Don’t Skip Your Colonoscopy

The dreaded colonoscopy.

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Hey everyone, Dr. Dale here.

Out of all the procedures I perform, this is the one that patients tend to feel the most apprehensive about, hands down.  And while it’s true that no one really looks forward to having a colonoscopy, there’s one very simple reason that doctors continue to recommend the procedure—it can save your life.

According to the American Cancer Society, there were an estimated 50,630 colorectal cancer-related deaths in 2018.  A staggering 60% of these deaths could have been avoided with appropriate preventative care, namely colonoscopy (research shows that colonoscopy is the most effective preventative tool we have for this disease).

Traditionally, doctors recommended that most patients begin colorectal cancer screening at age 50, and continue to have regular colonoscopies every 10 years.  In May 2018, the American Cancer Society updated their guidelines, and now recommend that most patients begin colorectal cancer screening when they turn 45.  Screening can include colonoscopy, as well as other lab and imaging tests, such as the Fecal Occult Blood Test (FOBT).

Patients who have an increased risk of colorectal cancer may need to start screening sooner.  That includes patients with inflammatory bowel disease, and those with a family history of colorectal cancer or certain types of polyps.  Because every patient is different, I can recommend the screening schedule that’s best for your particular health needs.

It’s normal to feel anxious about having a colonoscopy, particularly if it’s your first one.  But keep in mind that there are a lot of common misconceptions about this procedure, which could be feeding your anxiety.  In fact, after the procedure is over, patients often tell us “that wasn’t nearly as bad as I thought it’d be.”

The night before your colonoscopy, you’ll be asked to prepare for the procedure by drinking a laxative solution.  This will ensure that your bowels are completely cleaned out, so that I can see the lining of your colon and detect any polyps or other abnormalities.

During the procedure, a thin, flexible tube is inserted into the rectum, and slowly guided into the colon. There’s a small camera on the end of the tube, which transmits images onto a video monitor.  If polyps are found, they can be removed during the colonoscopy, and may be sent for biopsy.  You’ll also receive a sedative medication to ensure that you feel comfortable and relaxed.  Many patients are actually asleep during the colonoscopy itself.  And that’s it.  When you awake from the procedure, I’ll discuss your results with you.

So don’t put off your colonoscopy due to fear or anxiety.  I have over 14 years of experience treating patients with colorectal conditions. I use the most current, state-of-the-art colonoscopy equipment, and can meet with you to discuss any questions or concerns you might have about this procedure.

Contact my office at 310-360-6807 or click here to schedule a consultation with me.

- Dr. Dale

Cervical Health Awareness Month

I want to bring to your attention the importance of cervical health.
— Dr. Dale

From Cervical Health Awareness Month

Cervical cancer was once one of the most common causes of cancer death for American women. But over the last 30 years, the cervical cancer death rate has gone down by more than 50%. The main reason for this change is the increased use of screening tests. Screening can find changes in the cervix before cancer develops. It can also find cervical cancer early – when it’s small, has not spread, and is easiest to cure. Another way to help prevent cervical cancer in the future is to have children vaccinated against human papilloma virus (HPV), which causes most cases of cervical cancer. (HPV is linked to a lot of other kinds of cancer, too.)

The American Cancer Society is actively fighting cervical cancer on many fronts. We are helping women get tested for cervical cancer, helping them understand their diagnosis, and helping them get the treatments they need. The American Cancer Society also funds new research to help prevent, find, and treat cervical cancer.

What Are Hemorrhoids?

Hemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes the walls of these blood vessels stretch so thin that the veins bulge and get irritated, especially when you poop.

Swollen hemorrhoids are also called piles.

Hemorrhoids are one of the most common causes of rectal bleeding. They're rarely dangerous and usually clear up in a couple of weeks. But you should see your doctor to make sure it's not a more serious condition. He can also remove hemorrhoids that won't go away or are very painful.

Internal and External Hemorrhoids

Internal hemorrhoids are far enough inside the rectum that you can't usually see or feel them. They don't generally hurt because you have few pain-sensing nerves there. Bleeding may be the only sign of them.

External hemorrhoids are under the skin around the anus, where there are many more pain-sensing nerves, so they tend to hurt as well as bleed.

Sometimes hemorrhoids prolapse, or get bigger and bulge outside the anal sphincter. Then you may be able to see them as moist bumps that are pinker than the surrounding area. And they're more likely to hurt, often when you poop.

Prolapsed hemorrhoids usually go back inside on their own. Even if they don't, they can often be gently pushed back into place.

blood clot can form in an external hemorrhoid, turning it purple or blue. This is called a thrombosis. It can hurt and itch a lot and could bleed. When the clot dissolves, you may still have a bit of skin left over, which could get irritated.

What Causes Them?

Some people may be more likely to get hemorrhoids if other family members, like their parents, had them.

A buildup of pressure in your lower rectum can affect blood flow and make the veins there swell. That may happen from extra weight, when you're obese or pregnant. Or it could come from:

  • Pushing during bowel movements

  • Straining when you do something that's physically hard, like lifting something heavy

People who stand or sit for long stretches of time are at greater risk, too.

You may get them when you have constipation or diarrhea that doesn't clear up. Coughing, sneezing, and vomiting could make them worse.

