New WHO study links moderate alcohol use with higher cancer risk

 

One in four new breast cancers and one in five colon cancers in Canada attributed to alcohol

CENTRE FOR ADDICTION AND MENTAL HEALTH

Alcohol drinking caused nearly 7,000 cases of cancer in Canada in 2020. Breast cancer made up almost 1 in 4 of the new cases attributable to alcohol.

CREDIT

World Health Organization's (WHO) International Agency for Research on Cancer (IARC)

A new study from the World Health Organization's (WHO) International Agency for Research on Cancer (IARC), published in the journal Lancet Oncology, has found an association between alcohol and a substantially higher risk of several forms of cancer, including breast, colon, and oral cancers. Increased risk was evident even among light to moderate drinkers (up to two drinks a day), who represented 1 in 7 of all new cancers in 2020 and more than 100,000 cases worldwide.

In Canada, alcohol use was linked to 7,000 new cases of cancer in 2020, including 24 per cent of breast cancer cases, 20 per cent of colon cancers, 15 per cent of rectal cancers, and 13 per cent of oral and liver cancers.

"All drinking involves risk," said study co-author Dr. Jürgen Rehm, Senior Scientist, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute at CAMH. "And with alcohol-related cancers, all levels of consumption are associated with some risk. For example, each standard sized glass of wine per day is associated with a 6 per cent higher risk for developing female breast cancer."

"Alcohol consumption causes a substantial burden of cancer globally," said Dr. Isabelle Soerjomataram, Deputy Branch Head, Cancer Surveillance Branch at IARC. "Yet the impact on cancers is often unknown or overlooked, highlighting the need for implementation of effective policy and interventions to increase public awareness of the link between alcohol use and cancer risk, and decrease overall alcohol consumption to prevent the burden of alcohol-attributable cancers."

Dr. Leslie Buckley, CAMH Chief of Addictions, added: "In our clinic we are seeing many people who report increased alcohol use since the onset of the pandemic. Although this may be related to temporary stressors, there is a potential for new habits to become more permanent. The consequences with alcohol use are often subtle harms initially that take time to show themselves, while long-term consequences such as cancer, liver disease and substance use disorder can be devastating."

The modelling study was based on data on alcohol exposure from almost all countries of the world, both surveys and sales figures, which were combined with the latest relative risk estimates for cancer based on level of consumption.

"Alcohol causes cancer in numerous ways," explained Dr. Kevin Shield, Independent Scientist, Institute for Mental Health Policy Research, and study co-author. "The main mechanism of how alcohol causes cancer is through impairing DNA repair. Additional pathways include chronic alcohol consumption resulting in liver cirrhosis, and alcohol leading to a dysregulation of sex hormones, leading to breast cancer. Alcohol also increases the risk of head and neck cancer for smokers as it increases the absorption of carcinogens from tobacco."

Dr. Rehm says research into the link between light to moderate drinking and cancer is relatively new and that public policy does not yet reflect the degree of cancer risk. He added, "As an epidemiologist, I would recommend higher taxes to fully reflect the burden of disease from alcohol. Along with limiting the physical availability and marketing of alcohol, price controls are recognized as high-impact, cost-effective measures to reduce alcohol-related harm." Governments can also consider requiring manufacturers to include information about health and safety risks associated with alcohol consumption, including cancer risk, on alcoholic beverage labels.

These suggestions and many others can be found in CAMH's Alcohol Policy Framework. Updated in September 2019, the document proposes evidence-informed measures to effectively address the health and social harms associated with alcohol.

Eating whole grains linked to smaller increases in waist size, blood pressure, blood sugar

Study in middle- to older-aged adults suggests whole grains may protect against heart disease

Research News

Middle- to older-aged adults who ate at least three servings of whole grains daily had smaller increases in waist size, blood pressure, and blood sugar levels over time compared to those who ate less than one-half serving per day, according to new research.

