June 17, 2025 • 31 mins
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Dr. Bobby begins with a walk through his local deli, which sparked a deeper investigation into what actually goes into processed meats.
He outlines how processed meats are defined by the USDA as those altered through salting, curing, or smoking for preservation, dating back to Paleolithic food practices. The real concern, he explains, lies in compounds like nitrates (NO3) and nitrites (NO2), which can convert into nitrosamines, a group of chemicals potentially linked to colorectal cancer.
Citing the American Institute for Cancer Research and the International Agency for Research on Cancer, Dr. Bobby notes that processed meats have been labeled carcinogenic, with consumption linked to an increased cancer risk. However, he contrasts this with a weak recommendation from the Nutritional Recommendations Consortium, which found low-certainty evidence that processed meat increases cancer risk, suggesting most people could continue their usual consumption patterns.
He scrutinizes observational studies like the UK Biobank study and a meta-analysis of 15 studies involving 2.5 million participants, both hinting at a modest increased risk but fraught with methodological flaws such as poor adjustment for confounders like diet, exercise, and lifestyle habits.
The conversation deepens with the Shanghai study that found nitrate-related cancer risk only in individuals with low vitamin C intake, pointing to the potentially protective effects of antioxidants. Supporting this, Dr. Bobby highlights that 70% of dietary nitrates come from vegetables like spinach and beets, which are associated with lower cancer risk, adding nuance to the nitrate debate.
And it gets more paradoxical—beetroot juice rich in nitrates has been shown in 75 randomized controlled trials to lower blood pressure by up to 7 points systolic, rivaling medication.
To put things into perspective, Dr. Bobby crunches the numbers: if processed meats raise colorectal cancer risk by 13%, your lifetime risk might increase from 4% to 4.4%—a marginal difference. In real terms, out of 1,000 people who completely avoid processed meats, only four might avoid colorectal cancer.
Other additives like sodium erythorbate and sodium ascorbate appear non-problematic at normal levels, and while sodium may raise blood pressure in salt-sensitive individuals, it’s not linked to cancer risk—explored further in Episode 27.
Dr. Bobby closes with a pragmatic and humor-tinged "bacon hack": since vitamin C may counteract the formation of harmful nitrosamines, consider enjoying your bacon with a glass of orange juice—a personal theory grounded in biochemical plausibility but not tested.
Takeaways:
If you enjoy processed meats, the absolute cancer risk appears minimal based on current evidence. Leafy vegetables, despite their high nitrate content, are protective—likely due to vitamin C and other antioxidants. To balance pleasure and prudence, pair your bacon with a side of vitamin C, and above all, remember: wellne
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
I love bacon for breakfast, for lunch, for dinner
and I've even been known to eata hot dog or some salami,
although I don't really cravethem.
So often you hear thatprocessed meats are bad for you.
What does the evidence actuallysay?
(00:21):
Should I stop eating a foodthat I love, or is there more
smoke than fire here?
Hi, I'm Dr Bobby Du Bois andwelcome.
To Live Long and Well, a podcastwhere we will talk about what
(00:46):
you can do to live as long aspossible and with as much energy
and vigor that you wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
(01:07):
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
I'm honored to be your guide.
Welcome my listeners to episode41.
Do I need to give up bacon tolive long and well?
(01:29):
Well, in Washington DC, there'slots of discussions now about
chronic disease and how it maybe caused from our food or the
environment.
There's recently been a ban oncertain food dyes.
There's concern aboutultra-processed foods like
Doritos or packaged meals,because they have the triad of
(01:55):
fat, carbs and sugar that we allcrave.
What about processed meats?
Aren't they also bad for you?
Processed meats, aren't theyalso bad for you?
Will I get cancer from eatingbacon?
Or is it much ado about verylittle, as always?
Where will the evidence take us?
(02:16):
And I will include links tothat evidence in our show notes.
Just to reassure you, I am notpaid for.
This episode is not paid for bythe makers of bacon or salami
or processed foods.
As you know, I have no sponsors.
I have no financial part ofthis.
(02:37):
My only sponsor, of course, ismy dear wife, who I want to
thank because she's alwaysavailable to bounce ideas off
her.
This is just another one of myquirky questions.
Obviously, there's no financialgain from this one way or the
other.
As I've said before, my rewardis helping other people.
(02:59):
Please refer somebody.
I have about 8,000 followers atthis point.
If each one of you justrecommended one person, imagine
how many more people I couldchat with and I could help and
we could all be in thiscommunity together.
So please, please, please, ifyou're able to, please do that.
(03:21):
All right, why, now?
Which is always my question atthe beginning?
Well, I was walking through mylocal market, the HEB, which is
a major chain in Texas and Iwent up to the deli counter and
I was chatting with them abouttheir deli turkeys.
So they have a big oven andthey make these turkeys and then
(03:43):
they slice it and then you canbuy the sliced meat.
And I got to talking with thelady behind the counter about
what goes into that turkey, whatkind of seasonings I was
thinking about preservativesjust wanting to know what went
into that turkey Turns out not awhole lot other than usual
spices.
But then we got to talkingabout salami and bologna and
(04:05):
cured ham and as I was walkingdown the chilled aisles I got to
the section on hot dogs andbologna.
Well, it seemed like a goodtime to look at ingredient
labels.
With what's going on inWashington, I figured, well, I
guess I ought to know what's inthese things and then try to
(04:28):
make an assessment.
That, of course, led tocreating this episode.
Now, in a few minutes I'll comeback with what I learned
reading the ingredients.
But our plan for today part one,what are process?
Meets.
Of course we've got to talkabout that.
Two.
What are the concerns aboutthem?
(04:48):
Is it the nitrates and nitritesin them?
Is that the problem?
What does the evidence tell us?
Part three are there otheradditives besides the nitrates
and the nitrites that we shouldworry about?
And the all-important part fourwhat do I take from all this?
