Is This the Best Food Score Yet? | With Dr. Ty Beal

Ty: 
They don’t belong at the bottom of the list, and that’s a bit controversial. 

Bret: 
It’s so frustrating though that that is going to have a much higher level of scrutiny and review and higher chance of rejection just because of that.

Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a non-profit initiative of Baszucki Group, where we’re providing information about the intersection of metabolic health and mental health and metabolic therapies, such as nutritional ketosis as therapies for mental illness.

Thank you for joining us. Although our podcast is for informational purposes only and we aren’t giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health.

So, what do you think? Do you need a food scoring system to tell you what foods are good and what foods are bad? You might not. And I think as a world or as a country, maybe as a world, when we look at the food scoring systems that are out there, they’re all pretty bad. So, you might want to say, “Why do we need another one?”

Today, I’m joined by Dr. Ty Beal, who is the lead author on a new food scoring system. I got to say, this one is better than any of the ones I’ve seen. It’s not perfect, and he actually even will admit that. He’ll openly admit that this is not a perfect system. But when you understand the assumptions and the inputs and what his intentions were, then you can see why this system is really so much better than the others with its addressing chronic diseases, with its bioavailability and protein and nutrient density, and all the inputs that went into it.

It really is better. Now, what does that mean? it might mean that if you are trying to formulate a diet for yourself to address psychiatric symptoms or metabolic health, that this is a list of foods that will help you see some that are above others. And it can fit a plant-based, vegetarian, omnivore, Mediterranean, carnivore.

It can help fit any of those contexts. So, as Ty says, it’s very personalizable. Now, if you don’t know who Ty Beal is, you hopefully should, he is a Senior Technical Specialist and Global Nutrition Scientist at the Global Alliance for Improved Nutrition, GAIN. He leads the Food Systems Data and Analytics sub-unit and is passionate about translating complex research into actionable insights.

And he posts a lot on his social media accounts about nutrient availability and nutrient insufficiency, not just across the globe, but even in industrialized countries, like here in the United States. And the importance of addressing that, but addressing it in a way that also addresses non-communicable diseases, chronic diseases, and metabolic health.

He is extremely well-spoken and very knowledgeable about this topic. So, I hope you enjoy this interview about this new food scoring system with Dr. Ty Beal. Many of the interventions we discuss can have potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.

In addition, it’s important to note that people may respond differently to ketosis, and there isn’t one recognized universal response.

Dr. Ty Beal, welcome back to Metabolic Mind. It’s great to see you again. 

Ty: 
Great to see you, Bret. 

Bret: 
So, I am very interested to talk to you about your Nutritional Value Score system that you just published, which I think anybody who wants to publish a nutritional value score is really just painting a big bullseye on their chest.

So, I’m curious about, that. But before we get into that, I always like to start by asking my guest what is one big main misconception in the world of nutrition, health, medicine that you really wish were different? 

Ty: 
Yeah. I think in nutrition it’s this animal-sourced foods are bad. They’re bad for human health. They’re bad for the planet.

That, I think, is a very dominant narrative in mainstream news and even among some of the sort of advocacy groups out there. So, I would just love to say, look, you don’t have to go carnivore, but animal-sourced foods have a role. Meat, fish, eggs, and dairy are nutritious foods that can be part of a healthy diet.

Bret: 
Yeah, that is a big one. That belief, that dogma that just is so pervasive. And when you really dig into it, as you have many times, it really falls apart. But it’s really hard to undo decades and decades of that sort of simplistic message. So, that’s a big one. I agree 100%.

And like you said, it doesn’t mean carnivore is the way for everybody. It doesn’t mean animal-based foods are the way for everybody, but it certainly means that they’re not by default negative and harmful. 

Ty: 
That’s right. 

Bret: 
Yeah. So important. All right. Thank you for that. Great. Now, let’s get into this bullseye that you painted on your chest.

Published in The Journal of Nutrition, Nutritional Value Score rates foods based on nutrient density and non-communicable disease prevention. So, right away, in the title, we can see how this is going to be, I think, different from prior food scores. But we’ve all seen these graphs where they list all the foods, and it’s so easy to just jump on them and tear them apart.

How can this sugary processed cereal be higher than eggs or higher than meat? And how can this food be higher than that food, right? We love to take them apart. 

Ty: 
Yeah. 

Bret: 
But really when these systems come out, it really emphasizes how it’s all based on what you put into it.

What are your assumptions? What are how are you defining it? And that is the key. So, I want to get into that. But first, rewind for a second. Like, why’d you want to do this? Why did you even want to do a nutritional value score knowing that the amount of attention and negative feedback it frequently attracts?

Ty: 
Yeah, that’s a great question. Maybe I’m a glutton for punishment? I think anytime you publish anything about a rating of foods, ranking them on a numeric scale, you’re going to have people who are very critical of that, right? And attacking it. So, I expected that, and I was not wrong about that.

I think we first met, Bret, when we were looking at Food Compass had just come out pretty recently. That was one of the early conversations we had about, I was like, this is a decent system overall, but a lot of these scores made me scratch my head. Lucky Charms scoring pretty high.

