DEAR MAYO CLINIC: I am thrilled to say I am a breast cancer survivor. It has been almost six months since I finished treatment. But I can't shake the fatigue. I was never a napper, but I find myself feeling desperate to close my eyes in the middle of the workday. I don't feel sharp in my thinking, and I fall asleep in front of the TV at night. I'm worried. How can I get past this stage? I want my life back.

ANSWER: Cancer-related fatigue can be distressing. It is a persistent, subjective sense of physical, emotional and cognitive tiredness and/or exhaustion related to cancer or cancer treatment that is not proportional to recent activity. It interferes with daily function and quality of life. Cancer-related fatigue is different from the usual tiredness we all experience. It's more intense, it's not temporary and it's not relieved by rest alone.

Several factors can contribute to cancer-related fatigue. The cancer itself can lead to fatigue. 

Some cancers weaken muscles, damage organs or alter hormones, which can cause fatigue.

Sometimes treatment damages healthy cells in addition to cancer cells. Treatments such as chemotherapy, molecular targeted therapy, hormonal therapies and radiation all may cause fatigue. 

Side effects of treatment may result in a blood problem called anemia, pain or stress, all of which can add to your fatigue. 

If you're not feeling well, your activity level may lower, which causes the body to decondition, causing fatigue. Preexisting conditions, such as anxiety and depression, also may worsen with cancer and play a role in fatigue.

Cancer-related fatigue can happen at any stage. It might start before treatment, become more pronounced during treatment, and sometimes linger even after treatment has ended. Everyone experiences this differently. 

The duration of cancer-related fatigue can be variable. For some people, it might improve a few weeks after finishing treatment. For others, it can last for months or even longer. It affects a lot of cancer patients but doesn't always get proper attention from healthcare professionals. It's important to communicate with your healthcare team about any ongoing fatigue. 

Treatments can include physical therapy and exercise guidance to help increase activity levels, medications, complementary and integrative medicine approaches such as yoga and tai chi, and psychological and mindfulness-based strategies to manage emotional stress and monitor fatigue levels. As every patient is different, a combination of these approaches typically works best.

While there's no way to prevent cancer-related fatigue, several self-care strategies can help boost energy levels, including: 

• Staying as active as possible, even if it's just light exercise. Start slow and find a routine.
• Eating a balanced diet and staying hydrated. When you have cancer, you may need more protein and nutrients than ever. Drink plenty of fluids, and limit caffeine.
• Setting a regular sleep schedule, taking short naps if needed, and finding time to relax and reduce stress. 

If you need guidance or you are experiencing fatigue that is not responding to these modalities, ask your primary care team for help. You may need help from family and friends to help with household tasks too. — Touré Barksdale, M.D., Physical Medicine & Rehabilitation, Rochester, Minnesota

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DEAR MAYO CLINIC: My husband and son are constantly coming home with an energy drink in hand. I tell them that they are bad for you, but I don't know enough to make a strong case. What are the effects of energy drinks on the body?

ANSWER: Energy drinks are a multibillion-dollar industry and are the most consumed supplement not under the control of the Food and Drug Administration other than multivitamins. It's a bit like the "Wild West" in the sense that energy drinks and their stimulating ingredients are under no FDA regulation and are not classified as a food or a drug but as a supplement. 

Energy drinks contain ingredients such as caffeine, taurine and guarana that affect the heart, the heart's electrical system and the heart's muscular pump. When our bodies react to these chemicals, the heart rate and blood pressure can change. The heart's recharging of the electrical system can be affected by these chemicals. For most people with a healthy heart, the consumption of an energy drink would have no serious impact on our health. However, if you have a genetic heart condition that predisposes you to sudden cardiac death, exposure to an energy drink may not be as harmless. 

People with underlying genetic heart disease or adults with coronary artery disease or weaker heart pumps can be more vulnerable to the chemicals in energy drinks. About one in 200 people have a sudden death-predisposing genetic heart disease, including hypertrophic cardiomyopathy, long QT syndrome, arrhythmogenic cardiomyopathy and catecholaminergic polymorphic ventricular tachycardia. A healthy heart can handle caffeine in moderation, but a fragile heart may not be able to. 

