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DR. ROACH: Alternate approach to screening for colon cancer

DEAR DR. ROACH: Would you be kind enough to give me your opinion on colonoscopy? I last had one done three years ago, and there were no problems. I am approaching 87 years, and am enjoying good health. I have heard pros and cons of colonoscopy at my age. --A.L.

ANSWER: Colonoscopy is probably the most effective screening tool for colon cancer. There is no doubt that screening for colon cancer between the ages of 50 and 70 saves lives, although colonoscopy has both costs and risks. As we get older, risks increase. Since it takes, on average, seven to 10 years for a polyp to become a cancer, when a person's life expectancy is less than 10 years, it doesn't make sense to do a colonoscopy. The average life expectancy for an 87-year-old is five or six years, but you don't sound like the average 87-year-old.

An alternate approach might be the use of stool cards, which look for evidence of microscopic bleeding. Only if they are positive would you get a colonoscopy. That would avoid much of the risk of colonoscopy, which can include perforation of the colon by the scope. Stopping screening also is a reasonable option, since yours have shown no problems.

DEAR DR. ROACH: I am 67 years old, and have had abdominal bloating for a while. I made a gastroenterologist appointment, and was recommended a low-FODMAP diet! The food list the gastroenterologist gave me is quite incomplete -- and restaurant combination foods are a real problem. Is there a better, more complete food list out there? Is this something new? Thanks for any comments for those of us who suffer with extreme bloating! -- Anon.

ANSWER: The low-FODMAP diet is designed to be a treatment for irritable bowel syndrome, for symptoms of nausea, bloating and bowel changes. "FODMAP" stands for "fermentable oligo-, di- and monosaccharides and polyols." The theory is that these foods are poorly absorbed, tend to have laxative effects and are fermented by bacteria, causing gas and distention. It's a very compelling theory and makes sense with what I have seen in clinical practice, as well as the many letter writers who have asked me to warn others of the dangers of polyols, such as mannitol, sorbitol, xylitol and others.

Recent studies on this diet shows that up to two-thirds of people are helped by reducing the overall content of foods high in FODMAPs. Examples of these foods, and suggestions for alternatives, can be found at od/ibsfood/a/The-FODMAP-Diet.htm. However, the author states -- and I quite agree -- that a licensed nutritionist can be essential in making sure the dietary changes are right for you. I am a little surprised your gastroenterologist did not suggest this.

DR. ROACH WRITES: Back in May, I wrote about A.M., who had hand tremors. A reader wrote to tell me that her tremors improved dramatically after stopping the prescription medication bupropion. A.M. discussed this with her doctor, tried going off her bupropion, and her tremor is much improved. I wanted to take the opportunity to thank the readers who write in with their suggestions. Sometimes I haven't heard of them, and sometimes they work.