Nutrition Essentials | Red Meat and Colon Cancer Risk with Christine Lee, MD

Podcast Transcript

John Horton:

Hello, and welcome to another episode of Nutrition Essentials, a spinoff of our Popular Health Essentials podcast. I'm John Horton, your host. When it comes to the American diet, beef is big. The average person in the US eats more than 82 pounds of beef per year. A flame-grilled total that is four times higher than the global average. Not coincidentally, the US also ranks near the top of the world when it comes to colon cancer cases. Research shows that eating large quantities of red meat can increase colorectal cancer risk by about 30%. The risk is even higher, 40%, for those who frequently chow down on processed meats such as hot dogs, sausages, and deli meats. So today we're going to take a closer look at what a meat-centric diet does to your gut and why you might want to think twice before always ordering a double-stacked burger or a dinosaur-sized T-bone steak. As always, we have registered dietitian, Julia Zumpano with us to talk about the nutrition side of things. Our guide through the twisty turns of the digestive system is a regular guest on the podcast. Julia, who's with us today?

Julia Zumpano:

Sure thing, John. We're joined by Dr. Christine Lee, who's making her fifth appearance on the show. She's one of our favorite guests given how well she explains the bodily processes that isn't always easy to talk about. Now with the recent increases we've seen in colon cancer among some groups, today's topic deserves attention. The choices we make can make a difference when it comes to this type of cancer. What we hear from Dr. Lee should really drive home that point.

John Horton:

Without a doubt, Julia. So let's get this conversation started. Welcome back to the podcast, Dr. Lee. We always appreciate you making some time in your day for a little gastrointestinal talk.

Dr. Christine Lee:

Thanks, John. I'm happy to be here.

John Horton:

So we brought you in here today to talk about ways to reduce colon cancer risk, particularly through diet. And it seems like we have some lifesaving opportunities there, given that the US sees about 150,000 colon cancer diagnoses a year, and even more startling, more than 50,000 deaths a year from the disease.

Dr. Christine Lee:

Yeah, so that's quite alarming. Colon cancer is the third most common cancer in this country. Second cancer causing death in the United States. So there's a lot of room for education, get the information out. So early prevention saves lives. So it's important that we get the word out so that we can protect our loved ones.

John Horton:

And I know one of the more surprising trends, which we were talking about earlier, is the recent increase in colon cancer among younger people, and that's a group that traditionally has been lower risk. I know the studies I've read all seem to point toward diet and lifestyle factors as the main causes for this.

Dr. Christine Lee:

Yes, it's quite tragic. We started noticing an uptick on early cancer diagnosis in the younger population, but what's even more tragic is that it's at advanced stages. So the strong speculation at this point is that it's pointing to lifestyle habits, lack of sleep, poor nutrition, lack of exercise, increased stress, a large gamut of variety of factors that may play a role in this tragic uptick.

John Horton:

Well, we're going to dive into the diet part of what you were just talking about today, and I know when we start looking at diet factors that contribute to colon cancer, the spotlight often seems to shine on red meat. So Julia and Dr. Lee, what is it about eating too many burgers and brisket and ribs and steaks that just doesn't sit well with our gut?

Julia Zumpano:

First of all, I want to clarify red meat. So I think most of us consider red meat being beef only. Red meat includes beef, pork, veal, and lamb. So all of that is considered red meat. So we want to just be cautious of the volume of red meat and the frequency of red meat. We're not trying to demonize one specific category of food. All foods can fit. There's a lot of nutrients that red meat can offer, but we know that certain types of red meat are worse than others, such as processed meats. The way you cook the meat can create more carcinogenic compounds. So charring or grilling or smoking the meat can worsen it. So it's really how the meat is prepared, how much you're eating and how frequently.

Dr. Christine Lee:

Very well said. I think obviously in the last two decades we've noticed a lot more food that are pre-made or made for us or under the realm of fast food. They're just convenient, readily available, and people are wolfing these down in their busy lifestyle for going from point A to point B. And because they're readily available, I think the consumption obviously have gone up and it's really the quantity as well as all the other life influences, lack of sleep, the increased stress, lack of variety of nutrition, meaning the colors of the rainbow. It's important to make sure you get your vegetables in. And with all of that put together is a setup for... Or that's the concern for the uptick or increased rise in colon cancer.

