RHR: The saturated fat – heart disease myth, colonoscopy health risks, and intermittent fasting

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In this episode we talk about a really interesting study that came across my desk on the saturated fat – heart disease myth. I also revisit the colonoscopy question we had in a previous episode and take questions from Facebook.

In this episode, we cover:

3:55 New Study: is the saturated fat – heart disease myth finally dead?
18:18 The health risks associated with colonoscopies
29:12 Managing histamine intolerance
34:40 Chris answers: “What is health?”
44:00 Does intermittent fasting harm the adrenals?
51:30 Chris Answers: “What is your workout routine?”

Links We Discuss:

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Full Text Transcript:

Steve Wright:  Hi and welcome to another episode of the Revolution Health Radio Show.  This show is brought to you by ChrisKresser.com.  I’m your host, Steve Wright, and you can find my work at SCDLifestyle.com, but we’re both here to learn from integrative medical practitioner and healthy skeptic Chris Kresser, so Chris, how’s your day going?

Chris Kresser:  My day is going great.  It’s a sunny, clear, beautiful day here in February in California.  Can’t complain.  How are you?

Steve Wright:  My day is good as well.  You know what?  We actually have a clear, sunny day in Michigan as well!

Chris Kresser:  Fabulous.  Well, I’m excited.  I posted a little request for questions on Facebook yesterday and was surprised to get 194 of them in less than 12 hours, so we better hurry up if we’re going to get to all those questions today, Steve.

Steve Wright:  Yeah, I was trying to take some classes on speed-reading and speed-talking, but I don’t know if we’re going to do it, Chris.

Chris Kresser:  Haha.  But we have enough for a couple years now on the show, so that’s good news.  There were some great questions, actually.  It was hard to pick some, and of course, we have a backlog of some from the podcast submission form as well.  So, I think we’re good for a little while.

Steve Wright:  Yeah, we’re definitely good until at least 2014, but we would still appreciate more questions.

Chris Kresser:  Yeah.  It’s fun to get fresh questions.  That’s why I like posting to Facebook to see what people are thinking about right now, and the other cool thing about Facebook is other people will like questions that they have as well, so then we can kind of get a sense of which questions are most relevant to people that are listening to the show.  So, go social media!

Steve Wright:  Yes, go social media!  And if you want to follow Chris and where all this action took place, head over to Facebook.com/ChrisKresserLAc.  And we didn’t solicit Twitter that I know of, but if you want to follow Chris on Twitter, it’s Twitter.com/ChrisKresser.

Chris Kresser:  Yeah, well, maybe next time we’ll just do Twitter and get the Twitter crowd.

Steve Wright:  Yeah, we could do a tweet-a-thon question thingamabob.

Chris Kresser:  Haha, all right.  So, are you ready to dive in Steve?  Shall we do it?

Steve Wright:  I am but most importantly I need you to make sure you’re fresh because 194 questions — you better have your voice with you, so get some water, some tea, some coffee, all of those things above, and I want to tell everyone about Beyond Paleo.  So, if you’re new to listening to the Revolution Health Radio Show, if you’re new to the paleo diet, or you’re just interested in optimizing your health, you’re going to want to check out what over 10,000 other people already have signed up for.  It’s a free 13-part email series that Chris has put together called Beyond Paleo, and like I said, it’s 13 emails that Chris has put together on tips and tricks for burning fat, boosting energy, and preventing and reversing disease without drugs.  Now, if this is something you’re interested in, head over to ChrisKresser.com, look for the giant red box in the middle of the page, and go ahead and put your name and email in there and get on the list.

OK, Chris, how’s the voice?

New Study: is the saturated fat – heart disease myth finally dead?

Chris Kresser:  It’s pretty good, pretty good.  So, I’m going to talk about a really interesting study that just came across my desk today, so to speak, and I want to revisit the colonoscopy question that we had.  I said I would come back to that after doing a little more research.  This isn’t going to be the conclusive answer on the subject, and I don’t know that there is one actually, but I’ll talk a little bit more about that, and then we’ll get into some questions.

Steve Wright:  OK, perfect!  So, what is the study?

Chris Kresser:  This was a study about omega-6 and saturated fat and their respective relationships to heart disease.  More specifically actually, what the researchers did — This was Christopher Ramsden, his group.  He has done a lot of the studies on linoleic acid, omega-6 polyunsaturated fat, and heart disease.  And what they did is they went back and resurrected some data from the Sydney Diet Heart Study, which was done in the 1960s, and reanalyzed it using modern statistical methods.  Some of the data from that study wasn’t published in the original reporting of that study, and so they went back and looked at the raw data and then reanalyzed it.

You know, one of the cornerstones of the advice given for heart disease, at least in the mainstream paradigm, is to replace saturated fat with polyunsaturated oils, so soybean oil and corn oil and safflower and sunflower oil.  I think that’s changing a little bit now.  In fact, I think the most current guidelines don’t suggest those oils.  They talk more about the monounsaturated oils, like olive oil and stuff like that, but still there are a lot of people out there who were listening for those 20 or 30 years that the mainstream health organizations were telling people not to eat saturated fat and to eat margarine and corn oil instead.  And when this advice originated back in the ’60s, polyunsaturated fat and omega-6 were used interchangeably as terms because at that time, they only really knew about linoleic acid.  They didn’t know about the omega-3 fats yet.  And so, a lot of the early studies that suggested that polyunsaturated fat or omega-6 were beneficial also included omega-3’s because they didn’t know enough to separate them out.  Of course, we now know that omega-3’s have really different properties than omega-6, and when you actually look at studies that separate linoleic acid, which is the main short-chain, plant-based form of omega-6 fat, from the omega-3’s, there’s really no evidence that replacing saturated fat with linoleic acid lowers heart disease risk, and there’s some evidence that it might even increase it, which this study contributes to.

So, as I mentioned, this paper resurrected data from the Sydney Diet Heart Study.  It was a randomized, single-blind trial from 1966 to 1973, and it’s a pretty unusual opportunity to study the effects of linoleic acid because they used safflower oil, which is 75% linoleic acid by weight, so if you have 100 g of safflower oil, 75 g of that is going to be linoleic acid.  And there are no other polyunsaturated fats in safflower oil, so you don’t run into the problems that we have in other studies where you have multiple polyunsaturated fats and you can’t tell which one is having which effect.  So, the participants were men between 30 and 59 years old who had recently had a heart attack or an acute episode of angina, and there were 221 men in the intervention group and 237 in the control group, and the intervention group was told to increase their linoleic acid or total polyunsaturated fat intake to 15% and to decrease saturated fat and cholesterol to below 10% per day.

And a really important point about this study is that some people in the control group went ahead and decreased their saturated fat intake and increased their linoleic acid anyhow after their heart attack on their own.  They weren’t told to do that by the study investigators, but they had heard enough maybe through the media or whatever and they had recently had a heart attack and they thought maybe it was the butter or something, and so they did that on their own.  So, this study was not a perfect — as observational studies rarely are — it wasn’t a perfect separation between people who were following these guidelines and people who weren’t, and what that means is that the difference that was observed between the two groups could have been even greater if the control group was strictly just eating animal fats rather than vegetable oil or a combination of vegetable oil and animal fats.

So, what the researchers did is they provided the participants in the trial with safflower oil and safflower oil margarine — mmm, yum — and then they also gave them safflower oil to take in capsules as a supplement.

Steve Wright:  Oh, wow.

Chris Kresser:  Yeah.  So, it was a little different than just a completely free-living study where they gave instructions and then just left it up to the participants to do whatever they were going to do.  They actually provided the safflower oil and the margarine for them to use as fats to put on their toast and use in salad dressing and things like that, and then they also gave them safflower oil in capsules, so definitely not like a metabolic ward study where people were living in the hospital while they were doing this, but it was a little bit better than a typical free-living study.  And then the food frequency questionnaires were every seven days, which is really much more frequent than they typically are in these longer-term studies.  You still have some of the problems of people not being able to remember what they ate, but those should be a little bit less with seven-day questionnaires rather than people being asked to remember what they ate six months or a year ago.

In this study, because of the way it was designed and using safflower oil, which is pretty much mostly linoleic acid with no other PUFA, they were able to selectively increase linoleic acid levels without also increasing omega-3 levels.  So, what were the results?  The intervention group, the people who had the safflower oil and decreased saturated fat, had an increased risk of death from all causes, 17.6% versus 11.8% in the control group; they had an increase in death from cardiovascular disease, 17.2% versus 11%; and then an increase in deaths from heart disease, 16.3% versus 10.1%.  And the researchers calculated that an increase of 5% of calories from linoleic acid predicted a 35% increase in deaths from cardiovascular disease and a 29% increase in deaths from all causes.

Another important thing about this study is that the intervention group that had a statistically significantly higher risk of death had lower cholesterol levels than the control group.  So, linoleic acid did indeed reduce their cholesterol levels, but they were more likely to die, and that’s really important to get because some of the studies that suggest that omega-6 linoleic acid improves heart disease risk didn’t even have mortality as an endpoint.  All they did was look at people’s cholesterol levels, and if the cholesterol levels went down, in the conclusion of the study they’d say:  Oh, it reduces the risk of heart disease because everybody knows that when your cholesterol levels go down, your risk of heart disease goes down as well.  Of course, we know that there are studies that actually show the opposite and that the concentration of cholesterol inside of the lipoprotein is not the main driving risk factor for heart disease, but there’s this whole group-think thing that happens, and in the studies they don’t even bother sometimes to cite a reference for that when they make that claim.  It’s just so deeply ingrained that they figure they don’t even need to cite a reference for it.  So, yeah, the cholesterol levels went down, but people still died more frequently in the group that was eating more linoleic acid.

And the researchers went on to speculate a little bit about the mechanisms.  The theory is that omega-6 fats are — and this isn’t so much a theory.  This is pretty well established that they’re very fragile and vulnerable to oxidative damage.  And studies have shown that oxidized metabolites of linoleic acid, which are referred to as OXLAMs, are the most abundant oxidized fats in oxidized LDL particles.  So in other words, when LDL oxidizes, it’s usually the linoleic acid in the LDL particle that oxidizes, and this is important because oxidized LDL is potentially much more atherogenic than normal or native unoxidized LDL because it stimulates collagen formation, which forms the fibrous plaque.  It weakens plaque stability, which makes plaque more likely to rupture, and that’s the precipitating event for a heart attack.  Oxidized LDL is smaller and denser than native LDL, which makes it more likely to penetrate the fragile lining of the artery, and that’s what initiates the process of plaque formation.  So, when you put all those together, it might explain why some recent trials have shown that if you look at omega-6 individually in studies where they isolated the effects of linoleic acid from other polyunsaturated fats that it increases the amount of these OXLAMs, these oxidized metabolites of linoleic acid, and possibly increases the risk of heart disease because of that.

And then there was another study recently that showed that lowering linoleic acid in the diet reduced levels of OXLAMs and their precursors and then increased levels of EPA and DHA.  So, it’s just another study to add to the pile of research that we already have that suggests that we should base our diet on traditional fats that human beings have been eating for a very, very long time that we get naturally from eating animal products, long-chain saturated fats, medium-chain triglycerides, and omega-3 long-chain fats DHA and EPA from eating cold-water fatty fish are particularly important.  And then a low to moderate amount of omega-6 linoleic acid as it naturally occurs in things like nuts and avocados and poultry is fine, but this idea that we should be dramatically reducing our saturated fat intake and increasing our intake of vegetable oils to protect against heart disease really just has no support for it in the scientific literature.

Steve Wright:  Well, I can’t say that I’m surprised, Chris.

Chris Kresser:  No.

Steve Wright:  But I will try to add to the conversation.  I think something that is still kind of confusing to some people in the health sphere that we work in is this idea that some of the higher-level fats can actually convert into EPA and DHA.  Can any of the linoleic acid actually convert into EPA or DHA?

Chris Kresser:  No, those are different pathways.  You have conversion and retroconversion in both pathways.  For example, some of the longest-chain omega-3’s can retroconvert to EPA, which is a long chain but it’s not the longest, so you can go backwards in the conversion process in some circumstances.   And the main conversion process that happens is from the short-chain fats to the longest-chains.  So, alpha-linolenic acid is the short-chain omega-3, and that has to go through several steps to get to EPA, and then further down the line is DHA.  And I think I mentioned this before, but less than half a percent of alpha-linolenic acid, the plant-based omega-3 that’s found in flax and walnut, gets converted into DHA, which is probably the most beneficial long-chain omega-3 fat.  Something like 5% gets converted into EPA.  But that’s in healthy people, and the enzymes that are required to make those conversions are dependent on B6 and zinc and other micronutrients that a lot of people are deficient in, especially vegetarians and vegans who need that conversion to be more efficient because they’re only eating the shorter-chain fats, so there’s kind of a cruel irony there, where they’re more likely to be deficient in the nutrients that are needed to make those conversions, and the conversion is already so poor, even in people who have sufficient amounts of those nutrients.  And then the other thing where the relationship is, is that omega-6 can compete for some of the conversion enzymes, and so if you have an excess of omega-6 in your diet, that’s going to impair your conversion of short-chain omega-3 to the EPA and DHA.  That can be mitigated to some extent by just eating EPA and DHA, so you don’t need to worry about the conversion as much, but particularly for people who aren’t eating those longer-chain fats, it’s really problematic if they have a diet that’s high in omega-6.

Steve Wright:  And that’s why you recommend eating fish several times a week, correct?

Chris Kresser:  That’s right.

The health risks associated with colonoscopies

Steve Wright:  All right.  So, shall we move on to the dirty subject of colonoscopies?

