“Tomatoes and Health”gland. His recent work has included a study of how tomato and tomato-based...

“Tomatoes and Health”

TRANSCRIPT OF TOMATO HEALTH PANEL

HOSTED BY THE

CALIFORNIA TOMATO GROWERS ASSOCIATION, INC.

February 6, 1997Sacramento, California

“T OMATOES AND HEALTH” PAGE 2

CALIFORNIA TOMATO GROWERS ASSOCIATION

“Health & Tomatoes”Biographies of Panelists

Mary N. Haan, MPH, DrPHDirector, Center for Aging and HealthUC Davis School of MedicineDepartment of Epidemiology and Preventative MedicineDr. Mary Haan has worked in public health and medicine since 1969. She received her doctorate inepidemiology in 1986, and has been a faculty member of the School of Medicine at UC Davis since1991. The Center for Aging and Health, which she has directed since 1992, is an interdisciplinaryeducation and research unit, focusing on a broad array of health issues that affect older adults. Dr.Haan’s primary research is into the health of older women. Notably, she is the CoPI of the Women’sHealth Initiative Vanguard Clinical Center at UCD. She is also conducting research into the role ofdiet in the prevention of breast cancer. She is widely published on topics related to adult health.

Kathleen M. Egan, Sc.D.Harvard Medical SchoolHarvard School of Public HealthDepartment of Epidemiology, and Department of OphthalmologyDr. Egan is a graduate of the Harvard School of Public Health, having completed a doctorate degree inEpidemiology in May 1996. Dr. Egan’s primary research interest involves exploring the role oflifestyle, primarily diet, in the development of breast cancer. With expertise in Cancer Biology, Dr.Egan is also engaged in studies examining genetic aspects of breast cancer, including the role offamily history, and the interactions of family history with established breast cancer risk factors.During the past six years, Dr. Egan has served as Project Director of a multicenter population-basedcase control study of breast cancer.

Dr. Edward GiovannucciHarvard Medical SchoolHarvard School of Public HealthDr. Giovannucci graduated from Harvard University in 1980, and receive a medical degree from theUniversity of Pittsburgh School of Medicine in 1984. After completing his residency, he returned toBoston where he completed a doctoral degree in epidemiology from the Harvard School of PublicHealth in 1992. Currently, Dr. Giovannucci is in the Department of Nutrition at the Harvard School of

Public Health and the Department of Medicine at the Harvard Medical School.Over the past decade, Dr. Giovannucci’s work has included the study of how

dietary factors and other “lifestyle” or “environmental” factors influence theoccurrence of various cancers, particularly malignancies of the colon and prostrate

gland. His recent work has included a study of how tomato and tomato-based productsmay affect risk of prostrate cancer. He and his colleagues found that high consumption oftomato-based products appear to protect against risk of developing prostrate cancer, thesecond leading cause of cancer death in U.S. men.



“Health & Tomatoes”EXECUTIVE SUMMARY

DR. EDWARD GIOVANNUCCI

DR. KATHLEEN EGAN

DR. MARY HAAN

Pizza, ketchup and canned tomatoes are all included in therecipe to fight cancer according to panel of leading re-searchers who met during the California Tomato Growers

Association’s 50th annual meeting in early February. In the dis-cussion, led by moderator Dr. Mary Haan of the U.C. Davis Schoolof Medicine, Dr. Edward Giovannucci and Dr. Kathleen Egan,both of Harvard Medical School, labeled processing tomatoes asthe richest food source of lycopene, a carotenoid thought to beespecially powerful in fighting free radicals that may lead to sometypes of cancer.

Based on his research of male subjects who had five or moreservings per week of processing tomato products, Dr. Giovannuccisaw a 40 percent reduction in the incident of prostrate cancer.Prostrate cancer, Dr. Giovannucci says, is the number one cancerfound in men and strikes over 200,000 men in the United Statesannually leading to 40,000 deaths.

“The bottom line is that there has been three studies to date thathave looked at lycopene and prostrate cancer, and all three stud-ies show a benefit of lycopene or tomatoes,” said Giovannucci.All bodies produce off-balance molecules called free radicals, Dr.Haan explained. These molecules indiscriminately create chainreactions that produce more free radicals. All of this leads to dam-age to critical cells in our bodies, which accelerates the agingprocess. The process is called oxidation, and places humans athigh risk for heart disease, makes us more vulnerable to cancersand is possibly linked to Alzheimer’s Disease, reported Haan,who heads the Center for Aging and Health at U.C. Davis.

Earlier research has found that fruits, vegetables and reduction ofdietary fat intake can help prevent free radicals from doing harm.Many fruits and vegetables contain substances classified as anti-oxidants. Among these substances are vitamin C, vitamin E, vita-min A, retinal, keratin, gluten and lycopene. These antioxidants

seize rampaging free radical oxygen mol-ecules and convert them into harmless

forms. Researchers feel that combinations ofantioxidants may be the most effective way to re-

duce the risk of cancer and heart disease.

In addition to the widely reported research on the linkbetween processed tomato consumption and reducedlevels of prostate cancer, Dr. Haan says that studies


have drawn similar parallels between a dietrich in tomato products and reduced levels ofgastrointestinal cancers.

“A recent comparison of people living inNaples, Italy to those living in Gristle, En-gland revealed that the Italians ate more to-matoes and tomato juice along with olive oil,and had about 40 percent lower levels of oxi-dation of lipids, which is a contributor to ar-teriosclerosis, hardening of the arteries, thanthe British group,” Dr. Haan said.

Her studies of breast cancer led Dr. Egan togive tomatoes greater attention as a possiblepreventative. “We’ve recently become inter-ested in the question of whether the caro-tenoid, lycopene, may be a critical preventa-tive for breast cancer, given that it’s the mostpotent antioxidant among carotenoids,” Dr.Egan announced. She claims that most lyco-pene in the diet comes from tomato sources.“At least one study does suggest a protectiveassociation for lycopene in human breast can-cer,” Dr. Egan said. She says that she willaddress the question definitively in a largecase control study of breast cancer involving10,000 women.

