Our Gastroenterology Blog
Have you noticed how other people love to refill your glass at parties? Often when you still have half your drink left! Alcohol can be a great social lubricant. But many of my patients come to me with concerns, asking how many drinks are allowed, and if they're still permitted that small glass of wine with dinner at the weekend.
While there is no one-size-fits-all solution for you or my patients, I feel that it’s important to lay out the facts on alcohol and your gut, to help you consider the advantages and disadvantages. Ultimately, your body’s digestive system is not designed to process large amounts of alcohol. Alcohol consumption is of particular concern to me as a GI doctor, because it affects so many areas of the gastrointestinal tract. I think it's an excellent idea to educate yourself, and make the choice that's right for you.
How Do We Digest Alcohol?
When you drink an alcoholic drink, it initially passes down into your stomach, which contains alcohol dehydrogenase (ADH), your body's main line of defense against alcohol molecules. How effectively you metabolize alcohol is dependent on age, gender, and ethnicity. Most of your ADH resides in your liver, ready to filter and breakdown the alcohol that makes it to your bloodstream.
Alcohol molecules are very small, so, when they hit your small intestine, they can easily pass through your gut wall and into your bloodstream, quickly creating that relaxed effect enjoyed after a glass of wine – the alcohol does indeed go straight to your head! Drinks containing carbonated bubbles are metabolized much quicker. On an empty stomach, the alcohol meets even less resistance from the gut. So it’s true: drinking after a meal can slow down the rate of absorption.
While your stomach can breakdown some alcohol molecules, a small amount of alcohol is excreted directly through your urine, breath, and sweat. But the ADH in your liver is responsible for neutralizing the majority of the alcohol you consume. On average, it takes 1 hour for your body to break down one alcoholic drink. But this is not a hard and fast rule – often it can take hours for your liver to metabolize one drink. The size of one standard drink corresponds to:
- 12-ounce bottle of 5% beer
- 5-ounce of 12% wine
- 1.5-ounce of 80% liquor
Alcohol can cause heartburn, by provoking your stomach into attacking its own lining and surrounding muscles. Drinking large quantities can also cause nausea, vomiting, and ulcers, and go on to trigger further damage in your gut. Let's dive into the details, so you can make an educated decision about your alcohol consumption, even if you're not currently experiencing any gastrointestinal effects.
Drinking alcohol harms your gut microbiome – this stands to reason because alcohol or ethanol is used as a disinfectant, and your microbiome is made up of important bacteria! The only alcoholic drink that can improve your gut microbiome is red wine (consumed in moderation) because it contains polyphenols, which increase your ‘good’ bacteria.
Just as heartburn is an inflammatory reaction to alcoholic drinks in the stomach, alcohol can also worsen symptoms of IBS. In fact, binge drinking can create a similar reaction in non-IBS patients causing symptoms such as:
You may be surprised to learn that alcohol inhibits your gut’s ability to absorb crucial nutrients and proteins. Drinking large quantities of alcohol regularly reduces the number of digestive enzymes your pancreas can release into your digestive tract. These enzymes are needed to oxidize the alcohol, to break it down into energy and components that eventually passes from your body. But the enzymes are also crucial to the proper digestion of food. Without them, you lack the ability to take up the vitamins and minerals needed for different functions in your body.
Because alcohol causes an inflammatory response in your gut, it can lead to intestinal inflammation. And, in alcoholics, it can affect the intestinal permeability, potentially letting toxins and other debris through the gut wall and into the bloodstream. These conditions can create serious discomfort and pain for the sufferer.
The Risk of Colon Cancer
In 2012, the International Agency for Research on Cancer evaluated ethanol in alcoholic beverages as a group 1 carcinogen. While drinking alcohol is well known as a cause of cancer of the liver and breast, in terms of your digestive system, heavy alcohol consumption can raise the risk for cancer of the mouth, throat, and bowel - both colon and rectum.
When you drink, the alcohol makes direct contact with the epithelial surface of your mouth and throat. More than four drinks a day seriously raises your chances of getting a gastrointestinal cancer.
Many of my patients ask me about colon cancer at their appointment. You may know someone who had or has colon cancer, as it is the third most common type of cancer in the United States.
Colon cancer symptoms can include*:
- Bleeding from the rectum
- Blood in your stool
- Abdominal cramps
- Pain from gas
- A change in your bowel habits
- A change in consistency of your stool
*However, in the early stages colon cancer can be asymptomatic.
In the moderate drinker demographic, men are at slightly higher risk than women. Men and women break down alcohol differently, due to hormonal differences.
With this information in mind, I believe that if you enjoy the occasional alcoholic drink – preferably after a hearty meal – then you are not putting yourself at a huge risk. However, there is certainly an increased danger to your digestive system and gut if you choose to regularly drink heavily. Binge drinking or drinking every day can put an added strain on your body, but the occasional celebratory drink is not a cause for concern.
If you're concerned about the health of your gut, or would like to schedule a colonoscopy in the Dallas/Plano TX area, please fill out our appointment form or call us at 972-867-0019.
The American Cancer Society (ACS) has recently updated their starting age recommendation for colon cancer screening to now begin at age 45 for people of average risk. This change is significant since it has been universally accepted for many years that non-symptomatic colon cancer screening should begin at age 50.
In light of the ACS guideline change, I wanted to take this opportunity to explain why they made this change and how it affects adults over 40 years of age.
Why did the ACS update the Colon Cancer Screening Starting Age?
The ACS guideline change is based on a study they conducted on adults (ages 20-54) that revealed that the death rate of this age group due to colorectal cancer had been increasing since the mid-2000s. The primary findings from this study are as follows:
- The death rate for colorectal cancer in adults ages 20 to 54 increased by 1% each year from 2004 to 2014.
- The death rate for colorectal cancer among those ages 20 to 54 increased in white people by 1.4% each year since 2004. In contrast, the death rate slowly decreased in black people throughout the 45 years studied.
