Jewish World Review May 5, 2003 / 3 Iyar, 5763

Vitamins & Colorectal Cancer

By Robert A. Wascher, M.D., F.A.C.S. | There have been a number of factors linked to the development of colorectal cancer, many of which I have discussed in past columns. A new study in the journal Gastroenterology looks at the relationship between dietary intake of the vitamins folate and B12 and the incidence of colorectal cancer. The addition or removal of methyl groups (one carbon atom attached to three hydrogen atoms) to or from specific regions of our DNA can result in changes in the expression of the affected genes. Low levels of folate in the body can result in a reduction of the number of genes that contain attached methyl groups (hypomethylation).

In this study, 35 patients with precancerous polyps of the colon (adenomas), 28 patients with colorectal cancer, and 76 patients without any colorectal disease, were evaluated. At the time of colonoscopy, biopsies of the lining of the colon were obtained on all study patients, and blood samples were colleted and tested for levels of folate, vitamin B12, and the extent of DNA methylation. Dietary folate intake was estimated using detailed questionnaires.

This study determined that the patients with colorectal cancer had an average blood level of folate that was 26% lower than the average of the control patients without colorectal disease, as well as a 21% lower blood level of vitamin B12. The degree of DNA hypomethylation in the colon biopsy samples was 26% lower in the adenoma patients, on the average, when compared to the control patients, and 30% lower among the patients with colorectal cancer. High folate concentrations in the blood were associated with a significantly reduced risk of developing colorectal cancer in this rather small study.

Although this study was modest in size (and should be repeated using larger numbers of patient volunteers), it does suggest that high levels of folate and vitamin B12 in the diet and blood may lead to a reduction in the risk of developing colorectal cancer. This study joins previous studies that have identified a colorectal cancer risk reduction in people with calcium-rich and red meat-poor diets, and in patients who take certain antiinflammatory medications.

A healthy balanced diet, based upon currently accepted standards, will already cover most of these colon cancer prevention factors. Regular colonoscopies after age 60-65 (and earlier in patients with a strong family history of colorectal cancer) have also been demonstrated to substantially reduce the risk of dying of colorectal cancer.


By now, most of us know that many disease-causing bacteria are becoming resistant to many of the antibiotics historically used to treat such infections. This is a particular problem in hospitals, where such killer bugs tend to lurk.

Seriously ill and immunocompromised hospitalized patients are the most susceptible hosts to such resistant bacteria. In the current issue of the Archives of Internal Medicine is a study that looked at the antibiotic prescribing habits of doctors caring for non-intensive care hospital patients. The appropriateness of the selected antibiotics was assessed based upon the patients' diagnoses and, when performed, the results of bacterial cultures taken from ill patients.

A total of 129 patients were included in this study, with each patient staying an average of 15 hospital days. The study's experts calculated that antibiotics were not even indicated 30% of the time, although they were prescribed by attending doctors nonetheless.

The most common reasons for unnecessary antibiotic therapy included: excessively long durations of otherwise appropriately prescribed antibiotic therapy; use of antibiotics in the absence of apparent bacterial infections; and treatment of bacterial cultures that actually represented the patients' own normal bacteria, or bacteria that were not causing any clinical infections.

In view of the alarming rate at which life-threatening infection-causing bacteria are becoming resistant to our best antibiotics (as well as the risk of patients becoming infected with normally innocuous bacteria following the elimination of their naturally-occurring indigenous bacterial flora after prolonged exposure to broad spectrum antibiotics), this study should be made required reading for all physicians.


Common sense would seem to dictate that children who bully other children may go on to exhibit violent behaviors against others later in life. A Health & Human Services Department study, just published in the Archives of Pediatric & Adolescent Medicine takes a more scientific look at this problem.

