Category Archives: Diet, Habits, & Other Behaviors

Are Processed Meats More Dangerous than Other Red Meats?

Megan Cole, Claire Karlsson, and Sage Wylie, Cancer Prevention & Treatment Fund

You have probably heard it many times already: don’t eat too much red meat or processed foods. But research shows processed red meats, like bacon, hot dogs, and salami are the biggest problem. Here’s why.

Red Meats vs. Processed Red Meats

In 2015, the International Agency for Research on Cancer (IARC) of the World Health Organization concluded that processed meats are a Group one carcinogen, which means it causes cancer.  Other Group one carcinogens include tobacco and asbestos. Based upon a review of over 800 studies, 22 scientists from ten countries determined that processed meats can cause colorectal cancer and probably stomach cancer. [1] Although people who eat more red meat are more likely to develop pancreatic and prostate cancer, nobody knows whether people who eat more red meat tend to have other poor health habits that are the real causes of these cancers, rather than the red meat itself.

Are processed meats more dangerous than other red meats? Yes!Bacon, hot dogs, bologna, and other processed meats are now blamed for causing cancer, and they also increase your chances of developing heart disease and diabetes. A 2010 study led by Dr. Renata Micha from the Harvard School of Public Health analyzed 20 previous studies and concluded that while eating more red meat didn’t predict whether a person developed heart disease or diabetes, eating processed meat did. [2]  A person who ate one portion (about one hot dog or two slices of deli meat) of processed meat every day was 42% more likely to develop coronary heart disease and 19% more likely to develop diabetes than if that person did not eat processed meat every day.  That risk was the same if the person ate 2 portions of processed meat every day instead of one, and doubled if the person ate 2 portions a day instead of none.  In other words, even if you like the taste or convenience of processed meat, eating less processed meat is always better for your health than eating more.

Why the Difference?

When comparing red meats with processed meats, there are some key nutritional differences. While levels of saturated fats and cholesterol are usually similar in processed and unprocessed meats, processed meats generally have four times the amount of sodium and 50% more preservatives than red meats.[3] Researchers suggest that these increased levels of sodium and preservatives may explain the increase in health risk. To determine if that is true, further research is needed. What is known, however, is that sodium increases blood pressure and preservatives have been shown to reduce tolerance to sugars. High blood pressure contributes to heart disease and reduced tolerance to sugars increases the risk of diabetes. Other studies have found that processed meats that have been cured, smoked and barbequed at high temperatures are more likely to cause colon cancer than other red meats.[4] Cured meats like salami may pose particular risks for cancers because the nitrate and nitrite salts used in the curing process can promote cancer cell growth. Yet much more research is needed to clarify how processed meats can lead to cancer.

In addition, a study found an increase in breast cancer for Hispanic women with the highest consumption of processed meat, although that was not found in non-Hispanic white women. [5]

…But Don’t Pick up That Steak so Fast.

Does this mean that you are now free to eat all the red meat you want as long as it isn’t processed? Well, no.  Studies have shown that red meat raises the level of “bad cholesterol,” because it is high in saturated fat. Chicken and fish are much lower in saturated fat.  While processed meat is labeled as a definite carcinogen, red meat is categorized as probably carcinogenic to humans (called Group 2A by IARC). Plus, eating less red meat may help reduce climate change, because cows emits harmful greenhouse gases.[6] Additionally, a study of 150,000 women, published in a major medical journal in 2016, found that eating red meat for protein instead of eating plants increases the chances of developing heart disease and dying at a younger age.[7]

What Meats Should I Eat and What Meats Should I Avoid?

As outlined by the US Department of Agriculture (USDA), consider the following when selecting meats for you or your family:
• Choose lean or low-fat meat and poultry. Avoid ground beef that is less than 80% lean (the leaner, the better), and choose skinless chicken.
• If you do buy processed meats, be sure to read the ingredients and Nutrition Facts label to avoid foods high in salt. Look for products labeled “low sodium,” “reduced sodium,” or “no salt added.” To be considered “healthy,” products must not have more than 600 mg of sodium per serving.
• Consider eating fish rich in omega-3 fatty acids, such as salmon, trout, and herring, or getting protein from other non-meat sources, such as beans, legumes, almonds, sunflower seeds, and egg whites.[8]

Is All Processed Meat Worse than Red Meat?

All processed meats are not necessarily worse than all other red meats, as the “healthiness” of a meat depends upon the number of calories per serving as well as its sodium and fat content. For instance, lean deli meat may be healthier than a fatty unprocessed hamburger or steak. However, in general, bacon, sausage, hot dogs, pastrami, and many other processed meats are fattier, saltier, higher in calories, and contain more additives than unprocessed red meats such as beef, pork, and lamb. Lean and low-sodium varieties of processed meat are less unhealthy, but still not as healthy as most non-processed meats.

The Bottom Line

Foods that are higher in calories, saturated fat, and sodium tend to increase weight, fat, and blood pressure, which in turn, may lead to the development of heart disease and/or diabetes. So? Eat a balanced diet with plenty of whole grains, fruits, vegetables, low-fat dairy, and lean proteins. Enjoy red meat in moderation and remember: if you have to choose between a hot dog or a hamburger, the unprocessed meat of the hamburger is the safer bet when it comes to avoiding cancer, coronary heart disease and diabetes. However, try to avoid topping your burger with high-salt processed condiments such as ketchup, salt, and pickles.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. Bouvard, Véronique; Loomis, Dana; Guyton, Kathryn Z; Grosse, Yann; El Ghissassi, Fatiha; Benbrahim-Tallaa, Lamia; Guha, Neela; Mattock, Heidi; Straif, Kurt. (October 2015). “Carcinogenicity of consumption of red and processed meat”. The Lancet. DOI: http://dx.doi.org/10.1016/S1470-2045(15)00444-1.
  2. Micha, R., Wallace, S.K., Mozaffarian, D. (June 2010).“Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes: A systematic review and meta-analysis”. Circulation. 121(21): 2271–2283. doi: 10.1161/CIRCULATIONAHA.109.924977.
  3. Sinha R, Cross AJ, Graubard BI, Leitzmann MF, & Schatzkin A (2009 March 23) Meat intake and mortality: a prospective study over half a million people. Archives of Internal Medicine 169(6):562-571.
  4. Santarelli, R.L., Pierre, F., Corpet, D.E., (2008). “Processed meat and colorectal cancer: a review of epidemiologic and experimental evidence”. Nutrition and Cancer. 60(2):131-44. doi: 10.1080/01635580701684872.
  5. Kim, A.E., Lundgreen, A., Wolff, R.K., et al. (2016). “Red meat, poultry, and fish intake and breast cancer risk among Hispanic and Non-Hispanic white women: The Breast Cancer Health Disparities Study.” Cancer Causes Control.  doi: 10.1007/s10552-016-0727-4. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26898200. Accessed on November 13, 2017.
  6. Powell R (2008) Eat less meat to help the environment, UN climate expert says. Telegraph.
  7. Song M, Fung TT, et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Internal Medicine; 2016.
  8. United States Department of Agriculture (USDA) (2010). Inside the Pyramid (Meat).

Should I Get the Flu Shot?

Lauren Goldbeck, Alex Pew, and Arista Jhanjee, Cancer Prevention & Treatment Fund

It’s that time of year again — time to get your flu shot! Everyone aged 6 months or over and without any restrictive health conditions is encouraged to get the vaccine every year.[1]

Flu season usually starts as early as October and can last all the way until May. The flu usually peaks between December and March. The Centers for Disease Control and Prevention (CDC) recommends getting vaccinated by the end of October. Even if you don’t get your vaccine by then, it’s good to get vaccinated anytime during the flu season.

Check if your office, school, or local government is giving free flu vaccines first. If not, don’t worry! Most (if not all) pharmacies and doctors’ offices have the vaccine available and it is free (no co-pay at all) under nearly every insurance plan. Just call first to make sure the vaccine is available.

Thanks to the Affordable Care Act (Obamacare), health insurance companies have to provide free preventive services like the flu shot.[2] However, insurance companies can require you to go to certain places to get the shot. You should check with your insurance company first before getting your shot.

What’s New This Year?

This year, the CDC does not recommend getting the nasal spray form of the flu vaccine, which contains live viruses. This is because the nasal spray has not been effective for the last few years.[3]   We agree that the nasal spray vaccine is ineffective, so you should not get it even if you (or your children) don’t like shots. Even before that warning came out, researchers knew that the live viruses in the spray were too dangerous for pregnant women, because they could harm the baby.

Scientists change the flu vaccine every year to try to make it as effective as possible against the new flu strains that are most common that year. Vaccines are made with either three or four viral strains. This year’s vaccines differ from last year’s vaccines by a single strain.

How Effective is the Flu Vaccine in 2017-2018?

The most common flu viruses change every year. Since the new seasonal vaccine requires about 6 months to make, scientists have to do their best to predict which strains will be most common months in advance. These predictions aren’t always accurate.[4] In a good year, the vaccine can reduce your risk of getting the flu by 60%.[5] The evidence shows that the 2017 vaccine will probably reduce your risk of getting the flu by 50% this year. Although it’s far from perfect, it’s definitely worth getting.[6]

Can the Flu Shot Give Me the Flu?

No, the flu shot can’t give you the flu. The flu shot is made of proteins that come from dead viruses, so you can’t get infected. However, the flu shot can cause soreness, redness, or swelling around the injection site. It can also cause a low-grade fever or body aches.[7]

Things to Remember for Young Children

  • Children aged 6 months to 8 years who have never received a flu vaccine should get two doses of the vaccine. The two doses should be separated by at least 4 weeks.
  • Children aged 6 months to 8 years who have previously received 2 or more vaccine doses only need one dose this year.[1]

If I’m over 65, Is There Anything Different for Me?

