A Message From Dr. David Katz

 

David L. Katz MD, MPH, FACPM, FACP is a nationally recognized authority on nutrition, weight control, and the prevention of chronic disease.

 

 

A frequently asked question from dietitians and consumers alike is "Does The NuVal® Nutritional Scoring System adequately consider the importance of specific nutrients for specific populations?"
 

 

"As the author of two editions of a nutrition textbook for clinicians- and the developer of an on-line CME program to train clinicians in lifestyle/dietary counseling- I consider this worry about one disease/one nutrient to be among the greatest of fallacies bedeviling modern dietary guidance.


For whom would the oat cereal be recommended?  Presumably a hyperlipidemic patient; the principal utility of soluble fiber is cholesterol reduction.


Most people simply fail to take the next step and ask themselves this: why do we care about lowering cholesterol?  It's not because we care about the lab value, per se; it's because we care about preventing Myocardial Infarctions (MIs, or heart attacks) and strokes.  And so on.

 

Well, if someone is at risk for an MI, then... their intake of sugar, sat fat, trans fat, MUFA, omega-3, etc.- are comparably important to their intake of soluble fiber. If you eat enough soluble fiber to lower your cholesterol from foods high enough in sodium to raise your blood pressure, have you lowered, or raised, your risk of MI?

 

In fact, the only way to apply food/diet/nutrition to disease prevention and health promotion-which is what we actually care about but allow ourselves to forget-is holistically.

 

It is not the soluble fiber content, per se, that EVER matters; because a food concentrated in both soluble fiber and trans fat could well have a net detrimental effect. A food concentrated in both soluble fiber and omega-3 could be substantially 'better' than a food concentrated in soluble fiber and sodium. It is always the overall nutritional quality that matters. And that, of course, is what NuVal scores. I believe the endorsement of the system by the American College of Preventive Medicine (ACPM) is a reflection of their understanding of this crucial but neglected concept.

 

The NuVal System goes the extra step, and actually weights each nutrient so that its actual association with specific health outcomes is fully factored in.  Thus, soluble fiber gets all the credit it deserves, no more nor less, just as sodium, or added sugar, or trans fat in the same food gets just the penalty warranted.

 

As an expert in the prevention of cardiometabolic diseases, I fully appreciate the merits of soluble fiber.  But I also agree with the NuVal System that shredded wheat, which provides both insoluble and soluble fiber, albeit less of the latter, and nothing harmful to accompany them, is a better choice for almost anyone at risk of heart disease than toasted oat cereal, which provides more soluble fiber, but in the company of a rather hefty dose of sodium.  And toasted oat cereal, in turn, is a far better choice than a cereal with comparable sodium, and/or added sugar, but not the whole grain oats and soluble fiber.  The NuVal score for toasted oat cereal is, in fact, pretty good, but you can do a whole lot better.  A cereal with the soluble fiber of Cheerios (or more) but without the sodium would be an even better choice than the shredded wheat; for example, pure oat bran scores 100. Cereals made from pure whole grain oats without added salt or sugar score in the 80s."