Recently I interviewed Dr. Sarah Ballantyne, and we chatted about nutrient density and Nutrivore principles. If you would prefer to listen the interview you can access it by Clicking Here [1].
An award-winning public speaker, New York Times best-selling author, and world-renowned health expert, Dr. Sarah Ballantyne, PhD believes the key to improving public health is scientific literacy. She creates educational resources to help people improve their day-to-day diet and lifestyle choices empowered and informed by the most current evidence-based scientific research.
Dr. Sarah began her career as a science communicator and health educator when she launched her original website ThePaleoMom.com in 2011. On this platform, Dr. Sarah combined her background in medical research with her experience of using diet and lifestyle to mitigate a dozen diagnosed health conditions to create a wealth of educational resources and amass an audience of millions.
Since then, Dr. Sarah has continued to follow the science, diving deep into immune health, metabolic health, gut microbiome health, nutritional sciences, and the compelling evidence for help at any size while also observing the harm of healthism, diet culture, dogmatic misinformation, predatory marketing. With Nutrivore, which we will chat about, Dr. Sarah seeks to create a positive and inclusive approach to dietary guidance based in science and devoid of dogma using nutrient density and sufficiency as its basic principles.
Thank you so much for joining us, Dr. Sarah. If you couldn’t tell, I am so excited to have this conversation with you.
Dr. Sarah Ballantyne:
Thank you so much for having me. I’m excited, too.
Dr. Eric:
A lot of my audience is familiar with your Paleo Mom website, which is just amazing. Now you are making the transition to a wonderful Nutrivore website as well. Can you talk about that transition?
Dr. Sarah:
It’s a transition that began probably six or seven years ago. It really started with observing a problem in not just the paleo community but the health and wellness community more broadly, where we continue to define diets based on the foods we avoid. Most of the diets that are popular now—I might venture so far as to say all of the diets that are popular right now, when you are learning about that diet, you have a list of restrictions, things that you are going to cut out completely or avoid or things you have in very measured quantities. Most diets boil down to a list of roles, the good foods and the bad foods.
The problem with this is first of all, psychology studies show that dichotomist approaches to diet, where you have rules, yes foods and no foods, or good foods and bad foods, actually increases the risk of regaining lost weight and increases the chance of developing disordered eating patterns. My observation in this community is that I think this is very human nature. I think what happens is we have some kind of reason why we go on a diet. I think it’s very common for that reason to be weight loss. We go on a diet that you avoid these 10 foods or 100 foods.
What happens is our bodies fight weight loss. Our bodies do not want to lose weight. As we lose weight, our basal metabolic rate slows down, and our hunger hormone, ghrelin, increases. It becomes harder and harder to keep losing weight, and it becomes harder and harder to maintain that weight loss. When we define a diet based on “I cut out these things. I lost weight initially. I am not losing weight anymore. What is the next thing to do? I am going to cut out more things.” Then we repeat that cycle of an ever more restrictive eating pattern.
This goes back to the ‘70s with low fat. Defining diets based on the thing that you cut out creates a mindset where when we want more results, whatever that is, the natural next step is, “I have these results by cutting stuff out. I will cut out more stuff to get that next step of results that I want.” What’s happening in my observation, and certainly the scientific evidence would back this up, is that we are actually magnifying a problem that already exists, which is the rampant prevalence of nutrient deficiencies and insufficiencies.
Our food supply is abundant in calories. Doesn’t actually contain that many foods that are really dense in vitamins and minerals and phytonutrients, unless you are eating a very whole foods and very varied diet. Unless you are in that privileged space to be able to afford food like that, you have nutrient deficiencies.
When you get on this diet train yo-yo, what ends up happening is the more things you learn through diet culture, the more restrictive your eating becomes, the more you’re exaggerating nutrient deficiencies, which are driving your health problems, which are then driving that guilt/blame cycle, and the yo-yo continues. In observing this as a thought leader and health educator, and dare I say influencer (it’s not my favorite word), I have really been searching for the solution to this problem.
I have done a lot of communication around nutrient density since my very earliest days blogging in 2011/2012. That to me was the missing piece. The missing piece of education that people don’t have, which is very basically what do nutrients do in the body? What foods contain them? How much do I need? That’s not integrated into most dietary approaches. It’s obviously integrated into the autoimmune protocol because of my work.
