nuts Archives - Health Tips From The Professor

Does Red Meat Cause Frailty In Older Women?

May 31, 2022 by Dr. Steve Chaney

Which Proteins Are Best?

Author: Dr. Stephen Chaney

The ads from the meat lobby say, “Red meat does a body good”. Are the ads true?

If we consider the health consequences of regularly eating red meat, the answer appears to be a clear, “No”. Multiple studies have shown a link between red meat consumption and:

Coronary heart disease.
Stroke
Type 2 diabetes.
Colon cancer, prostate cancer, and breast cancer.

And, if we consider the environmental consequences of red meat production, the answer also appears to be, “No”. I have discussed this in a recent issue of “Health Tips From the Professor”.

But what about muscle mass and strength? Red meat is a rich source of protein, and we associate meat consumption with an increase in muscle mass. Surely, red meat consumption must help us build muscle mass and strength when we are young and preserve muscle mass and strength as we age.

This is why the recent headlines claiming that red meat consumption increases the risk of frailty in older women were so confusing. I, like you, found those headlines to be counterintuitive. So, I have investigated the study (EA Struijk et al, Journal of Cachexia, Sarcopenia and Muscle, 13: 210-219, 2022) behind the headlines. Here is what I found.

How Was The Study Done?

This study utilized data acquired from the Nurses’ Health Study (NHS). The NHS began in 1976 with 121,700 female nurses aged 30 to 55. This study followed 85,871 nurses in the NHS once they reached age 60 for an average of 14 years.

Dietary intake was assessed using a food frequency questionnaire that was administered to all participants in the study every four years between 1980 and 2010. The long-term intake of red meat and other protein sources was based on a cumulative average of all available diet questionnaires for each participant.

The participants also filled out a Medical Outcomes Short Report every four years between 1992 and 2014. Data from this survey was used to calculate something called the FRAIL scale, which includes the following frailty criteria:

Fatigue

Low muscle strength.

Reduced aerobic capacity.

Having ≥5 of the following chronic diseases:

- Cancer
- High blood pressure
- Type 2 diabetes
- Angina
- Myocardial infarction (heart attack)
- Congestive heart failure
- Asthma
- COPD (chronic obstructive pulmonary disease)
- Arthritis
- Parkinson’s disease
- Kidney disease
- Depression

Greater than ≥5% weight loss in two consecutive assessments.

Frailty was defined as having met 3 or more criteria in the FRAIL scale. The study looked at the effect of habitual consumption of red meat or other protein sources on the development of frailty during the 14-year follow-up period.

Does Red Meat Cause Frailty In Older Women?

The investigators separated the participants into 5 quintiles based on total red meat consumption, unprocessed red meat construction, or processed red meat consumption. The range of intakes was as follows.

Total red meat: 0.4 servings per day to 1.8 servings per day.

Unprocessed red meat: 0.3 servings per day to 1.3 servings per day.

Processed red meat: 0.04 servings per day to 0.6 servings per day.

Clearly none of the women in this study were consuming either vegan or keto diets. As might be expected from a cross-section of the American public, there was a fairly narrow range of daily meat consumption.

Here are the results of the study:

Each serving per day of total red meat increased frailty by 13%.

Each serving per day of unprocessed red meat increased frailty by 8%.

Each serving per day of processed red meat increased frailty by 26%.

When each component of the frailty index was examined individually, all of them were positively associated with red meat consumption except for weight loss.

This was perhaps the most unexpected finding of the study. Not only did red meat consumption increased the risk of chronic diseases in these women, which would be expected from many previous studies. But red meat consumption also made these women more tired, weaker, and shorter of breath.

The authors concluded, “Habitual consumption of any type of red meat was associated with a higher risk of frailty.”

Which Proteins Are Best?

The investigators then asked if replacing one serving/day of red meat with other protein sources was associated with a significantly lower risk of frailty. Here is what they found:

Replacing one serving per day of unprocessed red meat with a serving of:

- Fish reduced frailty risk by 22%.

- Nuts reduced frailty risk by 14%.

Replacing one serving per day of processed red meat with a serving of:

- Fish reduced frailty risk by 33%

- Nuts reduced frailty risk by 26%

- Low-fat dairy reduced frailty risk by 16%

- Legumes reduced frailty risk by 13%.