Consuming up to 400 mg of caffeine a day is safe for most adults — some energy drinks contain over half this amount in a single can. Depending on the age of your son, he may need to stay under 100 mg of caffeine per day, which is the recommended amount for adolescents ages 12-18. 

In addition to heart risk, studies have suggested an increased risk of stroke with energy drink consumption. Long-term exposure to these substances over time affects how the blood vessels and heart react to the chemicals. Our blood vessels that control our blood pressure are reacting to these chemicals, and the potential reason behind stroke risk is the tightening of our blood vessels. 

For the 199 out of 200 people who have a healthy heart and who do not have a genetic heart disease, energy drink consumption in moderation is safe. However, you might want to ask yourself: Can you go three days without it? If not, you may be experiencing some dependency on the chemicals in the energy drink. Heavy caffeine consumption can cause physical and psychological dependence, restlessness and insomnia. 

Overall, there is very little health value to energy drinks. Listen to your body — Are they making you feel shaky or causing you to experience withdrawals? Can you be satisfied with your morning coffee or tea instead? 

There is a lot of room for future research on these beverages. Consuming the wrong thing at the wrong time in the wrong person is a setup for the perfect storm. Caffeine may also interact with a person's medications. Tell your healthcare team that you are consuming energy drinks and the unregulated supplements they contain, and you can decide together what the right choice is for you. — Michael Ackerman, M.D., Ph.D., Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: My friend swears by intermittent fasting since her recent weight loss. I know it works for some people, but is it actually healthy? 
 
ANSWER: Although it may appear to be a new trend, intermittent fasting has been popular for over 1,500 years. While we know that it works for some people to lose weight, the reality is that whether or not it helps organs such as the heart is still to be determined. Early research presented at a recent scientific meeting suggested that intermittent fasting might be harmful or risky in general. It showed that people practicing intermittent fasting are twice as likely to die from heart disease or die in general than those who don't practice. 
 
The main problem is that intermittent fasting is not standardized. There are many ways to do intermittent fasting. Over the past few decades, it has been popularized in the UK as "eat whatever you want for five days, then don't eat for two full days other than fluids and soups." People were losing weight, and from that point on, people started adapting to fasting in very different ways. Some people will restrict their time for eating to 10 a.m. to 3 p.m., for example. The most common form of intermittent fasting I have seen is that people just skip breakfast.
 
Whether breakfast is "the most important meal of the day" is still under debate. Skipping breakfast historically hasn't been something necessarily healthy. It is not fully understood why, but there are numerous studies showing that people who skip breakfast have an increased risk for heart disease and other ailments. Early morning is the time when people have the most heart attacks. Part of the reason for that is the high-adrenaline state that occurs early in the morning. If you match that with no food, no calories at all, that might be the reason why studies show that people practicing intermittent fasting are not necessarily healthier or safer. I think that's important to keep in mind.
 
People who lose weight through intermittent fasting can benefit their overall health, but that doesn’t necessarily mean that they have to continue forever. We have to consider many other factors when people don't have breakfast or other meals. Stress hormones go up, which may increase blood pressure and adrenaline, causing many changes in our system that might actually be more harmful than beneficial.
 
When patients ask if intermittent fasting is healthy, the response should be, "It all depends." If they start skipping dinner, having very light dinners or just trying not to have dinner too late, that's an excellent way to practice. Or perhaps having a very light lunch or skipping lunch altogether — just not necessarily going for too long with no food.
 
Studies show that having multiple small meals throughout the day versus just two big meals results in better cholesterol and many other positive changes in the metabolism. So, this idea of not having any food or calories for long periods of time is still under debate. Based on recent evidence, intermittent fasting is particularly unsafe for patients with heart disease or with a history of heart disease. Practicing intermittent fasting can be safer with supervision from your healthcare team. — Francisco Lopez-Jimenez, M.D., Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
 

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Editor's note: April 16 is National Healthcare Decisions Day

DEAR MAYO CLINIC: My mom recently sat us down at the dinner table to talk about her wishes if something were to happen to her. She says we should all have advance directives made, but I feel like I'm too young to think about that. Who should have an advance directive? And what goes into it?

