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Welcome to “Should I Call a Doctor?” The podcast where we dive into trending health topics to separate fact from fiction. We bring in experts to talk about all things health, to empower you with knowledge and answer your questions hosted by Inova Health.
0: Welcome to, should I call a doctor,
the podcast where we dive into the questions you have about your health and
today's trending health topics to separate fact from fiction.
I'm one of your hosts, Dr. Sam Owly, an internal medicine physician at Inova.
1: I'm Tracy Schroeder. I lead communications for Inova.
Dr. Sam will give you the clinical perspective while I ask the questions that
keep patients up at night.
Today we're gonna talk about a topic that many people have probably experienced
in one way or another,
from heartburn and acid reflux to irritable bowel syndrome to cancer.
Gastrointestinal health is an important topic.
0: Joining us today to talk about GI Health is Dr. Neha Nigam,
specialty Care physician Board certified in Gastroenterology and internal
medicine at Inova. Welcome, Dr. Nigam.
2: Thank you for having me. Look.
0: GI Health is a huge topic and I'd have a couple of first questions for you.
One is just give us your kind of overview of what exactly GI Health is,
and then maybe the second part of that question is,
what do you feel like is the top thing that within GI Health that
people that you see in the clinic?
2: Um,
so gastrointestinal health really refers to a very large organ system
in the body. Um, so we are talking about the esophagus,
which is the tube that carries, uh,
food and liquid from your mouth to your stomach, your stomach, your small bowel,
and your large bowel or your colon as well as your liver, your pancreas,
and your gallbladder.
And all of these organs serve to break down the foods we eat,
absorb the nutrition, and then eliminate toxic waste from our body.
So given the number of organs,
there are a variety of disease processes that can affect, um,
any portion of the GI tract.
So things we commonly encounter in clinic are like inflammatory bowel disease,
so Crohn's or ulcerative colitis, uh,
that can cause inflammation in your large bowel or other parts of your GI tract,
uh, celiac disease,
which is a gluten allergy that can cause small bowel inflammation, acid reflux,
irritable bowel syndrome,
which can be associated with a change in bowel habits and abdominal discomfort.
Um, to answer the second part of your question, we, uh,
get a lot of questions in clinic these days about colon cancer screening.
We get a lot of questions about the role that food allergies may play.
Um, so, you know, uh,
teasing out food allergies from foods that may be causing digestive
issues, but, but the key point is not foods that you're allergic to.
So we often are finding ourselves making that differentiation in clinic. Um,
and then we see a lot of patients,
especially I have a lot of females in my practice and I see a lot of female
patients with irritable bowel.
0: So thank you. That's actually very helpful, um, and makes sense. Right.
Particularly, and I think, you know, you and I have talked before and, um,
particularly this idea that, you know,
colon cancer screening I think is always an important topic. Yes,
it always has been because it's this very tangible thing.
We've had screening guidelines for a long time.
1: Celebrities have made it famous. Yes.
2: Absolutely. It's.
0: True. What didn't, who was it that Katie Couric did the live colonoscopy. Um,
but recently, um, the guidelines changed. Yeah. You know,
and the age cutoff became younger. Yes.
You're saying that you're seeing it a lot, but it seems to be even more,
is it correlated to the age cutoff? Yeah.
2: I think it is. Um, so, you know, recently it's been all over the news. Uh,
I think a few years ago there's a New York Times article that initially brought
it to the forefront and then, uh, it's been covered tremendously since then,
but there's been an increase in the incidence of colon cancer,
booming patients 40 to 50 years of age. Um,
we don't know exactly what's driving that.
We postulate that it could be lifestyle factors. So like how, you know,
our processed food intake, our obesity rates, our lack of exercise,
our diminished sleep there, there are lifestyle factors.
We think certain races do carry an increased risk of colon cancer.
So African Americans do seem to have a higher incidence of colon cancer. Uh,
and for all of those reasons,
the recommendation was made to shift the starting age for colon cancer screening
from age 50 to age 45. Um,
and this was done right around the pandemic,
so it really opened the floodgates for patients coming in.
We already sort of had a backlog of patients that needed colon cancer screening
for whom it had been delayed due to the pandemic,
and now you're getting a whole other cohort coming in because they're all of a
sudden eligible for colon cancer screening. Um, so certainly, you know,
if you're 45, come on in, get screened, um,
it's one of the most important preventative health things you can do. Yeah.
