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What if living to 100 could mean thriving, not just surviving? The Lahvie Podcast explores longevity, healthspan, and what it truly means to live longer, healthier, and stronger. Join physician Dr. Amos Ladouceur as he uncovers the science of wellness, fitness, nutrition, and resilience, with a focus on health equity and making longevity accessible for everyone. The show blends patient cases, expert conversations, and compelling human stories to uncover the science and habits that add life to your years.
Doctor. Welcome back to the Lavie Podcast. Hi, I'm Doctor. Ladouceur and this is episode two. In our very first episode, I shared the story of Drew, a colorectal cancer patient of mine whose journey reminded us why prevention and awareness matters so deeply.
Speaker 1:Today, I'm honored to be joined by my colleague and friend, Doctor. Zuri Morel. Doctor. Morel was born and raised in Los Angeles. He went on to graduate from Morehouse College and earned his medical degree from the UCLA School of Medicine.
Speaker 1:And he completed his residency at Harbor UCLA and then trained as a fellow at Cedars Sinai Medical Center where I had the pleasure and the privilege of meeting him. He's now one of the nation's leading colorectal surgeons and today we're talking about the rise of early onset colorectal cancer, why it's impacting younger people, and most importantly what you can do to protect yourself and your loved ones. This conversation is about more than medicine. It's about life, legacy, and adding years and life to your years. Let's dive in.
Speaker 1:You know anything colorectal in nature, I'm always having to send my patients to you. You've already taken care of my patients. He's gonna be doing a colonoscopy with me next month.
Speaker 2:We gotta film that. We gotta
Speaker 1:film We gotta definitely film that. So I'm looking forward to that. So welcome to the podcast, and
Speaker 2:thank you
Speaker 1:so much, brother.
Speaker 2:Thank you so much for speaking
Speaker 1:me. I truly appreciate that.
Speaker 2:It's great to see you, and it's it's really neat to watch what you've done with your career. Yeah. I remember when you were a resident.
Speaker 1:Exactly. Right. Exactly. You're a fellow. So what made you go into colorectal?
Speaker 1:So we're jump right into it. What what what was the reason that you went into colorectal surgery?
Speaker 2:So that's a question everybody always asks. Right? Like, you know, do you like butts? Yes. So, you know, it's funny because in general, always I wanted to be a superhero when I was growing up.
Speaker 2:Right. So you jump off the roof a couple times, realize you can't fly, you know, maybe you broke, broke an elbow or something. You're like, how can I save lives? You know? So, it's interesting.
Speaker 2:My parents were social workers and, they always wanted me to be a doctor And they had a friend, Doctor. Randy Edmond, who all their friends didn't have kids. So they had like a group of 10 couples that would come over to the house all the time. And one of them was Doctor. Randy Edmonds, who was a pediatrician.
Speaker 2:And he used to spend time with me and bring his stethoscope and kind of just talk about how one he loved being a doctor.
Speaker 1:Right.
Speaker 2:Okay. So that was kind of my first, my the first inclination I had was I'm gonna be a doctor. Right. And then, you know, I used to watch TV shows about surgeons and how I wanted to fix everything. And like a general surgeon knew how to take care of medical problems and knew how to actually operate in order to fix problems.
Speaker 1:Right.
Speaker 2:So I, the good and bad part about that was that I always wanted to be a doctor. So I didn't really think about anything else. And, you know, going to Morehouse really, really changed my life. You know, I grew up here, like I said, in LA, I went to I Palisades was gonna go to Yale or Brown or one of the, one of those schools. Ivy's.
Speaker 2:Yeah. One of the Ivy's, I man, was all know right now I was all about the Ivy. Dad was like, you gotta go to Ivy. I got into some Ivy's. My mom was like, you gotta go down and check out Morehouse.
Speaker 2:I was like, Morehouse. I went down there and just, I found my people. Wow. And I really, for me, I think that was really instrumental in getting me the, the self confidence in order to pursue my passion fearlessly. I needed it.
Speaker 2:So then I go to UCLA school of medicine and I end up doing a rotation. My ro you know, we do our rotations, right? Our third year rotations.
Speaker 1:Right.
Speaker 2:And I was at Harbor UCLA and there was a guy who's still the he's the head of the hospital now, or no, the head of surgery now, Chris DiVergilio. And the guy was awesome. He was amazing. He's a vascular surgeon. He was amazing.
Speaker 2:And that's when I just knew I wanted to do surgery.
Speaker 1:Right.
Speaker 2:So I ended up applying and getting into Harbor UCLA for general surgery. Now this was old school general surgery. So if people don't know, when you train in surgery, it was, and probably still is kind of like the military, meaning that you you are sleep deprived, but you still have to learn how to operate under those conditions. There's something called M and M, which is the Morbidity Mortality Conference where
Speaker 1:That's why you just get beat up. Right. Exactly.
Speaker 2:So I remember that. So what happens for those little dogs is that you Right. Stand up, if there's a complication, anything like a UTI a patient gets or or anything, a pneumonia or or other things. You have to stand up in front of all of the residents Right. And all the attendings and break down what happened, what you could have done better, how
Speaker 1:do Defend yourself. Exactly.
Speaker 2:Defend yourself.
Speaker 1:Get beat up.
Speaker 2:By attendees. Get beat up by attendees.
Speaker 1:Right.
Speaker 2:There was attending, and I'm a make him watch this, doctor Michael Stamos. Doctor Michael Stamos is now the dean of the med school at UCI. Oh, wow. This guy was no joke. He's a colorectal surgeon, and he used to make people cry.
