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Does milk fight bowel cancer

The study was carried out by researchers from University of Otago Medical School, New Zealand. Funding was provided by Genesis Oncology Trust, the Dean’s Bequest Funds of the Dunedin School of Medicine, the Gisborne East Coast Cancer Research Trust and the Director’s Cancer Research Trust. The research was published in the peer-reviewed American Journal of Epidemiology. This was a case-control study in New Zealand that compared a group of adults with bowel cancer, and a group without bowel cancer, and looked at whether they drank milk at school. School milk was freely available in most schools in New Zealand until 1967 when the government programme was stopped. Many schools in the Southland region stopped free milk as long ago as 1950.

Case-control studies are appropriate for looking at whether people with and without a disease have had a particular exposure (milk in this case). The difficulty is in accounting for all potential confounding factors, particularly other health and lifestyle factors, which could be related to both diet and bowel cancer risk, for example regular childhood milk consumption could be a reflection of a ‘healthy’ diet and other healthy lifestyle behaviours that may reduce risk of cancer. In addition, when examining such a specific dietary factor – ie milk consumed in school – it is difficult to account for all possible milk or other dairy products consumed outside of school.

In this case-control study, 562 adults (aged 30 to 69) with newly diagnosed bowel cancer were identified from the New Zealand Cancer Registry in 2007. For a control group, 571 age-matched adults without cancer were randomly selected from the electoral register. All participants were mailed a questionnaire that asked about any previous illness, use of aspirin or dietary supplements in childhood, participation in school milk programmes, other childhood milk consumption, childhood diet (including other milk and dairy), smoking, alcohol consumption prior to 25 years of age, screening tests for bowel cancer, family history of cancer, education and sociodemographic characteristics. Childhood weight and height were not questioned. For school milk consumption they were specifically asked:

  • Whether they drank school milk
  • How many half-pint bottles they drank a week
  • What age they first drank school milk
  • When they stopped drinking school milk

Statistical risk associations between school milk participation and cancer were calculated. The calculations took into account several risk factors for bowel cancer risk including age, sex, ethnicity and family history.

What were the basic results?

Data on school milk consumption was available for 552 cases and 569 controls. As expected, people who started school before 1967 were more likely to have had free school milk than those who began school after 1968. Seventy-eight percent of cases participated in the school milk programme compared with 82% of controls. School milk consumption was associated with a 30% reduced risk of developing bowel cancer (odds ratio 0.70, 95% confidence interval 0.51 to 0.96).

When looking at the effect of number of bottles consumed per week they found that compared with no bottles, five bottles per week was associated with 32% significantly decreased risk, and 10 or more bottles with 61% significantly decreased risk. However, there was no significant association with one to four bottles or six to nine bottles. The researchers found a similar trend when the total school consumption of milk was compared with no consumption: 1,200-1,599 bottles was associated with 38% significantly decreased risk; 1,600-1,799 with 43% decreased risk; and 1,800 or more bottles associated with 38% significantly decreased risk. There was no significant association with fewer than 1,200 bottles. The researchers calculated that for every 100 half-pint bottles consumed at school there was a 2.1% reduction in the risk of bowel cancer. Outside of school, there was a significantly reduced risk of bowel cancer with more than 20 dairy products a week compared with none to nine dairy products a week.

The researchers conclude that their national case-control study ‘provides evidence that school milk consumption was associated with a reduction in the risk of adult colorectal cancer in New Zealand. Furthermore, a dose-dependent relation was evident’. This study has strengths in its relatively large size, its reliable and nationally representative identification of cases and controls, and its thorough data collection. However, the conclusion that school milk consumption is associated with a reduced risk of bowel cancer in adulthood must be interpreted in light of a number of considerations:

