What It’s Like to Have a Colonoscopy

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A colonoscopy is a procedure designed to examine your colon, and for that to happen effectively, the colon must be clear of all food and waste material. Based on my personal experience as well as Paula’s, the preparation for the colonoscopy is infinitely worse than the actual colonoscopy. There are several medical websites that will give you details of the procedure complete with diagrams and video. That’s not my purpose in this Memo, so there will be none of that sh*t here (sorry, I couldn’t resist).

The Colonoscopy Preparation

Preparing for a colonoscopy requires that you consume no solid food for 24 to 36 hours before the procedure. What you consume are laxatives and fluids designed to completely empty your colon. The reason is simple: if there’s any waste material in the colon, the physician won’t be able to see the lining of this organ and thereby will be unable to examine its health.

The best way to describe the prep is to take the worst case of diarrhea you’ve had and multiply it times three. You won’t necessarily have the cramping that goes along with a bacterial or viral infection that causes diarrhea, but soon after you take the laxatives, you will have to visit the bathroom again and again and again—and then again. I’m going to predict that you won’t always make it in time, so be sure you don’t plan to be anywhere but at home close to the bathroom.

But here’s the upside: you can use it as a legitimate colon cleanse because that’s exactly what it is. If you want to reset your digestive system by emptying it completely, a colonoscopy will certainly do that.

The Colonoscopy Procedure

The medications they use today during the colonoscopy are far different from what they used to be. I fell asleep in about two seconds and remember nothing; Paula was semi-awake throughout so she remembers a little. The point of the procedure is to visually inspect the entire length of the colon for abnormalities. The equipment is a long tube with a camera and a secondary tube to add air to the colon to make it easier to inspect. The two most common concerns are polyps and diverticula.

Our Results

My colonoscopy was completely uneventful, but Paula had two columnar polyps that were completely removed to be tested. The lab technologist found no indication of abnormal cells, so she’s in the clear; there are many types of benign polyps, and hers seem to be the most common. What does it mean? It means she’s fine for now but has to do the colonoscopy (and its prep) all over again in five years instead of ten.

The Bottom Line

If you’re serious about taking charge of your health, you have to know its status. A colonoscopy is a part of that process as we get older or if we have genetic tendencies toward colon cancer. I understand the personal nature of the procedure. Really, no one wants to see a 15-foot hose and think, “You’re going to put that where?” But it’s another point of taking charge and aging with a vengeance.

If it’s time for you to get it done, don’t delay any further; call your primary care provider and get a referral. Ignorance is not bliss, and it has no place in Aging with a Vengeance.

What are you prepared to do today?

        Dr. Chet

Protecting Your Colon Health

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I’m sure you’ve heard the Benjamin Franklin quote “An ounce of prevention is worth a pound of cure.” That axiom is true about many things from fire prevention, as Franklin intended, to our cars and lawn mower. The same is true when it comes to our bodies. Paula just had a colonoscopy, so I thought it appropriate to talk about preventive colon health.

To set the stage, experts estimate a colon cancer growth rate of 2% to 3% per year globally. Early stage detection increases the survival rate, which is close to 100% at Stage 0 and goes below 5% at Stage IV.

One of the primary risk factors for colon problems such as colon cancer and diverticulitis is age. Therefore beginning about the age of 50, a baseline colonoscopy is recommended. Depending on the results, it’s repeated every ten years if your colon is clear or more often if growths called polyps are found.

In the future, we’ll also have our microbiome health examined as well. In a recently published study, researchers examined the microbiome of centenarians of Asian descent. There appears to be a similar pattern of microbes between people who live to 100 and longer in that culture. There’s a lot of research to go to establish both patterns and testing procedures. For now, we have to stick with what we know.

What’s a colonoscopy like? How did Paula fare? What can we do to improve our colon health? I’ll talk about all that in the next Memo.

What are you prepared to do today?

        Dr. Chet

Reference: Nature. 2021. https://doi.org/10.1038/s41586-021-03832-5.

