Mayo Clinic findings also link specific gut bacteria to cancer survival and identify a pretreatment signal associated with chemotherapy toxicity

ROCHESTER, Minn. — Mayo Clinic researchers have discovered distinct gut microbiome patterns in adults age 50 or younger with colorectal and breast cancers compared with those diagnosed later in life — one of several findings from an analysis of stool samples from 1,364 patients with cancer across cancer types, stages and treatments.

Among younger patients, those with colorectal cancer had higher lactate levels and more Veillonella parvula, a gut bacterium that feeds on lactate. Early-onset breast cancer showed changes across 64 bacterial species and lower levels of primary bile acids.

Published in Cell, the findings come from the Mayo Clinic Cancer Microbiome cohort, a real-world study that recruited cancer patients at Mayo Clinic in Arizona, Florida and Minnesota, representing 40 states. Stool samples were collected before patients began a new treatment regimen and linked to detailed clinical data on side effects and outcomes. The samples provided a window into the gut microbiome — the trillions of microbes living in the digestive tract.

Cancer-specific microbiome patterns emerge

Researchers first compared patients with cancer with 287 people without cancer to identify broad microbiome differences. Comparisons across cancer types then revealed more specific signals. After accounting for other health conditions, researchers pinpointed 341 bacterial species associated with five cancer groups.

Among those groups, neuroendocrine tumors showed a broad loss of common, health-associated gut bacteria. Liver and intrahepatic bile duct cancers had higher levels of several bacteria, including Enterococcus faecalis, while esophageal cancer had higher levels of six species, including several Streptococcus bacteria. Distinct associations were also found in lymphoid leukemia and multiple myeloma and related plasma cell cancers.

Distinct patterns in early-onset cancers 

The findings come as colorectal and breast cancer rates rise among younger adults. Colorectal cancer incidence is increasing about 3% a year among adults ages 20 to 49, while breast cancer incidence is rising 1.4% a year among women younger than 50, according to the American Cancer Society.

The colorectal finding raises questions about a possible biological connection: Tumors can produce high levels of lactate, which Veillonella parvula uses to grow. Whether that relationship plays a role in early-onset disease is not yet known.

In breast cancer, one of the 64 species that differed in younger patients was Clostridium scindens, a bacterium involved in bile acid and steroid metabolism.

No comparable age-related microbiome differences were found in brain cancer, the third cancer examined in the early-onset analysis. The colorectal and breast cancer findings do not establish that these microbial or metabolic differences cause early-onset disease, but they identify associations that warrant further study.

Gut microbiome linked to survival and treatment side effects 

Researchers also identified specific gut bacteria associated with survival in colorectal, liver and intrahepatic bile duct, melanoma, ovarian and prostate cancers. In liver and intrahepatic bile duct cancer, Bifidobacterium longum was associated with longer survival and Blautia A massiliensis with shorter survival.

Researchers also studied whether the gut microbiome before treatment was associated with diarrhea during chemotherapy, a side effect that can make treatment harder to tolerate. Among patients receiving 5-fluorouracil, or 5-FU, a chemotherapy used to treat many types of cancer, those who later developed diarrhea had lower levels of bacterial genes capable of breaking down the drug. Much of that function came from Anaerostipes hadrus, a common gut bacterium.

The same signal was not linked to diarrhea in patients receiving carboplatin, another chemotherapy drug, suggesting the finding was specific to 5-FU.

"The microbiome is not the sole driver of cancer or treatment outcomes, but it is an underappreciated component that has not traditionally been considered in therapeutic approaches," says senior author Purna Kashyap, M.B.B.S., a gastroenterologist, director of the Mayo Clinic Microbiome Program and Bernard and Edith Waterman Director, Microbiomics Program, Mayo Clinic Center for Individualized Medicine. "This gives us a proof of concept that we can begin to understand why some patients experience a particular side effect and identify a target that could potentially be acted upon."