Honey Nut Cheerios was one of the top-scoring foods. And I just thought, this could be done in a better way. And I’ve been doing a lot of work on nutrient density, and I thought, why not make a more holistic score that looks at these factors and does something in a hopefully a more sensible approach?

And the work that GAIN was doing at the time, and we still are emphasizing is how do we promote more nutritious, nutrient-dense foods that are helping to meet nutrient needs and ultimately, I think, in a holistic way? Also protecting against chronic diseases, which are a huge issue worldwide, not just in the US but everywhere.

So, that’s what led me to this idea. And I think it, it was a long road to get there, starting from five years ago. But I’m really pleased with the initial results. And it’s not perfect, but I think it’s a step in the right direction. 

Bret: 
So, real quick, before we get too much into this, define nutrient density.

Ty: 
So, the common form of nutrient density is the quantity of the nutrients per unit of some sort of metric, which is usually calories, okay? So, usually, there’s something like, out of 1,000 calories, here are the exact quantities of nutrients when you average them all together. So, the higher the nutrient content per calorie, the higher the score.

That’s the common form of nutrient density. Now, there’s also this aspect of what about the breadth of nutrients? Or what about the form of the nutrients in terms of is our body going to absorb all of those nutrients? So, you could take a nutrient-dense food, like liver, which has insanely high amounts of vitamin A in the form of retinol, right?

And we may not need that high amounts, right? So, what we looked at during this sort of, we want nutrient density, yes, but we also would like to see a bit of a breadth of nutrients. Because in general, it’s better to get nutrients in regular quantities that we can make use of every day because super high quantities don’t necessarily always benefit us the way that a moderate amount of those nutrients would.

Bret: 
So, that adds a degree of complexity of how you’re going to rate that for sure. So, right away, we can see it’s not so simple. But now the other really challenging part that you put in here is how all this relates to non-communicable disease prevention, which right off the bat, it’s like how do you rate that?

How do you score that? So ,how did that factor into this? 

Ty: 
Yeah, that’s a good question. there are different components that contribute to non-communicable diseases. Things like how satiating is the food, what is the quality of the overall food, how high is the fiber content. It’s different components.

So, we have to work with the data we have, and we don’t have all the data in the world to be able to do whatever we want. But we had things like protein content and the DIAAS score we could calculate so that we could estimate the protein quality and the quantity. We had information that we could compile on omega-3 fatty acids.

So, they’re not just a nutrient density component, they’re also protective of chronic diseases, right? And so, we wanted to capture that omega-3 component. We included fiber as well because, in general, not for everyone but for most people, fiber has a positive association with health outcomes. Prevents, reduces risk of chronic diseases.

And then calorie density overall, we also wanted to capture. So, we didn’t penalize foods for having like moderate calorie density, but we did have a threshold at which once they got to very high calorie density, we said, “Okay, now we’re going to start taking away some from the score.” The last area is something called nutrient ratios.

This gets a little bit more sophisticated. We’re not just looking at the quantity of some nutrient, like saturated fat or sodium or carbohydrates. We’re looking at the ratio of those to other nutrients. So, we looked at the ratio of sodium to potassium. We looked at the ratio of carbohydrates to fiber.

Those indicate the level of processing of a food. If you ever take a plant-based product that has been highly processed and has a lot of additives, there’s very little potassium left in, even though the original plant product has a lot of potassium, and usually there’s a lot of added sodium. So, it’s an indication of that.

The last thing we did is we looked at processing. So, we gave another penalization for our ultra-processing, which I know is a controversial issue. But we felt, in general, if we don’t penalize for ultra-processing, then we’re going to have those foods like sugary breakfast cereals and Twinkies and whatnot. If they have some fortified nutrients, they can score higher than we would like them to.

So, that was the approach, and I know we can get into it. But saturated fat to unsaturated fat was a ratio we did not include originally. Because while some people, the saturated fat can be an issue for, we thought overall it’s not really the most important factor in diets, especially if you’re thinking of the whole foods sources of it.

But we had reviewer feedback, and we can get into the discussion around that where they were pretty adamant about. We should really be including this. The evidence suggests that this is an important component. So, we did include it. We incorporated it into that, but with the sort of caveat that it’s not saying that all saturated fat is the same. And it’s not saying that everybody has the same disease risk from saturated fat.

Bret: 
Yeah, that is really interesting. I want to get into that more, but just looking at the list, you can’t get those nuances and those details just looking at the list. And that, I think, it’s the saturated fat versus fortification that in the other systems has allowed Lucky Charms and Honey Nut Cheerios to be up high, and eggs and beef and cheese to be really down low, which your system doesn’t have.

So, even though you had that saturated fat to unsaturated fat ratio, which I would argue with your initial thought probably does not belong necessarily in here, but, even with that, it didn’t seem to penalize it too much, which I thought was really interesting. And it seems like you really doubled down maybe on fiber and on processing. Because you have the carbohydrate to fiber ratio, and you have fiber as a individual component. And then, you have the carbohydrate to fiber ratio as a marker of processing plus the 25% penalty for ultra-processing.

So, it seems like you kinda doubled down on those. Was that purposeful? 

Ty: 
Yeah. Think about all of these scores as playing a part of the role in chronic diseases or part of the role in nutrient adequacy. None of them are solely the biggest, most important factor, but they have some sort of contribution. Now, the big controversy is what is the percent that this contributes on average to any population?

