ZACH: Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I've worked in multimedia and television for over 15 years – and I'm also a longtime podcaster.

 

KATIE: I'm Katie McCallum. I'm a former researcher turned health writer, mostly writing for our blog.

 

ZACH: And Katie, you know, it’s 4^th of July and what else says 4^th of July like a nice hotdog?

 

KATIE: Yep, yep. I think for myself it’s not the first place my mind goes. I’m kinda like a hotdog 365 days of the year kinda person to be honest.

 

ZACH: Wow, okay.

 

KATIE: Yeah I love hotdogs, but I get the connection. It actually reminds me of a Legally Blonde 2 quote when Jennifer Coolidge sees her all dressed up in red, white and blue, and she’s like, “Oooh, you look like the 4^th of July. It makes me want a hotdog.”

 

ZACH: [Laughter] And you know, I never saw Legally Blonde 2.

 

KATIE: Okay, well yeah, obviously like sequels are never as good as the originals but you know, I mean --

 

ZACH: Well, that’s its own conversation.

 

KATIE: Yeah, it’s funny, it’s funny enough. Anyways, yeah, I mean, I think hotdogs are a big staple in the 4^th of July kinda party food line up.

 

ZACH: Yeah, you know, just like the summer cookout, right? And you have people over in the backyard, you cook up some hotdogs, you cook up some hamburgers, cook up a lot of processed meat.

 

KATIE: Yeah, processed meat, that is what hotdogs are, it turns out. I don’t think I’d really consider the term “processed meat” ‘til I started writing for our blog and I hear doctors say, “Limit processed meat,” and I’m like,” What is that?” and then he was like, “Oh, all the delicious meats: hotdogs, bacon, things like that. We’re gonna talk about them today which -- This is a bit of a fearful interview for me I would say.

 

ZACH: 365 days, you’re a hotdog person, you are. How many hotdogs do you really eat, you think? How many on the average?

 

KATIE: I don’t even know, Zach --

 

ZACH: I mean, that’s a scary answer.

 

KATIE: Yeah, that’s what I mean. I’m coming into this interview a little fearful of what we’re gonna find out. That being said, I am a person who likes to like, expect the worst so that when it’s not the worst or it’s not as bad as I’m thinking, I’m like, “Okay, some silver lining.” So, I’m kind of headed into this episode with that mindset, I think, for sure.

 

ZACH: Okay. You know, I’m more like a hamburger guy. Like, if you had to pick between the two of them. If I’m at, like, a friend’s party and there’s a platter of hotdogs and platter of hamburgers, I gravitate toward the hamburger.

 

KATIE: I’m probably doing both, to be honest. Hotdog and a hamburger. Those are just my, those are my -- I don’t even wanna call em’ guilty pleasure foods because I wanna wait for someone to tell me that they’re horrible for me. But love hamburgers, love hotdogs, love sausage. I also love bacon, love a good charcuterie board. And just to be clear, hamburgers are not processed meat. So --

 

ZACH: So, I’m in the clear?

 

KATIE: Yeah, well red meat, which that’s a whole topic for a different day, I think here, but --

 

ZACH: I like my meat probably about medium.

 

KATIE: What do you mean? Medium like cooked or?

 

ZACH: Yeah, what else am I, would I be referring to?

 

KATIE: I don’t know. I don’t know. You can’t really cook a hotdog medium.

 

ZACH: Like you’re talking about rare meat. I’m talking about --

 

KATIE: Oh, red meat. I said, “red meat.” [Laughter] But that’s actually one of the nice things about hotdogs, especially at a cookout or something, is that you can’t get anyone sick, like, they’re already cooked, you’re just heating them up to re-serve. So, anytime I’m having like, I’m grilling for a bunch of people, I get -- I mean, I think we’ve talked about this before. Former microbiologist. I get very in my head about food safety especially when I’m serving a bunch of people. And ground beef is up there for me of like, “I don’t wanna serve a medium rare burger but like a hotdog, you can’t go wrong. I can’t mess that up, it’s already cooked. I can serve them and no one’s getting sick.”

 

ZACH: Well, speaking of cooking techniques. Boiling or grilling on the hotdogs?

 

KATIE: Grilling.

 

ZACH: Thank you --

 

KATIE: Boiling sounds --

 

ZACH: ‘Cause boiled hotdogs, I’m like, whenever I see like a, that pot and like water and hotdogs in ‘em, I’m like uhhh.

 

KATIE: I didn’t realize that was like an option for people to cook them that way until I started like getting ready for this interview and was like, “Oh, people just put em’ in water?”

 

ZACH: I wanna see -- I wanna see grill marks on my hotdogs otherwise I’m not eating it.

 

KATIE: They gotta get like a little shriveled and like, you want a little bit of the burned ends, and I also don’t know that I prefer them when they’re on those like, those rotating, rotisserie style things.

