What's the deal with red meat?

21:38Emily, do you like, what do you think about saturated fat?

21:41Perry Wilson:Let me push back on like, I think fiber is very important, but none of these things have fiber in them. So like if you said chicken doesn't have fiber either. Chicken doesn't have fiber either. Right. I mean like – but plant-based proteins do, right? Plant-based proteins have fiber. But is this – is that people's most important source of fiber mostly? Well, it could be. Like if you're sitting here and asking the question of my concern is getting adequate amounts of protein and how should I do it? by the way, call back to the what's the deal with protein episode, like plant-based proteins would offer you fiber in addition to similar amounts of protein and less saturated fat than red meat.

22:18Perry Wilson:Okay. If you think that matters. I think, okay, fine. I'm going to, I think we're already getting a sense that Perry and I are not going to agree about everything here. I don't think this is that your protein sources are an important source of your fiber, but let's move on. Okay. Let's talk about saturated fat. Let's talk about saturated fat. Yeah. What makes saturated fat saturated? So should we do a very quick chemistry here? Let's do fat carbon chains. Big, long carbon chains. So fat is just a big, long chain of carbons, whereas sugars, like the kind of sucrose that we eat, are two carbons stuck together.

22:56So it's very simple. And then glucose is just one carbon with some stuff attached to it. But you're getting their energy from there. And fat is like carbon, carbon, carbon, carbon, carbon. You can have different lengths of these carbon chains, and then you break those things down and you digest them. And that's how you get energy. The end of that long chain of carbon has a little acid on it, which is why people used to talk about fatty acids. We now just say fats. That's basically what we're talking about. It's all fatty acid now. Saturated fats, the reason they're saturated is that their carbons are connected, are fully bound to hydrogen.

23:27So they only have single bonds to each other. And the practical upshot of that is that those long squiggly chains can pack very tightly together. And the way you notice that is that when something has more saturated fat, it will be solid at room temperature because the fat can all kind of pack together. So if you're wondering like butter or beef tallow or like coconut oil, right? So there are are relatively more and less saturated fats. And a hint as to what that is, is whether it's a liquid or not at room temperature. But that's a fun trivia fact, I guess. But the reason people care is because, I'm curious if you'll agree with me on this, Emily, there is a clear and causal relationship between saturated fat intake and serum cholesterol levels.

24:22Perry Wilson:Yeah, I think that's true. Okay. All right. Just wanted to make sure you weren't going to come out with like, well, actually. Okay. Great. So saturated fat raises cholesterol and higher cholesterol levels are causally linked to cardiovascular disease and stroke. Right. What I think is interesting and is a great opportunity to get into some complaints I have are how we draw links between those things. So consumption of more saturated fat leading to higher cholesterol. On average, people with higher cholesterol are more likely to have cardiovascular disease. I think the question is then if you change someone's diet from a low saturated fat to a higher saturated fat or vice versa, would that alter their cardiovascular risk?

25:11Perry Wilson:And that is the question that I think we want to talk about because in the course of this discussion on red meat, I think the core question is whether a diet that has its meat source be higher in saturated fat is going to put you at higher risk for cardiovascular disease than a calorically equivalent diet with less saturated fat. Right. Okay. I want to take an opportunity to give some complaints about nutrition science at this moment. Is this a good time for that? This is a perfect time. Great. A lot of what we know about nutrition is based on studies which are very large, but in my personal view, terrible.

25:54Perry Wilson:Many of these studies, many of the studies you hear about, you know, the difference in health outcomes for people who drink more coffee or drink more milk or dark chocolate or chocolate or chia seeds or blueberries or whatever is it. Most of that is based on getting data on people's diets and comparing the health outcomes for people who have one kind of diet versus another kind of diet. The problem is that those two groups are typically very, very different in many other ways that are not about their diet. Yeah. And it is extremely challenging for researchers to fully adjust for those factors.

