Conquer Your Weight

Dr. Sarah Stombaugh: Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With the GLP guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and to sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today’s episode. This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast. Announcer: Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to this week's episode of the Conquer Your Weight podcast. Today we are talking about reading nutrition labels and how do you actually make sense of what you are reading, what is good for you, bad for you, what is too much, what is not enough. How do you make sure that you are aligning with your health and your weight goals when you are in the grocery store, when you are looking at a nutrition label and let's break that down because it can be really confusing. Now I will say as part of our conversation today, some of the things will be fairly generalized advice, whether you are following a low fat diet or a high fat diet or a Mediterranean diet, there are pieces of this that you'll have to, you know, we'll sort of talk about which components make the most sense and how you would apply these in different scenarios, but I'm not going to be giving exact recommendations on calories that you should be following or exact gram of protein and carbohydrate and fat that you should be following. But we'll talk about some of those general principles. And then I want you to bring it to your physician or whoever is supporting you in your weight loss journey to have a conversation of how these principles apply to you. So let's dive in. When you were looking at a nutrition label, what are the most important things? Let's orient you to that label. So the very first thing I want you to pay attention to is what is the serving size? Now, a lot of times what serving will be the container, but it's very common that a large container especially may be broken into multiple servings. And so this can be very common in beverages. So a lot of times we see in a 20 ounce beverage, for example, and some of the sports drinks or sodas, you may see that the single container is not listed as a serving size. The single container is maybe two servings or two and a half servings can be very common. Similarly, other products, particularly very high calorie cakes and that type of thing very commonly may also be listed. you're holding the package, it looks like it would be appropriate to eat the whole thing. Many people have probably had the experience of eating the whole thing, but when you read the side of the label, you're like, oh gosh, that was actually two or three or four servings. So also things like a pint of ice cream, for example, certainly many people have had the experience of eating a pint of ice cream in one setting, but that is often three and a half or four servings depending on the brand. And so it's important to pay attention to the serving size and you certainly can always have more or less than the serving size, but being aware of, you know, if you've eaten an entire package of something and it was actually four servings, then obviously everything on the nutritional label, you're going to have to multiply by four in order to really understand what you got as part of that meal that you had. So being aware of the serving size. In my practice, I do not do calorie counting. I do not do macro counting. We do a lot of teaching around macronutrients, the roles of proteins, the roles of fats, the roles of carbohydrates, and how we build those in to create satiety and meet our different nutritional or weight loss goals. And so I am not having my patients do weighing or measuring. So we're not going to get into the exact grams, but again, I'll give you some general principles. Now, another thing I like to have people look at is the ingredients list. One of the things that you may not know about the ingredients list is that they are listed in order of which ingredient is most used in the recipe to less common in the recipe. So the first thing you use, that is the thing in the highest proportion in the recipe and then lowering down from there. And so it can be really valuable. You know, sometimes you're reading it and it can surprise you. What are the first couple of ingredients? I was reading a syrup container actually the other day and it was like a... Not maple syrup, but pancake syrup, as we call it. But it was high fructose corn syrup, regular syrup. It was not surprising because it looks like a syrup. It was made up of multiple different corn syrup type products, for example. And so when you are reading a nutrition label, getting an idea of what are the products that are in the highest proportion in that and what are the products that are used less commonly. So that'll be an order from most used to least used in that recipe. And then let's get into the label itself. At the very top below seeing what the serving size is, what the total calories is per serving size, you'll then see our different macronutrients laid out. You'll see fat, you'll see sodium, which is not a macronutrient, but you'll see fat, you'll see sodium, you'll see carbohydrates, and you'll see protein. And then you'll see some