 

ZACH: Yeah. Like at a gas station?

 

KATIE: Yeah, or in ballparks, it’s like, I need a grill.

 

ZACH: That’s another reason, like, I don’t know like --

 

KATIE: Yeah.

 

ZACH: Hamburgers probably. I mean, we’ll have our own conversation about beef one day on the podcast, so --

 

KATIE: Someday, we probably do need to talk about it.

 

ZACH: I’ll be in your chair there but for today, we’re talking about your problem with hotdogs and processed meat. Who are we talking to?

 

KATIE: We’re gonna talk to Dr. Millien. She is a gastroenterologist here at Houston Methodist and as you kinda pointed it out, we’re gonna talk about my hotdog problem.

 

[Sound effect signaling beginning of interview]

 

We’re here with Dr. Millien, gastroenterologist at Houston Methodist. Thanks for being here with us today, Dr. Millien.

 

DR. MILLIEN: Thanks for having me. I’m excited.

 

KATIE: We’re gonna talk about processed meat today. I have myself heard that processed meats should be limited but I’ve never really heard why that is in particular, and it’s something pretty near and dear to my heart ‘cause I’m a pretty big fan of hotdogs, also a pretty big fan of a charcuterie board.

 

DR. MILLIEN: Ah yes, yes, very classy.

 

KATIE: Yeah, I think when I, when I first read, they should be limited, I was like, “Okay, you like file it away,” but then, you keep hearing it, and so, you know, we’re gonna get into what makes processed meat, quote unquote “Bad for us,” today. To start though, could you just define for us what processed meat is?

 

DR. MILLIEN: Yes, yes, absolutely. I love hotdogs but I love bacon even more, so we will talk a little, we’ll talk a little bit about these things. But processed meats are basically the kind of meats that have been transformed by several processes. So, these processes include curing, salting, smoking, and specifically they’ve undergone through this process in order to preserve them, so they can have a longer shelf life. It’s also important for them in terms of their taste and maintaining their color. So, most usually is just the transformation process that defines what these foods are.

 

KATIE: Gotcha. And maintaining color sticks out to me as kind of like, “Okay, so something needs to be added to them to maintain color.”

 

DR. MILLIEN: Yes, yes, yes, absolutely.

 

KATIE: Always sounds a bit of a warning sign. 

 

DR. MILLIEN: Absolutely yeah. The chemicals that they use are specific chemicals to make sure that the color stays. When your ham looks pink --

 

KATIE: Oh my gosh.

 

DR. MILLIEN: It’s actually artificially pink, yes, absolutely.

 

KATIE: Okay, yeah, I didn’t know that actually. It makes sense as you’re saying it, but should clue you in maybe to where they fall in the health spectrum right there, nothing else.

 

DR. MILLIEN: Absolutely, yeah.

 

KATIE: So, you just mentioned ham, what else counts as processed meat? ‘Cause I know in my mind, hotdogs seems obvious but what’s the, what’s the spectrum of meats here that are included?

 

DR. MILLIEN: So, it incudes, yes, absolutely hotdogs, bacon is part of that, bologna, a lot of deli meats that you eat are a part of the processed meats, and then your pepperonis on your pizza and the sausage. You know, your meat lovers pizza. Those meats that they use in those pizzas are also considered processed meats.

 

KATIE: Okay, yeah, so a lot of the most delicious meats.

 

DR. MILLIEN: Absolutely, yeah.

 

KATIE: [Sighs] It seems to be how it goes --

 

DR. MILLIEN: That’s right. You can’t -- Health is not fun, I guess.

 

KATIE: So, when we talk about why they’re, quote unquote, “Bad for us,” I think what I have generally read is that processed meats are linked to cancer so much so that the World Health Organization classifies them as a Group 1 carcinogen.

 

KATIE: Yes.

 

DR. MILLIEN: Which is incredibly concerning when I learned that the other kind of two obvious things on that list are tobacco smoke and asbestos.

 

DR. MILLIEN: Yes.

 

KATIE: What is, what is your take on that sort of classification because to me, I hear, in my mind I hear, “If it’s grouped with asbestos and cigarette smoke like that, I shouldn’t have that anywhere near my body.”

 

DR. MILLIEN: Yeah, yeah. No, that’s true. So, one of the reasons why -- Like they said, these are transformed meats, right? So, they don’t occur naturally and it’s the chemicals specifically that are used in them that cause them to be carcinogenic. So, there are chemicals that are used in the process that result in production of nitrates and nitrites, and we’ll talk a little bit more about that, but the nitrates and nitrites once they’re exposed to high heat or the acid in your stomach, for example. They start producing different chemicals, and so, one of the chemicals that we know is something called nitrosamine and that one is known as a carcinogen. So, back in the early 2000’s, interestingly, people started getting more and more interested in this role of this processed meats and what they did, and evidence started coming out that the nitrates and nitrites within them are actually the ones that ended up causing the carcinogenic effects that now we know are associated in cancers, including not only colon cancer, which we’re talking about today, but also things like pancreatic cancer, and interestingly also in ovarian cancers. They’re pretty dangerous.