- The death rate is also increasing among adults in the screening population – people in their early 50s. This finding highlights that people are delaying getting their first colon cancer screening exam, which is resulting in a higher incidence of colon cancer.
NOTE: Colon cancer is very treatable when detected in its’ early stages. Getting screened significantly lowers your risk, which is why we are heavily promoting colon cancer awareness in the Plano, Dallas, Frisco TX and surrounding areas.
When should I be screened for Colon Cancer?
Prior to the updated recommendation by the American Cancer Society, the universal starting age for colon cancer screening was 50 years of age. Until other societies like the American College of Gastroenterology and American Gastroenterological Association issue their opinions on the ACS this topic is debatable.
My recommendation is to discuss with your doctor the pros and cons of when you should start colon cancer screening and collectively an educated decision can be made.
NOTE: Colon cancer screening ages can differ for those with a family history of colon cancer, polyps, symptoms and ethnicity. Please consult with your doctor to decide when you should start screening for colorectal cancer.
Does Insurance cover the cost of Colon Cancer Screening?
Screening tests for those adults at average risk for colon cancer are typically covered by insurance. Whether insurance providers will adjust their coverage to include adults beginning at age 45 is unknown.
We recommend that patients discuss coverage with their insurance provider to fully understand their financial responsibilities prior to scheduling a colon cancer screening.
Colon Cancer Screening Options
For most colon cancer screening has always been synonymous with a colonoscopy procedure. Other screening test options are available and should be discussed with your doctor if you have an apprehension towards colonoscopy.
Colonoscopy is considered the gold standard colon cancer screening exam since it is the only exam that allows your doctor to both detect and remove polyps in the same procedure. If you use a home test and receive a positive result, you will need to have a colonoscopy to remove any polyps.
I fully support a higher participation rate for colorectal cancer screening for those patients in the Plano and Dallas TX areas. If the usage of home or other testing methods than colonoscopy increase the screening rates, I am in favor of using alternative tests.
STATISTIC: 20 million + Americans over age 50 do not get tested for colon cancer. We can beat this cancer with early detection… get screened!
Do I need an office visit prior to scheduling a Colonoscopy?
NO. Dr. Malik offers Open Access Colonoscopy, which is a colonoscopy procedure that does not require the patient to have an office visit with their Plano, TX gastroenterologist prior to their procedure. The exchange of all needed information is done over the phone. This saves the patient both time and the expense of an office visit.
Click this link to learn more about open access colonoscopy.
Summertime is here and that means your calendars are probably filled with fun summer activities. Many of us will be running around dropping the kids off at summer camps or friends’ homes. But, it seems when the kids are out of school we tend to cater to their tummies for breakfast, lunch, and dinner, leaving us with a not so healthy gut.
When you’re at your best it means you can maintain energy and feel great all summer long, and it all starts in the gut. I wanted to create this article to offer some suggestions of gut healthy food choices along with a little background on the gut microbiome.
A healthy gut microbiome – the diverse community of microorganisms living in the digestive tract – is essential to your health. These bacteria are essential to a healthy metabolism, energy levels, and digestion.
So what should you feed these bacteria to optimize your health?
Prebiotics, Probiotics, and the Not So Healthy Antibiotics
The digestive tract is full of good (symbionts) and bad (pathogens) bacteria. The healthy bacteria need your assistance with the right foods to fight the pathogens to help keep your immune system healthy and digestion right on track.
Heavily refined and processed foods, antibiotics, and some environmental factors such as stress and a sedentary lifestyle can negatively affect the balance of gut microflora (bacteria).
Antibiotics wipe out not only the bad bacteria in your system but the good bacteria as well – leaving the gut in mayhem and open to intruders. So it’s important after a dose of antibiotics to flood your system with prebiotics and probiotics.
2 things you need to balance your gut microflora to promote healthy digestion:
1. Probiotics – These are the good live bacteria such as Lactobacillus or Bifidobacterium that we get mostly from fermented foods or drinks. Probiotics help fight off the bad bacteria, support immune system, produce vitamins and promote good digestive health.
2. Prebiotics – Different from the well-known probiotics are the non-digestible parts of food that help feed probiotics – the good bacteria. Prebiotics are found in most fiber-rich foods such as fruits and vegetables. They help your digestive system run smoothly, decrease inflammation, boosts your immune system and decrease your risk of certain diseases.
Eating healthy foods is not only good for you but great for your healthy bacteria. The following foods will help your good bacteria thrive giving them strength to fight off any pathogens trying to invade. So with all that running around you’ll be doing this summer – I wanted to provide some food suggestions to help keep your gut in tip-top shape!
1. Kombucha – This yummy drink is a great substitute for sodas in the summer to quench your thirst. Kombucha is a fermented black or green tea made with bacteria and yeast which carbonates after fermenting – this is great when you’re craving that coke this summer.
This drink is a wonderful probiotic for your stomach due to the good bacteria these drinks are made out of. The natural antioxidant in kombucha helps fight the pathogens that may be causing mayhem in your digestive tract.
2. Green leafy vegetables – How many times have you heard “eat your green leafy vegetables?” Well, if not enough we’ll say it again – “eat your green leafy vegetables” to stabilize your gut bacteria.
Healthy gut bacteria feed off these green leafy vegetables. They contain sugar molecules that good bacteria need to grow – shutting down the bad bacteria and promoting gut health.
So during those summer BBQs have a hearty green salad as a side dish!
3. Kefir – You’ve probably heard of this cultured dairy product before since it’s been the “it” health food of the 21st century. But, if you haven’t I’m glad to be the first to introduce it to you.
Kefir contains as many as 30 strands of good bacteria and is one of the best probiotic foods out there. Kefir benefits are endless, not only does it help restore your gut with an abundance of good bacteria but it fights cancer, builds strong bones, boost your immunity, and promotes detoxification.
4. Yogurt – Yogurt is one of the top consumed fermented dairy products in the United States making it the top probiotic food. The lactic acid-producing bacteria include Lactobacillus and Streptococcus species benefit your gut function through the gut microflora.
