Wednesday, July 16, 2014

The Lean Meat “Health Advice” is a Big, Fat Lie and It’s Keeping America Sick


We’ve all heard it before, if you want to get healthy consume less red and processed meats and eat more lean meats (i.e. chicken, turkey, fish). Right?

Your neighbor, family members, friends, and even your doctor tell you to do this. It’s all over the media. You can’t go five minutes without hearing a commercial raving about the importance of getting enough lean protein for optimal health.

Is this true? Are chicken and fish the superfoods of proteins? How lean are these lean meats? What does this mean for you and your health?

You’ve probably pondered these questions in the past, and you’re about to find out the answers. But first, if you have questions about protein, in overall terms of the diet, then please read my article, 35 Ways to Counter the Vegan Protein Interrogation.

What is Considered Lean?


The term lean when referring to meat is defined in the New Oxford American Dictionary as “containing little fat.”

Well, that solidifies it now, doesn’t it?

Containing little fat can mean a lot of different things to a lot of different people: I’m feeling pretty entitled today. The mirror treated me well after glancing into it this morning, so I think I’ll have two lean ground turkey patties for dinner instead of just one tonight. This might be someone's version of eating little fat.

Only one problem. That 93% lean ground turkey patty actually contains 49.8% of its calories from fat!1 Maybe you’ll opt for the canned white tuna next time, huh? After all, tuna is fish, and fish is lean isn’t it?

To get a better grasp on this subject, let’s take a look at the organizations considered to be the leading experts in the healthcare industry when it comes to nutrition and health for the respective diseases they cover. These organizations often set national guidelines for nutrition recommendations for medical professionals, hospitals, and patients to follow if they find themselves treating or suffering from the following chronic diseases.

American Heart Association


As part of their Diet and Lifestyle Recommendations, the American Heart Association (AHA) states on their website to “Choose lean meats and poultry without skin and prepare them without added saturated and trans fat … Eat fish at least twice a week.”2

The AHA considers a low-fat diet one that contains 30% of total calories from fat and <7% of calories from saturated fat.This is the AHA’s definition of “lean.”

American Diabetes Association


The American Diabetes Association (ADA) states on their website that “Healthy eating includes eating a wide variety of foods including … lean meats, poultry, fish.”4 The ADA says you should reduce dietary fat intake, but fails to give a hard number when it comes to a total percentage of calories coming from fat in the diet.

The ADA proclaims, “The optimal macronutrient distribution of weight loss diets has not been established … Studies in individuals with diabetes demonstrating the effects of specific percentages of dietary saturated and trans fatty acids and specific amounts of dietary cholesterol on plasma lipids are not available. Therefore, because of a lack of specific information, it is recommended that the dietary goals for individuals with diabetes be the same as for individuals with preexisting cardiovascular disease (CVD).”5

If you remember from the above AHA guidelines, these recommendations consist of <7% of calories coming from saturated fat. But, again, there is no mention of a hard number on total percent calories from fat in the ADA’s official recommendations. The science is apparently too complex and too confusing for the ADA to establish this.

With this being said, we’d have to assume the ADA’s definition of “lean” would be similar to the AHA’s version, which would put a limit on total percent of calories from fat at 30%.

American Cancer Society


The American Cancer Society’s (ACS) official dietary recommendations state the following:6
  • “Minimize consumption of processed meats such as bacon, sausage, luncheon meats, and hot dogs.”
  • “Choose fish, poultry, or beans as an alternative to red meat (beef, pork, and lamb).”
  • “If you eat red meat, select lean cuts and eat smaller portions.”

The ACS goes on to state, “More rigorous studies in humans have not produced compelling evidence that fat intake increases cancer risk, or that lowering fat intake reduces cancer risk.”

No current hard recommendations exist from the ACS for dietary fat intake. Like the ADA, the science is apparently too complex to come to any conclusions. Again, with this being said, the ACS’s definition of “lean” appears to be to choose chicken, turkey, fish, and lean cuts of red meat (without the fat dribbling off the edge or visible to the naked eye).

