Doctor’s Tip: How to avoid cancer of the esophagus
The esophagus is the muscular tube that carries food from your mouth to your stomach. There are about 18,000 new cases of esophageal cancer diagnosed in the U.S. annually, resulting in around 15,000 deaths. Cancer usually starts in the lining of the esophagus, and symptoms are often absent in this stage. Eventually the cancer invades the outer layers of the esophagus, and the final stage involves spread to other organs (metastases).
The primary risk factors for esophageal cancer are smoking, heavy alcohol consumption, and GERD (gastroesophageal reflux disease, aka acid reflux). According to Dr. Greger in his book “How Not to Die,” over the past 30 years “the incidence of esophageal cancer in Americans has increased six-fold,” primarily due to an increase in GERD. It’s interesting that 28 percent of Americans suffer from acid reflux at least weekly, whereas in Asia only 5 percent of the population are affected. The difference is not genetic, because when Asians move here and eat the S.A.D. (standard American diet) they suffer the same rate of GERD as the rest of us. The difference is in what they eat in their native countries.
According to Dr. Greger, “the most consistent association with [esophageal cancer] was the consumption of meat and high-fat meals.” A few minutes after eating a fatty meal, the sphincter muscle between the lower end of the esophagus and the stomach relaxes, allowing acid to backflow into the esophagus, where is doesn’t belong, which causes a burning sensation (heartburn). Over the years the chronic irritation and inflammation from acid in the esophagus leads to Barrett’s esophagus, which is a pre-cancerous abnormality of the lower esophagus. Eventually, cancer often ensues. (Scarring of the lower esophagus can also occur, which results in difficulty swallowing food).
Fiber, which is found in plant but not animal products, decreases reflux and reduces the risk of esophageal cancer by at least one-third. Fiber prevents constipation and straining at the stool — which can cause a hiatal hernia, where part of the stomach is pushed up through the diaphragm, which separates the chest and the abdominal cavities. Hiatal hernias are often the cause of cancer-causing acid reflux. Fiber also binds to and “flushes out” cancer-causing environmental toxins.
Plants not only contain fiber, but they also contain anti-oxidants and other cancer-killing micronutrients. Dr. Greger notes that “the most protective foods for esophageal cancer are red, orange,and dark-green leafy vegetables, berries, apples and citrus fruits.” In a randomized study, patients with mild to moderate precancerous esophageal lesions were given large quantities of powdered strawberries daily for six months, and progression of disease was reversed in 80 percent — in 50 percent the disease totally resolved.
The prognosis of esophageal cancer is grim, with a five-year survival of less than 20 percent. The tips noted above can help prevent it. But if you have difficulty swallowing, or more than occasional heartburn, see your primary care provider or a gastroenterologist without delay. An upper endoscopy can detect precancerous Barrett’s. Acid reducers such as Prilosec and Nexium can help, but when taken long-term can have side effects. I have seen countless patients over the years whose GERD resolved with lifestyle modification such as healthier eating; avoiding aspirin, ibuprofen and other irritating anti-inflammatories; raising the head of the bed; avoiding alcohol and caffeine; and avoiding eating within two2 hours of reclining.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and other medical issues, and to help people with hospital or other medical bills they don’t understand or think are too high. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.