Chris Kresser:  Yeah, let’s do that.  One of my listeners, Tucker, forwarded me an article about this subject, I think after he had heard us talk about this on the last podcast, and it was an article on a blog called the Roar of Wolverine, which is a pretty cool name for a blog if you ask me!  I don’t know the person who writes this blog.  He has a really fascinating story that’s relevant to the topic we’re discussing here, which I’ll get into in a second, but in this article about colonoscopy, he linked to study suggesting that colonoscopies may cause more deaths than they prevent, and this is something I touched on when we were talking about this originally.  In a lot of these screening procedures, that’s part of the issue is if the procedure itself is dangerous and it causes more deaths than it prevents, that’s obviously not very smart.  But sometimes even when the procedure itself is not dangerous, it can lead to overtreatment and the treatment can be dangerous, and then that can end up causing more harm than the thing that the screening procedure is designed to prevent in the first place.

This study suggested that the perforation rate — This is one of the main risks of a colonoscopy is you’re inserting a scope, a solid object, into the colon, which is a soft tissue, and one of the dangers of doing that is poking a hole in the intestine.  And the perforation rate apparently is 1 in 1000 procedures, which might not sound like a lot, but when you compare it to the rates of colorectal cancer, it’s fairly significant.  And then there are serious complications in 5 out of every 1000 colonoscopies.

Again, just to kind of put this in perspective, 999 people will get a colonoscopy and not have a perforation, and 995 people will have a colonoscopy and not have a serious complication, so overwhelmingly the odds are in favor of nothing serious happening if you have a colonoscopy.  I just want to point that out.  But there are a few reasons to believe that the numbers might even be higher.  For one — and this is the case in a lot of different situations, like with side effects of statin drugs — in any adverse effects, they tend to be underreported because the reporting system just isn’t that robust and it’s dependent on the doctor actually making the report and the patient and/or the doctor realizing that the problem is related to the procedure and just having time to fill out the paperwork and all that stuff, so it generally means reactions and complications tend to be underreported rather than overreported.

And then there are some other risks associated with colonoscopies, including infection.  It has recently been revealed that it’s impossible to completely sterilize an endoscope — there was actually an article in the LA Times about this awhile back — because the endoscopes have these cavities that are inaccessible to being cleaned completely by hand.  And then another problem is that one of the common sterilizers they use for colonoscopies, which is called glutaraldehyde, has actually been shown to cause colitis itself.  This might explain why some people actually develop colitis after having a colonoscopy.

We talked last time about the washout procedure that you have to do before the colonoscopy that removes a lot of the beneficial bacteria in the gut, which could definitely be problematic.  And then there are more rare reactions that can happen, like to general anesthesia.  A colonoscopy, I think, is the only cancer screening test that requires you to go under general to have it, and general anesthesia definitely can cause some problems for some people — deep vein thrombosis, pulmonary embolism, kidney damage, electrolyte imbalance, and a few other not-so-nice things.  Those are very rare, but since we’re talking about the risk, it’s worth pointing out.

There was another study in the Annals of Internal Medicine that showed that 70,000 or 0.5% of people who get colonoscopies are either injured or killed by complications related to the procedure.  And that figure is 22% higher than annual deaths from colorectal cancer.  So again, when you think about it, if the procedure is causing more injuries and deaths than what it’s screening against, you really want to think twice about whether you’re going to do it.  And that’s on a population-wide scale.  Part of the problem when talk about these studies is that studies are looking at populations, but when we’re talking about whether to get a test or do a treatment, we’re really talking about individuals, and individuals have medical histories and different risk tolerances and different circumstances and situations that need to be taken into account.  So, if someone is at very high risk for colorectal cancer, for example, it runs in their family and they have a number of other lifestyle risk factors, then it very well may make sense for that person to get a colonoscopy in spite of these statistics.  The statistics are just averages, but we don’t treat averages in a clinic, we treat people, so you just have to keep that in mind when we’re talking about things like this.

Another thing is the average age for the onset for colorectal cancer is, I think, 71, and typically the mainstream recommendation is to start screening at 50 years old and 45 for African Americans.  So, the first couple of decades there, based on these statistics, it would seem that getting a colonoscopy might be more risky than it’s worth, depending on your personal situation.  But perhaps as time passes, those odds start to even out a little bit.  It’s still a little unclear to me.

There was a study — just to present the other side of the argument — also in the Annals of Internal Medicine that looked at 10,300 patients who had died of colorectal cancer, and then they looked at five matched controls for each patient who died, so over 50,000 controls.  Seven percent of patients who died had not had a colonoscopy in the previous time leading up to study versus 9.8% of controls, so not a huge difference, but it was statistically significant.  And interestingly, the difference was only valid for cancer of the right colon, not the left.

So, this guy’s story who writes that blog is pretty interesting.  At 48, he developed colitis, and he went in to have a colonoscopy, and he suffered a perforation during the colonoscopy and developed a really serious infection and went through hell, it looks like.  His story is on his blog; you can check it out.  But he eventually had emergency surgery where they discovered his intestines were necrotic, so the tissue had died.  They removed all by 3 feet of his small intestine, and then after more surgeries, he ended up with just 10 inches of small intestine left, which is barely enough to live on.  And then he finally ended up receiving a full intestinal transplant, which is a really rare procedure.  And after he had that transplant, he had to receive regular colonoscopies to check up, and after one of them, he contracted an infection with a gram-negative bacteria pseudomonas species, which can be really, really serious in immunocompromised patients like him, and that almost finished him.  His blood pressured dropped to 35/28, and he was given a really small chance of surviving and basically told to say goodbye to his wife.  This is obviously a really extreme story on the spectrum.  Most people, as I said, get colonoscopies and don’t experience anything like this, but it is important to at least understand the risks when you’re considering a procedure like this so you can determine whether it makes sense for you to do it.

Steve Wright:  Yeah, it sure is one of those kind of catch-22 scenarios because it definitely seems to do some good, but the risks are definitely there.  I mean, we hear about them on our site quite often with people who have some sort of inflammatory bowel disease and they’re in basically what they believe to be is remission. — Remission is kind of an interesting term.  It’s kind of like ‘cure.’  You don’t really know what that is. — But for people who are feeling great, they’re not symptomatic, and then their doctor just insists that they get a colonoscopy every two years or every three years, and we routinely get emails from these people who after they’ve gone back in, even though they’re asymptomatic, that just sends them back into a whole symptomatic flare.

Chris Kresser:  Yeah.  I’ve definitely had a similar experience with my patients and in my own experience too, by the way.  Back when I was still trying to figure out what was going on with my gut, I had a couple of colonoscopies, and they absolutely wrecked me.  I had two, and in both cases it took me weeks to recover, and so I think it definitely depends where — You know, at that time, my gut was really inflamed, and if you go into a procedure like that with an inflamed gut, it’s just going to make it worse.

Steve Wright:  Yeah, it’s kind of scary to think about.

Chris Kresser:  So, let’s go on to a few questions.

Steve Wright:  OK, we only have a 194, Chris, so shall we start with the most voted-on question out of all 194?

Chris Kresser:  All right.  Sounds reasonable.

Managing histamine intolerance

Steve Wright:  OK.  With the most likes, this comes from Resolute Michaels:  “Histamine!  Can you discuss the whole histamine intolerance thing?  If the symptoms are ‘manageable,’ is it more of an annoyance issue, or are there greater issues with histamine overload?  If someone is truly intolerant, does this translate to health issues?  As an aside, I’ve been working with this for the last week or so with amazing results, with my sense of smell starting to return, and I’ve had this since a child.  I got sinus congestion, anxiety, and sometimes itchy skin and eyes.  I do not get hives.”

Chris Kresser:  Yeah, this is interesting.  I just wrote about this.  I think we’ve talked about it a few times.  Histamine intolerance is definitely on my radar in a much bigger way than it was a year ago, and I think the consciousness of it is increasing and more and more people are trying it and getting results.  I have a number of patients that have histamine intolerance and are experiencing reversal of symptoms they’ve had for years and even symptoms that didn’t resolve when they went paleo or switched to a real food, nutrient-dense type of diet.  So, it’s an exciting therapeutic tool.

In terms of answering the question, there are a couple things.  One is, is histamine intolerance on the rise?  Is it increasing in prevalence, or is it just that now we’re more aware of it and so more people realize that they have it?  I think it could probably be a little of both, and I’ll tell you why and this will kind of answer the question.  As I mentioned in the article, one of the main causes of histamine intolerance is an increase in histamine-producing bacteria in the gut, so if you through antibiotic use, perhaps, or other things that can shift the balance of bacteria in the gut and lead to more histamine-producing bacteria, it’s not totally clear yet.  We don’t have an extensive list of bacteria that produce histamine and bacteria that degrade histamine, but what I tend to see is the people who generally suffer from histamine intolerance are people with gut issues, and in many cases, the histamine intolerance came on or got worse when they developed gut problems or after they took a course of antibiotics or something like that.  So, I think that histamine intolerance is in many ways pointing to a deeper disharmony in the gut that probably needs to be addressed.  So, that’s one way of answering the question.  If it’s pointing to a gut dysbiosis, then yeah, I think just following a low-histamine diet, that will certainly help, but you’d also want to address any gut dysbiosis that might be present, gut infections, pathogens, leaky gut, etc., because that, number one, would enable you to tolerate some high-histamine foods, many of which can be really healthy otherwise, like fermented foods in particular, and number two, because the gut dysbiosis and other problems I just described can lead to other issues aside from histamine intolerance.

If it’s a genetic problem where you don’t produce enough diamine oxidase, the enzyme required to break down histamine, that might be a different story, but even then, there are some bacteria that we know about, like Lactobacillus rhamnosus and bifidobacteria, particularly B. infantis, that are histamine degrading, and so it’s possible that if you supplement with those specific strains of bacteria that you could increase your ability to break down histamine even if the problem is genetic in origin.

Steve Wright:  In your practice, Chris, has there been anybody that you’ve kind of worked through some GI infections or some gut dysbiosis issues and after this then they’ve been able to introduce histamine foods again?

Chris Kresser:  Oh, definitely.  Yeah.  And usually it’s slow and they have to be careful about going overboard, but for most people, that’s fine.  If they’re able to enjoy a moderate amount of histamine-containing foods, then they’re happy.  And some people have gotten over it almost entirely.  So, the response varies, and that probably is determined by what the original cause is in the first place.  But yeah, people do improve.

Steve Wright:  OK.  Well, I think that’s good for everyone to know that it is kind of manageable.  I think it’s kind of akin to using the Specific Carbohydrate Diet or the GAPS Diet sometimes to get rid of and start to heal some of the gut issues, but if you don’t ever get to the actual root causes on what has maybe started it or still growing in there, then you can never really get back to maybe a full paleo or a full real foods diet.

Chris Kresser:  Yeah.

Chris answers: “What is health?”

Steve Wright:  Awesome.  Well, let’s move on to a little lighter question.  This question comes from John:  “Chris, what is health?”

Chris Kresser:  Hmmm, profound question.  I think it’s the shortest question we’ve ever had.  I don’t think you could really get much shorter than three words, but it’s a really fascinating question.  It’s actually one that I’ve thought a lot about, and as someone who suffered from a very longstanding health challenge, it was on my mind and in the front of my mind for many years.  And of course, as someone who works with people who suffer from those challenges now, it’s still pretty front and center.  Probably the best definition of health that I’ve ever heard, the one that I resonate the most with is from Moshé Feldenkrais who created this body of work called the Feldenkrais Method, which is difficult to describe even if you ask a Feldenkrais practitioner what it is!  And I won’t pretend to describe it accurately even though my wife is a Feldenkrais practitioner!  But it’s a way of essentially reeducating yourself, reeducating the body and the nervous system, reprogramming the nervous system, but probably the easiest way to explain it is to tell you what Moshé Feldenkrais’ definition of health was, which was the ability to live your dreams.  And I really like that because if you use a really kind of objective measure of health, like you have these biomarkers, or you have this weight, or you’re able to do this much exercise, if you describe it in terms of function, I think what’s missing there is a much larger, broader perspective on health, which is, in my mind, the most important because there are people, for example, who are extremely and, in my opinion, obsessively focused on their physical health to the exclusion of other aspects of health, like their relationships with other people or their ability to function socially in the world or their ability to enjoy life and to be at peace with their own circumstances and their life in general.

So, for me I think I would even modify that description a little bit and say the ability to enjoy life and to be at peace with oneself and with one’s life, because let’s say someone had a dream of becoming an Olympic runner and then they get hit by a bus and they break their leg and they scatter it and it just becomes clear that they’ll never be able to achieve their dream of being an Olympic runner.  Well, does that mean that that person can’t be healthy?  If you strictly stick to Moshé’s definition, it would, but if you kind of broaden that definition to mean can somebody find joy and happiness in their life and can they live a life that they want to live and can they be at peace with themselves and their circumstances, then to me, that’s probably the broadest and most inclusive definition of health, and it’s one that takes into account that we’re not always in complete control of our circumstances.  We’re not always in complete control of what happens to our bodies.  It recognizes that not all problems are solvable.  There are illnesses so far that are terminal.  There are illnesses that are not completely curable.  And part of being healthy, I think, if you’re in a situation like that, is learning to accept each moment as it comes and continue at the same time to try to find a solution and improve your health but not lose your sanity and happiness and capacity to enjoy life as it is in that process.

And that can be a really tricky negotiation when you’re sick.  It’s something I know about firsthand, and again, as I said, it’s something I thought about a lot as I went through that period because there was a long stretch of time where, despite my best efforts, I was still very sick.  And I realized that I had a choice.  I could either struggle in every single moment against what I was experiencing, or I could accept it as it was.  It doesn’t mean giving up.  Acceptance is very different than submission.  Submission is giving up.  Acceptance is just realizing in each moment that you can’t change that particular moment.  You might be able to change the next one, but you can’t change the moment that you’re living in right then.  So, for me, it was this razor’s edge of continuing to search for the answers and find a solution to my problems but learning to relax around the situation in each moment as it was and enjoy life and reach some level of peace with things even when they weren’t exactly as I wanted them to be.  And so, to me, that’s my definition of health.  That might not be what John had in mind, and I’m sure a lot of other health care practitioners would have a really different way of responding to that question, but any definition of health, in my mind, has to take into account all of those factors that I just mentioned, and that’s the best that I can do at this point.

