Should We All Get Colonoscopies Starting at Age 50?

Should We All Get Colonoscopies Starting at Age 50?
4.55 (91.07%) 56 votes

Why do doctors in the United States continue to recommend colonoscopies when most other countries recommend less invasive colon cancer screening methods?

Discuss
Republish

Though colonoscopies can cause serious harm in about 1 in every 350 cases, sigmoidoscopies, which are shorter and smaller scopes, have ten times fewer complications. But, do colonoscopies work better? We don’t know, since we don’t have any randomized controlled colonoscopy trials, and we won’t until the mid 2020’s. So, what should we do?

The USPSTF, the official prevention guidelines body, considers colonoscopies just one of three acceptable colon cancer screening strategies. Starting at age 50, we should either: get our stool tested for hidden blood every year, no scoping at all; or a sigmoidoscopy every five years, along with stool testing every three; or a colonoscopy every 10 years. And, in terms of virtual colonoscopies or the new DNA stool testing, there is insufficient evidence to recommend either of those two.

Though they recommend ending routine screening at age 75, that’s assuming you’ve been testing negative for 25 years since your 50th birthday. If you’re 75 and have never been screened, then it’s probably a good idea to be screened at least into one’s 80s.

If there are three acceptable screening strategies, how should one decide? They recommend that patients work with their physician in selecting one after considering the risks and benefits of each option. For patients to participate in the decision-making process, though, they have to be given the information. The degree to which health providers communicate the necessary information was not known, until this study was published. They audiotaped clinic visits looking for the nine elements of informed decision-making. Discussing the patient’s role in making the decision, what kind of decision has to be made, what are the alternatives, what are the pros and cons of each option, the uncertainties, making sure the patient understands their options, and then finally asking them what they would prefer. That’s the role of a good doctor. It’s your body; it’s your informed decision.

How many of these nine crucial elements of informed decision making were communicated to patients when it came to colon cancer screening? Care to hazard a guess? In most of the patients, none. The average number nine addressed? One out of nine. As an editorial in the Journal of the American Medical Association put it, “There are too many probabilities and uncertainties for patients to consider and too little time for clinicians to discuss them with patients.” So, doctors just make up the patients’ minds for them, and what do they choose? Most often, as in this survey of a thousand physicians, doctors recommend colonoscopy. Why? Other developed countries mostly use the stool tests, the FOBT tests, with only a few recommending colonoscopies or sigmoidoscopies. That may be because most physicians in the world don’t get paid by procedure. As one gastroenterologist put it, “Colonoscopy is the goose that laid the golden egg.”

A New York Times exposé concluded that the reason doctors rake in so much money is less about top notch patient care and more about business plans maximizing revenue, plus lobbying, marketing, and turf battles. Who sets the prices for procedures? The American Medical Association, the chief lobbying group for physicians. No wonder gastroenterologists pull in nearly a half million dollars a year.

And, the American Gastroenterological Association wants to keep it that way. Referring to these exposés, the president of the Association warned that gastroenterology is under attack. Colorectal cancer screening and prevention may be reduced in volume and discounted. But, they have tips for how to succeed in the coming nightmarish world of accountability and transparency.

Why would primary care docs push colonoscopies though? Because many doctors get what are essentially financial kickbacks for procedure referrals. Studying doctor behavior before and after they started profiting from their own referrals, it’s estimated that doctors make nearly a million more referrals every year than they would have if they there were not personally profiting.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Mamin via Flickr.

Though colonoscopies can cause serious harm in about 1 in every 350 cases, sigmoidoscopies, which are shorter and smaller scopes, have ten times fewer complications. But, do colonoscopies work better? We don’t know, since we don’t have any randomized controlled colonoscopy trials, and we won’t until the mid 2020’s. So, what should we do?

The USPSTF, the official prevention guidelines body, considers colonoscopies just one of three acceptable colon cancer screening strategies. Starting at age 50, we should either: get our stool tested for hidden blood every year, no scoping at all; or a sigmoidoscopy every five years, along with stool testing every three; or a colonoscopy every 10 years. And, in terms of virtual colonoscopies or the new DNA stool testing, there is insufficient evidence to recommend either of those two.

Though they recommend ending routine screening at age 75, that’s assuming you’ve been testing negative for 25 years since your 50th birthday. If you’re 75 and have never been screened, then it’s probably a good idea to be screened at least into one’s 80s.

If there are three acceptable screening strategies, how should one decide? They recommend that patients work with their physician in selecting one after considering the risks and benefits of each option. For patients to participate in the decision-making process, though, they have to be given the information. The degree to which health providers communicate the necessary information was not known, until this study was published. They audiotaped clinic visits looking for the nine elements of informed decision-making. Discussing the patient’s role in making the decision, what kind of decision has to be made, what are the alternatives, what are the pros and cons of each option, the uncertainties, making sure the patient understands their options, and then finally asking them what they would prefer. That’s the role of a good doctor. It’s your body; it’s your informed decision.

How many of these nine crucial elements of informed decision making were communicated to patients when it came to colon cancer screening? Care to hazard a guess? In most of the patients, none. The average number nine addressed? One out of nine. As an editorial in the Journal of the American Medical Association put it, “There are too many probabilities and uncertainties for patients to consider and too little time for clinicians to discuss them with patients.” So, doctors just make up the patients’ minds for them, and what do they choose? Most often, as in this survey of a thousand physicians, doctors recommend colonoscopy. Why? Other developed countries mostly use the stool tests, the FOBT tests, with only a few recommending colonoscopies or sigmoidoscopies. That may be because most physicians in the world don’t get paid by procedure. As one gastroenterologist put it, “Colonoscopy is the goose that laid the golden egg.”

A New York Times exposé concluded that the reason doctors rake in so much money is less about top notch patient care and more about business plans maximizing revenue, plus lobbying, marketing, and turf battles. Who sets the prices for procedures? The American Medical Association, the chief lobbying group for physicians. No wonder gastroenterologists pull in nearly a half million dollars a year.

And, the American Gastroenterological Association wants to keep it that way. Referring to these exposés, the president of the Association warned that gastroenterology is under attack. Colorectal cancer screening and prevention may be reduced in volume and discounted. But, they have tips for how to succeed in the coming nightmarish world of accountability and transparency.

Why would primary care docs push colonoscopies though? Because many doctors get what are essentially financial kickbacks for procedure referrals. Studying doctor behavior before and after they started profiting from their own referrals, it’s estimated that doctors make nearly a million more referrals every year than they would have if they there were not personally profiting.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Mamin via Flickr.

Doctor's Note

Serious harm in 1 out of 350 colonoscopies? See What to Take Before a Colonoscopy for all the gory details.

Too often, truly informed consent is a joke in modern medicine. For more on this, see:

How do you know if your doctor is on the take? Check out Find Out If Your Doctor Takes Drug Company Money

2018 Update: Another common test is mammograms, and I just launched a new series about them. Check out the first one: 9 out of 10 Women Misinformed About Mammograms

If the content of this video was as enlightening (and infuriating) for you as it was for me, please consider making a tax-deductible donation to the nonprofit organization that keeps NutritionFacts.org going. There are staff and server costs to keep videos like these coming to you free-of-charge year-round. Thank you in advance!

If you haven’t yet, you can subscribe to my videos for free by clicking here.

145 responses to “Should We All Get Colonoscopies Starting at Age 50?

Comment Etiquette

On NutritionFacts.org, you'll find a vibrant community of nutrition enthusiasts, health professionals, and many knowledgeable users seeking to discover the healthiest diet to eat for themselves and their families. As always, our goal is to foster conversations that are insightful, engaging, and most of all, helpful – from the nutrition beginners to the experts in our community.

To do this we need your help, so here are some basic guidelines to get you started.

The Short List

To help maintain and foster a welcoming atmosphere in our comments, please refrain from rude comments, name-calling, and responding to posts that break the rules (see our full Community Guidelines for more details). We will remove any posts in violation of our rules when we see it, which will, unfortunately, include any nicer comments that may have been made in response.

Be respectful and help out our staff and volunteer health supporters by actively not replying to comments that are breaking the rules. Instead, please flag or report them by submitting a ticket to our help desk. NutritionFacts.org is made up of an incredible staff and many dedicated volunteers that work hard to ensure that the comments section runs smoothly and we spend a great deal of time reading comments from our community members.

Have a correction or suggestion for video or blog? Please contact us to let us know. Submitting a correction this way will result in a quicker fix than commenting on a thread with a suggestion or correction.

View the Full Community Guidelines

  1. This video illustrates why the experiences I, friends and family have had with gastroenterologists included procedures and not a word about food or nutrition.

    1. I specifically asked my gastroenterologist about diet and colon cancer. He noted the Adventists in California but also claimed that diet makes no difference unless done from childhood. I was at least appreciative of the fact that he had heard of the study.

