National Restaurant Menu Labeling

The Patient Protection and Affordable Health Care Act passed in March 2010, brought about menu calorie labeling. Restaurants and food vendors with more than 20 locations must disclose calorie information and make other nutrient composition data available to consumers. Consumers will now have a wider availability of calorie and other nutrient information than what was previously available. This labeling will also make a contribution to consumer’s efforts to enhance and maintain health. Having a federal approach to regulating menu labeling helps ensure consistency, and creating efficiencies for restaurants. The success of restaurant menu labeling to help improve nutrient intakes and reduce the rates of obesity will depend on how the consumers respond to the information.

Food manufacturers and producers have been required to provide standardized information for the Nutrition Facts Label since the Nutrition Labeling and Education Act of 1990 passed. Freshly prepared, institutional, and restaurant foods weren’t required to carry this information before. Some local governments have mandated nutrition information on menu items of multi unit restaurants. In 2008, many different chain restaurants were sued in for inaccurate information on menus by usually underreporting calories and fat. Today all foodservice industries are under pressure to provide nutrition facts.

True nutrient or nutrition analysis refers to an assay of select nutrients done by laboratory analysis using incinerated ash or chemical extraction to determine content. Newer techniques are used for extraction of bioactive chemicals. True nutrient analysis is usually used when precise data are essential, when the analysis will be entered into databases to be widely used, when nutrition claims will be made, when there are gaps in nutrient data, or when it’s impossible to obtain data by calculation. The disadvantages of this are the expense, collection of appropriate number and type of samples, and time needed to perform the analysis.

Most registered dietitians and dietetic technicians use computerized databases for estimating the nutrient content of foods. Some practitioners refer to the process as nutrition analysis by calculation or by database. Nutrient calculation software offers ease, speed, and reduced cost but is less accurate than true nutrient analysis.

Source: Marr, Liz. “National Restaurant Menu Labeling Legislation: Public Nutrition Education and Professional Opportunities.” Journal of the American Dietetic Association (2011). Print.


Phosphorus plays a critical role in bone formation. Calcium and phosphorus crystallize to form hydroxyapatite crystals providing the hardness of bone. About 85% of the body’s phosphorus is stored in the bones and the rest is stored in soft tissues like muscles and organs. Phosphorus helps activate and deactivate enzymes, is a component of the genetic material in the nuclei of the cels and is a component of cell membranes and lipoproteins.

Phosphorus is widespread in many foods and is found in high amounts in foods that contain protein. Milk, meats, and eggs are good sources. Phosphorus is found in many processed foods as a food additive to enhance smoothness, binding, and moisture retention. In the form of phosphoric acid, it’s also a major component of soft drinks. Phosphoric acid is added to soft drinks to give them a sharper, or more tart, flavor and to slow the growth of molds and bacteria.

Nutrition and medical professionals have become increasingly concerned that the heavy consumption of soft drinks may be detrimental to bone health. Researchers have proposed 3 theories to explain why consuming soft drinks may be detrimental to bone health.

  1. Consuming soft drinks in place of calcium containing beverages leads to a deficient intake of calcium
  2. The acidic properties and high phosphorus content cause an increased loss of calcium because calcium is drawn from bone into the blood to neutralize the excess acid
  3. The caffeine found in many soft drinks causes increased calcium loss through the urine

People with kidney disease and those who take too many vitamin D supplements or too many phosphorus containing antacids can suffer from high blood phosphorus levels. Severely high levels of phosphorus can cause muscle spasms and convulsions. Phosphorus deficiencies are rare but can occur in people who abuse alcohol, in premature infants, and in elderly people with poor diets. People with vitamin D deficiency, hyperparathyroidism, and those who overuse antacids that bind with phosphorus may also have low blood phosphorus levels.

Source: Thompson, Janice, Melinda Manore, and Linda A. Vaughan. The Science of Nutrition. San Francisco, CA: Pearson Benjamin Cummings, 2011. Print.

Vitamin B12

Vitamin B12 is part of coenzymes that assist with DNA synthesis, which is necessary for the proper formation of red blood cells. Vitamin B12 is essential for healthy functioning of the nervous system because it helps maintain the myelin sheath that coats nerve fibers. When this sheath is damaged or absent, the conduction of nerve signals is altered, causing numerous neurologic problems.