ANSWER: Kudos to your family for having those difficult conversations. Advance care planning is not just for elderly people or those with critical illnesses. We encourage everyone who is over 18 to think about completing an advance directive, which is a document that allows you to write out what your preferences are when you're getting to the end of life. 

There are usually two parts to an advance directive:

1. The healthcare surrogate form, which will allow you to write down who would help you make medical decisions if you can't make them for yourself. It usually allows you to put a first person and an alternate person as well. 
2. The second piece is a living will, which allows you to write what your wishes are at the end of life. You can indicate whether you want medical interventions that could artificially prolong your life if you have a terminal condition or are in a vegetative state. You mark yes or no.

When thinking about care are at the end of life, many people will say that quality of life for them is being able to engage and interact with family and do some of the things they love, not being on machines and tubes. Other people may say that quality of life for them is just being alive.

When you think about choosing your designated healthcare surrogate (the person who will make medical decisions for you) make sure the person knows enough about your medical condition and is aware of the available treatments and what state your condition is in. You also want to make sure this person would be comfortable making the decision you want them to make. 

Once you've completed a living will and have chosen your healthcare surrogates, make sure these people know you have chosen them, what your wishes are and where the document is. You should also give a copy of the document to your healthcare team and hospital.

In the U.S. in general, we don't do a good job at completing advance directives. Most people don't want to talk about their care at the end of life. There is a notable difference, however, in the completion of advance directives between Black people and white people, specifically older people. The medical literature suggests that African Americans are less likely to complete advance directives because of several things:

1. Culture. If the elders in the family don't want to talk about advance care planning, it oftentimes won't be discussed. 
2. Lack of information. African Americans are less likely to get information about advance care planning compared to white people. 
3. Spiritual beliefs. "If God is in control, why do I need to think about this?"
4. Mistrust. There is an understandable mistrust of the healthcare system given the injustices that have occurred in the past and are still occurring.

We often talk about the fact that we want people to complete an advance directive to ensure that their wishes are known when they are at the end of life, but in some minority communities, particularly the Black community, it's less about the individual person and more about what's best for the community or family. 

None of us really know when something serious may occur. Unfortunately, once people become critically ill, it's a difficult time to take a step back and think about their wishes, so it's good to have had these conversations before that happens. Think of it as a gift to your family members, your loved ones and your healthcare surrogates to be able to sit down with you when you're clear and levelheaded so that you can engage in conversations about what your wishes are to bring you all peace of mind. — Maisha Robinson, M.D., Neurology and Internal Medicine, Mayo Clinic, Jacksonville, Florida

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DEAR MAYO CLINIC: I catch myself constantly nagging my kids and spouse to put down their devices during dinner, in the evenings and on weekends. I feel burned out by screens by the end of the workday. How can I encourage tech-free time for my family and reduce screen time?

ANSWER: Smartphones, gaming systems and screens are everywhere. They are in our homes, bedrooms, offices, vehicles, pockets and purses. While these electronics can be helpful and entertaining, the amount of time we spend on them also can become a problem.

Consider this: When using a device, you disengage with something else. Is that something else important to you? Perhaps it's a child, a significant other, exercise, your job, chores or hobbies.

Many people feel like something is missing in life. Perhaps it's an unidentified desire to live life more fully. Reducing screen time frees up more time to connect with family and friends. Feeling connections with others can help ward off symptoms of stress, depression and anxiety. We often miss out on the fun and beauty happening around us because of screens. By being present and in the moment — perhaps by setting aside a device — you may find what you need to fill that void.

There are many wellness benefits to cutting down on screen time, including these four:

1. Improve your physical health

You know that physical activity is good for your health, but device use could reduce your exercise time. Maintaining healthy habits can be hard when you spend lots of time using screens. Benefits include:

• Preventing obesity and conditions related to excess weight. This includes conditions include type 2 diabetes and heart disease.Children who watch more TV have a greater risk of becoming overweight.
• Freeing more time for exercise and play. You can add physical activity to fill the new gaps in your schedule.
• Increasing your amount of sleep. Children who watch more TV tend to have more difficulty falling or staying asleep. They can feel tired and snack more often to make up for lost hours of sleep.
• Reducing mindless snacking which can lead to weight gain. Snacking or eating meals in front of the TV can lead to mindless eating, which can result in consuming larger portions. Eliminating distractions allows you to pay more attention to your body and its signals when you're full.

