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.

MSG: Does Chinese Restaurant Syndrome Exist?

Mono-sodium-glutamate (MSG) – the cause of “Chinese Restaurant Syndrome.”  It turns out  this syndrome is a myth.

HISTORY OF THE MYTH:
The syndrome was first reported in a letter to The New England Journal of Medicine in April of 1968. A physician wrote that he developed a syndrome which he thought might be associated with salt or MSG, and asked the medical community to respond to this syndrome. He described the symptoms as “ numbness at the back of the neck, gradually radiating to both arms and the back, general weakness and palpitation.” He said several of his friends had it also. He speculated that it might be the cooking wine, or the soy sauce- although the restaurant he went to used the same brand of soy sauce he used. He also noted his friends suggested it might be the seasoning of MSG used by the restaurant. (1)  The next month ten letters responded – one didn’t think it was MSG, one noted it didn’t happen in all Chinese restaurants – and might be placebo, and another reported a patient developing a stroke after eating the food. The media picked up the new disease “Chinese Restaurant Syndrome” and it became a food-type allergy. Ten months later the journal Science reported that Monosodium L-glutamate “is the cause of the Chinese restaurant syndrome and can precipitate headaches.” (2)  The report in Science, was written by one of the people who wrote the letter back to NEJM that May, Dr. Schaumburg. In fact, a later one of his letters was initially done in great humor, “ With the enthusiastic co-operation of the Shanghai Cafe one of us ate Chinese food for breakfast, lunch and dinner until the search had been narrowed to either hot and sour soup or wonton soup, both of which produced the reaction. A rough filtrate of wonton soup also produced the reaction. Upon sampling of the individual ingredients, the dagger of suspicion pointed at monosodium glutamate. Further experiments confirmed this suspicion. The experiments were performed with the use of approved blind and double-blind technics on three volunteers. If the suspicion that irresponsible human experimentation was done has crossed your mind, be at ease. The days of Walter Reed are not past.” (3)

MSG

My mother had this in her kitchen. Pure MSG – it made food taste a lot better

The MSG Follow Up Research
Forty years after that original letter, and in spite of years of trials, and clinical trials, it was finally put to rest that “so-called ‘Chinese restaurant syndrome’ and in eliciting asthmatic bronchospasm, urticaria, angio-oedema, and rhinitis. Despite concerns raised by early reports, decades of research have failed to demonstrate a clear and consistent relationship between MSG ingestion and the development of these conditions.” (4)

In spite of good clinical data putting this myth to rest, there will be plenty of people whose confirmation bias tells them they cannot eat in Chinese Restaurants, and will blame MSG, all the while not realizing that without MSG their bodies would cease to function, and that there is more MSG in the Italian food they prefer, than the Chinese food they shun. In test after test, MSG was not any worse than the placebo given in random studies.

In 2011 the Food and Drug Administration’s committee on GRAS (Generally Recognized as Safe) substances stated this: “  There is no evidence in the available information on L-glutamic acid, L-glutamic acid hydrochloride, monosodium L-glutamate, monoammonium L-glutamate, and monopotassium L-glutamate that demonstrates, or suggests reasonable grounds to suspects, a hazard to the public when they are used at levels that are now current and in the manner now practices. However, it is not possible to determine, without additional data, whether a significant increase in consumption would constitute a dietary hazard.”  Much like salt, too much isn’t a good thing. (5)

Why MSG is so Important to you
Proteins are made up of molecules of amino acids – some of those amino acids our body can manufacture (they are called non-essential because we do not need to get them from our diet) and some amino acids we must obtain from our diet (called essential amino acids). Glutamic acid, and its form MSG, is a non-essential amino acid – meaning, our body produces glutamate and uses it to build the proteins we need. Without MSG you would be unable to build proteins, run the metabolism your body needs– without this amino acid you would not exist.While glutamic acid  is present in every food that contains protein, umami can only be tasted when it is separated from the protein – and functions as an individual amino acid.

