In honour of world vegan day, here are some of our past posts on veganism:
CW: this post offers comments and critiques on a research article whose subject matter is methods for weight loss. The focus of this post is not to endorse any method of weight loss (because I don’t). I’m reframing the area of research as metabolism of body weight– how that works. I then point out how difficult it is to get clarity and confidence from scientific articles about this topic when the researchers as a group are in conflict.
Now, to the post:
Right now, the state of coronavirus research is what I would call the Wild Wild West. There’s not much law and order, shootouts among rival factions are common, and the most vulnerable among us are completely unprotected. But that’s understandable– COVID-19 is less than a year old, so researchers are starting from scratch, and many of them are working while at the same time taking care of patients who urgently need effective treatment.
But no researcher who works on human metabolism of body weight has these excuses, as it were. Trying to understand how body weight changes work– fluctuations up and down, how and when bodies maintain stable weights over time– is a well-established set of research questions with a long history of practices and accompanying literature.
So, what’s the deal here? What do we really know? What’s in dispute among researchers, and what’s just pseudoscientific fat-phobic nonsense?
(tl:dr version– I don’t have a good answer to this question. But, neither do the researchers, and there are reasons why they don’t that aren’t scientific ones.)
In a 2013 New England Journal of Medicine article, a research group took on the task of dividing up myths, presumptions and what they called facts about how body weight metabolism works. Some of their cited “myths” (I’m using scare quotes because whether they are myths is contested) included:
- how breast feeding affects body weight;
- how sex counts as physical activity or exercise;
- how physical activity classes affect body weight;
- claims about how different eating practices affect long-term body weight stability (see article if you want the details, but they’re not important here).
The researchers considered these to be myths because, according to their analysis, the studies they cite don’t support the above claims.
There’s more to the article (they also talk about what they call “presumptions” and “facts” about body weight, but I’ll leave that to the reader, as they say), but here’s the catch.
Many other researchers and experts didn’t and don’t agree with their conclusions. Why not? There are a lot of issues with their work, but one big one is this:
The primary researchers got a lot-a-lot of funding from Kraft, Jenny Craig, the Knowledge Institute for Beer (no, that’s not a joke), McDonald’s Global Advisory Council (which is also apparently a thing), and yes, Coca-Cola. The list goes on and on, and it’s fascinating reading. Go to the bottom of the article, and enjoy.
Getting serious, though: we know that the money for scientific research has to come from somewhere. Federal funding doesn’t cover all of the needs of all the scientists. Partnering with business and industries is common. And good solid science has been established doing just that.
But: when the connections among scientist, funding source and recommendations to the public get too close, we may be well-advised to take a step back and reconsider. In this case, one of the so-called “facts” cited was that meal-replacement drinks and commercially produced meals were an effective (and safe? not clear) eating practice that could result in lowered body weight (that would be stable? again, not clear). But the funders of this research included companies that would directly benefit from public uptake of this claim.
You might think, hmm. This was seven years ago. Surely this mess has been cleared up by now.
As my friends and I used to say in middle school, “you wish!” Alas, nutrition and human metabolism research (as it relates to body weight) is still in full Game-of-Thrones mode (yes, I switched from a Wild West to the Games of Thrones metaphor in the same article; so sue me…)
Does this mean we don’t know anything? Well, no. We know that there are lots of foods to choose from, that we all have nutritional needs, and there are lots of ways to fill those needs. We know that physical activity has loads of benefits for our well-being.
What about the nitty-gritty details, though? Those, my friends, are most definitely still under construction.
Readers: what are some of your favorite “myths” around this topic? I’d love to hear from you.
I finally got to use the hashtag “InMice” on Twitter. What’s it mean?
“Mice form the basis of all biomedical research. As the quintessential model organism, they are perfect specimens in which to study all sorts of human conditions. But just because a drug performs well in mice, that doesn’t necessarily mean it’ll have the same result in humans. Science journalists and press releases — as translators of these findings — often fail to clearly demarcate that line.
A new Twitter account hopes to make that line much clearer. Last Friday, tweets from @justsaysinmice started making the rounds on Twitter and they quickly went viral. Every tweet — all 11 of them so far — follows the same pattern: A news story or press release with a sensational headline is tweeted out, with two simple words tacked on top: “IN MICE.””
The story that caught my eye was on orange juice, partly because of a playful ongoing argument with a friend who is quick to remind me and others that OJ is the nutritional equivalent of coke. Not evil, but not exactly health food.
But this story suggested we’d been missing out.
“A new study from London’s Western University suggests drinking two-and-a-half glasses of orange juice a day could help prevent heart disease and diabetes. Researchers have found a molecule, called nobiletin, in sweet oranges and tangerines that significantly reduces obesity and can reverse its negative side-effects.“Obesity and its resulting metabolic syndromes are a huge burden to our health care system, and we have very few interventions that have been shown to work effectively,” said Murray Huff, PhD professor at Western’s Schulich School of Medicine & Dentistry in a statement.”
