We Need to Talk About the Colon Cancer Epidemic

New research shows an alarming increase in the number of younger adults dying from rectal cancer. Dying after a fight with colorectal cancer, the second leading cause of cancer death in America. If you're under the age of 50, it's likely that colorectal cancer isn't on your radar, but it should be. Once considered an older age disease, rates are skyrocketing among young adults. So a 45 year old today has roughly the same colon cancer risk as a 50 year old about 20 years ago. My grandfather died of colon cancer when he was only 36 years old. Right now I'm 32 and I obviously want to prevent that from happening to myself. Especially today, where we see colon cancer rates increasing among younger people. In the US, 1 in 5 new colorectal cancer diagnoses now occurs in individuals under the age of 55. In Estonia, where I'm from, colon cancer is the second most common cancer in men after prostate cancer, and colon cancer ties with lung cancer, which is caused by smoking. Younger people see a very sharp increase in the rates of colon cancer, but at the same time, colon cancer among older adults is becoming less common. That's because early screening works, and usually that starts around the age of 45 or 50. Younger people aren't suspected to have colon cancer, and that's why so many people discover the cancer too late. What's also puzzling is that cancer death rates overall have been declining. People nowadays are less likely to die to all cancers, except colon cancer. That's quite concerning. Researchers have spent years trying to find the reason for this. Maybe it's genetics, maybe it's food, maybe it's the environment, or maybe it's the microplastics. Because my grandfather died to colon cancer so young, I might have a genetic predisposition to also get colon cancer. So obviously, I'm going to pay more attention and investigate this a lot more. So that's what this video is for. I'm going to investigate why the colon cancer rates have been increasing in younger people, what you can do to reduce your risk, what are the potential warning signs you shouldn't ignore, and what you can do as early screening that doesn't necessarily require getting a colonoscopy. Also, if you want to discover your own health percentile, to know what level of health you're at, with various different types of biomarkers, like your fitness markers, body composition, and blood work, what are your bottlenecks and biggest weaknesses, then take the health assessment in our top 1% health community. Link in the description. Let's start with the genetics, because genetics does have a pretty big impact on your risk of future diseases. But when researchers looked more closely, they discovered that only about 20-30% of early-onset colorectal cancer can be explained by hereditary causes. Most of these new cancers are happening in people with no strong genetic link. Now for me, that's quite assuring, because it means that my grandfather's early-onset colon cancer might not necessarily translate over to me. I might have a slightly higher risk than someone who has no family history of cancers, but the genetics isn't the biggest factor that determines this. So if it's not the genes, the next obvious explanation is lifestyle and the environment. Over the last few decades, ever since I've been alive, there's been a big shift in people's diets, their household items, their exposure to various chemicals, and how much exercise they do. For starters, obesity rates have increased. People are carrying a lot more body fat with them, more than ever before. And obesity is a known risk factor for all cancers. In the US, obesity in adults has doubled from 20% of the population to 40%. In the UK, it's nearly tripled, from about 10% to nearly 30% of the population. A meta-analysis of 31 studies involving over 70,000 colorectal cancer cases found that people with obesity had a 19% higher risk of colorectal cancer compared to those with a healthy weight. The reason obesity increases cancer risk is because fat tissue is biologically active. It releases inflammatory molecules, alters hormones, raises insulin, and increases IGF-1. Insulin and IGF-1 are quote-unquote growth signals. IGF-1 and growth signals are useful when healing an injury and building muscle. But if cells keep receiving the growth signals, they have more chances to also become cancerous. That's why there is a U-shaped association between IGF-1 levels, total mortality, and cancer. Too high IGF-1 is bad, but so is too low levels of IGF-1. The lowest risk of cancer, cardiovascular disease, and all-cause mortality is seen to be at 120 to 160 nanograms per milliliter. So you could take an IGF-1 blood test to see if your body is in a state of excessive growth, which could lead to cancer growth. But a lot of people who do get colon cancer aren't overweight or obese. My grandfather certainly wasn't obese. So the second thing to talk