Category: Nutrition

I am pleased to share a new paper my colleagues and I published in Frontiers in Psychiatry describing the potential benefits of a ketogenic diet in patients with bipolar disorder, major depression, and schizoaffective disorder. University of Toulouse psychiatrist Dr. Albert Danan found that a whole-foods ketogenic diet was safe, feasible, and associated with unprecedented improvements in mental and physical health in hospitalized patients with serious mental illness.

The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients (open access)

The Inspiration for this Study

Dr. Danan’s patients are primarily people of French and North African descent with serious, persistent mental illness, all of whom also suffer from metabolic illnesses such as obesity, hypertension, and type two diabetes.

After witnessing marked improvement in seizures and autism behaviors in a family member within several weeks of having adopted a ketogenic diet, Dr. Danan became interested in the potential of the diet to improve the psychiatric and metabolic status of his most treatment-resistant patients, regardless of diagnosis. He created a metabolic psychiatry treatment program within his local hospital where patients with chronic mental illness who had exhausted standard psychiatric therapies could attempt a ketogenic diet in a supportive, medically supervised environment.

Ketogenic Diet Protocol

Dr. Danan admitted 31 of his patients with major depression, bipolar disorder, or schizophrenia to the Clinique du Castelviel in Toulouse where they were served a ketogenic diet in lieu of standard hospital fare. The program he implemented limits total carbohydrate intake to a maximum of 20 grams per day, and was based on the ketogenic diet protocol used by Dr. Eric Westman in his metabolic research at Duke University. [A description of the diet is included in the Supplemental Materials section of the paper.]

Results

Symptoms of depression and psychosis improved in all 28 patients who followed the diet for longer than two weeks, with improvements becoming noticeable within three weeks or less. Almost half (43%) of patients achieved clinical remission according to the Clinical Global Impressions Scale (CGI-S) which measures illness severity, and 64% were discharged from the hospital on less psychiatric medication. Dr. Danan had never witnessed this degree of improvement before in any of these patients—most of whom he had worked with for years or even decades, and all of whom had previously been hospitalized under his care one or more times.

Patients also experienced significant improvements in markers of metabolic health, including blood pressure, blood glucose, triglycerides, and weight:

All but one patient lost weight including 96% of those who were taking antipsychotics, and nearly half achieved clinically significant weight loss [defined as ≥5% reduction in body weight]. This welcome outcome alone makes a compelling case for the implementation of the KD [ketogenic diet] in people who are taking antipsychotic medications, whether or not psychiatric symptoms improve in response to the KD, as counteracting antipsychotic-induced weight gain is extremely difficult.

Significance

Until now, the evidence in support of ketogenic diets specifically for psychiatric conditions has been limited to hypothesis papers, animal studies, and a small but growing number of individual case reports.

As this was not a controlled trial, the extent to which the ketogenic diet may or may not have directly contributed to the outcomes reported cannot be ascertained. However, since this is the first time that a group of patients this large and this diagnostically diverse has ever been treated with a ketogenic diet in a hospital setting, these clinical observations serve to bridge the gap between existing case reports and the controlled clinical trials already underway at other institutions around the world.

When asked to reflect on his experience as principal investigator of this study, Dr. Danan said:

During my career, I’ve been struck by the limits of conventional therapies in psychiatry. Most patients relapse and have a poor quality of life. Most of them suffer from dramatic weight gain, obesity, diabetes, hypertension, and metabolic syndrome. Loss of life expectancy in this population can be measured in decades. This is a matter of public health and much more attention must be paid to these problems.

Introducing nutritional measures, particularly the ketogenic diet, helped me considerably to improve the results of therapy. Patients began improving their metabolic status by losing weight, improving blood pressure, etc., but most importantly, I observed real improvements in their psychiatric symptoms such as hallucinations, delusions, and mood instability.

After having led this study I’m convinced that nutritional measures can have a profound impact and lead to very important benefits, which makes me say that this represents the future direction to develop in psychiatric care.

Author Contributions

Albert Danan MD conceived of and implemented the intervention and generated clinical data and observations. Georgia Ede MD conducted the literature review and wrote the manuscript. Eric C. Westman MD and Laura R. Saslow PhD performed statistical analyses. You can read the study for free here.

Note: A version of this article was previously published on Psychology Today.

I am pleased to share a new paper my colleagues and I published in Frontiers in Psychiatry describing the potential benefits of a ketogenic diet in patients with bipolar disorder, major depression, and schizoaffective disorder. University of Toulouse psychiatrist Dr. Albert Danan found that a whole-foods ketogenic diet was safe, feasible, and associated with unprecedented improvements in mental and physical health in hospitalized patients with serious mental illness.

The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients (open access)

The Inspiration for this Study

Dr. Danan’s patients are primarily people of French and North African descent with serious, persistent mental illness, all of whom also suffer from metabolic illnesses such as obesity, hypertension, and type two diabetes.

After witnessing marked improvement in seizures and autism behaviors in a family member within several weeks of having adopted a ketogenic diet, Dr. Danan became interested in the potential of the diet to improve the psychiatric and metabolic status of his most treatment-resistant patients, regardless of diagnosis. He created a metabolic psychiatry treatment program within his local hospital where patients with chronic mental illness who had exhausted standard psychiatric therapies could attempt a ketogenic diet in a supportive, medically supervised environment.