Next, researchers will investigate whether cancer-specific microbial signals play a causal role in disease and validate the microbiome's potential to predict treatment side effects in larger patient groups.

The research was supported in part by the National Institutes of Health and philanthropic gifts from the Valhalla Foundation, the Maxine & Jack Zarrow Family Foundation, and other benefactors to the Mayo Clinic Microbiome Program and Center for Individualized Medicine.

Jun Chen, Ph.D., professor of biostatistics and consultant in Mayo Clinic’s Division of Computational Biology, is also a co-corresponding author. For a complete list of authors, disclosures and funding, review the study. 

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About Mayo Clinic  
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.  

Media contact:   

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu 

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ROCHESTER, Minn. — Mayo Clinic researchers have discovered that chemical signals produced by gut bacteria work together to control intestinal movement. One bacterial signal helps set the intestines in motion, while another primes gut cells to respond more strongly, amplifying the effect.

The research expands scientists' understanding of how the gut microbiome communicates with the body, moving beyond the traditional focus on individual bacteria or bacterial molecules.

The findings, published in the Proceedings of the National Academy of Sciences, point to a potential new direction for microbiome-based treatments: restoring combinations of microbial signals rather than targeting a single microbe or molecule. The strategy could have implications for constipation-predominant irritable bowel syndrome, a chronic condition marked by abdominal pain and constipation.

"The gut microbiome is made up of trillions of microbes producing a vast array of chemical messages that interact with cells throughout the digestive tract," says Purna Kashyap, M.B.B.S., a Mayo Clinic gastroenterologist, director of the Mayo Clinic Microbiomics Program and a senior author of the study. "Deciphering how those signals work in combination gives us a much more precise picture of what is disrupted in disease and what would need to be restored to recover normal function."

How bacterial signals work in combination

Researchers focused on two bacterial molecules: hypoxanthine and butyrate. Earlier Mayo Clinic research found lower levels of both in patients with constipation-predominant irritable bowel syndrome. That finding led researchers to a deeper question: How do these molecules affect intestinal movement?

In the new study, the researchers found that hypoxanthine prompts specialized cells lining the intestine to release serotonin, a chemical messenger that helps move food through the digestive tract. Butyrate works differently. It primes the cells to respond more strongly to hypoxanthine, amplifying the effect.

These specialized cells, called enterochromaffin cells, serve as hubs where different microbial signals come together. They help the gut receive and respond to multiple chemical messages at once.

Researchers followed that chain of events from what happens inside a single gut cell to how contents move through the intestines. They used laboratory-grown intestinal cells, miniature gut models called organoids, intestinal tissue and genetically altered bacteria to piece together each part of the process.

Gianrico Farrugia, M.D., president and CEO of Mayo Clinic and a co-author of the study, is a gastroenterologist whose research has focused on the mechanisms that control gastrointestinal function.

"We have an opportunity to move beyond managing the consequences of disease and toward restoring function for patients," Dr. Farrugia says. "That starts with answering the unanswered questions we see in our patients and following the biology until we understand the mechanism. With that depth of understanding, we can uncover new possibilities for treatment and ultimately advance new cures."

What's next 

Researchers next want to determine whether identifying combinations of microbial signals that are altered in individual patients could eventually help guide treatment. Future research will explore whether restoring complementary signals can improve intestinal movement, with the longer-term goal of developing more precisely targeted microbiome-based therapies.

The research was supported by the National Institutes of Health, Mayo Clinic Center for Individualized Medicine, Mayo Clinic Microbiome Program and other organizations. One or more of the investigators is an inventor of technology related to this research. For a complete list of authors, disclosures and funding, review the study.

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About Mayo Clinic  
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.  

Media contact:   

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

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ROCHESTER, Minn. — Mayo Clinic researchers have estimated the risk that pancreatic cysts with worrisome or high-risk features will progress to pancreatic cancer or advanced precancerous changes within three years. The findings, published in Gastroenterology, could help physicians and patients better assess risk and make more informed decisions about whether to monitor a cyst or consider surgery. 

