PAH - (Polycyclic Aromatic Hydrocarbons)

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Carcinogens are cancer causing agents HCA - (Heterocyclic Amines) form in meats grilled at high temperatures Grilled vegetables do not produce PAH - (Polycyclic Aromatic Hydrocarbons) found in smoke made from fat drippings hitting hot coals carcinogens! TIP #1: Use a vinegar based sauce and leave out the sugar - this reduces HCAs by 50-99%! TIP #2: Keep the grill on medium-high heat, and flip the meat often so it doesn't char TIP #3: Trim excess fat off of your meat TIP #4: Cover grill with punctured aluminum foil to prevent fat drips from hitting hot coals TIP #5: Keep a squirt bottle around to control flare-ups 2

ARE PROCESSED MEATS According to the AICR, any meat that is preserved by smoking, curing or salting, or addition of chemical preservatives is a processed meat Eating just ONE hot dog a day increases risk for colorectal cancer by 18% #1 - Replace deli meats and cold cuts with fresh chicken or fish #2 - Instead of bacon, chorizo, or salami, try spicy vegetarian sausages Ham Bacon Pastrami Sausages Hot dogs Cold cuts #3 - Trade red meat for lean poultry (like skinless chicken or turkey burgers) #4 - Replace sausage in chili and soups with beans or lentils #5 - Try other protein sources (like eggs, cottage cheese, tofu, hummus) Pepperoni Fish sticks Chicken nuggets 3

FOOD PRESERVATIVES Manufacturers add them into food to give the food color and to prolong the shelf life Hot dogs, sausages, brats, steak, lunch meat, and bacon Not only can they be found in meat, but also canned beans NITRITES - Prevent bacterial growth NITRATES - Prevent meat from turning brown and vegetables with bacon, and some seafood Most dietary nitrate is Some studies have shown that a diet higher in nitrites can increase thyroid and glioma cancer risk. This happens because during digestion and cooking, nitrites can form chemicals called nitrosamines, which are carcinogens that are linked to the increased cancer risk. naturally found in vegetables! Vegetables contain vitamin C, vitamin E and other antioxidants which help to stop the harmful nitrosation process within food. One study found that those with a higher vegetable intake had a 22% reduction in gastric cancer risk 4

#1 Minimize your consumption of processed foods and cured meat products #2 Check labels carefully and avoid products that list sodium or potassium nitrates & nitrites #3 Eat a diet high in antioxidants. Vitamin C and certain other vitamins can reduce the conversion of nitrates and nitrites to nitrosamines #4 Try to buy organic food when you can. Synthetic nitrates and nitrites are not allowed as preservatives in organic packaged foods and meats. However, don t forget that the American Cancer Society recommends that vegetables, fruits, and whole grains should form the central part of a person's diet, regardless of whether they are grown conventionally or organically. #5 Find out if your water is tainted with nitrates or nitrites. Public drinking water utilities test for these compounds and must disclose their results. If you drink well water, your local health department can help you find out if this is a problem in your area. Nitrite content in processed meats is not monitored The nitrite contents vary by food additive regulations that are monitored by the Food and Drug Administration and the United States Department of Agriculture Nitrate content in vegetables does not vary The nitrate contents does vary depending on the fertilizers the vegetable is grown in and other agricultural practices used 5

