Category Archives: Cancer

Huge U.S. Study Confirms Health and Longevity Benefits of the Mediterranean Diet

Posted on July 27, 2012 | 4 comments

This is a reprint of my very first blog post, from December 24, 2007, at the old Advanced Mediterranean Diet Blog. 

We now have results of the first U.S. study on mortality and the Mediterranean dietary pattern.  380,000 people, aged 50-71, were surveyed on their dietary habits and scored on their conformity to the Mediterranean diet.  They were visited again 10 years later.  As you would expect, some of them died.  12,105 to be exact: 5985 from cancer, 3451 from cardiovascular disease, 2669 from other causes.  However, the people with the highest adherence to the Mediterranean diet had better survival overall, and specifically better odds of avoiding death from cardiovascular disease and cancer.  Compared to the people with low conformity to the Mediterranean diet, the high conformers were 15-20% less likely to die over the 10 years of the study.  The study authors, funded by the National Institutes of Health, noted eight similar studies in Europe and one in Australia with similar results.

Once again, my promotion of the Mediterranean diet is vindicated by the scientific literature.  I’m not aware of any other diet that can prove anywhere near this degree of health benefit.  If you are, please share. 

Reference: Mitrou, Panagiota N., et al.  Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population,  Archives of Internal Medicine, 167 (2007): 2461-2468.


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Reduce Your Cancer Risk Starting Today

Posted on July 25, 2012 | Comments Off on Reduce Your Cancer Risk Starting Today

In 2007, the World Cancer Research Fund and the American Institute for Cancer Research jointly published a report having the potential to reduce cancer rates by at least a third, if their recommendations were adopted.  A multinational team of 21 respected experts was charged with analyzing over 7,000 studies relating to diet, exercise, body weight, and cancer.  The panel assumes everyone already knows to avoid smoking and chewing tobacco.  Here are their 10 basic recommendations:

1.  Be as lean as possible within the normal range of body weight (BMI or body mass index of 18.5 to 24.9).  Being overweight or obese promotes certain cancers.

2.  Be physically active every day.  Example: 30 minutes of brisk walking.

3.  Limit consumption of energy-dense (high-calorie) foods.  Avoid sugary drinks.  Water is the best alternative to sugary drinks.  Natural fruit juice is a reasonable fruit serving, but limit to one daily.

4.  Eat mostly foods of plant origin.  Fill at least two-thirds of your plate with vegetables, fruits, whole grains, and beans.

5.  Limit intake of red meat and avoid processed meats.  Red meats are beef, pork, and lamb.  Limit to 18 ounces of cooked red meat per week.

6.  For pure cancer avoidance, don’t drink alcohol.  The panel recognizes, however, that alcohol likely helps in prevention of coronary heart disease.  If you drink alcohol for heart benefits, limit to two drinks daily if you are a man, and one daily if you are a woman.

7.  Limit consumption of salt (associated with stomach cancer).  Avoid moldy cereals and legumes (molds produce aflatoxins which cause liver cancer).

8.  Aim to meet nutritional needs through food intake rather than supplements.

9.  Mothers should breast-feed for six months (at least?).  Children should be breast-fed.

10.  Cancer survivors should still follow the recommendations for prevention of cancer.

Much of this is consistent with my book, The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer (2nd Edition).  The AMD is a diet/weight loss book, with little reason to seriously address breast-feeding and cancer survivors.  The association between salt intake and stomach cancer is news to me.  Stomach cancer is not very common in the United States, where I and most of my audience live.  Overweight people following the Advanced Mediterranean Diet will be far ahead of the game if they get their BMI just down to 24.9.  I’m not convinced 18.5 would be any healthier, and many studies suggest the opposite.

Steve Parker, M.D.

References: Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective

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Your Lifetime Risk of Cancer

Posted on July 13, 2012 | 1 comment

I have good news and bad news.  Which would you like first?

The good news is that cancer death rates in the U.S. have dropped over the last 20 years.  The reduction is 18% for men and 10% for women.

The bad news is that the American Cancer Society projects around 600,000 yearly deaths from cancer in the U.S.

If we look at deaths of people under 85, cancer kills more people than heart disease.

In men, 25% of all invasive cancers 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 and dangerous.)

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%).

Obesity is associated with higher risk for kidney and esophageal cancer in both sexes, prostate and colo-rectal cancer in men, and uterine, gallbladder, cervical, ovarian and breast cancer in women.  Excess body fat causes  14 to 20% of all cancer-related deaths in the U.S.  It’s reasonable to believe that reducing excess body fat will lower the risk of developing these cancers.

