Determining Diet Quality: Not Grams and Milligrams

The Joys of Clinical Dietetics

In my 15 years of practice, very few of my clients have wanted to discuss diet quality. Instead, they want to know if they can eat a specific food. During one of my most frustrating experiences in the fun field of clinical dietetics, I had a husband and wife who were apparently under the influence of at least one potent substance. They yelled the names of foods at me in a rapid-fire, hyper style for well over an hour. He had hypertension, and she had diabetes.

Her: “Pickles!”

Me: “No carbohydrate to speak of, but very high sodium.”

Him: “Cereal!”

Me: “She needs to count it as carbohydrate, but it’s pretty low in sodium.”

Her: “Peanut butter!”

Me: “Are you putting it on bread or crackers, or just eating it with a spoon?”

Foods Aren’t “Good” or “Bad” for Everyone

This happens when we stop thinking of food as food and start thinking of it as a pile of nutrients. As a result, people want two things from me:

  1. A list of “good” foods and a list of “bad” foods.
  2. A month worth of menus written out for them that they can follow to the letter.

I refuse to provide either of these except in rare, desperate situations. Even if I offer two columns of foods to eat and foods to avoid, it certainly won’t be labeled with the derisive “good” and “bad.” Most of everything written about nutrition focuses on individual nutrients: protein, fat, carbohydrate, fiber, etc. Sometimes this makes sense – like when you’re discussing a specific deficiency in someone’s diet. Sometimes, though, it does nothing but confuse and frustrate people trying to improve their wellbeing. We need to focus on overall diet quality.

For example, maybe you heard that particular food was bad for you because it is high carb, and then the next day, you read that it’s one of the richest sources of a nutrient that most Americans are deficient in. Should you eat it or not? Well, that’s not a yes or no answer. I can’t answer you unless I know your health history and goals, what else you eat in a day or week, and how much of it you plan on eating. This is why yelling “pizza!” at me and impatiently waiting for a yes or no answer is a failing proposition.

Food is Much More Than the Sum of Its Parts

I can’t evaluate any food based on the sum of its nutrients. There is no calculation like grams of carb + grams of protein/grams of fiber x B12 content + vitamin D content – fat content. Because that’s not how food works; this is why no supplement will ever compare to whole foods.

You can shove all of the vitamins and minerals you want into a pill, and it will never compare to what you would garner from eating a diet rich in fruits, vegetables, and whole grains. An Ensure supplement does not take the place of a well-rounded diet, but it will keep you alive if you can’t eat food. If you look at a nutrition facts label on a container of kale, you’ll think that you’re getting a lot of calcium. Still, a dietitian can tell you that you’re not because another substance in the kale blocks calcium absorption. Another example is that the fat in dairy products has much less impact on lipids than we would expect just by looking at the saturated fat content. Also, the almonds you’re eating might contain 160 calories, according to the label, but you’re only absorbing 120 of them.

Start Thinking in Terms of Diet Quality

The bottom line is that we need to stop determining diet quality by singling out nutrients instead of looking at the big picture. As long as we continue to compartmentalize foods into categories of “high in (nutrient),” “low in (nutrient),” “good,” or “bad,” we are encouraging mass confusion and frustration. How does your day’s worth of food look? Is it bright and colorful? Are the portions reasonable? Does it contain a variety of foods from all of the major food groups? These are the sorts of questions that are the most meaningful to me, and they are ones that I rarely hear people answer.

If you’re curious about the healthfulness of your diet, be sure to check out this quiz developed by the University of Newcastle.

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One Comment

  1. Marylee says:

    Great article! There is so much confusing information and advice and it often doesn’t agree. I think we all know instinctively what we should eat and what to avoid. Moderation and reasonable goals are not as attractive as black and white thinking concerning food with it’s promised great health and physique in a short period of time.

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