Calcium phosphate, bile acids and colorectal cancer.

The biochemical and nutritional studies discussed here are consistent with the model presented in Figure 1. As shown in vitro, bile acids are precipitated by insoluble calcium phosphate. This calcium phosphate dependent precipitation drastically inhibits their cytotoxicity. A diet-induced increase in luminal surfactant concentration stimulates lytic activity of faecal water and intestinal cell damage resulting in an increased proliferation. The increase in luminal surfactant concentration and lytic activity of faecal water can be counteracted by supplemental dietary calcium phosphate. Supplemental calcium in humans increases the formation of insoluble calcium-phosphate-bile acid complexes in faeces, decreases the soluble fatty acid concentration and decreases lytic activity of faecal water. This sequence of effects offers a molecular explanation of the protective effects of supplemental calcium on proliferation as frequently observed (see studies cited above). It should be realised that this chain of evidence still lacks final proof of a preventive effect of dietary calcium on colorectal cancer. Until now, only protective effects on the first stage of development of colorectal cancer (hyperproliferation) have been observed. More well-designed studies in patients and healthy volunteers are needed using a combined biochemical, nutritional and clinical approach to elucidate the complex mechanism of the protective effect of calcium on colon cancer.