Category Archives: Diet, Habits, & Other Behaviors

Dietary Supplements Before and During Chemotherapy

Meg Seymour, PhD, National Center for Health Research


Many Americans, including those with cancer, take dietary supplements. People take supplements because they believe it will help them stay healthy and give them vitamins and minerals they may not get from their diet. Chemotherapy patients often take supplements because their nausea makes it difficult to eat, and they want to be sure to get enough nutrients. 

People think of dietary supplements as a no-risk insurance policy to improve nutrition, but a study published in 2020 shows that supplements can have risks if you are undergoing chemotherapy. More than 1,000 breast cancer patients were asked whether or not they took any supplements either before or during their chemotherapy.[1] The researchers then continued to evaluate any subsequent cancer or death for up to 15 years (almost all of the women were followed for at least 5 years).

Results showed that patients who took vitamin B12 both before and during their chemotherapy were more likely to develop cancer again in the 5-15 years after treatment and were more likely to die as a result. They were also more likely to die from any cause, not just from cancer. This increase in subsequent cancer or death was only for people who took the supplements both before and during their chemotherapy. Patients who only took the supplements before chemotherapy or only took supplements during chemotherapy were not more likely to develop cancer again or to die from cancer or other causes in the years after treatment. Patients who took iron supplements both before and during chemotherapy were also more likely to develop cancer again after treatment or to die of cancer or any cause. However, the same was also true for people who only took iron supplements during their chemotherapy.  

Results showed that patients who took vitamin B12 before and during their chemotherapy were more likely to die or have their cancer return. They were also more likely to die from any cause, not just from cancer. This increase in cancer recurrence or death was only for people who took the B12 supplements both before and during their chemotherapy. Patients who only took the B12 supplements before chemotherapy or only took supplements during chemotherapy were not more likely to have a recurrence of their cancer or die. Patients who took Iron supplements both before and during chemotherapy were also more likely to have their cancer return or to die of any cause. However, the same was also true for people who only took Iron supplements during their chemotherapy.

The researchers also looked at antioxidant supplements, which include vitamins A, C, and E. They found that patients taking these supplements both before and during chemotherapy had a 41% higher chance of cancer returning after treatment. However, this finding was not “statistically significant,” which means that more research is needed to determine whether these worse outcomes occurred by chance. The 44% of the patients in the study who were taking multivitamins did not have better or worse outcomes than people who were not taking them. 

This is what scientists call an observational study rather than a clinical trial. In a clinical trial, some patients would be randomly assigned to take supplements and others would be assigned to take a placebo (with no active ingredients). In an observational study, people make their own decisions about what treatment (in this case supplements) to take. Those who chose to take supplements might have different health issues or health habits than those who did not. For example, it is possible that the people who were more likely to take supplements both before and during their chemotherapy were less healthy to begin with. For example, they could have been taking B12 or Iron supplements because they had anemia, and anemia may have increased the possibility of cancer recurrence or death. Also, because patients were asked whether or not they took supplements (instead of being given the supplements by researchers), it is impossible to know whether what patients said about supplements was completely accurate. For example, some patients could have said that they were regularly taking a supplement, but really they only took it occasionally.   

Dr. Christine Ambrosone, the lead researcher of the study, said in an interview that this is only one observational study, and doctors should not necessarily base their recommendations on this single study. Doctors need to consider the specific needs of each patient. For example, someone with anemia might need a dietary supplement, and the benefits of those supplements might outweigh the potential risks. 

If you are considering taking a dietary supplement, it is important to keep in mind that the Food and Drug Administration does not regulate dietary supplements for purity and quality. There is no guarantee that a supplement will work or even that it contains exactly what the bottle says it contains.[2] It is always important to talk with your doctor to help you decide if the benefits of any dietary supplement you are considering outweigh the potential risks. 

 

  1. Ambrosone, C. B., Zirpoli, G. R., Hutson, A. D., McCann, W. E., McCann, S. E., Barlow, W. E., … & Unger, J. M. (2019). Dietary Supplement Use During Chemotherapy and Survival Outcomes of Patients With Breast Cancer Enrolled in a Cooperative Group Clinical Trial (SWOG S0221). Journal of Clinical Oncology, JCO-19.
  2. Brooks, J, Mitchell, J., Nagelin-Anderson, E. , & Zuckerman, D. National Center for Health Research. How Safe are Natural Supplements? Center4research.org. http://www.center4research.org/examining-safety-natural-supplements/. 2019.

Do Vitamin D Supplements Prevent Cancer and Heart Disease? What the Research Says

Meg Seymour, PhD


Approximately 40% of Americans are low in vitamin D.[1] Low vitamin D has been linked to a number of health problems, including cancer, heart disease, and heart attack.[2, 3] 

Sunshine on your skin (without sunscreen) is a great way to get vitamin D (15 minutes between 10 a.m. and 3 p.m is key)[4], but many Americans don’t get that much sun, especially during colder months. Popular foods that provide vitamin D include fish and fortified milks or cereals.[5]  Scientists have studied whether taking vitamin D supplements could decrease the risk of developing health problems for people who do not get enough vitamin D from these natural sources. 

Do Vitamin D Supplements Help Prevent Cancer?

Researchers have conducted several long-term clinical trials to determine whether vitamin D supplements can decrease the risk of developing cancer. Randomized, controlled clinical trials are the “gold standard” of research. In these trials, some participants were assigned to take vitamin D supplements, and others were assigned to take a placebo (sugar pill). Then, the researchers measured whether or not the people given the supplements were less likely to develop cancer over time. 

A 2018 study found that vitamin D supplements did not prevent cancer. Researchers assigned 5,000 people, ages 50-84, to either take 100,000 IU of vitamin D or placebo once a month for 3 years. After 3 years, they found that monthly supplements of high doses of vitamin D did not decrease the percentage of people developing cancer.[6] An even larger study from 2019, of almost 26,000 patients over the age of 50, also found no benefit. The researchers assigned participants to take either 2000 IU of vitamin D or a placebo every day for over 5 years. People taking vitamin D every day were just as likely to develop cancer as the people taking the placebo.[7] 

A meta-analysis published in 2019 also looked at the impact of vitamin D supplements on cancer. A meta-analysis is a type of combination study that combines the results of many smaller studies. The study found that although vitamin D supplements did not prevent cancer, people who took daily vitamin D supplements were less likely to die from cancer.[8] The researchers suggested that even though vitamin D supplements do not prevent cancer, perhaps they affect the way that tumors grow. However, a bigger meta-analysis (combining more than 30 studies totaling 18,000 participants) found no difference in deaths from cancer for those who did or did not take the supplements.[9] The two meta-analyses had different methods and looked at different studies, so further research is needed in order to determine whether or not vitamin D supplements actually can prevent deaths from cancer. 

Most people taking vitamin D are taking it combined with calcium. For that reason, it is important to look at research that examines the effect of taking them both. A 2017 study looked at more than 2,300 women ages 55 and up. Half were assigned to take 2,000 IU of vitamin D and 1,500 mg of calcium per day, and the other half were assigned to take a placebo every day. The researchers followed them for 4 years and found no difference between the two groups in the chances of getting cancer.[10]

Why is it that people with low vitamin D are more likely to develop cancer, but vitamin D supplements do not prevent cancer? One possibility is that people low on vitamin D might be different from people with enough vitamin D in ways that are related to an increased risk of cancer. For example, people might be low in vitamin D because they do not go outside and exercise regularly, and people who exercise regularly are less likely to develop cancer [11]. Obese people are more likely to develop cancer, and obese people tend to have lower levels of vitamin D.[12]

Are Vitamin D Supplements Good for Your Heart?

People who do not have enough vitamin D are more likely to develop heart disease and have heart attacks.[13,14] Researchers have conducted clinical trials to find out if vitamin D supplements can help prevent heart disease. The same large study from 2019 that measured vitamin D supplements and cancer also looked at whether or not people taking the supplements had fewer heart attacks. The study found no benefit: there was no difference in the number of heart attacks between those taking vitamin D and those taking placebos.[7] 

Since people taking vitamin D supplements often take calcium supplements as well, researchers want to understand if taking both of these supplements affects heart health. The results of these studies are not consistent, with some showing an increase in strokes,[15] and others finding no impact on heart health.[13] More clinical trials on the combination of vitamin D and calcium are needed to draw any conclusions about whether these supplements are helpful or harmful to heart health. 

