“Good” bacteria?

Deep inside our intestines, there’s a complex microbial ecosystem, known as the “gut flora” which we now know contains nearly a thousand species of bacteria which may affect our overall health in unimaginable ways!

It has long been recognized that our gastrointestinal system relies heavily on these gut flora or “good bacteria”.  They exert a pronounced effect on the nutrients and energy that get pulled out of food. In fact, these bacteria are thought to play a big role in a slew of health conditions, including combating obesity, diabetes, infections, lactose intolerance, irritable bowel syndrome, high cholesterol, and even colon cancer. There are many theories as to how these bacteria confer their positive benefits such as an anti-inflammatory effect for the body, increased immunity and therefore healing power after an infection, and even the power to fight off potential cancer cells in a microenvironment by competing for the same nutrients.

Probiotics:

At first glance, this concept may seem counter-intuitive and perhaps even downright strange. After all, from a very young age, we are trained to think of bacteria as creepy, crawly invisible things which can and will make us sick. Nevertheless, after the discovery of  the phenomenon of “good bacteria” in the gastrointestinal system in the beginning of the 20th century, scientists began to explore the idea of harvesting these bacteria, manufacturing them as pharmaceuticals and actually introducing them into our body’s system in the form of pills, capsules, and powders entitled “probiotics” with very promising results. Today, the World Health Organization defines probiotics as “Live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”.

Future Research

Our gut microbes have recently drawn the interest of heavy hitters like the National Institutes of Health, which launched the Human Microbiome Project in 2008. The bacterial cells in or on the average person outnumber human cells 10 to 1! This presents us with a huge target base for medical intervention which may yield infinite positive results if used correctly. The question now becomes if it’s possible to change your gut ecosystem to improve your health through probiotics, and what interaction exists between genetics, the gut flora and diet which may be manipulated to enhance overall health.

So What’s In It For Me?

Of course, now we know that many probiotic foods are actually produced by the action of lactic acid bacteria, yeasts or a combination of both. These invisible microorganisms break down sugars and carbohydrates in the foods and make them more digestible and more nutritious for us.

Is there sufficient data to recommend the addition of probiotics to one’s normal regimen (as is done with vitamins for example)? Although there is little downside except for the cost issue, at this point there is not enough data to insist on the routine use of probiotics for otherwise healthy individuals. People who suffer from chronic gastrointestinal diseases, have undergone recent surgery, or are in need of chronic antibiotics use, may certainly benefit from a probiotic regimen and should discuss the matter with their physicians.

The specific type of probiotics used has not been shown to make a major difference. It’s also interesting to note that some elements of our normal diet such as many yogurts, pickled vegetables, sauerkraut and soy sauce contain a significant amount of probiotics which may be sufficient in most cases.

Since the lactobacillus bacteria found in each probiotic food are not the same, plus the fact that every bacterium plays a different role in the body, it’s a good idea to include a variety of naturally fermented foods in our diet.

Dr. Rabin Rahmani is the newest addition to the Brooklyn Gastroenterology and Endoscopy Associates and the Greater New York Endoscopy Surgical Center. You can learn more about Dr. Rahmani here:http://nygicare.com/physicians/rabin-rahmani

Dr. Rabin Rahmani studies on Clostridium difficile (C. difficile) were featured at the American College of Gastroenterology (ACG) press conference this October. Dr. Rabin Rahmani is the newest addition to the Brooklyn Gastroenterology and Endoscopy Associates and the Greater New York Endoscopy Surgical Center. Dr. Rahmani currently serves as Director of medical education and research for department of Gastroenterology at Maimonides Medical Center. Dr. Rahmani has conducted and published extensively on this topic for past few years. Also it is important to mention his studies showed taking probiotics before starting antibiotics reduced the risk of developing antibiotic-associated diarrhea by about 60 percent.

These are some of the materials that were covered at the event:

Aspirin users had a 40% lower risk of Clostridium difficile diarrhea in a retrospective study of almost 30,000 hospitalized patients. The risk declined even further among patients who reported using a 325 mg aspirin as opposed to the 81 mg dose commonly used for cardioprotection.

