Making those New Year’s Resolutions?

You can do a lot to prevent colon and rectal cancer this year . . . and in the future.

Number One Resolution — Be screened for colorectal cancer if you are 50 or over, earlier if you are at higher risk.

In addition you can reduce your  colorectal cancer risk by:

• Exercising regularly.
• Keeping your weight normal.
• Eating less red meat, no processed meat at all, and mostly plant-based foods.
• Increasing the amount of fiber in your food.

Start on Monday, January 2, and review your progress toward better diet and exercise every Monday all year.  Research from leading public health schools for The Monday Campaigns shows that most people view Monday as a day for fresh starts.  They were most likely to begin exercising, start a diet, or stop smoking on Monday.

For the latest evidence on food, nutrition, and physical activity and their influence on colorectal cancer, read the World Cancer Research Fund’s Continuous Update Project focus on colorectal cancer.

Happy, healthy New Year!

Colorectal Cancer News in a Nutshell

Summer’s over. The black squirrels in the front yard are scurrying around hunting acorns and my inbox is full of neat nuggets of colorectal cancer news — and I don’t want to leave them buried all winter.

So here they are in brief.  You can check the links for more details.

Mixed Results Using Acupuncture for Radiation Nausea

The good news is that almost all patients felt they had less nausea after either real or sham acupuncture to manage nausea and vomiting during radiation therapy.  Nine out of ten wanted more treatments.

The sham procedure used non-penetrating needles just pressed against the skin, but neither the patients who got real acupuncture or those who got sham treatments knew which they received.

Ninety-five percent in the real acupuncture group and 96 percent in the sham acupuncture group believed that the treatment had been effective against nausea.  However, 70 percent of the real group and 62 percent of the sham group did experience nausea — for an average of 10 days for real treatments and 9 days for sham.

In addition, 25 percent of the real group and 28 percent of the sham group vomited.

So measured objectively, there was still significant nausea and whether or not acupuncture was “real” or just pretend, it made no measurable difference.

Dr. Anna Enblom from the Karolinska Institute in Stockholm said,

The beneficial effects seem not to come from the traditional acupuncture method, but probably from the patients’ positive expectations and the extra care that the treatment entails.

Read more in articles by Dr. Enblom and her colleagues in Annals of Oncology and earlier this year in PLoS ONE where acupuncture, both real and sham was compared to standard nausea care.  Dr. Enblom also was featured in a news release from the Karolinska Institute.

Why Research on Fruits and Veggies and Colorectal Cancer Risk is Confusing

More fruits?  More veggies? Less colon cancer? Less rectal cancer?

Doesn’t make a difference.  Makes a big difference.

Are you confused when you read media stories based on new research about the impact of diet on colon and rectal cancer?

It may be that different fruits and vegetables have different effects depending on where cancer develops — in the proximal colon (near the top), the distal colon (near the rectum), or the rectum itself.

The research team from the Western Australian Bowel Health Study compared fruit and vegetable intact between people who had been diagnosed with colon or rectal cancer and a similar group of cancer-free individuals. They specifically looked at where the cancer was in the colorectal tract.

While total intake of fruits and vegetables and total intake of vegetables did reduce distal cancer, neither had any impact on proximal or rectal cancer. Brassica vegetables like broccoli and cabbage reduced proximal colon cancer risk, while risk for distal cancer was significantly reduced by eating dark yellow vegetables and apples.

Rectal cancer risk was increased by drinking fruit juice.

The discovery of differences should impact future diet studies for reducing colorectal cancer risk. Epidemiologist and study author Professor Lin Fritschi, PhD explained.

Fruits and vegetables have been examined extensively in nutritional research in relation to CRC, however, their protective effect has been subject to debate, possibly because of different effects on different subsites of the large bowel.

It may be that some of the confusion about the relationship between diet and cancer risk is due to the fact that previous studies did not take site of the CRC into account. The replication of these findings in large prospective studies may help determine whether a higher intake of vegetables is a means for reducing the risk of distal CRC.

The study was reported in the October Journal of the American Dietetic Association.

The bottom line for people who want to reduce their risk of colon and rectal cancer is that eating fruit and vegetables does help prevent cancer in some parts of the colon and rectum, but doesn’t guarantee that cancer won’t occur.  Getting fruit from juice may not be the best choice because that does increase rectal cancer risk.

