Red meat & mortality & the usual bad science

[lapis]

Review of all the Red Meat DOOM! articles in the press lately by Zoe Harcombe (http://www.zoeharcombe.com/2012/03/red-meat-mortality-the-usual-bad-science/) (like this press release from Harvard, "Red Meat Consumption Linked to Increased Risk of Total, Cardiovascular, and Cancer Mortality (http://www.hsph.harvard.edu/news/press-releases/2012-releases/red-meat-cardiovascular-cancer-mortality.html). (http://www.hsph.harvard.edu/news/press-releases/2012-releases/red-meat-cardiovascular-cancer-mortality.html)")

This is a long article with a few tables, but here's the summary at the end with the take-home message:

There are numerous key problems with this study – I’ll share seven:

1) This study can at best suggest an observed relationship, or association. To make allegations about causation and risk is ignorant and erroneous.

2) The numbers are very small. The overall risk of dying was not even one person in a hundred over a 28 year study. If the death rate is very small, a possible slightly higher death rate in certain circumstances is still very small. It does not warrant a scare-tactic, 13% greater risk of dying headline – this is ‘science’ at its worst.

3) Several other critical variables showed correlation with death rates – lack of activity, low cholesterol, BMI, smoking, diabetes, calorie intake and alcohol intake. These have not been excluded to isolate meat consumption alone. The raw data actually shows deaths rates falling with increased meat consumption up to the third or fourth quintile – and this is before all the other variables have been allowed for. This would suggest that meat consumption has a protective effect while weight, alcohol, calorie intake, lack of exercise and so on are all taking their toll.

4) Several other critical variables were not measured, which would logically correlate with certain meat consumption. Unprocessed meat inexplicably included sandwiches, curries, hamburgers (which come in buns) – has the correlation with bread, margarine, white rice, egg fried rice, poppadoms, burger buns, ketchup, relish or even fizzy drinks been correlated with the death rates? Indeed, Frank Hu, one of the authors of this meat study, is also quoted in today’s paper saying that one soft drink a day raises the risk of heart (http://www.dailymail.co.uk/health/article-2114123/One-soft-drink-day-raises-heart-attack-danger-20-cent-according-U-S-study.html) attacks. It doesn’t of course – it is association at best, just as the meat article is – but one does wonder if that harmful soft drink was the one that just happened to be consumed with the hamburger or the bacon, lettuce and tomato sandwich ‘meal deal’?!

5) Hamburgers and pork sandwiches or lamb curries have been included as unprocessed meat. This is not a study of what real food devotees would consider unprocessed meat therefore. May I suggest that a study of consumers of grass fed ruminants would not deliver the desired headline? The lamb and beef grazing in the fields around me in Wales could not be further in health benefits from the hamburgers in buns and hot dogs in white rolls in fast food America.

6) We are all going to die. We have 100% risk of it in fact. We are not going to increase this risk by 13% or 20% if we have a hamburger and certainly not if we have a grass fed nutrient rich steak. This is headline grabbing egotistical academics doing their worst.

7) As I always consider conflict of interest, it would be remiss of me to end without noting that one of the authors (if not more) is known to be vegetarian and speaks at vegetarian conferences[ii] (http://www.zoeharcombe.com/2012/03/red-meat-mortality-the-usual-bad-science/#_edn2) and the invited ‘peer’ review of the article has been done by none other than the man who claims the credit for having turned ex-President Clinton into a vegan – Dean Ornish.[iii] (http://www.zoeharcombe.com/2012/03/red-meat-mortality-the-usual-bad-science/#_edn3)

[snip]

[i] (http://www.zoeharcombe.com/2012/03/red-meat-mortality-the-usual-bad-science/#_ednref1) http://www.meatami.com/ht/a/GetDocumentAction/i/48781
[ii] (http://www.zoeharcombe.com/2012/03/red-meat-mortality-the-usual-bad-science/#_ednref2) http://www.vegetariannutrition.org/speakers.html
[iii] (http://www.zoeharcombe.com/2012/03/red-meat-mortality-the-usual-bad-science/#_ednref3) http://archinte.ama-assn.org/cgi/content/full/archinternmed.2012.174

[lapis]

Here's another one by the intelligent and beautiful Ms. Denise Minger, the great slayer of The China Study book's many fraudulent claims (http://rawfoodsos.com/the-china-study/) whose Death by Food Pyramid will be published later this year.

Will Eating Red Meat Kill You? (http://www.marksdailyapple.com/will-eating-red-meat-kill-you/)


We’re already 74 days into the new year, which can only mean one thing: it’s high time for our latest episode of Science Says Meat Will Kill You, complete with a brand new study and commercial-free viral media coverage! Have a seat and tune in (or at least set your DVR for later viewing).

If you haven’t had at least one family member, coworker, or soon-to-be-unfriended Facebook acquaintance send you this study as a reminder that you’re killing yourself, you’re either really lucky or your inbox is broken. Thanks to an observational study called Red Meat Consumption and Mortality (http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.2287) freshly pressed in the Archives of Internal Medicine, a slew of bold headlines exploded across every conceivable media outlet this week:



“All red meat is bad for you, new study says (http://www.chicagotribune.com/health/la-he-red-meat-20120313,0,2364743.story)”
“Red meat is blamed for one in 10 early deaths (http://www.telegraph.co.uk/health/healthnews/9138230/Red-meat-is-blamed-for-one-in-10-early-deaths.html)”
“Scientists warn ‘red meat can be lethal’ (http://news.sky.com/home/uk-news/article/16187521)”


Media sensationalism aside, the study does seem to spell trouble for proud omnivores. Unlike some similar publications we’ve seen on meat and mortality, this one says that red meat doesn’t just make you die of heart disease and cancer; it makes you die of everything. Following over 120,000 women and men from the Nurses’ Health Study (http://www.channing.harvard.edu/nhs/) and the Health Professional’s Follow-up Study (http://www.hsph.harvard.edu/hpfs/) for 28 and 22 years respectively, researchers found that a single daily serving of unprocessed red meat was associated with a 13% increased risk of death from all causes, while a single serving of processed red meat—the equivalent of one hotdog—was associated with a 20% increased risk.

