Links: Processed Food and Disease

One of the other blogs I follow is the Angry Chef. I aspire to be as entertaining as that blog. But also to be seen as serious – which I think are mutually exclusive goals.

Recently posted was a two-parter about “Ultra-Processed Foods” and the dietary guidelines of Brazil and the World Health Organization.

Rise of the Ultra Foods, part 1 and part 2.

I encourage you to read them. But the short version is that the new nutrition guidelines of Brazil have a lot of positive characteristics about them. They encourage enjoying food, acknowledge the cultural and familial components of eating and meal times. These are good things. But they also go off on the concept of ultra-processed foods. Which is never defined. And the available evidence just doesn’t support the idea that UPF are inherently problematic

There exists this anti-chemical strain of though that modern processing of food is intrinsically bad. Because chemicals or something. That somehow the rise of lifestyle diseases like cardiovascular disease and diabetes are because of the chemicals and not calories and poverty.

There is already an enormous body of evidence that calories consumed are the primary driver of increased lifestyle diseases. And that the biggest confounder in this type of research is the known effect of poverty on health outcomes as well as on food choices/availability.

All of the various safety studies of chemicals used in processing food fail to show any evidence of harm.

Why then should we consider the idea that the “real” problem is processed foods? Well, as The Angry Chef points out, at least one researcher is actually performing a study to address this question. As opposed to just blaming the chemicals. It’s a randomized controlled study comparing matched diets of processed and not processed foods. Here’s the study at ClinicalTrials.gov.

I await the results of this study. And will update my understanding of the topic based on the results if they show that I’ve been wrong so far.

No. I Prefer Food. Not Protein Powder.

I asked a colleague if she had any suggestions for topics. She suggested protein powders.

I said, “ugh, no. I prefer food.”

So she suggested I explain why. And fine, I will.

Protein Powder for Strength Gains

The basic concept behind protein powder and supplements is that they “help” or are even necessary for strength training. Because you need sooo much protein (I resisted the urge to insert an eyeroll emoji). I saw some pretty big numbers for protein requirements for strength training, as big as 400g per day! And if you really believed those numbers then sure, protein powder would help you hit that number.

To the research!

How much protein do people need? The USDA gives a value of 0.8 g/kg/day. This number is set to be sufficient for 97.5% of the population. Let’s assume that people who are serious about strength training make-up the 2.5% who need more (not actually a reasonable assumption, but let’s pretend). But remember that plenty of folks actually need less than the RDA.

The American College of Sports Medicine (ASCM) recommends (PDF) 1.2-1.7 g/kg/day for strength training. With a floor of 1.5 for novice lifters recommended by the National Strength & Conditioning Association (NSCA).

Published research from the National Health and Nutrition Examination Survey (NHANES) shows that most people are getting enough protein. The average American is actually already getting enough protein to be engaged in serious strength training without having to change their diet or add protein powder/supplements.

The exceptions found in the NHANES study were that a small but significant number of adolescent and elderly women who were not getting enough protein. That’s it.

If most people are getting enough without doing anything extra then why is there such a business in protein powder sales?

Protein Powder is Easy

If you’re worried that you’re not getting the gains you want then protein powder provides an easy route to thinking you’ve solved the problem. Just buy something and you’re all set! You don’t have to actually analyze your diet, activity, form or program. Just buy something.

But protein consumption doesn’t trigger muscle building. If I deliver a bunch of construction materials to a local builder they aren’t going to just build a building because I provided the supplies. And you won’t build muscle just from eating protein. You need to do the strength training. You need to have a sensible program, with proper rest periods and enough work etc.

From looking around the gym it seems like a lot of the folks who are consuming the protein powder are already doing a reasonable program and are probably doing just fine with building muscle. In which case the powder is just a placebo. It does nothing but helps them feel like their approach is great. That feeling that they are doing all the right things probably helps with motivation and effort – which improves the outcomes. But the powder still isn’t actually helping.

But why not use it, just in case?

Because it’s false.

Because it’s a waste of time.

Because it’s a waste of money.

Because it causes some people digestive problems. And telling those people they “need” to do it is a problem.

Because facts matter.

But maybe I’m not getting enough protein.