Vitamin B12 in our diet comes almost exclusively from meat, eggs, dairy products and some seafood. The stomach secretes intrinsic factor which is a protein necessary for vitamin B12 absorption in the small intestine. Since it is a water soluble vitamin, we would think that it would get excreted in our urine when consumed in excess. However, it has a unique feature of being stored in the liver which is important for anyone who’s consuming little vitamin B12 in the diet.

The RDA for vitamin B12 for adult men and women aged 19 years and older is 2.4 micrograms a day. Individuals consuming a vegan diet need to eat vegetable based foods that are fortified with vitamin B12 or take supplements to ensure that they maintain adequate blood levels of this nutrient.

As we age, our sources for vitamin B12 may need to change. Nonvegan individuals younger than 51 years are generally able to meet the RDA for vitamin B12 by consuming it in foods. However, it’s estimated that about 10% to 30% of adults older than 50 years have a condition known as atrophic gastritis which results in low stomach acid secretion. Because this condition can affect almost one third of older adult populations, it’s recommended that people older than 50 years of age consume foods fortified with vitamin B12, take vitamin B12 supplements or have periodic vitamin B12 injections.

A vitamin B12 deficiency is rare, but is associated with dietary insufficiency or reduced absorption. A deficiency of B12, like folate, is associated with cardiovascular disease due to high levels of homocysteine. Pernicious anemia is a condition when reduced absorption of vitamin B12 happens. It’s caused by inadequate secretion of intrinsic factor by parietal cells of the stomach.

Source: Thompson, Janice, Melinda Manore, and Linda A. Vaughan. The Science of Nutrition. San Francisco, CA: Pearson Benjamin Cummings, 2011. Print.


Folate is a water soluble vitamin and one of the B vitamins. Folic acid is the form of folate found in most supplements and used in enrichment and fortification of foods.

Within the body, folate functions mostly in association with folate-dependent coenzymes that act as acceptors and donors of one carbon units. These enzymes are critical for DNA synthesis, cell differentiation and amino acid metabolism. Folate’s role in assisting with cell division makes it a critical nutrient during the first few weeks of pregnancy when the combined sperm egg cell multiplies to form the primitive tissues and structures of the human body. Without adequate folate, the embryo can’t develop properly. Folate is also essential in the synthesis of new cells like red blood cells and for the repair of damaged cells.

Folate, Vitamin B12 and vitamin B6 are closely interrelated in some metabolic functions. These include the metabolism of methionine which is an essential amino acid. If these nutrients aren’t available, methionine can’t be metabolized completely and homocysteine builds up in the body. High levels of homocysteine have been associated with an increased risk of cardiovascular disease. When folic acid is given as a supplement or in fortified food, such as breakfast cereal, the amount absorbed is higher than eating it as folate in food.

Folate is so important for good health and prevention of birth defects that in 1998, the US Department of Agriculture mandated the fortification with folic acid of enriched breads, flours, corn meals, rice, pastas, and other grain products. Because folic acid is highly available for absorption, the goal of this was to increase folate intake in all Americans and decrease the risk of birth defects and chronic diseases associated with low folate intakes.

The RDA for folate for adult men and women aged 19 and older is 400 micrograms a day and 600 micrograms a day for pregnant women. Ready to eat cereals, bread, and other grain products are the primary sources of folate in the US. Other good food sources are liver, spinach, lentils, oatmeal, asparagus, and romaine lettuce. Losses of folate can occur when food is heated or when folate leaches out of cooked foods and the liquid is thrown out.

A folate deficiency can cause many different health effects including macrocytic anemia. Folate and vitamin B12 deficiencies cause elevated levels of homocysteine in the blood. When folate intake is not adequate during pregnancy, neural tube defects can occur.

Source: Thompson, Janice, Melinda Manore, and Linda A. Vaughan. The Science of Nutrition. San Francisco, CA: Pearson Benjamin Cummings, 2011. Print.


Copper is a trace mineral and is widely distributed in foods so a deficiency is rare. In the body, copper is found mostly as a component of ceruloplasmin, which is a protein that’s critical for its transport. Copper is important for the oxidation of ferrous to ferric iron which is necessary before iron can bind to transferrin and be transported in the plasma. When ceruloplasmin is inadequate, the transport of iron for heme formation is impaired and anemia can result. Because iron can’t be transported properly, iron accumulates in the tissues which causes symptoms similar to hemochromatosis. Copper also functions as a cofactor in the metabolic pathways that produce energy in the production of connective tissues collagen and elastin. Copper is also necessary for the regulation of certain neurotransmitters, especially serotonin, important to brain function.