Steve Wright:  I think what I loved about what you just said was that when somebody probably heard me say that question, they probably thought, like you said, of a lot of physical traits, but really what you just talked about was meshing the physical with the mental — and a lot of the mental — and I think that in my own health fight, like you said, turning to allowance for what is and helping that guide you in your search for maybe a better physical health, I think was one of the biggest tools that I have come to learn over the last few years.  And I think it was really elegant where you went with that because I do think that one of the best books ever, in my opinion, is Man’s Search for Meaning by Viktor Frankl.  For him to be in his own head in a concentration camp and with no physical health basically but to have beautiful mental health that allowed him to go through that time period.  And of course, he had breaks that other people didn’t get breaks of, and there’s always some chance involved, but I think it’s just a great illustration of what having that robust mental health can also do for physical health.

Chris Kresser:  Yeah, that’s a fantastic example, Steve, and there are other examples of people who have become physically incapacitated, who are in a wheelchair and just have an amazing spirit and sense of peace and acceptance and joy, and then there are people who have almost perfect physical health, but they’re entirely miserable.  So, who is healthy in that situation?  What does health mean?  How does health help us to live our lives in a more meaningful and rewarding way?  Because what’s the purpose of health?  That’s another interesting question, and I think that’s what we’re getting at as we’re talking about this is, is health an end?  Is it a means to an end?  Is it both?  And what do we get out of being healthy?  Definitely a fascinating question for me and one that I continue to kind of toss around in my head, you know, not consciously every day, but it’s never far from my consciousness, so thanks for the question, John.  It was a pleasure to get to think about it and talk about it again.

Steve Wright:  And I would encourage all the listeners of this podcast if you’re just in iTunes or you’re on your phone, take the time to come back to the blog, to this post, and post your definition of health because I think it helps everyone broaden what they see the world as, as we learn other people’s definitions.  And the ebook that Jordan and I wrote, before we even talk about any sort of physical diet changes, we ask people to write out what is their health, what does health mean to them, what’s the goal here, because as Chris alluded to, in the end, I think happiness is really kind of tied into this whole thing, and a lot of that isn’t necessarily always physical based.

Chris Kresser:  Um-hum.  All right, well, looks like we have time for a couple more questions.

Does intermittent fasting harm the adrenals?

Steve Wright:  OK.  This next question comes from Sharon:  “Does intermittent fasting harm the adrenals?  Popular wisdom indicates it does, but IF proponents say it doesn’t.”

Chris Kresser:  Well, I’m going to say my typical answer and say yes, no, maybe.  And I don’t mean to be flippant, but really so many of these questions can be answered — The reason there is conflicting answers is because there are conflicting answers.  Sometimes it does harm the adrenals, and sometimes it doesn’t.  It really depends on a lot of factors.  I do not recommend intermittent fasting for someone who’s really overstressed and overtrained, who has a tendency towards hypoglycemia, and who’s just really kind of frayed around the edges.  For that person, in my opinion and in my experience clinically, intermittent fasting will generally harm the adrenals.  Will it always?  No.  Will it most of the time?  Yes, in my experience.  However, if someone is sleeping pretty well, not dealing with any kind of chronic infection or other catabolic process that’s breaking their body down, not overtraining, eating a good diet, then intermittent fasting can be really well tolerated.

I guess I’m doing a little bit of intermittent fasting now.  I’m kind of having two meals a day recently.  I think I mentioned that on a previous show.  And it just happened really organically and spontaneously.  There was no plan.  I’ve just noticed recently that I would wake up and didn’t feel as hungry as I typically do, and so I delay my first meal until around 11 and then have another bigger meal later in the day, and I seem to be doing really well with that right now.  But if history is any indication of the future, in a week or maybe two weeks or something, I’ll start feeling hungrier in the mornings, I’ll start feeling like I’m not getting enough nourishment, and then I’ll just switch back to my normal routine, which is eating three meals a day.

I think it’s really important to emphasize the individual nature of these questions, to learn to listen to your own body, to learn to kind of tune in to the symptoms that you experience, and I know this can be hard, especially if you don’t have experience with it or any kind of training to know what symptoms to associate with what, but I really do feel that most people have the capacity to do this.  If you start intermittent fasting and after a while you notice that your sleep is getting worse, you have cognitive issues, you’re starting to forget things, you feel kind of shaky and jittery all the time, you’re not recovering from workouts well, your performance is declining in your workouts, then most people are going to notice that, and that’s generally a sign that it’s not working for you.  If that happens for a couple of days during the adjustment period, that’s one thing, but it’s continually happening and it’s getting worse, that’s a sign that it’s not a good idea.  On the other hand, if you do it and you feel good and you feel an increase in mental clarity and you’re losing weight — if that’s one of the reasons you’re doing it — and you’re not extremely hungry in between meals to the point where you’re shaky and feel like you’re going to die if you don’t eat soon, then yeah, it probably will work for you.  And it’s important not to get too attached to either of those outcomes because like I was saying in my own experience, it will work for me for a period of time, and then it won’t work, and if I have this idea that it’s good or it’s not good, then that keeps me from just being present to what’s happening, listening to my body, and then making an appropriate decision.

I don’t talk about my training in Chinese medicine very much, but I think it really does inform my perspective in certain fundamental ways, and one of those ways is that in the Chinese theory on diet, they would never suggest that there’s one appropriate diet for everyone, and they wouldn’t even suggest that there’s one appropriate diet for one person throughout that person’s entire life, because for them and that way of looking at things, what the right diet is is affected by a person’s individual constitution, it’s affected by their current health status.  For example, if you feel like you’re getting a cold, you’re probably going to eat differently than if you’re not.  It’s affected by geography, so if you live in the tropics, you might do better eating more tropical fruit and things that have a higher water content than you would if you’re living in Alaska.  You know, in the winter, it might not be a good idea to be eating a lot of papaya and pineapple and stuff.  It will depend on your goals.  Someone who is trying to lean out for some kind of competitive activity is going to have a different approach than someone who just wants to maintain general health.

Yeah, I’m beating a dead horse here, but it’s really, really crucial to tailor your approach to your own needs and goals.  And of course, that’s the whole idea behind the Personal Paleo Code and why I created that program, because it was just really frustrating for me to see all this continual argument about what the best diet is, you know, should you do low carb, should you do high carb, should you eat dairy, should you not eat dairy?  The answer is always, almost always it depends, with those kinds of things.  I mean, there are some foods I think are just really harmful for everybody and some foods that are generally beneficial for everybody, but I can find an exception with almost every food or nutrient, so the message here is to tailor it for yourself.

Steve Wright:  I think that’s kind of a perfect follow-up to the ‘what is health’ question because I think if anyone has been in this community for a while, they can go out there and they can read stories about yourself and about other leaders like Robb Wolf and Mark who at various times even in their primal or paleo journeys have been doing intermittent fasting or have been higher carb or lower carb or ketosis or not, and I think it’s so much, even in my experience, about what is right about your current situation and what is working for your current situation and then just being open to the change.

Chris Kresser:  Absolutely.  If there was one message I could get across in my work, that would be probably the most important in terms of diet.  This is a good segue into the next question too, actually, which will be the last one for today.

Chris Answers: “What is your workout routine?”

Steve Wright:  OK, another simple, but probably elegant question.  Chris, this comes from John:  “What is your exercise regimen?”

Chris Kresser:  Let’s put this in the context that we’ve been talking about.  I right now am dealing with some not serious but significant and noticeable adrenal fatigue syndrome or hypothalamic-pituitary axis dysfunction, if I want to get nerdy and technical about it, and I’m extremely busy.  I’m writing a book, I have several other programs going on — the blog, the podcast, an 18-month-old daughter and wife, blah, blah, blah, etc.  So, my current physical activity regimen is a reflection of all of those factors, and my activity levels and types of activity I engage in, types of exercise that I do really change significantly over time based on how I’m feeling, what my health is like, what’s going on in my life.

Lately the most significant change I’ve made, which I’ve talked about and written about extensively now, is getting a treadmill desk, which has totally changed my life, really.  It’s probably one of the biggest changes in my health I’ve ever noticed from a single intervention, and I’ve done a lot over 15 years, probably more than most people.  I’m actually writing this chapter in my book right now, so it’s really fresh in my mind that a lot of research recently — and I know people who follow the health media have probably seen these stories — suggests that sitting for too long has uniquely harmful effects that are completely independent of exercise.  Someone who exercises, meets the current recommendations for exercise or even exceeds them, so someone who goes to the gym for a half hour five days a week or even someone who’s a marathon runner and running 60 miles a week or more in training, if they spend a large percentage of the rest of their time on their butt, like their drive to work for 45 minutes in both directions, then they’re sitting in a chair working at a computer for 6 or 7 hours, and then they come home and they watch a couple hours of TV, that’s like 8 to 10 hours of sitting in a day.  Even if they’re training hard, that’s going to be problematic.

For me, I was getting plenty of exercise and movement, going on hikes and lifting weights and surfing occasionally when I could and things like that, but I was sitting way more than was healthy because I do a lot of work on the computer and I consult with patients and talk to patients on the phone and stuff, and so I got this treadmill desk, and now I’m averaging between 15,000 and 20,000 steps a day, and I feel so different at the end of the day.  It’s night and day.  My brain is way more clear.  That’s one of the more unexpected effects, but I was having some back pain — that’s completely gone.  I was having some kind of muscle aches that I associated with adrenal fatigue issues, but I think they were actually caused by sitting too much because I don’t have them anymore!

So, my routine now is that I’m walking 15,000 to 20,000 steps a day.  Not all of those are at the treadmill desk.  I go on a long walk in the mornings usually with Sylvie.  We spend a couple hours in the morning together.  She and I both wake up early and we give Elanne a chance to sleep in for a couple hours and we get to hang out.  But I also have shifted from doing specific periods of training, of the higher-intensity stuff like going to the gym and doing 30 minutes of higher-intensity strength training or sprints or things like that.  Instead of doing that, I’ve incorporated those all the way throughout the day.  So, after we get off from recording this show, I might go over and do some weights.  I have some weights at home and a bench, and so I might do some strength training exercises.  Or I have some push-up bars and a weight vest, so I might do some push-ups.  I have a pull-up bar, so I might put the weight vest on and do some pull-ups, and I just do sets throughout the day.  In a given day, I might do anywhere from 4 to 10 to 12 or more sets of weight-bearing exercises, higher-intensity exercises.  Or I might do some sprints.  We have some stairs in front of the house, so I might sprint up and down the stairs.  I might jump rope intensely for periods of time.  So, I’m incorporating the movement all the way through the day, and that’s really great for me right now for a couple of reasons.  Number one, it has just completely freed up some time for me, which is really valuable at the moment.  We live way up in the hills, and so even to drive somewhere specifically to exercise takes an hour or an hour and a half out of my day, and now I have that time back to some extent.  And then it also is just working for my body better right now.  I guess you could say it looks like a combination of hiking, the walking all the way through the day, and then the higher-intensity strength training and sprints throughout the day.  Right now that’s what I’m doing.

Steve Wright:  OK, well, I’m sold.  Treadmill desk is on the 2013 goal list.  I’m writing it down.

Chris Kresser:  Yeah, it’s incredible.  It’s really, really phenomenal.  For me, at least, it’s been life changing.

Steve Wright:  I’ve heard nothing but good, so I’m taking your advice, Chris, and it’s going on the goal sheet.

Chris Kresser:  All right, cool.  OK, well, thanks everyone for listening.  Four questions down and 190 to go!

Steve Wright:  Yeah.  I’m telling you.  We’ll be good in 2014.

Chris Kresser:  All right.

Steve Wright:  Thanks everyone for sending in your questions both to the site, ChrisKresser.com, and also to Facebook, and we will do our best to get through as many as possible.  We just hit on a few today that definitely needed a little extra time.  If you enjoyed listening to the show, please head over to iTunes and leave us a review.  It helps get the message out to more people, and we’ll talk to you on the next episode.

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Comments Join the Conversation

  1. Stella says

    He DID chime in. It’s called the entire podcast and transcript. Industry profiteers won’t make me question his views or undermine anything he presents to me. I actually have a brain and can research and form my own opinions, and don’t need to be validated by others.

    • Iceman says

      Stella, I was not trying to undermine Chris’s credibility. I think that the value of having comments in a blog post is exactly to point out possible error or different opinions. What comes to the facts in this post I do believe there are some errors, like the fact that most colonoscopies are not done under anesthesia. I just would like to know where Chris got this idea. Wrong information is just wrong information, be the source credible or not.

      • says

        Chris, thank you for the remarkable work you have done introducing the topic of colonoscopies. It’s clear that Iceman doesn’t have the capacity to follow what’s been clearly said – in great detail – by both Nurse Annika and Wolverine. The divergent practices and study results show that there’s both 1. a lot of confusion with the use of terms for “general anesthesia” used, and 2. a large variation in clinical practices. For the record, Iceman, Wolverine makes it pretty clear, and he is not disputed in this, that propofol is USED as “general anesthesia”, fullfilling the purposes and intent of general anesthesia, yet it is not recorded as a general anesthesia by the regulators or authorities. Therefore, Iceman, people can be, are being, and have been, put under general anesthesia using propofol, yet this practice often is not recorded as “general anesthesia”. None of Chris’ points has been contradicted nor been pointed out as erroneous. He never said that in each and every colonoscopy practiced is the patient always placed under general anesthesia. What he said is that it’s the only cancer screening process that uses general anesthesia, which even Nurse Annika admits in her later comments that it does. So Chris is vindicated and proven correct.

