Breast Cancer Awareness Month: Seeing red over pink!

image of pink lit White House from CBC News

It's that time of year when I see red, even though October is all about the color pink. That's because it's Breast Cancer Awareness Month. Here in the states it's referred to as National Breast Cancer Awareness Month (NBCAM), and even the White House is wearing pink! This whole pink thing is really getting old and frankly, since going through my own breast cancer experience, I find I'm actually angered by it all. Now that I've gotten that off of my, er, dare I say, chest - I'll get straight to the issue. How could a positive thing like raising awareness about cancer rouse me to anger?

Well, before I tackle that question, I want to be clear that this isn't going to be a post bashing America, or medical experts, researchers, charities or any others that have made a positive difference in the diagnosis and treatment of breast cancer or any cancer. My family and I have personally benefited from these things, and I am especially grateful for early detection. My hope is that this post will provide some food for thought.

Experts agree that an increased awareness about a disease may encourage a person to receive medical screening that can lead to early detection (6). Obviously, this is a good thing. But after more than 25 years of raising awareness, is NBCAM actually impacting the early diagnosis of breast cancer? A recent study published in the Journal of Health Economics researched this question and they found the answer is no, not any more (1). So, if NBCAM is no longer effectively raising public awareness about breast cancer or encouraging early detection via screening, than why is it we are seeing more pink than ever? I believe it's because breast cancer has turned into a profit generating industry, and I'm not alone in this thinking.

Profiteering of breast cancer? -
What ever happened to the thinking that:

"An ounce of prevention is worth a pound of cure." Benjamin Franklin 

Benjamin Franklin's quote holds true for those of us health seekers doing our best to prevent disease. But how does this resonate with, for example, a pharmaceutical company, whose bottom line is to make a profit? Let's face it, there's just not much money to be made in preventing breast cancer, or any cancer for that matter. Consider the primary breast cancer treatments to date: slash, burn and poison, otherwise known as surgery, radiation and chemotherapy. In a previous post I discussed an instance where a pharmaceutical company that produced a chemotherapy drug also made a bovine growth hormone being used in dairy cows. This hormone has been linked to an increased risk of breast cancer (5). But, hey, we've got a drug for that.

Whose interests are being served here? This is just one sad example of how some corporations have turned breast cancer into a profitable industry. Breast Cancer Action explains it this way:

 "The cancer industry consists of corporations, organizations, and agencies that diminish or mask the extent of the cancer problem, fail to protect our health, or divert attention away from the importance of finding and working to prevent the disease. This includes drug companies that, in addition to profiting from cancer treatment drugs, sometimes produce toxic chemicals that may be contributing to the high rates of cancer in this country and increasing rates throughout the world. It also includes the polluting industries that continue to release substances that are known or suspected to be dangerous to our health, and the public relations firms and public agencies that protect these polluters. The cancer industry includes organizations like the American Cancer Society that downplay the risk of cancer from pesticides and other environmental factors, and that historically have refused to take a stand on environmental regulation. " (3). 

More to NBCAM than meets the eye?-
So what does National Breast Cancer Awareness Month (NBCAM) have to do with this? Well, let's see. According to Wiki, NBCAM "is an annual international health campaign organized by major breast cancer charities every October to increase awareness of the disease and to raise funds for research into its cause, prevention, diagnosis, treatment and cure. The campaign also offers information and support to those affected by breast cancer. As well as providing a platform for breast cancer charities to raise awareness of their work and of the disease, BCAM is also a prime opportunity to remind women to be breast aware for earlier detection." This sounds great doesn't it?

Well, if we look a little deeper, we find that NBCAM was formed by Imperial Chemical Industries, the creator of Tamoxifen, a breast cancer treatment drug. In the 90's, Imperial Chemical Industries spun off Zeneca Group. Then Zeneca merged with Astra and became Astra Zeneca, which formed a non profit arm that is known today as AstraZeneca Healthcare Foundation, one of the largest financial contributors to NBCAM.  Astra Zeneca also created and markets Arimidex, another breast cancer treatment drug. CancerCares was also involved in the formation of NBCAM. A look at their donors reveals several pharmaceutical companies as well. So, what message would you want to spread if you were a drug manufacturer financially invested in breast cancer treatment medications? Probably not prevention.

I do want to acknowledge again that cancer treatment drugs are not bad. I'm just saying that it's a fact that pharmaceutical companies spend a lot of money on the research and development of new drugs. Forbes  published an article earlier this year that puts the dollar amount between a high of $12 billion and a low of $55 million (4). Considering the magnitude of expense to produce a drug, pharmaceutical companies must be under an enormous amount of pressure to deliver a drug that will generate revenue and for that they need a disease to treat. As I said earlier, there's no profit in prevention.  

Pink washing -
This brings me to what has come to be known as the "pink washing" of breast cancer. You can read more about this here. The term "pink washer" has been used to describe a company "that purports to care about breast cancer by promoting a pink-ribboned product, but manufactures products that are linked to the disease" (Breast Cancer Action) (2). The point is non-profit organizations accepting donations from companies that stand to gain from their philanthropy seems to represent a conflict of interest to me. It's no wonder that little focus is being placed on breast cancer prevention! It's much more profitable for these powerful industries to keep the emphasis on looking for the so-called "cure", which is really just another word for drug treatment.

Awareness, screening and a cure are NOT prevention -
Let's face it,  awareness, screening and early detection is a means to find disease, not prevent it. A cure is defined as the "restoration of health; recovery from disease" (7). Primary prevention of disease is about avoiding or reducing the risk factors for disease. After over 25 years of seeing pink, I think it's safe to say we are aware of breast cancer. I can't help but wonder where we would be now if that focus had been directed toward the prevention of breast cancer.

Well, we can't go back, but we can take action going forward! Let's think before we let our emotions be swayed by all things pink. Let's do some due diligence when donating to a charity.  Where does our money go?  How much of what is spent on that pink colored item will go toward breast cancer prevention research? What chemicals are in my pink marketed cosmetics or foods that my be adversely affecting my body? What's my elected official's stance on this topic? Let's tell those in government how we feel about these issues. Going forward we can shift the focus from awareness to prevention, because the only way we can be cancer free is by preventing cancer from occurring in the first place! 

GO TO: http://org2.democracyinaction.org/o/6098/p/dia/action/public/?action_KEY=11729

Resources

(1) Health awareness campaigns and diagnosis rates: Evidence from National Breast Cancer Awareness Month

Grant D. Jacobsena, Kathryn H. Jacobsen, Journal of Health Economics http://www.sciencedirect.com/science/article/pii/S016762961000144X

(2) Breast Cancer Action, http://bcaction.org/

(3) Breast Cancer Action, 

(4) Forbes - http://www.forbes.com/sites/matthewherper/2012/02/10/the-truly-staggering-cost-of-inventing-new-drugs/2/

(5) Breast Cancer Fund - http://www.breastcancerfund.org/clear-science/chemicals-glossary/bovine-growth-hormone.html

(6) Planning Implementing and Evaluating Health Promotion Programs, James McKenzie, et al, 4th ed., Pearson, 2005.

(7) The Free Dictionary http://www.thefreedictionary.com/cure

The pinkwashing and profitizing of breast cancer

It's that wonderful time of year again, and I'm not talking about the upcoming joyous holiday season. Please forgive my sarcasm, but the reason for my less than mirthful attitude about October is because it's officially National Breast Cancer Awareness Month.  I have come to prefer Breast Cancer Action's more accurate designation of National Breast Cancer Industry Month.  

I've shared my feelings about this month-long marketing extravaganza in a previous post, along with a little background on the origin and history of pink ribbons and breast cancer.  You can read more about that here.  Unfortunately, not much has changed in the world of pinkwashing since I wrote that post a year ago. In fact, it appears things are getting worse.

First, however, the good news is that our awareness of this practice is increasing. This is evidenced by the creation of a new word to describe the phenomenon, i.e. pinkwashing. The term comes from a mash up of the words pink - the color of the ribbon used to commemorate breast cancer, and whitewashing - which means to gloss over or cover up vices or scandals (1).  The Urban Dictionary defines pinkwashing as "the use of breast cancer by corporate marketers in which companies promote their products with claims to donate a percentage of proceeds to the cause" (2). In the spirit of creating new words, let's throw in "profitizing" while we're at it because that's exactly the action that is occurring in what has become the industry known as breast cancer.

