Outrages of the Week in Food and Medicine

Ok, someone explain the logic behind this to me.  The egg isn’t in a cage, so it is allowed to be free- to roam around and enjoy the fresh air? And for this, we pay more because the egg, which is about to be scrambled, lived a beautiful egg free existence.
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GMO: Part 2 – The Promise, the Fear, Labeling, Frankenfoods

The Fear and Wonder of a Chimera

In ancient times people were told about hybrid animals: the horse that was half human- the torso and head of a man with the body of a horse, the man that had the head of a dog, the horse that had wings. Some have familiar names, like Pan- who had the hind quarter of a goat and horns of a goat but face of a man.

For some these were an abomination, an unholy thing made from cross breeding and to be cursed.  For some they provided a sense of wonder. The Centaur, half horse half human that were great warriors.

Even in the bible, when the “end times” come the description of the feet of the bear and the mouth of the lion and the body of a leopard – a beast and not something to be trifled with. Or Frankenstein, a chimera of people.

The fear of chimeras is throughout all human mythology – but now, those chimeras are no longer a myth – they are real. Humans  can produce a chimera from the DNA of different species, making crops and animals that are modified to produce a chimera.

Are those same fears, same sense of wonder a part of the human collective conscious? Does that explain the debate about genetically modified organisms?

 

Chimera

Since the ancient times the fear of chimeras has been a mix of wonder and horror. Now, with DNA technology, are we opening Pandor’s box? Or can we use the technology to save the world

What’s missing is science education, critical thinking, and the ability to talk the same language 

Perhaps it is my background in genetic engineering that makes the idea of genetic engineering interesting, and not scary. The knowledge that humans have manipulated genes in plants for at least 11,000 years gives some perspective. Genetically Modified Organisms (GMO) that are plants are neither the Frankenstein chimera that some suggest, nor are they the magic bullet for the common problems of feeding the world and saving the environment.

They are but one tool and sometimes that tool has  failed. What bothered me greatly as I researched the issue, was that the people who were anti-GMO did not even speak the same language as those who were proponents of GMO. The logical fallacies in arguments were on both sides: appeal to antiquity, appeal to authority, and ad hominem being the most common. One fact was alarmingly clear: people will say anything, put up any photograph, repeat falsehoods because they think their concern about GMO are valid.

This does not advance a rational discussion, this does not help advance the common quest we all would seek to find a safe way to feed the planet.  It also pointed out that critical thinking is not taught, and science education is lacking. There are rational concerns about some GMO, but those discussions become lost when histrionics replaces a sense of history, when the discussion is not about science but about fear. On the other side, the proponents of GMO, are often dismissive – partly because they lump those who express legitimate concern for GMO with those who are clearly irrational , and partly because they become forced into a position to support science.

Thirty Years of Molecular Engineering Plants

In 1983 a gene, made from DNA not belonging to the plant, was transferred into a plant and this technical feat and outcome reported in the journal Nature.  But genetic modification of  plants by humans has been going on for thousands of years. While at times we will specifically use “molecular engineering” for the modern technology of  modifying existing DNA or inserting new DNA into plants, for most we will use genetically modified (GM) crops to mean those crops which have specifically had their DNA modified by molecular technology. Molecular engineering of plants started 30 years ago, and 35 years since we first showed how the DNA coding for a protein from one species (a chicken) could be put it into the DNA of a virus (Herpes).  That use of a virus to host a DNA led to the idea that a plant virus could be used to insert DNA into a plant. DNA codes for all the proteins of the plant, much like humans. The techniques used then are now considered as outdated as using a floppy disc – and in fact, the ability to molecular engineer DNA can be done in a garage.

When we made our chimera (Herpes -Chicken) the concerns about molecular engineering were not yet articulated.  At that time it was a breakthrough to prove we could move a gene from one bit of DNA to another, and have that new organism make the chicken protein. Prior to that it was theoretically possible, but never proven. Once proven, did we open Pandora’s box or did we find the stairs to heaven?

Would you inject it?

We worry about our foods, a lot. So imagine injecting something like this directly into your body: in addition to an ingredient that has been extracted from a genetically modified organism  it is labeled like this-

 

insulin partial

 

People inject this everyday? Did you know that people not only inject this everyday but it keeps them alive? It is called insulin.  So when worried about the food supply, do not forget that GMO also applies to bacteria and yeast that produce proteins that some need daily to keep alive and healthy.

Would you ingest it- and should we Label it

Why not? The insulin above is clearly labeled, it says what it is- where it is from, and what else is in it. The question is- how do you label corn – because corn is a new plant, it wasn’t even around a few thousand years ago. Although most who wish food to be labeled intend those foods that contain proteins from another species. The insulin which the vast majority of Americans take, come from DNA from humans, but grown in yeast or bacteria.

The anti-label side states that most scientists, and the FDA find the food is safe, so why add an additional label to the ingredient. The counter argument: should not people decide for themselves if they wish to have it.  In a way this is an esoteric argument: I have a hard time getting my patients to read food labels- and most Americans do not read labels. But there is nothing wrong with a label, there is nothing wrong with letting people decide what they wish to consume.

Most of the corn and soy grown in the US are genetically modified. There has been no immediate ill effect, and yet, some would argue that trans-fats, once considered to be good fat, were not discovered to have an ill effect until years later.

The anti-label says that some people would shun those foods, wanting non GMO foods. The pro-label says, yes, that is the idea.

The fear of industry that they would have to change or educate the public is paternalistic, and reminds me of the argument at the beginning of the enlightenment that churches didn’t want their flock to learn to read lest they question authority.