"Our thought is that perhaps, in addition to the pH change that occurs as a result of aspirin, there is also a decrease in the inflammatory cascade that is present in the gut, which is known to be very important for C. diff infection," told by Dr. Rabin Rahmani.

"We know that toxin A, one of the toxins of C. diff, induces expression of COX-2 [cyclooxygenase 2], so the thought is that perhaps by inhibiting or modulating that, very simply by giving aspirin, you decrease the chances of patients at high risk getting C. diff.

The incidence and severity of C. difficile diarrhea have increased substantially and continue to increase throughout the U.S. Although the pathophysiology of the infection remains unclear, increased inflammation and decreased acidity in the colon may play a role.

Studies have suggested that induction of proinflammatory COX-2 and secretion of anti-inflammatory prostaglandin E2 in colonocytes modulate inflammation and fluid secretion in the bowel, said Rahmani.

"As our study demonstrates, aspirin, by virtue of its anti-inflammatory and acid-modulating effects may provide protection against C. difficile diarrhea," Rahmani and his co-investigators concluded in a poster presentation.

What’s Clostridium Difficile (C. Difficile)?

Antibiotic-associated diarrhea refers to diarrhea that develops in a person who is taking or recently took antibiotics. Clostridium difficile (C. difficile). A bactrail infection is one of the most common causes of antibiotic-associated diarrhea.

C. difficile infections are most common in people who are hospitalized, affecting more than 60 hospitalized patients per 100,000 (0.06 percent) in the United States. In fact, many physicians consider C. difficile to be the new epidemic of the 21st century!

C. difiicile is one of the many hundreds of thousands of bacteria that are normally found in the intestines of healthy people. The most common cause of C. difficile is antibiotics which were taken for other infections, which kill the “good bacteria” thereby allowing the C. difficile bacteria to multiply with release of toxins which damage the walls of the intestines leading to diarrhea, and potentially more severe symptoms.

Although most common in the hospital setting, community acquired C. difficile is becoming more and more common. C. difficile spores can be found on the surface of objects especially if they have been touched with people who have recently been hospitalized or healthcare professional such as nurses or doctors. Although recent antibiotics use is the most important risk factor, other people such as the elderly, those with diabetes, and other severe diseases are at increased risk for this infection. Multiple studies have shown that careful hand washing with water and soap is the most effective method for preventing this infection.

Sources: American College of Gastroenterology
Rahmani R, et al "Aspirin prevents the development of C. difficile associated diarrhea in hospitalized patients" ACG 2010; Abstract 401.
www.medpagetoday.com
vitals.msnbc.msn.com

Dr. Rabin Rahmani is the newest addition to the Brooklyn Gastroenterology and Endoscopy Associates and the Greater New York Endoscopy Surgical Center. You can learn more about Dr. Rahmani here: http://nygicare.com/physicians/rabin-rahmani

Constipation is an extremely common problem. Each year millions of Americans visit their doctor for help. A number of factors can influence this:

1- Constipation occurs more frequently as you get older.
2- Constipation may be a side effect of one of your medications.
3- A sedentary lifestyle can contribute. Remember: “If the body doesn’t move, the bowel doesn’t move!”.
4- Dehydration can cause or worsen constipation.
5- And, of course, your diet plays a very important role in the health of your colon.

How should you manage your constipation?

1- Remember that the bowels are most active following meals, but if you ignore your body’s signals to have a bowel movement, the signals become weaker and weaker over time. By paying close attention to these signals, you may have an easier time moving your bowels.

2- Increasing fiber in your diet. The recommended amount of dietary fiber is 20 to 35 grams of fiber per day. You may need to supplement this with commercial fiber preparations, but do it gradually to avoid bloating.

3- Osmolar laxatives. My patients have had the best experience with what we call osmolar laxatives, like Polyethylene glycol (MiraLax®, Glycolax®), Lactulose and Sorbitol. A great advantage of polyethylene glycol is that it does not cause gas or bloating. It is actually the same medication that we use to clean the colon before a colonoscopy…but in a smaller dose. Dissolve it in a big glass of water and take it regularly at night to have daily, formed and easy-to-pass bowel movements.