As we age, the flu can be more dangerous and vaccines are less effective because our immune systems are not as strong. You may have seen a “high-dose flu vaccine” advertised for people over the age of 65.  Should you consider it?

The high-dose vaccine has four times as many flu proteins than the usual flu shot, and so it is expected to be more effective. Studies comparing the high-dose and standard-dose vaccines found that those who received the high-dose version (IIV3-HD) were better protected against the flu during the 2012-2013 flu season[8,9]. Unfortunately, the CDC reported that the high-dose flu vaccine was not more effective during the 2013-2014 season. And, individuals receiving the high-dose version also had more of the common side-effects from the flu shot, like a low-grade fever and soreness. Since there is no clear evidence that the high-dose vaccine has benefits that outweigh the risks, the CDC doesn’t have a recommendation for getting one vaccine over the other. However, facilities that offer flu shots may administer the high-dose shot without asking patients what they prefer. If you are 65 or older and don’t want the high-dose shot, you should say so when requesting a shot.

What Should I Do If I Have an Egg Allergy?

Flu injection options are very similar for individuals with and without egg allergies.

  • If your only reaction to eating eggs is hives
    • You can receive any flu vaccine.
  • If you have a severe reaction to eggs, including nausea/vomiting, changes in blood pressure, respiratory issues, and/or any reaction requiring medication or emergency medical attention (ex. anaphylaxis)…
    • You can receive any flu vaccine.
    • You should receive the vaccine in a medical setting and under the supervision of a provider who is trained to address allergic reactions.[10]

Can I Still Get the Flu Even After Getting the Flu Shot?

 Yes, you can still get the flu after getting the flu shot. There are many strains of the flu that could possibly infect you, and the shot doesn’t protect you against all strains. And as we said, it works better on people with stronger immune systems. Even if you do get the flu, it might be less severe if you’ve had the vaccine.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.

References

  1. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2017–18 Influenza Season. MMWR Recomm Rep 2017;66(No. RR-2):1–20. DOI: http://dx.doi.org/10.15585/mmwr.rr6602a. Accessed on September 8, 2017.
  2. Will the Affordable Care Act cover my flu shot? U.S. Department of Health and Human Service. Retrieved from https://www.hhs.gov/answers/affordable-care-act/will-the-aca-cover-my-flu-shot/index.html.  Accessed on September 8, 2017.
  3. Centers for Disease Control and Prevention. (2016). ACIP votes down use of LAIV for 2016-2017 flu season. Retrieved from https://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html. Accessed on September 8, 2017.
  4. Selecting Viruses for the Seasonal Influenza Vaccine. (2016). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Retrieved from https://www.cdc.gov/flu/about/season/vaccine-selection.htm.  Accessed on September 8, 2017.
  5. Vaccine Effectiveness – How Well Does the Flu Vaccine Work? (2017). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Retrieved from https://www.cdc.gov/flu/about/qa/vaccineeffect.htm.  Accessed on September 8, 2017.
  6. Flannery B, Chung JR, Thaker SN, et al. Interim Estimates of 2016–17 Seasonal Influenza Vaccine Effectiveness — United States, February 2017. MMWR Morb Mortal Wkly Rep 2017;66:167–171. DOI: http://dx.doi.org/10.15585/mmwr.mm6606a3.  Accessed on September 8, 2017.
  7. Key Facts About Seasonal Flu Vaccine. Centers for Disease Control and Prevention. (2017). Retrieved from https://www.cdc.gov/flu/protect/keyfacts.htm. Accessed on September 13, 2017.
  8. Diaz Granadanos, C. A. et al. (2014). Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014 Aug 14;371(7):635-45. doi: 10.1056/NEJMoa1315727. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25119609. Accessed on September 14, 2017.
  9. Shay, D., Chillarige, Y., Kelman, J., et al. (2017). Comparative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries in Preventing Postinfluenza Deaths During 2012-2013 and 2013-2014. The Journal of Infectious Diseases; 215(4): 510-517. Retrieved from https://academic.oup.com/jid/article/3058746. Accessed on September 18, 2017.
  10. Flu Vaccine and People with Egg Allergies. (2016). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Retrieved from https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm.  Accessed on September 8, 2017.

Gastric Lap-Bands: What You Need to Know

Diana Zuckerman, PhD, and Jenna Carroll, Cancer Prevention & Treatment Fund

Commonly known as “Lap-Band surgery,” because of the brand name of the most popular version, gastric band surgery peaked in 2008 and has plummeted ever since. In 2008, there were about 35,000 of these procedures in the United States. By 2014, there were only about 5,000.[1] This decline is due to increased awareness of the many risks and limited benefits. Patients with a gastric band are likely to need follow-up surgeries (usually to remove them), which aren’t cheap. In addition, patients’ weight loss tends to be temporary – 6-12 months is typical. According to researchers from the University of Michigan, “There is broad consensus now that the use of gastric band device should be significantly restricted, if not eliminated.”[1]

The first gastric band devices, called Lap-Bands, were approved by the FDA in 2001. A similar device, the “REALIZE band,” was approved by the FDA in 2007 but U.S. sales were discontinued in late 2016. Today the Lap-Band is the only gastric banding device available in the US. The major manufacturer of Lap-Bands, Allergan, sold the rights to the technology in 2013, and the device is now made by Apollo Endosurgery.[2]

Most weight loss strategies don’t work for most people – usually they lose weight and then gain it back, and that can make it harder to lose it again. But it is important to keep trying, because obesity can kill by increasing the risk of heart disease, diabetes, and even some kinds of cancer.  Gastric bands help many people lose weight rather dramatically – some lose 50-100 pounds in the first 6 months or year. Unfortunately, the bands are not usually a lasting solution to obesity. For example, an obese woman with high blood pressure will see her blood pressure go down in the first year after surgery, but it will increase if she gains weight back after that.

Even more controversial than the use of Lap-Bands to treat life-threatening obesity is the use to treat people who are not extremely overweight. The American Heart Association advises that “bariatric surgery should be reserved for patients who have severe obesity” and only when medical therapy has failed and surgery is a safe option.[3] The FDA came to a different conclusion. Ten years after approving Lap-Bands for very obese patients in 2001, the FDA approved Lap-Bands for people who are only slightly obese (with a BMI as low as 30) in 2011.  Despite FDA approval that made more patients eligible for the device, the popularity of Lap-Bands decreased.

If you’re still thinking about getting a Lap-Band, here’s the information that can help you decide.

Q:  What Is a Lap-Band?

A:  A Lap-Band is a silicone band around your stomach that reduces the room for food so that you feel full after eating very small amounts. If you eat too much, especially too much of certain kinds of food, you will feel nauseous or will vomit. That will discourage you from overeating and help you lose weight. It is a less complicated surgery than gastric bypass surgery, but most people with Lap-Bands don’t lose as much weight as patients undergoing gastric bypass. Also, Lap-Bands are reversible, and gastric bypass is not.

Q:  Whatever Diet I Use, I Can’t Keep My Weight Off. Will a Lap-Band Help Me Lose Weight and Keep It Off?

A:  Most people with Lap-Bands lose weight during the first year. Surprisingly few people continue to lose weight after that, despite the small amounts of food they can comfortably eat. After a year, people who have Lap-Bands usually stabilize at their new weight, or start gaining weight again. Some gain and lose weight just like they did when they were on different diets. Despite how difficult it is to eat solid food, many people don’t lose weight with a Lap-Band. Research reveals that other weight loss methods are much more effective in the long-term.

Q: Which Is More Effective, Lap-Band or Gastric Bypass Surgery?

A: Studies comparing Gastric Bypass surgery to gastric banding surgery consistently find that Gastric Bypass is more effective and should be the recommended weight loss surgery instead.[4][5][6][7] For example, a study comparing the two after 3 years of follow-up found that Bypass patients lost more weight and saw more improvements in blood pressure and diabetes.[7] In contrast, patients with the gastric band device were more likely to require later procedures to fix complications.

Other studies have come to similar conclusions – short-term results for gastric band surgery are often positive, but as time goes on, patients have more trouble staying healthy. Lap-Band patients regain more weight than patients who have Gastric Bypass. They also need more follow-up operations because of problems with the banding devices.[6][8]

Q:  If a Lap-Band Makes It Impossible to Eat a Large Amount of Food, How Is It Possible That Some People Don’t Lose Weight with a Lap-Band?A

A:  There are fattening foods that people can eat in large quantities even with a Lap-Band, such as ice cream and liquids. If you enjoy ice cream, drink many high-calorie beverages, or eat small meals all day long, it is possible that you may not lose much weight or any at all. In fact, Allergan found in their research that some patients actually gained weight!

Q:  Can a Lap-Band Be Dangerous? Can It Kill You?

A:  All surgery has risks, including gastric band surgery. Almost all patients will survive the surgery, but the risks increase after surgery. We know that patients have died as a result of gastric bands, including some patients who were not so overweight that their obesity would have killed them. We don’t know exactly how often that happens, but it is important for patients and their families to understand that there are serious risks that may be greater than the likely benefits for patients who are not dangerously obese.

One of the risks of gastric band surgery is that weight loss after surgery can increase the risk of sudden death from cardiac arrhythmias. Research also shows that the Lap-Band can deteriorate or causes a perforation in the gastro-intestinal tract, where acids and fecal matter can leak into the abdomen. It can take less than 30 minutes of surgery to get a Lap-Band, but patients can end up undergoing emergency surgery and staying in the hospital for days when something goes wrong.

Q:  What Happens When Lap-Bands Deteriorate? Will Aging Lap-Bands Cause Even More Serious Health Problems?

A: Gastric bands do not last forever. A gastric band that deteriorates can kill or seriously harm a patient if it is not removed. Researchers at the European School of Laparoscopic Surgery studied patients with gastric banding devices for 12 years. They found that more than one-fourth of patients had their bands wear out, and half of the patients had their bands removed.[8] Each additional surgery, whether to take a band out or replace it, is an added risk. Even patients with good experiences will eventually need it removed (and replaced, if the patient wants it to be).

