Study Links Eating Whole Grains with Lower Risk of Liver Cancer

A large new study has found that regularly eating whole grains may significantly lower the risk of liver cancer. The study, published online in JAMA Oncology, followed 125,000 men and women for an average of 24 years, gathering information on participants' diet at regular intervals over that time.

The researchers found that those who ate the greatest amount of whole grains had a 37 percent lower risk of a common type of liver cancer (hepatocellular carcinoma) compared to those who ate the least. And benefits accrued with a relatively modest intake of whole grains, only around 33 grams a day. That's just over the amount in two slices of 100 percent whole-wheat bread, which has about 16 grams of whole grains per slice.

Despite being a large, well-designed study, the researchers were appropriately cautious in their conclusions and highlighted their study's limitations. There were relatively few cases of liver cancer among the participants, which makes it harder to rule out chance findings. Hepatitis infection, which is an important risk factor for liver cancer, was not well documented in participants, and so could not be fully taken into account in analyses, possibly impacting the accuracy of results.  And finally, the link between whole grains and liver cancer has only been looked at in a very small number of studies, so there is not yet enough evidence to draw solid conclusions about the links between the two.

Taking all that into account, the paper ends:

If our findings are confirmed, increasing whole grain consumption may serve as a possible strategy for prevention of primary HCC [liver cancer]. 

And if confirmed, these results would also further build on the already great evidence on the overall health benefits of a diet rich in whole grains, which we've written about previously in CNiC. From Be Less Refined: Eat More Whole Grains:

Whole grains are packed with fiber and other key nutrients and have been found to lower the risk of diabetes, heart disease, and certain cancers. They can also help keep weight in check and the digestive system running like clockwork.

For overall health benefits, the goal should be to eat three or more servings of whole-grains a day. One serving of whole grains is: 

• 1 slice of 100 percent whole-wheat bread 
• 1 cup of dry whole-grain cereal 
• 1/2 cup of cooked brown rice, wild rice, or hot whole-grain cereal, like oatmeal 

While whole grains taste great, they can also take a bit of getting used to if you're used to eating mostly refined-grain foods, like white bread and white rice. So, take a little time to transition. Add one slice of 100 percent whole-wheat bread to your sandwich to start. Or mix equal parts, brown rice and white rice, or regular pasta with whole-grain pasta. Then, slowly make whole grains a bigger part of the total grains in your diet. 

The benefits are well worth the effort. 

More Benefits of a Plant-Based Diet: Boost in Mood (and Other Positive Changes) for Those with Type 2 Diabetes

A new analysis out this week found that people with type 2 diabetes who eat a largely plant-based diet can experience a boost in quality of life and well being, in addition to improvements in other diabetes-related factors.

The analysis, which appears in BMJ Open Diabetes Research & Care, reviewed the results of 11 separate dietary intervention studies in adults with diabetes.  Each study included a group that followed a largely plant-based or vegan diet and a control group that followed a standard comparison diet.  The studies included in the analysis lasted for at least 3 weeks.

Compared to the control groups, those in the plant-based diet groups reported a higher quality of life, better self-esteem, and lower rates of depression and perceived pain.  They also largely showed better blood sugar control, improved blood cholesterol, greater weight loss, and a drop in use of diabetes-related medications.

These findings suggest there could be important, wide-ranging benefits if more people switched from the standard American diet to one that limits animal products and focuses on fruits, vegetables, whole grains, beans, and healthy oils (like vegetable and olive oil). Around 30 million Americans - or close to 10 percent of the population - have type 2 diabetes. And this number rises to 100 million if those on the cusp of developing diabetes (pre-diabetes) are included.

Plus, the benefits of plant-based diets reach well beyond those with diabetes. In more general studies, vegetarian or mostly vegetarian diets have been shown to curb weight gain and help with weight loss as well as lower the risk of developing heart disease, high blood pressure, unhealthy blood cholesterol, type 2 diabetes, and some cancers. And they are increasingly being recommended as a key aspect of efforts to improve environmental sustainability, as meat products require greater resources to bring to market than plant products.

