Why Population Studies Are “Associated” With Limitations

Sigh…another week, another population study “linking” a food with a health consequence. This just-published study involved 70,000+ participants in the Japan Public Health Center–based Prospective Cohort looked at the “association” between plant and animal protein intake and mortality from heart disease, cancer, and “all-cause” mortality (a.k.a. “death from any reason”). 

Here’s what it concluded:

  • Higher intakes of plant protein were “associated” with lower cardiovascular-related and all-cause mortality.
  • Animal protein, per se, was NOT associated with any of these mortalities.
  • If red and processed meat was replaced with plant protein, it was “associated” with lower mortality from cancer, cardiovascular disease, and all-cause mortality — according to their statistical models, which did include some assumptions.

These population or “epidemiological” studies typically recruit thousands of people, use a questionnaire to get their dietary pattern – usually only at the study’s start, then check their health status 20+ years down the road.  The researchers then conclude that what participants ate when they filled out that food questionnaire was “associated” with their health outcome two decades later. 

Essentially, it gets a lot of statistics and draws a lot of conclusions based on what these people ate on a Tuesday 20+ years ago. 

When you see it laid out like that it’s almost comical.  That’s fine, but too often it’s given more credit than it deserves.

Plant protein is great. But it’s not the only way to ensure good health.
(Photo: pixabay.com)

Some Fine Print

This study took a single dietary assessment at the start and never again. Would it be fair to base your current health status on what you ate on a Tuesday 20 years ago? Eating habits change, as do activity levels. These factors may actually skew the results toward less dramatic differences, but again, it’s unknown. To be fair, the authors acknowledge that the possibility for “residual confounding in the association between plant protein and mortality remains.”

Some other potentially confounding variables:

• The high plant protein eaters also ate at least 300 FEWER calories than those eating more animal protein.
• High consumers of plant protein ate more fruits and vegetables in general, compared with the high consumers of animal protein.

Mortality from various causes has so many variables.  It’s hazardous to attribute it all to diet.  In commenting on yet another population study, Frank Mitloehner, professor of Animal Science at the University of California, Davis, who specializes in agricultural productivity and environmental sustainability, felt, “The correction for confounders is near impossible. It is difficult to know what the relative risk of one such variable is on morbidity and mortality.”  He actually gives “little credence” to these nutrition population studies.

When Statistics Aren’t Reality

These studies produce tons of numbers that are “statistically significant”.  The problem, too often, is that they may not be “clinically” significant. 

Example: take two empty Olympic-sized swimming pools.  Put a drop of water into one, and three drops into the other.  The second pool has THREE TIMES the water that the first one has.  Easy to show this statistically.  The problem: the statistics are meaningless because no one should dive into either pool.

Population Studies CAN’T Show Cause-and-Effect

They’re only designed to generate a hypothesis that should then be tested by clinical research.  This is an important distinction, because many times the hypotheses don’t pan out.  We’ve seen this happen many times in nutritional epidemiology studies over the years.  Recall two of the big mishaps:

  • Eggs being demonized because of their cholesterol content. 
  • All fat was considered bad.  Fat-free was better. 

Nutrition epidemiology studies produced those conclusions but such studies simply cannot get granular enough to produce real insight. Clinical research proved them to be inaccurate. 

Clinical research has already shown that lean red meat can not only be healthful but useful.  The BOLD study (Beef in an Optimal Lean Diet) showed that lean beef – about 4 oz daily, you don’t need any more than that – found that LDL-cholesterol was lowered as much as by the DASH (Dietary Approaches to Stop Hypertension) diet that offered only an ounce of beef daily. 

A more recent study showed a greater reduction in LDL-cholesterol on a Med diet that contained MORE lean beef than the one with less lean beef. 

Proteins from plants AND animals have a lot of nutritional value. Regardless of the source, it’s best to keep ALL portions reasonable.  Three or 4 ounces of animal protein (or the plant-equivalent) per meal is all that’s needed. Then fill out with fruits, veggies, and whole grains on your plate.

Cut-to-the-Chase-Nutrition Take-Away

You’ll never stop seeing these population studies.  They’re easy to do, they generate huge databases and they give researchers the ability to publish papers for years.  Just see them with some healthy skepticism and know they aren’t capable of producing ANY cause-and-effect conclusions – no matter what the headline might imply.  Solid, clinical studies usually give a better picture that’s far more likely to be meaningful in the real world.  IMHO.

Depressed? Some Fruits and Veggies Might Help!

When I was a kid, and for basically my entire life, having a (huge) slice of watermelon – or two or three, made me happier than eating cake.  Yeah, watermelon made me happy.  But could eating more fruit – and veggies – make you less depressed?  Some new research says that’s not a far-fetched notion.

This review in the American Journal of Clinical Nutrition evaluated the body of studies that investigated the effects of eating fruits and vegetables on various measures of mental health.   The authors wanted to see if an actual causal relationship existed, so they looked at both experimental studies and observational studies.

