What's The Beef On Processed and Red Meat?

BIG NEWS in the nutrition world this week - the World Health Organization's International Agency for Research on Cancer (IARC) has stated that processed meat causes colon cancer. 

The science:  IARC assessed more than 800 epidemiological (population based) studies to evaluate the link between red meat, processed meat, and cancer, giving the greatest weight to prospective cohort studies, and taking additional evidence from high quality population based case-control studies.  They made a point of focusing on data that included large sample sizes and controlled for possible confounding factors (these are other factors that could be responsible for the same result, for example smoking).   Their meta-analysis found:

1.  An 18% increased risk of colon cancer per 50g of daily processed meat consumption (with confidence that there was no confounding or other explanation for the results);

2.  A 17% increased risk of colon cancer per 100g of daily red meat consumption (with less confidence that there was no other explanation for the results)

3.  Positive associations between consumption of processed meat and stomach cancer;

4.  Positive associations between consumption of red meat and cancers of the pancreas and prostate.


Based on these results, they have classified processed meats as being carcinogenic (cancer causing), and red meat as 'probably carcinogenic' to humans. 

It seems that how meat is cooked or processed is relevant to this discussion.  Meat processing, such as curing or smoking, can result in the formation of cancer causing chemicals such as N-nitroso-compounds and polycyclic aromatic hydrocarbons (PAH).  Cooking meat can produce chemicals also suspected of causing cancer, including heterocyclic aromatic amines and PAH.  High temperature cooking (pan frying, BBQ, or grilling) produces the highest amounts of these chemicals.

While red meat does contain lots of good quality protein and important nutrients such as B vitamins, iron and zinc, these nutrients can be found in other, healthier food choices.

So, meat lovers: you're best off to limit your intake of processed meats and red meats; consider healthier alternative such as poultry or fish.

A scientific discussion of the evidence can be found in The Lancet Oncology, and you can read more about the IARC (if interested) here.

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Canadian Medical Association Regonizes Obesity As A Chronic Diease

Finally, finally!  Canada has joined in with other nations to FINALLY recognize obesity as a chronic disease.

On October 9th, the Canadian Medical Association (CMA) officially declared obesity to be 'a chronic medical disease requiring enhanced research, treatment and prevention efforts'. 

As CMA president Cindy Forbes states:

"It is important for health care providers to recognize obesity as a disease so preventive measures can be put in place and patients can receive the appropriate treatment.  This move by the CMA speaks to the importance of addressing obesity and dealing with the stigma that is often associated with the condition."

I couldn't agree more.  There is an urgent need to shift society's thinking away from the idea that obesity is a lifestyle choice, and towards understanding the complex physiologic mechanisms that underlie this medical condition.

The CMA now joins other organizations, such as the American Medical Association and the World Health Organization, in recognizing obesity as a chronic medical condition.  With this important recognition, Canada has taken an important step towards supporting patients with obesity, and abolishing the obesity stigma that plagues not only our society, but also health care.

The way forward is now for improvements in access to important treatment options for patients with obesity - from nutritional counselling, to psychological support, to medications, to bariatric surgery.

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Health Canada Approves New Obesity Treatment

Hot on the heels of the FDA's recent approval, Health Canada has now also approved the use of a diabetes medication called liraglutide as a weight loss medication for people with or without diabetes.

  

Liraglutide is a medication that has been in use in Canada to treat type 2 diabetes for several years (called Victoza).  As an obesity treatment, it will have a different name, Saxenda; the medication is the same, but the dose to treat obesity is a little higher (based on clinical trials, which you can read more about here).  

Liraglutide can now be used as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of:

-      30 kg/m2 or greater (obesity), or;

-      27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbidity (e.g., hypertension, type 2 diabetes, or high cholesterol);

and who have failed a previous weight management intervention.

Liraglutide is a derivative of a human hormone called GLP-1, which is released in response to meals.  It works to tell the pancreas to release insulin, and suppresses another hormone involved in blood sugar regulation, called glucagon.  It helps with weight loss by sending a message to the satiety (fullness) centre of your brain, and it has an effect, particularly in the early weeks of treatment, to slow down the stomach.

As for any medication, there are potential risks with using liraglutide.  Common side effects include stomach upset, particularly nausea as the stomach is slowed initially, but this usually improves in the first weeks on the medication.  As for more severe side effects, the question has been raised as to whether this class of medications could cause inflammation of the pancreas (called pancreatitis), but to date, a causative connection has not been established (see more from the FDA and European Medicines Agency on this here).  Liraglutide has been shown to cause a rare form of thyroid cancer in rodents; this has not been seen in humans but is being monitored.  (For further discussion of side effects, see the FDA press release on Saxenda). 

