Can I have smoked sausage?

Image by Matthieu Joannon

By Dr Catriona Walsh

This excellent question was asked in a group that I moderate. I love it because it's actually not all that straight forward to answer. Essentially, I would say it depends on a lot of variables. Anyway, here are my thoughts on it.

Smoked sausage is actually a traditional food, which has a long history of consumption throughout recorded human history. Traditional cultures around the globe have found ways to grind up bits of leftover meat, herbs, spices, some filler, like rusks, oats or corn, and preserve them in casings, which were often just lengths of cleaned out intestines and bladder. Sometimes blood or offal is added as well. They may have used salt and added probiotic cultures to cure the meat as it dried, in order to reduce the risk of pathogenic microbes growing. Alternatively, smoking the sausage was another way to reduce the risk of the meat being contaminated with bacteria which would spoil it. In this way, whatever meat that could not be eaten by a family or community before it went off (this was also in a time before fridges and freezers) could be preserved and used much later, particularly in the lean winter months. Some cured meat (sausage, smoked sausage, bacon, pancetta, ham, or whatever was in the cellar) could be used to make a meal go further. Cooking cured meats with beans and grains is still very popular. Instructions and recipes have been handed down for centuries, sometimes changing as different cooks adapted them to their own palates, or found that availability of seasonal produce wasn't always reliable. Sometimes recipes remained unchanged for generations; why change a good thing?

More recently, industrialisation and the agricultural revolution have changed the production of cured meats, so that for many the most readily available cured meats are also highly processed. There are still artisanal sausage-makers out there, who pride themselves in lovingly preparing their cured meat products using time-honoured traditions. They charge a premium for these products, as they should, having used better quality meats, real-food ingredients, less cheap filler, and a longer preparation time.

But what does this actually mean for the consumer? 

Food Additives in Processed Foods

Typical smoked sausages, and other processed foods that you find on supermarket shelves tend to be made on an industrial scale. Check the ingredients list to see what has been added. In addition to the meat, which is often pork (although other meats can be added, including beef, turkey and horse), there will tend to be some sort of processed carbohydrate, which is used as a binding agent, and to bulk the product out a bit while improving texture. This can vary from potato starch and other modified starches, to wheat rusks, processed soy, maltodextrin, and various sugars, like corn syrup and dextrose. Other industrial food additives may include stabilisers and emulsifiers, like sodium pyrophosphate and polyphosphate, flavour enhancers, like MSG, and extracts of spices, antioxidants, including vitamin C, and citric acid, and preservatives, like sodium nitrite. Some of these food additives may appear to be fairly innocuous, particularly on their own, but there is little to no research on how they interact with each other, with other foods consumed alongside them, and with your microbiome. Adding sugar in a few different forms, as is often done with all sorts of processed foods, is another way to fool you into believing that the total sugar content is less than it is. I have seen several smoked sausage products that use the combination of dextrose, corn syrup and maltodextrin, all of which are very high glycemic carbohydrates. I am also more in favour of using whole herbs and spices, rather than spice extracts. Extracting the desirable compounds from spices is often done using solvents, which may damage the compounds themselves, or leave traces of solvents in the finished products. These all add up if you are consuming a large number of processed foods on a daily basis. As with most things, the dose makes the poison.

The quality of the meat

Cheap processed meat is made using cheap meat. In effect, this tends to mean Industrial, factory-farmed, concentrated animal feeding operation (CAFO) meat.  Animals kept in CAFOs live pretty miserable lives, and there is a huge environmental impact from these farms as well. But I just wanted to focus on the potential health effects from eating food raised in this environment. (However, if you are interested in learning more about the environmental impact of CAFO farming, head over to the Ethical Omnivore Movement's Facebook pages or website and ask there).

CAFO farms try to cram as many animals into as small a space as possible, so they are typically confined indoors. This leads to a combination of factors, including some pretty unsavoury hygiene, high stress, lack of sunlight to produce vitamin D, overcrowding, and a monotonous, processed diet which is designed to induce rapid growth in animals, rather than optimal health. As a result, infection and illness can very rapidly sweep through these farms, so much so that antibiotics are usually added to the feed to try to prevent infections. This greatly increases the risk of antibiotic resistance. Conventional grain and oilseed meal products are typically used as feeds, which leads to bioaccumulation of measurable amounts of toxins in the tissues of the livestock, including pesticides, herbicides, fumigants and heavy metals. There may be other sources of heavy metals, such as old lead paint chipping and being eaten, or lead pipes used to provide water. Other toxic chemicals, such as dioxins and PCBs are also found in the food chain, particularly in the meat from CAFO animals. Mixed meats, such as those used to produce sausages and other processed meat products, have been found to be more concentrated sources of these toxic chemicals.

