Friday, August 5, 2011

Stay regular with “Colon Blow”

By Richard P. Holm MD

Several years ago a comedy TV show on Saturday night parodied high fiber breakfast cereal calling their fake brand “Colon Blow.” At our house, that’s what we call our fiber breakfast cereal mix topped off with ground flax seed and dried or fresh fruit.

There is good reason I promote high fiber, but the story is a bit complicated. Many of my patients, especially the elderly, struggle with constipation problems. Very often these people have been taking one stimulant laxative or another such as senna or casanthralol, and have been doing so for many years.

Specialists have known for a long time that stimulating the bowels with an irritant only works for a short while, and then a higher dose is required, and then a higher dose… and so on. What’s worse, following the use of bowel stimulants, commonly there is diarrhea and then rebound constipation when these drugs are stopped. Thus, many people have had a roller-coaster bowel problem for a very long time as a result of using stimulant laxatives.

But in a controlled environment like a nursing home, I’ve noted that when you stop the stimulant laxatives, and use instead fiber with as-needed osmotic non-stimulating laxatives, the problem goes away in about two weeks.

Here’s the formula:

1. Start with enough fiber. I generally recommend food fiber, not the packaged type, such as bran-type breakfast cereal or oatmeal. Another good source is ground golden flax seed, which has an additional fish oil-type benefit. Start slow, and increase gradually;

2. If needed add plain stool softener, one to three capsules once or even twice a day if necessary. Adjust dose to daily balance bowels. Avoid softeners when in combination with a stimulant laxative. I repeat: don’t use stimulant laxatives;

3. If still no success by the above, add one of the following: milk of magnesia, polyethylene glycol (Miralax,) or sorbitol “but only when needed.” All three work by drawing fluid into the bowel rather than by irritating it.

Fiber is the most important part of the formula, and new science shows significantly reduced over-all death rates in those who eat enough fiber. So as the TV comedy skit goes: “I stay regular with colon blow. You can too.”

Early to bed?

By Richard P. Holm M.D.

I must admit I am not one for getting enough sleep. Like many others, I have an internal drive and clock, which I presume comes from the combination of disparate genetic threads of many and varied ancient ancestor. Somewhere from back in the recesses of my heredity appears the desire to stay up late, revel, and dance around a campfire. Yet within this same combination of chromosomes appears also a separate and compelling force to get up early and get work done.

The result of the coming together of just such ancestral drives is a guy who cuts short his daily requirement of sleep. I’m always pushing it, and short naps are my only saving grace.

Having watched the scientific literature about sleep through the years, until now I have noted that the data has been relatively inconclusive about the value of getting more sleep. Of course grandmothers have always scolded those who wanted to stay up late, and Ben Franklin joined in with, “Early to bed and early to rise makes you healthy wealthy and wise.” But where is the proof that people would benefit from getting more sleep?

A recent small study seems to clarify that question. It followed 11 male basketball players and monitored their sleep, finding the actual sleep obtained in this group was between six to nine hours. The researchers then required players to get at least 10 hours of sleep per night, including naps, for about seven weeks.

Measurement of player abilities before and after the sleep intervention found that with increased sleep the players ran faster sprints by five percent, free throw percentages increased by nine percent, three-point field goal percentages increased by 9.2 percent, and the players reported feeling and doing better during games.

Of course there is also scientific data to say that individual needs vary, and as a person ages sleep needs lessen. We also know that too much sleep can result from depression, and we don’t exactly know what the ideal hours of sleep would be for what age and what individual.

That said, perhaps it is time to heed what Grandmothers have told us for years, we would do better if we got more sleep.