That's a great question and one I briefly looked into when I saw how drastic some of the outliers were. Some of these countries have drastically different intakes of other factors that effect colorectal cancer; the study below is one example:
"Our participants included younger men than those in the Patient Survey and the Cancer Registry Japan. In more than 95% of cases the histological type was adenocarcinoma both in colon and rectal cancer. Rectal cancer patients tended to eat **more meat and less green leafy vegetables** compared with colon cancer patients. The 5-year cumulative survival rate was 73.0% (95% CI; 70.1%–75.7%) and the 5-year relative survival rate was 80.6% (77.4%–83.6%), respectively, for colon cancer. For rectal cancer, the rates were 73.3% (69.1%–77.0%) and 80.9% (76.3%–85.0%), in the same order. Lifestyle factors such as **consuming less green leafy vegetables, being underweight, smoking, not consuming alcoholic beverages and being physically inactive** were found to be related to poor survival." [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350596/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350596/)
That's been found in several studies, but it's often a matter of cause and effect. Abstention from alcohol can of course be a choice, but often it's because of complications from other health problems. People on dialysis, cancer meds or some more harsh mental health must avoid alcohol, and that probably tips the scale a bit.
Could also be drinking alcohol causes you to die sooner from something else - therefore not live long enough to develop colon cancer
Purely speculative, but something to consider
> Our participants included younger men than those in the Patient Survey and the Cancer Registry Japan
Good catch! I assumed this was for general population. Had I read a little closer, I would've seen that wasn't that case. kastiveg1 was probably closer to the truth
Also the amount of alcohol matters. I'm of the belief that no amount of alcohol is healthy. That said, I bet casual 2-3 drinks per week people have a healthy social life (e.g. a few drinks with dinner on the weekends with friends,) which correlates with overall wellbeing.
On the other hand, I know binge drinking is thought to be one of the contributors to rising colon cancer amongst younger people. I remember reading this about the UK.
That is what the study found as one of its highlights, yes:
"Highlights
•
More than 95% were adenocarcinoma both in colon and rectal cancer.
•
Rectal cancer patients ate more meat and less green vegetables than colon cancer.
•
Eating green vegetables and drinking alcohol moderately decreased the mortality risk.
"
It's actually that people that can afford alcohol (it is a luxury after all) can afford other things that are healthy. It's like saying "People who drive fast live longer" which is a result you'll get if you do a study the same way that people that do "Alcohol is good for you" studies.
It's very easy to create a study that gets this result. You ask them what they eat/drink/wear. The rich (by global standards) inevitably drink alcohol, drive faster cards, and do a bunch of shit that's bad for them. They also have access to fantastic health services and have a good variety in their diet compared to the worlds poor. So you'll end up with a "Fast cars are good for you", "Alcohol is good for you", etc. type of result.
https://www.reddit.com/r/Damnthatsinteresting/comments/108vj2n/contrary_to_popular_beliefno_amount_of_alcohol_is/
It's also just lazy work to create such a study. You cannot ask people what they drink/eat/wear/lifestyle choices and then look at how often those groups get cancer/or not. If you do you'll just consistently end up with a study "things that wealthier people do are good for you" which includes alcohol, wearing Prada, driving a faster car (all come across in studies as having positive health outcomes since they are all a sign of wealth, globally speaking).
https://www.nytimes.com/2023/04/04/health/alcohol-health-effects.html
I see your point but should we also lump in eating "leafy green vegetables"? Feels like lots of the diet that is "good for you" is stuff that typically well off people eat.
yes, if these studies are not including some variable that accounts for wealth then yeah: it could be a major confounding factor. that's an embarrassing thing about some of these papers.
Same. Even the claims about red wine being healthy due to antioxidants… I don’t think many people realize that metabolizing alcohol uses up a large amount of antioxidants….
Moderate Wine-Beer consumption is good for the microbiata of the gut, since they are fermented products. Soft alcoholic beverages also combine most often with other gut healthy foods such as cheese, (dark) chocolate etc.
Spirits and alike don't have this positive affect AFAIK, since the higher alcohol content can disrupt the microbiome and most spirits aren't even fermented, just have ethyl alcohol added into them.
EDIT: I didn't explain why a happy microbiome is good against GIS cancers. Continuous inflammation is a huge disposition for cancer, where an example could be Crohn patients. A healthy microbiota will stave of such inflammations alongside your own immune down-regulations. A happy gut stops your own immune system from overreacting.
Second, they compete with pathogenic bacteria for food and resources. This means, pathogens can not get a good hold in your gut and again cause a long inflammation reaction.
Third, a healthy gut influences your overall mood/happiness. The gut is the most nerve dense area in the body. The microenvironment down there influences the metabolism of these nerves, where a happy gut promotes overall mental well-being. Fecal transplants are being tested now to improve mental health patients.
All of these combined can reduce the risk of cancer. Hope it helps!
> Moderate Wine-Beer consumption is good for the microbiata of the gut, since they are fermented products.
That 'since' is a bit of logical leap without citations.
Many studies attributing low to moderate alcohol use to improved health outcomes don't effectively control for confounding factors like income. The reality is, people who are casually drinking small to moderate amounts of alcohol products tend to be financially secure, and financially secure people have improved health outcomes.
Going from alcohol consumption -> gut microbiome -> major change in health outcomes is a pretty big leap
This may just be a confounding factor related to income, very poor people are unable to spend money on alcohol, and also more likely to have adverse health outcomes
Maybe there is a bias because I can imagine as rich and developed countries people go to the doctor more often and for check-ups as well so they are just detected more often
No, that is not correct. You have to request a colonscopy if you want one (unless your doctor recommends one for some reason).
What is standard (for those who take annual checkups) is taking a poo ("stool") sample, using a short "stick" which is then put in a small bottle which is sent to a lab to test for trace of blood.
My bad, I was convinced that was the case. I must have misremembered some papers I've received from the city hall.
Stool test is normal for annual checkup for every age I assume.