Now, sneak preview at the endof this I'm going to share with
(05:11):
you my special hack that mightallow you to enjoy your bacon or
salami, or whatever, in ahealthy way.
So stay tuned.
That's coming up soon.
Let's dive in.
What are processed meats?
The USDA defines processed meatas any meat that's been
transformed through salting,curing, fermentation, smoking or
(05:36):
other processes to enhanceflavor or improve preservation.
So these are things like bacon,sausage, hot dogs, ham, salami
and bologna.
Now, this goes back thousandsand thousands and thousands of
years.
In Paleolithic times, theydried meats to preserve them.
(05:59):
Generally speaking, when youare processing a meat, generally
speaking, when you areprocessing a meat, you are
curing it.
This is typically what happensand you use salt or sugar or
sodium nitrates, which is justanother salt, to draw out the
moisture in the meat.
That preserves the meat,reduces bacteria that might grow
(06:22):
and it extends how long thatmeat will last.
It also enhances flavor and itmakes it more visually appealing
, because if you were just toyou know, cure or dry a meat
without this, the meat has atendency to turn gray not very
appetizing and so that nice redcolor is something that comes
(06:46):
from the curing process as well.
Back to my deli counter.
What is in this stuff?
Well, the really nice lady atthe deli counter was happy to
print out a whole bunch ofprinted labels for me of the
ingredients.
Then at the end of it she saysoh, by the way, we have an app
(07:06):
and that has all the ingredientsright there, so you don't
really need to print them allout in the future.
Well, what did I learn?
Let's start with bacon Now.
Let's start with Oscar Mayerbacon, sort of traditional
run-of-the-mill processed bacon.
And it says on the labelprocessed bacon.
(07:29):
And it says on the label curedwith water, salt, sugar, sodium
phosphate, sodium ascorbate andsodium nitrite.
So this is one of the oneswe're going to focus on, these
nitrates and nitrites.
Then I went down the aisle and Ilooked for some of these more.
I guess you'd call them upscalebacons.
They look like they're morehealthy.
They say they're uncured, and Ilooked at the ingredients.
(07:51):
What does it say?
So it says bacon, pork, seasalt, celery extract.
And it says on the label noadded nitrates.
But as we're going to learn injust a few minutes.
Guess what celery extract isfull of nitrate.
(08:12):
So by putting celery extractinto their bacon, guess what?
It has lots of nitrates.
So I would say the label's alittle bit of false advertising.
But I'm also not in the labelapproval business.
All right, let's go down thedeli aisle to the bologna
(08:35):
section.
Dan looked at Oscar Mayer, theusual sodium nitrate and celery
extract.
But there were also a wholebunch of these sodium salts,
sodium phosphate, sodiumpropionate, diacetate, benzoate,
ascorbate, which actually isvitamin C sodium lactate.
These are generally felt to besafe at usual amounts.
(09:00):
Obviously, you don't want toeat pounds of them, but in that
amount most of those things areconsidered to be safe.
Interestingly enough, when Ilooked at the ingredient label
for the bologna from Oscar Mayer, there were no food dyes.
Now there was corn syrup, therewas mustard seed, there was a
variety of other things, but Iwas surprised because I assumed
that would be one of the sourcesof food dye exposure.
(09:25):
Next to the salami section, andagain the usual items were there
, including the nitrates andthings like dextrose, sugar,
spice, lactic acid, starter,culture, garlic powder.
But they also had a series ofpreservatives BHA, bht and
citric acid.
(09:45):
Citric acid actually comes fromlemons, so even though it
sounds bad, it's just coming,you know, for something like
lemons.
Then I looked at mortadella.
Mortadella is kind of likesalami, also, of course, had
sodium nitrate, but in addition,had sodium erythrobate, and
(10:05):
you'll see this on labels forlots of different of these
processed meats.
So what did my field trip netout?
These food items contain redmeat, no surprise, nitrates.
Some have sodium erythrobateand they have a lot of salt.
This is what it nets out to ofthe things that let's focus on
(10:29):
to see if they're problematic.
Do I need to stop eating mybeloved bacon?
Well, I mentioned nitrates abunch, so now I need to define
what are nitrates.
So now I need to define whatare nitrates.
What are nitrites?
So all of these things thatsound like nitrate, nitrite,
nitrosamine all start with,basically, nitrogen and oxygen.
(10:55):
Now, nitrogen is the mostcommon item in air, so nitrogen
is probably not bad for us andoxygen obviously is important to
us.
So if you combine nitrogen andoxygen and you just have one
oxygen per nitrogen, you getnitrous oxide and that is
(11:15):
something that can help yourheart and lower your blood
pressure.
We'll come back to some of thislater.
If you take nitrogen and you addthree oxygens to it, that's
called a nitrate.
If you have two oxygens, it'scalled a nitrite, and the
nitrate becomes nitrites byconversion in our mouth or our
(11:36):
GI tract.
So whether it says nitrites,the nitrates are likely going to
turn into nitrites and thensome of these nitrates and
nitrites will turn intonitrosamines, which is the
nitrite that interacts withproteins in our gut and creates
(11:57):
these nitrosamines and that'sthe purported carcinogen.
So ultimately these things turninto potentially nitrosamines
and that's where some of theconcerns are Part.
Next, should I be concerned?
Well, it kind of depends uponwho you ask.
(12:18):
So here are expert bodies ofgroups that say what they say
about these things.
So the American Institute forCancer Research says processed
meat causes cancer, and this isa quote from them.
Eating hot dogs, bacon andother processed meats daily
(12:39):
increases the risk of colorectalcancer.
With the more you eat, thegreater the risk For processed
meats.
They say for every 50 gramsconsumed daily about one hot dog
it's linked to a 16% increasedrisk of colorectal cancer.
Another group, an internationalone, the International Agency
(13:02):
for Research on Cancer.
