Does Fiber Reduce Breast Cancer Risk?

Start Young And Finish Strong

Vegan FoodsThe idea that dietary fiber reduces the risk of breast cancer has been around for a long time. But it is controversial. It has been difficult to prove.

Part of the difficulty arises from what scientists call confounding variables. What do I mean by confounding variables? Let me explain.

A high fiber diet is usually a primarily plant-based diet. Plant foods contain much more than just fiber. They are full of antioxidants and phytonutrients. A primarily plant-based diet is, by definition, low in refined grains. It is usually low in sugar and saturated fat as well.

People who eat primarily plant-based diets are often health conscious. They tend to exercise more, weigh less, and smoke less than the general public.

Each of these things are confounding variables. They could reduce the risk of breast cancer on their own. That confounds (makes it more difficult to interpret) the data. Was the reduction in breast cancer risk due to the high fiber diet or to these factors that go along with a high fiber diet?

It is possible to correct for these confounding variables statistically, but that requires a very large study (a large population group) for the correction to be accurate. Large studies are expensive. Thus, you tend to end up with lots of small studies. And once they have been corrected for confounding variables, small studies give conflicting results. Some show a benefit of fiber. Some do not.

That is why this study (MS Farvid et al, Cancer, DOI: 10.1002/cncr.32816) is important. It is a meta-analysis of 20 clinical studies with almost 2 million women.

How Was The Study Done?

Clinical StudyThe meta-analysis combined data from 20 clinical studies with 1,994,910 women. Fiber intake was calculated from a food frequency questionnaire administered at the beginning of the study for all except one study that used 24-hour dietary records administered at the beginning of the study.

  • Study duration ranged from 2 to 20 years. Nine of the studies (1.37 million women) lasted for 10 years or more.
  • Four studies reported results for premenopausal breast cancer, fifteen studies reported results for postmenopausal breast cancer, and one study reported results for both.

Does Fiber Reduce Breast Cancer Risk?

breast cancerAfter correcting for confounding variables, the results of the study were as follows:

  • When comparing the highest intake with the lowest intake, total fiber consumption was associated with an 8% lower risk of breast cancer.
  • The effect was stronger for premenopausal breast cancer (18%) than for postmenopausal breast cancer (9%).
  • The effect was greater with soluble fiber (10% decreased risk) than for insoluble fiber (7% decreased risk).
    • Note: All plant foods contain a mixture of soluble fiber and insoluble fiber. However, the common foods richest in soluble fiber are fruits, oatmeal, nuts, beans, peas, and lentils.

The authors concluded, “A random-effects meta-analysis of prospective observational studies demonstrated that high total fiber consumption was associated with a reduced risk of breast cancer. This finding was consistent for soluble fiber as well as for women with premenopausal and postmenopausal cancer.”

Start Young And Finish Strong

Mother & Daughter Eating ApplesAn 8% risk reduction doesn’t seem like very much, but the 18% risk reduction in premenopausal breast cancer caught my eye. With a little digging I found a study (MS Farvid et al, Pediatrics 137, March 2016: e20151226) that focused on the effect of fiber intake in young women on their subsequent risk developing both premenopausal and postmenopausal breast cancer. This was, in fact, one of the studies included in the meta-analysis I described above.

This study followed 90,534 women (mean age 36 years) for 20 years. The women competed a food frequency questionnaire at enrollment and every four years thereafter. They also completed a questionnaire about their diet during their teenage years.

When comparing the highest versus the lowest fiber intake:

  • High fiber intake reduced total breast cancer risk by 19%.
    • Postmenopausal breast cancer risk was reduced by 13%.
    • Premenopausal breast cancer risk was reduced by 23%.

Interestingly, only 34% of women who consumed high fiber diets during their teenage years continued to consume high fiber diets as young adults. However, high fiber diets in the teenage years were important. When they looked at teenage diets:

  • High fiber intake reduced total breast cancer risk by 16%.
    • Postmenopausal breast cancer risk was reduced by 15%.
    • Premenopausal breast cancer risk was reduced by 25%.