26:37Perry Wilson:And I think people would be surprised at how much you can mess around with things to make stuff show up in whatever way you want. Oh, my gosh. So, for example, I once took the marquee study data source on diet, the NHANES, which is where we survey many Americans, thousands of Americans. Nationally representative survey sample. National representative survey. And I showed that you can do something that looks very close. which actually is kind of the standard approach to analyzing diet. And you can show that consuming iceberg lettuce raises your BMI. But consuming dandelion greens lowers your BMI.

27:16Perry Wilson:Now, both iceberg lettuce and dandelion greens contain no calories. They are calorically free. But the difference is that people who are poor tend to eat iceberg lettuce and people who are rich tend to eat dandelion greens. And in fact, even though you see in these data sets, things like education and income, you don't see enough about them. You can never adjust enough. You can never adjust enough. And so in like my view is that basically all studies that rely on this kind of observational data to analyze nutrition are just trash. Honestly, that's my view that they're all trash. Okay. I'm going to.

27:53Perry Wilson:It's a hot take. It's a hot take. And I'm not even that offended by your hot take. And I'm going to add one other problem to this body of literature, which is the food frequency questionnaire, where the NHANES data and a lot of other data comes from. A food frequency questionnaire is something that says, over the past week, how many times did you eat bananas? Over the past month, how many times? Over the past year, how many times? Okay. Over the past week, how many times did you eat walnuts? Over the past month, over the past... And so on and so forth. And there's about 110 different food items on the standard food frequency questionnaire.

28:29There are, of course, variants. Okay, what I can do with that data, if I have that on all the NHANES people, and I have outcomes on these NHANES people, I know who had heart attacks or whatever, at least maybe cross-sectionally, I know what their BMI is, for example. But in other data sets, I might have longitudinal outcomes. I can take all of those 110 things on the food frequency questionnaire and test whether they statistically associate with heart attack, stroke, divorce rates, whatever it is. And because there's 110 of them, several of them just by chance alone will be statistically significant.

29:03Perry Wilson:Five of them will be significant at the 5 % level. That's what that means. Okay, go ahead. Wait, there's more. People have taken those 110 items on the food frequency questionnaire and grouped them in weird ways. Sure, by macronutrients, right? Like, okay, based on your answers, how much carbs do we think you get? But they've done it for like pesticide exposure, right? They'll say, okay, based on your food frequency questionnaires, how much pesticide are you probably taking in? because we know that like whatever cucumbers have more pesticides than cherries or something like that. And now you have a new exposure called like pesticide exposure, which is based on no measurement whatsoever, except how you answered a survey.

29:38And you can link that to a bunch of different outcomes. And so there's a huge opportunity for kind of trolling through data and finding interesting things. They often get published because people love to talk about this stuff, right? Like it's relevant to everyone. We all have to eat. The one thing I do want to say is that while I agree that randomized trials are the gold standard of evidence here, it is completely infeasible to randomize someone's diet for a long enough period of time to witness the effects of that diet on hard clinical outcomes. And so we'll talk about some randomized trials.

30:18Perry Wilson:Trash than nothing. I'd rather have trash than nothing, yes. I think that I can, you know, take sort of triangulate from these – I'm not going to call them trash. I'm going to call them, you know, less than ideal study designs to make inference. And because if we don't, then we're totally – then what are we going to say? Like we don't know and we'll never know, so go crazy? Yeah. I think that's fair. I guess for me, that makes it very important to look at the size of these impacts. So an example that people always give in this space when they want to argue that we should use observational data, that it's good, is smoking.

31:01Perry Wilson:They say, you know, well, you know, when the first evidence that smoking gave you lung cancer was from just comparing smokers to non-smokers. And, you know, that if we had really trusted that evidence, then, you know, which later was confirmed by randomized trials. But if we really trusted that evidence, we would have, you know, told people to stop smoking earlier. And that's true. But in the smoking data, the excess risk of lung cancer was like 60 times. It was like a 60, 6 ,000 percent increase in lung cancer. And it was not subtle. And so you could say, well, is it likely that the other differences across these people could drive this effect to be 60 times as big, especially given that it's a cancer associated with something that you're inhaling through a smoke like there's some biological plausibility and the effect size was so big i think where i get stuck in a lot of these things is we're saying okay we're comparing this kind of diet to this kind of diet or this food to this food and the increase in cardiovascular risk is like seven percent and it feels to me like i can i can imagine we get a seven percent increase from the many other differences across these people.