        • Annika (@NEKLocalvore) says

          I would like to make a couple of clarifications: in an earlier comment, I said that general anesthesia is used for a colonoscopy ONLY if the the patient is having a surgery AT THE SAME TIME. While I’m sure there are some rare exceptions, I think it’s safe to say that screening colonoscopies are pretty much never done under general anesthesia. I never “admitted” that they were.

          Propofol can be used for EITHER deep sedation (as during a colonoscopy) OR as part of a general anesthesia (as during a surgery). It depends on the dosage and other drugs given. In general anesthesia, the airway must be secured and patients are not often able to adequately breathe on their own. In doses used during deep sedation for a colonoscopy, patients breathe on their own. Just because propofol can be used for general anesthesia does not mean that it’s always used for general anesthesia.

          I think the distinction is important because general anesthesia carries risks that deep sedation does not. Colonoscopy does involve some risk, but it does not include the risks of general anesthesia.

  2. Iceman says

    Hey Chris – there are some critique in the comments and specialists are disagreeing with you view of the colonoscopies. Please chime in and respond to the comments, otherwise this undermines the reliability of also you other blog posts.

  3. says

    Hey Chris,

    I am very interested in your histamine intolerance work. I have been dealing with hives for a year now. I believe I have nailed down that s. boulardii causes hives and probably because it causes histamine. I have been searching for knowledgeable people for a year now and it seems impossible to find. I would love to know if there are particular supplements that would be geared towards lowering histamine. For reference, my trouble began after a raw milk fast of 8 days a year ago. I assume I altered my gut flora and do not know how to put it back. I have a cabinet full of things like bio kult and some others that did not help. Please, please continue your posts on this subject. Thanks!!

  4. Marlaf says

    I had my first colonscopy at age 50 and they found a polyp which was supposed to be too large to remove and they said to monitor it. They also assured me it wasn’t cancer and I could wait a few years to have it checked again. Anyway, I did have my second colonscopy at 54 and the dr. removed the polyp and they told me it was an aggressive Adenocarcinoma and I had to have a section of the colon removed on either side of it, as well as go through the lymph nodes around it. I had no complications, no further treatment, and have had 2 subsequent colonscopies with no problems. I am so grateful for the dr. who recommended I get mine, otherwise i would definitely have had colon cancer and who knows what would have happened…..Also, they always only give me Versed, a very small amount like 5 mg. since i asked them to just give me the minimum (I love Versed, but not that much!).

  5. Willis says

    Re: Treadmill, I too am concerned with the many miles per day. Especially for people over 60 or somewhat overweight folks.
    Does “the more the better” prevail ? Seems like quitting when you get tired would not prevent slow joint damage from over-use. Be great for general health I would guess.
    Regards, W

  6. Todd says

    Chris mentions three specific bacteria: Lactobacillus rhamnosus and bifidobacteria, particularly B. infantis. Can anyone suggest a good source of them?

    • says

      Todd, this product, Renew Life Ultimate Flora Probiotic, is one of the best on the market. I know it’s the best available here in health conscious Vancouver. I recommend it to all clients who have had to undergo an antibiotic protocol. Even women having to take antibiotics to deal with something as simple as a yeast infection benefit from it. It’s pretty cheap.

      http://www.bodyenergyclub.com/health-conditions/digestion-stomach/renew-life-ultimate-flora-probiotic.html#desc

      Ultimate Flora Critical Care contains therapeutic levels of both Lactobacilli and Bifidobacterium, making it the most complete and effective probiotic supplement on the market. Each capsule provides 50 Billion active cells from 10 different strains in a ‘once a day’ serving (30 billion active cultures of Bifidobacterium and 20 billion active cultures of Lactobacilli and Lactococcus).

      For some reason, they sell a reduced version in the US, Udo’s Choice® Super 8 Hi-Potency Probiotic, which has only 7 strains and 42 billion active cells, and even their Canadian website does not list their more powerful top end product (but I’ve bought it and know it’s available at Body Energy).

      U.S. Flora site:
      http://www.florahealth.com/product_categories_usa.cfm?category_id=8&prod_id=306

      Good Health!

  7. Lucy says

    Thanks so much for the very informative post. I had no idea colonoscopies could be deadly, when I went for one a few years back. If I’d have known I would have thought twice about signing up for the procedure that ultimately still gave no answers for my constant indigestion. (Nothing 3 months of clean food and a back bending stretching regime didn’t cure!!!) And this was after six doctors, two endoscopes, a colonoscopy, and numerous blood tests, and a year and a half of PPIs!

  8. Confused says

    Ugh, I’m so conflicted about colonscopies now. Both of my grandparents died from colon cancer and my mother and her siblings all started having polyps removed in early 40s. I had my first colonoscopy last year at age 41 and 3 polyps were found. I also have MTHFR genetic mutation (still learning about this but one outcome can be colon cancer). Sigh.

  9. Alex Needleman says

    Hi Chris, I am really interested about your experiences regarding the treadmill desk. I have thought about using a Standing desk becuase of all the ill effects I’ve heard about sitting too long. Do you think that would provide alot of the same benefits of the treadmill desk, minus of course the extra calories burned. I’m just worried if I purchased a Treadmill desk(which can be quite expensive) that in the event it didn’t work out it would be a loss of money. On the other hand, I would have no problem standing and working since I do that anyway while working in my warehouse. The only time I do sit is when I’m at the computer anyway.

    I’ve also seen there are some adjustable desks that work with exsiting treadmills (of which I have an unused one), that might also work just for standing. If you could just give me your thoughts I’d appreciate it.

    Thank You

  10. Edward says

    Hi Chris, You are not concerned about long term joint wear with all that walking? I had the impression that you were a “Body by Science” type from your Beyond Paleo emails. All of the slow motion fitness people from Doug McGuff to Fred Hahn to Adam Zickerman say that prolonged low impact exercise is basically useless and even detrimental, but it sounds as though you are getting great results in many different ways. Thanks!

    • Wade says

      I was under the same impression. I guess whatever works for you at the moment. I tend to agree with Doug McGuff and Drew Baye on these things… One or two workouts per week (to FAILURE) is incredibly effective and efficient. It leaves more time for enjoying other things- family, walking, crafts, etc.

      Thanks Steve and Chris- some great, deeper stuff this time. Like it!

  11. B says

    What also concerns me about colonoscopies are the harmful products recommended for the prep and the lack of information provided to patients about the importance of re-establishing good gut flora following the procedure.

    Many of the prep products can be replaced by healthier options, such as coconut water and clear homemade broth in lieu of the HFCS-laden, chemically-flavored, food dye-drenched substances on many prep instruction sheets. I called the colonoscopy clinic we used and asked about better alternatives and they were able to confirm some of the ideas I had and provided helpful suggestions.

    Similarly, these instruction sheets should also recommend that people follow up with homemade broths, lacto-fermented sauerkraut brine (if not too histamine intolerant!) and other replenishing, probiotic-rich things afterward.

    If your clinic offers an evaluation form (or even if they don’t), it would be good to make these suggestions.

    Perhaps a complete list of healthier alternatives to the prep products would be a worthy follow-up post, for those who choose to go ahead with the test?

  12. Stella says

    I certainly wouldn’t trust a NY Times article that says all polyps turn into cancer. The NY Times has quite a comfortable arrangement with drug companies and device makers.

  13. says

    I dispute that colonoscopies result in more deaths than lives saves. I readily acknowledge, however, that colonoscopies are excessively performed and that our colon cancer screening strategy needs to be refined, which it will be. You point out risks of general anesthesia and colonoscopy. General anesthesia is hardly ever done for colonoscopy, at least not on earth. I have at least a working knowledge of the procedure having performed at least 20,000 of them.

    • Wolverine says

      Your argument is sort of a straw man fallacy, because never did I argue that the anesthesia was of great concern, as a matter of fact, I stated that injuries from propofol were very rare, but are possible.

      Whether you call propofol a general anesthesia is simply a technicality, because it certainly is not a local anesthetic. The point was that it renders the patient unconscious (so it is more than just a sedative, like a narcotic), which is rare for any other screening procedure. No one is knocked out for a mammogram. I only point this out so that people realize that they will not be able to watch this procedure, nor have any memory of it, so they have no idea how fast it may have been rushed or how sloppy the procedure was performed. They will have no say in this treatment, but be completely at the mercy of the doctor and their discretion alone – no different than a surgery.

      Why would I emphasize the anesthesia when I, and several other people I have met, were all damaged by the scope itself – a mechanical injury? That is the greatest danger. I also believe that a safer procedure could be invented, but I doubt it will if everyone believes that the present procedure is so safe. I know people who have died because of this procedure and others who lost organs to it.

      I believe the procedure does have a purpose, as in the one woman I know who suffered from Gardener’s Syndrome or anyone else who maybe at a high risk, but as you stated, the procedure is overused and was completely unnecessary in my case ( a sygmoidoscopy would have done the job) and in many other cases. If no one ever complains, then nothing new will be done, because it is too profitable to stay with old technology, whose research costs were paid for years ago and are pure gravy at this point. The doctors had one young woman with Crohn’s swallow a small camera that could take pictures of the GI tract – why is there not more research going into something like this? An endoscope cannot be sterilized. Surgical equipment that is reused and cannot be sterilized has historically turned out to be a bad idea. Why do the European doctors use endoscopes with disposable ends and a condom-like sheathe, but we do not? The only reason given was the cost, like colonoscopies are not profitable – get real.

      You could not possibly have any idea how many people are injured, because so few are ever reported nor is a connection ever made to the colonoscopy. Just like you cannot be confident of the statistics concerning pharmaceutical related deaths, because not all of them are realized.

      The only clinical study that I have found concerning the effectiveness of colonoscopies is the Telemark Polyp Study 1. Although there was a 2% reduction in colorectal cancers in the screening group that had polyps removed, they had a 157% higher mortality from other causes than the control group. So, the “all cause” death rate was significantly higher in the group that was screened. This may suggest that cancer cells are broken fee and able to metastasize after polyp removal. Either way, it shows that the damages done from a colonoscopy are not completely understood at this time. A 2% reduction would hardly demonstrate the life saving potential of this device.

      In the 1970s doctors used to perform mastectomies when presented with any masses – they now know this was wrong. But of course, it’s not possible that we are capable of making any such mistakes now, huh?

      This Telemark Polyp Study 1 would suggest that we do not have all the answers concerning the after-effects of colonoscopy and polyp removal. It’s similar to the studies done in the 1960s (which were supposedly lost, but have only recently been found) concerning vegetable oils. Though the study showed that the vegetable oils did lower cholesterol, the all-cause mortality rate was much higher in the vegetable oil group, than in the one eating butter. Isn’t it mortality rates that matter? Doctors seem to ignore mortality rates, as long as all the numbers say that you’re healthy or that all the polyps are snipped out of your colon – whether you die in a couple years is irrelevant – at least you died with a sleek looking colonic wall.

      I understand that because you’re a doctor, you have to be right on your assumptions, but there were many doctors who told me intestinal transplants were impossible – if doctors are always right, how am I still alive? They were all very wrong and completely misinformed, and it’s not like intestinal transplants are a new technology. The oldest living small bowel transplant survivor is over 21 years out (so they’ve been successful for as many years), yet more than 20 doctors, including gastroenterologists, told me they were not perfected yet. This could have been deadly advice given to me from multiple doctors. If one doctor is always right, then a bunch of doctors must certainly be right, right?

      They insisted that I remain on TPN, which was also killing me with systemic infections, liver damage and arterial damage. Had I simply taken the words of these doctors, I’d be dead by now. So excuse me if I don’t take your word for these things because you have an M.D. after your name – some of the doctors that told me there were no intestinal transplants also had PhD as well as M.D. after their name – they were wrong all the same.

      So, you can confidently claim that colonoscopies save more people than they’ll injure, but unless you have some serious clinical studies to prove that, you are just giving an opinion based on nothing. It is impossible for you to know all of the injuries, because so many are never reported or covered up. If you believe that this is not possible, you are the one living on a planet other than earth.

      Doctors will protect their license. The surgeon who botched my first surgery was a drunk, who had a history of malpractice reprimands, including the fact that his license was revoked in California, yet a Florida hospital was still permitting him to practice surgery. All of this information was hidden by the hospital, although they have since barred him from operating at their hospital, but only after he killed enough people. He had been successfully sued for the exact same malpractice that he committed on me, just nine months prior to my operation. He had a bad habit of leaving necrotic tissue when resecting bowels and too lazy to send the samples for pathology before closing.

      Sorry, but I have seen far too much to be so naive as you wish me to be. Pharmaceutical drugs are the second highest killer in the U.S., and medical errors, which I saw a great deal of, are like the fourth greatest killer of humans – when you combine the two, any American is at far greater risk to be killed by the medical system or their doctor than ever be shot by some madman – yet, everyone is more afraid of being shot. This is how underreported medical mishaps are by the media. If they dedicated a fraction of the time to the wrongful deaths within the modern medical system as they do every school shooter, maybe we would see some improvements in the system.

      My injury from the colonoscopy was never blamed on the colonoscopy on any official record, nor were the perforations that led to the death of the friends I made at Jackson. Why? Because they died many weeks after the endoscope injury, which only started the ball rolling. Two of them eventually died from sepsis and multi-organ failure and that’s what the cause of death will say on the reports – not an endoscope.

      So why am I to believe that every doctor reports every injury from colonoscopies or that they would even suspect the colonoscopy to begin with?

