by Zoë Harcombe
This study was called “Red meat consumption and risk of type 2 diabetes…” Notwithstanding that it is about processed meat and even more processed meat and association with type 2 diabetes, when will we see the study “Carbohydrate consumption and risk of type 2 diabetes…”?
3) To be fair – the study did not claim causation. Research papers rarely do. They propose association and let the media run the “just two rashers of bacon can increase the risk…” headlines. Association does not mean causation – either way round. We should not be able to jump from association to ‘meat consumption causes diabetes’ any more than we should be able to jump from association to ‘diabetes causes meat consumption’. Not only is causation usually assumed, a direction of causation is assumed. The people who developed diabetes may have all worn blue socks – does that mean that wearing blue socks increases the risk of anything?
4) Table 2 of the report negates the idea that there is any trend. Data is presented for the three studies, for five different levels of meat intake. The serving sizes are determined relatively, by quintile, so, as an example, for the Health Professionals Follow-up Study for what the study assumes to be unprocessed red meat, the five different serving categories are 0.17 servings per day, 0.43, 0.65, 0.94 and 1.44 servings per day). Finally, three models are presented for each of these different meat intake levels, by study:
– an age adjusted model;
– a model adjusted for age, alcohol consumption, physical activity, smoking, ethnicity, menopausal stage for women, family history of diabetes/hypertension/hypercholesterolemia, quintiles of total calories and a dietary score for diabetes that the team made up (more on that below);
– a model adjusted for everything above and BMI.
All of this is then done for their opinion of unprocessed red meat, processed red meat and total red meat (that should be total processed meat). You can see that this is indeed a multi variate model!
There is not a steady trend between meat intake and the incidence of diabetes in every model variant of every study. For the Health Professionals Follow-up Study (HPFS), increased (what they call) unprocessed red meat intake from 0.65 servings per day to 0.94 servings per day was shown to have a reduced incidence of diabetes in all three models.
It is not clear how the dietary score for diabetes impacted the assumptions and therefore results, but the team “created a low diabetes risk score as a diet low in trans fat and glycaemic load and high in cereal fiber and the ratio of polyunsaturated to saturated fat.” What the ratio of two fats, which nature can put naturally in foods in different proportions and man can put very unnaturally in foods in different proportions has to do with the risk of diabetes I do not know.
5) The final point to make, as is the case with all presentation of numbers from studies to achieve maximum impact (and likelihood of media reporting) is that there are lies, damned lies and statistics. If you buy two lottery tickets each week, I can halve your chance of winning by allowing you only to buy one. Your odds of winning are now (for example) one in fourteen million instead of one in seven million – still absolutely naff all. However I have halved your chance of winning. Imagine I halved your ‘chance’ of developing diabetes in a similar, playing with numbers, kind of way…
Let’s take some actual numbers from Table 2 as an example:
Processed red meat, age adjusted model, from the HPFS…
– 0.02 servings of processed red meat per day (one serving is 28g so that’s half a gram of processed meat!) is associated with 340 incidences of diabetes in 138,550 person years. That’s an incidence rate of 0.25% or 1 in c. 400 people.
– 0.12 servings of processed red meat per day (that’s 3 grams – can any of you actually measure your intake to that level?) is associated with 409 incidences of diabetes in 121,238 person years. That’s an incidence rate of 0.34% or 1 in c 300 people.
(This is raw data – adjusted for age only – not adjusted for smoking, exercise, calorie intake, family history of diabetes, weight etc i.e. impossible to isolate two different minute meat intakes and assume that this is the only difference.) This aside, this is presented as – if at 0.02 servings per day you have a 1.00 ‘risk’ of developing diabetes, at 0.12 servings per day you have a score of 1.38 i.e. a 38% higher risk. There’s the headline “3 grams of bacon a day and you have a 40% greater risk of diabetes.” There’s how numbers are played with to frighten the life out of you and to make sure that you have sugary cereal for breakfast instead of eggs from grass living chickens.
The bottom line
This is a study about processed meat and even more processed meat and observed associations between intake of each and incidence of diabetes. No biochemical pathway is proposed for how fat/protein is supposed to impact a condition of glucose/carbohydrate handling deficiency. The obvious connection between the buns, chips and ketchup being consumed with the hamburger has not been made.
To let the media have the last word – the Mail article tells us how it is: “There is now widespread evidence that red meat drastically (my emphasis – couldn’t resist it) increases the likelihood of major health problems including heart disease, strokes, and some types of cancer.”
Accuse modern, processed meat of all this and more – all modern food in fact. Hang processed ‘food’ generally for crimes against human health – heart disease, strokes, cancer, diabetes, Alzheimers – all modern illness. Throw the book at the man-made horrors. But, if we really think that nature put all the essential fats, essential amino acids, full range of B vitamins, fat soluble vitamins, iron, calcium, magnesium and zinc in red meat and was trying to kill you at the same time, we wouldn’t be here today!
Nutrition – where will a student
be taught the truth?