The authors concluded, “Replacing red meat with another source of protein including fish, nuts, legumes, and low-fat dairy may be encouraged to reduce the risk of developing frailty syndrome. These findings are in line with dietary guidelines promoting diets that emphasize plant-based sources of protein.” [I would note that fish and low-fat dairy are hardly plant-based protein sources.]

What Does This Study Mean For You?

I am not yet ready to jump on the “eating red meat causes frailty” bandwagon. This is a very large, well-designed study, but it is a single study. It needs to be replicated by future studies.

And, as a biochemist, I am skeptical about any study that does not offer a clear metabolic rationale for the results. As I said earlier, increased protein intake is usually associated with an increase in muscle mass when we are young and a preservation of muscle mass as we age. There is no obvious metabolic explanation for why an increase in red meat consumption in older women would cause a decrease in muscle mass and other symptoms of frailty.

On the other hand, there are plenty of well documented reasons for decreasing red meat intake. Consumption of red meat is bad for our health and bad for the health of the planet as I have discussed in an earlier issue of “Health Tips From the Professor”. And substituting other protein sources, especially plant proteins, is better for our health and the health of our planet.

Finally, we also need to consider the possibility that this study is correct and that future studies will confirm these findings. Stranger things have happened.

As we age, we begin to lose muscle mass, a process called sarcopenia. Increased protein intake and resistance exercise can help slow this process. While I am not ready to say that red meat causes decreased muscle mass, I do think this study should make us think about which protein sources we use to prevent sarcopenia. At the very least we should not use age-related muscle loss as an excuse to increase our red meat intake. That might just be counterproductive.

The Bottom Line

A recent study looked at the effect of red meat consumption on frailty in older women. It came to the unexpected conclusion that:

Each serving per day of total red meat increased frailty by 13%.

Each serving per day of unprocessed red meat increased frailty by 8%.

Each serving per day of processed red meat increased frailty by 26%.

The increase in frailty could be reduced by replacing one serving/day of red meat with a serving of fish, nuts, low-fat dairy, or legumes.

I am not yet ready to jump on the “eating red meat causes frailty” bandwagon. This is a very large, well-designed study, but it is a single study. It needs to be replicated by future studies. And, as a biochemist, I am skeptical about any study that does not offer a clear metabolic rationale for the results.

On the other hand, there are plenty of well documented reasons for decreasing red meat intake. Consumption of red meat is bad for our health and for the health of the planet.

Finally, we also need to consider the possibility that this study is correct and that future studies will confirm these findings. Stranger things have happened.

As we age, we begin to lose muscle mass, a process called sarcopenia. Increased protein intake and resistance exercise can help slow this process. This study should make us think about which protein sources we use to prevent sarcopenia. At the very least we should not use age-related muscle loss as an excuse to increase our red meat intake. That might just be counterproductive.

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 Diet Add Years To Your Life?

April 5, 2022 by Dr. Steve Chaney

Which Foods Have The Biggest Effect On Longevity?

Author: Dr. Stephen Chaney

Everyone over 50 is searching for the elusive “Fountain Of Youth”.

We want to look younger.

We want to feel younger.

We want the energy we had in our 20s.

We want to be rid of the diseases of aging.

The list goes on!

But how do we do that? Pills and potions abound that claim to reverse the aging process. Most just reverse your wallet.

Should we train for marathons or bodybuilding contests?

Should we meditate or do yoga to relieve stress?

Should we get serious about losing weight?

Should we get more sleep?

Is there some miracle diet that can slow the aging process?

All the above probably slow the aging process, but the evidence is best for the effect of diet on aging. Several recent meta-analyses have looked at the effect of diet on the risk of premature deaths. In this issue of “Health Tips From the Professor” I review a study (LT Fadnes et al, PLoS Medicine, February 8, 2022) that combines the best of these meta-analyses into a single database and provides a provocative insight into the effect of diet on longevity.

How Was This Study Done?

This study combined data from recent meta-analyses looking at the impact of various food groups on the risk of premature deaths with the Global Burden of Disease Study which provides population-level estimates of life years lost due to dietary risk factors.

The authors then developed a new algorithm that allowed them to estimate how different diets affect sex- and age-specific life expectancy.

They divided the population into three different diet categories based on their intake of whole grains, vegetables, fruits, nuts, legumes, fish, eggs, dairy, refined grains, red meat, processed meat, white meat, sugar-sweetened beverages, and added plant oils. The diet categories were:

Typical Western Diet (TW). This diet was based on average consumption data from the United States and Europe. This was their baseline.

