More on animal products and the environment

It’s been a big couple of days for trashing the beef and dairy industries. Those of you who have followed this blog over the last couple of months have heard me say several times that cows are insanely bad for the environment and are a chief contributor to climate change (global warming). Just to keep things real, I had another conversation with my 82 year old dyed in the wool, Wall Street Journal reading, staunch Republican father and it seems that Charles & David Koch and their ilk have worked miracles. Their campaign of disinformation about climate change has him convinced it’s some sort of complex hoax and no amount of evidence to the contrary will sway him. He sounds a lot like Senator Ted Cruise in this video. Of course, he then dismisses things like this video, with the actual scientist who runs the satellites and interprets the data explaining why Mr. Cruz is so completely off base. The main point is that a lot of people are still in denial about the whole climate change thing, but it seems that more and more are waking up to the reality that it really is a thing. I like to post the latest CO2 readings from time to time to remind everyone that it’s still on the rise. Recall that we don’t have any readings above 300 ppm prior to this cycle in the history of the planet. Last weeks number was 405.82. We just topped 400 in January…3:23:16  So this weeks news continues to put pressure on the climate change nay sayers. An article with the rather dense title “Analysis and valuation of the health and climate change cobenefits of dietary change” attempts to look at the economic impact of dietary choices. The authors conclude:

The food system is responsible for more than a quarter of all
greenhouse gas emissions while unhealthy diets and high body
weight are among the greatest contributors to premature
mortality. Our study provides a comparative analysis of the
health and climate change benefits of global dietary changes
for all major world regions. We project that health and climate
change benefits will both be greater the lower the fraction of
animal-sourced foods in our diets. Three quarters of all benefits
occur in developing countries although the per capita impacts
of dietary change would be greatest in developed countries.
The monetized value of health improvements could be com-
parable with, and possibly larger than, the environmental
benefits of the avoided damages from climate change.
Dr. David Katz has a nice blog piece about the article here. It’s worth a read. Dr. Katz also refers to a Time magazine article here that also discusses the same topic and this New York Times Op-Ed piece about the overblown risk of terrorism compared to the very real risk of climate change and why we are willing to pay exorbitantly to mitigate the low risk problem and are unwilling to pay anything to mitigate the catastrophic risk. Good stuff.
So what more is there to say? Eat your grains, veggies, and fruits. Start figuring out how to make meat a once a week treat rather than the centerpiece of every meal. It will not only make the planet livable for your kids, it might even make you healthier!
General Health Nutrition

The Case Against Dairy


I realize that I live just 25 miles from Wisconsin, the “Dairy State”, and that attitudes in this part of the country are solidly Midwestern, but the number of people who refuse to believe that dairy is not only unnecessary for good health, but is also detrimental to good health is a little staggering. So, let me begin with an open and honest disclaimer. I have no financial ties to any pro- or anti- dairy group. I stand to derive no financial benefit from this post (unless you click on one of the dopey ads). I do have a BS in Chemistry, an MD, 17 years of clinical practice experience in medicine and a certificate in plant based nutrition from Cornell. So you can choose to ignore what I tell you, but please admit that you’re doing so because you prefer to believe what you’ve been told by people who stand to gain financially from what you “know” and who trust you won’t be bold enough to change your habits because of new information.

OK, with that out of the way, I want to split this up thusly:

  1. What is milk?
  2. Why you think dairy is good for you.
  3. The Case Against Dairy
What is milk?

Milk is a liquid that contains macronutrients (protein, sugars, fats) and micronutrients that is made by the mammary glands of all mammals to feed their infant offspring. It is, quite literally, a growth formula that is species specific (i.e. human milk has a different composition than goat milk) and is designed to nurture the young until the digestive tract has developed enough to transition to food appropriate to the species. The particulars of human, cow, and goats milk are presented in the following table, derived from the USDA’s own food analysis tables1.

Human vs Animal MilkThe USDA and most dairy types express the amount of protein, fat, and carbohydrate as grams, but most clinical types of people (i.e. physicians (as if) and nutritionists) talk about protein, fat, and carbohydrate as percent of total calories. In the lower half of the table I’ve converted the numbers above into percent of total calories. I realize that the numbers don’t add up to 100%, so I’m just leaving them there because the raw data came right from USDA. If the number of calories for human milk was, for example, 175 per cup, then the numbers below would be 100%.

