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That Study about Milk and Risk of Breast Cancer – 6 Questions to Ask Before Jumping to Conclusions

Glass of milk

Image: Pixabay

You may have seen the recent media headlines about a study looking at drinking milk and its impact on breast cancer risk. It’s easy to get caught up in the news. But with any nutrition research, it’s important to read it with a critical eye and ask yourself a few important questions before jumping to conclusions.

Question #1 – Did the study involve humans, animals or cells in the lab? Who were the participants and how many? How long was the study?

Human studies are always the most applicable. This study looked at almost 53,000 adult women across North America. The average age of the women was 57 years and they were all initially free of cancer. The study lasted almost 8 years.

Question #2 – What is the source of the study? Was it published in a reputable, peer-reviewed journal? Was it preliminary research that has yet to be published? 

This study was part of the large Adventist Health Study-2 and published in the International Journal of Epidemiology, which is a peer-reviewed journal. Researchers were from the School of Public Health at Loma Linda University in California.

Question #3 – How was the study designed?

The study design has a big impact on the type of conclusions that can be drawn. This study about milk and breast cancer was an “observational” study meaning that researchers observed participants’ diets, collected data and then came up with a summary of their observations 8 years later.

The problem with observational studies is that we can’t make strong conclusions about cause and effect – in other words, we can’t say with certainty that “A causes B.” We can really only say that “A may be linked to B.” This is a big limitation of observational studies. A better study design would be “experimental”. In an “experimental” study, researchers randomly ask the participants to either undergo treatment A (such as drinking milk) or not undergo treatment A (such as not drinking milk), compare the results, and then see if treatment A causes outcome B (such as an increased risk of breast cancer). Of course, ethics are highly considered ahead of time, and the study needs to include a good number of participants for a decent duration. The advantage with experimental studies is that conclusions can be made about cause and effect.

Also, this study left out some important factors that could have affected the results. For example, the women were only asked if they ever smoked and how long they’ve used alcohol. The researchers didn’t ask for the amounts of tobacco smoked or the amounts of alcohol consumed. In addition, only “vigorous physical activity” was considered, not moderate physical activity (which might be more realistic) or even total minutes of physical activity. Social determinants of health weren’t considered either – like income, education or employment – and we know that these can all affect one’s health and risk for chronic diseases.

Question #4 – How was the nutrition information collected?

This study used self-reported food frequency questionnaires and 24-hour food recalls. In other words, participants told researchers how often they ate certain foods as well as what foods / beverages they consumed in the last 24 hours. There are a few problems with this type of data. First of all, this information was only collected ONCE, and at the beginning of the 8 year-long study. One has to ask if the participants ate exactly the same way years later? (Think about your own diet – has it changed over the last 8 years?) Secondly, self-reported data isn’t entirely accurate since it’s easy to under-estimate or over-estimate the amounts of food eaten. (Can you remember what and how much you ate yesterday or the day before?) And finally, a 24-hour food recall may have been taken on an “off” day, such as a weekend – which may not be an accurate picture of your true dietary intake.

Question #5 – How were the results interpreted?

This question is a bit tricky but crucial to the overall interpretation of the research. The researchers found that as milk intake increased, so did the risk of breast cancer. One news story stated that “women who drink as little as one cup of dairy milk per day could increase their risk of developing breast cancer by up to 50 per cent.” While this sounds alarming, we need to look at the statistics a bit closer.

At the end of the study, 1,057 women out of the 53,000 women developed breast cancer – this is a risk of 2% or 2 cases per 100 women. When women drank 1 cup of milk, their chances of developing breast cancer increased to 3% or 3 cases per 100 women. The difference is 1% and this is called the “absolute risk”. Since the risk of breast cancer went up from 2% to 3%, the overall increase is indeed 50% and this is called the “relative risk”. So while 50% sounds like a big number, the more important and more relevant number for YOU is the absolute risk which is only 1%.

Question #6 – What are other credible authorities saying about this topic?

Dietary guidelines are shaped by evidence-based studies, not just a single study. Always check to see what other credible, professional authorities are saying about the topic. When it comes to preventing cancer, both the Canadian Cancer Society  as well as the American Institute of Cancer Research recommend eating whole grains, vegetables, fruit, beans and lentils as a major part of your everyday diet. Sounds like great advice to us!

