Two issues can be highlighted when reading Our digestive health (Editorial Planeta), the new book by the head of the Gastroenterology Service of the Favaloro Foundation and former president of the Argentine Society of Gastroenterology, Fabio Nachman; and the doctor in Public Health and specialist in Medical Clinic and Gastroenterology, José María Sanguinetti: the importance of taking care of digestive health, but also, of not obsessing.
With the premise of providing information in a clear way, and taking into account the particularity of the customs and conditions of each patient (so much so that the last chapter proposes that it is the reader who completes it with his experience and defines his own roadmap); Doctors published a popular book summarizing the most prevalent gastrointestinal disorders, as well as the main guidelines of care.
On Digestive Health Day, both professionals spoke with Clarín.
—In the book, they propose to demolish myths and fashions about digestive health. What are they?
—Nachman (N): What we are seeing most is linked to food exclusions, diets that are considered miraculous, and we try to focus on issues that have evidence.
We highlight what can be useful for the person, focusing especially on not normalizing symptoms. In that sense, we must know that when there are symptoms a control is required, you have to go to the doctor, who will evaluate the need to do some study.
There is a very interesting chapter in the book, in which we talk about alternative medicine or the alternative to medicine. There we mention that there are alternative medicines that have pharmacological action, and there is a lack of studies regarding this type of medicine. Just because something is natural doesn't mean it's healthy.
Not normalizing symptoms is one of the central guidelines that doctors warn about. Photo courtesy of Planeta.
—Sanguinetti (S): There are classic examples to think about it, for example natural laxatives such as cascara sagrada, which has been used for decades and has important side effects, such as anemia.
The natural is not always healthy and the alternative is not always alternative, it can be part of a medical treatment, such as acupuncture, which scientifically demonstrated benefits in different digestive diseases. In the same way, there are myths, fashions related to consumption and also natural issues that can be harmful.
The myth is transmitted from generation to generation, instead fashion is something that arises at the moment, which has a boom and then a fall.
A classic myth regarding digestive diseases says that people with diverticula of the colon should avoid foods with seeds, mainly fruits and vegetables that contain them. They reduce also reduce fiber intake, when in fact it is not.
—What are the main disorders and diseases that affect gastrointestinal health?
—S: The most frequent pathologies linked to the digestive have to do with what is included in a group of diseases that are called functional digestive disorders: they can occur in the esophagus, in the stomach and in the intestine, and they are chronic diseases where what Fabio said happens, that the patient ends up naturalizing the symptom.
An example is "I, when I eat, swell and it's my way of being." These are expressions that can sometimes simulate or mask another more serious disease, and therefore often require the intervention of a professional who orders studies.
It should also be noted that they are diseases that interfere with the quality of life and that generate a lot of work absenteeism, and that is very common, between 13 and 20% of the population of Argentina at some point in life experiences symptoms related to these problems.
—What are the most determining habits for gastrointestinal health?
—S: In that line the generalities of the law apply, so to speak. We all know and have a certain degree of awareness of the importance of healthy habits: food is one; physical activity has an impact on health in general and in particular on what are digestive disorders; rest are beneficial; Not so the consumption of alcohol, smoking, or other toxic substances. Everything that has to do with healthy living impacts digestive health.
And then there are certain groups, such as celiac diseases: there is the habit of consuming gluten and foods that contain it, which are many, where you work on that habit in a specific way.
What is not recommended is to initiate restrictions only for the experience of feeling good, but to deepen and find if there is a cause, and one often does not end up restricting, but adapting, perhaps limiting, but not absolutely suppressing a food group.
Colon cancer is not only curable if caught early, it is also preventable. Photo courtesy of Planeta.
—In the book you point out that 60% of people over 80 have diverticula, what is the reason for this prevalence?
—S: Diverticula, as we know them, are a Western disease, in the East it is shown that there are fewer.
The consumption of many foods with low water content, low fiber content, increases the pressure in the colon, and some factors of the colon cause these diverticula to arise. Already at 40, 45 years, between 10 and 13% of people can have diverticula, and over the decades that percentage increases.
This does not mean that it is a natural or normal process, it is not typical of aging, but a high percentage has it due to these factors. Whenever we talk about disease, there is a combination between genetics and environment, and in most diseases there is hidden inflammation, so to speak, that participates in the disease process.
—What are the symptoms that tend to naturalize, but that should really act as a "red flag"?
—N: The most important thing is the appearance of a symptom when you never had it before, such as abdominal distension, pain, alternation of the evacuatory rhythm, constipation, diarrhea, some bleeding. Any of these kinds of things, they are red flags. The important thing is not to naturalize symptoms, think that it is "such a thing" and self-medicate, but to go to a consultation, to rule out pathologies.
As we pointed out, gastroenterologists usually divide pathologies into two large groups: organic and functional, with respect to the latter, there is more time to try to manage it and see how one can solve it. With organic, sometimes time is allowed to pass, and it ends up getting more complicated.
—S: Argentina in general is a country that is very accustomed to consulting specialists. The important thing is to know when to consult, to know if these are new symptoms, or chronic symptoms that worsen, or recurrent ones that one does not want to naturalize.
Then, there are times in life where you should consult, for example, after 50 for the prevention of colon cancer, or if I have someone in my environment with colon cancer as a relative, make the consultation before.
—Colon cancer is the third most common cancer in Argentina. What are the most important prevention guidelines and what advances do they highlight?
—N: Much of the book is dedicated to that, which is primary prevention, recommendations for appropriate dietary patterns, physical activity, not naturalizing symptoms, and on the other hand the recommendation that from between 40 and 50 years, according to whether there is a history or not, they should do some kind of control, with specialist or generalist.
There were advances, much progress is being made regarding what immunological treatments are as an alternative for therapy, but what is known is for example that the treatment of colon cancer early has a cure rate that is above 90% even without any alternative treatment other than surgery. So prevention is very important, not letting yourself be.
In Argentina, only a third of people who have the indication to have a colon cancer screening study (such as fecal occult blood test and / or colonoscopy) comply with the checkup.
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