Young Adults Are Dying Of Colon Cancer - How NOT To Be One Of Them!

Young adults are dying from colorectal cancer how not to die

Last week several news sources reported that young adults are getting colon cancer more frequently, and that an alarming number of the new cases are of advanced disease. This data was according to a new study published on July 22nd, 2019 in the United States.

Medical News Today Stated:

“A new study of recent trends in colorectal cancer in the United States confirms that rates among those under the age of 50 years are rising. The findings also reveal that diagnoses of colorectal cancer in younger adults are more likely to be of advanced disease.”

Colorectal cancer rates rising in younger adults https://www.medicalnewstoday.com/articles/325816.php

This new research found that the rate of young people receiving a diagnosis of colorectal cancer is on the rise. Previous investigations have shown that rates of colorectal cancer in the under 50s have risen since the 1970s. Using data from the National Cancer Database registry, the study authors found that 12.2% of colorectal cancer diagnoses in the U.S. in 2015 (the most recent year included in the database) were in people under the age of 50 years compared with 10% in 2004, and 6% in 1990.

In addition, doctors detected signs of advanced disease in more than half (51.6%) of colorectal cancer diagnoses in younger adults.

More colorectal cancer cases are being diagnosed in younger patients. https://www.medicaldaily.com/colorectal-cancer-eat-not-eat-439478

Journal Reference (Published 07/22/19): John Virostko, Anna Capasso, Thomas E. Yankeelov, Boone Goodgame. Recent trends in the age at diagnosis of colorectal cancer in the US National Cancer Data Base, 2004‐2015. Cancer, 2019; DOI: 10.1002/cncr.32347

The American Cancer Society predicts that the country would see 101,420 new cases of colon cancer and 44,180 new cases of rectal cancer in 2019. Among these cases, the organization estimates 51,020 deaths within the year. That is more than 1 in 3 deaths (35%) of newly diagnosed cases!

The Cause of Colorectal Cancer

It used to be thought that inflammation or inflammatory bowel disease was the cause of colon and rectal cancer. In September of last year (2018) Scientists discovered that cell stress in combination with altered microbiota (gut dysbiosis) in the colon drives tumor growth.

See: Colon cancer is caused by bacteria and cell stress https://www.sciencedaily.com/releases/2018/09/180918110908.htm

Journal Reference: O.I. Coleman, E.M. Lobner, S. Bierwirth, A. Sorbie, N. Waldschmitt, E. Rath, E. Berger, I. Lagkouvardos, T. Clavel, K.D. McCoy, A. Weber, M. Heikenwalder, K.P. Janssen, D. Haller. Activated ATF6 Induces Intestinal Dysbiosis and Innate Immune Response to Promote Colorectal Tumorigenesis. Gastroenterology, 2018; DOI: 10.1053/j.gastro.2018.07.028

What is meant by cell stress without getting overly technical, is when our cells fail to properly handle normal processes (protein folding), a stress signal is sent out and the ‘ATF6’ protein responds attempting to create homeostasis (cell stability), and if it can’t, cell death ensues called ‘aptopsis’. In order for aptopsis to eventually happen, the environment within the colon has to be in ‘dysbiosis’ and starved of nutrients and oxygen.

Activated ATF6 Induces Intestinal Dysbiosis and Innate Immune Response to Promote Colorectal Tumorigenesis https://www.gastrojournal.org/article/S0016-5085(18)34816-9/fulltext

Endoplasmic Reticulum Stress https://www.sigmaaldrich.com/life-science/cell-biology/cell-biology-products.html?TablePage=106514528

We have made massive strides in the last several years in our understanding of the human microbiome. Scientists have heavily documented the gut microbiome of healthy and unhealthy people. They have figured out that the gut microbiome is very much like an ecosystem, and a healthy environment is necessary to keep the proper balance of the microflora in our gut – or ‘symbiosis’. In addition, various bacterial species and their metabolites play critical roles in the development of colorectal cancer. In fact, several studies have been able to demonstrate that certain bacteria species are associated with colorectal polyps.

Gut microbiome identifies risk for colorectal polyps. https://bmjopengastro.bmj.com/content/6/1/e000297

Cancer-associated fecal microbial markers in colorectal cancer detection. https://www.ncbi.nlm.nih.gov/pubmed/28833079

For additional reading, the following review summarizes current studies regarding the association between gastrointestinal microbiota and the development of colorectal cancer:

Dysbiosis of gut microbiota in promoting the development of colorectal cancer https://academic.oup.com/gastro/article/6/1/1/4430984

The Gut Microbiome As An Ecosystem

When the environment within our gut changes, unhealthy bacteria overgrow creating dysbiosis. Gut dysbiosis is multi-factoral. There are several things that destroy healthy flora, conditions that help balance gut flora, and elements within our diet that cause the overgrowth of unhealthy bacteria as well as feed healthy bacteria.

