Where’s the beef? Experts chew on meat-eating: Bad for you, unknown, or what?

broillondonwikipedia-300x225The elite of public health organizations are up in arms about a new report from a group of international researchers who looked at red meat and its health benefits and harms, and more or less shrugged. The new take goes like this, reported the New York Times:

“If there are health benefits from eating less beef and pork, they are small, the researchers concluded. Indeed, the advantages are so faint that they can be discerned only when looking at large populations, the scientists said, and are not sufficient to tell individuals to change their meat-eating habits.”

That view, of course, contradicts what public health and nutrition experts have recommended for years, and so blue-chip health outfits like the American Heart Association, American Cancer Society, and Harvard’s T.H. Chan School of Public Health condemned the researchers for supporting what now may be akin to a health heresy.

The researchers seem to hold the credentials and to have put in some needed work — 14 of them, M.D.s and Ph. D.s, laboring in seven countries, at respected institutions, for three years, and publishing their results in the noted medical journal Annals of Internal Medicine. Their work included a scrutiny of “61 articles reporting on 55 populations, with more than 4 million participants. The researchers also looked at randomized trials linking red meat to cancer and heart disease (there are very few), as well as 73 articles that examined links between red meat and cancer incidence and mortality,” the New York Times reported.

So, how did such a giant variance crop up in their findings, versus accepted nutritional orthodoxy. As the news and information site Vox explained:

“In the past, many of the groups that have set guidelines for whether or not humans should cut back on meat considered a very broad range of research, from animal evidence to case-control studies, a relatively weak type of observational research. (Here’s more on different types of study designs.) As you may have guessed, there are all kinds of problems with these kinds of study designs. Models based on animal studies don’t always bear out in humans. Case-control studies are not the most reliable, either: Researchers start with an endpoint (for example, people who already have cancer). For each person with a disease (a case), they find a match (a control) — or someone who doesn’t have the disease. They then look backward in time and try to determine if any patterns of exposure (in this case, eating meat) differed in those with cancer compared to those who don’t have cancer. But since meat eaters differ so fundamentally from those who don’t eat meat, the reasons the two groups have varying health outcomes could have nothing to do with meat. Researchers try to control for these ‘confounding factors,’ but they can’t capture all of them … The five Annals papers did something different: They looked only at the health effects of processed and unprocessed red meat. Processed red meats — everything from hot dogs and bacon to lunch meats — are transformed by salting, curing, or fermentation. Unprocessed meats include beef, veal, pork, lamb, and venison. The papers were also systematic reviews and meta analyses, or syntheses of the research evidence that bring together a bunch of studies with the goal of coming to more fully supported conclusions. And the researchers used a very strict definition of what constituted reliable evidence for inclusion in their reviews.”

In brief, the researchers sought to apply the most rigorous and current scientific guidelines to sort out what nutrition and medical science knows and doesn’t about meat consumption and its health benefits and harms. They also tried to rank the knowledge from very low to high confidence.

Their findings — notably that the evidence is low against meat-eating as a harm — have been furiously disputed by respected experts. They, among other things, hasten to point out how Americans’ health has improved due to dietary recommendations that have put, front and center, recommendations on reduced consumption of not only meat but also dairy and fried foods. Heart disease, for example, has declined steadily and dramatically as Americans have followed these and other advisories, such as getting more exercise. The lead researcher for the controversial study also has a controversial past, the New York Times reported, noting that he has taken questionable industry funding before, including for a study that purported to debunk international recommendations for consumers reducing their sugar intake.

And, lest any consumers start to clear the fridge for only burgers, ribs, and steaks, hold up on firing up the grill: There are collateral concerns that Americans may wish to consider about diets laden with beef, including the sizzling, demonstrated, and significant environmental wreckage caused by industrial-sized cattle and dairy operations. The research is more direct and concrete showing how feeding, raising, and maintaining herds creates all manner of pollutants — in the air, water, and ground. It takes sizable energy and resources to grow and feed cows, much more than they return when consumed. Animal rights activists also would have lots to denounce about Americans’ raising of cattle.

Still, appetites globally seem hard to quench for beef and dairy, which also may be symbols of affluence and accomplishment. Despite the big and sustained public health campaigns urging reductions in their consumption, meat and dairy and the protein they provide persist as staples in much-promoted weight- and nutrition-plans like the carbohydrate-cutting and protein-promoting keto diet (which, to be fair, also pushes chicken, pork, and legumes as sources).

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to try to protect and improve their health and well-being by following medical and science news reports and trying to become informed consumers. This, like health care itself, has become an ordeal due to the ever-rising complexity and uncertainty of treatments and prescription medications, many of which not only have soaring costs but also too many of which often prove to be dangerous drugs.  How are non-experts supposed to keep track, much less to make sense of alarming and contradictory “expert” studies, especially on a vital topic like nutrition?

While it may seem as if research on, say, coffee-drinking alone could convert into a kitchen-industry to make sense of frequent and head-scratching “studies,” reliable experts have offered suggestions on how patient-consumers may wish to make themselves more savvy about research. Their healthy skepticism can include parsing researchers and their findings with care, digging in even a little more than usual to their credentials and methods, as well as employing common sense. Talk to your doctors. Unless a study is emphatic and directly on point to an aspect of your care, it may be good to see if it is a flash or if it builds into a body of convincing evidence.

Now that even the titans of the fast-food industry seem to have jumped on a giant, noisy bandwagon about stupendous or remarkable “meat-free burgers” — whatever they’re calling them, Big Food is no doubt seeing big money in them — American consumers likely will be served up hot plates full of steaming hokum about meat and nutrition.

Caveat emptor may be ancient words for the modern wise. Moderation matters —and with tastes and appetite to be accounted for, too  — maybe a sound course still would be more careful eating of plants, a bit of meat (now and then), not too much, and, of course, lots of exercise, no smoking, and restrained drinking. Doctors and health advocates also may wish to heed the long caution from Dr. John Ioannidis, a Stanford professor who studies health research and policy. He has assailed universities, hospitals, and researchers — especially in diet and nutrition — who promote weak findings to excess, especially when they result from shaky methods like observational studies (e.g. Sally, who lived to age 89, got up every day for her whole life and drank a shot of whiskey. By observation alone, drinking is good for longevity). As he told the New York Times:

The [new meat-eating] findings are a time to reconsider how nutritional research is done in the country … and whether the results really help to inform an individual’s decisions. ‘I would not run any more observational studies,’ said Dr. John Ioannidis …. ‘We have had enough of them. It is extremely unlikely that we are missing a large signal,’ referring to a large effect of any particular dietary change on health.

That sounds right, and we all may need to consider with care what we swallow when it comes to health and diet information.

Photo credit: ©Creative Commons, Jeremy Keith
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