How to Eat Healthy and Live Longer
A simple scientifically proven nutritional score can help
In theory, a healthy diet is easy to define: fewer carbs, saturated fats, and salt; more vegetables, plant oils, and fruits. Theory is easy, the devil lies in practice. As a physician, I am often asked to give advice to patients — and sometimes to their relatives as well — about a healthy diet. The short answer stated at the beginning of this paragraph doesn't cut it for the majority. Knowing which dietary components to avoid and which to consume is one thing, to be able to identify actual edible food with the right proportion of the desirable and non-desirable fractions is easier said than done. What do we do when faced with such a conundrum? We turn to math — only the counting part I promise, lest you return to watching cute puppy videos on Youtube.
Your food’s got Grades
Take your favorite food packet. Be honest, nobody is judging you. Now calculate the amount of good and bad nutrients in 100g of the food item. This is the method developed by the British Food Standards Agency (FSA) for their nutrient profiling system (NPS), which is widely adopted by European countries for grading the nutrient quality of food items and beverages.
The Bad Nutrients
Sugar; sodium; saturated fatty acids; and energy. Each one of them is scored on a scale of 1 to 10, based on their amount present per 100g of a food item. The final score obtained by adding the individual ones is termed the ‘A’ points.
The Good Nutrients
Protein; fruits, vegetables and nuts; and dietary fiber. Each group can have a maximum score of 5 — again — based on their amount or percentage present in 100g of an item. Their combined score yields the ‘C’ points. Subtracting the C from A points gives an overall nutrition profile score of the food item in question, which is an indication of its nutritional quality. Foods with a score of 4 or more are labeled ‘less healthy’. For beverages, a score of 1 is sufficient to merit this dishonor.
The Nutri-Score — Nutrition Profiling Score for Dummies
Now, armed with the knowledge of calculating the nutritional value of food, what are you going to do with the delicious-looking Chick-fil-A waffle fries in your hand? Of course, you are going to eat it. If you tell me you would tap the calculator app on your phone and start counting its nutrient grades, then I would say you are either a saint or you have lost your sense of taste. The point is, numbers and calculations stand little chance in front of the mouth-watering aroma of cheesy burgers, even when they hold the promise of a long life, less prone to cancer and cardiac diseases. Numbers are boring; calculations even more so. You need fire to fight fire. Against the irresistible scent of delectables, flashy colors might work. And they are easier to understand too.
A screaming red label might be able to persuade you to pick kale for dinner instead of ordering a chicken pizza with extra cheese, whereas a sober-looking ‘12’ would be difficult to interpret and less likely to tip the scales in favor of kale. The French public health authority devised such an easily understandable and simpler version of the nutrient profiling score (NPS). It is called the Nutri-score and uses a color scheme to grade food items into one of five groups, labeled A to E. “A” is green and means ‘more healthy’, in contrast to E denotes the ‘least healthy’ and is bright red. Nutri-score is widely adopted in European countries including France, Germany, and Switzerland, but what is the proof of its validity? Follow along to find out.
Diet, Disease, and Death — The Evidence
Spinach is healthy, goat cheese is less so. This is an accepted fact and the Nutri-score tells us so too. But how much ‘unhealthier’ the cheese actually is. It’s not often feasible to predict exact figures on an individual basis say, for example, how much taking an ounce of goat cheese, with its 6 grams of saturated fats, will increase your chances of dying of a heart attack. What we can establish with considerable certainty, however, are associations between disease or death risk and certain foods, through population-wide studies. The Nutri-score was found valid in predicting such risk associations between food and cardiac diseases and a variety of cancers in several studies, done mainly in France. A much larger, Europe-wide study, focusing primarily on mortality risk, was published recently in the British Medical Journal.
More than 500,000 individuals were recruited from 10 European countries and followed for a median duration of 17 years. A duration long enough to provide fruitful data regarding the risk of chronic disorders — like cardiac disease and cancer — and death. The nutritional quality of each individual’s food is presented as the dietary index, which is calculated using the FSA-NPS system mentioned earlier. A low index means high nutritional quality and vice versa. The researchers found the following results:
- The overall diet of study participants in Spain, Greece, Norway, and Italy had superior nutritional quality (lower dietary index) compared to the UK, Sweden, Netherlands, Denmark, Germany, and France.
- On average, participants with higher dietary indices (and thus lower nutritional quality) were more likely to be smokers, consume high levels of alcohol, observe a sedentary lifestyle, ones with higher education, and a history of cancer.
- Talking of death, a higher dietary index was associated with higher all-cause mortality (excluding deaths due to external factors like accidents). Moreover, a higher index also increased the risk of death due to specific causes — cardiovascular, respiratory, and digestive system diseases and cancer.
The association between poor nutritional quality diet and cardiac diseases, metabolic disorders, and cancer is already well established. This study, in addition, highlights and gives credence to the increasing awareness that respiratory health is also associated with diet. Several studies, for example, have suggested the detrimental effects of saturated fats and processed meat on respiratory health including, but not limited to, the exacerbation of asthma symptoms.
The bigger picture
On a global scale, it has been estimated that one in five deaths is attributable to poor diet. In other words, 11 million deaths could be prevented each year with healthier diets. The death toll from the current pandemic recently crossed the 1 million mark. The purpose of this comparison is not to undermine the lethality of the coronavirus, but to highlight the deadly aspect of poor nutrition quality food. Simple labeling information like the Nutri-score could go a long way in enabling people to make healthier food choices. While some companies provide Nutri-score labels on their food packages, none of the European countries has made it mandatory.
This piece is already 5 minutes long. I would stop now, my Popeye’s chicken sandwich is getting cold. If only a screaming red label was there to prevent me from eating my way to death.
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