How to Prevent Them

Eat fiber. A good way to get it is from plant foods -- vegetables, fruits, whole grains, nuts, seeds, beans, and legumes.

Drink water. It will help you avoid hard stools and constipation, so you strain less during bowel movements. Fruits and vegetables, which have fiber, also have water in them.

Exercise. Physical activity, like walking a half-hour every day, is another way to keep your blood and your bowels moving.

Don't wait to go. Use the toilet as soon as you feel the urge.

What Your Gut Bacteria Say About You

For years, we thought of bacteria as organisms to avoid. It turns out our bodies are already loaded with trillions of bacteria. They help digest food and play an important role in your well-being.

Research suggests your gut bacteria are tied to your probability of things like diabetesobesitydepression, and colon cancer.

What Are Gut Bacteria?

Living inside of your gut are 300 to 500 different kinds of bacteria containing nearly 2 million genes. Paired with other tiny organisms like viruses and fungi, they make what’s known as the microbiota, or the microbiome.

Like a fingerprint, each person's microbiota is unique: The mix of bacteria in your body is different from everyone else's mix. It’s determined partly by your mother’s microbiota -- the environment that you’re exposed to at birth -- and partly from your diet and lifestyle.

The bacteria live throughout your body, but the ones in your gut may have the biggest impact on your well-being. They line your entire digestive system. Most live in your intestines and colon. They affect everything from your metabolism to your mood to your immune system.

Gut Bacteria and Disease

Research suggests the gut bacteria in healthy people are different from those with certain diseases. People who are sick may have too little or too much of a certain type. Or they may lack a wide variety of bacteria. It’s thought some kinds may protect against ailments, while others may raise the risk.

Scientists have begun to draw links between the following illnesses and the bacteria in your gut:

Obesitytype 2 diabetes, and heart diseaseYour gut bacteria affect your body’s metabolism. They determine things like how many calories you get from food and what kinds of nutrients you draw from it. Too much gut bacteria can make you turn fiber into fatty acids. This may cause fat deposits in your liver, which can lead to something called “metabolic syndrome” -- a condition that often leads to type 2 diabetesheart disease, and obesity.

Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitisPeople with these conditions are believed to have lower levels of certain anti-inflammatory gut bacteria. The exact connection is still unclear. But it’s thought that some bacteria may make your body attack your intestines and set the stage for these diseases.

HPV discovery raises hope for new cervical cancer treatments

HPV is responsible for nearly all cases of cervical cancer and 95 percent of anal cancers. It is the most common sexually transmitted disease, infecting more than 79 million Americans. Most have no idea that are infected or that they could be spreading it.

"Human papillomavirus causes a lot of cancers. Literally thousands upon thousands of people get cervical cancer and die from it all over the world. Cancers of the mouth and anal cancers are also caused by human papillomaviruses," said UVA researcher Anindya Dutta, PhD, of the UVA Cancer Center. "Now there's a vaccine for HPV, so we're hopeful the incidences will decrease. But that vaccine is not available all around the world, and because of religious sensitivity, not everybody is taking it. The vaccine is expensive, so I think the human papillomavirus cancers are here to stay. They're not going to disappear. So we need new therapies."

HPV and Cancer

HPV has been a stubborn foe for scientists, even though researchers have a solid grasp of how it causes cancer: by producing proteins that shut down healthy cells' natural ability to prevent tumors. Blocking one of those proteins, called oncoprotein E6, seemed like an obvious solution, but decades of attempts to do so have proved unsuccessful.

Dutta and his colleagues, however, have found a new way forward. They have determined that the virus takes the help of a protein present in our cells, an enzyme called USP46, which becomes essential for HPV-induced tumor formation and growth. And USP46 enzyme promises to be very susceptible to drugs. Dutta calls it "eminently druggable."

"It's an enzyme, and because it's an enzyme, it has a small pocket essential for its activity, and because drug companies are very good at producing small chemicals that will jam that pocket and make enzymes like USP46 inactive," said Dutta, chairman of UVA's Department of Biochemistry and Molecular Genetics. "So we are very excited by this possibility that by inactivating USP46 we'll have a way to treat HPV-caused cancers."

Curiously, HPV uses USP46 for an activity that is opposite to what the oncoprotein E6 was known to do. E6 has been known for more than two decades to recruit another cellular enzyme to degrade the cell's tumor suppressor, while Dutta's new finding shows that E6 uses USP46 to stabilize other cellular proteins and prevent them from being degraded. Both activities of E6 are critical to the growth of cancer.

The researchers note that enzyme USP46 is specific to HPV strains that cause cancer. It is not used by other strains of HPV that do not cause cancer, they report.

Findings Published

The researchers have published their findings in the scientific journal Molecular Cell. The team included Shashi Kiran, Ashraf Dar, Samarendra K. Singh, Kyung Yong Lee and Dutta. All are from UVA's Department of Biochemistry and Molecular Genetics.

The work was supported by the National Institutes of Health, grant R01 GM084465.

Materials provided by University of Virginia Health SystemNote: Content may be edited for style and length.

What Are the Best Foods to Eat After an Intense Workout?

Eating the right foods after exercise can help you recover, build muscle, and prepare for your next regimen.

The new year is finally here and it’s time to start on your new exercise goals.

But before you get too far into January, keep in mind that your workout doesn’t end when you leave the gym or finish that final lap on the track.

