Article published in the Journal of the American Medical Association, Aug 2007, shows that diet has an important role in the prevention of recurrence in colon cancer patients.


Diet has been shown to be an important factor for the prevention of first-time colon cancer. 2 large studies showed that a "western diet" with large amounts of red meat, sweets, and desserts, and refined grains increased risk of first time cancer. Large studies on the effect of diet on survival, and recurrence of cancer, in patients with treated advanced colon cancer have not been done until now. This population is of course more difficult for dietary intervention to have a major role, but in fact that is exactly what was found.

This study, published mid-August of 2007, looked at over 1000 patients who had been diagnosed and treated for stage III colon cancer. Generally this means that the cancer had already spread to the lymph nodes in the region. Treatment was done with surgery and chemotherapy, and then rates of death and recurrence of cancer were studied in long-term follow up in groups of patients with markedly different diets.

Diets were divided into two main types: the "prudent diet" with many fruits, vegetables, poultry and fish; and the "western diet" with more red meat, fat, refined carbohydrates and grains, and dessert.

Prudent diet

Rich in:

  • green leafy vegetables, yellow vegetables

  • cruciferous vegetables (broccoli etc)

  • legumes

  • fruit

  • light salad dressing

  • tomatoes

  • garlic

  • fish, poultry

  • fruit juice

  • whole grains

  • low fat mayo

  • wine

  • tea


Western diet

Rich in:

  • high fat dairy, low fat dairy

  • refined grains

  • condiments, regular mayo

  • red meat

  • processed meat

  • dessert

  • margarine

  • potatoes

  • butter

  • french fries

  • eggs

  • nuts

  • sugar beverages

  • beer


Items above that potatoes and tomatoes showed some over-lap and were generally in higher amounts in both types of diets. It should also be noted that patients in the prudent diet ate significantly less sugared beverages and french fries. Another thing to note from the data is that when the researchers compared the actual foods in the patients who were separated into different groups, there was very little overlap, so patients who ate the "western diet" really seemed to like those foods!

Not surprisingly, patients who ate the "prudent diet" tended to be more active, have less body weight for their height, and were less likely to smoke. However, the researchers did look at the results, and did adjust for many risk factors including weight, exercise, smoking, and so forth, but still found an independent dietary effect.

The results?

When looking at the rate of either cancer recurrence OR death, patients who ate the most (top 1/5th) of the "western diet" foods had 3.25 times more risk of cancer recurrence or death compared to patients who ate the least (bottom 1/5th) amount of "western diet" foods! The possibility of these results being due to chance was less than 1 in 1000. 

The increased rate of death wasn't from patients who found out they had a recurrence and thus started eating poorly either. If a patient had a recurrence or died within 90 days of completing the questionnaire, their results were excluded.

Perhaps that was not so surprising, that a poor, high-fat, westernized diet would increase the risk of recurrence. 

There was a surprise in this study though, which is that the "prudent diet" - characterized by high fruits and vegetables, whole grains, chicken, and fish, showed no protective effect against recurrence of cancer or death. It is important to note that the researchers were looking at results within the prudent diet group, meaning they were looking to see if that people in this group ate way more fruits and vegetables, and the other "prudent foods", would they have more protection compared to patients who ate less of those foods (but still ate mostly well). 

In my reading of the study, it did not seem to compare rates of cancer recurrence between the western and prudent diet groups.

In a nutshell, they found that if patients were eating a westernized diet, if they ate more of the western foods, they were at increased risk.

If patients were eating a "prudent diet", and they ate more of the prudent foods, they were not more protected than patients who still ate that diet, but less of those foods.

Confusing, but the take home is simple: less of the high fat, red meat, processed meat, refined grains, and other western foods is likely better.


So in combination of the steps that I wrote for prevention of first-time colon cancer:

1. General blood chemistry screen and comprehensive metabolic profile to assess for iron deficiency, other problems. History and physical exam to assess for any significant immune system issues.

2. 25-OH vitamin D3 blood test: this is vital in my opinion to help determine ideal dosage of vitamin D3, if any, with the goal of immune system optimization and colon cancer prevention.

3. Provoked metal detoxification challenge: in those over 40 to assess for significant increased body burden of toxic metals. This is much better in my opinion than a simple blood mercury and blood lead, which are usually only indicative of acute exposure. Remember, many heavy metals are likely human carcinogens.

4. Consider folic acid, calcium, green tea, curcumin, diet rich in fruits and vegetables, diet low in red meat and preserved meats. The ideal plan is also based on the blood chemistry and metabolic profile, as this can give hints as to the ideal type of diet for a particular person’s metabolism.

