Gut Check: What You Need to Know About Colorectal Cancer

🎙️ March is Colorectal Cancer Awareness Month, and we’re getting straight to the gut of it! Erin sits down with Board-Certified Gastroenterologist Dr. Timothy Jenkins to talk prevention, early detection, and what you really need to know to keep your digestive health on track. Don’t miss this essential conversation—it could save your life! 

Transcript

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Erin Brinker: 0:00

Erin, welcome to the making hope happen radio show. I'm Erin Brinker, and I'm so excited I have a great guest for you today. But before we get started, I want to Well, keep with the tradition and tell you what I'm grateful for. As a reminder to my podcast listeners, this program airs on two radio stations in Inland Southern California on Sundays. That's X, 95.7 at 9am and kql, H, 92.5 at 7am and gratitude is a great way to start your day and week and and honestly, any day at any time, I am grateful for the rain that we had last week and the flowers that are coming. We don't get a long season of green landscape in our area, and spring flowers are fleeting, but I love them when they bloom, the lavender in Cherry Valley, the poppies in Lancaster, and the beautiful, diverse flowers of our rolling hills and mountains, they're just joyful. My favorite flower doesn't grow here. It's the Blue Bonnet, which grows wild in the Texas Hill Country. It's worth a trip just to see them. Storms in the winter bring flowers in the spring, and flowers, of course, are emblematic of renewal and hope. A few weeks ago, I talked about my gratitude for the things that challenged me in my life, the storms you see, bring flowers in the spring, and it was, as was written in Ecclesiastes and sung by the birds, for those of you all who were there in the 60s or just enjoyed it later, for everything, there is a season and a time for every matter under heaven, a time to be born and a time to die, a time to plant and a time to pluck up what was planted a time to kill and a time to heal, a time to break down and a time to build up, a time to weep and a time to laugh, a time to mourn and a time to dance, a time to cast away stones and a time to gather stones together, a time to embrace and a time to refrain from embracing, A time to seek and a time to lose, a time to keep and a time to cast away, a time to tear and a time to sow, a time to keep silence and a time to speak, a time to love and a time to hate, a time for war and a time for peace. And so when you're going through those stormy seasons. Just know, be grateful, because the spring is coming. All right. On to our guest. Did you know that March is colorectal cancer awareness month? I didn't, but today we're going to hear all about it. I am so honored to be interviewing Dr Jenkins. He is the Area Medical Director and Chief of Staff at Kaiser in San Bernardino County, and a board certified gastroenterologist, and he's joining us today to talk about all things colon health, which colon cancer is a scary thing and it hits more people than you think. Dr Timothy Jenkins, welcome to the show.

Dr. Timothy Jenkins: 2:59

Thank you so much, Erin, it's just such a pleasure to be here. I really appreciate the invite, and like you say, Sure, it sure is Colorectal Cancer Awareness Month, so I do appreciate your bringing some focus to this really important topic for the public and for everyone's health. We all have a colon. You know that we're born with some of us don't have one, and we have conditions that may lead to it, you know, not be still being there. But for those of us that do have our colon, it's a really, really important part of our body, and want to take good care of it. So

Erin Brinker: 3:33

why don't we start at the very basics? Uh, what is a colon? Because I think people have an idea, but they may not really no. And obviously, colon does include part of the rectum, or is that not considered part of the colon?

Dr. Timothy Jenkins: 3:47

It is Erin. It is part of the part of the colon. The rectum is part of the colon. And you know, and in the course of this discussion, we may be using some words like rectum or anus, or areas like that that are anatomical descriptions, but that's just the medical term that we have for that, and those are the names for those areas. These aren't often things that we discuss kind of at the dinner table or a polite company, but you know, it's really, really important, and it's important that these areas stay healthy. So absolutely, the rectum is a part of the colon. And I can certainly talk about the digestive tract and where the colon fits into all this,

Erin Brinker: 4:26

yeah, if you could, because I you know what people talk about. May I have a belly ache, or I have gas, or they just, they, it kind of is generic for all of the abdominal organs. So specifically, what is the colon?

Dr. Timothy Jenkins: 4:38

Sure, sure. Well, the colon is the the final part of the digestive tract that food moves through as it's taken in through the mouth, processed by the body, and then the waste products are expelled out through the end of the colon, which is through the anus, and out through the waste and so so there are several main major parts. Of the digestive tract that I can talk about, but the colon is the very last part of that sequence. So when you eat some food, of course, you put it in your mouth and chew and and swallow, and the food first goes into what's called the esophagus. And so that's a it's basically looks like a tube or a pipe that connects the mouth and the throat all the way down to the stomach, which sits kind of in the middle part of your abdominal area, kind of the middle section below your rib cage. And the food goes into the stomach. It's then it's, starts the digestive process. Or the stomach has acid, it churns, it squeezes, and it breaks the food into much smaller pieces after the stomach and the food sits there, typically 123, hours, maybe a little shorter, maybe a little longer, depending on whether it's liquid or solid or what you've eaten. Then it moves out of the stomach into the small intestine. The small intestine is about 20 feet long. So if you can imagine having a 20 foot long digestive organ kind of all coiled up in your midsection. That's really what it looks like. If you take an x ray, it shows it's kind of this coiled almost like, kind of like a snake foiling around 20 feet, 20 feet. That's crazy. It really is, if you think about it. And so the food goes in there. And the reason why the small intestine is so long is because human beings are designed in a way that it we are able to extract out all the nutrition out of that food, and there's a lot of surface area and a lot of link that's needed to be able to really get squeeze out every last bit of nutrition out of that food. And so the small intestine is that 20 foot long organ that food passes through after it's been kind of broken into small pieces, and that's where the main nutrient absorption happens as the food passes through the body. So there's a 20 foot long journey, and when it reaches the end of the small intestine, which is typically located down in the right corner of your abdomen. So if you look at your right hip, and you kind of kind of push down in that area a little bit, that's the typical place where the small intestine connects to the final organ in that process, which is the colon. And so now we're in the colon, and at that point, the food is still somewhat liquid. It's kind of been mostly digested all the nutrients extracted in that when it heads into the colon. Now it's a process of extracting out whatever water and liquid remains in that digested food, and it also becomes a solid as it moves its way through the colon, all the way down to the rectum, before it passes out with a bowel movement. And so, so the colon itself is typically about six feet long. It doesn't really kind of coil back and forth like a snake, like the small intestine, like I just described. It's, it's, if you looked at it straight on, like, say, I'm looking at you, Erin, and you're just standing there, your colon is almost like in the shape of a question mark. And so the and the and the tip of that question mark is over in the right lower side of your abdomen as you look down, if I'm looking at you, it's more to my left, and it and that's the end of that question mark. So it goes up toward the upper part of the abdomen, toward the rib cage, along the right hand side. It then crosses over the abdomen, over to the left hand side, up under the rib cage, and then it goes back down. So that's like the top of the question mark. Then it starts to come down. It makes a little little squiggly turn, like you see with the question mark itself. We call that the sigmoid part of the colon. And then it and then it goes down into the area where the buttocks and the rectum area is, and that's the very last part of the colon before the waste products are expelled out, out of the anal area. But that's the journey that it takes. It's about six feet long, and it goes from a liquid form when it first enters the colon all the way to the end, where it's usually solid. Now somebody's having diarrhea, or they're having loose bowels and so forth. In those situations, it's more liquid, but the typical bowel movement does have a more of a solid form. So

