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Lack Of Fiber May Be A Trigger For Inflammatory Bowel Disease
Irritable bowel disorder (IBD), which can manifest as either ulcerative colitis or Crohn's disease, develops out of inflammation in the gut or digestive tract, leading to a range of sometimes painful issues with digestion. Scientists have not been able to identify the root cause of this disorder yet, but a recent study suggests a connection between genetics, diet, and gut microbiota that could lead to the development of IBD.
The study, published in Cell Host & Microbe, found that fiber plays a significant role in the interplay between gut microbes and the mucus lining of the digestive system.
Fiber promotes the development of healthy mucus thickness and inhibits inflammation. For people who are born without interleukin-10, an IBD-associated cytokine, IBD typically develops in early infancy or childhood.
The present study shows that in mice lacking interleukin-10, fiber deprivation contributes to the deterioration of the colonic mucus lining, leading to lethal colitis. This suggests that fiber-rich diets may be valuable for individuals with IBD.
An estimated 6 million people worldwide have IBD, and the Centers for Disease Control and Prevention (CDC) says that there are about 3 million people in the U.S. Who have it. Industrialized nations have the largest numbers of IBD, and people who immigrate to more industrialized societies and begin incorporating highly processed foods are at risk for it, according to the new study.
A study published last year in Gastroenterology, the official journal of the American Gastroenterological Association, suggested that certain types of dietary fiber can actually make IBD symptoms worse. In that study, researchers found that unfermented dietary β-fructan fibers — which are soluble fibers from fruits and vegetables — caused an inflammatory response in people with IBD whose bodies couldn't break them down.
Some people who develop IBD, particularly children, are prescribed a formula-based, low-fiber diet known as exclusive enteral nutrition (EEN), and there has been success in reducing gut inflammation with this approach.
No fiber hurts good gut bacteriaThe new study used mice who also lacked interleukin-10, and what the researchers discovered was that inflammation was much higher with fiber-free diets. A fiber-free diet was shown to encourage the growth of mucin-degrading bacteria, which consume the mucus layer in the digestive system, reducing the barrier that the mucus provides for the lining of the gut. The mice who ate a high fiber diet had significantly less inflammation.
However, when researchers fed mice the EEN diet formula, some of them had less inflammation than those with a fiber-free diet.
What researchers deduced was that those mice had higher amounts of a fatty acid called isobutyrate, which is produced through fermentation in the gut by "good" bacteria.
Dr. Rudolph Bedford, MD, board certified gastroenterologist at Providence Saint John's Health Center in Santa Monica, CA, who was not involved in the study, told Medical News Today that lower-fiber diets for people with IBD have not been studied enough for medical professionals to have a blanket approach to them.
"Dietary recommendations for IBD patients have been highly variable, largely due to the dearth of research data available to guide clinical practice," Dr. Bedford said.
Why IBD patients may be told to limit fiber"Nonetheless, IBD patients are often instructed to limit their consumption of fiber or residue during an active flare in order to help minimize gastrointestinal distress, particularly when intestinal strictures are suspected," he said.
Melanie Murphy Richter, a registered dietitian nutritionist and the director of communications for the nutrition company Prolon, who was not involved in the study, told MNT that while less fiber can be advisable during the worst periods of IBD, the long-term effects of a diet high in fiber are important to keep in mind.
"A low-fiber diet may be recommended for people with IBD during acute (active) flare-ups when the inflammation in their gut intensifies. Fiber can be hard to break down, and can therefore exacerbate existing irritation in the gut or gut lining which can contribute to certain symptoms like diarrhea, stomach pain, rectal bleeding, bloating, or even fever. During flare-ups, it's best to avoid anything that may add to the existing inflammation in the gut."— Melanie Murphy Richter
"That said, high fiber diets have shown promising results in the management (and even reversal) of IBD in patients over the long run. This means that when patients are not experiencing acute symptoms or flare-ups, high fiber foods are encouraged to help diversify the composition of the gut which can positively benefit a person's gut pH, its permeability, and its ability to produce short-chain fatty acids," Richter said.
Richter said that healthy gut bacteria play a significant role in our immune systems as well as our digestive systems.
"Certain beneficial bacteria in our gut help to strengthen the integrity of our intestinal barrier. This gut lining is what helps to keep pathogenic (harmful) substances out of our gut," Richter said.