Hmm. But read on and the results were only shown in mice.
So I tweeted.
Medical researcher and occasional guest blogger Dr. Savita weighed in.
Sounds like unless you want 20g of sugar and you just want the health benefits, if the results work out in humans and not just #inmice, there are better ways to get it.
Continuing with the discussion of make-ahead meal preparations, today I thought I’d tackle lunch. Christine nudged me this way during my previous post on oatmeal, and I admit, I started with oatmeal because it was easier to describe and to write about! The trouble with lunch is all the pieces you need to have ready in advance in order to make the prep painless. Over the years, I’ve developed routines to make this pretty easy for me, but it took a while, and many Sundays spent too long in the kitchen, to develop the routine. However, I kept plugging away until it became habitual, and now I spend less than an hour prepping lunches for the week (sometimes a lot less), which works out to under 10 minutes per meal.
So, I am going to write this post with two parts, “Saturday” is going to be the prep that needs to happen before you want to make your meals for the week. This doesn’t have to be Saturday, of course, but at least a day before you need those ingredients. Judicious use of your freezer space can allow you to do this part weeks in advance, and as you develop a meal-prep routine, I strongly suggest you do it that way. “Sunday” is your meal-prep day. I always make enough to eat one of them that day, so then lunch planning is done.
A final note before I get to the recipes–you are going to have to experiment with how much variety you need in the week and from week to week. I do not require much variety to be satisfied with my breakfast and lunches. When I was single, I also ate the same dinner for four or five nights in a row. However, I know many people would be very disappointed in their meals to have so much sameness day to day. You will have to adjust these plans to meet your meal-variety needs, but be aware that the more variety you decide to require, the more time the preparations will take. Easy switches like a different serving of fruit or vegetable may be enough to give you a hit of variation without throwing off the whole week of preparations.
Prep your protein. My go-to is boneless skinless chicken breasts and/or thighs cooked in the slow-cooker on low heat for many hours. You can also do these in a low oven 20-30 minutes on a baking pan. I usually fill my slow-cooker to the top and leave it on medium for the day. This gives me enough chicken to last a month or so. Whatever I don’t need this week will be chopped up, placed on a cookie sheet and frozen individually. Then, once it’s frozen, I put it in plastic zipper bags to be pulled out as needed for the next month. You could sub in cooked ground or roasted turkey easily enough. I do not eat red meat, but I’d guess you could do something similar with beef. If you want fish or seafoods, I would recommend you keep them frozen until a day before you want to eat them to avoid spoilage.
Prep your grains/beans. Whenever I cook rice, barley, dried beans, lentils, quinoa, etc. for dinner, I make extra. Then I freeze the leftovers in convenient amounts (3 cups, if I’m going to add them to lunches.) Thaw just before you do your prep for the week. I often use canned beans to save time. Just drain and rinse in a colander before using. You can also find cooked grains and beans in the freezer section of the grocery store, and they work well, too.
Consider prepping vegetables. I “cheat” and buy frozen veggies these days, but when I had fewer financial resources and more time, I would buy fresh vegetables, chop and steam them to have ready for lunches all week.
Basic “boxed” lunch
This is my go-to lunch. To make it interesting week in and week out, I change which variation of flavorings I use. This is the starting place.
- Put out 6 reusable 4 cup containers with good lids.
- In each container begin with:
1 ½ cups chopped, cooked vegetables (I like broccoli, carrots, cauliflower, summer squash, and/or green beans, it’s ok if they’re still frozen)
4 oz chopped chicken, turkey, or protein of your choice (also fine if frozen)
½ cup beans and/or brown rice, quinoa, or other cooked grain (more if you’re vegetarian)
Teriyaki boxed lunch variation
Add the following to each container of the the basic boxed lunch:
Use black beans or small, mild-flavored beans like azuki or black-eyed peas
⅓ 8oz can of sliced water chestnuts, drained (about ¼ cup)
2 Tbs prepared teriyaki sauce (I use Kikkoman Takumi collection original)
1 tsp toasted sesame oil
2-3 tbs cashews
Suggested fruit pairing: tangerines, oranges and/or pineapple
Tex-Mex boxed lunch variation
Use pinto and/or black beans and rice.
Either use a prepared salsa or make a spicy tomato sauce by stirring together:
2-3 cups tomato sauce
2 tsp cumin
2 tsp chili powder
hot pepper flakes to taste
Put ¼ to ½ cup sauce/salsa over the veggies.
Sprinkle with 1 tbs. pumpkin seeds.
Add 1 oz grated monterey jack or pepper jack cheese on top.
Suggested fruit pairing: diced melon and/or papaya (with a squeeze of lime!)
