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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.

Vitamins: Four carotenoids are listed individually, but retinol itself is missing in the “Vitamin A” category. Even so, vitamin A’s close friends count four times as much as any other named nutrient. B vitamins are lacking pantothenic acid (B5) and biotin (B7). Vitamins D and K are missing, even though some pretty good vegetables–like broccoli and cauliflower–feature vitamin K and a few offer vitamin D.

Minerals: Potassium, which most Americans get too little of in their high-sodium processed diets, is left out of the mix of minerals (calcium, iron, magnesium are present), but selenium, which is toxic in more than trace amounts, is present.

Phytochemicals and not-quite-nutrients: Glucosinolates, the bitter compounds in brassicas (broccoli, cauliflower, etc.) are toxic in large amounts. They’re currently thought to be protective against carcinogens in sub-toxic doses, but the scientific evidence is not solid and none of the federal public health agencies are recommending them at this point. Lycopenes (in tomato and berry skins) are trendy with health food claims and thought to be mildly cardioprotective, but the scientific evidence is again not particularly conclusive. Resveratrol, a similarly vaunted phytochemical in grape skins and red wine (not included in the ANDI list), has recently been shown not to have significant protective effects in properly designed trials.

Antioxidants: the “ORAC score” lumps together a group of curiously unnamed phytochemicals for which there’s no established RDA on the assumption that they’re there and that they’re good for you. The ANDI designers attempt to calculate the antioxidant capacity of each foodstuff in terms of projected intake goals. Antioxidants in food are another questionable though long-fashionable criterion for food value, with recent clinical trials data showing inconclusive cardioprotective effects and an increase of harmful side effects for megadoses of antioxidants such as tocopherols (Vitamin E). To double the weight of the ORAC score, even if it’s calculated correctly, in the mix of ANDI scoring components is not particularly valid. Not to know or name the phytochemicals you’re including is even less so.

But that’s the micronutrient list. What about the larger concepts implied by the ANDI scoring system?

Here we have two or three assumptions that don’t work quite as advertised.

First, the ANDI scoring system assumes that micronutrients are what counts most in food value. The list contains nothing about protein, which most people would consider an important nutrient. It does include fiber.

Second, the list accounts only for positive characteristics, not negatives, so it’s silent on total fats, saturated fats, total carbohydrates, starches and sugars, and sodium.

Most confusingly, however, the ANDI system calculates nutrient density per calorie, not per serving. This makes it possible to consider leafy greens (ANDI scores from 600-1000) a better nutritional bargain than, say, olive oil (9). But you could have figured that out anyway, and servings are how people actually eat. Going by calorie is bound to distort the value of each item in people’s diets.

A few examples of the strangeness:

Because protein is disregarded, something like avocado, which is pretty fatty for its nutrient density, still ranks in at about 100 (out of 1000), while an egg scores 27 and tofu not much better at 30-ish.

Kale and bok choy come in at near 1000 points each on the ANDI scale–and they’re genuinely good vegetables. But they’re so low in calories that assessing micronutrients per calorie inflates their actual value at the dinner table. One of the sample meals on Eat Right America’s web site calls for three bunches of kale–for only four people. That’s pretty expensive for a single dish, and maybe unnecessary to fulfill the RDAs the team has in mind for these vegetables.

In short–you have a system that on the surface looks like it promotes vegetable consumption and a better-balanced and more nutritious diet. And perhaps if you don’t take the rankings too literally, the general idea is okay. The methodology is highly flawed, though, and displays signs of nutrition-fad marketing. The prescriptive regimens for both Fuhrman’s and Eat Right America’s companies are quite a bit more expensive than they need to be and both contain hidden agendas to push products that undermine the overall stated goals for teaching you how to eat better.

Perhaps this isn’t all that surprising–commercial diets are rife with evangelists and hucksters who spout all kinds of theories. This isn’t the worst, really, and it’s somewhat close to reality (as opposed to the “eat right for your blood type” fantasy). Who are the people behind ANDI and what are their actual credentials?

Eat Right America’s corporate team bios page gives very little confidence that they know much about nutrition in the professional, scientific sense.  Marketing, check. Business, check. Computers, check. Certified Holistic Health Coaches–all with psych degrees–check. Their token MD is a head and neck specialist. Not one of the team is an actual registered dietician or has as much as a master’s degree in nutrition.