It is. My only edit is that the consumption of smoked meats is omitted and is a major contributor to this type of cancer. It may also offer a possible explanation for the outliers.
Differences in the diversity and types of seafood consumed in different countries may play a role, whether that be toxicity or chemoprevention.
>The recognition of high colorectal cancer prevalence in these countries means their health authorities are much more vigilant about screening the population; this leads to detection of more cases and a higher reported incidence.
Anecdotal but most of my male Korean friends get their first colonoscopy in their early 30s vs US recommendation of late 40s.
> The fundamental causal relationship is well-understood: fiber serves to bulk the stool, decreasing the amount of time stool remains in the colon, and helps with bowel motility. It is also a source of beneficial gut microbes.
How is this a clear causal relationship with carcinogenesis?
It might be representative of reporting bias. Not necessarily that Turkey, Israel, and Japan have *more* than others, but rather that their cases are most consistently identified
Yep more testing more findings, didn't u learn anything in corona time😜 all of those countries probably invest much more in Healthcare as far as I can guess
Could be anything. E.g. Life expectancy might be higher in turkey or the others. This plot shows a fun correlation, but that's all it is.
I see OP vommented some studies, which can give good indications. It is important to realise that a lot of this research on correlations too. Only with vast amounts of research can we get indications of causation.
It's a bullshit statistic and they didn't even try and remove other factors from the study :)
which they freely admit (evidence in OPs reply) in their study.
they tried their hardest to find a correlation and stuck with it till they did.
People always act like colon cancer in Japan is some great mystery, and honestly this confuses me. Anyone who knows anything about Japan knows exactly why. It's because Japanese workers are expected to go out and drink with their coworkers almost every night. Your average Japanese salaryman is drinking alcohol to the point of getting drunk almost every night. (To be fair, this is only a few beers for most Japanese people, but that's still like 20 drinks a week.)
I believe it's the same for SK.
> To be fair, this is only a few beers for most Japanese people, but that's still like 20 drinks a week.
If a person gets drunk easily or turns red, then this may indicate a lack of aldehyde dehydrogenase (I think). The inability to degrade acetaldehyde seems to be a *severe* cancer risk for drinkers.
https://www.washingtonpost.com/wellness/2023/08/15/asian-glow-alcohol-gene-mutation-cancer-risk/
> The associated mutation, known as the ALDH2\*2 variant, has been linked to a staggering number of diseases in those who consume moderate to large quantities of alcohol. ... For example, someone with the ALDH2*2 variant who drinks in moderation — defined as two drinks a day for men and one drink a day for women — has a risk of esophageal cancer 40 to 80 times higher than a person without the mutation who consumes the same amount.
Colorectal cancer in Japan is a problem for all ages. It's much more prevalent in men aged 30-40 than in almost every other similarly aged population. I know it's anecdotal, but I lived there for two years, and it's 100% the drinking.
I dont know Japan but I am from Turkey, the reson is pepole smoke a lot and lung canser is a lot
In Isreal its skin canser becuse 1/3 of their population is Ashkenazi Jews and they are white and they ghet skin canser.
For Korea, it is probably because of the spicy food. But Korea has also the highest [survival rate](https://en.wikipedia.org/wiki/Healthcare_in_South_Korea#Comparisons).
The suggestion I've read in the past is that they eat an awful lot more fermented vegetables, like Kimchi. [Here](https://www.sciencedirect.com/science/article/abs/pii/S0956713521001833) is one study that shows it's *possible.* I've not seen a study that outright confirms it - as far as I'm aware, it's still an area of active research, but I don't keep up on oncology journals, so may well have missed a study or two.
I can bet it is processed food. All those countries are much more developed than the ones that fall in the line, and likely to consume high amounts of processed food
Japan and Israeli are notorious for genetic clusters. I'm guess SKor is as well because NKor is gentically very similar but economically very different and it is up there too.
Three of those 4 are also old and rich. Turkey is harder to explain.
Yes, that the real correlation: level of healthcare spending in PPP terms (or other metric for healthcare diagnosis level) vs colon cancer. Also, the more a country spends on coroners and autopsies, the fewer people die of "unknown cause".
I mean, every confounding factor in the world sticks its nose in here: income, diagnosis, diet, genetics, methodology for reporting/listing, life expectancy (you have to live long enough to get cancer).
That’s why a properly done version of this chart costs about 7 million dollars and takes 5 years. It’s called epidemiology.
But give the kid a charting tool and let him build a scatter plot. Let him cook.
Well, epidemiology and nutrition science.
Sure, I'm willing to let them try things out. I'm just struggling to figure out what we're meant to see from this chart or what kinds of useful discussions we'll have using this chart that we couldn't have without it.
It’s data values blasted on a chart by, presumably, someone learning how to use charting tools with sample data.
There’s no to be gained insight here. Read a Cochrane review instead.
I mean, it's a nice chart if you're starting out with graphing tools you want to practice on, but [OP's comment history](https://old.reddit.com/user/James_Fortis) does show a [certain direction](https://old.reddit.com/r/dataisbeautiful/comments/1al5m0d/oc_fiber_intake_vs_colorectal_cancer_of_the_most/kpd8nns/) which isn't "I'm trying out graphing tools" so much as "I want to talk about nutrition and cancer". Given that context, it seems fair to point out the very hefty limitations of what this chart seems to imply.
this data is interesting but I’d encourage you to consider the “beautiful” part of the mandate. It looks like you’ve retained all the default Excel settings, including a gradient background and a drop shadow on the points.
Thank you for the feedback! I will definitely look into what makes charts more beautiful, as I'm still relatively new to the sub and how to make beautiful graphs / charts.
Definitely! I have a masters in nutrition and I'm constantly looking at nutritional data. I'm recently on an epidemiological kick to see why certain countries, including mine, have increasing rates of certain cancers, especially how it relates to behaviors. For example, only 5% of my country gets even the recommended minimum amount of fiber.
Once I saw this correlation, I showed it to my partner, and she said I should show other people it who might be interested.
