EXPERT > Doctor In The House

Healthy From The Inside Out

By Dr. Herbert Lim
Interviewed by Melissa Moniz
Wednesday - August 06, 2008
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Dr. Herbert Lim
Gastroenterologist, Division Chief Gastroenterologist at The Queen’s Medical Center

Interviewed by Melissa Moniz

Where did you receive your schooling and training?

I graduated from Iolani. I got my undergraduate from Creighton University in Omaha and my medical school and residency at the University of Hawaii. My sub-specialty training was at the University of Florida in Gainesville.

What are the most common diseases that you see/treat?

I have a special interest in liver disease, so I see a lot of patients with Hepatitis C and B. Hepatitis B is a very common disease in Hawaii especially because of the Asian immigrants. I also see a lot of patients for heartburn, stomach aches and also, because there has been a lot of public awareness for colon cancer screenings, I do a lot of colonoscopies and upper endoscopies.

How many of the problems you see are genetic, and how many are attributed to diet and lifestyle?

That’s a hard question to answer. A good part of the colon problems that we see, especially in the younger patients in their 40s and 50s, are most likely to be genetic. In the older population, it’s most likely to be lifestyle - so things like diet, exercise and smoking. Not enough people are exercising, and most of the population is getting heavier. Fortunately smoking has been on the decline.

What’s your opinion on Internet sites and products that show the colon, and it’s clogged up with toxins that make you sick, sluggish, etc.?

My personal opinion is that it’s a good sales pitch. I have been on message boards and asked these people about these so-called toxins and what they do to the body and how their product works, and none of them has been able to give a reasonable answer. And many of them have not even been able to identify what toxins they are. So if you can’t identify the toxins, how can you make a product to clean it out? So I am a very strong opponent of these pseudo-science products. There’s no hard evidence to say it works. It’s not to say that the products are useless, but in order for me to say, as a physician, that it’s useful, I need to be shown evidence that it actually works. Show me evidence that things are getting clogged, and show me evidence that these things that are so-called toxins are giving people problems.

Of the diseases you see that are preventable, can you discuss what people can do to prevent them?

There has been a big push to vaccinate children for Hepatitis B. I believe that Hepatitis B is a disease that we can actually eliminate with aggressive vacci-nations.

With acid reflux and heartburn, part of it is due to diet and part of it is due to lifestyle and size. I do encourage many of my patients to exercise. It doesn’t take a lot of exercise for improvement. I tell my patients to walk for 30 minutes, five days a week, and many patients with heartburn, acid reflux and diabetes actually improve. It just takes minimal but consistent effort.

Denette Albero, Dr. Herbert Lim, Katherine Kaneko and Robynlee McCandless

Can you discuss in detail how exercise helps the digestive system?

Well, there two main things. Exercise does increase gut motility, so if you’re having problems with bowel movements, you won’t have as much problem going to the bathroom. The other thing is that reflux and heartburn are associated with weight. So if you’re lying down at night, the extra layer of what we call “prosperity” tends to promote acid to go to your esophagus at night. So just losing a few pounds means less pressure, and then you may not have to take medication anymore to suppress your acid reflux. Gallstones, for instance, are associated with obesity. These are some of the simple things to do to avoid major problems down the roads.

Can you talk about constipation - the causes and treatment?

Constipation is a very common condition. From a doctor’s point of view, there are various definitions of constipation. Some people describe it as not going to the bathroom frequently, some people describe it as going to the bathroom, but having a hard time to start making, and some people describe it as having hard, rocky, pellet bowel movements. So it depends on what the patient is telling us. But it’s not exclusive. One thing is that, in the Western diet, we don’t have enough fiber. I promote vegetables and fruits. The people who eat a lot of fruits and vegetables have less of an issue with constipation. One myth that is perpetuated is that you need to have a bowel movement every day. There’s no truth to that. The average is anything from three bowel movements a day to three bowel movements a week.

Can you talk about the long-term and even short-term risks with taking laxatives to treat constipation?

There are two types of laxatives: osmotic and stimulant. Osmotic laxatives are concentrated and your body tries to dilute them. There are the stimulant laxatives, which are things like Ex-Lax. What that does is it stimulates your colon to pump harder. The difference between the two is the osmotic laxatives make your stool watery, so it takes less effort, and the stimulant laxatives make your colon pump harder to get it out. The problem with the stimulant laxative is, on a regular basis, what you’re going to find is that you have to take more and more. Then, if you don’t take it, then you’re really stuck - figuratively and literally. So the problem with stimulant laxatives is that over a long period of time it stops working.

If you ever notice, all over-the-counter medication say “after two weeks see a doctor.” And the reason for that is you don’t want to use over-the-counter medication to mask the symptoms that imply something more serious. So simple constipation most of the time may be simple constipation, but occasionally it can be something serious - such as the first sign of colon cancer. So if you keep taking laxatives, you’re delaying a visit to the doctor, who can make a diagnosis to a serious problem. But that’s true for all over-the-counter medication because, after two weeks, something serious might be going on.

Is it uncommon for adults in their 20s and 30s to develop problems with their digestive systems?

Actually no. There are a lot of people who have digestive symptoms in their early 20s and 30s. Irritable Bowel Syndrome (IBS) for example, is very common and the typical patient is a young female under the age of 40. And that’s anything from diarrhea, constipation, gas and bloating. But a lot of people put up with these symptoms and, fortunately, most of them don’t have any serious problems that require a doctor to take care of them. Occasionally you’ll see people with serious problems. Unfortunately for the younger patients, they usually wait until the last minute when things get really out of control.