micronutrients and other vitamins and minerals broken down at the very bottom. In the fat section, this will have a total fat. So you'll see the total fat listed next to fat. You will also see this broke down into saturated fats, trans fats, polyunsaturated and monounsaturated fats, if those are in the different product. And one really good rule of thumb here is that fats are Generally, I will say fat should make up about a third of our diet. Now, the thing that's really interesting about fats is they are very calorically dense. So a gram of protein, a gram of carbohydrate, those each have four calories. One gram of fat has nine calories in it. So it's more than twice as calorically dense compared to protein compared to carbohydrate. So even though calorically having about a third of your calories come from fat, if you looked at a is so much more calorically dense, the amount of fat on the plate will be lower. Then a lot of foods, we sometimes characterize things as, oh, that's a fat or that's a carb or that's a protein. Many of the foods that we eat are combined with different things. So many meat products, for example, are going to be protein and fat. Many legumes, for example, are going to be protein and carbohydrate, primarily fiber, as well as then a little bit of fat. Most nuts are going to be a combination of all three protein and fat and carbohydrate. And so a lot of foods are not just singularly one of those macronutrients. So about a third of our calories or 30% rather of our calories coming from fat is a really good rule of thumb. So to give you some different examples of how this would play out, if we want about a third of our calories coming from fat, we can also look at how many of those are coming from the different types of fat. We also want no more than 10% of our calories coming from saturated fat. Ideally, there's no trans fat. Because of legislation, it's defined trans fat in America at least anymore, but we don't recommend having any trans fat. So total fat about 30%, saturated fat about 10% of our diet. Now what that looks like calorically because of that density of fat, if you were someone who was following a 2000 calorie diet, if you were aiming to have 30% of your diet coming from fats, that'd be 600 calories that you'd want to be getting from fat. Because those are so calorically dense, that would be 66 grams of fat distributed throughout the day. And then we think of how much of that would be saturated fat, 200 calories coming from saturated fat, which would be 22 grams of saturated fat. So over the course of the day in a 2000 calorie day diet, you would have 66 total grams of fat, of which 22 of those could be saturated fats. And then if we're thinking about a 1500 calorie per day diet, having 30% of those come from total fat, 450 calories, that's 50 grams of fat distributed throughout the day. And then 16 of those could be coming from saturated fats. So it is important when we're looking at fat on a label, being aware of both for that meal, but then even just throughout the course of your day, what are other meals going to look like? Do you want to be really intentional about the serving size because you're trying to limit fats, for example, or you know you're going to have a lot more at a being really intentional about what that looks like. Certainly some foods are going to be higher in saturated fats. Other foods are not going to be as high in those. Generally, when we look at most products that contain fat, they're a combination of both saturated and unsaturated fats as a really broad rule of thumb. Animal fats, so fats that are in animal products, fats, so meats, poultry, dairy products, eggs, and then fats that Fats that are in these animal products are going to be predominantly saturated fat, although there is unsaturated fat in those as well. And then fats that come from the earth, things like nuts and legumes and seeds and vegetables. like fruits and vegetables, things like avocados or olives, that type of thing, those are going to be predominantly unsaturated fat, although certain ones will have more saturated fat in as well. So being mindful of saturated and unsaturated fats. Now, the unsaturated fats are also broken down. We'll often see polyunsaturated, monounsaturated. We're not going to get too in-depth into that as part of the conversation today. You'll also see cholesterol broken down, which I feel like cholesterol has kind of had its heyday a few years ago with eggs are bad for you. We've been less focused on cholesterol over the last couple of years, but that is part of the fat label. Next, moving down on the nutrition label, you will see sodium listed. So for the average person, I don't worry terribly much about sodium. For someone who has high blood pressure, who's been told to monitor their sodium, for someone who has certain kidney diseases or heart failure, for example, those patients have often been advised that they need to watch their sodium, often given a recommended amount of sodium to stick below per day. And so if that is the case, certainly pay attention on food labels for sodium. Otherwise, if you're not dealing with those problems, you don't have high blood pressure, you