Even a Little More Exercise Helps

Although recommendations are for 150 minutes of exercise a week or 30 minutes a day to reduce risk of dying from cardiovascular disease or cancer, even less activity can increase life expectancy.

Following over 415,000 people in Taiwan over an average of 9 years, researchers found that even 15 minutes a day (92 minutes a week) of physical activity increased life expectancy three years compared to those people who had no exercise at all. The no exercise group had a 17% increased risk of dying compared to the low-exercise group.

After an initial 15 minutes every day (low-volume exercise) every additional 15 minutes of daily exercise decreased risk of dying from any cause by 4% and dying from cancer by1%.

Dr Chi Pang Wen MD from the National Health Research Institutes in Zhunan, Taiwan reported study results in the October 1, 2011 issue of The Lancet.

Dr. Lenz

I wanted to come up with some recommendations on diet over this Thanksgiving holiday. Searching the web and looking for advice to give you,  I came across a wonderful website  — TOP TEN FOOD tips by the National Foundation for Cancer Research — I wanted to share with you.

Here’s what they said.

• Skin the turkey – By removing the skin from the turkey (or chicken) after you cook it, you reduce the amount of fat and actually make the traditional centerpiece of the holiday meal better for you.

• Add more fiber to your stuffing – Try adding brown rice, celery, chopped apples, apricots, or nuts to your stuffing this year. These ingredients are all rich in fiber which is essential in a diet to deter cancer.

• Fruit not fudge – Rather than reaching for the tray of fudge and cookies this year for dessert, try Southern Ambrosia, a mixture of oranges, apples, bananas, pineapples, and coconut. Click here for the recipe!

• Use healthier cooking methods – Try broiling, grilling, roasting, or baking your holiday meals instead of frying and sautéing them. This reduces the amount of fat and allows the true taste of the food to come through.

• Cook with lower-fat dairy products – By using low-fat dairy products, you decrease the intake of fat that is later stored and used by cancer cells to grow. In most cases, you and your guests will not notice the difference in taste.

• Include fish in your holiday tradition – The Omega-3 oils in tuna, salmon, and mackerel appear to be protective of cell linings in fighting off cancer growth. Avoid tuna packed in vegetable oil, however.

• Eat plenty of fruits and vegetables – Research indicates that people who eat five to nine servings of fruits and vegetables each day can cut their cancer risk in half compared to those who eat only one serving per day.

• Make a spinach salad – Spinach contains one of the top cancer-fighting enzymes, sulforaphane, where traditional iceberg lettuce is a nutritional weakling. Don’t drench the salad with too much dressing which adds fat and calories. Even low-fat dressing may be loaded with too much sugar.

• Use tomato and pasta sauce – Research has proven that processed tomato products have a higher concentration of lycopene, the most powerful antioxidant carotenoid, than unprocessed tomato products. This includes tomato sauce, pasta sauce, stewed tomatoes, and other tomato products.

• Drink tea – Soda contains nothing more than empty calories and some juice drinks can be loaded with sugar. Green tea is one of the best drinks because it contains no calories and has well-documented cancer-fighting properties.

To all of you Happy Thanksgiving.

The Cancer Project has filed suit against five hot dog makers to require them to put cancer-risk warning labels on hot dog packages. The labels would read “Warning: Consuming hot dogs and other processed meats increases the risk of cancer.”

The suit, filed on behalf of three New Jersey residents, is a class action consumer fraud action, saying that Nathan’s Famous, Kraft Foods/Oscar Mayer, Sara Lee, Con Agra Foods, and Marathon Enterprises knew that eating processed meats increased cancer risk but didn’t warn consumers.

The lawsuit is based on a report from the American Institute for Cancer Research (AICR), Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective, which recommends eating no more than 18 ounces of red meat a week and avoiding processed meats. The AICR report found a 21 percent increase in colorectal cancer in people who eat a daily 50 gram serving of processed meat (equivalent to about one hot dog) over those who eat no processed meat.

The American Institute for Cancer Research (AICR) takes no stand on the lawsuit’s demand for hot dog labeling.  They say,

AICR does not take a position on the need for warning labels on hot dogs.

AICR is an independent, research-based organization. We fund research on diet and cancer at laboratories, clinics and cancer centers across the country. We also periodically collect and interpret the available data on diet and cancer and issue recommendations for cancer prevention.

AICR is not associated with the Cancer Project, the Physicians Committee for Responsible Medicine or any other advocacy organization.

