Four Ways to Improve on the Mediterranean Diet

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The traditional Mediterranean diet can be considered mainly, but not exclusively, as a plant-based diet, and certainly not a whole foods, plant-based diet. Olive oil and wine can be considered essentially fruit juices. Even if one is eating a "vegiterranean diet," an entirely plant-based version, there are a number of problematic nutritional aspects that are rarely talked about. For example, the Mediterranean diet includes lots of white bread, white pasta and not a lot of whole grains.

In an anatomy of the health effects of the Mediterranean diet, the single most important component was the high consumption of plant foods. In contrast, high cereal consumption, meaning high grain consumption, did not appear to help. This may be because most grains that modern Mediterranean dieters eat are refined, like white bread, whereas the traditional Mediterranean diet was characterized by unprocessed cereals--in other words, whole grains. And while whole grains have been associated with lower risk of diabetes, heart disease and cancer, refined grain may increase the risk of diabetes, obesity, heart disease and other chronic diseases. In the PREDIMED study, those who ate the most white bread--but not whole grain bread--gained significant weight.

Alcohol may also be a problem. As a plant-centered diet, adherence to a Mediterranean diet is associated with lower cancer risk, but does not appear to lower breast cancer risk. With all the fruits, veggies, nuts, seeds, beans and low saturated fat content, you'd assume there would be lower breast cancer risk, but alcohol is a known breast carcinogen, even in moderate amounts. When researchers created a special adapted version of the Mediterranean diet score that excluded alcohol, the diet does indeed appear to reduce breast cancer risk.

The wonderful grape phytonutrients in red wine can improve our arterial function such that if you drink nonalcoholic red wine (wine with the alcohol removed), you get a significant boost in endothelial function--the ability of our arteries to relax and dilate normally, increasing blood flow. If you drink the same red wine with alcohol, it abolishes the beneficial effect and counteracts the benefit of the grape phytonutrients. So, it would be better just to eat grapes. You can find more information about this in my video Improving on the Mediterranean Diet.

Similarly, there are components of extra virgin olive oil--the antioxidant phytonutrients, that may help endothelial function, but when consumed as oil, (even extra virgin olive oil), it may impair arterial function. So even if white bread dipped in olive oil is the very symbol of the Mediterranean diet, we can modernize it by removing oils and refined grains.

Another important, albeit frequently ignored issue in the modern Mediterranean diet is sodium intake. Despite evidence linking salt intake to high blood pressure, heart disease and strokes, dietary salt intake in the U.S. is on the rise. Right now, Americans get about seven to ten grams a day, mostly from processed foods. If we were to decrease that just by three grams every year, we could possibly save tens of thousands of people from having a heart attack, prevent tens of thousands of strokes, and tens of thousands of deaths. There is a common misperception that only certain people should reduce their salt intake and that for the vast majority of the population, salt reduction is unnecessary, but in reality, the opposite is true.

There is much we can learn from the traditional Mediterranean diet. A defining characteristic of the Mediterranean diet is an abundance of plant foods, but one thing that seems to have fallen by the wayside. No main Mediterranean meal is replete without lots of greens, a key part of not only a good Mediterranean diet, but of any good diet.

Here are some of my previous videos on the Mediterranean diet:

I touch more on whole grains in How Many Meet the Simple Seven? and Whole Grains May Work As Well As Drugs.

More on breast cancer and alcohol in Breast Cancer and Alcohol: How Much Is Safe?, Preventing Skin Cancer From the Inside Out, and Breast Cancer Risk: Red Wine v. White Wine.

I've touched on olive oil in the other videos in this Mediterranean diet series, but also have an older video Extra Virgin Olive Oil vs. Nuts and more recently, Olive Oil & Artery Function.

