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sugars, sugar substitutes, non-nutritive artificial sweeteners, and natural sweeteners (Stevia) all have different nutritive values, cariogenicity, and sweetness factors. (3) Overweight patients should look for smaller bars that are lower in calories. If glucose control is an issue, bars that are higher in fiber are preferred. Patients with high blood pressure or heart failure will need to consider the sodium content of the foods. Bars that are truly designed for endurance events have significant added sodium, but a natural or organic type bar often has lower sodium. Patients with diabetes will need to consider the carbohydrate and fiber content of the bar to determine how it can fit within their guidelines for eating. Terms such as “impact carbs” or “net carbs” may be used by manufacturers to differentiate types of carbohydrates. Generally, the sugar alcohols and fiber are subtracted from the total carbohydrate, and that number is said to be the amount of carbohydrates in the product that affects blood sugars. However, these claims are not regulated or approved by the Food and Drug Administration. It may be helpful for an active type 1 diabetes patient to use an energy bar as a consistent snack before exercising. A consistent snack food can make glucose control more predictable and avoid hypoglycemia. For type 2 diabetes, smaller bars with higher fiber content and carbohydrate less than 25 grams are preferred. Underweight patients may find the bars as a convenient, nutrient dense snack that is easy to keep with them for between-meal eating. In this case, taste may be the key factor, and higher calorie bars are optimal. Patients with food allergies will need to find a trusted brand. Most companies use a wide variety of ingredients including many common allergens such as nuts and wheat, so the possibility for cross-contamination is high. A 2009 report by ConsumerLab.com, an independent lab that evaluates health and wellness products, concluded that there were occasional discrepancies between ingredients on the label and what was actually in the bar. (4) Endurance athletes have many factors to consider. Options for before the activity (within 1-2 hours) should be easily digestible and thus not too high in fat, fiber, or protein. Products for use during training or an event should have carbohydrate and electrolytes, and possibly some protein. Athletes who are running or doing other high impact sports may prefer gels and chews for their digestibility. Cyclists and hikers are less prone to stomach upset, so they may prefer the taste and texture of bars. Products for after activity published study, researchers discussed how triathletes, who have frequent intake of carbohydrates during training, are at increased risk for dental erosion. (5) A patient involved in weight training or cross-fit type exercise activities likely gets adequate protein from his or her diet, but may be attracted to a high protein type product nonetheless. Many of these bars would make an easy before or after exercise snack.

CONCLUSION

Energy bars can provide a convenient snack, especially for athletes. No matter how nutritious a bar is, whole fresh foods are essential as the mainstay of a healthy diet. Foods contain far more nutrition and synergistic components than basic calories, carbohydrates, and vitamins. Consumers should be encouraged to eat less processed foods whenever possible to improve the health of their diet. Please reference the chart of Performance Bars Product Information (REI Store).

REFERENCES

1. Sebastian RS, Wilkinson Enns C, Goldman JD. Snacking Patterns of U.S. Adults: What We Eat In America, NHANES 2007-2008. Food Surveys Research Group Dietary Data Brief No. 4. June 2011. Available from: http://ars.usda.gov/Services/docs.htm?docid=19476. 2. Packaged Facts. Not Just for Breakfast: A Boom in the Food Bars Markets. Press Release April 3, 2012. Available from: http://www.packagedfacts.com/about/release.asp?id=2681. 3. Ligh R and Saxton C. The Dental Effects and Associated Properties of Natural Sugars, Sugar Substitutes, and Artificial Sweeteners. The Bulletin. 2014;20(3):34-35. 4. ConsumerLab.com. Sixty percent of nutrition bars fail to meet claims in ConsumerLab. com tests. Press release Oct 30, 2001. Available from: http://www.consumerlab.com/news/ Nutrition_Bars_Tests/10_30_2001/ 5. Frese C, Frese F, et al. Effect of Endurance Training on Dental Erosion, Caries, and Saliva. Scandanavian Journal of Medicine & Science in Sports. Epub 11 Jun 2014.

ABOUT THE AUTHORS

Claire Saxton is a clinical dietitian at Kaiser Santa Clara Medical Center in Santa Clara – 408/569-1551. She is also an avid runner. Dr. Randy Ligh is a private practitioner for Pediatric Dentistry in San Jose – 408/2866308. He was previously a physical trainer. MARCH / APRIL 2015 | THE BULLETIN | 43

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