Mayo Clinic cardiologist Stephen L. Kopecky, M.D. , discusses controversial research on red meat consumption and its impact on cardiovascular health in this video first shown on Medscape Cardiology .
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Hello and welcome back to the Mayor clinic Medscape Video series. I am Francisco Lopez, humanness cardiologist and professor of medicine at Mayo Clinic. Today we will be discussing no harm in red meat After all. I'm joined by my colleague Dr steve Kopetsky, consultant and professor of medicine and expert in this area. Welcome Dr kopetsky, thank you Francisco. The US has some of the highest red meat consumption per capita in any country of the world. The controversial 2019 annals of internal medicine article encourage red meat consumption and came to the conclusion that we do not need to cut down. Could you briefly tell us the key points of this study? Yes, that's a very interesting study in that it was a systematic analysis and it was an analysis of systematic analyses. So it had multiple studies in it and the conclusions where we don't need to cut down on our red meat. Well if you read the study, it actually showed that eating red meat increased cardiovascular events and increased cardiovascular death, that was their conclusions. But there overriding conclusion was that it wasn't a very big increase in people like to eat red meat. So we really shouldn't change our red meat eating habits. Now, that was very controversial. There were some issues about conflict of interest and other things that came out later. So it but it did generate much interest. And a lot of late press good. Do you think all red meat is the same in terms of health effects? Well, that's, you know, it's a very important question and it is very clear that red meat can be divided into two groups unprocessed and processed. So one processes the whole meat. You know, the whole organ. The whole muscle process though includes a lot of other things. You know, we classically think of processed, in fact, the top five processed foods meats eaten in this country, our lunchmeat, sausage, hot dogs, ham, and bacon. Now, what's a processed meat? You know, if it's cured, if it's smoked, if it's fermented, if it has salt added and or chemical preservatives, it's a it's a processed meat And it's very clear that processed meat for every 50 g you eat, uh which is about two bites. It increases your risk of coronary heart disease by about 40 over a few years. And that's, you know, for daily intake. So, If you look at the data, about 2/3 of that increased risk seems to be related to the sodium in the process meets because it's very heavily, very heavily uh added sodium too, because it's a preservative. So what we end up doing is have to divide them up into processed and unprocessed. Now, the unprocessed meat is not as bad by any means in terms of uh of causing coronary heart disease, but it doesn't really mean we can eat it ad lib either. I mean, people think, well it's okay, so I'll have a big 18 ounce steak and it really should be, you know, considerably less red meat that we daily good. Now this paper show results all over the place. I mean, it was not really a unified result in all of these studies. So why is this so difficult to do in a study of red meat intake and effects on health? Yeah, good question. It's uh you know, we are what we stand idly doing medicines would like to do a randomised placebo controlled double blind trial. You can't do that with red meat, you can't double blinded and you can't say, you know, this group of patients, you eat red meat. This group of patients not eat red meat because you would be including vegans or vegetarians and that would be a different, whole different subset of people. So it's impossible to do a randomized trial. Most, even the mediterranean diet trial, the premed study was basically a cohort that was followed. So we just can't really do a standard trial and there's a lot of crossover. So a lot of people that are eating red meat a little bit, we'll eat more. They'll have a family reunion or 4th of July picnic or something. And it's basically the studies that are done are done from recall and they not recall every day. They have a recall questionnaire every couple of years and say how much red meat do you eat every day? Well, as as humans, we tend to forget, you know, how much we actually eat and or misremember it. And so it's very, very difficult to know the dose of the red meat that people eat. Plus the final thing is what's what is accompanies the red meat. You know, if you're eating red meat with a lot of fats on it, manet's and you know, processed foods and etcetera, it really confounds things quite a bit and it's just almost impossible to separate those things out. And perhaps also, you know what the other question is, What, what the other people there are not meat eaters are eating, right? That might not be very healthy either. So, if if they eat a lot of sugar or low fat things might, might be also affecting the thing. No, thank you. So, uh, moving on the next question. Uh, so