Cardiology

Processed Red Meats And Cancer One Year Later: Cutting The Risk By Half

It is the one year anniversary of the announcement by the International Agency for Research on cancer(IARC), an agency of the World Health Organization known for expertise in analyzing scientific data for health risks, that meat acts as a carcinogen (http://www.iarc.fr/en/media-centre/pr/2015/pdfs/pr240_E.pdf). The analysis placed processed red meat at a risk similar to the notorious pesticide RoundUp at best and comparable to diesel fumes and tobacco at worst. These were very strong words that shocked many and made headlines worldwide (https://www.washingtonpost.com/news/wonk/wp/2015/10/26/hot-dogs-bacon-and-other-processed-meats-cause-cancer-world-health-organization-declares/). In case you missed it, the IARC, comprised of 22 scientists from 10 countries, reviewed over 800 studies and found that:

1. Processed meats like bacon, ham, salami, sausage and beef jerky are class I carcinogens, they highest risk assigned and cause cancer with sufficient data to make a firm conclusion. The relationship was strongest with colorectal cancer (CRC) and stomach cancer.

2. The risk increases incrementally with the amount of these meats that are eaten. Each 50-gram portion of processed meat eaten daily increases the risk of colorectal cancer by 18 percent.

3. Fresh red meats like steak and roasts, but including pork and lamb, were considered as probable causes of cancer to humans (Class 2a) with links to colorectal, pancreatic and prostate cancer.

The report of the IARC followed similar prior reports like that of the World Cancer Research Fund (http://wcrf-uk.org/uk/preventing-cancer/ways-reduce-cancer-risk/red-and-processed-meat-and-cancer-prevention) that drew similar conclusions.
Now new research has applied this announcement to indicate how the recommendations of the IARC along with other lifestyle measures can reduce the risk of CRC  https://www.ncbi.nlm.nih.gov/pubmed/27752849). Six dietary and lifestyle recommendations (body weight, physical activity, energy density, plant foods, red and processed meat, and alcohol) were examined in terms of their association with CRC incidence over 7.6 years of follow-up in 66,920 adults aged 50-76 years at baseline (2000-2002) with no history of CRC.
The analysis indicated that participants meeting 1-3 recommendations enjoyed a 34-45 % lower CRC incidence, and those meeting 4-6 of the targets experienced a 58 % lower incidence of CRC. The lowest CRC risk for women related to body fatness and red and processed meat and for men it was avoiding alcohol intake and red and processed meat.
The tragic nature of CRC in the US is enormous. In 2014 about 140,000 were diagnosed in the US with CRC and nearly 50,000 died of this disease (http://www.cancer.org/research/cancerfactsstatistics/colorectal-cancer-facts-figures). African American men and women experience the highest rates of CRC, as much as 50% higher than whites. 


Similar to the current debate about the crucial role of substituting animal saturated fats with healthy options other than processed foods rich in sugar (http://www.huffingtonpost.com/joel-kahn-md/saturated-fat-remains-the_b_12094842.html), a strategy of replacing a breakfast of sausage and bacon with a plant based bean burrito or a lentil patty would be anticipated to produce a dramatic reduction in the risk of CRC (https://www.ncbi.nlm.nih.gov/pubmed/26077375). On the 1 year anniversary of the IARC, choose plants over animal products. At least one major hospital system has announced a total ban on processed red meats to be implemented in 2017. Others must follow suit.

Follow Joel Kahn, M.D. on Twitter: www.twitter.com/drjkahn

Saturated Fat Remains The Major Issue For Heart Disease

It is funny how two lives can run parallel courses thousands of miles apart to eventually become intertwined. I am a cardiologist trained in interventional therapy (stents) for coronary artery disease (CAD) who has become a passionate advocate of lifestyle and prevention of CAD before stents are needed. I exercise daily using high-intensity protocols. I am appalled by the current status of hospital food. I emphasize the need for increased fruits and vegetables in the diet with reduced added sugars and value the pattern of eating in the Mediterranean (MED) basin as a model for balanced nutrition. I am a student of the voluminous nutritional research by Dr. Ancel Keys, the world renowned physiologist who introduced the MED Diet to the United States in 3 best-selling books after decades of seminal research on diet-heart relationships. Finally, I have recently traveled to Museum of the MED Diet in Pioppi, Italy, and the winter residence for nearly 40 years of Dr. Keys and his wife Margaret.

