Colorectal Cancer

What you do, what you eat, and how you handle stress impact your overall state of well-being.

Nearly 150,000 people were diagnosed with colorectal cancer in the United States in 2008, the most recent year we have data for, with roughly 50,000 deaths attributed to this disease.[1]

It is the second leading cause of cancer death among cancers that affect both men and women, although it is one thought to be largely preventable, with rates 10-fold higher reported in Western countries.[2]

One study conducted among nearly 50,000 men found that over 70% of colorectal cancer incidence could be prevented by diet, physical activity, and specific health behaviors, such as refraining from smoking.[3]

Nearly all colorectal cancers are adenocarcinomas, with the great majority arising from an adenomatous polyp.[4] Recently, 6 lifestyle factors were found to cumulatively increase the risk for adenomas. This provides strong evidence that lifestyle modification is important for the prevention of colorectal polyps, especially advanced and multiple adenomas, which are established precursors of colorectal cancer.[5]:

  1. Cigarette smoking
  2. Obesity
  3. No regular use of nonsteroidal anti-inflammatory drugs (NSAIDs)
  4. High intake of red meat
  5. Low intake of fiber
  6. Low intake of calcium
Emphasize plant-based whole foods, rich in micronutrients, cruciferous vegetables, omega-3 fatty acids, fiber, and calcium.

Causes/Contributing Factors

Colorectal cancer occurs more commonly in those over age 50, men, and individuals of African-American descent, and those with a family history of colorectal cancer or a personal history of polyps, inflammatory bowel disease, or low socioeconomic status.[6]

Smoking increases the risk for colorectal cancer for as long as 25 years after quitting, although having a normal body mass index (BMI) and having high fruit consumption mitigate this risk to a small degree.[7]

Other dietary factors associated with risk include consumption of animal foods, particularly red and processed meat and low fiber and calcium intake.[8]

Alcohol and an elevated BMI are also risk factors, while physical activity has a dose-dependent benefit for reducing risk.[9][10][11]

Limit alcohol intake and do not smoke.

Relevant Diagnostic Testing

A number of screening tests for colorectal cancer are available, and require a physician’s guidance to determine the most appropriate. Colonoscopy, for example, is the most likely to find polyps or cancer, but also to have complications such as bowel tears or infection.

Several tumor markers may be used to monitor progress or guide treatment decisions, including carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and tissue polypeptide antigen (TPA).

Low Vitamin D levels have been associated with the risk of developing colorectal cancer, as well as both overall and colorectal cancer specific mortality.[12][13]

Be physically active, every day. Even light intensity exercise has benefit.[14]

Dietary Action Plan


  1. Brightly colored, fresh vegetables, leafy greens and fresh fruits (choose organic if possible)
  2. Cruciferous vegetables, such as broccoli, cauliflower, cabbage, etc.
  3. Whole foods (foods that are as close to their natural form as possible)
  4. Low sugar/low glycemic diet (Glycemic index (GI) and glycemic load (GL) are measures of the effect on blood glucose level after a food containing carbohydrates is consumed)
  5. Omega-3 fatty acids, found in cold water fish such as sardines, wild-caught salmon, cod, mackerel, tuna
  6. High fiber, from whole grains, beans, vegetables and fruits
  7. Healthy fats, from avocados, nuts, seeds, olive oil, coconut oil, cold water fish
  8. For animal protein, choose lean poultry and fish over red meat, and aim to view meat as a condiment rather than a staple. Try to choose grass fed and organic meats and eggs whenever possible. Eat no fish larger than a salmon to minimize environmental contaminants, including mercury.


  1. Processed and grilled meats. Also, try to limit intake of red meat
  2. Fast foods, fried foods, baked goods and packaged, processed foods
  3. Sugar, sweeteners  and artificial sweeteners
  4. Vegetable oils, shortening, margarine and anything with hydrogenated or partially hydrogenated oils
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Colorectal Cancer Supplement Program

Multiple nutritional supplements have been associated with reduced cancer incidence and/or cancer progression. The list below contains those with the greatest evidence-base and benefit, though it is not necessary that they all be included.

Supplement Info



  • Vitamin D
  • Curcumin
  • Green Tea Extract
  • Resveratrol
  • Grape Seed Extract and/or Pycnogenol
  • Probiotics
  • Omega-3 Fatty Acids
  • Diindolylmethane (DIM)
  • Quercetin
  • Melatonin
  • Vitamin E
  • Vitamin K2
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[1] Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012 Nov;143(5):1179-87.e1-3.

[2] Joseph DA, King JB, Miller JW, et al. Prevalence of colorectal cancer screening among adults–Behavioral Risk Factor Surveillance System, United States, 2010. MMWR Morb Mortal Wkly Rep. 2012 Jun 15;61 Suppl:51-6.

[3] Platz EA, Willett WC, Colditz GA, et al. Proportion of colon cancer risk that might be preventable in a cohort of middle-aged US men. Cancer Causes Control. 2000 Aug;11(7):579-88.

[4] Stewart SL, Wike JM, Kato I et al. A population-based study of colorectal cancer histology in the United States, 1998-2001. Cancer. 2006 Sep 1;107(5 Suppl):1128-41.

[5] Fu Z, Shrubsole MJ, Smalley WE, et al. Lifestyle factors and their combined impact on the risk of colorectal polyps. Am J Epidemiol. 2012 Nov 1;176(9):766-76.

[6] Doubeni CA, Laiyemo AO, Major JM, et al. Socioeconomic status and the risk of colorectal cancer: an analysis of more than a half million adults in the National Institutes of Health-AARP Diet and Health Study. Cancer. 2012 Jul 15;118(14):3636-44.

[7] Gong J, Hutter C, Baron JA, et al. A pooled analysis of smoking and colorectal cancer: timing of exposure and interactions with environmental factors. Cancer Epidemiol Biomarkers Prev. 2012 Nov;21(11):1974-85.

[8] Jamin EL, Riu A, Douki T, et al. Combined Genotoxic Effects of a Polycyclic Aromatic Hydrocarbon (B(a)P) and an Heterocyclic Amine (PhIP) in Relation to Colorectal Carcinogenesis. PLoS One. 2013;8(3):e58591.

[9] Ferrari P, Jenab M, Norat T, et al. Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer. 2007 Nov 1;121(9):2065-72.

[10] Sanchez NF, Stierman B, Saab S, et al. Physical activity reduces risk for colon polyps in a multiethnic colorectal cancer screening population. BMC Res Notes. 2012 Jun 20;5:312.

[11] Chao A, Connell CJ, Jacobs EJ, et al. Amount, type, and timing of recreational physical activity in relation to colon and rectal cancer in older adults: the Cancer Prevention Study II Nutrition Cohort. Cancer Epidemiol Biomarkers Prev. 2004 Dec;13(12):2187-95.

[12] Ng K, Meyerhardt JA, Wu K et al. Circulating 25-hydroxyvitamin d levels and survival in patients with colorectal cancer. J Clin Oncol. 2008 Jun 20;26(18):2984-91.

[13] Stubbins RE, Hakeem A, Núñez NP. Using components of the vitamin D pathway to prevent and treat colon cancer. Nutr Rev. 2012 Dec;70(12):721-9.

[14] C B, M M, R D, et al. Cross-Sectional & Longitudinal Associations between Light-Intensity Physical Activity & Physical Function Among Cancer Survivors. Cancer Epidemiol Biomarkers Prev. 2013 Mar;22(3):475-6.

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