Side Project Podcast 13: Gastro Health with Bincy Abraham

Leyla Seka (00:01.215)

Hi everyone, welcome to Side Project, our foray into the fun that is middle age that we’re all dealing with in different stages in different ways these days. I’m here with my very good friend Ruthie. Hi Ruthie!

Ruthie Miller (00:14.763)

I’m happy to be here today too. And as always, we’re talking about ways we can, you know, maximize our health, be more proactive with our health so we can stay stronger for longer. And today we are talking about gastro health. I’ve actually been looking forward to this topic for a long time. Partially because, I mean, I’ve had gastro issues my whole life, so we can get into that. But gastro health feels like it’s a little bit taboo to talk about. Right? In the same sense that we’ve been about perimenopause a little bit, and that feels very taboo. And gastro health is kind of the same way, don’t you think?

Leyla Seka (00:51.539)

Yeah, people don’t like talking about shitting their pants. But let’s be clear, everyone shits their pants at one point or another. Yes, Ruthie, yeah. You go in the Peace Corps and then you talk to me about shitting your pants because trust me, I did it so many times in the Peace Corps that I was like, I’m kind of immune to it now so that when my midlife friends are bringing this up, I’m like, yeah, it’s okay. It’s gonna be okay. Nevertheless.

Ruthie Miller (01:02.517)

Okay.

Leyla Seka (01:14.213)

Let’s be clear, we all have problems with our stomach, right? One point or another, you drank too much, you didn’t eat enough, you ate too much, you ate the wrong thing, something weird went in, and you feel terrible. I mean, it happens to everyone just living our lives. But like menopause and like other topics, gastro health in particular, people feel uncomfortable talking about it because they’re embarrassed. Which is funny because like, if you’re honest, doesn’t everyone laugh when someone farts or when someone makes a fart joke? I don’t know anyone that doesn’t laugh at that, yet we can’t quite get to a place where we talk about this honestly, right?

Ruthie Miller (01:47.563)

That’s true. So, yeah, let’s get into it. So today we have with us Dr. Bincy Abraham. She is a gastroenterologist and professor who specializes in IBD. And I want to be clear, that’s inflammatory bowel disease, which is different from IBS, which is more common. That’s irritable bowel syndrome, I believe. So those two things are very different:one is chronic and one is more, you know, just you eat something bad. So Dr. Abraham specializes in IBD, which is like an umbrella that includes things like ulcerative colitis and Crohn’s disease. And who better is there to answer some of our crazy questions about digestive health? I am sure this episode is going to get down and dirty, and I am here for it. Welcome, Dr. Abraham.

Bincy Abraham (02:25.972)

Thanks Ruthie, thanks Leyla. I’m so excited to be here and get down and dirty with you.

Ruthie Miller (02:48.971)

This is like your life. You live this. When you were young, were you just like, I’m doing it. I’m going to be a gastroenterologist. How did you choose that as a specialty?

Bincy Abraham (03:02.36)

Well, I always like to say it’s a dirty job, but someone’s gotta do it.

Ruthie Miller (03:08.853)

I knew we’d pick the right person for this topic.

Leyla Seka (03:11.077)

Nicely done. Okay. All right. Let’s dig in. Let’s dig in to gastro health. So Ruthie wrote so many questions for this podcast. Ruthie always writes a lot of questions for our podcast, but this one, she was on a tear. But the first one started, which was a great one, which is like, what is the deal with our microbiome? Right? What’s going on and what’s going on with all these different types of supplements around like eating this or eating that or drinking a whole bunch of kumbacha or however you pronounce that. That’s the way my mom said it. My mom called it kumbacha. So I grew up in Berkeley, lest we remember, because I’ve been drinking this my whole life. So I say it wrong. But nevertheless, eating tons of yogurt, all this immunity, microbiome stuff. What’s going on? What’s really happening?

Bincy Abraham (03:59.672)

So actually very interesting fact. Actually, maybe I should ask you the question or the listeners, like, do you know how much bacteria we have in our body?

Leyla Seka (04:10.685)

A lot.

Ruthie Miller (04:11.473)

No idea!

Bincy Abraham (04:11.598)

Good answer. Good answer. Actually, we have, we’re actually in a space where we have 10 times more bacteria than we have human cells. So essentially we’re just like the host for the microbiome, essentially, and the majority possible, I know.

Ruthie Miller (04:29.065)

How does that even, that doesn’t even feel like it’s possible that you could cram all that. I mean, it must be absolutely micro cells are microscopic. And so this must be like micro-microscopic.