4- Stimulant laxatives include senna (eg, Black Draught, Ex-lax®, Fletcher’s® Castoria®, Senokot®) and bisacodyl (eg, Correctol®, Doxidan®, Dulcolax®. Some people overuse stimulant laxatives. Taking stimulant laxatives regularly or in large amounts can cause side effects, including low potassium levels. Thus, you should take these drugs carefully if you must use them regularly.

5- Lubiprostone (Amitiza®) is a new prescription medication that treats severe constipation. It is expensive compared to other agents. However, it may be recommended if you do not respond to other treatments.

When should you ask your doctor about it?

• When it is new (i.e., represents a change in your normal pattern)
• When it lasts longer than three weeks
• When it is very severe
• When it is associated blood on the toilet paper
• When it is associated with weight loss
• When it is associated with fever

The doctor will evaluate you; decide if you need to have blood tests, X-rays and possibly a colonoscopy or a sigmoidoscopy. Sometimes other tests are necessary to figure out why your colon is not working right, since some patients have a colon that moves very slowly, and some patients involuntarily squeeze (rather than relax) their muscles while having a bowel movement. Those uncommon conditions require specific treatment.

Hemorrhoids are inflamed and irritated skin containing blood vessels in the anus. They are a very common problem associated with constipation. One in three Americans will seek a physician in their life time for the treatment of hemorrhoids. About 10 million Americans suffer from them right now! While most people do not feel their hemorrhoids, and they are asymptomatic, many people will present with symptoms at one point of their lives.

In majority of cases, excessive straining, constipation, diarrhea, lifting heavy objects and being overweight can lead to or can exacerbate hemorrhoids. Hemorrhoids are very common in pregnant patients as well. There are two types of hemorrhoids, internal and external. Internal hemorrhoid typically present with painless bleeding in the toilet bowl or on tissue paper. At times a bulge can be felt by the patients protruding though anus, that is at times is extremely painful. External hemorrhoids typically present with pain, itching and at times severe rectal discomfort.

Hemorrhoids are easily diagnosed by examination of rectal area and are easily treated. Treatment includes medications to control pain and bleeding. In addition as majority of hemorrhoids caused by constipation, high fiber diet and adequate water intake is stressed. Non-surgical treatment modalities are highly effective, long lasting and should be tried first, as the success rate is over 90%. These include laser treatment and tying hemorrhoids with rubber bands. Both procedures take less than 3 minutes to perform and do not require any anesthesia.

Although hemorrhoids are very common, it’s usually not serious. However, many other conditions such as colitis, colon polyps, colon cancer, and anal fissure, can present in similar fashion such as rectal bleeding and discomfort and can be mistaken as hemorrhoids. This can lead to delay in diagnosis and treatment with potential for complications. A visit to an experienced specialist can typically result in a correct diagnosis and successful treatment of hemorrhoids.

Dr. Badalov successfully treats hemorrhoids with multidisciplinary approach that includes dietary, medical and nonsurgical modalities. Please feel free to contact Dr. Badalov at (718) 368-2960 or email him if you have a question about your gastrointestinal health.

Our Brooklyn office provides a multidisciplinary approach to the treatments of gastrointestinal disease. Our board-certified gastroenterologists, who have worked together for many years, provide ranging from all gastroenterology procedures to the treatment of hepatitis and Crohn’s Disease.

Author

Nison Badalov MD, recently joined the practice after developing skills in Advanced Endoscopy, ERCP and Endoscopic Ultrasound. With a background in Liver Transplantation from Mount Sinai Medical Center, this well rounded gastroenterologist offers the ability to provide both excellence in common clinical conditions such as colorectal cancer screening and peptic ulcer disease, and more complex diseases of the gastrointestinal tract, including pancreatic-biliary disease.

Does excess gas cause you embarrassment and discomfort?

You may feel that you pass a lot of gas, or just suffer from bloating and crampy abdominal pain. You may feel this pain in areas where gas can become trapped, such as in bends in the colon, which occur naturally in the area under the liver (upper to mid-right part of the abdomen), and in the area under the spleen (upper to mid left part of the abdomen).