Ketogenic Diet Protocol

Dr. Danan admitted 31 of his patients with major depression, bipolar disorder, or schizophrenia to the Clinique du Castelviel in Toulouse where they were served a ketogenic diet in lieu of standard hospital fare. The program he implemented limits total carbohydrate intake to a maximum of 20 grams per day, and was based on the ketogenic diet protocol used by Dr. Eric Westman in his metabolic research at Duke University. [A description of the diet is included in the Supplemental Materials section of the paper.]

Results

Symptoms of depression and psychosis improved in all 28 patients who followed the diet for longer than two weeks, with improvements becoming noticeable within three weeks or less. Almost half (43%) of patients achieved clinical remission according to the Clinical Global Impressions Scale (CGI-S) which measures illness severity, and 64% were discharged from the hospital on less psychiatric medication. Dr. Danan had never witnessed this degree of improvement before in any of these patients—most of whom he had worked with for years or even decades, and all of whom had previously been hospitalized under his care one or more times.

Patients also experienced significant improvements in markers of metabolic health, including blood pressure, blood glucose, triglycerides, and weight:

All but one patient lost weight including 96% of those who were taking antipsychotics, and nearly half achieved clinically significant weight loss [defined as ≥5% reduction in body weight]. This welcome outcome alone makes a compelling case for the implementation of the KD [ketogenic diet] in people who are taking antipsychotic medications, whether or not psychiatric symptoms improve in response to the KD, as counteracting antipsychotic-induced weight gain is extremely difficult.

Significance

Until now, the evidence in support of ketogenic diets specifically for psychiatric conditions has been limited to hypothesis papers, animal studies, and a small but growing number of individual case reports.

As this was not a controlled trial, the extent to which the ketogenic diet may or may not have directly contributed to the outcomes reported cannot be ascertained. However, since this is the first time that a group of patients this large and this diagnostically diverse has ever been treated with a ketogenic diet in a hospital setting, these clinical observations serve to bridge the gap between existing case reports and the controlled clinical trials already underway at other institutions around the world.

When asked to reflect on his experience as principal investigator of this study, Dr. Danan said:

During my career, I’ve been struck by the limits of conventional therapies in psychiatry. Most patients relapse and have a poor quality of life. Most of them suffer from dramatic weight gain, obesity, diabetes, hypertension, and metabolic syndrome. Loss of life expectancy in this population can be measured in decades. This is a matter of public health and much more attention must be paid to these problems.

Introducing nutritional measures, particularly the ketogenic diet, helped me considerably to improve the results of therapy. Patients began improving their metabolic status by losing weight, improving blood pressure, etc., but most importantly, I observed real improvements in their psychiatric symptoms such as hallucinations, delusions, and mood instability.

After having led this study I’m convinced that nutritional measures can have a profound impact and lead to very important benefits, which makes me say that this represents the future direction to develop in psychiatric care.

Author Contributions

Albert Danan MD conceived of and implemented the intervention and generated clinical data and observations. Georgia Ede MD conducted the literature review and wrote the manuscript. Eric C. Westman MD and Laura R. Saslow PhD performed statistical analyses. You can read the study for free here.

Note: A version of this article was previously published on Psychology Today.

I am pleased to share a new paper my colleagues and I published in Frontiers in Psychiatry describing the potential benefits of a ketogenic diet in patients with bipolar disorder, major depression, and schizoaffective disorder. University of Toulouse psychiatrist Dr. Albert Danan found that a whole-foods ketogenic diet was safe, feasible, and associated with unprecedented improvements in mental and physical health in hospitalized patients with serious mental illness.

The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients (open access)

The Inspiration for this Study

Dr. Danan’s patients are primarily people of French and North African descent with serious, persistent mental illness, all of whom also suffer from metabolic illnesses such as obesity, hypertension, and type two diabetes.

After witnessing marked improvement in seizures and autism behaviors in a family member within several weeks of having adopted a ketogenic diet, Dr. Danan became interested in the potential of the diet to improve the psychiatric and metabolic status of his most treatment-resistant patients, regardless of diagnosis. He created a metabolic psychiatry treatment program within his local hospital where patients with chronic mental illness who had exhausted standard psychiatric therapies could attempt a ketogenic diet in a supportive, medically supervised environment.

Ketogenic Diet Protocol

Dr. Danan admitted 31 of his patients with major depression, bipolar disorder, or schizophrenia to the Clinique du Castelviel in Toulouse where they were served a ketogenic diet in lieu of standard hospital fare. The program he implemented limits total carbohydrate intake to a maximum of 20 grams per day, and was based on the ketogenic diet protocol used by Dr. Eric Westman in his metabolic research at Duke University. [A description of the diet is included in the Supplemental Materials section of the paper.]

Results

Symptoms of depression and psychosis improved in all 28 patients who followed the diet for longer than two weeks, with improvements becoming noticeable within three weeks or less. Almost half (43%) of patients achieved clinical remission according to the Clinical Global Impressions Scale (CGI-S) which measures illness severity, and 64% were discharged from the hospital on less psychiatric medication. Dr. Danan had never witnessed this degree of improvement before in any of these patients—most of whom he had worked with for years or even decades, and all of whom had previously been hospitalized under his care one or more times.