As always, feel free to reach out to us if you’d like our help in translating the science of nutrition into easy to understand, practical advice.

Written by: Sue Mah & Lucia Weiler, Co-Founders n4nn

 

 

Healthy and Sustainable Eating: Leading the Shift – Event Highlights

Sue Mah with Dr. Fiona Yeudall and Dr. Cecilia Rocha

Sue Mah with Nutrition Connection Forum speakers Dr. Fiona Yeudall and Dr. Cecilia Rocha. Image source: Lucia Weiler

Hosted by Nutrition Connections, this year’s annual forum explored the shifts that will be required in eating habits and food choices in order to benefit the health of current and future generations as well as the health of the planet. Here’s our summary of a few of the presentations.

What is Sustainable Eating? – Dr. Cecilia Rocha

Dr. Rocha is a member of the International Panel of Experts on Sustainable Food Systems, a Professor in the School of Nutrition and a researcher at the Centre for Studies in Food Security at Ryerson University.

Sustainable diets, defined by the Food and Agriculture Organization (FAO) of the United Nations are: those diets with low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable; nutritionally adequate, safe and healthy; while optimizing natural and human resources.

Rocha reminded us of the 17 sustainable goals proposed by the United Nations, in particular, goal #12 which focuses on responsible consumption and production. Consumers have the potential to be agents of change through their healthy and ethical choices of what to eat. Through responsible consumption, ordinary people can effect change by carefully selecting the products they buy. However, price, convenience and brand familiarity are often the most important decision for most consumers, rather than fairness, sustainability and health.

In a world in which food is mostly a commodity, bought and sold through markets, how do we make the transition from unsustainable and unhealthy food systems to sustainable diets? Can consumers, through their choices of what food to buy, lead the way to that transformation? Rocha further posed this thought-provoking question: Is it realistic or reasonable to put this heroic task on the shoulders of consumers?

Rocha acknowledged that alternative food markets such as Community-Supported Agriculture (CDA), famers’ markets and fair-trade may offer consumers a more sustainable, healthy and ethical model of food production and consumption. Her opinion is that these alternative markets are still viewed as niche and alone, aren’t the answer. Rocha suggested that public policy is needed in at least three areas to facilitate responsible consumption:
– taxes and regulation (e.g. on sugar-sweetened beverages, use of chemicals, ultra-processed foods, and advertising)
– subsidies (e.g. for ecologically-friendly processes and alternative markets)
– information, education and nudging (e.g. food-based dietary guidelines).

 

How Do Our Eating Habits Compare to Canada’s Food Guide? – Dr. Rachel Prowse

Dr. Prowse, Applied Public Health Science Specialist at Public Health Ontario, compared the recommended proportions of food (by weight) in the new Canada’s Food Guide versus Ontario adults’ intakes from the 2015 Canadian Community Health Survey – Nutrition Public Use Microdata File. Research results are expected to be published next year, however preliminary findings show that we’re not eating according to the recommended proportions of the food guide. Dr. Prowse suggests that non whole grains and “Other foods” (such as cookies, cakes, pastries, ice cream and confectionary) may be displacing nutritious foods on our plates. A consumer shift towards eating a more plant-based diet may help to drive the production of sustainable food options.

 

A Deep Dive into Food Waste – Dr. Kate Parizeau

As an Associate Professor at the University of Guelph, Dr. Parizeau researches the social context of waste and its management. Parizeau shared some staggering statistics:
– Canada generates 12.6 million tonnes of organic waste per year
– Canada wastes $49.5 billion of food annually – enough to feed every person living in Canada for almost 5 months.

In collaboration with the Guelph Family Health Study, Parizeau looked at food waste both at the household level. Household food waste was defined as either “avoidable” (food that could have been eaten such as whole fruits and vegetables, spoiled food, uneaten leftovers, food past it’s best before date as well as bought but forgotten food) versus “unavoidable” (such as egg shells, banana peels and meat bones).

The study found that about ¾ of the household food waste was avoidable. Most of the avoidable food waste (over 65%) came from fruits and vegetables, 24% from bread and cereals, 6% from meat and fish, and 2% from milk, cheese and eggs. Overall, this amounts to an average of $936 per year, over 175,000 calories thrown out and 1,196 kg of C02 emissions created.

