Exam Room LIVE at ICNM with Dr. Alan Desmond

welcome to the exam room live brought to you by the physicians committee hi i'm the weight loss champion chuck carroll thank you so very much for raising your health iq with us live here at the international conference on nutrition and medicine 2022 in beautiful washington dc my guest today is somebody who has been on the show a number of times had never met him in person until just yesterday and man we just kind of hit it off dr alan desmond man thanks for making the trip all the way across the pond to be here oh i'm really really happy to be here man thank you it's getting right in there it's so good to be here this is my third year in a row presenting at icn but my first time doing it in person so it's been really good to meet you and to get the full chuck you know not just the uh the from waist up let's get the full chocolate challenge it's been so it's been great it's been so nice and the conference has been so awesome we've had and you know what it's really great i'm just looking at the program here to have representative jamie raskin give some opening comments to have dr rita redberg from jama internal medicine the editor of one of our leading medical journals to give some opening comments as well it's been just lovely to see these mainstream movers and shakers policy makers and influencers in the real sense of the word at this conference absolutely fantastic it kind of gives you hope that like we really are on the verge of having a healthier future right yes yeah and a lot of that is due to the work that you all are doing at pcrm i mean during my talk earlier today and just to get a little bit serious for a second i was out so i was in dc for the last couple of days went out for a big long walk i told you all about this yeah whatever a big long walk not quite the full colin o'brady i think they're like eight hours right okay and i just went exploring and i was around by linkin park two evenings ago and i was kind of just enjoying the atmosphere and i saw in someone's front yard when these great signs that are so prevalent in people's front yards in dc and instead of like a declaration for political candidate it was this incredible quote from cultural anthropologist margaret mead and i wrote it down and i'm sure many of your viewers will be familiar with this quote but never doubt that a small group of thoughtful committed citizens can change the world yes and indeed it is the only thing that ever has and to be here with the thoughtful committed citizens of the physicians committee and seeing how you guys are changing the world for the better is fantastic yeah man there's a song i listen to a lot to get hyped up um so one man can change the world right and i i truly believe that you know one man one woman it starts with that one person yeah and and and it builds from there so we always a lot of times i shouldn't say always but a lot of times we can feel powerless but i mean the fact of the matter is thoughts are power man and and then you just put those thoughts into action and magic and getting together like this is fantastic even for me just meeting other gis like i met a great guy called ira um just speaking through one for rob robin chitkan you know gupless and just like just all vibing together and just sharing data and you know you know supporting each other it's so important robin she was so cool she was just on the show this week as a matter of fact yeah she's the coolest uh man so yesterday uh when we meet literally for the very first time i'm going next door to get a smoothie at fruitive free plug uh and i go to get uh the cacao pow and bump into you you're over there eating lunch and you start telling the most fantastic story about going to get melatonin at cvs and then something else catches your eye at this particular drug store what caught your eye well a couple of things but you know so i'm in cvs i'm getting something for jet lag so i've just flown halfway around the world and i notice and this is why we are here at this conference this is why we're here in this podcast we're helping people to draw the dots join the dots here yeah so i'm in cvs pharmacy in aisle one we've got beef jerky turkey jerky and twinkies okay all the things you need all the things you need to fuel a healthy gut microbiome so you've got turkey jerky beef jerky twinkies yeah all the good all the good stuff right and i was just looking at the ingredients on a pack of twinkies yeah and you flip that thing over and there is hydrogenated tallow yes sir so i think that's hydrogenated animal fat uh in a cake yeah and then two aisles away from that you've got probiotics you've got tums you've got mylanta you've got pepcid ac you've got omeprazole lansoprazole isomeprazole yeah man and it's there for everyone to see we've got to join the dots here people it's it's the yin and the yang isn't it yeah yeah it's there it's there we should we should bring people on a walking tour of the beautiful monuments yeah in the but then nip into cvs right and just say look here here's the problem here's the solution you know it's uh we've got better solutions are the drug stores like that back home for you or no not really i think that's kind of a us phenomenon where pharmacies have are providing the problem and the solution yeah yeah well okay