September 12, 2011
I’ve had so many queries from people about studying nutrition that this blog is probably long overdue.
Nutrition is a fascinating topic. There is little more important to human health than what and how we eat. Modern epidemics of obesity and ill health are capturing media headlines and the attention of curious minds alike. This is a subject about which many people want to know more. However…
When I am asked to recommend a course on nutrition I can’t. I am not aware of a single programme being offered anywhere in the world, which is evidence based and which presents facts, rather than the current myths presented as facts. That doesn’t mean that there isn’t one, but I don’t know of one and I would be surprised if there were one given the extent of the misinformation being perpetuated by the vast majority of people working in this field.
What do you want to learn?
My starting advice to someone interested in studying nutrition would be to be specific about what you want to know. The British Dietetic Association curriculum for training as a dietician is detailed here. If this is your first higher qualification, the background in basic sciences and biology may be useful to you. For those who already have a degree and/or studied science to a reasonable level at school, reading a cell biology, physiology and biochemistry textbook will deliver the required background.
My passion is obesity. There is more than enough to study on this topic to do nothing else for the rest of one’s life. Hence I am not interested in (using the attached curriculum by way of example) immunology, microbiology, (food hygiene), clinical medicine, pharmacology, sociology and social policy, communication and educational methods and definitely not interested in ‘food’ science. Nature provides food – that’s the only food I want to understand. I’m not particularly interested in dietetics for the prevention of general disease (besides the fact that eating real food will achieve this naturally) and I’m only interested in public health to the extent of how we managed to get ourselves in the midst of an obesity epidemic.
Becoming a dietician
When I set out to study nutrition more formally, I investigated training as a dietitian. I rejected the prospect very quickly on two grounds:
i) With 1.5 bill
ion overweight people in the world, this is more than a big enough arena in which to specialise. As detailed above, I have no interest in the vast majority of the dietician curriculum and have no time to ‘waste’ on such topics when I could be spending that time reading obesity journals.
ii) Upon investigation of the weight management part of the course, I discovered that the first lesson is the calorie formula. I would be told that energy in equalled energy out and that to lose one pound of fat a deficit of 3,500 calories must be created.
Thus the one part of the course that I would be interested in, would be of no use to me. Presumably I would need to reproduce answers that I know not to be true to pass, or fail as a result of giving my honest answer. A quick analysis of the 58 page curriculum document confirms that I made the right decision: the word weight does not appear once; the word obesity does not appear once; the word calorie does not appear once and the word diet only appears six times and in a very general context of the word diet e.g. UK diet or diet and lifestyle.
A third reason became apparent when I was researching for my book The Obesity Epidemic: What caused it? How can we stop it? Conflict of interest…
Here are the sponsors of The American Dietetic Association. Here are the program partners of the Dieticians Association of Australia. Here are the major partners of the Dieticians Association of Australia. Here are the associate partners. I detail in my book, The Obesity Epidemic, how unwilling the British Dietetic Association is to disclose its conflicts of interest. After a number of email exchanges, a BDA spokeswoman confirmed “we have been delighted to work with the Sugar Bureau…” The chief executive’s foreword (Andy Burman) in the 2008-09 annual report of the BDA notes “We now have our first national partners with Danone and Abbott and we hope to announce new partners over the coming year or so.” There is reference to a “Bird’s Eye” education award, but no mention of other partners or sponsors. The accounts for 2009 showed a turnover of £2,359,013 with no details of the source for this revenue. The notes to the accounts, which could add detail to this number, are for the eyes of BDA members only. A press release, dated 1 March 2007 entitled Kellogg’s: commitment to health and wellbeing, informed me that Kellogg’s had been the lead sponsor for the British Dietetic Association’s annual obesity intervention campaign since 2002 (and may still be).
Here are the members of the British Nutrition Foundation. Here are the sustaining members of the British Nutrition Foundation.
It is a complete disgrace that our nutritional ‘education’ has been infiltrated in this way. The partner that most disturbs me is Abbott Nutrition. This company makes an infant formula called Similac. The feeding guidelines on the Similac web site range from 1-2 weeks to 9-12 months, so this is clearly a product designed for babies. The can of baby formula, of the part that is not water, contained 43% corn syrup solids and 10.3% sucrose. “It’s a baby milkshake,” said a horrified Robert Lustig in the video “Sugar: The Bitter Truth“. I wanted to analyse a product for myself, so I chose Similac Isomil Advance, Soy Formula and the composition of this was 50% corn syrup, 14.2% soy protein isolate, 10.4% high oleic safflower oil, 9.7% sucrose, 8.2% soy oil and 7.5% coconut oil. If a baby is unfortunate enough not to be breastfed, the infant can be started on a diet of 60% sugar from the first moment something is put in its mouth.
It is clearly in the interests of ‘food’ companies to partner with those giving us dietary advice – and to start as close to birth as possible. Does the public know that our advice is so conflicted? How can we “Trust a dietician to know about nutrition” (their slogan) when this conflict of interest exists?