 

KATIE: Got you.

 

DR. MILLIEN: As we’re getting to know more and more about them.

 

KATIE: And so, is this a pretty strong link in that -- I mean, would you say for instance -- I’m just thinking of myself here.

 

DR. MILLIEN: Yeah.

 

KATIE: As I mention, I love hotdogs. I probably ate a hotdog almost every day in college for four years.

 

DR. MILLIEN: Yes.

 

KATIE: So, is this something like, you know, previous smokers need to tell their doctors, “Hey, I have an extended history of eating a lot of hotdogs. Do I need to be worried about my cancer risk?”

 

DR. MILLIEN: Yeah. So, you know, we’ve, we’re getting better and better about discussing not just genetic risks but also dietary, environmental risks when we talk about cancers, right? So, when you come to see me, for example, for colon cancer screening, I’ll ask you about a family history and maybe I’ll ask you about your cigarette, tobacco use because we know these are risks. We’re not very good at asking about dietary risks and I think we’re getting to the point where we’re staring to look at that more, especially when you’re talking about eating hotdogs every day in college as we’re seeing increased rates of younger people developing colon cancer, we’re starting to look at to see what the role environmental factors are playing in dietary factors, most certainly. So, it is, it’s serious enough, first of all, for the World Health Organization to look at the evidence and to say that this is a carcinogen but it’s also serious enough that once that recommendation came out, countries like France started recommending removing nitrate-containing foods from the market, so it is a serious enough risk, and studies are strong, have strongly linked it to cancer.

 

KATIE: Yeah, you mentioned nitrates a few times now. I wanted to dig into those a little bit more. So -- You talked about how the nitrates and when they’re exposed to high heat creates some scary molecules. Maybe your gut is also able to digest them into scary things. When there’s processed meat that’s quote, unquote, “nitrate-free,” does that mean it’s not as worrisome? Or are there other things about processed meat that’s there that could be bad for us?

 

DR. MILLIEN: So, the idea of, “nitrate-free,” is very misleading --

 

KATIE: Okay.

 

DR. MILLIEN: You know? It’s a marketing -- There’s a lot of marketing that goes into some of these things, so studies have shown that when you even look at the nitrate-free products, they do have actually similar levels of nitrates and nitrites as compared to processed, nitrate containing foods. And then, the biggest thing is -- the FDA, for example regulates when you talk about labeling things, and that’s the Food and Drug Administration, how you label things. So, companies have found out that when you label something containing nitrates, there’s added, a natural nitrates. So, when you say, “nitrate,” or “nitrite-free,” basically you get around by that by just saying, “It’s nitrite-free but it actually contains natural nitrates from products like celery,” right?

 

KATIE: Okay.

 

DR. MILLIEN: So, the body doesn’t go, “Huh, this is a natural nitrate, it’s okay, and this is an unnatural one.” The body just sees this compound that was transformed and breaks it down, and causes the same kind of effect. So, long story short is avoiding processed foods in general, doesn’t matter if they’re nitrate-containing or nitrate-free, is actually the best way to go.

 

KATIE: Gotcha. A question I have for you, is the risk of eating processed meat and the risk of cancer, is this pretty -- Do we know if it’s equal for everyone? Or is this something where if you have a family history of cancer, maybe your risk is higher, if you have GI issues already is your risk higher? Do we know anything?

 

DR. MILLIEN: That’s an excellent question, actually. So, we know that umbrella risk 50 grams of processed meat a day increases your risk of colorectal cancer by 18%.

 

KATIE: Wow.

 

DR. MILLIEN: I like to tell people about what we call a “toothache hypothesis,” right? There is one risk, we know that this increased risk by eating processed meats, but then there is the other risk that we also talk about. So, exactly, you hit the nail on the head. Family history of colon cancer as a baseline increases the risk of colon cancer. Doesn’t mean that you’re gonna get it but it is that increased risk. People who have also ulcerative colitis have an increased risk of colon cancer. Smokers have an increased risk. So, they have that baseline increased risk but now you had the second hit which is that dietary component, and so now you’re adding on top of whatever risk you had from these other factors, now you’re additionally compiling another 18% risk. So, there is that idea of additional risk, it’s not just, “Umbrella, you ate processed meat, you’re gonna get colon cancer.” You do have that risk, but then they’re also other factors that make some people a little more at risk than the average pair.