      1. Well, as we have learned from this website and other plant-based doctors/nutritionists, changing your diet at any time can prevent and possibly reverse disease. Almost sounds like the doctor acknowledged the role of diet, but did not want you to try it. Interesting.

        1. Actually, I think you have a very interesting point. We tend to take things seriously only when there is a sufficient cascade of information that truly interferes with previous assumptions. The doc saw the Adventist study as just one point of information and I suspect he had studied nutrition little if at all. So for him it was a minor point. That leave him with the bulk of society absorbing and at least partially believing, “beef it’s whats for dinner” “milk is necessary for bone health” and “the incredible edible egg”, et al.

          I think that just my asking him reinforced the little knowledge he had,,, but only a little. Doctors generally are incredulous or dismissive when I explain that I have completely eliminated psoriatic arthritis with diet while forgoing the tried and true life threatening drugs that are sold constantly on TV. But when the information is posted more and more, it has and will have more and more effect.

          The last time I received actually derision for eating whole food and plant based was now about 3 years ago. It was interesting that the derisive individual made such a bad impression on the audience that many began asking why and how. Then when they saw my colorful plate of veggies, lack of obesity, and compared it with their size 40+ belts and plates of dead meat, many seemed envious. Were they to even see something like that 3 times a week, then I think we would have a monumental snowballing phenomenon.

            1. Hi Christina, happy to share. First, any auto immune disease might well have a whole host of different provoking factors. It could well come from specific things like a gluten sensitivity, nightshade reaction or who knows what.
              When I developed the arthritis my rheumatologist immediately wanted to put me on methotrexate but that seemed like a bad idea.
              So I looked at all factors that I could read about and decided to go gluten free since I have a sister with celiac. It seemed to work. Still I would have flair ups that could be painful and I continued to have associated swelling. Gluten free was a pain but a small price to avoid most of the pain and the methotrexate.

              I kept reading and read about all the pro inflammatory factors associated with meat dairy and eggs and decided to eliminate those. It worked! The residual swelling is now gone and I no longer have any flair ups at all. This took about 3 months before all swelling was gone. My plaque psoriasis has also improved though not been eliminated.

              I am convinced that gluten is healthy if there is no specific problem with it so after a while I started trying bread again. Sure enough, no problem. I love a good multi grain bread so this is a great relief.

              I also know that a vegan diet seems to give complete remission in something like 50% of those with rheumatoid arthritis and some relief to something like 95%. The specific factors might not be known but there are plenty of likely factors so it seems best to me to eliminate all. e.g. arachadonic acid, heterocyclic amines, and advanced glycation end products et al. MacDougall could well be right about the molecular mimicry also. Or it could be the synergistic effects of all these and others working together. Reducing CAD risk, cancer risk, generally improving my disease resistance and more easily controlling my weight and my T1 diabetes seem to be the only side effects.

              While I don’t yet know enough to have definitive answers, I do know enough to have eliminated my chronic pain from arthritis and improve my health in general.

              Hope you find this informative. The sun is barely up now and sometimes I am not at my most lucid state until the sun is higher in the sky.

              1. Stewart, I really liked your “case study.” I, too, have psoriasis, though luckily mostly hidden by hair, though some on elbows and knees. In reading you comment, I realized: I haven’t had an outbreak on my elbows and knees in a while now, and the hidden ones seem less extensive and less severe. I’ve been a vegetarian for 45+ years, and over the last few years transitioned to wfpb eating. I never made any connection between diet and symptoms before your comments. And I’m glad that you can eat wheat; I bake sourdough whole grain bread at home (I grind my own grains!) and it’s delicious!! (In fact, when I broke my wrist by slipping on ice hidden under new fallen snow 3 winters ago, and after buying commercial bread, my husband began baking our bread! With me hovering over him every step of the way. He did a great job! I think his loaves looked even better than mine — but he graciously conceded the bread baking back to me.)

            2. In his last paragraph and by being on this site. Whole Foods plant based diet. Plateful of veggies. If you’re new here, subscribe to the newsletters and learn a new nugget almost daily.

      2. I would argue that it’s “too late” to see any benefits from diet. It is Never Too Late To Start Eating Healthier!

        Dr. Greger says “It’s remarkable to me that after most of a lifetime eating the standard western diet, one can turn it around, reverse chronic disease risk with a healthier diet, even late in the game.”

        1. We’re in our fifties. I’m 56 and my husband is 54, and since May, when we stopped eating any animal product or by-product, we’ve both reversed our scary health conditions. I had high cholesterol, and I had early marker for rheumatoid arthritis. Dan had hypertension, and was per-diabetic. I re-tested in late August, and Dan in mid September. We were both reversed, and showed normal readings in our respective health issues. It’s early, and soon, and we know we’ve only just begun to heal and reverse damage done. I still have a lot of pain in my joints, and I would like to drop my cholesterol to the lowest end of what is considered normal, because as Dr. Greger has pointed out in other reports, A lot of people with normal ranges of cholesterol drop dead of a heart attack every year.

          Dan has gone from wearing a tight 38 to a loose 36, and I suspect he will eventually whittle down into a 34, because he’s active, and uses his strength and body for chores around the property often. He eats trail mix (healthy trail mix with nuts, seeds, and dried fruits–not Chex or other processed junk food), as a snack food, when he gets hungry between meals. He also eats oranges, bananas, apples, and peanut or almond butter and jam (low in sugar, but void of artificial sweeteners, on whole grain bread.

          For meals, we eat legumes with a grain, and sweet potatoes, and veggies. I make smoothies almost daily, and use almond milk and add fresh ground flax seeds, and cacao nibs to frozen blue berries, and frozen strawberries, and either curly kale, or spinach. Sometimes, when I remember, I’ll add Hemp seeds, as they are a good source of protein and are high in ALA Omega.

          My point is, we eat mostly high nutrient dense foods, with a few exceptions–the jams, and Dan loves to eat our combo meals all mixed up and wrapped in a large flour tortilla. Not the healthiest choice, but I can’t complain. It’s makes the food all the more appetizing and the results we’ve experienced are amazing. We are so grateful we discovered the way to optimal health, starting from where we each were when we started this journey to change our destiny for the better. Thank you!!!!

          1. Everything you are eating is a “good” source of protein if not particularly plentiful, so don’t worry too much about that. Our society today is way to focused on protein.

          2. My husband and I have done the same since last April. My only health issue was my hormones were out of whack after birthing 4 babies in 7 years and breastfeeding them for 10 years. So after trying Paleo and other diets with fats, I decided to try the vegan diet with “no oil” like Dr Esselstyn says. :) My husband joined me after 4 weeks of a calmer wife. :) We have both lost almost 100 pounds together in 6 months. We are running 5k for the first time in our lives. My husband no longer has pre-diabetic blood sugar levels, high blood pressure, fatty liver or any problems with ED. He is 54 and I am 44 years old. We feel better now than 15 years ago when we first met. I would say that changing your lifestyle nutrition will make a difference at any time of your life!!! My cycles are regular, My PMS only lasts one day and I no longer have heavy flow or horrible cycles. I can exercise normally on my second day with no swelling or weight gain at all. My Mom who was a vegetarian, adopted our strict vegan diet and in 8 weeks lost 10 pounds and her high cholesterol plummeted. She now weighs the same as on her wedding day (45 years ago). She’s 62 years old and just ran her first half marathon last month. My Dad who was diabetic and taking medications for the last 3 years without being able to keep his blood sugar level under control, is now off all medications and in great health. He’s 71 years old. My Grandmother is 86 years old. She lost 10 pounds and finally quit all her medications too. So as you see, changing your nutrition will do wonders for anyone at any age!!! :)

            1. Di, thank you for sharing your amazing story. I see the results in my husband, most definitely. I got off of HRT in October after being on it for more than 10 years, and I am stabilizing. Emotionally I’ve been steady, but physically I had some problems. Now my main issue, which grows worse, is my arthritis. Will this reverse? Will I get better? I’m staying the course.

              1. have you tried tart cherry supplements for arthritis ? I read somewhere that is good for that. I used it for a while last year to help me fall asleep and some of the comments I read were that it also helped with stiffness in the morning. At the time, I was doing a wheat free diet and I noticed I was less stiff in the morning. You might want to try going on an anti-inflammatory diet without wheat, corn and any sugar. Other than that, I think you just got to stay the course. The cleaner you eat the better you will feel. I notice now, that when I eat a piece of raisin bread from the store I get an instant headache. I don’t know if it’s the sugar or the additives and preservatives in it, but I can’t have it and be ok. I am learning to give my body time to heal and get better. I have spent so many years eating cr*p, instant healing is just not possible. Now consistent wellness, yes, for sure!!! Staying the course is definitely the way to go! :) Good job!

