May 21, 2024 • 25 mins
Can your brain really have that big of an affect on the gut? The answer that Dr. Kimberly Kolkhorst of Essentia Health will really get you thinking. Dr. Koko is a return guest that has some excellent perspectives on your GI and trendy topics that are the buzz these days. Like the popular weight loss meds and the big side effects, also having a bowl movement as soon as you go out shopping? We'll cover some other topical and concerning things about age and colon cancer too. And Dr.'s KOKO call to action asking for a well known celebrity to be the face for awareness and prevention!
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Episode Transcript
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(00:00):
Ladies, we are here to meetyou wherever you're aunt. Welcome to the
Dare to Ask Podcast, Season four, Episode seven, Brain and Your Gut.
The mind has a direct effect onthe gut. I'm Corey Jensen,
your host for this Dare to Askpodcast. I'm a mom to a big
family and have delivered five babies,and like many women, I try to
(00:21):
stay informed about my wellness as wellas the health of my kids. We've
created a space to have open conversationabout what's going on with the woman's body
without feeling intimidated in a clinical setting, a place to talk like girlfriends do.
A space that dares to ask,asking the questions like is this something
that's right for me. We're hereto make a connection, be authentic,
(00:44):
and really get to know your provider. Yes, know the person behind the
stethoscope. Dare to Ask will bewhere you hear the questions that we are
all curious to know, but justneed a space to do it. You've
landed on the Dare to Ask podcastshow hosted by Corey Jensen and sponsored by
Issentia Health. Once you've seen one, you've seen them all and it's the
(01:07):
truth. A return guest doctor Coco. She is head of a GI department
here at Assentia Health in Fargo,and there are many reasons why I adore
this woman. She is able totalk about your gut health, bowel movements,
issues like IBS, and she doesit in such a good natured way.
She makes you comfortable. And manyparts of modern life can affect your
(01:30):
gut, like a high stress levelsand too little sleep and just eating a
Western diet that's high and processed insugary foods. For us to hopefully make
our gut health a higher priority,with doctor Coco, I'm going to dig
into a little bit of how muchyour mind actually does affect the gut.
Trends that people are sharing about onsocial media channels about using the bathroom when
(01:53):
they go shopping, what's that connection. We'll also dig into the new changes
with all of the new weight lossmeds out there and how some of the
most consistent side effects are constipation andnausea. Obviously that has to do with
the gut. And one of thetopics that concerns doctor Coco is that colon
cancer in young people is on therise. Got a lot to talk about,
(02:15):
Let's get to it. Doctor KimberlyCole cursed, you got it,
but you go by Coco. Yes, everybody calls me Coco. I love
that. I really love that.Well, first and foremost, let me
just say welcome back. Okay.It's not often that I have return guests
on the Dare to Ask podcast,but we are going into season four and
(02:38):
you were one of my season oneers. I believe, yes, with
the poop episode, that's right.Ah, it was one of my favorites,
and I don't play favorites around here. All of my guests have offered
something so amazing. Every single episode, there's something that I take away from
it. I've either learned something,I've had an emotional connection. There's just
something that happens that is always veryspecial to me. But I have to
(03:00):
tell you, I've really kind ofdeveloped a little girl crush on you.
We vibed from the get I justadore you, and now, thank Heavens
for things like social media, wecan keep up on a personal level and
it's just it's so fun. WhatI would like to impart on the listeners
of our podcast is that you aregenuinely one of the best humans. You
(03:23):
are a mom and just a totalpro girl Boss doctor, And I know
people who have went to you,even though I haven't personally been seen by
you, and they have glowing thingsto always say about you, that your
professional, that your personality comes throughin your time. That was the thing
that I learned from the very firsttime that I interviewed you, is that
(03:44):
you just have a really great senseof humor. Well, you have to
love what you do, and Itruly, truly do. I love what
I do. I love seeing mypatients and I love talking to them and
just a smile on their face afterwards, and they're like, oh my gosh,
it's over, you know, andI'm like, that's it. It
was that easy. Come back seeme in five years, ten years.
You know, that really means alot. When you can enjoy what you
do. You wake up every morning, you're excited to go to work and
(04:06):
then make an impact on people's lives. And I'm happy to be here.
It's with Corey. This will begreat, this will be fun, and
you just bring out the best inpeople. Oh, thank you well.
Vice versa, vice versa. Incase somebody hasn't heard the episode that we
did, the poop episode in seasonone, will you give your position,
your title, what you do everyday. You still work at Essential Health,
(04:27):
how to give that like the historyof your career for sure? So
yeah, I've been at Essential Healthfor more than seven years now. I'm
the chair of the department, soI oversee all the administrative stuff that keeps
you very busy. I take careof all the gi I do impatient and
outpatient consults, and then also procedures, do your screening, kolenoscopies, egds,
(04:49):
ercps. That's the most part ofwhat I do. I was curious
about this gender specific How is thepercentage most people think men have to do
their calling off more often? Whereare we with that? Overall, your
risk of having colon polyps, whichincrease your risk for colon cancer. So
twenty five percent of patients will havecolon polyps, so you come in average
(05:12):
risk colonoscopy. One in four patientswill have colon polyps. It's about twenty
percent for women, but then thirtypercent for men. So men are a
little bit more likely to have colonpolyps. Therefore, once you have polyps
or you would need to be everyfive years sure, so they have surveillance
a little bit more frequently. Soyes, I'm more likely to have a
need for a male population. However, women will usually request a female provider.
(05:36):
Yeah, which I understand. Iget that feel more comfortable having a
procedure like a colonoscopy with a femaleprovider, and not even just the kolonosopy,
but even in clinic or anything.You just feel like it's somebody you
are more comfortable opening up to aboutyour symptoms and relating to things. So
having a female provider is something thatthey may request. As a female,
having birthed five children, I absolutelywould require a female going for anything.
(06:00):
GI It's just a vulnerable place.I've had male doctors deliver me too.
