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Brian Lehrer: Brian Lehrer on WNYC. We all know how important it is to eat well, but where we struggle is actually knowing how to eat well. Education on nutrition is confusing and often lacking. There's all sorts of seemingly contradictory advice, diet plans that verge on disordered eating, and pervasive myths about what foods are good and what to avoid. Now we continue our series on dispelling some of those nutritional myths that have permeated American culture. We're tackling two myths a day this week with Sophie Egan, author of How to Be a Conscious Eater: Making Food Choices That Are Good for You, Others, and the Planet.

She's a New York Times contributor. Maybe you saw the article that she wrote recently, 10 Nutrition Myths Experts Wish Would Die. We invited her on the show for every day this week to take them in order. Today we get to Sophie's myth number seven and myth number eight. Seven is, you should never feed peanut products to your children within their first few years of life. Myth number eight, the protein in plants is incomplete. Also joining us, another expert quoted in the piece, Christopher Gardner, Professor of Medicine at Stanford University and Director of Nutrition Studies at the Stanford Prevention Research Center. Welcome to WNYC, Christopher, and welcome back, Sophie.

Christopher: Thanks.

Sophie: Thank you. Great to be here.

Brian Lehrer: Sophie, we're at myth number seven, as I said, you should never feed peanut products to your children within their first few years of life. As you note, for years, doctors told new parents that the best way to prevent kids from getting allergies is to avoid certain common foods. I will say, Sophie, as the parent of a kid who wound up in the hospital as a baby for a nuts and seeds allergy that we didn't know he had, this immediately makes me nervous. Lay it out. What's the myth, and how can parents navigate this safely?

Sophie: Yes. Well, first, I'm so sorry to hear that, and for parents everywhere who've had peanut allergies especially, it can be truly life-threatening. Some of the myths we've covered this week have been about maybe a game of telephone where something got lost in translation. In this case, it's really that the science evolved. Food allergy research is still a relatively young field. What happened was that in about 2016, 2017, the guidelines changed based on better data.

There was the first actually randomized trial that showed that it's actually better to introduce peanut products to your child early on rather than to completely have your child avoid them in those early years of life. There's this building up some tolerance, so to speak, in the earliest months of a child's life. That's the new guidance.

Brian Lehrer: Is there a way to do it, like little bits of peanut butter on a spoon? I know they make those peanut puffs that are popular in Israel and other places called Bambas. Are there better ways and worse ways?

Sophie: Yes. The way that is recommended is to start around four to six months, which is the typical age for a baby to be ready for solid foods. You can do the puffs that you mentioned. Also, peanut powders, which you can mix into other things, oatmeal and mixed with formula, breast milk and so forth. Also, you can mix in about two teaspoons of smooth peanut butter, so that makes it watered down if you mix it with water. Do that a few times a week. That's the guidance from Dr. Ruchi Gupta, who is one of our country's top food allergy and asthma experts. She's a professor and director of the Center for Food Allergy and Asthma Research at Northwestern Feinberg School of Medicine.

[crosstalk] That's the best recommendation for children who do not have severe eczema or a known food allergy. That's a good way to start.

Brian Lehrer: You quote Dr. Gupta in the article. Can you talk more about the eczema piece of that? You warn to watch out for eczema. What does that signal to parents?

Sophie: Eczema is part of a triad that's called atopic march or allergic march, which is essentially this natural history or typical progression of allergic diseases that often begin early in life. The first one is typically eczema followed by a food allergy, followed by hay fever and/or asthma. It doesn't mean that if your infant has eczema that they will have a food allergy, it's just that there has been a very widely documented association between those. If your baby does have severe eczema, it's best to first consult your pediatrician or an allergist before jumping in with those peanut products per the guidance for all the other families out there around four months.

Brian Lehrer: Should you be doing it with other nuts as well? There's a lot of almond products. Some people like cashews. My kid actually reacted to macadamia nuts.

Sophie: Oh, wow.

Brian Lehrer: Is it peanuts in particular, just because peanut butter is so common and peanuts are so common in our country, or other products, too?

Sophie: Actually, there's been some other studies. The LEAP study was the one specifically on peanuts, but there have been subsequent studies that have looked at this in other areas like you mentioned. The two other most common food allergies for children are eggs and milk. There's definitely some studies and recommendations to essentially apply this across the most common types of food allergens. It's definitely cow's milk and eggs, other nuts as you noted. The vast majority of all food allergies, about 90%, are caused by what's called the top eight. Actually, this was recently expanded to the top nine to include sesame.

I won't list all of them, but essentially the guidance is to apply that logic that you can build up this tolerance. It's particularly just to how prevalent peanut allergy is, especially in children, how dangerous as you noted. Then especially thinking the most common ones being also milk and eggs. I would focus there based on what the guidance is now.

Brian Lehrer: All right. Moving right along to your nutrition myth number eight. This is where Christopher Gardner, who's been waiting patiently, comes in, the protein in plants is incomplete. Christopher, as Sophie writes in her article in the Times, vegetarians know this myth all too well. Can we start with a little 101, what's protein, and what does the term complete protein mean?

Christopher: Sure. If you think of the three things that we get calories from, it's proteins, carbs, and fats. Those comes in grams amounts in our diet. Everything else is in milligrams or micrograms, so you can see the protein, carbs, and fats, unlike the other things. Protein is like letters in the alphabet. There are 20 amino acids, just like there's 26 letters in the alphabet, and almost like a Scrabble Board game, as we make hair, fingernails, cells, enzymes, hormones, all these things come from proteins, you have to assemble them anywhere from three amino acids.

