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Prophylactic Colonoscopy & Prep


Member Forum >> Microbiome and Digestive Health >> Prophylactic Colonoscopy & Prep

Bob Niland
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Posted: 8/22/2024 10:19:01 PM
Edited: 8/26/2024 6:02:39 PM (8)

iconic representation of a colonoscopy

Prophylactic Colonoscopy & Prep

periodic table entry for Magnesium

Edition: 2024-08-26 colonoscopy,PEG,Miralax,Suprep,Sutab

Q. Should I consent to a proposed colonoscopy?

Because it is not risk free, it needs to be critically assessed.

Q. Is there an alternative to the standard prep?

Yes, but suggesting it is at some risk of dogmatic resistance.

Introduction

This is a roll-up of various comments from both the forum and the blog. This article presumes that the person making the inquiry has been on the program, or some other enlightened ancestral diet, and for some time (which dramatically reduces the risk for many colon pathologies). For someone on a standard diet or some modern fad diet, a colonoscopy is doing less than nothing to actually support a Super⇩Gut, so to speak.

Colonoscopies have been a topic on the blogs and this subscription forum back to the TYP days (2008 if not earlier), with frequent member opinions and case reports. The main focus is whether to have the procedure done at all, and then, if done, what’s the ideal prep.

This is a self-directed healthcare program, so unsurprisingly, the decision is in your lap. There is no formal program content for whether or not to consent. Dr. Davis has made a suggestion on the prep agent, and just seeking to use that tends to become an assessment of the care at hand, as can some other points below.

The decision process has to start with why the colonoscopy has been proposed. The lead word on this page, prophylactic, is deliberate. Cases that are, for example, symptomatic, already have other troubling test markers, or have a case history of cancer diagnosis or precancerous polyps, are a completely different matter from the precautionary test commonly suggested at some age.

Risks

Colonoscopy is an invasive procedure. Perforations, infections and bowel inflammation are common enough to raise the question of risk:benefit. Just what is the ACM for the procedure itself, and is there any NNT data on the benefit (which benefit may only apply to people remaining on standard diets).

If capsule endoscopy is an option, it is definitely worth considering. It both mitigates almost all of the interventional risks, and also explores the entire GI tract, which neither upper endoscopy nor colonoscopy are capable of.

Pre & Post Agents

Preparation, procedure and post-procedure agents also need scrutiny.

  1. Prep
    Prep is intended to wash out the entire GI tract, so that the colonoscopy optics can image things, and there’s adequate view for any biopsy or excisions. The whole pre- post-interval can be many days of lifestyle disruption, requiring suspension of other life activities. Be sure to include any sick days, flex time or lost vacation days in your out-of-pocket calculations.

    The problems with typical prep agents are that they are often mainly emulsifiers like polyethylene glycol (PEG), plus include needless artificial sweeteners (e.g. sucralose), flavorants, colorants, plus ‘Inactive ingredients’ that aren’t. The PEG is a major antagonist to the gut mucosa. If any kind of dysbiosis is present, this stuff is not your friend. PEG is the active ingredient in Miralax®.

    Yes, there are people using Miralax® chronically. They are making a double mistake. Dr. Davis has written “🧵Miralax is a potent emulsifying agent that disperses the intestinal mucus barrier and alters bowel flora in unfavorable ways.

    The suggested alternative laxative is merely high-dose magnesium citrate, which at modest portions, is one of the program-suggested magnesium supplements. Whereas normal supplement use might be one teaspoon a day, for clean-out, Dr. Davis reports “🧵It typically takes an entire bottle of liquid magnesium citrate to achieve an empty colon.

    Suggesting this to your colonoscopy team amounts to a screening question. If it has never been on their radar, they are going to say no. If you explain your concerns with the agent they propose, they may not have any safer alternatives to counter with.

    A typical 10-ounce bottle of Mg-citrate provides 17.46 grams of Mg-citrate, which would be about 6 tsp; (2 tbsp) of Mg-citrate powder. Retail liquid Mg-citrates tend to be loaded with junk amendments, so the safest bet is to make your own, using warm filtered water and a food-grade Mg-citrate powder, such as 🛒NOW Foods Magnesium Citrate Pure Powder.

    If you go with a prescribed agent, obtain a copy of the prescribing information or Drug Facts insert. Even the legacy Fleets Phosphosoda® (which may now be discontinued) had a long list of concerning side effects and medication interactions.

    No matter how accomplished, including by Mg-citrate⇩(below), a wash-out process, and the diet restrictions (and amendments, often high-glycemic), can result in either/both BG excursions or electrolyte imbalances, so some caution needs to be applied with diabetes and arrhythmias.
     
  2. Procedure
    It’s an unpleasant procedure. You are apt to be offered some IV combination fentanyl and midazolam. Those represent more fine print for pre-study. Plus, you may need someone else to drive you home.

    If anything is found…
    Any biopsy you would have known about, as it might have been the rationale for test. Any polyps would have required your pre-authorization for removal, so don’t skim over that fine print pre-op. Anything alarming, that can’t be removed, might result in an urgent consult for surgery.
     
