Spring Cleaning Your Colon

Steph Wells (00:00):

How do I know if my colon is healthy?

Mike Kelly (00:03):

What’s the difference between prebiotics and probiotics?

Steph Wells (00:07):

Are colon cleanses good for you?

Mike Kelly (00:09):

All that and more on this episode of The Healthiest You.

Steph Wells (00:13):

What goes in must come out. Today we’re talking about spring cleaning, but not your house, your colon.

Mike Kelly (00:20):

Did you actually just say, “What goes in must come out?”

Steph Wells (00:23):

Well, it’s true. It is true.

Mike Kelly (00:26):

Yes, yes, it is. It is true. And today we’re getting all up in it about what goes in and ... let’s just move on.

Steph Wells (00:32):

OK, on a serious note, thank you very much, getting a colonoscopy is very important and can save your life. In fact, Mike, I just had my first one last week and the process was the thing I was most scared about, the prep time and everything. It was easy. It was fine. The actual procedure, if you will, I was out and they said it took five minutes, which I don’t know if it was actually five minutes, but in any case, that was very easy. And if you haven’t gotten yours yet, definitely get in and schedule your appointments.

Mike Kelly (01:03):

Oh, yeah, I’m coming up on my second one. I’ve got my second one coming up. By the way, first one, triple A rating.

Steph Wells (01:07):

Oh, nice.

Mike Kelly (01:07):

How about that, huh?

Steph Wells (01:07):

Wow.

Mike Kelly (01:09):

Ten years off.

Steph Wells (01:10):

Gold star for you.

Mike Kelly (01:11):

So, I’ll be coming up on my second one. And I’m with Steph on that. Get it done as soon as you can, because it can save your life and it’s a very simple, easy procedure.

Steph Wells (01:18):

That’s right. We’ll be focusing on women’s health and wellness in this new season of The Healthiest You podcast. Whether you’re on your way to work or enjoying a cup of coffee, take this time to focus on your health. Here to talk to us about women’s colon health is Dr. Kristen Halm, colon and rectal surgeon with Colon-Rectal Surgery Associates and Lehigh Valley Health Network. Dr. Halm, welcome to the show.

Kristen Halm, MD (01:42):

Thank you. Thank you for having me.

Mike Kelly (01:44):

Doctor, let’s get right into it. Why does my colon health matter?

Kristen Halm, MD (01:49):

Well, the colon serves a pretty important function. The function of the colon is to absorb water from your body. It helps absorb nutrients, electrolytes. It eliminates the waste that your body doesn’t need, and it actually helps produce some of the vitamins that we need, like vitamin K and vitamin B.

Steph Wells (02:13):

So, how do I know if my colon is healthy?

Kristen Halm, MD (02:18):

So, that’s kind of a tricky question, but for the most part, you would want to see that you have no trouble with bowel movements. So, you don’t have trouble with constipation, no trouble with diarrhea, you’re not having any rectal bleeding. Also, some abdominal symptoms that could point toward some issues with the colon would be bloating or cramping, things like that.

Mike Kelly (02:49):

What are the warning signs of a colon in trouble?

Kristen Halm, MD (02:53):

So, some things that you would want to look out for would be if you had hard stools, that abdominal bloating that we just talked about. You could even have pain in your back, around the flank area or the low back. Some red flags, even more kind of worrisome things that you would want to look out for, would be a sudden change in your bowel movements or weight loss that you can’t explain, that you haven’t been trying to lose weight, rectal bleeding again, we said. Or if you have blood work that might show that you have a low blood count, that might be a red flag pointing to something wrong with the colon.

Steph Wells (03:33):

What are symptoms of constipation, and is it true constipation is more common in women?

Kristen Halm, MD (03:40):

So, constipation does tend to be more common in women, and there are certain criteria that we use to diagnose constipation. So, just not having a bowel movement for several days, that by itself is not worrisome for constipation. So, if you had a bowel movement one, two, three times a week and you felt fine otherwise, didn’t have abdominal bloating, didn’t have difficulty getting the bowel movement started, then that might be considered normal for you. But if you had abdominal bloating or if you had to strain to get your bowel movement started or if the stool that comes out is hard or lumpy, or after you have a bowel movement you feel like, “I don’t feel like I’m quite empty.” These would all be criteria that we use to diagnose constipation. And technically you should have two or more of the [symptoms] that we just talked about to quantify or to really diagnose constipation. So, one of those symptoms by itself is not enough really to call it constipation.

