Category Archives: Diet, Habits, & Other Behaviors

Do lemons prevent cancer?

Diet, Habits, & Other Behaviors,
By Caroline Novas
2013

A widely circulating e-mail claiming to be from the Institute of Health Sciences (or the Health Sciences Institute) in Baltimore states that lemons are a “proven remedy against cancers of all types” and that lemons are 10,000 times stronger than chemotherapy.  The e-mail also says that pharmaceutical companies have kept the truth from us because lemons are much less expensive than the less effective synthetic versions that companies can sell for a large profit.

Although there is an “Institute of Health Sciences” in Baltimore that is “dedicated to uncovering and researching most urgent advances in modern underground medicine,” the Institute’s web site has no article about the cancer-fighting properties of lemons. It does, however, contain numerous articles promoting unproven alternative medicines and treatments. Most certainly, is not a credible scientific or medical source.

Regardless of the source, the claims the e-mail makes are NOT correct. Lemons are not a “proven remedy against cancers of all types,” and no studies have ever been done that would compare the effectiveness of a lemon to chemotherapy.

A few studies indicate that lemons and other citrus fruits have naturally occurring substances that may have cancer fighting properties, namely modified citrus pectin and limonoids.  These properties have not been tested in humans.

Modified citrus pectin (MCP)

Modified citrus pectin is a carbohydrate found in the peels of citrus fruits modified to be absorbed into the intestinal tract for easier human consumption. In its natural state, pectin is an indigestible dietary fiber.  Animal studies have found that MCP can inhibit the spread of prostate, breast, and skin cancer to other organs. MCP makes it difficult for cancer cells to break off and spread, although it has no impact on the initial tumor.

However, there is almost no information about whether MCP is effective in humans.  One study that measured prostate cancer in humans treated with MCP after standard treatment failed, showed a slowing in the progression of the disease, as measured by doubling time for prostate specific antigen (PSA). The longer the doubling time for PSA in patients with prostate cancer, the better their prognosis is expected to be. Patients taking MCP for 12 months showed a statistically significant increase in prostate specific antigen doubling time (PSADT), when compared to the 12 month period before they began taking MCP.  Unfortunately, the study used no control group (men that did not take MCP after standard treatment failed) and therefore could not compare the survival rates of men who took MCP after standard treatment failed, with those who did not.

Limonoids

Limonoids are chemicals found in citrus peels that are responsible for lemons’ bitter taste. Research has found that at very high levels, limonoids are capable of slowing cancer cell growth and inducing apoptosis (cell death). However, studies have focused on animals and in vitro human breast cancer cultures (breast cancer cells removed from the human body and studied in a laboratory). As a result, there is little information about limonoids’ effectiveness in preventing or combating cancer in humans.

The bottom line

Although lemons have health benefits, the claims that “lemons are a proven remedy against cancer of all types” and “lemons are 10,000 times stronger than chemotherapy” are certainly false.  Furthermore, while a few studies have looked into the anti-carcinogenic properties of modified citrus pectin and limonoids and found some promising results, not enough research has been done to prove its effects on humans. It’s possible that in the future, after more research, a medicine will be developed to prevent or fight cancer using these ingredients; if so, it will probably be in much higher concentrations than found in nature

MCP and limonoids are not unique to lemons; they are found in all citrus fruits, which have many known health benefits and should be part of any healthy diet.

References:

The Health Sciences Institute. http://hsionline.com/

Glinksy Vladislav and Avraham Raz. (2009). Modified citrus pectin anti-metastatic properties: one bullet, multiple targets. Carbohydrates Research. 28;344(14):1788-91

BW Guess et. al (2003). Modified citrus pectin (MCP) increases the prostate-specific antigen doubling time in men with prostate cancer: phase ll pilot study. Prostate Cancer and Prostatic Diseases. 6, 301-304

Polouse SM, Harries ED, and Patil BS. (2005) Citrus limonoids induce apoptosis in human neuroblastoma cells and have radical scavenging activity.  Journal of Nutrition. 135(4): 870-7

Flaxseed: What is it and Can it Keep you Healthy?

Breast Cancer, Diet, Habits, & Other Behaviors, Other Cancers, Ovarian Cancer
Carla Bozzolo, Cancer Prevention and Treatment Fund

1024px-Brown_Flax_SeedsSuddenly, everyone is talking about adding flaxseed to your diet.  What is flaxseed and how can eating it make you healthier?

What is Flaxseed?

Flaxseed is the seed of the flax plant and can be eaten as whole seeds, ground into a powder (flaxseed meal), or the oil can be taken in liquid or pill form.[1] There is evidence that it is a great way to incorporate dietary fiber, antioxidants, and omega-3 fatty acids into your diet.

Flaxseed has been shown to lower cholesterol in some people and it may even reduce the risk of breast cancer. People take flaxseed to help with many digestive conditions, including chronic constipation, diarrhea, diverticulitis (inflammation of the lining of the large intestine), irritable bowel syndrome (IBS), ulcerative colitis (sores in the lining of the large intestine), gastritis (inflammation of the lining of the stomach), and enteritis (inflammation of the small intestine). According to the National Institutes of Health (NIH), more study is needed to prove that flaxseed benefits people who have these conditions.[2]

What’s in This Miracle Seed?

Omega-3 essential fatty acids

Flaxseed is the richest source of omega-3 fatty acids,3 which is good for our hearts, brains, and normal growth and development.4 Omega-3 fatty acid can also be found in fish, plants, nuts, and oils made from nuts. No matter how you consume flaxseed—whole, ground or the oil—you will increase your intake of omega-3 fatty acids.

Lignans

Lignans are a type of plant estrogen that may help slow down certain cancers—cancers that depend on hormones to grow. Lignans also work as an antioxidant, which means they protect cells from the damage that comes with aging. Antioxidants—found in berries and many other foods—may help fight certain cancers. Lignans are concentrated in the coat of the seed so when flaxseed is expressed into oil, the anti-cancer and antioxidant benefits of the lignans are lost.

Dietary fiber

Dietary fiber helps regulate the digestive system and can lower bad cholesterol. Dietary fiber in flaxseed is only found in whole and ground flaxseeds, not in flax oil.

Flaxseed and Breast Cancer

For women who have gone through menopause, a small daily serving of flaxseed (just over half a teaspoon) was enough to lower breast cancer risk. While more research is needed, some studies suggest that for younger women who have not yet gone through menopause flaxseed reduces the risk of breast cancer and slows down the progress of certain breast cancers and other cancers that need estrogen to grow. A study published in 2013 found that eating flaxseed decreased a woman’s chance of getting breast cancer by 82%.

Flaxseed and Cholesterol

Flaxseed (but not flax oil) seems to decrease bad cholesterol among people who have relatively high cholesterol. Once again, women who already went through menopause seemed to benefit most: their “bad” cholesterol dropped more than the bad cholesterol of men or younger women. This is important for older women, because bad cholesterol tends to increase after menopause, as estrogen levels decline.

Who Benefits the Most?

Flaxseed has the potential to benefit everyone as a great source of dietary fiber with almost no side effects.  People with high levels of bad cholesterol and women who are post-menopausal benefit the most.

Different Ways to Eat It

Flaxseed is sold as whole seeds, ground seeds (flaxseed meal), liquid oil, and oil in a pill form. It can easily be added to cereal, baked goods, salad, yogurt, and many other types of food.  Since whole seeds tend to go through the body undigested, ground seeds are considered to be more beneficial.  Flaxseed oil delivers essential fatty acids but it doesn’t have fiber or lignans. If you want to get all the benefits of flaxseed—omega-3 fatty acids, fiber, anti-oxidant and cancer-fighting properties—choose ground flaxseed.  

Cautions

Few side effects have been reported from flaxseed. When taken to reduce constipation, it should be taken with plenty of water.

The fiber in the flaxseed may also lower the body’s ability to absorb medications that are taken by mouth, so it should not be taken at the same time of day that you take pills or dietary supplements.

The Bottom Line

Flaxseeds are a great source of dietary fiber and omega-3 essential fatty acids for men and women of all ages. They don’t have any known serious side effects, and ground flaxseeds are easy to include in the foods you eat every day.

