HOW TO PREVENT CANCERS

A few weeks back, we took our toddler to see Sesame Street Live - a groan-inducing rite of passage for many parents of toddlers. This year's subtitle was "Elmo's Healthy Heroes," and the show followed Grover in his efforts to locate his "superness," which he regained through 4 healthy habits: eating right (in this case, eating fruits and vegetables), exercising, taking a bath and sleeping. A good message. The irony came in that said event was at one of those big sports arena, which offered a kids meal for the event. Said kids meal contained: a hot dog, chips, a cookie, a crispy marshmallow rice bar and a juice. Now granted, there was a "healthy" kids meal option. It contained some sad (truly) looking celery sticks, a few slices of orange, an orange juice and one of those prepackaged peanut butter and jelly sandwiches that are crimped together with the crusts cut off. This was my first encounter with this particular food-like item and one I hope to not repeat (the peanut butter was of an unnatural consistency and there was about 5 times as much jelly as I think is reasonable for a sandwich all together on a really dry "bread"). My PB&J loving toddler ate about half and lost interest.

This got me thinking about the need for our behaviors to reinforce our words when it comes to raising kids who will make healthy choices and like healthy food. A number of food writers and bloggers (not to mention researchers, advocates and NGOs) have discussed that kids who participate in food growing and preparing are more interested in eating the food, even when it contains things previously considered "yucky". (For some resources on this, see this PDF from our colleagues at Planet Health & the Harvard School of Public Health)

With that in mind (and it being winter so we aren't growing anything), I wanted to make more of an effort to include my toddler in food preparations. I figured that the best way to start was to involve her in cooking something she DOES like. And my kid LOVES cake, which is, according to Cookie Monster post-2006, a “sometime snack.” That said, me being me, I wanted to find a cake that was healthier than the average standby. I found Martha Rose Shulman’s flourless carrot cake, which featured a few things I liked: it didn’t make a gigantic cake that would have us eating this “sometime snack” for days; it didn’t have a ton of sugar; it didn’t have any oil (other than what you use to grease the pan); it didn’t have white flour, relying on grounds almonds instead and instead; and it wasn’t covered in a sickly-sweet frosting. The last one being a significant “con” in my daughters eyes.

Sunday morning, we set up shop in the kitchen. It turns out the bags of whole almonds at the grocery store have 1 ¼ cups and the recipe calls for 1 ½ cups, so we tossed some sliced almonds we also had in the food processor. The recipe calls for turbinado (raw) sugar. We have white sugar and some demerara sugar so we mixed the two and hoped for the best.



Warning: pulverizing nuts in the food processor may scare the heck out of a small child.



but it looks tasty



(next time, I'd grind it a bit more, but we needed to cease the loud noise making!)

Toss in the flavor adding goodies













Shulman then has you grate carrots on the smallest holes of your grater. If I'm going to go through the trouble of getting the food processor out and washing all those parts, you better believe the carrots are getting grated in the food processor. So I dumped the almond meal mixture into a bowl, swapped in the grating attachment and we went to work. (My daughter didn't mind this noise - it wasn't quite as loud.)



Thankfully, we grated a lot of carrots as my daughter was quite interested in sampling at this stage and I was happy to oblige.



I tried to involve my daughter in as many of the steps as I could including measuring, pouring, grinding and mixing. Here she is adding the carrots to the beaten egg/sugar mixture (remember, this is healthiER food...)



When it comes out of the oven, it doesn't look super pretty



A quick shake of confectioners sugar solves this, but takes you one teensy step away from the healthy part of healthier. I like my desserts a bit pretty so I did it.



As you might expect with a toddler adventure, this one involved some clean-up, but we had so much fun it was well worth it.



The end result was fantastic. My whole family, including the most important voter, my daughter, LOVED it. I brought leftovers into the office, and it got good reviews there, too. This isn't the carrot cake you find in the dessert case at your local diner or coffee shop, but it is a tasty "sometimes treat" you can make with your kid.

This morning, I had the extreme pleasure of hearing Dr. Bill Dietz of the CDC's Division of Nutrition and Physical Activity in the Center for Chronic Disease Prevention and Health Promotion speak about Policy and Environmental Changes to Prevent and Control Obesity at the Washington University School of Medicine Grand Rounds. Dr. Dietz touched on many topics, but one that stood out to me was the focus CDC has on its list of priority strategies to address important health behaviors: increasing access to fruits and vegetables through retail stores.