That’s what Nutrivore is. It’s very much understanding outside of any particular dietary structure, outside of labeling foods as good or bad, getting away from those dogmatic approaches to food. It’s about understanding what foods contain what nutrients. How do we choose foods to make sure we are getting all of the nutrients that we need?
What I think is so powerful about Nutrivore is you can apply Nutrivore principles to a diet that you resonate with. If you love the paleo diet, you can apply it to paleo, but you can also apply it to no dietary structure in particular. You can apply it to anti-diet, the 10th principle of intuitive eating, and you can use it for your primary guiding principle for a diet. It lives in between the worlds of diet culture and anti-diet, pushing back on diet culture by providing this simple and logical solution. Let’s just get all the nutrients that our bodies need from the foods we eat.
Dr. Eric:
Makes sense. You kind of answered a question that I had while you were talking. You mentioned someone could follow a paleo diet but still incorporate Nutrivore. You talk a lot about the autoimmune protocol with Paleo Mom. Just because you follow AIP doesn’t mean it still has to be a restrictive diet where you are not getting necessary nutrients. You can and should probably incorporate Nutrivore concepts.
Dr. Sarah:
I would argue that the AIP was my test case for Nutrivore principles because the AIP has had nutrient density as one of its five pillars. AIP has three lifestyle pillars: sleep, activity, stress management. And then two diet pillars: the elimination challenge, the phases of the AIP where you discover your own food triggers, and nutrient density. Nutrient density is synonymous with Nutrivore. We are choosing foods that have a lot of nutrients per calorie.
Nutrivore provides an amazing tool for AIPers by using the Nutrivore Score, which is a profiling method that I developed as part of the foundational content for Nutrivore, to help identify those nutrient dense foods. It gives additional tools to people following the AIP to actually increase the nutrient density of their diets, which is important for immune health.
Dr. Eric:
I love the Nutrivore Score. I was fascinated. For example, I am pretty sure you mentioned that collard greens had a higher Nutrivore score than kale, which I had no idea.
Dr. Sarah:
Yes.
Dr. Eric:
We will talk about Brazil nuts, how they had the highest score for nuts. That being said, can you talk about some of the foods, especially vegetables, with the highest scores?
Dr. Sarah:
I pulled some scores and brought notes, so I had some scores to share. I think this is such a fun intellectual exercise. Taking a step backwards, the Nutrivore score is a profiling method. When I started to build Nutrivore, my first intention was to go through the science of nutrient profiling, find a nutrient density score I liked, and use that. What happened after reading nothing but nutrient profiling papers for three months was I decided I didn’t like any of them. None of them made sense.
One thing that is happening in nutrient profiling right now is this effort to retrofit a nutrient density score to what’s called the Healthy Eating Index, a measurement of how well someone fits USDA dietary guidelines. They are trying to figure out what nutrients to include in the score, so a high score would match a high healthy eating index. I think it’s completely backwards. I think we should be just doing the math, whatever makes the most sense, to represent the food, and using that to better understand diet. That is what I have done with the Nutrivore Score.
It’s algorithmically very similar to the Nutrient Rich Foods Index, but it uses 33 nutrients in the calculation, basically every nutrient we have complete enough data that it’s fair to include it. Very carefully making sure not to overweight plant food nutrients or animal food nutrients. You really just get total nutrients per calorie.
The insight that the Nutrivore Score has given me into different foods has just been fascinating. For me, it was like, “Let’s do this math. Let’s do the math on 8,000 foods. Then let’s look at the numbers and see what they tell us.” That’s the scientific method, right? It really shows for example just how important leafy vegetables are, how important the cruciferous vegetable family, the cabbage family are, how important mushrooms are. It really shows you why organ meat is so fantastic. Shellfish and fish are just crazy high as well.
The #1 top food in the entire database is canned clam liquid, which has a Nutrivore Score of 14,744. I would have never, ever guessed in a million years that the liquid you drain from canned clams, or clam juice, would have the most nutrients per calorie. It just so happens you have a lot of dissolved minerals and vitamins in that liquid. There is a lot of protein. It’s like bone broth on steroids.
Watercress is one of the highest vegetables that most of us could find in a grocery store. There’s lots of obscure ones that are higher. It has a Nutrivore score of 6,989.
Turnip greens have a Nutrivore score of 6,370.
Swiss and rainbow chard are up in that range. Rainbow chard is 6,573, and Swiss chard is 6,198.
Radishes are a surprising super nutrient dense food. They have a score of 5,863.
