What about just eating less fat? A low-fat diet has been the earliest and longest-lived candidate for breast cancer reduction.

As we've seen, those countries with the very lowest fat intake, such as China, have the very lowest breast cancer rates. Countries with the very highest fat intakes, New Zealand, the Netherlands, England, and the United States, have the very highest breast cancer rates. And when women in other countries actually increase the amount of fat they eat, up goes their risk of breast cancer. Higher fat consumption in childhood and adolescence can lead to faster growth and earlier menarche, both known risk factors for breast cancer. With the adoption of a higher-fat diet, even women in the Far East are suffering from a striking increase in breast cancer. In Singapore there has been a staggering 3.6 percent increase per year in breast cancer rates as women there change to a high-fat, low-fiber Western diet. The danger of high fat has been a very convincing argument. In the United States, however, the argument fell flat on its face. Fifteen years ago everyone thought a high-fat diet explained the high rate of breast cancer in America. Today they don't. When studies of dietary fat were done within the United States, no such low-fat connection was made. Researchers hoped to find a 24 percent decrease in breast cancer with a 25 percent fat diet. Instead, they found none. Why? Lowered fat content is just one ingredient. Women in Asia take advantage of all the other steps outlined in this book. Their diet has a low glucose load, is high in fiber, high in soy, and low in calories. Fat was just one small element. Look what happens when you add just one more ingredient, fiber, to a low-fat diet. Barry Goldin and Margo Woods of Tufts University report in the journal Cancer that a low-fat, high-fiber diet did decrease blood estrogen by 9 to 15 percent. Remember how the South African villagers whose diets were low-calorie, low-fat, and high-fiber had a strikingly low rate of breast cancer? A low-fat diet that is high in calories and omega-6 fats, low in fiber, devoid of soy, and has a high glucose load (the average American low-fat diet!) is likely to raise your risk of breast cancer.

The other major reason that the low-fat diet has not panned out in American studies is that no studies were really low-fat! Consider that Asian women are eating a 10 to 15 percent fat diet. The average American diet ranges from 34 to 43 percent fat! The biggest and best study of fat and the risk of breast cancer, the famous Harvard nurses study, had very few women who even dropped to a diet of as low as 20 percent fat. Also, most American studies have been too short to show more of an effect. Japanese and Chinese women eat low-fat foods in childhood, adolescence, and early adulthood. No American studies have tracked women since adolescence, when much of the benefit of a low-fat diet is evident. Breast cancer prevention pioneer Dr. Ernst Wynder, president of the American Health Foundation, is currently enrolling 1,400 women in a trial of a 15 percent low-fat diet to settle the issue once and for all.

There is only one real way to undertake a low-fat diet and that is to undertake a high-quality vegetarian diet. On a high-quality vegetarian diet, I would aim for 10 to 15 percent fat. Twenty percent is the upper limit recommended by most cancer centers. There is no real argument/or eating a high-fat diet just because a low-fat one hasn't proven out in clinical trials. A diet high in saturated fats poses a high threat of death from heart disease. The choice is yours, the low-fat vegetarian diet of Asian women or the healthy-fat diet of Mediterranean women. Both strategies are described in the chapter "Healthy Cuisines."


Women's health

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