It's a different intimacy, I know. You know what I'm talking about.
Absolutely, at the end of theday, you talk poop every day your
life that people like, Okay,we're gonna have a colonospie, Well you're
about to see a new side ofme. And I'm like, listen,
once you've seen one, you've seenthem all. And it's the truth.
(06:23):
And the truth is I'm not lookingat your butt the whole time. I'm
looking on the screen, and I'mnot examining your colonosity, your colon you
know, it's nothing. It's Andthen if I see people out in public,
you know, I wonder if they'rethinking, oh my god, you
see my button, like honey,I don't remember it by ways all.
I have no idea what your buttlooks like. I may not even remember
(06:45):
your colon. You know, don'tworry about it. We're here to take
care of you and keep you healthy. As human beings, we become so
self conscious. It could be yourgi doctor, it could be your guyano,
it could be literally you seeing somebodyin the gym. You're just trying
there to go get your fitness on, and you're so consumed with am I
(07:05):
doing it wrong? Or people makingfun of me? Am I going to
be talk to? Nobody's paying attentionto you because we're all thinking the exact
same thing. We're thinking. Somebodyelse is judging me seeing me whatever,
No judge on the zone, releaseand let go some of those things.
We're just human beings. Just thebeauty of aging. To undergo life saving
procedures. This is life, youknow, and it's aging. Yes,
(07:29):
as you get older, it's timefor my mammogram, yep, yep,
and it's just time for the smushingyou know. It is just it just
comes with age. It does.It does, and there is a beauty
in that. There's freedom in itonce you are able to kind of release
on. Like we will recognize isthe peace of mind that goes along with
having had it done, yes,and then knowing, Okay, I don't
(07:50):
have colon cancer. I'm good foranother five to ten years. That is
really really important. It really isgetting it done and knowing I got it,
I'm done, check it off,and now I can move on.
Yeah, and once we talk aboutit, I think having an open conversation
like that helps remind others you shoulddo it too. Let's put our health
at the top of mind. Ithink we can red rover this thing.
(08:13):
Yeah, Like let's just link armsand just everybody get together and put your
health on the forefront. Absolutely,it's well worth it to get it done.
This is a twist, a littlebit, a couple little fun ones.
Are you ready for me? Curvevolume for sure? First and seeing
it on TikTok more than anything,it threw me the first time I saw
it. I'm like, is thisa thing? So people that say that,
(08:35):
what is it about shopping that makesme go to the bathroom. Have
you heard this phenomenon? I havenot heard the phenomenon. Okay, however
it sounds probably like it's IBS.Let me tell you what I've heard.
Okay. When people will hop on, they will say shopping places like I've
heard Barnes and Noble, Target,TJ Max, that sort of place where
(08:58):
they get in they're going on theirsh and usually it's like I'm by myself
and suddenly not like this urgent needto go, but like they have released
indorphins, and maybe it's like I'mabout ready to shop, I'm now comfortable,
and then suddenly the urged I couldgo use the bathroom right now,
and then they go use the bathroomat this shop, and people are sharing
(09:20):
these stories that they're doing this.Does that sound like IBS to you?
There is something to be said aboutthe fact that if it's a Saturday morning
and you don't have to go towork, so you don't have to set
an alarm right, and you're notset to deadlines, you don't have things
you need to worry about, anddo you drink your cup of coffee and
you're more relaxed, you're definitely morelikely to have a bowel movement in that
(09:43):
type of situation, because then it'slike, Okay, I'm more relaxed.
I'm not worried about what's the nextthing I need to do, So I
feel like that might be what's goingon here. They finally relax, they're
out, they're shopping, they're notworried about time, there's no stressors,
and then all of a sudden,it's like, oh wow, now my
GI tractors turn on and I thinkI'm ready to have a nice bottle.
(10:05):
That's exactly so that is kind ofwhat I've been picking up on the social
media movement. It's it's mostly peoplethat identify also with the pleasure portion of
shopping because they find a comfort init, like yep, this is a
happy space for me, and Irealize not everybody feels that way about shopping.
The opportunity to disconnect, yes,yes, that's probably what it is,
(10:26):
is that disconnection from going, going, going, go, go,
go, schedule, schedule, schedule. Okay, I can finally disconnect,
relax. Yeah, and all ofa sudden, hey, I know the
GI tract is saying now it's timefor me. I'm so happy that I
got to pass along this trend.That I've been seeing on social media.
I believe it. It's poop.Everybody does it right when you can release
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and let go is probably not ona I have fifteen minutes to run in
I've got this, this, andthis right. It has to probably be
a more. I don't have anyplace to be this afternoon. I don't
have to pick my kids up fromschool for three hours. I can literally
do whatever I want this afternoon.I think I'm gonna stop by Target.
Yeah, I think this is whyTarget and Barnes and Noble gets brought up,
(11:07):
because what do they have in them? Starbucks? I think that also
might have something to do with itoutelyhurt them. Say this as well.
I don't even have to get aStarbucks, but I go in, I'm
comfortable, and I smell the cot, the coffee and the Starbucks, and
it's amazing what your body remembers.Yeah, there's still a lot of research
(11:28):
that needs to go into that.But in terms of we know for sure
that the mind has a direct effecton the gut, what is it?
Is it they'll decrease in cortisol orthere's something biochemically that it's occurring that might
even then affect the gut flora.And there was one study that was looking
at lacto bacillis. If you're highstressed, you have more lactobacillis. So
if you're less stressed and more relaxed, then you have overgrowth of more beneficial
(11:54):
bacteria that then's telling the GI trackyou know what, Okay, it's time
to relax and release, you know. So there's definitely something biochemically behind that.
I think there's so much to thecomfort and relaxation what you just explained.
When I travel, it is likemy body decides you're going to be
a raisin right now. Just closein on myself. I'm closing up.
