Prevention

Eating Well/Diet

Diet can promote or prevent colon cancer

Dr. Joel Fuhrman M.D.

Over 100,000 new cases of colon cancer occurred in the U.S. in 2009.[1]  Most colon cancer cases occur in people with no family history – genetics are thought to play only a small role in the development of colon cancer.  Colon cancer is most prevalent in Westernized societies, whose diets are higher in animal products and processed foods and lower in unrefined plant foods.  Epidemiological studies have suggested that diet is a key contributor to colon cancer risk.  The cells lining the intestinal tract come into direct contact with what we choose to eat – the substances contained in our food can therefore have profound effects on these cells and tissues.  The protective value of fruits and vegetables have been established by several prospective studies following subjects for years, keeping track of dietary patterns and colon cancer diagnoses.  Studies published in the past two years have attributed risk reductions up to 26% to high intakes of vegetables and fruits.[2],[3],[4] However these modest benefits are mostly because dietary improvements were modest and the improvements were implemented later in life.  Earlier life intake of a diet rich in natural plant matter may offer more dramatic protection.  Data on cancer incidence in different populations suggests that a 20% increase in vegetable intake would result in a 20% decrease in cancer incidence in a particular population and a higher intake would beget even greater benefits.

Several food components that may modulate colon cancer risk have been identified—fiber, omega-3 and -6 fatty acids, and certain antioxidants, vitamins, and minerals all play a partial role, but the intake of thousands of unnamed phytochemicals have the most powerful benefits.  For those who wish to reduce their colon cancer risk, it is important to focus on the protective effects of whole foods – each vegetable and fruit contains thousands of micronutrients and phytochemicals, many of which work synergistically to exert their anti-cancer properties.  For example, fiber was considered to be a protective substance because of early epidemiological studies showing that diets high in fruits and vegetables were associated with decreased colon cancer risk.  But we realized it was all the features of high fiber natural foods, not the fiber itself that is important.  Later studies on fiber supplements showed no benefit[5], and it also seems that among the high fiber foods, vegetables, beans and fruits are far more protective than grains.[6],[7],[8]

Nutritious foods are very rich in fiber and disease-causing foods are generally fiber-deficient.  Red meat, processed meats are the most cancer causing, but all meats and dairy products do not contain any fiber, and are also lacking in anti-oxidants and phytochemicals.[9] Foods made from refined grains (such as white bread, white rice, and pasta) are also not only fiber deficient but void of micronutrients and phytochemicals as well – these foods are also associated with colon and rectal cancers.[10]

At each meal, our food choices influence our future health.  Choosing a diet rich in nutrient dense plant foods like vegetables, fruits, beans, nuts, and seeds is a simple step we can take to protect ourselves against colon cancer.

[1]American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_How_Many_People_Get_Colorectal_Cancer.asp?sitearea=

[2] Reedy J, Wirfält E, Flood A, et al. Comparing 3 dietary pattern methods--cluster analysis, factor analysis, and index analysis--With colorectal cancer risk: The NIH-AARP Diet and Health Study. Am J Epidemiol. 2010 Feb 15;171(4):479-87. Epub 2009 Dec 21.

[3] van Duijnhoven FJ, Bueno-De-Mesquita HB, Ferrari P, et al. Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr. 2009 May;89(5):1441-52. Epub 2009 Apr 1.

[4] Wirfält E, Midthune D, Reedy J, et al. Associations between food patterns defined by cluster analysis and colorectal cancer incidence in the NIH-AARP diet and health study. Eur J Clin Nutr. 2009 Jun;63(6):707-17. Epub 2008 Aug 6.

[5] Asano T, McLeod RS. Dietary fibre for the prevention of colorectal adenomas and carcinomas. Cochrane Database Syst Rev 2002;2:CD003430.

[6] Nomura AM, Wilkens LR, Murphy SP, et al. Association of vegetable, fruit, and grain intakes with colorectal cancer: the Multiethnic Cohort Study. Am J Clin Nutr. 2008 Sep;88(3):730-7.