Potential Risks of Supplements 

Some older research found that taking a combination of vitamin D and calcium increased the risk of kidney stones.[16] However, more recent research has found that there is no increased risk of kidney stones in people taking the combination of vitamin D and calcium.[10] A large clinical study conducted in 2019 found that taking vitamin D supplements alone did not increase the chances of developing kidney stones, upset stomach, or hypercalcemia (too much calcium in the blood).[7] 

The Bottom Line

There is not enough evidence to conclude whether taking vitamin D prevents cancer or heart problems. The United States Preventive Services Task Force, a federally funded group that analyzes scientific research, has concluded that there is not enough evidence to say that the benefits of taking supplements, including vitamin D and calcium, to try to prevent heart disease and cancer outweigh the risks.[17]

If you are worried that you are not getting enough vitamin D, talk with your doctor about getting your vitamin D levels tested. If you choose to take a supplement, be sure to talk with your doctor about the amount of vitamin D you are taking. Unless you have a medical need and your doctor recommends it, it is not recommended to take more than 4,000 IU of vitamin D per day. It is better to try to get your vitamins from food or the sun.[18] The Food and Drug Administration requires that food packaging in the United States say what percentage of your daily vitamin D needs are included in a serving of packaged food. Read the labels on your food if you are concerned about getting enough vitamin D in your diet. For more information about vitamin D, what it does for the body, and getting vitamin D from food and the sun, click here

 

  1. Forrest, K. Y., & Stuhldreher, W. L. (2011). Prevalence and correlates of vitamin D deficiency in US adults. Nutrition Research, 31(1), 48-54.
  2. Hossain, S., Beydoun, M. A., Beydoun, H. A., Chen, X., Zonderman, A. B., & Wood, R. J. (2019). Vitamin D and breast cancer: A systematic review and meta-analysis of observational studies. Clinical Nutrition ESPEN, 30, 170-184.
  3. Garland, C. F., Garland, F. C., Gorham, E. D., Lipkin, M., Newmark, H., Mohr, S. B., & Holick, M. F. (2006). The role of vitamin D in cancer prevention. American Journal of Public Health, 96(2), 252-261. 
  4. U.S. News and World Report. How Much Time in the Sun Do You Need for Vitamin D? Health.usnews.com. Updated July 2018.  https://health.usnews.com/wellness/articles/2018-07-18/how-much-time-in-the-sun-do-you-need-for-vitamin-d
  5. Dietary Guidelines 2015-2020. Vitamin D: Food Sources Ranked by Amounts of Vitamin D and Energy per Standard Food Portions and per 100 Grams of Foods. Health.gov https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/appendix-12/
  6. Scragg, R., Khaw, K. T., Toop, L., Sluyter, J., Lawes, C. M., Waayer, D., … & Camargo, C. A. (2018). Monthly high-dose vitamin D supplementation and cancer risk: a post hoc analysis of the vitamin D assessment randomized clinical trial. JAMA Oncology, 4(11), e182178-e182178.
  7. Manson, J. E., Cook, N. R., Lee, I. M., Christen, W., Bassuk, S. S., Mora, S., … & Friedenberg, G. (2019). Vitamin D supplements and prevention of cancer and cardiovascular disease. New England Journal of Medicine, 380(1), 33-44.
  8. Keum, N., Lee, D. H., Greenwood, D. C., Manson, J. E., & Giovannucci, E. (2019). Vitamin D supplementation and total cancer incidence and mortality: a meta-analysis of randomized controlled trials. Annals of Oncology, 30(5), 733-743.
  9. Goulão, B., Stewart, F., Ford, J. A., MacLennan, G., & Avenell, A. (2018). Cancer and vitamin D supplementation: a systematic review and meta-analysis. The American Journal of Clinical Nutrition, 107(4), 652-663.
  10. Lappe, J., Watson, P., Travers-Gustafson, D., Recker, R., Garland, C., Gorham, E., … & McDonnell, S. L. (2017). Effect of vitamin D and calcium supplementation on cancer incidence in older women: a randomized clinical trial. JAMA, 317(12), 1234-1243.
  11. Willer, A. (2005). Cancer risk reduction by physical exercise. World Review of Nutrition and Dietetics, 94(R), 176.
  12. Nair, R., & Maseeh, A. (2012). Vitamin D: The “sunshine” vitamin. Journal of Pharmacology & Pharmacotherapeutics, 3(2), 118.
  13. Chin, K., Appel, L. J., & Michos, E. D. (2017). Vitamin D, calcium, and cardiovascular disease: a “D” vantageous or “D” etrimental? An era of uncertainty. Current Atherosclerosis Reports, 19(1), 5.
  14. Vanga, S. R., Good, M., Howard, P. A., & Vacek, J. L. (2010). Role of vitamin D in cardiovascular health. The American Journal of Cardiology, 106(6), 798-805.
  15. Khan, S. U., Khan, M. U., Riaz, H., Valavoor, S., Zhao, D., Vaughan, L., … & Murad, M. H. (2019). Effects of nutritional supplements and dietary interventions on cardiovascular outcomes: an umbrella review and evidence map. Annals of Internal Medicine, 171(3), 190-198.
  16. Jackson, R. D., LaCroix, A. Z., Gass, M., Wallace, R. B., Robbins, J., Lewis, C. E., … & Bonds, D. E. (2006). Calcium plus vitamin D supplementation and the risk of fractures. New England Journal of Medicine, 354(7), 669-683.
  17. Moyer, V. A. (2014). Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 160(8), 558-564.
  18. Harvard Health Publishing. Harvard Medical School. Taking too much vitamin D can cloud its benefits and create health risks. health.harvard.edu. https://www.health.harvard.edu/staying-healthy/taking-too-much-vitamin-d-can-cloud-its-benefits-and-create-health-risks. Published November 2017. Updated December 2019. 

 

Is Vaping Safer than Smoking Cigarettes?

Laura Gottschalk, PhD, John-Anthony Fraga, Jared Hirschfield, Diana Zuckerman, PhD, National Center for Health Research


Electronic cigarettes, or e-cigarettes, are being marketed as the “safe” new alternative to conventional cigarettes. By February 2020, reports of 68 deaths and more than 2,800 vaping-related hospitalizations due to lung illnesses have made it clear that vaping can be even more dangerous than smoking.23, 24 Many of the patients report vaping marijuana products or marijuana and nicotine products, but others only vaped nicotine products. Based on what they know so far, doctors believe that the cause is chemical, not bacterial. But until these reports of hospitalized teens and adults are scrutinized in greater depth, we won’t know what types of vaping are most dangerous and under what circumstances.

E-cigarettes come in a variety of forms and include vape mods, Juuls, and vape pens. There are brand name products (Juul is the most widely used) and “home-made” versions.  Some contain high levels of nicotine, while others contain marijuana or just contain flavoring.  The focus of this article is on e-cigarettes because most of the research that exists has been done on them, but much of the information below is relevant to these other products as well.

The big questions are: Are they safe?  Will they 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.

What are E-cigarettes?

E-cigarettes are battery-operated devices that were initially shaped like cigarettes, but now include vape mods, Juuls, and vape pens. The brand-name products contain nicotine, an addictive drug that stimulates, relaxes, and is naturally found in tobacco. It is the nicotine in cigarettes that makes smoking so addictive, and the same is true for most vaping and juuling. These electronic products allow nicotine to be inhaled, and 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

Is Vaping Safer than Smoking Traditional Cigarettes?

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

While smoking can cause lung cancer, breast cancer, emphysema, heart disease, and other serious diseases, those diseases usually develop after decades of smoking.  In contrast, in 2019 it became clear that vaping could cause seizures and serious lung damage after just a year, possibly less, based on CDC reports of almost 200 patients hospitalized for lung damage apparently caused by vaping.2,3   While there have been warnings about the possible risk of e-cigarettes for a decade, it was not expected that they could cause such severe damage in such a short period of time.

Since 2009, FDA has pointed out that e-cigarettes contain “detectable levels of known carcinogens and toxic chemicals to which users could be exposed.” 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.4 Another study looked at 42 of these liquid cartridges and determined that they contained formaldehyde,  a chemical known to cause cancer in humans.5 Formaldehyde was found in several of the cartridges at levels much higher than the maximum EPA recommends for humans. In 2017, a study published in the Public Library of Science Journal showed that significant levels of benzene, a well-known carcinogen, were found in the vapor produced by several popular brands of e-cigarettes. 6

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.7 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.

