The intestine affects our health much more than was known a few years ago. The intestinal mucous membrane with its special flora made up of billions of microorganisms has a decisive influence on how well our defenses are set up, whether there is a risk of chronic inflammation, acne, autoimmune diseases or obesity.

But even if these connections have now been proven, the way we deal with the most important factor influencing intestinal health has hardly changed: diet.

We know how important the intestines are, but we still don’t pay attention to them

Most of us still eat too much meat and sausage, sugar and fat, fast food and ready meals, plus the “intestinal enemies” smoking and alcohol .

• The direct consequences: The intestinal flora is out of balance, flatulence , constipation and obesity result.
• The indirect ones: there is a risk of immunodeficiency, skin problems, inflammation and, last but not least, an increased risk of cancer, at least for colon cancer.

Particularly harmful: Leftovers lie in the intestines for days

Especially when food remains in the intestine for a long time, it is harmful to health. In the process, animal protein (from meat and sausage residues) in particular forms toxins that can cause damage not only in the intestines, but also in the whole body.

The medical term is intestinal auto-intoxication. Typical toxins that arise in the intestine: including neurin, putrescin, indican and cadaverine, the dead body poison.

Biliary cancer, with around 5500 new cases per year, is one of the rare forms of cancer, but it is particularly risky. According to popular opinion, the tumor causes almost no early symptoms and is therefore usually only recognized late when an operation is no longer possible and the tumor has already metastasized.

Biliary cancer – important: inside or outside the liver

The fact is, however, that the colloquial term biliary cancer, medically cholangiocarcinoma (CCA), covers different forms. First of all, there is gallbladder cancer, which forms in the gallbladder, which in turn is embedded in the liver.

Secondly, a carcinoma can form in the bile ducts, which are not only located within the liver and direct the bile to storage in the gallbladder, but also away from the gallbladder, which lead the bile to the small intestine.

“Depending on the localization, we differentiate between intra- and extrahepatic carcinoma, i.e. those that develop inside or outside the liver,” explains Arndt Vogel, spokesman for the “Hepatobiliary Tumors” working group of the Internal Oncology Working Group (AIO) and head of the Visceral Oncological Center Hannover Medical School (MHH).

The risk of developing cholangiocarcinoma increases with age. Overall, the incidence of intrahepatic carcinomas is increasing, while that of extrahepatic carcinomas falls somewhat.

Risk factors for biliary cancer

An exception in connection with cholangiocarcinoma is Southeast Asia, especially countries like Thailand. This cancer often occurs there because certain parasites can inflame the biliary tract. Chronic inflammation plays an important role in the development of biliary cancer.

The following risk factors come into play in the western industrialized nations, but they are also closely related to inflammation:

• Primary sclerosing cholangitis, an inflammation of the bile ducts that mostly affects men.
• Cysts in the bile and bile ducts, including Caroli’s syndrome; they increase the risk of biliary cancer.
• Smoking, because the substances in smoke are known to be carcinogenic, are not only excreted via the kidneys and urine, but are also collected, processed and passed on in the bile.
• Gallstones; However, only when they cause problems, i.e. inflame the bile, do they promote the development of cancer.

Gallstones and biliary cancer

Around ten percent of Germans are said to have gallstones, and the risk increases with age. “But very few of those affected develop cholangiocarcinoma. This cancer is very rare, ”says the medicine professor reassuringly.

The gallbladder should only be removed if the stones cause problems, i.e. colic and inflammation.

Symptoms appear differently late, but are similar

The signs of gallbladder inflammation caused by stones are somewhat similar to those of cholangiocarcinoma (CCA).

So biliary cancer can cause the following signs:

• Jaundice (jaundice)
• nausea
• Vomit
• Pain in the left upper abdomen.

The location of the carcinoma is crucial for the stage at which symptoms appear:

• Intrahepatic carcinoma triggers these clear signs quite late, “because the liver doesn’t hurt when a tumor grows there,” explains the expert.
• Extrahepatic carcinoma, on the other hand, usually quickly means that the bile can no longer flow into the intestine. Bile congestion and jaundice are relatively early signs of this type of cancer.

