Direct Primary Care Week is June 18-22, 2018

From June 18-22, 2018, New Jersey will celebrate the first-annual Direct Primary Care (DPC) Week. The goal of DPC Week is to raise awareness of the State’s progressive program to break down barriers between a patient and his/her physician.

Multiple events and activities will be held to bring attention to New Jersey’s DPC program which is available to workers and their family members who are part of the State Health Benefits Program (SHBP) or School Employees’ Health Benefits Program (SEHBP). Membership to a Direct Primary Care doctor’s office is included at no additional cost and with no change to existing health benefits. Features include no co-pays, more time with the doctor, little to no wait, 24/7 access to a personal doctor, and much more.

A tele town hall will be held on Thursday, June 21 at 7 pm to learn more about the program. You can sign up here.

You can also find more information about R-Health in NJ here.

Time to Get to Work

It’s very easy to stay stationery, especially at the work place. While we all have our routines, it’s important to incorporate new activities to reinforce health habits. May is National Physical Fitness and Sports Month where the goal is to spread awareness about the benefits of getting and staying active, while creating opportunities for everyone to partake in more activities.

These physical activities aren’t limited to the outdoors. Long periods of inactivity (for example in office job settings) can lead to increased risks of diabetes, heart disease, and some types of cancer, per Live Better. Therefore, it’s important to find time to be active, even in the workplace, and there’s more than a few ways to get started.

  • Walk or ride part of your way to work
    • If possible, you can take the train and walk to work, or park further away from work and walk the rest of the way.
  • Have standing or walking meetings
    • Standing meetings can not only keep you active, but helps in increasing efficiency.
  • Wear comfortable clothes and shoes
    • More comfortable attire aids in your likelihood to be more active at work, like taking the stairs instead of the elevator.
  • Pack exercise clothes
    • If you’re unable to make it out the house due to a busy schedule, bring a change of clothes to work. Before heading home, change into your exercise clothes and make a quick stop at a park or gym and get some minutes of exercise going.
  • Track your steps
    • Having smart devices like a Fitbit or other smart watches can give you that extra boost of incentive to take more steps and reach the recommended 10,000 count per day.
  • Walk instead of calling/emailing
    • Take every opportunity to leave your desk. When communicating with a colleague across the room, take the time to get away from your desk and walk over to have your interaction.
  • Move during Lunch Break
    • Small segments of exercise over the course of a day can be very beneficial than a single session of activity. Simply 10-15 minutes can be very beneficial physically and mentally.
  • Stretch
    • Sitting all day can develop into pain in the body, specifically in the neck and back. Taking the time to stretch at your workspace every 30 minutes can help you feel more energized.

As you see there many more ways to exercise during work than are excuses not to. It’s important to find the time throughout the day stay active to stay healthy and lower the risks of developing other diseases. For more tips on how to stay active and healthy, visit your doctor and develop the best health plan for you.

Breaking Down Mental Health

Mental health is an issue that affects millions of Americans. According to MentalHealth.gov, one in five adults experienced a mental health issue, and one in ten young people experienced a period of major depression. Signs of mental disorder may show as early as 14 years old, however, less than 20% of cases with diagnosable problems get treated.

When mental health issues are treated properly, it can result in you being able to live, work, and enjoy life to the fullest. However, if left untreated, mental health can affect your diet, sleep, stress, gut health, and exercise. Mental Health America shared a toolkit on the impact of mental health.

Diet and Nutrition

Both your physical and mental health are impacted by the quality of food you consume. Studies have shown those with a diet high in junk and processed foods are 80% more likely to have depression. Healthy diets including the consumption of more fruits, vegetables, fish, and other healthy foods are used as effective treatment methods for depression. A study showed one in three participants saw full relief of symptoms with a healthier diet.

Sleep

Sleep is a major key to a healthy body but more importantly, a healthy mind. Sleep accounts for our moods, memories, healthy organs, immune system, among other things. Sleep re-energizes cells, and increases the space between brain cells to allow free flowing fluid to clear away toxins. Poor sleep quality can lead to manic episodes, paranoia, anxiety, and depression.

Gut Health

There’s a very important connection between the gut and the brain. Your gut connects with the brain through hormones and neurotransmitters that help exchange messages. Gastrointestinal symptoms like indigestions, acid reflux, heartburn, diarrhea, and etc., are linked to mental health problems. Changes in your gut can be caused from a stress response, which may ultimately lead to diseases like Parkinson’s and autism.

Exercise

An hour of exercise has been linked to lower levels of anxiety and substance use disorders and less likely to have panic disorders, phobias, and depression. Exercise plays an important role in brain function in terms of protecting nerve cells, sending messages, and releasing endorphins among other things.

Mental health is a very important issue that we must continue to address. If you are experiencing some symptoms, or have some general questions, reach out to your doctor and get the assistance you need right away.

