What you’re getting yourself into
The nutritional guidelines are standing on a mountain of junk studies that should never have been used as evidence. You shouldn’t fear meat, or feel obligated to get your fruits and veggies in. Here’s a deconstruction of the core issues of nutritional epidemiology.
There’s a reason why millions across the world are petrified at the sight of a well marbled steak, and why the same people feel a smug sense of satisfaction when they balance out the wine and chocolate with a quick skim through the vegetable aisle.
This is the product of decades of being lectured to by the distributors of nutritional science. The boundaries of what makes a healthy diet have been drummed into our subconsciousness.
“Eat the rainbow”
“Plant fats are healthy, animal fats clog your arteries”
“Your gut will starve without fibre”
“You need fibre to sweep your colon clean”
“Red meat has suddenly decided to start killing us over the last century”
“Calorie deficit, that’s all you need to know. I didn’t write physics”
It’s high time we questioned what we take as absolute facts. Because this science isn’t close to being settled.
It wasn’t even science in the first place. What you have here are speculative takes gleaned from correlations in epidemiological data, that never reached the point of being verified.
And yet, they’ve been presented to us by clinicians and government guidelines like gospel. Leaving people like me, who go against the grain, to appear “controversial”.
But I’ll tell you what is true. Nutritional science is basically just nutritional epidemiology, which means that the nutritional guidelines are merely hypothetical, and by following them, you’re playing the part of the guinea pig.
So let me explain just what epidemiology is, where it ranks in the evidence hierarchy, why science is inherently political, and how the findings of nutritional studies get kidnapped by the healthy user bias.
The idea that you should eat the rainbow is based on science. The dietary guidelines are based on science. It’s just a shame that the science is assembled from junk.
What Is Epidemiology?
You might have caught the latest headlines on the insidious exploits of red meat, where it was pinned with increasing the risk of diabetes by 62%. In previous years, both red and processed meat has also been blamed for increasing the risk of colon cancer by 20%, and heart disease by 9 and 18% respectively.
All these point to red meat’s role as the harbinger of chronic disease. But you know what else they all have in common?
You guessed it, they are all conclusions that have been formed from observational studies, otherwise known as epidemiology. These studies are designed to identify potential links in the diet by drawing from food frequency questionnaires. There’s a reason epidemiology is the default option for researchers. It’s relatively easy, inexpensive, can be drawn from huge populations, and tracked over a long period of time.
Unfortunately, by its nature, observational studies are wide open to biases, confounding variables, and data manipulation. It relies on self-reported data, making it practically impossible to verify. Nevertheless, they form the vast chunk of nutritional science.
Observational studies are designed to provide hypothetical links that can then be verified by randomised controlled trials (RCTs), where subjects are randomly assigned to a control group and a treatment group.
This is designed to eliminate bias, and while it will reduce it, a truly randomised control trial in nutrition is basically impossible. The subjects will still be well aware that they are choosing between tofu and steak, and that leaves the door open for preceding biases to influence the outcome.
Another thing that undercuts RCTs in nutrition, is the fact that they would need to be cover a long period of time in order to best assess the impacts of different foods on the metabolism. A vegan diet, for instance, might perform well in the short term simply due to eliminating processed food and instilling a calorie deficit.
But there are obvious pitfalls to following a nutrient deplete diet, and the consequences could eventually be incisive. A six month study that could expose those nutrient deficiencies would be way too expensive to create with a large enough population in the modern era.
So what we’re left with, is observational studies. And that’s an issue, because they can only in very rare situations be used to prove causality, and their results tend to evaporate when tested in a clinical setting.
A 2011 analysis of 52 claims made by nutritional epidemiology tested in 12 well controlled trials found that not one of the 52 claims—0%–could be confirmed.
A 2005 analysis by Stanford epidemiologist John Ioannidis concluded that highly-cited observational findings such as those in nutrition were confirmed by RCTs in only 20 percent of cases.
That’s why observational studies shouldn’t be used to prove causation. Unfortunately, that hasn’t stopped people from running with it and presenting them as infallible evidence for their cause. Exhibit A being the nutritional guidelines.
There are a few core issues that make nutritional epidemiology so difficult to translate into real results. Great for making headlines on the Daily Mail, not so great for stemming the incessant rise of chronic disease.
1. The Healthy User Bias
For many of us, much of what we do, and how we construct our lifestyle, is shaped by the preconceptions that we have about what is or isn’t healthy. These preconceptions have been ingrained in our sub consciousness by decades of nutritional propaganda masquerading as science.
We accept that saturated fat is bad for us, because we’ve been endlessly told by clinicians to minimise steak and butter to keep heart disease at bay. We’re reminded of this danger every time we see bright red labels on beef burgers. Newspaper headlines and government guidelines repeatedly link red meat to all the classic chronic diseases.
