Lynch syndrome (LS), also known as hereditary non-polyposis colorectal cancer (HNPCC), is an autosomal dominant condition characterized by a predisposition to several adult-onset cancers, most commonly colorectal cancer (CRC). Managing cancer risk for individuals with Lynch syndrome often involves screening, surveillance, and sometimes preventive surgery. While medical care remains paramount, dietary choices can play a supportive role, potentially influencing how inherited risk factors interact with the body. This article provides a comprehensive overview of dietary recommendations for individuals with Lynch syndrome, incorporating the latest research and expert opinions.
Understanding Lynch Syndrome and Cancer Risk
Lynch syndrome is caused by mutations in DNA mismatch repair (MMR) genes (MLH1, MSH2, MSH6, and PMS2) that can be identified through clinical genetic testing. MMR mutation carriers have a higher lifetime risk for several cancers compared with the general population; for example, CRC risk ranges from 74% to 82% for men and from 30% to 54% for women, and women have a 40% to 60% risk of endometrial cancer. Lynch syndrome confers modestly increased lifetime risks for other malignancies, including ovarian, stomach, small bowel, hepatobiliary tract, pancreatic, urinary tract, brain, and skin cancers. Consequently, individuals with Lynch syndrome are advised to follow high-risk management recommendations including annual colonoscopy (often initiated at age 20-25 years) and screening for endometrial cancer and other cancers associated with the syndrome.
Several lifestyle behaviors are known or suggested to increase risk for sporadic cancers that also occur in Lynch syndrome. Smoking, alcohol consumption, fat intake and red meat consumption have been associated with increased risk for CRC. Diets high in fruits and vegetables and low in red meat consumption may reduce CRC risk; additionally, dietary fiber has been considered protective, although more recent studies show conflicting results. Obesity is considered a risk factor for both CRC and endometrial cancer, and physical activity may reduce CRC risk.
The Role of Diet in Managing Lynch Syndrome
In Lynch syndrome, most dietary advice has focused on colorectal cancer. However, emerging research highlights the impact of diet on overall cancer risk for individuals with LS. Studies suggest that certain dietary components may offer protective effects, influencing cancer pathways and potentially reducing the incidence of both colorectal and non-colorectal cancers.
Resistant Starch: A Promising Dietary Component
Researchers found that a daily dose of resistant starch (also known as fermentable fiber), a type of fiber naturally found in foods like beans, oats, green bananas, and cooked pasta, reduced the incidence of non-colorectal cancers by 50% in people with LS. The international trial, known as CAPP2, involved almost 1,000 patients with Lynch syndrome. It found that a regular dose of resistant starch, also known as fermentable fiber, taken for an average of two years did not affect cancers in the bowel. But the supplement did reduce cancers in other parts of the body by more than half.
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“We found that resistant starch reduces a range of cancers by over 60%. The effect was most obvious in the upper part of the gut,” explained Mathers. “Resistant starch can be taken as a powder supplement and is found naturally in peas, beans, oats and other starchy foods. The dose used in the trial is equivalent to eating a daily banana, before they become too ripe and soft. “Resistant starch is a type of carbohydrate that isn’t digested in your small intestine, instead it ferments in your large intestine, feeding beneficial gut bacteria-it acts in effect, like dietary fiber in your digestive system.
It’s especially notable that the protective effect appeared years after supplementation ended, implying that diet may influence long-term cancer pathways, not just short-term outcomes.
We hypothesize that resistant starch reduces production of secondary bile acids by the gut microbiome and so reduces the amount of DNA damage.
Resistant starch and dietary fiber may lower cancer risk by slowing cell growth in parts of the colon and changing the expression of genes that block cancer growth. Many different types of bacteria in our gut consume resistant starch. These bacteria produce substances that stop cancer cell growth and kill cancer cells after they consume resistant starch. For people with , resistant starch does not alter colorectal cancer risk, but it does lower the risk of non-colorectal Lynch syndrome-associated cancers, especially upper GI cancers. Since screening, diagnosis and management of these cancers are difficult, this finding could lead to a change in the standard of care for people with to help reduce their risk for upper GI cancers.