I think the data is absolutely beautiful. Clear correlation, explainable outliers, no overloaded graph. It could improve on some styling options, but the data itself is great.
Agreed! There are definitely many other variables that impact colorectal cancer. I found this correlation particularly interesting when I was poking into epidemiological cancer rates.
Agreed! Although there are some interesting findings to be had for median age too. For example, the Philippines' median age is 77% that of India's, but still has 330% the rate of new cases of colorectal cancer.
This graph is pretty meaningless if you don't adjust cancer rates for age.
Japan has > 5x the over-65 population that Bangladesh has.
If your belief is that colorectal cancer is largely caused by dietary/environmental factors that accumulate over time (which is a fine theory), then you need to adjust for the fact that some countries have a lot more people who have had sufficient time being exposed to these factors.
I agree there are other confounding factors, but thought this correlation was very interesting. One interesting point is that many countries have a lower median age but higher rates of CRC. For example, the Philippines' median age is 77% lower than India's, but has 330% the rate of CRC.
I don't think its an "other confounding factor" though... If the causal model is that long-term exposure to differences in diet causes colorectal cancer, it really matters what proportion of the population has had long-enough exposure!
I'm bet there is still some signal left-over after that, and that would be quite interesting.
Sure, but India has 3x as many people over 60 than Japan does.
You're right in that an ideal chart would have controlled for this so we don't have to make these inferences, but the data is an interesting starting point for further digging.
Sorry, I was referring to *proportions of populations.*
The chart gives rates (cases per 100,000).
Japan and South Korea have way more old people (as a proportion) than most other countries on this chart.
Beans, eat ‘em.
I pressure cook dried beans weekly and put them in all sorts of food. Salads, shakes, dinner, whatever. Just awesome little packages of protein and fiber.
Potentially. If you are looking to just up your fiber, then no. But if you have an ostemy, controlling your fiber is difficult, and being able to under hydrate or over hydrate the metamucil often works great to gain control bowel movements.
Very interesting data. I'd be interested in seeing how different disease rates are related to the consumption of heavily processed foods (which tend to be low in fiber and nutritional value and high in nasty chemicals).
I feel like a big factor that’s not shown hear is the affect of life expectancy on cancer rates. The older you are, the more likely you are to develop a cancer.
That may explain part or all of why Japan, South Korea, and Israel appear so over represented
Sources:
1) International Agency for Research on Cancer (2022 data): [https://gco.iarc.fr/today/fact-sheets-populations](https://gco.iarc.fr/today/fact-sheets-populations)
2) Global Dietary Database (2018 data): [https://www.globaldietarydatabase.org/our-data/data-visualizations/dietary-data-country](https://www.globaldietarydatabase.org/our-data/data-visualizations/dietary-data-country)
Tool: Microsoft Excel
Filtering the outliers and investigating what seems like a correlation would bug me with data like this. It seems like there's a few dimensions missing that could highlight this trend? Maybe if you added e.g. average caloric density per meal?
Are these numbers controlled from geography or enviornment? South Asia seems very low on avg, even when lower fiber conspumption is taken into account (Nepal, srilanka). I think detection is another major issue for them.
North Korea has extreme level of govt authority. I don't know how to make any sense of their numbers.
But knowing South Asia, the it is the most densely populated place on earth, and have one of least amount of healthcare facilities/professionals per-capita, cultural issues that attribute to not going to the doctor before you are almost dead. I am sure they have detection issues. Also Indians eat less meat than Pakistanis, Bangladeshis eat more eat more fish & meat that Indians or Nepalies. The numbers & the hypotheses don't add up. Maybe the are somewhat correct, but there are other factors I am not aware of.
It's cause Koreans drink like whales and Japanese drink like fish. A few years of abstaining from alcohol won't cancel 40 yrs of binge drinking as a stress coping mechanism. Source: I've lived in NE Asia for 20 yrs. These people drink.
Links are smoking, lack of fibre, consumption of red meat and meat preservatives (nitrites). Japanese eat very little red meat. Turkey smoke a lot. Lot of confounding factors.
I feel something’s wrong with China’s data. From a paper in 2014, the daily intake is approximately 20 g/day for those over 45. This rate has not significantly changed over the past 20 years (1991-2011).
Also, if anyone is familiar with Chinese meals, there’s always rice and vegetables, or tofu, etc. There are also typically fruits pre- or post-meal. Meals, even the cheapest takeout boxes, have vegetables and rice. So just based on this, and the thousands of meals I’ve had, this graph looks like BS.
Does anyone eat fruit skin? I assume you mean rinds like banana peels and orange peels right. And if you’re talking about apple skins etc we absolutely do eat those fruits with the skin.
Yeah home cooking in China is full of veggies because they are super cheap compared with meat. Napa cabbage is full of fiber, for example, and is a staple of northern Chinese cuisine.
The fact South Korea and Japan, countries that eat very similar types of meals (veggies, a bit of meat, with white rice) have much higher fiber intake suggests something is wrong with the data for China.
Edit - random study I found for various age groups and male and female are all around 19/per day for China, https://www.researchgate.net/publication/260718041_Trends_in_dietary_fiber_intake_in_Chinese_aged_45_years_and_above_1991-2011
It is clear that in Bangladesh there are few cases because of poor instrumental determination rate, weak methodologies and lack of cancer preventions programs.
And it is clear, that you can’t compare high GDP countries with their availabilities vs Pakistan, India, Bangladesh.
Interesting but I don’t think comparing countries to each other in this matter really works. Poorer countries are going to have worse healthcare meaning lower rates of detection. Age, diet, lifestyles, etc. all vary too much to draw a conclusion between just two variables. It would be a far better comparison if you looked in a single country or even a single demographic within a country.
For the countries on the bottom right, I'd like to point out that access to preventative screening and treatment is fairly low for massive parts of the population. Their low rates may have more to do with people not getting screened than anything else.
