Cheeseburger Please, and Make It a Double


Consider that for the last year or so, we have been treated a deluge of entreaties to reduce our salt intake, with the American Heart Association going so far as to claim that daily sodium intake should not exceed 1,500 mg. This puts it at odds with the Institute of Medicine, and now European researchers whose data indicates that the healthy range for sodium intake appears to be much higher.

Our conversation about  sodium, much like advice about purportedly evil saturated fats and supposedly beneficial polyunsaturated fats, exemplifies a national obsession with believing eating more or less of a one or a small number of nutrients is the path to nutritional nirvana.

A few weeks back, an international team of scientists did their level best to feed this sensationalistic beast by producing what’s become known since then as the meat-and-cheese study, because it damned consumption of animal proteins.

  • A lot of the key data is in the supplementary tables, which weren’t embedded in the press release, so no one noticed it. The supplementary tables reveal that almost 40% of study subjects were former smokers and nearly 20% are current smokers. These proportions are far greater than the general population; smoking promotes many more cancers than just lung, and it impacts diabetes risk. The last time 40% of American adults smoked was 1965.

  • Study subjects, on average, did not graduate high school, meaning that they were at a substantial socioeconomic disadvantage for having either knowledge or incomes to cultivate and support healthy habits.

  • Like nearly all junk science on health habits, this study doesn’t even mention the importance of physical capacity to mortality and the ability of physical capacity to modulate risk even in the presence of adiposity. In fact, it ignores fitness completely.

  • Study subjects ate an average of 1,823 calories daily, while federal data says American adults eat about 2,200. The quality of calories consumed is described poorly. Fiber intake is not reported, and neither is how the protein was eaten. A cheeseburger made with 70% beef and eaten on a white flour roll is a different animal than grilled salmon consumed on a 100% whole grain roll, even though they might offer similar overall calories and protein content. They also do not report alcohol intake, even though it is a well-established cancer risk factor.

  • The conclusion that people should depend on plant-based proteins to reduce health risks and eat less protein before age 65 is inconsistent with the consensus findings from the Institute of Medicine and with informed thinking on the role that protein plays in satiety and how it may help to reduce obesity levels. Further, sarcopenic obesity is a growing problem that may be affected not only by increasing protein intake but by getting people to engage in resistance training, starting both in middle age.

  • Senior author Valter Longo founded medical food company L-Nutra, which is currently developing two products. One is a plant-based weight-loss food ProLon that the company claims will have “a potent effect in causing weight loss while optimizing the micronutrient nourishment and promoting anti-aging effects in patients.” Interesting nexus for a paper promoting plant-protein consumption.

This is what the study really says: In a population of fat, older, poorly educated Americans who somehow magically ate fewer calories than average, many of whom are or were smokers who apparently never exercised and maybe guzzled alcohol, the authors, including a senior author who stands to benefit directly from the media chittering about plant-protein consumption, conclude that (excess) animal protein is the problem.

This paper is a perfect example of ‘bridge-to-nowhere’ academic nose picking. It also reinforces growing concerns about the validity of research findings in the increasingly dubious peer-reviewed literature. If published at all, this paper would have fit better in the Journal of Irreproducible Results or the wellness literature alongside other forgettable health trivia.

To paraphrase my pal Al Lewis, you don’t have to challenge the data to invalidate it, you merely have to read the data (but you have to go the supplementary tables), and it will invalidate itself.

I’m hungry. Who’s buying the the cheeseburger, fries and beer tonight?

Vik Khanna is THCB’s Editor-At-Large for Wellness. He is also author of THCB’s next e-book, Your Personal Affordable Care Act: Making Yourself Scarce in the Dysfunctional US Healthcare System. Along with Al Lewis, he is co-author of THCB’s inaugural e-book, Surviving Workplace Wellness With Your Dignity, Finances and Major Organs Intact.