(12:16):
I'm battening down the hatches and it'sterrible. Yes, because it only takes
a few days for me to thenstart feel absolutely miserable. Yes, change
in diet, change in time zone, those are all things that are going
to affect the gut. Is therethat mental element of I don't know where
I'm at going new places? Ihave such a routine almost built up.
(12:37):
I know what I'm doing in themorning, I know in the afternoon,
and where am I both of thosetimes I'm at home. My body is
incredibly comfortable with home and I don'thave to worry about anybody like walking in
a public restroom and a stall.And yes, when it comes to bawel
movements, routine is definitely important.When you mess up that routine, you're
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definitely and affect your bowel movements.So I even tell my patients that travel
I even have a patient who's aflight stewardess. You're changing your time zone,
you're traveling all the time. Whenyou are traveling, you take a
vacation, bring stool softeners with you, Yes, and just anticipate that you're
gonna get a little bit more backedup. Maybe eats more fruits and prunes
kiwis are really good, Drink lotsof water, but anticipate that you'll probably
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get a little bit more constipated,So take your stool softeners. Is stool
softener your number one recommendation. Itdepends on the level of constipation, So
stool softeners if you have more mildconstipation, So colase is one of the
tip of stool softeners. But ifyou want something a little bit more effective
than a stool softener than I likemy relax, so me relax is usually
my go to. It's a nonstimulant laxative, white powder, no flavor,
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one capful, mix it into acup. Do that every night when
you're on vacation, and then you'remore likely to have a bowl movement in
the morning. It's not going toblow you out, but it's a non
stimulant lax If you're a pretty severeconstipation, then you might need a stimulant
laxat of like a senna or adulcalax. Let's say for the person who just
experienced this, they didn't do anythingto solve it. What is the fastest
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way to get back on track.Now we're getting back home, we're finding
routine again, that constipation is stillhanging on. What is your recommendation.
I would probably do the Mara RelaxOkay, that way you don't have too
much crimping. And even instead ofone capful, maybe do two capfuls of
my relax make sense? Who drink? Drink that that night. Then you're
more likely to have a bowl momentin the morning and then kind of get
you back on track. And ifyou haven't had a bomb movement the next
day, then do another capful ofMaralacs that night and do a capful every
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night until you get back on tracklong term. Anything can be abused.
People do things like colon brooms andmixing, and they're making these things and
they're never stopping. That's now theirroutine. Is that good? Is it
bad? Some patients need that andsome patients need to hear that too,
and after they have a colonospiy andI tell them, listen, your colon
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is very twisty, especially some women. We have more kinks and twists and
turns in our colons. Then womenhave more twists than their colons. If
you've ever had endometriosis or previous dominalsurgery, you're gonna have more twists in
your colon. So if you knowyou have more twists, if it's harder
for me to go in, it'sharder for stool to go out. Sure.
The other thing about this is justmotility. If you just have a
sluggish colon, or if you're onmedicines that can affect the gut motility.
(15:13):
And a big topic right now isall those GLP one agonists, the ozempic
ye, all the weight loss drugs. Yes, big big topic, but
we know for sure that they slowgut motility. And that's across the board,
not just ozempic Manjaro, we gov all of it. There's so
many now, one hundred percent.That's how they are effective because they slow
gut motility, so they make youfeel full quicker and you don't want to
(15:37):
eat as much. Sure, butyou will have issues with constipation for those
no judgment. You're doing whatever youhave to do. Yeah, what we
would probably recommend here first is pleasedo any and all of this side by
side with your physician. Absolutely.I'm just amazed at what is being gotten
away with with the internet. Peopleare getting some of these weight loss things
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just shipped their home. This issupposed to be physician prescribed, right.
How are some of these people gettingweight loss shots to do at home on
their own, right? I knowit's really too soon to say, in
my opinion, it's really early.We know these are effective. Patients are
losing weight, and weight loss isa good thing, especially when you have
(16:18):
diabetes and high blood pressure and heartnosease, OBC crisis astry. So we
know weight loss is a good thing, but sometimes you wonder if it seems
easy, there's there a catch somewhere, And that's the part of it that
we just kind of have to bea little bit more cognizant of We do
know that for sure, it's goingto decrease your gut motility, You're going
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to feel more nauseated, And someof my patients have even told me I
had to stop it because I couldn'teven take the nausea. But if you
can get through the nausea and you'relosing the weight, then yeah, I
mean, we'll have to see whatthe long term effects of these drugs are.
The thing is a lot of patientswill say, well, once I
started, then what happens if Istop? Well, I don't know.
What I've heard is that the weightloss provides will say, well, obesity
(17:00):
is a chronic condition, so technicallywe want to keep you on these medicines
indefinitely. You know, So whatare going to be the long term effects
of taking this medicine for ten plusyears? And that's what remains to be
seen. We don't have the history. It's exactly to point to that as
a physician. In the same chapterof this conversation, do you have these
worries when hot drugs like this comeout fen fen days? Right? Oh,
(17:25):
yeah, everybody's doing it. Ifit totally works feeling the essence,
So where's the catch? Yeah,I absolutely feel that way. I do.
We'll have to wait and see ifyou absolutely need it and you have
diabetes, especially so many diabetes patientsthat want to be on these drugs and
they can't get on them because ofsome people that are using them improperly.
I say, if you have aproper indication, absolutely let's get on them.
(17:45):
And then in terms of what's goingto transpire, that's what remains to
be seen. But patients definitely arelosing weight on them. We've actually adopted
some new anesthesia policies so when patientscome in for a procedure, they're supposed
to be NPO after midnight, nothingto eat or drink after midnight. But
if if they're on these medicines,we actually ask them to hold them a
week prior. Even if they're NPUafter midnight, you can still find food
(18:06):
in their stomach and then they're higherrisk for aspiration. There's all these new
things that have popped up because ofall the patients that are taking these meds.
