What's New In GI?
This part of the patient education section provides current GI (gastroenterology) reports from the medical literature and other authoritative sources such as the Johns Hopkins Medical Letter, The Mayo Clinic Health Letter, The Harvard Health Letter and University of California at Berkeley Wellness Letter. It is meant to give you topical tidbits of GI information that you may find interesting. It is not detailed and is not advice to anyone. You should always see a qualified health professional such as your physician for specific questions on health problems.Previous Issues of What's New In GI?
Posted: March 1999
- Body Cleansing = Wallet Cleansing
- DIED (not really) - Drug Induced Esophageal Damage
- Garlic, Cholesterol, Hemorrhoids, Whatever
- Hepatitis C - Bad News/Good News
- What About Cholesterol and Cholestin?
- Ouch! Hepatitis C From Mosquito Bites? Come on!
- Bones and Crohn’s
- Colon Cancer, Fiber and Calcium
- Diverticulosis and Seeds
- Health Fraud and Rumor
Body Cleansing = Wallet Cleansing
Many people, often influenced by the appeal of alternative healthcare or herbal products, have become enamored by the concept of body cleansing or detoxification.
The Pitch
Pitch No. 1 is that the body’s intestinal tract is loaded with a huge number of bacteria, many of which are harmful. These bacteria then release toxins that get into the body and cause all sorts of ills. Pitch No. 2 is that there are a huge number of toxins and pollutants in the environment (almost always unidentified) and that we ingest and subsequently poison our intestinal tracts and body when the pollutants are swallowed. The cure is to periodically cleanse the body and, especially, the intestinal tract. This process is accomplished by a wide and wild combination of the following: periodic fasting, laxatives, enemas and, especially taking a variety of pills, powders and liquids, most of which are herb based and which are sold by the promoter of body cleansing. The hidden therapeutic agent, of course, is the skill and enthusiasm of the promoter who sells the product and program.The Skinny
The human intestine is a beautiful organ. The long, almost sterile, small intestine is where calories, vitamins and minerals from the food you eat are absorbed. The large bowel or colon that follows is 5-6 feet long. Its main purpose is to dehydrate liquid stool that enters it and to store formed stool until it is evacuated through the rectum. The colon is loaded with bacteria, up to 500 different types at last count. These bacteria are almost always beneficial, creating stool bulk, and manufacturing certain necessary vitamins. Yes, they do create rectal gas but this is not a disease nor does it injure the bowel in any way.Can toxins be absorbed from the intestine? Sure, any type of toxic agent such as cyanide, arsenic, lead or dioxin chemicals can be absorbed and injure a person. These should be avoided. Once ingested, they are quickly absorbed. There is nothing in these body cleansing or detoxification programs that prevents this type of poisoning. The breakdown products from the intestine’s bacteria almost never are absorbed. Over the years, our bodies have learned how to deal with and benefit from these bacteria.
Does it hurt to reduce the bacteria in the gut? The answer to this question may be yes. Antibiotics taken for any reason reduce the number of intestinal bacteria and, thereby, make room for certain other very nasty bacteria to grow. One is Clostridium difficile. Doctors call it C. diff. This bug is resistant to most antibiotics, causes a serious illness, and requires prolonged treatment. You should especially avoid “high colonic enema” clinics. These are not medical facilities. They are run by people who known nothing about sterility and transmission of diseases. Wide outbreaks of infections such as hepatitis have occurred in such places.
The bottom line is that body cleansing or detoxification is a fraud. It will only cleanse your wallet or purse and it may injure you.
References:
Quackwatch
Quackwatch investigates questionable claims and illegal marketing in the media and on the Internet. If something sounds suspicious or too good to be true, check it out first on the Quackwatch website.The symptoms of injury to the esophagus are chest pain, pain on swallowing and food sticking in the esophagus. There are certain risk factors that make DIED more likely. These include:
1. The elderly - who take more medication
- who have less saliva to wash them down
- who are often lying in bed, sometimes in a nursing home
- who often have poor esophageal contraction, (poor motility or dysmotility) which ordinarily sweeps pills into the stomach
2. Blockage in the esophagus from hiatus hernia or reflux of stomach acid resulting in a benign stricture or narrowing. A malignant narrowing can do the same thing. So can the condition called achalasia.
3. Trying to swallow pills only with saliva.
4. Large horse pills - some pills, especially certain potassium preparations, are huge and are more likely to get hung up because of their large size.
The treatment of DIED is simple. Stop the medication, check with the physician, take pain medication and wait it out. At times, the physician will need to perform an endoscopic examination of the esophagus to be sure of the diagnosis.
Prevention of DIED includes the following:
1. Take medication while sitting or standing whenever possible.
2. Drink 4-6 ounces of fluid immediately after swallowing pills and remain upright for at least 10-15 minutes.
3. If you have an esophageal disorder (stricture, achalasia, diverticulum) or if you must lie in bed, then take the medicine in a liquid or crushed form whenever possible.
4. Take medications with meals whenever possible.
5. Be especially careful of the large horse pills and the following drugs - slow release potassium, Quinaglute and Fosamax.
