Beer and Sausage Diet: Update

You can see our interview talking about the Beer and Sausage diet, on our local Phoenix Fox affiliate below:

Major news outlets picked up the story about our unique Beer and Sausage diet and you can see Evo Terra interviewed by Fox News’ Shepard Smith below:

Interviewing Fox News for Evo Diet

Interviewing Fox News for the Diet

For the third year in a row my friend did this- and now- we have three years of data:

Beer and sausage for a month: 1500 calories a day max, six beers a day max. Result: weight down every year. Cholesterol down by 1/3, triglycerides down, lipids down, and no change in the liver enzymes. All lab values improved, weight improved. The only bad thing: three years doing this (every October for the month) Evo has had to buy new clothes.

Why a Beer Diet?

When my good friend Evo Terra mentioned his desire to go on this special one-month diet, it was initially going to consist of just beer. Beer wouldn’t contain enough protein (9.6 grams a day for the six beers) nor would it contain enough other micronutrients. To add some protein to the diet, sausages to fit the October theme, and Evo didn’t take much persuading. Plus, it would give me a reason to make my favorite, reindeer sausage, as his inaugural meal.

If you have been influenced by popular press and are aghast at what Evo did, you’re probably wondering how a physician could condone such a diet. The answer is simple: because we needed to know.

There are a lot of myths about what a person should eat, what they should eat to be fit, to lose weight, and to maintain health. What we think we know about how the body reacts and what we really know are two different things. We are influenced by the latest book on the subject, thinking that everyone should just eat vegetables, or protein, or (insert here).

If you follow the “protein” diets – such as Paleo or Atkins, you would assume that sausages are ok, but beer would be horrible. If you are a vegetarian you could find a reason to drink beer, but you would never eat sausages – -after all it is “processed” meat. Where do we get those ideas, and is there real science behind them? We get them from popular press, we get them from cherry-picking scientific data, we get them from our own prejudice.

So Evo was embarking on a diet that was at odds with the two great themes of American diets – he was not eating “clean” and he was eating “processed foods” therefore he should be doomed to failure.

Here is the problem- most of what you have read or heard about diets has more baloney than the sausages that Evo would eat. But they do sound good from a sound bite: veggies are good for you so only eat those – or alternatively – the cavemen were “evolved” to eat certain things and we have messed up the world by processing food so it has to be bad.

The most dangerous assumptions about diets come from “population studies,” where researchers take a collective look at an entire population, get food diaries from some individuals and then look at their overall health. It’s just bad science.

Here are a few popular ones you may have heard of over the years, along with the myths they’ve generated.

Seven Countries Study
From the 1960s through the 1970s, cholesterol was offered up as a serious health threat. Both the American Heart Association and the “McGovern Report” that set national dietary policy in 1977 cited findings from the Seven Countries Study as evidence for their official statements clearly showing dietary cholesterol is bad for you, me, and everyone else. This study was a subgroup of a larger study- and it set policy about saturated fat and cholesterol for the United States for years.

Ancel Keys, a physiologist, architected and promoted the Seven Countries Study, establishing the conclusion that serum cholesterol was strongly associated with heart disease. That part is true- if your blood level of cholesterol is high, the incidence of heart disease and stroke is dramatic. Where Keys got into trouble was making the leap that: a diet low in cholesterol would reduce heart disease. The first assumption was that dietary cholesterol would impact blood cholesterol – it does so very modestly, and the second was that saturated fat would impact heart disease. All these conclusions based on the “diet” reported in the population of those seven countries.

But here’s the rub: The statistical data from the Seven Countries Study did not back up Keys’s conclusion. He left out the “French” paradox. The French had a diet rich in saturated fats from both meats and dairy, and yet had one of the lowest rates of heart disease in the western world. This paradox could not be ignored, but the study did ignore it. Later people tried to invoke the increased red wine consumption as some magic counter to the saturated fat. The other data point the study ignored was the Japanese had significantly increased consumption of meats after WWII and yet still showed a reduction in strokes and heart disease. Today, we know the “epidemic” of heart disease in those decades was more attributed to the increase in cigarette smoking than dietary changes.

Later in his life, Keys recanted his position, saying cholesterol wasn’t so important. He then discovered olive oil, and was one of the founders of the Mediterranean Diet. He lived to be 101.

Many vegetarians and vegans cite the China study as “the study” showing that eating vegetables will not only reduce heart disease, but cancer. This study was then summarized in a best selling book filled with conclusions and anecdotes, but no real science. Rural China had low reported incidence of heart disease and they continued to eat their traditional diet. Hence, the low incidence must be from diet so lets see what those rural villagers eat and tie diet and heart disease together. To do this, the lead author, T. Colin Campbell drew blood from all the people in the villages and then pooled the samples together (yes, you take blood from everyone, mix it together then analyze it). Based on the data from a sample size of 100, he came to the conclusion (one he had come to before) that those with a diet high in vegetable proteins lived the longest, and that animal proteins were the primary cause of heart disease, cancer, and halitosis (OK, maybe not halitosis.)

The primary flaw of the study is the main flaw in all population studies: you have to have good data about what people die from. The incidence of heart disease in China is greater than it was 40 years ago, not because heart disease has increased, or because they are eating more protein, but because when a person died of heart disease it was often recorded as something else. To this day heart disease in China is under-reported – and in the day when there were no doctors in these villages, it was dramatically under-reported.

Most of the data in the study, when critically examined, support the opposite conclusion of the “findings” he suggests in his book. For example, one village had an extremely higher per-capita consumption of meat–twice that of the US population at the time. Yet they had the lowest incidence of cancer and heart disease. These data also showed that the higher the amounts of processed wheat and sugar in the diets of the villagers in the study, the greater incidence of heart disease. Statistical outliers? More like evidence of the null hypothesis.