Then use MyFitnessPal and check. The app is free, unlike the powder. Or any other fitness and nutrition app – I can personally vouch for liking this app and finding it useful and having heard almost universally positive reviews.

Odds are you are getting enough protein, though.

Don’t use the target number the app generates. Use the math above.

Vegetarians and Vegans

Folks with these types of diets are more likely to be not getting enough protein. For meat eaters it’s pretty easy to get enough protein. For non-meat eaters is frequently takes a bit more effort and planning. But it’s still perfectly possible to do so just using food. And they need to make sure they’re protein sources are complete, which most vegetarians and vegans seem to already be aware of. Vegetables and fruits do have protein and a quick Google search brings up plenty of lists of high protein plant foods.

Conclusion

Protein powder is unnecessary and if you really are having trouble getting enough with the foods you are eating then I encourage you to first try upping your intake of protein rich foods to hit the goal. In particular vegetables and fruits. The real reason for preferring food though is the benefits of the micronutrients and fiber contained in the food. Both of which are good for health.

Bibliography

Fulgoni, V. L. (2008). Current protein intake in America: analysis of the National Health and Nutrition Examination Survey, 2003–2004. The American Journal of Clinical Nutrition, 87(5), 1554S-1557S. https://doi.org/10.1093/ajcn/87.5.1554S

protein-intake-for-optimal-muscle-maintenance.pdf. (n.d.). Retrieved from https://www.acsm.org/docs/default-source/brochures/protein-intake-for-optimal-muscle-maintenance.pdf

Szedlak, C., & Robins, A. (2012). Protein Requirements for Strength Training. Strength & Conditioning Journal, 34(5), 85. https://doi.org/10.1519/SSC.0b013e31826dc3c4

Appendix: Looking at Online Searches

I expected to find that most of the links I clicked would overestimate protein needs. And perhaps my results are associated with my search history and particular search terms, but I was pleasantly surprised to not find that. In fact WebMD even low-balled the protein estimate (and didn’t even say I had cancer!). Many of the sources I found just quoted the USDA and/or ACSM recommended numbers, which is encouraging.

But the hits weren’t all good. Strength training oriented sites (like BodyBuilding.com) tended to recommend higher amounts than actually needed. With the International Sport Sciences Association (ISSA) recommending 2-3 g/kg per day. Which is almost double the actual need. The reason I highlight this is the fact that ISSA does personal trainer certifications. Which shows that the cert isn’t necessarily a reliable indicator of knowledge. (I’ll also point out that they provide references for the rest of the info on that ‘myths’ page but have no reference for this recommendation.)

In general the hits I got were for sites emphasizing the need to get enough protein and generally taking the attitude that you need more or need to make sure you’re getting enough. But the reality is that most people already are. So the emphasis is all out of whack.

Oh no, Carbs

(Updated for clarity based on Facebook feedback)

There is a lot of hullabaloo about carbs in nutrition circles, especially in clean eating types of diets. Especially if those carbs are from sugar. And extra especially if that sugar is high-fructose corn syrup. But the reality is that for weight loss and general health goals* carbs are not, in and of themselves, a big deal.

The science is clear that low carb and low fat diets produce the same long term outcomes when measuring weight loss. These two links do a good job of addressing this:

Low Fat vs Low Carb – No Difference

Sorry, but Low Carb and Low Fat Diets Get Pretty Much the Same Results

This is the study being discussed: Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion

So, rather than repeat that content, I want to address why this is the more reliable research. Because, of course, there will be replies about research showing that low carb works better.

To analyze diet science we need to look at a couple of factors:

Time

How long was the study? Any study of just a few months can show weight loss. The reality is that if you can’t show weight loss in a 12-16 week study then you are just bad at your job. Any possible diet strategy can show weight loss in this time frame. Such results are meaningless to this conversation.

The health outcomes that are important for this kind of research are ones that evolve over the course of decades. Some of the landmark studies in this field have been running longer than most of my readers have been alive.

So let’s be clear. 6 months or less is short. Too short for me to care about. Too short to inform human interventions. 1 year is the bare minimum to matter.

