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Ultra-processed foods increase your risk of breast cancer 07/13/22
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Black Women, Meat, and Colorectal Cancer 06/29/22
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Instead of red meat
If you've spent your life as an omnivore - that is, eating land animal proteins such as beef and pork (red meat) and poultry such as chicken and turkey (white meat) - along with (perhaps) fish and shellfish, then the news that red meat isn't great for you might hit a little close to home.

Diet quality and mortality
We've seen plenty of research assessing the possible relationships between overall mortality (risk of death) and certain dietary patterns, such as Mediterranean diet or DASH diet. Other studies have examined the relationship between certain food types, such as legumes, red or processed meats, or whole grains, and mortality.

Eating more highly processed foods linked to greater risk of cancer
My goal, whether through my own practice as a physician (yes, I see patients almost daily), through Dr. Gourmet, or through my work at the Goldring Center for Culinary Medicine, is to get people back in the kitchen and cooking for themselves and their families. At the most basic level, we know that cooking your own food is better for you because you have more control over what goes into the food you cook as well as the portion size you serve.


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Black Women, Meat, and Colorectal Cancer

processed meats

Looking at the evidence, it is clear that eating more processed red meat (bacon, sausage, or lunch meats, all with added nitrates or nitrites) leads to a greater risk of colorectal cancers. In fact, it's one of the reasons that the Mediterranean-style diet recommends saving "processed red meats" for occasional treats and limiting "unprocessed" red meats to a weekly average of 4 ounces of intake per day for men and 3.25 ounces of unprocessed red meat, again on average per week, for women.

Bear in mind, however, that this average weekly intake means it's perfectly acceptable for men to consume 4 ounces of unprocessed red meat every single day, while women, on the other hand, can theoretically consume as much as 3 1/4 ounces of unprocessed red meat every day.

Much has been made, however, of the link between processed red meats, defined as sausage, hot dogs, bacon, and deli lunch meats such as cured ham, bologna, and salami, and the risk of colorectal cancers. For example, one study we reported on earlier this year suggested that substituting one serving of fish or poultry for one serving of processed red meat resulted in a 9% reduction of risk of overall mortality, while making the same switch of fish or poultry for unprocessed red meat made no difference. Another study showed a 23% increase in the risk of colon cancer for every additional portion of processed meats consumed by men in Europe and the United States as well as greater risk of rectal cancer in both men and women in the US - but not in Europe or Asian-Pacific regions.

It's tempting to say that unprocessed meat is ok and processed meat is bad, but the problem with this research is that in the United States those who are recruited to participate in long term observational studies are overwhelmingly White. The Nurses' Health Study (I and II) and the Health Professionals Follow-Up Study, for example, are comprised of a significant majority of White persons. Given that Black persons experience and participate in health care in vastly different ways than Whites in this country, it's reasonable to wonder if it's reasonable to claim that the health risks to White persons are applicable to everyone regardless of ethnicity or even gender.

In today's prospective study, the authors analyzed data gathered for the Black Women's Health Study (J Nutr 2022;152:1254-1262), which began recruitment in 1995 and ceased data collection in 2018. This study initially recruited 59,000 Black women between the ages of 21 and 69, primarily through ads placed in Essence magazine. Respondents filled out initial questionnaires regarding their demographics, medical history, lifestyle factors, and diet. Participants were recontacted every 2 years after the initial recruitment survey to update their information.

The researchers focused on participants' processed and unprocessed red meat intake, using the definition noted above for "processed" meats and defining "unprocessed" red meats as "hamburgers, steak, roast, and stew" along with lamb and pork that were not treated with nitrates/nitrites.

A serving of any type of red meat, processed or unprocessed, was defined as 85 grams, or just about 3 ounces. Each participants' intake of red meat was classified into increasing levels of unprocessed red meat, processed red meat, and total red meat (both processed and unprocessed together), and the intake of those who developed any type of colorectal cancer was then compared with that of those who did not.

In their analysis, the authors also took into account participants' total number of calories consumed per day, the amount of fiber they reported consuming, their Body Mass Index, level of physical activity, smoking status, highest level of education, and whether they had a history of type 2 diabetes.

After excluding those with unrealistic responses to the dietary survey as well as those who reported a diagnosis of colorectal cancer within a year of their first survey response there remained nearly 53,000 women who were ultimately included in the analysis.

The results are rather surprising. Those women who consumed at least 4 servings per week of red meat - whether processed or unprocessed - were 25% more like to develop colorectal cancer than those who consumed less than 2 servings of red meat per week.

Those who consumed at least three servings of UNprocessed red meat also saw a 25% increase in risk of colorectal cancer when compared to women who consumed less than 1 serving of unprocessed meat per week.

And finally, those who consumed the most processed meat - 1 or more servings per week as compared to 1/2-serving or less per week - saw no increase or decrease in their risk of colorectal cancer.

What to make of this seemingly inexplicable result? Black women should avoid unprocessed meat in favor of processed meat? Far more likely is the authors' suggestion that "the observed association of red meat consumptioni with [colorectal cancer] risk could have to do with foods that are consumed in conjunction with red meat as part of the overall dietary pattern."

The authors did NOT take into account overall diet quality for this study - a huge hole in their analysis. The study we reported on last week looked at the amount of junk food Americans eat as defined by standards set by Chile, which categorize highly processed foods and foods with high amounts of additives as "junk". This could arguably take at least some "hamburgers" out of the unprocessed meat category and move them firmly in the junk food/processed meat category. Can we be sure? No.

What this means for you

Research into the specific health issues and disparities that Black Americans face is sorely lacking, so extrapolating from this one study is questionable at best. Rather than focusing solely on the amount of red meat or processed meat you're consuming as part of preventing colorectal cancer, look at your overall diet. Get plenty of fiber, avoid cooking your meat at high temperatures, and reduce the amount of animal fats in your diet. Here's an overview of the research on colorectal cancer.

June 29, 2022