The traditional Mediterranean diet is associated with less risk of prostate, breast, colon, and uterus cancer.  And lower rates of cardiovascular disease.  Combine a Mediterranean diet with loss of excess body fat, and what’s not to love?

Steve Parker, M.D.

Reference:  Jemal, Ahmedin, et al.  Cancer Statistics, 2008.  CA Cancer Journal for Clinicians, 58 (2008): 71-96. 

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Mediterranean Diet Reduces Cancer Risk

Posted on July 7, 2012 | Comments Off on Mediterranean Diet Reduces Cancer Risk

In 2008, the British Journal of Cancer published a report linking the traditional Mediterranean diet “…with markedly and significantly reduced overall cancer….”

Researchers from the University of Athens, the International Agency for Research on Cancer, and the Harvard School of Public Health looked at 25,623 participants of the Greek portion of the European Prospective Investigation into Cancer and nutrition (the EPIC study).  Adherence to the Mediterranean diet was assessed with a food-frequency questionnaire.

Cancer developed in 851 participants over an average follow up of 7.9 years.  Non-melanoma skin cancers were not included since they are usually not serious or life-threatening.  The common cancers in men involved the lung, prostate, colon, and stomach.  For women, common cancers were breast, colon, ovary, and uterus.

Participants’ conformity to the Mediterranean diet was graded on a 10-point scale based on consumption of vegetables, legumes, fruits and nuts, cereals, fish, meat and meat products, dairy products, ethanol (alcohol), and the monounsaturated to saturated lipid ratio.  A score of zero indicated minimal adherence; maximal adherence scored a nine.

Every two-point increase in adherence was associated with a 12% reduction in the incidence of overall cancer.  So those participants with greatest conformity to the traditional Mediterranean diet had a dramatically reduced incidence of cancer compared to those with minimal adherence.

The researchers cite three independent studies that found a similar association between the Mediterranean diet and cancer.  The study at hand was not sufficiently powered to determine reliably which specific cancers were reduced with the Mediterranean diet.  Other studies indicate that the reduced cancers are prostate, breast, colon, and uterus.

The researchers surmise that the cancer-reducing benefit of the Mediterranean diet relates to the whole diet rather than to individual components.

To move your way of eating in a Mediterranean direction, review the diet here.

Steve Parker, M.D.

Reference:  Benetou, V., et al.  Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort.  British Journal of Cancer, 99 (2008): 191-195.

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Huge Study Confirms Health and Longevity Benefits of Mediterranean Diet

Posted on June 27, 2012 | Comments Off on Huge Study Confirms Health and Longevity Benefits of Mediterranean Diet

Italian researchers reported in the September 11, 2008, online issue of the British Medical Journal what is already known:

“Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinsons’s disease and Alzheimer’s disease (13%).  These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.”

Methodology

Researchers, mostly at the University of Florence, performed a meta-analysis of 12 other published studies that looked at the effects of a Mediterranean-style eating pattern on health and longevity.  [Meta-analyses are popular, in part, because they are cheap.  This study required no specific funding.]

Most, if not all, of these 12 studies were observational, and involved 1,574,299 participants.  Six of the 12 studies were in Mediterranean countries, the others were in the U.S., northern Europe, and Australia.  Study participants were followed between 3.7 and 18 years.

The researchers devised their very own Mediterranean diet scale based on study participants’ intake of various foods.  Participants were given a point if they had higher than average intake of vegetables, fruits, legumes, cereals, fish, and red wine during meals.  They were given a point if they had lower than average intake of red meat, processed meats, and dairy products.  Due to differences among the 12 studies, “the total adherence scores…varied from a minimum of 0 points indicating low adherence to a maximum of 7-9 points reflecting high adherence to a Mediterranean diet.”

(This version of a Mediterranean diet score is problematic.  Curiously, olive oil – the predominant source of fat in the traditional Mediterranean – is not in the score.  Olive oil is a key characteristic of the Mediterranean diet.  Furthermore, the study authors also state that dairy products are “presumed not to form part of a Mediterranean diet.”  Most experts would argue that cheese and yogurt are a significant part of the Mediterranean diet, if only in low amounts.  I also doubt that participants in the 12 original studies  were surveyed whether they drank red wine – as contrasted with white – and whether it was with meals or not.  I admit I did not read each of the 12 component studies.  The underlying cause of this idiosyncratic definition of the Mediterranean diet is that the 12 original studies themselves used different definitions of the Mediterranean diet.  The meta-analysts had to pigeonhole the data.  There are a handful of respected Mediterranean diet scores in existence, but the authors of this study couldn’t apply them across the board due to database inconsistency or inadequacy.)