      From my experience, many doctors are extremely reluctant to blame reactions, injuries or deaths on medical drugs or procedures. When my blood platelets were crashing, I suggested that the Fragmin they had me on may be responsible, but the doctors quickly scoffed and claimed that no way could the Fragmin do this. They continued to ignore the plummeting platelets, even when the vessels began rupturing in my legs and was bleeding around the hair follicles (and even wanted me to undergo a sigmoid scope while I was at high risk for bleeding out – I refused). I finally removed myself from the drug and guess what? The platelets came immediately back up to normal. It may just be a rare allergy to heparin, but doctors should consider such things, but they rarely do.

      My mother’s doctor continues to keep her on daily doses of Nexium (daily for nine years), even after she lost the ability to absorb B12. They continued to insist this was not a result of the Nexium (even though Nexium is notorious for screwing up the intrinsic factor in the stomach and causing anemia from inability to absorb B12). Then her iron levels plummeted and the doctor still refused to even entertain the idea it could be the Nexium (as a matter of fact, they insisted she have a colonoscopy to look for bleeding – pretty far stretch, given her symptoms and the more obvious choice of the Nexium). Now she must inject B12, and has to get regular iron infusions and more recently her bones are constantly snapping and won’t heal (another known side effect of Nexium) – yet she will continue to take the Nexium until her doctor tells her to stop.

      I could go on with many more examples that I have seen, but you get the idea. On second thought, I’ll give one more, because this one was committed by a group of famous super-doctors, who have PhDs and M.D.s out the ass, but can still not always be right (they are the multiviscreal transplant team who performed my transplant).

      A young woman, who was the recipient of a six organ multivisceral transplant, stomach, liver, spleen, pancreas, duodenum, large and small intestines, was tested positive for organ rejection. Typically, the doctors would infuse Campath, but for some unknown reason (possibly experimenting, because they are always trying to improve this procedure) they infused thymoglobulin instead. Thymoglobulin is also notorious for causing seizures in some individuals, yet when the young woman began to have seizures, the doctors refused to considers that it may be the Thymoglobulin. You would think that just based on the fact that the seizure only started when the medication was started would at least be a clue, but it wasn’t. It wasn’t until she finally had a grand mal seizure that they decided to remove the medication. The seizures stopped, but unfortunately, not before she lost the sight in her right eye.

      And you want me to believe that doctors will always make the connection between injuries and infections, and know when they are connected to a recent colonoscopy, even if these things develop several weeks or months later? The three examples I stated happened at the same time that the medication was started, so there is no way they would make the connection weeks later. My intense abdominal pain began directly after the colonoscopy and the doctors still couldn’t see the connection. Because of that, they delayed treatment for three days.

      So, we have no idea how many injuries and infections are caused by colonoscopies. I figure it is many times what is reported and I have yet to see any clinical study that clearly illustrates where colonoscopies prevent or are an early detection for cancer. Given the fact that the large polyps are less than 11% of the malignant cancer and it is the small flat legions (usually missed and never removed during a colonoscopy) that are ten times more likely to be malignant, we need a better technology. With all the recommended colonoscopies over the last decade, especially since Katie Couric began hawking them in 2000, we would expect to see a forty or fifty percent drop in colorectal cancer, if colonoscopies were as effective as we are told – but we have not seen that. It’s just what people want to believe, so they do – like aliens, Bigfoot and psychic powers.

      • greg says

        The doctor denies general anaesthetics are used for colonoscopies?well in my experience,the endoscopy clinic used an anaesthestist to administer a sedative,that caused me to become unconscious during the procedure.

      • says

        Thank you Wolverine for sharing your heart rendering story in such consistent detail. That you share your story is a gift to the rest of us. It’s pretty obvious that Kirsch is on another planet. Totally apart from whether he has a valid point to make or not, he misquotes you. He both misses and mis-states your point about anesthesia entirely. If his skills at perception and analysis are so limited, as he himself presents, it makes me wonder how thorough he would be at interpreting symptoms and coming to a valid conclusion and treatment of them. I’ve had a few doctors as clients, ranging from one of Vancouver’s top anesthesiologists, to cancer researchers, to plastic surgeons and skin care specialists, and it’s sometimes remarkable how badly some can suffer from tunnel vision that leads to an abrupt blindness to reality.

        I don’t know if Kirsch deliberately manipulated your points or if he suffered from an overconfidence in his erroneous interpretation of what you said, and also of his “slight-of-mind” ignoring the use of propofol and substituting “general anesthesia” instead. What I do see is that his limited point is already debunked by studies both you and Nurse Annika have listed, diverse as they are. What I do know is that if Dr. Kirsch can be so intellectually irresponsible in a discussion like this, one would naturally wonder that he can be trusted in each and every medical analysis and conclusion that he would come to. His contribution is very informative, but obviously in a direction that he did not intend.

  14. Cathryn says

    Really appreciate Annika’s chime-in and correcting the mis-information about general anesthesia. Also appreciate that Chris shared his own experience with colonoscopies. I recently had one on the advice of my naturopath. My last one was 22 years ago and I was pretty adamant about not getting another, dreading the prep and possible problems from wiping out my good bacteria, apparently of which I have very little. Turns out the whole thing was a breeze and the worst thing that happened was a surprising “jones” for the Crystal Lite lemonade that is recommended to make the prep solution more palatable. I fancy myself a food purist and never buy artificial stuff, don’t drink sodas (yuck), etc. And I was going to throw the remaining packets (a mini box worth) of Crystal Lite away but the monkey on my back wouldn’t allow it! I craved the stuff. So, I decided to finish what I had and enjoy it. I will not buy more, but it sure gave me a deepened understanding of what the food scientists are capable of.

  15. says

    No one has jumped on the HEALTH question yet!?

    HEALTH, with thanks to the inspiring Frank Forencich of course, is this:
    “Existing in one’s physical body in a way that allows the mind and body to BE an exuberant human animal.”

  16. Stella says

    Thanks so much for providing a transcript of your show. I find it quite helpful to print out the info and study it, especially when you mention specific blogs and websites to check out.

    The info I get from you (and others like you) has significantly changed my life for the better. I eat coconut oil with my fried eggs from my own chickens every morning. It’s also cooked in rendered organic lard that I did myself. I eat little or no processed foods, have a doctor who knows how to look for thyroid and hormone dysfunction, which is a major cause of weight gain, and who also understands the incredible importance of healthy adrenals. The Weston A. Price Foundation has been a wonderful insight into how to get and stay healthy, and the info there is life changing.

    Please stay healthy and on the air forever!

  17. says

    As a nurse who spends much of my day assisting with colonoscopies, I have to chime in.

    You stated: “A colonoscopy, I think, is the only cancer screening test that requires you to go under general to have it”. Absolutely not true! I have assisted in hundreds of colonoscopies, and the only times I have seen general anesthesia used was if the patient was having a colonoscopy in conjunction WITH A SURGERY – never for for someone just having a scope. Patient typically undergo moderate sedation (using Versed and a narcotic) or deep sedation (using Propofol, sometimes with Versed and a narcotic), but I have done several with no sedation at all at the patient’s request.

    You stated: “It has recently been revealed that it’s impossible to completely sterilize an endoscope … because the endoscopes have these cavities that are inaccessible to being cleaned completely by hand”. It is true that colonoscopes are not sterilized. Rather, they undergo high-level disinfection. The CDC defines high-level disinfection as “High-level disinfection traditionally is defined as complete elimination of all microorganisms in or on an instrument, except for small numbers of bacterial spores”. The scopes are cleaned by hand – in a multi-step process – but then they are put in a cleaning machine designed specifically for this make of scope. The glutaraldehyde is flushed out and rinsed off with sterile water. A colonoscopy is not a sterile procedure, because the GI tract is not sterile. But believe me, they are extremely clean inside and out and going through the cleaning process. Your GI tract is exposed to bacteria all the time from your food and from your hands, but not from a colonoscope (except in rare incidences where proper cleaning protocols are not observed, as in the VA hospital scandal a few years ago).

    You compared the number of patients injured by colonoscopies (0.5%) to the number of annual deaths from colon cancer and said “if the procedure is causing more injuries and deaths than what it’s screening against, you really want to think twice about whether you’re going to do it”. The procedure is most certainly NOT causing more injuries and deaths than colorectal cancer is. The lifetime risk of developing colon cancer is 1 in 20, or 5%. The Annals of Internal Medicine article you cited (at least I think it’s the same article, you did not give a link) noted one death due to colonoscopy out of 16,318 patients, and risk of injury of 5 in 1000, or 0.5%. Personally, I would prefer having any of these complications (death excepted!) occur to me over having a colon cancer diagnosis. An episode of post-polypectomy bleeding would likely require a re-scope, perhaps a blood transfusion, and maybe a night in the hospital – no fun, but a hell of a lot quicker and less unpleasant than being treated for cancer.

    We have found many early colon cancers on screening exams on patients in their 50s. If found early enough, patients generally need that section of bowel surgically removed, and they are done – no chemo or radiation necessary. If patients wait until they have symptoms, chemo and radiation are often necessary and survival rates plummet.

    Like any medical procedure, colonoscopy is not risk-free. But people should not be scared away from a potentially life-saving procedure by inaccurate information.

    • Crystal says

      Annika, thanks for your response. As a proctitis patient myself for 8 years, diagnosed initially by a colonoscopy, I’m scared to get another colonoscopy. After being in remission for many years, I went into a flare last November. In December I started a strict diet and probiotic. I’m finally starting to feel better after 3 months of hard work. My GI doc wants me to get a colonoscopy, but my stomach is still a little sensitive. For me, the concern of having my gut flora removed at this point is a real concern. Can you respond to this concern?

      • says

        I also have had concerns about the disruption of gut flora from a bowel prep. My concerns are theoretical at this point; when I have tried to educate myself about this, I have found more questions than answer. So, I decided to do a quick literature review.

        I found three articles looking at the effects of PEG (polyethylene glycol, the most common ingredient in bowel preps) on gut flora. The studies were designed to determine whether flora in samples taken during a colonoscopy (immediately after a bowel prep) would be different from samples taken before a bowel prep; the author’s purpose was to determine whether the samples would be an accurate representation of the normal state of the gut flora, or whether the samples would be inaccurate because of the effects of the bowel prep. The data was conflicting; this study (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC184241/pdf/aem00097-0266.pdf) found no changes, while these two (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568139/ & http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0032545) found significant changes. IMPORTANT: please note that the authors only measured samples before and during colonoscopy, so there is no information about gut flora after the bowel became filled with stool again.

        I found one study which followed 5 patients for several weeks following colonoscopy: (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856456/) The authors found changes in gut flora: “all methods indicated that microbiota composition is disturbed in patients undergoing screening colonoscopy, which might have implications for potential health effects that we do not yet understand.” Astonishingly, the authors did not note what bowel prep was used for these patients. This would be the biggest question in my mind, and it was not mentioned!

        I found a study stating: “PEG inhibits the colonic fermentation process usually considered to be beneficial to the host. The long-term consequences of such effects are unknown and require further study” – however, the patients in the study took PEG for four weeks instead of just a few hours, and were taking it as a laxative for chronic constipation, not as a bowel prep (http://www.ncbi.nlm.nih.gov/pubmed/15080850).

        Based on what I found, I am uncomfortable voicing any real opinion on the matter. The data were sparse and conflicting. The only study looking at screening colonoscopy and following patients after the procedure did not even mention what medication was used for the prep – which is CRITICAL information. I am frustrated by the lack of data, and will continue to search.

    • Wolverine says

      Now that we have heard the POV of someone in the medical profession (you know, someone who makes money from you getting a colonoscopy), I thought maybe we could get the opinion of someone for the other side – a victim of this procedure. I am a very rare intestinal transplant survivor and I lost all of my bowels to guess what?

      I received an injury from a colonoscopy, you know one of those injuries that the nurse considers a minor inconvenience, which she would have no problem making the choice to endure. I am not surprised that she is unaware of the real damages that can be afflicted, because after the damage was done to me, the gastroenterologist and assistants cut and ran and it was a whole host of doctors, who were in a far different league, that had to save my life and repair the damage done.

      Before I explain the extent of my injuries, I would like to say that her information is quite disingenuous and deceiving, but someone has to run damage control for the medical industry on these things and she has done herself proud. In my experience with endoscopes, I have had more endoscopes than most humans will experience in three lifetimes, Versed and narcotics are usually used for the sigmoid scopes, which are far less invasive (only through the rectum to the sigmoid). A full colonoscopy are usually performed with the patient under propofol – which certainly isn’t a local anesthetic or narcotic, as our nurse would have us believe.

      It is misleading to suggest that propofol is merely a sedation, similar to a narcotic. It is, in many cases, used as a light general anesthetic. No matter what technical classification she wishes to spin to avoid the term “general anesthesia”, the patient is rendered unconscious. This is the point that Chris was trying to make. No other screening procedure I know of requires that the patient be rendered unconscious. I was once kept in a drug induced coma (more on that later) for more than two weeks by the use of propofol, so her suggestion that it is a narcotic-like sedative is very misleading. Propofol suppresses respiration and can kill a patient if administered improperly – though this is very rare and contingent on the qualifications of the doctor, but is possible. Many patients I met also complain of many residual effects from propofol months, even years later (I was lucky and didn’t, but my niece who is an ICU nurse at George Washington University Hospital confirmed that claim to me)

      Why she can so confidently spit out a fraudulent number, like .05% when she couldn’t possibly know that true number as so many injuries are either under-reported or never tied directly to the colonoscopy. I know that my injury was never reported, as was the same for several other people I met at the transplant center, who were injured by this procedure.