Mike Kelly (04:55):

How can women relieve and prevent constipation?

Kristen Halm, MD (05:01):

So, kind of the basic things to try to prevent constipation would be a well-balanced diet, adequate water intake, high fiber in your diet. Even people who think that they take in a lot of fiber with their diet, oftentimes they’re falling short of what the recommendation is. So, the recommendation is 25 to 35 grams of fiber, which is actually a fair amount. And I often tell people, even if you think you’re taking a high-fiber diet, do a food diary and just keep track for a day or two and then you’ll see, are you falling within that mark or are you falling short?

Steph Wells (05:41):

What are some dos and don’ts for those dealing with diarrhea?

Kristen Halm, MD (05:45):

So, diarrhea, the other end of the spectrum. So, diarrhea, again, has certain factors that we look at to actually say diarrhea. Some people think they have diarrhea if they have four or five bowel movements a day, but if the stool is formed, soft and not a water consistency, that could be normal and not considered diarrhea. But if you’re having watery stools, that by itself, even if it’s just once or twice or day, would be considered diarrhea. And so, one is just getting the accurate diagnosis of diarrhea and then kind of determining what are the dos and don’ts.

(06:28):

So, don’t ignore it. If it’s a change in your normal bowel habit, get it addressed, talk to your doctor about it, and make sure that it’s not a problem to be more concerned about. And don’t treat it for a prolonged period of time with over-the-counter medications without being evaluated. So, there are some over-the-counter medications like Imodium, anti-diarrheal medications, and you don’t want to take them for too long without being evaluated, because you could be masking something that needs medical treatment.

Mike Kelly (07:02):

Doctor, when is it time to discuss poop problems with a doctor? And do you actually go to them and say, “I have a poop problem,” or is there a better way to word it?

Kristen Halm, MD (07:12):

You can certainly go and say, “I have a poop problem.” I have people coming in with all different ways of describing their issues down below. And often on the heels of that, people will ask me, “Why did you ever choose to go into this?” But I think a lot of people need help in this area. … If you have a change in your bowel habits that lasts a week or two and then you go back to normal, that’s OK. If you have chronic constipation or diarrhea, something that lasts three months or more, then it’s time to go see your doctor about that. If you have blood in the stool or you’re losing weight and you can’t explain it, those are reasons that you would want to go talk to your poop doctor.

Steph Wells (08:02):

What is the difference between prebiotics and probiotics, and should women take these daily to support their colon?

Kristen Halm, MD (08:13):

This area is kind of a hot topic, and so just a little background. The gut, your colon especially, is full of bacteria and it’s a good thing. Usually we think of bacteria as something bad, but these good bacteria are what we call the microbiome. It’s the environment of bacteria that live in your colon. And so the prebiotic is a specialized fiber, a plant fiber that kind of acts like a fertilizer to help those bacteria grow. And we hear a lot about it as far as supplements go, but ... you can get an adequate source of prebiotics in your diet. And some examples would be asparagus or yams. I mean, you can look on Google. There’s a whole bunch of examples of what prebiotics would be.

(09:10):

And then probiotics are actually live organisms or bacteria that you can take. Again, you could take it in a dietary form, which would be active yogurt or sauerkraut has a lot of probiotics. Kimchi would be another example, or you could take a pill and they have the probiotics in the pill. And the two work together. Basically the bacteria are there to support good digestive health, and the prebiotic helps to foster that growth of the good bacteria.

Mike Kelly (09:48):

Are there other supplements beneficial for colon and gut health?