Confining animals indoors also has the undesirable effect of reducing the amount of certain micronutrients, such as vitamin D3 and carotenoids. Land animals make vitamin D3 in their skins on exposure to sunlight (specifically ultraviolet B radiation), so keeping them indoors results in reduced vitamin D3 storage in their fat. A smaller amount of vitamin D may be available in animals' diets from irradiated fungi, a lot like how we can get some vitamin D2 from eating irradiated mushrooms, but most land animals which have evolved to be active and above ground during the day rely on sun exposure for their vitamin D. Vitamin K2 is another important vitamin which should be found in meat, liver, and dairy fat. However, vitamin K2 is made in the guts of animals which have consumed foods rich in vitamin K1. Leafy greens are a great source of vitamin K1, and pastured animals can eat lots of grass, weeds and other leafy greens. But grains are not a good source, and vitamin K1 content is reduced by exposure to light,  cooking, and in storage, so the vitamin K content of concentrated animal feed is fortified using synthetic altered forms of vitamin K3 which are water soluble and never found in nature. Vitamin K3 is more toxic than the natural forms (vitamin K1 and vitamin K2). The normal role of microbes in producing vitamin K2 in the guts of any animals given antibiotics (and this includes humans, not just our meat) is diminished. Vitamin K1 and vitamin k2 perform different roles within the human body, and it is necessary for us to consume both in adequate amounts. We now know that just consuming leafy green vegetables every day won't provide us with sufficient vitamin K2 to meet our needs. And we also know that we can no longer rely on our gut microbes to produce vitamin K2 for us. For some people their gut microbes are still able to perform this function, but many people's microbes have been decimated by courses of antibiotics, pesticide exposure, heavy metal exposure, stress, sleep deprivation, and exposure to antimicrobials like chlorine in water, and preservatives in foods. And if we thought the microbial and gut health of modern humans eating a standard western diet and exposed to medications and antibiotics was bad, the microbial and gut health of animals living in a CAFO is usually going to be much worse!

The food provided for animals also affects how much essential omega fats can be found in their meat and fat. Animals fed a high grain diet (rich in short chain omega 6 linoleic acid) will accumulate high levels of omega 6 fats. They will be omega 3 deficient, unless they eat sources of food rich in omega 3s, such as leafy greens (grass and weeds), and insects, as well as small animals. The meat of pastured animals has been shown to have a more favourable omega 6:3 ratio, more similar to the wild game our ancestors relied on until the domestication of animals, when they began feeding their livestock with grains and seeds to the exclusion of all other foods. Confined pork may contain about 8g of omega-6 and 0.8g of omega-3 fats per 100g serving. Whereas it is possible to reach a ratio approaching 1:1 in free-living pastured heritage pigs.

There are other important antioxidants which tend to be higher in pastured animals than in grain-fed CAFO meat as well, particularly vitamin E, selenium, glutathione, superoxide dismutase and catalase.

Trying to procure your meat from pastured and organic animals can reduce the risk of exposure to higher levels of toxins, while increasing the amount of some micronutrients, like fat soluble vitamins, D3 and K2, omega 3 fats, and some antioxidants, probably mostly due to differences in nutrient profiles of their food, but possibly also due to differences in exposures to toxins, antimicrobials, sunlight, fresh air, stress and sleep patterns.

Smoking, carcinogens, and amadori products, oh my!

The chief objection that you are likely to see when it comes to eating smoked sausage, is the fact that smoking and cooking foods until they get deliciously crispy, golden brown, charred, and aromatic also results in the production of a number of products which have been linked to the development of chronic health problems, including diabetes, heart disease, and cancer. Animal studies also appear to support the theory that these products can directly cause cancer. Liquid smoke also contains these chemicals. Products such as polycyclic aromatic hydrocarbons, heterocyclic amines and nitrated polycyclic aromatic hydrocarbons, as well as other free radicals produced by the combustion of fuel and the browning of food are strongly reacting in the body, and can damage cells.

On the other hand, there is pretty good evidence that cooking food has allowed us to develop our unusually large brains, and widened the variety of foods we can safely consume. This is especially true of plant foods, where cooking, as well as soaking, sprouting and fermenting, ensures that we are able to fairly safely eat a number of foods that would otherwise be pretty poisonous, including many species of beans, lentils, cassava, taro, and even potatoes. So how bad can cooking really be for our health? The smoking of food also provided a way to reduce exposure to food borne illness, which was one of the main causes of premature death.

