SINCE 2002, breakfast food manufacturers

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1 PRODUCT UPDATE Column Editor: Maria Karalis, MBA, RD, LD Hidden Phosphorus at Breakfast: Part 2 Lisa Murphy-Gutekunst, MSEd, RD, CDN, CSR, and Kelly Barnes, RD SINCE 2002, breakfast food manufacturers have faced many new challenges. The popularity of low-carbohydrate diets, the increasing consumer demands for grab and go foods, and the release of the updated 2005 US Department of Agriculture s (USDA) Dietary Guidelines for Americans have all influenced changes within the industry. 1 3 The 2005 USDA Dietary Guidelines for Americans have had the greatest impact. New to this set of guidelines are the USDA s recommendations to increase consumption of whole grains to a level that is at least half of the recommended grain servings and to increase potassium-rich foods in the diet. 3 General Mills (Minneapolis, MN) was the first breakfast food company to make changes to meet these new standards by reformulating their products to 100% whole grain. Impact on CKD Patients Whole grains are higher in phosphorus and potassium than refined grains. Both the chronic kidney disease (CKD) patient and the renal dietitian will be impacted as manufacturers make changes to meet consumer needs and governmental standards. For the CKD patient, food choices may become further restricted, or the patient may need to take more phosphate binders to accommodate the increase in phosphorus load. For the renal dietitian, time will be spent educating the patient on the changes the food industry has made, finding acceptable alternative food choices to replace the new higher-phosphorus Cleve-Hill Dialysis, Buffalo, NY. Address reprint requests to Lisa Murphy-Gutekunst, MSEd, DaVita, Inc, Cleve-Hill Dialysis, 1461 Kensington Ave, Buffalo, NY lmurphy@davita.com 2005 by the National Kidney Foundation, Inc /05/ $30.00/0 doi: /j.jrn breakfast foods, and adjusting patient meal plans or phosphate binders. Both patients and dietitians alike will face the challenge of keeping abreast of ongoing formulation changes made by food manufacturers. Keeping Abreast of the Nutrition Content of Breakfast Foods Regular monitoring of in-store food nutrition labels is the best way to keep abreast of the nutritional content of breakfast foods. In researching this article, the investigators found problems obtaining accurate analyses from widely used resources available to dietitians and patients. In some instances, we found as many as three different analyses for the same product, none resembling the other! In trying to clarify these discrepancies, we found limitations to nutrition analysis resources generally used by the public and the professional. Breakfast foods manufacturers change formulations throughout the year, but are only required to report nutritional content of their products to the USDA once per year (Linda Lamahr, US Department of Agriculture, personal communication, January 28, 2005). As a result, nutrition analyses found in the USDA National Food Database and nutrition analysis programs that use the USDA for their databases may be obsolete. Nutrition fact labels listed on a company s website are not always accurate. On visiting a website of a product believed to be low in phosphorus, we found a picture of the product s nutrition label that listed the phosphorus content as 0% daily value. However, in a different area of the website, which provided a detailed description of the product, the phosphorus content was reported to be 230 mg per serving! When questioned, the company responded that they were not required by law to list the phosphorus content of their product. However, they did ac- Journal of Renal Nutrition, Vol 15, No 3 ( July), 2005: pp E1-E6 e1

