A REALLY Plant-Based Meal — With Beef!

When people tell me “I don’t eat meat, I’m plant-based,” the implication is that plant-based diets can’t include meat, poultry, or fish.

They can!  “Plant-based” means only that a majority of the diet comes from plants.  Period.  That said, being “plant-based” tells nothing about the QUALITY of someone’s diet.  You can eat nothing but candy and soda and have a “plant-based diet.”  You can live on nothing but kale — a terrific food and all-plant — but both diets would be unbalanced.

Balanced: The Size That Matters  

If you want to eat a plant-based diet but also include meat, what’s the right portion?

Less than you think.  Figure 3- to 4-oz. of meat, poultry, or fish are definitely enough protein in any meal, because this amount provides about 28 grams of protein.  You’ll have several more grams from the grains, starches, and vegetables that balance the meal, bringing you well over the 30 grams of protein for the meal.  That’s definitely enough protein!

Why?  Because the body can’t utilize more than 30-35 grams at a time, so any extra will just be converted to energy or, if the meal has too many calories, stored in fat tissue.

This huge platter has 4-oz. of ribeye. It served one, and is not vegan, but TOTALLY plant-based!

I’m an omnivore, but I’m also a huge fan of produce (seriously, I can’t get enough veggies and fruit).  The sliced ribeye in the platter you see at the right was exactly 4-oz., half the weight of the ribeye.  It’s one way we make an expensive cut of beef go farther — as it should.  It also leaves plenty of space on your plate for the other foods we like and need and that balance the meal.

Being a Plant-Based Omnivore

I like simple and easy meals, but they have to taste good.  Here’s how I made this dish.  It’s a “guide” and it’s quite adaptable:

  • Take an 8-oz. ribeye, grill or fry it (I used a grill pan) to medium doneness (internal temperature of 145°F ). Let it rest for about 10 minutes.
  • Combine all the fresh veggies you like in a large bowl. Include a little fruit if you like (we do). This one is a platter of lettuce, cucumbers, tomatoes, corn, and red pears.
  • Divide the salad among two platters.
  • Slice the ribeye into 1/4″ slices and put half the slices on each of the two platters.
  • Add a fresh herb (optional, but if they’re on hand, add them). I topped the platter with julienned broad-leaf thyme because it grows like a weed on my windowsill, but fresh mint or basil is just as delicious.
  • A teaspoon of grated Parmesan adds umami.
  • Drizzle with EVOO and balsamic vinegar, or your favorite dressing, but please don’t drown it. You want the flavors of the ingredients to shine through.

All the produce here came from our local farmers market this time, but use whatever you have.  It’s easy to substitute leftover chicken, deboned, or grilled fish.  Salmon works especially well, but I’ve also done this with canned salmon and sardines.  (Laugh if you must, but both are loaded with omega-3s, inexpensive, and great to have in the pantry!  I like them packed in water.)  

This simple recipe is just a template, but there are dozens more chef-developed, delicious recipes at: beefitswhatsfordinner.com.  The Mediterranean Beef & Salad Pita in the featured photo is one of them.  Takes 30 minutes and uses budget-friendly 80% lean  ground beef, or go even leaner with 95% ground beef.  Adapt it with your own touches! 

More Than Ever, We Need “Polypills” & “Activity Snacks”

Even “BC” (before COVID), much of the world was pretty sedentary, and our new “pandemic lifestyles” haven’t helped. Now a new WHO report says worldwide levels of physical activity have been flat for nearly 20 years. This varies by country, but globally about 1 in 3 women and 1 in 4 men, are not meeting guidelines for adequate activity.

What’s “Adequate Physical Activity”?

This is defined as 150 minutes of moderate-intensity activity (think brisk walking) per week, OR 75 minutes of vigorous-intensity activity per week (whatever has you huffing).

The WHO report was sobering. Sedentary lifestyles may be how our lives evolved in modern-day society, but they aren’t what we are built for. Still, such physical inactivity is a big negative on our health.

The Reasons We Don’t “Exercise”

I’ve used all of these over the years, so if they sound familiar, you’re not alone:

  • Gym memberships are expensive (and possibly still closed).
  • I’m not seeing changes I expected to my body.
  • I don’t know “the right way” to exercise. I don’t have the right shoes.
  • I’m too busy and stressed out.
  • It’s too cold/hot.

