Guide to red meat: Is it healthy?

Is red meat healthy, harmful, or neutral? Should you enjoy it freely on your healthy diet or limit your consumption?

Depending on which expert you ask, these questions may receive very different answers.

Has a strong link between red meat and heart disease, cancer, or other diseases been established? Will consuming it on a regular basis shorten your life or put you at risk of health problems?

Here is our guide to what we currently know about red meat, so you can make an informed decision about whether to include it – and how much – in your own diet.

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What is red meat?

Red meat comes from mammals. When raw, it usually appears dark red because it contains a lot of myoglobin, the iron-rich protein that stores oxygen in animal muscle. The red meat category includes beef, pork, lamb, veal, goat, bison, venison, and other game.

Red meat can be fresh or processed. Fresh red meat is exactly what it sounds like: meat that contains no additives, requires refrigeration, and needs to be consumed within a few days, after roasting, grilling, stewing, etc.

Processed red meat is a broader term referring to meat that’s been modified by salting, curing, smoking, canning, or treating with preservatives. Popular types include bacon, salami, sausage, hot dogs, and jerky.

Some processed meats contain salt as their sole additive, whereas others may include sugar, starch, other fillers, and chemicals such as nitrites.

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Benefits of eating red meat

Animal foods are an important part of our evolutionary past, having likely played a critical role in our development as a species.

They have even been credited with allowing us to develop the large, complex brains that are unique to humans, although evolutionary science like this is imprecise at best. Indeed, we may be genetically wired to enjoy the flavor and texture of meat.

In addition to being tasty and filling, red meat provides many nutritional benefits:

• High-quality protein: A 100-gram (3.5-ounce) serving of red meat contains about 20-25 grams of protein, depending how fatty it is (leaner cuts have more protein). Like eggs, dairy, and other animal products, red meat provides protein that is considered complete, meaning it contains all nine essential amino acids in the amounts your body needs.
  Learn more about protein:
  Protein on a low-carb or keto diet

  Guide Along with fat and carbohydrates, protein is one of the three macronutrients (“macros”) found in food, and it plays unique and important roles in the body. Here’s a guide to everything you need to know about protein on a low-carb or keto lifestyle.

• Several vitamins and minerals: Red meat is an excellent source of many important micronutrients, including vitamin B12, niacin, selenium, zinc and potassium.
• Heme iron: All types of red meat are rich in heme iron, which your body absorbs more easily than the non-heme form of iron found in plants.
  Consuming red meat on a regular basis may help increase your iron stores and prevent iron-deficiency anemia.
• May help preserve muscle: It’s an unfortunate fact that we usually lose muscle as we age due to hormonal and other physiological changes. In one study, older women who ate red meat in combination with resistance training achieved greater gains in lean muscle and strength than the resistance-training-only group.
  Similar improvements have been shown in studies of young and middle-aged men who consumed beef and triathletes who took beef-based supplements, when compared to men of similar age who ate lacto-ovo vegetarian diets or took whey-based supplements during strength training.
• May help prevent frailty: In a study of older women, consuming higher amounts of animal protein, including red meat, was linked to a decreased risk of weakness, loss of strength and other changes that often occur with aging.

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What does the research show with respect to meat’s potential harm?

News media have reported on studies showing an association between eating a lot of red meat and increased risks of cancer and heart disease. Some articles have even stated that meat is flat-out “killing us.”

But how strong are these associations, especially when considering all available types of studies? Let’s take a look at the research on red meat and disease risk to date and assess the strength of the evidence.

Red meat and cancer

In October 2015, the International Agency for Research on Cancer (IARC) issued a press release classifying processed meat as “carcinogenic” and red meat as “probably carcinogenic” in humans. While the epidemiological studies reviewed by the committee suggest an association, other studies question the strength of the association.

Cancers other than colorectal

In large reviews and meta-analyses of observational studies, researchers have found inconsistent results. One very large meta-analysis found that the absolute effects of red meat on cancer risk are extremely low, with the certainty of evidence being low to very low.

While some have shown no association of red meat and cancer risk, others have shown a positive association with gastric, esophageal, breast, and prostate cancer.

For those that did show an association, the hazard ratios were quite small, in the range of 1.06 to 1.4. In comparison, cigarette smoking has a hazard ratio greater than 20 for being associated with cancer.

Therefore, although these observational studies can suggest an association between red meat and cancer, the very low hazard ratios weaken the assertion that red meat causes cancer.

