Category Archives: Diet, Habits, & Other Behaviors

Beginner’s Guide to Developing an Exercise Routine

Morgan Wharton and Caitlin Kennedy, Cancer Prevention and Treatment Fund

Exercise is one of NCHR’s seven recommended ways to maximize your health. If you want to exercise but aren’t sure where to begin, we can help! If you feel like your daily life doesn’t allow you to get fit (not enough time, no money for a gym membership, etc.), we have some “work-arounds” that may help.

Benefits of Exercise

Everyone knows that exercise helps keep you healthy by preventing weight gain, but did you know that it also lowers your risk of heart disease, stroke, high blood pressure, unhealthy cholesterol, type 2 diabetes, and depression?[1,2] In addition, a study published in 2020 reported that a physically active lifestyle is even associated with less likelihood of developing cancer, or of dying of cancer.[3] Exercising to improve muscle strength also improves balance, and reduces the risk of falling, fractures, and arthritis. Overall, regular exercise improves your chances of living longer and helps you have a higher quality of life.[1]   

Even people who have been diagnosed with cancer can benefit from exercise. Click here to read more how exercise can help cancer patients.

How Much Should I Exercise?

The Centers for Disease Control and Prevention (CDC) recommend that adults should aim for 150 minutes of moderate-intensity exercise every week (such as walking quickly) or 75 minutes of high-intensity activity per week (such as running), plus two days of strength training (training with weights or resistance bands). If you haven’t been very active, start exercising at a low intensity, then slowly increase the amount and intensity of exercise each week.[4]

A 2017 study found that any amount of physical activity can reduce the chances of dying from cardiovascular disease or cancer. This means that if you regularly exercise, are a “weekend warrior,” or are less active than the CDC recommends, that will still help you live longer than not exercising at all.[5]

How Do I Create an Exercise Routine?

Regardless of your fitness goals, start small to avoid discouragement or burnout: if you set your initial goals too high and aim for perfection, you’ll be more likely to abandon your exercise plans before they improve your health. Follow these exercise routines from the CDC to create a balanced, varied routine.

To prevent injury, always start your workout with a good warm up-short aerobic activity followed by dynamic stretching. Dynamic stretching involves moving different muscle groups through a full range of motion and is the best form of stretching before exercise because it warms up groups of muscles rather than individual muscles. Static stretching, such as holding a muscle in a position of resistance for up to 30 seconds, is helpful for improving flexibility and muscle imbalance over time, but is not beneficial just before exercising.[6] Investing in good running shoes will also help with preventing injuries such as shin splints that can develop after running on hard surfaces with the wrong kind of footwear.

If you don’t feel up to completing a full workout or are too busy on a given day, even taking the stairs instead of an elevator or escalator, walking around while you make phone calls, or walking to work or during your break can make up your exercise for the day. Even if it’s a shorter, less intense workout, it’s always best to get some activity each day, and you might be more likely to continue if you get others involved. Form a walking group and walk to work with people who live near you, or walk together on your daily breaks. If you don’t have a group of people to exercise with at work, consider using social media to benefit from peer pressure. Also upload your progress and fitness goals on sites like Facebook and Twitter.

Keeping track of your fitness goals and exercise can help you form a routine until exercise becomes a habit. If you don’t want to use mobile technology to keep track of your exercising, check out some tools designed by the U.S. Department of Health & Human services for other ways to track your fitness goals and routines.

In addition to running- and movement-based exercise, weight training is very valuable. If you enjoy weight lifting, joining a gym can add a financial incentive to working out: if you’ve already paid for a membership, you’ll have more reason to go and get your workout in! If you need more motivation to get to the gym, check out GymPact – you can get paid just for completing workouts at your gym! If you aren’t sure how to use the machines in the gym, check out these instructional videos for better technique.