Even diabetes, despite the fact that it’s an issue with glucose tolerance, and red meat is devoid of glucose.
Saturated fat is painted in the same light as cigarettes, as reflected in a brilliant study that stated that eating eggs was nearly as bad for your body as smoking. So it stands to reason that many people eager to improve their health will take these guidelines without too many questions. The same people who shun red meat, will also avoid smoking, minimise alcohol, engage in regular exercise, stay well above the poverty line, and get to bed on time. Behaviours that categorically improve one’s health.
They will also typically eat more fruits and vegetables, because they are presented as indisputably healthy components of a balanced diet.
All this means is that all these behaviours often get lumped together in populations that sit on the healthy end of the spectrum.
The Health-Conscious Person
- Low red meat and saturated fat intake
- High fruit and vegetable consumption
- None smoker
- Low alcohol consumption
- Regular exercise
- Financial security
- Good sleep hygiene
But correlation doesn’t equal causation. Just because this group of healthy people tend to eat less red meat, doesn’t mean they’re healthy because they eat less red meat. The cause could easily be embedded in one or more of the other factors.
In the meantime, people who aren’t health-conscious won’t be inclined to restrict their red meat intake. Especially when it comes wedged between two buns and served along fries that have been soaked in seed oils and a coke sugar bomb.
The Health-Apathetic Person
- Higher red meat and saturated fat intake
- Low fruit and vegetable consumption
- Smoker
- High alcohol consumption
- No gym membership
- Living paycheck to paycheck
- Insomniac
The Seventh Day Adventists are a great example of the healthy user bias being erroneously used to prove the superiority of being powered by plants. You might recognise them as the religious cult that invented veganism as the antidote to healthy sex drive.
A 2001 study on SDA members in California showed that they lived around 6 years longer than other Californians. Much of this was inferred to be down to their vegetarian diet. Hence why they’ve been held up as one of the long living plant-based blue zones.
Another observational study on the SDA stated that “Levels of cholesterol, diabetes, high blood pressure and metabolic syndrome all had the same trend – the closer you are to being a vegetarian, the lower the health risk in these areas.”
But is it the lack of meat that’s getting them to outperform their neighbours, or is it their strict lifestyle that shuns alcohol and cigarettes? Thankfully, we don’t have to look far to find the answer to that question, because we have another religious cult that eat plenty of meat while restricting alcohol and smoking. And as it happens, the Mormons show similar improvements to life expectancy, which puts the benefits of vegetarianism back under the asterisk.
The amusing thing with nutritional epidemiology, is that while it has obvious flaws that prevent it from determining causation, we don’t seem to hear as much from the many studies that show that higher meat intake correlates with longevity.
A graph comparing the meat consumption and lifespan of countries across the globe would show you such a pretty significant trend. Hong Kong, the country with the largest meat consumption also happens to have to be the country with the longest life expectancy. This is the general trend that reveals itself when you’re not being shown very specific populations like the SDA that have confounding lifestyle factors.
In case you’re wondering whether a study’s been done that looks at the relationship between red meat and chronic disease, while removing such confounding factors, here’s one from 2023.
“When meat consumption is part of healthy dietary patterns, harmful associations tend to disappear.”
Without the health user bias to prop it up, plant-based living has little to stand on. And yet, this is just one of the core issues.
2. The Inaccuracy Of Self Reporting
The latest headlines against red meat came last year in the form of an observational study looking at the link between red meat intake and diabetes. Which gave us snappers like the Guardian’s “Eating red meat twice a week may increase type 2 diabetes risk”.
The study reached that conclusion while including sandwiches and lasagna as part of meat intake. Red meat is often just one ingredient amongst many in fast food, coming saddled with sugar, seed oils, chemicals, and a host of empty calories. This gets reported as red meat intake, while containing other products that are known to be unhealthy.
The food frequency questionnaire (FFQ) used for the diabetes study asked participants the question: “How often did you eat the following over the past 12 months?”
Now tell me how accurately you’d be able to answer that. I’d guess it would end up more than a little off the mark, and that’s true in general for FFQs. The recounting of what you ate for lunch on Tuesday, six months ago, is going to be imprecise.
The amount of ounces of red meat you ate is going to be even more scattered. Your biases might further eschew the numbers, as you unfaithfully jack up the vegetable servings because you know they’re the healthiest thing on the menu, and you want to be able to sleep soundly that night.
3. The Difference Between Relative Risk And Absolute Risk
This is where statistics can be downright misleading, and I’m going to illustrate that point by bringing up another classic study that claimed that eating 50 grams of bacon a day increased your chances of getting colon cancer by 18%. This wasn’t good for bacon sales, which experienced a temporary dip before people realised that cancer was too delicious to turn down.
But here’s the thing. The 18% number that was offered by the study was the relative risk, which represents the increase in the absolute risk, which was at 5%. So the ingestion of bacon only took the risk from 5% to 5.9%.
