Weight Loss Interventions and Colon Cancer, with Dr. Dale Prokupek

Episode Transcript

Dr. Dac: Hello, folks, and welcome to the “Colon Health Podcast” brought to you by Colonoscopy.com. I’m your host Dr. Dac Teoli and I wanna thank you for listening in today and for taking an interest in learning more about colon health. Today’s episode we’re gonna have three big problems as well as a number of solutions that might help you tackle them. The problems include colon cancer, obesity, and weight loss. Today we’re gonna hear about a number of potential solutions from our guest expert Dr. Dale Prokupek, also known as Dr. Dale.

A little bit more about Dr. Dale. So he’s a celebrated and award-winning physician out of Beverly Hills, California. He’s board-certified in internal medicine and gastroenterology, and in fact, he has over 25 years of experience with some of the most difficult and complex cases related to his expertise. He’s affiliated with the prestigious Cedars-Sinai Medical Center and is Associate Clinical Professor of medicine at the renowned Geffen School of Medicine at UCLA. You can learn more about him and his practice at www.drdalemd.com. Again, that’s www.drdalemd.com. Thanks for being here today, Dr. Dale.

Dr. Dale: Hey. Thanks for having me. It’s good to be here.

Dr. Dac: I wanted to just kick us off if I could with some statistics and then I really wanna hear what you have to say. So the National Health and Nutrition Examination Survey from data actually within the past 10 years showed that nearly 70% of the U.S. population is overweight or obese. In fact actually, one third of our citizens have actually been clocked in and weighing in at the kind of obese BMI level. Among the potential health problems, which are numerous, one in particular jumps out at me, and I’m sure is gonna jump out to the listeners of this podcast, and that is there is a well-known and heavily researched link between obesity and the risk of developing cancer.

Now this includes things like multiple myeloma and many other types of cancers. In fact, you know what, here’s a list, endometrial, esophageal, gastric, liver, kidney, pancreatic, gallbladder, breast, ovarian, thyroid, and colorectal cancer. In fact, people who are obese have about a 30% more likelihood risk of developing colorectal cancer than normal weight people. A higher BMI is associated with increased risk of these cancer in both men and women, but in fact there appears to be a bit higher risk in men compared to their female counterparts. Now, this is heavily researched as I mentioned. There’s numerous studies out by Gallagher, et al., as well as Sheflin, et al., and we’ll have all the links to some of these studies on our colonoscopy.com main page.

That said, I just wanted to talk about some of the theoretical basis for some of this interaction because you might be wondering at home, “Hey, what does obesity have to do with colon cancer? How do they come together? What’s the link there?” So there is a number of theoretical relations. One of those include that individuals that experience obesity have a chronic low level degree of inflammation or oxidative stress in their body at all times. This could potentially cause DNA damage and therefore lead to a higher risk of developing cancer. Additionally, fat tissue produces excess amounts of estrogen which also have been having…shown links in the past to different types of cancer.

Obese people often have increased blood sugar levels as well as insulin resistance. High levels of insulin may promote the development of colon, kidney, prostate, and endometrial cancers. And in addition to all of this, fat cells produce adipokines, which is basically just a fancy name for hormones that may stimulate or inhibit cell growth, and in this case we’re worried about them stimulating that cell growth, i.e. cancer cells. To be fair and balanced I wanna point out real quickly that the research is not currently overwhelmingly conclusive on how weight loss impacts these mechanisms and this degree of risk for cancers, specifically colon cancer, compared to having never gained weight to begin with, but there are some observational studies which explored diet and exercise as a means of weight loss and development of cancer, and some of these have had actually pretty reassuring and promising results.

Now, I will say that some of these studies took specifically place in populations of bariatric surgery patients, which isn’t necessarily gonna be everyone who’s listening at home right now. That said, again, this is being actively researched. The science is always changing. So I wanna learn more about different ways of weight loss. Certainly everyone knows diet and exercise, very frequently touted as the king, but for some people that’s not enough, or for some people that just doesn’t always cut it. I wanna learn about some other weight loss techniques, some other weight loss solutions that might be out there that might be able to decrease someone’s obesity-related risk factors for developing cancer and at the same time might decrease the risk of developing cancer, specifically colorectal cancer, in the future.

And that’s why I’m so happy to have Dr. Dale here with us today. He is not only, like I said, board-certified in both internal medicine and gastroenterology, for everyone listening, that means he’s a pretty dang smart guy, but also he’s well-spoken and well-renowned within the world of weight loss, so I want to hear a little bit more from him right now. Go ahead, Dr. Dale. I think I’ve said enough. Everyone wants to hear from you.