Italian boxed lunch variation
Use garbanzo or white beans.
Either use a prepared marinara sauce or make one by stirring together:
2-3 cups tomato sauce
2 tsp dried basil and oregano
1 tsp dried thyme
1 minced garlic clove
Put ¼ to ½ cup sauce over the veggies.
Sprinkle with 1 oz grated mozzarella cheese and 1-2 tbs. parmesan.
Suggested fruit pairing: grapes or an orange
For each of these, when you’re ready to eat, simply remove the lid and heat them up until hot, 3-4 minutes in the microwave. This is what I’m eating these days, although I’ve gone through periods when I was eating soups, stews or big salads instead. I’d be happy to share some of those recipes and ideas in future posts if folks are interested, so let me know and keep an eye out for them!
Do you have a go-to lunch that you like to make ahead for the week? Please comment below, and do let me know if you try any of these and what you think!
Marjorie Hundtoft is a middle school science and health teacher. She can be found eating out of reusable containers, picking up heavy things, and putting them back down again in Portland, Oregon.
Catherine recently mentioned her desire to do more meal prep. I love to prep ahead my meals for the week. I have a Sunday routine in which I make enough breakfasts and lunches to last me through Friday. These little containers give me peace of mind–reassurance that I will be well-fed without a hassle all week. If dinner has to be on the fly, that’s somehow more manageable than breakfast or lunch. For me, the hardest part of making meal prep a routine was consistently coming up with the plan before I went to the grocery store on Saturday. If I forgot to think about the entire meal–forgot a serving of fruit, or didn’t think to check if I had enough eggs–then the meal prep would be off for a whole week. So, in the spirit of helping others prep, I thought I’d share some of my recipes and shortcuts.
I eat oatmeal at least 6 days a week, sometimes twice a day. Here are some of my favorite ways to prepare it in advance. I make it a complete meal with coffee, a couple eggs, some plain Greek yogurt and fruit, if there isn’t some added to the oats already.
Easiest Apple Oats.
This is my go-to oatmeal. It is endlessly variable, depending on what sounds good to me and what fruit is seasonal at the time. Apples are the easiest, since they stay pleasant all week, whereas pears, bananas, peaches and such can eventually become brown and soggy. Canned or dried fruit are options as well, of course.
1. Set out as many reusable containers with tight lids* as meals you are preparing ahead (I make 6 at a time, eating one the morning I prep).
In each container, place the following:
½ cup old-fashioned oats
¾ cup water
a sprinkle of cinnamon
1 tbs coarsely chopped nuts
1 tbs raisins, dried cranberries, or cherries
½ a chopped tart apple
2. Store covered in the refrigerator. When you are ready to serve the oats, remove the lid and cook in the microwave 2 minutes, or until the oats have soaked up the liquid.
3. Serve with a little brown sugar, milk/nondairy milk, or Greek yogurt on top.
Slow-cooker Steel-cut oats
These are just as easy as the last recipe, you just cook them ahead. Using the slow-cooker allows you to avoid the regular stirring and management that cooking steel-cut oats on the stove-top requires. These cook in about 30 minutes on the stove, if you want them faster, but be aware that they can stick and burn if not regularly stirred.
1. In your slow-cooker, place the following:
1 ½ cups steel-cut oats
6 cups water
Tsp or so of cinnamon and/or anise seeds
2. Cook on low heat overnight, or at least 8 hours, until most of the liquid is absorbed and the oats are chewy.
3. If you want to add fruit, add it now after it has cooked. Otherwise, it breaks down over the long cooking time and becomes unpleasant.
Optional add-ins to stir in now:
6 Tbs raisins or other dried fruit, chopped if appropriate
6 Tbs chopped walnuts or other unsalted nuts
3 chopped apples
4. Divide into 6 containers, cover and refrigerate until needed.
5. Serve warm by reheating in the microwave when you’re ready to enjoy it. This will thicken up considerably when it cools, so I like to serve it with milk (or actually soymilk, since I’m lactose intolerant) and a bit of butter and brown sugar.
I like this variation in the warmer months or when I need to pack breakfast somewhere where the extra liquid would be unwelcome. (Note that TSA might give you a side eye on this one, so I don’t recommend it for breakfast on a morning flight in the US.) Multiply the basic recipe by as many servings as you want in advance.
1. Using a wide rubber spatula, stir together in a large bowl:
½ cup old-fashioned or quick oats
¾ cup plain Greek yogurt
½ tsp vanilla (cheap fake vanilla is fine for this)
½ coarsely chopped apple
1 tbs chopped nuts
optional but recommended:
½ chopped orange or a whole tangerine
some grated citrus zest
2. Press the mixture into a container that seals well and store up to 5 days. Optional but delicious–drizzle with a little honey before enjoying!
Your turn: do you have a favorite way to prep oatmeal in advance? I’d love to hear about it! And do let me know if you give any of these a try and how it goes!
