Ayurvedic perspective of dietary risk factors of colorectal cancers - A hospital-based case control study.

Introduction

Data from Globocon 2020 showed that India alone bore 6.86% of the world's cancer burden among which fatalities from colorectal cancers (CRC) accounted for 35,385 deaths equivalent to 4.15% of all the cancer deaths in the year 2020 [ 1 ]. CRC ranked fourth and seventh globally in incidence, while thirteenth and sixteenth in India. The 5-year survival rate of colon and rectal cancers after diagnosis at an early and localized stage is 91 and 90%, respectively; however, when distant metastasis occurs, the 5-year survival rate drops down to 13 and 17%, respectively [ 2 ].

Considering the numerous CRC treatment options, adjuvant chemotherapy is preferred for patients with stage III illness. In contrast, surgery is the only feasible curative option for localized colon cancer (stages I–III). Patients with metastatic CRC typically receive chemotherapy rather than surgery. Radiation therapy is currently restricted to palliative care for specific metastatic locations such as bone or brain metastases [ 3 ]. Surgically treated cases of CRC may have a 40–60% recurrence possibility in the first three years following surgery, with the majority arising in the second year, although specific rates of recurrence at each stage are still uncertain [ 4 ]. Following surgery, a 20–30% recurrence rate for lymph node metastases with/or nearby organ involvement in stage II, and a 50–80% recurrence rate for stage III have been reported. Despite various combinations of chemotherapy treatments, recurrence of CRC particularly in patients with metastases is common, resulting in a low survival rate. In addition, enduring endless sessions of chemotherapy may turn out to be torturous for the patient, both physically and mentally [ 5 ].

There are various risk factors such as lack of exercise, interrupted sleep, and conditions like diabetes, obesity, piles, ulcerative colitis, and irritable bowel syndrome, reported to lead to malignant changes in the colon and rectum [ 6 ]. Like in most cancers; smoking, alcohol consumption, prolonged exposure to carcinogenic chemicals, and heredity could be the additional factors for CRC. According to conventional medicine, a diet heavy in processed meats, such as hot dogs and other luncheon meats, as well as red meats like beef, lamb, or liver increases the risk of colon cancer [ 7 ]. By deep-frying, simmering, or roasting meat at exceedingly high temperatures, certain chemicals are possibly generated that increase the risk of cancer.

As per Ayurvedic concepts, during foetal development colon and rectum ( Antra and Guda ) are formed by the essence of Rakta and Kapha , and the process is guided by Pitta accompanied by Vata [ 8 ]. Also, the function of the colon concerning the digestion of food, absorption of digested food, and formation of faeces ( Malas ) are controlled by various elements. Pittadhara Kala [8, Sharira Sthana, 4/18], Purishadhara Kala , [8, Sharira Sthana, 4/17] and the inner lining of the digestive tract, are responsible for the production of digestive enzymes while Jatharagni [ 9 , 10 ] and Pachaka Pitta , [10, Chikitsa Sthana, 15/8] are partly comparable with the digestive enzymes. Apana Vayu [9, Sootra Sthana 12/10–12] helps in the separation of useful digestive products and waste. Vitiated Tridoshas affect the functions of these elements resulting in Shotha and further in Granthi/ Arbuda [ 11 ]. Ayurveda emphasizes on proper diet and dietary habits, which are the main components in maintaining a healthy life while wrong diet and dietary habits are the root cause of almost all the diseases [10, Sootra Sthana 28/4]. The gastrointestinal tract is directly exposed to the food constituents hence any wrong dietary factor may affect the epithelial lining of the tract directly.

Secondly, genetic predisposition is one of the risk factors in many types of cancers including CRC. Lynch Syndrome, hereditary non-polyposis colorectal cancer (HNPCC), and familial adenomatous polyposis (FAP) are the major syndromes connected to this CRC [ 12 ]. Aadibalapravrutta vikara [8, Sootra Sthana, 24/5] and Sahaja vikara [10, Chikitsa Sthana, 14/05] as explained in Sushrut Samhita and Charaka Samhita are the genetic disorders caused due to beejadosha (similar to a mutation in a specific gene). Sahaja Arsha [10, Chikitsa Sthana, 14/5] (congenital hemorrhoids) is one such disease that resembles FAP. It is further mentioned that Arsha (hemorrhoids ), Atisara (diarrhea), and Grahani (Malabsorption Syndrome) are the three conditions that can precede each other and the root cause of these three diseases is Agnimandya [10, Chikitsa Sthana, 14/244]. Thus, patients suffering from Sahaja Arsha can develop Grahani and CRC, if left untreated.