Unfortunately, most of the yogurt brands on shelves pack their products with sugar which the bad bacteria in the gut love to feed off of. It’s important to read the labels and ingredients on your foods!
5. Sauerkraut – Essentially sauerkraut is just cabbage and salt, but when it’s fermented the health benefits skyrocket compared to fresh cabbage. Fermentation is the process of microorganisms like yeast and bacteria that convert the sugars on the cabbage to beneficial probiotics.
Studies have proven that these probiotics help protect against gastrointestinal disorders such as gastrointestinal infection and inflammatory bowel disease.
Sauerkraut is high sodium – so keep this in mind if you’re watching your salt intake.
6. Onion and garlic – The two most flavorful ingredients to add to your summer shopping list if they aren’t already there. Not only do they make every dish pop with flavor, onions and garlic are high prebiotic foods.
The prebiotics in these foods promote the growth of Bifidobacteria – good bacteria – in your gut and prevent disease-promoting bacteria from accumulating leading to a balanced digestive system
Since onions are high in fiber they promote better digestion, and garlic can aid in eliminating any digestive problems such as dysentery, colitis, and diarrhea.
7. Mushrooms –The polysaccharides found in mushrooms are considered non-digestible by your digestive tract. But, what these fibers can do for us is feed the healthy bacteria in the large intestine and in return we give them an environment to thrive in. Now that’s a symbiotic relationship!
This prebiotic vegetable can be added to your summer salads or what’s even better is mushrooms on the grill!
8. Asparagus – Another wonderful grilled summer vegetable – asparagus. Filled with prebiotic fiber and antioxidants, asparagus is a must for your summer grocery list.
The prebiotics stimulate healthy gut bacteria growth while the antioxidants help prevent colon cancer.
9. Bananas – Bananas are a quick snack for kids and parents on the go. They are a great source of vitamins, minerals, fiber, and prebiotics. Make sure you buy bananas a little under-ripe since the unripe bananas are full of resistant starch which gives the bananas their prebiotic effect.
10. Dandelion – Surprisingly you can eat these dandelion flowers you see growing in your yard and what’s even better – they are rich in fiber and prebiotics for your gut. Their similar taste to arugula makes them great for salads or even boiled up for tea.
If you pick your own be sure to avoid the dandelion’s treated with weed-killer – a not so healthy option for your gut.
Healthy Gut, Healthy You
The trillions of microorganisms living in your gut need food to survive, just like us. If you are feeding your gut processed and unhealthy foods – we are directly feeding bad bacteria, giving them an invitation to set up shop and create havoc.
But, if you are eating nutritional foods filled with prebiotics, probiotics, vitamins, and minerals you’re strengthening your body to fight off a laundry list of diseases.
Gastrointestinal issues can be detrimental to your health, so it’s important to keep your diet on track. It can be hard when you’re always on the go, adding these nutritional foods to your diet at least once a day can help balance your gut bacteria. If you’re in the Dallas/Fort Worth area and need guidance with your gut issues call or book an appointment today with my practice.
We all know what we eat significantly affects the health of our digestion but what many don’t realize, is what’s also important is how much we move. Exercise not only helps you digest food better, it also changes the composition of your gut microbiome – making you healthier from the inside out.
Your gut microbiome are the 100 trillion microbes living in your gastrointestinal tract and include bacteria, viruses, fungi, parasites and more. When you exercise, certain microbes are favored and become stronger. The interesting thing about the effects of exercise on your gut, is it favors disease-fighting, weight loss promoting microbes. This means not only do you get the immediate benefits of exercise like calorie burning and detoxification that comes with sweating – you also get the benefits of a healthier digestive system, long after you finish working out.
The lasting benefits exercise has on the gastrointestinal tract and its microbiome help support a healthy immune system, promote weight loss, and fight disease. With 80 percent of your immune system living in your gastrointestinal tract, it’s no surprise that keeping it healthy with exercise would offer you these five awesome digestive health benefits.
1. Reduces risk of colon cancer
Colon cancer kills about 50,000 people in America each year. It’s a cancer of particular concern because it can be largely asymptomatic until it’s too late. Fortunately, exercise has been found to reduce a person’s chances of developing colon cancer. A 2011 study found strong evidence that regular physical activity reduces the risk of developing colon cancer overall.
While exercise has been shown to reduce one’s risk of colon cancer, we all need to follow the recommended screening guidelines to best reduce our risk of developing this cancer. I encourage you to read the page I’ve created about why colonoscopy is the gold standard of exams used to screen for colon cancer to learn more about how colon cancer can be easily prevented.
2. Improves quality of life in those with irritable bowel syndrome
Irritable bowel syndrome (IBS) is a condition I see regularly in my practice. Unfortunately, it’s also a problem that is on the rise. The good news is, exercise has been found to reduce the symptoms and improve the quality of life of patients with irritable bowel syndrome.
A recent study found exercise not only improved digestive related symptoms in patients with irritable bowel syndrome, but it also improved their overall quality of life. Physical activity appears to be an effective way to reduce symptoms such as depression, anxiety, and fatigue in those with irritable bowel syndrome.
3. Relieves constipation
Exercising helps the food you’re digesting move through the intestines better, especially in patients with IBS. A study on patients with IBS found that those who exercised regularly had a significant reduction in constipation. In another study, researchers found that constipation was associated with a lack of physical activity in teenagers.
While you might not feel like exercising when you’re constipated, it could be exactly what you need. Try moving around and stretching more if you become constipated easily.
4. Prevents gallstones
Gallstones occur when deposits of bile form in your gallbladder. These painful stones can result in acute pancreatitis, which usually results in hospitalization. Research has found exercise to be effective in preventing gallstones from forming.
This is believed to be because exercise lowers insulin and triglyceride levels, while raising good cholesterol. Also, exercise reduces bile stasis, which is when bile can’t move thus causing stones. A study of 25,639 volunteers found that those who participated in the highest level of physical activity had a 70 percent decreased risk of developing gallstones.