In fact, a preliminary study presented at the 2018 annual meeting of the American Chemical Society found that vaping could damage DNA.8 The study examined the saliva of 5 adults before and after a 15-minute vaping session. The saliva had an increase in potentially dangerous chemicals, such as formaldehyde and acrolein. Acrolein has been proven to be associated with DNA damage, for example, and DNA damage can eventually cause cancer. 9

A study of mice funded by the National Institutes of Health found that e-cigarette smoke could cause mutations in DNA that could increase the risk of cancer. These specific mutations have been shown to potentially contribute to the development of lung and bladder cancer in mice exposed to electronic cigarette smoke. The researchers claim that these chemicals could also induce mutations leading to cancer in humans.  It has not been reported how many of those harmed had used juul devices. While many of those harmed had vaped marijuana, many also used nicotine e-cigarettes,10 so the risks of “juuling” need to be carefully and immediately studied.

Because they are smokeless, many incorrectly assume that e-cigarettes are safer for non-smokers and the environment than traditional cigarettes. However, a study published in the International Journal of Hygiene and Environmental Health found that the use of e-cigarettes results in increased concentrations of volatile organic compounds (VOCs) and airborne particles, both of which are potentially harmful when inhaled.11 Although e-cigarette vapor may not result in the obvious smell and visible smoke of traditional cigarettes, it still has a negative impact on air quality, especially when vaping indoors.

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.

There is also danger from e-cigarettes exploding in the user’s mouth or face.  Last year, the British Medical Journal used data from several agencies to estimate that there were roughly 2,035 e-cigarette explosion and burn injuries in the U.S. just in a three-year period from 2015 to 2017.  One of the authors of the study stated that the number was likely higher as such incidents were not well tracked.  The report also said that e-cigarettes, commonly powered by a lithium-ion battery, could overheat to the point of catching fire or exploding, a phenomenon known as “thermal runway”.12

Can Vaping Help 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.13 Other year-long studies, conducted in the U.S., had similar findings.  A study published in a prestigious medical journal in 2014 found that although smokers may believe they are vaping e-cigarettes to help them quit,  6-12 months after being first interviewed, nearly all of them are still smoking regular cigarettes.14 Similarly, a year-long study published in 2018 compared smokers who used e-cigarettes to traditional cigarette smokers, and concluded that e-cigarette users were more likely to say they were trying to quit but no more likely to successfully kick the smoking habit, with 90% of e-cigarette users still smoking regular cigarettes at the end of the study.  Until there are results from well-conducted studies, the FDA has not approved e-cigarettes for use in quitting smoking.15

Teenagers, Children, and Vaping

The percentage of teenagers who have tried e-cigarettes has more than quadrupled in recent years, with 25% of seniors and 20% of sophomores vaping in just the last month.26 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.16

E-cigarette and juul 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 18.17
  2. Nicotine and other chemicals found in e-cigarettes, juuls, etc.  might harm brain development in younger people.18
  3. Vaping 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 vaping or juuling is 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 vaping among youth 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 and related products. The liquid 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!19

For more information about juuls, check out our article here.

How are these products 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.20

E-Cigarette Ad

It wasn’t until 2016 that the FDA finalized a rule to regulate e-cigarettes, which would ban the sale of e-cigarettes to anyone under the age of 18 and would require all e-cigarettes that hit shelves after February 15, 2007 to go through a “premarket review,” the process that the FDA uses to determine whether potentially risky products are safe.21 Companies were to be given from 18 months to two years to comply with this rule and prepare their applications. However, in 2017, the Trump administration appointed a new FDA Commissioner, Dr. Scott Gottlieb, who defended the safety of e-cigarettes and delayed implementing the rules until 2022.8 Nevertheless, as the epidemic of e-cigarette use among youth became obvious, in 2018, Commissioner Gottlieb threatened to crack down on the advertising of e-cigarettes to children under 18.22 Critics have questioned whether sales and ads can be effectively restricted. Moreover, Commissioner Gottlieb resigned in 2019, and it is unclear how the agency will respond to the growing evidence that vaping can cause serious harm.

In the meantime, individual states have always had the power to pass laws restricting the sale and use of e-cigarettes. Current laws pertaining to e-cigarettes are available on the Public Health Law Center website: https://www.publichealthlawcenter.org/resources/us-e-cigarette-regulations-50-state-review

The Bottom Line

E-cigarettes, juuls, and other similar products have not been around long enough to determine the harm they cause 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. 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. There is evidence that some of these toxic chemicals can cause DNA damage that can cause cancer. More important, the reports of teens and adults who died or were hospitalized due to vaping are proof that vaping can be extremely dangerous even after just a few weeks, months, or years.

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.

Although there are clearly serious dangers from vaping, more research is needed to confirm the impact of vaping on DNA damage, especially in children. Meanwhile, claims that e-cigarettes are an effective strategy to quit smoking are not supported by the evidence thus far. In addition, more toxicological studies and epidemiological studies are needed to understand the hundreds of reports of permanent lung damage and deaths from vaping.  It is essential to find out whether some types of vaping are more dangerous than others in the short-term and the long-term.  To understand the risks for everyone who vapes, research is needed to compare the risks of specific brands of e-cigarettes with tobacco products, as well as to neither smoking nor vaping.

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

The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.

  1. O’Connor RJ. Non-cigarette tobacco products: What have we learned and where are we headed? Tobacco Control. 2012;21(2): 181–190. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716250/
  2. Hauck G.  CDC reports 153 possible cases of vaping-related illnesses, many involving THC. USA TODAY. August 22, 2019. https://news.yahoo.com/cdc-reports-153-possible-cases-180325194.html
  3. Sum LH. He went from hiking enthusiast to ‘on death’s door’ within days. Doctors blamed vaping. Washington Post. August 24, 2019. https://www.washingtonpost.com/health/one-mans-near-death-experience-with-vaping-related-lung-failure/2019/08/24/ca8ce42c-c5b4-11e9-9986-1fb3e4397be4_story.html 
  4. Food and Drug Administration. Summary of Results: Laboratory analysis of electronic cigarettes conducted By FDA. FDA News & Events. July 22 2009.
  5. Varlet V,  Farsalinos K, Augsburger M, et al. Toxicity of refill liquids for electronic cigarettes. International Journal for Environmental Research and Public Health. 2015;12:4796-4815. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454939/
  6. Pankow JF, Kim K, McWhirter KJ, et al. Benzene formation in electronic cigarettes. PLOS ONE. 2017;12(3),e0173055. https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28273096/
  7. Centers for Disease Control and Prevention. Overviews of Diseases/Conditions. February 2019.  https://www.cdc.gov/tobacco/campaign/tips/diseases/index.html
  8. McGinley, L. FDA sued for delaying e-cigarette, cigar regulations. Washington Post. March 27 2018.  https://www.washingtonpost.com/news/to-your-health/wp/2018/03/27/fda-sued-for-delaying-e-cigarette-cigar-regulations/?utm_term=.f92695720619.
  9. Lee HW, Park SH, Weng MW, et al. E-cigarette smoke damages DNA and reduces repair activity in mouse lung, heart, and bladder as well as in human lung and bladder cells. Proceedings of the National Academy of Sciences of the United States of America. 2018;115(7), E1569. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816191/
  10. Kaisar MA, Prasad S, Liles T, et al. A decade of e-cigarettes: Limited research & unresolved safety concerns. Toxicology. 2016;365: 67–75. http://doi.org/10.1016/j.tox.2016.07.020
  11. Robert Langreth. More Evidence Links Vaping Lung Injuries to Vitamin E Acetate. December 20, 2019.
    https://www.bloomberg.com/news/articles/2019-12-20/more-evidence-links-vaping-lung-injuries-to-vitamin-e-acetate  
  12. Kaplan S. E-Cigarette exploded in a teenager’s mouth, damaging his jaw.  The New York Times. June 19 2019.  https://www.nytimes.com/2019/06/19/health/ecigarettes-explosion.html
  13. Adkison SE, O’Connor RJ, Bansal-Travers M, et al. Electronic nicotine delivery systems: International tobacco control four-country survey. American Journal of Preventive Medicine. 2013;44(3):207-215. https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23415116/
  14. Grana RA, Popova L, Ling PM. A longitudinal analysis of electronic cigarette use and smoking cessation. JAMA Internal Medicine. 2014;174(5):812–813. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122246/
  15. Food and Drug Administration. Electronic Cigarettes. FDA News & Events. 25 July 2013.
  16. 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. 2016. 65(14);361-367. https://dx.doi.org/10.15585/mmwr.mm6514a1
  17. Centers for Disease Control and Prevention. Fact sheets: Youth and tobacco use. Updated 2019. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/
  18. Centers for Disease Control and Prevention. Preventing tobacco use among youth and young adults. 2012. http://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm
  19. Kamboj A, Spiller HA, Casavant MJ, et al. Pediatric exposure to e-cigarettes, nicotine, and tobacco products in the United States. Pediatrics. 2016;137(6). pii: e20160041. https://pediatrics.aappublications.org/content/137/6/e20160041.long
  20. Food and Drug Administration. Regulation of E-Cigarettes and Other Tobacco Products. FDA News & Events. April 25, 2011.
  21. Food and Drug Administration. 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;81(90):28973-29106. https://www.govinfo.gov/content/pkg/FR-2016-05-10/pdf/2016-10685.pdf 
  22. Saltzman J, Freyer F. The FDA issues a warning: Teen vaping is ‘an epidemic.’ Boston Globe. September 13 2018. https://www.bostonglobe.com/metro/2018/09/12/fda-cracks-down-vaping-orders-makers-address-sales-minors/JaiqQYzZAl4CINLufnkKlL/story.html.
  23. Knowles H, Sun LH. What we know about the mysterious vaping-linked illness and deaths. Washington Post. January 10, 2020. https://www.washingtonpost.com/health/2019/09/07/what-we-know-about-mysterious-vaping-linked-illnesses-deaths/  
  24. Centers for Disease Control and Prevention. Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Updated 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
  25. Vaping Could Up Risks for Asthma, COPD and Other Lung Diseases. Dec 16, 2019. (HealthDay) Newshttps://consumer.healthday.com/cancer-information-5/electronic-cigarettes-970/vaping-could-up-risks-for-asthma-copd-and-other-lung-diseases-753003.html 
  26. NIDA Press Office. Researchers sound alarm on potential health effects of vaping. September 18, 2019. https://www.drugabuse.gov/news-events/news-releases/2019/09/teen-e-cigarette-use-doubles-2017