32:08Perry Wilson:And so like maybe we look at the observational data, but the kind of observational data with tiny effect sizes tells me like you should, this is, it feels like zero. Yeah. I mean, we may conclude that the evidence isn't strong enough for you to seriously worry about. And like in terms of the mental energy you want to spend trying to get healthier, like there are other areas where there's stronger evidence, like not smoking, right? If you are a smoker and are debating whether you should be eating red meat or chicken, don't worry about it. Please stop smoking. All right. I feel like I literally, I mean, this is a topic of my research, so I could literally talk about this for like an entire semester course, but maybe we should move on to - As long as I can get a credit because - You get credit.

32:56Perry Wilson:Continuing medical education credit for - I need some of those. vent about my feelings. Okay. All right. So with that as the background, I think that tells us to step out of the weeds a bit. I think what this says is that it is actually quite difficult to answer this question. And part of the reason we see so much debate and discussion and disagreement about questions around nutrition, including red meat, is that the data is not perfect or really very good for the most part. Yeah. So let me draw a mechanism for you and saying what we do have with high quality data. Let's start with cardiovascular disease, because I think that's what people often think about, but we will get to cancer because that's sort of an emerging concern from certain dietary habits.

33:47So in terms of cardiovascular disease, We do know from fairly high quality evidence that in randomized trials over a limited period of time, yes, not over years and years and years, but over weeks to months, replacing a diet high in saturated fat with a diet lower in saturated fat reduces LDL cholesterol. So this comes from the Cochrane Collaboration, which is many people would say the gold standard of evidence synthesis groups. They performed a meta-analysis of 50-something trials in this space and found this relationship to LDL cholesterol. It was stronger in people who had higher LDL cholesterols to begin with.

34:34So there's potentially some floor effect here. You can only, you know, there's only so much bang for your buck you can get by switching out saturated fats for unsaturated fats. And of course, you can get saturated fats from places that aren't red meat. But I think if we're really thinking about like a high red meat diet, that is an area of major concern is the saturated fats. So looks to me like it increases LDL.

34:55Perry Wilson:I think that's right. Or at least switching it out will decrease LDL. Yeah, that switching it out will decrease LDL. I think that seems fair. I think the biological mechanism works. I think the evidence is reasonable. It's not, these effects are not like spectacularly large, but they are significant. Yep. In a statistical sense. Okay. And then what we, I think, would most want to know then is does that have any actual like health implications? Yeah. Right? Like. So, okay. So we know, go with me here. We know from randomized trial data that reducing LDL reduces the risk of cardiovascular events.

35:36This is from statin trials, for example. Okay? So I know what you're going to say, but, you know, if reducing saturated fat intake reduces LDL and reducing LDL, albeit by some other mechanism, reduces cardiovascular events, I'm comfortable saying probably reducing saturated fat intake will reduce the risk of cardiovascular events.

36:03Perry Wilson:And I will say that if you look in the Cochrane Review trials that do try to look long term at saturated fat and cardiovascular events, you do see a small, marginally significant reduction in cardiovascular events with a diet. what you don't see is impacts on mortality. So although we see reductions in cardiovascular events, we do not see reductions in all cause mortality or cardiovascular mortality. So this relationship seems is more complicated to me than we might think. Yeah, I guess I think it would be a stretch to say that reducing your red meat intake or reducing your saturated fat intake would cause you to live longer.

36:53Maybe it's not a stretch to say it would reduce your LDL and that

36:57Perry Wilson:it might reduce your risk of cardiovascular events by a small amount. Yeah. I mean, death is messy that you can, unfortunately, you can die. You can die from many things. And so it's always harder to prove an overall mortality benefit. Certainly, I'm not seeing anything that suggests that like enhancing red meat in your diet is doing anything particularly wonderful for you systematically. And we should say, or in terms of cardiovascular disease, at least. And we should say, though, that the vast majority of real studies that look at red meat intake are using unprocessed, like lean red meat, like not lean, you know, but like red meat that you would buy in the refrigerator section of the grocery store, not processed red meat.

