The Fat Nutritionist - Nutrition at Every Size

When eating falls apart.

By Michelle | Published: April 10, 2012

I’ve been kind of allergic to all things marketing lately, so I didn’t really get the word out about my spring groups as loudly as I could have.

So consider this the post that makes up for my oversight – the groups are starting this week and next, and you should sign up for them.

[/end marketing spiel]

Every round of groups, there is something that I want to work on for myself. For the past three months, it was eating regular meals at regular times – something that I struggle with given my flexible and unpredictable schedule, and the fact that I eat with people for a living.

Early in the year, thanks to a post-traveling readjustment crisis, I was pretty awful at feeding myself for a while. I was scrounging up the bare minimum required for survival at random times of the day, and not giving any thought whatsoever to frivolities like “vegetables” or “food groups” or “not feeling like total crap.”

And given that I deal with depression on a semi-regular basis, this is something that comes up cyclically – one of the first things to go with my mood is eating well.

For me, eating well looks like this: I eat a breakfast that contains multiple food groups soon after waking up, and then about four hours later (five if I’m drinking coffee through the morning), I eat a lunch that also contains multiple food groups. Then around three hours later, I have a snack, and then dinner in another three or four hours. Dinner contains multiple food groups, and possibly even more than one dish. In another three or four hours, I will have dessert or a snack.

In the course of all this, I end up eating fat, protein, and carbohydrate at each meal, and I make an effort to offer myself roughly five fruits and veggies throughout the day, as well as a couple servings of meat/nuts/legumes.

Everything else kind of takes care of itself. I remind myself that I do not need to clean my plate or finish my vegetables if I don’t want, but that I have permission to get seconds or thirds if I do want.

So that is what I focused on for the past three months, while I worked with my group on eating competence.

At first, I just made a deal with myself that I would eat food before drinking coffee in the morning, because I noticed that if I drank coffee first, it killed my appetite, but that the lack of breakfast left me lethargic and tired for the rest of the day.

That was my first step – food before coffee, and preferably soon after getting up.

This probably took a week or two to get going. Then I focused on having lunch at a reasonable time each day – I eventually settled on 1pm because it fit into my work schedule, and because it was long enough after breakfast that I would actually feel hungry, but not starving. If I tried eating at noon, it felt like I was just forcing it.

After practising for another week or two, I started getting predictably hungry right around 1pm each day. Sometimes 12:45 and sometimes 1:15, but relatively consistent. And on the days when something came up and I didn’t get around to lunch until 2pm, I was very hungry but not desperate.

The last, and most difficult, was dinner. Dinner requires cooking. Cooking requires planning, and when I’m feeling gloomy, planning is my least favourite thing to do. But after a few weeks of eating frozen lasagna and other no-plan delights, I was tired of it, and willing to put up with some amount of planning to get a more decent variety of food.

I hauled out my meal-planning sheet (yes, I actually have one), put it in a plastic sheet protector and stuck it to the fridge, next to a dry-erase marker. Then I started by writing down three easy dinners to make in the coming week, and I filled in the rest of the nights with leftovers or more frozen lasagna.

It began with a few of my no-brainer favourites – spaghetti, clam linguine, pork chops. Then the next week, I added a day for beans (usually Sunday, to accommodate slow cooking) and a pizza night on Fridays (because it’s Friday, and we always want pizza on Friday, so I may as well plan for it.) The bean recipes usually made a ton of leftovers, so I began freezing them in individual containers, and then I also had an easy lunch.

Eventually, after a few more weeks, I worked my way up to planning 5-7 meals per week. Sometimes the plan literally is “frozen pizza and pre-prepared salad” because, goddammit, it still counts as a meal. It’s got food groups and everything! Plus if I don’t buy a frozen pizza, I will just order one at some point anyway. There’s no point in fighting it.

For a while, the plan was almost the same rotation every week (spaghetti on Tuesday, linguine on Thursday, pork chops on Monday, chicken on Wednesday, etc.), and then I got bored of that, too.