Colorectal cancer

Colorectal cancer is by far the most common type of cancer studied regarding its relationship to red meat. Here, studies have shown a more consistent association.

However, once again the association is very weak with hazard ratios mostly below 1.4. While this does not invalidate the data, the weak hazard ratios do raise the question of what it is, exactly, about meat that may increase risk.

In some studies, the association with colorectal cancer has been attributed to heterocyclic amines (HCAs) and other potentially harmful compounds that form when meat is cooked at high temperatures. Therefore, it seems reasonable to wonder if limiting high-temperature cooking of red meat could mitigate the very small risk of colorectal cancer.

The heme iron found in red meat has also been suggested to play a causative role in colorectal cancer, based on findings in animal studies and some epidemiological studies in humans.

However, other studies have failed to show a connection between ingesting HCAs and heme iron with developing colorectal cancer.

While many observational trials suggest red meat is associated with colon cancer, some researchers point out that other lifestyle factors could influence those results. With low hazard ratios, it’s difficult to completely exclude that high sugar consumption, alcohol intake, smoking, decreased physical activity, lack of vegetable intake or other factors impacted the results.

In contrast to the large amount of observational research available, very little experimental research on red meat consumption and colon cancer exists, at least in humans.

However, we do want to highlight one particular clinical trial that suggests green leafy vegetables may mitigate the presumably very low risk of colon cancer from red meat. The evidence is short-term, uses surrogate endpoints, and requires larger confirmatory trials, but at the same time is encouraging for demonstrating a potentially protective effect.

Looking at other human clinical trial data, one study in people with precancerous colon polyps found that cutting back on red meat over a four-year period did not decrease the risk of polyp recurrence.

In addition, a systematic review of RCTs comparing lower vs. higher red meat consumption found the overall quality of evidence to be low or very-low, and the authors concluded there is no meaningful increase in cancer with higher red meat consumption.

While there are compelling mechanistic data to explain how compounds in red meat or produced by the cooking of meat could cause colorectal cancer, it’s important to remember that plausible mechanisms are not sufficient to prove a causal relationship.

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Red meat and heart disease

Many observational studies show a relationship between eating meat and the risk for heart disease, stroke and heart disease deaths.

One large review failed to find a consistent and definitive relationship between red meat and increased risk of ischemic heart disease (also known as coronary artery disease).

But other large reviews found evidence for an increased risk of heart disease and all-cause mortality, albeit extremely small.

Still other reviews of the literature show a link with processed meat but not minimally processed red meat.

Recognizing that trying to link red meat to cardiovascular events requires studying very large numbers of subjects for long periods, many investigators choose to focus instead on surrogate endpoints.

One meta-analysis of randomized controlled trials (considered the strongest, highest-quality evidence) showed that eating three or more servings of red meat per week had no adverse effects on CVD risk factors like cholesterol, triglyceride or blood pressure values.

A 2019 review of RCTs and cohort studies used the GRADE technique to assign a level of quality to studies comparing more vs less red meat intake. They found no meaningful increased cardiovascular risk from higher red meat consumption.

Part of the problem is separating the effects of red meat from the effects of other dietary and lifestyle factors. The evidence suggests that those eating meat as part of a high-carb and high-fat Western diet tend to be less healthy at baseline than those choosing not to eat meat.

Investigators try to control for unhealthy behaviors, but it’s really hard to do that. This leads to weak statistical relationships and fairly uncertain conclusions. Perhaps the best we can say is, if you are unhealthy at baseline and eating a standard Western diet, then the data suggest red meat consumption is associated with heart disease risk.

But what if you aren’t eating a standard Western diet? What if you aren’t unhealthy at baseline? Here, the data are much sparser regarding the role of red meat in heart disease.

A user guide to saturated fat

Guide This guide explains what is known about saturated fat, discusses the scientific evidence about its role in health, and explores whether we should be concerned about how much we eat it.

In addition to looking at surrogate endpoints like cholesterol, investigators have also looked at the tendency of red meat to raise blood levels of TMAO (trimethylamine-N-oxide), which some studies show correlates with increased heart disease risk.

Yet, what’s often not mentioned is that eating many other foods — including fish — also raises TMAO. Further, the production of TMAO is dependent on gut microbiota, not just the consumption of red meat.

As we have written about the inconclusive evidence for a relationship between TMAO and CVD, questions remain regarding the role of TMAO as an independent risk marker or causative factor for coronary disease.

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Red meat and insulin-resistant conditions

Some studies suggest that eating red meat on a regular basis may increase the risk of diabetes and other conditions characterized by insulin resistance.

