Like many Americans these days, Lisa M. Delmont is kept up at night by worry. But for Ms. Delmont, it’s the empty grocery store shelves that bring on dread.
Her 2-year-old son, Benjamin, is severely allergic to milk, eggs, cashews, pistachios and bananas, so she has to be judicious about the items she brings home. Exposure to the wrong food could send Benjamin into anaphylactic shock, something that has happened three times since he was born.
“I am way more terrified of taking him to an E.R. now than I’ve ever been,” said Ms. Delmont, 35, of Jacksonville, N.C.
Ms. Delmont, a part-time registered nurse, has gone to great lengths to find products that won’t cause a reaction, researching ingredients, emailing manufacturers and cooking meals from scratch. Without access to certain brands — Ms. Delmont said her local store was sold out of many foods — her options are more limited than ever.
For now, Benjamin will have to eat a lot of beans. “They might not be the most exciting of meals,” she said, “but they won’t kill him, either.”
Ms. Delmont isn’t the only one hunting far and wide for harmless foods.
After the pandemic began to spread in the United States, Kelley D. Lord, of Orlando, Fla., wasn’t able to find the brand of pasta she makes for her 12-year-old son, Mason, who is allergic to eggs. She asked a friend — who lives nearly 400 miles away in Columbus, Ga. — to check out a nearby shop. The friend found the pasta, confirmed it was the right one in a text message, and shipped it to Ms. Lord.
“It’s so scary when your child has an allergy, because it’s literally a life-or-death situation,” said Ms. Lord, 50, who runs a travel agency and is herself allergic to peanuts and onions. “You can’t substitute something else.”
Even before the coronavirus outbreak, grocery shopping was stressful for people with food allergies. The federal government requires companies to tell consumers when particular ingredients are used. If something is made with one of eight types of foods — milk, eggs, fish, shellfish, peanuts, wheat, soybeans and tree nuts — the company must declare it on the label.
This alerts people to potentially dangerous ingredients, but not all allergens are on that list. In addition, companies sometimes need to warn consumers about possible “cross-contact” with allergens, telling them that something “may contain” peanuts, which can create more confusion.
Alicia M. Ames, of Elbridge, N.Y., said her 4-year-old son, Jackson, is allergic to sesame, eggs, peanuts and legumes. Sesame is not part of the Food and Drug Administration’s labeling law, and its presence is sometimes hidden under obscure descriptions like “natural flavors” or “spices.”
Ms. Ames bakes her own bread, but her supplies of safe flour and yeast are running low. “Our worry is that these foods aren’t going to be available, and what are we going to feed our family?” said Ms. Ames, 32, a musician.
Her unease is shared by others across the country.
Recently, Elana D. Zimmerman put on gloves and a mask and ventured out to many grocery stores in her neighborhood on the Upper East Side of Manhattan. She did it again the next day. And the day after that. Ms. Zimmerman, 36, has a 1-year-old daughter and a 2-year-old son, both with severe allergies.
Laura C. Schorn, of Aurora, Colo., has been going to stores at various times in the day, hoping to catch a lucky break and arrive after a restock. Ms. Schorn, who has an intolerance to wheat and soy, said she has left stores crying, feeling defeated.
“My fear right now is less that I’m going to get the virus and more that if I do get it and I become quarantined, I’m not going to have enough food to get through it,” said Ms. Schorn, 25, who works as a supervisor at a restaurant chain.
On a recent Sunday, Eric J. Payne, of Hollis, Maine, found himself staring at empty store shelves. His 3-year-old son, Elijah, is allergic to dairy, egg, cashews and pistachios. Produce and meat were almost entirely gone. Flour was completely sold out.
“The hoarding is the concern for us,” said Mr. Payne, 33, a marine biologist whose wife, Kimberly, also has food allergies. “Be mindful of others. Be mindful of the allergy kids.”
Some companies that cater to people with dietary restrictions are feeling the crush of demand.
Oatly, a Swedish oat milk company that has expanded its presence in the United States in recent years, has seen purchase orders and requests from retailers “increase by orders of magnitude,” said Mike F. Messersmith, the president of Oatly’s North America operations.
To meet the surge, Mr. Messersmith said, the company has made more of its products available on its website and is keeping its facility in Millville, N.J., running during the coronavirus crisis.
Other companies said that demand has been sharply higher than usual — including MadeGood, which specializes in granola, cookies and other foods free of several allergens, and King Arthur Flour, which makes a gluten-free flour.