The past couple of weeks, I’ve been experimenting more. I made some marinated salmon, tried a new green bean recipe (hint: Parmesan cheese), and last night we had Moroccan-style pork tenderloin. One weekend, I made a very labour-intensive stir-fry that I hadn’t made in years.

It’s been nice, and along the way I’ve developed a bunch of short-cuts and sanity-saving techniques to help myself along. One of them is that I rarely cook a recipe all in one session – I always do some pre-prep in the morning so that the burden doesn’t all come crashing down at 6pm. For the stir-fry, I actually made the sauce the night before, then chopped up all the veggies in the morning, and then just assembled it and cooked the noodles in the evening.

Because I’m terrible about doing too much at once, and then never wanting to do it again, this is essential for me. I also started making my meal plan and grocery list the day before I go shopping, because I hate doing them both on one day.

Overall, I’d call this past three months of putting my eating back in place a success. Right now, I’m operating at a pretty high level – although we still have frozen pizza night on Friday like clockwork, and I intersperse a bunch of easier recipes along with one or two more complicated ones during the week.

But here’s the thing: it won’t always be this way.

Something will happen to mess up my routine again, and it will all fall apart. That’s life. Once I get used to whatever has changed I can work up, step-by-step, from the bottom of the pyramid again – because I know how. And I also know that periods of just getting by, and just doing the bare minimum with eating, are survivable. They’re not going to hurt me, and they don’t say anything about my worth as a human being, or my overall capacity to feed myself well.

I used my boredom with repetition to help push me along, because if I’d set out with a goal of “cook fancy new recipes all week” I would still be eating frozen lasagna every day. I did it because I wanted to, and because it felt good.

Eating falls apart for everyone, from time to time, but it doesn’t have to stay that way forever – and it won’t if you refuse to beat yourself up about it, and focus instead on doing what helps you to feel good.

Now I have to figure out what I’m going to work on for the spring groups. I’ll let you know what happens.

If you want to hear more about the groups, you can go here.

Have you been working on anything lately? Let’s hear it in comments.

Posted in eating | 59 Comments

Lesson Seven – Finding fullness.

By Michelle | Published: March 28, 2012

Close on the heels of checking in, but also permission, comes the sometimes-tricky issue of figuring out when you are full.

If you have been eating regular meals at regular times for a while, then chances are pretty good that you are developing regular and consistent hunger signals. This tends to happen when your body becomes accustomed to getting fed at particular times during the day, which actually makes responding to that hunger a lot more convenient, because it is predictable. I know I will be hungry around 1:00pm each day; therefore, I can plan to have food on hand before things get desperate.

In the past, I would have waited until I felt hungry before I even started thinking about what to eat, and then by the time the decision-making was finished, the food acquired and put together, I would probably be cranky and famished. Not a good way to go! So, eating at regular times for a while, even, at first, when when I am not hungry at those times, sets up the predictable-hunger system.

As a result, having predictable, moderate hunger signals seems to make it easier to figure out how full you are. After all, if you start eating in that nebulous state of not-quite-hungry, you’re probably only going to finish eating when you’re either not-quite-full, or else seriously-overfull. Neither of which are great options. We’re looking to establish a habit of both comfortable hunger and comfortable fullness.

Once you are coming to the table hungry, on a regular basis, and finding that table laden with enough tasty food, and giving yourself full permission to eat that food, then you are in a good position to start listening for the sounds of fullness.

I do this by checking in with myself when my plate is about 3/4 empty.

This does not mean I am necessarily going to stop eating or declare myself finished. A lot of the time, it might mean I actually need to get up and get seconds, because I’ve miscalculated how much food was there, or how hungry I was. The important part of this end-of-plate check-in time is permission.

Yes, that again – permission to still want the food, and permission to go and get more if I want it.

I find that it’s important to continue eating until my mouth, or my aesthetic hunger, is satisfied – not just my stomach. I have sometimes messed this up, and stopped eating when my stomach felt full, even if the food was still incredibly appealing to me. The result was simply that I was hungry again within the hour – not a tragedy, but not super-convenient, either. I need to know that I can eat enough to not feel hungry again for a few hours, because otherwise I will never stop thinking of food.