The prospective study found that risk increased with the number of worrisome features, or findings that the cyst needs closer monitoring. Patients whose cysts had one worrisome feature had about a 2% chance of developing pancreatic cancer or advanced precancerous changes within three years. The risk rose to 4% for those with two worrisome features and 18% for those with three or more. 

"This information will help us counsel patients. If we want to intercept pancreatic cancer while also sparing patients from unnecessary interventions, we must really know what is likely to become cancer and what is not," says Shounak Majumder, M.D., lead author and a gastroenterologist at Mayo Clinic.  

What does pancreatic cyst risk mean for patients?  

Pancreatic cysts are common and often discovered during imaging for an unrelated reason. Most do not become cancerous, but certain features seen on imaging can indicate a greater risk. Pancreatic cysts are classified as having high-risk features, worrisome features or neither. 

Pancreatic cysts without worrisome or high-risk features have a relatively low likelihood of progression to cancer. Cysts with high-risk features may prompt physicians to recommend surgery because of greater concern about cancer or advanced precancerous changes. Cysts with worrisome features often are monitored closely, although some may also require surgery.  

"Sometimes, we are unable to reliably determine whether a cyst will become pancreatic cancer or not," Dr. Majumder says. "That uncertainty creates a lot of anxiety for some patients undergoing surveillance, and some will opt for surgery." 

More precise estimates of progression risk can help patients and physicians weigh the potential benefits of surveillance and surgery.   

How did researchers determine pancreatic cancer risk?  

The study followed 230 people with pancreatic cysts that had worrisome or high-risk features. Unlike studies that look back at existing medical records or primarily include patients who underwent surgery, researchers enrolled participants and followed them over time, regardless of whether they chose surgery or surveillance. 

Of the 230 participants, 32 underwent surgery within the first three months after enrollment, and 198 entered clinical surveillance. Among those monitored, 185 had cysts with worrisome features, and 13 had cysts with high-risk features.  

The study found that patients with multiple worrisome features may represent a substantially higher-risk subgroup, while risk was not markedly elevated in patients with a single worrisome feature. 

Pancreatic cancers diagnosed among patients under careful surveillance were detected at a very early stage, suggesting that surveillance of appropriately risk-stratified patients may provide an opportunity to catch pancreatic cancer early. The finding suggests that regular surveillance may be an appropriate approach for some patients rather than immediate surgery. 

The three-year risk estimates also provide a benchmark for evaluating blood tests and designing studies of other approaches to early pancreatic cancer detection. 

Can blood tests and biomarkers predict pancreatic cancer risk? 

In a separate study led by Dr. Majumder and colleagues published in Clinical Gastroenterology and Hepatology, researchers examined CA 19-9, a blood biomarker that may be elevated in people with pancreatic cancer and is sometimes used to monitor pancreatic cysts. 

An elevated CA 19-9 result alone did not reliably predict which patients with pancreatic cysts would develop cancer. Among patients with low-risk cysts who had an elevated CA 19-9 level, none developed pancreatic cancer during the study's follow-up period. 

The findings suggest that a blood biomarker test should be considered with other information about a patient's health and cancer risk. They also underscore the need for new biomarker tests that can reliably detect the earliest stages of cancer in patients with pancreatic cysts. 

The data from these studies could help researchers design larger studies and clinical trials of new approaches to the early detection and prevention of pancreatic cancer as part of a broader effort at Mayo Clinic known as the Precure Research initiative.  

"The goal is more precise, personalized surveillance and an early detection approach that identifies patients who may benefit from earlier intervention while helping those at lower risk avoid unnecessary procedures and major surgery," says Dr. Majumder.  

For a complete list of authors, disclosures and funding, review the study.  

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:  

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu  

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After years of living with Crohn's disease and trying treatments that didn't work, Amy Marshak felt she was running out of options. The chronic illness affected her career, her energy and the everyday family moments she cherished most. At Mayo Clinic, she found a new treatment approach and renewed hope for the future.

