DO YOU HAVE A STRATEGY?
The holidays are here and part of the fun of the season is the gatherings and spending more time with family and friends. Almost all of these occasions involve food, and it's a fair guess that they also include treats, sweetened beverages, and alcohol. While everyone has to make up his or her own mind about how to handle these occasions, I don't think it's a good idea to throw caution to the wind, eat anything and everything, and start over again in January for several reasons. One of them is that you were engaging in this type of behavior for a long time before deciding to change your diet and lifestyle to a healthier version, and it contributed to weight gain and health issues. One very important principle of the program I teach is that it is a plan for life. It is not a short-term heroic and restrictive diet that cannot be sustained. On the other hand, binging on junk food for short periods of time is not a good idea either.
Another reason to avoid a holiday eating orgy is that it will inevitably be accompanied by weight gain and feeling bad. It does not help to go backwards if you have been making progress toward your weight and/or health improvement goals.
The better strategy is to continue the "changing your life" program and learn to how to be a healthy eater who can enjoy the holidays. If you have been to any of my classes or events, remember the key strategies to implement any diet and lifestyle changes. It needs to be accessible, sustainable, and defensible with science.
If you are attending a party, eat a large salad, or a healthy soup with lots of veggies before you go. It's important to not attend these events when you are "starving". Fill up on salad and vegetables at family dinners and enjoy a few Christmas cookies!
Remain mindful of your strategy and intentions. This way you can have fun, indulge yourself a little, and wake up on January 1 feeling good about yourself, your weight, and your health.
Lastly, don't forget about exercise! Continuing your workouts is part of learning how to enjoy holiday seasons as a healthy person. Exercise can offset the effects of those cookies!
Stay tuned for 2024 as I resume classes and events, with hopefully more zoom meetings for the out-of-town folks.
I wish all of you a happy and healthy 2024!
Looking for a healthy side dish to bring to dinner? Check out this Cranberry Kale Pilaf. If you don't like Kale, sub spinach. Cranberry Kale Pilaf - Center for Nutrition Studies
Your Wellness Lifestyle Starts Here
What you eat has a profound impact on your health and your diet is one of the most controllable aspects of your health status. You can decide what you are going to eat every day. The average adult human consumes one ton of food every year – an astounding amount – and it is impossible to make the argument that this amount of food does not have an impact on your health. The effect can be either positive or negative depending on the choices you make.
New research from Johns Hopkins Children’s Center shows that a phytochemical in broccoli and other cruciferous vegetables called sulforaphane can have a powerful effect on fighting viruses like the common cold and COVID-19.
Giving 30 mg of sulforaphane per kg of body weight to mice before infecting them with SARS-CoV-2 decreased the loss of body weight typically experienced by COVID-19 patients. Pre-treatment with sulforaphane also decreased viral load in the lungs and upper respiratory tract and resulted in a 29% decrease in injury to lung tissue as compared to mice who were not given the phytochemical. Additionally, sulforaphane decreased inflammation in the lungs and protected cells against the hyperactive immune response that has proven to be both common and fatal for many patients.
Sulforaphane has already been proven to have powerful anti-cancer properties, so these results are not surprising.
While you might be tempted to purchase a sulforaphane supplement, I’ve always advised that it’s best to eat the whole plant food because whole foods are more powerful. For example, cruciferous vegetables, which include not only broccoli but also arugula, Bok choy, cabbage, Brussel sprouts, and cauliflower, contain lots of powerful nutrients such as carotenoids, indoles, glucosinolates and isothiocyanates.
The same is true of all other plant foods – they are packed with protective nutrients that will not only reduce the risk of colds and flu – but also the risk of heart disease and cancer, which remain the leading killers.
You might have heard me say it before, but it is the whole of your diet and lifestyle, it is the breadth of what you eat and do on a daily basis. One note does not make a symphony. The temptation is to take a multitude of supplements because you are not eating enough fruit and vegetables. Supplements have role, but on a needed basis, such as Elderberry syrup if you feel a cold coming on, or a good probiotic for gut health. "Nutrient supplements do not prevent disease because when isolated from their whole food context, their biological properties may be substantially different or even opposite than expected." (T. Colin Campbell, PhD.) I will be having a class on supplement use in the future.