That is why bile duct cancer that grows outside the liver is usually diagnosed earlier – but it is difficult to operate because of its often complicated location next to blood vessels and does not make the generally difficult situation with cholangiocarcinoma any easier, the oncologist limits the associated high expectations.

Diagnosis of cancer of the gallbladder and bile ducts

Doctors use cross-sectional image diagnostics such as MRI and CT. “This allows the suspicion to be clarified and the staging, i.e. stage and spread, to be identified,” explains Vogel.

The histological examination provides additional details about the tumor, whereby the samples in gallbladder cancer are relatively easy to obtain. However, this is more difficult with extrahepatic tumors because the biliary tract is often narrow and winding. The examination is carried out through an endoscope, the method here is called endoscopic retrograde cholangiopancreatography (ERCP examination).

Are there any less invasive methods? Ultrasound, carried out endoscopically through the stomach from the inside or from the outside, can also be informative, says the cancer specialist. However, the methods of first choice are MRI and CT.

Treatment of biliary cancer – surgery not always possible

If the suspicion has been confirmed and the results of the examination enable the tumor to be classified, the goal is to remove the carcinoma surgically. “However, as already described, this is sometimes difficult due to the location of the tumors,” reports Vogel. However, the surgical techniques have improved significantly in recent years.

The standard treatment for patients with advanced tumors is chemotherapy, with a combination of gemcitabine and cisplatin.

In a palliative situation, i.e. to lengthen survival time and / or improve quality of life, local therapies such as selective internal radiotherapy (SIRT, radioembolization) are currently used in clinical studies . Radioactive microspheres are guided to the tumor via an inguinal catheter, its cells are destroyed and healthy tissue is spared. The first results show that for some patients many months can be gained with this.

The prognosis for biliary cancer is poor …

Despite all these possibilities, few patients can be cured. Even if the tumor could be completely removed in the healthy, the recurrence rate is still relatively high. “60 to 80 percent of the tumors come back,” reports Vogel. Because the tumors spread very early.

… but with the therapy “a small revolution is emerging”

This is the bad news. In fact, these prospects could improve in the future. The oncologist says: “Because a small revolution is taking place here at the moment.” The interest of pharmaceutical companies in this rare cancer has increased significantly, and intensive work is being carried out on the development of new drugs.

The reason for this change is the fact that it has been discovered that numerous genetic changes occur in these tumors and thus allow a molecular, i.e. targeted therapy. There have been many studies on this topic for a few years now.

Two developments are particularly promising:

1. Inhibitors against IDH1 mutations , from which patients with a corresponding cholangiocarcinoma can clearly benefit.

2. Inhibitors against FGFR2 , fusions, MSI, NTRK and others.

“There are currently a number of very promising active ingredients in the test that have the various genetic changes as a starting point,” reports the oncologist. How much these new therapies could improve the treatment of biliary cancer becomes clear when one realizes that 40 to 50 percent of all these tumors, especially intrahepatic ones, show such genetic changes and are therefore suitable for targeted, molecular therapy.

Prevention Of Bile Cancer – Quit Smoking!

However, it will be some time before the new therapies are available to all patients. Until then, it is still true that biliary cancer is difficult to treat and the prognosis is unfavorable.

This makes prevention all the more important. To what extent can everyone prevent this tumor – apart from the advice not to smoke, which is so important with regard to many other diseases? The expert also has one recommendation in particular:

Get gallstones cleared up if they’re causing problems. However, this does not mean that everyone who has gallstones should be afraid: Gallstones are considered to be risk factors for gallbladder cancer, but only one percent of all gallstone carriers develop this tumor.

Surveys by the Federal Statistical Office show that Germany’s men are getting fatter year after year: If the body mass index is used as a benchmark, 62 percent of men are currently overweight (BMI over 25) and 18 percent are obese (BMI over 30) . And while only a third of the 20 to 25 year olds are overweight, the proportion among the over 50 year olds rises to more than 70 percent. Among women, 43 percent carry too many pounds around – but the proportion of people who are overweight shrinks slightly every year.