Add in family responsibilities and any physical limitations and the list seems endless.

Revving Back Up: Let’s Ask A Pro

I decided to call on an internationally respected colleague, Chris Rosenbloom, nutrition professor emerita at Georgia State University, and author of Food & Fitness After 50 about ways to encourage us to be more active.
Dr. Rosenbloom knows the benefits of better fitness, but says communicating it well is key. “When we talk about ‘exercise’, some people are turned off but when put it in terms of ‘activity’, it can be more palatable.”

Rosenbloom also has the same feelings about “exercise” as everyone else. “I know for me, when I use an exercise bike in the gym I can’t wait for the timer to go off and be done with it, but when I ride my bike outside I can go forever.” Rosenbloom encourages everyone to do what they like to do. “Dancing, gardening, walking the dog, riding bikes…all of those are more fun than an hour of high intensity exercise in a gym.”

If you’re more home-based now, she advises checking into some great sites for online fitness classes. Among her favorites are FitnessBlender.com (totally free!) and, for older folks, Silver Sneakers (often free with Medicare plans).

The Value to YOU

Even a little strength training makes everyday tasks SO much easier!

 

It’s OK to make all the health benefits of activity secondary: focus on fitness that’s meaningful to you. Rosenbloom calls this “functional fitness” – having the ability to do things you like to do without being hindered by fatigue from weaker muscles. She’s encourages at least some strength training. “You can see the results very quickly…admire that bicep and it can keep you motivated to continue to lift weights!” Lugging those groceries gets easier, too.

“Sometimes it is hard to get to an exercise class, take that walk, or turn on the video,” Rosenbloom said, but keep your eye on the payoff. “I’ve never, ever said to myself, ‘Wow, I’m sorry I worked out.’” Instead, she gets a lift from a sense of accomplishment, “and that makes me feel good,” she noted.

Rosenbloom is spot-on – I’m always happier afterwards. My own motivation to be active daily is two-fold: it busts stress and really lifts my mood. If I don’t have time for the full exercise routine, then I just do what I have time for.

“Activity snacks”

Being active doesn’t have to be a huge time commitment to bring big bennies, Rosenbloom says. “Be active in 10-minute increments throughout the day.” Tied to your computer all day? She favors “activity snacks.” “Take 5 or 10 minutes every hour to do easy things like walk up and down the stairs, use therabands for bicep curls, do some walking lunges, or simply stretch in a forward fold.

I like this. It’s not just “being active” but also “less sedentary”. Doing those little things during the day also helps prevent muscle stiffness.

Taking a “Polypill”?

Yes, daily, or as often as you can.  Exercise is not only medicine, it’s a medication that has innumerable benefits, what Rosenbloom calls a “polypill”.  “It has many benefits that no prescription medicine can match,” she says, including physically, mentally, and even socially. “Activity helps in so many ways.”

This post dedicated to Diane Likas Ayoob, January 5, 1928 – September 21, 2020, who firmly believed in the polypill of physical activity.

COVID-19 Got You Depressed? Could Probiotics Help?

Whether COVID-19 has you sheltering-in-place, quarantining, or just frustrated by not being able to have your usual life, lots of people seem a little down in the dumps, grumpy, and yes,  even “depressed”.  The “life sucks now” feelings are real, but different from true clinical depression, which can happen for no observable reason. 

Could “Bacteria” Improve Mood?

The right kind of bacteria – probiotics – just might help truly depressed people, even those who on antidepressant medication.  This just-published study reviewed clinical research on the impact probiotic supplements had on people formally diagnosed with clinical depression.  

Probiotics are what give Greek (& regular) yogurt that tangy taste. 

Probiotics are live healthy bacteria, found in cultured foods like yogurt, kimchi, and kefir.  These are different from PRE-biotics, which are various types of dietary fiber found in fruits, vegetables, grains, nuts, and beans.  Prebiotic fiber feeds the growth of probiotic bacteria in the gut.  

What The Results Showed

In the 7 studies that met the criteria for inclusion in the review, all found that probiotic supplementation “demonstrated a significant, quantitatively evident, decrease/improvement of symptoms and/or biochemically relevant measures of anxiety and/or depression for probiotic or combined prebiotic– probiotic use.”  Whether the studies used one strain of probiotics or multiple strains, the results showed improvement in reducing depression symptoms. 