about then is diet and food. Over the last 50 years, ultraprocessed foods went from a small part of our diet to over half of calories consumed in many Western countries. A meta-analysis involving more than 460,000 people found that those who consumed the most ultraprocessed foods had a 26% higher risk of colorectal cancer compared to those people who consumed the least. Interestingly, the researchers didn't find a clear dose-response relationship, which suggests that there may be a threshold effect rather than a steady increase in the risk with every additional ultraprocessed food consumed. The biggest reason ultraprocessed foods increase the risk of colon cancer is probably indirect. These foods promote obesity, they promote incident resistance, they promote metabolic syndrome and atherosclerosis. All of this creates an environment in your body that favors the growth of cancer. But that's only one part of the story. Ultraprocessed foods also change your entire body's ecosystem. They're basically very low in fiber, high in salt, sugar, and fat, and also contain various additives, fillers, and other kinds of materials that can disrupt your gut microbiome and cause more inflammation. And because we're talking about colon cancer specifically, then the ultraprocessed foods would have a direct point of contact with the colon. They would cause more intestinal inflammation, which would disrupt your colon functioning and gut microbiome, and that would allow the proliferation of colon cancer inside the colon. Imagine two identical gardens. One gets sunlight, water, nutrient-rich soil, and the other gets almost nothing. Within months, they would look completely different. The same happens in your colon. Your gut bacteria feed on dietary fiber. Vegetables, beans, whole grains, berries, nuts, legumes, most of that fiber passes untouched through your stomach and small intestine. Only in the colon do your bacteria finally get to eat the fiber. And in return, the bacteria produce short-chain fatty acids, such as butyrate, acetate, and propionate. Butyrate is the primary energy source for the cells lining your colon. High butyrate strengthens the intestinal barrier, reduces inflammation, supports healthy cell turnover, helps damaged cells self-destruct before turning cancerous, and creates an environment hostile to harmful bacteria. It's one of the main reasons scientists believe that fiber protects against colon cancer. Fiber also improves stool frequency and consistency, which reduces the time within which potential carcinogens spend in contact with the colon lining. The fiber also binds to different toxins and compounds like microplastics and eliminates them via the feces. Basically, the more consistent stool frequency reduces the time various metabolic byproducts, bad bacteria, and other types of toxins spend in the colon. The more time these harmful compounds spend in your colon, the greater the likelihood they cause inflammation and promote cancer growth. This isn't just theory. Large meta-analyses across hundreds of thousands of people consistently show that the highest fiber intake correlates with significantly lower colorectal cancer risk, including other cancers. It's one of the strongest, most consistent findings in cancer nutrition research. Unfortunately, most people aren't getting close enough fiber. Up to 40 grams of fiber appears to be beneficial. It's probably even better at 50 or 60 grams, but there's not enough data on such high quantities of fiber. That's one of the reasons why nearly every major cancer organization recommends increasing fiber intake. 40-50 grams of fiber is a lot compared to the 15-20 grams of fiber the average American eats in a day. And that's also one of the reasons why I started to eat a lot more fiber. Over the last 4-5 years, I've basically doubled my fiber intake. I went from around 25-30 grams of fiber a day to now 50-60 grams of fiber. I don't take any fiber supplements. I think those are kind of not necessary. I just eat a lot of foods that contain fibers, such as vegetables, berries, fruits, nuts, seeds, whole grains. People with colorectal cancer consistently have a less diverse gut microbiome. They have fewer beneficial bacteria, especially butyrate producers, such as Fecalibacterium prausnitzii and roseburia. They also have more harmful species, such as Fusobacterium nucleatum, which can promote inflammation, damage DNA, suppress anti-tumor immunity, and accelerate tumor growth. I've gotten a few gut microbiome diversity tests over the years, and my diversity is generally quite good. In 2022, when I was eating a bit less fiber, my gut microbiome diversity score was 3.5, which was in the optimal range. And I had 104 different bacterial species, which is a healthy range from 94 to 131. That's when I just started eating more fiber. In 2026 today, I've been eating a lot more fiber, and my microbiome test results show that my microbiome