“It will come as good news to many thatfrench fries with ketchup and pizza with sauceseveral times a week may not be so bad afterall,” Dr. Egan said.

The role of tomatoes in the diet was furtheremphasized by Dr. Giovannucci. “There are14 different types of carotenoids that are im-portant enough for us to mention,” he stated.“And the tomato is an important source of 8of the 14.” Giovannucci explained that lyco-pene is readily absorbed into the body, in con-trast to other such substances, and is the most

concentrated antioxi-dant found in theprostate. “Lycopene

gets in the prostate, whichis exciting,” said

Giovannucci. “But it is more ex-citing if you think lycopene mayhave these beneficial effects

against cancer in terms of preventing free radical reactions.”

In his initial studies researching the affect of diet on pros-tate cancer, Dr. Giovannucci says three foods were readilyassociated with decreased risk of prostate cancer: Toma-toes, tomato sauce and pizza.

“We wanted to be cautious, as we waited another two years,”Dr. Giovannucci says, before he recreated the study. “Again,these same three foods, tomatoes, tomato sauce and pizza,were associated with lower risk of prostate cancer.” Thetest was conducted yet a third time with the same results.

“The relative risk (of developing prostate cancer) for con-sumption (of tomato sauce) of two to four servings per weekwas reduced by 24 percent,” Dr. Giovannucci told the audi-ence. “And the men consuming five servings a week, had a40 percent reduction in risk.”

“The strongest benefit we’ve seen [against cancer] was withtomato sauce and processed tomatoes,” said Giovannucci.“For some reason, it seems lycopene is absorbed better intothe body through tomato sauce and other processed tomatoproducts than fresh tomato products.

“In terms of overall health, the message should be for theAmerican public to increase consumption of fruits and veg-etables,” he said. “One caveat that I would like to add isthat it’s important to have a variety of tomatoes or processedtomatoes (in that diet).”

Dr. Haan wrapped up the session by pointing out the op-portunities open to the tomato industry. “I only hear goodthings about the tomato industry,” she said. “So I think youhave a golden opportunity to support more research in thisarea and also to promote your product as a healthy and safeproduct.”



“Health & Tomatoes”Transcript of Panel Discussion

February 6, 1997

DR. MARY HAAN:

I’m particularly happy to be speaking to agroup of tomato growers. I live in SolanoCounty myself surrounded by tomatoes, andI understand that tomatoes are one of thelargest legal cash groups in Solano County.

Tomatoes have come a long way since theMiddle Ages when they were dubbed “loveapples” and believed to be poisonous. Farfrom being viewed with suspicion, tomatoesare now believed to contribute to goodhealth and to retard heart disease, cancer,dementia, and other degenerative diseasesof aging.

I’d like to spend a few moments now ex-plaining why tomatoes and other vegetablesand fruits may help us to live longer,healthier lives. My colleagues will go intomore depth about their research into thehealth benefits of tomatoes and other sub-stances that are similar to those found intomatoes.

All bodies produce what are called free radi-cals. These are not carryovers from the1960’s, but are, in fact, molecules that areoff balance. They’ve lost an electron and

are out looking for areplacement. Free

radicals are the bad ac-tors of the body. They at-

tack other molecules indiscrimi-nately. They produce chain re-actions and make more free radi-

cals. They break up other molecules and create cross-link-ages between molecules that shouldn’t exist. If they werehuman beings, they’d be arrested.

All of this leads to damage to critical cells in our bodies,and they accelerate the aging process. Indeed, this damageby free radicals may be one fundamental reason why weage, and the more free radicals we are exposed to, the fasterwe may age. This process is called oxidation. Oxidationputs us at high risk for heart disease and atherosclerosisand may also enhance damage to our genetic material andmake us more vulnerable to cancer. Oxidated damage hasalso been linked to Alzheimer’s Disease and otherdementias.

Some of the things that we do to our bodies such as smok-ing, breathing in pollutants such as nitrous oxide, eating afatty diet and not exercising, speed up the creation of freeradicals. Is there any hope against the gang of free radi-cals? The hope in this case comes largely from threesources: vegetables, fruits, and reduction of dietary fat in-take. Today we’re going to be talking in depth about howmy favorite vegetable, the tomato, may help to prevent dis-ease. Dietary fat also affects health by producing oxida-tion or by influencing hormones that would lead to can-cers and other health problems.

Many fruits and vegetables contain substances classifiedas antioxidants. These are the substances that combat oxi-dation. Although the major source of these is from our di-ets, our bodies also manufacture some of them in responseto our diet. What are these and how can we get them? Thelist is long, but to name just a few: Vitamin C, Vitamin E,Vitamin A, retinal, keratin, lycopenes, and gluten.

These heroes of the body work in a wide variety of ways toprotect our bodies against the invasion of free radicals. For


example, beta keratin molecules will seize arampaging free radical oxygen molecule andconvert it into a harmless form. Combina-tions of the antioxidants may be the mosteffective way to reduce risk from cancer andheart disease. Tomatoes contain high levelsof lycopene, one of many antioxi-dants, and lower levels of other an-tioxidants including beta keratin.

Research is ongoing that examinesthe contributions of vegetable con-sumption and food consumption,intake of vitamin supplements anddietary fat reduction in relation-ship to the risk of heart disease,cancer, dementia and many otherserious diseases of aging. Some re-search, which you will hear abouttoday, is specifically focused ontomatoes or on lycopene andkeratins.

