The Role of Stress and Diet in Colorectal Cancer Progression
By Julia Haimovich, Accredited Practising Dietitian.
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Colorectal cancer (CRC) remains one of the top causes of cancer-related mortality worldwide. Although genetic factors influence CRC risk, growing evidence highlights the crucial role of lifestyle factors, especially chronic stress and dietary habits, in shaping the gut’s immune environment and influencing CRC development and progression (1,2).
The intestinal mucosal immune system acts as the primary defence barrier in the gut. Both prolonged stress and unhealthy diets can weaken this defence by compromising the intestinal lining, disrupting immune responses, and increasing the risk of inflammation-driven tumour formation (1,3).
Chronic psychological stress triggers activation of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in persistent cortisol secretion that dampens essential immune activities. Research by Yang et al. (2024) showed that ongoing stress alters the distribution and functionality of mucosal immune cells such as macrophages and dendritic cells, which are vital for detecting and removing abnormal gut cells (1).
This immunosuppression damages the epithelial barrier, enabling bacterial components like lipopolysaccharides to enter circulation and spark systemic inflammation that supports tumour growth (3). Additionally, stress disrupts the balance of gut microbiota, lowering beneficial bacteria and promoting harmful species a condition known as dysbiosis (4,6).
Further studies have found that chronic stress reduces populations of beneficial microbes, which play a protective role in maintaining gut health and inhibiting tumour progression (6,7).
Nutrition profoundly affects the gut’s immune landscape. Vallis and Wang (2022) highlighted that diets high in fibre, plant-based foods, and whole grains offer protection against CRC, while those rich in processed and red meats, saturated fats, and sugars are linked to higher CRC risk and poorer survival rates (2,5).
Fibre supports the production of short-chain fatty acids (SCFAs) like butyrate, which strengthen mucosal integrity and exert anti-inflammatory and anti-cancer effects in the colon (5). Conversely, Western-style diets impair gut microbial diversity and increase pro-inflammatory metabolites, undermining immune defence in the gut (3,5).
Additional factors, including regular physical activity, maintaining a healthy weight, and moderate alcohol intake, also correlate with lower CRC risk and better outcomes, partly through reducing inflammation and enhancing immune regulation (5).
Chronic stress often leads to unhealthy eating patterns, typically involving high-fat and high-sugar “comfort” foods that worsen gut inflammation. This synergy accelerates mucosal injury, raises inflammatory markers, and disturbs microbial balance, thereby contributing to CRC initiation and progression (3,7).
Effective prevention and management require a holistic approach that integrates psychological therapies such as cognitive behavioural therapy and stress reduction with targeted nutrition strategies aimed at restoring gut health and immune function (2).
In summary, CRC progression is tightly linked to gut mucosal immune integrity. Chronic stress impairs immune control, weakens the gut barrier, and shifts microbiota composition in ways that favour tumour development. However, protective dietary patterns and healthy lifestyles can counteract these effects. Therefore, public health policies and clinical practice should emphasise combined stress management and nutritional support to reduce CRC burden and improve patient outcomes (1,2,5).
References
- Yang S, Li Y, Zhang Y, Wang Y. Impact of chronic stress on intestinal mucosal immunity in colorectal cancer progression. Cytokine Growth Factor Rev. 2024;76:1–10.
- Vallis J, Wang PP. The role of diet and lifestyle in colorectal cancer incidence and survival. In: Morgado-Diaz JA, editor. Gastrointestinal Cancers [Internet]. Brisbane (AU): Exon Publications; 2022 Sep 30. Chapter 2.
- McCollum SE, Shah YM. Stressing out cancer: chronic stress induces dysbiosis and enhances colon cancer growth. Cancer Res. 2024 Mar 4;84(5):645–647. doi: 10.1158/0008-5472.CAN-23-3871. PMID: 38437637; PMCID: PMC12176054.
- Chronic stress accelerates colorectal cancer progression by disrupting the balance of gut microbiota, new study shows. ecancer. 2024 Oct 14.
- World Cancer Research Fund/American Institute for Cancer Research. Diet, nutrition, physical activity and colorectal cancer. 2017.
- News-Medical.net. Chronic stress disrupts gut microbiota, promoting colorectal cancer growth [Internet]. 2024 Oct 13 [cited 2025 Jul 3]. Available from: https://www.news-medical.net/news/20241013/Chronic-stress-disrupts-gut-microbiota-promoting-colorectal-cancer-growth.aspx
- Drug Target Review. How chronic stress hastens the progression of colorectal cancer [Internet]. 2024 Oct 13 [cited 2025 Jul 3]. Available from: https://www.drugtargetreview.com/news/153691/how-chronic-stress-hastens-the-progression-of-colorectal-cancerens-the-progression-of-colorectal-cancer