And Fuhrman isn’t a formally trained nutritionist either. He’s a family physician but he’s not board-certified in nutrition, hasn’t got another nutrition-related degree from an accredited university, and his own prescriptive regimen shows the personal biases noted above. His research methods are somewhat loose scientifically–a few are actually not much better than straw polls drawn from his site members, even though they were accepted for publication through peer review.

His web site has text claiming he doesn’t distort any nutritional study findings and has nothing to gain. The FAQ page advice he gives actually looks all right on the key cardiovascular risk factors. He expresses  a few fishier or perhaps wishier fears about specific foods–fish, olive oil, tofu–but on the whole, most of the explanations look surprisingly okay. Certainly better than I was expecting after having reviewed what Eat Right America made of his system.

But his diet–the stringent part of it, the one that’s supposed to last the first 6 weeks of your new nutritarian life, reminds me of nothing so much as the Duke University Rice Diet (rice, peaches and sugar, and eventually supplemented with a few B vitamins). The Rice Diet started out in the mid-1940s as a last-ditch effort to save hospitalized patients with malignant high blood pressure and kidney failure. No sodium, no protein, incredibly bland, and barely enough calories to maintain weight because after a full day of that diet, you just wouldn’t want to eat the whole allotment. For those patients it worked–they shed a lot of the water weight they were carrying, and then some of their extra fat, and their hearts, which were enlarged from having to pump extra fluids under edema conditions, shrank back down to normal.

But then in the 1960s someone in Hollywood decided it would be the perfect quick weight loss regimen for their actors and the money and fame started rolling in. What had been an extreme-measures hospital diet for those near death’s door was now a fashionable and exclusive crash diet, damn the risks, juggernaut which completely turned the administrator’s head as he became a punitive weight loss cult leader–the details of his conduct toward patients came out in a lawsuit in the early 1990s. Despite the infamy and the shaky scientific foundation, Duke continues to promote and profit from the diet with minor tweaks.

Fuhrman’s diet has more vitamins and minerals and somewhat less carbohydrate but the makeup of the diet is pretty similar in terms of protein and sodium (the one real plus).

And then again–Fuhrman’s claim that he has nothing to gain is blatant long-form direct sales copy. Dig into the site at all and you find out what’s driving all of this fervent fitness evangelism. Items for sale include, first and foremost, site membership–$3.95 a month or $39.95 a year. Fitness and lecture videos–10 DVDs per set, about $150 (slightly less with membership). The famous book (about $40, also less with membership, but less still on Amazon).

And–this is the kicker–multivitamins and nutritional supplements in vegan form. Am I wrong here, or wasn’t the whole point of nutrient-dense vegetable-forward eating to get those micronutrients from the food itself and eliminate the need for supplements?

This is clearly where Dr. Fuhrman’s web site is bound to profit most. Books and videos you need to sit down and read or watch. That takes time. A vitamin supplement–easy! Even though it completely undermines the message Fuhrman has set up in the main front pages of his web site.

It’s as though his marketing team had got ahead of him and decided to monetize the site with a sure-fire hit amid all the nutritarian talk that generates a dubious audience reaction in the focus groups. Certainly the 10-part lecture series on DVD and all the fitness vids go along with the image.

And what do we charge for vitamin supplements in an infomercial by a former national figure skating champion? Do we charge what they cost in a standard chain drugstore? No. Here the vitamin supplements are part of the exclusive, personally selected value package your membership gives you access to buy, and we present them like the marketing jewels they are.

A standard bottle of 100 Centrum or Flintstones one-a-day multivitamin plus iron costs something under $10, and the generic brand is probably under $5. Check out the web shop vitamin prices under the “Vitamin Advisor” tab and you see a 90-day supply of vegan-vites going for between $40 and $100. A bottle of Dr. Fuhrman’s own brand of “freshness-guaranteed, no rancidity” vegan DHA (omega-3 fatty acid) liquid with a dropper is astronomical as well. Look at the recommended number of doses of any of these items, for any age group from birth to postmenopausal, and you quickly realize that subscribing to the program has some hefty costs. Like your kid’s college tuition fund. The gullible may indeed find themselves weighing 75 pounds less after 6 months. Much of that loss will not be water weight. It’ll be wallet weight.

