Horizon: ‘Should I Eat Meat? – The Big Health Dilemma’

Horizon: ‘Should I Eat Meat? – The Big Health Dilemma’

I don’t really know why I watched this after the abysmal ‘Fat vs Sugar’ in January (a masochistic streak perhaps). I ran out of patience quite early on but managed to last out the hour. Pop over to here to watch it in full. Alternatively have a read of my post and see if it’s worth the bother. The documentary jumped from one issue to another in a confusing and ultimately pointless manner. Repeating the well-worn mantra of ‘all things in moderation’ and leaving the viewer ultimately frustrated at the lack of hard evidence for any of the scare stories, I felt this programme did nothing to seriously address the question.  Let’s hope that the next edition is better than this.

Presented by Dr Michael Mosley the programme questioned whether meat is a nutritious form of protein or an artery clogging danger that causes cause cancer and premature death. ‘What is the truth about meat?’ Dr M asks (in a sort of conspiracy-theory way). He rather guiltily admits to eating meat most days but adds that he is sceptical of the scare headlines about red meat and cancer. Dr M notes that as meat eating has doubled world-wide, we need find out if this is a good thing.  For the purpose of the documentary, he decides to go on a ‘high meat diet’ to see the effects on his body.

The requisite experts then appear (British Nutrition Foundation, Interventional Cardiologist, Senior Heart Health Dietician) and give a series of quite positive opening statements regarding meat. Dr M tells us that ‘as a species we evolved to eat red meat, but not that much and not that often’ (so don’t get too excited).

Dr M advises that we need to look at ‘studies’ (although perhaps we need to turn away from studies, academia and experts and start looking at how we feel on an individual basis, but that’s another argument). We hear that chicken and other white meat are ok (factory-farmed, antibiotic-laden chickens are obviously not a problem) but that it is the effects of eating red meat (beef, pork and lamb) as well as processed meat that needs to be considered.

The average meat consumption in the UK is 70 grams of red and processed meat a day, with a quarter of men eating 130 grams. Therefore Dr M decides that his experiment should consist of eating 130 grams of red and processed meat per day.

Dr M gets a health check (body fat, blood panel etc.) but admits that this is a sample size of 1 and so won’t be representative of everyone. He then hops over the pond to meet some very pleasant vegetarian Seventh Day Adventists who (on average) live for 7 years longer than the (average) American. Not all Seventh Day Adventists are vegetarian though; some eat limited amounts of meat. The community extol the virtues of leading a ‘healthy, wholesome lifestyle’ and so are interesting subjects to study for a comparison between meat eaters and non-meat eaters (the half that do eat meat tend not to smoke or have other unhealthy habits).

Extensive epidemiological studies have been carried out to look at the Seventh Day Adventists and their health in relation to meat-eating. We then skip to an interview in a café where Dr M talks to Dr Gary Frazer leading the research (himself a vegetarian). Dr M tucks into some pulled pork and admits guiltily to the clearly concerned doctor (munching a vegetarian salad) that he has also eaten 4 rashers of bacon the same morning. After reflecting on Dr M’s survival outlook if he carries on like this (bleak), Dr Frazer explains that the vegetarians are doing much better in terms of cardiovascular disease, diabetes and hypertension and tells us: ‘That whole area is fairly well-established.’ Oh…

We are told that men who eat beef 3 times per week, double the risk of heart disease. At this point we see Dr M consuming a huge, deep-fried onion ring. This behaviour translates to 4-5 years reduction in life expectancy (that’s the beef, not the onion ring – keep up with me here…).

Dr M then goes back to Reading University to find out what it is in meat that is doing us harm. We look at the various nutrients in meat as opposed to vegetarian options. The scientist at Reading tells us that red meat is a ‘good, high quality protein’ but that cheese has the same amount of protein. Pork and vegetarian sausage have the same amount of protein. Tofu has a lot less.