Optimal diet (OD). This diet is similar to a vegan or semi-vegetarian diet. However, it was not a purely vegan diet nor a purely semi-vegetarian diet. Instead, it represented the best diet people in this study were consuming.

Feasibility diet (FA). This diet recognizes that few people are willing to make the kind of changes required to attain an optimal diet. It is halfway between the Typical Western Diet and the Optimal Diet.

To help you understand these diets based on the foods the study participants were eating, here are the comparisons in terms of daily servings:

Food	TW Diet	FA Diet	OD Diet
Whole grains	1.5 servings	4.3 servings	7 servings
Vegetables	3 servings	4 servings	5 servings
Fruits	2.5 servings	3.75 servings	5 servings
Nuts	0 serving*	0.5 serving*	1 serving*
Legumes	0 serving**	0.5 serving**	1 serving**
Fish	0.25 serving	0.5 serving	1 serving
Eggs	1 egg	0.75 egg	0.5 egg
Dairy	1.5 servings	1.25 servings	1 serving
Refined grains	3 servings	2 servings	1 serving
Red meat	1 serving	0.5 serving	0 serving
Processed meat	2 servings	1 serving	0 serving
White meat	0.75 serving	0.6 serving	0 serving
Sugar-sweetened beverages	17 oz	8.5 oz	0 oz
Added plant oils	2 tsp	2 tsp	2 tsp

*1 serving = 1 handful of nuts

**1 serving = 1 cup of beans, lentils, or peas

Using their algorithm, the authors asked what the effect on longevity would be if people changed from a typical western diet to one of the other diets at age 20, 60, or 80 and maintained the new diet for at least 10 years. The 10-year requirement is based on previous studies showing that it takes around 10 years for dietary changes to affect the major killer diseases like heart disease, cancer, or diabetes.

Finally, the authors improved the accuracy of their estimates of the effect of diet on longevity by taking into account the quality of each study included in their analysis. I will discuss the importance of this below.

Can Diet Add Years To Your Life?

The results were impressive.

The authors estimated that if people in the United States were to change from a typical western diet to an “optimal diet” and maintain it for at least 10 years,

…starting at age 20, men would live 13 years longer and women would live 10.7 years longer.

…starting at age 60, men would live 8.8 years longer and women would live 8 years longer.

…starting at age 80, both men and women would live 3.4 years longer.

But what if you weren’t a vegan purist? What if you only made half the changes you would need to make to optimize your diet? The news was still good.

The authors estimated that people in the United States were to change from a typical western diet to a “feasibility diet” and maintain it for at least 10 years,

…starting at age 20, men would live 7.3 years longer and women would live 6.2 years longer.

…starting at age 60, men would live 4.8 years longer and women would live 4.5 years longer.

…starting at age 80, both men and women would live ~2 years longer.

The authors concluded, “A sustained dietary change may give substantial health gains for people of all ages for both optimized and feasible [diet] changes. [These health gains] could translate into an increase in life expectancy of more than 10 years. Gains are predicted to be larger the earlier the dietary changes are initiated in life.”

Which Foods Have The Biggest Effect On Longevity?

The algorithm the authors developed also allowed them to look at which foods have the biggest effect on longevity. The authors estimated when changing from a typical western diet to an optimal diet, the greatest gains in longevity were made by eating:

More legumes, whole grains, and nuts, and…

Less red and processed meat.

The authors concluded, “An increase in the intake of legumes, whole grains, and nuts, and a reduction in the intake of red meat and processed meats, contributed most to these gains [in longevity].”

However, this conclusion needs to be interpreted with caution. We also need to recognize that an “optimal diet” was defined as the best diet people in this study were eating. In addition, the effect of different foods on longevity depends on:

The quality of the individual studies with that food, and…

The difference in consumption of that food in going from a western diet to an optimal diet.

For example:

Legumes, whole grains, nuts, red & processed meat made the list because the quality of data was high and the difference in consumption between the typical western diet and optimal diet was significant.

The quality of data for an effect of fruits and vegetables was also high. For example, one major study concluded that consuming 10 servings a day of fruits and vegetables a day reduces premature death by 31% compared to consumption of less than 1 serving a day. However, the difference in consumption of fruits and vegetables between the western and optimal diets in this study was small, so fruits and vegetables didn’t make the list.

