Chapter 8: Restaurant Nutrition and Ingredient Facts

What a difference a decade or so makes when it comes to access to and availability of restaurant nutrition and ingredient information! The Internet offers access to a website for nearly every restaurant, whether they boast of one location or thousands. Many, but not all, restaurants are open books (or rather web pages), when it comes to their menu, nutrition facts, ingredients, and even allergen information (if they have them). Plus we’ve got access to food and nutrition databases galore, which we can access through the internet or a mobile app. That includes the companion app to this book.

In recent years, the push for healthier restaurant foods and nutrition and ingredient information has escalated—for reasons including widespread concern about health and food allergies—to the level of having city, state, and even federal regulations passed. This drumbeat for healthier foods and a tell-all approach to nutrition facts and ingredients will continue to mount as people increasingly rely on restaurant meals to get the job of eating done. This chapter provides a quick look back at the history of nutrition facts, and then focuses on the recent federal regulations on restaurant nutrition and ingredients. Let’s explore what types of nutrition information you can expect to find both at restaurants and at your fingertips when you use your device of choice to search the particulars.

A Bit of History on Nutrition Facts

When the first edition of this book, originally titled Guide to Healthy Restaurant Eating, was published in 1999, the Internet was in its infancy. Restaurants generally did not have websites—even most of the large chain walk-up-and-order types. The minimal nutrition information that was accessible was in a brochure, which may or may not have been available at each restaurant location. While nutrition facts have long been available on packaged foods in supermarkets, restaurants weren’t, until recently, required to serve up this information.

Slowly over the early 2000s, as the Internet infiltrated our lives and as consumer demand for nutrition information increased, fast-food and walk-up-and-order type restaurants began divulging their facts both online and in each restaurant location. In both the previous and current decades, there has been an explosion in the availability of nutrition and ingredient information for restaurant foods. Also during this timeframe several cities (including New York, Philadelphia, and Seattle) and the state of California passed regulations that required larger chain restaurants serving the same menu in each location to provide their nutrition facts in the restaurants.

At this point it continues to be difficult to find nutrition information for single-unit, independent restaurants no matter what kind of cuisine they serve, from pizza joints to fine dining establishments to ethnic restaurants. There are a couple of reasons why. First, it can be expensive to obtain nutritional analyses for menu items. Some single-location restaurants can’t afford to do this. Second, these restaurants tend to change their menus more frequently than larger chains, which makes keeping the information up to date a challenge. As you’ll see, this book contains nutrition information on some of the best and some less than healthy food options—in sections called Health Busters and Healthier Bets—in most of the cuisine-specific chapters of Sections 2 and 3. However, there are no Health Busters or Healthier Bets for Chapter 16: Fine Dining or Chapter 24: Indian. There’s simply not enough nutrition information available for these types of restaurants to make the sharing of that info in this book educationally valuable.

Your ability to decipher the nutrition facts of restaurant foods can help you fit these foods into your diabetes eating plan. But this requires know-how and, oh yes, definitely effort. Read Put Your Best Guesstimate Forward in Chapter 4 and learn to fine-tune your guesstimating skills; they’re essential when eating restaurant foods. Also, make your job of searching for the nutrition facts of the restaurant meals you regularly eat a bit easier by building your own personal food and nutrition database.

Federal Regulations Put Nutrition Facts Front and Center

Fast forward to the present. You can now access nutrition information and ingredients for the vast majority of large national and regional chain restaurants and even some smaller chains. Until recently, much of this information was provided voluntarily. Around 2008, with the concerns about obesity and the closely related epidemics of prediabetes and type 2 diabetes mounting, several cities and states passed legislation to require some restaurants to disclose certain nutrition facts. With these efforts snowballing around the country, food and nutrition activists, the National Restaurant Association (NRA), and other interested parties began pushing for federal restaurant menu labeling. Did NRA and restaurant chains really want these regulations? Well, not really, but they definitely preferred having one set of federal regulations over a myriad of city and state regulations.

In early 2010, as part of the Patient Protection and Affordable Care Act (aka Obamacare), Section 4205 of the law amended (revised) the Food, Drug, and Cosmetic Act to require chain restaurants, retail food establishments, and vending machines with 20 or more outlets in the U.S., doing business under the same name, and offering for sale substantially the same menu items to provide specific nutrition information. Restaurants and similar retail food establishments that are not covered under the regulation can choose to “opt in” to the federal menu labeling requirements by registering with the FDA every other year. For example, a chain with fewer than 20 locations may choose to do this.

The focus of this regulation is on calories, not so much on nutrients, like carbohydrate or saturated fat, that may be of interest to people with diabetes. The number of calories, with the word “Calories” (or “Cal” for short), for standard menu items must be listed adjacent to the name of the menu item. (Think about the menu board in a fast-food burger chain or a coffee shop.) Calories must be disclosed prominently on all menus and menu boards, including menu boards at drive-through locations. The calories for variable menu items, such as combination meals, should be displayed in ranges. (A combination meal could be a choice of a sandwich, side dish, and beverage.) If foods are on display, calories must be listed per item or per serving on a sign next to the food. For self-service foods, such as a salad bar in a restaurant, calories also should be listed per serving or per item on a sign next to the food.