Some of that research is happen-ing right here in Sacramento. Agreat deal of my research is focused on theWomen’s Health Initiation, which is a na-tional clinical trial involving 167,000 womennationwide. Here in Sacramento we have re-cruited nearly 4,000 women between theages of 50 and 79, and approximately 1,400of them at this time are involved in this studythat is looking at the relationship between adiet that is high in fruits and vegetables andlow in fat and its relationship in the preven-tion of both breast cancer and cardiovascu-lar disease. This constitutes one of the larg-est major clinical trials that has ever specifi-

cally looked at di-etary factors in breast

cancer.

The Well Study, also a multi-center study, coordinated out ofSan Diego is a study that I’m in-

volved in that is looking at the question as to whether adiet high in fruits and vegetables and low in fat can help toprevent breast cancer from recurring in women who havealready had it. So these two studies are extremely impor-tant. They look at whether we can prevent breast cancerand heart disease by changing our diet, and they also look

at whether we can prevent mortality from breast cancerby changing our diet.

As Dr. Giovannucci will tell you in more detail, he haslinked consumption of tomatoes and tomato sauce to areduced risk of prostate cancer. You could consume toma-toes, tomato sauce, tomato juice and pizza and you mayreduce your risk of prostate cancer by as much as 35 per-cent and have fun doing it.

Just to put you in the picture a little bit, and I’m sure Dr.Giovannucci will go into more detail about this, prostatecancer is an extremely common problem in men. About99 percent of men actually develop microscopic prostatecancer. Another 50 percent or so progress to macroscopiclevels of disease and another 50 percent after that progressto clinically treatable prostate cancer, but only about 3percent of men die from it. Nevertheless, it’s a very largepublic health problem, and if tomatoes can be found toproduce significant contribution to preventing the progres-

LYCOPENE❑ most potent antioxidant among carotenoids

❑ red pigment in fruits and vegetables

❑ more than 90 percent of dietary lycopenecomes from tomatoes

❑ protective against prostrate cancer

❑ few data on the role of lycopenes in other�oxidative stress� disorders


sion of this disease, that will be a very im-portant contribution indeed.

Other studies have shown a reduced risk ofvarious gastrointestinal cancers in peoplewho eat tomatoes, especially with the intakeof raw tomatoes, which mayreduce your risk of esoph-ageal, stomach and coloncancer by as much as 60 per-cent. It has also long beenobserved that Mediterraneanpeople have lower levels ofheart disease than people liv-ing in other parts of Europeand the United States. And arecent comparison of peopleliving in Naples, Italy tothose living in Gristle, En-gland, revealed that the Ital-ians ate more tomatoes andtomato juice along with ol-ive oil and had about 40 per-cent lower levels of oxida-tion of lipids, which is a con-tributor to atherosclerosis,hardening of the arteries,than the British group.

In a more general way, therole of antioxidants such asVitamin E, carotenoids, inthe cardiovascular diseasereduction continues to be ex-tensively investigated, and the news is gen-erally good. As we all know, dependency,dementia and memory loss is common inelderly people. However, the benefits of an-

tioxidants in our dietfor prevention of

these problems havescarcely been examined.

Certainly the protective effectsthat these substances seem to

have on heart disease and stroke will extend to preventingmemory loss and dementia that are a result of cardiovas-cular disease. It is the case that elderly people often be-come disabled and become dependent as they age, and Dr.Snowdon, who could not be here today, has conducted

this study on elderly nunswhich showed a very strongrelationship between highlevels of Lycopene, which isagain, found in tomatoes, anda reduced risk of dependencyin older nuns.

Finally, Dr. Kathleen Eganwill talk to us about her re-search into whether tomatoes,and more specifically, lyco-pene and other carotenoidscan help to prevent breastcancer. The role of diet in theprevention of breast cancer isone of the most controversialareas in the world of science.The link between dietary in-take of vegetables or fat inbreast cancer has not beenestablished. As I mentionedearlier, the Women’s HealthInitiative Clinical Trial is ad-dressing this very question.

As you can see, there aremany positive signs that to-matoes and other fruits and

vegetables can play a very important role in health, and Iwould now like to turn to the next panelist, Dr. Egan, todiscuss her work with you in more detail. Thank you.

DR. KATHLEEN EGAN:

I’m going to spend the next ten minutes talking about someof the latest evidence supporting a protective influence ofcarotenoids found abundantly in tomatoes against certaineye diseases and cancer in general.

�It�s believed that a diverseselection may be most effec-

tive in guarding againstdisease, and here tomatoeswin out over all other good

carotinoid sources. Ninedistinct carotenoids have

been identified in tomatoescompared to only two in

broccoli and three in carrots,for example, and several are

found in no other foodsource. Tomatoes are also

the richest source of thecarotinoid, lycopene, which

new research shows mayreduce cancer incidence.�

Dr. Egan


As Dr. Haan mentioned, researchers are in-terested in dietary carotenoids based on ex-perimental data and growing evidence fromstudies in human populations that these com-pounds protect against oxidated damage.Damage in target molecules by highly reac-tive particles called free radicals is thoughtto play a role in all major chronic diseaseswhich plague mankind.

As tomato and processors you might be in-terested to know that tomatoes are a particu-

larly rich source orcarotenoids. A large

number of nutritionalcarotenoids have not been

isolated to date in part becausewe don’t know the function ofall of them. It’s believed that adiverse selection may be most ef-

fective in guarding against disease, and here tomatoes winout over all other good carotinoid sources. Nine distinctcarotenoids have been identified in tomatoes compared toonly two in broccoli and three in carrots, for example, andseveral are found in no other food source. Tomatoes arealso the richest source of the carotinoid, lycopene, whichnew research shows may reduce cancer incidence.

Carotenoids are thought to be potentially important play-ers in the prevention of an eye disease known as age-re-lated macular degeneration. Now, this is an obscure dis-ease, but really shouldn’t be, because it is the leading causeof irreversible blindness in the Western world. There’sgood news now though. Diets with high levels of certaincarotenoids may prevent against this devastating disease.

