A Functional Approach to Minimizing Risk
Colorectal cancer is increasing among young adults
Colorectal cancers are becoming increasingly common in young adults, even as their incidence falls in older people (The Scientist, August 26, 2019). Studies in the United States, Canada, and Europe have all found a demographic shift in these cancers, with higher increases in rates for younger adults, and all within just a decade or so. A study of 20 European countries out of the Netherlands in 2019 found that “over the past decade, the incidence of colorectal cancer had increased by nearly 8 percent per year among people in their 20s, by 5 percent for people in their 30s, and by 1.6 percent for those in their 40s.” (The Scientist, cited above). Younger people in particular are less likely to be concerned about these cancers since it is still perceived by them (and some of their doctors) to primarily affect older people. There is less knowledge among younger people about the signs and symptoms of colorectal cancers, younger people are less likely to be fully insured, and less likely to have established medical relationships with their practitioners. Colonoscopies are not routine until 45, or even 50, and the fact that many insurance plans won’t pay for that procedure for those who are younger may deter many young people from getting one in a timely manner even if they do notice symptoms.
Colorectal cancers are discovered at a later stage among younger people
Not only are younger people not as likely to have the same support network in place and the knowledge to clearly identify the problem, but these very factors result in colorectal cancers being caught later among younger than older individuals. In fact, it can be common for younger adults to not see a practitioner about this condition until the cancer has advanced to stage three or four. A 2008 study published in Medicine (Dozois, et al) found that not only were those under 50 more likely to have more serious stages of colorectal cancer but that they were also more likely to have rectal cancer rather than colon cancer, especially among men. Rectum cancer tends to be more difficult to treat than colon cancer. Although colorectal cancers are still relatively rare, their incidence is rising and they can be deadly, particularly when they are not diagnosed before stages 3 or 4. The National Cancer Institute says that colorectal cancer is the leading cause of cancer death for men under 50, and the third leading cause of cancer death (behind breast and lung) for women under 50. With rates rising for younger adults and most cancers being detected late for this demographic, these death rates will likely continue to rise.
Our modern lifestyles may be behind this shift in colorectal cancer to the young
Because these shifts have occurred in such a short time frame, it’s thought that these changes are not because of genetic changes in the population, but due to environmental conditions changing over the last three or four decades. So to examine a potential preventative solution to help with the problem, what are the sort of environmental changes that have been occurring over the last four decades that might explain the shift in colorectal cancer from an “old person’s disease” to one that should concern a younger demographic? There is no absolute agreement, but there is a consensus emerging about which environmental factors play a role. It’s also important to understand that most of these studies excluded individuals who had a special risk for developing colorectal cancers, like genetic predisposition (10-20% of early-onset colorectal cancers), or already diagnosed inflammatory bowel disease. If a patient has an inherited condition like Lynch syndrome or has been diagnosed with IBD, they are at a higher risk for early-onset colorectal cancer and should be screened early. Certain other factors are known to put a patient at a higher risk for cancers, such as obesity, physical inactivity, and smoking. In fact, one of the reasons for the decline in rates of colorectal cancers among older adults is the decrease in smoking in that demographic. If one of these known factors applies to a patient, then having them lose weight, exercise more, and stop smoking can all lower their risk factors.
Increase awareness!
A basic thing that can be done is to increase awareness. Young adults need to be made more familiar with the risks and symptoms of colorectal cancer and informed that it’s being seen more in their demographic. Many younger adults pass off symptoms of colorectal cancers such as rectal bleeding, gut or bowel cramping, gas, gut pain, change in stool, weakness, or fatigue as something more minor. Some practitioners may not consider colorectal cancer in their differential diagnosis for younger adults because of the lingering perception of the condition being only an affliction of the aged.
The microbiome can be key to prevention
In the last four decades, there has been a marked increase in the consumption of prepared foods with their baggage of extra salts, sugars, and preservatives. There has been a decrease in how much fiber is consumed. There has been an explosion in the use of antibiotics, both for treatments, for feedlots, and by secondary exposure through runoff to waterways. There has been a rise in food allergies and sensitivities. All of these trends have tended toward altering the microbiome in the gut. Unhealthy diets as well as a lack of physical activity have independently been linked to early-onset colorectal cancers. The National Cancer Institute has pointed out that “certain types of bacteria in the gut have been pegged as accomplices in the growth and spread of colorectal cancer, and some may even affect how certain cancer treatments work”. Both unhealthy diets and a damaged or altered microbiome can cause inflammation in the gut. The NCI goes on to say: “As for gut bacteria, some bacterial toxins intensify inflammation, Dr. Sears noted. Studies have also shown that certain gut bacteria can recruit immune cells that help cancer grow, as well as block immune cells that fight cancer. Inflammation can also generate harmful chemicals that can mutate DNA and promote cancer, explained Dr. Ng.” (Cynthia Sears, M.D., an infectious disease expert from Johns Hopkins University, and Kimmie Ng, M.D., of Dana-Farber Cancer Institute). Testing for and addressing gut dysbiosis and inflammation could be crucial in helping to curb the rising rate of early-onset colorectal cancers. This is borne out by the fact that “Half of younger adults with colorectal cancer also have a chronic condition that can cause inflammation in the gut.” according to the NCI.
How can you manage the microbiome?