In nutshell, inflammatory conditions like Inflammatory Bowel Diseases (IBD), ulcerative colitis, and Crohn's disease are associated with development of colorectal cancers [ 13 ]. Parallelly, in Ayurveda, diseases associated with the development of colorectal cancer are chronic conditions such as Grahani , Pravahika (dysentery), and Arsha (hemorrhoids). These conditions simulate chronic inflammatory conditions ( Shotha ) which are responsible for the development of CRC.

In the present study, based on the Ayurvedic perspective for CRC certain risk factors, especially dietary, have been identified and data for dietary habits, lifestyle, family history of cancer, and addiction history of 420 patients with CRC were documented and analysed for their correlation to CRC, if any.

Materials and methods

Developing the survey items

An extensive food frequency questionnaire was designed outlining the dietary intake of green chillies, red chilli powder, and curd. It recorded the specific mean consumption frequency of these food items (times/day, times/week, times/month, and times/year) along with information about the average quantity consumed in a day (number, teaspoon, and gram measurements; respectively) and the average duration of consumption in years. (Supplementary File 1).

Executing the survey

Approval of the study

The study received clearance from the Institutional Ethics Committee, [approval dated August 04, 2006]. Every participant in the survey was briefed about the goal, importance, and protocol of the survey. Only those participants who provided their consent to participate were enrolled.

Study design

This single-centre, hospital-based, retrospective study was conducted for the patients who registered at the institute from January 1994 to December 2014.

Cases group

The cases were randomly selected from a cohort of CRC patients who had received treatment at both, inpatient and outpatient departments of our institute, regardless of their age, gender, or clinical condition. The eligibility requirements for participation included having a diagnosis of CRC and being older than fifteen years [ 14 ]. The demographic data, medical history, and cancer details were retrieved from the institute's medical records, whereas, the dietary history was obtained from the questionnaire.

Healthy volunteers (control) group

A cross-section of the healthy volunteers (control) enrolled by simple random sampling, were also assessed simultaneously. The age limit of fifteen to ninety years, absence of gastrointestinal disorders, absence of history of CRC, or other malignancies were considered before including them in the study. The control participants were recruited from the outpatient department of our institute. Cases and controls were matched by age, sex, and family relationships.

Data collection methodology and respondent attributes

The structured interviews were conducted in the presence of a single research associate based at our institute with the help of the pre-designed questionnaire. The optimum quantity of green chillies was considered as 5-6 g/day, red chilli powder as 1–1.5 tsp (5–7.5 g) per day in three meals [ [15] , [16] , [17] ] and curd as 80 g equivalent to 1/2 cup. [10, Chikitsa Sthana, 12; 5]. The quantity exceeding the above measure was considered a causative risk factor. To mitigate any researcher bias, a research associate was available at the time of filling out the questionnaire, thereby ensuring that all participants had a comparable comprehension of the questionnaire items. To control the possible confounding bias; age, sex, and family relationship were matched in the study design. After completion of the survey, completed forms were collected and subjected to data entry and analysis. Every step of the data collection process was carried out in compliance with the Helsinki Declaration. Privacy and confidentiality were upheld at every stage of the study period.

Data analysis

Microsoft Excel 2007 was used to store and analyse data. A descriptive analysis using response observation in % was carried out including all the considered variables in the study namely; Age, Sex, Socioeconomic status, Addictions, Primary site, Stage of disease, Grade of disease, and Metastatic status by multivariate analysis with the help of radar plots. Using logistic regression models, the adjusted odds ratios (ORs) and their 95% Confidence Intervals (CIs) were computed to determine the contribution of each potential risk factor to the development of CRC by employing MedCalc Software Ltd.'s calculator for ORs [ 18 ]. P-value less than 0.05 was regarded as statistically significant difference. The consumption of red chilli powder, green chilli, curd, green chilli + curd, and red chilli powder + curd in cases and controls was considered while creating the logistic regression model.