This slide shows results from a recent study which com-pared the diets of 356 persons with AMD to 520 healthycontrols. What these numbers tell you is that diets rich invarious carotenoids, particularly ludene and zetoxanthene,

0 1 2 3 4 5

Minestrone soup

Vegetarian vegetable soup

Vegetable beef soup

Pink grapefruit

Watermelon

Vegetable juice

Tomato juice

Tomato soup

Tomatoes, canned

Tomato Sauce

Spaghetti Sauce

Tomato Ketchup

Lycopene in the American DietMilligrams in 1 oz.


protect against the worst forms of AMD.Looking at the result for ludene andzetoxanthene to the far right, people in thehighest, 20 percent of intake, had less thanhalf the risk of disease compared to those inthe lowest 20 percent, and the risk declinedprogressively with increasing dietary levels.

Now, carotenoids are pig-mented molecules thatgive fruits and vegetablestheir color. An accumulat-ing body evidence sug-gests that multiple serv-ings of these foods everyday may also protectagainst many cancers. Infact, there’s an impressiveconsistency among epide-miological studies, mostof which shows substan-tial reductions in cancermortality among personsconsuming large quanti-ties of the fruits and veg-etables known to be goodcarotinoid sources.

My research at theHarvard Medical Schoolfocuses primarily on di-etary determinants of breast cancer. Datafrom a large study we completed severalyears ago suggests that carotenoids in gen-eral can reduce the risk of breast cancer, par-ticularly among women with a family his-tory of the disease. Our data indicates thatas much as 25 percent reduction in risk can

be achieved in thesewomen, which is im-

portant because theirbaseline risk of breast cancer

is already elevated in compari-son to women without this ge-netic predisposition.

But we’ve recently become interested in the question ofwhether the carotinoid, lycopene, may be a critical pre-ventative for breast cancer, given that it’s the most potentantioxidant among carotenoids, and it has been shown byDr. Giovannucci and his colleagues to reduce prostate can-cer risk. Most lycopene in the diet comes from tomatosources.

Evidence from the laboratory is encouraging. In one study,lycopene was more effectivethan either alpha or beta kera-tin in controlling growth in hu-man endometrial lung andbreast cancer cell lines. The lineon the bottom in every case cor-responds to the curve for celllines that were exposed to ly-copene, and you can see thegrowth is cut almost to zero.

In laboratory mice bred to have a high background inci-dence of mammary tumors, tumor incidence was substan-tially reduced in animals fed a diet high in lycopene com-pared to controls. In every case, at every age, the animalsfed diets high in lycopene had a much lower incidence ofmammary tumors.

Now, currently there’s only very limited epidemiologicaldata, but at least one study does suggest a protective asso-ciation for lycopene in human breast cancer. So we planto address the question definitively in a large case controlstudy of breast cancer in which more than 5,000 womenwith invasive disease and 5,000 healthy controls wereasked about their typical diets including consumption of

Breast Cancer Risk According toCarotenoid Consumption

CBCS 1 ('89-'91)Family history of BRCA?

YesNo1000 IU/day1.001.00<20.790.982-30.670.924-50.760.896-80.730.77.80.020.01P for Trend =

Advanced AMD According toCarotenoid Consumption EDCCS (1986-1990)

356 subjects with exudative AMD / 520 controlsLutein / ZeaxanthinLycopeneBeta CaroteneQuintile

1.001.001.0011.141.000.8620.840.700.8630.770.700.7240.431.160.595

< .0010.960.03P for trend =


tomatoes. Analyses of data from that studyare currently underway.

Now, it appears that despite allthe evidence that a good dietprolongs life and prevents dis-ease the message has not got-ten out to many Americans.Data from the second nationalhealth and nutrition survey sug-gests that the majority of ourcitizens are not eating their veg-etables against current recom-mendations by the USDA thatfive or more servings per daypromote health. Therefore, itwill come as good news tomany that French fries withketchup and pizza with sauceseveral times a week may notbe so bad after all. Thank you.

DR. EDWARD GIOVANNUCCI:

We all know what a tomato is. Now, for thehard part, what’s inside. These are a list ofthe various carotenoids, at least a chemicalformula. Fortunately, I won’t be quizzingyou, but it’s interesting to know that there isa variety of different chemicals in tomatoesand other fruits and vegetables.

As Dr. Eganmentioned, to-matoes are ap a r t i c u l a r l ygood source of

a lot of different carotenoids. There are about 14 differentof these chemicals that are absorbed in appreciable

amounts in the body. There areactually about 600 or morecarotenoids in nature, but givenour dietary sources and thefoods that we eat, there are onlyabout 14 that are importantenough for us in terms of whatwe eat. And the tomato is animportant source of 8 of the 14.As was mentioned earlier car-rots, which we always associ-ate with beta keratin, is reallya source of beta keratin and afew other carotenoids, but ithas almost essentially no lyco-pene, which seems to be an im-portant carotinoid. So tomatoesare a very good source of caro-tenoids.

Now, as this slide demonstrates -- these are various caro-tenoids of these chemicals in tomatoes, and the first one islycopene. But as you can see, tomatoes also has some othercarotenoids which may have some benefit. My talk willfocus on lycopene because that is a particularly importantcarotinoid in crunching these free radicals.

Probably what happened many billions of years ago is thatplants developed these chemicals to protect them againstsunlight, and the lycopene seems to be probably the best,

Relative Risk (RR) of Prostate Cancer Adjusted for Age and TotalEnergy, Excluding Stage A1 and 95% Confidence Intervals (CI)Among 47,894 Members of the HPFS (1986 to Jan. 31, 1992)

P trendQ5Q4Q3Q2Q1a-carotene

0.771.091.071.091.051.00RRB-carotene

0.701.050.990.961.241.00RRB-cryptoxanthin

0.760.940.991.140.971.00RRLycopene

0.040.790.890.940.901.00RRLutein

0.341.100.961.011.011.00RR

�...a very interesting find-ing in that there werethree foods that were

associated with decreasedrisk of prostate cancer.These were tomatoes,

tomato sauce and pizza,and these were all indepen-dently statistically signifi-

cant related to reducedrisk of prostate cancer.�

--Dr. Giovannucci


or at least among the best, of these com-pounds. It’s like our bodies. We don’t getthe same damage from sunlight that toma-toes are exposed to every day, but we do havea lot of chemical reactions that have similaroxidated reactions, chemical reactions to freeradicals. It seems perhaps gratuitous that ly-copene may help us in terms of quenchingthese bad reactions.