What doesn’t help is this: we have lost science journalism. Finding a journalist who can look critically at a paper and present the information in a detached way is gone. Most journalists now, even from The New York Times, are more entertainment-style journalists – flashing a headline, quick quotes from a pool of scientists or physicians, and off with a story. But GMO are too important to leave to such journalists, GMOs are here to stay, but need to have a place where rational discussion can happen from those who are concerned.

 

Proteins and Plants

DNA is the programing code for proteins that are made by an organism. Even more than just a code for the proteins, it is the program for how the proteins are produced, when they are produced, and how much is produced. The code can  keep a given protein from being made under certain circumstances.  If you take the DNA that codes for a protein  and put it into corn you will have corn that produces that protein (sometimes).  Not all proteins that are in one species can be produced by another species even if we put the proper DNA sequence in the host.

For GM crops, most of the proteins that are manipulated with DNA are either the plants own proteins, or proteins from species that interact with that plant.  Bt cotton, for example, is a cotton plant who has had bacterial DNA  that codes for a protein that discourages bollworms and thus decreases the need for pesticides. This Bt DNA has also been placed in corn, and it was estimated to save 3.2 billion dollars  to farmers in Illinois, Wisconsin, and Minnesota over the past 14 years as well as a savings to non-Bt corn growers of more than 2.4 billion over 14 years – in pesticide costs.  The farmers were able to have higher yields of the corn, reducing loss from insect damage, reducing pesticides (mycotoxins), and providing a simpler and less expensive and environmentally friendly pest management option.

Lovers of organic farming will tell you that soil is a viable, living thing- with many different animals contributing to the balance that allows plants to grow. The most common are organisms called nematodes. A study out of China showed that planting the GM cotton did not affect soil nematodes. Compare that with the non Bt fields, where increased use of pesticides has wiped out a number of the organisms rendering the soil sterile.

On the horizon are crops that produce pheromones that pests interpret as “danger” signals, meaning less pesticides or even the promise of no pesticides would be needed.

Genetic Engineering: Farmers are more concerned with the environment than most know

City folk seem to think they are the only ones who know about industrial and organic farming. Many city folk assume, sometimes correctly, that modern farming has sterilized the land upon which we grow crops and make the assumption that GMO is another step in the destruction of our planet. Yet, if they were to go to farm conferences the most well-attended presentations are about environmental issues.

No one is closer to the land than a farmer, no one cares more about their land than a farmer – including those who own the large agri-business.  It is not the goal of agri-business to destroy the land they get their crops from. The goal of farming production, is to use less fertilizer, less herbicides, less pesticides, and less water. The hard way to do genetic engineering is what the Mayans did.  But over a few thousand years they took one plant, and made it into another species – one that wasn’t recognized until 10,000 years later.

The Promise of Molecular Engineering plants:  The promise of molecular engineering is based upon what Genetic engineering already showed: the ability to make crops that (a) grow faster (b) resistent to pests (c) resistant to weeds. We would add that the new goal of molecular engineered plants would be environmentally friendly, at the least, and helpful to the environment at the most.  The ability of plants to convert carbon dioxide to oxygen may be one of the major ways to diminish green-house gases.

In GMO farms there are less pesticides and less herbicides used. That doesn’t mean it will always be this way. What GMO has done is improve the yields of crops, it has decreased the use of some toxic chemicals on the land, it has provided a mechanism to improve nutrition, and decreased the use of water. But that can change.

Fake GMO

The has been widely viewed on the internet – and is a doctored experiment.

In an effort to find the truth about GMO – and avoid the hyperbole on both sides, I did discover some rather disturbing myths out there. One is a photograph that shows a picture of two corn cobs, one eaten, the other not. One labeled GMO corn, the other not – it is a doctored photograph.  To think a squirrel would have more taste or better taste than a human is not only biologically incorrect, it is laughable. The person who put this up is a well known anti-GMO activist. This does nothing to further discussion, but is propaganda to increase fear.

In a rational discussion about the pros and cons of GMO we need a basis of discussion and not myths

Here are some things that are on the internet that are myths

- the tomato fish: They have a tomato which has a gene inserted in it from arctic fish so that the tomato will survive cold weather. This is not true. The cartoon 0f a chimera fish/tomato was a rallying point for some anti-GMO sentiment, but it turns out that such a product is not to be found on any market shelf. I understand one of the main issues was vegetarians who were concerned that having a protein from an animal in a plant would violate their vegetarianism (ok, that one made me scratch my head also). It was an interesting idea, and no one has any idea how far these experiments went, but biology would tell you that a frost resistant fish probably isn’t going to be helping a tomato. When the company who was working on the project was approached they noted that the experiment was a dismal failure. Then again- think about it: a fish has a heart and blood vessels and is pumping things – a tomato, well, doesn’t. Still the idea of transferring proteins from one species to another, much as we did 35 years ago, raises concerns. The problem is that there is too much hyperbole in the debate and the discussion.

German Cows Die after Eating GM modified Corn: It is true that Syngenta(the supplier of GM corn) reimbursed the farmers for the loss of cows, and that the cows did eat the corn that had been genetically modified.  The investigation of the cow deaths concluded that the GM corn was not the cause of death. In addition, there were extensive feeding studies of that GM corn (Bt 176) which were published in peer review journals and there was no adverse effect. Further, that corn had been planted for a number of years without adverse effect in those fields.  Turns out the cows probably died of botulism.