Results

“The cumulative analysis of 12 cohort studies shows that a two point increase [emphasis added] in the score for adherence to a Mediterranean diet determines a 9% reduction, in overall mortality, a 9% reduction in mortality from cardiovascular diseases, a 6% reduction in incidence of or mortality from neoplasm [cancer], and 13% reduction in incidence of Parkinson’s disease and Alzheimer’s disease.”

The only one of the 12 original studies focused on Alzheimer’s disease, and it showed a 17% reduction in participants with high adherence to the Mediterranean diet.  The two studies that focused on Parkinson’s disease revealed a 7% reduction in men, and 15% reduction in women.  These reduced incidence figures, again, apply to a two-point increase in Mediterranean diet adherence score.

Discussion

The authors indicate that their report is the first ever meta-analysis of the data associating the Mediterranean diet with reduced mortality and chronic disease in the general population.  Congratulations, guys!

The authors’ idiosyncratic Mediterranean diet score is unusual and won’t be widely adopted.  However, the 12 studies comprising the meta-analysis did have reasonable Mediterranean diet characteristics.

Combining Alzheimer’s data with Parkinson’s data doesn’t make sense to me, nor did the authors try to explain it.   You could lump them into the category of “neurodegenerative diseases,” but they aren’t the only ones by any means.  The single Alzheimer’s study, by the way, was quite small compared to the two Parkinson’s studies.

Nearly all the popular media stories reported the findings as I did in my first paragraph above, which may be  misleading.  The specific improvements in mortality and various disease rates is per two-point increase in Mediterranean diet score.  For example, consider the 9% reduction in overall mortality.  If a population increased its Mediterranean score by four points, would overall mortality be reduced by 18%?  I’ve read this study four times and cannot answer my own question.  But I suspect that the answer is “yes.”  So the news here may better than it seems at first blush.

In other words: If a population’s score goes from 5 to 7, the death rate is reduced by 9%.  If that same population then moved its score from 7 to 9, would mortality improve another 9%?  I think so, but this study as written does not make it clear.

I’m starting to see why the popular media simplified the study findings.  The reporting on this study is amazingly uniform.  They must have all gotten the same news release.

Of course, “populations” don’t die or get cancer, heart attacks, strokes, Alzheimer’s, or Parkinson’s disease.  Individuals do that.  If I as an individual had a low Mediterranean diet score, I’d try to improve my score by at least two points.  A good place to start would be a review of the Mediterranean diet.

Steve Parker, M.D.

Reference:  Sofi, Francesco, et al.  Adherence to Mediterranean diet and health status: Meta-analysis.  British Medical Journal, 337; a1344.  Published online September 11, 2008.  doi:10.1136/bmj.a1344

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Prostate Cancer Deaths Linked to Overweight and High Insulin Levels

Posted on June 20, 2012 | Comments Off on Prostate Cancer Deaths Linked to Overweight and High Insulin Levels

Lancet Oncology in 2008 published a report associating worse prostate cancer outcomes—death, that is—with overweight, obesity, and hyperinsulinemia.

Grapes are an iconic Mediterranean fruit

Researchers looked at data from the respected Physicians’ Health Study, finding 2,546 men who developed prostate cancer during many years of observation. Of these men, 38.8% were overweight (body mass index 25–30) and 3.4% were obese (BMI over 30).

(For definitions of overweight and obesity, and to calculate your body mass index, click here.)

Compared with normal-weight men (BMI under 25) who developed prostate cancer, overweight men with prostate cancer were one-and-a-half times more likely to die from the cancer. Obese men with prostate cancer were two-and-a-half times more likely to die.

A blood test called C-peptide is a marker of insulin resistance and hyperinsulinemia. Obesity is often accompanied by high insulin levels and insulin resistance. Overweight, not so much. Eight hundred twenty-seven of the men with prostate cancer had C-peptide levels drawn at baseline, before diagnosed with cancer. Men with the highest C-peptide levels were almost two-and-a-half times more likely to die of prostate cancer than men with the lowest C-peptide levels.

Study participants having both excess body weight and high C-peptide levels had the worst outcome.

