Probiotics and Travel

I travel internationally at least once a year and recently it has been quite rough on my stomach. Despite following all of the usual precautions (don’t drink the tap water, don't eat raw foods, etc), I have fallen ill to traveler's diarrhea more times than I would like to admit. It is very difficult to control EVERYTHING when traveling. Electricity outages are frequent — It made me think of how the refrigerator may not actually be keeping the food from spoiling, if it is constantly being turned on and off. Eating out can become challenging. Spoons, forks, plates, cups may not be washed adequately and even prepping surfaces may not be cleaned sufficiently.

Diarrhea when traveling can affect up to 70% of travelers, so it is not a rare thing and I am certainly not alone. Bacterias really account for most of the cases of traveler's diarrhea. If you check out the CDC, there are generally 3 types of travel destinations in relation to traveler's diarrhea - countries that are low risk, intermediate risk and high risk. And clearly, 1 attack of traveler’s diarrhea doesn't necessarily prevent another attack from happening.

What is someone to do when traveling? I know when traveling my gut microbiome is put under pressure by the stress of traveling to a different time zone and the introduction of foreign bugs from contaminated food, so I wanted to review how probiotics can help with prevention.  Probiotics are thought to help either by changing the immune system or by directly attacking the bag bugs and/or their toxins. Generally, when looking for an appropriate probiotic strain and product to buy, I first look up research studies using probiotics to treat the specific condition I’m interested in (in this case - traveler's diarrhea). Once I find the studies, I look at the publication date and review how many people were included in the analysis.

The two biggest players in the probiotic space to prevent traveler's diarrhea are:

First place - Saccharomyces boulardii CNCM 1-745

Honorable mention -  L. rhamonosus GG

These two were studied as individual strains, not in combination with other strains. Most of the studies had participants take the individual probiotic strain 2-5 days before the trip and during the trip. 

Of course, speak to your healthcare provider before traveling to discuss all of your options to prevent traveler’s diarrhea

How to Prevent Inflammation in the Colon: Avoiding Colon Cancer

Colon cancer is near and dear to my heart. My mom was diagnosed with colon cancer and this really drove my desire to become a gastroenterologist. I knew my risk for getting colon cancer was now higher and I would need a colonoscopy earlier than usual. If you have a family member with colon cancer and want to decrease your risk with things YOU CAN CHANGE, read on:

Floss - How in the world is flossing connected to colon cancer? A bug called Fusobacterium nucleatum was found in actual colon cancer tumors. This bug doesn’t even usually live in the colon. Where does this bug usually live? In dental plaque. Yep, in our mouths. We can’t be sure yet if Fusobacterium actually causes colon cancer, but I’ll do my part to floss and get my teeth cleaned every 6 months. Now there are these cool flossers out that are quite addictive. I can’t use them because they don’t reach all four of my wisdom teeth.

Eat more fermentable fibers – These types of foods are gobbled up by the bugs in the colon, which then produce short chain fatty acids (SCFA). If you read anything about the microbiome, this buzzword comes up over and over again - short chain fatty acids. SCFAs help with regulating our immune system, supporting the growth of good bugs, and promoting an anti-inflammatory state. Where to find them? Oats, apples, apricots, cherries, oranges, carrots, banana, plantain, onion, garlic, leeks, onions, asparagus, just to name a few. Check out my Insta for a yummy plantain pancake recipe. 

Decrease red meat and processed meats - The data shows increased risk of colon cancer in populations who eat more red meat (beef, lamb, pork, veal, goat, venison) and processed meats (hot dogs) 

Regular exercise reduces your risk for colon cancer. Obesity, smoking and alcohol use all increase your risk for colon cancer.  These four really apply to many diseases, so not surprisingly they also apply to colon cancer risk.

Get the colonoscopy - I forced my older brother to get his. Just do it. If you have family members with colon cancer, this is really the only way to get those polyps (growths that can turn into cancer) removed and prevent colon cancer. 

For those with family members with colon cancer, the guidelines are not straightforward as to when you have to start getting colonoscopies. It depends who in the family was diagnosed and how old they were. Ask your doctor where you stand. 

For those who are not at high risk for colon cancer (don’t have Crohn’s disease, ulcerative colitis, family/personal history of polyps/colon cancer, genetic syndromes called familial adenomatous polyposis (FAP) or Lynch syndrome/hereditary nonpolyposis colon cancer AKA HNPCC, or radiation to the belly) the American Cancer Society changed the age to start routine colon cancer screening to 45 in 2018 because of the rising rates of colon cancer seen in younger people.

