When the Archives of Internal Medicine published the article “Red Meat Consumption and Mortality” all I could think of is “here we go again.”

First to go through this paper- which is a statistical population study from the Health Professionals Follow-up Study (HPFS) and the Nurses’ Health Study (NHS). Of the 140,000 combined participants they tossed out 20,000 because of a history of the diseases reported or those who did not fill out the forms perfectly.

To start with – this is not a study where people were followed from baseline to death to see if what they ate contributed, and determining amounts along with following other variables as they progress (lifestyle issues with exercise, smoking, etc). This instead is a study based on food questionnaires, and statistical analysis. Correlation does not imply causation.

One has to be careful with epidemiological studies, as they are not  proof of a cause, rather they point to a number of variables that might be involved to form a hypothesis. It is these same types of statistical studies that told us that women should use hormone replacement therapy because it prevents heart attacks in 1991, only to be told 11 years later that it might cause heart attacks. It is a sampling bias of those individuals who choose to participate in the studies that led to the erroneous conclusions.

The second issue with these studies is the ability of the food questionnaire and its accuracy. This has been studied – that is, the ability of people to recall and fill out what they ate. We do this in our office all the time- ask people what they eat—and since we are involved in weight loss and healthy lifestyle here is what we can say: people have no ability to remember what they ate, how much they ate much beyond the last day. When studied by others, looking at the questionnaire (FFQ or Food Frequency Questionnaire) in the Nurses’ Health Study was found to be useless. As reported by others, the accuracy of the questionnaire compared to reality was unacceptable.

For example, 20 per cent of the nurses reported living on 1200 calories per day or less, and low intake of red meat, and 20 percent report over 2000 calories a day.

In the study the first table showed that the highest reported red meat consumption was associated with smoking, drinking more, obesity, and higher calories. Oh wait- have you ever heard that smoking, obesity, eating more calories, or drinking more might lead to an early death? Perhaps you have, in fact, there are some correlations (which don’t imply causation) for these, and there are some great prospective studies showing that obesity leads to early death.  Of course, in any statistical paper you can remove the confounding factors – and THEY DID NOT in this paper.

One other cute correlation- in the data, those who report eating the most red meat had the lowest cholesterol levels. Yes, that is odd isn’t it. Readers of this blog know that cholesterol and meat have less to do with one another – and that isn’t a statistical issue, that is just basic biology.  Eating more meat does not mean you will have a higher cholesterol – having bad genetics does.

Here is what three systematic reviews of prospective studies show in the relationship between saturated fat and heart disease- zip. There has been a consistent lack of an associated between saturated fat intake and heart disease. While this new study statistically makes the argument that changing diet would decrease events from heart disease and cancer, when looked at (references below) none of the pooled studies show a change in that risk relationship. And, when some studies have shown a change in risk, when the data was examined there was no difference in mortality. While some say red meat clearly is bad, the evidence is anything but clear. Proving again that population studies, without isolating the variables, without having a scientific basis, are worthless.

Finally, the science of red meat—what do we know? Red meat is a large category of meats includes everything from bacon (considered “processed” by some and delicious by others) to cows raised on grain, and cows raised on grass. Grass fed beef have higher levels of omega-3 fatty acids. Consuming different red meats mean you are consuming different levels of ingredients. Lumping them together is just sloppy science.

Nothing like great grill marks on a steak

Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab 2009;55:173–201.

Mente A. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169:659–69.

Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 2010;91:535–46.

Who would have imagined that my patient, Evo, would have lost 14 pounds on the “beer and sausage” diet (now called the Evo diet).

From the medical side there are two other benefits — his triglyceride level dropped by half, his cholesterol dropped by a third, and his “good” cholesterol increased.  There was never an increase or a blip in any of the liver enzymes.  His fat mass dropped, the only non-fat mass of his that decreased was that tissue associated with and supporting the fat mass (I know, sounds complicated).  His muscle mass maintained itself.

One important lesson learned: we do not know enough about science and medicine and diets to be able to say anything to anyone about which diet is healthy and which is not. But let me give you an example – we had more data points for this one month of the Evo diet than Ornish had for his diet program.

The famous Ornish line is that his data showed a decrease in “Plaques” of patients who had heart disease. This was based on less than 20 patients, including the control group.  He has since gone on to show poor data with prostate cancer, as well as aging. The data that Ornish has isn’t good, and when you look at the data we generated in one month from the Evo diet, one could assume that we would find people would do better not doing the Ornish diet and following the Evo diet.  This is said with a smile, because never has a “lifestyle” and diet – such as Ornish, been propagated with less data and more press.  Ok- there is also the China Project (a single misuse of data to say the same thing).