This review included studies that reported fruits and vegetables together, as well as those that looked only at intakes of vegetables or fruits.  Being this specific really pared down the pool of eligible studies, but they did find ten that met the criteria, and these included over 33,000 people.

Watermelon may not cure depression, but I am ALWAYS happy when I’m eating it!

The authors concluded that increased fruit and vegetable consumption had a “positive effect on psychological well-being”, with vegetables having somewhat more impact than fruits, in studies that looked at the effects independently.  The effect on mental health however, was less clear. 

Basic Brain Chemistry

There may be some chemical reasons for the improved mental outlook from eating more produce.  Fruits and vegetables are loaded with micronutrients like vitamin C and B-complex vitamins, that influence the formation of neurotransmitters, such as serotonin, dopamine, and norepinephrine in the brain.

Neurotransmitters are known to influence our mood and impact mental health.  Indeed, many medications that treat depression are focused on modulating neurotransmitters like serotonin, to optimize their impact on mental health, depression, and psychological well-being.

Chicken vs. Egg

My first response was, “did the fruit and vegetable consumption improve their psychological well-being, or was their consumption of fruits and vegetables higher just because they had a better sense of well-being in the first place.  The latter would be called “reverse causality”. 

The amount of fruits and vegetables needed for “meaningful changes” varied among studies, ranging from 3.7 servings to 7-8 servings.  Counting a typical “serving” as about ½ cup, you’re looking at from 2-4 cups per day to have an effect.  This is well within recommended amounts by pretty much all global health authorities.

A simple “modified-Mediterranean diet”
seemed to modify depression as well

While this review didn’t include clinical research, a 2017 clinical study looked directly at the impact of increasing adherence to a “modified-Mediterranean” diet, which emphasizes fruit and vegetable consumption, as adjunctive treatment in persons diagnosed with moderate to severe depression.  Scores on the Montgomery–Åsberg Depression Rating Scale (MADRS) were used as a measure of the severity of depression.  This study checked some important boxes for quality of design:

  • Randomized controlled trial.
  • Parallel groups.
  • Some received regular nutrition counseling on a modified Mediterranean diet, others received social support on the same schedule.

Result: The dietary intervention group had significantly improved scores.  Even better, 32% of the dietary intervention group achieved remission of their depression, vs 8% in the social support group, and these results were statistically significant. 

The dietary group also at significantly more:

  • Fruits
  • Dairy foods
  • Fish
  • Pulses (beans, peas)
  • Nuts

They also ate fewer servings of less nutritious items, like sweets and, empty-calorie foods.

The study lasted only 12 weeks, so further research that addresses longer term results and with larger groups, is certainly warranted.  Still, given a relatively simple intervention that just encourages people to eat a diet that’s balanced and includes what they need anyway, it’s hard to dismiss the value of results. 

Cut-to the-Chase Take-Away

Aa clinician, I care mostly about people eating as many of each as possible and I’m less fussy about fruits vs. veggies.  None of them are nutritious unless you eat them and all of them are good for us.  Eat the ones you like and eat them daily.  You’ll certainly be happier with your choices!

When Did “Plant-based” Become “Plants ONLY”?

When the New York State Assembly said so.  They recently passed A04072,, requiring all hospitals to – upon request – offer  “a plant-based food option as an alternative to every meal or  snack  offered  in  food service  to  the patient.”  In addition, all the hospital’s written material describing food offerings must now include the availability of a plant-based food option.

They take it a step further by defining “plant-based” as plants-only:

  • “Plant-based food option” means a food or beverage that is free of animal products and that has nutritional value comparable to the non-plant-based food option that it replaces.
  • “Animal product” means meat, poultry, seafood, dairy, eggs, honey, and any derivative thereof.

“Basically they are saying “plant-based” equals vegan,” said Toby Amidor, a NY-based registered dietitian nutritionist and best-selling cookbook author. “Those are two separate entities. [The State Assembly] is defining it as they wish.” 

Historically, “plant-based diet” has always meant plant  dominant, whereas vegan diets are exclusively from plants.  By the NY Assembly’s definition, even honey is excluded (bees are tiny but they’re animals).   

“Comparable Nutritional Value”? No Such Animal

Add a sprinkle of grated parmesan?
Oops! Then won’t be “plant-based”!


As for the bill’s requirement that the “plant-based” meals and snacks have a “nutritional value comparable to the non-plant-based food option that it replaces”, this is a huge ask.  “It might sound good on paper but it’s not truly possible,” according to registered dietitian nutritionist and certified diabetes educator Melissa Joy Dobbins.  “Offering plant-based options is one thing, but requiring them to be nutritionally comparable is problematic.” 

Nature just doesn’t work like that – there just isn’t always an ideal plant-based counterpart for an animal food, nor vice-versa.  Milk and yogurt are perfect examples.  There are plant-based alternatives, but none is nutritionally equivalent.  This is the whole premise of eating a varied diet.  The more food groups you exclude, the more nutritional risks you take. 

