Category Archives: Diet, Habits, & Other Behaviors

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.

Eating Habits that Improve Health and Lower Body Mass Index

Diet, Habits, & Other Behaviors
Susan Dudley, PhD and Sarah Pedersen, Cancer Prevention and Treatment Fund

More and more research studies are confirming the importance of keeping body mass index (BMI) and waistline measurements under control in order to reduce the risk of cancer, other serious diseases, and premature death. But sticking to a healthy diet – especially when we’re trying to lose weight – can be hard for lots of reasons. Keeping track of calories and fat percentages can be confusing, and the nutrition labels on the foods we buy aren’t always that helpful. How are consumers supposed to figure out which diet advice is just hype – that ultimately don’t contribute to better health – and which advice offers good, medically sound information?

Here are some basic guidelines to keep in mind:

  • Calories matter
  • Serving size matters
  • Fats and cholesterol matter
  • Fruits, vegetables and whole grains matter
  • Exercise matters
  • Sticking to it matters

The Only Way to Lose Weight is to Eat Fewer Calories Than You Burn in a Day

Simply increasing your activity level might be enough if you only need to lose a few pounds to get your BMI into a healthy range.  Most of the time, however, eating fewer calories is also going to be needed.  The calories and fat in the foods we eat add up quickly!  For example, have you eaten at a fast food chain recently?  To work off the calories from a double cheeseburger, extra large fries and a 24 ounce soft drink – about 1500 calories – you would have to run for two and half hours at a ten minute mile pace! (For more information, see Fast Food Facts: Calories and Fats).

Eating Fewer Calories Doesn’t Necessarily Mean Eating Less Food

The trick to dieting without being hungry is to choose foods that contain fewer calories and also fill you up. An example of this would be having a piece of fruit instead of fries with lunch.  It helps to remember that not all foods are created equal!  Some foods, such as nuts, are high in nutrients and essential vitamins, while others lack nutritional substance, such as products containing added sugars. “Nutrient-dense food” provides substantial amounts of vitamins and minerals and relatively few calories, but leaves you feeling fuller while also supplying valuable fuel for your body.  A person is more likely to stick to a diet-while feeling better and healthier-if calories are nutrition-dense.  Empty calories from simple carbohydrates found in foods with processed and refined sugars, such as candy, pasta and bread made from white flour, and foods with corn syrup, leave you hungry again soon after, craving more food.  This is because simple carbohydrates quickly turn into useless sugar, whereas complex carbohydrates, such as vegetables, whole-grain breads and cereals, and low-fat yogurt and milk, provide long-lasting nutrients, improve digestion, help stabilize blood sugar, and keep your energy at an even level.  Although foods such as fruit are also considered simple carbohydrates, they contain vitamins and nutrients that occur naturally, unlike those found in processed and refined foods.

A 2011 study in the respected New England Journal of Medicine found that certain foods were linked to weight change more than others. After following participants for an average of 17 years, researchers found that weight increase was most strongly linked to foods such as potato chips, sugar-sweetened beverages, and unprocessed red meats.  Foods such as vegetables, whole grains, nuts, fruits, and yogurts were closely linked to preventing weight-gain.

Eating 5 Smaller Meals Might Work Better Than Eating 3 Larger Ones

Most people are surprised to learn that eating 5 or 6 times a day can be a better way to lose weight than eating only 3 times a day! This only works, however, if you take care to control not only the calorie content but also the amount of food you’re eating.  The goal is to eat a small amount of food – like a cup of no-fat yoghurt, for example – every 3 hours or so.  Eat only enough so that you don’t feel hungry, but never so much that you feel stuffed. Some people recommend eating your meals off of smaller plates, because research has shown that people have a tendency to try to eat all of what is served to them. Unfortunately, portion sizes for restaurant meals and other prepared foods, and even in our homes – everything from breakfast muffins to a plate of spaghetti – have grown to very unhealthy proportions in the last two decades.

Eat Less Cholesterol and Less Fat – Especially Less Saturated Fat, and Almost No Trans-Fat

Most people have heard that cholesterol is bad, and eating less of it is important.  But our bodies also make cholesterol from the fats that we eat. Fats are also very high in calories. So cutting down on total fat intake is helpful.

All fats, however, are not alike, and that’s why it’s important to check food labels to be sure that you’re eating the smallest amount of saturated fat and of trans fat possible. These tend to be the kinds of fat that are found in milk and milk products, those that are solid at room temperature – like the fat in meat products, butter, margarine, shortening and lard – and the fats that come from baked goods and fried foods. The fats you do eat should be mostly “unsaturated” or “polyunsaturated” fats. Although there are some exceptions, these tend to be liquid at room temperature, like canola oil, olive oil and some of the other vegetable oils.

