5 Questions: Dietitian Raymond Palko on report labeling some meats carcinogens

The Stanford clinical dietitian shared his thoughts on the World Health Organization report and offered some suggestions on what we might want to change about our food choices.

Raymond Palko

This week, the World Health Organization’s International Agency for Research on Cancer released a report concluding that red meat and processed meat should join the list of foods that can, under certain circumstances, raise our risk of cancer. The group analyzed more than 800 studies on cancer in humans to reach its conclusions. The reaction was noisy: Prosciutto makers in Parma, Italy, protested; vegetarians and vegans saw it as an affirmation; and the rest of us wondered what it all meant. Must we swear off these kinds of meats completely, or is it safe to consume a little every now and then?

Raymond Palko, MS, RD, is a clinical dietitian who provides nutritional counseling to cancer patients at Stanford Health Care. In an interview with writer Sara Wykes, Palko shared his thoughts on the WHO report and offered some suggestions on what we might want to change about our food choices.

Q: What did you notice first about the WHO report?

Palko: Many of its numbers and guidance on red meat and processed meat is what we’ve been using at Stanford Health Care for years. Cautions on processed meats have been around since 2007. What I like is seeing how much fanfare it’s caused. It’s important to be having these conversations about meat consumption. The report itself will become another tool that dietitians can use when we talk to people about what they eat. No longer will this idea of lowering how much red and processed meat you eat be an idea we just made up. It does build a framework for what a cancer-prevention diet looks like. There’s been a lot of conversation about it in the oncology dietitian community because it confirms the recommendations we’ve been making with our patients. It’s good to see that expanded to a broader stage. 

Q: What should people know about the relationship between cancer and the consumption of red meat and processed meat?

Palko: I do have an issue with any conclusion that says if you eat red or processed meat, you will get cancer. No matter what numbers you choose to accept about the increased risk related to eating these kinds of meats, it’s important to remember that cancer is a multifactorial disease. It’s not just diet alone. It’s diet, weight related to that diet, inherited risk and environmental exposures. Your cancer risk can also be raised by other illnesses you may have had and treatments for those illnesses. Diet is just one part of cancer risk, albeit an important one.

Q: If you decide not to eat red meat, how can you get enough protein and iron?

Palko: Chicken, fish, turkey, eggs, dairy, beans, nuts and seeds are very good sources of protein. Plant foods like dark-green vegetables contain the iron we need and do not have the risk of the form of iron found in red meat — a form called heme iron. Ample evidence suggests heme iron contributes to chronic disease risk, such as heart disease and digestive tract cancers. Heme iron, a strong pro-oxidant, is also found in other meats like fish and poultry, but in much smaller quantities that are not associated with cancer risk.

When we talk with people about their diet, we like to start first by talking about fruits and vegetables — not about protein. Fruits and vegetables should be the first building block of a diet. There are other benefits, too. When people stop eating red meat, we often see weight loss and an improvement in their daily digestive health. We know this sometimes happens because people have been eating fast-food burgers or burritos, washing them down with unhealthy beverages and just overconsuming calories.

Q: If you want to eat some red meat, how much is safe?

Palko: Our guidance on red meat is a maximum of 18 ounces a week. We tell our patients that 3 ounces of meat is about the size of a deck of playing cards. We do recommend that you don’t eat red meat every day. Have a fish or vegetable protein meal instead.

Q: Is there such a thing as a cancer-prevention diet that’s trustworthy?

Palko: A cancer-prevention diet looks very similar to a heart-disease or diabetes-prevention diet: lots of vegetables and fruits; more plant foods like beans, legumes, nuts and seeds; high-fiber, lower-fat, limited-fried, processed or salted foods; and alcohol in moderation.  If you had to summarize what that is, you could look to food writer Michael Pollan’s shorthand version: “Eat food. Not too much. Mostly plants.” 


Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.

Leading in Precision Health

Stanford Medicine is leading the biomedical revolution in precision health, defining and developing the next generation of care that is proactive, predictive and precise. 

A Legacy of Innovation

Stanford Medicine's unrivaled atmosphere of breakthrough thinking and interdisciplinary collaboration has fueled a long history of achievements.