Tag Archive for: Diet

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Colorectal Cancer in Young Adults: What Are We Learning?

By Deepthi Nishi Velamuri

Colorectal cancer (CRC) is a disease that typically affects older adults, but it is becoming increasingly common in young adults. In fact, data indicate that 15% of patients diagnosed with CRC in the U.S. are under the age of 50 years and the mean age at diagnosis is 42.5 years.

There are a number of factors that may contribute to the rising risk of CRC in young adults. These include:

  • Changes in diet and lifestyle: Young adults are more likely to eat a diet high in processed foods and red meat, and to be less physically active than previous generations. These factors can increase the risk of developing CRC. Young adults with CRC are more likely to be obese. This suggests that obesity may be a modifiable risk factor for the disease in young adults.
  • Genetics: Some people have a genetic predisposition to CRC. If you have a family history of the disease, you are at an increased risk.
  • Inflammatory bowel disease: People with inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease, are also at an increased risk of CRC.

Prevention, Genetics, and Disease Outcomes

The good news is that CRC is often preventable. If you are at an increased risk, you should talk to your doctor about getting screened for the disease. Screening can help identify polyps, which are growths that can develop into cancer. If polyps are found, they can be removed before they have a chance to turn cancerous.

Young adults diagnosed with CRC are more likely to have advanced-stage disease at the time of diagnosis. This suggests that young adults are less likely to be screened for the disease—often despite showing symptoms such as rectal bleeding, abnormal or changing bowel patterns, fatigue, etc—which can lead to later-stage diagnosis and poorer outcomes.

A number of genetic mutations associated with CRC in young adults have been identified. These mutations can help identify people who are at an increased risk of the disease, and they can also be used to develop new targeted therapies.

Need for Improved Management of Young Adults

While we are still trying to understand the mechanism of CRC development in young adults, it is clear that this is a serious and growing problem. By understanding the risk factors for the disease and getting screened, young adults can protect themselves from CRC.

Here are some tips to reduce your risk:

  • Eat a healthy diet that is low in processed foods and red meat
  • Get regular exercise
  • Maintain a healthy weight
  • Don’t smoke
  • Limit your alcohol intake
  • Talk to your doctor about getting screened for CRC if you are at an increased risk

 

Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Plant-Based Diets Lower Colorectal Cancer Risk in Men

Colorectal cancer (CRC), the third most common cancer and the third leading cause of cancer-related deaths in the U.S., is preventable with regular screening. In addition to routine screening, other modifiable risk factors, such as diet, play an important role in lowering the risk of CRC. For example, red and processed meats are associated with an increased risk for CRC, while diets rich in dietary fiber reduce the risk of CRC. 

A recent prospective cohort study discovered that plant-based diets rich in healthy plant foods were associated with a lower risk of CRC in men, and varied based on race, ethnicity, and tumor location. These findings signify the importance of incorporating healthy plant foods into diets and reducing meat consumption to lower the risk of CRC. 

The multiethnic cohort study included 79,952 men and 93,475 women. Three plant-based diet scores were investigated to determine the incidence of invasive CRC:

  • Overall plant-based diet index (PDI)
  • Healthful plant-based diet index (hPDI)
  • Unhealthful plant-based diet index (uPDI)

The participants completed a food frequency questionnaire with over 180 food items. PDI, hPDI, and uPDI were calculated based on scoring methods and defined food groups that included:

  • Healthy plant foods, such as whole grains, fruits, vegetables, vegetable oils, nuts, legumes, tea, and coffee.
  • Less healthy plant foods, such as refined grains, fruit juices, potatoes, and added sugars.
  • Animal foods, such as animal fat, dairy, eggs, fish and seafood, and meat. 

Each food group was associated with specific scores. 

  • High PDI scores demonstrated greater consumption of all types of plant foods. 
  • High hPDI foods showed greater consumption of healthy plant foods and lower consumption of less healthy plant foods. 
  • Higher uPDI scores demonstrated lower consumption of healthy plant foods and greater consumption of less healthy plant foods. 