It should be obvious right away is that human milk has more carbohydrate and much less protein than cow or goat milk. Remembering that milk is a growth formula for the time of life when the individual will grow the fastest, it’s remarkable that human milk is about 6% protein, which should suggest that this is the amount of protein that is necessary for sustained growth and health. Interestingly, 112 years ago, a nutritionist at Yale University named Russel Henry Chittenden published the results of his research on the amount of protein necessary for adult humans. Challenging the status quo of 116 grams of protein suggested by Carl Von Voit, Chittenden found that active adult men (Yale student athletes and men in the Army Corps of Engineers) did perfectly well on 40 grams of protein a day2. Given an average diet of 2400 calories for these active men, Chittenden’s 40 grams of protein translates to protein as about 6.5% of total calories, almost identical to the protein content in human breast milk. Unfortunately, Chittenden’s work, although of great interest at the time, has largely been lost to posterity.

Why you think dairy is good for you.

When asked, most people say that cow’s milk is “good for you” because it is high in protein and has calcium to “make your bones strong”. Let’s look at those two things.

Cow milk does have a lot of protein. As our table shows, protein is 20% of the total calories. I’m going to keep this short and not get bogged down in the numbers, but it turns out that 20% of calories as protein is not good for your health, particularly if the proteins come from animal sources. Animal proteins are usually labeled as “high quality” because the protein sequences are very similar to our own and our bodies can use them more efficiently than plant proteins. This oversupply of efficiently used proteins does promote growth in the human body, but it’s not well regulated. And there are unintended (and unwanted) consequences including (but not limited to) cancer initiation, promotion, and progression. Cow milk protein is approximately 80% casein, which has been identified as a powerful carcinogen.

Cow milk has calcium. Yes, this is true also, but it must be said that cows have certainly not cornered the market on calcium. There are, in fact, much safer sources of calcium that don’t mix calcium with excess protein, saturated fat, and carcinogens. And where, do you suppose, cows get all their calcium? It’s not like they’re out in the field taking calcium supplements. No, cows get their calcium from the same place that you should, from their greens.

Furthermore, this study3 from the American Journal of Clinical Nutrition concluded “neither milk nor a high-calcium diet appears to reduce risk (of osteoporosis)”. In fact, as this map from the International Osteoporosis Foundation shows, high dairy consumption areas like the US and New Zealand have significantly higher osteoporosis risk than low dairy areas like Brazil, China, India and Indonesia.Osteoporosis

The Case Against Dairy
  1. Lactose Intolerance: affects approximately 95 percent of Asian-Americans, 74 percent of Native Americans, 70 percent of African-Americans, 53 percent of Mexican-Americans, and 15 percent of Caucasians.4 Doesn’t it seem odd that with this striking degree of lactose intolerance among non-Caucasians that the USDA mandates milk consumption in school age children?
  2. Growth Hormones: I know that there has been some lip service to decreasing the amount of bovine growth hormone given to cows to increase their milk production, but we’re talking about big agriculture doing the right thing when it could adversely effect profits? When has that ever worked? And that’s just the growth hormones that are synthetically given to the cow. What about all of the growth hormones that occur naturally in cow’s milk because the milk was designed to act as a growth food for the baby calf? Most worrisome is high levels of insulin like growth factor 1 (IGF-1) that is present in cow’s milk and is linked to a number of human cancers.
  3. Bacterial contamination and antibiotics: I admit I got a little squeamish on this one, so be warned. According to the USDA5 guidelines, “the legal maximum BTSCC for Grade A milk shipments is 750,000 cells/ml”. That sentence needs a little background and if I get this wrong, I hope one of my dairy farming knowledgeable friends will correct me (gently). But as I understand it, when the milk is removed from the cows it is placed (on the dairy farm) in the blending tank (where the milk from all of the cows is blended). This is then tested periodically for contamination. Somatic Cell Counts are the number of “somatic cells” present in the sample. According to the Agriculture and Horticulture Development Board (in Britain) “The Somatic Cell Count (SCC) is a main indicator of milk quality. The majority of somatic cells are leukocytes (white blood cells).” White blood cells are also the primary component of pus and are present in increasing amounts in dairy cows because of an infection of the mammary glands (mastitis). And just so we’re clear, because there are 237 mL in a cup of milk, that means that Grade A milk in the U.S. can contain 177,750,000 white blood cells. If that isn’t enough to make you put down your glass, I don’t know what is. Of course, to treat that mastitis in the cow you have to give the cow antibiotics. The CDC has recently warned about the impending doom caused by resistant organisms, but the truth is that 80% of all antibiotics are used on our farm animals. The CDC has even put out this little infographic. ar-infographic-508c
  4. Type I Diabetes: Cow’s milk proteins are clearly linked to the development of Type I diabetes mellitus. Among other convincing evidence, the American Academy of Pediatrics observed up to a 30 percent reduction in the incidence of type 1 diabetes in infants who avoid exposure to cow’s milk protein for at least the first three months of their lives.6
  5. Environmental risks: The contamination from cattle and dairy production is potentially catastrophic. Arable farmland and forests are cleared to support more cows. The nitrogen rich effluent of farms growing grain to support the cows as well as the manure cause coastal water algae blooms and oceanic “dead zones”. The methane from cow belches and flatulence is a major green house gas contributor. The Chatham House think tank from the UK came to these key findings:

