In this slide deck I show on the basis of meta-analyses how red and processed meat is linked to diabetes, strokes, heart disease and cancer whereas dairy is not.

1. Risk of diabetes, cardiovascular
disease and colorectal cancer
Impact of protein sources
Authorized nutritionist, M.Sc, MBA
ReijoLaatikainen
www.pronutritionist.net
www.pronutritionistblog.com
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2. 2

3. Diet high in animal protein & fat -
health risk in prospective cohorts
Sjögren Lagiou et al. Trichopoul Halton et Fung et al. Koning et Similä et al,
et al. 2007 ou et al. al. 2009 2011 al. 2011 2012
2010 2007
(adequate
reporters)
Mortality NS 11 %  22 %  N/A 12 %  N/A N/A
per 5 index per 5 index (lowest vs
points points highest)
CHD NS 37 %  9% N/A NS N/A N/A
mortality per 5 index per 5 index
points points
Any 50 %  N/A N/A N/A N/A N/A N/A
cardiac per SD
event
T2D N/A N/A N/A N/A N/A 37 %  4 %↑/fat 2 E%
15 %/pro 2 E%
Note! Read meat and processed meat are the biggest sources of animal protein & fat
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4. Red meat. Prospective cohorts / meta-
analyses
RR
1.6 1.51
1.42
1.4 Effects are
1.28
1.19 independent of fat
1.2 1.11 1.13 1.09 content
1
1
1 serving Red
0.8
meat (Fresh)
0.6
50 g
100 g
100 g
100 g
120 g
30 g
50 g
0.4
50 g
1 serving
0.2 Processed meat
0
* ** ***
T2D CHD* Strokes Colorectal
cancer
*) Michas G, Mozaffarian D, Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes -
An Updated Review of the Evidence.Micha R, D.CurrAtheroscler Rep. 2012 Sep 22. [Epub ahead of print]
**) Kaluza J, Wolk A, Larsson SC
Red meat consumption and risk of stroke: a meta-analysis of prospective studies. Stroke. 2012 Oct;43(10):2556-60.
***) Larsson SC, Wolk A.
Meat consumption and risk of colorectal cancer: a meta-analysis of prospective studies. Int J Cancer. 2006 Dec 1;119(11):2657-64
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5. SFA per se is not risk factor for CHD
(prospective cohorts)
Siri-Tarino PW et al. Am J Clin
Nutr (January 13, 2010).
doi:10.3945/ajcn.
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6. Is saturated fat from meat different ?
RR for CVD
(per each 5 % increase as of energy)
1.6 1.48
1.4
1.2
1
0.8 0.62
0.6
0.4
0.2
0
SFA from dairy SFA from meat
”The substitution of 2% of energy from meat SF with energy from dairy SF was associated with a 25% lower
CVD risk [HR (95% CI): 0.75 (0.63, 0.91)]. No associations were observed between plant or butter SF and
CVD risk, but ranges of intakes were narrow.”
de Oliveira Otto MC, Mozaffarian D, Kromhout D, Bertoni AG, Sibley CT, Jacobs DR Jr, Nettleton Dietary intake of saturated fat by food source and incident cardiovascular
disease: the Multi-Ethnic Study of Atherosclerosis .Am J Clin Nutr. 2012 Aug;96(2):397-404.
www.pronutritionist.net

7. Dairy. Prospective cohorts / meta-
analyses
RR
1.05
1
1
0.95
0.91
0.9 0.87
0.86
0.85
200 ml
Highvslow
200 ml
200 ml
0.8
0.75
T2D* CHD ** Strokes** Colorectal
cancer ***
*) Tong et al. Dairy consumption and risk of type 2 diabetes mellitus: a meta-analysis of cohort studies. Eur J
ClinNutr. 2011 Sep;65(9):1027-31
**) Soedamah-Muthu et al,Milk and dairyconsumption and incidence of cardiovasculardiseases and all-
causemortality: dose-responsemeta-analysis of prospectivecohortstudies, J ClinNutr. 2011 Jan;93(1):158-71
***) Aune et al, Dairyproducts and colorectalcancerrisk: a systematicreview and meta-analysis of
cohortstudies, ,AnnOncol. 2012 Jan;23(1):37-45
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8. Red and processed meat in
randomized controlled trials
Data is sparse but quite coherently against
high intake of red & processed meat
8 www.pronutritionist.net