Lisa G. Gable, the chief executive of Food Allergy Research & Education, a nonprofit organization in McLean, Va., is concerned about the diminishing options. She is calling on shoppers to consider those with food allergies when filling their grocery carts.
“Be aware of that as you’re pulling these things off the shelves,” Ms. Gable said. “The ability to substitute food is something that keeps them alive and healthy and out of emergency rooms.”
Q. I find all of the labels on food products overwhelming in-store. I know I should be eating whole grains, but what should I look for when in the grocery aisle?
A. Nutrition experts recommend that adults aim to eat 48 grams, or three servings, of whole grains per day. Whole grains are high in fiber and other nutrients; as part of a healthy diet, they have been tied to a lower risk of heart disease, Type 2 diabetes, obesity and other health issues. Common examples of a serving include a slice of 100 percent whole-grain bread, a half cup of oatmeal, or a half cup of cooked brown rice.
Unfortunately, you won’t find whole-grain servings listed on the Nutrition Facts panel on packaged foods. But there are a few reliable ways to identify whole-grain foods.
First, you can look on food packages for the whole grains stamp, created by the Oldways Whole Grains Council, a consumer advocacy group.
“We created the whole grains stamp in 2005 because we knew how challenging it could be to identify products that contain significant amounts of whole grain and wanted to give consumers an easy tool that they could use to locate whole grain items when shopping,” said Caroline G. Sluyter, program director of the Whole Grains Council.
With its characteristic yellow background and perforated edges that resemble a postal stamp, the whole grains stamp comes in three versions, with decreasing levels of whole grains:
100 Percent Whole Grain: Of the grain in the product, all of it is whole grain. Must have a minimum of 16 grams per serving, which is equivalent to one serving of whole grains.
50 Percent Plus Whole Grain: Of the grain in the product, at least half is whole grain. Must have a minimum of 8 grams per serving, equivalent to a half serving of whole grains.
Whole Grain: Of the grain in the product, less than half is whole grain. These foods also must provide at least 8 grams of whole grains per serving, but proportionally it might contain more refined grain than whole.
The Whole Grains Council has approved use of the stamp for over 13,000 products in 61 countries. But not all whole-grain products use the stamp, and not all whole-grain products, including those found in the bulk section, come in packages.
Another good way to ensure there’s a significant level of whole grain in a product is to check whether the first (or at least the second) ingredient in the ingredients list is a whole grain. Ingredients are listed in descending order by weight, so the first one is particularly important.
Whole grains are made of three main components: the bran and the germ, which are the most nutritious parts, as well as the endosperm. Whole grains retain all three components, so they are eaten intact (such as oats) or milled in a way that retains all three parts (such as whole-wheat flour).
Two types of grain are virtually always whole: brown rice and oats. Ancient grains like quinoa and amaranth are very rarely refined so are a solid bet as well.
In most other cases, you’ll want to look for the word “whole” in front of the grain, Ms. Sluyter said. Even grains like sorghum and farro may not necessarily be whole since they are frequently pearled. This means that manufacturers polish off the outer bran layer, in order to make a product that cooks faster. Checking for the word “whole” is especially important in the case of “whole wheat,” such as in bread, or “whole grain corn,” such as in tortillas, since wheat and corn are so often refined. (Popcorn, though, is an automatic whole grain, since the entire kernel gets popped.)
Another good strategy when looking to get your whole grains is to see if the front of the package notes the number of grams of whole grains or the percentage (ideally 100 percent, such as “100 percent whole wheat”).
Labels to ignore when hunting for whole grains:
Multigrain: It could mean a mix of whole grains, a mix of refined grains, or some amount of each. Since the label alone doesn’t specify, it’s best not to rely on this term.
Made with whole grain: Again, too ambiguous. This label doesn’t set any threshold for how much of the grain is whole, so it could be just trace amounts.
Stone-ground: Like “multigrain,” this label doesn’t tell you anything about whether the grains are whole or refined. It’s about the type of mill — in this case, two big stones grinding together, as opposed to more common steel roller mills — used to make the flour.
Organic: The organic label applies to farming and production practices and doesn’t tell you whether a product contains whole grains.
Certain additional words and phrases are a tipoff that the product is not whole grain: “wheat flour” without the word “whole” in front of it; “enriched flour”; or, when an ingredient indicates that one of the main parts of the grain is missing, such as “degerminated corn meal.”