Now the bad news. Sadly, it's no longer uncommon for corporations to put profits before the welfare of people. However, things have gone from strange to bizarre considering the fact that joining the long line of companies marketing their products under the pink ribbon is the queen of breast cancer charities - the Susan G. Komen Breast Cancer Foundation.  Evidently, the Komen Foundation has enlisted a company to manufacture a fragrance for them called Promise Me (4).  The slogan listed on the ShopKomen webpage reads, "purchase with purpose to end breast cancer forever" (4).  Have you ever wondered how much of the purchase price of a product that is marketed as "pink" actually goes toward the noble mission to "end breast cancer forever"? At ShopKomen it's 25% (5) (see the small print at bottom of the Komen webpage).

Now, if you're reading this blog you are probably clued in to the fact that the beauty industry is unregulated and as a result most beauty care products, including fragrances, contain chemicals that are proven to be unhealthy. Can you believe that the safety testing of personal care products is left up to the manufacturers? You read that correctly! According to the Environmental Working Group, they police themselves. So, considering this revelation, it will probably come as no surprise to learn that the original Komen Promise fragrance contained at least 2 chemical toxins (8):
• Galaxolide – a synthetic musk that works as a hormone or endocrine disruptor and has been detected in blood, breast milk, and even newborns.
• Toluene – a potent neurotoxicant linked to a variety of demonstrated negative health effects and is widely known as one of the toxic trio. Toluene is banned by the International Fragrance Association.

HELLO!! Endocrine disrupting chemicals are linked to cancer (6). This is outrageous and appalling to me. The Susan G. Komen Foundation is an organization whose mission is to "eradicate breast cancer as a life-threatening disease by advancing research, education, screening, and treatment" (3), yet they are marketing and selling a product containing chemicals that are suspected cancer causing agents.

That's why at this wonderful time of year, when everything is awash in pink, it is especially important to "think before you pink." This phrase, coined by Breast Cancer Action, suggests we ask the following questions before we generously support a charity or buy a pink ribbon product (9):

1. Where does the money raised by pink ribbon products go?
2. How much money goes towards breast cancer programs and services?
3. How are the funds being raised? For example, is it through the sale of cosmetics that contain potential cancer causing chemicals?
4. What types of programs are being supported? Is the money being used to conduct research to understand the causes of breast cancer, or in support of the prevention of the disease?

Check out the video below and please spread the word. Let's join together to let those who are choosing to profit from this disease that we won't be pinkwashed anymore!

Sources
(1) Wikipedia - definition of whitewashing - http://en.wikipedia.org/wiki/Whitewash_%28censorship%29
(2) Urban Dictionary - pinkwashing - http://www.urbandictionary.com/define.php?term=pinkwashing
(3) Susan G. Komen Breast Cancer Foundation - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508105/ 
(4) Shop Komen - http://www.shopkomen.com/cart.php?m=product_detail&p=1687
(5) Shop Komen homepage - http://www.shopkomen.com/
(6) http://www.ewg.org/skindeep/2011/04/13/why-this-matters/
(7) Endocrine Society - http://www.endo-society.org/journals/scientificstatements/upload/edc_scientific_statement.pdf
(8) Breast Cancer Action - Think before you pink - https://org2.democracyinaction.org/o/6098/p/salsa/web/thank_you_page/public/thankYou.sjs?thank_you_page_KEY=1654
(9) http://bcaction.org/our-take-on-breast-cancer/politics-of-breast-cancer/the-cancer-industry/#anchor2 
 

Eating for healing: Functional foods that support health

If you're considering eating for healing you might be wondering exactly what to eat. Obviously, there is an overwhelming variety of foods from which one can choose.  Taking into account the fact that we should consume a certain amount of calories daily, it makes sense to select foods that provide the biggest nutritional benefit per calorie.  Functional foods are an excellent choice because they provide health benefits that extend beyond basic nutrition (1).

Functional foods -
Be aware, however, that all functional foods aren't equally beneficial. This category of foods can also include processed foods which have been fortified or enriched with vitamins and minerals that are lost during manufacturing or storing (2).  Processed wheat flour is an example of a fortified food because some B vitamins and iron are added back in to it after the refining process. Another instance of fortification is when micronutrients which aren't normally present in a food are added. Calcium enriched orange juice would be an example of this type of mineral enrichment (3). At first glance fortification and enrichment of foods seems like a good thing.  However, I think it just makes sense to consume unprocessed foods that retain their naturally occurring, unaltered nutrients whenever possible.

So, let's take a look at one functional food that deserves more publicity - black rice. This unprocessed rice has been a staple for a large part of the world's population, but it's only recently gaining popularity here in the US.  I'm not sure why it's taken so long to catch on because I love the delicious nutty taste, firm texture and exotic touch that black rice adds to any dish. Not only does this rice look and taste good, but it's health benefits are outstanding.

Health benefits -
Research has shown that consuming black rice reduces the build up of plaque in the arteries and it also helps to reduce inflammation (4). These health benefits are thought to be the result of the intact outer bran layer that black rice retains.  White rice, on the other hand, loses this outer bran layer during processing.  In addition, research published in the Journal of Agriculture and Food Chemistry reported on the effects of black rice bran on skin inflammation in lab mice.  This study found that the black rice reduced inflammation by 32%, compared to controls and these benefits weren't seen in tests performed with brown rice extracts (5). These results show the potential anti-inflammatory and anti-allergenic benefits that black rice bran possesses. For those looking to reduce chronic inflammation, I think this food is definitely worth adding to your diet.

Here's a quick, easy and tasty recipe suggestion:
Asian Black Rice Stir Fry
Black Rice - cook per package directions (I found the Forbidden Rice brand at Market Street)
julienne carrots
Fresh pea pods
sliced red and yellow peppers
sliced green onion
sliced bok choy
julienne squash
ginger
handful of sesame seeds
cashews

After you've prepped the vegetables, heat grapeseed oil in a wok and add the vegetables in the order listed and cook until tender but crisp. Add organic sesame oil and tamari to taste, stir and top with cashews and enjoy.

Emerging science is giving us a better understanding of how the nutrients in the foods we eat can effect our health, and black rice is just one example of an excellent functional food. So, when faced with the decision of what to eat for our next meal it's important to consider our bodies' unique and specific needs, and then choose foods that will support these needs.  The next post will discuss functional foods in more detail. Until then, when planning your menus over the next few weeks, I encourage you to keep in mind this quote from Hippocrates:  "Let food be thy medicine..." 

Sources
(1) University of Michigan - http://www.med.umich.edu/mfit/nutrition/knowhow/pdfs/FuncFoodsExamples.pdf
(2) http://en.wikipedia.org/wiki/Functional_food 
(3) http://www.eufic.org/page/en/page/FAQ/faqid/fortified-enriched-food-products/ 
(3) http://www.foodinsight.org/Resources/Detail.aspx?topic=Background_on_Functional_Foods
(4) http://jn.nutrition.org/content/131/5/1421.short
(5) http://pubs.acs.org/doi/abs/10.1021/jf102224b

Eating for healing:Where do I start?

Have you heard the expression change begins with the first step? Well, the last post (found here) discussed several strategies relating to eating for healing.  Did you feel empowered enough to try any of them? If you did, than congratulations! You just took the first step toward a lifestyle that promotes wellness.  On the other hand, if you read the post and said, "where do I begin," or, "I can't do this," please don't throw in the towel.  I'm sure you're not alone, because I felt overwhelmed, somewhat intimidated and a little frustrated when I first contemplated the eating for healing information I received. Respect yourself for where you are right now on your path to wellness. Obviously you're on the right road, or you wouldn't be reading this. So, let's get started.