References:

  1. National Institutes of Health. National Center for Complimentary Medicine. Herbs At A Glance: Flaxseed and Flaxseed Oil. April 2012: http://nccam.nih.gov/health/flaxseed/ataglance.htm
  2. National Institutes of Health. National Library of Medicine. Flaxseed: MedlinePlus Supplements. August 2011. http://www.nlm.nih.gov/medlineplus/druginfo/natural/991.html
  3. National Institutes of Health. National Cancer Institute. Antioxidants and Cancer Prevention: Fact Sheet. July 2004. href=”http://www.cancer.gov/cancertopics/factsheet/prevention/antioxidants”>http://www.cancer.gov/cancertopics/factsheet/prevention/antioxidants  ▲
  4. Brown L, Rosner B, Willett W, and Sacks F. Cholesterol-lowering effects of dietary fiber: a meta-analysis. American Journal of Clinical Nutrition. 1999; 69:30-42.  ▲
  5. Cotterchio M, Boucher BA, Kreiger N, Mills CA, & Thompson LU. Dietary phytoestrogen intake–lignans and isoflavones–and breast cancer risk (Canada). Cancer Causes Control.2008; 19:259–272  ▲
  6. Buck K, Zaineddin AK, Vrieling A, Linseisen J, & Chang-Claude J. Meta-analyses of lignans and enterolignans in relation to breast cancer risk. American Journal of Clinical Nutrition. 2010; 92:141–15  ▲
  7. Velentzis LS, Cantwell MM, Cardwell C, Keshtgar MR, Leathem AJ, & Woodside JV.Lignans and breast cancer risk in pre and post-menopausal women: meta-analyses of observational studies. British Journal of Cancer. 2009; 100:1492–1498  ▲
  8. Lowcock E, Cotterchio M, & Boucher B. Consumption of flaxseed, a rich source of lignans, is associated with reduced breast cancer risk. Cancer Causes Control. 2013. E-publicaton ahead of print. Retrieved from href=”http://www.ncbi.nlm.nih.gov/pubmed/23354422″>http://www.ncbi.nlm.nih.gov/pubmed/23354422.  ▲
  9. Pan A, Yu D, Demark-Wahnefried W, Franco O, and Lin X. Meta-analysis of the effects of flaxseed interventions on blood lipids. American Journal of Clinical Nutrition. 2009; 90:288-297.  ▲
  10. Fukami K, Koike K, Hirota K, Yoshikawa H, and Miyake A. Perimenopausal changes in serum lipids and lipoproteins: a 7-year longitudinal study. Maturitas. 1995; 22:193-197.  ▲

 

Can Taking Fish Oil Supplements Help Lung Cancer Patients Undergoing Chemotherapy?

Diet, Habits, & Other Behaviors, Lung Cancer, Treatment & Management
Katherine Ip, Cancer Prevention and Treatment Fund

Fish oil is a well-known dietary supplement that is likely to reduce the risk of getting heart disease. More research is needed to find out if it may also reduce high blood pressure, menstrual pain, the risk of stroke, and the symptoms of arthritis, bipolar disorder and ADHD.[1]

Some studies have suggested that fish oil and the omega-3 fatty acids it contains might also help improve the effectiveness of chemotherapy for cancer patients, while reducing the bad side effects.  The types of chemotherapy tested include anthracyclines, cisplatin, irinotecan, and alkylating agents. Only two studies were done on humans, and the others were done on animals or cancer cells in test tubes.[2]

Fish Oil Supplements, Lung Cancer, and Chemotherapy

Late-stage non-small cell lung cancer (NSCLC) is usually treated with chemotherapy, but chemotherapy is often ineffective.[3] And, the current treatments have very unpleasant side effects that can severely harm the quality of a patient’s life, so researchers are always looking for ways to minimize damage to the body’s healthy cells while still attacking cancer cells with full force.[4]

In 2011, a very small study by researchers from Canadian Universities looked at whether fish oil could help chemotherapy patients with non-small cell lung cancer (NSCLC) that has spread to the lymph nodes or to other parts of the body (Stage III and Stage IV).[5] Patients with these late stages of lung cancer, on average, only live about 2 years after being diagnosed.

Since the cancer had already spread, all the patients were given the same palliative chemotherapy, aimed at reducing cancer symptoms and improving the patient’s quality of life, rather than curing the patient. Researchers only included lung cancer patients who had never had chemotherapy before. Only 15 of the patients were given fish oil and 31 were not. When they started their chemotherapy, the patients in the group taking fish oil had a choice of taking four capsules a day (each with 1 gram of fish oil), or 7.5 milliliters of actual fish oil, which provides the same amount of omega-3 fatty acids.

How did Fish Oil Affect Survival?

The patients who took fish oil responded much better to chemotherapy than those who didn’t. Their tumors shrank more in size or shrank more quickly, and they were almost twice as likely to be alive a year after treatment compared to the patients who didn’t take fish oil (60% compared to 39%). These results held true regardless of how old the patient was, whether the patient was a man or woman, and how much muscle mass the patient had.  The latter is important because patients with lower muscle mass tend to suffer from more negative side effects from chemotherapy.

Patients who did not take fish oil were more likely to have their cancer get worse after two cycles of chemotherapy than patients who took fish oil. And, more of the patients who took fish oil were able to complete all of their planned chemotherapy, because they experienced less side effects for the same levels of chemotherapy as patients who did not take fish oil. Since the patients who took fish oil felt well enough to receive more cycles of chemotherapy, their tumors also shrank more and they lived longer.

Did Fish Oil Affect Quality of Life?

When chemotherapy kills the body’s healthy cells (think of it like “friendly fire”), it can cause side effects such as nausea, vomiting, and constipation, and it also lowers the body’s ability to fight infection. Since the patients taking fish oil were able to complete more cycles of chemotherapy, we would expect them to have worse side effects. Instead, the side effects listed above were about the same for patients taking fish oil and those that did not. The researchers suspect that the reason why is that fish oil protected the healthy cells from the chemotherapy, but not the cancer cells. Their findings are consistent with a study where mice with lung cancer responded better to treatment when fed fish oil.[6] They are also consistent with a study in which breast cancer patients responded better to chemotherapy when their breast tissue had a higher concentration of DHA, one of two fatty acids found in fish oil.[7]

Is There a Catch?

The study of fish oil and lung cancer included only 31 patients not taking fish oil and 15 patients taking fish oil. Such a small study does not provide adequate evidence, but it does mean more research is warranted.

The Bottom Line:

In this one small study, taking fish oil supplements appears to help late stage lung cancer patients tolerate their chemotherapy better so that they can get the most benefit from it.  And, fish oil is inexpensive and has no known risks. More research is needed to find out if fish oil is usually effective for lung cancer patients and possibly other cancer patients. Since fish oil is very safe, if you or someone you know is about to start chemotherapy, it’s probably a good idea to start taking fish oil supplements right away.

References:

  1. Natural Medicines Comprehensive Database. Omega-3 Supplements: Medline Plus supplements. 2012. Available at: http://www.nlm.nih.gov/medlineplus/druginfo/natural/993.html. Accessed February 4, 2013.
  2. Bougnoux P, Hajjaji N, Ferrasson MN, Giraudeau B, Couet C, Le FO. Improving outcome of chemotherapy of metastatic breast cancer by docosahexaenoic acid: a phase II trial. Br J Cancer. 2009; 101: 1978-1985.
  3. Pujol JL, Barlesi F, Daures JP. Should chemotherapy combinations for advanced non-small cell lung cancer be platinum-based? A meta-analysis of phase III randomized trials. Lung Cancer. 2006; 51: 335-345.
  4. Carney DN. Lung cancer–time to move on from chemotherapy. N Engl J Med. 2002; 346: 126-128.
  5. Murphy RA, Mourtzakis M, Chu QSC, Varacos VE, Reiman T, & Mazurak VC. Supplementation with fish oil increases first-line chemotherapy efficacy in patients with advanced nonsmall cell lung cancer.
  6. Yam D, Peled A, Shinitzky M. Suppression of tumor growth and metastasis by dietary fish oil combined with vitamins E and C and cisplatin. Cancer Chemother Pharmacol. 2001; 47: 34-40.
  7. Bougnoux P, Germain E, Chajes V, et al. Cytotoxic drug efficacy correlates with adipose tissue docosahexaenoic acid level in locally advanced breast carcinoma. Br J Cancer. 1999; 79: 1765-1769.