red meat has been linked to saturated fats because obviously red meat has a considerable amount of saturated fat. And this has been linked since the seven nations study published about 50 years ago. What uh what have we learned that is still true regarding saturated fat right now? Well, you know, the saturated fat story from the Seven Nations study. It's very interesting if you go back and look at these studies and they're, you know, they're minutes their notes of their meetings and such that I reviewed and many of the of the mediterranean countries that were involved around the mediterranean ocean. See, they they said to the principal investigator, g um, you know, you're focusing a lot on red meat and saturated fat. And maybe, you know, what we really do more here is we use more mono unsaturated fat, like olive oil for our primary source of uh And the principal investigator, Ancel Keys, who was really a leader in this field, and many of the things he said are exactly correct. But he said, you know, I really think it's more red meat and that's where the saturated fat came from. Well, subsequent studies have been done. One of our colleagues bob Francis father was one of Ancel Keys is investigators with him. And some data has come out showing that it really wasn't that important to worry about saturated fat that instead try to have more olive oil in the diet and limit saturated fat to a certain degree. The other thing is what do you eat instead of saturated fat? Well you tend to eat at least when those studies were done, a lot of carbohydrates and a lot of trans fats which have now been outlawed and a lot of carbohydrates that were that contain trans fats and they're highly processed. So it's it's again it's very difficult to separate out individual macro nutrients in the diet. And I think the best way to handle this is to help us all understand in our patients what to eat in terms of things they understand, like eat, you know, red meat or eat a blueberry or eat an apple or you know, things like that. No, thank you. Now, going back to the red meat consumption. So based on the annual study, analysts study that showed a modest but significant increase in risk uh but only in the group that had a very high intake of red meat. Will it be safe to say that modest amounts of meat will not be necessarily harmful compared to being vegetarian? Any thoughts on that? Yeah, that's a good question, Francisco. You know, if you look at what our bodies have eaten for the past tens of thousands of years in millennia, we've had red meat, we've eaten red meat, but we didn't eat a lot every day. We couldn't go out and kill a deer for breakfast. We would uh, use meet at for celebratory purpose is, you know, a new, a wedding or a new king or queen or a new birth or uh, you know, celebration of some sort. So small amounts of red meat we've been using, we've been eating, you know forever. But again, emphasize the small amounts. If you look at some of the tribes in the world, like the bolivian jungle, Amazonian jungle, the tsunami indians, they, you know, a few ounces of red meat on average today. And if you look at the pretty med study, the mediterranean diet study, they allowed up to three ounces of red meat today. Now I ask my patients to eat three ounces of red meat and I show them it's a deck of cards and they say, oh my God, I mean that's like two bites doctor, what am I going to do? And so we have to encourage our patients to slowly change their habits. And I due emphasis the slow one bite at a time because you cannot change quickly, but take one bite, put it on the side and fill something else in there that maybe a little better or healthier for you. So the bottom line is processed meats are the ones to avoid. The whole meat is okay to have a little bit, but be careful because the, you know, it's it's small amounts and it gets away from us very quickly. And finally, the even the whole red meat while it doesn't seem to increase our risk much, although it does increase the risk for diabetes, it doesn't seem to lower our risk any at all. Like some of the other things we eat like fruits, vegetables, legumes, olive oil. Now, the mediterranean diet has been shown to be beneficial for cardiovascular disease. Um, event reduction. Does this dietary pattern allow red meat? And if so how much? Yeah, Well, mediterranean, they suggested this three ounces of me today and not to go over that it wasn't required, but don't go over it and then really avoid the process. Meats. Like we talked earlier, they're the ones that are full of sodium, raise our blood pressure, have a lot of chemical additives and that's what we really have to be careful with. And the issue there of course, is when we're in times like now with the pandemic, we tend to eat a lot more pre made foods and that would include processed meats, luncheon meats, which is the number one processed meat, the wheat in this country. Good. Well, excellent. Thank you. Doctor Kopetsky. Uh, those were very important points. Thank you for joining us on the heart dot org. Medscape Cardiology. Thank you. Thank you.