They classified processed meatas a definite cause of cancer,
or what they refer to as a groupone carcinogen, and that's the
same grouping where smoking fitsin.
But now we have a very differenttake on this.
There's a group called theNutritional Recommendations
(13:24):
Consortium Bottom line.
What they said is the evidenceon all of this stuff, in terms
of whether it's good or bad foryou, is really weak.
And they say that the panelsuggests adults continue current
processed meat consumption.
Now they say it's a weakrecommendation with low
certainty of the evidence.
(13:45):
But basically they're sayingthe evidence is murky and it
doesn't tell us clearly thatit's problematic.
They also point out that peoplelike red meat and processed
meat.
I certainly like it and if youwere to take it away from me,
yeah, I'd survive, but Iwouldn't be as happy when I
(14:07):
approach my breakfast meal.
So this all seems ratherconfusing, all these different
groups saying completelydifferent things.
So let's dive into the evidenceand see what we find and we can
either believe this isproblematic or perhaps not.
Okay, I want to begin by sayingthe type of evidence that we
(14:30):
like to see is randomized,controlled trials.
You take one group of people.
You say you're having baconevery day.
Other group of people sayyou're never having bacon, and
then we randomly do that andthen we follow them for 10 years
or whatever it is, and we seewhat happens.
That would be what we wouldlike to see.
(14:50):
Of course, that's never beendone.
It's likely never to be done,so we're left with observational
studies which, as we've talkedabout many times, can be
problematic.
All right, so let me give you aflavor for some of these studies
.
The UK Biobank, this very largedatabase that gets analyzed
(15:13):
over and over and over again474,000 people followed for
seven years and if people had 70grams per day like a hot dog or
something like that, for red orprocessed meat, there was a 32%
increased risk of colorectalcancer.
(15:34):
Now that seems like a lot.
But now here comes the problemswith that study.
First of all, as I said, theywere looking at the combination
of red meat or processed meat.
They did not separate them out.
So we don't know that red meatis the problem or processed
meats are the problem.
(15:54):
They just lump it all together.
Some people probably had nobacon, other people had lots of
bacon along with their steak, sowe just don't know.
Also, they didn't fully adjustfor a lot of things that matter
In observational studies.
What happens is you find a groupof people who eat something,
(16:14):
you find a group of people whodon't eat something.
One group eats sausage andbologna, another group doesn't,
and then you see whether theyget colorectal cancer or not.
The problem is that when you dothat, you're not really
comparing apples to apples.
People who eat a lot of sausageand bologna may be overweight,
(16:38):
more so than the people thatnever eat that.
They may smoke more.
They may not eat as manyvegetables.
Obviously, if you're eating alot of meat and sausage and
bologna and bacon, maybe you'renot eating as many vegetables
and it's really about thevegetables and not about the
bacon.
Or maybe the group that eatsquote healthier might get more
(17:02):
exercise and again, it may belooking at the exercise.
So this is the problem withthese kinds of studies.
Well, there was a meta-analysisof 15 observational studies so
15 studies like the one I did,and there were about two and a
half million people in that andwhat they found was that people
(17:22):
who had a fair bit of dietarynitrate typically these were
processed meats they had aslight increased risk of
colorectal cancer about a 13%increase in risk, and we are
going to come back later to saywhat do we take from a 13%
increase in risk back later tosay what do we take from a 13%
(17:49):
increase in risk?
But once again, these studiesraise more questions than they
answer.
So they found that when you ateprocessed meats there was this
increased risk of colorectalcancer.
But when nitrates came fromother sources because nitrates
can be in your water supplybecause of pesticides that run
(18:09):
off into the water supply therewas no dose-response
relationship.
So when nitrates came fromthese meats, yeah, they found
something, but when nitratescame from other places, they
didn't find a problem.
Well, how could found something?
But when nitrates came fromother places, they didn't find a
problem.
Well, how could that be?
Aren't nitrates the problem andwouldn't it be a problem
(18:30):
whether you had it in your water, your vegetables or your meats?
Well, that's not what theyfound and I like to find a
dose-response relationship inthese observational studies.
So a little bit is maybeharmful, more of it is more
harmful, more still is even moreharmful.
So what do I take out of thismeta-analysis?
(18:50):
You know it's not veryconvincing to me.
There's a group of scientistswho published kind of a review
of the field and themethodologies that were used in
these studies on processed meatsand I'll have a link, of course
, in my show notes.
And what they said is thatreally almost all of these
(19:12):
studies were not done very well.
They didn't really fullycontrol with how old people were
, their family history ofcolorectal cancer, whether they
were overweight or not, whetherthey smoked, whether they drank
a lot of alcohol.
So what they said is that thisis kind of a morass of
literature and we really justdon't know.
(19:35):
Okay, we're about to go downsome interesting rabbit holes,
because this area isn't asstraightforward as you might
think.
So a study called the Shanghaistudy.
They looked at 73,000 people,they followed them for 11 years
and overall what they found wasnitrate intake wasn't associated
(20:00):
with colorectal cancer.
Okay, so maybe my bacon is okay, but what they found was if you
also had very little vitamin Cin your diet, then in fact there
was a risk of colorectal cancer.
Nitrates were bad for you, itappeared, if you had low vitamin
(20:21):
C intake, and they also foundour favorite dose response.
But if your vitamin C intakewas high, there was no increased
risk of colorectal cancer.
Now that's fascinating.
It also turns out that thelargest source of nitrates is
(20:42):
not my bacon, my salami, my hotdogs or other processed meat.
70% comes from leafy vegetableslike spinach or kale or romaine
or beets and, of course, celery.
And aren't these things we'resupposed to be eating?
Well, yes, we're supposed toeat them.
(21:03):
They're good for us, but that'swhere most of the nitrates in
our diet come from, and studiesof people who eat these types of
vegetables show lower rates ofcancer, including GI cancer,
like stomach cancer.