And in case that’s not enough to chew on, there’s more: the researchers waved their statistical wands and declared you could outrun death for a few more years by swapping red meat for so-called “healthier foods” like nuts, chicken, or whole grains. In fact, the researchers suggest that up to one in ten of the deaths that struck their study participants could’ve been prevented if everyone had kept their red meat intake under half a serving per day!

But if you’ve been hanging around the nutrition world for very long, you’ve probably realized by now that health according to the media and health according to reality are two very different things—and even scientific studies can be misrepresented by the researchers who conduct them. Is our latest “killer meat” scare a convincing reason to ditch red meat? Is it time to put a trigger lock on your lethal grass-fed beef when the young’uns are around? Or is there more to this story than meats the eye? (Sorry, I had to.)


Observations vs. Experiments


Before we even dig into what this study found, let’s address an important caveat that the media—and even the researchers, unless they were terribly misquoted—seem to be confused about. What we’ve got here is a garden-variety observational study, not an actual experiment where people change something specific they’re doing and thus make it possible to determine cause and effect. Observations are only the first step of the scientific method—a good place to start, but never the place to end. These studies don’t exist to generate health advice, but to spark hypotheses that can be tested and replicated in a controlled setting so we can figure out what’s really going on. Trying to find “proof” in an observational study is like trying to make a penguin lactate. It just ain’t happening… ever.

Nonetheless, the media blurbs—and even quotes from the scientists themselves—suggest this study has a major case of mistaken identity. The lead researcher Frank Hu claimed the study (http://www.nydailynews.com/life-style/health/red-meat-boosts-risk-dying-young-study-portion-processed-meat-boosts-death-risk-20-article-1.1038010?localLinksEnabled=false) “provides clear evidence that regular consumption of red meat, especially processed meat, contributes substantially to premature death,” despite the fact that the study is innately incapable of providing such evidence. It’s as if someone pulled a Campbell (http://rawfoodsos.com/the-china-study/) on us.
[http://www.freesmileys.org/smileys/smiley-laughing001.gif]Only an actual experiment, with controls and manipulated variables, could start confirming causation.

But the study’s over-extrapolation isn’t really that surprising. A conclusive experiment is what every observational study secretly yearns to be, deep down in its confounder-riddled, non-randomized heart. And like pushy stage mothers, some researchers want their observational studies to be more talented and remarkable than they truly are—leading to the scientific equivalent of a four year old wobbling around in stilettos at a beauty pageant. Our study at hand is a perfectly decent piece of observational literature, but as soon as its authors (or the media) smear it with lipstick and make it sing Patsy Cline songs on stage, it’s all downhill from there.


Food Frequency Questionnaires: A Test of Superhuman Memory and Saint-like Honesty


To kick this analysis off, let’s take a look at how the study was actually conducted. As the researchers explain, all of the diet data came from a series of food frequency questionnaires (FFQs) that the study participants filled out once every four years, starting in the 1980s and ending in 2006. (If you’re feeling brave, you can read the questionnaire yourself (http://www.channing.harvard.edu/nhs/questionnaires/pdfs/NHSI/2002.PDF) (PDF) and try imagining how terribly the average, non-diet-conscious person might botch their responses.) The lifestyle and medical data came from additional questionnaires administered every two years.

The full text of our study offers some additional details (emphasis mine):

In each FFQ, we asked the participants how often, on average, they consumed each food of a standard portion size. There were 9 possible responses, ranging from “never or less than once per month” to “6 or more times per day.” Questionnaire items about unprocessed red meat consumption included “beef, pork, or lamb as main dish” (pork was queried separately beginning in 1990), “hamburger,” and “beef, pork, or lamb as a sandwich or mixed dish.” … Processed red meat included “bacon” (2 slices, 13 g), “hot dogs” (one, 45 g), and “sausage, salami, bologna, and other processed red meats” (1 piece, 28 g).

Notice that one of the foods listed under “unprocessed red meat”—and likely a major contributor to that category—is hamburger, the stuff fast-food dreams are made of. Although this study tracked whole grain intake, it didn’t track refined grain intake, so we know right away we can’t totally account for the white-flour buns wrapped around those burgers (or many of the other barely-qualifying-as-food components of a McDonald’s meal).

And unless these cohorts were chock full of folks who deliberately sought out decent organic meat, it’s also worth noting that the unprocessed ground beef they were eating probably contained that delightful ammonia-treated pink slime (http://abcnews.go.com/blogs/headlines/2012/03/70-percent-of-ground-beef-at-supermarkets-contains-pink-slime/) that’s had conventional meat consumers in an uproar lately.

Next, we arrive at this little gem:

The reproducibility and validity of these FFQs have been described in detail elsewhere.

Ding ding, Important Thing alert! As anyone who’s spent much time on earth should know, expecting people to be honest about what they eat is like expecting one of those “Lose 10 pounds of belly fat” banners to take you somewhere other than popup-ad purgatory: the idealism is sweet and all, but reality has other plans.

And so it is with food frequency questionnaires. Ever since these questionnaires were first birthed unto the world, scientists have lamented their most glaring flaw: people tend to report what they think they should be eating instead of what actually goes into their mouth. And that’s on top of the fact that most folks can barely remember what they ate yesterday, much less what they’ve eaten over the past month or even the past year.

As a result, researchers compare the results of food frequency questionnaires with more accurate “diet records”—where folks meticulously weigh and record everything they eat for a straight week or two—to see how the data matches up. If we follow that last quote to the links it references, we end up at one of the validation reports (http://www.ajcn.org/content/69/2/243.full) for the food frequency questionnaire used with the Health Professionals Follow-up Study. Here’s where it gets interesting:

Foods underestimated by the FFQs compared with the diet records (ie, the gold standard) included processed meats, eggs, butter, high-fat dairy products, mayonnaise and creamy salad dressings, refined grains, and sweets and desserts, whereas most of the vegetable and fruit groups, nuts, high-energy and low-energy drinks, and condiments were overestimated by the FFQs.