I'm sure many of my fellow news junkies saw the NY Times Magazine story about Walgreens' new program to eliminate food deserts. A food desert the NY Times describes as "urban neighborhoods where there are few grocers selling fresh produce, but a cornucopia of fast-food places and convenience stores selling salty snacks (though, strictly speaking, the term can be applied to rural or suburban areas, too). Often the problem afflicts low-income areas abandoned or shunned by food businesses that focus on better-off consumers"

Food deserts are a problem that numerous non-profit and community groups have worked to tackle. Most notable is probably the Food Trust based in Pennsylvania. The Food Trust work has expanded to other states and has had some notable successes in encouraging supermarket development and expanded farmers' market programs. Perhaps it shouldn't be surprising then that when the US government announced the $400+ million Healthy Food Financing Initiative to bring grocery stores to underserved communities, it did so in Philadelphia.

Do big intiatives like this work? The general consensus is cautious optimism. Certainly having the White House behind programs like this is a big deal. But, as Marion Nestle noted, voluntary programs such as these don't always move us very far in the path to healthier communities. That businesses are seeing an opportunity here, perhaps points to some real movement (even if the cynic in me points out that this is about the bottom line for any business). I'm looking forward to seeing Walgreens provide some data on the successes (or not) of their program, something the Times article notes it has been unwilling to do so far. I'm also curious to see more data on whether these programs change fruit and vegetable intake, and ultimately rates of associated comorbidities, like obesity. Economic disparities have a big effect on food choices and the economic challenges facing families will be a big driver of our success in food access and numerous other health challenges.

CNiC recently gave a big endorsement of Mark Bittman’s new Food Matters cookbook. This week, we gave two of the recipes a whirl.

One of the things that appeals to me about Bittman as a food writer is that he appreciates fine complex cuisine, but pushes us to realize that every meal (or most meals) need not be complicated (in preparation or flavor) to be delicious.

Food Matters has a recipe for simply making grains. Bittman points out that there are lots of wonderful whole grains in the market (or your pantry) and you can often make substitutions. In an effort to clean out some of what is in our pantry and freezer in anticipation of the holiday cooking madness that will shortly begin, I decided to use up the barley we had following Bittman’s recipe. Cooking barley is as simple as cooking rice and Bittman’s recipe nicely points out the variations in cooking times for different grains, including different types of barley, along with tips for knowing how the grains are done. The directions were clear and the result was perfectly cooked barley.
The grain cooking instructions are followed with a nice list of suggested variations – essentially things you can add to the grains. Looking at the list, I realized our refrigerator contained two of the suggestions – tomato sauce and leftover meat, in my case, some left over roasted chicken from Sunday dinner. I tossed a couple tablespoons of marinara sauce
with some chopped chicken
and the barley and called it dinner. Served with a heaping portion of sautéed zucchini, it was a simple, but tasty meal and everyone seemed satisfied.
Cooked barley reheats nicely so I actually cooked that in the morning while we were getting ready for school/work and put it in the fridge. When I got home from work, I added the other ingredients and reheated.
It meant dinner got on the table in 5 minutes (which was basically the time it took to sauté the zucchini). Pretty great for a weeknight.

Later in the week, I gave his recipe for vegetable fried noodles a whirl. Plenty of food writers and chefs have pointed out that stir fry is a great way to get dinner on the table fast, but our house has never embraced this for some reason. I expect that will change. Again, Bittman’s recipe is designed as a template – with plenty of suggestions for variations. We went with the recipe as written – cook some soba noodles, toss with a little sesame oil. Sautee julienned carrots, sliced celery, chopped scallions and some snow peas with a bit of garlic and ginger in a smidge of oil.
Toss with a little stock or water (I had some homemade chicken stock on hand that I made from Sunday’s roasted chicken carcass).
At the end, toss with a bit of soy sauce and an egg. Toss all that with the cooked noodles and top with a few chopped peanuts.
Unlike fast food/take out fried rice or noodles – this wasn’t overly sauced. I could taste the vegetables – which was great because they were obviously where most of the money in the meal went – and because I bought some great fresh ones, it tasted great. Limiting the soy sauce also limited the salt content in the meal. This one was a big hit all around – and because the noodles are mixed with the vegetables at the very end, I simply separated out a bit of each before serving to my toddler, who is at that stage where different foods should not touch on the plate.

Food Matters isn’t a vegetarian cookbook, but it is about making meat (red or other color) an accent and not the centerpiece of your meals. Both meals included some chicken (one had a few chunks of chicken, the other used chicken stock because it was what I had and an egg, which was optional), but could have very easily been made vegetarian.

Food Matters reminds us that eating healthy food can be both simple and tasty.

It seems everywhere you turn, someone is touting a new herbal supplement or extract as the solution to what ails you – prevent cancer, lose weight, reduce cholesterol, boost immunity. You name it, someone is probably selling an herbal concoction to fix it. And often, these claims seem to be backed by scientific research. So what’s the problem?

