The Protein Myth

The Protein Myth

 

The Protein MythIn the past, some people believed one could never get too much protein. In the early 1900s, Americans were told to eat well over 100 grams of protein a day. And as recently as the 1950s, health-conscious people were encouraged to boost their protein intake. Today, some diet books encourage high-protein intake for weight loss, although Americans tend to take in twice the amount of protein they need already. And while individuals following such a diet have sometimes had short-term success in losing weight, they are often unaware of the health risks associated with a high-protein diet. Excess protein has been linked with osteoporosis, kidney disease, calcium stones in the urinary tract, and some cancers.

The Building Blocks of Life

People build muscle and other body proteins from amino acids, which come from the proteins they eat. A varied diet of beans, lentils, grains, and vegetables contains all of the essential amino acids. It was once thought that various plant foods had to be eaten together to get their full protein value, but current research suggests this is not the case. Many nutrition authorities, including the American Dietetic Association, believe protein needs can easily be met by consuming a variety of plant protein sources over an entire day. To get the best benefit from the protein you consume, it is important to eat enough calories to meet your energy needs.

The Trouble with Too Much Protein

The average American diet contains meat and dairy products. As a result, it is often too high in protein. This can lead to a number of serious health problems:

  • Kidney Disease: When people eat too much protein, they take in more nitrogen than they need. This places a strain on the kidneys, which must expel the extra nitrogen through urine. People with kidney disease are encouraged to eat low-protein diets. Such a diet reduces the excess levels of nitrogen and can also help prevent kidney disease.
  • Cancer: Although fat is the dietary substance most often singled out for increasing cancer risk, protein also plays a role. Populations who eat meat regularly are at increased risk for colon cancer, and researchers believe that the fat, protein, natural carcinogens, and absence of fiber in meat all play roles. The 1997 report of the World Cancer Research Fund and American Institute for Cancer Research, Food, Nutrition, and the Prevention of Cancer, noted that meaty, high-protein diets were linked with some types of cancer.
  • Osteoporosis and Kidney Stones: Diets that are rich in animal protein cause people to excrete more calcium than normal through their kidneys and increase the risk of osteoporosis. Countries with lower-protein diets have lower rates of osteoporosis and hip fractures.

Increased calcium excretion increases risk for kidney stones. Researchers in England found that when people added about 5 ounces of fish (about 34 grams of protein) to a normal diet, the risk of forming urinary tract stones increased by as much as 250 percent.

For a long time it was thought that athletes needed much more protein than other people. The truth is that athletes, even those who strength-train, need only slightly more protein, which is easily obtained in the larger servings athletes require for their higher caloric intake. Vegetarian diets are great for athletes.

To consume a diet that contains enough, but not too much, protein, simply replace animal products with grains, vegetables, legumes (peas, beans, and lentils), and fruits. As long as one is eating a variety of plant foods in sufficient quantity to maintain one’s weight, the body gets plenty of protein.

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Pink Slime Aside, Meat is Not Safe

By    |   Posted on April 4, 2012 

pinkslime1 Pink Slime Aside, Meat is Not Safe

The recent uproar over “lean beef trimmings”—also known as “pink slime”—has led the maker of this ammonia-treated meat to suspend operations at all but one plant. Beef Products, Inc., acknowledged that the company has taken a huge hit since social media exploded with concerns about this disturbingly unhealthful, chemically-treated substance going into school lunch lines.

The U.S. Department of Agriculture is considering removing pink slime from schools, and fast-food companies have even taken the slime out of their burger recipes. The pink slime pandemonium has inspired bloggers to expose the long list of other unlabeled chemicals that end up in almost all industrial meat. Without any labeling requirement, meat processors can lace meat with chemicals used to bleach fabric, disinfect pools and hot tubs, and bleach wood pulp, just to name a few.

These revelations have consumers fuming. Some are calling for more labeling, and less processing of meat. The meat industry is claiming that these chemically treated products are safe—maybe even safer than beef not treated with chemicals.

But ultimately there is no such thing as safe meat. Meat is loaded with cholesterol and saturated fat, not to mention E. coli and other pathogens that can cause serious illnesses. If treated with chemicals, it then contains substances that may increase the risk of cancer and other health problems.