A cross-sectional sample of 15,686 American students in public and private schools, in grades 6 through 10, participated in the World Health Organization's Health Behavior in School-aged Children survey in 1998. The survey asked students to anonymously report on weapon-carrying behaviors, fighting with other students, and being injured in fights with other students. These threatening or violent behaviors were then correlated with self-reporting on the incidence of engaging in or being the recipient of bullying behaviors.

Involvement in each of the violence-related behaviors ranged from 13% to 23% of boys, and in 4% to 11% of girls. Bullying others and being bullied were consistently related to each violence-related behavior for both boys and girls. Not surprisingly, greater odds of engaging in violence-related behaviors were linked with bullying others rather than with being the recipient of bullying.

Moreover, the likelihood of engaging in violence-related behaviors was greater among children who engaged in bullying outside of school property when compared to schoolyard bullies. As an example, and based upon statistical analysis, being on the receiving end of weekly bullying at school was associated with a 1.5 times greater likelihood of weapon-carrying, while bullying other kids at school translated into a 2.6-fold increased risk of weapon-carrying. Being bullied by other kids off of school property was associated with a 4.1 times greater risk of weapon-carrying, while children who bullied other kids away from school had a nearly 6-fold increased likelihood of engaging in weapon-carrying behaviors.

The study concludes what most parents, and probably all kids who have been on the receiving end of intimidating or violent behavior at the hands of their schoolmates, already know: bullying behavior is not a benign rite of passage for school kids. It is abnormal, unhealthy and inexcusable behavior in virtually every case. Such behaviors are also clearly linked to a greater propensity towards engaging in patently violent and illegal behaviors towards others.

Sadly, even the recipients of such abuse appear to, subsequently, be at increased risk of displaying the violence-related and sociopathic behaviors displayed by their tormentors.

I urge each and every parent to take bullying seriously, whether their child is on the "giving" end or the receiving end, and to adopt a zero-tolerance attitude towards such behaviors. Children who have been victimized by such behaviors should understand that, quite apart from the humiliation and risk of emotional and physical harm that they may suffer, they too are at increased risk of recapitulating the bullies' behaviors.

Such children should seek help from their parents, and from trusted school officials. In those cases where school officials are properly notified that bullying behaviors are known or suspected, it is absolutely incumbent upon those authorities to take aggressive and preemptive action to stop such behaviors. The failure to do so, by all parties concerned, can have especially tragic consequences, as many of us who follow the news carefully are already aware.


The bacterium Streptococcus pneumoniae, or "pneumococcus," is a common cause of ear infections, sore throats and respiratory infections in children, and in adults as well. This disease-causing bug has also started to show a worrisome trend towards becoming resistant to the traditional first line antibiotics long used to treat pneumococcal infections.

In 2000, a new vaccine against pneumococcus was approved for use in children in the United States. Two new studies in the current issue of the New England Journal of Medicine look at the impact of this new vaccine on the incidence of pneumococcal infections in the US.

The first study looked at Centers for Disease Control data on pneumococcal infections among a database encompassing 16 million people between 1998 and 2001. The data shows that the rate of invasive pneumococcal disease dropped from an average of 24.3 cases per 100,000 persons in 1998 and 1999 to 17.3 cases per 1000,000 in 2001.

The largest decline was seen among children less than 2 years of age. In this age group, the rate of disease was 69% lower in 2001 than in the pre-vaccine years studied.

Pneumococcal disease rates also fell among adults following the introduction of the vaccine to children in 2000. Following vaccine introduction in 2000, the rate of pneumococcal disease for adults 20 to 39 years of age dropped 32%, while for 40 to 64 year-old adults, the disease rate dropped 8%. In the 65 years and above age group, the rate of pneumococcal disease fell 18%.

The authors of this study conclude that the pneumococcal vaccine appears to be having a significant impact on pneumococcal disease, and not only among the vaccinated children, but among adults in the population as well. This vaccine "bystander" effect is a common observation for children's vaccines against communicable diseases, and points out the population-wide benefits of having all children immunized against serious diseases.

