Introduction

A public health controversy is intensifying across the United Kingdom as mounting evidence links nitrite food additives to the nation's alarming rise in colorectal cancer cases. British health advocates, cancer charities, and an increasing number of parliamentarians are now calling for an outright ban on sodium nitrite and potassium nitrite—preservatives ubiquitous in processed meats including bacon, ham, sausages, and deli meats. This debate has reached a critical juncture as bowel cancer rates continue climbing, particularly among younger adults, prompting urgent questions about whether the convenience and shelf-life extension provided by these additives justify their potential health costs.

The controversy centers on a well-established scientific concern: when nitrites are exposed to high heat or combine with proteins in the acidic environment of the stomach, they form N-nitroso compounds (NOCs), particularly nitrosamines, which are potent carcinogens. The International Agency for Research on Cancer (IARC) classified processed meat as a Group 1 carcinogen in 2015, placing it in the same category as tobacco and asbestos—a classification driven largely by the nitrite-nitrosamine connection (Bouvard et al., 2015). Yet despite this unequivocal evidence, nitrites remain legal and widely used throughout Europe and North America, protected by industry arguments emphasizing food safety, particularly botulism prevention.

The United Kingdom faces a particularly acute colorectal cancer crisis. Bowel cancer is now the fourth most common cancer in Britain, with over 42,000 new cases diagnosed annually and approximately 16,800 deaths each year. More troubling still is the emergence of early-onset colorectal cancer, with cases among individuals under 50 rising steadily over the past three decades—a trend that cannot be explained by screening programs alone and points toward environmental and dietary factors (Vuik et al., 2019). As the scientific evidence accumulates and public pressure intensifies, Britain stands at a crossroads: will it become the first major nation to ban nitrites in processed meat, or will economic and food safety concerns prevail?

The Science of Nitrites: Preservation, Pink Color, and Potential Danger

Sodium nitrite and potassium nitrite have been used in meat curing for over a century, serving multiple functions that the meat industry considers indispensable. These compounds inhibit the growth of Clostridium botulinum, the bacterium responsible for potentially fatal botulism, while also preventing lipid oxidation that causes rancidity. Additionally, nitrites react with myoglobin in meat to produce the characteristic pink color consumers associate with cured meats—a cosmetic function that has no nutritional value but significant commercial importance (Sindelar & Milkowski, 2012).

The chemical transformation that makes nitrites potentially dangerous occurs through a multi-step process. In the acidic gastric environment or during high-temperature cooking, nitrites can react with secondary amines and amides present in protein-rich foods to form N-nitroso compounds, predominantly nitrosamines. These compounds are among the most potent carcinogens known, capable of inducing DNA damage, promoting cellular proliferation, and initiating the cascade of genetic mutations that lead to cancer development (Jakszyn & González, 2006). Animal studies have conclusively demonstrated that nitrosamines cause tumors in multiple organs, with particular affinity for gastrointestinal tissues.

The epidemiological evidence linking processed meat consumption to colorectal cancer is substantial and consistent across numerous large-scale studies. A comprehensive meta-analysis by the World Cancer Research Fund found that each 50-gram daily serving of processed meat—equivalent to approximately two slices of bacon—increases colorectal cancer risk by 18% (World Cancer Research Fund/American Institute for Cancer Research, 2018). While processed meat contains multiple potentially harmful components including heme iron, saturated fat, and heterocyclic amines formed during cooking, researchers have identified nitrite-derived NOCs as a primary mechanistic driver of this association (Cross et al., 2010).

Importantly, the endogenous formation of nitrosamines varies substantially based on individual factors including gastric pH, gut microbiome composition, and consumption of inhibitors such as vitamin C. This variability helps explain why not all processed meat consumers develop cancer, but it does not diminish the population-level risk. Research measuring fecal NOC levels has demonstrated significant increases following processed meat consumption, with levels correlating directly with nitrite content rather than meat consumption per se—providing strong evidence that nitrites specifically, rather than meat generally, drive carcinogenic risk (Kuhnle et al., 2007).

Britain's Bowel Cancer Crisis: Alarming Trends Demand Action

The United Kingdom confronts a colorectal cancer burden that ranks among the highest in Europe, with incidence rates that have remained stubbornly elevated despite advances in screening and treatment. According to Cancer Research UK, bowel cancer accounts for approximately 12% of all cancer cases in Britain, making it the fourth most common cancer overall but the second leading cause of cancer death. The five-year survival rate, while improving, remains disappointingly below 60%, largely because many cases are diagnosed at advanced stages when curative treatment is no longer possible (Cancer Research UK, 2023).