                1. Tereza, thank you, I too believe instant healing is not possible for me and that staying the course is the way to go. Good luck, too.

            2. Wow, I though I had a compelling story. You seem to have a compelling book. Interesting to me that it started with a random trial on your part. The point I keep harping on is that the more those examples are highlighted, the more compelling they become. At a certain point it will become necessary for those on an unhealthy diet to try to justify themselves. But at this point they still seem to want to have a healthy diet justified.

              1. You are so right about people trying to justify an unhealthy diet. What I know is that PAIN is the best tool to cause change. Let me share with you another reason I decided to try the vegan diet: my husband had to have lithotripsy just a few months before due to kidney stones. I decided to investigate and find out what was causing those kidney stones. That’s when I read that animal protein causes kidney stones and damage to the organs. So I talked to him but did not convince him of going vegan right away. This is a man who ate steak and eggs for breakfast almost everyday. But then, after 4 weeks of me being on the diet and him seeing how easily I shed 10 pounds and how I turned into a pussy cat. :D He decided to try it too. So the small stones he still had in the kidneys disappeared with the diet. The fatty liver gone. He used to take naps every day when he got home from work. No more! Now, instead, he goes running with me! Yes! What changed his mind ? The pain in his back, from his kidney. Although he had the lithotripsy and busted a huge stone (12mm), it took months to pass it. And he was still in pain. The idea that with this diet, there would no longer be any pain was very tempting! And voila!! He is pain free. Now he eats meat in one meal per week and is healthy and happy this way.

                1. What does your husband eat now? Can you give me a couple things for a typical day. I eat as much WFPB food as I can, but my diet is limited because I don’t have a really good way to manage it and I don’t cook very complicated stuff? How did you manage that transition, if I might ask?

                  1. Hi Brux, thanks for asking. I am originally from Brazil and the staple of a Brazilian diet is rice and beans. So at my house, I cook rice and beans almost everyday. We add salads, fruit, guacamole, fruit salsas, cooked veggies, sweet potatoes, sauteed mushrooms etc as side dishes. I have 4 children and I homeschool, so I HAVE to keep it simple. I soak my beans for 24 hours and I cook them in my crock pot overnight. So I have beans cooking almost every night. We eat some and I freeze the excess, so I always have food ready when I don’t have time to cook. I have a rice cooker that I call my sous chef. She’s in charge of getting us yummy rice on the table. :D I grew up eating brown rice but my husband and kids don’t like it. So I rotate between brown and white jasmine rice. In order to get them eating more brown rice I am now mixing it with the white. I still find resistance. :) But I persevere. Once a week, we have sandwiches on whole wheat bread. I also cook pasta with a veggie ragu or vegan cheesy sauce. I make veggie lasagna; shepherd’s pie, lentil stew, soups etc. I also make veggy stir fry with peanut sauce over rice. Recently I tried my hand at making vegan meat with vital gluten. I made sausage and meat balls. It was a success! We eat stir fried cabbage with peanut sauce over rice once a week. I also bake potatoes, and we stuff them with bean chlli, sauteed mushrooms, caramelized onions, guacamole, hummus etc. For my husband, like I mentioned he is American and has come a long way from eating an overloaded animal protein diet. I just got him to quit eating store bought creamy Caesar salad dressing and using my homemade cashew dressing instead. But he still eats 2 eggs every morning over rice with veggies (mushroom, broccoli, onions, carrots – I make a big batch and keep it in the fridge. He re-heats it with the rice in the morning and lays his fried eggs on top). On the weekend, he eats my homemade vegan whole wheat pancakes and oatmeal. But he does not like oatmeal. For lunch, I pack him a lunch (after 14 years of marriage, he finally is taking lunch from home to work). It’s usually rice, beans, salad, greens, sweet potatoes. For snacks, I pack him nuts, bananas and granola bars. For supper, we eat as I described above. He still drinks coffee in the morning – about 2 cups with sugar and probably 3 tablespoon of milk in each cup. He’s not 100% vegan but he’s much better than before. We are still transitioning. I’M LUCKY BECAUSE HE LOVES RICE AND BEANS!!!! :D I used to be a vegetarian in my 20s so it’s easier for me. I have always fed the kids healthy : lots of fruits, veggies, beans, potatoes… they never drank a soda in their lives, don’t eat candy or gum, were breastfed, didn’t drink cow’s milk … so it’s not hard. The hardest for us all was to quit cheese. We ate a lot of cheese. NO more.

                    I would say find out what you like and it’s easy to prepare and stock in the fridge and then add to that. I always have cooked sweet potatoes in the fridge. I cook sweet potatoes and white potatoes in my crockpot. Takes about 2-3 hours with just 1-2 cups of water on the bottom of it. I load it full of potatoes, add the water (just a little on the bottom) and turn on high. Usually 2-3 hours later, a knife will slide easily into a potato. They are ready. I then serve it for lunch to the kids with ketchup, or my vegan mayo, or hummus, or a bean salsa. They eat until they are full. I know they are satisfied and fully nourished.

                    I do smoothies too. I cook greens a lot. Greens and beans go hand in hand. To get the kids to eat them, I make potato casserole and make my vegan cheesy sauce and add the greens chopped in it. They eat it all up! There’s never any left! Frozen veggies are also easy. I always have frozen broccoli, Brussels sprouts, cauliflower in the freezer. When I am rushed or out of ideas, it’s rice and beans and a side of veggies. Or rice and a side of veggies with peanut sauce or vegan cheesy sauce. Snacks at our house are always fruits in general, banana, dates, other dried fruits, granola bars etc. I test and create a lot of recipes with the kids so that they can learn and “own” this lifestyle.
                    Once a week, I cook a meal with meat in it. So I ask to find out what the majority wants and I prepare it. I used to cook 10 boneless chicken thighs for a meal and have nothing left. Now I cook 5 cut up into pieces mixed with veggies, served with rice and salad and they are happy and full. :D So again, transitioning. Learning to go with less if not completely without it.
                    I hope that helps… I would say keep going. Do the best you can. It’s about improving. Always! :)

                    1. Oh, the truth comes out … sound like you were well primed to eat WFPB from youth. ;-)

                      Seriously that is really great. i wish I had been Most of my life it was meat, sandwiches, iceberg lettuce for salads, though I always used to eat my parsely garnish, that is not a significant thing.

                      Most of my veggies I get prepared from various places. I usually think negative about frozen veggies, but maybe that should be part of my answer.

                      I do not like the fake meats, although I do like Morningstar Grillers Prime Veggie Burgers better than real burgers these days. That surprises me.

                      I try to eat meat about like you say, once a week or even less. Good suggestions, thanks.

                      Someone should write a cook book that starts with really easy things, like instant oatmeal for breakfast, and rice and steamed veggies for dinner, and works up in complexity bit by bit over time to real cookings. Beans, hummus, chili, stuff like that to real productions. That would be really useful.

                    2. tereza: What great tips. How kind of you to write all that out. It’s great because it shows that a busy family can eat healthy without spending hours or mega money doing it. Thanks.

                    3. Hi Tereza, I thought I replied to this, with suggestions for someone to write a progressive cookbook that has recipes that one can start with that are easy and works its way up, but it seems to be gone … but thank you for the ideas. It does seem like it takes a long time for someone like me to learn the skill of cooking, and it does take a long time to make stuff like this. That’s just the way it is and probably why so many eat junk food, and too much too. I envy you your background in cooking, but you also included some quick ideas to use frozen veggies. Some folks here are so disparaging about anything that is not fresh picked off the vine, organic that it makes frozen sound like more trouble than it is worth, but lots of people can be wrong and I’ve heard frozen veggies are just about as good as fresh. and often in better shape.

                    4. There is something odd about the reply links that I am getting then, because when I click on them, your last comment to Tereza, Thea, is gone or not showing up for me, and my previous comment that I thought was gone is still gone???

                    5. Brux: That’s weird. I’m sorry, but I don’t know why that is happening. From my own experience, I find that when the comments exceed a certain number, you have to keep pressing the “Load More Comments” button at the bottom of the page again and again until the button disappears. And then I see all of the comments. But I don’t know if that is an issue in your case.

                      The comments area is a 3rd party product called (as I’m sure you know) “disqus”, and I think that means that we don’t have a lot of control over how things work. So, we have these issues from time to time when posters think that their comments are being deleted, but I think that disqus display issues are really the problem.