Diet quality is based on the foods you eat, not transient nutrient levels which usually have little to do with health status.
During the holiday season, we all express gratitude for our blessings, family and friends. Let's also place value on and be grateful for our health and take care of our bodies. Remember – an ounce of prevention is worth a pound of cure. Eat your vegetables!
If you are local, I hope to see you on Thursday, December 14 at the Epochary Inn. I will have Elderberry Syrup, probiotics, and the Wellness Forum Health smoothie mix available for purchase.
New recipes have been added on the recipe blog, so check them out!
Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
Wellness Forum Health
Wellness Forum Health (the company that I represent) held our annual conference last weekend. One of my favorite speakers, fellow member and therapist is Kylea Rorabaugh, MA, PLPC. Her talk was titled "Finding Stillness in a World that Won't Stop." Stillness is essential for our mental, emotional, spiritual, and physical wellbeing.
If you are like me, you find it difficult to find stillness. We (especially women) find it necessary to continually overextend ourselves, as if it will earn us an award. We all need to focus on a day of rest. In Dan Buettner's research on the Seventh Day Adventists, he found that they all were committed to taking a day of rest. On average, they live 10 years longer than the average American.
How can we be intentional about taking that one day a week of rest, of finding intentional stillness?
Consider your "diet": What are you putting in your mind on a consistent basis? Did you know that the Poison Dart Frog is not actually poisonous? They eat deadly and poisonous insects, ingesting the poison so that they become poison themselves. Are you reading every news article, watching every news station? We can choose how much chaos to ingest and how much stillness to consume. Watch your mental diet. We still need to be aware of what is going on in the world, but not to consume all of the poison content.
Embrace boredom: If you are sitting around in a waiting room, or standing in a long line, be intentional, make eye contact, listen to conversations around you, smile, people watch, observe. By doing this, you are grabbing hold of your boredom, giving it the hug it deserves, and welcoming it to stand right next to you as an ally.
Put down the distractions: Is it possible that, as a society, we have a disturbing obsession with entertainment? And with the compelling draw toward action, speed, and extreme stimulation, could it be that the concept of stillness is so foreign that we will miss something? What if we miss listening, discovering, engaging? We allow the deafening sounds of the modern world to drown out the whispers of the things that really matter. If we don't put down our distractions, how will we ever know if we are missing something? What if we intentionally filled those moments with something purposeful instead of something mindless?
Find your dam: What if we slowed our pace, what if we stopped the hurriedness of our moments? It's easy to miss our dam, or to never discover and experience them in the first place. Sometimes the things that are the hardest for us to embrace are the very things that are most important for us to cling to. Do you have a dam? A place to go to be still, and savor, and rest, and laugh?
Rediscover delight: We miss simple delight in this day and age. What might it look like to rediscover delight in your life, now, in real time, as an adult? What would it be? Do you have any delight in your life? Norman Wirzba said "When you are in the throes of entertainment, are you generally thinking that you are having a good time? Do we settle for being amused?"
Disconnecting from traditional productivity: In our culture, busyness and productivity are worshipped. But sometimes productivity gets in the way of living our life to the fullest. Or sometimes we miss out on joy filled living. What we do in that stillness may differ. But it's not so much about what we do per se but rather about what it does in us.
Being still enough to stick like Velcro: Author and psychologist Rick Hansen puts it this way: "The brain is like Velcro for negative experiences but Teflon for positive experiences. In other words, the goodness of life has the tendency to slip away as opposed to the negative which clings to our mental framework. But if we are harried and hurried every moment of the day, it's awfully hard to acknowledge or grab hold of these things. What if stillness is the key to us taking the time to pause, acknowledge and embrace the goodness that surrounds us. And when we absorb all of that goodness, we reverse roles, and our goodness gets Velcro-ed and our difficulties get Teflon-ed.
The world won't ever stop, but we can: What would you add to your vision of stillness? Likewise, what would you remove from that space? Determine your environment and your mindset: where would your thoughts be situated? What would it take to implement a position of stillness with intent, consistency, and commitment? Long for stillness and embrace it. We can choose to stop. It's not so much about what you do in your stillness but rather what you allow the stillness to do within you.
Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
Wellness Forum Health
Your Wellness Lifestyle Starts Here
Do you get confused and conflicted with all of the crazy diet and lifestyle articles? Some of them are true but most are nonsense and fearmongering. I stay committed to teaching evidence based nutritional science so that you aren't throwing out all of your bread and staying home to avoid flesh-eating bacteria. It's important to be well-informed, prioritize learning about health, and invest your time and resources in adopting the right diet and exercise program. Then you can determine if something is health promoting or disease mongering.
Let's look at some of these articles for food for thought and future discussions:
Colorectal cancer is rising among Gen X, Y, & Z
According to the NPR article, about 20,000 people in the U.S. under the age of 50 will be diagnosed this year. And an estimated 3, 750 young adults will die. While stating that more screening is needed, at least they mentioned that "diet may play a role". There are many studies that prove eating more ultra-processed foods, processed lunch meats, carbonated beverages, alcohol use, and high consumption of red meat increases the risk of colorectal cancer. The "grab and go" and sedentary lifestyle of teens and young adults is what will put them in this high-risk category.
Teach your kids that food is so much more than fuel.
Statins
Reporting the results of a 2008 study, the New York Times noted that the risk of heart attack was "more than cut in half by statins". But was it really? The study evaluated AstraZeneca’s rosuvastatin (Crestor) on 17,802 people without high cholesterol, finding about a 50 percent relative risk reduction of heart attack in the statin group.
Another study, commonly cited to exemplify statins’ robust protective effects, is a large trial investigating Pfizer’s atorvastatin (Lipitor), called ASCOT-LLA. In this case, statins were 36 percent more protective than the placebo.
However, the absolute risk reduction for both studies was approximately 1 percent. As opposed to relative risk reduction, assessing the efficacy of a drug is more accurately interpreted by using absolute risk reduction. As Dr. Malcom Kendricks, a Scottish based physician and statins researcher says "It's a way to hype results."
Click the link to learn the difference between relative and absolute and how researchers use it to skew results in their favor. (Relative vs Absolute Change - Analysis Mistakes (dataschool.com)
"Pharmaceutical companies also seek to “downplay or deny” the significance of statins’ side effects, such as severe muscle damage."
In a 2015 investigative meta-analysis published in The Journal of American Cardiology, researchers reviewed all phase 2 and 3 clinical trials in a decade. They found that nearly 80 percent of the trials had a conflict of interest, and almost 60 percent involved over half of the authors. Of these studies, 54 had favorable outcomes, and only 12 had unfavorable results.
High blood pressure? Eat more grapefruit.
If people with high blood pressure ran to the store to buy grapefruit, I hope that they also bought more fruit and vegetables in general, along with high-fiber whole grains. If you are eating an unhealthy diet, full of saturated fats and lots of dairy, that grapefruit won't do a thing. Grapefruit is a wonderful addition to your daily intake of fruit and vegetables. Claiming that one food or supplement will cause you to lose weight, lower blood pressure or cholesterol, is called "reductionism". Optimal health comes with the totality and breadth of your diet and lifestyle. Think "whole". One note does not make a symphony.
Animal Antibiotics, Contraceptive Detected in Top 10 Popular Fast Foods
In September, Moms Across America (MAA) submitted food samples from 10 popular U.S. food chains to the Health Research Institute, an Iowa-based nonprofit laboratory that tests food for nutritional value, bio functionality, and contaminants and toxins, requesting that the laboratory test the samples for more than 100 common veterinary drugs and hormones. With the exception of Subway and Chipotle, all of the food samples tested positive for veterinary drugs. One of the drugs, monensin, is a commonly used veterinary antibiotic with a slim margin of safety. Side effects of monensin in animals include anorexia, diarrhea, weakness, and motor problems; an overdose can lead to poisoning or even death.
Less than 0.5 microgram per kilogram of the antibiotic monensin was detected in the Taco Bell, Dunkin', Wendy’s, Domino's, Burger King, and McDonald's samples.
The acceptable daily intake for monensin is 12.5 micrograms per kilogram of body weight per day. Other drugs found were Narasin, an antibiotic and antiparasitic feed additive that helps to control parasitic infections in fattened chicken, and Nicarbazin, an animal antiparasitic and contraceptive. Although these drugs were under the acceptable level, does it concern you that they are acceptable at all? Few studies have investigated the effects of veterinary drugs in humans. Some people are consuming this food every day, so we don't know how much they are accumulating in their body.