Watch: A mom's journey beyond Crohn's disease and back to the moments that matter

Journalists: Broadcast-quality video (2:35) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"I first started noticing symptoms of my Crohn's disease in the fall of 2018," Amy recalls.

She is a lawyer, a wife and a mom of two.

"It was about six months after my younger daughter was born," Amy says. "She's really never known me as a parent without Crohn's."

Crohn's disease is a chronic inflammatory condition that can cause abdominal pain, weight loss and digestive issues.

"It's really difficult day-to-day living with Crohn's because of the amount of pain I experienced," Amy says. "It really felt like I could do one or the other, be a lawyer or be a mom, to have the energy to do either of those things."

Amy had a portion of her colon and small bowel removed, then went through a series of medications.

"Some of them worked for a short period of time, and then I developed antibodies to them and would never work again," Amy says. "I was sort of at the end of all the options that exist because my Crohn's disease is spread throughout my small intestine."

Months turned into years.

"I worked so hard to find a solution to make Crohn's disease livable but felt no closer to a solution than I was before," Amy says. "I did some research, spoke with my doctor, and they suggested coming to Mayo Clinic." 

In July 2024, Amy traveled to Jacksonville, Florida, to meet Dr. Jana G. Al Hashash, a Mayo Clinic gastroenterologist.

"She really did want something cutting-edge and something different," recalls Dr. Al Hashash, who has collaborated closely with colleagues, including Dr. Ernesto Ayala, a hematologist and oncologist, to treat refractory Crohn's disease.

"What we're performing here is a newer protocol," says Dr. Al Hashash. "This stem cell transplant program is for patients like Amy who have failed multiple medical therapies and whom we want to try to reset the (immune) system."

The process uses chemotherapy followed by the body's own stem cells to reset the immune system and reduce the effects of Crohn’s disease.

"If Crohn's disease comes back, we'd like to see that it's coming back weaker than it was before, with less inflammation and less impact on the body," says Dr. Al Hashash.

"This was really both the best and the only option there was, and that there was another option that had such promise was really exciting," Amy says.

In addition to getting back to her family and career, Amy had another milestone in mind: to be able to sit through a whole family dinner without pain.

"I love family dinners," Amy says. "I think they're a wonderful way to connect with my kids. It just feels frustrating not to be part of that family moment."

Amy's treatment began in early 2025 and kept her in the hospital for nearly two months. She recorded herself reading bedtime stories to her children nightly, who were nearly 1,000 miles away.

About 100 days after treatment, tests confirmed that the stem cell transplant was successful.

"Amy is a beacon of hope for people with Crohn's disease who failed multiple therapies," says Dr. Al Hashash. "She's done fantastic."

Amy's care team continues to monitor her progress. Since returning home, Amy has been able to get back to the things she loves, starting with that family moment around the dinner table.

"I'm excited to be able to play with them more, to be with them more, to have more energy for their projects and ideas," Amy says. "And also, to be able to balance work-life in a way that I haven't been able to balance in the past few years because of my Crohn's."

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Mayo Clinic oncologist explains risk factors, treatment considerations for patients under 50

PHOENIX — You may have heard that colorectal cancer is increasingly affecting young adults. However, it is not the only gastrointestinal (GI) cancer that doctors are diagnosing in patients below the age of 50, explains Christina Wu, M.D., an oncologist at Mayo Clinic Comprehensive Cancer Center in Arizona.

"People under 50 are not too young to develop gastrointestinal cancers," Dr. Wu says. "If young adults notice new or persistent symptoms, it's important to get them worked up."

At Mayo Clinic, early-onset gastrointestinal cancers are defined as GI cancers diagnosed in people under 50 years old. Research shows that the most common type of early-onset GI cancer worldwide is colorectal cancer, followed by stomach cancer, esophageal cancer and pancreatic cancer. Less common types of early-onset GI cancers include bile duct, gallbladder, appendix, neuroendocrine and small bowel cancers.

