Ask Dr. H: A better way to prep for your colonoscopy

Question: When are they going to have a better way of preparing for a colonoscopy? My doctor keeps reminding me that I need one, but it seems like such a hassle! - F.P., Tacoma, Wash.

Answer: The worst part of a colonoscopy is the bowel prep. A clear, liquid-only diet the day before the procedure is not fun, either. The procedure itself is a breeze. With the superb short-acting intravenous sedation used nowadays, not only will you not feel the scope, but you'll probably never even see the scope either. Just one hour after I awakened from my last colonoscopy, I was alert and eating lunch.

There's a brand-new bowel prep that might make the experience a whole lot easier. On July 16, the FDA approved Prepopik powder to help clean out the colon before colonoscopy. The recommended cleansing regimen is to dissolve a small packet of citrus-flavored laxative powder in just five ounces of cold water, taking one packet the evening before the planned procedure and a second packet dissolved in five ounces of cold water the morning of the procedure. The evening dose is followed by the consumption of 40 ounces of water or a clear liquid of your choice; the morning dose is followed by the consumption of 24 ounces of water or clear liquids. This is the simplest bowel-cleansing regimen to date.

Colon cancer is the No. 2 cancer killer in the United States (behind lung cancer), and yet is also one of the most preventable (and curable) cancers - if caught early by colon screening. Unlike breast cancer, colon cancer (in nearly all cases) doesn't just appear. It begins as slow-growing and completely silent precancerous polyps. If we can find them, we can nip a potential problem before it causes harm. To do this properly, the doctor needs to be able to see everything clearly on the inside. A colon filled with stool is impossible to examine.

Q: I read an article that described a big jump in the number of children with juvenile (type 1) diabetes. I can understand the big increase in type 2 diabetes from today's obesity problem, but why would rates of diabetes in children be going up? Is there something in our food or environment to blame?

- T.U., Orlando, Fla.
A: It's definitely a real phenomenon. The incidence of type 1 diabetes (an autoimmune condition in which the young person's body attacks its insulin-producing cells in the pancreas) is now twice as high as it was in the 1980s, and 10 to 20 times more common than it was 100 years ago. While rising rates of type 2 adult-onset diabetes can be explained by the obesity epidemic, the incidence of type 1 diabetes should be relatively unchanged over a few decades.

We don't know for sure what's causing the worldwide trend toward higher rates of type 1 diabetes, but several hypotheses have been proposed:

The hygiene hypothesis: The lack of exposure to once-prevalent germs results in autoimmune hypersensitivity and the destruction of insulin-producing cells by rogue white blood cells.

The sunshine hypothesis: Increased time spent indoors is reducing children's exposure to vitamin D. Lower vitamin D levels are linked to an increased risk of type 1 diabetes.

The accelerator hypothesis: The rising height and weight of children has accelerated their risk of type 1 diabetes by stressing the insulin-producing cells.

The cow's milk hypothesis: Exposure to cow's milk during the first six months of life wreaks havoc on the immune system and increases the risk of type 1 diabetes.

The "POP" hypothesis: Exposure to "persistent organic pollutants" in our environment increases the risk of diabetes.

To learn more about this disturbing and puzzling trend, read Diabetes Rising: How a Rare Disease Became a Modern Epidemic, by Dan Hurley.


Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H," Box 767787, Atlanta, Ga. 30076. Due to the large volume of mail received, personal replies are not possible.