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 14215. E-mail: lmurphy@davita.com 2005 by the National Kidney Foundation, Inc. 1532-8503/05/1503-0012$30.00/0 doi:10.1016/j.jrn.2005.04.007 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
e2 PRODUCT UPDATE knowledge the error and planned to correct it (White Wave, E-mail 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 2005. 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 55440 763-464-7600 Kashi PO Box 8557 LaJolla, CA 92038 858-274-8870 Kellogg s 1 Kellogg Square Battlecreek, MI 49016 800-962-1413 Malt-O-Meal PO Box 631 Northfield, MN 55057 800-743-3029 Quaker PepsiCo Beverages and Foods PO Box 049003 Chicago, IL 60604-9003 312-821-1000 References 1. Duxbury D: Measuring and labeling carbohydrates. Food Technol 58:72-73, 2004 2. The International Dairy Deli Bakery Association. What s in Store Report. The International Dairy Deli Bakery Association, Madison, WI, 1998 3. US Department of Agriculture. Dietary Guidelines for Americans, 2005. Washington, DC, US Government Printing Office, 2005
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 200 320 Malt-O-Meal Honey Graham Squares 3/4 c 200 50 General Mills Shrek 3/4 c 188 23 Quaker Squares 3/4 c 155 158 Kellogg Complete Wheat Bran Flakes 3/4 c 150 170 Kellogg Cracklin Oat Bran 3/4 c 150 220 Kellogg Smart Start Healthy Heart 3/4 c 150 228 Malt-O-Meal Balance Bran Flakes 3/4 c 150 170 Quaker Squares Cinnamon 3/4 c 147 158 Quaker Life 3/4 c 133 90 Quaker Oatmeal Honey Nut Heaven 3/4 c 122 135 Quaker Oatmeal Brown Sugar Bliss 3/4 c 116 120 Quaker Cinnamon Life 3/4 c 115 80 General Mills Multibran Chex 3/4 c 113 165 General Mills Oatmeal Crisp Almond 3/4 c 113 135 General Mills Wheat Chex 3/4 c 113 143 Kellogg Smart Start Soy Protein 3/4 c 113 308 Malt-O-Meal Frosted Mini-Spooners 3/4 c 113 120 Kashi Heart to Heart 3/4 c 100 120 Kellogg Complete Oat Bran Flakes 3/4 c 100 120 Kellogg Just Right Fruit and Nut 3/4 c 100 140 Quaker Toasted Oats 3/4 c 87 64 Cascadian Farms Hearty Morning 3/4 c 80 200 Cascadian Farms Multigrain Squares 3/4 c 80 115 Cascadian Farms Wheat Crunch 3/4 c 80 75 General Mills Basic 4 3/4 c 75 100 General Mills Berry Burst Cheerios Strawberry 3/4 c 75 75 General Mills Berry Burst Cheerios Strawberry Banana 3/4 c 75 75 General Mills Berry Burst Cheerios Triple Berry 3/4 c 75 68 General Mills Cheerios 3/4 c 75 150 General Mills Honey Nut Cheerios 3/4 c 75 94 General Mills Multigrain Cheerios 3/4 c 75 64 General Mills Oatmeal Crisp Raisin 3/4 c 75 135 General Mills Total Raisin Bran 3/4 c 75 232 General Mills Wheaties 3/4 c 75 79 Kellogg Cruncheroos 3/4 c 75 68 Malt-O-Meal Honey and