What Does the Science Say About Fat Intake and Chronic Diseases?


Now that we’ve established what the leading healthcare organizations are saying about lean meats and the risks of the world’s most common chronic killers (cardiovascular disease, cancer, and diabetes), let’s take a closer look at some interventional trials to see what the science says about this topic.

[*NOTE – Interventional trials are the gold standard in terms of strength of evidence in proving or disproving a suspected hypothesis. The ultimate in these trials are double-blind, randomized, placebo-controlled interventional trials. This exact model is difficult to do with diets though, because human beings can recognize the difference between a vegetable or piece of fruit sitting on their plate or a serving of grilled chicken breast or seasoned fish filet sitting on their plate. It’s also impossible to use placebo food products because they don’t exist. So, we’re left with interventional trials (sometimes controlled, involving an experimental group versus a control group and sometimes not, just involving an experimental group). Obviously, longer studies provide greater strength of evidence in terms of proving results. Therefore, years of diet intervention and follow-up is desired as compared to weeks or months. With that being said, sometimes there are no long term data when it comes to interventional studies on diet with certain disease states.]

Now, let's look at the data…

Cardiovascular Disease Trials


Two physicians have led the way in studying the effects of diet on cardiovascular disease. Caldwell Esselstyn, Jr., MD and Dean Ornish, MD published studies showing the halting and reversing of coronary heart disease with a low-fat, whole foods plant-based diet back in the 1990s.

Neither physician included “lean” meats, or any meat for that matter, in their study’s interventional group (referred to as the experimental group). The experimental group implemented a whole foods, plant-based diet. Both Ornish and Esselstyn put their experimental group on a diet consisting of 10% of total calories from fat. Dr. Ornish’s experimental group went head-to-head with a control group of patients following a diet resembling the AHA Step 2 type diet that consisted of 25% of total calories from fat. The AHA-type diet included “lean” meats and had no other restrictions regarding the avoidance of any food items so long as they met the fat content guidelines of 25% of total calories from fat. Dr. Esselstyn’s study consisted only of an experimental group following a whole foods, plant-based diet.

Dr. Esselstyn’s five-year results:7
  • 100% of experimental group halted coronary heart disease
  • 73% of experimental group saw reversal of coronary heart disease

Dr. Ornish’s five-year results:8
  • 100% of experimental group halted coronary heart disease
  • 68.4% of experimental group saw reversal of coronary heart disease
  • Control group (patients on AHA diet) saw 27.7% worsening of coronary artery blockages
These are impressive results to say the least. Ornish and Esselstyn performed well, but some people weren't convinced because both studies used small patient populations (18 individuals followed a plant-based diet in Esselstyn's study and 20 individuals followed a plant-based diet in Ornish's study). So, Dr. Esselstyn went to work once again.

This time Dr. Esselstyn took 198 patients in total and tested his previous whole foods, plant-based diet out on them. A total of 177 patients were 100% compliant with following a whole foods, plant-based diet (again, there were no "lean" meats or meat of any kind included), while an additional 21 patients were not compliant with following the plant-based diet. Patients were followed for an average of 3.7 years.15 The results:
  • 99.4% of compliant patients halted coronary artery disease (1 individual experienced a stroke)
  • 62% of noncompliant patients experienced further cardiac events (strokes, surgery to implant stents, heart transplant, sudden cardiac death, etc.)

Type 2 Diabetes Trials


Neal Barnard, MD has conducted some remarkable research on diet and diabetes. His studies frequently compare experimental groups on a low-fat, vegan diet compared to a control group on the standard ADA diet.