Dr. Dale: Yeah, well, you’ve certainly done your research, so you’re spot on. So in our practice…as you mentioned, I’ve been in practice about 25 years, and we have a pretty large practice and it is representative of the American population at large. And I will echo what you said that a significant number of patients come into our office who are overweight or obese. So if you’re in Southern California…so it’s probably not quite as bad as other parts of the country because people’s interests in health and fitness seems to be a little bit more of a priority here. It’s probably because of the weather and things like that, but it’s still a huge problem. And so the problem with colon cancer is about 30 years ago we developed a screening test for colon cancer called the colonoscopy.

And in theory, the colonoscopy…the purpose of a colonoscopy was to take a look inside the colon, look for polyps. Polyps are the precursors to cancer. And the theory is that you find the polyps, remove the polyps, prevent the cancer. And it’s been only marginally successful in reducing the incidence of colon cancer, about 2% per year since about 1998. So there’s still 150,000 people getting colon cancer a year and about 50,000 people dying. It hasn’t decreased a whole heck of a lot considering we spent hundreds of millions of dollars on this screening. And one of the reasons that it is touted as…the reason we’re not seeing such a dramatic decrease is because the environmental factors that contribute to colon cancer are flourishing all around us, and probably the biggest one is obesity. And again, I echo what you said, it’s not known with 100% certainty why this is the case, but the things that you mentioned certainly are the top contenders.

And one of the other things that I will add is the presence of red meat in our diets. Red meat has determined by the World Health Organization as a class A1 or A2, depending on how you interpret it, carcinogen. So I don’t know personally of any other food that is ubiquitous in the American diet that has been labelled a carcinogen. I mean, perhaps nitrates and bacon, things like that, but there’s no other food that Americans typically eat on a daily, certainly multiple times a week, basis that is a major carcinogen. And of course, eating red meat is associated with obesity as well. And so I think the first thing I would say to people who are listening is if you wanna decrease your risk of colon cancer, decrease your intake of red meat, and then in addition, any kind of processed foods also decrease the risk.

And the thing about it is…well, the good thing is that…for people who are overweight or obese is that even small amounts of weight loss would decrease your risk of colon cancer. So the increased risk of colon cancer is proportional to the amount of weight one gains. And the other thing that we should talk about is the fact that it usually is the weight that is gained in early adulthood toward midlife that gives you…that confers the higher risk of cancer. So for example, if you were overweight as a child and you lost the weight as an adult that doesn’t necessarily mean you’re going to have a higher risk of colon cancer. Or for example, when we get to the past midlife and we get to grow into our sort of third phase of life, our metabolism slows down and we tend to gain a little bit of weight. That also doesn’t necessarily signify an increased risk of colon cancer, but it’s that early adulthood to midlife that really is the trouble spot.

And so whatever we can do to minimize that will be very helpful in decreasing our risk. And so in my office we have a mini weight management clinic and we target those people, and of course we use the regular diet and exercise intervention, which is very helpful. A lot of people are not as well-versed as a lot of doctors think in terms of how to make sure you exercise and eat properly, and I’m sure all of your listeners know that there’s a new diet a day that comes out, right?

Dr. Dac: Oh, yeah.

Dr. Dale: And people are confused. I mean, doctors are confused. So some work for very short periods of time and then people yo-yo right back, and anything that’s going to work for a short period of time… But what we try and do at our office is try and set goals and try and change the lifestyle choices with the goal of decreasing weight slowly over time. That is what seems to work the best, and that’s also what seems to give our patients more encouragement and they feel less defeated when they don’t lose 10 pounds a week because they read that in “The National Enquirer” somewhere. So we do that and we work with a nutritionist, and after a period of time if they don’t meet their goals and we know that it’s gonna be difficult for them to reach their goals in the future then we offer other choices, other interventions that they might find that they’re interested in.

One of the ones that we use a lot is a balloon therapy that…specifically we use a balloon therapy called Orbera. And what that is is a balloon that we fill with saline solution and we take an endoscope, a rubber tube that we go down the patient’s throat with, and we put this saline-filled balloon in their stomach and then we come out. And what happens is the saline balloon makes a person feel full, or it makes people feel full after eating a much smaller amount than they would normally be. And so primarily by that mechanism, they eat much less. And it can be very successful. It’s kept in for about six months and people can lose between 8% and 15% of their body weight.

Dr. Dac: Wow.