Addressing the Systems of Health and Disease

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A systems approach to dealing with diseases and conditions is not what we currently do: if you have pain, you want to relieve the pain. That approach may fix the symptom, but it also may not fix the failure of a complex system that caused the problem. If you’ve broken a bone or had a torn ligament surgically repaired, that was not a system failure, but the approach to get things back to normal would be the same. Multiple systems would be involved, not just pain control.

To illustrate the point, I’m going to talk about one of the most complicated conditions: carrying too much body fat. It affects 70% of the population of the U.S. and is a growing problem around the world. My advice for dealing with it goes like this: Eat less. Eat better. Move more. Those recommendations really don’t change, but to permanently lose the weight and keep it off, the number of systems involved is staggering.

A Systems Overview of Obesity

Here are some of the questions yet to be answered about organs and systems that are involved in weight reduction:

  • What will happen to fat cells? The fat cells manufacture hormones that can impact appetite and hunger. At this point, there’s no research to suggest they’re ever reabsorbed.
  • The pancreas produces digestive enzymes and insulin. How will less food or different foods along with more exercise impact their involvement in digestion and metabolism?
  • Our taste buds have developed over the years. Will they change to reduce the taste and feel of sugar, fat, salt, and umami we may crave?
  • Can the impact of insulin on the liver change? Your liver develops a process to convert carbohydrate to fat and store it. Will that be reversed?
  • Will the adrenal gland respond to the decrease in fat intake and cholesterol production to reduce the production of cortisol and lower inflammation?
  • What happens to the microbiome in the long term? Does it adapt? Does it stimulate hunger or decrease it?

I could go on and on, but I think you get the point. It’s complicated to deal with complex systems. We don’t have the answers yet because we haven’t been asking the right questions.

The Impact of Aging on Complex Systems

We know as people age, we lose muscle mass, gain body fat, and lose bone density among many other changes. What we don’t know much about is the specific changes in every type of cell, organ, or system. If we don’t have that, we may not be able to address the correct cog in the system. That doesn’t mean we shouldn’t try; we can take what we currently know about how our bodies change over a lifetime and use that as a starting point. The earlier in life the better, but we still have to deal with individuals and the bodies they have right now.

We live a lot longer than we did 100 years ago. It’s time we began making those years better in every way rather than simply managing pain and other infirmities.

The Bottom Line

This challenge lies before us: Find a way to manage complex systems in order to not just survive but thrive throughout our entire lives. That’s where I’m headed in developing Aging with a Vengeance. We have to deal with the changes from aging that contribute to where we are today, regardless of age. Along the way, we’ll find out the optimal age for preventing some of those issues or at least slowing them down. I’m pumped for this journey to be the best version of ourselves, regardless of our current age or physical state. We just have to keep our heads in the game.

What are you prepared to do today?

        Dr. Chet

How Complex Systems Fail

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If we acknowledge that the human body is itself a complex system and is made up of individual complex systems, then we can examine where things may go wrong to cause disease. In order to “fix it,” we have to be able to identify where things can go wrong. For ideas on that, I’m going to use a paper written in 1998 by Dr. Richard Cook titled How Complex Systems Fail. If you get a chance to read it, please do so at the link below. In the paper, he talks about how large organizations such as healthcare systems and other businesses can fail as complex systems. There are 18 points in the article and not all apply directly to the human body; I’m going to use only the first two in this memo.

Complex systems are intrinsically hazardous systems.

Your heart beats between 60 to 80 beats per minute on average. In order for it to do that, it relies on the muscular system of the heart, the nervous system within the heart as well as the autonomic nervous system, hormones, blood vessels, and on and on. In one heartbeat, there are intrinsic hazards in many locations that can impact whether the heart works well or doesn’t.

Complex systems are heavily and successfully defended against failure.

The best example of this is your immune system. Every day, you’re going to have cells that do not reproduce correctly. If not addressed immediately, they could grow into some form of cancer or other type of abnormal cells, but your immune system recognizes that the protein structure is incorrect and eliminates it.

The same holds true for every system in the body. Some of the trillions of cells in the body fail just about every second of the day, but there are safeguards and defense mechanisms that clean up after the problem cells. If these defense mechanisms didn’t work, none of us would be here.

