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Will Plant Proteins Help You Live Longer?

April 13, 2021 by Dr. Steve Chaney

Is A Vegan Diet Healthiest?

Author: Dr. Stephen Chaney

Unless you are Rip Van Winkle and have been asleep for the past 40 years, you have probably heard that whole food, primarily plant-based diets are good for you.

They help you control your weight.

They reduce inflammation.

They reduce your risk of diabetes and heart disease.

They even reduce your risk of some cancers.

But do they help you live longer? If we take that question literally, the answer appears to be no. There is no “Fountain Of Youth”. There are no diets that extend our lives significantly.

However, what if you could reduce your risk of premature death? It would be tragic to have your life cut short by a heart attack or some other major disease. What if you could prevent that?

And what if you could live healthier longer? It would be equally tragic to spend your golden years debilitated by chronic diseases like heart disease, diabetes, or dementia. What if you could delay these diseases and live healthier longer?

The study I discuss this week (Y Sun, Journal of the American Heart Association, 10:e015553, 2021) looks at the effect of different dietary protein sources on premature death.

This study, like many others, suggests that primarily plant-based diets are healthier than meat-based diets. But what does this mean for you? Should you go completely meatless? Is a vegan diet healthier than other plant-based diets? I discuss what we know and what we do not know about the vegan diet compared to other plant-based diets.

How Was This Study Done?

The data for this study were drawn from the Women’s Health Initiative (WHI). The Women’s Health Initiative was designed to help identify strategies for preventing heart disease and other diseases in postmenopausal women. It enrolled 161,000 postmenopausal women from 40 sites across the US between 1993 and 1998 and followed them through 2017.

This study excluded women who had heart disease or cancer when they entered the WHI study and women who had incomplete data on either their diet or their use of postmenopausal hormone therapy. They were left with 102,521 women, age 50-79 at time of entry, who were followed for 18 years.

Each woman filed out an extensive dietary survey at the beginning of the study. There were 25,976 deaths during the study. The cause of death was determined by reviewing death certificates, medical records, autopsy reports or by linkage to the National Death Index.

The investigators asked whether women who ate more plant proteins were healthier than those who ate primarily meat protein. To answer this question, they correlated protein sources in the diet with all-cause mortality and deaths from various diseases.

The greatest difficulty with this type of study is that people who eat more plant protein tend to have a healthier diet and a healthier lifestyle. That makes it hard to separate out the benefits of eating plant proteins from benefits associated with other aspects of their diet and lifestyle. So, the authors corrected their data for every factor known to influence the risk of heart disease, diabetes, dementia, and premature death.

Specifically, the data were statistically corrected for age, race/ethnicity, socioeconomic status, hormone use, lifestyle (smoking status, physical activity, and alcohol intake), baseline health status (diabetes and/or high blood cholesterol), family history of heart attack/stroke, dietary factors (calorie intake, dietary fiber intake, whole grain consumption, fruit and vegetable consumption, sugar-sweetened beverage consumption, glycemic load (effect of foods in the diet on blood sugar), and percentage of saturated fats, polyunsaturated fats, monounsaturated fats, and trans fats), and weight (BMI).

In short, the authors corrected for every other factor that could influence disease risk and/or premature death. By doing so, they were able to focus on the effect of protein sources on disease risk and/or premature death.

Will Plant Proteins Help You Live Longer?

The investigators divided the study participants into quintiles with respect the kind and amount of protein they consumed.

For animal protein, the intake ranged from 4 ounces/day in the lowest quintile to 9 ounces a day in the highest quintile (For comparison, 3 ounces is roughly equivalent to the size of a deck of cards).

For plant protein, the intake ranged from 2 ounces/day in the lowest quintile to 3.5 ounces/day in the highest quintile.

When you combine plant and animal protein in these women’s diet, plant protein ranged from 18% of total protein intake in the lowest quintile to 48% of total protein intake in the highest quintile.

When women who had the highest intake for plant protein were compared with women who had the lowest intake of plant protein, the women with the highest plant protein intake had:

12% lower risk of premature death from heart disease.

21% lower risk of premature death from dementia.

9% lower risk of premature death from all causes.

There was an inverse relationship between the amount of plant protein in the diet and premature death. Specifically, every 3 ounces of animal protein that was replaced with 3 ounces of plant protein resulted in:

22% lower risk of premature death from heart disease.

19% lower risk of premature death from dementia.

14% lower risk of premature death from all causes.

The Effect Of Individual Animal Proteins On Mortality

The authors also looked at the effect of various animal proteins on premature death. For example:

Red Meat: Women with the highest consumption of red meat had:

14% higher risk of premature death from heart disease.

20% higher risk of premature death from dementia.

10% higher risk of premature death from all causes.

Eggs: Women with the highest consumption of eggs had:

24% higher risk of premature death from heart disease.

14% lower risk of premature death from dementia.

14% higher risk of premature death from all causes.

Dairy: Women with the highest consumption of dairy had:

11% higher risk of premature death from heart disease.

The authors concluded, “In this large prospective cohort study, we found that higher plant protein intake and substitution of animal protein with plant protein were associated with lower risk of all-cause mortality, cardiovascular mortality, and dementia mortality…Our findings support the need for consideration of protein sources, in addition to the amount of protein intake, in future dietary guidelines.”

Is A Vegan Diet Healthiest?

Years ago, as my brother-in-law was coming out of anesthesia at the end of quadruple bypass surgery, the first question he asked was, “Does this mean I need to eat tofu?” Obviously, nothing terrified him more than the thought of eating tofu the rest of his life. In the same vein, some of you are probably asking, “Does this mean I need to go vegan?”

The good news is that none of the women in this study were consuming a vegan diet. They were consuming a typical American diet with varying amounts of plant and animal protein. The group with the highest plant protein consumption were still getting 52% of their protein from animal sources.

This study shows that even people consuming a typical American diet can become healthier by simply swapping out some of the animal protein in their diet with plant protein.

However, you are probably thinking, “Plant protein is good for us, and a vegan diet is 100% plant protein. Does that mean a vegan diet is healthier than other plant-based diets?

The answer is………”Maybe”

If the linear relationship between plant protein consumption and risk of premature death could be extrapolated all the way to 100% plant protein, the answer would be obvious. Vegan diets would be healthier than other plant-based diets. But that extrapolation is an assumption. It might not be true.

For example, some recent studies suggest that completely eliminating meat, eggs, and dairy from your diet may slightly increase your risk of heart disease and stroke:

One recent study found that adding 1.4 ounces of fish/day to a primarily vegetarian diet decreases the risk of stroke by 20%.

Another study reported that adding one egg/day to a primarily vegetarian diet decreases the risk of heart disease by 12% and stroke by 10-26%.

These studies need to be confirmed, but they do suggest we need to be cautious about assuming that vegan diets are healthier than other primarily plant-based diets. This is why, when I recommend primarily plant-based diets, I include everything from vegan through semi-vegetarian, Mediterranean, and DASH.

They are all healthy diets. My advice is to choose the one that best fits your lifestyle and food preferences. And focus on whole foods, not processed foods.

The Bottom Line

A recent study asked whether women who ate more plant proteins were healthier than those who ate primarily meat protein. To answer this question, the investigators correlated protein sources in the diet with all-cause mortality and deaths from various diseases.

When women who had the highest intake for plant protein were compared with women who had the lowest intake of plant protein, the women with the highest plant protein intake had:

12% lower risk of premature death from heart disease.

21% lower risk of premature death from dementia.

9% lower risk of premature death from all causes.

22% lower risk of premature death from heart disease.

19% lower risk of premature death from dementia.

14% lower risk of premature death from all causes.

[Note: A 3-ounce serving is roughly equivalent to a deck of cards.]

I discuss the answer to that question in the article above.

For more details and a discussion about the vegan diet versus other primarily plant-based diets read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

What Is An Anti-Inflammatory Diet?

July 21, 2021April 6, 2021 by Dr. Steve Chaney

Can Diet Douse The Flames?

Author: Dr. Stephen Chaney

If you have arthritis, colitis, bursitis, or any of the other “itis” diseases, you already know that inﬂammation is the enemy. Chronic, low level inﬂammation is also a contributing factor to heart disease, cancer, and many other diseases. Clearly, inﬂammation is a bad actor. It is something we want to avoid.

Obesity and diabetes are two of the biggest contributors to inﬂammation, but does diet also play a role? With all the anti-inﬂammation diets circulating on the internet, you would certainly think so. How good is the evidence that certain foods inﬂuence inﬂammation, and what does an anti-inﬂammatory diet look like?

The Science Behind Anti-Inflammatory Diets

Let me start by saying that the science behind anti-inﬂammatory diets is nowhere near as strong as it is for the eﬀect of primarily plant-based diets on heart disease and diabetes. The studies on anti-inflammatory diets are mostly small, short duration studies. However, the biggest problem is that there is no standard way of measuring inﬂammation.

There are multiple markers of inﬂammation, and they do not change together. That means that in every study some markers of inﬂammation are altered, while others are not. There is no consistent pattern from one study to another.

In spite of these methodological diﬃculties, the studies generally point in the same direction. Let’s start with the strongest evidence and work our way down to the weakest evidence.

Omega-3 fats are anti-inﬂammatory (I. Reinders et al, European Journal of Clinical Nutrition, 66: 736-741, 2011). The evidence is strongest for the long chain omega-3s found in ﬁsh and ﬁsh oil, but the shorter chain omega-3s found in foods like walnuts, ﬂaxseeds, chia seeds and ﬂaxseed oil, soybean oil, and canola oil also appear to be anti-inﬂammatory.

Inﬂammation is directly correlated with glycemic index (L. Qi and F.B. Lu, Current Opinion in Lipidology, 18: 3-8, 2007). This has a couple of important implications.

The most straightforward is that reﬁned carbohydrates and sugars (sodas, pastries, and desserts), which have a high glycemic index, increase inﬂammation. In contrast, complex carbohydrates (whole grains, most fruits and vegetables) decrease inﬂammation. No surprise there. The second implication is that it is the glycemic index, not the sugar, that is driving the inﬂammatory response.

That means we need to look more closely at foods than at sugars. Sodas, pastries and desserts are likely to cause inﬂammation, but sugar-containing foods with a low glycemic index are unlikely to be inﬂammatory.

Fruits and vegetables are anti-inﬂammatory. This has been shown in multiple studies. At this point most of the research is centered on identifying the nutrients and phytonutrients from fruits and vegetables that are responsible for the reduction in inﬂammation. I suspect the investigators are hoping to design an anti-inﬂammatory supplement and make lots of money. I will stick with the fresh fruits and vegetables.