Garlic is 5,622.
Kale, which I feel like is the pinnacle example of a superfood, is 4,233.
All of these are crazy high.
The lowest is 0. White sugar has a Nutrivore score of 1. It shows you this math really does bear out if you have foods that are 0 and foods that are 14,000. If you were to get 100% of everything in your diet, and only 100%, on a 2,000-calorie day diet, you would be looking at an average Nutrivore score of 165. We typically say anything over 150ish because 2,000 calories is not a super accurate way to determine how many calories someone needs. Over 150ish is going to give you more nutrients than energy.
The great thing about the super high score foods is the more of them you eat, the more room you are earning for quality-of-life foods, to round out with foods that aren’t nutritionally impressive but still can be very valuable foods. Something like white rice has a Nutrivore score of 66, I believe. It’s not nutritionally impressive, but it is a great source of resistant starch if you tolerate rice. There are studies showing that people who eat more rice, especially men, have lower rates of cardiovascular disease, likely due to the impact on the gut microbiome, which studies show are very favorable. The more of these kale and collard greens and mustard greens and turnip greens and seafood and organ meat that we eat, the more having something with a low Nutrivore score won’t impact the overall quality of our whole diet. We get to enjoy these foods to round out our meals.
Dr. Eric:
It sounds like diversity is still important, not just to focus on the high Nutrivore score. As an example, I believe you said during one of the videos I was watching that strawberries is the #1 berry when it comes to Nutrivore Score, followed by blackberries. A lot of people think blueberries would be the highest. Cranberries weren’t too high. This is not saying you can’t eat blueberries or cranberries, and you should just focus on strawberries and blackberries, correct?
Dr. Sarah:
Correct. This is getting into the challenges of scientific communication and attention spans in our modern age. One of the things I am building out on the Nutrivore website is a better understanding of what I call nutritionally distinct food families. Instead of thinking of our four or five food groups, which are typically based on how a food is grown and/or maybe one nutrient, we have protein foods and fiber foods. We have calcium foods. That’s how we think of food groups, at least in terms of USDA dietary guidelines and my plate.
With Nutrivore, we are taking a broader look at what nutrients food contain. There is a collection of food families that offer something very special. Seafood in general, some of our most nutrient dense animal foods. The long chain Omega 3 fats are incredibly important. Plus they are very good sources of vitamins and minerals. They are nutritionally distinct because of those long chain Omega 3 fats.
Vegetable families that are nutritionally distinct include cruciferous vegetables. They contain glutamates, which we can’t get from other vegetables. They are very important phytonutrients that reduce cancer risk most strongly as well as cardiovascular disease risk.
Alliums, the onion family, are a nutritionally distinct food because they have thiosulfinates, which are very important for reducing cardiovascular disease risk and cancer risk and also type two diabetes risk.
Leafy vegetables, we are talking about fiber types that are particularly important for the gut microbiome, and some of our most nutrient dense foods.
Mushrooms have a lot of different things going on. They have a few classes of really unique phytonutrients. They have also unique fiber types we can’t get anywhere else. They contain an amino acid that is not part of the 20 our bodies use to make proteins but has an important role in our body. It’s found in almost every tissue. It’s called ergothioneine. It has this potent antioxidant effect that has been nicknamed the longevity vitamin in scientific studies because it’s so cool. Not a vitamin at all, but an amino acid. Mushrooms are important.
Root vegetables have a functionally distinct collection of fibers for the gut microbiome. Those are the most important families.
From there, we would say avocadoes and olives, that little group, would be important as healthy fat sources.
Fruit, we really see the biggest benefits to our health from the berry family and citrus.
Each one of these has something nutritionally distinct to offer. The Nutrivore Score can help us identify the most nutrient dense within each of these families. It’s important to understand we are not adapted to one food or one food group. We really need this collection of foods in order to meet our nutritional needs, in order to get all of the different nutrients that our body needs. We can use the Nutrivore Score on top of identifying these important food families to help up the ante in terms of how much nutritional benefit we are getting from every bite.
Dr. Eric:
You mentioned citrus and berries. I also saw a video on bananas, raving about them. I’ll admit, that’s one of the fruits that I usually tell people not to eat too much because of the sugar. I’d like to get your thoughts on fruit and sugar. Maybe I shouldn’t be advising people to avoid bananas on a regular basis, or maybe they should stick with small bananas.
