Nutrivore - Nutrient Density for Lifelong Health (Sarah Ballantyne)

Transcript

1. NUTRIVORE: NUTRIENT DENSITY FOR LIFELONG HEALTH Dr. Sarah Ballantyne, PhD www.Nutrivore.com
2. What is Nutrivore and why is it important?
3. WHAT IS NUTRIVORE? no͝ o-trĭ-vôr' noun 1. A person who chooses foods to supply all the nutrients their body needs to thrive. 2. A diet predominantly comprised of nutrient-dense whole foods. 3. A radical yet simple idea: Get all the nutrients we need from the food we eat.
4. PREVALENCE OF DIETARY INSUFFICIENCY Proportion of American adults consuming less than the Estimated Average Requirement For 10 essential nutrients, more than half of American adults are falling short. J Nutr. 2011 Oct;141(10):1847-54. doi: 10.3945/jn.111.142257.
5. NUTRIENT INSUFFICIENCY • Nutrient insufficiency (or inadequacy) is defined as usual dietary intake falling below the Estimated Average Requirement but without clear disease of deficiency. Image credit: Quizlet.com
6. NUTRIENTS VS. DISEASE RISK Nutrient insufficiency increase risk of EVERYTHING: • cardiovascular disease • type 2 diabetes • cancer • autoimmune disease • asthma • allergies • neurodegenerative diseases • neurological disease • depression and anxiety • chronic kidney disease • osteoporosis • sarcopenia • neural tube defects • erectile dysfunction • infection Recent evidence has shown that suboptimal levels of vitamins, even well above those causing deficiency syndromes, are risk factors for chronic diseases. doi: 10.1001/jama.287.23.3127
7. WHY DO MOST DIETS FALL SHORT? It’s harder (and more expensive) than ever to eat healthy foods and most people are confused about which foods to choose
8. “BUT I EAT SO HEALTHY!” A 2006 study • analyzed 70 detailed food logs from 20 healthy subjects • half male and half female • included 14 athletes J Int Soc Sports Nutr. 2006 Jun 5;3(1):51-5. doi: 10.1186/1550-2783-3-1-51. Each of them had dietary shortfalls of between 3 and all 17 essential vitamins and minerals evaluated in the study.
9. THE GOAL OF NUTRIVORE IS… …to thoughtfully select foods such that the sum of all the nutrients those foods contain add up throughout the day to meet or safely exceed the nutritional needs of your body, while staying within your caloric requirements.
10. What do I eat on a Nutrivore diet?
11. NUTRIVORE IS A DIET MODIFIER • There are many different ways to choose foods to meet the body’s nutritional needs. • there’s no food you have to avoid • there’s no food you have to eat • So you can apply Nutrivore to your preferred diet or anti-diet. If you have eliminated all food sources of important nutrients, make sure to talk to your doctor or a registered dietitian about supplements or other strategies to make up this dietary shortfall.
12. NUTRIVORE LOOKS AT THE WHOLE DIET Image credit: The Healthy Chew, Foodie Crush, Healthy Food Guide
13. NUTRIVORE LOOKS AT THE WHOLE DIET Image credit: The Healthy Chew, Foodie Crush, Healthy Food Guide, Sugar Geek Show
14. NUTRIVORE LOOKS AT THE WHOLE DIET • Did you meet your nutrition requirements from the foods you ate today? GREAT! • It doesn’t matter if some of the foods you ate didn’t contribute much nutrients!
15. DIFFERENT WAYS TO APPLY NUTRIVORE 1. Develop a basic understanding of what nutrients do in the body, what foods contain them, and how to combine different foods to get the full range of nutrients our bodies need. 2. Use tools like the Nutrivore Score, the Nutrivore Meal Map, and the Nutrivore Weekly Serving Matrix to track nutrient density. 3. Simply focus on the 3 eating patterns for lifelong health: whole foods, eat plenty of veggies and fruit, and eat a diverse diet. Pre-order BONUSes! https://nutrivore.com/book