5. Improves your gut microbiome composition
A 2017 study found that exercise affects the types of predominant bacteria in your gut, independent of other factors, like your diet. This was found to be true in both lean and obese adults who had sedentary lifestyles. This means you can change your gut microbiome composition with exercise, which is good news for anyone trying to be more healthy!
First, a baseline sample of their gut microbiome was taken. Then they exercised for six weeks and had another sample taken. Researchers found a decrease in microbes associated with inflammatory disease, obesity, type 2 diabetes, and heart disease. If you need another reason to exercise, that’s it! The fact that exercise is able to change your gut microbiome that dramatically and that quickly is great news.
Interestingly, the study found that as soon as those individuals stopped exercising, their microbiome returned to how it was initially. That means exercise needs to be a lifestyle change, not something you do every now and them.
Keep in mind, a little exercise is better than nothing. I believe it’s better to make it a habit and do it regularly no matter how much or little you do. Some days you might only feel like going for a walk, but that’s better than nothing.
5 Ways to Improve Your Digestive Health
Other things you can do to improve your digestive health along with exercising, include:
- Eat a nutrient-dense diet with lots of diverse foods.
- Eat prebiotic-rich foods like garlic, onion, and leeks
- Eat probiotic-rich foods like sauerkraut and kimchi
- Drink plenty of water
- Reduce sugar and refined carbohydrate intake.
Your gut health is the foundation of your overall health. When you incorporate these factors into your life as much as possible, you support your body from the inside out. Exercising goes beyond looking great, it also triggers mechanisms within your gastrointestinal tract that help keep you healthy, more easily.
Remember, there can be too much of a good thing. Exercising too aggressively can have the opposite of your desired effect. Especially if you have gastrointestinal issues, consider trying more gentle exercises such as yoga, biking, or even strength training.
Sedentary lifestyles and gastrointestinal issues can become a vicious cycle. Without sufficient exercise you can develop gut issues, but if you have gut problems the last thing you’ll feel like doing is working out. I totally get it and am here to help. If you’re in need of a gastroenterologist in the Dallas/Fort Worth area with experience in complex digestive health issues, you can request an appointment here or call 972-867-0019. There’s no need to struggle alone, let’s get your health back on track today.
Arshad Malik, MD
Open Access Colonoscopy
An Open Access Colonoscopy allows qualifying patients in the Plano, TX area the ability to schedule a colonoscopy without having an office visit with their gastroenterologist prior to the procedure. Dr. Malik offers this option in order to make screening for colon cancer as affordable as possible and encourage a higher participation rate for those in the Plano and Dallas TX areas.
BENEFITS: Saves the patient the time and expense of an office visit prior to colonoscopy
The key to beating colon cancer is early detection. Dr. Malik encourages everyone to follow the colon cancer screening guidelines established by the American College of Gastroenterology:
- Anyone age 50 or over
- Anyone with a family history of cancer or polyps should start at age 40
- African Americans should have their first screening colonoscopy at age 45
SCREENING INFO: Visit our colonoscopy page to learn why it is the gold standard for colon cancer screening, procedure details and tips for making the prep easier!
Open Access Colonoscopy Qualifications
The main criteria to qualify for an open access colonoscopy are:
- No ACTIVE heart disease
- No breathing issues (e.g. asthma)
- Not using blood thinning medications (aspirin is ok)
Difference between Screening Colonoscopy and Diagnostic Colonoscopy
It is important to understand the difference between screening and diagnostic colonoscopies, since they can affect the cost of the colonoscopy. Patients need to discuss with their doctor how their colonoscopy will be coded (screening or diagnostic) and then confirm their financial responsibilities with their insurance provider prior to the procedure.
Screening Colonoscopy - This procedure is for those over the age of 50 with no symptoms (either past or present) and without a personal or family history of gastrointestinal disease, colon polyps, or cancer. Insurance will typically cover the cost of a screening exam once every 10 years beginning at age 50.
Diagnostic Colonoscopy - Patient has past or present history of gastrointestinal symptoms or disease, polyps, or cancer. Additionally, if the colonoscopy is performed due to physical symptoms such as rectal bleeding or pain, the procedure will be considered diagnostic. Diagnostic cancer screenings are typically not covered by insurance.
Cost of Colonoscopy in Plano, TX
Like many other medical procedures, the cost of a colonoscopy varies based on the patient’s insurance plan and whether it is a screening or diagnostic exam.
- Screening exams are typically covered by insurance
- Diagnostic exams are NOT typically covered by insurance
REMINDER: When calling to schedule a colonoscopy, remember that if you indicate the screening is needed due to symptoms… it will be coded as diagnostic.
If you are unsure of how your colonoscopy will be coded by the gastroenterologist performing the procedure, I encourage you to ask your doctor prior to the procedure to get all of your questions answered.
If you or your insurance provider should need any clarification from Dr. Malik’s office, please contact us at 972-867-0019 and we would be happy to assist.
Many media publications have reported over the past few years that gluten sensitivity for those without Celiac disease is not a real condition. That inaccuracy and gluten related questions from my patients have inspired me to write this article. My hope is to provide clarity regarding symptoms, causes, diagnosis of reactions to gluten along with a few dietary recommendations.
We should start with first defining gluten. Celiac.org defines gluten as the proteins found in wheat that helps foods maintain their shape. The gluten protein is prominently found in wheat and other grains. Common foods that regularly contain gluten are pasta, bread and spice mixes. However, there are many other foods and products that contain gluten, so those suffering from reactions to gluten will need to be very aware of anything they consume that contains this protein.
Gluten Sensitivity vs Celiac Disease
Celiac disease is a life-long auto immune disorder in which the body creates a reaction to the ingestion of any type of gluten by attacking the small intestine. The undigested gluten is treated by your body as a foreign invader, irritating your gut and flattening the microvilli along the wall of the small intestine. Without those microvilli, the body does not absorb nutrients properly and can lead to malnourishment.