Q:  Why Do People Have Their Lap-Bands or Other Gastric Bands Removed?

A:  Some people never lose weight from a gastric band, so they get the band removed a few months after it’s put in. Some have terrible side effects, such as nausea, vomiting, or perforation of the gastro-intestinal tract, mentioned above. In some cases, the gastric band slips off or starts to deteriorate, requiring surgery, and the patient decides to remove the band and not take that risk again.

Some people just get tired of their Lap-Bands because they don’t like to have such draconian limits on what they can eat. They long to have a sandwich or a small bowl of pasta, or to eat a regular meal with their family or friends. As long as you’re losing weight, the restrictions may be tolerable for many people, but may not seem worth it if you haven’t lost any weight in months or even years.

Q:  How Much Does Lap-Band Surgery Cost? How Much Does It Cost to Remove a Lap-Band?

A:  The average cost of Lap-Band surgery in the United States is about $15,000, but it can cost as much as $30,000. If there are complications, removal will cost at least that much and possibly much more. If you are considering a Lap-Band, be sure to find out if your health insurance will pay for the surgery and if it will pay to have the Lap-Band removed. Some insurance companies will only pay for one Lap-Band surgery, so they will pay to put it in, but not to take it out. Some insurance plans will not pay for any type of bariatric surgery, including Lap-Bands. For plans that cover bariatric surgery, many companies will only pay for a Lap-Band for extremely obese patients and when other weight loss surgeries have not worked for them.

Remember that Lap-Bands do not last forever. Because the post-market studies submitted by the makers of Lap-Band ended after only five years, we don’t know exactly how long Lap-Bands last. Many patients do not keep their Lap-Bands for 10 years, either because they stopped losing weight or had complications, such as the band slipping or deteriorating.

Many people who get a gastric band have a follow-up surgery, and the cost of those operations is substantial. From 2006 to 2014, $820 million of the $2.1 billion spent on gastric banding devices was for reoperations. As time goes by, more and more of the money spent on gastric bands is for removal, adjustment, and replacement rather than the initial operation. This suggests that fewer people are spending money to implant a gastric band, and more people are spending money to fix the complications that it caused. In recent years, about 90% of total spending on gastric banding devices was for reoperations.[1]

Q:  I’ve Seen Ads That Say a Lap-Band Can Save Your Life. Can They Say That If It Isn’t True?

A:  It is possible that a Lap-Band could save a person’s life. That doesn’t mean it can save your life, and it doesn’t mean it will save the lives of most people who get them. It may not even improve the health of most people who get them. Ads by doctors are usually not regulated to ensure “truth in advertising.”

Q:  What Is the Scientific Evidence That Lap-Bands Are Safe and Effective?

A: Allergan, formerly the largest manufacturer of Lap-Bands, provided two studies to the FDA. One was a 3-year study of about 178 patients from the ages of 18 to 55, with the original BMI criteria of 35 or higher. Those people were dangerously obese.

The second study had only 149 patients from the new target weight group, who were slightly obese (BMI of at least 30) with weight-related health problems. All the patients were 18 to 55 years old and none had diabetes. They were all studied for only one or two years.

Q:  Isn’t 149 People a Rather Small Study? Did the Studies Include Men and Women and Different Racial and Ethnic Groups?

Yes, 149 people is a small study, and the study included only 14 men, 14 African Americans, and 16 Hispanics. There were even fewer Asians and Native Americans. The men had less success with the Lap-Band than women. We need better research to determine whether men don’t do as well when researchers control for confounding variables such as weight and illnesses. We need to study more African Americans and Hispanics to know if it is safe and effective for them. But at this point, many experts question whether Lap-Bands may not be safe or effective enough to justify use for any patient group.

Q:  Why Was the New Study Only One Year Long?

A:  As stated above, one has to wonder if the company was concerned that a longer study would not have favorable results. We are left wondering why the FDA did not require a study that lasted at least 3 years. Obviously, a one- or two-year study is too short to determine long-term safety. Implanted devices often work well for a few years, and then problems arise.

In fact, we now know that Allergan’s small, short study underestimated how often patients had surgeries to adjust, replace, or remove their Lap-Bands. The study found that as few as 4% of patients required reoperation. However, in the entire population during that same year, more than 50% of total spending on Lap-Bands was for reoperations. This suggests that many more patients require additional surgeries than the study found.[1]

Q:  Are Lap-Bands Especially Risky for Some People?

A:  People with a personal history or family history of autoimmune diseases should not get a Lap-Band. The implant was not studied on people with a history of autoimmune problems because of concerns that it would make problems worse. Lap-Bands also should not be implanted in people with any problems with the GI tract, liver, or pancreas.[10] Lap-Bands already have a high risk of complications. When you already have problems with your digestive tract, the risk of something going wrong increases even more.

In the studies submitted to the FDA by the makers of Lap-Band, the participants were not representative of the types of people who get Lap-Bands. For example, one study to see how effective Lap-Bands were for less obese people. Less than 10% of the participants were men and over 75% of the participants were white.[11] This and other studies have not determined if sex or race affects how Lap-Band works.

African American women and Hispanic women are especially vulnerable to lupus and several other autoimmune diseases. There are also other racial and ethnic differences that could influence safety. Is the Lap-Band safe for them? We can’t answer that question because so few were studied. However, we think the risks are even more likely to be greater than the benefits for African American and Hispanic women because they are more likely to have autoimmune symptoms or diseases.

Q:  Should I Get a Lap-Band?

A:  Are you addicted to eating? If so, a Lap-Band is probably not going to help you lose weight.

Do you love ice cream or fattening drinks? If so, a Lap-Band is probably not going to be effective in helping you lose weight.

Do you have autoimmune symptoms or family members with an autoimmune disease such as rheumatoid arthritis, lupus, MS, or scleroderma? If so, the risks of a Lap-Band are higher for you.

Does your insurance cover additional surgery if the Lap-Band doesn’t work out? If it does, are you sure your insurance will be as generous a few years from now, when you are most likely to need additional surgery? If insurance or tight finances might be a problem for you, you should probably not undergo Lap-Band surgery at this time.

Think about all the eating restrictions with a Lap-Band: no more regular size meals. (We don’t mean no more Thanksgiving dinners, we mean no more dinners that are one-third the size of a Thanksgiving dinner). No more pasta dinners – maybe four noodles will be ok, but not more. Before choosing a life of those types of restrictions, make at least one more serious effort to improve your diet and exercise habits, and see if you can lose weight without surgery. After you have made that effort, if you are still obese, check out what the latest research shows about Lap-Bands and talk to your doctor about your options, including other types of bariatric surgery.

After you read this article, think about how you feel about your life. What risks are you willing to take to lose weight for what might be only a year or two? If you are dangerously obese or extremely unhappy with your weight, the weight loss surgery risks might be worth it, but this should not be a quick decision.

Bottom line: Recent research shows that gastric band surgery may help only a small set of patients. There are likely more effective and less risky alternatives for you to lose weight.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. Ibrahim AM, Dimick JB. Monitoring Medical Devices: Missed Warning Signs Within Existing Data. JAMA. Published online June 24, 2017. doi:10.1001/jama.2017.6584
  2. The Wall Street Journal. “Apollo Endosurgery Buys Lap-Band from Allergan.” October 29, 2013. https://www.wsj.com/articles/DJFVW00020131029e9atf0dzi
  3. Bariatric Surgery and Cardiovascular Risk Factors: A Scientific Statement from the American Heart Association, Circulation, 2011, 123, available online on March 15, 2011.
  4. Courcoulas AP, Yanovski SZ, Bonds D, et al. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg. 2014;149(12):1323–9.
  5. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013; 347:f5934.
  6. Chang S, Stoll CRT, Song J, Varela JE, Eagon CJ, Colditz GA. The Effectiveness and Risks of Bariatric SurgeryAn Updated Systematic Review and Meta-analysis, 2003-2012. JAMA Surg. 2014; 149(3):275-287. doi:10.1001/jamasurg.2013.3654
  7. Himpens, J., Cadière, G., Bazi, M., Vouche, M., Cadière, B., & Dapri, G. (2011). Long-term outcomes of laparoscopic adjustable gastric banding. Archives of Surgery, 146(7), 802-807. doi: 10.1001/archsurg.2011.45
  8. Tice, JA. et al. Gastric Banding or Bypass? A Systematic Review Comparing the Two Most Popular Bariatric Procedures. The American Journal of Medicine. 2008. 121, 10, 885 – 893.
  9. Cottam, DR. et al. A Case-Controlled Matched-Pair Cohort Study of Laparoscopic Roux-en-Y Gastric Bypass and Lap-Band® Patients in a Single US Center with Three-Year Follow-up. Obesity Surgery. 2006. 16, 534-540
  10. LAP-BAND AP® Adjustable Gastric Banding System with OMNIFORM® Design, http://www.lapband.com/resource/1394661427000/Lapband/Lapband/pdf/lapband_AP_dfu.pdf
  11. Dixon, J B, Eaton, L L, Vincent V, Michaelson R. LAP-BAND for BMI 30–40: 5-year health outcomes from the multicenter pivotal study. International Journal of Obesity, 2016 Feb;40(2):291-8. doi: 10.1038/ijo.2015.156. Epub 2015 Aug 18.

Third-hand smoke

Noy Birger and Celeste Chen, Cancer Prevention & Treatment Fund

You know that smoking and being exposed to other people’s cigarette smoke (second-hand smoke) is dangerous, but did you know that residue from cigarette smoke, which remains on just about every surface exposed to that smoke, is also harmful? This is called third-hand smoke.

Third-hand smoke or smoke residue clings to hair and fabrics, including clothing, carpets, drapes, and furniture upholstery.[1]  The residue reacts with other chemicals and materials in the air, combining to form substances that cause cancer.[2] This toxic mix is then breathed in or absorbed through the skin.