    1. Public awareness of the link between diet and climate change is very low. There is a considerable awareness gap around the links between livestock, diet and climate change. While awareness-raising alone will not be sufficient to effect dietary change, it will be crucial to ensuring the efficacy of the range of government policy interventions required.
    2. Governments must lead. Our research found a general belief across cultures and continents that it is the role of government to spearhead efforts to address unsustainable consumption of meat. Governments overestimate the risk of public backlash and their inaction signals to publics that the issue is unimportant or undeserving of concern.
    3. The issue is complex but the message must be simple. Publics respond best to simple messages. Efforts must be made to develop meaningful, accessible and impactful messaging around the need for dietary change. The overall message remains clear: globally we should eat less meat.
    4. Trusted sources are key to raising awareness. Unless disseminated and supported by trusted sources, new information that encourages shifts in meat-eating habits is likely to be met with resistance. Trust in governments varies considerably between countries, but experts are consistently seen as the most reliable source of information within a country.
    5. – See more at:
  6. Greenhouse-gas-emissions
The Bottom Line (or, in Reddit speak, tl:dr)

There is no compelling reason to consume dairy from a nutritional or health perspective and a wealth of high quality data to strongly suggest eliminating it from the diet. It has too much protein, saturated fat, and a number of very potentially deleterious effects. Dairy can provide calcium, but this is readily available from many sources.

  1. USDA. (n.d.). USDA National Nutrient Database. Retrieved 03 11, 2016, from
  2. Chittenden, R. H. (1904). Physiological economy in nutrition, with special reference to the minimal proteid requirement of the healthy man: An experimental Study. New York, NY, USA: F.A. Stokes & Co.
  3. Feskanich, D., Willett, W., & Colditz, G., Calcium, vitamin D, milk consumption and hip fractures: a prospective study among postmenopausal women, Am J Clin Nutr 2003;77:504-11.
  4. Bertron P, Barnard ND, Mills M. Racial bias in federal nutrition policy, part I: the public health implications of variations in lactase persistence. J Natl Med Assoc. 1999;91:151–157.
  5. USDA. (2013, July). APHIS (Animal Plant Health Inspection Service). Retrieved March 11, 2016, from
  6. Eidelman AI, Schanler RJ. Policy statement: breastfeeding and the use of human milk. From the American Academy of Pediatrics. Pediatrics. 2012;129:827–841.


Healthcare Politics

“Obamacare” and Health Insurance Premiums

As a rule, I try to stay away from political discussions. As the saying goes, opinions are like assholes, everyone’s got one and they’re generally not pretty. More to the point, quoting, politicians are like diapers; they need to be changed often and for the same reason. But every once in a while I hear something that just makes me shake my head. Last week it was the “I was vegan for a month” article. Yesterday it was this doozy. “I’m planning to vote for Trump because Obamacare has made my health insurance too expensive”. Ugh. Really? I get that I have a little more time on my hands than most, but this is such a lazy and untrue thing to say, that I feel I have to share my 3 minutes of Google results.