Speaker 2:He would make grown men and women cry. Like, I wouldn't let you operate on my dog. I wouldn't let you do, like, x, y, and z. And I was like, this man will never get me.
Speaker 1:Right.
Speaker 2:My dad don't make me cry. There's no way I'm a cry in front of all these people. So I just study, study, study, and he never got me. He never got me on Eminem. Like, no matter what he asked, I was just like, bam.
Speaker 2:I was ready. Ready to go. And then he asked me to do research with him, man. And did research with him. The nicest guy Wow.
Speaker 2:In the world. Like, literally the nicest guy in the world. He he respected me, man. And until this day, he he's, you know, he says we're friends, but he's like a mentor in
Speaker 1:the world.
Speaker 2:Exactly. Like, I'm I'm his friend, but I have so much respect for him. He took me under his wing, and colorectal was for me. The coolest thing with colorectal is as much as I love the work, the real number one thing I love about colorectal is that colorectal surgery, especially colorectal cancer surgery is that it should not have to be done anymore. My mom died of breast cancer.
Speaker 1:I'm sorry to hear that. Yeah. With- I know your dad, he's
Speaker 2:a- Yeah, my dad said prostate cancer and you can't really, most of the time you can't prevent cancer. Okay. Colorectal cancer is the number two cause of cancer related death in America when you look at men and women. So it's the third most common cancer in men and it's the third most common cancer in women. When you put the deaths together, it's about a fifty thousand patients who die from colorectal cancer a year.
Speaker 2:Right. And that's the second highest in the country. Wow. But what if I tell you it's also, it doesn't even have to exist.
Speaker 1:Right.
Speaker 2:Now, what does that mean? Now, colorectal cancer can actually be prevented by two different ways. We'll talk about some of
Speaker 1:those. Right, right.
Speaker 2:Traditionally and all those, but even a certain test. Now, my mom had a million mammograms, a million CT scans. She had a million x rays. We put patients through all these things. There's something we'll talk about called a colonoscopy.
Speaker 2:Right. It's the only test a man or woman could have that actually prevents this cancer.
Speaker 1:Right.
Speaker 2:And so that to me was something that I love. I love to obviously talk. Right. And I love to empower patients, but it's need to be to to know that hopefully through enough education, we can prevent this cancer. Exactly.
Speaker 2:And that's my goal. My goal is every time I do a colon cancer operation, I feel like it's a failure of the system. Right. And that's what I want to talk about.
Speaker 1:Right. Yeah. So here's the deal. When I graduate from medical school in 2006 Yeah. Columbia, came to see the sign that that's where we met.
Speaker 1:Yeah. Colon cancer was something that 60 year olds, 70 year
Speaker 2:olds got. Yep.
Speaker 1:And so when I had the patient, Drew, that I talked about in
Speaker 2:the in the article Right.
Speaker 1:I and he said he had rectal bleeding. It was in the back of my mind. I was like, no.
Speaker 2:It's not cancer.
Speaker 1:Don't worry about it. Let's just get a a scan. And when he called me back after the colonoscopy and it came back, colon I was shocked.
Speaker 2:Yeah.
Speaker 1:I'm a physician. Yeah. I was shocked. Yeah. And I called you immediately.
Speaker 1:Yeah. And within two days, doctor Morell had him in the office.
Speaker 2:Yeah.
Speaker 1:Since you've been practicing, what's going on? There's been not this it's now an epidemic. Yeah. Did you was that always the case when you first started doing colorectal surgery? Is this something in the last five years, ten years?
Speaker 1:Tell me your experience of what you've seen in terms of the trends.
Speaker 2:Well, that's a great question because there has definitely been a change. But one thing I will say about you, you you helped to save his life because you didn't just pardon the pun, poo poo his complaints and just say, oh, it's hemorrhoids. You made sure he got the appropriate test So, right so not only you're a doctor, you're hell of a doctor. Okay. Because that, that especially in young people goes misdiagnosed for a long time.
Speaker 2:So you're right, colorectal cancer typically occurred in people over the age of 55, and it still does. However, we've seen a 12 fold increase in people 45 getting colorectal cancer, a 12 fold increase. Now, this means that if you are, if you were born in 1990s, you have a higher chance of getting colorectal cancer than if you were born in the 1950s. I want people to let that sink in. If you were born in the 1990s, that's when I, you know, I graduated high school.
Speaker 2:That's all I am. Me too. If you were born in the nineteen nineties, you have a better chance, and by better, I mean a worse chance, but a better chance of getting colon cancer than if you were born in nineteen fifties. Why is that? Well, we know traditionally, okay, when you look at the traditional, population of people who get colon cancer, what are the traditional, causes?
Speaker 2:Okay. Number one is we know obesity. Right. So obesity is a major, major cause of a lot of cancers. Obesity, the reason this happens is because obesity is a pro inflammatory condition.
Speaker 1:Right.
Speaker 2:We used to think fat cells were dead, were inert, but they produce a lot of inflammatory mediators that can lead to all types of cancers. So the way I explain it is your body spends so much time fighting itself that it can't fight some of these carcinogens that we consume. Right. So that's obesity. This is all traditional.
Speaker 1:And you know what's interesting? My mom was diagnosed with uterine cancer, like, pre pandemic.
Speaker 2:Yes.
Speaker 1:And as soon as she told me, my mom's obese.
Speaker 2:Okay.
Speaker 1:And I knew, I was like, it's because of obesity. I don't think people really know Yeah. You know, obesity can cause cancer.
Speaker 2:Most cancers, except for blood cancers, obesity is related. Oh, wow. Okay? So that's one. One.