So the screening always the same process. So screening really starts at age 45.
Um, it does start earlier for patients that have certain risk factors, um,
most commonly a family history.
So if someone has a family history of having family members that either were
affected by colon cancer or had polyps in their colon,
then they may start screening earlier around age 40 or even sooner if needed
based on when their family members were affected. Uh,
when it comes to colon cancer screening, you have some options.
So you have stool tests,
and these stool tests can pick up the presence of blood and some can even pick
up the presence of genetic material in your stool.
And that genetic material is coming from the polyps or growths in your colon or
potentially colon cancer. Uh,
and these stool tests are done every year to every three years,
depending on the type of test that you pick.
The tests though are not as sensitive and specific as a colonoscopy.
So your colonoscopy is really a gold standard. It is the most sensitive,
it's the most specific, and most importantly,
it allows you to not only detect a polyp,
but it allows you to remove a polyp at the same time. Right. Um,
and then similarly, if you had colon cancer,
let's say if you were found to have colon cancer,
having a colonoscopy sometimes allows you to detect it early enough that you end
up with a surgical resection and you may avoid chemotherapy or radiation because
you may pick up that cancer before it's spread to other parts of your body.
So do you have stool tests as an option? You have colonoscopy and um, you know,
really you should have a conversation with your primary care provider or your
gastroenterologist about what's the best suited modality for you.
1: That's really helpful.
So I feel like when people are going in for a colonoscopy,
the prep gets the bad rep, right? ? Yes. Yes. Yeah.
So tell people a little bit about that. I've had it a few times. I,
I can say from my own experience, it's gotten better over the years. It has.
2: It has. So, um, you have options for preps. Um,
you have some preps that are, uh,
larger volume preps where you have to drink larger jugs.
You have some smaller volume solutions.
You have some pills that are available to help you prep. Um,
and again, a lot of it has to do with your medical history,
any medical issues you may have that may decide which prep is better suited for
you. Um, if you have a history of constipation,
you may need a little bit of a longer prep. Uh,
but we've also made some adjustments to prep over the years.
So we used to ask patients to drink all of the prep the night before.
Now we split dose it. So we ask patients to split it in half,
drink half the evening before and half a few hours before the exam. Um,
that not only improves the cleanliness of the colon,
but it also decreases nausea, vomiting, um, improves the tolerance of the prep.
And I think that if, you know, it's,
it's a really good idea to meet with your GI physician beforehand if you have
questions about the prep because it is the part of the procedure that, um,
is really vital in order to have a really clean colon so we can get a good look
and we can detect those tiny, tiny polyps. So.
1: I've heard of people having to go back a second time Yes.
Because they did not do a good prep.
2: Absolutely. Absolutely.
And oftentimes those are patients where maybe it wasn't picked up that they had
constipation and that they needed a longer prep or they needed to be doing some
things even a week or two before the prep. Wow. Um,
like eating a low fiber diet or avoiding their fiber supplements or avoiding
iron supplements which could constipate them. So I tell patients, you know,
it's a good idea to read your prep instructions, not just the few days before,
but even two weeks before.
It's a good idea to talk to your GI physician about the different prep options
that are available.
1: Yeah. The procedure's, the easy part, the procedure.
2: Is the easy part. It's a nice, and I always tell people, you know,
colonoscopy is 45 minutes. It's, um, you're sedated, you're comfortable,
you don't feel or remember anything. It's outpatient.
You wake up really quickly afterwards and most of the time if all goes well,
you're buying yourself several years worth of peace of mind afterwards.
That's really great. So yeah.
1: That's a nice thing as a patient to hear.
2: Absolutely. .
0: What about the role of, you know,
'cause you were talking about screening tests with, um,
stool tests and the colonoscopy. You know, in the last few years,
people certainly have asked and talked about the role of like CAT scans Yeah.
Things like that, right. CT colonography,
like is it a reliable diagnostic test and if and when do you use it? Yeah.
2: So in my practice, and I think in most of our practices,
we really rely on it not as an initial screening test. Um,
and there are a couple of reasons why. Um, one is,
is that it does still require a prep.
So your patients are not being able to avoid the prep portion,
which is sometimes the more challenging part of undergoing a colonoscopy. Um,
some patients do find that the process of getting that when they insufflate air
or push a little bit of air into the GI tract can be a little painful,
and it's not a procedure that's done under sedation.