Did rats get tumors when eating GMO corn?: Rats developed tumors when eating GMO corn – not really. This was a paper that was published- and it had a lot of flaws: (a) These types of rats all develop tumors when they get old (b) severe statistical issues, with a small control group (c) No basic statistical significance (d) No dose response curve. The rats were fed unlimited amount of corn – if you feed this type of rat unlimited food they develop cancer.  Bad study, highly repeated in the internet – not repeated by anyone. Here is a response printed in full to that article: Seralini et al. (2012) claim to have found evidence for the long term toxicity of roundup-tolerant genetically modified maize (GMM). Using one-tailed Fishers exact test we show that there is no statistically significant increase in mortality rates or the number of tumors in rats fed GMM compared to control groups in the original data. Seralini et al. state that “In females, all treated groups died 2–3 times more than controls”. As follows from the figures presented: 2 female rats out of 10 died before the mean survival time in the control group, compared to 29 out of 60 in the six GMM fed groups. This difference is not statistically significant (P = 0.09). Note that this P-value requires a further correction for multiple comparisons due to two groups of rats (of different sexes) being independently analyzed. Among males 3 rats out of 10 died prematurely in the control group, compared to 19 out of 60 rats in the six GMM fed groups. This difference is statistically not significant (P = 0.615). Ironically if we forget about the importance of statistical significance and present the data in a manner used by Seralini et al., we could say that “In males, groups with 22% and 33% GMM in their diet died 3 times less than controls”, however this was not reported. This difference is also statistically not significant (P = 0.291 for each comparison). Seralini et al. state that “In treated males, liver congestions and necrosis were 2.5–5.5 times higher” and that “Females developed large mammary tumors almost always more often than and before controls”. Two male rats out of 10 had liver pathologies in the control group, compared to 30 out of 60 GMM fed male rats. Five female rats out of 10 developed mammary tumors in the control group, compared to 44 out of 60 GMM fed female rats. These differences are not statistically significant (P = 0.076 and P = 0.133). Note that this analysis should be done with care: over 30 different organs were analyzed in this study, but data on only a few was presented, giving rise to the statistical problem of multiple comparisons that was not addressed in the article. However, even despite this problem, all reported differences between the number of rats with specific organ pathologies in control and GMM fed rats are not statistically significant. It is also worth noting that tumors are frequent in Sprague–Dawley Rats: a spontaneous tumor incidence of 45% was previously recorded during a 1.5 year period (Prejean et al., 1973). The images of GMM fed rats with large tumors presented by Seralini et al. are misleading as they imply that such tumors do not normally occur or occur less frequently in untreated rats. Such tumors may occur in rats that are not fed GMM and Seralini et al. provide no statistical evidence that the incidence of tumors in general or any specific kind of tumor is increased in GMM fed rats. The random nature of the observed differences between control and GMM fed rats in the study is consistent with the lack of dose-dependent relationships between the amount of GMM in the diet and the supposed toxic effects of GMM. A news article published in Nature stated that “The controversy over the findings is likely to be settled only after detailed analysis of the paper and its data, and replication of the experiments” (Butler, 2012). Analysis of the data suggests that no statistically significant findings of GMM toxicity were presented in the first place.

Did sheep die from eating cotton with Bt? In a word, no. In almost every anti-GMO site I visited this was repeated over and over again, in spite of the simple evidence against it. This involved a group of sheep who died after grazing on a field of cotton. The accusation was that the sheep died from some unexplained poison – and that part is true. Sheep have been dying from toxins in cotton fields long before Bt cotton, and with the same lesions described by the anti-GMO groups.  In all cases the veterinarians describe that the sheep died of a toxin, probably pesticides used. Veterinarians  could not rule out nitrate or gossypol (a natural toxic ingredient of cotton plants) as toxic agents.  When Bt was fed to laboratory animals there were no deaths. Less pesticides are used on Bt Cotton modified plants, the total use of pesticides in the 10 million farmers who use Bt cotton has gone down.

 

DISCLOSURE:

I am not, nor ever have received funding support from Monsanto, or any corporation making or considering GMO. The funding received for the original research done with molecular engineering came from a grant from the National  Institutes of Health, and not associated with any industry.  Nor have I been paid any stipend, nor received any accommodation from such industries. Nor am I seeking such.

FUTURE BLOGS:

Allergies and GMO – the real story

GMO and the Third World

 

REFERENCE:

(1) Areawide Suppression of European Corn Borer with Bt Maize Reaps Savings to Non-Bt Maize Growers W. D. Hutchison, E. C. Burkness, P. D. Mitchell, R. D. Moon, T. W. Leslie, S. J. Fleischer, M. Abrahamson, K. L. Hamilton, K. L. Steffey, M. E. Gray, R. L. Hellmich, L. V. Kaster, T. E. Hunt, R. J. Wright, K. Pecinovsky, T. L. Rabaey, B. R. Flood, E. S. Raun Science 8 October 2010: vol. 330 no. 6001 pp. 222-225 PMID: 20929774

(2) A 2-year field study shows little evidence that the long-term planting of transgenic insect-resistant cotton affects the community structure of soil nematodes. Li X, Liu B. PLoS One. 2013 Apr 16;8(4):e61670. doi: 10.1371/journal.pone.0061670. Print 2013. PMID: 23613899

(3)Beever D and Kemp C (2000). Safety issues associated with the DNA in animal feed derived from genetically modified crops. A review of scientific and regulatory procedures. Nutritional Abstract Reviews Series B: Livestock Feeds and Feeding 70:175–182.

(4)Flachowsky G, Chesson A, and Aulrich K (2005). Animal nutritional with feeds from genetically modified plants. Archives of Animal Nutrition 59, 1–40.

