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Dietary fibre and the risk of colorectal cancer
  1. Imperial Cancer Research Fund, Histopathology Unit
  2. 44 Lincoln's Inn Fields, London WC2A 3PN, UK

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It has long been accepted that a high fibre diet is a “good thing” and protects against colon cancer: however, recently there has been a spate of extensive studies, published in prestigious journals, which have not supported this claim. This started with the report from Boston tracking the eating habits of 88 000 female nurses over 16 years which found no protective action of fibre on the development of colorectal cancer or polyps.1 This year saw the publication of more epic studies which found that low fat/high fibre diets2 and dietary supplement with wheat bran fibre did not protect against recurrent colorectal adenomas.3 Fruit and vegetables also seem to have null associations.4 5The recent report by the European Cancer Prevention Organisation Study Group has even found that a soluble fibre supplement had a deleterious effect on recurrence of colorectal adenomas6; similar increases in tumour yield in APC mutant mice following supplementation with fibre-like substrates have also been reported.7

The implications of this are obviously a cause of some concern but most pundits would appear to be in a state of denial. This is exemplified by the papers themselves and by the published comments. The study of Fuchs and colleagues1 actually found that those individuals who ate the most vegetables (significantly) increased their risk of colon cancer by 35%. When reviewed inGastroenterology,8 the conclusion was that it was too early to throw away the “baby with the bath water” and ended with the standard American advice to consume 25 g of fibre a day (the UK recommendations are less as it was not thought that such intakes could be sold to the public). These articles,2 3 while appropriately stating that high fibre cereal supplements or a low fat/high …

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