Dr Aseem Molhatra is a cardiologist practicing in London who is 20 years younger than me but who shares the same credentials listed above. I praise the fact that he fights for better nutrition for children with a campaign to lower added sugars in the diet and shuns processed junk foods. However, we have quite different opinions in terms of the role of dietary saturated fats, mainly from animal sources such as red meat, butter, full fat dairy, cheese, and eggs. Dr. Molhatra gained international attention with an editorial in the British Medical Journal titled “Saturated Fat is Not the Major Issue.” He presented selected references he used to conclude that the health of the public suffered when it was led towards a low fat diet rich in added sugars. He blamed the research of Dr. Keys, who he claims “demonized” saturated fats. He relies on a meta-analysis in 2010 on the topic and a randomized trial examining different versions of a MED diet on CAD outcomes. His National Obesity Foundation, which receives funding from meat producers and pharmaceutical manufacturers, has been criticized for a recent proposal on managing obesity in the U. K.. The irony is that his NOF report was accused of “cherry-picking” studies to support its claims, the very same claim that has been erroneously hurled dozens of times at Dr. Keys since his death. Dr. Malhotra recently released a documentary on his visit to Pioppi, Italy, The Big Fat Fix. Finally, he was recently featured in the New York Times holding a cup of coffee with butter and coconut oil blended into it while advocating for more cheese, eggs, and bacon in the public diet.

Space does not permit a full listing of all the issues I have with Dr. Molhatra’s new documentary. I will not comment further on the fact that he used multiple videos and photographs from the collection of the University of Minnesota without copyright permission (personal communication Henry Blackburn, MD) or that he climbed the fence of private property that was Dr. Keys home in Italy. I will also not respond to a strange claim that in his late 80s’s (Dr. Keys lived until just shy of his 101st birthday), he was unable to publish a paper on HDL cholesterol, with the implication that it was some sort of fundamental change in his thinking on the role of saturated fat and CAD. Both his son Henry Keys and Dr. Blackburn deny there was any such manuscript (personal communications, Henry Keys, MD and Henry Blackburn, MD). For sake of brevity, the following comments are offered in bullet points.

1) The 2010 meta-analysis mentioned above on which Dr. Malhotra relies was resoundingly criticized by a leading cardiovascular epidemiologist Jeremiah Stamler in the very same issue, a rather unusual event for a medical journal. Neither the authors nor Dr. Malhotra have responded to Dr. Stamler’s lengthy review of the study. The fact that Dr. Krauss, senior author on the meta-analysis, has long received funding from the meat and dairy industry, is overlooked by Dr. Malhotra.

Finally, the fact that in more recent publications the same research group has noted the benefits for preventing CAD by reducing dietary saturated fats substituting polyunsaturated oils, fruits, vegetables, fish and nuts is missing from the documentary.

2) The “demonization” of Dr. Keys began soon after his death in 2004 and can be attributed to errors in research on his long career by Gary Taubes and others. His is accused of manipulating American food policy to favor low fat, high sugar foods. Nothing could be further from the truth. Indeed, Keys never testified before the U.S. Senate working on such policies. A review of Dr. Keys’ best-selling books, co-authored with his wife, are replete with recipes substituting butter and cheese with copious amounts of olive and other vegetable oils. They would never be categorized as low fat meals. Dr. Keys and over a dozen co-authors performed the first long term observational study of widely different cultures in the Seven Countries Study. Their research was the first to identify that while both Finland and Crete had diets with about 40% of calories from fat, deaths for CAD was low in Crete due to the reliance on vegetable oils low in saturated fats while highest in the world in Finland where butter and cheese were the staples of the diet. Finally, Dr. Keys called for a reduction in dietary sugar as early as 1959 in his books, decades before Dr. Malhotra was born. The reality was that in analyses from the Seven Countries Study, dietary sucrose did not predict CAD with anywhere near the statistical power that dietary saturated fat, particularly butter, did.

3) The MED diet was given a new and dangerous spin in Dr. Malhotra’s film. While visiting the Museum of the MED Diet in Pioppi, he alters the MED diet food pyramid into something very different, a low carb-high fat (LCHF) plan. He removes the base of cereals, pasta and bread and emphasizes this again later in the film when he places the bread basket far out of reach. Instead he adds butter, full fat dairy and cheese, and even coconut oil to his prescription pad for the MED diet. This alteration of the MED diet pyramid, including foods like coconut not indigenous to the Mediterranean basin, might be easily overlooked. In reality, this is an obvious perpetuation of the LCHF diet promoted for decades beginning with Robert Atkins, MD and others. The actual MED diet, as studied in PREDIMED and other trials, emphasizes the central role of cereals. By removing carbohydrates as breads and cereals and adding in high saturated fat ingredients, this LCHF diet raises major concerns for CAD. A LCHF diet is associated with an increase in all-cause andCAD mortality in large databases. That a cardiologist would promote a LCHF diet in view of this known risk is concerning at best and seemingly dangerous at worst.

