Meat, Cancer Risk, and Nutrition Confusion

No wonder people are confused about nutrition

I was perusing the NY Times website last week, and noticed two articles appearing on the same day:  How Salad Can Make Us Fat and Is Grass-Fed Beef Better for You? No wonder people are confused about nutrition and health! Granted, reading beyond the headlines presents a more nuanced picture. Unfortunately, many people don’t read beyond headlines, and are left with a case of nutritional whiplash… “What? Salad is fattening? And beef is actually good for me?” Given this type of experience, it should come as no surprise that many people do not trust nutrition professionals.

A report worth reading

Despite this, I encourage you to pay attention to the World Health Organization (WHO) report released today on red meat, processed meat, and cancer risk. This report validates what I have always said about grass-fed meat and health: grass-fed meat may be healthier than conventionally-produced, “feed-lot” meat, but that doesn’t necessarily mean it is healthy.

What about grass-fed and organic meat?

Some who advocate for more grass-fed meat, butter, and milk focus on just one aspect of the meat: fat. When people say grass-fed, organic meat is healthier, I always ask, “Healthier than what?” I agree, these products are healthier than conventionally-raised meat. They do have a healthier fatty acid profile. But there’s more to food than one single nutrient or category of nutrients.

Also consider that according to the report from the WHO’s dedicated cancer agency, the International Agency for Research on Cancer (IARC), meat includes all mammalian muscle meat, such as beef, veal, pork, lamb, mutton, horse, and goat. Is there such a thing as grass fed pork? Regardless, keep in mind that in this WHO report, meat refers to all meat, not just beef.

So, back to the grass-fed meat question…based on available research, I believe how you raise the animal does not lessen the increased cancer risk associated with consuming it, particularly if the meat is processed. The WHO report classified the consumption of meat as probably carcinogenic to humans, and classified processed meat as carcinogenic to humans.

This implies that conventional or grass-fed, meat is a probable carcinogen. And once you process either type of meat, it is definitively carcinogenic, according to WHO, and other large health/research agencies, such as the American Institute for Cancer Research (AICR).

Why is meat linked with cancer risk?

In addition to the nitrates/nitrites in processed meats, three key issues to consider with meat in general are:

  • heme iron
  • polycyclic aromatic hydrocarbons (PAHs)
  • heterocyclic amines (HCAs)

Ample evidence suggests heme iron contributes to chronic disease risk, such as heart disease and digestive tract cancers. Heme iron is a strong pro-oxidant. In processed meat, heme iron likely worsens the carcinogenic effects of the nitrites as well.

As for PAHs and HCAs, you cannot avoid these if you eat cooked flesh. These compounds are generated due to the substances naturally found in meat.

  • HCAs are formed when amino acids (protein building blocks), sugars, and creatine (found in muscle) react at high temperatures.
  • PAHs are formed when fat and juices from meat grilled directly over an open fire drip onto the fire, causing flames and smoke, which rise up and coat the meat.

This means you can reduce PAHs by not grilling over open flame, but HCAs are formed regardless, simply because it’s meat plus heat.

There are ways to reduce the generation of these compounds in cooked flesh, but you can never get levels down to zero. Take the AICR quiz on safer grilling to learn more, and check out AICRs enews Guide to Healthy Grilling for additional information.

As an aside, you can grill your carrots and eggplant until they resemble a charcoal briquette, and you will not form PAHs or HCAs, because vegetables do not contain the precursor compounds from which these carcinogens form. You may create other noxious compounds, but the carcinogens PAHs and HCAs are particular to cooked flesh.

While it isn’t definitively known that PAHs and HCAs directly cause cancer in humans, evidence suggests this is the case.

The bottom line

  • Processed meat, regardless of whether it is conventionally-raised or grass-fed, contains nitrates/nitrites, heme iron, PAHs, and HCAs.
  • Fresh meat, regardless of whether it is conventionally-raised or grass-fed, contains heme iron, PAHs, and HCAs.

These substances (nitrates/nitrites, heme iron, PAHs, and HCAs) likely account for at least some of why processed meat and fresh meat are linked with increased cancer risk. Other research suggests animal protein in the diet may increase cancer risk as well.

Finding balance

Most health agencies do consider the adage, “the dose makes the poison,” when advising on meat consumption. Many of these agencies suggest up to 18 ounces of meat per week is not likely to measurably increase cancer risk. They do advise that no amount of processed meat is known to be “safe,” though they stop short of saying, “never eat these foods.”

The WHO/IARC report also stopped short of giving a definitive amount of meat that is “safe to eat.” According to Dariush Mozzafarian, MD, DrPH, the dean of the School of Nutrition Science and Policy at Tufts University, there’s not enough evidence to give meat eaters a specific amount that is safe to consume. However, as Dr. Mozaffarian detailed in a recent interview, his recommendations are “no more than one to two servings per month of processed meats, and no more than one to two servings per week of unprocessed meat.”

Keep a robust “health bank account”

I believe it’s important to note that we all engage in ‘pro-cancer’ and ‘anti-cancer’ behaviors all the time. This will help you keep scary nutrition news stories in perspective. I like to think of it this way. We all have a personal “health bank account.” We are constantly making deposits (improve health) into our health accounts and withdrawals (not so good for health) from them.

For example, perhaps you exercised today… that’s a deposit. You met a friend for coffee… that’s a deposit (social support improves health!). You had two glasses of wine with dinner… that’s a withdrawal. You ate a 12 ounce T-bone steak… that’s a withdrawal too. You don’t smoke and you maintain a healthy body weight… both are very important deposits. And so on.

There’s no way anyone can consistently make only deposits and take no withdrawals. Think how boring and pleasureless life would be! Life should be joyful, and most of us need to make “health account withdrawals” to enjoy ourselves fully. And if you make only deposits, you may have orthorexia, which is defined as an “unhealthy obsession” with otherwise healthy eating. The term “orthorexia nervosa,” literally means “fixation on righteous eating.”

I encourage people who are concerned about these issues… We all have to find which things bring us enough pleasure to justify making a withdrawal on our health account. For me, meat and animals foods don’t give me pleasure, so I don’t use my “withdrawals” for those things. Alcohol, on the other hand, which is considered a carcinogen, is something I enjoy. I’m more than happy to take a “health account withdrawal” to meet friends for a drink, and I like a beer or glass of wine with dinner. That’s my balance.

We tend to get hung up on the “minutia” of nutrition. These nitty gritty details are enough to drive anyone crazy. This is why I advocate focusing on the big picture with nutrition. As the journalist and author Michael Pollen succinctly stated, “Eat food. Not too much. Mostly plants.”

In other words, eat real food, not the processed junk that comes in plastic wrap; don’t overeat, so you can maintain a healthy body weight; and if you eat animal foods, such as meat, eat it sparingly, and balance it out with eating plenty of healthy vegetables, fruit, legumes, nuts, seeds, and whole grains.

This aligns very nicely with Dr. Mozaffarian’s recommendation on meat: “no more than one to two servings per month of processed meats, and no more than one to two servings per week of unprocessed meat.” That leaves a lot of room on your plate for plant foods.