Speaker 2:Number two is is red meat consumption. We know that red meat consumption, and I hate to say it, pork is not the other white meat. Pork is also red meat. But red meat consumption is a red meat is a pro carcinogen. What does that mean?
Speaker 2:The way that we break down meat, I don't care if it's organic, free range, cage free, just whatever kind. Okay? The way we break that down is into something called a nitrosamine. Nitrosamines are pro carcinogenic, which means that if you take a chemical and you put it on the whatever tissue
Speaker 1:Right.
Speaker 2:Eventually, could become a cancer. Right. So that's something else. High red meat consumption. Okay?
Speaker 2:That's part of the reason why we see a huge epidemic in the South of our country, in the South.
Speaker 1:So you're doing your there's even
Speaker 2:High a check obesity
Speaker 1:Right.
Speaker 2:Goes along with high red meat intake
Speaker 1:Right.
Speaker 2:Goes along with low fiber. So fiber, you guys. Doctors always say you need fiber. We need twenty five to thirty grams of fiber a day. Okay?
Speaker 2:So once again, we're talking about traditional colon cancer.
Speaker 1:Right.
Speaker 2:Low fiber diets. People who eat a lot of red meat usually don't eat a lot of fiber. Now fiber is important, okay, because fiber helps to hold water in the colon. Fiber is not absorbed. So when we eat food, we chew it, masticate, goes down our esophagus, goes to our stomach.
Speaker 2:Stomach grinds up the food. After about thirty minutes, that food goes into the small intestine. The small intestine consists of three parts, the duodenum, the jejunum, and the ileum. This is where 90% of our absorption of nutrients occurs. Then you get to what I call God's organ, the colon.
Speaker 1:Right.
Speaker 2:So the colon's job is not to make poop. Everybody always says, what's the colon's job? Oh, it makes poop. No. The colon's job is to reabsorb water, and then the rectum's job is to hold stool that is formed, the waste.
Speaker 2:Right. And the anus's job is to decide when to let it go, so to speak. My daughters love that movie Frozen.
Speaker 1:Right.
Speaker 2:When you gotta let it go. Exactly. So fiber helps to hold water in the colon. Why is this important? Because anything you do eat has some carcinogen material in it, and you want to decrease something called your colonic transit time.
Speaker 2:Right. Colonic transit time is the time that waste gets into the colon from the time it's empty. Okay? So fiber helps you do that. Right.
Speaker 2:Okay? So low fiber diets also are associated with cancer. Now, something else that we're learning too is vitamin D. Wow. So vitamin D deficiency is really high in this country, especially with African Americans.
Speaker 2:Okay? So vitamin D is made when the sun, as you know, the sun hits our skin and is converted to this vitamin. Vitamin D is incredibly important, incredibly important for our immune function. It helps to fight cancer. Wow.
Speaker 2:And so that's something that's very, very important. Okay? And so, obviously, smoking, things of that nature. Right? But now we're seeing this in this subs group of people who
Speaker 1:don't smoke. And so for the for the younger Right. The the early onset
Speaker 2:Right.
Speaker 1:What are some of your theories? What are some of the things that you know
Speaker 2:Right.
Speaker 1:That we can tell our audience that you think might be causing this significant Right.
Speaker 2:Now some of it is a crossover. Now I want people to hear this. Highly processed food consumption is one of the biggest things. So when you look at people 18 and younger, 75% of the diet is highly processed foods. Highly processed foods are and people always wonder what that means.
Speaker 2:That means that foods that are actually made in a lab to increase the salt, increase the sugar Right. Increase the different Make it palatable. Make it more palatable, but it also makes it addictive to your body. But it's actually chemicals that are done to make food taste better.
Speaker 1:Right.
Speaker 2:And this is 75% of the diet of of people who are 18 and younger. Now the hard part is when I go out and and talk about diet, when I was a kid, my mom you know, my parents worked hard too. They're social workers. I was the first one dropped off at school, last one picked up. Right.
Speaker 2:Now I was starving when mama came to pick me up. I'm like, mom, I passed various fast food restaurants. I don't know who your sponsors are. So I'm like,
Speaker 1:name sponsors.
Speaker 2:But let's just put it this way. It smell like fried. The fries smell tasty.
Speaker 1:Right. Right. Right.
Speaker 2:I'd be like, mom, I want some. Mom, I want some. Mom's like, I'm a cook you something healthy, and that's just too expensive. Right. Well, now guess what?
Speaker 2:It's cheaper to eat that than a lot of times to cook at home.
Speaker 1:So how
Speaker 2:do I tell a mom or a single dad or even, you know, a a couple, hey. I want you to go out, and I know the kids are hungry, and I know it's more expensive, and I know it takes more time to cook this healthy food. You know? Like, so it's hard to
Speaker 1:do that. Exactly.
Speaker 2:Seventy five percent of millennials will be obese Wow. By the age of 40. So obesity still plays a big part. Now, why does highly processed foods actually cause a problem? Well, we think it changes something in our microbiome.
Speaker 2:So our microbiome, as you know, are the bacteria that line our gut. So after the skin, the skin protects us from disease. Right. After that, it's the gut. It's the bacteria that lines the gut.
Speaker 2:And we think that, or the thought is that these highly processed foods change the lining of our gut. We have perfect homeostasis. So I hate to say there's good bacteria and bad bacteria. There's bacteria that have a function and they live together.
Speaker 1:Right.
Speaker 2:The problem is certain processed foods will kill some bacteria causing an overgrowth of bacteria that then becomes bad. So it's to the point now where we can actually see if you have a left sided colon cancer, it has a predominance of a certain bacteria. If you have a right sided, it has a predominance of a different bacteria. At some point, there's gonna be a test that you can do a poop test and say, oh my god. I have a higher proportion of this bacteria.