Interesting Facts About Skin Cancer

May is Skin Cancer Awareness Month, with the goal to encourage and educate sun-safe habits while raising awareness for lifesaving programs.

Skin cancer is the most common form of cancer in the United States. According to The Skin Cancer Foundation there are over five million new cases diagnosed each year, and although it is the most preventable form of cancer, spreading awareness about unprotected exposure to the sun can change habits and save many lives.

Here are a few skin cancer facts:

  • One in five Americans develop skin cancer by the age of 70.
  • There are three major types of cancer: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) [also known as non-melanoma skin cancers], and melanoma.
    • Nonmelanoma skin cancers
      • Regular use of SPF 15 sunscreen or higher reduces risk of these cancers by 40%
      • 90% of these cases are associated with exposure to ultraviolet (UV) radiation from the sun
    • Melanoma skin cancers
      • The vast majority of melanoma is caused by the sun
      • Men age 49 and under have a high probability of developing melanoma than any other cancer
      • Women age 49 and under are more likely to develop melanoma than other cancers except breast and thyroid cancers
      • Regular use of SPF 15 sunscreen or higher reduces risk of these cancers by 50%
      • Although more common in lighter skin tones, melanoma is more dangerous in darker skin tones
      • Acral lentiginous melanoma is found in skin areas not exposed to the sun, and is more common in those that have dark skin tones

How can you keep your skin safe during the upcoming summer months? EverydayHealth shared some tips and other helpful facts from the top dermatologists in the country.

  1. Avoid indoor tanning.
    • Tanning beds can increase your chances of developing melanoma by 20%
  2. Re-apply SPF to keep you skin safe.
    • The active ingredients in SPF can break down with time and UV exposure, so to be sure to re-apply every three to four hours. Avoid spray versions and stick to SPF 50 or higher.
  3. Some medications may increase sun sensitivity.
    • Some antibiotics or medications can make your skin more prone to burning, while also affecting your immune system, so ask your doctor about any medications you are taking.
  4. Sunscreen may trick you into feeling protected.
    • Spray sunscreens are difficult to apply and may leave areas unprotected, and can be inhaled and entered into bloodstream and trigger skin reactions. It’s best to avoid any spray sunscreen.
  5. Certain foods can combat UV effects.
    • Foods like red bell peppers, broccoli, and others may help boost UV defense, so get your fill of these helpful veggies.

If you are spending time outdoors it’s good to know different sunscreen types:

  • Mineral Sunscreens
    • Sits on top of your skin and physically block your skin from the UV waves.
  • Chemical Sunscreens
    • Works by absorbing into your skin and absorbing the UV rays.

Remember, some sunlight is healthy too! A recent study has shown that not only does sunlight help us make Vitamin D, it also increases levels of other important molecules in the body like serotonin, melatonin, nitic oxide, and may increase endorphins.  These changes may improve risk for diabetes, high blood pressure, mood disorder and breast and prostate cancers.   

For more skin protection tips, or if you want to know which sunscreen works for you and balancing sun protection and sun exposure, please visit your doctor before you enjoy your time in the sun.

Growing a Healthy Baby

We can positively influence the health of our children for years to come – even while in the womb.

Making sure that we are getting the right nutrients, exercise, enough sleep, and surrounding ourselves with love, support, and laughter can influence epigenetics.  Think of epigenetics like a librarian. If the books in the library are your DNA, the librarian determines which genes will be opened and read.

There are experiments done in mice that show how what their mothers ate or were exposed to during gestation, determined their genetic expression of a gene that put them at risk for obesity.

So what can you do to live a healthy lifestyle during pregnancy to ensure the “good” books will be opened and the” bad” ones closed?

Try eating whole foods and organic foods as much as possible during pregnancy, with a rainbow of vegetables and fruits. This will increase phytonutrients or substances found in certain plants that are thought to prevent disease. By also eating whole, organic foods, you will cut down on pesticide and plastics exposure, which can interfere with epigenetics as well as a full-term pregnancy. A recent study at the University of Indiana that showed that higher exposure to glyphosate (found in Round up and Round up Ready GMO foods) shortened the length of pregnancy.

Here are some other helpful prenatal tips:

  • Take a prenatal vitamin especially with Folate, Vitamin D, Vitamin B6, Zinc, Vitamin K1 and L2 and eat foods or supplements rich in Omega-3 fatty acids (both DHA and EPA, as DHA is important for brain development, and EPA is required for DHA to get into the brain)
  • Morning sickness can be due to Zinc or Vitamin B6 deficiencies or to drops in blood sugar.
  • Avoid eating processed foods. Instead, eat plenty of healthy fats (from nuts, seeds, avocados, coconut, etc.) and protein, while avoiding refined grains and sugars that can quickly raise and then lower blood sugar. This will also help prevent gestational diabetes.
  • If allergies run in your family, taking probiotics during the 3rd trimester can decrease your baby’s risk of developing allergies and eczema.  Go for a variety of fermented foods. If that is not your thing, pick up a capsule of probiotics filled with good bacteria.
  • Most importantly, surround yourself with happiness and seek support from loved ones or your community.  Endeavor to practice techniques to manage your stress as your baby is exposed to those same stress hormones.  Put yourself first, listen and attend to your body, try prenatal yoga, diaphragmatic breathing, journaling, or guided imagery.  If needed, reach out to a therapist or a health coach.