  3. Post
    Any biopsy or excisions performed may result in antibiotics. Be sure to explore which ones pre-op. Some, like the quinolones, are worth pushing back on.

    Further medications may be offered for post-procedure discomfort. Ask for a list of what might arise, and ask about them on the forum. Many are also no friend to your gut health, and…

    …expect zero useful advice on how to restore ideal intestinal function (more⇩below).

Considerations

Presuming that there is a case for considering a colonoscopy…

  • Procedure Rationale:
    What is suspected, and does the proposed procedure even see enough of the GI tract to settle the question?
     
  • Has basic occult blood testing been done?
    If not, the colonoscopy is probably premature. If run, reported positive, and simple explanations like hemorrhoids have been ruled out, the colonoscopy may well be needed.
     
  • Stool Tests?
    Has a more comprehensive stool testing already been performed? Did it include genetic sequencing? If not, at least a basic 16s RNA test is indicated. These can be had for US$100 or so. More expensive tests can report on more Domains, down to strains, and might pick up less common things, like some parasites.
    🅐 Bowel Flora Testing - A Practical Guide (members) and
    🅕 Review and Comparison of Four, PCR-based Stool Test Kits (public),
    both linked from
    ⨁ Gut Flora Resource Overview (public).
    The more advanced stool tests are not cheap, and none of them may be covered by insurance, as Standard of Care has no idea what to do with the results.
     
  • If Bacteria were sequenced…
    If run, did the test report taxonomical detail down to at least the Phylum level? If so, what did it report about Fusobacteriota? If run, and Fuso was nil or not detected, skip the next bullet.
     
  • On Fusobacteriota
    If sequencing was performed and any of Fusobacteriota » Fusobacteriia » Fusobacteriales » Fusobacteriaceae are above nil, some clarity is needed down to Genus and Species Fusobacterium nucleatum, and if that’s not nil, specifically subspecies animalis clade C2, as this oral microbe is highly correlated with colon cancer—indeed, considered not just a cause, but the cause by some researchers.

    If any of this is news to your care team, they are behind on the literature.
    nature: A distinct Fusobacterium nucleatum clade dominates the colorectal cancer niche
    https://doi.org/10.1038/s41586-024-07182-w
     
  • Root Cause(s):
    If a suspected condition is found, will there be any useful insight on what caused it, and whether or not simply addressing causes might be all that’s needed? If the suspected condition is found, what interventions are planned to address it?
     
  • Prep Outcome
    Were you able to get agreement on the Mg-citrate approach?
     
  • Is any of this news?
    Does this page contains anything you consider alarming, surprising or merely important, that wasn’t made available to you when the colonoscopy was proposed? Well, welcome to Standard of Care. This is by far not the only topic on which you need to engage self-directed healthcare.

Post colonoscopy recovery

While many people are concerned that the laxative flush may wipe out their microbiome, this is not the case. But it will set it back.

blog member: «…but I am worried about what that will do to the microbiome and mucus lining of my poor colon. How to restore it to a healthy state? I have searched this blog and can’t seem to find a post that addresses restoring the microbiome after an invasive procedure like a colonoscopy…»

It’s apparently no different than what to do about a disturbed microbiome in the wake of any number of modern settler insults (diets, antibiotics, emulsifiers, preservatives, etc.)

How to have a Super Gutcover: Super Gut book

What do for optimal gut health has a whole book (at right), plus supporting site content: ⨁Gut Flora Resource Overview (public)

So what does the book have to say about colonoscopy? It’s only mentioned three times (page numbers are for U.S. print edition):

  1. Likewise, during colonoscopy, a six-foot-long colonoscope can visualize the five feet of colon all the way to the cecum, a short blind sac that marks the beginning of the colon, but no farther. This means that twenty-some feet—greater than the length of your car—of small bowel between the duodenum and cecum cannot be visualized. This has proven to be a perennial problem in pinpointing, for instance, a source of bleeding from the small bowel, which could be a leaking two-millimeter blood vessel twelve feet down from the duodenum, twelve feet up from the cecum, and completely inaccessible to a scope.
     
  2. Or worse, your primary care doctor sends you to a gastroenterologist, who performs the obligatory upper endoscopy and colonoscopy, then declares, "Good news: you don’t have a stomach ulcer or colon cancer." You ask, "What about my question about SIBO?" Once again: "I don’t know what that is." "Don’t waste my time." "There is no such thing.
     
  3. You might have even undergone a colonoscopy and no mention was made about bacterial or fungal overgrowth because these conditions cannot be seen with a scope.

___________
Bob Niland [⎆disclosures] [⎆topics] [⎆abbreviations]


Tags: colonoscopy,Miralax,PEG,Suprep,Sutab

Bob Niland
No Avatar
STAFF
Join Date: 7/7/2014
Posts Contributed: 22875
Total Likes: 3805
Recommends Recd: 11
Ignores Issued: 0
Likes Recd: 0

Posted: 8/22/2024 10:20:09 PM
Edited: 8/26/2024 6:03:36 PM (2)


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