Dr. Kevin Most: Nutrition and colon cancer screenings

Dr. Kevin Most on the Steve Cochran Show

We are going to spend a little time on nutrition today, and a big change in cancer screening was announced last week that actually ties into our topic of nutrition. The American Cancer Society has announced that it is moving the recommended date for individuals to start screening for colon cancer from age 50 to age 45. If you remember we discussed that the incidence of colon cancer in younger individuals was changing when we talked recently. Eddie Olczyk was diagnosed with advanced colon cancer at the age of 50.  If these new guidelines were in place Eddie would have identified his cancer early and possibly would have not needed the extensive treatment he received.

Why are they moving the age to 45? Studies have shown a 51% increase in colon cancer rates for individuals under the age of 50. To put this in perspective individuals born in 1990 have 2-4 times the risk of developing colon cancer than the individual who was born in 1950. Colon cancer is the fourth most common cancer diagnosed in the US, we expect next year that close to 150,000 individuals will be diagnosed with colorectal cancer. Unfortunately the trend is continuing for even younger individuals as well.

The recommendation is for screening, this may include colonoscopy, stool DNA testing, stool blood testing and virtual colonoscopy. If any of the non colonoscopy tests are positive, colonoscopy is recommended. Remember Colonoscopy can diagnose and also treat many of the early colon cancers, it is thought to be the best screening test.

Why are we seeing this increase in younger adults, the main reason is our diet and the influence processed food has on our intestines. Couple that with our lack of activity and obesity in this age group, which are two other risk factors and it is no surprise that this cancer is being found in younger age groups.

So if you are between the ages of 45-50, reach out to your doctor to discuss the screening options for colon cancer, doing that may save your life or may save you from going thru what Eddie Olczyk had to go thru.

Let’s touch base on diet and nutrition as we enter the summer season, and some things you can do to minimize your chances of colon cancer.

Many of you probably heard last week as listeners shared their great gas station diet foods,  a bunch of interesting combo’s for sure, sugar babies and cheese popcorn, corn dogs with cheese sauce, the list went on. We commented on how throughout the year we try to touch on nutrition at times, or at least share information on the importance of vegetables in our diet, or limiting other foods in our diet. We touch on diets from time to time as the fascination on the easiest way to lose weight is always on people’s minds. How many of you have asked your doctor a question about nutrition.

If you asked me how much education I received in medical school and residency about nutrition, it would not take me long to say very little or in fact possibly none. The starving medical student I assure you is not following the most nutritious diet in the world, drug rep donuts, fast food and cheap pasta was a typical day.

Medical School and Residency used to be about learning how to treat illness and really little about nutritional prevention of illness. Sure we were taught that salt raises blood pressure and fat food causes heart disease, and processed food has increased the rate of colon cancer in this country. We were not taught about counseling healthy people on how to eat, what to eat or more importantly how to prepare food. Numerous studies have shown that physicians coming out of medical school lack the knowledge to counsel patients about nutrition. Now physicians for the most part are not disagreeing with me, it is not their fault, it was never a priority for medical schools. How many of you have had a doc really talk to you about nutrition? Sure we have print out on diets that we may give you or we will tell you what an ideal body weight is for you, but have any of you had great counseling on food from your doctor?

Many may ask their doctor about the newest diet that Oprah or some other celebrity is promoting. Every diet ever proposed will have some well thought scientific basis, that proves that it will work in your pursuit to lose weight. We have brilliant nutritional experts who can make a case for their diet, and boy does each one sound good, and many sell a lot of books. As we have shown over decades diets work for a while but many get boring or expensive after a while and we go back to bad habits. Jenny Craig is a perfect example, balanced diet, even get some dessert, but after a while you begin to think I can do this without paying for the meals and next thing you know, the serving sizes have crept back up.

We can go on about diets and weight loss but my main point is that many physicians should not be your go to person for insight into good nutrition. It is sad but also true, there are many places trying to change this. Physicians are being offered courses in “Culinary Medicine” This is an emerging field that actually teaches physicians not only how to cook but also educates on the basics of nutrition. Residents are now being educated in a more formal way in most medical schools.

What are they being taught? They are learning not only the basics of nutrition but also how to read a nutrition label, how to really interview a patient about dietary habits, how to cook nutritious meals on a limited budget. The concept of food insecurity cannot be over looked and grocery store deserts are found in many urban areas of the US. The ability for a family in some urban areas to purchase fresh fruit and vegetables is either impossible or too expensive, so the alternative of canned vegetables seems like a good idea, yet they are loaded with salt and the nutrional value is often lost in the processing.

We are finally acknowledging that healthy diet education will improve health outcomes and minimize diabetes, heart disease and obesity in this country. It is time for doctors to start caring for patients to prevent diabetes rather than treat diabetes. Now I assure you doctors who are listening are thinking, I barely have enough time to address health issues and treatment in our 15 min office visits, I don’t have another 15 min to discuss nutrition, nor do the insurance companies see value in this as it is not compensated time.