While there are other points that apply to the human body in the document, the first two set the stage for dealing with diseases and conditions once systems fail. I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: How Complex Systems Fail. RI Cook, MD Cognitive Technologies Laboratory. University of Chicago. 1998.

The System Theory of Disease

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I first heard about systems and disease in a TED talk by Dr. David Agus, an oncologist in Southern California. (You can watch that TED talk by clicking the link above or copying the one in the references.) In it, he talks about how cancer is being treated: attack the cancer directly wherever it’s located. Based on a follow-up in the 12 years since his talk, I don’t know that things have changed a great deal.

The problem is that cancer is a complex system once it gets established. That’s why early diagnosis is critical. He goes on to say that cancers can be cured if caught early; if they’re not, the odds that the cancer can be eradicated decrease tremendously. That’s a little disheartening, to say the least, but out of that came a theory: a systems theory of disease that I’ve been thinking about since I heard that first talk.

Diseases Result from System Failure

The basis for my theory of disease as a system is that we have to look at all systems and organs involved in a disease, not just a specific organ. When it comes to something like cancer, it could include the cardiovascular system that sends blood and thereby nutrients to the tumor, no matter where the tumor is located. Restricting the blood flow to the tumor in some way can certainly impact its ability to gain nutrients, get rid of waste products, and inhibit it from defending itself.

In my opinion, we can use this approach for every disease and condition. We think in terms of doing one thing to be able to deal with a disease or condition: attack what we perceive as the cause. What we have to understand is that a condition such as obesity is not just a matter of overeating and under-exercising. Many of you have heard me say that it’s all about the calories—the end. I’m not modifying that because it really is about the calories, but the diet, the exercise, and other factors may be different for different people to achieve a solution to excess body weight based on genetics. For example, if you want to lose weight, maybe you first need to get treatment for your depression or your insomnia.I think the same is true for cardiovascular disease, type 2 diabetes, and on and on.

Systems and Aging

These days, my focus is on the diseases and conditions associated with aging: loss of muscle mass, excess body fat, changes in brain and memory, hypertension, vision, and so on. Each one is associated with complex systems, and thus must be dealt with in a multi-factorial way. That’s the purpose of Aging with a Vengeance: to find those solutions.

But before we get to that, we need to identify why complex systems fail. What goes wrong? How did they go wrong? That’ll be the focus of Tuesday’s memo.

What are you prepared to do today?

        Dr. Chet

Reference: Dr. David Angus TED Talk. https://bit.ly/2ThlJt5

The Systems Theory of Health

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When we consider Aging with a Vengeance, a systems approach to health is critical. We cannot consider one issue such as high blood pressure or arthritis without understanding that it’s not just a single organ or parts of organs that are involved in improving if not completely fixing a health problem. As Aging with a Vengeance progresses, a systems approach will be a critical component of the process.

The concept of a systems approach to biology and subsequently healthcare originated in 1969 with an Austrian biologist, Karl Ludwig von Bertalanffy. He described what has since become known as General Systems Theory. This is the concept that “systems cannot be reduced to a series of parts functioning in isolation, but that in order to understand a system as a whole, one must understand the interrelations between its parts.”

It seems obvious when you read it, but that’s not how we approach health and disease today. Blood pressure involves the heart and blood vessels, but also the renal system and the nervous system, to name just two others. Our health is reliant on multiple organs working as part of a system and interacting with other systems. That also means that disease does as well. More about that on Saturday.

Tomorrow night is the monthly Insider conference call. I’m going to talk about a review study of the metabolism of artificial sweeteners you don’t want to miss. I’ll also answer Insider questions. Isn’t it time you became an Insider?

What are you prepared to do today?

        Dr. Chet

Reference: J Thorac Cardiovasc Surg. 2016 August ; 152(2): 593–594.