Dr. Dale: Which can translate to probably 35% to 40% of the excess body weight. And it’s really remarkable and it’s very encouraging for the patients. And I think what the patients find surprising is that…the first thing they see is their blood pressure goes down. They have more energy. Their cholesterol levels plummet, so their cardiovascular system improves almost immediately. And then the data is very pretty good. It suggests that the incidence of colon cancer trends down towards the average risk after about five years of weight loss, so that’s very encouraging. So we know that these interventions can reduce the risk of future cancer, so it’s a very encouraging prospect for the patients.

Dr. Dac: Absolutely. It does sound pretty interesting. In fact, I was reading a bit more on the Orbera and it had some interesting results that there’s other options out there for the intragastric balloons for our listeners that…there’s balloon interventions that kind of sit in the stomach essentially. There’s another one called for example the ReShape, and I don’t know, Dr. Dale, if that’s one that you offer as well, but it looks like the Orbera, at least on some of these studies, had a higher weight loss average with the Orbera compared to some of these alternative options for intragastric balloons. Is that right?

Dr. Dale: Yeah, that’s right. So there’s three or four different balloons that are on the market. And the way intragastric balloons are sort of marketed is they’re… Well, some people would call them a bridge between diet and exercise alone and going full throttle to weight loss bariatric surgery, which is obviously very invasive and has a lot of risks and side effects, but also has the most profound effect on your weight. But a lot of people shy away from that because of the risks involved, and if there are major complications it’s hard to reverse that. And so a lot of people opt for this, what we call a bridge.

And the reason we call it a bridge is because there’s no operation. It’s done with an endoscope. So there’s no cuttings, no surgery. You’re sedated and then you take this little rubber tube and you… I put it in their mouth and go into their stomach and then, through a channel in that tube, I deploy the balloon. And the Orbera is the most extensively studied. It’s probably got the most press. It differs… The thing that’s kind of unique about it is that it’s filled with saline. You can alter the amount of saline you put in the balloon so that, depending on the patient’s size, a bigger person, bigger stomach, you can put more saline so the balloon is bigger and they get a better result.

The other ones, like ReShape for example, uses two or three different balloons, and the theory behind that is that if one of the balloons should break then that balloon is still present and inflated can prevent the broken balloon from traveling into your small intestine and causing a blockage, because one of the complications of all balloons is small bowel obstruction, you know, if the balloon gets caught where the stomach empties into the small intestine. If it gets lodged in there it can really cause a lot of problems. So that’s the purported benefit. But in practice, it appears as though the multiple balloon effect doesn’t translate into better weight loss. Actually there’s less weight loss associated with multiple balloons.

And if you monitor your patients properly with the Orbera, as with any balloon, you can avoid the complications and side effects that would necessitate dramatic intervention if a balloon should pop. There’s also another balloon and what it does is that it’s filled with air. I think it’s called Obalon, and the concept is that filling a balloon with air you can inflate and deflate appropriately and if it pops it’s not gonna cause any damage to your system. But when all is said and done, the Orbera seems to be the most efficacious. It’s gonna give you the most weight loss, and it’s a six month trial. We go in after six months and take out the balloon and then it’s done, so…

Dr. Dac: Because as you mentioned before, and I 100% agree, is you mentioned that the weight loss journey is more of a marathon, more so than a sprint.

Dr. Dale: Yes. When you first get the balloon put in, first of all, you’re gonna be nauseous. You may vomit for the first few days because your body isn’t used to it, and then afterward you’re gonna eat much less. But as most people probably know, the more you eat the more stretched your stomach becomes, and so people can adapt to that balloon and their stomach can just stretch and stretch to the point where six months later they’re eating the same amount of food they did before the balloon was put in.

So we only do the Orbera balloon if the patient will commit to making radical changes to their diet and exercise regimen, and that they agree they’re gonna work with a nutritionist on a twice weekly basis, and that their weight and their glucose and lipid parameters are monitored very frequently so we know that they’re having success. Because by the time six months has elapsed, we wanna make sure that their lifestyle changes are set in stone so that when it comes out they won’t revert back to the patterns that helped get them to where they were, but if people aren’t able to do that then the balloon is gonna have a short-term effect and, just like other diets, it’s gonna…they’re gonna rebound back to where they were before the balloon and at the end of the day there’s gonna be no advantage.

