Three Ways to Really Reduce Your Cancer Risk

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In the last Memo before Spring Break, I said I’d cover ways to reduce your risk of getting cancer that really work. Every cancer website has lists, ranging from 10 to 15 recommendations. I’m going to give you my top three ways to reduce the risk of cancer of the items you can control. You can’t control your age or your genetic risk factors, but there are many elements of your health you can control if you work at them.

I’m not including smoking cigarettes or other tobacco products. That’s a no-brainer and shouldn’t even be mentioned, because no one should smoke. (I’m not saying that from my perch on Mount Olympus; I smoked when I was young and foolish, and quitting was one of the best decisions I ever made.)

Dr. Chet’s Top Three Ways to Prevent Cancer

  1. Eat more vegetables and fruits every day and the wider the variety, the better. They don’t have to be organically farmed; you just have to eat eight to ten servings per day. That seems like a lot, and I’m not perfect at it, but you get a new chance every day. Here’s a tip: weigh your produce instead of measuring it. Find out what constitutes a serving in grams or ounces. You may find out that a large banana is actually two servings. Do supplements matter? Yes, but the important point is to eat the fruits and veggies first, then add a multivitamin as backup.
  2. Exercise for 30 to 45 minutes per day. The fitter you are, the lower your risk of cancer. It doesn’t all have to be aerobic; yoga and strength training count as well.
  3. Reduce your weight until you achieve as close to a normal BMI (under 25) as you can; you’ll find all the info you need in the Body Mass Index article on the Health Info page at drchet.com, including how to adjust your target for your body type. We talked about caloric restriction in February, and that’s a way to slowly reduce your weight. My theory is that the older you are, the more movement matters, so if you are doing well at Numbers 1 and 2, you’re well on your way to accomplishing Number 3.

Those may sound very familiar: Eat less. Eat better. Move more. The reason these are my top three is that they reduce inflammation in different ways.

On Thursday, I’m going to cover a study on the relationship between a test for inflammation and cancer.

What are you prepared to do today?

        Dr. Chet

Artificial Sweeteners and Cancer: The Bottom Line

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In the paper on artificial sweeteners and cancer risk that I covered on Tuesday, the researchers made it clear that although the study was done well, cause and effect cannot be determined. They also acknowledge that because 80% of the subjects were women, the results couldn’t be applied to the entire French population, let alone the population of any other country. What it could mean is that artificial sweeteners in combination with other dietary, environmental, or genetic factors could contribute to cancer development.

Here are some other issues with the data and the analysis:

  • They did not test the subjects for cancer before the study. They eliminated several thousand people for already having had cancer, but they didn’t check for present cancers that hadn’t reached the point where they could be diagnosed. That would have added to the complexity, but it was possible.
  • They didn’t seem to ask when the subjects began using artificial sweeteners. The mean age was 42 at the beginning of the study, so subjects might have been using them for decades; some may have been using them for only a few days. Most cancers take years to develop, so the possible link between artificial sweeteners and cancer is probably zero in people who’ve used them a short time. The real question is whether long-term users had a higher risk.
  • I would like to have seen scattergrams of artificial-sweetener intake along with fruit-and-vegetable intake on rates of cancer. In other words, could the increase in fruits and/or vegetables reduce the impact of artificial sweeteners? Fiber intake, exercise, and BMI could also have been plotted against artificial-sweetener consumption. They accounted for these statistically, but seeing what happens when plotted could show how behavioral changes might help neutralize the artificial sweeteners.
  • One thing they didn’t is factor in is use of animal products (except dairy) and the risk of cancer—the only factors accounted for were weight-loss, a healthy diet, and a Western diet. All the studies I’ve seen assess meat intake and cancer, especially processed meat.

The Bottom Line

Take this study for what it is: an indicator that there are numerous potential causes of cancers. Clinical trials can determine cause and effect if the studies are well designed. This study did a wonderful job of measuring the intake of artificial sweeteners; they just didn’t take it all the way in analyzing the data they collected.

So what should you do? If you use artificial sweeteners, that’s fine. If you prefer not to or want to cut down, that’s fine as well. There’s nothing from this study that indicates there’s anything to fear. Paula and I both use artificial sweeteners, we’ll continue to use them, and we won’t worry about them at all.