Non celiac gluten sensitivity refers to symptoms related to gluten ingestion in patients who have no serologic or histologic evidence of celiac disease. The most common complaints are abdominal pain, bloating, change in bowel habits and sometimes extraintestinal symptoms too such as rash etc. The onset of symptoms is typically within hours or a few days of ingesting gluten, whereas in celiac disease symptom onset is often delayed days to weeks. In many such patients gluten is probably not the specific trigger and symptoms may be induced by other factors such as fermentable poorly absorbed short chain carbohydrates (FODMAPs), IBS, or perhaps placebo
What Causes Gluten Sensitivity?
The cause of a sensitivity to gluten isn't fully understood, but it's believed to be the result of a mix of mostly genetic factors. Researchers are studying the possibility of a virus causing this reaction to gluten, but that work is in its early stages.
Gluten Sensitivity Symptoms
Symptoms related to a gluten sensitivity usually begin within minutes of consuming gluten, but the reaction can be delayed up to a few hours for some. The most common symptoms include:
- Abdominal cramping
- Neurologic disorders
- Nutrition deficiencies
- Skin rashes
When to see a Doctor for possible Celiac Disease
Patient experiencing any of the above described symptoms on a chronic basis, as well as individuals with unexplained iron deficiency anemia, for the vitamin B12 deficiency, persistent elevation in liver enzymes, dilated puberty, reduce fertility, recurrent migraine headaches, as well as asymptomatic first-degree relatives of patients with confirmed diagnosis of celiac disease should be seen for further evaluation
Gluten Sensitivity Tests and Diagnosis?
A typical diagnosis for celiac would involve a blood test to screen for celiac disease antibodies. If the blood test was positive, then an upper endoscopy would be performed to allow the doctor to evaluate the intestines and take biopsies.
NOTE: I do not recommend starting a gluten-free diet prior to seeing your doctor. This diet could falsely affect the results of the diagnostic blood tests like the tTG-IgA test.
There is no test that can determine that you have a non-celiac sensitivity to gluten. This diagnosis is typically made by excluding other causes for symptoms and based on a clinical history suggesting the diagnosis
What is Gluten Cross-Reactivity?
A food allergy occurs when the immune system overreacts to a food. Those with a sensitivity to gluten can still feel the effects of gluten even while on a gluten-free diet. Cross-reactivity occurs when the protein structure in one substance are like the protein structure in another. Dr. David Perlmutter notes that close to 50% of those who are gluten-intolerant are also sensitive to dairy. You can view other foods noted by Dr. Perlmutter that may trigger gluten-sensitivity symptoms by reading his cross-reactive foods article.
How to Start a Gluten-Free Diet
Get ready to play food detective. While companies are required to list allergens on the label, they are not required to disclose if a food contains gluten. The Celiac Disease Foundation recommends avoiding foods that list these ingredients on the label… wheat, barley, rye, malt, brewer's yeast and oats. Also, if you are not familiar with an ingredient, wait to eat that item before you can confirm it does not contain gluten. Those that are celiac are susceptible to being deficient in fiber, iron and calcium, so it is important that they work with a dietician to avoid malnutrition.
Dieticians recommend all diets are full of vegetables, fruits, beans, nuts, seeds, fish and lean meat. This is a good place to start when creating your diet, and then add in food items after you identify if they are gluten-free. If you enjoy grains, you don’t have to avoid them on this diet. You just need to be selective with your choices. Some options are plain rice (all forms), quinoa and millet. Also, there are gluten-free pasta and bread options as well.
I would recommend staying on a gluten-free diet at least 6-8 weeks to determine whether gluten is the cause of a health condition or symptom.
Expert Tip: Some people starting out on a gluten-free diet have a tendency to consume a large amount of gluten-free packaged foods (e.g. muffins, pizza). These foods are often high in calories and refined sugars, so you are susceptible to weight gain if you consume too many of these food items. My recommendation is to keep the consumption of these food items to a minimum and focus on taking the time to eat real foods. Also, there are quality online resources to help guide you with your gluten-free diet that I would recommend using as a reference. A few popular websites are:
Why is Gluten Sensitivity Increasing?
Beyond Celiac notes that research estimates 18 million Americans have gluten sensitivity. That’s 6 times the number of Americans who have celiac disease. Just a decade ago, gluten-intolerance levels were at 1 in 2500 worldwide. Today, it’s at 1 in 133.
The primary culprit for this dramatic increase is thought to be a peptide strand in the gluten molecule, not the gluten itself. This peptide strand wasn’t present in ancestral varieties of wheat, which could explain the increase in those reporting sensitivities to gluten today. However, this research is not conclusive and more data is needed before that reasoning becomes universally accepted.
In conclusion, if you suspect that you may have a reaction to gluten, my recommendation is to be properly diagnosed by a physician and not to try a gluten-free diet without the supervision of a medical professional.
Disclaimer: The information presented on this website is not intended to take the place of your personal physician’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your healthcare provider to determine what is right for you. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical condition.
Which Probiotic is Best for My Gut?
As a gastroenterologist in Plano, TX I receive a lot of questions from my patients regarding bacteria in our digestive system. With the emergence of probiotics, many people are wondering how much good/bad bacteria they should have and whether they need to supplement the number of bacteria their body naturally produces.
While there is not a definitive answer to those questions, I felt it was important to provide a brief background on probiotics and give the perspective of a gastroenterologist in regards to the potential benefits of probiotics. Hopefully, the information in this article will help to educate those interested in probiotics and in their evaluation of which probiotic may be best for them.
How Do Probiotics Work?
The National Center for Biotechnology Information notes that normal intestinal flora aids in digestion, fights off harmful bacteria & viruses, and produces vitamins. The intestinal floral can be damaged or lessened by a variety of things such as illness, hereditary diseases, radiation, chemotherapy, and antibiotics. That’s where probiotics come into play. Probiotics are live, friendly microorganisms that can improve the native flora within the digestive and respiratory systems. These microorganisms help break down food, assist in the absorption of nutrients, and can help fight off the harmful organisms that cause illnesses such as diarrhea, bowel diseases, and infections.
Probiotic Bacterial Strains – What’s the difference?