"More research needs to be done to understand what causes the rise in incidence of early-onset GI cancers," Dr. Wu says. "We know that certain factors can increase the risk of developing GI cancers, and early detection gives patients a better chance of successful treatment."

Risk factors

Several factors can increase the risk of developing early-onset GI cancers, including genetic conditions, chronic diseases and lifestyle:

• Lynch syndrome and familial adenomatous polyposis are hereditary conditions that are associated with an increased risk of early-onset colorectal cancers.

• Inflammatory bowel disease and primary sclerosing cholangitis can increase the risk of developing GI cancers such as colorectal cancer and cholangiocarcinoma, respectively.

• A sedentary lifestyle, obesity, diets high in processed foods, alcohol consumption, smoking and environmental exposures may be associated with an increased risk of GI cancers.

Early detection and symptoms

Recommendations for when people at average risk for colorectal cancer should be screened vary by country but generally start in their 40s or early 50s. In the U.S., colorectal cancer screening is recommended to start at age 45 for people at average risk; people with risk factors such as a family history of colorectal cancer may need to start screening earlier.

Having a primary care clinician, getting regular health checkups and discussing any health concerns with a healthcare professional can help determine what screening or tests may be needed, depending on individual risk factors.

In some cases, symptoms of early-onset GI cancers may present and be associated with specific cancer types:

• Unintentional weight loss with jaundice and pain may indicate pancreatic cancer.
• Weight loss, pain, and difficulty eating or swallowing may be linked to stomach cancer.
• A persistent change in bowel habits, abdominal pain and iron-deficiency anemia may be associated with colorectal cancer.

"Any new symptoms that are persistent or worrisome should prompt a visit to a healthcare professional to get checked out," Dr. Wu says. "If symptoms are ignored or not investigated, young adults may experience a delay between when they first experience symptoms and a cancer diagnosis. Recognizing symptoms early is important," Dr. Wu explains.

Tailoring care for younger adults  

Young adults diagnosed with GI cancers often need multidisciplinary care due to differences in cancer biology, as well as unique social and life-stage needs.

"Before starting treatment, we perform genetic testing and tumor profiling to identify mutations that may guide targeted therapies," says Dr. Wu. "These advances allow us to provide more personalized and effective treatment for our patients."

In addition, young adults may require support, such as fertility preservation and resources to navigate the emotional and practical challenges of a cancer diagnosis. Mayo Clinic's Early-Onset and Hereditary GI Cancers Program provides specialized, multidisciplinary care for this patient population.

Innovations in treatment

With advances in genetic testing and tumor profiling, cancer care teams can provide more personalized and targeted treatments, including immunotherapy in some cases, and identify patients who may be eligible for clinical trials. Analysis of the tumor helps guide treatment decisions and identify appropriate therapies.

For certain GI cancers, treatment may involve a combination of chemotherapy, radiation (including proton beam therapy) and surgery. Advances in treatment, including minimally invasive approaches and immunotherapy, are improving care for some GI cancers.

Mayo Clinic researchers have been exploring the use of artificial intelligence as an additional aid in the detection of gastrointestinal cancers such as colorectal cancer and pancreatic cancer.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Caroline Auger, Mayo Clinic Communications, newsbureau@mayo.edu

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Research identifies subtype of `hungry gut' obesity phenotype

ROCHESTER, Minn. — Why do some people lose substantial weight with GLP-1-based medications while others see more modest results? A Mayo Clinic study offers a potential answer by identifying a distinct biological subtype of obesity that responds especially well to tirzepatide, a medication that mimics two naturally occurring hormones involved in appetite and blood sugar regulation, moving the field closer to precision medicine for obesity.

The research, published in Gastroenterology, identified a subgroup of patients with obesity who produce lower levels of natural appetite-regulating hormones, experience faster stomach emptying and report greater hunger after meals. This is a subtype of the "hungry gut" obesity phenotype, characterized by an abnormal duration of fullness. People with hungry-gut obesity may eat normal portion sizes but snack more frequently.