5. Aerobic exercise.

6. Crohn’s / Ulcerative Colitis patients:  Screen for food sensitivities (IgG) / allergies (IgE) through either blood ELISA/RAST test. Food elimination / challenge testing may be done to determine symptoms that may be provoked by positive foods. Groups with inflammatory bowel diseases, such as Crohn’s and ulcerative colitis, are at known elevated risk for colon cancer.

7. “watch-and-wait” colonoscopies and fecal occult blood tests.



Reference: Discussed Diet & Colon Cancer recurrence JAMA article

Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Hu FB, Mayer RJ, Nelson H, Whittom R, Hantel A, Thomas J, Fuchs CS. 2007. Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA. 2007 Aug 15;298(7):754-64.



References: Vitamin D & Cancer (extraordinary number of studies in this area)


Guo H, Guo J, Xie W, Yuan L, Sheng X. 2018. The role of vitamin D in ovarian cancer: epidemiology, molecular mechanism and prevention. J Ovarian Res. 2018 Aug 29;11(1):71. doi: 10.1186/s13048-018-0443-7.


Yokosawa EB1, Arthur AE, Rentschler KM, Wolf GT, Rozek LS4,5, Mondul AM. 2018. Vitamin D intake and survival and recurrence in head and neck cancer patients. Laryngoscope. 2018 Nov;128(11):E371-E376. doi: 10.1002/lary.27256. Epub 2018 May 14.


Karthikayan A, Sureshkumar S, Kadambari D, Vijayakumar C. 2018. Low serum 25-hydroxy vitamin D levels are associated with aggressive breast cancer variants and poor prognostic factors in patients with breast carcinoma. Arch Endocrinol Metab. 2018 Aug;62(4):452-459.




Reference: Heavy metals & Cancer risk


Zhang L1,2, Zhu Y3, Hao R1, Shao M1, Luo Y1. 2016. Cadmium Levels in Tissue and Plasma as a Risk Factor for Prostate Carcinoma: a Meta-Analysis. Biol Trace Elem Res. 2016 Jul;172(1):86-92.


Joseph P1. 2009. Mechanisms of cadmium carcinogenesis. Toxicol Appl Pharmacol. 2009. Aug 1;238(3):272-9. doi: 10.1016/j.taap.2009.01.011. Epub 2009 Feb 6.


McElroy JA, Shafer MM, Trentham-Dietz A, Hampton JM, Newcomb PA. 2006. Cadmium exposure and breast cancer risk. J Natl Cancer Inst. 2006 Jun 21;98(12):869-73.


Smith AH, Marshall G, Roh T, Ferreccio C, Liaw J, Steinmaus C. 2018. Lung, Bladder, and Kidney Cancer Mortality 40 Years After Arsenic Exposure Reduction. J Natl Cancer Inst. 2018 Mar 1;110(3):241-249. doi: 10.1093/jnci/djx201.


Kuo YC, Lo YS, Guo HR. 2017. Lung Cancer Associated with Arsenic Ingestion: Cell-type Specificity and Dose Response. Epidemiology. 2017 Oct;28 Suppl 1:S106-S112.


Cohen SM, Chowdhury A, Arnold LL. 2016. Inorganic arsenic: A non-genotoxic carcinogen. J Environ Sci (China). 2016 Nov;49:28-37.


Buha A, Matovic V, Antonijevic B, Bulat Z, Curcic M, Renieri EA, Tsatsakis AM, Schweitzer A, Wallace D. 2018. Overview of Cadmium Thyroid Disrupting Effects and Mechanisms. Int J Mol Sci. 2018 May 17;19(5). pii: E1501. doi: 10.3390/ijms19051501.




References: Irritable Bowel Disease & Food Sensitivities / Allergies


Limketkai BN1, Sepulveda R1, Hing T1, Shah ND2, Choe M1, Limsui D1, Shah S1. 2018. Prevalence and factors associated with gluten sensitivity in inflammatory bowel disease. Scand J Gastroenterol. 2018 Feb;53(2):147-151.


Van Den Bogaerde J, Cahill J, Emmanuel AV, Vaizey CJ, Talbot IC, Knight SC, Kamm MA. 2002. Gut mucosal response to food antigens in Crohn's disease. Aliment Pharmacol Ther. 2002 Nov;16(11):1903-15.


Cai C, Shen J, Zhao D, Qiao Y, Xu A, Jin S, Ran Z, Zheng Q. 2014. Serological investigation of food specific immunoglobulin G antibodies in patients with inflammatory bowel diseases. PLoS One. 2014 Nov 13;9(11):e112154.


Gunasekeera V, Mendall MA, Chan D, Kumar D. 2016. Treatment of Crohn's Disease with an IgG4-Guided Exclusion Diet: A Randomized Controlled Trial.  Dig Dis Sci. 2016 Apr;61(4):1148-57.