The Dietary Guidelines for Americans advises that you make sure at least half of the total grains you eat each day are whole. Now that you know what to look for, the best strategy may be to make whole grains your default.
Do you have a health question? Ask Well
Sophie Egan is the author of “How to Be a Conscious Eater: Making Food Choices That Are Good for You, Others, and the Planet.”
Four years after Chile embraced the world’s most sweeping measures to combat mounting obesity, a partial verdict on their effectiveness is in: Chileans are drinking a lot fewer sugar-laden beverages, according to study published Tuesday in the journal PLOS Medicine.
Consumption of sugar-sweetened drinks dropped nearly 25 percent in the 18 months after Chile adopted a raft of regulations that included advertising restrictions on unhealthy foods, bold front-of-package warning labels and a ban on junk food in schools. During the same period, researchers recorded a five percent increase in purchases of bottled water, diet soft drinks and fruit juices without added sugar.
“An effect this big at the national level in the first year is unheard-of,” said Lindsey Smith Taillie, a nutrition epidemiologist at the University of North Carolina, Chapel Hill, and the study’s lead author. “It is a very promising sign for a set of policies that mutually reinforce one another. This is the way we need the world to go to begin to really combat preventable diseases like obesity, hypertension and diabetes.”
The rules, adopted in 2016, were a bold gambit by the government of a country with some of the world’s highest obesity rates. Three-quarters of Chilean adults and more than half of children are overweight or obese, and health officials warned that the medical costs of obesity could consume 4 percent of the nation’s health care spending by 2030, up from 2.4 percent in 2016.
Since then, Peru, Uruguay, Israel have adopted Chilean-style front-of-package labels; Brazil and Mexico are expected to finalize similar labels in the coming months, and a dozen other countries are considering them as well.
The Chilean regulations were championed by then-president Michelle Bachelet, a socialist, and passed by the National Congress over fierce objections from big multinational food companies. Despite his initial opposition, Chile’s current president, Sebastián Piñera, a conservative billionaire businessman, has left the regulations in place.
The law is far-reaching. It includes mandatory package redesigns that erased cartoons like Tony the Tiger from sugary cereal boxes, and television advertising restrictions that banished ads for unhealthy products from the airwaves between 6 a.m. and 10 p.m. A study published last year by the journal Public Health Nutrition found that Chilean children were subjected to half as many ads for junk food and sugary drinks after the restrictions were put in place.
The regulations followed a 2014 measure that raised the tax on sugary beverages to 18 percent from 13 percent.
A centerpiece of the rules is a series of black stop signs that must appear on the front of packaged foods and beverages high in salt, sugar, fat or calories. Experts say the “high in” logos have had an unmistakable impact on the way Chileans shop for groceries. In focus groups, parents have described being reprimanded at the supermarket by their children if they reach for products emblazoned with the stop signs.
“Children are learning at an early age what types of food they should eat and which ones they should avoid,” said Camila Corvalán, a nutritionist at the University of Chile who also worked on the study. “We believe these regulations will change the way this new generation approaches eating, hopefully empowering them to demand healthier foods.”
The study, which tracked the purchasing habits of 2,000 households from 2015 to 2017, found that the drop in sugary-beverage consumption occurred both among the highly educated and those without a high school degree, although the reductions were somewhat greater among individuals who attended college.
The food industry’s initial resistance to the measures has largely faded. To avoid having to display the dreaded stop signs on their products, companies like Nestlé, Coca-Cola and PepsiCo have reformulated hundreds of products, reducing the amount of sodium in salad dressings and substituting artificial sweeteners for sugar in carbonated drinks.
Asked to comment on the new study, a number of companies expressed a grudging acceptance of Chile’s laws but called for additional studies to assess their impact on obesity.
“We are committed to working with governments and other stakeholders to ensure that consumers have the information they need at their fingertips to support a balanced diet, and we offer a wide array of smaller-portion and lower or no-sugar options,” the International Council of Beverages Association said in a statement. A spokeswoman for Nestlé noted that the company had eliminated more than 3,000 tons of sugar from dairy products and breakfast cereals sold in Chile.
Experts say it is too soon to know whether the food regulations are making a dent in Chile’s obesity rates. But the early results could embolden policymakers in Chile. Barry M. Popkin, a University of North Carolina nutritionist who is advising the government, said legislators there are considering what he called a “mega tax” on processed foods — the frozen pizza, instant noodles and fast-food meals that are responsible for two-thirds of all calories consumed by children.
