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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.

Questionable sodium study, even more questionable comments

A new European study that purportedly shows low-sodium diets to be ineffective in preventing high blood pressure, and even more unlikely, that they increase the risk of death from heart attack or stroke, is being published in the May 4 issue of JAMA, and predictably it’s already excited a variety of comments in Gina Kolata’s current New York Times article from the CDC and from…Dr. Michael Alderman.

Predictably, because the CDC researchers think too few people were studied for too short a time with unreliable methods (24-hour urine collection to measure sodium intake indirectly, after the fact as it were.)

Alderman’s reaction was also predictable: he’s still insisting that only a nation-wide feeding study sort of clinical trial that follows its subjects until they die is sufficient to prove a true link between sodium intake and cardiovascular disease. Something so expensive and unwieldy it couldn’t be completed even if it were started, and we’d still be waiting around 30 years later wondering if salt had anything to do with heart attacks or strokes. Very convenient for the processed food industry, but pretty useless for public health. And also conveniently, Gina Kolata found more than one expert to say so.

What she didn’t find, but could have, is that a number of large-scale feeding studies have already been done and shown that eating a balanced lower-sodium diet helps reduce blood pressure and prevent blood pressure increases. DASH-Sodium is one of them. And no one had to wait until the study subjects died to figure it out.

AHA: Diet sodas and excess salt both linked to strokes

The latest from the American Heart Association and American Stroke Association’s joint International Conference on Stroke 2011, which is going on in Los Angeles this week from Wednesday through Friday.

Diet soda may raise odds of vascular events; salt linked to stroke risk.

Two large studies on a mixed-race/age/gender/other health status population have just shown that:

1. Drinking diet soda every day increases your risk of a heart attack or stroke in the next 9-10 years. In the study, diet soda regulars had a 48% higher rate than nondrinkers even after accounting for metabolic syndrome and existing or past heart disease.

2. For every 500 milligrams of sodium you eat per day over the AHA’s recommended 1500 max, you have a 16% higher risk of getting a stroke–no matter whether you have high blood pressure or normal blood pressure.

There was one other piece of really bad news announced:

The Centers for Disease Control’s analysts looked at hospitalizations for ischemic stroke (blocked arteries to the brain) between 1994 and 2007 and found that while strokes are decreasing in people over 65 (which is good), they’re INCREASING in children, teens and younger adults. Although older adults still have much higher overall risk of stroke than younger people, the trend toward higher stroke hospitalization rates for younger people is significant and needs to be explored further. Stroke hospitalizations increased by:

  • 31% among boys 5-14; 36% among girls 5-14
  • 51% in men 15-34, 17% in women 15-34
  • 47% in men 35-44, 36% in women 35-44

The CDC researchers didn’t have clear evidence of a cause for the rise in strokes among younger people, but said the rise in average body weight, blood pressure and diabetes, which are known risk factors for stroke, bore a closer look.

The fact that stroke hospitalization rates started rising in children over 5 (the researchers looked at younger children as well but didn’t find an increase under age 5) suggests to me that part of the trend may be due to a more processed diet with higher salt consumption as children head for school. All in all, it gives you the impression that we are the junk food generation, and it’s catching up with us as we speak.