Colonoscopy Risks vs. Benefits

Welcome to Healthy Gut Healthy Thyroid!

This is your weekly roundup of the BEST actionable steps for those people with thyroid and autoimmune thyroid conditions who want to restore their health…by healing their gut. Whether you have hyperthyroidism or Hashimoto’s you will benefit from the content in this newsletter.

In today's issue:

• Main Topic: Colonoscopy Risks vs. Benefits

• Podcast Review: Overcoming Alopecia Areata and Other Types of Hair Loss

• Ask Dr. Eric: When is it necessary to get an endoscopy?

Colonoscopy Risks vs. Benefits

Colonoscopy is a commonly performed screening procedure in the United States, with over 15 million Americans undergoing colonoscopies annually.¹ Due to the concerning rise in early-onset colorectal cancer, the American Cancer Society now recommends initiating screening at age 45 for individuals at average risk, regardless of race.²

The standard medical perspective is that routine colonoscopies are critical for colorectal cancer prevention, early detection, and post-treatment surveillance. This may seem logical, considering colorectal cancer remains the third most common malignancy and the third leading cause of cancer-related deaths in the U.S.³

The United States Preventive Services Task Force (USPSTF) recommends a colonoscopy every 10 years for adults aged 50 to 75 at average risk. For those with a first-degree relative diagnosed with colon cancer, the first colonoscopy is recommended at age 40, or 10 years before the relative’s age at diagnosis, whichever comes first.⁴

Weighing Risks vs. Benefits

At the end of the day, this is a personal decision based on risk tolerance, family history, and access to quality care. While colonoscopies can be life-saving, they are not without risks—many of which are not routinely discussed in conventional medical settings.

As of writing this, I’m approaching my 55th birthday and have not had a colonoscopy myself. While I don't have a family history of colorectal cancer, I still take this decision seriously, and I encourage you to as well.

Potential Benefits of Colonoscopy

✔️ Cancer Prevention: Polyps, which are potential precursors to cancer, can be detected and removed during the same procedure.

✔️ Early Detection: Early-stage colorectal cancer is highly treatable, often before symptoms even develop.

✔️ Long-Term Monitoring: Individuals with a history of polyps or cancer can be closely monitored with regular colonoscopies.

Risks and Complications of Colonoscopies

1. General Complications. Although colonoscopies are considered safe, they’re still invasive procedures. Common general risks include anesthesia-related reactions, nausea, bloating, and discomfort post-procedure.

2. Perforation. In rare cases, the colon wall may be perforated (torn) during the procedure. This is a serious complication that often requires emergency surgery and hospitalization. The risk increases in older adults or those with diverticulosis or inflammatory bowel disease.

3. Post-Polypectomy Syndrome. This occurs when the removal of a polyp causes a burn injury to the colon wall without a full perforation. It can cause pain, fever, and requires hospitalization and monitoring.

4. Bleeding. Bleeding can occur, especially after a polyp is removed. While it's often self-limited, some cases require additional intervention, such as cauterization or even transfusion.

5. Splenic Injury. Although extremely rare, trauma to the spleen can occur and may lead to internal bleeding. This complication is often missed initially because symptoms may mimic more common post-procedure discomfort.

Non-Invasive Alternatives to Colonoscopy

Cologuard. Cologuard is a stool DNA test that detects abnormal DNA and blood associated with colorectal cancer. While convenient and non-invasive, it has a relatively high false positive rate, meaning a positive result often leads to a follow-up colonoscopy.

One study showed that up to 10% of patients with colorectal cancer or advanced precancerous lesions received false-negative results with Cologuard.⁵

Virtual Colonoscopy. This procedure uses CT imaging to generate a detailed view of the colon. It's less invasive and doesn't require sedation. However:

• If abnormalities are detected, a traditional colonoscopy is still required for polyp removal.

• The same bowel prep is necessary.

• There's some radiation exposure due to the use of CT.

Concerns with Bowel Preparation

To ensure the colon is clear for examination, a bowel cleanse is necessary. While effective, this preparation significantly alters the gut microbiome.

The good news is that research shows the microbiome typically recovers within 14 days of the procedure.⁶ However, in individuals with pre-existing dysbiosis, the recovery process might take longer and warrant post-procedure microbiome support with prebiotics, fermented foods, or probiotics.

Should You Get a Colonoscopy?

The decision to undergo a colonoscopy should be made after evaluating your personal and family history, current health, risk factors, and access to trusted healthcare providers.

If you're leaning against it, know that alternatives like Cologuard and virtual colonoscopy exist, though they have limitations. If you're leaning toward getting one, consider seeing an experienced practitioner who has done a lot of these, and will guide you through proper preparation and post-care.

Remember, being proactive with your health doesn't always mean saying "yes" to every test—but it does mean being informed, asking questions, and choosing the best path for you.

Conclusion

Colonoscopy is recommended for the early detection and prevention of colorectal cancer. But it’s not without risks. By understanding both the benefits and potential complications, you can make a more empowered and personalized decision—one that aligns with your health goals, values, and risk profile.

If you're on the fence, don’t hesitate to ask questions, explore alternatives, and discuss your options with a healthcare provider who will listen—not just prescribe.

Find Your Hashimoto’s Triggers

If you have Hashimoto’s thyroiditis, visiting an endocrinologist is likely to result in a prescription for thyroid hormone replacement. And while there is a time and place for thyroid hormone, the problem is that it doesn’t do anything for the autoimmune component of Hashimoto’s.

And so what happens is that many people will take thyroid hormone without doing anything to improve the health of their immune system, which means that over time further damage to their thyroid gland will take place.

The good news is that you can do things to reverse the autoimmune component of Hashimoto’s. And the best way to accomplish this is by finding and removing your triggers.

