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Colorectal cancer risk depends on the quality of the carbohydrate consumed rather than the overall quantity, with high consumption of carbohydrates from high GI (glycemic index) foods related to an increased cancer risk and high consumption of carbohydrates from low GI foods related to a decreased cancer risk. Carbohydrates in foods with a high GI are more quickly digested and absorbed and, consequently, diets with a high GI are associated with an excessive increase in blood glucose and insulin. Insulin stimulates cell proliferation by direct activation of insulin/insulin-like growth factor (IGF) receptors, or via inhibition of IGF binding proteins, which may result in increased levels of bioavailable IGF-1, which plays an important role in the etiology of colon cancer. A high GI diet is typically low in resistant starch (which escapes digestion in the small intestine) and resistant starch has been associated with reduced postprandial insulin levels. Resistant starch is extensively fermented by large intestine flora resulting in increased butyrate levels which play an important role in maintaining intestinal homeostasis and appear to induce the selective apoptosis of colon cancer cells.
Sabina Sieri, PhD, Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1 20133 Milan – Italy +39-0223903506 / +39-0223903510 (FAX), sabina.sieri@istitutotumori.mi.it
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