These patients lost nearly twice as much weight after six months of tirzepatide treatment as patients with other obesity subtypes.

"Obesity is a complex disease driven by different biological mechanisms," says senior author Andres Acosta, M.D., Ph.D., a gastroenterologist and the Delaney Family Director of the Nutrition Obesity Research Program at Mayo Clinic in Minnesota. "Our findings suggest we can begin identifying which patients are most likely to respond to specific therapies rather than treating obesity as a single disease."

Researchers studied 483 adults with obesity and found three different biological types of the disease. About 1 in 4 participants produced lower levels of GLP-1 and other hormones that help people feel full after eating. Patients in this group lost an average of 21.5% of their body weight after six months of treatment with tirzepatide, compared with 11.7% for patients in the other groups.

The findings support growing efforts to personalize obesity treatment using an individual's underlying biology rather than relying on a one-size-fits-all approach. Because obesity increases the risk of diabetes, heart disease, certain cancers and many other serious chronic conditions, identifying the right therapy sooner could improve long-term health outcomes.

The researchers also found that the reduced hormone levels were associated with decreased hormone production in the intestine rather than differences in the gut microbiome, providing new insight into the biology underlying this subtype of obesity.

The authors caution that prospective studies are needed before this approach can be incorporated into routine clinical practice, but these findings represent an important step toward more precise, individualized treatment for obesity.

For financial disclosures and other details, please see the paper.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

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A routine screening turned into a life-changing diagnosis for Angela Tripido. After learning she had stage 4 colorectal cancer that had spread to her liver, she faced months of treatment, multiple surgeries and uncertainty about what came next.

When the cancer returned, a liver transplant offered a new path forward.

Watch: A routine screening reveals stage 4 cancer, leads to life-changing transplant

Journalists: Broadcast-quality video (2:35) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Screening

"I have lived a super healthy life. You know, always been an athlete, always working out," says Angela.

"I ended up having my, what I would just call, 50th (birthday) screening colonoscopy. The nurse said, 'The doctor will be over in a minute. We're just getting your husband.' I knew immediately that wasn't good," she says. "(The doctor) showed us some pictures and said, 'You have stage 4 colorectal cancer."

Additional imaging showed the cancer had spread to her liver.

Near her home in South Florida, Angela began treatment with chemotherapy and a series of surgeries to remove tumors.

But the cancer returned.

"(Another institution) identified some recurrent lesions in the liver," says Dr. Kris Croome, a Mayo Clinic transplant surgeon. She was not felt to be resectable because she didn't have adequate liver left."

That's when Angela turned to Mayo Clinic for another option.

"She was an excellent candidate for our liver transplant," says Dr. Croome. "She was otherwise a very young, healthy person, and so we felt that if we were able to do a liver transplant, we would be able to clear her of her disease."

"As scary as everything was that was on the plate of what was coming, I want to live, and I want no tumors in me," says Angela.

The wait

Once Angela's disease was confined to her liver and she completed a comprehensive evaluation, she qualified for transplant and was placed on the waiting list.

"My phone rang," Angela remembers. "The voice on the other end said, 'I'm calling to see if you are interested in liver that we believe will be a perfect match for you.'"

After an anxious night with little sleep, transplant day arrived on July 7, 2025. She remembers the final moments with the surgical team before the procedure began.

"I always say to the team, right before they put me under, 'Thank you all for taking really good care of me.' And there was this nice gentleman next to me, one of the nurses, and he was like, 'We've got you, don't worry,'" says Angela.

Good news

The surgery was a success.

"What the transplant has given me is there's a lot more hope for longevity — not having chemo in me, quality of life," says Angela.

Nearly a year after her transplant, Angela is getting back to the life she loves. She and her husband have celebrated their 30th wedding anniversary. They're traveling again and raising awareness in the community.

"We were involved in a charity run locally to promote screening for colon cancer with one of the local health groups, and had the opportunity to run into her," says Dr. Croome. "Just to see her out and about enjoying her life disease-free, I think, really is why we do all this."