Beef Products, Inc., is desperately trying to rebuild business, taking out a full-page Wall Street Journal ad and launching a website that proclaims that “Beef is Beef.”

The company has that right. From ground beef to sirloin steak to rump roast, every cut of beef contributes to more deadly illnesses than the chemicals in pink slime will likely ever cause. Whether it’s pink slime or organic, grass-fed beef, it all leads to obesity, heart disease, type 2 diabetes, and other life-threatening illnesses.

The pink slime victory shows just how powerful consumers are when they come together to fight an unsafe product. But it’s hardly the end of the battle: It’s time to face up to the consequences of our meaty diets and move to more healthful ways of eating.

As originally published on PCRM.org

Too Much Breast-Cancer Treatment?

Every few months, another study reports that many breast cancers are being “overdiagnosed”—that is, detected and treated even though they would never cause problems if they were left alone. In one article, epidemiologists in Norway estimated that 15% to 25% of breast cancers found by mammograms were being treated unnecessarily.

A study in Norway fuels the debate over whether breast cancer can be overtreated. Melinda Beck on The News Hub discusses the debate over the concept of too much breast-cancer treatment. Photo: Bloomberg.

The study in the Annals of Internal Medicine in April calculated that for every 2,500 women offered mammograms over 10 years, one breast-cancer death was averted, but six to 10 women were subjected to surgery, radiation and/or chemotherapy unnecessarily.

The researchers in Norway compared breast-cancer rates in counties where a government mammogram program had begun with those without such screening, as well as with past years. They found that detecting and treating many early-stage breast cancers reduced the number of late-stage cancers and deaths only slightly, prompting them to conclude that much of the treatment was unnecessary—in some cases because the cancers wouldn’t have progressed, and in some cases because they were fatal despite being treated early. Other studies have estimated that the overdiagnosis rate falls in a wide range, anywhere from 2% to 52%.

There is currently no way to tell which patients diagnosed with breast cancer—200,000 a year in the U.S.—could safely forgo treatment, breast-cancer specialists say. “When you can tell me which cancers need to be treated and which don’t, then I will consider this argument” about overdiagnosis, says Clifford Hudis, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York City.

Clinicians say leaving breast cancer untreated is a gamble they can’t take. “I don’t know anyone who offers women the option of doing nothing,” says Eric Winer, director of the breast cancer program at Dana-Farber Cancer Institute in Boston. “On the one hand, we are aware of the overtreatment, all of us. On the other hand, there are still 40,000 women every year who die of breast cancer.”

Otis Brawley, an epidemiologist and breast-cancer specialist who heads the American Cancer Society, notes such estimates are all statistical presumptions. “Even if we overdiagnose 1 in 5, we have numerous studies showing that by treating all these women, we save a bunch of lives,” he says.

A 2011 Cochrane review of seven trials in which 600,000 women were randomly assigned to get mammograms or not estimated that while 30% were overdiagnosed, breast cancer deaths were reduced by 15%.

Even in the precancerous stage, called ductal carcinoma in situ (DCIS) when abnormal cells are confined to a milk duct, physicians almost always advise women to have a lumpectomy or mastectomy along with radiation, because about 20% of the 65,000 cases of DCIS found every year in the U.S. become invasive cancer.

A few women do opt to monitor their DCIS to see if it progresses. A study in the journal The Breast last year of 14 such women, who took hormone-blocking drugs, found that after two years, eight decided to have surgery, with five of them having progressed to stage 1 invasive breast cancer. Six remained on active surveillance with no evidence their DCIS had worsened.

The authors, from the University of California, San Francisco, noted that even when DCIS becomes an invasive cancer, it’s treatable when found at an early stage: The odds that a 60-year old woman with a 7 millimeter breast tumor, would die from it in the next 10 years are less than 3%, half the risk she faces of dying from another cause during that time.

Physicians say it would be far riskier to leave invasive breast cancers untreated. “At this point, any breast cancer does need to be removed,” says Bhuvaneswari Ramaswamy, a breast cancer researcher at the Ohio State University Comprehensive Cancer Center in Columbus, Ohio. “We do more than we need to because we don’t know how to do less.”