One particular chemical found in third-hand smoke, NNA, has been scrutinized because it can directly interact with and damage DNA, possibly paving the way for cancer to grow. Researchers believe that NNA behaves similarly to a byproduct of nicotine called NNK, which has long been known to cause cancer.

In a 2014 study, researchers confirmed that NNA not only breaks up DNA just like NNK does, but also attaches itself to DNA. By breaking up and attaching to DNA, NNA is able to produce cells that grow when they shouldn’t, creating tumors and causing damaging genetic mutations.[3]

Third-Hand Smoke Is Sneaky

Many public buildings ban indoor smoking, and the majority of people who smoke are aware of the health risks–to them and everyone around them–and therefore confine their smoking to outdoors, away from children and non-smokers. But even after the cigarette has been put out, you can carry dangerous nicotine residue back inside on your hair and clothes, and consequently put others at risk of developing cancer.[1]

Children are particularly vulnerable. Like adults, they can absorb the tar and nicotine leftovers through their skin. The effect on children is greater because they are smaller and still developing. Also, children are more likely to put their residue-covered hands on their nose or in their mouth.[4] Chemicals such as NNA that are produced when smoke residue mixes with chemicals in the air can cause developmental delays in children.[1] Parents should know that if they smoke in the car, their children can absorb the cancer-causing chemicals from the car upholstery, even if the children weren’t inside the car when the parent was smoking

Third-hand smoke is a new health concern.  While we know that the residue combines with the air and other pollutants, like car exhaust fumes, to make a cancer-causing substance, we don’t yet know for certain that it causes cancer in humans and if so, how much exposure is dangerous.[5] Figuring out the answer will be challenging, because most people exposed to third-hand smoke are also exposed to second-hand smoke. We know that non-smokers develop lung cancer, for example, but we usually don’t know if a non-smoker developed cancer because he or she was exposed to third-hand smoke, or for other reasons unrelated to smoking.

Bottom Line

Smokers with children or who live with non-smokers should never smoke inside the home or in their car, and clothing worn while smoking should be washed as soon as possible. If you smell cigarette smoke in a place or on someone, it means you are being exposed to third-hand smoke. An expert on helping people quit smoking recommends that after quitting, people should thoroughly clean their homes, wash or dry clean clothing, and vacuum their cars to remove the dangerous smoke leftovers.[2] Ideally, it would be best to replace furnishings that may have absorbed the chemicals from third-hand smoke, such as sofas, and re-carpet floors, re-seal and re-paint walls, and replace contaminated wallboard. Even if a smoker hasn’t quit yet, it’s a good idea to vacuum and wash clothes, curtains and bedding regularly to reduce their and their loved ones’ exposure to the dangerous chemicals that form when smoke residue mixes with the air.[3]

All articles on our website are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. “The dangers of thirdhand smoke.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 13 July 2017. http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/third-hand-smoke/faq-20057791.
  2. Sleiman M, Gundel LA, Pankow JF, Peyton J, Singer BC, Destaillats H. Formation of carcinogens indoors by surface-mediated reactions of nicotine with nitrous acid, leading to potential thirdhand smoke hazards. Proceedings of the National Academy of Sciences. January 6, 2010 www.pnas.org/cgi/doi/10.1073/pnas.0912820107.
  3. American Chemical Society (ACS). “Major ‘third-hand smoke’ compound causes DNA damage and potentially cancer.” ScienceDaily. ScienceDaily, 16 March 2014. www.sciencedaily.com/releases/2014/03/140316203156.htm.
  4. Winickoff JP, Friebely J, Tanski SE, Sherrod C, Matt GE, Hovell MF, et. al. Beliefs About the Health Effects of “Thirdhand” Smoke and Home Smoking Bans. Pediatrics. (123.1)74-79.
  5. Ballantyne C, What is third-hand smoke? Is it hazardous? Scientific American. January 6, 2009. http://www.scientificamerican.com/article.cfm?id=what-is-third-hand-smoke.

Fat Moms and Fat Babies? Weight Gain During Pregnancy

Heidi Mallis, Anna E. Mazzucco, PhD, and Jenna Carroll, Cancer Prevention and Treatment Fund

The obesity epidemic in the U.S. is affecting newborns and pregnant women. Being overweight or obese during pregnancy causes health problems for the mother and her baby. Several studies have examined ways to reverse the current trend.

The National Academy of Medicine (formerly the Institute of Medicine) offers guidelines for weight gain during pregnancy.[1] The report concludes that women today are heavier when they become pregnant than women used to be, and they gain more weight during their pregnancy than before. This can harm the health of both the mother and the baby.

What Are the Risks Associated With Being Overweight or Obese During Pregnancy?

An obese woman is less likely to go into labor naturally (or even to have it induced successfully), which means she is much more likely to have a Caesarean section. Obesity during pregnancy also increases the risk of several birth defects, such as cleft palate, intestinal tract abnormalities, and heart defects.[2]

When a baby’s birth weight is greater than 10 pounds, known as macrosomia (which merely means heavy birth weight), the baby is likely to grow up to be an obese child. Obese children tend to remain obese during their teenage years and as adults.

A study conducted by researchers at Virginia Tech College of Veterinary Medicine showed that a diet high in saturated fat among pregnant mice was associated with the offspring developing chronic disease in adulthood. The adult offspring had signs of hyperglycemia (high levels of sugar in the blood), insulin resistance, obesity, and hypertension, despite being fed healthy rodent food.[3]  This finding is significant because it shows that a child’s healthy eating habits can’t necessarily make up for a mother’s poor eating habits during pregnancy.

There is also evidence that children may have a higher risk of developing asthma if their mothers are overweight when they get pregnant. Obesity increases the amount of cytokines (which are small proteins) circulating in the body that cause inflammation, which is a type of immune response. When a pregnant woman’s body is in a constant state of inflammation due to excess fat (as opposed to weight gain from the developing fetus), it affects the lung development of the baby in the womb and may lead to a higher risk of asthma symptoms in childhood.[4]

A study of pregnant women in the Netherlands found that women who had excessive weight gain during pregnancy were eating more, were not physically active, and also were not getting enough sleep. The relationship between too little sleep and obesity has been known for several years: people who do not get enough sleep tend to eat more, and people who are obese tend to have sleep apnea, resulting in less sleep.[5]

Pregnancy Weight Gain: Too Much Isn’t Good But Neither Is Too Little!

While these studies make it clear that gaining an unhealthy amount of weight during pregnancy isn’t beneficial for the mother or the baby, research also suggests that gaining too little weight during pregnancy isn’t a good thing either.   A study published in 2014 found that babies from mothers who gained less than the recommended amount of weight tended to have higher levels of pesticides in the fluid in their umbilical cords than those from mothers who gained the recommended amount of weight.[6]

The reason may be because many pesticides get stored in body fat.  Women who don’t gain enough weight during pregnancy may use more of their body fat to nourish their growing baby, which means that the pesticides stored there will enter the blood of both the mom and the baby.

While we don’t know exactly how which pesticides or how great the exposure of pesticides are harmful to a growing baby, many experts recommend avoiding pesticide and toxin exposures during this sensitive time of growth and development.  Studies have shown that pesticide exposures in the womb can cause problems with brain, reproductive and immune system development.  For more information on pesticides and children’s health, see our article here.[7][8][9] For information on avoiding unsafe chemical exposures both before and during pregnancy, check out this article.

Gaining too little weight can also increase a mother’s chances of giving birth too early, or having a baby that is much smaller than average, which can sometimes lead to other health problems for the baby later in life.[10][11] Overall, studies support the Institute of Medicine recommendations for healthy weight gain, neither too little or too much.  And, having a healthy weight and balanced nutrition before getting pregnant will make it easier to keep weight gain during pregnancy within the recommended range.

Risk of Diabetes During Pregnancy

About 5% of pregnant women develop gestational diabetes, which means that a woman has high blood sugar while carrying her baby but has never had diabetes before.

Research indicates that women with gestational diabetes should avoid certain foods. A long-term study found that when pregnant women with gestational diabetes ate more than 4 servings of refined grains (found in most bread and pasta) per day, their children were 80% more likely to be obese by age 7 compared to children of women who ate less than 2 servings of refined grains per day.[12]

Artificially sweetened beverages also have health risks for women with gestational diabetes.  Women who consumed at least one artificially sweetened beverage daily during pregnancy had children who were more likely to be obese or overweight by age 7 – possibly twice as likely.[13] The more artificially sweetened beverages women drank during pregnancy, the more likely it was that their children were obese or overweight.  Drinking water instead of one or more artificially sweetened beverages per day lowered the risk. Click here for more information about managing gestational diabetes.

Tips for Maintaining a Healthy Weight During Pregnancy

Many women find that their usual strategies for keeping their weight down don’t work during pregnancy. For example, when clothes get tight or the scale shows a few extra pounds, that is usually a reminder to watch what you eat; but those clues are not helpful for a women who is pregnant.

