The Nutrivore Score – The Paleo Mom

How Nutrient Profiling Could Inform Dietary Guidelines

It makes vastly more sense to devise a nutrient profiling method that simply reflects the nutritive value of a food, and then to study how eating more nutrient-dense foods impacts disease risk. In fact, there was a 2104 study of people over the age of 55 that showed that the higher the NRF9 of their diet as a whole, the lower their risk of all-cause mortality—the highest NRF9 quartile had a 16{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} lower chance of dying than the lowest NRF9 quartile. This study helps to prove that potentially huge health benefit of a diet replete with nutrient-dense foods, but more studies like this that incorporate even more nutrients into the calculus are necessary to advance this field of research.

To illustrate how important it is to take a comprehensive approach to nutrient profiling, take a look at how ten whole foods rank, when using 9, 15, 20 or 33 nutrients to quantify their nutrient density (in the NRF9, NRF15, NRF20 and Nutrivore Score, respectively). The more nutrients that are included in a calculation, when following the NRF model which does not cap a nutrient at 100{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} DV, the higher the score can be—that’s why every food has a higher score when more nutrients are taken into account. However, look not only at the order of the foods, and how including more nutrients provides a more complete picture of how nutrient-dense a food is, but also the spread between the scores. The more nutrients used in the calculus, the easier it is to differentiate between the most nutrient-dense foods and the least. Given what a nutrient powerhouse liver is, it just makes sense that its score would be vastly higher than, say, chicken breast.

The above table also helps to illustrate how a single nutrient can dramatically shift the nutrient profiling score of a specific food. For example, zinc is not included in the NRF9 but is included in the other scores. Oysters are the top food source of zinc, insufficiency of which affects an estimated 73{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} of Americans in large part because zinc-rich foods are few and far between and those that are, like oysters, are not a common food on the Standard American Diet. In fact, a single serving of oysters contains 174{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} DV of zinc! As soon as zinc is added to the score, oysters rank much more highly, which makes sense since they’re such a valuable source of vitamins, minerals and healthy fats while being an invaluable source of zinc!

The insight gleaned from nutrient profiling is profound. It emphasizes the value of certain families of plant foods (especially cruciferous vegetables, mushrooms, leafy greens, and fresh herbs) while also elevating the value of fish, shellfish and organ meat. At the same time, it emphasizes the high caloric density and low nutrient density of grains and dairy products.  This information would be super useful were it incorporated into the USDA dietary guidelines, helping people to identify the most nutritious foods to eat!

The Problem with Penalizing, Capping and Emphasizing

Some scores penalize for the presence of nutrients whose excess consumption have been (even loosely) linked to health problems, like sodium, saturated fat, added sugars, and cholesterol.

As I discussed in detail in Eggs: Nutritious Protein or Cholesterol Bomb?, dietary cholesterol does not increase serum lipids for most people and is the backbone of vitamin D and other steroid hormones. Dietary saturated fat is only problematic when intake exceeds about 15{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} of total calories (although this does depend on genetic predisposition, see Saturated Fat: Healthful, Harmful, or Somewhere In Between? and Genes to Know About: ApoE). Sodium is only problematic when intake exceeds about 7 grams per day, and there are studies showing that even this level is only worrisome when potassium intake is concomitantly low, see Is Salt Paleo?. Added sugars become problematic above about 10{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} of total calories (and 25{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} of total carbohydrates), see How Does Sugar Fit into a Healthy Diet? and TWV Podcast Episode 467: Can Eating Sugar Daily Be Healthy?. Most importantly, all of these nutrients are healthy in moderate amounts, and only unhealthy when the whole diet includes excess. And, all of these potentially problematic nutrients are abundant in fast food, junk food and other hyperpalatable manufactured foods that are also low in essential nutrients and very high in calories—this is why scores that penalize for these nutrients give these types of foods scores less than zero!

Penalizing individual foods for the presence of these nutrients does not reflect the diet as a whole, and has the capacity to undervalue otherwise nutrient-dense whole foods which can fit into a health-promoting diet, while not being necessary to show that fast food and junk food are unhealthy (they’re nutritionally void enough to already have low scores!).