It is a hot topic right now. Any other hot topic, you
think it's time I address this thingswith GI there's problems swallowing, there's heartburn,
there's bloating, ibs, ce bowt, diarrhea, compation. I mean,
you and I could sit here andtalk for twelve hours, we really
(18:27):
could. One of the things that'sreally important to me is just that the
fact that colon cancer is on therise in young people, and I see
it. I see it every day. So in twenty twenty one, we
decrease the age of colon cancer screeningfrom fifty to forty five. So now
we're screening forty five year olds,and even the forty five year olds are
coming in and I'm finding colon cancer. I had one over Thanksgiving and the
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patient had no symptoms. Yeah,so you've got to get this done.
This is life saving. If youhave symptoms and you're not forty five and
you need to get screened earlier,do it. Speak up. So that's
what's really important to me, isthat if you have blood in the stools,
change a bell habits, nuancet ofconstipation, diarrhea, abdominal paint,
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anemia, especially in a male.A male should never be an emicus females
we mention raight. But still,if you have unexplained anemia, get this
checked out. Get a kolonospy andget it done and know your family history.
A lot of patients are like,I didn't know I had a grandfather
who had colon cancer. So knowyour family history, speak up, get
the KOLONOSK be done. Thank youfor that. Yeah, it was twenty
(19:32):
twenty when we had our first conversation. I vividly remember you saying, this
is something we're all pushing for.Is forty five, Like that's a recommendation,
But like within a year it officiallychanged. I remember accelebrating that time
yea, thinking this is so great, and when I was talking to friends,
just because of that conversation with you, I believe the medical community is
(19:53):
really pushing for this change and howimportant it is. Just this last year,
Ryan Reynolds who did He was fortyfour, forty five. It was
he and a friend and there wassome sort of bet involved or something.
It was kind of silly or whatever, unexpected, and cameras were rolling yes
and his GI doctor was saying Ifound polyps yep, and he was just
(20:15):
floored, like, zero symptoms.I'm only this age. So this is
really speaking to what you're talking about. I would love to see Josh Dumil.
Yes, yes, I would loveto see him come through a sential
health Let me scope him and dothe same thing video from start to finish,
and then promote colon cancer screening.Because I think he's around forty five.
(20:37):
He is already fifty. Oh see, I don't know if he says
han't had his eye holding he has. If he's listening, I need doctor
Coco. Yes, that's right,and they'll set you all up. You'll
set the stage for all North Dakotin's. This is important. Let's get it
done. It really is important coloncancer screening and awareness. I love that,
my Josh, get on board.Is there anything else that you would
(20:59):
love to talk? Big thing isibs, And we talked about a little
bit about the mind affecting the gut, and a lot of us have some
element of IBS. A lot ofthat comes down to diet, the fact
that our foods are so overprocessed.When people go abroad and they go to
other countries, that'll come back toAmerica and we realize how unhealthy we are.
Oh my gosh, trying to makehealthier choices because that affects the gut,
(21:22):
and then the gut flora, eatmore fruits and vegetables and whole grains,
and the Mediterranean diet is such agreat diet, and really just try
and avoid all that process fast food. I think that is so important for
North Dakotas to hear, because it'seasy, it's quick. You get into
a habit and then you crave thosefoods, but you can break that habit.
Really try to make an effort toeat healthier because that will result in
(21:45):
the healthier gut and decrease your riskfor colon cancer and ibs. Some people
they hear that they hear their doctor'srecommendation. At times can feel like a
mount everest in front of you.Where do I still even start? Try
it for a day and I couldn'tget through it? Unfortunate in some element,
so addicted in this country to theseprocessed foods. They are made that
way with the trans fats and themsgs and just all these things that we
(22:08):
put in our body somewhat unknowingly.Yeah, if you're opening any kind of
bag that's been sealed, there's aquestion mark on that, like how many
times a day are you doing that? That's right, versus something that you
just ate that had a peel onit? Right? And is there moments
small ones like a snack begin theprocess instead of having something that you have
(22:30):
cracked open with a can or openinga bag that's been sealed, versus what
can I pick up that's either greenor has a peel on it? That's
right. We even keep it simple. No chips, no cookies, and
no white bread. If you stuckwith those things and then just try to
eat more fruits and vegetables with anapple a day keeps the doctor away.
But that's true. I mean appleis high in soluble fiber. We need
(22:52):
more fiber. Our guts need morefiber. Thinking about that, get rid
of those chips, cookies, andwhite bread. If you did that,
that would really make a big difference. The gut health perfection is obviously daunting.
You're also a real person. Youunderstand never ever's rarely ever. Work.
No, don't want it every day, break the habit of every day.
Save these things for the weekends ora special event, yes, like
(23:15):
you're going to the ballgame. Havea hot dog. Yes, I always
tell patients everything in moderation, justdon't eat those things every day. Thanks
for bringing that up, And ifanybody has any questions about IBS. You
might be living with it and haveno clue. Other causes of diarrhea could
be you've had your ball bladder out, IBS, CIBO, lactose intolerance.
(23:37):
There's a commission called microscopic colitis whereyou actually need colon biopsies, Crohn's disease,
ul schi of colitis. So yeah, I mean it could be IBS,
but talk to your doctor and getit checked out. Bring up symptoms.
You're dealing with diarrhea that gets tothe point where you're afraid to leave
your house, talk about it,next level, talk about it. We
can fix this. We can fixyour quality of life that should not be
(24:00):
hindering you from going out and doingspecial events, getting on a plane,
getting in a car. We canfix this. I love it, Doctor
Coco, you are fabulous in everyway. I just adoorio once again.
Thank you. I mean we spokefor a half hour in it five minutes,
yes, so thank you so muchfor your time. And absolutely I'll
see you in the future because thereis no way this relationship is stop.
(24:22):
Let's do it again. We haveso much to talk about. I don't
know if you can tell, butI had a smile on my face.