We need to grasp the thought that our diet plays an important role in our health, and let’s make sure we show that in our healthcare process. If a doctor does not talk about diet and nutrition, what message does it send to the patient.

So in the true way we practice medicine today let’s talk about summer food and how to prevent illness……( I am not saying it is right)

I thought it might be more a few minutes to discuss summer food and what we should do to minimize the chance of illness. Some of the recommendations are a little more than common sense but a reminder is never a bad idea, other recommendations may change how you feel about some good old summer favorites.

First let’s talk about some of the basics. In this time of great weather having a backyard bar b q is something we all look forward to. You want to make sure you keep your guests safe from any food borne illnesses, if you don’t you will be the talk of the town and probably not in a good way.

We want to keep our food safe and there are some simple things you can do. The easiest thing we can do to protect food is temperature control, and it goes both ways, some you want to keep cool and other foods you don’t want to get too hot. Let’s take the cold first, bacteria love moisture and heat and they can take a perfectly good potato salad and make it into a not so desirable side. The safety of this starts before it is set out to be eaten, if you are traveling with a cold salad, keep it cold while driving, icing down a salad after it has been sitting in a hot trunk of a car does nothing except give a false sense of security to those eating it. Bacteria are able to multiply in the heat and release a toxin that can make individuals sick quickly, or it may be the ingestion of bacteria that causes one to be sick a day or two later.  So just a few simple things to do. Always pack a salad in a cooler, and have it surrounded by ice. Many will say the bowl does not fit in the cooler, I assure you gallon zip lock bags do. Place it in the fancy bowl when you get to the party. Now that it is in the fancy bowl, make sure that bowl is surrounded and sitting on ice. A great guest will bring extra ice and share with the host that your salad tastes much better cold and thus should be surrounded by ice while being served.

If you an astute guest, you will watch individuals arrive and any salad taken out of a trunk or from a car that traveled a good distance, is a good one to avoid. Aunt Mable may want you to try her new bean salad, be polite, put some on a separate plate and discretely dispose of it. Do Not Feed it to the Dog !!!  Many hosts are all over keeping the salads cold and do a great job of this, others remember to take great care of the salads but forget about the condiments Placing them in a bucket of ice is also good. I think you get the drift, bacteria do not multiple quickly in cold temperatures but flourish in warm or hot temps

Now I don’t want to be a Debbie Downer on grilling but we do need to understand the risks associated with grilling as  well. There have been a few studies on BBQ grilling, some have to with using charcoal, others have to do with how well you cook the meat.  A recent study of 87,000 adults showed that eating grilled meat, poultry or fish, 15 or more times a month showed close to a 20% higher risk of hypertension. Some critics  feel that the salt associated with grilling is more the culprit than the grilling.

We do know that eating well done meats or charred meats has a definitive increased risk of cancer including   pancreatic, bladder and breast cancer. Meats that are well cooked allow for the formation of 2 major carcinogens, PAH’s and HCA’s. Both of these are formed when the meat is heated to a point of causing charring or well done cooking. The smoke generated my smell great but it is not good to breathe in, combine that with the ingestion and the cook takes the highest risk.

The other side of that is undercooked poultry, a hamburger medium rare is fine,  chicken medium rare is dangerous. The chance of getting a food borne illness from under cooked meats is present, but under cooked poultry can transmit very dangerous bacteria that can cause major intestinal problems, so knowing that your chicken is cooked to 165 degrees is key to safe poultry.

Now we all enjoy the bar b q cook outs so is there anything we can do to minimize the health concerns from grilling? There are many things we can do and most of them are simple, here are just a few, use a couple of them or remember a couple of them and you will be a bit healthier.

  1.      Before you start grilling, make sure the grill is clean. Now we all see these grill scrapers that are small wire brushes. If you have one throw it away !!!   The small pieces of wire come loose and can attach to your meat, you ingest them without even knowing it, Those same small pieces can cause holes in your intestines.
  2.      I know this one will make no sense but actually cooking the meat in the microwave for a portion of the time can eliminate up to 95% of the HCA’s. You still get the great grilled lines and marinades but the meat is on the grill for a much shorter period of time, and the HCA’s are not sent in the air to be inhaled.
  3.      Trim the fat from the outside of the steak and remove the skin before cooking chicken, both of these techniques decrease the fat. Those flare ups we see and the smoke from them are not good for us, they contain carcinogens. When that flare up occurs, we breathe it in and it is placed onto the meat that is being cooked
  4.      Grilled vegetables do not carry  the risk we see in meats, the health impact of vegetables cooked on the grill is actually much better than boiling the vegetables where many of the vitamins and nutrients are lost.
  5.      Use a thermometer for poultry cooking, making sure every part of the chicken is at 165 degrees or higher
  6.      Make sure you don’t use the same plate to bring both cooked and uncooked food to the grill. Salmonella and other bacteria will be on the plate with the uncooked food, so you can re infect the cooked food, along this same line do not use the marinade that the meat soaked in, later in the meal