When you first Google this, one of the leading political numbskulls of all time (mortifyingly from my own state), Michelle Bachmann, shows up prominently blaming President Obama:

We are seeing huge increases in these premiums, not only in the Obamacare exchanges, but in the private market. Because remember, a lot of times it’s the private market where we are getting health care through our employers. It’s the private market that has to offset government programs, whether its Medicaid or whatever government program. So the costs are going through the roof.

Not surprisingly, this is from a Fox News show. (Disclaimer, I copied and pasted the transcript. I can’t stand to listen to her talk, it makes my head throb.) It should go without saying that watching Fox News demonstrably makes you less knowledgeable about the world, but that’s not the point. The point is that Ms. Bachmann and her ilk can and do make these claims and most people are too lazy to do minimal fact checking.

Let’s back it up a bit. In 2009, the year that President Obama was inaugurated for the first time, this article ran in Time magazine, showing that health insurance premiums during the Bush administration had increased 131%. For those a little rusty on the math, if your health insurance cost you $2000 a year when President George W. Bush took office, it cost you $4620 when he left. To be sure, that’s setting the bar pretty high for President Obama. The same article noted that premiums were expected to increase 166% in the next decade.

But in 2015, right around the time Ms. Bachmann was spouting her inanity on Fox, this embarrassing piece was published by the insurance industry no less, showing just a 3.2% increase in health care premiums for 2015, the lowest increase in over 20 years. That doesn’t mean that insurance companies are taking that lightly, though. For an industry that is used to hiking rates 10% every year, a down year like 2015 where they just got a cost of living increase must seem like a disaster. And so, yes, health insurance companies are seeking huge premium increases for 2016, as reported in the New York Times. But let’s be clear, this is, pure and simple, corporate greed. It is not the Patient Protection and Affordable Care Act that raises premiums at all. It’s the companies that sell health insurance and who, for the most part, are accountable to their shareholders and not to their customers. The boom in profitability for health insurance companies is well documented here, here, here, and here.

So, as insurance companies charge more and make more, you pay more. I’m not really seeing the role of government in that sentence except as a barrier to keep the insurance companies from raising premiums too quickly. Prior to the ACA (“Obamacare”) health insurance companies were entitled to made as much profit as they could. The ACA capped that amount to 20% effective January 1, 2011. Other developed countries deliver their health care far more efficiently than the United States and have much lower administrative costs.

It is true that many people do have to pay much more out of pocket for health care than they used to. This is primarily due to the increasing popularity of high deductible health care plans that are associated with healthcare savings accounts (HSAs). But, again, making people more accountable for their health care spending decisions, while not a terrible idea, isn’t really a particularly Democratic solution, nor does it sound like a part of the Affordable Care Act! It does have a decidedly Republican ring to it and, lo and behold, the HSAs were legislated by President George W. Bush in 2003.

So, what have we learned?

  1. health care insurance costs were going up at least 10% every year during the last Republican administration
  2. health care insurance costs have gone up much less since the passage of the Affordable Care Act
  3. a large majority are paying more “out of pocket” money for health care
  4. health insurance companies are making more profit than ever before

Three finals thoughts on the Affordable Care Act.

First, we should all be immediately suspect when someone blames something on “Obamacare”. It’s an easy scapegoat because so very few people actually know what the legislation does. I’ve found the best response to be “what, in particular, is there about the Affordable Care Act that you find offensive?”. I have yet to find a single person who claims to “hate Obamacare” that can elucidate a single part of the legislation that they don’t like. Most, in fact, like most of the changes that have been made, if you ask directly.

Second, for those who are interested but don’t want to read the entire legislation, which is daunting, I’d strongly recommend Inside National Health Reform by John E. McDonough. Entertaining, readable, and will give you great insight into the Affordable Care Act and how it was passed.

Lastly, for those who never knew or have forgotten, most of the key aspects of the Affordable Care Act are nicely summarized here. Might be worth 2 minutes to scroll through. Hell, it might just change your mind.