Another critic of Dr. Keys and the Seven Countries Study, Nina Teicholz, accused Keys of fudging his data, recognizing it is hard for Keys to respond since his death! She implies that he misled the public into the current obesity epidemic. While the topic is complex, and the recent reports of sugar industry payoffs (unrelated to Dr. Keys) 50 years ago are very concerning, the real fudging can be found in The Big Fat Fix. This documentary and the other writings of Dr. Malhotra ignores the copious new data on the confirmed risk of dietary saturated fats and CAD. Also ignored is the documentation that a no added fat, plant based diet can reverse CADand improve blood flow to the heart. His writings and film contribute greatly to the confusion amongst the public about what to eat. Dr. Malhotra lectures about confusion as a classic strategy from the tobacco industry “playbook” to delay the public view linking smoking to cancer. We should be alarmed that the Big Fat Fix is taking a page out of that same playbook at the risk of the wellbeing of the public. This is not a personal attack as I know Dr. Malhotra to be an intelligent and personable individual. Rather, for the sake of the health of CAD patients, known and developing, I call upon him to rethink his passion for adding saturated fats to the diet of patients with known or occult heart disease and instead join me in advocating for diets with more fruits and vegetables low in added sugars. The olive branch that includes olive oil is extended. Physicians swear to “primum non nocere” or “first do no harm”. As there is no safety data for his recommendations in heart patients, Dr. Malhotra would be wise to review that credo. Meat, dairy products and artificial foods usually high in saturated fat remain the main felon in CAD with added sugars an obvious accomplice.

Dr. Joel K. Kahn, MD, FAAC

Cardiologist’s Case Study: A Patient’s Lab Results After 30 Days on a Plant-Based Diet

Adam is a well-known Detroit businessman who is legendary for his huge smile, energy, and successful restoration business. We became friends at a CrossFit gym a few years back. On social media, Adam was known for food posts that were usually centered around his love for bacon and burgers. He was about as meat-oriented as anyone I have ever met. As we all know, change has to come from within, and so we maintained our friendship despite the fact that we were polar opposites when it came to food.

In March of this year, Adam texted me to tell me he was ready for a change. He hadn’t had a health crisis yet (he is in his 40s), but he knew his diet, heavy in processed meat, could not work in the long-term. I was shocked, pleased, and, of course, supportive when he suggested going fully plant-based for 30 days. On top of this 30-day challenge, a huge departure from his normal diet, was the added challenge that he ate nearly every meal out at restaurants. So he was going to have to do some extra maneuvering.

The Bacon-Lover’s 30-Day Vegan Challenge
To document a baseline, we arranged for some advanced blood work at the Kahn Center for Cardiac Longevity at the end of March. On April 1, he jumped right in, switching out eggs and bacon for oatmeal and fruit plates. Lunches of soups and vegetables began to appear on his Facebook page. Dinners of steak house appetizers, tofu stir fries, and entrees from my plant-based restaurant GreenSpace Café got him through the first few days. He bravely and publicly posted about his diet switch on social media and received a lot of positive support. There were, of course, a few taunts and invitations to return to the dark side.

He found grocery shopping difficult at first, so I helped him through a couple shopping trips. We filled his baskets with fresh whole foods along with a few processed vegan choices. To his credit, Adam quickly decided to only eat whole-food, plant-based meals.

He stuck to the program 100 percent, and began to notice that he got better sleep and had increased energy and greater brain clarity. He was not overweight, so he didn’t need to lose weight, but he did mention his bowel movements were easier with all the added fiber from the fruits and vegetables. He made it through the 30 days successfully.

May 1 was the day we had scheduled for his repeat laboratory studies. To be honest, we were both nervous. What if there were no changes from his abnormal baseline lab results? We knew that 30 days was not a very long time, and perhaps wasn’t long enough to see significant changes. We were both overjoyed when the results returned.

Advanced Lab Results After 30 Days on a Plant-Based Diet

Adam’s first baseline blood level showed a seriously elevated C-reactive protein at 6.1 mg/L. High sensitivity C-reactive protein (hs-CRP) is a marker of inflammation that has been linked to heart attack, stroke, diabetes and cancer. Adam’s repeat level was 0.7, a dramatic and meaningful decline to normal.

Adam’s baseline microalbumin/creatinine ratio had been a very worrisome 8.5, indicating his arteries were sick from his food choices. This simple but powerful urine test reflects the health of the arteries in the kidneys and throughout the body. If elevated, it predicts increased risks of heart disease, heart attack, and stroke. Adam’s second test, just one month later, showed an undetectable level! This dramatic improvement shocked and pleased us all.