Speaker 2:I need to get a colonoscopy, or I need to increase something else.
Speaker 1:How soon do you think that's gonna
Speaker 2:I I don't know, but hopefully within my lifetime.
Speaker 1:Right. Right.
Speaker 2:And so that's really how highly processed foods can lead to cancer because of that aspect. It changes our microbiome. Antibiotics. So we have a high use of antibiotics. That is something else that we think also can change the microbiome.
Speaker 1:Right.
Speaker 2:And now, you know, what I'm really afraid of, especially when COVID happened is that kids are going outside less. Okay?
Speaker 1:So sedentary.
Speaker 2:So they're vitamin d. So now we're seeing a vitamin d level. And what's interesting, especially in 18 and under, one of the common most common causes of depression is vitamin d deficiency. Wow. And so you have all of these things.
Speaker 2:Right? I I'm worried that we'll see even a more increase in young people from this COVID generation in the future because of vitamin D.
Speaker 1:Right.
Speaker 2:But we don't go outside. We don't we're not as active. More antibiotics and more and, you know, highly processed foods.
Speaker 1:Right.
Speaker 2:Right. And I think all of those things are why we're starting to think that we're seeing it in younger and younger people. So You notice I left out smoking. Right. Because we're not, you know, people aren't hopefully smoking at that young age.
Speaker 1:Right. Now for me, my my dad, my aunt, my uncle all had colon cancer. Right. So when I was 40, I was like, I'm not playing around.
Speaker 2:Yeah.
Speaker 1:Especially being African American. So instead of waiting till 50 or even 45
Speaker 2:Great.
Speaker 1:I got my colonoscopy at 40. Good. I'm do it again now. Good. And so my question to you is, we know that recently they dropped the colorectal cancer screening from 50 to 45.
Speaker 2:Right.
Speaker 1:What do you recommend? What because our patient Drew was 35 years old.
Speaker 2:Right.
Speaker 1:I saw something that you did on CBS where the patient was 32 years old.
Speaker 2:Right.
Speaker 1:I had, you know, recently, I had another patient who got diagnosed on Christmas at Cedars, and she's 40. Yeah. So that's you know, what what are your thoughts about colonoscopy screening, when we should be doing it?
Speaker 2:So I'm gonna break it down into two into two groups. I'll share a personal story.
Speaker 1:Okay.
Speaker 2:I was blessed enough because a lot of us now are starting to know our parents' cancer history. Right. But we don't know our polyp history.
Speaker 1:Okay.
Speaker 2:So all colon cancer starts as polyps. The reason you do a colonoscopy is because during the colonoscopy, right, which is a test, as most of the audience knows, where you take a scope, you enter through the anus, look at the whole colon, you're looking for polyps, which are precancerous lesions. You take them out during the colonoscopy. So my dad had his colonoscopy and ended up having four or five polyps. The story really is that he was in a certain health system that tried to just do a flexible sigmoidoscope.
Speaker 2:So that's a test that's done in the office while you're awake.
Speaker 1:Right.
Speaker 2:And they said, oh, you're fine. My dad thought he was having a colonoscopy. He he's like, Zuri, I'm going to get my colonoscopy. Right? All of a sudden, you know, hours later, he drives back up and he's walking in like this.
Speaker 2:He's like, can't believe you do this for a living. I'm like, what are talking about, dad? I just had a colonoscopy. I'm like, wait. You drove yourself home?
Speaker 2:I'm like, you didn't have a colonoscopy. You had a flexible sigmoidoscope, which looks at one third of the colon that you're awake.
Speaker 1:Right.
Speaker 2:I had to convince the health system to get his colonoscopy. This was this was back in the day. He was like 55.
Speaker 1:Right.
Speaker 2:He ended up having four polyps proximal to where they did their Right.
Speaker 1:Their colonoscopies. So beyond what they were able
Speaker 2:to Beyond what they were able to see. Right. So I ended up I always joke with him. He had his polyps removed. He's a polyp form.
Speaker 2:I'm like, I saved your life. Exactly. I'm back. Now, and you know my dad. Right.
Speaker 2:Fast forward, I because I knew he had polyps, right, the national guidelines say with and national guidelines are meant screening means you have no symptoms and you have no family history. Once again, you don't have any blood when you poop. You don't have any changes in bowel habits. You don't have any abdominal pain. You don't have a family history of colon cancer or polyps.
Speaker 2:I knew I had a history of polyps. So at 42, I got my colonoscopy, and I had a huge two centimeter polyp that would have been cancer. So that's number one. Now a lot of us don't know our family history, let alone our family's polyp history. Right.
Speaker 2:The hardest part is I think, and I and I hope that people could get screened at 30 because we've seen this, but the problem is insurance won't pay for it. It's about $3,000 to pay cash for a colonoscopy.
Speaker 1:But you'll save somebody's life.
Speaker 2:But you save your life. You save somebody's life. I'm really hopeful in the future we can either
Speaker 1:decrease So maybe as early as thirty.
Speaker 2:Right. I and I and listen. When I say this
Speaker 1:So if someone if someone's worried they're 37 and they're willing to have it paid by insurance or paid themselves, you're okay with 37 year old coming to your office, gonna call nonstop.
Speaker 2:Yes. Now I'm gonna say this, that when you look at all the medical research, I just wanna be clear.
Speaker 1:Right.
Speaker 2:Nobody says that.
Speaker 1:Exactly.
Speaker 2:Okay? Nobody's saying this without knowing your history. But I'm just telling you that as somebody who who deals with this subset of patients, the most important thing is that you have to be in tune with your body. Okay? So that's the number one thing, is that you have to be in tune with your body because all the patients I've seen with colon cancer who are young had an issue.