diversity was 3.6, which is a slight improvement. And the amount of bacterial species in my gut was 113, which is about a 10% improvement. By the way, if you want to do the same microbiome test, then check out the link in the description. The company ships across Europe, and you can use the code CM15 for a 15% discount. Studies looking at the microbiome of the Hadza hunter-gatherers shows that compared to contemporary Italians, their microbiome diversity is significantly richer and more diverse. They also had more species that were completely absent in the urban Italians. The Hadza hunter-gatherers aren't plant-based or vegetarian by any means, but they do eat quite a lot of fiber. During some periods of the year, they eat up to 80 to 100 grams of fiber per day. They're eating these wild, undomesticated plants, which have a lot more fiber and a lot less carbohydrates and glucose. In 2025, researchers analyzed the genomes of 981 colorectal cancers from 11 countries. They discovered that tumors diagnosed before age 40 were about 3.3 times more likely to carry the distinctive DNA fingerprint left behind by colibactin, which is a toxin produced by certain strains of gut E. coli. Those mutations appeared very early in tumor evolution, which suggests that the damage may have occurred during childhood or even decades before the cancer was diagnosed. Now, before you panic, this doesn't mean that people who carry this bacteria are destined to get colon cancer. There are millions of people with E. coli who don't get colon cancer. There's also currently no evidence that you should try to eliminate E. coli because only certain strains of bacteria produce this colibactin. The best strategy that you have is to just eat the diet that increases your gut microbiome diversity because with that diversity, the more these bacteria that are associated with better health outcomes you have, the greater the likelihood that you will have less of the bacteria that are associated with colon cancer. It's like a rotten apple. The more rotten apples you have in your basket, eventually the entire basket becomes full of rotten apples. But if you take out the rotten apples before they spread, you're just going to have healthy apples. What about meat intake? The biggest driver of colon cancer comes from processed meat like sausages, bacon, etc. It's often found that processed meat is associated with increased risk of colon cancer, but the relationship is weaker with unprocessed meat. In the United States, where the colon cancer rates are rising the most, meat consumption per person has increased. However, most of that increased meat intake has come from consuming a lot more poultry. Beef intake has dropped and pork intake has stayed relatively the same. But what is the mechanistic explanation why meat intake could increase the risk of colon cancer? One leading theory involves heme iron, the type of iron found in red meat, which can promote the formation of compounds that damage DNA inside the colon, Processed meats add another problem, nitrites and nitrates, which can be converted into carcinogenic nitrosamines. How you cook the meat matters too. Grilling, barbecuing, and pan frying at high temperatures produces compounds called heterocyclic amines and polycyclic aromatic hydrocarbons. These are chemicals that can also damage DNA. A diet high in meat and low in fiber may also shift the gut microbiome towards fewer beneficial bacteria and towards lower butyrate production while increasing inflammation and harmful metabolites. Lastly, animal protein also increases IGF-1 levels, which, as we discussed, is associated with higher cancer risk at higher levels. Now, none of these mechanisms explain the increased risk of colon cancer among younger people. But combined together with all these other factors that we've discussed, there are several biologically plausible mechanisms by which the meat intake could contribute to colon cancer risk, especially in the context of a low-fiber diet. So what if you do eat a higher meat diet with also a high fiber intake? In the EPIC study on half a million Europeans, higher fiber was associated with lower colorectal cancer risk, even after adjusting for red and processed meat. In the longer follow-up, each additional 10 gram per day of fiber was associated with about 13% lower colorectal cancer risk. In the NIH AARP study on 489,000 participants, people who ate dietary patterns with relatively more plant protein and less red meat did see a lower colon cancer risk. Again, is it because of the higher fiber intake is not clear, and the evidence for meat and cancer is also somewhat conflicting? Whatever the case is, I think you should just start as a baseline with a higher fiber intake, because that's what has the most evidence in terms of diet and cancer risk. In the example of my grandfather, he was living in the former Soviet Union Republic of Estonia, so they didn't have very healthy