37:44And I think we need to touch on this when we get to cancer, because there's a big difference between eating like a steak, you know, with its high saturated fat and but high amount of protein and relatively little other things and like a equivalent amount of processed salami or something like that. And we can talk about that.

38:05Perry Wilson:Yeah, let's get into that. But I think here, here we are really talking about the like, again, kind of switching out your red meat for a calorically equivalent amount of chicken. Yeah. It's a way to slightly reduce your cardiovascular risk. There are probably better ways to reduce your cardiovascular risk. Yeah. Like exercising or not smoking. Yes. Yeah. Those are better. But let's talk about cancer. This is the concern I've heard most from people I've talked to about this. It's interesting. I feel like for my parents' generation, heart attacks and strokes were the thing that killed everyone and they were very concerned about this.

38:45And I think to some extent, because we've gotten a better handle on cholesterol management, that's less scary to our generation who thinks more about cancer and dementia. There has been a rise in colon cancer diagnoses among younger and younger people in the United States. There's an interesting discussion about what the causes of that are, but it's certainly in the zeitgeist. People are thinking about this, even the guidelines for colon cancer screening have recently changed to start at a younger age, to start at 45 instead of 50 based on some of this data. And most of the, again, observational data would suggest that higher red meat intake does increase the risk of colorectal cancer.

39:30Yes.

39:31Perry Wilson:Most of the observational data would say that. Yeah. Does that worry you? No. I mean, like, does it worry? I am worried about the rise in colon cancer among younger people, of course. Do I, let me think about how to say this. So do I think it is plausible that changes in dietary patterns have driven some of this rise in colon cancer? Absolutely. I think people, obesity rates have gone up. My guess is that explains a fair amount of this surprise. Consumption of whole foods, fiber in particular, has gone down. My guess is that also explains something with the rise. Clearly something we need to understand much better.

40:14Perry Wilson:Some of the data that's come out about GLP-1 suggests that they reduce the risk of colon cancer, which I think points to at least the first of those mechanisms as being important. If you asked me, do I think that replacing tofu and chicken with a calorically equivalent amount of beef in your diet would raise your risk of colon cancer? I do not think that that is supported by the data. The observational data on this is just, it's really weak. It's confounded by other aspects of people's diet. It's confounded by the fact that a lot of the ways people are eating red meat are ultra processed, are with Doritos.

41:00I mean, this feels to me like the data is so poor that if that's the question people are asking, I think absolutely.

41:09Perry Wilson:Absolutely not. And I will say, let me just say one other thing, which is that we have one pretty large-scale, long-term health study that evaluated the risk of cancer with a low-fat diet. It wasn't red meat specifically, but evaluated low-fat diet called the Women's Health Initiative Dietary Modification Trial. Yes, the Women's Health Initiative Dietary Modification Trial. And that showed no impact of switching people to a low-fat diet on cancer risk or basically anything else. And that feels informative to me. Yeah, I suspect this is true for unprocessed red meat. And I'm worried from a biological perspective on processed meats.

41:57Um, there has long been, for example, a dramatically higher rate of gastric cancer in China than there is in the United States. Um, and thought to be driven by heavily, uh, preserved, you know, meat intake, um, and protein intake. There have been a number of studies that show that these nitroso compounds, like you use nitrates to preserve, uh, to preserve meats and, and things like Slim Jims and stuff like that. there are studies in, you know, in Petri dishes and stuff that do show that these compounds can damage cells and can affect the lining of the GI tract. And you can actually recover these compounds in stool and like the poop of people based on how much they take in.

42:43So, you know, I think, you know, having that nice steak is one thing. Having a bunch of Slim Jims is another thing. But, But to your point, Emily, there's a certain type of person who can afford to have the nice steak, and they probably can afford a lot of other healthful things. And then there's a type of person whose major source of calories is going to come from that type of foods because they can't afford to eat the nice steak at the end. And that's going to be a major source of confounding.