have healthy kidneys, you don't have heart failure, generally you can sort of skip over the sodium portion of that. Next, we're going to come to carbohydrates. Now, one of the things I feel very strongly about is that carbohydrates have been really demonized over the last handful of years. And the reality is, carbohydrates make up a lot of very important parts of our diet. Things like fruits, things like vegetables, things like grains in their whole form, those are predominantly carbohydrate. So when we think about carbohydrate, I really want someone to be focused on the quality of their carbohydrate and paying attention to that piece of it will be much more important than the exact amount of carbohydrate. In the way that eating Skittles, for example, compared to eating an apple, those are very different things. the way your body processes that, uses that for energy. The apple has a lot more fiber. It's going to be satiating for a longer period of time compared to Skittles that are straight sugar. But the amount of carbohydrate of those could be exactly equal depending on how many Skittles you ate, for example, and those are both products that are basically 100% carbohydrate and nothing else. So carbohydrates in and of themselves are not bad. We just want to focus on the quality of carbohydrate. So is this a fruit? Is this a vegetable? Is this a grain in its whole form? Are these seeds? Are these nuts? Are these things that are going to contain fiber? And we will see a nutrition label broken down initially with total carbohydrates, as you see also with fat, And then you'll see it broken down. It'll include fiber, and then it will include any added sugars. So these can be really, really important things to pay attention to. So from a fiber standpoint, most of the fiber that we consume, again, as a general rule of thumb, is going to be coming from whole products, coming from fruits, coming from vegetables, coming from grains in their whole form, from legumes, from nuts. So certainly we're going to see those on some nutrition labels, but as I've read more and more nutrition labels over the year, a lot of packaged foods are not always going to be the highest option in terms of fiber. And so if you're looking to get fiber, getting those from the produce section, from your whole grains, beans, et cetera, will be an excellent way to do that. That being said, there is fiber listed on the package if there is fiber in it. And this can be really important as we're thinking about how much total carbohydrate are we getting versus what is that proportion of fiber in it. So a really good ratio to keep in mind is a less than five to one ratio of total carbohydrate to fiber. So what this can look like is basically how much of that is coming from fiber versus from a more processed carbohydrate. So So if we look at certain breads, for example, many will have very low fiber in them. Recently, I was looking at Dave's Killer Bread, which is an example of a bread that's made with whole grain as well as has a lot of nuts and seeds in it as well. And Dave's Killer Bread has 20 grams, I believe, of total carbohydrate. I take that back. It's 22 grams of total carbohydrate and four grams of fiber in it. And so when we look at the ratio there, this actually doesn't even meet the ratio for sort of the ideal ratio of less than five to one. So if we multiply our four grams of fiber by five, that would be 20. And so with 22 grams of total carbohydrate, only four of which are fiber, even this is a food that falls sort of less than that threshold. Now, when you're thinking about building a meal, if you look at something like this, there's nothing wrong with having a piece of toast as part of your diet, but you want to think about, okay, how am I going to incorporate other fiber in? For example, am I going to be having a fruit or vegetable alongside of this? Maybe I'm having a nut butter spread on it or something like that, making sure that I am going to include fiber. So they can really have a nice balanced ratio of both total carbohydrate and fiber, which is going to be helpful for satiety, slowing down absorption of nutrients, really important for gut health. So that fiber piece is really important. And we've talked about this a little bit before, especially in the context of the gut microbiome conversation, but fiber is one of the most important things in our diet. And I, I fear, especially with this emphasis on keto diet that's been really high in fat, this emphasis on protein that our society has been really excited about recently. Nobody's been talking as much about fiber. I'm starting to see, you know, hear about it here and there, but it's not, it doesn't have the same limelight as we've seen with fat, with protein over the last couple of years. And so fiber is one of those things that is absolutely really important for us. It is recommended that women get at least 25 grams of fiber per day, and that men get at least 38 grams of fiber per day. And so what this looks like, if you imagine hitting those minimums, let's say you are a woman and you are eating three meals per day, for example, you're dividing that 25 grams by three. So you're going to