This shouldn’t come as a shocker if we consider human psychology. Unless we literally live in a cave, most of us are constantly inundated with messages about how high-fat dairy, meat, sweets, desserts, and anything delicious and creamy is going to either make us fat or give us a heart attack—while it’s more like hallowed be thy name for fruits and veggies. Is it any wonder that folks tend to under-report their intake of “bad” foods and over-report their intake of the good ones? Who wants to admit—in the terrifying permanency of a food questionnaire—that yes, they do bury their salad in half a cup of Hidden Valley Ranch, and they do choose white bread because 12-Grain Oroweat tastes like lightly sweetened wood chippings, and sometimes they even go a full three days where their only vegetable is ketchup? If food frequency questionnaires were hooked up to a polygraph, we might see some much different data (and some mysteriously disappearing respondents).

Another reference in our study du jour takes us to a validation report (http://ije.oxfordjournals.org/content/18/4/858.abstract) for the Nurses’ Health Study questionnaire. And here we find the same trend:

Mean daily amounts of each food calculated by the questionnaire and by the dietary record were also compared; the observed differences suggested that responses to the questionnaire tended to over-represent socially desirable foods.

Of course, if everyone over-reported or under-reported their food intake with the same magnitude of inaccuracy, we could still find some reliable associations between food questionnaires and health outcomes. But it turns out that how much someone fudges their food reporting—especially for specific menu items—varies wildly based on their personal characteristics. Using an Aussie-modified version of the Nurses’ Health Study questionnaire, a study from Australia (http://jn.nutrition.org/content/136/2/459/T3.expansion.html) measured how accurately people reported their food intake based on their gender, age, medical status, BMI, occupation, school-leaving age, and use of dietary supplements.

Like with the other validation studies, it compared the results of the food frequency survey with the Almighty Weighed Food Record.

The surprising results? Folks with a “diagnosed medical condition”—including high cholesterol, high triglycerides, diabetes, high blood pressure, stroke, cancer, and heart disease—were much more likely to mis-report their meat consumption (http://jn.nutrition.org/content/136/2/459/T3.expansion.html) than folks without a diagnosed medical condition, generally overestimating their true intake on food frequency questionnaires compared to the weighed food record. Why this occurred is one of life’s great mysteries, but it might have something to do with the fact that people who develop diet- and lifestyle-related diseases pay less conscious attention to what they eat. (In this study, women were also more likely to inaccurately report their intake for a wide variety of foods—a phenomenon that’s been examined in greater depth (http://www.ncbi.nlm.nih.gov/pubmed/15139892) by other researchers.)

So what does this mean for studies based on food frequency questionnaires, like the one currently hijacking the news outlets?

Unfortunately for lovers of scientific accuracy, it means that meat consumption and modern diseases might be statistically more likely to show up hand-in-hand by mere fluke. If sick folks have a tendency—for whatever reason—to say they’re eating more meat than they really are, that’ll have profound effects on any diet-disease associations that turn up in observational studies, where correlations hinge so heavily on the accuracy of the data.

And if the results of that Australian study are applicable not only in the Land Down Under but also in the Land Up Over, it could mean that meat is pretty much doomed to look guilty by association with disease whenever food frequency questionnaires are involved. Woe is meat!


Red-Meatophiles: A Species of Their Own


Now that our confidence in food frequency questionnaires should be thoroughly and disturbingly shattered, let’s hop back to the study in question. To gauge the effects of red meat consumption on mortality, the researchers for our Red Meat Consumption and Mortality (http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.2287) study divided folks up into five quintiles based on their red meat intake. The first quintile represents the people who reported the fewest servings per day, while the fifth quintile represents the shameless red-meat gluttons who indulged in the most (or rather, reported indulging in the most). Luckily for us, the researchers provided a magical table of marvels (http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.2287v1/IOI110027T1) comparing various diet and lifestyle variables between the quintiles. Please take a minute to look at it yourself and, if you feel so compelled, bask in its glory.

If you secretly suspected that this was a “people who eat red meat do a lot of unhealthy things that make them die sooner” study, you can now gloat.

Here are a few lifestyle variables I graph-ified for greater visual impact. (“Red Meat Intake” is measured in servings per day, and “Physical Activity” is measured in hours of metabolic equivalent tasks.)

http://i247.photobucket.com/albums/gg158/MDA2008/MDA%202011/health_professionals_lifestyle_graph.jpg
http://i247.photobucket.com/albums/gg158/MDA2008/MDA%202011/nurses_health_lifestyle_graph.jpg

As you can see, the folks eating the most red meat were also the least physically active, the most likely to smoke, and the least likely to take a multivitamin (among many other things you can spot directly in the table, including higher BMIs, higher alcohol intake, and a trend towards less healthy non-red-meat food choices). Although the researchers tried their darnedest to adjust for these confounders, not even fancy-pants math tricks can compensate for the immeasurable details involved in unhealthy living, the tendency for folks to misreport their diet and exercise habits, and whatever mild insanity emerges from trying to remember every food that hit your tongue during the past year.

And in case you didn’t spot them yet, our magical table has two particularly ogle-worthy things. The first one’s this:

http://i247.photobucket.com/albums/gg158/MDA2008/MDA%202011/calorie_graph.jpg

If you had any doubt that people fib on food questionnaires, this should put your mind at ease. Take a look at the average (reported) calorie intake for the women in the first quintile of red meat consumption. Yes, that does say “1200 calories.” Yes, that is low enough to make most people wake themselves up at night as they unconsciously gnaw on their own arm in a quest for nourishment. And the red-meat-avoiding men aren’t much better, clocking in at a bit over 1600 calories for fully-grown adults. If there really is an 800-calorie gap between the folks with the lowest and highest red meat consumption, there’s obviously something much more significant going on in their diets than the color of their chosen animal foods. And if—in a much more likely scenario—there’s some major mis-reporting going on, that only bolsters the notion that we shouldn’t trust food frequency questionnaires any farther than we could throw ‘em.

Here’s the other ogle-worthy thing:

http://i247.photobucket.com/albums/gg158/MDA2008/MDA%202011/high_cholesterol_graph.jpg

Ah, yes: here we see the folks eating the least red meat have the highest rates of elevated cholesterol, while the red-meat-indulgers have the lowest rates. Given the media’s eagerness to assign cause and effect to this study, it’s mighty strange none of the headlines proclaimed “Red meat reduces cholesterol!”