Bincy Abraham (04:40.844)

Yeah, well, that’s what we call a microbiome, right? They’re small, tiny, you can’t really see those bugs in their regular naked human eye. And it’s very interesting, like, so that whole concept of we are what we eat, like, that’s exactly true. And so the healthier we eat, our microbiomes are healthier, the unhealthier foods that we eat, our microbiomes end up being unhealthy for us. And there’s a huge interaction in our microbiome and what’s going on in our cell layer in the GI tract and our immune cells. So, you talked about my specialties and taking care of patients that have inflammatory bowel disease. We know that having a good microbiome can potentially prevent the disease or when the question is what came first, the chicken or the egg, was it the bad microbiome that caused the inflammation was the inflammation that messed up the microbiome. I think it’s probably a combination of both. There’s such huge interplay between the cells, the mucosal layer of our GI tract and the bacteria that’s there, and they’re always talking to each other as well. So there’s a lot to discuss there, and I won’t go into all the nitty gritty, but the bottom line is that what we eat, if it’s healthy, we generally tend to have a healthier microbiome. The unhealthy foods, and we can go into details of what’s unhealthy or not, and diet as well, but that leads to a messed up microbiome essentially.

Ruthie Miller (06:10.569)

And so what are some of the signs, if your microbiome is not quite right, what are some of the signs that we should be looking for?

Bincy Abraham (06:17.644)

Yeah, so sometimes there may not be any signs at all. You may just feel normal until something bad happens years down the line, like inflammatory bowel disease. Or others can have some early signs that you eat something and your microbiome’s aren’t the usual. You can get bloating or sometimes you can get a change in your bowel habits, diarrhea, or maybe constipation. So it can really vary based on what your normal microbiome is, how much has changed, what your diet is. So all that interaction, so it can really vary.

Leyla Seka (06:49.493)

Okay, I have kind of an off the cuff question. How many times are you supposed to go to the bathroom a day? Like, have a bowel movement?

Bincy Abraham (06:56.81)

Exactly 2.2 times… no, I’m just kidding. 

Ruthie Miller (07:00.787)

Like wow that’s very specific.

Leyla Seka (07:05.301)

Sometimes I have friends that don’t go to the bathroom for like two days and I’m like, what’s happening? I mean, they might be traveling or stuff. This is not my experience just for the record.

Bincy Abraham (07:10.188)

I’m totally kidding. Yeah, no, there’s no set rule. So that’s why I joke about like, no, please don’t take that to heart. Like you shouldn’t have exactly two bowel movements per day or one per day, et cetera. It can again all vary. It all depends on your microbiome status, your genetics, what your motility of the GI tract is, what you’re eating, how much fiber intake you have, your hydration, the amount of activity, are you really mobile or running around, or are you laying in bed all day? Like all those factors play a role. So on average, going even two to three times a day can actually be normal in some patients, or some just in the population in general, I should say. And others going to three times a week may be normal for them as long as the bowel movements are soft and not hard, you’re not struggling to go, or you’re not having loose watery stools. So the consistency, as long as it’s not in a liquidy form or really hard pebbles, if it’s somewhere in between for the most part, you’re not struggling to go, is not the number of times you go per day or per week, it’s more of is it normal for you.

Ruthie Miller (08:23.019)

Okay, that makes sense. That makes sense. So we often talk a lot about perimenopause and menopause and the ways that our bodies are changing currently as we age. How do these things? How does aging affect your gastro health and your systems?

Bincy Abraham (08:40.866)

Yeah. So you brought up menopause or perimenopause, and that’s when a lot of our hormones, especially in females, are changing. And any changes in hormones can lead to gut issues, essentially. But what we see overall is that the older we get, things tend to slow down. No big surprise, right? So the older we get, our GI tract tends to slow down. So we tend, in general, to get more constipated as we get older, compared to when we were younger. That’s why, you know, our grandparents were like, prune juice and prunes, I love that. That’s what keeps me consistent. And it’s true because there’s a lot of good fiber in the prunes and the sugars, you know, it’s not as absorbed so can actually go to the bathroom. 

Ruthie Miller (09:26.473)

Metamucil ads. Do you remember all these Metamucil ads from the 1980s?

Bincy Abraham (09:40.098)

Yes, the Metamucil ads! You don’t see 18 year olds on those ads. You see the 70, 80 year olds on those ads. Yeah. So in general, we tend to slow down as we get older, but it also depends on your activity level, fiber intake and genetics and all the things I talked about earlier as well.

Leyla Seka (09:51.189)

What do you think about taking fiber pills or eating Metamucil or drinking it or however, you know, like I take fiber pills every day. I’m no lie. I do. But like, what’s your general? Yeah.

Bincy Abraham (09:57.592)

Okay, so I think I know a lot about your microbiome. This is great. I love it. I’m so glad you’re able to openly talk about your fiber intake. So yeah, fiber, great question regarding fiber. So fiber is great for your GI tract.

Ruthie Miller (10:07.339)

Leyla’s an open book. I think that’s pretty clear.

Leyla Seka (10:10.287)

Isn’t that the point? Why not?

Bincy Abraham (10:23.886)

So our colon cells love fiber. In general, we’ve seen studies that show that it helps in reducing colon cancer risk. There’s an entity called diverticulosis where you can have outpouching of your colon. That can happen at increased risk if you’re on a low fiber diet. So fiber can help prevent those structural changes from happening as well. So fiber in general is good for you.