Dobbins added, “Implying that it’s a simple swap is misguided at best, and has the potential to contribute to nutritional deficits in an already compromised patient population.”  Hospital patients often have poor appetites, yet their protein needs can be higher than normal, due to the stress of surgery and illness.  Elderly patients at bedrest for an extended period lose muscle mass faster than younger counterparts, and may benefit from a diet that contains extra protein of the highest quality, such as in meat, dairy foods and eggs, and in less volume than a vegan diet would need to provide the same protein.

A “Solution” In Search of a Problem

What did hospitalized vegans do BEFORE this legislation?  “Accommodating vegan patients is standard,” according to Jessie Pavlinac, a chief clinical dietitian at the Oregon Health and Science University hospital in Portland and past president of the Academy of Nutrition and Dietetics. 

Pavlinac noted that hospitals would be cited by accreditation bodies for not having options for vegetarians and vegans.  

Cut-To-The-Chase Nutrition Advice

Dairy foods — and meat — can be in
YOUR plant-based diet, and for good reasons!

As consumers muddle through this “plant-based/plants-only” forest, there are a few facts – not hype – to remember about these terms:

  • “Plant-based” and “vegan” are NOT health claims.
  • Neither term indicates dietary quality.
  • These terms are simply descriptive, nothing more.

Defining plant-based to mean “excludes all animal foods” is incorrect and confusing.  Does the delicious salad pictured being “plant-based” if you sprinkle some parmesan over it?  Of course not, and no law should say otherwise — IMHO.

My guess is that the “nutrition-naïve” legislators were strongly influenced by lobbyists with a vegan agenda.  The bill still has significant hurdles in the Senate and the governor’s office before it could become law, but a similar bill was signed into law by California’s Governor Jerry Brown.  

Featured image courtesy of www.inkmedia.eu

Got a Salty Tongue? New Study Says It’s Not So Bad!

Hypertension and “low-sodium diet” seem to go together like two peas in an unsalted pod.  Salt, has been one of the “eat less of” ingredients that dietary guidelines and health organizations have warned us about forever.  We’ve been told of the risks to our blood pressure and heart health in particular.

In the US, we get about 3,500-4000 mg of sodium daily, according to the Centers for Disease Control   (women tend to be on the lower end of this range).  You may exceed these levels if you eat out a lot, as restaurant chefs are known for their generosity with salt.  US Dietary Guidelines recommend a max of 2,300 milligrams, and if you’re at risk for cardiovascular disease, it’s only 1,500 mg.  Even at 2,300 mg, it means cutting out a third of the sodium we eat.

Kimchi: Yes, it’s salty, but it’s OK,
just don’t binge!

The problem?  People HATE low-salt diets and they love salty food!   Even excluding French fries, these foods also figure into our love of salty savories:

  • Grandma’s chicken soup (and most canned or homemade soups)
  • Cured meat, fish (smoked salmon!) and cold cuts
  • Most condiments, from Worcestershire sauce to anchovy paste
  • Most ethnic dishes and restaurant meals
  • Almost everything savory that‘s canned or jarred (pasta sauces, tomato sauce, baked beans, and on)

S.O.S.: Save Our Sodium?

This study looked at just how bad the present intake of sodium is for our health and it turns out sodium may be a minor player. 

The study estimated sodium intake by assessing sodium in the urine (where 90% of our sodium ends up) and divided the groups into low, medium, and high excretion groups and followed them for about 8 years, looking at risk for cardiovascular events and death.

Interestingly, the groups at the most risk had both the highest and the LOWEST intakes of sodium, but only when they also had a low intake of potassium. 

The group with the LOWEST risk for death and cardiovascular events?  They had a moderate sodium diet (3.000-5,000 mg/day) but diets that were highest in potassium. 

D.A.S.H.-ing Through the Clutter

A diet that’s moderate in sodium but high in potassium.  That’s pretty much the DASH diet: “Dietary Approaches to Stop Hypertension”.  It works and it’s simple.  Just eating more fruits, vegetables, and low-fat and fat-free dairy foods (milk is an astoundingly good source of potassium) does the trick, and it’s what most people’s diets need more of anyway.  Here’s why I like the DASH approach:

  • It’s not regimented or prescriptive. It’s an eating style that works with all cuisines.
  • Plenty of delicious foods are also loaded with potassium. Eat your favorites and eat them daily. 
  • Bonus: eating more fruits, veggies and low-fat dairy foods will probably push out some of the higher-salt foods people eat now, especially for snacks.

ALL fruits and vegetables are good sources of potassium, but here are some superstars:

  • All melons and berries
  • All citrus fruits and juices (100% juice, please)
  • All potatoes, squash, pumpkin
  • All leafy greens (lettuce, spinach, kale, the whole lot)
  • Beets (don’t laugh – beets are the new “in” veggie for 2019!)
  • MILK!  Whole, 2%, 1% and fat-free, also yogurt are the top non-plant sources of potassium – and calcium.