Health Insurance Marketplace Quality Initiatives
The Center for Medicare and Medicaid recently announced these initiatives: "The Quality Rating System (QRS) is a 5-star rating system used to rate QHPs (Qualified Health Plans) based on relative quality and price. The goals of the QRS are to provide comparable and useful information to consumers, facilitate oversight of QHPs, and provide actionable information to QHPs to improve quality and performance." They are basically developing data collection and reporting tools. This sounds like they are doing something great for health care. But this is the reason that doctors cannot spend quality time with patients, especially to counsel them on diet and lifestyle changes. Physicians are penalized because they need to show adherence to prescribed medications. This is why we call it the "medical mill". The scoring system that this initiative refers to is based on the doctor "managing" the patients by continuing to prescribe medications, rather than reversing their disease. Doctors who have become board certified in Lifestyle Medicine are penalized by this system. Treatment to reverse disease using diet and lifestyle modification requires more follow-up. The patient needs to pay a co-pay for each visit, which is not affordable in most cases. What we have is government bureaucrats managing healthcare.
Healthcare was in terrible shape before COVID; it is worse now. The American medical system is in the process of collapsing and there are many reasons for it. Disease mongering and overtreatment have increased costs to unsustainable levels. Most members of the public no longer trust the system because there is no integrity left. Health professionals working in institutions are expected to follow prescribed protocols for care, even if these protocols are inadvisable for their patients.
As I stated in the first paragraph (and I am glad that you read this far) It's important to be well-informed, prioritize learning about health, and invest your time and resources in adopting the right diet and exercise program.
Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
Wellness Forum Health
Your Wellness Lifestyle Starts Here
While billions of dollars have been spent on initiatives like The War on Cancer, the incidence of cancer continues to increase, along with the death rate, for many forms of cancer. The National Cancer Institute estimated that 1,685,210 new cases of cancer would be diagnosed in the U.S. in 2016 and that approximately 595,690 people would die, which means an average of 1632 cancer deaths per day.[1] This is an increase from 2009, when it was estimated that 1,479,350 Americans would be diagnosed with cancer, and 562,340 would die, or an average of 1,500 cancer deaths per day.[2]
Some of the most significant contributors to cancer risk are diet and lifestyle choices, weight, and inflammation, all of which can be modified to reduce risk. The best option is to prevent cancer, and research shows that most cancers and deaths from cancer are preventable.[3]
One of the leading contributors to many types of cancer is being overweight. A review of over one thousand studies conducted by the International Agency for Research on Cancer showed that being overweight or obese increases the risk for at least 13 types of cancer.[4] According to Dr. Graham Colditz, chairman of the research group, these 13 cancers represent 42% of all cancer diagnoses. Colditz says that weight status is an even more important factor than smoking in terms of cancer risk, and that obesity should be at the top of the list of risk factors to address for cancer prevention.[5]
While many factors contribute to weight gain and obesity, diet is the most important. It’s easier to gain weight while eating foods that are high in calories and fat, like beef, cheese, and pastries. And it’s easier to lose weight while eating a plant-based diet that includes more calorie-dilute foods like fruits, vegetables and starches.
Inflammation increases the risk of cancer and can also accelerate its progression. Cancers often develop at sites where infection, chronic irritation, or inflammation have occurred.[6] Take colon cancer, for example. Over 35% of Americans develop polyps due to changes in the mucosal layer that protects the lining of the colon.[7] A major cause of these changes is over-consumption of animal foods. Sulfur-containing amino acids in animal protein increase the production of hydrogen sulfide. This substance reduces mucus production, leaving the lining of the colon vulnerable to irritation, which in turn can lead to the formation of polyps.[8] The more irritation, the bigger the polyps become, and the higher the risk they will develop into colon cancer.
