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Does red meat cause cancer?

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Paul Saladino, MD

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I am sorry but Dr Pal Manickam, the Gastroenterologist from California, is becoming not just a health misinformation menace, but also a subtle "hate-monger" with his divisive attitude towards dietary choices in India, also known as Bharat, a Union of States and marriage of [dietary] cultures and traditions. Claims: 1. Eating red meat (beef and pork) causes colon cancer 2. Nitrosamines (from nitrites/nitrates) in red meat causes colon cancer 3. Cancer screening in USA above age of 50, but not in India 4. Kerala has maximum number of colon cancers in India 5. Kerala has maximum number of colon cancers because Malayalees eat a lot of beef. A lot. Response: 1. Eating red meat does not cause colon cancer Higher red meat consumption was shown to have a correlation with increased risk for colon cancer, but the evidence for independent association was weak and remains weak Eating red meat does not increase risk of colon cancer. Excessive consumption of red meat/ processed meat (excessive not yet fully defined across populations) was confusingly correlated with increased risk of colon cancer 2. Studies have only looked at nitrites and nitrates [and hence nitrosamine formation] causing stomach cancer and not colon cancer. The International Agency for Research on Cancer (IARC) also focussed on nitrosamines and stomach cancer, but the potential role for dietary nitrate/nitrite in colon cancer is not conclusively proven. Meat-based diets (specifically processed meat, not fresh meat) have a well described higher risk for cancer, but it is not readily attributable to nitrite consistently in all studies. Most studies are on ground and well water and not meat. And the strongest study to show cancer link and nitrite consumption is in mice, not humans The biggest source of nitrate exposure is dietary consumption of certain types of vegetables that are naturally high in nitrate. This is a clear case of investigator bias, looking at any possible way to force the data into a specific conclusion (like Dr. Pal is doing in the video). The IARC maintains the tone of its conclusion, but only to reiterate its validity in a theoretical state, while acknowledging that the epidemiology does to support these conclusions. Nitrites are just one reason processed meats may contribute to bowel cancer, and their relative importance is uncertain. Other factors that may contribute include iron; PAHs (polycyclic aromatic hydrocarbons) which are formed in smoked meats; and HCAs (heterocyclic amines), which are created when meat is cooked over an open flame – and which also are tumour-promoting. So its not just red meat, but the cooking method signficantly affecting health outcomes. 3. India does not have a national level screening protocol because the proportion of colon cancer among all cancers in India is only 3% which would lead to wastage of medical resources on a low-incidence cancer detection protocol. But in the USA, colon cancer is the second most common cause of cancer death. Overall, the lifetime risk of developing colorectal cancer is about 1 in 23 for men and 1 in 26 for women - which is much much higher compared to India and that is why they have screening protocols in place - not because they eat more red meat than Indians. 4. Kerala has the highest crude incidence rate of all cancers followed by Mizoram. Not colon cancer. All cancers. Highest colon cancer rates and burden of colon cancer are observed in Goa and Orissa, not Kerala. & While the discussion on beef and colon cancer is ongoing in the video, a segment of the clip shows a news item "concerning increasing cases of colon cancer in Kerala" - this is that news piece - - and read what it says: it talks about only younger age group and colon cancer. "Experts opine that underlying factors leading to the rise in cases, especially at this age, could be lifestyle, environment and genetic factors" - they do not mention beef at all. The report also says: "Though we have no authentic records to show the statistics of rising cases, we have been observing a trend here. Our changing lifestyle is most likely to blame for the rise in colorectal cancer cases amongst younger people, though hereditary reasons are also a major cause." - again, no mention of beef eating. 5. Lakshwadeep is India's biggest meat eater followed by north-east states such as Arunachal Pradesh, Mizoram, Nagaland and Manipur followed by Kerala. MEAT EATING. Not beef eating. Specifically looking at the largest beef consuming state - it is Meghalaya, where more than 80% of the population consumes this meat, not Kerala. Kerala is the largest beef consuming state in the context of male population only. [ 6. Oh by the way, about pork and colon cancer --> the risk was not increased consuming high amounts of pork: and there is only one study showing colon cancer risk in women in Japan, not India and that too who consumed pork >/= 3 times/week compared to </=1 time: Add-on: The risk for colon cancer is not red meat alone (with weak evidence), but more importantly (with stronger evidence), alcohol use, smoking, family history of cancer, presence of inflammatory bowel disease, obesity and polyps or adenoma of colon. These have been very conviniently ignored by the Gastroenterologist from California. Summary - red meat causing colon cancer is not convincingly proven. Increased intake of processed red meat more than higher intake of unprocessed red meat is weakly linked from evidence point of view to colon cancer risk. Nitrosamine in red meat as cancer causing in humans is not proven. Kerala does not have the largest burden of colon cancer in India, nor it is the largest consumer of beef. There is no realistic evidence that eating pork increases risk of colon cancer. These are actual facts. And I am not even a Gastroenterologist from California. I am a Hepatologist. From India.
