Serrated polyposis syndrome (SPS) is characterized by the presence of multiple serrated polyps in the colon. Some serrated polyps of the colorectum are likely pre-invasive lesions, evolving through a newly recognized serrated pathway to colorectal cancer. Understanding the factors that influence the development of these polyps is crucial for prevention. This article synthesizes current research and expert recommendations to provide a comprehensive guide to dietary and lifestyle modifications that may reduce the risk of serrated polyps and colorectal cancer.
Understanding Serrated Polyps
Serrated polyps are a diverse group of colorectal lesions that share a common feature of glandular serration, i.e., a “saw-toothed” infolding of colonocytes in the lumen of the crypts. Historically, polyps with serrated architecture were thought to be a single entity, hyperplastic (or metaplastic) polyps, and considered indolent, non-neoplastic hyperproliferative lesions. Thus, they were considered distinct from adenomas (traditionally defined as polyps with cytological dysplasia), the precursors to most colorectal cancers.
Understanding of the biology, epidemiology, and natural history of serrated polyps is incomplete and the appropriate categorization of the lesions is a matter of current investigation and discussion. A few recent studies demonstrated that diagnostic agreement for the different types of serrated polyps is variable, and that discrimination between the newly defined sessile serrated adenoma and the traditional hyperplastic polyp is challenging, although in a non-diagnostic research setting the ability to reliably distinguish the different lesions was reported to be reasonable in some analyses.
Key Risk Factors
Several factors contribute to the development of colon polyps, ranging from genetic predispositions to lifestyle habits. These include:
- Family History: Family history plays a significant role in the development of colon polyps and colorectal cancer.
- Age: Age is a significant risk factor for colon and colorectal cancer. The American Cancer Society recommends that individuals at average risk begin screening for colorectal cancer at age 45. However, those at higher risk due may need to start screening earlier.
- Obesity: Excess weight and obesity have been associated with an increased risk of colorectal cancer and colon polyps. Numerous medical studies have found that being overweight is a colon cancer risk factor for both men and women. The heavier you are, the higher the risk.
- Smoking and Alcohol: Drinking too much alcohol has been linked to an increased risk of colorectal cancer, so keep your intake to a relatively small level. Is there any disease or disorder where smoking cigarettes and excessive alcohol are not implicated? Sad to say, the same holds true for polyps and colon cancer.
- Dietary Factors: Diets lacking in fruits, vegetables, and whole grains tend to contribute to chronic inflammation in the colon and promote the growth of polyps. The western type of diet with large portions of animal meat, little fiber, low intake of vegetables, and possible low intake of vitamin D and calcium all seem to be major factors.
General Dietary Recommendations
This diet describes the dietary steps you can take to reduce your chance of getting colon cancer or polyps. While genetics is the main factor in the development of colon cancer, diet also plays a large role, as does our intake of large amounts of red meat. Furthermore, our diet tends to be deficient in dietary fiber, fruits, and vegetables, which also contributes to the development of colon cancer. No one is certain which of the following points are most important. Some are easy, such as increasing vegetables and other plant-based foods in your diet. Some are more difficult, such as getting your weight under control and reducing your consumption of red meat. Taken together, a fairly good case and set of recommendations can be made to reduce your risk.
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- Increase Fiber Intake: Eat more fiber. As a general rule you should try to have 25-30 grams of fiber daily. Examples include broccoli, brussel sprouts, cauliflower, cabbage. Eat salad regularly. Consider adding oatmeal or high fiber cereal to you daily routine. Consider fiber supplements such as Metamucil or Citrucel which can provide 4-6 grams of fiber per serving. Cooked vegetables may cause less production of gas.
- Limit Red and Processed Meat: Decrease the amount of red meat you eat (up to 4oz. total per day).
- Choose Healthier Protein Sources: Eat white meats such as chicken, turkey, fish. Consider soy as an alternative protein source.
