“A missed opportunity” is how Susan Higginbotham, PhD, RD, Vice President for Research, American Institute for Cancer Research (AICR), described the “failure” of updated dietary guidelines to recommend limiting consumption of red and processed meat. Doing so would have “the potential to save thousands of American lives,” she added.
“We are very focused on the red and processed meat aspect, because we have done our own research and have our own recommendation about red and processed meat and how they increase the risk of colorectal cancer in particular,” Dr. Higginbotham explained in an interview with The ASCO Post. That research “has shown that diets high in red meat are convincingly linked to colorectal cancer,” according to an AICR Cancer Research Update article.1
Richard C. Wender, MD
A similar concern was voiced by Richard C. Wender, MD, Chief Cancer Control Officer, American Cancer Society, in a recent article.2 “The science on the link between cancer and diet is extensive,” Dr. Wender stated. “By omitting specific diet recommendations, such as eating less red and processed meat, these guidelines miss a critical and significant opportunity to reduce suffering and death from cancer.”
‘Healthy Eating Pattern’
Issued by the U.S. Department of Health & Human Services and the Department of Agriculture and intended for use by policymakers and nutrition and health professionals, the 2015–2020 Dietary Guidelines for Americans3 recommend a “healthy eating pattern” that includes a “variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products.” The guidelines do not, however, differentiate among these protein sources or recommend a quantitative limit for any of them.
The guidelines “definitely” should have recommended limiting red meat consumption, Dr. Higginbotham said. “They should not have scared people into thinking that if you eat red meat you are going to get cancer, but that red meat can be eaten in moderation. Limit your intake to about 18 ounces or less and avoid processed meat. The risk for processed meat is a little bit higher,” she said. According to the AICR Recommendations for Cancer Prevention, “Studies show we can eat up to 18 ounces a week of red meat without raising cancer risk. Research on processed meat shows cancer risk starts to increase with any portion.”4
Risk-Reducing Recommendations
The AICR did commend as useful to helping consumers lower their risk for cancer the guideline advice to eat a healthy diet with plenty of plant foods and a specific recommendation to consume less than 10% of calories per day from added sugar. That would work out to about 12 teaspoons of added sugar per day.
“We were very happy to see that,” Dr. Higginbotham said. “Our recommendation that is the closest in line with that is to avoid high-calorie foods and sugary drinks. This really has to do with calorie density, energy density, and causes of obesity—obesity being itself a cause of cancer. There is a clear relationship between being overweight, having excess body weight, and cancer.” An AICR blog posting about the sugar recommendation noted that obesity is “a cause of 10 cancers, including colorectal, postmenopausal breast, and kidney.”5
The connection between obesity and cancer continues to be “a very active area of investigation,” Dr. Higginbotham said. “Some of the things that the scientists we work with are looking at are how different hormone pathways are affected by obesity,” she said, as well as the effects of insulin resistance and the metabolic syndrome.
Total and Saturated Fats
The dietary guidelines do not contain a recommendation to limit overall fats in the diet but do recommend consuming less than 10% of calories per day from saturated fats. The AICR does not have a recommendation on either saturated or total fats. “Our research hasn’t shown a clear increase in cancer incidence with fat intake. So, therefore, we have no recommendation on fat,” Dr. Higginbotham said.
“A lot of people still believe that a high-fat diet causes breast cancer, but the evidence has not borne that out,” she continued. “So people seem to have this embedded in their consciousness that fat in the diet causes cancer, but our research has not shown that.”
Evidence on Meat Grows Stronger
The AICR recommendation for limiting consumption of red meat notes that evidence showing “red meat is a cause of colorectal cancer is convincing” and “is much stronger now than it was in the mid 1990s.”5 So why haven’t Americans, no matter what the official recommendations say, been convinced to cut back on meat? Dr. Higginbotham cited a combination of factors.
One factor is the massive amount of nutrition information reported and available through the Internet and other sources. “People get so much information about dietary studies and nutrition, and it is confusing to everybody. It is confusing to the general public, confusing to health professionals, and confusing to researchers. One study is reported in the news one day, and the next day a contradictory study is reported, Dr. Higginbotham said. “There is fatigue with nutrition information.”