Angela also carries deep gratitude for the organ donor who made it possible.

"You can give someone a chance at a longer life and a healthier life, and that's a miracle," she says. "I will be writing that letter and thanking that family, and I hope they know what it's given me."

Related stories:

• How innovation is shaping the future of transplant care (VIDEO)
• Mayo Clinic Q&A: What is life like after an organ transplant or donation?
• Mayo Clinic Minute: How liver transplant is transforming care for patients with advanced colorectal cancer

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The findings offer new insight into how the immune system and gut microbiome interact in this chronic condition and point to potential new therapeutic strategies.

IBD, which includes Crohn's disease and ulcerative colitis, affects millions of people worldwide. The condition is driven in part by the immune system reacting to normally harmless bacteria in the gut, reflecting a breakdown in what is known as immune tolerance. Symptoms of ulcerative colitis and Crohn's disease usually include belly pain, diarrhea, rectal bleeding, extreme tiredness and weight loss.

While many current therapies focus on reducing inflammation, less is understood about how to restore balanced interactions between the immune system and the gut microbiome.

"This study suggests vitamin D may help rebalance how the immune system sees gut bacteria," says lead author John Mark Gubatan, M.D., a gastroenterologist at Mayo Clinic in Florida. "That's an important step toward understanding how we might restore immune tolerance in IBD."

In the study, researchers evaluated 48 people with IBD who had low vitamin D levels. Participants received weekly vitamin D supplements for 12 weeks. Blood and stool samples collected before and after treatment were analyzed using advanced sequencing to map interactions between immune responses and the gut microbiome.

Vitamin D supplementation was associated with increased levels of immunoglobulin A (IgA), which is typically linked to protective immune responses, and decreased levels of immunoglobulin G (IgG), more often associated with inflammation. The researchers also observed changes in immune signaling pathways and increased activity of regulatory immune cells that help control inflammation.

Together, these findings suggest vitamin D may help promote a more balanced, protective immune response to the gut microbiome.

Vitamin D supplementation was also associated with improvements in disease activity scores and a stool-based marker of inflammation. However, the researchers emphasize the study was small and not designed to establish cause and effect.

"We saw encouraging signals, but this was not a randomized trial," Dr. Gubatan says. "These findings need to be confirmed in larger, controlled studies."

The researchers caution that patients should not change their vitamin D use without medical guidance.

“Vitamin D is widely available, but dosing needs to be individualized, especially in patients with chronic inflammation,” Dr. Gubatan adds. “Patients should work with their healthcare team.”

This work was supported by a grant from Doris Duke Physician Scientist Fellowship Award (Grant #2021091), Chan Zuckerberg Biohub Physician Scientist Scholar Award, and National Institutes of Health (NIH) NIDDK LRP Award (2L30 DK126220). For a complete list of authors, disclosures and funding, see the study.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post Vitamin D linked to immune response to gut microbiome in inflammatory bowel disease appeared first on Mayo Clinic News Network.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:09) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Polyps in the colon can vary in size and shape. Some are more mushroom-shaped, but that's not always the case. 

"Some polyps spread out more like a bed of moss; they're flat," says Dr. Wallace.

Advances in imaging and tools help care teams detect and treat difficult polyps. 

"Technology has been clearly shown to improve our ability to find more polyps and reduce the miss rate for some of these flat, subtle polyps," says Dr. Wallace. 

Early detection leads to better outcomes. 

"Stage 1 cancer, so-called T1 cancer, we can actually remove that through an endoscope or through a colonoscope, specifically, in a curative way," says Dr. Wallace. "This is something that has had profound implications for patient care." 

Dr. Wallace adds that the most important step is to get screened. 

"Whatever test you choose, get screened," Dr. Wallace says. "This is a preventable cancer. It's one of the very few cancers that we can almost completely prevent. So getting screened starting at the age of 45 — one caveat is — if you have a family history of colon cancer, you need to start even earlier."

