Category Archives: cancer

Meat and Mortality

Red meat and processed meat consumption are associated with “modest” increases in overall mortality and deaths from cancer and cardiovascular disease, according to National Institutes of Health researchers.  This goes for both sexes.

Data are from the huge NIH-AARP Diet and Heart Study, a prospective cohort trial involving  over 550,000 U.S. men and women aged 50-71 at the time of enrollment.  Food consumption was determined by questionnaire.  Over the course of 10 years’ follow-up, over 65,000 people died.  Investigators looked to see if causes of death were related to meat consumption.

What do they mean by red meat, processed meat, and white meat?

Red meat:  all types of beef and pork (wasn’t there a U.S. ad campaign calling pork “the other white meat”?}

White meat:  chicken, turkey, fish

Processed meat:  bacon, red meat sausage, poultry sausage, luncheon meats (red and white), cold cuts (red and white), ham, regular hotdogs, low-fat poultry hotdogs, etc.

What did they find?

See the first paragraph above.

Studies like this typically look at the folks who ate the very most of a given type of food, those who ate the very least, then compare differences in deaths between the two groups.  That’s what they did here, too.  For instance, the people who ate the very most red meat ate 63 grams per 1000 caories of food daily.  Those who ate the least ate 10 grams per 1000 cal of food daily.  That’s about a six-fold difference.  Many folks eat 2000 calories a day.  The high red meat eaters on 2000 cals a day would eat 123 grams, or 4.4 ounces of red meat.  The low red meat eaters on 2000 cals/day ate 20 grams, or 0.7 ounces.

The heavy consumers of processed meats ate 23 grams per 1000 cal of food daily.  The lowest consumers ate 1.6 grams per 1000 cal.

Comparing these two quintiles of high and low consumption of red and processed meats, overall mortality was 31-36% higher for the heavy red meat eaters, and 16-25% higher for the heavy processed meat eaters.  (The higher numbers in the ranges are for women.)  Similar numbers were found when looking at cancer deaths and cardiovascular deaths (heart attacks, strokes, ruptured aneurysms, etc).

It’s not proof that heavy consumption of red and processed meats is detrimental to longevity, but it’s suggestive.  The “Discussion” section of the article reviews potential physiological mechanisms for premature death.

The researchers called these differences “modest.”  I guess they use “modest” since most people eat somewhere between these extreme quintiles.  The numbers incline me  to stay out of that “highest red and processed meat consumer” category, and lean more towards white meat and fish.

The study at hand is from 2009.  Another research report in Archives of Internal Medicine this month supported similar conclusions. (Click for Zoë Harcombe’s critique of the study.)

The traditional Mediterranean diet and Advanced Mediterranean Diet are naturally low in red and processed meats, but not designed specifically for folks with diabetes.

Steve Parker, M.D. 

Reference:  Sinha, Rashmi, et al.  Meat intake and mortality: a prospective study of over half a million peopleArchives of Internal Medicine, 169 (2009): 562-571.

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Filed under cancer, coronary heart disease, Stroke

Got Spare Time?: Track Your Omega-3 and Omega-6 Fatty Acid Consumption

One of the major changes in the Western diet over the last century has been the increase in our consumption of omega-6 fatty acids, primarily in the form of industrial seed oils.  Examples include oils derived from soybeens, corn, and rapeseed (canola oil).  Omega-6 fatty acid consumption in the U.S. increased by 213% since 2009.  This may have important implications for development of certain chronic diseases like cancer and heart disease.  Excessive omega-6 consumption may be harmful.  On the other hand, omega-3 fatty acid consumption may prevent or mitigate the damages.  Hence, the omega-6/omega-3 ratio becomes important.

This’ll improve your omega-6/omega-3 ratio!

I haven’t studied this issue in great detail but hope to do so at some point.  Evelyn Tribole has strong opinions on it; I may get one of her books.

I saw an online video of William E.M.Lands, Ph.D., discussing the omega-6/omega-3 ratio.  He mentioned free software available from the National Insitutes of Health that would help you monitor and adjust your ratio.

You can see the video here.  Dr. Lands’ talk starts around minute 12 and lasts about 45 minutes.  He says it’s just as important (if not more so) to reduce your omega-6 consumption as to increase your omega-3.  And don’t overeat.