Now, there’s different types of fiber. There’s soluble and insoluble fiber. So I kind of think it as, you know that whole saying of eating an apple a day keeps the doctor away. At least an apple a day may keep the GI doctor away, at least from constipation issues and all of that. In the sense that if you think about the apple, there’s the skin, right? Think of that as the insoluble fiber. You have to like chew it up and it’s rough and all of that. And then…

The apple actually has soluble fiber, which is a pectin that’s in the inside, the meat of the apple essentially. So that’s two different types of fibers. So some people, if let’s say, have a patient with Crohn’s disease and it has a narrowing or a stricture in their intestine, they may not be able to tolerate that insoluble fiber because it’s roughage that has to get through a narrowed area. In those cases, I recommend more of the soluble fibers for them. They still get the benefit of that fiber. But they can at least tolerate it and food’s not going to get stuck and they’re not end up in the hospital with the bowel obstruction or anything like that. So yes, so fiber in general is good for you, what you can tolerate. In general we recommend getting about 30 to 35 grams of fiber in your diet every day, and in our regular American diet sometimes it’s tough to get that. However, if you don’t get it in your regular diet with fruits, vegetables, whole grains, then it’s recommended that you take some fiber supplements, Leyla, like you’re doing, just to keep our GI tract healthy and happy and also more regular as well.

Leyla Seka (12:33.269)

I mean, is there anything wrong with doing both? Like, you’re a whole bunch of vegetables and you’re taking the pills. So that’s, I mean, that’s good, right? Can you eat too much fiber?

Bincy Abraham (12:41.59)

You almost, well, you can always do too much of anything, right, in general. I think the bigger issue is we’re getting too little fiber. And if you’re really, and you have to work at taking more fiber, right? It’s not like you can eat, you know, 20 oranges or, you know, 20 bowls of broccoli, but you can easily eat 20 Snickers bars or, you know, 20 chocolate chip cookies more easily, right? So I think I’m not really too worried about people taking too much fiber. The issue would be if they were on more fiber and they would get like an obstruction if they have some structural damage, like I mentioned, like in patients with Crohn’s disease or some narrowing from prior surgery or something like that. But other than that, you almost can’t do too much fiber.

Ruthie Miller (13:36.661)

Well, speaking of supplements, let’s talk about probiotics for a minute and prebiotics. I’m not even sure what prebiotics are, but it’s a term I hear a lot. But probiotics are more common. think everybody’s like, you’ve got to take a probiotic for your stomach. It’s so helpful to keep your microbiome healthy. Is that true or is this just like something, you know, again, another marketing ploy to get us all taking more supplements than we really need to?

Bincy Abraham (14:01.55)

So yes and no is the answer. Well, let me just first clarify probiotics are the actual good bacteria such as lactobacillus, bifidobacter, those are things that you find in yogurt. Prebiotics are the foods that help nurture the good bacteria. So things like inulin, onions, garlic, things that help grow the good bacteria essentially.

So it’s good to have both essentially in your diet. Now, as far as its role in GI health, of course, it’s always beneficial to take it in the natural form, eating yogurt, eating the fruits, vegetables, fibers, onions, things like that. Now, you can take supplements if you feel like it will help you. And I can tell you there’s a lot of different studies, but it’s so hard to study probiotics because each of our microbiome is so different, right? And the probiotic supplements have different formulations of it as well. And also anything that you take in, keep in mind that whatever you swallow, it has to get through this very acidic environment in your stomach. Your stomach is making all this acid. Whatever you take in has to survive that to get to your small intestine, to get to your colon, to provide all the benefit the probiotics will, you know, give to you. So if you look at overall health, if you’re getting probiotics naturally, if you don’t have any GI issues, that’s the best way to do it. If you have specific issues like irritable bowel syndrome, different studies show that probiotics can help with some of the symptoms like bloating or pain or diarrhea. So if it helps you, great, continue taking it. If you tried some probiotics and it didn’t help you, then stop taking it. There’s no point in continuing something that’s not helping you. Now, more specifically, if you’re focusing on, let’s say, someone who has inflammatory bowel disease, there actually has been studies looking at treating or using probiotics in Crohn’s disease, ulcerative colitis. But I can’t say that in the Crohn’s disease trials, the probiotics haven’t really mounted to be very beneficial, especially if you look at randomized controlled trials.