• Diabetes: Several large reviews of observational studies have found weak associations between frequent red meat and processed meat consumption and diabetes risk.
  Once again, however, we need to consider this association between meat and diabetes risk in a real-world context: it is possible that many of these study subjects were also eating high-carbohydrate diets and low-quality foods. It is critical to note that randomized controlled trials have shown impressive improvement in diabetes with unlimited animal food sources, including red meat.
  We review the topic in more detail in one of our videos.

  It’s less likely that meat itself leads to diabetes; rather, the risk may more likely be due to a combination of foods that tend to be high in both fat and carbohydrates, as well as other poor lifestyle habits.

• Obesity and metabolic syndrome: A 2014 systematic review of observational studies showed a weak relationship between red meat and obesity but a much stronger one between red meat and large waist size.
  But once again, that is far from proving causation.

  Another trial, an analysis of data from the PREDIMED trial — a large study exploring health-related effects of the Mediterranean diet — found similar results.

On the other hand, a well-controlled trial in overweight and obese people found that including 500 grams (17.6 ounces or approximately three 6-ounce servings) of lean red meat per week as part of a Mediterranean diet resulted in equal weight loss and reduction in metabolic risk factors compared to following the same basic diet but eating much less red meat.

And a meta-analysis of 24 RCTs found no differences in glycemic control, insulin sensitivity, or inflammatory markers among metabolically healthy people, comparing those whose average red meat intake was less than 0.5 servings (35 grams) per day to those who consumed more than 0.5 servings per day.

How can we interpret these data? For those eating a standard Western diet with high carbohydrates and high fat, red meat consumption is likely associated with insulin resistance and metabolic syndrome. However, other studies show that low-carb diets that include red meat successfully treat type 2 diabetes and insulin resistance.

Therefore, we come back to the concept that the overall content of the diet may be more important than the specific intake of red meat.

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Red meat and gout

Gout, one of the most acutely painful joint conditions, is characterized by high levels of uric acid in the blood (hyperuricemia). People with gout are often advised to strictly limit the amount of red meat they eat.

However, a systematic review of 19 observational studies found that consuming red meat intake was only weakly associated with gout and elevated uric acid levels, whereas alcohol and fructose intake were found to have stronger correlations with each of these conditions.

Read more about gout and low-carb diets here.

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Red meat and all-cause mortality

Multiple epidemiologic studies have shown a weak association between meat consumption and increased risk of premature death. However, once again these studies have low hazard ratios consistently under 1.4, and they are subject to healthy user bias and other weaknesses of nutritional epidemiology studies.

Given that the correlation between red meat intake and all-cause mortality is consistently weak, it’s not surprising that the some of the largest cohort studies and meta-analyses have demonstrated just a tiny increased risk regarding red meat intake and all-cause mortality.

What’s more, a 2013 review of dietary habits among Asians not only found no association of increased risk of death among red meat eaters but also a slightly decreased risk of CVD mortality in men and cancer mortality in women who reported the highest intakes of meat.

Just as with the risk for cancer and heart disease, what else is eaten with the red meat likely plays a significant role as do other health habits. For instance, one study tried to control for these factors and recruited “health conscious” participants. They found no mortality difference between meat eaters and vegetarians.

Nonetheless, we can’t dismiss the data associating red meat with mortality. If someone fits the common subject profile in many of the epidemiologic studies – eating 40-50% carbohydrates, overweight, metabolically unhealthy – then that person may have a slightly higher risk of premature death if eating red meat. Is it the meat or is it other unhealthy lifestyle choices? That remains to be proven.

We also need to ask: what happens when someone lowers their carbohydrates, loses weight, reverses metabolic disease, and improves their overall lifestyle? In that situation, we do not have incriminating evidence against red meat.

Five facts to keep in mind about red meat evidence

When we repeatedly hear that eating red meat is unhealthy and could possibly shorten our lives, it’s entirely understandable to become concerned. However, keep several things in mind.

1. Observational data: Studies showing a relationship between red meat and disease risk have several problems, first and foremost being that they rely on observational rather than experimental data. Observational studies can only infer a relationship between a behavior (such as meat eating) and an outcome (such as cancer or heart disease).
   
   Unless the correlation between the two is strong (hazard ratios greater than 2 at a minimum, and better if greater than 5) and consistent across multiple studies, we can’t use these types of studies to draw certain conclusions.
   Too many other factors can influence the results.