Now this is really confusing tome, or maybe it's enlightening.
(21:24):
How could one source ofnitrates be bad for you Don't
eat bacon but another sourceleafy vegetables is good for you
.
Nitrate isn't a complicatedmolecule.
It shouldn't really matter howit gets in your body.
Remember back when I wastelling you about the deli
(21:46):
ingredient list, the uncuredbacon, what was called uncured
bacon?
That had no added nitrates.
Guess what it had celeryextract and celery, celery salt.
Celery extract is full ofnitrates.
Celery salt, celery extract isfull of nitrates.
(22:08):
So they're actually making thebacon using celery extract other
than making the bacon withsodium nitrate, but it pretty
much seems like it's the samething.
So the people who are againstbacon or against processed meats
now have a problem.
How do you explain why eatingyour nitrates in a nice leafy
(22:28):
vegetable is okay, is good foryou, but eating similar nitrates
with our processed meats isn't.
So their theory is that theleafy greens yes, they'll admit
they do have nitrates, but theyalso have vitamin C.
So perhaps it's not just thenitrates but it's the combo of
(22:55):
nitrates with or without vitaminC which could be important.
And they're arguing that thevitamin C stops the formation of
those nitrosoamines.
Remember I mentioned thatnitrates become nitrites.
They combine with some proteinsin our GI tract and become
nitrosoamines, but the vitamin Cis an antioxidant and maybe it
(23:16):
stops that.
Of course, that's a totally atheory as to what's going on.
Now, if it wasn't confusing, I'mgoing to make it even more
confusing.
Aren't nitrates bad for you?
Well, those nitrates can alsobe good for you.
There's a lot of excitement nowabout beetroot juice.
(23:39):
Guess what?
Beetroot juice has lots ofnitrates and they found in a
meta-analysis of 75 randomizedcontrolled trials that beetroot
juice, or other source like that, reduce people's blood pressure
by seven points.
That's as much as mostmedications do.
The systolic by seven.
(24:00):
Do the systolic by 7, diastolicby 2.
Okay, so a lot of confusingevidence here, nothing clearly
saying we have a major problem,but let's just say for the
moment that we believe the datafrom the meta-analysis and that
there is a 13% increased risk ofcolorectal cancer in people who
(24:23):
have lots of bacon or sausageor hot dogs or the like.
Let's put that in theperspective.
In episode 24, I talked aboutalcohol use.
Little or none, that was thequestion.
Do we really need to stop allalcohol?
Clearly, lots of alcohol notgood.
(24:44):
But what about a small amount,a glass or so a day?
So we talked about theincreased risk of cancer from
alcohol and we've explored howmuch that risk increased and
whether it was something weshould worry about.
So let's take it as truth.
Not that I think it necessarilyis true, but let's say the
(25:07):
process meets increase your riskof colorectal cancer by 13%.
Well, our typical average riskof colorectal cancer is about 4%
.
Okay, so it's not like all ofus are going to get colon cancer
.
It's about 4%.
So if, in fact, we ate ourbacon and processed meats all
(25:30):
the time, that 4% might rise to4.4%.
It's not doubling it, it's nottripling it, it's not saying
you're going to get colorectalcancer.
Definitely, it rises from 4% to4.4% or so.
Let me put this in another wayof thinking about it.
(25:50):
If a thousand of my listenerssaid I'm never eating processed
meats and my kids are never,ever going to be exposed to
bacon or these processed meats.
Of that thousand people whogave up bacon their entire lives
, four of the thousand mightavoid colorectal cancer.
(26:12):
So a tiny number a real numberperhaps, but a tiny number, and
it's for you to decide whetheryou want to continue to eat
these foods.
Well, it looks like nitrates andnitrites are a confusing area,
not really the cause of theproblem, as best as I can see.
What about some of the otheradditives?
(26:35):
I mentioned sodium erythrobatethat was in mortadella and some
other things, and I looked thisup and there are apparently no
harms associated with.
You know the small amounts thatyou would find.
What about sodium ascorbate?
Well, sodium ascorbate isreally something from vinegar
and we don't think vinegar isbad for you.
What about sodium citrate?
(26:57):
Well, that's vitamin C.
So hard to believe.
These are major problems.
Well, what about sodium?
There certainly is a lot ofsodium in all this stuff.
Now, if you are salt sensitiveand you have high blood pressure
, yes, salt can be a problem.
If you're interested in thiswhole topic, this relates to our
(27:19):
N of 1 trials.
In fact, are you salt sensitive?
And if you're not saltsensitive, enjoy salt.
I happen to be one of thosepeople and I do enjoy salt.
But the N of 1 trials arediscussed in episode 27.
So sodium may affect our bloodpressure, but there's no
indication that it's causingcancer.
(27:40):
So I can't blame any increasedrisk in cancer to the salt
that's in a lot of these things.
All right, let's come up nowwith some concluding thoughts
and the biohack that I promisedyou.
Okay, I've reviewed thisliterature for quite a while now
(28:02):
.
I dug in, I looked at therecommendations, I looked at the
flaws in the literature.
I don't find convincingevidence that nitrates and
processed meats cause cancer.
There aren't any randomizedcontrol trials.
They're all observationalstudies.
Most everything is low quality.
(28:22):
And how can it be that bacon isbad but leafy vegetables are
good for you?
Nitrates are nitrates, likeseed oil.
So if you want to listen to myepisode on seed oils, basically,
seed oils have been maligned,in part because when seed oils
and things were invented orpopularized, that's when
(28:45):
ultra-processed foods becamepopular and all the calories and
other things associated with it.
So it wasn't really the seedoil, it was all the things that
got made from the seed oils thatwere yummy and full of calories
.
It may turn out that really,people are maligning the
processed meats and it may havereally almost nothing to do with
(29:07):
that.
Remember, in my last episode, drBobby's law of large number of
studies.