A staggering increase of 0.9%, that was hardly substantial even if you were to disregard the obvious confounders like the healthy user bias.
The issue for these researchers was that the numbers that they got at the end of the study weren’t meaningful, so they went with the option of misrepresenting the data by hiding away the absolute risk.
This appears to be part of the rules of engagement for studies trying to link meat to chronic disease. The aforementioned diabetes study found a huge 62% risk with increasing red meat intake. In the meantime, the absolute risk had risen from 0.32% to 0.52%.
Imagine the pandemonium in the alternative meat aisle if the headline had been changed from:
“Eating red meat increases your chances of diabetes by 62%”
To this:
“Eating red meat may increase your risk of diabetes by 0.2%”
Whenever you see big percentages being thrown up in observational studies, just keep in mind that they’re describing relative risk over absolute risk in order to appear statistically meaningful.
4. Science Is Political
What we should understand at this point is that nutritional science is almost entirely gleaned from observational studies, and these studies are at a much greater risk of being rendered void by biases than they are at showing statistically significant risk factors.
Unfortunately, this is what we get when we glean our science from studies that use self-reported data, often involve small sample sizes, and get pumped around through different formulas by researchers until they arrive at the headline that their studies were funded to find.
Yes, because someone had to pay for it, and they’ll generally have a vested interest in the outcome. What happens if they can’t get the result they’re after? Just do the right thing for your benefactor, and bury the incriminating data so that it never reaches the scientific community.
This is exactly what happened with the Sydney Diet Heart Study, one of the largest clinical studies in nutrition, which compared the effect of saturated fat and vegetable oil. Guess which group lived longer? A big mark against Omega 6 and factory fats that wasn’t revealed until someone discovered a 9-track magnetic computer tape hidden away in a garage almost a half century later.
You can’t separate science from politics. Scientists are given grants, and if they don’t produce the results, they run the risk of being excluded from future grants, and being frozen out of research entirely. The scientists brave enough to step out and reveal undesirable results have their character destroyed for not toeing the party line.
In 1972, a British scientist named John Yudkin made the case that it was sugar rather than saturated fat that was the greater threat to health. And for such a case, he was ridiculed by his counterparts, his reputation was dragged through the mud, and his college ostracized him.
But I’d love to hear more about how Big Steak is driving the global agenda. Not Procter and Gamble, who gave the American Heart Association (AHA) a healthy $20 million donation before the latter had any sort of relevancy. The AHA proceeded to recommend that everyone should replace their butter and lard with Procter and Gamble’s very own creation: Crisco, the world’s first margarine.
A recommendation, with a massive conflict of interest and zero credible science, that went on to influence the first US dietary guidelines in 1977 that prescribed higher carb consumption, restrictions on saturated fat, and the inclusion of plant fats. And since the rest of the world tends to sing to America’s tune, global dietary policy followed in its wake.
I wonder how obesity has trended since the injection of such majestic science into the public consciousness. The pre-eminent studies of recent times that sought to dictate global nutritional guidelines, 2019’s Global Burden Of Disease and the EAT-Lancet study, have only sought to continue that trend by making colossal assumptions out of epidemiological data.
The GBD report set the minimal risk exposure level for red meat to zero, without displaying any of the gymnastics they took to arrive at that conclusion.
EAT-Lancet recommended that red meat intake shouldn’t exceed anymore than 14 grams a day.
Besides the complete lack of evidence to provide substance for these recommendations, it does beg the question: how are we going to make up for the obvious drawbacks involved in virtually removing the most nutrient dense food on the planet?
We’re not getting there with tofu.
Wrapping Up – Is There Any Science We Can Trust?
Hopefully this will give you an idea that I’m not simply a contrarian or a conspiracy theorist when I show a blatant disregard for the “settled science” that people continue to refer back to when talking about the dangers of red meat and the delights of fiber.
Nutritional science is a bit of a mess at this point.
– Confounded by the healthy user bias
– Unreliable self reporting
– Underpowered risk percentages
– Dictated by politics
But that doesn’t mean we can’t shape our diet by science. The point here is that we won’t get there by looking at epidemiology. There is just too much junk to wade through. The strongest case for an optimal human diet is found in evolutionary biology.
What we primarily ate for the majority of our existence as a species, will work for us now, because evolution doesn’t unravel and reset our biology over a few thousand years.
While the foods with no historical precedent, and the foods we only ever ate infrequently and meagre amounts, should be avoided or at least limited. Because chronic disease is a thoroughly modern phenomenon.
You shouldn’t have to wonder what diet that leads us to.
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I love reading these well written articles.
Great article. At the end of section 1(?) you mention a study about meat consumption with confounders removed but there is no link.
I had it in the quotes, which I guess wasn’t the most conspicuous place to put it. I’ve fixed it now.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10105855/