John Horton:

So Julia, when we start looking at red meat, what is it that it does within our bodies that kind of contributes to some of these issues?

Julia Zumpano:

Sure. So first of all, there could be harmful chemicals that are produced during the cooking and processing of red meat that have been linked to DNA damage and cancer development. Inflammation in the colon can also increase cancer cell growth, which can be caused by a high meat intake, especially not enough of those colorful foods that Dr. Lee just referenced. And then an altered gut microbiome can also lead to it, which meat can alter the microbes in your gut leading to an imbalance that can favor the growth of cancer causing microbes.

Dr. Christine Lee:

Additionally, red meat is a little bit more difficult to digest, so they stay in your system a lot longer. So not only does it stay in your stomach a lot longer to digest, but once it passes through the stomach, small bowel and in the colon, it stays in the colon a little bit longer. So it's important that you marry that with high fiber diet, exercise, and hydration so that you can get the waste eliminated. The longer it sits in your intestinal tract, higher the risk of it causing stagnation, bacterial overgrowth, not the good type, and possibly the irritation and inflammation of the stomach lining that causes a faster cell turnover causing a setup for not only just constipation, but perhaps irritable bowel diverticular disease and whatnot.

Julia Zumpano:

Dr. Lee, can you break down that faster cell turnover? Can you explain that a little bit more? I think we all can get a little confused by what that is and why that's negative.

Dr. Christine Lee:

Your colon is lined by intestinal cells that line the inside of the colon and they're not meant to live forever. There's always a cell turnover, kind of like the skin on the surface of our skin. They desquamate, we shower, the dead skin slough off and we get new skin that replaces the dead cells. The same process occurs on the inner lining of the colon. And when there is inflammation or stretch or damage or hostile environment, that turnover is forced to turn over much faster. And if your DNA mechanism is set that it's trying to repair faster than it's able to produce, then it's a setup for a DNA damage or a mishap. And if it doesn't get corrected, that's when it continues to perpetuate and you get a setup for an abnormal tissue growth that goes unchecked and it can increase your risk of cancer.

Julia Zumpano:

That's a great way of explaining it. Thank you.

John Horton:

Dr. Lee, you had mentioned too how meat is just... It's difficult to digest, which anybody who's put down a steak probably understands at some point. When that meat is just sitting down there, I mean, is it just kind of rotting away? I mean, what is it doing in our gut?

Dr. Christine Lee:

Well, meat generally have not just the high protein, but it also has high fat and it may also have some preservatives or however it was prepared. And all of those contribute to how long it stays in your stomach and it may even create a gastroparesis situation. So then that's when it feels heavy. It increases the risk of you having gastro reflux disease or even regurgitation. And then you can get small bowel bacteria overgrowth and that's when you feel bloated, feel very uncomfortable.

And then by the time it finally does reach to the colon, it creates the same problem in the colon. Your colon's quite long. And so by the time it travels through your cecum to the ascending, transverse, descending sigmoid and rectum, that movement process can take days in some people, sometimes two to three days, and in some patients three to five days. And during that time, obviously it would cause quite a bit of bacterial overgrowth, methane gas, hydrogen gas, sulfuric gas, they can all accumulate causing a lot of abdominal bloating, discomfort, stretch, and it can cause diverticular disease and all sorts of problems. So it's important. If you do consume, moderation portion control is key. And also to make sure you marry that with fruits, vegetables, fiber, hydration, exercise, so you can get that movement going.

Julia Zumpano:

Yeah, you really can't downplay the benefits of fiber. I mean, I just really think most Americans are just not consuming nearly enough fiber. It's so essential and important for digestion and just if you are going to eat meat, as Dr. Lee said, really making sure you're upping your fiber intake that day, even a little bit higher than normal, knowing that that meat is a little bit more difficult to digest and can kind of slow that digestive process down.

Dr. Christine Lee:

This is where, Julia, is so important. You know, I myself, when I go grocery shopping and I go down the aisle, it is so confusing because all the labels say high fiber, there's fiber in this, fiber in that. And it's so easy to be misled thinking I eat a high fiber diet because everything I grab has fiber in it. But those labels are misleading because they're trying to sell you a product. So they may put just a tiny bit of fiber and they're like, this is fiber and they're not lying. There is fiber in there, but it's just not enough. So it's important not just to read the first label, but to flip it and see exactly how much fiber and is it one gram, is it two gram, is it 0.5 gram? It's so important to turn the product over and look at the small nutritional labels. I myself have to take these things out and look, otherwise it's so easy to misunderstand, get misled that you are consuming the right amount of fiber when you're clearly not.

