Do Vitamin Users Get More Cancer?

The latest study on vitamins and health is out. It isn’t pretty. This research adds to other studies suggesting that multivitamins don’t improve health. They may, in fact, increase risk of chronic diseases, such as heart disease, cancer, and heart failure.

By the Numbers

Researchers in Sweden examined the connection between multivitamin use and breast cancer risk. They followed more than 35,000 women for an average of 10 years. The women were free of cancer and 49 to 83 years old at the beginning of the study.

The researchers collected and adjusted for other factors that can affect breast cancer risk. This includes family history of breast cancer, body weight, vegetable and fruit intake, physical activity levels, and use of tobacco and alcohol.

Not Best for Breast Health

After ten years, the study indicated that the women who had taken multivitamins were 19% more likely to be diagnosed with breast cancer compared with the women not taking multivitamins.

It is important to note that this is an observational study. Study participants were not randomly assigned to take or not take multivitamins. The study does not prove cause and effect. It shows an association between multivitamin use and higher breast cancer risk.

Nonetheless, the study authors noted that a connection between multivitamins and breast cancer risk is plausible. Also keep in mind that this is not the first study to show that multivitamins and other supplements may pose a risk to health.

The Bigger Picture

The first hint that isolated nutrient supplements may harm health came in the mid-1990s. Two large, randomized, placebo-controlled trials looked at this question. The trials included a total of more than 47,000 study subjects between them. They examined how beta-carotene and vitamins A, C, and E affected lung cancer risk in people at high risk for the disease. High-risk study subjects included current and former smokers and asbestos workers.

The researchers expected the vitamin supplements would decrease risk of lung cancer. They found the exact opposite. The men who had been randomized to take the supplements had a significantly higher risk of developing lung cancer. They also had a higher risk of other types of cancer. They had higher risk of heart disease and stroke too. Back to the drawing board!

Since that time, studies have continued to demonstrate that antioxidant supplements can increase the risk of cancer and heart disease. This is especially true for people who smoke or have smoked in the past.

Not So Fast

“Great,” you say, “I’m not a smoker anyway. I’ll keep taking my vitamins and beta-carotene pills.” Not so fast.

Don’t forget about the Swedish study. It points to the possibility that multivitamins increase breast cancer risk. And if you’re not a woman or not concerned about breast cancer, there are plenty of additional studies showing problems with multivitamin and antioxidant supplements.

A 2007 comprehensive research review concluded, “Treatment with beta carotene, vitamin A, and vitamin E may increase mortality.” A similar review that same year stated that clinical trials of antioxidant supplements, “should be closely monitored for potential harmful effects.”

Other studies have shown that vitamins C and E do not decrease risk of Alzheimer’s disease and dementia. Unfortunately, vitamin E does increase the risk of heart failure in people with vascular disease or diabetes. Many US adults have, or are at high risk of, these conditions.

Are Isolated Antioxidant Nutrients Friend or Foe?

Multivitamins and other sources of isolated antioxidant nutrients may be problematic for several reasons. One of the most likely is that they can have a dual nature. To understand why this matters, it helps to understand oxidation.

Oxidation is a damaging process that can occur inside the body. A good way to think of oxidation is to think of rusting. But instead of causing damage to metal in the environment, oxidation causes damage to your cells. Excess oxidation is believed to contribute to the major diseases that plague us today.

This means that antioxidants, which prevent damaging oxidation in the body, should be a good thing. This is true only if they act like antioxidants. Unfortunately, when taken in isolation, antioxidants actually may become pro-oxidants. Under some conditions, antioxidant supplements promote oxidation, not stop it!

Singles Lack Synergy

Another potential issue multivitamins and antioxidant supplements is that these products lack synergy. Synergy refers to the idea that two or more things can work together in a way that their combined effect is greater than the sum of their individual parts.

Food is so incredibly complex. Trying to duplicate it in a vitamin pill is something of a fool’s errand. Consider the carotenes. Beta-carotene is the most well known of the carotenes. But there are several hundred carotenes found in nature and in the foods we eat.

Taking a pill that provides just one, two, or three carotenes is nothing like eating a beta-carotene-rich food. The food provides many carotenes plus dozens of other nutrients. And don’t forget about the fiber.

Polyphenols are another large group of nutrients. Research suggests polyphenols provide numerous health they come from food. Taking one or two polyphenols really misses the “nutritional boat.” There are thousands of polyphenols in hundreds of foods. Polyphenols are found in foods as diverse as apples to tea and onions to berries.

Why Food Rules

And so we come back to food. Food is the ideal way to nourish our bodies. Make it a priority to fill two-thirds to three-quarters of your plate with nutrient-rich foods. Think of the bounty of the garden to guide your choices.

Brilliant orange carrots and ruby red tomatoes, shiny green pea pods and deep magenta beets, bright purple blueberries and deep purple blackberries…these are the very foods that will give your body what it needs. And getting what you need is the greatest nutritional gift you can give yourself.