So What About This Death Stuff?


For those of you who hoped this analysis would completely obliterate any link the researchers found between red meat and “dying prematurely,” here’s the anticlimactic part. In the context of what’s ultimately wobbly, imperfect, and tragically inconclusive observational data, the researchers did find that the folks reporting the highest intake of red meat had slightly elevated rates of death from cardiovascular disease, cancer, and total mortality (though as we should know by now, correlation isn’t causation!). After adjusting for age and the other documented confounders, the association went down but didn’t disappear completely. (If you like staring at numbers, you can take a gander at the tables for all-cause mortality (http://archinte.ama-assn.org/cgi/content-nw/full/archinternmed.2011.2287v1/IOI110027T2), cardiovascular disease mortality (http://archinte.ama-assn.org/cgi/content-nw/full/archinternmed.2011.2287v1/IOI110027T3), and cancer mortality (http://archinte.ama-assn.org/cgi/content-nw/full/archinternmed.2011.2287v1/IOI110027T4) to see how death risk changed between quartiles and with various statistical adjustments. And you can check out the lovely Zoe Harcombe’s parsing of the study (http://www.zoeharcombe.com/2012/03/red-meat-mortality-the-usual-bad-science/#_ednref1) if you’re craving an even geekier data safari.)

But there’s still more to the story.

Those numbers thrown around in the fear-mongering news clips—20% increased risk of death from all causes for processed meat and 13% increased risk of death from all causes for unprocessed meat—are classic examples of how even the most ho-hum findings can sound dramatic if you spin them the right way (and remember to attribute them to Hahhh-vard). If your risk of dying from a particular disease is 5% to start with, a “20% increased risk” only bumps you up to 6% in the grand scheme of things. That’s a lot less scary. Especially when delectable foods are involved.


Lessons From the Past


In case you’re skeptical that observational studies can run disturbingly contrary to reality, look no further than the hormone replacement therapy (HRT) craze that peaked a few decades ago.

By 1991, 30 observational studies (http://www.ncbi.nlm.nih.gov/pubmed/1826173?dopt=Abstract)—including this one (http://www.ncbi.nlm.nih.gov/pubmed/1870648) based on none other than the Nurses’ Health data—collectively showed that women taking estrogen seemed to have a 44% reduction in heart disease risk compared to their non-hormone-replacing counterparts. Naturally, this led literally millions of women to jump on the estrogen bandwagon in pursuit of better health and longer lives. A very unfortunate oopsie-daisy sprouted up later when some randomized, controlled trials finally emerged and revealed that rather than being protective, hormone replacement therapy actually increased heart disease risk by 29% (http://jama.ama-assn.org/content/288/3/321.abstract)!

Just like we see with red-meat avoiders versus red-meat indulgers, these observational studies showed that women using hormone therapy generally had healthier lifestyles than women who weren’t—including smoking less and exercising more (http://www.nejm.org/action/showImage?doi=10.1056%2FNEJM199109123251102&iid=t001). Their good lifestyle habits obscured the true effects of taking hormones, just as meat eaters’ bad lifestyle habits might obscure the true effects of eating red meat. Are we sure that a similar risk ratio flip-flop wouldn’t happen if we moved away from observational studies of meat consumption and towards infinitely more reliable randomized, controlled trials?

Until we actually have some studies like that, it’ll be impossible to know—but if history has any say in the matter, it’s a strong possibility. And while we patiently twiddle our thumbs waiting for those well-designed meat studies to start existing, we should keep in mind that humankind has survived a pretty doggone long time—in much more robust shape than most of us are today—without carefully swapping our lamb shanks for an equivalent serving of kidney beans.


Does Red Meat Make Bad Things Happen?


Since the very dawn of the taste bud, it seems red meat has been shrouded in mystique and evilness. Although the crumbling foundations of our anti-saturated-fat beliefs have partially redeemed meat and restored its throne on the dinner plate, red meat hasn’t quite escaped the stigma of being bad, even if we can’t totally pinpoint why. Is there a valid reason to avoid it?

Assuming you’ve nixed nitrite-laden processed meats and seek out higher-quality animal parts, one of the biggest legitimate dangers with red meat has more to do with preparation methods than the meat itself. High-temperature cooking—like pan-frying or grilling to the point of well-doneness—can create mutagens called heterocyclic amines (http://www.cancer.gov/cancertopics/factsheet/Risk/cooked-meats)(among other nefarious compounds) that may potentially contribute to cancer. Although the research here isn’t totally conclusive yet, it’s probably wise to stick with gentler cooking methods as often as possible (or better yet, learn to love steak tartare).


In Conclusion


Although the wildfire-esque media coverage of this study is enough to make any omnivore feel like punching Al Gore for ever inventing the internet, it’s actually a great opportunity to test our critical thinking skills and explore the unending deficiencies of observational studies—including the self-reported data they’re often built from. We might not emerge with any newfound health guidance after breaking down bad science, but it’s always nice to have a better understanding of what the tumultuous world of research is really saying.

And with that, our latest installment of Science Says Meat Will Kill You has come to a close. But worry not: this is just the beginning of an exciting new season of food drama. Will the butter defeat the margarine in their upcoming oil-wrestling contest? Will the asparagus discover who really killed her uncle’s stepdaughter’s boyfriend’s roommate’s poodle’s groomer? Tune in next week to find out!*

*Episode may or may not actually air

[Shami-Amourae]

Red meat isn't the problem. It's improperly treated grains (basically everything in the store), and sugar. Red meat that's bad is typically from the GMO-corn fed cows. Humans are omnivores, not herbivores.

[lapis]

Here's Anthony Colpo's take. I highly recommend his The Great Cholesterol Con book.

Red Meat Will Kill You, and Other Assorted Fairy Tales (http://anthonycolpo.com/?p=3143)



http://anthonycolpo.com/wp-content/uploads/2012/03/steak-600.jpg (http://anthonycolpo.com/wp-content/uploads/2012/03/steak-600.jpg)
Breaking news from the deluded world of epidemiology: This T-bone is the same as a Big Mac, and will kill you!