We learn that red meat is made up of amino acids which are essential, many of which the body cannot make. Red meat is a complete protein and is also rich in vitamins and minerals. However, cheese has nearly the same amount of B12. It also has more saturated fat, but as people tend to eat less cheese this is ok. The cheese appears to be coming out tops in all this…

We are told that beef, bacon and sausages all have high amounts of saturated fat ‘which are linked to heart disease’. Then there is some talk about the research in the 1950s on heart disease and saturated fat, with the terms ‘red meat’ and ‘processed meat’ being constantly linked. This really is all over the place.

Dr M admits that recent research has suggested saturated fat is not that bad. He goes to talk to Dr Ronald Krause at Berkeley. Dr Krause was a former adherent to a low-fat dogma but found that his patients did not do well on low-fat diets. He set out to examine the studies regarding saturated fat and heart disease but found the evidence lacking. However, just before we get too complacent Dr M warns us that this ‘doesn’t suggest that saturated fat is a health tonic’ and asks if there is something else in red meat ‘that could be clogging our arteries.’

On to the subject of L-Carnotine found in the lean part of the meat and which ‘potentially’ affects the build-up of cholesterol in the arteries by reacting with the bacteria in the gut to produce TMAO (Trimethylamine N-oxide). We are told by an expert that ‘this has not been proven to occur in our bodies but is a potential mechanism for how this might work.’ Dr M then tells us that we now have evidence that saturated fat isn’t that bad but that ‘lean meat could be doing damage.’ The words ‘potential’ ‘could’ and ‘possibly’ crop up an awful lot over the space of an hour.

(Incidentally, pop over to here, and here for some interesting reflections on TMAO. Fish also raises TMAO).

Back to the UK experts and I noticed a hint of mild excitement that although they appear to have been barking up the wrong tree regarding saturated fat, there may be this ‘other thing’ that justifies them telling us to avoid red meat.

There is some dramatic music and then Dr M tells us that ‘the jury is still out regarding what it is in meat that increases risk of cardiac problems and how big this risk is’… Then we watch as he tucks into a burger with huge bun and a load of chips.

There is a brief and totally pointless bit about meat and culture, in which the experts link meat and ‘affluence’, and then Dr M goes to Harvard University to interview Walter Willett. Dr Willett has studied 120, 000 people over 30 years and explains the following findings:

Red meat (unprocessed):

  • Those who ate red meat had a higher risk of mortality, cancer, etc.
  • 85 grams (beef burger) = 13% increase risk of premature death

Processed meat is worse:

  • 35 grams per day (2 rashers of bacon) = 20% increase risk of premature death (because of heart disease and cancer)

Dr M warns us that things are ‘looking grim for meat eaters’. But wait! The EPIC study (European Prospective Investigation into Cancer and Nutrition) followed 0.5 million people over 12 years in 10 countries. This found that moderate amounts of red meat had no effect on mortality rates and that eating meat is ‘better than being vegetarian.’

(Incidentally the study showed that ‘Subjects in the highest fifth of blood vitamin D levels showed a 40% reduced risk [of colorectal cancer compared with those in the lowest fifth.’ See here)

At this point Dr M admits that epidemiological observational studies are ‘not certain’ (funny that he didn’t mention it before now) and that we ‘cannot prove that dietary components are causing specific diseases’.  At this point you wonder why you bothered watching…

Back to the experts and their final recommendations on how often to eat which ranged from ‘meat-less days’ (if you can’t go vegetarian, which is the ideal), ‘once a month’, ‘in moderation’ to Dr M’s advice that ‘a moderate amount a couple of days per week is ok’.

Dr M then considers colonoscopies and their importance in detecting polyps in the bowel (which may lead to bowel cancer). This leads him to look at why processed meat is a possible carcinogenic. Dr M cures some bacon at Reading University using 12 teaspoons of salt which clearly disturbs him (‘salt is obviously not good for us’), 5 teaspoons of sugar (not particularly bothered) and a teaspoon of nitrates. We are informed that Sodium Nitrate stops us getting botulism but reacts with amino acids. However, ‘we have yet to establish a direct link’ between nitrates and colon cancer. The smoking process (producing chemicals called PAH’s) may be another ‘potential mechanism whereby red and process meats increase our chances of gastro-intestinal cancer.’  As with all of this, there seems to be no conclusive proof. As an aside, the possibility of nitrate-free bacon is not mentioned.