So now I’ll talk a little bit about prostatecancer. These are a list of cancer rates in menin 1994 and top on the list is prostate can-cer. Prostate cancer is by far the number onecancer in men, followed by lung cancer. Theslightly good news about prostatecancer is that not all the cancersare deadly. In fact, probably about20 percent that are diagnosed maybe deadly. There are 200,000 casesdiagnosed every year, but 40,000men die of the disease. So whilea lot of the cancers are not thatmalignant, still 40,000 men in theUnited States every year is a veryhigh number, and there’s effec-tively no good treatment for pros-tate cancer once it has spread.

So it seems that the best thing thatyou can do is prevent the disease.Early detection is good, but eventhat’s questionable. Given thattreatment is probably many yearsaway, if not decades, it seems that all wecan hope for now is to prevent the disease,and I think perhaps that’s where diet mayhave a role as I will talk about carotenoids

and the prostate.

In a study done by acolleague of mine, Steve

Clinton, in Boston, he got tis-sue from men who had prostatecancer, and this is actually look-

ing at the normal prostate tissue to see if these carotenoidsactually get into the tissue. This brings up somewhat of aninteresting point.

The beneficial effects of grapes and how a compound ingrapes is good for cancer made the news recently. I don’tmean to offend anyone who might be in the grape indus-

try, but that compound actuallyis not well absorbed into thebody. So even though this studywas very exciting and should befollowed through, I don’t thinkthat really can explain much interms of what we know nowabout cancer.

Lycopene, in contrast, is foundin very high quantities in thebody. So we seem to absorb ly-copene, and, in fact, in the pros-tate. On average lycopene is themost concentrated carotinoid inthe prostate. This is exciting ifyou think lycopene may havethese beneficial effects againstcancer in terms of preventing

free radical reactions.

We conducted a study testing a hypothesis in human popu-lation. We have detailed dietary information on 52,000men, and, as shown in the diagram, we collect dietary in-formation every four years. The study began in 1986, andwe collected diet information again in 1990 and again in1994. So this is an ongoing study, but one of the points ofthe study is to look at what men were eating in 1986, forexample, to see if their diet is related to various cancersand other diseases, and one of my interests was looking at

�This shows that themore tomato sauce youeat, the lower your risk

goes. And those menconsuming five serv-ings a week actually

have the lowest risk ofprostate cancer. Theyhad a 40 percent re-

duction in risk.�--Dr. Giovannucci

Multivariate Analysis of Current Use ofTomatoes as Related to Prostrate Cancer

Risk in Male Adventists '(1976-82)Two-tailed P ValueRR(95% CI)Food Frequency

1.00< 1 x/week0.02.64 (.42-.97)1-4 x/week0.02.60 (.37-.97)> 5 x/week


prostate cancer. I also looked at prostate can-cer and the various carotenoids in risk ofprostate cancer.

This slide shows a lot of potential beneficialcompounds in many fruits andvegetables. I certainly agree withthe statement that a diet high infruits and vegetables offers manypotential benefits in terms ofhealth. Perhaps, some benefitsare very specific to certain dis-eases. Perhaps, Vitamin C is ben-eficial to some disease and an-other compound for another dis-ease.

For prostate cancer we did a verysimple analysis just correlatingintake of all these fruits and veg-etables to a risk of prostate can-cer. As you can see in that longlist, there is no association withmost of the fruits and vegetables.So high intake, for example, ofbananas didn’t increase or de-crease your risk of prostate.There was no association. Now,if you look at the bottom, where it says “re-duced risk”, we have at first glance a veryinteresting finding in that there were threefoods that were associated with decreasedrisk of prostate cancer. These were tomatoes,tomato sauce and pizza, and these were allindependently statistically significant relatedto reduced risk of prostate cancer.

When we saw this association, we didn’twant to jump thegun. An association

was seen in 1988, butwe wanted to be very cau-

tious. We conducted more fol-low-up, and again this associa-tion or benefit was there in 1990.

Again, we wanted to be extra cautious, and we waited an-other two years, and again these same three foods: toma-toes, tomato sauce and pizza, were associated with lowerrisk of prostate cancer.

So at that point we feltthat this can’t just bechance. There’s some-thing. These three foodsthat are high in lycopeneand perhaps other caro-tenoids have been asso-ciated with a lower riskof prostate cancer. In asense, three consecutivestudies -- supported ourfindings, and that’swhen we published thestudy you probablyheard about last year.We are continuing ourstudy, and, in fact, wesee a stronger associa-tion with even more fol-low-up. The initial studywent up to 1994. Now,we have follow-up to1996, and, again, the ex-

act same associations uphold.

This slide shows tomatoes, tomato sauce, and pizza, andthe relative risk for consumption of two to four servingsper week. What this actually shows is the men who wereconsuming tomato sauce two to four times per week had arelative risk of .66. That’s a 34 percent reduction in risk ofprostate cancer. That was highly statistically significant.

For those consuming canned tomatoes two to four per timesper week, there was a 26 percent reduction in risk. Andmen who consumed the same amount of pizza saw a 15percent reduction of risk. These were all statistically sig-nificant. This shows that the more tomato sauce you eat,the lower your risk goes. And those men consuming fiveservings a week actually have the lowest risk of prostatecancer. They had a 40 percent reduction in risk.

