Which Foods Should I Avoid?

What Is Nutritionism?

In Defense Of FoodRecently, 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?

Low Fat LabelSimply 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.”

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”.

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?

Question MarkNow, 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.lowfat

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.

fatty steakRed 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 Sugar Comparisons“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.

Apple With Nutrition LabelI 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.

low carb dietCarbs. 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:how much carbohydrates should we eat aric

  • 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?

Questioning ManNow 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.

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.

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.

Does Fiber Reduce Breast Cancer Risk?

Start Young And Finish Strong

Vegan FoodsThe idea that dietary fiber reduces the risk of breast cancer has been around for a long time. But it is controversial. It has been difficult to prove.

Part of the difficulty arises from what scientists call confounding variables. What do I mean by confounding variables? Let me explain.

A high fiber diet is usually a primarily plant-based diet. Plant foods contain much more than just fiber. They are full of antioxidants and phytonutrients. A primarily plant-based diet is, by definition, low in refined grains. It is usually low in sugar and saturated fat as well.

People who eat primarily plant-based diets are often health conscious. They tend to exercise more, weigh less, and smoke less than the general public.

Each of these things are confounding variables. They could reduce the risk of breast cancer on their own. That confounds (makes it more difficult to interpret) the data. Was the reduction in breast cancer risk due to the high fiber diet or to these factors that go along with a high fiber diet?

It is possible to correct for these confounding variables statistically, but that requires a very large study (a large population group) for the correction to be accurate. Large studies are expensive. Thus, you tend to end up with lots of small studies. And once they have been corrected for confounding variables, small studies give conflicting results. Some show a benefit of fiber. Some do not.

That is why this study (MS Farvid et al, Cancer, DOI: 10.1002/cncr.32816) is important. It is a meta-analysis of 20 clinical studies with almost 2 million women.

How Was The Study Done?

Clinical StudyThe meta-analysis combined data from 20 clinical studies with 1,994,910 women. Fiber intake was calculated from a food frequency questionnaire administered at the beginning of the study for all except one study that used 24-hour dietary records administered at the beginning of the study.

  • Study duration ranged from 2 to 20 years. Nine of the studies (1.37 million women) lasted for 10 years or more.
  • Four studies reported results for premenopausal breast cancer, fifteen studies reported results for postmenopausal breast cancer, and one study reported results for both.

Does Fiber Reduce Breast Cancer Risk?

breast cancerAfter correcting for confounding variables, the results of the study were as follows:

  • When comparing the highest intake with the lowest intake, total fiber consumption was associated with an 8% lower risk of breast cancer.
  • The effect was stronger for premenopausal breast cancer (18%) than for postmenopausal breast cancer (9%).
  • The effect was greater with soluble fiber (10% decreased risk) than for insoluble fiber (7% decreased risk).
    • Note: All plant foods contain a mixture of soluble fiber and insoluble fiber. However, the common foods richest in soluble fiber are fruits, oatmeal, nuts, beans, peas, and lentils.

The authors concluded, “A random-effects meta-analysis of prospective observational studies demonstrated that high total fiber consumption was associated with a reduced risk of breast cancer. This finding was consistent for soluble fiber as well as for women with premenopausal and postmenopausal cancer.”

Start Young And Finish Strong

Mother & Daughter Eating ApplesAn 8% risk reduction doesn’t seem like very much, but the 18% risk reduction in premenopausal breast cancer caught my eye. With a little digging I found a study (MS Farvid et al, Pediatrics 137, March 2016: e20151226) that focused on the effect of fiber intake in young women on their subsequent risk developing both premenopausal and postmenopausal breast cancer. This was, in fact, one of the studies included in the meta-analysis I described above.

This study followed 90,534 women (mean age 36 years) for 20 years. The women competed a food frequency questionnaire at enrollment and every four years thereafter. They also completed a questionnaire about their diet during their teenage years.