Aside from changing their diet, losing weight, and changing unhealthy habits, how else can a patient manage their gut? There are a host of things they can do. Eat more fiber or supplement with fiber. Take a good probiotic, especially if they also require antibiotics for any other condition. If they have been diagnosed with an inflammatory gut disorder like IBS, IBD, or Crohn’s disease, they may need to be under medical care to help manage their condition. Most importantly, assess their risk. Have your patients take a battery of functional gut tests:
- P88 Dietary Antigen Test to assess food sensitivities and allergies as well complement (C3d) which can indicate not only gut inflammation but pinpoint the foods that may be causing it.
- G-DAP – Gut & Detox Assessment Profile to examine the overall state of gut health, including an assessment of leaky gut through testing for zonulin.
- Comprehensive Stool Analysis with Parasitology to test the ecology and physiology of the GI tract and examine the overall health of the microbiome.
Gut health is not only fundamental to help avoid colorectal cancers, but also for general immune support and overall well-being.
Manage toxicity
Another change that has wreaked havoc on our bodies and contributed to conditions like early-onset colorectal cancers, is the increasing toxicity of our environment. The National Toxicology Program, led by NIEHS, has identified 18 chemicals that cause cancer in the intestines of mice or rats, said NIEHS Director Rick Woychik, Ph.D., who also heads the National Toxicology Program. Some of these chemicals might damage DNA, potentially leading to harmful mutations in cells of the colon and rectum. Heavy metal exposure, the increase in pesticide usage, and the proliferation of chemicals in our foods mean that not only must we safeguard ourselves as best we can by limiting exposure and eating more naturally if we can, but also by testing patient exposure to heavy metals and other toxins with the Comprehensive Heavy Metals Urinalysis from Precision Point Diagnostics. Depending on the results of that test, it might be warranted for the practitioner to initiate a detoxification protocol for the patient.
Support Circadian Rhythms
An emerging environmental explanation that may help explain the rise in early-onset colorectal cancers is an increasing disruption in circadian rhythms, especially in those younger than 50. Why? Increased screen time, irregular hours, sleeping with the light on, working the night shift, or erratic hours as part of the gig economy, and turning to your phone if you can’t sleep can all contribute to insufficient, poor, or fitful sleep, thereby disturbing a person’s circadian rhythms. An earlier study showed that nurses who worked the late shift had a higher risk of breast cancer than those who didn’t. This study prompted researchers to study the same effect in early-onset colorectal cancers since they posited that studies showing the screen and sleep habits of younger adults might intersect with the rise in rates of early-onset colorectal cancers. Sure enough, their study did demonstrate a connection. In the study, reported in Science on August 10, 2022, researchers from Cal State Irvine found not only that “Genetic and environmental disruptions to circadian clocks accelerate the progression of colorectal cancer in organoids and mice”, but “This link between the body’s natural circadian clock and colorectal cancer, the researchers behind the study say, may explain the alarming rise in young-onset colorectal cancer observed over the last two decades.” (The Scientist, Aug 19, 2022). More study is needed on how exactly light sources fit into this link, but for now, there seems at least to be a correlation between the disruption of circadian rhythms and the development of colorectal cancers.
Limit screen time
Circadian rhythms are 24-hour cycles tied to the sleep/wake cycle that determines when our bodies expect to be asleep and awake. They are tied to light and are the reason behind seasonal affective disorders in latitudes with too much light or too much darkness, and have been well documented as being disrupted when reversing when the body sleeps and wakes. Subsequent research has demonstrated their importance to human health and more recently to cancer specifically. Many things can disrupt circadian rhythms, but those who can practice good sleep practices and limit screen time seem to fare better according to numerous studies. Many people can’t or don’t practice good sleep practices. They may depend on their phone or computer screen for their job or their social life. They may enjoy social time with their family in front of the TV.
Assess a patient’s sleep state and adrenal health
Melatonin is a natural hormone produced by the brain in response to darkness. It helps regulate circadian rhythms and sleep, and being exposed to light can block melatonin production (as per the NIH). If melatonin production is disrupted, it may mean that a patient won’t be able to sleep in or get enough rest the following night. Continued disruptions may make them sleep-deprived, upset their circadian rhythms, and lead to other health concerns- like increasing the risk for early-onset colorectal cancer. In addition, there is some evidence that melatonin increases apoptosis (cell death) in some cancers, so it may independently help combat colon cancer cells specifically ( Journal of Pineal Research, 2017, Gao, et al). In addition, melatonin is crucial in the regulation of the glymphatic system, which is essential in removing proteins and metabolic waste products that are correlated with the development of neurodegenerative disease (Bitar, R.D., Torres-Garza, J.L., Reiter, R.J. and Phillips, W.T. 2021. Neural glymphatic system: Clinical implications and potential importance of melatonin. Melatonin Research. 4, 4 (Dec. 2021), 551-565.) One impact of disrupted sleep cycles can be a disruption of the adrenal system. Patients who describe themselves as “tired but wired” may be suffering from adrenal fatigue and their cortisol levels may still be too high when they try to sleep, and too low when they get up in the morning. Assessing the cortisol cycle requires measuring a patient’s cortisol level over a 24-hour period to plot their adrenal cycle. An excellent way to do this is with the salivary-based Advanced Adrenal Stress Test from Precision Point Diagnostics.
Thinking about colorectal cancer can be a daunting prospect for a young patient, but NOT thinking about it is even worse. If a patient can embrace control over their health and strive to live an overall healthier life, they may help avoid the terrible toll of colorectal cancer. Educating younger patients about these lifestyle risks, and assessing the state of their health through the tests mentioned here might make a difference in reversing the trend of increasing colorectal cancers in those under 50.