Bincy Abraham (16:18.784)

Those are the scientific ways to see if one thing works better than another, right? So in Crohn’s disease, the studies, the evidence has really been very positive. So I generally tell my Crohn’s patients, like, if it helps you, great, take it. But if it’s not helping you, don’t waste your money on the supplements. Sure, eat your yogurt, eat the healthy stuff to continue your overall general health. In ulcerative colitis, most of the studies are in general to help with prevention of a flare to kind of keep you at baseline for the most part is not really useful if you have severe active inflammation because your microbiome is already so messed up that adding a little yogurt or probiotics not going to really help that much. Now we have the most evidence actually in patients that have pouchitis or have J pouches. And if you’re not familiar with that, what, exactly. that the J pouch is where if let’s say you had a patient with a lot of inflammation, their colon, they had to get their entire colon removed and to get you back, instead of having a stoma ostomy back on your abdomen, the surgeons will make a little pouch, it’s called a J shape because it’s made of the small intestine. They have a little reservoir that, that J, the bottom part of the J essentially, and they connect to, you know, to your, or your rectum used to be the anal canal. So you can have like more normal, you know, movements rather than going through an ostomy bag. So sometimes when you have this J pouch, you can actually get pouchitis or inflammation of that pouch. And we think it’s because the stool, the small bowel is really not used to a lot of bacteria where the colon is, but because you have this pouch and there’s a bacteria stagnant in there, it can irritate and cause inflammation. And actually using probiotics can help with preventing pouchitis or even as an adjunct treatment while we’re treating the pouchitis flare with some antibiotics as well. So that’s the best evidence we have with using probiotics in the GI tract.

Leyla Seka (18:18.995)

Is that the evolution of the colostomy bag?

Bincy Abraham (18:22.016)

No, so the colostomy or ileostomy bag is just a bag that’s, you know, to help collect stool if you’re having, you’re diverted away from your rectum, the anal canal. But this pouch is actually internalized. So, you may have had a bag in like a temporary thing while you’re getting the inflammation under control and the surgeon goes back in and reconnects you back to your anal canal. So you can have more like a normal bowel movement. Yeah.

Ruthie Miller (18:49.813)

So these are all very scary sounding things. So in terms of being a little bit more proactive, what are three things that you recommend to anybody, your casual Jane here and there, ways we can take care of our digestive health, you know, so we can be stronger for longer.

Bincy Abraham (19:10.732)

Yeah, so in general, so yeah, all the stuff I talked about could be very specific to that individual. In general, regardless of age, I think we can all improve our gut health by just being really good to ourselves. The stuff that our mom said, eat our vegetables, eating a healthy diet, right? If we increase our fiber intake, fruits, vegetables, those can keep our microbiome happy and our gut happy, it improves our glucose regulation. We’re not eating sweets all the time. The fiber helps slow down the how we digest the foods in our stomachs. We’re not overeating. As I mentioned, like you can’t overeat on, you know, bowls of broccoli, but you can eat a bunch of chocolate chip cookies, right, easily. So it helps with that. And actually that healthy diet, we’ve actually been found in studies that can prevent inflammatory bowel disease.

So it may be even a preventive measurement as well. It can also keep our bowel movements more consistent as well. So you’re not going one way or the other. In fact, fiber can help with treating diarrhea. It can also help with treating constipation. So it kind of gives your bowel movements a bit more regular as well. Second thing I would say would be, besides actually proactively eating a healthy diet, is avoiding processed foods. The things that are in packages where you can’t pronounce half the ingredients.

It’s really a simple way to look at it. So if you are going inside, this is some chemistry label that you remember. I remember trying to do that in chemistry class, but I’m eating that right now. That’s the wrong way to go. avoiding those foods now doesn’t mean we’re all human. I still like to eat my bag of chips once in a while. It doesn’t mean that you can’t have it once in a while, but that shouldn’t be your daily routine of your diet, essentially. So avoiding the process. Another way to think about it is when you go to the grocery store, start shopping on the outside, right? Where there’s the fresh fruits and vegetables, the bakery where there’s freshly made bread, not the packaged with the processed stuff that’s to keep it fresh for months and months, right? The meats, the dairy that’s actually fresh, like it’s real food, nuts, things like that. Avoid or minimize what you eat or take or buy from the aisles where everything is in boxes and have preservatives in there. That can also keep your gut happy and healthy and the microbiome healthy as well. So that’s like another simple way to think about eating, improving your gastric health as well. And the third thing is there are non-diet stuff that can improve your GI tract and keep your microbiome happy. And that includes getting enough sleep and exercise, staying hydrated.

Bincy Abraham (21:56.398)

Actually, there’s been, we looked at studies showing that lack of sleep can affect your microbiome. Of course, when you don’t get enough sleep, you feel miserable anyway. Who cares what you eat or don’t eat? You have brain fog, you don’t feel good, you don’t have as much energy. So simple things like that can help. And exercise also can help improve your microbiome as well.

Ruthie Miller (23:28.555)

So you talked a lot about diet and I want to segue over into the standard American diet, our favorite, the SAD as we call it. So the standard American diet is a ton of bread and meat and dairy. So on a scale of one to 10, how bad is the standard American diet for our gastro health?

