Low Carb Denver- Food in the (Mis) Anthropene
My summary of Georgia Ede’s presentation at Low Carb Denver
I attended this year’s Low Carb Conference in Denver, Colorado to gain a better understanding of the potential health benefits of a low carb diet. This is the first of many posts about my experience. For this post, I will summarize what I learned from Georgia Ede’s presentation critiquing the newly released EAT-Lancet Report. EAT is a non-profit startup with the goal of transforming the global food system to feed and sustain the growing population. Lancet is one of the oldest and most respected medical journals. The EAT-Lancet Report claims to review what constitutes both a healthy and sustainable diet. At the end of this post, I will provide my own thoughts on the presentation.
For a healthy and sustainable diet, The EAT-Lancet Report recommends that we consume a diet mostly of grains, fruits and vegetables. It recommends that we we consume less than half an ounce of red meat per day, less than one ounce of poultry per day, 1 ounce of fish and 1/4 an egg. Here is a quick summary of a few of Georgia’s criticisms:
- The report is based off of weak science.
- The report is filled with contradictions.
- Conflicts of interest
The problems with nutritional epidemiological studies
Nutritional Epidemiology is the study of how diet affects health and disease. These studies are conducted by assessing dietary intake of groups of people and then examining disease rates by statistical analysis. Nutritional epidemiology suffers from a lot of challenges because most of the data is self-reported. One problem with using nutritional epidemiology is that it can only demonstrate association between two factors NOT causation. In addition, nutritional epidemiology is subject to participant bias. Lastly, nutritional epidemiology is problematic because most of the data relies on participant memory. Some nutritional epidemiology questions require participants to summarize their behavior over as long as a year-long span. In The EAT-Lancet Report, all of the evidence linking red meat consumption to early death is based off of epidemiological studies.
Association does not equal causation
Here is an example of how association does NOT demonstrate causation:
As ice cream sales rise, so do sun burns. Therefore, ice cream causes sun burn.
This is clearly incorrect. As we all know, people get sun burned when they are out in the sun. People also eat ice cream when they are out in the sun. Just because both ice cream consumption and sun burns occur around the same time, we can NOT assume that one causes the other. Why not? Because we are not taking into account the other hidden factors in play.
The same logic applies to epidemiological studies.
According to nutritional epidemiological studies, people who eat less meat and more fruits and vegetables appear to live longer. Therefore meat causes heart disease, diabetes, cancer stroke, everything.
How can we be so sure that meat is causing all of these negative health outcomes? Could we maybe think of a few other factors (besides limited meat consumption) that may be protecting these people from negative health outcomes?
Interfering factors
One factor that may conflict with this data is the “Healthy User Bias.” The kind of subjects that enroll in clinical trials are not representative of the general population. These people can be expected to be healthier because they are generally more concerned about their health and are predisposed to following their doctors advice.
Doctors tell us to consume more fruits and vegetables and less meat. People who care about their health listen to their doctor. Therefore, someone who listens to their doctors dietary advice (to eat more fruits and vegetables & less meat) is more likely to engage in other health promoting activities such as abstaining from drinking, smoking and sugar etc. On the other hand, people who are less interested in health are less likely to listen to their doctor. They are probably more likely to adopt other poor health habits as well such as smoking, drinking and sugar consumption. So is it the meat that we should blame or is it the lifestyle? We can not say for sure from this type of study.
Flawed study structure
It is difficult to make conclusions from Food Frequency questionnaires because they completely rely on the memory of the participants. Some questions require participants to summarize their behavior over a year long span. During Georgia’s presentation, she displayed a commonly asked question from a food frequency questionnaire for a nutritional epidemiological study:
The question requires participants to remember how many servings they consumed of a certain food in a given year. How on earth is someone supposed to accurately remember that? In addition, if a person perceives a certain food is less healthy than other foods (meat), they are more likely to underestimate their consumption of that food and overestimate their consumption of healthy foods (fruits & veggies). Georgia noted that when tested in clinical trials, epidemiological studies are wrong at least 80% of the time.
