Recently, I interviewed Dr. Sarah and we discussed the Nutrivore principles, the concept of nutrient density and why it matters, how the Nutrivore score works, the value of a diverse diet, common misconceptions about certain foods, the roles of macronutrients and micronutrients, balanced eating patterns, sustainable nutrition practices, and more. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
I am beyond excited to have the following conversation with our repeat guest, Dr. Sarah Ballantyne, as we will be chatting about her new book Nutrivore, which is one of the most comprehensive and well-researched books related to nutrient density. Let me go ahead and dive into Dr. Sarah’s impressive bio.
Dr. Sarah Ballantyne, Ph. D, is the founder of Nutrivore.com and New York Times best-selling author of Nutrivore: The Radical New Science for Getting the Nutrients You Need from the Food You Eat. She creates educational resources to help people improve their day-to-day diet and lifestyle choices, empowered and informed by the most current, evidence-based scientific research.
Dr. Sarah began her career as a science communicator and health educator when she launched her original website in 2011. Since then, Dr. Sarah has continued to follow the science, diving deep into immune health, metabolic health, gut microbiome health, nutritional sciences, and the compelling evidence for health at any size while also observing the harm of healthyism, diet culture, dogmatic misinformation, and predatory marketing.
With Nutrivore, Dr. Sarah has created a positive, inclusive approach to dietary guidance based in science and devoid of dogma, using nutrient density and sufficiency as its basic principles, nourishment, not judgment. Welcome, Dr. Sarah.
Dr. Sarah Ballantyne:
Thank you so much for having me back.
Dr. Eric:
Very excited to speak with you. We were chatting before about how I listened to the audiobook, which I thought was truly amazing. You did a great job. Really enjoyed listening to it. I will read the print book, too. The audiobook is just a lot easier when making smoothies and doing other things.
Dr. Sarah:
Yes. Lovely to make that driving time also productive time, to be able to listen to a book. I do the same.
Dr. Eric:
Exactly. Let’s dive into nutrient density. Why is nutrient density so important? If you could also explain the difference between nutrient deficiency and nutrient insufficiency.
Dr. Sarah:
The 30,000-foot view answer is our bodies need nutrients. Nutrients are what we’re made of. They are used up in all of the different chemical reactions that keep us alive. We need to be continuously topping up our nutrient stores from the foods we eat. That’s why we eat. It’s not just for energy; it’s for all of these different resources, all of the chemical reactions that make us us. That’s why we need vitamins and minerals and other essential fatty acids, essential amino acids.
We’re at an interesting moment in time where even though most people have enough food, the nutrient density of that food, meaning how much nutrients there are for the amount of energy that food has, for most people, it’s not enough. We’re getting enough energy, most of us, but we’re actually not getting all of those building blocks, all of those chemical resources that our body needs in order to be healthy.
What happens when we don’t have those nutritional resources is it puts a strain on all of the different systems in our body: the cardiovascular system, the immune system, the neurological system. That strain builds up over time when those parts of our body don’t have the things that they need to function optimally. It’s like driving a car without oil. It’s going to create this wear and tear. Eventually, the engine will seize. That’s what happens to us.
But like a car needs more than oil, it also needs gas, etc. We’re the same. We need those nutritional resources. We need energy. Then we also need sleep and activity and our stress not to be crazy. We also have genetics and epigenetics that are factors. What high quality motor do we start off with? That also interacts with social determinants of health, things that are influencing our health that we have no control over.
Altogether, that is what leads to the car breaking down. That is what leads to some kind of chronic condition or even increased risk of infection. Nutritional resources play a really important part, even though they’re not the whole picture in terms of what influences our health.
Most of us are not getting all of the nutrients that our bodies need to be healthy. But it’s not solo that we develop a disease of deficiency. That’s where the difference between deficiency and insufficiency comes in.
We don’t see a lot of scurvy nowadays. We don’t see a lot of Rickett’s or beriberi or pellagra. These are diseases of malnutrition that are caused by incredibly low intake of essential vitamins. If our intake is so low in Vitamin C, we can develop this thing called scurvy, where we have bleeding gums. Maybe if it’s bad enough, our teeth will fall out. There’s a rash. There’s various distinctive symptoms.
Instead, we are in what’s called the insufficiency range. Our intake of these essential nutrients is high enough to avoid diseases of malnutrition that used to be very common. They are not very common anymore. It’s still falling short of what we need. That is the range called insufficiency. We could also refer to it as a dietary shortfall. We are not quite getting as much as we actually need in order for all of our biological systems to have all of the nutritional resources they need to function well and hopefully reduce our risk of disease instead of increase it.
That weird gray, in-between, where we are not getting enough, but it’s still enough not to have this really obvious disease of malnutrition. What is so insidious about it is we don’t recognize it. There’s very vague symptoms if there are any symptoms at all. It might just be a little bit of fatigue, or maybe you get stressed out more easily, or maybe we have a little brain fog. Maybe there is nothing. Maybe there’s absolutely no obvious symptoms of these nutrient shortfalls. But they’re there. That wear and tear is still happening. That’s still interacting with all of these other risk factors to potentially lead to poor health outcomes.