The following suggestions can help a woman stay healthy during pregnancy:

PRE-PREGNANCY BMI TOTAL WEIGHT GAIN FOR ONE BABY (LB.) TOTAL WEIGHT GAIN FOR TWINS (LB.)
Underweight: BMI less than 18.5 kg 28-40 No guideline available
Normal weight: BMI between 18.5-24.9 kg 25-35 37-54
Overweight: BMI between 25.0-29.9 kg 15-25 31-50
Obese: BMI greater than 30.0 kg 11-20 25-42
  • Discuss these guidelines with a health care provider to create a personalized plan that best meets your pregnancy needs.
  • Maintain a healthy diet, emphasizing foods that are low in fat and high in fiber. In addition to prenatal vitamins, aim for foods that are a natural source of folic acid (also called folate), such as orange juice, green leafy vegetables, beans, peanuts, broccoli, asparagus, peas, and lentils. Folic acid can reduce the risk of birth defects of the brain and spine.
  • Participate regularly in physical activity. The American College of Obstetricians and Gynecologists recommends a minimum of 30 minutes of moderate physical activity a day for pregnant women (unless there are medical or obstetric complications). Of course, avoid activities with a high risk of falling or abdominal harm.[13]

By maintaining a healthy weight, it is possible to reduce the risk of complications during pregnancy and delivery, and decrease the chances of your child developing health problems later on.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. Institute of Medicine (2009, May). Weight gain during pregnancy: re-examining the guidelines. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy-Reexamining-the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf (Accessed November 30, 2009).
  2. Rowlands I, Graves N, de Jersey S, McIntyre D, Callaway L (2009, October 12). Obesity in pregnancy: outcomes and economics. Seminars in fetal and neonatal medicine: 1744-65.
  3. Liang C, Oest M, Prater M (2009, September 11). Intrauterine exposure to high saturated fat diet elevates risk of adult-onset chronic diseases in C57BL/6 mice. Birth Defects Res B Dev Reprod Toxicol. -Not available-, ahead of print.
  4. Scholtens S, Wijga A, Brunekreef B, Kerkhof M, Postma S, Oldenwening M, de Jongste J, Smit H (2010, April). Maternal overweight before pregnancy and asthma in offspring followed for 8 years. International Journal of Obesity. 34(4):606-13
  5. Patel SR, Hu FB (2008). Short sleep duration and weight gain: a systematic review. Obesity, March 2008; 16(3): 643-653.
  6. Vizcaino E, at al. Gestational Weight Gain and Exposure of Newborns to Persistent Organic Pollutants. Environmental Health Perspectives. May 2014.
  7. Forns J, Lertxundi N, Aranbarri A, Murcia M, Gascon M, Martinez D, et al. 2012. Prenatal exposure to organochlorine compounds and neuropsychological development up to two years of life. Environ Int 45(1): 72-77.
  8. Herbstman JB, Sjodin A, Apelberg BJ, Witter FR, Halden RU, Patterson DG, et al. 2008. Birth delivery mode modifies the associations between prenatal polychlorinated biphenyl (PCB) and polybrominated diphenyl ether (PBDE) and neonatal thyroid hormone levels. Environ Health Perspect 116(10):1376-1382.
  9. Hertz-Picciotto I, Park HY, Dostal M, Kocan A, Trnovec T, Sram R. 2008. Prenatal exposures to persistent and non-persistent organic compounds and effects on immune system development. Basic Clin Pharmacol Toxicol 102(2):146-154.
  10. Stotland NE, et al. Gestational weight gain and adverse neonatal outcome among term infants. Obstet Gynecol. 2006 Sep;108(3 Pt 1):635-43.
  11. Mumbare S, et al. Maternal Risk Factors Associated with Term Low Birth Weight Neonates: A Matched-Pair Case Control Study. Indian Pediatr 2012;49: 25-28.
  12. Zhu, Yeyi, et al.  Maternal dietary intakes of refined grains during pregnancy and growth through the first 7 years of life among children born to women with gestational diabetes. American Journal of Clinical Nutrition. June 2017.
  13. Yeyi Zhu, Sjurdur F Olsen, Pauline Mendola, Thorhallur I Halldorsson, Shristi Rawal, Stefanie N Hinkle, Edwina H Yeung, Jorge E Chavarro, Louise G Grunnet, Charlotta Granström, Anne A Bjerregaard, Frank B Hu, Cuilin Zhang; Maternal consumption of artificially sweetened beverages during pregnancy, and offspring growth through 7 years of age: a prospective cohort study. Int J Epidemiol.June 2017.
  14. Centers for Disease Control and Prevention (2008, April 27). Healthy Weight: Adult BMI Calculator. U.S. Department of Health and Human Services. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html(Accessed October 19, 2009).
  15. American College of Obstetricians and Gynecologists (2002, January). ACOG Committee Opinion No. 267: Exercise during pregnancy and postpartum period. 99 (1): 1-3.

Are Women Who Work Night Shifts at a Higher Risk for Developing Breast Cancer?


Night shift work may seem like an odd thing to link to breast cancer. Nevertheless, scientists found that women who work night shifts for many years are more likely to get breast cancer than other women. This includes nurses and flight attendants who work overnight. The International Agency for Research on Cancer, which is a part of the World Health Organization, reported that shift work is a likely risk factor for certain cancers, just as diet can increase or decrease the risks. Researchers found that night shift work links to breast cancer because it can change a person’s sleep-wake cycle. This has a lot to do with artificial light.[1]

What does the research say about the link between night shift work and breast cancer?

Researchers have studied this question in different ways and have come to different conclusions. This can be confusing. One way researchers can help make sense of different conclusions is to combine multiple studies into a larger combination study. Six groups of researchers in the past decade have used these larger studies to ask if night shift work affects breast cancer risk. Five of these studies found that the risk of breast cancer increased by between 5% and 20%.

The number of years a woman has worked night shifts also seems to matter. One team found that a woman’s risk for breast cancer increased 3% for every 5 years that she worked night shifts and 13% for every 500 night shifts worked.[2] Johns Hopkins University researchers found that women who “regularly” worked night shifts increased their risk for developing breast cancer by 20% compared with women who did not.[3] A third group found that women who worked night shifts for fewer than 5 years had a 2% increase in  risk. However, those that worked night shifts for over 20 years had a 9% increase in risk.[4]

One of the larger studies, done in 2016 by a University of Oxford research team,  made the news because they did not find a link between night shift work and breast cancer risk.[5] However, experts on this topic quickly criticized this study for the way it was designed[6]  For example, the Oxford researchers used studies that only followed women for 2 to 4 years. This is much shorter than the previous studies that found a link between breast cancer and shift work. Following women for only 2 to 4 years is not enough time to see if women’s risk of breast cancer risk will change.

Another major problem with the Oxford study had to do with confusing survey responses measuring how often a woman worked night shifts. This was a significant flaw in the study.

What does this increased risk mean?

The average woman has a 1 in 8 chance, or 12.4% chance, of getting breast cancer at some point during her life.[7] In addition, a woman’s risk of developing breast cancer increases as she ages. Working night shifts for a long time increases risk by between 5% and 20% of a woman’s current risk.  So, for a woman working night shifts, her risk would increase to about 13%-14%. This is a small increase in risk for the average woman. However, any increased risk is of concern for women that have other risk factors for breast cancer, such as a family history of breast cancer or mutations of the BRCA1 or BRCA2 genes (often called the “breast cancer genes”).

Why is night shift work linked to breast cancer?

Night shift work can change a person’s regular sleep-wake cycle. Our sleep-wake cycle is a roughly 24-hour rhythm that tells us when we are alert or sleepy.[8] Humans are naturally active during the day and sleepy at night. However, women who work night shifts reverse this pattern. When a woman is working night shifts, she might use external signals, like artificial light or caffeine, to help tell her body to stay awake. The problem is that her body still sends internal signals that it is time for sleep. These different signals disrupt her natural sleep-wake cycle.

Hormones and other bodily activities do not change to match the woman’s work schedule either. Some of these hormones affect tumors, so this can allow tumors to grow.[9]  One example is the melatonin that our bodies make at night to help us sleep.[8] Melatonin helps to prevent tumor growth.[9] A woman who works in artificial light at night makes less melatonin. Another example is glucocorticoids, which our bodies make when we are stressed. People who work night shifts have higher levels of glucocorticoids that help tumors survive.

Why is this important?

Breast cancer is the most common form of cancer in women.[10] We know that 1 in 8 U.S. women will develop invasive breast cancer over the course of her lifetime. In this next year, 255,000 women in the U.S. will be diagnosed with invasive breast cancer. Another 63,410 will be diagnosed with ductal carcinoma in situ, a non-invasive condition when abnormal cells develop in the milk ducts in the breast).[11]  The number of people that work on night shifts full-time is increasing. In 2004, there were 15 million Americans.[12] This is concerning for women who work night shifts over a long period of time because they may be at an increased risk for developing breast cancer.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. International Agency for Research on Cancer (IARC). (2007). IARC monographs on the evaluation of carcinogenic risks to humans. Volume 98. Shift-work, painting and fire-fighting. Lyon: International Agency for Research on Cancer.
  2. Wang, F., Yeung, K. L., Chan, W. C., Kwok, C. C., Leung, S. L., Wu, C., Chan, E. Y. Y., Yu, I. T. S., Yang, X. R., & Tse, L. A. (2013). A meta-analysis on dose-response relationship between night shift work and the risk of breast cancer. Annals of Oncology, 24(11), 2724-2732. doi:10.1093/annonc/mdt283.
  3. Kamdar, B. B., Tergas, A. I., Mateen, F. J., Bhayani, N. H., & Oh, J. (2013). Night-shift work and risk of breast cancer: a systematic review and meta-analysis. Breast Cancer Research and Treatment, 138(1), 291-301. doi:10.1007/s10549-013-2433-1.
  4. Lin, X., Chen, W., Wei, F., Ying, M., Wei, W., & Xie, X. (2015). Night-shift work increases morbidity of breast cancer and all-cause mortality: a meta-analysis of 16 prospective cohort studies. Sleep Medicine, 16(11), 1381-1387. doi:10.1016/j.sleep.2015.02.543.
  5. Travis, R. C., Balkwill, A., Fensom, G. K., Appleby, P. N., Reeves, G. K., Wang, X., Roddam, A. W., Gathani, T., Peto, R., Green, J., Key, T. J., & Beral, V. (2016). Night Shift Work and Breast Cancer Incidence: Three Prospective Studies and Meta-analysis of Published Studies. Journal of the National Cancer Institute, 108(12). doi:10.1093/jnci/djw169.
  6. Hazards Magazine special online report. (2016, December). Cancer all-clear for night work based on ‘bad science’, warn scientists. Retrieved from http://www.hazards.org/cancer/graveyardshift.htm.
  7. National Cancer Institute at the National Institute for Health (NIH). (2012). Breast Cancer Risk in American Women. Retrieved from https://www.cancer.gov/types/breast/risk-fact-sheet.
  8. National Institute of General Medical Sciences at the National Institute of Health (NIH). Circadian Rhythms Fact Sheet. (2012, November). Retrieved from https://www.nigms.nih.gov/Education/Pages/Factsheet_CircadianRhythms.aspx.
  9. Ball, L. J., Palesh, O., & Kriegsfeld, L. J. (2016). The Pathophysiologic Role of Disrupted Circadian and Neuroendocrine Rhythms in Breast Carcinogenesis. Endocrine Reviews, 37(5), 450-466.
  10. World Health Organization (WHO). (2017). Breast cancer: prevention and control. Retrieved from http://www.who.int/cancer/detection/breastcancer/en/index1.html.
  11. org. (2017, January 10). U.S. Breast Cancer Statistics. Retrieved from http://www.breastcancer.org/symptoms/understand_bc/statistics.
  12. The National Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and Prevention (CDC). (2016, June 21). Work Schedules: Shift Work and Long Hours. Retrieved from https://www.cdc.gov/niosh/topics/workschedules/.