The second important part of Evo’s diet was this: there was a simple and yet profound control of the portion sizes that he had. It was measured, it was regulated to around 1500 calories per day.  Based on that,  Evo lost more than we would expect him to have lost. Why? No clue.

What can you take away from this: First, if you want to have a diet begin by strictly regulating portions. Portion control is a key for any weight loss, including weight loss surgery.  Limit your portions, and thus your calories, and you should lose weight.  The advantage of beer and sausages is that they come in nice units that you can measure.

Processed meats appear to increase risk of colo-rectal cancer

What you should NOT take away from this: beer and sausage are not “diet foods.” Beer and sausage were, in this case, a tool for great portion control. And Evo ate more than just sausage. He ate what came with it.  When I cooked for him he had the peppers and onions that went with my famous recipe (recipe will be on terrysimpson.com later). He had bread (yes, I know some of you think bread is the devil’s tool) – if it came with the sausage.

The final message is most important- We don’t understand food as well as Ornish, Atkins, or pick some diet guru would have you believe.

Artificial sweeteners are either the saving grace of America, or the devil. The first issue with artificial sweeteners came to light when cyclamates (the first marketed artificial sweeteners) were found to cause cancer in rats. So in 1969 cyclamates were taken off the market. Saccharin was the next agent, but many didn’t like its after taste. Then came aspartame (Equal). This had no bitter after taste and became the favorite until someone started a rumor that aspartame killed ants, and was originally developed as a rat poison – this is untrue on both counts.

First, aspartame was developed as an artificial sweetener and second, it does not kill ants (I tried it, as have a lot of others – sadly it doesn’t work). Splenda does contain calories (because of our FDA regulations it is allowed to be listed as “zero calories” but it is not). Splenda has 3.36 calories per packet (1 gram). It tastes like sugar and is generally easy to cook with – however; one package of Splenda is 600 times sweeter than an equal amount of sugar.

Two other sweeteners have joined the market in the United Sates. Stevia- is a product of several plants and was recently approved as a food additive in the United States, and Truvia (a proprietary blend of Stevia made by Coca-Cola and Cargill the Pepsi produce it PureVia). These are essentially all the same. There are some other sugar-alcohols like Xylitol that function as sweeteners.

The issue with artificial sweeteners has been getting use to the sweet taste, and thus an increase in appetite. In rats that are consuming artificial sweeteners there is an increase in their body weight over time as they increase the amount of food they consume. Not that we are rats – but avoiding the overly sweet taste is important. And there is no accident that while many of my weight loss patients consumes large quantities of “diet cola” – they still consume a lot of calories to go with them. It is also no accident that once our patients get off artificial sweeteners, they lose more weight.

People who drink sodas that have artificial sweeteners have a sixty percent increase in stroke and heart disease. Sixty percent!

How do you gain weight with artificial sweeteners? Since they are so sweet, you naturally want food to balance out the sweetness. Increasing the quantity of food allows you to increase the bitter, sour, and other sensations to balance the sweet taste. Remember, your palate always wants to return to a balance.

Overall –avoid the artificial sweeteners. Still- what is better than artificial sweeteners in soda? Simple water. It is free (unless you are in a city where the water tastes bad) and is regulated more tightly than most things

Heart disease happens when the arteries feeding the heart become infiltrated with plaques – and these plaques happen to contain fat, cholesterol, white blood cells. If the plaque builds up slowly the flow of blood to the heart diminishes and people develop chest pain or angina. If that plaque ruptures and causes the artery to close- that is a heart attack or myocardial infarction.

Plaque formation was thought to be because of a person’s diet – since the plaques had high levels of fat and cholesterol, it was thought that a diet that was low in fat and cholesterol would minimize a person’s risk of heart disease. Sometimes that is true- but not always- as the French have shown us- with a diet high in fat and cholesterol and one of the lowest levels of heart disease in the western world.

It turns out the instigator of plaque formation are the lipo-proteins that carry cholesterol and triglycerides. Think of LDL, HDL, VLDL, and IDL (low density lipoprotein, high density lipoprotein, very low density lipoprotein, and intermediate density lipoproteins) as boxcars that carry cholesterol and triglycerides. Those lipoproteins set off an inflammatory reaction in the blood vessel (they become oxidized) and that leads to plaque formation. The more of those proteins a person has, the higher the likelihood that they will develop heart disease.

Think of LDL as “lousy.” The HDL levels are associated with fewer tendencies for heart disease – but they still can cause inflammation of the artery, and a problem. Hence, artificially raising HDL levels causes more issues with heart disease (as was recently discovered in the niacin trials). HDL levels are seen in people who have more omega-3 fatty acids in their diets, but increasing their levels is still harmful.

The more lipoproteins your body makes the higher incidence of heart disease you will have.