Another factor relates to degree of risk. “High consumption of red and processed meat is a cause of colorectal cancer, but not the only cause and not a necessary cause of colorectal cancer,” Dr. Higginbotham noted. “There is an increase in risk, but it is fairly modest. So it is not like if you eat meat, you are going to die of colorectal cancer. Nothing like that.”
The countervailing message, often conveyed by lobbyists for the meat industry, Dr. Higginbotham said, is that “red meat has health benefits, which it does have some vitamins in it, of course. We are not saying to avoid it all together.”
Intense Lobbying Efforts
Dr. Higginbotham cited intense lobbying, primarily from the National Cattlemen’s Beef Association, as a reason the updated dietary guidelines did not include limits on the consumption of red meat despite evidence-based recommendations from an independent expert advisory committee. “As an organization dedicated to cancer prevention, we are dismayed to see that the Dietary Guidelines have allowed lobbying efforts to supersede the scientific evidence when it comes to meat and cancer risk,” Dr. Higginbotham noted.
Alice G. Bender, MS, RDN
The AICR did have input into the process of updating the guidelines, submitting a written statement outlining its views and summarizing research linking the consumption of red and processed meat to an increased risk of colorectal cancer, and Alice G. Bender, MS, RDN, Associate Director for Nutrition Programs at AICR, presented oral testimony. In addition, “we were part of a coalition, the National Alliance for Nutrition and Activity, that worked together on some of these issues,” Dr. Higginbotham explained. Members of the coalition also had an opportunity to comment on the advisory committee’s draft report before the guidelines came out.
Many people expected the final guidelines to include a limit on red and processed meat. “That’s what we thought, too,” Dr. Higginbotham said. “The advisory committee clearly said that it thought that red and processed meat should be limited.”
According to the AICR blog, “Unfortunately, the Dietary Guidelines do not reflect the evidence-based recommendation from the independent expert committee to advise Americans to limit red and processed meat. It is disappointing that industry lobbying efforts succeeded in preventing the clear and simple message that they increase the risk for colorectal cancer. AICR research has shown that red and processed meats are convincingly linked to colorectal cancer, and the World Health Organization has also recently established that link.”5
Others Also Voiced Disappointment
Kari Hamerschlag
Michael Greger, MD
Others also voiced disappointment in the final guidelines and dismay at the influence of industry lobbyists. According to Kari Hamerschlag, Senior Program Manager, Friends of the Earth, “The administration has clearly put the financial interests of the meat industry over the weight of science and the health of the American people.”2
In an article in the U.S. News & World Report, Michael Greger, MD, founder of the website NutritionFacts.org remarked, “Every 5-year cycle, the finalized guidelines tend to be watered down for political palatability compared to the scientific advisory committee recommendations.”6 ■
Disclosure: Ms. Hamerschlag and Drs. Higginbotham, Wender, and Greger reported no potential conflicts of interest.
References
1. American Institute for Cancer Research, Cancer Research Update: The dietary guidelines, a ‘missed opportunity’ for cancer prevention. January 13, 2016. Available at http://www.aicr.org/cancer-research-update/2016/01_13/cru_New_Dietary_Guidelines_and_Cancer_Prevention.html. Accessed February 4, 2016.
2. U.S. cracks down on Americans’ intake of added sugar, saturated fat. Reuters, January 7, 2016. Available at http://www.reuters.com/article/us-usa-healthcare-guidelines-idUSKBN0UL1NE20160107. Accessed February 4, 2016.
3. U.S. Department of Health and Human Services and U.S. Department of Agriculture: 2015–2010 Dietary Guidelines for Americans, 8th ed. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/. Accessed February 4, 2016.
4. Recommendations for Cancer Prevention. American Institute for Cancer Research. Available at www.aicr.org. Accessed January 18, 2016.
5. American Institute for Cancer Research Blog: New dietary guidelines: Helping you with plant foods, added sugar; misses mark on meat. January 7, 2016. Available at http://blog.aicr.org/2016/01/07/new-dietary-guidelines-helping-you-with-plant-foods-added-sugar-misses-mark-on-meat/. Accessed February 4, 2016.
6. Esposito L: New dietary guidelines for Americans go public. U.S. News & World Report. January 7, 2016. Available at http://health.usnews.com/health-news/health-wellness/articles/2016-01-07/new-dietary-guidelines-for-americans-go-public. Accessed February 4, 2016.