Eggs and white meat didn’t make the list because the quality of data was low for those foods. Simply put, that means that there was a large variation in effect of those foods on longevity between studies.

Other foods didn’t make the list because the quality of data was only moderate and/or the difference in intake was small.

So, the best way to interpret this these data is:

This study suggests that consuming more legumes, whole grains, and nuts and less red & processed meats has a significant beneficial effect on health and longevity.

Consuming more fruits and vegetables is likely to have a significant benefit on health and longevity, but you would need to consume more than people did in this study to achieve these benefits. In the words of the authors, “Fruits and vegetables also have a positive health impact, but, for these food groups, the intake in a typical Western diet is closer to the optimal intake than for the other food groups.”

Other foods may impact health and longevity, but the data in this study are not good enough to be confident of an effect.

What Does This Study Mean For You?

This study is the best of many studies showing the benefit of a more plant-based diet on health and longevity. It particularly encouraging because it shows:

You can achieve significant benefit by switching to a more plant-based diet late in life. You get the biggest “bang for your buck” if you switch at age 20. But even making the switch at age 60 or 80 was beneficial.

You don’t need to be a “vegan purist”. While the biggest benefits were seen for people who came close to achieving a vegan or semi-vegetarian diet, people who only made half those changes saw significant benefits.

As I said above, this is a very strong study. However, the underlying data come from association studies, which can have confounding variables that influence the results.

For example, people who eat more plant-based diets tend to weigh less and exercise more. And both of those variables can influence longevity. Each study attempted to statistically correct for those variables, but they still might have a slight influence on the results.

However, I don’t see that as a problem because, in my view, a holistic approach is always best. As illustrated on the right, we should be seeking a lifestyle that includes a healthy diet, weight control, and exercise.

As for supplementation, both the vegan and semi-vegetarian diets tend to leave out whole food groups. Unless you are married to a dietitian, that means your diet is likely to be missing important nutrients.

The Bottom Line

A recent study asked whether changing from the typical western diet to a healthier, more plant-based diet could influence longevity. The results were very encouraging. The study showed that:

Changing to a healthier diet could add up to a decade to your lifespan.

The improvement in lifespan was greatest for those whose diets approached a vegan or semi-vegetarian diet, but a significant improvement in lifespan was seen for people who made only half those dietary improvements.

The improvement in lifespan was greatest for those who switched to a healthier diet in their 20’s, but significant improvements in lifespan were seen for people who didn’t change their diet until their 60’s or 80’s.

In terms of the foods that have the biggest effect on longevity.

This study suggests that consuming more legumes, whole grains, and nuts and less red & processed meats has a significant beneficial effect on health and longevity.

Consuming more fruits and vegetables is likely to have a significant benefit on health and longevity, but you would need to consume more than people did in this study to achieve those benefits.

Other foods may impact health and longevity, but the data in this study are not good enough to be confident of an effect.

An increase in the intake of legumes, whole grains, and nuts, and a reduction in the intake of red meat and processed meats, contributed most to these gains. Fruits and vegetables also have a positive health impact, but, for these food groups, the intake in a typical Western diet is closer to the optimal intake than for the other food groups.”

For more details about this study and what it means for you, 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.

If You Want To Be Green, You Have To Eat Green

April 26, 2021 by Dr. Steve Chaney

What Is The Planetary Diet?

Author: Dr. Stephen Chaney

Earth Day was last Thursday. You have recommitted to saving the planet. You plan to recycle, conserve energy, and turn in your gas guzzler for an energy efficient car. But what about your diet? Is your diet destroying the planet?

This is not a new question, but a recent commission of international scientists has conducted a comprehensive study into our diet and its effect on our health and our environment. Their report (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019) serves as a dire warning of what will happen if we don’t change our ways. I touched on this report briefly in a previous issue of “Health Tips From The Professor”, but this topic is important enough that it deserves an issue all its own.

The commission carefully evaluated diet and food production methods and asked three questions:

Are they good for us?

Are they good for the planet?

Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.

The commission described the typical American diet as a “lose-lose-lose diet”. It is bad for our health. It is bad for the planet. And it is not sustainable.

In its place they carefully designed their version of a primarily plant-based diet they called a “win-win-win diet”. It is good for our health. It is good for the planet. And, it is sustainable.

In their publication they refer to their diet as the “universal healthy reference diet” (What else would you expect from a committee?). However, it has become popularly known as the “Planetary Diet”.