What Destroys Healthy Gut Bacteria?

Alcohol (See: https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-018-0448-x )
Antibiotics (See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709861/)
Antibiotics in animal based ‘food’ like factory farmed meat and diary. It is not currently known how much is transferred to humans. (See: https://bit.ly/2SLgahI )
Antibiotics in our water resources from agricultural run-off.
Antimicrobial agents like Pesticides ( See: https://www.ncbi.nlm.nih.gov/pubmed/31003127 and https://bit.ly/2qpve9D )
Some Artifical Sweeteners (aspartame, sucralose, saccharine, neotame, advantame, and acesulfame potassium-k, See: https://www.mdpi.com/1420-3049/23/10/2454/htm )
Various Medications (27% of prescribed drugs alter the gut microbiome according to this review: Extensive impact of non-antibiotic drugs on human gut bacteria https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108420/ )
Overgrowth of unhealthy gut flora. See below.
Overproduction of bile acids. See below.
Lack of Fiber ( A Dietary Fiber-Deprived Gut Microbiota Degrades the Colonic Mucus Barrier and Enhances Pathogen Susceptibility https://www.sciencedirect.com/science/article/pii/S0092867416314647 )

What Causes Overgrowth Of Unhealthy Bacteria?

Healthy bacteria will multiply and colonize our gut microbiome under the proper conditions, in turn crowding out the unhealthy bacteria. Some gut flora called ‘bacteriocins’ are antimicrobial in a good way, in that they will inhibit the growth of bacterial pathogens. Without the healthy bacteria, the unhealthy bacteria will take over.

High fat diets have been unequivocally proven to cause dysbiosis and overgrowth of unhealthy bacteria. This has been proven in mice studies and human studies.

In mice, a high fat diet increased bile acid production, induced gut barrier alterations, induced intestinal inflammation, inhibiting pathways involved in metabolic homeostasis, and decreasing butyrate production by the microbiota. (More info on butyrate and it’s importance below).

Bilophila wadsworthia aggravates high fat diet induced metabolic dysfunctions in mice https://www.nature.com/articles/s41467-018-05249-7

In humans, there are three studies of note. In one study, they swapped the diets of 20 healthy middle aged African Americans (high in fat) and 20 rural Africans (high in fiber). Remarkably, Africanization (of the African Americans) reduced colonic evacuate secondary bile acids by 70%, and Westernization (of the Rural Africans) increased them by 400%! The products of bacterial bile acid conjugation, secondary bile acids, are carcinogenic. (See: Carcinogenicity of deoxycholate, a secondary bile acid. https://www.ncbi.nlm.nih.gov/pubmed/21267546 ). They also found that markers of inflammation increased on switching Africans to the high fat diet, and decreased in Americans given the high fiber diet.

Study Abstract: Rates of colon cancer are much higher in African Americans (65:100,000) than in rural South Africans (<5:100,000). The higher rates are associated with higher animal protein and fat and lower fiber consumption, higher colonic secondary bile acids, lower colonic short chain fatty acid quantities and higher mucosal proliferative biomarkers of cancer risk in otherwise healthy middle aged volunteers. Here we investigate further the role of fat and fiber in this association. We performed two-week food exchanges in subjects from the same populations, where African Americans were fed a high-fiber, lowfat African-style diet, and rural Africans a high-fat low-fiber western-style diet under close supervision. In comparison to their usual diets, the food changes resulted in remarkable reciprocal changes in mucosal biomarkers of cancer risk and in aspects of the microbiota and metabolome known to affect cancer risk, best illustrated by increased saccharolytic fermentation and butyrogenesis and suppressed secondary bile acid synthesis in the African Americans.

Fat, Fiber and Cancer Risk in African Americans and Rural Africans https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415091/

The second human study of note took obese subjects with type 2 diabetes or hypertention and placed them on a strict vegetarian diet for one month. In that one month, they noted reduced body weight and the concentrations of triglycerides, total cholesterol, low‐density lipoprotein cholesterol and haemoglobin A1c, and improved fasting glucose and postprandial glucose levels. The diet led to a decrease in the pathobionts (disease causing bacteria) such as the Enterobacteriaceae and an increase in commensal (healthy) microbes such as Bacteroides fragilis and Clostridium species. Basically, the study show the benefits of dietary fiber for improving the risk factors of metabolic diseases and shows that increased fiber intake reduces gut inflammation by changing the gut microbiota.

Strict vegetarian diet improves the risk factors associated with metabolic diseases by modulating gut microbiota and reducing intestinal inflammation. https://onlinelibrary.wiley.com/doi/abs/10.1111/1758-2229.12079

The third study measured the abundance of various microflora, SFCA production, and bile acid production of subjects randomized to an entirely plant-based (vegan) diet and an animal based (carnivore) diet. The animal-based diet increased the abundance of bile-tolerant microorganisms, (more specifically Bilophila wadsworthia) and thus supports the link between dietary fat, bile acids, and the outgrowth of microorganisms capable of triggering bowel disease.