Published July 13, 2021, in the Journal of Nutrition, the study by researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University examined how whole- and refined-grain intake over time impacted five risk factors of heart disease: Waist size, blood pressure, blood sugar, triglyceride, and HDL ("good") cholesterol.

Using data from the Framingham Heart Study Offspring Cohort, which began in the 1970s to assess long-term risk factors of heart disease, the new research examined health outcomes associated with whole- and refined-grain consumption over a median of 18 years. The 3,100 participants from the cohort were mostly white and, on average, in their mid-50s at the start of data collection.

The research team compared changes in the five risk factors, over four-year intervals, across four categories of reported whole grain intake, ranging from less than a half serving per day to three or more servings per day. According to the Dietary Guidelines for Americans 2020-2025, the recommended amount of whole grains is three or more servings daily. An example of a serving is one slice of whole-grain bread, a half cup of rolled oats cereal, or a half cup of brown rice.

The results showed that for each four-year interval:

Waist size increased by an average of over 1 inch in the low intake participants, versus about ½ inch in the high intake participants.

Even after accounting for changes in waist size, average increases in blood sugar levels and systolic blood pressure were greater in low intake participants compared to high intake participants.

The researchers also studied the five risk factors across four categories of refined-grain intake, ranging from less than two servings per day to more than four servings per day. Lower refined-grain intake led to a lower average increase in waist size and a greater mean decline in triglyceride levels for each four-year period.

"Our findings suggest that eating whole-grain foods as part of a healthy diet delivers health benefits beyond just helping us lose or maintain weight as we age. In fact, these data suggest that people who eat more whole grains are better able to maintain their blood sugar and blood pressure over time. Managing these risk factors as we age may help to protect against heart disease," said Nicola McKeown, senior and corresponding author and a scientist on the Nutritional Epidemiology Team at the USDA HNRCA.

"There are several reasons that whole grains may work to help people maintain waist size and reduce increases in the other risk factors. The presence of dietary fiber in whole grains can have a satiating effect, and the magnesium, potassium, and antioxidants may contribute to lowering blood pressure. Soluble fiber in particular may have a beneficial effect on post-meal blood sugar spikes," said Caleigh Sawicki. Sawicki did this work as part of her doctoral dissertation while a student at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University and while working with the Nutritional Epidemiology Team at the USDA HNRCA.

The greatest contributor to whole-grain intake among participants was whole-wheat breads and ready-to-eat whole-grain breakfast cereals. The refined grains came mostly from pasta and white bread. The difference in health benefits between whole and refined grains may stem from the fact that whole grains are less processed than refined grains. Whole grains have a fiber-rich outer layer and an inner germ layer packed with B vitamins, antioxidants, and small amounts of healthy fats. Milling whole grains removes these nutrient-dense components, leaving only the starch-packed refined grain behind.

"The average American consumes about five servings of refined grains daily, much more than is recommended, so it's important to think about ways to replace refined grains with whole grains throughout your day. For example, you might consider a bowl of whole-grain cereal instead of a white flour bagel for breakfast and replacing refined-grain snacks, entrees, and side dishes with whole-grain options. Small incremental changes in your diet to increase whole-grain intake will make a difference over time," McKeown said.

Methodology

To measure daily grain intake, the researchers used diet questionnaires that participants completed every four years from 1991 to 2014, resulting in a median of 18 years of data.

Dietary assessment data came from five study examinations, and observations were only included if participants attended at least two consecutive examinations with accurate dietary data. Participants with diabetes at baseline were excluded.

The statistical analysis was adjusted for factors that might influence the results, including other aspects of a healthy diet. Limitations of the study include the fact that food consumption is self-reported, and participants may over- or under-estimate intake of certain foods based on perceived social desirability. Due to its observational design, the study does not reflect a causal relationship.

A fermented-food diet increases microbiome diversity and lowers inflammation

A diet rich in fermented foods enhances the diversity of gut microbes and decreases molecular signs of inflammation, according to researchers at the Stanford School of Medicine.

