Monday, March 17, 2014

Smoking Meat?

One of the fun parts about blogging is trying to think up catchy titles for blog posts, particularly since "news" writers get to think up scary sounding titles like Diet High in Meat and Cheese Can Be Bad as Smoking and The Scary News about the Paleo Diet.  Of course, since my sense of humor runs toward the teenage variety, that first title make me think of someone lighting up a sausage and smoking it like a cigarette, hence my title.  (I was probably the only one who thought was funny, unless you are also twelve years old).  So, if you thought I was going to talk about various culinary techniques, thanks for reading so far, but I'm actually going to be talking about whether or not we should be as fearful of eating animal protein as these articles imply.

I think this calls for a review of Emily Willingham's excellent post on how to read science and medical news over at Double X Science: Science, health, medical news freaking you out? Do the Double X Double-Take first!  So let's apply this to some of the article about this topic, shall we?

1) Skip the Headline.  This one is hard (for me anyway), but remember that these titles often employ the Appeal to Emotion fallacy to get your attention.  (I think a lot of your friends that post these articles on social media use this appeal as well!).

2) What is the Basis of the Article? Some news articles will make it easy to find the original article (like this one), with other articles you will need Google as your friend to input as much detail as you can find--I used the author's name, the journal, and protein.  We also lucked out in that the entire article was available for viewing online and you didn't have to sidle up to one of your friends with access to a particular journal and/or seek out your nearest medical library to see if they had a copy of that journal.  Now if you read the article (you did, didn't you?  If not, we'll be here while you do) you can see that this article "lots of people or mice or flies, lots of data, lots of analysis, a hypothesis tested, statistics done–is considered “original research.”  So it looks like this was original research that has undergone a peer review.

3) Look at the words in the article.  Here you see words like "risk" and "association" tossed around, so, you are going to see a "correlation" here, but not necessarily a "causation."

4) Look at the original source of the information. You will also want to make sure that the journal and the article are peer reviewed and not just commentary by an "expert" as even some of the experts can have some not so scientific ideas!  In this particular case you can go to the "about" or "journal information" section to see that this is a peer reviewed journal.

5) Remember that every single person involved in what you're reading has a dog in the hunt.  Fairly self explanatory, except sometimes the speculation about what dog you have in the hunt can launch into quite the ad hominem fallacy where suddenly a person who just wants to find out about protein intake finds themselves labeled as a grant whore (and that was one of the nicer terms I've seen), etc. Michael over at Skeptical Raptor sums up his frustration with this statement quite nicely: "The problem with actually trying to dismiss these accusations is that it’s nearly impossible to dismiss the accusations with evidence, because as we know, proving the negative is almost impossible."

6) Ask a scientist.  What do I think about this?  I'm so glad you asked!  Other than the "correlation does not equal causation statement I found some other points to ponder:
--The human data was observational and appeared to rely on people reporting intake, meaning that people could have over or under reported their protein intake.  Do you remember exactly how much you ate yesterday?  Last week?  Last year?
--The study didn't appear to take into account how much or what type of carbohydrate the people ate.  If they ate a bunch of white flour with their protein, and therefore consumed extra calories and/or increased your risk of blood glucose related issues, that could increase your mortality.  At the same time, the people eating less animal protein could have been eating less sugar and engaging in the other healthy behaviors as well.
--I didn't see mention of taking the amount and/or type of fat into account either.
--What about fruit and vegetable intake?
--What about exercise?
--What about the different between feedlot beef and grass-fed, or farm raised fish vs. wild caught, etc?
--Human beings aren't the same as rats, although you can use the info from the animal studies as the basis for future human studies.
--If you actually look at some of diets pointed out as being problematic, like the Atkins', they don't usually advocate "high protein" as even too much protein can cause problems with blood glucose levels, etc.   Loads of cheese isn't part of the Paleo plan either.
--A lot of the news article neglected to mention that a higher protein intake can be beneficial for older adults.
--Going overboard on anything will probably hurt you.

So what should we do with this information?
1) Don't smoke tobacco.
2) Figure out what your protein needs really are.  (0.8-1 gm protein per kg body weight on average, and for older adults it might be more like 1-1.2 gm protein per kg body weight).  The very overweight/obese might need to use a "lean body mass calculator" to get an estimate on what "weight" to use to calculate protein needs (some need more protein at the beginning of their weight loss plan to maintain lean body mass and then it will reduce as you lose weight)
3) Find out how much protein in is the food that you are eating.  If you are reading this, you probably have regular or semi-regular access to the Internet and can easily access sites like  Keep a record of how much you're eating for at least 3 days.
4) Limit or avoid added sugars and processed carbohydrates, choose fresh fruit and tubers for your starches as often as you can.  If you tolerate grains, choose unprocessed ones. (Hint, most bread products are "made with whole grain" and not actually whole grain.)
5) Consume vegetables at every meal.
6) Avoid deep fried foods and trans fats.
7) If you tolerate vegetable protein sources, find ways to incorporate them (legumes aren't part of my low FODMAPS plan), but that doesn't mean other people can't include them.
8) Find ways to be as active as possible.