More on sodium in Dietary Guidelines: With a Grain of Big Salt, Big Salt - Getting to the Meat of the Matter, and Can Diet Protect Against Kidney Cancer? But what if without salt everything tastes like cardboard? Not to worry! See Changing Our Taste Buds.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

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Four Ways to Improve on the Mediterranean Diet

Improving on the Mediterranean Diet.jpg

The traditional Mediterranean diet can be considered mainly, but not exclusively, as a plant-based diet, and certainly not a whole foods, plant-based diet. Olive oil and wine can be considered essentially fruit juices. Even if one is eating a "vegiterranean diet," an entirely plant-based version, there are a number of problematic nutritional aspects that are rarely talked about. For example, the Mediterranean diet includes lots of white bread, white pasta and not a lot of whole grains.

In an anatomy of the health effects of the Mediterranean diet, the single most important component was the high consumption of plant foods. In contrast, high cereal consumption, meaning high grain consumption, did not appear to help. This may be because most grains that modern Mediterranean dieters eat are refined, like white bread, whereas the traditional Mediterranean diet was characterized by unprocessed cereals--in other words, whole grains. And while whole grains have been associated with lower risk of diabetes, heart disease and cancer, refined grain may increase the risk of diabetes, obesity, heart disease and other chronic diseases. In the PREDIMED study, those who ate the most white bread--but not whole grain bread--gained significant weight.

Alcohol may also be a problem. As a plant-centered diet, adherence to a Mediterranean diet is associated with lower cancer risk, but does not appear to lower breast cancer risk. With all the fruits, veggies, nuts, seeds, beans and low saturated fat content, you'd assume there would be lower breast cancer risk, but alcohol is a known breast carcinogen, even in moderate amounts. When researchers created a special adapted version of the Mediterranean diet score that excluded alcohol, the diet does indeed appear to reduce breast cancer risk.

The wonderful grape phytonutrients in red wine can improve our arterial function such that if you drink nonalcoholic red wine (wine with the alcohol removed), you get a significant boost in endothelial function--the ability of our arteries to relax and dilate normally, increasing blood flow. If you drink the same red wine with alcohol, it abolishes the beneficial effect and counteracts the benefit of the grape phytonutrients. So, it would be better just to eat grapes. You can find more information about this in my video Improving on the Mediterranean Diet.

Similarly, there are components of extra virgin olive oil--the antioxidant phytonutrients, that may help endothelial function, but when consumed as oil, (even extra virgin olive oil), it may impair arterial function. So even if white bread dipped in olive oil is the very symbol of the Mediterranean diet, we can modernize it by removing oils and refined grains.

Another important, albeit frequently ignored issue in the modern Mediterranean diet is sodium intake. Despite evidence linking salt intake to high blood pressure, heart disease and strokes, dietary salt intake in the U.S. is on the rise. Right now, Americans get about seven to ten grams a day, mostly from processed foods. If we were to decrease that just by three grams every year, we could possibly save tens of thousands of people from having a heart attack, prevent tens of thousands of strokes, and tens of thousands of deaths. There is a common misperception that only certain people should reduce their salt intake and that for the vast majority of the population, salt reduction is unnecessary, but in reality, the opposite is true.

There is much we can learn from the traditional Mediterranean diet. A defining characteristic of the Mediterranean diet is an abundance of plant foods, but one thing that seems to have fallen by the wayside. No main Mediterranean meal is replete without lots of greens, a key part of not only a good Mediterranean diet, but of any good diet.

Here are some of my previous videos on the Mediterranean diet:

I touch more on whole grains in How Many Meet the Simple Seven? and Whole Grains May Work As Well As Drugs.

More on breast cancer and alcohol in Breast Cancer and Alcohol: How Much Is Safe?, Preventing Skin Cancer From the Inside Out, and Breast Cancer Risk: Red Wine v. White Wine.

I've touched on olive oil in the other videos in this Mediterranean diet series, but also have an older video Extra Virgin Olive Oil vs. Nuts and more recently, Olive Oil & Artery Function.

More on sodium in Dietary Guidelines: With a Grain of Big Salt, Big Salt - Getting to the Meat of the Matter, and Can Diet Protect Against Kidney Cancer? But what if without salt everything tastes like cardboard? Not to worry! See Changing Our Taste Buds.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

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The Role of Caffeine in Artery Function

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There are dietary guidelines for food, but what about for beverages? A Beverage Guidance Panel was "assembled to provide guidance on the relative health and nutritional benefits and risks of various beverage categories." They ranked them from one to six, and water was ranked number one.