diets back then. He probably couldn't afford a lot of meat. He also couldn't afford eating a lot of different vegetables. So he wasn't eating a high meat diet, but he also wasn't eating a high fiber diet. I think the biggest thing that got to him was just smoking and having a poor quality diet, which was because they couldn't just afford a higher quality diet. I want to shift gears from the microbiome to another thing that you could measure to assess your future cancer risk, and that's your biological age scores. A new analysis on UK and US participants saw that Gen X and younger generations have a higher biological age than the boomers. Those born in 1965 to 1974 were seen to have a 23% higher biological age gap compared to those who were born in 1950 to 1954. The gap in millennials was even higher. In the US, those born in the 90s had a 92% higher phenoage age gap than those born in 1965 to 1969. Biological age was estimated with phenoage, which is based on nine blood markers plus chronological age. albumin, alkaline phosphatase, creatinine, CRP, glucose, mean cell volume, RDW, white blood cell count, and lymphocyte percentage. This isn't a 100% perfect depiction of someone's biological age, but it reflects systemic health based on common blood markers. Phenoage has been shown to strongly predict mortality, with people who have a higher phenoage score than their chronological age having a higher risk of mortality, and people with a lower phenoage score have a lower mortality risk. But the researchers in this study also saw that people with a higher phenoage score had a higher risk of certain cancers. In the UK Biobank, each one standard deviation increase in phenoage age gap was associated with 8% higher risk of early-onset solid cancers, 57% higher risk of early-onset lung cancer, 17% higher risk of GI cancers, 14% higher risk of colon cancer, and 31% higher risk of uterine cancer. Now, this study doesn't necessarily prove that a higher phenoage causes cancer, but what it does reflect is that if you have a higher phenoage score, which will be reflecting your worst blood markers, the ones that we mentioned, albumin, creatinine, CRP, and glucose, etc, if those markers are worse for you, then that appears to also correlate to a higher risk of cancers, at least some of the cancers. The millennials and younger generations just have worse diets. They're more obese, they have circadian rhythm disruption, they're more sedentary, they have worse metabolic health, higher inflammation, and worse immune system function. That's the link that increases the colon cancer risk. Fortunately, my own biological age scores are excellent, and I have 19 years lower phenoage, which is one of the best in the world, and 20 years lower Bortz age, which is about 11% more accurate than the phenoage. The best strategy overall to reduce your risk of developing and dying to colon cancer is early screening. The reason younger people nowadays are more likely to die to colon cancer than older people is because the younger people, they don't go get tested. They don't know if they get the cancer, and when they do detect it, it's too late. Whereas people in their 50s, they get regular checkups and regular screening for cancer. Here's an overview of the best tests you can do. The phenoage test. It's the biological age estimation based on nine blood markers plus chronological age. The markers are albumin, fasting glucose, alkaline phosphatase, HCRP, lymphocyte percentage, white blood cells, creatinine, red cell distribution width, and mean corpuscular volume. A higher phenoage above your chronological age can be a sign of worse metabolic health, which then increases your risk of cancer. You could also measure Bortz age, which is based on the nine phenoage markers, plus 12 more. It's shown to be 11% more accurate than phenoage. Other blood markers you can measure include IGF-1 and insulin. As we discussed, high IGF-1 promotes the growth of all cells, not just muscle, but also cancer cells. The good news is that colon cancer is the only cancer where if you detect it early enough, you can prevent it from developing fully. If you get a colonoscopy, for example, the doctors see that there are some cancerous polyps growing there, they can immediately cut it off and prevent the polyps from developing into a real cancer. Here are some warning signs you shouldn't ignore. Blood in or on the stool, as well as rectal bleeding, black and tarry stool, a persistent new change in your bowel habits or stool structure, unexplained iron deficiency anemia, unexplained weight loss, persistent abdominal pain, a persistent feeling that the bowel hasn't emptied, and new fatigue or weakness associated with anemia. Now, occasional constipation, occasional diarrhea, occasional, you know, blood in your stool doesn't mean that you have colon cancer. It just might be a sign that you should investigate a bit further. Here's a common