43:12Perry Wilson:Yeah, it's a major source of confounding. And I will say, back to my point about sizing, if you look at these meta-analyses and what's the size of the increase in risk, We're talking about like a 20 percent increase in risk, not a 400 percent increase or a 4000 percent increase. And that that's not that big an effect. I mean, it feels big. It's like a 20 percent increase, but it's actually magnitude quite small. And it could easily be explained by either other aspects of people's diet, other aspects of their exercise, smoking. I mean, we see like everything is different between groups that eat more and less red meat in these observational studies.

43:49Perry Wilson:everything, not just a few things, literally everything. And I think that's just really hard to fix. It's very hard to fix. And diet is so culturally relevant. Diet is just, it's so much a part of you. It is very hard to control anything here. I want to move on to some other cancers, particularly breast cancer, which is another obesity-associated cancer, as they are defined. But there's an interesting trial here, the PREDIMED trial, which I really like. This is about a 7 ,500 participant trial who are randomized to sort of a Mediterranean diet, which, you know, is, again, it's not really red meat.

44:30It's actually a lot of like fish and legumes and things like that. But it's a lower carb diet and a higher amount of meat protein, either with olive oil or nuts versus a controlled diet. And the Mediterranean diet arms, which limit red and processed meat, significantly had a 62 % reduction in breast cancer incidence. Now, this wasn't the primary endpoint of the trial, but this is a hazard ratio of 0.38. That's a relatively big effect size. You wanted some big effect sizes. This is a randomized trial. It's not just limiting red meat. It's also like olive oil and nuts and beans and all the other wonderful things from the Mediterranean diet that might be affecting things here.

45:17But it's, again, some evidence that the dietary, a red meat dominant dietary pattern may not be the best. Yeah.

45:26Perry Wilson:I mean, I think we have the Mediterranean diet is one of our best tested diets. Like if you if you said, you know, I'm totally neutral. I don't care what I eat. Just tell me what's the best kind of diet for overall health that we have seen in the data. I think it is it is the Mediterranean diet. This has a lot of components, as you said, not just an avoidance of red meat. It's not that we have head to head tested that versus a version of that that has a higher red meat component. And I think that's there's a limit to what we can conclude from that. Yeah. Yeah. Fair. There's a couple of things that people wanted us to dig in on here as they're thinking about red meat.

46:06I think people get the idea that there's a difference between beef jerky and salami and processed meats and the steak and unprocessed stuff you get. People like eating steak. It's quite pleasurable for a lot of people. One question I got asked a lot is the difference between grass-fed and non-grass-fed beef. Should we be paying a premium for this? Come on.

46:30Perry Wilson:I think it just, it tastes different. And I think this, this to me feels like you absolutely, absolutely are not going to get any evidence that is meaningful on this. What you're going to find is that grass fed beef is eaten by rich people and rich people are doing better on their health for a lot of reasons. It's probably not the grass fed beef. But if that's a thing you want to spend your money on and you like the way it tastes better and you feel better about it, like that's Great. It is a bit leaner. So again, yeah, I agree. It's not going to make a difference in your long-term health. It does have slightly less fat.

47:03Actually, in the research though, I found that in 2016, the USDA eliminated their definitions, like their inspection process for grass-fed beef. So now it's via self-certification. So the meat producers themselves get to tell you whether they are grass-fed or not.

47:26Perry Wilson:Unless you have seen the cow eat, you cannot be sure. You cannot be sure. This is like a trust us bro type of situation. So let's touch on the carnivore diet. Because like we kind of talked about dietary patterns. Certain dietary patterns have more red meat. But like this is the apotheosis of being a meat eater, right? I am only going to eat meat. This isn't even paleo where it's like we can have grains. This is meat exclusively and organ meats exclusively. It's like the – I mean it's – so I think what's interesting about the carnivore diet is its connection to the keto diet, which is something that we should spend an episode on, which is a diet with effectively no carbohydrates.

48:10Extraordinarily low carbs, yeah.