                    6. Hi Brux, you did reply previously . :) as for frozen vegetables., I wasn’t a big fan of them either because I was used to eating them fresh in Brazil all the time. Only in the last 15 years t people are beginning to peruse more convenient foods. And it’s starting to show: the obesity levels are skyrocketing! ! But it’s better to eat frozen than none. Better to have conventional produce instead of organic than none. I can’t find or afford organic a lot of times. As for cooking skills, I think it has a lot to do with upbringing. My mom cooked. Her mom cooked. Homemade food n family get together were always a big thing in my family. From a young age we enjoyed good homemade food n liked cooking it too. That’s one of the reasons I’m teaching my kids. Unfortunately here in the States people rather buy everything store made. :/ don’t give up. Just do the best u can. There are a lot of great YouTube channels teaching easy recipes. I like to go w Indian, Asian or Latin cuisine a lot. Most of their dishes is just a bunch of veggies stirred together w some spices for a fantastic dinner. Some of the ones I like to watch are SIM’ s kitchenette, Mary’s test kitchen, party in my plants, Bhavna’ s kitchen… they are great source for ideas. Hope that helps. :)

                    7. Tereza, A different compromise, better than simple white, is organic white Basmati rice. I’ve seen info that it has lower lead levels as well, but verify for yourself.

              1. hi, Suzanne! Thanks! No, we are not on Facebook. I have a busy life taking care of my kids, I can’t afford to be on Facebook, if you know what I mean. ;) You can check out my blog http://creatingtreasures.blogspot.com where I post updates on what I am doing at home and with the kids. And my YouTube channel; there’s a link on the blog. I’m seriously thinking of maybe posting videos of recipes and how-to. I’ve had so many people asking me to do it. To tell you the truth, I’m afraid of the commitment. :) But I’m considering it because even my husband thinks I should do it. If I do, you will be able to find out through my blog. You can subscribe there or follow me. Thanks again! :)

          3. It really Doesn’t matter what you eat or how much you eat. You can be at your optimal weight and colesteral count and if God needs you you’re gone. I’m living proof of this, I’ve always been slim and in good health. I used to run competitive foot races and ran 20 miles a day in training runs. But on Oct 28,2007 l was almost killed in a motorcycle accident involving 3 f_ _ _ing deer and l should have died. But the Only reason l can think of for why lm still alive and a functioning human being is God didn’t need me then. I suffered a traumatic brain injury and lost everything. My home, my painting contractors business of 18 years, and my marriage after being in the hospital for 2-3months and she helped nurse me back to being able to care for myself 6 months after I got out of hospital she couldn’t handle my not being able to work anymore a nd the thought of us losing our home. She left me, we still talk Every day and see each other frequently. We are Best Friends and take care of each other. We will be together again when God chooses to bring her back into my home. I’m Not a deeply religious man but l have Always believed in God. Now l Know he is the Real Deal because there is NO other way that l am still here. My point to my short story is you can eat and do whatever you think is the best for your health and it can’t stop the reality that if God needs you he Will come n get you.

            1. William, I’m sorry for all the suffering you’ve endured. I know we can be taken out at any moment, so it’s a good idea to live like every moment may be your last; spare yourself regrets and spare others regrets for not having shared loving words and connections. Mend fences, and nurture love where there is now broken hearts.

              That said, just in case we are to be here for many years to come, be mindful of how you life, and what you eat so that you many thrive while you are alive.

          4. GadflyR, I had psoriatic arthritis and reversed it with a wfpbd. When I did this, it took a good 3 months for all the symptoms to disappear. Having said that, there might still be some other dietary factors that are implicated in the arthritis. I believe you indicated that things have improved, just not enough. I totally understand that.

            I had a gluten sensitivity that induced my arthritis but it took a whole host of other factors working with it to produce that particular reaction on my part. I eliminated the animal products and the arthritis is completely gone even while returning to eating bread.

            With your continuing symptoms I would certainly be looking to any other factors. Even citrus can sometimes be a factor, so there are lots of possibilities and what affects me might be totally innocent in your case. So, good luck but remember, even the improvement without a complete cure is worthwhile and the side effects for a wfpbd are great.

            1. Stewart, yes, I’ve since discovered Dr McDougall, and Dr Klaper, both who treat patients with inflammatory arthritis with wfpbd. For many like you, simply getting of the meat and dairy did the trick. For others, it’s as you said, one or several sensitivities, and a very compromised immune system that needs to be restored.

              Thanks for sharing your story. It is encouraging.

          1. I see how it reads funny, but no I think it makes sense if you read who I am replying to. At any rate, click the video I linked to see why there is plenty of time to change one’s diet and it is never too late for change :-) Thanks!

    2. I am a family doc and I recommend what the CDC says about a colon cancer screening algorithm, which parallels your presentation. I show it to the patients and they are very accepting of this information. Many patients are harassed by the gastroenterologists to have follow up colonoscopies.
      Love your site

  2. after the colonoscopy normally the gut flora it is Detroit (as i understand) i wonder if the standard pharmaceutical probiotics contain the whole variate of organism that are normally in the gut?

    1. Nora: I’m no expert; based on what I’ve read a healthy person’s gut is home to thousands of different strains of probiotic bacteria, and there’re no supplements containing 100 strains, let alone thousands. The best way to get probiotics is to eat unpasteurized fermented foods. Some probiotic products is heat resistant, as long as it’s not very hot, and acid resistant. I buy mine online but never order during summer. I buy in the winter and stock up for the rest of the year.

      1. Hi Doc, just wanted to throw this out there. I have a friend who is a well respected immunologist in California. He is in his mid 60’s and he eats an “ok” diet according to him.,enjoys the occasional burger and fries. But what he does take daily for 25 years is around 2 tablespoons of Apple Cider Vinegar one dose in am and one in pm. He recently went in for his current colonoscopy and came out with flying colors (no pun) but what the Dr did tell him he has the most remarkable colon she has ever seen…that of a teenager… not a single polyp or even signs of one. She asked him what he eats, takes (vitamin wise) and alcoholic intake…he told her a few drinks here and there not a lot of pills….but ACV daily. She said “stop right there!!” that’s why your colon is so healthy and clean…Have you had any experience with this? Obiously he and his Gastro know something we dont!!! correct?? what gives?

        1. I have not heard about ACV for colorectal health, but there may be other reasons to use it. Plus, some find it flavorful and delicious. Dr. Greger mentions a bit of research on ACV.

      2. What about NON-malignant colorrectal polyps found at age 50 in that first colonoscopy? Should you continue to have colonoscopies? How often, 5 years, 10 years? Till age 75?

        1. Yes, I have the same question. I had a colonoscopy five years ago, and became a strict vegan about a year later. The procedure revealed one benign polyp. I wondering if I should continue to have the procedure and at what interval?

          1. Same here – 1 adenomatous (not cancerous but can become so) polyp at 60, 1 at 65, and now I’m suppose to have another colonscopy. (This time the doc is recommending a virtual MRI colonoscopy.) I’ve been a vegeatarian since about 40 years and a vegan for about 2 years. Confusing.

            Technical note from Mayo Clinic website: About two-thirds of all polyps are adenomatous. Only a small percentage of them actually become cancerous. But nearly all malignant polyps are adenomatous.

              1. In general terms, an adenoma is a benign tumor of glandlike structure. In the context of colon cancer, the best thing to do is to check out the explanation of colon polyps at e.g.

                https://www4.mdanderson.org/pe/index.cfm?pageName=opendoc&docid=3235

                Here’s the part dealing with adenomatous (= adenamous) colon polyps:

                “Adenomatous Polyps (Precancerous): These polyps are not cancer. They may become
                cancer if they are not removed. They are confined to the inner lining of the colon. There are
                two kinds of adenomatous polyps.
                • Tubular adenomas are the most common type of polyps. Patients with tubular adenomas
                need to be screened more often for colorectal cancer.
                • Villous adenomas are the most serious polyp. They have the highest risk of becoming
                cancer as they grow larger. Patients with these polyps need to be screened more often for
                colorectal cancer”

      3. I have a strong family history of colon cancer (although poor diet may have had a hand in this). Had my first large polyp removed in my 20s found due to gastro and bleeding symptoms. Have had colonoscopies every three years since. Went WFPB in late 2010. Last colonoscopy showed only one 2 mm sessile hyperplastic polyp in the ascending colon. Does this still warrant colonoscopy – now suggested every five years for me? Family doctor is NOT a good source of nutrition-based health decisions even though all my blood work has dropped to “normal” levels since changing my diet.

  3. What timing .. I just received my notice to have my 1st FOBT test done. I’ll be 60 next month .. lol .. Even the literature that came with it says to start at age 50.

  4. This is a very emotional topic for me. I fought with my GP about this last year and finally gave in and had the procedure. One “thing” was analyzed and found to be not of concern. I’ve been vegan for 5 years and suspect my risk is low. Then, a friend, my age (59) who ate like crap, died of colon cancer this past summer. He was in the UK and never had a colonoscopy. He may never have had a sigmoidoscopy or fecal blood test for all I know but I have to say, it made me think I’m just going to get tested every 10 years. Period. I will re-evaluate this when the emotion of his death passes, but I sure do wish he’d had a colonoscopy (or sigmoidoscopy) 5 years ago. Odds are decent, he’d be alive today.