This is important for people with diabetes: In addition to calorie information, a clear and prominent statement must be posted on menus and menu boards stating that additional nutrition information for standard menu items is available to consumers on request. The restaurant must have the ability to provide you with the information on site. This additional information includes: total calories, calories from fat, total fat, saturated fat, cholesterol, trans fat, sodium, total carbohydrate, sugars (this includes both total added and naturally occurring sugars), dietary fiber, and protein. As a person with diabetes or a caregiver, don’t be shy to ask about carbohydrate or fat grams, sodium counts, or other nutrients of interest on the list. As you know, the calories are really just the tip of the iceberg of the information you, as a person with diabetes, need. The overarching goal of this federal regulation is to ensure that consumers have adequate nutrition information to make healthier food choices away from home, just like we’ve become accustomed to having in the supermarket and other places where labeled food is purchased, such as convenience stores.

A stipulation of this regulation is that it supersedes (replaces) the existing city and state laws already on the books. State and local governments are not allowed to impose any different or additional nutrition labeling requirements on foods sold in restaurants or similar retail food establishments covered by the federal requirements. However, they can establish nutrition labeling requirements for food-serving establishments that aren’t covered by the new law or regulations.

Non-Government Restaurant Nutrition Labeling Programs

Other restaurant nutrition labeling programs have come and gone over the years, always making an effort to help people eat healthier and, of course, generate interest in (and in some cases income for) the organization promoting the program. One program was started in San Diego, California, in 1991 by Anita Jones-Mueller, MPH. Anita was the mother of a child with type 1 diabetes and had a need for restaurant nutrition information. She developed Healthy Dining Finder and today serves as the president and founder of the program. Healthy Dining Finder has evolved to be Internet and app-based. It’s a great resource! Check it out at: http://www.healthydiningfinder.com/. Healthy Dining Finder has also partnered with the National Restaurant Association to bring us the Kids LiveWell program, which focuses on offering nutritional restaurant meals for children. Learn more about this program in Chapter 7.

The American Heart Association has teamed up with some restaurants that use their Heart-Check Meal Certification Program. Learn more about this program on the American Heart Association website: http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/DiningOut/Heart-Check-Meal-Certification-Program-Foodservice_UCM_441027_Article.jsp.

Nutrition Facts in This Book (and App)

This book contains a sampling of nutrition information for popular restaurant foods, mainly for the purpose of raising your awareness about what’s in restaurant foods—both the healthy and not-so-healthy options.

A note of caution about the accuracy of the restaurant nutrition facts in some online resources and apps: While much of the content in these databases is based on USDA data and some is from major national chains and food manufacturers, some of these resources allow what’s called crowdsourcing. Crowdsourcing allows people who access the database to add information they’ve collected. Crowdsourced information may or may not be reliably accurate. So, if data for a food looks fishy to you, revise your estimate based on your own knowledge base or go directly to the restaurant’s nutrition information, if available.

Can Having the Facts Help You Eat Healthier?

You’d think that if people have access to the calories and other nutrition facts for restaurant foods, whether they are provided by restaurants or accessible online, it would be hard for them not to change their restaurant food choices and eat healthier. Well, think again! A few handfuls of studies conducted over the last decade or so delve into this question. The research does not conclude hands down that having access to the nutrition facts always leads people to make healthier decisions. The results are mixed and depend on the population of people and the types of restaurants studied. The research does find that if people use the nutrition information, it can save a few calories here and there. The bottom line for people with diabetes should be that the nutrition information for restaurant foods is becoming increasingly available and that you have access to it to help you make healthier, more nutrition-conscious decisions about what you eat. Please, use it to benefit your glucose control and overall health.

One plus of getting the nutrition facts front and center is that it may lead to more restaurants offering a few more healthy and nutrition-conscious choices or changing the formulations of some menu items to lighten their fat, calorie, or sodium load. But, not to worry, you’ll still have to navigate your way through plenty of less-than-healthy options in most restaurants for years to come.

How Well Do People Estimate Calories?

It’s well known that people underestimate the calories they eat and overestimate the calories they burn. Surprised? Perhaps it’s simply human nature! A few studies show that people respond similarly when it comes to estimating calories in their restaurant foods. One study showed that teens eating in fast-food restaurants underestimated the calories in their meals by nearly 35%. In another study among more than 500 adults, only 11% could identify the restaurant choice that was highest in calories. Another study determined an underestimation of more than 600 calories in less-healthy restaurant items by 9 out of 10 people studied. And last, but not least, one study showed that even health professionals underestimated the number of calories in restaurant food by 200–600 calories! So, rather than relying on your estimating skills, which may have room for improvement, use the restaurant nutrition facts where and when you can. And always put your guesstimating training and skills into action. (Check these out the guesstimating tips in Chapter 4.)