When comparing the highest versus the lowest fiber intake:

  • High fiber intake reduced total breast cancer risk by 19%.
    • Postmenopausal breast cancer risk was reduced by 13%.
    • Premenopausal breast cancer risk was reduced by 23%.

Interestingly, only 34% of women who consumed high fiber diets during their teenage years continued to consume high fiber diets as young adults. However, high fiber diets in the teenage years were important. When they looked at teenage diets:

  • High fiber intake reduced total breast cancer risk by 16%.
    • Postmenopausal breast cancer risk was reduced by 15%.
    • Premenopausal breast cancer risk was reduced by 25%.

Other important observations from this study were:

  • There was a 13% decrease in breast cancer risk for every 10 gram increase in fiber intake.
    • 10 grams of fiber is equivalent to one apple plus two slices of 100% whole wheat toast or half a cup of cooked kidney beans plus half a cup of cooked cauliflower or squash.
  • Both soluble fiber (14% decreased risk) and insoluble fiber (20% decreased risk) were effective.
    • In terms of foods, the most significant effects were seen with fruits and vegetables.

The authors concluded, “Our findings support the hypothesis that higher fiber intakes reduce breast cancer risk and suggest that intake during adolescence and early adulthood may be particularly important.”

What Does This Mean For You?

Questioning WomanAs I said before, an 8% decrease in breast cancer risk may not sound like much. You might be tempted to say, “Why bother? Why should I give up my favorite processed and convenience foods and switch to a more whole food, plant-based diet?”

Here are some thoughts to consider:

1) As I mentioned above, there are side benefits to a plant-based diet.

    • Plant based diets have a lower caloric density, so you are less likely to be overweight.
    • Your intake of antioxidants and phytonutrients is increased.
    • Plant foods feed beneficial gut bacteria.
    • Your diet is likely to be lower in sugar, highly processed foods, and saturated fat.

All these factors decrease your risk of developing breast cancer, but they were statistically factored out in calculating the 8% reduction in risk. In other words, the 8% reduction in risk was based on fiber intake only. When you consider all the beneficial effects that accompany a high fiber diet, your actual reduction in risk is likely to be substantially more than 8%.

2) When you consume a high fiber diet, your risk of developing premenopausal breast cancer is decreased by 18%. That is twice the risk reduction seen for postmenopausal breast cancer. This is consistent with several other studies showing the premenopausal breast cancer is more influenced by diet than postmenopausal breast cancer. There are a couple of likely explanations for this.

    • By the time they reach menopause women are more likely to be overweight and some of those fat calls accumulate in breast tissue. Those fat cells continue to produce estrogen after menopause. Even worse, that estrogen is produced right next to the breast cells, where it can do the maximum damage.
    • Mutations accumulate in breast tissue as we age, and some of those mutations increase the risk of breast cancer.

3) When you start consuming a healthy, high fiber diet early in life your risk reduction is much greater (a 13-15% decreased risk of developing postmenopausal breast cancer and a 23-25% decreased risk of developing premenopausal breast cancer). Now, we are talking about numbers that should get your attention!

Plus, these numbers are based on fiber intake only. Once again, when you consider all the other benefits of a high fiber diet, your real risk reduction is likely to be much greater.

In closing I should mention that none of the studies were done with fiber supplements. A fiber supplement may help you be more regular, but there is no evidence that a fiber supplement will reduce your risk of breast cancer.

The Bottom Line

Two recent studies have looked at the effect of fiber intake on the risk of developing breast cancer.

The first study showed that:

  • High fiber diets decreased the overall risk of breast cancer by 8% and the risk of premenopausal breast cancer by 18%.
  • As I describe in the article above, these reductions in risk were based on fiber intake only. If you consider all the side benefits of a high fiber diet, the actual risk reduction is likely to be much greater.

The second study looked at fiber intake during adolescence and early adulthood. It found that when high fiber diets were started early in life:

  • High fiber diets decreased the overall risk of breast cancer by 13-15% and the risk of premenopausal breast cancer by 23-25%.
  • Once again, if you consider all the side benefits of a high fiber diet, the actual risk reduction is likely to be much greater.