2 e2 PRODUCT UPDATE knowledge the error and planned to correct it (White Wave, communication, January 12, 2005). Customer service representatives are limited in the information provided on the company s website or the nutrition label. To receive a detailed nutrition analysis, consumers must make a special request that may not be granted because of the company s proprietary information policy. For this article, the investigators contacted the media relations department of each company for nutrition analysis and permission to publish the company information. Phosphorus and Potassium Content of Breakfast Cereals and Cereal Bars Table 1 lists the phosphorus and potassium content of most breakfast cereals and cereal bars found in the United States. This information was obtained directly from manufacturers in March For product comparison, data were adjusted to reflect the National Renal Diet serving sizes. Note that Post/Nabisco cereals are not included in this list because Kraft, the parent company, did not give permission to publish the data. Manufacturer Information General Mills PO Box 631 Minneapolis, MN Kashi PO Box 8557 LaJolla, CA Kellogg s 1 Kellogg Square Battlecreek, MI Malt-O-Meal PO Box 631 Northfield, MN Quaker PepsiCo Beverages and Foods PO Box Chicago, IL References 1. Duxbury D: Measuring and labeling carbohydrates. Food Technol 58:72-73, The International Dairy Deli Bakery Association. What s in Store Report. The International Dairy Deli Bakery Association, Madison, WI, US Department of Agriculture. Dietary Guidelines for Americans, Washington, DC, US Government Printing Office, 2005

3 MURPHY-GUTEKUNST AND BARNES e3 Table 1. Phosphorus and Potassium Content of Breakfast Cereals and Cereal Bars Ready-to-eat cereals Kellogg Special K Low Carb Lifestyle 3/4 c Malt-O-Meal Honey Graham Squares 3/4 c General Mills Shrek 3/4 c Quaker Squares 3/4 c Kellogg Complete Wheat Bran Flakes 3/4 c Kellogg Cracklin Oat Bran 3/4 c Kellogg Smart Start Healthy Heart 3/4 c Malt-O-Meal Balance Bran Flakes 3/4 c Quaker Squares Cinnamon 3/4 c Quaker Life 3/4 c Quaker Oatmeal Honey Nut Heaven 3/4 c Quaker Oatmeal Brown Sugar Bliss 3/4 c Quaker Cinnamon Life 3/4 c General Mills Multibran Chex 3/4 c General Mills Oatmeal Crisp Almond 3/4 c General Mills Wheat Chex 3/4 c Kellogg Smart Start Soy Protein 3/4 c Malt-O-Meal Frosted Mini-Spooners 3/4 c Kashi Heart to Heart 3/4 c Kellogg Complete Oat Bran Flakes 3/4 c Kellogg Just Right Fruit and Nut 3/4 c Quaker Toasted Oats 3/4 c Cascadian Farms Hearty Morning 3/4 c Cascadian Farms Multigrain Squares 3/4 c Cascadian Farms Wheat Crunch 3/4 c General Mills Basic 4 3/4 c General Mills Berry Burst Cheerios Strawberry 3/4 c General Mills Berry Burst Cheerios Strawberry Banana 3/4 c General Mills Berry Burst Cheerios Triple Berry 3/4 c General Mills Cheerios 3/4 c General Mills Honey Nut Cheerios 3/4 c General Mills Multigrain Cheerios 3/4 c General Mills Oatmeal Crisp Raisin 3/4 c General Mills Total Raisin Bran 3/4 c General Mills Wheaties 3/4 c Kellogg Cruncheroos 3/4 c Malt-O-Meal Honey and Nut Toast Os 3/4 c Malt-O-Meal Scooter s 3/4 c Quaker Marshmallow