I believe that if we all followed this advice, it would go a long way toward reducing cancer burden. Of course, making these healthy, unprocessed foods widely available to all communities, and giving people the tools and skills to integrate these items into their lives must be tackled too.

As a final note, there certainly are other opinions on this… The National Cattlemen’s Beef Association’s FB page has a link:
Science Does Not Support International Agency Opinion on Red Meat and Cancer. My advice? Consume this story at your own risk.

GMO Take 2: Golden Rice Research Paper Retracted

In my previous post, I used Golden Rice as an example of one potential positive use of technology for genetically modifying food crops. The latest news sounds bad for Golden Rice; however, if you look beyond the headlines, you’ll see that the retraction of a Golden Rice research paper was justified, but why it was recalled isn’t related to the science itself.

In the article, “Judge Decides on GM Rice Retraction” The Scientist noted, “They found that the rice was just as good as a β-carotene supplement and better than spinach.”

The article further noted, “According to a Tufts spokesperson who spoke with Retraction Watch, no one is questioning the validity of the data. The problem instead lies in how the study was conducted—in particular, a lack of evidence that all participants gave full consent. Tufts investigated the situation in 2012. “There was no evidence found of falsification or fabrication of the data that underlie the study’s primary findings,” according to the spokesperson. “Those reviews did, however, determine that the research had not been conducted in full compliance with Tufts research policies and federal research regulations.””

The American Journal of Clinical Nutrition‘s original decision to retract the paper, and the judge’s decision to uphold that retraction were justified. While it may seem like “no big deal” to feed rice – rice which has been proven safe for human consumption – to a group of people, it is a serious breach of ethical standards to fail to obtain 100% consent of every person affected by the research. This standard must be applied to every study, in order to protect potential research subjects from harm and abuse.

While eating rice may be “no big deal,” not addressing the researchers’ failure to obtain consent from each subject individually would have opened the door to studies in which it is a very big deal to ignore standards of consent… giving vaccines, providing experimental therapies, and more. The history of medical research is littered with abuses of study subjects, and this paper retraction shows that in many (though sadly, not all) cases, our current system does operate in a way to protect people involved in current-day research.

As with all research, and the controversies that surround many studies, be sure to read beyond the headlines to understand the full picture, and all of the details that make up that picture.

Importance of Nutrition in Cancer Care Getting Good Press!

I was recently interviewed by US News & World Report on dietary supplements during cancer treatment and the importance of good nutrition during chemotherapy

This is a topic near and dear to my heart, so It’s amazing to see these key issues getting good press in a venue that will reach many, many people! I hope you enjoy reading these articles as much as I enjoyed contributing to them!

GMO Food: Is It Black and White?

I’m going to share some thoughts on GMOs or genetically modified organisms, as this relates to food. This may incite a riot… or at least a lot of negative feedback. I’m going to propose something a bit radical. The truth about GMO foods may not be black and white. GMO may be shades of gray, and I’ll tell you why I believe this may be true. Please don’t tune out… there are important questions we must tackle.

The good, the bad, and the ugly… with a focus on the bad and the ugly

The unfortunate face of GMO

I believe that the GMO issue is not very well-understood by most people, but I don’t think it’s their fault. I blame the large agribusiness (“Big Ag”) interests for this problem. In my opinion, it’s very unfortunate that the face of GMO, in fact, the very first thing that Americans (and most other people around the world) think when they hear the phrase, “GMO” is Monsanto and Roundup Ready soy. While soy was the first, there are now many Roundup Ready crops, including corn, canola, alfalfa, cotton, and sorghum. So, why is it so unfortunate that GMO is synonymous with Big Ag in general, and Monsanto in particular? Because I honestly believe the entire purpose of these GMO products was to enrich Monsanto, period.

Contrary to Monsanto’s claims, Roundup Ready crops have not resulted in more food grown per area of land, and less application of herbicides overall. What they have resulted in is record profits for Monsanto and its shareholders. These crops result in two profit streams for the company. Farmers must buy Monsanto’s herbicide Roundup to use on their crops, and farmers pay more for the “special” GMO seeds. It’s a lose-lose for the farmer, and a win-win for Big Ag. Monsanto promotes Roundup ready foods in particular, and genetically engineered foods in general as the solution to feeding a growing world. Skeptics (myself included) don’t buy it – literally or figuratively.

Further profits come from the fact that the Roundup Ready crops use a technology referred to as “terminator technology.” This means seeds grown for a second generation are sterile, in essence, useless to the farmer. Farmers must purchase new seeds from Monsanto every single year if they want to continue to grow these crops. This goes against centuries, millennia even, of farming practice. Saving back seeds from a previous year’s harvest is a way that farmers the world over are ready for the next season. Even better, the farmer can pick which seeds to save back… maybe those from plants that were the biggest and yielded the most food, or plants that seemed most resistant to pests. Over time, this resulted in genetically varied and strong plants, and cost the farmer nothing, as he or she did not have to buy seeds every year.

Big (Ag) lies

Also troubling is that the American public was told Roundup Ready crops would yield more food, and result in less total application of herbicides on crops across the United States. Neither of these things turned out to be true. In 2002, an organization called the Soil Association published a comprehensive, well-researched report, called Seeds of Doubt, on the many impacts of GMO crops. According to the findings detailed in this 68 page report:

  • Many claimed benefits of Roundup Ready crops have not been seen in practice
  • The profitability (to the farmer) of growing Roundup Ready soy is less than non-GM crops, due to the extra cost of GM seed and because lower market prices are paid for GM crops
  • The claims of increased yields have not been realized, and Roundup Ready soy appears to yield 6–11 percent less food than non-GM varieties.
  • GM herbicide tolerant crops have made farmers more reliant on herbicides, new weed problems have emerged, and farmers are applying herbicides several times, contrary to the claim that only one application would be needed.
  • Rogue GMO oilseed rape plants (‘volunteers’) have become a widespread problem in Canada, with contamination from these GMO plants causing the loss of nearly the entire organic oilseed rape sector in the province of Saskatchewan; organic farmers are struggling economically and many can no longer sell their product as organic due to GMO contamination.
  • Within a few years of the introduction of GMO crops in North America, the majority of the $300 million annual US maize exports to the EU and the $300 million annual Canadian rape (canola) exports to the EU had disappeared, and the US share of the world soy market had decreased. Why is this a problem? Because…
  • US farm subsidies were meant to have fallen over this time frame. Instead they rose dramatically, paralleling the growth in the area of GMO crops. The lost export trade as a result of GMO crops may have contributed to a fall in farm prices and hence a need for increased government subsidies, estimated at an extra $3–$5 billion annually
  • In total, it is estimated that GMO crops may have cost the US economy at least $12 billion net from 1999 to 2001.
  • Accusations of farmers infringing on Monsanto company patent rights has contributed to severe legal difficulties for farmers: One non-GMO farmer whose crop was contaminated by GMOs was sued by Monsanto for $400,000.