Kristen Halm, MD (09:54):

So, we really try to encourage getting everything you need from a dietary standpoint. The one, probably the biggest supplement that we do recommend, and I tell people it’s like a vitamin for your colon, is fiber. So as we talked about before, getting 25 to 35 grams of fiber just out of what you eat can be difficult. People have a busy lifestyle and running around, and so it’s hard to get that in your diet alone. So, the fiber supplement helps you reach that goal, and that’s the one supplement that I really do recommend to patients.

Steph Wells (10:35):

What are the top things that mess up your gut health?

Kristen Halm, MD (10:41):

Probably the biggest thing is antibiotics. So, you have an infection, your doctor puts you on antibiotics, it treats the infection, great, you’re feeling better, but you start having diarrhea. Very common side effect to antibiotics. And that goes back to what we talked about, altering that good bacteria that help maintain good colon health. And so, antibiotics can certainly mess that up. Other things that alter that microbiome or that bacteria balance is sugar. Now, sugar in moderation is fine. But if your diet is high in sugar, then that’s something that could alter that microbiome. Stress is another thing, anxiety; those things can alter the microbiome and alter your gut health.

Mike Kelly (11:39):

How can hormones impact gut health in women?

Kristen Halm, MD (11:44):

So, recent studies have shown that there’s actually what we call a bi-directional interaction between the bacteria and the hormones. So, your bacteria balance can affect your hormone balance or imbalance, and your hormonal balance or imbalance can alter your microbiome, or your bacteria balance. So it’s kind of like back and forth between the two.

Mike Kelly (12:11):

Doctor, how does your gut health affect the rest of your body?

Kristen Halm, MD (12:17):

It actually can affect areas that you wouldn’t necessarily think it would affect. So, your gut health can influence your mood, it can affect your metabolism, and by that also affect your weight. It has an important role in your immune system. So, those bacteria, it all kind of comes back to the bacteria. The good bacteria can help support your immune system to fight off other diseases.

Steph Wells (12:46):

And I know I have another question I’m supposed to get to, but I’m very curious. What exactly is sleep hygiene?

Kristen Halm, MD (12:53):

The things that they tell your kids, not having screen time right before you go to sleep, trying to get adequate hours of sleep. So, that’s different for everybody, but being able to get a good night’s sleep, whether that’s eight hours or six hours. People with obstructive sleep apnea, they may sleep eight hours or 10 hours, but they’re not getting the right kind of sleep because of their obstructive sleep apnea. So paying attention to those things and getting a good night’s sleep.

Steph Wells (13:23):

Thank you. I was curious about that. What is a colon cleanse, also called colonic irrigation or colonic hydrotherapy, and is it good for women?

Kristen Halm, MD (13:35):

So, a colon cleanse, as you both know, can be what you take to clean yourself out for your colonoscopy. So, it’s essentially anything that you ingest that goes through your intestines, gets to the colon and helps you clean out all of the stool. And so, the problem with it is it can also clean out your microbiome and it can disrupt the balance of healthy bacteria and can even cause some of the not-so-healthy bacteria to take over, essentially. And so, people tend to use it or you can get it independent of a procedure – so not recommended or prescribed by your doctor –  to detoxify. A lot of the colon cleanses will say that they can detoxify your colon, but your body doesn’t need that. Your kidney and your liver are actually the main organs that help rid your body of the toxins that you don’t need. So, your body already has a mechanism for doing this detoxification. And so, as a physician, we typically do not recommend the colon cleanse, other than in preparation for a procedure.

Mike Kelly (15:09):

I know ColonBroom is a popular detox currently. What is this magic pooping drink, and is it safe to use?

Kristen Halm, MD (15:17):

So, the active ingredient in this ColonBroom is actually just fiber. So psyllium husk fiber, which is essentially the same as Metamucil, which is a very common popular fiber supplement. In addition to that, there are some other inactive ingredients. It has artificial sweetener in it, it has lemon juice in it, it has crystallized lemon, salt. So, the clean-out or the pooping drink, the effective ingredient is the fiber. And so, you have to be careful, I think, with the artificial sweeteners, added salt if you’re on a low-salt diet, for other health reasons. You have to pay attention to the content of the salt. The effective lemon, they think may help with some of these bloating and cramping and symptoms like that. And so, that may be an added benefit to the ColonBroom that the regular Metamucil doesn’t have. But you just have to be careful; make sure you talk to your doctor and it’s not going to interact with other medical problems that you have.

