A few years ago, a health and nutrition story made a splash by appearing in numerous leading news outlets, including the New York Times, the Washington Post, National Public Radio, and CNN. Almost everybody who was anybody was discussing this story. The problem is that its subject, a report published in the Annals of Internal Medicine, was the very definition of fake news.^[1] The report, titled “Unprocessed red meat and processed meat consumption: dietary guideline recommendations,” came from the Nutritional Recommendations (NutriRECS) consortium. Purporting to be above the fray and careful to minimize conflicts of interest, the 19 authors write, “We developed [the consortium] to produce rigorous evidence-based nutritional recommendations adhering to trustworthiness standards.”

Here is the bottom line of their report: “The panel suggests that adults continue current unprocessed red meat consumption [. . . and] processed meat consumption.”

You can see why the publication got such widespread coverage: it is completely opposite the majority of dietary guidelines and health organizations today, which have increasingly recommended avoiding red and processed meats and emphasized whole plant-based foods. These health organizations include the WHO’s International Agency for Research on Cancer (IARC), which classifies processed meat as a group 1 carcinogen (i.e., carcinogenic to humans) and red meat as group 2A (probably carcinogenic to humans), as well as nearly every other health organization you could think of closer to home.^[2] Though there are several reasons to be critical of the IARC’s assessment of meat (read about them here), they throw into sharp relief just how out of step the NutriRECS consortium is with the mainstream scientific community on this subject.

From my perspective, the recommendation to continue the current consumption of red and processed meats does a great disservice to the public. I reject not only the recommendation itself but also the authors’ understanding of nutrition.

The health effects of meat have been the subject of medical and scientific interest for many decades. As a researcher, lecturer, and food and health policy participant, I have been close to this topic for more than 6 decades. In fact, I have been a member or chairman of the panels and committees whose findings are being challenged by this new report. However, the story is even older than that. My most recent book, The Future of Nutrition, about 35 years in the making (no, this is not a typo!), focuses on how nutrition came to be so confusing, a confusion exemplified by this NutriRECS report. Within the vast literature on diet, nutrition, and health, going back at least two centuries, I find that the most significant reason nutrition is misunderstood is the way research is conducted and the findings interpreted.

Meat’s health effects are not characterized by a simple cause-and-effect relationship. There are many different kinds of meat, disease outcomes (cancers, cardiovascular diseases, etc.), and experimental studies used to investigate this relationship. Almost every phase of experimental research and clinical practice in medicine is focused on minute parts of the total information. This reductionism affects how we interpret causes, effects, mechanisms of effect (i.e., biological plausibility), and disease treatment modalities. Likewise, marketing, media coverage, and food and health policy development all focus on exceedingly small parts of the total information. The cost of this myopia is tremendous.

With this background in mind, although there are several problems with the NutriRECS article, I suggest that the critical issue is the authors’ inferior understanding of the advantages and disadvantages of randomized clinical trials (RCT) and observational (correlation) studies, which form the basis of their judgment on the “quality” of the evidence. For them, quality is highest when results are produced by RCT data and lowest when it relies on observational studies. This displays a fatal misunderstanding of nutrition.

RCT studies are useful for studying specific entities (one cause, one effect); however, this is fundamentally not how nutrition works. Nutrition involves countless entities working together to produce countless effects. The RCT study design itself is incompatible with wholistic nutrition. As for the authors’ dismissal of observational studies, concerns about residual confounding variables are fair but only when researchers make the same incorrect assumption of single-agent effects, which, to reiterate, is not how nutrition operates.

This report refers to evidence as if nutrition were a derivative of pharmacology. Its authors also make the bizarre choices of ignoring the environmental impact of meat and using current food preferences as justification for continued consumption.^[3] How might we respond if a similar report recommended the continued consumption of highly processed foods in part because people enjoy them? Surely, the entire point of recommendations like these is to look beyond preferences and assess health impacts.

This report is a figment of the modern medical establishment’s imagination. Nutrition, far from being a derivative of pharmacology, is a science discipline of the highest priority. Our failure to understand this discipline has resulted in an unimaginable number of lives prematurely lost and dollars wasted.

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;171(10):756-764. doi:10.7326/M19-1621
2. World Health Organization (WHO). Cancer: Carcinogenicity of the consumption of red meat and processed meat. October 26, 2015. Online access: https://www.who.int/news-room/questions-and-answers/item/cancer-carcinogenicity-of-the-consumption-of-red-meat-and-processed-meat
3. Qian F, Riddle MC, Wylie-Rosett J, Hu FB. Red and processed meats and health risks: how strong is the evidence?. Diabetes Care. 2020;43(2):265–271. https://doi.org/10.2337/dci19-0063