MSG – It is one of the tastes you perceive
Before MSG was known for “Chinese Restaurant syndrome” it was used for the flavor it produced, to enhance food.  MSG  produces a  distinct savory flavor that is called Umami. MSG is a common additive in China- while visiting you would see it used almost as we would use salt here. In the United States MSG was sold under the name “Accent.”

China Lamb

In every market in China, such as here in Xi’an, one of the common flavors added to foods is MSG

We have discovered that humans have taste buds for  Glutamic acid  (MSG).  That flavor, umami, or savory (meat-like)  stimulates specific receptors located in taste buds, and is now recognized as one of the five basic tastes in addition to sweet, salty, sour, and bitter.  MSG is found in many foods, especially in parmesan cheese, tomatoes, soy sauce.  One would think if MSG was a real problem there would be an “Italian Restaurant Syndrome.”

There is no one region of the tongue that tastes sour, salt, bitter, sweet, or umami.  You may have seen “tongue” maps that show this, it turns out that the taste buds are distributed throughout the tongue. The entire tongue, has taste buds throughout – as well as the intestine (but that is for another blog).

Balance of flavor
If you ever eat something that is too salty, you want to balance it with sweetness – why we love dessert. But umami, that savory taste is why we love the balance in Italian cooking. We add Romano cheese to noodles to enhance the “flavor” – romano is filled with umami. America is in love with ketchup, and tomatoes provide that unique umami flavor. In Japan, instead of adding Romano or Parmesan to their noodles, they are judged by dashi – a broth that is made with seaweed (kombu) that has lots of MSG (and where some of the original MSG was derived from).

While in China, our favorite places to eat were on the streets – and beside almost every wok was a bowl of MSG – used to liberally season the foods, much like we use salt here. Street food in China is among the best food you can get. Some have even suggested that the balance of flavor that umami provides is one reason the Chinese are not subject to obesity (more about that later).

In Australia and the United Kingdom Vegemite and Marmite are all MSG or glutamate based – and all an essential part of that culture.

We are born to appreciate that flavor- human breast milk has almost 3o times higher glutamate than cow’s milk.

In my home state of Alaska, we prefer oysters, clams, and crabs when harvested in February through March – and it turns out they have their highest level of glutamates then. One would think that the Bering Sea would be better to harvest in the tranquil months of summer, but in August the lowest levels of glutamate are then, and Natives will tell you there just isn’t the flavor of the crab that you would like.

Whale Tale

August is great in Alaska to see whales, but not great for getting oysters, clams, or crab – the MSG levels are too low and they have less flavor

If you have an imbalance in flavor, then you compensate. Umami, it has been suggested, would provide a better balance if used more in foods. In other words, the emphasis on fat, sweet, and salty has led to some of the obesity, had there been more emphasis on umami, less food would be consumed, because there would be more of a balance. (6)

MSG and Obesity:

Apparently this “non essential” amino acid is now being blamed for obesity and short stature.  As you can see by reference (6) MSG can be used to help regulate appetite. Then came a paper in 2011 (7) claiming to show a correlation between MSG and obesity.  Sadly- this was one of the most poorly written papers, and was taken apart for multiple flaws in (7). To quote them: ”

Finally, even though observational studies often provide useful information for hypothesis formulation, given the significant questions and concerns raised in this study, it is premature to even generate a plausible hypothesis on MSG intake and obesity.

The current epidemic of obesity is worldwide, including in Asia. Because MSG has been extensively used as a flavoring agent in Asia, it could also potentially play an important role of enhancing palatability and acceptability of calorie-reduced diets. Until further confirmatory information becomes available, extreme caution needs to be exercised not to raise undue public safety concerns regarding MSG consumption.”