Reality: It Doesn’t Have to Bite

High-potassium foods are a “must-have.” More important than “low-sodium”!

People in the free-living world aren’t going to stop eating their favorite savory foods and they shouldn’t have to.  It’s time we accepted that and focused on encouraging everyone to eat more high-potassium foods. This latest study suggests it may be more effective anyway.

While the research continues, make sure your favorite savories keep better company:

  • Ham sandwich?  Instead of the chips and soda, try an apple or banana and some iced tea.
  • Going out to dinner?  Start with a salad – dressing on the side so you stay in charge.  Have a nice baked potato – sour cream has no sodium! 
  • Soup’s on?  Add some beans and greens for good measure.
  • Bacon and eggs?  Lox and bagels?  Have a fruit and yogurt parfait along with it.  Or at least a glass of OJ or a banana.
  • Get the herbs and spices into everything: soups, salads, meat, fish, even yogurt!  Dried or fresh, herbs and spices are loaded with antioxidants and replace the need for some of the salt.

There’s no requirement for a specific fruit or veggie to be healthy.  Just eating more fruits, veggies and dairy foods is a start and a good one.  It’s a super-tasty way to get healthier all-around – and just by eating, because these foods also fill nutrient gaps.  The benefits go way past getting more potassium. 

Did Your Child Eat 90 Cups of Strawberries This Morning?

If that happened, then be concerned with pesticide residues.  Everyone else can forget about the Environmental Working Group’s annual “Dirty Dozen” list.  

I can always tell it’s spring — that’s when the EWG issues it’s list of fruits and veggies with pesticide residues, just when people are looking forward to spring and produce.  The EWG’s message is always the same:  Avoid the Dirty Dozen.  And the failures of their message are also the same:


AGAIN, the EWG fails to put pesticide use into context and AGAIN, that’s irresponsible. (Example: even a child would have to eat 181 servings (about 90 cups) of strawberries, the #1 food on Dirty Dozen list, to exceed safe levels. An adult male would need to eat 635 servings (about 317 cups) of strawberries. 

AGAIN, the EWG doesn’t mention the pesticides used in organic agriculture.  There are hundreds of them, and even a few dozen synthetic ones that are allowed under certain circumstances – while still allowing the food to carry an “organic” label.

AGAIN, consumers should be reminded that the feds have been looking at this for decades, through its Pesticide Data Program.

The “Villains”

Kale: The new addition to the “Dirty Dozen”
  1. Strawberries
  2. Spinach
  3. Kale
  4. Nectarines
  5. Apples
  6. Grapes
  7. Peaches
  8. Cherries
  9. Pears
  10. Tomatoes
  11. Celery
  12. Potatoes

It Really Is ALL Good

You’ve heard that “the dose makes the poison.”  It’s true, but the dose also brings the benefit.  Let’s remember: ALL the research proving the healthfulness of eating plenty of fruits and vegetables – fresh, canned, frozen, dried – throughout our lives, was done using CONVENTIONALLY grown produce, not organic. 

Organic is just another choice.  If buying organic gets you eating more fruits and vegetables, then terrific!  But if you can’t find them, can’t afford them, or simply want to eat healthful food that’s also more economical, then the conventionally-grown option is fine.  I eat organic produce sometimes, when it’s convenient and reasonably priced.  I also eat ALL the conventionally-grown produce on the “dirty” list. 

No, I Won’t Peel My Apples

Eat the peels! There’s good stuff there!

That may remove pesticide residues but it’s probably healthier to eat the edible peels and skins on produce – they’re loaded with antioxidants and prebiotic fiber.  The research supporting eating fiber outweighs the near-non-existent negative research on pesticides on our food.  It’s also a huge waste to throw away these edible portions.


My EdibleRx about LAST YEAR’s Dirty Dozen holds as true today as it did then, except that kale made this year’s list, bumping off sweet bell peppers. Yawn.  If you hate kale, you’re thrilled.  But if you like it, then it won’t kale you to keep eating it without concern.  

Still Have Doubts?

Get the facts.  This cool tool calculates how many servings of one of the Dirty Dozen a man, woman or child would have to eat before pesticides could become a concern.  It’s from the Alliance for Food and Farming – a non-profit organization of BOTH organic and conventional growers of fruits and vegetables on all sizes of farms.

Organic: The Answer To Cancer Prevention?

If anyone tells you they have the definitive answer, they’re misleading you.

Growing foods conventionally usually – but not always – involves the use of some pesticides when there’s a need to control harmful bugs, plant viruses, fungi, etc. that damage either the whole plant or the edible portion of it.  These compounds are expensive, so farmers tend not to use them unless absolutely necessary, and then in the least amount possible for the needed benefit. 