Artificial Sweeteners and Your Digestive System

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Before I address the concerns of the study on artificial sweeteners I talked about on Tuesday, be assured that I’m bringing you the facts as I interpret them. If you don’t use artificial sweeteners, I’m not trying to convert you, but I’m not going to let slide inflammatory headlines that only seek to raise fear where none should exist. The problem with the artificial sweeteners study is that it didn’t use a systems approach.

Bench Science

What the researchers did would be considered bench science. It’s basic in its approach: create a medium where the bacteria will grow, throw in various quantities of the artificial sweeteners, and see what happens. That’s a good first step in any type of research to see an impact on an entire organism. The same is true for examining the effect of the artificial sweeteners on the bacteria in the cancer cell medium. They established that chronic exposure to artificial sweeteners cause two probiotics to become pathogenic.

However, that’s where it ends. Trying to explain an increase in the obesity and diabetic epidemics because of how artificial sweeteners may impact a couple of gut bacteria doesn’t make any sense. It’s stretching things way too far with no evidence that what they’re describing happens at all. In effect, they’re trying to explain a health issue by looking at potential causes. Fine, good start—but now there’s a whole lot of animal and human clinical research that has to take place in order to prove whether it’s true, because what happens in a lab is often not what happens in a human.

Bench science has its place for sure, but it has serious limitations. In our headline-a-minute world, everyone is too eager to claim credit for something that hasn’t been proved.

The Digestive System

The human body is made up of various systems; the digestive system is one of them, but it doesn’t begin and end with the epithelial cells of the intestine. Food (including artificial sweetener) starts in the mouth with its salivary glands, goes down the esophagus, enters the stomach with its specialized fluids, travels the 20 to 30 feet of small intestine where more unique fluids do their jobs, and then the 10 to 15 feet of large intestine before it exits the body. The digestive system doesn’t act alone; it requires input from other organs and systems along the way: the pancreas, the liver, and so on. Every one of those could have an impact on the metabolism and elimination of artificial sweeteners and could impact how bacteria behave in the digestive system.

I could write a book on this subject, but let me just point out one thing that should be obvious: they tested two probiotic lines. Two. As of the last count, there are at least 6,500 different microbes that coexist within our digestive system. There are also trillions of them, each with a role to play, and we still don’t know what each and every one does. As I said, it’s complicated.

The Bottom Line

This study illustrates where good research begins: in bench science. There’s a lot more science that has to happen before we become alarmed about whether or not artificial sweeteners directly impact our microbiome, but their approach does raise a question that I’ll talk about next week: a systems approach to Aging with a Vengeance. We look at pain or other conditions as something that stands alone, but in reality, we may need a systems approach to deal with it.

What are you prepared to do today?

        Dr. Chet

Reference: Int. J. Mol. Sci. 2021, 22, 5228. https://doi.org/10.3390/ ijms22105228

Are Artificial Sweeteners Toxic to the Microbiome?

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If you use artificial sweeteners and you saw the words “danger,” “artificial sweeteners,” and “serious health issues” all in the same headline, you’d probably be concerned. The headline recently appeared in my newsfeed, and because many of us use artificial sweeteners, I had to check it out. Here’s what researchers found in a study published in the International Journal of Molecular Sciences.

The researchers examined the impact of three artificial sweeteners (aspartame, sucralose, and saccharin) on two strains of probiotics and one form of tissue from the digestive system. First, they tested whether the artificial sweeteners at various concentrations impacted the growth of the bacteria in a typical medium. They didn’t (with the exception of saccharin at the highest concentration.)

Then they tested whether the sweeteners affected the ability of the bacteria to produce a biofilm, something that’s important to our intestinal health. They didn’t.

Finally, they examined whether exposure to artificial sweeteners would cause changes in the bacteria to make them pathogenic; that can happen, for example, with E. coli. Using cell lines drawn from an established line of colon cancer in this experiment, they demonstrated that the bacteria could potentially become pathogenic and enter the cell walls of the epithelium. That means they could theoretically enter the bloodstream and impact our health.

That sounds pretty bad, right? It certainly seems to merit the use of the words “artificial sweeteners,” “dangers,” and “serious health issues” in a headline. But is it of any real concern to you and me? I’ll let you know in Saturday’s memo as we talk about an important topic related to Aging with a Vengeance.