It’s an annual event. Every year, without fail, the headlines are awash with claims that ‘new’ research shows red meat causes cancer. The source for this scary claim is invariably some big data-dredging project…uh, I mean, “epidemiological” study by researchers from Harvard or some other ‘prestigious’ institution (there are no actual randomized controlled clinical trials showing red meat causes cancer).


When the yearly ‘red meat causes cancer’ circus’ rolls into town, I tend to yawn and quickly divert my attention to other more pressing matters, like the finer points of beef spare rib preparation. Did you know the longer and gentler you cook those little suckers, the more likely they are to slip off the bone due to absurdly mouth-watering tenderness? And that just the right amounts of sea salt, cardamon and fenugreek make these delicacies even more sinfully delicious? Try it some time; just as your taste buds are about to reach the point of orgasm, spare a thought for those poor buggers who earnestly believe all this red-meat-is-bad-for-you nonsense.

Which brings me to the latest red meat-bashing paper that has everyone’s knickers in a knot. The study comes from Harvard researchers, and unlike the usual cancer focus, this one primarily addresses the risk of overall mortality allegedly imparted by eating red meat (the full text is available here (http://anthonycolpo.com/archinte.ama-assn.org/cgi/content/full/archinternmed.2011.2287)). I’ve had a lot of folks asking for my ten cents worth on this study, so here it is:

I think this paper is a load of hogwash.

That’s my ten cents’ worth, hope that helps, I’m going out now.

Ciao!

What?

You wanted something a little more scientific, like a discussion of the methods, data, and possible flaws in the study?

Damn it…I thought I was about to make an early getaway!

Oh alright, give me a second to pull the paper up again, and I’ll explain just why I think it’s a complete joke.

Epidemi-hogwash versus Clinical Trials

The first thing that should be pointed out about this paper is that it reports on two epidemiological studies, sometimes referred to as prospective, population-based or follow-up studies. These are studies in which researchers recruit a bunch of people, ask them a series of questions (sometimes only at the start of the study, sometimes at intermittent periods during the study) and then follow them up over a given number of years. In the case of health- and nutrition-oriented epidemiological projects, researchers will ask questions about diet and exercise habits, then see if there is any statistical association between diet, lifestyle and subsequent illness (morbidity) and death (mortality).

If you’ve read my book The Great Cholesterol Con (http://www.thegreatcholesterolcon.com/), you’ll know I have an extremely poor regard for epidemiological studies, or more precisely, I have an extremely poor regard for the way in which they are routinely used as alleged ‘proof’ of a causal relationship between dietary factors and disease occurrence. Let’s be perfectly clear: epidemiological studies can not be used as proof of a causal relationship between meat and cancer, or saturated fat and heart disease, or anything else. They can only detect statistical associations; that is, the observation that people who eat this type of food tend to have more, less, or similar occurrence of X disease.

Whether disease X is actually caused by that type of food, or whether people who eat that type of food more often are succumbing to the disease due to other behaviours they also engage in more often can not be conclusively determined from an epidemiological study.

For that, you need a randomized controlled clinical trial, in which you recruit a group of subjects, then randomly assign each subject to one of two groups. In the case of red meat, one group would be assigned to consume a diet low in red meat, another would follow a diet identical in every aspect except for a substantially higher red meat content. Both groups would receive clear instruction as to how to best construct and adhere to their respective diets. Although randomization isn’t perfect, it maximizes the likelihood that there is an equal number of smokers/diabetics/non-exercisers/drinkers/drug users/etc in each group, so that one group isn’t disadvantaged by a higher number of subjects with unhealthy habits and/or poorer health.

How to Avoid Prospectively Chasing Your Tail

I’ll give you an example of the futility of drawing concrete conclusions from epidemiological studies. Several decades ago, when Ancel Keys was making a big splash with his absurdly biased Six and Seven Countries studies that claimed fat and cholesterol caused heart disease, another researcher devoid of cherry picking tendencies decided to look at the problem in a little more depth. His name was John Yudkin, and he analyzed a greater number of countries than Keys’ had employed in his small handpicked sample, and found no relationship between fat and CHD. He did, however, find a strong relationship between television ownership and CHD; people who owned televisions were more likely to get heart disease.

Now, if I were a Harvard researcher and got a result like that, I’d immediately conclude televisions cause CHD and issue a sensationalist press release titled “Your TV is Killing You: New Study Shows Television Causes Heart Attacks!” And because most journalists responsible for health and nutrition stories are sheep-like creatures who know absolutely nothing of value about health and nutrition, and would assume that because I’m from Harvard I must really know my stuff when it comes to health research, my claims would get worldwide headline coverage.

However, having graduated not from Harvard but the University of Commonsense, and having majored in Bullshit Detection 101, my first reaction would be to ask, “Is there anything inherently toxic about televisions themselves, or is there some other associated factor at play here?”

Well, we know that television does not emit some toxic poison that seeps into the arteries of viewers, causing them to clutch their chests in terror and inconveniently die just as Lieutenant Horatio is about to nail the bad guys in CSI Miami.

What we do know is that, if you’re watching television, you’re sitting on your butt. Which means you’re not exercising. Instead, you’re probably eating high-calorie junk. If you watch a lot of TV, then that means you’re probably eating even more junk and even less likely to be exercising at all. In which case, you’re more likely to be overweight, unfit, and have the arterial elasticity of a steel girder.

Using the powers of deduction endowed to me by my advanced degree in BS Detection 101, I would promptly suspect that the actual causal factors for increased CHD risk are your poor physical condition and intemperate nutritional habits. This would then prompt me to make recommendations that would seek to directly improve your fitness and nutritional habits. Concluding that TV was the causal factor and telling you to get rid of your TV would do you a fat lot of good if you stayed on the couch and kept snacking your way to an early grave.

This, ladies and gentlemen, is the very real danger inherent in the modern obsession with epidemiological studies. They are vastly inferior to randomized clinical trials, but when treated as if they are essentially the same thing – as is the widespread practise nowadays – they can lead to wildly inaccurate and misleading conclusions.