Ingredients: 3 med. bell peppers, chopped (any color) 2 medium zucchini, thickly sliced 1 medium cauliflower, cut into small florets 1 container baby bella mushrooms (~8 oz) 2 Tbsp extra virgin olive oil Salt and pepper, to taste 1 cup balsamic vinegar 2 Tbsp chopped fresh basil Directions 1) Place chopped veggies and mushrooms in a large mixing bowl. Toss with oil, salt, and pepper. 2) Add vegetables to a grill basket and grill over medium heat for 15 minutes or until vegetables are fork tender. If you don t have a grill, spread vegetables evenly over 1-2 baking sheets and roast for 20 minutes at 400 F, stirring after 10 minutes. 3) While vegetables are cooking, bring balsamic vinegar to a boil in saucepan. Reduce heat to medium/low and let vinegar simmer for 10-15 minutes, stirring occasionally. The reduction is done when vinegar has thickened enough to lightly coat the spoon. Let the balsamic glaze cool (at room temp or in fridge); it will continue to thicken as it cools. 4) To serve, drizzle glaze over roasted veggies and garnish with chopped fresh basil. Marinade: Juice of 4 lemons 2 Tbsp. extra virgin olive oil 4 garlic cloves, minced 1 Tbsp. dried Italian seasoning Sea salt and freshly ground pepper Kebabs: 1 lb. wild salmon, cut into 2-inch cubes 4 small plum tomatoes, cut into quarters or 8 cherry tomatoes 4 large whole mushrooms, stems removed, halved 1 medium bell pepper, deseeded, cut into 12 pieces 1 medium yellow squash, cut into 8 pieces Canola oil cooking spray 4 skewers Directions 1) If using wooden skewers (in lieu of metal), soak them in water for about 30 mins. 2) In large mixing bowl combine juice, oil, garlic, seasoning, salt and pepper. Mix well and divide in half. 3) Add salmon and vegetables to half of marinade and gently toss to coat pieces. Cover and marinate for about 30 minutes, occasionally rearranging pieces to ensure even coating. 4) Preheat oven broiler. 5) Spray large shallow baking dish. Remove skewers from water. Divide fish and vegetable pieces into 4 even portions. Arrange and distribute them evenly on skewers, being careful not to break the pieces. 6) Place on baking dish. Brush with remaining marinade not used for marinating raw fish. Broil for about 5-8 minutes, brushing frequently with marinade. Carefully turn over kebabs and continue cooking for an additional 4 minutes, basting frequently until fish is done. Serve! Broiling in the oven helps cut down carcinogens! 6

Ingredients: 1 lb prepared whole-wheat pizza dough 2 large crimini mushrooms, stemmed, cut crosswise into 1/2-inch slices 2 large plum tomatoes, halved lengthwise, seeded, and cut into 1/2-inch strips 1 medium zucchini, cut into 1/2-inch slices 1/2 medium red onion, cut crosswise into thin slices 2 cloves garlic, cut vertically into 4 slices Salt and ground black pepper 2 Tbsp. extra virgin olive oil, divided 1.5 cups (6 oz.) shredded low-fat mozzarella cheese 4 large basil leaves, cut crosswise into thin strips Directions 1) Divide pizza dough into thirds. Set aside one third for later use. Divide remaining thirds in half, for a total of four pieces. Gently form into balls and place in lightly oiled bowls. Cover bowls with dishtowel and let sit until dough is soft and pliable, 30 min - 1 hour, depending on how cold it is. 2) For topping, in mixing bowl, combine mushrooms, tomatoes, peppers, zucchini, onion, and garlic. Sprinkle on salt and 4-5 grinds pepper. Add 4 tsp of oil and toss until veggies are coated with olive oil. Set veggies aside for 30 minutes. 3) When pizza dough is soft, lift 1 piece and pat it into a disk. Holding disk by its edge so dough dangles down, gradually work your fingers around the edge, turning and gently stretching it into 4-inch disk. Place stretched dough on large baking sheet and repeat with remaining 3 pieces. Cover dough and let rest for 10 minutes, until soft enough to repeat, stretching 7-8 inches. Leave dough on baking sheet while preparing grill. 4) Heat grill to medium-high. Place marinated veggies in grill basket. Grill and stir until crisp-tender (7-8 min). Set aside. 5) Turn grill to low. Use remaining oil to brush disks of pizza dough lightly on both sides. Arrange dough on grill, and grill 5-6 minutes, until dough is puffy on top and bottom is golden brown. Using tongs, turn pizza crusts over. Immediately sprinkle one-quarter of cheese over each crust, leaving 1/2 inch edge. Close lid and grill until bottom of crust is golden and cheese is just melted (1-2 min). Remove grilled pizza crusts to individual plates and heap on the veggies. Sprinkle on basil and serve! Ingredients: 1/4 cup balsamic vinegar 2 Tbsp honey 3 medium peaches (pitted & cut into 6 wedges) 1 Tbsp extra virgin olive oil Salt and freshly ground pepper (to taste) 10 cups arugula, loosely packed 2 Tbsp goat cheese Cooking spray Directions 1) Prepare grill to medium-high heat. Spray grill rack with cooking spray and set aside. 2) In small saucepan over medium-high heat, bring vinegar to a boil. Reduce heat and simmer until vinegar is reduced (~2 mins). Remove from heat and stir in honey. Cool to room temp. 3) Place peach wedges on grill rack. Grill 30 seconds on each side or until grill marks appear but peaches are still firm. Remove from grill and set aside. 4) In large bowl, combine oil, salt, and pepper. Add arugula, tossing gently to coat. Arrange arugula mixture on platter. Top with peach wedges, balsamic syrup, and goat cheese. Serve! 7