 

Image source: Kate Parizeau

 

Food literacy skills can result in reduced food waste. Behaviours such as meal planning, shopping with a list, food preparation, storing food safely and cooking at home are encouraged. A new cookbook Rock What You’ve Got – Recipes for Preventing Food Waste is now available for free download. This cookbook was created by the Guelph Food Waste Research Group in partnership with The Helderleigh Foundation, George Brown College’s Food Innovation and Research Studio (FIRSt).

 

 

 

Five healthy eating tips while travelling

Lucia Weiler, RD, PHEc.

When you travel for work or pleasure do you find it tricky to stick to a healthy eating plan? You’re not alone! Most people find it harder to keep up their smart lifestyle choices when away from home. However there are benefits to maintaining a healthy lifestyle while travelling and a healthy diet can help keep up your energy, reduce stress and enjoy your time while travelling for work or pleasure.

We were thrilled to present our N4NN Workplace Wellness workshop to executives who really wanted to energize their meeting. Are you travelling for business or pleasure? Check out our Travel Tip Sheet for five dietitians’ tips on how to find good food that will help you stick to a healthy eating plan while away from home.

Travel Tip Sheet

Five ways to help you stick to a healthy eating plan while away from home:

  1. Carry on & carry out
    Pack some healthy foods, high protein snacks in your bags. Fresh fruit, nuts, seeds, or a granola mix are handy snacks to carry on board especially if you are travelling within Canada. When you arrive at your destination, if you can, go to a food market or grocery store to pick up portable traveler friendly foods to carry out to your hotel room. Some examples are nuts, seeds, fruit, veggies, and whole grain crackers. If you have a fridge in your room, yogurt, cheese hard cooked eggs and hummus are healthy options to keep on hand.
  2. Drink water
    Stay well hydrated and don’t drink your calories. Drink water regularly, which is a calorie free way to quench your thirst. Limit sugary drinks, energy drinks, syrup flavoured hot or cold beverages and alcohol. Calories from these types of drinks can add up quickly and undermine your healthy eating goals.
  3. Scope out foodservice options
    If you travel for work you may return to the same city regularly. Find a few places you can count on for healthy options and plan your meals there. Check menus online to find your healthy go-to preferences where you travel. In most chain restaurants, calories are listed on the menu which can be helpful to compare meals. Remember it’s not just the total number of calories that count but the quality of the calories matter too. Look for foods with less saturated fat, less sodium and less added sugars.
  4. Order mindfully
    When eating at a restaurant keep these tips in mind: double up on veggies, avoid deep fried foods and watch portion sizes (keep them small or ask for half portions). Always order sauces on the side so you can decide how much to add. If you’re watching your calories, skip the appetizers and dessert.
  5. ENJOY your food choices!
    HOW you eat is just as important as WHAT you eat so look for ways to enjoy your food. Improving your eating habits takes time and it can be especially challenging while travelling. Find a few tips that work for you and then build on them as you journey toward making healthier choices while travelling.

Want more tips and insights on building healthier people? We translate the science of nutrition and offer life-changing advice for healthy living. Contact us for more information.

Food and Nutrition Trends from FNCE 2017

Sue FNCE sign 1 CROP

We were thrilled to attend the centennial Food & Nutrition Conference & Expo (FNCE) – the world’s largest annual nutrition meeting hosted in Chicago by the Academy of Nutrition and Dietetics! With over 13,000 attendees, FNCE did not disappoint! The Expo trade show featured hundreds of food and nutrition products. Here are the ones that caught our eye!

PREBIOTICS and PROBIOTICS

Gut health is a growing trend! Prebiotics and probiotics work together to keep the gut healthy. Prebiotics are non-digestible carbohydrates that actually act as food for probiotics. Probiotics are healthy bacteria that live in our colon where they help to maintain a balance between the “good” and “bad” bacteria. From crackers to drinks to powders, these innovative products are designed to keep your gut healthy.

Farmhouse Culture Gut Shots – probiotic beverages and foods made with fermented veggies. Slogan: We’re here to ferment a food revolution!

Farmhouse Culture Gut Shots – probiotic beverages and foods made with fermented veggies. Slogan: We’re here to ferment a food revolution!