Different people choose to reach different levels of fullness, but almost everyone knows that feeling of being unpleasantly full, and almost no one wants to go there on a daily basis. There may be occasions, like holidays, where the discomfort is worth the experience, but who wants to put themselves into a state of pain regularly? Not me. But before “painfully full” there is a range of experiences of fullness, from neutral to kinda-full, to good-n-full, to really-full-but-not-in-pain-yet. And you get to decide which one you like, at every meal you eat.

This is a learning process, and one that will require you to make mistakes in choosing a level of fullness. You will sometimes leave the table under-full and be hungry again soon (but if you have a snack coming up, it won’t be a big deal.) You will sometimes leave the table feeling like you blew it, ate too much, and now will be uncomfortable for a while until it subsides – but it will subside, and you may find yourself naturally wanting to eat less at your next meal or snack. This is how self-regulation of food intake works – you take in feedback, and then you respond to that feedback in the way that helps you feel most comfortable.

Never, at any point, is there a reason to beat yourself up for what is a simple miscalculation. Getting overly full, even if it happens a lot, does not say anything about your character, your worth as a person, or your willpower. It simply says that something is getting in the way of your fullness signals, or some anxiety is pushing you to override them.

That anxiety is most often related to a fear of not getting enough to eat – and it can take time to build trust and soothe that anxiety by continuing to feed yourself regularly and give yourself permission, regardless of whether you get overfull. The anxiety might also feel like a form of rebellion or resentment, where you purposely eat too much for your own comfort because, screw the world that tells you not to eat, you want this food, dammit! But the root of the problem is the same – lack of permission, and fear of not getting enough.

The answer to both of these problems is more permission, more trust, and more commitment to continuing to feed yourself reliably.

When you are calm enough around food, you can feel the sense of fullness that Ellyn Satter terms “the stopping place.” It is more than just stomach fullness, more than just satisfaction from the food, and more than just the relief of nutrient stores being replenished – it’s a combination of all three, plus the overarching sense of well-being that comes from knowing you can, and you will, take good care of yourself with food.

When all the forms of hunger are extinguished, you will find a stopping place that is subtle but definite, and slightly different from anyone else’s. It might require a slightly different mix or amount of foods, but you will know it when you feel it.

If you trust that more food will be coming later, when you need it again, you can calmly let go of eating when you’ve reached the stopping place.

It will take some practise, permission, tuning in, and the healing of broken trust. But it will be worth it.

There are ten spots left in the spring Eat Without Drama groups. If you’re raring to do some intensive work on the how of eating, come along with me.

Or if you just want to tell me how you figure out fullness, I’m all ears.

Posted in eating, Humane Nutrition | 69 Comments

Lesson Six – Checking in.

By Michelle | Published: March 26, 2012

When discussing emotional eating, I described a method of doing what is often termed “mindful eating” – picking a delicious food, sitting down alone with it in a comfortable place, giving yourself permission, and then eating it without external distractions.

This is basically what is meant by “mindful eating” when it is discussed as part of intuitive eating, and I do think it has its place. However, I feel like the term “mindful” has some connotations that make it challenging for lots of people. It seems to imply full, willful attention given to the food. Even the circumstances of mindfully eating a delicious food can seem rather ascetic – no distractions allowed. The focus is solely on the food.

However, in real life, not all eating can be this way. And maybe all eating shouldn’t be this way.

For example, eating is often a social experience. We eat with family, we cook for friends, we go out to restaurants on dates, we eat at parties. Socializing while eating, when you get down to brass tacks, is a form of distraction. It is also a wonderful way to eat.

There are other cultural food rituals in which distraction is embedded, and I really can’t bring myself to have a problem with them – popcorn and Jr. Mints at the movie theatre, pizza in front of the TV on Friday night. You can pry these from my cold, dead hands.

“Mindful eating” terminology also conjures up, for me, images of the previously-mentioned foodgasm. Real talk: not every meal is foodgasm material. Sometimes you just have to get the job done, quick-and-dirty style. Sometimes eating isn’t pretty.