We don’t recognize it because we don’t feel nutrient insufficiencies. We would feel a nutrient deficiency. We would have a disease of malnutrition. Nutrient insufficiency is weird, like you are not getting enough sleep, but you’re not so sleep-deprived that coffee isn’t enough to get you going in the morning. It’s that same kind of weird in-between, where it’s increasing risk of bad things happening, but it’s not obvious to us walking around in day-to-day life that that is this thing happening in the background that is going to catch up with us eventually.
That’s why nutrient density is so important. We want to be able to get the recommended dietary allowance of all of the essential nutrients. There is a lot of non-essential nutrients that are still really important for reducing our risk of long-term health problems. When we can understand what nutrients do in the body, what foods contain what nutrients, what different types of foods we want to be eating so we are getting the full range of nutrients our body needs, that is my goal with Nutrivore.
Then, within our other dietary priorities, within our budgets, within the foods we have access to, it’s pretty easy to make some small changes, not to have that thing happening in the background of nutrient insufficiency to be a contributor to long-term health problems. Instead, we can be getting all of the nutrients that we need, improving our long-term health, never having that moment where those nutrient shortfalls catch up with us.
Dr. Eric:
Thanks for that explanation. I like the analogy with sleep you made. I was going to ask you about the Nutrivore philosophy, but you answered it with that response.
Some people might already be familiar with the Nutrivore Score. I want you to talk more about that. I find that fascinating. The goal obviously is not just to focus on the foods highest in Nutrivore, but just like you said, you want to try to get a good variety of foods. Still, it’s nice to see the rankings, see what’s highest.
For those who are not familiar with the Nutrivore Score, why don’t you talk more about it?
Dr. Sarah:
If we think of Nutrivore as the goal of getting all the nutrients our body needs from the foods we eat, that is the overarching principle of Nutrivore. The follow-up question is how do we do that?
The Nutrivore Score is one tool of many. It is not the only thing we want to look at as you already alluded to. It is quite simply a way of quantifying the nutrient density of foods, which is scientifically defined as nutrients per calorie. You can think about it as the quality of the calorie of food. How many nutrients am I getting for each calorie in this food?
There are limits. It doesn’t tell us what nutrients we are getting. It’s total nutrients per calorie. It doesn’t tell us nutrients per serving. We need extra information on top of the Nutrivore Score to be able to work that out. It’s a great way to identify those foods that are really nutritionally important. Foods that have a ton to offer us per calorie.
You can divide those foods into two buckets. There are the foods that have a ton to offer us per calorie but also don’t have a lot of calories. Vegetables would fall into that range. Fruit in general would fall into that range.
Then what are the foods that do have more calories but are still so valuable? Even more nutrients for each calorie. That is where I would put seafood, nuts, and seeds. Foods that are calorically dense, but those calories are so worth it because that food is contributing a lot of nutrition in addition to energy to our overall diet.
That is what the Nutrivore Score is about. It’s about doing some math and figuring out what foods have the most nutrition to offer us per amount of energy it offers us. That is one tool for achieving that Nutrivore goal among others, like identifying overall eating patterns, identifying foundational foods. There are lots of other ways we can get more sophisticated.
If we are going to talk about nutrient-dense foods being valuable, we need a way to identify what those are that is objective. Prior to the Nutrivore Score, in our broader wellness community, there have been a lot of us talking about the importance of nutrients and nutrient-dense foods for a long time. The only way we could identify what foods are nutrient-dense is to look at a list of nutrition facts and see, “Yep, that looks good! That looks like a nutrient-dense food.” We didn’t have a way of actually mathematically defining it.
We have had a lot of foods over the years that have reputations for being nutrient-dense, some of which are. But when you actually crank the numbers, some foods are better than you would have thought based on the gut check of looking at the nutrients per serving. Some foods are not as good as you would have thought. It’s about bringing in a more objective lens to that identification of nutrient-dense foods rather than it just being “This feels like a valuable food.” It’s being more sciencey.
Dr. Eric:
Makes sense. I know we both said you don’t want to just focus on the top Nutrivore Score foods. That being said, I’m sure some people want to know what are some of the top Nutrivore Score foods? There might be some surprises that people aren’t expecting.
Dr. Sarah:
There is lots of surprises. All of the really top scores are all very low energy density foods. If we are going to define nutrient density as nutrients per calorie, which is not my definition, it’s the scientific community’s definition. Then that means that a food that doesn’t have a lot of calories doesn’t need to have as much nutrition in order to have a really high score. A food that has a lot of calories needs to have a lot more nutrients in order also to have a high score.
This is why I am not going to choose between watercress or liver on my plate, for example. They are not going to give me the same nutrients, and they are not going to contribute the same amount of nutrition to my overall diet. One is a very low energy density food, and one is a very high energy density food.
I like to use the Nutrivore Score practically by identifying simple swaps. What could I have in place of a dinner roll that is going to have more nutrition? A baked potato will double my nutrients per calorie. What could I have in place of a baked potato? A baked sweet potato. It will double my nutrients per calorie again. What could I have in place of the baked sweet potato? Let’s go for butternut squash. That is about 50% more nutrients per calorie.