Unfortunately, there are many:

1. Quality. As detailed in today’s Wall Street Journal, when supplements are submitted to quality testing, about 25% have problems like contamination or mislabeled dosage. In some cases, that contamination can be quite dangerous such as with lead.
2. Safety. Herbal supplements aren’t subject to the same kind of testing that pharmaceutical drugs have to go through. This often means unsubstantiated claims and little information about risks associated with long term or high dosage use.
3. Research quality. Many of the claims made about supplements are backed by research. Unfortunately, the fine print often reveals the research was funded by the supplement maker. The potency of plants can often vary as well – so the variety tested in the research study may not be the one included in the supplement you buy.  In many instances, the studies are also very small or not well designed, which makes for less reliable results, something often missing from the scientific pedigree supplement makers list in their ads or on their websites.  That many people who write about the benefits of these supplements don't have a great understanding of the research process, and what may seem in an article to be rock solid health benefits of a supplement, may be little more than anecdotal evidence.
4. Reductionism.  Reductionism is when a single component of a whole food found to have health benefits is put into a supplement and assumed to have the same (or greater) health benefits of the whole foods.  The food is "reduced" to a single component, usually with mixed results.  The classic example is beta-carotene.  Studies had found that individuals who consumed higher amounts of fruits and vegetables had lower rates of lung cancer. Researchers hypothesized that this was due to the antioxidants (like beta-carotene) found in fruits and vegetables and began randomized controlled trials to see if these individual components had any health benefits in smokers.  The results were surprising.  Lung cancer rates were HIGHER in the groups taking beta-carotene. These results don’t mean you should go off and eat Twinkies instead of carrots, but they do suggest that extracting one component from a food doesn’t always lead to the desired result.
5. Extrapolation. Extrapolation is taking a narrow set of results and applying it to broader populations.  It's a common practice, particularly in health news stories, and while it makes for great headlines, it often results in over-reaching.  Supplement makers do the same.  A small study in mice or cells in a petri dish can have seemingly astounding results - but the problems is that these studies are in....mice and cells.  Animal and cell studies are just a starting point in the research process, and more often than not the results don't pan out in good studies in humans.  It is also important to note that the doses of supplements and extracts applied to animals and cells in the laboratory often exceed those that humans would (or could) consume. The big concern here is that these extracts and compounds, tested in labs, will result in the same unanticipated consequences that beta-carotene did on lung cancer when tested in humans. Of course, there is also the possibility that they will have benefit, but until they are evaluated, we just don’t know.

It might seem that we're anti-supplement here at CNiC.  But that's certainly not true.  For a very long time, we've recommended a daily multivitamin as a great nutrition insurance policy for most people. A daily multivitamin with folate can provide added protection against certain cancers and other chronic diseases. Folate is a B vitamin that has been shown to lower the risk of colon cancer, as well as breast cancer in women who regularly drink alcohol. The calcium and vitamin D in most multivitamins may also help provide added protection against colon cancer.

What we worry about are the health claims many supplement makers and other proponents make that over-reach (often by a great deal) what the science has to say about both the effectiveness and the safety of their products.

In this day of ever-growing health care costs and tight budgets, it's only natural that we want to take control over our health, and turning to supplements can seem like an easy route to take.  But, it's important to know about some of the potential pitfalls with supplements so you can make good, informed decisions about your health.  Most of the time, the best choice is to keep those supplements on the store shelves and go for a good walk instead. Focus on fruits, vegetables, and whole grains, trying to get a wide variety of each. A single 100% RDA daily multivitamin is also a good nutrition insurance policy for most people.

Today I hopped over to Forbes.com to review their "most stressful cities" list (and was relieved that St Louis wasn't topping another "bad" place to live list -- I think topping the syphilis list is enough). While I was there, a link to a list of "10 foods you should be eating" caught my eye. I'm always wary of such lists, and this one provided a nice reminder of why:

The list starts out with three great foods - cherries, blueberries and kiwi. All three are great choices because they are fruit and eating a lot of fruits and vegetables have been shown to decrease risk of several diseases, including cancer. The problem, to me, is that most Americans don't come anywhere near to eating enough fruit, regardless of the type. Also, the three fruits are in season for a pretty short period of time, making their cost pretty high the rest of the year. Add to that, the fact that berries tend to top lists of fruits that absorb the most pesticides, so other lists are telling you to only buy organic and you've got a major cost issue on your hands. For most people, just starting to eat 2-3 servings of fruit a day, of ANY fruit, is going to be a big step.