It has only been recently that science has recognized that one must measure the lipoproteins directly. Not indirectly by measuring cholesterol – as the laboratories do today. In the recent article from the Journal of the American Medical Association, they measured LDL-cholesterol in people placed on diets rich in soy proteins, fiber, and walnuts – showing a decrease in the LDL-cholesterol – a classic mistake. LDL-cholesterol does not measure the total number of lipoproteins. The amount of lipoproteins one has depends on how much cholesterol and triglycerides the lipoproteins have to carry. If a person has a lot of cholesterol and/or triglycerides in the blood the body will make more lipoproteins. If you have too many, those lipoproteins will get into the wall of the artery and lay down their cholesterol and triglycerides (which are fats).

If you have a lot of triglycerides it will bump off the cholesterol and you will make more proteins to carry the triglycerides. Your cholesterol level will be low, but your number of lipoproteins will be high- and thus, even with low cholesterol you will have a high incidence of heart disease. This explains some of the seemingly contradictory data of people who had low LDL-cholesterol levels but a higher incidence of heart disease – when that blood was looked at later they were found to have a high level of the LDL proteins.

We still don’t understand everything about the biology of the formation of plaque but we do know this: genetics determines most of the level of cholesterol, and if your level is high reducing it with medication will reduce the incidence of heart attacks and strokes. If you have genetically high triglyceride levels, the same applies.

In terms of diet- dietary cholesterol has minimal impact on blood cholesterol. Triglyceride level can be greatly impacted by diet – however.

To reduce triglycerides in your diet, here are some suggestions:

* Eat fewer calories if you are overweight. Excess calories are converted into triglycerides and stored as fat.
* Avoid trans fats, found in some fried foods and commercial baked products.
* Replace saturated fat (found in animal fat and some tropical oils) for mono-unsaturated fat (found in olive/canola/peanut oils, etc.).
* Consume at least 2 servings of cold water fish each week, such as salmon, mackerel, tuna, lake trout, herring, and sardines (all of which are high in omega-3-fatty acid). *Include into your diet other foods high in omega-3 fatty acid, such as ground/milled flaxseed, walnuts, almonds, canola or soybean oil, etc.
* Avoid refined foods and foods that contain sugar (such as white flour, desserts, candy, juices, fruit drinks).
* Choose carbohydrates that have 2 grams fiber or more per serving, such as brown rice, whole wheat bread, and whole grain cereals.
* Consume at least 2-3 cups of vegetables and 1 cup of fruit each day.
* Follow your doctor’s advice regarding alcohol. Alcohol increases triglyceride levels for some individuals. If you have high triglycerides and do consume alcohol (such as red wine), it is recommended to limit intake to 5 ounces per day or limit it entirely.
* Exercise to burn excess calories, aiming for at least 30 minutes of physical activity on most days of the week.

Medications
People who have high triglycerides and low HDL or high LDL levels may require medications as well as diet modifications. Patients with triglycerides in the very high range (over 500 mg/dL) generally will require medications, because triglyceride levels this high may cause an acute inflammation of the pancreas.

For a while it seemed that everyone was talking about the importance of fiber,  and its role in preventing a variety of diseases.  After much speculation, we now have a few answers about  what fiber really does, and what makes it an  important component of good nutrition.

Fiber is simply things that humans cannot digest.  Many vegetables and fruit have methylcellulose – the stringy stuff– and we, as humans cannot digest it.  Cows can, horses can, deer can – but not humans.  This is why it is better to cook vegetables – because by breaking down some of the fiber our bodies can get to the nutrients that are locked into the vegetables.

What we do with it is simply pass the material through our body.  If you don’t have enough fiber you can become constipated – and develop things like hemorrhoids or diverticulosis.  Fiber is also good if you have chronically loose bowel movements – it will help bulk up the stools.

Years ago a group of people thought increased fiber would lead to less colon cancer – -with the theory that fiber acts as a broom to sweep out the colon and thus keep the colon from being in contact with toxic stool.  Well- that has been tested in a number of places and just isn’t the case.  Even people with high fiber diets have no lower incidence of colon cancer than those with an average fiber diet.

Some thought fiber would increase the metabolism – so by taking more fiber in you would be able to loose weight.  That was proved to be incorrect also.

What is known is that the more bulk fiber you have- from fruits and vegetables- with higher fiber — the longer the sense of feeling full is.

This is why we recommend to patients to increase green vegetables, or squash, or beans – to increase their fiber – and to keep them feeling full for a longer period of time.

So- if you want to lose weight- increase your fiber and decrease your processed food.  If you suffer from chronic hemorrhoids – see your doctor- but before then start on a high fiber diet (I recommend to my patients they take a scoop of fiber in 12 ounces of water followed by 12 more ounces of water).