Related posts:

• Mayo Clinic Q&A: Treating colorectal cancer with surgery
• (VIDEO) Transforming colon cancer care through precision medicine
• (VIDEO) Treatment options for advanced colorectal cancer

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DEAR MAYO CLINIC: Fiber has been getting a lot of attention in the news lately. What exactly is dietary fiber, and why is it important to my overall health?

ANSWER: Dietary fiber refers to the parts of plant-based foods that your body can’t digest or break down. Unlike proteins, fats or simple carbohydrates, fiber passes through the digestive system largely intact. Because your body can't digest it, fiber becomes an important fuel source for the trillions of microbes that live in your gut.

As food moves through the digestive tract, nutrients your body can absorb are taken up earlier in the process. What remains — much of which is fiber — travels to the colon, where gut bacteria use it for energy. 

Dietary fiber is often associated with digestion, but its role in the body goes far beyond keeping you regular. Fiber plays an important part in gut, heart, immune and metabolic health. Research shows that adequate fiber intake helps:

• Lower cholesterol levels and reduce blood pressure.
• Improve blood sugar control, aiding in the prevention and management of type 2 diabetes.
• Decrease the risk of colorectal cancer, stroke and chronic inflammation.
• Manage a healthy weight.
• Regulate immune responses.
• Maintain a healthy and diverse gut microbiome, which supports many aspects of overall health.

Fiber is often described as soluble or insoluble, based on whether it dissolves in water or not. However, this distinction is less important for overall health than how fiber functions in the body. A more meaningful way to think about fiber is whether it’s fermentable or nonfermentable. Here’s what this means:

• Fermentable fiber can be broken down by gut microbes and used as fuel. This process produces beneficial compounds, such as short-chain fatty acids.
• Nonfermentable fiber isn’t readily used by microbes and mainly adds bulk to your stool, which helps support regular bowel movements.

While you may hear about the benefits of taking supplements to add fiber to your diet, but fiber is best obtained from food rather than supplements. That’s because many whole foods contain a mix of different fibers, which is especially beneficial for gut health. Fiber-rich foods include:

• Fruits, such as berries, pears and apples.
• Vegetables, like broccoli, Brussels sprouts and leafy greens.
• Legumes, including lentils, chickpeas and beans.
• Nuts and seeds, such as almonds, chia seeds and flax seeds.
• Whole grains, including whole-wheat bread, oats and wheat bran.

It's important to eat a variety of these foods. The more different types of fiber-rich foods you eat, the more different types of fiber you'll get, which is optimal for your health. Making small, sustainable changes, such as choosing whole-grain bread instead of white bread or swapping chips for nuts or fruit, can add up over time.

Most adults who are in good health should aim for 30 to 40 grams of fiber per day. However, your fiber needs can vary by age and general health. For example, older adults may need to balance fiber intake with adequate calories and protein. 

As you increase your fiber intake, you may experience some abdominal discomfort, bloating and gas. To prevent or lessen these symptoms, gradually add more fiber to your diet rather than increasing your intake all at once. A helpful approach is to:

• Increase fiber intake by about 3 grams per week. This can be as easy as adding just 1/2 cup peas, squash or cauliflower; 1 cup carrots; 1 medium sweet potato; 1 cup brown rice; 3 tablespoons of shredded coconut; or 2 tablespoons of sesame seeds.
• Maintain that level for seven to 10 days before increasing again.
• Drink plenty of water, aiming for 80 ounces a day.

Slowly increasing your fiber intake allows your digestive system and gut microbes time to adapt, and any symptoms will improve after a short while.

Fiber is an essential part of a healthy diet. By eating a variety of plant-based foods, increasing fiber intake gradually and staying well hydrated, you can support gut health and overall well-being while making fiber goals more achievable and sustainable.

Purna Kashyap, M.B.B.S., Gastroenterology, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q&A: Why is fiber good for your overall health? appeared first on Mayo Clinic News Network.