Saturated fats are inﬂammatory. At face value, the data on saturated fats appear to be contradictory. Some studies say that saturated fats increase inﬂammation, while others say they do not. However, similar to my earlier discussion on saturated fats and heart disease), the outcome of the study depends on what the saturated fats are replaced with.

When saturated fats are replaced with reﬁned carbohydrates, sugar and highly processed foods (the standard American low-fat diet), inﬂammation doesn’t change. This doesn’t mean that a diet high in saturated fat is healthy. It just means that both diets are bad for you. Both are inflammatory.

However, when saturated fat is replaced with omega-3 polyunsaturated fats (J.A. Paniagua et al, Atherosclerosis, 218: 443-450, 2011) or monounsaturated fats (B. Vessby et al, Diabetologia, 44: 312-319, 2001), markers of inﬂammation decrease. Clearly, saturated fats are not the best fat choice if you wish to keep inﬂammation in check.

I would be remiss if I did not address the claims by the low-carb diet proponents that saturated fats do not increase inﬂammation in the context of a low-carb diet. I want to remind you of two things we have discussed previously:

The comparisons in those studies are generally with people consuming a diet high in simple carbohydrates and sugars.

These studies have mostly been done in the short-term when the participants are losing weight on the low-carb diets. Weight loss decreases inﬂammation, so the reduction in inﬂammation on the low-carb diet could be coming from the weight loss.

The one study (M. Miller et al, Journal of the American Dietetic Association, 109: 713-717, 2009) I have found that compares a low-carb diet (the Atkins diet) with a good diet (the Ornish diet, which is a low-fat, lacto-ovo vegetarian diet) during weight maintenance found that the meat based, low-carb Atkins diet caused greater inﬂammation than the healthy low-fat Ornish diet.

Red meat is probably pro-inﬂammatory. Most, but not all, studies suggest that red meat consumption is associated with increased inﬂammation. If it is pro-inﬂammatory, the inﬂammation is most likely associated with its saturated fat, its heme iron content, or the advanced glycation end products formed during cooking.

What Is An Anti-Inflammatory Diet?

Anti-inﬂammatory diets have become so mainstream that they now appear on many reputable health organization websites such as Harvard Health, WebMD, the Mayo Clinic, and the Cleveland Clinic. Each have slightly diﬀerent features, but there is a tremendous amount of agreement.

Foods an anti-inﬂammatory diet includes: In a nutshell, an anti-inﬂammatory diet includes fruits and vegetables, whole grains, plant-based proteins (like beans and nuts), fatty ﬁsh, and fresh herbs and spices. Speciﬁcally, your diet should emphasize:

Colorful fruits and vegetables. Not only do they help ﬁght inﬂammation, but they are a great source of antioxidants and other nutrients important for your health.

Whole grains. They have a low glycemic index. They are also a good source of ﬁber, and ﬁber helps ﬂush inﬂammatory toxins out of the body.

Beans and other legumes. They should be your primary source of protein. They are high in ﬁber and contain antioxidants and other anti-inﬂammatory nutrients.

Nuts, olive oil, and avocados. They are good sources of healthy monounsaturated fats, which ﬁght inﬂammation.
Fatty ﬁsh. Salmon, tuna, and sardines are all great sources of long chain omega-3 fatty acids, which are incorporated into our cell membranes. Those long chain omega-3s in cell membranes are, in turn, used to create compounds that are powerful inﬂammation ﬁghters.

Walnuts, ﬂaxseeds, and chia seeds are good sources of short chain omega-3s. The eﬃciency of their conversion to long chain omega-3s that can be incorporated into cell membranes is only around 2-5%. If they ﬁght inﬂammation, it is probably because they replace some of the saturated fats and omega-6 fats you might otherwise be eating.

Herbs and spices. They add antioxidants and other phytonutrients that ﬁght inﬂammation.

Foods an anti-inﬂammatory diet excludes: In a nutshell, an anti-inﬂammatory diet should exclude highly processed, overly greasy, or super sweet foods, especially sodas and other sweet drinks. Specifically, your diet should exclude:

Reﬁned carbohydrates, sodas and sugary foods. They have a high glycemic index, which is associated with inﬂammation. They can also lead to weight gain and high blood sugar, both of which cause inﬂammation.

Foods high in saturated fats. This includes fatty and processed meats, butter, and high fat dairy products.

Foods high in trans fats. This includes margarine, coﬀee creamers, and any processed food containing partly hydrogenated vegetable oils. Trans fats are very pro-inﬂammatory.

French fries, fried chicken, and other fried foods. They used to be fried in saturated fat and/or trans fat. Nowadays, they are generally fried in omega-6 vegetable oils. A little omega-6 in the diet is OK, but Americans get too much omega-6 fatty acids in their diet. Most studies show that a high ratio of omega-6 to omega-3 fatty acids is pro-inﬂammatory.

Foods you are allergic or sensitive to. Eating any food that you are sensitive to can cause inﬂammation. This comes up most often with respect to gluten and dairy because so many people are sensitive to one or both. However, if you are not sensitive to them, there is no reason to exclude whole grain gluten-containing foods or low-fat dairy foods from your diet.

Can Diet Douse The Flames?

In case you didn’t notice, the recommendations for an anti-inﬂammatory diet closely match the other healthy diets I have discussed previously. It should come as no surprise then that both the Mediterranean (L. Gallard, Nutrition in Clinical Practice, 25: 634-640, 2010; L. Schwingshackl and G. Hoﬀmann, Nutrition Metabolism and Cardiovascular Diseases, 24: 929-939, 2014) and DASH (D.E. King et al, Archives of Internal Medicine, 167: 502-506, 2007) diets are anti-inﬂammatory.

Vegan and vegetarian diets also appear to be anti-inﬂammatory as well. The anti-inﬂammatory nature of these diets undoubtedly contributes to their association with a lower risk of heart disease, diabetes, and cancer.

As for the low-carb diets, the jury is out. There are no long-term studies to support the claims of low-carb proponents that their diets reduce inﬂammation. The few long-term studies that are available suggest that low-carb diets are only likely to be anti-inﬂammatory if vegetable proteins and oils replace the animal proteins and fats that are currently recommended.

What does this mean for you if you have severe arthritis or other inﬂammatory diseases? An anti-inﬂammatory diet is unlikely to “cure” your symptoms by itself. However, it should deﬁnitely be a companion to everything else you are doing to reduce inﬂammation.

The Bottom Line

Obesity and diabetes are two of the biggest contributors to inﬂammation, but does diet also play a role? With all the anti-inﬂammation diets circulating on the internet, you would certainly think so. In this article I review the evidence that certain foods inﬂuence inﬂammation and describe what an anti-inﬂammatory diet looks like.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does Eating Plant Protein Help You Live Longer?

August 25, 2020 by Dr. Steve Chaney

Are Whole Grains Heart Healthy?

The diet wars continue. Dr. Strangelove and his colleagues are still trying to convince you that you can eat all the red meat you want. It is those deadly whole grains, beans, and fruits you need to avoid.

However, as the benefits of primarily plant-based diets continue to accumulate, it is becoming harder for them to maintain these preposterous claims.

For example, several recent studies have shown that replacing animal protein with plant protein in your diet results in better health.

The Iowa Women’s Health Study found that plant protein substitution for animal protein is associated with reduced risk of dying from heart disease.

The Nurse’s Health Study and Health Professionals Follow-up Study found that greater plant protein intake was associated with reduced risk of dying from heart disease and reduced risk of dying from all causes.

The Japan Public Health Center-Based Prospective Cohort Study found a reduced risk of dying from heart disease, cancer, and all causes with substitution of plant protein for red meat protein.

These were all very large studies in which populations were followed for long periods of time. You might be thinking that with such overwhelming evidence no further studies are needed.

However, these studies did not examine which plant protein sources were most beneficial and which animal protein sources were most detrimental. The study (J. Huang et al, JAMA Internal Medicine, published online July 13, 2020) I describe in today’s “Health Tips From The Professor” was designed to answer that question.

How Was The Study Done?

416,104 participants from the NIH-AARP Diet and Health Study were enrolled in this study in 1995 and 1996 and were followed for 16 years. At the time of enrollment, the participants filled out a comprehensive Diet History Questionnaire. The participants also completed questionnaires about their health, lifestyle, and socio-economic status.

Deaths were obtained from the Social Security Death Master File. Causes of death were obtained from the National Death Index Plus.

The basic characteristics of the study population were:

Gender: 57% men, 43% women.
Racial identification: 90% non-Hispanic white.
Average age 61 (range 50-71).
Average BMI = 27 (in the overweight range).
Participants were excluded from the study if they had pre-existing cancer, heart disease, stroke, or end-stage kidney disease.

In terms of protein intake:

Average protein intake was 15.3% of calories.

Plant protein contributed 40% (range 27% – 57%) to the total protein intake.

Animal protein contributed 60% (range = 43% to 63%) of the total protein intake.

The major sources of animal protein in the diet were:

Dairy products = 31.6%

White meat (poultry, fish, and processed white meat) = 31.3%

Red meat (both fresh and processed) = 30.6%

Eggs = 4.0%

The major sources of plant protein in the diet were:

Grains (bread, cereal, and pasta) = 45.8%

Beans and legumes = 8.0%

Nuts and seeds = 4.5%

Other plant protein (including plant protein from supplements) = 41.7%

All these protein intake figures are normal for the American diet.

I should note that beans, nuts, and seeds are among the best sources of plant protein. However, they are only a minor part of the typical American diet, so they contribute relatively little to our plant protein intake.

Does Eating Plant Protein Help You Live Longer?

In terms of overall protein intake, this study mirrored previous studies.

There was an inverse association between plant protein intake and premature death from heart disease, stroke, and all causes. Put another way, the more plant protein people in this study ate, the lower was their risk of premature death.

To quantify the effect, the investigators asked what happened when 3% of calories came from plant protein instead of animal protein. I recognize, however, that 3% of calories is a rather abstract concept, so let me break it down for you so you can apply it to your lives.

For participants in this study, protein was 15% of their total calories. That means when the investigators were talking about shifting 3% of total calories from animal protein to plant protein, they were talking about 20% of the protein in the diet coming from plant protein rather animal protein.

Based on the average caloric intake of participants in this study, that corresponds to 15 grams of protein for men and 12 grams of protein for women.

With that in mind, let’s look at the results:

Changing just 3% of calories from animal protein to plant protein:

Lowered the risk of premature death from all causes by 10% for both men and women.

Lowered the risk of premature death from cardiovascular disease by 11% for men and 12% for women.

Lowered the risk of premature death from stroke by 22% for men and 19% for women.

These findings are consistent with previous studies. By now, it should be apparent that primarily plant-based diets are best for your overall health. Primarily plant-based diets also appear to reduce your risk of dying prematurely from heart disease and from all other diseases combined.

