Elizabeth Klodas, MD, FACC

This conclusion was based on the studies the panel chose to analyze — and there were significant problems here.

For example, one of the pivotal analyses of cardiac risk involved looking at randomized controlled trials — of which there are few in nutrition research. By default, this meant that much of the data came from one study, the Women’s Health Initiative Dietary Modification trial. This trial was not designed as a more meat vs. less meat trial. Rather it was usual diet vs. lower fat intake. Yes, the women in the lower fat arm consumed approximately 1.4 servings less meat per week, but this represented a mere 20% reduction in meat intake — and what was substituted in was not analyzed. If the substitution was low-fat processed carbohydrates, for example, a lack of significant outcome advantage would not be surprising.

In addition, eating slightly less of a bad thing might not result in a divergence of outcome curves for decades — and the average follow-up of the studies evaluated was closer to 10 years. A good analogy would be evaluating the health outcomes, over a decade, of smoking two packs per day vs. one and one-fifth packs per day and finding relatively little difference.  And then, because people enjoy smoking and have a hard time quitting, concluding that everyone might as well smoke two packs.

Finally, I take issue with the premise that people don’t want to change their eating habits or that small changes don’t matter. People are willing to change if the new option fits their lives. Plant-based burgers are taking off because people like burgers even if they’re not made with meat. And we’ve shown by randomized controlled clinical trial in a free-living population that through an exchange of two small food servings a day, significant and rapid health improvements are attainable.   

What’s most distressing is that these recommendations fly in the face of what we can readily observe. There are communities of people around the globe who experience exceptional healthy longevity, where being a centenarian is not unusual and where people experience 80% less heart disease, 75% less cancer and two-thirds less dementia. What do these people eat? A whole food plant-based diet. Meat consumption is celebratory and processed meat is rare. There’s certainly more to it that low red meat and processed meat consumption — but whatever those people are doing, I’m doing that! And telling my patients to do the same.

Leonard H. Calabrese, DO

I am profoundly disappointed in these guidelines, both in terms of content and design. I feel sorry for people who work in the world of nutritional science, for I think that the ultimate goal they have is to elucidate the highest level of scientific data on diet and nutrition, which can be utilized to promote health and wellness — I give them that. The way these data are disseminated is highly problematic. It confuses and frustrates the public, and that this will be a disservice to patients who seek to enhance their wellness behaviors. The reason I think this is that you can’t take diet, as one of our behaviors, and treat it like people are taking pills — do you want to eat meat, or do you not want to eat meat? Do you want to eat an egg, or do you not want to eat an egg? Do you want to drink dairy, or do you not want to drink dairy? Do you want to eat vegetables, nuts, etc.? People need to adopt diets that are known to be healthy based on strong science, I give them that, but not one food stuff at a time.

I believe that meat is fine to eat if three-quarters of your plate is plant-based and one quarter of you plate is high quality meat, preferably grass fed — I would encourage people to continue that. But to say “Oh, I’m going to now eat meat,” I want to know what’s on the rest of the plates. Is it full of french fries, or is it brussels sprouts and beans? I just don’t know how people can interpret these data in any type of responsible way. My goal in talking to patients, individually and in groups, is to have them adopt a diet with a prudent overall strategy — whether it be Mediterranean, vegan, paleo, or a combination of paleo and vegan — it’s not incriminating anybody for eating any one individual food.

The last thing I’ll add is that people wrestle over whether they can eat an egg, or whether they can have a cookie, or whether they can have something that’s refined, stripped carbohydrates. People need to be empowered to recognize what they’re eating for their daily nutrition, health and wellness, and what they’re eating for entertainment. You can eat whatever you want for entertainment, but you need to have a plan that is prudent and doable for eating.

Just cranking something out, saying it’s ok to eat meat — what does that tell anybody? I feel sorry for the people that work in this field, I mean, they’re good scientists, they’re trying to interpret these data, but it’s not one thing at a time — we eat holistically.