Some of these scores (like the NDS) cap a nutrient’s contribution at 100{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} DV, whereas others recognize that a food having more than a 100{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} DV of a specific nutrient per serving makes that food a very valuable source of that nutrient! There’s no such thing as a nutritionally complete food, so the goal is nutrient sufficiency of the entire diet, not of any one particular food. Thus, it’s important to understand how to combine foods that are good sources of different nutrients in order to achieve dietary nutrient sufficiency. Capping a nutrient’s contribution to the nutrient density score at 100{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} hinders our ability to understand the importance of food combining for nutrient sufficiency. For example, Brazil nuts are the most nutrient-dense nut attributable to their very high selenium content—a 1-ounce serving delivers nearly 1000{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} DV of selenium! But, if you capped the contribution of selenium to the calculation of Brazil nut nutrient density, they would erroneously appear to be one of the lowest nutrient-density nuts. It just makes sense to fully value the awesome selenium content of Brazil nuts and have that reflected in its nutrient density score!

Another topic for discussion is whether to weight certain nutrients more in nutrient profiling.

It makes sense on the surface to count those nutrients for which a larger proportion of the population are deficient more than those nutrients for which very few people are deficient. But, here’s the challenge with that logic: the potential for overcorrection and simply shifting towards different common nutrient deficiencies. If those foods that are particularly good sources of the nutrients that, for example, an estimated 70{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} or more of Americans routinely don’t consume enough of (vitamin B9, vitamin D, vitamin E, choline, calcium, potassium, zinc, omega-3 fats, and polyphenols) had inflated scores as a result of weighting these nutrients more heavily in nutrient profiling, food sources of other nutrients end up being undervalued. This approach has the capacity to shift food choices in a way that could help address some population level nutrient deficiencies over the short term, but that’s not the same thing as moving towards nutrient sufficiency, especially over the long term.

When we look at nutrient profiling methods described in the scientific literature, it becomes abundantly clear that a nutrient-density score best describes a food when it includes as many nutrients as possible, when the contribution of nutrients are not capped at 100{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} DV, when they are presented relative to calories, when they are not weighted by food groups, and when they are not normalized to a fixed scale.

Consumer-Focused Nutrient Profiling

Several other nutrient profiling methods have been devised by non-researchers with the goal of educating consumers, such as the ANDI Score, NuVal (based on ONQI), Guiding Stars, and Nutrition IQ.

The ANDI score may be one of the most comprehensive nutrient profiling systems, but the score overemphasizes nutrients inherent to plant foods while deemphasizing nutrients inherent to animal foods, creating a biased result. For example, the ANDI score incorporates separately into its calculation: beta carotene, alpha carotene, lycopene, lutein and zeaxanthin (all carotenoids); fiber and resistant starch (both fiber); glucosinolates and organosulfides (both organosulfur compounds); phytosterols, angiogenesis inhibitors, aromatase inhibitors, resveratrol and ORAC score (most plant phytonutrients are antioxidants as are vitamin C and E). On the other hand, the score omits protein, functional amino acids and peptides (like anserine, creatine, carnosine, carnitine, and taurine) and all types of health-promoting fats (like omega-3s, monounsaturated fats, CLA and MCTs).

The ONQI is calculated based on 16 nutrients, with penalties for 5 nutrients and corrections for fat and protein quality and for glycemic load. Most notably, only 5 minerals are included, only three of the B vitamins are included, and only two types of phytonutrients (flavonoids and carotenoids) are included, while vitamin K and choline are excluded. In addition, because both cholesterol and saturated fat are penalized (despite the fact that whether these are problematic is entirely context-dependent), animal foods are penalized unnecessarily.

The Guiding Stars system rewards whole grains (despite their low nutrient-density compared to vegetables, fruits, legumes, nuts and seeds), and penalizes for total fat, sodium, sugar and cholesterol  And, the Nutrition IQ system also rewards whole grains, uses only a few nutrients in its determination, and also penalizes for saturated fat and sodium. The net result for both of these scores is to overemphasize grains, which are not nutrient-dense by any objective measure, and deemphasize animal foods.

The Problem of Incomplete Data

There’s one final challenge to nutrient profiling: incomplete data.

The United States Department of Agriculture maintains arguably the most comprehensive nutrient database in the world, called Food Central, with expanded nutrient data compiled for over 7,000 basic foods and partial nutrient data (at least what is required on food label) for nearly 360,000 different branded foods. But, even this amazing database is missing some key information. Many of the main entries are missing measurements for some nutrients (commonly vitamin D, vitamin B5, manganese, vitamin K2, and phytosterols) and certain nutrients aren’t included in the database at all (including vitamin B7, iodine, polyphenols, CoQ10, and other functional compounds, including most phytonutrients). Fiber is not differentiated between soluble and insoluble, and the method used to measure fiber is known to undercount resistant starch and oligosaccharides.