Results

Demographic information

In this study, there were 420 cases (251 rectal cancer and 169 colon cancer) and 116 healthy volunteers. The demographic information of cases and controls is depicted in Table 1 .

Age, sex, socioeconomic status, and family history

The mean age of the participants was 54.9 years (range 18–85), and about two-thirds of the participants were male (n = 279, 66.4%). Most cases were in the age group of 46–60 (n = 176, 41.9%) and belonged to middle-class socioeconomic status (n = 311, 74.1%). On the other hand, 26.75% (n = 31) of controls belonged to the age group 31 to 45 and 73.3% (n = 85) were males. Out of 420 CRC patients investigated, 13.3 % (n = 56) had a family history of cancer ( Table 1 ). Compared to the cases, the controls were younger, included higher proportion of males, predominantly belonged to middle- and lower-income groups and had family history of cancer.

Histopathology, stage, and grade

Table 1 depicts that most of the patients had cancer in the rectum (n = 168, 40%) followed by the sigmoid colon (n = 59, 14.05%). Most of the patients belonged to stages III (n = 123, 29.3%) and IV (n = 129, 30.7%) and grades II (n = 94, 22.4%) and III (n = 206, 49%) of the disease.

Metastatic status

The metastatic status of colorectal cancers depicts the liver (n = 59, 14.04%) as a common site for single organ metastasis followed by omentum (n = 8, 1.9%) and lung (n = 4, 0.95%). Multiple organ involvement was seen in 31 patients (7.38%), whereas 70.23 % (n = 295) showed no distant metastasis ( Table 1 ).

Analysis of risk factors

Dietary risk factors

Table 2 refers to the number of patients consuming green chillies, red chillies and curd and their combinations in the CRC patients while Fig. 1 compares the percentage of consumers of green chilli, red chilli powder, and curd and their combinations amongst cases and controls. It was observed that a higher proportion of green chilli 61% (n = 257) and curd 37% (n = 158) were consumed by the cases in comparison with the controls.

Addiction

Tobacco consumption is common addition in India and is known to cause various cancers. As illustrated in Table 3 , about 50% of the patients consuming excessive chillies did not use tobacco in any form, which was more evident in the case of patients consuming red chilli powder. Similarly, 2/3rd of the patients consuming excessive curd did not have tobacco habit.

Risk factors and site of metastasis

This was depicted through radar chart for each of these parameters ( Fig. 2 ). The maximum number of patients frequently consuming these three dietary items and their combinations presented majorly with rectal cancer and liver metastasis and were in advanced grade and stage of cancer. Green chilli consumption was found to be the maximum within the lower-income group (n = 18, 66.67%), while that of red chilli (n = 150, 48.23%), and curd (n = 107, 34.04%) within the middle class. Tobacco was noticed as the most common addiction in all groups. It was observed that the maximum number of patients frequently consuming these three dietary items, presented with stage III and grade III of cancer, with very high percentage at the higher duration ( Fig. 3 ).

Maximum consumption of green chillies (Males n = 48,29.27%; Females n = 36,21.95%) and red chillies (Males n = 40,29.85%; Females n = 16,24.61%) and curd (Males n = 31, 28.97%) was observed in the age group 46 to 60 irrespective of sex ( Table 4 ).

The calculated ORs for more exposed and no or less exposed groups are presented in Table 5 . Curd and curd with red chilli powder had a significant association with the development of CRC with an OR of 2.728 (95% CI 1.6346 to 4.5531) and 5.0806 (95% CI 2.4015 to 10.7485), which was highly significant (p < 0.0001). Green chilli showed notably associated risk with an OR of 2.0095 (95% CI 1.3258 to 3.0458), which was statistically significant (p = 0.001). Also, red chilli powder and green chilli + curd had ORs as 1.6917 (95% CI 1.1105 to 2.5771) and 2.1778 (95% CI 1.1591 to 4.0918) with p = 0.0144 and 0.0156, respectively.