That’s where you get into the controversies. So we looked at vitamins. We have 11 vitamins. Those make up 20% of the score. This is the default, right? We do say in there, and we publish this open access. You can refine these, and it depends on the population, which we’ve done some changing.

The scores do hold up relatively consistently, even if you change these weights. But notice that we include vitamins and minerals and other nutrients that are public health challenges usually. So, we’re not looking at dietary cholesterol because we don’t think that’s a big public health risk.

We didn’t look at phosphorus because that’s not a huge risk to public health in terms of inadequacy. But we did include choline, for example, because there’s a lot of people don’t have enough choline, right? And so, we chose those nutrients. But then the weight of those domains, if you call this like a domain of vitamins, domain of minerals is 20%.

Those ratios are, those proportions are a judgment call based on your interpretation of the evidence. Now, what we chose is actually pretty small for fiber, 7.5%. So, the thinking behind that is fiber is important, but it’s also not an essential nutrient, and it’s one component. So, if you have 11 vitamins, we score that 20%. So, that’s about three times higher than the fiber component alone.

Now, of course, if you look at the nutrient ratios, that’s also getting into carbohydrate quality. We thought there’s an independent factor of carbohydrate quality and an independent factor of fiber itself. So, that’s why we have those included. Calories is about 7.5. Omega-3s, notice we don’t include omega-6, which is also different from other scores because there’s so much omega-6 in the diet.

We don’t really need to worry about that. We don’t need more. So, omega-3 is 10%, protein’s 12.5%. And then, you have these ratios. So fiber, if you think about it, it’s actually not the biggest component. In fact, if you talk about some of the plant-based advocates, they would say fiber should be higher because we’re low on fiber.

So, it’s all a judgment call. I’ve heard people say very opposite sort of criticisms where it’s okay. One group feels like the ratio should be totally different in this direction, and another group feels like it should be totally different in the other direction. I get that. And so one of my hopes is that we have a general system.

It’s not the perfect system. There’s never going to be a perfect system. I don’t want perfect to get in the way of the good, right? Perfect be the enemy of the good. And I also want to say, look, there’s flexibility. If people want to use this tool, and they say, “I want to customize it for what works for me or what I think it should be,” they can do that.

Bret: 
That’s super interesting. I love that you can play with it and change things around. That you’re not saying, “This is set in stone, and this is the way it has to be,” but you’re really saying this is the framework. And actually, there are more details I want to talk about. But actually probably should take a step back, and I guess you may have already answered this, but what was your hope?

What were you when you were creating this, what impact did you hope it would have? And how did you hope people would use it, and where did you think it would be most helpful? 

Ty: 
I think there’s three areas I see personally for people to use this. So, one is in the program implementation side of things.

There’s a lot of organizations, mine being one of them, the Global Alliance for Improved Nutrition, where we want to promote or incentivize production of a certain food group or food to help improve the nutrition situation in a country. So, it may be eggs or it may be dark leafy greens. And it helps us distinguish between where are you going to get the biggest bang for the buck. Because while we wish everyone could consume healthy diets, the reality is we can’t really do interventions all the time that are just make everyone eat all of the healthy foods they need and none of the unhealthy.

You have to target foods. So, that gives us a bit better targeting information about how do we promote the foods that are going to have the biggest impact, right? So, that’s one lever. You could also do this on the policy side. So, when you think about policies, there are ways to incentivize production of more nutritious foods or less nutritious.

So there’s, you could do a front of package food label, right? You could have a little, a green light, a yellow light, or a red light for foods to encourage moderate limit, right? That gives some agency to the consumer, and it also influences industry because they’re not going to want a lot of their products with the red packaging, right?

So, they’re going to think, how do we have more nutritious products? So, there is an impact there. You could also do this with grocery stores in terms of which products show up on the webpage or the app when you’re ordering foods. Food companies pay for their products to be listed for what people see when they search or they go to the homepage.

So if you had some regulation or some grocery stores have actually r- said there’s interest in actually promoting healthier foods because they care about public health. You can use something like this to prioritize which foods do people see if they’re walking around in the grocery store, which foods are more accessible, right?

Companies play, pay for product placement as well. And then the third area, which I’m excited about, is I think you could use this really as a Personal guidance on an app, right? You have a mobile app. There’s some apps out there, like Yuka, that do this and some others where you get a food score.

You scan the barcode, you take a picture of your food, and it tells you how nutritious is this, right? Or what’s in this food. I would love to see that in an app where it tells you score from 1 to 100. It gives you a color code, tells you if you should consume it more. And then, ultimately, have some flexibility where maybe the user has a template where they can select, “I want to have the low carb stuff.

I want to have chronic disease protection. I am this dietary pattern.” And then, give them some guidance within that framework or whatever their choice is that gives them the most nutritious options. So, I see there’s three different ways to influence, and I think, just so you know, like I don’t think this is the only way, this is how everyone’s going to decide what’s healthy or not.

I don’t agree with all of the scores. I look at cheese and I’m like, “I don’t necessarily think cheese should be low, as low as it is.” There’s things I don’t think are perfect about the score and overall it’s about the whole diet, right? So, it’s if you have an unhealthy item or a less nutritious food for breakfast, and then lunch and dinner are fine, just it’s not a huge deal.