Steve Parker, M.D.

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Filed under cancer, coronary heart disease, Fat in Diet

Book Review: Zest For Life – The Mediterranean Anti-Cancer Diet

I recently read Zest For Life: The Mediterranean Anti-Cancer Diet, by Conner Middelmann-Whitney.  I give it five stars per Amazon.com’s rating system.

♦   ♦   ♦

The lifetime risk of developing invasive cancer in the U.S. is four in ten: a little higher for men, a little lower for women.  Those are scary odds.  Cancer is second only to heart disease as a cause of death in western societies.  The Mediterranean diet has a well established track record of protecting against cancers of the prostate, colon/rectum, uterus, and prostate.  Preliminary data suggest protection against melanoma and stomach cancer, too.  I’m not aware of any other way of eating that can make similar claims. 

So it makes great sense to spread the word on how to eat Mediterranean-style, to lower your risk of developing cancer.  Such is the goal of Ms. Conner Middelmann-Whitney.  The Mediterranean diet is mostly, although by no means excusively, plant-based.  It encourages consumption of natural, minimally processed, locally grown foods.  Generally, it’s rich in vegetables, fruits, legumes, oive oil, whole grains, red wine, and nuts.  It’s low to moderate in meat, chicken, fish, eggs, and dairy products (mostly cheese and yogurt).

Note that one of the four longevity hot spots featured in Dan Buettner’s Blue Zones was Mediterranean: Sardinia.  All four Blue Zones were characterized by plant-based diets of minimally processed, locally grown foods.  (I argue that Okinawa and the Nicoya Peninsula dwellers ate little meat simply due to economic factors.)

Proper diet won’t prevent all cancer, but perhaps 10-20% of common cancer cases, such as prostate, breast, colorectal, and uterine cancer.  A natural, nutrient-rich, mostly plant-based diet seems to bolster our defense against cancer.

Ms. Middelmann-Whitney is no wacko claiming you can cure your cancer with the right diet modifications.  She writes, “…I do not advocate food as a cancer treatment once the disease has declared itself….” 

She never brings it up herself, but I detect a streak of paleo diet advocacy in her.  Several of her references are from Loren Cordain, one of the gurus of the modern paleo diet movement.  She also mentions the ideas of Michael Pollan very favorably.

She’s not as high on whole grains as most of the other current nutrition writers.  She points out that, calorie for calorie, whole grains are not as nutrient-rich as vegetables and fruits.  Speaking of which, she notes that veggies generally have more nutrients than fruits.  Furthermore, she says, grain-based flours probably contribute to overweight and obesity.  She suggests that many people eat too many grains and would benefit by substituting more nutrient-rich foods, such as veggies and fruits.

Some interesting things I learned were 1) the 10 most dangerous foods to eat while driving, 2) the significance of organized religion in limiting meat consumption in some Mediterranean regions, 3) we probably eat too many omega-6 fatty acids, moving the omega-6/omega-3 ratio away from the ideal of 2:1 or 3:1, 4) one reason nitrites are added to processed meats is to create an pleasing red color (they impair bacterial growth, too), 5) fresh herbs are better added towards the end of cooking, whereas dried herbs can be added earlier, 6) 57% of calories in western societies are largely “empty calories:” refined sugar, flour, and industrially processed vegetable oils,  and 7) refined sugar consumption in the U.S. was 11 lb (5 kg) per person in the 1830s, rising to 155 lb (70 kg) by 2000.

Any problems with the book?  The font size is a bit small for me; if that worries you, get the Kindle edition and choose your size.  She mentions that omega-6 and omega-3 fatty acids as “essential” fats. I bet she meant to say that linolenic and linoleic fatty acids are essential (our bodies can’t make them); linolenic happens to be an omega-3, linoleic is an omega-6.  Reference #8 in chapter three is missing.  She states that red and processed meats cause cancer, or at least are strongly linked; in my view, the studies are inconclusive.  I’m not sure that cooking in or with polyunsaturated plant oils causes formation of free radicals that we need to worry about.