Speaker 2:And unfortunately, a lot of times they had to talk to their doctors and a lot of doctors at the time didn't understand that this was
Speaker 1:And what are some of those issues that people blow Right.
Speaker 2:So we all have had blood in our stool.
Speaker 1:Okay.
Speaker 2:Okay. Now, if you had blood mixed in your stool and you could tell, that means that you should always look when you poop white, you should look at the paper. You should look in the toilet. Okay? I know it sounds gross people, but you should.
Speaker 2:Okay? It's you. Alright? And when you do that, if you see blood in the stool, that's an automatic colonoscopy. Because that doesn't mean you have cancer, but that means that there's something higher up most likely that is bleeding.
Speaker 2:Okay? So that's automatic colonoscopy. A lot of times you see blood on the paper. Now that could be, we call that outlet bleeding. So that could be, and most likely is internal hemorrhoids, However, something like if you try over the counter remedies and you still are seeing this issue and it's not getting better, you need to see your doctor.
Speaker 2:Give it a month. I tell everybody, give whatever's going on a month, try to treat it the way, you know, you can read and try, you know, creams and all that. Let's say for bleeding. If there's no change within a month, you gotta see your doctor. Right.
Speaker 2:Okay. Change in bowel habits. What does that mean? That means if you poop like clockwork every day and all of a sudden three days or you start to poop every three days and it's hard and all that, that's, that is a change of habits. So you try your MiraLAX, you try laxatives, things get better, most likely you're good to go.
Speaker 2:Things don't get better within a month, you're seeing your primary doctor. Okay? And this is very embarrassing for young people, especially men, but you're not alone. And you know what is worse is having to deal with this disease. Okay.
Speaker 2:Now, one of the things I always preach and I hate to say preach, but I feel like that's what it is, It's important for you to have a great relationship with your primary care.
Speaker 1:A lot of people don't have PCPs
Speaker 2:don't have PCPs anymore. That's what you need you guys. And I know it's hard. That's a big issue. People wait till they go the ER.
Speaker 2:An ER doctor Or
Speaker 1:urgent care. But it's just pop Right. In, pop out. They only have someone who's followed them for longer term.
Speaker 2:Yeah. There's somebody you trust who trusts you. Like, I say that me like, when a patient comes in, we're a team. I ask a patient, even if they have cancer, I'm like, what do you want? Some patients are like, well, doc, I lived a full life.
Speaker 2:I don't wanna be in pain. And so I won't operate on, but I'll help you achieve your goal. We're a team. Right. And really more than your surgeon because most surgeons aren't like me.
Speaker 2:They're just cut out. But especially with your primary care doctor, your primary care doctor and you should be your role dogs. Meaning that you respect what they say, the doctor respects what you say. You guys formulate a plan. That doctor knows your goals.
Speaker 2:You share them with your doc. That's what's really important. So that when you have a problem, your doctor knows what they've never had this before. You know what I mean? Like, you need to get evaluated.
Speaker 2:So that's really, really important. Right. And that will also be able to and somebody you'll be able to get in and see when you have these changes.
Speaker 1:Right. So let's talk a little bit about colonoscopy. I'm a tell you what I was shocked about. Yes. So six weeks ago, eight weeks ago, I did a sort of Zoom call talk on colorectal cancer after I wrote the paper.
Speaker 1:And it was mostly men.
Speaker 2:Yeah.
Speaker 1:And when we got to the part Porsche told my colonoscopies, I was surprised how many of the guys are saying, oh, no. I don't want a colonoscopy. I'm like, what do mean? Yeah. Oh, I'm not gonna let somebody do that to me.
Speaker 1:I'm like, are you serious right now? Yeah. At first, I thought they were joking.
Speaker 2:Yeah.
Speaker 1:And then after about twenty minutes, I realized at least 50% of the guys there did not wanna get a colonoscopy because they're afraid of the procedure. Now as a physician, I'm like, are you crazy?
Speaker 2:Like Yeah.
Speaker 1:Give you anesthesia. You're even gonna know what's happening. Right. You're gonna wake up thirty minutes later.
Speaker 2:Right.
Speaker 1:Can you just talk about and demystify some of the I was surprised by that, that people are actually afraid of it. Do you come across this and how can you talk a little bit about that?
Speaker 2:All the time. And this is the biggest thing is that I always say, and my my saying is you shouldn't die from fear and you shouldn't die from embarrassment. Okay? So when I meet patients and a lot of times and and a lot of times it's it's us, it's people of color. Right.
Speaker 2:Okay? Doc, I don't want you sticking anything in my butt. Yeah. So the thing I hate about that the most is that often other health systems will then offer them another test without talking to them about it, which is like one of the stool tests. Stool tests are good at finding cancer, but they don't prevent cancer.
Speaker 1:Right.
Speaker 2:Okay? I explain to my patients. I say, well, you should have one, it's preventative. They're like, doc, I don't want anybody singing anything in my life. I'm like, well, do you love your wife?
Speaker 2:Do you love I mean, mostly because it's men.
Speaker 1:Usually Right. It's a women tend to
Speaker 2:be used to these invasive exams. Right. I'm like, do you love your wife? Do you love your partner? Whoever that is.
Speaker 2:Yeah. But they'll be alright. I have insurance. They'll be alright. I I always say, do you love your kids?