36 replies »

  1. Vik,

    I absolutely agree with you – “Health is not a medical product and the majority of what’s needed to remain healthy (for most people most of the time) should not require robuset interaction with the medical care system.” (-Vik Khanna) I also absolutely love the content of what you said about graduate and professional degrees not being independent validations of the opinions they produce, although I don’t consider people with such degrees clowns. Each opinion stands on its own. And most of the knowledge required to enjoy good health does not require formal education, although in the absence of being raised with an awareness of the habits that foster good health some level of education is needed.

    My bias is that, having seen what is playing out in politics, healthcare, the ER, and society in general, I would like to shift the focus from healthcare to health. A part of that shift is healthcare changing to support the things that foster health, but a bigger part of it is our communities and country being clear on what those things are. Knowing is not enough, but it is a prerequisite to doing in this case.

    What are those things that foster health? We could say they’re simple – leave it to intuition. I addressed that in the previous response. Or we could say it’s simple, in a way, but when it comes to explaining it things get quite complex. I like your honeycomb metaphor because it gives a nod to the conceptual complexity of health. You, me, and others who agree with and understand the honeycomb metaphor also probably don’t need a metaphor to suggest what the basics are. That leaves me at the pillars. To me it’s a balance between not saying anything and the impossible feat of explaining everything. Every point in between has its own unique audience who will subscribe to only a particular message.


  2. I agree with a lot of what you say. It is uncommonly wise.

    However, please don’t talk to people about pillars of health. It’s an oft-used wellness metaphor and strikingly wrong. Pillars, like the corporate silos that business leaders complain about, lack interconnectedness and don’t conjure an image in the listener’s or reader’s mind of how apparently disparate concepts such as exercise, nutrition, stress management, etc. all connect at multiple levels. A honeycomb might be more apt.

    One of my biggest concerns is that we are tipping towards making everything about healthy living dependent upon the judgments of the professions. Whether it’s physicians or the Ph.D.-adorned clowns who produced this meat and cheese dreck, we are too invested in what experts think and not what experience tells us. Health is not a medical product and the majority of what’s needed to remain healthy (for most people most of the time) should not require robuset interaction with the medical care system.

  3. Vik,

    Even when the science behind a study is good, I have a problem with accepting a study as the final verdict on a subject rather than as an informing opinion. Even the best study is an opinion within a particular context about a population. It doesn’t say anything about Vik, Anoop, or anyone else in particular. Taken out of context, they can be harmful. Considered in context, they can be life saving.

    The article you linked to that questions the validity of many studies (was that a study as well? 🙂 says it well. t’s appropriate to really look at the science behind some of these studies, as you did. What we’ll find is that there’s a difference between truth, which is what studies are supposed to unearth, and reproducibility, which is what studies are designed to find. In most of these studies, if a finding is reproducible across a cohort of people, we say that it’s true. That’s a loaded leap we make. We are so quick to want certainty in the form of a truth, a verdict, a piece of hard evidence as we call it, that often times we are willing to blind ourselves to the limits of not just the study you analyzed, but studies in general.

    What becomes apparent is that is the quality of a study and its stated conclusions are entirely dependent on the author’s ability and motives. Know the storyteller and you know the story. It’s human nature. And it’s true of every opinion we encounter.

    It looks like we generally agree. Let’s take it to the next level then.

    Do you feel that health leaders have a responsibility to articulate a clear message about the direction we need to move in as a country? I use the unusual phrase “health leaders” because the people we really need to step forward are not limited to healthcare. I also include as a health leader just about everyone involved in healthcare and allied health fields. I’m also not reserving it for managers, executives, or providers because many times such positions are dependent on the current system for income (like myself) and face a personal challenge in doing something to shift the system back to basics, as we talked about previously. After all, it doesn’t take a healthcare provider to manage pre-hypertension, pre-diabetes, or someone on their way to depression. A caring friend with a healthy lifestyle can often do it better.