Soda ranked last at number six. Whole milk was grouped with beer, with a recommendation for zero ounces a day, in part out of concern for links between milk and prostate cancer, as well as aggressive ovarian cancer due to IGF-1. Number two on the list, though, after water, was tea and coffee, preferably without creamer or sweetener.

Even without creamer, though, lots of unfiltered coffee can raise cholesterol, but the cholesterol-raising compounds are trapped by the paper filter in brewed coffee, so filtered coffee is probably better.

But about ten years ago, a study was published on the effects of coffee on endothelial function, the function of our arteries. I profile this study in my video Coffee and Artery Function, showing that within 30 minutes of drinking a cup of coffee there was a significant drop in the ability of our arteries to dilate, whereas decaf did not seem to have a significant effect. This was the first study to demonstrate an acute unfavorable effect on arterial function of caffeinated coffee, but one cup of decaf didn't seem to affect performance. And two cups of decaf appeared to have a beneficial effect. So maybe it's a "battle between caffeine and antioxidants." Something in caffeinated coffee appears to be hurting arterial function, whereas something in decaf appears to be helping.

It's similar to red wine. De-alcoholized red wine significantly improves arterial function, as there are grape components trying to help, but the presence of alcohol counteracts and erases the benefit.

Drinking really high antioxidant coffee, by preparing it Greek style for example (where we actually drink the grounds), coffee drinkers may actually be at an advantage

It might not be the caffeine in caffeinated coffee that appears to be harmful, though. In a randomized, double-blind, placebo-controlled, cross-over study, researchers found that caffeine alone--about two and a half cups of coffee worth--significantly improved arterial function in both people with and without heart disease.

Coffee contains more than a thousand different compounds other than caffeine, many of which are also removed by the decaffeination process, so there must be something else in the coffee bean that's causing the problem. In fact, caffeine may even enhance the repair of the fragile inner lining of our arteries by enhancing the migration of our endothelial progenitor cells, the stem cells that patch up potholes in our artery walls.

But how might we get the potential benefit of caffeine without the risky compounds in caffeinated coffee? Tea consumption enhances artery function, and there are substantial beneficial effects of both green tea and black tea. Instead of other components in tea leaves undermining caffeine's potential benefits, they appear to boost the benefit in healthy individuals, as well as heart disease patients, reversing some of their arterial dysfunction, both immediately and long-term.

All the measurements in the studies I've talked about so far were done on the brachial artery, the main artery in the arm (just because it's easier to get to). What we care about, though, is blood flow to the heart. And caffeine appears to impair blood flow to our heart muscle during exercise even in healthy folks, but especially in those with heart disease. Thankfully caffeine in tea form appears to have the opposite effect, significantly improving coronary blood flow, suggesting that tea consumption has a beneficial effect on coronary circulation, though the addition of milk may undermine the protective effects.

I'm fascinated by how complicated such a simple question can get. The take-home is that water is the healthiest beverage, followed by tea.

The effects of coffee on cancer risk are more salutary:

I've previously covered Walnuts and Artery Function and Dark Chocolate and Artery Function. Stay tuned for a few more coming up further exploring the effects of tea, olive oil, and plant-based diets on our lovely endothelium.

Low Carb Diets and Coronary Blood Flow is one of the few other studies I've done that measured blood flow within the coronary arteries themselves. For more background on the brachial artery test, see my video The Power of NO.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations--2013: Uprooting the Leading Causes of Death, More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

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Preventing and Treating Colon Cancer with Turmeric Curcumin

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The low incidence of bowel cancer in India is often attributed to natural antioxidants such as curcumin, the yellow pigment in the spice turmeric, used in curry powder. However, it is important to remember that the benefits of a diet are seldom produced by a single ingredient in that diet. For example, diets rich in beta-carotene lower the risk of tobacco-related cancers, but beta-carotene pills do not. That doesn't stop researchers from trying, though.