Julia Zumpano:

I couldn't agree more, Dr. Lee. Really reading labels, reading ingredient lists can really help. So when you're looking for a high fiber food, first of all, it's not going to be in the center aisles, so it's not going to be in boxed and packaged foods as much as it is on the outside of the grocery store aisles, more where the fresh fruits and vegetables are, the produce, the legumes, dried goods.

So we want to look for whole foods for our fiber first. There's nothing wrong with shopping the center aisles and choosing some foods in the middle too, but we're going to really maximize fiber from whole foods, fruits and vegetables and grains. Now if you are shopping those center aisles and want to choose a high fiber bread or cereal, what we're aiming for is three grams of fiber or more per serving. So that's what we consider a good source of fiber. A high fiber food is considered five grams of fiber or more. So when you start to read labels, you'll realize, wow, that's hard to get to the three and the five targets are really hard to get to on a single serving food, but when you look at a half a cup of beans, you're easily accomplishing six to seven grams of fiber. So just keep that in mind that whole foods can contain more fiber sometimes than those packaged foods, but it's important to get a variety of sources of fiber. So nuts and seeds have fiber, so maximizing it from all avenues are really key.

Dr. Christine Lee:

Absolutely. And the other thing to keep in mind is that those recommendations are tailored for the ideal person. So we're talking about maybe 60 kilograms, certain height and whatnot, but we all know that we come in all shapes and sizes. So some of us actually need more. And rarely, some of us actually need a little less for the most part, most of us really need more because we're not five foot two and perfect height, perfect weight. Some of us are just taller and just bigger boned. And so just keep in mind, don't fixate on that number. More is also fine if your body needs that and also your diet. If you're predominantly a high protein diet, then you're going to need more fiber. If you're predominantly a vegetarian, then you may be okay with the recommended guidelines. So it's so important to make sure that there's some variations to that fiber gram recommendation per day.

Julia Zumpano:

Sure. I completely agree. The total just general guidelines for fiber range from 25 to 35 grams a day, but certainly some people need more. I need a higher end. I need a little more around 35, 40 to get my system moving. I've always had a slow system, so I really need to be very aware of how much fiber I'm taking in and how much fluid I'm taking in. And even myself, I know the nutrition totals of all foods, but I still track it sometimes. I like to track it and see like, hey, have I not hit my target today? Things are slow moving. So it's important to have that reset to even track it for a day or two, getting your average intake of fiber and seeing where you can sneak in more.

Again, like I said, there's never too much fiber. Your digestive system will tell you if you have too much, but that just means you probably added it too quickly too. So don't allow that to scare you off. So fiber is essential to start slowly and to pair with enough fluid, so your digestive system can get used to that influx of dietary fiber and start to increase it slowly. And most people can handle utmost of 40 to 60 grams of fiber a day.

Dr. Christine Lee:

Wow, you could not have said that any better. You hit it right on. I can't tell you how often I get patients that say, I tried what you recommended and I couldn't tolerate it. So oftentimes I try to explain to the patient, it's almost like exercise. When somebody recommends an exercise, you don't go out and start running a marathon, you have to start where you are at. So that might be start walking one mile a day and then increase that to three miles a day and then work your way up to the ideal recommendations. You can't just go right off the bat. So I couldn't agree with you more. I'm so thankful you mentioned that. The second point is it is very common for women to need more than men just because our bodies have a lot more twists and turns in our colon. And due to our anatomy, it does take a lot more fiber to get the job done. But you have to pace yourself, like exercise, don't go out and start running 22 miles a day. You have to start where you're at and work yourself up. That is so important.

John Horton:

I got to be honest, I'm still a little focused on that burger. So when we're at the next cookout or you're just looking for dinner, is there room for some beef in a healthy diet?

Julia Zumpano:

I would say absolutely. As I mentioned, we're not going to demonize one specific food. Red meat has a lot of nutritional benefits, B vitamins, iron, protein, high quality protein. So I do think it still can fit. Absolutely. Just keep in mind the portions. We want to stick to about the size of the deck of cards, but what I think is a better measure is the palm of your hand.