anyway that's enough i'm not blaming the people i'm blaming the system no no i'm not shaming anyone but it's just that's how the system's developed i mean like i'm not much of a rebel rouser but i think that uh it's incumbent upon us to kind of shake up that system a little bit and just point it out to people absolutely absolutely it's fun to think in those kinds of terms uh i want to talk to you about some of the things that you've been talking about at this conference you know diverticular disease is a big part of your presentation here at icnm uh a lot of people know the word diverticulitis a very common uh issue here but when we're talking about diverticular disease what is that well the first thing to know is that this is a really common condition that costs u.s healthcare about nine billion dollars a year with a b would it be nine billion okay so there's a great incentive to try and sort this problem out yeah okay so the diverticulum is an abnormal outpouching in the wall of your large belt if you think of a bike tire that has like a little hole in it and the inner tube starts pushing out or maybe on a football the inner tube starts pushing out yeah that's a diverticulum okay so if you get a lot of diverticulums or diverticulate in your large bowel there are parts that tube that don't look like a tube anymore it's like a little maze of little pouches and holes and narrowings and that's called diverticular disease okay now diabetic disease can sometimes cause very mild symptoms a little bit of tummy upset a little bit of cramping discomfort and that's probably the case in most situations but it can also become a life-threatening condition because those pouches can become blocked infected inflamed they can bleed they can hemorrhage and like a lot of gi's i have taken care of patients who have died from complications of diverticular disease so it's like most gut health problems right it's not a small deal okay there's a famous athlete uh here uh ufc fighter professional wrestler guy by the name of brock lesnar i mean just a big old hulking individual you look at him you would think man this guy's pretty healthy he's like zero percent body fat just all muscles he got diverticulitis and almost died from this disease yeah the complications i'm sure that you were talking about and it's not the other thing we know about diverticulitis and diverticular disease is that this is a very common condition in countries that have embraced the standard western standard american style of eating this meat-heavy dairy-heavy plant-life fiber deficient approach to food is a perfect recipe for developing diverticular disease now if you live in the u.s right now your odds your chances of having diverticular disease is about your age minus 20 so if you're 80 there's a 60 chance you have this condition it may be even higher but if you live in a country where people eat a high fiber diet that is light on the animal products or with no animal products diverticular disease is almost unheard of now there are two dietary components that are really important on whether or not you get diverticular disease and the first one of course is fiber we've known this since the 1970s the great doctor dennis burkett dennis dennis burkett who had an irish connection he went to medical school in dublin he's a british surgeon who promulgated the fiber hypothesis in the 1970s and he looked at the patients that he treated in rural africa and uganda the patients he treated in urban uk and he's like okay i'm a surgeon in both countries but when i'm in rural africa i'm not getting out of bed in the middle of the night because of diverticular perforations i'm not seeing patients with diverticular disease and he forms the fiber hypothesis of diverticular disease so his theory was that if you had a fiber deficient diet it would negatively impact what he called the bacterial flora we now refer to as the gut microbiome but also impact on transit time and interluminal pressure too much pressure inside that tire which is going to push out these pouches and although he formed those theories in the 1970s they have been proven time and time again and if you live in the us or the uk and you tend to eat a lot of fiber you may be 70 or 80 less likely to develop diverticular disease let's talk about that transit time here for a second so i guess like the simple part of me wonders like is that really such an issue because um it takes longer to excrete all that bad stuff so it gets reabsorbed in the body or like what else is going on there yeah well we know that um we talked a lot about the gut microbiome during the presentation right okay and we know that a long transit time so if it takes a long time for the stool to get through your body that is generally a good predictor of a unhealthy diet and an unhealthy gut microbiome and again that's been validated time and time again and i think it all does relate back again to healthy dietary intakes fiber and an adequate hydration and look let's not get too graphic here but everybody poops okay do they now everybody poops who's your who's your favorite uh nfl player uh right now i'll throw tom brady okay tom brady poops okay even the great tom brady in fact he probably poops really really effectively because he's often talked about his plant-based diet and that's why he has