Organic crops are thought to be grown without pesticides, but there are hundreds of pesticides approved for use on organic crops.  Most are organic ones, but in certain circumstances, as with a particularly difficult to control pest, USDA has rules in place to allow limited use of a few dozen synthetic pesticides is allowed, and the food produced can still be labeled “organic”. 

But Is Organic Food Healthier?

Twice the price,
but twice the benefit?

“Healthier” has no formal definition, but let’s say it means you have a lower risk of developing cancer, since that’s a highly desirable outcome by everyone.  Would eating organic food make you less likely to develop cancer?

This recent study wanted to find out.  It was a prospective study – meaning that it went on for years before results were determined.  As part of a large study involving 68,946 French participants, all volunteers “self-reported” the frequency of consumption of organic foods.  Responses about consumption were multiple choice and ranged from 1 (“most of the time”) to 7 (“never”), with an option for “I don’t know”.  Demographic information was also gathered, including about household income.  This was interesting, because the top household income bracket was US $3,100, hardly “upper income” even in 2009, when the study launched.

The Good News: Organic Eaters Had Less Cancer

More frequently eating organic foods was “associated” with lower your cancer risk.   Key word, “associated”.  It’s the bane of my existence because it is often interpreted as “cause-and-effect,” a very wrong assumption. 

Why?  This study was “observational”.  These types of studies aren’t designed to evaluate cause-and-effect.  They can only generate a hypothesis that clinical studies could then evaluate for more direct conclusions.  This study is incapable of making such conclusions.

Photo: www.inkmedia.eu

The not-so-good news: the benefit of eating organic was minimal, at best.  The risk of getting cancer went down only 0.6% — that’s 6/10ths of one percent, and only for the most frequent eaters of organic food.  Even then, the benefit may be less than reported. Read on… 

Limitations of the Study, A.K.A. the “Fine Print”

The authors responsibly called out a fairly lengthy list of limitations of this study, and why the results need to be seen with caution:

  1. The participants were volunteers who were “likely particularly health conscious individuals”, therefore limiting the application of the results to the general public.
  2. The questionnaire used asked about frequency of consumption but not quantity.    Also, possible misclassification of organic foods, “cannot be excluded.”
  3. Follow-up time was short – an average of only about 4½ years.  Cancer can take many years to develop and it’s unclear what the diets of these participants were prior to participation.
  4. Possible “residual confounding resulting from unmeasured factors or inaccuracy in the assessment of some covariates cannot be totally excluded.”  This means there is a lot they didn’t measure or that they couldn’t measure accurately. 
  5. They could not exclude the non-detection of some cancers. 

Cut-To-The-Chase-Nutrition Takeaways

  • Will eating organic food help prevent cancer? Not based on this study.
  • Organic food is expensive, and thus out of reach of many, even if they can find it.
  • Organic doesn’t mean pesticide-free. 
  • Focus on this: A mountain of research showing the health benefits (including cancer risk reduction) of eating plenty of fruits, vegetables, beans and whole grains, was done using conventional foods! 

Got the Blues? Try Onions & Grapefruit!

OK, onions and grapefruit together isn’t appetizing, but eating more high-fiber foods like these, and maybe some butter, might help, according to new research.

You’ve heard for ages that diets high in fiber can reduce your risk for stroke, hearty disease, cancer, hypertension, and all sorts of chronic health problems.  In addition to all the above benefits, mounting evidence is telling us that a high fiber diet can improve brain health. 

This recent review looked at a wide body of research and concluded that compounds produced by healthy gut bacteria, especially a compound called butyric acid, may positively impact our brains.  Some of the research they reviewed involved only rats, but much of it looked at the impact of high-fiber diets on human behavior, and they found a reduction of anxiety and an improved ability to focus and multitask when there were more healthy bacteria present in the gut. 

An even more recent study that analyzed human gut bacteria found that people reporting a low quality of life and/or depression had different bacteria in their colon than people who had normal mental health and were happier.  The bacteria don’t impact our mental health directly, because they stay in the colon, but the compounds they produce do make it into the circulation and appear to positively impact our brain health.

Fiber: Why eat it if we can’t digest it? 

Fiber: you can’t digest it & you probably need more of it

When we eat, we’re not just feeding ourselves, we’re also feeding the bacteria in our colons, and high-fiber foods like oat and wheat bran, beans, and pretty much most fruits and veggies, promotes the growth of good bacteria.  That’s what makes high-fiber foods PRE-biotic. 

Undigested fiber sails past the small intestine, landing in our colon, where beneficial bacteria see fiber as an all-you-can-eat buffet.  When they’re through with it, they’ve produced beneficial by-products called short-chain fatty acids.  The three main ones are:

  • Acetic acid (think vinegar),
  • Propionic acid, and
  • Butyric acid (also called butyrate).

Butyric acid is getting attention because of its diverse biological functions in our bodies outside of the colon.  A lot of the benefits noted in the studies above have been attributed to butyrate, to the point that its potential health impact shouldn’t be ignored. 