So everyone's palm is a little different, but it is pretty equivalent to what their needs are. So look at that palm, line the palm around, and then the thickness as well. So you're looking at the thickness of your hand. So that's what we're looking for as an appropriate serving size for you for red meat.

And we want to minimize the frequency. So we don't have a set number. The World Health Organization recommends no more than 500 grams of red meat a week. That's about a pound of red meat a week. That's actually pretty giving. So you can safely have red meat a couple times a week, but again, that may vary by person, what else you're consuming with it and how your body tolerates it, et cetera. But you can still safely have red meat, keep portions down and vary your protein is key. So really offsetting some of that red meat with some oily fatty fish to give you some Omega-3, some meatless meals, like a meatless meal a week to get you some extra legumes, which are beans, which are going to again, boost that fiber.

So you want to provide variety because if you're limiting yourself to red meat, of course you're going to increase your risk, but also you're not maximizing your nutrient intake. So when we vary our nutrition, we're going to gain nutrients from other foods that we otherwise wouldn't have if we don't add that variety. A couple other things to keep in mind is the cuts of red meat. That does make a big difference. So we want to try to avoid very fatty cuts of red meat, so where you see a lot of marbling. You want to stick to leaner cuts of meat like a tenderloin, a sirloin, a flank, a fillet. Those are the leaner cuts. You want to trim off visible fat as much as possible and avoid those processed meats. So those are things like bacon and sausage, pepperoni, salami, hot dogs. So we want to try to avoid or limit those to as little as possible.

Dr. Christine Lee:

I couldn't have said it any better. The using the palm of your hand is just right on just because everybody has different needs. They have different metabolisms, they have different nutritional requirements, and we're all built a little bit different. Some people are bigger and some people are smaller, so using their own hand is a great tool. I always try to make analogies myself when I see patients, when they talk about how big is my colon or what the size of their rectum is. And you use your hand, your rectum mirrors the size of your fist. And likewise, when you're looking for portion control using your palm, the thickness and the size, it would be a great tool and you always have it with you. So you can use that as a measuring stick or a rule of thumb, if you will, as far as the portion control.

John Horton:

Well, I have to say right now I am very happy that I have large hands, so that's definitely going to be a benefit. Moving ahead here. Julia, you had mentioned a few kind of pro-tips to enjoy red meat in a more healthy way. It sounds like going over the cuts again, what are the best cuts people should look for when they're at the grocery store?

Julia Zumpano:

So first of all, you want to look at the meat and make sure there's not a lot of white marbling in the meat. So that's a sure sign that there's a lot more fat. So you want to see more of that red muscle, that red meat without as much of the white marbling. So that's definitely what we want to avoid. If it's just on the outside, we can easily trim that off and that's fine. But we want it to be way more red than white. When you're looking, if you're looking at ground meats, you're looking for 85 to 90% lean, so you want the lowest amount of fat possible. So it can go up to 95% lean, which is phenomenal. So trying to get very lean cuts of ground beef or pork for that matter. And then cuts are things like the round, the tenderloin, the sirloin, flank or fillet. Any of those are great cuts too, because they just tend to be from the leaner part of the animal.

John Horton:

And again, it sounds like portion control is also the main-

Julia Zumpano:

Yeah, and I mentioned the way that you cook it. So you want to use lower heat cooking methods, so things like bake and simmer, stew, broil, or braise. So really low heat cooking methods. You want to avoid very high heat temperatures because some of that high heat can stimulate some of those carcinogenic compounds and create more risk to eating red meat. So things like grilling, high heat, grilling, pan frying, deep-frying, charring, those are the things we want to avoid when it comes to red meat. So really try to choose the oven as often as possible.

John Horton:

Yeah, it sounds like those grill marks are just not exactly the best thing for us once they get inside.

Julia Zumpano:

No, absolutely not. We really want to avoid those high, high heat cooking methods. I mean, on occasion, that's okay. Or if you are using the grill, just try to really turn it down and allow it to cook a little bit longer. So it's the temperature that really stimulates those mechanisms and compounds in the red meat.

John Horton:

Go low and slow. That's the way they always want to do barbecue anyway.

Julia Zumpano:

Absolutely.

