Quality Matters in Preventing Colon Cancer

March is Colorectal Cancer Awareness Month. This gives me an opportunity to discuss this very important disease with my patients.  Colorectal cancer is the second leading cause of cancer death in the United States when men and women are combined together. It is the third leading cause of cancer death in men behind lung cancer and prostate cancer. In women, it is the third leading killer behind lung cancer and breast cancer.

Over the past 10 years, there has been a decline in the incidence of colorectal cancer attributed to the detection and removal of precancerous polyps (adenomas) as a result of increased colorectal cancer screening. This has resulted in a significant decline in the death rates from colorectal cancer over this same time period.

To summarize: Screening colonoscopy significantly reduces the chance of developing colorectal cancer.

Despite this, statistics show that only 60% of individuals of screening age (age greater than 50) actually undergo screening colonoscopy. That is, 4 out 10 people do not undergo screening colonoscopy. This is a disappointing statistic! I believe individuals avoid this life saving procedure because they fear the “unknown.”

These are common misconceptions about colonoscopies:

  • The procedure is going to hurt.
  • You will be awake during the procedure.
  • The bowel preparation is torture.

All these ideas are completely false. Patients are completely asleep during the procedure, there is no pain involved, and the bowel preparation is manageable.

Finally, a colonoscopy is only as good as the physician performing the examination. One the most important measures of a “quality” colonoscopy examination is the ability to detect and remove precancerous polyps (adenomas) from the colon. The rate at which a physician discovers and removes these polyps is called the adenoma detection rate (ADR). This rate of detection is determined by how meticulous the physician is with the examination and the amount of time spent examining the colon. Physicians with low adenoma detection rates have a higher chance of their patients developing colon cancer in future years.

We measure this adenoma detection rate in our practice as a way of monitoring our quality. The performance targets recommended by the American Society for Gastrointestinal Endoscopy (ASGE) are > 20% for women and > 30% for men. My adenoma detection rate consistently exceeds the recommended standards.   This equates a to superior examination for my patients.

Don’t you want a physician performing your colonoscopy who will provide a quality examination to reduce your chance of developing colorectal cancer?   I believe quality matters.


Richard Warneke, M.D.


Let’s “Chew the Fat” Over Losing Weight

It’s that time of year where most of us set resolutions to improve ourselves. The most common of those is to lose weight. Yet, most of us don’t successfully achieve this goal. Patients often ask me, “What is the best way to lose weight?” The answer is there is no one best way to lose weight.

I believe we complicate the dieting process. It all “boils down” to decreasing our daily caloric intake. It is that simple. There is no complicated formula. It doesn’t matter if you adopt a Low Carbohydrate Diet, a High Protein Diet, an All Fruit Diet. These diets all have one thing in common: for them to be effective, you have to burn (use) more calories than you consume.

The focus is on calories. The next question to ask yourself is, “How many calories do I need each day to maintain my current weight?” This question can be answered easily. Here is a link to a website that will calculate your daily caloric needs www.active.com/fitness/calculators/calories. That is, if you consumed this number, you would neither gain nor lose a pound. In order to lose weight, you will need to consume fewer calories each day on average. Let’s say that number is 2,500 calories per day. If you decreased your caloric intake to 2,000 calories per day, you would be have burned 500 calories. If you did this each day for one week, you would have burned 3,500 calories. 3,500 calories equals one pound of fat.

If you don’t want to go to the trouble of calculating this number, a good target is 2,000 calories per day for men and 1,500 calories per day for women. It does not matter where the calories come from. The total number of calories is what counts. You will find that eating foods that low in fat and refined sugars will allow you to eat more per day. The target foods should be lean meats (fish, poultry, lean pork), fruits, vegetables, whole grain breads (in moderation), and unsaturated fats (nuts, seeds, avocados).

In order to keep your caloric intake within your target, you need to understand how many calories are in the foods you consume. This requires an understanding of true serving sizes (refer to Reference Guide at the bottom the text).

You have to maintain a daily log of your calories. This is important for several reasons: it enables you to accurately track your progress, and you are more likely to stay on track. Otherwise, you will never truly know how many calories you are consuming. I recommend purchasing a calorie counting paperback book. They are inexpensive and available at bookstores and your local grocery store.

I often have patients give me the excuse, “I can’t lose weight because I’m unable to exercise due to ______________.” Fill in the blank: my arthritis, my busy job/schedule, shortness of breath, etc. The truth is the majority of your weight loss will come from reducing your caloric intake; not from exercise. Of course, it would be preferable to perform aerobic exercise in conjunction with reducing calories. Most will be able to begin an exercise program once they lose some weight!

Most of us seek to lose weight so that we look better in clothes. There are, however, so many other important reasons to achieve an ideal body weight: reduction in heart disease (the number one cause of mortality in the United States by far), decrease risk of many cancers (including colorectal cancer, breast, pancreas, endometrial), reduced gastroesophageal reflux disease and it’s complications (Barrett’s esophagus and esophageal cancer).  Obesity is also linked to fatty liver disease and cirrhosis.

Finally, many of the patients I see in my practice with chronic gastrointestinal complaints are often linked to obesity. Instead of taking a pill or multiple medications, wouldn’t it be better lose weight, feel better, and simplify your life?


Richard M. Warneke, M.D., M.S. 




Vegetables (raw) = 35 calories

Fruit = 80 to 100 calories

Potatoes = 120 calories

Rice or corn = 170 calories

Pasta, Oatmeal, Cereal, Beans (cooked) = 220 calories



Lean Beaf, Chicken, or Pork = 150 to 200 calories



Fish = 100 to 150 calories



Lean Deli-Meats = 75 to 90 calories



Cheese = 110 calories



Nuts and Seeds = 170 calories



1 Slice of Bread = 70 calories

1 Flour Tortilla = 70 calories

1 Slice of Bacon = 40 calories

1 Pat of Butter = 50 calories

1 Cup (8 ounces) of 2% Milk = 130 calories

1 Large Egg = 70 calories

Don’t Go Nuts Over Nuts.

In my practice, I spend a great deal of time dispelling the myth that seeds and nuts are the main cause of diverticulitis.  My patients are told this by concerned friends, they read it on the internet, or they are told this by other physicians.

Diverticulosis is the condition of having diverticula, small outpouchings of the wall of the large intestine at areas of relative weakness in the wall of this organ.  These “pockets” are thought to occur over time due outward pressure applied to the walls of the large intestine during contraction of the bowel.  Diverticulosis is a common disorder in the United States.  We estimate that approximately 70% of individuals will have diverticulosis by the time they reach the age of 80.  It is one of the most common findings I encounter on routine colonoscopy examination.

The most common complication of diverticulosis is diverticulitis affecting up to 25% of those with diverticulosis.  Diverticulitis is inflammation and/or infection of the diverticular “pockets.”  This is caused by stool lodging in the neck of the diverticulum.  The stool abrades the lining of the pocket, causing inflammation and infection.  There is no good data to support the theory that seeds and nuts ingested cause diverticulitis.

Eating a diet rich in fiber as well as taking daily fiber supplements has been shown to lower the risk of diverticulitis.  We believe that the “protective” benefit of fiber is from “bulking” the stool thereby preventing small pieces of stools from lodging in the diverticular pockets.

So don’t go nuts over nuts!  You should focus on a low fat, high fiber diet.  This has health benefits on multiple levels: decreased risk of diverticulitis, decreased risk of colorectal cancer, and decreased risk of cardiovascular complications (eg. Stroke, heart attack, etc.)

Richard Warneke, M.D, M.S.