The two most commonly used groups of probiotics are Lactobacillus & Bifidobacterium. Lactobacillus organisms metabolize sugar to produce lactic acid. Bifidobacteria are the predominant bacteria in our intestinal flora. They produce acetic acid in addition to lactic acid, both of which are beneficial to our health.
There are many strains of bacteria within these two groups. Here are some of the strains used most often today.
- L. acidophilus – Occurs naturally in the mouth and gastrointestinal tract and aids in the fermentation of sugar.
- L. brevis – Normally found in the human intestines and excrement. L. brevis is also in many fermented foods.
- B. lactis – Breaks down body waste and helps with vitamin and mineral absorption. B. lactis has been found to improve digestion.
- B. infantis – Important for infant health. Can be passed along from mother to baby during pregnancy. B. infantis lives in our bodies our whole lives and improves digestion. Produces acid within the digestive tract making it more difficult for harmful bacteria and parasites to colonize.
- L. reuteri – Has been found to inhibit the growth of harmful bacteria, yeasts, fungi, and protozoa.
What is a Probiotic Delivery System?
A probiotic delivery system is the method by which probiotics are delivered into the body as usable, functional bacteria in large enough numbers to survive the harsh effects of the digestive system while still remaining effective.
There are two primary systems for which probiotics are delivered:
- Non-Conventional Commercial Products – Consists mainly of food products produced with probiotic strains. Yogurt, cheeses, cream, chocolate, milk, and even meat. These are good delivery systems that are readily available, convenient, and beneficial to those who use them.
- Conventional Pharmaceutical Formulations – These delivery systems tend to be the most effective formulations for the delivery of probiotics and come in the form of capsules, beads, and tablets. Pharmaceutical formulations tend to be more effective overall than the food-based systems.
Which Probiotic is Best for Me?
Each probiotic is different and which strains you take should largely depend on what ails you. Listed below are some of the most common digestive conditions and which probiotic may work best to treat and prevent them. However, keep in mind that it is recommended to discuss with your doctor before taking probiotics or other supplements to treat specific conditions.
- Diarrhea - Lactobacillus bacteria are considered the most effective in the prevention and treatment of diarrhea (especially in children when diarrhea is caused by rotavirus). L. reuteri has been found to reduce diarrhea for both rotavirus and non-rotavirus cases.
- Lactose Intolerance – L. acidophilus helps support the digestion of lactose.
- Irritable Bowel Syndrome (IBS) – Probiotic combinations that include bifidobacteria strains are suggested as working best to limit IBS symptoms. In particular, B. infantis has shown in some instances to reduce the pain, bloating, and constipation that are associated with IBS.
- Inflammatory Bowel Diseases
- Ulcerative Colitis – Studies have shown that there is a benefit to using probiotics to manage ulcerative colitis. Probiotics should be multiple strains of Lactobacillus and Bifidobacterium (particularly including B. infantis) as clinical trials did not show the efficacy of single strain probiotics. VSL#3 has been demonstrated to be of benefit in maintenance of remission in mild UC
- Pouchitis – VSL #3 which contains four strains of Lactobacillus and three strains of Bifidobacterium has helped some with relieving the symptoms associated with pouchitis
- Constipation – The Bifidobacterium are noted as the most effective in relieving constipation and the bloating associated with it. B. lactis has been found to be the most successful for relieving adult constipation but was not as successful in constipated children. Eating yogurt and fermented food, such as sauerkraut and pickles, can help alleviate constipation systems.
Probiotic Benefits – A Gastroenterologist’s Perspective
Probiotics certainly have a place in the management of GI symptoms but it is important to keep in mind that probiotic supplement efficacy is typically moderate as compared to traditional pharmaceuticals. As such, they are often better as a supplement to, rather than replacement for, traditional pharmaceuticals. Probiotic strain(s), quantity and preparation make a difference. Multi-strain or even dual-strain probiotics are not necessarily better.
I often get asked if routinely taking a probiotic or a probiotic yogurt is good for “general digestive health.” Product labels often indicate that their probiotic “improves digestive health” or “strengthens the immune system.” The FDA has not approved any health claims for probiotics. I suggest patient’s monitor if their own symptoms respond to taking the probiotic for a month. If not, your money is probably better spent elsewhere.
At present patient interest in “first-generation” probiotics is at an all-time high but “next-generation” probiotics and probiotic derived products are being worked on. Many questions remain to be answered.
“With a projected estimate of 50,000 deaths in the United States caused by colon cancer in 2017, this is something that everyone should be made aware of. While colon cancer is a very serious and real problem, it is highly preventable. The key is to follow the recommended screening guidelines and to spread this cancer awareness to others. I encourage everyone to join my colleagues and I at the Digestive Health Associates of Texas, by helping us spread the word about how colon cancer screening is the preventable option to beating colon cancer!”
Arshad Malik, MD
Colon Cancer – How does it start?
Typically, colon cancer starts as a polyp or a small clump of cells that form on the wall of the colon. A polyp grows on the inner lining of the colon or rectum, which can be cancerous depending on the type of polyp. The three prominent types of polyps are Adenomatous, Hyperplastic and Inflammatory polyps.
- Adenomatous polyps: These polyps sometimes change into cancer. Because of this, adenomas are called a pre-cancerous condition.
- Hyperplastic polyps: These polyps are typically benign and do not develop into cancer except in some syndromes where having excessive numbers of hyperplastic polyps raises the risk of colorectal cancer
- Inflammatory polyps: These polyps are not pre-cancerous.
Anyone can develop polyps, so that is why screening for them is so important. Colon polyps if found in the early stages of development can usually be completely removed.
Colon Cancer Screening Guidelines
The American Cancer Society recommended guidelines for colon cancer screening should begin at age 50 for most people. However, factors such as ethnicity and family history could result in starting this screening at an earlier age. It’s important to discuss this with your doctor and follow their recommendations on when to start this cancer screening.
