Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#41 Do I need to give up bacon to Live Long and Well?
Send me feedback here
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
I love bacon for breakfast, for lunch, for dinner and I've even been known to eat a hot dog or some salami, although I don't really crave them. So often you hear that processed meats are bad for you. What does the evidence actually say? Should I stop eating a food that I love, or is there more smoke than fire here? Hi, I'm Dr Bobby Du Bois and welcome.
Speaker 1:To Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide. Welcome my listeners to episode 41.
Speaker 1:Do I need to give up bacon to live long and well? Well, in Washington DC, there's lots of discussions now about chronic disease and how it may be caused from our food or the environment. There's recently been a ban on certain food dyes. There's concern about ultra-processed foods like Doritos or packaged meals, because they have the triad of fat, carbs and sugar that we all crave. What about processed meats? Aren't they also bad for you? Processed meats, aren't they also bad for you? Will I get cancer from eating bacon? Or is it much ado about very little, as always? Where will the evidence take us? And I will include links to that evidence in our show notes.
Speaker 1:Just to reassure you, I am not paid for. This episode is not paid for by the makers of bacon or salami or processed foods. As you know, I have no sponsors. I have no financial part of this. My only sponsor, of course, is my dear wife, who I want to thank because she's always available to bounce ideas off her. This is just another one of my quirky questions. Obviously, there's no financial gain from this one way or the other. As I've said before, my reward is helping other people. Please refer somebody. I have about 8,000 followers at this point. If each one of you just recommended one person, imagine how many more people I could chat with and I could help and we could all be in this community together. So please, please, please, if you're able to, please do that. All right, why, now? Which is always my question at the beginning?
Speaker 1:Well, I was walking through my local market, the HEB, which is a major chain in Texas and I went up to the deli counter and I was chatting with them about their deli turkeys. So they have a big oven and they make these turkeys and then they slice it and then you can buy the sliced meat. And I got to talking with the lady behind the counter about what goes into that turkey, what kind of seasonings I was thinking about preservatives just wanting to know what went into that turkey Turns out not a whole lot other than usual spices. But then we got to talking about salami and bologna and cured ham and as I was walking down the chilled aisles I got to the section on hot dogs and bologna. Well, it seemed like a good time to look at ingredient labels. With what's going on in Washington, I figured, well, I guess I ought to know what's in these things and then try to make an assessment. That, of course, led to creating this episode. Now, in a few minutes I'll come back with what I learned reading the ingredients.
Speaker 1:But our plan for today part one, what are process? Meets. Of course we've got to talk about that. Two. What are the concerns about them? Is it the nitrates and nitrites in them? Is that the problem? What does the evidence tell us? Part three are there other additives besides the nitrates and the nitrites that we should worry about? And the all-important part four what do I take from all this? Now, sneak preview at the end of this I'm going to share with you my special hack that might allow you to enjoy your bacon or salami, or whatever, in a healthy way. So stay tuned. That's coming up soon.
Speaker 1:Let's dive in. What are processed meats? The USDA defines processed meat as any meat that's been transformed through salting, curing, fermentation, smoking or other processes to enhance flavor or improve preservation. So these are things like bacon, sausage, hot dogs, ham, salami and bologna. Now, this goes back thousands and thousands and thousands of years. In Paleolithic times, they dried meats to preserve them. Generally speaking, when you are processing a meat, generally speaking, when you are processing a meat, you are curing it. This is typically what happens and you use salt or sugar or sodium nitrates, which is just another salt, to draw out the moisture in the meat. That preserves the meat, reduces bacteria that might grow and it extends how long that meat will last. It also enhances flavor and it makes it more visually appealing, because if you were just to you know, cure or dry a meat without this, the meat has a tendency to turn gray not very appetizing and so that nice red color is something that comes from the curing process as well.
Speaker 1:Back to my deli counter. What is in this stuff? Well, the really nice lady at the deli counter was happy to print out a whole bunch of printed labels for me of the ingredients. Then at the end of it she says oh, by the way, we have an app and that has all the ingredients right there, so you don't really need to print them all out in the future. Well, what did I learn?
Speaker 1:Let's start with bacon Now. Let's start with Oscar Mayer bacon, sort of traditional run-of-the-mill processed bacon. And it says on the label processed bacon. And it says on the label cured with water, salt, sugar, sodium phosphate, sodium ascorbate and sodium nitrite. So this is one of the ones we're going to focus on, these nitrates and nitrites.
Speaker 1:Then I went down the aisle and I looked for some of these more. I guess you'd call them upscale bacons. They look like they're more healthy. They say they're uncured, and I looked at the ingredients. What does it say? So it says bacon, pork, sea salt, celery extract. And it says on the label no added nitrates. But as we're going to learn in just a few minutes. Guess what celery extract is full of nitrate. So by putting celery extract into their bacon, guess what? It has lots of nitrates. So I would say the label's a little bit of false advertising. But I'm also not in the label approval business.