Bincy Abraham (23:49.742)

Oh, that’s a big question. in general, standard American diets, maybe 10 being the worst. 10, I would say. It just depends on how much of that you take in. Now, bread is not necessarily bad for you. Meat is not necessarily bad for you. Dairy is not necessarily bad for you. It’s just a matter of how much and how much is it processed, right? So one thing, if you go to a name, you know, chains, et cetera, if you go to a food chain and what do call it, the fast food chain, right? And you grab the stuff that, you and you probably saw those TV shows looking at those hamburgers can last for five years and looks the same as the first day. You know, that’s not real food, right? So that’s that would be really bad. But let’s say you make your burgers at home, you had grassfed beef,  and you got fresh stuff with good spices and you load it with lots of tomatoes and lettuce and, you know, like good cheese and a bread maybe from sourdough or freshly made, then that actually may not be so bad for you compared to what’s processed, right? So there’s some components of it that we need to, you know, look into more details about. You know, and then meat. So fish is considered a meat product. Fish is overall generally healthier than red meats. Chicken, depending on how much fat is in there and all of that. And the other thing we don’t think about is we lump meats in general. But we also need to think about where did they come from? Is it grass fed versus they were getting chickens or were getting cornmeal all the time? the way their meats form, their muscles and everything forms, we’re eating that. So what we eat is what our meats ate as well. So that can also play a role. So you can eat good meats, you can eat bad meats as well. So I think you have to keep those in mind. You can probably eat a happy, sad diet, or you can eat a really sad, sad diet too.

Ruthie Miller (26:02.291)

Yeah, I mean, it really sounds like that the answer is getting rid of processed foods. I mean, just being more conscious about what we put into our bodies, which I think, you know, most of us, you know, who are listening here try to do that anyway, but we’re not perfect. So it’s just a nice reminder that, you know, all these things really affect us, all the systems inside that we don’t necessarily think about all the time, you know, stuff’s happening inside us.

Bincy Abraham (26:25.122)

Yeah. Right, and one thing, we talked about bread, and dairy, but actually sugars are one of the biggest killers, essentially, I should say. Because if you think about the processed foods, we thought about low-fat diet, okay, great, that was a big thing back then, but we realized that we do need fats, we need good fats. So in a lot of the low-fat processed stuff, they added a lot of sugars to make sure it tasted good. But sugars actually turn into fat in our bodies. We’re not metabolizing it. And that’s been a big issue. And our new epidemic essentially, besides the whole obesity epidemic is metabolic associated teatosis or fatty liver essentially, what used to be called. And what happens is that the liver loves sugar. And if you’re eating only sugar, then it gets absorbed quickly and if you’re using it up, you’re not running a marathon, you’re going to be eating and sitting at your desk all day. What happens to all that sugar? It turns into fat. We think about getting fat as underneath her skin or bellies blow up or thighs or hips or buttocks, etc. But actually the most dangerous fat is the one that stored in our organs. If you have fat stored in our liver and you have fatty liver there, you actually can cause damage to that liver over time, where it can cause fibrosis or scarring, and it can even cause liver failure. And now more more of our patients getting liver transplants are due to the metabolic disease, not from hepatitis or even alcohol. It’s really because of this metabolic dysfunction, because we’re eating more than we’re actually utilizing and eating more sugars, and that’s getting processed into or changed into fat and stored as fat.

Ruthie Miller (28:22.635)

That’s really interesting. So you mentioned the liver. So one thing that Leyla and I like to ask all of our guests is, why can’t we drink wine anymore? And all of our experts are like, yeah, you just can’t. And they don’t really say it. They’re like, I don’t know. It just doesn’t work for us anymore. We can’t sleep. We’re like, yeah, we know. But what’s your take on this? And I know alcohol has a lot of complex opinions on it these days as well. But, know, like scientifically, how come when women hit perimenopause, the way we process alcohol changes?

Bincy Abraham (29:01.08)

Wait a minute, did you say we can’t have white wine anymore? Wait, what is this?

Ruthie Miller (29:08.054)

Yeah, news flash! But yeah, if I have a glass or two of wine, I’ll wake up at two o’clock in the morning, BING! Wide awake.

Bincy Abraham (29:15.534)

When life is over: you just said we can’t have wine anymore. Life is over. Okay.

Ruthie Miller (29:19.717)

No, no, we still enjoy our wine, trust me. But you know, kind of have to decide like, am I willing to chance it tonight or am I gonna be okay with being a little bit more groggy in the morning than I used to be?

Bincy Abraham (29:24.952)

Yeah, so wine in general. I know you probably have heard, having a glass of red wine can be good for your heart health back in the day, like decades ago. You probably have heard those slogans or so. We actually found that wine or any type of alcohol is really not good for us in general. We’ve seen increased risk of cardiovascular disease and even cancers with increased alcohol intake as well.

Now, it doesn’t mean, like I said, even with the processed foods, like, you know, if we avoid everything that’s bad for you in life, well, what’s the point of life, right? But again, going back to this is not just shouldn’t be your norm. Sure. Have a drink to celebrate a birthday or an anniversary or a wedding or whatever, you know, whatever celebration life. Otherwise, what is there to to life in general? But it but the key thing is I’m not even saying like moderations like it should be a rarity. Why is that? Because we already know alcohol is not good for you in the sense that it can increase your risk of cancers. It can also affect your mental ability. It can also make you wake up at 2 a.m. because it’s dehydrating.