The authors of both studies concluded that high fiber diets reduce the risk of developing breast cancer. The risk reduction is greater for premenopausal breast cancer than for postmenopausal breast cancer. Finally, the risk reduction is greatest when high fiber diets are started early in life.

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.

Which Foods Affect Stroke Risk?

Why Is Diet And Stroke Risk So Confusing?

strokeOne 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?

Clinical StudyThis 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?

Heart Healthy DietFor 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.

high blood pressureHowever, 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?

egg confusionAs 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.

Vegan Foods2) 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?

Questioning WomanFor 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.

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.”

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.

 

Is The Impossible Burger Healthy For You?

Is The Impossible Burger Healthy For the Planet?

Vegan BurgerAmericans love their meat. In 2018 we averaged over 200 pounds of meat per person. If we just focus on beef, we eat about 54 pounds per year. That’s equivalent to four quarter pounders a week!

But we are also getting the message that too much meat, especially red meat, may be bad for us. Nearly 40% of us are trying to eat a more plant-based diet.

The problem is that we love the convenience of fast food restaurants, and we love our burgers. Plus, in the past the meatless burgers on the market were, in a word, disappointing. Their taste and texture left something to be desired. You really needed to be committed to a plant-based diet to eat them in place of a regular burger.

That all changed a few years ago with the introduction of the and new generation of meatless burgers – the Impossible Burger and the Beyond Burger. They had the taste and texture of a real burger, but they were completely plant-based. What wasn’t to like?

  • Both companies claimed that their meatless burgers were healthier for the planet than regular burgers. For example, Impossible Food’s mission statement is: “Animal agriculture occupies almost half the land on earth, consumes a quarter of our freshwater, and destroys our ecosystems. So, we’re doing something about it: We’re making meat using plants, so that we never have to use animals again”.
  • Neither company claims their burgers are healthier for you. However, because their burgers are plant-based, the almost universal assumption has been that they are healthier than regular burgers.

Since their introduction they have taken the world by storm. You can find them in almost every supermarket and in many of your favorite fast food restaurants. Now that they are omnipresent, it is perhaps time to step back and take a closer look at this new generation of meatless burgers. In this article, I will ask two questions:

  • Are they healthier for you than regular burgers?
  • Are they healthier for the planet than regular burgers?

For the sake of simplicity, I will focus on the Impossible Burger with occasional comparisons with the Beyond Burger. It is beyond the scope of this article to compare these burgers with the many other meatless burgers that are now starting to flood the marketplace.

What’s In The Impossible Burger?

  • When we think of a burger, the first thing we think of is protein. The Impossible Burger gets its protein from soy, while the Beyond Burger gets its protein from peas.

Coconut OilHowever, soy and pea protein don’t give you the mouth feel, flavor, red color, and texture of a beef burger.

  • The mouth feel of a burger comes from its saturated fat. Both the Impossible Burger and Beyond Burger use coconut oil as their source of saturated fat.
    • Coconut oil has gained a reputation as a “healthier” saturated fat. However, as I have discussed in my book, “Slaying The Food Myths”, we have no long term studies on the health effects of diets high in coconut oil. We don’t really know whether it is healthier than other saturated fats.
  • The taste and color of a beef burger come from its heme content. Heme does not occur in the parts of plants we eat. However, heme is involved in nitrogen fixation, so it is found in the roots of some legumes.
    • The Impossible Burger has genetically engineered yeast to produce a type of heme called leghemoglobin that is found in soy roots. The Beyond Burger uses beet juice extract and annatto for the color and unspecified “natural flavor” for the flavor.
  • To get the texture of a beef burger, both the Impossible Burger and the Beyond Burger use maltodextrin, modified food starch, and a variety of other ingredients. They are both highly processed foods.
  • Iron is another important nutrient you expect to get from a beef burger. The Impossible Burger contains 4.5 mg of iron and the Beyond Burger contains 5.4 mg of iron.
    • However, that is only part of the story. When iron is attached to a heme molecule, it is more efficiently absorbed by our bodies. Beef burgers and the Impossible Burger contain heme iron. The Beyond Burger does not.
  • In addition, the Impossible Burger adds in the vitamins, including B12, that we would expect to get from a beef burger. The Beyond Burger does not.

