This entry is part 1 of 2 in the series Health

Introduction

So I’ve been building these pig forts. I’m making them out of saplings in the hedgerows. They’re cheap to build and the pigs seem to like them. It’s a lot of work but winter is coming and the herd is growing. In fact, I should be out there getting the farm ready for winter right now. Except that this week the World Health Organization released a hack of a report that has caused global panic and I feel the need to respond to it. Since the WHO didn’t do its job now I can’t do mine, either. I’ve been meaning to do a series of health related posts anyway. I was hoping to start with a more dignified topic that having to discredit the WHO but they gave me no choice.

This actually turned out to be a pretty good article. It’s a bit long but I think if you stick it out you’ll be happy you did. First we’ll talk about the problems with the WHO “study” but also the problems with the current state of nutritional science in general. Then we’ll talk about nitrates, the subject that seems to have confused everybody. We’ll go on to do a little armchair epidemiology, much like the WHO “researchers” did. I think you’ll enjoy the ride.

I don’t get much into the difference between pasture raised meats and industrial meats in this article because the WHO report painted all meat with a broad brush and so I’m just talking about meat in general. Trust me, there is a huge difference between what we do and industrial pork but that’s for another article. Read on!

One more note. I actually really do have to go feed the pigs in a minute. For the time being I’m leaving out a lot of the links to my supporting points. I’ll come back to this article when I get a minute and back and fill some of the holes but I swear I’m not making any of this. This is basically the same approach the WHO took. They didn’t publish any data. Not a single table or chart. All they did was makes a press release that they had found something and a promise that they’ll give us the data later.

Junk “Science”

If economics is the dismal science then nutrition is the abysmal science.

Last week’s report from the World Health Organization is generating headlines around the world. WHO researchers have concluded that red and processed meats are carcinogens. The paper begins, ”In October, 2015, 22 scientists from ten countries met at the International Agency for Research on Cancer (IARC) in Lyon, France, to evaluate the carcinogenicity of the consumption of red meat and processed meat.” Their findings were published in the news section of the Lancet Oncology in the same month, which means that their findings didn’t have to undergo peer review. Very clever. This was a witch hunt.

Peer review is one of the bedrock principles of modern science. You submit your article to a journal who then sends it out to your peers. They get to read it and tell the journal either, “this is rubbish, don’t publish it” or “it’s fine but the author needs to show more supporting data”. Then the journal sends you back the critiques and then you edit the paper until everyone is satisfied. If it doesn’t go through peer review then it’s not science. A common theme of this article is that the “researchers” apparently all flunked eighth grade science, where you learn about the basic principles of science. Things like controls, peer review and testing of hypotheses are completely missing from this “research”. They also make the scientifically bankrupt logical leap that correlation equals causation. This is pop science, amateur hour stuff.

Twenty two “scientists” spent untold amounts of money to fly into Lyon, stay at a fancy hotel, wining and dining themselves while they googled old studies. While they were there they found that 7 of 15 studies on red meat consumption and 12 out of 18 studies on processed meat correlated with colorectal cancer rates. There was no evidence that red meat correlated with any other cancers. They then jumped to the invalid conclusion that correlation equals causation (again, apparently they skipped eighth grade science class) and declared processed meats to be a carcinogen and red meats to be a likely carcinogen. They published the whole thing as news to avoid the peer review process. The peer review process is designed to hold scientists accountable and this exercise was clearly about headlines, not accountability.

Most of the studies used to draw these conclusions were observational studies. These studies are notoriously sloppy. Participants complete a questionnaire about what they’ve eaten in the last 24 hours or maybe in the last week. Then they are tracked for a period of years to see what health ailments befall them. Correlations are drawn between the foods they said they ate on the questionnaire and the health ailments they have. The studies have many problems. The first is that people tend to not remember what they’ve eaten and they lie to themselves and their doctors about exactly what they’ve eaten to make themselves feel better. Another problem is that a 24 hour window is often not indicative of a person’s overall diet. By far the biggest problem of these studies is that there are far too many variables involved. For instance, red meat eaters also eat more sugar and processed foods, are three times as likely to be smokers and are half as likely to have high cholesterol (according to the nurses’ health study and yeah, you read that right but you probably didn’t see any headlines about it, did you?). What these studies end up finding (some of them, anyway) is that there is a correlation between, in this case, colorectal cancer and the type of person who admits to eating red or processed meat on a questionnaire that they hand to a nurse. Eating at McDonald’s and other fast food joints also correlates with eating red meat. I suspect that eating bologna and hot dogs correlate with lower socioeconomic status. Maybe even more importantly, the people being studied don’t live in a vacuum, they read the news. They know that red meat and bacon are supposed to be “bad” and yet they eat it anyway and then admit it on the questionnaire. How can a study like this control for the behaviors of people with that kind of devil may care attitude? How can this kind of study tease out whether the cancer connection is due to the red meat, the cigarette smoking, the sugar and processed foods, eating at fast food joints or being lower on the socio-economic ladder? The answer is that it can’t. To do that would require real science. Real science is hard. Generating headlines is easy.