16. What is the Nutrivore Score?
17. THE NUTRIVORE SCORE • a measure of the total amount of nutrient density, i.e., total nutrients per calorie of a food • a tool to identify the most nutrient-dense options within every food group and subgroup, to inform your day-to-day choices • a way to quantify the nutrient-density of foods and make the nutritional evaluation of foods objective Look up Nutrivore Scores of ~8,000 foods at https://Nutrivore.com/search
18. • The Nutrivore Score is calculated as the sum of each of 33 nutrients relative to its daily value present in the food, divided by the food’s energy density. • By dividing the amount of each nutrient by its daily value, we’re factoring into the calculation how much of each nutrient our bodies require. • And, by dividing by the energy density we’re converting the sum of percent daily values to a measure of total nutrients per calorie. THE NUTRIVORE SCORE The Nutrivore Score is algorithmically based on the Nutrient Rich Foods Index
19. EXAMPLE NUTRIVORE SCORES Arugula 2019 Avocado 251 Beef Liver 4021 Bell Peppers, Red 1358 Blueberries 396 Brazil Nuts 694 Broccoli 2833 Butternut Squash 670 Cheddar Cheese 126 Chia 450 Chicken, Breast 309 Brown Mushrooms 2279 Eggs 355 Garlic 5622 Green Leaf Lettuce 2245 Kale 4233 Mango 342 Oranges 418 Oysters 3049 Potato 273 Rice, White 66 Salmon, Wild Atlantic 868 Spinach 4548 Strawberries 762 Sugar, Granulated 1 Sweet Potato 379 Walnuts 303 Watercress 6929 Wheat Flour, All-Purpose 70 Yogurt, Greek, Whole 178
20. WHAT IS A GOOD NUTRIVORE SCORE? • Any food with a Nutrivore Score over 150 contributes more nutrients than calories to the diet • But all foods lie on a spectrum! There’s no cusp above which a food is “good” and below which a food is “bad” • There are many foods with lower Nutrivore Scores that fill important nutritional niches • e.g., cheese has an average Nutrivore Score of 140 but is the most concentrated food source of calcium
21. APPRECIATING THE NUTRIENTS IN FOODS The Nutrivore Score shows us the value of many foods that have reputations for being unhealthy or pointless! Nutrivore Score 773 Nutrivore Score 273 Nutrivore Score 212 Nutrivore Score 405
22. SIMPLE SWAPS TO UP NUTRIENT INTAKE We can use the Nutrivore Score to identify simple swaps to increase nutrient density. 266 130 497 718 < < <
23. We can use the Nutrivore Score to identify easy additions to increase nutrient density. Examples: • Adding vegetables • Adding herbs and spices ADDITIONS TO UP NUTRIENT INTAKE Image credit: https://theherbeevore.com/ + + = 575 5622 3381 707 e.g., adding 3 cloves of garlic and ½ cup fresh basil to an entire jar of store-bought marinara sauce
24. • We don’t only want to choose the highest Nutrivore Score foods • Instead choose among the higher Nutrivore Score options from nutritionally-distinct food groups! • There’s no such thing as a nutritionally-complete food or food group RECOGNIZE UNIQUE FOOD SOURCES Ergothioneine Glucosinolates Minerals Vitamins
25. SELECTING FOODS BY NUTRIVORE SCORE The more high NUTRIVORE SCORE foods we eat, the more room there is for quality-of-life foods. MORE CALORIES MORE NUTRIENTS Ave ra g e En e rg y De n s it y (c a lo rie s p e r 10 0 g ra m s )
26. DIFFERENT WAYS TO APPLY NUTRIVORE 1. Develop a basic understanding of what nutrients do in the body, what foods contain them, and how to combine different foods to get the full range of nutrients our bodies need. 2. Use tools like the Nutrivore Score, the Nutrivore Meal Map, and the Nutrivore Weekly Serving Matrix to track nutrient density. 3. Simply focus on the 3 eating patterns for lifelong health: whole foods, eat plenty of veggies and fruit, and eat a diverse diet. Pre-order BONUSes! https://nutrivore.com/book
27. Choose mostly whole and minimally-processed foods.
28. WHY CHOOSE WHOLE FOODS? • NOVA Food Classification groups all foods according to the nature, extent and purposes of the industrial processes they undergo • Whole foods can be: • unprocessed • minimally-processed • processed Whole foods have most or all of their inherent nutrition intact.