If, after many, many, manystudies have been done and we're
still not certain whethersomething works or not, or
something is harmful or not, ifwe're still not certain whether
something works or not, orsomething is harmful or not, if
we're still uncertain, then ifthere is a harm, it's really
(29:29):
likely to be small, if at all.
So that's if you apply DrBobby's law of large number of
studies.
We have a fairly large numberof studies here.
It's murky.
My take is if there is a harm,it's really small.
All right, here's Dr Bobby'ssolution to the problem.
(29:49):
Remember that, eating the leafyvegetables, those nitrates seem
fine and the argument is thatthey also have vitamin C.
All right, how about this one?
When you have your bacon?
Have a glass of orange juicewhich has vitamin C.
All right, how about this one?
When you have your bacon?
Have a glass of orange juicewhich has vitamin C.
Now you'll have your nitrates,your vitamin C and all should be
(30:13):
well with the world.
This is completely untested.
It's just Dr Bobby's opinionand theory.
It's consistent with some ofthe arguments that you've heard
me talk about.
Do let me know what you decideon this important question of to
eat bacon or to not eat bacon.
(30:33):
Until next time, please, let'sall try to live long and well.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
(30:57):
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
drbobbilivelongandwellcom.
That's, doctor, as in D-R Bobby.
Live long and wellcom.
I love bacon for breakfast, for lunch, for dinner
and I've even been known to eata hot dog or some salami,
although I don't really cravethem.
So often you hear thatprocessed meats are bad for you.
What does the evidence actuallysay?
(00:21):
Should I stop eating a foodthat I love, or is there more
smoke than fire here?
Hi, I'm Dr Bobby Du Bois andwelcome.
To Live Long and Well, a podcastwhere we will talk about what
(00:46):
you can do to live as long aspossible and with as much energy
and vigor that you wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
(01:07):
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
I'm honored to be your guide.
Welcome my listeners to episode41.
Do I need to give up bacon tolive long and well?
(01:29):
Well, in Washington DC, there'slots of discussions now about
chronic disease and how it maybe caused from our food or the
environment.
There's recently been a ban oncertain food dyes.
There's concern aboutultra-processed foods like
Doritos or packaged meals,because they have the triad of
(01:55):
fat, carbs and sugar that we allcrave.
What about processed meats?
Aren't they also bad for you?
Processed meats, aren't theyalso bad for you?
Will I get cancer from eatingbacon?
Or is it much ado about verylittle, as always?
Where will the evidence take us?
(02:16):
And I will include links tothat evidence in our show notes.
Just to reassure you, I am notpaid for.
This episode is not paid for bythe makers of bacon or salami
or processed foods.
As you know, I have no sponsors.
I have no financial part ofthis.
(02:37):
My only sponsor, of course, ismy dear wife, who I want to
thank because she's alwaysavailable to bounce ideas off
her.
This is just another one of myquirky questions.
Obviously, there's no financialgain from this one way or the
other.
As I've said before, my rewardis helping other people.
(02:59):
Please refer somebody.
I have about 8,000 followers atthis point.
If each one of you justrecommended one person, imagine
how many more people I couldchat with and I could help and
we could all be in thiscommunity together.
So please, please, please, ifyou're able to, please do that.
(03:21):
All right, why, now?
Which is always my question atthe beginning?
Well, I was walking through mylocal market, the HEB, which is
a major chain in Texas and Iwent up to the deli counter and
I was chatting with them abouttheir deli turkeys.
So they have a big oven andthey make these turkeys and then
(03:43):
they slice it and then you canbuy the sliced meat.
And I got to talking with thelady behind the counter about
what goes into that turkey, whatkind of seasonings I was
thinking about preservativesjust wanting to know what went
into that turkey Turns out not awhole lot other than usual
spices.
But then we got to talkingabout salami and bologna and
(04:05):
cured ham and as I was walkingdown the chilled aisles I got to
the section on hot dogs andbologna.
Well, it seemed like a goodtime to look at ingredient
labels.
With what's going on inWashington, I figured, well, I
guess I ought to know what's inthese things and then try to
(04:28):
make an assessment.
That, of course, led tocreating this episode.
Now, in a few minutes I'll comeback with what I learned
reading the ingredients.
But our plan for today part one,what are process?
Meets.
Of course we've got to talkabout that.
Two.
What are the concerns aboutthem?
(04:48):
Is it the nitrates and nitritesin them?
Is that the problem?
What does the evidence tell us?
Part three are there otheradditives besides the nitrates
and the nitrites that we shouldworry about?
And the all-important part fourwhat do I take from all this?
Now, sneak preview at the endof this I'm going to share with
(05:11):
you my special hack that mightallow you to enjoy your bacon or
salami, or whatever, in ahealthy way.
So stay tuned.
That's coming up soon.
Let's dive in.
What are processed meats?
The USDA defines processed meatas any meat that's been
transformed through salting,curing, fermentation, smoking or
(05:36):
other processes to enhanceflavor or improve preservation.
So these are things like bacon,sausage, hot dogs, ham, salami
and bologna.
Now, this goes back thousandsand thousands and thousands of
years.
In Paleolithic times, theydried meats to preserve them.
(05:59):
Generally speaking, when youare processing a meat, generally
speaking, when you areprocessing a meat, you are
curing it.
This is typically what happensand you use salt or sugar or
sodium nitrates, which is justanother salt, to draw out the
moisture in the meat.
That preserves the meat,reduces bacteria that might grow
(06:22):
and it extends how long thatmeat will last.
It also enhances flavor and itmakes it more visually appealing
, because if you were just toyou know, cure or dry a meat
without this, the meat has atendency to turn gray not very
appetizing and so that nice redcolor is something that comes
(06:46):
from the curing process as well.
Back to my deli counter.
What is in this stuff?
Well, the really nice lady atthe deli counter was happy to
print out a whole bunch ofprinted labels for me of the
ingredients.