Colonoscopy is considered the gold standard for colon cancer screening, since the physician can both screen for polyps and remove them. Other screening exams require a separate procedure to remove polyps. For more information on colonoscopy, I encourage you to visit the colonoscopy page on this website.
If you have questions or would like more information about colon cancer screenings – call my office at 972-867-0019.
2017 Colon Cancer Events in Plano, TX and surrounding areas
National Dress Blue Day
- Date: March 3, 2016
- Participation Info: http://www.dressinblueday.org
- Photo Contest: https://www.ccalliance.org/awareness-month/photo-contest/
TDDC Colon Cancer Fun Run (Austin)
Get Your Rear in Gear 5k Run/Walk
- Date: March 25, 2017
- Location: Trinity Park, pavilion 3 in Fort Worth, TX
- Event Info: 5k run/walk, kid’s fun run & 13-mile bike ride
- Food: 2 food trucks will be at the pavilion
According to the American Cancer Society, colon cancer is the third leading cause of cancer-related deaths in the U.S. and is expected to cause close to 50,000 deaths in 2016. As a gastroenterologist in Plano, TX promoting the awareness and prevention of colon cancer is very important to my practice. The gold standard procedure used to screen for colon cancer is colonoscopy. This is due to being able to both screen and remove polyps in the colon during the same procedure. However, since colonoscopy has a rather negative public perception I wanted to take an opportunity to provide some important information on this potentially life-saving procedure along with questions to discuss with your gastroenterologist regarding colonoscopy.
When Should I Get a Colonoscopy?
The American College of Gastroenterology (AGA) recommended guidelines for colon cancer screening should begin at age 50 for most people. However, factors such as ethnicity and family history could result in starting this screening at an earlier age. It’s important to discuss this with your doctor and follow their recommendations on when to start this screening.
How Can I Be Sure that My Gastroenterologist will do a Careful Examination?
While several types of doctors do perform colonoscopy, studies have shown that gastroenterologists have better results in detecting colon cancer. The AGA recognizes that when selecting a gastroenterologist there are 2 quality indicators that provide the best assessment of a physician’s skills and thoroughness during a colonoscopy – adenoma detection rate and the cecal withdrawal time.
The adenoma detection rate is the percentage of time that adenomatous or “precancerous” polyps are detected in asymptomatic individuals. Finding this type of polyp is the main objective of colonoscopy and decreases the incidence of colon cancer. The current goal for each provider as outlined by the American Society of Gastrointestinal Endoscopy is an adenoma detection rate > 25%. In 2015, Dr. Malik’s adenoma detection rate was 37% (females) and 39% (males).
The cecal withdrawal time is the duration it takes for the gastroenterologist to withdraw the scope after they have already advanced the scope to the beginning of the colon. The accepted minimum withdrawal time in the U.S. is 6 minutes. In 2015, Dr. Malik’s cecal withdrawal time was 8.3 minutes.
While these indicators are not currently available to the public, patients should feel free to ask their gastroenterologists their adenoma detection rate and average cecal withdrawal time when evaluating which doctor is best for them.
Why is Effective Bowel Preparation Important for Colonoscopy?
Bowel preparation for colonoscopy refers to the laxatives taken before the procedure to clean the colon of fecal debris. The less debris in the colon allows your gastroenterologist the best opportunity to identify a polyp or even a small cancer.
I’ll acknowledge that this is the most unpleasant part of the exam process, but also the most important! I’ve created a short video for patients that reinforces the importance of the prep along with a with a few tips to make it more pleasant -
If you have questions about the prep, I encourage you to discuss them with your doctor in advance of the colonoscopy.
Are there certain medications I should stop taking before colonoscopy?
Yes. Most gastroenterologists recommend to stop taking any aspirin or ibuprofen products. Also, stop taking blood thinners 3-5 days prior to colonoscopy. If you regularly take either of these, you’ll want to discuss with your gastroenterologist prior to the colonoscopy.
If I undergo sedation, should it be given by an anesthesiologist?
Most gastroenterologists work with nurse anesthetists to deliver sedation for the procedure. This is done since there is virtually no evidence that the procedure is any safer when an anesthesiologist is involved, and using an anesthesiologist for a routine procedure like colonoscopy, if you are healthy, is not a cost-effective medical practice.
If you have questions regarding the anesthesia used during colonoscopy, I recommend that you discuss with your doctor prior to the procedure so that they can address any concerns that you may have and make sure that you are as comfortable as possible during the colonoscopy.
Is the Colonoscopy Painful?
Since patients are under anesthesia during colonoscopy, there is no pain or discomfort.
How will I feel after Colonoscopy?
Most people feel fine after a colonoscopy, although it is perfectly normal to feel a little woozy from the anesthesia. Nurses will observe you as you awaken after colonoscopy and make sure that you are doing ok. Due to the anesthesia, all patients must have a ride home after the procedure and should not return to work that day.
What Happens if the doctor finds a polyp in my colon?
The purpose of a colonoscopy is to look for polyps and to remove them before they turn into cancer. Once a polyp is found several different methods can be used to remove it depending on the size and location of the polyp. As far as safely possible all polyp tissue is removed at the same time during the colonoscopy.
Since 2000, the month of March has been dedicated as National Colon Cancer Awareness month. As a gastroenterologist in Plano, TX, this is an important topic that I want to help promote to my patients and those in the Dallas area. I wanted to share some important information regarding colon cancer prevention along with some specific awareness events that are occurring in the Dallas, TX area in 2016 to help promote colon cancer awareness for our community.
2016 Colon Cancer Events in Plano, TX area
- National Dress Blue Day
- Date: March 4, 2016
- Event Info: http://DressInBlue.org
- Get Your Rear in Gear! 5k Run/Walk
- Event Info - http://www.coloncancercoalition.org/get-involved/events/
- Date: March 5, 2016
- Location: Trinity Park in Fort Worth, TX
- Undy Run/Walk
- Event Info: http://www.ccalliance.org/undy-runwalk/
- Date: November 2016
- Location: Not yet announced
Colon Cancer Facts
- According to the American Caner Society, colon cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death in the U.S.