Can Belly Fat Cause Cancer?

Ammu Dinesh and Claire Viscione, National Center for Health Research


Belly fat is common among men and women. However, when a person’s body shape looks more like an apple than a pear, that could increase their likelihood of developing cancer. 

More than two-thirds of adult Americans are overweight or obese.1 Most people know that obesity increases the risk of diabetes, heart disease, and high blood pressure. But did you know that being overweight increases your chances of developing cancer, and that having an “apple” body shape due to belly fat can increase your chances of developing cancer even if you are not overweight?

Why is belly fat dangerous?

Whether your body fat is located at your waist (giving you an apple shape) or hips (giving you a pear shape) makes a difference to your health. Women tend to gain more belly fat as they get older. Regardless of their weight, white, black, and Latina women with a waistline measurement of 35 inches or more have higher health risks. This is also true for Asian women with a waistline of 31 inches or more. Although it is important to get rid of excess fat in general, belly fat is the most threatening to your health.

Physicians use often use body mass index (BMI) to estimate whether you are overweight or obese. However, determining your waist circumference is just as important. Even if you are not overweight or obese, if you have a lot of belly fat, you are more likely to develop cancer.

Unlike the fat that sits just beneath the skin, the fat that sits around internal organs is called visceral fat.2 This fat is the most dangerous, and it is typically what shows up as belly fat. If you measure your waistline, you can get a good idea of whether you have a dangerous amount of belly fat. 

Women Men
Low health risk 31.5 inches or less 37 inches or less
Intermediate health risk 31.6 – 34.9 inches 37.1 – 39.9 inches
High health risk 35 inches or more 40 inches or more

Table 1. What does your waistline measurement mean? 2

Several studies have looked at the relationship between belly fat and cancer. One study followed over 150,000 post-menopausal women ages 50-79 for about 20 years.3 This study found that women who have extra belly fat are at higher risk of death regardless of their weight. Causes of death in the study included cardiovascular disease and cancer. The women of normal weight who had extra belly fat tended to be older, nonwhite, and with less education and income. They were also less likely to use menopausal hormones and to exercise. 

To figure out your BMI for the chart below, enter your height and weight into this calculator.

Apple Shape (Extra Belly Fat) Not “Apple Shape”
Not Overweight (BMI below 25) 20% more likely to die from cancer within 20 years
Overweight (BMI of 25-29.9) 19% more likely to die from cancer within 20 years 4% less likely to die from cancer within 20 years
Obese (BMI of 30 or higher) 26% more likely to die from cancer within 20 years 4% less likely to die from cancer within 20 years

Table 2. Likelihood of death due to cancer in women based on BMI.3

Women who were not overweight or obese but had extra belly fat were just as likely to die from cancer as overweight women with extra belly fat.

A different study followed over 3,000 men and women for 7 years.4 They used CT scans and physical exams to look at the fat throughout the body. Over the course of the study, the men and women developed 141 cases of cancer, 90 heart-related incidents, and 71 deaths from various causes. The study found that people with more belly fat, specifically visceral fat, were about 44% more likely to develop cancer and heart disease, even when adjusting for waist circumference. 

What can you do?

As you can see, belly fat can be very dangerous, especially for women, even if they are not overweight. Losing weight or preventing weight gain can lower health risks. By exercising regularly, you can get rid of unhealthy belly fat. It is also important to change your diet to eat foods that are high in nutrients and essential vitamins. You can do this by eating more fresh vegetables, nuts, and whole-grain breads instead of processed meat, red meat, candy, pasta, and white bread. These few changes can help you lose belly fat and improve the quality and length of your life.

Local bans on unhealthy food and drinks may also be effective in reducing belly fat. A recent study shows that a ban on the sale of sugar-sweetened beverages at a large college campus substantially decreased consumption and led to significantly less belly fat.5 Students who stopped drinking the beverages had improved insulin resistance and lower cholesterol. The combination of the ban and a brief motivational talk was even more effective than the ban by itself.

Learn more about how extra body fat can increase your risk for developing cancer, and how you can make a commitment to your health and reduce risky belly fat:

 

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

 

References:

  1. Center for Disease Control and Prevention. FastStats- Overweight Prevalence. CDC.gov. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm. Updated June 13, 2016.
  2. Harvard Health Publishing. Abdominal obesity and your health. Health.Harvard.edu. https://www.health.harvard.edu/staying-healthy/abdominal-obesity-and-your-health. September 2005. Updated January 20, 2017.
  3. Sun Y, Liu B, Snetselaar LG, Wallace RB, Caan BJ, Rohan TE, et al. Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women. JAMA Network Open. 2019;2(7):e197337. https://www.ncbi.nlm.nih.gov/pubmed/31339542.
  4. Britton KA, Massaro JM, Murabito JM, Kreger BE, Hoffmann U, Fox CS. Body Fat Distribution, Incident Cardiovascular Disease, Cancer, and All-Cause Mortality. Journal of the American College of Cardiology. 2013; 62(10): 921-925. http://www.onlinejacc.org/content/62/10/921.
  5. Epel ES, Hartman A, Jacobs LM, Leung C, Cohn MA, Jensen L, et al. Association of a Workplace Sales Ban on Sugar-Sweetened Beverages With Employee Consumption of Sugar-Sweetened Beverages and Health. JAMA Network Open. 2019. doi:https://doi.org/10.1001/jamainternmed.2019.4434

Does Infrared Light Therapy Work for Weight Reduction?

Danielle Pavliv, Sandy Wang and Varuna Srinivasan, National Center for Health Research


Wouldn’t it be great if we could each shed a couple of inches off our waist without having to diet or exercise?  For years, millions of Americans have tried pills, injections, “natural” herbs, and even berries that are supposed to help us shed pounds.  Unfortunately, these usually don’t work.