John Horton:

So our focus so far has been squarely on red meat, but that's not the only food connected to colon cancer risk. So what are some other menu items that we should be limiting or maybe even avoiding?

Julia Zumpano:

So just like general health, this is the common things that we know that we should be avoiding. So processed foods, ultra-processed foods. So we're thinking, again, those center aisles, that bakery section. So you want to avoid commercial baked goods, even store-bought baked goods. They're containing a lot of extra saturated fat and sugar and preservatives. Snack foods like chips or granola bars or any of those snacky type foods. So we want to avoid, as I mentioned, processed meats or processed foods. So box prepared meals, canned foods, really anything in a box bag or can, where we want to re-evaluate what that food is, check nutrition labels, check ingredients before we choose those foods on a regular basis.

John Horton:

And Dr. Lee, what are those sort of foods, those ultra-processed foods that we were just talking about and fried foods and all that. When those get in our gut, what kind of things are you seeing down there?

Dr. Christine Lee:

With those predominant foods in their diet, we see a lot of patients that develop what we call pseudo gastroparesis, meaning they don't have diabetes, but their stomach looks like they have diabetic gastroparesis. They can kind of develop things like gastric outlet obstruction kind of scenarios, bacterial overgrowth or particularly in the small bowel and a lot of colon disorders like irritable bowel, maybe even microscopic colitis. And then it actually changes the anatomy of the colon. You see more of the dilated, what we call floppy colon or redundant colon diverticular disease, hemorrhoidal disease. So a lot of bowel issues.

John Horton:

And do those all also open the door to colon cancer, which I know has kind of been a little bit of our focus today?

Dr. Christine Lee:

Yeah, so we don't have a controlled prospective clinical trial to prove cause and effect at this time, but there's a lot of evidence that suggests causation and causation with correlation. So we do speculate that it does contribute clearly to increased risk of colon cancer, but at this time we don't have a clear randomized controlled prospective trial at this time.

Julia Zumpano:

Well, we also want to remember those foods are really low in fiber, if any. They really very much lack fiber. So you're really going to struggle meeting those fiber goals if you're consuming ultra-processed foods. So not only are they high in fiber, they're high in processed chemicals and ingredients that lead to more inflammation, whole body inflammation, but again, very inflammatory to the gut because that's where we're digesting those foods. So we want to make sure we understand how those foods affect our whole system and specifically more importantly, our gut.

Dr. Christine Lee:

Yes, autoimmune disorders are on the rise as well, and that include even microscopic colitis or inflammatory bowel disease. There's now increased case reports of meat allergy, meaning they actually have an anaphylactic reaction to meat. And those were unheard of many decades ago. And so is it the meat itself or is it how it was processed or what preservatives are on them? We're not quite sure at this point, but we do know there's a lot of inflammatory processes that are on the rise for people with an increased incidence and diagnosis of autoimmune disorders throughout, whether it's urticaria from skin or the inflammatory bowel disease or just eczema or allergic rhinitis. We now also have a condition called EOE, eosinophilic esophagitis. That's an allergy mediated, autoimmune mediated. So again, I think diet is so important. We need to go back in time and have the diet of the long time agos before all the invention of processed fast foods and convenience. Just go back to having gardens, growing your tomatoes, washing the dirt off and just eating it as is. It's so important to go back to basics.

Julia Zumpano:

One thing reminded me when you were speaking is really thinking about the quality of meat and the quality of food you're buying too. So if you are able to afford more grass fed types of meats or organic meats, we're going to at least minimize some of the ingredients that are added and given to the animals or used in processing that can really help decrease inflammation in that sense too. So we're looking at trying to minimize what kind of hormones they're providing, what kind of preservatives are being added. So again, trying to choose grass-fed organic meats as often as possible.

Dr. Christine Lee:

Yeah, when I was young, I also remember my mom taking me grocery shopping and we'd go to the local butcher and he would know her by name and we knew where the meat came from and he would know how she would want her certain cut. Nowadays, we go to these big box stores, we have no idea where the meat is from, but they're nicely packaged. And so times are changing. And so it is important to try to go back to basics, know where your food is from or resourced, try to buy local if you can, and then everything in moderation.

