Transcription
So, colonoscopy is a critical procedure that can save your life from colon cancer. You have to get it done at a certain point in your life. Yes. But, but the prep and the process definitely can provide a hit to your gut microbiome, which, you know, is so important for so many aspects of your health. So, what we're going to talk about today is what can you do afterwards to restore your gut microbiome after the destruction that is caused by the prep? We have firsthand experience. Oh, we got a guest again. Uh, no, we got, we got you. I don't like being the case study. Yeah. Well, 23 days ago, Dr. Zaza had a colonoscopy. I just got out of the hospital day before yesterday. He's going to speak to his unique experience. This is not a trial, but this is an end of one, an anecdote, per se, but a unique experience that might help some other people know, hey, this is what my normal was, and if you're going through this, here's, here's what can happen.
That's right. Now, when you do that bowel prep beforehand, yes, as I was doing, I was thinking, this is like hitting control alt delete on your gut microbiome. It really is because you're, you're almost like completely wiping it out. And so, we're going to talk about all that. So, welcome to Talk with Docs. I'm Dr. Brad Wein. I'm Dr. Paul.
Okay. So, so it all starts with, with the prep. So, we've talked about this in our other video, kind of, you know, what I wish I knew before colonoscopy. So, the nature of this prep is to try to get rid of all the stool. So, when a camera goes up there, they can see rather than being in the bottom of the ocean, murky, dark, can't see a polyp or cancer that way. No. And prep's a soft word. I would have chosen a word more like assault on your gut is what you're doing really to clear it out so that they can see.
Right. And, and what they've shown is that this prep not only reduces the number of bacteria, but also a little bit the diversity, but really, it just reduces it. It flushes them out. Some of them still stay. Some of them stay in your small intestine. Some stay in the folds of your colon in the mucous lining. So, it's not down to zero. And even if you did multiple preps, you probably couldn't get it to zero. But certainly, the balance is really disrupted.
Rewind. The gut microbiome is the trillions of bacteria that live inside your intestines symbiotically with you and help you digest, help your immune system. The genetic information contained in those trillions of bacteria is 150 times more than your own genetic information. And even your mind, that whole gut-mind combo that we've talked about or learning more about and the gut immune system. So, like, it's really a vital part of life is this gut microbiome. And we've made a video about it before. Yes.
So, the good news is most people's gut microbiomes will recover over a period of one to two weeks. Some people a little bit faster. And then every now and then, people can have long-term problems. And, and we hope that that's not you, but just know that there is hope and we're going to give you seven, even eight things that you can do to help improve the efficiency with which this happens. Yeah, it's so resilient. Hey, the human, like the fact that you can wipe out that whole trillion colonies and then grow them back again.
Okay, so early on, say, say day one. So, first, you got to, you got to start eating again. Yeah. Okay. So, what kind of foods should you eat? This is number one. Well, you want to eat foods that are going to be conducive to growing that colony of bacteria again, and those are the prebiotics. We've talked about those before. Those are high-fiber foods. Fiber is that substance that comes from the cell wall of the plant. It's not digestible. There's soluble, there's insoluble, but it is critical for the life of the bacteria that are living happily in your gut.
Right? All right. And those, those bacteria ferment the fiber and lead to short-chain fatty acids, particularly butyrate is one of the most common and most important ones. And particularly so, a, a wide variety of plant foods, whole plant foods. So, vegetables, fruits, nuts, and seeds. And ideally, if you can work a little bit of inulin in, it's a specific type of fiber found in in garlic, leeks, um, and onions. So, that allium class that, leeks, which is something you're going to be doing during this prep, it just has a higher chance. It's a little more resistance. So, there's a little higher chance of getting through that small intestine into the large intestine where other bacteria like, feed me and allow me to grow.
So, diverse whole foods, basically. Number one, 25 to 35 grams, even above. We had Dr. Fong on recently, a colorectal surgeon, said, hey, I think we should be eating 50 grams of fiber a day, and most people are getting about 15. So, yeah, eat a pound of it. Of the fiber. One thing people are going to say is, you know what, I, I'm kind of gassy, I'm kind of bloated, I got some abdominal discomfort. So, do this when you can, but know that it, it's safe to introduce early.
When? So, let's talk about your experience, Paul. Number one, did you go right to some high-fiber foods, 35 grams a day? No, I was not allowed because if you watched our previous video, I had a minor complication, which wasn't so minor, of the colonoscopy. I had a post-polypectomy syndrome, acting like a micro-operation. Happens rarely. Of course, if you're in the healthcare profession, there's a higher chance it happens to you. That's just fate. And you had to come in the hospital. I was admitted for a couple of days and then upon discharge, I was told to eat a very low-fiber diet because the idea is my bowel was very inflamed.