The analysis took into account established risk factors for bowel cancer including age, sex, ethnicity and family history. However, many other potential confounders were not considered, including diet, physical activity, overweight and obesity, smoking or alcohol consumption. Diet in particular has been implicated in bowel cancer risk, with diets high in saturated fat, red meat and processed foods and low in fibre, fruit and vegetables thought to increase risk. Potentially, any of these lifestyle behaviours could be confounding the relationship between school milk consumption and bowel cancer and regular childhood milk consumption could be a reflection of a ‘healthy’ diet and other healthy lifestyle behaviours that reduce risk of cancer. When looking at the effect of number of bottles consumed per week, the researchers found that, compared with no bottles, five bottles were associated with 32% significantly decreased risk and 10 or more bottles with 61% significantly decreased risk. However, there was no significant association with one to four bottles or six to nine bottles. Therefore, the trend here is not very clear. Particularly as only 16 cases and 31 controls drank 10 or more bottles a week, statistical comparison between such small numbers should be viewed with caution. With many food questionnaires there is the potential for recall bias. For example, adults may have difficulty remembering how many bottles of school milk they drank many years before. When estimating their average weekly amount, it is highly possible that this could be inaccurate or that their consumption varied slightly from week to week and year to year. Particularly when researchers were using this response and combining it with the number of weeks in the school year and their total years at school to give a total number of bottles consumed at school (figures in 100s or 1,000s), there is the possibility of being incorrectly categorised. Hence, there may be less reliability when calculating risk according to the category of total milk bottles consumed. Cancer prevalence, and particularly environmental and lifestyle risk factors for cancer, can vary between countries. These findings in New Zealand may not be represented elsewhere. Of note, the researchers acknowledge that a cohort study in the UK found the opposite: increased childhood dairy consumption was associated with increased risk of bowel cancer. Case-control studies are most appropriate for looking at rare diseases, where you would expect there to be only a small number of cases developing among a large number of people. In the case of bowel cancer, which is common, the slightly more reliable cohort design could have also been used, where children who drank milk at school and those who didn’t were followed over time to see if they developed cancer. However, such a cohort would consequently need extensive long-term follow-up.

The possible association between milk/dairy consumption, or calcium intake, in childhood, or in later years, is worthy of further study. However, from this study alone, it cannot be concluded that school milk prevents bowel cancer later in life.

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Fish diet lowers risk of stroke

Fish diet lowers risk of stroke

Women who eat more than three servings of fish per week are less likely to experience a stroke, a new study suggests. Specifically, fish-lovers in Sweden were 16 percent less likely to experience a stroke over a 10-year-period, relative to women who ate fish less than once a week. “Fish consumption in many countries, including the U.S., is far too low, and increased fish consumption would likely result in substantial benefits in the population,” said Dr. Dariush Mozaffarian of the Harvard School of Public Health. When choosing fish to eat, it’s best to opt for fish that are rich in omega-3 fatty acids, found most abundantly in fatty fish like salmon, mackerel and albacore tuna. “But any fish is better than none,” Mozaffarian noted.

 

fish

 

“Indeed, these fatty acids likely underlie the benefits of fish on stroke risk”, said study author Dr. Susanna Larsson of the Karolinska Institute in Stockholm. “These fatty acids may reduce the risk of stroke by reducing blood pressure and blood (fat) concentrations.”

This is not the first study to suggest that people who eat more fish have a lower risk of stroke, and experts already recommend a fishy diet to reduce the risk of cardiovascular problems, Mozaffarian added. “This study supports current recommendations.” Earlier this year, for instance, a study showed that middle-aged and older men who eat fish every day are less likely than infrequent fish eaters to develop a suite of risk factors for heart disease, diabetes and stroke.

In the current study, published in the American Journal of Clinical Nutrition, Larsson and her colleagues looked at 34,670 women 49 to 83 years old. All were free of cardiovascular disease and cancer at the beginning of the study, in 1997. During 10 years of follow-up, 1,680 of the women (4 percent) had a stroke. Stroke caused by blockage of an artery that supplies blood to the brain — also known as a “cerebral infarction” or “ischemic stroke” — was the most common event, representing 78 percent of all strokes in the study. Other types of strokes were due to bleeding in the brain, or unspecified causes.

Women who ate more than three servings of fish per week had a 16 percent lower risk of stroke than women who ate less than one serving a week. “Not a small effect,” Mozaffarian said, noting that it was roughly equivalent to the effect of statin drugs on stroke risk. Furthermore, the researchers asked women about their diets only once, using a questionnaire, which might have caused errors that would underestimate the link between a fishy diet and stroke risk, he explained. “So, the true risk reduction may be larger.”

Interestingly, women appeared to benefit most from eating lean fish, when other research shows fatty fish is better for health. This finding may stem from the fact that most fatty fish, such as herring and salmon, is eaten salted in Sweden, Larsson explained. “A high intake of salt increases blood pressure and thus may increase the risk of stroke,” she said. “So the protective effects of fatty acids in fatty fish may be attenuated because of the salt.”