This is actually one that has 35,000 amino acids, one after the other, and they have to be in the right order to be functional. The right number of amino acids in the right order. A lot of our body is protein. The incomplete part comes in when people suggest that you do have to have all the right ones in the right proportions. There are 11 of the 20 that technically we can actually make from different metabolic pathways in our bodies and modify a carbohydrate and turn it into an amino acid, but there's 9 that are called essential. You have to get the essential ones from your diet, which isn't hard because everything has protein in it.

There has been this myth that plants don't have all nine amino acids. That some are missing, so to get complete protein, you have to get animal products. That's the myth. It's actually just like Sophie said, it's like the telephone thing. When it's mentioned that it's incomplete, that's often been translated as they're missing. They are not present, plants are missing some of the amino acids. If you really go into the literature on this, what you'll find is, let's think of a Scrabble Board, there's only one Z, only one Y, and one X. There's a whole lot of As, Es, Is, and Us. There's a whole bunch of Rs.

There's a couple amino acids. Lysine, in particular, is an amino acid in all grain products, let's think oats and rice and wheat, that is present, but it's like in Scrabble, it's like you might have been missing a couple of Ns or Rs or maybe, in this case, an L because L for lysine. It's not that there aren't any lysines, it's just not quite in the right proportion that you need. It turns out in beans, legumes, peas, chickpeas, lentils, things like that, there's a little less methionine than you need. It's not missing, it's just in a smaller proportion.

Brian Lehrer: It's just less. That's how you're quoted in Sophie's article, saying, "The difference is that the proportion of these amino acids isn't as ideal as the proportion of amino acids in animal-based foods." When people often say, "Well, if you have the right grain and the right legume," like you have rice and beans, very, very common, rice and beans, "you're putting together amino acids in the proper proportions." That's what people use shorthand, the word complete to mean, yes?

Christopher: No. Actually, they call it complementary. It turns out that grains are a little low in lysine but a little high in methionine. Beans are a little low in my methionine but a little high in lysine. Actually, Frances Moore Lappé immortalize this and made it famous 50 years ago in Diet for a Small Planet. If you google her now you'll say, "I apologize. I didn't have it quite right." It actually does make sense. They do complement one another, but the only time this comes up is if you just barely get enough protein for the day.

If you just barely get enough total protein, dang it, those proportions better be dead on because you don't have any extra to spare. The reason this is very myth-like is that Americans get about twice as much protein as they need. Oh my God, as a nation, we are protein-obsessed. Protein bars, protein cereals, protein shakes, meat and more protein. That's a myth. If you just eat a decent variety of food, even vegans and vegetarians, we all tend to get plenty of protein.

Brian Lehrer: Sophie, how do you know if you're getting enough protein or types of protein or proteins in the right proportions?

Sophie: In general, as Christopher said, you need to worry less, if you're in the United States, that is, because the vast majority of people do get much more than is even needed. It's part of this variety or package of myths. It's also that your total amount that you need is higher than it is in reality. It cuts both ways in addition to that point that the assumption is you can only get enough from animal-based foods.

The bottom line is that you'll know if you're eating an adequate mix of food throughout the day. Those can be 100% plant-based foods, if that's what you're eating. The main message is honestly to just not worry about it as much, particularly, again, with an American lens. Doesn't mean that protein deficiency isn't an issue in other parts of the world but that by and large most people living in the US and eating a variety of foods can just relax a bit on the protein front.

Brian Lehrer: Christopher, I think protein deficiency in other parts of the world is relevant to this. You referenced that book from 50 years ago by Frances Moore Lappé, Diet for a Small Planet, which introduced the complementary protein idea to a lot of Americans who wanted to go vegetarian. I think part of her premise was diet for a small planet, that was the title of the book, because it's so resource-intensive to grow meat, to raise the animals for meat, that she saw that as relevant to why there's so much malnutrition around the world. It would be so much more efficient to grow plants. The whole world could be fed adequately more easily in that way.

Does that come into it? I know you're a nutritionist. You do nutrition research. You're not a global politician, but is that an aspect? Is that another benefit?

Christopher: Interestingly enough, I'm in Boston right now at the American Heart Association's conference. Last year at this time at this conference, I was asked to give a talk on food and sustainability. You hit it nail on the head there. The idea is this intersection of human health and the health of the planet is very well aligned. Animal products are very resource-intensive, so we can make a lot of benefit for the planet if we're going to eat less meat, with one caveat, there are some countries in the world where there's very little arable land.

It's very hard to grow crops on a hilly side that doesn't really have much growing but a bunch of weeds. Oftentimes their livestock can graze on that land where you couldn't have grown any food and they can actually convert that grazing into edible food, that's meat for humans. There is a flip side of this in some countries.

Brian Lehrer: Christopher Gardner from Stanford, thank you very much for joining us today. Sophie, thanks for roping him in for us as one of the sources in your New York Times article who joined you for this conversation about it on the show. We will leave it there. My guest all this week continues to be Sophie Egan, author of How to Be a Conscious Eater: Making Food Choices That Are Good for You, Others, and the Planet, and a New York Times contributor. We are going up the 10 myths that she laid out in her article 10 Nutrition Myths Experts Wish Would Die. Sophie, one more time around the block tomorrow when we do myths 9 and 10. Looking forward to it.

Sophie: Looking forward to it as well. Thank you so much. Take care.

Brian Lehrer: Christopher Gardner, thank you so much.

Christopher: Sophie, you rock. Thanks, everybody. Thanks for having me.

Sophie: You too, Dr. Gardner. Take care.

Brian Lehrer: Brian Lehrer on WNYC. More to come.

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