The list then moves on to proteins -- grass-fed beef, wild salmon, flax seed and whey protein powder. While I certainly see the merit of choosing grass-fed beef over industrial beef for the reasons listed (omega-3 content being a big one, environmental impact being another), the context is missing here. Grass-fed beef is expensive and most Americans eat too much red meat of all kinds and certainly don't need beef appearing on a list of things they need more of. If you want to up your omega-3 intake, replace your meat intake with other sources of protein rich in omega-3, like fish and flax seed and aim to reduce your meat intake in general.

The list ends with dark chocolate. With overweight and obesity rates topping 60% in the US, I don't think anyone needs encouragement to eat more chocolate. Granted, the fine print suggests looking for chocolate with at least 60% cocoa content (ruling out most candy bars in the checkout aisle), but portion size and frequency of intake are big issues here and neither is mentioned.

Also overlooked in the discussion is that much of the data supporting the "superfood" concept don't come from studies of people eating those foods. The data come from studies of human cell lines or of extracts of a single component/nutrient that the food is high in. The problem with these studies is 1) that flesh and blood humans are very different from a collection of cells in a petri dish and 2) that the volume of intake needed to reach the dose given to the cells or extracted and given to humans is difficult to achieve through consumption of the food itself.

So, the cold reality is that there are no real "superfoods," just like there are no magic bullets.  It's simply a title dreamed up by magazine editors or folks who don't have a good understanding of the science linking diet and human health.

Of course, overall diet can have a large impact on chronic disease, and making simple, largely inexpensive, changes to what we eat can have big benefits.  Eating a diet rich in fruits, vegetables, whole grains, and healthy fats (like poly and monounsaturated fats); and low in red meat and unhealthy fats (like saturated and trans) will trump any collection of "superfoods" when it comes to health benefits, and it'll likely save you a lot of money along the way.

I wonder if by suggesting that people need to go spend $30 on organic blueberries and eat chocolate to be healthy we actually encourage the status quo as so few people have the ability to spend at this level and so few read the fine print of the message? What do you think? Do these lists help you make healthy choices or confirm that you are/aren't healthy already?

The headlines this week about fruits and vegetables doing little, if anything, to lower cancer risk may entice you to reach for a candy bar rather than a carrot (study), but there's still plenty of good reasons to keep working on your 5 or more each day.

Most importantly, there's still very good evidence that eating a diet rich in fruits and vegetables can significantly lower the risk of heart disease and stroke - two major killers in the United States.  One 2004 study that included over 70,000 participants from the Nurses' Health Study and over 35,000 participants from Health Professionals Follow-Up Study found that those people eating eight or more servings of fruits and vegetables per day had a 30 percent lower risk of cardiovascular disease than those eating less than 1.5 servings per day (study) (1).  On top of this, studies also strongly suggest that a diet high in plant foods can lower the risk of diabetes and high blood pressure (2,3), and help keep weight in check (4,5).

In terms of cancer risk, while it's true that the recent study out of Europe that included over 400,000 people followed over eight years found only a very small benefit from eating fruits and vegetables, it's important to keep some things in mind when looking at these results (6).

First, they don't rule out a benefit for specific cancers from eating specific fruits and vegetables.  It can get fairly complicated, fairly quickly, but the European study looked at links between overall cancer risk and overall fruit and vegetable intake.  Yet, there is good evidence that some certain types of fruits and vegetables may lower the risk of some certain types of cancer.  For example, diets high in tomato-based foods have been found in previous studies to lower the risk of prostate cancer and diets rich in yellow/orange vegetables have been found to lower the risk of lung cancer (7-9).  The broad approach of the European study could have washed out such targeted benefits.

Second, the study only looked at adult intake of fruit and vegetables.  One thing that's become clear over the years is that when a person is exposed to a factor can have important implications on how it affects cancer risk. The time frame for prevention matters.  Radiation is one good example, and one mentioned in the editorial accompanying the study (editorial) (10).  The younger a person is when exposed to a given amount of radiation, the greater the impact that exposure will have on later cancer risk.  Soy intake and breast cancer risk is another prime example, with studies showing that the reduced risk linked to high soy intake may be strongest for intake in childhood and adolescence (11). The relationship could be similar with fruits and vegetables.  Eating a diet rich in fruits and vegetables early in life could have a much bigger impact on lowering cancer risk than such a diet later in life.  Looking at diet so late and only a few years before cancer is diagnosed may be looking in the wrong place. (See related post).

The results of this new study are little surprise to the scientific community, who have seen the cancer benefits of total fruit and vegetable consumption dwindle as good evidence has accumulated over the past ten years.  Yet, the overall health benefits of a diet rich in fruits and vegetables aren't in question when you look beyond cancer to heart disease, stroke, diabetes, and weight control.