Then at the end of it she saysoh, by the way, we have an app
(07:06):
and that has all the ingredientsright there, so you don't
really need to print them allout in the future.
Well, what did I learn?
Let's start with bacon Now.
Let's start with Oscar Mayerbacon, sort of traditional
run-of-the-mill processed bacon.
And it says on the labelprocessed bacon.
(07:29):
And it says on the label curedwith water, salt, sugar, sodium
phosphate, sodium ascorbate andsodium nitrite.
So this is one of the oneswe're going to focus on, these
nitrates and nitrites.
Then I went down the aisle and Ilooked for some of these more.
I guess you'd call them upscalebacons.
They look like they're morehealthy.
They say they're uncured, and Ilooked at the ingredients.
(07:51):
What does it say?
So it says bacon, pork, seasalt, celery extract.
And it says on the label noadded nitrates.
But as we're going to learn injust a few minutes.
Guess what celery extract isfull of nitrate.
(08:12):
So by putting celery extractinto their bacon, guess what?
It has lots of nitrates.
So I would say the label's alittle bit of false advertising.
But I'm also not in the labelapproval business.
All right, let's go down thedeli aisle to the bologna
(08:35):
section.
Dan looked at Oscar Mayer, theusual sodium nitrate and celery
extract.
But there were also a wholebunch of these sodium salts,
sodium phosphate, sodiumpropionate, diacetate, benzoate,
ascorbate, which actually isvitamin C sodium lactate.
These are generally felt to besafe at usual amounts.
(09:00):
Obviously, you don't want toeat pounds of them, but in that
amount most of those things areconsidered to be safe.
Interestingly enough, when Ilooked at the ingredient label
for the bologna from Oscar Mayer, there were no food dyes.
Now there was corn syrup, therewas mustard seed, there was a
variety of other things, but Iwas surprised because I assumed
that would be one of the sourcesof food dye exposure.
(09:25):
Next to the salami section, andagain the usual items were there
, including the nitrates andthings like dextrose, sugar,
spice, lactic acid, starter,culture, garlic powder.
But they also had a series ofpreservatives BHA, bht and
citric acid.
(09:45):
Citric acid actually comes fromlemons, so even though it
sounds bad, it's just coming,you know, for something like
lemons.
Then I looked at mortadella.
Mortadella is kind of likesalami, also, of course, had
sodium nitrate, but in addition,had sodium erythrobate, and
(10:05):
you'll see this on labels forlots of different of these
processed meats.
So what did my field trip netout?
These food items contain redmeat, no surprise, nitrates.
Some have sodium erythrobateand they have a lot of salt.
This is what it nets out to ofthe things that let's focus on
(10:29):
to see if they're problematic.
Do I need to stop eating mybeloved bacon?
Well, I mentioned nitrates abunch, so now I need to define
what are nitrates.
So now I need to define whatare nitrates.
What are nitrites?
So all of these things thatsound like nitrate, nitrite,
nitrosamine all start with,basically, nitrogen and oxygen.
(10:55):
Now, nitrogen is the mostcommon item in air, so nitrogen
is probably not bad for us andoxygen obviously is important to
us.
So if you combine nitrogen andoxygen and you just have one
oxygen per nitrogen, you getnitrous oxide and that is
(11:15):
something that can help yourheart and lower your blood
pressure.
We'll come back to some of thislater.
If you take nitrogen and you addthree oxygens to it, that's
called a nitrate.
If you have two oxygens, it'scalled a nitrite, and the
nitrate becomes nitrites byconversion in our mouth or our
(11:36):
GI tract.
So whether it says nitrites,the nitrates are likely going to
turn into nitrites and thensome of these nitrates and
nitrites will turn intonitrosamines, which is the
nitrite that interacts withproteins in our gut and creates
(11:57):
these nitrosamines and that'sthe purported carcinogen.
So ultimately these things turninto potentially nitrosamines
and that's where some of theconcerns are Part.
Next, should I be concerned?
Well, it kind of depends uponwho you ask.
(12:18):
So here are expert bodies ofgroups that say what they say
about these things.
So the American Institute forCancer Research says processed
meat causes cancer, and this isa quote from them.
Eating hot dogs, bacon andother processed meats daily
(12:39):
increases the risk of colorectalcancer.
With the more you eat, thegreater the risk For processed
meats.
They say for every 50 gramsconsumed daily about one hot dog
it's linked to a 16% increasedrisk of colorectal cancer.
Another group, an internationalone, the International Agency
(13:02):
for Research on Cancer.
They classified processed meatas a definite cause of cancer,
or what they refer to as a groupone carcinogen, and that's the
same grouping where smoking fitsin.
But now we have a very differenttake on this.
There's a group called theNutritional Recommendations
(13:24):
Consortium Bottom line.
What they said is the evidenceon all of this stuff, in terms
of whether it's good or bad foryou, is really weak.
And they say that the panelsuggests adults continue current
processed meat consumption.
Now they say it's a weakrecommendation with low
certainty of the evidence.
(13:45):
But basically they're sayingthe evidence is murky and it
doesn't tell us clearly thatit's problematic.
They also point out that peoplelike red meat and processed
meat.
I certainly like it and if youwere to take it away from me,
yeah, I'd survive, but Iwouldn't be as happy when I
(14:07):
approach my breakfast meal.
So this all seems ratherconfusing, all these different
groups saying completelydifferent things.
So let's dive into the evidenceand see what we find and we can
either believe this isproblematic or perhaps not.
Okay, I want to begin by sayingthe type of evidence that we
(14:30):
like to see is randomized,controlled trials.
You take one group of people.
You say you're having baconevery day.
Other group of people sayyou're never having bacon, and
then we randomly do that andthen we follow them for 10 years
or whatever it is, and we seewhat happens.
That would be what we wouldlike to see.
(14:50):
Of course, that's never beendone.