On to the best piece of information in the whole documentary and if you have one ‘take-away’ it has to be this. Dr M recruits a statistician and asks him ‘If we were to nail down what we can really, really say  about  how long we live, what sort of things are we reasonably certain will cut years off your life?’. The statistician tells us that eating 2 rashers of bacon a day translates to an hour per day off our life. Dr M looks suitably grave at this announcement and exclaims ‘Wow!’ This is science at its best.

Dr M then returns to the hospital for a check-up and finds out the following:

  • No change in compounds linked to cancer (we are told that this is possibly because he has been consuming a lot of fibre with his meat)
  • LDL cholesterol has increased (no mention of what type here)
  • Body fat and blood pressure have increased

Therefore the suggestion is that eating more meat increases ‘bad’ cholesterol, makes you fat and sends your blood pressure up. No mention of anything else that Dr M may have tucked into on his high meat diet (onion rings, chips, burger buns…)

Dr M advises that we should eat unprocessed, ‘fairly lean’ meat on occasions and that ‘if you are going vegetarian make sure that you get all the vitamins and minerals that you need’. An expert adds that a healthy diet is a ‘predominantly plant-based diet, supplemented with meat.’

Dr M then finishes on a plea for more ‘vegetables, vegetables, vegetables’ and then it ends. Phew! Once again, Horizon comes up with the goods regarding cutting-edge science documentaries.

I feel genuinely sorry for those people looking to find an answer in all of this mess. The lightweight treatment of what is a serious subject (the avoidance of diseases such as heart disease and cancer) is frustrating. The confounding factors in all of the arguments put forward simply serve to confuse things even further. Apart from a fleeting comment (we evolved to eat red meat ‘not that much and not that often’),  our existence as hunter-gatherers for the majority of our time on earth eating meat, fish, fat, roots and tubers, a variety of other vegetables, with some limited fruit is not discussed or considered relevant. It as if we have all been beamed down from another planet. We need to look at the consumption of meat in the context of a real food diet; quality meat produce eaten alongside healthy fats and vegetables. The lumping together of meat-eating with a high carbohydrate diet for the purpose of ‘scientific’ observational studies such as this will always obscure the benefits of eating meat.

If people are encouraged to cut back their consumption of meat, many will probably increase carbs (as I did), as most people have been scared to death of fat. This has all sorts of implications for health – especially in terms of gluten and excess carbohydrates. The satiating effects of meat, and especially fat, are so important in the context of a healthy diet, particularly if people are struggling to lose weight and come from a background of low-fat, low-calorie eating that the ‘experts’ have pushed on us for many decades. When eaten with sufficient fat, meat portions do not have to be huge to be satisfying (particularly if you are looking to move into ketosis, in which case protein should be limited).

Meat quality was not addressed, although that may be a subject for next week’s edition (but what if you don’t watch that?). I also noticed that the benefits of offal was not discussed which was a shame as it provides some of the best nutrition by far.

I will watch next week’s edition but I wonder how many years of my life I have wasted – and will probably continue to waste – by watching rubbish documentaries such as this.  So a bacon sandwich a day takes an hour off your life? In that case I’m sticking to my bacon (without the bread) and if I could just give up watching these hour-long pointless documentaries, things will even themselves out…



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Horizon Fat vs. Sugar BBC2

I was so excited as I read the headlines on Tuesday’s Daily Mail website (not something that I say too often). ‘One twin gave up sugar, the other gave up fat. Their experiment could change YOUR life’.  “This is it!” I thought “This is the turning point!” and I enthusiastically began reading with my heart in my mouth (yes I really do get that excited about these sorts of things). However, the article (a preview of the BBC Horizon programme) was a complete let-down and so I watched the programme last night with a heavy heart knowing what was in store.