Perhaps most concerning is the emergence of early-onset colorectal cancer as a growing public health threat. While screening programs have successfully reduced incidence among older adults, cases among individuals aged 20-49 have increased by approximately 50% over the past 25 years in the UK and other developed nations (Vuik et al., 2019). This demographic shift cannot be attributed to improved detection alone, as the cancers diagnosed in younger individuals are often more aggressive and located in the distal colon and rectum—distribution patterns consistent with environmental rather than genetic causation.

Dietary factors, particularly processed meat consumption, feature prominently among suspected drivers of this troubling trend. British dietary patterns include substantial processed meat intake, with the average adult consuming approximately 25 grams daily—half the amount associated with significantly elevated cancer risk in epidemiological studies. Certain demographic groups, particularly men and individuals from lower socioeconomic backgrounds, consume considerably more, with some exceeding 100 grams daily (Public Health England, 2020). This dietary pattern, combined with inadequate fiber intake, physical inactivity, and rising obesity rates, creates a perfect storm for colorectal cancer development.

The economic burden of colorectal cancer in the UK is staggering, with direct healthcare costs exceeding £1.6 billion annually and indirect costs from lost productivity adding billions more. These costs will inevitably rise as the younger cohort currently developing early-onset disease progresses through treatment and survivorship, requiring decades of medical care and surveillance. From both humanitarian and economic perspectives, prevention through dietary modification represents the most rational approach—yet requires confronting powerful food industry interests that benefit from current regulatory permissiveness regarding nitrites.

The Case for a Ban: Public Health Versus Industry Interests

Advocates calling for a nitrite ban point to a compelling convergence of scientific evidence, public health necessity, and the availability of safer alternatives. Professor Chris Elliott of Queen's University Belfast, who led the independent review of Britain's food system following the 2013 horsemeat scandal, has been particularly vocal, arguing that the continued use of nitrites represents an "unacceptable risk" given both the strength of evidence and the existence of viable nitrite-free preservation methods (Elliott, 2021).

The scientific case rests on several pillars. First, the IARC classification of processed meat as a Group 1 carcinogen, driven primarily by nitrite-derived nitrosamine formation, represents the highest level of evidence-based certainty regarding carcinogenic risk. Second, dose-response relationships from epidemiological studies demonstrate that risk scales with consumption, meaning population-level reductions in processed meat intake or nitrite content would yield proportional public health benefits. Third, biomarker studies confirming increased fecal NOC levels following processed meat consumption provide mechanistic validation for the epidemiological associations (Kuhnle et al., 2007).

Consumer advocacy organizations, including the UK charity Bowel Cancer UK, have joined calls for regulatory action, emphasizing that consumers cannot make truly informed choices when nitrites are rarely highlighted on product labels and their cancer risk is not widely understood. Surveys indicate that fewer than half of British adults are aware of the processed meat-cancer link, and even fewer understand that nitrites specifically drive this risk (Bowel Cancer UK, 2022). This knowledge gap represents a failure of public health communication and suggests that voluntary reduction strategies, which rely on consumer choice, are insufficient.

The food industry's counter-arguments focus primarily on food safety concerns, particularly botulism risk, and economic impact. Industry representatives contend that nitrites remain the most reliable antimicrobial for preventing Clostridium botulinum growth and that removing them would necessitate more aggressive thermal processing, potentially creating other health concerns through the formation of heat-induced toxins. They also argue that a ban would devastate traditional meat-curing industries, particularly small artisanal producers who lack resources to reformulate products (Sindelar & Milkowski, 2012).

However, these arguments increasingly face scientific and practical rebuttals. Botulism is extraordinarily rare in modern industrialized nations, with the UK reporting fewer than 30 cases annually, predominantly from non-meat sources. Refrigeration, pH control, salt content, and other hurdle technologies effectively prevent botulism growth without nitrites, as demonstrated by successfully marketed nitrite-free products. Several European manufacturers have developed commercially viable nitrite-free bacon, ham, and sausages using combinations of cultured celery powder (which contains naturally occurring nitrates that bacteria convert to nitrites, though at lower levels), protective bacterial cultures, and modified packaging—demonstrating that alternatives exist, even if they require reformulation investment (Alahakoon et al., 2015).

Nitrite-Free Alternatives: Technical Feasibility and Market Reality

The technical feasibility of eliminating nitrites from processed meat has been conclusively demonstrated, though with important caveats regarding product characteristics, cost, and shelf life. Multiple preservation strategies can effectively control microbial growth and oxidative rancidity without synthetic nitrite addition, though each involves tradeoffs that have historically limited commercial adoption.

