Colonoscopy Conversations: An Integrative, Honest, Empowering Look at Screening
Colorectal cancer is no longer a “later in life” conversation. Rates are rising in adults under 50, and my patients ask about colonoscopies more than ever—especially in functional medicine spaces where the recommendations online vary wildly.
As someone who has practiced in both conventional and functional medicine, I hold two truths at once:
Our healthcare system absolutely needs an overhaul
Colonoscopies can save lives, and the data supports that
And — I just had my own colonoscopy.
My prep wasn’t glamorous. Cue 2 puking episodes that left me drained. And, like many of you, I had questions about the risks, the microbiome impact, and whether there are alternatives.
This blog is the deep-dive I wish patients had before they make a choice.
Why This Conversation Matters Right Now
Colorectal cancer is rising in young adults
This isn’t fear-mongering; it’s well-documented.
Early-onset colorectal cancer (under age 50) has increased 50% since the 1990s (NCI SEER data).
It’s now the #1 cancer killer of men under 50 and #2 for women under 50 (American Cancer Society, 2024).
Most young adults diagnosed had no symptoms.
The reality? Screening matters.
The nuance? How, when, and with what method — that’s where integrative healthcare shines.
My Colonoscopy Experience
I have a strong family history on my dad’s side of colon cancer. My dad had polyps discovered in his late 40’s and my paternal grandparents both died of colon cancer. I know so much comes down to lifestyle but with this history in mind it was important to me to be screened. Because of this history I am not a candidate for the cologard screening.
Most have heard that the prep experience isn’t fun and I was hopeful but also realistic. I’ve never been able to chug anything, do a keg stand, or beer bong. I don’t love drinking lots of fluids in general and can’t do a shot to save my life. I knew this was going to be a challenge.
The prep went well until it didn’t. I mixed the Miralax powder in water, and then would add my Ultima electrolyte to each amount I was drinking.
There are two specific things I will do differently next time.
1.Use a Straw. Reduces “gulp volume” → stomach tolerates it better
Late in prep, it’s not the flavor causing nausea.
It’s the physical act of swallowing a big sip.
Your stomach basically says:
“If you give me one more full swallow, I’m going to send it back up.”
A straw forces:
smaller sips
less air
less swallowing pressure
less stomach expansion per mouthful
2. Chill It. Cold prep reduces gastric spasm
Warm room-temperature liquid hits an irritated stomach like:
“Nope.”
Chilled liquid:
slows gastric contraction
decreases acid activity
reduces the “tight ball” feeling you get before vomiting
Again — not about taste.
It’s about calming your stomach wall.
The actual colonscopy experience was a breeze and thankfully everything looked good! I do have to go back in 5 years vs. 10 based on my family history.
What Colonoscopies Actually Do (and Don’t Do)
What they do well
✔ Detect polyps
✔ Remove polyps before they become cancer
✔ Identify bleeding, inflammation, diverticulitis, strictures
✔ Give a real-time visual assessment
A 2022 NEJM study found colonoscopy screening reduced colorectal cancer risk by 18% and mortality by 50% in people who actually underwent the procedure.
Cite: NEJM. 2022; “Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death.”
What they don’t do
✖ They do NOT prevent all cancers
✖ They do NOT replace lifestyle (fiber, exercise, obesity, smoking influence risk more)
✖ They are NOT perfect (6–12% miss rate for right-sided lesions)
Addressing the Claims Circulating in the Holistic Community (Gently)
Many influencers raise concerns about colonoscopies. Some are valid questions. Others stem from misunderstanding the data.
Claim 1: “Prep solutions are contaminated with EO (ethylene oxide).”
Ethylene oxide is used to sterilize medical devices, but…
What the evidence shows:
Polyethylene glycol (PEG-3350) bowel preps are not manufactured with EO.
EO sterilization is used for medical devices, not the PEG solution.
The FDA confirms PEG preps do not contain measurable EO in testing.
(Citation: FDA: “Ethylene Oxide Sterilization: FAQs About Testing and Exposure Risks”, updated 2024)
The concern comes from a misunderstanding about PEG and EO — they are not the same substance.
Claim 2: “Colonoscopies wipe out the microbiome.”