Identifying those easy places to swap something out that occupies the same role in the overall meal rather than saying, “I am going to look at these top 10 Nutrivore Score foods and just eat those.” If we did that, we would find ourselves in a position where we are only eating these very low energy density foods, and we wouldn’t be getting that full range of nutrients that we need.
The fun thing about this calculation is I would have never guessed what the most nutrient-dense food is. If you’d asked me, I would have said something like kale or liver. Those are extremely nutrient-dense; they’re very high. But the single most nutrient-dense food is canned clam liquid, which I do not want us to start a trend of drinking canned clam liquid. That is not what this math is designed to do.
But the reason why canned clam liquid is so high is it’s very low energy density. It’s about five calories per cup. That cup of canned clam liquid has 500% of the daily value of Vitamin B12. Plus lots of other vitamins and minerals. It has a ton of nutrition but also not very many calories, which is why it has such a fantastic Nutrivore Score.
Leafy vegetables in general tend to have really high scores. The next highest food is gardencress, which is not very common in North America but is a grocery store vegetable in Europe. It’s very peppery, arugula’s very angry big sister. So peppery. I have grown it myself because as soon as I saw the math, I needed to know what that tasted like.
Watercress is up there. Rainbow chard is up there. Coffee is up there. It has a ton of polyphenols, some B vitamins, and one or two calories per cup. That is another good example of those foods that have really tremendous scores, even though they aren’t contributing a ton of nutrients because typically, we would only have a few calories’ worth.
Of the foods that are doing both, contributing a ton of nutrients per calorie but also just a ton of calories to our diet, that is where you see foods like organ meat, shellfish, seafood in general, root vegetables, fruit, legumes. Legumes are very nutrient-dense. That is where nuts and seeds fit in. Those are all the foods that offer a lot of nutrients per calorie as well as nutrients per serving.
Dr. Eric:
When it comes to the vegetables in the Nutrivore Score, is that based typically on raw vegetables compared to cooked?
Dr. Sarah:
You can look up the Nutrivore Scores of close to 8,000 foods on my website, Nutrivore.com/Search. There, I have Nutrivore Scores of every form that I have enough nutrition data to do the calculations. Raw broccoli but also boiled broccoli with salt and boiled broccoli without salt. I can’t remember if broccoli in the microwave. Frozen broccoli. There is a ton of different broccoli forms.
Canned green beans along with frozen green beans with fresh green beans. Canned green beans drained along with canned green beans not drained. You can fall down the rabbit hole of the math and see how the nutrient density differs a little bit with different cooking methods.
Overall, those differences are not meaningful. You are getting roughly the same nutrition having your broccoli raw versus steamed versus roasted versus boiled versus in a stir fry versus blended into your smoothie. However you want to eat it, that is a nutritious vegetable. It has a lot of beneficial things.
When I am comparing foods, for example, there is an appendix in the book that lists the Nutrivore Score of 700 common foods, mostly whole foods. In that case, I just put in the score for the raw, whole version. That gives us a really good benchmark to compare to because cooking can be complex.
Some foods might be more nutrient-dense cooked one way and less nutrient-dense cooked a different way. It’s partly because we are all in the noise in terms of nutrients per calorie when we are comparing those very small differences. Some nutrients go up a little bit when you cook, and some can be lost. They are more lost if it’s a high water technique.
It’s all fascinating if you are a data nerd like I am. Not the type of detail that the average person just looking to increase their nutrient intake needs to worry about. It’s much more beneficial at that point to see that broccoli has a Nutrivore Score raw of 2,318. It’s a fantastic food. The cool nutrients that it has that benefit your health are these types of phytonutrients called glucosinolates. That is plenty of information to go, “Broccoli is great,” and eat it however you like from there.
I do have the math on those differences. It’s a little bit of a level of attention to detail that doesn’t have a meaningful impact on diet quality at the end of the day.
Also, I think it’s where the Nutrivore Score gets into gamification in a way that is not healthy. One of the things that I really struggle with in terms of communication, and I am really trying, is to share this really cool thing that the Nutrivore Score tells us. It’s fascinating. It’s really fun to compare different foods and go, “How cool is it that cantaloupe melon has double the nutrient density as honeydew melon?” That’s interesting.
How cool is it that strawberries are more nutrient-dense than blueberries? That doesn’t go with what we’ve heard about blueberries being so amazing. Yet strawberries are even more amazing from a nutrient density perspective.
I love sharing those types of fun facts. But I think it’s really important to caution against a really simplistic view of food. Swapping out our old view of calories or carb grams to the Nutrivore Score. That’s not what we want to be doing with that. We don’t want to just choose the highest Nutrivore Score foods.
It’s really important that we don’t use the Nutrivore Score to try to moralize foods. That’s a real problem in the diet culture and wellness community at large. There are always these lists of good foods and bad foods, yes foods and no foods.
The biggest thing I’ve learned in building Nutrivore is when you look at the full database, all 8,000 foods, that’s something you can download and peruse if you join my Patreon. It’s a 227-page table. You can scroll through it. You see quickly that all foods lie on a spectrum. There is no line where you can say, “All of the whole foods are above this line, so above this line is good. All the ultra-processed foods are below this line, so we can say below this line is bad.”