Steph Wells (16:36):

How common is colorectal or colon cancer in women?

Kristen Halm, MD (16:42):

So unfortunately, it is on the rise and it is actually affecting women of younger ages. So, it’s right about one in 25 women in the United States are at risk for developing colon cancer.

Steph Wells (17:00):

Wow.

Mike Kelly (17:01):

What are the risk factors for colon cancer?

Kristen Halm, MD (17:04):

The biggest risk factors are history, really. So, if you have a family history of colon cancer or even colon polyps, that puts you at increased risk. If you have a personal history of polyps or if you have a personal history of colon cancer, you could actually get it again. There’s inflammatory bowel disease. It’s an inflammation of the colon and also the small intestine, known as ulcerative colitis or Crohn’s disease. Those diseases put you at a higher risk of getting colon cancer. Also, genetic syndromes. If you have gene mutations, that could lead to increased risk of colon cancer. Those are kind of the main risk factors.

(17:49):

There are some lifestyle modifications that may affect your risk for colon cancer. The studies are a little bit back and forth, but some of the things that we think may increase your risk of colon cancer [include] the low-fiber diet. Again, the importance of that fiber. High-fat diet, excessive alcohol, tobacco, which we know is a risk factor for a lot of cancers. It can also increase your risk of colon cancer. And obesity seems to be tied to an increased risk of colon cancer.

Steph Wells (18:24):

Women may dismiss things like abdominal bloating. What symptoms shouldn’t be ignored and could be a sign of a deeper concern?

Kristen Halm, MD (18:35):

So, things to be concerned about would be, again, the unintentional weight loss. So, not somebody who’s dieting and losing weight appropriately, but [someone who] hasn’t really changed anything with their eating habits and is losing weight. Rectal bleeding. Rectal bleeding, the majority of the time, is benign. Often it is related to hemorrhoids, but it’s something that you shouldn’t take for granted and shouldn’t ignore, because it could be a sign of colon cancer or something else going on in the colon. And then a sudden change in your bowel movements. So, chronic constipation or chronic diarrhea, things that have been going on for years, are less concerning than a change from your normal pattern.

Mike Kelly (19:18):

Doctor, at the beginning of the show, Steph and I both said everyone should get a colonoscopy. Now that we’re downforce, who should get a colonoscopy and how often?

Kristen Halm, MD (19:30):

So, the new screening age is 45. That’s for people who are at average risk and that’s changed relatively recently from the age of 50. So, they’ve lowered the start of your colonoscopies, because we have seen an increase in colon cancer in people in the younger ages. So, now the age to start is 45. That’s again, it’s your average risk. If you have a family history of colon cancer or colon polyps, especially in a first-degree relative, then the recommendation is actually to start at 40. And then how often depends on what they find at your first colonoscopy, and again, what your history is.

(20:17):

So, it sounds like you, Mike, had a clean colonoscopy, no polyps, no risk factors, so 10 years is the recommendation. So if everything’s good, then it would be 10 years for your next colonoscopy. If you have polyps, then it depends on some factors related to the polyps, but anywhere between three and five years typically for your repeat colonoscopy after you’ve had polyps. If you have a family history of colon cancer, especially in a first-degree relative, then we usually tell people they shouldn’t go more than five years. They should get it every five years.

Steph Wells (20:52):

Well, not everyone can be triple A like Mike Kelly.

Mike Kelly (20:55):

I studied hard for that test.

Steph Wells (20:56):

Yes, you did.

Mike Kelly (20:57):

And I did very well.

Steph Wells (20:57):

I’m scheduled to go back in five years, so there you go. Do you have any tips for preparing and calming anxiety related to having this procedure done?