Extra traumatized. Yes, it was traumatized. There was no, you know, we're thinking that the lumen is small. So, you don't want to challenge it with a lot of fiber. So, unfortunately, I knew I had to eat fiber to get my microbiome back in check. I wasn't allowed to. I had to eat a very low-fiber diet. So, your colon was like a drama queen, a little bit. Yeah, a little bit. Some attention. It was attention-seeking and, and attention it got.
Okay. So, so number one, high-fiber food, uh, diverse plant food diet as soon as you can. Okay. Number two is kind of along the same lines, but it's something that's unique that a lot of people don't know about. It's something called resistant starches. Yes. Starches. Uh, this is things like in cooled rice, um, and cooled potatoes. Yeah. So, so those kind of complex carbs, you cook them, the leftovers, you put them in the fridge, next day, you take them out. What's interesting, it has this kind of, it crystallizes in a way that allows it to traverse your stomach and your small intestine to get to the large intestine in more of its whole fashion so that it provides more food to be fermented for the bacteria. So, number two, add some resistance. Who doesn't like reheated potatoes? Everybody loves it after Thanksgiving. Get those mashed potatoes back up again. Delicious.
Okay, so that's, and you mentioned fermentation and fermented foods is really number three, right? This is things like kimchi, uh, kombucha. Well, kombucha is low. Yeah. So, the evidence on kimchi is not great, but a lot, I think, I think there is some. And the main reason they say that the data on kombucha is not the greatest is because it's so variable. So, some of them have lots of bacteria and others don't. And different types of bacteria. So, the idea of fermented foods is you're eating those bacteria that are eventually supposed to colonize your, right? So, like sauerkraut, kefir, yogurt is probably the most common one that people would do. So, add some fermented foods if you can. Yeah. Um, because they have that kind of probiotic food.
Okay. Number four, actually, is formal probiotics. Right? Taking probiot, probiotics, which now, prebiotics is the fiber that feeds the biotics, and probiotics are actually the bacteria. Right? So, ideally, two specific ones. So, lactobacillus and bifidobacterium are two of the most common ones that are implicated in gut microbiome disruption and definitely they're selectively wiped out more with the nature of the prep. So, if you can have, um, probiotics that have these. We've talked before that just taking probiotic if you have a healthy diet and a normal gut microbiome, really probably doesn't provide much of a benefit.
And interestingly, when you take probiotics, it's not like those bacteria go and kind of take up residence in your colon. I was trying to figure out an analogy. What they said is that these bacteria are familiar to your colon, but they don't stay. So, it's almost like if your kids come back to your house after a party to help you clean up. Oh, so like they're welcome, they're familiar, they're useful, but then they leave. So, what they do is they facilitate your own bacteria growing more, which I thought was interesting. Set the stage. Set the stage. Every time I hear bifidobacterium, I think of Back to the Future. Biff. Oh, yeah. The villain. Yes, he was. Oh, Biff.
All right. And then the next thing you're going to want want to do is, and this is what you're doing all through your prep before, so this should be nothing new to you by the time you've had your colonoscopy and you're recovering. It's adequate hydration. Okay. So, you need to intake a lot of fluid to keep up with the fluid losses that are happening through your digestive system. Right? It's a lot. And the way you gauge it is you want to drink it, drink enough. The way I, we always tell people to gauge how much hydration you're doing is, are you peeing? Are you peeing regularly? And is your pee clear or is it like super concentrated? If it's super concentrated, you're dehydrated. If it's nice, clear, slightly color-tinged, then you're adequately hydrated. And certainly, in our comments in the other video, like people were like, drink a lot, consider maybe some of the sports drinks, electrolyte substances to add to that. Um, and yeah, people said definitely hydration was a key component. And what this does, provides your, your colon lining to be well-hydrated and, and more functioning. So, adequate hydration, honestly, is so important for so many things, whether it's your kidneys, your gut, whatever. Yeah, blood pressure.
Okay. Number six is exercise. And people are like, really, you guys, why do you, why do you always put exercise on every list? Well, there actually are some good studies. We're going to do a journal club in the next couple weeks about a specific paper that looked at gut microbiome's response to exercise. And I was like, how is this possibly even linked? What they think is it has anti-inflammatory properties. It, it changes the, the way that your colon moves. So, we tell people post-operatively, if you get moving, it's going to reduce your risk of constipation. Get that colon moving. So, a lot of beneficial effects that are kind of a little bit intangible, but definitely exercise has been shown to not only alter the diversity, but the amount of bacteria that you have in your, in your gut, or your body.