This report was published over a decade ago, and this situation has continued to play out, in exactly this direction of diminishing returns, and more costs to farmer and society, since that time.​

Herbicide use only going up

As for herbicide application, it has increased year over year at a significant rate since the introduction of GMO crops. According to a 2012 study published in Environmental Sciences Europe, “Contrary to often-repeated claims that today’s genetically-engineered crops have, and are reducing pesticide use, the spread of glyphosate-resistant weeds in herbicide-resistant weed management systems has brought about substantial increases in the number and volume of herbicides applied.” The researchers also concluded, “If new genetically engineered forms of corn and soybeans tolerant of 2,4-D are approved, the volume of 2,4-D sprayed could drive herbicide usage upward by another approximate 50%.”

Guess what happened in October 2014? The Environmental Protection Agency (EPA) approved a Dow Chemical herbicide blend of 2,4-D and glyphosate, intended for use on Dow’s patented 2,4-D resistant GMO corn and soybeans. For some background the Dow-produced 2,4-D was a component of “Agent Orange,” the toxic defoliant used in Vietnam, and is the seventh largest source of dioxins in the United States.

Recent designation: Roundup is probable carcinogen

On March 20, 2105, the International Agency for Research on Cancer (IARC) – a research arm of the World Health Organization (WHO), published a research paper which recommended that glyphosate (Roundup) be classified as a probable carcinogen. A carcinogen is anything that causes cancer. Remember, glyphosphate is the most widely produced herbicide, by volume, on the planet.

No wonder people hate GMO

I hope by now you are convinced that I am by no means a fan of GMO crops. In fact, I am adamantly opposed to how they are being used in North America, and I personally avoid GMO foods as much as possible. After reading these facts I hope you also believe GMO crops are nothing but bad news. And this is the baseline from which most people have formed their opinions about GMO. Rightly, they have concluded these products are not good, and are simply one more way for Big Ag to make money, foul the environment, disregard the farmer, and completely ignore the very serious health and environmental consequences of application of these highly toxic chemicals.

The sad thing about all of this is that the true potential of GMO to actually help people has never been realized, because Monsanto, other Big Ag and chemical companies (i.e., Dow, Archer Daniels Midland, Cargill, BASF, Syngenta, Bayer, and DuPont) all got there first.

Based on this very awful track record, I certainly don’t have a positive association in my mind with GMO food. Beyond these egregious and obvious harms from GMO as it is used in North America, a lot of questions need to be answered about the safety of the practice of inserting genes – safety to humans and for the environment, including large ecological systems, watersheds, soil resources, and more.

We know the chemicals used with these seeds are a major issue. We know that mono-cropping – growing large swaths of one or two varieties of food across the country – is bad for the environment, depletes soil, and makes it more likely that a crop destroying disease develops. We know losing all of the diversity in our food crops promotes a very poor diet among Americans… Keep in mind that commodity crops are grown in lieu of healthy foods, and these crops are widely used to produce junk food. And we need more information on whether the food itself, with its inserted genes (assuming it isn’t contaminated with chemicals) is safe, for people and for the planet.

The gray areas: potential upsides of GMO

But what about GMO plants that actually may help people? This would be plants that aren’t designed solely to drive profits (harms be damned), but rather plants that could address serious human global health problems. For example, consider Golden Rice (yes, I know many of you are rolling your eyes, but bear with me). This product was developed, using GMO techniques, to provide beta-carotene into the diets of people living in the developing world. Why the focus on beta-carotene?

Beta-carotene can be converted into vitamin A in the body, and vitamin A deficiency is at crisis proportions in the developing world. Vitamin A deficiency is the leading cause of blindness in children in the the developing world, and contributes significantly to their inability to mount an immune response, a condition termed “anergy.” This means Vitamin A deficiency causes a lot of infant and childhood death indirectly, by making kids much more likely to die of an infectious disease. Even vaccination will not elicit an immune response in someone with severe vitamin A deficiency.

Per the World Health Organization, 122 countries have vitamin A deficiency of public health significance in preschool-age children. And once a child is diagnosed with night blindness, progression to death is not far behind if the deficiency isn’t corrected. By numbers, night blindness is estimated to affect 5.2 million preschool-age children and 9.8 million pregnant women. Low serum retinol (a form of vitamin A measured in the blood) affects an estimated 190 million preschool-age children and 19.1 million pregnant women globally.

This is a completely preventable problem, if we could just get vitamin A (or its precursor beta-carotene) into the diet. Rice was chosen as a possible food for doing this, because it’s a staple food in so much of the world. Golden Rice was not developed by a corporation, but by nutrition researchers in Switzerland and Germany.

Per information provided by the Golden Rice Humanitarian Board,  “The inventors of Golden Rice were Ingo Potrykus, Professor emeritus of the Institute for Plant Sciences of the Swiss Federal Institute of Technology (ETH, Zurich), and Professor Peter Beyer, of the Centre for Applied Biosciences, University of Freiburg, Germany (Ye et al 2002). The search for a Golden Rice started off as a Rockefeller Foundation initiative in 1982. After years of research by various research groups, a meeting of experts was convened in New York in 1992. There, Ingo Potrykus and Peter Beyer met for the first time, and subsequently decided to embark on the project that would lead to the development of Golden Rice in 1999. Their great contribution consisted in showing that a very complex biosynthetic pathway could be tweaked to enhance the health-promoting virtues of a crop. The breakthrough insight was that most of the pathway was already present in the rice grain and it only needed two genes to reset the whole pathway.”

Baby out with the bathwater

Sadly, it is unlikely that Golden Rice will ever be put to its intended use. Many health and nutrition experts hold this up as example that GMO is useless. For example, Marion Nestle, who I hold in high regard for her intelligence and sensible approach to nutrition, has noted, “Golden Rice is the most prominent example of the benefits of agricultural biotechnology but ten years later its promise was still unfulfilled. Field trials began in 2008 and the rice might be in production by 2011 [Oops. It’s still not in production].”

I think this is unfortunate, because it proverbially, “throws the baby out with the bathwater.” Basically, because Golden Rice has never made it to market, we should just stop exploring the biotechnology avenue altogether. Another issue raised by those who cite Golden Rice as an abject failure is that it does not address the huge, intractable, underlying issues contributing to malnutrition… lack of empowerment of women, the legacy of colonialism, lack of access to indigenous seeds and loss of the knowledge on how to grow them, government corruption, war, and so forth. The list of contributors to malnutrition is long, and permanent solutions are tough to implement.

My big questions:

  1. Why wouldn’t we use something like Golden Rice (assuming it is proven safe) as a stop gap? People the world over are going blind and dying due to vitamin A deficiency, as I type this!! The permanent solutions take time.
  2. Why wouldn’t we use something available now, to stop the carnage of malnutrition, even if it isn’t the end game, even if it doesn’t solve every social ill, and even if it only helps a portion of those affected by vitamin A deficiency?
  3. Why wouldn’t we use something like Golden Rice to help even a few? We may say, well, it can’t be rolled out widely enough to help all of those affected, so why bother? But to the few who may be saved from blindness or death, it matters a whole lot.

What I really believe we need to do is to get mad. We need to get really angry and ask our regulators and legislators why they would approve something like GMO Round up Ready soy, while not helping to bring a GMO crop that actually may help people, to market.