Indulge During the Holidays Without Gaining Weight

We’re right smack in the middle of holiday-celebration season, and, if you’re like most of my patients, you want to indulge in all the food and merrymaking and not have to worry about weight gain. Well, the holidays are for fun and fantasy, but, we have to be a little realistic when it comes to keeping that scale needle from moving too far forward during the holidays.

Did you know that most people average 1-2 pound weight gain over the holidays? It’s true. That wouldn’t be so bad if they got rid of it in the first 2-3 weeks of New Years. Unfortunately, most holiday weight gain tends to not only stay on during the winter months but may even stay permanently getting added to every year! To prevent that from happening, I’d like to share with you some tips on how NOT to gain weight during the holidays, and still have fun and partake in the delicious feast of foods that characterize this time of year.

Control Your Food Intake

There’s no real reason why you shouldn’t be able to eat the foods you love during the holidays andnot gain any additional weight. Sound impossible? Well, it’s a lot harder than it sounds. Here are some of my favorite holiday weight gain prevention tips:

Water is your ally. A staple of all natural health diets is water, and you should be drinking adequate amounts of water every day anyway, but during the holiday party times, let it also be your ally in helping you control how much you eat. Drink a full, 12-16 ounce tumbler size of cold water with some lemon slices in it on the way to a party or upon first arriving, before you eat anything. When your stomach is full, it will really help you pare down food portions.

Don’t go hungry. To avoid overeating at a party, don’t starve yourself during the day, thinking you’re saving up for party food. This always ends in overeating because psychologically you’ve already given yourself a free pass to eat too much. Instead, eat a smaller, yet nutritious, breakfast, and lunch if the party is not until evening, or just eat an apple and an ounce of cheese, if the party starts in the early afternoon. Make your small meals a little protein, like tuna fish, chicken, a hard boiled egg, cottage cheese, and a small amount of complex carbohydrate like a vegetable or fruit.

Spoonfuls, not Platefuls: The best way to outsmart a holiday buffet filled with a number of things you want to eat is to take a little of everything you would like instead of a small plate with a few things that you keep going back for more. I recommend using the large plate and, instead, using the dish’s serving spoon, which is about twice the size of a regular tablespoon, take 1 spoonful of several things you would really enjoy. Just be sure your plate has more proteins like roast beef, turkey or ham, and more green and yellow vegetables, than white potatoes, corn, or breads, go very lightly with the gravies. Think drizzle rather than river on your plate, a pat of butter on vegetables, rather than a golf ball. If you have room for dessert after this amount of food, use a small plate with a small sample of whatever is served. Think grocery store food sample size for desserts. This allows you to try a few things and not feel deprived.

Exercise. Many of us have a hard time keeping a regular exercise routine in non-holiday times, but during the holidays, it’s even more crucial to get some regular exercise at least 4-5 days a week if you can. This will help burn off those extra calories. Aim for 30-40 minutes a day of walking, bicycling if the weather allows, or using a stair stepper or elliptical at the gym.

Focus on fun. Did you ever go to a holiday party and leave without knowing what really went on in some of the other rooms where people were dancing, or having a lively discussion about something, because you were sitting too close to the buffet table? Get up and mingle and join in a conversation, dance with someone, or get a group together to go for a walk to look at holiday lights. In other words, focus on doing something other than eating. Most of all have fun!

Alcohol. Some of my patients like to have a glass of wine or two, or a mixed drink, at holiday parties, and this is fine. Just don’t over do it and be sure to eat soon after. Avoid the sugary mixed drinks, or liqueurs, as they really spike your appetite. Try to stick to clear red or white wines, a martini, etc.

Calorie trading. The day after the holiday party, trade down your higher amount of party calories by eating less the next day or so. Focus on proteins and vegetables, very limited amounts of sugar (read labels), and drink plenty of water.

As I tell my patients, the holidays are for the 4 F’s – family, friends, fun and food. Enjoy all four of them by controlling your food and alcohol intake, and getting in some exercise. Most of all enjoy yourself and have a healthy, happy holiday season!

Believing This Could Raise Your Cancer Risk

Do Fruits and Vegetables Prevent Cancer? Or Not?

We’ve been told again and again that eating more fruits and vegetables will protect us from cancer. But headlines about recent findings from the European Prospective Investigation Into Cancer and Nutrition (EPIC) study suggest otherwise:

“Fruits and Vegetables Have Only Weak Effect in Cancer Prevention”

“Cancer Protective Effect of Fruits and Vegetables May Be Modest at Best”

“Fruits and Veggies Have Small Effect on Cancer Risk.”

What gives? Do fruits and vegetables protect us against cancer or not? It turns out the devil is in the details.

Contrarian Views Sell More News

When you read media stories about medical and nutrition science research, it helps to keep in mind that contrary headlines sell. For example, a low-fat diet has been touted for years as the best way to beat heart disease. If a study shows that a low-fat diet is not useful for decreasing heart disease risk, this is big news.

You can bet that the media will trumpet these headlines, which are contrary to conventional wisdom.