You start to see there are some whole foods with much lower scores, but they are still nutritionally valuable. They still have science showing they are beneficial. There are ultra-processed foods that have higher scores. A lot of breakfast cereals have high scores. Thanks in part to fortification. They are still beating a lot of whole foods in terms of their nutrients per calorie.
When you start to let that fact sink in, you go, “Oh, there is no line. There is no above this is good and below this is bad.” There is this whole range of gray, where you then start to see the benefit of a varied diet, where we are eating a lot of different foods. You start to see the importance of proportion of food in the whole diet. “Is this food contributing nutrients to my whole diet? Am I eating so much of it that it’s displacing other nutritionally important foods?” We give ourselves permission in that once we have that realization to stop viewing any food as good or bad and start viewing eating patterns as health-promoting or not.
That is also where the Nutrivore philosophy lies. It’s not in Yay to this food and Nay to that food. I understand where the Nutrivore Score intuitively aligns with moralization of foods. That’s not where we want to go with it. We want to actually use it as a tool to get over moralization of foods.
There are so many rumors online. Iceberg lettuce is the nutritional equivalent of cardboard, that it’s just crunchy water, that it’s a waste. Why bother eating it? It has more nutrients per calorie than cucumber, celery, or artichoke. It has a lot of valuable nutrition. That’s how I want the Nutrivore Score to be used. Drop our moral judgment of iceberg lettuce as being nutritionally pointless, and view it as a nutritionally valuable food, helping us to get over those moral judgments rather than propelling them.
Dr. Eric:
It comes down to variety. I always thought the same thing, too, with iceberg lettuce. I don’t want iceberg lettuce if I have a salad, not knowing it is more nutrient-dense than celery and some other foods. I would never have guessed.
On a side note, we’ll bring this up again later. You mentioned the Patreon, which I am a member of. Definitely recommend joining Sarah’s Patreon. Great value.
Macro nutrients. You have a chapter on macronutrients, micronutrients. With macronutrients, you get, just like anything else, different perspectives. Eat a high fat diet. Eat a high protein diet. Low carb diet. Just like with what you spoke about with the Nutrivore score, don’t just focus on high Nutrivore Score foods. Same thing with macronutrients. It’s about balance.
Dr. Sarah:
Yes, I agree completely. I think of Nutrivore as a diet philosophy rather than a diet or a diet modifier. It’s a focus on more nutrient-dense foods and getting the full range of nutrients that we need that can be overlaid on top of other dietary priorities.
If you have other recommendations from your doctor to focus on certain types of foods or to limit other types of foods, you can still apply the Nutrivore philosophy on top of that. If there are certain foods you don’t eat for religious reasons, or you’re allergic, or you just have a diet that you really resonate with, that you really like, that has worked really well for you, you can apply Nutrivore on top of that. You could be a Nutrivore vegetarian.
Nutrivore is a way of focusing food choices. There is a default state, which is balanced macronutrients. If you have medical reasons for following a low carb diet, or it’s something that’s worked really well, you could be Nutrivore low carb. That is something that could happen.
What would then happen is you would use Nutrivore as a way of identifying those nutrients that are a lot harder for you to get on a low carb diet. There is a list for all of the main, major, popular diets in chapter one of the book, of the nutrients that are hardest to get on those dietary templates.
On this diet, I am going to struggle to get fiber, if we are talking about low carb because that is one of the hardest ones. What are the foods that I can eat that are going to match my other dietary priorities but help me achieve that Nutrivore goal of all of the nutrients that my body needs? How am I going to get this fiber? Nutrivore can be used to improve the quality of however you eat now, whatever your preferred diet is, or even anti-diet. It’s very aligned with intuitive eating for example.
What is Nutrivore without other dietary priorities? Without other reasons for choosing foods, what I think of as the default mode. What does Nutrivore look like right out of the box? It just opened. What is the shiny new Nutrivore? That is macronutrients. A proportion of the diet that is protein, carbohydrates, and fat, falling within the accepted macronutrient distribution ranges. That is set by the Institute of Medicine. Those are the happy mediums for approaching carbs and fat that studies show reduces risk of long-term health problems the most.
Also, one of the things that goes into that calculus is the fact that we tend to get certain types of micronutrients packaged with certain types of macronutrients. Carbohydrate-containing foods tend to be plant foods, root vegetables, fruit, and legumes. There are certain vitamins and minerals and fiber types and phytonutrients we are getting from those types of foods. That actually is a thought process that goes into the accepted macronutrient distribution ranges. Those are the ranges that make it easiest to achieve the Nutrivore goal.
Not low or high of anything is where the starting point is on Nutrivore. Not that we can’t apply Nutrivore to a macronutrient manipulation diet. The default is balance.
Dr. Eric:
Makes sense. Micronutrients. The audience consists of those who have a thyroid or autoimmune thyroid condition. Feel free to focus on other minerals as well. Brazil nuts are fascinating to the thyroid community. They love to eat Brazil nuts for selenium. Of course, you not surprisingly spoke about selenium and Brazil nuts. Some also wonder if you can eat too many Brazil nuts. From what you said in the book, if you eat more than 10 every single day, that might be problematic. If you are eating three or four a day on average, probably not a big deal. Or even 10 every now and then usually isn’t an issue, correct?