 

KATIE: Right, so, is it fair to say, you know, everybody should be limiting processed meat but those -- First of all, know your family history. If there is a risk of cancer or ulcerative colitis, those people should be even more maybe cognizant of like, “Hey, should I have a second hotdog?” or something like that.

 

DR. MILLIEN: Yeah. Limiting their -- they’re some things that we talk about when you talk about disease in general. They’re some things that are modifiable, right? And then, they’re non-modifiable. I can’t change that my mom gave me curly hair, for example, right? That’s just nothing I can change about that, so it’s the same thing. I can’t change it generically. I inherited genes that put me at risk for colon cancer, so then, the focus becomes on those modifiable factors. Absolutely, you start looking at things that you can change environmental-wise, smoking, processed foods to really try to at least decrease the modifiable risk that can increase your risk of cancer.

 

KATIE: Gotcha. One last question I have for you as in just the aspect of how processed foods affect the intestine, the colon, things like that. Do we know if they also lead to just general GI issues, maybe like IBS, Irritable Bowel Syndrome, or other GI issues, or is the link really just with cancer?

 

DR. MILLIEN: I think, in general, not just the GI tract, when you talk about systemically throughout the entire body. Consumption of processed food does increase inflammation --

 

KATIE: Okay.

 

DR. MILLIEN: Okay? And so, then when you go back to the GI tract, for example, increased inflammation in the colon is what leads to inflammatory bowel diseases for example and so then the question is, “How? How do processed foods do that?” So, one of the ways is just basically some of the chemicals that they do produce during the breakdown process, the digestive process, can break down what we call the mucosal layer which is a protective barrier that’s in the colon. So, once you break that protective barrier, now all of a sudden, bacteria that never had access to the cells within the colon now has access and can result in inflammation as those cells are trying to protect themselves. So, there’s that aspect of it that we talk about. And so, then you see manifestation of things like inflammatory bowel diseases. Then, also some of the chemicals produced by processed foods, for example, can also alter the bacteria within the gut. We know, you know, everybody now talks about my micro biome, “let me fix my micro biome,” so, we know that just things like inflammation that can happen from breakdown of processed foods for example can disrupt some of the good bacteria, the anti-inflammatory bacteria and now, all of a sudden you have the bad bacteria propagating, dividing more. And so, then, those can cause things like the abdominal bloating that some people have, for example, with IBS symptoms. So, certainly, they do have an effect on other things, not just cancer. Now, when you think systemically, you also think about, as I mentioned, pancreatic cancer, ovarian cancer, some of the inflammation that they produce can also cause some of these systemic effects.

 

KATIE: And down that line that inflammation, I think, I also read that there is a connection potentially between processed meats, and even diabetes, and heart disease. Is it that same just chronic inflammation just there causing, wreaking havoc?

 

DR. MILLIEN: Exactly, exactly. So, there is the increase cardiovascular risk that we do see in patients. There is diabetes, yeah, and a lot of it has to with the inflammatory model. So, for example, things like arteriosclerosis, that’s in cardiovascular disease, is associated with inflammation, so, certainly, there is some concern that the contribution of processed food to inflammation can lead to those disease processes.

 

KATIE: I know you’ve been describing theses as transformed meats and things and I think to me, what comes out of that is that they’re unnatural almost, or they’ve been brought to an unnatural state. Is this something where our bodies just prehistorically, we didn’t have to deal with these compounds, they didn’t exist ‘cause they’re manmade in some sense of the word? Or we’re doing something to meat now that’s causing these changes, so, is it that our bodies just don’t know what to do with some of this stuff as well?

 

DR. MILLIEN: I think part of it is that. They don’t -- The body doesn’t know what to do with it. But also, I mean, the body does something with it, it’s just the byproduct of it is the issue, right?

 

KATIE: Okay.

 

DR. MILLIEN: So, for example, nitrates and nitrites that are in these processed meats, and I keep going back on that, they can produce, during their breakdown, they produce things that cause DNA damage, right? So, the body is trying to break down these products you’re giving it, but the byproducts are, for example, DNA-damaging product, that over time cause accumulation of damage over time in general, and that can, we know that accumulation of DNA damage is really key in development of cancer, and this damage happens as you and I are sitting here, we undergo DNA damage, but it also becomes woven to the fiber of our own genetic makeup, and so, over time as generations go on, the cancer risks just keep multiplying, right, because now, that we’ve passed on some of this damaged DNA to the next generation. So, maybe the cavemen did not have access to some of the complex ways that we process our foods now but then over time, as humans, we become more and more sophisticated, we find these ways of processing these foods, and then we introduce these, some of these byproducts into our system, we cause damage. So, each generation just kinda becomes a little bit more vulnerable and more at risk of developing the cancers and it becomes easier for them to develop it just because of generational accumulation risk.