Discussion

Ayurvedic principles and nutritional studies on dietary risk factors of cancer

As per the Ayurvedic principles, diet plays a very important role in causing Arbuda (cancer) and Dushta Arbuda , therefore, emphasis has been given to the dietary components in our studies. Other dietary factors like meat and white meat, sugar, and fat intake, have already been studied [ 7 ]. Hence, we focussed on factors that are mentioned in Ayurveda and not studied earlier. Based on the outcome in cases and controls, the use of green chilli, red chilli powder, and curd as dietary factors for longer duration (30–60 years) can be adversely associated with the development of CRC. Among the chilli eating group, green chilli appears to show an increased risk of cancer. Also, common metastasis was observed in liver, as capsaicin (an active component of chilli peppers) is metabolised in the liver [ 19 ]. We observed a direct proportional relationship between consumption of these three dietary items for longer duration with advanced stage and grade of cancer.

A study suggests an inverse association between age and spicy food liking, with younger people preferring spicy foods over senior people [ 20 ]. Another study depicts that personality variables influence spicy food intake differently in men and women and that the relationship between personality, perceived burning/ stinging of capsaicin, liking spicy foods, and spicy food consumption may differ between men and women [ 21 ]. In another study most of the chilli and curd consumption was found in middle age group with males being the maximum consumers [ 22 ] whereas, yogurt consumption was more common among people with higher socioeconomic status [ 23 ]. Our study also has a similar finding, that the lower and middle-income groups consumed chilli to the maximum extent while the curd consumption was maximum in the middle-income group ( Table 1 ). Also, tobacco is a known risk factor of CRC [ 24 ]. In our study, we noticed most of the cases were addicted to tobacco, which is in accordance with the previous studies.

It has been well reported that the consumption of chilli is a risk factor for oropharyngeal, gall bladder, lung, esophageal as well as gastric cancers [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] ]. Also, curd has been associated with malignancies like renal, prostate and multiple myeloma [ [33] , [34] , [35] ]. In contrast to the above observations, several studies have been done about chilli, and its anti-cancer and chemoprotective effects [ [36] , [37] , [38] ], as well as daily consumption of yogurt to be inversely associated with cancer [ 39 ], especially bladder cancer [ 40 ], colorectal cancer [ 41 ], and upper aero-digestive tract cancer [ 42 ]. Despite these findings, our study holds significance as it clearly demonstrates that consumption of these dietary factors regularly and for longer duration (for 30–60 years) is a potential risk factor for development of CRC.

Risk factors of colorectal cancer

In Ayurvedic texts, chilli is mentioned as Katuveera or Lanka, and its properties are mentioned as pacifying Kapha Dosha ( Kaphagna ), inducing burning sensation ( Dahakaraka ), as well as vitiating Pitta Dosha ( Pitta vardhaka ) and blood ( Rakta dushtikara ) [ 43 ]. Chilli possesses a pungent taste ( Katu rasa ) and hot potency ( Ushna veerya ), thus vitiating Pitta Dosha . Excess intake of dietary items having a pungent taste ( Katu rasa ) increases heat ( Ushna guna ), dryness ( Ruksha guna ), and lightness ( Laghu guna ) in the body causing vitiation of Vata Dosha ( Vata vruddhi ), burning ( Tapa / Daha ), process of suppuration ( Paka ), emaciation ( Karshana ) and loss of strength of organs ( Bala nasha ) [9, Sootra Sthana 10–19] [10, Sootra Sthana, 26/43)]. All these changes mentioned in Ayurveda lead to the formation of Dushta Arbuda .

Curd ( Dahi ) when taken in excess is responsible for Shotha , a process of inflammation. It causes excessive secretions ( Abhishyandi ), increases Kapha and Pitta Dosha, elevates Kleda (an obnoxious form of Kapha ), and increases heat in the body and blockage of vessels. It is, therefore not recommended in diseases caused by vitiation of Rakta , Pitta, and Kapha , which are the main causes of malignant changes [10, Sootra Sthana, 27/04].

Ayurveda vouches that over-consumption of chilli and curd could be the main reason for inducing vitiation of Tridosha leading to Shotha i.e., inflammation in various forms [10, Sootra Sthana 26/43].

Strength and limitation of the present study

The present study highlights the dietary risk factors for CRC. Strength of our study includes use of a food frequency questionnaire tailored to the Indian diet, a high sample size, and the inclusion of a control group for comparison. Furthermore, this is the first study to examine the link between these commonly used dietary items and colorectal cancer. However, it also has some possible shortcomings. Our questionnaire was a condensed version with only three food groups, even though it asked for extensive details about food consumption and food groups. Secondly, recall bias was unavoidable, as dietary recollection across many years offers lapses resulting from memory issues and makes it cumbersome to assess the true intake of these foods using the questionnaire.