Eating for healing - Let's get started

As I mentioned before, this lifestyle isn't just for people coping with illness. It's for everyone who wants to support their body as it attempts to deal with the daily assaults of living.  All that said, where does one begin? Well, I find it's easiest if I have a meal plan and a shopping list. Here are the main things I consider when planning my menu:

Roberta Larson Duyff "Complete Food and Nutrition Guide"

1. Get colorful - This is so important. There is no doubt that the phytonutrients, (organic chemical substances), found in plants are fundamental to the health of those that consume them (1). That's why it's imperative that we strive to eat a variety of fruits and veggies every day. By doing this you are providing your body with more of the vital phytonutrients it needs for healing.  According to Roberta Larson Duyff, American Dietetic Association, of the thousands of known phytonutrients, only a few hundred have been studied. It has been discovered that each fruit or vegetable has different amounts and types of phytonutrients. An orange, for example, has "more than 170 different phytonutrients" (1). Of the thousands of  known phytonutrients, "more than 2,000 are plant pigments"(1). It's now understood that the colors of the plants reveal a little about their health benefits. You may be familiar with the best known phytonutrients: carotenoids, flavonoids, and isoflavones. The table above outlines what they do and the foods that provide them. 
2. Choose functional foods - Researchers are also beginning to understand that phytonutrients work in concert with other nutrients and fiber in our diets, and as a result effect changes in our health (1). The foods that are capable of doing this are called functional foods because "they may provide a health benefit [or function] beyond basic nutrition" (2). The International Food Information Council Foundation has a useful listing of the top functional foods found here.
3. Buy or grow organic food -  Research shows that organic food contains "substantially higher levels of vitamins, minerals, and phytochemicals than non-organic food" (3). "For example, you would need to eat 4 conventionally grown carrots today to get the same amount of magnesium that you could get from one carrot in 1940" (3).  Organic foods are more nutritious. They also aren't exposed to conventional growing practices that utilize pesticides, herbicides, fungicides and fertilizers.  These chemicals contain heavy metals, like lead and mercury, which have been found in conventionally grown produce. Granted, buying organic can be slightly more expensive than commercially grown foods, but the benefits are definitely worth it. However, if budget prohibits, the Environmental Working Group has compiled a list of what they call the "Dirty Dozen." You can find a list of these foods here. The Dirty Dozen are the top 12 most pesticide contaminated fruits and vegetables in America. It seems prudent to focus on purchasing these as organic. 
4. Select whole foods - What's a whole food? These are foods that are "as close to their whole or natural state as possible" (3).  Examples of whole foods include fresh fruits and vegetables, nuts and seeds, whole grains and dried beans.  Whole foods are free of additives, preservatives, dyes, flavorings and are unprocessed. In addition, because they are in their 'whole' state, whole foods "retain all of the nutrients to properly digest and metabolize themselves" (3).  As a result, we have the potential to get more nutrients when we consume these foods.
5. Eat nutrient dense vs. energy dense foods - If you're eating whole foods, than this is really a moot point, because whole foods are typically nutrient dense foods. However, the point still bears repeating and I dedicated a prior post to this topic here. The bottom line is that eating nutrient dense foods like fruits, vegetables and whole grains aids in weight loss.  This is because energy dense foods like fast foods, cakes, and chips not only have less nutrients and fiber, they also typically have more calories. Obviously when it comes to weight loss, less calories is the goal.  Another down side of eating  foods categorized as being more energy dense is the greater fluctuations in insulin levels. If that's not enough, another negative of energy dense foods is that they also typically lack fiber.  Whole, nutrient dense foods containing fiber provide the added benefits of increasing satiation, as well as aiding with elimination.

What to eat? One week of eating for healing -

Sample Menu
Day 1

• Breakfast -
• hot buckwheat cereal made with homemade almond milk, ground flax, organic mashed apple, dried cranberries, walnuts, fish oil, turmeric and cinnamon; 
• matcha tea (Dr. Weil discusses the benefits of this tea on his website here).
• Lunch - 
• quinoa fiesta salad - made with chopped red, yellow and green peppers, black beans, jicama, grape tomatoes, spinach and cumin seed, with a lime cilantro dressing. I love the variety of colors in this salad and it is very satisfying. Don't let my pitiful food photography put you off. This tastes even better than it looks.
• fruit smoothie - frozen organic cherries, peaches, mixed berries, coconut water, 2 small spoonfuls of vanilla goat yogurt
• Dinner
• Grilled Seared Tuna Steak on a bed of red cabbage, chopped apple, celery, and green onion  with ginger sesame dressing

Day 2

• Breakfast
• Homemade granola (organic oats, pumpkin seeds, sunflower seeds, prunes, raisins, dried cherries and blueberries and nuts) in goat yogurt with diced pear, ground flax and fish oil.
• matcha tea
• Lunch
• leftover quinoa salad on bed of lettuce, sliced apple
• Dinner
• Spinach Frittata
• mixed green salad

Day 3

• Breakfast
• leftover spinach frittata
• matcha tea
• Lunch
• Asian sunshine salad - chopped green cabbage, tangelo, navel orange, mango, cashews, green onion, bok choy, chopped carrots, mixed micro greens and black rice with Asian ginger dressing
• fruit smoothie
• Dinner
• Quinoa polenta vegetable lasagna.  This is my husband's delicious and ever evolving dish. We use organic quinoa polenta found at our local grocery store, but he has made his own organic corn polenta from scratch.  The polenta is the base layer and then you put fresh basil, Mexican oregano, onion, garlic, sliced green or red peppers, heirloom tomatoes, spinach (from my friend's bountiful garden, thanks Ann), diced kalamata olives, and top it with a little goat mozzarella on top. This is a satisfying and tasty dish.
• micro greens salad

Day 4

• Breakfast
• Sweet potato hash with pastured eggs over easy
• fruit bowl
• Lunch
• leftover Asian salad
• piece of fruit
• Dinner
• Chicken soup
• homemade gluten free bread (the best recipe I've found so far for a tender white bread is from the back of Bob's Red Mill's Potato Starch bag, but you can view it here).  It's a bread machine recipe and it comes out consistently tasty.  I substitute powdered goat's milk and brown rice flour.

Day 5

• Breakfast
• Hot buckwheat cereal 
• matcha tea
• Lunch
• Quinoa polenta vegetable lasagna leftovers
• mixed greens salad
• fruit smoothie
• Dinner
• Soba noodle stir fry with shitake mushrooms, bean sprouts, green onions, carrots, celery, bok choy, peas and ginger in a tamari sauce topped with cashews
• dessert of fresh blueberries over coconut macaroons

Making the change
I hope this menu gives you a bit of an idea of how to begin eating for healing.  You can find more ideas, as well as recipes from the Whole Life Nutrition Kitchen site here. Side note: Because I receive food from my local food coop I have found that I make meals based on what is seasonally available.  This is a good rule of thumb. Foods that are grown locally will be fresher and are less taxing to the environment because they weren't shipped from distant places. Having said that, I confess to buying foods that aren't locally grown. 

Tips -

• Plan your menu and have a shopping list
• Make more food at one time- It might seem like a lot of cooking, but I usually make enough to get at least two meals out of what I've prepared and then eat those on days I'm pressed for time or don't feel like cooking
• If you make a pot of soup or a casserole, freeze some for later
• Snacking - I didn't list snacks in my menu suggestions because you may find that you don't want a snack every day.  The foods you're eating are more nutrient dense and satisfying.  However, if you do find yourself craving a snack, one of my favorite snacks is fruit, but when I want something crunchy I pop up some popcorn or I have an organic brown rice cake, spread with almond butter, topped with sliced dates, and sprinkled with coconut on top.  Yum. 

Final thoughts
Change can be challenging, especially if you're dealing with long standing habits. I encourage you to take things slowly. Begin by looking at your pantry.  Clean out what isn't healing. Try making one new dish a week. By the end of 7 weeks you'll have a bevy of eating for healing recipes and you'll have revamped your eating habits too. It's important to note that eating for healing will require an awareness on your part of not only the foods you find nourishing, but also those that make you feel healthier and more energized.  In this case your gut will literally tell you what it prefers. It's important to listen to your body.  Follow your intuition and begin with small changes. As I said in the last post, you really have nothing to lose, except for maybe a few unwanted pounds. Go ahead. Take that first step!