Dr. Sarah:
Correct. If I had to distill the message that I’m trying to give with my book to one sentence, it would be: Why should I care about nutrients? Me the reader, why should I care about nutrients? The entire book is geared at helping you care.
It’s about understanding the role of nutrients in that big picture, but also making the value of nutrients personal. What I do to achieve that goal is in the second part of the book, the chapters are organized by nutrient type. Macronutrients, vitamins, minerals, and phytonutrients. Each chapter is a series of short stories, where I examine the link between one specific health condition or symptom and one nutrient. To round out that resource, there is a table on the appendices that lists all of the nutrients that have been strongly associated with 120 different health conditions and symptoms.
If you have thyroid problems, here is why selenium is so amazing. With thyroid, you get a twofer because I also talk about the discovery of iodine in the introduction in the minerals chapter. And how that related to treating goiter, which is fascinating history. Then talk about how selenium is important for thyroid function.
Brazil nuts is by far the most concentrated source of selenium. After that, seafood is our main source. Brazil nuts are so concentrated. Even though we don’t see selenium toxicity in practice, even in communities that are eating a lot of Brazil nuts, it is, at least on paper, possible. It’s something for us to be aware of. You can overdo any food, but there are certain foods. I highlight them all in a section in the book where I talk about the tolerable upper limit.
The three foods that really come up again and again, which is really easy to overdo these foods, and it’s really easy to hit a potentially toxic level of a certain nutrient. Brazil nuts potentially have too much selenium. Certain types of seaweed, especially kelp, can be extremely high in iodine, which is relevant to people with thyroid problems. Then liver can be so high in Vitamin A and copper that you can hit hypervitaminosis A, which is Vitamin A toxicity, or copper toxicity. A serving or two per day will get you there. With kelp, even half a serving a day. Some varieties of kelp are extremely high in iodine. With Brazil nuts, about 10 Brazil nuts per day.
There is not too many cases in the medical literature of nutrient toxicity from foods. Foods seem to have competing nutrients that will compete for absorption, which blocks us from absorbing too much. They tend to have more synergistic amounts of different nutrients in food. We tend not to have to worry about getting too much of any nutrient when we are focusing on getting our nutrients from food. That is usually something you only have to think about in terms of supplements. Except these few foods that really can deliver too much of a good thing.
With Brazil nuts, three or four is well in the range of a good amount of selenium. One is actually more than enough to hit your selenium for the day. 10 is right at that chronic toxicity level for selenium.
Fun fact: One of the symptoms of selenium toxicity is garlic breath without the garlic. If that’s a thing that’s happening, I would talk to your doctor and get tested for selenium levels.
Dr. Eric:
You mentioned foods higher in iodine. That is a controversial area in thyroid health also. Kelp is the main type of seaweed. The other ones don’t have nearly as much iodine where it’s a concern for those with Graves’.
Dr. Sarah:
Yep.
Dr. Eric:
Wonderful.
Dr. Sarah:
At one point in the book, I had a graphic representation of the iodine content of different sea vegetables. It got removed for a variety of reasons. In the interest of not having complicated graphics that need a lot of explanation.
Really the only one there that we need to worry about is kelp. The most common varieties of seaweed, like nori sheets that sushi is made out of, you don’t need to worry about that. You can have a serving or two of that every single day, and you will be just fine.
The thing with all nutrients is we want to stay in that happy medium. We want to be getting enough and not too much. We want to hit the recommended dietary allowance while staying well clear of the tolerable upper limit.
Iodine is fascinating because both too little and too much iodine affects thyroid function, hence all the controversy.
What is fascinating about iodine is we don’t have a complete data set in terms of how much iodine content there is in different foods.
Also, the iodine content of food varies geographically. This is why there was a goiter belt prior to iodized table salt in the United States. It’s because there was this region in the upper Midwest where the iodine content of the soil was so low that those crops grown in that soil didn’t have very much iodine. The animals feeding off of those crops, the chickens eating that corn, their eggs didn’t have much iodine. There wasn’t much iodine in the food supply.
Iodine is a weird one because it varies so much, depending on growing conditions in different foods. We don’t have good nutrition data for a lot of different foods in terms of iodine. It’s actually really hard to gauge iodine intake for the average American. Is it in the happy medium range? Is it not enough? Is it way too high? That also helps with the controversy, I think.
Dr. Eric:
Yeah, I agree. One of my favorite chapters in the book was the myths. I was going to bring up this myth last, but I am going to bring it up now because it ties into what we were talking about, which is goitrogenic foods. The myth of eating broccoli and inhibiting thyroid hormone production. You mentioned not only that being a myth, but I’m pretty sure you said even if someone is low in iodine, that is usually not a concern.
Dr. Sarah:
This was one of the fun things about writing this myth-busting chapter. I initially didn’t intend the myth-busting section of the book to be an entire chapter. Then as I started, I had this list of myths that I knew were things I had bought into in the past, which I knew were really important to include in the book from my own narrative story arc. I also wanted to make sure that I was busting all of the most prevalent myths about foods that are among all different diets right now.
I talk about why red meat is probably not bad for you, but also busting the myth of plant toxins. Talking to a wide variety of communities in that chapter.