John Horton:

So our conversation keeps flipping back to fiber. And so I want to spend a minute if we can over there and kind of talk about why it has these magical properties when it comes to our downstairs plumbing. And Dr. Lee, I know this is a topic you love talking about, so if you could give us a little bit of info as to what this fiber is actually doing inside us.

Dr. Christine Lee:

So most fibers are generally not digestible. So what it does is it kind of acts like a binding agent. It kind of picks up all that charred stuff that fell off... The charred grilled marks and it picks up the old bad pieces and it kind of helps you form your stool. It's easier to eliminate when you have one large entity rather than a thousand small pieces. Kind of like picking up Play-Doh in carpet. If your kid was playing with Play-Doh and you got little pieces of Play-Doh everywhere, it's just easier to get a big ball of Play-Doh and just kind of roll it to pick up the little pieces and you get rid of it in one fell swoop.

So it helps pick up and bind your stool so you have a little bit more form soft, but form stool, so that's easier to eliminate. It also gives your colon muscle wall something to squeeze. So those muscles in the colon, like any muscles in your body, they need to exercise, right? They need to squeeze, that way the muscular wall part of the colon stays strong so that they don't get thin floppy and atrophy, meaning you start losing that muscle tone. So it's almost like exercise for the colon. It acts like a binding agent so you can eliminate better. It also helps lower your cholesterol a little bit, not enough to be the sole agent, but any little bit helps by binding the fats and getting it out of your body before you can absorb and eliminate. So it has so many benefits.

It also creates an oncotic gradient so it pulls water and that's how come your stools are a little bit soft and you can't really digest it, so it really can't harm you because it's going to come out the other end eventually. And so I could just go on and on on the health positive aspects of fiber. So we really should try to invest in ourselves and invest in the foods that we put into our bodies, and that way we can keep our system clean, healthy, and moving along.

John Horton:

Dr. Lee, I got to tell you, I'm not going to look at play-doh the same after the discussion we just had, but that was just a wonderful way to explain how this fiber works in your system and kind of helps clean things up a little bit. Julia, I know we talk about fiber a lot and it's a term that comes up, but when you're at the grocery store, there is not just a fiber aisle. So what are just some quick things people can look to grab that will kind of boost their fiber intake and maybe help keep the pipes clean?

Julia Zumpano:

Sure. Well, first of all, I love the Play-Doh analogy. Amazing. It was exactly spot on. So you want to think about something that's going to bind. So we want to look for foods high in fiber. So there's two kinds of fiber, insoluble and soluble fiber. So Dr. Lee mentioned cholesterol reduction. That comes from the soluble fiber. Insoluble is good too. It's roughage, both are very important, but soluble fiber, it creates that gummy, gooey gel, it absorbs water, it creates a gel. So we're thinking foods like apples or applesauce, pears, bananas, beans and lentils, oats, barley, root vegetables like potatoes and turnips.

So those are those binding foods that we want to really focus on. Those are the soluble fiber. The insoluble fiber just as important. It works in a different way, but insoluble fiber is what we also call roughage. So like nuts and seeds, wheat products, the skin of fruits and vegetables, they might be the things that you can kind of see floating around in your stool. We don't fully digest fiber, we don't digest it at all. It's a form of creating and forming stool and waste and elimination. So when you think of foods that are high in fiber, we're thinking whole grains, fruits and vegetables, nuts and seeds and beans. And my go-to phrase is anything that grows from the ground will be high in fiber. Anything that walks on the ground will not have fiber. So just remember, whole plant-based foods have fiber. Animal foods do not contain fiber unless it's being added to the food. So we want to really focus on heavy plant-based intake, especially if you're eating red meat on a regular basis.

John Horton:

I do love that idea that if you are going to eat red meat, it sounds like if you combine it with food that's a little higher in fiber, they kind of work together a little bit and the fiber will kind of maybe offset some of the concerns we have with red meat.

Julia Zumpano:

I wouldn't say it offsets. It just allows for better digestion. So again, that magic number of how much fiber you need varies per person, but I think it just helps you create that stool and eliminate that meat in a proper timeframe and eliminate it properly with a soft form stool versus having it sit in your gut. So I think it's essential to look at know, am I having a bowel movement regularly? Do I feel like I'm fully eliminating? Is my stool soft? You know, things like that where you know you have a regular comfortable elimination.

John Horton:

So any discussion involving colon cancer risk needs to address the importance of screenings, especially as we age. So Dr. Lee, tell us why this can be such a lifesaving action to go do and to schedule.