*Oh, as a side note, any reusable container with a good lid will do for these. We have switched over nearly entirely to a set of Pyrex storage bowls in the last year. The lids are pretty tight (sometimes there’s a little liquid loss in transit, if I’m packing it to work in the morning), and the bowls are nice to reuse since they don’t take on flavors like plastic can. I caution you to not heat the lids, if you have these, though. They do not hold up well in the heat.
Marjorie Hundtoft is a middle school science and health teacher. She can be found eating oatmeal, picking up heavy things and putting them back down again in Portland, Oregon.
There’s a story we tell here on the blog. Do the things you love, whatever movement fits into your day is good movement, eat what your body feels like eating.
Regular readers, you know our drill. It’s a relaxed, forgiving tune we sing around here most of the time.
Regular readers know too that I’ve been struggling a bit with that tune. These things are all true, I still sing that song, but at the same time things are getting more complicated with age and with injury. I’ve written before about doing things that aren’t fun (so much painful knee physio!) and about rest. Tl;dr: It’s complicated and sometimes I get frustrated.
It’s especially more complicated as we age. It’s especially more complicated for those of us with performance oriented fitness goals. Martha and Marjorie Rose are serious about their lifting. Kim and I have cycling goals. Others run and race. Cate is often preparing for her next big solo adventure. Christine is training for her next martial arts test.
As a group we’ve got a lot going on. We all do some strength work, some aerobic activity for endurance, some aerobic activity for intensity, and some activities for flexibility and mobility. For me, right now, it’s physio, weights, cycling and yoga.
I don’t mean to sound whiney. I’m not really complaining. It is what it is. But what it is is not simple or easy.
So we’re busy but what do I mean by “more complicated”?
Do you remember when if you had a big project due for work or school you could just stay up all night, maybe even for a couple of nights, and push through? If you were working late you could skip meals, no problem. Aging takes away that ability for most of us. We need to be more organized and scheduled with our work and with our lives.
There are new rules for everyday eating too. For example, there’s a whole list of foods I don’t eat late in the day not because I’m concerned about my weight but because of heartburn. Oh, midlife. Lots of my friends are pretty scientific about their caffeine consumption. Luckily, I can still drink regular coffee after dinner but I think I’m the last in my friend group who is able.
All of these changes are present as we age as athletes too.
Here’s Abigail Barronian talking about the aging athlete, “It’s no secret that our bodies change as we age. Muscle mass and strength decline, it takes longer to recover from hard efforts, and our capacity to handle high training volumes can diminish. On top of that, mobility decreases and we become more prone to certain injuries. When an older athlete stops training, their fitness deteriorates significantly quicker than it did when they were young—and building it back is much harder.”
So given all the constraints it’s hard to be relaxed about things. Fitness in midlife and beyond requires more structure and thoughtful planning. If it used to be the fun, intuitive, freewheeling part of your life, that’s a tough psychological change too. Mostly it’s still a lot of fun for me but these days I’m finding the planning and organizing a bit stressful.
First, as we age rest becomes more important and it’s harder scheduling workouts and scheduling rest days, not to mention getting enough sleep. Aging athletes need more rest between tough workouts. I love rest but even for me sometimes the recommended amount of rest feels like too much. In recent years we’ve discovered that aging athletes can still work out hard. There’s no need to dial back workout intensity but there is a real need to rest more between workouts. We don’t recover and bounce back the way we used to.
A colleague of mine, and former bicycle racer, who is now 59 years old, put it something like this: “In my twenties I recall being able to do five or six hard workouts a week and race back-to-back days without any trouble.
In my thirties this changed to three or four hard workouts a week and it was more difficult to race back-to-back days. In my forties, two or three hard workouts a week were more than enough, and racing back-to-back days was a bit of a challenge. In my fifties, one or two hard workouts a week were enough and recovering from a race took me about a week. Now, approaching 60…don’t even ask.”
The rest and recovery time of a 20 year old athlete is significantly different than that of a 45 year old athlete. It’s different again at 55 and so on. But this means that taking training plans off the internet won’t work. Often they don’t allow enough rest.
From Here’s how to get stronger after fifty: “As you age, your body bounces back more slowly from intense exercise. Successful older athletes should take their recovery as seriously as their training. “Younger athletes can get away with a poor lifestyle and still perform, but older athletes cannot,” Swift says.”
When I was younger it was just a matter of juggling, fitting in the activities I wanted to fit in, amid kids and a busy work schedule. But as we age there’s also the matter of resting between workouts which becomes more and more important. I’ve long been a fan of deliberate rest days and every coach I’ve had has talked about their importance. Except now they’re more important and I don’t have a coach to make sure I take them.