want to be aiming for at least eight grams of protein, maybe nine grams of protein per meal in order to hit that 25 grams of fiber per day. And then for men to get that 38 I mean, you're really looking at getting, you know, at least 12 or 13 grams of fiber per meal, if you're having three meals a day, for example. And so as you think about building your meals, if you're recognizing that your fiber is a little bit low, are there other things that you can pull in that are going to help bolster that fiber? So you can pay attention to that ratio, but I also want you to be thinking if that fiber is not going to be high enough, are there other ways that you can pull fiber into that meal? Now, one of other things I like to think about when I'm looking at carbohydrates is added sugar. So added sugar is required to be added to nutritional labels. And this is really important because added sugar, you know, certainly when we're thinking about a lot of our desserts or sweet treats, we expect that there is going to be sugar in there, but sugar hides in a lot of our modern processed foods, things that can look like really healthy options, things like yogurts, things like granolas, things like salad dressing or other sauces. It's very common that there is sugar that is added to those. So it's important to be aware of what that looks like. There's all sorts of different recommendations out there about how much sugar or added sugar you should have in your diet per day. I will say generally the lower, the better. Now, certainly you can have some when you have it, having it in a very intentional and planful way, I think is the best way to do it. So if you're going to have sugar, I personally think it feels sort of silly to do that in a sauce. Why don't you have it in a decadent dessert that you're really excited about rather than having it something else. The fun thing is you are the boss of your body. You could decide your own preferences and where you want to have that, but be mindful about added sugar and where that is coming in throughout your day. So again, lots of different recommendations out there. I've heard people say less than 20 grams of added per sugar, 24 grams. I think the food guidelines say 32 grams of added sugar per day. I would just say, keep that as low as you can throughout the day and just be really intentional about where it's included. Are there places that it's sneaking in and does it really need to be there? Because that can be sort of a low hanging fruit of things that we can cut out. I even find if you're taking gummy multivitamins, for example, it's very common that those have like four or five grams of added sugar, for example, and that just seems kind of silly. Do you really want to be getting added sugar from a multivitamin when maybe you could take a pill version or you could do a chewable tablet, for example? So there's other options out there. So just are you actually enjoying your added sugars when they come in? And another thing I like to think about is that four grams of added sugar equals a teaspoon. And so when I see a food item in front of me, I'm a very visual person. So I imagine taking the teaspoon and I imagine scooping from a sugar bowl, one teaspoon of sugar and dropping it into that food item. And so if you imagine a yogurt, for example, that has eight grams of sugar in it, and you imagine scooping one, you imagine scooping two, and then dumping that into just a small four or five ounce cup of yogurt, I don't know, that feels like kind of a lot. I've seen other yogurts that have even 20 grams of added sugars. You imagine doing that five times and you're looking at this teeny tiny yogurt cup and it's like, wow, that's really a lot of sugar. You know, if you had an unflavored yogurt, would you go to your sugar bowl, get a teaspoon out and put five teaspoons of sugar in it? Probably not. And so just being mindful of what that looks like, where that's coming in. One of the really big trends that we've seen is that foods that are low fat or fat-free often will have sugar added in order to help bolster some of the flavor. One of the things we know is that when you take fat out of a product, it loses a lot of flavor. Fat is really flavorful, creates a lot of that sort of round balanced flavor that food items will have. And so when you reduced fat in something, what happens is you end up losing a lot of flavor. So one thing that food companies have done, and this isn't new, this has been going on for decades since the low fat era, but they add in sugar in order to improve the flavor profile that would have just been totally lacking if they cut the fat out. And today I was actually looking at a cottage cheese container in a fat-free cottage cheese. I don't know that this is true across every brand, but the brand that we had bought from our local grocery store was a fat-free yogurt, and it had two grams of added sugar. Now, two grams is not a lot. That's half of a teaspoon. And we're talking about a serving size, which is half of a cup of cottage cheese. But when you compare that to, they have a 2% option, they have a 4% option, and those don't have any added sugar. And so when you look at what are your