Patients also experienced significant improvements in markers of metabolic health, including blood pressure, blood glucose, triglycerides, and weight:

All but one patient lost weight including 96% of those who were taking antipsychotics, and nearly half achieved clinically significant weight loss [defined as ≥5% reduction in body weight]. This welcome outcome alone makes a compelling case for the implementation of the KD [ketogenic diet] in people who are taking antipsychotic medications, whether or not psychiatric symptoms improve in response to the KD, as counteracting antipsychotic-induced weight gain is extremely difficult.

Significance

Until now, the evidence in support of ketogenic diets specifically for psychiatric conditions has been limited to hypothesis papers, animal studies, and a small but growing number of individual case reports.

As this was not a controlled trial, the extent to which the ketogenic diet may or may not have directly contributed to the outcomes reported cannot be ascertained. However, since this is the first time that a group of patients this large and this diagnostically diverse has ever been treated with a ketogenic diet in a hospital setting, these clinical observations serve to bridge the gap between existing case reports and the controlled clinical trials already underway at other institutions around the world.

When asked to reflect on his experience as principal investigator of this study, Dr. Danan said:

During my career, I’ve been struck by the limits of conventional therapies in psychiatry. Most patients relapse and have a poor quality of life. Most of them suffer from dramatic weight gain, obesity, diabetes, hypertension, and metabolic syndrome. Loss of life expectancy in this population can be measured in decades. This is a matter of public health and much more attention must be paid to these problems.

Introducing nutritional measures, particularly the ketogenic diet, helped me considerably to improve the results of therapy. Patients began improving their metabolic status by losing weight, improving blood pressure, etc., but most importantly, I observed real improvements in their psychiatric symptoms such as hallucinations, delusions, and mood instability.

After having led this study I’m convinced that nutritional measures can have a profound impact and lead to very important benefits, which makes me say that this represents the future direction to develop in psychiatric care.

Author Contributions

Albert Danan MD conceived of and implemented the intervention and generated clinical data and observations. Georgia Ede MD conducted the literature review and wrote the manuscript. Eric C. Westman MD and Laura R. Saslow PhD performed statistical analyses. You can read the study for free here.

Note: A version of this article was previously published on Psychology Today.

Introduction

We’re back to epidemiology this week, but it’s an interesting one. The paper is called “Dietary fats and their sources in association with the risk of bladder cancer: A pooled analysis of 11 prospective cohort studies” (Ref 1). The paper was published in January 2022, but it was recently reported by the UK Independent newspaper, which is when it came to my attention (Ref 2).

The paper opened with the global position on bladder cancer. It is the 10th most commonly diagnosed cancer worldwide, with approximately 573,000 new cases and 213,000 deaths each year (Ref 3). Approximately 75% of bladder cancer cases are nonmuscle invasive bladder cancer (NMIBC) “characterized by frequent recurrences, which requires intensive treatments and follow-up measures, posing a large burden on the national health care budgets and patient’s quality of life” (Ref 1).

The introduction to the paper noted that previous research has reported that fluids, fruit, vegetables and yogurt are associated with reduced risk of BC, while a ‘Western diet’ has been associated with a higher risk. This study set out to examine the effect of fat intake from different dietary sources on bladder cancer. It found and pooled data from 11 population studies. These included the countries involved in the European Prospective Investigation into Cancer (EPIC), which are Denmark, France, Germany, Italy, The Netherlands, Norway, Spain, Sweden, and United Kingdom. Plus, the Netherlands cohort study and the North America VITamins and Lifestyle cohort study (VITAL).

This past week in Orlando I tried Purple Ocean Superfood Bar for the first time and it was EPIC! Josiah, the owner is from Puerto Rico and created Purple Ocean Superfood Bar in order to not only bring home a little closer but also to promote well-being through healthy eating. Purple Ocean not only brings the Caribbean feel of Puerto Rico to Orlando but is a healthy option for locals as well.Purple Ocean is mostly vegan (except honey), they use 80% organic products, and have gluten-free options. They serve the most amazing acai bowls I have ever seen – they come in a pineapple shell! Each acai bowl is named after a surf  break in Puerto Rico – how cool! The bowls taste as good as they look! Purple Ocean also serves 3 different plant-based burgers, fries, and a variety of smoothie and drink options.I tried both the Roasted Garlic Quinoa burger and a Beyond Meat burger. Beyond meat is definitely a major upgrade for other plant-based meat options on the market. It’s super tasty and if you are wanting to have a “burger” every once in a while this is a great plant-based option. However, their quinoa burger would be my choice if something like this is available. It is made in house and comes with vegan cheese, lettuce, tomato, sautéed onions, avocado, and you can ask for a gluten-free bun. All of their burgers are cooked in avocado oil. 

For acai we tried the Survivor Bowl. It’s loaded with all kinds of fruits and you can get superfood toppings added, we also had the Tres Palmas bowl which comes with granola, banana, pineapple, mango, and coconut oil. Everything was amazing!

I cannot recommend this place enough if you are looking for a healthy place to eat in Orlando! Purple Oceans is the spot since they have both sweet and savory – something for everyone. Plus the decor is so tropical and makes you feel like you’re in Puerto Rico. Give them a try next time you’re in Orlando, they have 3 locations, one brick + mortar, and the other two are permanent food trucks, how fun!

We’re told that we need to wear sunscreen as the primary way to protect ourselves from skin damage, but many sunscreens contain chemicals that are harmful to our health. There are many ways that we can enjoy the sun responsibly and that includes what we eat and how we interact with the sun. There is a wide array of foods that offer sun protection and most of them are easily available in the summertime. Nature is smart like that – in fact, there are many surprising health benefits of sunshine, too!