Take home message--Always question the news articles you read, particularly if they appeal to emotion.  Finding out how much protein you are eating, from any source, and not overdoing can help you meet your health goals.

Tuesday, March 4, 2014

Opinion: New Food Label

Last night I had the privilege to chat with dentists Jason and Grant of the Prism Podcast about diabetes, nutrition and pseudoscience, and my favorite gluten free beer (It's Omission by the way).  I was asked about my thoughts on the new nutrition label, and I thought I would expand on my thoughts in writing (which has always been my preferred medium of expression over the spoken word anyway).

Currently there are two different label formats that are proposed, as shown in this graphic from the Washington Post:

What I like about the proposed changes to the "new" label:

1) I like to have easy access to basic information about food, and I like for my patients/clients to have the same access.  Not everybody is equipped with smart phones to be able to look up information in the grocery store, and not everyone has Internet access at home to make up their grocery list either.

2) I like the bigger print for the serving sizes and calories, particularly since I work with a population that tends to have diminishing eye sight.

3) I like the addition of the mineral "potassium" to the food label.  One of the unfortunate consequences of being a diabetes educator is that you wind up working with people who have already developed kidney failure (usually from uncontrolled diabetes, uncontrolled blood pressure, or both)and they have to be cognizant of how much potassium they take in since the kidneys can no longer filter any excess potassium.

4) There has been an effort to make the serving sizes more in line with what
people might actually eat.

What I don't like about the proposed changes/wish they would have done differently:

1)  I wish they would leave the percentages off, as I have never found them useful in teaching people how to read a food label.  Who wants to calculate a percentage while they are in the grocery store anyway?  Many people already don't have a framework for how many calories, carbohydrate grams, etc they should have--and those that do have a framework are going to look at the calories/grams, etc and not look at the percentage.

2) I wish they would do away with the serving sizes and give the information for the entire container.  It would remove one more way that food companies can manipulate the serving size to cause a product to look healthier than what it really is, and I think more people would rather adjust for their own serving size.

3) I hope they don't go with proposal 2, as it's a more crowded format, they are still emphasizing saturated fat as a problem (when it's not really) while ignoring the added sugars, and once again I don't think people respond well to being "told" what to do either.

For those of you who are wanting to establish a good framework for how many calories you need, etc, I recommend the use of the Body Weight Simulator as it uses the most up to date info on how much to cut back over time and what to do to maintain your weight.  For those of you with diabetes/re-diabetes/insulin resistant conditions who are trying to figure out your carbohydrate intake, your ball park intake will be no more than 100 grams of carbohydrate per day if you are trying to lose weight and no more than 150 grams per day if you are trying to maintain (and that's just ball park, if you have diabetes you will only figure out your optimum intake by testing your blood glucose before and after meals when trying new foods.  Try not to aim for more than a 30 mg/dL increase 2 hours after eating).

For other info on label reading and portion control from this blog:
Label reading: Carbohydrate Edition
Portion Distortion
Grocery Shopping with Radio Lab

Monday, March 3, 2014

On My Reading List: The Diet Fix

I have been asked before to do a blog post about "diet books that don't contain a lot of woo."  I've avoided doing that post because even though I can think of books that have good information, I have trouble finding ones that also do not contain a lot of ad hominem fallacies or that promote enough flexibility to keep the plan sustainable.  Today, as I was catching up on blog postings from I found one that looks promising: The Diet Fix, by Yoni Freedhoff, MD.

I say "looks promising" because it won't be published until tomorrow (I have pre-ordered), and because I like the highlights that Scott Gavura gave over at this this blog post.  I am also happy because it looks like we might finally have a book that does not ascribe demonic powers to either saturated fat (yay bacon and coconut oil!) or all carbohydrates for all people.  I also like his (seeming) focus on sustainability and self awareness (i.e. a diet plan only works as long as you have a plan for that pasta taking a leap into your shopping cart).  I'm also looking forward to reading a book that doesn't contain references to toxins/detoxing/cleansing.

I'm still waiting, however, to check out his references and look at the kind of language he uses.  I'm already wishing he hadn't used the term "Post Traumatic Dieting Disorder" as many of my patients with Post Traumatic Stress Disorder (PTSD) have eating problems that are tied up with their PTSD and I would really hate to draw a false equivalency.

Will report back with my findings/thoughts.  Meanwhile, if your reading list isn't long enough, check out this Goodreads list of recommended books:  Science Based Medicine Recommends.