3-4% of butter is butyric acid,
but better sources abound

You CAN Believe It’s Butter

High fiber foods aren’t the only way to increase the butyric acid in your colon.  There are some naturally-occurring sources of butyrate, such as probiotic foods like yogurt and kefir, that can increase strains of bacteria that produce butyrate. 

One of the largest single natural sources of butyrate is butter.  It’s true – butter contains about 4% butyric acid.  I’m not advocating eating more butter, and there are better ways to help get butyric acid into the gut.  Including fermented dairy foods, however, is definitely worthwhile for so many nutritional reasons.

The Fine Print

Ironically, people with irritable bowel and other gastrointestinal conditions are often advised to be on a “low-FODMAP” diet that eliminates many high-fiber foods that good bacteria use to produce butyric acid.  No worries – there are still lots of fruits and vegetables you can eat.  Stick to your prescribed diet and as your condition improves, just add FODMAP foods back into your diet as advised.  Kate Scarlata, RDN, is an outstanding registered dietitian who specializes in the FODMAP diet has tons of info on her website.   

Cut-to-the-Chase Conclusions

The point here is that the gut does communicate with the brain in very specific ways, and these may be influenced by the type and amounts of various strains of bacteria – both good ones and negative ones. Most people only get about 12-14 grams of fiber daily, and we should be eating twice that amount, according to US Dietary Guidelines.

Aim to gradually eat more fruits, vegetables, whole grain breads and cereals, and beans (these are loaded with great fiber!). As for fresh vs. frozen, vs. canned, no need to get too obsessive. Just eat more of these foods overall. Me? I never peel apples, carrots or potatoes. I’m not tossing away good fiber!

While nothing is a guarantee of good mental health, optimizing our gut environment is likely to also optimize our gut’s ability to send good messages to the brain.  It may not cure depression but even if it doesn’t change our perceived quality of life, it’s very likely to lay down a good foundation for the gut to operate at its full potential. A higher fiber diet is good for our gut — and good for the rest of our body as well. #winwin

I’ll take that.     

Dear Tom Brady: You Won, Your Nutrition “Beliefs” Don’t

Tom Brady is a multiple Super Bowl winner.  He’s also a businessman, and he’s glommed onto the formula for marketing a diet regimen:

  • Be a celebrity, preferably a sports celebrity, because they’re instantly believable.  Not credible, but no one cares about credibility or facts, just that you’re believable.
  • Look good, have a killer bod.  People will think your diet is the reason. Hey, sexy sells.
  • Have an equally hot spouse or significant other who can endorse you. And when you say you get to bed early every night, no one would doubt you. 
  • Talk about nutrition “beliefs” and “philosophy”.  Facts aren’t good for business.
  • Exclude all the standard food commodities. They’re not elite enough (see below).
  • Have all the trendy “free-froms”:
    • No gluten.
    • No red meat.
    • No dairy.  
    • No white potatoes or any other nightshade vegetables either, like peppers, eggplant, or tomatoes.  They’re “inflammatory”. 
    • No GMOs.
  • Keep it as green as possible.  Heavy on leafy foods, but he also includes beans – I do like this part.
  • Go against the grains – at least the common ones, like wheat and corn – again, those commodity foods the masses eat, because you aren’t most people.
  • Have expensive “uniquely formulated” products to sell – only available from your web site.  It’s critical to eat like a wealthy, elite athlete, not a commoner.
  • ELECTROLYTES!  The ones he sells in particular — the TB12 electrolytes.  They’re part of his “alkalinizing” the body, a must for health in his book.  (NO science supporting this – none).  A 20-serving, 1.7-ounce bottle sells for $15 (plus shipping).  That’s 71 cents per serving.  A serving of milk gives you three times more potassium, plus protein, sodium, calcium, and other nutrients you  need after a workout, for one-third the price. This from someone who chastises food companies about “brainwashing” consumers.  Shame on you, Tom. 
  • WHEY PROTEIN POWDER?!  This dairy food is OK – IF it’s TB’s specially formulated one.  It’s $50 for 21 servings, or $2.38 per serving.  To get the same amount of protein from real milk would set you back only about 65 cents, and you’d get all the other nutrients in milk to boot. 

Keep Edgy: Diss the Mediterranean Diet!

Sweet red pepper: One of many superfoods
NOT allowed on TB’s diet!

No cooking with olive oil!  Swap it for coconut oil.  No scientific basis for this – coconut oil is way more saturated than any animal fat.

No yogurt, eggplant, tomatoes, or peppers!  No cheese!  Nutrient-rich foods that have fed and sustained Italians and Greeks for thousands of years have no place in this winner’s diet.  Fish only if it’s wild-caught.  Farmed salmon, while quite healthy and affordable, but probably not exclusive, elite, or expensive enough.

You’re Busted, Tom. Ditching Dairy Is Dumb.