Likewise for lifting, as we age there’s more need for rest. I read a study recently that claimed for midlife women lifters the right ratio for strength training is two hard workouts followed by one easier workout with lighter weights. I’m not sure if that’s right or not but the main point stands, it’s complicated.
I’ve read too that after 50 you should move to two rest days a week of which one can be active recovery, gentle cardio or yoga maybe.
What am I trying to fit in? The big and important thing is knee physio and strength training. Say three days a week. Next up is cycling, also three days a week. I would like to do hot yoga twice a week. And I also want to take a complete rest day. Oh and also I have to be flexible and fit things in around a very demanding work schedule.
Wish me luck!
(Update: I see Catherine just purchased a training program that works in all the elements including rest. That’s one solution to fitting it all in. Go Catherine!)
Second, food is more complicated too. For me, there’s some planning involved. I have medication I have to take each morning on an empty stomach and then wait an hour before breakfast. That’s tricky. I also have medicine I have to take after breakfast because it can’t be taken on an empty stomach. Oh, and I need to get to work sometime.
There’s also this whole thing about aging athletes and muscle loss. Our bodies use protein less effectively so we are supposed to eat more of it, some with each meal. I also need fewer calories to get through the day–thanks also to aging– so protein takes up a good chunk of the calories. Add vegetables. Where’s the room for other food? That’s not easy to organize either.
See Muscle loss is in the news again for more details.
Thirdly, for pretty much all of us there are complications related to injury. My knee is an ongoing thing and recently Tracy injured her Achilles. When that happens you’re doing workouts but also physio and in my case massage therapy too. It can feel like a lot to manage.
Now maybe you might think that one doesn’t need to take it all so seriously. You can walk to work, stretch once in awhile, and do work around the house. And that’s true. You can. But if your goals are more about maintaining fitness as you age and not losing muscle, it’s complicated. Mostly I’m good with that. But I confess that some days I just want to not think about what I’m eating or when I’m next riding or lifting and curl up on the sofa with a mug of hot tea and a book.
How about you? How do you fit it all in?
I don’t know about you, but news headlines with the phrase “early death” tend to capture my attention much more than, say, those with the phrase “second quarter economic forecast”. Here’s one from the Washington Post, warning us against all sodas–with and without sugar. Either way, they lead to our premature demise.
Salon, in its coverage of the study, decided that a picture was worth a thousand words. I think we get it:
You may be wondering:
I think the answer is “no, not really”. But of course that’s not the whole story. Why?
The real and longer answer is “we don’t know, based on the results of the study”. So, let’s take a look at that study and the results.
Here’s the Washington post summary:
The study, one of the largest of its kind, tracked 451,743 men and women from 10 countries in Europe. It found that consumption of two or more glasses of artificially sweetened soft drinks a day was positively associated with deaths from circulatory diseases. For sugar-sweetened soft drinks, one or more glasses a day were associated with deaths from digestive diseases, including diseases of the liver, appendix, pancreas and intestines.
The researchers recruited people from Britain, Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain and Sweden between 1992 and 2000, surveying them on their food and drink consumption. Participants were excluded if they reported incidents of cancer, heart disease, stroke or diabetes. Mean age was 50.8, and 71.1 percent of participants were women.
This sounds fairly clearly true, as reported by the Post. So why am I skeptical?
Any big population epidemiology study on nutrition and mortality risk that states some categorical claim is automatically going to raise my antennae. It’s notoriously hard to do this kind of research and get clear results. Why? Think about it for a moment: trying to isolate the contribution to better or worse health over time of the occasional intake of some substance for a whole population is incredibly difficult. For some substances, like tobacco, it turns out it’s pretty easy to establish that it’s harmful in just about any amount. But for, say, alcohol intake, when we graph the risks for drinking it, we get what’s called a J-curve. It looks like this:
What we see here is that, as alcohol consumption increases from zero to about one drink a day, the risk of death drops, and then starts to increase slowly. Looking at it without any other information, you would think that drinking up to say, 5 drinks a day is actually beneficial for your health. Pro health tip: it’s not. But there’s a lot more needed than just this data on this graph in order to understand alcohol consumption and health. If you’re interested in more about J curves, public health and what to do when you get one, look at this nice JAMA article (which is where the graph came from).
Back to the soda study: when we look carefully at the data presented here in the article, what we see is another J-curve. That is, the people in the study who drank between 1 glass a month and 6 glasses a week of soda (either sugar-sweetened or artificially sweetened) had a LOWER risk of all-cause mortality than those who drank less than one soda per month. The risk was a bit higher for those who drank 1–2 glasses of soda (either kind) per day and then higher again for the group who drank more than 2 glasses per day.
When you look at their disease-specific mortality risk data, results are mixed, but there are still J-curves. For women who drank between 1 glass a month and 6 glasses a week of soda, their cancer risks were lower. For men, the risks were mixed, but not appreciably higher. Ditto (almost) for heart-related disease risks (it’s a little more mixed, but a similar pattern).