The second study looked at the impact of administering the pneumococcal vaccine to elderly adults. Pneumococcus is a major cause of severe bacterial pneumonia in adults, and among the elderly in particular (Muppet creator Jim Henson died from pneumococcal pneumonia in 1990 at the age of 53). In this retrospective study, the association between pneumococcal vaccine administration and the incidence of pneumococcal disease was studied among 47,365 volunteers 65 years of age and older, over a three year period.

Prior receipt of the pneumococcus vaccine cut the risk of pneumococcal blood infections nearly in half among these elderly volunteers. However, the overall incidence of pneumonia did not appear to be affected by patient vaccine status. The study concluded that the pneumococcal vaccine protected elderly patients against developing infections with pneumococcus in the blood, but did not appear to have any significant impact on the risk of developing bacterial pneumonia, which is the most common disease caused by this bug in older adults. This suggests that other strategies for preventing bacterial pneumonia in the elderly must be found.


Breast milk is rich in a form of fat known as long chain fatty acids (LCFA). However, most commercial formulas do not contain a sizable portion of their fat content in the form of LCFA. There is some scientific evidence that babies fed with breast milk tend to have a lower incidence of high blood pressure in later childhood. In adults, dietary supplementation with omega-3 fatty acids has also been shown to reduce elevated blood pressure in patients with established hypertension.

A new European study, just published in the British Medical Journal, looked at the effects of supplementing commercial infant formula with LCFA. A total of 111 newborns were fed with LCFA-supplemented formula, while 126 newborns were fed with unsupplemented formula.

The babies were then followed until age 6. The study determined that the children who had received the LCFA-supplemented formula as infants had significantly lower average blood pressures when compared to the children who had been fed standard infant formula. The study's authors noted that blood pressure trends during childhood tend to continue into adulthood, and postulate that early exposure to dietary LCFA may reduce the incidence of high blood pressure during adulthood. A study of much longer duration will, obviously, be required to prove the authors' hypothesis.


Over a thousand Asian-American women, including 501 with breast cancer, were included in this interesting study, which has just been published in the journal Cancer. A survey looking at levels of recreational physical activity was administered to all study participants, and the results were statistically analyzed.

The study found that increasing levels of recreational physical activity were significantly associated with a decreased risk of breast cancer. Asian-American women reporting the highest levels of recreational physical activity experienced just under half the risk of developing breast cancer when compared to women with little or no recreational physical activity. Intermediate levels of physical activity were, in turn, associated with a 9% to 47% decrease in breast cancer risk that was proportional to the amount of regular weekly recreational physical activity.

Thus, this study strongly suggests that physical exercise confers a significant protective effect against breast cancer. Of course, there may be other factors in play here. The women with the greatest investment in regular exercise may also be engaging in other health-positive behaviors that might be additive to the cancer-reducing effects of regular exercise. Still, we know that physically fit people have a smaller risk of developing cancer, cardiovascular disease, stroke, high blood pressure and diabetes when compared to people who are not physically fit.

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.


04/28/03: Body Weight & the Risk of Cancer; Bone Protection Following Discontinuation of Hormone Replacement Therapy; C-reactive Protein & Stroke

04/14/03: Echinacacea & Quality Control; Obesity Update; Aortic Valve Stenosis, Arteriograms & Strokes; Preventing Recurrent Blood Clots

03/31/03: Breast Fibroadenomas & the Risk of Breast Cancer; Inflammatory Markers & Risk of Heart Failure; Update on Smallpox Vaccine; SARS Update

03/10/03: More Data on Hormone Replacement Therapy & the Risk of Breast Cancer; Oral Health & the Risk of Cardiovascular Disease; More Bad News about C-reactive Protein; Update: Daily Multivitamin & Minerals Supplements; Baby Aspirin & the Risk of Colorectal Adenomas; Aspirin & the Risk of Colorectal Polyps