Moreover, in one of the studies that also measured “quality of life”, it increased with supplementation but returned to baseline 8 weeks after the supplementation stopped.

Why Probiotics Helped

If something works, I always want to know WHY, and this paper suggests a mechanism for how probiotics might help depression.

The gut is known to be the center of our immune system, and when probiotics have been found to be useful, as they have with conditions like ulcerative colitis, it’s often because of their ability to reduce inflammation by suppressing the production of some annoying substances, called “cytokines”. 

The gut also is known to connect with the brain via the “gut-brain axis”, part of the central nervous system, so “food and mood”, or the notion that what’s happening in one’s GI tract could impact one’s emotional state has weight behind it.

The “Fine Print” 

It would be great to learn that just by having some yogurt, your mood would soar, but alas, reality must be acknowledged.  These studies looked at persons with diagnosed, measurable depression.  Those who got the probiotic supplements seemed to become less depressed, but those supplements contained higher doses of probiotics than you’d get from a cup of yogurt. 

Tempeh is made from fermented soybeans & contains lots of probiotics, plus protein & fiber!

Probiotic foods and supplements may not be useful mood-boosters if you’re just having a down day, but there are plenty of reasons to eat foods that naturally contain probiotic bacteria, like these:

  • Yogurt, including Greek yogurt
  • Kefir
  • Kombucha
  • Tempeh
  • Miso
  • Kimchi

Look for “Live and Active Cultures” on yogurt and kefir labels, to be sure they contain useful amounts of probiotics. 

“Live & active cultures” guarantees a high amount of probiotic bacteria.

These being dairy foods, they also have a whole lot of essential nutrients we need, especially calcium and potassium, to help fill gaps in most people’s diets.

The main ingredient in kimchi is cabbage, and it’s fermented soybeans in tempeh, so they both have PRE-biotic fiber, too.  Heads up, if you’re sodium-sensitive: Miso and Kimchi can be loaded with sodium.  

Is there a down side to getting probiotic bacteria?   So far, there doesn’t seem to be, especially if you get them from food.  Getting some probiotics daily though, gives you the most benefit, and the study found this as well: depression returned when the probiotics stopped. 

Even if probiotic foods don’t lift your mood, you can definitely feel good about adding some healthy foods to your eating style!

CHOCOHOLICS REJOICE! It’s Healthy(ish)! Here’s the Evidence!

I love chocolate, particularly dark chocolate.  I make no apologies, and the more I learn about chocolate and the cocoa bean, the more I realize no apologies are needed.  It’s no joke, cocoa has health benefits.  Indeed, if I ruled the world, dark chocolate would be a deductible medical expense. 

Perhaps the science isn’t quite sufficient to justify chocolate as a deductible medical expense, but it ain’t junk food either.  There’s enough info on Theobroma cacao to warrant treating it with respect.  

What Makes Chocolate “Healthy-ish”?

Chocolate is loaded with antioxidants.  It contains flavonoids, a group of phytochemicals with anti-inflammatory powers and benefits for the immune system.  There are several subgroups of flavonoids, such as anthocyanidins that give foods like Concord grapes and red cabbage their purple color, and flavones, found in celery and bell peppers.  It’s the  flavanols however, that give chocolate (and other foods like tea and blueberries) it’s healthful properties.

So, What’s Chocolate’s Impact On Health?

Improved blood flow: This review of the research studying the combination of eating cocoa flavanols and doing aerobic exercise improved cardiovascular risk factors and vascular function (read: improved blood flow).  Cocoa helps reduce blood pressure by relaxing the walls of the blood vessels, improving blood flow, not only to the heart, but also to the gray matter of the brain.  This doesn’t mean eating a candy bar will make you a genius, but there may be bennies from eating some dark chocolate regularly.

Cholesterol benefits: Cocoa consumption seems to raise the HDL cholesterol (the good form) and reduce the “LDL cholesterol” (the bad one you want less of).  It works best when your total cholesterol levels are high.

Reduces “oxidative stress”: In a just-published systematic review of 48 studies on cocoa, the researchers found that cocoa consumption “plays an important role in the human metabolic pathway through reducing oxidative stress.”  Oh, bring it on.  