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I am sorry but Dr Pal Manickam, the Gastroenterologist from California, is becoming not just a health misinformation menace, but also a subtle "hate-monger" with his divisive attitude towards dietary choices in India, also known as Bharat, a Union of States and marriage of [dietary] cultures and traditions. Claims: 1. Eating red meat (beef and pork) causes colon cancer 2. Nitrosamines (from nitrites/nitrates) in red meat causes colon cancer 3. Cancer screening in USA above age of 50, but not in India 4. Kerala has maximum number of colon cancers in India 5. Kerala has maximum number of colon cancers because Malayalees eat a lot of beef. A lot. Response: 1. Eating red meat does not cause colon cancer Higher red meat consumption was shown to have a correlation with increased risk for colon cancer, but the evidence for independent association was weak and remains weak Eating red meat does not increase risk of colon cancer. Excessive consumption of red meat/ processed meat (excessive not yet fully defined across populations) was confusingly correlated with increased risk of colon cancer 2. Studies have only looked at nitrites and nitrates [and hence nitrosamine formation] causing stomach cancer and not colon cancer. The International Agency for Research on Cancer (IARC) also focussed on nitrosamines and stomach cancer, but the potential role for dietary nitrate/nitrite in colon cancer is not conclusively proven. Meat-based diets (specifically processed meat, not fresh meat) have a well described higher risk for cancer, but it is not readily attributable to nitrite consistently in all studies. Most studies are on ground and well water and not meat. And the strongest study to show cancer link and nitrite consumption is in mice, not humans The biggest source of nitrate exposure is dietary consumption of certain types of vegetables that are naturally high in nitrate. This is a clear case of investigator bias, looking at any possible way to force the data into a specific conclusion (like Dr. Pal is doing in the video). The IARC maintains the tone of its conclusion, but only to reiterate its validity in a theoretical state, while acknowledging that the epidemiology does to support these conclusions. Nitrites are just one reason processed meats may contribute to bowel cancer, and their relative importance is uncertain. Other factors that may contribute include iron; PAHs (polycyclic aromatic hydrocarbons) which are formed in smoked meats; and HCAs (heterocyclic amines), which are created when meat is cooked over an open flame – and which also are tumour-promoting. So its not just red meat, but the cooking method signficantly affecting health outcomes. 3. India does not have a national level screening protocol because the proportion of colon cancer among all cancers in India is only 3% which would lead to wastage of medical resources on a low-incidence cancer detection protocol. But in the USA, colon cancer is the second most common cause of cancer death. Overall, the lifetime risk of developing colorectal cancer is about 1 in 23 for men and 1 in 26 for women - which is much much higher compared to India and that is why they have screening protocols in place - not because they eat more red meat than Indians. 4. Kerala has the highest crude incidence rate of all cancers followed by Mizoram. Not colon cancer. All cancers. Highest colon cancer rates and burden of colon cancer are observed in Goa and Orissa, not Kerala. & While the discussion on beef and colon cancer is ongoing in the video, a segment of the clip shows a news item "concerning increasing cases of colon cancer in Kerala" - this is that news piece - - and read what it says: it talks about only younger age group and colon cancer. "Experts opine that underlying factors leading to the rise in cases, especially at this age, could be lifestyle, environment and genetic factors" - they do not mention beef at all. The report also says: "Though we have no authentic records to show the statistics of rising cases, we have been observing a trend here. Our changing lifestyle is most likely to blame for the rise in colorectal cancer cases amongst younger people, though hereditary reasons are also a major cause." - again, no mention of beef eating. 5. Lakshwadeep is India's biggest meat eater followed by north-east states such as Arunachal Pradesh, Mizoram, Nagaland and Manipur followed by Kerala. MEAT EATING. Not beef eating. Specifically looking at the largest beef consuming state - it is Meghalaya, where more than 80% of the population consumes this meat, not Kerala. Kerala is the largest beef consuming state in the context of male population only. [ 6. Oh by the way, about pork and colon cancer --> the risk was not increased consuming high amounts of pork: and there is only one study showing colon cancer risk in women in Japan, not India and that too who consumed pork >/= 3 times/week compared to </=1 time: Add-on: The risk for colon cancer is not red meat alone (with weak evidence), but more importantly (with stronger evidence), alcohol use, smoking, family history of cancer, presence of inflammatory bowel disease, obesity and polyps or adenoma of colon. These have been very conviniently ignored by the Gastroenterologist from California. Summary - red meat causing colon cancer is not convincingly proven. Increased intake of processed red meat more than higher intake of unprocessed red meat is weakly linked from evidence point of view to colon cancer risk. Nitrosamine in red meat as cancer causing in humans is not proven. Kerala does not have the largest burden of colon cancer in India, nor it is the largest consumer of beef. There is no realistic evidence that eating pork increases risk of colon cancer. These are actual facts. And I am not even a Gastroenterologist from California. I am a Hepatologist. From India.

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