48:12Perry Wilson:Had some interesting results on treating some diseases. It's like that's an interesting diet. It's very, very hard to stick to because it's really, really restrictive. the carnivore diet is kind of a like a bro-y version of more relaxed bro-y version of that it has almost no fiber so i would be shocked i'm not i'm not saying i would be interested in this i am kind of interested in how people's digestion is on the carnivore diet i would imagine if fiber is nature's broom i'm concerned oh my god about what happens when people like Bruh, I haven't pooped in two weeks, bruh. Exactly. I haven't pooped in two weeks, bruh.

48:53And so this is a very extreme form of the diet.

48:56Perry Wilson:And it's hard to know often when we are eating something that is so extreme, like what that's going to do to our systems. And just like evolutionarily, right? Like we're not carnivores. Humans are clearly omnivores. And in fact, you don't have to take my word for it. we don't contain the apparatus to synthesize certain things that only come from plants like vitamin C, for example. Some animals, carnivores actually synthesize their own vitamin C. So like tigers and lions don't get scurvy because they can make their own vitamin C and they don't have to eat fruits and vegetables and stuff. We can't.

49:33So we need to get vitamin C from other sources. Actually look to see if there's been case reports of people on the carnivore diet developing scurvy. I did find one case of a guy who was kind of, he was living alone in a hut in Appalachia. I don't think he would have described himself as being on the carnivore diet, but he clearly was only eating meat and he did develop scurvy.

49:55Perry Wilson:There are some meats that have vitamin C, like seal meat. That's what I learned from one of the many, many, many books I've read about people who die in Antarctica, which is my favorite book genre. But it turns out eating like Like penguins and seals have vitamin C. Right. It was always kind of a mystery that like how do Inuits who really have almost no plant intake like not get scurvy. And yeah, that's part of it. Blubber has vitamin C. Vitamin C is broken down by heat though. So a lot of that comes from like eating stuff raw. The organ meats that people who adhere to the carnivore diet, like liver does have some vitamin C in it.

50:34It's still very low. Like you've got to be eating a fair amount. But, you know, this is –

50:39Perry Wilson:Let's just say probably don't do this. Don't do this. I'm not sure what – like it's of a theme. Do you remember when we were talking about declining sperm counts and we were sort of like – like if you're not trying to get someone pregnant, like why do you care about that? I don't know. There's some like relationship here that I see. I think this is a manosphere thing. I think this is a diet that's like I'm a big tough guy and all I have to do is eat meat. And it's like I don't care if I get colon cancer from – or just severe constipation from not having any fiber or scurvy or whatever. Scurvy is terrible.

51:19Like guys, eat a varied diet.

51:22Perry Wilson:Let's talk about beef tallow before we end because people love beef tallow and RSPA really loves it. Yeah, yeah. Sometimes people ask, what do I do with beef tallow? And it's just another fat. And you could cook with it. I think it has quite a high smoke point, maybe making it good for cooking. I have one friend who's like a very serious chef. And he said he has beef tallow in his fridge because it's useful for particular cooking sources. People do like to put it on their face as a moisturizer. But it can clog your pores, I think. So it's lovely. I would imagine it can. Good as some other moisturizers that you might purchase from, say, CVS.

52:07Perry Wilson:So, you know, we have, I would say, this is a fat. You could use it to cook. It's not a magic fat. It's just - No, it's not particularly healthy. There's a meta-analysis of 54 randomized trials looking at LDL reduction through supplements of various types of fats. And all of the plant-based oils reduced LDL more than beef tallow. But beef tallow was better than butter. Like beef tallow raised your LDL less than butter. But like you've got a million choices for fats. I don't particularly know. I mean, it tastes good, actually. I mean, I think the reason to use beef tallow is it's actually quite tasty.

52:50If you've ever had French fries deep fried in beef tallow, this isn't a good, a healthy snack by any stretch. But they do. They do taste good.

52:57Perry Wilson:And that's okay. We're supposed to get enjoyment out of life, right? Totally. And I think that is, I mean, that is an important point for me here because sometimes we'll talk about sort of these products that you'll say, well, you know, what's the reason to have steak if, you know, even if we only have a little bit of evidence that plant-based sources reduce our LDL and we can't really connect it to health outcomes, you know, why not do it? And the answer is like, well, I, I, that's not the diet I would most prefer. And food is something that we enjoy. And so that's actually a reason to do it.