Sources
(1) Duyff Roberta, Complete Food and Nutrition Guide, American Dietetic Association, 2006
(2) International Food Information Council Foundation - Functional Foods PDF http://www.foodinsight.org/Content/6/FINAL-IFIC-Fndtn-Functional-Foods-Backgrounder-with-Tips-and-changes-03-11-09.pdf
(3) Segersten, A. Malterre, T., The Whole Life Nutrition Cookbook 2nd ed., Whole Life Press 2010

Chemical body burden: Are you toxic?

As the Britney song goes, "Don't you know that you're toxic?" Given that the belt I purchased on sale recently contained lead, these lyrics could be prophetic. I just might be toxic! Of course, the toxic love Britney sings about isn't to be taken lightly. Thankfully, we usually have the option to walk away from a toxic relationship. I wish the same could be said about the toxins in our environment.

Toxins in our environment-

How did we get here? Warning labels attached to accessories? You would think that the past experiences of public safety concerns due to chemical risks would have brought about a change in practice. For example, toys, jewelry, accessories, clothing, furniture, crafts, foodware and office supplies have been recalled because they were found to contain dangerous levels of heavy metals, usually lead and/or cadmium. Evidently, if we are warned about something containing a toxic substance, that somehow makes it OK to be sold. 

I know, "caveat emptor" and all that. Given that you're reading this it's probably safe to say that you're concerned about your health and all that influences it. So, when we choose our purchases we try to consider their impact on us and our environment. I could simply choose to buy a different belt.  One that doesn't contain lead. But how would I know which belt doesn't contain a toxic substance given that this warning label isn't required by every state government? How are we to ascertain whether something we are purchasing contains a toxic substance known to cause harm to our health and well being?

Toxins in our bodies: biomonitoring and body burden-

An even bigger question for me is how many of these toxic substances are we exposed to in our environment, and what are the cumulative health risks, if any? In the bigger scheme of health hazards, wearing a belt that may expose me to a low dose of  lead might seem relatively benign. However, when you combine that particular exposure with the multitude of other toxins we encounter daily, the health risks increase and we end up with something scientists call the body burden (1).

According to the Environmental Working Group (EWG), body burden is the total amount of of toxic chemicals that have built up over time in our bodies (1). "Scientists estimate that everyone alive today carries within her or his body at least 700 contaminants, most of which have not been well studied" (3). To my horror I learned that the presence of toxic chemicals is found even in fetuses (2)(3). Evidently, pregnant mothers unintentionally pass toxins on to their babies through the placenta. According to the EWG, "358 industrial chemicals, pesticides and pollutants [were found] in the cord blood of American infants" (6). One expert calls this the state of being born "pre-polluted" (4).

The knowledge of body burden is available because scientists are now better able to measure and track the levels of chemicals present in us through blood, urine, breast milk and hair specimens. This process is called biomonitoring. According to Commonweal Breast Cancer Fund, biomonitoring is an important process for monitoring public health because it indicates "trends of exposure, identifies highly exposed communities and helps in setting priorities for legislative and regulatory action" (10). You can find one overview of some of the chemicals currently being biomonitored here, as well as the CDC's 4th Report on Human Exposure to Environmental Chemicals here. Interestingly, biomonitoring is also being used to watch wildlife that inhabit chemically contaminated environments like toxic waste dump sites. Scientists find that biomonitoring these animals serves as a "front line indicator of pollutant levels and potential health impacts" (7). You can read more about this here at the National Institute of Environmental Health Sciences.

Chemical regulation - Innocent until proven guilty-

When it comes to the chemical industry and our government's regulation of it, it appears their thinking is that chemicals are innocent until proven guilty. Historically speaking, it hasn't been until recent times that chemicals and their link to ill health effects have come under closer scrutiny. Back in the 1970's, the US Environmental Protection Agency (EPA) began to regulate a limited number of chemicals, mostly pesticides, under the Toxic Substance Control Act (TSCA). In 1992, the TSCA was amended to include a Lead Exposure Reduction Provision.

Toxins and health effects-

The health problems resulting from lead exposure are documented and well-known, with children being the most adversely effected. It took years, but health advocates pushed for tighter regulation of lead. As a result unleaded gas, paint and plumbing components are now the norm (5). However, as is evidenced by the warning label attached to my belt, lead is still finding its way into our lives. The lead example highlights what is broken with the current laws: 1) poor control of the import of goods made in countries that still allow the use of toxic substances and 2) current regulations are outdated.

The TSCA was enacted before the current scientific findings that show even small levels of chemical exposure, which were once considered harmless, actually do cause detrimental health effects. In addition, there are now hundreds of new chemicals that have been created since the TSCA went into effect. These chemicals aren't being regulated. Also, the present regulation of chemicals tends to focus on the effect that just one chemical has on our health and not the effects of total body burden. Given the past negative history of, for example, lead, one would expect that the government would choose to err on the side of caution and at least restrict the use of newer chemicals until more is known about their effects on us. Sadly, this just isn't the case. This wait and see attitude is like playing a game of chemical roulette. 

Since this post is focusing on what we can do to limit our body burden, I won't go into a lot of detail about the ill health effects of toxins.  Suffice to say, current scientific evidence clearly shows increased risk for birth defects, as in genetic mutations, reproductive issues, and cancers (3). These risks, combined with the fact that babies are being born pre-polluted is compelling enough to take at least a little protective action.

How are we exposed? The biggest chemical culprits-

One of the biggest areas of our exposure comes from the consumer products we use. Government health authorities have identified the following chemicals as being "human carcinogens, serious neurotoxins or well-established hormone disrupters" (4), so it would seem prudent to try to limit our exposure to these (click on each if you want to learn more):

• Brominated flame retardants
• pesticides
• the Teflon chemical PFOA
• the Scotchgard chemical PFOS
• BPA
• lead
• cadmium
• mercury
• perchlorate
• dioxins
• furans

Several other areas of exposure include the air we breathe, the water we drink and the foods we eat. If you've just thrown your hands up in surrender, I share your frustration. However, the situation isn't hopeless.  We may not be able to avoid toxins, but there are things we can do to reduce our level of exposure. Checking to see what your body burden currently is might seem like a logical place to begin.  However, at this point experts are saying that individual biomonitoring is difficult to use for specifically assessing how relevant your individual results are to your actual risk for disease. So, where do we begin?

What we can do to limit our body burden:

1. Let our government officials know that:
• we find the current regulation of chemicals unacceptable.  Public outcry was exactly what prompted the chemical DDT to be banned. The EWG states that "Proper environmental regulation does work to reduce people's chemical burdens" (8). The Toxic Substances Control Act must be amended to at least require that the complete health and safety data on chemicals be known and disclosed to the public. No more innocent until proven guilty. Dangerous chemicals should be phased out and safer alternatives assured.
• we desire community biomonitoring programs. The Centers for Disease Control (CDC) has been conducting biomonitoring for the past 30 years and several states are also biomonitoring for a small number of specific toxins only. One example is the program in Pennsylvania that tracks blood lead levels (9). You can read more about this at the CDC site here. However, more wide-spread biomonitoring of the chemicals experts have linked to increased risk for disease needs to be conducted in communities.
2. Support "watch dog" organizations that advocate for us by keeping an eye on the largely unregulated chemical industry, like the Environmental Working Group,  The Natural Resources Defense Council, or the Children's Environmental Health Network.
3.  Filter your water.
4. Buy organic foods if possible, especially if you have young children. If this isn't an affordable option, try to focus on buying organic products that make the most difference.  EWG has a handy list of the most pesticide laden produce here and it's also available as a free Iphone app.
5. Know what's in your personal care products and household cleaners and what chemicals to avoid. The list above gives you a good head start. Try to use natural products. You can read more about the natural personal care products at Skin Deep here and the household cleaning products here.
6. Know what kind of plastics are safer and avoid plastic baby bottles, water bottles, toys, teethers and  pacifiers and canned foods whose cans are lined with BPA. Avoid microwaving foods in plastic containers.
7. Throw away aluminum cookware and pans with non-stick coated surface. 
8. Avoid fabrics treated with flame retardants, wrinkle relaxers or stain repellents and limit use of fabric softeners and air fresheners.
9. Use low VOC (volatile organic compounds) paints whenever possible.
10. Try not to use chemical pesticides on your lawn, pets or in your home and take your shoes off before you walk in the house.