03/03/03: Management of enlarging thyroid nodules; Long-term anticoagulation reduces the risk of recurrent blood clots in the veins; colon polyp recurrence after colonoscopic polyp removal; Vitamins C & E and Atherosclerotic Disease: The Debate Continues

02/24/03: Tamoxifen & Benign Breast Disease; New Recommendation on Digitalis Dosing; Creutzfeldt-Jakob Disease & the Nose; Radiologist Experience & Accuracy of Mammogram Interpretation; More Data on the Incidence of GI Side Effects with Selective COX-2 NSAIDs; Regular Rest Breaks & the Risk of Industrial Accidents

02/18/03: Update on Alzheimer's Disease; Very Low Birth-weight Babies & Cognitive Development; The Great Blood Pressure Medication Debate

02/03/03: Update on C-reactive Protein; COX-2 Inhibitors & Arterial Function; COX-2 Inhibitors and Gastrointestinal Complications; Telomere Shortening & Risk of Death

01/24/03: Bo-tox that BO Away!; The Super-sizing of America; Marijuana: A Gateway Drug?

01/21/03: Dietary Soy & Prostate Cancer Risks; Retention of Surgical Foreign Bodies after Surgery; Diet & hormone levels in adolescent girls

01/10/03: Can Aspirin Prevent Esophageal Cancer?; A Drink to Your Health!; Hormones & Breast Cancer; The Impact of Obesity on Lifespan

01/06/03:"The Pill" for Males?; Obesity & Diabetes Trends in the United States; Binge Drinking in the United States; One Less Reason to be Depressed; Liver Failure: Trends

12/20/02: Citrus Pectin & Cancer; Echinacea & the Common Cold; Update on High Blood Pressure Treatment

12/06/02: Calcium Intake & Prostate Cancer Risk; Alcohol Consumption & Risk of Breast Cancer; Reducing Blood Transfusions in Critically Ill Patients

12/06/02: Alcohol, Tamoxifen & Carotid Artery Wall Thickness; Coffee & Gallstones?; Irritable Bowel Syndrome Update; Statins: More Good News

11/22/02:Alcohol, HRT & the risk of breast cancer; hormone replacement therapy: more bad news; new vaccines may eliminate cervical cancer; more

11/15/02: The Effects of Diet & Exercise on Blood Pressure & Health; Growth Hormone & Sex Steroid Supplements & the Elderly; C-Reactive Protein & Cardiovascular Disease Risk

11/08/02: More Good News About Statin Drugs; Hormone replacement Therapy (HRT) & Alzheimer's Disease; A Role for Antibiotics in the Treatment of Vascular Disease?; more

11/01/02: Digoxin & gender; driving & degenerative disc disease; Coenzyme Q10 & Parkinson's Disease; Ginseng & erections; Viagra & stroke

10/25/02: Aspirin & coronary artery bypass surgery; glucosamine sulfate & progression of knee arthritis; hospital nurse staffing & patient mortality

10/18/02: Motor Vehicle Exhaust Pollution & Mortality; CT Scans, C-Reactive Protein & Heart Disease; Antiperspirant Use & the Risk of Breast Cancer; Atomic Bomb Radiation Exposure Update; more

10/04/02: Antioxidants & the Risk of Stomach Cancer; Best Way to Diagnose Appendicitis?; Coronary Artery Disease: Stent or Surgery?

09/27/02: Breast Feeding & the Risk of Asthma; HMOs & Quality of Care Scores; Red Wine & Vascular Disease

09/20/02: Dietary Folate & the Risk of Colorectal Cancer; Risks Associated with Smoking after Heart Attacks; BRCA1 Gene Mutation & the Risk of Breast & Non-breast Cancers; Breast Tissue Density & Inheritance

09/13/02: Dairy Products, Calcium, Vitamin D & the Risk of Breast Cancer; Efficacy of Nonprescription Smoking Cessation Aids; A Nutty Approach to Heart Disease Prevention; Update on Prostate Cancer