Nut Toast Os 3/4 c 75 71 Malt-O-Meal Scooter s 3/4 c 75 60 Quaker Marshmallow Safari 3/4 c 75 55 Quaker Honey Nut Oats 3/4 c 70 55 General Mills Oatmeal Crisp Apple Cinnamon 3/4 c 67 128 Cascadian Farms Honey Nut Os 3/4 c 60 53 Cascadian Farms Purely Os 3/4 c 60 75 General Mills Apple Cinnamon Cheerios 3/4 c 60 60 General Mills Brown Sugar and Oat Total 3/4 c 60 60 General Mills French Toast Crunch 3/4 c 60 40 General Mills Honey Nut Clusters 3/4 c 60 101 General Mills Reese s Puffs 3/4 c 60 65 Kellogg Smart Start Antioxidant 3/4 c 60 68 Malt-O-Meal Apple Cinnamon Toasty Os 3/4 c 60 55 Malt-O-Meal Blueberry Muffin Tops 3/4 c 60 45 Malt-O-Meal Toasted Cinnamon Twists 3/4 c 60 45 Quaker Honey Grahams 3/4 c 59 65 Cap n Crunch Peanut Butter 3/4 c 52 60 Cap n Crunch Regular 3/4 c 46 55
e4 PRODUCT UPDATE Table 1. Phosphorus and Potassium Content of Breakfast Cereals and Cereal Bars (Cont d) Quaker Frosted Oats 3/4 c 46 34 Cascadian Farms Clifford Crunch 3/4 c 45 64 General Mills Frosted Cheerios 3/4 c 45 41 General Mills Team Cheerios 3/4 c 45 53 Kellogg Special K 3/4 c 45 45 Cap n Crunch Crunchberries 3/4 c 44 55 Quaker Cinnamon Crunch 3/4 c 43 45 Cap n Crunch Ooops Choco Donut 3/4 c 41 50 Quaker Cocoa Blast 3/4 c 41 45 Quaker Frutangy Os 3/4 c 41 45 Cap n Crunch Neutron Berries 3/4 c 40 49 General Mills Berry Berry Kix 3/4 c 40 40 General Mills Cinnamon Toast Crunch 3/4 c 40 45 General Mills Golden Grahams 3/4 c 40 50 General Mills Peanut Butter Toast Crunch 3/4 c 40 70 General Mills Red Cinnamon Toast Crunch 3/4 c 40 55 Kellogg Honey Smacks 3/4 c 40 40 Malt-O-Meal Golden Puffs 3/4 c 40 35 Quaker Fruity Ocean Adventure 3/4 c 38 41 Quaker King Vitamin 3/4 c 37 40 Quaker Crunchy Corn Bran 3/4 c 35 60 Quaker Apple Zaps 3/4 c 34 38 Quaker Quisp 3/4 c 32 26 Quaker Sweet Crunch 3/4 c 31 26 General Mills Cookie Crisp 3/4 c 30 30 General Mills Lucky Charms 3/4 c 30 38 Kellogg Product 19 3/4 c 30 38 General Mills Kix 3/4 c 28 23 General Mills Kaboom 3/4 c 24 24 General Mills Rice Chex 3/4 c 24 30 Kellogg Rice Krispies 3/4 c 24 24 General Mills Total Corn Flakes 3/4 c 23 28 General Mills Frosted Chex 3/4 c 20 30 General Mills Honey Nut Chex 3/4 c 20 35 Kellogg Cinnamon Crunch Crispix 3/4 c 20 35 Kellogg Cocoa Krispies 3/4 c 20 50 Kellogg Rice Krispies Treats Cereal 3/4 c 20 26 Malt-O-Meal Cocoa Dyno-Bites 3/4 c 20 40 Quaker Cocoa Bronto Blasts 3/4 c 17 15 Quaker Fruity Bronto Blasts 3/4 c 17 15 Quaker Sweet Puffs 3/4 c 16 49 General Mills BooBerry 3/4 c 15 26 General Mills Cocoa Puffs 3/4 c 15 45 General Mills Corn Chex 3/4 c 15 34 General Mills Count Chocula 3/4 c 15 53 General Mills Country Corn Flakes 3/4 c 15 38 General Mills Frankenberry 3/4 c 15 26 General Mills Red Cocoa Puffs 3/4 c 15 53 General Mills Red Trix 3/4 c 15 26 General Mills Trix 3/4 c 15 26 Kellogg Froot Loops 3/4 c 15 26 Malt-O-Meal Apple Zings 3/4 c 15 26 Malt-O-Meal Honey Buzzers 3/4 c 15 26 Malt-O-Meal Tootie Fruities 3/4 c 15 26 Quaker Honey Crisp Corn Flakes 3/4 c 14 25 Quaker Frosted Flakes 3/4 c 13 25