Diet rapidly and reproducibly alters the human gut microbiome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957428/

What Feeds Healthy Bacteria?

A high-fiber diet in particular affects the type and amount and diversity of microbiota in the intestines. Dietary fiber are broken down and fermented into short chain fatty acids. An important short-chain fatty acid (SCFA) is butyrate which is critical for reducing inflammation and keeping gut tissue healthy. It also helps kill off cancer cells, and inhibits the growth of unfriendly bacteria. In addition to fiber, resistant starch and fermented foods play an important role in gut health.

A Dietary Fiber-Deprived Gut Microbiota Degrades the Colonic Mucus Barrier and Enhances Pathogen Susceptibility https://www.sciencedirect.com/science/article/pii/S0092867416314647

More technical info on fiber and butyrate:

Many of the health benefits ascribed to fiber are a consequence of their fermentation by the colonic microbiota and the metabolites that are produced. Carbohydrates are fermented to organic acids that provide energy for other bacteria, the bowel epithelium and peripheral tissues. SCFA are the major end products of carbohydrate fermentation. These weak acids help lower the pH within the colon thereby inhibiting the growth and activity of pathogenic bacteria.

Butyrate serves as the principal source of metabolic energy for the colonocytes (the paper thin lining of the colon), is instrumental in maintaining mucosal integrity within the colon, modulates (controls) intestinal inflammation and promotes genomic stability (keeps DNA together). The capacity of butyrate to regulate colonocyte differentiation and apoptosis, promoting removal of dysfunctional cells, underscores its potential to protect against colon cancer.

Relevance of protein fermentation to gut health https://www.ncbi.nlm.nih.gov/pubmed/22121108

Dietary Fiber Treatment Corrects the Composition of Gut Microbiota, Promotes SCFA Production, and Suppresses Colon Carcinogenesis. https://www.ncbi.nlm.nih.gov/pubmed/29462896/

What Balances The Gut Microbiome?

Colorectal cancer is regarded as a Westernized disease, as it has the highest incidence rates in North America, Australia, New Zealand, and Europe. The Western Diet or Standard American Diet (SAD) is high in fat, low in fiber, and high in simple carbohydrates. When we destroy our healthy bacteria as outlined above, and eat a high fat diet lacking in fiber, we create an environment for bacterial pathogens to take over.

It has been demonstrated in many studies that the gut microbiome changes dramatically based on what we eat. Fiber, Resistant Starch, Polyphenols, and Fermented Foods, all play a role in keeping our gut microbiome healthy. High fat diets, red meat, processed meat, eggs and diary products will cause dysbiosis, inflammation, and very realistically colon cancer.

Fiber: Foods that support increased levels of SCFA are indigestible carbohydrates and fibers (a.k.a. prebiotics) that feed our beneficial microflora. In general, those foods are fruits and vegetables, whole grains, and resistant starches like bananas and potatoes.

Resistant Starch: Resistant starch escapes small intestinal digestion and is fermented in the colon by the resident microbiota. Unripe bananas, cooked and cooled potatoes, cooked and cooled rice, whole grains, beans, and legumes are all excellent sources of resistant starch.

Resistant starch: a promising dietary agent for the prevention/treatment of inflammatory bowel disease and bowel cancer https://www.ncbi.nlm.nih.gov/pubmed/23385525

Polyphenols: Polyphenols, in plant foods increase Bifidobacterium and Lactobacillus (healthy bacteria) abundance, and increases SCFA production which provide anti-pathogenic and anti-inflammatory effects as well as cardiovascular protection. Common polyphenol-rich foods include fruits, seeds, vegetables, tea, cocoa products, and wine.

Fermented Foods: Fermented foods are probiotic rich with Lactobacillus reuteri. Probiotic lactobacilli have health-promoting effects such as pathogen inhibition, restoration of the microbial balance, and enhancement of epithelial barrier function. You can easily ferment your own foods. Some can be purchased like tempeh, kimchi, miso, natto, and sauerkraut.

Role of Lactobacillus reuteri in Human Health and Diseases https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5917019/

Probiotic Supplements? I am sure that you have heard that probiotic supplements are good for gut health. Because the supplement industry is largely unregulated, and because there have been MANY reports of illness and even death from the use of probiotic supplements, I don’t suggest them. You may have dead probiotic bacteria (vs. live) in your supplement. You are likely better off eating fermented foods instead. There is one exception to this rule and that is after antibiotic medications. It takes time to rebuild and recolonize your microbiome after antibiotic use so ask your doctor what he or she recommends.