Erin Brinker: 9:16

so how does cancer develop in the colon? In that and I'm sure there are lots of different ways to answer that question, because I you know, people say, Oh, if you eat bacon and cured meats, that you're going to get cancer, or if you do this, that and the other thing, you're going to get cancer. And other people say, No, it's perfectly fine. So let's talk about how you might end up with a diseased colon. Sure,

Dr. Timothy Jenkins: 9:37

absolutely. Erin, so, so cancer is a condition where there's an abnormal growth of cells that are happening inside the colon. And when we talk about the cancer in the colon, the colon has several layers to it, if it, if you look at, if you took out the colon and look at it, it is like a it's like a hollow channel with that's a tissue. But there are actually several. Layers to that. And the cancer that typically forms in the colon is the innermost lining of that tube, and that's called the mucosa. That's the medical term for that. But those cells that line the inner part of the colon, those are the ones that can become a cancer. And what's a cancer? Well, a cancer is an abnormal growth of cells that that continue to grow, and they can spread, and they destroy the other tissues that they're located in, and they can actually dislodge from where they start, and they can end up in other parts of the body, like the liver or the lungs or other places and and of course, it's it's a deadly condition, if it's not treated. Cancer is often a fatal condition, and people, people won't survive that when it's not treated. And so that's what we mean by colon cancer. And the cancer can happen anywhere in that six foot colon that I was just describing. It can happen starting down in the rectal area at the very end. It can happen in the part of the colon where it first joins the small intestine. We call that the cecum cancer in that location, or really anywhere in between, and so, so this is what we want to prevent. And if we have, if it's not prevented, if it's formed, we want to find it as early as we can so we can treat it and cure it. So

Erin Brinker: 11:22

well you answered the you've kind of already answered the question, but I'm going to ask you anyway, why is it important to get screened for colorectal cancer? Because I color rectal cancer, and forgive me, for whatever reason I'm having a difficult time saying that. You know, because I know that, especially if you're over the age, I think of 40, you start getting, if you're a member at Kaiser, you start getting, once a year, you'll get a little packet in the mail, say, take a sample and send it in. And I think once you're over 50, you get colonoscopies, you know, because they're, they're looking for stuff. So, so, you know, why is it, why is that early screening

Dr. Timothy Jenkins: 11:57

important? Well, thanks, Erin, it's a great question. And you know, there's many, many different types of cancer. There's cancers in all types of the body, all places in the body, sorry. And colon cancer is very common. It's, it's the second leading cause of death from cancer in men and women. And there's about 150,000 cases in the United States every year. Wow. And so it's a common, it is a relatively common condition. There's about a one in 25 chance of any of us. Me, you anyone having a colon cancer over the course of our lifetime? So we're, we're not talking about something that's extremely rare.

Erin Brinker: 12:34

No, you know, I'm thinking about a classroom that has 30 kids in it. That means one kid in that classroom is going to get colon cancer.