I’m talking about the overall dietary pattern, but this is just one of the tools among many that can be used to influence the public health of the country. 

Bret: 
Yeah. I like how you listed all three. I think where most people’s minds go is, “How am I going to use this as an individual?” But really, from a policy standpoint and just from a food sourcing standpoint, it really could have an even bigger impact than what the individuals do.

And the other interesting thing though is you mentioned about if someone’s low carb, maybe there will be an app or some way that they can filter out low carb or keto. Or if they’re vegetarian or plant-based, then they can filter that way. That this isn’t saying you have to eat all of these foods to be healthy.

It’s like you can fit this into any dietary context, which is also really important because it truly was international. You in the paper, you mentioned Indonesia, Bangladesh, Kenya, Nigeria, and the United States using local food composition data for those very diverse area, which is why we get fufu and congee and foods that I had never heard of, but they show up on the list.

So, tell us about your rationale for really wanting to make this sort of an internationally appropriate system. 

Ty:
Yeah. Part of it is just due to the nature of our work. We do programs in lower income contexts. I care about health and nutrition everywhere, and one thing that is a big challenge is we don’t have any agreed upon system to implement to start helping policies and guidance around the world.

We don’t even have something in the US that we’re bought into, right? And so, there’s been a lot of talk around Nutri-Score or Health Star Rating, which are these other popular systems in Europe and Australia and such, that have been proposed to start influencing what people consume and what types of policies get done.

And so, I thought, you know, we need to create a system that really works, that’s based in evidence, that’s sophisticated enough to include all these dietary components that we know matter, right? Some of these, like Nutri-Score, it only includes a few information data points, like calories and fiber and fat or something, right?

It’s not a lot of information. You’re not getting into the nutrient density side of things, and most of them don’t look at anything around nutrient ratios as well. So, we wanted to introduce a system that was rigorous, that was really looking at this diversity of foods, and we’ve been expanding those. So, we’ve already now compiled about 1,800 foods from around the world.

Bret: 
Wow. 1,800 different foods.

Ty: 
We’ve been including things like insects, traditional crops that are super nutritious that you may never have heard of that are just in some remote region in the world. Because we’re also wanting to influence how do we incentivize production of those really nutritious crops and foods that are not necessarily commonly known?

But at the same time, we hope to include this in the US, right? Make a whole, a whole system available so that if you do have an app, you can actually see all the packaged products just where they stand. And then, you can make a better decision based on that information. 

Bret: 
Yeah. Oh, that’s great.

All right. I really like that. Now, so there, I guess, there’s the main graph everybody has been posting and talking about is the graph of all the different foods, which I want to get to, but the graph that I like better is where you more categorize them as dark, leafy greens or organ meats or fish and seafood, unprocessed red meat, vegetables, eggs, legumes, right?

Instead of the specific food, you go through the general category. So, dark green leafy vegetables being number one, which for someone who’s more protein-centric would be like, how can that be number one? You’re going to have to eat boatloads of that to get protein, which shows how one, if you come from a one specific nutrient centric, it’s not going to make sense.

But so, why are dark leafy greens number one, and what would you say to the protein-centric person who doesn’t agree? 

Ty: 
Look at the number two food group. It’s organ meats, right? And it’s just below.

So, they both matter. You’re right. Dark leafy greens are things, like kale and spinach and romaine lettuce, and the reason they score well is because they contain a lot of nutrients. They contain fiber. They don’t contain a lot of calories. I should add that we didn’t just look at nutrient density in terms of calories.

That’s what all the other systems do, but we also looked at nutrient density in terms of mass or volume because both of those matter. If you look at only one or the other, it favors low-calorie foods or higher calorie foods. So, we do look across both of those. But yeah, in general, dark green leafy vegetables, I think the biggest fault people have with them online is oxalates.

You can have lower oxalate greens, like romaine lettuce. There’s many different options. But you can also cook them, and in general, I don’t think the public health burden of oxalates is very high. If we were to have more salads, people, I think, that would be a positive to public health in general.

So, I think the dark leafy greens, they earn their spot there. Organ meats were next, and those are, if you look at the score just based on nutrient density alone, the organ meats win. They really do win because they have such high concentrations of these minerals. But we’re looking at chronic disease prevention as well, and I think you’re absolutely right.

You don’t consume just one food. We consume a variety of foods. The third food group, which I’ll pause after this, is just fish and seafood, which is a really nutritious food group because it contains the protein and the omega-3 fats and the vitamins and minerals. So, there’s a lot of benefits from that food group, in general.

And so, when you look at those anytime you publish, I think one thing I’ll add is that this list that we’re talking about, it’s spreading out and looking at the variation and the diversity across the group. So, it’s not just saying this is a mean or a median. One point it’s saying, here’s the range. We have a range of scores.

And most of these food groups overlap with the ones above and below them. So, it’s not to say that all dark leafy greens are the same or all fish and seafood is the same. It’s not. There’s actually a range in the nutritional quality within these food groups. 

Bret: 
And that’s one of the things I like about this graph. More than just the individual foods with one score, is that you do have those bars that show the range.