WHAT IS RED MEAT? Beef, pork, and lamb THE RESEARCH Diets high in red meat are linked to colorectal cancer THE RECOMMENDATION Limit red meat Consume less than 18 oz. (cooked) red meat a week HOW CAN RED MEAT INCREASE MY CANCER RISK? Red meat contains heme (a form of iron) which can damage the lining of the colon Red meat can create carcinogens called N-nitroso compounds, which are cancer-causing agents Grilling red meat produces two cancer promoters: HCAs and PAHs HOW TO CUT DOWN RED MEAT Fill your dinner plate with veggies and whole grains instead of meat Use beans instead of meat in stews, casseroles, and soups Enjoy other sources of protein like fish, poultry, nuts, tofu, quinoa, eggs, and low-fat dairy products WHAT IS PROCESSED MEAT? Meat that has been preserved by smoking, curing, salting, or adding other chemical preservatives Examples: Sausage, bacon, ham, hot dogs, pepperoni, salami, pastrami, bologna, corned beef, and deli/luncheon meat THE RESEARCH Like red meat, diets high in processed meats are linked to colorectal cancer THE RECOMMENDATION Avoid all processed meat HOW CAN PROCESSED MEAT INCREASE CANCER RISK? The processing of red meat commonly involves nitrites, which can form cancer-causing N-nitroso compounds Smoking the meat causes formation of PAHs Adding high amounts of salt to meat can promote development of stomach cancer HOW TO CUT OUT PROCESSED MEAT For breakfast - replace bacon and sausage with eggs and low-fat dairy For lunch - replace ham or bologna sandwiches with tuna, turkey, or hummus For dinner - veggie burgers are a healthy replacement for hot dogs and hamburgers on the grill! 8

REFERENCES 1) https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5302962/ 2) https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3980001/ 3) https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4690057/ 4) http://www.healthychild.org/how-to-avoid-added-nitrates-and-nitrites-in-your-food/ 5) https://www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physicalactivity-cancer-prevention/food-additives.html 6) http://blog.foodnetwork.com/healthyeats/2009/03/27/food-additive-to-watch-sodiumnitrite/ 7) https://www.cancer.org/latest-news/world-health-organization-says-processed-meat-causescancer.html 8) http://blog.aicr.org/2012/02/23/what-is-processed-meat-anyway/ 9) https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/cooked-meats-fact-sheet 10) http://www.pbs.org/newshour/updates/faq-exactly-processed-meat-avoid-questions/ 11) http://www.straitstimes.com/sites/default/files/attachments/2015/10/29/ st_20151029_llcancer29new_1797654.pdf 12) http://www.rodalesorganiclife.com/food/healthy-grilling Created by: Caitlyn Cummins, Dietetic Intern Patient Food and Nutrition Services 300 N. Ingalls Street NIB NI8E20 Ann Arbor, MI 48109-5407 (734) 936-5197 9