Health Benefits Of The Sun

We’ve demonized sunshine when it’s really not the enemy. In truth, the earth and the humans, plants, and animals that live on it need sunshine for survival. The sun is our primary source of Vitamin D, which is made in our skin after sun exposure. Vitamin D is crucial for immunity, mental health, hormone production, bone health, and sleep. While we can receive Vitamin D from foods as well, the sun is one of the simplest and no-cost ways to get it.

Sunlight also helps to regulate our circadian rhythms, improve our mood and cognition, and even reduce our risk of certain cancers.

Safe Sun Exposure Tips

If we’re going to reap the benefits of sunshine, it’s important to be responsible about it. The right amount is beneficial to our health – but too much of it, especially without practicing safe sun exposure, can be detrimental. Some of the things you can do to enjoy the sun safely include:

• Enjoy the sun during non-peak hours, such as the early morning or later in the afternoon/early evening. Keep in mind that Vitamin D is absorbed best from noon to 2 pm – so if you’d like get your optimal dose of Vitamin D, a short 5 to 10 minutes in the sun during this time can help.
• Cover up with appropriate clothing (hats, long sleeves and pants, sunglasses, etc.).
• If using sunscreen, purchase a safe sunscreen and apply it regularly.
• Our skin produces Vitamin D and if you shower right after sun exposure, you might wash it off. When showering, use soap on your underarms and genitals and water only on everything else to retain that Vitamin D.
• Darker skin tones require more time in the sun to absorb Vitamin D than lighter ones – ensure you plan sun time accordingly based on your skin tone.
• Stay hydrated throughout the day with hydrating foods and beverages.

9 best foods for sun protection

Diet plays an important role in sun protection by providing us with nutrients that ward off damage and help our skin become resilient. Include these best foods for sun protection in your diet to receive a healthy dose of nutrients that can help arm your skin against the sun.

Blueberries

Blueberries, and all berries for that matter, are a rich source of antioxidants. Sunlight exposes us to UV radiation, but the free radical-fighting properties of antioxidant foods help to protect us from that sun damage. Blueberries are also a wonderful source of Vitamin C that helps to strengthen and boost collagen production.

Find blueberry recipe inspiration right here!

Hemp Seeds

Hemp seeds, as well as chia seeds and flax seeds, are a rich source of omega 3 fatty acids, which help our skin maintain its integrity, keeping it smooth, strong and supple. Omega 3s are also highly anti-inflammatory, so these foods can help with healing if a sunburn occurs.

Add hemp seeds to smoothies, or use them as a topper for soups, stews, cereals, dairy-free yogurt, granola, or nut butter on toast. One of our faves is this hemp chocolate spread.

Carrots and Red Bell Peppers

Carrots and red bell peppers are both high in beta-carotene, which our bodies convert into Vitamin A, a nutrient that supports vision, skin and mucosal healing. Research shows that beta-carotene shields us from sunburn; however, these sun-protective effects kick in after a minimum of 10 weeks of consuming beta-carotene, so start chowing down on these veggies stat!

Try these carrot cake energy bites for carrot-y goodness.

Tomatoes

Gorgeous tomatoes of all shapes, sizes, and colours are abundant in the summertime for good reason – their concentration of the pigment lycopene helps to protect us from sunburns. Studies have found that research participants who ate tomato paste daily for 10 weeks were much less susceptible to sunburns than groups who hadn’t consumed tomato paste. We especially adore consuming tomatoes in salsa and tomato sauce.

Now you have another reason to enjoy the bounty of tomatoes this summer, don’t you think?

Dark Leafy Greens

Dark leafy green vegetables are an incredible source of antioxidants, which can help offset the damage from UV rays. Studies have shown that lutein and zeaxanthin – specific antioxidants found in greens – prevent skin wrinkles and protect us from the sun. Research also shows that eating dark leafy greens can decrease our risk of skin cancer.

You can add greens to virtually any meal. We also love making kale chips!

Cacao Powder

If you’re looking for another reason to eat more chocolate, here it is: the antioxidants found in cacao powder help prevent sun damage. In one study, women who were given a high-flavanol chocolate beverage for 12 weeks were less sensitive to UV radiation than women who consume a low-flavanol beverage. This same study showed that consuming chocolate improved blood flow to the skin, as well as enhanced skin texture and structure. Score!

You can get started with these incredible dairy-free chocolate recipes.

Green Tea

Green tea is rich in polyphenols, particularly one called epigallocatechin-3-gallate (EGCG), which offers natural sun protection, helps to destroy free radicals, and may inhibit skin tumors. When applied topically, EGCG preparations can reduce skin redness. If it’s hot outside, simply chill your green tea to make iced tea, or use it in smoothies.

Find more ways to use green tea – and all different kinds of teas – in your cooking and baking.

Sardines

These small but mighty fish are packed with selenium, an antioxidant that may help prevent damage from UVB rays. They are also rich in amino acids (protein) that help with healing and repair, as well as anti-inflammatory Omega 3s. Evidence indicates that Mediterranean-style diets, which include plenty of fish, nuts and seeds, olive oil and vegetables, help to protect against melanoma.