CES 2019: Review of Digital Health

Why I went to CES: 

CES = Consumer Electronic Show (bit giant conference for the latest and greatest tech)

Started in 1967….it’s been around for a long time

It has more than 180,000 attendees from 150 countries…lots of people from everywhere

VCR debuted in 1970… wow, we moved from that quickly. Though, I think my mom still has a VCR.

I specifically went to look at trends and to see if there’s a product that would be viable for a gastroenterology practice. I also follow healthcare tech + digital health and wanted to stay on top of the innovation in my field.

Overall trends in digital health:

1.           Make the user experience fun. 

People were very excited about the shiny TVs from Samsung and LG, but digital health was upping their game by making their products fun and interactive

For example, The Muse is an EEG device used for meditation – you hear peaceful weather when your mind is calm and stormy weather when your focus drifts off. You get points for how long you stay in the calm state. This let’s you compete with yourself or others.

Obstacles: Lots of sleep and meditation devices on the market = fierce competition

2.           Make the tech super helpful.  

Enter robot assistants. Samsung bot care is Wall E meets R2D2 plugged with all sorts of sensors. It detects your breathing as you sleep. It takes your vitals (blood pressure and heart rate) when you touch it. It reminds you to take your medicine and detects falls. This would allow health care workers to remotely monitor patients.

Obstacle: People have to get used to robots in the home. For my Short Circuit fans, Johnny Five is very much alive and sleeping next to you.

3.           Disintermediation

 Cut the middlemen and have a direct to consumer product. One of the digital health products, Foodmarble, works by analyzing hydrogen levels in the breath to determine if there are food intolerances or an overgrowth of bacteria. We use this test in GI already – it’s called the hydrogen breath test.

Obstacle: Foodmarble’s results need to be compared to the gold standard, the hydrogen breath test, to prove effectiveness.

4.           Tech will make things easy

Everything is going wireless. There were devices that just sit next to you, like a piece of furniture, and use radio frequency to measure your heart rate and breathing rate.

 Obstacle: the devices need to have a good WiFi signal. Ever lose Wifi at home? Yep, tracking will then be cut off.

Interesting products unrelated to Digital Health:

Intelligent connection of the Internet of Things (IoT) - Everything in the home will be connected and will be smarter than you! Well, not quite, but it will be like having a personal assistant maintaining the home - the frig can track and order products. Out of milk? Boom, it was already ordered before you had a chance to write it in the notes section of your phone.

Proctor and Gamble came out with the Opte Precision Wand. A beauty wand that you run over your skin to detect darker spots and essentially prints over them.

Facial recognition being used in customer experience at SK-II (skincare line in Japan) stores– I had my face scanned to determine my skin age and make product recommendations.

What would I have liked to see in the world of digital health?

This won’t appear in 2020, but I foresee a home where we have the most intelligent IoTs tracking our health without doing or wearing anything extra. We live our normal lives without being disturbed. Our bed can detect how we slept. Our mirrors can use facial recognition to detect emotion. Our toothbrushes can detect gum disease. Our toilets can analyze our poop and determine what we need to eat. Maybe our floors can detect our blood pressure and pulse. Who knows? Remember, the VCR came out in 1970 and that was a big deal.

3 Tips to Have Great Poop

This is certainly not a sexy topic, but it needs to be discussed.

Avoid Waiting

Go to the bathroom when you feel the urge. Holding your poop is okay every now and then, but try to go when you feel the need. Peristalsis is a worm-like contraction that helps move feces down.  When the stool arrives at the bottom, nerves send a signal indicating the pressure in the rectum is increasing and, in turn, you feel ‘it’s time to go’. If you don’t relieve yourself, the colon can further extract fluid from the stool making it harder and drier. Obviously, hard/dry stool is not ideal.

Do not sit for too long

Keep the phone and magazines outside of the bathroom to prevent prolonged sitting. Instagram feeds are very interesting, but do not let them distract you from the end goal! Evacuation should take 10 minutes or less. Prolonged sitting transfers pressure down to the anus. And, I must mention all of those germs you might transfer to your phone screen, if it’s keeping you company…

Buy a Squatty Potty

This changes your sitting position to a squatting position (knees high). In a squatting position, a muscle called the puborectalis relaxes and the colon is able to empty completely. This is genius and how humans had been pooping for ages before the creation of the porcelain throne. And yes, I own one and it is that awesome.