The entire conversation a lot of greatinformation from Gi doctor Coco at Essentia Health
got more episodes yet in this season, so stay tuned for the Daar to
Ask podcast. The information contained inthis podcast is not intended to be a
substitute for personalized professional medical advice,diagnosis, or treatment. The information is
(24:47):
general in nature. If you havequestions or concerns, please contact your provider.
Ladies, we are here to meetyou wherever you're aunt. Welcome to the
Dare to Ask Podcast, Season four, Episode seven, Brain and Your Gut.
The mind has a direct effect onthe gut. I'm Corey Jensen,
your host for this Dare to Askpodcast. I'm a mom to a big
family and have delivered five babies,and like many women, I try to
(00:21):
stay informed about my wellness as wellas the health of my kids. We've
created a space to have open conversationabout what's going on with the woman's body
without feeling intimidated in a clinical setting, a place to talk like girlfriends do.
A space that dares to ask,asking the questions like is this something
that's right for me. We're hereto make a connection, be authentic,
(00:44):
and really get to know your provider. Yes, know the person behind the
stethoscope. Dare to Ask will bewhere you hear the questions that we are
all curious to know, but justneed a space to do it. You've
landed on the Dare to Ask podcastshow hosted by Corey Jensen and sponsored by
Issentia Health. Once you've seen one, you've seen them all and it's the
(01:07):
truth. A return guest doctor Coco. She is head of a GI department
here at Assentia Health in Fargo,and there are many reasons why I adore
this woman. She is able totalk about your gut health, bowel movements,
issues like IBS, and she doesit in such a good natured way.
She makes you comfortable. And manyparts of modern life can affect your
(01:30):
gut, like a high stress levelsand too little sleep and just eating a
Western diet that's high and processed insugary foods. For us to hopefully make
our gut health a higher priority,with doctor Coco, I'm going to dig
into a little bit of how muchyour mind actually does affect the gut.
Trends that people are sharing about onsocial media channels about using the bathroom when
(01:53):
they go shopping, what's that connection. We'll also dig into the new changes
with all of the new weight lossmeds out there and how some of the
most consistent side effects are constipation andnausea. Obviously that has to do with
the gut. And one of thetopics that concerns doctor Coco is that colon
cancer in young people is on therise. Got a lot to talk about,
(02:15):
Let's get to it. Doctor KimberlyCole cursed, you got it,
but you go by Coco. Yes, everybody calls me Coco. I love
that. I really love that.Well, first and foremost, let me
just say welcome back. Okay.It's not often that I have return guests
on the Dare to Ask podcast,but we are going into season four and
(02:38):
you were one of my season oneers. I believe, yes, with
the poop episode, that's right.Ah, it was one of my favorites,
and I don't play favorites around here. All of my guests have offered
something so amazing. Every single episode, there's something that I take away from
it. I've either learned something,I've had an emotional connection. There's just
something that happens that is always veryspecial to me. But I have to
(03:00):
tell you, I've really kind ofdeveloped a little girl crush on you.
We vibed from the get I justadore you, and now, thank Heavens
for things like social media, wecan keep up on a personal level and
it's just it's so fun. WhatI would like to impart on the listeners
of our podcast is that you aregenuinely one of the best humans. You
(03:23):
are a mom and just a totalpro girl Boss doctor, And I know
people who have went to you,even though I haven't personally been seen by
you, and they have glowing thingsto always say about you, that your
professional, that your personality comes throughin your time. That was the thing
that I learned from the very firsttime that I interviewed you, is that
(03:44):
you just have a really great senseof humor. Well, you have to
love what you do, and Itruly, truly do. I love what
I do. I love seeing mypatients and I love talking to them and
just a smile on their face afterwards, and they're like, oh my gosh,
it's over, you know, andI'm like, that's it. It
was that easy. Come back seeme in five years, ten years.
You know, that really means alot. When you can enjoy what you
do. You wake up every morning, you're excited to go to work and
(04:06):
then make an impact on people's lives. And I'm happy to be here.
It's with Corey. This will begreat, this will be fun, and
you just bring out the best inpeople. Oh, thank you well.
Vice versa, vice versa. Incase somebody hasn't heard the episode that we
did, the poop episode in seasonone, will you give your position,
your title, what you do everyday. You still work at Essential Health,
(04:27):
how to give that like the historyof your career for sure? So
yeah, I've been at Essential Healthfor more than seven years now. I'm
the chair of the department, soI oversee all the administrative stuff that keeps
you very busy. I take careof all the gi I do impatient and
outpatient consults, and then also procedures, do your screening, kolenoscopies, egds,
(04:49):
ercps. That's the most part ofwhat I do. I was curious
about this gender specific How is thepercentage most people think men have to do
their calling off more often? Whereare we with that? Overall, your
risk of having colon polyps, whichincrease your risk for colon cancer. So
twenty five percent of patients will havecolon polyps, so you come in average
(05:12):
risk colonoscopy. One in four patientswill have colon polyps. It's about twenty
percent for women, but then thirtypercent for men. So men are a
little bit more likely to have colonpolyps. Therefore, once you have polyps
or you would need to be everyfive years sure, so they have surveillance
a little bit more frequently. Soyes, I'm more likely to have a
need for a male population. However, women will usually request a female provider.
(05:36):
Yeah, which I understand. Iget that feel more comfortable having a
procedure like a colonoscopy with a femaleprovider, and not even just the kolonosopy,
but even in clinic or anything.You just feel like it's somebody you
are more comfortable opening up to aboutyour symptoms and relating to things. So
having a female provider is something thatthey may request. As a female,
having birthed five children, I absolutelywould require a female going for anything.
(06:00):
GI It's just a vulnerable place.I've had male doctors deliver me too.
It's a different intimacy, I know. You know what I'm talking about.
Absolutely, at the end of theday, you talk poop every day your
life that people like, Okay,we're gonna have a colonospie, Well you're
about to see a new side ofme. And I'm like, listen,
once you've seen one, you've seenthem all. And it's the truth.