Choosing the right foods after your workout can help you recover more quickly, build muscle, and get ready for your next workout.

Here’s a quick guide to making the most of your post-workout nutrition.

When you work out, your muscles use their glycogen energy stores. Some of the muscle proteins also get damaged, especially during strength workouts.

Vanessa Voltolina, a registered dietitian in the greater New York City area, says “eating the right combination of carbohydrates, protein, vitamins, and minerals helps speed the process of rebuilding the used glycogen stores, as well as repairing muscle proteins.”

People also shouldn’t shy away from including some healthy fats in their diet.

“I think most people are in need of more healthy fats to help take in the fat-soluble vitamins,” said Adam Kelinson, a New York City-based private chef and nutritional consultant for athletes, celebrities, and executives.

What you eat after a workout depends on the duration and intensity of exercise. The type of exercise is also important.

“Higher carbohydrate meals are most beneficial after endurance activities — such as running or cycling — lasting more than an hour,” Voltolina told Healthline. “Following strength training, it’s important to consume protein in combination with moderate carbohydrate.”

Timing also matters, but you have more wiggle room than you might think.

“The ideal timing for consuming a post-workout snack is within 45 minutes,” said Voltolina, “but benefits can be seen up to 2 hours after training.”

Keeping it in perspective

Karina Inkster, a vegan fitness and nutrition coach based in Vancouver, British Columbia, said unless you’re an athlete or work out a lot, post-workout nutrition is not as important as other factors — such as your overall macronutrients (protein, carbs, fats), eating mainly whole foods, and your overall calorie intake.

So, when deciding what to eat after your workout, you have to keep in mind how the whole day fits your exercise goals.

“You want your 24-hour period to look great,” said Inkster. “If that means amping up your protein content, then by default, your post-workout nutrition meal or snack is probably going to be a little higher in protein.”

Vegans and vegetarians, though, need to eat protein from a variety of sources throughout the day to make sure they’re getting enough of the essential amino acids.

Kelinson said you should also be honest about how much of your workout is actually moderate or high intensity.

“Ultimately, you may spend just 30 or 40 minutes out of an hour working out,” Kelinson explained to Healthline. “You move from one thing to the next, you talk a little bit, you get some water, you take your breaks. We’re not talking high-exertion efforts here.”

So be careful about overdoing the packaged post-workout snacks, many of which have added sugars.

“Just because you move your body a little bit, it is not a license to overconsume,” said Kelinson.

You can also probably get away with following your workout with one of your regular meals or snacks, rather than adding another meal to your day.

“People who train really early in the morning will often have something really small before their workout, just for a bit of energy,” said Inkster. “And then their breakfast, which they would normally have anyway, becomes their so-called post-workout nutrition.”

Don’t forget to hydrate

Drinking enough water before, during, and after your workout can help with recovery and your next day’s performance.

Professional athletes sometimes measure their body weight before and after a workout to know how much water they need to replace. 

But you can probably get away with keeping an eye on the color of your urine — pale yellow is where you want it.

Depending on the intensity of your workout and the temperature of the environment, you may also need an electrolyte drink to replenish sodium and potassium lost in your sweat.

Post-workout foods

When choosing foods to eat after your workout, look for foods that are easily digested to speed up nutrient absorption.

You should also lean toward whole foods that are packed with other micronutrients.

Here are a few options.


  • chia seed pudding

  • crackers

  • fruit (berries, apple, bananas, etc.)

  • oatmeal

  • quinoa

  • rice cakes

  • sweet potatoes

  • whole grain bread

  • whole grain cereal


  • chocolate milk

  • cottage cheese

  • eggs

  • Greek yogurt

  • turkey or chicken

  • salmon or tuna

  • peanut butter

  • protein shake (plant- or animal-based)

  • tofu scramble

Healthy fats

  • avocado

  • coconut oil

  • flax seeds

  • nut butters

  • nuts

Feeling more gassy than usual? Here's why.

Why Am I So Gassy?

An explanation of the most common gas symptoms and how to make it all go away.

By Nicole Pajer

Feeling more gassy than usual?

Let’s get this out of the way right now: Flatulence is totally normal. Embrace it. But sometimes it can be a bit excessive and that’s where the discomfort can come inWe all know that certain foods have a reputation for causing gas ― as the chant goes, “beans, beans, they’re good for your heart. The more you eat, the more you ... ” ― but there are other contributing foods and factors that could be causing problems. And discovering what’s going on can help you get a grip on it.

HuffPost chatted with experts to get to the bottom of tummy troubles. Below is everything you need to know about dealing with gas and why it’s happening in the first place:

Common Reasons Why You’re Experiencing Gas Problems

Your diet and lifestyle can obviously have an impact on how your intestines react. Some of the most common culprits of excessive gas include:

You have an underlying medical condition: According to Russell D. Cohen, a board member of the GI Research Foundation and the director of the Inflammatory Bowel Disease Center at the University of Chicago, some people with certain medical conditions have worse gas than others. This includes those who live with inflammatory bowel disease or inflammatory bowel syndrome, Crohn’s disease or Colitis and other gastrointestinal issues, he explained, all of which impact the digestive track or intestines.

Your body is not a fan of lactose: John Tsai, a board-certified gastroenterologist with Austin Gastroenterology, said that it is very common to be intolerant to lactose, which is found in items like dairy products.