Prostate cancer is the most common invasive cancer in U.S. men, with about 185,000 cases diagnosed every year. It is one of the cancers that can be prevented by following the traditional Mediterranean diet for years. The other prevented cancers are breast, uterus, and colorectal. Obesity predisposes men to cancer of the prostate, colon, rectum, kidney, and esophagus.

The study at hand suggests that if you are overweight or obese and then develop prostate cancer, you have a greater risk of dying from the cancer compared with healthy-weight men. Given that prostate cancer is so common, why not cut your risk of getting it and dying from it by controlling your weight with a Mediterranean-style diet?

Steve Parker, M.D.

Reference: Ma, Jing, et al. Prediagnostic body mass index, plasma C-peptide concentration, and prostate cancer-specific mortality in men with prostate cancer: a long-term survival analysis. Lancet Oncology, online publication October 6, 2008. DOI: 10.1016/S1470-2045(08)70235-3

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Mediterranean Diet May Prevent Melanoma (Serious Invasive Skin Cancer)

Posted on June 18, 2012 | Comments Off on Mediterranean Diet May Prevent Melanoma (Serious Invasive Skin Cancer)

A 2008 study suggests a protective effect of the Mediterranean diet for cutaneous melanoma. This is the first study to examine melanoma’s association with the Mediterranean diet.

Melanoma is the seventh most common cancer in Americans, and the most common fatal malignancy among young adults. Lifetime risk of developing melanoma is one in 71. Incidence of melanoma in the white U.S. population has more than tripled in the last 20 years. The U.S. had 62,000 new cases of melanoma in 2008.

The researchers in Rome, Italy, used a hospital-based case-control method including 304 cases of melanoma and 305 matched controls who did not have melanoma. Information on sun exposure, skin pigmentation, smoking, medical history, and socio-demographic characteristics was collected.

The researchers report:

After careful control for several sun exposure and pigmentary characteristics, we found a protective effect for weekly consumption of fish, shellfish, fish rich in omega-3 fatty acids, daily tea drinking and high consumption of vegetables in particular carrots, cruciferous and leafy vegetables and fruits, in particular citrus fruits.

[For the sake of clarity, I have omitted odds ratios and confidence intervals. Odds ratios for many of these associations were around 0.50, meaning half the risk of developing melanoma.]

Conclusion overall: Our findings suggest that some dietary factors present in the Mediterranean diet might protect from cutaneous melanoma.

Prior studies have demonstrated lower incidence of breast, colon, prostate, and uterus cancer in people who adhere to the traditional Mediterranean diet. Note also that death rates from cancer are lower. We can probably add melanoma to the list of cancers prevented with a Mediterranean-style diet, although I would have more confidence if the current study had included more participants.

Steve Parker, M.D.

Reference: Fortes, C., et al. A protective effect of the Mediterraenan diet for cutaneous melanoma. International Journal of Epidmiology, 37 (2008): 1,018-1,029.

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Alcohol Consumption and Cancer in Women

Posted on May 30, 2012 | Comments Off on Alcohol Consumption and Cancer in Women

The Million Women Study (2009) looked at the association between alcohol consumption and the incidence of various cancers in middle-aged women in the United Kingdom.

Here’s the conclusion from the abstract in the Journal of the National Cancer Institute:

Low to moderate alcohol consumption in women increases the risk of certain cancers. For every additional drink regularly consumed per day, the increase in incidence up to age 75 years per 1000 for women in developed countries is estimated to be about 11 for breast cancer, 1 for cancers of the oral cavity and pharynx, 1 for cancer of the rectum, and 0.7 each for cancers of the esophagus, larynx and liver, giving a total excess of about15 cancers per 1000 women up to age 75.

Other cancers seemed to be reduced by increasing levels of alcohol consumption: thyroid, non-Hodgkin lymphoma, renal cell carcinoma.

Comparing wine with other alcohol types, no differences in cancer risks were found.

Low to moderate alcohol consumption is associated with prolonged life, lesser risk of dementia, and lower rates of cardiovascular disease. The article abstract doesn’t mention these issues, nor the possibility that the benefits of judicious alcohol consumption may outweigh the cancer risks. 

Steve Parker, M.D.

References:

Allen, Naomi, et al. Moderate Alcohol Intake and Cancer Incidence in Women. Journal of the National Cancer Institute, 101 (2009): 296-305.