One approach utilizes naturally derived nitrate sources, particularly cultured celery powder or vegetable juice concentrates, which contain high nitrate levels. When combined with starter cultures containing nitrate-reducing bacteria, these natural nitrates convert to nitrites during fermentation—producing the same antimicrobial effects and pink color as directly added sodium nitrite but at generally lower concentrations. Products labeled "uncured" or "no nitrites or nitrates added" in the United States typically employ this strategy, though critics rightly note that the distinction between synthetic and natural nitrite sources is chemically meaningless and potentially misleading to consumers (Sindelar & Milkowski, 2012).

Genuinely nitrite-free approaches rely on alternative preservation systems. These include protective bacterial cultures that produce antimicrobial compounds such as bacteriocins, organic acids that lower pH below levels supporting pathogen growth, modified atmosphere packaging that excludes oxygen, and natural antimicrobials including rosemary extract, green tea polyphenols, and certain essential oils. Research has demonstrated that combining multiple hurdles creates preservation systems effective enough for commercial application, producing shelf-stable products meeting safety standards (Alahakoon et al., 2015).

However, these alternatives face significant challenges. Products preserved without nitrites typically display grey-brown rather than pink color, which consumer research suggests reduces acceptability and purchase intent—a purely cosmetic issue with no nutritional significance but substantial commercial impact. Flavor profiles differ subtly, shelf life may be reduced requiring more frequent production cycles and fresher inventory management, and production costs increase due to more expensive ingredients and processing modifications. These economic factors create disincentives for voluntary reformulation absent regulatory pressure or strong consumer demand (Alahakoon et al., 2015).

The market reality is that nitrite-free products remain niche offerings commanding premium prices, typically 20-40% above conventional alternatives. This pricing structure positions them as specialty products for health-conscious affluent consumers rather than accessible options for the broader population that would benefit most from reduced nitrite exposure. A regulatory ban would level the playing field, forcing all manufacturers to invest in reformulation and enabling economies of scale that would minimize cost impacts—a market transformation achievable through policy but unlikely to occur through consumer choice alone.

International Perspectives: How Other Nations Address Nitrite Risk

The United Kingdom's deliberations occur within a broader international context where regulatory approaches to nitrites vary considerably, reflecting different balances between public health precaution, food industry interests, and cultural food traditions. Examining these international perspectives provides instructive lessons for British policymakers.

The European Union, of which the UK was formerly a member, permits nitrites in processed meat but has progressively reduced maximum allowable levels over recent decades in response to accumulating health evidence. Current EU regulations limit sodium nitrite to 150 mg/kg in most products, down from historically higher levels, and prohibit its use in certain categories including products intended for infants and young children (European Food Safety Authority, 2017). However, these incremental reductions, while beneficial, fall short of addressing the fundamental carcinogenic concern—lower nitrite levels reduce but do not eliminate nitrosamine formation.

Denmark has taken the most aggressive European stance, with legislation passed in 2021 requiring warning labels on processed meat products containing nitrites, stating that consumption increases cancer risk. This labeling requirement, while stopping short of an outright ban, represents a significant policy shift acknowledging that current consumption patterns pose unacceptable public health risks. Industry representatives challenged the legislation, but it survived legal review and took effect in 2023, providing a potential model for other nations (Hansen, 2021).

France has witnessed particularly robust public debate following the publication of "The Silent Epidemic" (translated title) by journalist Guillaume Coudray, which synthesized scientific evidence on nitrites and cancer risk for lay audiences. The resulting public outcry prompted legislative proposals to ban nitrites, though these have faced fierce industry opposition and remain under consideration. French legislators have commissioned extensive review of alternatives and economic impact assessments, with growing parliamentary support for at least phased reduction if not complete prohibition (Coudray, 2017).

In contrast, the United States maintains a more industry-favorable regulatory approach through the FDA, which continues authorizing nitrite use at levels similar to or exceeding European standards. American regulations permit up to 200 mg/kg sodium nitrite in cured meat products, and enforcement of labeling requirements for "naturally cured" products using celery powder has been inconsistent. The USDA's Food Safety and Inspection Service emphasizes botulism prevention over cancer risk reduction, reflecting regulatory capture by industry interests and political resistance to food regulation more broadly (U.S. Food and Drug Administration, 2020).