Speaker 1:All right, let's go down the deli aisle to the bologna section. Dan looked at Oscar Mayer, the usual sodium nitrate and celery extract. But there were also a whole bunch of these sodium salts, sodium phosphate, sodium propionate, diacetate, benzoate, ascorbate, which actually is vitamin C sodium lactate. These are generally felt to be safe at usual amounts. Obviously, you don't want to eat pounds of them, but in that amount most of those things are considered to be safe. Interestingly enough, when I looked at the ingredient label for the bologna from Oscar Mayer, there were no food dyes. Now there was corn syrup, there was mustard seed, there was a variety of other things, but I was surprised because I assumed that would be one of the sources of food dye exposure.
Speaker 1:Next to the salami section, and again the usual items were there, including the nitrates and things like dextrose, sugar, spice, lactic acid, starter, culture, garlic powder. But they also had a series of preservatives BHA, bht and citric acid. Citric acid actually comes from lemons, 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 like salami, also, of course, had sodium nitrate, but in addition, had sodium erythrobate, and you'll see this on labels for lots of different of these processed meats. So what did my field trip net out? These food items contain red meat, no surprise, nitrates. Some have sodium erythrobate and they have a lot of salt. This is what it nets out to of the things that let's focus on to see if they're problematic.
Speaker 1:Do I need to stop eating my beloved bacon? Well, I mentioned nitrates a bunch, so now I need to define what are nitrates. So now I need to define what are nitrates. What are nitrites? So all of these things that sound like nitrate, nitrite, nitrosamine all start with, basically, nitrogen and oxygen. Now, nitrogen is the most common item in air, so nitrogen is probably not bad for us and oxygen obviously is important to us. So if you combine nitrogen and oxygen and you just have one oxygen per nitrogen, you get nitrous oxide and that is something that can help your heart and lower your blood pressure. We'll come back to some of this later.
Speaker 1:If you take nitrogen and you add three oxygens to it, that's called a nitrate. If you have two oxygens, it's called a nitrite, and the nitrate becomes nitrites by conversion in our mouth or our GI tract. So whether it says nitrites, the nitrates are likely going to turn into nitrites and then some of these nitrates and nitrites will turn into nitrosamines, which is the nitrite that interacts with proteins in our gut and creates these nitrosamines and that's the purported carcinogen. So ultimately these things turn into potentially nitrosamines and that's where some of the concerns are Part. Next, should I be concerned? Well, it kind of depends upon who you ask.
Speaker 1:So here are expert bodies of groups that say what they say about these things. So the American Institute for Cancer Research says processed meat causes cancer, and this is a quote from them. Eating hot dogs, bacon and other processed meats daily increases the risk of colorectal cancer. With the more you eat, the greater the risk For processed meats. They say for every 50 grams consumed daily about one hot dog it's linked to a 16% increased risk of colorectal cancer. Another group, an international one, the International Agency for Research on Cancer. They classified processed meat as a definite cause of cancer, or what they refer to as a group one carcinogen, and that's the same grouping where smoking fits in.
Speaker 1:But now we have a very different take on this. There's a group called the Nutritional Recommendations Consortium Bottom line. What they said is the evidence on all of this stuff, in terms of whether it's good or bad for you, is really weak. And they say that the panel suggests adults continue current processed meat consumption. Now they say it's a weak recommendation with low certainty of the evidence. But basically they're saying the evidence is murky and it doesn't tell us clearly that it's problematic. They also point out that people like red meat and processed meat. I certainly like it and if you were to take it away from me, yeah, I'd survive, but I wouldn't be as happy when I approach my breakfast meal. So this all seems rather confusing, all these different groups saying completely different things. So let's dive into the evidence and see what we find and we can either believe this is problematic or perhaps not.
Speaker 1:Okay, I want to begin by saying the type of evidence that we like to see is randomized, controlled trials. You take one group of people. You say you're having bacon every day. Other group of people say you're never having bacon, and then we randomly do that and then we follow them for 10 years or whatever it is, and we see what happens. That would be what we would like to see. Of course, that's never been done. It's likely never to be done, so we're left with observational studies which, as we've talked about many times, can be problematic.
Speaker 1:All right, so let me give you a flavor for some of these studies. The UK Biobank, this very large database that gets analyzed over and over and over again 474,000 people followed for seven years and if people had 70 grams per day like a hot dog or something like that, for red or processed meat, there was a 32% increased risk of colorectal cancer. Now that seems like a lot. But now here comes the problems with that study. First of all, as I said, they were looking at the combination of red meat or processed meat. They did not separate them out. So we don't know that red meat is the problem or processed meats are the problem. They just lump it all together. Some people probably had no bacon, other people had lots of bacon along with their steak, so we just don't know. Also, they didn't fully adjust for a lot of things that matter In observational studies.