Dr. Sarah:
I should have come with a visual aid for this one. There is a variety of studies that do dose responses and all-cause mortality. That’s a measurement of general health and longevity. It’s basically a way of scientific studies telling us whether or not something is good or bad for us. There is a variety of studies, including these huge meta-analyses, that look at the level of intake of food or food groups has what effect on all-cause mortality.
There are certain foods that the more of them you eat, the better you are. Vegetables are like that. The more vegetables you eat, the healthier you’ll be on average. Almost a straight line. I eat more vegetables and reduce my all-cause mortality. Interestingly, legumes are more similar. I eat more legumes and reduce all-cause mortality.
There are other foods that are the other way around. The more of them I eat, the more I increase all-cause mortality. We see this in sugar-sweetened beverages like soda. We see this in processed meats. The more processed meats on average, the higher our all-cause mortality rates.
Then there are foods that have non-linear relationships. Nuts and seeds, for example, have a benefit up to—it’s a steep little slope on this graph—about an ounce a day, and then it levels off. There is no additional benefit above an ounce a day, but it’s not erasing the benefits that you were getting from that 0-1 ounce.
Fruit has almost a J-shaped curve. It’s not quite E-shaped. We see a really steep decline in all-cause mortality from 0-300g per day of fruit. That is 2-3 servings, depending on the fruit, per day. We see pretty impressive declines in all-cause mortality. Then it levels out, and it starts to creep back. At about 600g daily, you’ve lost about half of the benefits. It’s approximately a 10-12% decrease in all-cause mortality at 300g, and only 5-6% decrease at 600g.
What’s really important, especially when we are trying to make healthy changes sustainable, is to emphasize that 600g of fruit daily, so that’s 5 or 6 servings of fruit, is still better than no fruit. 300g, getting into that sweet spot, that would obviously be the best. 2-3 servings of fruit per day would be awesome. High fruit consumption is still better than no fruit consumption. That really helps us get over that fear of fruit as nature’s candy, which I think has done us a disservice, to label fruit as the same as refined sugars.
What is actually really interesting: Because fruit has fiber and so many antioxidants, phytonutrients, Vitamin C, there are studies that have compared high fructose corn syrup, a lot of fructose, versus the same amount, 100g of fructose a day, which is very much above the toxicity levels for fructose, and compared that from whole fruit. They have shown that whole fruit is not as detrimental for the same amount of fructose as drinking a glass of corn syrup sweetened liquid, which is what they kind of do in those studies. The metabolic impact is not as high. It would still be able to have a water fructose intake of less than 45g per day. Even getting up to 100g per day, if that fructose is coming from fruit, it is not as harmful as that fructose coming from a refined source.
We look at all of the science together. Fruit in moderation, and it really doesn’t matter what fruit that is. The fruit you like is great. Fruit in moderation is actually incredibly beneficial. Fruit in excess is still not as harmful as avoiding fruit.
Dr. Eric:
Good to know. When I was younger, a child, teenager, even a young adult, I honestly didn’t eat any vegetables. It was all fruits. Now, it’s the opposite, where I am eating plenty of vegetables and a little bit of fruit. It sounds like it’s not a big deal if someone is eating, not that you are encouraging them to eat 4-6 servings per day, but it’s not harmful to do that. The next question: If they are eating that many servings of fruit, should they up the ante when it comes to vegetables? Or does it not make a difference?
Dr. Sarah:
Especially for bitter supertasters, for people who detect that very strong bitter flavor from especially cabbage family vegetables, these people often don’t like any vegetables. It tastes different to them than it tastes to us. It tastes bitter and gross. Some people learn to love the bitter, but most people don’t. They tend to gravitate toward special treats. For someone like that, if fruit is your way into eating more fresh fruits and vegetables, I think that’s an amazing trade. That’s a great compromise.
I don’t work with clients, but if I had clients, the conversation I would want to have would be: Can we start trading some of that fruit for a little more vegetables? We are eating 5-6 servings of fruit per day and 1-2 servings of vegetables. Can we even keep fruit where it is, and just add a serving or two of vegetables? Can we ease into a little bit more vegetable? There is some really fantastic recipes that actually combine fruits and vegetables. l think about how fruit can really offset the bitter flavor of something like kale in a salad. Looking at how can we combine this fruit with some vegetables to make those vegetables taste better? We are talking about a person who loves their fruit.