Results from a 22-week interventional trial comparing a vegan diet (18.9% fat) to the ADA diet (33.6% fat). [*Note – fat intake levels are the exact measures reported in study results]:9
  • Vegan group reduced HbA1c levels by 1.23% and the use of diabetic medications by 43%
  • ADA group reduced HbA1c levels by 0.38% and the use of diabetic medications by 26%

Results from a 74-week interventional trial comparing a vegan diet to the ADA diet. Actual fat intake reported in the study for the vegan group was 22.3% of total calories, and for the ADA group was 33.7% of total calories. Study results are as follows:10
  • Vegan group reduced HbA1c levels by 0.4% and fasting plasma glucose (blood sugars) levels by 14.1 mg/dL
  • ADA group saw an increase in HbA1c levels by 0.01% and a reduction in fasting plasma glucose levels by 6.5 mg/dL

Cancer Trials


Most of the interventional trials done on cancer and low-fat, plant-based diets are with prostate cancer. I am not aware of any other cancers that have undergone such rigorous interventional studies. If you know of any please feel free to comment on this article sharing the cited reference(s).

I am also not aware of any interventional studies analyzing the ACS dietary recommendations. But, then again, the ACS doesn’t really have any specific dietary recommendations regarding fat intake levels in terms of total percentage of calories. If you know of any interventional trials specifically studying the ACS dietary recommendations please feel free to comment on this article sharing the cited reference(s).

With this in mind, Dr. Ornish has done some cutting-edge research on prostate cancer and plant-based diets using an interventional study design. In addition, Saxe and colleagues have published interventional studies analyzing plant-based diets on prostate cancer.

Before analyzing Ornish’s study results, it’s important to have a basic understanding of what is being tested in his study. As a standard of practice the test to monitor prostate cancer development and progression is typically the prostate specific antigen (PSA) test. The higher the PSA level the higher chance of prostate cancer, and the more severe it is, in general. However, the PSA is not a direct measurement of prostate cancer, but rather a biomarker used to "screen for" or “keep an eye” on prostate cancer. It is well known in the medical community that there are false positives that occur at times when testing PSA levels. Ornish reported PSA levels along with other data in his study. You can read the study for yourself if you wish to go beyond PSA level results.

Dr. Ornish’s 1-year interventional study compared an experimental group on a whole foods, plant-based diet (11.2% fat) to a control group on a standard diet (25.3% fat):11
  • Plant-based diet group experienced a 4% decrease in PSA levels and none of the men required additional treatment for their prostate cancer
  • Control group experience a 6% increase in PSA levels and six of the 49 men required additional treatment for their prostate cancer

Saxe and colleagues conducted two interventional studies (4-month and 6-month) looking at men with recurrent prostate cancer put on a plant-based diet. They compared doubling times of PSA for both before and after the diet interventions. (*Note – longer doubling times of PSA are positive news for prostate cancer sufferers, as this shows a cancer that is growing very slowly or not at all. In other words, PSA doubling times test tumor progression in prostate cancer.) Unfortunately, I do not have the specific fat intake levels of these studies, but the participants were on a whole foods, plant-based diet which is typically 20% of total calories from fat.

The study results are as follows:12,13
  • 4-month study group had PSA doubling times increased from 6.5 months (pre-diet intervention) to 17.7 months (post diet intervention)
  • 6-month study group had PSA doubling times increased from 11.9 months (pre-diet intervention) to 112.3 months (post-diet intervention)

As mentioned before, I know of no interventional studies using the ACS dietary recommendations and cancer risk. Therefore, the best available data I've found in regards to the standard "eat lean meats and lower amounts of fat in the diet" advice comes from a prospective study design. A prospective study design simply takes a group of people and observes them over time, documenting the outcome of interest (for example, cancer) to suspected risk factors that could affect this outcome (i.e. diet). The following prospective study is clear in what it is testing for just by looking at its title.

Prospective Investigation of Poultry and Fish Intake in Relation to Cancer Risk

The investigators of this study looked at replacing portions of red meat intake with white meat (poultry and fish). They also looked at the addition of white meat to the diet while keeping red meat intake levels consistent. This study followed 492,186 participants with a mean follow-up of 9 years. Below are the study’s conclusions:14

“In substitution models with total meat intake held constant, a 10 gram (per 1,000 kilocalories) increase in white meat intake offset by an equal decrease in red meat intake was associated with a statistically significant reduced (3-20%) risk of cancers of the esophagus, liver, colon, rectum, anus, lung, and pleura. In addition models with red meat intake held constant, poultry intake remained inversely associated with esophageal squamous cell carcinoma, liver cancer, and lung cancer, but we observed mixed findings for fish intake. As the dietary recommendations intend, the inverse association observed between white meat intake and cancer risk may be largely due to the substitution of red meat. Simply increasing fish or poultry intake, without reducing red meat intake, may be less beneficial for cancer prevention.”

