Monday, April 12, 2010

Don't throw the baby out with the bathwater!

Last week a study was published in the Journal of The National Cancer Institute that was given wide-spread negative press. “Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC)”. Even the opinion piece in the same journal ran the catchy title “Fruits, Vegetables, and Cancer Prevention: Turmoil in the Produce Section”. 

In a nutshell, this very very large observational study (a study that relies on people's recall of their dietary intake, not a controlled dietary intervention study) showed that dietary intake of fruits and vegetables was only "weakly" associated with a reduced incidence of cancer. I think the word "weak" or some variation of it appeared in all of the news headlines I saw.

The results which made the big headlines were that every two portions of fruits or vegetables consumed on a daily basis only showed a reduced association of cancer risk of 2.5%.  

However, I think the American Institute of Cancer Research (AICR) gives a much more balanced view of these results as does Dr. Ralph Moss in his newsletter. This study also showed an 11% reduced incidence of all cancers in those people who ate the most fruits and vegetables (6 or more servings/day) in addition to a 30% decrease in coronary heart disease or stroke. Those results are not trivial, but they did not make the headlines or even the article content of most of the sound bites you saw or heard.

I am putting myself into the largest risk reduction pool possible to optimize my cancer survival,  overall health, and quality of life, with my continuing goal of consuming 6-9 servings of a wide variety of fruits and vegetables per day (each and every day and often as many as 10-12 servings/day). 

However, the important conclusions from this study are the following:

(1) Cancer is a tough task-master.
(2) Not all cancer is preventable with what is understood at this point. Risk reduction is the name of the game.
(3) Do not put all your eggs (or fruits and vegetables) in one basket so to speak.
(4) Don't look for (or wait for) the one 'magic bullet', i.e., any particular food or constituent of a food such as lycopene, selenium, vitamin, whatever - you name it, to be put into a pill.
(5) Don't take this study as the easy road back to thinking that french fries and catsup are vegetables.
(6) Cancer risk reduction needs to be multi-focused by creating a healthy lifestyle that consists of quitting (please don't start!) smoking, working toward achieving or maintaining a healthy weight, daily exercise, finding an enjoyable way to handle the stresses in life (we all have 'em!), and eating a healthy diet filled with healthy foods (recipes abound on my blogs and on my website).

My last point:

Small percentages are real, and I'll take them.  I would rather be nuancing over the choice of variety of apple, how it tastes, whether it is locally grown or shipped in from another state, organically grown or not, etc, etc in contrast to debating the side effects of various chemotherapy regimes that may also offer only a few small % points of potential benefit and/or difference between them (ugh - been there, done that, twice, not fun).

However, I don't live my life based on fear (i.e., apple or chemo). Instead, I live my life based on what I like to call "active hope".  So here is what I recommend: 

Intentionally reach for an apple (hopefully a Michigan apple or one grown near you - that's great, too!) or other fresh fruit or vegetable instead of a candy bar, etc, and instead of thinking that you are depriving yourself, ie. "apple or chemo", replace that thought with the following, "An apple is active hope". :-)

"Cultivate your life - you are what you grow - inch by inch, row by row"

Diana Dyer, MS, RD


Nancy -The Frugal Dietitian said...

Thanks for a very nice commentary - when I want to explain the weakness of the headlines I will just forward your link!!
Nancy Ortiz, MS, RD

lookinout said...

Very good post, as usual. Making a guess, I suspect that I always have that reaction to what you write.

Unknown said...

Thanks Diana - as always - you are a great resource!