Observational studies are designed to generate hypotheses. If these people were actually scientists doing their job, the meeting in France would have given them the hypothesis that red and processed meats cause cancer. Then they should have put their heads down and gotten to the hard work of science. They have to test their hypothesis. This would mean designing a study with controls. Eighth grade science stuff. A study like this would be one where people are randomly assigned to two different groups and then one group is told to avoid red meat and the other is told to continue eating like they always have. Then you have to do the hard work of following up, making sure they are following the diet they are supposed to be on and tracking their medical records for five or ten years until you can see if the dietary intervention had any effect. At the end of that study they would look at their results and either accept or reject their hypothesis. That process is hard and it takes a long time and a lot of money. Guess, what? My job is hard and takes a long time and a lot of money. Cry me a river!

This study is pure pop science. By skipping out on peer review the authors have chosen to not even pretend they are doing science. No research has been done. Nothing new has been found. They knew what was in those papers before they got to France. The point of this excursion was purely to generate headlines and incite panic in the public. They were pushing an agenda. They don’t know if processed meat is carcinogenic and neither does anyone else because no one has ever done any real science on this topic. If nutritional science stays on its current path, no one ever will do any real science. All they ever do is observational studies. Then they report their hypotheses as if they found something, the media laps it up, publishes it like it’s science, the public reacts, and we repeat the cycle. Remember the 90s? Eggs are bad! Eggs are good! Eggs are bad! That’s why we get these crazy vacillations. It’s easy to find correlations in the world to support whatever your agenda is. Real easy. Science is hard.

This would all be fun and games if it didn’t affect so many people, but I think releasing this kind of “science” is not only stupid but actually dangerous. Stick with me and you’ll see why.

Degree Of Risk

My belief is that the correlation found in some of these studies between being the type of person who eats red meat and being the type of person who is likely to get cancer has nothing to do with red meat per se. I suspect it has everything to do with being the type of person who eats fast and processed foods, is impoverished, eats sugar and smokes. The thing is that if you stop eating red meat you’re still the same type of person. In all likelihood switching from a quarter pounder to a grilled chicken sandwich at your local burger chain will make zero difference to your overall health outcome. See what I mean? But I could be wrong. We’ll probably never know.

If I am wrong, there is still no need to panic. The actual risk, according to the WHO, are tiny. They say an extra 50 gram portion of processed meat increases your risk of getting colorectal cancer by 18%. According to the cancer atlas, in the US 25 out of 100,000 people develop colorectal cancer every year. This is about 0.025 percent of people. If you assume that colorectal cancer only affects people over 40 that probably doubles the risk so we’ll say that for people over 40 the risks of getting colorectal cancer is about 0.05 percent per year, which is about 0.5 percent per decade. So if you eat an extra 2 ounce hot dog every day your risk of getting colorectal increase by 0.09 percent (18 percent of one half percent) over a decade. My opinion is that this probably isn’t an amount of risk that rises to the level of inducing global panic. It’s more like an amount of risk where scientists should put their heads down and get to the hard work of science.

The Nitrate Section

A reporter called me yesterday and really wanted me to feed him the sound bite that synthetic nitrate causes cancer, which, as he says, “everyone knows”. I guess this is the end result of decades of fear mongering. This is where we need to take a deep breath and a big step back.

What is Nitrate?

Nitrate (NO3 – one nitrogen molecule bonded to three oxygens) is the basic building block of all protein consumed by human beings. It is “fixed” out of the air, which is mostly Nitrogen gas, by bacteria that live in “nodules” on the roots of leguminous plants. The bacteria secrete the nitrate into the soil where it is taken up by plant roots, transported throughout the plant, converted into nitrite, then into amino acids which are then built into proteins. Then we consume those proteins directly or by eating livestock that have gotten their protein by eating the plants or even sometimes by eating fungus that have eaten the plants. Pretty neat! Plant tissues are loaded with nitrates because that’s how they make protein. Whenever you eat a plant that has been fertilized with synthetic nitrate, which means most all commercially available produce that isn’t organic, those plants are full of synthetic nitrate that was made in a chemical plant, put into the soil, absorbed by the plant roots and transported throughout the tissues of the plant. You are literally eating synthetic nitrate molecules every time you eat a non-organic salad. Your saliva converts a fair amount of that nitrate into nitrite in your mouth. Nitrate is the chemical that is used to cure meat.

