Colonoscopy and Gut Microbiome

When, if ever, is it reasonable to not get a routine Colonoscopy at age 50, in order to protect your incredibly valuable Gut Microbiome?

In today's New York Times comes this article, which discusses the additional affects of the enemas and laxatives given to people before colonoscopy. Here is my response.

"As far as we know..." and " most cases..." are the operative words spoken by the M.D.s in this article telling us not to worry.

Of course our colon is so full of bacteria it seems unreasonable that "all" our colon bacteria will be wiped out by the laxatives and enemas prescribed before a colonoscopy.

And that if we follow a colonoscopy with feeding our biome with large doses of good bacteria via fermented foods and probiotic supplements, if we are someone with a normally very  healthy gut, we will be ok. In fact, as I write this it occurs to me that it would probably not hurt to feed your gut well the weeks leading up to a colonoscopy.

Are Routine Colonoscopy At Age 50 Always Wise?

But the question arises, what is the tipping point in someone whose health is already poor in some way, and a routine colonoscopy is recommended?

And what if this person has zero family history of colon cancer, has been a lifelong vegan, etc. Is it ever wiser not to do a routine colonoscopy at 50? We know the standards for mammagram has changed, yes?

Is it possible to have a calm, respectful, intelligent, unheated, unemotional (one of the times emotions ARE best left out of it) conversation with an MD on this topic when you are the patient and you don't want to do what she wants you to do? In my experience, all too often, not.

As one of the researchers comments,

Dr. Martin Blaser, who directs the Human Microbiome Program at NYU Langone, said he doesn’t think scientists understand the microbiome well enough to conclude that it rebounds completely after a procedure like a colonoscopy or a medication like an antibiotic. The studies may be missing subtler changes, he said.
“Do we ever bounce 100 percent back, or are we bouncing 95 percent back or 98 percent back?” Dr. Blaser asked. That difference may some day be shown to make a difference, he said.

The Best Way to Take PreColonoscopy Enemas

And yet another issue, is are we doing the enemas we must take before a colonoscopy correctly, and must we take enemas and laxatives full of toxic chemicals, or could we use natural laxatives and enema materials.

Leaving the subject of which materials to use aside for now, what's clear is that most of us are being told to use the enema's in a way that is more harmful than necessary. This is a dangerous characteristic of western medicine sometimes. Doing what is easier, (tell the patient to do one enema and they are more likely to comply) than explaining the neccessity of doing two separate enemas, as follows,

One 2014 study of 23 people found that the volunteers’ microbiomes bounced back faster if they drank two one-liter doses of the bowel prep drink typically used before a colonoscopy — one in the evening and one the following morning, rather than the full two liters on the morning of the procedure.
“So, it’s actually better for your gut microbiome and better for bowel prep to do two separate doses,” said Gail Cresci, a gastroenterology researcher with the Cleveland Clinic who specializes in the gut microbiome.
Sadly, the article also notes however, that
"But your bowel preparation schedule will depend on what your doctor recommends."
And from what I can tell, few, if any, are the M.D.s keeping up to speed on this better pre-op schedule.

Is Colon Cleansing for Toxins a Wise Therapy

An entire other issue, unrelated to colonscopy, is the obsession with "Colon Cleansing." I have had numerous patients who have damaged their microbiome via Colon cleansing because someone talked them into the false notion that colon cleanses are a therapy for "cleansing toxins" and/or for chronic constipation.

I am yet to meet a patient whose chronic constipation does not respond very well to some combination of acupuncture and herbal medicine, along with Trifala, a natural, gentle, and generally good for you stool softener. Herbal treatment has to matched to the type of constipation, whether due to lack of urge, or dry hard stool.

As to colon cleansing to remove "toxins"; plainly said, its not the right way. The best ways to cleanse toxins are by eating vegetables and by meditation. More on that in other articles. Please see my blog on the website,

copyright Eyton J. Shalom, M.S., L.Ac. San Diego, CA All Rights Reserved, Use With Permission Ayurveda, Acupuncture, and Chinese Medicine in San Diego