3 Tips for Eating Healthy at Restaurants

Eating out is part of the NYC culture. I love getting together with friends and family, but I don’t always agree with their restaurant choices. Here are some things I do before I eat out so I don’t become ‘that’ friend who constantly objects to restaurant selections.

I look up the menu online ahead of time to identify healthy options.

This does require a bit of effort, but at least I know if I have to eat a snack before I get to the restaurant.

If healthy options are limited, I end up choosing a salad with the dressing on the side. Dressings can be loaded with sugar and, boy, do some restaurants go dressing-happy on those salads.

My eyes go down to the ‘sides’ area. There are usually some great veggies in this section. Some of my favorite sides are sautéed mushrooms, broccoli rabe, and brussel sprouts.

Think beyond the menu options.

Depending on the restaurant, you can ask the waiter for a vegetarian or vegan option off the menu. The chef might be willing to steam some veggies.

Mind the portion size.

Find a friend who’s willing to split an entree. 

How to be Healthy on a Budget

I didn’t always try to eat healthy. But, when I changed my eating habits, my shopping habits had to change while still paying off student loans. Here are some tips to prevent you from spending your ‘whole paycheck’ while shopping healthy.

Buy fruits and veggies when they are in season

If not, you are going to pay a premium for having strawberries flown in from far, far away. Food that hasn’t traveled a distance also tastes better. But, if you are having a craving for off-season produce, then…

Frozen fruits and veggies are A-ok

Frozen produce is picked at its peak ripeness and immediately frozen.  Also, frozen produce is usually already washed and cut. Winning!

Download your supermarket app for coupons

Yes, even Whole Foods has some savings. I peruse the available coupons before I do my shopping.

Subscribe to Environmental Working Group (EWG) Dirty Dozen/Clean 15 when buying organic

It’s so expensive to buy everything organic, so stick to EWG’s list.

Buy inexpensive sources of protein

Wouldn’t we all love a freezer full of grass-fed organic meats? Well, maybe not our vegetarians/vegan friends… Canned wild-caught salmon, mackerel and sardines are some options for the carnivores. Beans, lentils, and chickpeas are some picks for the vegetarians.

Avoid the middle isles

Packaged/processed foods are housed in the middle isles and do not provide adequate nutrients. Replace candy bars with healthier counterparts from the outer aisles.

Buy in bulk at discount stores

For those who have the space, this can significantly help out with costs.

Eating healthy on a budget shouldn’t be so hard. Hope this helps ease you in!

Get Better Sleep

I know what you’re thinking…why am I writing about sleep? This is supposed to be a gut blog! I am partial to the gut as it is notoriously known as the second brain (rightfully so as it contains more neurons than the spinal cord), but the first brain needs a break. You know how awesome it feels to wake up from a restful night’s sleep.

Good sleep is just as important for optimal health as exercise and nutrition. And, the gut isn’t just an innocent bystander in the process. Our gut houses a microbiome, which consists of microorganisms that carry out special functions. The gut microbiome has the ability to produce important neurotransmitters that impact our sleep.

Sleep and our delicate microbiome are intertwined; therefore, it is important to keep sleep hygiene in mind when thinking about gut health.

Here are some tips —beyond black-out shades — to help get some quality shut-eye:

Get out in the sun
Our sleep is affected by our exposure to natural light. Unfortunately, most of us spend far too much time indoors, even sometimes in a location without a window. Sunlight exposure for at least 30 minutes helps set our internal clock, the circadian rhythm, and suppresses our good-night friend, melatonin. Generally, for purposes of this discussion, the best time to be the sun is in the early morning (6 am-8:30 am). If this isn’t possible, and you find yourself stuck inside a building at work most days, then you should at least try to go outside during your lunch break.

Start to wind down
No phone, computer, or TV for at least 30 minutes before the Z’s. If you are brave, stretch it out and stop using devices 1 hour before bedtime. Blue light is emitted by these devices (even from your digital clock) and suppresses melatonin.

There are many blue light blocking products. I personally use f.lux on my computer. This is a free program that adjusts the lighting of the computer based on when the sun sets.

Eat better
The gut is responsible for more than 90% of the production of serotonin, an important substance in making melatonin. In order to feed our hard-working gut and keep the good organisms happy, it is important to eat indigestible fibers AKA plants.

For all those Margaret Wise Brown fans…goodnight stars, goodnight air, good night noises everywhere.