Go Live Probiotic & Prebiotic Beverages – the probiotic is housed in a foil-blister cap which can be added to the beverage when you’re ready to drink. Slogan: Think outside the bottle, look inside the cap!

Go Live Probiotic & Prebiotic Beverages – the probiotic is housed in a foil-blister cap which can be added to the beverage when you’re ready to drink. Slogan: Think outside the bottle, look inside the cap!

Regular Girl – prebiotic fibre and probiotics for the women whose life is anything but regular. Can be sprinkled on food or in beverages. Slogans: Eat, drink and be regular! You go girl! Déjà poo!

Regular Girl – prebiotic fibre and probiotics for the women whose life is anything but regular. Can be sprinkled on food or in beverages. Slogans: Eat, drink and be regular! You go girl! Déjà poo!

PROTEIN

We’ve been watching the protein trend grow for the past decade now. Featured at the FNCE show were protein packed pancake mixes and protein enhanced beauty products.

FlapJacked Protein Pancake & Baking Mix – boasting 19 grams of protein per 60 g serving from whey protein isolate and pea protein.

FlapJacked Protein Pancake & Baking Mix – boasting 19 grams of protein per 60 g serving from whey protein isolate and pea protein.

Vital Proteins – from free range bone broth collagen to wild caught marine collagen to collagen beauty water…with the belief that collagen will support bone health, joint health, gut health and a glowing skin, nails and hair.

Vital Proteins – from free range bone broth collagen to wild caught marine collagen to collagen beauty water…with the belief that collagen will support bone health, joint health, gut health and a glowing skin, nails and hair.

PLANT-BASED BEVERAGES

Move over soy, almond and rice. Make way for new plant-based beverages made from nuts and pea protein.

Elmhurst Milked Peanuts – 2 new beverage options: straight up peanuts (made with 21 peanuts) or peanuts plus Dutch cocoa. Contains 8 g of protein per cup however not fortified with either calcium, vitamin D or vitamin B12.

Elmhurst Milked Peanuts – 2 new beverage options: straight up peanuts (made with 31 peanuts) or peanuts plus Dutch cocoa. Contains 8 g of protein per cup however not fortified with either calcium, vitamin D or vitamin B12.

Bolthouse Plant Protein Milk -  made with pea protein, contains 10 g protein per cup and fortified with calcium, vitamin D and vitamin B12.

Bolthouse Plant Protein Milk – made with pea protein, contains 10 g protein per cup and fortified with calcium, vitamin D and vitamin B12.

Veggemo – veggie-based  non-dairy beverage made from pea protein. Fortified with calcium, vitamin D and vitamin B12, but only 3-4 g protein per cup.

Veggemo – veggie-based non-dairy beverage made from pea protein. Fortified with calcium, vitamin D and vitamin B12, but only 3-4 g protein per cup.

Sodium versus Potassium – What’s the Difference?

You asked from time dot com

This is a terrific question asked by participants at our recent N4NN 2017 course in Toronto. Did you know that the new Canadian Nutrition Facts Table now requires that BOTH sodium and potassium amounts be shown in a food? Discover the significance and impact of these important nutrients. Count on us as dietitians to share expert advice and science-based information.

Sodium is an essential mineral and electrolyte. Sodium is needed to maintain normal blood pressure, support your nerves and muscles, as well as regulate your body’s fluid balance.

In food, sodium acts to: enhance flavour, preserve freshness of food, increase shelf life of food, prevent food spoilage / bacterial growth, and allow bread to rise as well as cheese to ripen.

According to Statistics Canada, over 75% of the sodium we eat comes from processed foods such as deli meats, cheese, pizza, soups and sauces.

We do need some sodium for good health, however Canadians eat on average 3,400 mg of sodium a day – this is more than double the amount we need. Eating too much sodium can lead to high blood pressure which is a major risk factor for heart disease, stroke and kidney disease. The 100% Daily Value (% DV) for sodium is 2,300 mg (down from the previous 2,400 mg).

Potassium is also an essential mineral and electrolyte. Potassium is needed to maintain normal blood pressure, regulate your body’s fluid balance, support muscle contractions and nerve impulses, as well as maintain a regular heart rhythm.