The authors concluded: “This large cohort investigation showed small but significant associations between higher intake of plant protein and lower overall and cardiovascular mortality…Findings from this and previous studies provide evidence that dietary modifications in choice of protein sources may promote health and longevity.”

However, this part of the study merely confirms what other studies have shown. What makes this study unique is that it identifies which animal proteins are worst for us and which plant proteins are best for us.

Which Animal Proteins Are Least Heart Healthy?

Let’s start with the animal proteins (Note: To simplify a complex set of data, I am going to average the results for men and women).

Changing 3% of calories from egg protein to plant protein:

- Lowered the risk of premature death from all causes by 23%.

- Lowered the risk of premature death from cardiovascular disease by 27%.

- To put this into perspective, 3% of calories from egg protein corresponds to around 2.5 eggs/day. So, talking about replacing 3% of calories of egg protein creates a false narrative. The average egg consumption in this study was 0.5 eggs/day and very few participants consumed even 2 eggs every day. If we make a more reasonable comparison, replacing one egg/day with an equivalent amount of plant protein:

- - Lowers the risk of premature death from all causes by 9%.

- - Lowers the risk of premature death from cardiovascular disease by 11%.

Changing 3% of calories from red meat protein to plant protein:

- Lowered the risk of premature death from all causes by 14%.

- Lowered the risk of premature death from cardiovascular disease by 12%.

- Lowered the risk of premature death from stroke by 21%.

- To put this into perspective, 3% of calories from red meat protein corresponds to around 2 ounces/day.

Changing 3% of calories from dairy protein to plant protein:

- Lowered the risk of premature death from all causes by 8%.

- Lowered the risk of premature death from cardiovascular disease by 11%.

- Lowered the risk of premature death from stroke by 21%.

- To put this into perspective, 3% of calories from dairy protein corresponds to around 1.7 8-ounce glasses of milk, 2 ounces of cheese, or 1 cup of yogurt (most yogurt “cups” sold commercially are less than an 8-ounce cup).

Changing 3% of calories from white meat protein to plant protein had no effect on premature death from any disease in this study. I will discuss the reasons for that below.

Are Whole Grains Heart Healthy?

Now, let’s look at the flip side. What happens when you replace 3% of calories from red meat protein with various kinds of plant protein?

Changing 3% of calories from red meat protein to plant protein from whole grains:

- Lowered the risk of premature death from all causes by 28%.

- Lowered the risk of premature death from cardiovascular disease by 32%.

- Lowered the risk of premature death from stroke by 32%.

- To put this into perspective, 3% of calories from whole grain protein corresponds to around 2.5 slices of whole grain bread, 2 cups of oatmeal, or 2.5 cups of brown rice or whole grain pasta – or any combination of them during the day.

The results were similar for replacing egg protein with whole grain protein.

Changing 3% of calories from red meat protein or egg protein to other types of plant protein had no effect on premature death from any disease. The reasons for that will be discussed below.

The authors concluded “…this investigation showed prominent inverse associations between overall and cardiovascular mortality and the replacement of egg protein and red meat protein with plant protein, particularly for plant protein derived from bread, cereal, and pasta…”

Why Do Animal Proteins Increase Your Risk Of Premature Death?

Let me take a deep dive into the data. If you like, you can skip to “What Does This Study Mean For You?”

To help you gain a better understanding of these results, I will answer two questions for you:

Mechanism: What is/are the metabolic explanation(s) for these results?

Perspective: How can you apply this information to your own life?

Reminder: This section is for those of you who want the details. I will give the Cliff Notes summary in the section “What Does This Study Mean For You”.

Eggs

Mechanism:

The bad effect of eggs on cardiovascular mortality and all-cause mortality is thought to be almost exclusively due to their high cholesterol content.

On the flip side, eggs are an excellent source of low-fat animal protein and provide nutrients like choline and carotenoids that are often insufficient in the American diet.

Perspective:

Our bodies have a beautifully designed system for regulating blood cholesterol levels. This means under ideal conditions dietary cholesterol has very little effect on blood cholesterol levels. However, as I have pointed out in a previous issue of “Health Tips From the Professor”, conditions are often far from ideal.

Diet context matters. Obesity, saturated fat, and sugar all interfere with our ability to regulate blood cholesterol levels. People consuming the typical American diet, like the ones in this study, have more difficulty regulating their blood cholesterol levels and are more likely to be adversely affected by dietary cholesterol from eggs and other high-cholesterol foods.

- Previous studies suggest that adding eggs to the typical American diet may increase risk of cardiovascular disease and premature death.

- In contrast, adding eggs to a primarily plant-based diet, such as found in China and Japan, appears to decrease risk of heart disease and premature death.

Red Meat

Mechanisms: The mechanism(s) associated with the bad effects of red meat are less clear. Here are the potential mechanisms discussed by the authors of this study.

Red meat is high in cholesterol. While many experts have downplayed the importance of dietary cholesterol in recent years, it still may be of concern in the context of the typical American diet because of our body’s inability to regulate cholesterol metabolism normally.

Red meat is high in saturated fat. While some experts have downplayed the importance of reducing saturated fat intake, I pointed out in a previous issue of “Health Tips From the Professor” that it depends on what the saturated fat is replaced with.

- When saturated fats are replaced with sugar and refined carbohydrates in the typical American diet, reducing saturated fat is of no benefit.

- When saturated fats are replaced with polyunsaturated fats in the context of a primarily plant-based diet, such as the Mediterranean diet, reducing saturated fats leads to a substantial reduction in the risk of heart disease and premature death.

Red meat also contains heme iron which is associated with 57% increased risk of cardiovascular disease.

Diets high in red meat result in populations of gut bacteria that are associated with increased risk of cardiovascular disease. This is most likely because red meat is displacing plant foods that support the growth of healthy bacteria.

As discussed in a recent issue of “Health Tips From the Professor”, the gut bacteria associated with red meat consumption convert the L-carnitine in red meat to a metabolite called trimethylamine N-oxide (TMAO) which appears to significantly increase the risk of cardiovascular disease.

Finally, a recent study suggests that foods high in sulfur-containing amino acids significantly increase risk of cardiovascular disease. However, this mechanism is not specific for red meat. White meat, beans, and legumes are also high in sulfur-containing amino acids.

Perspective:

While the exact mechanism(s) is/are uncertain, there is substantial evidence from multiple studies that red meat consumption increases the risk of premature death from cardiovascular disease and from all causes.

Grass fed beef is not a “get out of jail free card”. Grass fed beef is modestly lower in cholesterol and saturated fat. However, those are only two of six potential mechanisms for the link between red meat consumption and cardiovascular disease.

However, those of you who, like me, enjoy red meat should not consider this to be an absolute “red meat should never touch your lips” edict. As I have discussed in a previous issue of “Health Tips From the Professor”, the health effects of red meat are a matter of quantity and diet context.

- If you are thinking in terms of a juicy 8-ounce steak with a baked potato and sour cream, red meat is probably not a healthy choice.

- However, if you are thinking of 2-3 ounces of lean steak in a vegetable stir fry or a green salad, red meat may be a healthier choice.

Dairy: I have reported on the health risks and benefits of dairy foods in a previous issue of “Health Tips From the Professor”, so I will just give you a brief summary here.

Perspective:

Eating dairy foods, even high-fat dairy foods, has relatively little effect on cardiovascular disease risk in the context of the typical high-fat, high-sugar American diet.

Eating dairy foods, even high-fat dairy foods, in the context of a healthy plant-based diet appears to lower cardiovascular disease risk.

As this study suggests, moving towards a more plant-based diet by substituting some plant protein for dairy protein in the diet will also decrease your risk of cardiovascular disease

White Meat: This and previous studies suggest that white meat is less likely than red meat to increase the risk of cardiovascular disease and premature death. I have discussed the differences between red and white meat in a previous issue of “Health Tips From the Professor”. However, I can summarize the differences best here by going back to the mechanisms associated with the link between red meat and cardiovascular diseases and highlight those that do not apply to white meat.

Mechanisms:

Saturated fat. Many fish are much lower in saturated fat and are excellent sources of heart-healthy omega-3 fats. Chicken and turkey breast with the skin removed are also much lower in saturated fat than red meat.

Heme iron. Chicken breast is lower in heme iron than red meats.

TMAO. White meats contain 10-50 times less L-carnitine than red meats. Since L-carnitine is the precursor of TMAO, they are much less likely to cause TMAO production.

Why Do Plant Proteins Decrease Your Risk Of Premature Death?

Whole Grains: Whole grains have been much maligned in recent years. They have been lumped in with sugar and refined grains and have been added to everyone’s “naughty list”.

If you are following a low-carb diet, you are told to avoid all grains.

If you are following a Paleo diet, you are told our paleo ancestors ate no grains.

If you are trying to avoid lectins…you get the point.

That’s unfortunate, because whole grains are very healthy. In a recent issue of “Health Tips From the Professor” I shared a study showing that whole grain consumption reduced the risk of premature death from heart disease, cancer, and all causes. The current study shows essentially the same thing.

The only question is why whole grains are uniquely effective at decreasing premature death from cardiovascular disease and all causes in this study. Why aren’t all plant proteins equally effective? I will share both a suggested mechanism and perspective.

Mechanism:

In a recent issue of “Health Tips From The Professor” I reported a study showing that grains and a few other foods contain a unique type of fiber called resistant starch that suppress growth of the gut bacteria which convert L-carnitine to TMAO. This may be why whole grains are uniquely effective at reducing the risk of cardiovascular disease and premature death.

Some refined grains are also good sources of resistant starch. However, I don’t recommend them because they lack the antioxidants, vitamins, phytonutrients, and insoluble fiber found in whole grains.

Perspective:

The fact no other plant protein source significantly reduced heart disease risk in this study is most likely an artifact of the study.

The study asked what happens when you change 15 grams of the protein in your diet from red meat protein to different kinds of plant protein. That question was easy to answer for grains because they are a major source of protein in the American diet. However, Americans don’t get enough protein from other high protein plant foods like beans and legumes or nuts and seeds to provide a statistically valid answer to that question.

However, all plant foods have their own health benefits. They are excellent sources of antioxidants and phytonutrients that provide heart health benefits.

In addition, each plant food provides a different blend of fibers and supports different populations of gut bacteria with different health benefits. For example, fiber from fruits and vegetables is associated with a lower risk of cancer.

What Does This Study Mean For You?

A recent study has shown that changing as little as 20% of the protein in our diet from animal protein to plant protein significantly reduces our risk of premature death from cardiovascular disease, stroke, and from all causes.

The effect of replacing 2 ounces of red meat, 1 egg, or 2 servings of dairy with an equivalent amount of plant protein was equally beneficial.