Dr. Timothy Jenkins: 12:41

There you go, on average that. That's kind of how it works out. So it's so it's pretty common. So that's the So, that's the sobering, that's the news where, you know, we have to look at that and say, Wow, this is, this is a major public health issue for for people in the United States and all out and throughout the world, frankly, and so, so the goal of cancers is prevention. And so cancers that are tend to be slow to develop and slow to grow, which describes colon cancer. Most colon cancer is a perfect target for something where we can try to find it early, and with cancers earlier, you identify it and diagnose it, the better the prognosis, the more chance that you'll have of surviving it, and the less chance it has of being something that's going to be a deadly diagnosis. So we really want to find these things early. Well, colon cancer is perfect for screening because it grows, it starts as something that's not a cancer that we can identify. We can see it if we if we examine the colon, we can find abnormalities that have a risk of turning into cancer, but they haven't yet. So that's a good thing, because that's where we can take action before there's even a cancer. And then when it becomes cancer, it's still, it's still something that doesn't progress, say, in days or weeks, it's still typically months of a progression that it takes before it really becomes advanced, and something that it's going to be going to be more challenging to treat and so so it fits in those categories, it makes it a really good target for us to do screening. And what is screening? Well, screening means something where you you say you're going to be screened for something. You have no symptoms, you have no concern, there's no stomach pain, there's no bowel problems, there's no bleeding, nothing like that. You're purely doing a test as a screening, meaning, do I have anything that's showing that could indicate that I might have a cancer or something that could become a cancer, and so that's really where we put all of our efforts, and not just at Kaiser Permanente, but you know, throughout the nation, there's health systems are doing this everywhere, looking to screen for colon cancer, and you talked a little bit about the ages and part of the. Part of the challenge that I have as a gastroenterologist is keeping up with the latest guidelines on who should be screened. And you mentioned age 40 about a screening of sewol samples, and age 50 for colonoscopy. And these guidelines have changed over the years. So I could talk a little bit about that, like, Yeah, please do the screening. Certainly. Erin, yeah, absolutely. And so there's really, it used to be several years ago that the cutoff for screening was age 50, and you know, I, I'm, I'm a little past, on the other side of 50. I won't say exactly about two years, a few years past that. And so I am in that age category. So when I turned 50, the guidelines were still to start at 50, so I started my screenings a few years ago. In recent years, it's actually decreased to age 45 and part of that was because what we were seeing as gastroenterologists is younger patients coming in with cancer. And we noticed that, and when we look back at the data and did the information, we found that, wow, the number of people we're seeing who were diagnosed with colon cancer before the age of 50 has doubled since the 1990s mostly. Yeah, it's, it's pretty, pretty amazing to think about. Just in a manner of a few decades. You could have that kind of a change, and we're still seeing them, mostly close to the age of 50. It's it's still quite rare for someone in their 20s or or 30s to have a colon cancer. It happens we do see it, but that's still on the more rare side. But we were seeing more patients, particularly in their late 40s, getting colon cancer. And so a few years ago, the guideline changed to move it back to 45 so right now, if you have no family history, no risk factors, no symptoms, woman or man, we do recognize, we do recommend that you have have screening begin at age 45 and so that's the current guideline. And so how do you do the screening? Well, there's really, there's really two primary ways of doing that, and you mentioned the most. So Erin, you you already know a lot about this, and you're, you're sharing that with the public today, but they're really these two methods. So a colonoscopy, we call, kind of like the gold standard, that's really the most complete exam of the colon, and it's a procedure that only needs to be done once every 10 years, and we can talk about what is a colonoscopy and how we do all that. I'll get into that a little later, if you'd like absolutely, yeah, that's a that's the one of the screening procedures that we do. I do that procedure. I've done 1000s and 1000s of those procedures, and I just did a series of them just a few days ago. And so that's one option. The other option is to give a small stool sample that's tested for a trace of blood. And so this isn't like a bloody bowel movement. This is just what looks like a normal bowel movement, and there's a microscopic amount of blood that could be there, and there's tests that are able to test for that. And if that test is positive for a trace of blood, then we recommend the colonoscopy. The thing about that test, it requires it to be done every year, and so if one starts at age 45 and it's say they do the stool sample, it's negative, they've got to come back and do it again. At age 46 it's negative. Age 47 it's negative. And some people prefer that. I, as much as I enjoy performing colonoscopies, I It's a, it's a, I've had one myself. I do understand not everyone wants to have a colonoscopy. So that's, that's, you know, that's just the way the world is. And so given that we have this other option for them, and as long as those stool sample tests every year are negative, we have enough evidence and data and science to show that the risk of colon cancers is very low. So

Erin Brinker: 18:51

there's you can't have cancer absent any blood. So is it possible that you have a cancerous polyp, or whatever, and it and you don't have any blood present the stool, yet,

Dr. Timothy Jenkins: 19:02

it is possible, and so is the test. So any screening test we talk about, how sensitive is it, how accurate is it, those types of things, and so those stool samples are highly accurate, and they do, they're very, very effective. They say, with there's lots of evidence going back, I'd say 4050, years now, from studies showing they're very effective at finding cancer, diagnosing it, finding early cancer, finding other conditions that can lead to that, and they save lives. So there's proof of that. Are they 100% accurate? No, they're not, and so and so there has to be the understanding that if I do that test and it's negative, I'm very, very unlikely to have a colon cancer. However, I still need to do that test every year, and it's really the process of the yearly test that really is what makes it really strong, a strong way of screening colonoscopy is highly accurate. But it also is not 100% and there's even some situations where very, very rarely, extremely rarely, where there may be something that's a small finding, or something that's just not very difficult to identify that could be there. So even that test is not 100% but I will tell you, both of these tests are very, very good. They save lives. They they, you know, really should be done. You know, any people you know, family members, people in the public anywhere, should be having one of these tests done. Because if they don't, like I said at the beginning, there's a one in 25 chance that someone could have, you know, a cancer in their lifetime. And this really, really lowers the chance of that ever happening so, so it

Erin Brinker: 20:42

strikes me that you said that we've there's been a doubling since the 1990s of incidences of this. I'm like, okay, so what was going on in the 1990s we saw a dramatic increase in childhood obesity and and obesity overall. I mean, before that, you know, people were, you had people all over the spectrum, but a far, far smaller percentage of Americans were overweight or obese, and it's just exploded since then. And so I imagine that that weight has a big in sedentary lifestyle has have dramatic impacts. Kind of talk about what, what you can do with your with your lifestyle, to help prevent it? Yeah,