A valid question — but here’s the nuance.
The evidence:
Prep temporarily lowers bacterial diversity.
Most people return to baseline within 2–4 weeks.
Some studies show changes up to 6 weeks.
No long-term, permanent damage has been shown in healthy adults.
Key study citations:
Jalanka et al., 2015: microbiome disrupted for 14–28 days, then normalized.
Drago et al., 2021: diversity changes persisted 4–6 weeks in some people but were not harmful.
No evidence of permanent harm in healthy subjects.
For people with dysbiosis before the procedure, symptoms can flare more noticeably.
Functional medicine note:
This is why post-colonoscopy support matters:
25–35g fiber
Polyphenols (berries, pomegranate, cranberries)
Bifido + Akkermansia support (probiotics can help)
Avoiding heavy antimicrobials after the prep
Claim 3: “There are better screening methods.”
This one is partially true — but depends on the goal.
FIT test (fecal immunochemical test)
Detects blood → good for detection, not prevention.
Cologuard (DNA + FIT)
Great option but:
13% false-positive rate
Less effective for right-sided lesions
Does not detect polyps well
CT colonography
Radiation exposure, still requires bowel prep, still requires colonoscopy if abnormal.
Blood tests (like the ECLIPSE test or Guardant SHIELD)
Promising but not a replacement right now.
Colonoscopy remains the only tool that detects AND removes precancerous polyps in real-time.
Claim 4: “Colonoscopies profit the system.”
Fair question — and systemic critique is warranted.
Reality:
Yes, it’s a multi-billion-dollar industry.
Also reality:
Preventing a single case of colorectal cancer saves the system far more than a colonoscopy costs.
The data consistently shows:
Screening reduces mortality
Screening reduces treatment cost
Screening is cost-effective
(Citation: Lansdorp-Vogelaar et al., Gastroenterology 2011)
Being skeptical of “the system” is valid.
Rejecting effective screening because the system profits? That’s where nuance matters.
So When Should You Get a Colonoscopy? (Integrative Guidance)
General population
Start at 45
Sooner if symptoms, family history, or risk factors
Higher-risk groups
Personal or family history
IBD
Genetic syndromes (Lynch, FAP)
African American patients (higher incidence)
Younger adults (<45) should consider screening if they have:
Rectal bleeding
Change in stool caliber
Unexplained weight loss
Chronic abdominal pain
Chronic anemia
History of antibiotic overuse + poor diet + metabolic dysfunction
High inflammatory markers
(Young adult CRC is often diagnosed late because symptoms get dismissed.)
Integrative Prevention: What Matters Even More Than the Procedure
Here’s where the functional medicine lens shines.
Top lifestyle factors for reducing colorectal cancer risk (supported by mountains of data):
1. Diet high in fiber (25–40g/day)
Reduces CRC risk by 22–43%.
(Crowe et al., BMJ 2011)
2. Regular strength training + movement
Reduces risk 20–30%.
(Wolin et al., Int J Cancer 2009)
3. Vitamin D optimization
Higher vitamin D levels = 50% lower risk.
(Song et al., JNCI 2018)
4. Limiting processed meats + alcohol
5. Maintaining healthy body fat percentage
6. Microbiome balance
High diversity → “colon-protective” butyrate production.
How to Protect Your Microbiome Before & After a Colonoscopy
Before (1–2 weeks prior):
Increase fiber
Add resistant starch
Polyphenols
Reduce alcohol + sugar
Keep up with hydration
Day-of / After
Electrolytes
Bone broth
Gentle meals
Reintroduce fiber gradually
Probiotics (Seed + Akkermansia-friendly foods)
DGL, colostrum, glutamine for gut lining support
The Bottom Line
You can hold two ideas:
Yes, colonoscopies can be uncomfortable, imperfect, and overused
And yes, colonoscopies save lives — especially with rising early-onset colorectal cancer
My stance as an integrative provider:
I’m not pro–colonoscopy. I’m pro–informed choice.
I’m pro–root cause AND pro–evidence.
I’m pro–patients staying alive to see their children grow up.
If you choose to do a colonoscopy, I support you.
If you choose another screening method, I support you — but we must screen somehow.
The most dangerous option is no screening at all.