  5. Thanks Dr Greger! It is really interesting to learn that the increase in referrals are directly related to the their personal profits from those referrals. As a 50 year old, I think that I’ll opt for the stool sample.

  6. About 7 years ago I went to a GI doctor regarding various bowel issues I was having and told him that eating foods rich with fatty dairy products (butter, cream) made me feel horrible. He told me that it was impossible for such foods to make me feel sick since the body hoards fat. After a colonoscopy and a couple of years of routine visits I went plant-based and never looked back. I feel significantly better now and my GI issues have mostly disappeared.

  7. To paraphrase Captain Renault in Casablanca: “I’m shocked, SHOCKED, to find that doctors have a vested interest!!” Thanks again to Dr. Greger for providing the data to be informed consumers. Blessings upon him.

  8. This video is an excellent example illustrating why our health care (I prefer to call it disease care because Docs ultimately love to see a disease . . woops, patient . .. walk in the door) system is so expensive and broke. Our health care system is set up as a Fee For Service (FFS) system. This means a physician gets paid $X-dollars to perform X-procedure or X-appointment-time. A cardiologist makes his money by performing procedures on your heart. He does not get paid any money to counsel you on how eating a whole foods low fat plant-based diet can keep you healthy or reverse your disease. And he does not want to tell you either because he has a very hefty medical school bill to pay off. He’s just as stuck with the system as the rest of us. And the reason for this is because it is the pharmaceutical and medical device companies that “own” the medical schools and set the policy . . er . . curriculum. It’s a self-reinforcing system that keeps real and genuinely helpful information on true healing from getting to the public.
    My friend – 74 years – went to a whole foods plant based diet (after reading China Study) and reversed his Type II diabetes that he’d had for 6 years. He took China Study to his doctors appt, told his Doc what he was going to do and asked for his doctors help with changing meds as needed. He left the book for his Doc to read, which, to his credit, his doctor did. My friend reversed his Type II, got off all his meds (saving $500 out of pocket drug costs/month), and lost 50lbs. After reading China Study, his doctor said to my friend, “Wow. We were never taught ANY of this in medical school.”
    Regarding Informed Consent – I am just WAITING for someone to sue a Cardiologist for not providing all options i.e., diet change to a patient who needs full information/choice. There is so much information out there now on halting/reversing heart disease via diet that I consider it malpractice to not provide this information to a cardiac patient.
    But . . let us remember . .. our system is Fee For Service. A cardiologist is not going to get paid to give anyone information about how to stay healthy, . . but will make a nice living cracking open your chest or inserting a stent.
    It’s ALWAYS about the money.

    1. Looking at the situation from a system-wide viewpoint, how about if we had a
      medical system that bypassed the insurance companies (and
      Government!) altogether? Ie. the doctor would not get paid until the
      patient was healed or at least got better. The patient would make a
      contract directly with the doctor, just as with an ordinary service
      company as in other areas of expertise. As an analogy, when I need a
      tree cut down from my yard, I hire a landscaping company to come and
      remove the tree. I make a contract and the lanscaper doesn’t get
      paid until the job is done. I realize that human health is much more
      complex, but it’s the overall concept that’s important. Of course,
      the patient will have to become a well informed customer, to keep
      from being misguided into non-optimal treatments (by-pass surgery vs diet change),
      but that’s true in any field. It seems to me that until we get the massive bureaucracy
      of the insurance companies and government out of the way, and start
      dealing with doctors on an individual, one-to-one basis, things will
      never change.

      1. Unfortunately the idea that ” Ie. the doctor would not get paid until the patient was healed or at least got better.” is not realistic. Doctors are not miracle workers and need to make a living too. Anyone can have a very costly medical problem, few could pay for it. Insurance is the only method to spread risk over a population so that everyone can afford medical care. The issue is how to best implement the required insurance.

        1. > Insurance is the only method to spread risk over a population so that everyone can afford medical care. The issue is how to best implement the required insurance.

          Or Universal Single Payer, which I suppose can be looked at as insurance, but I don’t really think it is when you consider that the thing that distinguishes insurance in the US is PROFIT … maximizing profit. When you think about it, the only thing that insurance companies do is to confusing things so they can pick those who will get care and those who won’t, and they do not even have to worry about those without any money, at the time when the vast majority of people really do not have the time and resources to dispute their decisions.

          Insurance companies are the real death panels.

        2. Yes, I agree with you that a “pure” implementation of that concept would not be realistic because of the complexity of human health and the measuring of health parameters. It just seems that the “medical system” has evolved so far in the opposite direction!

  9. Screening tests for cancer or that matter any condition is not a straight forward problem. The best resource I have seen in exploring these issues is H.Gilbert Welch’s 2004 book, Should I be Tested for Cancer. Although over a decade old the issues haven’t changed and unfortunately the science on which the recommendations are made hasn’t added much to the equation. The role of the US Preventive Services Task Force is important in bringing together “experts” to formulate guidelines. The studies on the effectiveness of “expert consensus” in arriving at the best recommendation is poor at best. The recommendation should be viewed as a starting point for figuring out the best programs and not “gospel”. Unfortunately the studies that need to be done are not being done. Some of the open questions that cry out for answers are:
    At what age to start?
    Once a negative screen how frequent should the test be repeated?
    Which screening should we recommend?
    For specific findings such as the different type of polyps what is the proper followup?
    Do certain populations such as those following a healthy plant based high fiber diet need less screening?
    The truth is we don’t know the answers. Quite frankly there is a paucity of good studies to support current USPSTF recommendations. Just the fact we are given three options should raise concerns.
    So what to do and recommend?
    Practicing medicine for 40 years has provided some perspective.
    I remember when we did stool tests based on studies that showed that the testing reduced mortality/morbidity form colon cancer. Then came studies that showed flexible sigmoid screening every 10 years worked as well. Since we all lose some blood in stool everyday we run the risk of a false positive test. Repeating every year raises the likelihood of a “false positive” test which then results in a flexible sigmoid or colonoscopy. I tend to not recommend stool tests. The literature shows that flexible sigmoid scoping works. Colonoscopy is not well supported.
    I have come to be line with Dr. McDougall’s recommendations. I would recommend you read his August 2010 article, Colonoscopy: A Gold Standard to Refuse and his July 2012 comments and review of the large screening study published in the New England Journal of Medicine in 2012.
    At this point it is reasonable to have one flexible sigmoidoscopy between ages of 55 and 64. If negative no further screening unless symptoms develop. Occult blood screening and colonoscopy should be reserved for specific clinical situations. It is important for each person to become informed and work with their physicians to decide what is best for them.
    At any rate all patients especially those who voice concerns over Colon CA should be informed of the proper dietary approach to lower their risks of Colon CA. Since the science continues to change it is important to keep up by tuning into NutritionFacts.org.

    1. Good input, Dr. Don. I’m following Dr. McDougall’s well-reasoned recommendations (I did already undergo a full-throttle colonoscopy before I had this info). I love Dr. H.Gilbert Welch’s work. His books and his YouTube videos are well worth everyone’s time.

  10. If you insist on eating red and processed meat….
    Doctors here are zero on prevention and all about treating disease after you have it, not preventing it….
    As previously published in Nutrition Facts, African Americans 2nd leading cause of cancer is colorectal…after lung cancer, another largely preventable cancer.
    African Americans in Africa have 50 times less incidence of colorectal cancer, if you can measure that low…
    African Americans here eat – you know it, cheeseburgers, pepperoni pizza, fries, dairy, …. like most Americans.
    In Africa, ground whole grain corn, vegetables, fruits, …
    So we stopped eating red meat and processed meat. My wife had a colonoscopy several years ago, horrible experience, and statistically severe side effects ranging from fatal salmonella to perforated intestine, you name it.
    Inform people, some of us will make the choice, others smoke anyway….
    BTW, vegetables, fruits, whole grains, peas & beans, nuts, no portion control, just stop when I’m full. Physiolocically what our stomach and long intestines are meant to digest. We don’t have teeth like a carnivore, strongly acid stomachs to digest meat, and short intestines to get rid of the stuff before it putrefies….

    1. Ive only been on a WFPB diet for a couple of years now but at age 50 I had one small NON-malignant polyp removed for my first colonoscopy. The doctor recommended that I get another in 5 years so I did at 55 and I was clean. I just had one at age 60 and they found 2 NON-malignant polyps. My mother has had polyps over the years and decided to have one last colonoscopy at age 82 because here mother had colon cancer. Long story short one week after the procedure she was rushed to the emergency room with a punctured colon. She almost died but thanks to a good doctor and his team she recovered after months and months of care. I suspect that had I not had a colonoscopy at age 50 I could have been in trouble by age 55 or 60. Damned if you do damned if you don’t. Love the site and the videos keep up the good work.

