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Diet, Dreams, and Nightmares

In the process of creating ONQI 2.0, we are obligated to look at how the algorithm handles every food, including all of the quirkiest foods. In doing so, I wind up learning all of the intimate details about foods I could not otherwise have cooked up in my nightmares.
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NuVal began as, and remains, a dream of mine -- a dream about helping everyone find and choose better foods, and in the process, putting pressure on the food industry to offer better foods in the first place. They'll stop selling what we stop buying, after all.

This was a dream born initially of frustration. I have been caring for patients for over 20 years, and placing an emphasis on the power of lifestyle -- and diet in particular -- as medicine. Some of my patients were not all that interested in the work required to transform the debacle of a typical American diet into what I deem the richly rewarding opportunity to love food that loves us back. The patient is the boss -- so it's entirely up to them.

Most of my patients, however, have been interested, but that hasn't meant they've managed to get there from here. Between their efforts and my counseling, and the promised land of dietary pleasure in the pursuit of health and health from the pursuit of pleasure -- lay the constant shadow of food industry distortion, if not deception.

We've all seen, for example, those lively and engaging commercials for kids' breakfast cereals that unfailingly end with the very reassuring "fortified with ## essential vitamins and minerals; part of a complete breakfast!" But those added nutrients could easily be obtained either from actual food in which they occur naturally, or from a multivitamin, without the need to eat something much like multi-colored jelly beans and marshmallows, pour milk over it, and call it breakfast. Yes, it is potentially part of a complete breakfast -- the stupid part.

Perhaps most people with average intelligence and common sense could learn to see through such deceptions, although it doesn't help that the commercials are aimed as much at our 5-year-olds as they are at us. But this is just the tip of a marketing iceberg, and the myriad, subtle deceptions under the water line are apt to get the better of even the savviest shoppers. When I first proposed the project that became the Overall Nutritional Quality Index (ONQI) algorithm, and then NuVal, to the U.S. Secretary of Health, I told the tale of how my wife, Catherine -- Ph.D. in neuroscience from Princeton University and all -- would at times struggle to pick out the most nutritious bread.

So the ONQI was built. And NuVal was born. (It works like this: 1 to 100, the higher the number, the more nutritious the food.) And we've since shown the system to work as intended, to effect real benefit for real people, to shift sales patterns to higher-scoring foods, and to correlate significantly with the health outcomes that matter most. So I still have a dream of helping everyone who cares to find their way to better diets, and better health, one well-informed choice at a time -- and evidence that dream can come true.

But I'll be honest: Increasingly, NuVal isn't just about my dreams. Increasingly, NuVal is costing me sleep, by haunting my nutritional nightmares! Because NuVal is a large and clear window to a world of Frankenfoods; it's a magnifying glass for all the ghastly efforts to put the "die" in diet.

This is particularly true right now because my team and I are updating the ONQI algorithm to reflect the latest dietary guidelines and Dietary Reference Intakes, and to incorporate the most current science into what we are calling ONQI 2.0. It was always our intent to update and improve the algorithm periodically, rather like the iPhone. Even very good engineering can be improved -- both from advances in relevant science, and just from the insights gained from extensive use.

In the process of creating ONQI 2.0, we are obligated to look at how the algorithm handles every food, including all of the quirkiest foods. That's the window I'm talking about -- I wind up learning all of the intimate details about foods I could not otherwise have cooked up in my nightmares.

What do I mean? Well, for starters, how about fat-free, sugar-free, calorie-free barbecue sauce. Think that over for a minute, and ask yourself: What possibility is there of any actual "food" in such a product? The answer is none -- but the product itself is for sale, on supermarket shelves, masquerading as a food. It's not the worst.

Reviewing test scores for ONQI 2.0, my lead research dietitian recently brought to my attention fat-free, sugar-free, calorie-free nut butter. It goes without saying that the product contains no actual nut, nor the butter from any. Honestly, I don't know what the hell it actually is; I only know it is called nut butter, and sold as such. Frankenfood! Not a week goes by I don't learn about some new monstrosity masquerading as food. My sleep is suffering for it!

Of course, such foods are the reason a system like NuVal is needed in the first place. If there were just foods, and no Frankenfoods, we could choose to eat just food, not too much, mostly plants.