You do see the overlap. So, I was just egging you on to say that the dark green leafy vegetables were number one where clearly they overlap with organ meats. They overlap with fish and seafood. 

Ty: 
Yeah. 

Bret: 
Yeah, I totally agree, and I think that’s well done. Now, I think this list is really good, but one thing that stands out to me that I’m wondering if you got feedback is that whole grains are down towards the bottom third or bottom, yeah, I guess bottom third of that, knowing that there’s some overlap there as well.

But the healthy whole grains, that we’ve been told for decades basically have this health halo, were a little bit lower on your list. So have you one, have you gotten some pushback about that? And two, how do you feel about it? 

Ty: 
Yeah. I think this is, this is a very interesting one to see.

So, it’s not the bottom third, but it is less than the midway point. So, I think it’s around 40, 41. And so, it’s not the highest scoring food. And again, I don’t have anything against whole grains. I’m not, none of this work, what sets us apart from others is none of this was funded by industry.

We had no private sector funding whatsoever. No influence from industry. So, we did our best to be objective and whole grains scored that way because they do contain some fiber and some nutrients. But they’re not particularly nutrient dense, and they’re not comparable to, say, legumes.

The legumes category scores quite a bit higher for higher mineral density, higher fiber content, and higher protein content. So, it just puts it into perspective. I don’t think whole grains are an unhealthy food. I think that for many people, they can do well on whole grains, right? I think that’s not a huge issue.

But it’s just that when you look objectively at the foods, they don’t contain as high of nutritional quality as some of these other food groups that we’re seeing around here, right? And I think that’s important information to use. And I wouldn’t say that we should make all of these huge policy decisions based on this list.

I don’t think this means that if you’re less than 50, we should just never consume that food and we’re going to, we’re going to divest from all products that contain that. That’s not the case. But I think it does give you a sense of, okay, if I want to get the most nutrition out of each of these foods, where do they stand?

Bret: 
Now, if we do jump to the individual food chart, and this is where people love to say, how’d this one get higher than that one? And even if they’re super close. So, of course, I’m going to do that. So, let’s start with my favorite, Lucky Charms, which is already down towards the bottom at about 38, where it should be. But higher than watermelon and higher than white rice. So, I get white rice doesn’t have a lot and that watermelon has a lot of water and so forth, but Lucky Charms has all the sugar and processing. And so, how does Lucky Charms get higher than watermelon and white rice?

Ty: 
Yeah. Okay, so let’s take a look at this. So, we were thinking about this exactly how you were thinking about it. And ultimately, fortified breakfast cereals have a, it’s a double-edged sword. So, in general, they typically contain very high quantities of added sugar. Not all of them, but the ones that kids want to eat typically do, right?

So, Lucky Charms are high in sugar. They also contain, at the same time, a lot of added vitamins and minerals. And I think it’s just important to keep in mind when we look at nutrients, even in the US, a third of women do not have enough iron. They’re actually deficient in iron, right? So, that’s a big, that’s a big issue.

We see a lot of nutrient inadequacies when you look at the diet. So, I think the fortified nutrients are making some contribution. Now, I wouldn’t say that means that you should eat Lucky Charms over watermelon, but it’s just they’re about the same score anyway. It’s just to say, if you have overall, if you look at what the undernutrition could be, and again, keep in mind this is around the world. So, we’re talking about the algorithm could be tweaked differently, right? We could have a higher penalty for ultra-processed foods in the US, for example. But if you look around the world, they are contributing a lot more nutrients than the white rice and the watermelon, even though those nutrients are not the same quality as a food intrinsically dense in those nutrients.

Now, what we did to account for this is a few things. So, we ended up penalizing foods that had these multivitamin type addition of nutrients, right? Because if you actually do that in any system, you could make it score off the charts. If you just chemically add whatever nutrients you want, you can get away with it.

So, what we did is we actually made a penalty so that the nutrients that are added do contribute to the score, but they’re penalized. So, they don’t count as much as intrinsic nutrient density. So, that deducts some. And then, we also do this ultra-processed penalty of 25%, right? So, they’re reduced by this value.

So yeah, I think the Lucky Charms thing, it’s completely reasonable to say, look, Lucky Charms shouldn’t be a part of anyone’s diet. We should just never really have that. And I think that even our system here is really saying, yeah, this is actually either to be limited or to be moderated type food.

But it does contain a lot of nutrients. And so, I think there is this sort of, okay, there are some benefits to it, even though there’s a lot of risk to it. And I think that ultimately, overall, we did our best to have a system that was defensible. And I have to say, I’ve had people on both sides. So, I’ve had people say, you shouldn’t penalize any added nutrients.

There’s nothing different about them. Typically, that’s the vegan plant-based crowd, right? And then, the people who said, you shouldn’t give any value to added nutrients because you really should just care about the whole things, right? We did somewhere in the middle. Same thing with ultra-processing. People say ultra-processing is just a useless definition.

It’s more problematic than it is beneficial, and we should just do away with the system. And then others who say ultra-processed food is, it’s everything. You should not promote anything that has ultra-processing. And I think that what we’re trying to do is find a sensible middle ground, and I recognize that makes nobody happy.

I think everybody can take issue. But at the same time, this system is we have to make those choices. And so, we at least are transparent about those choices, and then we also publish this open access so that anyone who wants to can change the system if they want to use it for their own purpose, right?