2. Free up time to have fun playing and exploring

Exploring and learning about the world is an integral part of life. Children are naturally curious, but adults can explore too. Instead of spending time on devices, you and your family can try new activities. Go for a bike ride, take a walk, visit a park, check out the museum or explore a local nature trail. Activities that don't involve screens can be as exciting as what is on them. Try coloring, reading, crafting or other activities that use your imagination. Decreasing screen time allows more time for play and creative activities.

3. Make social connections

Connecting with others is crucial for us to feel cared for. Children look to their caregivers for this sense of belonging; adults may find it within their families and friends. Devices can damage these relationships.

When parents engage with a screen, children may feel they need to compete for attention. When you set down your device, you are more emotionally available and can help strengthen the family bond.

One study found that children who went without electronic devices for five days were better at recognizing facial emotions and reading nonverbal cues than those who lived life as usual. Less screen time can result in better face-to-face social skills. Having a TV on, even as background noise, will direct your focus to it rather than what is happening around you.

4. Boost your mood

Putting down your phone and going outside or doing an enjoyable activity can be a mood booster. It can make you feel more accomplished and improve your well-being. Depression and anxiety can cause a person to withdraw and isolate themselves from others. Engaging in social activities helps you connect with others and reduce symptoms of these conditions. Children who spend more time looking at a screen are more likely to have behavioral problems and divided attention; decreasing screen time can improve their focus. Violence in media may cause kids to feel anxious and depressed and lead them to think that violence is an acceptable way to deal with problems.

While technology is a great tool, it also can hinder your wellness and make you feel disconnected from those around you. Taking a break from devices frees up more time to be active and enjoy time with loved ones. Why not give it a try? — Mysoon Ayuob, M.D., Family Medicine, Mayo Clinic Health System, Faribault, Minnesota

Related post:

• Mayo Clinic Minute: How staring at screens can affect your vision
  
  

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DEAR MAYO CLINIC: A friend was just diagnosed with colorectal cancer. She's only 30. I didn't know young people could get this cancer. Can you tell me more about it?

ANSWER: Unfortunately, your friend is among a growing number of adults under 50 who are being diagnosed with colorectal cancer. Many younger adults don't consider themselves at risk, since screening for colorectal cancer typically doesn't start until age 45.

That's why it's especially important to know the warning signs of colorectal cancer and not put off getting medical attention. Early diagnosis is essential to surviving colorectal cancer. If this cancer is found when it's only in the colon or rectum, the five-year survival rate is over 90%. That survival rate drops to roughly 15% if the cancer spreads beyond the colon and rectum.

 What is colorectal cancer?

It's not one type of cancer but two: colon and rectal cancer. The large intestine has several regions. The last part of the large intestine is known as the rectum. The other areas of the large intestine are called the colon. The treatments for cancers of the colon and rectum are different.

Who is at risk for this cancer?

Risk factors for colorectal cancer include:

• Older age
• Black race 
• Low-fiber, high-fat diet 
• Not exercising regularly
• Diabetes 
• Obesity 
• Smoking
• Drinking alcohol 

Those who are at higher risk for colorectal cancer tend to have at least one of these factors:

• Medical condition that places them at higher risk.
• Genetic condition that increases their risk. 
• Family history that places them at higher risk. For example, this is could be a first-degree family member such as parents or siblings who have had a diagnosis of colorectal cancer or advanced polyps.

Are there warning signs?

Four warning signs of colorectal cancer are:

• Abdominal pain
• Rectal bleeding
• Diarrhea
• Iron deficiency anemia

Although these symptoms can be embarrassing, you need to share them with a healthcare professional — don't put it off.

You may not easily notice blood loss after bowel movements, but that bleeding can lead to low iron levels. If a routine blood test reveals iron deficiency in a young adult, it can prompt the primary care clinician to consider colorectal cancer.