AICR Three Prevention Guidelines

Summarizing its report, AICR recommends three inter-related steps for cancer prevention:

• Be as lean as possible, without becoming underweight.
• Be physically active for at least 30 minutes every day.
• Avoid sugary drinks. limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fiber, or high in fat).

A brochure with a simple version of the AICR Recommendations for Cancer Prevention is available.

Research has found aspirin or resistant starch doesn’t help people with Lynch syndrome avoid new polyps.  While almost all people had seen a cancer-related ad, very few actually got a prescription for the advertised drug. People who followed a low-fat, high-fiber diet most carefully had fewer new polyps.

A Johns Hopkins team has developed SUDS — a device for cleaning ER equipment that wipes out dangerous bacteria and keeps it from returning for several days.  The Caring Connection will help you find advance directive forms and instructions for your state.

Research Reports

• People with Lynch syndrome don’t benefit from either aspirin or resistant starch (Novelose) even when aspirin is given at a high dose of 600 mg a day.  Over four years, Lynch patients on aspirin, Novelose, or a combination of the two had no fewer polyps than clinical trial participants on placebo.  Serious adverse events, gastric bleeding, strokes, and heart attacks, weren’t any different between the two groups either.  Dr. John Burn and the CAPP2 team report their results in the New England Journal of Medicine, December 11, 2008.
• Almost 9 out of 10 patients in treatment asked about cancer-related advertising directed at consumers had seen ads, mostly on television.  A majority of surveyed patients felt that the ads made them “aware of treatments they did not know about“, presented information “in a balanced manner“, and helped them have “better discussions” with their doctor.  One in ten felt that the ads reduced their confidence in their doctor’s judgment.  Of those who were aware of ads, 1 in 5 discussed an advertised medicine with their doctor, but of those only 20 percent actually received a prescription for the drug. Gregory A. Abel and the team at Harvard Medical School report the results of the survey in an early online edition of the Journal of Clinical Oncology August 3, 2009.
• People prone to colorectal polyps who were “super-compliers” in following a recommended low-fat, high-fiber diet with high amounts of fruits and vegetables had 35 percent fewer new polyps than people who were not on the diet at all.  However, most trial participants didn’t report that level of compliance.  Of 1,900 people in the trial, only 210 consistently reported success in following all three diet recommendations:  low fat, high fiber, and high fruit/vegetable intake.  Dr. Leah B. Sansbury and her team from the Polyp Prevention Trial Study Group reported their results in the American Journal of Epidemiology online July 30, 2009.

Other Headlines

• A team at Johns Hopkins has developed a device, similar to a shower cubicle, that can clean and decontaminate hard-to-clean emergency room equipment from electrocardigram machines to  cell phones.  SUDS or  the Self-cleaning Unit for the Decontamination of Small instruments beats manual scrubbing for removing bacteria and keeping it away for at least two days.  Two days after manual cleaning, 1 in 4 devices had new bacterial growth, but SUDS-cleaned devices were bacteria-free even in heavy ER settings.  Treatment inside the 7 foot high SUDS machine didn’t appear to damage electronics, and its use can replace expensive  and wasteful disposables.  Development and testing of the SUDS device is described in Annals of Surgical Innovation and Research, online July 30, 2009.
• Caring Connections, a program of the National Hospice and Palliative Care Organization, provides free advance directives and instructions for each state that can be downloaded and filled out.  The packets include information about the HIPAA Privacy Rule and the specific forms and information you’ll need for your own state.  Depending on the state, advance directives allow you to appoint an advocate or proxy to make health care decisions if you are unable to speak for yourself and to specify what health care you do or do not want if you are critically ill.

News in Brief catches up today after celebrating the Fourth of July with swimming, sailing, and time with family.  We hope you had as good a time relaxing as we did.

Research shows that children whose parents have cancer have more social and psychological problems, mice who are fed a high-fat Western-style diet don’t benefit from exercise and develop more colon polyps, and adding irinotecan to 5FU after surgery to remove liver mets adds no benefit but has more serious side effects.

The VA is upgrading equipment to sterilize endoscopes and train staff to clean them properly with $26 million from its reserve funds.  Two scientists at MIT are sampling and freezing their own stools each day to study changing patterns of millions of  microbes in the intestinal tract.