09/06/02: C-Reactive Protein & Estrogen Replacement Therapy; Walking Women & Cardiovascular Disease; Physical Activity Among Teenaged Girls

08/30/02: Babbling babies & brain function; homocysteine levels, vitamins & coronary artery disease; St. John's Wort & chemotherapy

08/16/02: A New Weapon Against Anthrax?; cataracts & motor vehicle accidents; gingko biloba takes a hit; air pollution & heart function during exercise; breast cancer genes & the estimated risk of breast cancer

08/09/02: Botulinum Toxin & Post-Stroke Spasticity; Intestinal Hormone Kills Appetite; Bone Marrow Cells Improve Blood Flow in Vascular Disease; Effectiveness of Restraining Orders on Domestic Violence

08/02/02: Mammography Saves Lives!; Obesity & the Risk of Heart Failure; High Sugar Diets & the Risk of Colon Cancer; Abuse During Childhood & Possible Effects of Genes on Antisocial Behaviors

07/26/02: Cancer: Nature vs. Nurture; Cardiorespiratory Fitness & Inflammation; Kidney Transplants from Cadaver Donors; Aircraft Cabin Air Recirculation & the Common Cold

07/19/02: PCBs & the Gender of Babies; Breastfeeding & the Risk of Breast Cancer; More Bad News About Hormone replacement Therapy

07/12/02: A cancer surgeon's perspective on hormone replacement therapy

07/08/02: Hormone replacement therapy & the risk of disease; more good news about statins; antioxidant vitamins & disease prevention; more

06/28/02: Antioxidants & the Risk of Alzheimer's Disease; Effects of Exercise on the Hearts of Patients with Mild Hypertension; Statins reduce cardiac events following angioplasty; more

06/21/02: Sex & violence and Advertising: Do Advertisers Get What they Pay For?; Don't Drink the Water (or the Salsa Either!); Vasectomy & Prostate Cancer Risk; Update on Smoking & Disease

06/14/02: Young Men, Obesity & Heart Disease; Breastfeeding & Obesity; Irritable Bowel Syndrome & rectal pain threshold; more data on cox-2 inhibitors & cancer; more

06/07/02: New coronary artery stent reduces risk of restenosis; possible cause of Parkinson's Disease identified; more

05/31/02: New biological insights into obesity & weight loss; broccoli kills cancer-causing stomach bug; anti-inflammatory drugs and the risk of heart attack

05/24/02: Molecular detection of tumor cells in the blood & prognosis; Cox-2 & breast/lung cancers; BRCA2 gene mutations & the risk of breast cancer; breast density & the risk of breast cancer

05/19/02: Moderate alcohol intake and blood sugar levels; more good news for tea drinkers; blood potassium levels & the risk of cardiovascular disease; ethnic differences in diabetic complications

05/10/02: Tea drinkers and the risk of death following heart attack; duration of breastfeeding & adult intelligence; abdominal aortic aneurysms: surgery or observation?