Dr. Timothy Jenkins: 21:18

it's a, it's a really great question. And and when I say doubling, it's doubling in the young people. So and to be, you know, just to just to be clear, it most colon cancers are still a condition that happens in people over the age of 50, or even over the age 60 or 70. It's more common that colon cancer happens in the older population. But we did see a doubling in the under age 50 cancers. And so we asked, like the question you just asked, Well, why? How could that be? And there's a lot of debate happening in the medical community, just like you just said about, well, what was going on between 1990s and 2025 that could result in this? And you are spot on in terms of your conclusion that obesity is one of those areas where where we have seen a significant increase in the public and so and so. If we look back at obesity rates from the 70s, 80s, 90s and beyond, those rates have been going up, and we also see more conditions like diabetes happening, which is associated with obesity. And if you look at those two risk factors, both of those are associated with with colon cancer. There's a risk if someone has obesity or diabetes or both, there is a higher risk of developing several cancers, not just colon cancer, but several and so those are a couple factors. So I do agree with you. I think from everything I've read and and studied, I do think that's a factor from the 1990s you know, some other, some other medical experts have really looked at, well, is it anything in you know, how we process our food, for example, is that different? And you could think about, well, the types of diets that people had years and years ago, when our country was much more of a rural, rural society. We kind of got things directly from the farm, and there wasn't a lot of processing and all that. And you flash forward to today, and it's, you know, everyone's on the go, and we, you know, there's processed food and fast food and all that, and we kind of get things quickly, but there's a lot more processing involved there. There is evidence to show that some of the you know, like highly processed types of foods, can be a risk factor as well. And so it could be, not only that, and these all may be connected, it can be maybe that the processed foods that have our high fat content and a lot of processing are also associated with obesity, and those are things are associated with diabetes, and they're also connected to higher rate of colon cancer. So I think it all starts to connect together. It can have to do with the fact that we're eating more processed foods, higher fat content foods, there's more obesity. And all those things are working together, especially in young people, you know, these days, to to increase those cancer rates, you know, I

Erin Brinker: 24:13

I've got to thinking you talked about when we're a more we were a more agrarian society. But even even in before screens became ubiquitous, young people, especially, maybe they were eating that high fat diet, but then they were active. They were outside. I mean, kids would go outside all day long and play, and they're moving their bodies and not they're not eating a big meal and then sitting, which is very much, especially since COVID very much what the world seems to be doing, or at least the United States seems to be doing, and I and physical inactivity. Okay, so I'm, I'm going to ask a so for those of you all who have sensitive stomachs, be warned, I'm going to

Dr. Timothy Jenkins: 24:52

ask a very good question. It's all fair game.

Erin Brinker: 24:55

I would imagine that the presence of material filling your. Colon sitting there for a long time would make it more likely that you would that things would go sideways, whereas opposed whereas moving improves motility. Is that correct? It

Dr. Timothy Jenkins: 25:11

well? So that's interesting, and that's a it's a wonderful topic, and I get in a lot of my patients ask me about that, and they could, because I see patients with different gi conditions, and one of them is constipation, though, you know, I get referred a patient from primary care, and then Dr Jenkins has got this constipation, and I just have difficulty with bowel movements in my everything sits in my colon for a long time. And one of the questions is like, what you just asked Is Dr Jenkins, am I at higher risk for colon cancer? And you'd think, you know, well, this waste product is sitting in the colon for a long time. Gee, Shouldn't that be something that's that can be, you know, cause cancer. It's, maybe it's, you know, waste material sitting there. You'd think that would be something that you'd reason would be the case. But it turns out that we really, we really don't see that that's the case, which is, which I find very interesting. And it actually if we, if we take that one step further, and we have a group of patients that have something called inflammatory bowel disease, and this includes something called Crohn's disease and ulcerative colitis, these patients tend to have diarrhea, and so these patients have frequent bowel movements, and they're always needing to go to the bathroom. And you think, well, well, maybe that's a good thing, because they're getting the waste out of their body. But as it turns out, there's inflammation in the colon lining, and that predisposes them to colon cancer. We do actually, for patients who have those can diarrhea, inflammatory conditions like Crohn's disease and ulcerative colitis. It's those people, those patients, are needing colon cancer screening even at an earlier age. Some of them I'm, I'm seeing in their teens or 20s, to do their colonoscopies and screen because of the risk. So it's, it's a little bit of the opposite of what you think, like the constipation is, is not the risk factor. It's more inflammation, diarrhea, with Crohn's and colitis that do that. But it's a really good question. And you're, you are definitely not the first one who that, who asked,

Erin Brinker: 27:15

Well, that's good, that's good. I'm going to ask a dumb question. I hope it's been asked before.

Dr. Timothy Jenkins: 27:19

No, no. It's a really good question. It's an excellent question.

Erin Brinker: 27:23

So, you know, it's interesting, because I've talked to other physicians about the impact of inflammation on the body, and and, and, you know, maybe people are are consuming more products that cause inflammation. You know, whether or maybe our lifestyle, maybe it's environment, you know, maybe they're drinking sodas or diet sodas, or maybe they're, I don't know, eating fast food that causes inflammation. And so it seems like inflammation is a big risk factor.

Dr. Timothy Jenkins: 27:50

It really is, and it's and in particular, that those two conditions I just talked about, Ulcerative Colitis and Crohn's disease, and those conditions are, are where the body's immune system, in which is your body's defense against infections, overreacts to a part of the body, and in this case, it's the colon. And so if you if you look at the colon, and some patients that have Crohn's and Colitis, it's damaged. It has ulcers. It's inflamed. It's red. It sounds miserable, those poor souls. Yeah, it really is. It's a, it's a very difficult condition. And it's, it's, it's, it's fairly common, actually, and so and so that's what's happening. And it's the body's immune system, if, if you kind of back up from that, and think about it, that the body's immune system is designed to prevent infections from getting into your body. So you have, you may know about your white blood cells, and you have all the different types of white blood cells. So if a bacteria gets into your body where it isn't supposed to be, like in your bloodstream or in your lungs or places like that, the body's immune system goes in and attacks and kills that bacteria, that virus, whatever that might be trying to invade your body. Your immune system is your defenses. Well, so patients who have inflammation conditions like Crohn's and Colitis, the immune system, there's something about it that it makes it the body itself is what it needs to fight. And it goes in and it starts damaging the colon, and that's where you have have the issues. And it's, you know, as I think about it, I always have been fascinated with GI for for a long time, since medical school and my internal medicine training. But the here you have a large organ in the body. You've got the small intestine, 20 feet long, colon, six feet long, filled with bacteria, because the waste product includes bacteria inside your body. And what's amazing is your immune system is not attacking that colon. If here it is, a full of waste products and bacteria going through your body, and the immune system not. Is just kind of, you know, looking at it, but not really. You're not really attacking that in a normal condition, which to me, is just fascinating, miraculous. It really is. It's miraculous how that actually happens. And it's only when the body's immune system turns on itself, is when these inflammatory conditions happen. So so your body is designed to tolerate bacteria going through the digestive tract. When you eat some food, you know, we, you know, our foods clean and all that, we have to make good precautions of it. But there's always some bacteria. There's bacteria in your mouth that live there. There's some bacteria in different you know, and basically, in everything, we wash it, we clean it. But there's bacteria, and there's bacteria that live inside your body, and your body just tolerates that, and it does okay with it. So, so that's where there's a lot of research in terms of, well, what causes that switch from the body tolerating everything with the bacteria in that and doing okay, to going to saying there's a problem, and it starts attacking the colon, and then you've got inflammation. So So that's just one example. There's other other examples that we could talk about, but that's, I think that's probably the best one I can think of, involving the colon.