Kristen Halm, MD (21:08):

So, yes. I mean, I think that anxiety is one of the biggest reasons why people don’t go for their colonoscopy. But I think, as you mentioned, you both mentioned, it’s not as bad as what the horror stories that are out there. It is a bowel prep. You have to drink a lot of fluid and you have to poop a lot. But in the grand scheme of things, what I tell people is keep the goal in mind. So, colonoscopy is one of the screening tests that we have that can actually prevent cancer. So, the colonoscopy, you’re looking for polyps. Polyps are precancerous. So, if you have your colonoscopy and the polyps are removed, then you’ve basically prevented the cancer. So, kind of keeping the big picture in mind and what the goal for the colonoscopy and what you’re accomplishing by getting it done, I think help people kind of tolerate the prep, get through it. And in the end, like you said, realize it’s not so bad.

Mike Kelly (22:18):

Are at-home screening tests for colon cancer reliable?

Kristen Halm, MD (22:22):

They are. There’s been an increase in the number of what’s available. The Cologuard is one test that’s available that’s very popular. The FIT test is another one. Kind of an old test is just a fecal occult blood test, just checking the stool for blood. So, these are all at-home tests, usually mail-in results. The benefits of the tests, probably the biggest benefit is you don’t have to do a prep. And so like I said, a lot of people, their anxiety about the colonoscopy is not about the procedure itself, but about the bowel prep. So, that’s one thing that you can avoid by doing the at-home tests.

(23:09):

The one caveat for these tests is that it’s for the average-risk patients. So, it’s really not approved for people who have high-risk factors, so the family history or the inflammatory bowel disease, any of those things that we talked about. It’s just for average-risk people. And then, another benefit, or maybe some people would say is a con, is you don’t have to take time off for work. So, you don’t have to miss a day of work to go get your colonoscopy done. You can do it at home and send it in. One thing to consider is if it’s positive, then you have to get the colonoscopy. So the next step if you have a positive test is to do the colonoscopy.

(23:59):

And they’re not quite as good as the colonoscopy. They are very good at detecting colon cancer, but as we talked about, the colonoscopy, one of the benefits of the colonoscopy is that it can prevent the cancer. So, it does have a good success rate for detecting cancer in its early stages, but not as good at detecting the polyps. And one of the other kind of negatives is that getting a positive test does not necessarily mean that there’s something wrong. So, up to 45% of the time, a positive test, you won’t detect any colorectal cancer or polyps. So people, they worry then after they have a positive test for no reason.

Steph Wells (24:52):

Are there ways women can prevent or decrease their risk of colon cancer?

Kristen Halm, MD (24:57):

The best way to prevent or decrease the risk of colon cancer is the colonoscopy, or the appropriate screening home test, and doing it on time. That’s the biggest way that you can prevent and decrease the risk of colon cancer.

Mike Kelly (25:15):

Dr. Halm, I have one more question for you and they’re probably going to cut this from this, but I just want to know one thing. What’s the deal with corn? Why doesn’t it go away? Why doesn’t it break down? What’s going on with corn?

Kristen Halm, MD (25:29):

So, the nutrients of corn actually do break down, not that there are a whole lot of nutrients in corn, but it’s that shell. And so, the shell is actually kind of like a capsule. So sometimes people, they don’t pay attention as much, because there’s only one capsule, like a pill that you take, but sometimes the capsule will come out whole too, but the medication that was in the capsule has dissolved. So, it’s kind of the same thing with corn. The shell of the corn just doesn’t get digested.

Steph Wells (25:55):

I want to point out that we just did a half-hour’s worth of great information, telling people what they need to do, and people are going to tune in for the corn question.

Mike Kelly (26:05):

They’ll all remember the corn question.

You’re absolutely right.

Steph Wells (26:07):

That’s great. Dr. Halm, thank you so much for joining us today.

Kristen Halm, MD (26:11)

My pleasure. Thank you very much for having me.

Steph Wells (26:14):

To learn more about colon cancer screenings at Lehigh Valley Topper Cancer Institute, visit LVHN.org/colonoscopy or attend the Colorectal Cancer Awareness Event at Lehigh Valley Hospital–Cedar Crest on March 29. For more info and to register, click the link in the description. Don’t forget to subscribe or follow The Healthiest You, wherever you get your podcasts, so you never miss an episode.

Mike Kelly (26:38)

And remember: Be safe, be smart and be the healthiest you.