See my article: ‘The Role of Fermented Foods in Human Health‘

PrEbiotic Supplements? NO! Seriously, just eat high fiber foods. Prebiotic supplements are a waste of money.

Gut Dysbiosis from high fat diets, red meat, processed meat, eggs and diary products + TMAO:

When we eat a high fat diet, our liver produces bile in order to break down those fats. When we consume milk fat, our liver over produces a type of bile rich in sulfur that creates an environment wherein certain pathobion bacteria’s like Bilophila wadsworthia thrive and flourish. These bacteria invade the wall of our colon and trigger tissue damage.

Western diet changes gut bacteria and triggers colitis in those at risk. https://www.uchicagomedicine.org/forefront/news/2012/june/western-diet-changes-gut-bacteria-and-triggers-colitis-in-those-at-risk

We know that diet can quickly change the gut microbiome and we have been able to reproduce those results in studies.

Diet rapidly and reproducibly alters the human gut microbiome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957428/

Researched at Loma Linda University conducted a large observational study of 77,659 men and women (Adventist Health Study 2) with a 7 year follow up. They found that vegetarians had on average a 22 percent reduction in the risk of developing colorectal cancer, compared with non-vegetarians.

Vegetarian dietary patterns and the risk of colorectal cancers. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420687/

The International Agency for Research on Cancer, which is the World Health Organizations cancer research agency, has classified processed meat as a group 1 carcinogen (in the same category as plutonium and cigarettes), and red meat as a probable carcinogen. Twenty-two experts from 10 countries reviewed more than 800 studies to reach this conclusion. They found that eating 50 grams of processed meat every day increased the risk of colorectal cancer by 18%. That’s the equivalent of about 4 strips of bacon or 1 hot dog. For red meat, there was evidence of increased risk of colorectal, pancreatic, and prostate cancer. When it comes to prostate health, supplements like Prostadine help regulate the production of testosterone and supports bladder function. Visit This Website to learn more about it.

(Red meat includes beef, veal, pork, lamb, mutton, horse and goat. Processed meat includes ham, bacon, salami, hot dogs, sausage, and some deli meats.)

World Health Organization Says Processed Meat Causes Cancer (page went missing at cancer.org). See instead: Carcinogenicity of consumption of red and processed meat. http://ucpvalencia.es/wp-content/uploads/2015/10/Lancet-Oncology.pdf

A critical overview on the biological and molecular features of red and processed meat in colorectal carcinogenesis. SEE: https://pubmed.ncbi.nlm.nih.gov/27913919/

Accumulated evidence of prospective epidemiological studies and their meta-analyses shows that red meat and processed meat convincingly increases colorectal cancer risk by 20-30%!

Potential health hazards of eating red meat https://onlinelibrary.wiley.com/doi/10.1111/joim.12543

A final note on gut microbiome and eating an animal based diet: Trimethylamine N-oxide (TMAO) is a gut microbiota-dependent metabolite generated from choline, and carnitine. Red meat, eggs, dairy products and salt-water fish are rich in choline, and carnitine and, hence, are a source of TMAO. TMAO is linked to heart disease, type 2 diabetes, chronic kidney disease, liver cancer, and colorectal cancer.

A genome-wide systems analysis reveals strong link between colorectal cancer and trimethylamine N-oxide (TMAO), a gut microbial metabolite of dietary meat and fat. https://www.ncbi.nlm.nih.gov/pubmed/26100814/

Dysbiosis of gut microbiota in promoting the development of colorectal cancer https://academic.oup.com/gastro/article/6/1/1/4430984

influence of tmao from gut microbiome and implications for human health — Image Source: Influence of diet on the gut microbiome and implications for human health. https://www.ncbi.nlm.nih.gov/pubmed/28388917) ncbi.nlm.nih.gov/pubmed/28388917

Summary

There are huge benefits to switching from an animal based diet to a predominantly or all plant based diet. Not only will you decrease your risk of developing colorectal cancer (perhaps even by 20-30%), you will also decrease your risk of developing other chronic diseases like type 2 diabetes and cardiovascular disease. In general, you will feel better, have more energy, and you won’t spend your older years fighting disease.

The fact that dietary fiber increases the production of butyrate, coupled with the fact that dietary fats increase bile acid production and thus pathiobont bacteria take hold, are excellent reasons to consider a plant-based diet. This is also reason to not to do a ketogenic or low carbohydrate diet.

I do want to note that a plant-based or ‘vegan’ diet does not automatically assume a healthy way of eating. After all, Oreo cookies, potato chips, and Coca-cola are vegan/plant-based. A whole food plant-based diet that is high in fiber, low in fat, and low in processed foods is a better option than choosing faux vegan meat and cheese substitutes, and prepackaged ‘food’. Your gut microbiome will thank you.