Mindful eating is also often promoted as a sneaky method of food restriction, either overtly by intuitive eating approaches that promise weight loss, or we do it accidentally to ourselves, because our neurotic feelings about food can creep into even the most benign and food-positive activities.

And for these reasons, I’ve chosen to think about mindful eating a bit differently, and in a way that removes some of the pressure — since we looooove to pressure ourselves about eating, and even when we’re rejecting the idea of dieting pressure, somehow we manage to find ways of flagellating ourselves with the idea of Doing Intuitive Eating Right.

I think about mindful eating, at regular day-to-day meals, in terms of checking in.

Checking in with your food does not require a sustained level of monastic attention and being-in-the-present – although if this is something you do well, then by all means, knock yourself out. Checking in takes only a few seconds. It will not make you look weird. It is not even noticeable at all to the people I eat with. In fact, I’m willing to bet it’s something you may already do from time to time.

If you don’t, then having an explicit, sustained practice of mindful eating – the intense kind, where you sit down and eat food without distraction – on a regular basis, actually can start to generalize itself to other situations. It can become a completely unintentional habit that feels damn near effortless – this is how it happened for me.

After practicing having some pretty intensely mindful meals and snacks (mainly because I had reached the desperation point and couldn’t take another moment of alternately over- and undereating and feeling like crap about it, so I finally just went and did the thing that my dietitian was telling me to do), in a few months I started to notice that I do this thing, and I don’t really do it on purpose. It looks like this.

While I’m eating dinner with my family, or even just eating Kraft Dinner out of a mixing bowl in front of the TV (it happens), there will come a point where I stop for a second. Maybe five seconds. I stop picking up food with my fork, I stop looking at the TV, I stop talking, I even stop listening, and I just look at my food. Or I just close my eyes briefly and taste what’s in my mouth. I give my mind a moment to float, and listen to my little caveman thoughts of “Mmmmm, food. Food good.”

On occasion, I’ve been known to make a yummy sound.

And then, I go back to the rhythm of eating and talking, or eating and watching.

It happens several times during any given meal – tiny moments of food appreciation. Even if the food is not spectacular, I can still appreciate the sensation of hunger becoming satisfied.

Checking in also allows me to eat exactly what I want of what is offered – no more, no less. It tells me when I’m full, when I need seconds, or when I’m done with dinner but still want dessert. It tells me whether or not I’m still enjoying the food, and thus, whether to keep eating. It brings the food I’m eating into brief bursts of focus, enough to let me enjoy what I’m doing and truly get enough – so that I can then be truly finished with eating, and move onto other things.

Eating is one important part of your life. Whether you are having a sandwich or a five-course meal, practise spending a few moments to give it its due – no obsessing needed.

Sign-ups are now underway for the spring Eat Without Drama groups. If you want a safe, fun place to practise eating normally, come join us.

If not, that’s cool – I still want to hear about any sneakily-restrictive “mindful eating” messages you’ve received, in comments.

Posted in eating, Humane Nutrition | 36 Comments

Nutrition agnosticism.

By Michelle | Published: March 19, 2012

On this blog, I talk a lot about the how of eating, with little attention to the what.

There are a few reasons for this.

One is my belief that, until you have a solid foundation for how to eat, it’s very, very difficult to make positive changes to the “what.” Before you can decide which food is best for you to eat, you need to be eating food, period.

Plenty of people who read this blog, and who I work with, have major trouble with this step. And this is why I’m here – this is the core of my job and my writing.

Another reason I don’t focus on “what” is because it is my opinion that nutrition is quite individual. Okay, it’s not just my opinion – it’s even tacitly admitted by the fact that such a thing as the Recommended Dietary Allowance for most micronutrients even exists – the RDA is based on a bell curve, which is a graph that says “some people need a tiny amount, some people need a lot, and most people need an amount somewhere in the very broad in-between.” Individuality is also the reason why the Acceptable Macronutrient Distribution Range is a “range” instead of a single, prescribed number: people vary.