“For the majority of us, the ability to cleave lactose diminishes as we get older. If too much lactose is in the intestinal tract and not broken down, our gut bacteria finish the digestion process and this, in turn, can cause gas, bloating, pain and diarrhea,” he said, adding that reducing or stopping lactose intake will often result in resolution of these symptoms.

You have a gluten intolerance: “We estimate that 1 to 2 percent of the population may have an allergy to gluten,” Tsai said, adding that the substance, which is found in wheat, barley and rye, can trigger the body’s immune system to cause inflammation and damage primarily to the intestinal tract.

This can lead to diarrhea, bloating, malnutrition and multiple serious health issues. Tsai added that the majority of patients who report an issue with gluten, however, are not allergic to gluten, but rather intolerant to it.

“This can result in the symptoms of gas, bloating, pain and diarrhea,” he said, noting that formal testing can be performed by your doctor to accurately diagnosis a gluten allergy (known as celiac disease) versus a gluten intolerance.

It’s a side effect of a past surgery: Cohen noted that people who’ve had GI surgeries in the past can often experience increased gassiness.

“Imagine your GI system is a pond,” Cohen said. “After you have a GI surgery, that pond gets compromised in the part the surgery occurred ― similar to an area where pond scum gathers. Our GI and bowel systems gather that bacteria in one spot, too, if it the area has been compromised.”

You just gulped some air: Samantha Nazareth, a double-board-certified gastroenterologist practicing in New York City, said that “swallowing air from talking while eating, drinking from a straw or chewing gum” can definitely cause some flatulence.

It’s specific veggies or your beverage: According to Cohen, certain foods can cause your body to expel more gas while digesting them. “Pickled and fermented foods are the No. 1 causes that make you gassier,” he said.

Next in line are cruciferous vegetables like kale, broccoli and cauliflower, which can be frequent contributors to gas. Beans, of course, are also gas-causing culprits.

Cohen added that carbonated beverages may also cause a build-up of gas in your body. “If you can’t shake it, don’t drink it,” he said.

You’re eating a high FODMAP diet: “There’s a whole class of foods called FODMAPs that are known to cause gas,” Nazareth said.

FODMAPs, which stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols groups, “essentially are short-chain carbohydrates that are poorly absorbed and rapidly fermented” in the body, she explained, adding that they can therefore case flatulence. High-FODMAP foods include things like regular milk, dried fruit, artichokes, baked goods made of whole wheat, artificial sweeteners like Xylitol, garlic, onions and cashews.

You’re backed up: “In many cases, people who get constipated often get more gas. This is because your body is literally fermenting that food and feces in your body until your bowels sweep everything out,” Cohen said.

Amanda Nighbert, a registered dietitian based in Kentucky, added that addressing constipation in a healthy way can go a long way in helping you to reduce gas. “Make sure you are getting plenty of water daily, adequate fiber and consider [trying] magnesium citrate if constipation is chronic,” she said. “This is a great, all-natural way to treat and prevent constipation.”

You are eating too fast: Scarfing down your meals and not properly chewingcan also increase the likelihood of excess gas or air in your stomach.

“This will make you feel very gassy and bloated,” Nighbert said. In order to work around this, she recommends trying mindful eating and taking a breather in between bites.

You’ve changed up your diet too suddenly: Colene Stoernell, a pediatric GI dietitian who offers nationwide online consultations for clients, said that making healthy food swaps are good, however, switching your diet up too rapidly can definitely lead to gas and bloating.

“Whenever you change your eating habits, your body needs time to adjust,” he said. “One example is deciding to eat more veggies and going from zero to eight servings in a day ― especially the veggies that are known gas producing ones like the cruciferous, broccoli, cauliflower ― which are high in fructans and can cause bloating and gas in sensitive individuals.”

It could be certain additives in foods: Attention fans of sweeteners in their coffee. Consuming a lot of sugar alcohols ― like Xylitol, sorbitol, and maltitol ― and inulin ― such as chicory root ― may be to blame.

“The food industry has been adding these items to more and more foods, like ice cream and protein bars, and if you are not used to them or sensitive to them, they can cause a lot of gas and discomfort,” Stoernell said. She added that inulin and sugar alcohols are not absorbed well in the body and can ferment in the gut, which in turn can cause gas and bloating.

How Do You Deal With it?

According to Tsai, gas pains are typically not a sign of a serious medical condition, although the symptoms can be a nuisance that can interfere with daily life and cause embarrassment.

Cohen added that if gassiness is combined with other symptoms, you should see a GI specialist. “Those symptoms include vomiting, blood in stool, fevers or illness, sudden weight loss, and for kids, a key symptom is a loss of height growth or weight gain,” he said.

And here are a few other ways you can troubleshoot gas in your everyday life, according to Nazareth:

  • “Get regular exercises and movement to keep things moving along, as moving stimulates the movement in the intestines called peristalsis,” she said.

  • Avoid eating too much and late at night.

  • Eliminate FODMAPs for up to eight weeks. Once gassiness goes away, then gradually reintroduce each category one at a time to determine if you can tolerate a specific fermentable carbohydrate. This would be better facilitated with a health care provider, she added.