I have spoken before about the importance of a primarily plant-based diet for our health. In that context it is a personal choice. It is optional.

However, this report is a wake-up call. It puts a primarily plant-based diet in an entirely different context. It is essential for the survival of our planet. It is no longer optional.

If you care about our environment…If you care about saving our planet, there is no other choice.

How Was The Study Done?

The study (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019) was the report of the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. This Commission convened 30 of the top experts from across the globe to prepare a science-based evaluation of the effect of diet on both health and sustainable food production through the year 2050. The Commission included world class experts on healthy diets, agricultural methods, climate change, and earth sciences. The Commission reviewed 356 published studies in preparing their report.

If You Want To Be Green, You Need To Eat Green

When they looked at the effect of food production on the environment, the Commission concluded:

“Strong evidence indicates that food production is among the largest drivers of global environmental change.” Specifically, the commission reported:

- Agriculture occupies 40% of global land (58% of that is for pasture use).

- Food production is responsible for 30% of global greenhouse gas emissions and 70% of freshwater use.

- Conversion of natural ecosystems to croplands and pastures is the largest factor causing species to be threatened with extinction. Specifically, 80% of extinction threats to mammals and bird species are due to agricultural practices.

- Overuse and misuse of nitrogen and phosphorous in fertilizers causes eutrophication. In case you are wondering, eutrophication is defined as the process by which a body of water becomes enriched in dissolved nutrients (such as phosphates from commercial fertilizer) that stimulate the growth of algae and other aquatic plant life, usually resulting in the depletion of dissolved oxygen. This creates dead zones in lakes and coastal regions where fish and other marine organisms cannot survive.

- About 60% of world fish stocks are fully fished and more than 30% are overfished. Because of this, catch by global marine fisheries has been declining since 1996.

“Reaching the Paris Agreement of limiting global warming…is not possible by only decarbonizing the global energy systems. Transformation to healthy diets from sustainable food systems is essential to achieving the Paris Agreement.”

The world’s population is expected to increase to 10 billion by 2050. The current system of food production is unsustainable.

When they looked at the effect of the foods we eat on the environment, the Commission concluded:

Beef and lamb are the biggest contributors to greenhouse gas emissions and land use.

- The concern about land use is obvious because of the large amount of pasture land required to raise cattle and sheep.

- The concern about greenhouse gas emissions is because cattle and sheep are ruminants. They not only breathe out CO₂, but they also release methane into the atmosphere from fermentation in their rumens of the food they eat. Methane is a potent greenhouse gas, and it persists in the atmosphere 25 times longer than CO₂. The single most important thing we can do as individuals to reduce greenhouse gas emissions is to eat less beef and lamb. [Note: grass fed cattle produce more greenhouse gas emissions than cattle raised on corn because they require 3 years to bring to market rather than 2 years.]

In terms of energy use beef, lamb, pork, chicken, dairy and eggs all require much more energy to produce than any of the plant foods.

In terms of eutrophication of our lakes and oceans, beef, lamb, and pork, all cause much more eutrophication than any plant food. Dairy and eggs cause more eutrophication than any plant food except fruits.

In contrast, plant crops reduce greenhouse gas emissions by removing CO₂ from the atmosphere.

What Is The Planetary Diet?

In the words of the Commission: “[The Planetary Diet] largely consists of vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils. It includes a low to moderate amount of seafood, poultry, and eggs. It includes no or a very low amount of red meat, processed meat, sugar, refined grains, and starchy vegetables.”

When described in that fashion it sounds very much like other healthy diets such as semi-vegetarian, Mediterranean, DASH, and Flexitarian. However, what truly distinguishes it from the other diets is the restrictions placed on the non-plant portion of the diet to make it both environmentally friendly and sustainable. Here is a more detailed description of the diet:

It starts with a vegetarian diet. Vegetables, fruits, beans, nuts, soy foods, and whole grains are the foundation of the diet.

It allows the option of adding one serving of dairy a day (It turns out that cows produce much less greenhouse emissions per serving of dairy than per serving of beef. That’s because cows take several years to mature before they can be converted to meat, and they are emitting greenhouse gases the entire time).

It allows the option of adding one 3 oz serving of fish or poultry or one egg per day.

It allows the option of swapping seafood, poultry, or egg for a 3 oz serving of red meat no more than once a week. If you want a 12 oz steak, that would be no more than once a month.