The evidence linking toxins to deteriorating health is mounting and seems compelling. The good news is that by becoming educated about the situation we can take steps to decrease our chemical body burden. While making these changes in our lifestyle are important to reducing our chemical exposure, it is critical that we also push for improved government and industry standards regulating chemicals.

As for the lead belt that prompted this post, it went back to the store, along with a letter to the company letting them know how I feel about their sale of a lead laced accessory! I like a bargain, but with this purchase I got more than I bargained for!    


Sources
(1) Environmental Working Group (EWG) http://www.ewg.org/news/proof-burden 
(2) Biomonitoring http://www.cdc.gov/biomonitoring/
(3) Chemical Body Burden http://www.chemicalbodyburden.org/whatisbb.htm
http://frwebgate.access.gpo.gov/cgi-bin/usc.cgi?ACTION=RETRIEVE&FILE=$$xa$$busc15.wais&start=9720137&SIZE=4204&TYPE=TEXT
Environmental Protection Agency (EPA) http://www.epa.gov/lead/pubs/titleten.html
(4) EWG http://www.ewg.org/minoritycordblood/pressrelease
(5) EWG http://www.oregon.gov/DHS/ph/lead/docs/introhealtheffectsmedicalprovider.pdf?ga=t  
(6) EWG http://www.ewg.org/files/2009-Minority-Cord-Blood-Report.pdf
(7) National Institute of Environmental Health Sciences - http://www.niehs.nih.gov/research/supported/srp/products/products2_s3_s1.cfm 
(8) EWG http://www.ewg.org/news/proof-burden
(9) Centers for Disease Control (CDC) - http://www.cdc.gov/nceh/tracking/trackbiomon.htm

Make sleep a priority for good health.

Ahhhhh, the luxury of an extra hour of sleep. This happy event occurred because US Daylight Savings Time ended yesterday and we woke to turn our clocks back. It is such a great feeling to gain this extra hour. Unfortunately, it can't make up for months of lack of sleep.  Evidently, we're not the only sleep deprived nation. According to findings from a 2005 around the world survey of 35,327 people in Austria, Belgium, Brazil, China, Germany, Japan, Portugal, Slovakia, Spain and South Africa, the Japanese slept the least and the Portuguese slept the most. However, the study revealed that although people in Portugal spent more time sleeping, they reported the most sleep disturbances (1).  It turns out that when it comes to sleep, quality and quantity are equally important. Since most of us are lacking in one or both, it's probably safe to say that we are globally sleep deficient.

It seems sleep has become a victim of the current 24/7 mindset, and we are only just beginning to understand the health consequences. Scientific evidence suggests that erratic sleep or lack of sleep increases our risk for a number of diseases, including cancer, heart disease, diabetes and obesity. In addition, although scientists are only just beginning to understand the interactions between sleep and the immune system, they have found that decreased sleep affects our bodies ability to fight infection (3).  Even more startling is the link between lack of sleep and a shortened life expectancy (2). According to researchers at Standford University, "sleep is the most important predictor of how long you will live, perhaps even more important than whether you smoke, exercise or have high blood pressure" (3). That's a pretty strong statement.

I was surprised to learn that a lack of sleep could impact our health so profoundly. How could skipping a few zzz's cause this to happen? Well, in the case of heart health, it seems that researchers found sleep deprivation elevated levels of an inflammatory marker for heart disease called C-reactive protein (5, 6). One study conducted at Harvard University over a ten year span found that "sleeping six hours a night was associated with an 18% greater risk of heart attack," whereas, sleeping 5 hours a night upped the risk to 40% (4). Elevated C-reactive protein levels have also been linked to other health concerns like high blood pressure, diabetes and even cancer (5). If you're interested in discovering more about the emerging science on inflammation and its link to cancer you can read more here. 

If you've been dieting and exercising and are still frustrated with stubborn weight loss you might consider your sleep. There's a wealth of scientific evidence showing that the two most common risk factors for obesity are overeating and inactivity, but experts are now including lack of sleep as well. Interestingly, recent research has revealed that people "who habitually sleep less than 6 hours per night are much more likely to have higher than average body mass index (BMI)" compared with people who sleep 8 hours (4). It seems that a lack of sleep causes changes in the levels of a few hormones that regulate corresponding body functions like appetite and metabolism. When we sleep less the body produces less leptin, an appetite suppressant and more cortisol, a stress hormone that effects the metabolism of proteins, carbohydrates and fats (8). In addition, levels of  insulin, a glucose regulating hormone, and grehlin, an appetite stimulant hormone, are also raised (8). These effects all combine to create a pro weight gain state.

Not only is lack of sleep a health concern, but poor quality of sleep is as well. The around the world study mentioned in the first paragraph found that 1 in 4 people felt they did not sleep well (1). Experts suspect that the numbers of people sleeping poorly are even higher because most people don't recognize what makes up a night of good, quality sleep. Perhaps adding to the issue of quality sleep is the effect aging may have on  changing sleep patterns. You can find more information about that here. For now, let's take a look at some steps to make quality sleep more possible. Here are the top 10 tips from the Mayo Clinic:

1. Stick to a sleep schedule, even on weekends.
2. Don't eat or drink large amounts before bedtime.
3. Avoid nicotine, caffeine and alcohol in the evening (caffeine limited as much as 8 hours before bedtime).
4. Regular aerobic exercise can help you fall asleep, but don't exercise right before bed.
5. Make your bedroom environment perfect for sleep. Keep it cool, quiet and dark. If it can't be quiet try white noise.
6. Get your primary sleep at night. If you work nights keep your windows darkened.This helps set your body clock and establish sleeping patterns.
7. Choose a comfortable mattress and pillow.
8. Start a relaxing bedtime routine.
9. If you can't fall asleep within 15-20 minutes try getting up and doing something calming. Then return to bed, but try not to stress about falling asleep as this will only keep you from doing so.
10. Use sleeping pills as a last resort (10).

You can find a helpful video, along with other information ranging from adopting healthy sleep habits to when to seek treatment to improve your sleep on the Harvard Medical School's Division of Sleep Medicine Site.

Although it's no guarantee, clearly the quality and quantity of sleep we get is important to our health. Why not try to schedule a little extra sleep time for yourself? Our 24/7 world may seem to suggest that sleep is a guilty luxury, but there's absolutely nothing wrong with giving yourself the gift of being well-rested. Sweet dreams. 

PS - This week is National Drowsy Driving Prevention Week.  Check out the National Sleep Foundation's videos and FAQ sheets found here.   

Sources
1) Soldatos, C.R., Allaert, F.A., Ohta, T. and Dikeos, D.G. How do individuals sleep around the world? Results from a single-day survey in ten countries. Sleep Medicine, 6:5-13, 2005.
2) http://www.sciencedaily.com/releases/2009/04/090421181032.htm
3) http://healthysleep.med.harvard.edu/need-sleep/whats-in-it-for-you/health
4) http://healthysleep.med.harvard.edu/healthy/matters/consequences/sleep-and-disease-risk
5) http://www.ncbi.nlm.nih.gov/pubmed/14975482 
6) http://en.wikipedia.org/wiki/C-reactive_protein


7) http://en.wikipedia.org/wiki/Leptin
8) http://www.nlm.nih.gov/medlineplus/ency/article/003693.htm
9) http://en.wikipedia.org/wiki/Insulin
10) http://www.mayoclinic.com/health/sleep/HQ01387
11) http://www.nlm.nih.gov/medlineplus/ency/article/004018.htm

The not so rosy side of breast cancer pink ribbons

National Breast Cancer Awareness month celebrates its 26th anniversary this year, and pink seems to be everywhere. Even football players are wearing pink. Have you ever wondered how this campaign began and what impact it is actually having on the prevention of breast cancer? Personally, I didn't give it much thought, that is until I was diagnosed with breast cancer. Before then, I rather naively assumed that anything pink was linked to a benevolent organization that was supporting the critical research needed to prevent the disease. That's why it came as a total surprise to realize that when it comes to the pink movement it seems there's a whole lot of gray.