Other important observations from this study were:

  • There was a 13% decrease in breast cancer risk for every 10 gram increase in fiber intake.
    • 10 grams of fiber is equivalent to one apple plus two slices of 100% whole wheat toast or half a cup of cooked kidney beans plus half a cup of cooked cauliflower or squash.
  • Both soluble fiber (14% decreased risk) and insoluble fiber (20% decreased risk) were effective.
    • In terms of foods, the most significant effects were seen with fruits and vegetables.

The authors concluded, “Our findings support the hypothesis that higher fiber intakes reduce breast cancer risk and suggest that intake during adolescence and early adulthood may be particularly important.”

What Does This Mean For You?

Questioning WomanAs I said before, an 8% decrease in breast cancer risk may not sound like much. You might be tempted to say, “Why bother? Why should I give up my favorite processed and convenience foods and switch to a more whole food, plant-based diet?”

Here are some thoughts to consider:

1) As I mentioned above, there are side benefits to a plant-based diet.

    • Plant based diets have a lower caloric density, so you are less likely to be overweight.
    • Your intake of antioxidants and phytonutrients is increased.
    • Plant foods feed beneficial gut bacteria.
    • Your diet is likely to be lower in sugar, highly processed foods, and saturated fat.

All these factors decrease your risk of developing breast cancer, but they were statistically factored out in calculating the 8% reduction in risk. In other words, the 8% reduction in risk was based on fiber intake only. When you consider all the beneficial effects that accompany a high fiber diet, your actual reduction in risk is likely to be substantially more than 8%.

2) When you consume a high fiber diet, your risk of developing premenopausal breast cancer is decreased by 18%. That is twice the risk reduction seen for postmenopausal breast cancer. This is consistent with several other studies showing the premenopausal breast cancer is more influenced by diet than postmenopausal breast cancer. There are a couple of likely explanations for this.

    • By the time they reach menopause women are more likely to be overweight and some of those fat calls accumulate in breast tissue. Those fat cells continue to produce estrogen after menopause. Even worse, that estrogen is produced right next to the breast cells, where it can do the maximum damage.
    • Mutations accumulate in breast tissue as we age, and some of those mutations increase the risk of breast cancer.

3) When you start consuming a healthy, high fiber diet early in life your risk reduction is much greater (a 13-15% decreased risk of developing postmenopausal breast cancer and a 23-25% decreased risk of developing premenopausal breast cancer). Now, we are talking about numbers that should get your attention!

Plus, these numbers are based on fiber intake only. Once again, when you consider all the other benefits of a high fiber diet, your real risk reduction is likely to be much greater.

In closing I should mention that none of the studies were done with fiber supplements. A fiber supplement may help you be more regular, but there is no evidence that a fiber supplement will reduce your risk of breast cancer.

The Bottom Line

Two recent studies have looked at the effect of fiber intake on the risk of developing breast cancer.

The first study showed that:

  • High fiber diets decreased the overall risk of breast cancer by 8% and the risk of premenopausal breast cancer by 18%.
  • As I describe in the article above, these reductions in risk were based on fiber intake only. If you consider all the side benefits of a high fiber diet, the actual risk reduction is likely to be much greater.

The second study looked at fiber intake during adolescence and early adulthood. It found that when high fiber diets were started early in life:

  • High fiber diets decreased the overall risk of breast cancer by 13-15% and the risk of premenopausal breast cancer by 23-25%.
  • Once again, if you consider all the side benefits of a high fiber diet, the actual risk reduction is likely to be much greater.

The authors of both studies concluded that high fiber diets reduce the risk of developing breast cancer. The risk reduction is greater for premenopausal breast cancer than for postmenopausal breast cancer. Finally, the risk reduction is greatest when high fiber diets are started early in life.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Organic Foods Decrease Cancer Risk?

Is Eating Organic Worth The Cost?