So that's something to just keep in mind. Um,
usually I think a CT colonography plays a role when patients have a
colonoscopy that for some reason is difficult to complete either because of
their anatomy or because of their medical comorbidities, et cetera. So, uh,
usually I would say it's not something we consider right off the bat with our
stool tests and our colonoscopy,
but it is something we're in a very select patient population we do think about.
0: That makes sense. Yeah. Um,
what are the best things you usually say in terms of mitigating your risk? Yeah.
What can people do now if they're worried about this?
And let's say they already had a colonoscopy and it was negative, it's like,
okay, great. I bought some time. How can I ensure that I use that time well?
So the next time I have to do it, I'm still good. You know?
2: Absolutely. Um,
and I get this question a lot from patients even after they have a normal
colonoscopy,
like what gives you the peace of mind moving forward that you're doing the right
thing?
So I always kind of break it down that there are certain lifestyle factor. Well,
there's certain factors that you can control and certain ones you can't. Um,
the ones you can control are the fact that you're getting older.
are the fact that you may have a family history of colon polyps or colon
cancer. Um, you may have, uh,
genetic syndrome that increases your risk of having polyps.
So there's certain things that are out of your control,
but then there are a lot of lifestyle factors that are in your control. Um,
and those include, again,
making sure that you're consuming a diet that is well balanced.
So decreased amount of red meats, more, um, whole grains,
fruits, legumes, vegetables, nuts, um,
making sure that you're getting adequate amounts of sleep that you're exercising
and preventing obesity. Um, you're avoiding smoking and tobacco,
so all or smoking and alcohol. So all of those things I think are,
are the recipe for a healthy life in general,
but they also have a big impact on your gut health and then diminish your colon
cancer risk or decrease your colon cancer risk.
0: Does fiber make a difference?
2: Makes a huge difference. Fiber makes a huge difference. . Um,
so I think fiber makes a difference in symptoms, uh,
the advertising industry for serious, certainly think so. ,
definitely . So you know, there's,
there's fiber supplements and then there's consuming a diet that's high in
fiber. And I always tell patients,
if you can get your fiber in a more holistic manner through your diet,
that's probably more ideal, especially when it comes to, um,
helping improve gut health and diminishing the risk of,
or decreasing risks of colon cancer. Um,
but then sometimes we do use fiber supplements a lot in gi,
especially when we're dealing with symptoms that patients are having either way.
Fiber is never a bad thing for your gut. It can only help, it will never hurt.
0: Idea of GI health overall and how it influences so many things. So.
2: Um, patients often come in and it can be something simple like a change in bowel
habit or bloating or, um,
feeling more gassy or having nausea. And these things,
even though as one symptom may not feel like it's, it's a very big deal,
but when it's happening on a daily basis,
it starts taking a toll on people's life. Um,
your GI health really impacts your digestion, your nutrient absorption.
And then we think now that it also your GI health has to do with sort of your
gut balance. So the type and the balance of bacteria in your gut,
which although research is ongoing,
we think can affect all parts of your physical and mental health.
1: So I hear we're hearing a lot about gut health mm-hmm .
And I'd love for you to tell our listeners what can they control and how can
they maintain having a good gut health?
2: Yeah, absolutely.
So you hear a lot in the news right now about your gut microbiome, um,
and your microbiome is basically the type and the balance of bacteria
in your GI tract. Um, there are things that can affect your microbiome.
So like taking antibiotics for prolonged periods of time, um,
having a major medical illness, sometimes traveling outside of the country, um,
even having things like the stomach flu,
all of these perturbations can really affect your gut microbiome.
There's a lot of research going on about how this impacts basically all facets
of our health.
And we think that your gut microbiome really has an impact on physical health,
mental health, um, your immune function, all of these things.
And this has lended itself to the idea of also having a gut brain axis or
say that one more time. Gut brain axis. Um, so basically that there is.
1: One influences the other.
2: There, there is an influence between one and the other. Um, and again,
going back to the fact that the makeup of your gut health can really influence
extra gi, like not extra gi, but can influence organs outside of your GI tract.
Um, things that you can do. So in the news, you know,
I get a lot of questions in clinic about probiotics mm-hmm . Um,
are probiotics helpful? Is it something that everyone should be on?