The latest magical way to lose weight is infrared light, also known as “red light therapy” or “low light therapy”

Infrared therapy is also suggested for pain management, jaundice, eczema, wrinkles, scars, improved blood circulation, and to help wound and burns heal faster. That doesn’t mean it actually works for any of those things. But in this article, we’re focusing on whether it works to help you look thinner. 1

Light therapy uses near infrared light, usually from lasers, lamps, or tanning bed-like devices. The patient is told to either lie down or sit in front of the light for a specific amount of time on a regular basis (usually once a day). One popular device is the infrared body wrap, consisting of large silicone bandages or pads that emit infrared light around the legs, torso and arms. In addition, patients are told that red light therapy is supposed to improve the appearance of cellulite and help shape the body.

If it sounds too good to be true, it probably is. There is little scientific evidence supporting the claims that infrared light, whether administered by lamp, laser or while in a body wrap, can help people lose weight or shape their body. Nevertheless, in 2010, the FDA cleared a laser called Zerona, manufactured by Erchonia Medical Inc., which uses red light therapy to remove “unwanted” fat without surgical procedures. This device is not approved by the FDA – it is “cleared for market”, which is a different cleaning service process that does not require that a device be proven safe or effective.  Since 2010, several devices using the same technology have been cleared for marketing in the U.S. for body contouring and fat reduction. 2

Light therapy has been tested in clinical trials of patients, but these studies were not as scientific as they would need to be to prove safety or effectiveness. Most studies have few patients who have very similar demographics. Since the patients and clinicians know that the patient is being treated, and in most studies the patients getting treatment weren’t compared to patients getting a different treatment, this could result in a type of “placebo effect.” The placebo effect is when patients believe in a treatment and for that reason it seems to help even if the treatment isn’t actually effective. Also, the companies that make the light therapy devices provided funding to conduct the studies, which can result in overly optimistic results.

Despite all these substantial shortcomings, the studies showed only a small benefit from the light therapy.  So, even if the treatment has some benefit, which is doubtful, the benefit may not be substantial enough to be worth the time and money for the treatment.

In addition, all of the studies were short – none were more than 4 months long, and none followed up with the patients for more than a few weeks after treatment. So, we cannot know how long even small changes might last or what might happen if patients continued the treatment for years.

And what about the risks? Almost all of the studies did not provide any information about potential side effects of the therapy. However, one study done in Poland looked at the effects of LLLT used in close contact with the skin.  They found that patients developed skin ulcers as a result of certain types of lasers. 3

What exactly do the studies show?

A study funded by Erchonia (the company that makes Zerona) included 54 overweight or obese patients.4 Most of the patients were Caucasian men which is odd, since most weight loss patients are women. The patients were treated weekly for 6 weeks. The study found a significant reduction in the combined circumference of hips, waist, thighs, and upper abdomen by 13 cm (about 5 inches) after 6 weeks. Two weeks after the final treatment, patients lost another 2 cm (about 0.8 inches). However, patients knew that they were getting this treatment and may have changed their diet or exercise in an effort to succeed. These patients were not compared to a control group, so we can’t tell how much patients would have changed without the treatment. Also, patients were only studied for two weeks after their last treatment, so we do know how long this reduction lasted.

Whether or not infrared therapy is effective on its own, some scientists are studying whether it can potentially boost the benefits of exercise. To do this, they study obese patients all of whom are in an exercise program. Half the patients also get light therapy and the other half don’t. Results in these studies show us that it is possible that infrared therapy boosts the effect of exercise on weight loss. However, the studies were not well designed so it is impossible to know.

 A study in Brazil tested whether LLLT and aerobic exercise could reduce the chances of obese women developing heart disease.5 It was a well-designed study: 62 women were given an exercise regimen and randomly assigned to either be exposed to LLLT or a placebo for 4 months. LLLT increased the effectiveness of aerobic exercise to improve the women’s heart health. The scientists reported that LLLT reduced the abdominal fat and the women’s total body fat as measured by waist circumference and other measures. However, the study did not follow the women after their 4 months of treatment, so we don’t know how long the effect lasted.

Another device using Water Filtered Infrared Radiation (known as wIRA) is currently being studied to see if it helps patients lose weight.6 In this study, all 40 patients engaged in aerobic exercise 3 times a week for 4 weeks, with some patients also treated with wIRA while exercising. Although they were able to show a statistical difference in weight loss between the two groups (p<0.001), there were so few people in the study to be certain, and not enough information about any benefits lasting more than 4 weeks.

The uses of wIRA are currently being studied for a variety of medical conditions.7,8 However, there are currently not enough studies to conclude how effective it is for weight loss.

Bottom Line

Light therapy may possibly reduce fat in the short term, but studies are small and only follow patients for a few weeks or months. We don’t know if any likely benefit is large enough to be meaningful or how long it might last.  So, if you want to lose weight, sustain weight loss, and get fit, we suggest exercise and dieting in a healthy manner. These tried and tested methods are also shown to decrease the overall risk for heart disease and some cancers in the long term.

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

References:

  1. LED light therapy accelerated healing pain reduction red near infrared. (2015). Retrieved fromhttps://www.elixa.com/light/healing.htm
  2. Accessdata.fda.gov. (2018). 510(k) Premarket Notification. [online] Available at:https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm
  3. Jankowski M, Gawrych M, Adamska U, Ciescinski J, Serafin Z, Czajkowski R. Low-level laser therapy (LLLT) does not reduce subcutaneous adipose tissue by local adipocyte injury but rather by modulation of systemic lipid metabolism. Lasers in Medical Science. 2017;32(2):475-479. doi:10.1007/s10103-016-2021-9.
  4. Thornfeldt CR, Thaxton PM, Hornfeldt CS. A Six-week Low-level Laser Therapy Protocol is Effective for Reducing Waist, Hip, Thigh, and Upper Abdomen Circumference. The Journal of Clinical and Aesthetic Dermatology. 2016;9(6):31-35.
  5. Duarte FO, Sene-Fiorese M, de Aquino Junior AE et al (2015) Can low-level laser therapy (LLLT) associated with an aerobic plus resistance training change the cardiometabolic risk in obese women? A placebo-controlled clinical trial. J Photochem Photobiol B 153:103–110. https://doi.org/10.1016/j.jphotobiol.2015.08.026
  6. Möckel F, Hoffmann G, Obermüller R, Drobnik W, Schmitz G. Influence of water-filtered infrared-A (wIRA) on reduction of local fat and body weight by physical exercise. GMS German Medical Science. 2006;4:Doc05.
  7. Hoffmann G. Principles and working mechanisms of water-filtered infrared-A (wIRA) in relation to wound healing. GMS Krankenhaushygiene Interdisziplinar. 2007;2(2):Doc54.
  8. Al-Ahmad A, Bucher M, Anderson AC, et al. Antimicrobial Photoinactivation Using Visible Light Plus Water-Filtered Infrared-A (VIS + wIRA) Alters In Situ Oral Biofilms. Hamblin M, ed. PLoS ONE. 2015;10(7):e0132107. doi:10.1371/journal.pone.0132107.

The Dangers of Juuling

John-Anthony Fraga, National Center for Health Research


What is Juuling? Is it safer than smoking?

A new type of e-cigarette called “juul” has become so popular that it is now about 68% of the $2 billion e-cigarette market. The “juul” is especially popular among children and young adults due to its sleek and discreet design, its ability to be recharged on a laptop or wall charger within one hour, and its liquid-filled cartridges that come in popular flavors like cool mint, creme brulee, and fruit medley.

As of February, 68 deaths and more than 2,800 cases of serious lung illness related to e-cigarettes have been reported to the CDC. [9] It was not initially known whether those harmed had used juul devices. However, the most recent reports state that all types of e-cigarettes were used by the teens and adults who were harmed by vaping, so the risks of “juuling” need to be carefully and immediately studied. [10]

Juuling has become very common at teenage hangouts and even at school. Medical professionals are very concerned because juul delivers higher concentrations of nicotine than other e-cigarettes. Not only is nicotine highly addictive, but it is also toxic to fetuses and is known to impair brain and lung development if used during adolescence.[1] It is not replacing cigarette smoking but rather encouraging it: A 2017 study found that non-smoking adults were four times more likely to start smoking traditional cigarettes after only 18 months of vaping, which includes “juuling.”[7] For more information about e-cigarettes in general, check out our article here.

How does the Juul Work?