EAT-Lancet Report is filled with contradictions.
The EAT-Lancet Report states that red meat consumption its linked to heart disease, stroke, T2 diabetes, obesity, cancer and early death. However the report still acknowledges the potential health benefits of meat. Here is a quote from the report on how animal-based foods can help the nutritional status of children in sub-saharea Africa:
“growing children often do not obtain adequate quantities of nutrients from plant source foods alone…promotion of animal source foods for children, including livestock products, can improve dietary quality, micronutrient intake, nutrient status and overall health.” [page 10]
So meat is the root cause of all of our chronic illness yet it can also significantly improve the health status of growing children?
Egg contradictions
The EAT-Lancet Report states:
“Eggs are a widely available source of high-quality protein and other essential nutrients needed to support rapid growth.
“in large prospective [epi] studies, high consumption of eggs, up to one a day, has not been associated with increased risk of heart disease, except in people with diabetes.”
“However, in low-income countries, replacing calories from a staple starchy food with an egg can substantially improve the nutritional quality of a child’s diet and reduce stunting.” [randomized clinical trial].
The report clearly acknowledges the nutrition of eggs. However when it comes to recommendations, the report states the following:
“We have used an intake of eggs at about 13 g/day, or about 1.5 eggs per week, for the reference diet, but higher intake might be beneficial for low-income populations with poor dietary quality.” [page 11].
This is confusing. If eggs are so nutritious and beneficial for health, why would the report recommend such a low amount?
Protein contradictions
EAT-Lancet’s thoughts on protein in the diet:
“Protein quality (defined by effect on growth rate) reflects the amino acid composition of the food source, and animal sources of protein are of higher quality than most plant sources.”
High-quality protein is particularly important for growth of infants and young children, and possibility in older people losing muscle mass in later life.” [page 8].
“However, a mix of amino acids that maximally stimulate cell replication and growth might not be optimal throughout most of adult life because rapid cell replication can increase cancer risk.”
So the report acknowledges that animal protein is the highest quality of protein. Yet this high quality protein could be dangerous because essential amino acids can cause cancer growth?
This claim is supported by one study on the cell mutation theory of cancer. No where in that study are the words “protein” “amino acid” or “meat” even mentioned. The study they use to make this claim does not support the argument that consuming meat increases our risk of developing cancer.
Vitamin & mineral contradictions
In regards to vitamin & mineral rich foods, the report stated the following:
“Although inclusion of some animal source foods in maternal diets is widely considered important for optimal fetal growth and increased iron requirement, especially during the third trimester of pregnancy, evidence suggests that balanced vegetarian diets can support healthy fetal development, with the caveat that strict vegan diets require supplements of b12.”
“Adolescent girls are at risk of iron deficiency because of rapid growth combined with menstrual losses. Menstrual losses have sometimes been a rationale for increased consumption of red meat, but a multivitamin or multimineral preparation provide an alternative that is less expensive without the adverse consequences of red meat intake.” (page 13)
The report claims that their diet is adequate only if you supplement. Is a diet really optimal for health if it requires supplementation?
In changing to the The Eat-Lancet diet, the commission claims that:
“The adequacy of most micronutrients increases, including several essential ones, such as iron, zinc, folate and Vitamin A, as well as calcium intake in low-income countries. The only exception is B12 that is low in animal based diets. Supplementation or fortification with vitamin B12 (and possibly riboflavin [vitamin B2]) might be necessary in some circumstances.” [page 14].
This statement is concerning in that the report downplays the bioavailability of plant foods. Though plant foods are high in these vitamins and minerals, our body is not good at utilizing them. This is because plant foods contain other substances called anti-nutrients that interfere with our body’s ability to absorb them. In addition, many plant nutrients do not exist in a form that is usable for our bodies. Our bodies have to convert these nutrients a usable form and we aren’t always efficient at making this conversion. So when a plant product claims to contain 50% of the RDA, it may be way off because the nutrient exists in a form that is not usable for our bodies.