so many super bowl rings that's why he has all those rings but everybody poops and if we look at the uh quantity and frequency of our bowel movements and dr burke had talked about this you know in the 1970s he said famously countries that produce small stools require large hospitals because if you if a patient tells you how often they poop how much they poop that's actually a really good predictor of their overall health and it all relates back to transit time dietary fiber and take healthy dietary intakes alright so kind of a silly but semi-serious question like if when it's like really slow transit time and it comes out hard as a rock like yep can that do some damage because it's so well yeah in theory that can put your risk of developing things like little uh tears around the bottom and which can be very very uncomfortable yeah and very sore and also really embarrassing to talk about and you know i talk to my patients all the time say look if you have diverticular disease which you were talking about a moment ago don't be embarrassed these are it's not your fault it's like the food system that we have here yeah and if you do have diverticules and you do have pain you got some pain at your bottom end or whatever talk to someone about it don't be embarrassed get checked get the proper tests done and you know make sure everything is okay and then start making some healthy changes with your diet but you know we've talked about diverticular yes earlier okay so if you or one of your loved ones has diverticular disease what can they do to reduce their risk of getting diverticulitis what can they do to reduce the risk of being hospitalized with diaper particulates huge huge okay yeah so two big questions when it comes to food increasing our dietary fiber is really important people who have diabetic disease who eat a healthy amount of fiber 30 40 50 grams per day are less likely to be hospitalized with acute diverticulitis but there's one other essential change that you've got to make because there is one other food that you need to know about and that is meat consumption so red meat consumption processed meat consumption and white meat consumption chicken poultry etc are also independent predictors of being hospitalized with diverticulitis so when i speak to my patients with diverticular disease because every patient with a gi disorder says what can i eat doc to improve my prognosis make me feel better make sure i'm as healthy and happy uh for as many years as possible what can i do yeah we've got to talk about increasing the fiber we've also got to talk about cutting out the animal products so is is diverticular disease reversible we know that a lot of these chronic conditions are or is it just something that you have to manage it's something we have to manage i mean if we catch it in its early phases and we can get you on a healthy high fiber diet and you know cut the animal products and everything your prognosis is great um but those little pouches that are formed in this inside your bowel they don't go away as far as we know but over time you can accumulate more and more of them unless we address the underlying problem and you know i met a patient recently a woman in her mid-30s and she had seen her doctor and had had been diagnosed by her gp as having had a episode of acute diverticulitis so i met her on the day of her colonoscopy she wasn't a patient of mine but she i was there to do the colonoscopy and she explained to me how she was really surprised to be diagnosed with diverticulitis in her 30s because she had been vegetarian for years for health reasons and for the animals okay but what she did when she learned a little bit more about diabetic disease and the importance of dietary fiber in diet particular disease is she went to the trouble of tracking her dietary intakes for a few days and discovered that she was consuming less than 10 grams of fiber per day that's a vegetarian a vegetarian wow which is entirely possible now you know you've got your white bread you've got your replacement cheeses you've got your replacement meats you can be a vegetarian and still get diverticular disease so but i didn't have to do any work with her because i did her colonoscopy confirmed the diagnosis she'd early diverticular disease but by the time she'd come in for the colonoscopy in just those two weeks she'd increased her dietary intake up to about 40 50 grams per day so she'd gotten on the gotten on it got around the fiber gotten on the plants it's uh the patient then i would assume feels better pretty quickly you know they start adding that they get you know things moving along things and we're back to tom brady yeah ma'am you're winning super bowl rings in no time folks yeah okay that's that's really important to know um i you know that's one of those diseases i don't think gets talked about a whole heck of a lot very prevalent here how does the the rate of of prevalence compare here in the states versus back home for you it's actually pretty similar i mean dietary intakes in general in the uk ireland mainland europe etc and the us aren't as different as they used to be i think in the last 20 years there's been a convergence there hasn't there we're seen the same brands the same big companies for only the same unhealthy food yeah so it's becoming just as common you