In addition, the entries generally provide average measurements for common quality food products, so it’s not possible to differentiate the nutrient content of higher quality options. And, while many of these gaps can be filled in from measurements presented in scientific studies, it’s surprising to discover how incomplete human knowledge is about the nutrient content of common foods.

There’s really no good solution, other than to scour the scientific literature and other databases for as many nutrients as possible missing from the USDA Food Central database (which my team and I are doing), label when a nutrient-density score is calculated based on incomplete data, and advocate for continued measurements of the nutrient content of foods.

How the Nutrivore Score Is Calculated

The Nutrivore Score is currently the most comprehensive, and least bias, method for representing the inherent nutrient content of foods, borne out of a confusing array of similar, yet all flawed, nutrient density scores, while recognizing the current limitations posed by incomplete data.

The Nutrivore Score is calculated based on 32+1 nutrients. The 32 primary nutrients that go into the score are:

The score is calculated as the sum of each nutrient relative to its RDA or AI present in 100 grams of the food, divided by the amount of calories per 100 grams. Data that’s not included in the Food Central Database are obtained from scientific papers and other databases like Phenol Explorer whenever possible. When multiple papers report the amount of a nutrient for a particular food, the highest value is utilized, unless there’s a clear methodological advantage to one specific measurement, and provided it is no more than one standard deviation from the mean of all available data (in which case, the second highest value is utilized following the same statistical test). Also, periodically two entries from the Food Data Central database are amalgamated to calculate the Nutrivore Score when two highly-related foods (for example, sockeye salmon and Coho salmon) have incomplete data. This is noted wherever it’s the case.

Further, the Nutrivore Score adds the highest value of available data for one bonus nutrient (that’s the +1), relative to a threshold set using epidemiological studies for that nutrient, similar to a {e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f}DV. The bonus nutrient currently can be any of: glucosinolates (the precursor for isothiocyanates and indoles), thiosulfinates, CoQ10, CLA, betaine, betalains, myo-inositol, ergothioneine, taurine and medium-chain triglycerides. The reason why only one bonus nutrient is included in the Nutrivore Score is because incomplete data would mean less common or understudied foods are unnecessarily penalized. Where the level of multiple nutrients in a food remain unknown, the Nutrivore Score is marked with an asterisk to denote that the score is likely underestimated for that food and should be thought of as a minimum.

The Nutrivore Score is not corrected for nutrient bioavailability, nutrient absorption capacity, or metabolic conversion inefficiencies. It’s true that specific isoforms of nutrients are more easily absorbed and/or used by the body. For example, while vitamin K1 accounts for approximate 90{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} of the total vitamin K in the diet, only 10 to 15{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} of it is absorbed in the digestive tract, the net effect being that vitamin K1 accounts for about half of the total absorbed vitamin K, whereas vitamin K2 is highly absorbable and represents the remaining 50{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f} (see TWV Podcast Episode 417: Vitamin K2, Hype, or Essential?).  While vitamin K isoform data is available for some foods in the USDA Food Central database, as a general rule, nutrient isoform data is rarely available, making correcting for absorption or utilization efficiency of different nutrient forms impossible. It’s also true that certain combinations of nutrients can either enhance or hinder absorption. For example, vitamin C can increase iron absorption, fats can increase carotenoid and vitamin K absorption, but zinc and copper compete for absorption as do calcium and magnesium. However, this can’t be accounted for in a nutrient density score for an individual food because all nutrients present in an entire meal interact. And sometimes, absorption is influenced by factors independent of food. For example, vitamin D status influences calcium absorption; a functioning gallbladder is necessary for efficient fat and fat-soluble vitamin absorption; and while folic acid is much more readily absorbed in the digestive tract than the active form of vitamin B9, L-methylfolate, those with MTHFR gene variants can’t covert folic acid efficiently (see Paleo for Pregnancy and Lactation and Genes to Know About: MTHFR). So, because nutrient absorption competition or facilitation goes beyond an individual food and is instead related to all of the foods consumed at a meal as well as other factors such as genetics, it makes no sense to correct for these in a nutrient profiling method. The Nutrivore Score also does not incorporate a satiety index, again because satiety is related to macronutrient and water combinations from an entire meal rather than an individual food.