(5)Flachowsky G, Aulrich K, Bohme H, and Halle I (2007). Studies on feeds from genetically modified plants (GMP) – Contributions to nutritional and safety assessment. Animal Feed Science and Technology. 133: 2-30.

(6)Goldstein DA, Tinland B, Gilbertson LA, Staub JM, Bannon GA, Goodman, RE, McCoy, RL, Silvanovich A (2005). Human safety and genetically modified plants: a review of antibiotic resistance markers and future transformation selection technologies. Journal of Applied Microbiology 99:7–23.

Bacteria, Heart Disease, and Red Meat and eggs?????

Bad News for Red Meat: Well, read the fine print
There are more bacteria in your colon than people on planet earth. Without bacteria people couldn’t survive or thrive. Bacteria are responsible for us being able to get vitamins, they break down fiber into chemicals that protect us against colon cancer. Now, in a study recently published in Nature, proposing that red meat leads to heart disease through bacteria.

The mechanism is a byproduct of the metabolism of some bacteria called TMAO (trimethylamine N-oxide) which, in some studies, is correlated with an increased risk of heart disease.

is red meat healthy

In the experiments conducted they took meat eaters and vegans and fed them steaks. Why I wasn’t invited to participate is clearly an oversight – after all, steaks…. They discovered when red meat eaters ate steak their level of TMAO went up, but not if vegetarians ate it. They even discovered it wasn’t the meat, but rather the carnitine in the meat that did this (a common supplement in protein drinks for those who want to look like Arnold Schwartzeneger on steroids).

Takes a bit of presumption doesn’t it. But lets work backwards from this hypothesis and start with a favorite saying:

Correlation does not equal Causation
The evidence that red meat causes an increase in coronary artery disease is mixed, at best. The latest study showed there was no evidence that this was an independent risk factor. Smaller studies such as the Nurses Health Study and Health Professional Follow-up study showed an association with a relative risk factor of much less than 2. I blogged a summary of those studies.

Your Gut and Bugs
The bacteria in your gut are important. They protect you- by simply occupying space, they prevent bacteria that are harmful to you from finding a home, as well as  parasites, yeast, and perhaps some viruses.  It has been estimated we have over four pounds of bacteria in our gut. Just a few other numbers that are fun: it is estimated there are over 100 trillion bacteria in our gut (the human  being is made up of about 10 trillion cells, so there are more of them than there are of us – or, a philosopher might ask – who are we really).  We have grown only about 70% of the bugs found in our gut, or so we guess. The byproducts of these bacteria include chemicals that prevent fungus from taking hold,  prevent other bacteria from getting close, and they alter the pH of the gut to keep it comfortable for us and our friendly bacteria, but not so much for the bad bacteria.

These friendly bacteria help produce vitamin K, and biotin. In addition to helping ferment other substances that our body cannot break down, and by breaking down those substances make them available for us to get nutrients from them. While humans cannot digest fiber, some of the bacteria in the gut can digest fiber, and the byproduct of that digested fiber is an agent that decreases the risk of colon cancer (our poop has stuff that bacteria eat and bacteria poop keep us from getting cancer). Is it possible that the bacteria in our gut could create something that makes it more likely for us to have heart disease, or cancer? Yes, it is quite possible.  What you eat does alter your gut bacteria. Who you kiss alters your gut bacteria. Who your parents are alter your gut bacteria. When you get an antibiotic, your gut bacteria change.

With some antibiotics and a combination of stomach acid reducing agents (Prevacid, Nexium, etc) a bacteria that overgrows the colon called Clostridium difficile  (C diff).  This bacteria so overgrows the colon and as a result people can develop ulcers, bleeding, toxic mega-colon, and perforation as well as death. This is a concern for surgeons, something we encounter far too often.

Some people can get overgrowth of bacteria in their small bowel that can lead to malabsorption of nutrients including bloating, nausea, diarrhea, constipation, and long term problems like  anemia from iron malabsorption, and has been linked with some auto immune diseases.

Think of your gut like an eco-system. If it is in perfect harmony, you benefit from it. If not, an overgrowth of one or another bacteria can lead to problems. 

Diet certainly affects which bacteria inhabit your gut. The big question remains, is there a diet, or set of foods, that will encourage the gut to have more “friendly” bacteria and less “bad” bacteria. Here is the realm of speculation – other than a diet rich in fiber being healthy, we don’t have a great answer.  This doesn’t stop people from speculating about one diet or another being better.  In this case, the speculation would be that vegans and vegetarians eat a diet that keeps the bacteria that produce TMAO to a minimum.

And the colon- remember, people have been telling you for years about how bad the colon is- from Kellog and his enemas (he died in his 60′s from heart disease, was a perfect vegetarian and loved colonics) to modern day colon cleansers.  No doubt there will be on Walgreen’s supplement shelves a pro-biotic that will get rid of the bugs that make TMAO.

Gut bugs and Diet
There are three types of gut flora that have been described based on the diet that people have. The “enterotypes” are descried as Prevotella, Bacteroides, and Ruminococcus.  Each one associated with a specific type of diet. Prevotella comes from diets with lots of simple sugars, or high-glycemic index carbohydrates. Bacteroides is associated with animal proteins, or the typical western diet. It is those people who have the Prevotella species that had a higher TMAO blood level. Oddly 3 our of 4 of the subjects that had the Prevotella species were omnivores.

In another study showed that these broad enterotypes were associated with long-term diets. When people were fed a controlled diet the enterotypes remained the same during the ten day study. While some bugs changed quickly, it appears your gut ecology takes a while to change – which, if you think about it, is not surprising.