Previous studies show that diet context is important. A small amounts of animal protein in the context of a whole food, primarily plant-based diet is much less likely to cause harm and may provide benefit. For example:

Eggs are high in cholesterol but are also excellent sources of low-fat protein and nutrients that may be missing in a plant-based diet.

- Previous studies suggest that adding eggs to the typical American diet may increase risk of cardiovascular disease and premature death.

- In contrast, adding eggs to a primarily plant-based diet, such as found in China and Japan, appears to decrease risk of cardiovascular disease and premature death.

Dairy foods are high in saturated fat but are excellent sources of calcium, vitamin D, and other nutrients that may be missing in a plant-based diet.

- Eating dairy foods, even high-fat dairy foods, has relatively little effect on cardiovascular disease risk in the context of the typical high-fat, high-sugar American diet.

- Eating dairy foods, even high-fat dairy foods, in the context of a healthy plant-based diet appears to lower cardiovascular disease risk.

Red meat has multiple suggested mechanisms for it increasing the risk of death from cardiovascular disease. However, diet context still matters.

- If you are thinking in terms of a juicy 8-ounce steak with a baked potato and sour cream, red meat is probably not a healthy choice.

- However, if you are thinking of 2-3 ounces of lean steak in a vegetable stir fry or a green salad, red meat may be a healthier choice.

- Grass fed beef should not be considered a “get out of jail free card”. Grass fed beef is modestly lower in cholesterol and saturated fat. However, those are only two of six potential mechanisms for the link between red meat consumption and cardiovascular disease.

White meat does not appear to affect your risk of developing cardiovascular disease.

Whole grains significantly decreased the risk of premature death from cardiovascular disease and death from all causes. This may be because whole grains contain a unique type of fiber called resistant starch that suppresses the growth of the gut bacteria which convert L-carnitine to a heart-damaging compound called TMAO.

- Notice that I specified “whole grain”. While some refined grains are also a good source of resistant starch, they lack the other heart healthy nutrients and phytonutrients found in whole grains.

- - Wonder Bread, Frosted Flakes, Honey Bunches of Oats, and white-flour pasta are not on my approved list. I agree with low-carb enthusiasts about eliminating them from our diets.

- - You should also be aware that “whole grain” on the label means nothing. You want to choose foods that say “100% whole grain”.

- Finally, this study only focused on plant protein sources. It is important to remember that other plant foods are an excellent source of antioxidants, phytonutrients, and fiber. Each plant food provides unique heart health benefits.

The Bottom Line

The effect of replacing 2 ounces of red meat, 1 egg, or 2 servings of dairy with an equivalent amount of plant protein was equally beneficial. White meat did not affect the risk of cardiovascular disease or premature death.

Grass fed beef should not be considered a “get out of jail free card”. Grass fed beef is modestly lower in cholesterol and saturated fat. However, those are only two of six potential mechanisms for the link between red meat consumption and cardiovascular disease.

Diet context is important. Small amounts of animal protein in the context of a whole food, primarily plant-based diet appear to be much healthier for us than large amounts of animal protein in the context of the high-fat, high-sugar American diet.

On the flip side of the equation, whole grains significantly decreased the risk of premature death from cardiovascular disease and death from all causes. This has also been seen in other recent studies.

Notice that I specified “whole grain”. Wonder Bread, Frosted Flakes, Honey Bunches of Oats, and white-flour pasta are not on the list.

You should also be aware that “whole grain” on the label means nothing. You want to choose foods that say “100% whole grain”.

Finally, this study only focused on plant protein sources. It is important to remember that other plant foods are an excellent source of antioxidants, phytonutrients, and fiber. Each plant food provides unique heart health benefits.

For more details, read the article above, especially the “What Does This Study Mean For You?” section.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Can You Improve Your Healthspan?

June 23, 2020 by Dr. Steve Chaney

Can You Live Healthier, Longer?

Ever since Ponce de Leon led an expedition to the Florida coast in 1513, we have been searching for the mythical “Fountain Of Youth”. What does that myth mean?

Supposedly, just by immersing yourself in that fountain you would be made younger. You would experience all the exuberance and health you enjoyed when you were young. There have been many snake oil remedies over the years that have promised that. They were all frauds.

But what if you had it in your power to live longer and to retain your youthful health for most of those extra years. The ability to live healthier longer is something that scientists call “healthspan”. But you can think of it as your personal “Fountain Of Youth”.

Where are we as a nation? Americans ranked 53^rd in the world for life expectancy. We have the life expectancy of a third-world country. We are in sore need of a “Fountain Of Youth”.

That is why I decided to share two recent studies from the prestigious Harvard T.H. Chan School of Public Health with you today.

The first study (Y Li et al, Circulation, 138: 345-355, 2018) looks at the effect of a healthy lifestyle on lifespan (how many years you can live).

The second study (Y Li et al, British Medical Journal, 368: 16669, 2020) looks at the effect of a healthy lifestyle on healthspan (how many disease-free years you can live).

How Were The Studies Done?

These studies started by combining the data from two major clinical trials:

The Nurse’s Health Study, which ran from 1980 to 2014.

The Health Professional’s Follow-Up Study, which ran from 1986-2014.

These two clinical trials enrolled 78,865 women and 42,354 men and followed them for an average of 34 years. During this time there were 42,167 deaths. All the participants were free of heart disease, type 2 diabetes, and cancer at the time they were enrolled. Furthermore, the design of these clinical trials was extraordinary.

A detailed food frequency questionnaire was administered every 2-4 years. This allowed the investigators to calculate cumulative averages of all dietary variables.

Participants also filled out questionnaires that captured information on disease diagnosis every 2 years with follow-up rates >90%. This allowed the investigators to measure the onset of disease for each participant during the study. More importantly, 34 years is long enough to measure the onset of diseases like heart disease, diabetes, and cancer – diseases that require decades to develop.

The questionnaires also captured information on medicines taken and lifestyle characteristics such as body weight, exercise, smoking and alcohol use.

For analysis of diet quality, the investigators use something called the “Alternative Healthy Eating Index”. [The original Healthy Eating Index was developed about 10 years ago based on the 2010 “Dietary Guidelines for Americans”. Those guidelines have since been updated, and the “Alternative Healthy Eating Index” is based on the updated guidelines.] You can calculate your own Alternative Healthy Eating Index below, so you can see what is involved.

Finally, the investigators included five lifestyle-related factors – diet, smoking, physical activity, alcohol consumption, and BMI (a measure of obesity) – in their estimation of a healthy lifestyle. Based on the best available evidence, they defined “low-risk” in each of these categories. Study participants were assigned 1 point for each low-risk category they achieved. Simply put, if they were low risk in all 5 categories, they received a score of 5. If they were low risk in none of the categories, they received a score of 0.

Low risk for each of these categories was defined as follows:

- Low risk for a healthy diet was defined as those who scored in the top 40% in the Alternative Healthy Eating Index.

- Low risk for smoking was defined as never smoking.

- Low risk for physical activity was defined as 30 minutes/day of moderate or vigorous activities.

- Low risk for alcohol was defined as 0.5-1 drinks/day for women and 0.5-2 drinks/day for men.

- Low risk for weight was defined as a BMI in the healthy range (18.5-24.9 kg/m²).

Can You Live Healthier Longer?

The investigators compared participants who scored as low risk in all 5 categories with participants who scored as low risk in 0 categories (which would be typical for many Americans). For the purpose of simplicity, I will refer to people who scored as low risk in 5 categories as having a “healthy lifestyle” and those who scored as low risk in 0 categories as having an “unhealthy lifestyle”.

The results of the first study were:

Women who had had a healthy lifestyle lived 14 years longer than women with an unhealthy lifestyle (estimated life expectancy of 93 versus 79).

Men who had a healthy lifestyle lived 12 years longer than men with an unhealthy lifestyle (estimated life expectancy was 87 versus 75).

It was not necessary to achieve a perfect lifestyle. Life expectancy increased in a linear fashion for each low-risk lifestyle behavior achieved.

The authors of the study concluded: “Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults. Our findings suggest that the gap in life expectancy between the US and other developed countries could be narrowed by improving lifestyle factors.”

The results of the second study were:

Women who had a healthy lifestyle lived 11 years longer free of diabetes, heart disease, and cancer than women who had an unhealthy lifestyle (estimated disease-free life expectancy of 85 years versus 74 years).

Men who had a healthy lifestyle lived 8 years longer free of diabetes, heart disease, and cancer than men who had an unhealthy lifestyle (estimated disease-free life expectancy of 81 years versus 73 years).

Again, disease-free life expectancy increased in a linear fashion for each low-risk lifestyle behavior achieved.

The authors concluded: “Adherence to a healthy lifestyle at mid-life [They started their analysis at age 50] is associated with a longer life expectancy free of major chronic diseases. Our findings suggest that promotion of a healthy lifestyle would help reduce healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy.”

Can You Improve Your Healthspan?

I posed the question at the beginning of this article, “Can you improve your healthspan?” These two studies showed that you can improve both your life expectancy and your disease-free life expectancy. So, the answer to the original question appears to be, “Yes, you can improve your healthspan. You can create your personal “Fountain of Youth.”

However, as a nation we appear to be moving in the wrong direction. The percentage of US adults adhering to a healthy lifestyle has decreased from 15% in 1988-1992 to 8% in 2001-2006.

The clinical trials that these studies drew their data from were very well designed, so these are strong studies. However, like all scientific studies, they have some weaknesses, namely:

They looked at the association of a healthy lifestyle with life expectancy and disease-free life expectancy. Like all association studies, they cannot prove cause and effect.

The clinical trials they drew their data with included mostly Caucasian health professionals. The results may differ with different ethnic groups.

These studies did not look at the effect of a healthy lifestyle on the onset of Alzheimer’s disease and other forms of dementia. However, other studies have shown that people who were low risk for each of the 5 lifestyle factors (diet, exercise, body weight, smoking, and alcohol use) individually have a reduced risk of developing Alzheimer’s and/or dementia.

Finally, I know you have some questions, and I have answers.

Question: What about supplementation? Will it also improve my healthspan?

Answer: When the investigators analyzed the data, they found that those with the healthiest lifestyles were also more likely to be taking a multivitamin. So, they attempted to statistically eliminate any effect of supplement use on the outcomes. That means these studies cannot answer that question.

However, if you calculate your Alternate Healthy Eating Index below, you will see that most of us fall short of perfection. Supplementation can fill in the gaps.

Question: I cannot imagine myself reaching perfection in all 5 lifestyle categories? Should I even try to achieve low risk in one or two categories?

Answer: The good news is that there was a linear increase in both life expectancy and disease-free life expectancy as people went from low-risk in one category to low-risk in all 5 categories. I would encourage you to try and achieve low risk status in as many categories as possible, but very few of us, including me, achieve perfection in all 5 categories.