  • Practice mindful eating, which means coming to the present moment of mealtime. First, identify if you are hungry and eat then, Nazareth said. Sometimes we eat when we are bored, sad or stressed. Take a breath before eating, and also take the time to notice what the food’s texture, smell and lastly the taste. Take the time to chew your food down and only focus on the task of eating.(So no scrolling on social media feeds at the same time, Nazareth said.)

“If, after all of those attempts, gassiness persists, then you should be evaluated by a physician,” Nazareth added.

THANKSGIVING: What You Can and Cannot Eat on the Low-FODMAP Diet

By Barbara Bolen, PhD 

The FODMAP theory holds that consuming foods high in "FODMAPs"—short for fermentable oligo-, di-, mono-saccharides, and polyols, a collection of short-chain carbohydrates found in many common foods—results in increased volume of liquid and gas in the small and large intestine, contributing to symptoms such as abdominal paingas, and bloating, and the motility problems of diarrhea and constipation. The theory proposes that following a low-FODMAP diet should result in a decrease in these symptoms. 

Research has also indicated there appears to be a cumulative effect of these foods on symptoms. In other words, eating more high-FODMAP foods at the same time will add up, resulting in symptoms that you might not experience if you ate the food in isolation. 

In the next two sections, you will find lists of common high- and low-FODMAP foods. This list is based on the most updated research from Monash University and may change over time. In addition, you may have your own individual sensitivities to foods. 

If you are interested in following a low-FODMAP diet, it is recommended that you work individually with a qualified dietary professional. There are risks to devising your own diet. It is tempting to pick certain items based on your personal preference, which could result in continued symptoms due to a lack of strict compliance to a sanctioned low-FODMAP diet. Working with a trained dietary professional will also help to ensure that you receive adequate and balanced nutrition, including a healthy intake of dietary fiber.

As with any new treatment or dietary approach, it is always best to discuss the issue with your own personal physician.

High-FODMAP Food List

Katarina Lofgren/Maskot

The following foods have been identified as being high in FODMAPs:


  • Apples

  • Apricots

  • Blackberries

  • Cherries

  • Grapefruit

  • Mango

  • Nectarines

  • Peaches

  • Pears

  • Plums and prunes

  • Pomegranates

  • Watermelon

  • High concentration of fructose from canned fruit, dried fruit or fruit juice


  • Barley

  • Couscous

  • Farro

  • Rye

  • Semolina

  • Wheat

Lactose-Containing Foods

  • Buttermilk

  • Cream

  • Custard

  • Ice cream

  • Margarine

  • Milk (cow, goat, sheep)

  • Soft cheese, including cottage cheese and ricotta

  • Yogurt (regular and Greek)

Dairy Substitutes

  • Oat milk (although a 1/8 serving is considered low-FODMAP)

  • Soy milk (U.S.)


  • Baked beans

  • Black-eyed peas

  • Butter beans

  • Chickpeas

  • Lentils

  • Kidney beans

  • Lima beans

  • Soybeans

  • Split peas


  • Agave

  • Fructose

  • High fructose corn syrup

  • Honey

  • Isomalt

  • Maltitol

  • Mannitol

  • Molasses

  • Sorbitol

  • Xylitol


  • Artichokes

  • Asparagus

  • Beets

  • Brussels sprouts

  • Cauliflower

  • Celery

  • Garlic

  • Leeks

  • Mushrooms

  • Okra

  • Onions

  • Peas

  • Scallions (white parts)

  • Shallots

  • Snow peas

  • Sugar snap peas

Low-FODMAP Food List

The following foods have been identified as being low in FODMAPs:


  • Avocado (limit 1/8 of whole)

  • Banana

  • Blueberry

  • Cantaloupe

  • Grapes

  • Honeydew melon

  • Kiwi

  • Lemon

  • Lime

  • Mandarin oranges

  • Olives

  • Orange

  • Papaya

  • Plantain

  • Pineapple

  • Raspberry

  • Rhubarb

  • Strawberry

  • Tangelo


  • Artificial sweeteners that do not end in -ol

  • Brown sugar

  • Glucose

  • Maple syrup

  • Powdered sugar

  • Sugar (sucrose)

Dairy and Alternatives

  • Almond milk

  • Coconut milk (limit 1/2 cup)

  • Hemp milk

  • Rice milk

  • Butter

  • Certain cheeses, such as  brie, camembert, mozzarella, Parmesan

  • Lactose-free products, such as lactose-free milk, ice cream, and yogurt


  • Arugula (rocket lettuce)

  • Bamboo shoots

  • Bell peppers

  • Broccoli

  • Bok choy

  • Carrots

  • Celeriac

  • Collard greens

  • Common Cabbage

  • Corn (half a cob)

  • Eggplant

  • Endive

  • Fennel

  • Green beans

  • Kale

  • Lettuce

  • Parsley

  • Parsnip

  • Potato

  • Radicchio 

  • Scallions (green parts only)

  • Spinach, baby

  • Squash

  • Sweet potato

  • Swiss chard

  • Tomato

  • Turnip

  • Water chestnut

  • Zucchini


  • Amaranth

  • Brown rice

  • Bulgur wheat (limit to 1/4 cup cooked)

  • Oats

  • Gluten-free products

  • Quinoa

  • Spelt products


  • Almonds (limit 10)

  • Brazil nuts

  • Hazelnuts (limit 10)

  • Macadamia nuts

  • Peanuts

  • Pecan

  • Pine nuts

  • Walnuts


  • Caraway

  • Chia

  • Pumpkin

  • Sesame

  • Sunflower

Protein Sources

  • Beef

  • Chicken

  • Eggs

  • Fish

  • Lamb

  • Pork

  • Shellfish

  • Tofu and tempeh

  • Turkey

More Young Adults Getting, Dying From Colon Cancer

By Jennifer Clopton

Heather Blackburn-Beel was 34 years old when the pain in her belly started. The Indiana resident was diagnosed with irritable bowel syndrome, and the mother of two and full-time nurse felt that made sense with her busy and stressful schedule.