The idea that people vary is further confirmed for me by my education in clinical nutrition, which taught me that perfectly nutritious food for one person can constitute a major health crisis for another – because sometimes people have food allergies, food intolerances, as well as various diseases with a nutritional component (one big caveat here: not all diseases have a confirmed nutritional component or treatment – though we often talk about all disease as if it were caused and/or treated by diet. There simply isn’t evidence to support this.)

Different people seem to feel and function well by eating different things, and different amounts of things – this I’ve based on my own little observations about life and people and eating in general. You could also say that the existence of differences in cuisine by region and culture seems to fit this observation – especially in cases where a person suddenly stripped of their culture and its attendant foodways gets very ill. Which happens.

This leads into yet another reason not to focus on “what” – because health is more than just food, and food is more than just nutrients. And before you think I’m going there with this, I want to say that food is also much more than our hunches or culturally- or cognitively-biased definitions of “real food.”

“Real food” (a term I find almost as distasteful as “real women”) looks a lot different to different people. And here we revisit the Hierarchy of Food Needs again – and take a look at the second tier, which is “acceptable food.”

Hierarchy of food needs, in order: enough food, acceptable food, reliable ongoing access to food, good-tasting food, novel food, and instrumental food.

Food that would be perfectly acceptable to some people is abhorred by others, for lots of reasons. Heck, as a very mild microexample, my husband was put off when he learned that I made a regular habit of eating crayfish (I use the proper term “crawdads”, which is translated from the original Grandma-ese to mean “delicious tiny lobsters from the crick”), because to him they are bugs. And he doesn’t eat bugs.

On the other hand, I find his habit of putting ketchup into Kraft Dinner totally unappealing. Still. After living in this country and spelling things with extra u’s for well over a decade now. And neither of us is right or wrong.

Slight (very slight) cultural differences between central Canada and west coast USA, as well as different growing-up experiences, different families, different social norms, and different habits cultivated over years and years of living, play into these disagreements. So, imagine if you will, the much more extreme differences, on a much larger scale, that exist between various places and cultures all over the world.

Then you may get an inkling of how difficult it is to sum up (to borrow again from the original Grandma-ese) all good eatin’ in that one condescending term, “real food.”

It is similarly impossible, and I would argue undesirable, to divorce food-as-nutrients from food-as-identity and food-as-emotional-experience. All eating is emotional, remember? Even on a strictly biomedical level, isn’t it possible that the stress induced from being deprived of an emotionally meaningful, culturally significant food source might negatively impact your health? I think it might.

That’s not to say that sometimes the cost of some stress isn’t worth the health benefit someone may receive by cutting a particular food out of their diet, especially when that food is doing them direct and measurable harm – but it is to say that monkeying with food restrictions isn’t a purely benign practice. There are consequences to physical health, and to quality of life. Sometimes the consequences are overwhelmingly positive. Sometimes not.

(See how complicated this already is? Phew.)

And the last reason I’ve mostly neglected the “what” on this blog is this: despite having spent four school years allegedly learning what is the best, healthiest food to eat, I just don’t know.

I have a lot of learning to do in this area, and I have a funny feeling that it’s not just me who does. Nutrition is a young science, as fields of inquiry go, and it studies incredibly complicated systems – and I think we, as a species, still have a lot to learn about it.

So, I don’t know. And I caution you to be skeptical of anyone who claims, unequivocally, that they do.

My first foray into the world of figuring out what to eat was probably back in 1999 or 2000, when I did a Google search for “healthy eating” or “nutrition” or something equally vague. (I wouldn’t recommend trying this if you are struggling with disordered eating of any kind. Or if you just want to have a nice day.)

The results of that search, as you can probably guess, were bewildering and slightly terrifying. Guess what? They still are in 2012 — maybe moreso.