      1. I appreciate your remarks as I am pretty much in the same boat. I’ve been a vegetarian for about 40 years and a vegan for 2, plus I exercise a lot, do not smoke or drink, etc. I’ve had 2 adenomatous polyps (1 at 60, 1 at 65) and am suppose to have another colonoscopy (a virtual MRI one) this year. People should realize that anyone can have adenamatous polyps (and most malignant cancers come from those), not just those on SAD or Paleo diets. It’s true most adenomatous polyps do not turn into malignant cancer but most that do come from adenomatous polyps. So once you’ve had polyps, depending on type, size, etc., one’s views tend to change about colonoscopies.

    2. If you want it to be healthy, it has to be from organic, free range farms. And don’t be like some lazy paleos and say if I eat that, I don’t need to eat my fruit and veg/mushies.

  11. I,a surgeon, am a long term supporter and admirer of you and your approach to disease prevention thru diet and lifestyle

    Your implication that doctors refer patients for colonoscopy primarily for kickbacks is wrong, ignorant and insulting to the 99% of all practicing physicians
    Colonoscopy and polypectomy is singularly responsible for the recent dramatic decrease in a leading killer, colon cancer
    Colon cancer has been routinely prevented by the use of colonoscopy and polypectomy over the last three decades
    Although the other screening methods are acceptable colonoscopy remains the gold standard of PREVENTION

    1. I don’t want to appear to be skeptical here, but could you provide some evidence (i.e., peer reviewed studies) that show “colonoscopy remains the gold standard of Prevention?”

    2. With all due respect, Dr. Rocchio, don’t shoot the messenger. The GAO report speaks for itself:

      “Self-referral occurs when providers refer patients to entities in which they or their family members have a financial interest. Services that can be self-referred under certain circumstances include anatomic pathology–the preparation and examination of tissue samples to diagnose disease.”

      Now, I’m no lawyer (or Goodfella), but that sounds like a kickback to me.

      I see colonoscopies not so much as medical procedures, but as emblematic of how Americans are being treated (read: brutalized) by the systems of entrenched power and unbridled greed that are metastatic cancers on our society. Americans are awakening rudely to the fact of their alimentary canals having being converted into the ‘Rio de Oro’ by Big Food and Big Pharma rowing downstream, Big Cancer rowing upstream, and the average citizen up the creek with neither a paddle, nor meaningful democratic representation. The Washington Post and New York Times investigative journalism pieces referenced in today’s video are quite explicit (and exhaustive) on these points.

  12. I certainly understand the idea that docs have a financial incentive to promote procedures that are expensive. This trend has been seen time and again – back surgeries, open heart surgeries, caesarean sections, to name a few. I don’t doubt that docs who have a financial incentive to perform colonoscopies have a tendency to recommend them. I had one three years ago, and my wife had one less than a year ago, and I can confirm that no alternative strategies or procedures were discussed, much less analyzed or recommended. The consultation with the doc really amounted to a sales meeting – I think it is a travesty that the doc actually charges for it and that insurance reimburses for it.

    But…
    I think the point made at the end of the video about primary care doctors is unclear. I had understood that providing “kickbacks” to referring doctors was unlawful. So it is not clear to me how a referring physician can profit from his patient having a colonoscopy. Many docs have become part of larger medical groups, and I suppose referring within the “family” drives revenue and profitability of the corporation, but that is different than a direct kickback. Please explain this point more fully.

    Thanks, Mike

  13. Its sad how the medical industry has been corrupted by profits, and colonoscopy isn’t the only thing doctors clean up on. There are several other procedures that are often sprung onto the patient at the last minute, and many of them are experimental and/or unnecessary. I’ve encountered more than I can comment on here, but I can guarantee that if I can avoid a doctor and subsequently take the bread out of his or her mouth, I will. If its as hidden as bowel cancer and I die, then I die. Just furnish me with the appropriate drugs and leave the room.

    1. Never wished for my foreskin back until I got serious with cycling and started riding hours upon hours. Sure we have snug shorts with padding and all…but a little more skin could be EVER so helpful on occasion. I never had kids, but I would vote against circumcision EVERY time if I did.

      1. This is exactly why I chose to leave my son intact. My condolences on your loss. I’ve heard of foreskin “restoration” or augmentation techniques, and know of one individual who has had some success with that. Though there is nothing like the original, skin expansion can help at least ease the daily discomfort.

      2. Stewart, I really liked your “case study.” I, too, have psoriasis, though luckily mostly hidden by hair, though some on elbows and knees. In reading you comment, I realized: I haven’t had an outbreak on my elbows and knees in a while now, and the hidden ones seem less extensive and less severe. I’ve been a vegetarian for 45+ years, and over the last few years transitioned to wfpb eating. I never made any connection between diet and symptoms before your comments. And I’m glad that you can eat wheat; I bake sourdough whole grain bread at home (I grind my own grains!) and it’s delicious!! (In fact, when I broke my wrist by slipping on ice hidden under new fallen snow 3 winters ago, and after buying commercial bread, my husband began baking our bread! With me hovering over him every step of the way. He did a great job! I think his loaves looked even better than mine — but he graciously conceded the bread baking back to me.)

      3. Wade Patton, I now ride a Me-Mover — upright, no seat, stair stepping carving 3 wheeled human powered exercise and mobility device. It is fun! And a great workout. You might look into it, since it’s too late to reverse what has already been done. A practice that I hope is disappearing. (There are lots of nerve endings removed, too, I understand. To me, it sounds like male genital mutilation, and I don’t know why more men aren’t speaking up against it.)

  14. I love you Dr. Greger for you have changed my life for the better, having convinced me thru your blogs and videos to become a vegan. But I have to disagree with you on this subject. I have to say that I would have given whatever profits they wanted for them to have performed a colonoscopy on me. What is never mentioned by physicians is that having a sigmoidoscopy is like having a mammogram of only one breast, and that the FOBT finds the problem AFTER the polyp has turned cancerous, assuming one has performed the test properly to begin with so that it is detected before the cancer has become too advanced. My GP refused to let me have a colonoscopy at the age of 50 because I didn’t have any “risk factors.’ I now understand that most colon cancer is found in people without “risk factors.” I am very grateful to be alive, but my ascending colon is gone, I live with fear of the cancer having spread since it was stage III when removed, I will live with chemo-induced peripheral neuropathy the rest of my life, and I now have to have so many more colonoscopies than I would have had to experience if they had just performed the one at the age of 50 to begin with. My cancer was just beyond the reach of the sigmoid scope, at the hepatic flexure….. people, go for the gold standard of a colonoscopy and nothing less… it’s your life and quality of life at stake here …. it has cost my healthcare provider so much more to care for me than the colonoscopy would have cost them…. I should have paid out of pocket to get one!

    1. Trisha, Thank you so much for being willing to share your story. I am glad you are alive and mostly well and eating a diet that will reduce your chances of getting a recurrence.

    2. Yes, thanks very much for sharing your story. I’m in the middle of deciding whether to have a repeat colonoscopy and hearing your experience is helpful to me.

  15. I was shocked to hear that doctors make a kickback for referring patients to have procedures. Can someone explain how this works?
    If this is true then I totally lose all respect for doctors.

    1. I am a practicing gastroenterologist for over 21 years. I am unaware of any kickbacks in all this time.
      A stool test has never saved anyone unless it is positive and then it triggers a colonoscopy. The most common test, the FIT stool test has a false positive rate of 25%. This test is recommended yearly. The same goes for a sigmoidoscopy, if a polyp is found during this study then a full colonoscopy is advised.
      Colon cancer is the 2nd leading cause of cancer death in the US and is highly preventable with adequate screening. The “serious harm” most commonly occurs following removal of a large polyp. Significant bleeding requiring blood transfusions, hospitalization and repeat colonoscopy to control the bleeding may be required. A perforation from a colonoscopy in the Medicare population occurs in less than 1:1000 cases.
      I generally love the videos, very informative. This video I feel missed the mark.

      1. I’m inclined to agree. Pointing to the USPSTF guideline is not wrong, but privileging one set of statistics over another without discussion of the discrepancy is not so good.

        What Greger describes as “essentially financial kickbacks” are apparently a politicized (but somewhat inaccurate) label for behavior under changed regulations about self-referral. The implication is that with colonoscopy, many physicians are not operating at arms length from the specialist screening services that they recommend. Whether it’s direct profit from business ownership, a cash kickback, or the give-and-take of family bonds in business, there will be a vested interest that can be at odds with those of the patient.