Conclusion

The two medical sciences, Ayurveda and Allopathy, explain the pathogenesis of cancer in different terminologies, but the common element in the pathogenesis of cancer in both the medical sciences is Shotha i.e., chronic inflammation. Chilli due to its Katu rasa and Ushna veerya produces Shotha (inflammation), which leads to Vrana shotha and Arbuda . Similarly, Dadhi (Curd) when taken in excess produces Shotha , vitiates Kapha and Pitta, and produces Kleda , which is in turn responsible for malignant changes in the colorectum. Thus, consumption of green chilli, red chilli, and curd in large quantities and for a long duration can cause chronic inflammation leading to various types of cancers including colorectal cancer.

Source of funding

None.

Author contributions

SS, VD conceptualized the integrated approach of using Ayurveda for cancer patients along with conventional treatments and initiated the project; SS, VD, VG, SG, and SK developed the methodology for this study and carried out the investigation, visualization, and validation of the data collected by SD, SB, NS, BS, DD, VA, AS, AR, SV and SC. VD, SD, SB, and SC wrote the first version of the manuscript while all the authors approved the final manuscript.

Declaration of generative AI in scientific writing

None used.

Conflict of interest

None.

Acknowledgments

The assistance of our supporting staff is highly recognized by the authors.

Footnotes

Peer review under responsibility of Transdisciplinary University, Bangalore.

Supplementary data to this article can be found online at https://doi.org/10.1016/j.jaim.2024.100969 .

Supplementary data

The following is the Supplementary data to this article.

Multimedia component 1

References

1. Globocan. 2020. https://gco.iarc.fr/ Available from:

2. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA A Cancer J Clin. 2023;73:17–48. doi: 10.3322/caac.21763.

3. Jones JA, Simone CB. Palliative radiotherapy for advanced malignancies in a changing oncologic landscape: guiding principles and practice implementation. Ann Palliat Med. 2014;3:192–202. doi: 10.3978/j.issn.2224-5820.2014.07.06.

4. Van den Berg I, Coebergh van den Braak RRJ, Van Vugt JLA, Ijzermans JNM, Buettner S. Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study. World J Surg Oncol. 2021;19:96. doi: 10.1186/s12957-021-02207-4.

5. Qaderi SM, Galjart B, Verhoef C, Slooter GD, Koopman M, Verhoeven RHA., et al. Disease recurrence after colorectal cancer surgery in the modern era: a population-based study. Int J Colorectal Dis. 2021;36:2399–2410. doi: 10.1007/s00384-021-03914-w.

6. Lewandowska A, Rudzki G, Lewandowski T, Stryjkowska-Góra A, Rudzki S. Risk factors for the diagnosis of colorectal cancer. Cancer Control. 2022;29 doi: 10.1177/10732748211056692.

7. Veettil S.K., Wong T.Y., Loo Y.S., Playdon M.C., Lai N.M., Giovannucci E.L., et al. Role of diet in colorectal cancer incidence. JAMA Netw Open. 2021;4 doi: 10.1001/jamanetworkopen.2020.37341.

8. Acharya Y.T., editor. Sushrut Samhita of sushruta. seventh ed. Chaukhamba Orientalia; Varanasi: 2002.

9. Kunte A.M., editor. Ashtang hrudayam of vagbhata. Krushnadas Academy; Varanasi: 1995. Reprint.

10. Acharya Y.T., editor. Charak Samhita of agnivesha. fifth ed. Chaukhamba Sanskrit Sansthan; Varanasi: 2001.

11. Dhruva A., Hecht F.M., Miaskowski C., Kaptchuk T.J., Bodeker G., Abrams D., et al. Correlating traditional ayurvedic and modern medical perspectives on cancer: results of a qualitative study. J Alternative Compl Med. 2014;20:364–370. doi: 10.1089/acm.2013.0259.