Now, if you're bowel prepping or you're in the post-scope recovery phase and you had a complication, exercise is not something you feel like doing. Okay. Oh, yeah. However, it is important. And I'll tell you, while I, you did, while I was in the hospital, I managed to get up and I did like bodyweight squats. I like, I got to exercise just because I know that muscle is an organ. It's not just an organ that moves you. No, it's actually has some like, almost like endocrine-like functions, right? Yeah. So, we know that muscle releases chemicals and molecules and things that are important to healing. So, I thought, you know what? I got to get. And my quads are my biggest muscles. You were having to, I remember visiting you. You're like stressed. You're like, I'm eating no protein, I'm not doing next to the line in bed, I'm literally wasting away. Sarcopenia, here I come. I'm a bad patient. It was like two days. You're like walking around irritating the nurses. Think I need this IV. Get this IV out. Yeah.
Okay. So, so you tried. Good for you. I did try and even after I got home, I tried. I, I went to the gym. I didn't, You probably don't want to go for a run just because probably your bowels are a little suspecting in there. Yeah. Jiggling around. Like I was trying. Ab crunches were not on the list. No, that hurt. Oh, not with a diaper on anyway.
Okay. Number seven. Wasn't wearing. I know you. I should have been. Number seven is avoiding ultra-processed food. And people are like, okay, again with ultra-processed food, we blame this on everything. Well, there's actually real data. So, ultra-processed foods have a couple things. One, additives, and two, something called emulsifiers. So, these are things that change the nature of the food, often to make it more addictive and to make it last longer. But what this does, it specifically disrupts the bacteria's ability to kind of hang on to the colon lining. So, avoiding ultra-processed food is good advice anyway, but specifically post-colonoscopy, do this and try to replace it with real whole foods that have fiber. Just remember, bacteria don't like molecules with names that are longer than their name. That's right. It's like, I don't trust you. You got a longer name or extra. Lactobacillus. I thought that was long enough. Yes. So, these chemicals are man-made chemicals. And it's not rocket science to think that this is gonna. And, and the artificial sweeteners. We have covered that before. There's some evidence to support that artificial sweeteners are not very good for your gut microbiome. I think that would fall into the ultra-processed as well as the not natural food. For sure. Totally agree.
So, this was tough for me after because I had these dietary restrictions for like a week. Not to mention, I was on antibiotics. Oral antibiotics. So, that's the honorable mention. Avoid unnecessary antibiotics if you're trying to get your gut microbiome back. It's a good principle for life. I said, life. Yeah. Why take antibiotics if you don't have to? But I had to. So, I was on oral antibiotics. I couldn't eat five. I said, I was eating like a teenager's weekend. That was my diet for like a week. Yeah. Right. Just junk. Yeah. Basically. Was there a small party that was like, well, it's not so bad. Right? I got to do it. Maybe I should do it for two weeks. Did you work any chicken wings there? I did. Yeah. They're low fiber. I might as well enjoy this somehow. I like it. It's ridiculous. I like it.
So, so now you know. Oh, and interestingly too, about the specific types of bacteria. They found that, you know, when you do a colonoscopy prep, C. difficile, or Clostridium difficile, which is a pathogenic bacteria, when it overgrows, has a unique ability to to protect itself and to get reduced in a way that it's self-preservation. So, people like, you know, C. diff, what, what about C. diff? Why can't we just wash that up? Well, you can't. You wash all the other stuff and it has like a better ability to kind of hang on. So, yeah, it's our microbiome is so amazing. But I, I'm with you. It's so cool that it can come back. Control alt delete and it'll come back again. You got to treat it right. And that's by eating the way we just described. And know that discomfort and bloating is normal. If you have severe pain, obviously see your doctor, go to the hospital like you can speak to. And if this goes on for a more prolonged period of time, definitely talk to your doctor and then they can give you some other more specific medical kind of interventions that can help recover. But, um, most people thankfully will be better in a week or two.
And you have to do the colonoscopy. Okay? Like, if your healthcare professional has recommended it, if it's available to you in your as a screening program, if you've hit that age or if you have risk factors, don't not do it. I mean, I had a complication of it, but I know what the complication happened. I'm better now. And now I still maintain that I'm glad I had it done. Right? Leave a comment if you've had a colonoscopy, if you had trouble afterwards, your strategy to recovering, because certainly that will help lots of people. Yeah. If you can have some tips and pointers about how to get your gut microbiome back on track, and you'll know when it's back on track when you're having regular bowel movements again and the regular consistency, and you're feeling generally, your abdomen's feeling more like its normal self. Right? I'll let you know if I ever get there. Yeah. You're still, So, you're 23 days and you're still not quite right. I'm not 100%, but I'm pretty close. Now, you know, if you like this video, please like it. Subscribe to our channel. Most people are not subscribed. Please subscribe and share it with someone that you know has got a colonoscopy coming up so they can maybe be a little bit more prepared. Don't scare them away though. Maybe show them after. Yeah. For the recovery. That's probably better. Remember, you are in charge of your own health. We'll see you next time.