Speaker 2:They're like, what do my kids have to do with it? I tell them that story about my dad. I'm like, if you get a colonoscopy and you have polyps, your kids can get a colonoscopy sooner and insurance will pay for it and that will help prevent cancer. And then after they get their colonoscopy, especially we find a polyp, they are the biggest, the biggest, cheerleaders for colonoscopy. But I sit there and luckily the practice I have, you know, doctors get pulled in so many different directions by healthcare systems, by insurance companies.
Speaker 2:I'm luckily because the kind of practice I have, I can sit and have these conversations with patients. But that's what really it takes is that I explain to them that this is something, if you don't want to do it for yourself, at least do it for your kid because you can help save your generation's life. You can help save your family name's life because if you find cancer early, or if you find a polyp, then you can actually remove that during the time.
Speaker 1:Right. So, you know, I'm a big fan of the colonoscopy. Yeah. I had one. I'm gonna have another one with you.
Speaker 1:We'll both film that. Sure. That's what I always push. Yes. And if you could just maybe explain a bit more about the advantage of colonoscopy versus we could talk about the other screens.
Speaker 2:Yeah. We'll talk about it.
Speaker 1:But why the colonoscopy is the gold standard?
Speaker 2:Okay. So the reason that gold the colonoscopy is the gold standard is because it's the only test that's preventative. Right. So all colon cancer starts as these growth called polyps. And that's actually what you're looking for when you do a colonoscopy.
Speaker 2:Polyps don't have signs or symptoms until they're really, really big. Okay? There's no bleeding, there's no abdominal pain, there's nothing. That's why this test is more than screening, it's diagnostic and it's preventative. It's amazing because you see these polyps and you have a little grasper, you pull them out and cancer's gone.
Speaker 2:There's no, there's not a chance of that polyp turning into a colon cancer. Right. Now there's other screening. And now if patients refuse, refuse, refuse.
Speaker 1:And sometimes it's insurance. Yeah. Sometimes, you know, they don't they don't can't do the out of pocket costs. What other things can they do? What other screening tests?
Speaker 2:So there's something called a gold Cologuard, which is when you defecate and then you mail it in. And that's good. That test is the second best test. It's good at finding cancer. And what happens is if it's positive, doesn't mean you have cancer, but there's some source of blood, then you get a colonoscopy.
Speaker 2:That test is decent, as good at finding cancer, it's just not as good as finding polyps. Right. Then there's something else called a FIT test
Speaker 1:Right.
Speaker 2:Which is also kind of a step below the Cologuard test.
Speaker 1:Okay. So you like the Cologuard?
Speaker 2:Yeah. Cologuard's like stool DNA test. Right. And then there's another test that's coming out now that you've heard of, where it actually is really good. It's a blood test.
Speaker 1:Right.
Speaker 2:So that test is supposed to be good. I don't have experience with that. That's a new test. But more and more, there's there's tests that can that can that are going to be very specific for this disease. But none of it is specific for polyps.
Speaker 1:And should we be doing it earlier? Should I have my patients do it at thirty two, the Cologuard?
Speaker 2:So I think at least if you can't get a colonoscopy then, I I the hard part is I so science isn't backing this up yet. Right. Okay. The studies, the randomized control, double blind side. But, Like, if patients can't get that if they don't know their family history, if they don't know their polyp history, then yes.
Speaker 1:Yes.
Speaker 2:Yes. I and granted, I am very aggressive. And and I would have told you as of five years ago, I would not have said what I just said. I was like, wait till
Speaker 1:40 At what point did things change in your practice? Were you like, what is going on? So because for me, it was last year with that
Speaker 2:patient, Drew.
Speaker 1:When did when did you realize, okay
Speaker 2:Chadwick Wow. So Chadwick Boseman, I always say he played superheroes on TV and on the movies, but he became a superhero in death. I had so many brothers of their own volition, first time in my life, not because their partners told them to, came in and wanted colonoscopies. None of them had symptoms. I was finding polyps in like forty percent of these patients.
Speaker 2:And these people had no symptoms, no signs. They just wanted it because of Chadwick Boseman. And I was like, wow. You know, at least probably five percent of those would have been cancers Wow. If I would have waited.
Speaker 2:And that changed my my whole paradigm. Also, had a a patient, Michael Fryerson, and he they don't mind when I say his name. God bless him. His dad has just started a whole nonprofit.
Speaker 1:Is that the one I saw you with on NFL? Exactly.
Speaker 2:Was an NFL channel. This brother was one of the most amazing people. He went through some, some stuff that, so usually as a surgeon, right? I operate and then I'm done. I still see you occasionally, but I've never watched anybody.
Speaker 2:Surgery did well and then chemo and it came back surgery did well. Like he, I I've never watched anybody die. Never, never watched anybody die. What he went through, and and the sad part with him and the truth is that he did everything right.
Speaker 1:Yeah. I remember he was like exercising.
Speaker 2:He was exercising. He went to the wrong doctor, went to a doctor who told him to come back in a year, even though he had a ton of polyps. And it to this day, I'm tight with his dad. We do talks all the time together. But watching him, I get teary eyed talking about him.
Speaker 2:Watching the grace with which he went through what he went through, but just he just wanted us to not let this happen again. Subsequently, it's happened a ton of times.
Speaker 1:I know.
Speaker 2:And so for me, that's when it changed. I I was like, I'd rather and it's hard because in this country look. I'm private practice. I understand economics and all that. However, some things are beyond money.
Speaker 2:Right. And I wish people could get screened and all that because it is preventative. Like, when you look at and I hate to say in this country, you look at cost. Right? Like, the truth is capitalism.
Speaker 2:I'm a capitalist, but not necessarily in health care, but it's still cost. How much is your life worth? Right. That's how these insurance companies look at it. And it still is if everybody was getting a Cologuard test, it would still end up being better than people getting cancer.