WHERE DOES ALL THIS GAS COME FROM?

There are two main sources of intestinal gas: gas that is ingested (mostly swallowed air) and gas that is produced by bacteria in the colon.

Air swallowing

It is normal to swallow a small amount of air when eating and drinking and when swallowing saliva. Some of that air comes out through belching and some moves on to the small intestine. Belching is more common with certain foods that relax the sphincter around the lower end of the esophagus where it joins the stomach, like peppermint, chocolate, and fats.

Bacterial Production

The colon normally provides a home for billions of harmless bacteria, some of which support the health of the bowel. Did you know that there are more bacteria than human cells in your body? Certain carbohydrates that are incompletely digested by our body’s enzymes are “eaten” by those bacteria instead. The by-products of this process include lots of different gases.

A condition called bacterial overgrowth can increase the number of bacteria and cause excess gas production.

But most people who complain of excessive gas do not produce more gas than the average person. Instead, they are more aware of normal amounts of gas. People with IBS (irritable bowel syndrome) and FD (functional dyspepsia) are especially sensitive, for example.

WHAT CAN CAUSE INCREASED GAS?

1- Swallowed air, called aerophagia, typically an unconscious process. Treatment focuses on decreasing air swallowing by eating slowly without gulping and avoiding carbonated beverages, chewing gum, and smoking.

2- Foods that cause gas such as beans, cabbage, Brussels sprouts, asparagus, broccoli, potatoes, corn and some whole grains, such as wheat.

3- Lactose intolerance — Lactose intolerance occurs when your body has difficulty digesting lactose, the sugar found in most milk-based products.

4- Intolerance to other food sugars, like fructose (found in fruit and many processed foods) and sorbitol (a sugar substitute contained in some sugar-free candies and chewing gum).

5- Diseases associated with increased gas, like Celiac disease.

WHAT’S THE BEST TREATMENT FOR GAS AND BLOATING? 

Diet Recommendations

A great start is keeping a diary of the foods that are most bothersome, so you can avoid them. These may include milk and dairy products, certain fruits or vegetables, whole grains, artificial sweeteners, and carbonated beverages.

If you are lactose intolerant, do not consume products that contain lactose. Most yogurt and hard cheeses are ok, but stay away from milk, fresh cheeses and ice cream. You can always have those dairy products you love if you use a lactose-digestive aid, such as lactase supplements (eg, Lactaid® tablets or liquid), or you can try lactose-free products.

Over-the-Counter Medications

Try an over-the-counter product that contains simethicone, such as some antacids (eg, Maalox® Anti-Gas, Mylanta® Gas, Gas-X®, Phazyme®).

You can also try an over-the-counter product that contains activated charcoal (eg, CharcoCaps®, CharcoAid®). If you have gas mostly after eating vegetables like beans, try Beano®.

However if your condition is not improving, you need to consult a doctor immediately. Gas and bloating can also be symptoms of more serious condition. Such as Colon cancer or intestinal disorders like irritable bowel syndrome (IBS).

Our Brooklyn office provides a multidisciplinary approach to the treatments of gastrointestinal disease. Our board-certified gastroenterologists, who have worked together for many years, provide ranging from all gastroenterology procedures to the treatment of hepatitis and Crohn’s Disease. 

Please feel free to contact us at (718) 368-2960 if you have a question about your gastrointestinal health.

Author: Dr. Caterina Oneto, she serves as Co-Director of the Women’s Health Center, Brooklyn Gastroenterology and Endoscopy Associates. Fluent in Spanish, wth expertise in endoscopy, colonoscopy, liver and pancreatic disease, Dr. Oneto recently joined the practice after completing her Fellowship in Gastroenterology at Montefiore Medical Center, Albert Einstein College of Medicine.

The way medicine is often practiced is to diagnose the ailment and then treat the ailment. It is rather impersonal and doesn’t take in the full impact and ailment has on a human being. Brooklyn Gastroenterology and Endoscopy is different. They look at the whole patient, not just what’s currently physically wrong with them.