29. ULTRA-PROCESSED FOODS VS. HEALTH BMJ. 2024 Feb 28;384:e077310. doi: 10.1136/bmj-2023-077310.
30. ULTRA-PROCESSED FOODS VS. NUTRIENTS The more ultra-processed foods a person eats, the lower their intake of: • fiber • protein • potassium • zinc • magnesium • vitamin A • vitamin B3 • vitamin B12 • vitamin C • vitamin D • vitamin E Nutrients. 2021 Sep 27;13(10):3390. doi: 10.3390/nu13103390.
31. ULTRA-PROCESSED FOOD THRESHOLD A 2019 prospective study of Spanish university graduates • 62% increased risk of total mortality in people who consumed 4+ servings of ultra-processed foods • 18% increased risk of total mortality with each additional serving BMJ. 2019 May 29:365:l1949. doi: 10.1136/bmj.l1949. No significant health impact at ≤3 servings of ultra- processed foods per day
32. ULTRA-PROCESSED FOOD THRESHOLD A 2022 prospective study out of the UK (UK Biobank cohort) showed: • 17% increased risk of cardiovascular disease in people who got 43% or more of their calories from ultra- processed foods • 22% increased risk of total mortality in people who got 43% or more of their calories from ultra-processed foods Eur J Public Health. 2022 Oct 3;32(5):779-785. doi: 10.1093/eurpub/ckac104. No significant health impact at ≤20.8% of calories from ultra-processed foods
33. THE 80/20 RULE FOR WHOLE FOODS • The Pareto Principle, used mostly in business and economics, states that 80% of outcomes results from 20% of causes • As a dietary principle, the 80/20 rule refers to eating healthy meals 80% of the time, and whatever you want the other 20% Image credit: The Fashion Fitness Foodie Absolutely *any* food can fit into a healthy diet—it fits in the 20%!
34. Eat Plenty of Vegetables and Fruits
35. BENEFITS OF EATING FRUITS AND VEGGIES • cancer • cardiovascular disease • type 2 diabetes • obesity • chronic kidney disease • osteoporosis • bone fragility fractures (including hip fracture) • cognitive impairment • dementia (including Alzheimer’s disease) • neurodegenerative diseases • asthma • allergies • chronic obstructive pulmonary disease • age-related macular degeneration • cataracts • glaucoma • depression • ulcerative colitis • Crohn’s disease • rheumatoid arthritis • inflammatory polyarthritis • non-alcoholic fatty liver disease • acne • seborrheic dermatitis Eating vegetables and fruit in abundance lowers risk of: Crit Rev Food Sci Nutr. 2020;60(13):2174-2211. doi: 10.1080/10408398.2019.1632258.
36. FRUITS AND VEGGIES A 2017 meta-analysis showed that if everyone consumed ≥ 800 grams of veggies and fruits every day, we could prevent: • 2.24 million deaths from cardiovascular disease • 660,000 deaths from cancer • 7.8 million deaths from all causes globally, each year. Int J Epidemiol. 2017 Jun 1;46(3):1029-1056. doi: 10.1093/ije/dyw319.
37. WE USE CULINARY DEFINITIONS Culinary Vegetables Botanical Fruits Culinary vegetables that are botanically fruit
38. HOW MANY VEGGIES? • 3 servings per day reduces all-cause mortality risk by 25% • BMJ. 2014 Jul 29;349:g4490. doi: 10.1136/bmj.g4490 • 5 or 6 servings per day reduces risk of all-cause mortality by 25%, of cardiovascular disease by 28%, and of cancer by 12% • Int J Epidemiol. 2017 Jun 1;46(3):1029-1056. doi: 10.1093/ije/dyw319 • 3 or 4 servings per day reduces all-cause mortality risk by 11% • Am J Clin Nutr. 2017 Jun;105(6):1462-1473. doi: 10.3945/ajcn.117.153148. • 4 or 5 servings per day reduced risk of stroke, ischemic heart disease and type 2 diabetes all by 23% or more • Nat Med. 2022 Oct;28(10):2066-2074. doi: 10.1038/s41591-022-01970-5 Am J Clin Nutr. 2017 Jun;105(6):1462-1473. doi: 10.3945/ajcn.117.153148.