What is the screening process for colorectal cancer?

Your primary healthcare professional may order a screening that can help detect colon polyps or cancer. These tests include:

Stool DNA test. This test uses a stool sample to look for changes in cells' genetic material. Certain DNA changes are a sign that cancer is present or that it might happen in the future. The stool DNA test also looks for hidden blood in the stool.

If your stool DNA test returns positive (abnormal), you'll need a follow-up colonoscopy.

Colonoscopy. This test looks inside the colon. For it to be most effective, you need to thoroughly cleanse your colon, which involves reducing the fiber in your diet. The last step is consuming a special solution to ensure your colon is clean so the gastroenterologist is able to get a clear view. Although preparing for the procedure can be unpleasant, your care team can provide tips to make it more doable.

If the gastroenterologist finds any precancerous growths, called polyps, these will be removed during the colonoscopy and sent for testing. The number, size and type of polyps removed help determine when the next colonoscopy should be scheduled. If cancer is found, your care team will discuss treatment options with you.

How can I reduce my risk for colorectal cancer?  

No matter your age, there are five steps you can take to avoid developing colon cancer:

1. Eat your vegetables and healthy fats. Research has shown that the Western diet correlates to higher colorectal cancer rates. People who eat high-fiber diets are less likely to develop the disease.
2. Get moving. Exercise benefits your heart and helps you maintain your weight. It also can lower your colon cancer risk. Aim for 30 minutes of moderate exercise on most days of the week.
3. Watch your weight. Talk to your health care team if you need help losing weight.
4. Limit alcohol and don't smoke. If you choose to drink alcohol, do so moderately. That means no more than one drink a day for women or two drinks a day for men. And if you smoke, quit.
5. Follow colorectal cancer screening guidelines.

Derek Ebner, M.D., Gastroenterology, Mayo Clinic in Rochester

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DEAR MAYO CLINIC: One of the biggest things I have missed since my office went remote is going on walks with my coworkers throughout the day. With so many added responsibilities at work, I can hardly find time to leave my desk. How is all this sitting affecting me? How can I find a balance?

ANSWER: We understand the reality is that people have less and less time to exercise. While exercising before or after work is extremely important, it is just as important to stay active throughout the day. You may be surprised to hear that sitting for eight or more hours a day is comparable to smoking a pack of cigarettes a day in terms of heart risk. Sitting for too long throughout the day is one of the major risk factors for heart disease, cancer and many medical conditions. The solution? An active office can empower you to break out of a sedentary lifestyle. 

An active workstation is essentially a desk where you are not sitting. This can mean a standing desk or one where you move around, such as biking, walking or using a step machine. An active workstation has many benefits. The main benefit is that it allows the user to be productive while burning calories at the same time. Walking pads or treadmills allow you to walk at a slow speed and answer emails, work on a project or participate in a video conference call.

An active workstation does not mean that you need to be moving all the time. And you don't have to be active for too long to reap the benefits of activity. It has been shown that even when you are standing, you are more likely to be spontaneously mobile than when you are sitting. This is important to keep in mind. Overall, sitting for less than three or four hours throughout the day is a good goal for those who are able.

Another concept that is gaining popularity is the idea of "snack" activities. A "snack" is doing something for two or three minutes after sitting for an hour. This helps you break the sedentary status of your body by taking the stairs for a few flights, doing some pushups or something meaningful in terms of activity for just a few minutes, and then coming back and continuing your work. These little episodes of activity reset your metabolic clock. Activity snacks can cause significant biological changes in your cells, metabolism and cholesterol. You may notice your mind feeling sharper for the next half hour. 

While "activity snacking" is an affordable way to implement movement into your daily routine, you don't need a lot of money or a big investment to switch up your office furniture. There are some adapters out there that you put on top of your desk to raise or lower your monitor or laptop computer, allowing you to stand. Some people get creative and use a stack of books or other existing items. The bottom line is that everyone should feel motivated to redesign their home offices in order to be active longer throughout the day. This leaves us with less room for excuses. And, if you have days where you’re stuck going into the office, you still have options. Consider taking the stairs instead of the elevator. — Francisco Lopez-Jimenez, M.D., Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.