Here’s the reality. People who lived in rural China during the time of data collection were classic omnivores. They ate–and by all accounts still eat–any and all protein sources available. Mammals, birds, insects … If it flies, walks, crawls, swims, or slithers on the ground, it’s quite literally fair game. But when asked by well-meaning researchers in stiff lab coats to detail their protein sources? Well … pride is strong motivator. Self-selected surveys are always suspect. Direct observation paints a vastly different picture.

The Norwegian Study
Cited by vegetarians as proof that if you eliminate animal proteins from your diet you will have less heart disease, the decrease in heart disease during World War 2 in Norway is cited as further proof that animal proteins lead to heart disease. The thesis – heart disease went down because they ate less animal protein because the German soldiers confiscated it to feed their army. But that conclusion is incorrect.

In 1940, Norway was invaded and occupied by Nazi Germany. Over the course of the next four years, the Germans confiscated nearly all the livestock to feed Nazi soldiers. In the Norwegian population, land-based animal protein consumption was suddenly and almost completely absent, while fish-based protein shot up over 200%. Also sugars, flours, and processed goods were highly rationed and hence only available on a very limited basis. During this time the Norske were forced to forage for plants and eat more fish to survive. There was a noticeable drop in death from heart disease during the German occupation.

Popularized vegetarian conclusion: Since the Norwegians didn’t have red meat their heart disease rate went down. This conclusion ignores that in wartime, the chance of dying from other causes such as trauma (guns), pneumonia, and other infectious diseases increases dramatically before a person has a chance to live long enough to choke off their coronary artery.

“During the first year [starting in spring of 1940] the rationing included all imported foods, bread, fats, sugar, coffee, cocoa, syrup, and coffee substitute. In the second year [starting in late 1941] all kinds of meat and pork, eggs, milk and dairy products were rationed” – from Food Conditions in Norway during the war, 1939-1945: Proceedings of the Nutrition Society.

No reduction in red meat the first year, and not until late in the second year? Then the mortality drop for 1941 cannot be linked to a reduction in animal protein that clearly didn’t happen.

In reality, it appears that Norway suffered from increasing fish (great source of Omega 3 fatty acids) They grew and ate a lot of potatoes, but had a low amount of refined sugars and almost no margarine (I don’t know a respectable Norwegian today who cooks with margarine). But that’s really not why heart disease went down.

As mentioned previously, heart disease takes time to kill you. War doesn’t. The increase of mortality from infectious diseases like pneumonia killed more Norwegians during this time than any other time.

Paleo Diet: Cavemen knew better
Until someone invents a time machine, data collection on the daily habits and lifestyles of paleolithic man isn’t feasible. We cannot even make valid assumptions of people who live during world war two, so imagine the manipulations you have to go through to conclude what the caveman ate. While there people still left in the world who still gather and hunt as they did in the Paleolithic era, we don’t have good data about their over-all health, and if they die from heart disease or other causes of death (most hunter-gather societies are still ravaged by infectious disease killing them long before heart disease will). . But what we cannot conclude is that for 250,000 years we were disease free, had few cavities, or lived in the proverbial garden of Eden, harmonious with nature. This is made up. Totally made up. It sells a lot of books, and justifies eating bacon.

Strong Heart Studies–The Pima Indians
When I arrived as a vascular surgeon to Arizona, I was told that the Pima Indians had something special about them, as they didn’t suffer from heart disease. This conventional wisdom was so prevalent that a study was created, the Strong Heart Study, to try to determine what the Pima Indians had that made them immune from today’s heart disease. Especially this was true since they have the highest incidence of type 2 diabetes in the world. ( As it turns out, closer examination revealed that most Pima Indians do die of heart disease. Simply put: Their hearts were no different than anyone else’s and their rate of death from heart disease was actually higher than the general US population.

The embarrassment of this conclusion was that it was made with “the most well studied population in the world.” The Pima Indians were studied for years by the National Institutes of Health, they even had an outpost and health data there. In addition, these Native Americans received their health care from the Indian Health Service, with a hospital on the reservation and tertiary care in the metropolitan Phoenix Indian Medical Center. Even with backing of the NIH–a fully staffed health service–the statistics collected and recorded were clearly poor. For years they concluded that Pima Indians had a low rate of heart disease. So if the NIH cannot get this one right, then imagine: data collection taking place in a third-world country without constant oversight. Consider hastily scribed pencil markings in record books from just a few decades ago.

The statistics about mortality rates from any population survey are suspect. Conclusions drawn from poor data are useless. The common thread in the popular studies about diet are filled with confirmation bias of the authors. t

With Evo’s diet, we examined not only his weight but his body fat, total body water, and muscle mass. We also took blood draws to examine his blood count lipids, and liver profiles. Based on that data, we were prepared to stop the diet if he took a turn for the worse. As you will see, not only did he lose weight, his cholesterol decreased, his body fat decreased, and he did not appear to suffer any ill effects.

Physician disclaimer time: Do not attempt this diet on your own. You need a physician’s supervision for something like this. We need to examine this diet on many more individuals and get good data before we recommend this without a physician’s supervision. Please share this book with your doctor if you’re considering something similar. We’ll even autograph a copy for you or will sign your e-book reader with a sharpie.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit

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  1. Dr. Terry Simpson says:

    I don’t think you see me advocating that – but in spite of many people saying this should cause all sorts of problems – it didn’t. But- his labs came out perfectly normal and improved – and we looked at everything. There was not a lack of fiber (read the articles). But your point is well taken – no N of 1 is good for anything. It is, to put it simply, unique and interesting- – but scientific.

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