With the death of actor Chadwick Boseman at age 43 from colorectal cancer and the early retirement of Japanese Prime Minister Shinzo Abe at age 65 due to ulcerative colitis, colon health is on many people’s minds. How can you best take care of your colon?

That’s not a simple question. The ­colon is not just a simple tube. It is a living, constantly changing organ whose microbiome (the mix of bacteria that call it home) is associated with many forms of serious disease besides cancer and colitis, including neurodegenerative disorders such as ­Alzheimer’s and psychiatric conditions such as depression and anxiety. I’m happy to report that colon health is a very active area of medical research, but mostly what we have now are associations between lifestyle choices and outcomes rather than hard, scientifically proven causations.

Still, with each new finding, recommendations continue to focus in the following very basic areas to give your colon the best fighting chance…

Pay attention—even if it’s gross or embarrassing. In recent years, young-onset colorectal cancer (affecting people under age 50) has been on the rise. It is both a preventable disease and one that is highly treatable when it’s caught early—but too many young people ­ignore symptoms that would allow for early intervention. 

Understand that when it comes to bowel habits, there is a wide spectrum of “normal” in terms of how often you move your bowels, what the consistency is and so on. Feeling like you’re outside of the norm is not cause for alarm, but seeing a dramatic change in what is normal for you should get your attention. Don’t ignore significant and persistent changes in bowel habits such as blood in the stool, constipation or abdominal pain, any of which could indicate a problem. If a close family member—parent, grandparent, sibling—has had colorectal cancer, be especially vigilant.

Get screened. Even if you have no symptoms, you still should be screened for colon cancer. If you’re age 50 or older, most private insurance will cover a colonoscopy every 10 years or less. If you’re between ages 40 and 50, check with your provider—colonoscopy typically is covered earlier when there is a family history and then again every five years. Medicare will pay for screening (including colonoscopy) in people age 65 and older or otherwise Medicare-eligible. 

You may have heard of alternative screening methods such as fecal immunochemical testing (FIT), which looks for hidden blood in the stool…“virtual colonoscopy” (actually called CT colonography)…or at-home stool tests such as Cologuard, which analyze stool DNA in addition to FIT. These types of tests avoid the small risk associated with the invasive colon-oscopy, and the stool tests avoid the unpleasant prep process. Those are fine if you’re not in a high-risk group and are symptom-free. Note that insurance usually won’t pay for virtual colonoscopy as a first test and coverage varies for Cologuard, but the cost may be substantially less than for colonoscopy. If you don’t have insurance or if you have a high deductible that you never meet, you may come out ahead financially with one of these tests, assuming that you are a good candidate for them. Depending on the results, you may need to follow up with an actual colonoscopy. Whatever you do, don’t put this off. Early detection is the best tool we have for fighting these cancers. 

Don’t stir up the microbiome unnecessarily. Doctors are learning more and more about treating bacterial infections such as C. difficile and conditions like irritable bowel syndrome with “good” bacteria (probiotics or, in the case of C. difficile, fecal transplantation from a healthy donor). That has led some people to consume probiotics religiously, thinking that they’ll proactively promote bacterial diversity and correct imbalances between “good” and “bad” bacteria in their gut. But they do so without any baseline knowledge about their existing levels and composition of bacteria before they start messing with it. While most probiotics are safe, they vary in their mix of bacteria, and it is unclear what the effects will be on your system and how long they will persist.

Other people undertake “colon cleanses” thinking that they’ll flush out bad bacteria and make room for more good bacteria to grow. In fact, what tends to happen after a colon cleanse is that the exact same mix of bacteria grows back. So you may be wasting your money and putting yourself through discomfort for nothing. 

Now, if you’ve been on an ­antibiotic and experience bowel issues such as diarrhea, it may be worth trying a live-culture yogurt or probiotic supplement to help get things back in balance. But even that is something the medical community needs to learn more about. Although there is a large body of ­research, the evidence is far from ­definitive. Persistent symptoms, however, require evaluation by your physician to rule out more serious disease. 

Engage in physical activity and get plenty of sleep. We know there’s a strong association between regular ­exercise and colon health, and researchers currently are studying the link between sleep and a healthy colon. As a rule of thumb, things that are good for your heart also are good for your colon, and aerobic exercise is the best example of that. Research shows that physical activity in the form of regular exercise may prevent up to 15% of
colon cancers and is effective in reducing symptoms of irritable bowel syndrome and other digestive issues. 

Watch your diet. It should come as no surprise that what you put into your body matters. Nutrition affects every cell of your body, of course, but  it has a direct impact on the gut. Eat a diet with plenty of fruits, vegetables, whole grains and the omega-3 fatty ­acids found in fish oil and olive oil. Limit intake of red and processed meats and alcohol. Fiber intake in the form of fruits, vegetables and whole grains is associated with a lower risk for colorectal cancer across populations, but the reason for this is multifaceted. Other dietary components such as calcium, folate and vitamin D have been found beneficial. A general “eating well” approach is preferable to targeting specific nutrients. In one study, adherence to a Mediterranean-style diet, as described above, lowered risk for colorectal cancer by up to 11%. 

Limit—or eliminate—unhealthy fats such as from fried foods, red meat, ­refined sugars and processed foods. 

If you are a young person, don’t cheat yourself by waiting until you’re older to clean up your diet. Nutritional interventions are not only most effective when you’re young, they also lay the groundwork for a healthier future.