The Inuit were a group of people who enjoyed robust health while living their traditional lifestyles, and who enjoyed smoked fish, among many other foods. Cancer and diabetes only became a problem after they were introduced to European foods including white flour and sugar, at which point their health plummeted. In Okinawa, an island known for its centenarians, they also smoke some of their foods, including smoked shima tofu and katsuobushi. Pancetta Sarda Affumicata is smoked pork belly originating in Sardinia, another blue zone. So how certain can we be that smoking foods leads to metabolic diseases? Certainly not 100%. Nor do I have any way of knowing whether the centenarians living in the blue zones eat much of the smoked foods that are available there, or leave them for their shorter-lived compatriots to enjoy. You are probably just going to have to make your own mind up about whether you believe the smoking of a sausage is likely to reduce your lifespan, as the evidence doesn't seem to be particularly decisive at this point.

Photo by Evan Kirby on Unsplash

Food Fraud

A spotlight on food fraud has only really started to be shone on this practice in greater detail in the last few years. It has probably been a part of life for a long time, but we were less aware of it. As it is, this might be the first time you've heard the phrase. However, in recent years, many scandals have rocked the industrial food world in particular. Thanks to whistle blowers, the scandalous practice of passing off horse meat as beef was identified as widespread in Europe a few years ago. One of the greatest risks from this was that veterinary drugs, banned in food animals, like phenylbutazone, could have entered the food chain.

In 2008 it was discovered that animal feed in Ireland had been contaminated with high levels of dioxins, resulting in a worldwide recall of pork products originating in Ireland, and levels of dioxins and dioxin-like PCBs were found in affected pork products between 80-200 times the EU's recommended limits.

There have been numerous other food contamination incidents, some of them quite notable, such as the 2017 Fipronil eggs contamination scandal. Food fraud and safety is such an important topic, the scope of which potentially touches on almost everyone on the planet, that there are now courses on it, including this one from Queen's University, Belfast.

These, and other, scandals highlighted the fact that traceability of food supply chains is easily compromised, particularly when ingredients are sourced from large companies, or from multiple countries. Food fraud can, of course, affect small producers, but the fewer ingredients a food has, and the more transparent food production is, the less likely this is to be a problem.

So what's a consumer to do?

Make the best decisions you can with the available evidence. Always read the ingredients list. Real foods are not described as "extracts", "modified", or "isolated", and you will probably recognise the names of almost all the ingredients. If a product contains ingredients you don't recognise, quickly search for that ingredient on the internet to find out what it really is before committing to buying the product. Look out for sources of hidden sugar.

Organic, pastured meat products appear to be considerably more healthful than CAFO-raised meat, as well as much better for the environment. Artisanal producers, who may even be local to you, and may supply your local farmer's market, may use techniques which reduce exposure to problematic chemicals. You might be able to talk to them about their techniques, their farming methods, or even be able to visit the farm. Farmers who raise pastured animals are often delighted when people take an interest in how they care for their animals, and take a great deal of pride in their animal husbandry.

Photo by Benjamin Ashton on Unsplash

Cook fresh and cured meats under liquid to reduce further production of harmful chemicals, e.g. in casseroles and stews. Pressure cooking and slow cooking are also good methods to reduce the production of harmful chemicals. If you are barbecuing, grilling, or frying, using a marinade containing herbs, spices and/or acids like lemon juice can provide enough antioxidants to protect the meat from charring and developing toxins.

If you have a lot of free time on your hands, confidence and good instructions, you could even dabble in preparing some sausages and smoked sausages yourself. But be sure you know the risks of this, and use recipes and instructions from reputable sources. Follow them to the letter.

Eat a wide variety of real, whole foods, including ethically raised, sustainable, pastured, preferably organic eggs, poultry, meat, dairy, and sustainably caught wild fish and seafood, but also include a variety of good quality plant foods, as tolerated. Eat nose-to-tail: Some of the most nutritious cuts of meat are the organs. Reduce your intake of processed foods, and avoid ultra-processed foods as much as possible. Cook your own food from scratch as much as you can. Try to eat local, seasonal foods when you can as well. They tend to be more ripe and fresh, and thus more nutritious, plus your local farmers will appreciate your support. You might even be able to do a bit of foraging, but only pick and bring home foods you definitely recognise, and follow local guidelines for foraging and hunting: nobody wants you to serve them an omelette made with death cap mushroom and golden eagle eggs.

Eat mindfully, and in company, if you can. There is a social aspect to eating that is difficult to quantify, but which appears to be protective. Enjoy your food (except when you make a crazy culinary mistake in the kitchen, and it ends up being a disaster. Then chalk it down to experience, look back on it and laugh), chew, take your time eating, savour the aroma and flavours.

If you absolutely must have some smoked sausage, and all you can find is (sub)standard, ultra-processed CAFO stuff with lots of food additives, try to curb yourself a bit, minimise the amount you consume, and eat it infrequently. Perhaps if you accompany it with plenty of antioxidant-rich fresh, real food and fluids, you might be able to mitigate some of the danger...PERHAPS.

If you are interested in optimising your health, then why not get in contact with me through


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