Bret: 
Yeah, I think that’s a great point about how it’s open access. And I do really like that you made an effort to, you could say, punish the processing or to reward the whole foods. Like you said, the nutrients that are naturally occurring are not punished. I hate the word, use punished, but I’m lacking for another word right now.

Ty: 
Penalized. 

Bret: 
Penalized. There you go. 

Ty: 
Penalized or deducted, yeah. 

Bret: 
Yeah. Whereas they were for added. So, that does give like the whole foods the benefit of the doubt and rank them higher, which I think really helps. And then, another one we heard about was the skim milk versus whole milk. That skim milk was higher, quite a bit higher, than whole milk.

And I assume, that’s the same sort of thing though. That it’s fortified whereas the whole milk is not, probably has a lot to do with it. And maybe the calorie density or the saturated fat? So, tell us about that difference. 

Ty:
Yeah. So yeah, a lot of people are up in arms about skim milk and whole milk.

So, I have to say, first of all, I think it’s really interesting that the full-fat dairy has shown in studies to be just as beneficial as the low fat skim milk. It doesn’t increase consumption. That’s a bit surprising to me, like the calorie density. There is a food matrix effect that makes them…

So, I think they’re both great foods, okay? Now, by definition, when you look at nutrient density and you cut out fat, you’re going to have by definition a higher score. Skim milk contains more nutrients per calorie than whole milk does, right? We considered per calorie and per gram or per volume as well, but that’s just by definition going to happen, right?

So, I think there’s no way to argue with that point. Now, you can argue about the, maybe the healthfulness of it, for sure. When you look at the energy density in general, there is a penalization of foods that are higher in energy density. But milk is not one of them. It’s not a very energy-dense food.

So, it’s not getting really super penalized. It’s not getting penalized for the calorie density itself. It’s just the fact that the nutrient density per calorie is going to be higher in skim milk, by definition. So that’s what’s going on there, and there is a penalty for the saturated.

So, when you have the saturated fat to unsaturated fat ratio, there is also a penalty there. So, that’s being factored in. So, those two things, the overall nutrient density in terms of per calorie and the penalty for the saturated to unsaturated fat ratio is there. Now, again, I think we could, there are ways to…

For example, let’s say that there is a bit more evidence to say that the saturated fat in whole dairy products is not a net negative or a problem in public health, right? This would get into controversial decisions. But you could decide, we’re not going to penalize saturated fat from dairy products or from whole dairy products, right?

Because that’s another issue. Whether do you do it with the butter or do you do it with just the whole dairy product. So, a lot of decisions, and I get people up in arms. But I think with skim milk, if you understand nutrient density and how it works, it’s just a no-brainer that you’re going to have more nutrients per unit, right? That’s the way it works. 

Bret: 
Yeah, so that makes total sense. But let’s talk a little bit more about the saturated fat. So, I’m fascinated to hear that you initially did not have it in, which I think makes a lot of sense, especially if you’re talking about whole foods and the dietary matrix and all that. Saturated fat isn’t one thing, but then under peer review, it sounds like they strongly suggested or maybe forced, I don’t know the word you’re going to use, that you to put it in there, which one, how you felt about that, to have it critiqued in that way? And then two, how much did penalize or how much weight did you give that?

Ty: 
So, we initially did not include it. And again, that’s because we didn’t think it was the most important thing, and it could unfairly penalize some foods like full-fat dairy, for example, that we didn’t necessarily think was fully evidence-based. But we originally submitted this to Nature Food, which is a very high-impact journal.

It went through three rounds of review over the course of a year. It was a very strenuous review process. We were trying to make concessions and do whatever we could to maintain a rigorous system that we were behind while also conceding to reviewer requests because we wanted to get it published. It ultimately was rejected, which was really hard to face. And I think what we realized is that when you’re trying to get into high-impact journals and you’re publishing something that kind of challenges the status quo, there can be pushback to that, especially when most reviewers are going to be aligned with the status quo.

So, we next went to Nature Communications, which is another high-impact journal. We faced another round, two rounds of feedback, and we made changes. And ultimately, were not published there. So, even though we made the concession around the saturated fat, we were ultimately still not published. So, we had to pick our battles, and I think when you’re publishing, it’s unfortunate that it can be hard to get into higher journals.

Of course, I’m biased because I wrote the paper, right? So, take that as you will, but it seemed like a pretty rigorous process. We went through our own internal review before submitting it to journals. We went through three rounds of review, and I’m talking this took months to address feedback.

Ultimately, the feedback from multiple reviewers was probably three times longer than the actual paper itself, just for the first journal review. Like 15,000 words of reviews, right? Addressing all sorts of things. Sometimes one reviewer says something that in the next round of review another reviewer says the opposite. “You shouldn’t penalize ultra-processed foods.

You should penalize ultra-processed foods,” right? So, it’s just a really challenging process, and I’m thankful. I wanted to give up at multiple points. This took two and a half years of peer review, and it’s a very tough process to get papers, especially like this, published where you’re making judgment calls about things and you’re publishing something that says animal source foods are actually pretty nutritious.

They don’t belong at the bottom of the list, and that’s a bit controversial. 