You are probably thinking- 100 trillion bacteria, and the population of some types more than others?  Think of the United States with its population and other countries with their population. In Norwegian countries there are more Scandinavians, in Italy there are more Latins – now think of your gut. In Vegans, there are going to be more bacteria that do well with their host who eats vegetables – and in omnivores, the bacteria that populate it will likely be more of those that like chewing on remnants of meat.  The hypothesis here is that those bacteria produce more TMAO, and thus meat eaters, when given meat, make that harmful substance that leads to more cardiac deaths (forget that this is a poor correlation in any study looked at, just go with it for a bit). Now- bacteria don’t just eat meat and poop out TMAO – there are enzymes involved in the conversion to this “deadly” substance – and one of them is Vitamin B2, which is typically LOW in vegetarians.

What about TMAO and the Nature Article?
One arm of the human study was with six people.  Five of them were meat eaters and there was one vegan. This is little more than an observation, and hardly  enough of an observation to make headlines.  That one vegan didn’t make TMAO means nothing. It could be that the vegan had antibiotics recently, it could be that they are an exception, it could be a lot of things. The one vegan was a male, and the non-vegans were females – and when the statistics were examined carefully – well, not a difference. But significant, even as an observation – nope.

Of course of the 23 vegans/vegetarians and 30 omnivores they looked at the bacteria in their stool (reminds me of the movie The Madness of King George – when they were obsessed with his stool) – and found the different types of bacteria attempting to correlate those bacteria with meat eaters or vegetarians. The problem was, some of the individuals with the “good bacteria” were omnivores.

The Nature article also looked at a mouse study. Mice are not humans, but with mice they didn’t feed them steaks. Instead they used carnitine. Carnitine is an amino acid, often used in supplements, but your body makes this amino acid naturally. To date there have not been studies that show that carnitine rich foods increase TMAO, in fact the one food that elevates TMAO is some seafood. Seafood, by the way, is associated with decreased risk of heart attack.

In the mouse study they fed them enough carnitine to the equivalent of a human eating about a thousand steaks a day. And I would submit if you eat that many steaks a day you might have some problems. The other issue is this: the gut bacteria of the mouse are not the same as the gut bacteria of the human. Are you a man or a mouse can apparently be answered by checking your fecal bacteria.

AND NOW EGGS?

It is the same argument and discussion for eggs. Turns out that the correlation with eggs and heart disease is zip. In fact, one of our patients finished a month of eating nothing but eggs and saw his cholesterol drop! Again, this is just a bad article with a lot of bad press.

A House of Cards
This study and news report is a part of a house of cards. Conclusions built upon conclusions, with a benign observation from one vegan, and a study in mice. In their conclusion the Nature paper stated that this went along with evidence of risk reduction for non red meat eaters and they cited the Mediterranean diet study in NEJM.  What they fail to grasp is that diet didn’t show a decrease in heart attacks, or heart related events, only a decrease in risk of dying from a stroke – and no absolute decreased risk of dying.

This study again falls into the “red meat is bad,” and shows two things: studies that make headlines in newspapers show that in the slow death spiral of print media they fired their science reporters first  and second, if you want your study to get headlines, find something that shows what the popular press thinks is true.

Saturated fat and cholesterol in beef don’t cause heart problems, and your body makes more carnitine than you get from your diet by a factor of six (unless you are a mouse that is force fed).  TMAO is a huge byproduct of fish, and fish eaters seem to have longer lives and less heart disease.

So- this study make sense to you? Is there maybe a message here? One thing is certain: vegetables are not bad things for you. While some of the omnivores in this group had “good gut bacteria” it could be because they ate a lot of vegetables. So- if I were you, I’d make sure I had plenty of that good old fashioned fiber in my diet.  Who knows, maybe that helps the good bacteria from having heart attacks.

steak and beans

REFERENCES:

The red meat article, published originally on Nature.com

Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. 2013 Apr 7  Koeth RA, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, Britt EB, Fu X, Wu Y, Li L, Smith JD, Didonato JA, Chen J, Li H, Wu GD, Lewis JD, Warrier M, Brown JM, Krauss RM, Tang WH, Bushman FD, Lusis AJ, Hazen SL. PMID: 23563705

Here is the article showing that fish and other sea products give rise to increases in TMAO more than meats.

Dietary precursors of trimethylamine in man: a pilot study. Food Chem Toxicol. 1999 May;37(5):515-20.  Zhang AQ, Mitchell SC, Smith RL. PMID: 10456680

Here is an outstanding article by Chris Masterjohn that gives a far more in depth analysis than I did.

Mummies & Eskimos with Heart Disease: it isn’t Modern Diets that are the Problem: The People of St. Paul

The recent study that came out showing that ancient people had heart disease, including a group of Alaska Natives whose mummified remains revealed that the perfect paleolithic diet did not protect from heart disease. Funny thing, Alaska Natives have known this for years. While some may want to say our diet is the ultimate, we have known it is just our way to survive – to live.   St. Paul is a small community of several hundred in the Pribilloff Islands. A remnant of the ancient people of Alaska, with only minimal changes from our paleolithic era.

Most people would never know about these islands were it not for the TV series, Most Dangerous Catch.  It is these islands that the crab fisherman come to process some of their crab. Viewers of the show will recognize the name of the place.

St George Island from St. Paul

In the distance is St. George, the smaller of the two islands. St. Paul is 7 miles wide, 14 miles long. Formed from volcanic activity.

Lonely islands, in the middle of the Bering Sea – but home to some of the most ancient people on earth. St Paul is a three hour flight from Anchorage. Sometimes the weather is so fierce that people have been unable to leave the island for several days.