Before I start I just want to make a quick comment about the quality of documentary programmes on the BBC – or lack of it. To say that they resemble documentaries better suited to an early secondary school audience is rather demeaning to the children. Everything is filmed to show exactly what the presenter is talking about – just in case we can’t quite understand. Talking about eating fat and sugar? Let’s set up a camera in his kitchen to show him shovelling sugar and cream in his mouth. People like a particular flavour of doughnut? Let’s waste several minutes showing the presenters offering doughnuts to random people in the street. Craving for carbohydrates? Let’s show a close-up of him almost putting a chip in his mouth and then stopping. It’s as if we can’t understand things without them being literally demonstrated by the presenter/’actor’ on the screen. I remember Horizon as being a serious science programme. What has happened? Anyway, rant over…

Right, let’s get to it. The programme (watch here while still available) was presented by two chirpy and camera-friendly twin doctors, Alexander and Chris van Tulleken, one a specialist in infectious disease and the other a specialist in Tropical medicine. They did admit that despite being doctors, they knew nothing of ‘eating healthily’ and that nutrition ‘fell between the cracks’ at medical school. I thought it was quite refreshing to hear doctors admit that.

The battle lines were drawn. The experiment would find out ‘which is worse’ with the anti-fat brigade amassing on UK shores and the ‘sugar is toxic’ brigade over the pond. The doctors agreed to go on ‘extreme diets’ in order to settle the debate once and for all and prevent all-out war. They could eat as much as they want and the idea was to look at the effect of these diets on weight and ‘lifestyle diseases.’ It was quite interesting that they set up the ‘battle’ as American vs. UK opinion.

The high-fat diet consisted of cheese, meat, steak and burgers. There was confusion here because in both the article and the programme, they mention ‘no carbohydrates’ and then go on to talk about low-carbohydrates. Nutritionist Amanda Ursell (more about Amanda’s advice later) talks about minimal carbohydrates but the proportions are never made clear. I would have liked to see the fat/protein/carbohydrate ratio explained just for the sake of clarity. It looks like Alex was on a ketogenic diet (rather than a Paleo-ish high fat diet) but even with a ketogenic diet we would possibly go as high as 50g of carbs a day, so I can’t quite figure if they cut ALL carbs out or whether they just didn’t film him eating the minimal amount of carbs permitted while still remaining in ketosis. Alex worries that he is going to be ‘craving fresh greens’ so I assume that no veg was allowed at all. In addition to this, there was no mention of a period of ‘keto-adaptation’ before the body transitions fully to a fat-burning state. Alex also bemoaned the fact that he would suffer from bad breath and constipation, subjects that were brushed under the carpet for the rest of the programme.

The twins then hop over to Richard Mackenzie at University of Westminster for some tests before embarking on the diets. Dr Mackenzie informs us that ‘High amounts of cholesterol blocks our arteries’ and annoyingly does not differentiate between types. He measures the twins’ body fat percentage which is at 26.7% for Alex and 22% for Chris.

Two weeks into the diet, there is an inane experiment to test their mental agility, in which the twins are given $100,000 to trade with on the stock exchange in the hope of making more cash (with a wonderful cameo by ‘JJ’ who berates Alex for his negativity before the task begins). This test was intercut with Professor of Psychology Robin Kanarek’s grave comments about glucose being ‘the primary and best fuel for the brain’ without which it ‘doesn’t function properly’. I would have liked to see their performance pre-diets and then a comparison made, but never mind. I would also have liked to see any other factors that may have influenced either of the twins, such as caffeine intake, sleep, time difference (as they were on opposite sides of the Atlantic). We were assured that ‘ketones aren’t as efficient as sugars’ and Professor Kanarek very carefully worded the following statement: ‘At least on a short-term basis (my italics), a high carbohydrate diet will facilitate memory.’