Speaker 2:But the trick is with them is that if you get colorectal cancer early, then it's still curable. But my point is I don't want you but with surgery, with somebody like me. But if I never do a colorectal cancer surgery again, I am good, man. I do hemorrhoid. There's a ton of stuff I do.
Speaker 1:You can do it right
Speaker 2:I like to operate on. I really don't want to do colorectal cancer anymore. Meaning that I don't want there to be colorectal cancer anymore. Right. And we can actually prevent that.
Speaker 2:There's a lot of things we can do to prevent it. Colonoscopy being one of the main things, but there's other things.
Speaker 1:What are the things we can do to prevent it?
Speaker 2:So In
Speaker 1:your opinion, you know, based
Speaker 2:Yeah. And based on science. I'll tell you. So it's very interesting. African Americans, we have the highest rate of colorectal cancer.
Speaker 2:Actually, Native Americans and African Americans.
Speaker 1:Now is that also for early onset colorectal as well?
Speaker 2:You know, what's interesting is that we're seeing that, but we don't know why that is. We don't know if that's access to care or not.
Speaker 1:But we
Speaker 2:do know overall African Americans Right. Native Americans versus African Americans. So people always wanna say why. So it's multifactorial. Okay.
Speaker 2:Number one is that a lot of times we were getting the flexible sigmoidoscopes and not the colonoscopies. Okay. Most of our polyps were on the right side. So we were getting higher rates of cancer even if we got what was deemed the right test. Right.
Speaker 2:Number one. Number two is there is implicit bias. African Americans are offered colonoscopies less. Okay. There's been studies looking at rich, every time there's a difference in races, they always say because white people are rich, white people are poor.
Speaker 2:No, they looked at studies where there's rich blacks, rich whites, middle middle poor poor, and found that African Americans are still offered colonoscopies less. Why is that? That's just because of bias. Like, one of the biggest things I tell patients when you walk in and you say, I don't want nobody sticking anything into my butt, doctors, if they don't have time to talk to you, will be like patient refuses.
Speaker 1:Right.
Speaker 2:Here's this test or here's no test. So that's one of the one of the the biases kind of. Right? And also just thinking that a patient will say no, that's another bias. Now also it has to do with obesity.
Speaker 2:Our obesity rate is high. One of the biggest things is that it's also vitamin D. For African Americans, we have to be in the sun longer because melanin is great, protect us from the sun, but it protects us from the sun. So you need sunlight to hit the skin in order to make vitamin D. Our vitamin D levels are low.
Speaker 2:And so that's something else. Now here's what here's the most amazing thing. And this is how you know how environmental factors really are important. So I do medical mission work in Uganda. Uganda, there was hardly any colon cancer.
Speaker 2:Now there's nothing hardly that separates a Black and a white person genetically, let alone an African from African American.
Speaker 1:Right.
Speaker 2:Okay. They're minuscule. But I'm telling you, we have the, one of the highest rates in the world, African Americans. And Uganda, Nigeria, almost none. Okay?
Speaker 2:Same people. Now what's the difference? They eat a high fiber diet. When we go to Nigeria, you know, it's so funny. What I learned is that meat, fresh meat is gross.
Speaker 2:Like, fresh meat, like like, I go over there, and I remember we there was, like, fresh meat. I was like, ugh. Right. They eat all the the they barely eat meat. Right.
Speaker 2:And it's a lot of poja. That's what they call it, but it's like beans and rice, fiber, fiber, fiber. Right? So you eat a lot of that. You're outside.
Speaker 2:Most of the work is still physical, so they're working out. Wasn't a lot of smoking, hardly any obesity. And guess what? They're out in the sun a lot. Vitamin d levels are are stacked.
Speaker 2:Right. So there's things we can do. Right? There's things we can do to help prevent that. Now what's really interesting in countries that are traditionally low disease, India and parts of Africa, you can actually see now that obesity rates are rising, especially among rich people.
Speaker 1:Right.
Speaker 2:Well, guess what? Rich people are the only ones that that can afford. Now the fast food restaurants that we have exported, you can actually look at clusters of fast food restaurants and obesity rates and now colon cancer rates in these countries that don't have an issue. A lot of times here we see it in poor people. We can see colorectal cancer because you're eating a lot of food that, you know, you it's affordable for you, but it's not necessarily healthy.
Speaker 1:They're good for you. Right.
Speaker 2:There are obese rates in rich people and colon cancer. It is because of what we as Americans have exported there. Our food, I always say we have a ton of food, but a lot of it is garbage. Right. And it's interesting, but that shows you the power that we actually have to fight this disease.
Speaker 1:Right. Now let me ask you a question. One of the things that kind of came up in my reading, because after the Drew, I was like, I gotta I gotta read up on this thing. Alcohol.
Speaker 2:Yes.
Speaker 1:What are your thoughts? You know, the surgeon general is now talking about alcohol. I read that five percent of cancers might be caused because of moderate alcohol.
Speaker 2:Alcohol is really none. Like, I hate to say it, but but listen, I'm not gonna lie. I have a cocktail every once in a while. Right. Right?
Speaker 2:Alcohol is a pro carcinogen. Alright? Even like red wine, we used to think was good for you, but nothing none of it is good for you. We at least let's just agree on that. None of it is actually good for you.
Speaker 2:Right. Things in moderation are important. And, you know, but I'll often see people say things like, well, you know, eating steak every night. They'll eat steak every night, but they're like, but I don't drink. You know what I'm saying?
Speaker 2:Or or I'm a vegan, but all I do is drink a ton of alcohol. You know what I'm saying? So any of these things that are done disproportionately are are not good
Speaker 1:for you. Right.