Before I get to the gray, here's a brief history of the pink. Back in 1985, National Breast Cancer Awareness Month (NBCAM) was organized through the sponsorship of Astra Zeneca, a pharmaceutical company, the American Academy of Family Physicians, a medical society, and CancerCare, Inc., a non-profit. More on this later, suffice to say for now that their purpose in forming NBCAM was to "promote breast cancer awareness, share information on the disease and provide greater access to screening services." NBCAM's initial week long event spawned what is now an internationally recognized month devoted to breast cancer awareness.

On to the story of how breast cancer awareness became wrapped up in a pink ribbon. In the early 1990's, activist Charlotte Haley was inspired by the yellow ribbons tied on trees to honor American soldiers. She decided to make peach ribbons in her home and distribute them in an effort to raise public awareness about the National Cancer Institute's small percentage (5%) of their then $1.8 billion budget going towards cancer prevention.  Her efforts caught the attention of Estee Lauder and Self Magazine executives. They contacted Charlotte about joining her efforts.  She refused saying they were "too commercial". The attorneys at Self Magazine suggested that the color of the ribbon be changed in order for Self to use the concept. That's when the pink ribbon began to be associated with breast cancer, and shortly after Avon began their breast cancer cause related marketing campaign. 

Now, there is absolutely nothing wrong with pink ribbons, or raising money for cancer research, or providing greater access to mammography for the under or uninsured. When done altruistically, these are extraordinary  things. What is disconcerting is when pink ribbons are used to boost a company's profits or image under the guise of philanthropy. Unfortunately, it seems that breast cancer has become big business. It's because of those seeking to profit from breast cancer that some critics of NBCAM are now referring to it as "BCAM SCAM", or Breast Cancer Industry Awareness Month.  But how is it that such a noble and worthy cause has come to be viewed by some as a scam? To answer this question, a little research, along with some open minded consideration, is required.

When it comes to the public's health, the primary goals of health officials are prevention, intervention and eradication of disease, with prevention being preferable to intervention (McKenzie). For example, "immunizing to prevent a disease is preferable to taking an antibiotic to cure one" (McKenzie). Case in point, the human papillomavirus (HPV) vaccine and cervical cancer. Yet, when we look at the pink ribbon message, it focuses not on prevention, but detection and cure. Wait a minute. If prevention is preferable, why is the push for detection and cure? Because the detection and treatment of breast cancer has become a multi-billion dollar industry. Simply stated, prevention just isn't as profitable.

Skeptical? Perhaps a closer look at NBCAM might provide additional insight. Their organization was formed by Imperial Chemical Industries, the creator of Tamoxifen, a breast cancer treatment drug. In the 90's, Imperial Chemical Industries spun off Zeneca Group. Then Zeneca merged with Astra and became Astra Zeneca, which formed a non profit arm that is known today as AstraZeneca Healthcare Foundation, one of the largest financial contributors to NBCAM.  Astra Zeneca also created and markets Arimidex, another breast cancer treatment drug. CancerCares was also involved in the formation of NBCAM. A look at their donors reveals several pharmaceutical companies as well. So, what message would you want to spread if you were a drug manufacturer financially invested in breast cancer treatment medications? Probably not prevention. Might this explain NBCAM's focus on awareness and detection? To be clear, I'm in no way suggesting that awareness, screening and early detection of breast cancer is negative. The point is non-profit organizations accepting donations from companies that stand to gain from their philanthropy seems to represent a conflict of interest.

The pink campaign isn't only effected by conflicts of interest. There are also the companies that profit from linking their products to the breast cancer cause. At first glance this may seem altruistic, but sometimes things aren't always as transparent as they seem. For example, 12 years ago Yoplait began a pink ribbon campaign called Save Lids to Save Lives. A portion of the proceeds from the sale of their yogurt are donated for breast cancer research. The conflict resulted from their yogurt being made with milk from cows that were given a synthetic growth hormone, called rBGH. This chemical has been linked to breast cancer and is banned from use in many countries. You can read more about the topic here, and Oregon Physicians for Social Responsibility has an interesting video discussing rBGH and milk found here or click on the Videos tab in this blog.

The term "pinkwasher" has been used to describe a company "that purports to care about breast cancer by promoting a pink-ribboned product, but manufactures products that are linked to the disease" (Breast Cancer Action). When you consider that Yoplait was both contributing to and profiting from breast cancer, one could say they were successful at "pinkwashing." Thankfully, because of pressure brought about by health activist groups, like Breast Cancer Action and their "Put a Lid on It" campaign, as well as concerned consumers, to their credit as of 2008 Yoplait has stopped using rBGH milk in their yogurt.

The above is just one example of pink ribbon profiteering. Breast Cancer Action has some great information on their Think Before You Pink site to help guide consumers when purchasing "pink" products. They suggest asking the following questions:

1. How much money from your purchase actually goes toward breast cancer?
2. What is the maximum amount that will be donated? Sometimes contributions are capped at a certain amount. 
3. How are the funds being raised? 
4. To what breast cancer organization does the money go, and what types of programs does it support?
5. What is the company doing to assure that its products are not actually contributing to the breast cancer epidemic? 

You can find a more detailed discussion of these points here.

In a recent post I mentioned my support of the Love/Army of Women, a non-profit foundation dedicated to stopping breast cancer before it starts.  At first inspection I felt this group represented something that I feel is of critical importance - the need for more research into the prevention of breast cancer. However, after closer scrutiny I realized that this group is funded through a grant from Avon. This cosmetics company uses a number of chemicals in their products that have been linked to cancer through standard laboratory feeding tests done on mice and rats by the National Toxicology Program. Their study results have been published and accepted by the International Agency for Research on Cancer. A perfect example of the importance of the need to "think before I pink."

A final thought. On my last visit to the doctor she mentioned that Tamoxifen is now being recommended as a breast cancer prevention treatment for women who are considered to be at high risk for developing the disease. I was hoping that more breast cancer prevention research would be focused on how to reduce our exposure to cancer causing agents, such as the above-mentioned chemicals. Sadly, this doesn't appear to be a research priority, but it's not that surprising.  All things considered, I suppose drugs would be the first line of defense offered for prevention, if the pharmaceutical and chemical companies are underwriting a great deal of the research being conducted in the area of cancer prevention. Evidently there isn't anything completely transparent when it comes to this issue. One thing is for certain, pink looked a whole lot rosier before I took off my rose-colored glasses.

Sources
McKenzie, J., et.al., An Introduction to Community Health, 5th Ed., Jones & Bartlett, MA, 2005
http://www.nbcam.org/newsroom_nbcam_facts.cfm
http://bcaction.org/index.php?page=newsletter-88d
http://www.safe2use.com/drsherman/life/15.htm
http://www.cancercare.org/about_us/
http://www.cancercare.org/about_us/annual_reports/2009/donors.php
http://globalrace.info-komen.org/site/PageNavigator/hq_gr_learn_FAQ_2010
http://en.wikipedia.org/wiki/Imperial_Chemical_Industries#History
http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
http://www.ajcn.org/cgi/content/full/86/3/878S
Lancet - Circulating concentrations of insulin like growth factor 1 and risk of breast cancer -  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2897%2910384-1/abstract
Potential public health impacts of the use of recombinant bovine somatotropin in dairy production - http://www.consumersunion.org/food/bgh-codex.htm
Breast Cancer Action - http://thinkbeforeyoupink.org/?page_id=10
http://ntp.niehs.nih.gov/

Breast cancer jeopardy: cause vs. cure

Image from Memphis Flyer

Would you like to play a game called Breast Cancer Jeopardy? I'm going to assume a very firm and collective NO answer to this question. Unfortunately, the reality is regardless of whether or not we want to play, we are in the game. This is because when it comes to risks for breast cancer (BC), there are some we simply cannot avoid.