53:31Yeah, yeah, yeah, yeah. Life is for the living.

53:33Perry Wilson:Life is for the living. I've got to go to one more thing before we smash or pass this one, Emily, because I had a feeling how this was going to shake out. I felt like Emily was going to look at all the observational data and be like, this is all crap. It's fine. Just be healthy. And then And I was like, but I've got a trump card because I'm going to scour the literature to find a study of endurance athletes and see if I could show her that actually if you're an endurance athlete, eating red meat is better. So I found a study, a huge study of 28 cross-country runners who were randomized to their usual diet versus supplementing nine ounces of lean red meat a week times eight weeks.

54:22It's not that much, but it's the best I could find. They looked at about 800 different outcomes, like metabolic outcomes.

54:29Perry Wilson:That's how you get some things to be significant. No problem. It's an insane amount. Actually, I was quite surprised at how few of these were statistically significant because they measured so many things. But I do have one. Women in the control arms hematocrit, which is their red blood cell concentration, decreased by 3.8 % over the eight weeks. And women who got randomized to have the lean red meat had a 14.8 % increase in their hematocrit. That's their red blood cell count. This is biologically plausible because red meat contains iron and women as opposed to men, certainly college age women, premenopausal women have ongoing iron losses due to menstruation.

55:15And maybe this is a decent source of iron to help mitigate the anemia that can come from that.

55:22Perry Wilson:Yes, actually, most of the serious endurance athletes that I know do eat like do eat a reasonable amount of red meat or eat red meat because it is very common to be an anemic and iron the iron levels that are optimal for endurance performance are typically much higher. and particularly ferritin levels are much higher than would be sort of necessary for just being a person. And so people like to supplement with iron, but they also like to eat meat. But I will say that the carnivore diet is not well suited for endurance athletes who primarily should be consuming carbohydrates. Yeah. Not when you have 10 pounds of stool that you're carrying around on the run.

56:09Perry Wilson:Very, very challenging to run if you have eaten exclusively liver. Iron is absorbed from myoglobin better than it's absorbed from plant-based sources. So like soy, I mentioned early on that soy has a fair amount of iron in it, but it isn't absorbed quite as well as from red meat. That is mitigated somewhat by vitamin C intake. So if you really do want to avoid red meat, but get your iron through a natural source. You can soy plus something that contains vitamin C. So soy plus orange. Or you can take a hematocrit iron pill, which comes with vitamin C. You can also do that. That is mostly what people are doing.

56:49Perry Wilson:Okay, Perry, are you smashing or passing red meat? I'm so interested. I am a pass on processed red meat. I think it should be avoided. I think go ahead and eat unprocessed red meat if you enjoy it. But I wouldn't like target. I'm not going to smash it. I'm not going to say like go out and have more of it. I think there are plenty of other good sources of protein that are probably better for you. So I guess I'm a pass. Emily, smash your pass. Yeah, I'm a smash. I think that, again, I will say I don't think eating a lot of processed food in general is very good. So let's put that aside. But on the red meat, I think that this can be a part of a balanced diet.

57:33Perry Wilson:And if it is something that people enjoy, they should consume it. I'm a smash. All right. That's it for red meat. Your mailbag question of the week after the break. What if your soda actually did something for you? Introducing Sky Pop Protein Soda. With 10 grams of complete protein, zero sugar, and 45 calories, Sky Pop Protein Soda offers four delicious flavors with big taste and real benefits. Light, refreshing, and ready for wherever your day takes you. It's anytime protein that helps you reach higher. Sky Pop Protein Soda. Reach for the sky. Get your Sky Pop Protein Soda now at Target, Walmart, or Kroger.

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59:51Hi, Emily and Perry. I'm Genevieve calling from Hudson, Ohio. And my question is, do dave piercings really help with migraines? Something to do with the pressure points? I would love to get one for the looks, but I just think it's interesting that people say they help with headaches. So thank you. So this is an interesting question. I'm going to disclose something here. I lack the part of your ear that gets a dave piercing. Like it is, I don't know if you can see on video here. It is problematic because like earbuds don't stay in my ears. Like they have nothing to tuck into. So they just kind of fall out.