"When the junctures of our gut lining become weak due to the presence of inflammation or other harmful bacteria that can degrade the lining, this leads to intestinal permeability otherwise known as 'leaky gut.' Leaky gut, which is often present in IBD and IBS patients, can either be the root cause of inflammation or a symptom of other gut imbalances," she explained.
Richter added that gut health also can be closely tied to mental health.
"Certain gut bacteria help to produce neurotransmitters like serotonin and dopamine, which are needed for proper brain function, circadian sleep patterns, and the reduction of anxiety and depression," Richter said. "Without these good bacteria, the signaling between the gut and the brain is negatively impacted, which can lead to mental and emotional disorders."
Dr. Bedford said that a lack of diversity in the gut lining can make immune systems much weaker.
"Your gut is more vulnerable to diseases when it's in dysbiosis," Dr. Bedford said. "Changes to your gut microbiome may occur because the different organisms in your gut are not at the right levels. When the gut microbiome loses its diversity of bacteria, it can increase your risk of getting a chronic disease.
Richter said that alcohol, processed foods, candy, sodas, and products with high-fructose corn syrup can cause gut inflammation and dysbiosis and make any IBD symptoms far worse.
She suggested eating fermented foods with probiotics and no added sugars, as well as healthy forms of types of fiber in fruits and vegetables to continue feeding healthy gut bacteria.
Probiotic foods for gut health
"Probiotic-rich foods like kimchi and yogurt contain living bacteria from strains like Lactobacillus and Bifidobacterium, which are highly beneficial for overall gut health. By consuming fermented foods, you are also consuming these living bacteria which can then innoculate in our gut and help to diversify our microbiome and help to alleviate certain symptoms related to IBS and IBD such abdominal pain, bloating, or constipation."— Melanie Murphy Richter
"It's one thing to consume the actual living bacteria. It's another thing to feed them the right types of food (fiber) to keep them alive. You can take all the probiotic supplements and eat fermented foods, but the diet and lifestyle you adopt affect whether or not they stick around," Richter added.
What Millennials Need To Know About Colon Cancer: Q&A With Dr. Jon LaPook
Colon cancer rates continue to rise in younger age groups, prompting questions about signs to look for and how to reduce risk.
A report from the American Cancer Society in 2023 shows colorectal cancer increasingly being seen in younger individuals, and cases are being detected at more advanced stages, when it's more difficult to treat. The study found 60% of new cases in 2019 were advanced-stage disease.
"Shockingly, 1 in 5 people who will be diagnosed presently are younger than 55 years of age, which is quite young for colorectal cancer," says American Cancer Society CEO Dr. Karen Knudsen. The study showed the increase in ages ranging from 20 to 49, which includes the millennial generation.
Overall, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, according to the American Cancer Society. The organization anticipates 106,590 new cases of colon cancer in 2024.
There are several ways to screen for early signs of the potentially deadly disease. Researchers are also working on a blood test intended to detect colorectal cancer, which performed well in a clinical study published earlier this month, correctly detecting the cancer in 83% of people.
"The gold standard for colon cancer screening is colonoscopy because it can detect colon cancer in its earliest, most treatable stages and it can find and remove precancerous polyps before they have a chance to turn into cancer," said CBS News chief medical correspondent Dr. Jon LaPook. But he notes the potential of having a blood test option is attractive because "it's relatively easy to do and there's no 'ick factor' that can keep people from doing home stool testing."
We spoke with LaPook, who is also a gastroenterologist at NYU Langone Health, to get answers to some common colon cancer-related questions.
Q: What's driving the rise in cases?
LaPook: "We don't really know. There are a lot of suspects, but the actual villain isn't clear. Is it the fact that we are more obese? Because obesity is a risk factor. More sedentary? Something in the environment? Something we're eating or drinking? Or fascinating to me is the microbiome, the trillions of bacteria, thousands of species, in our colon. Our microbiome is changing and that may be contributing to the increase."
Q: Are there steps people can take to reduce their risk?
LaPook: "You can get screened. That is why they have dropped the age that you first get screened, if you're at average risk, from 50 down to 45."
If you're at increased risk, which includes having a family history or inflammatory bowel disease, talk to your doctor about being screened earlier.