It actually is more of a stimulant. You might think that, I’m to drink a glass of wine to go to bed. Like, yeah, you may initially go to bed, but you’ll wake up all stimulated while your body’s trying to break down the alcohol as well. And some populations, like genetically, some people have this deficiency in this alcohol dehydrogenase, which is an enzyme that helps break it down where they can’t tolerate wine at all. They get flushing or palpitations and things like that. So they’re kind of protected. They already know what’s going to mess up their bodies, so they’ll avoid it at all cost. But for the rest of us, just need to keep in mind that alcohol in general is not good for you because of how we metabolize it, that it’s a stimulant. It can affect your brain capacity. The other thing is alcohol. you think about it, if you remember back in chemistry, the OL is also a sugar. And guess what sugars do in the body? The liver goes, let me store you as fat. And we also see fatty liver if you drink too much alcohol as well. And that can also cause damage to liver and fibrosis and scarring and liver failure as well. So there’s numerous reasons where we shouldn’t drink any type of alcohol as a norm.

Ruthie Miller (32:08.213)

So maybe that’s why, so like we could process it in our 20s and 30s and now maybe it’s our gastro system that has changed and that’s why we can’t process it in our body. Like I don’t drink a ton of wine anymore. might, know, once or twice a week maybe. But is that it? Is it because I think for me, maybe it is the sugar. Cause I have problems with sugar anyway. So is it that? Because it’s converting the sugar in my liver and that’s why I have trouble with it.

Bincy Abraham (32:39.384)

Well, yeah, and I think that’s part of it. As we get older, metabolism slows down. We’re not metabolizing things as normally. So it stays in our system a bit longer. And when you’re 18, you’re super metabolized. You’re growing. We can tolerate a lot more anything. Yeah. Alcohol, lack of sleep, running around, muscle tone, all of that. I think it’s very multifactorial.

Leyla Seka (32:58.291)

Youth is wasted on the young. Youth is wasted on the young. Okay, I have one question on that. So I know we’re not supposed to drink. I know, you’re doctor, I know. But if we are going to drink, is there something better to drink? Should we drink beer or wine or booze or a spritzer? 

Bincy Abraham (33:27.606)

Yeah, so I mean, you can definitely look at the alcohol percentage, right? So that’s something. So the lower the alcohol percentage in whatever drink you’re getting, the better, you know? 

Leyla Seka (33:40.115)

But mentally I want the higher alcohol percentage, Dr. Abraham. So, medium? Can we meet in the middle? Is that what we do here? was like, when drinking to get the higher alcohol percentage, be as fast as possible.

Bincy Abraham (33:51.81)

Right, right. Well, so you have to look into what you also like, right? So although there was one study that said that drinking like champagne or a spritzer, you know, like the bubbly drinks or some reduced risk of sudden death. Why? Don’t ask me. Don’t ask me. I’m like, I can have a champagne. I’m not going to die today if I drink that.

Ruthie Miller (34:11.499)

Hahaha! That sounds like a big pile of BS to me, but who am I? I haven’t looked at the science.

Bincy Abraham (34:23.042)

I know this is, yeah, so anyway, that’s just one study and I don’t know how well validated this is and all of that. so the key is lowest percentage of alcohol, but you also have to keep in mind that the volume can differ, right? So like whiskey, for example, you need a few list and ounce and that’d be more alcohol than a glass of a, or a entire container of a Spritzers. So just really look at the percentage alcohol content. And the other thing is you also don’t want to drink something you hate. Like if you are not a whiskey or bourbon type of person, well, it would be the opposite. If you’re not a champagne kind of person or a spritzer kind of person, avoid it altogether and have your little glass of whiskey once in a blue moon, rather than drink more of something else that you do not prefer. The other dangerous thing is actually the mixed drinks with lots of sugary syrups and all of that. You’re getting double, double sugars. it’s not even, it’s, what?

Leyla Seka (35:22.195)

No more Red Bull and vodka, Dr. Abraham? I mean, it was like, that was my jam. That was my jam, dude. My 20s, my 30s, I went well into my 40s with Red Bull and vodka.

Ruthie Miller (35:24.294)

In our 20s, yeah. I was living in San Francisco in my 20s and that’s what I wanted to drink. And I was working at this advertising agency and making peanuts, and if they would charge you for like the glass of vodka and the Red Bull, and so like there’s my paycheck. 

Bincy Abraham (35:46.862)

Oh my gosh. Yeah. Let’s not even get to Red Bull. That’s another story. Like the whole caffeination and I don’t even want to know what was going on in our bodies.

Leyla Seka (35:57.961)

It was really fun. I’ll tell you that Dr. Abraham, I had a great time drinking Red Bull. It was awesome. But yes, I’m not drinking that anymore in my 50s, not to worry.

Ruthie Miller (36:02.707)

Yeah, my 20s were super, super fun. Well, so what about caffeine? How does your gastro system handle caffeine?