In a clinical trial, 36 healthy adults were randomly assigned to a 10-week diet that included either fermented or high-fiber foods. The two diets resulted in different effects on the gut microbiome and the immune system.

Eating foods such as yogurt, kefir, fermented cottage cheese, kimchi and other fermented vegetables, vegetable brine drinks, and kombucha tea led to an increase in overall microbial diversity, with stronger effects from larger servings. "This is a stunning finding," said Justin Sonnenburg, PhD, an associate professor of microbiology and immunology. "It provides one of the first examples of how a simple change in diet can reproducibly remodel the microbiota across a cohort of healthy adults."

In addition, four types of immune cells showed less activation in the fermented-food group. The levels of 19 inflammatory proteins measured in blood samples also decreased. One of these proteins, interleukin 6, has been linked to conditions such as rheumatoid arthritis, Type 2 diabetes and chronic stress.

"Microbiota-targeted diets can change immune status, providing a promising avenue for decreasing inflammation in healthy adults," said Christopher Gardner, PhD, the Rehnborg Farquhar Professor and director of nutrition studies at the Stanford Prevention Research Center. "This finding was consistent across all participants in the study who were assigned to the higher fermented food group."

Microbe diversity stable in fiber-rich diet

By contrast, none of these 19 inflammatory proteins decreased in participants assigned to a high-fiber diet rich in legumes, seeds, whole grains, nuts, vegetables and fruits. On average, the diversity of their gut microbes also remained stable. "We expected high fiber to have a more universally beneficial effect and increase microbiota diversity," said Erica Sonnenburg, PhD, a senior research scientist in basic life sciences, microbiology and immunology. "The data suggest that increased fiber intake alone over a short time period is insufficient to increase microbiota diversity."

The study will be published online July 12 in Cell. Justin and Erica Sonnenburg and Christopher Gardner are co-senior authors. The lead authors are Hannah Wastyk, a PhD student in bioengineering, and former postdoctoral scholar Gabriela Fragiadakis, PhD, who is now an assistant professor of medicine at UC-San Francisco.

A wide body of evidence has demonstrated that diet shapes the gut microbiome, which can affect the immune system and overall health. According to Gardner, low microbiome diversity has been linked to obesity and diabetes.

"We wanted to conduct a proof-of-concept study that could test whether microbiota-targeted food could be an avenue for combatting the overwhelming rise in chronic inflammatory diseases," Gardner said.

The researchers focused on fiber and fermented foods due to previous reports of their potential health benefits. While high-fiber diets have been associated with lower rates of mortality, the consumption of fermented foods can help with weight maintenance and may decrease the risk of diabetes, cancer and cardiovascular disease.

The researchers analyzed blood and stool samples collected during a three-week pre-trial period, the 10 weeks of the diet, and a four-week period after the diet when the participants ate as they chose.

The findings paint a nuanced picture of the influence of diet on gut microbes and immune status. On one hand, those who increased their consumption of fermented foods showed similar effects on their microbiome diversity and inflammatory markers, consistent with prior research showing that short-term changes in diet can rapidly alter the gut microbiome. On the other hand, the limited change in the microbiome within the high-fiber group dovetails with the researchers' previous reports of a general resilience of the human microbiome over short time periods.

Designing a suite of dietary and microbial strategies

The results also showed that greater fiber intake led to more carbohydrates in stool samples, pointing to incomplete fiber degradation by gut microbes. These findings are consistent with other research suggesting that the microbiome of people living in the industrialized world is depleted of fiber-degrading microbes.

"It is possible that a longer intervention would have allowed for the microbiota to adequately adapt to the increase in fiber consumption," Erica Sonnenburg said. "Alternatively, the deliberate introduction of fiber-consuming microbes may be required to increase the microbiota's capacity to break down the carbohydrates."

