Colorectal (bowel) cancer remains the fourth most common cancer in the UK, accounting for 11% of all new cancer cases (CRUK). While it is typically associated with older age, with many cases occurring in people aged 75 and older, there has been a concerning trend in recent years. We have seen a noticeable rise in early-onset colorectal cancer (EO-CRC) among people under 50, which is gaining attention worldwide. Although this shift has been making the headlines recently, researchers have been studying this trend for some time.
Understanding the Surge:
More and more people are getting colorectal cancer at a younger age, especially those born after 1950. Rates of colorectal cancer among people under 50 has been climbing since the mid-1980s. Researchers aren't exactly sure why this is happening, but they're looking into a few possible reasons.
Possible Factors:
Family History and Genetics: Some people with early-onset colorectal cancer have a family history of the disease, but not everyone. While genetics play a role in some cases, most seem to happen without a clear family link. Scientists are still figuring out all the genes involved in colorectal cancer risk.
Medical Conditions: Some health conditions, such as adenomatous polyps, inflammatory bowel disease (ulcerative colitis and Crohn’s disease), and type 2 diabetes, have been linked to an increased risk of CRC.
Lifestyle and Diet (modifiable risk factors): The way we live and eat can affect our risk of bowel cancer. Current research suggests that factors like sedentary behaviour, obesity, smoking, excessive alcohol consumption, and following a Western-style diet (high in red and processed meat, low in fibre, and high in sugary drinks) are all linked to higher rates of bowel cancer. These factors are particularly concerning because they contribute to the rise in bowel cancer rates among young people. What we eat and how we live during our younger years might have a lasting impact on our risk of developing bowel cancer later in life. Some scientists propose that changes in our bodies during youth and adolescence make us more sensitive to how our diet affects things like insulin, DNA repair, and the bacteria in our guts, which play a big role in our health.
Gut Microbiome: Studies show that people with colorectal cancer often have a less healthy mix of gut bacteria. This means there are more bacteria causing inflammation and making harmful substances, and fewer bacteria that protect the cells in the colon. What you eat affects this balance of bacteria, and habits like eating a Western-style diet and being overweight can make it worse. While researchers are learning more about this link, more studies are needed to be sure.
Metabolic Conditions: Chronic inflammation and insulin resistance associated with metabolic syndrome and type 2 diabetes show consistent links to early-onset CRC.
Environmental Factors: Researchers are currently exploring the impact of environmental factors such as plastics and chemicals, and we await further research to fully understand their role in colorectal cancer.
Navigating the Complexity of Early-Onset Colorectal Cancer:
The rise in early-onset CRC challenges the common belief that it primarily occurs in older individuals. More young, seemingly healthy people are presenting with colorectal cancer, which can feel surprising given their lifestyle choices. These are the cases that don't make sense, as many patients express.
While adopting a healthy lifestyle cannot shield us entirely from every case of early-onset or other cancers, the evidence is clear - it plays a vital role in reducing the risk. It is completely natural to feel concerned about early-onset CRC. As we await more answers from ongoing research, it is beneficial to focus on what we can do based on current evidence. Investing our energy in lifestyle changes and dietary patterns supported by research can be a positive step forward, offering us some control and comfort during times of uncertainty. Each positive choice you make contributes to your well-being.
Recognising Symptoms and Seeking Help:
Symptoms of bowel cancer include change in bowel habits, bleeding from your bottom, persistent abdominal pain, and unexplained weight loss. It is important to seek medical advice promptly. You can learn more about the symptoms of bowel cancer and when to seek help on the NHS website.
Actionable Advice - 5 Steps to Protect Against Colorectal Cancer:
Nutrition and lifestyle play crucial roles in lowering the risk of colorectal cancer. The World Cancer Research Fund International thoroughly reviews global research to understand how factors like diet, weight, and physical activity affect cancer risk, providing evidence-based recommendations. While their guidelines primarily focus on preventing colorectal cancer, ongoing research, especially looking at cases in younger people, might discover more things in the future.