Dairy foods – from milk to yogurt to cheese – have unparalleled qualities.  If you know your nutrition, this isn’t debatable.  It might be boring, but facts often are. 

He writes, “When I was a kid, the dairy industry rolled out lots of campaigns urging people to drink lots of milk.  But research today is pretty clear that we should consume dairy in more limited amounts. Our belief [there’s that word again] at TB12 is that dairy products are high in calories and lower in nutritional value than other foods.”

I don’t know what “research” he’s talking about (I’d bet he doesn’t either), but there is no drink that can match a glass of milk for nutritional value and affordability.  None.  Furthermore, a mountain of solid science verifies the benefits of dairy foods, including that a glass of low-fat chocolate milk after a workout is BETTER than sports drinks for repairing muscle mass and improving endurance in subsequent workouts.   Why? Probably a great carb-to-protein ratio and a great electrolyte balance, plus vitamins and minerals.  Of course, milk is a commodity, so it has to be out. 

No GMOs?

Tom seems to disagree with over 100 Nobel prize winning scientists who have attested to the safety and nutritional value of foods produced with genetic engineering. I wonder what he knows?

Cut-To-The-Chase-Advice

Nutrition advice should be grounded in science and facts, not beliefs or philosophies.  Using the word “belief” shouldn’t give you a pass to propagate nutrition myths and misinformation. 

Most of us don’t have personal chefs to cook our meals (and clean up afterwards).  Tom’s diet may not be harmful to the average person, but the DASH and the Mediterranean diets have far more science behind them and are solid, affordable, and sustainable paths up the mountain towards good health.  They don’t require expensive “website” foods and supplements or forbid foods either – it’s a matter of how much and how often.  Not sexy, just solid.  For my health, I’ll go there.  Sorry, TB.

Food Fashions: Full-Frontal & Fickle!

It’s coming up on Fashion Week in New York and while that’s all about styles of clothes, foods come into – and go out of – fashion, too.  A previous post dealt with foods that nutritionists never thought would become popular, yet they did just that. 

Now think of the foods that were “in” — for a while.  I actually heard or read these comments recently:

  • “I’m so over kale, already.”  I read this comment by a former editor of a prominent food magazine. (Cauliflower is the new kale, if you’re wondering, but beets are gaining.)  
  • “Cottage cheese? What are you, like, 80?”  (This was said to me and no, I’m not 80 — but hey, nothing wrong with 80!)
  • “A baked potato?  A white one? Are you serious?”
  • “I don’t’ do bread.  All that gluten.  Quinoa is my thing.”
  • “She wants a Cosmo? No one drinks those anymore.”

All the above foods (excluding the Cosmo) are delicious and healthful.  They’re also “out of fashion” (including the Cosmo).  If this sounds a little ridiculous, read on.

Food Fashions Fade, Food Value Doesn’t

People may be “done” with kale, but is it less healthful than it was when it was “in”?  Of course not. It’s a superfood.  A baked potato is one of the best sources of potassium, even better than a banana, and has as much vitamin C as a tomato!  It always has!  Even so, all the buzz is that white potatoes are bad and sweet potatoes are a little better, but still a “starchy vegetable” to be eaten in minimal amounts. (Thanks, Harvard.)  

Fashion eating aside, the nutritional qualities of these foods have ALWAYS been there.  Whether it’s kale or cauliflower, or They’re as nutritious today as when they were first “discovered” by food fashionistas. 

Consider the following:

A healthful Russet Burbank white potato grown in Idaho!
  • Kale is every bit as good for you now as it was when you first tasted it.  It may even taste better now, since all that attention motivated chefs to develop inventive ways of eating kale.  Bravo.
  • White potatoes. Before you were told of their “horrors”, they were a staple food for millions of people from Paris to Poughkeepsie to Peru.  The nutrition they had is the nutrition they still have.  (Check out www.potatogoodness.com for a ridiculous number of facts and recipes. 
  • Bread?  It takes a hit for having “carbs” and gluten, which celebrities tell us are both bad (proof you should never get nutrition advice from celebrities).  Yet, it’s been a staple, indeed, the “staff of life” in many cultures throughout history.  Made with whole grains, it’s also loaded with fiber, vitamins and minerals.  It’s versatile, oh, and people like it. 
  • Cottage cheese?  PLEASE!  If you think it’s only for elderly ladies who lunch, experts disagree. registered dietitian nutritionist and exercise physiologist Jim White is one guy trying to set the facts straight about the value of cottage cheese. “If your goal is to increase lean muscle, mass try cottage cheese with a serving of your favorite fruit after a hard earned workout,” he says. He educates clients that a typical cup of low-fat cottage cheese boasts a walloping 27 grams of protein for those muscles, plus 200 mg of calcium to support bone health.