As would be expected, the author and I don’t see eye to eye on everything.  For example, she worries about bisphenol-A, pesticide residue, saturated fat, excessive red meat consumption, and strongly prefers pastured beef and free-range chickens and eggs.  I don’t worry.  She also subscribes to the “precautionary principle.”

The author shares over 150 recipes to get you started on your road to cancer prevention.  I easily found 15 I want to try.  She covers all the bases on shopping for food, cooking, outfitting a basic kitchen, dining out, shopping on a strict budget, etc.  Highly practical for beginning cooks.  Numerous scientific references are listed for you skeptics.

I recommend this book to all adults with normal carbohydrate metabolism, particularly for those with a strong family history of cancer.  But following the author’s recommendations would do more than lower your risk of cancer.  You’d likely have a longer lifespan, lose some excess fat weight,  and lower your risk of type 2 diabetes, dementia, heart disease, stroke, vision loss from macular degeneration, and obesity.  Particularly compared to the standard American diet. 

Steve Parker, M.D.

Disclosure: The author arranged a free copy of the book for me, otherwise I recieved nothing of value for writing this review.

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Filed under Book Reviews, cancer, Health Benefits, Mediterranean Diet

Health Benefits of the Mediterranean Diet

The enduring popularity of the Mediterranean diet is attributable to three things:

1.       Taste

2.       Variety

3.       Health benefits

For our purposes today, I use “diet” to refer to the usual food and drink of a person, not a weight-loss program.

The scientist most responsible for the popularity of the diet, Ancel Keys, thought the heart-healthy aspects of the diet related to low saturated fat consumption.  He also thought the lower blood cholesterol levels in Mediterranean populations (at least Italy and Greece) had something to do with it, too.  Dietary saturated fat does tend to raise cholesterol levels.

Even if Keys was wrong about saturated fat and cholesterol levels being positively associated with heart disease, numerous studies (involving eight countries on three continents) strongly suggest that the Mediterranean diet is one of the healthiest around.  See References below for the most recent studies.

Relatively strong evidence supports the Mediterranean diet’s association with:

■ increased lifespan

■ lower rates of cardiovascular disease such as heart attacks and strokes

■ lower rates of cancer (prostate, breast, uterus, colon)

■ lower rates of dementia

■ lower incidence of type 2 diabetes

Weaker supporting evidence links the Mediterranean diet with:

■ slowed progression of dementia

■ prevention of cutaneous melanoma

■ lower severity of type 2 diabetes, as judged by diabetic drug usage and fasting blood sugars

■ less risk of developing obesity

■ better blood pressure control in the elderly

■ improved weight loss and weight control in type 2 diabetics

■ improved control of asthma

■  reduced risk of developing diabetes after a heart attack

■ reduced risk of mild cognitive impairment

■  prolonged life of Alzheimer disease patients

■ lower rates and severity of chronic obstructive pulmonary disease

■ lower risk of gastric (stomach) cancer

■ less risk of macular degeneration

■ less Parkinsons disease

■ increased chance of pregnancy in women undergoing fertility treatment

■  reduced prevalence of metabolic syndrome (when supplemented with nuts)

■ lower incidence of asthma and allergy-like symptoms in children of women who followed the Mediterranean diet while pregnant

Did you notice that I used the word “association” in relating the Mediterranean diet to health outcomes?  Association, of course, is not causation. 

The way to prove that a particular diet is healthier is to take 20,000 similar young adults, randomize the individuals in an interventional study to eat one of two test diets for the next 60 years, monitoring them for the development of various diseases and death.  Make sure they stay on the assigned test diet.  Then you’d have an answer for that population and those two diets.  Then you have to compare the winning diet to yet other diets.  And a study done in Caucasians would not necessarily apply to Asians, Native Americans, Blacks, or Hispanics.

Now you begin to see why scientists tend to rely on observational  rather than interventional diet studies.

I became quite interested in nutrition around the turn of the century as my patients asked me for dietary advice to help them lose weight and control or prevent various diseases.  At that time, the Atkins diet, Mediterranean diet, and Dr. Dean Ornish’s vegetarian program for heart patients were all popular.  And you couldn’t pick three programs with more differences!  So I had my work cut out for me. 