Managing Inflammation and Insulin Resistance
Another area of research has focused on how diet influences systemic inflammation and insulin resistance, both of which are associated with higher cancer risks. For those with LS, managing inflammation may be especially important. Chronic inflammation doesn’t always show obvious symptoms, but it can be quietly active in the background, altering cellular environments and making them more susceptible to mutations.
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Fiber-rich foods not only support digestive health but also help regulate blood sugar levels, reduce insulin spikes, and improve satiety, which are factors that all contribute to metabolic balance and may reduce cancer risk.
Excess fat tissue, especially in the abdominal region, isn’t just stored energy. It acts like an active organ, producing hormones and inflammatory molecules that may raise cancer risk.
Vitamin D and Cancer Prevention
High levels of vitamin D in the body have been associated with a decreased risk of large bowel tumours. Our main prediction is that higher vitamin D concentrations are associated with a decreased large bowel tumour risk in people with LS. Vitamin D levels will be measured in the blood, through genetic data and through intake via diet and supplements.
Studies have recently indicated the sun is great for us as a major contributor of Vitamin D within our body! A new study released January of 2010 indicated of 1248 patients, those with the highest blood levels of vitamin D had a 40% lessor risk of contracting cancer than those with lessor levels. Of course, more studies need to be completed. In respect to taking Vitamin D supplements, long termed adverse effects are not known if Vitamin D taken in high doses. However, it does appear Vitamin D, obtained from foods and the sun, is extremely good for us and may be a deterrent against cancer. Grab your sun screen and head outside every day to take in a few rays! However, while Vitamin D is helpful in alleviating some cancers, a recent study indicates it does little for lessor known cancers.
Vitamin D, made by the body when the skin is exposed to ultraviolet (UV) rays, helps keep bones and the immune system healthy. You can also get it from foods like fatty fish, some mushrooms, fortified foods (milk, orange juices, cereals) or from supplements. Some studies suggest vitamin D might lower cancer risk, particularly colorectal cancer. Most Americans don’t get enough vitamin D in their diets, and many have low blood levels. While research continues on vitamin D and cancer risk, avoiding low vitamin D levels is recommended.
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Specific Dietary Recommendations for Lynch Syndrome
The healthiest eating is mostly based on plant foods like vegetables, fruits, whole grains, beans, and nuts/seeds. They also include healthy protein sources, such as beans, fish, or poultry, while limiting red and processed meats. Studies have shown that these dietary patterns are linked to a lower risk of cancer, certain other diseases, and early death.
Emphasize Plant-Based Foods
Vegetables (including beans) and fruits are full of vitamins, minerals, fiber, and other substances that may help prevent cancer. Eating vegetables and fruits may also control weight, since they are low in calories, high in fiber, and have lots of water.
Whole grains keep all parts of the original grain, so they have more fiber and nutrients than refined (or processed) grains. These include things such as whole wheat, brown or wild rice, oats, and corn. Studies show that eating whole grains might lower the risk of colorectal cancer.
Dietary fiber is found in plant foods such as beans, whole grains, fruits, vegetables, nuts, and seeds. Eating these foods may help prevent excess body weight, which can lower the risk of cancer.
Limit Red and Processed Meats
Processed meat has been cured, smoked, salted, or fermented to improve or preserve flavor. Examples include bacon, sausage, hot dogs, and deli meats. Evidence that red and processed meats increase cancer risk has existed for decades, and many health organizations recommend limiting or avoiding these foods. In 2015, the International Agency for Research on Cancer (IARC) classified processed meat as “carcinogenic [cancer-causing] to humans” (Group 1) and red meat as “probably carcinogenic to humans” (Group 2A), based on evidence that they increase the risk for colorectal cancer. It isn’t known if there is a safe level of red or processed meat to eat. Because of this, the ACS recommends eating more protein from fish, poultry, and beans instead of red meat.
Limit or eliminate red meats. (The World Cancer Research Fund recommends no more than 18 ounces per week.) Some studies indicate a reduction of 50% red meat may reduce cancer risk as much as 50%. Recommended individual meat portions are the size of a deck of cards (about three ounces.) Eating meat sparingly as an ingredient and taking it from the center of the plate, rather than as an entree, such as in a beef stroganoff or pastas or soups and stews can help reduce eating meat, painlessly. We seek organic beef from animals which graze, rather than are fed with filler foods such as corn, etc.
