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  • SlowFoodFast sometimes addresses general public health topics related to nutrition, heart disease, blood pressure, and diabetes. Because this is a blog with a personal point of view, my health and food politics entries often include my opinions on the trends I see, and I try to be as blatant as possible about that. None of these articles should be construed as specific medical advice for an individual case. I do try to keep to findings from well-vetted research sources and large, well-controlled studies, and I try not to sensationalize the science (though if they actually come up with a real cure for Type I diabetes in the next couple of years, I'm gonna be dancing in the streets with a hat that would put Carmen Miranda to shame. Consider yourself warned).

The CDC tries defining “powerhouse” veggies

carrotsareveryhealthytom-ABS“Carrots are very healthy!” “Mmmhm, very healthy, Tom. Good for your eyes. Vitamin A I think.” A six-year-old’s view of carrots and nutrition, courtesy of my daughter from several years ago, and (obviously) influenced by the best of the cartoon world…

The Centers for Disease Control seems to have taken up the nutrition density scoring gauntlet to rate high-value fruits and vegetables for their “powerhouse” value. A research paper in this month’s Preventing Chronic Disease journal derives a nutrient density formula that’s not a million miles away from the ANDI scoring scheme Whole Foods was touting a couple of summers ago. The author presents a table of 41 plain, raw and unadorned fruits and vegetables that made the cut by delivering more than 10 percent of your recommended daily value of a combo of 17 major nutrients for 100 grams of raw weight and/or (this part wasn’t quite as clear) 100 kcal worth of food.

The fact that the CDC is now publishing this kind of study lends nutrient density scoring more legitimacy than perhaps it really deserves.

On the plus side:

  • The author, Jennifer Noia of William Paterson University in New Jersey, is an actual trained nutrition researcher with a Ph.D. in the field.
  • She’s not making a pitch or selling special dietary supplements. Her stated goal is to help the CDC develop practical guidelines for public health reduction of cancers and cardiovascular disease by rating vegetables and fruits for their general nutrition-worthiness.
  • She doesn’t bias her formula in favor or disfavor of her favorite name-dropping superfoods or taboos, as Joel Fuhrman and the admirers who started the ANDI scoring empire did.
  • Avocado doesn’t score big; it’s not even included (too caloric for what it delivers).
  • Noia does not include trendy components with questionable or untested nutritional value, things like  selenium, antioxidants (unspecified groups of) and phytochemicals (unspecified groups of) among the 17 well-tested nutrients she counts in for the composite formula.

So far, so good.

But the specific method she derives is still kind of muddled, and the logic behind the nutrient density comparisons is too.

First, are we going for 100 grams or 100 kcal (also known outside the lab as “100 calories”) as the standard amount of each food for comparison? The article switches back and forth without clarifying and the formula does not normalize to one or the other as a uniform standard.

Second, how does that amount, whichever one is in use, compare with a likely normal serving of the specific fruit or vegetable? Arugula’s way up near the top for nutrient density–but if you ate 100 grams of it, or worse yet 100 calories’ worth, at a sitting, you’d be trying to eat an entire plateful or maybe several platefuls of it. Very bitter. Most people include a small handful, maybe a quarter cup per serving, in a mixed salad for interest, or (as I do) on a sandwich. With mustard or vinaigrette and some other veggies.

Same for watercress. And both are expensive per serving compared with romaine, bok choy, Chinese cabbage, turnip greens…parsley??? Who’s going to eat 100 grams OR 100 calories’ worth of parsley? Scallions? Maybe if you grill them, but then again, 100 grams? 100 calories?

The list is also a little arbitrary and incomplete in terms of what’s included. Green beans make no appearance on the list, for good or ill. Maybe it’s because they don’t deliver a ton of vitamins per se, even though they have some fiber and potassium and are low in calories. Mostly, though, they don’t happen to fit into one of the four broad categories (cruciferous, leafy greens, citrus, and yellow/orange) included in the selected list. That’s not a nutrition criterion, it’s a plant classification criterion, even though it is based on some generalizations that those four categories are the most nutrient-dense of the common vegetables and fruits. But at least the author acknowledges that limitation in her study and isn’t saying green beans have no worth in one’s diet.

Of what is included in the list, the rankings by nutrient density score are a bit counterintuitive. Broccoli and cauliflower are, perhaps disappointingly, rated a lot lower on the scale than watercress–in the 20-25  range, not the 100 (maximum score). So are carrots and tomatoes.