Our need for copper is very small but our dietary intakes are variable and absorption is influenced by a number of factors. High zinc intakes can reduce copper absorption and copper status. Zinc supplementation is used to treat Wilson disease, where copper toxicity occurs. High iron intake also interferes with copper absorption. The RDA for copper for men and women aged 19 years and older is 900 micrograms a day. Good food sources of copper include organ meats, seafood, nuts, and seeds. Whole-grain foods are also good sources.

Toxicity symptoms include abdominal pain and cramps, nausea, diarrhea, and vomiting. Liver damage occurs in extreme cases that occur with Wilson disease and other health conditions. In Wilson disease, the copper accumulates in the liver because the liver cells can’t incorporate the copper into ceruloplasmin or eliminate it in the bile. Copper deficiency is rare but can occur in premature infants fed milk based formulas and in adults fed prolonged formulated diets that are deficient in copper. Deficiency symptoms include anemia, reduced levels of white blood cells, and osteoporosis in infants and growing children.

Source: Thompson, Janice, Melinda Manore, and Linda A. Vaughan. The Science of Nutrition. San Francisco, CA: Pearson Benjamin Cummings, 2011. Print.


Without zinc, the body can’t grow, develop, or function properly. It’s estimated that more than one hundred different enzymes in the body require zinc in order to function. We require zinc to metabolize alcohol, digest our food, help form bone, provide the body with energy through glycolosis and synthesize the heme structure in hemoglobin. Zinc also helps maintain the structural shape of proteins. If proteins lose their shape, they lose their function. Zinc stabilizes the structure of certain DNA-binding proteins. Zinc has received so much attention for its contribution to immune system health that zinc lozenges have been formulated to fight the common cold.

Zinc also helps turn genes on and off which regulates the body functions that these genes control. If zinc isn’t available to activate certain genes related to cellular growth during the development of the fetus and after the child is born, growth is stunted. Zinc also helps maintain blood glucose levels by interacting with insulin and influencing the way fat cells take up glucose. Zinc is also a critical component of cell replication and normal growth.

Zinc absorption increases during times of growth, sexual development and pregnancy. High non-heme iron intakes can inhibit zinc absorption. Also, the phytates and fiber found in whole grains and beans inhibit absorption. However, dietary protein enhances zinc absorption, especially animal based proteins.

The RDA for zinc for adult men and women aged 19 years and older are 11 mg/day and 8 mg/day. Good food sources are red meats, some seafood, whole grains, and enriched grains and cereals. Zinc deficiency is a concern for people eating a vegetarian or vegan diet because zinc is more absorbable in animal based foods.

Excessive zinc supplementation has been shown to depress immune function and decrease HDL concentrations. High intakes (5-6 times the RDA) can also reduce copper and iron status because zinc absorption interferes with these minerals. Zinc deficiency is uncommon in the United States. A deficiency occurs more often in countries where people consume mostly grain-based foods. Zinc deficiency symptoms include growth retardation in children, diarrhea, delayed sexual maturation, eye and skin lesions, hair loss, and impaired appetite. Also because zinc plays an important part of a healthy immune system, a deficiency can lead to an increased incidence of infections and illnesses. In developed countries, those who are at risk for zinc deficiencies include whose with malabsorption syndromes and adults and children who eliminate high zinc foods from their diet.

Source: Thompson, Janice, Melinda Manore, and Linda A. Vaughan. The Science of Nutrition. San Francisco, CA: Pearson Benjamin Cummings, 2011. Print.


Fluoride assists in the development and maintenance of teeth and bones. During the development of both baby teeth and permanent teeth, fluoride combines with calcium and phosphorus to form fluorohydroxyapatite, which is more resistant to destruction by acids and bacteria. Treating our teeth with fluoride, whether it’s at the dentist’s office or using fluoridated toothpaste, gives them more protection against dental caries than teeth that aren’t treated. Fluoride enhances tooth mineralization, decreases demineralization and inhibits the acid producing bacteria which cause cavities. Fluoride is also responsible for stimulating new bone growth.