Sunflower Seeds

Sunflower seeds are high in Vitamin E, which has antioxidant properties that help to protect the skin against damage. Eat as a snack, fold into trail mix, or make sunflower seed butter with them.

A nutritious diet plays a key role in our overall health and building resilience, as well as providing support to us when we are outside in nature. These best foods for sun protection are packed with nutrients, delicious, and easy to incorporate into our everyday lives.

More Awesome Sun-Protective Resources

Plant based iron rich Smoky Black Beans and Veg on toast

A bit of ugly delicious, iron rich, #plantbased eating to start the week. Sautéed smoky black beans with spinach, tomato, spices and a sprouted bread (you can enjoy with sourdough/wholewheat bread or even on top of quinoa)

NUTRITION per serve (not including bread)
Protein : 14.2g
Fibre: 17.3g
Calcium: 177mg
Iron: 5.6mg
Magnesium: 140mg

To make: heat approx 1/2 tsp garlic infused oil in fry pan, add 1 large tomato, 2-3 cups baby spinach and sauté 2 minutes, add 3/4 cup cooked black beans, 1/2 tsp Smokey paprika, pinch chilli flakes and iodised salt, and cook a further 2 minutes. Top with 2tbsp fresh chopped parsley and black pepper and serve on a sprouted / sourdough / whole-wheat bread.

The addition of tomato in this recipe (vitamin c rich) helps the absorption of plant based heme iron. You could also benefit by eating a c-rich kiwi fruit after as a nice sweet finish too!

A new study by researchers at Tufts University and the Cleveland Clinic and published in the American Heart Association journal Atherosclerosis, Thrombosis, and Vascular Biology claims that higher red meat intake is associated with increased risk for heart attacks and strokes (ASCVD or atherosclerotic cardiovascular disease), partly because it contains carnitine, a nutrient found only in animal source foods (ASF), particularly in red meat. More than 50 news outlets have already picked up this article. How important are these new findings? Should you worry that eating red meat could cause you to have a stroke or a heart attack?

Unfortunately, this happens to be a nutrition epidemiology study, so it is simply not capable of providing meaningful information about this question that we can use to guide our food choices.

No nutrition epidemiology study can be taken seriously because the methodology used is wholly unscientific. [To learn more, please see: The Problem with Epidemiological Studies.]

Nutrition epidemiology relies on memories, not measurements

Science requires data. Data, by definition, must be objective and quantifiable. Nutrition epidemiologists do not generate dietary data because they do not measure actual food intake. Instead, they use memory-based questionnaires that force people to estimate their intake of a select list of foods over long periods of time.

These excerpts below, taken from this new study, tell you everything you need to know about how this plant-biased sausage was made:

“Usual dietary habits over the past year were assessed in 1989 to 1990 using a validated 99-item picture-sort-food frequency questionnaire (FFQ) adapted from the National Cancer Institute, and again in 1995 to 1996 using a validated Willett semiquantitative FFQ.

For each FFQ, participants were asked to indicate how often, on average, they had eaten given amounts of various foods during the past year. [my emphasis]”

Notice:

1. People were asked to remember what they had eaten over an entire year. How accurately do you think you could quantify all of the foods you have eaten since August 2021? Most people can’t remember what they ate last week, let alone what they ate 12 months ago.
2. This study claims to have followed nearly 4,000 participants over more than 12.5 years, yet they only inquired about dietary intake twice: once in 1990 and once in 1996, as if intake during these two years would accurately represent intake over the entire 12-plus years of follow-up.
3. One of the FFQs only contained 99 food questions (and the other probably contained no more than 131 items*), yet the typical U.S. supermarket contains thousands of food items. Don’t all of the other foods matter?

*It’s unclear which version of Professor Willett’s FFQ was used because the authors provide three different citations. Below is a description of the 131-item FFQ taken from ref. #37:

“The semiquantitative FFQ is designed to assess dietary variables that are hypothesized to affect the occurrence of heart disease and cancer. It includes 131 food items with specific serving sizes that are described using natural portions (eg, one banana, two slices of pizza) or standard weight and volume measures of servings commonly consumed in this study population. For each food item, participants indicated their average frequency of consumption over the past year in terms of the specified serving size by checking one of the nine frequency categories. The selected frequency category for each food item was converted to a daily intake. For example, a response of “two to four per week” was converted to 0.429 servings a day (three per week). [my emphasis]” 1

Translation: the authors “convert” ballpark guesses into concrete quantities down to the third decimal place, thereby creating the illusion of precision.

Even if the information gathered was accurate (which is not possible given the methodology), the strength of the associations (represented by the hazard ratios) between meat and heart disease risk are all well below 2.0, the threshold recommended by the Bradford-Hill criteria as one of (many) prerequisites for establishing causality (1.0 = no association). Notice also that the lower limit of the confidence intervals (noted in parentheses following each bolded value) approach 1.0:

“After multivariable-adjustment, higher intakes of unprocessed red meat, total meat, and total ASF  associated with higher ASCVD risk, with hazard ratios (95% CI) per interquintile range of 1.15 (1.01–1.30), 1.22 (1.07–1.39), and 1.18 (1.03–1.34), respectively.”

Using the first “data” point as an example: the hazard ratio was 1.15 (far below 2.0) and the confidence interval ranged from 1.01 to 1.30, meaning that the actual value could fall anywhere within that range. The lower limit is 1.01…just a whisker above 1.0; these are truly trivial and therefore meaningless associations.