Erin Brinker: 31:14

So what are some of the symptoms of colorectal cancer? We've talked a little bit about blood in the stool, whether it's visible or not. What are some other symptoms? Sure.

Dr. Timothy Jenkins: 31:22

Yeah, so, so bleeding is one of them. Although bleeding tends to happen visibly, like a patient has a bowel movement and they see they see blood, and that's something anytime someone sees that, that's that's not a normal condition, and that's something you should check with your doctor about if you see blood with a bowel movement. But it tends to happen when the colon is down there, near the rectum of the very end of the colon, if there's a colon cancer over at the beginning of that question mark that I talked about, and there's some bleeding that happens by the time it passes through that waste and it kind of goes all the way through the colon. You don't really see anything. It just looks like a normal bowel movement. So bleeding is is can be a sign it often is not. Hemorrhoids can bleed. There can be other causes of bleeding, but that's one symptom. But in terms of the other symptoms, as colon cancer grows inside the colon, it can do a couple of things. It can cause abdominal pain. So patients with a colon cancer, if it's reaching a larger size, it can put pressure on the nerves and the nerve endings around the colon area where the cancer is located, and that can be painful. So if someone has, say, abdominal pain in a certain area, you know that's also something they need to see their doctor and be evaluated for most of the time. It's not a colon cancer. There's many causes of abdominal pain, but that is one of the symptoms that it can be. The other could be a change in bowel habits, and it can be either constipation or diarrhea. And so the way to think about that is the colon is like a it's like a hollow tube. It's, it's, I'd say, 234, inches across as the bowel movement moves through there. And a colon cancer is a very hard, firm growth inside the colon. So as that colon cancer grows, you can imagine, like, say, you had, you know, a tube, and there's something in there increasing in size, what's going to happen? Well, it's going to start to cause a blockage, and the blockage doesn't happen all at once. It tends to, tends to increase slowly over time. And so what can happen is, a patient's had normal bowel movements their whole life, and then they say, Well, Dr Jenkins, last two or three months, I've noticed, you know, I'm having trouble with bowel movements. I've become constipated when I never used to have that. And so that's something that needs to be evaluated as a change in bowel habits. The other thing that can happen is it can go from normal to diarrhea. And that can be just because it all that can get through the partial the partial blockage of the colon is just some liquid. And so they go from having normal bowel movements into liquid. And so if you, if you're going along normal, and we're not talking about just like a one day change, because, you know, you might eat some food or something that that's not good, and you have to

Erin Brinker: 34:12

have a to Taco Bell. I'm joking. I'm joking, but just

Dr. Timothy Jenkins: 34:16

joking. But you know what I'm talking about? Like, there's, there's kind of, what you know, these, as I mentioned, colon cancer take don't grow in days or weeks. They progress over a longer time. So we're not talking about a one day change in bowel movement, but if it's something that happens over a period of weeks, either diarrhea or constipation, it really is something you need to see your doctor and and be evaluated for and so so those would be the two other so abdominal pain and change in bowel habits in addition to bleeding. Now there are some other general symptoms of cancer. One of them is progressive weight loss. And weight loss doesn't tend to happen when the colon cancer is still just contained in the colon. But if you recall I mentioned about colon cancer can spread to other. Parts of the body, like the lungs or the liver. And so when, when it spreads, it starts to cause like we call an anorexia, where people just don't want to eat. They're not hungry, and they're kind of just, we say, wasting. They're losing weight. And so progressive weight loss that can't be explained. The person's not on a diet. They're not, you know, they're eating, they may not be so hungry, but they're losing progressive weight. Week after week after week, their weight is going down. That's, you know, that's potentially a serious symptom, that could be a symptom of a colon cancer that's spread to other parts of the body and is causing those symptoms. And what happens is, the tumors produce different factors that go through the bloodstream, and they they can shut down appetite, they can cause nausea, they can cause weight loss, and so, so that's, that's another symptom, but that tends to be the progressive weight loss tends to be a more advanced symptom of cancer.