Author: Dr. Stephen Chaney

 

organic foods decrease cancer riskMillions of Americans choose organic foods whenever possible. However, organic foods are expensive, and some experts claim they are a waste of money. That is why recent headlines claiming that eating organic foods decrease cancer risk have created such a stir. I will look at the study behind the headlines below, but first let me summarize what we do know about organic foods.

I discussed a study comparing organic and conventionally-grown produce in a recent issue, Organic Foods Healthier, of “Health Tips From the Professor”. It was a major study that combined the results from 343 of the best-designed previous studies. The study found that pesticide and herbicide residues were 4-fold lower in organically-raised produce than in conventionally-raised produce. It also found that the polyphenol content of organically-raised produce was slightly higher than in conventionally-raised produce.

Neither of these findings automatically mean that eating organic produce will improve your health. However, there is increasing evidence that pesticide exposure is linked to increased risk of cancer. Thus, it seems logical that eating organic might decrease cancer risk. It is that hypothesis that the current study (J Baudry et al, JAMA Internal Medicine, doi: 10.1001/jamainternmed.2018.4357 ) was designed to test.

 

How Was The Study Designed?

stethoscopeThis study is part of a major French study called NutriNet-Santé that was launched in 2009. The NutriNet-Santé study is web-based study designed to investigate associations between nutrition and health.Volunteers with access to the internet were recruited from the general population. After agreeing to participate in the study, the volunteers were asked to complete a battery of online assessment forms.

The baseline data for the NutriNet-Santé study included age, sex, occupational status, education level, marital status, income, number of children, smoking status, physical activity, and diet. Dietary intake was assessed using three 24-hour dietary recalls collected over a 2-week period. Two of the 24-hour dietary recalls were on weekdays and one was on a weekend.

The dietary recalls were used to create a “score” of diet quality. Without going into detail, diets that favored animal protein, animal fats, sweets, and highly processed foods were considered “poor quality diets.” Diets that favored plant proteins, vegetable oils & and omega-3 fats, fruits, vegetables, and whole grains were considered “good quality diets.”

This portion of the NutriNet-Santé was designed to measure the correlation between organic food consumption and cancer risk. Two months after enrollment in the study, the participants were asked to provide information on the frequency with which they chose the organic version of 16 different types of food. From this information each participant was assigned an “organic food score” ranging from 0 to 32 points.

The participants in this study were also asked to complete a yearly health status questionnaire online. If they reported a cancer diagnosis, they were asked to provide their medical records, and the study physicians contacted the patient’s physician to confirm details of the diagnosis.

A total of 68,946 French adults completed the study (78% female, mean age 44.2 years). They were followed for an average of 4.56 years. During this time period there were 1340 new cancer diagnoses in this population.

 

Do Organic Foods Decrease Cancer Risk?

 

organic foods decrease cancer risk chartThe participants were divided into four groups based on their organic food score. When participants with the highest organic food score were compared to those with the lowest organic food score there was a:

  • 25% reduction in total cancer risk.
  • 86% reduction in non-Hodgkin lymphoma risk. This is not a novel finding. A previous study has also suggested eating organic might reduce the risk of non-Hodgkin lymphoma.
  • 76% reduction in all lymphoma risk.
  • 34% reduction in postmenopausal breast cancer risk.

The authors concluded “A higher frequency of organic food consumption was associated with a reduced risk of cancer. Although the study findings need to be confirmed, promoting organic food consumption in the general population could be a promising preventive strategy against cancer.”

These are the results and conclusions that made the headlines. However, the scientists who designed the study were aware of previous data showing that people who eat organic are also more likely to eat a healthy diet and follow a healthy lifestyle. Thus, their statistical analysis of the data considered all factors that might influence cancer risk. This analysis provided a much more nuanced interpretation of the data. They found that the association between increased organic food consumption and decreased cancer risk:

  • Was significant for women, older adults, individuals with a family history of cancer, individuals who had a poor diet, and former smokers.
  • Was seen for people of all weights but was greatest for individuals who were obese.
  • Was non-significant for men, younger adults, individuals with no family history of cancer, individuals who had a good diet, never-smokers, and current smokers.
  • Was non-significant for other types of cancer.