One reason? Our entire political system is propped up on money, lobbying, and the fact that the person with the most money has the loudest voice. The Citizens United supreme court decision ensures that “corporations and unions have a green light to spend unlimited sums on ads and other political tools, calling for the election or defeat of individual candidates.”

But this is a story for another day….. Or maybe it is a story for today, as this NY Times article points out: A significant number of Americans, of all political stripes, want the political funding system overhauled.

Targeting the wrong GMO

So, while “Big Ag” busily courts the political decision makers to bring (in my opinion) useless GMO products to market – products which time and again have been shown to enrich corporations at the expense of human and environmental health – anti-GMO activists have stymied the ability to bring a potentially useful GMO food (Golden Rice) to market. In fact, a recent report noted that anti-GMO activists have destroyed Golden Rice test crops and lied about who they were, and why they were destroying the crops.

Again, don’t get me wrong, I think GMO needs a lot more study and careful consideration. Frankly, I would be pretty happy if the USDA had a complete turnaround, and revoked approval of Round Up Ready soy!.That is the last place where GMO is going to help, other than perhaps, to help enrich a few executives and shareholders associated with big agribusiness and multinational corporations.

Beyond Golden Rice

Beyond golden rice, there are many places where GMO is being studied, not by industry, but by people who have made it their life’s work to alleviate suffering due to food insecurity around the world. I find it heartening that one researcher has used conventional plant breeding techniques to create “orange corn.” Again, the goal is to get more pro-vitamin A carotenes into the diets of people who are suffering the dire consequences of vitamin A deficiency. Perhaps this approach, because it is more politically palatable, will finally bring a nutrient-enriched staple crop to places that desperately need immediate access to vitamin A-rich foods… Again, think of this as a stop gap, until we can fully address the big questions, which we most certainly need to do.

But what about dealing with climate change? Many environmental and organic food activists note that conventional breeding techniques can be used to create more drought tolerant plants. However, there are some issues that simply cannot be tackled with these methods. Consider rising seas and salt water incursion into farm land. This process – soils becoming more saline (salty) due to rising sea levels – happens over a period of months, not years. It is unlikely that in one or two generations of conventional breeding, a plant can be adapted fast enough to grow well in these high-salt soil conditions.

As farmers in Bangladesh can attest, if there is sea water incursion, even after the brackish (sea and ground water mixtures) water recedes, nothing conventional will grow there. Conventional seeds just don’t do well with all that salt. And this problem is huge. Per the Rockefeller Foundation’s Catalysts for Change, Paths Out of Poverty website, Bangladesh has a coastal area of 2.5 million hectares. Out of this, approximately 1 million hectares of land have already been affected by different levels of salinity.”

It’s also worth noting that sharing this same page on the potential benefits of using genetic modification techniques to address the “salty soils” problem, is a link to an article, “Organic Rice Farming in Thailand as a Method to Escape Debt Entrapment.” The Rockefeller Foundation is no shill for GMO, and recognizes the clear need for organic farming methods to improve lives and livelihoods around the globe.

What next?

I suppose it’s “pie in the sky” and naive to believe we (humanity) could actually use biotech for good in agriculture, only where it’s needed, while also ensuring local seed varieties are preserved, empowerment of women is fostered, better stewardship of the land is prioritized, local initiatives to fix problems rule the day, anti-corruption initiatives are implemented, and more. That is my wish; unfortunately, I feel very alone in this.

I understand many people remain staunchly anti-GMO in all circumstances because this approach never seems to work out for anyone’s benefit, except large corporations. Sadly, GMO is now tainted with this reputation, so there is no longer the ability to have thoughtful discussions about whether and how this approach could possibly be used to help people.

Without those thoughtful discussions we may never know whether the risks of even “good” GMO foods, such as Golden Rice or saline tolerant rice, outweigh the “bad.” If we could have thoughtful discussions, we may discover that indeed, the anti-GMO position is the way to go; perhaps we should never go the GMO route. But we will probably never know.

We will never be able to conceive that perhaps good people, with the goal of alleviating suffering immediately, are working on these potential applications of GMO to help people the world over. In our 24/7 media-saturated culture, nuance is lost, and we are forced to “pick a side.”

If you have to pick a side, I suggest that side be to stop the current trend in GMO development in the United States. There is nothing to be gained from creating more crops requiring more pesticides.

Suzanne’s Fantastically Tasty, Gluten Free, Soy Free, Dairy Free, Egg Free, Vegan Cookies

Dry Ingredients:
1 and 1/2 cups oat flour
1 cup coconut flour
1 cup brown sugar
1/4 cup arrowroot powder*
1 and 1/2 teaspoons xantham gum powder*
1 teaspoon baking soda
1 teaspoon salt
Wet Ingredients:
2 tablespoons vanilla extract
3/4 to 1 cup applesauce (no sugar added)
3/4 cup melted coconut oil (Melt on stove top over very low heat (in a metal bowl))
Other Ingredients:
One 12-ounce package semisweet chocolate chips

Preheat oven to 325 F. Mix wet ingredients together. Stir dry ingredients into wet, a bit at a time. Add chips. Form into cookies on ungreased cookie sheet. Thicker, smaller cookies (form a ball and flatten very slightly with fingers) work best. Bake at 325 for 15 minutes.

*If you cannot obtain arrowroot powder and xanthum gum, substitute 3 tablespoons corn starch for arrowroot powder and omit xanthum gum; this results in dryer, more cake-like cookies.

The Epidemic of Being Overweight and Undernourished

It sounds contradictory, but a significant number of people in the United States today are simultaneously under- and overnourished. How can that be? If you’re significantly overweight, surely you can’t be malnourished, right?

As a former overweight person myself, a registered dietitian who has worked with many people on weight loss issues, and an epidemiologist who studies the science of chronic disease and body weight regulation, I know firsthand that it’s all too easy to be both overweight and malnourished.

The key to understanding this paradox is to understand the difference between macro- and micronutrients. Macronutrients provide the body with energy in the form of calories. Think carbohydrate, protein, and fat. There’s also alcohol, which isn’t an ideal source of calories, but which provides them nonetheless. Being a fan of a nightly glass of wine or a beer, I’d be remiss if I didn’t mention that alcohol provides calories! One gram of alcohol provides 7 calories. This means that in terms of caloric density, your drink is roughly halfway between protein and carbohydrates (4 calories per gram) and fat (9 calories per gram).

Tiny Nutrients, Enormous Benefits

Micronutrients are indeed “micro,” meaning that we need them in small quantities for good health. This includes vitamins, minerals, and phytonutrients, which are non-vitamin/non-mineral plant nutrients. Examples include carotenes and flavonoids. Vitamins and minerals are vital for life – it’s right in the name – vitamins. Without them, we’d end up with a deficiency, and eventually, a deficiency of essential vitamins and minerals can lead to death. Fortunately, in this country, severe vitamin and mineral deficiencies are uncommon. Unfortunately, they are very common in parts of the developing world (I’ll be revisiting this important issue in a future post).