Restaurants’ Use of Nutrition and Health Claims

Restaurant menu labeling regulations also include guidelines about restaurants’ use of nutrition and health claims. Some examples of nutrition claims are “low fat,” “low sodium,” and “healthy.” Nutrition claims like these were originally defined in the 1994 regulations that implemented the Nutrition Labeling and Education Act. Table 8.1 provides you with the definitions of some common nutrition claims used on packaged foods and by restaurants. Health claims (there are a few different types) are scientific statements approved by FDA and used to explain the relationship between one or more categories of foods and the reduction of a particular disease—for example, the claim that eating more fruits and vegetables or dietary fiber is linked to the reduction of cancer or heart disease risks. Learn more about FDA-approved health claims at www.fda.gov.

The restaurant menu labeling regulations enacted within the Affordable Care Act, permit restaurants to make specific nutrition claims about a menu item’s nutritional content and require the use of terms to be consistent with the respective regulatory definitions used on packaged foods. If a nutrition claim is used, the restaurant must be able to provide you with the nutrition information to back up their use of the claim. The claim can be substantiated by a nutrition database, nutrition information in the cookbook from which the recipe was made, or another source that provides nutrition information. Regarding health claims, the FDA criteria to make the health claim must be met and the information used to support this claim must be made available to you upon request. At present there’s minimal use of health claims for restaurant foods. Nutrition claims, while also minimally used, are used a bit more often than health claims.

Food and Ingredient Allergen Labeling in Restaurants

Today, there’s greater awareness of and attention paid to food allergies of all kinds, including shellfish allergies, nut allergies, and gluten intolerance. As restaurant foods represent an increasing percentage of our food choices, ingredient and allergen labeling has increased in importance. Activists in this area have also pushed for local and federal regulations.

The big question on this topic is: how do federal regulations impact the allergen labeling of restaurant foods? Food and ingredient allergen information became more plentiful in 2006. This was due to the federal Food Allergen Labeling and Consumer Protection Act of 2004 (abbreviated as FALCPA), an amendment to the Federal Food, Drug, and Cosmetic Act. The FALCPA requires that the label of a packaged food that contains an ingredient that is, or that contains, a “major food allergen” declares the presence of the allergen. There are eight major food allergens: wheat, crustaceans (e.g., shrimp, crab, lobster), eggs, fish, peanuts, milk, tree nuts (e.g., almonds, pecans, walnuts), and soybeans. The FALCPA regulation only applies to packaged FDA-regulated foods, not foods sold in restaurants. However, many of the large national restaurant chains are increasingly providing information about the ingredients in their foods. Your root to the vast volume of this information is restaurant websites.

The FALCPA labeling requirements extend to retail and food-service establishments that package, label, and offer products for consumption, but it does not apply to foods placed in a wrapper or container in response to a customer’s order, such as a made-to-order sandwich. If you have a food allergy, the FDA advises you to ask questions about ingredients and preparation and make special requests when eating restaurant foods. Learn more about the FDA allergen regulation at: http://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/allergens/ucm106890.htm#q24

Gluten-Free Labeling in Restaurants

Due to the prevalence of celiac disease in people with type 1 diabetes, as well as the challenges of maintaining a gluten-free eating plan when eating restaurants foods, this book includes information about gluten-free eating in several places. Chapter 6 offers a full rundown on celiac disease and how to eat gluten-free, both at home and in restaurants. Then you’ll find Tips and Tactics for Gluten-Free Eating in the chapters in Sections 2 and 3.

After a long wait, in 2013 the FDA issued a final rule establishing a federal definition of the term “gluten-free” for food manufacturers that voluntarily label FDA-regulated foods as “gluten-free.” This definition, and guidelines for the use of the term “gluten-free,” fall within the Food Allergen Labeling and Consumer Protection Act of 2004 discussed above. The definition (outlined in Chapter 6) is intended to provide consumers with celiac disease and others who want to avoid gluten with a reliable way to avoid it. Unlike the initial guidelines from FALCPA regarding the other eight allergens, the gluten-free regulation requires food manufacturers who market food as “gluten-free” to meet the FDA’s definition of gluten-free, and restaurants who use the term “gluten-free” are expected to meet this definition as well.

Table 8.1 What Nutrition Claims Mean*
Nutrition Claim	Meaning
Cholesterol-Free	Less than 2 mg of cholesterol per serving and 2 g or less of saturated fat per serving
Low-Cholesterol	20 mg or less of cholesterol per serving and 2 g or less of saturated fat per serving
Fat-Free	Less than 0.5 g of fat per serving
Low-Fat	3 g or less of fat per serving
Light or Lite	Cannot be used by restaurants as a nutrient claim, but can be used to describe a menu item, such as “lighter fare” or “light size”
Sodium-Free	Less than 5 mg of sodium per serving
Low-Sodium	140 mg or less of sodium per serving
Sugar-Free	Less than 0.5 g of sugar per serving
Low-Sugar	May not be used as a nutrient claim
Healthy	The food item is low in fat, low in saturated fat, has limited amounts of cholesterol and sodium, and provides significant amounts of one or more key nutrients—vitamins A and C, iron, calcium, protein, or fiber.
*This is not a complete list of FDA allowable nutrition claims. Definitions for nutrition claims are the same as those used for packaged food products. Learn more nutrient claims at: www.fda.gov.