Eat More Fruits, Vegetables, Whole Grains, and Low- or No-Fat Dairy Products Every Day

There are many good resources to help you learn about healthy eating. For example, the US Department of Agriculture website at My Plate helps you tailor the government’s dietary recommendations to your nutritional needs. Nutritionists at the Harvard School of Public Health have similar (but not identical) healthy food guidelines. What these diets have in common includes recommendations to:

  • Aim for at least five servings of fruits and vegetables a day. Usually, the more colorful the fruit or vegetable, the more nutritious. For example, dark green spinach has more nutrients than light green iceberg lettuce.
  • Try and choose whole grain cereal, pasta, rice, and bread. Many foods that claim “whole wheat” or “whole grain” on the front of the package are really made with mostly white, processed flour – which isn’t nearly as nutritious. Always check the ingredients to see if “whole wheat” or “whole grain” is thefirstingredient listed. And don’t be fooled by how a food looks. For example, some dark brown breads are colored with coffee or other dyes, not whole grains. And remember, whole grain rice is brown, not white rice.
  • Avoid food that is high in sugar, like pastries, sweetened cereal, and soda or fruit-flavored drinks.
  • Reduced-fat or no-fat (skim) milk, reduced-fat cheese, and low-fat or no-fat yoghurt are good sources of the protein and calcium we need. Try to eat 2-4 servings of low-fat or no-fat dairy products each day.

Exercise Does More Than Burn Calories

Increasing the amount of exercise you do each day means you burn more calories to help you lose weight.  And, research has shown very clearly that 30 minutes of moderately strenuous daily exercise is also one of the most important requirements for disease prevention – even for people who are already at an ideal weight.  The exercise you choose doesn’t need to be elaborate, or to take place in a gym.  Walking, biking, swimming, or gardening can do the trick, and getting a friend or family member to exercise with you can turn this into a valued part of your daily routine.  Learn more about the health benefits of physical activity and how to get started from the CDC.

Staying Healthy is a Life-Long Proposition

When we think about dieting, most of us think about setting a weight-loss goal that will determine how long we watch what we’re eating.  A better way to think about it might be to ask yourself the question: How long do I want to try to avoid developing chronic disease? Put in those terms, it’s easy to see that getting control of BMI and eating foods that contribute to continuing good health (or that don’t directly contribute to the development of dangerous disease conditions) is not a short-term goal.  For many of us, doing what it takes to get our BMI into a healthy range and to keep it there means learning to live our lives in a new way. Scientists have found that one of the keys to success is to think about these goals every day. For example, people who get on a scale and check their weight daily are more successful at keeping their weight under control than people who don’t.

Don’t Waste Your Time, Energy, and Money on “Quick Fix” Solutions

For some people, there may be faster ways to lose weight than following the diet suggestions listed here.  But the important thing to remember is that weight loss is not the only goal.  The more important goal is to keep your risk of developing chronic disease and dying younger as low as possible.  Fad diets, diet pills, protein powders, liposuction, and even intestinal or gastric bypass surgery might provide a leaner profile, but they don’t provide the nutrients needed to keep you as healthy as you could be.

For more information about BMI and how it is calculated, see Obesity in America: Are You Part of the Problem? Mozaffarian D, Hao T, Rimm, EB, et al. Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men. The New England Journal of Medicine. 2001;364:2392-404.

A very useful demonstration of the trend toward larger portion sizes can be found in the two “Portion Distortion” slide sets that you can view at http://hp2010.nhlbihin.net/portion/.

Some fats that are liquid at room temperature, like coconut oil, are still high in saturated fats. Check the nutrition label before you buy, to be sure that you’re choosing the product with the lowest possible saturated fat content.

Will Acai Help Me Lose Weight?

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

If you are trying to lose weight to prevent cancer, you may notice that there are claims that the acai (AH-sah-EE) berry will help you lose weight. Dieters beware: these claims are false. Ads promising weight loss have been spotted on popular social networking sites and search engines. Before you give out your credit card number, read on!