In addition to exploring these possibilities, the researchers plan to conduct studies in mice to investigate the molecular mechanisms by which diets alter the microbiome and reduce inflammatory proteins. They also aim to test whether high-fiber and fermented foods synergize to influence the microbiome and immune system of humans. Another goal is to examine whether the consumption of fermented food decreases inflammation or improves other health markers in patients with immunological and metabolic diseases, and in pregnant women and older individuals.

"There are many more ways to target the microbiome with food and supplements, and we hope to continue to investigate how different diets, probiotics and prebiotics impact the microbiome and health in different groups," Justin Sonnenburg said.

Want to avoid running overuse injuries? Don't lean forward so much

The ubiquitous overuse injuries that nag runners may stem from an unlikely culprit: how far you lean forward.

Trunk flexion, the angle at which a runner bends forward from the hip, can range wildly--runners have self-reported angles of approximately -2 degrees to upward of 25. A new study from the University of Colorado Denver (CU Denver) found that greater trunk flexion has significant impact on stride length, joint movements, and ground reaction forces. How you lean may be one of the contributors to your knee pain, medial tibial stress syndrome, or back pain.

"This was a pet peeve turned into a study," said Anna Warrener, PhD, lead author and assistant professor of anthropology at CU Denver. Warrener worked on the initial research during her postdoc fellowship with Daniel Liberman, PhD, in the Department of Human Evolutionary Biology at Harvard University. "When [Lieberman] was out preparing for his marathons, he noticed other people leaning too far forward as they ran, which had so many implications for their lower limbs. Our study was built to find out what they were."

The study was published in Human Movement Science.

A New Angle on Overuse Injuries

The head, arms and trunk constitute roughly 68% of total body mass. Small changes in trunk flexion have the potential to substantially alter lower-limb kinematics and ground reaction forces (GRF) during running.

To study the downstream effects, Warrener and her team recruited 23 injury-free, recreational runners between the ages of 18 and 23. They recorded each participant running 15-second trials at their self-selected trunk position and three others: a 10-, 20-, and a 30-degree angle of flexion. But to make the study work, they had to first figure out how to get each runner to bend at the right slant.

"We had to create a way in which we could reasonably force someone into a forward lean that didn't make them so uncomfortable that they changed everything about their gait," said Warrener. The team hung a lightweight, plastic dowel from the ceiling just above the runners' heads, moving it up or down, depending on the angle needed.

Contrary to the team's original hypothesis, the average stride length decreased 13 cm and stride frequency increased from 86.3 strides/min to 92.8 strides/min. Overstride relative to the hip increased 28%.

"The relationship between strike frequency and stride length surprised us," said Warrener. "We thought that the more you lean forward, your leg would need to extend further to keep your body mass from falling outside the support aera. As a result, overstride and stride frequency would go up. The inverse was true. Stride length got shorter and stride rate increased."

Warrener believes this may be due to a decrease in the aerial phase (if they're not getting as much air time, runners will take shorter steps), which means leg swings quickened as a result of reduced forward movement.

"The act of swinging your leg is really expensive as you're running," said Warrener. "Swinging it faster as you lean forward may mean a higher locomotor cost."

Compared to the participants' natural trunk flexion, increased angles led to a more flexed hip and bent knee joint. A bigger lean also changed the runners' foot and lower limb position, leading to an increased impact of GRF on the body (rate of loading by 29%; vertical ground reaction force impact transients by 20%).

The combination of trunk flexion angle, foot and leg placement, and GRF variables, shows that excessive trunk flexion could be one cause of injurious running form and, according to Warrener, is key for understanding how diverse running forms optimize economy and performance.

"The big picture takeaway is that running is not all about what is happening from the trunk down--it's a whole-body experience," said Warrener. "Researchers should think about the downstream effects of trunk flexion when studying running biomechanics."

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Latest Health Research - Diet

What should I eat to avoid heart disease?

