COLON CANCER PRECAUTIONS

Q. I am a 42 year old man who very recently had 2 benign polyps removed from my colon. Colon cancer runs in my family. My father was diagnosed and treated for colon cancer in his 60's and my aunt on the same side, as well. I have been told that I am a little young to have polyps and I am obviously worried about the chance of recurrence, as well as the increased risk of developing colon cancer. Other than increasing my fiber intake, which I plan to do, what other steps can I take to decrease the likelihood of polyp recurrence and their progression to cancer?

A. This question is of personal interest to me, as colon cancer, one of the four most common cancers in Canada, has also affected my family. I want to applaud you for thinking in terms of prevention. There is, undoubtedly, a genetic component to the development of colon cancer. This being said, environment, whether it by the physical environment we live in, or our internal environment and general health, plays an equally important role in determining the development of disease. There are so many natural ways to decrease cancer risk, through diet and lifestyle, as well as with supplementation.

You mentioned fiber intake, so I will start there. Just as important as increasing your fiber, is cutting out all refined carbohydrates from your diet. This is much easier to do than it sounds, but it will take a little label reading when you are shopping the bread aisle. Refined grains are all white products – white bread, white pasta, etc. The problem with refined grains is that only the endosperm portion of the grain is used. A whole grain, in comparison, includes the endosperm, the germ and the bran. Not only does this mean that whole grains are naturally higher in fiber, but that it includes the anti-oxidants present in the germ portion of the grain. Very simply put, it is the grain as nature intended the grain to be and therefore a more nutritionally dense product. That being said, if you read labels, you may notice that your white bread has more fiber than its whole grain equivalent. This usually means the bread has been fortified in some way, had some of the fiber and nutrients put back in. Don't be mistaken in thinking this means it has become the healthier choice. It is also important to know that in Canada, up to 70% of the germ can be removed before the product cannot legally claim to be a whole grain. Therefore, it is always best to look for a label that reads 100% whole grain, or look at the first ingredient on the ingredient list. If it does not read whole grain, chances are the product includes only a small percentage of the good stuff. Whole grains include wheat, oat, hulled and dehulled barley, brown rice, maize, rye spelt, quinoa, millet, teff and amaranth. Any whole grain can also be sprouted, while refined cannot.

Fiber is also readily available in fruits and vegetables. Another staple to any 'health conscious diet'. Canada's Food Guide, which is actually quite conservative with their recommendations, suggests that an adult male, aged 19 and older eat 7-10 servings of vegetables and fruits a day. An attempt at 10 servings a day is a great place to start. This way, if you miss your target the odd day, you are still within a healthy range. In general, 1 piece of fruit is one serving and one half cup of vegetable or cut fruit is considered one serving. For spinach and other leafy greens, 1 cup is considered one serving. Another general rule at meal time is to split your plate in half, on one half you put your whole grains and your protein and the other half should be covered with your vegetable. This means that for every meal, you are eating at least two servings of veg. It does not matter if your vegetables are cooked are raw, although try not to overcook them. There should still be a little crispness to a cooked carrot or broccoli, for example.

As far as added fiber supplementation, as long as you are eating whole grains and getting adequate servings of fruit and vegetables into your diet, you may not need anything more. The exception here is if you are someone who is already prone to constipation and/or hemorrhoids. If this is the case, I would still stay clear of laxatives, as your body can become dependent, but I would suggest adding an additional 2-4 tbsp of ground flax to your diet. To get the most out of ground flax, buy the seeds, along with a simple coffee grinder and grind the seeds daily as needed. It may take an extra 2 minutes out of your day, but it is well worth it. Ground flax is also an excellent source of ALA, a plant-based omega 3 fatty acid. Be sure to increase fiber slowly and always increase water intake proportionally.

Onions and garlic, both high in prebiotic inulin, can also significantly decrease risk of developing a number of gastrointestinal cancers. These vegetables help to selectively increase our natural production of 'healthy bacteria', including both the lactobacillus and bifidobacteria species. These bacteria not only regulate the amount of potentially harmful bacteria in our gut, but also ferment certain fibers that cannot be digested elsewhere along the gastrointestinal tract. This fermentation process creates by-products that promote a healthier more acidic colonic environment. Garlic also has significant anti-bacterial properties that have been implicated in cancer prevention.

The next food group that absolutely needs to be mentioned here is protein. Red meat has been directly linked to increased incidence of colorectal cancer. It is believed that the high fat content of red meat, along with increased bile acid production, and carcinogen formation when cooking, are all in part responsible for the correlation. Interestingly, just as important in terms of risk, is high intake of pork and processed meats. Individuals with a family history of colon cancer or polyps need to be very cautious to reduce, if not cut out altogether, these protein sources from their diet. Instead, focus on organic or local chicken, eggs and fish, as well as non-animal sources of protein, such as beans, lentils, whole grains (especially quinoa), and a variety of nuts and seeds.

Alcohol consumption is associated with moderate risk of colon cancer, and some research states slightly higher risk of rectal cancer. Be conscious of alcohol intake and make an effort to lower your intake if necessary, and depending on risk factors.

Supplements:
Probiotics can be taken as a supplement, either alone or in combination with prebiotic fructooligosaccharides (FOS), often referred to as a synbiotic. This allows for the probiotic bacteria to survive better within our digestive tract, as well as increases our natural and selective production of beneficial bacteria. Studies have shown that these bacteria strengthen the gut associated lymphoid tissue (GALT), including preventing carcinogen-induced suppression of our natural killer cells, which kill cancer cells. They also increase production of sodium butyrate which increases apoptosis (programmed cell death) of cancer cells.

I must also mention the importance of vitamin D. Vitamin D has been studied both for its preventative effect in colon cancer, as well as polyp recurrence and prevention. Studies using dosages of 1000-2000 IU/day, or more depending on deficiency and during the winter months, have shown significant results. If you are at risk for developing colon cancer, ask your doctor to have your serum vitamin D levels tested. Individuals with a level equal to or greater than 33ng/ml have been shown to be 5 times less likely to develop colon cancer. .

Increasing your intake of selenium and vitamin B6, via food or supplementation, has also been shown to decrease the risk of colorectal cancers.

The Canadian cancer society recommends that men and women over 50 years old have a fecal occult blood test at least every 2 years to screen for polyps. Individuals at high risk for the development of colon cancer should be screened much earlier. High risk individuals include those with:

• A first degree relative with colorectal cancer (parent, sibling or child)
• A personal history of colorectal cancer
• An inflammatory bowel disease (IBD)
• Benign polyps of the colon or rectum
• Some inherited syndromes such as (FAP) Familial adenomatous polyposis or (HNPCC) Hereditary non-polyposis colon cancer

Some inherited syndromes such as FAP (familial adenomatous polyposis) or HNPCC (hereditary non-polyposis colon cancer) Colo-rectal Cancer Prevention: Read More from Canadian Cancer Society

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