Erin Brinker: 35:57

So, you know, I, I've known people who have had what I'll call irritable bowel syndrome, or what is called, maybe it's not called that officially, but that's what I know it as, where they have they cycle that. Sometimes they have constipation, sometimes they have diarrhea, and, you know, they've gone to their primary care physician or whomever, and they're really just kind of told, yeah, you have IBS. Sorry. Stinks to be you, you know, what is that? Why does that happen? You know? Yeah, really

Dr. Timothy Jenkins: 36:27

good question. And in medicine, in some aspects, we're still asking that question a little bit, because it's, I think there's still more research being done and trying to understand that. And you're absolutely right. It is called irritable bowel syndrome. You're correct on the medical terminology. It's a it's a real diagnosis. It's a condition that's extremely common. So if we were to say one in 25 lifetime with colon cancer we're talking about, I'm trying to remember, I mean, it's common. It could be 2010, 20% of the have irritable bowel at some point in their lifetime. So that's like one in three, one and four. And in irritable bowel syndrome, if I do a colonoscopy and look inside of the person's colon who has irritable bowel syndrome, it looks completely normal. It there's no cancers, there's no abnormalities. There's nothing like that causing it. There's no inflammation. The lining looks healthy. The bowel looks healthy, you know, all of that. And so you look at that and say, well, wow, it's normal. Why am I, you know? Why am I having diarrhea, one day constipation, one day of my gut, stomach cramping and all that kind of thing, you know? Why is that? And the reason behind that is due to something called motility. And so how does this waste product make it through the colon? You know, I've just described that you've got something shaped like a question mark that goes down in your by your right hip. It goes up across to the rib cage, across the side, and then back down again. So clearly, it's not gravity that's, you know, that's pulling all that stuff through there. That's because it has, it has to go up. It's going, you know, away from the ground. Yes, you're standing on your head. You're standing and you're right. And as we know we did that, we we don't, you know, that's, that's the amazing thing about our bodies. We don't have to stand on our head, I guess, our food and get our colon to work. So, so how can that be? Well, it's something called motility. So if I'm in, if I'm doing a colonoscopy, performing a procedure, and I'm inside with a camera inside, say I'm say you're having the procedure, and I'm doing that, so I'm inside and looking at the colon, what you see is this contraction movement, and it's and it contracts down, and it opens back up. And it's kind of like, I don't know if you see like an inch worm, or an earth worm or something, where you'll see how the worm, part of the worm contracts, and then it elongates and, yeah, like a wave. It looks exactly like that, except you're on the inside, and what that's doing is for the material that's in there. It's propelling it forward. So it's a squeezing motion that propels everything through. And so when it's in a normal condition, you're not even feeling that like I'm sitting right here right now, I feel fine. My colon is working. I think it's working. I

Erin Brinker: 39:17

hope it's working.

Dr. Timothy Jenkins: 39:19

No problems today, and it's but if you if I were to have a way right now of looking at what my colon is doing, it's doing that constant contracting motions, and it it's about three or four full contractions every minute. And there are these waves of contraction that come down. We don't feel it, we don't know about it. It's happening. And then what happens is, it pushes everything to the end. And then, you know, the average bowel movement seems to be about two or three a day to two or three a week. There's a range that's normal. Then there'll be a bowel movement, and that's kind of the end result of all those contractions. So what happens with back to irritable bowel syndrome? Them is that people start perceiving those contractions, and it can show up in several ways. It can be pain in the abdomen, it can be constipation, difficulties. It can be diarrhea, or it can be a mixture of the two, conservation, alternating or diarrhea, and all of those we call irritable bowel syndrome, we have different abbreviations, like IBS is the abbreviation irritable bowel syndrome, dash c for irritable bowel syndrome, constipation, and you have IBS that's mixed for the alternating and you have IBS with pain as a predominant symptom. And we believe that there's something about something that changes or happens in the body where people start to feel those contractions as pain, and it causes abnormal bowel movements. And so, so that's and so the treatments for irritable bowel syndrome are really more aimed at the nerves that control the colon and cause those motions to happen, and that's really where our best treatments have been. Now there's other treatments as well, like a high fiber diet. We find that people with a low fiber diet tend to have more pain and more difficulty with their bowel movement. So that's a that's a recommendation. We find people that don't drink enough fluids and water throughout the day, have can have difficulty. We find people that don't exercise can have worsening of the symptoms. So there's things you can do if you have irritable bowel syndrome that can help with it, that are not medication and that don't give medicine that's going to go after the nerves in the in the GI tract and then the colon. But really, that's what that means. But if you look at the colon itself again, it's normal. There's not an increased risk for colon cancer. We don't find more cancers in patients with irritable bowel or normal. It's there's not an association with that. And so, so hopefully that summarizes a little bit about it, does

Erin Brinker: 41:58

it? Yeah, it does. And it makes me wonder, you know, is, is the volume, how the volume of food that a person eats impacts their their colon and their digestive system? Is it better? You know, you hear a lot of hubbub about intermittent fasting, but you know, is it, is it better to have less food in your digestive system on a more regular basis. And, you know, save the feast for those special days. You know, are we just eating too much?

Dr. Timothy Jenkins: 42:26

Right? Really good question. So, you know, the colon is, is not so much the gatekeeper. We call it like the gatekeeper, what food's coming in, what, how's it going through? That part is really more the upper part of the digestive tract, and especially the stomach. And so the stomach is like the gatekeeper. The stomach has a certain amount of space that it's enabled to accommodate, as far as food or liquid, and once it reaches that point where it's pretty full, it it tells your brain, and it tells your, you know, your mouth and everything else, it says, stop eating. You should you are full. Do not eat anything more, because your your stomach is full, and then the stomach spends the next two or three hours churning that food into kind of a liquid, solid material that then goes into that 20 foot small intestine. And so I think whether someone eats small meals, they'll get hungry faster, faster, because the stomach empties out quicker. They'll be hungry again in an hour or two or 30 minutes. Or if they eat a large meal, it takes longer for the stomach to empty, and they won't be hungry for many hours after that. It's more the stomach that governs what you're asking about. By the time it gets down to the colon, it's like a conveyor belt. By the time it gets there on a conveyor belt, you're just seeing like a constant, very slow stream and some liquid, solid kind of going into the colon from when you put small intestine. And in the small intestine kind of averages everything out. But if you just look at the small intestine, you don't know whether that person had a big meal a small meal, because it's been churned and it's been kind of gatekeeper action from the stomach leading into that small intestine.

Erin Brinker: 44:09

Okay, so now I have to ask an influencer kind of question, because all over Instagram and and other social media platforms, there are people talking about, quote, unquote, leaky gut, and then you have people say, yeah, that's not actually a thing. So is leaky gut a thing?