Animal foods are also high in fat, and higher fat intake increases the production of bile acids, which also irritate the colon. A diet lower in fat and higher in fiber is protective because it reduces bile acid production and helps the body to eliminate bile acids more quickly.[9]
Many studies have shown a relationship between the consumption of animal foods and the risk of colon cancer in a dose-dependent manner – the more animal foods consumed, the higher the risk.[10] [11] [12] On the other hand, research shows that eating a higher fiber diet reduces the risk of colon cancer,[13] [14] [15] and that vegetarians are about 40% less likely to develop colon cancer as compared to meat eaters.[16] [17]
Another way in which high intake of animal foods contributes to increased inflammation and an increased risk of cancer is that animal foods contain concentrated amounts of arachidonic acid, which can increase inflammation levels through numerous pathways.[18]
Reducing intake of animal foods can significantly reduce inflammation levels and cancer risk.
Obesity contributes to inflammation because fat cells produce inflammatory cytokines and other similar molecules.[19] Adopting a low-fat plant-based diet usually results in weight loss, which can, in turn reduce inflammation. And plant-based diets are high in fiber, which has been shown to reduce inflammation through interaction with gut bacteria.[20]
Well-structured plant-based diets reduce the risk of cancer in several other ways too. In addition to fiber, plant foods contain concentrated amounts of antioxidants which can counteract the oxidative stress caused by poor diets, inflammation and infection.
The role of IGF-1 in cancer development has been known for some time. A 2002 study showed that higher plasma IGF-1 levels were associated with a higher incidence of prostate cancer, while higher levels of IGF-1 binding proteins were inversely associated.[21] Other studies have shown a relationship between IGF-1 levels and breast, colorectal, lung, thyroid, bone, brain, and ovarian cancers.[22] [23] [24] [25] [26] Lower levels of IGF-1 are associated with longer survival for cancer patients.[27]
The good news is that IGF-1 levels are related to diet, and dietary changes can lower plasma levels. Higher protein intake is associated with higher plasma levels of IGF-1, and lower protein intake is associated with lower plasma levels, lower incidence of cancer, and lower mortality in people under age 65.[28] Other studies have confirmed the relationship between lowered protein intake and lower plasma IGF-1 levels,[29] particularly animal protein.[30] Milk and whey protein intake increase IGF-1 levels significantly,[31] [32] which explains why dairy intake is associated with so many types of cancer.
The idea that diet can prevent cancer is not a new one. In 1892, an article in Scientific American reported that "cancer is most frequent among those branches of the human race where carnivorous habits prevail."[33] So why don’t more people eat optimal diets in order to reduce their risk of cancer, and why aren’t more doctors promoting plant-based nutrition for cancer prevention?
Medical training is one contributing factor. U.S. doctors receive almost no training in nutrition. According to a 2015 study, only 27% of U.S. medical schools offer the 25 hours of nutrition education currently recommended. The average is 19.6 hours of nutrition classes during four years of medical school, or less than 1% of total lecture hours. Most of this consists of biochemistry, not practical information about diets or food-related decision-making.[34]
Another issue is that while many doctors recognize the need for nutrition education, there are few incentives for providing it. For example, the current licensure exam evaluates "biochemical knowledge and information relating to nutritional deficiencies," but does not test for knowledge or skills needed for discussing diet and lifestyle changes with patients. Board certifications, including those for internal medicine and cardiology, do not require demonstration of expertise in nutrition.
Another very important issue is the tendency of physicians to assume that patients are not interested in dietary change or working to improve their health. A common misconception is that people only want "quick fixes" for their health issues. But "quick fixes" – meaning drugs and procedures - are usually the only choices offered to patients. Most people are not told that diet and lifestyle habits can prevent or resolve their health issues, and there is no multi-billion-dollar media campaign promoting nutrition as an effective strategy for addressing health conditions.
It is clearly time for several changes, which include nutrition education as a part of medical training, and demonstration of nutrition knowledge as a criterion for licensure. Doctors should be taught how to have conversations with patients in which all options for prevention and treatment are discussed, including improved diet; and medical practices should include nutrition and lifestyle education for patients. These changes will require time, commitment, and resources. But our only hope for winning the war on cancer is to invest more effort in preventing it.