A few years ago, probiotics really came out with a lot of, um, media attention.
And since then, I think a couple things are important to point out.
One is that it's an FDA unregulated industry. Um,
each probiotic can be very different from the next one on the shelf at the
grocery store. And you,
each probiotic can have thousands and thousands of different types of bacteria
in it. So it's important to consider, you know,
who is the ideal patient that would benefit from such a strong replenishment of
bacteria mm-hmm . And in some patients who for it,
it's perhaps too much. And so probiotics can often actually cause bloating.
They may not improve your GI symptoms. Um, in some instances they do,
but it's typically not the first thing that we reach for when we think of how to
improve someone's gut help. Um, so it's, it's there in our options,
but it's not our first, it's.
1: Not the first.
2: Lever. Usually when I'm talking to patients about how to improve their gut help,
I am going to the basics, you know, what do you eat in a typical day? Um,
are you eating a lot of carbonated beverages?
Are you eating a lot of processed foods? Are you um,
eating a lot of fried greasy foods? What are you taking in?
And then simple things, how often are you having a bowel movement?
Are your bowel movements ideal? Are you constipated? Are you emptying out fully?
And that maintaining that sort of, um,
good nutrition and that improved forward flow in your GI tract
can do wonders for your gut health. In fact,
sometimes we find that even simple things like treating constipation can
actually end up improving acid reflux symptoms.
Because when you empty out fully from below,
you have less of sort of bad back pressure, you get less constipate,
you get less acid reflux. So a lot of things are interconnected,
kind of going back to the basics and figuring out what am I eating?
How much am I, you know, what, what is my intake? Like, um,
what are my lifestyle factors? How much do I exercise? How much do I sleep?
Am I doing good stress prevention in life? Um,
am I maintaining good bowel habits play a much larger role in your gut health
than even just supplements and probiotics may be doing?
0: Yeah. This gut health topic, like you guys said,
I feel like I hear about it all the time. Read it about it all the time,
have friends who are concerned about it. Um,
are you noticing a trend in,
um, an increase in food allergies or food allergy complaints?
I feel like in general there's,
there are a lot of trends of increase in medicine center mm-hmm .
Like, like you said, with colon cancer.
And we're trying to figure out why it seems like in the allergy realm overall,
and this is not just in gi but obviously we're focusing on gi,
there seems to be an increased incidence of various quote unquote food
allergies. Mm-hmm . And so number one is that true number two,
food allergy is kind of a generic phrase.
How much of this is actual food allergy? Um, and for that,
for those that are food allergies, for example, do we have a sense of look,
are we just better at catching things? No.
2: Absolutely. So we get this question a lot in clinic. You know,
we have patients come in and they say,
can you help me figure out what are the foods that I'm allergic to?
And I think the first thing to point out is that, um,
if you go to an allergist and they do a food allergy testing panel and you come
up as being positive to a few different foods,
that doesn't necessarily translate into digestive symptoms.
Mm-hmm . So a lot of food allergy is looking at testing, um,
various proteins in your skin and your blood,
and that does not necessarily correlate. It can,
but it does not necessarily correlate to you eating a certain food and having GI
symptoms as a result of that. Um, so largely I tell patients, you know, I don't,
I refer patients to allergy testing for, for very certain diseases,
disease processes, but I don't think that if you are coming in with bloating and
constipation and a lot of gas production,
that food allergy testing is what's gonna get you your answer.
I think at that point you go back to the drawing board and you think about what
you're eating and how much you're, you're having, you know,
in terms of bowel movements, what,
what is your overall sort of GI health look like? Um,
we do see certain allergies in clinics.
So we see gluten allergies or celiac disease,
and we do diagnose that with blood tests and endoscopy, so with a, with a scope.
Um, and we see lactose intolerance,
so that's not an allergy necessarily, but we do,
we do see the symptoms that go with lactose intolerance. So a lot of flatulence,
a lot of bloating, a lot of loose stools. Um,
so sometimes we ask patients to maintain food diaries and that's how we pick
that up. Um, we also see patients I mentioned earlier with gluten allergies,
but we also see patients with gluten intolerance.
So patients that don't necessarily come up with positive blood testing and
endoscopic findings,
but may have an intolerance where if they eat a lot of gluten, a lot,
a big bowl of pasta, for example, they may have symptoms,
but they won't have symptoms if they eat smaller amounts of gluten.
