Beer Diet: What We Learned

The “Beer Diet” – I’m the doctor that supervised Evo Terra as he spent every October for the last three years drinking beer and eating sausages – and while doing this lost weight, lowered his cholesterol, lowered his body fat, and lowered his C-reactive protein and blood homocysteine levels (measures of the body’s inflammatory response).

Here are the Five big lessons we have learned from this experiment:
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Identifying Yourself with Your Diet

Raw Food, Vegans, Paleo, and Your Identity

T Rex

Did T Rex become extinct because they were not vegan, or because their arms were too short to floss?

Did you ever meet a vegan who, in the first 20 minutes of conversation, doesn’t let you know they are a vegan?  How about someone who only eats raw food? Or someone who eats “paleo?” People self-identify with the food they eat – believing that somehow, by only eating  in one manner they are (a) eating healthier (b) protecting the world from itself and (c) superior to others because of their chosen diet.

People who change their diet are often changing from a typical American diet to something better. Like the person who finds religion, or the smoker who quits, they become a food evangelist.  For the first time in their life they are paying attention to what they are eating – or as they like to say what they are “putting into their body.”  Their bias is that ” they feel better ” and they don’t hesitate to tell the world how their diet is working for them. Then they start reading more and more about how their diet is better – and there will be thousands of articles one can find about it.  They will spend countless hours researching and confirming their bias about a particular diet. Then they will flood social media with citations. Never did they convert from a “balanced” diet to “veganism” or “paleo” –  they always went from typical American junk to a diet where they paid attention to what they ate.  Never considering that simply eating better and avoiding junk was the reason for their improved “health.”

Cartoon from APEY

Then there are those who seek to put everything into a shake, or a bar, or a pill. Mix this protein powder with this supplement powder, and while you are at it toss in a supplement or two. Ok, it may not taste great but don’t you feel better (healthier) and superior to those who are eating that burger? The extreme of this is what we physicians can do intravenously – feeding a person by IV. Physicians do that, we can put every micro and macronutrient into an iv bag and feed a person. It saves lives when we do this to patients in the intensive care unit, or people who have lost their guts and people can live on this, but they cannot thrive on that. So before you buy into that latest shake or bar, or pill, think that real food, not highly processed is far better and healthier for you.

Five myths about eating and diets that might surprise you:

(1) Raw vegetables are better for you and contain more nutrients than cooked

False: People cannot break down the methylcellulose that is the cell wall of plants.  Hence, when you study people who eat raw food, versus the same vegetables cooked- and then test their blood to see who has more micronutrients (vitamins, minerals, and other good stuff) – the cooked vegetables and fruits provide more nutrition than the raw.

The reason raw food people lose weight is because they don’t get as much nutrition from raw foods as cooked. The ability to cook allowed more nutrients to be available, and some evolutionary biologist state this is why early man was able to leave sub-Saharan Africa and go throughout the world. Today people will starve themselves eating raw food, but feel they are eating better, lose weight – without any concern with a balanced diet.

(2) Vegans live longer 

This is false. When you look at broad categories, the longest living group in study after study are those who primarily eat fish for their protein, not vegans. Next come vegetarians, then vegans – who have about the same lifespan as meat eaters. Some will tell you about The China Study but that had a number of flaws.

 

(3) Red meat is bad for you

Red Salmon

People who primarily eat fish live longer than vegans or vegetarians

Too much of anything is bad – be it red meat, carrots, or celery. But red meat is easily broken down by the body, provides enough nutrients and in the latest study out of Europe, with over half a million people (the largest study ever) there was no association with red meat and cancer.

(4) Cavemen ate without certain foods like wheat and they lived well so we should because we have not had enough time to evolve to eat things like gluten.

False again.  First a genetic mutation happens in one generation, not thousands of years. Second, in spite of the paleo-folk thinking that it takes 10,000 years to make a genetic change (see above) we have been grinding plants into a flour since at least 30,000 years ago. There are clearly people who should not eat gluten, just as some people should not eat peanuts, but that is not the majority of people.

Speaking of cavemen – noodles have been found in ancient China, and it was noodles that allowed trade between China and Rome (the Silk Road).  A pot of noodles from 4000 BCE has been found (I wonder if it should be cooked with pork or chicken?).

(5) The human is meant to eat (or not eat) ( fill in this blank).

 

What should we eat, Dr. Simpson?

There are a lot of people out there who will try to convince you that the body is only meant to eat meat, or vegetables, or not eat something else. They have diagrams of teeth, comparing to other teeth of other animals but here are a few clues (a) we evolved from them (b) the primates that ate primarily vegetables have not survived well and (c) we have societies from pure meat eaters to almost pure vegetarians who have all lived well and prospered. The human body is quite flexible.

In the last year we have had one person eat sausage and beer for a month – lost over 15 pounds, and liver enzymes were fine, but the cholesterol lowered as did lipids. Then eat nothing but eggs and beer for a month with similar results. We also had someone do nothing but shakes and smoothies for a month with similar results.  What did they prove? That if we limit our intake of food, which all of those did, and keep things in a bit of a balance, you can do just fine.