  16. Until two years ago, diagnostic and screening colonoscopy was a large part of my practice, and I cannot imagine paying PMD’s for referrals. Is there evidence that this happens? Isn’t it illegal?

    I am a general surgeon, but gave up scopes, largely because the margin has decreased so much in recent years. Medicare pays $197.00 to the doctor for a colonoscopy, and after all the office expenses, it just was not feasible to continue this service line.

    1. I am curious if you ever had perforation complications in your practice of this procedure. I am not questioning your skill or expertise only wondering whether the statistics quoted in this video would be accurate in your experience. Are they? Thanks.

      1. By the way, doctors who perform fewer colonoscopies have worse outcomes on average. One must not just evaluate the risks of a procedure but the risks associated with a particular doctor. This applies to all serious procedures. Know your doctor!

          1. It’s far simpler and safer as far as the risk of the method goes to be sure but since it only detects cancer and not precancerous polyps, there is an element of risk, I must admit that I declined to have a colonoscopy before age 60. I have now had 2 with no complications (but my GE is very competent), yet am reluctant to have another. There’s no perfect solution.

            1. That’s not strictly true, David, since precancerous adenomous polyps bleed. I definitely second your idea that emoting your way through this and presuming an ideal solution on that basis is not good. You need to think about your total risk in quantitative terms along with the total cost of testing. If you can’t do all that by yourself, it’s helpful to rely on some input a physician who knows about your risk factors and what they likely mean.

              1. Thanks for the correction (I appreciate the desire for accuracy). But I think the way you stated it is itself not strictly true, and should be worded as “precancerous polyps **can** bleed”, since most polyps of any type (cancerous or not) in fact, do not. Hence, although fecal occult blood tests can reduce colon cancer mortality, there is still an element of risk (false negatives). As you said, people should educate themselves and decide based on their particular situation.

                Thanks for prodding me to look into this further.

  17. So what’s your opinion regarding colonoscopies if one has had the procedure five years ago and it revealed a single benign polyp? Would you have the procedure performed again if it was you?

  18. I’m sitting at my desk on Thanksgiving morn going over the list of new psych admissions. One patient stuck out, and not only because her name is Baloney. She is 48 y/o and has had a total of 169 visits to the emergency department. Complaints/diagnoses have been: abdominal pain, constipation, IBS, gallstones, kidney stones, fibromyalgia, endometriosis, and now, finally, depression. Meds include: Lexapro, Dilaudid, Norco, Valium and Reglan. She weighs 112 lbs., smokes marijuana and three packs of cigs a day.One wonders how her life might have been different had she been on a whole food plant-based diet all these years.

    1. A sad story indeed. But as many people have commented, it’s never too late to change one’s diet. Just need some knowledge such as this website provides, and some firm willingness to change. Of course, easier said than done for most people :-(

      1. I have no idea what the total cost of her care has been; certainly over a million dollars, paid for by Medicaid, much of which could have been avoided by healthy lifestyle choices. The vast majority of patients I see have absolutely no interest in changing their habits in any meaningful way.

  19. Another timely topic, thank you, I’m due for my first colonoscopy this year. My doctor said my other option was to have a sigmoidoscopy plus double contrast barium enema. She didn’t mention fecal occult blood test (FOBT). Can you shed any light DCBE as a diagnostic tool? I’m wondering why it wasn’t mentioned in this video.

  20. Michael you slide by the way primary care docs supposedly benefit from referrals for colonoscopy. In order to do that you would have to have financial interest a surgicenter. What % of primary care docs actually have such an interest? It must be low. Another important point you did not cover is that colonoscopy is the best procedure for discovery of colon cancer or polyps. Why recommend a test that is not as effective, especially in the USA? For us enlightened nutritionfacts.org watchers/WFPB eaters we will have no to few diverticuli therefore bypassing a big cause of complications.

  21. Rockford IL – I have a friend with colon cancer who is going in for surgery on Feb 23. In the meantime, his Dr. tells him to eat more liver due to its high iron content. What on earth?!

  22. I have a question regarding a resource Dr. Greger used in this video. When explaining the reason primary care doctors are so quick to refer patients for colonoscopies he states that according to a GAO report, doctors receive something of a “kickback” for self-referring. How is referring to a specialist self-referring? I read the GAO article and it seemed to be about specialists ordering excessive byopcies not about general practioners receiving kickbacks. I am no expert, so I would appreciate it if anyone could further explain this connection.

  23. I will never consent to a colonoscopy. My sister died because a colonoscopy left a hole in her intestine which caused a massive infection. They did emergency surgery, but it was too late. The surgery was difficult and massively invasive, with removal of a large portion of her large intestine. and a colostomy. The pain was so awful that they kept her knocked out and unaware. I forget the name of the drug, but I do know it’s a type of anesthesia that causes you to forget what you went through. She opened her eyes one time after the surgery and they dosed her up again to keep her out of pain. She bled to death internally while they waited on her husband to call everyone in the family to ask whether he should consent to blood transfusions. She died about 36 hours after the surgery. BTW, she was a vegetarian. She believed her doctor’s advice and had an annual colonoscopy. I have never been advised of alternatives to colonoscopy.

    1. anniesnow, I am so sorry about your sister. I know of two elderly women who had colonoscopies, and both suffered perforations, and went on to ostomy bags. One elected to have hers reversed about 6 months later, I think, and did well. The other — my mother, age 80 at the time — said reversing it wasn’t necessary, because she was probably going to die soon anyway (she had several problems). Well, she lived another 13 years with her ostomy bag, and said that not reversing it was a mistake. She also agreed that having the colonoscopy in the first place was a mistake. Neither my husband nor I have had one: he’s 74, and I’m 66. Although we were both vegetarian (I have been one for over 45 years, and he became one when he started eating my cooking about 9 years ago), we have since become essentially “vegan,” eating a WFPB diet. We both prefer the “poop scoop” tests — but they are not easy to get our PCPs to agree to. Mine offers terrible ones — not the most effective, or huge hassles to use. I’m now going to ask if she gets a kick-back for each colonoscopy referral, because it seems as though the alternatives are designed to encourage patients to opt out of them.

  24. First, not all doctors are rich. Just ask any rural GP or pediatrician. I ran a lot of clinics with most patients on Medicaid where my overhead was greater than my fee. For example, because quadriplegic people can’t move well and has very little sensation, they require tremendous help dressing and undressing as well as getting out of their wheelchair on to the examining table and back. In addition due to many”silent” complications, every part of their history and examination must be done very carefully, usually taking 11/2 hours for a follow up. Secondly, despite being a vegan, I had a proximal colon villous adenoma, pre-cancerous, with guaiac negative stools only reached and removed by colonoscopy. I admit this is a difficult issue, but though most may be well served with sigmoidoscopy and/ or heme tests, some individuals with pre malignant, proximal colon tumors will be missed.

    1. Thank you for pointing this out! A couple of the links were missing so it defaulted back to this page. I just updated the page. They should take you to those news articles now!

  25. I’m in a bit of an argument with my wife about a colonoscopy. I switched to eating meat only twice a week about a month ago, and I follow the daily dozen (though exercise, flax and cruciferious vegetables are my weak points). The timing was bad because I donate blood 4 times a year and they check for anemia, so I know I haven’t been low before. Now I happened to change a month before my annual physical and my doctor finds me to be anemic. He does a prostrate exam and finds blood in my stool. I sometimes bleed near the outside of my anus and I explained that can cause a false diagnosis. I also explained about my diet changed. But he wants me to get a colonoscopy. And worse, my wife answered the phone and she’s on me about it. But my research online seems to indicate that I should instead insist on waiting 6 months (during which I’ll concentrate on my green leafy vegetables) and take a FIT test at home and then see the results before deciding to go to the extreme of a colonoscopy. It gets worse because I would insist on an all-male staff, a hospital setting, and general anestesia in order to perform a colonoscopy. And I know I would cheat and not eat the liquid diet the day before. I told my wife that if I don’t have cancer, the test would cause it, and that’s far worse. But she doesn’t understand. She recently had an aunt diagnosed with cancer and now she’s hyper sensitive and wants to do whatever the doctor says even if he’s wrong.

    Anyone have any advice?

    1. Hi Brendan,

      My name is Dr Renae Thomas and I am one of the medical moderators :) Tough question and one that you have to make the decision you feel most comfortable with. I would highly recommend you switch your diet and commit to a WFPB one. The evidence against meat, especially with regard to colon issues is overwhelming. From a medical perspective, new-onset of anaemia in a male, plus blood in the stool is usually suggestive for a colonoscopy. An alternative could be a rigid sigmoid and a FOBT, that could suggest if colonoscopy is required. Colonoscopy does not cause cancer. The risk of a colonoscopy is about 1/200 of perforation. If you don’t follow the prep liquid diet before, there is little point having the test, as the colon won’t be visible, it will be coated in your faeces. I suggest you find a doctor you trust and work with them.