What’s oxidative stress?  It’s caused by “free radicals”.  Free radicals in your body can “nick” or damage the cells in arterial walls, making it easy for plaques to adhere and build up, clogging arteries. Cocoa consumption seems to help prevent free radicals from forming.  Ever taste rancid oil or nuts?  You’re tasting “oxidized” food damaged by free radicals.

Adapted from Tuenter, et al.

In the Mood

In this review of studies that looked at chocolate, mood, and cognition, the authors developed a “mood pyramid”.  They placed more general mood benefits from the flavanols at the bottom, since these are benefits associated with flavanols in other foods as well.  Secondary mood benefits appear to come from the caffeine-theobromine combination in chocolate. 

More specific is a possible dopamine effect from a substance in chocolate called salsolinol.  This is emerging research, but the hypothesis is that salsolinol may play a role in the impact of chocolate on mood.  Just how much chocolate you’d need to eat is still unclear. 

The Fine Print

Yes, there is some.  Some of the research found benefits from low intakes of chocolate, as little as 7.5 grams.  Other studies used significantly more however, up to 100 grams a day and produced good results.  (How do I sign up?)

These cocoa flavanols are NOT present in all chocolate foods.  Read labels: if it says, “cocoa processed with alkali” you can pretty much forget getting any flavanols.  This form of cocoa is also known as “Dutch-processed”.  The process makes cocoa appear darker (see photo) and taste a tad less acidic but it blows the antioxidant content to smithereens.  Some chefs and bakers prefer this type of cocoa for recipes.  I do not.  Give me the lighter powder on the right.  I like my flavanols, thanks.

Chocolate isn’t calorie-free.  Solid bars have about 150-170 calories per ounce.  I keep it to a max of 2 ounces a day, but an ounce of good chocolate, at 170 calories, makes for a rich snack or even a lower-calorie dessert.  Fair enough.  Cocoa powder however, is low in calories and the most concentrated source of cocoa flavanols, so use it to make your own hot chocolate.  I sweeten with stevia or a no-cal sweetener to minimize added sugar calories, and often add some cinnamon or other spice (smoked paprika is a favorite of mine).   

Get a high — in percent cocoa.  The most benefits are seen with chocolate that has at least 70% cocoa solids.  Not a problem for me, but it takes getting used to.  Go gradually!

No, I Don’t Care If Kids Eat Candy on Halloween

Letting kids loose on Halloween doesn’t have to mean all hell breaks loose afterwards.

Halloween is a once-a-year occasion.  I’m focused on what kids do the other 364 days of the year.  If they’re eating well on those other days, then there’s absolutely nothing wrong with letting them enjoy Halloween!

Every year around this time I get a ton of questions from parents about what to “allow” kids to eat on Halloween, how much candy to let them collect and keep, and what kind of candy is “best” to give out on Halloween.

Sugar Shakedown

No, sugar won’t make them hyperactive.  They might have a burst of energy, but the whole “sugar-gives-them-a-buzz” thing has been completely dismissed.  The rigorous science just doesn’t show anything.  Actually, a high-sugar snack has even been shown to help keep you on-task.  I’m NOT encouraging more sugar.  It’s not angel food, but not devil’s food, and it’s not a new food, either.  Just keep it real.

Your Homework: Laying the Groundwork

Planning ahead is everything here.  Kids (and adults) don’t like sudden, unexpected changes, especially to their eating habits.  Here are a few tips to help things go smoothly on the big day:

  • Be real about how much you buy. You know how many kids typically visit you, so get enough for THEM.  Buy with an eye to having as few leftovers as possible.
  • If you’ve already bought the candy, let the kids know ahead of time about the plan for leftovers: share with neighbors, you’re bringing them into work for co-workers, making up a bag for a child who couldn’t Trick-or-Treat (a nice thing to do for a child who is ill), and so on.
  • Buy only the smallest portions of candy! No full-sized bars, just the little mini things.  That way even with leftover stuff, the treat is reduced to a bite, not a commitment.

Tricks Before Treats

The idea to reinforce to kids is to “take care of business” first, by spending calories on the foods we need.  If there’s anything left, have a treat and enjoy it.  That’s the eating style I want kids to have 364 days a year.

