American College of Physicians: Internal Medicine — Doctors for Adults ®

Tuesday, November 3, 2015

Meat and cancer: hammering at the memo

You have doubtless heard that the International Agency on Cancer Research, a subsidiary of the World Health Organization, has concluded that processed meats are carcinogenic, and red meat in general is probably so.

A whole lot of ink (well, electrons, mostly) is being allocated to the topic, with most members of the nutrition, public health, animal welfare, and environmental communities saying something along the lines of “amen” or “we told you so,” and the sellers of meat and their representatives saying, predictably, “what does IARC know, anyway?”

Given the barrage of commentary through which you are invited to sift as the spirit moves you, I will limit my own to a succinct list of implications. Here are my top 10 take-aways, counting down in the tradition of David Letterman.

10) There isn't cause to panic.

For those thinking, “I ate bacon once, I'm doomed!”, a moderating word of reassurance. The pig in question certainly is doomed, but you, not so much. Living involves inevitable exposure to carcinogens, sunlight among them. Exposure to a carcinogen does not mean cancer will happen.

9) The dose, as ever, makes the poison.

Even those who have dug rather deeply into the IARC materials are thus far still asking questions about dose of meat intake, and duration, and when the cancer risk becomes meaningful. We may simply note that Paracelsus was right rather universally when noting that “the dose makes the poison.” The contribution of meat of any kind to bad outcomes of any time relates not to isolated exposures, but to dose, a combination of quantity, frequency, and duration.

8) Meat isn't what it used to be.

Those inclined to refute the IARC conclusion because we are constitutionally omnivorous as a species (we are) are ignoring 2 very important considerations. First, our Stone Age ancestors had a lifespan about half our own, so didn't have time to develop cancer for the most part. What natural selection never sees, natural selection cannot address. Further, the meat of our native diets is rather far removed from the meats that prevail today, and in particular, the processed meats that have earned the skull and crossbones warning label from IARC. I have addressed this topic before, for those inclined to chew it more thoroughly.

7) Processed meat isn't even what the meat that isn't what it used to be … is.

Calling a food “cereal” may mean it is exclusively a whole grain (e.g., steel cut oats); or it may mean it is a Frankenfood with some variety of sugar its first ingredient, followed by an inventory that runs off the package and includes the constituents of multi-colored marshmallows. So, too, for meat. Click here for the details on what IARC considers processed meat. We may simply note that in our culture, it is customary to invoke some mantle such as the “Paleo diet,” and then use it to justify eating meat our ancestors would never even have recognized as such.

6) The precautionary principle applies.

I have heard experts for the meat industry refuting the IARC report, saying we don't know this for sure. Frankly, I'll go with the international team of independent experts over the paid spokespeople every time, but either way, the precautionary principle pertains. That principle states that when risk is a possibility, presume it to be real until it can be disproven. Are parents really inclined to go with “IARC COULD be wrong, so have some more bacon?” I hope not.

5) More X, less Y.

Diets high in fruits and vegetables are consistently associated with less chronic disease, cancer included. When discussing dietary cause and effect, we tend to overlook the fact that a higher percentage of our calories from X means, inevitably, a lower percentage from Y. Eating more meat, as a percent of total calories, means eating fewer plant foods, which actually fight cancer. Thus, the harms of meat are not necessarily limited to the meats one adds to one's diet; they extend to what meat subtracts from the diet.

4) We had other good reasons to eat less meat: biodiversity.

Experts in biodiversity, our planet's luminous distinction, espouse the view that one of the best ways for us to protect that treasure is for the massive, global horde of Homo sapiens to eat less meat.

3) We had other good reasons to eat less meat: water and climate.

Ditto, essentially, for responsible stewardship of accessible water and the global climate.

2) We had other good reasons to eat less meat: ethics.

Much of the meat on modern menus comes to us from animals subject to various forms of abuse and cruelty. If we are decent, cruelty to other creatures has no place on any menu.

1) Plant-predominant diets are decisively associated with better health. In other words: duh!

My initial reaction to the new report was along the lines of: so? We have overwhelming evidence born of both research and real-world observation that plant-predominant diets are associated with longevity and vitality and lesser rates of all chronic disease, including cancer. Since this same shift in our dietary patterns would be better for us and the planet, did we really need another reason? Are we now waiting for tomorrow's news that eating deli meats causes eyeballs to burst into flames? In other words: even before the new report from IARC, we knew what we should be eating; we just keep finding reasons not to swallow it. That's what needs to change.

One final thought. The advocates of “more meat” mostly depend on the contention that our health did not improve when we “cut fat” beginning decades ago. As artfully addressed in a recent study, that's because we replaced 1 way of eating badly with another.

We should, indeed, eat less meat, but only Big Food will profit, and our health not at all, if processed meat calories are replaced with Snackwell cookies or multi-colored marshmallows. The 2015 Dietary Guidelines Advisory Committee recommended neither processed meat, nor cotton candy; they pretty much nailed it. Michael Pollan pretty much nailed it.

So, to the extent this new report continues to hammer away at a message we had, essentially, already received, may it help drive the final nail into the coffin of fixating on only one food or nutrient at a time, ignoring the big picture, and inventing new ways to eat badly. Yes, processed meat is bad for us. So are dogma, perennial discord, and cultural dysfunction.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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