      The gastroenterologist was so cynical and sure that no damage could have been inflicted (as our nurse is) that my complaints of abdominal pain were ignored for more than three days, which is why he and his assistants know not what happened later. By the time I was taken into surgery (I had been unconscious for more than a day at that point) they discovered that most of my small intestines had become necrotic, so all but three feet of jejunum was removed. It was this same cocky and cynical attitude with which she writes her rant that nearly cost me my life and certainly cost me my small bowels. The idea that the procedure is so safe and couldn’t hurt a fly was the reason for the delay in treatment, which could have saved most, if not all of my small bowels.

      I was given a very small chance for survival (which seems odd for an injury that our nurse has claimed is very minor) at the age of 48 (how many people die instantly at that age from colorectal cancer?). Five days later, when the stoma was dark and inactive, I was sent to a larger hospital for a vascular procedure. Shortly after the procedure, I began to have a series of seizures and it was determined that I was in septic shock, so I was rushed in for surgery a second time, where the remaining three feet of bowels were found to be necrotic and I was given even less chance of surviving that night. The last three feet of small bowel was removed, but I was in surgery for hours as the trauma surgeons had to clean the entire abdominal cavity, which was full of the fluid that used to be my small bowels.

      I was left with less than ten inches of small bowel and about two feet of colon (which was disconnected). According to her rant, all of this should have all been a cakewalk, but for some reason was quite stressful on me (I guess I’m simply a wimp). I was given a very small chance of living a year – two at best – but was also warned that I could die at any time from dehydration, infections or a whole host of other complications. Because of the high volume of TPN (Total Parential Nutrition) that I required, and the constant threat of dehydration, I spent the entire six months hospitalized. I didn’t have enough intestines to absorb water, so I could not drink to quench my thirst, but had to instead turn up the pump on the fluids, which does nothing to help the craving, so I lived in a perpetual state of thirst.

      I suffered two bouts of septic shock from systemic infections over those six months, due to the high volume of TPN which had to be delivered through the vena cava via a mediport surgically implanted in my chest. Because of the high sugar and vitamin content of the TPN, the port became a magnet for fungal and bacteria infections. Though my wife and I were told by every doctor that intestinal transplants were impossible, my wife continued to research, because it was my only hope of living.

      I’m not sure why our nurse feels that such a death is somehow preferable to a death from colon cancer? To me, death is death and I nearly died several times and many people have died from similar injuries and sepsis. It seems that colorectal cancer would have taken a much longer time to become lethal (I did not have cancer, just ulcerative colitis, which is hardly a terminal disease – but I was in terminal condition after that scope was done)

      It turned out that there are several hospitals in the U.S. that have performed intestinal transplants successfully. It is the rarest of organ transplants with less than 3,000 ever performed world wide. It was my only chance for a life (living on TPN is no quality of life, At least for me, our nurse claims that she would chose this life easily).

      On March 23rd, 2010, I underwent a small bowel transplant, which was headed by Adreas Tzakis at Jackson Memorial Hospital in Miami. I was in surgery for more than 12 hours. Though the transplant was a tremendous success, I contracted an infection from an ileostomy about six weeks after the operation. Being immunosuppressed by that time, the infection went quickly systemic and I was rushed to the ER, where I arrived with a BP of 35 over 28.

      My right lung was perforated while being intubated and collapsed. Before placing me into a drug induced coma, they told me they were sending in my wife so I could day goodbye to her – that’s how sure they were that I would not survive. This was about the forth time my wife was told she would be a widow within 24 hours. I was placed in the coma using propofol, that mild sedative according to our nurse, which was able to keep me unconscious for two weeks while also suffering a pneumothorax and pneumonia – yeah, that’s a mild sedative.

      The infection was a very deadly strain. It was a multi-drug resistant gram negative rod called, pseudomonas, and went systemic (obviously a hospital borne strain). The PICC line was tested and found to be negative for the pseudomonas. If not by the PICC line, then the only way I could have contracted it was from a ileoscope that I had received two days prior as an outpatient. All intestinal transplant recipients are required to have an ileoscope every week following the transplant for the first ten weeks, then once a month for a year after that or until the stoma reversal.

      This is why I say that I have been scoped more than most people in three lifetimes. During this time I saw how these scopes were handled, because the ileoscope was inserted through a stoma made from the ileum (last length of the small intestines) which has no feeling. The procedure was painless, so no sedation or anesthesia was used. While in the hospital, they would roll the machine into my room on a cart and the endoscope would be simply lying on a towel. The doctors would toss it across my legs (still on the towel, but how sterile is a terry cloth towel?), while he cut a hole in my ostomy bag to access the stoma. They had to do this for every patient on the fifteenth floor, so they would roll the cart from one room to the next.

      When receiving a scope as an outpatient I was taken into a small tiled room. I could see through the window in the door to the supply room. Inside I could see about ten scopes hanging on a rack that was mounted to the wall. The scopes hung just inches from the concrete block wall. Because my condition required a scope with a zoom, on two occasions, the assistant had the scope prepared when I arrived, but it was the wrong kind. The doctor would ask her for a zoom scope and she would take that one back in the room and I could see through the window that she placed it back on the rack and grabbed another.

      Does this match the image painted by the nurse of how clean and careful they are handled? I know that conditions can vary from clinic to clinic and maybe her facility is better, but how can she speak for every clinic, gastroenterologist and hospital? She can’t. Thousands of these procedures are performed every day and some doctors do a few in a day and some cram in as many as they can. The insurance company will pay the same price whether the doctor takes twenty minutes to two minutes to do the procedure, so I get irritated when anyone makes such a general statement concerning every colonoscopy performed.

      This is why the point of being unconscious is important. Most people do not get to see the procedure, when it is a colonoscopy, so they are not aware of how things are handled or how much time the doctor spends and I’m sure that can vary from practice to practice.

      Our nurse says that the intestines are a dirty organ, so the scope doesn’t need to be sterile. Yes, the intestines are a dirty organ, but that does not mean that it hosts Hepatitis C, HIV or hospital born strains of superbugs, like that pseudomonas I received. This is a weak excuse for using the same scope over and over, with no disposable parts.

      In many colonoscopy procedures, a sample will be cut from the walls or a polyp removed. In my case I could watch the monitor as the doctors would tear off a piece of villi for biopsies. The tool that was used to gather the villi sample looked like a tiny alligator clip on a wire. While the doctor would navigate the scope, another doctor (usually a Fellow) would feed the wire through a port at the handle of the endoscope and fish it through the entire length of the scope until it came out the end inside me. Now the wire was taken from a sterile package and was disposable, so we know it was sterile going in, but there was no way it remained sterile coming out. Now you know that the piece of flesh was scraping the side walls of the tunnel within the endoscope.

      And this nurse wants to convince us that they can sanitize the entire stretch of this tiny tunnel, which runs the length of the scope? Remember, this machine cannot be placed in an autoclave or subjected to high temperatures, because of the optics and electronics. I seriously doubt that tunnel can be sterilized.

      Each time they would tear out a sample from the villi, I would see blood come from the wound (these scopes for the ileostomies had a powerful zoom to magnify the villi. The first sign of organ rejection would be the shortening of the villi, so the doctors were magnifying them to examine the length.). So the injury was very tiny, though it looked like a lot of blood when magnified. Yet, we are expected to believe that the scope does not have to be sterile near this open, bleeding wound – after the tool has been pushed through a tiny tunnel, where it scraped the sides of a scope that has been in many other intestines.

      The doctors do not linger around inside until the bleeding stops. This is another danger, especially for anyone on blood thinners, low platelets or bleeding disorder. This is where I know that many deaths and complications are not reported nor the association made with the scope. And don’t tell me doctors won’t take unnecessary risks. A years after my transplant, they wanted me to have a sigmoid scope, yet my latest blood work (I had to get full blood work weekly and have to now get it monthly for the rest of my life) showed that my blood platelets had mysteriously dropped and the doctors were well aware of how dangerously low they were, yet they were going to do the procedure anyway and, in fact, applied a lot of pressure when I refused. How are you going to know if you continued to bleed inside?

      Then there’s the air pressure. Some of the doctors would inject more air pressure than others. One doctor pushed so much pressure that I began to complain of the pain. He continued until the pressure was so great, that it launched all the food from my stomach out my mouth and all over him. I did not vomit. There was no retching or gagging, nor was I even nauseous. The endoscope is capable of injecting so much air pressure (they inflate the intestine to make scraping the walls less of a risk) that it could push open at least two sphincters (from the ileum, up through the stomach and esophagus) and rocket all of the food out my mouth. Even this much air pressure can cause severe injuries or perforations. The colon is not indestructible, nor is it an inflatable floatation device.

      Some gastroenterologists can cram in as many as twenty to thirty patients in a day, depending on how money motivated they are, and I’m to believe that in such a rush, that tiny little five foot long, nearly microscopic tunnel is so thoroughly clean that it can be exposed to an open, bleeding wound. That is a direct line to your blood stream, without the protection of stomach acid and a by-pass of the liver. You decide if you think that’s possible and that the intestine is so dirty, it doesn’t matter if the scope is sterile or not.

      The lungs are also considered a dirty organ, yet it is a major access for infections. I was told by the CT surgeon who performed the lung resection that the lung was considered the next dirtiest organ to the colon – but it’s not important whether something goes in your lung infected. In Europe, a disposable end for the colonoscopy AND a condom-like sheath are required for the endoscopes. Doctors in the States have complained that it would raise the cost too much – what’s your life worth?

      After I managed to survive the deadly sepsis from a gram negative, hospital borne pathogen, which had to come from the ileoscope, I then required a right lung resection to repair the hole in the lung caused by the respirator. I had a total of five chest tubes placed over those weeks. My entire right side of my torso has no feeling anymore because of the nerve damage from all the chest tubes, but hey,mthat’s a minor inconvenience right?

      Sorry if this seems overly long and detailed, but this is only a fraction of the things I suffered. I just wanted you all to get an idea of the life I lived and still do. It is not all some minor injury that can be magically fixed by a quick surgery as our nurse has suggested. This was a major, life-altering injury. How can we trust any of her information, when her claim that colonoscopy injuries are not only rare, but are not very serious, has been proven to be a total fabrication? She either has no idea just how traumatic they can be or does and purposely wrote a rant to mislead as damage control. By all of the doctor’s account, and I’m talking about some of the most world renown surgeons (Dr. Tzakis is one of the pioneers of the intestinal and multivisceral, multi organ transplants and has performed more transplants than any living doctor), I should not be alive. It is a complete mystery why I’m still alive.

      The doctors had told us that most people would not have survived what I did, and yet our nurse feels this was some kind of joke. I would love to see her actually choose this fate. While at Jackson Memorial’s transplant hospital, I met eleven other recipients that I came to know well. Of those eleven, three others, besides myself, were perforated by these ileoscopes. The woman who was assigned as my mentor barely survived a perforation of the small bowel, even though she received immediate surgery. One of the readers of my blog, roarofwolverine.com, wrote to me last year about her father, who was pressured into a colonoscopy because his hematocrit was low. His bowel was perforated during the procedure and he was rushed immediately into surgery, which he survived, but was unable to come off the respirator after the surgery. She continued to write to keep me appraised of his condition. He passed away two months after the procedure went bad. Does this nurse want to tell her how safe these procedures are? She told me that her father walked in to the hospital on his own power, but he exited in a casket. It was a slow, agonizing death. Just how was this more desirable than a death by colon cancer?

      Then there was a very sweet woman who I met at Jackson. She received an intestinal transplant soon after mine. She was a strong and athletic woman, very tall and played varsity basketball at Florida State when she was younger. Her transplanted bowel was perforated during a routine ileoscope and she was rushed in to surgery. Though she survived the operation at first, her condition continued to decline and led to kidney failure and ultimately multi-organ failure and she passed away just a few weeks after I was released from the hospital. This is no F#+*#*g joke! Death is death, and this woman died at the age of 49 – the average age for colorectal cancer is 71.

      Though our nurse speaks of 50 year old people with colorectal cancer, they are quite rare. The woman that was assigned as my mentor had Gardener’s Syndrome and had intestinal cancer at the age of 33, but then again, not only is this a rare disease, but it is congenital, so these people typically know who they are and what ran in their family. Her mother died of intestinal cancer at the age of 42 because of Gardener’s Syndrome, so she knew to have regular colonoscopies. In her case it was necessary, but I disagree with this idea that they are so safe that everyone should get one every ten years after their 50th birthday, whether cancer runs in their family or they are feeling fine. The fact is that the injuries can be deadly or totally destroy your life, like it did mine. I was self employed all my adult life and lost my entire business because of an unnecessary colonoscopy.

      It is my experience that these injuries are far more common than we are led to believe. Three people out of eleven that I met were perforated, there were other injuries, but those were actually perforations. Then the fact that I was injured twice by endoscopes within six months (the original perforation and the Pseudomaonas infection). Both nearly cost me my life. None of these incidents were officially reported in some statistic database and it is not always easy to connect the dots on every case. Many times, the problems can arise a few days or weeks after the procedure and few people or doctors will associate an infection that comes on later as being associated with the colonoscopy – especially when they are so convinced that it cannot happen at all, as we see our nurse is.

      They will deny any connection that cannot be proven within a shadow of a doubt. I began publishing my blog two years ago and without advertising I do not get a great amount of traffic, yet I have already had eight people contact me after reading my story to tell me that they had lost a loved on to a complication after a colonoscopy. How many more would I find if I had the kind of traffic like Chris gets?

      While at the transplant hospital, I was curious and asked a nurse what was the most common cause for patients to need intestinal or multivisceral transplants. I really expected the answer to be cancer or Crohn’s Disease. She told me that those were the least common, especially cancer. She said that the number one reason for women was as a result of bariatric surgery (later, I met two women who were there for a six organ transplant and both lost their intestines to botched gastric by-pass surgeries.). Then she said that the most common loss among men was liposuction! Many doctors rush these procedures and injure the intestines while sucking away the visceral fat from these men.