The Bad Fat isn’t Bad and the Good Fat isn’t Good

President Eisenhower followed a low-cholesterol diet with military precision. But his cholesterol continued to climb. Even with exercise and strictly eating no foods with fat. He listened to the best medical advice of the day- and they were wrong.

President Eisenhower could not have been more frustrated. Following the advice of his cardiologist and General Thomas Mattingly, and the famed Paul Dudley White, Eisenhower was eliminating all cholesterol and fat from his diet. But every time they would take his blood level his cholesterol was higher.  He was no stranger to exercise, he gave up smoking in 1949, and days he would just have grapefruit with some melba toast.  The blood cholesterol would come back, higher than before. It was so frustrating that the White House physicians seeing him would make up numbers to tell him that it was getting better. But it didn’t. Eisenhower was crippled in retirement by his heart disease – determined to eat as prescribed, he ended his days as a cardiac cripple.

Lyndon B Johnson had a heart attack while he was a senator. General Thomas Mattingly was also his physician. Mattingly prescribed the same low fat diet that he had given to President Eisenhower. For months after his first attack Johnson followed it to the letter, shedding some 4o pounds and feeling better. But still his cholesterol was high.

LBJ, a heart patient, tried the “low cholesterol, low fat” diet, but realized his cholesterol didn’t change – so he gave it up. Remarkably, once he started eating the beef from his ranch his cholesterol decreased.

Johnson fell back into his old habits, and had another heart attack, which derailed his presidential ambitions for a while. Finally, in retirement Johnson started to follow the regime again – but noticed that when he started to eat beef from his ranch, his cholesterol went down. He came to his own conclusions, stopped trying to avoid beef- and enjoyed the bounties of his retirement. He enjoyed friends coming to the ranch, with frequent barbecues – often coming late for dinner.

For years America was told that saturated fat is bad for your heart. It was based on a faulty principle – that the fat in the arteries came from the fat in the blood which came from the fat in the diet. While it makes sense, it wasn’t until after Johnson and Eisenhower died that science discovered that dietary fat contributes only a small amount to blood lipid levels. The idea was popularized by Ancel Keys.

But in spite of evidence to the contrary, once a popular notion is in the press, it stays there. Which brings us to President Clinton. The president enjoyed his burgers, and when he had his heart attack he began to examine the notion that plant based diets would reverse heart disease. His disease arteries bypassed, he turned to Dr. Dean Ornish. Ultimately, Clinton became a vegan. Was it a wise choice? President Clinton is a smart fellow, but if he were to critically go through medical journals he might question his choice. ,

It has been 16years since Dean Ornish published his data showing a 3 per cent reduction in the plaques seen by coronary angiograms on a select group of patients who followed his Ornish diet and “lifestyle” plan. To be exact: the 28 patients who followed his plan had a 1.75% decrease in atherosclerotic plaque after one year and 3.1% decrease after five years. With the control group there was an increase of 2.3% in one year and 11.8% at five years.

In 16 years no one has reproduced that data. No one. Still, from one old paper Dean Ornish has made a career; first being the anti-Atkins, and riding the anti-cholesterol, low-fat band wagon with the same religious fervor as Keyes did thirty years before. Ornish has since become the lead health-blogger for Huffington Post, has influenced Bill Clinton – turning him into a vegan, and is favorably mentioned by Dr. Oz.

The difficulty is this: science has caught up with him, and we know a lot more about how atherosclerotic plaques form. We know that dietary lipids and their carriers are far less important that what the body makes. We know that the dietary component is far more related to the trigycerides – and triglycerides are raised much more by the grains and pastas that Ornish preaches on (in his trial, the “Ornish lifestyle” patients had a rise in their triglycerides).

What Ornish and his crew call a landmark paper, would not be accepted by the same journals today for a number of reasons:

(a) No one compares angiograms – a two-dimensional photograph of an artery – because they can be manipulated so easily and interpreted differently from one experienced radiologist or cardiologist to another. Depending on the angle you take the angiogram from, you can show a reduction in plaque by varying the recorder by a few degrees. Today intra-vascular ultrasound is the test of choice – this gives us a three dimensional view of the artery, from within the artery. The recent article in The New England Journal of Medicine, comparing lipid medications and their long-term effect on atherosclerotic plaque, is the most accurate measurement of plaque and its formation.

(b) We know about the science of lipids, plaque formation, and how we can manipulate those to provide a better answer for atherosclerosis that does not involve severe manipulations of a diet. For example, it appears it is the carrier proteins that cause the damage to the arteries – and more carrier proteins are made in response to certain stimuli (triglycerides being one).

(c ) There were deep and troubling issues with the groups of patients serving as controls. For example, we do not know how many pack-years of smoking were in one group or the other. This is not a minor flaw, as science understands the highly inflammatory changes that are made with smoking as opposed to those made with hyperlipidemia.

(d) Lipid lowering drugs were used in some, and not others – however, the drugs today are far better, and more targeted than before.

To this day when most talk about saturated fat we are given “alternatives” like margarine, olive oil, oils from nuts, seeds, and the like.  They are suppose to be better for us than “animal fat.” They are not.