Speaker 1:What happens is you find a group of people who eat something, you find a group of people who don't eat something. One group eats sausage and bologna, another group doesn't, and then you see whether they get colorectal cancer or not. The problem is that when you do that, you're not really comparing apples to apples. People who eat a lot of sausage and bologna may be overweight, more so than the people that never eat that. They may smoke more. They may not eat as many vegetables. Obviously, if you're eating a lot of meat and sausage and bologna and bacon, maybe you're not eating as many vegetables and it's really about the vegetables and not about the bacon. Or maybe the group that eats quote healthier might get more exercise and again, it may be looking at the exercise. So this is the problem with these kinds of studies.
Speaker 1:Well, there was a meta-analysis of 15 observational studies so 15 studies like the one I did, and there were about two and a half million people in that and what they found was that people who had a fair bit of dietary nitrate typically these were processed meats they had a slight increased risk of colorectal cancer about a 13% increase in risk, and we are going to come back later to say what do we take from a 13% increase in risk back later to say what do we take from a 13% increase in risk? But once again, these studies raise more questions than they answer. So they found that when you ate processed meats there was this increased risk of colorectal cancer. But when nitrates came from other sources because nitrates can be in your water supply because of pesticides that run off into the water supply there was no dose-response relationship. So when nitrates came from these meats, yeah, they found something, but when nitrates came from other places, they didn't find a problem. Well, how could found something? But when nitrates came from other places, they didn't find a problem. Well, how could that be? Aren't nitrates the problem and wouldn't it be a problem whether you had it in your water, your vegetables or your meats? Well, that's not what they found and I like to find a dose-response relationship in these observational studies. So a little bit is maybe harmful, more of it is more harmful, more still is even more harmful. So what do I take out of this meta-analysis? You know it's not very convincing to me.
Speaker 1:There's a group of scientists who published kind of a review of the field and the methodologies that were used in these studies on processed meats and I'll have a link, of course, in my show notes. And what they said is that really almost all of these studies were not done very well. They didn't really fully control with how old people were, their family history of colorectal cancer, whether they were overweight or not, whether they smoked, whether they drank a lot of alcohol. So what they said is that this is kind of a morass of literature and we really just don't know. Okay, we're about to go down some interesting rabbit holes, because this area isn't as straightforward as you might think. So a study called the Shanghai study. They looked at 73,000 people, they followed them for 11 years and overall what they found was nitrate intake wasn't associated with colorectal cancer. Okay, so maybe my bacon is okay, but what they found was if you also had very little vitamin C in your diet, then in fact there was a risk of colorectal cancer. Nitrates were bad for you, it appeared, if you had low vitamin C intake, and they also found our favorite dose response. But if your vitamin C intake was high, there was no increased risk of colorectal cancer. Now that's fascinating.
Speaker 1:It also turns out that the largest source of nitrates is not my bacon, my salami, my hot dogs or other processed meat. 70% comes from leafy vegetables like spinach or kale or romaine or beets and, of course, celery. And aren't these things we're supposed to be eating? Well, yes, we're supposed to eat them. They're good for us, but that's where most of the nitrates in our diet come from, and studies of people who eat these types of vegetables show lower rates of cancer, including GI cancer, like stomach cancer. Now this is really confusing to me, or maybe it's enlightening. How could one source of nitrates be bad for you Don't eat bacon but another source leafy vegetables is good for you.
Speaker 1:Nitrate isn't a complicated molecule. It shouldn't really matter how it gets in your body. Remember back when I was telling you about the deli ingredient list, the uncured bacon, what was called uncured bacon? That had no added nitrates. Guess what it had celery extract and celery, celery salt. Celery extract is full of nitrates. Celery salt, celery extract is full of nitrates. So they're actually making the bacon using celery extract other than making the bacon with sodium nitrate, but it pretty much seems like it's the same thing.
Speaker 1:So the people who are against bacon or against processed meats now have a problem. How do you explain why eating your nitrates in a nice leafy vegetable is okay, is good for you, but eating similar nitrates with our processed meats isn't. So their theory is that the leafy greens yes, they'll admit they do have nitrates, but they also have vitamin C. So perhaps it's not just the nitrates but it's the combo of nitrates with or without vitamin C which could be important. And they're arguing that the vitamin C stops the formation of those nitrosoamines. Remember I mentioned that nitrates become nitrites. They combine with some proteins in our GI tract and become nitrosoamines, but the vitamin C is an antioxidant and maybe it stops that. Of course, that's a totally a theory as to what's going on.