Of course a random Google search cannot represent Our Current Scientific Understanding of Human Nutrition, but it tells me a few things. It tells me people are interested in nutrition. It also tells me people are scared. Plenty of them are zealous, vociferous, and sometimes obsessive – and I believe this is because they are scared. It tells me that there is a lot of confusion, and a lot of mistrust of official guidelines on health and eating. It tells me there is a lot of dichotomous, black-and-white, all-or-nothing, good-against-evil thinking and discourse.

I can sympathize with all of this. I have, at various points, been guilty of all these things, and I probably still am, and I probably will continue to be. Because I am just muddling my way through this, like everybody else. My brain takes lots of the same shortcuts, and thereby makes a lot of the same mistakes, that all brains do in their attempt to find patterns and make sense of the penultimate human fear – the unknown.

If the unknown were a place, it would be a scary place to hang out. A dark closet, the place just beyond the circle of campfire light, the mouth of a black cave. The lack of light is really just imagery for a lack of information. A lack of information makes it more likely you’ll get into very bad trouble. Something might kill you, which is, in my opinion, the ultimate human fear. The unknown is death’s handmaiden.

Being in the unknown is like being out to sea. You very badly want something to grab onto, some solid sense of security instead of just endlessly shifting, changing, inscrutable depths of water – depths that probably contain something dangerous and deadly.

This means it is tempting, intellectually, to grab onto a theory, any theory, and there cling.

I don’t think people pick nutrition theories at random – but they pick ones that feel suited to their particular beliefs (ethical, observational, aesthetic) and that complement their worldviews. These are actually very good reasons, not some kind of humanoid silliness to be scoffed at from on high. It’s only logical that you’d be more inclined to align yourself with something that makes sense to you on multiple levels – but here’s where our sometimes-clunky habit of pattern-finding intrudes.

You generalize the theory to everyone else.

The one that seems custom-tailored for, uniquely-suited to, and perfectly paired with your life – which was the reason you chose it in the first place.

I want to stop for a moment and clarify something: I don’t think we always choose a way to eat that is best for us, physically or emotionally. I think we mess it up fairly often, but I also think having the freedom to mess it up is part of what being an autonomous human is all about.

Thankfully, in the absence of disordered eating, we can usually learn from feedback of various kinds whether or not the food we’re eating is doing us harm, and then we get to decide what to do about it. And I actually trust that most people have the capacity to do that, to make their own choices, provided they have some supports to help them (a safe and varied food supply, access to appropriate and respectful health care, shelter and enough food to eat, and the skills and facilities to prepare it, in the first place.)

So — back to generalizing. I think we do it because it makes the world seem like a less scary place. Taking that one thing to cling to and then extrapolating that everyone else can be saved if they will only cling to it, too, feels very reassuring. It feels like making sense of an incredibly complicated and counter-intuitive world. Unfortunately, in practice, it can also make that world a more miserable, divisive place, because it almost invariably results in judging other people’s choices, which are based on factors so diverse and complex that it might be impossible to truly understand them.

I also think that, in our current state of nutritional understanding, it’s inaccurate to generalize from one theory to one whole population, let alone the entire species. We simply don’t know enough yet.

So, at this time, I consider myself mostly agnostic on the subject of what to eat. Even my dearly-held theories about how are, I recognize, probably limited to certain people in certain circumstances — though many of them are readers of this blog. And I’m okay with that.

Tolerating ambiguity and not-knowing, I believe, is also part of the human condition. Floating in the water, accepting what can’t be seen, and making sense of our own experiences without assuming that those experiences are shared by everyone else, is about the best we, as individuals, can do.

One of my peculiar beliefs is that no one should need a degree in science or nutrition in order to figure out what to eat. No one should need to spend their day reading and analyzing studies in order to make a reasonable choice about what to have for dinner. (If you have the time, resources, and inclination to do that, then Godspeed and good luck.)

We might, at some point, have a better answer about what everyone should be eating for optimal biomedical health — and even then, this might not overlay neatly onto what type of food provides meaningful social and hedonic experiences, which makes it an incomplete answer, at best — but until then, we can guess that variety and not too much or too little of any one thing is probably a good idea.