 

[Music plays to signal a brief interjection in the interview]

 

ZACH: Whether at a summer-time-cookout, a ballpark, or even if it’s just a random weeknight, we love hotdogs. In fact, The National Hot Dog and Sausage Council, the NHDSC, yes, that’s a real thing, estimates that during peak hotdog season which spans from Memorial Day to Labor Day, Americans consume about seven billion hotdogs which boils down to over 800 hotdogs each second. They also estimate that Americans will eat 150 million hotdogs on Independence Day alone. They may seem like a simple food, but hotdogs are anything but average to us. Martha Stewart is quoted to have said that she looks for a hotdog everywhere she goes. Betty White, that hotdogs are one of her three favorite foods. And Humphrey Bogart once said that, “A hotdog at a baseball game beats roast beef at the Ritz.” And Katie’s already mentioned the concerning number of hotdogs that she ate during just her college years. All to say, you’re not alone if you find learning that we should cut back on processed meats a bit of a buzzkill but just don’t despair, Dr. Millien shares tips for reframing how we think about processed meat and healthier swaps you can make after the break.

 

[Music ends, sound effect signals commercial break]

 

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KATIE: And we’re back with Dr. Millien.

 

[Sound effect signals return to the interview]

 

We’ve deep-dived into some pretty concerning evidence behind processed meats here and you know, the short phrase of, “Limit processed meats,” I mean, now we know why, now we know how, what they can do to the body.

 

DR. MILLIEN: Yeah.

 

KATIE: I think something that I definitely want to be able to provide our listeners is the realistic aspects that we can take away from this, you know, for, in terms of how much really, you know, what does, “Limit processed,” mean in reality for me? So, in your mind when you’re asking someone to limit processed meat, whether that’s, you know, the amount in one sitting or frequency per week, what does that look like to you?

 

DR. MILLIEN: You know, I’m a big fan of moderation. I think moderation is the key to life. If I tell you to stop eating chocolate, you’re gonna eat it every single day just because it’s gonna be on your mind. And so -- There was a study that came out that said, “Limit your processed meat to about 5.3 ounces,” which is about 150 grams per week, is what they said, but newer evidence is saying we need to go down even lower than that.

 

KATIE: Wow. Okay.

 

DR. MILLIEN: So, let’s say you go this weekend, and you have a barbeque, and you have two hotdogs or you have your burger, and red meat’s a different topic, but you have, for example, you have your burger with bacon on it, for example, that’s not gonna the be the end-all-be-all, right? So, it’s supposed, it’s not about how much processed meat are you eating daily. Are you one of those people who thinks, you know, “I’m healthy, I’m having a salad. I’m putting deli meat every single day,” right? So, it’s more-so maybe once or twice a week, if you allow yourself a hotdog. I don’t think that’s gonna be the issue. Let’s say you go this weekend, and you have three hotdogs, that’s not gonna be an issue, four hotdogs. It’s just limiting how frequently you’re ingesting those products. So, once a week, twice a week, I don’t think it’s an issue, but when you do it every single day, it keeps challenging the body, that when I think it becomes an issue.

 

KATIE: Hearing you talk about this and immediately, my mind is going straight to deli meat and sandwiches because I mean you, deli meat, you mentioned some deli meats are processed, so maybe that’s the first place to start, actually. Is all deli meat processed? Is there any deli meat that’s safe here?

 

DR. MILLIEN: By and large, deli meat is processed, right? And that’s how it maintains in your fridge for weeks and you can ingest it. By and large, a lot of people think things like turkey and chicken, for example, the deli chicken are not processed meats but they actually are. A lot of the topic when we talk about processed meat, we talk about red meats, but we know that turkey, for example deli turkey, deli chicken, is also processed. So, I usually challenge people, it doesn’t taste as delicious, but going to the grocery store, picking up a rotisserie chicken and cutting it up at home. Buying turkey yourself over thanksgiving, roasting it and cutting it up. Over time, you’ll acquire a taste for it, right? The reason processed food is so popular is because we processed it to taste good, right?

 

KATIE: Right, the cheat code.

 

DR. MILLIEN: Exactly. So, over time you’ll acquire taste for this other healthier options that are better for you.

 

KATIE: Yeah, I have to admit, I’m one of the people who I really did assume like, you know, you hear, “Sliced turkey breast,” and I’m like, “Oh, they’re just back there slicing turkey breasts, nothing’s happening to this meat,” you know? “I’m at the deli counter, this is probably fine.” It’s like another -- I mean, it’s sounds like I think you’ve said it, but I’ll just ask to clarify. If I’m ordering from behind a deli counter, and it seems like it’s fresh, kind of deli meat as opposed to I’m going to the refrigerated section, picking the prepackaged plastic containers of deli meat. Is it all the same thing or is behind the counter maybe a little better?

 

DR. MILLIEN: It is basically the same thing because when you see the big thing of ham that’s back there and they take it, and they cut it up, they’re just cutting up and giving you what looks like in the container, right?