Dr. Dac: And you mentioned another good advantage of this is that it’s not a surgical procedure in the traditional sense, so there’s no big incisions. There’s not gonna be a big scar from your chest down to your lower abdomen. It sounds like, given how this balloon is placed with you mentioned the endoscopy, kind of that special thin camera that can either go down the esophagus, or sometimes when someone’s getting a colonoscopy, a different scope but it’s going in the other way…

For when someone’s getting this Orbera placed I imagine it would be good for the patient to go to someone who has done a lot of endoscopies before, say a board-certified gastroenterologist, or at least a specialist that is well-trained in that procedure. Would you agree?

Dr. Dale: Yeah. So you have to use an endoscope, like you said. So we enter the mouth and then we have to go into the esophagus and then travel through to the stomach and then small intestine, so you need to have some expertise in the anatomy of the upper GI tract. Also, before one even has the balloon put in, you have to do a deployment inspection of the area. And if you don’t have a deep understanding of the anatomy and some of the variants of the anatomy for example or some of the other pathologies that could be present at that time, you’re just asking for trouble. And one of the problems is that when you see complication rates it… Of course complications can happen with the best physicians, but the complication rate tends to be higher with people who have less experience.

For example, if you over-inflate the balloon, you are much more likely to have an obstruction or small bowel obstruction, which can be life threatening of course, or if you placed the balloon in the wrong location you could get patients who have intractable nausea and vomiting afterward and you have to go back in 24 hours later and just deflate the balloon because they’re just not gonna tolerate it. So you want somebody who’s done a lot of these cases. You want people that have had a lot of experience prior to the…prior to them doing the Orbera, and also you want people to have been properly trained, and that can be done through the various…so the company has a great training program, and then various fellowships around the country have great training programs. So, hey, you want someone who definitely knows what they’re doing.

Dr. Dac: Right. So it sounds like definitely, for our listeners out there, it pays to see the best, or at least some of the best out there. You don’t want to skimp or maybe see someone that you don’t have full confidence in or their abilities just because it might save you a little bit of money on the side, because, again, as Dr. Dale mentioned, this is a intervention that can have complications with it, and since those complication risks are always there to some degree, you’re probably better off minimizing those risks as much as possible. It makes a lot of sense to me.

Dr. Dale: Yeah. You also want a doctor who’s affiliated with… A lot of times doctors get into trouble because there’s a new procedure and people get excited of course, and they should, and they wanna, you know, be involved in that, which of course they should as well. But if you don’t have a… I’ve been in practice for 25 years, and even being the most conscientious doctor, there are certain times when you’re gonna get into trouble and you have to have a medical center that you can get the patients to. So if you’re doing this in a strip mall with no hospital privileges you’re really taking a big risk.

Dr. Dac: Right, and that’s an excellent point too.

Dr. Dale: Yeah. I mean, in the proper hands with the proper backup and all the precautions taken and you got your…the nurses who know what they’re doing, they’ve done this, they’re your indispensable helpers, I think it’s a good choice for a lot of people, especially that bridge patient who, you know, diet and exercise are not working, but either they don’t wanna commit to a surgery or there are just…some insurance companies only will allow or only will pay for surgery if your BMI is above 50, which is pretty significant, or 45. So if you have a BMI of 35, which is still obese, it’s a good choice. It really is a good choice.

Dr. Dac: Right, absolutely. Some of our listeners might be wondering, “Hey, this sounds awesome. I wanna see Dr. Dale in the near future. I wonder though, how quick can I get back to work?” If I was to say have a appointment with Dr. Dale and we’re gonna do this on a Friday, is this something where you think they’d be able to get back to work on Monday, or are they going to have to take a week or two off from work?

Dr. Dale: So after you have the procedure done you wake up. The procedure takes about two hours, and it’s outpatient. You’re gonna go into the outpatient surgery center. Two hours will elapse of the procedure and you’ll walk out the door. However, you will have…the first couple of days there will be some nausea associated with it and there could be some vomiting, and you need to start…you need to get used to that feeling. People feel full, right? They sometimes they feel like they’ve got a bubble floating in their belly, and so many times during the first two, three, four days afterwards we have to give them prophylactic or preventative anti-nausea medicine and medicines to decrease that feeling of fullness, and we have to monitor their input, make sure they’re very soft, almost baby-food-like feedings and monitor them to make sure that they tolerate it.