“Right now people are just focused on sugary beverages, which is a tiny part of the problem,” he said. “This is just the beginning of a fairly profound change to encourage healthy eating.”
Sara Bleich, a professor of public health policy at Harvard University who was not involved in the study, said the early results suggested that a raft of food policies, not just stand-alone measures like soda taxes, were needed to address a growing obesity crisis that is affecting nations rich and poor. “For countries hoping to move the needle on obesity, all eyes are on Chile,” she said, noting that half of American adults could be obese by 2030. “We need policies like these that are going to make a meaningful difference. And we need them now, not in five or ten years.”
If you (like me) kicked off 2020 by trying to kick the sugar habit, you are probably still adjusting to this new way of eating.
Added sugar lurks in so many surprising places — many foods we think of as healthful are really loaded with sugar. And food companies try to trick us by disguising added sugar with names that may sound more wholesome like “barley syrup” or “agave” or even “fruit juice.”
This week, I’ve been swamped with questions from readers who have taken our 7-Day Sugar Challenge, which offers several strategies for cutting added sugar. Here are answers to some of the questions you’ve been asking.
Q. I have never understood why “added sugar” is more unfriendly to health than “natural sugar,” which can be found in abundance in so many fruits, starting with morning natural orange juice. Can you explain?
A. The natural sugar in whole fruit (fructose) is accompanied by fiber and nutrients and makes a slow journey through your body. But when sugar is added to beverages or packaged foods, it’s more quickly absorbed and burdens the liver. Here are three good reasons to choose whole fruits versus foods with added sugar or fruit juice.
Fiber: Whole fruits contain fiber, which slows the absorption of fructose. Sugars enter the bloodstream more slowly, so the liver has more time to metabolize them.
Satiety: Processed food is digested quickly as soon as it enters our intestines. Fiber-rich foods like whole fruits break down slowly and travel farther through the digestive track, which triggers the release of satiety hormones that make us feel full.
Gut Health: The slow journey of the fiber, fructose and nutrients in whole fruit essentially allows the body to feed the healthy bacteria in our intestine, supporting the health of our microbiome.
Q. Why aren’t bananas and grapes recommended for people cutting sugar?
A. While most fruits make a slow journey through the digestive tract, bananas and grapes are particularly high in fructose given the amount of fiber they contain, so they give us a faster sugar spike. Dr. Robert Lustig of the University of California, San Francisco, calls grapes “little bags of sugar.” Enjoy bananas and grapes sparingly and opt for a variety of fruits.
Q. Can I eat dried fruit on a low-sugar diet?
A. Dried fruit is packed with nutrients, but the drying process removes the water and concentrates a lot of fruit sugar in a very small bite. The risk is that it takes more dried fruit to fill you up than whole fruits. Raisins and dates are about 60 to 65 percent sugar, dried figs and apricots are about 50 percent sugar, and prunes are about 38 percent sugar. The good news is that dried fruit still has the fiber, and it can be a great snack as long as you are aware of how much you are eating.
Another way to weigh the pros and cons of dried fruit is to look at glycemic load, a measure of how fast your body converts a serving of food into sugar. Ideally you should eat foods with a glycemic load of 10 or less. Anything above 20 is considered very high. Prunes have a glycemic load of 10, whereas raisins have a glycemic load of 28. Compare that to whole fruits. Strawberries, apricots, grapefruit, lemon, limes, cantaloupe, nectarines, oranges, pears, blueberries, peaches, plums, apples and pineapple have glycemic loads of 6 or less.
Q. I use milk in my coffee. Is that added sugar?
A. A quarter-cup of milk contains about 3 grams of a natural sugar called lactose. The sugar in milk is not considered an “added sugar,” and it doesn’t overwhelm the liver the way added sugar does. Adding milk or cream to your coffee and enjoying the naturally sweet taste of milk is a great way to kick the added sugar habit in the morning.
Drinkers of soy and nut milks need to check the label. Many of those products have added sugar. If you love a few teaspoons of sugar in your morning coffee, try adding more milk and cut the sugar in half to start. Over time you can cut it in half again and wean yourself off the sugar.
Q. Can a few more details be provided about a no-sugar, no-grain breakfast? Doesn’t bacon have sugar? What if I don’t want eggs all the time?
A. With so much added sugar lurking in granola, cereals, pastries, breads and yogurts, you might as well just call it dessert. But readers have had a tough time figuring out alternatives to popular grain-based breakfast foods. Here are some ideas.