So we do see that in clinic. Um,
so I think overall what I try to stress again is that, um,
before we think about food allergies, we should think about food intolerances.
We should think about consuming too much types of,
too many types of a certain food. Um, we talk a lot in clinic about low FODMAPs.
So FODMAPs are certain carbohydrates in foods that create a lot of gas when
they're metabolized by the body. Um, and that can be like crunchy fruits,
crunchy vegetables. Um, and so we give patients a list and we say,
maybe these are some foods that you can avoid to help decrease the amount of
gas. Again, this is not an allergy,
this is just that if you eat us too many types of this type of food,
it'll cause symptoms.
0: Irritable bowel syndrome. Mm-hmm .
Is probably the last thing I'd probably ask you about. Yeah. And again,
I don't know how much it's talked about now versus before,
but certainly for a long period of time,
I feel like IIBS is one of these terms that is well known to the public. Yes.
Um, and it's sort of this interesting term that is very
overarching, doesn't have this tangible diagnostic test for it.
How much are you seeing that, what are your overall thoughts about it?
What is the general approach and thinking?
2: Yeah,
so irritable bowel syndrome is probably one of the most common complaints that
we see in GI clinic. Um,
many times people have not necessarily diagnosed themselves with IBS,
but when they come in, their symptoms may fit the constellation of IBS. Um,
so with IBS,
we're really looking at patients that are having abdominal discomfort with the,
with a change in bowel habits. Um, and IBS is, again,
it's a huge quality of life, uh, issue. It affects patients' quality of life.
It is, it disproportionately affects women compared to men. Um,
and so we mean, in my clinic,
I typically end up seeing a lot of female patients that come in that are having
a very non-specific constellation of GI symptoms. Um,
something like bloating, abdominal cramping, discomfort. Um,
a lot of them are sometimes vacillating,
meaning that they're having constipation and diarrhea.
So there's not a clear pattern,
but there's a big vacillation in their bowel habits. Um, and so I think, again,
you know, when we assess that clinical situation,
we're really looking at first ruling out specific disease etiology.
So we wanna rule out that they have any inflammation, they have any allergies,
et cetera. And then we work to figure out how can we streamline their digestive
functioning, how can we improve, um, their,
their bowel movement pattern?
How can that then in turn decrease their bloating?
How can we address their food choices? Um, and then sometimes that's,
that's all we need and sometimes we need some more medications on top of that.
So, um, there are certain medications that we sometimes turn to that can, um,
affect the pain signals that our GI tract sense to our brain.
And those are adjuncts that we use to help treat this overall,
this medical condition. So I think IBS is, it's very casually spoken about.
It carries a whole, a huge toll on quality of life for a lot of people. Um,
and it's important to get GI help for it because a lot of times over the
counter stuff is,
is not sufficient to deal with the whole constellation of symptoms that you may
be having.
1: And is that something that they like, that can be under control,
like brought under control and then you don't have to continue taking a
medication?
Or is it one of those things that like once you go off whatever regimen you're
on, the symptoms are gonna come right back? Yeah.
2: That's a great question. So I think it varies. Um,
I think for some people they are able to identify certain triggers and when they
address that,
then they may realize that their symptoms have pretty much got away. Mm-hmm.
I think there's some patients that need to stay on some type of long-term plan
either with, um, you know, treating constipation or diarrhea or the certain, or,
or addressing the types of food they eat, or like I said,
adding some medications. So it, it really varies case by case.
1: Great. What did we not talk about that you wanna make sure everybody knows? I.
2: Think the biggest thing is that, you know,
you don't have to wait till you get referred to a gastroenterologist. Mm-hmm.
Right. So if you are having GI symptoms,
if you feel like they have been going on for a long time,
if you feel like they haven't been maybe properly addressed or you haven't
addressed them with enough attention, um, seek,
seek the care of a gastroenterologist because, uh,
it's better for someone to really sit down and walk through exactly
what's going on, identifying triggers, figuring out what's happening. Um,
so don't,
don't wait till it's too late for really any constellation of GI symptoms.
Seek help soon as you can. That's.
1: Great advice. Yeah. Thank you so much for spending time with us today.
2: Absolutely. This, thank you. It's been a pleasure.
1: Thanks for tuning in. We hope you enjoyed this episode.
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