Colorectal cancer remains the second leading cause of cancer mortality in the United States.
Although there is increasing push for screening, why not also push for preventing this horrible disease as well?
Of the things we can do, modifying diet is a big one. There is evidence that red meat, especially processed meat is linked to increased risk while foods with dietary fiber (only in plants) are linked to decreased risk. Evidence also links increased adiposity to increased colorectal cancer risk.
In the Adventist Health Study-2, which was a large prospective study in north America with a substantial proportion of vegetarians, a vegetarian diet was associated with several beneficial health outcomes. There was lower mortality, lower prevalence of obesity, hypertension, metabolic syndrome, and type 2 diabetes.
Preliminary investigations have shown to reduce the incidence of all cancers combined and of cancers of the gastrointestinal tract, but not with mortality from all cancers.
Results from the Adventist Health Study-1 showed meat intake to be associated with an increased risk of colon cancer and legume consumption with decreased risk of colon cancer.
When evaluating the data between different types of vegetarians and nonvegetarians, vegetarians tended to…
Be older, exercise more, use calcium supplements (except vegans), have lower BMI, ate more fiber, ate lower total fat and saturated fat.
They also were less likely to have….
Smoked, drink alcohol, to have had a colonoscopy or sigmoidoscopy (especially vegans), to use statins or aspirin, to have diabetes treated within the past year, or to have history of peptic ulcers.
Vegans and semi vegetarians had lower dietary calcium intake.
Vegetarian diets were associated with overall reduced risk of colorectal cancer.
In addition to reduced consumption of animal products, vegetarians ate less refined grains, added fats, sweets, snack foods, and caloric beverages. They also had an increased variety of whole plant foods. This could reduce hyperinsulinemia, which has been proposed as a possible mechanism by which diet increases colorectal cancer risk. Some research suggests IGF (insulin like growth factor) and binding proteins may relate to cancer risk.
Another modality could be high levels of animal protein in middle age and its link to increased levels of insulin like growth factor 1 and increased risk of cancer and higher mortality.
It was also noted that there was a significant protective effect for pescovegetarians compared with nonvegetarians. Further analysis would be interesting to see if this is due to fish, omega 3 fatty acids, or some other factor in their diet.
The EPIC study demonstrated reductions in risk of 8% and 11% for the highest and lowest Mediterranean pattern score. A meta-analysis of studies of the Mediterranean diet and colorectal cancer showed overall 10% risk reduction.
With these studies at hand, there may be valuable lifestyle, and hence dietary prescriptions to be made in the prevention of colorectal cancer.
Board Certified in Internal Medicine and Lifestyle Medicine
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