Gently encouraging a shift in balance ideally, we would have about eight servings of fruits and vegetables. About two of those would be fruit, and six would be vegetables. That is the ideal ratio. Can we slowly shift that ratio?
It’s also really important when we are trying to make dietary changes to make those give and take compromises to keep things in a sustainable level. When we get into that “I have to use all my willpower to keep doing this thing. I hate what I’m eating,” we are setting somebody up to fall off the wagon again. Being able to ease into a habit where we just eat more vegetables, and it’s really natural, is a more sustainable approach than how am I going to force myself to eat more vegetables?
Dr. Eric:
Yep, that makes a lot of sense. What are some of the more common nutrient deficiencies that you see? Most people listening to this have a thyroid or autoimmune thyroid condition. If there are any nutrients more common in those with hypothyroidism or hyperthyroidism.
Dr. Sarah:
That’s a really good question. Studies that have just looked at typically NHANES status, so it’s nutritional surveys of what Americans are eating, are- Actually, it’s really surprising how common nutrient shortfalls are. I will use the words “shortfall” or “insufficiency” instead of “deficiency.”
Studies show that about 1/3 of Americans are at risk for nutrient deficiency. Deficiency is when we are going to have a disease of malnutrition, like scurvy from Vitamin C deficiency or Rickets from Vitamin D deficiency or beriberi from VitaminB1 deficiency or anemia from iron deficiency.
Insufficiency is where we are not getting enough of those nutrients, but it’s not so bad that we are going to have a disease of malnutrition. What’s really important to understand is not getting enough nutrients, those nutrient shortfalls increase our risk for every single chronic disease and infectious disease. That is because our body uses nutrients. It’s the raw materials of all the chemical reactions happening in our body all the time. When you don’t supply the raw materials that a cell needs to perform its function, it can’t perform its function as well. That string builds up over time to impact that biological system in a negative way, an increased risk for chronic disease.
Nutrient insufficiencies are a big deal, but they are technically something different than a deficiency. A deficiency is like “Your gums are bleeding. You have scurvy.” An insufficiency, you might not have any overt symptoms. You might feel fine, but your risk for some kind of chronic illness is increased over time.
The most common nutrient insufficiency is Vitamin D. Basically 100% of us don’t get enough Vitamin D from our diet. I don’t know if we count that one as much because we are obviously making more Vitamin D from sun exposure. Also, if you are deficient or insufficient, it’s very hard to build your serum levels back up from diet and sunshine. This is definitely an exception to the Nutrivore philosophy. Go get tested, figure out what your Vitamin D is, talk to your healthcare provider, supplement accordingly, and retest to make sure you are supplementing enough and not overshooting the mark. Vitamin D, we will put to the side. I thought it’s worth noting: Nobody gets enough vitamin D from their diet.
Potassium is the next most common nutrient insufficiency. 97.8% of Americans don’t get enough potassium in their diet, which is crazy. Not only that, but the USDA Dietary Guidelines, the brand new 2020-2025 ones, they have a paragraph about the nutrients that if you followed USDA dietary guidelines perfectly, here is the nutrients you wouldn’t get enough of. Potassium is on that list. I think it’s a flaw in the USDA dietary guidelines if they can list six essential nutrients you won’t get enough of, even if you follow the guidelines perfectly, which only 7% of people even try to do. That’s a tangent.
Vitamin E is next. 96.2% of people don’t get enough Vitamin E in their diets.
Folate is next. 90.2% of people don’t get enough folate in their diet.
80.1% of people don’t get enough Vitamin A in their diet.
72.4% of people don’t get enough Vitamin K in their diet.
66.3% of people don’t get enough magnesium in their diet.
56.3% of people don’t get enough Vitamin B1 in their diet.
54.9% of people don’t get enough calcium in their diet.
52% of people don’t get enough Vitamin C in their diet.
Those are 10 nutrient deficiencies that over half of the population are not getting enough from their regular foods, which is just the most shocking statistics. Everyone is walking around with nutrient shortfalls, and that is increasing our risk for chronic disease. No wonder we have so much chronic disease in Western countries.
Dr. Eric:
Have you done any research when it comes to thyroid health to see if any of those nutrients are more deficient in people with hypo and/or hyperthyroidism?
Dr. Sarah:
Certainly, there is research showing that there are four nutrients important for thyroid health. People with especially hypothyroidism or hyperthyroidism are more likely to have these deficiencies: iodine, selenium, zinc, and iron.