1:00:31I did look into this. It is apparently a normal anatomical variant. So if you're like me and your earbuds always fall out and there's nothing to pierce in your like inner helix of your ear. I guess we should say that, right? A date piercing is like that like inside of your ear helix piercing. Look it up. I think it looks kind of cool actually. You don't like it?

1:00:51Perry Wilson:It seems so painful. Oh, definitely painful. But you know, it's better to look good than to feel good. It's not. No, I don't think that at all. Anyway, does it help with migraines? I don't know. No, I don't think so. No. No, I mean, this is out there. Like people say it and they argue that, you know, maybe it's stimulating the vagus nerve or something like that. But there haven't been any rigorous studies, but even the sort of observational ones don't support any long-term benefit. But it could be the placebo effect, which is our favorite effect. Short term, absolutely. If you believe you're not going to get migraines, you will get less migraines.

1:01:32But those things do tend to wane over time. You sort of forget that it's there.

1:01:37Perry Wilson:Yes. All of the evidence for this is like some people said it might help. Yeah. Yep. That's fine. But it does look cool. So go ahead and get it if you can tolerate the pain. Do you have any weird body parts pierced? I have entirely normal body parts pierced. No, I'm just kidding. I don't have any. I don't have any. What's a weird body part? No, I don't. I have no piercings. I mean, unusual like piercings. Do you have any tattoos? I don't know. I don't have tattoos. I don't have. No tattoos. What about you? You don't have tattoos, I'm sure. Absolutely not. Are you kidding me? I don't even have Botox.

1:02:18Perry Wilson:I'm afraid of me. I forget about tattoos. Okay. All right. That's it for us today. Stick with us next week when we'll ask, what's the deal with cupping and dry needling? Speaking of needles. Wellness Actually is produced in association with iHeart Media. Our senior producer is Tamar Avishai. Our executive producer at iHeart is Jennifer Bassett. Our theme music is by Eric Deutsch. And our content is for educational purposes only. If you like the show, help other people find us. Leave a rating and review on Apple Podcasts or your podcatcher of choice. and help us spread the word about the show, you can follow us on Instagram at wellnessactuallypod.

1:03:00And don't forget, we want to hear from you. Head over to wellnessactually.fm and leave us a question for our mailbag or suggest a topic for a future show. We'll let the influencers have the last word. I've eaten nothing but meat and butter for seven years. My husband thinks I'm absolutely insane for this, but I'm obsessed with eating cold meat. The flavor and texture gets better and the cold fat turns into this buttery frosting. I literally cook extra steak on purpose just so I can eat it straight out of the fridge. Am I the only one?

1:03:45Perry Wilson:Wait, this is a soda? Yeah. And it has protein? 10 grams. No sugar? Zero. And it actually tastes good? It's Sky Pop. Sky Pop Protein Soda delivers the refreshing taste you want from a real soda. Crisp and delicious with 10 grams of complete protein, zero sugar, and just 45 calories. So you're not choosing between great taste and real benefits. You're getting both in every sip. Sky Pop Protein Soda. Reach for the sky. Get your Sky Pop Protein Soda now at Target, Walmart, or Kroger. What's up, everybody? It's Bretzky, and America is turning 250. And I can't think of a better way to celebrate that than playing on an American-owned social casino, SpinQuest.com.

1:04:28With all of your favorite games, live craps, bubble craps, live blackjack, there's no better place to play for free and win real cash prizes. SpinQuest.com. SpinQuest is a free-to-play social casino. Avoid where prohibited. Visit SpinQuest.com for more details. Hey everyone, it's Kel Penn. I'm inviting you to join the best sounding book club you've ever heard with my podcast, Earsay, the Audible and iHeart Audiobook Club. Every episode, I nerd out with amazing guests and dive into the best new audiobooks available on Audible. It's the book club for your ears. Listen to Earsay, the Audible and iHeart Audiobook Club on the iHeartRadio app or wherever you get your podcasts.

1:05:16Perry Wilson:This is an iHeart podcast. Guaranteed human.