Safari 3/4 c Quaker Honey Nut Oats 3/4 c General Mills Oatmeal Crisp Apple Cinnamon 3/4 c Cascadian Farms Honey Nut Os 3/4 c Cascadian Farms Purely Os 3/4 c General Mills Apple Cinnamon Cheerios 3/4 c General Mills Brown Sugar and Oat Total 3/4 c General Mills French Toast Crunch 3/4 c General Mills Honey Nut Clusters 3/4 c General Mills Reese s Puffs 3/4 c Kellogg Smart Start Antioxidant 3/4 c Malt-O-Meal Apple Cinnamon Toasty Os 3/4 c Malt-O-Meal Blueberry Muffin Tops 3/4 c Malt-O-Meal Toasted Cinnamon Twists 3/4 c Quaker Honey Grahams 3/4 c Cap n Crunch Peanut Butter 3/4 c Cap n Crunch Regular 3/4 c 46 55

4 e4 PRODUCT UPDATE Table 1. Phosphorus and Potassium Content of Breakfast Cereals and Cereal Bars (Cont d) Quaker Frosted Oats 3/4 c Cascadian Farms Clifford Crunch 3/4 c General Mills Frosted Cheerios 3/4 c General Mills Team Cheerios 3/4 c Kellogg Special K 3/4 c Cap n Crunch Crunchberries 3/4 c Quaker Cinnamon Crunch 3/4 c Cap n Crunch Ooops Choco Donut 3/4 c Quaker Cocoa Blast 3/4 c Quaker Frutangy Os 3/4 c Cap n Crunch Neutron Berries 3/4 c General Mills Berry Berry Kix 3/4 c General Mills Cinnamon Toast Crunch 3/4 c General Mills Golden Grahams 3/4 c General Mills Peanut Butter Toast Crunch 3/4 c General Mills Red Cinnamon Toast Crunch 3/4 c Kellogg Honey Smacks 3/4 c Malt-O-Meal Golden Puffs 3/4 c Quaker Fruity Ocean Adventure 3/4 c Quaker King Vitamin 3/4 c Quaker Crunchy Corn Bran 3/4 c Quaker Apple Zaps 3/4 c Quaker Quisp 3/4 c Quaker Sweet Crunch 3/4 c General Mills Cookie Crisp 3/4 c General Mills Lucky Charms 3/4 c Kellogg Product 19 3/4 c General Mills Kix 3/4 c General Mills Kaboom 3/4 c General Mills Rice Chex 3/4 c Kellogg Rice Krispies 3/4 c General Mills Total Corn Flakes 3/4 c General Mills Frosted Chex 3/4 c General Mills Honey Nut Chex 3/4 c Kellogg Cinnamon Crunch Crispix 3/4 c Kellogg Cocoa Krispies 3/4 c Kellogg Rice Krispies Treats Cereal 3/4 c Malt-O-Meal Cocoa Dyno-Bites 3/4 c Quaker Cocoa Bronto Blasts 3/4 c Quaker Fruity Bronto Blasts 3/4 c Quaker Sweet Puffs 3/4 c General Mills BooBerry 3/4 c General Mills Cocoa Puffs 3/4 c General Mills Corn Chex 3/4 c General Mills Count Chocula 3/4 c General Mills Country Corn Flakes 3/4 c General Mills Frankenberry 3/4 c General Mills Red Cocoa Puffs 3/4 c General Mills Red Trix 3/4 c General Mills Trix 3/4 c Kellogg Froot Loops 3/4 c Malt-O-Meal Apple Zings 3/4 c Malt-O-Meal Honey Buzzers 3/4 c Malt-O-Meal Tootie Fruities 3/4 c Quaker Honey Crisp Corn Flakes 3/4 c Quaker Frosted Flakes 3/4 c 13 25

5 MURPHY-GUTEKUNST AND BARNES e5 Table 1. Phosphorus and Potassium Content of Breakfast Cereals and Cereal Bars (Cont d) Malt-O-Meal Crispy Rice 3/4 c Quaker Honey Dipps 3/4 c Quaker Rice Crisps 3/4 c 0 19 High-fiber cereals Kellogg All-Bran Original 1/3 c Kellogg All-Bran Bran Buds 1/3 c Kellogg Frosted Mini-Wheats Bite Size 24 biscuits Kellogg Frosted Mini-Wheats Bite Size Maple and 24 biscuits Brown Sugar Kellogg Frosted Mini-Wheats Bite Size Vanilla Crème 24 biscuits Kellogg Frosted Mini-Wheats Original 5 biscuits Kellogg All-Bran With Extra Fiber 1/3 c Quaker 100% Natural Granola Oats and Honey 1/3 c Quaker 100% Natural Granola With Raisins 1/3 c General Mills Fiber One 1/3 c Cascadian Farms Cinnamon Raisin Granola 1/3 c Cascadian Farms Oat and Honey Granola 1/3 c Quaker Shredded Wheat 1 biscuit General Mills Raisin Nut Bran 1/3 c Kashi GoLean 1/3 c Kellogg Low-fat Granola Without Raisins 1/3 c Kellogg Mini-Wheats With