Phytonutrients are different than vitamins and minerals. For one thing, there are thousands of them, compared to just a few dozen essential nutrients. Many phytonutrients are found in vegetables and fruit, and they give these foods their bright red, yellow, purple, green, and orange colors. Most of us are familiar with the phytonutrient beta-carotene, the nutrient that makes carrots and sweet potatoes orange. Other important phytonutrients hide inside whole grains, beans, and nuts.

Unlike vitamins and minerals, phytonutrients aren’t vital for life: you won’t die of a beta-carotene deficiency. But if you don’t get enough phytonutrients, you can have major health problems, which can contribute to difficulty losing weight, and difficulty maintaining weight loss.

What’s the Connection?

Most people don’t give much thought to micronutrients and body weight. Many people figure if it’s not a calorie, it doesn’t matter. The truth is more complex. Sure, calories are one key to weight loss. But dig a little deeper, and you’ll see how adding in the right foods, rich in micronutrients, will aid weight loss, help your body function better, and may even help keep overeating in check. And this is no “diet.” This is how you want to eat. For the rest of your life.

Stronger and Leaner: Phytonutrients appear to help people maintain muscular strength, lean body mass, and muscle function. And if there’s one thing that anyone who’s tried to lose weight understands, it’s that more muscle means more calorie burning, even when you’re not moving. Who knew an apple, a blueberry, green tea, or broccoli could fuel your muscles?

Better Body Chemistry: Many obesity experts now consider obesity to be a state of chronic, low-grade inflammation. This matters a lot if you’re trying to lose weight, because inflammation makes it harder for you to shed fat and much harder for you to build lean, healthy muscle. It’s a vicious cycle: carrying extra body fat promotes inflammation, and inflammation makes it harder to lose weight.

Phytonutrients dampen inflammation. By including plenty of phytonutrient-rich, anti-inflammatory foods in your diet, you fight the low-grade inflammation that results from being overweight and that may be contributing to staying overweight. By dampening inflammation, phytonutrients appear to improve body chemistry, and improve the odds of weight loss success.

Less Overeating: If that’s not enough to convince you to change your dieting ways, consider this: noted nutrition experts now suspect that when we’re overnourished in terms of calories, but undernourished in terms of micronutrients, our bodies have a harder time judging how much food we truly require to satisfy nutritional needs.

We have basic needs for micronutrients – vitamins, and minerals, in particular, but likely phytonutrients, as well. Our bodies will tell us to keep eating until we meet those basic needs. If you eat foods that are low in micronutrients, which not surprisingly includes many “diet” foods, you need to eat more of them to reach the point where your body senses that you’ve gotten enough micronutrients.

Better Gut Health: The human “microbiome” is a hot topic right now. The microbiome refers to the collection of bacteria, fungus, and yes, even viruses, that reside in and on our body. These microbes appear to contribute significantly to health, and this is particularly true for gut health. In fact, the latest research has shown that some microbes in the gut may contribute to obesity, while others help keep us lean. But it’s a chicken and egg thing… which came first? Is a poor diet of unhealthy processed food the cause of “obesity-inducing” microbes? Or are “obesity-inducing” microbes present in higher numbers in the guts of some people, and this is what contributes to obesity, and inability to lose weight and keep it off?

The latest research on this topic came out just this week, presented on March 5, 2015, at the 97th Annual Meeting of the Endocrine Society in San Diego. Researchers studied people who had recently undergone bariatric surgery – the type of surgery used to induce rapid and dramatic weight loss in people who are significantly overweight (obese). Those people with the highest proportion of gut microbes that produce methane and hydrogen had the least weight loss. The researchers speculate that these methane-producing gut bacteria may be preventing or slowing down weight loss after bariatric surgery.

Other studies have shown that overweight and obese people have different combinations and numbers of specific gut bacteria compared with “lean” people. When you transplant microbes from obese people into “germ-free” mice, they put on weight, but the mice did not put on weight if transplanted microbes came from a lean person. Further, the “lean” bacteria can crowd out the “obese” gut bacteria, which prevents the mice from gaining weight… but only if the mice also ate a healthy diet.

Consider all of these facts together, along with the known gut health benefits of whole plant foods, and it makes sense that these foods can nourish our “lean” bacteria. These foods also may limit the number of “obesity-contributing” bacteria in our digestive tracts, helping us maintain a healthier body weight.

Go Low on the Food Chain

In order to nourish your body properly, you need to eat real food, not count calories. Eating “low on the food chain” gives your body the micronutrients it needs to build muscle, keep fat-promoting inflammation in check, and help you minimize the chances of overeating and bingeing. Of course, much of managing body weight is emotional, psychological, and mental. We know that binge eating disorder (BED) is a real medical condition, and using food to cope is very, very common. No amount of healthy eating will “fix” obesity without getting the emotional help and support you need.

However, once you begin working with a qualified mental health professional to address these very important mental health issues, food choices can help you move closer to your goal of a healthy, happy body, regardless of whether you shed a single pound. Yes, I’m a firm believer that everyone deserves to be healthy, and am a supporter of the Health at Every Size approach to wellness. Beating yourself up for “failing” diets is the last thing you need to do. Further, we live in a toxic food environment; people don’t fail diets, our toxic food environment – in which a bag of chips is cheaper than a bag of apples – fails people!

Now, getting back to eating “low on the food chain…” this means eating mostly whole, unprocessed, plant foods. The closer a food is to its natural form, or what it looks like when it comes out of the ground or off the tree or vine, the more micronutrients it contains. It’s also helpful, of course, that these foods tend to have the fewest calories per amount or volume of food. You get more micronutrients with fewer calories – a win-win all around.

I’m living proof this approach works, and I “walk the walk” every day. At my heaviest, I carried about 50 extra pounds on a 5’4” frame, which I lost for good about 114 years ago to reach a healthy body mass index (BMI) of 21.

Work with the Plate

To best understand the proportions of different phytonutrient-rich foods you need, visualize a typical round plate. Divide that into quarters. Three of those quarters should be filled with plant foods. Keep the balance tipped toward eating mostly vegetables, followed by slightly less fruit, and a very small amount of whole grains. It’s not that I don’t love whole grains, I do! However, between the bread, the bagels, and the cereal, most Americans do not need to be encouraged to eat more grains, whole or otherwise.

The other one-quarter is left for lean protein. Focus on plants – legumes (beans, peas, chickpeas), nuts, and seeds for most of your protein. Eat fish if you’d like, a couple of times per week.. Enjoy organic, free-range/grass-fed chicken, beef, or pork twice per week at most. And if you have a sweet tooth, save room in that last quarter for dessert!