There are many ways to help lower the risk of colorectal cancer, and these five tips are a great place to start.
Aim to be at least moderately physically active, following or exceeding national guidelines (at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week PLUS strengthening activities that work all the major muscle groups on two or more days per week.
Avoid prolonged periods of sitting and limit sedentary habits.
Regular physical activity is essential for maintaining good health. It involves moving your body, engaging muscles, and burning energy, which has a positive effect on hormones and the immune system, reducing the risk of certain cancers. Additionally, staying active helps in managing a healthy weight, offering additional protection against cancer.
Tips to be more physically active:
Ramblers Wellbeing Walks: Free, short walks that take place all across England. They are designed to help you take the first step towards better health and wellbeing.
NHS Couch to 5K: Gradually work up towards running 5km in just 9 weeks.
Yoga with Adriene: Access free yoga videos to incorporate yoga into your routine.
Wholegrains are rich in important nutrients like vitamin E, selenium, copper, zinc, and dietary fibre. These nutrients, found mainly in the outer layers of the grain, may help protect against cancer. For instance, certain compounds in whole grains can boost antioxidant activity, which helps protect cells from damage. Studies suggest that eating wholegrains regularly may lower the risk of colorectal cancer. They may also help by binding to harmful substances (carcinogens) and regulating blood sugar levels.
Tips to eat more whole grains:
Choose wholegrain bread, pasta, and rice instead of their refined equivalents. Look for labels that specifically mention "wholegrain" or "wholewheat."
Include whole grains in your main meals, such as using quinoa, brown or wild rice, oats, or buckwheat.
Explore ancient grains like barley, farro, or bulgur. These grains not only provide nutritional benefits but also add variety to your meals. Try incorporating them into soups, stews, casseroles, salads, or side dishes.
Dietary fibre is found in plant-based foods like fruits, vegetables, nuts, seeds, wholegrains, beans, and lentils. These foods naturally contain various types of fibre, each offering unique health benefits. To ensure overall health protection, it is recommended to include a diverse range of fibre sources in your daily diet.
Some fibres, like those found in oats, barley, beans, and lentils, form a gel in the intestinal tract. Research suggests that these gel-forming fibres may help you feel fuller for longer, potentially aiding in weight management. Since being overweight increases the risk of colorectal cancer, incorporating these fibres into your diet can be beneficial.
Others, like those in lentils, chickpeas, quinoa, onions, garlic, and artichokes, act as fuel for beneficial gut bacteria. This fermentation process produces short-chain fatty acids, including butyrate, which has been linked to protective effects against colorectal cancer. Although more research is needed to fully understand this relationship, experimental studies have shown promising anti-cancer effects on colon cancer cells.
Additionally, insoluble fibres found in whole grains, nuts, seeds, and fruits and vegetables with skins contribute to regular bowel movements by adding bulk to the stool. This helps speed up the movement of food through the intestines and reduces the chance of harmful substances interacting with the colon lining, ultimately lowering the risk of colorectal cancer.
Overall, a high-fibre diet may also help reduce insulin resistance, which is another risk factor for colorectal cancer.
According to government guidelines, adults should aim to increase their daily dietary fibre intake to 30g as part of a healthy balanced diet. However, the average adult is only consuming about 20g of fibre per day. Therefore, it is essential to explore ways to boost our fibre intake.
Tips to increase fibre:
Leave the skin on fruits, vegetables, and potatoes: Many fruits, vegetables, and potatoes have edible skins that are rich in fibre. Leaving the skin on when you eat them can help boost your fibre intake.
Instead of reaching for processed snacks like shop-bought crisps or biscuits, choose whole food snacks like raw vegetables with hummus, a piece of fruit and a handful of nuts and seeds.
Sprinkle seeds like sesame seeds, flax seeds, or chia seeds onto salads, yoghurt, soup, or porridge to add extra fibre and beneficial fats.
4. Limit consumption of processed meat
Processed meat refers to meat that undergoes treatment to extend its shelf life or enhance its flavour, often through methods like smoking, curing, or salting. Chemical preservatives such as nitrates may be added to achieve these effects. Examples of processed meat include ham, bacon, corned beef, as well as certain sausages like salami, chorizo, and hot dogs.