The reason I realized it had to be a whole chapter is the philosophy is designed to be a landing place on the other side of diet dogma, of misinformation, of all of the things that we learn from different fad diets that are actually wrong, not supported by the scientific literature, and hurting us healthwise.
Nutrivore is as much to me the solution to diet culture in general and how to understand how to eat a higher quality diet without depriving ourselves of our favorite foods, so we are setting ourselves up to eat that higher quality diet sustainably for the rest of our lives.
It’s as much about understanding food outside of these moral judgments. In order to create that clean slate, to be able to view foods in this new, simpler way, and this new, non-judgmental way, I realized I had to at least briefly, with some citations for the people who want to dig into it in a lot more depth, bust all of the myths that come from not just our corner of the wellness community, but from all corners of the wellness community.
Among those was plant toxins in general and foods like soy and cruciferous vegetables being goitrogenic. What’s fascinating is a lot of those myths come from some time prior to the science that would have supported them ever being performed. They are myths that became common knowledge before there would have actually been the discovery that would have said yes or no to that myth.
Some of them come from science. They come from early scientific studies that you would interpret one way, and more science comes, so you go, “Actually, now we know better.” Some of those myths actually come from early studies.
The goitrogenic cruciferous vegetables is one of them. That myth originates from these early studies done in rabbits that were eating a ton of cabbage in an area with iodine-depleted soil and developing goiters. The idea being okay, now we can identify in cabbage, iodized sulfinate interfering with thyroid hormone production. Aha, we have our goitrogens in this cabbage. Therefore, people with hypothyroidism should not eat cabbage.
Then the science started to evolve. Those rabbits also had low iodine, so there is this series of studies done using the isolated compounds where they gave it to animals with iodine deficiency or not. That is where the surprise was, oh, we can’t actually explain why these rabbits had goiters. It must have been more complex than just the cabbage. When we give this to rats, it doesn’t actually cause hypothyroidism with or without iodine.
Then we have this collection of human clinical trials, where people are given what were thought of as goitrogenic compounds. In a Petri dish, yes. They for sure interfere with thyroid hormone production. In the complex human being, they don’t seem to.
In humans, we have a radish sprout extract or broccoli sprout extract. These supplements were given to humans. We see that it doesn’t impact thyroid hormone function at all.
We now have this collection of science that refutes these early studies. That’s why reproduction in science and building on our knowledge is so important. We never just want to do one study and go, “Aha, now we know this thing.” Can we reproduce this? Does it work in other animals? Does it work in humans? Does it work in this dose or that dose? Does it work in this context or that context?
That’s why understanding science as an iterative expansion of human knowledge is really helpful for understanding the evolution of these myths, and then being able to be receptive to where scientific consensus leads once we have a big enough body of scientific literature to support that. Being receptive to that is the answer to this question once we can say for sure that’s the answer.
Dr. Eric:
Even before listening to your book, I did some research. Personally, I haven’t seen a problem in most people with cruciferous vegetables. I still encourage people with Hashimoto’s to eat broccoli and other cruciferous vegetables.
I don’t know when I told you this last year when I interviewed you. With hyperthyroidism, in the past, I intentionally had people take larger amounts of cruciferous vegetables to see if it would suppress thyroid function. It didn’t. I actually tried to test the goitrogenic properties, see if it had those goitrogenic properties. I agree with what you said.
Dr. Sarah:
It would be lovely in the context of Graves’ to have such a simple solution, wouldn’t it?
Dr. Eric:
Exactly.
Dr. Sarah:
I actually think it’s sad that it didn’t. It would have been a nice thing just to be able to say, “You have Graves’. Eat all the Brussels sprouts.” That is where the scientific studies are, too.
Dr. Eric:
There are other interesting myths, like it’s fine to eat non-organic foods. It sounds like you will choose organic, but it depends on the situation. If the non-organic produce for example looks better than the organic produce, you mention that you will go for the non-organic produce.
I do agree to some extent. I definitely recommend organic. The #1 thing is whole, healthy food. If that’s all they can afford is non-organic produce, they are still eating whole, nutrient-dense foods. To me, that’s still okay. I’ll let you expand on that because it was very interesting.
Dr. Sarah:
We have this collection of studies that show that organic foods are healthier than conventional. The couple of meta-analyses that have been done that look at the body of scientific literature as a whole.
What’s so important about meta-analyses is they do a couple of really important things. They look at everything. What are all the studies that have looked at this question? What do they all say together on average? They pool together all of the data from all of these different studies, so they have a much larger data set. They have much higher statistical power that is really important.
They also include a step where they evaluate the quality of studies. They look for things like: Was this controlled properly? Was this blinded properly? Nutrition studies are tough to do blinded because you know what you’re eating. Did this have an appropriate control? Did the statistical analysis include these types of corrections? They will include stuff like that.
Right now, there is only a few meta-analyses that are actually looking at this question of organic versus conventional. In this particular field right now, there is not really good, really big studies yet, so we definitely need more studies. The ones that have been done don’t control for healthy user bias very well. Healthy user bias is something that we see in epidemiological studies. You have to control for it in your statistical analysis. Even then, sometimes, it’s so impossible to get rid of this residual effect.