Adam’s total cholesterol fell from 224 mg/dl to 196, his LDL cholesterol fell from 142 to 115, and his LDL particle number fell from 1714 to 1474. These are significant improvements in just 30 days.

I’ve practiced medicine for over 30 years and have eaten a plant based diet for nearly 40 years. Even after all that time, I am still so impressed at how quickly the body can recover when excess salt, sugar, fat are removed and whole plant foods replace meat, dairy, and processed foods. I am proud to report that Adam is still eating a plant-based diet, encouraged by the way he feels and the results of his laboratory reports. I recommend all of my patients dive headfirst into a vegan challenge of at least 21 days in length. The patients that take the challenge feel so much better, and many continue long-term as Adam is now doing. It’s inspiring to see!

Adam’s labwork showing his improved results after 30 days. 

Adam’s labwork showing his improved results after 30 days. 

Dr. Joel K. Kahn, MD, FAAC

Citing Sources: www.forksoverknives.com

The Unexpected Source Of Household Toxins + How To Stay Safe: A Cardiologist Explains

I don't like to be an alarmist. The world is not coming to an end tomorrow. But the fact that we've created a far dirtier planet cannot escape posing some serious concerns.

In my field of cardiovascular disease, air pollution as a trigger for heart attack and death is rarely mentioned but is highly supported by quality research. Indeed, in a rather shocking analysis, living near a freeway was equated as a health risk to passively smoking 10 cigarettes a day. And the famous Framingham Heart study recently added to the huge database of research studies by identifying a relationship between air quality and cardiovascular inflammation.

So, perhaps like you, I hold my breath as long as possible when a truck or bus burps dark black fumes on the sidewalk—and I will not visit Beijing without a gas mask!

Of more immediate concern is indoor air pollution, right in your own home. The World Health Organization recently published a document that shocked me with statistics that might just push me into alarmist mode. Some of the facts they report on air quality in our homes and health include:

  1. Around 3 billion people cook and heat their homes using open fires and simple stoves burning biomass (wood, animal dung, and crop waste) and coal.
  2. Over 4 million people die prematurely from illness attributable to the household air pollution from cooking with solid fuels.
  3. More than 50 percent of premature deaths due to pneumonia among children under age 5 are caused by the particulate matter (soot) inhaled from household air pollution.
  4. There are 3.8 million premature deaths annually from noncommunicable diseases including stroke, heart disease, chronic obstructive pulmonary disease (COPD) and lung cancer that are attributed to exposure to household air pollution.

Did you read the same words I read? Over 4 million people a year die from illnesses related to household air pollution. Of these deaths, 60 percent are due to stroke and heart disease—the conditions that I, as a cardiologist, am striving to prevent at all costs!

Two scientific studies have looked at the utility of high-quality air filters in the home to reduce indoor air pollution and heart disease measures, with different results. One demonstrated some reduction in the impact of nearby traffic air pollution in a residence using an air filter while another failed to show any benefit. A recent review on the topic favors a home air filter, with benefits for conditions from asthma to blood pressure. But clearly the jury is still out on the topic.

Until there is more information, here are five simple steps you can use to keep your indoor pollution down:

1. Keep your floors clean with door mats, regularly mop to pick up the dust, and use a vacuum with a HEPA filter.

2. Keep your home lower in humidity, as mites and mold love moisture. Fix leaky plumbing, vent the clothes dryer, don’t overwater plants, and use an exhaust fan when cooking, bathing, or running the dishwasher.

3. Make your home a no-smoking zone—that includes a wood-burning fireplace and grilling indoors. Do not have indoor fires whether for pleasure, heat, or cooking.

4. Test for radon periodically, which is linked to lung cancer and is odorless. This is true whether your home is new or old. Granite countertops have been linked to radon.

5. Avoid fragrances that use synthetic and volatile organic compounds (VOCs) that plug in, get thrown in the dryer, or are sprayed in the bathroom. Enjoy natural good smells as much as possible.

Considering all this, I've placed a powerful HEPA air filter in my bedroom. I have two rescue dogs that sleep on my bed every night after visiting every bush and flower bed all day long. Plus, the windows are open with screen doors blowing in all kinds of outside matter that I'd rather be filtered out. And I'm guilty of not taking my shoes off at the door (despite my wife’s reminders). I take comfort in knowing that the low-grade hum of a HEPA filter I hear at night is circulating and filtering the air I breathe. It may be a consideration for your home, too.

Joel Kahn, MD, FAAC