But her mother, Kaye Blackburn, wasn’t convinced. Colon cancer runs in the family, and it had claimed the lives of many relatives, including Kaye’s older brother at age 32. She didn’t want her daughter to take any chances.

Kaye says she begged her daughter to get a colonoscopy, even offering to pay for it. But Heather didn’t feel that she had the time or that anyone needed to spend money on it. She finally relented when the pain worsened over several months, but by then, her mother’s worst fear had come true. Heather was diagnosed with stage IV colon cancer. Her colon was removed and she began chemotherapy, but the cancer had already spread to other parts of her body.

“I think her biggest concern was for her children. She wanted to live to see them. Her goal was to see them through high school,” Kaye says, pausing with heavy sadness in her voice. “But that didn’t happen.”

Heather Blackburn-Beel was diagnosed with colon cancer at age 34. She died four years later.

Heather died on May 23, 2014, after a 4 1/2-year battle against the disease. The 38-year-old is survived by a large family that includes her husband, two teenage children, mother, father, and two sisters.

“I think it’s probably the worst loss that anyone can have. I don’t think there is anything that prepares you. It’s not natural,” Kaye says. “You never get over losing a child. You just never do. You deal with it. You live with it. But you still have a lot of bad days where you miss her terribly.”

Rising Rates of Colon Cancer in Young People

Heather’s death is part of a concerning trend: More young adults are being diagnosed with colorectal cancer, and more are dying.

Because getting tested is key to prevention, the American Cancer Society released updated screening guidelines this month. The new guidelines say that adults at average risk should start getting tested at age 45 -- five years younger than the previous recommendations.

“One of the most significant and disturbing developments in CRC [colorectal cancer] is the marked increase in CRC incidence – particularly rectal cancer --among younger individuals,” the authors wrote in explaining the new recommendation.

The American College of Gastroenterology had already said that African-Americans should start routine screening at 45 because they have higher odds of getting colorectal cancer than whites. In addition, anyone with a first-degree relative diagnosed before age 60 is supposed to start getting tested either at age 40 or 10 years before the age of diagnosis of the youngest  relative who had the disease.

Colorectal cancer is the second leading cause of cancer-related deaths in the U.S. While the death rate for young adults is small, it is on the rise. Last year, the American Cancer Society published a study finding a 1.4% annual increase in death rates for colorectal cancers for adults under 55 between 2004 and 2014. That increase only applied to white adults.

Prevent Cancer With Exercise

Adults who stay active seem to have a powerful weapon against colorectal cancer. In one study, the most active people were 24% less likely to have the disease than the least active. It didn't matter whether what they did was work or play. 

The American Cancer Society recommends getting 150 minutes per week of moderate exercise, like brisk walking, or 75 minutes per week of vigorous exercise, like jogging. Try to spread your activity throughout the week.

Reviewed by Laura Martin on 7/31/2018

An earlier study from the group showed that between 1974 and 2013, colon cancer diagnoses increased by 1% to 2% per year among people between the ages of 20 and 39, and by .5% to 1% per year for those between the ages of 40 and 54. Rectal cancer rates have been increasing even longer and faster, rising about 3% annually since the 1970s and 1980s among those between ages 20 and 39. The study did not look at race or sex.

“One of the things we’ve been trying to do with these papers is to increase awareness. There are a lot of delays in diagnosis for young people because their doctors aren’t thinking cancer when a 20-year-old says their stomachis hurting and they have rectal bleeding,” Siegel says.

A recent study found that it took 217 days after they first had symptoms for someone under the age of 50 to get treatment for rectal cancer. That compared with just 30 days for those over 50.

“We have to get rid of the old concept and old idea that young people don’t get cancer. We have to believe and understand that they can,” says Felice H. Schnoll-Sussman, MD, director of the Jay Monahan Center for Gastrointestinal Health at New York-Presbyterian Hospital/Weill Cornell Medicine in New York City. It’s named after broadcaster Katie Couric’s late husband, who died of colon cancer at age 42.

“This age of 50 that was chosen for starting colorectal screening, there is nothing magical about it. We had to decide upon an age, and the rationale is 10 years before the average age of diagnosis. But what’s the difference between a 49-year-old and a 50-year-old? Nothing,” Schnoll-Sussman says.

Lisa Johnson is well aware of that bias toward young people. She has no family history of colorectal cancer. So when the 26-years old from Rivesville, WV, first had constipation, bloating, and cramping, urgent care clinics kept telling her it was hemorrhoids.

Lisa Johnson, diagnosed with colon cancer at age 26, is now in remission.