So you’re not gonna have it on Friday and go back to work on Monday, but you could have it on Friday and go back to work the next Friday. That’s certainly possible. The patients have to commit to seeing the doctor every day for five or six days, and that’s just a safety thing. I wanna see my patients every day. I wanna make sure they’re keeping enough fluids in. I wanna make sure that they’re eating, they’re getting their vitamins, because people who… Of course people who don’t eat very much they tend to… Like patients with gastric sleeves or gastric bypass or bariatric surgery are often vitamin-deficient because they eat so little and the foods they’re choosing don’t have all the vitamins the body requires. So we wanna make sure that that kind of thing doesn’t happen. So we like to see them every day for at least a week and then touch base with them by following a couple of times a week just to make sure they’re okay.

Dr. Dac: Right. And after talking with you I thought we were gonna say that, because going back to that, say strip mall practitioner, that is gonna place this before, imagine it happens where they’re like, “Okay, we’re gonna get you back to work the next day. We’re gonna place this balloon and then we’ll see you in six months, and see you. Bye,” kind of thing. So I’m really glad to hear that you track your patients so closely.

Dr: Dale: Yeah, a lot of patients come for second opinions where that has happened. And that is a bad…that’s a recipe for a bad outcome. It really is, because the balloon isn’t necessarily covered by insurance, so that’s the other thing. And so it can be expensive for the patients. It can be a couple thousand dollars, and you wanna make sure that…the patient wanna make sure they do their research. They wanna…you know, it’s a lot of money for a lot of people and you wanna ensure the best possibility of success, and the way you do that is find someone who’s done it a lot that has success in the past and that will follow you very closely so that if something does happen, we can walk you through it, we can help you through it, as opposed to, “Okay, let’s just rip out this balloon.” So that’s one way to prevent is to stay in very close contact with the patients.

Dr. Dac: Absolutely. When it comes to the Orbera, and before moving on quickly to the next topic, I just wanted to see is there anything else our listeners you think need to know about that intervention or any other final thoughts on the Orbera?

Dr. Dale: No, I think that we’ve covered it. Just to know that the patients need to expect that in the first few days they’re gonna have some nausea, maybe some vomiting. They’re not gonna be able to eat very much. You may need to have IV fluids, but people get through that. And then the other thing is they have to really commit. In fact, Orbera won’t even let you…the company won’t even let you do the procedure unless the patients have signed up for their nutritionist intervention. So they gotta… I mean, there’s a commitment involved. This is not just pop the balloon in and go away and come back six months later dropping 50 pounds. It’s not like that. There is a lot of effort and education and re-learning habits that occurred during that six months, and so it’s a process and it’s a commitment and it’s more than just the balloon itself.

Dr. Dac: Absolutely. It sounds like the total package. And when your patients go and they see Dr. Dale it sounds like they’re getting the total package.

Dr. Dale: We hope so, yeah. We’ve had good success, good success.

Dr. Dac: If I could ask Dr. Dale, in your expertise, is there any other options? So again, Orbera aside right now, and diet and exercise aside, all of those are great potential options. What about other options that you think our listeners might like to hear about, at least just maybe naming a couple? We won’t have to deep dive into those today.

Dr. Dale: Yeah. That’s a great question because one of the most exciting things that’s come on the market in the last year, specifically in the last few months, is a medication. Anti-obesity medications historically have been fraught with problems because of all the side effects, or they don’t work, or the drug interactions, or they’re stimulants and people get high blood pressure and they’re cousins of amphetamines so there’s an addiction potential. So I don’t tend to prescribe those types of appetite suppressants.

But in the last year or so I started to use a medicine that was originally developed for patients with type two diabetes, and in the last two months that type of medicine has now been FDA approved for patients with obesity. They don’t have to have type two diabetes in order to get it and it’s kind of a game changer. It’s a simple, small subcutaneous injection, something like an insulin injection. You give it to yourself once a week. And it’s a molecule that sort of mimics a molecule that is found in your own body, and it works in three different ways. It slows down the emptying of your stomach. It attacks or attacks this, you know what we call the satiety center or the fullness center in your brain, and it also keeps your blood sugar very low so that your insulin levels stay nice and low, which is important for many different reasons.

But through those three mechanisms of action, it combines and people get significant weight loss almost from the very beginning and you can feel it working, and people like that feeling because they’ll take it and a week later they know that it’s working. And if you give it correctly…you have to sort of titrate up because it works so well that if you give too much too soon, your stomach won’t empty and you’ll feel like you’ve just had Thanksgiving dinner for an entire week, so you don’t want that.

Dr. Dac: Wow.