This is obviously very different from the way most Americans currently eat. According to the Commission:

“This would require greater than 50% reduction in consumption of unhealthy foods, such as red meat and sugar, and greater than 100% increase in the consumption of healthy foods, such as nuts, fruits, vegetables, and legumes”.

“In addition to the benefits for the environment, “dietary changes from current diets to healthy diets are likely to substantially benefit human health, averting about 10.8-11.6 million deaths per year globally.”

What Else Did The Commission Recommend?

In addition to changes in our diets, the Commission also recommended several changes in the way food is produced. Here are a few of them.

Reduce greenhouse gas emissions from the fuel used to transport food to market.

Reduce food losses and waste by at least 50%.

Make radical improvements in the efficiency of fertilizer and water use. In terms of fertilizer, the change would be two-fold:

- In developed countries, reduce fertilizer use and put in place systems to capture runoff and recycle the phosphorous.

- In third world countries, make fertilizer more available so that crop yields can be increased, something the Commission refer to as eliminating the “yield gap” between third world and developed countries.

Stop the expansion of new agricultural land use into natural ecosystems and put in place policies aimed at restoring and re-foresting degraded land.

Manage the world’s oceans effectively to ensure that fish stocks are used responsibly and global aquaculture (fish farm) production is expanded sustainability.

What we can do: While most of these are government level policies, we can contribute to the first three by reducing personal food waste and purchasing organic produce locally whenever possible.

What Does This Mean For You?

If you are a vegan, you are probably asking why the Commission did not recommend a completely plant-based diet. The answer is that a vegan diet is perfect for the health of our planet. However, the Commission wanted to make a diet that was as consumer-friendly as possible and still meet their goals of a healthy, environmentally friendly, and sustainable diet.

If you are eating a typical American diet or one of the fad diets that encourage meat consumption, you are probably wondering how you can ever make such drastic changes to your diet. The answer is “one step at a time”. If you have read the Forward to my books “Slaying The Food Myths” or “Slaying the Supplement Myths”, you know that my wife and I did not change our diet overnight. Our diet evolved to something very close to the Planetary Diet over a period of years.

The Commission also purposely designed the Planetary Diet so that you “never have to say never” to your favorite foods. Three ounces of red meat a week does not sound like much, but it allows you a juicy steak once a month.

Sometimes you just need to develop a new mindset. As I shared in my books, my father prided himself on grilling the perfect steak. I love steaks, but I decided to set a few parameters. I don’t waste my red meat calories on anything besides filet mignon at a fine restaurant. It must be a special occasion, and someone else must be buying. That limits it to 2-3 times a year. I still get to enjoy good steak, and I stay well within the parameters of the Planetary diet.

Develop your strategy for enjoying some of your favorite foods within the parameters of the Planetary Diet and have fun with it.

The Bottom Line

is your diet destroying the planet? This is not a new question, but a recent commission of international scientists has conducted a comprehensive study into our diet and its effect on our health and our environment. Their report serves as a dire warning of what will happen to us and our planet if we don’t change our ways.

The Commission carefully evaluated diet and food production methods and asked three questions:

Are they good for us?

Are they good for the planet?

Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.

The Commission described the typical American diet as a “lose-lose-lose diet”. It is bad for our health. It is bad for the planet. And it is not sustainable.

In its place they carefully designed their version of a primarily plant-based diet they called a “win-win-win diet”. It is good for our health. It is good for the planet. And, it is sustainable.

The Planetary Diet is similar to other healthy diets such as semi-vegetarian, Mediterranean, DASH, and Flexitarian. However, what truly distinguishes it from the other diets is the restrictions placed on the non-plant portion of the diet to make it both environmentally friendly and sustainable (for details, read the article above).

I have spoken before about the importance of a primarily plant-based diet for our health. In that context it is a personal choice. It is optional.

However, this report is a wake-up call. It puts a primarily plant-based diet in an entirely different context. It is essential for the survival of our planet. It is no longer optional.

If you care about global warming…If you care about saving our planet, there is no other choice.

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.

Are Nuts Good For Your Heart?

September 1, 2020 by Dr. Steve Chaney

Which Nuts Are Best?

Last week I shared an important study about the benefits of replacing some of the animal protein in your diet with plant protein from whole grains. In case you have forgotten, the study showed replacing just 15 grams of the animal protein in your diet with an equivalent amount of protein from whole grains significantly decreased the risk of premature death from cardiovascular disease, stroke, and from all causes.

