Thursday, July 10, 2014

An easier way to prep for a colonoscopy Ask Dr. H Mitchell Hecht

February 16. 2013 8:03PM

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Q: When are they going to have a better way of preparing for a colonoscopy? My doctor keeps reminding me that I need one, but it seems like such a hassle!

A: I agree with you that the worst part of a colonoscopy is the bowel prep. A clear liquid-only diet the day prior to the procedure is not fun either. The procedure itself is a breeze. With the superb short-acting intravenous sedation used nowadays, not only will you not feel the scope, you'll probably never even see the scope. There's a brand new bowel prep that might make your cleanout experience a whole lot easier. On July 16, the FDA approved Prepopik powder to help clean out the colon prior to colonoscopy. The recommended cleansing regimen is to dissolve a small packet of citrus-flavored laxative powder in just five ounces of cold water, taking one packet the evening prior to the planned procedure and a second packet dissolved in five ounces of cold water the morning of the procedure. The evening dose is followed by the consumption of 40 ounces of water or a clear liquid of your choice; the morning dose is followed by the consumption of 24 ounces of water or clear liquids. This is the simplest bowel cleansing regimen to date.

Q: I read an article that described a big jump in the number of kids with juvenile (type 1) diabetes. I can understand the big increase in type 2 diabetes from today's obesity problem, but why would rates of diabetes in children be going up? Is there something in our food or environment to blame?

A: It's definitely a real phenomenon. The incidence of type 1 diabetes (an auto-immune condition where the young person's body attacks its insulin-producing cells in the pancreas) is now twice as high as it was in the 1980s, and 10-20 times more common than it was 100 years ago. While rising rates of type 2 adult-onset diabetes can be explained by the obesity epidemic, the incidence of type 1 diabetes should be relatively unchanged over a few decades.

We don't know what's causing the worldwide trend toward higher rates of type 1 diabetes, but several hypotheses have been proposed:

• The Hygiene Hypothesis: The lack of exposure to once-prevalent germs results in autoimmune hypersensitivity and the destruction of insulin-producing cells by rogue white blood cells.

• The Sunshine Hypothesis: Increased time spent indoors is reducing children's exposure to vitamin D. Lower vitamin D levels are linked to an increased risk of type 1 diabetes.

• The Accelerator Hypothesis: The rising height and weight of children has accelerated their risk of type 1 diabetes by stressing the insulin-producing cells.

• The Cow's Milk Hypothesis: Exposure to cow's milk during the first 6 months of life wreaks havoc on the immune system and increases the risk of type 1 diabetes.

• The "POP" Hypothesis: Exposure to persistent organic pollutants in our environment increases the risk of diabetes.

—F.P., Tacoma, Wash. —T.U., Orlando, Fla.

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