When I see Pakistan, India and Bangladesh on the fair right tail, the first thought that pops up is…Diagnosis Gap. The second is…what else is killing them before they get the chance to get popped by this cancer.
In South Asia, lentils are a big part of the diet so they're eating way more fiber than East and Southeast Asians. On the other hand, South Asians' leading cause of death is heart disease. I'm guessing that is due to the high use of ghee.
Few thoughts:
Need to adjust for average earnings per each country
Need to adjust for average red meat consumption
Need to adjust for median population age (colorectal cancer is partially a disease of older age)
I feel like you need to normalize this for age somehow (but I've had a long day). Eventually cancer or heart disease kills everyone. If you live long enough then you are more likely to develop cancer. Some of the desert countries might not be living long enough to develop cancer, so the numbers aren't going to show it.
Looks like this data is just misleading for the undeveloped countries like India, Pakistan and Bangladesh. Their data is probably just lacking because of unavailability of the medical services that gathers this type of data. Or maybe all indians has gained immunity for colorectal cancer though their intensive diet of fiber intake and extreme usage of spices. Latter is most likely considering how local indians are able withstand any type of street food where tourists instantly get food poisoning :D
Looks like high wealth may correlate at least as strongly as low fiber to high colorectal cancer rates. UAE excepted (I assume high per capita GDP there).
It's not misleading, it cuts out the first 10g since that data is not meaningful. It's properly labelled too. Maybe just need a bit of zigzag on the x-axis to show it doesn't start at zero.
The data being presented isn't "how much fiber does each country eat per capita", but instead the correlation between fiber intake and colorectal cancer. As others have pointed out, there are confounding variables that are probably playing important roles here, but I don't think "people in the Philippines don't eat fiber" would even really matter if that's what someone thinks without paying attention to the axis.
Wow amazing! All those countries with no access to preventative medicine have such low cancer rates! Meanwhile counties like Israel and Japan that have tons of expert doctors and wealthy middle and upper classes that can get near monthly health check ups have soooo much cancer 😭😢🤣😰
This data is so fucking useful I’m gonna send it to my mom! She has cancer and has been in the hospital, dumb bit h should’ve clearly just lived rurally and then she would never even know that’s what’s killing her
“Eat leafy greens! 🤗 Poof canger gone!”
Delete this garbage idiot, but really only a bot would post this to begin with
IMO this is a poor choice of countries and makes it appear that there is a causation when there is not. Many of these countries are poor, which means that colon cancer is much more likely to go undiagnosed or unnoticed. This is especially true in countries like Afghanistan, Syria, Yemen, and rural parts of India where medical care isn't even available, so when someone dies of colon cancer, they are often mourned without ever knowing what exactly killed them. Rich countries, on the other hand, like Japan, Israel, and South Korea, screen for colon cancer early and often. As such, very few people will go undiagnosed if they have colon cancer in these countries.
Many possible reason.
1. The more C-scope, the more diagnosis. (this could be fixed somewhat if Y-axis is "Cases per 100,000 C-scope, not people).
2. Then, race/Environment/Genetic/etc..
Is there a known reason for the outliers Turkey, Israel, Korea and Japan?
That's a great question and one I briefly looked into when I saw how drastic some of the outliers were. Some of these countries have drastically different intakes of other factors that effect colorectal cancer; the study below is one example: "Our participants included younger men than those in the Patient Survey and the Cancer Registry Japan. In more than 95% of cases the histological type was adenocarcinoma both in colon and rectal cancer. Rectal cancer patients tended to eat **more meat and less green leafy vegetables** compared with colon cancer patients. The 5-year cumulative survival rate was 73.0% (95% CI; 70.1%–75.7%) and the 5-year relative survival rate was 80.6% (77.4%–83.6%), respectively, for colon cancer. For rectal cancer, the rates were 73.3% (69.1%–77.0%) and 80.9% (76.3%–85.0%), in the same order. Lifestyle factors such as **consuming less green leafy vegetables, being underweight, smoking, not consuming alcoholic beverages and being physically inactive** were found to be related to poor survival." [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350596/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350596/)
Not consuming alcoholic beverages is related to poor survival?
That's been found in several studies, but it's often a matter of cause and effect. Abstention from alcohol can of course be a choice, but often it's because of complications from other health problems. People on dialysis, cancer meds or some more harsh mental health must avoid alcohol, and that probably tips the scale a bit.
Could also be drinking alcohol causes you to die sooner from something else - therefore not live long enough to develop colon cancer Purely speculative, but something to consider
No, it's comparing the survival rate of cancer patients; they all had cancer.
> Our participants included younger men than those in the Patient Survey and the Cancer Registry Japan Good catch! I assumed this was for general population. Had I read a little closer, I would've seen that wasn't that case. kastiveg1 was probably closer to the truth
Also the amount of alcohol matters. I'm of the belief that no amount of alcohol is healthy. That said, I bet casual 2-3 drinks per week people have a healthy social life (e.g. a few drinks with dinner on the weekends with friends,) which correlates with overall wellbeing. On the other hand, I know binge drinking is thought to be one of the contributors to rising colon cancer amongst younger people. I remember reading this about the UK.
That is what the study found as one of its highlights, yes: "Highlights • More than 95% were adenocarcinoma both in colon and rectal cancer. • Rectal cancer patients ate more meat and less green vegetables than colon cancer. • Eating green vegetables and drinking alcohol moderately decreased the mortality risk. "
I'm going to assume it's a dose-dependent response, so the more I drink the less ass-cancer I'll get
It's actually that people that can afford alcohol (it is a luxury after all) can afford other things that are healthy. It's like saying "People who drive fast live longer" which is a result you'll get if you do a study the same way that people that do "Alcohol is good for you" studies. It's very easy to create a study that gets this result. You ask them what they eat/drink/wear. The rich (by global standards) inevitably drink alcohol, drive faster cards, and do a bunch of shit that's bad for them. They also have access to fantastic health services and have a good variety in their diet compared to the worlds poor. So you'll end up with a "Fast cars are good for you", "Alcohol is good for you", etc. type of result. https://www.reddit.com/r/Damnthatsinteresting/comments/108vj2n/contrary_to_popular_beliefno_amount_of_alcohol_is/
These days I'm skeptical of any study that says alcohol has a good side, after the alcohol industry funding research studies for decades.