Raisin 1/3 c Kellogg Mini-Wheats With Strawberry 1/3 c Kellogg Raisin Bran 1/3 c Malt-O-Meal Raisin Bran 1/3 c Quaker 100% Natural Granola Low Fat 1/3 c Quaker Frosted Shredded Wheat 1/3 c Cascadian Farms Raisin Bran 1/3 c Kellogg Low-Fat Granola with Raisins 1/3 c Kellogg Mueslix 1/3 c Kellogg Shredded Wheat Miniatures 1/3 c General Mills Whole Grain Total 1/3 c Kashi Good Friends 1/3 c Kellogg Raisin Bran Crunch 1/3 c General Mills Raisin Bran 1/3 c Puffed cereals Quaker Crispy Corn Puffs 1 c Kashi Puffed Seven Whole Grains and Sesame 1 c Malt-O-Meal Puffed Wheat 1 c Malt-O-Meal Puffed Rice 1 c Popeye Puffed Rice 1 c Popeye Puffed Wheat 1 c Hot cereals Quaker Quick Oats With Salt 1/2 c Quaker Old-Fashioned Oats 1/2 c Quaker Quick Oats 1/2 c Quaker Oatmeal Nutrition for Women Golden Brown 1 packet Sugar Malt-O-Meal Oatmeal Cinnamon and Spice 1 packet Malt-O-Meal Oatmeal Maple and Brown Sugar 1 packet Malt-O-Meal Oatmeal Regular 1 packet Quaker Oatmeal Nutrition for Women Vanilla 1 packet Cinnamon Quaker Oatmeal Supreme Cinnamon Pecan 1 packet Quaker Oatmeal Cinnamon Spice 1 packet Quaker Oatmeal Take Heart Golden Maple 1 packet Quaker Oatmeal Double Raisin Danish 1 packet

6 e6 PRODUCT UPDATE Table 1. Phosphorus and Potassium Content of Breakfast Cereals and Cereal Bars (Cont d) Quaker Oatmeal Maple Brown Sugar 1 packet Quaker Oatmeal Honey Nut 1 packet Quaker Oatmeal Cinnamon Roll 1 packet Quaker Oatmeal Take Heart Blueberry 1 packet Quaker Oatmeal Nutrition for Women Apple 1 packet Cinnamon Quaker Oatmeal Supreme Banana Walnut 1 packet Quaker Oatmeal Dinosaur Eggs 1 packet Quaker Oatmeal Lower Sugar Maple Brown 1 packet Quaker Oatmeal Supreme Apple Raisin 1 packet Quaker Oatmeal French Toast 1 packet Quaker Oatmeal Breakfast Blast Chocolate Chip 1 packet Quaker Oatmeal Banana Bread 1 packet Quaker Oatmeal Regular 1 packet Quaker Oatmeal Breakfast Blast Cinnamon Toast 1 packet Quaker Oatmeal Breakfast Blast S Mores 1 packet Quaker Oatmeal Raisin, Date, Walnut 1 packet Quaker Oatmeal Raisin Spice 1 packet Quaker Oatmeal Bananas and Cream 1 packet Quaker Oatmeal Apple Crisp 1 packet Quaker Oatmeal Lower Sugar Apple Cinnamon 1 packet Quaker Oatmeal Blueberries and Cream 1 packet Quaker Oatmeal Peaches and Cream 1 packet Quaker Oatmeal Strawberry and Cream 1 packet Quaker Oatmeal Apple Cinnamon 1 packet Quaker Oatmeal Express Cups Cinnamon Roll 1/2 c Quaker Oatmeal Express Cups Golden Brown Sugar 1/2 c Quaker Oatmeal Express Cups Baked Apple 1/2 c Breakfast bars Milk n Cereal Bar Cinnamon Toast Crunch 1 bar Milk n Cereal Bar Cocoa Puffs 1 bar Milk n Cereal Bar Honey Nut Cheerios 1 bar Milk n Cereal Bar Peanut Butter Toast Crunch 1 bar Milk n Cereal Bar Trix 1 bar Quaker Breakfast Squares Oatmeal Raisin 1 bar Quaker Breakfast Squares Banana Bread 1 bar Quaker Breakfast Squares Brown Sugar Cinnamon 1 bar Quaker Breakfast Squares Baked Apple 1 bar Chewy Trail Mix Bar Apple Cinnamon 1 bar Chewy Trail Mix Bar Fruit N Nut 1 bar Nature Valley Crunchy Granola Bar Banana Nut 1 bar Nature Valley Crunchy Granola Bar Peanut Butter 1 bar Chewy Trail Mix Bar Mixed Berry 1 bar Nature Valley Crunchy Granola Bar Apple Crisp 1 bar Nature Valley Crunchy Granola Bar Cinnamon 1 bar Nature Valley Crunchy Granola Bar Maple Brown 1 bar Sugar Nature Valley Crunchy Granola Bar Oats N Honey 1 bar NOTE. Nutrition analysis reflects data received in March Listed values may change. Please consult products nutrition fact labels.