12. PDQ Cancer Genetics Editorial Board . 2002. Genetics of colorectal cancer (PDQ®): health professional version.

13. Mattar M.C., Lough D., Pishvaian M.J., Charabaty A. Current management of inflammatory bowel disease and colorectal cancer. Gastrointest Cancer Res. 2011;4:53–61.

14. Zhou C., Xiao W., Wang X., Chen H., Niu S., Wang Q., et al. Colorectal cancer under 20 years old: a retrospective analysis from three tertiary hospitals. J Cancer Res Clin Oncol. 2021;147:1145–1155. doi: 10.1007/s00432-020-03397-2.

15. Siruguri V., Bhat R.V. Assessing intake of spices by pattern of spice use, frequency of consumption and portion size of spices consumed from routinely prepared dishes in southern India. Nutr J. 2015;14:7. doi: 10.1186/1475-2891-14-7.

16. Siebert E., Lee S.-Y., Prescott M.P. Chili pepper preference development and its impact on dietary intake: a narrative review. Front Nutr. 2022;9 doi: 10.3389/fnut.2022.1039207.

17. Saito A., Yamamoto M. Acute oral toxicity of capsaicin in mice and rats. J Toxicol Sci. 1996;21:195–200. doi: 10.2131/jts.21.3_195.

18. MedCalc Software Ltd. Odds ratio calculator. https://www.medcalc.org/calc/odds_ratio.php (Version 22.023). [Last accessed on 30 January 2024].

19. Chanda S., Bashir M., Babbar S., Koganti A., Bley K. In vitro hepatic and skin metabolism of capsaicin. Drug Metab Dispos. 2008;36:670–675. doi: 10.1124/dmd.107.019240.

20. Guido D., Perna S., Carrai M., Barale R., Grassi M., Rondanelli M. Multidimensional evaluation of endogenous and health factors affecting food preferences, taste and smell perception. J Nutr Health Aging. 2016;20:971–981. doi: 10.1007/s12603-016-0703-4.

21. Byrnes N.K., Hayes J.E. Gender differences in the influence of personality traits on spicy food liking and intake. Food Qual Prefer. 2015;42:12–19. doi: 10.1016/j.foodqual.2015.01.002.

22. Ma C., Song Z., Yan X., Zhao G. Accounting for tastes: do low-income populations have a higher preference for spicy foods? J Chinese Sociol. 2018;5:17. doi: 10.1186/s40711-018-0089-2.

23. Possa G., de Castro M.A., Marchioni D.M.L., Fisberg R.M., Fisberg M. Probability and amounts of yogurt intake are differently affected by sociodemographic, economic, and lifestyle factors in adults and the elderly—results from a population-based study. Nutr Res. 2015;35:700–706. doi: 10.1016/j.nutres.2015.05.020.

24. Cross A.J., Boca S., Freedman N.D., Caporaso N.E., Huang W.-Y., Sinha R., et al. Metabolites of tobacco smoking and colorectal cancer risk. Carcinogenesis. 2014;35:1516–1522. doi: 10.1093/carcin/bgu071.

25. Wang J.M., Xu B., Rao J.Y., Shen H.B., Xue H.C., Jiang Q.W. Diet habits, alcohol drinking, tobacco smoking, green tea drinking, and the risk of esophageal squamous cell carcinoma in the Chinese population. Eur J Gastroenterol Hepatol. 2007;19:171–176. doi: 10.1097/MEG.0b013e32800ff77a.

26. Rodríguez-Molinero J., Migueláñez-Medrán B. del C., Puente-Gutiérrez C., Delgado-Somolinos E., Martín Carreras-Presas C., Fernández-Farhall J., et al. Association between oral cancer and diet: an update. Nutrients. 2021;13:1299. doi: 10.3390/nu13041299.

27. Dawsey S.M., Fagundes R.B., Jacobson B.C., Kresty L.A., Mallery S.R., Paski S., et al. Diet and esophageal disease. Ann N Y Acad Sci. 2014;1325:127–137. doi: 10.1111/nyas.12528.

28. Bravi F., Edefonti V., Randi G., Ferraroni M., La Vecchia C., Decarli A. Dietary patterns and upper aerodigestive tract cancers: an overview and review. Ann Oncol. 2012;23:3024–3039. doi: 10.1093/annonc/mds197.