(06:23):
And the truth is I'm not lookingat your butt the whole time. I'm
looking on the screen, and I'mnot examining your colonosity, your colon you
know, it's nothing. It's Andthen if I see people out in public,
you know, I wonder if they'rethinking, oh my god, you
see my button, like honey,I don't remember it by ways all.
I have no idea what your buttlooks like. I may not even remember
(06:45):
your colon. You know, don'tworry about it. We're here to take
care of you and keep you healthy. As human beings, we become so
self conscious. It could be yourgi doctor, it could be your guyano,
it could be literally you seeing somebodyin the gym. You're just trying
there to go get your fitness on, and you're so consumed with am I
(07:05):
doing it wrong? Or people makingfun of me? Am I going to
be talk to? Nobody's paying attentionto you because we're all thinking the exact
same thing. We're thinking. Somebodyelse is judging me seeing me whatever,
No judge on the zone, releaseand let go some of those things.
We're just human beings. Just thebeauty of aging. To undergo life saving
procedures. This is life, youknow, and it's aging. Yes,
(07:29):
as you get older, it's timefor my mammogram, yep, yep,
and it's just time for the smushingyou know. It is just it just
comes with age. It does.It does, and there is a beauty
in that. There's freedom in itonce you are able to kind of release
on. Like we will recognize isthe peace of mind that goes along with
having had it done, yes,and then knowing, Okay, I don't
(07:50):
have colon cancer. I'm good foranother five to ten years. That is
really really important. It really isgetting it done and knowing I got it,
I'm done, check it off,and now I can move on.
Yeah, and once we talk aboutit, I think having an open conversation
like that helps remind others you shoulddo it too. Let's put our health
at the top of mind. Ithink we can red rover this thing.
(08:13):
Yeah, Like let's just link armsand just everybody get together and put your
health on the forefront. Absolutely,it's well worth it to get it done.
This is a twist, a littlebit, a couple little fun ones.
Are you ready for me? Curvevolume for sure? First and seeing
it on TikTok more than anything,it threw me the first time I saw
it. I'm like, is thisa thing? So people that say that,
(08:35):
what is it about shopping that makesme go to the bathroom. Have
you heard this phenomenon? I havenot heard the phenomenon. Okay, however
it sounds probably like it's IBS.Let me tell you what I've heard.
Okay. When people will hop on, they will say shopping places like I've
heard Barnes and Noble, Target,TJ Max, that sort of place where
(08:58):
they get in they're going on theirsh and usually it's like I'm by myself
and suddenly not like this urgent needto go, but like they have released
indorphins, and maybe it's like I'mabout ready to shop, I'm now comfortable,
and then suddenly the urged I couldgo use the bathroom right now,
and then they go use the bathroomat this shop, and people are sharing
(09:20):
these stories that they're doing this.Does that sound like IBS to you?
There is something to be said aboutthe fact that if it's a Saturday morning
and you don't have to go towork, so you don't have to set
an alarm right, and you're notset to deadlines, you don't have things
you need to worry about, anddo you drink your cup of coffee and
you're more relaxed, you're definitely morelikely to have a bowel movement in that
(09:43):
type of situation, because then it'slike, Okay, I'm more relaxed.
I'm not worried about what's the nextthing I need to do, So I
feel like that might be what's goingon here. They finally relax, they're
out, they're shopping, they're notworried about time, there's no stressors,
and then all of a sudden,it's like, oh wow, now my
GI tractors turn on and I thinkI'm ready to have a nice bottle.
(10:05):
That's exactly so that is kind ofwhat I've been picking up on the social
media movement. It's it's mostly peoplethat identify also with the pleasure portion of
shopping because they find a comfort init, like yep, this is a
happy space for me, and Irealize not everybody feels that way about shopping.
The opportunity to disconnect, yes,yes, that's probably what it is,
(10:26):
is that disconnection from going, going, going, go, go,
go, schedule, schedule, schedule. Okay, I can finally disconnect,
relax. Yeah, and all ofa sudden, hey, I know the
GI tract is saying now it's timefor me. I'm so happy that I
got to pass along this trend.That I've been seeing on social media.
I believe it. It's poop.Everybody does it right when you can release
(10:46):
and let go is probably not ona I have fifteen minutes to run in
I've got this, this, andthis right. It has to probably be
a more. I don't have anyplace to be this afternoon. I don't
have to pick my kids up fromschool for three hours. I can literally
do whatever I want this afternoon.I think I'm gonna stop by Target.
Yeah, I think this is whyTarget and Barnes and Noble gets brought up,
(11:07):
because what do they have in them? Starbucks? I think that also
might have something to do with itoutelyhurt them. Say this as well.
I don't even have to get aStarbucks, but I go in, I'm
comfortable, and I smell the cot, the coffee and the Starbucks, and
it's amazing what your body remembers.Yeah, there's still a lot of research
(11:28):
that needs to go into that.But in terms of we know for sure
that the mind has a direct effecton the gut, what is it?
Is it they'll decrease in cortisol orthere's something biochemically that it's occurring that might
even then affect the gut flora.And there was one study that was looking
at lacto bacillis. If you're highstressed, you have more lactobacillis. So
if you're less stressed and more relaxed, then you have overgrowth of more beneficial
(11:54):
bacteria that then's telling the GI trackyou know what, Okay, it's time
to relax and release, you know. So there's definitely something biochemically behind that.
I think there's so much to thecomfort and relaxation what you just explained.
When I travel, it is likemy body decides you're going to be
a raisin right now. Just closein on myself. I'm closing up.
(12:16):
I'm battening down the hatches and it'sterrible. Yes, because it only takes
a few days for me to thenstart feel absolutely miserable. Yes, change
in diet, change in time zone, those are all things that are going
to affect the gut. Is therethat mental element of I don't know where
I'm at going new places? Ihave such a routine almost built up.