Research Reports

• Children whose parents whose parents have cancer have more psychological and social problems than peers with healthy parents, particularly boys between 6 and 11 and adolescent girls.  There appear to be more problems when fathers are ill.  Children internalize their problems when parents are depressed and act them out when there problems with family functioning.  Writing in Cancer (online June 10,2009) Mikael Thastum, PhD and his team said, “The results indicate the need for a family-oriented approach to psychological support of cancer patients.”
• Even treadmills don’t help mice who eat a high fat “Western Diet.”  Mice specially bred to develop colorectal tumors got fatter and developed 75 percent more polyps than mice who ate healthy chow.    They also had signs of inflammation and immune system suppression. Running on a treadmill didn’t reduce the number of polyps, amount of inflammation, or reduced immune function.    Similar mice who were fed the healthier diet had fewer polyps, less inflammation, and reduced immune system changes when they exercised.  Kristen A. Baltgalvis and her team at the University of South Carolina discuss their mouse studies in the July 1, 2009 issue of Cancer Prevention Research.
• Adding irinotecan to continuous infusion 5FU with leucovorin didn’t improve either disease-free or overall survival after surgery to remove liver mets.  Median time before cancer got worse was 21.6 months for LV5FU alone compared to 24.7 months with FOLFIRI.  In addition, serious side effects were more common with FOLFIRI (47 percent vs 30 percent).  The most common was grade 3 or 4 low white cell counts (neutropenia), with 23 percent of patients on FOLFIRI having them compared to 7 percent who received LV5FU.  Marc Ychou and colleagues report their results in Annals on Oncology, online June 30, 2009.

Other Headlines

• The Department of Veterans Affairs is providing $26 million from its reserve funds for sterilizing equipment for endoscopes. Funds will be available immediately to be sure that the right equipment is available to clean and disinfect reusable medical devices. In addition, money will go toward training and enforcing stricter guidelines for cleaning scopes that examine the throat, ears, and colon. Read the story from WBIR-TV in Knoxville, TN.
• Two scientists at MIT are collecting and freezing their own bowel movements every day to study changes in the many microbes that live in human intestines.  They’re also keeping track of over 100 measures of daily health — diet, exercise, blood pressure, mood, etc — to see if they have any impact.  After collection is complete, they plan to use a new system they are developing to quickly and cheaply analyze RNA in the communities of microbes.  Graduate student  David Lawrence told The Scientist, “The point is to figure out the normal dynamics of what’s probably the densest microbial community in the world.”

What you eat can increase your risk for rectal cancer . . . or reduce it.  But race makes a difference too.

Whites had an increased risk of rectal cancer when their diets had lots of refined grains and white potatoes, while African Americans risk was increased with fruit and added sugar.

The North Carolina Colon Cancer Study studied diet patterns and colorectal cancer risk among whites and African Americans with rectal cancer and matched controls.  They identified three major eating patterns and found that risk for rectal cancer differed between the two racial groups.

• While both groups ate foods in the high fat/meat/potatoes group, only whites had increased risk for rectal cancer when high amounts of these foods were eaten.  Risk was almost doubled for whites who ate mostly high fat foods, meat, and potatoes.
• For whites eating mostly vegetables, fish, and poultry reduced risk of getting rectal cancer, as did fruit, whole grains, and dairy foods.
• African Americans had higher risk from legumes and dairy products and lower risk from fruits and vegetables.

Christina Dawn Williams and her team at the University of North Carolina in Chapel Hill concluded,

Our findings indicate that associations of certain food groups and overall dietary patterns with rectal cancer risk differ between Whites and African-Americans, highlighting the importance of examining diet and cancer relationships in racially diverse populations.

SOURCE: Williams et al., Cancer Epidemiology, Biomarkers, and Prevention, Volume 18, Number 5, May 2009.

We know that throughout history people have lived well when their diets were rich in fruit and vegetables. There is evidence that eating fruits and vegetables helps to reduce gastric and colon cancer. All fruits and vegetables contain fiber which is helpful in preventing colon cancer. Now science has proven without a doubt that there is a relationship between intake of fruits and vegetables and health.

We now understand better why dietary fiber is protective. Fibers are fermented by bacteria in the colon which leads to short-chained fatty acids which protect against cancer causing substances. Recently, evidence shows that tomatoes may protect against esophageal and prostate cancer and carrots against cancer in the mouth and pharynx.

The reasons fruits and vegetables protect against cancer is because they contain antioxidants, increase activity of enzymes that detoxify cancer causing substances, alter estrogen metabolism, and alter the bacteria and pH in the colon. For example, onions, garlic, scallions and leeks (Allium vegetables) are rich in sulfur compounds which increase enzymes to inhibit bacteria that convert nitrates to nitrites in the stomach, and nitrites can combine with amines to form nitrosamines which can cause cancer of the stomach.

