Dr. Stein's Chronicles

Colon Cleansing and CAM

Cleaning colons is apparently the rage of the 21st century. Celebrities, friends and TV talk show hosts are all discussing it, but is it a healthy thing to do? Are there truly pounds of waste backed up in that colon that has accumulated over the past 20 years? The answer to the first question is maybe, the answer to the second question is an emphatic NO! The theories behind a build-up of waste were debunked in the early 1900s. The concept was called auto-intoxication, the idea that poisons in the stool built up over time and caused disease.

This theory was disproved more than a century ago. Yet it seems so logical that people say it must be true. When one truly understands how miraculous the human body is you realize that these theories make no sense. The body is designed to not waste anything - in fact our waste - the stool, contains the nutritional components that keep the colon healthy! Bacteria in our colon help our body modify the waste so it is usable for the cells in the colon lining, known as the mucosa. Repeated cleansing actually traumatizes the colon lining and may lead to problems such as colon ulcers, bleeding and perforation.

So why the obsession? It is true that most of Western Societies have an element of constipation, but this is mostly do to a lack of fiber intake. If we all took in the recommended dose of dietary fiber, and drank enough water, we would eliminate constipation, diverticular disease and symptomatic hemorrhoids. So if colon cleansing means taking high-dose fiber products, I have no problems with it. For a full review on colon cleansing feel free to go to http://www.betterbowel.com/articles/the-truth-about-colon-cleansing - an article I wrote a year ago.

Much of the publicity for colon cleansing comes from sources in alternative medicine. We have learned over the years that there is much value in understanding herbal remedies, and many of them work. Witch hazel is used for hemorrhoids, and is also the active ingredient in Preparation H (sorry - I can talk about this stuff for days). So how do you figure out what is reliable and what is pure fiction? You need to find resources for complementary alternative medicine.

So what is complementary alternative medicine, affectionately called CAM? Nobody seems to know. On the one hand, the Institute of Medicine defines it as follows: "Complementary and Alternative Medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed."

I am not sure that helps - I did not understand that definition at all. The bottom line is CAM is what you make of it. It varies between people, religions, cities and countries. In some countries, CAM programs are run by medical physicians. In the United States, CAM has traditionally been independent of Medical Doctors. Many Naturopathic Physicians obtain degrees for Alternative Medicine via web based programs. The question is simply how one can decide if their CAM practitioner is well trained and understands the complementary nature of traditional medicine and alternative therapies.

Modern medicine has needed to embrace and understand the nature of alternative therapies and for most of the 20th century has failed to do so. Recently, academic medical centers have begun incorporating alternative therapies into their healthcare delivery systems.
My simple advice is to only use those CAM Centers affiliated with Medical Schools and Hospitals, such as the University of Maryland’s Center. This may help weed out alternative therapies that really have no basis in science or medicine, such as colon cleansing enemas. Did I mention colon cleansing enemas are a load of..........waste?

Dr. Stein's Chronicles

An aspirin a day to keep colon cancer away!

The media has been buzzing about newly published data on the use of aspirin in patients with colon and rectal cancer. Since the 1980s, the genetic mechanism of colorectal cancer development has been known. Colon cells, called colonocytes, take a "hit" to one of their genes. The cells begin to grow abnormally, and they form disorganized tissue which can become a polyp. A second "hit" makes the cells even more irregular, and the polyp turns into a cancer. Although admittedly, this is a simplified version of the genetic mechanism, these are the genetic steps required for the development of cancer. Why does it happen to some people and not others?

The human body is complex. There is an interaction between a person’s immune system, the environment and genetics. These complex interactions are what determines who will develop cancer and who will not. We have known for some time about something called the inflammatory response. Basically, an increased inflammatory response may actually worsen injury – think keloid formation – the body tries so hard to heal it forms bigger scars as the cells grow more.

This response is mediated by a protein called Cox-2. This protein is stimulated during an inflammatory response, and Cox-2 also stimulates cellular growth. That is why the inflammatory response also promotes colon polyp and colon cancer growth – Cox-2 causes these cells to multiply at a faster rate.

This pathway has been extensively studied in patients with abdominal obesity (the metabolic syndrome), and the increased risk of colon cancer and polyps may be due in part to the increased production of Cox-2. Inhibiting Cox-2 has been studied for many years as a way to decrease cellular growth and reduce cancer risk.

Aspirin and NSAIDs (nonsteroidal anti-inflammatory drugs) decrease the inflammatory response and they inhibit Cox-II. That is why they are effective as pain relievers. The pain from an injury is due to the inflammatory response. This is also why aspirin benefits patients with coronary artery disease and heart attacks, as it decreases the injury to the blood vessels that supply the heart.

There have been prior studies in the New England Journal of Medicine and other journals showing aspirin use decreases polyp formation and may also reduce the risk of colon cancer. The study in this week’s JAMA showed that even after a diagnosis of colon cancer, aspirin use reduces the risk of dying from non-metastatic colon cancer by almost one third.

There are some caveats. Firstly, the aspirin used was full strength and not a baby aspirin, so there is the risk of side effects such as bleeding and GI problems. Second, not every colon cancer is caused by Cox-2, so the benefit is limited to those cancers that express the Cox-2 protein. That being said, I routinely recommend a daily aspirin to all of my patients that have had polyps or colorectal cancer. This study at least re-enforces this aspect of my practice, and tells us that an aspirin a day can keep some colorectal problems away.

Dr. Stein's Chronicles

The Beginning

As I am now entering the world of the blogosphere, I cannot help but to think back to chronicle the events that brought me here. It was a cold night in December, 2004 (I really do not remember if it was cold or in December but it sounded good) and my cellphone rang. It was one of my patients who had undergone a laparoscopic right colon resection for a large polyp in the cecum and appendix. He was a few months out from surgery and he was doing great. He asked me if I was willing to speak with a colleague of his who was trying to get a foundation off the ground. I said sure.............. my life would never be the same.



I spoke with Bobby Smith and became involved in Susie's Cause. Together we designed websites, established the mission and I was fortunate enough to meet David Cohan. His passionate and articulate plea that no one desrved to die from colon cancer and suffer like his daughter had resonated within me. It was then I decided I would do everything I can to help this fledgling foundation grow. It was soon afterwards that we decided to combine interactive learning with the energy of teenagers, and the concept of The Save Our Parents Program was born.


Throughout the United States, Canada and Puerto Rico The Save Our Parents Program has galvanised teens to educate their parents and loved ones about screening for colorectal cancer. Featured on the news and on morning shows, this program placed a unique stamp on Susie's Cause, and with each successful program, Susie's Cause repuation as a grass roots organziation that gets involved at the patient level has grown.


In the coming months, as a blogger for Susie's Cause, I will attempt to provide important or interesting information related to GI Health. Although alot of the information will be related to Colon and Rectal Cancer, I will discuss other topics as well. Even for me, there is a limit as to how often I can write about the colon.