Back in 2001, in a last ditch attempt to save the lives of 15 patients with advanced colorectal cancer that didn't respond to any of the standard chemotherapy agents or radiation, researchers started them on a turmeric extract. The extract appeared to help stall the disease in a third (5 out of 15) of the patients, suggesting that turmeric extract may clinically benefit at least some patients with advanced refractory colorectal cancer.

If we were talking about some new kind of chemotherapy, and it only helped one in three, we'd have to weigh the benefits against chemo side effects, such as losing our hair, the sloughing of our guts, intractable vomiting, maybe being bed-ridden. Therefore, a drug scenario, a one in three benefit may not sound particularly appealing. But when we're talking about plant extract proven to be remarkably safe, it would be worth considering even if it just helped 1 in a 100. With no serious downsides, a one in three benefit for end-stage cancer is pretty exciting.

To see if colon cancer could be prevented, five years later, researchers at Cleveland Clinic and John Hopkins School of Medicine tested two phytochemicals, curcumin (from turmeric) and quercitin, (found in fruits and vegetables such as red onions and grapes) in people with familial adenomatous polyposis, an inherited form of colon cancer in which individuals develop hundreds of polyps that may become cancerous unless prophylactically removed. (See Turmeric Curcumin and Colon Cancer). Researchers gave supplements of curcumin and quercetin to five such patients who already had their colons removed, but still had either polyps in their rectum or in a little intestinal pouch. Each patient had between 5 and 45 polyps each, but after six months on the supplement they ended up with on average fewer than half the polyps, and the ones that were left had shrunk in half. One patient got rid of all polyps by month three, but then they seemed to come back. The researchers asked the patient what's what, and it turned out that the patient stopped taking the supplements. So researchers put the patient back on the phytonutrient supplements for another three months, and the polyps came back down with virtually no adverse events and no blood test abnormalities.

By studying people at high risk for colon cancer, the researchers were able to show noticeable effects within just months. But polyposis is a rare disease; they were only able to recruit five people for the study. Thankfully, smokers are a dime a dozen. After another five years, researchers put 44 smokers on turmeric curcumin supplements alone for a month and measured changes in their colorectal aberrant crypt foci, which may act like the precursors to polyps, which are the precursors to cancer. After just one month there was a significant drop in the number of these abnormal crypt foci in the high dose supplement group but no change in the low dose group. There were also no dose-limiting side effects (although the stools in the participants did turn yellow).

The low cancer rates in India may also be related to phytate consumption (Phytates for the Prevention of Cancer) and plant-centered diets (Back to Our Roots: Curry and Cancer).

More on turmeric and Cancer in Carcinogenic Blocking Effects of Turmeric and Turmeric Curcumin Reprogramming Cancer Cell Death.

Given the poor systemic absorption of turmeric compounds, what cancers other than that of the digestive tract may be directly affected? See my follow-up video Topical Application of Turmeric Curcumin for Cancer.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: sea turtle / Flickr

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Dr. Greger’s 2015 Live Year-in-Review Presentation

Food as Medicine

View my new live presentation here: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet

Every year I scour the world's scholarly literature on clinical nutrition, pulling together what I find to be the most interesting, practical, and groundbreaking science on how to best feed ourselves and our families. I start with the thousands of papers published annually on nutrition (27,000 this year--a new record!) and, thanks to a crack team of volunteers (and now staff!), I'm able to whittle those down (to a mere 8,000 this year). They are then downloaded, categorized, read, analyzed, and churned into the few hundred short videos. This allows me to post new videos and articles every day, year-round, to NutritionFacts.org. This certainly makes the site unique. There's no other science-based source for free daily updates on the latest discoveries in nutrition. The problem is that the amount of information can be overwhelming.