Scientists have made progress in analyzing individual breast cancers and tailoring treatment accordingly. About two-thirds of tumors have estrogen receptors that make them vulnerable to hormone-blocking medications. About one-third test positive for a protein called HER2 that makes cancers particularly aggressive, but susceptible to the drug Herceptin.

A new wave of tests can predict how tumors will behave based on their genetic profile. The most commonly used test is Oncotype DX, which analyzes 21 genes. Cells from about half the breast tumors in the U.S. are now sent to Genomic Health Inc. in Redwood City, Calif., which developed the test. The company’s technicians determine how likely the cancer is to recur in 10 years and whether the patient would benefit from chemotherapy as well as radiation and surgery. Company officials say the test has reduced the number of U.S. breast-cancer patients on chemotherapy by 20% since it became available in 2004.

A new Oncotype DX test can predict whether a patient with DCIS would benefit from radiation in addition to surgery. But there is no test that can determine whether a breast tumor can be left untreated. “That’s a dream that we would all have for the future,” says Steven Shak, co-founder of Genomic Health, who led the development of Herceptin.

The company is testing a version of Oncotype DX that may be able to tell which prostate cancers don’t need treatment. More than 60% of prostate cancers are thought to be so slow-growing that they would never be life-threatening, but as of now, there is no way to tell those apart from the fast-growing ones that kill 28,000 men in the U.S. every year. About 20% of prostate cancer patients opt for “active surveillance” rather than immediate treatment—in part because the side effects of radiation and surgery can be severe, including impotence and incontinence.

Biostatisticians argue that fewer mammograms would reduce the number of small, early cancers found, as well as the rate of false positives that require additional scans and biopsies. That’s the rationale the U.S. Preventive Service Task Force used in 2009 when it recommended that women get mammograms every two years starting at age 50, instead of annually starting at age 40.

“I’m certainly not asking anyone to stop getting mammograms. I am asking my profession to tell women the truth about the [overdiagnosis] deal,” says H. Gilbert Welch, professor of medicine at Dartmouth Institute for Health Policy & Clinical Practice.

Patients are seldom even told about the overdiagnosis issue and there is very little data on the long-term side effects of cancer treatments, which can include chronic pain, debilitating fatigue, “chemo brain” or foggy thinking, and additional cancers linked to radiation treatments, says Fran Visco, president of the National Breast Cancer Coalition, a nonprofit advocacy group. “We shouldn’t not tell them the truth because we are worried they’ll be confused.”

Many physicians who treat breast cancer patients are loath to stop looking so hard for cancer, and hope for additional tests that can better predict which breast tumors will stay harmless. Meanwhile, says Memorial Sloan-Kettering’s Dr. Hudis, “we are quibbling over whether everyone benefits or only some people. Let’s not lose sight of the fact that we are saving lives.”

The Facts About Breast Cancer

A look at data about the disease in the U.S. and the typical treatments.

Estimated new cases in 2012: 226,870 women; 2,190 men

Estimated deaths in 2012: 39,510 women; 410 men

Median age of diagnosis: 61

Median age at death: 68

Percentage diagnosed as Stage IV (metastasized): 5%

Five-year survival by stage: local 98%; regional 83%; metastasized 23%

Five year survival overall: 89%

Diagnosed in lifetime with breast cancer: 1 in 8 women

Sources: NCI/SEER data from 2005-2009; National Cancer Institute

Typical Treatments by Stage:

Stage 0 (noninvasive DCIS): lumpectomy or mastectomy and radiation, sometimes hormone therapy

Stage I or II: lumpectomy or mastectomy, radiation and often chemotherapy

Stage III: chemotherapy and radiation before or after mastectomy, underam lymph nodes removed, often targeted therapy

Stage IV and recurrent: surgery (depending on where cancer has spread), chemotherapy, radiation, hormone, other therapies

Is Heart Surgery Worth It?

By John Carey, with Amy Barrett You start breathing hard after climbing stairs, and your chest hurts. You go to your doctor. Scans reveal that arteries feeding your heart are severely narrowed. Your doctor sends you to the hospital for coronary bypass surgery or angioplasty to restore the blood flow to your heart. Despite the trauma of surgery, you’re glad the blockage was caught in time, saving you from a potentially fatal heart attack.

 

There’s just one problem with this happy tale of modern medicine: More and more doctors are questioning whether such heart procedures are actually extending patients’ lives. One of them, Dr. Nortin M. Hadler, professor of medicine at the University of North Carolina at Chapel Hill and author of The Last Well Person, is urging the U.S. medical establishment to rethink its most basic precepts of cardiovascular care. Bypass surgery in particular, he says, “should have been relegated to the archives 15 years ago.”

UNLIKE PLUMBING. That is an extreme view that is disputed by cardiac surgeons. “The reason thousands and thousands of bypass surgeries have been done is that [the procedure] is successful,” says Dr. Timothy J. Gardner, co-editor of Operative Cardiac Surgery and a cardiothoracic surgeon at Christiana Care Health System in Wilmington, Del.

 

Nevertheless, the data from clinical trials are clear: Except in a minority of patients with severe disease, bypass operations don’t prolong life or prevent future heart attacks. Nor does angioplasty, in which narrowed vessels are expanded and then, typically, propped open with metal tubes called stents.

 

“People often believe that having these procedures fixes the problem, as if a plumber came in and fixed the plumbing with a new piece of pipe,” explains Dr. L. David Hillis, professor of cardiology at the University of Texas Southwestern Medical School. “But it fundamentally doesn’t fix the problem.”

IMAGE OF INVINCIBILITY. With doctors doing about 400,000 bypass surgeries and 1 million angioplasties a year — part of a heart-surgery industry worth an estimated $100 billion a year — the question of whether these operations are overused has enormous medical and economic implications. “It is one of the major issues in cardiology right now,” says Dr. David Waters, chief of cardiology at the University of California at San Francisco.

 

It is also part of a far broader problem — what some health-care experts call the medicalization of life. “None of us will live long without headache, backache, heartache, heartburn, diarrhea, constipation, sadness, malaise, or other symptoms of some kind,” argues Hadler. Yet under relentless bombardment by messages from the pharmaceutical and health-care industries, Americans increasingly believe that these symptoms — and many others — are conditions that can and should be cured.

 

“We have an image of ourselves as invincible and powerful and able to overcome all odds,” Hadler says. “And the lay press is too quick to talk about the latest widget and gizmo without asking what it is and does it work.”

HIGHER COST, BIGGER RISK. Indeed, there is compelling evidence that more health care and more aggressive treatment across the complete spectrum of illnesses is not necessarily better. When Dr. Elliott S. Fisher, professor of medicine at Dartmouth Medical School, first looked at regional differences in health-care spending in the U.S., he assumed that people in areas with lower expenditures would have worse health than people in regions where spending was 1 1/2 to 2 times as high because they were failing to receive needed care. It turned out that the opposite was true.

 

“Patients have a substantial increased risk of death if cared for in the high-cost systems,” he says. Why? For one thing, additional doctor visits and testing often lead to unnecessary procedures and hospitalizations, which carry risks. “My data suggest that we are wasting 30% of health-care spending on stuff with no benefit and perhaps causing harm,” says Fisher.

 

International comparisons support his reasoning. The U.S. spends 2 1/2 times as much as any other country per person on health care, but that doesn’t translate into better outcomes, according to studies that compare such indicators as fatality rates after a heart attack and length of survival after a kidney transplant. That suggests that “the investment in health care in the U.S. is just not paying off,” says Gerard Anderson, director of the Center for Hospital Finance & Management at Johns Hopkins Bloomberg School of Public Health and co-author of a 2004 study that looked at 21 different health-quality indicators in five nations.

LUCRATIVE CARDIAC UNITS. Similar comparisons can help pinpoint dubious treatments. The classic case: tonsillectomy. In the early 1970s, Dr. John E. Wennberg, now director of the Center for Evaluative Clinical Sciences at Dartmouth Medical School, showed that some hospitals removed tonsils 10 times as often as others. But the children in areas with low rates weren’t worse off, so the operation fell out of favor.

 

More recently, Dr. James N. Weinstein, chair of orthopedic surgery at Dartmouth-Hitchcock Medical Center, found that people with back pain are up to 20 times as likely to have back surgery in some parts of the country as in others. Yet it’s not clear that they do better as a result. Weinstein is comparing the outcomes in patients who get different treatments, from rest and physical therapy to spinal fusion. Meanwhile, he says, “billions of dollars are being spent without good information.”

 

This is of obvious concern to those who pay for health care, from the government to private insurers, which are struggling to better balance costs and benefits. And nowhere are the financial and health stakes higher than in the area of cardiac surgery. U.S. patients and insurers will spend $3.4 billion this year on drug-coated stents from suppliers Boston Scientific (BSX

) and Johnson & Johnson (JNJ

), according to Citigroup. At many hospitals, cardiac units have become major profit centers.

 

“We’ve shown that it is a lucrative area for hospitals,” says Paul B. Ginsburg, president of the Center for Studying Health System Change. But are heart procedures always the best path for patients who currently get them?

HEART ATTACK’S CAUSES. The answer seems to be no. As Hadler describes in his book, data from bypass-surgery clinical trials in the late 1970s show that the procedure extends life or prevents heart attacks only in a small percentage of patients — those with severe disease. More recent trials with angioplasty show it reduces deaths mainly just in emergencies.

 

“For people in the throes of heart attacks, opening the artery definitely prolongs life,” says UCSF’s Waters. Not so for patients with stable chronic disease. “The overwhelming number of heart procedures done these days do not affect patients’ life span at all,” says Hillis.

 

The latest thinking on heart attacks may explain why not. In the traditional view, the slow accumulation of plaque inside arteries gradually narrows the vessels. Reduced blood flow causes chest pain, or angina. Eventually the arteries are blocked, bringing on heart attacks. Newer evidence, however, pins the blame not on this gradual narrowing but on unstable plaque that breaks off and causes clots. The clots are what obstruct the arteries, causing the heart attacks — which is why so many such events are unexpected and why “there is no evidence that opening chronically narrowed arteries reduces the risk of heart attack,” says Waters.

DIET AND LIFESTYLE. A better way to lower heart-attack risk is to fight the unstable plaque with aggressive cholesterol-reducing drug therapy, diet, and lifestyle changes, many cardiac physicians say. That can be a tough sell to patients who want a quick fix, says Hillis.

 

“Medical therapy is just not as sexy as doing a procedure,” he explains. “The assumption our society makes is that the more aggressive your medical care is, the better it is. It’s not true. But if I explain to a patient why he doesn’t need surgery, 9 times out of 10 he will go across town and find someone who will do the procedure.”

 

The surgeries do relieve angina symptoms — and for some doctors that’s a slam dunk. Emory University cardiologist Dr. Robert A. Guyton, co-chair of the American College of Cardiology and the American Heart Assn. committee that wrote the current bypass-surgery guidelines, points to patients disabled by pain and shortness of breath who, a month after bypass surgery, “are walking around as healthy as you or I,” he says. “To say the whole operation ought to be scrapped is nuts.”

MAJOR PLACEBO EFFECT. Similarly, angioplasty eases the often crippling pain of angina. “There is quite a lot of good evidence for symptom relief,” says Dr. Robert Henderson, a cardiologist at Nottingham City Hospital in Britain and co-investigator for a key angioplasty clinical trial.

 

Critics such as Hadler, on the other hand, emphasize the risks. Not only is there a 1% to 2% chance of dying during a bypass operation, he explains, there is a high risk of complications and a 40% chance of cognitive deficits. The healthy, active post-surgery patient is an “urban legend,” he says. “An alarming number never return to the workforce or describe themselves as well again.”

 

Recent studies even raise questions about whether surgery causes the symptom relief. In June, Harvard Medical School associate professor of medicine Dr. Roger J. Laham reported on follow-up results of a randomized trial looking at laser surgery to improve blood flow. Patients who got the surgery had significantly less pain and improved heart function. But so did patients who had a sham operation — the equivalent of a placebo.

 

After 30 months the placebo effect was still there. Scans and other tests showed physiological gains in blood flow among only those who thought they had been operated on. A similar large placebo effect might explain “most of the benefits that we’ve seen so far with balloon angioplasty and bypass surgery,” Laham says.

CLOTS AND STENTS. There are also fresh concerns about the safety of drug-coated stents, now widely used in angioplasty. When doctors first tried to open clogged arteries with a balloon, they found that arteries soon closed again. So they began inserting metal mesh stents to hold them open. When arteries continued to clog up again, companies devised stents impregnated with drugs that slow the growth of cells, reducing chances that patients would have to have their arteries opened again.

 

First approved in April, 2003, drug-coated stents account for 88% of the stents used in the U.S. But when pathologist Dr. Renu Virmani, medical director of CVPath, a research service of the International Registry of Pathology, examined the hearts or heart vessels of 39 patients who died after getting the new stents, she found clots in 11 cases that developed more than 30 days after the procedure.

 

The sample is small, and it’s not clear that the clots caused the deaths. But it’s a big jump from her experience with patients who died after getting bare-metal stents. Just 12.5% of them had late-developing clots.

SURGERY VS. DRUGS. What worries some doctors is that people getting the new stents might have a higher risk of clots, which then could cause heart attacks more than a month after the procedure. “Out of 100 patients who get a drug-coated stent vs. a bare-metal stent, maybe 10 will avoid a repeat procedure,” says Dr. Eric J. Topol, chief of cardiology at the Cleveland Clinic Foundation. “But how many will wind up with a heart attack or death? Maybe one in 1,000? We just don’t have that nailed down yet.” Drug-coated stentmakers Boston Scientific and Johnson & Johnson say their clinical trials show no such increased risk of late-developing clots.

 

Cardiac surgeons readily admit there are big unanswered questions. “We can handle the criticisms, and we should be accountable,” says cardiothoracic surgeon Gardner. “But there is plenty of hard work going on to try to determine the appropriate patients for whom such treatments are necessary.” There are also large clinical trials under way comparing surgery with cholesterol-reducing drugs and other medical treatment, which will provide better answers.

 

If the trials show no benefit to surgery compared to medicine, “it will be a serious challenge to the coronary-intervention industry,” says Dr. Robert H. Jones, distinguished professor of cardiothoracic surgery at Duke University Medical Center. His prediction? “I’m a surgeon, so I think surgery will hold up.”

VITAL INFORMATION. The answers still may not be definitive, however, because medicine continues to advance. “Every time these studies come out and show that revascularization [improving blood flow] doesn’t do much, cardiologists say: ‘Well, that study was started four years ago, and now we have shinier stents, and the results are better,'” notes UCSF’s Waters. “But medical therapy [with drugs] is getting much, much better, too.”

 

Harvard’s Laham suggests that as many as 400,000 of the angioplasties done in the U.S. each year may be medically unwarranted. “I’m sure we are way overtreating our patients,” he says.

 

Some scientists argue that the rational solution is to let patients decide for themselves. But that requires providing detailed information about the risks and benefits of medical procedures, such as coronary surgery — including the unknowns. In trials where one group gets the information and the other group receives no special attention, the well-informed patients opt for more invasive, aggressive approaches 23% less often, on average, than the other group.

 

Without this full information, “patients typically don’t understand that they have options, and even if they do, they often wildly exaggerate the benefits of surgery and wildly minimize the chances of harm,” says Annette M. Cormier O’Connor, clinical epidemiologist at Ottawa Health Research Institute and a leader in this field of so-called decision aids.

MEDICINE’S LIMITATIONS. It’s a model approach for medicine in general. As Hadler argues, the exaggeration regarding benefits goes far beyond heart surgery. Too many common conditions are viewed as diseases needing treatment, and too many treatments of uncertain benefit are used too often. “What Hadler does is question the soundness of that thinking in a very profound way,” says Dr. Glenn D. Pomerantz, senior vice-president for global innovation at Cigna.

 

Hadler hopes that enlightening people about the limitations of medicine will help them worry less and stay well longer. It also could help cure an ailing health-care system, making it more rational. In the end, few doctors will object to the basic prescription: Avoid drastic procedures that probably won’t help and might actually do harm.

 

Carey is a senior correspondent for BusinessWeek in Washington, and Barrett is BusinessWeek’s Philadelphia bureau chief