Iodine is really interesting because of course, too little iodine can cause hypothyroidism. Too much can cause hypothyroidism. Iodine is part of the structure of thyroid hormone. The enzymes that are making thyroid hormone are seleno-enzymes; they are based on selenium. Iron and zinc are important cofactors. Those nutrients are the most important from a thyroid health perspective, or at least the nutrients where there is pretty good science with people with hypothyroidism, where supplementing with those nutrients can improve thyroid hormone production.
Dr. Eric:
You mentioned iodine. I wanted to ask you about sea vegetables because sea vegetables are higher in iodine. A lot of people I work with are concerned about iodine and do everything they can to avoid it. I don’t recommend avoiding all food sources of iodine. How about seaweed and kelp and other sea vegetables? Is it safe for people with Hashimoto’s and Graves’ to consume sea vegetables in your opinion?
Dr. Sarah:
I would definitely say first of all, talk with your doctor. This is where a food journal where you are evaluating what iodine sources are in your diet already would be really important. You can do blood tests for iodine levels. Looking at what your regular iodine intake is, most people are getting iodine from iodized table salt. That is the fortified food in Western countries that is supplying the most iodine. When you decide to switch to Kosher salt or sea salt or Himalayan pink salt, you are now using a salt that has very little iodine. There is some, especially in Himalayan pink salt, that has such high mineral content. It’s nowhere the same concentration as you are getting from iodized table sat.
If you are eating a predominantly whole foods diet, and you are using these unrefined salts, chances are you are not getting enough iodine, unless you happen to eat a lot of seafood. We can get iodine from different foods. Eggs have a good amount of iodine. The dominant food source of iodine is things that were in the ocean. Sea vegetables are some of our richest sources of iodine.
Really interestingly, studies show that about a serving or two per day of sea vegetables has some pretty big impacts on health, especially cardiovascular disease risk. That may be because not just iodine, but sea vegetables tend to have a lot of trace minerals. They also have some really unique carotenoids. Fucoxanthin, which we can’t get in other foods, that have some really impressive health beneficial properties. But we do want to be careful about the iodine.
Kelp sequesters iodine. It’s a very high iodine sea vegetable. Most of the other sea vegetables you will get in the store have a tenth the amount of iodine as kelp. Our daily value is 150mcg. The tolerable upper limit is 1100mcg. 1-2 servings of sea vegetables other than kelp will hit your iodine daily value, and you won’t get close to that upper limit. You will be in a good range. With kelp, you would want to keep to one serving or less on a daily basis. A serving is 5g dried. It’s not huge. It’s like one nori sheet.
Nori itself, I feel like that’s the most common sea vegetable that most people are eating. Nori is a lower iodine option. With nori, you can have several sheets a day, and you won’t be anywhere close to that tolerable upper limit for iodine. The one to be aware of is kelp. Kombu is a type of kelp. Knowing your sea vegetables and which ones are kelp. Most ones like arame, wakame, nori are all low enough in iodine that you can definitely have a serving or two every single day, get the benefits of sea vegetables, and not have to worry about the iodine in it.
Dr. Eric:
All right, wonderful. Earlier, I mentioned that Brazil nuts have the highest Nutrivore score with regards to nuts. A lot of people know that Brazil nuts are high in selenium, so a lot of people will eat Brazil nuts. One question I had, which I don’t know if you have the answer, but is selenium toxicity a concern if someone eats too many Brazil nuts? Or since it’s a food-based source, it’s not a concern if someone were to eat a cup of Brazil nuts, for example.
Dr. Sarah:
Let’s differentiate between acute toxicity and chronic toxicity. Acute toxicity is if you had a dose of something in one dose that is so much that it was a health problem. For selenium, that’s not very well defined. Chronic toxicity is. That’s where you have that same amount every single day for months. Chronic toxicity for selenium is around 900mcg. The tolerable upper limit is 400mcg, but there is a lot of studies showing intake, and that in between 400-900 being totally fine. There are obviously some people who are more sensitive. That’s why they set tolerable upper limits very conservatively.
The daily value is 155mcg. You can get the daily value of selenium from like two Brazil nuts, which is phenomenal. They are such a rich source of selenium. That is what pushes their Nutrivore Score up to 700, which is way higher than just about any other nut and seed. That’s because of their incredible selenium content. 10-12 Brazil nuts would hit that chronic toxicity level, but you would have to eat that many every single day for months in order for chronic selenium toxicity to show.