  • Keep only the “top 10%” – their absolute fave candies. The rest gets donated or shared with others.  Quickly – like, get it out of the house the next day. (Note: For me, candy corn got tossed first thing!  Never could stand the stuff, even as a kid!)
  • Make it social! Halloween is also about dressing up, hanging with friends, and walking the neighborhood. This applies to all holidays or occasions.  It helps them see food and eating in perspective.
  • Never make candy a “reward” for good behavior (save that for training the dog), but see it as a teachable moment. Candy is an “extra”, it provides mostly empty “discretionary calories” so treat it that way.  It’s something to have in a small amount AFTER the rest of needs are met.

“What Does the Research Say”?

Yes, someone actually did a study on whether seeing Michelle Obama’s face (versus other political women’s faces) might influence them to choose a box of raisins or a small name-brand candy bar.  Connecticut home.  Three years of Halloween.  Kids were directed randomly to either of two sides of the porch – one with Michelle Obama’s pic, the other side pics of other political women (Hillary, Ann Romney, or no photo) and asked if they wanted a box of raisins or a small candy bar.  Authors described the community as politically liberal.

Result: The kids on the Obama side were 19% more likely to choose the box of raisins than the candy.

Great, but there was no info on whether the kids then ATE the fruit.  After all, no food can be nutritious until you EAT it.  Ironically, the box of raisins is about the same calories as the small candy.

Cut-To-The-Chase-Nutrition Take-Away

Halloween can be a blast.  It should be.  It’s also over in a day so enjoy it fully.  On other days, it’s about getting what you need first: the fruits, veggies, whole grains and dairy foods FIRST.  Be active, FIRST.  Those are the tricks, before the treats.

Wanna “Meat Up”? New Research Says Risks Are Lower Than Thought

Well, the meat wars have resumed. When new research suggests that the advice people have heard to eat less meat might have been based on weak evidence, and the New York Times sees fit to make it front page news, you know it’ll be one of the most talked about topics in the food and nutrition world. Pass the popcorn.

It was bound to happen: red meat has been touted as unhealthy, processed meat even worse. Yet lean meat is nutrient-rich and can have a place in your diet if you so desire it.  Several new studies, all published September 30 in the Annals of Internal Medicine, concluded the following:

• “The absolute effects of red and processed meat consumption on cancer mortality and incidence are very small, and the evidence is low to very low”.

• “Low- or very-low-certainty evidence suggests that dietary patterns with less red and processed meat intake may result in very small reductions in adverse cardiometabolic and cancer outcomes.”

• The panel conducting the research made a “weak recommendation” for consumers to continue their consumption of meat, noting that “the desirable effects (a potential lowered risk for cancer and cardiometabolic outcomes) associated with reducing meat consumption probably do not outweigh the undesirable effects (impact on quality of life, burden of modifying cultural and personal meal preparation and eating habits).”

• Regarding reduction of cancer and heart-related diseases, they found “Low- or very-low-certainty evidence suggests that dietary patterns with less red and processed meat intake may result in very small reductions in adverse cardiometabolic and cancer outcomes.”

• Omnivores happen to like eating meat and were averse to changing, even “when faced with potentially undesirable health effects.”

Meat Wars & Culture Wars

None of these latest studies addressed animal welfare or environmental impact of meat consumption. The EAT-Lancet report did however, and looked at an omnivore diet from an environmental and sustainability standpoint, namely that eating meat and all animal foods was unsustainable for the planet. This could be perceived as strategic, as it makes the consumption of animal foods an issue for virtually everyone, not just people interested in health. This “bad-for-the-planet” approach strives to change global dietary culture, almost excluding the consumption of meat and most animal foods.

One thing seldom addressed: meat and animal foods as part of food culture:

• Are the Spanish going to forego their famous Iberian ham, which goes into so many dishes, even diced and added to sautéed vegetables?

• Are the Italians ready to give up their prosciutto and melon?

• Is it realistic to expect cultures to bid farewell to Peking duck? Shish-kebob? Sauerbraten? Sega Wat (Ethiopian beef stew)?  

• Would the French give up omelets?  Cheese, yogurt and milk?

These foods are rooted in centuries of culture and history the world over. As for eating meat, people happen to like it. One of the studies in the Annals concluded that omnivores happen to like eating meat and were averse to changing, even “when faced with potentially undesirable health effects.”