There are circumstances in which epidemiological research is indeed useful. If there is an outbreak of a new viral contagion, for example, researchers don’t have time to sit around discussing the finer nuances of a clinical trial. Epidemiological analysis allows them to determine what geographic locations/age groups/occupations/habits/ethnicities/etc seem to be most susceptible, and then take the appropriate action to contain the outbreak.

The other thing epidemiological research can be valuable for is as a prelude to clinical research, i.e. to determine associations worthy of confirmation or refutation in a far more controlled setting.

Concluding from an epidemiological study that meat causes cancer or that driving Holden Barinas causes men to develop effeminate habits is plain stupid. However, noting that these relationships seem to be consistently observed in prospective studies and then commissioning a clinical trial to examine whether the relationship still remains evident in a far more controlled setting is not stupid – it’s good science. You know, the kind of science that would be practised in a world where drug companies and food conglomerates didn’t virtually own the medical and health fields and where researchers were a noble group of independent thinking mavericks who placed more value on relentlessly seeking out the truth than simply milking the same epidemiological study for one headline-grabbing paper after another. But I digress…

The bottom line is that concluding red meat increases cancer risk from an epidemiological study is very sloppy science. And that’s exactly what’s happening with this latest Harvard paper by Pan et al.

It Wasn’t the Inactivity, Smoking and Diabetes that Killed Them – it Was the Red Meat, Damnit!

One of the first things I look at when reading a paper like this is the baseline characteristics of the subjects. Doing so often gets alarm bells ringing, and right now, as I peruse Table 1 of the paper, my head is ringing like an incoming call centre. There are so many discrepancies it actually boggles my mind that anyone would take a paper like this seriously.

The researchers divided meat intake into five quartiles, from lowest to highest. And as you peruse the table, something quickly becomes blindingly obvious: The more red meat people ate in these studies, the more likely they were to live unhealthier lives overall.

Remember how I said this paper covered two studies? The first was the Health Professionals Follow-Up Study (HPFS), the baseline data of which shows that as red meat intake rose, so too did the prevalence of all the following:


Physical inactivity
Smoking (the highest quartile of red meat consumption had three times as many smokers!)
Diabetes

Those who ate the most red meat also drank more alcohol, were less likely to use multivitamin supplements, and had a self-reported daily caloric intake over 800 calories more than those in the lowest quartile (2396 vs 1659 cals/day, respectively…more on that later).
So in HPFS, those who ate the most red meat also tended to live lifestyles that were unhealthier all-round.

And it’s much the same in the second project, the Nurses’ Health Study (NHS). The baseline data again show that those who ate the most red meat did less exercise, were more likely to smoke and have diabetes, were less likely to take a multivitamin, and also self-reported eating an extra 800+ calories daily.

Again, the more prolific red meat eaters smoked more, exercised less, and had a higher incidence of diabetes – a disease of disordered glycemic control with no plausible connection to red meat but strong links to excess caloric and refined carbohydrate consumption and physical inactivity.

I think it’s incredible that I even need to point this out in 2012, especially to Harvard researchers, but it’s pretty well established by now that smoking, diabetes and physical inactivity all greatly increase the risk of cancer, heart disease and premature mortality; the very outcomes that the researchers are ascribing in this paper to poor old red meat, everybody’s favourite whipping boy.

Some readers may object that this was countered by the multivariate analysis performed by the researchers, which adjusted for age, body mass index, physical activity level, smoking status, race, menopausal status and hormone use in women, family history of diabetes, myocardial infarction, or cancer; history of diabetes, hypertension, or hypercholesterolemia; and intakes of total energy, whole grains, fruits, and vegetables.

My response to that would be: Yeah, right.

Assuming that multivariate analysis can honestly remove all confounding variables and provide a truly accurate risk assessment is to basically claim that researchers have magical powers. Running a statistical model after the fact is a far cry from conducting a clinical trial scenario in which subjects are randomized to two groups and given explicit instructions on what they should and should not eat. Furthermore, think about all the factors that weren’t even considered; illicit drug use, which is highly prevalent in society (and a very real problem (http://psychcentral.com/news/2009/02/25/physicians-with-substance-abuse-issues/4339.html) in the medical field), is rarely probed in nutrition-slanted prospective studies. Nor are many other risk-taking behaviours, or such factors as poor sleep habits or greater psychosocial stress exposure. These factors certainly didn’t feature in Pan et al’s multivariate analysis, even though there is a very real possibility that, due to their generally unhealthier lifestyles, the more frequent red meat eaters were more likely to display these characteristics.

Just How Accurate Was this Data, Anyway?

The very high prevalence of inaccurate dietary reporting in prospective studies and even free-living clinical trials is well established. Keeping that in mind, remember how in the Pan et al paper, as red meat consumption went up so too did self-reported daily calorie intake? And that as red meat intake went up, physical activity levels went down? Unless you’re one of the dopey low-carb sods who still believes in MAD, we should by all rights expect a far greater prevalence of overweight and obesity with increasing red meat consumption – but we see no such thing. Mean BMI is inexplicably similar across all five quintiles of red meat intake.

According to this study, unlike the rest of us mere mortals, doctors and nurses are metabolic freaks who can eat more, exercise less, yet still not gain extra weight.

Sure.

You’ll recall that in long-running epidemiological studies, sometimes a single dietary questionnaire is filled by the subjects, in others the questionnaires are filled periodically. In the HPFS and NHS studies, “periodically” was once every four years(!)

To quote the researchers themselves: “In 1980, a 61-item FFQ was administered to the NHS participants to collect information about their usual intake of foods and beverages in the previous year. In 1984, 1986, 1990, 1994, 1998, 2002, and 2006, similar but expanded FFQs with 131 to 166 items were sent to these participants to update their diet. Using the expanded FFQ used in the NHS, dietary data were collected in 1986, 1990, 1994, 1998, 2002, and 2006 from the HPFS participants. In each FFQ, we asked the participants how often, on average, they consumed each food of a standard portion size.”

Most people struggle to accurately remember what they ate three days ago, but this method makes the very generous (some would say absurd) assumption that the subjects not only gave highly accurate portion sizes, and highly accurate frequency estimates, but were able to do so for a period covering twelve months prior to the questionnaire being filled out.