Airport Security and Radiation

Brain Cancer, Breast Cancer, Diet, Habits, & Other Behaviors, Environmental Exposures, Skin Cancer
Laura Covarrubias, Cancer Prevention and Treatment Fund

Following the September 11th attacks in 2001, the Transportation Security Administration (TSA) was created and given responsibility for protecting the public from security threats in transportation systems, such as airports. Although metal detectors were once the main security devices used at American airports, the TSA introduced new technologies after terror attempts were made using hidden explosives (in shoes and underwear, for example). These backscatter and millimeter scanners have begun replacing metal detectors and are designed to scan a person to determine what weapons or explosives they may have beneath their clothing. Currently, there are about 250 backscatter and 264 millimeter wave scanners in the United States. The TSA hopes to have 1,800 scanners of either type installed by the end of 2014 – which would mean that nearly every airport in the country will have one.

Backscatter scanners look like two large blue boxes. People raise their arms and stand sideways between these two boxes when they are scanned.

In contrast, millimeter wave scanners look like circular glass phone booths, and the person being scanned stands with their arms raised while part of the scanner rotates around them:

If you are not sure which scanner is in use at your airport, ask a TSA official at the security checkpoint.

Privacy

When a millimeter scan is used, the machine determines if the person has any potentially harmful items on his or her body. If so, only the outline of a standard human body is shown with potentially dangerous objects highlighted in yellow. If no dangerous objects are detected, the security officer will only see an empty green screen. The security official does not see an image of the actual individual when the millimeter scan is used.

In contrast, when a backscatter scan is used, a blurred, colorless image of the individual (without clothing) is produced. A security officer views the image and determines if further screening is necessary. In an effort to increase passenger privacy, the TSA updated the software on backscatter machines to make it harder to see details in the images. Still, some people argue that both types of machines violate their privacy.

Radiation

While metal detectors and millimeter scans both use non-ionizing radiation, which until recently was assumed to be safe (see our article Can Cell Phones Harm our Health?), backscatter scans use ionizing radiation, which is used in x-rays and known to potentially increase the risk of cancer. Backscatter scans work a little differently from x-rays. X-rays work by sending high-energy radiation to the body and recording the radiation that passes through the body. Dense parts of the body (like bones) block some of the radiation, resulting in lighter areas on the recorded image.  Backscatter scanners also send radiation toward the body, but at much lower energy than an x-ray. Because it is not as strong as the radiation used in x-rays, the radiation does not pass through the body. Instead, the outer layers of the body “scatter” the radiation, which bounces off the body and back toward the machine. Most of the radiation that is absorbed by the body is deposited in the outer layers (like the skin and ribs), although a 2012 study showed that radiation from these scans may penetrate to other organs.[1] Because the radiation is concentrated in the skin, there are concerns that this could cause skin cancer.

All data on backscatter scans are provided by TSA, a government agency that does not allow independent researchers to examine the machines they use.[2] Researchers must therefore make educated guesses using data provided by the TSA, or they must make models of the scanners based on information that the agency releases.

Scientists differ in their opinions regarding whether small doses of radiation increases the risk of cancer.[3] Some scientists think that very small doses-like those received during backscatter scans-pose zero risk to the individual. Other scientists think that there isn’t enough research on the effects of such low doses of radiation to be able to say how it will affect a person’s cancer risk. However, radiation risk accumulates during a person’s lifetime. This means that even though a single exposure may be very small, it is “added” to every other exposure the person has ever encountered.

The TSA states that backscatter scans use such low doses of radiation that estimating the potential effects of the scan is extremely difficult. [4] 2011 report using information from the TSA found that these backscatter scans expose people to the same amount of radiation that they receive from 3 to 9 minutes of normal daily life or from 1 to 3 minutes of flight. To put this into perspective, we would expect only 6 of the 100 million airline passengers each year to develop a cancer in their entire lives due to the backscatter scans.

Dr. David Brenner, a researcher at Columbia University, produced a different estimate based on the risk that the scanners are to the entire population, not just to an individual. Dr. Brenner multiplied the risk associated with one scan by the number of scans conducted each year to estimate the number of people who may develop cancer in one year because of the scanners. Because up to one billion scans may be performed each year, Brenner estimated that each year 100 people would develop cancer because of their exposure.

In April 2010, a group of scientists from the University of California, San Francisco wrote a letter of concern to Dr. John Holdren, the Assistant to President Obama for Science and Technology, about the backscatter scans. These researchers pointed out that because backscatter scans only penetrate outer layers of the body, it is possible that these layers receive a higher concentration of radiation than previously believed. Because of this, conventional estimates would be inaccurate.[5] This higher concentration of radiation could pose particular risk to certain groups such as:

  • The elderly (due to their susceptibility to skin cancer)
  • Women who have the BRCA gene mutation
  • People with weakened immune systems (such as those with HIV or cancer)
  • Children and adolescents (who have smaller bodies but receive the same amount of radiation as adults with larger bodies)5

The scientists also expressed concern that sperm may mutate because the testicles are close to the surface of the skin and are exposed to radiation during these backscatter scans. In addition, they noted that the effects of radiation on the cornea (the outer surface of the eye) and the thymus (a part of the immune system located in the chest) have not been studied. While this letter only outlined concerns of the scientists and did not present new data, it called for further testing of backscatter scans. The scientists called for more rigorous and independent studies to ensure that the scans are safe for the entire population, as well as for all parts of the body. When Dr. Holdren received the letter, he sent it along to the Food and Drug Administration (FDA). The Food and Drug Administration does not have authority to regulate backscatter scanners because the devices are classified as electronic devices, not medical devices. However, the FDA has experience in regulating radiation-emitting devices used in medicine, such as mammography devices. In a joint reply with the TSA, the FDA stated that the radiation exposures from the backscatter scans were within established legal limits, even for frequent fliers.[6] In reply to the scientists’ concerns that the radiation dose to the skin would be higher, the FDA wrote that their calculations showed that a person would have to pass through the scanner 1000 times in a year in order to begin to absorb the annual limit of what is considered safe.[7]

Not everyone agrees with the FDA, and some people have pointed out that TSA agents operating the scanners may improperly manage the devices or that mechanical errors may occur, either of which could cause the machines to emit more radiation than they are supposed to. From May 2010 to May 2011, there were 3,778 calls for mechanical problems on backscatter machines, but only 2% of those machines were evaluated for radiation safety. Anyone who is concerned about the radiation from the scanners has the legal right to refuse to undergo a scan, as long as they agree to a full-body pat-down by a security officer.

For more information on other types of radiation, see our article Everything You Wanted to Know About Radiation and Cancer, But Were Afraid to Ask.

References:

  1. Schmidt T, Hoppe M. Estimation of organ and effective dose due to Compton backscatter security scans. Medical Physics. 2012;39(3396).
  2. Mehta P, Smith-Bindman R. Airport full-body screening: what is the risk? Archives of internal medicine. 2011;171(12):1112-5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21444831. Accessed March 17, 2012.
  3. Brenner DJ. Are x-ray backscatter scanners safe for airport passenger screening? For most individuals, probably yes, but a billion scans per year raises long-term public health concerns. Radiology. 2011;259(1):6-10. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21436091
  4. Cerra F. Assessment of the Rapiscan Secure 1000 Body Scanner for Conformance with Radiological Safety Standards. 2006. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Assessment+of+the+Rapiscan+Secure+1000+Body+Scanner+for+Conformance+with+Radiological+Safety+Standards#0. Accessed June 18, 2012.
  5. Sedat J, Agard D, Shuman M, Stroud R. Letter to Dr. John P. Holdren. 2010.
  6. Rabin R.C.. X-Ray Scans at Airports Leave Lingering Worries. The New York Times. August 6, 2012. Available at http://well.blogs.nytimes.com/2012/08/06/x-ray-scans-at-airports-leave-lingering-worries/. Accessed August 7, 2012.
  7. McCrohan J, Shelton Waters K. Letter to Dr. John P. Holdren. 2010.

 

Pomegranate Juice and Prostate Health

Diet, Habits, & Other Behaviors, Prostate Cancer, Prostate Cancer
Laura Covarrubias, Cancer Prevention and Treatment Fund

Pomegranate juice contains plenty of antioxidants, but does it improve health, as the ads imply? Pom Wonderful, a large company that makes pomegranate juice and other products from pomegranates, would like you to believe that the juice can prevent or treat a number of health problems, including prostate cancer and erectile dysfunction. However, a close look at the science behind these claims shows that drinking pomegranate juice to treat or prevent prostate cancer and erectile dysfunction might not be worth the cost or the calories.