I still believe that obesity is a greater risk, not just for cancer but for many other health issues; if artificial sweeteners help you reduce or maintain your weight, I’d say the scale tips toward using them.

We’re taking next week off for spring break, so I’ll see you back here April 12. Then we’ll look at what science shows you can do to really limit your risk of cancer.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1371/journal.pmed.1003950

Do Artificial Sweeteners Increase Cancer Risk?

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Last week, my health news feed filled up with headlines that almost all sounded like this: “Artificial Sweeteners Linked to Higher Cancer Risk!” This isn’t the first study to suggest that relationship and it won’t be the last. This French epidemiological study of over 100,000 subjects collected data for more than seven years. One of the things I almost always criticize is data collection using food frequency questionnaires. Not this time.

The subjects completed at least two food diaries per year. Portions were assessed by comparing with pictures of portions sizes. What they did particularly well is to list all the foods that contained artificial sweeteners, including all brand names; then they tested most of the foods in the lab to verify the presence of artificial sweeteners. Researchers collected as many confounding variables as they could to account for everything that contributes to cancer.

After the statistical analysis, the overall hazard ratio demonstrated a 13% increase in the risk of cancer. Aspartame and acesulfame potassium were the artificial sweeteners with the highest hazard ratio among all those tested. Based on this information, do we need to avoid artificial sweeteners or at least lower the amounts we consume? I’ll talk about that Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1371/journal.pmed.1003950

Do You Need a Fruit-and-Vegetable Concentrate?

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Vegetable-concentrate and fruit-concentrate products are popular now, judging by the number of ads on TV and the web; the implication is that they can replace real fruits and vegetables in the diet.

For the fruit concentrate, manufacturers remove all the fiber and water, yielding concentrates from various fruits and phytonutrient blends plus aloe vera. The supplements include 2,000 mg per serving with 17 ingredients; that works out to 120 mg per ingredient if equally divided. Are those amounts significant, especially after removing the fiber and water? Hard to say without a lot of research on each nutrient to find the effective amount, both individually and combined; for example, we don’t know if there’s an interaction between the nutrients that affects absorption and utilization.

One more type of concentrate would be single-nutrient supplements, such as a specific type of curcuminoids from a certain species of turmeric. Manufacturing is not my area; it takes some hard-core chemistry to figure out how to get the nutrient you want.

Here’s an example: curcumin is extracted from the dried root of the rhizome Curcuma longa. After drying, the process of extraction requires the raw material to be ground into powder and washed with a solvent that selectively extracts coloring matter, the curcuminoids, which then can be put into supplement form. Might there be some vitamins and minerals remaining? Probably, but that isn’t the point of the supplement. The curcuminoids are.

The Bottom Line

At the end of the day, our bodies need the fiber and water from plants to feed our microbiome. That’s why these types of products complement the vegetables and fruits you’re supposed to be eating—they don’t replace them.

I think the best way to get the best of both worlds is eating the five to ten servings of fruits and vegetables you’re supposed to eat, plus taking a multivitamin-multimineral with plant concentrates as insurance to make sure you get all the basic nutrients. If you know you’re not going to be eating as you should for a while, like an accountant working 14-hour days at tax time or a student cramming for finals, a fruit-and-vegetable concentrate might be a good addition. Then add specific concentrate-phytonutrient blends you may be missing in your diet; for example, if you hate mushrooms, take a mushroom-blend supplement. Now you’ve got all your bases covered.

What are you prepared to do today?

        Dr. Chet

Reference: www.fao.org/fileadmin/templates/agns/pdf/jecfa/cta/61/Curcumin.pdf

Vitamins and Minerals in Supplements

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I got an interesting question last week about a supplement that contained a blend of fruit and vegetable concentrates: vitamins and minerals aren’t included on the label, so are they in there? The answer is probably. It all comes down to the purpose of the supplement.

A concentrate is typically the entire vegetable or fruit with the water removed by a dehydration process; whatever is in the plant will be in the concentrate. You could liken this to drying a fresh herb to use as a spice. A more sophisticated process is to remove some of the fiber as well; that would remove solids, but some vitamins and minerals could remain.