Indeed, when it comes to fish, not all have equal benefits, Mozaffarian noted – for instance, he said, research has not shown any cardiovascular benefits from eating fast food fish burgers or fish sticks. In addition, women of childbearing age should avoid certain types of fish known to carry relatively high levels of pollutants, such as shark and swordfish, Mozaffarian cautioned. “This is a very, very short list of fish to avoid or minimize — there are many, many other types of fish to consume,” he said. “Women at risk of stroke are generally beyond their child-bearing years, and so for these women, all types of fish can be consumed.”

Larsson and her team speculate that certain nutrients in fish, such as fatty acids and vitamin D, might explain its apparent benefits. The Swedish study cannot prove cause and effect for high fish consumption and lowered stroke risk, however. For instance, fish consumption could be a sign of a generally healthier lifestyle or some other mechanism at work. Last December, Larsson and colleagues published data from the same group of women in the journal Stroke showing that those who eat a lot of red meat may also be putting themselves at increased risk of stroke.

SOURCE: bit.ly/dKunk8 American Journal of Clinical Nutrition, online December 29, 2010.

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Stroke deaths higher where fried fish aplenty

The steep rate of death from stroke in a swath of Southern states often referred to as America's “stroke belt” may be linked to a higher consumption of fried fish in that region, new research suggests. A study published in the journal Neurology shows people living in the stroke belt — which comprises North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas and Louisiana — eat more fried fish and less non-fried fish than people living in the rest of the country, and African-Americans eat more fried fish than Caucasians. “Differences in dietary fish consumption, specifically in cooking methods, may be contributing to higher rates of stroke in the stroke belt and also among African Americans,” says study author Fadi Nahab, medical director for the Stroke Program at Emory University Hospital in Atlanta.

The research, part of a large government-funded study, Reasons for Geographic and Racial Differences in Stroke (REGARDS), involved 21,675 participants from across the country; the average age was 65. Of the participants, 21% were from the “stroke buckle,” the coastal plain region of North Carolina, South Carolina and Georgia where stroke mortality rates are even higher than they are in the rest of the stroke belt. Another 34% were from the rest of the stroke belt and 44% were from the other states.

Participants were interviewed by phone and then given an in-home physical exam. The questionnaire asked how often they ate oysters, shellfish, tuna, fried fish and non-fried fish. The American Heart Association recommends people eat fish high in omega-3 fatty acids—essential fatty acids humans get through their diet—at least twice a week, baked or grilled but not fried. Fewer than one in four overall ate two or more servings of non-fried fish a week. Stroke belt residents were 32% more likely to eat two or more servings of fried fish each week than those in the rest of the country.

African-Americans were more than 3.5 times more likely to eat two or more servings of fried fish each week than Caucasians, with an overall average of about one serving per week of fried fish compared with about half a serving for Caucasians. When it came to eating non-fried fish meals, stroke belt residents ate an average of 1.45 servings per week, compared with 1.63 servings eaten by people elsewhere.

“This is good stuff. It's a well-done study, but I think one thing to bear in mind is that it's not specifically a study of stroke risk. You're looking at a community and seeing how it's behaving on the whole,” says Daniel Labovitz, a stroke neurologist at Montefiore Medical Center in the Bronx. “This study can't tell you causation. It can't tell you there's a direct link between one thing and another, it just tells you they're associated,” says stroke neurologist Victor Urrutia, an assistant professor at Johns Hopkins University School of Medicine.

How might eating fried fish impact stroke?

It could be that frying the fish leaches out the omega-3s, says Jeremy Lanford, stroke director at Scott & White Healthcare in Roundrock, Texas. Or the increased fat calorie content from the frying oil may contribute to stroke, says author Nahab. He also notes that fish used for frying, such as cod and haddock, tend to be the types lower in healthy fats. More research is needed to tease out whether cooking methods affect stroke risk, Labovitz says. “In other words, is fried fish a problem, or is it another red herring?” he says.

The study was supported by the National Institute of Neurological Disorders and Stroke, the National Institutes of Health, and the Department of Health and Human Services. Funding was provided by General Mills for coding of the food frequency questionnaire.