Our needs for fluoride are small. There’s no RDA. The AI for children aged 4-8 is 1 mg/day, 9-13 years is 2 mg/day. For those 14-18 years old it is 3 mg/day. The AI for adults is 4 mg/day for men and 3 mg/day for women. It is available in many communities in the United States by fluoridated water and dental products. Fluoride is absorbed directly in the mouth into the teeth and gums and can also be absorbed from the GI tract once it’s ingested.

There are concerns for those who consume bottled water exclusively who might be consuming too little fluoride and increasing their risks for dental caries because bottled water doesn’t contain fluoride. Toothpastes and mouthwashes that contain fluoride are widely marketed and used by consumers in the US and these products can contribute as much fluoride in the diet as fluoridated water. Fluoride supplements are available only by prescription who are generally given to children who don’t have access to fluoridated water.

Consuming too much fluoride increases the protein content of tooth enamel which results in fluorosis. The teeth become more stained and pitted. Teeth seem to be at highest risk for fluorosis during the first 8 years of life when permanent teeth are developing. Mild fluorosis causes white patches on the teeth but has no effect on tooth function. The primary result of fluoride deficiency are dental caries. Deficiency may also be associated with lower bone density.

Source: Thompson, Janice, Melinda Manore, and Linda A. Vaughan. The Science of Nutrition. San Francisco, CA: Pearson Benjamin Cummings, 2011. Print.


Magnesium is one of the minerals that make up the structure of the bone. It’s also important for the regulation of bone and mineral status. It is a critical cofactor for more than 300 enzyme systems. It’s necessary for the production of ATP and plays a major role in DNA and protein synthesis and repair. Magnesium supports normal vitamin D metabolism and action and is necessary for normal muscle contraction and blood clotting.

People who are adequately nourished generally consume enough magnesium in their diet. The RDA for magnesium changes by age groups and genders. For men 19-30 years of age the RDA is 400 mg and then increases to 420 mg for men 31 years and older. The RDA for women aged 19-30 is 310 mg/day and increases to 320 mg/day for women aged 31 and older.

Magnesium is found in green leafy vegetables like spinach. Also it is found in whole grains, seeds, and nuts. Other good sources include seafood, beans, and some dairy products. Refined and processed foods are low in magnesium. Also, the “harder” your drinking water is, the higher the content of magnesium. The ability for the small intestine to absorb magnesium is reduced when consuming a diet high in fiber and phytates. On the other hand, high protein intake enhances the absorption of magnesium.

High blood magnesium, hypermagnesemia, happens in those with impaired kidney function who consume large amounts of nondietary magnesium like antacids. In contrast, hypomagnesemia, results from magnesium deficiency. This may result from kidney disease, chronic diarrhea, or chronic alcohol abuse. Elderly seem to be at a high risk of low intakes of magnesium because they have a reduced appetite and face some challenges related to shopping and preparing meals. Long term deficiency in magnesium is associated with osteoporosis because of its role in bone formation.

Source: Thompson, Janice, Melinda Manore, and Linda A. Vaughan. The Science of Nutrition. San Francisco, CA: Pearson Benjamin Cummings, 2011. Print.


Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue. This leads to bone fragility and increases your risk for fractures. The bone tissue becomes more porous and thinner. These changes weaken the bone, leading to reduced ability of the bone to bear weight. Osteoporosis is the most important cause of fractures in the hip and spine in older adults. These fractures are extremely painful and can cause an increased risk of infection and other illnesses leading to premature death. About 20% of older adults who are suffering a hip fracture die within 1 year after the fracture occurs and death rates are higher for men than for women. Gradual compression fractures in the vertebrae of the upper back lead to shortening and hunching of the spine, also known as kyphosis.

Osteoporosis is a common disease and worldwide one in three women and one in five men over the age of 50 are affected. In the United States, more than 10 million people are diagnosed. Some factors that influence the risk for osteoporosis are age, gender, genetics, nutrition, and physical activity. Modifiable risk factors are smoking, low body weight, low calcium intake, low sun exposure, alcohol abuse, history of amenorrhea, estrogen deficiency, testosterone deficiency, repeated falls, and having a sedentary lifestyle.

