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Basic concepts / Intestinal transitOestrogens are excreted in urine and bile. In the intestine, excreted oestrogens are largely reabsorbed following deconjugation by bacterial betaglucuronidases before being reconjugated and recycled. The intestinal bacterial flora increases the biological activity of the absorbed oestrogens by transforming reduced oestrone into active oestradiol. Also, slowing of intestinal transit seemingly increases the oestrogenic environment, thereby favouring hormone-dependent breast cancer. Although a diet rich in fibre and vegetables, which are known to enhance transit, is thought to protect against breast cancer, to date there have been no studies supporting a relationship between intestinal transit time and breast cancer risk. In addition, it has been shown that a fibre-rich diet rich reduces blood oestrogen levels in pre-menopausal women.
A further consequence from slow intestinal transit is the occurrence of increased levels of deoxycholate and biliary cholesterol, which facilitates the formation of gallstones. In the general population, constipation is associated with a higher incidence of gallstones, particularly in non-obese women.
According to some authors, transit time may play a role in colonic cancer, regardless of diet. There is an inverse correlation between intestinal transit time and concentration of butyrate in the colon. Butyrate may act either directly (exerting an action on motility) or indirectly via decreased colonic pH, and, in fact, it is known that low or neutral pH is associated with low risk of colonic cancer(2).
During transit in the colon, concentrations of SCFA decrease (they are absorbed and used by the intestinal mucosa), while intraluminal pH gradually increases towards neutral values. Furthermore, colonic cancer is more commonly found in the distal colon(2).
However, it can not be the only factor since the incidence of colonic cancer is not higher among women, who generally have longer transit times than men. This apparent contradiction may be due to the protective effect exerted by oestrogens.
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