Stop running! STUBBORNNESS: the silent killer.

 
 

Hi friends!  

I want to bring something really important to your attention.  Everyone knows how stern I am with promoting the importance of the colonoscopy — especially if you’re over the age of 45.

The Washington Post has a great article titled, “5 reasons to stop avoiding that colonoscopy,” and it really should be read by everyone.

Colon cancer is the second-deadliest type of cancer!  Don’t let your stubbornness keep you from asking me or your primary doctor how to takes steps toward this life-saving procedure.  I’m here to help you!  All it takes is an understanding of the 5 concerns below, and you’ll feel much better.  I promise.

DON’T LET THESE FEARS SCARE YOU.   Or kill you.

I got you.

-- Dr. Dale


http://www.washingtonpost.com/national/health-science/5-reasons-to-stop-avoiding-that-colonoscopy/2013/12/20/a9408568-27a8-11e3-b3e9-d97fb087acd6_story.html

5 reasons to stop avoiding that colonoscopy

By Consumer Reports

Colonoscopy is highly effective at preventing colorectal cancer, the second-deadliest type of cancer, because it allows a doctor to detect precancerous growths in the colon and remove them on the spot.

Yet only about half of Americans age 50 and older get any kind of screening for colorectal cancer, colonoscopy or otherwise, according to Otis Brawley, chief medical officer of the American Cancer Society. He estimates that an additional 15,000 to 20,000 lives could be saved each year if that rate rose to 90 or 95 percent.

Here are five common barriers to this important test and how to overcome them.

The concern: You’ll get bad news.

The fix: Colorectal cancer grows slowly, typically taking 10 to 15 years to develop. Getting screened at recommended intervals increases the likelihood of catching it early, when you have the best chance of being successfully treated. A study of 1,071 colon-cancer patients published in June in JAMA Surgery found that those whose disease was detected by a screening colonoscopy tended to have it diagnosed earlier and to have longer survival rates than people whose tumors were detected in other ways.

The concern: Preparation for the test is a nightmare.

The fix: You’re limited to a clear-liquid diet for about 24 hours before the procedure, and you may also have to drink up to a gallon of a laxative solution. To improve the solution’s taste, chill it first or ask your doctor whether it’s okay to add lemon, lime, ginger or a flavor enhancer such as Crystal Light. Other steps that might help include eating lighter than usual a day or two before your prep, using a straw to drink the solution, staying near a bathroom and using flushable wipes and diaper ointment to prevent irritation.

The concern: Complications.

The fix: It’s true that both colonoscopy and the less invasive flexible sigmoidoscopy (in which only the lower colon is checked) pose a small risk of bowel perforation or infection. And the sedating drugs under which colonoscopy is typically performed — such as propofol (Diprivan and generic) or midazolam (Versed and generic) — have rare but potentially serious risks, such as difficulty breathing. But the benefits of the procedure far outweigh the dangers for people age 50 to 75, says Carla H. Ginsburg, a gastroenterologist in Newton, Mass.

If even the small risk of complications is intolerable, you can do an annual stool test instead, though you’ll need to follow up with a colonoscopy if the result is positive.

The concern: You can’t afford it.

The fix: Under the health-care law passed in 2010, Medicare and private insurers are required to cover most types of colorectal-cancer screening, including colonoscopy. (They might not fully cover removal of polyps during the procedure.) The requirement is already in effect for Medicare; group and individual plans must comply by 2014. But you’ll probably be billed separately for the procedure and the anesthesia, so find out ahead of time whether the anesthesiologist is in your insurance plan’s network.

The concern: You feel generally squeamish about the whole thing.

The fix: Meet with the gastroenterologist who will do the procedure ahead of time to talk about the test. (For example, you can ask who else will be in the room.) Also keep in mind that the average procedure takes only 10 to 15 minutes, and you won’t be cognizant enough to feel bashful. By the time you’re lucid, it will all be over.

What are some lifestyle tweaks for constipation-predominant IBS?

Dale Prokupek MD - High Res.jpg

Constipation-predominant irritable bowel syndrome, or IBS-C, is a condition that involves chronic, recurring abdominal pain and constipation. It is one of the major subtypes of IBS, the other most common being IBS-predominant diarrhea (IBS-D). More than a third of people diagnosed with IBS manifest this subtype of IBS.