My book “Hashimoto’s Triggers” will show you how to do this. By reading this book you will discover the following:

• More than one dozen triggers of Hashimoto’s thyroiditis

• The different diet options, and how to detect your specific food triggers

• Everything you need to know to heal your gut

• How to reduce fatigue, brain fog, hair loss, lose weight, and address other common symptoms

• Strategies to lower thyroid antibodies when nothing else has worked

• Nutritional supplements and herbs for Hashimoto’s

• A comprehensive list of the blood tests you should get, along with other specific tests that can help detect your triggers

• What you need to do to achieve optimal adrenal health

• Natural treatment options for viruses, pathogenic bacteria, parasites, Candida, and SIBO

Click Here to order the book “Hashimoto’s Triggers”

Save My Thyroid Podcast Review

I have a podcast called "Save My Thyroid", where I discuss how people with hyperthyroidism and Hashimoto's can save their thyroid and regain their health. And during each edition of this newsletter I'll briefly discuss a recent podcast episode.

In a recent podcast episode I chatted with VJ Hamilton, The Autoimmune Nutritionist, about overcoming alopecia areata and other forms of hair loss by addressing root causes. We dive into nutrient deficiencies, gut health, thyroid imbalances, and inflammation and how functional medicine can help hair grow back naturally.

If you’ve been told there’s no hope for hair loss, this episode will challenge that belief.

Ask Dr. Eric

During every issue I'll answer a question or two that I think can benefit most people with a thyroid or autoimmune thyroid condition. If you'd like for me to consider your question for a future edition of this newsletter email your question to [email protected].

QUESTION: WHEN IS IT NECESSARY TO GET AN ENDOCSCOPY?

Dr. Eric, I visited a gastroenterologist for my heartburn and reflux, and he is recommended an endoscopy. When is this procedure absolutely necessary?

Thank you for your question! In the main topic above I spoke about routine colonoscopies, and while endoscopies aren’t usually routine, they are commonly recommended by gastroenterologists. In fact, when someone is experiencing gastrointestinal symptoms, they might recommend both an endoscopy and a colonoscopy.

An esophagogastroduodenoscopy (EGD)—often referred to simply as an upper endoscopy—is a diagnostic procedure that allows direct visualization of the upper gastrointestinal tract. This includes the oropharynx, esophagus, stomach, and proximal duodenum.⁷ It’s most commonly performed by a gastroenterologist to identify or rule out causes of persistent or unexplained upper GI symptoms .

According to clinical guidelines, an EGD is typically indicated in the following situations:⁷

✅ Ongoing or severe upper abdominal pain, especially when accompanied by unintentional weight loss or reduced appetite

✅ Dysphagia, or difficulty swallowing

✅ Symptoms of gastroesophageal reflux disease (GERD) that do not respond to conventional treatment

✅ Chronic vomiting with unknown cause or vomiting that contains blood (hematemesis)

✅ Iron-deficiency anemia, especially when chronic blood loss is suspected as the cause

✅ Suspected malabsorption or long-standing chronic diarrhea

✅ Routine monitoring in individuals with precancerous conditions, such as Barrett’s esophagus, familial polyposis syndromes, or a history of caustic ingestion

Should You Try Diet and Lifestyle First?

In many cases, particularly when symptoms are mild or intermittent, it makes sense to explore non-invasive options before proceeding with an endoscopy. Simple changes such as improving your diet, managing stress, and removing common dietary triggers (e.g., gluten, caffeine, alcohol, spicy foods, processed carbs) can significantly reduce symptoms like heartburn, bloating, or mild reflux.

Since it can often take weeks or even months to schedule an appointment with a gastroenterologist, there's usually time to experiment with lifestyle changes while waiting. Many people find that their symptoms improve or resolve with these interventions—potentially eliminating the need for further procedures.

When Medical Attention is Necessary

That said, certain symptoms should not be managed exclusively with diet and lifestyle changes. For example:

✔️ Vomiting blood (hematemesis) may indicate a bleeding ulcer or tear in the esophagus and requires immediate medical evaluation.

✔️ Progressive difficulty swallowing may signal a stricture or, in rare cases, an esophageal tumor—conditions that should be ruled out through direct visualization and biopsy.

✔️ Severe or persistent diarrhea, especially when accompanied by signs of dehydration or weight loss, may point to infections, inflammatory bowel disease, or celiac disease, all of which may need medical and endoscopic work-up.

In these more concerning scenarios, an endoscopy can be essential not only for diagnosis but also for timely treatment.

Functional Medicine Testing vs. Endoscopy

If initial lifestyle changes don't produce results, some individuals may consider functional medicine testing as an alternative to an endoscopy. For example, a comprehensive stool analysis (like the GI-MAP test) can identify infections, dysbiosis, inflammation, and digestive enzyme insufficiencies. These tests are valuable for uncovering root causes behind non-specific symptoms such as:

• Mild to moderate heartburn or reflux

• Gas and bloating

• Constipation or inconsistent stools

• Suspected dysbiosis (imbalance of the gut flora)

However, functional testing is not a replacement for an endoscopy in situations involving red-flag symptoms like unexplained bleeding, significant weight loss, or difficulty swallowing. In these cases, direct visual examination is typically necessary to avoid overlooking serious conditions.

Additional Thyroid-Related Resources

Click Here for Why Hair Loss Happens and What Helps with VJ Hamilton (Episode 214)

Click Here to access hundreds of thyroid-related articles and blog posts

Click Here to join the Graves’ disease and Hashimoto’s community

Click Here to purchase one of Dr. Eric’s thyroid-related books

Click Here to work with Dr. Eric and his team

📚References:

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That’s a wrap