After much scientific literature review, I find the Mediterranean diet to be the healthiest for the general population.  People with particular medical problems or ethnicities may do better on another diet.  People with diabetes or prediabetes are probably better off with a carbohydrate-restricted diet, such as the Low-Carb Mediterranean Diet

Dan Buettner makes a good argument for plant-based diets in his longevity book, The Blue Zones.  The Mediterranean diet qualifies as plant-based.

What do you consider the overall healthiest diet, and why?

Steve Parker, M.D.

References:

Sofi, Francesco, et al.  Accruing evidence about benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysisAmerican Journal of Clinical Nutrition, ePub ahead of print, September 1, 2010.  doi: 10.3945/ajcn.2010.29673

Buckland, Genevieve, et al.  Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort studyAmerican Journal of Clinical Nutrition, December 9, 2009, epub ahead of print.  doi: 10.3945/ajcn.2009.28209

Fortes, C., et al.  A protective effect of the Mediterraenan diet for cutaneous melanoma.  International Journal of Epidmiology, 37 (2008): 1,018-1,029.

Sofi, Francesco, et al.  Adherence to Mediterranean diet and health status: Meta-analysis.  British Medical Journal, 337; a1344.  Published online September 11, 2008.  doi:10.1136/bmj.a1344

Benetou, V., et al.  Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort.  British Journal of Cancer, 99 (2008): 191-195.

Mitrou, Panagiota N., et al.  Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population,  Archives of Internal Medicine, 167 (2007): 2461-2468.

Feart, Catherine, et al.  Adherence to a Mediterranean diet, cognitive decline, and risk of dementia.  Journal of the American Medical Association, 302 (2009): 638-648.

Scarmeas, Nikolaos, et al.  Physical activity, diet, and risk of Alzheimer Disease.  Journal of the American Medical Association, 302 (2009): 627-637.

Scarmeas, Nikolaos, et al.  Mediterranean Diet and Mild Cognitive Impairment.  Archives of Neurology, 66 (2009): 216-225.

Scarmeas, N., et al.  Mediterranean diet and Alzheimer disease mortality.  Neurology, 69 (2007):1,084-1,093.

Fung, Teresa, et al.  Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women.  Circulation, 119 (2009): 1,093-1,100.

Mente, Andrew, et al.  A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart DiseaseArchives of Internal Medicine, 169 (2009): 659-669.

Salas-Salvado, Jordi, et al.  Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial.  Archives of Internal Medicine, 168 (2008): 2,449-2,458.

Mozaffarian, Dariush, et al.  Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors.  Lancet, 370 (2007) 667-675.

Esposito, Katherine, et al.  Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetesAnnals of Internal Medicine, 151 (2009): 306-314.

Shai, Iris, et al.  Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.  New England Journal of Medicine, 359 (2008): 229-241.

Martinez-Gonzalez, M.A., et al.  Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study.  British Medical Journal, BMJ,doi:10.1136/bmj.39561.501007.BE (published online May 29, 2008).

Trichopoulou, Antonia, et al.  Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort studyBritish Medical Journal, 338 (2009): b2337.  DOI: 10.1136/bmj.b2337.

Barros, R., et al.  Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control.  Allergy, vol. 63 (2008): 917-923.

Varraso, Raphaelle, et al.  Prospective study of dietary patterns and chronic obstructive pulmonary disease among US men.  Thorax, vol. 62, (2007): 786-791

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Filed under cancer, coronary heart disease, Health Benefits, Mediterranean Diet, Prevention of T2 Diabetes

Mediterranean Diet Lowers Risk of Breast Cancer

A study in the current issue of the American Journal of Clinical Nutrition associates the Mediterranean diet with lower risk of breast cancer in postmenopausal women.

The data derive from the Greek portion of the massive EPIC study: European Prospective Investigation Into Cancer and nutrition.  Investigators followed almost 15,000 women for 10 years.  No protective effect was seen for premenopausal women eating Mediterranean-style.  The study at hand adds to prior evidence that the Mediterranean diet seems to protect against cancer of the breast, prostate, uterus, and colon/rectum.

Steve Parker, M.D.