Lauer, Michael and Sorlie, Paul. Alcohol, Cardiovascular Disease, and Cancer: Treat With Caution. Journal of the National Cancer Institute, 101 (2009): 282-283.

Szwarc, Sandy. In Vino Veritas – Part Two. Junkfood Science blog, March 1, 2009. Accessed March 10, 2009. A quote from Ms. Szwarc regarding the Million Women Study:

The bottom line is that scary claims that “there is no level of alcohol consumption that can be considered safe,” simply was not supported by the data. This study actually found no credible link between alcohol consumption and cancers at all. Or, if you want to split hairs and believe the small computed numbers, it found that the lowest risk for cancers was associated with women drinking up to 1-2 drinks a day.

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Which Components of the Mediterranean Diet Prolong Life?

Posted on May 22, 2012 | 1 comment

Researchers at Harvard and the University of Athens (Greece) report that the following specific components of the Mediterranean diet are associated with lower rates of death:

  • moderate ethanol (alcohol) consumption
  • low meat and meat product intake
  • high vegetable consumption
  • high fruit and nut consumption
  • high ratio of monounsaturated fat to saturated fat
  • high legume intake

Minimal, if any, contribution to mortality was noted with high cereal, low dairy, or high fish and seafood consumption.

The researchers examined diet and mortality data from over 23,000 adult participants in the Greek portion of the European Prospective Investigation into Cancer and nutrition. You’ll be hearing more about the EPIC study for many years. Over an average follow-up of 8.5 years, 1,075 of participants died. 652 of these deaths were of participants in the lower half of Mediterranean diet adherence; 423 were in the upper half.

Alcohol intake in Greece is usually in the form of wine at mealtimes.

The beneficial “high ratio of monounsaturated fat to saturated fat” stems from high consumption of olive oil and low intake of meat.

It’s not clear if these findings apply to other nationalities or ethnic groups. Other research papers have documented the health benefits of the Mediterranean diet in at least eight other countries over three continents.

The researchers don’t reveal in this report the specific causes of death. I expect those data, along with numbers on diabetes, stroke, and dementia, to be published in future articles, if not published already. Prior Mediterranean diet studies indicate lower death rates from cardiovascular disease and cancer.

Steve Parker, M.D.

Reference: Trichopoulou, Antonia, et al. Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort study. British Medical Journal, 338 (2009): b2337. DOI: 10.1136/bmj.b2337.

Additional Information: Childs, Dan. Take it or leave it? The truth about 8 mediterranean diet staples. ABC News online, June 24, 2009. Accessed June 25, 2009.

Addendum:

Here’s a direct quote from the study at hand:

Among the presumed beneficial components of the Mediterranean diet score, high consumption of all but fish and seafood was inversely associated with mortality, although none of these associations was statistically significant.

“. . . none of these associations was statistically significant.” So I can understand some skepticism about this journal article. The researchers had to use some very sophisticated statistical manipulation to come up with the “healthy components” list. I’m not saying that’s wrong. I will admit that the statistical analysis is beyond my comprehension, so I’m trusting the authors and peer-review process to be honest and effective. My college statistics course was too many years ago.

The take-home point for me is that the health benefits of the Mediterranean diet probably stem from an overall combination of multiple foods rather than any single component.

And remember to exercise regularly, maintain a healthy weight (BMI 18.5-25), keep your blood pressure under 140/90, and don’t smoke.

-Steve

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Mediterranean Diet Linked to Lower Stomach Cancer Risk

Posted on May 15, 2012 | Comments Off on Mediterranean Diet Linked to Lower Stomach Cancer Risk

The Mediterranean diet is associated with a 33% reduction in stomach cancer, according to a study published in the American Journal of Clinical Nutrition.

Stomach cancer (aka gastric cancer) is uncommon in the U.S. Most cases are advanced and incurable at the time of diagnosis. So prevention is ideal.

European investigators studied 485,000 people over the course of nine years, during which 449 cases of stomach cancer were found. Surveys determined how closely the food consumption of study participants tracked nine key components of the Mediterranean diet. Compared with people who had low adherence to the Mediterranean diet, those with high adherence had 33% less risk of developing stomach cancer.

The Mediterranean diet has long been associated with a lower risk of cancer: specifically, cancers of the breast, colon, prostate, and uterus. We can add stomach cancer to the list now.

Steve Parker, M.D.

Reference: Buckland, Genevieve, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. American Journal of Clinical Nutrition, December 9, 2009, epub ahead of print. doi: 10.3945/ajcn.2009.28209

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