[7] Terry P, Giovannucci E, Michels KB, et al. Fruit, vegetables, dietary fiber, and risk of colorectal cancer. J Natl Cancer Inst 2001;93:525-33.

[8] Ryan-Harshman M, Aldoori W. Diet and colorectal cancer: Review of the evidence. Can Fam Physician 2007;53:1913-1920

[9] Vano YA, Rodrigues MJ, Schneider SM. [Epidemiological link between eating habits and cancer: the example of colorectal cancer]. Bull Cancer. 2009 Jun;96(6):647-58.

[10] Higginbotham S, Zhang ZF, Lee IM, et al. Dietary glycemic load and risk of colorectal cancer in the Women's Health Study. J Natl Cancer Inst. 2004 Feb 4;96(3):229-33. 

Diet

Colon Cancer Prevention & Diet: What Can You Do?

Bethany Smith, RD, LD, CDE, Registered Dietitian, Georgia Cancer Specialists

According to the American Cancer Society, 1/3 of all cancer deaths this year will be related to lifestyle, including poor eating habits, inactivity, and obesity.  We all want to live cancer-free, so what steps can you take to help yourself and your community?

Eat More Fruits & Vegetables 

Eat five to nine servings every day.  Although five sounds like a lot, the serving sizes are small, making this easy!

• One serving of fruit equals 1cup fresh fruit, 1 tennis ball sized fruit, ¼ cup dried fruit, ½ cup canned fruit or 4 ounces of 100% juice.
• One serving of vegetables equals ½ cup cooked, 1 cup raw or 6 ounces of 100% vegetable juice.
• Fruits and vegetables contain fiber along with many anti-cancer nutrients, so fill up!

Limit Fast Food 

If you can’t avoid fast food, make healthy choices when you go. 

• Order a baked potato and salad, or vegetable soup with salad.
• Sub shops offer vegetarian sandwiches, so load up on the veggie toppings and low-fat condiments and enjoy!
• Pack your own lunch using one fruit, one vegetable, a whole grain and a low-fat protein to avoid grabbing something quick and unhealthy.

  Fruit	Vegetable	Lean Protean	Whole Grain
  1 orange	1 cup vegetable soup	1 cup beans added to soup	5-6 whole grain crackers
  1 banana	1-2 cups salad with low-fat dressing	2 Tablespoons natural peanut butter	2 slices whole grain bread
  1 cup berries	Sautéed vegetables (add to pita pocket with hummus)	½ cup hummus	2 whole grain pita pockets

• Review online nutrition information for fast food chains, so you can make healthier choices.Aim to create a meal with no more than 500-600 calories, including your drink.

  Usual Order:	Calories		Replace with:	Calories
  Fried Chicken Sandwich	410		Chargrilled Sandwich	270
  Large Waffle Fries	400		Side Salad	60
  Large Soda / Lemonade	390		Large Diet Soda	0
  			Large Fruit Cup	100
  			Light Italian Dressing	15
  Total Calories:	1200		Total Calories:	445
  # of fruits / vegetables:	Zero (0)		# of fruits / vegetables	3 1/2

Use Meat Substitutes

• Replace meat at meals three or more times per week with another protein, such as dried, cooked beans or a soy food, such as tofu.
•  Eat less beef, pork, and smoked, cured and processed meats such as luncheon/deli meats, jerky, sausage, bacon, ham, canned meat, Spamâ, pepperoni, and hot dogs.

Limit Alcohol

• Women should limit alcohol to one drink per day.  Men should limit intake to no more than two drinks per day.
• One drink equals 12 ounces of beer, 1.5 ounces of liquor or 5 ounces of wine.

Invest in Community Health

• Work with your employer and community to advocate for healthy food in the workplace and access to recreation, parks and trails.
• Support development of parks, sidewalks, bike paths, and rails to trails programs in your community to maintain a healthy lifestyle.