      1. Thank you for your advice Dr Thomas. I did move forward with both the upper and lower endoscopy and they both came out normal (as you can tell from me writing this, I did not become one of the unlucky few who died from the proceedure). I insisted on a hospital setting for the proceedure and chose a hospital that I have used before and that also has relatively high ratings online. Now my only problem is that my doctor wants me to take iron suppliments and I need to decide if that’s the best course of action. The numbers do support anemia (12.5 hemoglobin, 74.5 MCV, 24.2 MCH, 16.4 RDW). Lots more reading online to do before I take the drastic step of adding 2 grams of iron to my diet in pill form. Incidentally, those numbers are after a redraw of blood and I spent a month eating an iron rich, 95% plant-based, diet.

  26. I remember TMAO and the Organochlorines (PCB etc) from Dr Gregors videos. IGF-1 is fairly well accepted now – what about harmane, Neu5Gc and PAHs ? What are they?

    Presumably organic meat would at least not have any added hormones? But I agree – some people swear by the Paleo diet – even some well known doctors – but I don’t buy it.

  27. No surprise here. I’ve referred to the US colonoscopy recommendations as “the gastroenterologist’s full employment act” for some time. Despite the recommendations of my own care providers, I’ve resisted the colonoscopy recommendations until now. I always figure, why go looking for trouble?

  28. I watched one of Dr. Gregor’s ‘year end’ long videos where he discussed the implications of being screened for many of our diseases. He talked about mammograms, colonoscopies, and many others. I’m having a hard time locating those videos (they used to be right on the home page) and am trying to remember which one it was that talked about screening for disease. Can someone lead me to it? My husband just got a notice from his doctor that it’s that time again and I want him to watch the video, so he can go into it informed from both sides.
    We’ve been eating plant based for just over a year now and all his blood test ‘risk’ areas have moved into a very comfortable ‘normal’ area. That’s good enough for me, but he still likes to have the tests done.
    Thanks!

  29. I recall having read that colonoscopies can only examine about 2/3 of the colon: I think it can’t examine the ascending colon. And that colonoscopies tend to miss the flat cancers, and these tend to be the more dangerous ones than the polyps that they do find. I wonder just how effective colonoscopies are at preventing colon cancer. And I wonder what their effect is on overall mortality and quality of life.

  30. The last comment about primary MD’s receiving a million in kickbacks from specialists is complete rubbish and diminishes Greger’s credibility.

    1. james zucherman md: If you click on the ‘Sources Cited’ button under the videos, you can see some of the sources Dr. Greger references. After seeing your post, I took a look at some of the references, including this one: http://www.gao.gov/products/GAO-13-445

      A quote form the above study: “Questions have been raised about self-referral’s role in Medicare Part B expenditures’ rapid growth. Self-referral occurs when providers refer patients to entities in which they or their family members have a financial interest.”

      I’m guessing that Dr. Greger’s comment stems from this study. If I’m understanding the study correctly, this study supports Dr. Greger’s statement. Am I missing something?

      1. Thea thanks. Greger implies in the video that primary Docs get kickbacks to refer patients to colonoscopy. Primary Doctors do not usually own surgicenters or pathology labs. So there is no legal route for them to get a million in kickbacks. Surgical specialists on the other hand who make a lot of money may more commonly run supportive ancillary medical businesses that they can self -refer to. Since the move out of the hospital to outpatient treatment centers is so much cheaper the government has allowed some of this activity. A more likely explanation is fear of being sued if a primary doctors’ patient comes down with colon cancer and he makes a claims that his early symptoms were ignored by the primary doctor who should have referred hm for colonoscopy. jim

  31. I’m with Kaiser in Calif. As I understand it, Kaiser does not give routine colonoscopies, but instead relies on an annual fecal globin test (at least, they have never given me a colonoscopy and I am 63). Is the colonoscopy really necessary if you are religious about the annual fecal globin test?

  32. I watched this video with great interest as I got a reminder from my Dr.’s office that I am due for a colonoscopy: the last one was five years ago. They had found one polyp, which was benign. I was a vegetarian then, eating some dairy. For the last three years I have been on an oil free WFPB diet. Now, I wonder if I should go for the colonoscopy or cancel it. I am 71. I know I have to make this decision soon and by myself.

  33. I’m 60 and have never had a colonoscopy, and I have a family history. My father died of colon cancer. I have been a vegetarian for 43 years and a vegan for over 20. I know the symptoms and I don’t have them. I have no plans to ever get one unless there is a real reason for it. If it ain’t broke, don’t fix it.

    1. I’ve never had a mammogram either. My sister is 59 and she has breast cancer. But she has been eating meat and crap all of her life and drinking alcohol. I haven’t had 3 drinks in my whole life. I am very phobic of doctors, hospitals, and medical procedures. It has been easy to follow a very strict regime by just imagining myself on an operating table, lol.

  34. Re: “nine crucial elements of informed decision making”. Bulleted list, please? I counted at most eight items in the sentence that followed.

  35. I’m a vegan Family Physician who beats this drum all day long at work. I do take exception to the comment about kickbacks however. How would I go about getting these from GI MD’S exactly? I’ve apparently missed the boat all these years…

  36. Great video. I have a colleague whose mother died from a routine colonoscopy – perforation of some sort. His anger at what happened was palpable. I declined all colonoscopies after that. Amazing to think how many procedures have now been labelled routine and necessary. Ring the bell, dangle the cancer fear pellets and we all turn into Pavlovian specimens… I need psychotherapy from my doctor visits to keep well not routine colonoscopies.

    Speaking of prevention, and avoiding colon screening, how can one come up with a “broom” to keep the colon clean- a sort of personal “colon insurance” against “doctor-pressured” colonoscopies. I have noticed that not all vegetables provide the necessary dose of fiber to maintain the “shit through a goose” cleansing effect. Beans are not that easily digested and then some vegetables cause gass. A huge bowl of mixed greens, spring lettuce and broccoli, is not just enough…

  37. Do we get one or not ? I’m 55 , WFPB several years now. I have urgency to “ go “ when I wake up and “ go “ a few times before noon. Stool looks healthy. I feel good. What should I do ? Thanks

  38. A couple of years ago, at age 62.5, I had my first physical exam in several decades. The nurse practitioner suggested a colonoscopy. I replied that I was not interested in any invasive procedure, but that I would consider a fecal occult blood test. And that was the end of the conversation. I literally got no response. It was as though as soon as the prospect of making a lot of money off a colonoscopy disappeared, so did the NP’s interest in whether or not I had colon cancer. I found it curious, given that there didn’t seem to be any financial benefit to the NP if I had a colonoscopy, but maybe there would have been some kind of kickback involved.

    My feeling is that I’d rather bet on a diet that is shown to be linked to the near complete absence of colon cancer than on a procedure that has serious complications 1 in 350 times. I KNOW my chances of serious complications from colonoscopy are ZERO if I don’t have one. True prevention has everything to do with diet and nothing to do with testing.

  39. I have been WFPB for 7 – 8 years; b12 levels dropped to 199 (target 213-816) five years ago. Followup anti-parietal cell antibody testing showed high titers 1:1280 (target <1:20) I keep b12 levels up to around 359 with monthly injections.

    Both grandmothers had pernicious anemia. My biggest concern is risk for stomach cancer but I am sure there is something else I should be worrying about. I hope that my WFPB diet is taking care of the risk factors, but it feels like a leap of faith on my part. Do I get a baseline upper GI scope? What kind of specialist should I be looking for to help me stay on top of this autoimmune disease.

    Any research in this particular area? I would appreciate your suggestions.

  40. Dr. G,
    I have been a doctor for 25 years and encourage a plant based diet as prevention for all of our chronic diseases! I have encouraged people to get screening colonoscopies because that has been the recommendation, and have saved a few lives in doing so. I have had patients not get them until they are pooping blood and they had stage 4 colon cancer and were given 2 years to live. Now, these are Americans on the normal poison american diet. I have had 3 colonoscopies myself and they were all clear and I may (at 67) be done with them. However I have NEVER gotten a kickback or been paid anything for referring a patient for a colonoscopy or any other tests and am kind of resentful for your remark! I have not heard of any of my colleagues being paid for referrals. What data do you have to support that remark? I could see in a multi-specialty group that the primary care docs might get bonuses for referring in the system, but do not know this to be true. In fact in Texas, it is clearly against the law and is known as fee splitting.
    Horis

Leave a Reply

Your email address will not be published. Required fields are marked *

Pin It on Pinterest

Share This