Dr. Timothy Jenkins: 44:25

Well, I know people talk about it, and it's out on social media and Instagram and all that and x and, you know, it's definitely a large point of discussion. There are conditions that medical conditions that increase, what we call the permeability of the small intestine, and so they can increase flow of fluids out of the lining of the intestine into the intestines and makes more liquid. But really it's not that can that description leaky gut. That's not really a medical diagnosis in and of itself. Itself. It's more a description of some condition that can be happening. It can really be caused by a lot of different things. And so one example of that would be gluten sensitivity. So this is gluten is a component of things like wheat, and wheat has proteins that are called gluten, and there's some people that are very allergic to that, and that can trigger an inflammatory condition in the small intestine, and the small intestine can become leaky as a result of this allergic condition to gluten. And there's something called celiac sprue, which is, which is the main the medical condition for that. You know, that's a very serious condition. Well, if it's untreated, it absolutely can be people lose weight, they become iron deficient, they become anemic, and they can become come quite ill from that. The treatment for it is to avoid the precipitant, which is the gluten. So they have to be on a very special diet to avoid what triggers that. But yes, if they take the gluten, it causes a reaction of the small intestine to the gluten, inflammation, leaky gut, and then they're losing weight, they're becoming anemic, and they don't feel well, and so they they need treatment for that. So yes, that's, so that's one example. So it's, again, the leaky gut is more a description of the process, as opposed to, like a diagnosis. And so that's, that's how I see it. As a GI physician.

Erin Brinker: 46:25

Now, do you have recommendations for people like I know that there's a push to have be, have a plant based diet. There are some people out there saying it should be. People should eat a carnivore diet. And you know, Jordan Peterson is, is famous for saying that he eats steak, and that's about it in his his whole family is like that from a from a gastro and enter a logical position. I hope I said that right. What? What do you think about the type of diet that people should and I'm not really talking about fast food, because we all know that's that that's not good. But you know, the average person where what has the best results?

Dr. Timothy Jenkins: 47:00

Yeah, I would my own recommendation when I'm asked about is this balanced diet and human beings over, you know, 1000s, however long, many years, we've, we've, we've been here, have adapted to having a diverse diet. And it's it include, has included meat and plants and everything in between. And that's what our GI tract has has adapted to. If you look at it at an animal, for example, that's a plant eating animal, they have a very different structure to their GI tract. They often have very large stomach. Their intestines are much longer than what I just described, the 20 feet and the six feet and and that's because it takes longer to extract all the nutrients out of plants. So the GI tract has to adapt. If you look at more like a carnivore, like a lion or something, their GI tract look is more adapted to protein and meat more than the other vegetable matter and humans, we're kind of in between. We hit over, over many, many years, we've developed a GI tract that's used to just many different things coming in. And I think that has to do with humans are very resourceful, and they find what's in their environment to be able to eat and sustain their nutrition. So one day it might have been a mammoth, you know, years ago, and one day it might have been berries and plants, and we kind of adapt to that over the years. Well, Flash forward to today. You know what's what's the best thing to do? Well, we do know what can be harmful, and so we do know that that diets that are very high in meat, protein and fat do increase the risk for colon cancer. Now, that's not to say, you know, we should completely avoid those because I don't believe there's any evidence that you know that if you avoid that, that's a that's a cure completely will prevent colon cancer, because we see, we see people with who are full vegetarian, that that can get that condition as well. But there are benefits to having a moderate and less amount of fat and high protein meat in the diet, as opposed to a balanced diet that includes, you know, plant material, vegetable based, you know, foods and so that's really how I see it. It's more the balance. Absolutely, there's benefits to plant based diet. It's it's healthier if you compare it to the other diets of just the high fat, high meat content diet, definitely healthier to have the plant based but, but I would say it's not required. It's not something that you you absolutely should do. My daughter, it has a plant based diet, and she says, Dad, that's what I believe in, and I feel good, and I eat that, and I think, you know, and she has a lot of reasons for that, and it's healthy, and I encourage her in that, but I don't have that kind of diet. I have more of a balanced diet, and that's what works for me. And, you know, and I try to keep that all in balance. So, so that's, that's my thought about the diet. And we. Can get into more detail about specific elements. It's important you know that you have your vitamins and you have your different nutrients that you need, if you know. So again, the human body is developed around diverse food sources, different types of food sources, and that's what we're best adapted to, and that's what our digestive tracts adapted to. So I

Erin Brinker: 50:21

know that smoking is terrible for vascular health and I and I have to imagine that that's that it has its same negative impact on the colon as it does every other part of the body. But what about alcohol? Is,

Unknown: 50:33

Well, yes and yes, I would say yes and yes. So so tobacco use is a risk factor for many cancers, and it's it's a risk factor for colon so, so you don't want to smoke. There's no good reason. That's one thing. We were talking about, diet, plant based and all that. But I would say for tobacco smoke, cigarette smoking, please avoid that. That is does no good for your body. It increases many risks of cancer, lung disease, heart disease, you name it. So that's a big problem. That's something to stay away from. Alcohol is a risk factor for colon cancer as well. And you know, I can't really tell you this, what is the safe amount, but we do know that people who have you know frequent alcohol use, daily alcohol use, do have a higher risk for colon cancer, and the alcohol does seem to be an independent risk factor for colon cancer. And what I mean by that is it's not like the alcohol is causing obesity, and it's the obesity that causes colon cancer. We see people who have higher alcohol use, who don't have any other risk factor, obesity or anything else, have a higher risk of colon cancer. So So both of those are a risk factor. Avoid the smoking, you know, alcohol. There's many people who completely avoid that as well, and that's and that's a good thing, because it's not something that you need to be healthy. If it is used, I would say, definitely in moderation. And you could talk with your doctor about what that means, how many drinks, some of that depends on whether you're a man, a woman, your age, your weight, things like that, but definitely needs to be in moderation, because if it's more than that, it can increase risk for colon cancer. You

Erin Brinker: 52:17

know, it used to be that when and people heard the stories of, oh, you can have a glass of wine a night and it's good for you. And there's elements or compounds in the red wine, especially that are that are healthy. And then now, more recent studies seem to suggest that any amount of alcohol can have a negative impact on certain organs in the body, including the brain. And so, you know, it's hard to know what's good and what's not good.