While the switch to a plant-based diet can take some effort initially, it doesn't have to happen all at once, and it certainly doesn't need to be all-or-nothing. Try a new whole grain.  Go meatless for one day of the week.  Or make a recipe with beans that you'd normally make with ground beef.  There's no rush.  See what works for you and build on that.

Such moves toward more plant-based eating can have important benefits over time - for you, the nation, and the planet.

Why not give it a try?

New Diet Study Finds "Ultra-Processed" Foods May Be Linked to Cancer Risk

by Hank Dart

A new study out of France highlights another possible reason to avoid eating too many highly processed foods:  They may increase the risk of cancer.

The paper, published yesterday in the British Medical Journal, followed close to 105,000 adults for an average of 5 years.  Along the way, participants were asked to regularly report their dietary intake and any health events, such as a diagnosis of cancer.

Foods were then categorized into groups, with an "ultra-processed" group including foods like: soda (diet or sugary); mass-produced sweets; meats with preservatives other than salt; instant noodles and soups; and foods with industrial food additives and agents.

The proportion of participants' diets that was made up of ultra-processed foods was determined by the weight of food, rather than by calories.  This was done to take into account the potential impact of processed foods that have few, if any, calories, like diet sodas.

The researchers found that for every 10 percent increase in the proportion of ultra-processed foods in the diet, the overall risk of cancer increased by 12 percent and the risk of post-menopausal breast cancer increased by 13 percent.  

Risks were more pronounced when comparing high intake of processed foods with low intake. Participants who ate the most ultra-processed foods had a 21 percent higher risk of cancer overall and a 39 percent higher risk of post-menopausal breast cancer.  They also may have had a higher risk of colorectal cancer, but those results were less reliable.

In the analyses, researchers took into account many factors that could have swayed the results because they could be related to both processed food intake and cancer.  These included factors such as physical activity level, body mass index, alcohol intake, tobacco use, and overall diet quality.

In an accompanying editorial, Adriana Monge of the National Institute of Public Health in Mexico City and Martin Lajous of the T.H. Chan School of Public Health at Harvard University praised the researchers for their detailed study but recommended caution in interpreting such initial results.

"...as with any observational study, confounding by unknown factors common to consumption of ultra-processed foods and cancer outcomes cannot be excluded." 

"Their interesting results require replication and further refinement."

"We are a long way from understanding the full implications of food processing for health and wellbeing."

While more study is needed on the possible links between ultra-processed foods and cancer, well-established dietary recommendations call for limiting certain types of processed foods, which can be high in calories, sodium, refined grains, added sugar, and unhealthy fats -- and low in healthy nutrients.

A largely plant-based diet that is low in unhealthy processed foods and filled with fruits, vegetables, beans, and whole grains is best for overall health and can lower the risk of many important chronic diseases, including cancer.

Be Less Refined: Eat More Whole Grains

Editor's note: This post originally appeared as a Health Beyond Barriers podcast on Minds Eye Radio. It was produced in English, Spanish, Bosnian, Vietnamese, and Arabic through a collaboration with LAMP, Language Access Metro Project.

By Hank Dart

Whole grains. For something so often recommended as part of a healthy diet, they can seem pretty elusive.

We sort of know what they are - but not really.

We know we should be eating more of them - but don't really know how best to do that.

Well, the good news is that whole grains are pretty easy to get a grasp on with just a handful of helpful tips.

But, first, let's try to answer the question:

Why should we even care about whole grains?

As with most diet recommendations, the quick answer to this question is: for your health.

Whole grains are packed with fiber and other key nutrients and have been found to lower the risk of diabetes, heart disease, and certain cancers. They can also help keep weight in check and the digestive system running like clockwork.

On top of this, research has found that whole grains can lower the risk of dying prematurely. Results from a study that followed over 74,000 women and 43,000 men for around 25 years showed that those who ate the most whole grains over that time had a nearly 10 percent lower risk of dying from any cause than those who ate the least.

So, whole grains aren't just an out-of-the-blue recommendation put together by disgruntled dieticians. They can have a real impact on many of the most important - and preventable - diseases.

With that in mind, let's move on to the next big question:

What are whole grains?

Most of us know what grains are. They are things like wheat, oats, rice, bulgur, and millet. This is an incomplete list, but you get the idea.