For example, if you're a woman who is aging, than you're playing breast cancer jeopardy because these are  the 2 biggest risk factors for breast cancer. Here are other risks both in and out of our control:

• Being over 40 years old
• Having genetic links, or family members with breast, prostate or ovarian cancer
• Having high breast density on a mammogram
• Never having children
• Having your first child after age 35
• Going through menopause after age 55
• Being exposed to radiation, or having frequent x-rays in youth
• Overweight after menopause or weight gain as an adult
• Used or are using hormone replacement therapy

All of these up our stakes in the BC jeopardy game. Yet, even with all the information we have about the known risk factors, 80% of women in America who get breast cancer have no other risks besides being a woman.  According to the Dr. Susan Love Research Foundation, "more than 4 billion dollars has been spent on breast cancer research over the past 25 years". Yet, we still have no idea what causes this disease.  To date, doctors and researchers have focused most of their attention on curing breast cancer. Personally, I would rather not have gotten the disease in the first place!

Now, please don't get me wrong. It's wonderful that the focus on finding a cure has led to great strides in detecting and treating breast cancer. However, it seems to me to make more sense to turn our attention to what is causing breast cancer and stopping it before it starts. An ounce of prevention is worth a pound of cure, right?

A recent example of the medical community turning their research focus toward the cause and prevention of a disease is cervical cancer.  Through their study of women, researchers discovered that the disease was caused by a virus. Fortunately, a similar approach is being taken by some researchers, who are now looking into determining the causes of breast cancer and ultimately figuring out how to eradicate it once and for all. One of these research organizations is the Love/Avon Army of Women (AOW). Their goal is to enlist one million women (men are welcome too) to participate in breast cancer research studies aimed at determining the causes of breast cancer - and how to prevent it. They are doing this by connecting breast cancer researchers via the internet with men and women willing to participate in a variety of research studies which are prevention based, not necessarily clinical trials.

Signing up for the Army of Women doesn't mean you're signing up for a study. You are just signing up to be added to the AOW database. Then you'll be able to hear about studies being conducted in your area in which you can choose to participate. All ethnicities, all ages (18 and older), healthy women, women with cancer, and women who are survivors can participate, depending on the study.

There is NO COST to join and NO DONATIONS are being solicited. All that's needed is your willingness to be informed about studies. Than you decide if you want to participate and which type of study commitment best fits you. Studies require a variety of things, anywhere from answering an online questionnaire to being asked for a blood sample. It's totally your choice and entirely up to you. So far, there haven't been any opportunities in my area that I have qualified for, but I'm continually updated and can choose what works for me.

Need more info? Check out the AOW website here and also look for their monthly webinars presented by the healthcare experts doing research studies on understanding the causes of breast cancer.
Let's increase our odds of winning the breast cancer jeopardy game by joining together to help encourage, support and maybe even participate in research for the cause of breast cancer.  A world without this disease is in our hands. When it comes to breast cancer, prevention really is the breast, I mean best medicine!


Sources
http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factors
Dr. Susan Love Research Foundation
Avon/Army of Women
http://clinicaltrials.gov/ct2/info/understand

Health, weight and the energy/nutrient density of foods

Have you ever thought of food as medicine?  Well, if you have you're in esteemed company, because Hippocrates had the same thought when he said, "Let your food be your medicine and your medicine be your food." In our so-called modern age, how have we managed to stray so far from this ancient wisdom?  It's a well-established fact that what we eat impacts our health. Yet, for many of us who have access to an abundant variety of foods, often times what we select are foods like a fast food burger and soft drink, that have a higher energy density, but are more nutrient poor (USDA).

World Cancer Research Fund

When it comes to making decisions about what to eat, it's helpful to understand the energy and nutrient densities of foods. You're probably familiar with calories. A calorie is a unit of measuring energy. When referring to food the term kilocalorie is used. A kilocalorie (or kcal) "approximates the energy needed to increase the temperature of 1 kilogram of water by 1 °C" (Wikipedia).  This is important to understand because the nutrient and energy density of foods relates to calories. In general:

• Nutrient dense foods provide more nutrients with fewer calories per unit volume than other foods in the same food group (USDA). Another way to look at it is the ratio of nutrients to calories (energy) a food contains.  
• Energy dense foods  provide more energy with more calories for their volume than nutrient dense foods. At first impression, more energy dense foods may sound healthier, but typically the reverse is the case. Energy dense foods often contain "empty calories" that come from fat and refined sugars making them a less healthy choice (Clemson.edu). Foods that are lower in energy density provide fewer calories per gram than foods with a higher energy density (CDC). 

For example, foods such as candies, desserts and processed foods, are high in energy density and calories, but they are not very nutrient dense. Whereas, foods like fruits and vegetables contain fewer calories for their volume, so they are lower in energy density, but are higher in nutrient density. This is important to note, especially when it comes to weight loss, because for the same amount of calories a person can consume a larger portion of a lower energy dense food (like an apple) and feel fuller for longer than they would if they ate a higher energy dense food (like a doughnut) (CDC). Plus, they would be getting much greater nutritional value from the apple than the doughnut. It's a win/win situation.

When grocery shopping the nutrition label found on prepackaged foods can be helpful in determining its energy content per 100 grams. The World Cancer Research Fund has a useful food energy density calculator here, but as a general rule:

• high energy density (fast food, chips, cakes, cookies, butter and margarine) fall in the 225-275 kcal/100g range
• medium energy density (bread, lean meat, poultry, fish) fall in the 100-225 kcal/100g range
• low energy density foods (cooked grains like brown rice, whole meal pasta, beans and lentils) fall in the 60-150 kcal/100g range
• lower energy density foods (most fruits and vegetables) fall in the 10-100 kcal/100g range

How does the composition of food affect energy density? Three factors play an important role in the energy density of food:

• Water - Adds volume/weight to food, but not calories because water contains 0 kcal/gram. Fruits and vegetables contain a lot of water. For example, grapefruit "is about 90 percent water and has just 38 calories in a half-fruit serving. Carrots are about 88 percent water and have only 52 calories in 1 cup" (Mayo Clinic).
• Fiber - Adds volume and 1.5-2.5 kcal/gram to food, but fiber also increases the time it takes to digest foods and this contributes to our feeling fuller for a longer period of time after eating fiber rich foods.
• Fat - On the other side of the energy density spectrum is fat, which contains 9 kcal/gram.  Fat increases the energy (calorie) density of foods. For example, "one teaspoon of butter contains almost the same number of calories as 2 cups of raw broccoli." (CDC).

Keeping these factors in mind, it's not too difficult to spot a high energy density food.  They are usually high in sugar and fat, low in fiber and water and processed.

Weight loss/maintenance and energy density of foods - Research has shown that eating a diet that is "rich in low energy dense foods like fruits, vegetables, whole grains, lean meats and low fat dairy products helps people lower their caloric intake" (CDC).  However, even though calories consumed are usually lower with this type of eating, typically eating a diet that contains low energy foods doesn't mean skimping on nutrients. On the contrary, veggies and fruits are the superstars on our plates and will provide us with a good heaping of the required daily allowance of nutrients (CDC).

Not only can there be a weight loss/maintenance benefit from eating lower energy dense foods, but there is also strong evidence to suggest a reduction in the risk of certain cancers. In 2007, the UK's World Cancer Research Fund (WCRF) published findings from a panel of 21 of the world's top health experts who reviewed the current scientific research. After 6 years of work they produced the Expert Report. It is the most comprehensive statement "on the links between lifestyle and cancer risk. Because of the thoroughness of the Report and the expertise of the panel, people can be confident that it is the best advice on how to reduce cancer risk that is available anywhere in the world." (WCRF). Although it's been suggested for some time, the science is proving that taking steps toward improving nutrition, increasing physical activity and just generally making a healthy lifestyle a priority will actually help reduce risk for a recurrence of cancer, among other things.