One of the reasons for this is, as Dr. Noia writes, “As some foods are excellent sources of a particular nutrient but contain few other nutrients, percent DVs were capped at 100 so that any one nutrient would not contribute unduly to the total score.”

So the scoring formula is purposely handicapped toward well-rounded performers. Is that realistic or meaningful? Some of the foods that scored lower within each of the four broad categories  may provide large amounts of one critical nutrient–vitamin C or A, or fiber, or potassium, or iron–but perhaps not loads of B vitamins or calcium.

Well–that’s the way it is. Very few single vegetables–and almost no fruits–deliver so many different nutrients at high density in an edible portion. It’s why we eat a variety of vegetables and fruits and don’t just gravitate toward one impossible or hard-to-eat-exclusively jack-of-all-trades food.

And that’s the major flaw in this approach to defining nutrient-worthiness through a catch-all formula. The author of this study, the ANDI Score folks, Dr. Fuhrman and countless others really are looking for a magic bean. They want “AND”, not “OR”, a vegetable or fruit that delivers everything by itself. Even if they think they’re making it simpler for the average consumer to get better nutrition advice, they’re working from a false premise.

Still, at least Dr. Noia isn’t overreaching as much as the commercial popularizers of “superfoods” schemes. She admits the list is limited, and that the formula she’s derived from previously validated major studies is still preliminary. The correlation between her nutrient density score and established nutrients with some cardiovascular disease and/or cancer-prevention effect is predictably high–well, there’s a lot of overlap to begin with, so what it really tells you isn’t a great deal.

But there is some value in looking at the list of what scored at least a 10 out of 100. What can you really learn from this list?

First, “Bitter is Better.” Sort of, anyway. You wouldn’t want to make a whole dish of arugula or watercress, but you might want to throw a good handful or so into your salad or sandwich or pasta.

Notably, though, “More Expensive and Trendy isn’t Necessarily More Nutritious.” Kale isn’t as high up on the list as ordinary unglamorous spinach or turnip greens, or even darker leafy lettuces–isn’t that interesting?

Third, “Green is Good.” Darker greens are closer to the top of the list, and even between broccoli and cauliflower there’s a slight pan-nutrient decrease, though it’s not meaningful enough to start shunning cauliflower. Which I happen to like nearly as much as broccoli, and sometimes in combination with it. And although brussels sprouts are marginally more nutritious than cauliflower, they’re also more of a pain to peel and trim, and there’s a lot more waste.

The real Green Effect here has to do with calories. You notice that none of the citrus or berry fruits are up in the top 10 in the list. Apples and bananas don’t make the list at all, and melon is right out. So are summer stone fruits. Even apricots, which have a fair amount of vitamin A. That’s because the greens on the list are very low-calorie, with almost no carbohydrate or sugar. And because the nutrient density scoring formula accounts for nutrients per 100 calories (at least sometimes, when there are countable calories involved), fruits are naturally going to score lower.

From the perspective of diabetes prevention and weight control, this is a reasonable way of looking at how we get critical vitamins and minerals. The common phrase “fruits and vegetables” leads people to assume that fruits should be thought of first when you shop, and vegetables are kind of an afterthought. But it’s obvious from this kind of scoring that fruits should be considered dessert rather than the major source of vitamins and minerals.

However–given that citrus fruits, berries and stone fruits deliver large doses of vitamins C and A respectively, plus potassium and vitamin E and fiber on occasion, they shouldn’t be shunned for not “doing it all” and doing it carb-free. We need some carbohydrates, and if you eat an orange, a half a grapefruit, or even a nectarine at breakfast instead of a piece of coffeecake, so much the better. Just notice that you’re also eating some carbohydrate in the form of fruit and don’t eat three at a time. Or dump sugar and butter on it and still think it’s righteous because it’s nominally fruit.

I think we can all handle that. Even without calling anything a superfood.

ANDI Scores, Whole Foods, and diet scheme cha-ching

If you’ve taken a walk through your local Whole Foods Market in the past year, you’ve probably seen a stand with purple and green information sheets listing foods in order of “ANDI Top 10 for Produce”, “ANDI Top 10 Super Foods” and so on. Coordinated recipe cards, a suggested shopping list, and an attractive-looking book round out the offering. And the produce and bulk bins sport matching ANDI score labels. It’s a whole system. But is it right, or just another fad?

What is the ANDI Score system, anyway, and who owns it?

ANDI stands for Eat Right America ™’s Aggregate Nutrient Density Index, a proprietary nutrients-per-calorie scoring system that rates for foods from kale to cooking oil and everything in between on a scale of 1 to 1000 points.