Sometimes fashionable eating can have benefits.  I love anything that gets people eating more veggies, yogurt, and whole grains of any kind.   But I get concerned that people strop eating these foods when the trend fades and the benefits also go missing from their diets, especially if they replace them with something less healthful.  (Example: plant-based “milks” are more hype than benefit.)

Cut-To-The-Chase Advice

Work it.  Let food fashions motivate you to try a new food.  If you like it, keep eating it!    If it’s nutritious and out of fashion, it’s still just as good for you as it was when everyone else was eating it to be “in.”  Never be intimidated about eating healthy food you like.

Wanna Eat Healthy? Get Your Nitrates!

Think nitrates in your food and eating healthy don’t go together? What’s this gorgeous spinach salad have to do with nitrates? Read on, but let’s start at the beginning.

You’re not going vegan but you want to eat better and you’ll start with baby steps, like I talked about in my previous post.  OK, and here are some popular intentions:

  • Try and eat more leafy green stuff.
  • Definitely cut the hot dogs, ham, bacon, the deli stuff, and “processed” meat, even if it’s lean.  Everyone knows that stuff is “bad” because it has nitrates, right?

Swapping out hot dogs and ham for spinach and beets (the new “in” veggie for 2019, as I mentioned here) would at least cut back on the nitrates, right?  Wrong. 

Where the Real Nitrates Are

Indeed, a bunch of healthy, nutrient-rich veggies like beets, spinach, celery, even iceberg lettuce and broccoli, have more nitrates than that hot dog you snuck in for lunch last week.  Check out this chart from a 2012 report of the nitrate content in foods.  Amounts are in “parts per million” (ppm):

This image has an empty alt attribute; its file name is mushrooms-417101_1280-2.jpg
More nitrates than a hot dog — & it’s healthy food!
  • Beets: 2797 ppm
  • Spinach: 2333 ppm
  • Celery: 1496
  • Mushrooms: 590 ppm
  • Broccoli: 394 ppm
  • Strawberries: 173 ppm
  • Cured sausage (hot dog), cooked: 32 ppm

Are Nitrates in Fruits and Veggies a Problem?

No, and not in other foods either, according to Melissa Joy Dobbins MS, RDN, CDE and known as The Guilt-Free® RD.   “This is a great example of how misinformation can create a “fear factor” when it comes to food. I think most people who are concerned about nitrates/nitrites would be surprised to learn that the majority of these nutrients in our diet are not from cured meats, but from plant foods, namely a variety of vegetables.”

Dobbins’ statement is evidence-based and reflects the conclusion of this 2015 meta-analysis of many studies on dietary nitrates, nitrites, and nitrosamines, which found nitrates associated with a decreased risk of gastric cancer.  The slight increased risk associated with increased nitrite intake was considered weak, and tended to come from weak or poorly-designed studies, which muddied their findings.  Even then, spinach still has more nitrites than cured sausage.

Nitrates & Their Cousins: Nitrites and Nitrosamines

Here are the basics you need to know about these:

  • Nitrates are naturally present in lots of different foods. 
  • Nitrites are also naturally present in foods but most are formed when bacteria in your saliva convert nitrates to nitrites. 
  • Nitrosamines are not naturally present in food but can form in food through several pathways.  Cooking at a high temperature, such as frying cured meat, or when an acid (like stomach acid) is present.  If there’s any concern, it’s with the formation of nitrosamines.  Even then, conversion from nitrite to nitrosamine can be inhibited or stopped by the addition of compounds like ascorbic acid, or “vitamin C”.  Seriously – check the ingredient label of many cured foods like hot dogs and you’ll find “ascorbic acid” is often present. 

“Nitrate-Free” Cured Meat?

There are cured meats labeled “no added nitrates.”  What they add instead is celery powder.  As you’ll see from the table above, celery is loaded with natural nitrate.  There’s no evidence that there’s any difference between the nitrate in celery powder and the nitrate added to “nitrated” cured meat. 

Celery: Fine wherever you find it

Nitrates: The Boil-Down

It’s ironic to know that someone eating a spinach salad is probably getting 10 times more nitrates than the person eating the ham sandwich, but Dobbins noted, “Does that mean we should be afraid of eating vegetables? No. It means we should look at the overall nutrients a food provides and try to consume more nutrient-rich foods and fewer empty-calorie foods.”

It may be that the folks who eat lots of cured meat may also have a less-healthy lifestyle overall.  They may be less likely to engage in regular physical activity, and less likely to eat a lot of veggies and fruits, and may drink more soda or eat more junk snacks.

Cut-To-The-Chase-Advice

Eat all the spinach, beets, mushrooms, celery and broccoli you can fit into your diet.  As for cured meat, I like Dobbins’ approach. Nitrates may not be an issue but balance still is, so don’t go crazy at a cold-cut buffet.  If you like cured meats, make them leaner cuts, like ham, instead of sausage.  And have that ham with lots of veggies – even high-nitrate ones like spinach and broccoli.  A meal loaded with nitrates can, and should, still be healthy.  0000000000000