Until then, we can take comfort that our life expectancy, at least in certain parts of the world, is the best it’s ever been. That we have cures and treatments for many diseases that once ravaged entire populations.

And until then, we still need to eat, which means we all need to tread water and make our own choices as best we can.

Consider this my official announcement that the spring groups of the Learn to Eat program are open for sign-ups until early April. If you want to work on the “how,” that’s the place to be.

Posted in Humane Nutrition, Unified Theory | 32 Comments

Red meat and mortality – this one’s for you.

By Michelle | Published: March 15, 2012

So, you all saw that headline about red meat being unequivocally Bad For You, right? The headline was super scary – “All red meat is bad for you, new study says” according to the Los Angeles Times.

Very scary, very definite-sounding.

I tried to avoid looking at the study all day, because I knew it would make me angry. I suspected shenanigans from the get-go. Why? Because pretty much nothing in science is ever that unequivocal. Science is, allegedly, the study of material reality – when it’s done well. And material reality is incredibly complex and nuanced and unsure. Bets must always be hedged when observing it.

So I knew that, at the very least, the mainstream media reporting of this study — which might have been a very good study — was oversimplified and sensationalized, as any juicy news story is.

Finally, late last night, I gave into temptation and clicked on the LA Times link, which led me to the abstract of the study. And before I even got into the full-text, by looking at the numbers and methodology reported in the abstract, I was…deeply embarrassed.

I’m a nobody — I have a measly undergrad in applied science, and I have never been the best at math. And I was so dreadfully embarrassed for the researchers whose names were emblazoned on this study, for the journal who published it, and for the Harvard School of Public Health’s nutrition department. (My condolences to the rest of the Harvard School of Public Health.)

Why? Because it is an incredibly bad study – worse than I, a notorious crank with a streak of bias a mile wide, could have ever possibly hoped for in my wildest, crankiest dreams.

This study used a ridiculous methodology to determine how often people ate red meat – they used a food frequency questionnaire, something I was taught in school should never be used alone to assess a person’s actual food intake. It’s simply not precise enough – it is only a rough guesstimate, and it is vulnerable to faulty memory, to misunderstanding food amounts, and to embarrassment or shame.

Even if you gave a person a food frequency questionnaire every single day for the duration of the study, it would not be great data.

Sadly our friends, The Absent-Minded Scientists, didn’t even go to that much trouble. They based their analysis on food frequency questionnaires that were only updated once every four years.

I’m going to give you a second to let that sink in.

Once every four years.

Every four years, subjects in the study were given a piece of paper with a bunch of check boxes on it, next to a long list of foods, and asked to check off how often they ate each food over the course of the past four years. Totally accurate, I’m sure — accurate enough to pinpoint with reasonable certainty the type of food each person ate every single day for the 24 years of the study.

Oh wait a second, no. Not at all.

Then, based on this rigorous assessment of each subject’s diet, the researchers managed to find an association between people who reported eating a serving of red meat every single day…

I’ll give you another second.

A serving of red meat Every Single Day…

[Interlude: this is not to say that no one, anywhere eats red meat every single day for 24 years. Plenty of people around the world probably do. But one may assume they are not the vast majority of the population from which this study's subjects were drawn -- and even if they were, the results of the data from this study would give them no reason to worry.]

…was associated with a 20% higher risk of dying during the study.

That actually still sounds pretty scary, doesn’t it?

I mean, nobody wants to entertain a 20% higher risk of dropping dead at any moment. Death is the worst bad thing that could ever happen to you, and if avoiding a couple of hamburgers can stave it off, why the hell not?

Yes, it does sound scary — until you point out that the average risk of each person in the study dying, in the first place, was actually very low.

Per person, per year of the study, the risk of dying was less than 1%.

For the people who (allegedly) ate red meat every day, the risk of dying was…also less than 1%.

I’ll give you another second.

The risk of each person dying, per year of the study, was less than 1% — whether or not they ate red meat.

In fact, the risk of people in this study dying was quite a bit lower than the risk of the average person of the same age in the general US population (for year 1994, right in the middle of the study period.)