Reference:  Trichopoulou, Antonia, et al.  Conformity to traditional Mediterranean diet and breast cancer risk in the Greek EPIC (European Prospective Investigation into Cancer and nutrition) cohortAmerican Journal of Clinical Nutrition, published July 14, 2010.  doi: 10.3945/ajcn.2010.29619

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Filed under cancer, Health Benefits, Mediterranean Diet

Cancer and Diabetes: Any Connection?

ResearchBlogging.orgType 2 diabetes is associated with higher incidence of several cancers: liver, pancreas, uterus, colo-rectal, breast, and bladder.  On a brighter note, diabetics have lower risk of prostate cancer.

That’s about all we know for sure, according to a report from an expert panel convened by the American Diabetes Association and the American Cancer Society and published recently in CA: A Cancer Journal for Clinicians.

The report is focused on type 2 diabetes simply because 95% of all worldwide cases of diabetes are type 2; we have much more data.  [Type 1 diabetes, you may recall, has onset much earlier  in life and is fatal if not treated with insulin injections.  The type 1 pancreas produces no insulin.]

This report is a good summary of all we know about the cancer/diabetes connection in 2010.  What we don’t know far outweighs what we do know.

Does optimal treatment of diabetes reduce cancer risk?  Do particular diabetic medications raise or lower the risk of cancer?  If an overweight diabetic loses excess weight, does the risk of cancer diminish?  Sorry, we don’t know.

In men, 25% of all invasive cancers in the U.S. will be prostate cancer.  In women, breast cancer is the leader, comprising 26% of all cancers.  [Common skin cancers are rarely invasive or fatal and are not included in these statistics.  Melanoma, on the other hand, is invasive.]

The lifetime probability of an individual developing invasive cancer in the U.S. is about 4 in 10 (40%).  A little higher in men (45%), a little lower in women (38%).  The American Cancer Society projected 565,650 deaths from cancer in 2008.  If we look at deaths of people under 85, cancer kills more people than heart disease.

The traditional Mediterranean diet is associated with lower risk of prostate, breast, colon, and uterus cancer.  Three of these, you’ll note, are seen at higher rates in diabetics.

Lack of regular exercise is associated with higher cancer rates. 

If I were a type 2 diabetic wanting to reduce my risk of cancer, I’d be sure to exercise regularly, keep my body mass index under 30 (if not lower), refrain from smoking, consider a Mediterranean-style diet, and ask my doctor to monitor for onset of cancer.

Steve Parker, M.D.

Reference: Giovannucci, E., Harlan, D., Archer, M., Bergenstal, R., Gapstur, S., Habel, L., Pollak, M., Regensteiner, J., & Yee, D. (2010). Diabetes and Cancer: A Consensus Report CA: A Cancer Journal for Clinicians DOI: 10.3322/caac.20078

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Another Sacred Cow Slaughtered: Fruits and Vegetables DON’T Prevent Cancer

We’ve been told by the authorities repetitively that eating plenty of fruits and vegetables will lower our risk of cancer.  However, a recent study in the American Journal of Clinical Nutrition says that ain’t so.

Fire up the grill—we’re havin’ steak tonight!

Researchers looked at data from over 450,000 participants (men and women over 50) in the National Institutes of Health—AARP Diet and Health Study.  Diet data was collected by self-administered questionnaire.  State-level cancer registries identified the cancers that developed during the average follow-up of seven years.

Their conclusions and selected comments:

Intake of fruit and vegetables was generally unrelated to total cancer incidence in this cohort.

However, on the basis of animal studies, human case control and cohort studies, and randomized controlled trials, there is likely no harm associated with the consumption of fruit and vegetables and their consumption may prevent cardiovascular disease.

Indeed, analyses in this cohort and in others that have investigated dietary patterns rich in fruit and vegetables have found reduced risks of colorectal cancer [three references cited] and mortality, including death from cardiovascular disease and all cancers [one reference was cited supporting reduced deaths from CVD and all cancers—a Mediterranean diet study].

As in all good science reports, the researchers compare and contrast their findings with similar published research.  They note that theirs is one of only four large cohort studies that have examined this issue.  Two of the other three (see references below) also found no association between total cancers and fruit and vegetable consumption.  The one that did find a beneficial linkage was the smallest of the four, so not as compelling.

Before this research was published, some experts suggested that adequate fruit and vegetable intake could prevent between 5 and 12% of cancers.

Eat your fruits and vegetables because they taste good, provide myriad nutrients, and may have some other healthful properties.  But not to lower overall cancer risk.  

Steve Parker, M.D.

References:

George, Stephanie, et al.   Fruit and vegetable intake and risk of cancer: a prospective cohort studyAmerican Journal of Clinical Nutrition, 89 (2009): 347-353. 

Hung, H.C., et al.  Fruit and vegetable intake and risk of major chronic disease.  Journal of the National Cancer Institute, 96 (2004): 1,577-1,584.

Takachi, R., et al.  Fruit and vegetable intake and risk of total cancer and cardiovascular disease [in Japan].  American Journal of Epidemiology, 167 (2008): 59-70.

Benetou, V., et al.  Vegetables and fruit in relation to cancer risk: evidence from the Greek EPIC Cohort Study.  Cancer Epidemiology, Biomarkers, and Prevention, 17 (2008): 387-392.

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What Are Phytonutrients and What Have They Done For Me Lately?

Nutrition scientists think that plants have small amounts of numerous “bioactive compounds,” sometimes referred to as phytonutrients, that protect us against disease.

Many scientific studies have looked at groups of people over time, noting the various foods they eat as well as the diseases they develop.  These are called epidemiologic, ecological, or observational studies.  One finding is that lower rates of heart disease, vascular disease, and cancer are seen in people consuming plant-based diets.  “Plant-based” isn’t necessarily vegetarian or vegan.  The traditional Mediterranean diet, for example, is considered by many to be plant-based because meat, fish, and poultry are not prominent compared to plants. 

In contemplating what source of carbohydrates a person with diabetes should eat, I’ve been reviewing the scientific literature to see which sources of carbs might provide the biggest bang for the buck in terms of health and longevity benefits.

Here are some quotes from a 2002 review article in the American Journal of Medicine:

Phenolic compounds, including their subcategory, flavonoids, are present in all plants and have been studied extensively in cereals, legumes, nuts, olive oil, vegetables, fruits, tea, and red wine. Many phenolic compounds have antioxidant properties, and some studies have demonstrated favorable effects on [blood clotting] and [growth of tumors]. Although some epidemiologic studies have reported protective associations between flavonoids or other phenolics and cardiovascular disease and cancer, other studies have not found these associations.

Hydroxytyrosol, one of many phenolics in olives and olive oil, is a potent antioxidant.

Resveratrol, found in nuts and red wine, has antioxidant, [anti-blood-clotting], and anti-inflammatory properties, and inhibits [malignant tumor onset and growth].

Lycopene, a potent antioxidant carotenoid in tomatoes and other fruits, is thought to protect against prostate and other cancers, and inhibits tumor cell growth in animals.

Organosulfur compounds in garlic and onions, isothiocyanates in cruciferous vegetables, and monoterpenes in citrus fruits, cherries, and herbs have [anti-cancer] actions in experimental models, as well as [heart-healthy effects].

In summary, numerous bioactive compounds appear to have beneficial health effects. Much scientific research needs to be conducted before we can begin to make science-based dietary recommendations. Despite this, there is sufficient evidence to recommend consuming food sources rich in bioactive compounds. From a practical perspective, this translates to recommending a diet rich in a variety of fruits, vegetables, whole grains, legumes, oils, and nuts.

The article discusses phytoestrogens—plant chemicals that act in us like the female hormone estrogen—but effects are complex and I suspect we know much more now than we did in 2002 .  Soy products are the most well-known source of phytoestrogens.

The traditional Mediterranean diet is rich in all of the foods mentioned above, except for tea.  Even the Ketogenic Mediterranean Diet includes the aforementioned foods except for tea (I need to add tea and coffee), cereals, and cherries.

Steve Parker, M.D.

Reference:  Kris-Etherton, P.M., et al.  Bioactive compounds in foods: their role in the prevention of cardiovascular disease and cancer.  American Journal of Medicine, 113 (2002. Supplement 9B): 71S-88S.

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Filed under cancer, coronary heart disease, Fruits, Grains, Health Benefits, legumes, Mediterranean Diet, nuts, olive oil