These international variations demonstrate that nitrite policy reflects political choices rather than scientific inevitability. Nations prioritizing public health precaution have implemented progressively restrictive policies, while those emphasizing industry concerns and voluntary compliance maintain permissive approaches. For Britain, now charting its independent post-Brexit regulatory path, the question becomes which model to emulate—and whether to seize the opportunity to establish global leadership in evidence-based food safety policy.

The Political Landscape: Parliamentary Pressure and Regulatory Resistance

Within British politics, the nitrite debate has gained momentum through a combination of backbench parliamentary pressure, advocacy organization campaigns, and media attention to rising cancer rates. Several MPs have raised the issue in Parliament, calling for immediate regulatory review and expressing frustration with what they characterize as the Food Standards Agency's (FSA) excessive deference to industry concerns over public health imperatives.

The All-Party Parliamentary Group on Cancer has been particularly active, holding evidence sessions with oncologists, epidemiologists, and cancer survivors to examine the processed meat-cancer link. Testimony has emphasized not only the population-level statistical risk but also the individual tragedies of early-onset colorectal cancer cases among young adults with no family history or genetic predisposition—cases plausibly attributable to dietary exposures including nitrite-containing processed meats (All-Party Parliamentary Group on Cancer, 2022).

However, regulatory agencies have responded cautiously. The Food Standards Agency maintains that current nitrite use levels are "safe when used as directed" and emphasizes that complete dietary avoidance of processed meat, rather than ingredient modification, represents their recommended risk reduction strategy. This position reflects the FSA's mandate to balance multiple considerations including food safety, consumer choice, and economic impact—a balancing act critics argue inappropriately privileges industry convenience over cancer prevention (Food Standards Agency, 2021).

The political challenge is compounded by regional and cultural factors. Processed meat products are deeply embedded in British food culture, from the "full English breakfast" featuring bacon and sausage to traditional ham and meat pies. Industry representatives warn that a nitrite ban would threaten these culinary traditions, though advocates counter that recipes can be preserved using alternative preservation methods, even if appearance and flavor require adaptation. The framing of this debate—tradition versus health, consumer choice versus paternalism—significantly influences political feasibility.

Economic considerations also loom large. The British processed meat industry employs tens of thousands of workers and generates billions in annual revenue. Industry representatives warn that a nitrite ban would disadvantage British manufacturers relative to international competitors, potentially shifting production overseas where regulations remain permissive. However, proponents note that Denmark's labeling requirement and growing consumer awareness across Europe may be shifting market dynamics, potentially creating competitive advantages for manufacturers who successfully reformulate products for the health-conscious consumer segment (Food Standards Agency, 2021).

Public Health Recommendation: Addressing Risk While Respecting Complexity

From a public health perspective, the case for eliminating or dramatically reducing nitrite use in processed meat appears compelling, though implementation requires acknowledging complexity and avoiding oversimplification. The scientific evidence linking processed meat consumption, mediated primarily through nitrite-derived nitrosamines, to colorectal cancer is as strong as epidemiological evidence can be outside of randomized controlled trials (which would be unethical to conduct for carcinogen exposure). The dose-response relationship, mechanistic plausibility, consistency across populations, and biomarker validation collectively meet standard criteria for causal inference (Cross et al., 2010).

However, several nuances deserve consideration. First, not all processed meats contribute equally to cancer risk. Products subjected to high-heat cooking (bacon, grilled sausages) generate more nitrosamines than those consumed without additional heating (pre-sliced deli ham). Products with higher residual nitrite levels pose greater risk than those with minimal residual nitrite but sufficient to achieve antimicrobial effects during processing. These distinctions suggest that risk reduction strategies could be graduated, with most aggressive restrictions applied to highest-risk product categories.

Second, individual risk varies substantially based on overall dietary patterns. Individuals consuming high fiber diets rich in fruits and vegetables experience lower colorectal cancer rates than those consuming equivalent processed meat quantities on low-fiber diets. Vitamin C and other antioxidants inhibit nitrosamine formation, while fiber accelerates intestinal transit and dilutes carcinogen exposure. This dietary context implies that public health strategies should address overall eating patterns rather than focusing exclusively on single ingredients—though this systems-level perspective doesn't negate the case for removing unnecessary carcinogens from the food supply (World Cancer Research Fund/American Institute for Cancer Research, 2018).