Anyway, back to the trading floor with shots of high-fat Chris sighing and burying his head in his hands as his finances went into meltdown. Triumphant, sugary Alex announces that ‘I’ve absolutely thrashed him’ and we are told that Alex has made only $300 while Chris a whopping $800. Chris announces that ‘a big carb breakfast helped me do that.’ Really?! I make that 0.5% difference of the starting value, not really enough to sell me one fuel over another, but let’s not be picky…

We then have an interview with Robert Lustig, Professor of Clinical Pediatrics at the University of California, San Francisco and presenter of Sugar:the bitter truth. Professor Lustig explains about how the liver turns excess fructose into fat and how glucose activates insulin. This is followed by Alex stating that reports on high sugar diets use ‘unrealistic amounts of sugar to prove their point’ and he announces his scepticism. Move along please, nothing to see here…

The twins then pop in to see nutritionist Amanda Ursell to see if eating fat and sugar have different effects on how hungry we get. As we expect, the high fat diet leaves Alex feeling fuller for longer while Chris eats around an extra 30% of food and admits that ‘calories do not necessarily make you feel full and I was hungrier quicker.’ Does this signal a move away from the calories are calories are calories thesis? No, not quite as the twins explain that ‘as sugar is an easy source of calories, you get fatter quicker.’ Back to calories then…

Then we moved on to fats. We are told that the recommended saturated fat intake is no more than 30g while quickly slipping in a fleeting comment about this being ‘currently contested’. Things are moved very swiftly on to trans-fats and how bad they are. There is no attempt to examine the argument in favour of saturated fats, although they can spend precious minutes of the documentary handing out doughnuts to people in the street. We are just told that fat has twice as many calories as sugar (back to calories again) and we are informed that our body ‘turns dietary fat into body fat easier than it turns sugar into body fat.’ That’s fat sorted then…

We then saw the twins taking a gruelling test riding a bike up a mountain, alongside a ‘commercial’ for porridge from the helpful Tour de France man. He also tells us that Alex is in ‘the last state that we want our athletes to be in.’ Alex announces that he ‘hasn’t eaten carbs for weeks.’ I remind myself that this is all about extremes…

A return visit to a worried looking Dr Mackenzie confirms that sugary Chris has lost 1kg – 0.5kg of fat and 0.5kg of muscle. Alex has lost 4kg – 1.5kg of fat and 2kg of muscle (where did the other 0.5 kg go?!). Proportionally, they have lost the same amount of muscle (50% of the total loss). The doctor informs us that people who lose muscle mass are ‘more likely to visit the hospital and be ill.’ However, presumably people who are very overweight are even more likely to visit the hospital and be ill, so it makes sense to get the fat off with a very effective high fat, low-carb diet and later exercise to build muscle if they can. I don’t remember seeing headlines about the amount of people turning up at the hospital with diseases due to lost muscle mass, but there is an awful lot about the effects of diseases due to obesity. Maybe I’m missing something.

There is also a quick examination of their cholesterol which has stayed normal in both twins (no mention about what type of cholesterol here, or any measurements of tryglycerides). On to announce that Alex has a raised blood glucose from 5.1 to 5.9 which is apparently ‘pre-diabetic’ although I keep turning up results on the internet that suggest this is at the top of the ‘normal’ range. Again, I would have liked to see what their levels were pre-diet as Alex was quite overweight and carrying a lot of extra body fat around the midriff. Chris, who worryingly is becoming ‘better at producing insulin’ in response to all that sugar (oh that’s ok then…), appears to be relieved and oblivious to the fact that another few months on this diet will surely make him insulin resistant and diabetic.

We then go over to Professor Susan Jebb at Oxford University who confidently informs us that a diet ‘which has extreme composition is not the answer’ and that ‘cutting out sugar does not have a big effect.’

We are now into the home run and while Richard (my other half) is losing the will to live I encourage us to battle on to the end. The conclusion is in sight and with the help of some rats and cheesecake we finally get to the advice we have been waiting for all along – avoid processed food. Yes it’s the magic combination of 50/50 fat and sugar in processed food that is making the nation obese. All faddish diets are worrying and misguided, and the enemy is neither fat nor sugar but both together. It’s not the fat that’s the problem (although remember that warning about saturated fats) and it’s not the sugar (as one of the twins explained earlier, we don’t binge on sugar cubes). A final suggestion to cut calories was slipped in for the last time and that was that. Phew!