Prostate cancer is the most common cancer among men, other than skin cancer. (For more on skin cancer, read Tanning Beds: Safe Alternative to Sun? and Running and Skin Cancer Prevention.) Since almost everyone knows someone with prostate cancer, and since treatments can cause erectile dysfunction and incontinence, there is a tremendous desire to find a way to prevent the disease.

Even among men who have not had prostate cancer, erectile dysfunction-the inability to have or maintain an erection (called “ED” in advertisements)-is common. Many men suffering from erectile dysfunction want treatments that are less expensive and more natural than Viagra and other prescription medications.

Drinking pomegranate juice has been touted as an easy solution to decreasing the risk of prostate cancer and improving erectile dysfunction, but does it work? Nearly all of the studies are sponsored by Pom Wonderful, which is selling the products that the studies are evaluating. The company reports having spent at least $35 million on the research; unfortunately, studies sponsored by a product’s manufacturer tend to be biased in favor of the products.[1]

A May 2012 ruling by the Federal Trade Commission (FTC) concluded that Pom Wonderful’s promotional materials about the health benefits of their products are misleading and that their claims that pomegranate juice can treat, prevent, or reduce the risk of certain health conditions (including prostate cancer, erectile dysfunction, and heart disease) were deceptive.[2] Because of federal laws against making misleading disease prevention and treatment claims, the court issued a cease-and-desist order to Pom Wonderful. While the ruling prohibits Pom Wonderful from promoting its juice as a treatment for prostate cancer or erectile dysfunction, it doesn’t prevent the company from making broad claims about pomegranate juice such as that it “promotes prostate health.”

What the Science Says about Prostate Cancer and Pomegranate Juice

Only one study has been published in a peer-reviewed medical journal that looks at the effect of drinking pomegranate juice on prostate cancer. This 2006 study, funded by Pom Wonderful, is often used by the company to back its claims that their juice can help fight prostate cancer.[3] Only 46 men treated with either surgery or radiation for prostate cancer participated. All the men had rising prostate-specific antigen (PSA) levels, which is interpreted as a sign that their prostate cancer had come back, and all were given 8 ounces of Pom Wonderful to drink daily for a period of two years. The study found that the men’s rising PSA levels slowed, which can mean that their cancers were no longer growing as fast. To read more about PSA tests, click here.

In most scientific research, some patients receive a new treatment and the others receive either a placebo (sugar pill) or an older treatment. The Pom study was poorly designed because all the men drank the juice, making it impossible to evaluate the impact of the juice. Since PSA levels vary over time, we can’t know if PSA levels dropped because of the juice or would have dropped even without the juice.  In addition, the study only evaluated 46 men, all of whom had been treated for prostate cancer.  This small number of prostate cancer patients is not large enough to draw conclusions about all men, or even all men who have been treated for prostate cancer.

This 2006 study also looked at samples of cancer cells that were taken from other men with prostate cancer-not the same men who drank the pomegranate juice. These cancer cells were then treated with serum – a component of blood – from the men who drank pomegranate juice to see if the cancer cells stopped growing. The study found that cancer cells died when treated with the serum.  That sounds impressive, but there are many reasons why the serum could have caused the cancer cells to die. The researchers called for a future study with a control group (where cancer cells are treated with nothing), but six years later no study like that has been published.

Studies of pomegranate juice on mice and on human cells were more promising, but also not conclusive. One study funded by the U.S. Public Health Service, a government agency, looked at the effect of pomegranate extract – a very concentrated form of pomegranate juice – on prostate cancer cells that were taken from patients but grown outside of the body.[4] They found that the growth of cancer cells treated with the pomegranate extract was slower in comparison to the cancer cells not treated with the extract. In this same study, scientists also looked at the effects of pomegranate extract on the tumor size of mice with prostate cancer. They saw that the growth rate of the tumors in mice treated with the extract was slower in comparison to the growth rate of tumors in the mice that were not treated.

Another laboratory study found that more prostate cancer cells died in the samples treated with pomegranate juice concentrate provided by Pom Wonderful than in samples treated with different types of pomegranate extract.[5] The researchers believe that the many different chemical compounds in pomegranate juice work together to kill cancer cells, and that the pomegranate extract did not have all of these compounds and so did not have as strong of an effect. However, this study does not tell us if drinking pomegranate juice-rather than applying it to cancer cells-can prevent or treat cancer.  Even if there were research indicating a benefit from drinking the juice, how much juice would men have to drink?

Pom has also funded studies on clogged arteries and diabetes, which required people to drink 8 ounces of pomegranate juice every day (these studies were also inconclusive about the effects of pomegranate juice).[6,7] Even if 8 ounces a day was effective at lowering prostate cancer risk or improving health, this is a solution that not everyone could afford.  The cost of the juice, which would not be covered by health insurance, would be about $780 a month.[8] Drinking 8 ounces of Pom Wonderful adds an additional 160 calories per day, which equals 1,120 calories a week and 4,800 calories a month.  Unless the juice replaces an equally caloric drink, this could increase a person’s weight, which in turn increases the risk of prostate cancer and several other types of cancer (Weight and Cancer: The Latest Research).

What other alternatives are there?  Diets high in fiber and low in meat products and saturated fats have been linked to a lower risk of prostate cancer in men, and these diets also have other positive health effects such as reducing the risk of developing diabetes, heart disease, and stroke.[9,10,11] To learn more about the connections between diet and prostate cancer, read here.

What the Science Says about Erectile Dysfunction and Pomegranate Juice

There is even less evidence behind Pom Wonderful’s claims that drinking pomegranate juice decreases erectile dysfunction than there is about prostate cancer or other illnesses. Two studies used by Pom Wonderful to back these claims were conducted on rabbits – not humans.[12,13]These studies found that antioxidants (not pomegranate juice specifically) may be useful against erectile dysfunction, although no definite conclusions were made even for rabbits, and certainly not for humans.

The only study of humans used by Pom Wonderful divided the 53 participants with erectile dysfunction into two groups.[14] One group was assigned to drink pomegranate juice every day for the first 28 days, while the other group drank a placebo drink. After 28 days, the men answered questions about their erectile function. For the next two weeks, both groups stopped drinking their assigned drink (juice or placebo) – this time is known as a “washout” period. Research studies use washout periods to make sure that any effects of the treatment do not continue to be measured when the person begins drinking the new drink. After the washout period, the groups switched drinks so that the group that drank pomegranate juice drank the placebo for 28 days (and vice versa). Again, the men answered the same questions about their erectile function. Overall, the researchers did not find any statistically significant difference between the two groups.  Although there was a slight decrease in erectile dysfunction among the men drinking the pomegranate juice, the difference was small and could have occurred by chance. The researchers called for a larger and longer study to determine if pomegranate juice really does improve erectile dysfunction. We agree.

More Research Needed

Better research on men is needed to determine if regularly drinking pomegranate juice or taking pomegranate extract pills prevents or helps treat prostate cancer, erectile dysfunction, or other conditions. In the meantime, there is no harm in drinking pomegranate juice as long as it does not contribute to overweight or obesity.  Men who choose to drink pomegranate juice should consider the extra calories and cost.

Bottom Line:

  • There is no strong evidence to support the claim that pomegranate juice protects against prostate cancer or helps with erectile dysfunction.
  • Age increases the likelihood of prostate cancer and erectile dysfunction, and weight gain can also increase the chances of getting prostate cancer or having it return after treatment.[15]
  • If you or a loved one is undergoing treatment for prostate cancer, pomegranate juice is not an effective alternative.