Currently I have more than a thousand videos covering 1,931 nutrition topics. Where do you even begin? Many have expressed their appreciation for the breadth of material, but asked that I try to distill it into a coherent summary of how best to use diet to prevent and treat chronic disease. I took this feedback to heart and in 2012 developed Uprooting the Leading Causes of Death, which explored the role diet may play in preventing, arresting, and even reversing our top 15 killers. Not only did it rise to become one of the Top 10 Most Popular Videos of 2012, it remains my single most viewed video to date, watched over a million times (NutritionFacts.org is now up to more than 1.5 million hits a month!).

In 2013 I developed the sequel, More Than an Apple a Day, in which I explored the role diet could play in treating some of our most common conditions. I presented it around the country and it ended up #1 on our Top 10 Most Popular Videos of 2013. Then in 2014 I premiered the sequel-sequel, From Table to Able, in which I explored the role diet could play in treating some of our most disabling diseases, landing #1 on our Top 10 Most Popular Videos of 2014.

Every year I wonder how I'm going to top the year before. Knowing how popular these live presentations can be and hearing all the stories from folks about what a powerful impact they can have on people's lives, I put my all into this new 2015 one. I spent more time putting together this presentation than any other in my life. It took me an entire month, and when you see it I think you'll appreciate why.

This year, I'm honored to bring you Food as Medicine, in which I go through our most dreaded diseases--but that's not even the best part! I'm really proud of what I put together for the ending. I spend the last 20 minutes or so (starting at 56:22) going through a thought experiment that I'm hoping everyone will find compelling. I think it may be my best presentation ever. You be the judge.

You can watch it at no cost online, but it is also available on DVD through my website or on Amazon. If you want to share copies with others, I have a five for $40 special (enter coupon code 5FOR40FAM). All proceeds from the sales of all my books, DVDs, downloads, and presentations go to the 501c3 nonprofit charity that keeps NutritionFacts.org free for all, for all time. If you want to support this initiative to educate millions about eradicating dietary diseases, please consider making a donation.

After you've watched the new presentation, make sure you're subscribed to get my video updates daily, weekly, or monthly to stay on top of all the latest.

-Michael Greger

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What to Eat to Reduce Our Toxic Exposure

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It is not very common that a single molecule attracts enough interest to merit international scientific conferences of its own. "Ah receptor," however, "belongs to the rare elite of such molecules." Ah receptors are an important factor in how our immune system works. For background, see my video, The Broccoli Receptor: Our First Line of Defense. The latest conference offered "new reports about the way plant-derived compounds in our diet are necessary for a fully functioning immune system of the gut." One study in particular out of the journal Nature, "expanded our understanding of how diet impacts immunity and health by showing that a plant-derived nutrient profoundly shapes the capacity for intestinal immune defense." And intestinal defense not only protects us against the pathogens we may ingest, but also against toxic chemicals.

We're constantly exposed to a wide range of toxins, from such sources as cigarette smoke, exhaust fumes, furnace gases, cooked meat and fish, cow's milk, and even mother's milk (because of what mothers themselves are exposed to) as seen in my video Counteracting the Effects of Dioxins Through Diet. Many of these pollutants exert their toxic effects through the Ah receptor system. For example, dioxins invade the body mainly through the diet (where we get more than 90% of our exposure) as it concentrates through the food chain, presenting a serious health concern. But there are phytonutrients in fruits, vegetables, tea, red wine, and beans that block the effects of dioxins at levels close to what we find in people's bloodstream. Just three apples or about a tablespoon of red onion a day may cut dioxin toxicity in half. And the half-life of these phytonutrients in the body is only about 25 hours, so we have to keep eating these health-promoting foods day after day.

At first we just thought that it was only cruciferous vegetables that could dock in these receptors and fend off toxins, but does that make evolutionary sense? As Lora V. Hooper from the Howard Hughes Medical Institute notes, "Given the variety and flexibility of most mammalian diets, a specific dependence on cruciferous vegetables for optimal intestinal immune function would seem overly restrictive. Rather, it seems likely that many other foods contain compounds with similar immune-stimulatory properties."