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DEAR MAYO CLINIC: I just turned 45 and am dreading my first colonoscopy. Why do I need to be screened if I'm not having issues? Can you walk me through the process?

ANSWER: Feeling anxious or afraid surrounding a procedure, particularly when you've never done it before, is completely normal. The purpose of screening is to act before someone develops symptoms. If we're able to identify polyps, which are precancerous lesions in the lining of the colon, we would then have the opportunity to remove them and prevent the development of cancer in the first place. So through screening, we can prevent cancer. At the time of diagnosing cancer, we've missed that opportunity. 

There are a number of ways we can screen for colorectal cancer. In the U.S., we most often use a colonoscopy. Colonoscopy is an invasive test, but it allows us an opportunity to not only see polyps, but also remove them at the same time. For people with no additional risk factors besides age, it is recommended to start screening at the age of 45. If other risk factors are present, though, it may be recommended to have a colonoscopy sooner than 45. 

The colon preparation prior to the colonoscopy is key. The goal of colonoscopy prep is to make sure that there is nothing in the colon by using a laxative liquid solution. Then, at the time of the colonoscopy, we're able to see and detect even small precancerous lesions so they can be removed. 

It is very common to hear complaints from patients about the preparation, such as the consistency or taste of the solution, cramping, abdominal bloating or discomfort. That's to be anticipated. Unfortunately, some patients also experience nausea. Try slowing down how fast you are drinking the solution. For those who tend to struggle with the taste or consistency, try drinking it through a straw. You can also bite into a small wedge of lime or lemon, or you can chew gum or ice between drinks. 

After you finish the last of the prep solution and check in for your appointment, you'll often be greeted by the front desk team and then escorted back by a healthcare team member. They will review things like your medical history and medications and see how the colon prep treated you. There is a risk that you may have to come back and repeat the test at a later time if the colon prep was not adequate.

Another critical thing they will do is establish your intravenous therapy or IV. The IV is the route in which they will give you the medication to help make the procedure a little bit more comfortable. Some people don't do any sedation at all, but it is totally appropriate to opt for it. There are several different ways that sedation could be done for the procedure. A lot of that depends upon how the procedure is scheduled with your healthcare team. Then, you will end up going back to the procedure room where they will review the nature of the procedure before starting the colonoscopy. Afterwards, there's a bit of a recovery period, and then you're able to head back home. Because of the sedation, we don't want people driving, consuming alcohol or making any critical decisions for 24 hours. 

We still don't have a perfect recipe for preventing polyps, but maintaining a healthy diet and exercise can protect you. It is important to be aware of any symptoms and then follow through with screening. Best of luck as you take this important first step. — Derek Ebner, M.D., Gastroenterology, Mayo Clinic, Rochester, Minnesota.

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DEAR MAYO CLINIC: It seems like no matter what I do, I can't lose weight. Most of my family members struggle with their weight too. Do our genetics play a part in this?

ANSWER: It's important to understand that we are all unique and gain weight for many different reasons. When trying to understand weight gain and why some of us have difficulty losing weight, there are factors such as gut and brain connections, how we control our sensation of hunger and fullness and how long we stay full. Over a decade of studies at Mayo Clinic have helped identify characteristics that can be associated with groups of people called obesity phenotypes. 

Each phenotype has a single genetic predisposition (an increased likelihood of developing obesity based on a person's genetic makeup) and interacts differently with their environment. In many environments we see today, there is an excess of food, and we're less active than before. Some people may feel hungry between meals, while others only have one big meal a day — our genetics drives this. Your genetic makeup determines which phenotype you're going to have. These phenotypes can help guide treatment for weight loss. Each of these genetic phenotypes, or genotypes, identifies the type of obesity and which medication would work best. 

The first phenotype is what we call "hungry brain." These patients start eating and don't feel full even after consuming large meals with second and third helpings. Usually, this runs in families. The other phenotype is what we call "hungry gut." These patients start eating and feel full after their usual portion, but the gut does not send those signals to the brain. Because of that, they feel hungry between meals. Signals from the gut to the brain are hormones, such as glucagon-like peptide-1 (GLP-1). Semaglutide medications such as Wegovy, Ozempic and Rybelsus work on behalf of the GLP-1 hormone. They connect between the gut and the brain, and they signal to the brain that you're full. 