Dr. Timothy Jenkins: 52:42

Yeah, you're exactly right. There's been a lot of rethinking of that. And I remember years ago in medical school and before that, back in the 80s and 90s. Well, look at the, you know, the French people, for example, they drink a red glass of wine every night. Look how healthy they are. But there was more to that. And I think now that we're looking deeper into that question. Just like you said, it's very difficult to define, you know, what, if any, is the healthy amount? So we say, you know, moderation, but the best moderation is completely avoided. It's not necessary to have that, but we know a lot of people enjoy that, so they want to know, well, what is a healthy amount, and I think there's still active debate about that. So

Erin Brinker: 53:24

one of the other things that people are, shall we say, enjoying now in, especially in states where it's legal, is cannabis. And is there anything about cannabis consumption that increases the risk factors for colorectal cancer?

Dr. Timothy Jenkins: 53:41

Cancer? Yeah, it's a really good question. And I haven't. I would have to go back and look at this some more, because I don't, I don't, I don't have a study I can quote to you, but I do. I can let you know that I do see patients who have gi problems from cannabis, and specifically, it seems to affect the upper part of the GI tract, more and specifically severe nausea and nausea vomiting. And so there's a condition called cannabis hyperemesis condition and hyperemesis disorder. Emesis is vomiting medical

Erin Brinker: 54:16

morning sickness from your weed.

Dr. Timothy Jenkins: 54:19

We're still at this dinnertime conversation, but it's, it's vomiting syndrome, and that's very unpleasant. And I've had patients who, who I've seen, who say, Doctor, I'm just, I'm always nauseated. I'm vomiting, you know, I, you know, I just don't feel good. And we in nausea can come from many places. It can come from, from start in the brain. I mean, conditions in the in the head can cause nausea. Conditions in the body can cause that. So there's a, there's a kind of long evaluation for nausea, but in younger people, that's one of the first questions I asked were, are you using cannabis, and how much and And inevitably, these folks with a lot of vomiting and nausea. A It's a daily thing, and they're using it all the time, and they're getting sick from it. So, so I've seen that a number of times in my career and and it's remarkable how, after they abstain, their symptoms markedly improved. Wow, yeah.

Erin Brinker: 55:16

So nobody's talking about that. I had no idea. Yeah,

Unknown: 55:19

yeah. So we're can. So, yeah, cannabis emesis, or hyperemesis, is something that we do see.

Erin Brinker: 55:27

So we only have about a minute and a half left. What are some, you know, parting comments about colorectal cancer screening? You know, should people call their doctors today and get a get an appointment scheduled to get to do some kind of screenings, right?

Dr. Timothy Jenkins: 55:42

So it's your perfect question to close out. And so like I said, we have our colons, and we need to take care of them. And so if you have not been screened, meaning if you're over the age of 45 and you haven't done a stool sample screening test in the last year, or you haven't done a colonoscopy in the at least the last 10 years, that was normal. You need to be screened. And so that would be something where, you know, you check with your doctor and you and you go in and have the screening. And I don't know that, I'd say, like, call them all the day. I'd say, you know, it's not, it's not something you have to do this minute. But I would say, you know, the next time you see your doctor, you do need to do that. And if you're not planning to see your doctor here soon, it would be worth a call to their office and to say, you know, no emergency or anything. But I would, I do want to be screened. And they can give you your options, refer you for a colonoscopy, get that set up as an appointment. They can send you the stool sample test, and you can take care of it, and you're good, you get it, and if it's fine, something, that's a good thing as well, because then you know, then you know, and you've caught it early. And I, and I just just saw a patient just a few days ago who we diagnosed cancer, and he's in his 40s, from a screening test, didn't expect it, and I told them the, you know, the we this isn't the news I wanted to give you after your procedure, but I can tell you the best thing you ever did was turn in that test, and it came out positive and and we've identified it, and we're going to take really good care of you, and we're going to, you're going to do everything we can to cure this now, but you I know that had you not done that test and this was more advanced, that would be much more difficult, so get screen, contact your doctor and and let's do this, and let's, let's stamp out this disease. Well,

Erin Brinker: 57:31

Dr Timothy Jenkins, thank you so much for for spending time with us today. This has been an absolutely engaging conversation. It's something that every single person, if you are alive, this applies to you. And so thank you so much for joining us.

Dr. Timothy Jenkins: 57:47

Thank you so much, Erin, it's been an honor, and I really love your show and appreciate you. Thank you for all you do. Thank

Erin Brinker: 57:53

you. Thank you so much for joining me today. I'm Erin Brinker, this has been the making hope happen radio show. For more information about the making hope happen Foundation, go to www.makinghope.org That's www.makinghope.org Have a great week. Everyone. Aloha. Get ready to embark on an unforgettable journey to the islands at the making hope happen Foundation's 2025 Gala, a tropical escape. Join us on Thursday, May 8, at 6pm at the breathtaking hilltop banquet hall where the spirit of ohana meets the power of education and community transformation. This year's gala will be an enchanting evening filled with live music, vibrant Island themed entertainment, festive tropical cocktails, mouth watering cuisine, an inspiring student art auction and the prestigious hope and carnig awards, your presence will directly impact the future of San Bernardino students, let's give back celebrate and create brighter futures together. For more information, visit www dot Making hope.org/events. That's www. Dot Making Hope. Dot O, R, G, slash events sponsorships are now available again for more information, go to w, w, w, dot Making hope.org.