She lived with the symptoms for several months until she got an unrelenting, stabbing pain in her right buttock. That’s when she sought out more specialized help. A surgeon found a tumor about 7 centimeters (2.75 inches) long blocking 90% of her rectum, and her colon cancer diagnosis came quickly after that.

“I have lost way too many friends in their 20s because people say screening shouldn’t start until 50 or their insurance won’t pay for it because the guideline says 50. Everyone I meet that is my age or in their 30s when diagnosed, we all have the same story.

“We had doctors who didn’t take us seriously, and we had to fight to get to a doctor who understood that something wasn’t right,” Johnson says. “If I walked into a doctor’s office in my 20s and said I found a lump on my breast, a doctor would never say, ‘Ah, you are 25, don’t worry. You’re too young for it to be cancer.’ But that’s happening all the time for patients with colon cancer.”

Cracking the Mystery

While researchers can clearly see a rise in colorectal cancer diagnoses and mortality rates in young people, they don’t know what’s driving it.

“It bothers me on a daily basis,” Siegel says.

By 2030, colorectal cancer incidence rates will be up 90% in people between ages 20 and 34, and 28% for people between ages 35 and 49.

Lack of exercisedietobesitysmoking, and alcohol can raise the odds of having colon cancer at all ages, and researchers are looking at all for potential causes. Siegel says she thinks there could also be a connection to the body's microbiome -- the bacteria that build up in our gut and are influenced by a wide variety of things in our diet and environment.

Researchers says some clues are starting to emerge, showing differences in the disease in younger people. It’s most commonly found on the left side of the colon or in the rectum. Some studies show that younger people have more aggressive cancer with worse prognoses. The disease is generally more advanced -- stage III or IV -- in younger people, perhaps a reflection of the challenge in getting diagnosed when you're younger than 50.

“Money needs to be put into this research because there are undoubtedly genes we have not found. This is only going to become more clear if we have research funds to try to figure it out. The answers are out there. We just don’t know them yet,” Schnoll-Sussman says.

The Power of Prevention

Siegel says the American Cancer Society is determined to raise awareness of colorectal cancer and improve its diagnosis. Ninety percent of people diagnosed at an early stage survive beyond 5 years, compared with an 11% survival rate after 5 years with the late-stage disease.

Colon Cancer Early Detection


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Colon Cancer Early Detection

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“We need to really talk about the symptoms. No matter how old you are, if you have these symptoms and they are persisting, go to your doctor and get it checked out. It probably isn’t cancer, but it could be,” she says.

Doctors say the most common symptoms of colorectal cancer in young patients are:

Young patients may also see a difference in the shape of their stool and the frequency or difficulty with bowel movements.

Many mutations, or changes in genes, are associated with a higher chance of having colorectal cancer, and people who have those changes do often get diagnosed at an early age. But the majority of cases are sporadic, meaning there is no known cause.

Knowing your family history is important. The general population has a 2% lifetime risk of getting colorectal cancer. That goes up to over 80% for people with the inherited Lynch syndrome and 100% for familial adenomatous polyposis or FAP, both genetic mutations

Eduardo Vilar-Sanchez, MD, PhD, an assistant professor in the Department of Clinical Cancer Prevention at the University of Texas MD Anderson Cancer Center in Houston, did a study on his own hospital’s population that found one-third of colorectal cancers diagnosed before the age 35 are hereditary.

“I would interpret this for doctors or medical oncologists as saying that every time we see a patient that is young with colorectal malignancy, we must think about hereditary syndrome,” he says. “For a third of the patients, we should be referring all these people for genetic counseling. The management isn’t going to change for them, but there will be implications for family members.”


By 2030, colorectal cancer incidence rates will be up 90% in people between ages 20 and 34, and 28% for people between ages 35 and 49.

Heather Blackburn-Beel’s family is one of many who didn’t know Lynch syndrome ran in their family until Heather’s doctor recommended genetic testing and found she had it. Now the family understands why so many aunts, uncles, and cousins through the years have been diagnosed with, and died from, colon and stomach cancers.

Since Heather’s diagnosis, surviving family members have gotten serious about regular colonoscopies long before the recommended age of 50. Her children, for example, will start when they are 20 and get one every year. “If something happens, they’re going to know about it and be able to get ahead of it,” Kaye says.

Colonoscopies are generally the preferred screening method, and studies show they cut the odds of death by about 50%. They look at the rectum and entire colon.

Other approved methods include:

  • Sigmoidoscopies. These look at the rectum and part of the colon. If no polyps are found, these tests are generally repeated every 10 years

  • .Stool tests that detect blood in fecal matter. Studies show they can lower the number of colorectal cancer deaths by 15% to 33% in people ages 50 to 80 when done every 1 to 2 years.

  • Stool DNA test. Cologuard is currently the only FDA-approved test. This is a new test, so the benefits and harms are less well-established than for other tests.

Moving Forward

Vilar-Sanchez says managing young colorectal cancer patients requires a different approach than for patients over 50. He says his hospital started making this shift in treatment about 2 years ago.

“The expertise of a multidisciplinary team is needed, including genetic counselors, geneticists, fertility doctors, and psychological support, because being diagnosed at that age is a shock,” he says. “The best message we can get out there is young patients have their own issues, and it’s very important to recognize those.”

He also says that colorectal cancer in young people tends to be more aggressive and may need to be treated differently.