Speaker 2:But alcohol is a pro carcinogen. That's something else I should say in Uganda, there was not a lot of alcohol either.
Speaker 1:Right. Now what message, you know, as we sort of kinda wrap this up? And before you give your message, I wanna say I wanna give you your flowers. You know, I trained you know, went to medical school at Columbia, some of the Ivy kids. And
Speaker 2:By the way, my daughter got into Brown.
Speaker 1:Gonna be Ivy.
Speaker 2:She's gonna be Ivy, man. Ivy's Yeah.
Speaker 1:Yeah. And so the surgeon the colorectal surgeon who actually did the colonoscopy on Katie Couric.
Speaker 2:She got one.
Speaker 1:No. But it made a significant difference when Katie Couric got the colonoscopy because there was a significant increase. People getting it. Yeah. And so the reason why I wanna give you a flowers is when I saw what you're doing on Instagram, getting a message out, I realized how powerful media can be.
Speaker 1:And that's why I started thinking about things that I can do. Yeah. And so I wanna really give you your flowers because, you know, when we see someone one on one, that's great. But when we can sort of get the message out to everybody
Speaker 2:Exactly.
Speaker 1:That can be very, very powerful. But what would be one thing or a couple of things that you would want us to all take away from your experience Yes. With colorectal cancer that you think that everyone needs to hear that we wanna really I'm
Speaker 2:very passionate. I'm gonna look straight into the camera when I say this. You shouldn't die from fear and you shouldn't die from embarrassment. Colorectal cancer is preventative, but we have to get over the stigma. Okay?
Speaker 2:I say the best time to talk about colorectal prevention is at the dinner table. At the dinner table. Because guess what? That's when you have the power to help fight it. Eat more fruits and vegetables.
Speaker 2:Decrease your red meat consumption. You're at the dinner table. You can help to prevent that disease. That's number one. Number two is talking about it.
Speaker 2:Talking about your family history at the dinner table. Hey, you know what? I had my colonoscopy. I had five polyps. That's gonna be important for you to know.
Speaker 2:Right. You know, asking the doctor questions and being your own health care advocate. What does that mean? Patients who come in, prepare for an appointment with me, a whole different kind of appointment than other people. Right.
Speaker 2:I always tell patients that your goal is when you go into an appointment, you tell the doctor how you're doing. If you have a problem, the doctor tells you what they want to do. You, your follow-up is if this does not work, what is our plan? You should always leave the doctor's office with a new plan, with a, with a, if this doesn't work, when are we gonna follow-up? When are we gonna do this?
Speaker 2:Guess what? You ask these questions. I'm sitting down. I'm ready for your appointment because I know I have to be ready. You know?
Speaker 2:So these are the things I wanna I wanna impart to people is that especially when it comes to colorectal, nobody likes the word rectum. I give these talks at churches and I go, I make everybody say the word colon. Make everybody say the word rectum, and I make everybody say the word anus. And then I say, you shouldn't die from fear. Shouldn't die from embarrassment.
Speaker 2:Those words make people uncomfortable. When I do, you know, TV interviews, rectum, and they get choked up.
Speaker 1:Right.
Speaker 2:The word rectum, everybody has one. Everybody has one. And the key is that when you start saying these words, you can kind of get over the stigma. When somebody's sticking something in your butt, you're asleep. Okay.
Speaker 2:You don't feel that. Alright. Number one. Number two. And and you're helping to prevent disease in yourself, but in your family.
Speaker 2:And that's something you have to think about, that this is bigger than you. Okay? It's your body and all of that, but it's bigger than you. You love your family. If you don't have kids, you got a sister, you got a brother, like, like this is something and information that can be preventative to you, but prevent death in your family.
Speaker 2:Right. And that to me is so powerful. And it makes no sense why this is the second cause, leading cause of cancer related death. It does not make sense. It's access to care in this country.
Speaker 2:People can't get them when they need it, number one. They don't know they need it. And we don't and a lot of times up until recently, doctors weren't aware that young people needed it. Right. And so that's changing.
Speaker 2:But now we need to change insurance structure so that it can be because a lot of times patients want them, but they can't afford it.
Speaker 1:Yeah.
Speaker 2:Can't afford Right. Right. And so it's hard out here, guys, but you know, squeaky wheels and all those things, but it has to start with not being afraid, not being scared to have something stuck in your butt. Okay. To even say those words.
Speaker 2:Cause when you say those words to some doctors, patient refusing, you're never offered it again. Right.
Speaker 1:Well, doctor Morell, thank you so much. Guys, please follow him on TikTok as doctor Zuri. Please follow him on Instagram as doctor Zuri Morell. Thank you so much. We named the newsletter LaVee.
Speaker 1:It's Haitian Curl for life.
Speaker 2:My man.
Speaker 1:We want you guys to live long. You know, we wanna add life to to years and years to your life.
Speaker 2:And and So important. I appreciate you in this doc. I'm a give you your flowers too.
Speaker 1:Thank you, man.
Speaker 2:Appreciate it. Seeing where this man has he was always dynamic as a resident. And and and the number one thing people don't understand is that I think to be a good doctor, it's not none of these dictatorial things like it used to be. It's somebody like you. You know I'm saying?
Speaker 2:Extremely knowledgeable, but somebody who's personal, who a patient feels comfortable talking to. I think as doctors, that's where we would lose patients, but not us.
Speaker 1:Right. Exactly.
Speaker 2:I'm in.
Speaker 1:Thank you so much, doctor.
Speaker 2:Alright brother. Thank you so much. Take care. Alright.