High-protein breakfast: Eggs are a high-protein option, and while they are also high in cholesterol, many people can probably eat them in moderation without worrying about heart risks. But many people don’t want to eat eggs every day. Bacon is also high in protein but, like other processed meats, also shouldn’t be consumed daily. (Most bacon does not have added sugar, though if it’s maple-cured or brown-sugar-cured, it probably does.) Consider eating smoked salmon, tuna or chicken salad for breakfast. Make a vegan breakfast bowl of sweet potatoes, beans and avocado.
Sweet alternatives: Try plain, unsweetened yogurt with berries and nuts or sliced apples with sugar-free peanut butter. Or just eat and savor a whole orange or make a fruit salad.
Greens and vegetables: Try a breakfast salad with avocado and hard-boiled eggs. Use a big kale leaf to make a breakfast burrito or egg salad wrap. Experiment with cauliflower to make hash browns. Bake a sweet potato and add salsa, yogurt or nuts.
Soups: Try miso soup, butternut squash soup or another variety of hot soup. You’d be surprised how great soup tastes on a winter morning.
[What’s your favorite sugar-free breakfast? Let us know, and help inspire others! Post pictures of your breakfast on social media with the hashtag #WellSugarChallenge.]
Q. What about steel-cut oats? Or regular oats? Do they have added sugar?
A. Morning oat-eaters are by far the biggest demographic we’ve heard from since starting the Sugar Challenge. Because even many whole-grain products still have added sugar, the Challenge urges you to eliminate all grains from your breakfast to explore new options. However, oat-eaters are a committed bunch.
If you want to eat oats, check to make sure your brand really has no added sugar (that means it should have no sugar on the ingredient list, and zero grams of sugar on the label.) The Harvard Nutrition Source has a lot of good advice about the health benefits of oats, which are associated with heart health. Steel cut oats are the least processed, meaning they have more fiber and are the best choice. Rolled oats have been partially cooked, making them increase blood sugar faster. Instant oats should be avoided, because they will be rapidly converted to sugar.
Q. I eat 100 percent whole wheat bread that I make myself. While it has some sugar in it in the form of molasses, it does not have the added sugars and other ingredients of mass-produced breads.
A. A tablespoon of molasses has 15 grams of sugar so you are, in fact, eating added sugar — just not added sugar processed by the food industry! The goal of the Sugar Challenge is not to ban all sugars. It’s to make you aware of what you are eating so you can choose how much sugar to ingest, rather than letting food makers decide for you. It’s great that you bake your own bread. (Bread making is time consuming, so if we all only ate bread we baked, we would probably eat less of it. ) I’d suggest trying a recipe with less added sugar. Most of the time you can cut the sugar by a third to a half without affecting the flavor or texture.
Q. I buy a sprouted rye from She Wolf Bakery at my farmers’ market. The “malted barley syrup” is the sweetener, but I don’t have any grams or sugar or percentages. Any thoughts?
A. After asking this question, the reader who submitted it, Kate McMullen, called the bakery directly and learned that an 1,800-gram loaf of its sprouted rye bread contains a relatively small amount of added sugar: 40 grams, in the form of malted barley syrup. By buying just a half loaf at a time and slicing it thin, Ms. McMullen is getting only about a half a gram of sugar per slice. The reward for doing a little extra research? Ms. McMullen gets to enjoy her sprouted rye guilt-free and (mostly) sugar free.
Q. If I can’t have orange juice, what am I supposed to drink in the morning?
A. Even though orange juice is a natural food, the juicing process eliminates much of the fiber and concentrates the sugar, making it a poor choice. Make juice a once-a-week treat. Instead, try ice water with an orange wedge.
Q. Why is it that the information on the nutrition label doesn’t seem to follow any one rule indicating added sugar?
A. Starting in 2020, most large food makers are required to list “added sugar” on the nutrition facts label, but some smaller companies have until 2021 to comply with the rule. As a result, you may see a mix of old and new food labels for another year. The new label will help consumers distinguish between sugars that occur naturally in foods and those that are added.
As an example, take a look at the label on whole milk, which shows 11 grams of sugar in a one-cup serving. That sounds like a lot, but the new label will make it clear that all that sugar occurs naturally as lactose and that the same cup of milk has zero grams of added sugar. A chocolate milk label will show 26 grams of total sugar, which includes 11 grams of lactose, and the extra information that a serving has 15 grams of added sugar.