LaPook also says to be aware of the Centers for Disease Control and Prevention's list of risk factors, which includes:
For more about when to consider screening, check CBS News' guide to preventative health screenings for each decade, from your 20s to your 60s.
Q: What are the red flags that someone should get an exam?
LaPook: "If you are younger than the recommended age for a screening, look out for symptoms including:
"If you're told of a low iron and there's no obvious explanation, then that's something that your health care provider should help evaluate. And you know, one of the things you can do is do a test to see if you have invisible blood in the stool."
That means if you have low iron levels levels, don't just assume it's just from menstruating, and "if you have rectal bleeding, don't just write it off to hemorrhoids," he adds.
Q: Colonoscopies can be daunting. What words of encouragement do you have for readers who are hesitant or nervous to get this screening?
LaPook: "Whether you have symptoms or not, it can be intimidating to do a colonoscopy and just the thought of an instrument going into your colon can be daunting, but the hardest part is truly the prep, and even that can be made tolerable. ... The risks are extremely low here, and this is an extraordinarily effective procedure that has already very significantly decreased the risk of colon cancer over the last five decades and could save your life."
If people are still uncomfortable with that screening option, there are also at-home tests available.
Q: Any other takeaways?
LaPook: "The main thing is to just be aware of symptoms and understand that this is a no-embarrassment zone. It's very hard for people to talk about rectal bleeding and anything to do with their stool, but we have to use our words. ... It's very important to have a relationship with a health care provider where you can be absolutely honest ... And you tell that person everything that's on your mind, including if you have what could be construed as embarrassing symptoms."
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MoreSara MoniuszkoColon Cancer Is Killing Young People More Than Ever: What To Know About The First Signs Of The Disease
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.
Colorectal cancer is the third leading cause of cancer deaths amongst men and women. (Photo via Getty Images)
Colon cancer is gaining traction online, as recent research from the American Cancer Society shows it's killing more younger people than ever. As more Canadians ask questions surrounding symptoms and first signs of colon cancer, and seek information on screening and testing, it's important to stay informed. Knowing whether colon cancer is treatable and understanding its causes, especially in women, can help you in your health journey. Here's what you need to know.
A cancer statistics report released in January indicated colorectal cancer is the first leading cause of cancer death amongst men younger than age 50. It's also the second deadliest cancer for women in the same age group, behind breast cancer.
That's compared to the late-1990s, where colorectal cancer was the fourth-leading cause of cancer deaths among both men and women under 50.
"The continuous sharp increase in colorectal cancer in younger Americans is alarming," American Cancer Society senior vice president of surveillance and health equity science Dr. Ahmedin Jemal said in a statement. Between both sexes, colorectal cancer ranks third amongst overall cancer deaths.
The report also estimated in 2024, the United States will see more than 152,000 new cases of colorectal cancer amongst men and women. Out of all cases for the year, there could also be more than 53,000 deaths. For the first time ever, more than two million new overall cancer cases are projected for 2024.
In Canada, it was estimated in 2023 that 24,100 Canadians will be diagnosed with colorectal cancer, and 9,300 Canadians will die from it — representing 11 per cent of all cancer deaths in 2023.
But what exactly is colorectal (colon) cancer, and how can you reduce risks? Here's what you need to know.
What is colorectal cancer?Colorectal cancer is a disease that affects your large intestine (colon) or your rectum (the end of the colon).
Colon and rectal cancers are grouped together as colorectal cancer because the two organs are made of the same tissues without a distinct border between them.
When cells in the colon or rectum no longer grow or behave normally, the changes may lead to non-cancerous tumours, precancerous conditions (i.E. Adenomas) or colorectal cancer.
Colorectal cancer can affect anyone at any age. "Black Panther" actor Chadwick Boseman died from the disease at age 43 and Raven-Symoné's younger brother, Blaize Pearman, at age 31. However, 93 per cent of cases in Canada occur in adults aged 50 and over.
Like the United States, colorectal cancer is also the third most common cancer in Canada, according to federal cancer statistics. Roughly one in 14 men will be diagnosed with colorectal cancer in their lifetimes, alongside one in every 18 women.
"Black Panther" actor Chadwick Boseman died of colon cancer at age 43 in 2020. (Photo via Getty Images)
What are the first signs and symptoms of colon cancer?Colorectal cancer may not present any significant signs or symptoms in its early stages, making it all the more important to stay up-to-date on your colon health and get screened regularly. If caught in its early stages, colorectal cancer is 90 per cent curable.