The subjects would have been between the ages of 44 and 89 years old by the middle of the study, and the risk of an average USian (of roughly this age group) dying in the middle year of the study was 2.5%. (I’m just grabbing rough numbers to make a point here – please don’t mistake for Actual Science.)

Which tells us something important – and probably not that Being In A Study Reduces Your Risk of Death by 67%!!! – it tells us that not only did the people in this study who allegedly ate red meat every single day for 24 years have a lower risk of death than the average person, it tells us that the people in the study don’t represent average people.

You could very well say that not being a predominantly white health professional or nurse is associated with an increased risk of death. Investigating why that is might be a pretty interesting question, no?

But, sadly, it’s not as newsy as saying that red meat will kill you.

Last layer of the onion: this study was not a clinical trial, which means it can only draw correlations between things – it cannot prove causation.

So even if the dietary assessment strategy were sound, even if the population of the study did represent the average person, and even if the difference in risk of death between meat eaters and not-so-much meat eaters was very large, it would only signal the need to do a more rigorous study to get to the bottom of the association, and to find out whether it’s likely that eating more red meat makes you die faster. Nothing more.

Results of the study aside, if a wholly unimpressive person like myself can read the abstract and see some pretty big problems in this study, then certainly a doctor, or a biochemist, or a dietitian, or an epidemiologist, or anyone who has taken a statistics course most definitely can and will. Which should be rather embarrassing for its authors.

Which leads me to think that I, and all the people out there with real scientific training, are not the target audience for this piece of scholarship.

So who is the target audience? Who might take it at face value?

It would have to be someone who wouldn’t look at the abstract, let alone the full text of the study. It would have to be someone, if they did look at the abstract, whose first instinct wouldn’t be to pull out a calculator and do some arithmetic. Someone like, say, a hurried journalist who reads the press release, hears what seems a plausible and common-sense conclusion, and leaves it at that.

Someone like a person who leads a real life, in a complex world with a bunch of information flying at them from all sides, and who counts on the news to at least resemble the truth — and who doesn’t have time to fuss with a bunch of statistics. Who furthermore, in an honest world, wouldn’t have to.

I’m convinced that this study, embarrassment that it is, was not written to gain respect from people who would read the full text, calculator in hand, as part of their day job. It wasn’t written for other scientists, doctors or, actually, for anyone like the health professionals who were actually in the study.

It was written for the sake of headlines. It was hand-crafted for newspapers, which we count on to deliver at least a Reader’s Digest version of the truth. Last, and most importantly, it was written for someone like a person who leads a busy, complex life, and who doesn’t always carry a calculator.

Someone who might never know that the data is bad, and the headline misleading. Maybe someone like your friends who are Facebooking it, and your mom who’ll now think twice about buying dad’s favourite beef jerky. Maybe even someone a lot like you.

This study didn’t prove that red meat was bad, because it didn’t prove anything at all — except that predominantly white health professionals die less often than the average person, and that while the nutrition department at the Harvard School of Public Health can easily drum up media attention, they are not easily embarrassed.

The foundation of nutrition as we know it remains variety. And variety, as we know it, can still include red meat if you like it and are inclined to eat it. I personally wouldn’t suggest eating it every single day for 24 years, but even if you wanted to, this study wouldn’t give you a single good reason to worry.

I’d be more concerned if I were not a predominantly white health professional, since their risk of death is so much lower than average — probably because they have the luxury of not being terrorized by studies like this.

Just a note — I don’t want comments to turn into a referendum on red meat. Some people eat it, some people don’t — it’s a judgment call everyone has to make for themselves. Let’s talk instead about how propaganda shouldn’t be dressed up and paraded around like science.

ETA: Some commenters have pointed to some other critiques of this study, which you may want to take into consideration:

http://evimedgroup.blogspot.ca/2012/03/unpacking-meat-data.html

http://summertomato.com/red-meat-is-killing-us-all-or-not/

http://www.marksdailyapple.com/will-eating-red-meat-kill-you/#more-27840

Posted in Humane Nutrition, Unified Theory | 90 Comments