Third, the magnitude of individual risk, while statistically significant at the population level, remains modest for individuals consuming processed meat occasionally. The 18% relative risk increase per 50-gram daily serving translates to approximately 6 additional colorectal cancer cases per 100,000 people annually—meaningful at population scale but small in absolute terms for any individual. This risk profile suggests that outright prohibition may be disproportionate, while clear labeling, public education, and incentivizing reformulation represent more balanced approaches respecting consumer autonomy while enabling informed choice.

A comprehensive public health strategy would include multiple complementary elements. Maximum allowable nitrite levels should be reduced to the minimum necessary for microbial safety, with requirements for manufacturers to justify nitrite use and demonstrate that alternatives are genuinely unavailable. Clear labeling should inform consumers that products contain added nitrites and that regular consumption increases cancer risk. Public education campaigns should emphasize that processed meat consumption should be occasional rather than daily. Investment in reformulation research should accelerate development and commercialization of genuinely nitrite-free alternatives. And screening programs should be maintained and enhanced, particularly for high-risk populations (Public Health England, 2020).

The Path Forward: Policy Options and Their Implications

Britain's policymakers face several potential paths forward, each with distinct implications for public health, industry, and consumer choice. At one end of the spectrum lies immediate prohibition—a bold stance that would eliminate nitrite use entirely, forcing rapid industry reformulation. This approach would deliver maximum public health benefit by eliminating a known carcinogen from widely consumed foods, positioning Britain as a global leader in evidence-based food safety policy.

However, immediate prohibition carries significant risks and challenges. The food industry would require transition time to reformulate products, validate alternatives' safety and stability, retrain workers, and modify production systems. Insufficient transition time could disrupt food supply chains and potentially create food safety risks if manufacturers rush implementation without adequate testing. Small traditional producers might lack resources for reformulation, threatening artisanal food traditions and rural livelihoods. And without coordinated international action, banned products might simply be imported from permissive jurisdictions, achieving no public health benefit while disadvantaging domestic industry.

A more gradual approach would involve phased reduction, establishing progressively declining maximum allowable nitrite levels over a multi-year timeline, ultimately reaching zero or near-zero levels. This strategy, implemented successfully for trans fats in several jurisdictions, provides industry adaptation time while signaling clear regulatory intent. Phased reduction allows manufacturers to invest in reformulation methodically, enables market testing of alternatives, and provides opportunities for course correction if unexpected challenges emerge. Denmark's approach, beginning with labeling requirements before considering further restrictions, exemplifies this graduated strategy (Hansen, 2021).

Alternatively, Britain could adopt a targeted approach focusing on highest-risk products or consumer segments. Prohibiting nitrites in products marketed to children or pregnant women would protect vulnerable populations. Restricting nitrites specifically in high-heat-cooked products where nitrosamine formation is maximal would address disproportionate risk sources. Banning nitrite use for purely cosmetic color maintenance while permitting minimal amounts for genuine antimicrobial purposes would eliminate unnecessary exposure. Such targeted approaches acknowledge that not all nitrite uses contribute equally to cancer risk and allow regulatory precision matching intervention to evidence.

The most politically feasible near-term strategy may combine elements of these approaches: mandatory warning labels implemented immediately, phased reduction in maximum allowable levels over 5-10 years, investment in alternative preservation research, and public education campaigns. This multifaceted strategy respects complexity, provides transition time, maintains consumer autonomy through labeling transparency, and establishes clear trajectory toward elimination—achieving public health goals while minimizing economic disruption (Food Standards Agency, 2021).

Conclusion: Precautionary Principle and Public Health Leadership

The debate over nitrite additives in processed meat ultimately reflects fundamental questions about how societies balance competing values: public health versus economic interests, precautionary principle versus regulatory inertia, consumer autonomy versus collective protection. The scientific evidence is unambiguous—processed meat consumption increases colorectal cancer risk, nitrite-derived nitrosamines represent a primary mechanistic driver, and alternatives exist that could substantially reduce population exposure to these carcinogens.

Britain's alarming colorectal cancer rates, particularly the troubling rise in early-onset disease, demand urgent action. With over 42,000 new cases and 16,800 deaths annually, and economic costs exceeding billions of pounds, the status quo is untenable. The precautionary principle—that when an activity raises threats of harm to human health, protective measures should be taken even if cause-and-effect relationships are not fully established scientifically—argues for regulatory intervention even absent absolute certainty, which epidemiological science can never provide.

The path forward requires political courage to challenge powerful economic interests, regulatory sophistication to implement effective policies without unintended consequences, and public health leadership willing to prioritize long-term population wellbeing over short-term convenience. Whether through immediate prohibition, phased elimination, or comprehensive labeling and reduction strategies, Britain has the opportunity to demonstrate that evidence-based policy can prevail over industry lobbying, and that public health imperatives can drive meaningful food system transformation.