Question: I am past 50 already. Is it too late for me to improve my healthspan?

Answer: Diet and some of the other lifestyle behaviors were remarkably constant over 34 years in both the Nurse’s Health Study and the Health Professional’s Follow-Up Study. That means that the lifespan and healthspan benefits reported in these studies probably resulted from adhering to a healthy lifestyle for most of their adult years.

However, it is never too late to start improving your lifestyle. You may not achieve the full benefits described in these studies, but you still can add years and disease-free years to your life.

How To Calculate Your Alternative Healthy Eating Index

You can calculate your own Alternative Healthy Eating Index score by simply adding up the points you score for each food category below.

Vegetables

Count 2 points for each serving you eat per day (up to 5 servings).

One serving = 1 cup green leafy vegetables or ½ cup for all other vegetables.

Do not count white potatoes or processed vegetables like French fries or kale chips.

Fruits

Count 2½ points for each serving you eat per day (up to 4 servings).

One serving = 1 piece of fruit or ½ cup of berries.

(do not count fruit juice or fruit incorporated into desserts or pastries).

Whole Grains

Count 2 points for each serving you eat per day (up to 5 servings).

One serving = ½ cup whole-grain rice, bulgur and other whole grains, cereal, and pasta or 1 slice of bread.

(For processed foods like pasta and bread, the label must say 100% whole grain).

Sugary Drinks and Fruit Juice

Count 10 points if you drink 0 servings per week.

Count 5 points for 3-4 servings per week (½ serving per day).

Count 0 points for 7 or more servings per week (≥1 serving per day).

One serving = 8 oz. fruit juice, sugary soda, sweetened tea, coffee drink, energy drink, or sports drink.

Nuts, Seeds and Beans

Count 10 points if you eat 7 or more servings per week (≥1 serving per day).

Count 5 points for 3-4 servings per week (½ serving per day).

Count 0 points for 0 servings per week.

One serving = 1 oz. nuts or seeds, 1 Tbs. peanut butter, ½ cup beans, 3½ oz. tofu.

Red and Processed Meat

Count 10 points if you eat 0 servings per week.

Count 7 points for 3-4 servings per week (½ serving per day).

Count 3 points for 3 servings per week (1 serving per day).

Count 0 points for ≥1½ servings per day.

One serving = 1½ oz. processed meats (bacon, ham, sausage, hot dogs, deli meat)

Or 4 oz. red meat (steak, hamburger, pork chops, lamb chops, etc.)

Seafood

Count 10 points if you eat 2 servings per week.

Count 5 points for 1 serving per week.

Count 0 points for 0 servings per week.

1 serving = 4 oz.

Now that you have your total, the scoring system is:

41 or higher is excellent
37-40 is good
33-36 is average (remember that it is average to be sick in this country)
28-32 is below average
Below 28 is poor

Finally, for the purposes of these two studies, a score of 37 or higher was considered low risk.

The Bottom Line

Two recent studies have developed a healthy lifestyle score based on diet, exercise, body weight, smoking, and alcohol use. When they compared the effect of lifestyle on both lifespan (life expectancy) and healthspan (disease-free life expectancy), they reported:

Women who had had a healthy lifestyle lived 14 years longer than women with an unhealthy lifestyle.

Men who had a healthy lifestyle lived 12 years longer than men with an unhealthy lifestyle.

Women who had a healthy lifestyle lived 11 years longer free of diabetes, heart disease, and cancer than women had an unhealthy lifestyle.

Men who had a healthy lifestyle lived 8 years longer free of diabetes, heart disease, and cancer than men who had an unhealthy lifestyle.

It is not necessary to achieve a perfect lifestyle. Lifespan and healthspan increased in a linear fashion for each low-risk lifestyle behavior (diet, exercise, body weight, smoking, and alcohol use) achieved.

These studies did not evaluate whether supplement use also affects healthspan.

- However, if you calculate your diet with the Alternate Healthy Eating Index they use (see above), you will see that most of us fall short of perfection. Supplementation can fill in the gaps.

The authors concluded: “Our findings suggest that promotion of a healthy lifestyle would help reduce healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy.”

For more details, including how to calculate whether you are low risk in each of the 5 lifestyle categories, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Which Foods Should I Avoid?

May 26, 2020 by Dr. Steve Chaney

What Is Nutritionism?

Recently, I have been reading Michael Pollan’s book “In Defense of Food”. Yes, I know the book has been around for a long time. Normally I read the scientific literature rather than popular health books. However, in the past few weeks I have had a lot more time to read books, so I decided to read this one.

Some of the things he says are “off the wall”. As he readily admits, he isn’t a scientist or a medical doctor. However, a lot of what he says is “right on”. He echoes many of the things I have been talking about for years. But he does a masterful job of pulling everything together into a framework he calls “nutritionism”.

If you have a chance, I highly recommend that you read his book.

I will briefly summarize his discussion of nutritionism below. I will also share some scientific support for what he is saying. Finally, I will close by sharing what the Bible says on the subject.

What Is Nutritionism?

Simply put, nutritionism is the belief that we can understand food solely in terms of its nutritional and chemical constituents and our requirements for them. I use the term “belief” purposely. As Michael Pollan puts it: “As the ‘-ism’ suggests, nutritionism is not a scientific subject, but an ideology.”

As he points out, that leads to debacles like the creation of margarine as a substitute for butter. Of course, everyone reading this article knows that we subsequently found out that the trans fat in margarine was worse for us than the saturated fat in butter. He offers many other examples like this.

He also points out that the nutritionism concept has given free rein to the food industry to replace whole foods with processed foods that are cholesterol-free, sugar-free, low-fat, low-carb, or high in fiber, omega-3s, etc. He says that these foods are seldom healthier than the foods they replace. I agree.

Finally, he points out that the scientific support for the classification of individual ingredients or foods as “good” or “bad” is weak. That’s because when scientists design a study that removes a chemical constituent or a food from the diet, they have to replace it with something. And what they replace it with determines the outcome of the study. I give some examples of this in the next section.

The essence of Michael Pollan’s message is:

The effect of an individual nutrient or chemical constituent on your health depends on the food it is found in. Forget the fancy nutrition labels. Whole foods are almost always healthier than processed foods.

The effect of a food or food constituent on your health also depends on your overall diet. We should be thinking about healthy diets rather than the latest “magical” or “forbidden” food.

I will discuss these points below.

Which Foods Should I Avoid?

Now, let’s get to the question, “Which Foods Should I Avoid?” If we are talking about whole foods, the short answer is “None”. As I said in my book, “Slaying The Food Myths”, “We have 5 food groups for a reason”.

For example, if we are talking about plant foods, each plant food group:

Has a unique blend of vitamins and minerals.
Has a unique blend of phytonutrients.
Has a unique blend of fiber.
Supports the growth of a unique combination of beneficial gut bacteria.

Dr Strangelove and his friends are telling you to eliminate whole grains, fruits, and legumes (beans) from your diet. Recent studies suggest that might not be a good idea. Here is one example.

If we are talking about animal foods, each animal food group:

Has a unique blend of vitamins and minerals.
May have unique components that are important for our health. [Note: This is an active area of research. Theories have been proposed for which components in animal foods may be important for our health, but they have not been confirmed.]

Vegan purists will tell you that you have no need for meat and dairy foods. Recent studies suggest otherwise. Here is one example.

With that as background, let’s turn our attention to nutritionism and look at some of science behind claims that certain food components are either good for us or bad for us.

Saturated Fat. Saturated fat is the poster child for nutritionism.

First, we were told by the American Heart Association and other health organizations that saturated fat was bad for us. Recently Dr. Strangelove and his friends are telling us that saturated fat is good for us. Instead of limiting saturated fat, we should be limiting carbs by cutting out fruits, whole grains, and legumes. Both cite clinical studies to support their claims. How can this be?

Perhaps a little history is in order. When the American Heart Association recommended that we decrease intake of saturated fat, they were envisioning that we would replace it with monounsaturated and polyunsaturated fat in the context of a healthy diet of fruits, vegetables, whole grains, and legumes. That never happened.

Big Food quickly realized that if the American public were to follow the AHA guidelines, it would be disastrous for their bottom line. So, they sprang into action. They mixed sugar, white flour, and a witch’s brew of chemicals to create highly processed, low fat “foods”. Then they told the American public, “Don’t worry. You don’t have to give up your favorite foods. We have created low fat alternatives.”

This is the essence of what Michael Pollan refers to as nutritionism. By marketing their fake foods as low fat Big Food created the halo of health. In fact, Big Food’s fake foods were less healthy than the foods they replaced. Americans got fatter and sicker.

Now let’s look at the conflicting claims that saturated fat is bad for us or good for us. How can clinical studies disagree on such an important question? The answer is simple. It depends on what you replace it with. You need to consider saturated fat intake in the context of the overall diet.

I discussed this in a previous issue of “Health Tips From the Professor”, but let me summarize it briefly here. The American Heart Association tells us that replacing half of the saturated fat in a typical American diet with:

Trans fats, increases heart disease risk by 5%.

Refined carbohydrates and sugars (the kind of carbohydrates in the typical American Diet), slightly increases heart disease risk.

Complex carbohydrates (whole grains, fruits & vegetables), decreases heart disease risk by 9%.

Monounsaturated fats (olive oil & peanut oil), decreases heart disease risk by 15%.

Polyunsaturated fats (vegetable oils and fish oil), decreases heart disease risk by 25%.

Unsaturated fats in the context of a Mediterranean diet, decreases heart disease risk by 45%.

My advice: Saturated fat is neither good for you nor bad for you. A little bit of saturated fat in the context of a healthy diet is fine. A lot of saturated fat in the context of an unhealthy diet is problematic.

Red Meat. Is red meat bad for you? Like saturated fat, it depends on the amount of red meat and the overall diet. I covered this in detail in “Slaying The Food Myths”, but let me summarize briefly here:

According to the World Health Organization, red meat is a probable carcinogen. If we look at the postulated mechanisms by which it causes cancer, they can be mostly neutralized by components of various plant foods.

My advice: An 8-ounce steak with fries and a soda is probably bad for you. Three ounces of that same steak in a green salad or stir fry may be good for you.

I should make one other point while I am on the topic. Dr. Strangelove and his friends have been telling you that grass-fed beef is better for you than conventionally raised beef. Once again, that is nutritionism. Grass-fed beef is lower in saturated fat and high in omega-3s than conventionally raised beef. That may be better for your heart, but it has no effect on the cancer-causing potential of red meat. It doesn’t give the license to eat 8-ounce steaks on a regular basis. You still want to aim for 3-ounces of that grass-fed beef in a green salad or stir fry.

High-Fructose Corn Syrup. This one seems to be on everyone’s “naughty list”. You are being told to read labels, and if the food has high-fructose corn syrup on the label, put it back on the shelf. But is that good advice?