In other words, the study says that eating more white meat does not in itself reduce cancer risk. So adding fish, chicken, and turkey to your diet is not going to benefit you in terms of cancer protection.

Summary of Trial Data


Contrary to what the aforementioned professional healthcare organizations state, the science is not too complex or too confusing to understand if you look diligently enough at the data. There are some excellent interventional studies on low-fat, plant-based diets and their effects on our most common chronic diseases (heart disease, cancer, and diabetes).

Based on the available data, it is clear that low-fat, plant-based diets excluding “lean” meats and other animal-based and processed foods produce favorable results in halting and reversing heart disease and prostate cancer, as well as improving type 2 diabetes. The AHA and ADA diets when tested against these low-fat, plant-based diets failed to produce the same results. Instead, these diets often make patients sicker, worsening the very medical conditions these organizations purport to help.

This should speak volumes to the characters of these organizations. They proclaim they want to wipe out heart disease, eliminate diabetes, and cure cancer. But then they turn around and dispense the very advice, from a nutritional standpoint, that's been proven in the peer-reviewed, evidenced-based scientific and medical literature to cause these same diseases.

These organizations know that a whole foods, plant-based diet exists. They know the superior results it produces. They just choose not to dispense the advice. Don’t fool yourself into believing otherwise (see below). They simply ignore life-saving advice that could be saving millions of American lives. A major reason they do this is because they have far too much to lose financially in terms of donations from the pharmaceutical, medical, and insurance industries to support their "not-for-profit" causes. Hence, America and the rest of the world get the "lean" meat health advice.

When your purpose for existing is to save as many lives as possible and to not harm anyone, then being popular (saying what everyone wants to hear instead of saying what everyone needs to hear in terms of the factual evidence) needs take a back seat to conducting business in a moral and responsible manner. It's not ok to dispense disease-promoting advice and dietary guidelines.

Dr. Joel Fuhrman's article on using a whole foods, plant-based diet to reverse type 2 diabetes in his patients is rejected by the American Diabetes Association for publication due to drug company sponsorship



Howard Jacobson, PhD explains how donations to disease organizations may not be the best or most effective use of resources (32:05 of this video)




Physicians Committee for Responsible Medicine and John McDougall, MD call the American Cancer Society out on their Cattle Baron's beef fundraiser


Dr. John McDougall calls out the American Heart Association in their own journal, Circulation, for misinforming healthcare professionals and the public on a supposed deficiency of plant foods to provide adequate protein


What is the Actual Fat Content of “Lean” Meats?


Most people look at the meat they buy in the supermarket and figure if it’s white (chicken or turkey) or pink (fish) then it must be lean, and it must be good for you.

You’ve seen the studies on various fat contents and the clinical results they produce in heart disease, cancer, and type 2 diabetes. You’ve seen the dietary recommendations from organizations like the AHA, ADA, and ACS. The studies that produce halting and reversing of disease have two things in common:
  1. They eliminated animal products including “lean” meats and...
  2. They contained approximately 20% or less of total fat (the best results were in those studies with a fat content around 10% of total calories)

Below is a table that I made of various plant and animal foods and their total fat content.1 Tabulating these results and making this table took a little time and effort. It required a basic calculator and some simple math skills but anyone can do this. The data comes from the United States Department of Agriculture’s Nutrient Database (http://ndb.nal.usda.gov). This is the standard reference used by all in the field of nutrition. It’s what healthcare professionals, like dietitians, refer to when devising dietary plans formulated for their patients.

