Dr. Keith Roach

DEAR DR. ROACH: I’ve been having constipation issues and allergic reactions to some food for so long. When I do research on these issues, I look for natural ways to heal my body. But one of the most debated topics I see is on psyllium husk and whether you are able to take it daily for long-term use. I see articles that say it shouldn’t be taken long-term, while others say that it is OK. Why is there so much conflicting information out there?
I do notice that psyllium husk can make me feel dry and give me headaches. Is that because I need to decrease my daily use of it or possibly drink more water? — Z.
ANSWER: Constipation is a common problem. Not only is it uncomfortable, the increased pressure in the colon predisposes people to developing diverticula, which are bulges that can bleed or become inflamed.
Although many people can get good results through a diet high in fruits, vegetables, whole grains and healthy fats like olive oil, some people still have issues with constipation. In my opinion, the benefits of treatment outweigh the risks, especially with a very safe treatment like fiber, which is found in psyllium husks. (Metamucil is one over-the-counter brand, or you can buy it at your local health food store.)
There have been many studies on the safety of psyllium’s long-term use. Of course, there are no substances that are perfectly safe, and if you take too much, especially when your body isn’t used to it, you may notice bloating, cramping or nausea. It does require water to work properly, so an extra glass or two of water when taking psyllium, or another fiber supplement, is wise.
You do have to be cautious when looking at advice. There are always multiple opinions, so it’s wise to look for a consensus. Be particularly wary of advice from those selling a solution. In my opinion, the consensus of expert opinions and the weight of scientific evidence supports the safety of long-term fiber supplementation in cases where dietary changes are inadequate for the person.
DEAR DR. ROACH: I am a 77-year-old male and have not had a rectal exam for three years. My newest physician says it is not necessary, in light of my PSA exams over the past six years. (The result of the last one in March was 0.2 ng/mL.) I have had this doctor, who is in his 50s, for one year. My previous doctor, who was in his 80s, always did a digital rectal examination (DRE) yearly. I am concerned that a DRE is necessary. — G.L.
ANSWER: A rectal exam very rarely makes a diagnosis of prostate or rectal cancer when the PSA test (in the case of prostate cancer) or the colon exam (for colorectal cancer) is normal. This recommendation is fairly recent. Your PSA level is very low, putting you at an extremely low risk.
There’s not much harm of a rectal exam, and I perform them on my patients who feel their exams are incomplete without it. But most men don’t really want them, and a few simply refuse.
Prostate cancer screening is appropriate for men who have at least a 15-year life expectancy. Several decision analyses have suggested more harm than benefit for PSA screening in most men over 70, since they get all the harm right away and only receive benefit after 10-15 years.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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