Bret: 
That’s so frustrating, though, that is going to have a much higher level of scrutiny and review and higher chance of rejection just because of that. It’s one thing if you just threw it in there with no justification and no explanation of why. But when you’ve have detailed exactly why it is and exactly the system you use, I would like to think that they would be like, “Okay, we want to publish this because it’s rigorously done.

Whether we agree with the final chart or not.” You can point out why things are where they are. That’s the scientific process. Not getting a result that we agree with at the end, that’s not the scientific. I know it’s, I’m getting frustrated for you. You must have been so frustrated during this process

Ty: 
It was very frustrating, and you’re right. We did not say, “Okay, we’re going to take animal source foods and create a category called animal source foods are good. Give them 10 more points.” We didn’t do that. You can see very transparently we treat foods the same. We make some decisions around processing and stuff that are judgment calls, but we’re not saying plant-based is penalized for being plant-based and animal source foods.

it’s an objective system, and I think people may say, “Oh, you can claim that you were not accepted because you were challenging the status quo, but probably just wasn’t a very rigorous analysis or something.” But I have published over 70 peer-reviewed manuscripts before, and I have never faced the same type of scrutiny in publishing a paper.

And I’ve reviewed many manuscripts before, and so I know what the process is like. And I can say it felt like this was held to a whole different standard, especially when I think of the actual feedback in our paper versus what I saw in Food Compass, which Food Compass, I think it deserved to be published. But they made a lot of decisions that were very arbitrary or they just stated the choice, and they got it published in a top journal, right?

Nature Food. It felt very much like when we made the similar type of assumptions, sometimes the exact same assumption as Food Compass, which like penalizing ultra-processed foods. We would get reviewer feedback that ultimately led to a rejection. So, it’s hard to, it’s hard to not feel like there was some nature of bias in the review process because it was a really big struggle.

And we went through, we probably went through, seven rounds of review to get this published, which is just crazy. 

Bret: 
Yeah. So, that just says a lot about your experience, and how this was more challenging than any of the others you’ve experienced, which I guess a whole other podcast we’ll have to have. I’ll have you back to figure out how are we going to change that?

What can we do to make that change? But to stick to the score. So, now it’s out there. It’s published. You’ve been getting feedback, and you have it open source. What do you think is a good next step for using this? You talked about an app. You talked about different ways to use it.

You talked about policy. What do you think the next, the very next step should be or what do you hope it is? 

Ty: 
Yeah. I think there’s three ways I’d like to see it used. So, the first is really in interventions, guidance to organizations looking to promote or incentivize. There’s all sorts of efforts to do this.

We do this. GAIN does this. And just having a system that says, “Okay, here’s the foods to really target and promote to have the best impact.” Okay, that’s general guidance. The second is on policy. We talked about front-of-package labeling to some extent. I think you can put a label on a food that has a green, a yellow, or a red, and it gives the consumer an idea of which foods are going to be more nourishing versus which are going to be detrimental to my health.

It also changes industry because industry doesn’t want to have their foods in the red. They want to have foods that are scoring in the green. So, that can have an impact through that mechanism. The third one is through this personalized individual app-type thing, right? You have a mobile app, and it tells you the score.

Maybe it’s 1 to 100, but then also has the color coding of green and yellow and red. And it just gives a bit more personalization of, oh, okay, here are the foods that are really going to nourish me. Here’s the foods that are going to support my metabolic health. Because we look at the US, and 75% of adults are overweight or obese.

Most of us have some chronic disease indicator of some kind, nine in 10 of us by most estimates, right? So, it’s a big issue. And I think if we look at this at all these different levels, hopefully we can start making an impact. It’s not the only thing that matters. Overall diet quality is huge, and there’s a lot of other tools.

But it does give a way to start influencing things that make a difference. And I’ve started talking with the FDA about this, and I’m hopeful that in time we can build out the database where this is actually possible. We can have all the foods in the US food supply, and we can say, “Here’s the rating.

Here’s the scores.” They can be used, these can be used for policies. They can be used for an app or individual guidance and whatnot. And we’ve also talked a little bit with the Italian government. They have an organization called CRIA, which is similar to the USDA, and they’ve shown interest in.

They don’t like Nutri-Score, which is the common one used in Europe because it makes a lot of penalizations. For example, sardines score pretty poorly, and sugary breakfast cereals sometimes get the top score. And so, it’s like the Italian government is really wanting to do something that’s a bit more evidence-based and sophisticated.

And so, I think there’s a chance that they would also be interested in implementing this type of system. So, we’ll see where it goes. But that’s my hope, is make the data, start building out the databases, and make it available so that we can actually start using this in various contexts. 

Bret: 
Oh, very good. Very good.

That’s ambitious, but I think this would serve that purpose so well in so many different ways. Now, before we wrap, though, I got to know, what’s fufu? 

Ty: 
Fufu. Yeah. Did you notice fufu on there? 

Bret: 
Yeah. it’s at number 16. So, it’s down at the bottom. So, I’m guessing I’m never going to eat it. But I’ve never heard of it.

So, what is it? 

Ty: 
So, fufu. So, we have a lot of these foods. So again, you’ve mentioned that we had this in, around the world. So, we had parts of Africa, and we had Asia, and even Latin America for the foods we’re building out now. So, it’s like a starchy, dough-like staple food. It’s made from, I think it’s starch.

