Processed meats – cancer risk or hype

Bacon is perhaps the archetypical of processed meats – whether typical US or Canadian – it is one of the most identified foods by sight or smell.  Recently, the World Health Organization (WHO) classified  processed meats as a cancer risk, equating it to smoking.  How did they come to this decision, and can we infer the same risk about all meat – processed or not?

What did the WHO say?

The WHO evaluated data from about 800 studies of meat intake and cancer.  About 14 of them were designed well enough to analyze the information.  There were another 15 studies that had strong design to help with the decision-making.  Based on these 29 studies, they found evidence that processed meat increased cancer risk – specifically colon cancer by about 17%.  The data for red meat in general was not strong enough to make an association.

How should we interpret the WHO statement?

The association of processed meats and GI tract cancer has been known for quite some time.  In cultures where these foods are consumed regularly, stomach cancer has had an increased rate, leading to screening programs.  The statement from the WHO adds strength to the association, and should encourage people who have multiple risks for colon cancer to consider their diet as a controllable  risk factor.

What does this mean for most people?

The risks for colon cancer are age, smoking, a low fiber diet, family history and now processed meats.  Just like most health decisions we make, our diets should be modified based on our risks.  Moderation, or occasional consumption of processed meats is a better choice than daily consumption.  Of course, getting a colonoscopy based on your doctor’s recommendation further minimizes the risk of developing colon cancer!

Life is full of choices – moderation and a varied diet seems to be one of the better ones.  In the words of Joe Jackson, “Everything gives you cancer”

The path to wellness begins with a proper diagnosis.

 

Stop Counting Cholesterol? New Dietary Guidelines say so

At the end of 2014, The Dietary Guidelines for Americans Council issued its 2015 guidelines and analysis of what we should eat, what we do eat, and what the consequences of what we eat are.  Many of the recommendations and observations are what we expected – we eat too much sodium and sugar, not enough fruits, and are overweight.  What was surprising is that they do not recommend watching cholesterol intake any longer – saturated fat yes, but cholesterol, no.

What did the report say?

The main thrust of the report emphasizes a diet with lots of fruits and vegetables, whole grains, low in saturated fat.  Limiting processed meats, refined grains (white bread) and drinks with added sugar is also recommeded.  Good food such as seafoods, nuts and legumes, as well as low-fat dairy are emphasized.
Notably, the report for the first time removed the recommendation to limit cholesterol intake.  Prior recommendations were to limit cholesterol intake to under 300mg daily.  Instead, it is recommended to limit saturated fat and empty calories such as processed sugars.  It is these foods that are contributing to obesity and its consequences much more that dietary cholesterol.  Added sugars and saturated fat should be < 10% of total calories in a day.
Saturated fat has 9 calories per gram.  So in a 2000 calorie diet, saturated fat should be limitied to 22 grams daily.  Sugar has 4 calories per gram.  In the same diet, sugar should be limited to 50 grams daily.
For a real world example, a Snickers bar has 250 calories.  That is over 10% of a 2000 calories diet.  It has 4.5 grams of saturated fat, which is 20% of daily recommendation, and 27 grams of sugar, which is 54% of the daily recommendation!  By contrast, 2 scrambled eggs has about 200 calories and the same amount of saturated fat, but only 2.1 grams of sugar, or about 4% of the daily recommendation.

So what does this mean?

The report brings dietary guidelines more in line with current research.  We have seen several studies showing the benefits of a Mediterranean style diet – high in fish, nuts, vegetables and good fats such as olive oil.  The guidelines now support those findings.  It means a heart healthy diet can include some fats, and should limit the empty starches – those made with refined flour that add little nutrition but many calories.  It means that moderate intake of eggs and lean meats is healthier than meals based on breads, rice and pasta.
Perhaps the best news in the report (at least for me) is that up to 5 cups of coffee a day does not seem to be harmful!!!

The path to wellness begins with a proper diagnosis 

Steaks and Statins – weight gain and cholesterol management

Recently there have been several news stories with contradictory  health information; obesity has reached a peak, obesity is still rising.  Running leads to a longer life, but marathon runners don’t live longer.  Supplements don’t work, except when they do.

One of the latest stories is that people who take statins are gaining weight faster than those who don’t.    Have statins become a crutch or do statins cause weight gain?  Are we healthier now that we can have our steaks with a side of statins?

What did the study look at?

To assess the question of statins and weight gain the authors used a large database called the National Health and Nutrition Examination Survey (NHANES) which was a large study conducted from 1999-2010 that collected data on tens of thousands of Americans, looking at illnesses, medication use, diet, supplement use and other  items.

For this study, 28,000 people were evaluated:

  • those with high cholesterol and taking statins
  • those with high cholesterol and not on statins
  • those without high cholesterol and not on statins

They compared calorie and fat intake between statin users and nonusers in 1999-2000 and 2009-2010.  In 2010, statin users were eating almost 250 calories more a day than they did in 2000.  They were eating more fat, as well as having gained more weight than non-statin users.  However, statin users did have lower cholesterol.

What the study did not assess was if the rate of heart attacks changed in the groups – the study wasn’t designed to answer that question.  But is that the only question that matters?

The reason why it matters is that diabetes rates, linked to weight gain and obesity are still on the rise.  Are people being helped if they lower heart disease risk by taking statins but raise their risk of developing diabetes?

Possible explanations of the data

  • Doctor effect – are doctors advocating medication over healthy lifestyles?  It is easier and takes less time.
  • Patient effect – are patients interpreting taking statins as a free pass to keep the same lifestyle they had before medication?  Again taking a pill a day is easier than maintaining a healthy lifestyle.

The truth is probably a little bit of both.

How does this affect my practice?

I’m a strong proponent of preventing disease.  We prevent heart disease by not smoking, controlling blood pressure and reducing the Low Density Lipoproteins that clog our arteries with statins.  Central to this, and what I recommend with or without medication is lifestyle – a healthy and active one!  Doing so may avoid the need for medication or allow us to use a lower dose – reducing side effects!

What we don’t know from this study is if people had an increase in heart attacks despite their lower overall cholesterol levels – meaning the increase in calories, fat and weight offset the benefit of taking a statin.  Or, did the statin allow people to safely lead a more permissive lifestyle?  Can you have your steak if you have your statin too?

The study did show an increase in diabetes  – presumably related to the weight gain in the statin users.  They consumed about 250 calories a day more in 2010 than in 2000 – which can lead to almost 10 pounds a year in weight gain!

So when I discuss taking statins with my patients, I always frame it as a component of a plan to reduce the risk of heart disease.  If diet and exercise reduce risk enough, medication can be stopped and risk reassessed.  Even if lifestyle does not reduce risk enough to stop medication, it may minimize the need for dosage increases.

For those that do not alter their lifestyle, they run the risk of developing diabetes.  While statins will reduce some of the risk of heart disease, diabetes carries its own risks – kidney, nerve and eye damage – which statins won’t protect against.

My role as an Internist is to look at a person as  a whole – evaluate all their risks and how they relate to each other.  So this study serves as an example that we can treat a singular problem, but if that is our whole focus, we lose sight of the person and may not truly improve their health.

The path to wellness begins with a proper diagnosis