We built pyramids – food pyramids, based on avoiding certain foods. We went out of our way to define the chemical nature of fats: polyunsaturated, monounsaturated, a trans-fats. We made charts so we could keep track of which fats were the “good fats,” so we could tell patients to eat these.

Monounsaturated fat Polyunsaturated fat
Olive oil Corn oil, Grapeseed oil
Avocados Fatty fish
Almonds, peanuts, macadamia nuts Walnuts, sunflower seeds, flaxseed
 

 

Then of course we had to tell people what was “bad” because it caused problems so we made tables like this:

Saturated fat Trans fat
Beef, lamb, pork Margarine (stick form)
Ice cream Fried foods (french fries, breading)
Milk, cream Crackers, popcorn, chips
Lard Shortening

 

But wait – then we had to tell what to change in their diet so we made tables like this one:

 

Less Healthy Better Choice
Beef that is corn-fed Beef that is grass-fed
Butter Olive oil
Standard eggs Eggs high in omega-3 fatty acids
Ice cream Frozen yogurt
Milk Fat-free milk, soy milk, almond milk
Shortening, lard Grape seed oil, canola oil, vegetable oil

Did I mention we were wrong?

In science we make a hypothesis – then we test the hypothesis – then based on our findings we refine things, test again, and somewhere we develop a theory that explains the nature of things. In this case – food.

When the USDA and Europeans looked at the data to make recommendations about fat, they cherry-picked the data about saturated fats. Meaning, in spite of studies showing that saturated fat did not increase heart disease, in spite of studies showing that polyunsaturated fats may be worse than saturated fats, they pressed through guidelines and recommendations that were based not on critical thinking, but the bias of the committee members.

Remember: in those days, everyone had the thought that the fat laden arteries of people with coronary artery disease came from butter, animal fat, and the like.

Heart artery plaque- low fat diet doesn’t prevent this

What do we do?

It turns out that saturated fat is not bad for a person, and the studies showing we should substitute with other fats were wrong.

Still the ideas of eating “healthy” for many people means avoiding red meat, avoiding saturated fats, even though the evidence for this is almost non-existent.

How We Live:

Which brings us to one simple fact: how we live is more important than how when we die- especially if the quality of life is less than satisfying. I doubt Eisenhower enjoyed his last days as much as Lyndon Johnson.

But let me bring one simple point: learn to cook. Appreciate fresh food. Yes, you can live on processed food but you cannot thrive.

 

REFERENCES:

In 2003, a meta-analysis of over 50 trials was published examining the relationship of dietary fat to serum cholesterol levels (Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serumlipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003;77:1146–55.).  The conclusion was that saturated fat increases the levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) but without changing the ratio of total to the HDL cholesterol.   They concluded that using cholesterol alone as a marker of risk was unreliable. This was because if you replace the saturated fat with carbohydrates or tropical oils if you examine the effects on HDL and apolipoprotein B. They concluded that “… we can never be sure what such fats and oils do to coronary artery disease risk.” To translate that from doctor-scientist language: we can improve some laboratory markers, but really not by any mechanism that makes a difference from what we know.

While a systematic review of randomized trials showed that when saturated fats are replaced by polyunsaturated fats there is a reduction in the laboratory marker for risk of heart disease, there was no association with mortality from heart disease.  To emphasize this: the laboratory values of the patients studied improved, but their mortality didn’t. The review also showed that monounsaturated fat intake significantly increased cardiac events, but no effect from the intake of saturated or polyunsaturated fat. Let me emphasize that: Monounsaturated fats, by at least one study, not only didn’t improve issues with the heart- the patients in that study did worse.

When examining other prospective studies about the risk of saturated fat and cardiovascular disease, there has been a consistent lack of an association between fat intake and heart disease, stroke, or total cardiac events.

Cohort studies show that by replacement of saturated fats with unsaturated fats, or carbohydrates – and examining the hazard ratios for heart attacks and deaths from heart disease were as follows: 0.87 for polyunsaturated fat, 1.19 for monounsaturated fat, and 1.07 for carbohydrates.  For those not familiar with statistics, these are essentially no difference, and if these small statistical numbers are accepted than polyunsaturated fat shows an alarming trend. So here is a study that indicates (with as much precision as most studies these days) that polyunsaturated fats are worse for you than saturated fats.

There is a difference between protection against what we define as risk of heart disease and death from heart disease.  Risk reduction means that we lower the laboratory values of factors we associate with risk – but the end point is death.  In a meta-analysis published in 2010 (Ramsden CE, Hibbeln JR, Majchrzak SF, Davis JM. N-6 fatty acid-specific and mixed polyunsaturated dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. Br J Nutr 2010;104:1586–600.) examined seven different trials, they found that there was a risk reduction but no change in mortality.  Another study (Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomized controlled trials. Ann Nutr Metab 2009;55:173–201.  ) had eight trials found “There is probably no direct relation between total fat intake and risk of CHD (heart disease).

The advice of the USDA is reflected in places like WebMD, recounted in public service commercials, and recited as gospel by health care workers everywhere.  Giving false impressions about what an appropriate diet is.

 

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.