Stomach Cancer and Diet: Can Certain Foods Increase Your Risk?

Laura Gottschalk, PhD, Cancer Prevention & Treatment Fund

There is growing evidence that the foods we eat can increase the chances of developing certain types of cancer. A new report by the World Cancer Research Fund International says that stomach cancer is one of them.

Stomach cancer is the fifth most common cancer worldwide and the third most common cause of death from cancer.[1] Older adults are more at risk to develop stomach cancer with most people in the U.S. being diagnosed over the age of 70.[2] Men are twice as likely to develop stomach cancer compared to women.[2]

You can’t control how old you are or whether you are a man or woman, but what you eat can either increase or decrease your chances of developing stomach cancer. The World Cancer Research Fund looked at all the scientific research that was available discussing diet, weight, physical activity, and the risk of stomach cancer.[3] After looking at 89 studies that examined nearly 77,000 cases of stomach cancer, the report concluded that each of the following can increase a person’s risk for developing stomach cancer.

  • Drinking three or more alcoholic drinks per day.
  • Eating foods preserved by salting, such as pickled vegetables and salted or dried fish, as traditionally prepared in East Asia.
  • Eating processed meats that have been preserved by smoking, curing or salting, or by the addition of preservatives. Examples: ham, bacon, pastrami, salami, hot dogs, and some sausages
  • Being overweight or obese, as measured by body mass index (BMI).

Based on their findings, the WCFR has made several recommendations to reduce your risk of stomach cancer:

  • Maintain a healthy weight
  • Be physically active
  • Eat a healthy diet that avoids processed meat and limits salt
  • Limit your alcohol consumption

These recommendations are good ones for preventing cancer in general, not just stomach cancer.

Still not convinced to give up your 6-packs, kimchi, and bacon just yet? This is just the latest of many studies showing that being overweight and eating processed meats increases your risk of cancer. And, previous research has also shown that drinking more alcohol increases your chances of developing cancer.[4] However, this is probably the most comprehensive study showing the link between a range of eating and drinking habits and stomach cancer.

In addition to what you eat, there are other aspects of your life that increase the risk of stomach cancer.

  • Smoking: It is estimated that 11% of stomach cancer cases are due to smoking.
  • Infection: A bacteria called pylori is known to cause chronic inflammation of the stomach which can lead to stomach cancer. Fortunately, food sanitation in developed countries dramatically cuts down on risk of infection.
  • Industrial chemicals: Exposure to dust and high-temperature environments in the workplace increases the risk of stomach cancer.

If you can’t reduce the risks of smoking, infection or industrial chemicals, changing your diet is the best option for reducing your chances of stomach cancer. Eating fresh vegetables and meats is better than preserved and processed ones. That doesn’t mean you should never eat another hot dog or slice of bacon, but it does mean trying to eat them only rarely. As with most things, moderation is key. Try and balance your diet:  don’t just decrease the amount of unhealthy foods you eat, but also increase the amount of healthy foods. Studies have shown that eating lots of fresh fruits and vegetables, especially citrus fruit,[5] may even reduce your chances of developing stomach cancer![3]

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. end Centers for Disease Control and Prevention. “Global Cancer Statistics.”  Department of Health and Human Services. 02 Feb. 2015. Accessed: 05/04/2016. http://www.cdc.gov/cancer/international/statistics.htm
  2. end National Cancer Institute. “What you need to know about stomach cancer.” NIH Publication No. 09-1554. Printed September 2009. Brochure.
  3. end World Cancer Research Fund International/American Institute for Cancer Research. Continuous “Update Project Report: Diet, Nutrition, Physical Activity and Stomach Cancer.” 2016. Available at: wcrf.org/stomach-cancer-2016.
  4. end IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. “Personal habits and indoor combustions. Volume 100 E. A review of human carcinogens. Exit Disclaimer.” IARC Monographs on the Evaluation of Carcinogenic Risks in Humans. 2012: 100(Pt E):373-472.
  5. end Bae JM, Lee EJ, et al. “Citrus fruit intake and stomach cancer risk: a quantitative systematic review.” Gastric Cancer. 2008;11(1):23-32.

Are E-Cigarettes Safer Than Regular Cigarettes?

Brandel France De Bravo, MPH, Sarah Miller, Jessica Becker, and Laura Gottschalk, PhD, Cancer Prevention & Treatment Fund

Electronic cigarettes, or e-cigarettes, are being marketed as the “safe” new alternative to conventional cigarettes. But are e-cigarettes safe?  What does the FDA think about them?  Are e-cigarettes going to reverse the decline in smoking—giving new life to an old habit—or can they help people quit smoking? Here is what you need to know before picking up an e-cigarette.

What Are E-Cigarettes?

E-cigarettes are battery-operated devices shaped like cigarettes that provide a way to get nicotine. Nicotine is an addictive drug (it stimulates and relaxes) that is naturally found in tobacco. The most popular way for people to take in nicotine is to inhale it by smoking cigarettes. E-cigarettes also allow nicotine to be inhaled, but they work by heating a liquid cartridge containing nicotine, flavors, and other chemicals into a vapor. Because e-cigarettes heat a liquid instead of tobacco, what is released is considered smokeless.[1]

Are E-Cigarettes Safer Than Traditional Cigarettes?

The key difference between traditional cigarettes and e-cigarettes is that e-cigarettes don’t contain tobacco.  But, it isn’t just the tobacco in cigarettes that causes cancer. Traditional cigarettes contain a laundry list of chemicals that are proven harmful, and e-cigarettes have some of these same chemicals.

Since 2009, FDA has pointed out that e-cigarettes contain “detectable levels of known carcinogens and toxic chemicals to which users could be exposed.”[2] For example, in e-cigarette cartridges marketed as “tobacco-free,” the FDA detected a toxic compound found in antifreeze, tobacco-specific compounds that have been shown to cause cancer in humans, and other toxic tobacco-specific impurities.[3] Another study looked at 42 of these liquid cartridges and determined that they contained formaldehyde,  a chemical known to cause cancer in humans.[4] Formaldehyde was found in several of the cartridges at levels much higher than the maximum EPA recommends for humans.

The body’s reaction to many of the chemicals in traditional cigarette smoke causes long-lasting inflammation, which in turn leads to chronic diseases like bronchitis, emphysema, and heart disease.[5f] Since e-cigarettes also contain many of the same toxic chemicals, there is no reason to believe that they will significantly reduce the risks for these diseases.

There are no long-term studies to back up claims that the vapor from e-cigarettes is less harmful than conventional smoke. Cancer takes years to develop, and e-cigarettes were only very recently introduced to the United States. It is almost impossible to determine if a product increases a person’s risk of cancer or not until the product has been around for at least 15-20 years. Despite positive reviews from e-cigarette users who enjoy being able to smoke them where regular cigarettes are prohibited, very little is known about their safety and long-term health effects.

Can E-Cigarettes Be Used to Cut down or Quit Smoking Regular Cigarettes?

If a company makes a claim that its product can be used to treat a disease or addiction, like nicotine addiction, it must provide studies to the FDA showing that its product is safe and effective for that use. On the basis of those studies, the FDA approves or doesn’t approve the product. So far, there are no large, high-quality studies looking at whether e-cigarettes can be used to cut down or quit smoking long-term. Most of the studies have been either very short term (6 months or less) or the participants were not randomly assigned to different methods to quit smoking, including e-cigarettes. Many of the studies are based on self-reported use of e-cigarettes. For example, a study done in four countries found that e-cigarette users were no more likely to quit than regular smokers even though 85% of them said they were using them to quit.[6] Another year-long study, this one in the U.S., had similar findings.[7] People may believe they are smoking e-cigarettes to help them quit,  but 6-12 months after being first interviewed, nearly all of them are still smoking regular cigarettes.

Until there are results from well-conducted studies, the FDA has not approved e-cigarettes for use in quitting smoking.[8]

Teenagers, Children, and E-Cigarettes

The percentage of teenagers who have tried e-cigarettes has almost quadrupled in just four years, from 5% in 2011 to 19% in 2015.  Three million U.S. students in middle school and high school tried e-cigarettes in 2015, according to the National Youth Tobacco Survey.  And, 1 in 5 middle schoolers who said they had tried e-cigarettes also said they had never smoked conventional cigarettes.[9]

E-cigarette use by young people is worrisome for a number of reasons:

1) The younger people are when they begin smoking, the more likely it is they will develop the habit: nearly 9 out of 10 smokers started before they were 18.[10]

2) Nicotine and other chemicals found in e-cigarettes might harm brain development in younger people.[11]

3) E-cigarettes may introduce many more young people to smoking who might otherwise never have tried it, and once they are addicted to nicotine, some may decide to get their “fix” from regular cigarettes. Whether e-cigarettes end up being a “gateway” to regular cigarettes or not, young people who use them risk becoming addicted to nicotine and exposing their lungs to harmful chemicals.