      There you have it. I later confirmed this with some of the transplant surgeons. By far, the most common loss of organs was due to medical procedures, not diseases. We are also told that bariatric surgery and liposuction are super safe procedures also. Like I said, the dirty little secret is that things are kept a secret. Had I died, I seriously doubt that the cause of death would have been recorded as a colonoscopy. Because the doctors delayed treatment so long, the intestines that the surgeon sent for the pathology report was so necrotic that most of it had turned to liquid, so it yielded no answers. This is why it was not reported as a colonoscopy injury.

      The hospital swept it under the carpet to avoid any legal action, yet we are supposed to believe that doctors and hospitals freely admit when a colonoscopy is the cause of an injury or death? The cancer statistics are most likely pretty accurate, because no one has a motive to hide a cancer death. Medical errors are subject to legal action, so there are many reasons to hide the real cause of death or never look for it, which seemed to be the option I’ve witnessed. I’ve never heard of a doctor attempting to determine where an infection came from, unless there was an epidemic.

      How high are injuries from colonoscopies? I doubt anyone will ever know, but I guarantee you they are far higher than the .05% our nurse confidently stated. the most recent statistic say that 5 in 1,000 will be injured by a colonoscopy and 1 in 1,000 will suffer a perforation. I’m sure it’s at least double that, if not more if we included all infections. One thing I do know, is that the injury is not a minor inconvenience – people die. I nearly did – several times. My life has been completely wrecked, yet this nurse says all I suffered was nothing. And the friend that I made at the hospital, her death was just a minor inconvenience to her also. Why would her death have been somehow worse if it was due to cancer? At least cancer would have been natural causes, whereas her death was preventable.

      I actually take the opposite position, because had my injury been from a natural cause, like cancer, I would not have to face the rest of my life blaming myself for having the procedure and constantly having to ask myself “what if?”, as in, what if I had not gotten that procedure? I would still have my native intestines, my business and not be dependent on very costly anti-rejection medication for life. So take it from someone who actually experienced this tragedy, rather than someone just shooting off at the mouth – the psychological damage is far worse when injured by a procedure.

      These are my facts and my story, and of course I have nothing to gain or lose, no matter what you wish to believe, or do, from here. I am selling no product or service, just telling my story so people can make an informed decision concerning their health and safety. Or you can believe the facts from our nurse. Someone who makes a living doing these procedures and is simply repeating facts given to her from the medical industry (who make a butt-load of money from this procedure) and the manufacturers of the endoscope (like GE, who was also Katie Couric’s employer when she performed her televised colonoscopy).

      You can believe her book-learned knowledge of the damages that this procedure can cause (which she claims is minor) or the words of someone who lived through this nightmare and still does everyday. Certainly my life has been shortened by this profitable procedure (how long can I expect to live with such a rare transplant?) and I have suffered pain that this nurse can not even imagine.

      I writhed in a hospital bed for three days, with over twenty feet of necrotic bowels, which were going gangrene, all the while the gastroenterologist kept telling me it was just post procedure discomfort and there was nothing wrong with me. Then he left the scene of the crime and the hospital doctors took over and just pumped me up with tons of dilaudid. That was the last I remember until I woke up in the ICU while being intubated (a horrible way to wake up, especially when you don’t know where you are, how you got there or that you had just had surgery) – and you want to downplay all this as a minor problem? Is that a big joke saying that you would happily choose?

      That’s just when the real troubles began. For the next six months, in and out of septic shock, fevers above 105.5, with rigors so bad my muscles cramped from shaking. I was cut and gutted like a fish, from sternum to groin, not once or twice, but three times. Because the colon was disconnected from the small bowels, I suffered what is known as diversion colitis. When the colon does not have stool passing through it (which is how it is fed – the fiber is converted to butyrate which the cells consume) it becomes inflamed and ultimately ulcerated as the cells die. Mine became so ulcerated over the six months, that I required a blood transfusion of two units every 14 days and the pain was so bad that I needed 4 mg of dilaudid (8 times stronger than morphine) every two hours to withstand the it. This went on for months, not days.

      Sorry if I seem angry. I was not angered because of her erroneous and misleading information (her rant was very similar to the sales pitch pharmaceutical companies give on how safe all their drugs are) – this I’ve come to expect from those in the medical industry. but it was the cocky way she claimed that colonoscopy injuries are no big deal and that she would choose that over cancer any day, when it is obvious that she has no idea how bad they can be – so I took it personal.

      Anyway, I’ll leave it there. BTW, I am the Wolverine that Chris was referring to in the article. If you made it this far, thanks for reading this rant. Thank you Chris for mentioning my story. I would love for more people to know my story, not just because of the danger of colonoscopies, but because of the miracle of intestinal transplants, which so few doctors know about. Over twenty doctors that worked on me here in Orlando told me they were impossible and that I should just stay on TPN, which they also said would kill me inside two years, because the high sugar content ultimately destroys the access arteries and the soy lipids do liver damage. Had my wife not been so tenacious and not accept everything the doctors told us, I would most certainly be dead already, because my three year transplant anniversary will be next month.

      Again, sorry for the length of this reply, but it was necessary to illustrate that the nurses claim that colonoscopy injuries are a walk in the park compared to colorectal cancer was complete ignorance or a lie.

      Remember people, every doctor in Orlando told me intestinal transplants were impossible, but I am living proof that they are possible, so people in the medical profession may think that they’re authorities on everything, but we can see that they aren’t. If you think that is just because of backwoods Orlando, you would be wrong. I had one of blog readers contact me to tell me about her mother, who had a bowel obstruction that was twisted and the doctors refused to operate, because they said she could not survive without the intestines. When she told them that she had heard of my transplant, the doctors in Chicago told her that intestinal transplants were impossible. Unfortunately, her mother died before I could get her in touch with the transplant surgeons. Why? Because the doctors in Chicago refused to believe that intestinal transplants were possible. Had the doctors been up on the latest in transplants or believed what I was telling the daughter and done the operation, her mother may well be alive today. Stay well everyone.

      • STG says

        Amen! Thank you so much for sharing your story and exposing the dangers and problems with over-treatment. Here are a few books that are worth reading regarding the medical/industrial system and over-treatment: The Last Well Person by Nortin Hadler, Should I be Tested for Cancer by H. Gilbert Welch, Overdiagnosed–Making People Sick in the Pursuit of Health by H. Gilbert Welch et al. Perhaps you are already familiar with these books? Like you, I was also harmed by treatment: a had a femur fracture as a result of 5 years of Fosamax treatment. I have healed and I am skiing and hiking again but I will NEVER take another pharmaceutical drug. I would rather die at an early age then be damaged by medicalization.

        Your blog sounds very interesting and informative. I visit it and tell others about it.

        Chris–this was a incredible podcast. I think that your blog is the absolute best health blog!
        You are thoughtful, insightful and informed. For those of us who have dropped out of the medical/industrial machine your blog provides hope and info. Thanks!

        • says

          Wolverine: you have had a horrible series of events which ruined your health, and while I can never imagine the magnitude of your experience, I can try to understand your anger. After what you have suffered you have every right to be bitter, and I respect that you wish to educate others about the potential dangers of medical treatments. However, I believe people need to carefully weigh the risks and benefits of any medical procedure, and for that they need factual information. I was merely trying to correct some statements in Chris’s article which I thought to be in error or misrepresented.

          On the subject of medications: we use propofol in about 20% of our colonoscopies. A small nearby hospital uses it in nearly all of theirs; the big medical center we refer to almost never uses it. In other words, practice varies a lot even within a small geographic area. I never suggested propofol was similar to narcotics, or was a light sedative, as you accuse me of. Yes, propofol can kill someone; so can Tylenol, or any drug. The dose makes the poison.

          Reading back over my post, I realize that I may have come across as too breezy when I was discussing complications, and for that I apologize. I have never personally seen a truly bad outcome following a colonoscopy. In my experience (I did a very rough calculation and estimate that I’ve assisted in around 2500 colonoscopies, not hundreds as I said earlier), the complications that I have seen have not been life-threatening; they would be counted in the 5 out of 1000 that you cited, but would be nowhere near the type of injury you suffered. Even the worst injuries, the perforations (there have been two in my hospital in the 5 years I have been there, but I wasn’t present), entailed a surgery, hospital stay, and recovery, but the patients eventually recovered without major issues. I do not deny that terrible complications occur – you, unfortunately, prove that – but I believe they are rare. Our hospital did have one death following a colonoscopy and barium enema before I started working there. It was an awful event; the patient was relatively young (60s) and healthy. She had pain following her procedures, but had a family event that she had to cook and clean for, and she ignored the pain she was having. By the time she came in a couple of days later, she had an advanced infection and died of sepsis. It was horrible; I know the story well even though it happened before I worked there. I have since done colonoscopies on two of her family members. They understood that even though their loved one died, that didn’t mean the risk-benefit ratio was such that they shouldn’t have a colonoscopy themselves.

          Colon cancer is not rare. As a nurse, I have taken care of patients dying of cancer, and it is no walk in the park. I have seen many colorectal cancers during colonoscopies, some in 50-year-old patients with no symptoms or risk factors. These young patients probably had their lives saved by choosing to have a routine colonoscopy. I believe patients like these greatly outnumber those who have been severely injured by colonoscopy. Also, colonoscopy is not just a screening test; it can prevent cancer by removing polyps that, if left in place, would eventually turn into a cancer (http://www.nytimes.com/2012/02/23/health/colonoscopy-prevents-cancer-deaths-study-finds.html?pagewanted=all). We find and remove polyps every day. If we didn’t remove these polyps, the rate of colorectal cancer would be even higher than the 1-in-20 risk that it is today.

          I could imagine agreeing with an argument against healthy 50-year-olds with no risk factors coming in for routine colonoscopies. The risk-benefit ratio has a tipping point, and I’m unsure exactly where it is. Certainly the risk of colon cancer is less in younger patients, but so is the risk of injury. Any procedure becomes more risky in an older patient.

          • Wolverine says

            Thank you for your reply and I’m sorry if I came across angry. It was not your defense of the procedure that angered me, because I expect that from people who work in the industry. It was when you downplayed the severity of possible injuries that set me off. Besides the horrible damages done to me, I saw several others who were injured and two that even died as a result of endoscopes. (Not to mention the people who have emailed and commented on my blog about losing family members to colonoscopies)

            By all accounts, I should be dead, the fact that I survived is not a free ride for the procedure, because every doctor claimed that most people would have died in my situation.

            The other problem is that I believe that you are guilty of the false census effect, which is a common mistake, but can misrepresent reality. Just because the facility you work at does things in a careful manner, does not mean that all others do. You cannot paint with such a broad brush and speak for the industry at large based on your facility alone.

            The fact that you only use propofol 20% of the time is not the norm. According to my research, it is the go-to drug for most facilities. But to be clear, I have never claimed that the propofol is any great risk, I actually mentioned that injuries from propofol are rare. I only bring it up in rants to illustrate that the patient will be unconscious during the procedure and will have no idea how sloppy or rushed the procedure may have been performed – that is the only reason I ever mention it. For this reason, you are at the mercy of the doctor, so you better be sure that you know this doctor’s skill level and professionalism. An endoscope is like a gun, it is only as good or bad as the person operating it.

            To me, it is important for people to understand that they will be unconscious, because some doctors are known to rush in as many patients as possible. Not many other screening procedures require that the patient be knocked out. No one is rendered unconscious for a mammogram. You also cannot lump a sygmoidoscopy with a colonoscopy – there is a big difference, especially where risk factors are concerned. Pushing an endoscope all the way to the ascending colon is far more dangerous than just to the sigmoid. Many doctors are performing a colonoscopy where a sigmoid would do just as well, probably because the colonoscopy takes the same amount of time, but charges out at ten times the cost. (I am referring to UC and Crohn’s Disease, where a sigmoid would be enough to diagnose, but doctors take great risk with ulcerated and inflamed colons with a colonoscopy). I understand that cancer screening requires an full on colonoscopy.

            You say that the severity of my injury is very rare and that may be so, but so too is colon cancer in 50 year old people. People need to know my story so they will know just how bad the damage can be.

            I am not as sure as you are that colonoscopies are so effective at curing colorectal cancer. The only clinical study I have found that had even tested the effectiveness, is The Telemark Polyp Study 1. Although there was a 2% reduction in colorectal cancers (hardly impressive) in the screening group that had polyps removed, they had a 157% higher mortality from other causes than the control group. The all-cause death rate was significantly higher in the group that was screened. So, you may die prematurely, but at least you will die knowing that you have no polyps in your colon while being embalmed.

            I believe that many doctors snip out a polyp and claim it victory over cancer, yet 90% of polyps, especially the large ones, are benign and are no more of a risk than a mole on your skin. We could also burn every mole off of everyone’s skin and claim victory over melanoma, because any mole could potentially become a melanoma.

            My mother had a double mastectomy back in the 1970s, for lumps that no doctor would even remove now. Back then, they were too quick to remove breasts, but we have learned that not all lumps are a threat. How am I to know that they are not doing the same thing now with colonoscopies? Is every polyp a threat to the person’s health?

            The following is the only information that I came across in my research.

            From an article in the New York Times, dated 2006; “The patients in all the studies had at least one adenoma detected on colonoscopy, but did not have cancer. They developed cancer in the next few years, however, at the same rate as would be expected in the general population without screening.”

            Another research study published in 2006 concluded that the screened patients in all of the studies developed colorectal cancer “at the same rate as would be expected in the general population without screening” in the next few years, even though all found polyps had been removed.