Find yourself hungry mid-afternoon — consider a high fiber snack – like fruits.

So fiber has a lot of advantages – and the best source of fiber — vegetables

www.234Slim.com

When it comes to finding simple things to lose ten pounds in a year, often the answer is easy.  It means changing your tastes – and finding something that is a lower calorie alternative or substitution for what you normally drink.

Soda pop is nothing but pure liquid calories – and often I see people walk around with a huge container filled with soda from some convenience store.  Did you know that a can of soda is about 100 calories for 8 ounces? There it is– a simple way to save ten pounds in a year.

I don’t think that even diet soda is a great thing for the health-conscious consumer- but it is a step to better health.

Still, be on the look out for liquid calories that add up quickly for your weight gain.

The 20 ounces bottle of Sunkist soda is 325 calories! That isn’t “natural goodness” in there– that is the same amount of calories as over a dozen chocolate chip cookies.

Snapple 20 ounces is 250 calories. Drink one of those a day above what you burn for calories and at the end of the year you will have gained 25 pounds!

And don’t forget that cup of latte you get – well, the Starbucks Frappuccino (13.7 ounce bottle) is 290 calories! A simple cup of coffee with a teaspoon of sugar and creamer is 25 calories (add ice in the summer to make a cold coffee drink).

So, when it comes to liquid calories- water is best, calorie free, and will quench your thirst. If you “must” drink soda– don’t drink the kind with sugar or high fructose corn syrup – instead, drink zero calorie soda.

Other healthy alternatives include Propel Fit Lemon, only 25 calories, or Desani Plus Pomegranate Blackberry, zero calories. Sobe Lean Mango Melon is 12.5 calories.  And for your water you can always purchase packages of Crystal Lite to place in the water– zero calories!

Remember, changing 100 calories a day is 10 pounds in a year. So think about those liquid calories – and try some new ones.

Thinking of skipping meals? Think Again! from McMedia ProducerGirl on Vimeo.

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Oprah admits that this is her fault, that with all her accomplishments this is the one thing she has been unable to accomplish, and for this she offers us some clues as to why she gained the weight.  Before we go through the “stars” and what they can or cannot offer, let’s see the reasons she lists for her weight, and take the skeptic Doc’s eye to those reasons.

She tells us that she was “listless” and has discovered that she has a hypo-active thyroid.  Sounds reasonable. But what is the evidence that having a hypoactive thryoid leads to weight gain.  For years we have known that an over-active thyroid can lead to weight loss, and a very underactive thryoid can be linked to weight gain.

Recently a review of over 2400 men and women in the Framingham study were examined for their thryoid function and found that some individauls who had “normal” levels of thryoid function but on the low side, had some weight gain. In examining this over 3.5 years, they found that lower functioning thryoid patients had an average weight gain of about five pounds. Not the 40 pounds.  In men, these increases were even less.  However, at this low level they could not say that thryoid hormone treatment would be warranted.

Oprah’s thyroid problem, according to her website has stabilized, and she is no longer taking thyroid  medication.  So was it her thyroid?  Being a skeptic, I don’t think so.  Oprah also blamed her “food addiction.”

What is a food addiction? Since we need food, is it an addiction? I don’t think so. She states that she doesn’t have a weight problem, she has a “self-care” problem that manifests it through weight.

The answer is simpler — Oprah ate too much. It wasn’t her thryoid, it wasn’t her spiritual core, it was her weight. As a weight loss physician, the first step to losing weight isn’t medication, it isn’t psychology, there isn’t an “addiction” to food — it is accountability. I can place a laparoscopic adjustable band in almost anyone, but if they are unwilling to admit that it is what they eat, and how much they eat, as the root cause of their excess weight, then their chance of losing weight and keeping it off is small.

This brings us back to her “star studded” panel of weight loss experts.  The question a good skeptic would ask is this — what is the evidence?  Here is the experiment: take the panel of stars, give them an assignment, and see how well they do.  Over the last number of years Oprah has had Bob Greene, now Dr. Oz, and a few dozen spiritual and psychological advisors. The experiment is we give you this panel — don’t have to buy the book, and they tell you what to do. You get someone to cook your meals, and all the supplements that the think you need.  What is the result of the experiment?  — Oh, she gained 40 pounds (that she admits to).

Oprah is known for having a number of quacks on her show.  She advocates homeopathy, that has no evidence based medicine to back it  up, as well as accupunture — as well as Chi-gong. Any evidence in medicine these work? None.  More about those on future episodes of skepticdoc.

The bottom line for the skeptic doc is this.  Weight gain comes from eating.  There is no “food addiction,” there are cravings. It isn’t stress, it isn’t menopause, it isn’t from spiritual depravation (whatever that is). It is from eating too much.