The acai palm produces a very small berry that is found in South and Central America. It has become popular in the United States over the last few years. While there are plenty of good things about the fruit, make no mistake-there are no special properties that make you suddenly or quickly lose weight. Acai does have antioxidants-a substance our bodies need-but no more than cranberries or cherries, and less than blueberries, pomegranate, and grapes.[1]

Here are some tips that have been scientifically proven to help you lose weight:

  • Exercise on a regular basis-most days of the week
  • Eat well-balanced, nutritious meals
  • Start each day off with breakfast
  • Get enough sleep (at least 7-9 hours)

It is important to remember that if a product claims fast weight loss, either the product is risky or the claims are false. Healthy, safe weight loss consists of losing no more than two pounds per week-that’s 7,000 fewer calories consumed than burned off each week, since one pound equals 3,500 calories. Weight loss at the rate of .5 to 2 pounds per week is more likely to be permanent. If acai really were a miracle weight loss product, there would be no obesity epidemic in the United States! So please, use your better judgment next time you are tempted to buy an acai weight loss product.

Reference:

  1. Navindra P. Seeram, Michael Aviram, Yanjun Zhang, Susanne M. Henning, Lydia Feng, Mark Dreher, David Heber. Comparison of Antioxidant Potency of Commonly Consumed Polyphenol-Rich Beverages in the United States. Journal of Agricultural and Food Chemistry 2008 56 (4), 1415-1422.

Fast Food Facts: Calories and Fat

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

Fast Food Facts

Let’s face it: With so much to do, it’s hard to eat right on the go.  And no matter how compelling you found the movies Fast Food Nation or Super Size Me, you sometimes find yourself making the occasional purchase at the nearest Wendy’s. While avoiding fast food may be the wisest and most health-conscious option, it may not be the most realistic.

With so many Americans being obese, President Obama signed a new law into the health care reform bill that requires every big restaurant chain (more than 20 stores) to post calorie information on every menu and drive-thru sign, as well as the amount of calories a healthy person should eat. The bill went into effect in this year.  The law also requires vending machines to have nutritional information on them

How Many Calories Should I be Consuming in a Day?

The United States Department of Agriculture (USDA) has recommended dietary guidelines that include the number of calories you should consume a day, depending on your age, level of activity, and whether you are a man or woman. The chart below will help you find out how many calories you should be getting. If you regularly consume more than the recommended amount, you will gain weight.

Recommended Daily Calorie Intake by Gender and Age based on Activity Level

Activity Level
Gender

Age (years)

Sedentary

Moderately Active

Active
Child

2-3

1,000

1,000-1,400

1,000-1,400
Female

4-8
9-13
14-18
19-30
31-50
51+

1,200
1,600
1,800
2,000
1,800
1,600

1,400-1,600
1,600-2,000
2,000
2,000-2,200
2,000
1,800

1,400-1,800
1,800-2,200
2,400
2,400
2,200
2,000-2,200
Male

4-8
9-13
14-18
19-30
31-50
51+

1,400
1,800
2,200
2,400
2,200
2,000

1,400-1,600
1,800-2,200
2,400-2,800
2,600-2,800
2,400-2,600
2,200-2,400

1,600-2,000
2,000-2,600
2,800-3,200
3,000
2,800-3,000
2,400-2,800

Source: HHS/USDA Dietary Guidelines for Americans, 2005 

Sedentary means a lifestyle that includes only the light physical activity associated with typical day-to-day life. Moderately active means a lifestyle that includes physical activity equivalent to walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life.  Active means a lifestyle that includes physical activity equivalent to waling more than 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life. The calorie ranges shown are to accommodate needs of different ages within the group. For children and adolescents, more calories are needed at older ages. For adults, fewer calories are needed at older ages. So we at the Cancer Prevention and Treatment Fund give you the skinny on a variety of menu choices offered by some of the most popular fast food chains. Take a look–you may be surprised!