Another variation is if a company were to focus on a phytonutrient blend, such as the polyphenols and hesperidin from citrus fruit. They would standardize the supplement to the amounts of those phytonutrients but wouldn’t be concerned about vitamins or minerals unless they met a percentage of the RDA.

There is still more precision in concentrate and phytonutrient supplements, and we’ll talk about them on Saturday.

What are you prepared to do today?

        Dr. Chet

Wait a Minute!

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It was a beautiful day in Grand Rapids on Thursday: 65 degrees, hazy sunshine, no wind, and a perfect day to take a kid to the park. Riley likes basketball (as is required of all children in the Midwest); he can’t hit the rim with the net at 10 feet, but that didn’t stop him and three other kids his size. Attempts were many, but baskets were few, and they didn’t seem to care.

Naturally I had to give it a try. I tried from 10 feet to the right of the basket, but my shot fell two feet short. Whoa! Tried again, and watched the ball sail under the basket. So in spite of having a three-month old knee, I tried a jumpshot—and stumbled a little as I landed. Yikes. My balance, spatial awareness, equilibrium, and power all seem to have left me in the past few months.

I sat down on a bench and pondered, “How do I get back from this far down?” I never expected things to get this bad so quickly; or has it really been even longer? I haven’t attempted anything like a jumpshot in a while. Then a phrase Riley likes to say popped into my head: “Wait a minute!” I already know the answers: Eat less. Eat better. Move more.

Moving more may mean going back to working on balance movements; spatial awareness may mean standing tall, closing my eyes, and touching my nose with my index finger. Neural pathways have to be awakened. They’re still there, just dormant.

There may be no NBA in my future, but I’ll get back to hitting that 15-foot baseline jumper this summer. Lucky for me, I have a built in practice buddy who’s always ready to play. Grandkids are the best!

What are you prepared to do today?

        Dr. Chet

The Default Is Always Exercise

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Ever have one of those days? For no particular reason at all, you don’t really want to bother watching what you eat or doing any exercise. What do you do?

Get on the floor and do five or ten push-ups or sit-ups, or get on your exercise bike and get your legs going for one minute. Then re-assess: what’s next? Maybe you stick with floor exercise. Maybe you put on some walking shoes and walk around the yard. Then you decide it’s a nice day so you’ll go for a longer walk. Or bike ride.

Or maybe you’ll just stop. That’s okay as well. Exercise is always the default to get yourself moving in the right direction. Maybe you’ll find out you can do more sit-ups than you thought.

It’s important that you think about why you didn’t care about your exercise or meal plan. Are you coming down with something? I’m currently battling a Supercold, so I know how that can sap your good intentions. Are you feeling down about something? Is it a small setback? Or is depression slipping up on you? Whatever the reason, being active beats sitting and thinking you’re not worth anything. When it’s one of those days, getting the blood moving is the way to get going.

What are you prepared to do today?

        Dr. Chet

Lessons from the Starvation Study

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The analysis of data in the Minnesota Starvation Study was immense—1,385 pages in two volumes—but I found two fascinating quotes from interviews with the subjects and lead author Dr. Ancel Keys. Let’s begin with a quote from one of the subjects in an interview 40 years later.

Lesson 1: How You Know You’re Restricting Food Too Much

“I don’t know many other things in my life that I looked forward to being over with any more than this experiment. And it wasn’t so much . . . because of the physical discomfort, but because it made food the most important thing in one’s life. . . food became the one central and only thing really in one’s life. And life is pretty dull if that’s the only thing. I mean, if you went to a movie, you weren’t particularly interested in the love scenes, but you noticed every time they ate and what they ate.”
Harold Blickenstaff, Study Subject

If you try to restrict calories, and you’re obsessed with food all day long, you’re restricting calories too much. For most of us, lowering our intake 10% to 15% by making better choices should not be that noticeable. Yes, it takes a little time to get used to eating a different way, but it shouldn’t create an obsession with food.