I could have been an apostle of Pollan's pithy counsel, and spared myself literal years of often excruciating effort involved in building and testing the ONQI, establishing some means to get it into the hands of consumers, adapting it to deal with every bizarre creation masquerading as food, defending it against critics with ulterior motives, and keeping it fully current with nutrition science -- if only such "either/or" choices were even remotely realistic. Alas, they are not. Our food options make 50 shades of gray look like black and white.

Lentils, for instance, are on every nutritionist's and every foodie's roster of star players. So far, so good: Lentils are real food. But dried lentils come in a bag with a nutrition facts panel. Cooked lentils can come in a can, with added salt, and potentially a variety of other ingredients. Lentils can be an ingredient in many other dishes, from breakfast cereals to veggie burgers. And lentils may be one item in a multi-component, pre-packaged dish. And in a world of nut-free nut butters, who knows what kind of pseudo-lentil might lurk around the next corner.

Across this spectrum are entries with stellar nutritional pedigrees, and others -- well, not so much. And let's be clear: So far, we are only talking about lentils! Start with any pure food, and you get the same kind of ramifications.

So unless "eat food" means avoid lentils because they and their many uses are just too confusing, we really cannot act on such simplistic either/or guidance. Good food choices start with knowing what is good, real food -- but then require knowing something about nutritional quality as good foods are put into combinations ranging from good, to bad, to downright ugly.

That, of course, is where NuVal comes in -- and the very thing it was designed to do. I truly wish it weren't necessary to use a GPS-like system to find better nutrition. But across an expanse of tens of thousands of choices in every supermarket, and hundreds of thousands of choices in the food supply at large, it just is. I am currently writing the third edition of a nutrition textbook for health care professionals. I have studied, researched, advocated, and practiced excellent nutrition for decades -- and, honestly, I find myself confused at times by the choices, and NuVal very helpful.

I also find it imperfect, of course. It's imperfect partly because our knowledge of nutrition and health is imperfect. It's imperfect partly because the available nutrition information about our food supply is imperfect. And it's also imperfect in the same way that any GPS system is imperfect. Sometimes you know a better way (or think you do). Sometimes you just prefer a better way. Like GPS, NuVal doesn't tell you what to do; it just tells you what's what, using the best available information in an objective, standardized way. At any given intersection, you can decide to go another way for reasons of your own.

Michael Pollan wisely advises us to eat food, not too much, mostly plants. Brian Wansink cleverly brings our mindlessness and vulnerabilities out of the shadows. Michael Moss provocatively informs us how the food industry has engineered food to be addictive. David Kessler explains how the food industry has us overeating by design. Marion Nestle tells us our food guidance has been contaminated by politics. Melanie Warner shows us the systematic sabotage of our children's lunches. Mark Bittman tells us how to be moderate, and simplify, and blend the pleasure of food with health.

I can add that certain food industry elements are ever at the ready to devise a new Frankenfood to exploit the acute concern du jour or popular preoccupation. Worried about sugar? We'll take it out of our barbecue sauce. Averse to fat and calories? We'll remove those from our nut butter (along with the nuts).

And I can append that even devoutly fastidious foodies may at times cross into the world of challenging choices. They/we may at times want to pick out a breakfast cereal, or bread, or something with lentils, or a sauce, or even a nut butter. We might all readily learn that a barbecue sauce with no oil, no sugar, and no calories that isn't just water -- must be a chemistry experiment masquerading as food, and that it's still better than a nut butter with no nuts. But somewhere along the line, the choices might get tricky even for the best of us.

I have not renounced my dream of people getting to better diets and better health. I retain the dream of helping people make it so, one well informed choice at a time. Any dream worth having is worth fighting for.

But I do have a unique window now on the reality of our food supply, since the ONQI has been used to score over 100,000 foods, and foods so called. Looking through it, I am obligated to concede that in many ways I could not even have imagined, our food supply really is a nightmare!

Of course, we could banish monsters and bogeymen from the foodscape by rejecting them at every checkout counter. In our collective might as the source of the food demand, we could put sanity and safety back into the supply, but putting the nuts back into nut butters. We could terminate the nutritional nightmare. And so, my plea is please shop accordingly. Because we all deserve to eat better food -- and I need the sleep.


Dr. David L. Katz;

Dr. Katz is the principal inventor of the Overall Nutritional Quality Index, and Chief Science Officer for NuVal, LLC.

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