Nutritional ‘education’
That’s the conflict inherent in our nutritional training, what about the content of programmes?
I only know one way to learn and that is to “get the facts”. I am a thinker, not a feeler. If I am told something I need it to be evidence based. I want to know the source of everything – where did that come from? when did this become known and so on. This stood me in good stead studying economics (maths, statistics options) at Cambridge. Applying the same rigour to the subject of nutrition was the most shocking thing I have ever done.
During the three years of full time research for The Obesity Epidemic, the following nutritional beliefs did not hold up to scrutiny. Please note – these points are only in the part of nutrition related to dietary advice and weight loss. There may be many more errors in the teaching of nutrition outside my areas of interest.
Starting at the very beginning – dieticians state that “energy in = energy out.” “You can’t change the laws of the universe”, they say. But there is no law of the universe that says “energy in = energy out.” I detail in The Obesity Epidemic exactly what the laws of thermodynamics say and which law we have misunderstood and which law we have ignored.
We are then told that 1lb = 3,500 calories. It doesn’t.
We are told that we will lose 1lb if we create a deficit of 3,500 calories. We won’t.
We are told that 98% of diets fail (true for calorie deficit diets) but are continually told to “eat less/do more” despite this.
Five-a-day is a marketing myth. Eight-a-day (drinking) is similarly fabricated. Alcohol guidelines are numbers “picked from the air.” Fruit is essentially sugar (fructose/glucose – aka sucrose) with vitamin C and not much else by way of nutrition. Offal, red meat and butter, the foods most often condemned by diet advisors, are nutritionally exemplary.
Saturated fat is life vital. Mother Nature is not trying to kill us.Cholesterol is life vital. Our own body (which makes our cholesterol) is not trying to kill us. The formula for cholesterol is C27H46O. There is no good or bad version.Grazing (don’t); fibre (pointless); sedentary behaviour (how humans were designed to be) – there’s so much that we have got terribly wrong.
As Kaayla Daniel said at the 2011 Weston Price Conference – “If you’re told it’s bad, it’s good and if you’re told it’s good, it’s bad – work on that basis and you can’t go far wrong!”
Check out this free ebook or any of these presentations: Calories, Energy Balance, Thermodynamics and Weight Loss; Ten diet myths; The Obesity Epidemic to find out more.
Conclusion
I cannot recommend any dietetic or nutrition course because I know of none that will teach the truth about everything from thermodynamics to the role of insulin in fat storage. My genuine recommendation is that you need to study via amazon (Sean Croxton, Underground Wellness, concluded the same) and medical journal web sites.
Read Mary Enig and Sally Fallon Morell on fats; Uffe Ravnskov, Duane Graveline and Dr Malcolm Kendrick on cholesterol and the lipid hypothesis; The Diet Delusion (Gary Taubes); critical reviews of all of these and weigh the evidence for yourself. There will be many more non-conventional wisdom works for different areas of interest. The seminal journals to be read include Benedict (1917); Newburgh & Johnson (1930); Hugo Rony (1940); The Minnesota Starvation Experiment/The Biology of Human Starvation (1950); Stunkard & McLaren-Hume (1959). The Seven Countries Study (1970); The COMA report (1984). There are 400 references here for convenience – the books and journal articles are recommended.
When I started to question the origin of the calorie theory (1lb = 3,500 calories, so to lose 1lb you need to create a deficit of 3,500 calories), I asked the Department of Health, the National Health Service, the National Obesity Forum, The National Institute for Clinical Excellence, the Association for the Study of Obesity, Dieticians in Obesity Management and the British Dietetic Association. None could source the calorie theory. None could prove it.
The British Dietetic Association reply was: “Unfortunately we do not hold information on the topic that you have requested.” It was suggested that I contact a dietitian. I happened to be with several dietitians at an obesity conference later that month (June 2009), so I asked fellow delegates and no one knew where the 3,500 formula came from. No one knew where the ‘eatwell’ plate proportions came from. One dietitian said to me “
You’ve made us think how much we were just ‘told’ during our training, with no explanation. A group of us over there don’t even know where the five-a-day comes from.”
I rest my case!
Other books by Zoë Harcombe
The Harcombe Diet:
Stop Counting Calories & Start Losing Weight
You’ve tried every diet under the sun. You’ve lost weight and put it back on. The more you diet, the more you crave food. You’ve given up hope of being slim. This book explains why. Count calories & end up a food addict. Stop Counting Calories & Start Losing Weight!
ISBN 978-1-907797-11-8
Copies available on www.theharcombediet.com
Other books by Zoë Harcombe
The Harcombe Diet:
The Recipe Book
Real food; great taste; optimal health – that’s what The Harcombe Diet® is all about and here’s how to do it. With over 100 recipes for Phase 1, another 100 for Phase 2 and some seriously special Phase 3 cheats, this is the ultimate diet-recipe book. If you want to eat well, lose weight and gain health – this is a must for your kitchen shelf.
ISBN 978-1-907797-07-1
Copies available on www.theharcombediet.com