According to the American Cancer Society, a polyp can take as long as 10 to 15 years to develop into cancer. Therefore, symptoms often only start appearing once a tumour grows and affects the surrounding organs and tissues. The early signs of colorectal cancer are often similar to other health conditions, including anemia and irritable bowel syndrome.
Dr. Monika Krzyzanowska, a medical oncologist at the Princess Margaret Cancer Centre, told Yahoo Canada in a previous interview that one of the early signs of the disease is a change in bowel habits."[People] may not be going as often [to the bathroom] as they usually do," she told Yahoo Canada. "The calibre of your stool may change. For example, it can become thinner or more narrow."
Krzyzanowska noted that abdominal pain, bleeding and unexplained weight loss are causes for concern, alongside iron-deficiency anemia. "One of the things people may not know [to pay attention to] is iron-deficiency anemia," she added. "They may be feeling tired, go see their family doctor and are found to be anemic. This can sometimes be an initial presentation of colon cancer."
Constipation, diarrhea, and abdominal pain may be signs of colon cancer (Photo via Getty).
Symptoms of colorectal cancer in women are the same as in men, and may include:
Diarrhea
Constipation
Narrow stool (compared to average)
Blood in the stool
Unexplained weight loss
Anemia
Abdominal cramps and pain
Nausea and vomiting
Pain or discomfort in the rectum
Bleeding from the rectum
Krzyzanowska said the urgent symptoms you should never ignore are "any sort of severe abdominal pain or abdominal pain associated with nausea, vomiting and an inability to pass stool," as they could be symptoms of a bowel obstruction.
Who is at risk for colon cancer?Colorectal cancer can affect anyone, but people living with inflammatory bowel disease (Crohn's disease and ulcerative colitis) are at an increased risk compared to the general population.
The average age of a colorectal cancer diagnosis is in people aged 50 and over, where the risk increases with age.
Risk factors include a family history of polyps and colon cancer, obesity, smoking, alcohol, sedentary behaviour and a diet high in processed and red meat.
"Ironically, a lot of the lifestyle factors [that are good for colon health] are good for other things as well," said Krzyzanowska, who added "having a healthy diet, not smoking and having a good weight" can decrease your risk of the disease.
Why are colorectal cancer rates rising among young people?No one can say for certain why colorectal cancer numbers are rising in young people. However, some experts theorize increased incidence rates could be linked to dietary or lifestyle factors.
A sedentary lifestyle, obesity, smoking, heavy alcohol use, low-fiber, high-fat diets, diets high in processed meats and other environmental factors have all been linked to colorectal cancer. But more research must be done to explain why people under 50 are now at an increased risk of developing the disease.
Colorectal cancer cases are rising amongst younger people, but experts aren't sure why. (Photo via Getty Images)
Should younger people get screened for colon cancer?Despite increased colorectal cancer rates among young people, Canada's screening policies still recommend waiting until age 50 for average-risk adults.
But some studies note lowering the screening age "may be justified."
At present, an average-risk adult is someone between ages 50 and 74 with no first-degree relative — such as a parent, sibling or child — who has been diagnosed with colorectal cancer. If you have a personal history of colon cancer, ulcerative colitis, Crohn's disease or other higher-risk factors, your doctor may suggest you begin screening early.
While a stool test is no one's idea of a good time, it saves thousands of lives every year.
"Colon cancer is one of the few cancers that we do have an effective screening test," said Krzyzanowska. "The evidence is quite strong that screening for colon cancer can decrease the incident [rate] and increases survival, so if you're in the right age group, go ahead and get screened."
A standard abdominal ultrasound won't show a tumor in your colon or rectum, but it can show whether the cancer has spread to other organs in your abdomen (for example, liver or pancreas).
Similar to cervical cancer screening, screening for colorectal cancer looks to find and identify polyps before they ever become cancerous. "If you're picking up a polyp and you can remove it, then you're moving the diagnosis a lot earlier in the disease course," Krzyzanowska said.
"I know it's scary to think you might have cancer, but it's better to be picked up early or at the pre-cancerous stage."
Colorectal cancer is "treatable, but you need to be availing yourself to the screening tests that are available," she said. "If you're having any kind of symptoms, seeking medical attention early" can save your life.
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