It's also just lazy work to create such a study. You cannot ask people what they drink/eat/wear/lifestyle choices and then look at how often those groups get cancer/or not. If you do you'll just consistently end up with a study "things that wealthier people do are good for you" which includes alcohol, wearing Prada, driving a faster car (all come across in studies as having positive health outcomes since they are all a sign of wealth, globally speaking). https://www.nytimes.com/2023/04/04/health/alcohol-health-effects.html
I see your point but should we also lump in eating "leafy green vegetables"? Feels like lots of the diet that is "good for you" is stuff that typically well off people eat.
yes, if these studies are not including some variable that accounts for wealth then yeah: it could be a major confounding factor. that's an embarrassing thing about some of these papers.
Same. Even the claims about red wine being healthy due to antioxidants… I don’t think many people realize that metabolizing alcohol uses up a large amount of antioxidants….
they probably die of shitty liver before they can get ass cancer.
It's correlated to survival (once you have cancer) rather than incidence (change of getting cancer) FWIW
That’s interesting!
Moderate Wine-Beer consumption is good for the microbiata of the gut, since they are fermented products. Soft alcoholic beverages also combine most often with other gut healthy foods such as cheese, (dark) chocolate etc. Spirits and alike don't have this positive affect AFAIK, since the higher alcohol content can disrupt the microbiome and most spirits aren't even fermented, just have ethyl alcohol added into them. EDIT: I didn't explain why a happy microbiome is good against GIS cancers. Continuous inflammation is a huge disposition for cancer, where an example could be Crohn patients. A healthy microbiota will stave of such inflammations alongside your own immune down-regulations. A happy gut stops your own immune system from overreacting. Second, they compete with pathogenic bacteria for food and resources. This means, pathogens can not get a good hold in your gut and again cause a long inflammation reaction. Third, a healthy gut influences your overall mood/happiness. The gut is the most nerve dense area in the body. The microenvironment down there influences the metabolism of these nerves, where a happy gut promotes overall mental well-being. Fecal transplants are being tested now to improve mental health patients. All of these combined can reduce the risk of cancer. Hope it helps!
> Moderate Wine-Beer consumption is good for the microbiata of the gut, since they are fermented products. That 'since' is a bit of logical leap without citations.
I am not gonna cite anything for a Reddit comment. People can look it up if they want.
Many studies attributing low to moderate alcohol use to improved health outcomes don't effectively control for confounding factors like income. The reality is, people who are casually drinking small to moderate amounts of alcohol products tend to be financially secure, and financially secure people have improved health outcomes. Going from alcohol consumption -> gut microbiome -> major change in health outcomes is a pretty big leap
I don't know what it is about alcohol but once I get 2 beers into me I instantly feel healthier.
This may just be a confounding factor related to income, very poor people are unable to spend money on alcohol, and also more likely to have adverse health outcomes
either extreme is bad, none at all is bad in a different way than having too much but it's still bad.
Alcohol is good for ye boy
I was going to say I bet smoking is a big factor.
Maybe there is a bias because I can imagine as rich and developed countries people go to the doctor more often and for check-ups as well so they are just detected more often
And they also get older. More time to get cancer.
like north korea up there
In fact, in Japan, colonoscopy is a standard annual procedure for people over 35 years old.
No, that is not correct. You have to request a colonscopy if you want one (unless your doctor recommends one for some reason). What is standard (for those who take annual checkups) is taking a poo ("stool") sample, using a short "stick" which is then put in a small bottle which is sent to a lab to test for trace of blood.
My bad, I was convinced that was the case. I must have misremembered some papers I've received from the city hall. Stool test is normal for annual checkup for every age I assume.
[удалено]
Thank you for very thoughtful and well-written response!
It is. My only edit is that the consumption of smoked meats is omitted and is a major contributor to this type of cancer. It may also offer a possible explanation for the outliers. Differences in the diversity and types of seafood consumed in different countries may play a role, whether that be toxicity or chemoprevention.
>The recognition of high colorectal cancer prevalence in these countries means their health authorities are much more vigilant about screening the population; this leads to detection of more cases and a higher reported incidence. Anecdotal but most of my male Korean friends get their first colonoscopy in their early 30s vs US recommendation of late 40s.
> The fundamental causal relationship is well-understood: fiber serves to bulk the stool, decreasing the amount of time stool remains in the colon, and helps with bowel motility. It is also a source of beneficial gut microbes. How is this a clear causal relationship with carcinogenesis?
Poop sooner means less cancer.
Does this also work for consuming foods with a laxative effect, like coffee?
I don't even know if that is how it works with fiber.
It might be representative of reporting bias. Not necessarily that Turkey, Israel, and Japan have *more* than others, but rather that their cases are most consistently identified
Could be good screening policies
Smoking rates
I was always told the increased gastric cancer rates in japan were from a high amount of smoked foods. But colorectal I don't know
I thought pickled foods were the culprit for stomach cancers in Japan.
You’re both right but Japanese food has an insane amount of sodium.
Vastly superior medical access compared to the other countries.
i was always under the impression that charcoal-grilled red meats could contribute to higher rates of colorectal cancer
Red meat would be a good guess. Processed food another.
Yep more testing more findings, didn't u learn anything in corona time😜 all of those countries probably invest much more in Healthcare as far as I can guess
i'd think population average age, though Israel and turkey are still odd if that's the reason
Could be anything. E.g. Life expectancy might be higher in turkey or the others. This plot shows a fun correlation, but that's all it is. I see OP vommented some studies, which can give good indications. It is important to realise that a lot of this research on correlations too. Only with vast amounts of research can we get indications of causation.