39. FRUIT IS NOT NATURE’S CANDY Nutrients. 2018 Nov 28;10(12):1833. doi: 10.3390/nu10121833 Fruit fiber is more impactful than vegetable fiber, cereal fiber or total fiber for reducing risk of metabolic syndrome For some outcomes, fruit is even more beneficial than vegetables. Fruit reduces risk of hypertension more than vegetables, per serving.
40. HOW MUCH FRUIT? • 2 to 3 servings of fruit daily reduces all-cause mortality by 10% • Am J Clin Nutr. 2017 Jun;105(6):1462-1473. doi: 10.3945/ajcn.117.153148 • 2 to 3 servings of fruit daily is optimal for reducing risk of cardiovascular disease, type 2 diabetes, obesity, chronic obstructive pulmonary disease, chronic constipation, and inflammatory bowel disease • Nutrients. 2018 Nov 28;10(12):1833. doi: 10.3390/nu10121833 • 4 grams of fiber from whole fruit (equivalent to 1 to 2 servings) reduces risk of coronary heart disease by 8% and risk of cardiovascular disease by 4% • BMJ. 2013 Dec 19;347:f6879. doi: 10.1136/bmj.f6879 Am J Clin Nutr. 2017 Jun;105(6):1462-1473. doi: 10.3945/ajcn.117.153148.
41. 7+ SERVINGS OF FRUITS & VEGGIES DAILY • Studies consistently show that eating a diet rich in vegetables and fruit is the most important dietary factor for improving health. • Greatest risk reduction is at ≥800 grams per day. • Aim for: • about 500 to 600 grams of vegetables (5+ servings, depending on the vegetable, and as much as you want above that) • about 200 to 400 grams of fruit (2 or 3 servings, depending on the fruit) • Mix up whether your veggies are raw versus cooked–both are good! 7+ DAILY SERVINGS OF VEGETABLES AND FRUIT IS A GREAT GOAL, BUT IT’S OKAY IF YOU HAVE TO WORK UP TO IT!
42. WHAT IS A SERVING? • 1 cup, measured raw and chopped for more veggies • 2 cups, measured raw and shredded for leafy veggies • Most veggies shrink to about ½ cup when cooked It’s less than you think!
43. • 1 cup, measured raw and chopped • Most fruits shrink to about ½ cup when cooked WHAT IS A SERVING? It’s less than you think!
44. VEGGIES AND FRUIT MAKE YOU HAPPIER! • A 2016 study showed that, for each serving of fruit and vegetables you eat daily, up to 8 servings per day, you increase: • happiness • wellbeing • life satisfaction • Going from almost no fruit and veggies to 8 servings per day increases in life satisfaction equivalent to moving from unemployment to employment • Benefits are seen within 24 months! Am J Public Health. 2016 Aug;106(8):1504-10. doi: 10.2105/AJPH.2016.303260.
45. Eat a wide variety of different whole foods.
46. WHAT IS DIETARY DIVERSITY? • Dietary diversity generally refers to the number of different food items in the diet • There’s several ways to measure it: • Dietary Species Richness • Dietary Diversity Score • Household Dietary Diversity Score • Minimum Dietary Diversity for Women • Modified Functional Attributable Diversity • Nutritional Functional Diversity Crit Rev Food Sci Nutr. 2023;63(25):7837-7851. doi: 10.1080/10408398.2022.2051163.