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Diabetes Risk from Dining Out

A GOURMET meal may be as bad for you as a Big Mac, according to diabetes researchers who are alarmed at the rise in young men diagnosed with the disease.Corporate lunches and dinners at restaurants dishing up rich, fatty foods, coupled with sedentary working lives are being blamed for the trend. Dr Neale Cohen, of the Baker IDI Heart and Diabetes Institute, said many patients were unaware meals at upmarket restaurants were often as high in fat, salt and sugar as fast food. 

''Eating out is really code for eating badly,'' Dr Cohen said. ''Whether it's a fine French restaurant or McDonald's, it's the type of food that causes the problem.'' He said doctors at the institute are seeing men as young as 40 affected by type 2 diabetes, which is often triggered by obesity and linked to poor diet. ''Many of my patients will eat out three or four times a week for work and we are seeing 40-year-old businessmen who are in real trouble. To have diabetes at that age and otherwise be perfectly well with very little family history, is a really worrying thing.''

Dr Cohen recommends his patients only eat out once a week but said the ''MasterChef effect'' was encouraging people to re-create the elaborate dishes at home.

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Meal replacements may not help teens keep weight off

A new study at the Children's Hospital of Philadelphia found that meal replacements like shakes, bars and prepackaged entrees aren't a good long-term solution for obese teens. For the new study, researchers randomly assigned 113 obese teens and their families to different diets for a year. One group of teens ate self-selected low-calorie meals not exceeding 1,300 to 1,500 total calories per day. The other group ate meal replacements (three SlimFast shakes and one prepackaged entree), along with five servings of fruits and vegetables. Four months into the study, participants in second group were randomized to a second-phase diet: some were put on the low-calorie self-selected diet, while the rest stayed on meal replacements.

At the four-month mark, all participants had lost weight, but the teens on meal replacements lost more — a 6.3% reduction in body mass index (BMI) versus 3.8% for the low-calorie group. But by the end of the one-year study, many participants had regained much of the weight they had lost, resulting in no significant differences in weight loss between the groups: on average, the teens had reduced their BMI 3.4% since the beginning of the study.

The results underscore one of the many difficulties of dieting: keeping the weight off long term. Many dieters regain weight because they can't stick to rigid eating programs for long: one-third of the participants in the current study dropped out before its conclusion. The monotony of the meal-replacement diet couldn't have helped either: teens in the meal-replacement group started out drinking SlimFasts 5.6 days a week (in Month 2); by the end of the study, they were only able to tolerate the shakes 1.6 days each week.

“The potential benefit of (meal replacement) in maintaining weight loss was not supported,” the researchers concluded. So for those of you who are gearing up to begin a weight-loss program in the New Year, it helps to remember that austerity isn't the best strategy long-term. Focus on variety — both with your diet and your exercise regimen — and manageability instead. A regular visit with Nastaran can ensure that you stay on track and keep the weight off long term.

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Chocolate reduces effect of Chronic Fatigue Syndrome

Chocolate reduces effect of Chronic Fatigue Syndrome

Researchers from the University of Hull and the Hull York Medical School have found dark chocolate has a significant effect on reducing the symptoms of Chronic Fatigue Syndrome (CFS). The research, published in Nutrition Journal, found that polyphenol rich chocolate eases the condition, with subjects noting significant improvements to their well-being. Chocolate is known to increase neurotransmitters like phenyl ethylamine, serotonin, and anandamide in the brain, but this is the first time that polyphenol rich chocolate in people with CFS has been studied.

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Above: Professor Steve Atkin.

Subjects with CFS having severe fatigue of at least 10 out of 11 on Chalder Fatigue Scale were enrolled on the pilot study. Participants were given one of two types of chocolate, one with a high cocoa content and the other without.

Over an eight week period the volunteers consumed one type of chocolate followed by a two week wash out period and then another eight weeks of eating the other variety. The dark chocolate contained 85% cocoa solids with the alternative containing none. Each individual bar weighed 15g with each volunteer expected to eat three per day, and also told not to consume more or make changes to their diet.

Researchers also noted the weight of subject did not significantly alter despite consuming an extra 245 calories per day for two months.

Professor Steve Atkin who led the study says: “The significance of the results is particularly surprising because of the small number of subjects in the study. A further study is needed to see what the effects would be on a larger group of people, but this is potentially very encouraging news for those who suffer from Chronic Fatigue Syndrome.”