But why are studies like this even done if they are not meaningful? Well, they are preliminary research. Preliminary research plays an important role in the process of science but they are clearly not the end point. News stories about them are usually counterproductive and they shouldn’t be used to guide interventions in humans.

A preliminary study might just be used to determine in an approach is feasible, or to determine dosing, safety and similar characteristics. But they don’t tell us if an intervention works.

There is, of course, another more cynical reason for short-term diet studies: using them to sell stuff. Since positive results are just about guaranteed in a short-term study they create an easy way to apply the “clinically proven” sticker to your diet and resist FTC objections.

Petri Dishes and Animals

A lot of the objection to sugar and carbs is the result of a belief that calories from those sources are particularly bad for human health compared to protein or (good) fats. However, this comes pretty much entirely from research in petri dishes or animal studies.

Again this is another example of over-interpreting preliminary research. The results of applying a substance directly to a cell in a petri dish cannot be generalized to the whole human body. There are so many other factors at play in understanding how a substance will affect clinical outcomes. How is it digested? How does it interact with other substances in the body? How do homeostatic mechanisms operate to limit any changes? Etc.

And while animal research is a useful step in health research for humans we are, forgive me for stating the obvious, not mice. Or rats. Or guinea pigs. Or regular pigs. Or even monkeys. The question of what animal are we most like, a mouse or a rat, suffers from the fact that it depends on what part of the human system you are studying. And even then, we cannot just blithely assume that any animal results will apply to humans.

Biomarkers!

An extension of the last point is research into biomarkers. In short biomarkers are substances found with chemistry tests that are thought to indicate a particular (disease) state. Some are well validated, like troponin for a heart attack, others are not, like telomere length for aging. It is important to understand that a biomarker is correlated to the state of the body and is not a direct measure of the state of interest. They can be suggestive, but they don’t always predict actual health outcomes.

One of the most commonly misused biomarkers are any markers for inflammation. The assumption being that such markers indicate that something Bad is happening. So if eating sugar boosts the levels of some inflammatory biomarkers it must be terrible for you! But the research into actual health outcomes – death, disability etc. – doesn’t bear this out. Sure, eating too many calories leads to problems but the source of those calories doesn’t actually predict outcomes.

Conclusion

Yes it’s calories. Clearly though, understanding that is not the hard part. Behavior change is the hard part. Establishing new eating patterns and habits is the hard part. Fad diets that focus on one, or a few, components like sugar or carbs attempt to create the impression that it’s what you eat, not how much, that really matters. And it’s just not true.

* General health goals = is the phrase I’m using to mean premature death and disability/loss of function due to lifestyle modifiable diseases and risk.

“The Dirty Dozen” – Brief Response to News

(We’ll see if this becomes a regular thing for this blog)

The Environmental Working Group released its annual Dirty Dozen list again. They are a non-scientific group of scaremongers. This list of theirs epitomizes this fact. They take the publicly available USDA data on pesticide residue and then report characteristics like the number of different residues found and the amount of those residues. Then they rank grocery store produce based on these numbers.

What they never do is compare those values to the actual amounts necessary to harm a person. Because if they did, they’d look silly. For instance you’d have to eat 10 kilograms a day of strawberries just to reach the low end of minimum appreciable risk (RfD). (I got the math from here.)

The techniques used to detect pesticide residue are incredibly sensitive. Far more sensitive than necessary for human health. The tiniest amounts can be detected. But those tiny amounts need to be compared to results from toxicology studies to have any meaning.

The Environmental Working Group also asserts, without evidence, that a wider variety of pesticides on a plant is somehow intrinsically more dangerous than just one pesticide. This statement might be true – different chemicals may interact to be more dangerous than toxicology research on a single chemical indicates. But no evidence suggests that it is. And human health is carefully tracked by the CDC.

And even if more chemicals on the plant is more dangerous they fail to take into account the fact that the plant already has thousands of different chemicals inside. At at much higher concentrations than the pesticides. And those plant chemicals include substances evolved to kill other life forms to protect the plant i.e. pesticides. There is more of those pesticides than the ones applied by farmers.

In short, their list has nothing to do with known toxicology information. It is just an attempt to scare people. And CNN and other media swallowed it whole.