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 12 24 Quaker Honey Dipps 3/4 c 11 42 Quaker Rice Crisps 3/4 c 0 19 High-fiber cereals Kellogg All-Bran Original 1/3 c 233 233 Kellogg All-Bran Bran Buds 1/3 c 150 300 Kellogg Frosted Mini-Wheats Bite Size 24 biscuits 150 200 Kellogg Frosted Mini-Wheats Bite Size Maple and 24 biscuits 150 180 Brown Sugar Kellogg Frosted Mini-Wheats Bite Size Vanilla Crème 24 biscuits 150 170 Kellogg Frosted Mini-Wheats Original 5 biscuits 150 170 Kellogg All-Bran With Extra Fiber 1/3 c 133 180 Quaker 100% Natural Granola Oats and Honey 1/3 c 105 174 Quaker 100% Natural Granola With Raisins 1/3 c 101 167 General Mills Fiber One 1/3 c 100 120 Cascadian Farms Cinnamon Raisin Granola 1/3 c 75 80 Cascadian Farms Oat and Honey Granola 1/3 c 75 70 Quaker Shredded Wheat 1 biscuit 75 74 General Mills Raisin Nut Bran 1/3 c 67 87 Kashi GoLean 1/3 c 67 160 Kellogg Low-fat Granola Without Raisins 1/3 c 67 80 Kellogg Mini-Wheats With Raisin 1/3 c 67 111 Kellogg Mini-Wheats With Strawberry 1/3 c 67 73 Kellogg Raisin Bran 1/3 c 67 120 Malt-O-Meal Raisin Bran 1/3 c 67 120 Quaker 100% Natural Granola Low Fat 1/3 c 65 95 Quaker Frosted Shredded Wheat 1/3 c 61 77 Cascadian Farms Raisin Bran 1/3 c 50 90 Kellogg Low-Fat Granola with Raisins 1/3 c 50 90 Kellogg Mueslix 1/3 c 50 120 Kellogg Shredded Wheat Miniatures 1/3 c 50 80 General Mills Whole Grain Total 1/3 c 35 40 Kashi Good Friends 1/3 c 34 87 Kellogg Raisin Bran Crunch 1/3 c 33 70 General Mills Raisin Bran 1/3 c 25 68 Puffed cereals Quaker Crispy Corn Puffs 1 c 99 85 Kashi Puffed Seven Whole Grains and Sesame 1 c 80 80 Malt-O-Meal Puffed Wheat 1 c 40 80 Malt-O-Meal Puffed Rice 1 c 20 20 Popeye Puffed Rice 1 c 17 15 Popeye Puffed Wheat 1 c 16 44 Hot cereals Quaker Quick Oats With Salt 1/2 c 192 150 Quaker Old-Fashioned Oats 1/2 c 183 143 Quaker Quick Oats 1/2 c 183 143 Quaker Oatmeal Nutrition for Women Golden Brown 1 packet 154 146 Sugar Malt-O-Meal Oatmeal Cinnamon and Spice 1 packet 150 142 Malt-O-Meal Oatmeal Maple and Brown Sugar 1 packet 150 148 Malt-O-Meal Oatmeal Regular 1 packet 150 140 Quaker Oatmeal Nutrition for Women Vanilla 1 packet 143 117 Cinnamon Quaker Oatmeal Supreme Cinnamon Pecan 1 packet 141 133 Quaker Oatmeal Cinnamon Spice 1 packet 138 115 Quaker Oatmeal Take Heart Golden Maple 1 packet 137 363 Quaker Oatmeal Double Raisin Danish 1 packet 136 190