In their natural state, grain kernels have three key parts - bran, germ, and endosperm. When a grain contains all three of these it is considered a whole grain.

This is different from "refined" or "enriched" grains - like white rice and white flour - that have the bran and germ removed during processing. Bran and germ are rich in many healthy compounds, like fiber, vitamins, minerals, and phytoestrogens.

So, now that what we know what they are, we need to ask:

What amount of whole grains should we eat?

The latest Dietary Guidelines for Americans recommends that at least half of the grains we eat each day should be whole grains. While that's a little ambiguous - for most adults, it translates to about 3 - 4 ounces of whole grains every day. That's the equivalent of around 3 - 4 slices of whole grain bread, or 1½ to 2 cups of cooked brown rice. Every day.

It's not a huge amount, but it's enough that it's important to make sure you have enough healthy whole grain foods on hand. Which begs the question:

What's the best ways to find healthy whole grain foods at the store?

Luckily, we're all probably familiar with a number of healthy whole grains, like - 100% whole wheat bread, brown rice, bulgur, rolled oats, and even whole-grain pasta. So to buy more whole grains, all we need to do is take the extra step of actually putting them in our shopping carts more often.

After these easy-to-find foods, it can get a little trickier to identify healthy whole grain foods, but it's not really that hard.

First, and most important: Let the label be your guide.

Choose foods that have as the first ingredient on the food label a grain that starts with words like "whole grain" or "whole." The first ingredient in the list is the most common ingredient in the food. So, if the label on your breakfast cereal starts with "whole grain oats," then whole grain oats are the main ingredient.

This isn't a perfect system because some foods can have whole grains as a first ingredient but also have a lot of added sugar. Sugary breakfast cereals can be a good example of this. So it's best to choose whole grain foods that also have little or no added sugar.

It's also important not to let the color of a food be your only guide. Some dark breads, for example, may seem to have a lot of whole grains in them, but in fact, may have little in any - getting their color from things like molasses.

Now that we know how to find healthy whole grains, let's ask one final question:

What's the best way to fit more whole grains into our diet?

The one word answer: slowly.

If you've been eating a lot of refined grain foods, moving to whole grains can take some getting used to. Whole grains have an appealing and complex taste, but they do taste different than refined grains. So making the transition slowly gives you time to adjust and build up habits for long term success.

Start by mixing half-and-half white rice and brown rice. Do the same with white pasta and whole-grain pasta - and other grain foods you regularly eat.

Then slowly increase the amount of the whole grain foods. Over time, you may not even miss the refined grain options.

Making healthy whole grain choices doesn't mean giving up completely on the refined grain foods we like. With a little effort, though, we can add more whole grains into our day and give our diets, and our health, a real boost.

And don't we all deserve that?


Additional resources

The Nutrition Source - Harvard School of Public Health
http://www.hsph.harvard.edu/nutritionsource/whole-grains/

Choose My Plate - USDA
http://www.choosemyplate.gov/grains-tips

Dietary Guidelines for Americans 2015 - 2020
http://health.gov/dietaryguidelines/2015/guidelines/

Your Disease Risk - Siteman Cancer Center
http://www.yourdiseaserisk.wustl.edu


References

1. Dukas L, Willett WC, Giovannucci EL. Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. Am J Gastroenterol 2003;98:1790-6.

2. Ye EQ, Chacko SA, Chou EL, Kugizaki M, Liu S. Greater whole-grain intake is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. J Nutr 2012;142:1304-13.

3. Aune D, Chan DS, Lau R, et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ 2011;343:d6617.

4. Huang T, Xu M, Lee A, Cho S, Qi L. Consumption of whole grains and cereal fiber and total and cause-specific mortality: prospective analysis of 367,442 individuals. BMC Med 2015;13:59.

5. Wu H, Flint AJ, Qi Q, et al. Association between dietary whole grain intake and risk of mortality: two large prospective studies in US men and women. JAMA internal medicine 2015;175:373-84.

6. US Departments of Agriculture and Health and Human Services. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Washington, DC: US Departments of Agriculture and Health and Human Services; 2015.

Photo: Wheat field by François Philipp (CC License, CC BY 2.0)