Nutrition GPS For All: Appraisal, By The Numbers

07/28/2016 12:43 pm ET Updated Jul 29, 2016

What is, to the best of my knowledge, the world’s best GPS for nutrition ― or, more specifically, the most robustly validated nutrient profiling system ― is, at long last, available to all* via website and app. Yes, I noticed the asterisk, too ― we’ll get back to that.

First things first: What is a nutrient profiling system?

The term is used to refer to programs ― usually algorithms of some kind- that render a verdict about the nutritiousness of a food based on its profile of specific nutrients, such as protein and sugar, vitamins and fiber, and so on.

Yes, those nutrient details, and more, are available on the Nutrition Facts Panel of every packaged food here in the U.S. However, there is a big difference between bits of information, and a full understanding. There is a big difference between facts, and the interpretation of those facts.

Consider, for instance, your friend who has high blood pressure; type 2 diabetes; and coronary artery disease. Her main dietary concern for the first is sodium; for the second, it is probably added sugar and both the quantity and quality of carbohydrate (and maybe glycemic load, if that information were available); and for the third, it might be the kind and quantity of fat. Now consider a choice of breakfast cereals, or pasta sauces, or salad dressings, or breads, or any other food product in any other category. The one with the least sodium has the most sugar; the one with the most sugar has the most fiber; the one with the least fiber has the best fats; the one with the worst fats has the lowest sodium and sugar… and so on. Which, overall, is the best choice for your friend’s well being?

I have written three editions of a leading nutrition textbook, and frankly, when the choices vary for better and worse simultaneously across a wide array of nutrients, there are times I can’t answer the question ― and certainly not in the time most of us are willing to spend picking an item off a supermarket shelf. Maybe I could answer it after hours of analysis, but who wants to spend hours picking out a pasta sauce? A nutrient profiling system answers exactly that question ― or should ― at a glance, just as a good GPS system turns the complexities of satellites and trigonometry into a simple, actionable message: turn here, now.

Second things second: Which is the system in question?

The system I am talking about ― the “best” system ― is called NuVal®.

Perhaps the single, proudest achievement to date of my 25-or-so-year career in public health was leading the development of the Overall Nutritional Quality Index algorithm, or the ONQI®. That effort, which was completed in 2006, involved an illustrious team of colleagues from throughout North America, who worked closely with my staff and me for two years.

When we were done, we had a sophisticated formula that incorporated more than 30 nutrient properties of a food (including glycemic load), weighted each one for its health effects, and generated a number on a continuous scale, the higher that number, the higher the overall nutritional quality of the food. My original intent had been to give the system to the FDA. When that didn’t work out, because the system went beyond what the agency was willing to do at the time (and perhaps even now), a private company called NuVal, LLC was formed to license the program into supermarkets. The NuVal® system uses the ONQI to rate all foods on a scale from 1 (least nutritious) to 100 (most nutritious). The ONQI has been providing nutrition guidance to shoppers in nearly 2,000 supermarkets throughout the U.S., including Big Y and Price Chopper in my home state of Connecticut, for years.

Now, at last, the system is being made accessible to everyone as an interactive website and an app, called NuVal Empower. I have been advocating this for years, and frankly, am delighted.

Lest you think I am delighted for dubious reasons, I hasten to append third things third: I have no financial stake in the new offerings, or the business of NuVal, LLC.

As the principal inventor of the ONQI, I was compensated for my work over a span of years. But I have no stake in the business operations of NuVal now, and have not for quite some time. I do, however, have a permanent stake in the mission the ONQI was designed to serve in the first place: facilitating better diets, and better health, one well-informed choice at a time. Ultimately, that in turn serves the overarching objective of my career, and I suppose, my personal ambition of helping to add years to lives, and life to years ― while doing something to preserve the habitability, and hospitality, of this beautiful planet of ours.

So, no ― I will not benefit personally if you subscribe to the new NuVal offering. But you and your family might, and that’s the point.

Why these new offerings now? There are two main reasons why it has taken nearly a decade before NuVal at last became accessible on-line. The first is that the business side decided from the start to place particular emphasis on use in supermarkets, and for some time, wanted to favor that use with exclusivity. More importantly, from my perspective, is that the past decade has been used both to fortify the resources on which NuVal depends, and the science proving its value.

Regarding those resources, NuVal houses what is, to the best of my knowledge, the largest, most detailed, most current, and most carefully reviewed nutrient database in the world. That’s because well over 100,000 foods have been scored, each matched to highly specific identifiers, including those bar codes we all know and love. For every item in that vast database, there are over 30 nutrient entries. It’s a veritable treasure trove of nutrient information, and it took a lot of years and a lot investment to get it there.