But Are YOU overeating Beef?

Right now, average daily intake of beef is about 2 ounces, or 14 ounces per week. If you keep it to that, and choose the many lean cuts that are available now, you’re probably fine and are also getting the best of the nutrition that beef has to offer. Dairy foods are even more efficiently produced, provide excellent nutrition, and are under-consumed (and underappreciated, IMHO). Make sure to include these, especially low-fat yogurt and milk, if you eat animal foods.

Omnivores can – and should – maintain a plant-based diet, so aim for plenty of fruits, veggies, and beans.

As for the planet, all agriculture in the US generates about 9% of the country’s greenhouse gas, with beef taking up just about 2%. Beef production in this country is amazingly efficient, far more so than in the rest of the world. Indeed, one criticism – a fair one – of the EAT-Lancet report is that it lumped all agriculture together, not focusing on the efficient production of animal foods in more developed countries.

Given the difficulty of changing global food cultures, it may be more useful to help improve the efficiency of global animal agriculture to the level present in developed countries.

Veto The Keto! Here’s Why It ISN’T A Cure-All For Diabetes

“What If They Cured Diabetes And No One Noticed?” is a headline that’s total clickbait. It was published here and well-written by Piper Steele. The purported “cure”? Keto.

“Cure” is a touchy word. Before using it, you’d really better have all your ducks in a row. (Ducks are carb-free, by the way.) “Cure” implies it works and should be the premier treatment for a disease or condition, in this case, diabetes. We speak here of type-2 diabetes, the kind that is usually “acquired”, and that’s by far, the most common in adults.

Keto Isn’t Just “Low-carb”

It takes other low-carb diets like Atkins and “kicks it up a notch”. It’s a high fat diet, to the tune of at least 70% of the calories (often even more) provided by various fat sources. Even protein is limited, so it’s more than just eating high-fat foods like cheese and bacon. Your veggies (mostly green leafies, and even those aren’t unlimited) need added oils and butter.

The premise: the body has difficulty dealing with carbohydrates, so you give it fewer carbs to deal with, substituting fat. The fat is metabolized by the body into “ketones” which can also be used for fuel, even by the brain, even though the body would prefer to use glucose.

Does It “Cure” Diabetes?

According to Steele, it’s a no-brainer. The study she points to makes it look promising. Two groups: the “continuous care intervention” group on the keto diet, and the “usual care” group that just received routine counseling at visits of unspecified frequency. The latter functioned more as a control group.

SURPRISE! The keto group lost more weight and many more came off their insulin meds, compared to the control group. The study went on for two years and the results were sustained.

The Catch – And there Is One

The keto group also received different non-diet intervention. Indeed, they were treated to the following:

• And online app, giving access to “telemedicine communication, online resources and biomarker tracking tools.” The participants were able to upload their body weight, blood glucose levels, and ketone levels.

• The uploaded information allowed for daily feedback and individual instruction to participants. This is intensive intervention, well above that provided to the control group.

• The app facilitated remote communication with a health coach and medical provider, who also recommended modification to diabetic and hypertensive medications.

• Education modules for achieving and maintaining a state of ketosis.

• Clinic-based group meetings, weekly for 3 months, then bi-weekly, then monthly, then quarterly.

• Online peer social support with fellow participants.

If the “usual care” group was also treated to the same, would the outcome have been different? That is, are the outcomes strictly the result of the diet or did the continuous care intervention play a role? My guess is the latter is true, or else why use it for this group only?

Are we seeing the results of weight loss alone? If the control group had experienced similar weight loss, would the metabolic results have been similar?

Are Carbs the real “Devil’s Food?”

It’s ridiculous to place all carbs into one bucket. Dismissing foods such as beans, whole grains, and high-fiber vegetables and fruits is to dismiss some of the healthiest foods known. Their health benefits are indisputable. A diet that lacks these nutrient-rich, anti-inflammatory foods has to be viewed cautiously, especially if adopted on a permanent basis.

Steele doesn’t think caution is warranted here. She writes, “The publication of this study should be enough for doctors and the medical associations to recommend a ketogenic diet for diabetics.” Huh? A responsible practitioner would NEVER recommend a permanent dietary change on the basis of a single study.  Indeed, this recent study advises caution, when “enthusiasm outpaces evidence,” especially when a true keto diet may have long-term side effects, given the avoidance of so many nutrient-rich foods.  

