6 Steps to Gut Health and Colon Cancer Prevention

 

Poop is yuck. Colonoscopies- who would want one? “Colon Blow” skit on Saturday Night Live– hilarious! But all poop jokes aside, we need to spend more time thinking about poop so we can conquer one of the fiercest enemies of our healthy, long lives- colorectal cancer. With over half of Americans complaining of gut symptoms,^1,2  it is no surprise that cancer can take root in the GI tract. Indeed, in 2020, a global phenomenon emerged of younger people getting colorectal cancer twice as much as they did forty years ago!

The good news? Up to 70% of colon cancer cases could be prevented with diet and lifestyle changes. We will look at gut health as a path to prevent colorectal cancer (also known as colon cancer) using an integrative and functional medicine lens. In addition to the usual recommendations, such as screening tests, exercise, keeping a healthy body weight, and quitting smoking and alcohol, clinicians and consumers will get more tools to set up for optimum gut health, which can ward off cancer when it tries to take hold. We will go over six key steps to colon cancer prevention, including the gut microbiome, inflammation, the anti-cancer superstar butyrate, and the tests that help you know your status for certain, as well as one very surprising player in colon cancer. Scroll to the end of this article for a list of takeaway action items.

 

We are grateful to our sponsor, Diagnostic Solutions Laboratory, for making this blog possible.

 

Cancer (of all types) is the number two killer in the United States, says the Centers for Disease Control and Prevention. We spoke about heart disease last month- it is Numero Uno Bad Guy. Colorectal cancer, which is cancer of the colon or rectum, is the second most common cause of cancer death (for men and women combined) in the United States, according to the American Cancer Society. They predict about 158,000 new colon cancer cases will be discovered in 2026, and it will probably lead to about 55,230 deaths in the same year. However, as many as 70 percent of colon cancer cases are believed to be preventable through moderate diet and lifestyle modifications.³ Wow!

 

What is colon cancer?

Cancer cells come from our cells, but they have mutated DNA and they don’t act like healthy cells. They don’t have normal switches for turning themselves off, so they can grow and grow until they damage and take over other tissues in the body. Colorectal cancer starts in the lining of the colon or rectum, usually developing slowly over time from small growths called polyps. These polyps can be harmless at first, but under the right conditions—like chronic inflammation, poor gut health, or genetic susceptibility—polyps can transform into colon cancer.

 

Colon Cancer Rates Now Higher in Younger People

Colon cancer is affecting younger people now.⁴ Across the globe, rates of colon cancer have doubled in people under 50 years old as compared to the 1980s.⁵ Colon cancer is the leading cause of cancer death in men under 50 years old, according to studies from the last two years. Punctuating this grim reality, two famous American actors have died of colorectal cancer in recent years: James Van Der Beek at 47 years old (of Dawson’s Creek) and Chadwick Boseman at 43 years old (of Black Panther). All of this is happening alongside diminishing numbers of colon cancer diagnoses in adults older than 50 years old.

 

Why is colon cancer affecting younger people now?

There are no good answers yet, but some of the most likely causes are the Western lifestyle (obesity, lack of exercise, alcohol) and its harmful effects on metabolism,⁶ a diet high in ultra-processed foods including processed meat,⁷ chronic gut inflammation, and environmental toxins. What’s new about these factors? Nothing, but it’s possible that harmful factors are accumulating across generations, with greater impacts on younger generations.⁶ I look forward to hearing more from naturopathic physicians and experts in the integrative and functional medicine field as to what may be the cause of this change.

Colon Cancer Symptoms to Look Out For

• Persistent change in bowel habits (diarrhea, constipation, or stool consistency changes)
• Rectal bleeding or blood in the stool
• Abdominal discomfort (cramps, gas, pain, bloating)
• Feeling that the bowel doesn’t empty completely
• Weakness or fatigue
• Unexplained weight loss

The problem with this list of colon cancer symptoms is that many of them aren’t that unique. On average, more than one in two people in the United States already have gut symptoms like diarrhea, constipation, stool consistency changes, gas, bloating, or abdominal pain. So how can you tell when you may have a serious problem, like early colon cancer?

 

Conventional Treatment for Colorectal Cancer

Once you have a diagnosis of colon cancer, it is ideal to build a team of conventional medical oncologists and adjunctive cancer care providers. Colon cancer treatment is highly personalized, but surgery is still the main option for a cure. It offers strong survival odds when the disease is caught at earlier stages (stage I–III). As the disease progresses, chemotherapy, radiation, and newer targeted or immune-based therapies come into play— it is less about cure in advanced stages and more about slowing progression and improving quality of life. There’s also a growing role for precision medicine, where treatments are matched to the tumor’s biology, along with supportive strategies like nutrition to help the body handle therapy. Even tools like radiofrequency ablation or anti-angiogenic drugs are used to control disease when surgery isn’t an option.^8,9

Cancer isn’t something any of us want to experience, but many of us will. This is why doing all that we can to prevent colon cancer in the first place is so important. We will talk about the challenges with disease prevention more later.