The study found that a plant-based diet that includes natural, rather than processed, plant-based foods is associated with a reduced risk of CRC in men. For women, however, none of the plant-based diets were significantly associated with CRC risk. For both men and women, the average scores of PDI and hPDI were highest among Japanese Americans and lowest among Native Hawaiians. The mean uPDI was highest in Native Hawaiian men and lowest in African American men and white women. Men with higher scores for PDI and hPDI had a 24% and 21% lower risk of CRC than men with lower scores for those diets, respectively. Furthermore, no significant association was found between risk for CRC and uPDI for men.

These analyses highlight the potential significance of plant-based diets in preventing CRC and suggest that the benefits of plant-based diets can vary based on sex and race/ethnicity. The findings underscore the importance of increasing healthy and less-processed plant foods in our diet and reducing meat consumption to lower the risk of CRC.

 

Sahar Alam is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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In Conversation With Dr. Alessandro Mannucci: Understanding the Relation Between Lynch Syndrome and the Oral and Fecal Microbiota

Image Credit: CDC on Unsplash

The Colon Cancer Foundation (CCF) spoke with Alessandro Mannucci, MD, who received the 2022 Colon Cancer Foundation and CGA Colorectal Cancer Research Scholar Award to present his work at the 2022 CGA-IGC Annual Meeting in Nashville, TN, November 11-13. Dr. Mannucci, a medical resident in gastroenterology and gastrointestinal endoscopy at the San Raffael Hospital, Milan, Italy, will be presenting his work titled ‘Lynch Syndrome is Associated with Fecal and Salivary Dysbiosis’.

CCF: What is the importance of the gut and the microbial flora in the human body, and how do they influence our well-being?

Dr. Mannucci: Broadly speaking, the microbiota is made up of many different cell types, including bacteria, viruses, fungi, and other kinds of microorganisms. However, our study specifically focused on bacteria because it is known that we have way more bacteria in our body than human cells. That alone indicates the significant impact of the microbiome on different phases of our life—from childhood to adulthood. 

The disruption of a healthy microbiome equilibrium causes the components of the microbiome to converge toward a proinflammatory environment in several ways. Certain species increase the risk of colorectal cancer [CRC]. Organisms that increase in numbers in the presence of CRC are generally proinflammatory. This understanding has come simultaneously with the realization that inflammation is one of the new pillars of cancer. The inflammatory environment is a disruption that is particularly important when studying the colon because the colon is the first organ in direct contact with the microbiome. 

CCF: Can you tell us the importance of this fact in your research? 

Dr. Mannucci: In our study, we had a suspect: the microbiome. While the microbiome is known to play a role in turning a normal cell cancerous, this association had not been investigated in the context of the hereditary Lynch syndrome [LS]. Mutations in one of five genes can lead to LS. 

There is a spectrum of manifestations of LS, the most important of which is CRC, although developing the cancer is determined by penetrance. We were interested in knowing if the microbiome has a role in this process.We wanted to know if the microbiome in individuals with LS who had not yet developed cancer, differed from those without LS. While it may be difficult to explain a cause-and-effect relationship, it is important to understand why a difference exists. Germline pathogenic variants may influence the formation, conformation, and diversity of the microbiome, or vice versa. Interestingly, we found that the fecal microbiota was significantly different among those with LS, but we need more data.

CCF: What is the relevance of microorganisms in the oral cavity? 

Dr. Mannucci: In individuals with LS, the cells within their mouth are also mutated. So we decided to test the differ

 Alessandro Mannucci, MD

ence between the fecal and oral microbiota among those with and without LS and found that not only is the fecal microbiota different, which you would expect because LS is associated with an increased risk of CRC, but we also observed a proinflammatory change in the oral microbiota. We now know that the oral microbiota of patients with LS differs from that of healthy individuals, which raises the question that pathogenic variants inside the mouth may interact with microbiota species that cause a proinflammatory shift. 

Another hypothesis is that individuals with this particular hereditary predisposition to CRC may also have a predisposition to orthodontic diseases. While we currently have limited understanding of this association and are testing the hypothesis, our discovery of the unexpected difference of a proinflammatory environment led us to suppose that maybe something else was at play.

What is interesting when we talk about scientific studies is not only what you are interested in, but also what you compare it to. In our case, we compared LS patients without cancer diagnosis to unrelated, healthy patients. So we did not have within-family control, which other investigators might want to look at–within the family or individuals with LS in different age groups.