The sharp rise in young e-cigarette users highlights the need to stop manufacturers from targeting teenagers with candy-like flavors and advertising campaigns.

Even children who are too young to smoke have been harmed by e-cigarettes. The liquid used in e-cigarettes is highly concentrated, so absorbing it through the skin or swallowing it is far more likely to require an emergency room visit than eating or swallowing regular cigarettes. In 2012, less than 50 kids under the age of six were reported to poison control hotlines per month because of e-cigarettes. In 2015, that number had skyrocketed to about 200 children a month, almost half of which were under the age of two![12]

How Are E-Cigarettes Regulated?

The FDA was given the power to regulate the manufacturing, labeling, distribution and marketing of all tobacco products in 2009 when President Obama signed into law the Family Smoking Prevention and Tobacco Control Act and in 2010 a court ruled that the FDA could regulate e-cigarettes as tobacco products.[13]

It wasn’t until 2016 that the FDA finally announced a rule to regulate e-cigarettes.[14] Under the final rule, the FDA plans to ban the sale of e-cigarettes to anyone under the age of 18.  The rule also requires all makers of e-cigarettes sold after February 15, 2007 to go through a “premarket review.” This is the process that the FDA uses to determine whether potentially risky products are safe. However, companies are allowed to have anywhere from 18 months to two years to prepare their applications. And it will take another year for the FDA to actually approve these applications. So don’t expect e-cigarettes currently on the market to be officially allowed to be sold by the FDA for another couple of years.

In the meantime, individual states have always had the power to pass laws restricting the sale and use of e-cigarettes. For example, in May 2013, the California state senate proposed a law making all e-cigarettes subject to the same regulations and restrictions as traditional cigarettes and tobacco products.  However, that did not become law.

The Bottom Line

E-cigarettes have not been around long enough to determine if they are harmful to users in the long run.  Unfortunately, many people, including teenagers, are under the impression that e-cigarettes are safe or that they are effective in helping people quit smoking regular cigarettes.  Neither of these assumptions has yet been proven. Studies by the FDA show that e-cigarettes contain some of the same toxic chemicals as regular cigarettes, even though they don’t have tobacco.  The big three tobacco companies—Lorillard, Reynolds American, and Altria Group—all have their own e-cigarette brands, so it’s not surprising that e-cigarettes are being marketed and advertised much the way regular cigarettes used to be.  Here are the 7 Ways E-Cigarette Companies Are Copying Big Tobacco’s Playbook.

Unless you want to be a guinea pig, hold off on e-cigarettes until more safety information is available.  And if you need help quitting or reducing the number of cigarettes you are smoking, check out the smokefree.gov website.

Related Content:

Quitting smoking: women and men may do it differently
Third-hand smoke
Smoking cessation products

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff. 

References

  1. Richard J. O’Connor Non-cigarette tobacco products: What have we learned and where are we headed? Tob Control. Author manuscript; available in PMC 2013 July 19. Published in final edited form as: Tob Control. 2012 March; 21(2): 181–190. doi: 10.1136/tobaccocontrol-2011-050281.
  2. “Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted By FDA.” FDA News & Events. FDA, 22 July 2009. http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm173146.htm.
  3. “Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted By FDA.” FDA News & Events. FDA, 22 July 2009. Web. 09 Aug. 2013. http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm173146.htm.
  4. Varlet et al. (2015) Toxicity of refill liquids for electronic cigarettes. International Journal for Environmental Research and Public Health. 12:4796-4815.
  5. Stoller, JK & Juvelekian, G; Chronic Obstructive Pulmonary Disease; 2010 Cleveland Clinic Center for Continuing Education. https://my.clevelandclinic.org/departments/respiratory/depts/chronic-obstructive-pulmonary-disease.
  6. Adkison SE, O’Connor RJ, Bansal-Travers M, et al. Electronic nicotine delivery systems: international tobacco control four-country survey. Am J Prev Med. 2013;44(3):207-215.
  7. Grana RA, Popova L, Ling PM. A Longitudinal Analysis of Electronic Cigarette Use and Smoking Cessation. JAMA Internal Medicine, published online March 24, 2014
  8. “Electronic Cigarettes” FDA News & Events. FDA, 25 July 2013. http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm
  9. Singh T, Arrazola RA, Corey CG, et al. Tobacco Use Among Middle and High School Students – United States, 2011-2015. CDC Morbidity and Mortality Weekly Report. April 15, 2016. 65(14);361-367.
  10. Centers for Disease Control and Prevention. Fact sheets: Youth and tobacco use.  http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/.
  11. US Department of Health and Human Services. Preventing tobacco use among youth and young adults. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. http://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm.
  12. Kamboj A, Spiller HA, Casavant MJ, et al. Pediatric Exposure to E-Cigarettes, Nicotine, and Tobacco Products in the United States. Pediatrics. May 2016. In Press.
  13. “Regulation of E-Cigarettes and Other Tobacco Products.” FDA News & Events. FDA, April 25, 2011. http://www.fda.gov/newsevents/publichealthfocus/ucm252360.htm.
  14. Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Restrictions on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. 21 CFR Parts 1100, 1140, and 1143 (2016).

Prostate Cancer: Diet and Dietary Supplements

Stephanie Portes-Antoine, Brandel France de Bravo, MPH, Caitlin Kennedy, PhD, Anna E. Mazzucco, PhD, and Laura Gottschalk, PhD, Cancer Prevention & Treatment Fund

Prostate cancer is the most common cancer in men in North America. In 2008, approximately 186,000 men in the United States and 25,000 men in Canada were diagnosed with prostate cancer, which accounts for 25% of all cancers in men.[1][2]

Compared to most cancers, prostate cancer usually progresses very slowly, and many men live with it for years and even decades. Once diagnosed, some men decide to undergo treatment to halt the progression of the disease, and others refrain from treatment, preferring instead to closely monitor the cancer’s progression. Those who choose “watchful waiting” do this because the medical and surgical treatments for prostate cancer can cause debilitating side effects, and because most men with prostate cancer will die from something else. This strategy is especially likely for older men in the earliest stage of the disease.

At one time, it was unheard of to suggest that diet might have a role to play in battling prostate cancer. But there is now evidence that certain foods and dietary supplements have an impact on prostate health—both positive and negative. Some foods or supplements appear to promote prostate health and prevent cancer cells from developing, but others should not necessarily be taken by men who already have prostate cancer.

The role of diet drew researchers’ attention when they noticed that prostate cancer rates vary greatly from one country to another, with the highest rates appearing in countries where people tend to eat a lot of fat. Studies also show that men who are obese or have a high fat diet are more likely to have prostate cancer.[2] Diets high in saturated fats, such as the animal fats found in red meat, may pose the greatest risk. The lowest rates of prostate cancer are found in Asian countries where men eat a lot of soy foods, a rich source of naturally occurring phytoestrogens. It was hoped that by increasing men’s intake of phytoestrogens, they might reduce their risk of prostate cancer, slow its progression, or reduce the risk of prostate cancer recurring, but at least three studies have failed to find any protective benefit from phytoestrogens.[4][5][6]

As more and more people take dietary supplements containing antioxidants, studies have been conducted to determine their effect on reducing the risk and growth of cancers, including prostate cancer. Three antioxidants that have received attention with regard to prostate health are vitamin E, selenium, and vitamin D.

Studies comparing men who live in areas of the country with high levels of selenium to men in areas with low levels suggest that this mineral protects against prostate cancer. Selenium is believed to reduce the risk of developing prostate cancer because it keeps cells from proliferating or dying off in a rapid or unusual way. An analysis in 2002 of the Nutritional Prevention of Cancer Trial revealed that the men who took selenium supplements daily were half as likely to be diagnosed with prostate cancer.[7] However, in 2008, the Selenium and Vitamin E Cancer Prevention Trial (SELECT) indicated that neither selenium nor vitamin E, alone or in combination, was effective for the primary prevention of prostate cancer.[8][9]  In fact, a 2014 report showed that after several more years of observing the men from the SELECT trial, taking vitamin E supplements actually increased the risk of prostate cancer by 17%.[10]  This result led the researchers to discourage men over 55 from taking amounts of vitamin E higher than the recommended dietary allowance (RDA), which is 15 mg of alpha-tocopherol, especially for supplements which contain only the alpha-tocopherol type of vitamin E.

So do antioxidants prevent prostate cancer or not? The case of selenium is an interesting one that helps shed light on this question. Based on the newest research by Philip Kantoff, June Chan, and their colleagues at the Dana-Farber Cancer Institute in Boston, it seems that higher selenium levels in the blood may worsen prostate cancer in many men who already have the disease.[11]

In his earlier research, Dr. Kantoff had found that the risk of developing prostate cancer was modified by a strong interaction between a mitochondrial enzyme (SOD2) and selenium.[12] In his most recent study published in 2009, Dr. Kantoff and his research team measured selenium in the blood of men with prostate cancer and determined which of the two forms of SOD2 the men had: AA or V.9 Among the men with the AA genotype, those with a higher level of selenium in their blood had a lower risk of aggressive prostate cancer. In contrast, the men with the much more common V genotype who had higher levels of selenium in their blood were at an increased risk for aggressive prostate cancer. Unless a man knows which of the two genotypes he has, he may want to avoid taking supplements with selenium, particularly if he has already been diagnosed with prostate cancer.

But what about men who don’t have prostate cancer—should they take selenium?  In 2014, the SELECT trial  found that for men who already had high levels of selenium, taking selenium supplements increased their risk of prostate cancer by 91%.10 Clearly, men should avoid having too much selenium.  As a result of this trial, the researchers have encouraged men over 55 to limit their intake of selenium to the recommended dietary allowance (RDA) of 55 mcgs.