References:

  1. Lexchin J, Bero L, Djulbegovic B. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. Bmj. 2003;326(May). Available at: http://www.bmj.com/content/326/7400/1167.short. Accessed June 6, 2012.
  2. United States of America Federal Trade Commission. Initial Decision. 2012. Available at: http://www.ncbi.nlm.nih.gov/pubmed/1245105.
  3. Pantuck AJ, Leppert JT, Zomorodian N, et al. Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clinical cancer research : an official journal of the American Association for Cancer Research. 2006;12(13):4018-26. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16818701. Accessed March 28, 2012.
  4. Malik A, Afaq F, Sarfaraz S, et al. Pomegranate fruit juice for chemoprevention and chemotherapy of prostate cancer. Proceedings of the National Academy of Sciences of the United States of America. 2005;102(41):14813-8. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1253570&tool=pmcentrez&rendertype=abstract.
  5. Seeram NP, Adams LS, Henning SM, et al. In vitro antiproliferative, apoptotic and antioxidant activities of punicalagin, ellagic acid and a total pomegranate tannin extract are enhanced in combination with other polyphenols as found in pomegranate juice. The Journal of nutritional biochemistry. 2005;16(6):360-7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15936648. Accessed May 24, 2012.
  6. Aviram M, Rosenblat M, Gaitini D, et al. Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation. Clinical nutrition (Edinburgh, Scotland). 2004;23(3):423-33. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15158307. Accessed May 2, 2012.
  7. Rosenblat M, Hayek T, Aviram M. Anti-oxidative effects of pomegranate juice (PJ) consumption by diabetic patients on serum and on macrophages. Atherosclerosis. 2006;187(2):363-71. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16226266. Accessed May 13, 2012.
  8. United States of America Federal Trade Commission. Initial Decision. 2012. Available at: http://www.ncbi.nlm.nih.gov/pubmed/1245105.
  9. Cohen JH, Kristal a R, Stanford JL. Fruit and vegetable intakes and prostate cancer risk. Journal of the National Cancer Institute. 2000;92(1):61-8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10620635.
  10. Ma RW-L, Chapman K. A systematic review of the effect of diet in prostate cancer prevention and treatment. Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2009;22(3):187-99; quiz 200-2. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19344379. Accessed June 10, 2012.
  11. Anderson JW, Baird P, Davis RH, et al. Health benefits of dietary fiber. Nutrition reviews. 2009;67(4):188-205. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19335713. Accessed March 3, 2012.
  12. Azadzoi KM, Schulman RN, Aviram M, Siroky MB. Oxidative stress in arteriogenic erectile dysfunction: prophylactic role of antioxidants. The Journal of urology. 2005;174(1):386-93. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15947695. Accessed July 16, 2012.
  13. Zhang Q, Radisavljevic ZM, Siroky MB, Azadzoi KM. Dietary antioxidants improve arteriogenic erectile dysfunction. International journal of andrology. 2011;34(3):225-35. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20584092. Accessed July 16, 2012.
  14. Forest CP, Padma-Nathan H, Liker HR. Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind, crossover study. International journal of impotence research. 2007;19(6):564-7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17568759. Accessed July 16, 2012.
  15. Kaluza J, Wolk A, Larsson SC. Red Meat Consumption and Risk of Stroke: A Meta-Analysis of Prospective Studies. Stroke; a journal of cerebral circulation. 2012. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22851546. Accessed August 9, 2012.

Red Meat: The News is Not Good

Diet, Habits, & Other Behaviors, news-you-can-use
Langan Denhard, Cancer Prevention and Treatment Fund

Americans love red meat, but a March 2012 study of over 170,000 men and women may change that. The study found that eating just one 3-ounce portion a day of pork, beef, or lamb may significantly increase your risk of dying early.[1] And, unfortunately, a 3-ounce portion is much smaller than a typical American portion – it is about the size of a bar of soap. A double quarter pounder would be almost 3 day’s worth of meat,

The research team, led by doctors An Pan and Frank Hu of Harvard University, tracked a group of 51,529 male health professionals and 121,700 female nurses for over 20 years, beginning in the 1980s. Men and women with a history of cardiovascular disease or cancer were excluded from the study. Every four years, the researchers sent the participants detailed surveys asking them about their dietary habits. The researcher kept track of deaths and determined the cause of death. By the end of the study in 2008, 23,926 of the participants had died, 5,910 of them due to cardiovascular disease and 9,464 due to cancer.

The participants were analyzed by comparing 5 groups that were designated according to their daily consumption of red meat. The group that consumed the lowest amount of meat—Group 1—ate on average a quarter serving of red meat a day, or about 2 standard-size servings (3 ounces) weekly. Group 3, the group in the middle, ate about one standard-size serving of red meat per day. Group 5, with the highest level of consumption, ate on average 2 servings a day—or 14 servings of red meat each week.

The people who ate the most red meat were also the people least likely to exercise regularly, mostly likely to smoke and drink, and had the highest body mass index—an index which uses height and weight to calculate if you are overweight.But by controlling for age, body mass index, level of physical activity, smoking status, and family history, the researchers were able to determine to what degree red meat alone played a role in people’s death. They found that the men who belonged to the one serving a day group—Group 3—were 20% more likely to have died in the course of the study than were the men in Group 1 who only ate a quarter serving every day. Meanwhile, the “hard core” red meat eaters in Group 5 were 37% more likely to have died than Group 1.

Eating larger or more servings of meat did not affect women as dramatically as it did men. Women in the moderate meat-eating group (Group 3) were 11% more likely to have died than women in Group 1, whereas Group 5 women were 24% more likely to have died than women in Group 1.

Combining the data for men and women, the researchers were able to evaluate the dangers of eating unprocessed and processed red meat: an additional serving per day of unprocessed red meat increased the risk of dying early by 13%. An additional serving per day of processed red meat (such as 2 slices of bacon, 1 hot dog, or 1 slice of lunch meat), increased the chances of dying prematurely by 20%.

A one-serving-per-day increase of unprocessed red meat increased the risk of dying from cardiovascular disease by 18%, and it increases the risk of dying from cancer by 10%. And if the red meat is processed, your risk of dying from cardiovascular disease goes up by 21% and your risk of dying from cancer by 16%.

The researchers determined that 9.3% of deaths in male participants and 7.6% in females would have been prevented had they limited themselves to an average of one half serving of red meat per day (1.5 ounces.)

If by this point you’re considering cutting down on red meat, you may be wondering what to eat instead. The research team used substitution analysis to determine how much people could lower their risk of premature death by eating one serving per day of fish, poultry, nuts, legumes, low-fat dairy products, or whole grains instead of a daily serving of red meat. They found that for each serving consumed in place of one serving of red meat daily, the risk of premature death decreased as follows: 7% for fish, 14% for poultry, 19% for nuts, 10% for legumes, 10% for dairy, and 14% for whole grains.[1] It is impossible to know why fish was not as beneficial as the other alternatives, but perhaps it is because the most popular fish meals in the U.S. tend to be tuna salad or fried fish, both of which have high fat content.

How Worried Should I Be?

This study does not confirm a “cause and effect” relationship between red meat consumption and premature death. All it shows is that when meat-eating goes up, death is more likely. This study relied on food records that were updated by the participants once every four years, and while this is standard for a study of this immense size, it isn’t always that reliable. Try remembering how and what you ate four years ago!

Although meat is a popular protein source, it is not the healthiest. Red meat tends to be higher in saturated fat, which raises cholesterol in the blood. High cholesterol levels can result in cardiovascular disease. While processed and unprocessed read meats are both high in saturated fat, the high sodium content of processed red meat makes it even more harmful. When the body gets more sodium than the kidneys can handle or can be excreted through urine, sodium begins to build up in the bloodstream. This makes it harder to pump blood through blood vessels, which increases the pressure on the arteries. Americans consume about 3400 mg of sodium day, on average—much more than the USDA’s recommended limit of 2300 mg a day. Processed red meats generally have four times the amount of sodium and 50% more preservatives than unprocessed red meats.[2] You can read more about the differences between processed and unprocessed red meats here.

This study suggested a higher rate in cancer deaths among red meat eaters; however, the connection remains vague and poorly understood. It is not known why red meat could cause cancer, or whether it is only certain types, but studies indicate that people who eat a lot of red meat—regardless of whether it’s grilled (charred) or not—are at higher risk for various cancers, including colon,[3] breast,[4] and prostate cancer.[5]

Cutting Back on Red Meat

Giving up meat entirely would be tough for many, but the mounting evidence against regular meat consumption is hard to ignore. Try eating chicken or fish (but not fried!) as your protein source, rather than hamburgers, pork chops, or deli meats. Dr. Frank Hu, the lead author of the study, suggests eating unprocessed red meats no more than 3 times a week—that’s nine ounces of beef, lamb or pork over seven days. Bacon, hot dogs, bologna and other processed meats, although tasty, should only be eaten occasionally—at a baseball game or picnic.