Furthermore, if their theory about meat and TMAO were correct (which it’s not), then fish should have been much more strongly associated with ASCVD risk, because fish naturally contains high amounts of TMAO, whereas the carnitine in meat has to first be converted to TMAO in the intestine by gut bacteria. Yet this new study found no association between fish and ASCVD:

“Processed meat intake associated with a nonsignificant trend toward higher ASCVD (1.11 [0.98–1.25]); intakes of fish, poultry, and eggs were not significantly associated. [my emphasis]”

Norwegian fishery scientists have rightfully taken issue with this illogical “fish contains lots of TMAO but don’t fear fish, fear red meat” argument in more than one scientific rebuttal, including this one:

“Microbial Trimethylamine-N-Oxide as a Disease Marker: Something Fishy?” which concludes “We suspect that the TMAO story may be a red herring.”

Fishy indeed…

Nutrition epidemiology studies will continue to pollute the stormy seas of nutrition science unless and until academic journal editors decide to categorically reject them as unscientific and unpublishable. It should be considered scientific malpractice to subject the public to these epidemi-illogical, data-free hypotheses about food and human health.

Notes:

The Cleveland Clinic first began studying the potential relationship between red meat, carnitine, TMAO, and heart disease back in 2013. If you are curious to learn more, you can read my explanation and critique of that convoluted study here: “Does Carnitine from Red Meat Cause Heart Disease?.” (I must admit I had a little fun with it).

If nutrition epidemiology interests you, my forthcoming book Change Your Diet, Change Your Mind (2023) will devote a full chapter to the topic. This is necessary because, in order to arrive at a useful definition of what a brain-healthy diet is, we must first disrobe and discard the entire field of nutrition epidemiology. Since the lion’s share of what we have been led to believe about food and human health springs from this deeply flawed methodology, the way to the truth about what foods keep us healthy must begin with a clean slate.

A new study by researchers at Tufts University and the Cleveland Clinic and published in the American Heart Association journal Atherosclerosis, Thrombosis, and Vascular Biology claims that higher red meat intake is associated with increased risk for heart attacks and strokes (ASCVD or atherosclerotic cardiovascular disease), partly because it contains carnitine, a nutrient found only in animal source foods (ASF), particularly in red meat. More than 50 news outlets have already picked up this article. How important are these new findings? Should you worry that eating red meat could cause you to have a stroke or a heart attack?

Unfortunately, this happens to be a nutrition epidemiology study, so it is simply not capable of providing meaningful information about this question that we can use to guide our food choices.

No nutrition epidemiology study can be taken seriously because the methodology used is wholly unscientific. [To learn more, please see: The Problem with Epidemiological Studies.]

Nutrition epidemiology relies on memories, not measurements

Science requires data. Data, by definition, must be objective and quantifiable. Nutrition epidemiologists do not generate dietary data because they do not measure actual food intake. Instead, they use memory-based questionnaires that force people to estimate their intake of a select list of foods over long periods of time.

These excerpts below, taken from this new study, tell you everything you need to know about how this plant-biased sausage was made:

“Usual dietary habits over the past year were assessed in 1989 to 1990 using a validated 99-item picture-sort-food frequency questionnaire (FFQ) adapted from the National Cancer Institute, and again in 1995 to 1996 using a validated Willett semiquantitative FFQ.

For each FFQ, participants were asked to indicate how often, on average, they had eaten given amounts of various foods during the past year. [my emphasis]”

Notice:

1. People were asked to remember what they had eaten over an entire year. How accurately do you think you could quantify all of the foods you have eaten since August 2021? Most people can’t remember what they ate last week, let alone what they ate 12 months ago.
2. This study claims to have followed nearly 4,000 participants over more than 12.5 years, yet they only inquired about dietary intake twice: once in 1990 and once in 1996, as if intake during these two years would accurately represent intake over the entire 12-plus years of follow-up.
3. One of the FFQs only contained 99 food questions (and the other probably contained no more than 131 items*), yet the typical U.S. supermarket contains thousands of food items. Don’t all of the other foods matter?

*It’s unclear which version of Professor Willett’s FFQ was used because the authors provide three different citations. Below is a description of the 131-item FFQ taken from ref. #37:

“The semiquantitative FFQ is designed to assess dietary variables that are hypothesized to affect the occurrence of heart disease and cancer. It includes 131 food items with specific serving sizes that are described using natural portions (eg, one banana, two slices of pizza) or standard weight and volume measures of servings commonly consumed in this study population. For each food item, participants indicated their average frequency of consumption over the past year in terms of the specified serving size by checking one of the nine frequency categories. The selected frequency category for each food item was converted to a daily intake. For example, a response of “two to four per week” was converted to 0.429 servings a day (three per week). [my emphasis]” 1

Translation: the authors “convert” ballpark guesses into concrete quantities down to the third decimal place, thereby creating the illusion of precision.

Even if the information gathered was accurate (which is not possible given the methodology), the strength of the associations (represented by the hazard ratios) between meat and heart disease risk are all well below 2.0, the threshold recommended by the Bradford-Hill criteria as one of (many) prerequisites for establishing causality (1.0 = no association). Notice also that the lower limit of the confidence intervals (noted in parentheses following each bolded value) approach 1.0:

“After multivariable-adjustment, higher intakes of unprocessed red meat, total meat, and total ASF  associated with higher ASCVD risk, with hazard ratios (95% CI) per interquintile range of 1.15 (1.01–1.30), 1.22 (1.07–1.39), and 1.18 (1.03–1.34), respectively.”