29. López-Carrillo L., Camargo M.C., Schneider B.G., Sicinschi L.A., Hernández-Ramírez R.U., Correa P., et al. Capsaicin consumption, Helicobacter pylori CagA status and IL1B-31C>T genotypes: a host and environment interaction in gastric cancer. Food Chem Toxicol. 2012;50:2118–2122. doi: 10.1016/j.fct.2012.02.043.

30. Lam W.K. Lung cancer in Asian women-the environment and genes. Respirology. 2005;10:408–417. doi: 10.1111/j.1440-1843.2005.00723.x.

31. Serra I., Yamamoto M., Calvo A., Cavada G., Báez S., Endoh K., et al. Association of chili pepper consumption, low socioeconomic status and longstanding gallstones with gallbladder cancer in a Chilean population. Int J Cancer. 2002;102:407–411. doi: 10.1002/ijc.10716.

32. Tsuchiya Y., Terao M., Okano K., Nakamura K., Oyama M., Ikegami K., et al. Mutagenicity and mutagens of the red chili pepper as gallbladder cancer risk factor in Chilean women. Asian Pac J Cancer Prev APJCP. 2011;12:471–476.

33. Hsu C.C., Chow W.-H., Boffetta P., Moore L., Zaridze D., Moukeria A., et al. Dietary risk factors for kidney cancer in Eastern and Central Europe. Am J Epidemiol. 2007;166:62–70. doi: 10.1093/aje/kwm043.

34. Kurahashi N., Inoue M., Iwasaki M., Sasazuki S., Tsugane S. Dairy product, saturated fatty acid, and calcium intake and prostate cancer in a prospective cohort of Japanese men. Cancer Epidemiol Biomarkers Prev. 2008;17:930–937. doi: 10.1158/1055-9965.EPI-07-2681.

35. Shah U.A., Parikh R., Castro F., Bellone M., Lesokhin A.M. Dietary and microbiome evidence in multiple myeloma and other plasma cell disorders. Leukemia. 2023;37:964–980. doi: 10.1038/s41375-023-01874-4.

36. Lin S., Zhang J., Chen H., Chen K., Lai F., Luo J., et al. Involvement of endoplasmic reticulum stress in capsaicin-induced apoptosis of human pancreatic cancer cells. Evid base Compl Alternative Med. 2013;2013:1–12. doi: 10.1155/2013/629750.

37. Atawodi S.E. Nigerian foodstuffs with prostate cancer chemopreventive polyphenols. Infect Agents Cancer. 2011;6:S9. doi: 10.1186/1750-9378-6-S2-S9.

38. Aggarwal B., Kunnumakkara A., Harikumar K., Tharakan S., Sung B., Anand P. Potential of spice-derived phytochemicals for cancer prevention. Planta Med. 2008;74:1560–1569. doi: 10.1055/s-2008-1074578.

39. Larsson S.C., Andersson S.-O., Johansson J.-E., Wolk A. Cultured milk, yogurt, and dairy intake in relation to bladder cancer risk in a prospective study of Swedish women and men. Am J Clin Nutr. 2008;88:1083–1087. doi: 10.1093/ajcn/88.4.1083.

40. Pala V., Sieri S., Berrino F., Vineis P., Sacerdote C., Palli D., et al. Yogurt consumption and risk of colorectal cancer in the Italian European prospective investigation into cancer and nutrition cohort. Int J Cancer. 2011;129:2712–2719. doi: 10.1002/ijc.26193.

41. Michels K.B., Willett W.C., Vaidya R., Zhang X., Giovannucci E. Yogurt consumption and colorectal cancer incidence and mortality in the nurses' health study and the health professionals follow-up study. Am J Clin Nutr. 2020;112:1566–1575. doi: 10.1093/ajcn/nqaa244.

42. Kawakita D., Sato F., Hosono S., Ito H., Oze I., Watanabe M., et al. Inverse association between yoghurt intake and upper aerodigestive tract cancer risk in a Japanese population. Eur J Cancer Prev. 2012;21:453–459. doi: 10.1097/CEJ.0b013e32834f75b5.

43. Vaidya B. Chaukhambha Bharati Academy; Varanasi: 1999. Nighantu adarsh vol. II (Hindi)

Associated Data

Supplementary Materials

Multimedia component 1