know all right so we're kind of talking about like the back end staying out of hospital like so you know what let me ask you this so you just gave the example of the the woman who came in for the colonoscopy but do you get the opportunity to consult with patients at all when they're already in hospital or of course okay yeah it can be challenging on the board the war gastro i mean i was talking in my presentation today i mean when i first went to work on a gi ward as a young doctor 20 years ago the first thing that occurred that i noticed is that g awards are really busy and the patients can be really unwell yeah so i mean while those conversations can start on the hospital ward a very often if you're in hospital and you're really unwell we've got a few days to get your antibiotics in get your blood test done look after your fluids look after nutrition and in many ways those powerful conversations will start at the follow-up appointment you know and plus it's it's tricky right because in in i mean i work largely within the nhs okay and we've got a lot of work to do on hospital food yeah you know yeah so i can talk to my patients on the ward about slowly increasing the dietary fiber when they get home from hospital but trying to achieve that while you're in hospital can be tricky because hospital food has got a long way to go i was just gonna ask like what is the hospital menu like over there here i know we are working so hard to get healthier options put on the menu and it is a uphill battle in a lot of cases i mean we have freaking fast food restaurants in a lot of hospitals right and it's still nothing for a patient in a cardiac wing and a gastro wing whichever part of the hospital who are going to be served bacon and eggs you know for breakfast yeah sadly that's you know those fast food things are slipping into some of the big uk hospitals too but it's not as prevalent as it is here i tell you something though i was at my uh professional bodies national conference a few weeks ago back in the uk the british society gastroenterology meeting um which was you know it's like our professional society it was our first time all getting together as well as gastroenterologists in the in this pandemic era and there's food provided at this meeting yeah and i was really encouraged to see that almost all the meals provided were whole food plant-based now i years ago i would go to that meeting and you would see bacon buddies and you would see sausages and eggs and all that not nowhere to be seen chuck i'm not saying it was meat-free right but there was some there was some chicken there i saw one beef dish but like 60 70 80 of the meals would have looked right at home here at this meeting so what that tells me is that this is entering the medical mainstream okay here in the u.s we've seen the you know the official guidelines for treating type 2 diabetes recommended based out the uh cardi the american cardiology society is recommending that people move to a plant-based diet to prevent cardiovascular disease so the evidence here is because i mean we've had like we said we had the editor of java internal medicine here today okay yeah so this is hitting the mainstream and it's getting through but i did leave the bsg meeting thinking well hey that is amazing yeah that all of us gastroenterologists were hell were fed all this good healthy food all these fiber rich meals for these last three days but why can't we do the same for our patients who need it gotta talk to hospital administrators about that one man work to do um so we kind of talked about the bottom end a little bit uh let's talk about kind of the top end uh gastroesophageal disease yeah gerd in the uk we call it said gerd see now in the uk i'm not a doctor right so like it's easier for me to say gerd than what would it actually well in the uk we call it gourd because we have an o in front of esophageal gastroesophageal oh whereas in this gastro esophageal but however you spell it or pronounce it it's the same problem gerd so gerd costs the u.s health care system 12 billion dollars per year whoa so this is an expensive disease gerd it's one of the most common reasons for someone to consult their primary care physician and antacid medications as i noticed the other day in cvs are one of the top prescribed and top selling medications in the united states a lot of people don't think much about taking an antacid is there a risk for somebody who's chronically taking them every single day there i mean like all medications there is a little bit of a worry there i mean if you so in the u.s about one in three adults has gastroesophageal reflux disease okay so the advice they may be given is okay just take this antacid and forget about it all right okay that's not the right advice we'll we'll come on in a moment what the right advice is okay so look if you need an antacid to improve your quality of life so you can enjoy your day go to work and play with your kids that is absolutely fine okay but just be aware that you are artificially suppressing a really important natural function of your digestive tract the production of acid you are artificially suppressing that to try and put a lid on these symptoms when there is a lot of other stuff that you could be doing okay well okay so before we get to the stuff you could be doing let's