The ANDI scoring system started with Dr. Joel Fuhrman, the author of the diet book Eat to Live. On his home page, Fuhrman describes himself as a family physician and nutrition researcher.  His diet, which he calls “nutritarian” (and you can become a nutritarian too by signing up) is a highly prescriptive weight loss regimen that focuses on high-value vegetables and fruits and eliminates most meats, fats and carbohydrates. His evaluation of vegetables as high-scoring and processed foods, meats, starches and so on as low-scoring seems only common sense.

Fuhrman’s site claims hundreds of articles and interviews as well as numerous appearances as a nutrition expert on national TV. The site also prominently mentions his two US Nationals pairs figure skating wins back in the 1970s. Does he need to have that information on there if what he’s promoting is serious, science-based dietary advice? Altogether, the site has a very infomercial feel about it, with lots of testimonials from members who’ve lost over 75 pounds with before-and-after photos. Fuhrman himself looks very fit and tanned and taut-faced–maybe a little too much? Maybe it’s just the heavy pancake makeup that infomercial packagers are famous for plastering on their experts’ faces.

Eat to Live is a popular book. Fuhrman’s Kindle edition of Eat to Live is the #700-ranked download on Amazon.com. His web site has something on the order of 4000 subscribers, whose questionnaire responses he mines for some of his journal articles. According to one of the journal papers, his audience is about 65% female, 71% married, the largest proportion college-educated with household incomes over$100K.  (At this point, I thought, bingo, the perfect infomercial audience. This is clearly a commercial diet with legs. But wait, there’s more…)

Ahem! Enter Eat Right America, a company started by a businessman who became a fan of Dr. Fuhrman’s. The founder figured there must be a good way to automate the multi-nutrient density calculations for a wider variety of foods and developed a proprietary algorithm based on nutrient values in the USDA’s NAL database. What makes the ANDI algorithm attractive, the company says, is that they weight these calculations per calorie, not per serving. Finally, they claim, you’re getting the “right” comparison of nutrient density for the calories.

But a closer look at the the diet and menus offered on both the Eat Right America and Fuhrman web sites raises a few warning flags. Scan the ingredients list in the Eat Right America 3-day sample menu and you see frequent uses of high-priced fruits, vegetables and grains like quinoa (no surprise there about why Whole Foods might be happy with the shopping list) as well as some trendy and expensive ingredients that don’t sound all that nutritious. Dates? Avocado? Coconut?  Sun-dried tomatoes? Cashews–one of the lower-fiber and more expensive nuts, incidentally. Those are usually extras, snacks, not staples, even in a vegan diet.

More seriously, the menu designers seem to have a penchant for bottled carrot juice. They put 7 whole cups of it in a bean stew that feeds 10. Now, carrots, whole carrots, are fine raw or cooked into a stew. They have fiber and vitamin A and in whole form are relatively low-carb as well. But juice them, and you filter out the fiber. You concentrate the vitamin A and carotenoids about 3-4-fold, well beyond the RDA–risking vitamin A overdose–and you concentrate the sugars. What would ordinarily be a bean and vegetable soup with a reasonable amount of carb per serving–about 15 g per half cup or 30 g for a full cup–quickly rises, with the addition of a big 7-cup dose of carrot juice in the pot (NB also much more expensive than plain carrots) to 75 grams. That’s the amount of carb my diabetic daughter would figure for an entire holiday meal that includes a decent-sized slice of cake or pie.

Some of the Eat Right America recipe nutrition counts look like the ingredients as listed don’t quite account for them. The carb is high–occasionally the sodium doesn’t add up right either. And the overall protein is low. In the vegan versions on Fuhrman’s site, which prescribes a six-week starter regimen of a pound of vegetables a day, a pound of fruit, and a cup of beans, the protein is also incomplete or close to it. No grains, and no dairy or meat or fish. No tofu. Avocado and flax seed, two darlings of the vegan world, are recommended to supplement the caloric intake so you don’t lose too much weight (which I thought was the point, but maybe not for a whole six weeks at a time).

All these recommendations flow from the ANDI scores of the food and produce some logical puzzles. Somehow, you never see plain tofu or fish or cheese or yogurt. Apparently they don’t score as high as avocado. How is this possible? Isn’t avocado pulp high-fat and not too exciting as a vegetable?

So the next thing to check–is the ANDI food-rating method right? If you’re judging solely on the micronutrients list, which is what Eat Right America claims to be weighing into its ANDI scoring formula, no it isn’t. Continue reading