Rather than penalizing for the presence of nutrients whose excess is associated with health problems (like saturated fats, sodium and sugars), these nutrients are simply not included in the Nutrivore Score calculation. It is helpful to note that foods high in fats and sugars have a higher energy density, meaning more calories per gram or per serving of food, which does lower the Nutrivore Score. In addition, the presence of antinutrients such as phytates or oxalates are not taken into account. This is because the impact of antinutrients on nutrient absorption is also extremely context dependent. For example, our gut bacteria can liberate a substantial amount of the calcium, magnesium, iron, potassium and zinc bound to phytates for us, thereby releasing the bound minerals as well as phosphorus and thereby enhancing their bioavailability. A healthy, diverse gut microbiome can typically degrade about half (about 500 to 600 mg daily) of the phytate consumed in the average American diet. Other factors influencing bioavailability include health of the gastrointestinal tracts, nutrient status, competitive binding with other nutrients, meal composition, various drugs and supplements, time of day and biorhythms, age and gender. It doesn’t make sense to try to reflect nutrient digestibility and absorption in the Nutrivore Score when the system is so complex and varies from individual to individual.

You can think of the Nutrivore Score as a simple yet comprehensive representation of the inherent nutrients within a food, and acknowledge that a variety of factors will determine whether or not your body absorbs and uses all of those nutrients.

Because nutrients can be lost, formed and transformed by cooking, the Nutrivore Score is calculated based on the nutrients within the raw whole food, unless noted otherwise. Also, it is unusual for there to be nutrient data for different quality levels of a food. For example, the Food Central database contains only one entry for olive oil, but research has shown that the polyphenol content of virgin olive oil can range from anywhere between 50 to 5000 mg/kg, and the vitamin E content can range from 100 to over 1000 mg/kg. Another example: even though locally-grown, in-season organic vegetables and fruit and known to have higher nutrient density (due to being grown in higher quality soil, picked ripe, and eaten much sooner after harvest), there are no separate entries in the Food Central database for organic versus conventionally-grown produce. For this reason, we can think of Nutrivore Scores as a minimum or average value and feel confident that the effort to seek out higher quality options (grass-fed meat, wild-caught fish, fresh cold-pressed extra-virgin olive oil, and local in-season vegetables and fruit) is still nutritionally valuable if currently not quantifiable.

As more nutrient data become available, the Nutrivore Score will be updated to reflect more complete nutritional information. This obviously applies to missing nutrition information from the Food Central database, but there’s also the likelihood of adding nutrients to the Nutrivore Score calculation in the future. For example, a protein digestibility score, soluble versus insoluble fiber, trace minerals, functional nonproteinogenic amino acids and peptides, functional fatty acids, and vitamin-like compounds that aren’t currently utilized to calculate the Nutrivore Score could all be added once there is sufficient data to rationalize their inclusion. For now, extremely sparse data makes this prohibitive, and similarly would reward foods simply for being better studied, not necessarily for inherently higher nutritional value, relative to less common foods.

Using the Nutrivore Score

It is time for a positive approach to dietary guidance using nutrient density as a basic principle.  The Nutrivore Score is a necessary foundational step towards achieving this goal! By understanding the nutrients per calorie offered by individual foods via the Nutrivore Score, in addition to recognition that certain nutrients are exclusive to specific food groups, we can achieve nutrient sufficiency by choose a variety of nutrient-dense superfoods as well as the highest Nutrivore Score options from the various foundational food groups.

As I build Nutrivore.com, the Nutrivore Score is one of several tools that I am using to communicate which foods have the most to offer us. As you can see with the sample nutrient card above, I’m also highlighting the nutrients per serving (rather than only considering nutrients per calorie), including which are excellent sources (more than 20{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f}DV) and which are good sources (10-20{e2a5b4b931a58f767699fdd430343808d146204888b8453b8c1ba375f5682a1f}DV). I’m combining this nutritional information with a review of the scientific literature on the specific health impacts of eating a food, and detailed information on what nutrients do in the body and how much of them we need. And, I’m creating educational resources on how to select various foods with complementary nutrition to achieve nutrient sufficiency!

I’m building this website outside of any dietary dogma. Being a Nutrivore is about the overall quality of the whole diet, and not about a list of yes-foods and no-foods. Even though eliminating empty calorie foods helps to achieve nutrient sufficiency without overeating, no food is strictly off-limits. In this way, being a Nutrivore is a diet modifier rather than a diet itself—a Nutrivore approach can be layered atop of other dietary structures and priorities in order to meet an individual’s specific health needs and goals.