I think it’s usually cassava, yams, or plantains And it’s pounded and boiled. And so, I think it’s like a base that’s added to soups or stews and stuff. I’ve personally, I’ve never eaten it, but we wanted to highlight some of the examples of foods in these diverse contexts.

So, we have congee as well, which is this like rice-based porridge that’s common in Indonesia and certain parts of Asia as well. So, it just gives you example, because starchy staples, there actually is a range in the healthfulness of these starchy staple foods. There’s actually some traditional varieties like teff, sorghum, or millet, and those are more common, but there’s actually even more obscure varieties that have higher nutritional value.

And so, it gives you a sense of some of these products, okay, there actually is, if you look at the food group itself, that’s one of the ways to use this tool. Okay, starchy staples are a food group. What are the ones that are going to be the highest rated foods, right? It gives you a sense of the quality within those food groups, too.

Bret: 
Yeah. and I love how Gatorade was like the last one on the list, which just shows the power of marketing. Like how Gatorade has infiltrated every sports program, every kids sports league. That it’s almost like a necessity. But when you look at it from this way, it’s one of the least healthy things you can consume, and just so unnecessary for most sports.

But I think that’s, I want to show this to all the other sports parents out there and be like, look at this. Look at this, because it’s just brilliant marketing, brilliant marketing. It is, for it to be where it is. 

Ty: 
Yeah, and I think it’s also the case of if you look at a lot of the soft drinks available, Gatorade is actually one of the soft drinks at restaurants, at fast food joints, right?

So you can have it, and it’s basically like a soft drink with some sodium. So, you’re right. I think if you’re an endurance athlete running marathons, you can drink all the Gatorade you want during your race, it’d probably be fine, right? But for most people, you don’t want to be having that. And even if you think about the electrolytes, there’s a lot of other ways to get electrolytes without just straight added sugar along with it, right?

So it’s marketed very well, and you’re absolutely right. It’s something that I think people just take for granted. 

Bret: 
Exactly. Exactly. Ty, I want to thank you very much for joining me today to talk about this. So many different details that are important to bring out because it’s easy to just look at the score and say what you like and you don’t like. But it’s so important to know what’s behind it. What were the intentions? What were the assumptions? And what are the potential uses now that it’s out there?

So, thank you for covering all that with me. I’m curious if you have any last words about it? And then two, of course, where can people find you to learn more about the work that you’re doing? 

Ty: 
Yeah. I think what I’d like to just highlight as I wrap up is that I think we have different camps in the US and in other places where we have people who are really passionate about something, like a vegan diet or a plant-based diet and a low-carb diet or ketogenic diet. And I think there are valid reasons to pursue those diets, and I just hope that we also have a lot to agree on.

When I talk to some of my colleagues in different camps, we all agree there’s this huge issue with these really unhealthy processed carbs, right? There’s a lot of refined carbs. There’s a lot of refined additives, refined oils that are combined together into these products. So, if we even just unite that, everyone would benefit. Whether you’re plant-based or keto or whatever, if you cut out or reduce those refined carbs and the unhealthy foods and you replace them with minimally processed whole foods, especially if you look at more of the nutritious whole foods, then you’re going to have a big positive impact.

I think that’s just something hopefully we can have a bit of a unified message there. If you’d like to find me, tybeale.com is my website. You can find me there with all the links. And my handle on socials is tybealephd. 

Bret: 
Very good. Yeah, and I encourage everybody to look at your Twitter or X account where you posted about this, and see a lot of the comments because if people have questions about it, I think maybe a lot of them have already been asked in the comments, which you’ve addressed very well.

You’ve been very busy on social media keeping up with all the comments. So, thank you for that. And again, I appreciate you taking the time to join me. So, thanks a lot. 

Ty: 
Thanks for having me, Bret. It’s a pleasure.

Bret: 
To start with, I’ve got to say how much I respect Ty for one, for even doing this.

Doing a food rating system like this just opens you up to so much criticism, and it’s so easy to tear apart because it’s impossible to make it perfect, right? There are so many assumptions. So much variability. And Ty even admitted it’s not perfect, and it’s not meant to be perfect. And it’s not the last word. That this can be customizable and changed for your specifics or your environment or where you live and so forth, which I think is really important.

But I do have to say this is far better than any of the other rating systems I’ve seen. I really like a lot of his assumptions and inputs that he put in. They’re much more defensible than a lot of the other ones I’ve seen. So, the end product is pretty good. But again, even Ty admits it’s not perfect. So, we shouldn’t expect it to be. But instead, use it as a guidance, and understanding that the whole diet, the whole food matrix is so important, and this is one way to help pick the right components.

But what his aspirations are from a policy standpoint. From just influencing the foods that are represented in different parts of the culture, I really like that, and I love the idea of the app that can be customizable. But so hopefully, we’re going to see that. And again, hats off to Ty for doing this.

And please check him out on social media where he does go into some more detail and answer a lot of questions about this food scoring system. All right. Thanks for joining, and we will see you here next time at Metabolic Mind, a nonprofit initiative of Baszucki Group. Thanks for listening to the Metabolic Mind podcast.

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