You may have missed the brouhaha caused by some articles back in November in The Annals of Internal Medicine that said it’s ok to eat red meat after all. (1) It’s caused an uproar that is as bad as the civil war between hateful Trump voters and haters and it’s still raging. So if you haven’t heard about it we hereby include you in this pain.
Without getting into specific vitriol that’s ugly and sad, what can we learn from this dirty laundry? The first thing is that evidence for dietary recommendations is pathetically sorry to put it mildly. It’s almost entirely based on observational studies that ask people what they eat and then follow them for a period to see what happens to them. People must have bad memories of what they eat or lie because these issues are so fraught with the entanglements of obesity and body image in our society. As we’ve pointed out many times before, observational studies about diet are weak for these reasons and at any rate come up with very weak associations. Also, as we keep reminding you, association does not equal causation. Furthermore we’re not getting better at it because the kinds of randomized controlled studies that might settle the issues are just impossible to do to humans. So these systematic reviews and meta-analyses of the evidence that say red meat doesn’t cause cancer or heart disease or obesity or anything are only showing that – that the evidence is poor and weak. It was easier with smoking. You either smoke or you don’t. But everybody eats. And smoking is a massive killer.
One way to try and improve on this is to do blood or urine tests that can show what people are really eating but there aren’t many good biomarkers yet that can tell us what you eat. (2)
Americans especially like a lot of variety in their diet. When I was young we ate a very restricted Italian immigrant diet. For example breakfast was always 2 fried eggs on toast and cereal and juice and lunch was a baloney sandwich every day except Fridays when it was a cream cheese and jelly sandwich and dinner was a fixed rotation of just a few simple things. We still eat a pasta dinner on most days. When I lived in Mexico we ate beans and tortillas for breakfast lunch and dinner and that’s all and I loved it. Outside of the US most people in the world eat very restricted diets. Maybe that would make things easier to study. But Mexicans and Chinese and Africans are different and lead very different lives in many ways.
Any other ideas?
In the meantime we can relax with the abundant observation that humans are omnivorous and thrive on almost anything. Also we should follow the stoic philosophy and Micheal Pollan who say that we should do everything in moderation, including moderation.
John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- email@example.com or phone-354-6605.