It turns out that all the studies on the bad effects of high-fructose corn syrup have been done with sodas and highly processed foods. This should be your first clue.

Of course, as soon as high-fructose corn syrup gained its “bad” reputation, Big Food started replacing it with “heathier” sugars. Does that make those foods healthier?

The answer is a clear “No”. Both chemically and biologically, high-fructose corn syrup is identical to sucrose (table sugar), honey, molasses, maple syrup, coconut sugar, date sugar, or grape juice concentrate. Agave sugar is even higher in fructose than high-fructose corn syrup. This is your second clue.

Substituting these sugars for high-fructose corn syrup doesn’t turn sodas and processed foods into health foods. This is nutritionism at its worst.

My advice: Forget reading the label. Forget trying to avoid foods with high-fructose corn syrup. Avoid sodas and processed foods instead.

Sugar. Once the public started to realize that natural sugars in processed foods were just as bad for us as high-fructose corn syrup, sugars became “bad”. We were told to avoid all foods containing sugar in any form. In fact, we were told we needed to become “label detectives” and recognize all the deceptive ways that sugar could be hidden on the label.

I have discussed this in detail in a previous issue of “Health Tips From The Professor”.

Let me just summarize that article with one quote, “It’s not the sugar. It’s the food. There is the same amount and same types of sugar in an 8-ounce soda and a medium apple. Sodas are bad for you, and apples are good for you.” If you are wondering why that is, I have covered it in another issue of “Health Tips From the Professor”.

Before leaving this subject, I should mention that nutritionism has risen its ugly head here as well. Big Food has struck again. They have replaced sugar with a variety of artificial sweeteners.

Once again, nutritionism has failed. Those artificially sweetened sodas and processed foods are no healthier and no more likely to help you keep the weight off than the sugar-sweetened foods they replace. I have covered the science behind that statement in several previous issues of “Health Tips From the Professor”. Here is one example.

My advice: Forget about sugar phobia. You don’t need to become a label detective. Just avoid sodas, sugar-sweetened beverages, and sweet processed foods. Get your sugar in its natural form in fruits and other whole foods.

Carbs. Dr. Strangelove and his friends are now telling you that you need to avoid all carbs. That is pure nutritionism. Carbs are neither good nor bad. It depends on the type of carb and what you replace it with.

Once again, clinical studies have given conflicting outcomes. Each side of the carbohydrate debate can provide clinical studies to support their position. How can that be? The answer is simple. It depends on what assumptions went into the design of the clinical studies. I have written several articles on this topic in “Health Tips From the Professor”, but let me give you one example here.

In this example, I looked at two major studies. The PURE (Prospective Urban Rural Epidemiology) study included data from 135,000 participants in 18 countries. In this study, the death rate decreased as the % carbohydrate in the diet decreased. The low-carb enthusiasts were doing a victory dance.

However, it was followed by a second, even larger study. The ARIC (Atherosclerosis Risk In Communities) study included 432,000 participants from even more countries. In this study, the death rate decreased as the % carbohydrate decreased to about 40%. Then a curious thing happened. As the % carbohydrate in the diet decreased further, the death rate increased.

How can you explain this discrepancy? When you examine the PURE study:

The % carbohydrate only ranged from 70% to 40%.

The data for the PURE study was obtained primarily with third world countries. That is an important distinction because:

- In those countries, it is primarily the well to do that can afford sodas, processed foods, and meat.

- The poor subsist on what they can grow and inexpensive staples like beans and rice.

Simply put, in the PURE study, the type of carbohydrate changed as well as the amount of carbohydrate.

- At the highest carbohydrate intakes, a significant percentage of the carbohydrate came from sugar and refined grains.

- At the lowest carbohydrate intakes, most of the carbohydrate intake came from beans, whole grains, and whatever fruits and vegetables they could grow.

When you examine the ARIC study:

The % carbohydrate ranged from 70% to 20%.

The ARIC study added in data from the US and European countries. That is an important distinction because:

- Low carb diets like Atkins and Keto are popular in these countries. And those are the diets that fall into the 20-40% carbohydrate range.

- Most people can afford diets that contain a lot of meat in those countries.

Simply put, at the lower end of the scale in the ARIC study, people were eating diets rich in meats and saturated fats and eliminating healthy carbohydrate-containing foods like fruits, whole grains and legumes.

My advice: The lesson here is to avoid simplistic nutritionism thinking and focus on diets rather than on foods. When you do that it is clear that carbs aren’t bad for you, it’s unhealthy carbs that are bad for you.

Which Foods Should I Avoid? By now the answer to the question, “Which Foods Should I Avoid?” is clear. Avoid sodas, sugar-sweetened beverages and processed foods (The term processed foods includes convenience foods, junk foods, and most sweets).

What Does This Mean To You?

Now that we are clear on which foods you should avoid, let’s look at the flip side of the coin. Let’s ask, “Which foods should you include in your diet?

As I said at the beginning of this article, “We have 5 food groups for a reason”. We should consider whole foods from all 5 food groups as healthy.

Of course, each of us is different. We all have foods in some food groups that don’t treat us well. Some of us do better with saturated fats or carbs than others. We need to explore and find the foods and diets that work best for us.

However, whenever we assume one diet is best for everyone, we have crossed the line into nutritionism.

What Does The Bible Say?

Let me start this section by saying that I rely on the Bible for spiritual guidance rather than nutritional guidance. However, as part of our church’s Bible reading plan, I was reading 1 Timothy. A passage from 1 Timothy 4:1-5 leapt out at me. It reinforces the theme of Michael Pollan’s book and seems uniquely applicable to the times we live in.

“The Spirit clearly says that in later times some will abandon the faith and follow deceiving spirits and things taught by demons. Such teachings come through hypocritical liars, whose consciences have been seared as with a hot iron. They…order people to abstain from certain foods, which God created to be received with thanksgiving by those who believe and who know the truth. For everything God created is good, and nothing is to be rejected if it is received with thanksgiving, because it is consecrated by the word of God and prayer.”

Interesting.

The Bottom Line

In this article, I have discussed the concept of “nutritionism” introduced in Michael Pollan’s book “In Defense Of Food”. He defines nutritionism as the belief that we can understand food solely in terms of its nutritional and chemical constituents and our requirements for them.

What Michael Pollan is referring to is taking food constituents like saturated fats, cholesterol, sugar, carbohydrates, polyunsaturated fats, monounsaturated fats, fiber, antioxidants, and probiotics and labeling them as either “good” or “bad”. He points out that when we accept these simplistic labels, we often end up creating foods and diets that are less healthy than the ones we were trying to replace.

At the beginning of the article, I asked the question, “Which Foods Should I Avoid?” I then looked at several foods or food groups we have told to avoid, including saturated fats, red meat, high-fructose corn syrup, sugar, and carbs. When you look at the science behind these recommendations from the lens of nutritionism, you come to two conclusions:

We should avoid sodas, sugar-sweetened beverages and processed foods (The term processed foods includes convenience foods, junk foods, and most sweets).

Whole foods from all 5 food groups should be considered as healthy.

However, whenever we assume one diet is best for everyone, we have crossed the line into nutritionism.

For more details and a bible verse that supports the theme of Michael Pollan’s book and seems uniquely applicable to the times we live in, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Diet And Cancer Risk

March 31, 2020March 31, 2020 by Dr. Steve Chaney

What Can You Do To Reduce Your Risk Of Cancer?

It seems like everyone has a magic pill, essential oil, food, or diet that prevents cancer. It doesn’t take a genius to figure out that all the claims can’t be true. No wonder you are confused. You want to know:

Which of these claims are true?

What can you do to reduce your risk of cancer?

These aren’t trivial questions.

Cancer is the second leading cause of death in this country, and some experts predict it will surpass heart disease as the leading cause of death in the near future.

While cancer treatments have become much more effective in the past few decades, these treatment successes are often associated with severe side-effects, enormous expense, or both.

That is why I was intrigued by a recent study (FF Zhang et al, JNCI Cancer Spectrum (2019) 3(2): pkz034) on diet and cancer that came from the prestigious Friedman School of Nutrition and Public Policy at Tufts University. This study asked two important questions:

How many newly diagnosed cancer cases could have been prevented by changes in the American diet? This is something the authors referred to as the “preventable cancer burden associated with poor diet”.

Which foods increased or decreased the risk of cancer? This, of course, is the most useful information for you and me.

Diet And Cancer Risk

This study estimated that 80,110 new cancer cases among US adults 20 and older could be primarily attributed to poor diet. While poor diet contributes to many more cancers, the authors of this study felt 80,110 represented the number of cancer cases that were clearly preventable by some simple dietary changes.

While all cancers were affected by diet to some degree, the cancers most affected by poor diet were:

Colon cancer (65% of cases)

Mouth and throat cancer (18% of cases)

Endometrial cancer (4.0% of cases)

Breast cancer (3.8% of cases)

When the diet was broken down into individual food groups:

Low intake of whole grains was associated with the largest number of preventable cancer cases (35% of cases). This was followed by.

Low intake of dairy foods (22% of cases).

High intake of processed meats (18% of cases).

Low intake of vegetables (16% of cases).

Low intake of fruits (10% of cases).

High intake of red meat (7.1% of cases).

High intake of sugar sweetened beverages (4.0% of cases).

Of the diet-associated cancer cases, the scientists who lead the study estimated that 84% of them represented a direct effect of diet on cancer risk. The dietary factors most likely to directly increase the risk of cancer were:

Low intake of whole grains.
Low intake of dairy foods.
High intake of processed meats.

The scientists estimated that 16% of diet-associated cancer cases were “mediated by obesity”. In layman’s terms, this means that diet increased the risk of obesity and obesity increased the risk of cancer. The dietary factors most likely to increase the risk of obesity-mediated cancers were:

High intake of sugar sweetened beverages.
Low intake of fruits.

The authors concluded: “More than 80,000 new cancer cases [per year] are estimated to be associated with suboptimal diet among US adults…Our findings underscore the need for reducing cancer burden in the United States by improving the intake of key food groups and nutrients of Americans.”

What Does This Mean For You?

These findings aren’t novel. Many previous studies have come to the same conclusions. However, many people find these recommendations to be confusing. Should they increase their intake of certain foods? Should they follow some sort of magic diet?

Perhaps we need to get away from the magic food concept. We need to understand that every time we increase one food in our diet, we exclude other foods. We need to step back and look at the overall diet.

Let me break down the recommendations from this study into three categories: foods we should eliminate from our diet, foods we should include in our diet, and foods we should balance in our diet.

Foods we should eliminate from our diet:

Sugar Sweetened Beverages. They provide no nutritional benefit, and the sugar in most beverages rushes into our bloodstream and overwhelms our body’s ability to utilize it in a healthy way. This leads to obesity, diabetes, and a host of other health issues.