5 Responses

  1. Ya know, this dude wasn’t very good as a figure skater. He never made the Olympics. His career overlapped mine, and I didn’t remember him at all. I’m just saying, if he was really good, I would have met him back then at shows and competitions instead of not remembering him at all. (If I really cared, I could dig out my old magazines and not find him in those either)

    I’m sure his partner at the time knew about dieting — not the healthy sort, but the strict calorie restriction. Not as bad as gymnasts and dancers, but the girls are encouraged to keep their weight down so the men can fling them about. Admittedly, it wasn’t nearly so acrobatic back then, so it was nowhere near as bad as now.

    I personally am sticking with my generic version of Centrum, and feh to this guy’s overdoses of kale and carrot juice. I’m also going to continue to eat my carrots raw and have 2 scrambled eggs a week.

    • Thanks for catching my mistake–his site actually has a videoclip of his routine at the US Nationals–I’ve fixed the text. You were a skater? wild. Me–I’m afraid to get back on a pair of skates (and so is everyone around me), after age 14 experiences clinging to the railing long past the time when most people were stumbling to the middle. Still and all. The main idea of the diet is to lose most of the carb so you stop prodding your appetite, and I’ve done my own version successfully (1 piece of bread a day, and a lot of stairclimbing when I had actual stairs) but as lethalastronaut points out, six years later I have to go back and do it again, and figure a way to keep it going. Carb and I are clearly not meant to be. Chocolate, on the other hand?

  2. Reblogged this on Inspiredweightloss.

  3. Hi. Really, really interesting post, because I’ve got some friends who have “done Fuhrman” and lost LOTS of weight. And then had problems keeping it off. Not because they got bored of the diet or anything like that, but because they couldn’t afford to keep eating that way and had problems every time they ate out.

    One of my friends’ shopping bill shot up from $150 for the two of them per week to over $400/wk. Another friend didn’t give details for her family of four, but said “it was too costly for them to eat that way” and just stopped within about 3-4 weeks. Her husband is well paid (earns six figures) so I dread to think what they were spending.

    I’ve got Fuhrman’s books and, as you say, the principle of “eat real foods” makes a lot of sense. Fuhrman also says “make the salad the main meal” which is also a great idea, and my family and I have incorporated large amounts of salad and veggies into our daily meals and benefitted as a result. We grow our own salad veggies in summer, so this is affordable for us.

    But Fuhrman’s recipes, at least in New Zealand where we live, are mostly unusable. Many of the recipe ingredients are not available, or are prohibitively expensive. A lot use US-only ingredients, or products and ingredients that are a lot cheaper here than they are here. And they do not take into account climate – we live in a cold climate where you simply don’t feel like eating salad when there is snow on the ground and you have a log fire going!

    Kale is not available here at all. Cashews sells for $30/kg. Pine nuts sell for $80/kg. Carrot juice is $8 / litre. Pomegranate juice sells for $18 / litre. Broccoli is $3 a head, and even in season only drops to about $2 a head. Quinoa must be bought from a specialist health food store, and is also very costly. Tomatoes in winter sell for as much as $15 a kilogram. And WTF is Mrs Dash?

    So we just took what we saw was good advice from his program, and ignored the rest. Yes to real food. Yes to big salads. Yes to more veggies. Yes to making our own juices and smoothies. Yes to making our own soups. Yes to avoiding “anything with additives”. Yes to avoiding anything we can’t pronounce!

    But we do our own version of it. So we eat eggs. (In moderation). And lamb (in moderation). We grow both on our farm here. We’re not about to buy “grass fed beef” because it’s idiotic to pay for another form of meat when we grow our own lamb. And we grow our own chickens. We barter for fish from a fishing friend. But all are eaten sparingly (usually just on weekends – we’re vego in the week).

    What we’re doing now is working for us. Our friends who “did Fuhrman” are still trying to lose weight. I think the truth is, losing weight is hard, no matter what method you lose. Whatever you do MUST be sustainable long-term. And part of that includes affordability and accessibility.

    • Hi lethalastronaut–this is fascinating, particularly the info on current NZ prices! The US has close-to-slave-wages for a lot of field hands and migrant workers and we import a lot from Mexico…and Florida, which isn’t a foreign 3rd-world country but might as well be for the way field hands are paid and treated. And, at least on the west coast, we import a lot of stuff from China. So we’re somewhat insular and kept unaware of the true price of tomatoes and broccoli; they’re available year-round. Cheap(ish) nuts too. And your comments about maintaining weight loss long-term are spot on.

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