9. Randomized trials /mortality and
morbidity?
• 2 truly successful
randomized trials in terms
CHD mortality and morbidity
– Oslo Diet Heart
– Lyon Diet Heart
• In both studies beef, pork
and lamb were restricted
Leren et al. The effect of plasma cholesterol lowering
diet in male survivors of myocardial infarction. Acta
Med Scand. 1966; Suppl 466; 1-9 Oslo Diet heart
study, original thesis version
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10. White meat vs. red meat in RCTs?
• In 3 different randomized trials
replacing red meat by poultry
reduced albuminuria in diabetic
nephropathy
• Generally what is good for
kidney tends to be good for
heart and brain
1. de Mello et al, Long-term effect of a chicken-based diet versus enalapril on
albuminuria in type 2 diabetic patients with microalbuminuria. RenNutr.
2008 Sep;18(5):440-7
2. de Mello et all, Withdrawal of red meat from the usual diet reduces
albuminuria and improves serum fatty acid profile in type 2 diabetes
patients with macroalbuminuria. Am J ClinNutr. 2006 May;83(5):1032-8
3. Gross et al, Effect of a chicken-based diet on renal function and lipid
profile in patients with type 2 diabetes: a randomized crossover trial.
Diabetes Care. 2002 Apr;25(4):645-51
10 www.pronutritionist.net

11. Red meat in low carb trials
• LCD high in SFA based on high fresh beef
intake
– Small & Medium dense LDL ↑
– Total LDL ↑, apo B ↑
• “This was in contrast with our earlier studies
where the same amount of saturated fat and
very similar carbohydrate intake but a diet
not loaded up with red meat, had no adverse
effect even if it had lots of saturated fat in it.”
– Krauss R, April 17, 2012,
www.meandmydiabetes,com
Krauss R et al, Separate effects of reduced carbohydrate intake and weight loss on atherogenic.Am J ClinNutr. 2006
May;83(5):1025-31
Mangravite et al. Changes in atherogenicdyslipidemia induced by carbohydrate restriction in men are dependent on
dietary protein source. J Nutr. 2011 Dec;141(12):2180-5
Faghihnia et al, Effects of dietary saturated fat on LDL subclasses and apolipoprotein CIII in men. Eur J ClinNutr.
2012 Sep 5. doi: 10.1038/ejcn.2012.118
11 www.pronutritionist.net

12. Red meat or oily fish?
N=25, 8 week cross-over, women
red bars= red meat, black bars = fish
HDL –cholesterol was higher in
Navas-Carretero An fish group. No other significant differences between
oilyfishdietincreasesinsulinsensitivitycompared to a groups,
redmeatdiet in youngiron-deficientwomen. S Br J Nutr.
2009 Aug;102(4):546-53
12 www.pronutritionist.net

13. Red meat, soy beans and low grade
inflammation
• Following markers of
inflammation were reduced
on soy bean diet
– E-selectin
– IL-18
– Nitric Oxide
– TNF-α
– CRP
N=42, 8 week cross-over, women w
metabolic syndrome
Azadbakht L et al, SoyConsumption, Markers of Inflammation, and EndothelialFunction
A cross-overstudy in postmenopausalwomenwith the metabolicsyndrome. Diabetes Care 30:967–973, 2007
13 www.pronutritionist.net

14. Opposing evidence?
• I haven’t found any RCT or
prospective cohort evidence
that tied red and processed
meat to better health
outcomes in terms of T2D,
CHD, strokes and cancer
• Yes, red meat is a good
source of heme iron and
protein
• Yes, humans have eaten red
meat since stone age
14 www.pronutritionist.net

15. Conclusions on red meat
• Red and especially processed meat intake is strongly linked to T2D,
CHD, strokes and colorectal cancer whereas dairy is not
• Direct comparisons (RCTs) between red meat based diets and mixed
protein diets are needed
• Red meat is an example, how obsessing on one single nutrient
(saturated fat)nutrient may make us (almost) blind to see other emerging
evidence (like the risks of processed and red meat)
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16. Wellcome aboard!
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http://www.pronutritionist.net
ReijoLaatikainen, Authorized
Nutritionist, Registered dietitian, MBA
Food images bought and licensed from BigStockPhoto
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