Bincy Abraham (36:16.694)

Yeah, so caffeine is a stimulant as you know, there you go. Actually, so there’s a couple of things with caffeine. So caffeine is a stimulant. So it can actually even improve the motility of your GI tract to a certain extent. So sometimes we get this Starbucks phenomenon where you drink some caffeine, and you kind of have to go to the bathroom because it’s stimulating the motility of your GI tract. So that in general, if you’re more constipated, caffeine can actually help you in that aspect. Again, not as some strong super duper prescription medication, but the caffeine is more of a stimulant to GI tract and increases the motility. So you can actually help in that aspect. The other thing we know about caffeine, or at least we know about like black coffee, for example, is that it can help.

prevent or can be beneficial to your liver. If you have fatty liver, now you can’t add all the sugars and the milk and this and that, like drinking black coffee, that’s been shown to help with fatty liver metabolic associated liver disease. Yeah.

Ruthie Miller (37:25.353)

That’s great news. I love that because I recently gave up dairy and so I drink black coffee now so I know I feel like I’m doing double duty. Woo!

Bincy Abraham (37:30.474)

There you go. So as long as you don’t do, you know, double fist with black coffee in one hand and a wine glass in the other. 

Ruthie Miller (37:39.979)

Black coffee with a white wine chaser. Wow.

Bincy Abraham (37:58.604)

Yeah, what not to do, right? Yeah, it can be beneficial. Now, keep in mind that, you know, if you have heart palpitations or you don’t tolerate caffeine really well, that you shouldn’t, you know, do this Red Bull thing or a combination of that. But the other thing is if you drink caffeine too late in the day, it can also affect your sleep. And that’s not good for your overall health either, including your gut health, right? So each person has their own time cut off. For me, it’s like 4 PM. And if I finish my coffee or any caffeinated beverages by 4 PM, I can sleep well at night. But if it goes to five, then I’m struggling to go to bed at midnight thinking, why am I still up? And thinking, I finished my cappuccino at 5 p.m. because I left it on my desk all day. I get a chance to get to it until I was done in clinic or something like that. And that can affect your sleep. So keep that in mind. So just some precautions to the caffeine, not drinking it too late. And also if you get palpitations or any side effects, obviously not to continue using more of that.

Ruthie Miller (38:55.605)

Okay, now I’m going to dive right in. Let’s talk about colonoscopies. Now I’m super excited. Colonoscopies are like the worst. Why did they change the recommended age from 50 to 45, right? And I have heard that it’s because of the increase in colon cancers. So they’ve got to try to start with early detection and stuff. Can you tell us, you know, why are colonoscopies so important? What can you tell about a person’s system from a colonoscopy?

Bincy Abraham (39:33.46)

Yes, colonoscopies, one of my favorite subjects. So glad you asked.

Ruthie Miller (39:36.779)

Do you actually do colonoscopies? When you’re younger, you’re like, I want to be a colonoscopy doctor when I grow up.

Bincy Abraham (39:39.79)

I do colonoscopies. Yeah, like I said, it’s a dirty job, but somebody’s got to it, you know? So it’s very, I’m glad you brought this up because I think we really need to increase colon cancer awareness in the general population. You’re absolutely right. It used to be age 50. If you don’t have any other risk factors or any family history that we started everyone at age 50, and if things look good, then if you didn’t have any polyps, well then we’ll repeat in 10 years, et cetera. Now we reduce that age start to 45 because we’re starting to see more and more younger patients with colon cancer way earlier than we’d start before. So we, and colonoscopies are used to prevent cancer, right? That’s the main goal of colon cancer screening with colonoscopies and general population. Now granted, if there’s family history, someone who, you know, in your family that especially immediate family or even next gen, know, next of kin in that sense, if there’s someone with a younger, you know, history of colon cancer, even colon pobs, we generally want to make sure that that person, the family member, gets screened 10 years prior to that diagnosis in the family. So let’s say mom was diagnosed with colon cancer at age 50, then you would start at age 40 for screening, right? So if someone was diagnosed at age 40, then in your immediate family, you start at age 30. But if there was no family history, we start at age 45 now. 

And who knows if we continue with our sad diet, we may need to start doing surveillance, I mean, screening colonoscopies at age 40 or 35 and that’s just, you know, like more work for us to do, but it’s really truly sad. I mean, I think the cancer risk has a lot to do with their diet, right? Going back to what we’re taking in, the low fiber, the more processed foods, the increasing risk of all these changes in our DNA, where it’s causing mutations and really colon cancer occurs in the general population where these mutations happen, then you start growing these cells and becomes these what we call polyps. There are different types of polyps, adenomatous, tubular villus, tubular adenomas, villus adenomas, tubular villus adenoma, and then more villus it gets and generally becomes closer to the dysplasia or the cancer. And they’re serrated and there’s different types of polyps. Without getting into all those nitty gritty, the key is that with the colonoscopy, if we see a polyp in abnormal growth, kind of looks like nodules. You can look at different forms. It could be flat, it could be raised, could be in a little, like little peduncle. We see it, we can take it out. And once we remove it during the colonoscopy, those cells are no longer there to grow into cancer. So we have essentially prevented colon cancer in someone. We do have colonoscopy, we found polyps and we’ve taken those polyps out. 