- Public enemy number one is sodas. However, this category also includes fruit juices, sweetened teas and energy drinks, and sugary processed foods.

- This category also includes diet sodas. For reasons we don’t completely understand, diet sodas appear to be just as likely to lead to obesity, diabetes, and heart disease as sugar sweetened sodas. I have discussed the proposed explanations of this phenomenon in a recent issue of “Health Tips From the Professor”.

- Sugar, however, is not the enemy. Sugar found naturally in fruits and other whole foods enters the bloodstream slowly and is metabolized in healthy ways by the body. I have discussed this in another issue of “Health Tips From the Professor”. This is what I mean by restoring balance in our diet. Decreasing the sugar intake from sugar sweetened beverages and increasing sugar intake from fruits is associated with a decreased risk of obesity and obesity-related cancers.

Processed Meats. The evidence is overwhelming at this point that processed meats directly increase the risk of cancer.

- If you have trouble completely eliminating processed meats from your diet, my advice is to minimize them and consume them only in the context of an overall healthy diet. Personally, I still consume bacon occasionally as flavoring for a healthy green salad.

Foods we should include in our diet. I put these in a separate category because Dr. Strangelove and his colleagues have been telling us to eliminate them from our diet, and many Americans are following those recommendations:

Whole grains. We can think of whole grains as the underserving victim of the low-carb craze. The low-carb craze is on the mark when it comes to eliminating added sugars and refined grains from the diet. However, eliminating whole grains from the diet may be doing more harm than good. In fact, this and other studies suggest that whole grains are the most effective foods for reducing cancer risk. Why is that?

- If we assume whole grains are just a good source of fiber and a few vitamins and minerals, it is hard to grasp their importance. We could easily get those nutrients elsewhere.

- However, we are beginning to realize that whole grains play a unique role in supporting certain species of gut bacteria that are very beneficial to our health. In short, whole grains may be essential for a healthy gut.

Dairy Foods. This is another food that has been treated as a villain by Dr. Strangelove and his many colleagues. However, for reasons we don’t completely understand, dairy foods appear to decrease the risk of heart disease and cancer.

Foods we should balance in our diet.

Red Meat. Diets high in red meat are consistently associated with a slight increase in cancer risk. The World Health Organization lists red meat as a probable carcinogen, but that has proven to be controversial.

- Much of the research has centered on why red meat causes cancer. Several mechanisms have been proposed, but none of them have been proven.

- In contrast, very little consideration has been given to what red meat is displacing from the diet. Diets high in red meat are often low in whole grains, fruits and/or vegetables.

- Perhaps instead of eliminating red meat from our diets we should be talking about balancing red meat in our diets by consuming less red meat and more whole grains, fruits, and vegetables.

What Can You Do To Reduce Cancer Risk?

You may have been thinking that 80,110 cases/year represents a small percentage of new cancer cases. That’s because diet is only one component of a holistic cancer prevention strategy. Here is what the American Cancer Society recommends for reducing cancer risk:

Avoid tobacco.

Limit sun exposure.

Achieve and maintain a healthy weight.

Eat a healthy diet, with an emphasis on plant foods (Their recommendations are in line with this study).

Be physically active.

Limit alcohol use.

Get vaccinated against HPV.

Get regular medical checkups.

Doing any of these things will reduce your cancer risk. But the more of these you can incorporate into your lifestyle, the lower your risk.

The Bottom Line

A recent study looked at diet and cancer risk. The authors reported that 80,110 new cancer cases among US adults 20 and older could be primarily attributed to poor diet.

When the diet was broken down into individual food groups:

Low intake of whole grains was associated with the largest number of preventable cancer cases. This was followed in descending order by.

Low intake of dairy foods.

High intake of processed meats.

Low intake of vegetables.

Low intake of fruits.

High intake of red meat.

High intake of sugar sweetened beverages.

For more details, read the article above. For example, I discuss which foods we should eliminate, which foods we should eat more of, and which foods we should balance in our diet. To add a more holistic perspective, I also discuss the American Cancer Society’s recommendations for reducing cancer risk.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Which Foods Affect Stroke Risk?

March 24, 2020 by Dr. Steve Chaney

Why Is Diet And Stroke Risk So Confusing?

One day we are told vegetarian diets reduce our stroke risk. The next day we are told they increase stroke risk. It’s the same with red meat, dairy, and eggs. We keep getting mixed messages. It’s enough to make your head spin. Why is diet and stroke risk so confusing?

Part of the problem is that there are two distinct types of stroke. The technical names for them are ischemic stroke and hemorrhagic stroke.

An ischemic stroke occurs when an artery in the brain becomes blocked, shutting off blood flow and damaging part of the brain. This is usually caused by the gradual buildup of fatty deposits and cholesterol plaques in the arteries. When a blood clot forms and lodges in one of the narrowed arteries leading to the brain, an ischemic stroke occurs.

Ischemic strokes account for 87% of all strokes.

Ischemic strokes are associated with obesity, elevated cholesterol, diabetes, high blood pressure, and smoking.

A hemorrhagic stroke occurs when a weakened blood vessel bursts and bleeds into the surrounding region of the brain. Because our brains are surrounded by a protective skull, that blood has nowhere to go. Pressure from the buildup of blood damages brain cells in the vicinity of the bleed.

Hemorrhagic strokes account for only for only 15% of strokes but are responsible for 40% of stroke deaths.

The most common cause of a hemorrhagic stroke is the localized enlargement of a blood vessel due to chronic high blood pressure. This weakens the wall of the blood vessel, making it prone to rupturing.

Part of the confusion about diet and stroke risk is because many earlier studies did not distinguish between the two types of stroke.

If the studies just measured the incidence of stroke, the data were dominated by ischemic strokes (87% of strokes are ischemic).

However, if the studies focused on stroke deaths, hemorrhagic stroke made a larger contribution to the data set (40% of stroke deaths are hemorrhagic).

Fortunately, recent studies have started to focus on the effect of diet on ischemic and hemorrhagic strokes separately. However, many of those studies have been too small to accurately assess the effects of diet on hemorrhagic stroke.

The latest study (TYN Tong et al, European Heart Journal, ehaa007, published February 24, 2020) is one of the largest studies to look at the effect of diet on both kinds of stroke. It has enough patients in the hemorrhagic group to get an accurate estimate of the effect of diet on hemorrhagic stroke.

How Was The Study Done?

This study analyzed data on diet and stroke from 418,329 participants in the EPIC (European Prospective Investigation into Cancer and Nutrition). Although the study has cancer in the title, it actually investigated the effect of nutrition on multiple diseases (Presumably, the study title was chosen because EPIC is a more appealing acronym than EPID (European Prospective Investigation into Diseases and Nutrition)).

The participants were recruited from 9 European countries (Denmark, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the UK). The average age of participants was 50, and they were followed for an average of 12.7 years.

At the beginning of the study participants completed country-specific dietary and lifestyle questionnaires.

The dietary assessment was a food frequency questionnaire that asked participants about their dietary intake for the year prior to enrollment in the study. The food frequency data were used to estimate daily intake of red meat, processed meat, poultry, fish, dairy products, eggs, grains, fruits, vegetables, legumes, nuts, seeds, and dietary fiber (It measured total fiber and fiber from grains, fruits and vegetables individually).

The outcome measured was the incidence of ischemic and hemorrhagic strokes during the 12.7-year follow-up.

Which Foods Affect Stroke Risk?

For ischemic stroke:

Each 200 gram/day increase in consumption of fruits and vegetables decreased ischemic stroke risk by 13% (200 grams roughly corresponds to one large apple or one large orange without the skin).

Each 10 gram/day increase in consumption of fiber decreased ischemic stroke risk by 23%. Most of this decreased stroke risk was due to fiber from whole grains, fruits, and vegetables.

- Each 4 gram/day increase in fiber from whole grains decreased ischemic stroke risk by 10%.

- Each 4 gram/day increase in fiber from fruits and vegetables decreased ischemic stroke risk by 12%.

Dairy foods decreased ischemic stroke risk with the following breakdown:

- Each cup of milk decreased ischemic stroke risk by 5%.

- Each half cup of yogurt decreased ischemic stroke risk by 9%.

- Each ounce of cheese decreased ischemic stroke risk by 12%.

Each 50 grams/day (2 ounces) of red meat increased ischemic stroke risk by 14%.

- However, red meat was only half as likely to increase risk of ischemic stroke when the diet was also rich in fruits, vegetables, whole grains, and legumes.

For hemorrhagic stroke:

Each 20 gram/day increase in consumption of eggs increased hemorrhagic stroke risk by 25% (20 grams roughly corresponds to about 1/2 of a small egg or 1/3 of a jumbo egg).

This study did not measure the effect of salt intake on hemorrhagic stroke risk.

No other foods measured in this study had a significant effect on hemorrhagic stroke risk.

However, hemorrhagic stroke is highly associated with high blood pressure. When we look at the influence of foods on high blood pressure, here are the Harvard School of Medicine recommendations for keeping blood pressure low:

Eat more fish, nuts and beans in place of high-fat meats.

Choose fruits and vegetables instead of sugary, salty snacks and desserts.

Select whole grains rather than refined grains.Eat fruit instead of drinking fruit juice.

Use unsaturated fats like olive, canola, soybean, peanut, corn or safflower oils instead of butter, coconut oil, or palm-kernel oil.

Use herbs, spices, vinegar, and other low-sodium flavorings instead of salt; Choose low-sodium foods whenever possible.

Why Is Diet And Stroke Risk So Confusing?

As I mentioned at the start of this article, part of the reason that the headlines about diet and stroke risk are so confusing is:

Many studies did not distinguish between the two types of stroke.

Other studies were too small to reliably estimate the effect of food on hemorrhagic stroke risk.

However, there are still some unexplained inconsistencies among recently published studies. It is these inconsistencies I would like to address. For example:

1) In a recent issue of Health Tips From the Professor I reported on a major study (500,000 people followed for 8.9 years) in China. That study came to the opposite conclusion about eggs and risk of hemorrhagic than the EPIC study I discussed above. It found:

People consuming one egg per day had a 26% decrease in hemorrhagic stroke risk and a 28% decrease in hemorrhagic stroke deaths compared to people who never or rarely consumed eggs.

In other words, the two studies came to opposite conclusions. In the China study eggs decreased risk of hemorrhagic stroke. In the European study (EPIC) eggs increased risk of hemorrhagic stroke. The reason for this discrepancy is not clear, but one can speculate it might be explained by differences in the underlying diets of the two countries:

In China the diet is primarily plant-based. The addition of an egg/day may provide needed protein, fat, and cholesterol (Some cholesterol is essential. We just overdo it in this country).

