I am gastroenterologist Dr. Carey Strom, AMA!

How to you stomach this job? I don't think I'd have the guts to do it really.

Heh! That's why you don't do it! I think it's the most rewarding job around.

How do you feel about probiotics (pills, liquids, naturally occurring in foods)? Is the hype surrounding them worthy?

Probiotics are great, and they are probably hyped up a bit too much, but I prescribe a lot to patients in my practice. The one I like is called Culturelle, it has more of the live bacterium, there's another one called VSL Number 3, and the other one is called Align, I like that one too.

Doctors make a different diagnosis 90% of the time when they have a professional librarian on the rounds with them, to help source/validate research. Why hasn't that caught on? Is Evidence Based Medicine still a novel concept, or is it catching on in your opinion?

I think it's a trend, with cost-containments right now, people are looking at what tests not to get, etc. and the government is looking at cutting back spending as are insurance companies, but evidence-based medicine can make you VERY angry as patient if you need a CAT scan and the evidence says you don't need one... There's an art to medicine, is there a machine calling out strikes at home plate or a person? Would you rather go to a doctor with 30 years of experience or a machine for medicine? I rest my case.

Hey there,

As a lactose intolerant individual, other than cutting down on/cutting out dairy from my diet, what other changes would you suggest?

Thanks!

Ok, so there are enzymes one can take to break down the lactose - they're called Lactaid, you can buy them at a pharmacy, a lot of people have them and take them before you consume something that may bother you. You can consume slowly, as opposed to drinking a lot of milk at once - if you are overloaded with lactose at one time, your body won't accommodate it well. The best thing is to take a supplemental Lactaid tablet.

someone asked about family likelihoods of getting colon cancer: Yes. The answer to that is yes, so what you need to know is the AGES in which these polyps and cancers were diagnosed - because you will need a colonoscopy 10 years before the diagnoses of your relatives, mostly your father and brother because they are the closest. I mean, the grandfather most likely got colon cancer when he was older. It depends on the age at which your relatives developed polyps - the earlier, the more likely. You probably need a colonoscopy 10 years before your dad or brother were diagnosed. So if your brother got polyps at 50, you'll want a colonoscopy at 40.

Gluten intolerance, real or fake!?

Real. Absolutely real. There are conditions - there's a condition called Celiac which is true gluten insensitivity. There are other conditions where people may be sensitive but not have full-blown Celiac. But yes, gluten sensitivity is real.

I suppose I should rephrase my question. I have no doubt it is real. I have a close friend who I've known since childhood with celiac. I was referring to some recent publications casting doubt on the prevalence of the sensitivity.

Well, it's hard to diagnose gluten sensitivity without a firm test. There could be a lot of speculation you can't prove or disprove. Symptoms can be subjective, depending on who is reporting them. I do believe in gluten sensitivity, without the diagnoses of Celiac, and I would suspect that if people feel better off-gluten - that's terrific.

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Well, a Celiacs test is very important to do. So I would say yes. If you have not had one, you absolutely need one. Your symptoms don't sound typical, but can be related.

What are the typical symptoms and should I be worried about crohns?

Well, they can go hand in hand.

Typical symptoms are: gas, bloating, anemia, diarrhea, and weight loss.

You don't worry about Crohns, because it's not all that common, but if you have symptoms of Crohns, you should go see the doctor! If you have symptoms, you need to see a doctor. You need something more objective.

favorite snack?

My favorite snacks are grapes and almonds. Very healthy, good source of energy, and doesn't give you a lot of carbohydrates, easy to metabolize, easy to burn off the simple sugars - that's what I like. I don't like ice creams or cakes - those carbs are going to be too hard to burn off. And your weight is all about what you eat. You can exercise all day long, but if you're eating wrong, you're never going to take it off. When it comes to the holidays - Thanksgiving, most people eat around 2500 calories on the day.

A couple of tips:

• Don't come hungry to thanksgiving - eat a breakfast, fruit, yogurt, even a snack before you show up, so you feel a little bit full.
• Exercise during the day so you can decrease your appetite
• Eat slowly, and think about it - your stomach will tell you when you're full. A lot of people don't pay attention to their satiety and keep going.
• Sometimes thirst is associated with hunger. If you drink a big glass of water, that can help.

Stop if you feel stuffed. People want to eat casseroles, specials for Thanksgiving - practice mindful eating. Our problem of obesity is caused by lack of mindful eating. If you are mindful of what you eat, you won't eat as much.

And always - one other thing to mention - eat your vegetables and salads first. Use a smaller plate. And those vegetables and salad will fill you up with fiber. Turkey is good - white meat is better than dark meat - white meat has less calories. For instance, if some people like to associate size of food to how many calories - a serving of turkey should be the size of a box of playing cards - light meat is much better.

People like mashed potatoes, but they shovel them on the plate. A serving of mashed potatoes is half of the size of a baseball....

Gravy is terrible - fat free turkey broth might be better. Nobody would ever know the difference.

Casseroles are terrible - they have tons of sodium which causes water retention and bloating, not healthy at all. If you need something with sugar in it, use a substitute. Decrease oil and butter. Use fat free yogurt for dishes that traditionally use creams. Alcohol has an enormous amount of calories!

Pumpkin pie is healthier than Apple Pie. And traditionally using whipped cream is way healthier than ice cream! So these are just a few tips for Thanksgiving. Mindful eating and portion control are key.

Did you know 2500 calories are eaten on an average thanksgiving meal? That's more than most people have in a day! Don't overeat. You gotta eat breakfast or a snack before you go!

Do you enjoy your job? Is there any other profession you'd like to try?

No, I enjoy my job. I knew when I was 6 years old that this was what I was going to do. And I never regretted it.