I would like to thank both Samantha for pointing me to sources and Health Nerd on Twitter for his very detailed analysis of the study (which saved me some time and directed me to particularly interesting data patterns). Here’s the J-curve we see in this study, compliments of Health Nerd):
Does this mean we should all start drinking a little soda a day, to keep the grim reaper away? NO. What this means is that we need to look at the data a lot more closely. Health Nerd points out that the researchers didn’t control for income or ethnicity. We know from various studies that soda intake is higher among Latinx and African-American populations than among White populations, and it’s also higher among lower-income populations. We also know that there are major health disparities in the US both for lower-income and for non-white populations. So, is the soda playing some role in the health of these populations, or not? This is a very important question, and researchers are working on it. But it’s not easy to find a clear answer. And this JAMA study is not, in my view, giving us one.
Lots of people (including me) believe that sodas (either kind) are unhealthy-for-them (according to their views of what healthy-for-them means). There is some scientific evidence that supports this view. What headlines like this do, though, is provide an excuse to scare people and to demonize or blame those who drink soda for whatever happens to their health over time. Looking more closely at what drinking soda means to people seems a good place for public health to start, if the goal is to help people make their own lives healthier-to-them.
Here’s to your health!
Readers– what do you think about soda? Is it a daily part of your life? An occasional drink? Totally off your radar? Do you think it’s the devil, or the pause that refreshes? I’d love to hear from you.
Just when you thought it was safe to go back to the breakfast table: eggs are in the news again, and this time the news ain’t good. This week the nutritional research ouija board people once again asked the eternal question:
And the answer (for this week) is:
Many readers of this blog know that this is definitely not my first eggs rodeo. I follow egg news very closely and make sure Fit is a Feminist Issue followers are always informed of the latest in good-egg-bad-egg research. Here are some of my previous forays into ovo-journalism:
Tracy has also written often on food morality: not demonizing foods, avoiding all-or-nothing thinking about nutrition.
Okay, time to give y’all the 411 on the newest egg nutrition results. There is a serious question that nutrition researchers have been wrestling with for decades: what, if any, relationship is there between dietary cholesterol intake and mortality risk? The answer is (as it always is in real science, especially nutrition science): it’s complicated. Here’s some background from the New York Times coverage of the new study, that came out in JAMA on Friday:
Eggs are a leading source of dietary cholesterol, which once was thought to be strongly related to blood cholesterol levels and heart disease. Older studies suggesting that link led to nutrition guidelines almost a decade ago that recommended consuming no more than 300 milligrams of cholesterol daily; one egg contains about 186 milligrams.
Newer research questioned that relationship, finding that saturated fats contribute more to unhealthy levels of blood cholesterol that can lead to heart problems.
The latest U.S. government nutrition guidelines, from 2015, removed the strict daily cholesterol limit. While eating as little cholesterol as possible is still advised, the recommendations say eggs can still be part of a healthy diet, as a good source of protein, along with lean meat, poultry, beans and nuts. Nutrition experts say the new study is unlikely to change that advice.
So what’s new about this study? Here’s what CNN had to say about it:
The researchers examined data from six US study groups including more than 29,000 people followed for 17½ years on average. Over the follow-up period, a total of 5,400 cardiovascular events occurred, including 1,302 fatal and nonfatal strokes, 1,897 incidents of fatal and nonfatal heart failure and 113 other heart disease deaths. An additional 6,132 participants died of other causes.
Consuming an additional 300 milligrams of dietary cholesterol per day was associated with a 3.2% higher risk of heart disease and a 4.4% higher risk of early death, Zhong’s analysis of the data showed. And each additional half an egg consumed per day was associated with a 1.1% higher risk of cardiovascular disease and 1.9% higher risk of early death due to any cause, the researchers found.
Here’s where things get a bit interesting and more complicated. News sources are not consistent in their reporting of these results. The New York Times said this about the results:
The researchers calculated that those who ate 300 milligrams of cholesterol daily — about 1 ½ eggs — were 17 percent more likely to develop heart disease than whose who didn’t eat eggs.
So which is it? Eating 300mg of dietary cholesterol a day, or 300mg MORE of dietary cholesterol (than what?) a day is bad for me? I think the New York Times got it wrong this time.
I went to the original paper, which is long (15 pages, a lot for a medical journal), and has loads of tables with loads of data. In the discussion section (which is always what you want to read when tackling these technical papers), they raise a bunch of issues that bear directly on how to interpret their results, how to understand their results in contrast with eggs-good research results, and what they think is really going on with respect to eggs, dietary cholesterol consumption, and mortality risk:
- previous meta-studies have been all over the place, finding positive, negative and no correlations between more frequent (more than one a day) egg consumption and risks of death from various diseases.