Related Topics: Esophagitis and Stricture
References:
Gastro Endo 1998;47:547-550.
Garlic, Cholesterol, Hemorrhoids, Whatever
Were it only true that garlic was beneficial for so many things. At last count, someone compiled 150 different disorders which garlic was touted to help. The problem with almost all of these reports, indeed, with reports on almost all herbal products is that the studies, if any are done, are not acceptable to the FDA to allow a medical claim. One of the top claims for garlic is reducing a high cholesterol level. Two recent high quality reports studied the effect of a garlic powder and a garlic oil on cholesterol and other blood fats in a placebo controlled double-blind study. This means that half of the patients got garlic, the other half received the placebo and neither patient nor physician knew which was which. Results: no benefit from garlic and no change in the cholesterol blood level.
References:
JAMA 1998;23:1900-1902.
Hepatitis C - Bad News/Good News
Hepatitis C is a virus that infects the liver. Prior to 1985, when the blood test to identify the virus became available, it was most often contracted by a blood transfusion. Now, most cases are acquired by sharing IV drug needles. Sexual transmission occurs but is not common. Chronic hepatitis C (Hep C) is a bad actor. We are currently in the midst of an epidemic with 3-4 million cases in the U.S. alone.
The Bad News
In many patients, Hep C leads to liver cirrhosis. It is now the major cause of liver transplants in the U.S. Unfortunately, some patients with Hep C die while waiting for a transplant. Hep C also can cause liver cancer. The incidence of liver cancer from hepatitis viruses B and C is very high in Asia and Africa and is increasing in Europe and the U.S. Finally, Hep C responds very poorly to the single drug, interferon (IFN).
The Good News
In June 1998, the FDA released another drug called ribavirin to be used together with IFN. This treatment has shown a good response with liver blood tests becoming normal in up to 80% of patients. When the drugs are stopped, over 50% of patients remain in remission a year later. This means the liver tests are normal and the virus cannot be found in the blood. Equally important are recent studies that show that when the virus is cleared from the body, and even when it is significantly suppressed but not cleared, then the incidence of liver cancer is dramatically reduced.
So there is bad news but now good news. Impressive progress is being made against this most deadly virus.
Related Topics: Hepatitis C
References:
Mayo Clinic Health Letter 2/98
Hepatology Watch 4/98
Ouch! Hepatitis C From Mosquito Bites? Come on!
Hepatitis C is no laughing matter. It is a nasty virus that infects the liver and can cause cirrhosis, cancer and just makes you feel bad all the time. Before there was a good blood test for the virus, you could get it from blood transfusions. There is a 5% chance it can be transmitted by unprotected sex. Most cases presently result from sharing needles for IV drugs. Still, there had always been a large group of people in which no risk factors could be identified, no blood transfusions, no IV drugs, no promiscuous sex. Where did they get it? Physicians called it community acquired, a fancy way of saying they don’t know, just that they got it somewhere in the community.
But mosquitoes? Well, this is a breaking story and there may not be much to it but the early findings are a bit disturbing. Dr. Carroll Leevy, Professor of Medicine at the University of Medicine in New Jersey found that between 5% and 10% of mosquitoes in several areas of New Jersey were positive for the hepatitis B virus. He also found that up to 16% of the mosquitoes carried the antibody to hepatitis C. This suggests that the mosquitoes had bitten someone with hepatitis C. It is known that most people with the hepatitis C antibody also carry the hepatitis C virus.
Does this mean that mosquitoes in New Jersey are deadly carriers of hepatitis C and that any one who visits the New Jersey Shore is at risk? Hardly! One finding like this does not prove much. Although mosquitoes are known to transmit the deadly and, now never seen, yellow fever virus, it is quite a jump to incriminate mosquitoes for transmission of hepatitis C.
So keep your seat belts on. These preliminary studies need to be checked. Hepatitis C is a quiet epidemic and its transmission is still uncertain in many cases. More facts will be available in the near future. In the meantime and whenever you can, avoid mosquito bites. Who needs these itchy pests anyway?
Related Topics: Hepatitis C
References:
Gastro & Endo News 8/98
- Post menopausal female
- Cigarette smoker
- Heavy alcohol use
- Inactivity
- Family history of osteoporosis
- Long-term use of steroid medication (prednisone)
Second Step. Even if you have none of the above risk factors but only Crohn’s disease, get a bone densitometry test done. This test measures the bone density (i.e calcium concentration) of the bone. Make sure they measure the vertebral spine and the hips, the two sites where fractures most commonly occur. Get a bone densitometry surveillance every 3-5 years. Some insurers may balk and say it is medically unnecessary. Not so. It is true HMO -Health Maintenance.
Third Step. Prevention.
A - Lifestyle Change. Give up cigarettes and reduce excessive alcohol use. You can’t change your family history or sex but you can make lifestyle changes.
B - Adequate Calcium in the Diet. This means at least a quart of skim milk a day or its equivalent in calcium rich foods and/or calcium supplementation such as calcium carbonate (cheapest and effective) so as to reach 1200-1500 mg of calcium a day. Click on osteoporosis diet below for details.