Lesson 2: Post-Weight Loss Honeymoon Period

“Enough food must be supplied to allow tissues destroyed during starvation to be rebuilt . . . our experiments have shown that in an adult man, no appreciable rehabilitation can take place on a diet of 2,000 calories a day. The proper level is more like 4,000 calories daily for some months. The character of the rehabilitation diet is important also, but unless calories are abundant, then extra proteins, vitamins, and minerals are of little value.”
Dr. Ancel Keys, Lead Scientist

Caloric restriction is used to lose weight as well as to try and attain the many benefits of long-term caloric restriction. Eventually you reach a point of unity; you achieve your goal weight and that’s where you maintain.

But if you’ve ever reached a weight loss goal, chances are you’ve tempted fate: you experiment to find out if you can eat a little more of your favorite foods. You add little at a time, and you don’t see the scale move—at first. But eventually, the honeymoon period ends and you begin to gain back the weight. It’s happened to me several times. Be aware that it will happen to you. Remember, it’s always about the calories. Keep that in mind and you’ll abandon that weight permanently.

The Bottom Line

One more item from those interviews 40 years later: to a man, the subjects all said they’d do it again. In spite of the deprivation they went through, they knew the knowledge gained was important. I think it speaks to their character to know they would make those sacrifices again.

These two quotes provide us with guidelines. Keep them in mind so you know when you may be overdoing restricting or eating. We’re after the long-term benefits, so keep adjusting until you make it your way of life.

What are you prepared to do today?

        Dr. Chet

Reference: J. Nutr. 135: 1347–1352, 2005.

The Right Meal Plan for You

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“On Day 1 of semistarvation, February 12, 1945, the men sat down to a meal that included a small bowl of farina, two slices of toast, a dish of fried potatoes, a dish of jello, a small portion of jam, and a small glass of milk.”

This was a quote from the Minnesota Starvation Experiment to give an example of the meals the subjects ate during the six-month study. In our carbs-obsessed society, that’s just about the worst meal imaginable. Remember, the purpose was to lose 25% of their body weight in six months. They could eat only the foods that would be available during WWII; the non-combatants in the areas where the war was fought had been semi-starved for years, and we had to know how to begin to feed them so they didn’t get sick from overconsumption.

When I said it’s all about the calories, I really meant it. If you’re ready to try calorie restriction, eat exactly what you’re eating now but reduce it by 11% to 15%. It’s also a great time to eat better with more vegetables and fruit and less fried food, but it’s not mandatory. The Right Meal Plan is one you’re willing to maintain for the rest of your life.

I’ll cover a couple more lessons from the Minnesota study on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: J. Nutr. 135: 1347–1352, 2005.

Semifinal Thoughts on the CALERIE Study

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In case you’re thinking, “Wow, I can’t believe he’s still talking about this one study”—I know! I don’t typically spend this much time reviewing a single study, but this one answered a lot of questions about the benefits of cutting calories. Even with 60 publications so far from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) clinical trial, there’s still a lot more info to come and two big questions still to be answered.

More Results from the CALERIE Study

In this first controlled study of calorie restriction in healthy humans, researchers found that:

  • Fasting insulin decreased
  • Triglycerides, total cholesterol, and LDL-cholesterol decreased
  • HDL-cholesterol increased
  • Glucose tolerance increased
  • Working memory improved
  • Inflammation markers such as C-reactive protein and TNF-alpha decreased

As more data is examined and new analytics are discovered to test more variables, I’ll be bringing you more results that may help you be healthier.

What We Don’t Know

The most important thing we don’t know yet is whether calorie restriction is an effective way to lose weight and whether all those great benefits would still apply. By definition all diets restrict calories, but this is not a diet; this is changing your lifestyle to maintain a calorie restriction of 11% to 15% for a long time, preferably for life. If you want to maintain the benefits, such as better insulin control and reducing the risk of heart disease, you never stop.

The other question is whether one type of eating style would be more effective than others to sustain the diet and its effects. Mediterranean? Keto? Vegan? We still don’t know for sure, but my opinion is that it doesn’t matter—it should be one that you can live with long term using the healthiest foods you can afford.

The Bottom Line

The CALERIE Study has demonstrated specific health benefits for calorie restriction of 11% to 15% for normal weight people. I think it will apply to overweight people as well. In the next few weeks, I’m going to drop my caloric intake by 12.5%, and I’ll keep you posted on how you can do it as well.

What are you prepared to do today?

        Dr. Chet

Reference: Nutrition Reviews 2020: Vol. 79(1):98–113.