What it refers to is a person who does a lot of things that are good for their health that is associated with this one thing. A great example is the studies are now showing that red meat is probably pretty health-neutral and is a really good source of some important nutrients that a lot of people are short on. That’s where this science comes from.
Red meat has been demonized as a cause of cardiovascular disease for 50-60 years. A long time. Now, somebody who’s health-conscious is putting a lot of effort into their health. Someone who is more likely not to eat a lot of red meat. People who don’t eat much red meat are much more likely to eat a lot of vegetables, to be more active, not to smoke, not to drink. They are also more likely to have social determinants of health working in their favor, so they are more likely to come from middle class, not to be poor, things that are really important for overall health. They are more likely to have quality medical care.
These big studies will try to account for as many of these factors as we can. They will do these complex statistical analyses, where they go, “What is the effect of red meat if we control for BMI and annual income and age and gender and race and ethnicity? Then we will also control for activity, smoking status, etc.” They add all of these things together. Once I have controlled for everything else, is there still an effect?
The problem, when so many different health-promoting behaviors stack, there is a residual. Even if the statistical analysis is saying, I am going to control for all of these different things, there is a leftover. You still see this signal of organic foods are better than conventional.
One of the things that these studies don’t control for is diet quality. They are just looking at if this person is eating organic or conventional. They are not looking at how much vegetables or seafood or legumes they are eating. That is something we also see.
Again, it’s healthy user bias at work. Someone who eats more organic food is more likely to have more money and actually more likely to be younger and female. Females have lower risks of a lot of health problems compared to males. They are more likely to be active, not to smoke, not to drink. All of these things stack.
Where the science is at right now is it’s not clear that organic foods are better. They don’t seem to be worse. It’s really those overall eating patterns that matter.
For me and my life, I grow a lot of my own vegetables now. I have been growing my own vegetables for about four years. Every year, I add a bed to my vegetable garden. My plan is to keep doing that until it is too big, and I can’t keep up.
Every year, I add 15 more square feet, which is one more. I will dig it out and make my garden bigger. Every year, a bigger percentage of the vegetables my family and I eat come from my own backyard.
In my backyard, I grow organically. Part of that comes from the studies on pesticide use show that as an occupational hazard, absolutely. Also, pesticide use in home gardens can be a risk factor for a bunch of health issues. That level of exposure, even if it’s not occupational, can still be a problem.
In my garden, I just sacrifice a certain percent of my vegetable yield to slugs and aphids. It just is what it is.
In the grocery store, I would say I buy more often conventional than I buy organic now. I tend to go for organic. Sometimes, organic looks so much better. This week, the organic asparagus was only a dollar more, but it looked just amazingly so much better than the conventional asparagus. That is typically when I will buy organic in the store.
Also, most of my vegetables are organic because they are coming from my own garden now.
Dr. Eric:
Makes sense. For the sake of time, I will refer the listeners to your book for the other myths. Canned foods and BPA and raw versus pasteurized milk. There is plenty of great and interesting information.
As we wrap things up, if you could just talk about how people could apply the Nutrivore principles. How can people get started?
Dr. Sarah:
The easiest first step depends on where you are now. You can get incredibly sophisticated. I have weekly serving targets of 12 different foundational food families if you want to get into the weeds in terms of making sure you’re getting that full breadth of nutrients.
The easiest place to start is just focusing on those overall eating patterns. There are three overall eating patterns that we know from every scientific study ever performed. They support long-term health and reduce just about everything that can go wrong with us health-wise.
The first is to get ideally at least 80% of our calories from whole and minimally processed foods. That can include canned foods. That can include frozen foods. A lot of those are minimally processed. If it’s just green beans, water, and salt in that can, that is a minimally processed food.
Actually, nutrient retention is the cool thing of the Nutrivore score. It shows us nutrient retention in canned foods is actually way higher than I would have thought. I would have thought you would lose a lot of nutrients in canning. We don’t; it’s fascinating. That’s eating pattern #1.
The other 20% can come from anything that we like. Obviously that we are not allergic or intolerant to or we can’t eat for whatever other reason. 20% is really important for the sustainability part of an overall healthier diet. Worth a slight tangent.
One of the goals of Nutrivore is sustainable nutrition. Higher diet quality that doesn’t leave us feeling deprived, that doesn’t have us doing the diet rollercoaster, the on again/off again, yoyo thing. It has to necessarily then be a diet where we are enjoying the foods we eat. It is not taking too much time or energy or money in order to continue to eat that way.
In my life, that has also meant being very intentional to incorporate what I refer to as quality-of-life foods. These are treats in my life. It’s dessert. For me, that’s what it is. It’s foods that are really tasty, not objectively nutrient-dense by any stretch, but they’re foods that make sure I am getting enough joy from my diet that all of those other healthy choices are easy to keep going with.
Under that same umbrella is permission to cook vegetables in ways that you enjoy. One of the most toxic messages from diet culture is this idea that a healthy food doesn’t count if we’re enjoying it. Salad only counts if it’s plain. Vegetables only count if you are gagging them down.
We can absolutely add salad dressing or other flavorful ingredients to a salad that doesn’t take away from the nutrients in that salad. That salad dressing will actually make some of the fat-soluble nutrients easy to absorb. There are benefits to adding salad dressing.