This was an important study because whole grains have been maligned in recent years. Low carb diets, keto diets, paleo diets, and low-lectin diets all recommend cutting whole grains out of your diet. Dr. Strangelove and his friends have been telling us to avoid whole grains, and too many Americans have been doing just that.

The study I shared last week reminds us that whole grains are good for our hearts. They are a great source of antioxidants, B vitamins, minerals, and phytonutrients. More importantly, they contain a unique type of fiber called resistant starch that supports the growth of heart-healthy gut bacteria. There are a few other foods that are a good source of resistant starch, but they are also on Dr. Strangelove’s “naughty list” of foods to avoid.

Unfortunately, you might have come away from last week’s article thinking that other plant protein sources, like beans, legumes, nuts, and seeds, weren’t important for reducing your risk of heart disease. However, the fact that they didn’t reduce the risk of premature death from heart disease in that study was likely an artifact of the way the study was designed.

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 either beans and legumes or nuts and seeds to provide a statistically valid answer to that question.

To correct any misconceptions from last week’s article I thought it might be valuable to review a study (M Guasch-Ferré et al, Journal Of The American Journal Of Cardiology, 70: 2519-2532) from a few years ago that looked at the effect of nut consumption on the risk of heart disease.

How Was The Study Done?

This study started by combining the data from three major clinical trials:

The first Nurse’s Health Study, which ran from 1980 to 2012,

The second Nurse’s Health Study, which ran from 1991-2013, and

The Health Professional’s Follow-Up Study, which ran from 1986-2012.

These studies combined enrolled 169,310 women and 41,526 men and followed them for an average of 32 years. All the participants were free of heart disease and cancer at the time they were enrolled. The design of these studies was extraordinary.

A detailed food frequency questionnaire was administered every 4 years. This allowed the investigators to calculate cumulative averages of all dietary variables, including nuts. This assured that the effects of nut consumption and diet represented the participant’s average diet over the 32-year duration of the study, not just their diet when they entered the study.

Participants also filled out questionnaires that captured information on disease diagnosis, disease risk factors, medicines taken, weight, and lifestyle characteristics every 2 years with follow-up rates >90%. This allowed the investigators to measure the onset of heart disease for each participant during the study. More importantly, 32 years is long enough to measure the onset of diseases like heart disease, which requires decades to develop.

The primary endpoint of the study was “cardiovascular disease”, which the investigators defined as fatal and non-fatal heart attacks, fatal and non-fatal strokes, and deaths from all types of heart disease. During this study, 14,136 participants developed cardiovascular disease. This was a large enough number for a detailed statistical analysis of the data.

Secondary endpoints were heart disease (fatal and non-fatal heart attacks) and stroke (fatal and non-fatal strokes).

Are Nuts Good For Your Heart?

When the authors compared people who consumed 5 or more one ounce servings of nuts per week with people who never or almost never consumed nuts, they found that nut consumption decreased:

Cardiovascular disease by 14%.

Heart attacks by 20%.

Strokes by a non-significant 2%.

This part of the study merely confirms what other studies have shown. What makes this study unique is that it identifies the relative heart health benefits of different kinds of nuts.

Which Nuts Are Best?

Nuts are an excellent source of vitamins, minerals, phytonutrients, and fiber. But what makes them particularly heart healthy is the healthy fats they provide.

Peanuts (which are actually legumes rather than true nuts) are rich in monounsaturated fats.

Tree nuts in general are an excellent source of polyunsaturated fats.
Walnuts

Walnuts are particularly rich in omega-3 polyunsaturated fats.

When they looked at individual nuts:

Consuming a serving of peanuts (35 peanuts) 2 or more times per week decreased:

- Cardiovascular disease by 13%.

- Heart attacks by 15%.

- Stroke by 10%.

- Peanut butter had no effect on cardiovascular outcomes, probably because many commercial brands of peanut butter add saturated fats to reduce separation of the oil and make their product creamier.

Consuming a serving of tree nuts (12-15 nuts) 2 or more times per week decreased:

- Cardiovascular disease by 15%.

- Heart attacks by 23%.

Consuming a serving of walnuts (14 walnut halves) one or more times per week decreased:

- Cardiovascular disease by 19%.

- Heart attacks by 21%.

- Stroke by 17%.

