Wait. You mean nuts, beans, and whole grains aren't healthy?

Episode 11: If you don't know me well enough by now, you should know that I'm a firm believer in the "all foods fit" model of eating. But I wasn't always.

A basket of fresh basil sits on a chair next to fresh zucchini and tomatoes
What the ANDI score doesn't say about your health

I graduated from grad school with a degree in nutrition science that said, "you know what healthy food is - go forth and share your knowledge!"

My grad school education was based on the whole-food-first approach to eating, which made sense to me - still does.

But when I started working for Whole Foods Market (before the Amazon buy-out) offering education on their Health Starts Here Program, my healthy-eating ideals were challenged.

I'll never forget walking through the bulk department of the original Seattle Whole Foods Market, and having a fellow team member grab my attention by saying,

"Hey, I thought beans, nuts, and whole grains were healthy?"

Dead stop. Wait, what? I turned around and said, "well yeah, what makes you think otherwise?"

The team member was putting up signage in the department that showcased a scoring system created by one of the Whole Foods Market medical advisory board members, Dr. Joel Fuhrman, MD. The scoring system was called the Aggregate Nutrient Density Index (ANDI).

ANDI was designed as an educational tool to help consumers live up to Dr. Fuhrman's definition of health, H = N/C, meaning Health = Nutrients / Calories. As a retail partner, Whole Foods Market was adding signage throughout their stores to help shoppers easily fill their baskets with foods that promote health and well-being... at least according to Dr. Fuhrman and the other members of the Medical Advisory Board.

Since the ANDI ranks foods based on how many nutrients compared to how many calories a food has (also called nutrient density), can you guess what foods top the chart?

Yep, produce. Since fruits and vegetables are mostly fiber, water, vitamins, minerals, and antioxidants (the micro-nutrients), they rank higher because those nutrients don't have many calories - if any.

Back then, when walking around a Whole Foods Market, you'd see ANDI scores of 1000 on items like kale, collard green, lettuce, parsley, etc. The rankings went down from there dramatically the minute calories increased from natural sugars, carbohydrates, healthy fats, and protein. To the point where, in the bulk department, you'd see signs such as

Lentils 72, Kidney Beans 64, Peanut Butter 51, Oatmeal 36, Almonds 28, etc.

I doubt the marketers of the skinny almond campaign, "10 almonds a day for weight loss" would like this ranking very much. And according to this ranking system, unless you were only going to eat salads of dark leafy greens and cruciferous vegetables, you wouldn't be healthy.

To be honest I was as baffled as the other team member when I saw the signage they were posting on all the bulk bins. Here I was a trained medical professional, with years of experience in the field of food and health plus a graduate degree in nutrition science, and in good conscious couldn't support this index.

It's not that the ANDI is wrong. Yes, produce is more nutrient-dense. But, here's the kicker.

A table of people eating food at a restaurant
Eating carrots vs fries doesn't make you morally superior

As an eater, who's trying to be health-conscious and let's be honest, maybe hopes to lose a few pounds, and likely doesn't feel super about the way your body looks, how are you going to view those food rankings?

To you, and a good majority of women in the US who have tried every diet under the sun, you'll see eating that salad without any dressing or fruit or seeds or protein or carbs as being good.

"Yay, your meal just scored 1000! It has no taste and you probably won't absorb most of the nutrients because there's no fat drizzled over that pile of roughage, and you'll probably be face deep into the vending machine or candy dish on the receptionist desk by 3 pm 'cause you're starving (physically and emotionally) but yay, go you, you're amazing!"

Do you see the problem with this well-intented system?

The ANDI isn't the only tool out there trying to help you understand how to eat healthier. And there's nothing wrong with wanting to eat healthy to feel your best.

The problem, according to the research on the nutrient density approach to eating, is that there still isn't a consistent definition for 'nutrient density." The term has been loosely used to promote the Dietary Guidelines for Americans since 2010.

According to the paper by Nicklas et al (2014), the Dietary Guidelines for Americans consider 'nutrient-dense foods to be, "all vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas (legumes), and nuts and seeds that are prepared without added solid fats, added sugars, and sodium."

The paper goes on to state, "2010 Dietary Guidelines for Americans further states that nutrient-dense foods and beverages provide vitamins, minerals and other substances that may have positive health effects with relatively few (kilo)calories or kilojoules. Additionally, the definition states nutrients and other beneficial substances have not been 'diluted' by the addition of energy from added solid fats, added sugars or by the solid fats naturally present in the food."

However, the dietary guideline advisory committee and researchers have yet to come up with a clear definition of nutrient density to become industry standard for public policy, nutrition and health education, and consumer marketing.

In other words, it's been like the Wild West when it comes to defining nutrient density and trying to use tools like ANDI to promote healthy eating. Not to mention that ranking food with a numeric system wreaks of the moralistic view of health and beauty created by diet culture.

We already have enough moral judgement wrapped up in how we view nutrition labels. Isn't that enough?

Plus telling you how nutritious food is says nothing about how to check in with your body to see if you're hungry or not, emotionally distressed and drawn to food to cope, need a good night's sleep, or feel like you need to move your body.

You can't whittle down health and well-being to just eating nutrient-dense foods and only nutrient-dense foods all the time. An "all foods fit" approach means that there's room for foods that aren't nutrient superstars right alongside ones that are.

No matter how you chose to fill your plate, you're still a worthy human being that deserves to have good health from a holistic perspective - mind, body, and spirit; regardless if your meals score 1000 on any "healthy eating scale."

To get started on a more balanced approach to health and well-being, download the 6 Strategies to Savor Food Without Guilt. You'll also get weekly-ish newsletters with tips and recipes I don't share anywhere else. Sign up today and get started reclaiming your health from diet culture.

Resource: Nicklas TA, Drewnowski A, O'Neil CE. The nutrient density approach to healthy eating: challenges and opportunities. Public Health Nutr. 2014 Dec;17(12):2626-36. doi: 10.1017/S136898001400158X. Epub 2014 Aug 28. PMID: 25166614.