Chemicals present in the meat itself, added during processing, or formed when cooking it can heighten the risk of bowel cancer.
Nitrates and nitrites: Used to preserve processed meat, these compounds can transform into N-nitroso chemicals (NOCs) in our bodies, potentially damaging the cells lining our bowel.
Haem: Haem is a component found in most processed meats, contributing to their red colour. During digestion, haem can break down into cancer-causing N-nitroso chemicals, which have been shown to damage the lining of the bowel.
Heterocyclic amines (HCAs) and polycyclic amines (PCAs): These chemicals form when processed meat is cooked at high temperatures, such as grilling or barbequing, and have the potential to harm bowel cells.
Credit: Cancer Research UK
Tips to limit processed meats:
Use leftover cooked meats from previous meals, such as roasted chicken or turkey, as sandwich fillings.
Experiment with plant-based sandwich fillings such as hummus, avocado, roasted vegetables, falafel, or nut butter for variety and nutrition.
You can find twelve wholesome ideas to replace processed meats here.
Research suggests that alcohol contributes to about 1 in 17 cases of bowel cancer in the UK. Even small amounts of alcohol can elevate your risk, so it's advisable to restrict your intake. Whether you prefer beer, wine, or spirits, all types of alcohol can increase your cancer risk.
Here are the key ways alcohol consumption impacts bowel cancer risk:
Damage to cells: When we consume alcohol, our bodies convert it into a chemical called acetaldehyde, which can harm our cells and disrupt their ability to repair themselves.
Oxidative stress: This happens when there's too many harmful molecules (free radicals) compared to protective antioxidants in our bodies. Drinking too much alcohol can create more of these harmful free radicals, causing oxidative stress. This can harm cells and increase the risk of cancer. Eating foods rich in antioxidants, like fruits and vegetables, can help shield cells from damage.
Weight gain: Alcohol is calorie-dense and can contribute to weight gain. Being overweight or obese is a known risk factor for bowel cancer. Therefore, limiting alcohol intake can not only reduce the direct risk associated with alcohol consumption but also aid in maintaining a healthy weight, further lowering the risk of developing bowel cancer.
Tips to reduce alcohol intake:
You can find some nice tips to reduce alcohol intake at drinkaware.
Nurturing Healthy Eating Habits
Research tells us that while certain foods and nutrients matter in preventing colorectal cancer, it's the overall way we eat that really makes a difference. Whether our goal is to prevent cancer, maintain a healthy weight, boost heart health, or protect against diabetes, the same things hold true: load up on vegetables, fruits, wholegrains, nuts, and seeds, and go easy on saturated fats, red and processed meats, sugary drinks, and alcohol. What is great about these guidelines is how adaptable they are to our own tastes, our family's needs, and the traditions we treasure.
We are learning that the food habits we pick up in our younger years can shape our risk of colorectal cancer down the road. Starting our kids off with a diet packed with plants and tailored to their preferences is a good thing to do. Instilling balanced and nourishing eating habits early in life can contribute to long-term health and well-being.
Tailoring Your Diet for Colorectal Cancer Care
If you have recently been diagnosed with colorectal cancer, are undergoing treatment, in recovery, or in survivorship, it is recommended to seek personalised dietary advice tailored to your unique circumstances. Treatment for colorectal cancer may require adjustments to your diet, and you may encounter eating challenges and bowel changes post-treatment. It is common to have questions about which foods are suitable and how to maintain a healthy diet during this time. General prevention guidelines may not always apply or be feasible for people dealing with cancer. Consulting with a dietitian or nutritionist experienced in supporting people undergoing cancer treatment is highly recommended to address your specific nutritional needs and concerns.
If you are aiming to lower your cancer risk, or need support for yourself or a loved one affected by cancer, please do not hesitate to get in touch for personalised nutritional guidance.
Email: info@thecancerdietitian.com
Telephone: 020 8064 2865
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