I see Nutrivore as the natural extension of my science-grounded approach, and one that will allow me to both level up the depth of my resources for my long-time readers who love my science deep dives, but also meet people where they are and embrace the idea that even a small first step is worth celebrating. (See also What Is a Nutrivore?, Ditching Diet Dogma, My Personal Journey with the Autoimmune Protocol and My Personal Journey as a Blogger).

My vision for Nutrivore.com is extremely ambitious: A detailed educational resource devoid of dietary dogma and instead purely based on scientific studies and nutrient profiling to quantify nutrient density, all with the goal of helping people achieve dietary nutrient sufficiency (a.k.a. Nutrivore) through informed day-to-day choices.

The Nutrivore Score is a measure of much nutrients, relative to the daily value (DV), a food contains per calorie. A nutrient-dense powerhouse superfood is any food with a Nutrivore Score higher than 800. High nutrient-density foods have a Nutrivore Score between 400 and 800. Medium nutrient-density foods have a Nutrivore Score between 150 and 400. And, low nutrient-density empty-calorie foods have a nutrivore score less than 150. Remember, there are no yes-foods and no-foods on a Nutrivore approach, but instead what matters is whether the diet as a whole meets the body’s nutritional needs. Overall dietary nutrient sufficiency is easy to achieve by selecting a variety of the highest Nutrivore Score foods within each food category.

So far, I have calculated the Nutrivore Score of about over 7,500 different foods, and boy there have been some surprises!  Did you know that golden kiwis are a little more nutrient-dense than green kiwis? Or that dark meat turkey is more nutrient-dense than light meat turkey? Or that maple syrup and molasses have a medium nutrient-density score and that molasses is more nutrient-dense than cheese or pears?! Or that Asian pears are the most nutrient-dense Rosaceae family fruit (the apple and stone fruit family). Or that blackberries, strawberries and raspberries are all more nutrient-dense than blueberries? You’ll be able to find all of this information in my new e-book, Guide to Nutrivore!

Introducing the Guide to Nutrivore E-Book!

Guide to Nutrivore lays the foundation for Nutrivore as a general health approach, a base dietary philosophy devoid of dogma, on top of which you can layer additional food focus or eliminations to meet individual needs. In this sense, being a Nutrivore is a diet modifier rather than a diet itself.

With this beautifully-designed e-book, you’ll:

• learn how a Nutrivore approach can improve health
• appreciate what essential and nonessential nutrients do in the body
• get practical tips on how to increase nutrient-density
• examine how to use the Nutrivore Score to choose healthier foods
• find detailed nutrition information on the Top 100 Nutrivore Score Foods
• compare the nutrient-density versus energy-density of food groups
• easily implement Nutrivore with handy-dandy visual guides and reference tables!

The Guide to Nutrivore explains how to eat a Nutrivore diet and introduces the Nutrivore Score, the most comprehensive and least-biased method to assess the nutritive value of individual foods.  Detailed nutrition information for the Top 100 Nutrivore Score Foods is summarized with beautiful graphics for each food. And, the Guide to Nutrivore includes analysis of food groups, considerations when preparing Nutrivore meals, practical tips to increase the nutrient density of your diet, and a look-up table for the Nutrivore Score of approximately 300 foods.

Nutrivore Scores of Common Foods

And, while you wait for Guide to Nutrivore and Nutrivore.com, here’s the Nutrivore Scores of some common foods!

• Arugula – 2019
• Avocado – 251
• Beef Liver – 4021
• Bell Peppers, Red – 1358
• Blueberries – 396
• Brazil Nuts – 694
• Broccoli – 2833
• Butternut Squash – 670
• Cheddar Cheese – 126
• Chia – 450
• Chicken, Breast – 309
• Cremini Mushrooms – 2279
• Eggs – 355
• Garlic – 5622
• Green Leaf Lettuce – 2245

• Kale – 4233
• Mango – 342
• Oranges – 408
• Oysters – 2255
• Potato – 273
• Rice, White – 66
• Salmon, Wild Atlantic – 868
• Spinach – 4548
• Strawberries – 762
• Sugar, Granulated – 1
• Sweet Potato – 379
• Walnuts – 303
• Watercress – 6929
• Wheat Flour, All-Purpose – 70
• Yogurt, Greek, Whole – 178

And, don’t forget to grab my free Nutrivore Score Guide to Food Groups!

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