 

Colon Cancer Testing Options

Early colon cancer may be silent, meaning it doesn’t show any symptoms. That’s why screening to catch problems early is so important. Only 45% of adults ages 50-54 get colon cancer screening, so there are multiple options to hopefully increase the adoption of colon cancer screening.¹⁰ The main screening options broadly fall into two categories: stool-based tests and visual (structural) exams that actually look inside the colon. These can detect early warning signs or directly find and remove precancerous changes, giving you multiple paths to stay ahead of disease.³ Recommendations used to be to screen adults aged 50-75 years for colon cancer, but to account for more cases of colon cancer in younger people, it has been lowered to screen adults aged 45-75 years.

Visual/structural exams

• The American College of Gastroenterology recommends colonoscopy every 10 years, beginning at age 50 years, as the preferred screening strategy.⁹ Colonoscopy is the most comprehensive test, using a camera to directly view the colon and remove polyps before they turn into cancer.
• Flexible sigmoidoscopy is similar but only looks at the lower portion of the colon. Screen once every 10 years with annual fecal occult blood test.
• CT colonography, often called a virtual colonoscopy, uses imaging to create a picture of the colon and identify larger growths. Screen once every 5 years.

Stool tests

• Fecal immunochemical test (FIT) and guaiac-based fecal occult blood test (gFOBT) check for hidden blood in the stool (fecal occult blod), which can be an early signal that something isn’t right. Blood in the stool (which is often invisible to the human eye) can be a sign of pre-cancerous polyps and can tell if you have colon cancer risk. Screen once every year.
• Multitarget stool DNA test looks for genetic changes and abnormal cells that may point toward cancer or precancer.

The Cologuard at-home stool test combines both fecal occult blood (FIT) and multi-target stool DNA. Known as the DNA-FIT test, it is recommended for adults 45 years old and older who have an average risk of colon cancer. Screen once every 1-3 years.

What are the risks of colonoscopies when screening for colon cancer?

Risks of colonoscopies are believed to be quite low. The risks are bleeding, especially if a polyp is removed, or (very rarely) perforation of the colon wall. Some people may react to sedation or have gut symptoms after the procedure. The preparation for the procedure can impact the gut ecosystem. In a group of 80,118 colonoscopies, the risk of perforation of the gut wall was only ~0.06%.¹¹ In people with risk factors like Crohn’s disease, patients who are getting a colonoscopy in the ICU,¹¹ or in patients older than 80 years old,¹² the risks can increase, but are still low. Check with your integrative and functional medicine doctor about your unique clinical history when getting a colonoscopy for colon cancer screening.

 

Integrative and Functional Medicine Recommendations to Promote Colon Health and Stave Off Colon Cancer

In integrative and functional medicine, we live and breathe by this proverb: “An ounce of prevention is worth a pound of cure.” However, early in my career, I learned that nobody cares much about prevention. That isn’t to say we want to be sick. But it means that human beings are hard-wired for emergencies. It’s easy to see an immediate threat and jump to action. When all is well, it’s hard for us to put energy or investment into a potential risk  coming in the future. In my days doing medicinal plant drug discovery, there were serious hurdles in getting funding for our research. At the end of the day, we were trying to prevent disease. Consumers, entrepreneurs, and researchers are much more interested in funding research that treats disease, not research that helps prevent it from ever happening. Prevention doesn’t come naturally to most of us. Now that you know that prevention is something we have to willingly work on, you have the upper hand to make it work to your benefit.

 

Step 1. Eat More Fiber and Vegetables for a Cancer-free Colon

As always, a diet rich in antioxidant plant compounds and fiber is a golden ticket toward good health.¹³ The gastrointestinal tract does well on this type of diet. The microbiome does well in this type of diet. And people have longer lives on this type of diet. On the contrary, a diet high in meat and low in fiber is pretty well established to be a major problem and risk factor for colon cancer. Conventional diet recommendations are to completely avoid processed meat (like sausage, sandwich meat, or bacon) and restrict red meat in the diet to fewer than three times a week. When shopping for meat, select free-range, pasture-raised, and/or organically raised animals. While there is no perfect diet for everybody, pay close attention to what you’re eating. The standard American diet is high in meat, fat, dairy, ultra-processed meat and carbohydrates; it’s low in fiber and in vegetables; and it is associated with chronic illness. If you need some practical ideas, check out my article, “10 Tips for Eating Healthier Every Day.”