Like their ancestors, these Alaska natives get their food from fishing. Halibut, crab, salmon, char, and the occasional seal. The only thing that has been introduced into their diet has been the reindeer herd on the island – that would provide a bit of our dinner that night. While there is a single grocery store, products from the lower-48 are expensive and not often used.

The recent Lancet article stated:

 

The presence of atherosclerosis in  pre-modern human beings suggests that the disease is an inherent component of human ageing and not  characteristic of any specific diet or lifestyle.

alaska Aleut

The Aleuts, or Unangan, peoples inhabit the western most part of Alaska – purple. The two little spots above the t in Alutiiq is where St. Paul Island is-

In the article they had studied   mummified remains of Alaska Natives, my ancestors. The Aleuts  live on the  islands in the western part of Alaska.   These islands, formed from mostly volcanic formation, to this day are rich in marine life, with abundant fish, seal, whales, and occasional berries.

I was last there when invited to a celebration in St. Paul because of their new clinic. A beautiful facility, staffed by physicians out of Anchorage. But this facility is vital to the community.

St Paul Seals

The island is a natural breeding ground for seals, who migrate here yearly. The Russians forced Aleuts to inhabit the island to harvest the seals

The island was originally uninhabited until the Russians arrived. Used primarily as a hunting area for natives, then the Russians discovered the great seal population they forcibly moved hundreds of Aleuts here to harvest the fur.  Those families still remain.

Why, you might ask, should you think about Aleuts?  Why do food scientists think about them? These were/are one of the great hunter-gathering societies, eating a diet of fish, meat – even getting their vitamin C, not from citrus, but from marine life. Those relatives, my ancestors, had a diet rich in omega-3 fatty acids, did not eat processed grains – in fact, they rarely had any food but what would be the ideal paleo-rich, non-processed, occasional berry (in season – fresh and local) diet.

For the study in Lancet, it was made possible to see what my ancestors ate because  the climate in these parts allows mother nature to mummify the body, making the bodies available to study.

St Paul

Main Street in St. Paul. They have one bar, one post office, one grocery store, and one church

This group was use to physical activity, without animals to transport them they relied on the kayak for whaling, fishing, and transportation to visit one another on other islands.  With Russians reporting that some of these peoples would go hundreds of miles in Kayaks.

kayak

Restoring an ancient Kayaks. Much larger than the individual ones used for modern sport

Kayak

A better view of how large these ocean going vehicles were

It has been postulated that the Eskimo (the Aleut are the same group as the Eskimo) would have the lowest incidence of coronary artery disease because of their diet. The hunter-gathering society had a “reported” low incidence – although as with many population studies have shown, you often find it when you look for it. For a more in depth discussion about population studies and how we have missed them see here. The Pima Indians, of Arizona, are called “the most studied group” in the world. It was once assumed they had no heart disease, and thus began an intensive study as to why they didn’t have heart disease- but as more studies were performed, turns out the Pimas, like many societies, have heart disease. In fact more of it than western societies. It is the same with the Eskimo health, whether from Greenland or other areas, when critically examined, this society has the same rate of heart disease as others.

Modern Man:

Some have speculated that the incidence of coronary artery disease among Eskimos is because of their interaction with modern man. The introduction of grains into their diets, tobacco, and machinery with less exercise. Not only did the study in Lancet article show that cardiac disease was present in those paleo-people, it is in line with laboratory studies of Aleuts showing they have the same markers for cardiac disease as the rest of us.

Smoking:

Aleut home Alaska Native Center

This is a modern representation of homes of the Aleuts. This from The Alaska Native Heritage Center in Anchorage, Alaska. A worthwhile place

While they did not have tobacco, all ancient peoples used fire. The Native Alaskas of the Aleutians  had homes built partially underground, and used community fires with smoke going out of a hole in the roof, or used fires to heat water that would heat the homes. This might have lead to increased exposure that would accelerate heart disease, but the dispersion of smoke from this would be hundreds of times less than exposure from those who inhale tobacco.

Seal oil was used for lamps. Which, like olive oil, burns quite brightly.

Today they use electricity.  So the second-hand smoke from fires and lamps is no longer a factor. They still eat a diet primarily of fish.  Still, as we found from this little clinic for a town of 400 people, there is  heart disease. Several times a year a person is evacuated out of this town to the city of Anchorage for advanced cardiac care.

One of the  mummified remains of an Aleut lady showed severe artery disease to the extent that if we saw this today she would undergo vascular surgery. This in a woman who was in her late 40′s to early 50′s. She may very well have died of a stroke.

 

St. Paul island birds

The people still get eggs, but they prefer the fresh ones from the cliff. Higher in omega-3 fatty acids than the ones from the chicken farms. These islands have some of the most unique birds in the world.

In fact, in the recent study published on-line by Lancet, they discovered atherosclerosis was prevalent in all areas of the world, over a 4000 year time span, and several continents, with peoples having ancient diets from rich in saturated fat, to near vegetarian, to pure paleo.

Exercise:

Exercise you say? Turns out that in ancient cultures, without the benefit of cars, bikes, or probably even animals- physical activity was normal- and lean and mean were simply natural. Like a six-pack, probably every ancient Alaska Native  person had one– but in their coronary arteries were plaques, that would make any modern, beer belly, sedentary modern human proud.

Diet:

These ancient ones didn’t have trans-fats, they didn’t have soda, they didn’t have wheat, they didn’t have dairy, they didn’t have cheese, but they did have heart disease. And today, they stil do.