            Yet you’re claiming that colonoscopies and polyp removal saves thousands of lives. I have yet to find any studies that prove this, only people in the medical industry that claim it. But, these same doctors also claim that cholesterol causes heart disease, that saturated fat, not carbohydrates, causes diabetes – which are far greater killers than colon cancer. Every American is far more likely to die from these statistically. Everything doctors believe is not necessarily true – I saw plenty of mistakes by doctors – and doctors who are some of the most famous and respected in the world (the transplant team at Jackson are far beyond the average doctor and a few of only a handful that have successfully accomplished intestinal and multivisceral transplants)

            The majority of polyps removed during colonoscopies are the large type, but research has shown that the flat lesion, which are rarely found or removed during a colonoscopy, that are many times more likely to become malignant and life-threatening.

            The National Cancer Institute’s report suggests it is closer to ten times higher: “In a study in which endoscopists used high-resolution white-light endoscopes, flat or nonpolypoid lesions were found to account for only 11% of all superficial colon lesions, but they were about 9.8 times as likely to contain cancer (in situ neoplasia or invasive cancer) compared with polypoid lesions.”

            As I stated, these lesions are typically missed or not removed during a colonoscopy.

            This is why I do not believe that colonoscopies save more people than they injure or maybe it’s about equal at best. I don’t see how any cancer could be any worse than what I have been through and still live with. The injuries that you speak of, at your facility, are the ones that were detected immediately following the colonoscopy. Unfortunately, not all injuries show up so soon after. I was left for more than three days. I was being kept in the hospital because I was anemic at the time, otherwise I would have been sent home, where I would have most likely died three days later when the necrosis finally overtook me, because the gastroenterologist refused to accept the fact that I was injured by the endoscope, even though I complained of intense pain (if you can imagine what 25 feet of dying bowels feels like, which he insisted was just discomfort from the colonoscopy)

            Two of the people that I met, who died as a result of endoscope injuries, did not die right away. The one woman received immediate surgery to repair the damage, as the ones that you speak of. She was even released a few weeks later. It was only because she was a transplant recipient that she had to stay near the hospital in a place called the Transplant House. Had she not been a transplant recipient, the staff at that hospital would not have known what happened to her once she left the hospital. So, it is quite possible that many clinics and facilities that perform colonoscopies are never aware of some of the injuries, because the person is treated elsewhere and the connection is never made to the colonoscopy, or they die at home (they could bleed out or die from a sepsis). You act as though all injuries will be immediate, so you will know about it. Mine did not become lethal for three days.

            It is suspected that I was also infected with the pseudomonas from the endoscope. Even though the pseudomonas nearly killed me, it could have been worse. It just as easily could have been HIV, or Hepatitis, which would kill an immunossuppressed patient in short order. The PICC line tested clean, so how else did it go systemic? The only invasive procedure that I had was the ileoscopy two days earlier. Again, I was on immunosuppressant agents, so I would have failed much faster than a healthy person – also, I was made to stay at that Transplant House. Had I returned home, I would have died at home.

            I barely made it to the hospital, only a block away, as it was. I only had minutes to live from the time I got there- as a matter of fact, I was already in respiratory failure, which was why there was such a big rush to intubate me that they perforated the right lung. Another couple minutes and I’d have been toast. Had I died at home, who would have ever figured out it was from the endoscope? No one, nor would there have been any investigation. I only found out because I survived and was able to follow up the PICC pathology and learn that the pseudomonas I contracted was the same as one that had recently killed a couple of patients there at the facility where I was scoped.

            These are some of the reasons that I am not so convinced that the benefits outweigh the risk, at least for people with no risk factors for colon cancer. Someone with Gardener’s Syndrome or some other high risk factor would have much to gain by this procedure, so I’m not completely against it. I just don’t believe that it should be forced on everyone over fifty and to take that risk when you’re perfectly healthy seems insane to me. If I had it to do over again, I certainly would never have gotten the colonoscopy. If I lost my bowels to cancer, it would be easier to live with, because it would have been an act of nature. As it was, it was the act of irresponsible doctors, not just because of the injury, but because of their cynicism and refusal to believe that I was injured and delayed treatment. So from a psychological standpoint, it is far worse than cancer.

            One more thing. If injuries are so rare, then why do doctors and hospitals make everyone sign that waiver, which lists all of the risk factors – including death? It seems that if it were so rare, the doctors and hospitals would simply pay the very few suits for the small damages that they get, rather than frighten patients with such an intimidating paper? That’s why I have to believe that these injuries are very common and the financial bite would be huge, if everyone injured sued for damages. I received no compensation for all of the pain and suffering, plus the expense of a small bowel transplant (over a million dollars) and the expensive medication that I will have to take the rest of my life – because I signed that paper. If they only had to pay for one lawsuit every few years, this amount would be nothing compared to how much money this procedure generates and would be the right thing to do (I sure could have used the help, but got absolutely nothing).

            No, the truth must be that they would have billions of dollars worth of lawsuits and the damages could amount to so much, because the injuries are so severe, like mine. That waiver would make no sense, if the injuries were very rare and then so minor and inexpensive to fix when they happened – as you have suggested. But if such injuries and wrongful death were very common, I could see where it would drive most hospitals and clinics into bankruptcy real fast.

            Companies, like Disney, know that there are injuries from their rides and attractions, but they are so few, that they just pay the suits or make a settlement, rather than make every visitor sign a waiver. No one but hospitals do this, because it is bad business for anyone else. So the hospital must know that the suits would be endless and expensive.

            Statistics fly in the face of your observation, because pharmaceutical drugs are like the second highest killer of humans in the U.S. and medical errors are like the fourth leading cause of death. If you combine them, the medical industry is the leading cause of death in America (I believe the stats, because I witnessed a lot of potentially life-threatening errors nearly made on me. Had my wife not been present 24 hours a day in my room, I would certainly be dead from some of the errors.)

            Statistically speaking, people are around 1,200 times more likely to be killed by a doctor than a terrorist or mass shooter – yet terrorists and shooters are what people let occupy all their fears on. Makes no sense.

            • says

              Wolverine – let me be the first to agree with you that pharmaceuticals and medical interventions and errors kill a huge number of Americans each year. You’ll get no argument from me there. That’s partly why I chose to have home births rather than risk interventions in a hospital. That said, I don’t think that makes my argument wrong. You may be correct that colonoscopy injuries are vastly under-reported; I don’t know. Any injuries in a hospital (even ones that are identified later) are required to be reported and tracked. It sounds like you had the terrible misfortune to have a dangerous and negligent doctor.

              I found a very interesting article looking at many kinds of complications during/after colonoscopy: http://www.cghjournal.org/article/S1542-3565(09)01042-8/fulltext#sec2.1 – it also details use of sedation meds, noting that propofol was used in only 1.4% of colonoscopies (much less than at my hospital), and general anesthesia in 0.04%. You keep saying patients need to be unconscious for their colonoscopies, but many of my patients are awake for part or all of theirs. Often people sleep or doze through the insertion (the more uncomfortable part) and then the meds start to wear off and they can watch the rest. If they are comfortable and don’t mind being awake, we don’t give more meds unless they request them. A different source (http://www.cbsnews.com/8301-504763_162-57401162-10391704/study-colonoscopies-often-come-with-costly-unnecessary-sedation/) said that colonoscopies using an anesthetist (which implies the use of propofol) climbed from 14% in 2003 to 30% in 2009 – quite a different number than the 1.4% above, but still a minority.

              I’d like to address the efficacy of colonoscopy at reducing colorectal cancer deaths. This study (http://www.ncbi.nlm.nih.gov/pubmed/22356322) demonstrated a 53% reduction in mortality when comparing patients who had adenomas removed with an unscreened population. Another study (http://www.sciencedaily.com/releases/2012/07/120724131619.htm) showed “substantial reduction in the incidence of colorectal cancer and colorectal cancer-related mortality in a sample of asymptomatic individuals undergoing a single colonoscopy screening compared with non-screened individuals”. This study of average-risk patients (http://www.cghjournal.org/article/S1542-3565(09)00006-8/fulltext) concluded “CRC incidence and mortality were reduced after screening colonoscopy”.
              This article (http://www.medscape.org/viewarticle/714469) cites many studies, some of which show substantial reduction in mortality and others which are less definitive.

              I don’t want to start a debate about an entirely different topic, but I think there are many similarities between the colonoscopy argument and childhood vaccines. Both are profitable enterprises, both are something everyone is supposed to do, and both have risks which may be minimized by the authorities. As with all medical treatments, the risks and benefits should be weighed carefully, and for that we need accurate information. For the record, I delayed most vaccinations with my kids, and selectively vaccinated after considering the risks and benefits of each one. Despite being a nurse, I’m not just a shill for the medical industry; I do think for myself.

      • greg says

        Thanks for your story;just a glimpse of the distress caused to you by our modern medicine.
        After my brother died recently at 46 from bowel cancer surgery complications(the surgeon failed to protect the bowel from scar tissue adhesions that form after surgery)-the bowel surgery was successful,but the adhesions to the bowel twisted the bowel,blocking it 95%;the surgeon refused to operate to remove the adhesions,as the risk of perforating the bowel was high and my brother would have died on the operating table,which would not look good for the surgeon.
        Consequently,my brother was left to slowly starve to death,which took around 2 months.
        My doctor said I should have a colonoscopy and when I did the osmotic salt solution bowel prep,I discovered my bowel is osmotic resistant,which means that instead of retaining water in the bowel which causes the bowel clean-out,my bowel removed water as per normal through the kidneys/bladder,with the result my bowel was left with a high concentration of salt,which as you may know is deadly to bacteria.
        I couldn’t have the colonoscopy,as my bowel became constipated instead of being cleaned out;instead of being concerned about the state of my bowel,the gastroenterologist was annoyed that he was unable to do the colonoscopy and insisted that I have an enema so he could attempt a colonoscopy- the enema only flushed the end of my colon and his attempt to do the colonoscopy was a predictable failure as he couldn’t see anything,with a much higher risk of perforation than with a clean bowel,just so he could charge for doing a colonoscopy!
        That was 2 years ago and I’ve had chronic digestion problems ever since,despite varied attempts to restore proper gut flora;I may have to have a fecal transplant to hopefully restore healthy gut function.
        My 2 cents…don’t have a colonoscopy,unless you have colon blockage that needs investigation.

    • Sharon says

      I have a neighbor who got a colonscopy more than a decade ago. The doctor was administering the sedation in her hand and something went wrong. She told him her hand felt funny and it burned. Well..at the end of the day, she lost her hand and it was amputated.
      Very sad story and I imagine she sued the pants off the doctor, hospital, etc.

  18. Reynold Woelcke says

    You mentioned that in the saturated oil vs polyunsaturated oil study that the polyunsaturated fat used was safflower oil and safflower margarine. In the 1960’s and 70’s, the margarine in the study would have been made by hydrogenating the safflower oil, therefore meaning it would have been a significant harmful transfat source. Would this not have significantly skewed the results depending on how much margarine was ingested? Currently the belief is that hydrogenated oil tranfats are a significant contributor to coronary heart disease. The point is therefore that this study cannot truly show increasing omega 6 oil consumption increases coronary heart disease.

    • Glenn Atkisson says

      This is the most vital point about all “polyunsaturated oil” or “omega-6″ studies, Reynold. I’m so glad you see this. Studies of the effects of “omega-6″ oils on our bodies are always cited, but the actual oils used in the tests are never highlighted. And, as you point out here, they are usually using either cheap commercial oils that have probably already been compromised as to health, or they are using trans-fats that came from omega-6 oils, and they continue to call them “omega-6″. There is hardly a study that I can find that has carefully used a safe source of omega-6 and then tested to see, for instance, if there is a negative effect on the human body.
      In fact, in this study cited today, even the non-margarine oils was probably no longer a healthy source of omega-6 fatty acid. So of course you are going to see damaging effects from ingestion of the oil. Way worse than ingesting some other healthy form of fat.
      What I take from this is that there still is no entity in the scientific community that interested in the health benefits of omega-6 oils, as there are entities (sales organizations) interested in the health benefits of omega-3 (fish) oils. So we will languish with little information on actually what causes, say, inflammation in the human body when it comes to oils. Is it a preponderance of omega-6 sourced oils that have been damaged, or is it the actual, essential omega-6 fatty acid, as it occurs, not just in vegetables, as Chris hints above, but also in appropriate proportions in free-range animals, eggs, and dairy products? I tend to believe it is the former: ruined oils as used in this cited survey.
      Chris says: “…his idea that we should be dramatically reducing our saturated fat intake and increasing our intake of vegetable oils to protect against heart disease really just has no support for it in the scientific literature.” And he is spot on!
      In fact, I can still remember viewing billboard ads in the 1970’s that slammed beef, and pushed “polyunsaturated oils”. That was the oil industry fighting the meat industry for our dollar. Later, when more evidence of damage from the “poly’s” arose, then the recommendation was toward only “fish oil”, and then gradually omega-6 became known as a “bad oil”. It is all hype. Omega-6 is an essential fat, just as is omega-3. But uncaring testing manages to show omega-6 (when used as cheap vegetable oils) as an agent of harm. Well realize, we all eat healthy omega-6 fats every day. What should be avoided is the cheap vegetable oils.
      One way that olive oil always manages to shine as a source of health is not so much because it is healthy, in and of itself, but because the olive oil industry has always been careful to produce a quality, unoxidized product! That is what must be tested for an oil to be graded “extra virgin”. That’s it! But it does guarantee that you are not getting ruined oil. Ruined olive oil would be just as damaging to your system as ruined safflower oil. But the olive oil industry has insured that people get safe oil from them. The vegetable/seed oil industry however has never taken any pains to deliver a safe product. Buyer beware.
      I am convinced that it is precisely the ruined oils that have been manufactured only in the last 100 years that have brought on this epidemic of cardiovascular disease.

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