 

Step 2. Mind Your Gut Symptoms!

What is normal versus abnormal when it comes to gut health? Most people have no idea. And many of us avoid discussing TMI (too much information) whatsoever due to embarrassment. How many doctors are asking about your stool habits?

You should be pooping at least once a day and preferably three times a day. So many people are walking around, getting by day to day, with bothersome and sometimes debilitating gut problems. They may have never had healthy bowel function their whole lives. I was one of those people. I was constipated until I was 27 years old and I didn’t even know I had a serious problem!

If you have gas, bloating, diarrhea, constipation, abdominal pain, irritable bowel syndrome, inflammatory bowel disease, then you need to double down all of your efforts on improving your gut health.  Make sure you find an integrative and functional medicine doctor for any problems with gastrointestinal function and stay the course until you are pooping 1-3 times a day without other bothersome GI symptoms.

 

Step 3. Test for Gut Inflammation

Inflammation is often part of the picture in colon cancer. When there is a lot of inflammation in the gut, it is a perfect environment for cancer to set up shop. In fact, inflammation in the gut may be a root cause of colon cancer. People who have inflammatory bowel disease, like Crohn’s or ulcerative colitis have a much higher risk of developing colon cancer. Why? Because of runaway gut inflammation. Check out my other articles on how to cure gut inflammation by addressing the root causes with an integrative and functional medicine approach.

Calprotectin (fecal) is a gold standard test of inflammation in the gut. Calprotectin can be measured in stool regularly to make sure that the immune system is cool and calm and collected, and everything is functioning normally in the gut. No blood draw or doctor visit required. Just you, pooping in a collection box, in the privacy of your own home. Lovely, right?

This test can be done every year or even more frequently to check for gut inflammation and colon cancer risk. Most doctors are not recommending that you get a stool calprotectin test unless you already have a reason to check, such as Crohn’s disease or ulcerative colitis. However, it is a great test to run and gives information about the health of the gut, whether your doctor recommends it or not.

 

4. Balance the Gut Microbiome as a Colon Cancer Strategy

When it comes to getting the best gut health possible, one that protects from cancer, then you need to measure and balance the gut microbiome. Hundreds of trillions of bacteria in the gut make up the gut microbiome. They are responsible for a strong immune system; they defend us from infections; they make byproducts that protect us from cancer; they promote a healthy metabolism and body weight. When you don’t have enough of these friendly bacteria, or if you have too many bad ones, you are more at risk for abnormal cancer cells.

When it comes to colorectal cancer, it makes sense to test for pathogenic bacteria in the gut. Any microbes that can be harmful to the GI tract or create toxins are undesirable. Approximately 16% of cancers have been traced back to microbial origins, ¹⁴ therefore we want to make sure that the microbial communities in the gut are beneficial and not potentially harmful. Gut dysbiosis, or an imbalance of bacteria, has been implicated in colon cancer, especially E. coli, Fusobacterium nucleatum, and enterotoxigenic Bacteroides fragilis.14

The GI-MAP with StoolOMX from Diagnostic Solutions Laboratory measures pathogens, commensal bacteria, inflammation, fecal occult blood, butyrate, and other markers of digestion and immune function.

 

Step 5. Boost Butyrate and Stamp Out Colon Cancer

Butyrate is a colon health superstar made by friendly gut bacteria. You may have heard of butyrate supplements, which are very popular these days for gut health. When good bacteria ferment fiber (their fuel), they make beneficial byproducts that support immunity, weight management, blood sugar, liver, cardiovascular, neurological, and colon health.^15-18 They can ward off colon cancer.¹⁹ These healthy chemicals are known as short chain fatty acids and butyrate is the most famous one.

Cells of the colon love to consume butyrate for energy. Butyrate supports digestion and immunity in the gut, calms inflammation in the intestines, and keeps the gut lining strong.^13,20-23 As if that wasn’t enough, butyrate is your ally in the fight against colon cancer. It can “transform” cancer cells or even kill them by triggering them to commit suicide (known as apoptosis).¹³ When people don’t have enough butyrate, they have a higher risk for colon cancer.¹⁹

A healthy and robust gut microbiome should have plentiful butyrate. When you eat prebiotic fiber, your microbiome grows and it produces more butyrate, which is a win-win. 