 

KATIE: Yeah okay.

 

DR. MILLIEN: So, it is -- I mean, the standard umbrella recommendation honestly, even when we think about nitrate-free processed meat is, “limit them,” because you just don’t know how much of the harmful nitrates really are in there and it’s, you have to dig into the packaging to figure that out. So, it just becomes, you know -- The main message is, “Just limit that,” more fruits, more vegetables. Those are protective for cancer and the inflammation in general. Fish is good, fresh chicken, and turkey. I think those are, poultry in general are better for you when you’re thinking about limiting your risks from cancer and also from inflammation in general.

 

KATIE: And you know -- Sorry, I know I’m stuck on the deli meat thing ‘cause I’m just thinking about how like we send kids to school with sandwiches every day, and I eat a lot of sandwiches ‘cause they’re easy to make at lunch. I mean, you’ve said only have it a few, limit yourself to a few times a week, so is the five days a week, Monday through Friday sandwich with deli meat, is that a problem?

 

DR. MILLIEN: I think that’s something we need to look at and the reason why because of this disturbing trend of early onset colorectal cancer, right? We’re having people younger and younger being diagnosed. Sometimes people in their 20’s, right? And so, we have to start thinking about why are we seeing this, right? And a lot of it, we have to start thinking about our diet, what we are putting in our bodies. It is convenient. I have kids. It’s very convenient for me to pack them a sandwich to take to school, they love ham. But I think it’s important to also think about what the long-term detrimental effects are. I think when you think, you know, parent’s time, and our grandparent’s time, cigarettes were okay to smoke, right? People were given cigarettes to smoke and over time we found out that they are carcinogens, right? And it was hard to break that thinking that this could be harmful, but it is harmful. We have a lot of evidence. And so, as we’re seeing early onset colorectal cancer and trying to figure out why younger and younger kids are getting colorectal cancer. We really do need to look at diet and maybe as hard as it is do the hard work to limit how much, how many ham and cheese sandwiches we’re sending to school with them.

 

KATIE: Another question, just to clarify, and again, I think you’ve eluded to this but for someone that’s making this as -- Let’s say I’m gonna walk away from this interview, and to be honest I am, saying, “I’m gonna eat less processed meat,” but it’s still gonna happen, and I know you’ve said a hotdog here and there isn’t bad, but are there some processed meats that are better than others that I can help wean me off of them totally, or they all pretty much across the board about the same and it doesn’t matter what you have, limit it?

 

DR. MILLIEN: That’s an excellent question and you answered it yourself.

 

KATIE: Okay.

 

DR. MILLIEN: No matter what you do have, you have to limit it and that’s because, as I mentioned before, the body doesn’t go, “Well, this is a nitrite or nitrate that was produced after breakdown of a hotdog versus a bacon,” right? It doesn’t discriminate that. It just sees this chemical that was produced through this unnatural transformation process, and so, goes down the pathway that way.

 

KATIE: I keep trying to find a way out of limiting processed meat as you can tell. Another question I have, I’m just curious, if I pair a hotdog with like a bunch of veggies or something, you know, is the fiber in there gonna make this less worrisome? Is there any way to sort of mitigate some of that negative effect?

 

DR. MILLIEN: Actually, yes.

 

KATIE: Oh. We found one.

 

DR. MILLIEN: Well, yeah. And that’s because if you are eating a hotdog with vegetables, you’re gonna eat, the vegetables are gonna fill you up, right? So, the amount of hotdog you’re gonna ingest in gonna be less than if you were just having straight hotdogs across the board. So that, that is a way of thinking about it because we know that a diet high in fruits and vegetables is protective so, it’s almost that canceling effect.

 

KATIE: Okay.

 

DR. MILLIEN: So, think with eating more vegetables, you limit the amount of meats you’re gonna eat anyway. And so, that could potentially be a way for you to eat but I don’t think you should still eat more than one hotdog a day, honestly.

 

KATIE: Okay, heard, heard. Another question I have, are there any of these alternative sausages now -- You know, there’s like chicken sausage, and then there’s like veggie sausage, particularly the veggie sausage maybe is my question. Is veggie sausage still processed meat? ‘Cause its vegetables but it’s probably processed. What’s the story there?

 

DR. MILLIEN: So, not as much an issue with the vegetables. I think the issue -- But the other thing you just have to keep in mind is checking and seeing if there is a preservation. If you have vegetables that are gonna stay in your fridge, anything processed that’s gonna stay in your fridge for three months and it’s still okay, four months then they still, you need to start thinking about potentially that there is some kind of preservative that’s put in there, that still can cause an issue down the road. A lot of the issue that comes with processed meat is not only the chemicals that are used but also a lot of processed meats are red meats, right? So, pork, when we think about ham for example, bacon for example, hotdog which is a mishmash of mystery meat for example, that includes beef and pork. Red meats have heme in them and so, heme, and this is a topic when we talk about colon cancer and red meats, heme when it’s broken down in high temperatures becomes carcinogenic. It’s what produces the carcinogenic compound. So, a lot of the issues that we have with processed meats are because of the fact that they come from red meats and they have heme in them. But if anything is preserved, I mean, it’s still not a natural process so you always have to stop and think. We may not know it’s deleterious effect now, but that doesn’t mean there is not an effect.