The AHA, ADA, and ACS could have done these simple calculations. If they did, perhaps they would’ve realized their recommendations to consume “lean” meats are not exactly the “low-fat, health-promoting” recommendations they devised in the first place, especially considering most of the “lean” meats bought in grocery store exceed 20% in total fat content.

Remember, interventional studies done up to this point on diet and health have proven that diets higher in fat content produce continued sickness, suffering, and premature death. A person would literally have to hunt and fish wild game to consume only lean meats, but they’d also be consuming animal protein which has been shown in several studies to play a role in causing a number of chronic diseases (cancer, autoimmune diseases, heart disease, etc.). This is another discussion for another time though.

For now, use the chart provided to help you understand your choices between the fat contents of plant and animal foods. Clearly, the plant-food kingdom (with the exception of nuts, seeds, olives, and avocados) is much healthier and lower in fat than the animal-food kingdom.

The bottom line is, it’s irresponsible to recommend to hundreds of millions of Americans to eat “lean” meats. They play a significant role in causing the same diseases the AHA, ADA, and ACS are waging "war" on. The science doesn’t lie about this fact. Professional healthcare organizations shouldn’t either!

Don't get me wrong, I’m all for the rights of individuals to choose whatever it is they want to eat, whether it be broccoli and brown rice or chicken and fried potatoes. But organizations dispensing professional health, medical, and nutrition advice have a responsibility and obligation to warn others of their choices when those choices cause disease and sickness. There’s no difference between “lean” meats and cigarettes or alcohol. They all cause chronic sickness and premature death. They also reduce the quality of one’s life for several years, if not decades, while individuals suffer from these diseases.

My advice is simple—steer clear of any nutritional information handed out by the AHA, ADA, and ACS. It literally has the potential to disable you and lead to premature death.

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by Dustin Rudolph, PharmD
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References:
1 Source: U.S. Dept of Agriculture, Agricultural Research Service. 2013. USDA National Nutrient Database for Standard Reference, Release 26. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndl.
2 American Heart Association. The American Heart Association’s Diet and Lifestyle Recommendations. Updated 16 May 2014. Available: http://www.heart.org. Accessed 25 May 2014.
3 Krauss RM, Eckel RH, et al. AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000 Oct 31;102(18):2284-99.
4 American Diabetes Association. Diabetes Meal Plans and a Healthy Diet. Last edited 30 April 2014. Available: http://www.diabetes.org. Accessed 25 May 2014.
5 American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008 Jan;31 Suppl 1:S61-78.
6 Kushi LH, Doyle C, McCullough M, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention. CA Cancer J Clin. 2012 Jan-Feb;62(1):30-67.
7 Esselstyn CB Jr, Ellis SG, Medendorp SV, Crowe TD. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician's practice. J Fam Pract. 1995 Dec;41(6):560-8.
8 Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7. Erratum in: JAMA 1999 Apr 21;281(15):1380.
9 Barnard ND, Cohen J, et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care. 2006 Aug;29(8):1777-83.
10 Barnard ND, Cohen J, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-week clinical trial. Am J Clin Nutr. 2009 May;89(5):1588S-1596S.
11 Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005 Sept;174:1065-1070.
12 Saxe GA, Hebert JR, Carmody JF, et al. Can diet in conjunction with stress reduction affect the rate of increase in prostate specific antigen after biochemical recurrence of prostate cancer? J Urol. 2001 Dec;166(6):2202-7.
13 Saxe GA, Major JM, Nguyen JY, et al. Potential attenuation of disease progression in recurrent prostate cancer with plant-based diet and stress reduction. Integr Cancer Ther. 2006 Sep;5(3):206-13.

14 Daniel CR, Cross AJ, Graubard BI, et al. Prospective investigation of poultry and fish intake in relation to cancer risk. Cancer Prev Res. 2011 Nov;4(11):1903-1911.
15 Esselstyn CB Jr, Gendy G, et al. A Way to Reverse CAD? J Fam Pract. 2014 July;63(7):356-364,364a,364b.

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