It's likely never to be done,so we're left with observational
studies which, as we've talkedabout many times, can be
problematic.
All right, so let me give you aflavor for some of these studies
.
The UK Biobank, this very largedatabase that gets analyzed
(15:13):
over and over and over again474,000 people followed for
seven years and if people had 70grams per day like a hot dog or
something like that, for red orprocessed meat, there was a 32%
increased risk of colorectalcancer.
(15:34):
Now that seems like a lot.
But now here comes the problemswith that study.
First of all, as I said, theywere looking at the combination
of red meat or processed meat.
They did not separate them out.
So we don't know that red meatis the problem or processed
meats are the problem.
(15:54):
They just lump it all together.
Some people probably had nobacon, other people had lots of
bacon along with their steak, sowe just don't know.
Also, they didn't fully adjustfor a lot of things that matter
In observational studies.
What happens is you find a groupof people who eat something,
(16:14):
you find a group of people whodon't eat something.
One group eats sausage andbologna, another group doesn't,
and then you see whether theyget colorectal cancer or not.
The problem is that when you dothat, you're not really
comparing apples to apples.
People who eat a lot of sausageand bologna may be overweight,
(16:38):
more so than the people thatnever eat that.
They may smoke more.
They may not eat as manyvegetables.
Obviously, if you're eating alot of meat and sausage and
bologna and bacon, maybe you'renot eating as many vegetables
and it's really about thevegetables and not about the
bacon.
Or maybe the group that eatsquote healthier might get more
(17:02):
exercise and again, it may belooking at the exercise.
So this is the problem withthese kinds of studies.
Well, there was a meta-analysisof 15 observational studies so
15 studies like the one I did,and there were about two and a
half million people in that andwhat they found was that people
(17:22):
who had a fair bit of dietarynitrate typically these were
processed meats they had aslight increased risk of
colorectal cancer about a 13%increase in risk, and we are
going to come back later to saywhat do we take from a 13%
increase in risk back later tosay what do we take from a 13%
(17:49):
increase in risk?
But once again, these studiesraise more questions than they
answer.
So they found that when you ateprocessed meats there was this
increased risk of colorectalcancer.
But when nitrates came fromother sources because nitrates
can be in your water supplybecause of pesticides that run
(18:09):
off into the water supply therewas no dose-response
relationship.
So when nitrates came fromthese meats, yeah, they found
something, but when nitratescame from other places, they
didn't find a problem.
Well, how could found something?
But when nitrates came fromother places, they didn't find a
problem.
Well, how could that be?
Aren't nitrates the problem andwouldn't it be a problem
(18:30):
whether you had it in your water, your vegetables or your meats?
Well, that's not what theyfound and I like to find a
dose-response relationship inthese observational studies.
So a little bit is maybeharmful, more of it is more
harmful, more still is even moreharmful.
So what do I take out of thismeta-analysis?
(18:50):
You know it's not veryconvincing to me.
There's a group of scientistswho published kind of a review
of the field and themethodologies that were used in
these studies on processed meatsand I'll have a link, of course
, in my show notes.
And what they said is thatreally almost all of these
(19:12):
studies were not done very well.
They didn't really fullycontrol with how old people were
, their family history ofcolorectal cancer, whether they
were overweight or not, whetherthey smoked, whether they drank
a lot of alcohol.
So what they said is that thisis kind of a morass of
literature and we really justdon't know.
(19:35):
Okay, we're about to go downsome interesting rabbit holes,
because this area isn't asstraightforward as you might
think.
So a study called the Shanghaistudy.
They looked at 73,000 people,they followed them for 11 years
and overall what they found wasnitrate intake wasn't associated
(20:00):
with colorectal cancer.
Okay, so maybe my bacon is okay, but what they found was if you
also had very little vitamin Cin your diet, then in fact there
was a risk of colorectal cancer.
Nitrates were bad for you, itappeared, if you had low vitamin
(20:21):
C intake, and they also foundour favorite dose response.
But if your vitamin C intakewas high, there was no increased
risk of colorectal cancer.
Now that's fascinating.
It also turns out that thelargest source of nitrates is
(20:42):
not my bacon, my salami, my hotdogs or other processed meat.
70% comes from leafy vegetableslike spinach or kale or romaine
or beets and, of course, celery.
And aren't these things we'resupposed to be eating?
Well, yes, we're supposed toeat them.
(21:03):
They're good for us, but that'swhere most of the nitrates in
our diet come from, and studiesof people who eat these types of
vegetables show lower rates ofcancer, including GI cancer,
like stomach cancer.
Now this is really confusing tome, or maybe it's enlightening.
(21:24):
How could one source ofnitrates be bad for you Don't
eat bacon but another sourceleafy vegetables is good for you
.
Nitrate isn't a complicatedmolecule.
It shouldn't really matter howit gets in your body.
Remember back when I wastelling you about the deli
(21:46):
ingredient list, the uncuredbacon, what was called uncured
bacon?
That had no added nitrates.
Guess what it had celeryextract and celery, celery salt.
Celery extract is full ofnitrates.
Celery salt, celery extract isfull of nitrates.
(22:08):
So they're actually making thebacon using celery extract other
than making the bacon withsodium nitrate, but it pretty
much seems like it's the samething.
So the people who are againstbacon or against processed meats
now have a problem.
How do you explain why eatingyour nitrates in a nice leafy
(22:28):
vegetable is okay, is good foryou, but eating similar nitrates
with our processed meats isn't.
So their theory is that theleafy greens yes, they'll admit
they do have nitrates, but theyalso have vitamin C.
So perhaps it's not just thenitrates but it's the combo of
(22:55):
nitrates with or without vitaminC which could be important.
And they're arguing that thevitamin C stops the formation of
those nitrosoamines.
Remember I mentioned thatnitrates become nitrites.
