factors for heart disease.)

The trick with protein is that there is no Daily Value, so no % DV. How much to aim for? Ideally you would sit down with a Registered Dietitian for a personalized answer to this question, because it depends on your size, health conditions and daily activities. 

However, in the absence of that, I will say to aim for at least 20-30 grams of protein at every meal. More than 40 grams isn’t more helpful, and leaves you with little room for other beneficial nutrients. So no need to sit down to a dozen eggs from breakfast!

If you don’t eat meat, fish, chicken, or other animal foods, getting 20-30 grams of protein at every meal can be tricky but certainly possible. 

If you do eat those animal foods, the challenge is an absence of labels on most fresh meat products. A good rule of thumb is to assume about 7 grams of protein per ounce of lean meat, fish, or chicken, so the famous deck-of-cards sized serving, which is about 3 ounces, would be about 21 grams of protein. (Let’s call it 20 grams for round numbers.)

Add to that the protein we find in other food like dairy, grains, nuts, seeds, and even vegetables and fruit, you can see why the deck of cards is enough for most people.

If your food does have a label, of course you can use the Nutrition Facts table to better estimate the protein in your meal.

For example, this Healthy Choice Cauliflower Curry Power Bowl is a heart-healthy little meal, with ingredients like cauliflower, lentils, and kale, and only 17% DV sodium. But since it only contains 15 grams of protein, I would pair it with something like yogurt or a glass of soy beverage to ensure adequate protein.

5. Potassium

Finally, if the label you’re looking at has potassium, take a peek. Potassium is kind of the opposite of sodium, when it comes to blood pressure.

I also like potassium as an indication of how much food quality is in a food. If your lunch has a lot of potassium, it generally has more fruit, vegetable, beans, whole grains, etc. Not always, but it’s a strong clue.

Potassium has a % DV, so it’s easy to check. Just remember that less than 5% is low, more than 15 % is high. But use your judgement there.

Ingredient List

While the Nutrition Facts table tells us most of what we want to know, there is some value in taking a quick peek at the list of ingredients.

For heart health, the biggest thing I’m doing with this is searching for whole grains. We also like to see ingredients like vegetables, fruit, nuts, and legumes.

Of course if you have allergies or food intolerances, the ingredient list is critical for that. Scour the whole list.

Otherwise, just focus on just the first three ingredients, which are in order by weight. You’ll save yourself a headache.

For example, if you want to make sure your bread is a whole grain bread, you hunt for the word “whole” at the very start of that list. For example, this Mestemacher whole rye bread starts with “whole kernel rye.” No question there.

On the other hand, the more widely available “Canadian Rye Bread” from Dempster’s “Natural Bakery” starts with “wheat flour.” You could easily be tricked into thinking that’s a whole grain, but the word “whole” is nowhere in sight, so it’s white flour. Sorry.

The next two ingredients are water and “cracked rye meal,” which is actually a whole grain. So there’s some whole grain in there, but since it’s the third ingredient down the list, we can’t be confident that it’s a lot. 

A quick check of the Nutrition Facts confirms… a mere 7% DV for fibre, for two large slices! Better than white, but not by much.

(See here for a collection of examples like this, of grains that look whole but aren’t.)

Less important for heart health

I wouldn’t focus on the following nutrients, and here’s why:

Calories

What a loaded word! But calories just measure the energy provided by a food, and guess what? We need energy! Of course frequently eating more calories than your body needs can contribute to undesired weight gain. Just as bad, not eating enough calories can leave you ravenous later. 

Rather than count calories, I’d suggest that glancing at items like fibre and protein on the Nutrition Facts table will help you get more filling calories, which can help you avoid overeating. 

Listening to your body is critical here too. Only you know how many calories you need on a given day… not a formula. If you really struggle with how much to eat, seek help from a dietitian or psychologist who specializes in eating difficulties.

Fat

Back in the day we thought less fat was better, but studies have come up empty when tying the amount of fat in someone’s diet to health outcomes or weight changes.  

The type of fat you eat does seem to matter very much, which is why we look at the saturated and trans fat lines.

Cholesterol

You’d think that eating more foods rich in cholesterol would drive up your blood cholesterol levels, but for most of us, the effect is pretty small, unless you really go overboard on cholesterol-rich foods. So I wouldn’t worry about what the cholesterol line says. 

If you want to keep your blood cholesterol down, best bet is to enjoy plenty of foods with healthy fats – nuts, seeds, fish, and liquid oils, and foods with soluble fibre. Limiting saturated and trans fat intake can help too. I’ve included more details about all of that in this post about eating your way to lower cholesterol. 

Carbohydrate

For most people, the carbohydrate line isn’t particularly important for heart health. The exception would be people who use this information to help manage diabetes, although that wouldn’t be my first tactic for diabetes either.

Looking at the fibre and sugar lines gives you more information about the quality of the carbohydrates, as discussed above. 

Calcium, Iron, and other Vitamins and Minerals (if present)

These values may be interesting and important for other health reasons, but strictly for heart-health they’re not critical.

How are labels different in the US?

The fundamentals are the same, but labels in the US have a line for added sugars, which is similar to free sugars. Lucky them! 

There are other small differences, but nothing I would worry about. Switching back and forth won’t be a big deal if you’re travelling.

Canadian labels – you’ve got this!

So again, although there are many items on the label, providing you with a wealth of information, keep your life simple and your grocery shop short by doing the following:

Take a peek at the front of the package. We don’t have much nutrition information there yet, but it’s coming. Meanwhile, if the brand, product basics, and any nutrition information looks good, flip it over and check out the Nutrition Facts table.

That’s where we want to check out five key nutrients:

  1. Saturated and trans fat (are the fats healthy?)
  2. Fibre and sugars (are the carbohydrates healthy?)
  3. Sodium (is there too much, for blood pressure maintenance?)
  4. Protein (is there too much or too little?)
  5. Potassium (is there too much, for blood pressure maintenance, if it’s shown?)

If you can remember those five, you’re good to go, for heart health at least. Others may be useful for other conditions, like calcium if you’re trying to prevent osteoporosis, but some may just confuse you.

Learn to focus on the key five and you’re off to the races!

If you’re looking for whole grains, allergens, or other ingredients you wish to avoid, you can look at the ingredients list, but I’d argue that it’s of secondary importance also.

Keep things simple for yourself and you can identify your favourite products, heart-health-wise, without spending hours and hours at the grocery store. You’ve got this.

Question or Comment?

We encourage conversation in our free Facebook group, the Sweet Spot Heart-Healthy Cooking Club. You’re welcome to join if you’re not already a member. Someone will usually let you in within a few hours if not faster.