Remember that a healthy diet combined with regular physical activity is the best way to improve the quality and length of your life! Check out our 10 easy steps to get your family eating healthy!

References:

  1. An, Pan, Qi Sun, Adam M. Bernstein, Matthias B. Schulze, JoAnn E. Manson, Meir J. Stampfer, Walter C. Willett, and Frank B. Hu. “Red Meat Consumption and Mortality.” Archives of Internal Medicine (2012). Web. 15 Mar. 2012.
  2. Cole, Megan. “Are Processed Meats More Dangerous than Other Red Meats? Yes and No!” Center for Research. National Research Center for Women and Families. Web. 3. Apr. 2012.
  3. Biger, Noy; France De Bravo, Brandel. “Colon Cancer: Who is at Risk and How Can it Be Prevented?” Stop Cancer Fund. Cancer Prevention and Treatment Fund. Web. 3, April. 2012.
  4. “Does Red Meat Cause Breast Cancer?” Center For Research. National Research Center for Women and Families.December 2006.Web.3, April 2012.
  5. Porte-Antoine, Stephanie; France De Bravo, Brandel. “Prostate Cancer: Diet and Dietary Supplements.” Stop Cancer Fund. Cancer Prevention and Treatment Fund. August 2009. Web. 3, Apr. 2012.

Arsenic and Lead in our Juice (and You Thought Poisoned Apples Were only in Fairy Tales!)

Diet, Habits, & Other Behaviors, Other Cancers, Skin Cancer
Langan Denhard and Brandel France de Bravo, MPH, Cancer Prevention and Treatment Fund

Arsenic—it’s a scary word with dangerous connotations.Recent studies show that arsenic is present in many everyday beverages and food.In response, Congressman Frank Pallone and Congresswoman Rosa DeLauro introduced a bill named Arsenic Prevention and Protection from Lead Exposure in Juice (APPLE) in early February 2012. If it becomes law, it would require the FDA to set limits within the next two years on the amount of arsenic and lead allowed in fruit juices and other foods.[1]

What are the Dangers of Chronic Arsenic Exposure?

There are two types of arsenic: organic and inorganic.Organic arsenic is usually non-toxic and harmless when consumed.However, the FDA has identified two strains of organic arsenic that can cause cancer: dimethyl arsenic acid (DMA) and monomethyl arsenic acid (MMA).Recent testing by the FDA found small amounts of these strains in apple juice. Inorganic arsenic has been linked to increases in bladder, skin, and lung cancers when consumed in high quantities.It also increases the risk of cardiovascular disease and type 2 diabetes, and weakens the body’s immune system, making it harder to fight respiratory infections and flu. Exposure to high levels of arsenic can cause diarrhea, fatigue, nausea, skin discoloration, and in rare instances, death. Very little research has examined what happens to children exposed to low levels of inorganic arsenic over a long period.A 2004 study led by Columbia University’s Joseph Graziano, PhD, suggests that children who consumed water with arsenic levels above 5 parts per billion (ppb) showed evidence of lowered IQ.[2]

What are the Current Laws in Place Concerning the Levels of Arsenic in Food and Drink?

 

There is surprisingly little regulation on the levels of arsenic allowed in food and drink.According to Michael Taylor, deputy commissioner of the FDA, 23 ppb is the “level of concern” for arsenic concentration in fruit juices but there is no legal limit. Information on the FDA site states, “[The] FDA is collecting all relevant information to evaluate and determine if setting guidance or other level for inorganic arsenic in apple juice is appropriate.”[3] The FDA and the EPA revised the federal limit for arsenic allowable in public water and bottled water to 10 ppb in 2006, noting that the safest level would be 0 ppb.[4] States have the authority to mandate limits below 10 ppb, and New Jersey has the strictest limits, with a maximum level of 5 ppb. State officials caution against consuming or cooking with water at any higher concentration.[5]

Do my Family Members Consume Arsenic?

In November 2011, Consumer Reports completed a study of 88 samples of apple and grape juice that found that 10% had arsenic levels surpassing the drinking-water standards.Of this, most of the arsenic found was inorganic.A sample Walgreen’s grape juice was found to have an arsenic concentration of 24.7 ppb—more than double than the legal limit for drinking water—and most of it (82.9%) was inorganic.Of the two harmful types of organic arsenic, MMA was found in higher concentrations in apple juice whereas DMA was more likely to be found in grape juice.Consumer Reports also found that 35% of children younger than 5 drink more juice than is recommended by pediatricians.[2]

On February 2012, another study, led by a research group from Dartmouth College, presented troubling new findings.In an effort to cut down on the use of high fructose corn syrup as a sweetener, some manufacturers have been making the transition to organic brown rice syrup (OBRS).Because arsenic-based pesticides were once used in rice production, and rice plants are extremely effective in taking in the leftover arsenic from the soil, using syrup made from organic brown rice has resulted in arsenic in infant formula and other commonly used products.[6]

Currently, the only formula brand using OBRS is Nature’s One, which produces Baby’s Only Organic Dairy Toddler Formula and Baby’s Only Organic Soy Toddler Formula.These products were tested against 15 formulas that did not contain OBRS, and it was found that Nature’s One’s products had more than 20 times as much arsenic as the other brands.In a statement published on its web site, the company says, “An independent, third party testing laboratory completed testing on organic brown rice syrup used in formulas produced in 2011. The testing proved there are no safety concerns using the organic brown rice syrup ingredient.”The company has not released test results to the public, “to protect against inaccurate interpretations.”[7]

Cereal bars and “energy shots” are other possible daily sources of arsenic. A little less than half of all cereal bars contain organic brown rice syrup, and when tested, those with OBRS listed in the top five ingredients had the highest concentration of arsenic. At least half of the arsenic tested was inorganic and any organic arsenic was classified as DMA, one of the two harmful forms of organic arsenic.[6]

The Bottom Line

The drinking water limit on arsenic was set at a low level because water is frequently consumed on a daily basis throughout one’s life.For that reason, higher arsenic levels in foods consumed less often are of less concern.Fortunately, arsenic is usually excreted within 2-3 days of consumption.Nevertheless, some experts believe that the arsenic level allowed in water may be too lax, and additional sources of arsenic can add to those risks, especially for children and pregnant women.We need more research to know whether or not it is safe to consume low-levels of arsenic every day.

Meanwhile, the two things you can do are:

  1. make sure your drinking water meets the federal limit of 10 ppb of arsenic, especially if you have a private well or live in a rural area, and
  2. protect your children, whose bodies are smaller and still developing, from unnecessary exposure to arsenic.

It is especially important to protect infants from arsenic exposure until further research is conducted, so avoid formulas and baby foods containing rice products as a main ingredient.Most pediatricians advise against giving your children juice regularly because even when it has no added sugar, it delivers a lot of calories with little nutrition.The presence of arsenic is another reason to ration the juice!

If you are worried about your water supply, call your local health department for a list of labs certified to test for arsenic.The cost of testing ranges from $20-$35[8] NSF International provides extensive information on how to treat your home water.

References:

  1. Congresswoman Rosa L DeLauro. US House of Representatives. Congressman Frank Pallone (D-NJ) and Congresswoman Rosa DeLauro (D-CT) Fight to Protect Children from Arsenic in Apple Juice.Congresswoman Rosa L DeLauro: Representing the Third District of Connecticut. 8 Feb. 2012. Web. 28 Feb. 2012.
  2. “Arsenic in Your Juice:How Much Is Too Much? Federal Limits Don’t Exist.”ConsumerReports.org. Consumers Union, Jan. 2012. Web. 28 Feb. 2012.
  3. “Questions & Answers: Apple Juice and Arsenic.” FDA: US Food and Drug Administration. US Department of Health and Human Services, 16 Dec. 2011. Web. 21 Feb. 2012. <http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271595.htm>.
  4. “Basic Information about Arsenic in Drinking Water.” EPA: US Environmental Protection Agency. EPA, 26 Jan. 2012. Web. 01 Mar. 2012. <http://water.epa.gov/drink/contaminants/basicinformation/arsenic.cfm>.
  5. Buchanan, Gary A. “NJDEP New Jersey Department of Environmental Protection.” The Official Web Site for The State of New Jersey. 1 Nov. 2010. Web. 01 Mar. 2012. <http://www.state.nj.us/dep/dsr/arsenic/guide.htm>.
  6. Jackson, Brian P., Vivien F. Taylor, Margaret R. Karagas, and Kathryn L. Cottingham. “Arsenic, Organic Foods, and Brown Rice Syrup.” Environmental Health Perspectives (2012). Web. 21 Feb. 20
  7. “ORGANIC BROWN RICE SYRUP CONCERNS.” Nature’s One . Nature’s One, Inc. Web. 21 Feb. 2012. <http://www.naturesone.com/brown-rice/>.
  8. “Arsenic in Private Drinking-Water Wells.” Division of Toxicology and Environmental Medicine. ATSDR, 6 Aug. 2008. Web. 01 Mar. 2012. <http://www.atsdr.cdc.gov/arsenic/>.