In Europe the diet is already high in protein, saturated fat, and cholesterol. Getting more of them from eggs may not be such a good thing.

In short, if your diet is primarily plant-based, the addition of an egg/day may be a good thing. However, if your diet is already high in meat, saturated fat, and cholesterol, the addition of an egg/day may not be a good thing.

2) In another recent issue of Health Tips From the Professor I reported on the EPIC-Oxford study that claimed vegetarians had 20% increased risk of hemorrhagic stroke compared to meat eaters.

Interestingly, the EPIC-Oxford study represented a very small portion (~10%) of the overall EPIC study and differed from the rest of the EPIC study in two important ways.

It looked at the effect of diets rather than foods on stroke risk.

Oxford was the only one of the 22 research centers involved in the EPIC study to invite people following a vegetarian diet to enroll in the study, so it had a much higher proportion of vegetarians than other centers that participated in the study.

The current study did not find any evidence that fruits, vegetables, nuts, seeds, beans, or whole grains influenced the risk of hemorrhagic stroke. In other words, in this much larger data set there was no evidence that the foods associated with a vegetarian diet increased hemorrhagic stroke risk.

However, most of the participants in larger EPIC study were also eating meats. They were not following a pure vegetarian diet.

As I said previously, “If the data on hemorrhagic stroke risk in the EPIC-Oxford study are true, it suggests it may not be a good idea to completely eliminate meat from our diet. However, you don’t need to add much meat to a vegetarian diet. The fish eaters in this study were consuming 1.4 ounces of fish per day. That was enough to eliminate the increased risk of hemorrhagic stroke.”

What Does This Mean For You?

For ischemic stroke (blockage of blood flow to the brain), which is the most common form of stroke, the data are clear cut:

Fruits, vegetables, whole grains and dairy foods are good for you. (Your mother was right.)

Red meat is not so good for you. However, the bad effect of red meat on ischemic stroke risk can be reduced by including plenty of fruits, vegetables, and whole grains in your diet.

These conclusions are consistent with multiple previous studies, and the mechanisms of these effects are well established.

For hemorrhagic stroke (bleeding from a weakened blood vessel in the brain) the data are not as clear cut.

If you are consuming a primarily plant-based diet, eggs appear to reduce your risk of hemorrhagic stroke.

If you are consuming a diet with lots of meat, saturated fat, and cholesterol, adding eggs may increase your risk of hemorrhagic stroke.

A vegetarian diet may increase your risk of hemorrhagic stroke. But you don’t need to add much meat to a vegetarian diet. Consuming 1.4 ounces of fish per day appears to be enough to eliminate the increased risk of hemorrhagic stroke.

The mechanisms of these effects of food on hemorrhagic stroke are unclear, so these conclusions may be modified by subsequent studies.

In terms of an overall take-home lesson on diet and stroke risk, my advice is: “A primarily plant-based diet is a good idea, but you don’t need to become a vegan purist. Nor do you want to follow fad diets that eliminate whole food groups. We have 5 food groups for a reason. Eliminating any of them may not be a good idea.”

The Bottom Line

A recent study examined the effect of various foods on the risk of the two major forms of stroke.

For ischemic stroke (blockage of blood flow to the brain), which is the most common form of stroke, the data are clear cut:

Fruits, vegetables, whole grains and dairy foods are good for you. (Your mother was right.)

Red meat is not so good for you. However, the bad effect of red meat on ischemic stroke risk can be reduced by including plenty of fruits, vegetables, and whole grains in your diet.

These conclusions are consistent with multiple previous studies, and the mechanisms of these effects are well established.

For hemorrhagic stroke (bleeding from a weakened blood vessel in the brain) the data are not as clear cut.

If you are consuming a primarily plant-based diet, eggs appear to reduce your risk of hemorrhagic stroke.

If you are consuming a diet with lots of meat, saturated fat, and cholesterol, adding eggs may increase your risk of hemorrhagic stroke.

A vegetarian diet may increase your risk of hemorrhagic stroke. But you don’t need to add much meat to a vegetarian diet. Consuming 1.4 ounces of fish per day appears to be enough to eliminate the increased risk of hemorrhagic stroke.

The mechanisms of these effects of food on hemorrhagic stroke are unclear, so these conclusions may be modified by subsequent studies.

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Does Diet Affect Sperm Quality?

March 3, 2020 by Dr. Steve Chaney

Do Real Men Eat Meat?

Meat has a certain mystique among some men. They believe real men eat meat, especially red meat. The belief is that eating red meat makes them bigger, stronger, and more virile. In that world view, vegetarianism is effeminate.

How much of that is true? Let’s start by looking at the bigger and stronger part:

Animal proteins are higher in the branched chain amino acids, especially leucine, which help drive the increase in muscle mass associated with exercise. However, meat protein is digested slowly.

Milk protein is also high in branched chain amino acids and is digested more quickly. That’s why many body building supplements are whey protein based.

In addition, leucine is now being added to some of the plant protein supplements. Those supplements are often as effective as whey protein supplements at driving the increase in muscle mass associated with exercise

But what about virility? Does meat make men more virile? Fortunately, we now have an answer to these questions. A recent study (L Nassan et al., JAMA Network Open, 2020; 3(2) :e1921610) has looked at the effect of diet on sperm count and sperm quality.

How Was The Study Done?

In Denmark, all men are required to undergo a physical examination around age 18 to determine their fitness for military service. Research staff at the University Department of Growth and Reproduction at Rigshospitalet in Copenhagen approached young men undergoing their physical exams and invited them to participate in this study.

The men filled in a food frequency questionnaire, answered questions about their lifestyle and medical history and provided semen and blood samples for the study prior to undergoing their physical exam. 2935 men who were unaware of their fertility status and not using anabolic steroids were included in the data analysis.

The average age of participants in the study was 19 and 78% of them were of normal body weight.

The participants were divided into four groups based on their diet:

1. Western Diet characterized by a higher intake of pizza, French fries, processed and red meats, snacks, refined grains, sugary beverages and sweets.

2. Danish Diet characterized by a higher intake of cold processed meats, whole grains, fruits, mayonnaise, cold fish, condiments, and dairy.

3. Vegetarian Diet characterized by a higher intake of vegetables, soymilk, and eggs, without red meat or chicken.

4. Prudent (Healthy) Diet characterized by a higher intake of fish, chicken, vegetables, fruit, nuts, and water.

The effect of these diets on sperm count and sperm quality were compared.

Does Diet Affect Sperm Quality?

When the authors measured sperm counts in the study participants, the results were as follows:

Greatest adherence to a prudent diet resulted in a sperm count of 167 million.

Greatest adherence to a vegetarian diet resulted in a sperm count of 151 million.

Greatest adherence to a Danish diet resulted in a sperm count of 146 million.

Greatest adherence to a Western diet resulted in a sperm count of only 122 million -27% lower than for men eating a prudent diet.

Similar results were reported for measure of sperm quality, such as sperm motility (how fast the sperm can swim) and normal sperm morphology (sperm without visible defects).

These results are similar to several earlier studies showing that men eating a healthy diet have greater sperm count and sperm quality.

The authors concluded: “Our findings support the evidence that adhering to generally healthy diet patterns is associated with better semen quality and more favorable markers of testicular function. Because diet is modifiable, these results suggest the possibility of using dietary intervention as a potential approach to improving testicular function in men of reproductive age.”

Do Real Men Eat Meat?

Now it is time to come back to the original question, “Do real men eat meat”. Or more specifically, does red meat consumption increase virility? Of course, the whole question of whether a single food affects virility, or any other aspect of manliness, is bogus.

Individual foods don’t affect our health. Diets do. So, let’s review how diets affect men’s sperm count and sperm quality.

The highest sperm count and sperm quality was associated with the prudent diet. This diet relied primarily on fish and chicken as protein sources but did not exclude red meat. It was also a diet high in vegetables, fruits, nuts, and water (in place of sugary beverages).

The second highest sperm count and sperm quality was associated with the vegetarian diet. This diet relied on beans and eggs as the primary protein sources. It specifically excluded red meat and chicken but did not exclude fish. It was also high in fruits and nuts. Soy milk, tea, and coffee were the main beverages.

The third highest sperm count and sperm quality was associated with the Danish diet. This diet relied on cold processed meats (some of which were red meats), cold fish, and dairy for protein. However, it also was rich in whole grains and fruits. Water and sugary beverages were consumed in equal proportions.

The lowest sperm count and sperm quality was associated with the Western diet. This diet relied on red and processed meats as the primary protein source. However, it was also high in refined grains, snacks, sugary beverages, sweets, and junk foods.

So, if we are using sperm count and sperm quality as a measure of virility, it is clear that real men don’t eat red meat. Or put another way, a diet rich in red meat is more likely to reduce sperm count and sperm quality than it is to increase it.

However, a small amount of red meat as part of an overall healthy diet can be consistent with good sperm count and quality.

In short, diet does affect sperm quality. For example, based on this study:

An 8-ounce steak with French fries, cherry pie, and a soft drink (or, in our part of the country, sweet tea) may not be good for your sex life.

If you don’t want to give up red meat, a better choice might be 3-ounces of steak in a vegetable stir fry, fruit for dessert, and water or tea as your beverage.

If you want to maximize sperm count and sperm quality, an even better choice would be chicken, fish, or beans with vegetables, fruit for dessert, and water or tea as your beverage.

The Bottom Line

Meat has a certain mystique among some men. They believe real men eat meat, especially red meat. The belief is that eating red meat makes them bigger, stronger, and more virile.

How much of that is true. We already know that meat has no magical power to make men bigger and stronger. But what about virility? Does meat make men more virile? Fortunately, we now have an answer to that question. A recent study has looked at the effect of diet on sperm count and sperm quality.

The highest sperm count and quality was associated with a prudent diet. This diet relied primarily on fish and chicken as protein sources but did not exclude red meat. It was also a diet rich in vegetables, fruits, nuts, and water (in place of sugary beverages). In other words, it was a healthy diet.

The lowest sperm count and quality was associated with the Western diet. This is a diet that relies on red and processed meats as the primary protein source. However, it is also high in refined grains, snacks, sugary beverages, sweets, and junk foods.

However, a small amount of red meat as part of an overall healthy diet can be consistent with good sperm count and sperm quality.

In short, it appears that diet does affect sperm quality:

An 8-ounce steak with French fries, cherry pie, and a soft drink (or, in our part of the country, sweet tea) may not be good for your sex life.

If you don’t want to give up red meat, a better choice might be 3-ounces of steak in a vegetable stir fry, fruit for dessert, and water or tea as your beverage.

If you want to maximize sperm count and sperm quality, an even better choice would be chicken, fish, or beans with vegetables, fruit for dessert, and water or tea as your beverage.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.