Indeed, "the search for foods containing similar immunomodulatory compounds has begun." We now know that a wide variety of natural plant compounds can counteract the chemical pollution to which we're all exposed. There is actually one animal product that has also been shown to potentially block the cancer-causing effects of dioxins: camel urine. Camel urine--but not cow urine--was found to inhibit the effects of a known carcinogenic chemical. Importantly, the researchers emphasize that virgin camel urine showed the highest degree of inhibition, performing better than pregnant camel urine, for example. So the next time our kids don't want to eat their fruits and veggies, we can just say, "It's either that, or camel pee."

I report different mechanisms but similar outcomes in Plants vs. Pesticides and Eating Green to Prevent Cancer. So this all suggests a double benefit of eating lower on the food chain, since it would also entail lower exposure to toxic contaminants in the first place (Industrial Pollutants in Vegans).

How Chemically Contaminated Are We? Check out the CDC Report on Environmental Chemical Exposure. Where are dioxins found so we can avoid them in the first place? See Dioxins in the Food Supply.

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Images thanks to Feliciano Guimaraes / Flickr

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Breast Cancer and Wine

 

 

 

 

 

 

 

 

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After diagnosis, women with breast cancer may cut their risk of dying nearly in half by just instituting simple, modest lifestyle changes—5 or more servings of fruits and veggies a day and walking 30 minutes a day, 6 days a week. But what about preventing breast cancer in the first place?

If we follow the advice of the official dietary guidelines for cancer prevention, does it actually reduce our risk of cancer? If we manage our weight, eat more plant foods, less animal foods, less alcohol and breastfeed, based on the largest prospective study on diet and cancer in history, we may significantly lower our risk of breast cancer, endometrial cancer, colorectal cancer, lung cancer, kidney cancer, stomach cancer, oral cancer, liver cancer, esophageal cancer, and all cancers combined.

Of all the recommendations, the “eat mostly foods of plant origin” appeared the most powerful. For example, a study in the UK found that in just one year in Britain there were 14,902 excess cases of cancer caused by something participants were exposed to 10 years earlier. What was that something that ended up causing thousands of cancers?  

Deficient intake of fruit and vegetables.

If that was instead, some chemical spill causing 14,000 cancers, people would be up in arms to ban it—but instead when that killer carcinogen is not eating their “fruit and veg” (as the Brits would say), it hardly gets anyone’s attention.

What if we throw in smoking, too? Researchers created a healthy lifestyle index, defined by four things: 1) exercise;  2) a dietary shift away from the standard American diet high in meat, dairy, fat, and sugar towards a more prudent dietary pattern—for instance more green and yellow vegetables, beans, and fruits;  3) avoidance of tobacco; and 4) avoidance of alcohol. Young women scoring higher on those four things cut their odds of getting breast cancer in half, older women cut their odds of breast cancer by 80%!

We’ve covered how even light drinking can increase breast cancer risk (see my video Breast Cancer and Alcohol: How Much is Safe?), but for women who refuse to eliminate alcohol, which is less carcinogenic: red wine or white? Some studies, outlined in my four minute video, Breast Cancer Risk: Red Wine vs. White Wine, actually suggest less or even no risk from red wine, and we may have just figured out why. Remember how mushrooms were the vegetable best able to suppress the activity of aromatase, the enzyme used by breast tumors to produce its own estrogen? (from my video Vegetables Versus Breast Cancer). Well, if we run the same human placenta experiments with fruit, strawberries get the silver, but grapes get the gold.

For more on the aromatase story, see:

But what kind of grapes? The wimpy green grapes used to make white wine barely worked compared to those used for making red.  Bottom line: “red wine may serve as a nutritional aromatase inhibitor, which may ameliorate the elevated breast cancer risk associated with alcohol intake.” But why accept any elevated risk? Just eat whole grapes! And if you do, choose ones with seeds if you can, as they may work even better. More on grapes in Fat Burning Via Flavonoids and Best Fruit Juice.

Wasn’t there a study that found that fruits and vegetables weren’t protective against cancer, though? See my video on the EPIC Study.

What if you already have breast cancer? Well, Cancer Prevention and Treatment May Be the Same Thing, but I do have a few studies on breast cancer survival and diet:

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death and More Than an Apple a Day.