nutritional goals, are you dealing with things like insulin resistance, for example, and how are you trying to support that? Bringing an added sugar in something like cottage cheese to me just feels sort of silly. And so could you instead choose a 2% cottage cheese that does not have any added sugar is going to maybe have then some reduced fat but still have some flavor from that fat without having to add added sugar. So that just seems like a really silly way to get an added sugar. And so that's what I mean about taking a peek at those nutrition labels and being aware of, is there added sugar that's sneaking in? Another thing that I also think is really sneaky is that natural sugars do not have to be listed. So if something is sweetened with fruit juice or with fruit, recently I saw this in the setting of a cereal that was sweet with date powder. So dates are honestly nature's candy. Dates are very, very sweet, a phenomenal way to sweeten food items with something that's going to be less processed. But dates are still very sweet, lots of carbohydrates, right? They are very processed or not they're processed, they're not processed, but they're a very, very, very sweet type of food. And if you dried out a date and then you blended it up and turned it into powder and you sprinkle that over cereal and which is what happened in this situation, that would be a pretty sweet cereal. And so I had purchased this cereal for my children because said no sugar added and big bold letters across the front of the box. And then as I was looking at the nutrition label, I said, it said no sugar added. And I was like, oh, that's great. And we brought it home and I took a bite and I was like, oh my gosh, the cereal is really sweet. And I knew that it didn't have any artificial or non-nutritive sweeteners. So it didn't list anything like stevia or sucralose or, you know, any, any of those sweeteners. So I'm reading the, the ingredients list really closely. I'm like, what is creating sweet in this? because this is really sweet and it was date powder. And so they had taken dates, they had dried them out, they had blended them up, turned it into a powder, sprinkled it over the cereal. And certainly that sweetness was accounted for in the total carbohydrates. So we see it there, but it wasn't in the added sugars. So we see that to say, um, That's tricky. It's basically an added sugar. Even though it's natural, it's very processed. It's going to give you a quick spike of glucose, for example. Is it better than regular sugar? I don't know. Maybe, but not really. And so is it better than high fructose corn syrup? Sure. But This is a really sweet product. It's giving you that carbohydrate. It's basically an added sugar, but it doesn't have to be accounted for on the label. So we say that to say, if something is sweet, go looking for the source of sweetener. I have been fooled by this many times, particularly in beverages sometimes that are listed as no added sugars or no artificial sweeteners, for example. And then I take a gulp of it and you're like, oh my gosh, there's actually sweetener in there. If it is not listed as having no added sugar, it says no artificial sweeteners, but you taste it and it tastes sweet. There is a sweetener in them. And so you can evaluate, is it one of the non-nutritive sweeteners, meaning that there's no calories, but something like stevia or monk fruit, for example, no calories, but still very sweet, technically natural. So it doesn't have to be listed as an artificial sugar. Or is that something like the cereal that had the processed dates and the date powder on it to make it sweet? So pay attention there, both for that fiber ratio and then also for added sugar. Now, when we look at things like really processed carbohydrates, things like goldfish crackers, Ritz crackers, things like that, we're really looking at flour by itself. You know, there may be some oils and other things mixed in, but these are really a flour forward food substance and they are going to be almost entirely carbohydrate, very little fat, very little protein and very little fiber. And so when we look at, I was looking at goldfish crackers, for example, which my kids do eat. I have those in the pantry. We try to partner them with other foods like a protein source, for example, or like a fruit to make it a more well-rounded meal if they're going to eat that. But if you look at the nutrition label, what you'll see is there's 20 grams of total carbohydrate and less than one gram of fiber. Now, food labels are allowed to round up. So it's really less than like half of a gram of fiber. If it was more than half of a gram, they would list it And so basically no fiber that's in these, it's just flour that's in this. So being aware of those type of foods too, because if you eat those type of foods by themselves, if you haven't heard my episode on no naked carbohydrates, I think it was last month. but pretty recently did an episode on no naked carbohydrates and getting that good, well-rounded glucose response. That's a great way to see why having carbohydrates by themselves is not ideal. No, certainly it doesn't have to come from a single food item, but if you're