Advice on Gut Health
Gastrointestinal problems are unpleasant to discuss and even more unpleasant to suffer. Here, two doctors from our area answer questions about them.
If your stomach is bloated, burbling and upset, it may be time to grab an antacid or a Pepto—or to see a gastroenterologist. Wondering when you should opt for the latter instead of the former? Two gastroenterologists, Scott Dinneen, M.D., of the Atlantic Digestive Health Institute in Morristown and David O. Rahni, M.D., based in West Orange and affiliated with RWJBarnabas Health, offer insight on common gastrointestinal (GI) concerns.
What’s the most important thing people should know about GI health?
Dr. Rahni: “It affects your general well-being. The intestinal system has trillions of bacteria and immune cells and hundreds of millions of nerve endings. It interacts with what we eat and how we feel, and it influences everything from mental health to cardiovascular health to the risk of cancer.”
Dr. Dinneen: “There are a lot of products on the market right now, like probiotics and produce herbal treatments, that are aimed at gut health concerns. People are seeking ways to address them. But the most important thing is a healthy diet and lifestyle, along with following up with your physician and following age-appropriate screening.”
What lifestyle changes can people make to improve their gastroenterological health?
Dr. Dinneen: “You want a diet low in red meat, processed foods and high-fructose corn syrup. A good, all-encompassing diet is the Mediterranean diet.”
Dr. Rahni: “Regular exercise is great for the mind and the gut—it channels the stress of every day in a healthy way. I also need to really press home the point of diet. It can be hard in America because the food here is so processed. Be cognizant of where your food is coming from and how it’s been processed. Try to educate yourself about that so that you can make the best choices.”
What do you want people to know about gastroesophageal reflux disease (GERD)?
Dr. Rahni: “GERD, or heartburn, is an incredibly common issue. The predominant contributing factors are age, diet and weight. If you’re older, have a high-fat diet or are overweight, you are at a higher risk. Healthy diet modifications can help. You should also avoid eating late at night—leave two or three hours between eating your last meal and going to bed. If you have a particularly bad night of heartburn, think about what you ate in the previous 12 hours and sometimes you’ll realize what the culprit is and you can cut it from your diet. It doesn’t necessarily have to be unhealthy—I’ve seen people become sensitive to salmon and cucumber.”
Dr. Dinneen: “Oftentimes, a primary care doctor can manage GERD. Patients are sent to us if they’ve kind of hit that next level, or they’ve had GERD chronically for years. If someone is vomiting or has unintentional weight loss or trouble swallowing, we need to look more closely and screen for things like Barrett’s esophagus, a pre-cancer condition.”
Have there been recent advances in treatments for common GI problems?
Dr. Rahni: “We have new therapies and medications for inflammatory bowel disease, one type of which is Crohn’s disease. They increase the quality of life of patients, who can go into deep remission, which means they’re symptom-free. These medications are also safer than prior ones. In the world of hepatitis C, we have therapies that now eradicate the virus and have no side effects at all, a huge contrast to the last generation, which had a low success rate and high side effects. These medications have a 95–96 percent-plus eradication rate, which means it clears you from the virus.”
Dr. Dinneen: “Nonalcoholic fatty liver disease is a crisis in this country. It is now one of the top three causes of cirrhosis. There is now a once-aday medication that can stop the inflammation that leads to scar formation, and then cirrhosis. It is very exciting because for so long we did not have anything like that.”
Is there a myth you’d like to debunk?
Dr. Dinneen: “Some people have diverticulosis, or the presence of abnormal pockets that sort of stick out from the wall of the colon. It’s incredibly common. Fewer than 10 percent of people with it will get infection and inflammation of those pockets, called diverticulitis. For many years it was thought that popcorn seeds and nuts could trigger episodes of diverticulitis, but we now know they don’t.”
Dr. Rahni: “Marijuana is usually good for nausea, but in 3 to 5 percent of patients it can cause something called cyclical vomiting syndrome [CVS]. Once they stop smoking, it will go away. People should know and consider that.”
Why should people seek to get to the bottom of GI symptoms?
Dr. Dinneen: “Fortunately, most symptoms turn out to be benign issues, things we can deal with. But sometimes we discover things that require a higher level of care—sometimes even cancers. The sooner you seek care for something abnormal, the sooner we can find the problem and cure it before it becomes something that’s more life-threatening.”
Dr. Rahni: “If something is happening consistently and you feel like your body is off, don’t ignore it. Go get assessed by a good doctor and rule out the worst.”
What are the screening guidelines for tests that rule out disease?
Dr. Rahni: “Colon cancer is the No. 2 cancer in the country. It’s presenting younger and younger. The age of screening colonoscopies has been decreased to 45. A colonoscopy is totally painless. You’re sleeping with anesthesia while it happens, and it takes 20–30 minutes. The prep itself is much easier than it was in years past.”
Dr. Dinneen: “There are noninvasive options as well, such as stool testing. Some options are even at-home.”
What would you tell someone who is putting off seeing a gastroenterologist because of embarrassment or anxiety?
Dr. Dinneen: “There is no reason to be embarrassed at all. This is all we do all day, every day—talk about the gut. There is nothing people could say that we haven’t seen or dealt with before. Everyone needs to put their health first.”
Dr. Rahni: “There’s no judgment. A good doctor will listen and give you the most evidence-based, empathetic management that they can. So never allow any embarrassment or anxiety to become a barrier to seeing a doctor, who will listen and give you good care.”