Accusing nitrate or nitrite of being a carcinogen is a bit like accusing water or glucose or salt of being carcinogens. These things are the very basic building blocks that make life on this planet possible. If nitrate is a carcinogen why even get up in the morning? It’s everywhere. It’s in plants – it’s common for lettuce to have ten times the nitrates of bacon although there is typically less in organic lettuce, it’s in our drinking water, it’s made by lightning (which very likely played a huge role in the origins of life), it’s in wood smoke, and it’s in ham. Why?

When nitrite is added to meat it forms nitric oxide which tightly binds to the oxygen in the myoglobin (very similar to the hemoglobin molecule which binds oxygen in your blood and makes your blood red) molecule of the muscle tissues. This prevents the release of the oxygen molecule when the meat is cooked which is why ham stays pink after cooking unlike most meats which release their oxygen and turn grey. The nitrate gives cured meats its pink color and therefore shelf appeal. But, and this is of the utmost importance to remember, it is also what makes ham taste like ham. Without nitrate ham tastes like roast pork, which is delicious but it’s not ham.

Nitrate has been used to cure meats for thousands of years in Europe. Certain caves were known to contain salt deposits that made the best cured meats. Salt from these deposits were sought after for their curing prowess. It is likely that the cured meats of 1000 years ago had maybe 100 times the nitrates of cured meats today.

The nitric oxide isn’t toxic either. According to its Wikipedia page, “The endothelium (inner lining) of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, thus resulting in vasodilation and increasing blood flow.”

The chemicals that are supposed to be causing the cancer are chemicals formed when the meat is cooked. Things like N-nitroso-compounds (NOC), polycyclic aromatic hydrocarbons (PAH) and heterocyclic aromatic amines (HAA). Scary sounding words to be sure. These compounds are created when food is heated to very high temperatures by searing or grilling or frying or caramelizing or smoking. All of these products can be isolated and fed to lab animals at a high dosage rate to cause cancer but that is a very unnatural situation. None of these compounds are specific to red meat and it is unclear what the risk of them is in the amounts found in everyday foods. Vegetable oils are known to create PAH when heated to very high levels. Chicken and fish make HAA when grilled. Smoked fish, cheese and beer contain NOC. If I toss kale in olive oil and throw it on my charcoal grill over a very hot bed of coals, which I frequently do, I am presumably creating all of these compounds. Should I then conclude that kale is a carcinogen? If anything is indicated as harmful by this correlation it is high heat cooking rather than any specific food.

This is problematic since one of the things that has separated humans from other animal species since our origins is our ability to cook with fire. Our ancestors have been cooking food over direct flames or buried in ashes since the beginning of humanity. If it’s really that dangerous presumably we would have built some defenses against it?

Armchair Epidemiology

Let’s do our own study. We’re going to look at whether there is a correlation between red meat consumption and colorectal cancer in the real world. We’ll use country by country food “disappearance” data from the UN and cancer rate data from the cancer atlas. This is an observational study, much like the reports used by the WHO. The difference is that the data from the UN about what is actually eaten in a country is probably far more accurate than a 24 hour dietary recall.

If the hypothesis is correct there should be a correlation between countries that eat a lot of red and processed meats cooked to high temperatures and colorectal cancer. In one way this is actually true. Colorectal cancer is generally very low in developing countries. Developing countries don’t eat a lot of red meat, but they also don’t eat nearly as much sugar, vegetable oil, fried foods, processed foods and fast food as developed countries. Again, it’s easy to find a correlation but it’s hard to tease out the cause.

Let’s consider the case of modern, developed countries. If the hypothesis is true there should be a correlation between countries that eat more red meat and countries that do not and there should be differences based on cooking styles. For instance, Americans love to grill, sear, fry and smoke. Burgers, BBQ, bacon, grilled chicken, french fries and yes, even grilled, roasted and fried vegetables are a few of our favorite things. If any country should have a sky high rate of colon cancer it should be the US. Other countries that would be expected to have high rates are France and Italy where cured meats are beloved. Countries that would be expected to have low rates of colorectal cancer include Israel, where pork is not consumed for religious reasons and Japan, where seafood is favored over red meats. What do we see?