I have a colon cancer question. My grandfather passed away from colon cancer in his late 70s. My father has had gastric issues for roughly the last 12 years. It was characterized by bloating, diarrhea and/or constipation (it could switch back and forth every other week) and pain in his upper left quadrant. Recently, he has finally managed to control his symptoms by reintroducing fish into his diet and decreasing the amount of cruciferous vegetables. He does not eat any other meat, but consumes a decent amount of dairy which he finds does not upset his stomach.

Basically, I am wondering how increased his risk for colon cancer is because of his 12 years of GI issues combined with a family history? He has a colonoscopy done every 2 years and they've found benign polyps, but nothing malignant yet.

Thank you so much for any help/answers you can give me to clarify this. Or any other diet modifications.

His symptoms have nothing to do with colon cancer risk.

He's getting scoped too often. He probably needs a colonoscopy ever 5-7 years. The dad needs a colonoscopy every 5-7 years. Eating fish and vegetables is terrific, if dairy doesn't bother him, that's fine too. Diet will not increase or decrease the risk of colon cancer, it's all genetic.

Do you perform colonoscopies without sedation at patient's request ? When you have your own scope performed, do you opt for sedation/analgesia ? I ask because I generally prefer to avoid Versed, and was considering going without Propofol when I'm due for my next scan.

Yes, I have my colonoscopies without sedation, and I offer them without sedation. I did one on another doctor today without sedation.

Good to know that doctors aren't always opposed to it. Do you find the procedure to be painful, or just uncomfortable ?

Well, if you're sedated you don't feel anything - most people don't do it like I do. I get it without sedation and it's a little bit uncomfortable.

I have a lot of food allergies, and was given antibiotics dozens of times as a kid. I am very interested in the developments in gut bacteria's influence on mood, allergies, digestion, etc.... Why has there been so little research done to the point gut bacteria is called 'biological dark matter'? How optimistic are you that a lot of keys to health lie there?

Well, I think it's VERY important - as a matter of fact, there's a whole cottage industry now around probiotics. I'm a FIRM believer in probiotics - I prescribe them a lot to my patents, it's gotta be live strain. And I think they could absolutely affect someone's well-being and mood, etc.

However, having said that, you should absolutely make sure there is nothing else going on. You should go visit a doctor.

Why does tea help with digestion? What specifically does it do to the stomach?

Nobody really knows why tea helps with the stomach? Tea settles the stomach and decreases stomach distention, which helps reduce gas, blasting and belching. It basically decreases distention. Is it hot tea? Warm temperatures can sooth the stomach too. You remember when you were a kid and your mom would say "Have a warm cup of tea!" That's why!

How much influence do you believe diet plays in Crohns? I recently went back on my keto diet and my symptoms have significantly improved. Is it all in my head or can I not tolerate carbs?

Well, that's real difficult to know. I will tell you 20-30% of the time, it could be placebo. It could be in your head, it could be real, there's no right answer here. I would say that if you feel that it helps you to avoid carbs, then so be it.

My father died of (organ failure brought on by) pancreatic cancer. Is pancreatic cancer something I have an increased risk of developing, compared to the general population of the U.S.?

The answer is yes. There's no good screening for pancreatic cancer, but there are different scans that can be done. You should discuss with your doctor and see what kind of plan you can develop to keep an eye on that.

Good afternoon Dr. Strom. I've been having a bad case of GERD were it has made me wheeze during my episodes. I'm currently on Dexilant and yet it still comes back. This might be a dumb question, but do I really need to stop eating everything on the list that GERD diets say to avoid?

This person is asking a very poignant and common question. The answer is: Maybe.

First of all, Dexilant is a good drug.

A few questions:

• What time of day are you taking Dexilant?
• How long have you been taking it?
• Have you ever been 'scoped?

Those are important questions. And wheezing could absolutely happen from GERD, there's no question. It sounds like your GERD is not controlled well-enough.

In the mornings. Been taking it for 2 months. I was taking omeprozole for quiet a while. They even doubled my dosaged. I was really hoping that it didn't come down to me having to give up all these foods. For those who have seen that list on the GERD diet know what I'm talking about. You practically have to give up everything awesome. To answer your last question I have not yet been scoped but they did make me drink that thick liquid and watched it. I can't recall the name of the procedure.

Right, ok, so the medicine should be taken 1/2 hour before food. MUST be taken without food. If a single dose doesn't help in the morning, I would take a second dose of Dexilant 30 minutes before dinner. You have to eat after you take it.

If two doses don't do it, you need to be evaluated by a doctor.

I drink and consume a lot of Ginger (tea and root, cooked and raw) to make my stomach feel better. Do you recommend this or is this something you wouldn't consider telling patients?

Ginger is great for digestive issues.

Dr. Strom,

My father has carried an ostomy bag since the mid-1970s, and I have inherited and was diagnosed in 2007 with Ulcerative Colitis, which caused what he calls his "blow out" (when his large intestine ruptured and he almost died from septicemia, prior to the removal of his colon, and addition of the bag.).

Aside from stress, has medical science discovered any other trigger for colitis flare ups? What can I do to prevent flare ups, if I live in a stressful situation, and for chrissakes, why do I crave spicy food so much, if it's going to kill me?

You should see a doctor and make sure you're diagnosed properly. You can't extrapolate that. I would see a doctor and double-check that diagnoses.

I was diagnosed with UC 3 years ago and have only had 1 gastroenterologist since then. He seems.. alright, but it's hard to know if he's really good or bad. Our visits are mostly just quick chats about whether the drugs are working and if I need another flex sig or full colonoscopy.

Do you have any tips on assessing whether I should stick with my current guy or find someone else?

If you like the guy, you stay. If you don't feel comfortable, trust your intuition. I can't render an opinion on that.