CCF: How long will the subjects in your study be followed?

Dr. Mannucci: While we usually follow patients throughout their lives, five to ten years of follow-up will give us more insight. The idea is that if there is a proinflammatory environment within that patient, it could trigger cancer at an earlier age. To test that hypothesis, we are collecting samples of relatively young individuals, and we want to follow them and see if they develop cancer. The mean age of patients with LS was 48 years plus or minus 16 years.

CCF: Does diet influence microbial flora and the balance of pro- versus anti-inflammatory microbial flora in the oral cavity and the gut?

Dr. Mannucci: You raise a very, very interesting point! The microbiota is adaptable, and it can change very rapidly. There is some robustness to it, meaning you shape the health of your microbiome during your youth and by the time you reach adolescence or young adulthood, your microbiota is pretty much set. However, it can change based on your diet. 

One of our study limitations is that we could not control for diet. We could control other factors that can influence the changes within the microbiota itself, such as age, sex, smoking, the presence of cancer, or chemotherapy treatment—factors that can modify the shape, overall biodiversity, and the general composition of the microbiota.

However, we could not control the overall dietary composition. In the future, we may control our patients’ diet and place them either on a Western diet as opposed to a Mediterranean diet or a modern diet. 

Assuming that individuals with a higher risk of CRC follow an anti-inflammatory diet, you would expect to see an anti-inflammatory microbiota. We found the opposite; we found a proinflammatory change within the microbiota. While we are planning to control for participant diets in future studies, an alternative approach would be to include individuals with different genetic backgrounds and eating similar diets to investigate the differences in their microbiota. 

But remember, this is currently a hypothesis. What we know now is that these genetic predispositions are associated with a difference in the microbiota composition, and that difference itself is a proinflammatory environment. We don’t know the cause-effect relationship or how that can be altered, yet.

CCF: What would be a key takeaway from your study findings?

Dr. Mannucci: A key takeaway is that we’re developing a tool to better understand who does or does not get cancer. Hopefully, it will become a tool or a target to reduce the risk of cancer. I completely agree that diet can be a big influence. So maybe in the near future, we will be able to tell our patients that if they stop smoking, regularly exercise, reduce the intake of fatty foods, and if they have a specific kind of diet, they can reduce their risk of CRC. The microbiota has the potential to become an instrument for reducing the risk of cancer, but we are not there yet.

Thank you to Sahar Alam, CCF’s Colorectal Cancer Prevention Intern, for her assistance with this post.

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Ultra-Processed Foods a Risk Factor for Colorectal Cancer

Diet has been recognized as an important modifiable risk factor for colorectal cancer (CRC). In particular, diets consisting of high fats and carbohydrates, such as red and processed meats, are considered high-risk. Now, a large-scale cohort study among U.S. residents has revealed that high consumption of ultra-processed foods might increase CRC risk in men—the third most diagnosed cancer in the U.S.. 

For the past two decades, researchers have witnessed a significant increase in the consumption of ultra-processed foods, industrial ready-to-eat or ready-to-heat products high in refined sugars, refined starch, and trans fats. Ultra-processed foods currently contribute to 57% of the total daily calories consumed by American adults. A growing pool of evidence suggests that ultra-processed foods increase CRC risk by altering the composition and diversity of gut microbiota and increasing the risk of obesity.  Some examples of these foods include bread and rolls, breakfast bars and cereals, hotdogs and other processed meats, packaged sweet snacks and desserts, jams and jellies, and condiments, among other things.

The above-mentioned study analyzed responses from over 200,000 participants—159,907 women from the Nurses’ Health Study (1986-2015) and 46,341 men from the Health Professionals Follow-up Study (1986-2014)—across three large prospective studies in the U.S. that assessed dietary intake. The follow-up period was between 24-28 years. At the time of study enrollment, none of the participants had any cancer diagnoses. Information on dietary intake, demographic characteristics, lifestyle factors, and medical conditions of the participants was obtained through food frequency questionnaires every four years. 