Our bodies are pretty good for most nutrients of getting rid of excess. Sitting down and eating a cup one day is unlikely to be harmful. Not going to say guaranteed not to be harmful because different people are differently sensitive. Having a look through the literature, the case studies I can find on selenium toxicity are all from supplements, not from Brazil nuts.
Dr. Eric:
All right. I know you encourage people to eat organ meat. I don’t know if off the top of your head, you know the Nutrivore scores for different types of organ meat. We could talk about organ meats. A question I had is if someone absolutely does not want to eat organ meat, would having organ meat capsules be a substitute?
Dr. Sarah:
Liver is the most nutrient dense organ meat, depending on which animal you are talking about. The Nutrivore scores range from about 2,500 (chicken livers) to 4,000 (beef liver). Lamb liver is around 6,000. That is the range. They are incredibly nutritionally impressive foods.
Kidney is a little bit lower on average. Heart is quite a bit lower on average. Interestingly enough, there is not too many other organs that I have a really complete data set on. The most complete nutritional data I have is for these three that are the easiest for us to find generally.
If you look at the nutrients in liver, and you hate liver, but you know it’s a nutritionally valuable food. The first thing to emphasize is that you can get a very similar nutrient profile from mollusks. That is the group of shellfish that includes mussels, clams, and oysters. With about half the nutrient density. You’d have to eat twice as much mollusks per serving of liver to get the same nutrients. If you love clams and oysters and can afford them and can’t stand liver, that is one solution. Swap it out for another food that is nutritionally similar.
Organ meat capsules are a phenomenal option, especially these high quality freeze-dried capsules. I love Smidge brand for example. They are super convenient because you’re not tasting anything. It’s the liver, just freeze dried, which preserves the nutrients, is the best way to encapsulate it. They are just gelatin capsules.
The thing you need to know though is your fresh equivalent. Typically, the dose on the bottle, depending on the brand, is 4-6 capsules. That typically translates to, if you have that every single day, about two ounces of liver over the course of the full week. If you follow what’s on the bottle, you’re getting half a serving of liver over seven days. That’s just something to know. If that’s your only source of liver, it’s better to get a full serving a week. You might want to talk to your doctor because I can’t recommend any supplements. Talk to your doctor about doubling the number of capsules.
Dr. Eric:
That’s good to know. Fatty acid deficiencies, can you quickly talk about how common they are, especially if people don’t eat fish? I know you advocate eating seafood on a regular basis, including fish. If someone isn’t a seafood lover, there is fish oils and all that, but not exactly the same. I’ll let you take over.
Dr. Sarah:
True fatty acid deficiency is very rare. What we see is that the balance of Omega 3 fats and Omega 6 fats that we consume is very important. It’s not so much about exactly how much we get, but that we don’t want to have way too many Omega 6s and not enough Omega 3s.
Unfortunately, most of the foods in the modern food supply have quite a lot of Omega 6s. Where we are getting Omega 3s are mainly from seafood. We get the long chain Omega 3s from seafood and sea vegetables and algaes. For example, we can get short chain Omega 3s from plant foods, especially things like chia seeds, walnuts, sacha inchi seeds. We do convert some of that into longer chain Omega 3 fats in our body.
They do different things. They are both really good for us, but they do different things physiologically. Those long chain Omega 3 fats, the more of them we eat, they reduce risk of mental health conditions, neurodegenerative disease. They are important for preventing cardiovascular disease. They are really important for immune health and gut health in general.
Again, it’s not about how much we are eating, but the balance. We can typically not worry about how much Omega 6s we are getting as long as our diet isn’t super high fat and super high vegetable oil. As long as we are getting 3-4 servings of an oily fish per week, that is typically the amount that we would need to eat to balance Omega 6s in our diet.
For someone who is allergic to fish or shellfish, there are algae oil supplements that can provide those long chain Omega 3s. Or a vegan option if anyone was looking for a vegan way to get those long chain Omega 3s.
The most affordable option is to eat fish. Canned fish is a fantastic way to go. It’s very affordable. I feel like canned foods have been super maligned. One of the big insights I’ve had doing all of these calculations for the Nutrivore score is canned foods didn’t get this bad rap. They are nutritionally extremely similar to the fresh, raw food. There are examples of canned foods that are more nutrient dense than the fresh, raw version, including Eastern oysters. They are more nutrient dense canned than fresh. Don’t ask me why because I don’t fully understand why. That’s just the way the math works out.