Heart Disease:

The study showed that heart disease was found throughout ancient civilization. It wasn’t the diet that prevented it. In fact, probably was genetic like most of us thought all along. Like their ancestors before, the Aleuts of St. Paul have the same disease, virtually the same diet. Their lifestyle is better now, with indoor heat, better insulation. They still live a physical life. But one thing they need- much like many – is some statin drug like Lipitor  which works much better than their ancient diet, or any diet you can think of .

Ask an Alaska Native if their diet protected them from disease: they will tell you, it didn’t. Food wasn’t meant for medicine, food was meant to nourish the body. A lesson the ancient people knew – one that many doctors are still learning.

REFERENCES:

Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations.Randall C Thompson, Adel H Allam, Guido P Lombardi, et.al. www.thelancet.com   Published online March 10, 2013

High prevalence of markers of coronary heart disease among Greenland Inuit. Jørgensen ME, Bjerregaard P, Kjaergaard JJ, Borch-Johnsen K.Atherosclerosis. 2008 Feb;196(2):772-8 PMID: 17306273

 

Meat and Mortality: Does Eating Meat Decrease Your Lifespan?

Is Meat Unhealthy?

Ribs on BBQDoes eating red meat decrease your lifespan? This is a discussion that has been going on for years, with vegetarians and vegans stating that meat is not only bad because of the cruelty to animals, but it will decrease your life. There have been a number of studies looking at this, and the results vary, but this week a new study showed -

 After correction for measurement error, red meat intake was no longer associated with mortality, and there was no association with the consumption of poultry.

 

While this is good news to the lovers of red meat – those who love bacon had different news:

The results of our analyses suggest that men and women with a high consumption of processed meat are at increased risk of early death, in particular due to cardiovascular diseases but also to cancer. In this population, reduction of processed meat consumption to less than 20 g/day would prevent more than 3% of all deaths.

You have to wonder about a publication with editors that would let that statement slip. Imagine if we could prevent any death – but I suspect all members of that study will die. Besides the grammar, the real issue of the processed meat portion is the variable of smoking.

We cannot exclude residual confounding, in particular due to incomplete adjustment for active and passive smoking. The sub-group analysis for processed meat showed heterogeneity according to smoking, with significant associations only in former and current smokers and no significant associations in never smokers, which is compatible with residual confounding by smoking. 

This is explained further in the article with these statistics:

There was also a statistically significant interaction between smoking and processed meat consumption (P-interaction 0.01), with mortality being significantly increased among former (HR = 1.68, 95% CI 1.29 to 2.18) and current smokers (HR = 1.47, 95% CI 1.18 to 1.83), but there was no association among never smokers (HR = 1.24, 95% CI 0.89 to 1.72). 

Since the relative risk of smoking is 20, and the relative risk of this was 1.14 one must assume that smoking is bad for your health. So it may be the person’s smoked lungs rather than the smoked pork.  Although clearly smoking was bad for the pig.

Increasing vegetables and fruits in the diet was almost a protective factor:

Those with a lower fruit and vegetable intake (below median intake) had a higher overall mortality in the highest consumption category of processed meat (160+ g/day) as compared to subjects with a fruit and vegetable intake above the median intake (P-interaction 0.001).

But the study was in contrast to the US study:

However, in contrast to the US cohorts , there was no statistically significant association of red meat consumption with risk of cancer or cardiovascular mortality. (see ref 7 and 8 below)

The problem with the US studies has more to do with the basis of their data gathering than anything else. We blogged about the topic of red meat related to mortality last year. The basis of those studies is this: a bunch of people are given a questionnaire about what they eat. They fill it out. Depending on the study, their health is followed for a number of years, and using statistical analysis determination is made about what factors influence their health.

Human beings are not hardwired to remember what they ate a year ago, even a week ago. The flaws in this type of study are the data gathering, expecting people to remember what they ate over the last year.

The European study avoided this by having clinics that did more measuring and in depth analysis, and their data has less flaws than the US Data, but still, the basis is sketchy.

All Meat is not the Same
The other missing piece is this: meat is processed differently by different places, and the meat is handled differently. Animals that are raised on grass have higher levels of Omega-3 fatty acids, where animals raised on grains have higher levels of Omega-6 fatty acids.  If you process your meats in Italy, there is a different production than in Northern Germany, which is different than in Iowa – some being more prone to harsh chemicals that may (or may not) linger.

Vegetarians v Vegans
One study that looked at all groups- it turns out that Vegans and meat eaters live to be about the same age, those that have the best survival advantage were fish eaters.  In fact, occasional meat eaters have a longer lifespan than vegans.

REFERENCES:

1. Meat consumption and mortality – results from the European Prospective Investigation into Cancer and Nutrition. Rohormann S, et. al.  BMC Medicine 2013, 11:63

2.Food-Based Validation of a Dietary Questionnaire: The Effects of Week-to-Week Variation in Food Consumption. Salvini S, HunterDJ, Sampson L, et al:. International Journal of Epidemiology 18:858-867, 1989
3. Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaireHu FB, Rimm E, Smith-Warner SA, et al:. The American journal of clinical nutrition 69:243-249, 1999

4.  Lack of efficacy of a food-frequency questionnaire in assessing dietary macronutrient intakes in subjects consuming diets of known composition.Schaefer EJ, Augustin JL, Schaefer MM, et al: The American journal of clinical nutrition 71:746-751, 2000

5. Bias in dietary-report instruments and its implications for nutritional epidemiology.Kipnis V, Midthune D, Freedman L, et al: Public Health Nutrition 5:915-923, 2002

6.Red meat consumption and mortality: results from 2 prospective cohort studies. Pan A, Sun Q, Bernstein AM, Schulze MB, Manson JE, Stampfer MJ, Willett WC, Hu FB: Arch Intern Med 2012

7.Meat intake and mortality: a prospective study of over half a million people.Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin AArch Intern Med 2009, 169:562-571.