47. DIETARY SPECIES RICHNESS 48-64 DSR 64-72 DSR 72-81 DSR ≥81 DSR <48 DSR PLoS Med. 2021 Oct 18;18(10):e1003834. doi: 10.1371/journal.pmed.1003834 DSR: Dietary Species Richness, the # of different (whole or minimally- processed) foods per year 37% reduction in all- cause mortality with ≥81 foods per year
48. DIETARY SPECIES RICHNESS • Dietary Species Richness ≥ 81 reduces all-cause mortality by 37%. • Accounting for: sex, age, study center, smoking status, educational level, marital status, physical activity, alcohol intake, total energy intake, Mediterranean diet score, red and processed meat intake, and fiber intake. • High Dietary Species Richness also reduced deaths due to: • cancer • heart disease • respiratory disease • digestive disease • No one food group was responsible for the dietary diversity benefits. Our findings support the potential of food (species) biodiversity as a guiding principle of sustainable dietary recommendations and food-based dietary guidelines. doi: 10.1371/journal.pmed.1003834
49. *TOTAL* DIETARY DIVERSITY • A 2022 meta-analysis that included data from 20 longitudinal studies found: • high dietary diversity reduced all-cause mortality risk by 22% compared to low dietary diversity • high dietary diversity reduced cardiovascular disease mortality risk by 17% • high dietary diversity reduced cancer mortality risk by 10% • vegetable diversity only accounted for a 5% reduction in all-cause mortality risk Crit Rev Food Sci Nutr. 2021 May 27:1-17. doi: 10.1080/10408398.2021.1925630
50. WHY DIETARY DIVERSITY MATTERS • More diverse diets are higher quality and more nutrient-dense • J Am Diet Assoc. 1987 Jul;87(7):897-903. • Dietary Diversity Scores can be used as a proxy for nutrition, with low scores equating to malnourishment and high scores equating to healthy diets • BMC Res Notes. 2012 Aug 29;5:469. doi: 10.1186/1756-0500-5-469. Proc Natl Acad Sci U S A. 2018 Jan 2;115(1):127-132. doi: 10.1073/pnas.1709194115. Mean Adequacy Ratio
51. EAT THE RAINBOW Health outcomes that are improved by multiple pigments include: • body weight • lipid profile • inflammation • cardiovascular disease • type 2 diabetes • cancer • total mortality Molecules (Basel, Switzerland), 27(13), 4061. doi: 10.3390/molecules27134061 42% of health outcomes are improved by color- associated pigments
52. DIETARY DIVERSITY GOALZ • Evenness is also important, meaning that high dietary diversity is a consistent feature of your diet • What’s a good goal? • ≥12 different foods per day • ≥35 different foods per week • (weekly goals are more important than annual goals) Crit Rev Food Sci Nutr. 2023;63(25):7837-7851. doi: 10.1080/10408398.2022.2051163. Count all whole and minimally processed food ingredients you eat.
53. WHAT COUNTS AS DIETARY DIVERSITY? • YES! Count all whole foods! • e.g., count chocolate, coffee, chicken, cheddar cheese, etc. • e.g., count each type of green in a spring mix, or each nut in mixed nuts • e.g., count each herb and spice you use to season a dish (except salt) • YES! Count different varieties and cultivars of the same plant food • e.g., count both purple carrots and orange carrots • e.g., count both Fuji apples and Granny Smith apples • e.g., count broccoli and cauliflower and kale and cauliflower • YES! Count different organs from the same animal • Optional: you may even count different cuts of meat, like chicken breast versus chicken thigh
54. DIFFERENT WAYS TO APPLY NUTRIVORE 1. Develop a basic understanding of what nutrients do in the body, what foods contain them, and how to combine different foods to get the full range of nutrients our bodies need. 2. Use tools like the Nutrivore Score, the Nutrivore Meal Map, and the Nutrivore Weekly Serving Matrix to track nutrient density. 3. Simply focus on the 3 eating patterns for lifelong health: whole foods, eat plenty of veggies and fruit, and eat a diverse diet. Pre-order BONUSes! https://nutrivore.com/book
55. WHERE TO LEARN MORE • Nutrivore: The Radical New Science for Getting the Nutrients You Need from the Food You Eat • Coming May 14th, 2024!!! Pre-order BONUSes! https://nutrivore.com/book Dr. Sarah summarizes the current nutrition research in an engaging narrative, chock full of interesting tidbits, historical anecdotes, and practical advice. —Dr. Terry Wahls