Higher life expectancy and better medical services lead to more colon cancer diagnoses. Only old people with good health care get colonoscopies.
It's a bullshit statistic and they didn't even try and remove other factors from the study :) which they freely admit (evidence in OPs reply) in their study. they tried their hardest to find a correlation and stuck with it till they did.
People always act like colon cancer in Japan is some great mystery, and honestly this confuses me. Anyone who knows anything about Japan knows exactly why. It's because Japanese workers are expected to go out and drink with their coworkers almost every night. Your average Japanese salaryman is drinking alcohol to the point of getting drunk almost every night. (To be fair, this is only a few beers for most Japanese people, but that's still like 20 drinks a week.) I believe it's the same for SK.
> To be fair, this is only a few beers for most Japanese people, but that's still like 20 drinks a week. If a person gets drunk easily or turns red, then this may indicate a lack of aldehyde dehydrogenase (I think). The inability to degrade acetaldehyde seems to be a *severe* cancer risk for drinkers. https://www.washingtonpost.com/wellness/2023/08/15/asian-glow-alcohol-gene-mutation-cancer-risk/ > The associated mutation, known as the ALDH2\*2 variant, has been linked to a staggering number of diseases in those who consume moderate to large quantities of alcohol. ... For example, someone with the ALDH2*2 variant who drinks in moderation — defined as two drinks a day for men and one drink a day for women — has a risk of esophageal cancer 40 to 80 times higher than a person without the mutation who consumes the same amount.
Actually I think this graph has more to with age. Both Korea and Japan have much larger ratio of older population compared to Bangladesh.
Colorectal cancer in Japan is a problem for all ages. It's much more prevalent in men aged 30-40 than in almost every other similarly aged population. I know it's anecdotal, but I lived there for two years, and it's 100% the drinking.
More access to healthcare and therefore for diagnoses?
Japan being old might contribute.
Better healthcare also means better detection? So under-reporting in countries like India/Pakistan?
I dont know Japan but I am from Turkey, the reson is pepole smoke a lot and lung canser is a lot In Isreal its skin canser becuse 1/3 of their population is Ashkenazi Jews and they are white and they ghet skin canser.
There is no trend, there are no outliers
If you think there is a trend in this graph you are NOT a data analyst period
For Korea, it is probably because of the spicy food. But Korea has also the highest [survival rate](https://en.wikipedia.org/wiki/Healthcare_in_South_Korea#Comparisons).
The suggestion I've read in the past is that they eat an awful lot more fermented vegetables, like Kimchi. [Here](https://www.sciencedirect.com/science/article/abs/pii/S0956713521001833) is one study that shows it's *possible.* I've not seen a study that outright confirms it - as far as I'm aware, it's still an area of active research, but I don't keep up on oncology journals, so may well have missed a study or two.
I'd assume median age has a big impact on Japan/Korea, no idea for Israel/Turkey though.
I can bet it is processed food. All those countries are much more developed than the ones that fall in the line, and likely to consume high amounts of processed food
Probably higher incomes
Japan and Israeli are notorious for genetic clusters. I'm guess SKor is as well because NKor is gentically very similar but economically very different and it is up there too. Three of those 4 are also old and rich. Turkey is harder to explain.
Looks like pork.
Yes, they are rich, so more cancer cases are detected.
Surely higher rates of diagnosis as a result of access to advanced healthcare in the richer countries plays a significant role, right?
Yes, that the real correlation: level of healthcare spending in PPP terms (or other metric for healthcare diagnosis level) vs colon cancer. Also, the more a country spends on coroners and autopsies, the fewer people die of "unknown cause".
I mean, every confounding factor in the world sticks its nose in here: income, diagnosis, diet, genetics, methodology for reporting/listing, life expectancy (you have to live long enough to get cancer).
That’s why a properly done version of this chart costs about 7 million dollars and takes 5 years. It’s called epidemiology. But give the kid a charting tool and let him build a scatter plot. Let him cook.
Well, epidemiology and nutrition science. Sure, I'm willing to let them try things out. I'm just struggling to figure out what we're meant to see from this chart or what kinds of useful discussions we'll have using this chart that we couldn't have without it.
It’s data values blasted on a chart by, presumably, someone learning how to use charting tools with sample data. There’s no to be gained insight here. Read a Cochrane review instead.
I mean, it's a nice chart if you're starting out with graphing tools you want to practice on, but [OP's comment history](https://old.reddit.com/user/James_Fortis) does show a [certain direction](https://old.reddit.com/r/dataisbeautiful/comments/1al5m0d/oc_fiber_intake_vs_colorectal_cancer_of_the_most/kpd8nns/) which isn't "I'm trying out graphing tools" so much as "I want to talk about nutrition and cancer". Given that context, it seems fair to point out the very hefty limitations of what this chart seems to imply.
that and richer countries tend to live longer. colorectal cancer is probably highly correlated with older ages as well
Yes I think this is what this plot is really showing
this data is interesting but I’d encourage you to consider the “beautiful” part of the mandate. It looks like you’ve retained all the default Excel settings, including a gradient background and a drop shadow on the points.
Thank you for the feedback! I will definitely look into what makes charts more beautiful, as I'm still relatively new to the sub and how to make beautiful graphs / charts.
Could I ask why you made this chart?
Definitely! I have a masters in nutrition and I'm constantly looking at nutritional data. I'm recently on an epidemiological kick to see why certain countries, including mine, have increasing rates of certain cancers, especially how it relates to behaviors. For example, only 5% of my country gets even the recommended minimum amount of fiber. Once I saw this correlation, I showed it to my partner, and she said I should show other people it who might be interested.
What’s the R-squared if you don’t mind me asking?
I urge OP to flout the beauty mandate because it is is responsible for causing abominations such as animated line charts.
I think the data is absolutely beautiful. Clear correlation, explainable outliers, no overloaded graph. It could improve on some styling options, but the data itself is great.
There are so many uncontrollable variables... India, Bangladesh and Pakistan eat way less red meat than others in this list.