   For instance, red meat is often singled out as the culprit regardless of overall diet quality and composition. Does a person who typically consumes a dinner of 150 grams (5 ounces) of steak, salad, and a glass of dry wine carry the same level of disease risk as someone who typically eats the same amount of steak with french fries, a soda and a sugary dessert? It seems unlikely.

2. Food frequency questionnaires: Another major problem with observational studies is the common practice of using food frequency questionnaires to assess how much red meat people actually consume. They rely on memory recall and annual estimates and are notoriously unreliable.
   
   Moreover, these questionnaires are usually only filled out a few times over the course of a long study period. Obviously, what someone eats can change dramatically within a 5-year period, even if reporting food intake with 100% accuracy were at all possible.
3. Processed meat not all alike: Processed meat elicits more health warnings, but lumping all processed meat into the same category when assessing risk isn’t really fair. Although many types are made with poor-quality meat and unhealthy ingredients, other smoked and cured meats contain few additives and can be quite nutritious. What’s more, even though correlations are stronger for processed meat than fresh meat, they are still weak overall.
4. Healthy user bias: With red meat getting bad press these past few decades, the healthy user bias also comes into play. Many people who heed these warnings to eat little or no red meat will also likely follow advice to exercise regularly, avoid fast food and reduce alcohol intake.
   

   Such people also tend never to smoke and to practice other health-conscious behaviors. They also tend to have more education, better jobs and earn more money.

   The reduced disease risk found in these individuals could potentially be due to their healthier lifestyles and their better socio-economic factors, which have all been linked to better health, rather than to their lack of red meat consumption alone.

5. Few human RCTs: Unfortunately, very few randomized controlled trials looking at humans eating red meat and health have been conducted, although those that do exist suggest that consuming it on a regular basis appears to have few adverse effects and some beneficial effects.

At this point, we have mostly observational studies that show weak associations between red meat and disease risk, and sometimes no relationship between the two at all.

Because of the lack of high-quality research in this area, it’s hard to know for sure if eating red meat on a regular basis will jeopardize or even improve your health and longevity.

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Healthy choices for red meat eaters

We believe that there isn’t sufficient evidence to indict red meat as harmful for all of us. Therefore, we offer the following suggestions for how to include it in your diet in a way that may be best for your health and the health of our planet.

• Choose fresh red meat over processed types: Like other types of food, fresh usually wins over processed because it contains no preservatives or additives. If you are consuming processed red meat, look for types without sugar, fillers, or other questionable ingredients.
• Avoid charring or overcooking meat: Although the evidence to date remains inconclusive, the heterocyclic amines (HCAs) that form when meat is cooked at high temperatures and allowed to burn or char may possibly raise the risk of cancer, especially colon cancer. Enjoy your burgers and steaks cooked with lower direct heat to avoid charring.
• Whenever possible, select red meat from naturally raised animals: Grass-fed or pastured animals have better omega-3 fatty acid, conjugated linoleic acid, and antioxidant profiles than grain-fed animals.

While this does not prove it is healthier, if you can easily find and afford it, naturally raised and grass-fed meat may be worth it from an environmental and health perspective. However, since the science is not conclusive, don’t let this be a barrier to going low carb.

• Make environmentally healthy red meat choices: Learn more in Anne Mullens‘ three-part series, The green keto meat eater:

Summary: should you eat red meat?

Based on what is currently known, should you consume red meat?

If you don’t like the taste of red meat or don’t want to eat animals, you don’t need to feel you must eat any meat at all. A healthy diet does not require meat as long as you get adequate nutrients and protein in other ways. You can still enjoy the benefits of a carb-restricted lifestyle by following a well-balanced diet that doesn’t include red meat, poultry or fish, and instead eat a keto or low-carb vegetarian diet:

How to follow a healthy vegetarian keto diet

Guide Are you a vegetarian interested in experiencing the many benefits of a keto diet? A vegetarian keto lifestyle is definitely doable. However, there are some potential health issues to be aware of. Read this guide to learn how to follow a vegetarian keto diet in a healthy, sustainable way.

However, if you avoid or limit red meat because you’re concerned about its health effects, you may want to reconsider.

Although some studies suggest meat intake is associated with worse health outcomes, the science is mostly low quality and may not apply to those who eat it in the context of a healthy, low-carbohydrate diet.

/ Franziska Spritzler, RD

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Additional resources

Videos

Nina Teicholz: What about red meat and health?  
Dr. Peter Ballerstedt: Grass-based health and the ruminant revolution

Article

Dr. Jason Fung: Why red meat won’t kill you