Speaker 1:Now, if it wasn't confusing, I'm going to make it even more confusing. Aren't nitrates bad for you? Well, those nitrates can also be good for you. There's a lot of excitement now about beetroot juice. Guess what? Beetroot juice has lots of nitrates and they found in a meta-analysis of 75 randomized controlled trials that beetroot juice, or other source like that, reduce people's blood pressure by seven points. That's as much as most medications do. The systolic by seven. Do the systolic by 7, diastolic by 2. Okay, so a lot of confusing evidence here, nothing clearly saying we have a major problem, but let's just say for the moment that we believe the data from the meta-analysis and that there is a 13% increased risk of colorectal cancer in people who have lots of bacon or sausage or hot dogs or the like. Let's put that in the perspective.
Speaker 1:In episode 24, I talked about alcohol use. Little or none, that was the question. Do we really need to stop all alcohol? Clearly, lots of alcohol not good. But what about a small amount, a glass or so a day? So we talked about the increased risk of cancer from alcohol and we've explored how much that risk increased and whether it was something we should worry about.
Speaker 1:So let's take it as truth. Not that I think it necessarily is true, but let's say the process meets increase your risk of colorectal cancer by 13%. Well, our typical average risk of colorectal cancer is about 4%. Okay, so it's not like all of us are going to get colon cancer. It's about 4%. So if, in fact, we ate our bacon and processed meats all the time, that 4% might rise to 4.4%. It's not doubling it, it's not tripling it, it's not saying you're going to get colorectal cancer. Definitely, it rises from 4% to 4.4% or so. Let me put this in another way of thinking about it. If a thousand of my listeners said 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 who gave up bacon their entire lives, four of the thousand might avoid colorectal cancer. So a tiny number a real number perhaps, but a tiny number, and it's for you to decide whether you want to continue to eat these foods.
Speaker 1:Well, it looks like nitrates and nitrites are a confusing area, not really the cause of the problem, as best as I can see. What about some of the other additives? I mentioned sodium erythrobate that was in mortadella and some other things, and I looked this up and there are apparently no harms associated with. You know the small amounts that you would find. What about sodium ascorbate? Well, sodium ascorbate is really something from vinegar and we don't think vinegar is bad for you. What about sodium citrate? Well, that's vitamin C. So hard to believe. These are major problems. Well, what about sodium? There certainly is a lot of sodium in all this stuff.
Speaker 1:Now, if you are salt sensitive and you have high blood pressure, yes, salt can be a problem. If you're interested in this whole topic, this relates to our N of 1 trials. In fact, are you salt sensitive? And if you're not salt sensitive, enjoy salt. I happen to be one of those people and I do enjoy salt. But the N of 1 trials are discussed in episode 27. So sodium may affect our blood pressure, but there's no indication that it's causing cancer. So I can't blame any increased risk in cancer to the salt that's in a lot of these things. All right, let's come up now with some concluding thoughts and the biohack that I promised you.
Speaker 1:Okay, I've reviewed this literature for quite a while now. I dug in, I looked at the recommendations, I looked at the flaws in the literature. I don't find convincing evidence that nitrates and processed meats cause cancer. There aren't any randomized control trials. They're all observational studies. Most everything is low quality. And how can it be that bacon is bad but leafy vegetables are good for you? Nitrates are nitrates, like seed oil. So if you want to listen to my episode on seed oils, basically, seed oils have been maligned, in part because when seed oils and things were invented or popularized, that's when ultra-processed foods became popular and all the calories and other things associated with it. So it wasn't really the seed oil, it was all the things that got made from the seed oils that were yummy and full of calories. It may turn out that really, people are maligning the processed meats and it may have really almost nothing to do with that.
Speaker 1:Remember, in my last episode, dr Bobby's law of large number of studies. If, after many, many, many studies have been done and we're still not certain whether something works or not, or something is harmful or not, if we're still not certain whether something works or not, or something is harmful or not, if we're still uncertain, then if there is a harm, it's really likely to be small, if at all. So that's if you apply Dr Bobby's law of large number of studies. We have a fairly large number of studies here. It's murky. My take is if there is a harm, it's really small.
Speaker 1:All right, here's Dr Bobby's solution to the problem. Remember that, eating the leafy vegetables, those nitrates seem fine and the argument is that they also have vitamin C. All right, how about this one? When you have your bacon? Have a glass of orange juice which has vitamin C. All right, how about this one? When you have your bacon? Have a glass of orange juice which has vitamin C. Now you'll have your nitrates, your vitamin C and all should be well with the world.
Speaker 1:This is completely untested. It's just Dr Bobby's opinion and theory. It's consistent with some of the arguments that you've heard me talk about. Do let me know what you decide on this important question of to eat bacon or to not eat bacon. Until next time, please, let's all try to live long and well. Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobbilivelongandwellcom. That's, doctor, as in D-R Bobby. Live long and wellcom.