Dr. Christine Lee:

Well, so colon cancer, because we had mentioned earlier, third most common cancer in the United States, second cancer causing death in the United States, it's common. And so we always have to be on the lookout and the most common questions I'm asked is what are the symptoms should I look for? Unfortunately, because the hollow nature of the colon, by the time a cancer develops and it's big enough to cause symptoms, it's almost too late. So prevention is we want to get to it before it becomes cancer and before it becomes cancer, there really isn't a symptom. So it's important to look for your risk factors. So your risk factors would be do you have a family history? If you don't have a family history, do you have any other comorbidity that increases your risk of cancer, meaning chronic inflammation or inflammatory disease of some sort.

Also, lifestyle. Are you getting plenty of rest? Are you making sure you're eating good food? Are you hydrating and having good bowel movements? And when I say good bowel movements don't mean just because you went doesn't mean it was good. You got to look at what came out. If you're pooping, things that look like a couple of fingers, they're really misfires. They're not a real good bowel movement. So it's important for people to understand the size of what their colon size is so that when you see a bowel movement, was that a good bowel movement? Did you really empty well or did you really empty maybe 25% of the rectum and 75% still sitting there causing a lot of stagnation, pressure, discomfort, maybe even bleeding and irritation.

Those are all not good. So the current guidelines for colon cancer screening, meaning you have no symptoms, but you just want to be screened, start at age 45 for those who have no family history. If you have family history, it's 10 years minus the family history index age. So you want to start earlier. And the key to that is because we know it saves lives. If we do a colonoscopy, that is one way to see the precancerous growth polyps, they're benign until they're not. So a polyp, a definition of a polyp is an abnormal growth. A definition of an abnormal growth is actually called the tumor. But if we said, oh, we found three tumors, people get very alarmed. So we say, oh, we found three polyps.

John Horton:

It's definitely a word that sets off alarms.

Dr. Christine Lee:

That's right. So they change the word to a polyp, but they really mean the same. They both mean abnormal tissue growth. It's not supposed to be there. And that's why we remove them. We remove them and we send it to path. We need the pathologist then to know what type of polyp it was. Not all polyps are the same. Some turn into cancer in 10 to 20 years, some turn into cancer in one to three years, some turn into cancer typically in five to six years. So it is important not only to remove the polyp, but have them sent. The pathologist will look at it, they'll tell us what type of polyp and when the next surveillance colonoscopy should be so that we can catch them as they crop up. The smaller they are, the easier it is to remove completely. The bigger they are, if it gets so big, we can't remove it in one piece and the risks goes up where we have to remove it in piece style or we may even have to send them off to the surgical colleagues for a surgical resection.

So the longer you wait or the later you are discovered or diagnosed, the lesser option you have and more invasive intervention you require. At the end of the day, all colon cancer could have been prevented. And that's hard to say because you don't want to blame anybody. That being said, theoretically if they were screened, it could have been caught. And it just breaks your heart if anybody dies of colon cancer, because unlike other cancers, there is a great screening modality, there is a great prevention option available. So when someone dies of colon cancer, it really, really breaks your heart because it could have been prevented, but you don't want to blame anybody.

So at this point, we go by statistics, we go by the information we have at hand, we go statistically speaking, we find that number needed to treat. Right now the current guideline in the United States is at age 45, if you have no symptoms, if you have family history, 10 years minus the index case. Or regardless of your age, if you have any symptoms, meaning unexplainable weight loss, anemia, rectal bleeding, pain, any of those alarm symptoms, you really should check it out. And if it's really nothing other than hemorrhoids, that's fine, but it's worth getting that peace of mind and making sure you're not one of the statistics. And even if it's just a hemorrhoid, it's better to find why did you have that? Are you not emptying as well as you thought you did? Did you incidentally discover you have diverticular disease?

You don't want to ignore those because that's your body telling you something is going on in your body that you can help so that it doesn't get worse and lead to diverticulitis or lead to abscess or fistulas or even a bowel perforation. The earlier you discovered you can change that trajectory now and change it for the better.

John Horton:

Yeah, it sounds like, I mean, colon cancer is a very slow growing cancer, so it kind of gives us a window to find it before it becomes very problematic.