Country Red Meat Consumption (grams/day) Colorectal Cancer Incidence Rate (per 100,000 people annually)
US 179 25
France 170 30
Italy 172 33.9
Japan 81 32.2
Israel 89 35.9
Slovakia 107 42.7
Hungary 129 42.3
Denmark 134 40.5
Netherlands 137 40.2
Austria 236 26
Greece 173 13.5

The US actually has one of the lowest rates of colon cancers among all modern nations. The rates are more or less indistinguishable between France, Italy, Japan and Israel despite the fact that Israel and Japan eat half the amount of red meat as the other two nations. The countries with the highest rates in Europe – Slovakia, Hungary, Denmark and the Netherlands – eat less red meat than Italy, France and the US. Austria eats massive quantities of pork but has low rates compared to its European peers. The country with the lowest rate of colorectal cancer among developed countries is Greece, where they consume the same amount of red meat as the US, France and Italy. As a side note, someone apparently forgot to tell France, Italy and Greece that they’re supposed to be eating a Mediterranean diet. They eat as much red meat as the “glutinous” US.

We can conclude that if red meat consumption does indeed cause colorectal cancer it has little real world effect. Among developed countries there is no correlation whatsoever. Did anyone at the WHO even stop to consider this? All of this data is readily available online.

Real Harm Done

Finally I’d like to return to my earlier point that fearmongering about food is actively harmful. Let’s consider a previous poorly controlled study that showed a correlation between red meat and heart disease and the downstream effect on the American diet. The infamous “seven countries study” was done by Ancel Keys starting in the 1950s. It showed a direct correlation between saturated fat consumption and heart disease rates. The problem is that the populations being studied were hand picked and Dr. Keyes presumably had information on both health outcomes and dietary information when he designed the study. In a fiercely worded article in the September 22nd, 1977 issue of the New England Journal of Medicine, Dr. George Mann (who knew a thing or two about heart disease) said of Dr. Keys’ study, “The naivete of such an interpretation of associated attributes is now a classroom demonstration.”

As a direct result of Dr. Keyes study, the world came to believe that saturated fat consumption caused heart disease. It was replaced with corn oil, margarine and vegetable shortenings. Vegetable oils at that time were a brand new food – the technology to extract and hydrogenate vegetables oils was only decades old. Corn oil is loaded with Omega 6 oils that are now thought to be pro-inflammatory and play a role in fatty liver disease and certain cancers. Trans-fats found in margarine and vegetable shortening turned out to be so dangerous that New York City banned them in 2006 and now the FDA has ruled that they need to be eliminated from the US diet by 2018.

At the same time, saturated fat has failed in most trials to show any consistent correlation with heart disease rates, let alone causation. For instance, the nurses health study which I referenced above, failed to find any correlation between saturated fat consumption and heart disease rates among 86,000 nurses followed for 20 years. Several recent review articles have combed the literature and failed to find convincing evidence for a link between saturated fat consumption and heart disease rates. This is clearly a case of the cure being worse than the disease.

Perhaps even worse, although it’s hard to imagine there is much worse than the millions of people worldwide who died due to trans-fat consumption because of lazy scientists, the seven countries study and the following low fat craze has caused modern Americans to have a very strained relationship around food. To this day I cringe when I hear anyone make the all too familiar joke about how when they eat something delicious like bacon or steak they can feel their arteries clogging. There is no good science to back up that opinion but the phrase “artery clogging saturated fat” lives on in pop culture.

I firmly believe the cooking and enjoying of food is one of the most healthful activities one can engage in as an individual or as a family. How does being fearful of basic foods that have been a staple of humanity since the dawn of our race improve the healthfulness of cooking a meal? We are constantly told to eat more vegetables and the best way I can find to get people to eat more vegetables is to put bacon in it. But what if we’re afraid of bacon? Does that mean we should eat less vegetables?

The raising and consuming of pork and beef is a part of our culture, our nutrition and our cuisine and can fit into the ecology of our nation when it is done correctly like we do at The Piggery. Meat is an excellent source of protein, B vitamins and iron. Pork fat from pigs raised in sunshine is an excellent source of vitamin D and meat from grazing animals is a great source of vitamin K2. These are the things that keep our bodies strong. Since the seven countries study there has been a huge rise in the consumption of vegetable oil and sugar, worldwide but especially in the US, neither of which bring anything to the table nutritionally. Low-fat yogurt is a popular snack but has to be laced with sugar for palatability. Greek yogurt has as much sugar per ounce as Coca-cola. So we’ve traded milkfat, with its vitamin A, D and K2, and it’s short chain saturated fats like butyrate that are thought to help one’s metabolism for sugar and corn syrup. Is that really a win?

Given the fact that the risks found in the WHO study are so tiny and that the real world totally fails to support the hypothesis of the researchers, it seems highly probable that this whole episode is much ado about nothing. My suggestion to the researchers and any nutrition researcher is to keep your mouth shut, roll up your sleeves and do your job. By which I mean peer reviewed studies with controls. Eighth grade science kind of stuff. Until you can do your job please leave the rest of us alone.

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