What Are The Pluses Of The Impossible Burger?

thumbs upThere are some definite pluses for the Impossible Burger and Beyond Burger:

  • Both the Impossible Burger and Beyond Burger are made from plant-based ingredients rather than from meat.
  • Both are cholesterol free.
  • Both contain modest amounts of fiber (3 grams for the Impossible Burger and 2 grams for the Beyond Burger), while a meat burger contains none.
  • Both are good sources of iron, and the iron in the Impossible Burger is heme-iron, which is efficiently absorbed by our bodies.

What Are The Minuses of the Impossible Burger?

thumbs downThere are, however, some definite minuses as well.

  • Both the Impossible Burger and Beyond Burger are high in saturated fat. The Impossible Burger is higher in saturated fat and the Beyond Burger contains the same amount of saturated fat as a real burger. That’s important because the latest advisory of the American Heart Association warns that saturated fat increases our risk of heart disease (I have discussed this finding in detail in a previous issue of “Health Tips From the Professor”).
    • The saturated fat in both burgers comes from coconut oil. However, as I discussed above, we don’t know whether coconut oil is better or worse for us than other saturated fats. The relevant studies have not been done.
  • Both the Impossible and Beyond burgers are high in sodium. They have almost 5-times more sodium than a beef burger.
  • The heme in red meat catalyzes the formation of N-nitroso compounds in our gut which increase the risk of colon cancer. We do not know whether the form of heme added to Impossible Burgers catalyzes the same reaction, but it is likely.
  • Both plant-based burgers are low in protein compared to a beef burger (~20 grams versus 27 grams). On the other hand, 20 grams of protein is reasonable for a single meal.
  • The plant proteins used for these burgers (soy for the Impossible Burger and pea for the Beyond Burger) are highly processed. They lack the phytonutrients found in the unprocessed proteins.
    • The isoflavones found in soy are thought to decrease the risk of cancer and osteoporosis.
    • The phytonutrients found in peas have antioxidant and anti-inflammatory benefits. They are also thought to decrease the risk of certain cancers.
  • The Impossible Burger is GMO. The leghemoglobin is produced by genetically engineered yeast, and the soy is also GMO.
  • Neither the Impossible Burger nor Beyond Burger are certified organic. Organic certification refers to how the plant was grown. Both burgers are highly processed. Many of the ingredients in both burgers came from factories, not farms.

Is The Impossible Burger Healthy For You?

Eating Impossible BurgerNow, it is time to return to the original question: “Is the Impossible Burger healthy for you?” Since it is plant-based, it would be easy to assume that it is healthier than a burger made from beef. However, when you look more closely, it is not clear that it is healthier.

The manufacturers of the Impossible Burger and similar burgers have gone to the laboratory and have been successful at creating meatless burgers with the taste, mouth feel, and texture of real burgers. However, these improvements have come with a price.

  • The Impossible Burger and similar burgers are higher in saturated fat than a beef burger. This means they may be just as likely to increase the risk of heart disease as a beef burger.
  • The Impossible Burger contains as much heme as a beef burger, which means it may be just as likely to increase the risk of cancer as a beef burger.
  • The Impossible Burger and similar burgers are highly processed. That means:
    • The plant proteins no longer contain the phytonutrients thought to be responsible for some of their health benefits.
    • They also don’t contain the vitamins you would expect to find associated with the plant proteins.
  • The Impossible Burger and similar burgers are not organic. Even worse, the Impossible Burger is GMO.

On balance, we can’t really assume the Impossible Burger is any healthier than the beef burgers it replaces. Plus, if you include the usual condiments and add fries and a soft drink, any slight health benefits of the Impossible Burger will be lost.