According to Juul Labs, the company that owns and sells the juul e-cigarette, the device uses an internal, regulated heating mechanism that creates an easily inhaled aerosol. This mechanism prevents the batteries in the juul from overheating and exploding, which has been a problem for other brands of e-cigarettes. Juul is easy to use because there are no settings to adjust or control. All that is required is a non-refillable juul pod cartridge that clicks into the top of the juul and contains a nicotine e-liquid formula. This e-liquid is heated and converted into vapors that are inhaled by the user. One of the reasons it is so popular among youth is that it is so easy to use – no prior experience or knowledge required. All they have to do to intake nicotine is to put a juul to their mouth and inhale.

What makes Juuls different from other e-cigarettes?

The increased harm of juuls compared to other e-cigarettes is due to the concentration and contents of its juul pods. The e-liquid is 5% nicotine by volume, which is more than twice the concentration of nicotine in similar devices like the Blu e-cig cartridge (2.4% nicotine). This increases the risk of addiction; in fact, a study done by the UK’s Royal College of Psychiatrists showed that nicotine is about as addictive as cocaine and even more addictive than alcohol and barbiturates (anti-anxiety drugs).[2]

The impact on the developing brain is also of great concern. Brain imaging studies of adolescents who began smoking at a young age had markedly reduced activity in the prefrontal cortex of the brain, an area critical for a person’s cognitive behavior and decision making, leading to increased sensitivity to other drugs and greater impulsivity.[3] The amount of nicotine in one juul pod is equivalent to a pack of cigarettes. Since teens often use multiple pods in one sitting, they can unknowingly become exposed to unsafe levels of nicotine that can have immediate and long-term health consequences. In 2016, the Food and Drug Administration (FDA) was given the authority to regulate e-cigarettes such as juul but has allowed e-cigarette manufacturers to postpone their applications for FDA approval until August 2022. Meanwhile, these harmful devices can remain on the market and continue influencing adolescents to become addicted to nicotine.[8]

Another reason why the juul is a unique threat to teens is its patented formula of nicotine. While other brands use a chemically modified form called “freebase nicotine,” juuls use “nicotine salts” that more closely resemble the natural structure of nicotine found in tobacco leaves. This makes the nicotine more readily absorbed into the bloodstream and makes the vapor less harsh so that it is easier to inhale more nicotine for longer periods of time.

In addition to this patented formula, juul pods contain a greater amount of benzoic acid, 44.8 mg/mL, compared to other e-cigarette brands, which are in the range of 0.2 to 2 mg/mL. According to the Center for Disease Control and Prevention (CDC), benzoic acid is known to cause coughs, sore throat, abdominal pain, nausea, and vomiting if exposure is constant, which is the case when using a juul.[4] This is due to how juuls utilize the properties of benzoic acid to increase the potency of the nicotine salts in its e-liquid.

What makes Juuls popular among children and teens?

Since juuls are small, discreet, and closely resemble a USB drive, they can be easily hidden and used in a wide variety of settings, such as the classroom. Teachers and school administrators across the nation are finding students juuling when their backs are turned: Students can take a hit, blow the small, odorless puff of smoke into their jacket or backpack, and continue their school work in a matter of seconds. Compared to other forms of teenage rebellion, juuling is especially dangerous as middle and high school students are unknowingly becoming addicted to nicotine at an alarming rate.

Because a person must be at least 21 to purchase a juul or juul pod, a juul black market is the source for many teens, through eBay or Craigslist. In response, the FDA contacted eBay to raise concerns about listings of juul products on its website, resulting in the removal of the listings and the creation of measures to prevent new listings from being posted.[5]

In April 2018, FDA Commissioner Scott Gottlieb announced that he was creating a Youth Tobacco Prevention Plan aimed at stopping the dramatic rise in the use of e-cigarette and tobacco products among youth. The FDA specifically asked Juul Labs for documents related to product marketing and research on the health, toxicological, behavioral, or physiological effects of their products in order to understand why youth are so attracted to them.[6] Additionally, Juul Labs is currently facing lawsuits in several states claiming that its products were deceptively marketed to youth under the legal smoking age. The FDA now plans to create enforcement policies for e-cigarette manufacturers, including juul, that are marketing their products to children and teenagers.

The Bottom Line:

The popularity of juuls among adolescents exposes them to large amounts of nicotine that can have adverse health risks for their physical and emotional development. While juuls are called e-cigarettes, they look nothing like them, making it easy for children and teens to secretly use them without a parent, guardian, or teacher noticing. This may be just a temporary trend, but if the FDA does not quickly do more to restrict flavors that appeal to adolescents and to educate the public about the risks, it is likely to create an enormous increase in young people addicted to nicotine.

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

References:

  1. England, L., Bunnell, R., F. Pechacek, T., Tong, V., & A. McAfee, T. (2015). Nicotine and the Developing Human (Vol. 49).
  2. Nutt, D., King, L. A., Saulsbury, W., & Blakemore, C. (2007). Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet, 369(9566), 1047-1053. doi:https://doi.org/10.1016/S0140-6736(07)60464-4
  3. Musso, F., Bettermann, F., Vucurevic, G., Stoeter, P., Konrad, A., & Winterer, G. (2007). Smoking impacts on prefrontal attentional network function in young adult brains. Psychopharmacology, 191(1), 159-169. doi:10.1007/s00213-006-0499-8
  4. Centers for Disease Control and Prevention. Safety Material Data Sheet: Benzoic Acid. Accessed July 30, 2018. Available at: https://www.cdc.gov/niosh/ipcsneng/neng0103.html
  5. “Statement from FDA Commissioner Scott Gottlieb, M.D., on new enforcement actions and a Youth Tobacco Prevention Plan to stop the youth use of, and access to, JUUL and other e-cigarettes. ” FDA News & Event. FDA, April 24, 2018. Accessed: July 30, 2018. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm605432.htm
  6. “Official Request of Information for JUUL Labs.” FDA Rules and Regulations, FDA. April 24, 2018. Accessed: July 30, 2018. https://www.fda.gov/downloads/TobaccoProducts/Labeling/RulesRegulationsGuidance/UCM605490.pdf
  7. Primack, B. A., Shensa, A., Sidani, J. E., Hoffman, B. L., Soneji, S., Sargent, J. D., . . . Fine, M. J. (2018). Initiation of Traditional Cigarette Smoking after Electronic Cigarette Use Among Tobacco-Na&#xef;ve US Young Adults. The American Journal of Medicine, 131(4), 443.e441-443.e449. doi:10.1016/j.amjmed.2017.11.005
  8. “FDA’s Comprehensive Plan for Tobacco and Nicotine Regulation” FDA Newsroom, FDA. August 6, 2018. Accessed: August 8, 2018. https://www.fda.gov/TobaccoProducts/NewsEvents/ucm568425.htm
  9. Centers for Disease Control and Prevention. Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Updated 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
  10. Johnson CK.  What we know so far about the US vaping illness outbreak.  AP: The Washington Post.  September 10, 2019.  washingtonpost.com/national/health-science/what-we-know-so-far-about-the-us-vaping-illness-outbreak/2019/09/10/146e4fbe-d40a-11e9-8924-1db7dac797fb_story.html

Boosting Healthy Bacteria for a Healthy Pancreas

Jessica Cote and Danielle Shapiro, MD, MPH, Cancer Prevention and Treatment Fund

Pancreatic cancer is rare–less than 2% of Americans will develop it in their lifetimes. However, pancreatic cancer is the 4th most common cause of cancer-related deaths in the U.S. claiming more than 43,000 American lives in 2017.1  The good news is that  prevention is possible, since most pancreatic cancers are not cause by inherited genes. Smoking and alcohol use are the major known causes, and can double the lifetime risk to about 3%.2 Quitting smoking and cutting back on alcohol are good ways to prevent pancreatic cancer and so is a healthy mouth and gut. Scientists have recently discovered that the bacteria living in our bodies can help us stay healthy and ward off dangerous cancers.

What is the Microbiome?

Inside our bodies we have hundreds of type of living bacteria and other organisms; this community of microorganisms is called the microbiome. These organisms live in harmony with our body and can keep us from getting sick, so we call them “probiotic” or “good bacteria.” In 2012, Scientists from the National Institutes of Health started the Human Microbiome Project to study the role of the microbiome in human health and disease.

