Eating too much ramen may be linked to higher risk of stroke but not heart attack

The article published on Nutrition Journal on 09/04/2019 explicitly says "The prevalence of ramen restaurants, but not of other restaurant types, positively correlated with stroke mortality in both men and women (r > 0.5). We found no correlation between ramen restaurant prevalence and mortality from acute myocardial infarction." (my italics)

And yet some media such as nextshark.com ("Japanese Ramen Linked to Heart Attack and Stroke Risk, Study Says") or qz.com ("The researchers from Jichi Medical University suspected that ramen, which is high in sodium, might be linked to higher risk of strokes and heart attacks") incorrectly report that the research links ramen with heart attack, technically known as acute myocardial infarction. A heart attack is blockage of the blood vessels to the heart, while stroke is blockage of the vessels to the brain. It's a simple distinction naive people including some journalists are ignorant of. In any case, too much sodium is always bad, although what ingredient or ingredients in ramen are responsible for higher risk of stroke are not directly investigated in this research.

Amount of protein in food

Cleveland Clinic is a prestigious hospital in the US particularly for its heart program. So their newsletters about health are of top quality as well. In the July 26, 2019 newsletter, Which Is the Best Protein Source?, we read

Grams of ANIMAL PROTEIN per 100 grams of:
36.71 veal
36.12 beef
32.08 lamb
28.86 pork
28.74 chicken
25.51 tuna
24.62 sardines
23.63 cheese
22.10 salmon
20.50 crickets
12.58 eggs

Grams of PLANT PROTEIN per 100 grams of:
22.21 peanut butter
20.96 almonds
16.89 oats
9.04 tofu
9.02 lentils
8.86 black beans

This article is adapted from Dr. Hyman's book "What the 
Heck Should I Eat?" (© 2018, Hyman Enterprises, LLC)

On p.37 of Mark Hyman's Food: What the Heck Should I Eat?, we find this list, citing as its source a webpage on wired.com, Know Your Meat—and Bugs. Introducing the Periodic Table of Protein. Unfortunately, the wired.com article does not give the source, which is unusual among articles on a health topic. But it doesn't take long to find that the ultimate source of it (as well as many others such as nutritionvalue.org) to be USDA (US Department of Agriculture), where you can search for very detailed nutrition data, probably too detailed for a non-specialist. Since the amount of protein in 100 grams of eggs is surprisingly low, only 12.58 grams according to wired.com or its downstream book and webpage, let's search for "egg" on the USDA website, and we get (grams per 100 grams of eggs)

Egg, white, dried: 81.10
Egg, whole, dried: 48.05
Egg, yolk, dried: 33.63
Egg, yolk, raw, fresh: 15.86
Egg, whole, cooked, fried: 13.61
Eggs, scrambled, frozen mixture: 13.10
Egg, whole, raw, fresh: 12.56
Egg, whole, cooked, poached: 12.51
Egg, white, raw, fresh: 10.90
Egg, whole, cooked, omelet: 10.57
Egg, whole, cooked, scrambled: 9.99

We can see that wired.com's Periodic Table of Protein or other similar sources quote the protein content of eggs (12.58g) from USDA as probably "Egg, whole, raw, fresh" or "Egg, whole, cooked, poached", not for instance, "Egg, white, dried", which would be too high, nor "Egg, whole, cooked, scrambled", too low. If we search for "veal", the most protein-rich food in the Periodic Table of Protein, on USDA, we get a hundred of entries. I have not determined which of them most closely matches 36.71 grams per 100 grams of veal.

In short, the simple protein nutrition list is a good reference, but it hides a lot of details about whether the food is raw or cooked, which part of the food is measured, and how it is cooked.

Lessons learned from a story of a student that committed suicide

...

(6) If after the counseling, the child is less open to his parents, suspect the counselor, and stop the counseling immediately.