Bone density declines with age, so low bone ass and osteoporosis are health concerns for both older men and women. Hormonal changes occur with aging which also have an impact on bone loss. After 30 years of age, the average bone loss is 0.3% to 0.5% per year. During menopause, women’s levels of the estrogen decrease dramatically causing bone loss to increase about 3% per year during the first 5 years of menopause.

80% of Americans with osteoporosis are women. Adult women have a lower bone density then men, the hormonal changes occurring in men as they age don’t have a dramatic effect on bone density like on women, and on average, women live longer than men so more risks are available to women as they age. Extreme dieting during adolescence when bone mass is building and adequate consumption of calcium and other nutrients are critical, is harmful. Also, some individuals have family history of osteoporosis which increases their risk of the disease. Caucasian women of low body weight are particularly at risk.

Cigarette smoking is known to decrease bone density because of its effects on hormones that influence bone formation and resorption. Chronic alcoholism is detrimental to bone health and is associated with high rates of fractures.No more than 2 drinks a day for men and one drink a day for women should be permitted. Caffeine is also known to increase calcium loss in the urine so it’s important to keep caffeine levels to no more than 3 cups of coffee a day. Higher intakes of sodium are also known to increase the excretion and bone loss from the hip in postmenopausal women.

Calcium and Vitamin D have received the most attention for their role in prevention of osteoporosis. Older individuals have shown to reduce their risk for bone loss and fracture risk by taking these 2 supplements. If people don’t consume enough of these nutrients over a period of time, bone density is lower and they will have a higher risk of bone fractures.

Regular exercise is also a protector against bone loss and osteoporosis. Regular participation in weight-bearing exercises like walking, tennis, jogging, and strength training can help increase and maintain bone mass. However, when the body isn’t receiving the nutrients is needs to rebuild hydroxyapatite and collagen broken down, exercise can be detrimental to health. People who suffer from eating disorders and are active are at an increased risk for fractures.

Even though there’s no cures for osteoporosis, there are treatments that can slow and reverse bone loss. Bisphosphonates increase bone density and reduce the risk of spinal and nonspinal fractures (Fosamax). Some estrogen receptor modulators (Evista) have an estrogen like effect on bone tissue to slow the rate of bone loss and prompt bone mass. Calcitonin can reduce the rate of bone loss. Hormone replacement therapy combines estrogen with a hormone called progestin which can reduce bone loss, increase bone density and reduce the risk of fractures. All of these medications have side effects so it’s important to speak to your doctor about them. It’s extremely important for those with osteoporosis to consume calcium and vitamin D adequately and exercise regularly.

Source: Thompson, Janice, Melinda Manore, and Linda A. Vaughan. The Science of Nutrition. San Francisco, CA: Pearson Benjamin Cummings, 2011. Print.


Potassium and Sodium work together to maintain proper fluid balance and regulate the contraction of muscles and transmission of nerve impulses. Potassium also helps maintain blood pressure. Eating a diet high in potassium helps maintain a lower blood pressure.

The AI for potassium is 4.7 g/day for men and women aged 19 to 50. It is found in many fresh foods, mostly fruits and vegetables. Foods that are processed are usually loaded with sodium and decreases the amount of potassium. People with kidney disease aren’t able to regulate their blood potassium levels. Hyperkalemia or high blood potassium concentration, occurs when potassium is not efficiently excreted from the body. Severe hyperkalemia can alter the normal rhythm of the heart which can result in a heart attack or death. People with kidney disease must monitor their potassium intake.

Potassium is widespread in many foods so a deficiency is rare. Potassium deficiency is not uncommon among people who have serious medical disorders however. Kidney disease, diabetic ketoacidosis, and other illnesses all can lead to a potassium deficiency. People with high blood pressure who are prescribed diuretic medications to treat their disease are also at risk. Some diuretics can increase the body’s urinary excretion of potassium. Extreme dehydration, vomiting and diarrhea can cause hypokalemia, which is low blood potassium. People who abuse alcohol or laxatives can suffer from this. Severe cases result in fatal changes in heart rate. Many deaths attributed to extreme dehydration or eating disorder are caused by abnormal heart rhythms due to hypokalemia.

Source: Thompson, Janice, Melinda Manore, and Linda A. Vaughan. The Science of Nutrition. San Francisco, CA: Pearson Benjamin Cummings, 2011. Print.