The Prevent Cancer Campaign is almost over! Email me to sign a pledge card. For more information, email me at lizfattorehealth@gmail.com
[1] Cancer Statistics https://www.cancer.gov/about-
[2] American Cancer Society Cancer Facts and Figures 2009
Atlanta Georgia 2009
[3] Song M, Giovannucci E. "Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States." JAMA Oncol. Published online May 19, 2016. doi:10.1001/jamaoncol.2016.0843
[4] Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. "Body Fatness and Cancer — Viewpoint of the IARC Working Group." NEJM 2016 August; 375 (8): 79
[5] Bakalar N. "Obesity Is Linked to at Least 13 Types of Cancer." New York Times August 24, 2016
[6] Coussens L, Werb A. "Review article: Inflammation and Cancer." Nature 19 December 2002;420;860-867[7] Midgley R, Kerr D. "Colorectal Cancer." Lancet 1999 Jan;35(9150):391-399
[8] Tuan J, Chen Y. "Dietary and Lifestyle Factors Associated with Colorectal Cancer Risk and Interactions with Microbiota: Fiber, Red or Processed Meat and Alcoholic Drinks." Gastrointest Tumors 2016;3:17-24
[9] Ajouz H, Mukherju D, Shamseddine A. "Secondary bile acids: an underrecognized cause of colon cancer." World J Surg Oncol. 2014; 12: 164
[10] Giovannucci E, Rimm E, Stampfer M, Colditz G, Ascherio A, Willett W. "Intake of fat, meat, and fiber in relation to risk of colon cancer in men."
Cancer Res. 1994;54(9):2390-2397.
[11] Willett W, Stampfer M, Colditz G, Rosner B, Speizer F. "Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women." NEJM1990;323:1664-1672.
[12] World Cancer Research Fund. "Food, nutrition, physical activity, and the prevention of cancer: A global perspective. American Institute of Cancer Research." Washington, DC:2007.
[13] Reddy B. "Role of dietary fiber in colon cancer: an overview." Am J Med 1999 Jan 25;106(1A):16S-19S
[14] MacLennan R, Macrae F, Bain C, et al. "Randomized trial of intake of fat, fiber, and beta carotene to prevent colorectal adenomas."
J Natl Cancer Inst 1995 Dec 6;87(23):1760-1766
[15] Howe G, Benito E, Castellato R et al. "Dietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence form the combined analysis of 13 case-control studies." J Natl Cancer Inst 1992 Dec 16;84(24):1887-1896
[16] Chang-Claude J, Frentzel-Beyme R, Eilber U. "Mortality patterns of German vegetarians after
11 years of follow-up." Epidemiology. 1992;3:395-401.
[17] Chang-Claude J, Frentzel-Beyme R. "Dietary and lifestyle determinants of mortality among German vegetarians." Int J Epidemiol. 1993;22:228-236
[18] Samuelsson B. "Arachidonic acid metabolism: role in inflammation." Z Rheumatol 1991;50 Suppl 1:3-6
[19] Greenberg A, Obin M. "Obesity and the role of adipose tissue in inflammation and metabolism." Am J Clin Nutr Feb 2006;83(2):461S-465S
[20] Kuo SM. "The Interplay Between Fiber and the Intestinal Microbiome in the Inflammatory Response." Adv Nutr January 2013;4:16-28
[21] Chan J, Stampfer M, Ma J et al. "Insulin-like growth factor-I (IGF-I) and IGF binding protein-3 as predictors of advanced-stage prostate cancer. J Natl Cancer Inst 2002 Jul 17;94(14):1099-1106
[22] Wei E, Ma J, Pollack M et al. "Prospective Study of C-Peptide, Insulin-like Growth Factor-I, Insulin-like Growth Factor Binding Protein-1, and the Risk of Colorectal Cancer in Women." Cancer Epidemiol Biomarkers Prev April 2005 14; 850[23] Birmann B, Tamimi R, Giovannucci E. "Insulin-like growth factor-1- and interleukin-6-related gene variation and risk of multiple myeloma." Cancer Epidemiol Biomarkers Prev 2009 Jan;18(1):282-288See comment in PubMed Commons below
[24] Kaaks R, Johnson T, Tikk K et al. "Insulin-like growth factor I and risk of breast cancer by age and hormone receptor status-A prospective study within the EPIC cohort." Int J Cancer 2014 Jun 1;134(11):2683-2690
[25] Cao H, Wang G, Meng L et al. "Association between circulating levels of Igf-1 and IGFPB-3 and lung cancer risk: a meta-analysis." PLoS One 2012;7(11):e49884