Whether or not you go to a gym, there are plenty of ways to get a good workout at home! You can get a great workout with bodyweight exercises alone. Use this guide from the National Institutes of Health to begin resistance training and weight lifting at home. Investing in a jump rope, balance ball, medicine ball, resistance bands, and 5-pound dumbbells can give you more flexibility with your workouts. Variation is important to get the most benefits from exercise and prevent boredom from the same routines. Many apps can be effective exercise tools such as the Nike Training Club app for smartphones which has free workouts, sorted by difficulty, that can be done with basic equipment. The app also tracks your progress and adds new workouts once you reach specific milestones based on the number of minutes you’ve exercised.

Signing up for a race is a great way to motivate you to begin an exercise routine. It gives you a deadline to work towards – the date of the race – and a concrete goal to train for – the length of the race.  A 5k is a great first race to train for because it’s only 3.14 miles.

Avoiding the Risks of Exercise


People who exercise outside and do not drink enough water put themselves at risk for heat stroke and exhaustion. Drink plenty of water beginning the day before you exercise, and drink 10 ounces of water for every 20 minutes of exercise. Drink before you get thirsty, because thirst is the first sign of dehydration.[7] Finally, beware of the dangers of water bottles containing BPA. Be sure to select a stainless steel bottle or a plastic water bottle that is labeled “BPA free.” Read more about the harmful effects of BPA here.


While running and exercising outside, remember to apply sunscreen of SPF 30 or higher that offers full spectrum protection (protection against both UVA and UVB rays) and is water-resistant. Apply at least fifteen minutes before going outside to allow your skin to soak up the sunscreen. Reapply often-every two hours and after swimming and excessive sweating. You should also apply lip balm of at least SPF 30. This will reduce your risk of sunburn, skin cancer, and premature aging of the skin.[8] Read more about running and skin cancer here.


Overtraining can put too much stress on the immune system and keep it from doing its job, which is to keep you from getting sick! People who overtrain put themselves at risk of developing illnesses like colds and the flu because their immune systems are “run down.” You may feel fatigued all the time, or find yourself getting injured.  Some soreness and fatigue is a normal part of training, but if your discomfort becomes excessive, increase your rest/recovery time in between workouts.[9]

Regular endurance exercise may be risky, as well.  Running more than 30 miles per week may lessen or erase the health benefits, including a longer life, which moderate levels of running provide.  People who run a lot of marathons have been found to have higher levels of coronary plaque, a type of heart disease and a cause of heart attacks.[10] Therefore, moderate levels of regular exercise are recommended.

The Bottom Line

The potential benefits far outweigh the potential risks of regular exercise. Grab a friend, use social media, and register for a race to keep your motivation levels high until exercise becomes a part of your daily routine. Regular physical activity can improve your physical health, and also your mood and overall mental well-being. Maybe you’ve heard of a “runner’s high” – well, you don’t have to be a runner to experience the calming effects of exercise.  If you want to experience these health benefits and live a longer, healthier life, now is the time to begin a fitness routine!

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. Centers for Disease Control and Prevention. Benefits of Physical Activity. Updated August 2020. 
  2. World Health Organization. Physical activity. Updated 2018.
  3. Gilchrist SC, Howard VJ, Akinyemiju T, Judd SE, Cushman M, Hooker SP, Diaz KM. Association of Sedentary Behavior With Cancer Mortality in Middle-aged and Older US Adults. JAMA Oncology. 2020;6(8):1210–1217.
  4. Centers for Disease Control and Prevention. How much physical activity do adults need?. Updated May 2020. 
  5. O’Donovan G, Lee IM, Hamer M, Stamatakis E. Association of “weekend warrior” and other leisure time physical activity patterns with risks for all-cause, cardiovascular disease, and cancer mortality. JAMA Internal Medicine. 2017; 177(3):335-42.
  6. Parracino, L. A Simple Guide to Stretching. 2002.
  7. American Council on Exercise. Healthy Hydration. 2012. 
  8. American Academy of Dermatology. SUNSCREEN FAQS.
  9. Kellmann M. Preventing overtraining in athletes in high‐intensity sports and stress/recovery monitoring. Scandinavian Journal of Medicine & Science in Sports. 2010; 20:95-102.
  10. Mohlenkamp S, Lehmann N , Breuckmann F, Brocker-Preuss M, Nassenstein K, Halle M, Budde T, Mann K, Barkhausen J, Heusch G, Jockel K, & Erbel R. Running: The risk of coronary events. Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. European Heart Journal, 2008. 29(15): p. 1903-1910.