  1. Kolehmainen M, Ulven SM, Paananen J, de Mello V, Schwab U, Carlberg C, Myhrstad M,…, Dahlman I. Healthy Nordic diet downregulates the expression of genes involved in inflammation in subcutaneous adipose tissue in individuals with features of the metabolic syndrome. Am J Clin Nutr. 2015;101(1):228-39.
  2. Hartstra AV, Bouter KEC, Bäckhed F, Nieuwdorp M. Insights Into the Role of the Microbiome in Obesity and Type 2 Diabetes. Diabetes Care. 2015;38(1):159-165
  3. Rebello CJ, Greenway FL, Finley JW. A review of the nutritional value of legumes and their effects on obesity and its related co-morbidities. Obes Rev. 2014;15(5):392-407.
  4. Farhat G, Drummond S, Fyfe L, Al-Dujaili EA. Dark chocolate: an obesity paradox or a culprit for weight gain? Phytother Res. 2014;28(6):791-7.
  5. Herieka M, Erridge C. High-fat meal induced postprandial inflammation. Mol Nutr Food Res. 2014;58(1):136-46.
  6. Kim H, Suzuki T, Saito K, Yoshida H, Kojima N, Kim M, Sudo M, Yamashiro Y, Tokimitsu I. Effects of exercise and tea catechins on muscle mass, strength and walking ability in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. Geriatr Gerontol Int. 2013;13(2):458-65.
  7. Uusitupa M, Hermansen K, Savolainen MJ, Schwab U, Kolehmainen M, Brader L, Mortensen LS,…, Akesson B. Effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile and inflammation markers in metabolic syndrome — a randomized study (SYSDIET). J Intern Med. 2013;274(1):52-66.
  8. Willcox DC, Willcox BJ, Todoriki H, Suzuki M. The Okinawan diet: health implications of a low-calorie, nutrient-dense, antioxidant-rich dietary pattern low in glycemic load. J Am Coll Nutr. 2009;28 Suppl:500S-516S.
  9. Martin C, Zhang Y, Tonelli C, Petroni K. Plants, diet, and health. Annu Rev Plant Biol. 2013;64:19-46.
  10. Aoi W. Exercise and food factors. Forum Nutr. 2009;61:147-55.
  11. Mattes RD, Kris-Etherton PM, Foster GD. Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. J Nutr. 2008;138(9):1741S-1745S.
  12. Coates AM, Howe PR. Edible nuts and metabolic health. Curr Opin Lipidol. 2007;18(1):25-30.

High Fat, Low Fat, Saturated Fat, What the Fat?

I rarely write letters to publications, because, frankly, what’s the point? Very few people seem to read these letters and comments. In the end, it’s unlikely that sharing an opinion about how the publication got this or that detail wrong will reach anyone. Recently, however, I felt compelled to respond to an article. I believe it missed the mark so badly, and presented such an incomplete view of a complex nutrition topic; I just had to respond.Wired Magazine published “Why Are We So Fat? The Multimillion-Dollar Scientific Quest to Find Out,” a story about Gary Taubes’ efforts to further the research into what type of diet truly is best for health. I applaud Taubes’ efforts, and especially appreciate that his approach attempts to maximize the objectivity of the studies he’s seeking to fund. The article, on the other hand, left much to be desired. If you’re interested in what I found problematic in this story, read on.

Letter to the Editor:

Re: Gary Taubes “aha” moment about nutrition research:

The scientists and health professionals railing against salt didn’t seem to notice or care that the diets of those populations might differ in a dozen ways from the diets of populations with more hypertension. Taubes began to wonder if his critique applied beyond salt, to the rest of nutrition science.”

This is an incredibly obvious statement, and reveals a simplistic and shallow understanding of health research, on the part of both Wired and Taubes. This is something every public health student is taught on day one, of Epidemiology 101. It’s really not an amazing, revelatory event.

These things are called confounders, and go far beyond differences in diet that may affect the variable being studied… body weight, exercise, smoking habits, reproductive choices, environmental exposures, genetic differences, differences in rates of other diseases, the list is endless.

Further, Taubes himself demonstrates an inability to look at the full picture – something he accuses his detractors of doing. The population of the United States never has followed the advice that arose from the early 20th century ecological studies on diet and disease. In truth, nobody ever said, “add loads of simple carbs and keep your intake of saturated fat and total fat the same,” but that is exactly what happened in the US.

Sure, percent of calories from fat in a typical American diet appeared to decrease, but only because simple carb intake increased so dramatically. Nobody really followed a low-fat diet in the way in which it was intended. Total fat intake did not decrease.

The American public (and Taubes, apparently) completely missed the mark on this one, and the processed food industry was off and running, stuffing simple sugar into every food product imaginable. The advent of high fructose corn syrup (HFCS) further exacerbated the problem, not because HFCS is so much worse than sugar (they are both problematic), but because it is so cheap that it allows simple sugar to permeate the food supply at unprecedented levels.

The low-fat message was warped and misinterpreted, and Americans took this as an excuse to eat large quantities of completely nutrient-devoid, calorie-laden foods.

But don’t mistake me for a low-fat advocate; I’m not. I believe a diet that derives as much as 40 or 50% of calories from fat is fine, so long as the majority of it is not (most types of) saturated fat, and is not artificially created trans fats.

In essence, the true message was that the optimal diet is PLANT-BASED (not carbohydrate-based), derived from vegetables, legumes, nuts, seeds, fruit, and whole grains (ideally, in that order of importance).

All of these folks who embrace meat, butter, and saturated fat as the “healthiest” option misinterpret existing data. If you replace saturated fat with simple carbs, YES, I agree, that likely worsens health, and certainly contributes to insulin resistance, obesity, and cardiovascular disease. THAT is what the “low-fat experiment” taught us.

However, if you replace saturated fat with polyunsaturated and monounsaturated fats – the PUFAs and MUFAs from plants – WITHOUT increasing intake of simple carbohydrates, you will see better health outcomes. Unfortunately, nobody has really studied this, and very few Americans actually eat this way.

As for inflammation, cholesterol, other lipids, and similar biomarkers, if you replace the average, crappy, high simple carb, low-fiber, processed food, American diet with ANYTHING else, you will see improvements in these markers. You can replace the current American diet with a paleo diet, a vegan diet, a vegetarian diet, a plant-based low-fat diet, a plant-based high fat diet, the Mediterranean diet, the Okinawan diet, the Inuit diet, or just about anything else that eliminates processed foods; you will see improvements in health.

Again, no big revelation, because the standard American diet is so poor.

However, which one improves health the most? My money is on plant-based diets, low or high fat.

Over two decades ago, Dean Ornish proved that a low-fat vegan diet can REVERSE, yes, actually shrink, established plaques (fatty build ups) in arteries. Dr. Ornish more recently demonstrated that this type of diet can reduce markers associated with prostate cancer progression in men living with the disease, including a demonstrated lengthening of cellular telomeres. Telomeres are the small “caps” on the end of strands of genetic material, and the longer, the better. Longer indicates a younger “cellular age.”

Dr. David Jenkins’ Portfolio diet has been shown to lower so-called “bad” cholesterol levels (LDL-cholesterol) by 29.6% vs. a lowering of 33.3% for first line statin drugs. Can the high saturated fat diet advocated by Taubes, et al. match that? I’m eagerly awaiting results.

What does the Portfolio diet look like? Plants, plants, and more plants, including specifically selected foods known to have significant cholesterol-lowering effects: soy, almonds, oats, barley, psyllium, okra, eggplant, and almonds. A far cry from a meat-based diet being promoted as the “healthiest” option.