This latest finding follows recent research also carried out at the University of Hull and the Hull York Medical School where dark chocolate was found to help reduce the risk of heart attacks in people with Type 2 diabetes by increasing the amount of good cholesterol in the blood stream.

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Diabetes may be linked to air pollution

Cardiovascular and lung researchers at The Ohio State University Medical Center are the first to report a direct link between air pollution and diabetes. If the ongoing research continues to confirm this association, scientists fear human health in both industrialized and developing countries could be impacted.

“We now have even more compelling evidence of the strong relationship between air pollution and obesity and type II diabetes,” said Dr. Sanjay Rajagopalan, section director of vascular medicine at Ohio State's medical center and principal investigator of the study. The latest study builds upon previous research from Rajagopalan's team implicating air pollution as a major adverse risk factor for cardiovascular effects, high blood pressure and acute coronary syndromes.

Researchers found that exposure to air pollution, over a period of 24 weeks, exaggerates insulin resistance and fat inflammation. The results of the study are available online in the current issue of Circulation. “The prevalence of obesity has reached epidemic proportions with 34 percent of adults in the U.S., ages 20 and over, meeting the criteria for obesity,” said Rajagopalan. “Obesity and diabetes are very prevalent in urban areas and there have been no studies evaluating the impact of poor air quality on these related conditions until now.”

Type II diabetes, a consequence of obesity, has soared worldwide with a projected 221 million people expected to suffer from this disease in 2010, a 46 percent increase compared to 1995.

In the Ohio State research, scientists fed male mice a diet high in fat over a 10-week period to induce obesity and then exposed them to either filtered air or air with particulate matter for six hours a day, five days a week, over a 24-week period. Researchers monitored measures of obesity, fat content, vascular responses and diabetic state. The air pollution level inside the chamber containing particulate matter was comparable to levels a commuter may be exposed to in urban including many metropolitan areas in the U.S.

According to the U.S. Environmental Protection Agency, the four most common pollutants emitted into the air are particulate matter, ozone, nitrogen dioxide and sulfur dioxide. Air pollution is commonly the result of industrial emissions, power plants and automobile exhaust.

“This study provides additional guidance for the EPA to review air pollution standards,” says Rajagopalan. “Our study also confirmed a need for a broader based approach, from the entire world, to influence policy development.”

Dr. Qinghua Sun, first author of the study, is leading an international effort to understand the effects of urban air pollution in Beijing, where the impact of recent stringent measures on air quality during the Olympics is being monitored in another controlled experiment. Researchers at the University of Michigan and the New York University School of Medicine participated in the study. Along with Rajagopalan and Sun, other Ohio State researchers involved in the study were Peibin Yue, Jeffrey A. Deiuliis, Thomas Kampfrath, Michael B. Mikolaj, Ying Cai, Michael C. Ostrowski, Bo Lu, Sampath Parthasarathy and Susan D. Moffatt-Bruce.

Funding from the National Institutes of Health supported this research.

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Link between diet soft drink and preterm delivery

Could drinking one or more artificially sweetened, carbonated diet sodas a day boost a woman's odds of premature delivery? A new study from Denmark suggests such a link.dblclick('xxlA');

The researchers looked at the soft drink habits of nearly 60,000 Danish women enrolled in a national study there from 1996 to 2002. The investigators found a link between the intake of diet carbonated drinks and, to a lesser extent, diet noncarbonated drinks and delivering a baby early.

The study is published online and in the September print issue of the American Journal of Clinical Nutrition. In the report, the researchers conclude: “Daily intake of artificially sweetened soft drinks may increase the risk of preterm delivery.”

The researchers defined preterm as delivering before 37 weeks' gestation. They categorized the women into groups depending on beverage drinking habits: those who never drank soft drinks or those who drank less than one per week, one to six per week, one each day, two or three per day, or four or more daily. In all, 4.6 percent of the women delivered early, and one-third of those deliveries were medically induced. The team found no association between the premature delivery and the intake of carbonated drinks sweetened with sugar.

However, compared with those who never drank the beverages, women who downed four or more diet (artificially sweetened) carbonated drinks a day were 78 percent more likely to deliver early than women who never drank the beverages. And those who had four or more diet, noncarbonated drinks daily were 29 percent more likely to deliver early. Those who had one or more carbonated diet drinks a day were 38 percent more likely to deliver early.