It would be much healthier to choose a bean burger. They don’t taste like beef, but many of them are quite tasty. Plus, if you do some label reading, you can find ones that use only whole, unprocessed ingredients.

For example, I looked up the Organic Sunshine brand South West Black Bean burgers. It only provides half as much protein as an Impossible Burger, but all the ingredients are organic, non-GMO, and minimally processed. Note: I am not recommending a particular brand. However, with a little research I am confident you can find a healthy meatless burger with a taste you will enjoy.

Is The Impossible Burger Healthy For the Planet?

impossible burger good for planetNow, let’s look at the second question: “Is the Impossible Burger healthy for the planet?” The answer to this question seems obvious. As the Impossible Burger company states in their mission statement: “Animal agriculture occupies almost half the land on earth, consumes a quarter of our freshwater, and destroys our ecosystems”. It seems logical that any meatless burger would be an improvement.

If we are talking about a minimally processed black bean burger, like the one I described above, the answer is a clear yes. It is healthier for the planet. However, when you look more closely at the Impossible Burger, the answer isn’t as clear.

  • As coconut oil has increased in popularity massive areas of untouched, forested land have been cleared for coconut plantations.
    • These forested areas provide an essential ecosystem for animals and provide natural storm protection by absorbing rainwater. Therefore, coconut oil, like beef, also destroys our ecosystems.
    • In addition, many of the coconut plantations use large amounts of chemical fertilizers which contribute to phosphate pollution and algae overgrowth in lakes, rivers, and coastal ocean areas. This also degrades our environment.
  • The Impossible Burgers and similar meatless burgers contain many highly processed ingredients. Each of these ingredients imposes its own environmental burden. For example:
    • Coconut oil is often processed with hexane, which is categorized as a hazardous air pollutant by the Environmental Protection Agency.
    • In addition, coconut oil is primarily grown in the Philippines, Indonesia, and India. Transporting it to this country generates significant greenhouse gas emissions.
    • And, of course, coconut oil represents only one of the many highly processed ingredients in the Impossible Burger and similar meatless burgers.

In short, the Impossible Burger may be slightly healthier for the planet than a beef burger, but it is much less environmentally friendly than your typical, minimally processed, bean burger.

The Bottom Line

Two weeks ago, I wrote about recent headlines claiming that the best advice for the American public was to eat as much red meat as they like. I looked at the study behind the headlines and pointed out the many flaws in that study.

Last week I wrote about headlines claiming that red meat was just as heart healthy as white meat. I looked at the study behind the headlines and showed it was an excellent example of how the beef industry influences the design of clinical trials to minimize the health risks of red meat. It is also an example of how the media misleads and confuses the public about the effect of nutrition on their health.

What the studies I reviewed the last two weeks really showed was that very small amounts (2-3 ounces) of very lean red meat is probably OK as part of a healthy diet like the Mediterranean diet. Larger servings of fattier cuts of red meat as part of the typical American diet is problematic.

However, if you love your burgers, what are you to do? Are the meatless burgers like the Impossible Burger and Beyond Burger that are showing up in your favorite fast food restaurants the answer? Specifically, you are probably asking:

  • Is the Impossible Burger, and similar burgers, healthy for you?
  • Is the Impossible Burger, and similar burgers, healthy for the planet?

I looked at the composition, pluses, and minuses of this new generation of meatless burgers in this article. The bottom line is:

  • On balance, the Impossible Burger is only slightly healthier than the beef burgers it replaces. And, if you include the usual condiments and add fries and a soft drink, any slight health benefits of the Impossible Burger will be lost.

It would be much healthier to choose a bean burger. They don’t taste like beef, but many of them are quite tasty. Plus, if you do some label reading, you can find ones that are organic, non-GMO, and use only whole, unprocessed ingredients.

  • Similarly, the Impossible Burger may be slightly healthier for the planet than a beef burger, but it is much less environmentally friendly than your typical, minimally processed, bean burger.

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.

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