Further, the longest-lived people on the planet do not follow a meat-heavy diet. They eat plants. Period. Think Okinawan and Mediterranian dietary patterns. Not a paleolithic, caveman diet.

Until someone proves that a saturated fat, meat-heavy diet can reverse coronary artery disease, slow and possibly reverse cellular aging, improve markers in people living with cancer, and improve cardiovascular biomarkers nearly as well as a statin drug, I’ll stick to plants.

There is one thing we all can agree on: ANYTHING is better than the typical American diet.

Suzanne Dixon, MPH, MS, RD
Epidemiologist/Registered Dietitian

​Portland, Oregon​

Fasting and Cancer

Several years ago, a study suggested that fasting – avoiding most or all calories – for a short time before receiving cancer chemotherapy may enable the treatment to kill cancer cells more effectively. This study was conducted in mice, not people. We do not know if what happened in mice would happen in people with cancer.

Fortunately, there are several well-designed clinical trials on-going, and these trials are focused on determining whether fasting before, during and/or after chemotherapy or radiation treatment is beneficial. Further, these trials should help us sort out which people, with which types of cancer, are likely to benefit the most from this approach.

Understandably, people living with cancer do not want to wait for clinical trial results for an answer. They have cancer today, and for obvious reasons, many of these people are interested in trying fasting now.

What’s the harm in fasting?

Due to the lack of published studies in humans, it is premature to recommend fasting before chemotherapy or radiation therapy for all cancer patients. However, it is reasonable that people with cancer who are otherwise healthy, well-nourished, and not at risk of developing malnutrition try fasting. But this does not mean every person with cancer should try fasting.

The most important thing to remember is that weight loss and muscle wasting are common problems faced by cancer patients. For people with these concerns, deliberately depriving the body of calories and protein is not a good idea.

In fact, recent research on nearly 1,500 lung and gastrointestinal cancer patients found that weight loss and loss of muscle mass were stronger predictors of survival than even tumor type, stage of cancer, the patient’s age, and how well they functioned in their day-to-day life (performance status).

This points to the importance of addressing unintentional weight loss. This is the type of weight loss that simply “happens,” without the patient trying. Unintentional weight loss occurs even though the person is trying to eat enough to prevent weight loss.

Also key: this study clearly showed that even for people who were overweight or obese, losing weight led to poorer survival. In other words, carrying excess weight does not protect against the negative consequences of unintentional weight loss in people being treated for cancer!

Clearly, fasting is not for everyone.

Should I fast?

Remember, if you are having unintentional weight loss due to cancer or its treatment, fasting may cause more harm than benefit. People with unintentional weight loss have more severe side effects, more treatment dose reductions, and generally poorer survival.

The unintentional (not trying) aspect of weight loss during cancer care is important. People in this situation often are very different, physiologically, compared with patients who are not losing weight unintentionally.

When the body is losing weight without the person trying, it means that person is having more inflammation, more loss of lean tissue, more depressed immune function, and is experiencing many other markers of poor outcomes. For people who are not losing weight unintentionally, the picture is very different.

If a person is losing weight with a healthy diet and regular physical activity (including strength training and cardiovascular activities), the small amount of weight loss that may occur with fasting is not as likely to cause harm. Of course, this should only be attempted during cancer care with the approval of the medical team.

In these cases of weight loss “on purpose,” the benefits of fasting may outweigh the downsides. This type of person is in a better place to tolerate some calorie deprivation without losing healthy, lean tissue.

Why would fasting be good?

Normal cells and cancer (malignant) cells grown in test tubes behave differently under conditions of starvation. When deprived of nutrients, normal cells quickly stop growing and switch into a state of “housekeeping.” They perform only functions that are absolutely necessary for survival. Their growth slows, and they metabolize (use) nutrients at a much slower pace than when nutrients are readily available.

In contrast, cancer cells continue to divide under starvation conditions. In many cases, they grow and divide until they exhaust all nutrients, and then die.

This makes sense: the hallmark (key feature) of cancer cells is uncontrolled growth and replication. This means that regardless of the availability of nutrients, or anything else for that matter, cancer cells just go right on growing and dividing.

Unlike healthy cells, cancer cells don’t have the luxury of slowing down just because nutrients are scarce.

Also of interest is that under starvation conditions, normal cells in a test tube are up to 1,000 times better protected against chemotherapy drugs than cancer cells. This also makes sense.

If normal cells are growing very slowly (or not at all) due to a lack of nutrients, they aren’t going to ‘take up’ or absorb the chemotherapy drugs. This may be one explanation as to why fasting could protect normal tissues against damage during cancer treatment.

To summarize: fasting may protect normal cells against damage, while simultaneously making cancer cells more sensitive to the treatments that are aimed at killing them.

Who is studying the possible benefits of fasting during cancer treatment?

One researcher actively pursuing this line of inquiry is Valter Longo ( at USC.

Dr. Longo has published a human case series, which is available at: A case series simply reports what is observed. It is not a true test of whether a particular treatment approach (including fasting) is helpful, harmful, or neutral.

You can see more examples of these trials on the website. Searching on fasting and chemotherapy, fasting and radiation therapy, dietary restriction and cancer, and other, similar combinations of words will yield dozens of examples of on-going clinical trials on this topic.

What to consider with fasting during cancer care

For people who are interested in fasting, there are some very important things to keep in mind:

  • Never attempt fasting without discussing it with your doctor and dietitian. It is in your interest that everyone on your healthcare team be on the same page. Even if your medical team discourages you from fasting, if you plan to do it anyway, do not hide this from them.
  • Do not try fasting if you are taking oral chemotherapy medications. These are cancer drugs that are taken by mouth. Many oral chemotherapy medications must be taken with food, or taken with a very specific amount of calories, fat, protein, or other nutrients, to be absorbed fully, and to work properly. This issue hasn’t received much attention in the debate about pros and cons of fasting during cancer treatment. It is very important!
  • Hydrate, hydrate, hydrate! Fasting does not mean avoiding all liquids. In fact, if you are dehydrated when you receive cancer treatment, this can cause permanent damage to your body. For example, kidneys can be damaged when chemotherapy is given without the person drinking enough fluids. The liver may not detoxify and excrete the chemotherapy properly.
  • Be sure you know what you’re doing and how you plan to fast. To some people, fasting means avoiding all calories, solid and liquid. To others, fasting means cutting way back on what you are eating and drinking, but not going completely without calories. Some people want to fast for 3-5 days, which is a long time! They decide to fast for 1-2 days prior to receiving treatment, the day of treatment, and for 1 day after treatment. Do not do this without talking to your medical team!
  • Do not fast if you have other chronic conditions, such as kidney or liver problems, diabetes, heart disease, or other health issues. Fasting under these conditions may not be safe. Don’t risk your health by trying something that may cause more harm than benefit.
  • Stop fasting if necessary. For nearly all of the research studies on this topic, the researchers have specific guidelines (protocols) in place to address excessive weight loss. If weight loss reaches a certain point, and if the weight isn’t regained, fasting is discontinued. Even the researchers acknowledge that losing too much weight during cancer treatment can be harmful.

Right now, we don’t know if fasting during cancer treatment is a good idea, but early research suggests this approach may be beneficial to some patients.

