Spotlight on IBS and GI Health: The Last Thing Millennials Want to Talk About

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By Melissa Schenkman, MPH, MSJ

It’s a subject you just don’t want to talk about. Anything related to our gastrointestinal tract (GI), the part of your body that digests food, absorbs nutrients, and expels waste, (to put it kindly), seems to be something best kept behind closed doors. But you can’t escape the headlines highlighting the rising numbers of colorectal cancer in millennials.

In recognition of Irritable Bowel Syndrome Awareness month, YMyHealth asked GI Specialist and fellow millennial,  31-year-old, Vineel Kankanala, MD, gives us his take on IBS and all things GI when it comes to millennial healthcare.

Vineel Kankanala, MD, showing his passion for gastroenterology as he poses for a photo underneath an inflatable colon at the Digestive Disease Week Conference.

YMyHealth: In your experience, what types of conditions do you traditionally see millennials present with?

Dr. Kankanala: The majority of millennial patients I have seen present with abdominal symptoms, such as pain or bloating that are usually related to irritable bowel syndrome (IBS). A fairly large minority of patients have inflammatory bowel disease (IBD). There are some other rarer diseases, but IBS and IBD probably constitute over 90% of the millennial age patients I see.

YMyHealth: What are some signs that millennials should look for or pay attention to when it comes to colon and rectal health? When should we seek medical attention?

Dr. Kankanala: GI issues are extremely common, so it’s hard to give blanket advice about when to seek medical attention and when not to. Repeatedly bloody stools, unintentional weight loss, and severe diarrhea, particularly the kind that causes bowel movements overnight, will always prompt further investigation.

Dysphagia, or troubles swallowing, can be a sign of eosinophilic esophagitis, an allergic, inflammatory disease of the esophagus that predominantly appears in younger patients, and it usually warrants further testing as well.

More common symptoms such as abdominal pain, nausea, bloating, and constipation are usually benign but are worth mentioning to your primary care physician to determine if you should see a gastroenterologist. When in doubt, always seek medical attention.

YMyHealth: For the past few years, there have been several headlines with studies saying that colorectal cancer is on the rise in millennials. In hearing this, what should millennials who have no genetic risk, signs, or symptoms of colorectal cancer do when it comes to protecting their colorectal health? Should they be getting a colonoscopy?

Dr. Kankanala: As you noted, the incidence of colorectal cancer in younger patients, including millennials is on the rise. Despite the incidence of colorectal cancer decreasing as a whole, colorectal cancer in people younger than 55 years of age increased by almost 2% per year from the mid‐1990s to 2014. That being said, the incidence is still quite low, only 1 in 287 men will develop colon cancer before age 50 compared to 1 in 29 for men above the age of 70. The numbers are even lower for women.

What can millennials do about this? First, if somebody smokes, they should quit! In addition to all the other health issues it causes, smoking is the number one modifiable risk factor for colorectal cancer.

Second, I recommend millennials make sure they know their family’s history. Most people know the history of cancer in their family, but current guidelines also recommend that if you have a first degree relative with an advanced adenoma (precancerous polyp), you should have your first colonoscopy 10 years prior to that family member’s colonoscopy. A lot of patients don’t know what kind of polyps they had, so you will likely have to consult their physician to find out.

Although rates of colorectal cancer are increasing in younger individuals, at this point, essentially all physicians agree the rate is still too low to justify a colonoscopy in millennials who have no known risk factors for colorectal cancer. Colonoscopies are extremely safe, but no invasive test is 100% risk free, and there is likely more potential for harm than good in doing routine colonoscopies in millennials.

YMyHealth: On the flip side, should millennials who have something like IBS or periodic changes in bowel habits, consider getting a colonoscopy?

Dr. Kankanala: Prolonged or particularly severe diarrhea is almost always worth a colonoscopy. Colonoscopies are rarely necessary for simple constipation. Generally speaking, most gastroenterologists do not like officially diagnosing someone as having IBS until they have done an upper endoscopy and a colonoscopy to make sure there are no other diseases in play.

YMyHealth: When it comes to our age group’s diet, what foods should be must-haves for colorectal health? Which ones should we try to toss?

Dr. Kankanala: Fiber is extremely important for the colon, and it’s become increasingly scarce in the average American diet. Beans, lentils, nuts, and vegetables are all great sources that we should strive to incorporate more of into our diet.

As for what to toss, a few years ago, the International Agency for Research on Cancer, a division of the World Health Organization, classified processed meat as a carcinogen and red meat as a probable carcinogen. This is based on evidence they had linking it to colorectal cancer. I recommend eliminating or at least minimizing the consumption of these foods for people who want to minimize their risk of colorectal cancer.

YMyHealth: What other things would you recommend that we do in our 20s and 30s to maintain our colorectal health now and for our future?

Dr. Kankanala: Whether fortunately or unfortunately, genetics and luck are the biggest determinants of who will get colorectal cancer or other diseases. Similar to most other conditions, the best thing you can do is eating a healthy diet, exercise, and live well. Otherwise, make sure to get evaluated if you develop any issues and plan to get your colonoscopy at age 50 (45 if you’re African-American).

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