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.


  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:
  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 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, Arista Jhanjee, and Kousha Mohseni, MS, Cancer Prevention & Treatment Fund

Everyone 6 months or older who has no restrictive health conditions is encouraged by the Centers for Disease Control and Prevention (CDC) 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 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 for 2019-2020?

As parents are getting their kids ready for flu season, they need to decide whether their children (or they themselves) should get a flu shot or a flu vaccine that comes in the form of a nasal spray. This spray, known as FluMist, sprays a live virus up your nose via mist and is an alternative for those who don’t like the idea of a flu shot. The CDC did not recommend FluMist for the 2016-2017 and 2017-2018 seasons because they rated the spray as ineffective during those years. However, flu vaccines are revised every year, and the CDC expects that FluMist will be effective in 2019-2020 for healthy non-pregnant patients between the ages of 2 to 49.1 Similarly, The American Academy of Pediatrics (AAP) guidelines express no preference for the shot or the nasal spray this season.

How Effective Is the Flu Vaccine in 2019-2020?

The most common flu viruses change every year. Since the new seasonal vaccine requires about 6 months to make, scientists change the flu vaccine every year. Vaccines are made with either three or four viral strains.3 This year, all flu vaccines have four strains.  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, but that can be difficult to predict.4

For this flu season, current evidence shows that the vaccine will reduce your risk of getting the flu by 40 to 60%.5 Although it’s far from perfect, it’s definitely worth getting.

If I Have Cancer or Am a Cancer Survivor, Should I Get the Flu Shot?

Yes, getting a flu shot is recommended for people with cancer and cancer survivors. It is also important for family members and close friends to get the shot as well. People with cancer or a history of cancer can get more severe flu symptoms that can result in hospitalization and serious conditions if they get the flu. In some cases, patients with certain cancers like leukemia, lymphoma, and myeloma as well as patients who have recently been treated with chemotherapy should preemptively take medication to treat the flu if friends and family around them show signs of the virus.6

The most important thing to know is that people with cancer should get the flu shot and not the nasal sprays like FluMist. This is because the shot uses dead or “inactivated” virus while the nasal sprays use live virus. Make sure to ask your physician any questions you have.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.

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 While studies show that the high-dose flu vaccine (Fluzone) might be more protective than the standard flu shot, the CDC is still reviewing data to see how effective Fluzone is in the 2019-2020 flu season.1 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 shock)…
    • 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.


  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, 2019–20 Influenza Season. MMWR Recomm Rep 2019;68(No. RR-3):1–21. Retrieved from Accessed on April 8, 2020.
  2. Will the Affordable Care Act cover my flu shot? U.S. Department of Health and Human Service. Retrieved from  Accessed on September 21, 2018.
  3. American Academy of Pediatrics. Recommendations for Prevention and Control of Influenza in Children, 2019-2020. September 2, 2019. Accessed April 8, 2020.
  4. Selecting Viruses for the Seasonal Influenza Vaccine. (2018). Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Retrieved from Accessed on September 21, 2018.
  5. Frequently Asked Influenza (Flu) Questions: 2019-2020 Season. Centers for Disease Control and Prevention. Retrieved from Accessed on April 8, 2020.
  6. Should People With Cancer Get a Flu Shot? (2020). Retrieved from Accessed on April 8, 2020.
  7. Key Facts About Seasonal Flu Vaccine. Centers for Disease Control and Prevention. (2019). Retrieved from Accessed on April 8, 2020.
  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 Accessed on September 21, 2018.
  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 Accessed on September 21, 2018.
  10. Flu Vaccine and People with Egg Allergies (2019). Centers for Disease Control and Prevention,  National Center for Immunization and Respiratory Diseases. Retrieved from Accessed on April 8, 2020.