Regarding the science, the case after ten years is rather clear: NuVal is the most robustly validated nutrient profiling system on the planet. My own lab ran, and published, initial validation studies. Much more important, though, is the work of scientists completely independent of NuVal. A study out of the Harvard School of Public Health in over 100,000 people showed that NuVal scores correlated with both chronic disease rates, and all-cause mortality: the higher the average scores of foods consumed, the lower the rate of dying prematurely from any cause. To the best of my knowledge, NuVal was the first nutrient guidance system ever to clear that bar.

Numerous other studies since have shown that NuVal works just as intended where the rubber hits the road. It is easier to use and understand than any system to which it has been compared, and much more useful than the standard nutrition facts panel. It leads reliably, and consistently, to better food choices by individuals, and it shifts sales overall to more nutritious foods. My group has also published a paper showing that the more nutritious foods to which NuVal leads do not, on average, cost more. The anecdotes are impressive, too. We have heard from people who attribute losing more than 100lbs to NuVal guidance, and trading up their groceries.

Fourth things fourth: yes, of course, NuVal has its detractors. The main group that doesn’t much care for it is the makers of junk food. They have tried to kill it by various means over the years, such as advancing alternative, and useless, systems of their own. That effort has failed.

There is also opposition from those who mistake their own, impassioned opinion ― expert, or otherwise ― about any given nutrient for nutrition science, and the weight of evidence. Some, for instance, think any alternative to sugar is a good alternative. Others think that artificial sweeteners are the worst thing in the food supply. Some think all fat is bad fat; others think good fat is the best thing going. NuVal scores may not fully satisfy any given person’s array of preferences, any more than a GPS system is guaranteed to present every person’s favorite route. Both forms of GPS ― navigational, and nutritional ― are designed by teams to use the best available information, and get you there. If you prefer another way, go ahead and take it. Both systems help you get there, but neither is designed to tell you where you want to go.

There is also opposition born of misinformation. Some of this is due to genuine misunderstanding, and some of it, I think, is from the “we don’t like Katz, so there must be something wrong with this” crowd. You cannot be as public with your opinions as I am, for as long as I have been, without garnering your share of opponents. I have mine, and they are prone to be noisy.

But the criticisms of NuVal are invalid. No, NuVal is not unfair to dietary fat: harmful fats are penalized, beneficial fats are rewarded in the scores. No, NuVal is in no way gentle to sugar. The two most severely penalized nutrients in the algorithm are trans fat, and added sugar. While NuVal addresses total sugar, too, it has differentiated added sugar for years before the FDA decided to do the same.

There are, as well, respected colleagues who think that such detailed guidance to “better” packaged foods is a sorry substitute for avoiding packaged foods altogether. But the choices people make are inevitably subordinate to the choices people have. While the world’s Blue Zones may offer wholesome, unprocessed foods as the cultural norm, the rest of us are not so fortunate ― and have to find our way to good nutrition past an array of bags, boxes, bottles, jars and cans ― some of which offer excellent contents, and some of which offer very much the contrary. The Blue Zones don’t need a system like NuVal; but the laudable Blue Zones Project has a very long way to go before we can say the same here.

Nor is it a valid criticism to note that NuVal addresses foods, rather than the whole dietary pattern. It is, of course, the overall dietary pattern that matters most to health ― just as it is the things you do and places you go over the course of your lifetime that matter far more than any one trip. But if today you have an appointment at an unfamiliar address, you don’t need guidance about the pathways of your life; you need guidance to that one destination. Similarly NuVal is designed to do what it does in the context of other, excellent guidance about the overall dietary pattern that would make for the best, lifelong destination. No one tool, however good at what it is designed to do, is designed to do everything that matters.

But now fifth, and last, things fifth and last: there is that asterisk. The NuVal Empower system is a subscription offering, and comes with a subscription fee. I am very pleased to report there is 30-day free trial; you can take advantage of that by sending an email to empower@nuval.com with “free trial” in the subject line. You should hear back in due course, with instructions for enrolling.

Ultimately, though, on-going use of the system comes at a cost, and that cost, while not very high, is a concern for my public health aspirations just the same.

The harsh reality is that the families who need guidance to better nutrition most urgently are often those that can least afford food, let alone a subscription-based app to guide them to it. The answer, then, and what I hope will be the next phase for NuVal and public health, is for employers, insurers, and the government to subscribe to NuVal Empower on behalf of their clients, to whom they pass it on without cost. Why should they? Because those clients will cost them a lot less if they eat better, and develop significantly less chronic disease. Everybody can win.

A better diet is one of the most powerful steps any of us can take toward better health. I am delighted to help announce there is an empowering, new way to help you get there from here.

 

-fin

David L. Katz

Director, Yale University Prevention Research Center; Griffin Hospital
President, American College of Lifestyle Medicine

Senior Medical Advisor, Verywell.com

Founder, The True Health Initiative

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