One of the best things we can do to prevent problems with immune health, cardiovascular health, gut health, and brain health is to make sure we are consuming enough of those fatty fish. That’s where we are getting the most Omega 3 fats.
Dr. Eric:
I know we’re running out of time, but I wanted to ask you one more question as far as some of your favorite non-dairy sources of calcium. I do recommend especially when people follow AIP, they will be avoiding dairy. A lot of people are like, “If I can’t have dairy, where am I getting my calcium?”
Dr. Sarah:
On the AIP specifically, I will back up. Nuts and seeds are a great source of calcium. That is obviously not AIP friendly. On the AIP, green vegetables, especially dark green, leafy vegetables, are typically very good sources of calcium that is highly bioavailable. Mushrooms have a good amount of calcium. Oranges have a good amount of calcium.
One of my favorite sources though is blackstrap molasses. A tablespoon of blackstrap molasses only has 42 calories, so it’s not a high sugar sweetener. It has more calcium per calorie than cheese and more iron per calorie than steak. It actually has 20% of the daily value of both calcium and iron. It has some other minerals and lots of B vitamins. It has a Nutrivore score of 340, which is quite impressive. It’s in its own ballpark. It doesn’t even share a space with other sugars in terms of nutrient density. That’s a great option. Yes, permission to eat something sweet is always appreciated on the AIP.
Another great option for AIPers is mineral drops for water. Typically, natural water sources have a lot of dissolved mineral content. Tap water and most bottled water do not. One of the easiest ways to increase mineral content if you are not going for a spring water. Gerolsteiner Spring Water has a huge amount of calcium. That would be my go-to recommendation. Plus it’s delicious.
There are lots of different options of mineral drops out there. There are lots of unflavored options. It’s just for the minerals in water. It’s another way to up calcium intake on the AIP without having to reach for a calcium supplement because those are associated with higher risk of kidney stones and potentially increased risk of cancer over the long term in the scientific literature. There is always a time and place for supplements. Talk to your doctor. If they recommend it, completely different situation. But as a general rule, we usually only want to take calcium supplements if those are our only options.
Dr. Eric:
You mentioned fish. Sardines with the bones. Other fish as well.
Dr. Sarah:
Canned fish with the bones is as much calcium as a glass of milk. Sardines, canned salmon. If you are eating the bones, yes. Not only are you getting the calcium, but you are getting all of the minerals that our bones need.
The other thing that’s really important about calcium is Vitamin K and Vitamin D are really important for calcium metabolism. Vitamin D affects how much calcium we are absorbing, so you don’t want to be Vitamin D deficient because you can’t even absorb the calcium from your food. Vitamin K is important for shuttling calcium around to the right spot in our body, so you want to make sure you are getting enough of those as well. Seafood is a great source of Vitamin D. Those leafy vegetables are great sources of Vitamin K. Salmon and kale was the top recommendation there.
Dr. Eric:
Dr. Sarah, where can people learn more about Nutrivore? Feel free to share any other resources you’d like to.
Dr. Sarah:
Come on over to the new site: Nutrivore.com. We launched with 250 articles. We’re adding several articles every single week. We are continuing to build out the site. There is so much there to explore. You can search the entire Nutrivore Score database of 8,000 foods. You can see detailed nutritional information on a whole messload of foods. You can learn about different nutrients. There are detailed articles of what nutrients do in the body. Those detailed articles have links to the foods that are top sources. If you are really interested in food sources of calcium, you can go to the calcium article and click into the foods that are great sources of calcium. We are continuing to build out this resource. I think we will be for years. I have so many plans.
From there, make sure that you go up to the top menu and click Join. That’s where you can find links to my social media. I am @DrSarahBallantyne just about anywhere online that you can think of. That’s where you can find links to join my newsletter. I have five free Nutrivore guides I would love to send to your inbox. I have some awesome resources to share with you. That’s where you can link to things like my Patreon and my community in general.
Dr. Eric:
Thank you so much, Dr. Sarah, for sharing your knowledge about nutrient density and Nutrivore. I’m sure a lot of people will be visiting your website as well as your other social media platforms. Can’t say enough good things about what I have seen so far. I’m also excited about what’s to come in the future. Thank you for your time.
Dr. Sarah:
Thanks again for having me. I really enjoyed this.