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.


  1. “The dangers of thirdhand smoke.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 13 July 2017.
  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
  3. American Chemical Society (ACS). “Major ‘third-hand smoke’ compound causes DNA damage and potentially cancer.” ScienceDaily. ScienceDaily, 16 March 2014.
  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.

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.


  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
  7. National Cancer Institute at the National Institute for Health (NIH). (2012). Breast Cancer Risk in American Women. Retrieved from
  8. National Institute of General Medical Sciences at the National Institute of Health (NIH). Circadian Rhythms Fact Sheet. (2012, November). Retrieved from
  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
  11. org. (2017, January 10). U.S. Breast Cancer Statistics. Retrieved from
  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

The last 50 years of smoking: cigarettes and what we know about them has changed

Anna E. Mazzucco, Ph.D.

The U.S. Surgeon General just released an annual report on the negative health effects of smoking.  But this one marks the 50th anniversary of the very first report on smoking in 1964.  We’ve learned a lot about smoking in 50 years, and unfortunately most of the news is bad.

Many health problems in addition to Lung Cancer

While many people know that smoking comes with serious health risks, such as lung cancer and chronic obstructive pulmonary disease (COPD), the 50th anniversary report warns about less widely known risks. For example, smoking increases the risk of:

  • ectopic pregnancy (this type of pregnancy kills the fetus and the mother can also die or become infertile as a result)
  • birth defects
  • diabetes
  • heart disease
  • stroke
  • rheumatoid arthritis
  • difficulty getting or maintaining an erection (erectile dysfunction or ED).

Smoking also increases your chances of developing cancers. A United Kingdom study involving over 100, 000 women found a significant link between smoking and breast cancer. Over a 7-year period, about 2% of women who ever smoked developed cancer compared to about 1.6% of women who never smoked. This means that smoking causes about 4 in 1000 breast cancers. Even though that number seems small (less than half a percent), it is statistically significant. Starting smoking at a younger age, smoking 15 or more daily cigarettes, and smoking for at least 10 years increase the chances of developing breast cancer. If you smoke, you should talk to your doctor about ways to quit. Quitting decreases the chances of developing breast cancer, but it may take about 20 years to see the full benefits. To read more, click here.

Whether you’re a cancer patient, cancer survivor, or have no known health conditions, smoking puts you at greater risk of dying. Exposure to tobacco smoke while in the womb and smoking in the teenage years have both been shown to cause long-term problems regarding brain development.

 20 Million people have died from smoking since 1964

Although smoking has decreased over the 50 years—from 52% to 25% of adult men, and from 35% to 19% of adult women—the decline has slowed over the last two decades. However, among adults who never completed high school or who have a GED diploma, almost 1 in 2 are smokers.[end Centers for Disease Control and PreventionCurrent Cigarette Smoking Among Adults—United States, 2011. Morbidity and Mortality Weekly Report. 2012; 61(44):889–94 [accessed 2014 Feb 10]  The report estimates that half a million Americans die from smoking every year, and this number has not changed in a decade. Smoking costs the U.S. economy about $100 billion per year, including direct medical costs and the indirect cost of lost productivity from employee sick time due to smoking-related illness.

The Surgeon General cautions that current efforts to reduce smoking are not getting as much support as they need.  While many states have received substantial funds from settlements with tobacco companies which were intended for tobacco control programs, this funding is frequently been spent elsewhere.  In 2013, Alaska was the only state to fund their tobacco control programs at the level recommended by the Centers for Disease Control and Prevention (CDC).

