Pediatric nutrition notes: Is deli meat safe?

Summer is in full swing, meaning beach days, movie nights, and summer barbecues. Lunchtime staples like deli sandwiches are undeniably convenient and delicious. But with whispers of cancer risk swirling around processed meats, many patients wonder: is deli meat safe for my family?

Deli meat or cold cuts are considered processed meats. The American Institute for Cancer Research (AICR) defines processed meat as "meat preserved by smoking, curing or salting, or the addition of chemical preservatives."¹ The World Health Organization International Agency for Research on Cancer classifies processed meats, including deli meats, as a Group 1 carcinogen, meaning there's strong evidence they cause cancer. A recent systematic review and meta-analysis showed that high processed meat intake was positively associated with the risk of breast, colorectal, colon, rectal, and lung cancers. Higher risk of colorectal, lung, and renal cell cancers were also observed with high total red and processed meat consumption.² Beyond cancer risk, processed meats are often high in sodium and saturated fat, which can contribute to heart disease, diabetes, colorectal and other cancers.

Deli meat falls under the "processed meats" umbrella, which includes bacon, sausage, spam, and hot dogs. Research consistently suggests a link between processed meats and various cancers. However, studies tend to group all processed meats and they don’t differentiate based on processing methods, like whether nitrates were used. This makes it challenging to pinpoint whether the increased cancer risk is due to the inherent qualities of all processed meats, or specific types within the category.

Deli meat is processed with nitrates for preservation and to inhibit bacterial growth. Sodium nitrates and sodium nitrites are salt compounds that are naturally present in many fruits and vegetables, like celery, leafy greens, and cabbage. Most of the nitrates we consume come from vegetables and drinking water. Nitrates and nitrites themselves do not cause cancer, but we know that when nitrites combine with the amines in meat, they create nitrosamines, which some studies have found to be carcinogenic.

What about nitrate-free deli meat – are they safer? Nitrate-free processed meats often rely on celery juice or powder for preservation. Celery is naturally rich in nitrates. These meats will be labeled "uncured" and "celery powder" will be in the ingredients list instead of "sodium nitrite." So, even “nitrate-free” products don't necessarily translate to a significant nitrate reduction. Furthermore, regardless of nitrate source, processed meats may contain other potentially harmful compounds. Smoking meats, like salami, can introduce polycyclic aromatic hydrocarbons (PAHs), which have been linked to cancer.

What do we tell our patients? Until we fully understand the link between processed meats and cancer, moderation is key. Treat nitrate-free options just like any other processed meat and limit intake. According to the AICR’s Third Expert Report, regularly consuming even small amounts of cold cuts and other processed meats increases the risk of colorectal cancer. The report goes further, specifying that just 50 grams (roughly one hot dog or two slices of ham) of processed meat daily can raise your colorectal cancer risk by 16 percent.1 Encourage your patients to choose leaner cuts of deli meats more often—things like turkey or chicken breast. You can also consider other sandwich options like tuna, salmon, or even hummus.

An interesting study in 2020 looked at the effect of cancer risk and processed meat intake when people simultaneously ate foods rich in fiber, like fruits, vegetables, and whole grains.³ It showed that the carcinogenic effect of processed meat was lowered by following a diet rich in non-starchy vegetables and fruit, especially when processed meat was consumed in low and moderate levels. Combining fruits and vegetables with deli meat may lessen cancer risk and slow time-to-cancer occurrence.

The question of whether deli meat is inherently "bad" is a complex one. As with many aspects of nutrition, there's no simple yes or no answer. The key lies in understanding your patient. Factors like family history and overall dietary habits play a crucial role. For some, occasional indulgence in deli meat might be acceptable. However, for others, it's best to avoid it altogether. Regardless, encourage moderation if your patients choose to include cold cuts in their diet. Pairing them with whole-grain bread and plenty of vegetables promotes a more balanced and nutritious meal. For more on this topic, you can listen to the companion episode on The Exam Room Nutrition Podcast: https://www.examroomnutritionpodcast.com/61-summer-shorts-is-deli-meat-bad-for-me/

References:

1. American Institute for Cancer Research (AICR). Processed Meat and Cancer. 2019. Accessed June 24, 2024. https://www.aicr.org/resources/blog/processed-meat-and-cancer/Farvid MS,

2. Sidahmed E, Spence ND, Mante Angua K, Rosner BA, Barnett JB. Consumption of red meat and processed meat and cancer incidence: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2021;36(9):937-951. doi:10.1007/s10654-021-00741-9

3. Maximova K, Khodayari Moez E, Dabravolskaj J, et al. Co-consumption of Vegetables and Fruit, Whole Grains, and Fiber Reduces the Cancer Risk of Red and Processed Meat in a Large Prospective Cohort of Adults from Alberta's Tomorrow Project. Nutrients. 2020;12(8):2265. Published 2020 Jul 29. doi:10.3390/nu12082265