Patients who have emotional hunger are another group. Whether having a good or bad day, these patients look to cope with life by eating food. The fourth group is patients with a "slow burn" or abnormal metabolism where the body does not burn all the calories they consume. 

Looking at these four phenotypes can help individualize obesity therapy. How genes correlate with an obesity phenotype can help determine which medications should be prescribed. Each of us also should have a unique diet approach based on our genotype and phenotype. Many diets have mainly focused on obesity-related complications, such as managing Type 2 diabetes or preventing heart risk, but none have been customized to phenotypes. The concept of the phenotype-tailored diet came from multiple studies that showed metabolic benefits during and after the diet plan began. These findings were then matched to each phenotype to define recommended diets.

At Mayo Clinic, we work closely with our colleagues in bariatric surgery through endoscopic procedures to find out, based on our genetics, how we can identify who will be the most responsive to each course of action. We want to bring precision medicine as we have for any other disease, and I think it's time we do the same for obesity. — Andres Acosta, M.D., Ph.D., Bariatrician, Gastroenterologist, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I recently read that more and more young people are getting diagnosed with colorectal cancer. I'm in my 30s, am I at risk? What does colorectal mean?

ANSWER: The term colorectal cancer combines colon and rectal cancer, two parts of the intestine. The first part of the large intestine is called the colon, and the last part refers to the rectum. These two divisions of colorectal cancer are important because they're often treated differently. Cancers of the colon, for example, may initially be treated through surgery. With cancers of the rectum, we may do treatment long before someone goes to surgery. 

Symptoms of both cancers are similar and can include unintentional weight loss, overall changes in bowel characteristics such as more frequent diarrhea, blood from the rectum or in the stool and ongoing abdominal pain, cramps or gas. These symptoms can be embarrassing for some people to talk about, and that is normal. However, it is extremely important if you have any of those symptoms to share it with your healthcare team. Early diagnosis of colorectal cancer increases your chance of survival.

People of all ages are at risk for colorectal cancer. It is true that there have been increased rates of colon and rectal cancer in younger patients, which has led to a shift in screening recommendations. We used to start screening average-risk individuals at age 50, but because of this new trend, we're now encouraging average-risk individuals to start screening at age 45. Through screening, we can prevent the development of cancer and capture polyps (precancerous growths) even before symptoms start.

It is unknown what has caused this increase among young people. Findings show that it may be an environmental factor. Over the last 50 years, we've seen major changes in diet. Ultraprocessed foods and higher quantities of red meats have potentially led to some negative changes to the bacteria that are normally in our gut, making it not as protective as it once was. A decrease in exercise and an increase in obesity also could be contributing factors. Living a healthylifestyle is critical — exercise and a well-rounded diet can help protect you.

We typically divide people into two groups — those who are at average risk and those who are at high risk for colorectal cancer. Average-risk individuals are people who don't have any associated symptoms that would be linked to colorectal cancer or have any of the factors that would place them at high risk. 

For those who are at high risk, there tends to be at least one of three variables:

1. A medical condition that places them at higher risk.
2. A genetic condition that increases their risk. 
3. A family history that places them at higher risk. For example, a first-degree family member such as parents or siblings who have a diagnosis of colorectal cancer or advanced polyps.

Any of those three components would place you at higher risk, and therefore, you should start screening sooner and possibly more often than average-risk individuals.

When it comes to cancer care, we try to make our efforts personalized, particularly with rectal cancer. The treatment team consists of a gastroenterologist, an oncologist, a surgeon and a radiation oncologist who help direct what the next best step would be for you, whether that's chemotherapy, immunotherapies, surgery or radiation. 

Any delay in sharing information translates to a delay in diagnosis, which can lead to later-stage cancer. It is the later-stage cancers that can be a bit more challenging to treat. Don't delay in making an appointment. — Derek Ebner, M.D., Gastroenterology, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q and A:  Understanding colorectal cancer appeared first on Mayo Clinic News Network.