Restaurant Reviews

Phoenix, AZ

As readers know, I was off in Phoenix, Arizona last weekend. I went for the half-marathon, but it didn’t work out for me as planned. If you missed it, you can read about it here. But the trip to Phoenix was not a total bust. We had 4 really great vegan experiences in about 48 hours, so compared to the Twin Cities area, it was a bonanza!

I had not been to Phoenix since the mid-1970s on a family summer vacation road trip through the southwest. Although I know that a lot of older patients of mine winter in the Phoenix area, I hadn’t given the place a lot of thought and was surprised to find that the Phoenix metropolitan area is larger than the Twin Cities. More surprising still, however, was the state of vegan affairs in the Phoenix area. In this regard they are years ahead of us and all of the Midwest cities that I’ve visited.

Soon after getting settled I did a quick Yelp search for vegan restaurants in the area. I was amazed to get at least 15 solid hits and a number of other places that are vegan friendly. In the Twin Cities, as a vegan diner, you are the complete afterthought on the menu. The, let’s put a frozen veggie burger option on the menu in the off chance someone might order it, sort of afterthought. So imagine my surprise and delight at finding a basic cornucopia of dining options!

First off was The Oatmeal Cafe in Tempe. Here we had a long chat with Melissa (“Iss”) the founder. Most of the items are based off her “Magic Mix” oatmeal and the place looks pretty killer for breakfast. We had arrived for lunch, however, and were treated to two Magic Mix based “burgers” that were amazing. The Greek and Hillbilly BBQ. The place had a slow, but steady clientele and, while we were waiting, we discovered that the next day was the first Phoenix Vegan Festival. We, of course, snagged tickets right away. Turns out that Iss and the crew were making preparations for the festival which included packing up a huge supply of oatmeal mixes. I picked up a couple and, if anyone is interested, let me know and I’ll tell you how they are.

For dinner that night we were off to Ruchi. Anyone whose spent much time around me and food knows of my predilection for Indian food and Ruchi was extremely satisfying. If you find yourself in the Phoenix area and are looking for some good veg Indian, the place would be hard to beat. Two words: Vegetable Vindaloo. As you’d expect from a place in the southwest, it left your lips with a good, satisfying tingle.

Saturday afternoon we were off the Vegan Festival. It was outdoors and it was hot, at least 95° (F) and not a cloud in the sky. Relative humidity could not have been over 10%. It amazes me to see people (presumably Phoenix natives) wearing sweaters, jackets, and knit caps on a day like that; I can’t imagine what they would think if we were having a normal winter. There were probably 40-50 open air booths, plenty of products and tasting, and a beer bar with a tremendous line. It was, all in all, well, festive! A real scarcity of hippy types, lots of families and young people, but many older people as well. It struck me that we might be able to garner as large a crowd in the Twin Cities for an event like that, but I don’t think we have the vendors! There were so many vegan places represented and it was really cool to just be there and be surrounded by so many like minded people. I so often feel like an outlier here at home.

Finally, we headed out to Green – New American Vegetarian in Tempe on Saturday night. Green was a great place that is in a odd niche. The entire menu is vegan, but many of the menu items are very familiar to the carnists and less so to the more traditional vegans. It is certainly not the most healthy vegan fare I’ve ever had, but it was quite tasty and a wonderful treat. Mostly, though, it was a place where vegans can take their carnist friends and both enjoy a plant based meal. I can see it as a great stepping stone for those wanting to try the plant-based diet, but worried that it will seem too “weird”.

It’s a little humbling to find that your community is so far behind when it comes to veganism. I suppose that our entrenched former farm families will have a hard time accepting the pressing need to move away from dairy and beef production if not for their own health then to help stave off global warming. But it is also nice to know that others have made the leap and that the movement is alive, well, and flourishing in the desert.



Getting Started with Plant Based eating

This is a post that I’ve been thinking about for a while, mostly because a lot of people ask me what I recommend to get started. But I’ve put it on the back burner for a while and it probably would have remained there except for this post, which I saw this morning. If there was ever a post that demanded this reaction, this is it. picard face palm

Take a moment to skim it if you like, pay particular attention to the next to the last paragraph (assuming the call to eat a pepperoni pizza is a paragraph).