(12:37):
I know what I'm doing in themorning, I know in the afternoon,
and where am I both of thosetimes I'm at home. My body is
incredibly comfortable with home and I don'thave to worry about anybody like walking in
a public restroom and a stall.And yes, when it comes to bawel
movements, routine is definitely important.When you mess up that routine, you're
(12:58):
definitely and affect your bowel movements.So I even tell my patients that travel
I even have a patient who's aflight stewardess. You're changing your time zone,
you're traveling all the time. Whenyou are traveling, you take a
vacation, bring stool softeners with you, Yes, and just anticipate that you're
gonna get a little bit more backedup. Maybe eats more fruits and prunes
kiwis are really good, Drink lotsof water, but anticipate that you'll probably
(13:20):
get a little bit more constipated,So take your stool softeners. Is stool
softener your number one recommendation. Itdepends on the level of constipation, So
stool softeners if you have more mildconstipation, So colase is one of the
tip of stool softeners. But ifyou want something a little bit more effective
than a stool softener than I likemy relax, so me relax is usually
my go to. It's a nonstimulant laxative, white powder, no flavor,
(13:43):
one capful, mix it into acup. Do that every night when
you're on vacation, and then you'remore likely to have a bowl movement in
the morning. It's not going toblow you out, but it's a non
stimulant lax If you're a pretty severeconstipation, then you might need a stimulant
laxat of like a senna or adulcalax. Let's say for the person who just
experienced this, they didn't do anythingto solve it. What is the fastest
(14:05):
way to get back on track.Now we're getting back home, we're finding
routine again, that constipation is stillhanging on. What is your recommendation.
I would probably do the Mara RelaxOkay, that way you don't have too
much crimping. And even instead ofone capful, maybe do two capfuls of
my relax make sense? Who drink? Drink that that night. Then you're
more likely to have a bowl momentin the morning and then kind of get
you back on track. And ifyou haven't had a bomb movement the next
day, then do another capful ofMaralacs that night and do a capful every
(14:28):
night until you get back on tracklong term. Anything can be abused.
People do things like colon brooms andmixing, and they're making these things and
they're never stopping. That's now theirroutine. Is that good? Is it
bad? Some patients need that andsome patients need to hear that too,
and after they have a colonospiy andI tell them, listen, your colon
(14:50):
is very twisty, especially some women. We have more kinks and twists and
turns in our colons. Then womenhave more twists than their colons. If
you've ever had endometriosis or previous dominalsurgery, you're gonna have more twists in
your colon. So if you knowyou have more twists, if it's harder
for me to go in, it'sharder for stool to go out. Sure.
The other thing about this is justmotility. If you just have a
sluggish colon, or if you're onmedicines that can affect the gut motility.
(15:13):
And a big topic right now isall those GLP one agonists, the ozempic
ye, all the weight loss drugs. Yes, big big topic, but
we know for sure that they slowgut motility. And that's across the board,
not just ozempic Manjaro, we gov all of it. There's so
many now, one hundred percent.That's how they are effective because they slow
gut motility, so they make youfeel full quicker and you don't want to
(15:37):
eat as much. Sure, butyou will have issues with constipation for those
no judgment. You're doing whatever youhave to do. Yeah, what we
would probably recommend here first is pleasedo any and all of this side by
side with your physician. Absolutely.I'm just amazed at what is being gotten
away with with the internet. Peopleare getting some of these weight loss things
(15:58):
just shipped their home. This issupposed to be physician prescribed, right.
How are some of these people gettingweight loss shots to do at home on
their own, right? I knowit's really too soon to say, in
my opinion, it's really early.We know these are effective. Patients are
losing weight, and weight loss isa good thing, especially when you have
(16:18):
diabetes and high blood pressure and heartnosease, OBC crisis astry. So we
know weight loss is a good thing, but sometimes you wonder if it seems
easy, there's there a catch somewhere, And that's the part of it that
we just kind of have to bea little bit more cognizant of We do
know that for sure, it's goingto decrease your gut motility, You're going
(16:40):
to feel more nauseated, And someof my patients have even told me I
had to stop it because I couldn'teven take the nausea. But if you
can get through the nausea and you'relosing the weight, then yeah, I
mean, we'll have to see whatthe long term effects of these drugs are.
The thing is a lot of patientswill say, well, once I
started, then what happens if Istop? Well, I don't know.
What I've heard is that the weightloss provides will say, well, obesity
(17:00):
is a chronic condition, so technicallywe want to keep you on these medicines
indefinitely. You know, So whatare going to be the long term effects
of taking this medicine for ten plusyears? And that's what remains to be
seen. We don't have the history. It's exactly to point to that as
a physician. In the same chapterof this conversation, do you have these
worries when hot drugs like this comeout fen fen days? Right? Oh,
(17:25):
yeah, everybody's doing it. Ifit totally works feeling the essence,
So where's the catch? Yeah,I absolutely feel that way. I do.
We'll have to wait and see ifyou absolutely need it and you have
diabetes, especially so many diabetes patientsthat want to be on these drugs and
they can't get on them because ofsome people that are using them improperly.
I say, if you have aproper indication, absolutely let's get on them.
(17:45):
And then in terms of what's goingto transpire, that's what remains to
be seen. But patients definitely arelosing weight on them. We've actually adopted
some new anesthesia policies so when patientscome in for a procedure, they're supposed
to be NPO after midnight, nothingto eat or drink after midnight. But
if if they're on these medicines,we actually ask them to hold them a
week prior. Even if they're NPUafter midnight, you can still find food
(18:06):
in their stomach and then they're higherrisk for aspiration. There's all these new
things that have popped up because ofall the patients that are taking these meds.
It is a hot topic right now. Any other hot topic, you
think it's time I address this thingswith GI there's problems swallowing, there's heartburn,
there's bloating, ibs, ce bowt, diarrhea, compation. I mean,
you and I could sit here andtalk for twelve hours, we really
(18:27):
could. One of the things that'sreally important to me is just that the
fact that colon cancer is on therise in young people, and I see
it. I see it every day. So in twenty twenty one, we
decrease the age of colon cancer screeningfrom fifty to forty five. So now
we're screening forty five year olds,and even the forty five year olds are
coming in and I'm finding colon cancer. I had one over Thanksgiving and the
(18:49):
patient had no symptoms. Yeah,so you've got to get this done.