Johnson can speak to the impact a colorectal cancer diagnosis has had on her life. She was a recent college graduate, a newlywed, and worked as a dance teacher when she was diagnosed at 26. While her friends were getting married and buying houses, she had multiple surgeries, got chemotherapy and radiation, and had to give up her job.

I didn’t listen to my body for a very long time, and I want to keep others from making that same mistake.

Lisa Johnson, colon cancer patient

Now 34, she is in remission but lives with an ostomy bag. She is unable to have children because she had a complete hysterectomy and says she and her husband now focus their devotion on their nieces, nephews, and dogs. Still, she’s grateful to be alive and is working now to figure out what comes next.

“I’ve had to say goodbye to my old body. I have a new one now. This one saved my life, and I will embrace it. But the fight after the fight has been challenging. I felt like I became a really good professional cancer patient and often wonder: Now what,” Johnson says. “I think my goal now is to keep telling people my story. I didn’t listen to my body for a very long time, and I want to keep others from making that same mistake.”

Many doctors and patients also agree that doctors also need to be better educated about symptoms, no matter the age of the patient.

“I kind of blame some of the doctors who put Heather off, probably for a good 6 months to a year,” says Kaye Blackburn, now 66 years old. “It sounds cliché, but if I can help someone else avoid what we have been through, then I will do it. It was just so horrible for Heather and her kids and our whole family.

“So if you have symptoms, get them checked. If you don’t think the doctor knows what they’re talking about, find another doctor. And if you have a family history of colon cancer, you definitely need to be screened. Don’t wait until it’s too late.”

What's Your UV: IQ?

Read about how you can protect your skin from UV sun rays.
— Dr. Dale

From What's Your UV: IQ? 

The skin is the body's largest organ. It protects against heat, sunlight, injury, and infection. Yet, some of us don't consider the necessity of protecting our skin.

It's just smart to take good care of your skin

The need to protect your skin from the sun has become very clear over the years, supported by several studies linking overexposure to the sun with skin cancer. The harmful ultraviolet rays from both the sun and indoor tanning “sunlamps” can cause many other complications besides skin cancer - such as eye problems, a weakened immune system, age spots, wrinkles, and leathery skin.

How to protect your skin

There are simple, everyday steps you can take to safeguard your skin from the harmful effects of UV radiation from the sun.

  • Wear proper clothing Wearing clothing that will protect your skin from the harmful ultraviolet (UV) rays is very important. Protective clothing are long-sleeved shirts and pants are good examples. Also, remember to protect your head and eyes with a hat and UV-resistant sunglasses. You can fall victim to sun damage on a cloudy day as well as in the winter, so dress accordingly all year round.
  • Avoid the burn Sunburns significantly increase one's lifetime risk of developing skin cancer. It is especially important that children be kept from sunburns as well.
  • Go for the shade Stay out of the sun, if possible, between the peak burning hours, which, according to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), are between 10 a.m. and 4 p.m. You can head for the shade, or make your own shade with protective clothing - including a broad-brimmed hat, for example.
  • Use extra caution when near reflective surfaces, like water, snow, and sand Water, snow, sand, even the windows of a building can reflect the damaging rays of the sun. That can increase your chance of sunburn, even if you’re in what you consider a shady spot.
  • Use extra caution when at higher altitudes You can experience more UV exposure at higher altitudes, because there is less atmosphere to absorb UV radiation.
  • Apply broad-spectrum sunscreen Generously apply broad-spectrum sunscreen to cover all exposed skin. The “broad spectrum” variety protects against overexposure to ultraviolet A (UVA) and ultraviolet B (UVB) rays. The FDA recommends using sunscreens that are not only broad spectrum, but that also have a sun protection factor (SPF) value of at least 15 for protection against sun-induced skin problems. 
  • Re-apply broad-spectrum sunscreen throughout the dayEven if a sunscreen is labeled as "water-resistant," it must be reapplied throughout the day, especially after sweating or swimming. To be safe, apply sunscreen at a rate of one ounce every two hours. Depending on how much of the body needs coverage, a full-day (six-hour) outing could require one whole tube of sunscreen.

When to protect your skin

UV rays are their strongest from 10 am to 4 pm Seek shade during those times to ensure the least amount of harmful UV radiation exposure. When applying sunscreen be sure to reapply to all exposed skin at least 20 minutes before going outside. Reapply sunscreen every two hours, even on cloudy days, and after swimming or sweating.

Protecting your eyes

UV rays can also penetrate the structures of your eyes and cause cell damage. According to the CDC, some of the more common sun-related vision problems include cataracts, macular degeneration, and pterygium (non-cancerous growth of the conjunctiva that can obstruct vision). 

  • Wear a wide-brimmed hat To protect your vision, wear a wide-brimmed hat that keeps your face and eyes shaded from the sun at most angles. 
  • Wear wrap-around style sunglass with 99 or higher UV block Effective sunglasses should block glare, block 99 to 100% of UV rays, and have a wraparound shape to protect eyes from most angles.

Using the UV index

When planning your outdoor activities, you can decide how much sun protection you need by checking the Environmental Protection Agency's (EPA) UV index. This index measures the daily intensity of UV rays from the sun on a scale of 1 to 11. A low UV index requires minimal protection, whereas a high UV index requires maximum protection.