�It seems that the potentialbenefit of tomatoes was even

considerably stronger withmore aggressive cancers. Sonot only do you get less can-cers, you get less aggressive

cancers. You have an evenmore dramatic reduction in

mortality. So there�s like a 40percent reduction in overall

risk, but perhaps a 50 to 60percent reduction in mortality

from prostate cancer.�-- Dr. Giovannucci


In fact, what was even more interesting tous was -- as I mentioned earlier, prostate can-cer comes in different forms. Some of themare quite benign, but a certainpercentage are quite aggressive,and cause mortality relativelyquickly. It seems that the poten-tial benefit of tomatoes was evenconsiderably stronger with moreaggressive cancers. So not onlydo you get less cancers, you getless aggressive cancers. Youhave an even more dramatic re-duction in mortality. So there’slike a 40 percent reduction inoverall risk, but perhaps a 50 to60 percent reduction in mortal-ity from prostate cancer.

Now, in these studies, eventhough we tried to be as carefulas we could, we actually statisti-cally controlled for many otherfactors. What that means is thatwe’re looking to see that perhapsthe people who eat tomatoeswere exercising more or doingsomething else that was benefi-cial, but to the best that we can tell, this ben-efit seemed very specific for tomatoes andnot something else in the tomato consumer’slifestyle that was accounting for this benefit.

Another bit of interest-ing evidence is that afew other studies,smaller studies, demon-strated the same asso-

ciation. This is a similar study and again you can see therelative risks for consumption. The bottom line is that menconsuming the high levels of tomatoes (I think it was like

four times a week or more)had a relative risk of .60,which means a 40 percentreduction. That is very con-sistent with our study abouta 40 percent reduction ofrisk and high consumption.

Another study that actuallycollected blood samplesfrom over 10,000 men, fol-lowed the men over time.They looked at various lev-els of these carotenoids inthe blood that was col-lected years earlier, and themen who had the high lev-els of lycopene had thelowest risk of prostate can-cer. They had about a 70percent reduction in risk ofprostate cancer.

So the bottom line is thatthere have been three stud-

ies to date that have looked at the connection between ly-copene between and reduced risk of prostate cancer. Allthree studies show a benefit of lycopene or tomatoes. Theyare almost indistinguishable. We have other studies ongo-ing to look at this in more detail. The preliminary results

�For some reason it seemsthat the lycopene is ab-

sorbed better into the bodyin tomato sauce or pro-

cessed tomatoes than inthe fresh tomato, which isquite interesting. You hearsometimes negative things

about processing foodsbut, in this particular case,

it seems that processingmay actually have a ben-

efit in making lycopenemore easily absorbed into

the body.�-- Dr. Giovannucci

Age and Energy Adjusted Relative Risk (RR) of Prostate Cancerby Intake of Primary Contributions of Lycopene in the HPFS

P for trend2-4/wk1/wk1-3/mo0No. of Servings:Tomato Sauce

65.00158.00313.00209.00No. of Cases0.000.660.770.851.00RR

Tomatoes155.00300.00161.00148.00No. Of Cases

0.030.740.910.901.00RRPizza

11.0060.00287.00396.00No. of Cases0.050.850.760.941.00RR


look quite promising in confirming this as-sociation with tomatoes.

And just a final point I’d like to make is thatthe strongest benefit that we saw was withtomato sauce, processed tomatoes. For somereason it seems that the lycopene is absorbedbetter into the body in tomato sauce or pro-cessed tomatoes than in the fresh tomatowhich is quite interesting. You hear some-times negative things about processing foods,but in this particular case it seems that pro-cessing may actually have a benefit in mak-ing lycopene more easily absorbed into thebody.

QUESTIONSDR. GIOVANNUCCI: I will say that interms of overall health, the message shouldbe for the American public to increase con-

sumption of fruitsand vegetables, andthat’s a wide recom-

mendation made by manyagencies. But the one caveat

or one extra point that I wouldlike to add is that it’s importantto have a variety, and tomatoes,

or processed tomatoes, should definitely be part of thatequation.

For example, the recommendations to increase fruits andvegetables to at least five servings a day -- if you eat fiveapples a day, you follow the recommendation, and fiveapples a day is fine, but you won’t get many carotenoids,especially lycopene and other compounds.

So I think the key -- I don’t like to want to just focus ontomatoes, but, I believe, it’s an important part of a healthydiet, and I think the evidence is becoming quite clear thatthat’s the case.

DR. HAAN: Let me follow-up with another question toyou, Dr. Egan. Is there any study now that shows that adiet high in carotenoids and especially lycopene can pre-vent the progression of breast cancer once a person al-ready has it?

DR. EGAN: That’s a really interesting question, and it’sone that my colleagues and I at Harvard School of PublicHealth hope one day to be able to address. We are actuallythinking of forming a cohort of breast cancer survivorsfrom whom we collect dietary data and follow those samewomen forward in time to determine whether any aspectof diet may determine survival with breast cancer. But tomy knowledge there is no study at the moment which ad-dresses that question directly.

DR. HAAN: Let me ask one last question. What shouldthe tomato industry be doing to promote these research

Relative Risk of Prostate Cancer b y Intake ofTomato Sauce, Tomatoes, Tomato Juice and Pizza

P-trend>107.1-104.1-71.5-4<1.5Servin gs per week15,83432,20270,20295,67441,802PY

34.00102.00176.00293.00168.00Total Cases0.650.850.780.921.00RR

0.010.44-0.95(95% CI)8.0034.0061.00115.0053.00Stage C/D0.470.880.861.151.00RR

0.030.22-1(95% CI)2.0018.0034.0055.0026.00Stage D0.240.940.961.111.00RR

0.120.06-1.02(95% CI)


findings to consumers, if anything? Now, arewe ready to go out there and promote toma-toes as a sort of prescription for any part ofa healthy diet or is it too early to say?