This is life saving. If youhave symptoms and you're not forty five and
you need to get screened earlier,do it. Speak up. So that's
what's really important to me, isthat if you have blood in the stools,
change a bell habits, nuancet ofconstipation, diarrhea, abdominal paint,
(19:10):
anemia, especially in a male.A male should never be an emicus females
we mention raight. But still,if you have unexplained anemia, get this
checked out. Get a kolonospy andget it done and know your family history.
A lot of patients are like,I didn't know I had a grandfather
who had colon cancer. So knowyour family history, speak up, get
the KOLONOSK be done. Thank youfor that. Yeah, it was twenty
(19:32):
twenty when we had our first conversation. I vividly remember you saying, this
is something we're all pushing for.Is forty five, Like that's a recommendation,
But like within a year it officiallychanged. I remember accelebrating that time
yea, thinking this is so great, and when I was talking to friends,
just because of that conversation with you, I believe the medical community is
(19:53):
really pushing for this change and howimportant it is. Just this last year,
Ryan Reynolds who did He was fortyfour, forty five. It was
he and a friend and there wassome sort of bet involved or something.
It was kind of silly or whatever, unexpected, and cameras were rolling yes
and his GI doctor was saying Ifound polyps yep, and he was just
(20:15):
floored, like, zero symptoms.I'm only this age. So this is
really speaking to what you're talking about. I would love to see Josh Dumil.
Yes, yes, I would loveto see him come through a sential
health Let me scope him and dothe same thing video from start to finish,
and then promote colon cancer screening.Because I think he's around forty five.
(20:37):
He is already fifty. Oh see, I don't know if he says
han't had his eye holding he has. If he's listening, I need doctor
Coco. Yes, that's right,and they'll set you all up. You'll
set the stage for all North Dakotin's. This is important. Let's get it
done. It really is important coloncancer screening and awareness. I love that,
my Josh, get on board.Is there anything else that you would
(20:59):
love to talk? Big thing isibs, And we talked about a little
bit about the mind affecting the gut, and a lot of us have some
element of IBS. A lot ofthat comes down to diet, the fact
that our foods are so overprocessed.When people go abroad and they go to
other countries, that'll come back toAmerica and we realize how unhealthy we are.
Oh my gosh, trying to makehealthier choices because that affects the gut,
(21:22):
and then the gut flora, eatmore fruits and vegetables and whole grains,
and the Mediterranean diet is such agreat diet, and really just try
and avoid all that process fast food. I think that is so important for
North Dakotas to hear, because it'seasy, it's quick. You get into
a habit and then you crave thosefoods, but you can break that habit.
Really try to make an effort toeat healthier because that will result in
(21:45):
the healthier gut and decrease your riskfor colon cancer and ibs. Some people
they hear that they hear their doctor'srecommendation. At times can feel like a
mount everest in front of you.Where do I still even start? Try
it for a day and I couldn'tget through it? Unfortunate in some element,
so addicted in this country to theseprocessed foods. They are made that
way with the trans fats and themsgs and just all these things that we
(22:08):
put in our body somewhat unknowingly.Yeah, if you're opening any kind of
bag that's been sealed, there's aquestion mark on that, like how many
times a day are you doing that? That's right, versus something that you
just ate that had a peel onit? Right? And is there moments
small ones like a snack begin theprocess instead of having something that you have
(22:30):
cracked open with a can or openinga bag that's been sealed, versus what
can I pick up that's either greenor has a peel on it? That's
right. We even keep it simple. No chips, no cookies, and
no white bread. If you stuckwith those things and then just try to
eat more fruits and vegetables with anapple a day keeps the doctor away.
But that's true. I mean appleis high in soluble fiber. We need
(22:52):
more fiber. Our guts need morefiber. Thinking about that, get rid
of those chips, cookies, andwhite bread. If you did that,
that would really make a big difference. The gut health perfection is obviously daunting.
You're also a real person. Youunderstand never ever's rarely ever. Work.
No, don't want it every day, break the habit of every day.
Save these things for the weekends ora special event, yes, like
(23:15):
you're going to the ballgame. Havea hot dog. Yes, I always
tell patients everything in moderation, justdon't eat those things every day. Thanks
for bringing that up, And ifanybody has any questions about IBS. You
might be living with it and haveno clue. Other causes of diarrhea could
be you've had your ball bladder out, IBS, CIBO, lactose intolerance.
(23:37):
There's a commission called microscopic colitis whereyou actually need colon biopsies, Crohn's disease,
ul schi of colitis. So yeah, I mean it could be IBS,
but talk to your doctor and getit checked out. Bring up symptoms.
You're dealing with diarrhea that gets tothe point where you're afraid to leave
your house, talk about it,next level, talk about it. We
can fix this. We can fixyour quality of life that should not be
(24:00):
hindering you from going out and doingspecial events, getting on a plane,
getting in a car. We canfix this. I love it, Doctor
Coco, you are fabulous in everyway. I just adoorio once again.
Thank you. I mean we spokefor a half hour in it five minutes,
yes, so thank you so muchfor your time. And absolutely I'll
see you in the future because thereis no way this relationship is stop.
(24:22):
Let's do it again. We haveso much to talk about. I don't
know if you can tell, butI had a smile on my face.
The entire conversation a lot of greatinformation from Gi doctor Coco at Essentia Health
got more episodes yet in this season, so stay tuned for the Daar to
Ask podcast. The information contained inthis podcast is not intended to be a
substitute for personalized professional medical advice,diagnosis, or treatment. The information is
(24:47):
general in nature. If you havequestions or concerns, please contact your provider.
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