8.  Is It Time to Abandon the Food Frequency Questionnaire? Kristal AR, Peters U, Potter JD: Cancer Epidemiology Biomarkers & Prevention 14:2826-2828, 2005

9.Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Key, T., et. al. Am J. Clin. Nutr March 2013, 97 (3)

Mediterranean Diet: Heart Health – Not Just Yet

Mediterranean Diet Good For Your Heart?

Healthy Mediterranean Diet

This week most news outlets are touting the recent article in The New England Journal of Medicine about the Mediterranean Diet, and how it cut cardiovascular disease. But here is the rest of that story:

There was no significant reduction in heart attacks, there was no reduction in death from heart disease, but there was a small reduction in death from stroke. When you combine the strokes into a category of cardiovascular disease you have the difference the article noted.  To be clear, the study did not say a reduction in stroke, or a reduction in disability from stroke but just death from stroke.

There is a call for studies of diets to see how it affects heart disease, or cancer, or other diseases. But here is one that really didn’t show anything, and yet some are saying- hey, we need more.

What was not properly accounted for in the study was smoking, people who were taking statins, people who were taking blood pressure medicine,  and there was more obesity in the control group. There was no weight loss in the Mediterranean diet group.

Even the New York Times didn’t get this, their article said, “About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a large and rigorous new study has found.”

In another part of the NYT article they said, ” Disease experts said the study was a triumph because it showed that a diet was powerful in reducing heart disease risk, and it did so using the most rigorous methods. “ 

The study did not show that the diet was “powerful” in reducing heart disease risk, and the most rigorous method used was statistical jockeying to add stroke deaths to heart issues to put it all under one statistical umbrella.

Plus, one group were required to drink a liter of olive oil a week (thats a lot of oil).

What was also missing from the study was any laboratory data, nothing showing a change in blood lipid chemistry (which may not matter). There was nothing in the data that showed changes in plaque formation. There was nothing in the data that showed inflammatory markers were lower.

Bottom line: you have a study that makes a lot of reaches, conclusions, and promises, but the facts are simply not there to support it. It also shows that the era of science journalism is gone.

Eating Healthier is better than not – in fact: Just Cook! :

Olive oil- buy local (US olive oils).

There are plenty of ways a person can eat healthy. And once someone begins to pay attention, and eat healthier they tend to think that their diet is the best of any. Diets become a religion for some people- proselytizing with the evangelical fervor of a Revival preacher.

What the report in the New England Medical Journal showed was this: eating healthier is a bit better than not.

A lot to love in this diet – what I like most, is it gets people into the kitchen, and cooking. There is nothing wrong with a diet that is rich in fruits, vegetables, whole grains, fish (and shellfish) with less emphasis on cattle raised on corn (grass fed is ok), and decreased portions, is probably best. Oh- and don’t forget the red wine.

 One of the New York Times columnists got it partially right. Mark Bittman, whose contributions to the food section of the NY Times are known for advocating cooking, healthy foods, and less red meat.  His column pointed out the flaws, as Bittman called physicians who were critical of the article. Bittman’s colum about this can be found by clicking here.  Bittman does credit Ornish with a diet showing a reversal of heart disease – which, sadly is simply not true (our review of Dr. Ornish here). Essentially, Ornish’s cardiac imaging was flawed – and his studies have not been reproduced.

What is the Mediterranean Diet – a Diet Plan

Breakfast: Greek yogurt. Fruit, fresh and whole. Granola made from fresh nuts, whole grains, and sweetened with blueberries. Fresh, whole wheat toast, or sourdough pancakes. Cucumbers with onions dipped in balsamic vinegar with some olive oil.  Tea or coffee

Mid-Morning snack: fresh fruits, nuts, or – dried fruits (that you have made).

Lunch: Fresh fish grilled or fried in olive oil. A hearty lentil soup. Fresh fish with pita bread.

Mid-afternoon snack: 1 banana or 1 apple, or some fresh fruit. A handful of nuts

Dinner: Chicken – baked or roasted, in a warm hummus salad. Fresh pita bread. Green beans blanched, then dressed with olive oil and mustard. Or pasta with a true Marinara sauce. One the island of Sardinia, I ordered pasta with Marinara sauce – besides tomatoes, in the sauce were fresh mussels, lobster, mackerel, and tuna — and it hit me – this is what marinara means- from the sea.

2 glasses of red wine.

Dessert: Poached pear with yogurt, or baked apple with nuts, fresh fruit salad

 Mediterranean Diet: What it consists of 

Vegetables and Fruits: the base of the Mediterranean pyramid. The bulk of food in this comes from these ingredients. Fruits form the basis of most deserts. This means fruits or vegetables with every meal- and for every snack, up to ten servings a day. These are not processed juices, these are something you can identify out of the garden. If you have dried fruits, that is acceptable, and prefer that you do them.

Grains: Whole grains, not processed wheats: quinoa, wheat berry, and sesame seeds. Perhaps my favorite of this is hummus, a great snack, all vegetable, that provides all the essential amino acids. It was this snack that allowed migration across the world.

Dairy: Greek yogurt, cottage cheese, are all used in this diet.

Fats: Primary source is olive oil in this diet, also grape seed oil

Pasta: A basis of high-carbohydrate, high fuel for people from the Mediterranean to China.

 

 

 

REFERENCE:
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. Estruch R,et. al. N Engl J Med. 2013 Feb 25.PMID: 23432189

 

The NYT article can be found here.