DR. GIOVANNUCCI: Well, again, I wouldsay that at this point the evidence isquite promising. In the scientificcommunity we are taught to be quiterestrained and conservative in termsof making widespread recommenda-tions, but I think the evidence is quitestrong. If you look at the overall diet,a diet that’s high in fruits and veg-etables is quite beneficial. That’sbeen proven by hundreds of studies,and I think the evidence in the lastfew years regarding tomatoes is rela-tively new, but it seems that studyafter study is beginning to show this,and Dr. Hahn mentioned earlier thereare other cancers where it may be abenefit to tomatoes.

So there certainly doesn’t seem to bemuch harm in eating the products and they’requite tasty, and the evidence is getting prettygood that tomatoes may have some extra ben-efit in terms of cancer and other diseases.

I think a point that I’d like to make is thatpeople, sometimes in the press, and some-times even in the research community, jumpon one study and say well, this study showsthis, and this is the end all. But what we tryto do is to look at the evidence that’s accu-mulating, and after literally hundreds of stud-ies have tended to show something, then at

that point we’ll makea recommendation. I

think the evidence isgetting strong for tomatoes.

There isn’t much harm. So if youwant to recommend it, that’sokay with me.

AUDIENCE MEMBER: Basically is it better for healthto eat processed tomatoes or fresh tomatoes?

DR. GIOVANNUCCI: Well, our study showed that theprocessed tomatoes were more strongly beneficial for pros-tate cancer. In another study that we did we found that the

tomato sauce was by far thestrongest predictorate of ly-copene in the blood. And, infact, tomato juice did not pre-dict lycopene in the blood. Inother words, the men drink-ing fair amounts of tomatojuice did not have an increaseof lycopene in the blood. Itprobably has to do withsomething in the processing,perhaps in the cooking of to-matoes, that’s important.

Another point is that to ab-sorb lycopene you need someoil, a little bit of fat, and itseems that making spaghettisauce, cooking it in some ol-

ive oil, is the ideal way to absorb lycopene. So I think theprocessing and the cooking in an oil medium is probablythe best way to absorb lycopene. But I also will say that Ithink there needs to be more specific studies in this area.This is a very new theory of research.

AUDIENCE MEMBER: What portion constitutes a serv-ing?

DR. HAAN: Generally, that will be about a half cup. Idon’t know specifically with respect to tomato paste, butif you’re looking at, say, consumption of raw tomatoes,about half a cup constitutes one serving.

MALE AUDIENCE MEMBER: Is there a difference inthe potential health benefits of tomato juice that is madefrom reconstituted tomato paste versus that tomato juicewhich is made directly from raw tomatoes?

DR. GIOVANNUCCI: I think it’s a very good question,and I think probably people up until a few years ago werenot concerned about these questions. I mean, people didn’t

�Another point is thatto absorb lycopene

you need some oil, alittle bit of fat, and it

seems that makingspaghetti sauce,

cooking it in someolive oil, is the idealway to absorb lyco-

pene.�-- Dr. Giovannucci


really care how much lycopene you were ab-sorbing from tomato juice or tomato sauce.Actually ever since our study came out, thereare many people in the industry that haveasked similar questions. I think that if thereis a potential role for research thatsome of you people could supportit would be looking at some ofthese issues. I think that would beimportant work to supplement ourstudies. I’m interested primarily inlooking at the association withprostate cancer, and all these ques-tions are very important, but wecan’t do everything. We don’thave the money to do everything.

AUDIENCE MEMBER: Atwhat point does the research com-munity translate their finding intoaction by trying to influence gov-ernment feeding programs or anyrecommendations to change thefew programs that are available?

DR. EGAN: Generally that pro-cess takes years in terms of put-ting into, say, a nutritional label-ing statement or availability un-der FDA of any health claim. Idon’t personally know of any particular pro-cess regarding tomatoes about that at themoment.

AUDIENCE MEMBER: It seems to methat the wine industry is riding the wave ofthe red wine-French Paradox phenomenonwith far less conclusive studies than your

studies. Why aren’tyour findings as

broadly publicized andreaching as large an audi-

ence and making the same kindof impact?

DR. HAAN: First of all, it’s more fun to drink red wine.And they must have a better PR firm. That would be myprediction. Actually, I am quite serious. I think that if thetomato industry were to take the evidence that now existsand try to translate that message to the consumer that it

would have a similarimpact, although youmight not be able tomake quite the sameclaims that the alcoholindustry has made.And I would say thatat the moment the evi-dence that drinking redwine truly reduces therisk of cardiovasculardisease is still quite anunanswered questionalthough it’s enjoyableto test the question.

DR. EGAN: I justwould like to add tothat wine has the bag-gage that alcohol prob-ably does increasebreast cancer inci-dence, and, of course,there’s a segment of

the population prone to abuse. And this is a problem thatyou people won’t have selling your product.

DR. GIOVANNUCCI: I agree with the premise of thequestion that there has been a real proliferation (of infor-mation about the health benefits of wine). I have to rollmy eyes every time I hear something -- specifically aboutred wine, because I’m not sure -- there’s very little evi-dence at all that there’s anything specific to red wine be-yond the alcohol benefit.

DR. HAAN: Before you all rush out and order a bottle ofJohnny Walker Red, I’d like to mention that the evidenceon cardiovascular disease and alcohol consumption showsthat the reduced risk is really only for people who are mod-erate drinkers.

�You (tomato growers) donot have any negative

publicity or any negativefindings that I�m aware of

about the potential badhealth effects of tomatoes.

I only hear good thingsabout tomatoes. So I thinkyou have a golden opportu-

nity to support more re-search in this area and alsoto promote your product asa healthy and probably safe

product.�-- Dr. Haan


You (tomato growers) do not have any nega-tive publicity or any negative findings thatI’m aware of about the potential bad healtheffects of tomatoes. I only hear good thingsabout tomatoes. So I think you have a goldenopportunity to support more research in thisarea and also to promote your product as ahealthy and probably safe product.