Cut-To-The-Chase-Nutrition Advice

A keto diet for treating diabetics might be one way up the mountain, but it’s not the only way and it may still not be the best way. A more varied, nutritionally rich eating style, low in “empty-calorie” carbs, that includes daily physical activity consistent with one’s abilities – an absolute must in my book.  And get support, ideally from a certified diabetes educator, or “C.D.E.“, trained specifically to help diabetics. You may find such efforts are more sustainable (and enjoyable!) over the long-term – and with excellent results.  

I’ve seen people get off insulin after over two decades of daily injections, just by losing enough weight on a balanced, low-calorie diet with regular exercise.   

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.

Like Diversity? So Does Your Gut: FOUR Eating Styles to Help Out

I can’t count the times people have said to me, “this is the way everyone should be eating.” RIDICULOUS. The world is round. And there IS more than one eating style that’s good for your health.

This study looked at four eating styles known for their healthfulness: 

• The Healthy Eating Index 2010 (HEI 2010), is based on the 2010 US Dietary Guidelines for Americans. It focuses on fruits, veggies, legumes, whole grains, low-fat dairy foods and lean meats and other proteins.

This image has an empty alt attribute; its file name is MED-diet-ideal.jpg
“Alternative” Mediterranean diet:
Less credit for red & processed meat

• The Alternative Healthy Eating Index (aHEI), based on HEI-2010 but de-emphasizes meat and dairy foods.

• The Alternative Mediterranean Diet (aMED) focuses specifically on markers of inflammation and cardiovascular health. Its score does not consider dairy intake or potatoes and gives credit for less consumption of red and processed meats.

• Dietary Approaches to Stop Hypertension (DASH diet), developed to reduce hypertension with diet, it encourages plenty of fruits, vegetables and low-fat/fat-free dairy foods but nothing is excluded.

The researchers wanted to compare each eating style’s impact on the gut and the diversity of healthy gut bacteria.

Drum Roll…The Results Showed…

If you REALLY build it,
the good gut bugs will come

ALL four eating styles benefitted the gut – and in mostly similar ways The authors found the results showed “strikingly consistent patterns.”  People with higher scores on all four eating styles had less “bad” bacteria – the ones associated with inflammatory diseases like irritable bowel syndrome, diabetes, even colon cancer. 

Interestingly, the HEI-2010 – the more moderate of the eating styles studied and the one based on the 2010 Dietary Guidelines, was the only one of the four eating styles associated with lower amounts of harmful Escherichia-Shigella and Enterobacter, two species associated with diet-related conditions linked to systemic inflammation.

Higher scores on all the eating indices were also associated with a greater richness of beneficial fiber-fermenting bacteria in the gut.

For gut-geeks like myself, this study is incredibly interesting.  To consumers and “normal” people, here’s what it really means:

  • A healthy diet rules.  But not a single healthy diet.
  • There are at least four ways up the mountain to a healthy eating style.
  • It’s more about what you include than what you exclude!  Fruits, vegetables, beans and whole grains help grow the most beneficial bacteria, because they’re loaded with fermentable fiber. 

Why I like this study

  • It looks at diverse eating styles and their impact on gut diversity.  That is, how these eating styles positively or negatively impact our gut bacteria. 
  • The study used subjects with diverse ethnicities: Japanese American, Latino, Native Hawaiian, and African American, who were part of the Multiethnic Cohort Study
  • These were also senior citizens, average age: 69 years.

The study was long: subjects were enrolled between 1993-1996 and their gut bacteria were studied as of 2013-2015.

Study Weaknesses: 

All studies have limitations, but this one has fewer than most. Most observational studies like this look only at initial dietary intake and then analyze outcomes a decade or more later, not knowing if diets changed during the interim.  This study took dietary intake at the enrollment and also during a return visit in 2013-2015, at which time the subjecfts also provided a stool sample.

Cut-To-The-Chase Recommendations

The least “restrictive” of these four eating styles is a split between DASH and the regular HEI.  They don’t exclude anything, emphasize balance and are probably the easiest to follow. Best of all, they produce good gut health. 

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!