Evidence based fact sheet (FOLATE)

The Good and the Bad News: Colorectal Cancer (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer death in both men and women in the United States (1). The good news is that a diet high in fiber has been shown to reduce the risk of colon cancer (1)! Studies have consistently found a protective effect of fiber, especially fruit and vegetable fiber, against colon cancer (2). ______________________________________ What exactly is Colorectal Cancer (3)? It is a type of cancer that develops in the colon (the first and longest part of the large intestine) and the rectum (where waste from digestion ends up). Generally, this type of cancer arises slowly over a period of 10-15 years and starts with the development of polyps (growth of tissue on the lining of the colon or rectum), which can become cancerous overtime.

Possible Signs and Symptoms to look for (3): Often there are no early symptoms; therefore, regular screenings from your doctor is important. If you detect signs or symptoms of bleeding from the rectum, bloody or black stools, severe cramping, constant constipation or diarrhea, and unintentional weight loss, then you should consult a doctor for further screening. ______________________________________ Dietary Recommendations for the Prevention of Colon Cancer (3):

• The American Cancer Society recommends consuming a healthy diet with an emphasis on plant and fiber sources.

• Select foods and beverages in moderate quantities that aid in reaching and maintaining a healthy weight.

• Consume 5 or more servings of a range of fruits and vegetables each day.

• Make the majority of your grains 100% whole grains and limit consumption of processed (refined) grains.

• Limit consumption of processed and red meats.

_______________________________________ Some good fiber sources include (4): Whole-wheat flour, wheat bran, whole wheat bread, brown rice, nuts, seeds, oats, peas, beans, apples, citrus fruits, carrots, barley, high fiber cereals, tomatoes, dried fruit, broccoli, spinach, cauliflower, bell peppers, brussel sprouts, cabbage, onions, garlic, and sweet potatoes.

Daily fiber recommendation (5): -25g for women and 38g for men (ages 19-50) -21g for women and 31g for men (Ages 51+) Additional benefits of fiber (5): -Weight management -Regular bowel movements -Reduce risk of colorectal cancer -Reduced blood cholesterol and CHD risk -Improved blood glucose control _____________________________________ Tips for fitting in your recommended fiber daily (6): -choose high fiber cereals for breakfast (at least 5g per serving) - look for 100% whole grain products -when baking, substitute whole grain flour for half of the white flour; also can add flax, bran, and oats to baked goods -incorporate chopped up vegetables in things like sauces and soups to add more bulk -try to eat a piece of fruit at every meal -prepare snacks to carry with your throughout the day: nuts, trail mix, whole wheat crackers, dried fruit, cut up raw vegetables with hummus, fruit and yogurt are some of the many options

Fiber and Colorectal Cancer  

-Be sure to increase your fiber intake to the recommended goal slowly overtime and to drink plenty of water; otherwise gas, bloating, and cramping may result from increasing consumption too quickly ___________________________________ Recipe: Whole Wheat Pasta Salad with Mixed Vegetables (6):

Ingredients: -12 ounces whole-wheat rotini (spiral-shaped) pasta -1 tablespoon olive oil -1/4 cup low-sodium chicken broth -1 garlic clove, chopped -2 medium onions, chopped -1 can (28 ounces) unsalted diced tomatoes in juice -1 pound mushrooms, sliced -1 red bell pepper, sliced -1 green bell pepper, sliced -2 medium zucchini, shredded -1/2 teaspoon basil -1/2 teaspoon oregano -8 romaine lettuce leaves Directions: -Cook pasta according to the package directions. Drain the pasta thoroughly. Place pasta in a large serving bowl. Add the olive oil and toss. Set aside. -In a large skillet, heat the chicken broth over medium heat. Add the garlic, onions and tomatoes. Sauté until the onions are transparent, about 5 minutes. -Add the remaining vegetables and sauté until tender-crisp, about 5 minutes. Stir in the basil and oregano. -Add the vegetable mixture to the pasta. Toss to mix evenly. Cover and refrigerate until well chilled, about 1 hour. -About 8g of fiber per serving size = approximately 2 cups ______________________________________

Fiber is Important (7)! Studies have shown evidence that consuming high amounts of saturated fat is a contributing risk factor for colon cancer and that increasing consumption of foods high in fiber (specifically fruits and vegetables) is a defensive factor. Additionally, total fiber intake is associated with decreased reappearance of polyps, which are the growths that usually lead to the development of colon cancer. _______________________________________ References: 1. Tantamango YM, Synnove KF, Beeson L, Fraser G, Sabate J. Association Between Dietary Fiber and Incident Cases of Colon Polyps: The Adventist Health Study. Gastrointest Cancer Res. 2011; 4(5-6): 161–167. 2. Irabor, DO. Colorectal carcinoma: why is there a lower incidence in Nigerians when compared to Caucasians? J Cancer Epidemiol. 2011;2011:675154. 3. American Cancer Society. Colorectal Cancer Facts & Figures 2011-2013. Atlanta: American Cancer Society; 2011. 4.Steinmetz KA, Potter JD. Vegetables, Fruit, and Cancer Prevention: A Review. J Am Diet Assoc. 1996; 96: 1027-1039. 5. Anderson JW, Baird P, Davis RH Jr, Ferreri S, Knudtson M, Koraym A, Waters V, Williams CL. Health benefits of dietary fiber. Nutrition Reviews. 2009;67(4):188-205. 6. Mayo Foundation for Medical Education and Research. Dietary Fiber: Essential for a Healthy Diet. Available at http://www.mayoclinic.com/health/fiber/NU000 33/NSECTIONGROUP=2. Accessed February 29, 2012. 7.Neugut AI, Garbowski GC, Won CL, Murray T, Nieves JW, Forde KA, Fenoglio-Preiser C. Dietary Risk Factors for the Incidence and Recurrence of Colorectal Adenomatous Polyps. Annals Of Internal Medicine. 1993;118(2):91- 95.