If you are interested in this, ask your medical team for more information about the pros and cons of fasting during cancer care.


Raffaghello L, Lee C, Safdie FM, et al. Starvation-dependent differential stress resistance protects normal but not cancer cells against high-dose chemotherapy. Proc Natl Acad Sci USA. 2008;105(24):8215-8220.

Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, Murphy R, Ghosh S, Sawyer MB, Baracos VE. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47.

Is Your Sunscreen Killing You? Probably Not!

I recently wrote an “Ask the Expert” column for a client of mine, a wonderful company dedicated to providing quality, evidence-based health information to the public. Although this topic is not related to nutrition, it is timely, so I wanted to share it with you here.

My passion is to help people make sense of the confusing mix of hype and fear that makes up the majority of mainstream media reporting about a variety of health topics.

What’s Worse for Health: Sun or Sunscreen?
Expert Advice from Suzanne Dixon, MPH, MS, RD, Epidemiologist and Registered Dietitian

Make a habit of using a broad-spectrum sunscreen or physical block

Recent news reports have highlighted a study out of Sweden, which found women who avoid sun exposure have higher instances of death due to any cause (all-cause mortality) compared with women who regularly get more sun. Somehow these findings have been getting buzz as “proof” that sunblock is deadly, despite that the research did not examine sunscreen use at all.

What did the new study actually find?

The Swedish researchers collected information on sun exposure and health habits from approximately 30,000 women who were 25 to 64 years old at the start of the study. The women were not asked about sunscreen use. Over 20 years of follow up, the women who had the least sun exposure were twice as likely to die of any cause compared with women with the most sun exposure.

On the surface, these results seem to suggest that avoiding sun exposure is bad for health, but the study authors failed to take into account important considerations. When compared with the group with “active sun exposure habits,” those women who indicated they were not exposed to sun were significantly more likely to:

  • be overweight or obese,
  • be sedentary, meaning they engaged in very little physical activity compared with the sun-exposed group, and
  • have a hereditary risk of melanoma.

None of these factors—all of which are important predictors of the risk of death due to any cause—were properly corrected or controlled for by the researchers. Further, they did not consider other diseases that may contribute to risk of death. While they assessed the use of medications for diabetes and cardiovascular disease, this approach does not provide information about other chronic diseases, such as autoimmune conditions or mobility issues that may increase risk of death, and which tend to make it less likely a woman will spend time in the sun.

Activities used to determine “active sun exposure”—sunbathing, winter holidays to the mountains, and vacations to warm, sunny locations—also are likely related to overall health as well; women who are frail or ill are less able to engage in these active, sun-seeking habits.

Separating truth from fiction

Until a better-designed study comes along, people should continue to heed the advice of dermatologists and other experts, as the evidence still points to the importance of avoiding excess sun exposure for good health.

  • Get the D. If you do not sunburn easily, for your health, aim to get 15 minutes of sun exposure three times per week. However, if you do sunburn, you shouldn’t engage in this practice (I’m a redhead, I sunburn easily, and I do not ever expose myself to the sun intentionally). You can adjust the amount to account for living at northern latitudes, but even people with darker skin can develop skin cancer, so don’t overdo it.
  • Screen, for sure. Make a habit of using a broad-spectrum sunscreen. It’s true the jury is still out on whether chemical-based sunscreens may have other long-term health effects, but for now the risks of not using appear to outweigh the risks of applying sunscreen. If you fear chemical sunscreens, try physical blocks. Some health experts have raised concerns about metal nano-particles in some physical formulas, but you can find zinc- or titanium-based sunscreens that do not contain nano particles (though they may form a white sheen when applied).
  • Move more. As noted, the women in the sun-exposed group were significantly more active than the sun avoiders. Regular physical activity is strongly linked to better overall health, so add movement into your day, every day. If you’re a couch potato, just 20 to 30 minutes of brisk walking will do the trick.
  • Stay slim and trim. The sun avoiders were more likely to be overweight or obese. Maintain a healthy body weight throughout adulthood, and if you’re already overweight, losing just a few pounds can significantly improve health and reduce risk of death. And even if you don’t lose a single pound, getting more physical activity will improve your health. Heavy active people are much healthier than heavy inactive people!

What’s the danger?

Finally, keep in mind that having adequate vitamin D levels is linked with better health. Sweden is very far north, so there is the possibility that in this population, which receives no sun exposure for much of the year, blocking sun exposure is more harmful than not blocking it; this may lower blood vitamin D to insufficient or deficient levels.

(Journal of Internal Medicine, 2014, 276; 77–86)

Should You Supplement Vitamin D? A New Look at Old Data

Two new vitamin D studies offer tantalizing clues about vitamin D and health, though the newly published research challenges long-held assumptions about the sunshine nutrient and bone health. As with most nutrition research, details matter, and considering those details can help you make informed choices about the role of vitamin D in your self-care plan.

Both papers, published in the British Medical Journal, used a technique called meta-analysis, which combines existing studies:

  • One paper found people with low vitamin D blood levels were significantly more likely to die from heart disease and cancer compared with people who had higher levels. Supplementing with vitamin D3, though not D2, appeared to reduce risk of death from any cause by 11% in older adults as well.
  • The other study supported a connection between higher vitamin D levels and reduced risk of chronic disease. However, the authors concluded that vitamin D supplements alone do not improve bone health and recommended against routine vitamin D supplementation for healthy adults.

Do they stand up to scrutiny?

While meta-analysis may alert researchers to important connections about nutrition and health, the method has downsides. An editorial about the studies noted there is a huge range in type and quality of study included in these meta-analyses, which may lead to erroneous conclusions.

It is possible that low vitamin D levels are caused by disease, rather than disease being caused by low levels, or are an indicator of other factors tied to poor health, such as smoking and obesity.

Considering context

A look at the big picture can help you better understand the connection between vitamin D and optimal health:

  • Consider deficiency. Health experts note that as much as two-thirds of the population of the United States and Europe are vitamin D deficient. Considering this and their findings, the study authors reported up to 13% of deaths in the United States and 9% in Europe can be attributed to low vitamin D levels.
  • Know your nutrients. Dr. Robert P. Heaney, MD, Professor of Medicine at Creighton University, points out that if a person is low in other critical nutrients, such as magnesium, calcium, vitamin K, or even dietary protein, adding vitamin D is unlikely to improve bone health.
  • Supplement wisely. Start with a diet of whole, healthy, unprocessed foods, such as vegetables, fruit, legumes, nuts and seeds, and lean protein. Work with your doctor or dietitian to see where you may be coming up short on critical nutrients, and supplement accordingly.
  • Watch the maximums. For most nutrients, health agencies have set safe upper limits of intake. To avoid potential downsides of supplementing, do not exceed these safe upper limits unless directed to do so by your doctor.
  • Consider food and supplements. Many people aim to meet all of their nutritional needs with dietary supplements. A smarter strategy? Consider dietary and supplemental sources of key nutrients. Make sure these add up to meet your nutrition goals.

(BMJ 2014;348:g1903; BMJ 2014;348:g2035; BMJ 2014;348:g2280)