To start, our staff speaks English, Russian, Ukrainian, Polish, Persian, Hebrew, and Spanish, so they are able to address a wide range of patients in their native tongue. This is an often overlooked aspect of medicine. It can help a patient feel more comfortable and develop a level of trust and care that can truly help treatment.

The practice also has a dietician, psychotherapist, and pathologist on staff. This allows the doctors to treat, not just the ailment, but the complications someone goes through when dealing with such an ailment (and its treatment) and some of the underlying issues that contribute to the ailment in the first place.

Getting sick can be debilitating mentally and emotionally, it can mean having to develop a whole new lifestyle, it can mean changing habits (such as diet) that you’ve spent a lifetime developing. The additional staff allows the practice to address all aspects of a patient’s life. Disease is not just the destruction of the body. It affects everything that makes us human. It should be treated as such and there’s at least one place that understands that.

Brooklyn Gastroenterology and Endoscopy tries to make its patients feel as at home as possible. They provide care in more than just the strictly medical sense. Patients will know that their physician views them as more than just a chart.

All aspects of health affect one another. Patients who are happier and more hopeful heal faster and when a patient’s mental and emotional state gets dragged down, it can have a harmful effect on the physical healing process. Brooklyn Gastroenterology and Endoscopy treats, heals and prepares patients for a future post-ailment.

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As awareness about gluten has spread across the nation, we have received an influx of questions about Celiac Disease. The fact is less than 1% of the US population is known to suffer from Celiac, while it’s estimated that 10% or more suffer from a gluten sensitivity sometimes known as Non-Celiac Gluten Intolerance or NCGI.

So what are the differences between Celiac and NCGI?

• Symptom Length: Celiac Disease is a disease of the small intestines due to a sensitivity to foods containing gluten. It affects the small intestine and keeps it from absorbing important nutrients. Symptoms vary, but may include diarrhea, fatigue, nausea and constipation. NCGI is a food intolerance (specifically intolerance to gluten) that causes similar symptoms, such as gassiness, abdominal pain, and diarrhea, but the symptoms will pass and are not believed to cause permanent damage.
• Risk Factors: Because Celiac Disease keeps the body from absorbing important vitamins and minerals, it sometimes leads to more severe symptoms, such as cramps, mouth ulcers and nosebleeds. Celiac patients may also be more prone to serious conditions including cancer, iron deficiency anemia, infertility or osteoporosis. It would be highly unlikely to see any of these more serious risk factors in those suffering Non-Celiac Gluten Intolerance.
• Heredity: Celiac is believed to be inherited, which means if a family member has it, you should probably be tested also. NCGI is not known to be a hereditary condition.
• Testing: Blood tests are available to diagnose Celiac Disease, whereas the only way to test for NCGI is to remove gluten from the diet and monitor the effects.
• Treatment: For both conditions, the only effective treatment is to eliminate gluten entirely from the diet. People who have Celiac Disease are sometimes additionally prescribed a regimen of vitamins and other supplements to compensate for the nutritional deficiencies inherent to the disease. While Celiac patients should be strictly gluten-free, some people with NCGI may be less sensitive to gluten then others, and should feel free to eat whatever amounts of gluten they are able without suffering symptoms.

For further reading:

• http://www.csaceliacs.org/#
• http://americanceliac.org/celiac-disease/
• http://www.cnn.com/2011/HEALTH/04/12/gluten.free.diet.improve/?hpt=Sbin
• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001280/
• http://en.wikipedia.org/wiki/Coeliac_disease#Signs_and_symptoms

Eating processed food can cost you more than you think, in terms of money and your own health. There’s a special beauty in cooking your meals, and the benefits from it can led you to a healthier and happier existence. If you don’t take good care of yourself, nobody else will. Companies that offer you processed food are running businesses. And, to do so, they aren’t interested in your health; they only care about how to make these products more sugary, salty and saturated with savory fat.

Eating less processed food has definitely become a popular trend for the past few years. Michael Pollan, author of Omnivore’s Dilemma, In Defense of Food, and Food Rules, has a lot to do with this, especially because of his most important food rule: “If it came from a plant, eat it. If it was made in a plant, don’t.”