Fast Foods by Category

Pizza: Calories Fat
California Pizza Kitchen Original BBQ Chicken (whole pizza) 1136 19 grams
Domino’s Medium Ultimate Deep Dish EXtravaganZZa Feast, 1 slice 12″ 320 16 grams
Domino’s Cheese, 1 slice 12″ 210 8 grams
Papa John’s Garden Fresh on Original Crust, 1 slice 12″ 200 7 grams
Papa John’s Spinach Alfredo on Original Crust, 1 slice 12″ 210 8 grams
Pizza Hut Thin n’ Crispy, Pepperoni, 1 slice 12′ 200 9 grams
Pizza Hut Fit n’ Delicious Pizzawith Green Pepper, Red Onion, and Diced Tomato, 1 slice 150 4 grams
Hamburgers: Calories Fat
Burger King Whopper (with cheese) 770 48 grams
Five Guys (with cheese) 610 34 grams
McDonald’s Quarter Pound with cheese 510 26 grams
Wendy’s ¼ Pound Single Hamburger 470 21 grams
Chicken Strips: Calories Fat
Burger King 8 Piece Chicken Tenders 360 21 grams
McDonalds Chicken Selects Premium Breast Strips (5) 660 40 grams
Wendy’s 10 Piece Chicken Nuggets 450 29 grams
French Fries: Calories Fat
Burger King Medium Fries 440 22 grams
Five Guys 310 15 grams
McDonald’s Medium Fries 380 19 grams
Wendy’s Medium Fries 410 19 grams
Burritos: Calories Fat
Baja Fresh Chicken Burrito Ultimo 880 36 grams
Baja Fresh Bean and Cheese Burrito 840 33 grams
Chipotle Chicken (with rice, beans, sour cream and cheese) 950 37 grams
Taco Bell Burrito Supreme, Chicken 390 12 grams
Sandwiches: Calories Fat
Burger King Tender Grill Chicken (no mayo) 410 7 grams
McDonald’s Premium Grilled Chicken Classic 420 10 grams
Panera Turkey Artichoke Panini 750 24 grams
Panera Bacon Turkey Bravo 830 29 grams
Quiznos Honey Mustard Chicken Sub, Regular 830 41 grams
Quiznos Tuna Melt, Regular 1220 94 grams
Subway Turkey, 6 inch (no mayo) 280 3.5 grams
Wendy’s Ultimate Chicken Grill 370 7 grams
Salads (no dressing): Calories Fat
Burger King Tendergrill Chicken Garden 300 10 grams
McDonald’s Premium Southwest Salad with Grilled Chicken 320 9 grams
Panera Greek Salad 380 34 grams
Panera Strawberry and Poppyseed Chicken Salad 280 8 grams
Quiznos Chicken Caesar, Regular 440 16.5 grams
Quiznos Raspberry Chipotle Chicken, Regular 520 25 grams
Subway Oven Roasted Chicken, Fat-Free Italian dressing 130 2.5 grams
Wendy’s Mandarin Chicken Salad 390 16 grams
Muffins: Calories Fat Sugar
Au Bon Pain Cranberry Walnut 540 25 grams 28 g
Dunkin Donuts Blueberry 510 16 grams 51 g
Dunkin Donuts Honey Bran Raisin 500 14 grams 48 g
Starbuck’s Blueberry 470 24 grams 23 g
Starbuck’s Lowfat Blueberry 430 2.5 grams 57 g
Donuts: Calories Fat Sugar
Dunkin Donuts Glazed Donut 220 9 grams 12 g
Krispy Kreme Original Glazed Donut 200 12 grams 10 g
Starbuck’s Old-fashioned Glazed Donut 420 21 grams 34 g
Bagels: Calories Fat
Dunkin Donuts Everything 350 4.5 grams
Einstein’s Asiago Cheese Bagel 310 5 grams
Einstein Everything 270 2 grams
Starbuck’s Plain 300 1 gram
Other Breakfast: Calories Fat
Burger King Sausage, Egg, and Cheese Biscuit 550 37 grams
Dunkin Donuts Egg and Cheese Bagel 510 6 grams
McDonald’s Sausage McMuffin with Egg 450 27 grams
Starbuck’s Cheese Danish 420 25 grams
Starbuck’s Banana Walnut Loaf 350 16 grams
Coffee: Calories Fat Sugar
Dunkin Donuts Mocha Swirl Latte (10 oz) 220 6 grams 32 g
Dunkin Donuts Coolatta with Skim Milk (16 oz) 210 0 grams 49 g
Dunkin Donuts Latte (10oz) 120 6 grams 10 g
Dunkin Donuts Coffee (14oz), (no milk or sugar) 10 0 grams 0 g
Starbuck’s Caramel Frappuccino, Grande with Whip 390 15 grams 59 g
Starbuck’s Caffè Mocha, Grande 2% Milk, no Whip 260 8 grams 31 g
Starbuck’s Caffè Latte, Grande 2% Milk 190 7 grams 17 g
Starbuck’s Coffee Frappuccino Light 110 0 grams 23 g
Starbuck’s Caramel Macchiato, Grande 240 7 grams 31 g
Where to find this information?

Several fast food chains and restaurants have their nutrition information on their websites. If your favorite foods are not listed above, go to the chain’s website and look for the calorie information. You may be shocked…or pleasantly surprised! Remember: knowledge is power. Knowing how many calories are in your favorite snack or meal-on-the-go can help you watch your weight and stay health.
Reference:

1http://healthreform.gov/documents/title_iv_prevention_of_chronic_disease.pdf

2 USDA. (2008). Dietary Guidelines for Americans 2005.