What the recent Zantac scare teaches us about BBQ - and reducing cancer risk

There has been a lot in the news recently about voluntary recalls of Zantac (ranitidine).  In short, the FDA found trace amounts of N-nitrosodimethylamine (NDMA), a probable carcinogen (cancer-causing compound), in some lots of the medication by several manufacturers.  
 
While the headlines are scary, this topic deserves a little unpacking.
 
First, let’s gain a little perspective.  According to the FDA, the levels of NDMA in many tested ranitidine products are similar to those consumed through "common foods like grilled or smoked meats.”  For some people, this statement is quite reassuring, while others are thinking, “What?!  My favorite grilled meat can cause cancer?”.  Well, yes and no.
 
Cancer is caused when damages to DNA result in uncontrolled over-growth of a cell or tissue.  Most of the time, our cells recognize the damage and either fixes the DNA or destroys the cells that have gone rogue.  A person’s overall risk of cancer is based on a number of factors including genetics and environment exposures https://www.cancer.gov/about-cancer/causes-prevention/risk/substances.  While some exposures can be avoided (tobacco smoke, excessive sun exposure), others are more difficult to avoid since they are present in the environment, including the air we breathe and the food we eat.  
 
Health Suite 110’s stock of ranitidine was not affected by these recalls as we are stocked by a different manufacturer.  That said, the FDA recommends “patients taking prescription ranitidine who wish to stop should talk to their health care professional about other treatment options. Consumers taking OTC ranitidine, which is used to prevent and relieve heartburn associated with acid indigestion and sour stomach, may consider using other OTC products approved for their condition. FDA’s testing of samples of alternatives such as Pepcid (famotidine), Tagamet (cimetidine), Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole) show no NDMA in these medicines”. 
 
You can read more about the recall and specific lots affected on the FDA website: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-ndma-zantac-ranitidine. 
 
For patients who prefer to switch from taking Zantac, these medications are not all interchangeable.  While Zantac, Pepcid and Tagament are all histamine-blockers (H2-blockers), things like Prevacid and Prilosec are proton-pump inhibitors (PPIs) and have different implications.  H2-blockers are generally felt to be safe for long-term use, while long-term use of PPIs can increase the risk for C.diff, pneumonia and osteoporosis.  If you require antacid medication on a daily basis, be sure to discuss with your physician.  Sometimes there is an underlying cause that can be treated (H. pylori infection, obesity, food triggers) and other times the risk of taking a medication long term far outweighs the risks of not taking it, particularly for folks who have pre-cancerous changes in their esophagus from long term reflux (Barrett’s esophagitis).
 
 
In summary:

• If you suffer from heartburn or gastroesophageal reflux (GERD), do not stop or change your medication without first discussing with your doctor.

 

• Talk to your doctor to discuss ways to reduce your heartburn symptoms (weight loss, avoiding food triggers and late-night eating).

 

• Consider ways you can reduce your exposure to carcinogens, including limiting intake of meat cooked at high temperatures, see below.

 
 
 
Five Steps for Cancer-Safe Grilling
1. Marinate: Studies suggest that marinating meat before grilling can decrease formation of carcinogens. 
2. Pre-Cook: If you are grilling larger cuts, you can reduce the time your meat is exposed to flame by partially cooking it in a microwave, oven or stove first. 
3. Go Lean: Trimming the fat off your meat can reduce flare-ups and charring. Cook your meat in the center of the grill and make sure to flip frequently.
4. Mix It Up: Cutting meat into smaller portions and mixing them with vegetables can shorten cooking time.
5. Go Green: Grilling of vegetables and fruits produces no carcinogens. So, add veggies and cut down the amount of meats.
 
 
Happy grilling!
Kylie Vannaman MD