In an effort to increase awareness of the health benefits of eating more fruits and vegetables, the CDC has designated September as National Fruits and Veggies More Matters Month. (Their site provides some useful information, along with a fruits and veggie consumption calculator.) So, it seems appropriate that step one of creating a diet that is low in energy density has to do with, you guessed it, fruits and veggies! 

First step to take to create a diet low in energy density:

Incorporate a larger portion of fruits and veggies into meals.  For many people, purchasing fruits and vegetables can be limited by their cost. The CDC has a helpful resource entitled 30 Ways in 30 Days to Stretch Your Fruits and Veggies Budget. You can find it here. Eating more fruits and veggies is the first step in reducing our diet's energy density because they contain more water and fiber and less fat than other foods.

However, not all fruits and veggies are created equal. The CDC suggests incorporating more cruciferous vegetables.  These include "broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, kale, kohlrabi, mustard, rutabaga, turnips, bok choy, and Chinese cabbage. Arugula, horse radish, radish, wasabi, and watercress are also cruciferous vegetables" (Linus Pauling Institute). Then rounding out meals "by adding starchy fruits and vegetables, legumes, lean meats and low-fat dairy food.  These foods are important for creating a healthy, balanced diet" (CDC).

The next post will discuss the other steps as well as a few helpful strategies that will aid in creating a diet that is low in energy density and high in nutrient density.  Even though the term "diet" is used, this way of eating is a lifestyle.  The TLC way to weight loss discusses in more detail here the importance of adopting healthy habits, rather than attempting various diets.  Also, dieting is usually associated with calorie counting and hunger.  This isn't the case with eating more low energy/high nutrient density foods. With all the mounting scientific evidence that underscores the importance of healthy nutrition, it seems more critical than ever to get back to thinking about our food as medicine.



Sources
National Institutes of Health
http://www.jacn.org/cgi/content/abstract/23/2/163http://www.ajcn.org/cgi/reprint/72/4/929.pdf
http://www.wcrf-uk.org/PDFs/EnergyDensity.pdf
http://medical-dictionary.thefreedictionary.com/caloric
http://www.mypyramid.gov/steps/nutrientdensefoods.html
http://www.clemson.edu/extension/hgic/food/nutrition/nutrition/dietary_guide/hgic4062.html
http://lpi.oregonstate.edu/infocenter/foods/cruciferous/

Breast cancer prevention strategies

National Cancer Institute

When you hear health messages about cancer or any disease do you find yourself filtering it out? Well, if you do than this next sentence might cause you to stop reading, but please continue because there's a point I'm hoping to make. 1 out of 7-8 women will get breast cancer in their lifetime (American Cancer Society). Are you still reading? That's good, because the purpose of sharing that statistic was to illustrate that even though we frequently hear these kinds of health messages, we don't always feel connected to them. Perhaps you might be thinking as I did when hearing those numbers, wow, that sounds like a lot, but I'm not going to be the one.  Unfortunately, this kind of thinking often translates into inaction. Statistical health data, although sometimes shocking and troubling, may not be meaningful enough to inspire change for some of us.

If you find that you aren't motivated by statistics, you're not alone. Evidence suggests that health messages which highlight health consequences and the numbers of people who get disease aren't as effective as was once thought. What can be more successful in motivating change in health behaviors are messages that focus on causes and solutions for disease (McKenzie).

Obviously there is no clear solution to breast cancer at this point in time. However, there is a great deal of data available that is linking lifestyle factors with increased risk. This suggests that our best prevention strategy is to take steps to reduce our risk factors as much as possible. So, let's take a closer look at the modifiable risk factors -  in other words, the things we can do to lower the probability of  becoming one of the seven or eight women who will get breast cancer.

Prevention Strategies-

• Avoid weight gain and obesity - According to the National Cancer Institute (NCI), a gain in body mass index (BMI) may substantially increase a women's risk for breast cancer, especially after menopause.The NCI states, " In a recent analysis, women who reported a gain in BMI of five points [equivalent to about 30 pounds] or more between age 20 and postmenopausal age (ages 55-74) had nearly twice the risk of developing postmenopausal breast cancer compared to women who maintained their BMI during the same time period."  (You can read more about BMI in this post and more on this study here).  Interestingly, women who had never used hormone replacement therapy had the strongest association between breast cancer and BMI increases. It's also worth noting that regardless of a woman's starting BMI, if it went up 5 points the risk increased also.  This means that even if a woman's BMI is in the normal range to start with, a 30 pound weight gain during her lifetime doubles the breast cancer risk.
• Avoid hormone replacement therapy (HRT) - The study results of the Women's Health Initiative trial  showed that women taking hormones after menopause had more breast cancer than the women who took a placebo. Not only was increased cancer a risk, according to the Center for Science in the Public Interest, women taking estrogen plus progestin hormones were "29% more likely to have a heart attack, 41% more likely to have a stroke, twice as likely to have a blood clot and 47% more likely to show a marked drop on tests of memory and other mental abililties." Yikes! If avoiding HRT isn't an option, the Mayo Clinic suggests using the lowest dose possible and to shoot for short term use.
• Watch your diet, particularly the fats consumed - This will help with the first prevention strategy mentioned: avoid weight gain and obesity. The Mayo Clinic recommends limiting fat intake to "less than 35 percent of your daily calories" and also restricting "foods high in saturated fat." The findings from the Women's Intervention Nutrition (WIN) Study further suggests a diet consisting of  "lower proportions of saturated fats and higher proportions of polyunsaturated fats." If you want more details on dietary fat you can read more here and more specific details about the omega fats (polyunsaturated fats) here. 
• Get moving - Along with good nutrition, being more physically active will also help control weight gain. In addition, research from a recent study published in the American Journal of Clinical Nutrition on the relationship between BMI, physical activity and a woman's sex hormones showed that "low physical activity is linked with higher amounts of estrogens which is in turn linked with a higher risk of breast cancer."  So, how much physical activity should you aim for? According to the NCI, "existing evidence shows a decreasing risk of breast cancer as the frequency and duration of physical activity increase. Most studies suggest that 30 to 60 minutes per day of moderate- to high-intensity physical activity is associated with a reduction in breast cancer risk." 
• Limit alcohol consumption - Even though red wine has received a lot of good press with regard to heart health lately, it doesn't appear to be beneficial for reducing breast cancer, nor does drinking any alcoholic beverage. On the contrary, according to the Million Women Study which tracked over a million women for 7 years, "each daily alcoholic drink raised the risk of postmenopausal breast cancer by 12%." This is considered a modest, but significant increase in risk, especially when combined with additional risk factors. Another reason to limit alcohol is because calories contained in alcoholic beverages can be a factor in raising the daily amount of calories consumed, and therefore contribute to weight gain. 

If thinking about tackling the prevention strategies discussed above has you feeling overwhelmed, consider beginning with the most important step first - maintain or get to a healthy weight. This isn't just a positive step to take for breast cancer prevention, it's good for your overall health. There are many great resources on the internet to help you take action, just make sure they are credible sources. Also, make sure to talk these strategies over with your health care professional.

Making healthy choices is within reach when we have the information we need and the motivation to put the information into practice. Having knowledge of the known risk factors for breast cancer, as well as a corresponding plan of attack can be more empowering than a vague threat of becoming a negative health statistic. I know now that becoming a breast cancer statistic is a very real possibility. So it's important to take action sooner rather than later. 

Sources
http://www.cancer.org/acs/groups/content/@nho/documents/document/f861009final90809pdf.pdf
McKenzie, J. An Introduction to Community Health, 5th ed.
http://www.cdc.gov/healthyweight/assessing/bmi/
NCI - http://benchmarks.cancer.gov/2010/04/gain-in-body-mass-index-increases-postmenopausal-breast-cancer-risk/
Center for Science in the Public Interest, Nutrition Action Newsletter
http://www.mayoclinic.com/health/breast-cancer-prevention/WO00091
http://www.ajcn.org/cgi/content/full/86/3/878S
http://www.ajcn.org/cgi/content/abstract/86/3/817S
http://www.cancer.gov/cancertopics/factsheet/prevention/physicalactivity
http://www.millionwomenstudy.org/introduction/
http://mason.gmu.edu/~montecin/web-eval-sites.htm