Why the diet drinks, especially, were linked with early delivery is not known, but the researchers speculate that the link may be driven by high blood pressure disorders in pregnancy. They note that other studies have found a link between soft drinks and high blood pressure in non-pregnant women.

 

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School Lunch

What should a parent do when a child only wants to buy school lunch and it isn't healthy, or a child is bored with the lunches you pack from home? And really, does one meal a day make a difference? Yes. When kids get used to eating high fat food, this can form a long-term habit (fat does taste good). The time to set permanent healthy behavior is early and reinforcing during school is no exception.

Depending on the age of your child, have her help plan lunch or even prepare part of it. This can be done just once or twice a week to get your child involved.

Remember that children love to get out and play and sometimes will eat very little so they can have more time on the school playground. Packing a snack for early or late recess may be a good idea (peanuts and cashews are full of fiber and protein). Don't be upset with them if their lunch is only half consumed. She is just a social butterfly. Offer sliced peaches and plain yogurt when she gets home. Make a fruit smoothie with your son using frozen fruit, vanilla yogurt, and milk.

Talk to your child about the lunch program and help him choose a healthy option. Although it is quite convenient not to pack a lunch, try a bag lunch at least two times a week. For older kids this can help your budget as kids who can go off campus can spend a lot on lunch (of questionable nutritional value).

Healthy things to pack:

  • Edamame (soybean) or sugar snap peas (good source of protein)
  • Cube cheese and offer it on a toothpick
  • Trail mix (nuts, dried cranberries stick pretzels)
  • Sliced mango, kiwi, or apples (use orange juice to help prevent browning)
  • Vanilla yogurt with raspberries and granola or nuts on top (place it in a small plastic container (use an ice pack to keep it cold)
  • Use leftover chicken from dinner last night and make a sandwich vs. processed sandwich meat which is high in sodium (salt)
  • Use a cookie cutter to shape sandwiches into hearts, flowers, etc (young kids love to eat fun-shaped sandwiches)
  • Open faced bagel with cream cheese and a face (use raisin for the eyes, a cashew for the nose etc.)
  • Peanut butter and banana sandwich – apples will work too.
  • Fresh mozzarella cheese in a tortilla
  • Use a thermos in the cold months and fill it up with soup or pasta with a little bit of chicken broth for added taste
  • Cereal. Just make sure it is high in fiber (5 grams) and low in sugar (under 10 grams). Provide a container with a top and a spoon; your child can add the milk provided at school.

This family wellness article is provided by Nourish Interactive, visitwww.nourishinteractive.com for nutrition articles, family wellness tips, free children's healthy games, and tools. Available in English and Spanish.

Copyright ©2009 Nourish Interactive – All Rights Reserved.

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Designer diet for prostate cancer

Previous studies have suggested that the fifty percent of the population who have a GSTM1 gene gain more benefit from eating broccoli than those who lack this gene. The study showed that the presence of the GSTM1 gene had a profound effect on the changes in gene expression caused by eating broccoli.

This study fills the gap between observational studies and studies with cell and animal models. While observational studies have shown that diets rich in cruciferous vegetables may reduce the risk of prostate cancer and other chronic disease, they do not provide an explanation of how this occurs. Evidence from animal and cell models has sought to provide an explanation, but these studies are usually based on high doses that would not normally be experienced as part of the diet.

The results of the study suggested that relatively low amounts of cruciferous vegetables in the diet – a few portions per week – can have large effects on gene expression by changing cell signalling pathways. These signalling pathways are the routes by which information is transmitted through a molecular cascade which amplifies the signal to the nucleus of the cell where gene expression occurs.

The Norwich team are currently planning a larger study with men with localised prostate cancer, and will compare the activity of standard broccoli with the special variety of high glucosinolate broccoli used in the current study.

Designer studies for health promotion

“Other fruits and vegetables have been shown to also reduce the risk of prostate cancer and are likely to act through other mechanisms,” says Professor Mithen.

“Once we understand these, we can provide much better dietary advice in which specific combinations of fruit and vegetable are likely to be particularly beneficial. Until then, eating two or three portions of cruciferous vegetable per week, and maybe a few more if you lack the GSTM1 gene, should be encouraged.”

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