:

(1) Chinese-Restaurant Syndrome. Kwok, RHM. N Engl J Med 1968; 278:796April 4, 1968 (Letter to the editor)

(2) Monosodium L-glutamate: its pharmacology and role in the Chinese restaurant syndrome. Schaumburg HH, Byck R, Gerstl R, Mashman JH. Science. 1969 Feb 21;163(3869):826-8.PMID: 5764480

(3) Sin Cib Syn: Accent on Glutamate. Schaumburg HH, Byck R, N Engl J Med 1968; 279:105-106July 11, 1968 (Letter to the editor)

(4) Monosodium glutamate ‘allergy’: menace or myth?Williams AN, Woessner KM.Clin Exp Allergy. 2009 May;39(5):640-6. PMID: 19389112

(5) From the US Food and Drug Administration GRAS database.

(6) Umami flavour as a means of regulating food intake and improving nutrition and health. Mouritsen OG.  Health. 2012 Jan;21(1):56-75. PMID: 22544776

(7)↵ He K, Du S, Xun P, Sharma S, Wang H, Zhai F, Popkin B. Consumption of monosodium glutamate in relation to incidence of overweight in Chinese adults: China Health and Nutrition Survey (CHNS). Am J Clin Nutr 2011;93:1328–36.

(8)A lack of epidemiologic evidence to link consumption of monosodium L-glutamate and obesity in China.vBursey RG, Watson L, Smriga M.Am J Clin Nutr. 2011 Sep;94(3):958-60; author reply 960-1. doi: 10.3945/ajcn.111.020727.

Salads: The Myths

Have you ever noticed how many times people begin weight loss attempts by eating salads? How successful are they?

If you look over the calorie counts of the salads in most restaurants, you may be astonished at how many calories they really contain. The Apple-Walnut-Chicken salad at Applebee’s is 1160 calories. The Chicken Club salad from Arby’s is 810 calories. The Caesar salad with chicken at Chili’s is 1010 calories. Compare those to a quarter pounder from McDonald’s (410 calories) and you can see how easily people are fooled into ordering a tasty salad that contains a lot of calories, and a lot of fat.

The nutritional value of lettuce is low, in fact, almost nothing. The bulk and fiber value of lettuce is also low. So what is the problem with salads? The dressings in salads are the problem. Many salad dressings containing over 100 calories per tablespoon- and few people ever use a single tablespoon of dressing in their salad. Even the low-fat dressings contain a lot of calories.

We see this with our weight loss surgery patients. They eat a lot of salads, and once they give up their salads and begin to eat more cooked vegetables, they begin to lose weight. Vegetables contain more fiber, more nutrients, and when cooked, more nutrients are absorbed by the body then when consumed raw.

So if you are serious about weight loss increase your vegetables and give up the salads. Salads can be the enemy of your weight loss.

REFERENCES:
The references below come from our soon to be released cookbook, which includes a large reference section. Hope you find them helpful…

Salads are the enemy for patients wanting weight loss mainly because of the dressings used in the salads, and the high calorie count found in many of the salads. Most of my weight loss surgery patients will tell me, “I love salads,” – and what they love are less the vegetables, and more the use of vegetables as a vehicle to carry Ranch dressing. Check the average calorie count for salads in restaurants. But there is a good side to this. It appears that adding a bit of fat to the vegetables increases consumptions of carotenoids. By adding a minimal amount of fat, it makes these more “bioavailable” to eat.
J Nutr 2000
Pub Med ID 10702576

Carotenoids are responsible for the red, orange, and yellow colors of many vegetables. They have received a lot of attention in the scientific community because people with diets rich in carotenoids have less cardiovascular disease, cancer, and other degenerative diseases (key again- a diet rich in them, not supplements ). When looking at food, if your plate has more color, it is probably healthier – and the more it looks just brown, the less healthy it is thought to be (we call this the eye spectrometer view of food). These carotenoids can only be absorbed with mixed with fat in the intestine.
Front Physiol 2012
Pub Med ID 22934067