C - Exercise. Recent studies show that low impact exercise, focusing on the hips and spine, are helpful. These sessions may be as little as 10 times a month. There should be a steady increase in intensity. A qualified exercise instructor at a health club is advised.
D - If You Have Osteoporosis. There are now effective medications available to reverse osteoporosis. Even if you have no bone pain or previous fractures, treatment is still probably needed.
Remember, for a female over age 65 who breaks her hip, the death rate over the next year or so is about the same as if you had cancer. Osteoporosis is a serious disease. Prevent it, especially if you have Crohn’s disease.
Related Topics: Crohn’s Disease, Osteoporosis Diet
References:
Gut 1997;40:228-233
Gastro 1998;115:36-41So what is the best strategy to prevent colon cancer?
Pick your parents carefully. If there is colon cancer or polyps in your family history, you have an increased risk. So, you can’t pick your parents. If not . . .
Colon screening. Flexible sigmoidoscopy every five years and a stool exam for occult blood every year or one good colonoscopy exam at age 40 or 50 to detect and removed adenomas or pick up an early cancer. (Although many insurers will not pay for screening colonoscopy, gastroenterologists over-whelmingly consider this the gold standard in colon cancer prevention).
Calcium. One quart of milk (skim is fine) and/or calcium carbonate tablets to reach 1200-1500 mg of calcium a day. This is also great for osteoporosis prevention. Click osteoporosis diet below for more information.
Exercise. Regular exercise probably helps to reduce colon tumors in some, as yet, unidentified way. By all means, maintain a high fiber diet. It may not prevent colon cancer but its other health benefits are overwhelming.Related Topics:
References:
- Colon Polyps and Cancer
- Prevention of Colon Polyps/Cancer
- Flexible Sigmoidoscopy
- Colonoscopy
- Osteoporosis Diet
- High Fiber Diet
NEJM 340;3:169-176
NEJM 340;2:101-107Diverticulosis (tics) means tiny pockets developing out from the colon wall. These tics can occur elsewhere but most often occur in the left lower colon, called the sigmoid colon. In years past, physicians warned patients that seeds, nuts, popcorn and similar food items could get into these pockets, rattle around like dried seeds in a gourd, and cause diverticulitis, a serious bacterial infection of the diverticuli. There was never any science to support this recommendation. The idea that seeds and such can “rattle around” inside a tic borders on the absurd. In fact, it has been well shown that a high fiber diet, which includes lots of seeds, nuts and popcorn, is exactly the best prevention and treatment of diverticulosis. Go for the fiber.
Related Topics: Diverticulosis/Diverticulitis, High Fiber DietReferences:
UC Berkley Wellness Letter, July 1998How do you spot fraud in health or medical products, services, and especially on the web? What about rumors that get passed through the net that report that something is good or bad for you. First, have a great deal of skepticism about what you see on the web. Check the motives of the writer. Are they a university center putting out good public information? Is it a physician who is serving his/her patients? Or is it a company often with no more than a post office box that is trying to sell something?
Healthcare fraud can often be recognized by the following:Testimonials. One or more persons, paid or otherwise, may say some product is great. Don’t believe it! No reputable medical advance is made by testimonials, only by evidence or proof.
Words. Each of the following is an almost certain giveaway to healthcare fraud. If you see them, turn the page or click the channel.These words are used to snare the gullible. Reputable companies with proven products never use these terms.
- Miraculous
- Money back
- Instant
- Secret
- Amazing
- Guarantee
- Low blood sugar
- Patented
- Exclusive
- Cleanse or purify
- Raise energy
- Enhance immune system
- Immediate
Arthritis, cancer, AIDS. Be assured that any true advances in these fields come from research from established research/medical centers. People with these disorders are particularly susceptible to fraud.
A statement that the medical profession does not want this product out because it will decrease their business. Hogwash! Most doctors are very ethical and welcome and applaud advances in medical science.
Exercise equipment or machines to do a specific job - i.e. spot reduce fat, improve abs, tone body, etc. Exercise experts debunk almost all of these promotions.
Weight loss program. There are a few established good ones - Weight Watchers, Diet Workshop, many health club programs. However, most TV weight loss programs are frauds. Taking special pills or supplements, losing weight while sleeping, special machines, etc. These are all frauds.
The pyramid marketing approach. Friends or neighbors who sell you a health care product whether weight loss, vitamins, youth restorer or almost any other such products are to be avoided. This is the pyramid or multilevel sales approach where a customer then becomes a distributor and makes money from their own friends then selling the products. This approach is okay for buying or selling lipstick and tableware. For your health, they are virtually all fraudulent.
So, if it quacks like a duck and sounds too good to be true, then it almost certainly is just that, a medical fraud. Save your money.
For more information on health fraud:
The National Council Against Health Fraud, Inc.
PO Box 1276
Loma Linda, CA 92354-9983The National Council Against Health Fraud focuses on health fraud, misinformation and quackery as public health problems.
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