We can increase the amounts of good bacteria in our body by eating foods rich in natural probiotics or taking a probiotic supplement. Probiotic-rich foods include: yogurt, sourdough bread, sour pickles, soft cheeses, sauerkraut, tempeh (fermented soy and grains), and other foods. Check out this list — you’re bound to find something you like!

Oral Bacteria and Pancreatic Cancer

A 2017 review found that gum disease can increase the chances of developing pancreatic cancer in a lifetime to about 2.4% to 3.2%. When scientists studied the blood of patients before they got diagnosed with pancreatic cancer, they began to find patterns of “bad” vs. “good” bacteria.3

Since diagnosing cancer early is the key to effective treatment, scientists hope that it will soon be possible to have a simple screening test for pancreatic cancer by testing the saliva for certain bacteria. They believe that 9 times out of 10, if certain bacteria are present, the person is not likely to have pancreatic cancer.4

Although medical experts aren’t completely certain how to remove bad bacteria from the mouth and gums, they usually recommend flossing and brushing teeth regularly as well as rinsing with mouthwash as the best ways to get rid of them.

Gut Bacteria and Pancreatic Cancer

Like the mouth, certain bacteria in the gastrointestinal (GI) tract may have a role to play in the development of pancreatic cancer. The bacteria Helicobacter pylori, which causes stomach ulcers and stomach cancer, can increase the lifetime risk of pancreatic cancer to about 2.4%. These trends were more frequently seen in people living in Europe and East Asia rather than North America, which suggests that environment, diet (red meat or high temperature foods), and genetics may all help to increase or decrease the chances of developing pancreatic cancer.5

The Bottom Line

More research is needed to understand the link between bacteria and pancreatic cancer, and medical experts have not yet figured out how best to reduce the number of harmful bacteria in our bodies and increase the good kind. Until then, take good care of your mouth (brushing and flossing and regular visits to your dentist) and keep your gut healthy by eating fruits, vegetables, and foods rich in natural probiotics such as yogurt. See gleamcleanspecialists.com memphis article to know more.

Footnotes:

  1. National Cancer Institute. Cancer Stat Facts: Pancreas Cancer. Accessed Dec. 18, 2017. Available online: https://seer.cancer.gov/statfacts/html/pancreas.html.
  2. National Cancer Institute. Pancreatic Cancer Treatment (PDQ®)–Patient Version. (Dec. 23, 2016). Available online: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq#section/_162.
  3. Bracci PM. Oral Health and the Oral Microbiome in Pancreatic Cancer: An Overview of Epidemiological Studies.The Cancer Journal. 2017;23(6): 310–314. doi: 10.1097/PPO.0000000000000287
  4. Ertz-Archambault N, Keim P, Von Hoff D. Microbiome and pancreatic cancer: A comprehensive topic review of literature. World Journal of Gastroenterology. 2017;23(10):1899-1908. doi:10.3748/wjg.v23.i10.1899.
  5. Xiao M, Wang Y, Gao Y. Association between Helicobacter pylori Infection and Pancreatic Cancer Development: A Meta-Analysis. Miao X, ed. PLoS ONE. 2013;8(9):e75559. doi:10.1371/journal.pone.0075559.

Cancer Prevention Campaign

You can reduce your risk of cancer through small changes in your life, including what you eat!

See these links for tips on how to reduce your risk through eating healthy foods and losing weight, and click “Prevention” at the top of this site for all kinds of other ways to prevent cancer.

Tips for Healthier Eating

Ten Tips to Get Your Family Eating Healthy

How Do I Get My Child to Eat Healthier Foods?

MyPlate: A New Alternative to the Food Pyramid

Kids Talk About Healthy Eating

Eating Habits That Improve Health and Lower Body Mass Index


Nutrition, Obesity, Exercise, and Cancer

Weight and Cancer: What You Should Know

What’s a Woman to Eat?

The Cost of Obesity: A Higher Price for Women—and Not Just in Terms of Health

Obesity in America: Are You Part of the Problem?

Breastfeeding: The Finest Food for Your Infant Isn’t Sold in Any Store

Are Processed Meats More Dangerous Than Other Red Meats?  Yes and No!

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Heart Disease and Breast Cancer

Diana Zuckerman PhD, Cancer Prevention and Treatment Fund

In a first-of-its-kind scientific statement, the American Heart Association reminds women that heart disease is the #1 killer of women and that frequently used breast cancer treatments can increase a woman’s chances of developing heart disease.1 These treatments include radiation, hormone therapy, chemotherapy, and targeted therapy.

Facts that will Help you Decide your Treatment Options

Fact:  Heart disease affects almost 50 million U.S. women, and 1 in 3 deaths in women in the U.S. are due to heart disease. Breast cancer affects about 3.3 million U.S. women, and 1 in 32 deaths in women are due to breast cancer. That means that women are about 10 times more likely to die of heart disease than to die of breast cancer.

 Fact: Women with a history of breast cancer are more likely to die from heart disease than women without a history of breast cancer. That is because some health habits cause both heart disease and breast cancer, and because some breast cancer treatments can also increase your chances of dying of heart disease.

Fact: There are many things you can do to decrease your risks of developing both breast cancer and heart disease:  not smoking, eating a healthy diet, losing weight (if you are overweight or obese) and being physically active

Which Breast Cancer Treatments Harm the Heart?

Radiation therapy:

Radiation therapy is often recommended for women who have a lumpectomy, so it is important to know that it can cause inflammation that can damage heart muscles and blood vessels. Studies on animals show that it can also cause clots to form in the coronary arteries. The risks are higher for radiation that is directed at the left side of the chest. The effects are not immediate, but radiation can increase the chances of heart disease at any time between 5-30 years after radiation therapy.

Hormonal therapy:

Tamoxifen is a hormone therapy that is often prescribed for breast cancers that are sensitive to the hormone estrogen. Studies show that tamoxifen lowers bad cholesterol, but there is no evidence this decreased their chances of developing heart disease or dying from it. Perhaps that is because tamoxifen also increases the chances of forming blood clots, which can be dangerous if they are in the lungs, heart, or brain.

Aromatase inhibitors are a type of hormone therapy that is often prescribed for postmenopausal women with breast cancers that are sensitive to the hormone estrogen. Aromatase inhibitors increased the chances of developing heart disease by less than 1%, but the risks may be higher (about 7%) in women who already have heart disease. The U.S. Food and Drug Administration issued a warning about this for one aromatase inhibitor, anastrazole (brand name arimidex).

Chemotherapy:

Doxorubicin, a type of anthracycline-based chemotherapy, can have harmful effects on the heart, which can be permanent and irreversible. Doxorubicin can damage heart cells and cause inflammation that can weaken the heart muscles, which can lead to heart failure. Heart failure means the heart isn’t pumping well, which can cause the body to become swollen and the lungs to fill with fluid.  This can cause you to feel short of breath, tired, or weak.

5-Fluorouracil (5-FU), is a type of antimetabolite chemotherapy used for metastatic breast cancer and other cancers. Some women who take 5-FU develop chest pain caused by a blood clot or tightening in the blood vessels that feed the heart (coronary arteries). In very rare cases, the heart does not get enough blood, which can cause a heart attack.

Targeted Drugs:

Trastuzumab or pertuzumab are targeted drugs that work against breast cancer cells that make the protein HER2. These medications can cause heart failure that is reversible. Because of the risks, women should only take these medications for 1 year.  Women who are over age 50 with diagnosed heart disease, high blood pressure, reduced heart function, or prior use of doxorubicin are most likely to be harmed by this drug.

Prevention

Studies show that there are things you can change to help prevent breast cancer and heart disease.