Processed food, (defined by the US Food and Drig Administration as any food other than a raw agricultural commodity that has been subject to processing, such as canning, cooking, freezing, dehydration or milling), is more recurrent nowadays, and the key to enjoy of a healthy lifestyle is to detect and avoid the ones you could do without.

1) To begin, pick the processed food that is your favorite, the one you think you definitely can’t live without, and put it on a list. Try to not go over 5 foods.

2) Then, subtract from your diet the biggest “no no’s”, such as frosted cereal, cookies, hotdogs, potato chips, pickles and frozen dinners.

3) Find healthy food your palate will enjoy. Remember that healthy can also be tasty.

4) Finally, create a balanced diet of non-processed food mixed with (if totally necessary) processed food you can’t live without.
And keep this in mind: choose foods with less than five ingredients in their ingredient list.

At first this change might come as challenge, but after a while you won’t miss these big amounts of processed food at all. With time you’ll be surprised at how tasty whole foods can be. Eating healthy, Whole foods such as fruit, vegetables and nuts (among many other options), are authentically flavorful, have vibrant colors, and rich textures. Moreover, they are full of the micronutrient vitamins, minerals, antioxidants, phytochemicals, and fiber.

If you forget about fast food restaurants and start cooking at home, you will skip sodium, hydrogenated fat, added sugars (regardless of the type), dyes, and preservatives; ingredients you most certainly can live without and that your body will appreciate loosing. Build the base to a nice and long life. Start with what you eat. And as always, be in good health.

50% of the world population suffers from Gastritis. As an inflammation, irritation, or erosion of the mucous coat of the stomach wall develops, Gastritis can lead to the disruption of digestion, decrease of working capacity, and a marked feeling of fatigue. It is as common as the cold or flu, and one of the most widely-spread diseases of the gastrointestinal tract.

There are numerous causes and factors that can trigger a case of gastritis, but worldwide, the most common is infection with Helicobacter pylori bacteria: a microaerophilic bacteria that can deteriorate various areas of the stomach, particularly the antrum. Alcohol consumption, aspirin, cigarette smoke and emotional or physical distress are among the causes of this disease.

What are the main symptoms?

The symptoms vary among individuals, and in many people there are no symptoms. However, the most common ones include:

-Nausea

-Abdominal bloating

-Vomiting

-Indigestion

-Burning in the stomach

-Hiccups

-Loss of appetite

-Vomiting blood

-Black, tarry stools

In order to diagnose a case of gastritis, doctors use to recommend blood tests, upper endoscopy or fecal occult blood tests. But no worries, most cases of gastritis improve quickly once treatment has begun. This treatment includes taking antacids, vitamins and/or antibiotics, and avoiding hot and spicy meals.

You should also know that proper eating habits are vital to easing any digestive problems. If you want to avoid having Gastritis, start now by following these simple rules:

-Eat only fruit during the mornings.

-Don’t combine major proteins, such as chicken, fish, steak, during lunch or dinner time.

-Eat several small meals per day (i.e. six small ones per day instead of three large ones)

-Write a diary of foods and beverages that trigger gastritis symptoms, and avoid them.

Enjoy the perks of having a healthy and happy life.

The best way to diagnose symptoms caused by abnormal liver function is to have a liver biopsy.

Hepatitis, gastritis, cirrhosis and pancreatitis are only a few diseases that can be triggered as a consequence of abnormal liver function and the best way to beat them is to anticipate them.

Prevention is the key of modern medicine. By having a liver biopsy you not only can beat a disease to the punch, but also you can enjoy of some peace of mind by knowing that your liver is completely healthy and is functioning properly.

Usually, a liver biopsy is performed to estimate a degree of liver damage in order to decide a type of treatment. But don’t worry. A biopsy and a surgical procedure are nothing alike. On the contrary, liver biopsies are quick and painless methods, designed to remove samples of liver tissue to diagnose them.

As a matter of fact, Pamela Anderson had this procedure done. The beauty from Baywatch is perhaps the best-known hepatitis C patient that knows exactly what the value of liver biopsy is: priceless.