Dr. Christine Lee:

Yes, there's always that potential. There are some that grow a little faster, but like you said, as long as they're caught early, you can intervene.

John Horton:

Yeah. Now, you had mentioned colonoscopies, which I know are kind of the gold standard when it comes to colon cancer screenings, but you always see things, the colorful phrase is the poop in the box tests. How effective are those and is that something that people can use?

Dr. Christine Lee:

I always say any form of colon cancer screening is better than no form of colon cancer screening. So I advocate, like you said, the gold standard is the colonoscopy because there's nothing more accurate than being actually inside the colon with a $90,000 lens. And we can kind of look and if there's any abnormal growth, we remove it right then and there and you're done. So that is why it remains the gold standard. But it is considered invasive because a patient has to take a bowel prep and they have to have some anesthesia and they have to be instrumented. And some people, that's fine, and some people they're a little squeamish and they're reluctant to come in to do that. And if that's you and you're willing to do the test in a box, hey, any test is better than no test at all. So I'm all for it.

John Horton:

It'll at least give you some information to go on. And then, maybe you need to go in for a colonoscopy, but it's kind of an early step.

Julia Zumpano:

Dr. Lee, those tests, they wouldn't indicate if you had any polyps or anything like that, would they?

Dr. Christine Lee:

Actually, they do. These do. Scientists are amazing in this country. So they have come up with this device where they're looking for the DNA of adenoma and cancer. So hats off to the scientists. I really respect them and thank you for this opportunity. Yes, the unfortunate part is there is little room for error because the patient... It's important that the patient follows the instructions completely. There are some things that you have to follow those recommendations, and the most important part is you have to supply a good sample. So you have to put in the full bowel movement. So if you only do a partial or it wasn't particularly a good bowel movement, then you're limiting your sample for them to run for the DNA. So the smaller the sample, you're leaving room for error and not necessarily from the fault of the test. It's really the user error, right? So you're going to do that test, you please read the instructions carefully and you want to provide for them the best sample for them to study or run the test from. Help them help you.

John Horton:

So with everything that we've talked about today, it seems that colon cancer is a disease where we as individuals have a bit of control as to whether it's through diet or lifestyle or testing. So if there's one thing we want people to take away from our discussion today, Dr. Lee and Julia, what would it be?

Julia Zumpano:

So mine would definitely be eat enough fiber. So that would be key. Sneaking in fiber throughout your day. Again, adding slowly, but there's a lot of great ways to add fiber, like dried prunes or dates or ground flax seeds or chia seeds. I use those a lot, added to foods to boost fiber. So you really even meeting with a dietician to help you navigate how to add more fiber, how to slowly increase it so you don't have any gut related symptoms from too much fiber, what your fiber goal is. Maybe really breaking down your red meat intake and how frequently you're doing it and really getting that personalized approach to meet your nutrition needs and your health goals.

Dr. Christine Lee:

Yeah, so I can't agree with her more. Nowadays, it's so accessible. There's virtual visits, there's virtual appointments if you have transportation issues, but information is key. Education is power. If you are needing some help and guidance as far as what types of fiber or how to have a better variety in your diet, it is definitely worth consulting with an expert, like a dietician or nutrition specialist. And it may be that you only need one visit or you may need three visits. It's really up to you. And then beyond that, just know that it's not... Diet's very important, but also try to regulate the level of stress that to the best of your ability. Exercise, I always say exercise is the best medicine on earth, so make sure you're getting some exercise. Also, make sure you're getting rest. Sleep repair, DNA repair occurs during sleep. So make sure you're getting plenty of good quality sleep and just make sure that you have a well-balanced lifestyle as far as work, rest, hydration, sleep, and a great balanced diet.

John Horton:

Well, that's a perfect way to bring us to the end, Dr. Lee. So I appreciate both of you spending some time with us today, and like I said, we shared a ton of information that should help people live a little healthier and hopefully avoid becoming one of those colon cancer numbers.

Dr. Christine Lee:

Absolutely. Thanks for having us, John.

John Horton:

Thanks. Bye-bye.

For multiple reasons, colon cancer is often viewed as a preventable disease. Adjusting your diet and limiting red meat are just some of the things you can do to protect yourself as the years go by. Make sure to talk with your healthcare provider about colon cancer screenings too. If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, eat well.

Speaker 4:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.