The question is not whether scientific evidence justifies action—it clearly does. The question is whether Britain's political system can marshal the will to act, and whether public demand for protection from preventable cancer will overcome entrenched interests invested in the status quo. As other nations watch this debate with keen interest, Britain's choices may chart the course for international regulatory evolution, potentially catalyzing a global reassessment of how food additives are evaluated and regulated. The stakes—measured in thousands of preventable cancers and premature deaths annually—could not be higher.

References

Alahakoon, A. U., Jayasena, D. D., Ramachandra, S., & Jo, C. (2015). Alternatives to nitrite in processed meat: Up to date. Trends in Food Science & Technology, 45(1), 37-49. https://doi.org/10.1016/j.tifs.2015.05.008

All-Party Parliamentary Group on Cancer. (2022). Cancer and diet: Examining the evidence on processed meat and cancer risk. UK Parliament.

Bouvard, V., Loomis, D., Guyton, K. Z., Grosse, Y., Ghissassi, F. E., Benbrahim-Tallaa, L., Guha, N., Mattock, H., & Straif, K. (2015). Carcinogenicity of consumption of red and processed meat. The Lancet Oncology, 16(16), 1599-1600. https://doi.org/10.1016/S1470-2045(15)00444-1

Bowel Cancer UK. (2022). Public awareness of diet and bowel cancer risk. Bowel Cancer UK Research Report.

Cancer Research UK. (2023). Bowel cancer statistics. Retrieved from https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer

Coudray, G. (2017). Qui a tué le jambon coquillage? [Who killed the shell ham?]. La Découverte.

Cross, A. J., Ferrucci, L. M., Risch, A., Graubard, B. I., Ward, M. H., Park, Y., Hollenbeck, A. R., Schatzkin, A., & Sinha, R. (2010). A large prospective study of meat consumption and colorectal cancer risk: An investigation of potential mechanisms underlying this association. Cancer Research, 70(6), 2406-2414. https://doi.org/10.1158/0008-5472.CAN-09-3929

Elliott, C. (2021). The Elliott Review into the Integrity and Assurance of Food Supply Networks: Final report. UK Government.

European Food Safety Authority. (2017). Re-evaluation of potassium nitrite (E 249) and sodium nitrite (E 250) as food additives. EFSA Journal, 15(6), e04786. https://doi.org/10.2903/j.efsa.2017.4786

Food Standards Agency. (2021). Nitrites in cured meat: Position statement. UK Food Standards Agency.

Hansen, M. B. (2021). Denmark introduces cancer warning labels for processed meat products. European Food Safety News, 12(4), 23-25.

Jakszyn, P., & González, C. A. (2006). Nitrosamine and related food intake and gastric and oesophageal cancer risk: A systematic review of the epidemiological evidence. World Journal of Gastroenterology, 12(27), 4296-4303. https://doi.org/10.3748/wjg.v12.i27.4296

Kuhnle, G. G., Story, G. W., Reda, T., Mani, A. R., Moore, K. P., Lunn, J. C., & Bingham, S. A. (2007). Diet-induced endogenous formation of nitroso compounds in the GI tract. Free Radical Biology and Medicine, 43(7), 1040-1047. https://doi.org/10.1016/j.freeradbiomed.2007.03.011

Public Health England. (2020). National Diet and Nutrition Survey: Results from years 9-11 (combined). Public Health England.

Sindelar, J. J., & Milkowski, A. L. (2012). Human safety controversies surrounding nitrate and nitrite in the diet. Nitric Oxide, 26(4), 259-266. https://doi.org/10.1016/j.niox.2012.03.011

U.S. Food and Drug Administration. (2020). Food additive status list. U.S. Department of Health and Human Services.

Vuik, F. E., Nieuwenburg, S. A., Bardou, M., Lansdorp-Vogelaar, I., Dinis-Ribeiro, M., Bento, M. J., Zadnik, V., Pellisé, M., Esteban, L., Kaminski, M. F., Suchanek, S., Ngo, O., Májek, O., Leja, M., Kuipers, E. J., & Spaander, M. C. (2019). Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut, 68(10), 1820-1826. https://doi.org/10.1136/gutjnl-2018-317592

World Cancer Research Fund/American Institute for Cancer Research. (2018). Diet, nutrition, physical activity and cancer: A global perspective. Continuous update project expert report. World Cancer Research Fund International.