Summary And Conclusion

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This conference resulted in a foundation upon which consensus will be built in the future. Further, it provided a forum for the articulation of the critical need for carbohydrates in human nutrition. We have come a long way in the past 25 years in the food and nutrition sciences and this conference well illustrated that point. At the White House Conference on Nutrition in 1969, macronutrients were never even mentioned as being necessary to nutrition; only micronutrients were emphasized. In 1977 the term "complex carbohydrate" was used without definition in the Dietary Goals for the United States (1). This conference encapsulated the tremendous strides that have been made concerning the chemical, nutritional, biologic, and physiologic importance of carbohydrates in health and disease.

It is fascinating to review the recommendations concerning complex carbohydrate from 1977 on. The list includes recommendations made by the Senate Select Committee in 1977, the Dietary Guidelines of 1980, 1985, and 1990, the Surgeon General's reports of 1979 and 1988, the 10th edition of Recommended Dietary Allowances, the 1989 National Academy of Sciences Diet and Health: Implications for Reducing Chronic Disease Risk, the 1991 FDA proposal for labeling, and the 1992 Food Guide Pyramid (1-6,8). Indeed, as Joanne Slavin pointed out, ". . . there is a wide range of consensus that increased complex carbohydrate is consistent with good health . . . " and certainly as Gary Henderson said, ". . . the term complex carbohydrate has equity with consumers."

With this level of apparent clarity it is difficult at first to identify a problem for the food label. After all, if consumer health would benefit why not simply do it? However, a problem does exist in that carbohydrates may be classified chemically in groups that are difficult to analyze and to define as to their physiologic function in the body. Indeed, complex carbohydrates defined by chain length may have molecular structures less complex than those of smaller units and may vary in solubility and digestibility. A continuum does exist in each of the chemical, analytical, and physiologic characteristics of carbohydrates. Scien-

' Fergus Clydesdale

The Science and the Label

tists do not like a continuum and regulators probably like it even less, but such a continuum holds great promise for future consensus. This continuum provided the thoughtful alternatives presented above by Jonathan Devries, Dennis Gordon, and Alison Stephen. Devries suggested a scheme of complex carbohydrates, sugars, and sugar alcohols, while Gordon suggested complex carbohydrates, dietary fiber, and simple carbohydrates, and Stephen suggested starch, sugar, and non-starch polysaccharides. Surely, we can develop a meaningful technique for labeling from these recommendations, which illustrate the continuum.

Further complicating the complicated scientific questions are the questions raised by consumer understanding and education. The label is not only a statement of truth for package content but is a tool for creating better-educated and better-fed consumers. Scarbrough pointed out that FDA was concerned because a DRV does not exist for complex carbohydrates and because health benefits should not be exaggerated. Both of these are legitimate concerns. We are currently recommending that carbohydrate be the major macronutrient in the diet, which seems to lessen the concern for a DRV and exaggerated claims to eat more.

Consumers will conceivably derive many benefits from the labeling of what we consider complex carbohydrate. We must obtain more data from consumers on what and how they understand some of the proposals put forth today. If we do this correctly we can certainly do a better job of educating consumers. By labeling carbohydrates rationally and tracking our scientific knowledge, we will be able to reduce the good food / bad food syndrome that is all too prevalent in much of our nutrition education system. We could also eliminate the term "other carbohydrate" which can only cause confusion and concern. Lastly, and perhaps most importantly, we will have the potential to increase the consumption of foods that are high in carbohydrates.

Aside from consumer education other benefits would be derived from including complex carbohydrates on the food label. Incentives would be created for the support of more research to better define the relationship between carbohy- "S

drates and health as well as more research into the development of new food products that are consistent with national dietary goals. j

It is clear that this is not a simple task. Classifications cannot be made simply for chemical or analytic expediency if they do not adequately express physiologic significance. However, we are all committed to achieving a means to satisfy this continuum, and I have no doubt that in the future we will have labels presenting what we all think of as complex carbohydrate.

This summary has been reviewed and approved by each of the speakers and panel members from the workshop on Complex Carbohydrates: the Science and the Label. The views expressed herein are those of the individual authors and/or their organizations, and do not necessarily reflect the views of ILSI North America.

Lineback et al.

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