Where's the Beef?

I have been involved with ACP for about 7 years now, and I’ve heard many things. “Stay in your lane,” on the gun violence policy paper in Annals.  “Why is ACP talking about climate change?” Gun violence and climate change are big topics but not as big as beef.  Just ask Oprah in 1996 (my older millennial and above readers will enjoy that reference).

Annals recently published guidelines on red and processed meat (1), and I've received a flurry of questions from friends, family, and patients since.  Guidelines on “lifestyle” interventions, such as diet and exercise, are published with far less frequency than medication-based guidelines so when they do come out, they get attention.  The New York Times wrote about the guidelines, saying they go too far in limiting red meat consumption. Others have written that Annals and the beef industry are tied (they’re not). I must confess my conflict of interest: I really like steak. 

As much as I am bemused by the press from the article, my patients do bring up relevant questions.  In the era of keto and low carb, is it or is it not okay to have processed meat?  It was not that long ago that WHO named processed meat a carcinogen.  The gist of the Annals article is that it is okay to continue doing what you are doing in terms of meat consumption.  The guideline authors state:  “On the basis of 4 systematic reviews assessing the harms and benefits associated with red meat and processed meat consumption and 1 systematic review assessing people's health-related values and preferences on meat consumption, we suggest that individuals continue their current consumption of both unprocessed red meat and processed meat (both weak recommendations, low-certainty evidence).”

A weak recommendation with low-certainty evidence will not change my recommendations to patients.  This article does not seem to have data that are impactful enough for me to change my current recommendations, which in general is to consume lean proteins and decrease carbohydrate intake.  As much as I like steak, it is a treat to be had on occasion, not a regular staple.  Most of all, my recommendations are tailored to patients’ needs.  For my well-controlled diabetic with elevated triglycerides, limit red meat.  To my elderly patient with B₁₂ deficiency, eat the meatloaf if you want to. 

All of this goes into my larger gripe with guidelines.  We as a scientific community do a better job on evidence-based guidelines related to pharmaceuticals than with lifestyle recommendations.  And our patients are begging for evidence on lifestyle interventions.  It is a confusing world of apps, and vitamins, and supplements, and workouts, and diets.  As lighthearted as I may seem earlier, these questions need to be answered for our patients’ well-being.  Obesity, diabetes, dyslipidemia, and chronic disease are all on the rise.  My generation is expected to live a shorter life than the generations before it (2).  As a primary care doctor in practice, I ask the scientific community for high-quality studies on lifestyle interventions. 

References

1. Johnston BC, Zeraatkar D, Han MA, et al. Unprocessed red meat and processed meat consumption: dietary guideline recommendations from the nutritional recommendations (NutriRECS) consortium. Ann Intern Med. 2019. [PMID: 31569235] doi:10.7326/M19-1621
2. The Health of Millennials. Blue Cross Blue Shield; 24 April 2019. Accessed at www.bcbs.com/the-health-of-america/reports/the-health-of-millennials.