So that’s how can be very beneficial. So it’s very important tool. Sure, it’s one of those that people don’t like to talk about or even discuss or even get done because, my gosh, I have to get a scope and it’s, you someone’s going to put a scope into my bottom and look in there, et cetera. But really the hardest part is taking that bowel prep. That’s where you’re at home drinking the stuff to clear out your colon, right? But think of it as, I like to kind of say, well, how can we make this a positive thing? Just think you’re a Hollywood celebrity and you’re getting a high colonic before the Oscars or something and you’re lose like two pounds, you know, you’ll feel really good the next day Think of the bright side, but that’s the most important part because we want to make sure your prep is really good So when we go in to take a look, we can see the coin clearly We’re not like trying to clean up some left residual stool here or this mucus here and this and that so that’s really important But that’s really the hardest part once you come in that next day to get your procedure done, we’re to get you an IV, you’re going to be asleep, you’re to have like this really nice, one of the best naps you’ve had all day that year, whatever, you know, the 10 years, et cetera. And we get to do all the work to look and, you know, find pops and take those things out and prevent colon cancer in you. I really think we need to change that stigma of, what is this colonoscopy? I don’t want to go through with it because it’s really life changing, preventing cancer. 

So I’m so glad you brought it up and really, we just should change that stigma of, I don’t want to get this colonoscopy done, or I don’t know what it’s all about. And it’s a procedure. It’s an invasive procedure that you have to come in to a hospital or an outpatient center to get this done, but actually a relatively safe procedure. The risk of things like bleeding or perforations is actually extremely, extremely low. And the benefit far outweighs those potential risks. And if those things do happen, we can also treat them in there as well. It’s only very rarely that you end up need to have some sort of major surgery for those things. And we really are good about stopping a procedure if we feel like it’s too dangerous to continue as well. So I’m so glad you brought this up. I think we really need to improve this colon cancer awareness.

Leyla Seka (45:01.373)

It’s kind of like cleaning the pipes. You know, like when you have those guys come and look in the pipes with those scopes, like when you’re getting my pipes always have roots in them from the trees. So it’s sort of like you’re cleaning the pipes, you know, like kind of.

Ruthie Miller (45:13.651)

I didn’t mind the procedure at all. It was great. And I didn’t mind the bathroom stuff at all either. The only thing I didn’t like was the taste of the drink. I thought that was like the way I could not. I took everything in me to choke that down. But then the resulting stuff, it actually felt great to kind of get everything cleaned out. Like you said, I kind of like that aspect of it.

Leyla Seka (45:34.709)

They should put a whole bunch of sugar in the drink, maybe it’ll taste better.

Ruthie Miller (45:36.817)

I can’t have that! But okay, so what about the like poop-in-a-box methods?

Leyla Seka (45:42.325)

So that’s what I do. My doctor won’t, I ask every time I’m like, colonoscopies? Like, no, do a myth kit and send it in and then I’ll let you know.

Bincy Abraham (45:49.758)

Well, we should always offer the option of, you know, all of those, right? I would never tell a patient like, you should only get a colonoscopy or you should only do the poop-in-the-box method. It should be an option. So I told you about the colonoscopy. So you know all the details about that. We’re able to see and treat them right then and there. Yes, you have to do the bowel prep and all of that. So you kind of know the pros and cons to it. And if everything looks normal, then you don’t have to repeat that colonoscopy until 10 years later.

Unless of course there’s your higher risk family history, we might do it in five years. Or if we found polyps, we’ll have you come back sooner because we know that you may tend to grow more and that can be dependent on how many, how big the polyps were, what type of polyps are. We have like a little set of guidelines. You may come back in seven years, five years, three years, a year, just depending on what we find. 

Now, there are other options, right? So there’s like the cologar testing where it actually checks your DNA in the blood and stool that’s coming out to see if there’s any changes there that could predict that you may actually have polyps or colon cancer. So if you do that type of test and they find it to be positive, then you still, then you’re get referred to get a colonoscopy done to see why it became positive. So it’s just a test. And there’s always a chance we could miss something. Similarly with the poop-in-the-box testing, essentially we may miss something because maybe it detect that DNA or so as well. Now there’s even a blood test. You don’t even have to do the poop where it checks the DNA and it’s actually about over 80 % sensitive in picking up colon cancer. It may not be as good for picking up polyps. 

Ruthie Miller (50:01.803)

That makes sense. That makes sense. Well, I feel like you’ve given us a lot of really great information on how we can be more proactive with our gastro health. And that’s about all the time we have today. So Dr. Abraham, thank you so much for joining us to get down and dirty and talk about our digestive systems. We learned so much and anybody can find a recap of this gastro health convo on our website at sideprojecthq.com, and you can learn more about Dr. Abraham and her practice at HoustonMethodist.org.