    I feel we have that responsibility. I feel that there’s enough confusion out there about what to eat, how much to exercise, and how much to sleep. I agree with taking the “intuitive positive steps” you mention. Each person has to own the responsibility to tap into that. If that were all that’s needed we could wash our hands of the situation and say what happens is what happens – healthcare and health leaders don’t need to make an effort. But taking intuitive positive steps is only 50% of it. The message that we produce regarding what those steps are is the other 50%. Intuition is also informed by what’s happening around us.

    In fact, I’m now thinking that every opinion that we put out on health, no matter how remotely related through whatever medium of communication, should be accompanied by at least a couple lines on how we need to go back to basics so people don’t forget the big picture and the direction we need to move in. It’s easy to get lost in a compelling article or news/infotainment story. The basics, which I call the 4 pillars of health (nutrition, movement, rest, connection) ain’t sexy. It just works.

    We’ve reached a point as a country where we need a clear, concise message that cuts through all the other stories. That’s what I try to do for my patients when we talk about lifestyle – keep it simple and straightforward. I emphasize taking the next step. It could be a step toward a fresh food, plant-based diet, a step out the door for a walk, stepping into bed to get more rest, or stepping out with a friend. But that next step needs to be clear.


  4. Anoop: thanks for your very thoughtful note. I share some of your experience, having tried my hand at vegetrarianism, no oils, etc. At the end of it all, I eat this way: modest amounts of a broad range of foods, in quantities that I can easily judge will not push me towards overweight/obesity. I am also fanatically devoted to my exercise regime, and much of my eating is designed to support that.

    So, I agree with you: back to basics is the key. But studies such as the one I lampoon are not about back to basics. They are, as Al Lewis noted, thinly disguised sale pitches and, as such, they no less deserving of being lampooned than any fast food company’s advertising campaign.

    There is no one best way to eat, just as there is not single best way to exercise. I’d be happy if, instead of pursuing the “best diet” or the “best exercise” Americans resolved to just do something better today than they did yesterday. People learn best not from stupid science and equally stupid media coverage of it, but from experience. By spinning tall tales of eat-this, dont’t-eat-this, all we do is confuse people and discourage them from taking intuitive positive steps.

  5. Vik,

    I’m not vegetarian, but have gone through stints of being vegetarian, vegan, vegan & no oil – partly to see how it affected how I felt, but also because I have conversations about such diets with my patients in the ER sometimes.

    I like what Perry said, and you supported, about “going back to basics”, but for many Americans the basics of fresh fruit and vegetables, whole grains, and many of the other things on Perry’s list are not the reality. Many don’t even agree on what the basics are.I don’t think a hard-core “this is what you must eat” nutrition plan is the way to go for any one person because one size does not fit all. But, when we’re talking about the health of the country overall, we have to be able to indicate the direction we need to move in. And that direction involves a step toward a fresh food, plant-based diet. That would be a step “back to basics.”

    I love the title of @BobbyGVegas essay – “A Healing Burger.” A burger can heal – why not? But to me the question is whether that’s the direction we need to move in overall. If we’re talking about what’s best for me, you or any one person, we will have several different viewpoints. And if enough people read the post we would have thousands of people supporting each viewpoint. But does that take us where we need to go, not just as individuals, but as a country?

    I can say that from my experiences in the ER, I have no doubt that a step toward a fresh food, plant-based diet (meaning more fresh veg/fruits, less canned/fried/meat) will make a big difference in the lives of my patients.


  6. You’ve found me out. Truth be told, a great burger has been one my guilt pleasures for as long as I can remember, which is pretty amusing considering that when my family came to the US my parents were both praticing Hindus who did not eat beef. My first burger was at a White Castle in Queens when I was about 4. Love at first bite.

  7. Now that sounds good. Unfortunately, the nearest WholeFoods is about an hour away. I imagine the hippies dreamed that up after partaking of some weed.