- In 2016, approximately 140,000 adults will be diagnosed with colon cancer in the U.S. and 50,000 people are predicted to die of the disease.
- The lifetime risk of being diagnosed with colorectal cancer is about one in 19.
- With early screening and testing, colon cancer is Preventable, Treatable & Beatable!
What is Colon Cancer screening?
Colon cancer is one of the most preventable and treatable forms of cancer when it’s found early. Screening allows a gastroenterologist the ability to view your colon and check for signs of colon cancer. Dr. Malik uses colonoscopy to screen his patients for colon cancer. He prefers colonoscopy since it is the only colon cancer screening exam that can both screen for polyps and remove them.
In order to make colonoscopy more accessible to patients in the Plano, TX area, Dr. Malik offers an open colonoscopy option to qualifying patients. Open colonoscopy allows patients to schedule a colonoscopy without having an office visit prior to the colonoscopy. This will save patients the time and the expense of an office visit. Dr. Malik hopes that this convenience will help to increase the participation rates of those needing to be screened for colon cancer in the Plano, TX area. Detecting colon cancer in its early stages before it has time to grow and develop is the key to beating this deadly disease.
Colonoscopy Prep Tips
It’s important to remember that a clean colon is the key to a successful colonoscopy. The cleaner the colon is, the easier it is for your doctor to detect if any polyps are present. The day before your colonoscopy you will be on a liquid diet and then you’ll drink the prep that evening, which will start the process of cleaning out the colon.
Dr. Malik has provided a few tips on how to make the colonoscopy prep a better experience:
- The day before your exam drink lots of fluids (juice, broth, Jell-O, water) which helps flush you out and keeps you from being so hungry
- Put the bowel prep in the fridge to make it cool, but not too cold. The cool temperature will help the prep easier to drink.
- Put some flavoring in the bowel prep. I recommend using Crystal Lite packets.
- Use baby wipes. This will help to reduce potential irritation.
Everyone experiences a stomach pain once in a while, whether it’s from consuming something that your body doesn't like or having menstrual cramps (in women). But if you're experiencing stomach pains on a regular basis, it could be due to something you're doing every day. Examine these four common things you may be doing on a daily basis that is causing your stomach pains. Consult Plano gastroenterologist Dr. Arshad Malik MD if these symptoms persist.
Eating Foods Your Body Doesn't Like
One common cause of stomach pains is eating foods that your system doesn't "agree" with. Many people eat foods and drink beverages that they have unknown allergies to, and their bodies react accordingly. For instance, some people are allergic to gluten and dairy, which gives them upset stomach and problems properly digesting their food. It can also lead to problems like IBD (irritable bowel syndrome). Talk to Dr. Malik about an allergy test if this could be a potential issue.
You Don’t Chew Thoroughly
Patients of Plano gastroenterologist Dr. Malik are often surprised to learn that you're supposed to chew each bite of solid food (meats and vegetables) about 30 times for proper digestion. In reality, many people chew their food about 8-10 times before swallowing. This may cause your digestive system to have to work harder to break down the food, which could cause pains in the stomach.
Not Enough Fiber
Fiber is a substance that is specifically designed to smoothly push food through your digestive tract and eliminate waste. If you don’t have enough fiber in your diet, this could be a cause of stomach pains. As your bowels become compacted, this may cause a discomfort in your abdomen until the waste is finally eliminated. Try adding more fiber, including pears, oats, bran and whole wheat, to your diet to reduce stomach pains.
Overlooking a Possible Digestive Obstruction
In some cases your problem causing stomach pains could be some type of obstruction in your digestive tract. In this case, it’s important that you see Plano gastroenterologist Dr. Arshad Malik MD for an appointment. If you have stomach pains that won’t go away and are causing a strain on your lifestyle, call his office at (972) 867-0019 or visit http://www.arshadmalikmd.com to make an appointment request online.
Stomach pains can happen due to problems digesting food, gas or more serious concerns like ulcers and damage to the stomach’s lining. Some problems can be treated with antacids and a better diet, but there are some cases that should be seen by a doctor. Take note of these signs. For persistent stomach pains see you Plano gastroenterologist Dr. Arshad Malik MD for further evaluation and treatment.
The Pain Is Unbearable
It’s normal to have some discomfort in your stomach and digestive system, especially after eating a big meal. But when the pain is unbearable, where you’re doubled over, can’t walk, can’t work or can’t eat, it’s time to get it treated by Plano gastroenterologist Dr. Malik. The most important thing to remember is that stomach pains shouldn’t disrupt your normal life.
When your stomach pains are accompanied by unexplained vomiting, it may be time to see a doctor. Vomiting could be a sign that there’s a more serious gastro problem that won’t go away with home care and basic dietary changes, such as an infection, inflammation, ulcer or even food poisoning. Make an appointment to have the doctor evaluate this combination of symptoms immediately.
Inability to Eliminate
If you find it difficult or impossible to move your bowels while experiencing stomach pain, this also could be a sign of an issue that needs to be resolved at a doctor’s office. Constipation and stomach pain could be a sign of some type of blockage or a medical condition like IBS (irritable bowel syndrome).
Getting Help with Stomach Pains
If you’ve been displaying any of these symptoms, don’t wait another day to get in touch with Plano gastroenterologist Dr. Arshad Malik for an appointment. The doctor will diagnose your issue with an exam and tests, then provide you with the best treatment plan for your specific case. Call the office at (972) 867-0019 or visit the practice’s website at http://www.arshadmalikmd.com to make an “Appointment Request.”
Welcome to the Blog of Arshad Malik MD
Arshad Malik MD would like to welcome you to our blog. Here you will find informative and useful postings about gastroenterology and our practice.
At Arshad Malik MD we believe that educated patients are better prepared to make decisions regarding the health of their digestive system. Our blog was designed to provide you with the latest gastroenterology developments and valuable health advice from our dedicated team.
Arshad Malik MD hopes you find our blog to be a great resource for keeping up to date with proper digestive health care and treatments.
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