 What more should be done to reduce smoking?

In 2009, the FDA was given much more authority to regulate tobacco products, and in 2010, it made it illegal to sell tobacco products to anyone under 18, banned free samples of cigarettes, and prohibited cigarette brands from sponsoring music and other cultural events. While making public spaces smoke-free and increasing the price of cigarettes and other tobacco products has helped, we need to do more.  Most experts agree that effective tobacco control programs require a combination approach: public health campaigns supplemented by laws that limit where you can smoke, make cigarettes harder to buy, and ensure that programs to help people quit smoking are covered by all health plans.  Under the Affordable Care Act, Medicare, Medicaid and employer-sponsored insurance plans are required to cover medications to help with quitting.  Unfortunately, it is still unclear exactly what will be covered through the state insurance exchanges, even though they are subsidized through the federal government.

Of course, the ideal strategy is to prevent a person from starting to smoke, since tobacco is very addictive.  The Surgeon General’s report says more advertising campaigns targeting young people with anti-smoking messages are needed, since 87% of adult smokers had their first cigarette by age 18.  A study published in 2014 revealed that the nicotine dose from cigarettes increased 15% between 1999 and 2011, making them more addictive without any warning to consumers.[end Land T et al.  Recent Increases in Efficiency in Cigarette Nicotine Delivery: Implications for Tobacco Control.  Nicotine and Tobacco Research. 2014.]  That is only one example of a long history of misleading information from tobacco companies, which is why anti-tobacco ads are so important.  For example, the Surgeon General’s report details how “low-tar” cigarettes, advertised by tobacco companies as safer, were later found to be just as harmful.   In addition, other changes in cigarette design and content have also had unexpected health effects, such as increasing rates of one of the two most common types of smoking-related lung cancer, adenocarcinoma.

Once a person starts to smoke, all doctors and health experts agree: quitting smoking is one of the best things you can do for your health and the health of your loved ones, no matter how long you’ve been smoking.  Studies show that the health benefits of quitting kick in soon after you stop.   Twenty minutes after your last cigarette your high blood pressure will drop; within 3 months your lung function will improve; one year later your risk of heart disease will fall to half of what it was when you were smoking; and five years after your last cigarette your risk of several cancers will drop by half as well.[end S. A. Kenfield, M. J. Stampfer, B. A. Rosner, G. A. Colditz. Smoking and Smoking Cessation in Relation to Mortality in Women. JAMA: The Journal of the American Medical Association, 2008; 299 (17): 2037-2047.],[end Centers for Disease Control and Prevention. 2010 Surgeon General’s Report—How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. 2010.]  For information on how to quit, see this article.  If you are considering taking medication to help with quitting, check out this article.  And if you are thinking of using e-cigarettes to cut back on regular cigarettes, you should know that there are many unanswered questions about the risks of e-cigarettes and almost no research to support their use in smoking cessation. For more on e-cigarettes, read here.  Many e-cigarette brands are owned by tobacco companies which have been caught lying to the American public about the risks of their products repeatedly.


Ways You Can Cut Your Risk of Breast Cancer

Brandel France de Bravo, MPH and Diana Zuckerman, Ph.D., Cancer Prevention and Treatment Fund

Here’s the good news about how to cut your risk.

1. Lose weight

Numerous studies show that overweight and obese women are more likely to develop breast cancer.1 Estrogen, a female hormone, provides nutrition for most breast cancers. The more fat cells you have, the more estrogen you have circulating in your body. Maintaining a healthy weight is like telling breast cancer cells that the restaurant is closed for business! The healthiest way to lose weight and to keep your weight down is to reduce the number of calories you eat and also to exercise. Regular exercise helps to lower body fat, which keeps estrogen levels down. You don’t need to become a Marion Jones or a Natalie Coughlin. You just need to move! Walk at least part of the way to work, take the stairs instead of the elevator and pump iron (or choose the exercise of your choice) while you’re on the phone.