  8. I wonder how many people have gone out and ordered cheeseburgers after reading this post. admit it, vik you’re an agent of the meat industry ..

  9. I love ice cream…..though I;ve had it maybe ten times in two years. And btw, try coconut bliss, yes made from coconut milk. It is really, really good. WHole Foods carries it, company was created by a couple of hippies in Eugene. Pricey but worth every penny.

  10. I agree regarding FG; my favorite among the quick-serve options. If you are ever in the Mt. Airy section of Philadelphia try McMenamin’s. Quite good and the fries are excellent.

  11. For a quick burger, I love Five Guys. Double cheeseburger, with L/T/O & hot peppers. Their fries are awesome.

    For a premium burger, Trader Joe’s 8 oz Kobe beef patty on my grill, brushed with a little olive oil and dusted with salt and pepper. Big, thick slice of onion. Hmm, I think I’ll go make one for brunch.

  12. Perry, I applaud you for the advice to just get back to basics. In my case, that means eating like a pre-agriculturist, paleo, primal or whatever you wish to call it. I eat very little grain (maybe once a month) or sweetener (very, very rare), few fruits but plenty of vegetables, protein and fat-the majority of my calories from the latter.I use olive oil, coconut oil and some grass-fed butter. Once a week, I fast for 48 hours. Works for me.

    I have a cheesebuger once every couple of months. With fries:)

  13. Studies should simply be required to capitalize and bold the word MAY in their conclusions…rather than let it quitely morph into the word DOES in print and in peoples’ minds.

    And, in any articles written referencing the studies, the word MAY should be capitalized and bolded, as well. If we do both of these things, we just MAY get to a better understanding of science vs. spin…truth vs opinion.


  14. Alan, I am still laughing so hard at your last paragraph that I am finding it impossible to formulate a response other than I am really glad to be a trim, nonsmoking, normolipid American of Asian ancestry.

  15. Wow, there’s an article where the reader feedback is almost more impressive than the original. No offence, Vik, but thanks for lighting that particular fuse.

    Speaking of fuses, it was admittedly hard to concentrate on your arguments, with the accompanying visuals of a luscious cholesterol-laden cheeseburger that has now crowded out all other choices from my lunch plans (which may have included kale salad and a beet smoothie) and forced me into the single, logical choice (with fries, of course). Next we shall accuse you of shilling for Wendy’s.

    I see a huge parallel between the plant-protein salesman and the pharmaceutical industry here. If you substituted “cholesterol” instead of ‘animal protein’ you’d have the same sort of reductio ad absurdum thing happening.

    The 4S trial is the best example (when I say ‘best,’ I mean the one with the most impressive results for statins) took 4,444 overweight, high cholesterol, heavy-drinking, heavy-smoking Scandinavian men with previous heart attacks or heart disease and gave half of them simvastatin (Zocor) and half placebo. The result was that compared to placebo 4% fewer of the statin-eating men died over the next five and half years, a result so hidden in the supplementary tables, lengthy hyperbole on how bad cholesterol was, and enough relative risk reductions to choke a hippo, that it obscured one key fact: you can’t extrapolate even this meager result to the rest of us who are not hypercholesterolemic, overweight, smoking Swedes. It’s nice to see a study picked apart and shown how fraudulently the arguments have been constructed. Anyone who has taken the time to consume the overblown statin trials performed on study subjects best labeled as “people-who-don’t-look-like-us” would conclude that these researchers are also conducting “bridge to nowhere” academic nose-drilling of the finest kind. Bravo, Vik.

  16. Yeah, we don’t see many fat Amish around here. They eat like the Alabama farmers, but always walking, biking and doing chores. Now when the rest of us try to eat like that…

  17. Bobby, you are a man after my own heart. Make mine Kobe beef, 8 oz pre-cooked weight, on the most highly refined white flour roll you can find.

    Oh, and let’s get the duck fat fries.