  1. Stop smoking
  • For heart health – Smoking increases the chances of having a heart attack or stroke.
  • For breast health – Women who start smoking at a younger age, and smoke for many years, are more likely to develop breast cancer. Smoking causes about 4 in 1000 breast cancers. Quitting decreases the chances of developing breast cancer, but it may take about 20 years to see the full benefits.2
  1. Maintain a healthy weight
  • For heart health – Being overweight or obese (a BMI of 25 or above) increases the chances of developing heart disease.
  • For breast health – Every extra 10 pounds over “normal” weight (BMI below 25) increases the chance of developing breast cancer by about 10%.
  1. Be physically active
  • For heart health – Sitting, watching TV, lying in bed, or driving for 10 hours or more a day while you are awake instead of 5 hours or less per day increases the chances of developing heart disease by about 18%. The AHA recommends exercising for 30 minutes or more a day 5 days each week.
  • For breast health – Those same sedentary activities for 12 hours or more a day compared to 5.5 hours or less increase the chance of developing breast cancer by about 80%. To prevent breast cancer, exercise for 30 minutes or more a day 5 days each week.
  1. Eat a healthy diet
  • For heart health – Eating a diet rich in fresh vegetables, Fresh fruit, fish, poultry, and whole grains reduces your chance of dying from heart disease by about 28% compared to eating a typical U.S. diet with many fast foods, red meats/processed meats, and packaged or processed foods.
  • For breast health – The typical U.S. diet is associated with a greater chance of developing breast cancer, but the clearest evidence is for eating at least 15 oz of red meat or processed meat each week compared to less than 9 oz. of red meat or processed meat.

Heart Health for Breast Cancer Patients and Survivors

High blood pressure, diabetes and high cholesterol increase the chances of having a heart attack or dying from one. The AHA recommends controlling blood pressure, blood sugar, and blood cholesterol with diet, exercise, and medications when needed. Exercise is good for the heart and it also fights off cancer. Studies show that exercising 30 minutes a day for 5 days out of the week decrease the chances of breast cancer returning and from dying from breast cancer.

The Bottom Line

Heart disease is a major cause of deaths in women, and remains a number one cause of death in breast cancer survivors. Women who are at a higher risk of heart disease should talk with their doctors about the risks and benefits of commonly used cancer treatments.

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

References:

1Laxmi S. Mehta. et al. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation. 2018, originally published February 1, 2018. https://doi.org/10.1161/CIR.0000000000000556

2Jones ME. et al. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Research. 2017;19:118. https://doi.org/10.1186/s13058-017-0908-4

Alcohol and Cancer

Danielle Shapiro, MD, MPH, Cancer Prevention and Treatment Fund

The link between and alcohol and cancer may surprise you. A 2017 statement by the American Society of Clinical Oncology (ASCO) reports that drinking alcohol increases the risk of cancer of the mouth and throat, vocal cords, esophagus, liver, breast, and colon. The risks are greatest in those with heavy and long-term alcohol use. Even so, moderate drinking can add up over a lifetime, which could be harmful.[1]

What is Moderate Drinking? Heavy Drinking?

According to the National institute of Alcohol Abuse and Alcoholism (NIAAA), “moderate” drinking is 1 drink per day for women and 2 drinks per day for men, but not all “drinks” are equal. A drink is defined as approximately 14g of alcohol, which equals: 1.5 ounces of distilled spirits (e.g., vodka, gin, tequila, etc), 5 ounces of wine, 12 ounces of beer, and 8 ounces of malt liquor.[1,2] (Click here to see the CDC’s fact sheet.)

Heavy drinking is defined as 8 or more drinks per week OR 3 or more drinks per day for women and 15 or more drinks per week OR 4 or more drink per day for men. Most adults who engage in high-risk drinking started as teens.[1] (Click here to see our article on teen drinking.)

Drinking Amount and Cancer Risk

According to the International Agency for Research on Cancer (IARC), a branch of the World Health Organization (WHO), alcohol is a “group 1 carcinogen.” That means it can cause cancer in humans. Group 1 carcinogens include cigarette smoke, UV solar radiation, radon, and asbestos, for example.[3] Alcohol is known to cause six types of cancer, including cancer of the mouth and throat, vocal cords, esophagus (squamous cell), liver, female breast, and colon/rectum. Alcohol may also be tied to cancer of the pancreas, stomach, and lung, but more research is needed to find out for certain.[4] (Click here to see the National Cancer Institute’s Fact Sheet.)

Some of these cancers, such as mouth and throat cancer, are rare (about 1% lifetime risk), while colon cancer and breast cancer are much more common. [7] Depending on the amount a person drinks, he or she can increase the risk for even rare cancers. For example, moderate drinkers can almost double their lifetime risk of mouth and throat cancer to almost 2%, while heavy drinkers have a 500% increased risk of having mouth or throat cancer, from 1% to 5%.

Scientists believe that when alcohol comes into direct contact with tissue through drinking and swallowing, it causes more damage. For example, in the heaviest drinkers, alcohol raises the lifetime risk of esophagus cancer from about 0.5% to about 2.5%.[1,7]

Women need to be more cautious when drinking any amount of alcohol. The World Cancer Research Fund estimates that for every additional average drink per day, breast cancer risk goes up by 5% pre-menopause and up by 9% after menopause. Alcohol affects the amounts of certain sex hormones circulating in the body. For women who have had hormone receptor-positive breast cancer, 7 or more weekly drinks increased the chances of having a new cancer diagnosed in the other breast from about 5% to about 10%.[1]

How Alcohol Causes Cancer

Scientists believe that alcohol causes cancer in several ways:[1, 4]

  • Alcohol (ethanol) is broken down into a toxic substance called acetaldehyde. Acetaldehyde is directly toxic to the body’s cells.
  • Alcohol causes damage to cells through a process called free-radical oxidation.
  • Alcohol causes the body to absorb less folate (an important B vitamin) and other nutrients (antioxidant vitamins A, C, and E), which naturally repair damage and fight off cancers.
  • Alcohol increases the body’s level of estrogen (a sex hormone associated with breast cancer).

Does Quitting Change Your Chances of Developing Cancer or Cancer Recurrence?

Yes, drinking less alcohol on a regular basis reduces cancer risk, even in people who were already diagnosed with cancer. Research has shown that heavy or moderate drinkers who substantially reduce their alcohol consumption will slowly reduce their risk of developing mouth, throat, vocal cord, and esophagus cancer, but it would take 20 years of abstention to reduce the chances of developing those cancers to the lower chances of someone who never drank so frequently.  It is not clear whether reducing or giving up drinking after years of moderate or heavy drinking will have much impact for other alcohol-related cancers.[1]

In those who survived an esophagus cancer, drinkers tripled their risk for a new primary cancer diagnosis. On average, the risk of a new cancer diagnosis after esophagus cancer is removed is 8 % to 27%, and continuing heavy drinking will triple that risk.[5]

Among all cancer survivors, heavy drinking caused an 8% increased risk in dying and a 17% increased risk of cancer recurrence. Patients with cancer who abuse alcohol do worse because alcohol causes poorer nutrition, a suppressed immune system, and a weaker heart.[1]

What You Can Do to Lower Cancer Risk for You and Your Family

  1. . If you drink alcohol, limit drinks to an average of 1 a day for women and 2 a day for men.
  2. Recognize heavy drinking in a loved one, because the more a person drinks, the greater his or her chances of developing cancer. The “CAGE” questionnaire can help spot heavy drinking. Has the person tried to Cut back? Has the person been Annoyed when asked about drinking? Has the person felt bad or Guilty? Has the person needed a drink first thing in the morning (Eye opener)? Each “yes” counts as 1 point. A score of 2 or more suggests problem drinking.[6]
  3. Talk with your doctor about your risk. Doctors can refer or offer counseling and treatment services to patients with risky drinking habits.
  4. Seek help early. Problem drinking can’t be wished away. There are many resources to access information and help. The Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the U.S. Department of Health and Human Services (HHS) has a toll free hot-line and website. Call 1-800-662-HELP (4357) or visit https://findtreatment.samhsa.gov/  today.
  5. Practice healthy habits. Eating a diet rich in cancer-fighting nutrients (i.e., fruits and vegetables), exercising, maintaining a healthy weight, reducing stress, and getting restful sleep can all help to lower cancer risk. Don’t smoke, and quit if you do. Drinking and smoking increases cancer risk more than either one alone.

The Bottom Line

To prevent cancer, try to limit your drinking by sticking to a maximum average of 1 a day if you’re a woman and 2 a day if you’re a man.

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

Footnotes:

  1. LoConte, NK. et al. Alcohol and Cancer: A Statement of the American Society of Clinical Oncology. Journal of Clinical Oncology. published online before print November 7, 2017. DOI: 10.1200/JCO.2017.76.1155. Available online: http://ascopubs.org/doi/full/10.1200/JCO.2017.76.1155
  2. Centers for Disease Control and Prevention. Alcohol and Public Health. Fact Sheets- Moderate Drinking. Accessed November 16, 2017. Available online: https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm