Tag Archives: cancer

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.

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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

Exercise, Part 1: Exercise Postpones Death

Earlier this month, many folks made New Years’ resolutions to start exercising in conjunction with their other resolution to lose excess weight. I’ve got bad news for them.

Exercise is overrated as a pathway to major weight loss.

Sure, a physically inactive young man with only five or 10 pounds (2 to 4 kg) to lose might be able to do it simply by starting an exercise program. That doesn’t work nearly as well for women. The problem is that exercise stimulates appetite, so any calories burned by exercise tend to be counteracted by increased food consumption.

"Should I go with aerobic or strength training....?"

On the other hand, exercise is particularly important for diabetics and prediabetics in two respects: 1) it helps in avoidance of overweight, especially after weight loss, and 2) it helps control blood sugar levels by improving insulin resistance, perhaps even bypassing it.

Even if it doesn’t help much with weight loss, regular physical activity has myriad general health benefits. First, let’s look at its effect on death rates.   

EXERCISE PREVENTS DEATH

As many as 250,000 deaths per year in the United States (approximately 12% of the total) are attributable to a lack of regular physical activity. We know now that regular physical activity can prevent a significant number of these deaths.

Exercise induces metabolic changes that lessen the impact of, or prevent altogether, several major illnesses, such as high blood pressure, coronary artery disease, diabetes, and obesity. There are also psychological benefits. Even if you’re just interested in looking better, awareness of exercise’s other advantages can be motivational.

Exercise is defined as planned, structured, and repetitive bodily movement done to improve or maintain physical fitness.

Physical fitness is a set of attributes that relate to your ability to perform physical activity. These attributes include resting heart rate, blood pressure at rest and during exercise, lung capacity, body composition (weight in relation to height, percentage of body fat and muscle, bone structure), and aerobic power.

Aerobic power takes some explanation. Muscles perform their work by contracting, which shortens the muscles, pulling on attached tendons or bones. The resultant movement is physical activity. Muscle contraction requires energy, which is obtained from chemical reactions that use oxygen. Oxygen from the air we breathe is delivered to muscle tissue by the lungs, heart, and blood vessels. The ability of the cardiopulmonary system to transport oxygen from the atmosphere to the working muscles is called maximal oxygen uptake, or aerobic power. It’s the primary factor limiting performance of muscular activity.

Aerobic power is commonly measured by having a person perform progressively more difficult exercise on a treadmill or bicycle to the point of exhaustion. The treadmill test starts at a walking pace and gets faster and steeper every few minutes. The longer the subject can last on the treadmill, the greater his aerobic power. A large aerobic power is one of the most reliable indicators of good physical fitness. It’s cultivated through consistent, repetitive physical activity.

Physical Fitness Effect on Death Rates

Regular physical activity postpones death.

Higher levels of physical fitness are linked to lower rates of death primarily from cancer and cardiovascular disease (e.g., heart attacks and stroke). What’s more, moving from a lower to a higher level of fitness also prolongs life, even for people over 60.

Part 2 of this series will cover all the other health benefits of exercise. Part 3 will outline specific exercise recommendations, such as the type and duration of activity.

Steve Parker, M.D.

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THIS Is Why I Love the Mediterranean Diet

Italian researchers reviewed the medical/nutrition literature of the last three years and confirmed that the Mediterranean diet 1) reduces the risk of death, 2) reduces  heart disease illness and death, 3) cuts the risk of getting or dying from cancer, and 4) diminishes the odds of developing dementia, Parkinsons disease, stroke, and mild cognitive impairment.

These same investigators published a similar meta-analysis in 2008, looking at 12 studies.  Over the ensuing three years (as of June, 2010), seven new prospective cohort studies looked at the health benefits of the Mediterranean diet.  The report at hand is a combination of all 19 studies, covering over 2,000,000 participants followed for four to 20 years.  Nine of the 19 Mediterranean diet studies were done in Europe.

The newer studies, in particular, firmed up the diet’s protective effect against stroke, and added protection against mild cognitive impairment.

So What?

The Mediterranean diet: No other way of eating has so much scientific evidence that it’s healthy and worthy of adoption by the general population.  Not the DASH diet, not the “prudent diet,” not the American Heart Association diet, not vegetarian diets, not vegan diets, not raw-food diets, not Esselstyne’s diet, not Ornish’s diet, not Atkins diet, not Oprah’s latest diet, not the Standard American Diet, not the  . . . you name it. 

Not even the Low-Carb Mediterranean Diet.

Just as important, the research shows you don’t have to go full-bore Mediterranean to gain a health and longevity benefit.  Adopting  just a couple Mediterranean diet features yeilds a modest but sigificant gain.  For a list of Mediterranean diet components, visit Oldways or the Advanced Mediterranean Diet website. 

Steve Parker, M.D.

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

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Filed under coronary heart disease, Health Benefits, Mediterranean Diet

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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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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Do Fruits and Vegetables Really Help Prevent Disease?

How many times have you heard how important it is to eat fruits  and vegetables?  Now, is it five or nine servings a day?  Why are fruits and veggies always lumped together?  What does a watermelon have in common with spinach?

The author of a 2004 article in the Journal of Postgraduate Medicine answered some of these questions.  Here are a few quotes from from the summary:

The intake of 400-600 g/d of fruits and vegetables is associated with reduced incidence of many common forms of cancer, and diets rich in plant foods are also associated with a reduced risk of heart disease and many chronic diseases of ageing.

These foods contain phytochemicals that have anti-cancer and anti-inflammatory properties which confer many health benefits. Many phytochemicals are colourful, and recommending a wide array of colourful fruits and vegetables is an easy way to communicate increased diversity of intake to the consumer. For example, red foods contain lycopene, the pigment in tomatoes, which is localized in the prostate gland and may be involved in maintaining prostate health, and which has also been linked with a decreased risk of cardiovascular disease. Green foods, including broccoli, Brussels sprouts and kale, contain glucosinolates which have also been associated with a decreased risk of cancer. Garlic and other white-green foods in the onion family contain allyl sulphides which may inhibit cancer cell growth. Other bioactive substances in green tea and soybeans have health benefits as well.

Consumers are advised to ingest one serving of each of the seven colour groups daily, putting this recommendation within the United States National Cancer Institute and American Institute for Cancer Research guidelines of five to nine servings per day. Grouping plant foods by colour provides simplification, but it is also important as a method to help consumers make wise food choices and promote health.

Asking U.S. consumers to eat one serving from each of seven fruit and vegetable color groups daily is a bit much.  I don’t see that happening.  But the suggestion is a start.  Darya Pino (Summer Tomato blog) probably does it every day, but I don’t know any others.  My simplified message: Eat a variety of colorful fruits and veggies daily.

Note that the very low-carb Ketogenic Mediterranean Diet provides 400 grams of vegetables and fruits daily, and I count seven colors (assuming you allow me to include black olives).  On the KMD document I list avocado, cucumber, and tomato under “vegetables,” but they are indeed fruits.  Heck, I guess olives are fruit, too.

“So, what’s your point, Parker,” you might well ask.  I don’t expect anyone to follow the Ketogenic Mediterranean Diet for life.  When it’s time to move on to a “Diabetic Mediterranean Diet,” I’m considering adding more options: traditional fruits and some colorful vegetables like purple beets, yellow corn, and orange carrots and sweet potatoes.

I still don’t know why “fruits and vegetables” are joined at the hip.  Legumes, grains, and dairy products all rate their very own category.  It’s just not fair.

Steve Parker, M.D.

Reference:  Heber, D.  Vegetables, fruits and phytoestrogens in the prevention of diseases.  Journal of  Postgraduate Medicine, 50 (2004): 145-9.

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Alcohol Types Other Than Wine Increase Risk of Cancer in Men

Merlot, or Welch's Grape Juice?

Merlot, or Welch's Grape Juice?

Researchers recently reported that Canadian men who are regular alcohol drinkers – on a daily or weekly basis – have a higher risk of cancer of the esophagus, stomach, colon, liver, lung, and prostate.  The more men drink, the greater the risk.

The investigators suspect that alcohol may be responsible for up to 5% of all invasive cancer deaths.  Their article abstract does not address the possibility that regular drinkers may live longer than non-drinkers despite increased risk of cancer. 

Readers of this blog will note that I am a bit of an advocate of alcohol consumption – for carefully selected people – for prolongation of life and reduction of cardiovascular disease.  I’m also on record as favoring wine over other alcoholic beverages for these potential benefits.

I happy to report that the Canadians did not find an association between wine consumption and cancer

Steve Parker, M.D.  

Reference:  Benedetti, Andrea, et al.  Lifetime consumption of alcoholic beverages and risk of 13 types of cancer in men:  results of a case-control study in MontrealCancer Detection and Prevention, 32 (2009): 352-362.

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Adverse Health Effects of Obesity

"I'm not fat, I'm chubby"

"I'm not fat, I'm chubby"

As a physician, I see many illnesses and conditions that are caused or aggravated by overweight and obesity.  Both terms refer to excess body fat; obesity is a greater degree of fat.

Body mass index (BMI) is used to define overweight and obesity.  Your BMI is your weight in kilograms divided by your height in meters squared.  A BMI between 18.5 and 25 is considered healthy.  BMIs between 25 and 30 are overweight.  Here’s an online BMI calculator.  For example, a 5-foot, 4-inch person enters obesity territory – BMI over 30 – when weight reaches 174 pounds (79 kilograms).  A 5-foot, 10-incher is obese starting at 208 pounds (94.5 kilograms).

People trying to lose excess fat typically have days when willpower, discipline, and commitment waver.  On those days, it can help to remember why they started this adventure in the first place.  The reasons for many involve improved health and longevity.  Even if you have just 20 pounds of excess fat to lose, it will often take twenty weeks.  Your weight-loss goal is one to one-and-a-half pounds a week. 

This race is won not by the swift, but by the slow and steady.

Here’s a laundry list of obesity-related conditions to remind you why you want to avoid obesity:

  • Premature death.  It starts at BMI of 30, with a major increase in premature death at BMI over 40.  The U.S. has 200,000 yearly deaths directly attributable to obesity.
  • Arthritis, especially of the knees.
  • Type 2 diabetes melllitus.  Eight-five percent of people with type 2 diabetes are overweight.
  • Increased cardiovascular disease risk, especially with an apple-shaped fat distribution as compared to pear-shaped.  Cardiovascular disease includes heart attacks, high blood pressure, strokes, and peripheral arterial disease (poor circulation).
  • Obstructive sleep apnea.
  • Gallstones are three or four times more common in the obese.
  • High blood pressure.  At least one third of cases are caused by excess body fat.  Every 20 pounds of excess fat raises blood pressure 2-3 points (mmHg).
  • Tendency to higher total and LDL cholesterol, higher triglycerides, while lowering HDL cholesterol.  These lipid changes are associated with hardening of the arteries – atherosclerosis – which can lead to heart attacks, strokes, and peripheral arterial disease.
  • Increased cancers.  Prostate and colorectal in men.  Endometrial, gallbladder, cervix, ovary, and breast in women.  Kidney and esophageal adenocarcinoma in both sexes.  Excess fat contributes to 14-20% of all cancer-related deaths in the U.S.  Over 550,000 people die from cancer in the U.S. yearly.  Twenty percent of us will die from cancer.
  • Strokes.
  • Low back pain.
  • Gout.
  • Varicose veins.
  • Hemorrhoids.
  • Blood clots in legs and lungs.
  • Surgery complications: poor wound healing, blood clots, wound infection, breathing problems.
  • Pregnancy complications: toxemia, high blood pressure, diabetes, prolonged labor, greater need for C-section.
  • Fat build-up in liver.
  • Asthma.
  • Low sperm counts.
  • Decreased fertility.
  • Delayed or missed diagnosis due to difficult physical examination or weight exceeding the limit of diagnostic equipment.

I hope you find this information motivational rather than depressing.  For those already obese, weight loss can significantly improve, alleviate, or prevent these conditions.  Many obesity-related medical conditions and metabolic abnormalities are improved with loss of just five or 10% of total body weight.  For instance, a 240 pound man with mild diabetes and high blood pressure may be able to reduce or avoid drug therapy by losing just 12 to 24 pounds.  He’s still obese, but healthier.

Steve Parker, M.D. 

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Health Benefits of Nuts

You just don't see sickly squirrels.  Hmmm . . .

You just don't see sickly squirrels. Hmmm . . .

I frequently check in at CalorieLab for up-to-date nutrition news.

Karen Collins, M.S., R.D., C.D.N., was a guest contributor there March 14, 2009, writing about the potential health benefits of nuts.  I was aware of the cardiovascular benefits; she taught me about possible salutary effects on cancer and diabetes.

From my own literature review, the cardiac benefits are associated with a nut “dose” of three to five 1-ounce servings a week.

Last December, I blogged about reversal of metabolic syndrome with a Mediterranean Diet supplemented with nuts.

I recommend Ms. Collins’ article to you. 

Steve Parker, M.D.

Reference:  Albert, Christine, et al.  Nut consumption and decreased risk of sudden cardiac death in the Physicians’ Health StudyArchives of Internal Medicine, 162, (2002): 1,382-1,387.

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