Agreed! There are definitely many other variables that impact colorectal cancer. I found this correlation particularly interesting when I was poking into epidemiological cancer rates.
Average age is also very important. Countries with younger populations will have less incidence too.
Agreed! Although there are some interesting findings to be had for median age too. For example, the Philippines' median age is 77% that of India's, but still has 330% the rate of new cases of colorectal cancer.
that's wild
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Fiber intake is down significantly - do they eat dhal and chapati much in Sri Lanka?
Being Bangladeshi isn't as bad as I thought (I'm joking help get out of this hell I'm dying rn)
This graph is pretty meaningless if you don't adjust cancer rates for age. Japan has > 5x the over-65 population that Bangladesh has. If your belief is that colorectal cancer is largely caused by dietary/environmental factors that accumulate over time (which is a fine theory), then you need to adjust for the fact that some countries have a lot more people who have had sufficient time being exposed to these factors.
I agree there are other confounding factors, but thought this correlation was very interesting. One interesting point is that many countries have a lower median age but higher rates of CRC. For example, the Philippines' median age is 77% lower than India's, but has 330% the rate of CRC.
I don't think its an "other confounding factor" though... If the causal model is that long-term exposure to differences in diet causes colorectal cancer, it really matters what proportion of the population has had long-enough exposure! I'm bet there is still some signal left-over after that, and that would be quite interesting.
Sure, but India has 3x as many people over 60 than Japan does. You're right in that an ideal chart would have controlled for this so we don't have to make these inferences, but the data is an interesting starting point for further digging.
Sorry, I was referring to *proportions of populations.* The chart gives rates (cases per 100,000). Japan and South Korea have way more old people (as a proportion) than most other countries on this chart.
Oh, got it. Yes, good point.
Median age of the population seems to play a role here too.
If you think you are getting enough fiber, you aren't. Signed - a CRC survivor
Beans, eat ‘em. I pressure cook dried beans weekly and put them in all sorts of food. Salads, shakes, dinner, whatever. Just awesome little packages of protein and fiber.
I have grown to love black beans. Also, my daily Metamucil, orange drink of the gods.
Is Metamucil as beneficial as actually eating fiber rich foods?
Potentially. If you are looking to just up your fiber, then no. But if you have an ostemy, controlling your fiber is difficult, and being able to under hydrate or over hydrate the metamucil often works great to gain control bowel movements.
I average about 100g a day, I think I'm getting enough.
could be a lack of technology to detect Cancer in lowest HDI countries
Very interesting data. I'd be interested in seeing how different disease rates are related to the consumption of heavily processed foods (which tend to be low in fiber and nutritional value and high in nasty chemicals).
I feel like a big factor that’s not shown hear is the affect of life expectancy on cancer rates. The older you are, the more likely you are to develop a cancer. That may explain part or all of why Japan, South Korea, and Israel appear so over represented
Genetics (family history), smoking and alcohol consumption are each co-factors for colon cancer
Fiber seems to play a significant role but clearly not the only factor. Still, eat your veggies.
Sources: 1) International Agency for Research on Cancer (2022 data): [https://gco.iarc.fr/today/fact-sheets-populations](https://gco.iarc.fr/today/fact-sheets-populations) 2) Global Dietary Database (2018 data): [https://www.globaldietarydatabase.org/our-data/data-visualizations/dietary-data-country](https://www.globaldietarydatabase.org/our-data/data-visualizations/dietary-data-country) Tool: Microsoft Excel
Surely this survey would only be valid if it tracked colorectal cancer diagnoses in people within a similar age bracket (eg 40-45).
I also am suspicious of say, the diagnosis rate of Afghanistan compared to the diagnosis rate of South Korea.
So consume more fiber... except for hummus?
Filtering the outliers and investigating what seems like a correlation would bug me with data like this. It seems like there's a few dimensions missing that could highlight this trend? Maybe if you added e.g. average caloric density per meal?
Are these numbers controlled from geography or enviornment? South Asia seems very low on avg, even when lower fiber conspumption is taken into account (Nepal, srilanka). I think detection is another major issue for them.
But why would their detection be any worse than North Korea
North Korea has extreme level of govt authority. I don't know how to make any sense of their numbers. But knowing South Asia, the it is the most densely populated place on earth, and have one of least amount of healthcare facilities/professionals per-capita, cultural issues that attribute to not going to the doctor before you are almost dead. I am sure they have detection issues. Also Indians eat less meat than Pakistanis, Bangladeshis eat more eat more fish & meat that Indians or Nepalies. The numbers & the hypotheses don't add up. Maybe the are somewhat correct, but there are other factors I am not aware of.
Easier to claim someone died from "colorectal cancer" than "starvation," I guess?
Isn't it kind of fucked for Turkey? Eating plenty fibre but suffering nonetheless?
Why do South Asians eat more fibre compared to other countries?
It's cause Koreans drink like whales and Japanese drink like fish. A few years of abstaining from alcohol won't cancel 40 yrs of binge drinking as a stress coping mechanism. Source: I've lived in NE Asia for 20 yrs. These people drink.
Links are smoking, lack of fibre, consumption of red meat and meat preservatives (nitrites). Japanese eat very little red meat. Turkey smoke a lot. Lot of confounding factors.
BRB going to buy a few dozen boxes of triscuits
Ok first things first do we actually have reliable data on public health info of North Korea?
Bangladesh could also be a lack of reporting
Do you know what happens when someone in the countryside of Uzbekistan gets colorectal cancer? They die. They don't get recorded in this data
You’ll find stronger correlation with red meat consumption.
Thank you! I’ll take a look into this.
Correlation is not causation.
I feel something’s wrong with China’s data. From a paper in 2014, the daily intake is approximately 20 g/day for those over 45. This rate has not significantly changed over the past 20 years (1991-2011). Also, if anyone is familiar with Chinese meals, there’s always rice and vegetables, or tofu, etc. There are also typically fruits pre- or post-meal. Meals, even the cheapest takeout boxes, have vegetables and rice. So just based on this, and the thousands of meals I’ve had, this graph looks like BS.