- Reduce Fat Intake: Reduce the amount of fat in your diet. Cook with vegetable or olive oil.
- Focus on Plant-Based Foods: Place a major focus on plant-based foods that are high in fiber, vitamins, and antioxidants, such as fruits, vegetables, whole grains, and legumes. Fiber-rich foods, like fruits and veggies, whole grains, nuts and seeds, are also more nutrient-dense.
Specific Dietary Components
- Calcium and Vitamin D: Diets deficient in calcium and folic acid may be associated with an increased risk of colon cancer. Adequate calcium intake in the form of milk, dairy products, shellfish and vegetables is recommended. There is recognition that vitamin D deficiency is common, especially in the temperate weather zones where sun exposure is variable. This is startling information. The blood level of vitamin D should be above 30 ng/ml. National experts are not in agreement on the amount of vitamin D needed to reach this level. Some experts say 1,200 IU/day. Toxicity from too much vitamin D is very rare but can develop if vitamin D supplementation is taken in excess.
- Prebiotics and Gut Health: Prebiotics are the soluble fiber which go through the gut unchanged and then are used by good colon bacteria as a fuel source for their own growth. These bacteria then make short chain fatty acids such as butyrate. This substance renders the colon acidic and is a fuel source for the health of the colon’s own cells. The bacteria that live in our colon rely on the prebiotic fiber we eat to make substances that maintain the health of our own colon. Scientists call this mutualism. One of the possible benefits of this process is to make the colon cells less likely to turn into precancerous and cancerous cells. So, what are these prebiotic soluble plant fibers? Psyllium, found in bowel supplements such as Metamucil are fermented by colon bacteria. It will reduce cholesterol, but other health benefits have still not been demonstrated. The bottom line is that almost any plant food can be a benefit to the colon.
- Cruciferous Vegetables: Cruciferous vegetables such as cabbage, broccoli, Brussels sprouts and cauliflower are felt by many to be gassy. This is probably not true as they do not have an excessive amount of soluble fiber, which the colon’s bacteria need to make colon gas. What they do have is a lot of sulfur. But, there is an extraordinary payoff here. Sulforaphane is a key ingredient in these vegetables. In broccoli sprouts, it is exceptionally high. This is a powerful anti-cancer substance. The regular ingestion of these vegetables has been found in many medical studies, to be associated with a reduced cancer risk in many organs of the body. In the laboratory and in animal testing, sulforaphane has been found to have strong anti-cancer properties.
Lifestyle Modifications
- Regular Exercise: As advised by health guidelines, try to get at least 150 minutes a week of moderate-intensity activity or 75 minutes of vigorous-intensity activity.
- Weight Management: As hard as it is, control your weight.
- Avoid Alcohol and Smoking: Avoid alcohol and smoking which may increase the risk of developing colon cancer
- Consider a Multivitamin: Consider taking a multivitamin daily.
The Role of Aspirin
High risk patients can consider starting Aspirin. Aspirin and other drugs in its class, may have properties that can retard the development of colon cancer. In the past, it has been demonstrated that aspirin was believed to reduce the risk of recurrent polyps in the colon. Some studies demonstrate that regular aspirin, as little as two times a week, has shown a beneficial reduction in risk. Before starting these medications, consult with Dr.
Location-Specific Considerations
In a large, pooled analysis, it was observed that several demographic, lifestyle and dietary factors were associated with the risk of serrated polyps. In the left colorectum, obesity, cigarette smoking, dietary fat, total energy intake, and red meat intake were related to an increased risk of any and/or advanced serrated polyps. In the right colorectum, family history of polyps and folate treatment were associated with risk of serrated lesions whereas aspirin treatment was associated with a reduced risk of serrated polyps.
Screening and Prevention
For early identification and prevention, routine screening for colorectal cancer and colon polyps is essential. Maintaining a healthy colon and preventing colon polyps require a proactive approach that encompasses healthy lifestyle choices, regular screenings, and awareness of risk factors.
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