This programme set out to exonerate a high carbohydrate diet from any blame in the nation’s obesity crisis. It did this by deliberately choosing extreme diets with which to make its point and to hell with any sense of proportion or fairness. Important topics were skimmed over quickly (the debate about saturated fats, the different types of cholesterol, what causes heart disease, the effects of a low-fat, high carbohydrate diet). Subtle (and not so subtle) remarks were made throughout the programme that made it clear that the evidence had been carefully chosen to trash a high-fat, low-carb diet and to ‘protect’ high-carb diets. We are all aware that the hedonic impact of food is mighty important, but there are many people who have spent decades on high-carb, low-fat diets (while simultaneously avoiding hyper-palatable junk food) that have experienced a myriad of problems.

The consensus was a return to the same advice that governments and nutritionists have been trotting out for decades – a ‘healthy’ wholegrain diet, low in saturated fat and processed foods. Don’t worry too much about the sugar as long as its low fat, so stock up on those low-fat, sugary yoghurts because they are fine.

I wanted to have a look at the work of some of the experts that appeared in the programme. This turned up some rather interesting information. Professor Susan Jebb ‘works closely with the Department of Health, Public Health England and National Institute for Clinical Excellence’ and is also the Chair of The Department of Health Public Health Responsibility Deal – see here. They had something to do with that strange swimming pool/saturated fat pledge that I wrote about last year. Professor Jebb works with industry and retailers on such ‘Responsibility Pledges’ and is on a ‘high-level steering group that encompasses health professionals, food industry representatives and civil servants’ – see here. She has also been vocal in warning of ‘fad diets.’ Professor Jebb has previously come under fire for her work with Weight Watchers.  Also, check out this article from the excellent Dr Briffa here.

Amanda Ursell is a nutritionist and also a member of the British Dietetic Association. I wrote about the BDA take on ‘fad diets’ here. I was interested in the sort of diet that Amanda recommends and so I hopped over to her website and had a look. For breakfast, Amanda recommends amongst other things apple muesli, French toast, blueberry porridge, fruity toast, peanut butter toast, fresh fruit bowl and bacon sandwiches – and skinny cappuccinos. Plenty of sugar then… I was also interested in her take on the ‘French paradox’, which I always thought was to do with the fact that French people ate lots of saturated fat and yet had lower incidences of heart disease. Saturated fat is mysteriously missing from Amanda’s tips on French eating.

Professor Kanarek has served as ‘a member of the National Academy of Sciences, Committee on Military Nutrition Research, and on review committees for the National Institutes of Health, United States Department of Agriculture, and National Science Foundation’. Professor Kanarek contributed to a similar study on low-carb diets and cognitive function in this paper in 2008 with the USDA Human Nutrition research Centre on Ageing (unfortunately tracking dieters for only 3 weeks). A very low-carbohydrate diet (maximum of 10-16g per day) was compared to the ‘healthy’ diet as recommended by the American Dietetic Association.

All interesting stuff but it did leave me feeling that the scales were heavily weighted towards finding a favourable outcome for conventional wisdom on dietary matters. We were left with many unanswered questions, for instance what is the effect on weight and lifestyle diseases (the original question posed in the documentary) of a long-term high sugar, low-fat diet. I did not feel that this was addressed in any comprehensive way, in fact hardly at all other than Robert Lustig’s brief appearance followed by a sceptical comment from one of the twins.

Listening to people talk the day after the documentary was aired, the consensus seemed to be that all things in moderation and an avoidance of those ‘fad diets’ was the most sensible option. It’s a sad state of affairs.

Ending on a more positive note, my talk on Paleo to the ladies (and gentleman!) at the social club went down extremely well and their enthusiasm and interest cheered me no end. Perhaps things are not that bad after all…

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