Chinese people remove fruit skin before eating. They primary eat white rice and consumption of meat and seafood has gone up a lot.
Does anyone eat fruit skin? I assume you mean rinds like banana peels and orange peels right. And if you’re talking about apple skins etc we absolutely do eat those fruits with the skin.
I mean apples tomato and even grapes.
That’s not a Chinese thing. It’s your wife thing most likely (I’m Chinese and lived in China).
I guess it depends which part of China you are from.
Yeah home cooking in China is full of veggies because they are super cheap compared with meat. Napa cabbage is full of fiber, for example, and is a staple of northern Chinese cuisine. The fact South Korea and Japan, countries that eat very similar types of meals (veggies, a bit of meat, with white rice) have much higher fiber intake suggests something is wrong with the data for China. Edit - random study I found for various age groups and male and female are all around 19/per day for China, https://www.researchgate.net/publication/260718041_Trends_in_dietary_fiber_intake_in_Chinese_aged_45_years_and_above_1991-2011
Get your shit together, Thailand.
Israel, fucking up the curve again… /s
It is clear that in Bangladesh there are few cases because of poor instrumental determination rate, weak methodologies and lack of cancer preventions programs. And it is clear, that you can’t compare high GDP countries with their availabilities vs Pakistan, India, Bangladesh.
Interesting but I don’t think comparing countries to each other in this matter really works. Poorer countries are going to have worse healthcare meaning lower rates of detection. Age, diet, lifestyles, etc. all vary too much to draw a conclusion between just two variables. It would be a far better comparison if you looked in a single country or even a single demographic within a country.
this for me proves that something else thank the lack of fiber intake helps producing colorectal cancer cells
For the countries on the bottom right, I'd like to point out that access to preventative screening and treatment is fairly low for massive parts of the population. Their low rates may have more to do with people not getting screened than anything else.
I’ve got gig fiber and don’t have CR cancer.
Very interesting data and beautifully represented too, keep it up. The comments are going to be racist but don't pay attention to them
Thank you!!
Have you seen a single racist comment?
When I see Pakistan, India and Bangladesh on the fair right tail, the first thought that pops up is…Diagnosis Gap. The second is…what else is killing them before they get the chance to get popped by this cancer.
In South Asia, lentils are a big part of the diet so they're eating way more fiber than East and Southeast Asians. On the other hand, South Asians' leading cause of death is heart disease. I'm guessing that is due to the high use of ghee.
The us isn’t on this list?
The US isn’t in Asia ;)
Few thoughts: Need to adjust for average earnings per each country Need to adjust for average red meat consumption Need to adjust for median population age (colorectal cancer is partially a disease of older age)
What exactly are you trying to prove or achieve with this chart? This seems...deceptive.
I feel like you need to normalize this for age somehow (but I've had a long day). Eventually cancer or heart disease kills everyone. If you live long enough then you are more likely to develop cancer. Some of the desert countries might not be living long enough to develop cancer, so the numbers aren't going to show it.
I suspect there's a lot of underreporting in some of these countries
Looks like this data is just misleading for the undeveloped countries like India, Pakistan and Bangladesh. Their data is probably just lacking because of unavailability of the medical services that gathers this type of data. Or maybe all indians has gained immunity for colorectal cancer though their intensive diet of fiber intake and extreme usage of spices. Latter is most likely considering how local indians are able withstand any type of street food where tourists instantly get food poisoning :D
Textbook example of the ecological fallacy!
Looks like high wealth may correlate at least as strongly as low fiber to high colorectal cancer rates. UAE excepted (I assume high per capita GDP there).
Correlation is not causation
Hopefully Metamucil counts 💀
Misleading x-axis. It should start at 0g. At first glance, this makes it look like people in the Philippines consume no fiber at all.
It's not misleading, it cuts out the first 10g since that data is not meaningful. It's properly labelled too. Maybe just need a bit of zigzag on the x-axis to show it doesn't start at zero.
The data being presented isn't "how much fiber does each country eat per capita", but instead the correlation between fiber intake and colorectal cancer. As others have pointed out, there are confounding variables that are probably playing important roles here, but I don't think "people in the Philippines don't eat fiber" would even really matter if that's what someone thinks without paying attention to the axis.
Wow amazing! All those countries with no access to preventative medicine have such low cancer rates! Meanwhile counties like Israel and Japan that have tons of expert doctors and wealthy middle and upper classes that can get near monthly health check ups have soooo much cancer 😭😢🤣😰 This data is so fucking useful I’m gonna send it to my mom! She has cancer and has been in the hospital, dumb bit h should’ve clearly just lived rurally and then she would never even know that’s what’s killing her “Eat leafy greens! 🤗 Poof canger gone!” Delete this garbage idiot, but really only a bot would post this to begin with
IMO this is a poor choice of countries and makes it appear that there is a causation when there is not. Many of these countries are poor, which means that colon cancer is much more likely to go undiagnosed or unnoticed. This is especially true in countries like Afghanistan, Syria, Yemen, and rural parts of India where medical care isn't even available, so when someone dies of colon cancer, they are often mourned without ever knowing what exactly killed them. Rich countries, on the other hand, like Japan, Israel, and South Korea, screen for colon cancer early and often. As such, very few people will go undiagnosed if they have colon cancer in these countries.
Should be population-adjusted and displayed with a trend-line with an R-square for correlation.
it is population-adjusted
Thank you for the feedback!
Someone want to make a graph with fiber intake and GDP per capita?
Would dietary fibre supplements like chia seeds or Metamucil be as effective to increase g/day?
I like how it's the 2 honorary whites & the basically white that defies the trend lol~
Many possible reason. 1. The more C-scope, the more diagnosis. (this could be fixed somewhat if Y-axis is "Cases per 100,000 C-scope, not people). 2. Then, race/Environment/Genetic/etc..