What are you prepared to do today?

        Dr. Chet

Reference: Int. J. Mol. Sci. 2021, 22, 5228. https://doi.org/10.3390/ ijms22105228

Want Fewer Medications? Change Your Lifestyle

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The study that we examined on Tuesday showed that a regular exercise program can help reduce the number of medications related to cardiovascular disease and type 2 diabetes. We’re not talking about youngsters; 51 subjects completed the study with an initial mean age of 54. There were some outcomes that were likely unexpected; for example, waist circumference did not change between the experimental group and control group over the five years. There was a significant decrease in body fat in the exercise group that explained the difference in body weight. Still, the control group lost about two pounds in five years while the exercise group lost about six pounds. That actually turns out to be a good thing, as I’ll explain a little later.

The Exercise Program

The high-intensity interval training was just as advertised: intense. It included a 10-minute warm up, followed by four 4-minute intervals at 90% of maximum heart rate (HRMax) interspersed with 3 minutes of active recovery. They finished with a 5-minute cooldown. They used percentage of HRMax as assessed in the exercise test, because that’s an intense level. The focus is on the 4 minutes but those 4 are brutal. You do get to rest, but then you have to do it over again, and that’s a significant challenge to the cardiovascular system. As people got fitter, the intensity would be changed to sustain the 90% level.

What surprised me was that there was no organized exercise activity in the other eight months of the year; they just kept track of activity levels using the activity monitors. There were no differences between the control group and the exercise group in the eight months with no organized activity. That’s interesting.

Most Variables Didn’t Change

This probably surprised the researchers, but it was a desirable outcome. There were no significant differences in body fat, waist circumference, BMI, or overall percentage of body fat. While the subjects probably would have liked to have lost more weight, the fact that they didn’t shows that the changes that occurred in the risk factors for cardiovascular disease, such as high blood pressure and low HDL cholesterol as well as a lower insulin levels, showed that the difference was the actual exercise program itself. The differences in distribution of nutrients in the diet and in the total caloric intake were insignificant. As I mentioned earlier, the number of steps per day and other activities were still even. That means, again, the changes could be attributed to the exercise program alone.

The Bottom Line

What is abundantly clear is that if you really want to reduce medications, you have to pay the price by changing your lifestyle. In this study they focused on one variable: exercise. If you add a change in dietary intake, and or a change in the distribution nutrients, you may get even more benefits. But for me, it answers the question that I started with. You want to reduce medications? Change your lifestyle.

Is it worth it? That’s your call. But that’s what Aging with a Vengeance is all about.

What are you prepared to do today?

        Dr. Chet

Reference: MSSE. 2021. 53(7):1319-1325.

Can You Reduce Your Medications?

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One of the questions that I get asked frequently goes something like this: “Dr. Chet, how can I reduce the medications I’m taking?” Along with that question is, “I don’t want to have to take medications for blood pressure or cholesterol or diabetes. What can I do?” As we proceed with a focus on Aging with a Vengeance, a recently published study illustrated at least a partial answer to these questions.

Researchers in Spain recruited 64 subjects for an exercise program. The exercise program was a high-intensity interval training (HIIT) program, three days a week, that ran for four months under staff supervision. The rest of the year these subjects were given activity monitors that automatically uploaded data on activity, sleep, etc. The researchers also took a variety of blood samples for testing metabolic variables, tested the subjects’ fitness levels, assessed anthropomorphic measures such as body weight and waist circumference, and recorded medications related to blood pressure, cholesterol, triglycerides, and blood sugars. The subjects were retested after two years and again after five years.

Over the period of five years, an amazing 51 subjects completed the exercise sessions and all the testing required. That, in and of itself, is remarkable—I’ve done this type of study, and holding on to the subjects is one of the main challenges.

The primary question was answered: those who exercised as the study required took fewer medications for blood pressure, cholesterol, and blood sugar control. As you might expect, that isn’t the entire story, so we’ll wrap this up on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: MSSE. 2021. 53(7):1319-1325.