- Apparently egg consumption has been associated with low physical activity, smoking, and “unhealthy dietary patterns” (according to the paper). So it’s hard to separate egg consumption effects from these other effects.
- The associations found between egg consumption and mortality risk were modest, but statistically significant.
- Researchers claim a dose-response effect of egg consumption, which means the more eggs you eat, the higher the effect.
Their discussion raised some questions for me:
- Do the researchers think there is a “safe/normal” intake amount of dietary cholesterol? They say the mean intake in the US is 289mg/day, and that taking in 300mg more per day (which would be 1.5 eggs, including half the extra yolk) increases all-cause mortality. But what is their nutritional goal here?
- When researchers say egg consumption should be reduced, what do they have in mind for its substitutes? Eggs are a big source of animal protein, and lots of other sources have more saturated fat, which has its own scary back story.
- As always, I am wondering to what extent statistical or research significance translates to clinical or medical significance?
- All eating happens in social and cultural and economic contexts– if you ask people to reduce eating X, will substituting Y make things better or worse?
What do you think, dear readers? Is this new egg news throwing a monkey wrench into your brunch plans? Are you vegetarian or vegan and don’t care? Is this a reason to increase our vegetarian or vegan eating? Are you inclined to just turn the page and dismiss the nutritional research as a mass of confusion? Should we short-sell egg futures (I don’t know what that means, exactly, but I think it sounds business-y)? I’d love to hear from you.
This past Tuesday apparently was Ultra-Processed Food Study Release Day; two studies– one big and one small– were released for the consideration of the Internet. Both of them have bad news about the effects of eating ultra-processed foods: they result in weight gain and contribute to earlier death.
First of all, what is “ultra-processed food”? Yoni Freedhoff, in his Weighty Matters blog, offers two definitions: one fancy, one non-fancy. The fancy one is this:
“formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes”
What does this mean? “think of them as the boxes and jars of ready-to-eat and ready-to-heat foods.” Okay. Not that we really need these definitions. As US Supreme Court Justice Potter Stewart said in 1964 about the definition of obscenity, “I know it when I see it”.
Back to the studies. Here’s CNN on the big study:
…the researchers enlisted the help of 44,551 French adults 45 and older for two years. Their average age was 57, and nearly 73% of the participants were women. All provided 24-hour dietary records every six months in addition to completing questionnaires about their health (including body-mass index and other measurements), physical activities and sociodemographics. The researchers calculated each participant’s overall dietary intake and consumption of ultraprocessed foods.
Over the study period, 602 participants died. After adjusting for factors such as smoking, the researchers calculated an associated 14% higher risk of early death for each 10% increase in the proportionof ultraprocessed foods consumed.
This study doesn’t investigate why ultra-processed foods increase mortality risk; maybe it’s the chemicals in the packaging, or other features of the manufacturing processes.
The small study, however, provides some interesting detail for further study. Here are its details, courtesy of Yoni Freedhoff:
[Researchers] admitted 10 male and 10 female weight stable adults as inpatients to the Metabolic Clinical Research Unit at the NIH where they lived for 28 days. They were randomly assigned to either the ultra-processed or unprocessed diet for 2 weeks at which point they crossed over to the other diet for two weeks.
During each diet arm, participants were offered 3 daily meals and they were instructed to eat as much or as little of them as they wanted. Menus were designed to be matched for total calories, energy density, macronutrients, fibre, sugar, and sodium, but differed in the percentage of calories coming from ultra-processed sources.
When consuming ultra-processed food diets people ate on average 508 more calories per day. And not surprisingly given this finding, people gained weight on the ultra-processed diet (1.7lbs in just 2 weeks) and lost weight on the flip side (2.4lbs in just 2 weeks).
He adds, “Wow! That’s huge!” Yes, it is. But you might think, this isn’t surprising. People love junky food, and it’s designed to be addictive. Well, the researchers found that the participants didn’t find the ultra-processed food tastier. They just ate more of it. But why?
Here’s something I hadn’t heard about: the protein leverage hypothesis. The idea is that the participants ate more of the ultra-processed foods because their bodies wanted more protein. The amount of protein they consumed on both diets was about the same (also surprising), but the processed stuff had less protein in it, so they ate more to compensate. Of course they didn’t know this– it just happened. Wow. Here’s Yoni again with more detail:
[The researchers] believe might help to explain up to 50% of the increased caloric intake by way of something called the protein leverage hypothesis which suggests our bodies attempt to maintain a constant protein intake, and so people consuming less protein from ultra-processed foods may be eating more of them to try to maintain some predetermined physiologically-desired/governed protein intake.
We don’t know if this hypothesis is true, but if it is, that is very very interesting news about human metabolism.
I’m still chewing on this, so more as the story unfolds.