 

KATIE: Gotcha. You brought up a really interesting point and a good point of you know to check labels and things like that so if -- I think for me, it’s hard to tell what processed meat is. You know, we’ve talked about some of what it is, but are there any tips you’d have for someone to check the labels in a sense of like whether it’s a date on the package or flip it over, or there’s, are there ingredients people should be looking for to say like, “Hey, this is processed, maybe not a good idea,” or maybe something to limit?

 

DR. MILLIEN: Sometimes, it says it contains nitrates or nitrites, and the nitrate-free ones might say, “natural, from natural sources.” But I think the giveaway a lot of times is just the expiration date.

 

KATIE: Okay, yeah, you alluded to that earlier and as soon as you said it, I was like, “Yeah, that’s probably a good point.”

 

DR. MILLIEN: So, the expiration date really gives you a lot of idea what the process was to prepare it.

 

KATIE: The last question I have for you is tips for people coming out of this. You’ve mentioned one good swap that I really liked where if you’re making a sandwich that is deli meat maybe buy fresh, rotisserie chicken, slice it yourself. Any other tips you might have for some healthier swaps to get the processed meats out that like make you might feel like you’re still getting that meal that’s pretty similar? Anything like that or?

 

DR. MILLIEN: It’s really hard. There is some recommendations, you know, now they have those Beyond Meats products, right? And so, a lot of those Beyond Meat products are actually better for you because they contain a lot of vegetables. So, if you’re one of those people and you try it -- It’s difficult for me to eat those, but those are good swaps soy containing products. If you can tolerate soy, some of those really mimic as close as they get to some of these processed foods, so that helps a lot. I always tell my patients, you know, a health journey is not an easy journey. If it was easy, all of us would look like supermodels on TV, fit, right? So, it’s a difficult journey.

 

KATIE: Yeah.

 

DR. MILLIEN: But it’s one of those things once you embark on it and you actually train your body to develop a taste for something, things get better. So, I’m not saying the first, second week you’re eating that rotisserie chicken versus that chicken that you would have bought from the deli would be, “This is delicious and I’m never gonna do deli meat again.” It takes time. You just have to train your body to start getting accustomed to eating these fresher alternatives.

 

KATIE: Yeah, yeah, I think that’s a great message. Anything else you think you would want to leave our listeners with before we close out today?

 

DR. MILLIEN: Well, we talked a lot about processed meat and colon cancer, but I always like to remind people that colon cancer, first of all, has now become the second leading cause of cancer-related deaths in the United States. It’s affecting younger and younger people. If caught early, at stage one for example, it’s 90% curable and treatments are not as invasive versus by the time you get to stage four, it drops down to less than 20% survival rate of five years. So, 90% at stage one versus less than 20%, five years in stage four. And so, I usually tell people, if you’re 45, your doctor tells you, “Get screened,” get screened. If there’s a family history, you have any concerning symptoms bring them up to your doctor. It is also a preventable cancer. We screen, we remove polyps, and we prevent it. So, we can talk about all these risk factors but also preventative care really when it comes to colon cancer makes a huge difference. So, that’s really the biggest -- It’s a near and dear topic to my heart and always like to remind people, we’re here, it’s preventable, and if caught early, the treatments are really not as severe as it later on, and the survival rate is actually excellent.

 

KATIE: Yeah, that’s, I think that’s a great message to send especially as you mentioned I think as young adults we don’t really think about cancer. It's not on our radar.

 

DR. MILLIEN: No.

 

KATIE: Well, we really appreciate you coming on today. This has been a fascinating conversation. So glad you could join us. Thanks so much.

 

DR. MILLIEN: Thank you so much for having me. I appreciate it.

 

[Sound effect signals the end of the interview]

 

ZACH: Now, Katie, I know all this was pretty hard for you to hear. How are you feeling now?

 

KATIE: [Sighs] You were there during the interview, I think I left that interview in a bit of like a shellshocked state as like silly as that sounds. I think, I like, texted our podcast group chat but I was like, “Off the sauce, never eating processed meat again.” Had a pretty visceral reaction immediately but, you know, it’s been a couple of weeks and I’ve been able to sit with everything Dr. Millien said and relistened to it, and I think I’ve gotten myself into a pretty good place about everything. I’ve got some adjustments to make and I’m not going to never eat processed meat again. I just had some deli meat this past weekend at a birthday party. I will certainly have pizza again someday. I will eat a hotdog, another hotdog again. But I’ve also cut back even in these first couple weeks.