2. Avoid unnecessary hormones

Hormone therapy increases your risk of breast cancer, so avoid it if you can. If you’re taking hormone therapy, use it at the lowest possible dose for the shortest time – or just get off it as soon as possible. Also reduce your exposure to chemicals that act like hormones. Bisphenol A (BPA) is a chemical used in clear, hard plastic and in the linings of canned foods, canned drinks, disposable cutlery and many other common items, including baby bottles. BPA, phthalates (“Thah-lates”) and other chemicals known as “endocrine disruptors” appear to increase the risk of obesity, diabetes, early puberty in girls, and possibly the risk of breast cancer and prostate cancer. Here are some tips to limit your exposure to BPA:

  • Use frozen or fresh vegetables and fruits instead of canned. Get rid of older canned goods, especially if they contain tomatoes and other acidic fruits since the acid accelerates the leaching of BPA from can linings into the food. If you buy tomato or pasta sauce, look for brands sold in glass jars. Eden is one of the few brands of canned foods that doesn’t use BPA in the linings of its cans (except for its tomato products).
  • Look for drinks sold in glass, plastic bottles (soft plastic bottles like the ones typically used for soft drinks and water don’t have BPA), or cartons like those used for milk. Some of the glass bottles have tops lined with BPA but at least the top is not in constant contact with the beverage. If you carry a reusable water bottle, switch to stainless steel or look for the newer BPA-free sports bottles.
  • Switch to glass, porcelain, or stainless steel containers for hot foods and drinks because the heat is more likely to break down the BPA in the plastic and introduce it into your food or beverage.
  • When you microwave, use glass or ceramic, stoneware, or bone china containers. You can use any kind of non-plastic dishes and bowls as long as they don’t have gold or silver trim. If you need to cover the food to keep it from splattering in the microwave, use another dish or paper towel. Don’t microwave food or beverages in plastic or disposable containers (not even the ones they are sold in), and don’t cover dishes with plastic wrap in the microwave oven. Plastics that contain BPA are usually very hard and may have a triangle on the bottom with “7” inside or may say “PC.” Not all plastics with a Number 7 contain BPA, but all plastics break down when exposed to heat-whether in the microwave or the dishwasher-and strong soaps.

Phthalates, another endocrine disrupting chemical, have been linked to genital abnormalities in boys and men, and to early puberty in girls. While there is no proven link to breast cancer yet, anything that affects hormones has the potential to affect breast cancer. Phthalates are used to soften plastics and add fragrance to personal care products like lotions, shampoos, and make-up. When they aren’t used as part of the fragrance, they are sometimes used to mask the natural smell of the chemicals in a product. Phthalates are everywhere-except on a product’s label. Phthalates are almost never listed as an ingredient if their use is related to the way a product does or doesn’t smell. You can minimize your exposure to phthalates by using shampoos, hair spray, deodorants, lotions, perfumes, make-up and nail polish that are phthalate free. If the product doesn’t state “phthalate-free” (and few do), visit the Environmental Working Group’s Cosmetic Safety Database to find out which of your favorite products are safe. If you are not sure if a product has phthalates, choose the version that says “fragrance-free.”

3. Reduce stress

Reduce stress through regular exercise, meditation, or engaging in hobbies or activities that relax and fulfill you. You’ll never be able to eliminate stress from your life but you can learn to manage it better. If for you de-stressing includes watching television or “screen time,” try not to eat while doing it as people tend to eat more when they’re focused on something other than the food in front of them. If you’re going to snack, choose low-fat, nutrition-dense foods like fruits and low-fat yogurt or cheese and unsalted nuts.