While I was tempted to begin a post taking this girl apart for the ridiculous “article” she wrote, I think it’s better to think about what she tried and where she went wrong. As usual, there is more to be learned from failures than successes. In a nutshell, my recommendations are:

  1. Do your homework
  2. Start small
  3. Plan your snacks

As usual, I’ll elaborate.

Do Your Homework

Clearly poor Zoe Karavolis did not do her homework. She had a couple of friends who were going to try vegan and she jumped in without any knowledge, planning, or intent. Bad idea. I can think of very few things in life where most people would try to make a major change (car, house, job, etc.) without doing some basic research and planning. Yet many seem to think that changing your diet is not of the same importance. Approached that way, you are destined to fail.

I wanted to implement healthy eating habits into my diet and I only kind of did. Yes, I ate more fruits and vegetables, but I also ate a TON more carbs. Pasta. Rice. More pasta. Potatoes.

The failure to understand the difference between unrefined and refined carbohydrates was her downfall here. A little education on the difference between white rice and brown rice, whole wheat or other whole grain pasta compared to white pasta and the just plain greatness of potatoes (didn’t she see the Martian? Matt Damon lived on just potatoes and that’s been replicated in numerous scientific studies) leads her to somehow believe that carbohydrates are bad. But, in fact, a whole-food plant based diet should be 80-85% complex, unrefined carbohydrates. It’s what makes us full and happy, gives us plenty of fiber and staves off virtually every disease of affluence.

Perhaps one of the biggest mistakes people make when trying plant based eating is thinking that they’re just going to eat fruits and vegetables. Starch, in the form of unrefined foods, is your best friend. When you’re consuming the right kinds of starches, how much you eat becomes almost irrelevant.

When I decided to try plant based eating, I spent well over a month reading all sorts of books and cookbooks in preparation. I then committed myself for 4 months, thinking that would be a good trial. The rest, as they say, is history.

Start Small

I had a strong start. I really did. I even ate salad (a rarity for me). I dramatically increased my fruit and vegetable intake — I planned my meals around main courses made primarily of fruits and vegetables and was able to incorporate some unique new recipes.

Doesn’t this sound suspiciously like virtually every New Year’s resolution you’ve ever heard? While I admit that there are some people that really need to jump in with both feet to make progress, for a change of this magnitude I’d really recommend starting small. Meatless Monday is a great way to go. Check out the link for some good ideas on how to incorporate Meatless Monday into your life. It’s worth it!

2015_MM_environment_infographics2If you find that Meatless Monday is working for you, then you might start going plant based for breakfast each day. Making the switch from cow’s milk to almond or soy milk is pretty easy, especially if you’re using it on cereal or in coffee. Word of warning, the sweetened and flavored plant milks seem to be taking over the dairy case. Look for the unsweetened (sometimes called “original”) variety without vanilla.

Plan Your Snacks

I have been known to say, on more than one occasion, that the success of any eating plan depends not upon the meals, but upon the snacks. You’re plan is only as good as your snacks.

Seriously. Everyone eats snacks between meals. If your plan doesn’t have easy, nutritious snacks then you’re doomed to failure. For me, the breakthrough was homemade hummus. It takes about 5 minutes to make and a batch lasts me about a week. If you want a quick recipe, email me and I’ll be glad to send you mine.

I actually cried when I saw my dad making chocolate chip cookies.

And really, you couldn’t figure out how to make chocolate chip cookies vegan style? There are about a million recipes out there for everything from Tahini Chocolate Chip cookies to everyone’s favorite Cowboy Cookies (thanks Claryn, for both!)

OK, I tried, but I just can’t resist commenting on that next to last paragraph. Sorry.

For all of you that have a strong passion to veer away from animal products, I respect you. I love animals just as much as the next person. But I was raised eating dairy and meat and that is the way I intend to live.

The “I love animals just as much as the next person” line is a killer for me. What she meant to say is that I love some animals a lot and others I choose not to think about how they are treated and killed with gross inhumanity because I’ve be acculturated to eat them.

And the “I was raised eating dairy…” line might be the chorus for intellectual and emotional laziness. Why not just admit that you’re a lazy kid and change is hard, so I’m going back to the unhealthy diet that big business has pushed on me. Probably ought to take up smoking too.

Did I go too far? 🙂