talk about the causes again i'm assuming this is all going back to diet well it's a big part of it so what's actually happening is so your stomach is incredible okay food pops down through your esophagus the food pipe and lands in your stomach the acid that is produced in your stomach is almost as concentrated and almost as powerful as battery acid okay your your digestive system is incredible incredibly adaptable we can break down pretty much anything and turn it into usable food because humans have evolved to survive through the most challenging environment in circumstances okay but what happens with gastroesophageal reflux disease is some of that acidic liquid is refluxing to somewhere where it shouldn't be which is your esophagus which isn't ready for that that is not its job it is not supposed to be exposed to gastric acid it's simply there to bring the food down to the acid part right and because it's not geared up for it you would experience heartburn wheeze cough um you develop esophagitis when we look down our scope it's red and sore as it heals and gets scarred again and getting narrowed causing a stricture and in fact that's a major risk factor for developing a condition called virus esophagus which is a major risk factor for developing adenocarcinoma cancer of the esophagus which is a very difficult disease to survive okay if we look at high income countries where we eat a standard western diet like we said earlier high meat high processed food high dairy high junk food high fat low vegetable low fiber diet we see about one in three adults is living with gastroesophageal reflux disease if we look at populations like in east asia where the diet is way more fiber fueled way less animal fueled we see that 90 of people do not have gastroesophageal reflux disease so there's a lot we can do with our dietary intakes now we know that dietary fiber reduces the risk of developing these symptoms in the first place right and one of the main reasons for that and we're back to pooping again is because if you're on a high fiber diet you when you've got less straining to use the bathroom you've got less intra abdominal pressure that's important because that intra-abdominal pressure from straining to defecate can result in the uh formation of a hiatus hernia so your stomach kind of gets pushed up into your chest we can see it sliding up and down that makes the uh normal function uh inadequate so the sphincter this valve gets compromised so now food and your stomach can slide up and down in and out of your chest and that is a condition we call hiatus hernia it affects about one in five adults in high income countries okay so your anatomy is messed up and you are set up to experience gastroesophageal reflux disease but if you have a high fiber diet that is less likely to happen in the first place now we also know that people who have gastroesophageal reflux disease not only do they tend to have a fiber deficient diet but they also tend to get more fat in their diet more saturated fat more cholesterol a higher percentage of the calories in each meal coming from fat and why is that important is when we eat a high fat meal it triggers a number of hormonal mechanisms including cck within our body which relaxes the sphincter the relaxes the valve allows acidity to happen but also slows gastric emptying so the meal sits in your stomach for longer so it's more likely to reflux so what can we do we said so fiber deficiency is the problem right high fat meals are the problem high saturated fat meals high cholesterol meals are the problem can we flip that around can we can we take a different approach to food how about we do a fiber enriched diet which is also low in saturated fat has low or zero cholesterol and that's how i talk to my patients about eating for gastroesophageal reflux disease and there's been some nice studies done if you take someone who is eating a fiber deficient diet and you get them to take an extra 15 grams of fiber per day okay we see resolution of symptoms in more than half of patients wow and along with that healthy high fiber low fat diet what else do you get you get healthy weight loss and that is super important because unfortunately the higher the degree of obesity that you are living with the more likely you are to have gastroesophageal reflux diseases these things travel together and if you have someone living if you've just been to your gp or your doctor and you've got gashes after reflux season they've given you the prescription you ought to know that if you can reduce your bmi by four points healthily maybe by eating a high fiber low-fat diet you will see resolution of gerd in 60 percent of cases so healthy dietary intakes increasing the fiber losing weight getting towards a healthy weight and you know that weight loss issue yeah that even works in people who are in the upper limit of a healthy bmi so if you're technically in the healthy range but in the upper echelons of that healthy range then losing some weight can really benefit your gastroesophageal reflux so 60 is meal timing a factor here like a lot of people will say well i ate right before i went to bed and i woke up with the most wicked case of heartburn you're absolutely right so food is important so we've covered that few other things you can do if you're living with gastroesophageal