The SELECT findings on selenium don’t mean that antioxidants have no role to play in preventing cancer or slowing its spread. Scientists still have much to learn about antioxidants. Some antioxidants may be helpful and yet some may actually encourage small cancers to grow larger.  A 2013 study by researchers at the Bedford and Addenbrooke’s Hospitals in the U.K. tested the effect of Pomi-T, a supplement that contains broccoli, pomegranate, green tea, and turmeric on the health of men with prostate cancer. After six months, they found that the men taking Pomi-T had a smaller increase or sometimes even a decrease in PSA, a protein that becomes elevated with prostate cancer, as compared to men with prostate cancer who didn’t take Pomi-T. Also, fewer supplement-taking men went on to receive treatment or surgery than non-supplement-taking men. The researchers suggest that the unique blend of polyphenols and antioxidants in the supplement had a beneficial effect on health of these prostate cancer patients.[13]

A study published in 2016 brought yet another antioxidant, vitamin D, into the prostate cancer discussion. Vitamin D is well known for its role in helping build strong bones and teeth, but it may also contribute to the fight against cancer. Higher levels of vitamin D have previously been linked to better breast cancer outcomes (read more here). The prostate cancer study looked at the levels of vitamin D in men who had their prostates removed due to cancer. They found that men who had the most aggressive forms of prostate cancer had lower levels of vitamin D in their blood compared to men with less aggressive forms of cancer.[14] It is not yet known whether higher levels of vitamin D prevent more aggressive forms of prostate cancer or if aggressive prostate cancer lowers levels of vitamin D. Since it is impossible to know if low levels of vitamin D is a cause or effect of aggressive prostate cancer, and since high levels of vitamin D can be dangerous, more research is needed before experts will know if men diagnosed with prostate cancer should try to take more vitamin D.

More studies are needed in order to determine exactly how diet and dietary supplements can be used to prevent prostate cancer and slow its spread. Meanwhile, men should reduce saturated fats as much as possible. While the jury is still out on phytoestrogens, men may benefit from eating more soy products—especially if they are eating them in place of red meat!

For more on cancer and antioxidants, read here.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. American Cancer Society: Statistics for 2008. Available at http://www.cancer.org. Accessed July 31, 2009.
  2. Canadian Cancer Society: Canadian Cancer Statistics 2008. Available at http://www.cancer.ca
  3. Ma R, Chapman K. A systematic review of the effect of diet in prostate cancer prevention and treatment. Journal of Human Nutrition and Dietetics. Vol (22)2009:187-199.
  4. Ganry O. Phytoestrogens and prostate cancer risk. Preventive Medicine. Vol (41) 2005:1-6.
  5. Ward H, Chapelais G, Kuhnle GC, Luben R, Khaw KT, Bingham S. Lack of Prospective Associations between Plasma and Urinary Phytoestrogens and Risk of Prostate or Colorectal Cancer in the European Prospective into Cancer-Norfolk Study. Cancer Epidemiology Biomarkers & Prevention Vol (17) 2008: 2891-2894.5
  6. Bosland MC, Kato I, Zeleniuch-Jacquotte A, Schmoll J, Rueter EE, Melamed J, Kong MX, Macias V, Kajdacsy-Balla A, Lumey LH, Xie H, Gao W, Walden P, Lepor H, Taneja SS, Randolph C, Schlicht MJ, Meserve-Watanabe H, Deaton RJ, & Davies JA. Effect of soy protein isolate supplementation on biochemical recurrence of prostate cancer after radical prostatectomy. JAMA 2013; 310(2): 170-178. doi: 10.1001/jama.2013.7842
  7. Duffield-Lillico AJ, et al. Baseline characteristics and the effect of selenium supplementation on cancer incidence in a randomized clinical trial: A summary report of the Nutritional Prevention of Cancer Trial.Cancer Epidemiology, Biomarkers, and Prevention. Vol (11) 2002: 630-639.
  8. Lippman SM, et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers: The Selenium and Vitamin E Cancer Prevention Trial (SELECT). Journal of American Medical Association. Vol (301)2008: 39-51.
  9. Klein EA, et al. SELECT: The next prostate cancer prevention trial-Selenium and Vitamin E Cancer Prevention Trial. Journal of Urology. Vol (166) 2001:1311-1315.
  10. Kristal AR, et al., Baseline Selenium Status and Effects of Selenium and Vitamin E Supplementation on Prostate Cancer Risk.  Journal of the National Cancer Institute, 2014.
  11. Chan JM et al. Plasma Selenium, Manganese Superoxide Dismutase, and Intermediate-or High-Risk Prostate Cancer. Journal of Clinical Oncology. Vol (27) 2009: 3577-3583.
  12. Li H, et al. Manganese superoxide dismutase polymorphism, pre-diagnostic antioxidant status, and risk of clinical significant prostate cancer. Cancer Research. Vol (65)2005:2498-2505.
  13. Thomas RJ, Williams MMA, Sharma H, Chaudry A, & Bellamy P. A double-blind, placebo RCT evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer: The U.K. National Cancer Research Network (NCRN) Pomi-T study. Results presented at the 2013 Annual Meeting of the American Society of Clinical Oncology. Abstract retrieved on July 12, 2013 from: http://meetinglibrary.asco.org/content/112921-132
  14. Nyame Ya, et al. Associations between serum vitamin D and adverse pathology in men undergoing radical prostatectomy. J Clin Oncol. 2016 Feb 22.

Can a handful of nuts a day keep cancer away?

By Krista Kleczewski and Claire Karlsson

Evidence is growing about the many ways in which eating nuts, seeds, and legumes can improve your health. These foods have been linked to healthier hearts and a lower risk of diabetes, but now studies show they may also cut your risk of getting cancer! Here’s what we know and don’t know.

Several studies show a great benefit from eating nuts, seeds, and legumes. In 2015, a Dutch study of 120,000 men and women between the ages of 55-69 found that those who ate about half a handful of nuts or peanuts each day were less likely to die from respiratory disease, neurodegenerative diseases, diabetes, cardiovascular diseases, or cancer than those who consumed no nuts or seeds.1 The same benefit was not seen for peanut butter, however, which suggests that the salt, vegetable oils, and trans fatty acids in peanut butter may counterbalance the benefits of the peanuts. A 5-year study conducted in Spain of 7,000 men and women aged 55 to 80 years old found that eating at least three servings of nuts per week reduced the risk of cardiovascular and cancer death.2 Another study similarly found eating nuts – especially walnuts — reduces the risk of developing cancers, diabetes and heart disease when eaten in conjunction with the Mediterranean Diet, which also emphasizes fruits, vegetables, whole grains, and legumes.3 Walnuts were highlighted by the study as reducing inflammation associated with certain cancers and other conditions like diabetes and heart disease. More evidence is needed, however, to determine the specific impact of walnuts on cancer risk.

Breast Cancer

Eating large amounts of peanuts, walnuts, or almonds can reduce the risk of developing breast cancer, according to a 2015 study of 97 breast cancer patients. 4 The researchers compared the lifetime consumption of nuts and seeds among the breast cancer patients with the consumption of those without breast cancer, finding that women who ate large quantities were half to one-third as likely to develop breast cancer. No difference was found between people who ate a small amount of nuts and seeds and those who ate none at all, suggesting that a person needs to consume a substantial amount of nuts and seeds over their lifetime to reduce their chances of developing breast cancer.

Girls who regularly eat peanuts and nuts may be less likely to develop breast cancer as adults. In a study published in 2013, girls between the ages of 9-15 who regularly ate peanut butter or any kind of nuts had almost a 40% lower chance of developing benign breast conditions as adults.5 Although not dangerous, benign breast conditions increase a woman’s chances of eventually getting breast cancer.

Many people think of peanuts as nuts, but they are actually a type of legume. Researchers found that eating legumes, which include beans, lentils, soybeans, and corn, may all reduce the risk of benign breast conditions (and therefore, breast cancer).

Can eating nuts, legumes and seeds reduce colorectal cancer risk?

To find out whether snacking on foods with peanuts lowers your chances of getting colorectal cancer (also called colon cancer), researchers studied more than 23,000 adults in Taiwan, ages 30 and older.6 The researchers found that women who ate meals with peanut products at least twice each week were less likely to develop colorectal cancer. More research is needed to see if this benefit is actually from the peanuts.

In one of the largest studies of diet and cancer, which was conducted in 10 European countries, researchers discovered that eating nuts and seeds reduced women’s chances of developing colon cancer, but did not lower the risk for men.7 Women who ate a modest daily amount of nuts and seeds (about 16 peanuts or a small handful of nuts or seeds) every day were less likely to develop colon cancer, and women who ate the largest quantities of these foods were the least likely to develop colon cancer. Again, more research is needed to understand these findings.

Pancreatic Cancer

Eating nuts also seems to lower the risk of developing diabetes,8 which may then lower the risk of developing pancreatic cancer. In addition, a large study of women found that frequently eating nuts was associated with less chance of developing pancreatic cancer,9 one of the most deadly cancers.

What about ovarian cancer?

A 2010 study examined the possible link between ovarian cancer and foods high in phytoestrogens and/or fiber, including nuts, beans, and soy. They found that these foods seemed to help prevent “borderline ovarian cancer”—slow-growing tumors that are less dangerous and more likely to affect younger women. However, these foods did not seem to protect against the more aggressive types of ovarian cancer.10

The Bottom Line

There is growing evidence that nuts, legumes, and seeds reduce the risk for several types of cancer, as well as having other health benefits. Nuts are high in calories, so don’t overdo it. It seems safe to assume that adding these foods to your diet, in small quantities several times a week, is a good idea, especially if you use them to replace less healthy snacks.

This gives new meaning to the name “health nut”!