That odour you’re smelling? It’s the not-so-sweet smell of bovine poop.

Cholesterol Down! Mortality Up!

There’s something else in Table 1 that is very worthy of close attention, but was completely ignored in all the shrill press releases. Namely, as people ate more red meat, their likelihood of having high cholesterol decreased in linear fashion. This relationship was especially pronounced in HPFS, where those in the highest red meat quartile were almost half as likely to have high cholesterol.

Stop the presses!

For years, I’ve been banging on about how the war on cholesterol is an absolute absurdity, how cholesterol is a perfectly natural substance that is absolutely essential to the continued well being of each and every one of us. And while the occasional sickeningly smug Janet Brill-type attempts to portray me as a lunatic for stating this plain fact, the indisputable truth is that cholesterol is an essential cellular substrate which humans ought to grant far more respect. Pull all the cholesterol (and saturated fat) from your cell membranes, and you’d promptly collapse to the ground in a lifeless pile of mush and bones.

And here we have a study showing that as levels of this essential substrate went down, mortality went up. But once again, this is ignored in favour of far more fashionable and politically correct red meat-bashing.

Excuse me while I step outside for some fresh air…the smell from the Pan paper is killing me.

Unprocessed My Rump!

Like a lot of the meat-and-cancer studies, the researchers examined both unprocessed and processed meats, the latter known to often contain a number of questionable ingredients suspected of contributing to chronic diseases. In addition, processed meats are often subject to some rather dodgey manufacturing and preparation processes; in the US some of the largest ever food poisoning outbreaks (http://en.wikipedia.org/wiki/Deadliest_foodborne_illness_incidents) were caused by cold cuts, hot dogs, and inadequately cooked hamburger patties.

So obviously, the researchers had to group different types of red meats into the “processed” and “unprocessed” categories. In the “processed” category we see “bacon”, “hot dogs”,and “sausage, salami, bologna, and other processed red meats”.

No problem there.

Now let’s check out the “unprocessed” category. All you afficionados of free-ranged, pasture-fed beef might want to sit down before I continue the discussion. You might want to keep some oxygen handy, as well.

All set? Good.

According to the researchers, ‘unprocessed red meat consumption included “beef, pork, or lamb as main dish” (pork was queried separately beginning in 1990), “hamburger,” and “beef, pork, or lamb as a sandwich or mixed dish.”

What?

Since when is a hamburger “unprocessed”? Sure, if you buy fresh ground meat and make the patties yourself with no added artificial ingredients – but what tiny percentage of America’s hamburgers are actually consumed in that fashion?

And you don’t have to be a brain surgeon to know that sandwich meats are often of the processed “cold cut” variety…so just how did they sneak into the “unprocessed” category?

Folks, welcome to Bizarro World, where a fresh T-Bone and an additive-laden meat patty from MickeyD’s are considered the same thing!


While you don’t need to be a brain surgeon, it appears you must not be from the epidemiology department at Harvard to be alert to such blindingly obvious flaws.



http://anthonycolpo.com/wp-content/uploads/2012/03/hamburger.jpg (http://anthonycolpo.com/wp-content/uploads/2012/03/hamburger.jpg)
This is the same thing as a fresh, unadulterated, nutrient-rich cut of beef. It must be true, because the jokers from Harvard said so.


Relative Risk Shenanigans

OK, let’s talk about the actual risk increases the researchers claimed for red meat consumption. The HPFS study included up to 22 years of follow-up, while the NHS follow-up included up to 28 years’ worth. The total number of participants in both studies was 121,342; total number of documented deaths was 23,926 deaths (including 5910 CVD deaths and 9464 cancer deaths) during 2.96 million person-years of follow-up. So around 20 percent of the cohort died during the study.

After performing their multivariate analyses, the researchers claimed a relative risk increase in overall mortality of 12% for total red meat consumption, a 13% increase for “unprocessed” red meat, and a 20% increase for “processed” meat consumption. Even in a clinical trial, increases of 12-13% are not exactly earth-shattering. But in a prospective study, hopelessly prone to confounding factors and featuring questionable dietary retrieval methodology occurring about as frequently as the Olympic games, it’s an absolute non-event. Relative risk percentage in the triple digits, despite the flaws of epidemiological studies, certainly warrant attention. But to earnestly claim from such an inherently flawed study that red meat consumption imparts a 12% increase in overall mortality is a very, very bad joke.

Only a hopelessly biased vegan could love a study like this…

To all you journalists who insist on sensationalizing pseudo-scientific rot like this, shame on you. Seriously, stick to quoting lying politicians or writing up gossip columns or whatever other inane pap you are truly qualified for; people who truly have no clue about scientific research and merely accept press releases from research groups at face value have absolutely no ethical business being in a position where they can influence other people’s health knowledge and behaviours.

For everyone else, be very wary of sensationalist diet and health stories appearing in the popular media, and immediately ask yourself, “Was this finding derived from a randomized clinical trial or a prospective epidemiological study?” If the latter, take the results with a wee pinch of salt.

[Shami-Amourae]

Eskimos ate almost a completely meat diet with minimal vegetables. They are some of the most peaceful and healthy people on the planet. They have almost no cavities, heart disease, cancer, and so forth. They don't eat much of any grains or sugar. I'll post a video on this sometime, but seriously look into the Weston A. Price foundation.

I want you to look at something okay:

http://farm2.static.flickr.com/1057/3267522866_bc83323055.jpg

Notice how Elvis' parents had wider faces. Elvis has a narrow face. No, it's not since they are old/fat, they were born with wider faces. This is how humans genetically are supposed to look! This is because older generations ate healthier diets, including plenty of raw milk. Elvis' grandparents did this and gave birth to their children (Elvis' parents) who had wide, fully developed cheekbones. You can tell if someone was born healthy by how wide their cheekbones are. Childbirth is also much easier and sometimes painless in native/aboriginal cultures where everyone has the wide cheekbones. Wide cheekbones is an indication the parents were well nourished and healthy. Older generations had straight teeth, never needed braces, and had plenty of room in their mouths for their wisdom teeth to come in. This is how humans are MEANT TO BE.