You are probably wondering “Does this mean organic foods are beneficial for some people, but not for others?” A superficial interpretation of these data might lead to that conclusion, but let’s dig a little deeper.

 

What Does This Study Mean For You?

organic foods decrease cancer risk women ponderingIn interpreting a study of this type, it is important to ask whether enough people will develop cancer during the study for the results to be statistically significant. That depends on 3 factors:

  • The number of people enrolled in the study.
  • The duration of the study.
  • The probability that participants will develop cancer during the duration of the study.

When you look at the whole study population, all three criteria have been met. There were 68,949 participants who were followed for 4.56 years. During that time 1340 of them developed cancer, of which 459 were breast cancer, 47 were non-Hodgkin lymphomas, and 15 were other lymphomas. A higher frequency of organic food consumption was associated with a decreased in the risk of all these cancers, and that decreased risk was statistically significant. This is the main take-home lesson of the study.

However, when you start to break the study down into subgroups, the number of people in each subgroup and the duration of the study become limiting factors. For example:

  • We don’t really know whether eating organic foods are unimportant for men or whether there were too few men in the study for any benefit to be statistically significant.
  • Colon cancer and many other cancers develop gradually over a 10 to 20-year period. We don’t know whether choosing organic foods is unimportant for these cancers or whether 4.56 years is too short a time to show a significant benefit.
  • The same is true for several of the other variables in this study. For example, if you are an older adult, have a family history of cancer, have a bad diet, and/or have smoked in the recent past, your probability of developing cancer over a 4.56-year time period is relatively high. On the other hand, if you are younger, have no family history of cancer, have a good diet, and have never smoked, your probability of developing cancer during that same time period is very low.

So, how do we interpret the data with these subgroups? We could conclude that eating organic foods in unimportant for people who are young, have no family history of cancer, have a good diet, and have never smoked. A more likely interpretation, however, is that people in these groups have such a low risk of cancer that 4.56 years is too short to demonstrate a benefit of organic foods. It might require a 10, 20, or 30-year study to show benefit of organic foods for these people.

Let me close with three important observations:

  • People often say too me: “I can’t afford organic fruits and vegetables, but I am concerned about pesticide exposure. Does that mean I should avoid fruits and vegetables?” The data from this study provide a clear answer. Eating lots of fruits and vegetables is beneficial even if you can’t afford organic.

[I also let them know about “The Dirty Dozen” ( Rank Produce Items By Pesticide Level ). This is a list of the fruits and vegetables most likely to be contaminated with pesticides. If your budget for organic foods is limited, these are the most important fruits and vegetables to spend it on.]

  • I find it ironic that people who consume a poor diet are the ones most likely to experience an immediate benefit from choosing organic foods. This is, of course, the group that is least likely to eat organic.
  • If you smoke, eating organic probably isn’t going to help you much. Your best bet is to stop smoking.

 

The Bottom Line

 

A recent study looked at the association between organic food consumption and cancer risk. When participants who consumed organic foods frequently were compared to those who almost never consumed organic foods there was a:

  • 25% reduction in total cancer risk.
  • 86% reduction in non-Hodgkin lymphoma risk. This is not novel. A previous study has also suggested eating organic might reduce the risk of non-Hodgkin lymphoma.
  • 76% reduction in all lymphoma risk.
  • 34% reduction in postmenopausal breast cancer risk.

The authors concluded “A higher frequency of organic food consumption was associated with a reduced risk of cancer. Although the study findings need to be confirmed, promoting organic food consumption in the general population could be a promising preventive strategy against cancer.”

These are the results and conclusions that you have seen in the headlines. However, the scientists who designed the study were aware of previous data showing that people who eat organic are also more likely to eat a healthy diet and follow a healthy lifestyle. Thus, their statistical analysis of the data considered all factors that might influence cancer risk. This analysis provided a much more nuanced interpretation of the data, which I have discussed in the article above.

For more details read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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