‘Weight’ No More to Shed Some Pounds

• Know your Body Mass Index.  Visit http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/english_bmi_calculator/bmi_calculator.htm to calculate your BMI.  Aim to reach a BMI of 19-25.
• Increase your activity every day.  Wear a pedometer to help you track the number of steps you walk daily.  Record your steps and set goals to walk further each week.
• Meet w/ a Registered Dietitian in your area or join a reputable weight loss program, such as Weight Watcher’s.  To find a dietitian in your area, please visit the American Dietetic Association at www.eatright.org and click “Find a Nutrition Professional.”

Choose Healthy Fats

• Eat more foods high in Omega-3 fatty acids such as salmon, trout, tuna, swordfish, flaxseed, canola and soybean oils, walnuts, and wheat germ.
•  Limit shortening, margarine and “partially hydrogenated oils” in many processed foods.  Read the ingredients on food labels to look for these bad fats.
• Bake, steam, broil or grill foods instead of frying.

Monitor Your Food Supply

• Choose whole, natural foods over processed food.  Grow your own garden, when possible.
•  Wash and scrub all produce under running water.
• Peel produce and discard outer leaves of leafy vegetables.
• Use home pesticides safely.
• Eat a variety of fruits and vegetables.  If you eat a particular food most days of the week, consider buying organic.

Exercise

• Once you have made the decision to exercise, choose an activity that suits your personality – if you like the company of other people, choose an activity like a dance class or a team sport. If you prefer solitary activity, then walking or using equipment in a gym may be better for you.
• Get help: ask for assistance from someone with an understanding of your selected activity – a trainer at your gym, the aerobic instructor – to help you prevent injury and to get the most from your workout. 
• Remember that even moderate exercise has health benefits. Moderate exercise is defined as activity that burns 150 calories of energy a day or 1000 a week. Try walking, yard work or recreational games like tennis or basketball.
• Work toward 30 minutes of physical activity between three to five days a week.
• Set realistic goals for yourself based on your fitness level.
• Go slow and steady so you don’t become disappointed by setbacks.
• Keep to a regular schedule – you will establish a routine and be more likely to stick to it. If you don’t stick to your schedule, don’t worry. Just pick up again where you left off and start again.
• Always check with a physician when you begin a new exercise program, especially if you have been sedentary.

Colon Cleansing

Colon Cleansing is a topic that is second only to colon cancer on a list of frequently searched Google terms related to the colon.  The rationale for colon cleansing is the belief that toxins build up in the stool, sits in our bodies and leads to disease.  Many people believe that if we clean out the colon with different products – from enemas to oral preparations – we will decrease the amount of these toxins in our body.

At this time the Foundation has no supporting objective evidence, clinical trials, or any validated scientific information supporting the value of colon cleaners.  In fact, many leading experts agree that colon cleansers can do more harm than good to the colon.

What many people do not know is that the colon lining, called the mucosa, gets its nourishment from bacterial products that exist in the stool.  In addition, colon cleansing leads to sloughing of the colonic mucosa which can lead to inflammation and subsequent colonic diseases.

All of this can be very confusing when searching for information about colon cleansers, or colon cleansing.  Since there are so many companies advertising their brand of colon cleansers and absolutely no medical or governmental institutions policing these companies please be careful.  As with any advertised product on the internet or in your local store it is recommended to consult with your primary care physician, or a Gastroenterologist or Colorectal surgeon.

Medical Disclaimer

The information presented on the Susan Cohan Kasdas Colon Cancer Foundation web site is solely intended to provide you with information that will help educate you on the importance of diet, exercise and regular cancer screening in maintaining a healthy lifestyle. Adopting these habits is an individual choice and one that should only be made after consultation with your health care professional. No information provided on this Web site or otherwise offered by The Susan Cohan Kasdas Colon Cancer Foundation is intended to replace or in any way modify the advice of your health care professional.