Can Sleeping Pills Cause Cancer?

Colon Cancer, Diet, Habits, & Other Behaviors, Lung Cancer, Medical Treatments with Cancer Risks, Other Cancers, Prostate Cancer
Brandel France de Bravo, MPH, Kousha Mohseni, MS, Cancer Prevention and Treatment Fund

When we hear “sleeping pills,” most of us think of prescription drugs such as Ambien (generic name zolpidem), Restoril (temazepam), and Lunesta (eszopiclone).  While prescription sleep medications are big business — more than $41 billion/year in the U.S. many people with trouble sleeping turn to over-the-counter antihistamines such as Tylenol PM and Benadryl.[1]  However, the use of these drugs may take a nosedive in light of the findings of a study published in the prestigious British Medical Journal. Led by researchers at the Scripps Clinic Viterbi Family Sleep Center in California, the study shows that people who take these drugs are significantly more likely to be diagnosed with cancer or to die within the next two and a half years than people who don’t take them. Author Dr. Daniel Kripke estimates that these popular sleep medications could cause 320,000 to 507,000 deaths in just one year.

The researchers looked at 10,529 primary care patients who were prescribed sleeping pills between 2002 and 2007 and compared the health of each of them to at least two very similar patients without such prescriptions who were the same sex, ethnicity, marital status, smoking status, and had similar health conditions, alcohol use and BMI (which measures if a person is overweight). The patients were followed for 2.5 years on average, and were from a Pennsylvania clinic that serves a mainly low-income population.

Sleeping Pills, Death, and Cancer

Patients who were prescribed sleeping pills were at least three to five times more likely to have died during the study than were the patients not prescribed sleeping pills. Even the patients who were prescribed fewer than 18 pills per year were at higher risk of dying: 3.6 times higher. Patients who were prescribed more than 132 pills a year were more than five times as likely to die.

The researchers were careful to exclude from the study patients who were diagnosed with cancer before the study or very early in the study. Heavy users of sleeping pills (over 132 pills prescribed per year) had a 35% greater risk than those with fewer pills prescribed.  Among those with prescriptions for sleeping pills, the increased risk of their developing lymphoma, lung cancer, colon and prostate cancer was greater than the risk from being a current smoker.

Before this study, there were at least 18 other studies showing an increased risk of death for people taking sleeping pills, and several also showed an increased risk of cancer.  However, this study is especially well-designed and the only one that includes the newer, short-acting class of popular sleeping pills known as nonbenzodiazepines. These were generally believed to be safer than previous generations of sleeping pills because they wear off more quickly. In fact, before this study it was believed that the worst side effect was weight gain due to night time raids on the refrigerator while sleep walking.

Among study participants, the most commonly prescribed sleeping pill was zolpidem (sold as Ambien, Edluar, or Zolpimist), followed by temazepam (a benzodiazepine sold as Restoril). However, prescriptions for the use of any sleep aid was associated with a significant increase in the risk of death, including eszopiclone (”Lunesta”), zaleplon (”Sonata”), barbiturates, as well as antihistamines such as diphenhydramine (the active ingredient in Benadryl), which is also used in many over-the-counter sleep aids. The average age of patients was 54, but the study found harm associated with sleeping pill use in every age group.[2]

All the sleeping pills showed a similar increased risk of death except Lunesta, which showed a more than 500% increased risk compared to any of the other sleeping pills.  However, Lunesta was a relatively new drug at the time of the study, and relatively few people took it. For that reason, it is not possible to say whether the risk of Lunesta is really that high.  Also important to note: This study did not evaluate cancer among patients taking Belsomra, a newer sleeping aid with numerous side effects.[3]

One shortcoming of the study is that getting a prescription for a sleeping pill is not the same as taking sleeping pills.  It is possible that some of the people with prescriptions, especially for small numbers of pills, never took any of them. It is also possible that people who did not have prescriptions for sleeping pills took Benadryl or other over-the-counter antihistamines to help them fall asleep, instead of the prescription version of the same pills.  However, those shortcomings would tend to underestimate the risk of sleeping pills, rather than overestimate the risks.

In addition to the major study cited above, there is other evidence linking sleeping pills to cancer.  For example, a study of Taiwanese patients published in 2012 found that Ambien promoted viral infections, which reflects a weakening of a person’s ability to fight off infections and diseases.[4]  That could explain the increased risk of cancer.

Also, a study published in the Korean Journal of Family Medicine in 2018 found that sleeping pills were strongly associated with esophageal, kidney, prostate, liver, stomach and pancreatic cancers. Of all the sleeping pills in the study, Ambien most strongly predicted a diagnosis of cancer.[5]

But Why?

What could possibly explain these increased risks?  Are people who are prescribed sleeping pills more anxious or stressed out? There is evidence that they are more likely to have car accidents or to fall down, probably because of the residual effects of the drugs during the day.  Other studies show an increase in infections among people taking sleeping pills, and that can also increase the risk of cancer and death from other causes. These other studies all suggest that sleeping pills really do increase the risk of dying and there are no logical explanations to explain away the substantial increased risks found in this study, especially the increased risk of cancer.

While the researchers can’t say for sure that the sleeping pills caused death or cancer, many people who used to take these medications should think about these new research findings and consider other, safer ways to fall asleep.  The sleep specialists who conducted the research suggest that since these sleeping pills have limited benefits, old-fashioned sleep aids like warm milk, as well as cognitive-behavioral approaches that can be taught and used for the rest of your life, would be excellent alternatives.  If you decide to toss your sleeping pills, be sure to see our article Drugs in the Drinking Water for tips on safe medicine disposal.

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

References:

  1. Consumer Reports. Why Americans Can’t Sleep. ConsumerReports.org. https://www.consumerreports.org/sleep/why-americans-cant-sleep. Updated January 14, 2016. Accessed October 15, 2018.
  2. Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. British Medical Journal. Open 2012;2:e000850 doi:10.1136/bmjopen-2012-000850
  3. Kripke, D. F. (2015). Is suvorexant a better choice than alternative hypnotics? F1000Research, 4, 456. http://doi.org/10.12688/f1000research.6845.1
  4. Kao, C.-H., Sun, L.-M., Liang, J.-A., Chang, S.-N., Sung, F.-C., & Muo, C.-H. (2012). Relationship of Zolpidem and Cancer Risk: A Taiwanese Population-Based Cohort Study. Mayo Clinic Proceedings, 87(5), 430–436. http://doi.org/10.1016/j.mayocp.2012.02.012
  5. Kim, D.-H., Kim, H.-B., Kim, Y.-H., & Kim, J.-Y. (2018). Use of Hypnotics and Risk of Cancer: A Meta-Analysis of Observational Studies. Korean Journal of Family Medicine, 39(4), 211–218. http://doi.org/10.4082/kjfm.17.0025

Ten Easy Tips to get Your Family Eating Healthy

Diet, Habits, & Other Behaviors
Cancer Prevention and Treatment Fund

Keeping your weight down and avoiding certain foods help prevent cancer from developing, and help prevent it from returning after treatment. Does switching to healthier foods seem like an impossible chore?  It doesn’t have to be! Change your habits gradually with these 10 simple tips.