Note Lesson (6), which is related to (5). It is probably the most obscure aspect of mental counseling and yet is of vital importance, literally. It's not uncommon for a counselor to say, perhaps casually just like any non-specialist, that the parents are not caring (enough) or not doing a good job. Except in rare cases where the parents or one parent is truly irresponsible, these defamatory words alienate the child from the loving parents. And in view of the fact that an immature child may trust his teacher or counselor more than his parents, these words are particularly damaging, and could inadvertently push the child toward total isolation and possibly suicide.

Eating too much sugar leads to diabetes?

Does eating too much sugar cause type-2 diabetes? The answer has always been "not directly", that is, too much sugar, commonly consumed along with too much unhealthy food, causes weight gain, which contributes to diabetes. But the 2013 article by the UC San Francisco researchers, The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data, is said to give a positive answer to the question. According to news articles such as Quantity of Sugar in Food Supply Linked to Diabetes Rates, and High Sugar Consumption Linked To Type 2 Diabetes, the author of the research article said that “in medicine, we rely on the postulates of Sir Austin Bradford Hill to examine associations to infer causation, as we did with smoking. You expose the subject to an agent, you get a disease; you take the agent away, the disease gets better; you re-expose and the disease gets worse again. This study satisfies those criteria, and places sugar front and center.”

Unfortunately, I can't find much talk about this research on the Internet, especially some time after its publication. Six years have passed and the public opinion on whether there is relationship between sugar intake and diabetes largely remains negative. An 2017 article summarizes various studies, with a general conclusion of "No" to the title question "Does Sugar Cause Diabetes?", citing 16 references, without mention of the 2013 UCSF article.

[2019-11 Update] According to a new article Changes in Consumption of Sugary Beverages and Artificially Sweetened Beverages and Subsequent Risk of Type 2 Diabetes: Results From Three Large Prospective U.S. Cohorts of Women and Men, "[i]ncreasing consumption of sugary beverages or ASBs was associated with a higher risk of type 2 diabetes, albeit the latter may be affected by reverse causation and surveillance bias." Dr. Weil calls the study "the first to investigate whether or not changes in beverage choice and long-term consumption of sugar or artificially sweetened drinks is associated with the risk of type 2 diabetes."

Do TCM doctors have a shorter life span than doctors of western medicine?

It's a common theme on the Internet of the Chinese language: "台湾中医比西医短命六七岁" (Taiwanese Traditional Chinese Medicine doctors have a shorter life span than doctors of western medicine by six to seven years). Like almost all popular articles written in Chinese, the source of claim is not verified. In this case, it's simply stated as "台湾《联合报》报道" (according to the report of Taiwanese United Daily News), or "根据台湾医学会最新调查" (according to the latest investigation of the Taiwanese Medical Society"), without giving a link.

After some Googling, I managed to locate the earliest webpage that carried this information. At blog.udn.com/giveman/4346332 posted at 2010/08/23 15:08, the blogger attributed this claim to the Taiwanese 衛生署 (Ministry of Health) and 婦產科醫學會 (Taiwanese Gynecological Society) by quoting a reporter by the name of 陳惠惠. Unfortunately, there's no further link. One week later, on 2010/8/30, Professor 黃文璋 (Wen-Jang Huang) of National University of Kaohsiung wrote that "雖未能找到台灣婦產科醫學會的調查報告，但在網路上查到..." (Although the investigative report by the Taiwanese Gynecological Society was not found, I searched and found on the Internet that ..."

Literature search aside, the fact that a statement claiming that TCM doctors live shorter than non-TCM counterparts can quickly become popular and continue floating on the Internet for many years is an interesting one. Indeed, TCM is said to be strong at 养生 (maintaining health) and not so at medical treatment, as most people believe. Then, why would TCM practitioners themselves die younger? If that turns out to be true based on quality statistics, there may be one factor at play: TCM doctors are not fully appreciative of the toxicity of some ingredients (they know but choose to make light of them), or have not kept abreast of some latest studies (as in the case of 马兜铃酸 or aristolochic acid found to exist in much more herbs than previously thought).