 

Step 6. Fortify the Oral-Gut Axis and Ward Off Colon Cancer

Evidence is mounting that the mouth has a critical role to play in colon cancer, too, believe it or not. People with gum disease have a higher risk of colon cancer. Oral bacteria are quite different in people with colon cancer and mouth bacteria can help distinguish people with colon cancer versus those with health.²⁴ Further, certain bacteria from the mouth can cause trouble in the gut and they may even set the stage for colon cancer, such as Fusobacterium nucleatum and Klebsiella pneumoniae.¹⁴

It may seem shocking that mouth bacteria could tell so much about colon health, but it actually makes sense. Scientists call this the oral-gut axis, or the oral-gut connection. The mouth and colon hold the two most biodiverse microbial communities in the body and they are both integral parts of the human digestive tract. The mouth is part of the gut, as I often like to point out to gut health experts who overlook it. They can share their microbes, especially when the conditions are right. In my book, Heal Your Oral Microbiome, I call the mouth and the gut, “two stops on the same bus line” and “kissing cousins.”

Are oral bacteria causing colon cancer? We still don’t know for sure. Bad mouth bacteria and inflammatory chemicals seem to skyrocket the risk for a variety of gastrointestinal cancers.²⁵ Further, something like 16% of cancers are believed to be caused by microbial infections,¹⁴ so it pays to build up the good bacteria in your microbiome to have an ironclad defense against the bad ones. Scientists are suggesting the same thing: treat the microbiomes in both the mouth and the colon as an advanced way to address colon cancer.¹⁴

 

Defend Yourself from Colon Cancer with Diet, Lifestyle, and a Strong Microbiome

When it comes to colon health, there are countless good poop jokes to make, but it’s also serious business. We don’t want colon cancer to have the last laugh. Aside from the well-known risk factors for colon cancer like smoking, alcohol, obesity, inflammation, and a low-fiber, high-fat diet, clinicians and consumers can do so much more to discourage cancer cells.

First and foremost, don’t ignore gut symptoms. Constipation, diarrhea, irritable bowel, gut inflammation- these are all signs of problems in the GI tract. Colon cancer screening has low risks and since colon cancer rates in younger people was discovered to have doubled around 2022 (all around the world), recommendations are to start screening as early as 45 years old. Clinicians, use a comprehensive stool test to evaluate patients, such as the GI-MAP. Consumers, ask your doctor to run regular stool tests to check for optimum gut health. You will want to check levels of inflammation and bad bacteria. Measure good bacteria using a qPCR stool test and see if you have enough of the cancer-fighting superstar butyrate. Test for blood in the stool regularly to make sure bleeding polyps or tumors are not at play in the colon. Remember that the oral microbiome helps keep your colon healthy, too. Though it doesn’t come easily to us, we all know intuitively that an ounce of prevention is worth a pound of cure. We have to work at preventing colon cancer, but gut health is a worthy goal and can help ensure a well-functioning and cancer-free GI tract for many years to come. And that’s something we can laugh about!

 

Optimize Gut Health and Prevent Colon Cancer with an Integrative and Functional Medicine Approach

• Follow the usual colon cancer recommendations, such as avoid smoking and alcohol, stay active, and keep a healthy body weight
• Eat a whole-foods diet, rich in plant foods, colorful polyphenols, and prebiotic fiber
• Take probiotics (both oral probiotics for gut health and dental probiotics for oral health)
• Take supplemental prebiotics like SunFiber or inulin
• Regular colon cancer screening tests
  • Start at age 45 if you have average risk (due to rising rates of colon cancer in young people)
  • Start earlier if you have family history, IBD, or genetic risk.
• Ask your doctor for a GI-MAP stool test every year, to assess the microbiome, bad bacteria, occult blood (FIT), calprotectin, and butyrate
• If you have daily gut symptoms, find an integrative and functional medicine doctor to help you resolve them
• Keep up with regular dental hygiene and cleanings
• Address gum disease with a holistic or biological dentist
• Test the oral microbiome and address problem microbes
• Optimize blood sugar with diet and lifestyle changes
• Avoid toxins, including charred foods
• Promote liver detoxification

Diagnostic Solutions Laboratory bridges the gap between healthcare providers and the clinical laboratory by offering cutting-edge laboratory tests such as GI-MAP, OMX (Organic Metabolomics), IgG Food Explorer, IgE Allergy Explorer, CytoDX, and GenomicInsight. Designed to identify underlying root causes of symptoms and disease, our test results give practitioners the tools needed to formulate personalized treatment protocols for optimized patient outcomes. Our commitment to education and service ensures both practitioners and their patients will benefit from the latest research.

 

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