05/03/02: Risk of adverse drug reactions from newly released medications; preoperative beta-blockers may reduce heart bypass deaths; shape-shifting plastics may alter surgical practice; weight loss supplement may cause liver damage
04/26/02: Angry young men & risk of premature cardiovascular disease; stay-at-home dads & risk of cardiovascular disease; more on the effects of statins; dairy consumption and the risk of pre-diabetes; smallpox vaccine: good to the last drop?
04/19/02: Change your sex by drinking water?; Anti-inflammatory RXs may reduce growth of breast cancer cells; radiation treatment reduces repeat narrowing of bypass grafts
04/05/02: Fish & Omega-3 fatty acid consumption and cardiac health; news briefs
04/05/02: Can coffee reduce your risk of tooth decay?; exercise & blood pressure; a single high-fat meal reduces coronary artery function
04/01/02: Pre-diabetes: a newly defined category of health risk; teen television viewing and subsequent aggressive behavior; the benefits of strength training in the elderly; more ...
03/22/02: Bacteria, antibiotics & heart disease; mammograms: the debate continues; calcium & the risk of colon cancer ... and more
03/15/02: Mammography debate continues; statins & fracture risk; physical fitness & the risk of death; other intriguing findings
03/08/02: Blows to the chest & sudden cardiac death; air quality & the risk of lung cancer; tomatoes and your prostate
03/01/02: Diet & the risk of ovarian cancer; lifetime risk of developing high blood pressure; Osteoporosis prevention with a once-a-year injection?
02/26/02: The continuing controversy regarding screening mammography
02/22/02: Lowering body temperature after heart attack improves outcome; A silver lining for the chronically sleep-deprived?
02/15/02: Hormone replacement therapy & the risk of breast cancer; use it or lose it: Alzheimer's disease & cognitive stimulation; stress, divorce & death; child daycare, infections & parental guilt
02/08/02: Possible breakthrough in early cancer diagnosis; mammography: the controversy continues; CPR techniques revisited
02/01/02: Antibiotics in livestock feed & human disease; genetic detection of early colon cancer in the stool; genetic analysis of breast cancers may help decide treatment
01/25/02: Drug increases lifespan (if you're a fly...); workplace attitudes and smoking cessation; effects of inadequate sleep on surgeons
01/18/02: Lifelong effects of premature birth; smokers under the knife; aspirin and cardiovascular health
01/11/02: Estrogen levels in the blood & breast cancer risk; Heart attack: sex and survival; dangerous lettuce invaders
01/09/02: Cancer & aging: Two sides of the same coin?
01/04/02: Vitamin a & the risk of hip fracture in postmenopausal women; ovarian cancer risk and oral contraceptives
12/28/01: Magnetic Resonance Imaging (MRI) detects coronary artery disease; new development in obesity research; adverse childhood experiences & the risk of suicide attempts
12/21/01: Vaccination of children controls hepatitis a in the community; a possible cure for sickle cell disease; leptin and the risk of heart attacks
12/14/01: Chernobyl and the Risk of Thyroid Cancer in hildren; children & obesity; gastroesophageal reflux disease update
12/07/01: Update on school shootings; new implantable heart-assist device approved for further evaluation; prevention of fungal infections in pre-term babies
11/30/01: Flu vaccination in asthmatics; low-tar cigarettes are not less harmful; beans and your heart
11/21/01: Modified smallpox vaccine may reduce risk of cervical cancer; New approach to breast cancer diagnosis; New non-invasive prenatal diagnostic test for down's syndrome
11/16/01: Cholesterol-lowering drugs reduce risk of heart attack; supplemental radiation therapy reduces risk of breast cancer recurrence; brains of women may answer age-old questions
11/09/01: Bio-warfare (redux); my gray matter is bigger than yours; mad elk disease?
11/02/01: Making sense of bio-warfare
10/26/01: The impact of mammography on deaths due to breast cancer; diet & exercise may slow cancer cell growth; antidepressants and the risk of heart disease
10/19/01: New insights into autism; the wiley appendix
10/12/01: More bad news about obesity links to other diseases…Hey dad, can I borrow the car keys?
10/05/01: California leads nation in reduction of tobacco-related disease; exercise as an antidepressant?
09/25/01: Advances in the detection of breast cancer; primary care physician awareness of peripheral arterial disease; arsenic in the water
09/17/01: In perspective
09/12/01: Genes may hold secret to long life; men and women: cognitive function in the elderly; physical activity, obesity and the risk of pancreatic cancer
09/05/01: English milk cows prefer Beethoven and Simon & Garfunkel over Bananarama; new prostate cancer prevention study: looking for a few good men; exercise & diet can help prevent diabetes
08/28/01: Arthritis drugs may be linked with increased risk of heart disease; errors in blood clotting tests can be fatal; infant soy formula not associated with reproductive side effects

© 2002, Dr. Robert A. Wascher