Looking Beyond the Headlines

Another consideration?

Most health and science journalists are not trained scientists. They are not trained in complex statistics. They are not trained to fully understand the strengths, weaknesses, and caveats of different study designs. And they typically do not report on putting the new study into context with other research on the topic.

As Dr. Ralph Moss, PhD, who is a research scientist, points out, “According to the EPIC study, conversion to a moderately high fruit-and-vegetable diet could ideally save hundreds of thousands of people from getting cancer each year. This astonishing fact was hardly conveyed by the negative press reports on the EPIC study.”

Dr. Moss, author of the respected website Cancer Decisions, further explains, “if the subjects had increased their fruit and vegetable intake by just 150 grams per day, they would have reduced their risk of getting cancer by 2.6 percent (men) and 2.3 percent (women). Now, 150 grams is the weight of one apple.”

Nearly 1.5 million men and women were diagnosed with cancer in the United States last year. The EPIC study results suggest that one apple per day could prevent approximately 36,000 of these cancer cases every year. “Is it a small thing to keep more than 36,000 Americans from getting cancer at such a minimal cost?” asks Dr. Moss.

Which Cancer?

When assessing whether it’s worth the effort to eat more fruits and vegetables, we also need to look at the type of cancer studied. It turns out the type of cancer was “every type.”

According to Susan Higginbotham, RD, PhD, Director of Research at the American Institute for Cancer Research (AICR), “We’ve known for some time that fruit and vegetable intake is probably protective against some, but not all cancers. So when you look at its effect against all cancers, as this study does, those overall numbers are going to look low.”

By lumping together every single type of cancer into one study, including the ones that are least likely to be related to diet, we can’t see much of an effect of fruits and vegetables on risk. If we consider the cancers that do appear to be related to diet, the percentages are significantly higher.

In fact, the World Health Organization states, “Dietary factors account for about 30% of all cancers in Western Countries and approximately up to 20% in developing countries; diet is second only to tobacco as a preventable cause.”

The cancers most convincingly related to diet include those of the mouth, pharynx and larynx, stomach, esophagus, lung, and colon and rectum. Colorectal cancer alone takes the lives of approximately 50,000 Americans every year. It is the second leading cause of cancer death in this country.

Straight From the Horse’s Mouth

Whenever I see media reporting that downplays important nutrition research, I consult my friend and colleague Diana Dyer, MS, RD. I value her opinion. Diana is not only a scientist and a dietitian; she’s also a 3-time cancer survivor. After one childhood cancer and two breast cancers (the last one over 10 years ago!), she speaks with authority on issues of cancer and nutrition. In her blog about the recent EPIC study, Diana raises points that those touched by cancer should consider.

“Cancer is a tough task master. Not all cancer is preventable. Risk reduction is the name of the game. Do not put all your eggs (or fruits and vegetables) in one basket. Don’t look for one ‘magic bullet’. Cancer risk reduction needs to be multi-focused by creating a healthy lifestyle that consists of quitting (please don’t start!) smoking, working toward achieving or maintaining a healthy weight, daily exercise, finding an enjoyable way to handle the stresses in life (we all have ’em!), and eating a healthy diet filled with healthy foods.”

Wise words indeed! To this she adds, “Small percentages are real, and I’ll take them. I would rather be nuancing over the variety of apple… than debating the side effects of various chemotherapy regimes that may also offer only a few small % points of potential benefit…(ugh – been there, done that, twice, not fun).”

Real Life is Messy

As a final note, we should bear in mind that EPIC is an observational study. This type of study has major flaws and weaknesses. For many reasons, it’s often the best we can do.

A randomized controlled trial is the “gold standard.” Unfortunately, nutrition research is messy. It does not lend itself to this type of study. Of the several large-scale, randomized nutrition studies of the last few decades, nearly all have had problems keeping the intervention group on the intervention diet.

Sadly, our food environment is so toxic and difficult to navigate that almost nobody can be assigned to a healthy diet and actually stick to it.

And nutrition studies cannot be blinded. Simply by changing their diet, the people in the intervention group are fully aware that they are in the intervention group.

This doesn’t even touch on the problems we might see in the “control” group. This is the group of people assigned to go on living life normally. They are not supposed to make changes to their diets. Unfortunately, in this type of controlled nutrition trial, the control group commonly becomes “contaminated.” They end up attempting to follow the healthier diet themselves!

People in the control group may think, “If the intervention diet reduces disease risk, I want that advantage too.” In the end, both groups end up consuming a fairly similar diet. The study won’t find anything significant because the two diet groups aren’t significantly different from one another. So, we are left with observational studies, which are, admittedly, imperfect.

With nutrition and disease we have to consider the totality of the evidence and the consistency of the findings from other studies on the topic. And for now, the totality of the evidence very strongly points to fruits and vegetables reducing risk of several types of cancer (mouth, pharynx and larynx, stomach, esophagus, lung, and colon and rectum). And heart disease. And stroke. And hypertension. And diabetes. The list goes on.