A Self-Appointed “Expert Panel” Just Released New Guidelines on Eating Red Meat. Here’s Why They’re Wrong.

Rania Dempsey, MD MS | October 1, 2019
 

A paper published today in the Annals of Internal Medicine1 recommends that adults continue to eat unprocessed and processed red meat at current levels—in other words, that there is no need to reduce red meat consumption. The paper was released among a flurry of headlines picked up by the popular press including titles like “Red meat unhealthy? Maybe not after all.”

The problem is that the authors of this paper didn’t actually find that red meat was healthy.  In fact, the authors’ own analyses confirmed what the large body of research preceding today’s publication has already found: that there is some evidence that decreasing red meat consumption (both processed and unprocessed) results in a small reduction in the risk of cancer mortality, major cardiovascular outcomes, and type 2 diabetes.

The opinion of the self-appointed panel was that the decreased disease risk observed in people who eat less red meat is not significant enough to warrant recommendations to decrease red meat consumption. They also noted (rightly so) that the research around this particular topic is of relatively poor quality so the strength with which recommendations can be made is limited. But isn’t this something consumers should be able to decide for themselves? Isn’t it more responsible to share accurate information and let individuals decide for themselves whether or not to eat more or less red meat?

The panel’s recommendations were irresponsible for several reasons:

First, physicians are committed to the principle to “first do no harm”, so evidence should be fairly convincing in order to overturn the current recommendation of limiting red meat consumption. However, the authors themselves acknowledged that their own conclusions were a “weak recommendation” based on “low certainty evidence.” The evidence in the other direction (that eating higher amounts of red and processed meat increases heart disease, cancer, and diabetes risk) is based largely on observational studies—it simply isn’t realistic to conduct a 20 year-long randomized controlled trial (the “gold standard” of medical research) comparing those assigned to eat red meat for a lifetime with those assigned to eat none. But multiple studies report a lower risk of disease associated with lower red and processed meat consumption, and we do know from shorter-term randomized controlled trials that decreasing red and processed meat lowers inflammatory proteins found in the blood stream. This is important because inflammatory proteins play a role in disease processes such as heart disease, cancer, and diabetes. Taken together, the short-term reduction in inflammation from decreasing red meat consumption, combined with the longer-term lower disease risk associated with lower red meat intake (albeit small), is enough to convince me to recommend that my patients limit red meat until definitively proven otherwise.

Secondly, the authors concluded that individuals who eat red meat report that they enjoy eating red meat, so therefore the small risk reduction observed from limiting red meat doesn’t warrant a recommendation to limit intake. This simply doesn’t make sense. Of course each individual should weigh their own enjoyment of any activity against the perceived risks, and make informed decisions. In fact, in our household the 3 omnivores who love red meat do in fact enjoy it on rare (no pun intended) occasions. But the click bait-worthy press release distributed by the Annals of Internal Medicine entitled “New guidelines: No need to reduce red or processed meat consumption for good health,” implies that the evidence shows red and processed meat to be safe to consume at any level, and that just isn’t true. Would we be OK with telling smokers that if they really like it, smoking may be alright for them too since fewer than 10% of lifelong smokers actually get lung cancer? The data should be presented accurately so that each individual can make informed decisions, which means acknowledging that the preponderance of evidence shows at least a small increased risk of disease with eating red and processed meat.

Lastly and perhaps most importantly, the authors state that “Considerations of environmental impact or animal welfare did not bear on the recommendations…The panel took the perspective of individual decision making rather than a public health perspective.” To publish “Dietary Guideline Recommendations” without taking the public health or environmental impact into consideration in this era is beyond irresponsible. In the book “Drawdown: The most comprehensive plan ever proposed to reverse global warming” edited by Paul Hawken, increasing plant consumption/decreasing meat consumption is ranked as the 4th most important overall out of 100 strategies to help improve the climate crisis. The question of whether and how much red meat to eat is deeply intertwined with public health and climate considerations, and “Guidelines” should not be published without taking these factors into account.

My take home is this: Diets based on a foundation of plants (whether they include no red meat or small amounts of red meat) cost less, are better for the environment, and have proven health benefits. Is there enough evidence to tell my 15-year-old meat-loving daughter she can never enjoy barbecue ribs at a family cookout again? Not exactly. But to imply that scientists and physicians really have no idea whether eating less red meat has an impact on individuals or the environment is misleading and irresponsible. Dietary choices don’t have to be all or none, but if there is an option that definitely helps the environment and probably benefits my own health as well, I’m certainly going to shift my family’s eating patterns in that direction whenever I can.

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. [Epub ahead of print 1 October 2019] doi: 10.7326/M19-1621. Available at: https://annals.org/aim/fullarticle/2752328/unprocessed-red-meat-processed-meat-consumption-dietary-guideline-recommendations-from