We’re all used to watching nutrition pendulum swing back and forth, back and forth. You know what I mean:
One nutritionist blogger made a big list of advice she’s read, which is subject to change without notice:
- Don’t eat eggs, they are too high in cholesterol.
- Really, don’t eat any fat because it is all bad for your heart.
- Don’t drink caffeine containing beverages.
- Don’t drink soda or juice, they are full of sugar.
- Don’t drink diet drinks because they will give you cancer.
- Drink only water, but be careful because the bottle is harmful and tap water is full of contaminants and the natural spring water is really bottled from the tap at the bottling company.
- Don’t use salt in cooking and avoid all foods made with salt.
- Oh yeah, you can use sea salt or Himalayan salt.
- Don’t eat butter, only eat margarine.
- Oh yeah, don’t ever eat margarine because it contains trans fat.
- Oh yeah, don’t eat any fat.
- Oh yeah, eat as much coconut fat as you want, it’s a good saturated fat.
Last month, JAMA (Journal of the American Medical Association) took on the issue of whole-fat vs. non-fat dairy consumption: which is better for us?
tl:dr version: they don’t know. But they want us to eat low-fat dairy anyway.
It’s not for lack of trying that they don’t know whether high-fat dairy or no-fat dairy promotes or detracts from health, and in what ways. They’ve tried. Oh, they’ve tried a lot. But the results are conflicting.
…some recent studies have suggested that high-fat milk, cheese, and yogurt are at least as healthful as their low-fat or nonfat counterparts, and their authors are questioning the wisdom of advising people to avoid whole milk and products made with it.JAMA Dec 5, 2018
“I don’t think there’s enough evidence to recommend low-fat dairy,” said cardiologist Dariush Mozaffarian, MD, dean of the Friedman School of Nutrition Science and Policy at Tufts University. However, Mozaffarian added, “I don’t think there’s enough evidence to recommend whole-fat dairy, either.”
Uh, okay. But why isn’t there enough evidence to answer this question?
Part of the problem is dairy’s fault. Well, not really. But dairy products are not all created equal. Some cheeses are fermented, and some yogurts have probiotics, says Frank Hu, nutrition chair at Harvard School of Public Health.
Also, we eat dairy in different ways, Hu says:
For example, Hu said, while US consumers chow down on cheeseburgers and pizza, Europeans are more likely to eat cheese for cheese’s sake, not as a topping for foods that without it are already high in fat or sodium or both.
When researchers try to study the effects of dairy fat intake, they have to deal with the problems of which dairy products may be responsible for which effects, and which populations are affected by these results, as different regions eat different dairy products at differing rates.
Okay, fine. Maybe we need to throw some fancy technology at the problem– how about looking at biomarkers and seeing if there are correlations with risk for heart disease and other potentially related health problems?
They did that, too. No luck.
There are ongoing observational studies, where researchers observe and measure lots of features of participants who are consuming varying amounts of dairy fat in their diets over time. But even when they get results from these studies, they don’t tend to trust them:
[Mario Kratz, nutrition professor, University of Washington] “…people who eat the most full-fat dairy products in observational studies are usually among the ones who gain the least amount of weight.” That seems counterintuitive, but …“it’s very likely that there’s a type of compensation going on.” Low-fat or nonfat dairy isn’t as filling as whole-fat dairy, so people might end up craving unhealthy snacks if they opt for the former, he said. However, he added, “I would never recommend people consume large amounts of butter and cream.”Still JAMA; I’ll let you know when it changes.
Hey Mario– why wouldn’t you recommend that people eat lots of butter and cream? You just said there’s not evidence that it’s bad for us.
Well, maybe Mario is just following the US Dietary Guidelines on Dairy, which say this:
- Recommendations are 2 cups (or the equivalent in yogurt or cheese) for children ages 2 to 3 years, 2½ cups for children ages 4 to 8 years, and 3 cups for teens ages 9 to 18 years and for adults.
- Fat-free and low-fat dairy are advised.
Frank Hu is of the same view. Even though there doesn’t seem to be much firm evidence that high-fat dairy is bad for us (and there’s some evidence that it’s good for us), he says he doesn’t expect nutrition recommendations to change soon. Why? Because “more research is needed to examine health effects of different types of dairy products in diverse populations.”
So, we’re back to they don’t know. But they are still recommending low or no-fat dairy consumption.
You might think: well, better safe than sorry. But the thing is, they don’t know which is safer– no-fat or high-fat dairy. And I would be very sorry to have to eat low or no-fat dairy, as it doesn’t taste like anything to me. But Frank Hu says we shouldn’t stress about it; “Overall dietary pattern is very important, and dairy is only 1 of many food items on our plate.”
Excellent. In that case, I am going to not stress and enjoy these.
What do you do when you read some new nutritional advice? Do you take it with a grain of salt (provided you don’t eat low-sodium)? Do you shift with the pendulum? Do you ignore them all? I’d love to hear from you.