e6 PRODUCT UPDATE Table 1. Phosphorus and Potassium Content of Breakfast Cereals and Cereal Bars (Cont d) Quaker Oatmeal Maple Brown Sugar 1 packet 136 114 Quaker Oatmeal Honey Nut 1 packet 134 115 Quaker Oatmeal Cinnamon Roll 1 packet 133 111 Quaker Oatmeal Take Heart Blueberry 1 packet 133 357 Quaker Oatmeal Nutrition for Women Apple 1 packet 132 136 Cinnamon Quaker Oatmeal Supreme Banana Walnut 1 packet 132 144 Quaker Oatmeal Dinosaur Eggs 1 packet 131 109 Quaker Oatmeal Lower Sugar Maple Brown 1 packet 131 111 Quaker Oatmeal Supreme Apple Raisin 1 packet 130 168 Quaker Oatmeal French Toast 1 packet 129 107 Quaker Oatmeal Breakfast Blast Chocolate Chip 1 packet 128 118 Quaker Oatmeal Banana Bread 1 packet 126 116 Quaker Oatmeal Regular 1 packet 126 104 Quaker Oatmeal Breakfast Blast Cinnamon Toast 1 packet 123 102 Quaker Oatmeal Breakfast Blast S Mores 1 packet 123 107 Quaker Oatmeal Raisin, Date, Walnut 1 packet 120 157 Quaker Oatmeal Raisin Spice 1 packet 115 155 Quaker Oatmeal Bananas and Cream 1 packet 114 102 Quaker Oatmeal Apple Crisp 1 packet 111 111 Quaker Oatmeal Lower Sugar Apple Cinnamon 1 packet 111 120 Quaker Oatmeal Blueberries and Cream 1 packet 100 92 Quaker Oatmeal Peaches and Cream 1 packet 100 102 Quaker Oatmeal Strawberry and Cream 1 packet 99 101 Quaker Oatmeal Apple Cinnamon 1 packet 96 110 Quaker Oatmeal Express Cups Cinnamon Roll 1/2 c 85 70 Quaker Oatmeal Express Cups Golden Brown Sugar 1/2 c 85 70 Quaker Oatmeal Express Cups Baked Apple 1/2 c 78 82 Breakfast bars Milk n Cereal Bar Cinnamon Toast Crunch 1 bar 150 115 Milk n Cereal Bar Cocoa Puffs 1 bar 150 120 Milk n Cereal Bar Honey Nut Cheerios 1 bar 150 115 Milk n Cereal Bar Peanut Butter Toast Crunch 1 bar 150 120 Milk n Cereal Bar Trix 1 bar 150 100 Quaker Breakfast Squares Oatmeal Raisin 1 bar 120 162 Quaker Breakfast Squares Banana Bread 1 bar 114 132 Quaker Breakfast Squares Brown Sugar Cinnamon 1 bar 106 122 Quaker Breakfast Squares Baked Apple 1 bar 102 134 Chewy Trail Mix Bar Apple Cinnamon 1 bar 75 85 Chewy Trail Mix Bar Fruit N Nut 1 bar 75 95 Nature Valley Crunchy Granola Bar Banana Nut 1 bar 65 70 Nature Valley Crunchy Granola Bar Peanut Butter 1 bar 65 75 Chewy Trail Mix Bar Mixed Berry 1 bar 65 65 Nature Valley Crunchy Granola Bar Apple Crisp 1 bar 60 60 Nature Valley Crunchy Granola Bar Cinnamon 1 bar 60 65 Nature Valley Crunchy Granola Bar Maple Brown 1 bar 60 60 Sugar Nature Valley Crunchy Granola Bar Oats N Honey 1 bar 60 63 NOTE. Nutrition analysis reflects data received in March 2005. Listed values may change. Please consult products nutrition fact labels.