Image credit: TonalLuminosity / Flickr

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Breast Cancer & Alcohol: How Much is Safe?

 

 

 

 

 

 

 

 

Breast Cancer & Alcohol: How Much is Safe?

Nearly 5,000 breast cancer deaths a year may be attributable to just light drinking (up to one drink a day).

The International Agency for Research on Cancer, the World Health Organization body tasked with collating the totality of evidence as to whether or not something causes cancer, has now concluded that alcoholic beverages—all alcoholic beverages—are to be considered carcinogenic to humans.View image

There has been convincing evidence that alcohol consumption increases the risk of breast cancer, but most of the data were derived from studies that focused on the effect of moderate or high alcohol intakes, while little was known about light alcohol drinking (up to 1 drink/day). A recent meta-analysis of studies that compared light drinkers to non-drinkers found a moderate but significant association with breast cancer, based on the results of more than 100 studies.

The researchers estimate that about 5,000 breast cancer deaths a year are attributable to light drinking, meaning nearly 5,000 women that died of breast cancer maybe wouldn’t have if they had stayed away from alcohol completely, leading to an editorial in the medical journal Breast that concluded “women who consume alcohol chronically have an increased risk for breast cancer that is dose dependent but without threshold.” No threshold means there’s apparently no level of alcohol consumption that doesn’t raise breast cancer risk at least a little. Any level of alcohol consumption appears to increase the risk of developing an alcohol-related cancer. For example, the Harvard Nurses’ Study found that even consumption of less than a single drink per day may be associated with a modest increase in risk.

Most recent research has focused on acetaldehyde, the first and most toxic alcohol metabolite, as the primary cancer-causing agent. The bacteria in our mouths appear to oxidize alcohol into this acetaldehyde carcinogen, which we then swallow. So even a single sip of alcohol may be harmful. A new study found that just holding a teaspoon of hard liquor in our mouth for 5 seconds results in carcinogenic concentrations of acetaldehyde—even if we don’t swallow. The exposure continues for at least 10 min after spitting it out.

No surprise then alcohol-containing mouthwash can offer a carcinogenic spike as well. Researchers conclude: “All in all, there is a rather low margin of safety in the use of alcohol-containing mouthwash. Typical use will reach the concentration range above which adverse effects are to be expected. Until the establishment of a more solid scientific basis for a threshold level of acetaldehyde in saliva, prudent public health policy would recommend generally refraining from using alcohol in such products.”

So why isn’t the same recommendation made for alcoholic beverages? Well, as the Harvard paper concludes, “individuals will need to weigh the risks of light to moderate alcohol use on breast cancer development against the benefits for heart disease prevention to make the best personal choice regarding alcohol consumption.” They’re talking about the famous J shaped curve (watch my 4-min video Breast Cancer and Alcohol: How Much is Safe? to check it out). While smoking is bad and more smoking is worse, and in general exercising is good and more exercise is better, for alcohol there appears to be a beneficial effect of small doses. A six-pack a day raises overall mortality, but so does teetotalling.

The #1 killer of women isn’t breast cancer, but heart disease, and a drink a day reduces the risk of heart disease. Why just reduce the risk of heart disease, though, when you may nearly eliminate the risk of heart disease with a healthy enough diet? See, for example, my video Eliminating the #1 Cause of Death. A plant-based diet that excludes certain plant-based (alcoholic) beverages may therefore be the best for overall longevity.

For more on this topic, please see my follow-up video Breast Cancer Risk: Red Wine vs. White Wine. I’ve also previously addressed the pros and cons in Alcohol Risks vs. Benefits.

The other mouthwash video I refer to in the above video is Don’t Use Antiseptic Mouthwash, part of a video series on improving athletic performance with nitrate-containing vegetables (if interested, start here: Doping With Beet Juice).

How else might one reduce breast cancer risk? Please feel free to check out:

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death and More Than an Apple a Day.

Images thanks to ondrej.lipar / Flickr

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