  18. BTW,

    THCB continues to block any links to my REC/KHIT blog, now even if I use a Tinyurl proxy, so I can’t cite the link to this story.

    Google “REC blog” (1st result) and click on the right hand link with Sissy’s photo if you wish to read the entire thing

  19. From my 1998 essay about my late daughter’s cancer struggle:

    “A Healing Burger

    Or, the “healing pizza/chocolate shake/friesî? One day not long ago, after we’d visited with a pleasant, seemingly intelligent woman of recent acquaintance who had also endured a long struggle with cancer and was committed to a “holistic healing” regimen, I ribbed Sissy that we ought cruise down Sunset for lunch, specifically to order some “healing burgers,” — my facetious reaction to having been cut off mid-sentence the prior evening after uttering the phrase “fruit juice” in the course of responding to a query concerning Sissy’s daily diet. “Oh, no! No fruit juice!” “No sugar!” “No fat!” “No meat!”

    The magical quality that “holistic” evangelists impute to various vitamins, herbs, and certain foods (the latter for both good and ill), frequently shouts down the more circumspect and common-sense notion of an adequate and balanced diet. In my mind I parry their personal anecdotes with the equally anecdotal evidence of the long and mostly healthy lives of the large extended family comprising my in-laws. Most of these rural northern Alabama farmers manage somehow to live into their 90’s despite life-long daily breakfast doses of sausage and eggs with biscuits and gravy– along the rest of the typical meat-laden, putatively carcinogenic and arteriosclerotic farm fare that would make a brown rice zealot shrink in horror.

    Most of these dietary-herbal and related recuperative obsessions ring resonant with the “bargaining” stage of Elizabeth Kubler-Ross’s dying process model. Please, Lord, I’ll change my indulgent, unhealthy ways, please– just spare my life! See, I’m doing my herbal/ carrot juice/ seaweed/ colonic/ aromatic/ crystalite/ meditative/ mega-vitamin/ macrobiotic/ psycho-spritual penance; please, please spare my life!”

  20. Silly, John. You don’t have a company with a product to promote, which is much better done with the imprimatur of ‘science-based’.

    That whole schtick is the supplement industry’s stock in trade. You concoct an answer, design a ‘study’ to deliver that answer (and only that answer), frame the data exactly the way you want it to be reported (including the construction of supplementary data that no reporter will read because it upsets the process of re-writing the press release into ‘news’) and, viola, cheeseburger bad, veggie burger good.

  21. Frankly, I find this entire discussion baffling.

    Why do people keep trying to “scientifically” prove things that are, well – when you stop and think about it – straightforward common sense?

    I like cheeseburgers. I am an adult. I don’t need a study to prove to me scientifically that a cheeseburger-based diet is a bad idea.

  22. Al, that’s a good question for the editors of Cell Metabolism. On their website, I cannot find a list of editors or reviewers. To carry my thesis one point further, I think that given Dr. Longo’s promotional interest in having these “findings” widely dissseminated, the journal should release the names of editors and reviewers who passed judgment on the paper. As consumers and readers, we ought to know whether any of them benefit from uptake of this sales pitch as well.

  23. Perry: you hit the nail right on the head. Doing the fundamentals is what matters. But, by vesting so much in the alleged experts and their stilted views, most people no longer recall the basics.

    It isn’t hard at all. We only make it seem hard because that helps to promote something that someone wants to sell us to make it easy again.

  24. Do we really need more studies on these issues? How about going back to basics:
    encouraging fish and chicken consuption, lean meats
    fresh fruits and vegetables
    legumes, and nuts
    whole grains
    etc. and regular physical activity: walking biking swimming, no Arnold Shwarzeneggers needed.
    Sheez how hard can it be?

  25. Where are the growhups who are supposed to be reviewing this stuff before if gets “out there”? Why do we have to read the supplementary tables to figure out this is nothing but a sales pitch.