EUROPEAN SOCIETY OF CARDIOLOGY

Research News

Plant-based foods should dominate heart healthy diets, according to a paper published today in Cardiovascular Research, a journal of the European Society of Cardiology (ESC).1 This comprehensive review of research on food and heart disease provides updated evidence on how much, and how often, each item can be safely consumed.

"There is no indication that any food is poison in terms of cardiovascular risk. It's a matter of quantity and frequency of consumption," said study author Professor Gabriele Riccardi of the University of Naples Federico II, Italy. "A mistake we made in the past was to consider one dietary component the enemy and the only thing we had to change. Instead, we need to look at diets as a whole and if we reduce the amount of one food, it is important to choose a healthy replacement."

Overall, there is consistent evidence that for healthy adults, low consumption of salt and foods of animal origin, and increased intake of plant-based foods - including whole grains, fruits, vegetables, legumes and nuts - are linked with reduced risk of atherosclerosis. The same applies to replacing butter and other animal fats with non-tropical vegetable fats such as olive oil.

New evidence differentiates processed and red meat - both associated with increased risk of cardiovascular disease - from poultry, which shows no relationship at moderate intakes (up to three servings of 100 g per week). Red meat (i.e. beef, pork, lamb) should be limited to two servings of 100 g per week, and processed meat (i.e. bacon, sausages, salami) limited to occasional use.

Legumes (up to four servings of 180 g per week) are the recommended protein replacement for red meat. Moderate fish consumption (two to four servings of 150 g per week) is also supported by the latest evidence for prevention of heart disease, although there might be sustainability concerns. Poultry may be a suitable protein alternative to red meat, but in moderate amounts.

As for fruits and vegetables, given their strong association with a lower risk of atherosclerosis, daily consumption should be increased to as much as 400 g for each. Regarding nuts, a handful (around 30 g) per day is recommended.

For the healthy population, recent evidence does not support a requirement to use low-fat, instead of full-fat, dairy products to prevent heart disease. Rather, both full-fat and low-fat dairy products, in moderate amounts and in the context of a balanced diet, are not associated with increased risk.

"Small quantities of cheese (three servings of 50 g per week) and regular yogurt consumption (200 g per day) are even linked with a protective effect due to the fact that they are fermented," said Professor Riccardi. "We now understand that gut bacteria play a major role in influencing cardiovascular risk. Fermented dairy products contain good bacteria which promote health."

With respect to cereals, novel advice is given according to the glycaemic index (GI), where high GI foods raise blood sugar more quickly than low GI foods. High GI foods (i.e. white bread, white rice) are associated with an elevated atherosclerosis risk; therefore, consumption should be limited to two servings per week and they should otherwise be replaced with whole grain foods (i.e. bread, rice, oat, barley) and low GI foods (i.e. pasta, parboiled rice, corn tortilla).

As for beverages, coffee and tea (up to three cups daily) are associated with reduced cardiovascular risk. Soft drinks, including low-calorie options, are linked with higher risk and should be replaced with water except on limited occasions. Moderate alcohol consumption (wine: up to two glasses per day in men and one glass in women; or one can of beer) is associated with a lower risk of heart disease compared to higher amounts or abstinence. But Professor Riccardi said: "Considering the overall impact of alcohol on health, this evidence should be interpreted as the maximal allowed intake rather than a recommended amount."

Regarding chocolate, the available evidence allows up to 10 g of dark chocolate per day. The authors state that "for this amount of consumption the beneficial effects exceed the risk of weight gain and its related harmful consequences on cardiovascular health".

Professor Riccardi noted that eating should be enjoyable to motivate healthy people to make long-term changes. He said: "We need to rediscover culinary traditions such as the Mediterranean diet which has delicious recipes using beans, whole grains, nuts, fruits and vegetables."

The authors concluded: "A strategy based exclusively on guidelines and nutritional education will not be sufficient to change the lifestyle of the population; policy options to be considered should necessarily include initiatives to facilitate production, marketing, availability and affordability of foods that are not only healthy but also gastronomically appealing."