Reduce Added Sugars and Processed Foods
Added sugars and other high-calorie sweeteners (such as high-fructose corn syrup) are often used in sugar-sweetened beverages and energy-dense foods (for example, traditional “fast food” or ultra-processed foods (or UPFs). The health impact of UPFs (also called highly processed foods) is an area of increasing concern. These highly processed foods are usually high in fat, sugar, refined grains, and salt. Studies have linked them to health problems, including weight gain. More research is needed to understand the impact on cancer risk.
Strongly consider avoiding processed, smoked and prepared foods. Afterall, it only takes about two minutes more to prepare homemade salad dressings, mayonnaise, mustard, etc., and they taste so much better without the high amounts of sodium, the chemicals and the preservatives prepared items have. Bagels, pastries, sodas, chips and basic junk foods aren’t all that healthy for us.
Other Dietary Considerations
- Incorporate resistant starch: Try foods like green bananas, lentils, cooked potatoes, and barley to naturally increase your intake.
- Maintain a healthy weight: Focus on a balanced diet and regular physical activity to manage your weight and reduce cancer risk.
- Stay hydrated: Drink plenty of water throughout the day to support overall health.
- Spice it up: To spice foods, rosemary, turmeric, ginger, thyme, mint, anise, camphor, fennel and allium are great! (Some advocate to add black pepper and olive oil to the turmeric as it is felt pepper is needed to interact with the positive qualities. This may be true, but the evidence is slight.) Eating lots of garlic, onions and tomatoes is said to be very healthy. The National Institute of Health recognizes garlic as having anti-cancer properties as well as pomegranates, red grapes, strawberries, blueberries, raspberries, apples, pears, plums and prunes as they are considered excellent anti-cancer fruits.
- Green tea, dark teas and coffee: Green tea, dark teas and coffee has been greatly studied and it has been found all of these have a similar set of interesting and possibly useful anti-cancer compounds in them. Green tea is particularly fascinating as studies evolve. There is concern about drinking it at warm temperatures, however other studies are indicating it may have some benefits, especially as a cold tea. A recent study of the combination of selenium with green tea may be more effective in reducing the oncogenesis of colorectal cancer.
- Watch out for excess: Recent studies indicate Omega 3 fish oils, taken in excess can possibly increase the risk of prostate cancer by 70%. Studies indicate fish is good for us, so the real key here is to exercise moderation. It is recommended to eat fish a few times a week. Most of us love potatoes but in quantity, they aren’t all that good for us. Potatoes are fine on occasion but all too often we eat them as french fries, or with butter or fatty sauces upon them. Recent studies have evidenced the preparation of the potato can be a problem for those at high risk for cancers andsnacks, particularly chips, are particularly a problem. Brown rice, which if eaten in moderation and infrequently, can help us with our bodily functions on those special days when our colons are overactive and we need to use a BRATY diet. Its best to keep rice and other carbohydrates to a low level, just enough to balance the meal as there have recently been found a high level of arsenic in some rice. Substituting multi-grain and sourdough breads for white bread, purchase range fed chicken and use butter instead of margarine may be an option.
- Lower fat diet: Having Lynch syndrome and a predisposition to cancer, a lower fat diet is essential. Its been recommended to avoid excess salt and saturated fats.
- Dark chocolate: Dark chocolate has been considered to be good for us and a deterrent against cancer! The darker the chocolate, the more antioxidant it contains However caution is recommended. Only the dark chocolates are considered healthy and balance is the key.
- Diversity is key: Finally, a bit of diversity is always good for an open mind, open heart and cancer free life.
The Importance of Medical Supervision
It’s important to remember that while diet may support your body and potentially reduce cancer risk, it is not a substitute for LS-specific medical care. Surveillance, genetic counseling, and preventive strategies remain the cornerstone of LS management.
Discuss with your doctor, taking aspirin, as a cancer deterrent.
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