4. Eat the right foods

Some foods have been shown to increase your risk of breast cancer and others appear to help prevent breast cancer (or breast cancer recurrence). Eating more than 3-4 portions of red meat like beef, pork and lamb can increase your risk of several cancers, including breast cancer. So, try to eat those meats less often, and smaller portions. Several studies have found that women who eat lots of fresh fruits and vegetables are at lower risk of breast cancer or breast cancerrecurrence.  A study of post-menopausal women who ate a Mediterranean diet (lots of fresh fruits and vegetables, fish, and olive oil) also found a decrease in breast cancer, especially for women who supplemented their Mediterranean diet with more extra virgin olive oil.2   And a study of premenopausal women found that those who ate a lot fruits and vegetables with carotenoids in them had a lower risk of developing breast cancer. Carotenoid-rich foods are leafy greens like kale, spinach and collard greens and foods that are orange, red and sometimes yellow. They include: carrots, mangoes, apricots, squash, sweet potatoes, and tomatoes. And if you don’t like your veggies plain, you can add cayenne pepper or chili pepper for an extra dose of carotenoid!

It’s too soon to say if walnuts can reduce cancer risks, but one study found that they reduced the frequency and size of breast cancer tumors in mice.

5. Breastfeeding protects

If you are planning to have a child or add to your family, strongly consider breast feeding. Not only is breast milk good food for your baby, but the more you breast feed, the lower your risk of various cancers, including breast cancer. This is especially important if you got a late start on having a family, because delayed childbearing increases your breast cancer risk slightly—unless you have one of the BRCA breast cancer gene mutations. If you have BRCA1 or BRCA2, having children late in life or having no children at all does NOT add to your already elevated risk of breast cancer. Breastfeeding may lower the risk of breast cancer for women with BRCA1, but not for women with BRCA2. To read more about BRCA mutations and breast cancer risk, click here.

6. Don’t smoke (or quit, if you do)

A United Kingdom study involving over 100, 000 women found a significant link between smoking and breast cancer. Over a 7-year period, about 2% of women who ever smoked developed cancer compared to about 1.6% of women who never smoked. This means that smoking causes about 4 in 1000 breast cancers. Even though that number seems small (less than half a percent), it is statistically significant. Starting smoking at a younger age, smoking 15 or more daily cigarettes, and smoking for at least 10 years increase the chances of developing breast cancer. If you smoke, you should talk to your doctor about ways to quit. Quitting decreases the chances of developing breast cancer, but it may take about 20 years to see the full benefits. To read more, click here.

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

1 Neuhouser ML, Aragaki AK, Prentice RL, et al. Overweight, Obesity, and Postmenopausal Invasive Breast Cancer Risk: A Secondary Analysis of the Women’s Health Initiative Randomized Clinical Trials. JAMA Oncol. Published online June 11, 2015.

2 Toledo, Estefanía, et al. Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial A Randomized Clinical Trial. JAMA Intern Med. Published online September 14, 2015. doi:10.1001/jamainternmed.2015.4838.

3 Jones ME. et al. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Research. 2017;19:118.

MyPlate: A New Alternative to the Food Pyramid

Caroline Novas, Cancer Prevention and Treatment Fund

A goal of the U.S. government is to help guide adults and children to be as healthy as possible. “MyPlate” replaces the familiar “food pyramid” diagram that underwent several changes in the 19 years since it was first introduced.[1] The MyPlate model shows the five food groups (fruits, vegetables, proteins, grains, and dairy) in a place setting. It is designed to be easier to understand when you think about what types of food to include in each meal that you eat.



How Does MyPlate Work?

The plate is divided into four unequal sections to represent different food groups. Vegetables make up the largest section, followed by grains. Fruits and vegetables fill half the plate while proteins and grains fill the other half.

One of the most noticeable things about MyPlate is that it includes no distinct meat section. Instead, “protein” includes fish, shellfish, eggs, beans, peas, nuts, and seeds in addition to meat. In addition to recognizing the benefits of a plant-based diet, another big change is the elimination of the “oils” or “fats” section included in the food pyramid.

A small blue circle on the side of the plate represents dairy. This simple model is designed to make it easy for consumers to see what an ideal meal should look like, without too many restrictive details.