sense screening approach from the earliest point to the later point. Step one, basic health plus blood work. Start with routine blood work. In addition to the phenom age, you can measure your complete blood count, iron and ferritin levels, and overall metabolic health markers. You should do this even if you don't care about cancer risk or if your cancer risk is extremely low. Step two, stool blood testing. A fit fecal immunochemical test looks for tiny amounts of human blood in stool that you can't see with your eyes. It's very cheap, you can do it at home, it's non-invasive, and it is a standard colorectal screening option when you perform it regularly. If the fit test detects invisible blood in your stool, it doesn't mean you have cancer, but it generally warrants a follow-up. I've done a few of these stool blood tests over the last few years as an early screening method, and they've all been normal. And I'll keep doing them occasionally at least once a year because they only cost like 10 to 20 euros. Step three is the colonoscopy. This is the definitive examination. The doctor can directly inspect the colon, biopsy suspicious lesions, and remove precancerous polyps during the same procedure. For average risk adults, most of the major guidelines recommend beginning colorectal cancer screening at the age of 45. You shouldn't immediately jump to a colonoscopy, you probably even can't, but if your stool tests show higher amounts of invisible blood, then consult with your doctor to see if you qualify for a colonoscopy. Now, if you have family history of colon cancer or other types of cancers, you might want to start a little bit earlier, which is why I'm doing these stool tests already in my 30s. Now, so far I've had no warning signs, I have very good microbiome health, I have very good gut health, I have very good metabolic health and very good biological age scores, so probably my risk of colon cancer is still extremely low. But for me, at least, it makes sense to start a screening a little bit earlier. The biggest warning sign you shouldn't ignore is blood in the stool. Don't assume that it's just hemorrhoids or something else like that. Just go to the doctor and have it checked. Colon cancer doesn't happen overnight. It takes years to develop. And unfortunately, there have been many changes in our environment and our lifestyles and our diets that do increase the risk of colon cancer. Fortunately, colon cancer is also the cancer that can be completely prevented if you detect it early enough. So here's an overview of how you can reduce your risk of colon cancer. Step one, fix the fundamentals. Eat plenty of fiber, up to 40 to 50 grams. But not just any fiber. It's better to eat a diverse diet with different types of polyphenolic compounds, vegetables, berries, fruits, etc. Because these foods also contain many other beneficial compounds that improve the microbiome and your metabolic health. Minimize processed meats specifically or completely avoid it, ideally. Exercise regularly. Maintain a healthy body composition. Don't smoke. And keep your alcohol intake low. Because alcohol can also disrupt the gut microbiome and damage your colon. Step two, know your baseline. Regular blood work can identify things like unexplained anemia or iron deficiency. These tests like the PhenoAge can be useful for overall health tracking. But they're not cancer screening tests. A gut microbiome test can be useful, but it doesn't really predict your cancer risk. Step three, screening. From around age 45 for average risk adults and earlier for high risk individuals, do some early screening. A FIT stool test is a simple non-invasive option that detects hidden blood in the stool. A positive result could warrant a follow-up test. But if the follow-up test is also positive, it might warrant a colonoscopy. Consult with your doctor. Step four, the colonoscopy when appropriate. It doesn't just detect cancer, it can also find and remove pre-cancerous polyps before they ever become cancerous. Colonoscopy is generally low risk for most people, especially younger individuals, but it has a small risk for older individuals because you might develop some rectal bleeding. And if older individuals have poor blood clotting abilities, then that can be a health risk. Step five, don't ignore the warning signs. Blood in your stool or recurrent rectal bleeding, black catarrh stool, unexplained iron deficiency anemia, unexplained weight loss, and a new persistent change in bowel habits or consistent abdominal pain. Like with any other diseases, you don't need to be afraid of it. You just need to follow a healthy preventive lifestyle and do early screening as soon as possible. That's the way you stack the odds in your favor. All right, thanks for watching. If you want to discover your health percentage and get your roadmap to top 1% of health, then join the community using the link in the description. I'll see you there.