having something that's pure carbohydrate, making sure you're partnering with a fat, with a protein, with some really good fiber can be a good way to help with the way your body's going to process that. Then lastly, we are going to talk about protein. So protein will be listed at the bottom of the nutrition label. And this is just simple protein. It's not broken down in any further capacity. What you're looking for is, is this in line with moving you in the direction of your overall food goals per day? So we have had some episodes talking about protein goals, for example. As we've talked about earlier, there's a lot of emphasis recently on a high protein diet. I do think there's people who are getting actually far too much protein. And the reality is that's fine. Unless you're having kidney problems, most people's bodies are able to process their protein. But what can happen is if we have too much of it, we just burn it for energy, sort of similar to how we burn carbohydrates. And that's just silly. You might as well eat carbohydrates instead of overdoing your protein to such an extreme example. So when you're having protein... Have a good conversation with whoever's providing you nutrition advice in your weight loss journey. As I said, we've done a lot of content on this before. A general rule of thumb is 0.8 to 1.2 grams per kilogram of body weight, or about a third of your total calories or 30% of your total calories coming from protein. That's a really nice estimation as well. So if you think about someone, let's say we're talking about a 1500 calorie per day diet, 500 of those calories coming from protein would be getting 125 grams of protein per day. So that is honestly even on the higher side for most people. If you are sedentary or less active, your numbers may be quite a bit lower than that. I have patients whose goals are 50 or 60 or 70 grams per day. Other people who are in the low 100. So have a conversation with your doctor. A lot of this is going to be determined based on your age, based on your height, based on on other metabolic factors based on your activity level. And so the range there can be pretty broad. But aiming for about a third of your calories coming from protein can be a good sort of rough estimate. Unless you are a power lifter, a bodybuilder, anything like that, it is unlikely that you would need more than that. But again, have a conversation with your specific provider to understand what your own needs are. And so as you're looking at protein, a lot of the packaged foods may not necessarily be foods that are the highest in protein, but they may be things like yogurts, things like cottage cheeses, things like deli meats or prepackaged meats, for example. Even looking at nut butters and whole grains like legumes that are in cans, for example, we're going to see protein in those. I'm kind of surprised sometimes whole grains can be a really good source of protein. So even Dave's Killer Bread, which it's funny, that's just on my mind because I was reading the label earlier today, but it has five grams of protein per slice of bread. And so if you have two slices of bread there, you've got some good protein working towards building a decent meal, especially if you're going to pair that with another protein source, for example. And so thinking about if your protein goals are 90 grams per day, okay, am I getting 30 grams per meal? If your goals are 60 grams per day, am I getting 20 grams per meal? So looking at that protein on the label to make sure that you're working towards those goals. It doesn't have to be exactly equally distributed throughout the day. It's ideal if we can do a decent job of distributing proteins throughout the day because we actually, carbohydrates and fats, we do a really nice job of storing and utilizing at a later point. Our body does not have a storage mechanism for protein, so it is good to have that distributed throughout the day. So thinking about having at least three separate servings throughout the day can be ideal. And then at the very bottom, you're going to see those vitamins and minerals. You often see things like vitamin D, calcium, iron, potassium, maybe others sort of depending on what What are the additives? You'll see other B vitamins, vitamin A, all of that, and paying attention throughout the day. Are you hitting all of your micronutrients as well? Particularly in a weight loss journey, a multivitamin can be a really great way to have that fail-safe backup option to make sure that you are meeting those. So this was nutrition labels in a nutshell. I think we're gonna do some social media content, actually reviewing some labels. So if you have a food item, If you have confusion, you want me to go through it, feel free to shoot us an email, info at sarahstombaumd.com. I would be so happy to look through something with you, give some general advice that we could share on social media or maybe share in another podcast if there's interest to talk through some of that stuff. So please always feel free to reach out with topic suggestions. I love when you all do that. Thank you. And thank you so much for joining me for today's episode. We'll see you all next time. Bye-bye.