Halt heart disease or beat breast cancer? A woman's quandary

One is perceived to be the biggest health threat to women; the other is the real thing. Though both claim far too many lives, the 46,000 American women who die each year from breast cancer are but a small percentage of the 370,000 who succumb to this country's number one killer--heart disease. The truth is, after age 50, heart disease doesn't discriminate by gender.

Heart disease affects more than nine million American women in all, so it makes sense to seek protection. But sometimes reports in the media can be confusing for those trying to eat right to keep both heart disease and breast cancer at bay.

Already this year, researchers have released the results of two separate but equally compelling studies on diet and breast cancer that seem to sneer at current heart-healthy recommendations. What's a woman to do? First, don't panic. There's much more dietary advice in common for preventing the two diseases than you might think. But first, let's look at the two major areas of contention--fat and alcohol.

Fickle Finger of Fat. For decades, researchers have been playing tug-of-war with the implications of fat intake on breast cancer risk. It made sense at first to indict dietary fat. After all, countries with the highest rates of breast cancer also have the highest intakes of fat.

But the fat-breast cancer link was knocked down a peg in 1992 by Harvard researchers. After studying 80,000 women for eight years, they found no difference in risk between those who ate half their calories as fat and those who ate 30% as fat. Still, critics argue that a truly low-fat diet-under 25%--would be protective.

Now, a study from Sweden also suggests that a high-fat intake does not contribute to breast cancer. The study followed more than 61,000 Swedish women age 40 to 76 for more than four years. There was no correlation between the amount of fat the women consumed and their risk of breast cancer.

This time, however, the researchers went a step further and analyzed the resuits by the type of fat. Bingo! A more telling pattern emerged. Risk of breast cancer was lower in women who ate a diet high in monounsaturated fats-found in olive oil, canola oil and nuts, For every 10 grams of monounsaturated fat they ate, their risk fell by 45%.

Conversely, polyunsaturated fats were linked to increased risk. For each five grams eaten, risk rose by almost 70%. Poly fats include omega-6 fats like those found in vegetable oils as well as omega-3 fats found in fish oil. Though the study did not differentiate among individual fatty acids, a recent study found omega-3 fats protective against breast cancer, so presumably the omega-6 fats are the guilty ones.

The upshot for breast cancer seems to be that total fat intake doesn't really matter, though poly fats might be worse than other fats and mono fats might be better. At one time, this might have seemed to be heart-healthy advice turned upside-down. In fact, hearthealthy advice itself has been turned on its head of late.

Heart Disease Do's and Don'ts. Until now, heart-healthy advice has been mostly ad nauseum admonitions to cut back total fat calories to 30%. More recently, the message to reduce saturated fat has picked up steam as the dietary component considered to be most responsible for raising blood cholesterol levels, and thereby risk of heart disease. And lately, trans fatty acids have garnered suspicion as an additional anathema.

But as with breast cancer, new evidence is mounting that total fat intake may not be so important to heart disease risk, if the fat eaten is mostly mono (with little saturated or trans fats) and if calories are not excessive. (See EN, April 1998.) For now though, most experts still recommend keeping fat under 30% of calories.

Alcohol: The Red Herring? You'd think red wine was on the food pyramid these days, with all the glowing reports it's been getting. Experts think red wine protects against heart disease by supplying antioxidant compounds. Called phenols, they reduce the stickiness of blood, preventing dangerous coagulation. Whether alcohol itself has additional positive effects is still debated. There's been so much positive news about red wine that some doctors actually prescribe it. But not to women.

Until now, studies have merely suggested that alcohol increases breast cancer risk. But a new analysis that pooled the results from six studies involving more than 300,000 women has confirmed a strong link between alcohol and breast cancer. Risk of breast cancer increased 9% for those consuming 3/4 to one drink a day. Women who drank two to five drinks a day had a 41% increased risk compared to nondrinkers. Stephanie Smith-Warner, Ph.D., the study's lead researcher explains, "This risk is similar to the risk of women with a family history of breast cancer."

But before you swear off your nightcap, consider this: The American Cancer Society analyzed more than 500,000 middle-aged and older Americans for the link between alcohol and health. Those who consumed one drink a day had a 30% to 40% lower death rate from cardiovascular diseases and a 20% lower overall death rate.

Because so many more women die of heart disease than breast cancer, the odds favor erring on the side of preventing heart disease. If you do, limit alcohol to no more than one drink a day--that is, unless you already are at risk for breast cancer, because of family history, for instance.

Perhaps grape juice is the best of both worlds. It contains the beneficial phenols but no alcohol. A small study from the University of Wisconsin Medical Center recently found reduced clotting in those who consumed grape juice, similar to what's seen with red wine.

Common Sense Revisited. Bottom line? The good news is that, for the most part, there's no need to sacrifice the risk of one disease for the other. Most nutrition advice for heart disease and breast cancer does not conflict. In only one area is advice truly conflicting--alcohol. EN suggests you weigh your personal risk factors before making a decision.

Don't forget, however, to also eat plenty of fruits and vegetables, maintain a desirable body weight and increase fiber intake. All are still good moves to help prevent both diseases. Check out our chart below to put it all together.

Heart vs. Breast: Weighing Healthful Choices

Diet Component Heart Smart

Total Fat Decrease total intake to 30% of
calories or less or concentrate
on improving mix of fats (more
mono, less saturated and trans).

Omega-6 fats Neutral effect.

Omega-3 fats Beneficial. Increase consumption
of fish, walnuts and flaxseed.

Monounsaturated Beneficial. Increase consumption
fats of olive oil, canola oil and peanuts.

Saturated fats Reduce consumption of meats,
butter and full-fat dairy.

Trans fats Reduce consumption of stick
margarine and processed snacks.

Fiber Increase intake of soluble fiber
(fruits, vegetables, legumes).

Alcohol Moderate consumption (1-2
drinks a day) may be beneficial.

Weight Reduce weight to decrease risk.

Folic acid Get 400 micrograms from
food (legumes, leafy greens,
orange juice)and a multivitamin,

Diet Component Best for Breast

Total Fat Overall intake may not be important
but it may be best to keep intake
moderate (30%) until more is known.

Omega-6 fats May increase risk; limit vegetable
oils and margarine.

Omega-3 fats Preliminary research shows benefit;
further research needed.

Monounsaturated May be beneficial; further research
fats needed.

Saturated fats (Follow Heart-Smart advice.)

Trans fats (Follow Heart-Smart advice.)

Fiber Increase intake of both soluble and
insoluble (bran) fiber.

Alcohol Limit to 1 drink a day or abstain if
at high risk for breast cancer.

Weight Maintain desirable weight through-out
adulthood to decrease risk.

Folic acid (Follow Heart-Smart advice.)

C.G.
~~~~~~~~

By Catherine Golub, R.D.

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