Of the 206,000 participants who were followed for more than 25 years, the research team documented 1,294 cases of CRC among men and 1,922 cases among women. The study findings indicated that those who consumed the highest amount of ultra-processed foods had a 29% higher risk of CRC compared to those with the lowest consumption. However, this was not observed among women. Among women, the risk of CRC was positively associated with higher consumption of ready-to-eat or ready-to-heat mixed dishes. In contrast, higher consumption of yogurt and dairy-based desserts was linked to a reduced risk of CRC among women. 

These findings support the importance of limiting certain types of ultra-processed foods for better health outcomes. Here are some additional resources on diet and lifestyle and how they can influence your colon health and overall wellness:

  1. Healthy Inside and Out: How Diet and Lifestyle Impact Colorectal Cancer
  2. Dietary Mindfulness Can Reduce the Risk of Colorectal Cancer
  3. Diet and Nutrition to Prevent Colon Cancer

 

Kitty Chiu is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Image credit: Tim Toomey on Unsplash

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Diet and Nutrition to Prevent Colon Cancer

You can help significantly decrease your chances of colorectal cancer through proactive action related to your diet.

Maintaining a Healthy Weight Helps Prevent Colon Cancer

One of the best things you can do is to get yourself to a healthy weight and maintain it within a designated range. By maintaining a healthy weight you won’t just be proactively protecting yourself from colon cancer, you’ll also be making an investment in your overall health.

What to Eat to Beat Colon Cancer and Help Prevent it

Some of the best foods to be eating to lower your chances of contracting colon cancer include, chicken, fish, fruits, and whole grains.

Foods that you should avoid eating in excess include red meats and anything that is rich in refined sugars.

The Link Between Obesity and Colon Cancer

A strong link has been identified between obesity and colon cancer. Diet choices have a profound impact on how susceptible you are to contracting colon cancer.

It’s important to remember that making healthy choices with what you eat and how much affects much more than your susceptibility to contracting colon cancer. Your diet affects your overall health. It’s also important to remember that portion size is just as important as the food that you choose to eat. You can eat red meat without increasing your chance of getting colon cancer if you do it in moderation.

Someone who enjoys a steak every couple of weeks or so for dinner with a salad is not going to have a particularly high risk of getting colon cancer. Conversely, someone who eats steak, pork, sausage, and bacon in large quantities every single day or even every other day, will greatly increase their chances of having colon cancer.

Eating red meats in small amounts and in limited frequency is perfectly fine. No one needs to be panicking about eating a steak every now and again. No matter what you eat, your portion size is vital. Larger portion sizes are unhealthy and will put weight on fast.

You shouldn’t commit to a healthy diet just to decrease your chances of contracting colon cancer, you should want to eat healthy to feel better about yourself and increase your overall health. If you exercise and maintain a healthy diet, you won’t just be limiting your chances of getting colon cancer. You will feel better, and eliminate your susceptibility to countless other health problems.

How Does a Poor Diet Increase Your Chances of Contracting Colon Cancer?

Some of you might be wondering exactly how a poor diet increases your chances of contracting colon cancer. Obviously foods that are rich in fats aren’t good for you, but why does such delicious food have to make you more susceptible to such a horrible disease?

Studies have shown that when mice were fed a diet consisting of foods that were high in fats, they exhibited aggressive cell growth of stem-like cells that encourage mutation. This aggressive cell growth is typically coupled with the development of cancerous tumors along the intestine.

The unfortunate mice who were tested offer us invaluable insights into the factors that affect one’s chances of developing colon cancer. Their sacrifice, while trivial compared to the totality of scientific inquiry, is significant and it can save lives, human lives.

Further Recommendations

With so much information out there on the internet, it can be difficult to distinguish genuinely useful information from inaccurate drivel. For example, fiber supplements and antioxidant vitamins do not reduce one’s chances of having colon cancer, nor does it affect polyps.

Calcium, on the other hand, does have an effect on polyps and helps reduce polyp recurrence. Another thing that can help you is regular exercise. If you’re going to make the effort to maintain a healthy diet, you should double down and add exercise to the mix.

By exercising, eating healthy, and consuming the recommended amount of calcium, you can reduce your chances of contracting colon cancer significantly. Although these lifestyle changes can give you much better odds, it’s still imperative that you schedule regular screenings. If you aren’t being screened for colon cancer, you can still contract if and all of your efforts will be for naught, especially if it isn’t detected early on, hence the importance of regular screenings.

 

 

 

 

 

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