  1. Cut out trans fats. These fats are the worst for you, because they increase your chances of heart disease by increasing “bad” cholesterol and decreasing “good” cholesterol.  It’s easy to read food labels and eliminate trans fats from your diet.  To reduce other unhealthy dietary fats, try to bake, broil, or grill meats more often and avoid frying.  Also, try using cooking spray (it allows you to use less oil) or olive oil instead of other oils.
  2. Eat more fruits and vegetables. Fruits and vegetables are good for you and also help to fill you up so you won’t feel hungry.  If you fill up your plate with fruits and veggies, you probably won’t need vitamin pills, you’ll have fewer hunger pangs, and you will train your taste buds to crave fewer sweet and salty foods.
  3. Cut back on salt. That doesn’t just mean keep away from the salt shaker. You also have to read food labels because most of our salt comes from foods that the manufacturers have “salted” for us. The USDA recommends less than a teaspoon of salt each day!  A teaspoon of table salt contains 2,300 mg of sodium but 1,500 mg is what is recommended for all children, all African Americans, all people 51 and older, and other adults with certain illnesses.  Food without salt doesn’t taste boring if you use other seasonings, like garlic, pepper (cayenne or chili pepper if you like things spicy!), curry powder, ginger, lemon juice, or fresh herbs to add flavor.  Or, you can try using seasoned salt, which has less sodium per teaspoon than pure salt.
  4. Cut back on refined grains. Eat less “white” rice, pasta, and bread.  Choose whole grain products instead.  At least half of the grains your family eats each day should be whole grains-including whole wheat bread, whole grain pasta, and brown rice.  If you don’t like the taste of whole grain pasta or brown rice, try alternatives such as quinoa, whole wheat couscous, and bulgur for a change.  Some of these can be hard to find or more expensive than rice, but quinoa (pronounced “kin-o-wa”) tastes good and has almost double the protein of brown rice.
  5. Replace meat and poultry in your favorite recipes with beans, lentils, or fish. They have as much protein, and if the sauce or seasoning is good, you will hardly notice the difference.
  6. Try low-fat dairy products. If your family rejects fat-free cheese, try to slowly ease in low-fat or fat-free dairy and see which products pass the taste test.  If you usually use whole milk, try 2%.  If you usually use 2% milk, try 1% or skim milk.  It may be hard to believe, but once they get used to it, your entire family will prefer the milk, yogurt, and cheeses with lower fat.
  7. Cut out sugary drinks. Even if your family loves dessert, you can drastically reduce sugar consumption by switching to 100% juice, different flavored iced teas (it’s usually better for you to brew and sweeten them yourself), and water instead of sugary sodas, punch, or sports drinks.  Some coffee drinks that appeal to our sweet tooth have all the calories of a meal and none of the nutrients. Many have 500 or more calories and some of them top 1,000!
  8. Gradually reduce portion size. If overeating is a problem for your family, consider using smaller plates and bowls.  Family style eating-which  keeps extra food on the table for everyone to help themselves-is less work for parents but almost always results in everyone eating much more.  If you just serve everyone a single portion, they will eat less.  Keep second helpings small and let kids know that if they want a second helping of meat or grains, they must have a second helping of the vegetables as well. And if they are old enough, let them get up from the table to get it themselves.  Those rules can help everyone eat a more balanced diet.
  9. No food with screen time, and more outdoor activities. Don’t let kids or adults snack while watching TV or using the computer.  Eating in front of the TV or computer almost always results in mindless overeating.  Make plans to keep everyone more active, but when they are in front of a screen keep them away from snacks.
  10. Schedule regular mealtimes. If everyone in the family eats at regular times and snacks are available only when meals are far apart, you’ll be surprised by how that will affect everyone’s weight.  Regular mealtimes help people avoid overeating.  Once you start eating, it’s hard to stop, so try to stick to only 3 meals and no more than one snack each day.   And, it’s trite but true: starting the day with a nutritious breakfast is important for doing your best all day.  An easy and  nutritious breakfast can include cereal with yogurt or milk, and don’t forget fruit juice or fruit.

References:

Diana Zuckerman & Brandel France de Bravo, The Survival Guide for Working Moms (and Other Stressed-Out Adults), 2009.

United States Department of Agriculture and Department of Health and Human Services, Dietary Guidelines for Healthy Americans 2010, available at: http://www.health.gov/dietaryguidelines/

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Kids Talk About Healthy Eating

Diet, Habits, & Other Behaviors
Cancer Prevention and Treatment Fund

Energy In-Energy Out. (Manuel, age 11)

I don’t feel like walking when my backpack is really full. Sometimes it gets so heavy because I forget to clean it out. I just keep putting things in without taking out books I’ve already read, old homework assignments, food wrappers and other stuff that I don’t need to be hauling around. My mom keeps telling me, “Just carry what you need.”  I’m starting to think about food that way. I eat the foods my body really needs, and when I forget or have a craving to eat the ones it doesn’t need-like cookies and chips-I try to take the stairs instead of the elevator, or walk the last five blocks home instead of staying on the bus.

I like to Pick my Own Sneakers and Dress a Certain Way. My Mom Says That Eating Right Means Making Sure Your Plate is Wearing the Right Colors. (Alex, age 9)

When I dress, I like to stick to my favorite colors-blue and yellow. But when I serve myself food, I try to get as many colors on my plate as I can because each color has its own “magical powers” (Okay, they’re really just vitamins and nutrients). It turns out that orange and dark green are some of the most powerful. And one way I keep from eating too many of the wrong foods is by making sure that half my plate is covered with colorful fruits or vegetables.

The One Time I Don’t Want to be Multi-Tasking: When I’m Eating. (Alisha, age 13)

My parents don’t understand how I can be checking text messages, doing homework, IMing, and listening to music all at the same time. I can, though.  Really.  But one thing I’ve learned recently: if I’m eating while watching TV or YouTube videos, I don’t pay attention to how much I’m eating.  All of sudden I’m like, I just ate a whole box of crackers.  Everyone eats stuff on the go sometimes, but now I’m trying to eat my meals and snacks on a plate or in a bowl and not do anything else while I’m eating except enjoy my food.  Being focused on my food lets me see how much I’m eating and be sure that most of what I’m eating really is fuel.  Put the wrong thing in your gas tank and your car won’t run.

Let’s Move (Chris, age 15)

It’s true that I spend a lot of time sitting-too much time: in class, in front of the television or the computer, or in the car to and from school. Mrs. Obama has been telling kids (and their parents) that they need to get moving to stay healthy.  So now I’ve made myself some rules that I stick to pretty regularly: for every 30 minutes I am sitting down, I do 30 jumping jacks or 30 sit-ups. I call it “doing my 30s.” I can’t do 30 push ups yet, but you know what? I’m working on it! The funny thing is that instead of feeling tired after my “30s,” I feel like I have more energy.

Saving Calories is Like Saving Money to Buy Something Special (Jesse, age 10)

I don’t like to use up my spending money on stuff I don’t need.  And nothing makes me more upset than losing money, like sometimes I’ll pull something out of my pocket and drop a dollar bill without noticing.  It’s all right to drink a soda when you really feel like it or when you’re at a party, but drinking soft drinks, sugary ice tea, and sports drinks just because you’re thirsty is like throwing money away-not just because of what they cost, but because they’re a waste of calories.  Water has no calories, and at home and school you can usually get it for free.  If you want to stay healthy, save up your calories for foods and beverages that keep you feeling full and satisfied-food and beverages that give you the vitamins and nutrients you need.  When I’m thirsty I stick to water or 1% milk.

I’m Down With Brown (Keesha, 16)

Bread, spaghetti, rice.  Whatever it is, I ask for it “brown,” because that means it’s whole grain.  Nothing has been taken away-none of the nutrition and none of the flavor.  And when I drink milk or eat yogurt or ice cream, I get reduced fat or fat-free. I get all the taste without the calories or saturated fat (that’s the kind of fat you don’t want to eat too much of-it’s in food that comes from animals, like meat, cheese, butter, and other stuff made from milk).  Remember this: low fat is all that!

Reading for a Reason (Khalil, age 14)

Reading can save your life. We all need to be able to read the directions on a medicine bottle because medicine can make you feel better and even cure you-if you use it right. Too much medicine can poison you. Too much of the wrong foods and the wrong ingredients can poison your body. That’s why I’ve started looking at the writing on food packages. I don’t read everything but I at least look at how much sodium, how much sugar, and how much fat is in those crackers or cookies.  I don’t want to eat half of the fat I’m supposed to eat in one day in just one snack!  Even fast food restaurants have that kind of information available, and if it’s not posted, you can ask where to find out how much fat is in those fries.  We all have a right to know-that’s what getting an education is about.