Dr. Dale: But if you do it correctly and you titrate up, patients are very satisfied. And you can lose just as much weight with this injection than you can with a balloon for example. And so for people who…in my practice, I’ve noticed that people would rather choose the injection than the balloon just because of… The balloon is very safe, but there are risks associated with it and it takes a little bit of time to reverse it if things go sideways or if they don’t want it anymore, whereas with the injection if they don’t like it then either we reduce the dose or we stop it. And so they feel like they have more control.

So it’s a very exciting time and the name of the medication is called Semaglutide, and it comes…as I said, it’s an injection. There is an oral form of it. I haven’t used it with my patients, but the injections can come in a daily or a once weekly dosage. And what we found is that when people take the once weekly dose they tend to lose a lot more weight because their drug levels in their bloodstream are much more much more even, whereas if you take it every day it will work but you’re gonna…you’ll feel it at different times during the day, and some people can get…feel very bloated. They get heartburn because it’s kicking in, whereas you don’t typically get that with a weekly dosage. But it’s very exciting and I think your listeners are gonna see much more about this in the lay press in the next six months or so because I think it probably is gonna be a game changer for the obesity field.

Dr. Dac: Right. And that does sound actually pretty remarkable, because if there’s a significant…I mean, there is a significant amount of people out there that just hate taking pills. They feel like maybe they’re getting stuck in their throat, or for whatever reason, they just don’t like taking pills and tablets, and this once a week, potentially, injection sounds like a pretty decent workaround for that particular group of people.

Dr. Dale: Absolutely. People forget to take their daily pills. And with this drug it’s a very small needle. You pinch a little fat, put the needle in, two seconds later it’s gone. And the good thing is you will feel it when it’s worn off because you’re gonna get hungry again. So just like with the Orbera, the goal is while you’re on this to change some of the habits that predispose you to weight gain so that when you go off of it you’ll have made those changes and you will keep the weight off. The other good thing about a medication like this is it’s been FDA approved for an indefinite period. So it’s not a six month thing. If you tolerate it and it’s working for you you can stay on it as a maintenance dose, much like you have like a hypertension drug or a diabetes drug, so you can keep deriving the benefits of it for an indefinite period of time, which really helps with the success of the weight loss program.

Dr. Dac: Interesting stuff. And it sounds like kind of cutting edge, where the bar of science is kind of continuing to move forward. So I think it makes a lot of sense to see a specialist like you alluded to, someone really trained in the science, but also able to kind of break things down for the patient sitting on the other side of them.

Dr. Dale: Absolutely, yeah, these are challenging patients, but we love them and we like to work with them and a lot of them struggle, and so we like to be in the struggle with them. And it’s gratifying for the patient, and also gratifying for us, to see success. And with these kinds of tools we’re able to see success more frequently than ever.

Dr. Dac: Absolutely. I have no doubt about that. And Dr. Dale, I’m curious if you have anything else you wanted to share with me and our listeners today? Or if not, even how should they get in contact with you? Say they’re in the area or if they wanted to be seen by your practice, what’s the best way to get in contact with you and your practice?

Dr. Dale: Number one, thanks for having me on. I really appreciate the time. I would just say for patients that are listening that there’s hope and don’t give up the fight. And in terms of our original topic about the colon cancer, there are a lot of things that we can do to prevent our population from getting sick and dying of colon cancer, first and foremost, doing a colonoscopy. When done correctly, it will virtually eliminate the risk of colon cancer, but also just knowing that there are lots of things we can do to decrease our risk, and that includes losing weight and not eating red meat or processed foods, eating a high fiber diet. There’s a bunch of other ones we could talk about at a later date, but there’s lots of things we can do to change our environment and to take control of our future health. So it’s a good time to be alive.

And if anyone wants to contact us through our website www.drdalemd.com. My name is Dr. Dale Prokupek. I know you… Everyone calls me Dr. Dale because no one can pronounce my last name, but it’s Prokupek. So if you can’t pronounce it just Dr. Dale is just fine.

Dr. Dac: Got you. I want to thank you for being here tonight and sharing your expertise with us and our listeners. I learned a lot. No doubt they learned a lot as well. And I wanna also thank you, our listeners at home or at work or at the gym or on your commute. Wherever it is you’re tuning in from today, I wanna thank you again for your time. Make sure you like this post on your social media or on your favorite podcast app. Remember, that’s how we get feedback from you and that’s how we ensure to keep bringing you the content you want when you want it.

As always, we’ll have a summary of today’s episode including key points, and again, the best way is to contact Dr. Dale and his practice. There’s a list of all the other resources, including research articles on colonoscopy.com. Please take care, good night and good health.