In food, potassium chloride is used to: enhance flavour, increase shelf life of foods, prevent food spoilage / bacterial growth, control pH of foods as well as reduce the sodium content of foods.

Best sources of potassium are beans (e.g. white beans, adzuki beans), potatoes, sweet potatoes, leafy green vegetables, beets, Brussels sprouts and broccoli. Potassium declaration on the Nutrition Facts Table is now mandatory with the new regulations, and the 100% Daily Value (% DV) has been upped to 4700 mg from 3500 mg.

Sodium-Potassium Relationship
Sodium is associated with an increased risk of high blood pressure. On the other hand, potassium acts as a vasodilator to lower the risk of high blood pressure. Health Canada has approved the following health claim, “A healthy diet containing foods high in potassium and low in sodium may reduce the risk of high blood pressure.”

*Image source: time.com

New food guide consultations are open!

food-guide-consultationYou may have heard the big announcement that Health Canada is revising the Food Guide (CFG) and consultations are open for only 45 days until December 8th.  The last time CFG was changed was over 10 years ago so don’t miss this chance to let your voice be heard!

Why is CFG important?

CFG was, and will remain a key document that shapes the approach to healthy eating recommendations and policies in Canada, including nutrition education and menu planning. You know that nutrition science has evolved in the last 13 years.  We moved from ‘no fat’ or ‘low fat’ to good fat, from ‘low carb’ to high quality carbs, and at the end of the day more and more scientists agree that the overall dietary pattern is more important than any one food or nutrient. Of course, it’s a real challenge to translate complex science about nutrition into specific recommendations that meets the diverse needs of the Canadian population, but the new Food Guide revision set out to do just that. Let your voice be heard on how CFG can help you benefit from nutrition.

How to let your voice be heard!

We completed Canada’s Food Guide Workbook on line, which did not take very long, and we have a few tips for your consideration so you know what to expect when you participate.

The first question separates members of the general public from professionals who work in health, teaching or are representing an organization.  After a few more qualifying questions about who you are, the survey asks you to select 3 types of activities where you use healthy eating recommendations most often. The next set of questions are based on the 3 activities you just identified. They explore the type of guidance you find most valuable and the ways you would like recommendations presented. The final questions request you to rate the importance of a variety of topics related to healthy eating, including food enjoyment, eating patterns, security, environment, level of processing and sugars.

We encourage you to take the time and complete Canada’s Food Guide Workbook by December 8th. It’s your chance to influence the way Canadians will eat well for many years to come.

If you have any questions or comments on completing Canada’s Food Guide Workbook we’d be happy to hear from you!

Winners of the 2016 Grocery Innovations Show

Here are a few of the winning products, as selected by the Canadian Federation of Independent Grocers.

black-water

blk. Alkaline Mineral Water
blk. is a pure alkaline water that is infused with fulvic trace minerals.This beverage is naturally black with no artificial dyes or colouring. Fulvic acid (also called humic acid) occurs naturally in soil and sediment. Like all plain, unflavoured waters, blk has zero calories, zero sugar and zero caffeine.
My take: Tastes earthy. There are no human requirements for fulvic acid. Might make a good Halloween drink.

goh-goh-granola
goh-goh cereal
goh-goh cereal is made with air-dried milk. The first two ingredients are whole grain rolled oats and goh-goh whole milk powder. After adding water (warm or cold), the cereal is reconstituted. Available in two flavours: Honey, Hemp & Flax; and Raisin & Almond. A servings contains: 270-290 calories, 6-9 g fat, 43-45 g carbohydrates, 8-10 g protein, 3-4 g fibre, 15-20 g sugars and 10-15% DV (Daily Value) for calcium.
My take: Higher in sugars than I’d like, but tastes quite nice and is very filling. A novel idea for those who are camping, travelling or on the “goh”.

chickpea-beverage
Chickpea beverage
Made from organic chick peas, this is the first fortified chickpea beverage in the world. A serving (1 cup) contains: 70 calories, 2.5 g fat, 1 g omega-3 fat (from flaxseed oil), 2 g carbohydrate, 10 g protein, 0 g sugars and 30% DV (Daily Value) for calcium. (Vitamin D content not available.)
My take: Really does tastes like chickpeas. Contains more protein than other plant-based beverages such as almond beverage or rice beverage.