In case you missed it, walnuts were the superstars of the nut family. One serving/week of walnuts was more effective than two or more servings/week of peanuts or other tree nuts at reducing the risk of heart attacks, stroke, and overall cardiovascular disease. This is probably because walnuts are a particularly good source of omega-3 fats.

[Professor’s note: I include a serving of walnuts with my breakfast every morning.]

The authors concluded: “Findings from 3 large prospective cohort studies indicate that frequent intake of nuts, tree nuts, peanuts, and walnuts was associated with a lower risk of cardiovascular disease, independently from other cardiovascular risk, lifestyle, and dietary factors. Our findings support recommendations of increasing the intake of a variety of nuts as part of healthy dietary patterns to reduce the risk of chronic diseases in the general population.”

What Does This Study Mean For You?

I have consistently shared the evidence that primarily plant-based diets are associated with the best long-term health outcomes, especially when we look at chronic diseases like heart disease, diabetes, and cancer.

I have also consistently shared the message that “We have 5 food groups for a reason”. All 5 food groups are part of a healthy diet.

Unfortunately, Dr. Strangelove and his friends have been telling us that whole grains are bad for us. We should eliminate them from our diet. And too many Americans have been following that advice. That’s why last week’s “Health Tips From the Professor” article reviewed the evidence for heart health benefits from whole grain consumption.

The situation with nuts and seeds is a little different. Most people recognize them as healthy. They just don’t eat enough of them. That’s why this week’s article emphasized the heart health benefits from nut consumption. Here is the take home message I hope you get from this article:

Two or more servings/week of peanuts or tree nuts significantly reduces your risk of heart attack, stroke, and other cardiovascular diseases.

Walnuts are the superstars of the nut family. One serving/week of walnuts (14 walnut halves) was more effective at reducing the risk of heart attack, stroke, and other cardiovascular diseases than two or more servings/week of the other nuts.

This study was based on unprocessed nuts. Nuts coated with salt, sugar, or chocolate probably don’t qualify as heart healthy.

Processed foods made from nuts also may not be heart healthy. For example, peanut butter had no effect at decreasing heart disease risk in this study.

Finally, in closing I want to revisit my statement that “We have 5 food groups for a reason”.

The studies I shared this week and last week show that whole grains and nuts are important components of a heart healthy diet. But it doesn’t stop there.

All plant food groups are part of a heart healthy diet. In previous issues of “Health Tips From the Professor” I have shared studies showing beans, fruits, and vegetables are all important components of a heart healthy diet.

I have also shared recent studies showing that adding small amounts of eggs and dairy may make a vegetarian diet more heart healthy.

Finally, I have shared a study showing that small amounts of red meat can be heart healthy in the context of a primarily plant-based diet such as the Mediterranean diet.

Of course, we are talking about whole food diets. If you include sodas and highly processed foods in the diet, all bets are off.

The Bottom Line

I have also consistently shared the message that “We have 5 food groups for a reason”. All 5 food groups are part of a healthy diet.

The situation with nuts and seeds is a little different. Most people recognize them as healthy. They just don’t eat enough of them. That’s why this week’s article emphasized the heart health benefits of nut consumption. Here is the take home message I hope you get from this article:

Two or more servings/week of peanuts or tree nuts significantly reduces your risk of heart attack, stroke, and other cardiovascular diseases.

Walnuts are the superstars of the nut family. One serving/week of walnuts (14 walnut halves) was more effective at reducing the risk of heart attack, stroke, and other cardiovascular diseases than two or more servings/week of the other nuts.

This study was based on unprocessed nuts. Nuts coated with salt, sugar, or chocolate probably don’t qualify as heart healthy.

Processed foods made from nuts also may not be heart healthy. For example, peanut butter had no effect at decreasing heart disease risk in this study.

Finally, in closing I want to revisit my statement that “We have 5 food groups for a reason”.

The studies I shared this week and last week show that whole grains and nuts are important components of a heart healthy diet. But it doesn’t stop there.

All plant food groups are part of a heart healthy diet. In previous issues of “Health Tips From the Professor” I have shared studies showing beans, fruits, and vegetables are all important components of a heart healthy diet.

I have also shared recent studies showing that adding small amounts of eggs and dairy may make a vegetarian diet more heart healthy.

Finally, I have shared a study showing that small amounts of red meat can be heart healthy in the context of a primarily plant-based diet such as the Mediterranean diet.

Of course, we are talking about whole food diets. If you include sodas and highly processed foods in the diet, all bets are off.

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.

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.