Critics of MyPlate say it shouldn’t include dairy, which they argue is unnecessary for a healthy diet. Critics also say it is important to give information about the size of the plate.

History: From MyPyramid to MyPlate

For over 100 years, the U.S. Department of Agriculture (USDA) has provided Americans with different types of food guides and pyramids to encourage healthy food choices.  Since 1992, the Food Pyramid has been the dominant model.  The idea behind the original 1992 Food Pyramid was that the foods we should eat most are the ones that form the base of the pyramid, while those we should eat less of are near the top.  However, these guidelines were unclear and difficult to follow.  The Food Pyramid was based on servings, but there was no clear guidance about serving size, and no guidance on the total number of calories recommended per day.

Because of these problems a new pyramid – MyPyramid — was introduced in 2005. Food groups were coded by stripes in widths corresponding to the recommended servings from each group.  All the stripes tapered toward the top of the pyramid to remind people that each food group includes both healthy and unhealthy choices, such as foods with added sugar or “solid” fat. Although an improvement over the old Food Pyramid, MyPyramid was criticized as confusing to many consumers.  The USDA hopes that MyPlate will provide a simple, easy to understand visual method for consumers to eat healthfully.

How Do I Plan Family Meals with MyPlate?

MyPlate is based on the 2015-2020 Dietary Guidelines for Americans, which provides detailed instructions for planning healthy meals and snacks.  These guidelines are fairly long, but there are some simple points to take away:

  • Make half your plate fruits and vegetables. Try to choose whole or cut-up fruits without added sugars, and vary your vegetables; try different types and cooking them different ways (raw, steamed, roasted, sauteed) but try to avoid fried.
  • Switch to 1% or skim milk, cheese, and other dairy options. Avoid full-fat dairy products.
  • Half of your grains should be whole grains. Grains are the largest portion of MyPlate, and half of those should be whole grains. Look on labels for the word “whole”– not multigrain or seven grain. Brown rice and whole wheat pasta also count. Try to stay away from grain-based desserts and snacks, such as baked goods
  • Vary your protein. Try different types, such as seafood, eggs, beans, unsalted nuts, lean meat and poultry.
  • Watch out for sodium, saturated fat, and added sugars. Use nutrition labels to help you choose food and drinks that contain less sodium, fat and added sugar. Bread can have as much salt as salty snacks, for example. Many fruit juices have little fruit and lots of sugar, and sweetened coffee drinks can contain a lot of sugar and fat.  Try to drink water instead of sugary drinks.
  • Get more physical activity. Most Americans don’t get enough physical activity. Daily exercise is important to overall health. Kids, especially, should have limited “screen time,” and be encouraged to play outdoors rather than watching TV or using the computer.

For more guidance, the USDA offers the website. You can use the website’s SuperTracker tool to create a personalized plan just for you. It also has other resources to help you find healthy recipes, calculate your BMI (body mass index), and learn more about how to maintain a healthy diet.

MyPlate information is also available in 20 different languages, including Spanish.

MyPlate can be a helpful basic guideline for kids and adults to know how much to eat from each food group, but it’s important to also follow the additional guidelines above for healthy eating.

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

  1.  Retrieved June 7, 2011, from United States Department of Agriculture.

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 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.


  1. end Centers for Disease Control and Prevention. “Global Cancer Statistics.”  Department of Health and Human Services. 02 Feb. 2015. Accessed: 05/04/2016.
  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:
  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 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. 


  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.
  3. “Summary of Results: Laboratory Analysis of Electronic Cigarettes Conducted By FDA.” FDA News & Events. FDA, 22 July 2009. Web. 09 Aug. 2013.
  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.
  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.
  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.
  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.
  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.
  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).
  15. Vaping Could Up Risks for Asthma, COPD and Other Lung Diseases. Dec 16, 2019. (HealthDay) News