Visceral belly fat is a health risk

But while many of the overweight women have the word “lose weight” at least in the back of their minds, the term “diet” bounces off most men. Somehow, around 30, they gradually lose their firm body, but they feel comfortable with their figure, which they do not find too fat at all. Men seem to be more tolerant of their paunch than women of their love handles.

This has nothing to do with reason, because it is now known that so-called visceral belly fat in particular poses a health risk. The metabolically active tissue releases inflammatory substances and increases the risk of cardiovascular diseases, diabetes and erectile dysfunction.

The traditional image of the man promotes obesity

Papa gets the biggest piece of meat because a man has to eat properly – this age-old belief persists in Germany. And so men eat an average of 1.1 kilograms of meat every week. That is twice as much as for women and twice as much as recommended for a healthy diet. In addition, there are plenty of carbohydrates in the form of pasta, potatoes or white bread, sausage, butter and cheese – and the plates are often scooped up on the “all-you-can-eat” principle.

Many men get fat because they eat and drink too much of the wrong things, for example six times as much beer as women. And they stay fat because it is very difficult to change established eating habits.

Men need a lot of motivation to diet

Doctors and nutritionists find time and again that men rarely lose weight because they find themselves too fat. It almost always takes an external spark for the average man to change something in his lifestyle, for example when the doctor diagnoses diabetes or a heart problem, or when a relationship breaks up.

This was also the result of an evaluation of two major diet programs by the British health authority NHS. And there were even more men-specific issues on the subjectLose weight:

• Only ten percent of men had received a referral from their doctor for the programs.
• But: Once men start with such a measure, they develop ambition to lose weight and get out less often than women.
• Men are more likely to respond to programs that avoid the word “diet” and place great emphasis on exercise.

Proper diet and exercise

Weight loss results mainly from diet changes. However, if men also expand their muscle cushion in the process, the effect is increased because of the high energy requirements of the muscles. Men should exercise all muscle groups in the body and not just squint at the fast-growing biceps.

A sporting program that includes a mix of strength and endurance is often better accepted by men than women. Sport should be fun in any case, because after actively losing weight, exercise can stabilize the desired weight – without the man having to constantly watch the calories.

What men should eat for weight loss is no different from a diet for women:

1. less red / fatty meat, sausage and animal fat

2. more vegetables

3. less white flour and sugar (carbohydrates)

4. more white / lean meat, tofu, or legumes (protein)

5. no alcohol

Intermittent fasting – as invented for men

Intermittent fasting is a suitable diet method for those who like it simple and uncomplicated. With the simple principle, there are time windows for food intake, which alternate with fasting episodes. The fat metabolism is activated, excess pounds can melt – especially if you keep an eye on the calories.

• The popular “16: 8” method is suitable as a permanent nutritional principle: During the day, people eat in an 8-hour window, two to three meals without snacks in between. The nocturnal eating break is extended to 16 hours – ideal for men who do not like breakfast.
• The “5: 2” interval fasting allows you to eat normally on five days, then there are a maximum of 500 calories on two days.
• The “1: 1” method is considered to be the most difficult to stick to: alternately eat one day and one fast.

For men (and women), the combination of two protein shakes and a normal meal a day is a good start to losing weight. US presenter and comedian Jimmy Kimmel lost over twelve kilos before he switched to intermittent fasting “5: 2”.

The man’s body is the best weapon against obesity

Once men have decided to lose weight, they enjoy a great advantage over women. Men are taller, heavier and have more muscles – as a result, their bodies burn more energy even when they are resting.

If they also save calories, they lose more weight and lose weight faster than women. This was shown by a study with 2000 male and female participants who had exactly the same general conditions. After eight weeks, the men saw 16 percent more weight loss. Their bodies cling less to fat deposits, which in women are a stubborn reservoir for pregnancy and breastfeeding.