The esophagus is the tube-like structure that carries food from your mouth to your stomach. About 18,000 new cases of esophageal cancer are diagnosed in the U.S. annually, resulting in some 15,000 deaths. Once diagnosed, the prognosis is grim: the five-year survival rate is only 20 percent, with most people dying within the first year.

There are two types of esophageal cancer: Squamous cell carcinoma makes up 90 percent of cases in Eastern and Southeast Asia and sub-Saharan Africa. Today’s column is about adenocarcinoma, that makes up most of the cases in the U.S. and Northern and Western Europe. Risk factors for adenocarcinoma of the esophagus include age (50-70); obesity; tobacco; and particularly chronic GERD (gastroesophageal reflux disease, a.k.a. acid reflux).

According to Dr. Michael Greger in “How Not to Die,” the incidence of esophageal cancer in America has increased six-fold over the past three decades, primarily due to an increase in GERD. It’s interesting that 28% of Americans suffer from acid reflux at least weekly, whereas in Asia only 5% of the population is affected. The difference is not genetic, because when Asians move here and eat the typical meat, dairy-based, and processed food 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.

The most consistent factor associated with esophageal cancer is the consumption of meat and fat. A few minutes after eating a fatty meal, the sphincter muscle between the lower end of the esophagus and stomach relaxes, allowing acid to backflow into the esophagus, where it doesn’t belong. This reflux of stomach acid often causes a burning sensation in the chest (“heartburn”). Over the years, the chronic irritation and inflammation from acid reflux leads to Barrett’s esophagus, which is a pre-cancerous abnormality of the lower esophagus. Eventually, cancer can ensure. (Scarring of the lower esophagus can also occur, resulting in difficulty swallowing food).

Fiber—which is found in plant but not animal products—decreases reflux and reduces risk of esophageal cancer by at least a third. Fiber also prevents constipation. Increased abdominal pressure due to straining to have a bowel movement can cause a hiatal hernia, where part of the stomach is pushed up through the diaphragm, which separates the chest and abdominal cavities. Hiatal hernias are often the cause of cancer-causing acid reflux. Furthermore, fiber also binds to and “flushes out” cancer-causing environmental toxins.

Plant foods not only contain fiber, but they also contain antioxidants 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% of participants; in 50% the disease totally resolved.

Bottom line: To avoid this often-fatal cancer, maintain ideal body weight, don’t use tobacco, eat a high fiber diet, and eat intensely-colored fruits and vegetables (“eat the rainbow”). If food gets stuck when you swallow it, or if you have more than occasional heartburn, don’t just pop acid-reducing pills like Prilosec, but see your primary care provider. An upper endoscopy by a gastroenterologist can determine if you have pre-cancerous Barrett’s esophagitis. In many patients with mild to moderate reflux, the problem resolves with healthier eating; avoiding aspirin, ibuprofen, and other irritating anti-inflammatory agents; raising the head of the bed on 4-6-inch blocks (or use of a foam wedge); avoiding alcohol and caffeine; and waiting at least two hours between eating and going to bed.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.