Using the first “data” point as an example: the hazard ratio was 1.15 (far below 2.0) and the confidence interval ranged from 1.01 to 1.30, meaning that the actual value could fall anywhere within that range. The lower limit is 1.01…just a whisker above 1.0; these are truly trivial and therefore meaningless associations.

Furthermore, if their theory about meat and TMAO were correct (which it’s not), then fish should have been much more strongly associated with ASCVD risk, because fish naturally contains high amounts of TMAO, whereas the carnitine in meat has to first be converted to TMAO in the intestine by gut bacteria. Yet this new study found no association between fish and ASCVD:

“Processed meat intake associated with a nonsignificant trend toward higher ASCVD (1.11 [0.98–1.25]); intakes of fish, poultry, and eggs were not significantly associated. [my emphasis]”

Norwegian fishery scientists have rightfully taken issue with this illogical “fish contains lots of TMAO but don’t fear fish, fear red meat” argument in more than one scientific rebuttal, including this one:

“Microbial Trimethylamine-N-Oxide as a Disease Marker: Something Fishy?” which concludes “We suspect that the TMAO story may be a red herring.”

Fishy indeed…

Nutrition epidemiology studies will continue to pollute the stormy seas of nutrition science unless and until academic journal editors decide to categorically reject them as unscientific and unpublishable. It should be considered scientific malpractice to subject the public to these epidemi-illogical, data-free hypotheses about food and human health.

Notes:

The Cleveland Clinic first began studying the potential relationship between red meat, carnitine, TMAO, and heart disease back in 2013. If you are curious to learn more, you can read my explanation and critique of that convoluted study here: “Does Carnitine from Red Meat Cause Heart Disease?.” (I must admit I had a little fun with it).

If nutrition epidemiology interests you, my forthcoming book Change Your Diet, Change Your Mind (2023) will devote a full chapter to the topic. This is necessary because, in order to arrive at a useful definition of what a brain-healthy diet is, we must first disrobe and discard the entire field of nutrition epidemiology. Since the lion’s share of what we have been led to believe about food and human health springs from this deeply flawed methodology, the way to the truth about what foods keep us healthy must begin with a clean slate.

A new study by researchers at Tufts University and the Cleveland Clinic and published in the American Heart Association journal Atherosclerosis, Thrombosis, and Vascular Biology claims that higher red meat intake is associated with increased risk for heart attacks and strokes (ASCVD or atherosclerotic cardiovascular disease), partly because it contains carnitine, a nutrient found only in animal source foods (ASF), particularly in red meat. More than 50 news outlets have already picked up this article. How important are these new findings? Should you worry that eating red meat could cause you to have a stroke or a heart attack?

Unfortunately, this happens to be a nutrition epidemiology study, so it is simply not capable of providing meaningful information about this question that we can use to guide our food choices.

No nutrition epidemiology study can be taken seriously because the methodology used is wholly unscientific. [To learn more, please see: The Problem with Epidemiological Studies.]

Nutrition epidemiology relies on memories, not measurements

Science requires data. Data, by definition, must be objective and quantifiable. Nutrition epidemiologists do not generate dietary data because they do not measure actual food intake. Instead, they use memory-based questionnaires that force people to estimate their intake of a select list of foods over long periods of time.

These excerpts below, taken from this new study, tell you everything you need to know about how this plant-biased sausage was made:

“Usual dietary habits over the past year were assessed in 1989 to 1990 using a validated 99-item picture-sort-food frequency questionnaire (FFQ) adapted from the National Cancer Institute, and again in 1995 to 1996 using a validated Willett semiquantitative FFQ.

For each FFQ, participants were asked to indicate how often, on average, they had eaten given amounts of various foods during the past year. [my emphasis]”

Notice:

1. People were asked to remember what they had eaten over an entire year. How accurately do you think you could quantify all of the foods you have eaten since August 2021? Most people can’t remember what they ate last week, let alone what they ate 12 months ago.
2. This study claims to have followed nearly 4,000 participants over more than 12.5 years, yet they only inquired about dietary intake twice: once in 1990 and once in 1996, as if intake during these two years would accurately represent intake over the entire 12-plus years of follow-up.
3. One of the FFQs only contained 99 food questions (and the other probably contained no more than 131 items*), yet the typical U.S. supermarket contains thousands of food items. Don’t all of the other foods matter?

*It’s unclear which version of Professor Willett’s FFQ was used because the authors provide three different citations. Below is a description of the 131-item FFQ taken from ref. #37:

“The semiquantitative FFQ is designed to assess dietary variables that are hypothesized to affect the occurrence of heart disease and cancer. It includes 131 food items with specific serving sizes that are described using natural portions (eg, one banana, two slices of pizza) or standard weight and volume measures of servings commonly consumed in this study population. For each food item, participants indicated their average frequency of consumption over the past year in terms of the specified serving size by checking one of the nine frequency categories. The selected frequency category for each food item was converted to a daily intake. For example, a response of “two to four per week” was converted to 0.429 servings a day (three per week). [my emphasis]” 1

Translation: the authors “convert” ballpark guesses into concrete quantities down to the third decimal place, thereby creating the illusion of precision.