AUDIENCE MEMBER: How do we as anindustry support research in this area with-out it being self-serving?

DR. HAAN: Generally, and I’m sure thatDr. Giovannucci or Dr. Egan could add tothis, but generally what happens is that re-searchers at a University will receive funds.So believe me it happens that private indus-try gives money for research in the Univer-sity and that the agreement will generallyspecify that the industry can control the con-duct of the research, and, of course, any re-

searcher is concerned about those issues. However, I be-lieve that, especially at UC Davis, there’s a great deal ofprivate industry support particularly for research in thefood industry, and I would characterize that research ingeneral as being above board, well done, and ethical.

DR. GIOVANNUCCI: Getting back to an earlier ques-tions about absorption of lycopene and different products.I think that type of research is important, but it’s less likelyto occur. If the industry supports that kind of research, Ithink that it will add a lot of knowledge. Knowing if lyco-pene can be well absorbed without having the potentialfor bias and the studies correlating the lycopene directlywith a disease. I wouldn’t want to say that lycopene pre-vents prostate cancer sponsored by the California TomatoGrowers, but you support studies looking at some of theseissues in terms of absorption of a specific product and ab-sorption of lycopene. I think that research will be verybeneficial.


Dr. Gay R. BeecherUSDA/ARS/BHNC/FCLBuilding 161, Room 202Beltsville, Maryland 20705Phone: 301-504-9161

Steven K. ClintonDana-Farber Cancer InstituteBoston, MassachusettsPhone: 617-632-3000

Dr. Leonard CohenAmerican Health Foundation1 Dana RoadValhalla, New York 10595Phone: 914-592-2600

Dr. Kathleen Egan, Sc.D.Harvard Medical SchoolHarvard School of Public HealthDepartment of Epidemiology, andDepartment Ophthalmology

John W. Erdman, Jr.Director, Division of Nutritional SciencesUniversity of Illinois449 Bevier Hall905 S. GoodwinUrbana, Illinois 61801(217) 333-2527

Dr. Jean G. FordHarlem Hospital Center

Division of Pulmonary Medicine506 Malcolm X Boulevard, MLK 12-106New York, New York 10037Phone: 212-939-1459Fax : 212-939-1456


“Health & Tomatoes”References and Resources

Studying how reduced prostate cancermay be related to consumption oftomato-based foods

Additional Resource*

Additional resource.**

Work on the effect of tomatoes andlycopene as a preventative to breastcancer.

Studying the dietary factors whichaffect how lycopene is absorbed intothe system, transported and stored.

Study of 92 patients with lung cancerand 103 cancer-free controls foundthat low plasma level of lycopene isassociated with increased risk of lungcancer.


Dr. Edward Giovanucci, M.D., Sc.D.Harvard Medical SchoolHarvard School of Public Health655 Huntington AvenueBoston, Massachusetts 02115Phone: 617-432-4648Fax: 617-432-2435

Dr. Myron D. GrossDivision of Epidemiology13000 S. 2nd Street, Suite 300University of MinnesotaMinneapolis, Minnesota 55455(612-624-5417

Dr. Mary HaanDirector, Center for Aging and HealthUC Davis School of MedicineDepartment of Epidemiology andPreventive MedicinePhone: 916-752-3967Fax: 916-752-4474

Dr. Joseph HotchkissDepartment of Food Chemistry and ToxicologyCornell UniversityIthaca, New York607-255-7912

Elizabeth JohnsonUSDA Human Nutrition Research Center on AgingTufts University711 WashingtonTufts UniversityBoston, Massachusetts 02111(617) 556-3133

Barbara P. Klein, Ph.D.Department of Food Sciences and

Human NutritionUniversity of Illinois

268 Bevier Hall905 S. Goodwin AvenueUrbana, Illinois 61801Phone: (217) 333-1325

Cancer and the effect of lycopene onthe prevention of prostrate cancer andother cancers.

Has worked with Dr. David A.Snowden with the elderly to find highlevels of lycopene in the bloodcorrespond to ability maintain self-care while low levels correspond withinability to maintain self-care.

Doing research related to breastcancer and diet. Specifically withcarotenoids.

Additional resource?***

Additional resource.****

Has studied the effects of canning onthe carotenes in vegetables and foundthat they are just as available incanned as fresh vegetables. In somecases they appear to be moreavailable as the result of processing.


Steven J. SchwartzDepartment of Food Science & TechnologyOhio State University144 HowlettColumbus, Ohio 43210614-292-2934

Dr. David SnowdenSanders-Brown Center on AgingDepartment of Preventative MedicineUniversity of KentuckyPhone: 606-257-1527Fax: 606-323-2866

Has studied the influence of process-ing on the lycopene in tomatotomatoes, the chemistry of lycopeneand the physiological aspects of

Lead researcher on study of theelderly indicating high levels oflycopene in the blood correspond toability maintain self-care while lowlevels correspond with inability tomaintain self-care.

*Dr. Beecher participated in the San Diego conference and is referred to as a research chemistin the article by Jane Brody.

**Dr. Cohen is with the American Health Foundation which co-sponsored the San Diegoconference. He was referred to us by Dr. Steven Clinton who said he does “animalresearch” in the field.

***Dr. Hotchkiss’ name comes to us from your original list. We have not been able to contact himto verify whether or not he actually does research in this area

****Dr.(?) Johnson.’s name was given to us by Dr. Steven Clinton with no description as to thenature of her research. Given the source, she is undoubtedly active in the field.

Produced by the

CALIFORNIA TOMATO GROWERS ASSOCIATION, INC.10730 Siskiyou LanePost Office Box 7398Stockton, CA 95267-0398Phone: (209) 478-1761FAX: (209) 478-9460e-mail: [email protected]

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