Some people have reversed this trend by drinking raw milk, eating a lot of meats, especially offal like liver (many aboriginal and native cultures prize the liver for it's health benefits.) They also avoid refined sugar, improperly treated grains, and vegetable oils. Here's an example from the Food Renegade:
http://www.foodrenegade.com/have-you-got-a-weston-a-price-smile/

Child born recently with wider face since parents followed this diet:
http://www.foodrenegade.com/pics/samuelsmile2-550.jpg

[lapis]

I'll post a video on this sometime, but seriously look into the Weston A. Price foundation.

But I have! And all this time I thought I was the only one into WAP here. ;D


I want you to look at something okay:http://farm2.static.flickr.com/1057/3267522866_bc83323055.jpg


Notice how Elvis' parents had wider faces. Elvis has a narrow face.Yes, and so do most of today's kids, at least the ones that I see around these parts, in relatively affluent soCal.

It's what WAP called "physical degeneration," and it's something that can happen as quickly as one generation, but also can be reversed with the right diet as you point out.

I've posted this article here before but can't find the link so I'll mention it again; it's one of my favorites from WAPF about bone structure, teeth and health:

"Is it Mental or is it Dental? (http://www.westonaprice.org/dentistry/mental-or-dental)"

[Shami-Amourae]

My problem is a lot of people knock meat, when the problem isn't meat, it's this shitty state of meat today. It's how poorly animals are raised and fed. If they were treated properly, and fed well, then meat would be perfectly healthy again. I just feel like people ignore this other part and hate all meat because of it, missing out on something important because of the corporatization of the food process.

[lapis]

Someone asked about that at a talk by Sally Fallon (the president and founder of WAPF), and she said that a diet with factory-farmed food (meat, milk and eggs) is better than one without them. Because there are still nutrients in these poorly-raised and fed animals that are necessary for health, and can't be found in a vegan diet.

I think the main problem is that meat sold in stores is too lean. Even sausage is lean for goodness sakes. (Grrrr!) The butchers are probably trimming a lot of the fat off the cuts before they're packaged. But we're meant to eat the whole animal, fat, organs and all.

I don't know if it's related, but I wonder if some of the dramatic upswing in pancreatic cancer cases may be due to people eating lean meat, which is really hard on digestion.

[Shami-Amourae]

I'll post a video on it I downloaded off a torrent onto my YouTube. I was researching how to cure my cavity (http://gold-silver.us/forum/showthread.php?59608-My-Visit-to-the-Dentist-Today-About-Cavity-Fillings)and came across it. It's a presentation by Sally Fallon. It's good you know about her too.

[lapis]

I've been into WAP for about seven years. It's nice when I meet someone else who is too, because there's not that many of us!

[osoab]

http://www.youtube.com/watch?v=wQynViAF6Ds

http://www.youtube.com/watch?v=wQynViAF6Ds

[lapis]

http://www.freesmileys.org/smileys/smiley-gen014.gif Great song! Now I'm hungry. ;-)

[Shami-Amourae]

I'll post a video on it I downloaded off a torrent onto my YouTube. I was researching how to cure my cavity (http://gold-silver.us/forum/showthread.php?59608-My-Visit-to-the-Dentist-Today-About-Cavity-Fillings)and came across it. It's a presentation by Sally Fallon. It's good you know about her too.

http://www.youtube.com/watch?v=zNP_QOWxoDk

[lapis]

Wow three hours long! I wonder when this was recorded?

I wanted to let you know that I've found some additional information to heal cavities: homeopathic cell salts, specifically:

Calcium Phos 6X - bone health, gives solidity to bones and assists in building strong teeth.

Calcium Fluor 6X - assists with improving enamel of teeth and strengthening bones.

Magnesium Phos 6X - bone development & quick pain relief associated with toothaches.

Silica 6X - assists in building strong connective tissue to support deficient assimilation.

I got this info. from a thread on cavities (http://welltellme.com/discuss/index.php?topic=3982.30) on a tooth and dental forum, but I've read in other places that just taking two pellets each of the two Calcium remedies as often as possible is really helpful.

[horseshoe3]

I've been into WAP for about seven years. It's nice when I meet someone else who is too, because there's not that many of us!

There's more than you think.

[lapis]

There's more than you think.

I hope so! There's not that many where I live. I met a couple of friends through a WAP group they started, and only six people showed up (it was at a local health food store and they allowed them to advertise the meeting). However, I have heard that the Orange County chapter is very active, which is surprising to hear for soCal.

[Shami-Amourae]

I appreciate the information, but I don't believe in homeopathy. I believe it's bullshit. They dilute stuff that's meant to cause the problem to begin with till it's pretty much nonexistent, but the idea is that the water has "memory" and acts as the carrier of the stuff that was diluted in it to begin with. Some of the "stronger" homeopathy "medicines" equate to dropping a drop of a substance into the entire world's oceans, and mixing it all up, and drinking a sip of it. Logic would tell you that there's no way in Hell that there would be anymore of the "medicine" left, and you'd only be dealing with water.

[lapis]

Logic would tell you that there's no way in Hell that there would be anymore of the "medicine" left, and you'd only be dealing with water.

Logic in 2012, but I believe there will be a scientific explanation someday.

I understand your skepticism, but speaking from personal experience it cured me of a chronic urinary tract infection I used to get for years in my early 20s, it kept my cat alive who had kidney problems...without having to give her the (supposedly necessary) saline injections for three years after a terminal diagnosis, it helped me heal quickly from surgery, turned water into wine (oh wait a minute...lol) etc. etc.

Homeopathic Arnica used either topically and/or orally will prevent bruising and pain after an injury. Even plastic surgeons recommend it for their patients:

Benefits of Arnica in Plastic Surgery (http://exploreplasticsurgery.com/2008/04/06/benefits-of-arnica-in-plastic-surgery/)

ARNICA MONTANA RELIEVES BRUISING (http://arplasticsurgery.net/csblog/?p=106)

Is some of its success due to a placebo effect? Maybe. I don't care. It's cheap and works without side effects. But mainly, it works, and I care more for non-toxic things that give results than I am in knowing exactly the mechanism behind its effectiveness, although I'll be all ears when science finally catches up and finds an explanation.