While the condition may not be so bothering for some, many patients find IBS-C symptoms to be distressing and overwhelming. Fortunately, various well-studied, alternative approaches can help mitigate your symptoms and improve the quality of your life. That’s why I recommend biohacking your gut health by making a couple of dietary and lifestyle changes.

Up your Soluble Fiber Intake

Slowly add fiber to facilitate regular bowel movements. Soluble fiber (like psyllium husk) rather than insoluble fibers (such as wheat bran, vegetables, and whole grains) often help address constipation related to IBS. I advise my patients starting Psyllium/Metamucil at lower doses to avoid gas and abdominal bloating. Though the optimal serving of fiber for IBS hasn’t been established yet, aiming for 20–30 grams of the total diet and supplementary fiber is reasonable.

Lower your Intake of High-FODMAP Foods

FODMAP is short for ‘Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols.’ FODMAPs are carbohydrates and sugar alcohols that inflame your gut and are poorly absorbed. Hence, they are rapidly acted upon and fermented by bacteria within your digestive tract. The rapid fermentation of these carbohydrates contributes to GI symptoms by increasing the volume of liquid due to osmosis and by amplifying gas production.

A few examples of high-FODMAP foods include:

  • Wheat

  • Rye

  • Barley

  • Couscous

  • Farro

  • Semolina

  • Artichokes

  • Cruciferous vegetables

  • Legumes

  • Onions

  • Garlic

  • Fruits (like apples, apricots, nectarines, cherries, blackberries, mangoes, pears, plums, and watermelons)

  • Milk

  • Sweeteners

As you can see, a lot of high FODMAP foods are nutritious, avoiding them altogether may put you at risk of nutritional deficiencies. I, therefore, also suggest working with your dietitian to come up with a balanced diet that helps keep your symptoms under control as well as prevent any nutritional risks.

Hydrate, Hydrate, Hydrate

Drink plenty of water throughout the day to get your bowels moving. Fruit juice and fruit drinks may carry too many carbohydrates to upset your stomach. So, plain water is the best drink during an IBS-C flare.

Stay Active

Gentle or low-impact activities such as walking, cycling, tai chi, or swimming help promote bowel movements, reduce gut inflammation, curb stress, and alleviate IBS-C symptoms.

Meditate to Calm your Nerves

Stress and anxiety are well-known causes of an IBS flare-up. Your bowels are particularly susceptible to stress because of the crosstalk between your gut and brain. 

Practice stress-reducing techniques such as mindfulness meditation, massage, and warm baths to promote mental relaxation and help loosen up your bowels. To get the best results, you need to practice these tips daily, as your brain needs time to retrain and calm itself in stressful situations.  

Consider Probiotics

Mounting evidence suggests that disturbed intestinal ecology may trigger IBS. Talk to me or your doctor about adding a probiotic supplement or probiotic-rich foods such as yogurt, tempeh, kimchi, tofu, or kefir.

Touch base with your Doctor

When an IBS-C flare hits, remember to move more, hydrate more, and (gradually) add more fiber. Moreover, prescription medicines are available to help address IBS-C. If you have any questions about IBS treatment, you can contact the office at 310-360-6807 to schedule an appointment. You can also book an appointment online by clicking below. 

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

https://www.verywellhealth.com/foods-on-the-low-fodmap-diet-1944679

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:

Fruits:

  • 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

Grains

  • 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.)

Legumes

  • Baked beans

  • Black-eyed peas

  • Butter beans

  • Chickpeas

  • Lentils

  • Kidney beans

  • Lima beans

  • Soybeans

  • Split peas

Sweeteners

  • Agave

  • Fructose

  • High fructose corn syrup

  • Honey

  • Isomalt

  • Maltitol

  • Mannitol

  • Molasses

  • Sorbitol

  • Xylitol

Vegetables

  • 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:

Fruits

  • 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

Sweeteners

  • 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

Vegetables

  • 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

Grains

  • Amaranth

  • Brown rice

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

  • Oats

  • Gluten-free products

  • Quinoa

  • Spelt products

Nuts

  • Almonds (limit 10)

  • Brazil nuts

  • Hazelnuts (limit 10)

  • Macadamia nuts

  • Peanuts

  • Pecan

  • Pine nuts

  • Walnuts

Seeds

  • Caraway

  • Chia

  • Pumpkin

  • Sesame

  • Sunflower

Protein Sources

  • Beef

  • Chicken

  • Eggs

  • Fish

  • Lamb

  • Pork

  • Shellfish

  • Tofu and tempeh

  • Turkey