Ask The Experts: Cancer; Laxatives; Fiber & Cholesterol

Q. Colon cancer runs in my family, so I want to do everything I can to lower my risk. I’ve heard that taking extra calcium can help. Is this true?

A. Joel Mason, MD, director of the Vitamins and Carcinogenesis Laboratory at the HNRCA, explains: “Your dietary pattern does help determine your risk for colon cancer. To lower your risk, maintain a healthy weight and eat a diet low in animal fat and processed meats and high in fruits, vegetables, and fiber. Also, if you drink alcohol, do so in moderation.

“There’s evidence from clinical trials that taking 1,200 milligrams (mg) of supplemental calcium per day could reduce the chance of precancerous growths in the colon, called polyps. If you prevent polyps from forming in the first place, it could reduce the chance of developing cancer.

“Although not all studies have found this to be the case, it would be reasonable for you to consider taking extra calcium in addition to maintaining a healthy weight and eating pattern. There really isn’t any big risk to taking calcium supplements, although it can cause constipation in some people and, at doses exceeding 1,000 mg per day, has been linked to a slightly higher risk for kidney stones.

“Keep in mind, though, that if you want to get the full potential benefit of calcium supplementation, you are going to have to take it daily for an extended period, since nutritional strategies to prevent colon cancer require you to adhere to them for a very long period.”

Q. What changes in my diet can I make that would help with regularity?

A. Harmony Allison, MD, a gastroenterologist at Tufts Medical Center, says: “The two dietary and lifestyle changes that will help you the most are fiber, fluids, and regular exercise. The fiber and fluids add bulk to stools and make them easier to pass. Exercise helps to move things along.

“I advise my patients against taking fiber pills or fiber supplement bars. If they don’t drink enough water with them, the increased fiber can make the constipation worse. I suggest eating a bran or other fiber-rich cereal because people eat those with milk. If you want to try a supplement, get the kind you mix with water.

“Fruit is also a good source of dietary fiber. Studies have shown that prunes both draw water into the stools and stimulate the colon to move things along. The only catch is you need to eat about 12 prunes a day to get the full effect.

“If changing your diet and getting more exercise don’t work, you could talk to your doctor to figure out the cause. Certain medications, including those for high blood pressure or depression, can cause constipation.

“If you do need to take laxatives occasionally, they can be effective and are generally safe if used as directed. The two common types are osmotics and stimulants. Osmotics draw water into the stool; stimulant laxatives induce the colon wall to push stools along. Ask your doctor or pharmacist for a recommendation if you’re not sure what to take.”

Q. How do cereals like oatmeal reduce LDL cholesterol? To what extent does oatmeal lower cholesterol?

A. Helen Rasmussen, PhD, a senior research dietitian in the Metabolic Research Unit at the HNRCA, answers: “The soluble fiber in many fruits, vegetables, and grains—called soluble because it dissolves in water—is known to slightly lower blood levels of “bad” LDL cholesterol.

“Normally, the liver uses cholesterol to make bile acid, which helps to break down dietary fats in the small intestine. After the bile is finished doing its job, the body recycles it. However, soluble fiber prevents bile from being recycled. In response, the liver grabs more cholesterol from the bloodstream and uses it to make bile.

“Studies suggest that soluble fiber can lower LDL cholesterol slightly. According to one study, adding 3 grams of soluble fiber from oats (3 servings of oatmeal, 28 grams each) to your diet can reduce your cholesterol by a few points—for example, from 100 to 97 milligrams per deciliter.So, if your LDL is significantly elevated, fiber alone won’t solve the problem.

“But fiber is important for other reasons. Whole foods that people eat to get fiber are also nutritious in other ways. The benefits include increased insulin sensitivity and lower triglycerides.

“You can get fiber from a variety of whole foods and grains. For example, an apple, a half-cup of cooked carrots or broccoli, two slices of whole grain bread, or a half-cup serving of whole-grain breakfast cereal or cooked oatmeal all provide 1 gram of soluble fiber.”

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