They combine with some proteinsin our GI tract and become
nitrosoamines, but the vitamin Cis an antioxidant and maybe it
(23:16):
stops that.
Of course, that's a totally atheory as to what's going on.
Now, if it wasn't confusing, I'mgoing to make it even more
confusing.
Aren't nitrates bad for you?
Well, those nitrates can alsobe good for you.
There's a lot of excitement nowabout beetroot juice.
(23:39):
Guess what?
Beetroot juice has lots ofnitrates and they found in a
meta-analysis of 75 randomizedcontrolled trials that beetroot
juice, or other source like that, reduce people's blood pressure
by seven points.
That's as much as mostmedications do.
The systolic by seven.
(24:00):
Do the systolic by 7, diastolicby 2.
Okay, so a lot of confusingevidence here, nothing clearly
saying we have a major problem,but let's just say for the
moment that we believe the datafrom the meta-analysis and that
there is a 13% increased risk ofcolorectal cancer in people who
(24:23):
have lots of bacon or sausageor hot dogs or the like.
Let's put that in theperspective.
In episode 24, I talked aboutalcohol use.
Little or none, that was thequestion.
Do we really need to stop allalcohol?
Clearly, lots of alcohol notgood.
(24:44):
But what about a small amount,a glass or so a day?
So we talked about theincreased risk of cancer from
alcohol and we've explored howmuch that risk increased and
whether it was something weshould worry about.
So let's take it as truth.
Not that I think it necessarilyis true, but let's say the
(25:07):
process meets increase your riskof colorectal cancer by 13%.
Well, our typical average riskof colorectal cancer is about 4%
.
Okay, so it's not like all ofus are going to get colon cancer
.
It's about 4%.
So if, in fact, we ate ourbacon and processed meats all
(25:30):
the time, that 4% might rise to4.4%.
It's not doubling it, it's nottripling it, it's not saying
you're going to get colorectalcancer.
Definitely, it rises from 4% to4.4% or so.
Let me put this in another wayof thinking about it.
(25:50):
If a thousand of my listenerssaid I'm never eating processed
meats and my kids are never,ever going to be exposed to
bacon or these processed meats.
Of that thousand people whogave up bacon their entire lives
, four of the thousand mightavoid colorectal cancer.
(26:12):
So a tiny number a real numberperhaps, but a tiny number, and
it's for you to decide whetheryou want to continue to eat
these foods.
Well, it looks like nitrates andnitrites are a confusing area,
not really the cause of theproblem, as best as I can see.
What about some of the otheradditives?
(26:35):
I mentioned sodium erythrobatethat was in mortadella and some
other things, and I looked thisup and there are apparently no
harms associated with.
You know the small amounts thatyou would find.
What about sodium ascorbate?
Well, sodium ascorbate isreally something from vinegar
and we don't think vinegar isbad for you.
What about sodium citrate?
(26:57):
Well, that's vitamin C.
So hard to believe.
These are major problems.
Well, what about sodium?
There certainly is a lot ofsodium in all this stuff.
Now, if you are salt sensitiveand you have high blood pressure
, yes, salt can be a problem.
If you're interested in thiswhole topic, this relates to our
(27:19):
N of 1 trials.
In fact, are you salt sensitive?
And if you're not saltsensitive, enjoy salt.
I happen to be one of thosepeople and I do enjoy salt.
But the N of 1 trials arediscussed in episode 27.
So sodium may affect our bloodpressure, but there's no
indication that it's causingcancer.
(27:40):
So I can't blame any increasedrisk in cancer to the salt
that's in a lot of these things.
All right, let's come up nowwith some concluding thoughts
and the biohack that I promisedyou.
Okay, I've reviewed thisliterature for quite a while now
(28:02):
.
I dug in, I looked at therecommendations, I looked at the
flaws in the literature.
I don't find convincingevidence that nitrates and
processed meats cause cancer.
There aren't any randomizedcontrol trials.
They're all observationalstudies.
Most everything is low quality.
(28:22):
And how can it be that bacon isbad but leafy vegetables are
good for you?
Nitrates are nitrates, likeseed oil.
So if you want to listen to myepisode on seed oils, basically,
seed oils have been maligned,in part because when seed oils
and things were invented orpopularized, that's when
(28:45):
ultra-processed foods becamepopular and all the calories and
other things associated with it.
So it wasn't really the seedoil, it was all the things that
got made from the seed oils thatwere yummy and full of calories
.
It may turn out that really,people are maligning the
processed meats and it may havereally almost nothing to do with
(29:07):
that.
Remember, in my last episode, drBobby's law of large number of
studies.
If, after many, many, manystudies have been done and we're
still not certain whethersomething works or not, or
something is harmful or not, ifwe're still not certain whether
something works or not, orsomething is harmful or not, if
we're still uncertain, then ifthere is a harm, it's really
(29:29):
likely to be small, if at all.
So that's if you apply DrBobby's law of large number of
studies.
We have a fairly large numberof studies here.
It's murky.
My take is if there is a harm,it's really small.
All right, here's Dr Bobby'ssolution to the problem.
(29:49):
Remember that, eating the leafyvegetables, those nitrates seem
fine and the argument is thatthey also have vitamin C.
All right, how about this one?
When you have your bacon?
Have a glass of orange juicewhich has vitamin C.
All right, how about this one?
When you have your bacon?
Have a glass of orange juicewhich has vitamin C.
Now you'll have your nitrates,your vitamin C and all should be
(30:13):
well with the world.
This is completely untested.
It's just Dr Bobby's opinionand theory.
It's consistent with some ofthe arguments that you've heard
me talk about.
Do let me know what you decideon this important question of to
eat bacon or to not eat bacon.
(30:33):
Until next time, please, let'sall try to live long and well.
Thanks so much for listening toLive Long and Well with Dr
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
(30:57):
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
drbobbilivelongandwellcom.
That's, doctor, as in D-R Bobby.
Live long and wellcom.
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