reflux disease okay so eating smaller meals more frequently so we talked about this phenomenon of food refluxing back up so if you don't fill the tank all the way up you've got less reflux going on okay a lot of the reflux and damage that causes symptoms during the daytime happens at nighttime because you're lying flat on your back anything that's in there is going to reflux up so how can you reduce that don't eat or drink anything for two hours before bedtime you can also elevate the head of the bed if you can put a few wooden blocks or uh anti-reflux mattress wedge which is a thing that's the thing that is a thing that's it's an expensive thing okay i figure everyone's got a couple of bricks lying around in the garage right so get a few bricks if you're gonna elevate the head of your bed by about six to eight inches yeah that means when you're asleep at night there's less reflux happening okay avoiding alcohol is important alcohol slows gastric emptying relaxes the lower esophageal sphincter so these are things that not smoking can be helpful as well smoking neutralizes the antacids that's naturally producing your saliva that can help to break acid reflux so yes food is important but other measures are also important is does the amount of alcohol matter like what if somebody's like well i only have one beer maybe two beers tops in a day yeah if you are living with gastroesophageal reflux disease to the point that you're on medications and you do drink alcohol yeah it's worth taking a break okay so take a break see where you are if you want to bring that one beer back in you know i mean you're not going to trick this doctor into saying that beer is good for you chuck i i'm not trying to i'm just trying to talk to the man that's out there having that beer yeah wondering what what the deal is yeah you can i figure out if it's a trigger for you yeah but look when it comes to gut health in general um alcohol is not a great idea i mean the in the uk the official guidelines for alcohol consumption is 14 units or fewer per week right which comes down to maybe one small beverage per day and if you have more than two of those beverages on one day you're in a hazardous alcohol pattern so maybe that one little beverage a day you're probably flying in the level of safety but you know maybe maybe less than that is better for word to the wise easier to just avoid it i suppose and in these cases you know um gosh though but 12 billion and and people think like it's just heartburn but i mean like you you kind of took us down a dark path there doc yeah well it's so common like i said you know maybe one in three u.s adults are living with this condition yeah you know and the other thing i would say chuck if you are on medication for this condition yeah and if you've made all these healthy changes now you want to try reducing the medication first thing to do is check with your physician okay because there are certain conditions where i will still leave a patient on the antacid medication so if they've had you know structuring or you know very severe narrowing of the esophagus yeah that's a problem and if that i don't want that coming back and if they have bad esophagus which is a pre-cancerous condition of the esophagus i will even if they are super healthy they've done everything i'm asking they've got no symptoms doctors are cautious people we will still keep you on the proton pump inhibitor to reduce your risk of esophageal cancer but if you don't fall into one of those categories there's a really good chance you can get off the medication but if you are trying to come off something like uh omeprazole or esomepresol just be aware that when you stop taking it you get this rebound phenomena where all of the acidity in your stomach turns on it's all been switched off it all comes on so you'll often see a patient who had mild acid reflux the doc put some money is impressive and then a few weeks later they try and come off these omeprazole and suddenly they go oh my god i don't remember it ever being this bad right i've got to stay on the esomeperzoll well just bear in mind that that rebound phenomenon usually sells in a few days gotcha final question is uh what if somebody is already eating that that healthier diet they're going toward that um for the short term should they be avoiding acidic foods tomatoes citrus it can be pretty individual actually so a lot of time people will identify tomatoes chocolate and coffee as triggers okay so it's probably the three most common triggers so it's often worth keeping a food diary and see what are individual triggers for your acid reflux so with acid reflux you'll experience those symptoms within an hour or so of eating so it's pretty easy to join the dots between the food you've just eaten and whether or not you've had symptoms right and but just watch out those high fat meals right don't don't eat that hydrogenated tallow yeah avoid that absolutely not yeah avoid the twinkies avoid the hydrogenated tallow dr alan desmond thank you my friend pleasure thanks for joining us everybody appreciate it uh if you submitted a comment or a question i promise we will get you an answer on an upcoming episode thanks

Channel: Physicians Committee

Views: 10,708

Keywords:

Id: mWMXkIEBrzU

Length: 31min 1sec (1861 seconds)

Published: Thu Aug 18 2022