Cruciferous vegetables such as broccoli, cauliflower and cabbage have high content of organic sulfur which can stimulate enzymes in the gut to detoxify cancer-causing substances. These vegetables also contain indol-3carbinol which affects estrogen metabolism and may protect against breast and endometrial cancer.

Green vegetables such as lettuce, spinach,and mustard greens have high levels of antioxidants which block damage from free radicals within a cell. Green leafy vegetables also contain high levels of folic acid which can protect against colon cancer and heart attacks.

Red fruits and vegetables (tomatoes, red peppers, raspberries) are rich in lycopen (red pigment) which act as antioxidants and have been shown to protect against prostate cancer. Citrus fruits are rich in vitamin C, again acting as antioxidants and also preventing formation of nitrosamines.

Yellow fruits and vegetables are rich in beta carotene which is also an antioxidant and also can be metabolized to vitamin A which helps to maintain healthy cells.

Do the tomatoes in pizza may a difference? We have heard about pizza to prevent prostate cancer. Italian researchers claim that eating pizza on a regular basis may decrease a person’s chances of developing colon cancer by more than 25%. Does this sound too good to be true? Researchers asked 3,300 people who had developed cancer, how often they ate pizza. They asked the same question to 5,000 people who hadn’t developed cancer. Results showed that people who ate pizza at least once a week were less likely to develop cancer of the mouth, esophagus, or colon.

How is that possible? Well, we have data that lycopene in the tomato sauce (red color) has protective effects, It is not the pizza itself. So should we eat more pizza to prevent colon and prostate cancer? According to this study, yes, provided you pick the right kind of pizza and consume it in moderation.

Patients always ask what they can do. Well, there is a lot they can do to reduce the risk for tumor recurring after successful surgeries.

Recent studies have clearly shown that diet is directly associated with the risk of tumor recurrence. People who eat primarily a Western diet are significantly at higher risk than those patients whose diet has less red meat, processed sugar, desserts, and French fries. You can change your diet and reduce your risk of tumor recurrence.

You can change not only what you eat, but also how much you exercise. Daily exercise, such as walking for one hour, can reduce your risk by 50 percent — more than any chemotherapy can. For patients who are obese, weight loss will not only reduce risk for diabetes or heart disease but also decrease your risk of colon cancer.

Exercise, diet, and weight loss go along with significant changes in your body. Our immune response and reaction to stress, response to inflammation and tumor will all change the better shape our bodies are in. Every environmental change will impact the biology in our bodies. We need to strengthen our bodies to fight off the cancer. These studies show clearly that diet and exercise can easily do that.

Other data also show that taking aspirin every day can reduce the risk also by 50 percent.

All this is in your power. Please discuss these with your oncologist. In my own practice we stress the point of weight loss and exercise as well as diet.

To collect all this information I set up my blogs (go and check out the former blogs on Revolution Health). I did not want to stress out my patients writing down all this information for them, so I created these blogs where that they can go to anytime  and check out what to eat, what exercise to do, what supplements may help,whether to drink alcohol or not, whether to have sex or not . . .

The typical Western diet increases the risk of tumor recurrence for patients with colon cancer.

Patients who ate the most red and processed meats, refined grains, fats, and sugars were about three times as likely to die or have their cancers recur as patients who ate these foods the least. While there is no shortage of evidence linking the so-called Western diet to an increased risk for developing colon cancer, the study by the group at Harvard is among the first to examine the impact of such a diet on survival among patients treated for the disease.

We should not ignore these data and make sure that our patients are aware how important diet is to reduce the risk of tumor recurrence. From my own experience, patients always ask what they can do to decrease their risk. They want to know what they should be eating and whether they should be exercising.

The “Western” diet is characterized by high intakes of red and processed meats, sweets, refined grains, and desserts. Diet defined by the researchers as “prudent” was high in fruits, vegetables, poultry, and fish. Colon cancer recurrences or death were nearly 3.5 times more common among patients who most closely followed a Western diet than among patients who followed it the least.

In our clinic we suggest that a diet characterized by higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains should be avoided since it can increase the risk of cancer recurrence and decreases survival.

There are now many more good reasons for eating a diet rich in fruits, vegetables, and whole grains and limiting red and processed meats, refined grains, fats, and sugars.