 

ZACH: Now, we went to a baseball game.

 

KATIE: We did and --

 

ZACH: After this interview --

 

KATIE: We did --

 

ZACH: I had hotdogs, you did not.

 

KATIE: I did not. I went for the chicken fajita veggie bowl which it was delicious and I, you know -- So, I mean, I think I'm making some steps to cut back but I’m certainly not gonna never eat it again. I think, I think that’s what’s so interesting about getting to actually talk to our doctors about these kind of like sweeping statements that get made. I kinda mentioned this before, I’ve had to write, you know, in a bullet point form of like limit processed meat several times before but I’ve never done anything with it. But, you know, sitting down, hearing Dr. Millien talk about, you know, why it’s bad for us, give me like sort of the landscape of it, it does help you reframe how you wanna think about it and figure out what adjustments make sense for you. And so, I don’t know. I will say, I think often times I’ve been writing for a health blog for like four years now and you think you’ve like learned everything in some ways but this one was a bit of shellshock for me. How about you, Zach? I mean, as we just said you had a hotdog at the baseball game the other night, so --

 

ZACH: And I’m still here.

 

KATIE: [Laughter] Yeah, you’re still here. You know, that’s one thing I really loved about our conversation with Dr. Millien. Letting us know like the frequency at which this stuff becomes a problem and every day, yes, it’s a problem, but one or two a week is fine. So, I think -- I really liked having that information so that from here, we can make reasonable adjustments to our everyday life.

 

ZACH: Yeah. Like, I feel like we say this all the time in this podcast, but everything in moderation.

 

KATIE: Yeah.

 

ZACH: Right.

 

KATIE: Well, and she pointed out too. I mean, it is so true. So simple but it’s so true, you know, like -- I also loved when she said that like health journeys are not easy journeys and I think that’s another kind of point to reiterate of, like, we can’t hold ourself to some pious standard of, like, “Okay, we’re never eating processed meats, processed foods ever again,” like we’re going to. This is the life that we all live in. But just in moderation.

 

ZACH: Yeah. Well, sandwich meat --

 

KATIE: Oh yeah.

 

ZACH: Was the interesting part to me ‘cause I mean I eat sandwiches and much like you guys discussed like, “Oh, I’m gonna go to the deli section of the grocery store, the fancy -- Not this packaged stuff in the freezer department. I’m going straight to the source.” You think, right? You think.

 

KATIE: Yeah, no, I thought.

 

ZACH: That is just sliced up --

 

KATIE: Yeah.

 

ZACH: The same things that are sliced up and repackaged in a different way. It might be, you know, different flavors, or perhaps fresher, however you wanna define that.

 

KATIE: Fresher maybe.

 

ZACH: Yeah.

 

KATIE: Because yeah.

 

ZACH: But no, it’s just the same. I even found it interesting that Dr. Millien recommended the, you know, getting the rotisserie chickens and chopping those up as your sandwich meat if you’re gonna be a sandwich person. I feel like sandwiches are like the go-to lunch for people who are like on the go even like when you have kids and – Yeah. You remember when you were a kid, you’d pack up a sandwich, you got to school with the sandwich. How much processed meat -- Forget hotdogs you eat in college, how much processed meat did we eat when we were kids?

 

KATIE: I know.

 

ZACH: Right? Just lunch meat and all these sorts of things. And again, it’s not saying never do that ever again but it’s not the health jump that you think it is to go, “Well, I’m gonna go get the fancy meat at the deli.” It’s kind of doing the same thing.

 

KATIE: Yeah, pretty much. That surprised me to be honest. I was like so sure I was like, going in with like, “Oh --

 

ZACH: Your fresh turkey please.

 

KATIE: Yeah and like, “I get the fresh sliced turkey. Don’t worry. I’m good.” Which is, you know, she’s like, “No.” So, I -- Another, yeah, another great thing out of this is like, it’s so easy to have all these misconceptions about what we perceive to be healthy or unhealthy, you know. Getting the record set straight is nice ‘cause like here we are doing something that we think is healthier but it’s not, and like, we gotta know these things.

 

ZACH: Exactly. And so, as you’re listening to this podcast, as you’re cooking out in your backyard on July 4^th, we hope you’re having a happy holiday and remember everything in moderation. That huge pack of hotdogs you bought, share ‘em with your friends and family, don’t eat the whole thing yourself. That’s gonna do it for us this week on the On Health podcast, and we encourage you all to go to our blog at Houstonmethodist.org/blog and to share, like, and subscribe to our podcast. New episodes drop Tuesday mornings. So, until then stay tuned, and stay healthy.