My take on this? The approval of liraglutide for obesity is a landmark, in that this is the first time that a human gut hormone has been approved for obesity treatment.  There are many gut hormones involved in the feeling of fullness, many of which are being actively studied; combinations of these hormones look promising as well.   This is also a landmark decision for Health Canada, in that it has been almost twenty years since a medication was approved for the treatment of obesity in Canada.    

Please refer to my blog post on the FDA's approval last month for my further thoughts on this topic.  

Disclaimer: I was involved in the research trials of liraglutide as an obesity treatment.  I receive honoraria as a continuing medical education speaker and consultant from the makers of liraglutide (Novo Nordisk). I am involved in research of medications similar to liraglutide for the treatment of type 2 diabetes. 

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Canadian Obesity Guidelines - What's Missing

Last week, new clinical practice guidelines for the prevention and management of obesity in Canada were published by the Canadian Task Force on Preventive Health Care in the Canadian Medical Association Journal.

Unfortunately, it is not exactly a 'solutions based' document.   The main recommendations are as follows:

1.  Body mass index (BMI) should be calculated by family doctors to help prevent and manage obesity.

2.  Structured programs should not be offered to adults of normal weight, to prevent weight gain.

3.  For adults with overweight or obesity, structured programs should be offered to help with weight loss.

4.  Medications should not be used to treat obesity.


While I could pick apart their focus on BMI, or that not offering preventive programs was (in their words) a weak recommendation based on very low quality evidence, I want to focus on their recommendation not to use medications to treat obesity.

Advising us against using medications to treat obesity may be short sighted.  While Canada currently has very little in terms of medications to treat obesity, several medications have been approved in the last three years by the FDA in the United States to treat obesity, some of which may become approved for use by Health Canada as well.  Will the guidelines be hastily rewritten if/when these medications become available to us? Advising against medications to treat obesity leaves us with lifestyle measures on one end of the spectrum, and bariatric surgery on the other end.  While the US and Europe move forward in accepting obesity as a medical problem with medication options to treat it, is Canada going to stay in the dark ages on this?  Note that while our Task Force is telling us not to use medications to treat obesity, that the Endocrine Society in USA simultaneously released their Clinical Practice Guideline about how to treat obesity with medications.  While I agree that the current singular medication available to treat obesity in Canada (orlistat) is not very useful, a note that options may change in the near future may have given this section a little more balance.

Another concern I have with these guidelines: Discussion of bariatric surgery was conspicuous in its complete absence.  While bariatric surgery is an extreme treatment measure for obesity, it is a valuable one, and of great benefit for some patients.  It is stated that these guidelines are not intended for patients with a BMI over 40 (bariatric surgery is considered an option if BMI is >40, or >35 with complications of obesity), but I feel that at least a head nod to the existence of bariatric surgery should have been given in this document.

And - how does one exclude people with BMI >40 from the guidelines, when one in eight Canadian adults who struggle with obesity fall into this category?

The procedure that leads to creation of guidelines is a rigorous review of evidence, and I get that this is why these guidelines look the way they do - lifestyle intervention studies and evidence are poor, medication options in Canada are currently limited, and availability of bariatric surgery is minimal compared to the number of people who could benefit from these procedures.

However, as an advocate (warrior?) for my patients who struggle with excess weight, I will continue to remain optimistic that more options and accessibility will ultimately become available to Canadians to treat this condition.

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Dr Oz Fails The True Test Of Research

There are a lot of conflicting opinions about Dr Oz out there.  Some people feel that he is the guru of modern medicine, whereas others, including many health care professionals, are very critical of his claims.  I'm thrilled to report that researchers at the University of Alberta have put this debate to the true test of research.

In the study, which was published in the British Medical Journal, researchers analyzed 40 episodes each of The Dr Oz Show and The Doctors, and objectively analyzed medical claims made in each show.

They found that only one out of three Dr Oz recommendations had believable evidence behind it, and one out of two for The Doctors. They found that overall, insufficient information was provided for medical claims made, and therefore it was not possible for viewers to make informed decisions about what they were hearing.  Their conclusion was that recommendations taken by patients watching these shows ends up being based on trust of the TV host rather than on the actual information provided.

As quoted by one of the authors of the study on the University of Alberta website: “Our bottom-line conclusion is to be skeptical of what you hear on these shows.”  Amen!

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