A summer favorite for cookouts and baseball games, Americans spend more than $3 billion on hot dogs just in supermarket sales each year.

But as tasty as they might be, hot dogs have earned a well-deserved bad health rap in recent years. Hot dogs and other processed meats — like bacon, sausage, ham and lunch meat — have significant health risks. They've been linked to an increased risk of some cancers, as well as obesity, diabetes and cardiovascular diseases.

Yet despite the studies and the warnings, research published in the Journal of the Academy of Nutrition and Dietetics finds that U.S. adults still eat as much processed meat as they did 18 years ago.

"While factors other than health (e.g., social, cultural, and economic) can influence Americans' food choices, the lack of widespread awareness of health risks associated with processed meat may have contributed to the lack of consumption change in the past 18 years," said study co-author Fang Fang Zhang, a cancer epidemiologist and Tufts University associate professor, in a statement. "Our findings support further actions to increase public awareness of the health risks associated with high processed meat consumption in the U.S."

Meats that have been cured contain nitrates, which are added during the cooking process to prevent the growth of botulism and to help the meat maintain its color. In the human body, nitrates are converted to nitrites, which form nitrosamines that have been associated with various cancers, according to WebMD. (It's also worth understanding the difference between nitrates and nitrites, both of which are used as preservatives in meat, but we'll get into that in a moment.)

A Harvard University study from 2010 found that eating processed meats may raise the risk of heart disease and diabetes. Researchers found that found that eating processed meat, such as bacon, sausage or processed deli meats, was associated with a 42% higher risk of heart disease and a 19% higher risk of type 2 diabetes. By contrast, they found that eating unprocessed red meats — like beef, pork or lamb — did not have the same risk. What's the difference in the meats that contain similar amounts of saturated fat and cholesterol? The processed meats had four times the amount of sodium and 50% more sodium nitrite.

The other side of nitrates

deli lunch meat sandwiches Processed meats have been linked to as increased risk of some cancers, as well as obesity, diabetes and cardiovascular diseases. (Photo: FotoKulinaria/Shutterstock)

But the naysayers will retort that even vegetables like spinach and celery contain nitrates. As Healthline points out, "Vegetables are actually the biggest dietary source of nitrates... by far. The amount you get from processed meat is small compared to vegetables."

The difference is that these foods also contain vitamins C and D, which inhibit the formation of those N-nitroso compounds.

But there are some alternatives. You can buy nitrate-free hot dogs, like the ones from Applegate Farms or Organic Prairie. These hot dogs contain nitrates from vegetables, but don't contain synthetic nitrates. Frying bacon in lower heat or cooking it in the microwave may minimize your exposure to nitrosamines, which can form during high-heat cooking.

To make it all more confusing, a 2011 study from University of Kansas researchers revealed that hot dogs and other processed meats are better for you than some grilled non-processed meats, like rotisserie chicken. The study focuses mainly on the presence of HCAs in the meat, a lesser known chemical compound that has also been linked to cancer. The presence of the chemical was found more in grilled and charred meat than in, say, microwaved hot dogs.

So what's a meat-lover to do? The key is moderation. If you're going to have a barbecue three times a week for the entire summer, maybe you should think about backing off a bit, say to once a week or once every two weeks.

Editor's note: This story has been updated with new information since it was published in May 2011.

Mary Jo DiLonardo writes about everything from health to parenting — and anything that helps explain why her dog does what he does.

What's wrong with eating hot dogs, lunch meat and bacon?
Packed full of unhealthy nitrates, processed meats like hot dogs and bacon harbor health risks you should know about.