For example, plants do not actually contain Vitamin A. They contain carotenoids that our bodies convert to Vitamin A. The type of iron found in plant food (non-heme iron) is less bioavailable to us compared to animal iron (heme-iron). In addition, other anti-nutrients such as phytates further inhibit our ability to absorb iron. This pattern is common in most plant nutrients. Our body is able to utilize nutrients from animals better than plants.
Omega-3 contradictions
The EAT-Lancet report states the following about fish nutrition:
“Fish has a high content of omega-3 fatty acids, which have many essential roles…
“adequate intakes of omega-3 fatty acids are essential for neurodevelopment, and eating more than two servings of fish per week or taking fish oil supplements during pregnancy has been associated with improved child cognitive performance. [page 11].
“Plant sources of alpha-linolenic acid [ALA] can provide an alternative to omega-3 fatty acids, but the quantity is not clear.” [page 11]
“About 28 g/day (1 ounce) of fish can provide essential omega-3 fatty acids…therefore we have used this intake for the reference diet. We also suggest a range of 0-100g/day because high intakes are associated with excellent health.” [page 11]
The report states that we can use plants as a source of omega-3 fats, but the recommended amount is unknown. The reason the recommendation is unknown is because the plant form of omega-3, ALA, is not efficient at converting to the other essential forms of omega-3 fatty acids, DHA and EPA. EPA and DHA do not exist in plant foods, they ONLY exist in animal foods. Only 0-9% of ALA can be converted to EPA. The report fails to acknowledge that people are not efficient at converting ALA to EPA and DHA. Yet they still recommend that is is okay to consume 0g of fish, the richest source of essential EPA and DHA.
Environmental Contradictions
EAT-Lancet uses the following chart to justify that a vegan diet has less of a negative impact on the environment. Red is bad, yellow is ok and green is the best for the environment. As you can see by their own measurements, the only environmental advantage the vegan diet has over a regular diet is that it reduces greenhouse has emissions.
Georgia discussed during her presentation that Frank Mitloehner, a UC Davis Professor on Animal Science & Air Quality Specialist, reached out to to The EAT-Lancet Commission to ask how greenhouse gas emissions were calculated. He received the following answer back from the committee:
The report claims to be both a healthy and sustainable diet. Yet by their own accord, their dietary recommendations are not set due to environmental concerns. Who is this diet really for?
Conflict of interest
Georgia discussed in her presentation that EAT, the non-profit that spearheaded the report, co-launched FReSH (Food Reform for Sustainability and Health) in January of 2017, a partnership of 32 corporations. As you can see, many of these companies create fertilizers & pesticides, processed food, flavorings & additives. These are all plant-based foods that would benefit from the type of diet that The EAT-Lancet Report recommends. Is this report really using the best scientific information to make their recommendations? Is there a conflict of interest here?
My thoughts
I find this report to be deceptive in many ways. The report promotes itself as a healthy diet. However upon further examination, you can clearly see the many flaws in their recommendation. The report uses epidemiological studies to condemn meat. Epidemiological studies can not prove cause and effect. Period. Therefore it is not accurate to make the claim that meat is the root cause of all our problems. The EAT-Lancet Report claims that their diet is adequate in certain vitamins and minerals, but does not take into account the bioavailability of these nutrients. Just because a food is measured nutritionally valuable does not mean our body has access to it. Even by their own account, when further pressed about the environmental impact, they address that the recommendation is not set due to environmental considerations, but solely for health ones. This makes you question: who is this report really for and what are the true incentives behind this recommendation?
Further recommended reading about The Eat-Lancet Report
https://sustainabledish.com/20-ways-eat-lancets-global-diet-is-wrongfully-vilifying-meat/
https://www.nutritioncoalition.us/news/eatlancet-report-one-sided