All of that is under that first dietary pattern. If that’s the only place you start, that can be fantastic. It can be a big shift for a lot of people to reduce ultra-processed food intake and eat more whole foods. That is why I would recommend and think it’s important to talk about doing that in a way that is intentional, to make sure we are still getting joy from food.
Thes second eating pattern that is really important for overall health is dietary diversity: eating a wide variety of different foods. This is fascinating. I am working on a video to answer a question on social media that is tackling this topic. At the end of the day, I am so tired. I don’t have much energy. It’s really easy to eat the routine thing I always eat. There is actually a lot of benefit to routine as well.
Finding where we can increase dietary diversity in a way that again makes sure we are keeping it sustainable. It’s not taking too much time or energy or financial resources to do. What are the ways where we can mix it up in a way that still fits with our other constraints, the other things that we need to maintain our time and energy and money for?
Ideally, maybe it’s something to 30-35 different foods in a week. That sounds like a really big number. Getting a different variety of apple counts. Spices in your food count. Every single way that we can mix it up counts.
The reason why that is such a great eating pattern is diversity of foods tends to mean diversity of nutrients. It tends to lower the chances that there are shortfalls of any one nutrient if we are eating a wide variety of food.
The third eating pattern that is really important to work on is eating lots of fruits and vegetables. Ideally, the science is mixed on this. I interpret it as five or more servings of vegetables per week. A different scientist might look at it and say three or more is great. I always like to couch that because five servings of vegetables per day can feel extremely intimidating for some people. If three is an easier place for you to start, then three is a great place to start. Someone could also make a strong case for three being a great serving target for vegetables.
Then two or three servings of fruit is the Goldilocks zone for fruit. That is a long-term eating pattern.
Those eating patterns, it’s not counting anything. It’s not measuring anything. It’s just getting used to a slightly different meal composition. Maybe a slightly different grocery shopping list. Maybe getting used to cooking at home more often. Those overall eating patterns get us most of the way to Nutrivore.
Then we can get sophisticated. That gets us most of the way. All of those eating patterns are beneficial above and beyond just also being nutrient dense.
Dr. Eric:
All right. Whole foods, variety, and eat your fruits and veggies. This was amazing. Thank you so much for sharing. If you could let people know where to find out more about you. Obviously, your book is Nutrivore. Make sure to share your Patreon. I told you that I am a Super Nerds tier member of that. Right now, I’m telling people where they can find you. I’ll let you take over.
Dr. Sarah:
Thank you. My new book is called Nutrivore: The Radical New Science for Getting the Nutrients You Need From the Foods You Eat. It is available wherever books are sold. Any online bookseller. Many local, independent bookstores. It might be at your local library. If it’s not at your local library or local bookstore, you can also put in a request to get it in, whether you want to purchase it or borrow it.
It’s available in hardcover, digital format like Kindle, or audiobook, which I narrated myself. It’s also accessible in whatever way you like to read books.
Everything we talked about today is in the book. Plus 100x more. That is the most comprehensive resource I have for Nutrivore.
I also have a website, Nutrivore.com. That is where the most academic articles live. That is where if you want to know everything that Vitamin C does in the body, you can read about every single thing Vitamin C does. There is over 60 articles on different nutrients on the site right now.
It’s also where you can learn about every nutrient in different foods. If you want to know everything that is in iceberg lettuce, you can see that. There are lots of other practical strategies and Q&As on the site.
It’s a really humongous resource. My team and I are adding to it almost every day still. If something that you are looking for is not there, come back and check again later because it almost certainly will be very soon.
My Patreon is a wonderful community of supportive people like you who are really into Nutrivore.
I also create resources every single month specifically for my Patreon family. I create an e-book every single month. Right now, we are doing the rainbow series. I know what’s coming next, but I’m not quite ready to announce it. I am even more excited about what’s coming next in e-books.
I podcast every single month. We are going to start doing weekly videos, answering questions.
I also have what’s called a Nutrient Fun Fact sheet. It’s a two-pager of the most important things about a nutrient. There is a different nutrient featured every month. It’s in bullet points, so you don’t have to read detailed articles.
Also, recommended dietary allowance by all of the different age and gender groups.
Tons of great resources for Patreon. Tiers start as little as $3 a month. It can be a great place to come hang out with other nutrient nerds, all for the price of less than a coffee nowadays. I used to say $3 a month was the price of a coffee, but coffee is more expensive now. It’s 2/3 of a coffee, which helps support me and my team continue to build out the website.
Dr. Eric:
Check out her amazing book, her website, and become a Patreon member. She puts together amazing videos.
Dr. Sarah:
I didn’t even say social media, did I?
Dr. Eric:
YouTube, so much valuable information.
Dr. Sarah:
I realize the other place to get more information, I’m @DrSarahBallantyne on YouTube, Facebook, Instagram, Threads, Pinterest, and TikTok. I actually post different content on all of those platforms. Wherever you like to hang out, there’s something there for you. If you hang out multiple places, I have different things for you. There is a lot more bite-sized content in those places.
Dr. Eric:
Thank you so much, Dr. Sarah. This was a great conversation. Really enjoyed listening to your book. I’ll also read it as well. Thank you so much for your time. This was great.
Dr. Sarah:
Thank you.
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