Even if the information gathered was accurate (which is not possible given the methodology), the strength of the associations (represented by the hazard ratios) between meat and heart disease risk are all well below 2.0, the threshold recommended by the Bradford-Hill criteria as one of (many) prerequisites for establishing causality (1.0 = no association). Notice also that the lower limit of the confidence intervals (noted in parentheses following each bolded value) approach 1.0:

“After multivariable-adjustment, higher intakes of unprocessed red meat, total meat, and total ASF  associated with higher ASCVD risk, with hazard ratios (95% CI) per interquintile range of 1.15 (1.01–1.30), 1.22 (1.07–1.39), and 1.18 (1.03–1.34), respectively.”

Using the first “data” point as an example: the hazard ratio was 1.15 (far below 2.0) and the confidence interval ranged from 1.01 to 1.30, meaning that the actual value could fall anywhere within that range. The lower limit is 1.01…just a whisker above 1.0; these are truly trivial and therefore meaningless associations.

Furthermore, if their theory about meat and TMAO were correct (which it’s not), then fish should have been much more strongly associated with ASCVD risk, because fish naturally contains high amounts of TMAO, whereas the carnitine in meat has to first be converted to TMAO in the intestine by gut bacteria. Yet this new study found no association between fish and ASCVD:

“Processed meat intake associated with a nonsignificant trend toward higher ASCVD (1.11 [0.98–1.25]); intakes of fish, poultry, and eggs were not significantly associated. [my emphasis]”

Norwegian fishery scientists have rightfully taken issue with this illogical “fish contains lots of TMAO but don’t fear fish, fear red meat” argument in more than one scientific rebuttal, including this one:

“Microbial Trimethylamine-N-Oxide as a Disease Marker: Something Fishy?” which concludes “We suspect that the TMAO story may be a red herring.”

Fishy indeed…

Nutrition epidemiology studies will continue to pollute the stormy seas of nutrition science unless and until academic journal editors decide to categorically reject them as unscientific and unpublishable. It should be considered scientific malpractice to subject the public to these epidemi-illogical, data-free hypotheses about food and human health.

Notes:

The Cleveland Clinic first began studying the potential relationship between red meat, carnitine, TMAO, and heart disease back in 2013. If you are curious to learn more, you can read my explanation and critique of that convoluted study here: “Does Carnitine from Red Meat Cause Heart Disease?.” (I must admit I had a little fun with it).

If nutrition epidemiology interests you, my forthcoming book Change Your Diet, Change Your Mind (2023) will devote a full chapter to the topic. This is necessary because, in order to arrive at a useful definition of what a brain-healthy diet is, we must first disrobe and discard the entire field of nutrition epidemiology. Since the lion’s share of what we have been led to believe about food and human health springs from this deeply flawed methodology, the way to the truth about what foods keep us healthy must begin with a clean slate.

Introduction

When nutritional research is dominated by epidemiology, controlled trials are welcome and always worth reviewing. This week’s note is the latest dietary trial involving Professor Christopher Gardner, who has been prolific in this field. Gardner was the senior author for the DIETFITS study, which we reviewed three times previously (Ref 1). Gardner was the lead author of this week’s paper, which was called “Effect of a ketogenic diet versus Mediterranean diet on glycated hemoglobin [HbA1c] in individuals with prediabetes and type 2 diabetes mellitus: The interventional Keto-Med randomized crossover trial” (Ref 2).

As befits a good title, we know from the heading that this study sought to establish whether the keto diet or the Mediterranean diet performed better in people with borderline or diagnosed type 2 diabetes (T2D). The key outcome of interest was HbA1c, which is a measure of the sugar in the blood over the past three months. Finally, we know that it was a crossover trial, which means that all participants tried both diets. As a result, we don’t need to take into account how different people were in each part of the trial; everyone took part in both interventions. We will see that the title didn’t allow for nuance and that the Mediterranean diet was an adapted Mediterranean diet and there was another (medications) twist.

It’s the middle of Winter and you feel a little stuck in a rut. Comfort food has become regular and things have started to snowball. Fear not! Here we have some delicious solutions to kickstart your day back in a healthier direction.

5 Healthy Winter Breakfast Options Approved by a Dietitian

1. Power porridge:

   This one is easy. Swap your boring oats for something a little more exotic. Dress them up instead with adding 2x tbsp of healthy including a combination of sunflower seeds/pepitas/shredded coconut/hemp seeds/linseed and almond meal. Make sure you use milk instead of water to up the protein content of the meal. Finish with a shake of cinnamon and a splash of kefir.

2. Veggie frittata

   Our Lane Cove Dietitian Tatiana has got your sorted here. She has put up a tasty but nutritious recipe here packed full of veggies and some crumbled feta. You will be feeling full and content heading off to seize your day!

3. Tofu scrambled eggs

   Add a twist to your regular scrambled eggs. Ditch the butter and add some silken tofu to add some extra protein and fibre. Option to serve with some grainy sourdough bread, smashed avocado and roasted cherry tomatoes.

4. Sourdough fruit toast with ricotta and banana

   Many bakeries offer this type of bread or most supermarkets sell Bill’s bread which is a great option! Toast and then top with ricotta and freshly sliced banana.

5. French toast topped with berry compote, yoghurt and honey

   An excellent option! Its also very easy to keep your berries frozen and then defrost ready to add as a topping

We hope you enjoy our suggestions 🙂

Ashleigh