Simply put, eat a healthy diet, enjoy life, enjoy being pregnant and enjoy your baby! If you have questions or are having trouble accomplishing your goals for a healthy pregnancy, please reach out to your doctor.

Optimizing Bone Health: Decrease Risk of Low Bone Density and Fractures

Prevention is key for bone health – as with many health issues. Bone density peaks around age 30.  For most people after that, it steadily decreases with age. This even starts in the womb. Mom’s calcium and vitamin D levels influence bone density later in life, as does breastfeeding.  During childhood and young adulthood building a “bone bank” through adequate nutrition and weight bearing exercise is key to developing maximum peak bone density.  But, it’s never too late to start with healthy changes.  Maintaining good bone health can decrease the rate of bone loss and maintain quality of the bones, and there are many factors that play a role in this.

Food

Nutrition plays a big role in bone health. Calcium is often the first thing people think about, and though calcium is important it can be overdone. Too much calcium, especially if it is not balanced with magnesium and vitamin K can build up on artery walls.  Also, don’t rely on dairy – there is minimal link between dairy and bone health.
Try the foods in this list from the University of Wisconsin to promote bone health instead.

Onion family Fennel Parsley
Arugula French beans Pomegranate
Broccoli Garlic Prunes
Celeriac Leeks Red Cabbage
Chinese cabbage Lettuce Turmeric
Cucumbers Mushrooms Wild garlic
Dill Oranges & other citrus Soy (whole soy foods)

Too much of certain things can have a negative impact on your bones as well – so keep it to less than one alcoholic drink per day, and minimize cola and caffeine (except for tea) and don’t take more than 3000 iu of vitamin A.  Limit animal protein intake as well. The theory is that animal protein causes our blood to be slightly acidic, and to neutralize this effect our body steals calcium out of the bones.  Eat plenty of vegetables and fruit. A high vegetable to animal diet ratio seems to be protective against bone loss.

Vitamins and Minerals

Make sure you get adequate vitamin D. Vitamin D helps your body absorb calcium properly. Living in this area of the Northeast, we’re unable to make enough through the sunlight. Talk to your doctor about your levels and supplements.
Vitamin K, an important balance with calcium, is required for the activation of the hormone that tells our body to build bone.  Consider supplementing with vitamin K2 45-100mcg.  Magnesium helps keep the bones flexible. Try taking 400-800mg before bed. Talk to your doctor first if you are on blood thinners or if your magnesium dosage causes loose stools. Vitamin C, B vitamins, Potassium, and Zinc are all likely to be important as well.

Exercise

Benefits of exercise are seen at all age groups. Walking, other weight bearing exercise, and resistance training are all helpful. Vigorous walking at more than 3.8 miles per hour shows better benefit.

Smoking

Another reason to quit! Smoking increases fracture risk by as much as 40% compared to non-smokers.

Preventing Falls

The ultimate goal of prevention of bone density treatment is to avoid fractures, so preventing falls is a very important aspect of bone health. Exercise decreases fall risk and it maintains strength and coordination. Tai chi has been shown to reduce falls by improving balance.
Try these other tips from the Mayo Clinic to also help prevent falls:

1.  Talk to your doctor about your medications – some medications could cause dizziness
2.  Wear sensible shoes – avoid floppy slippers or shoes
3.  Remove tripping hazards – remove throw rugs that slip or stick up
4.  Make sure areas are well lit – use night lights
5.  Use assistive devices when necessary – like grab bars

Getting Your Bone Density Checked

Overall women have a higher risk of developing problems with low bone density because they have a lower peak bone density. Men with certain medical conditions or taking certain medications may be at higher risk too. Getting your bone mineral density checked is recommended if you are a woman over 65 years of age, or have the same fracture risk as a woman over 65.  You can calculate your fracture risk using this tool.  https://www.sheffield.ac.uk/FRAX/.

Bone density is checked with a test called a DEXA scan. Bone density in the hip and lower spine are the areas of the body that are X-rayed and then compared to a healthy 30-year-old of the same sex and given a score, called at T score. The more negative the number, the less dense the bones.  Osteoporosis is diagnosed with a T-score lower than -2.5.

Medication might be right for you if you have osteoporosis.  Talk to your doctor about this or any questions you have about your bone health or getting your bone density tested with a DEXA scan.

Why Environmental Health Matters

Each first full week of April celebrates National Public Health Week. The goals of this week are to identify the issues that impact poor health and disease risks for individuals and communities and to start conversations and develop strategies that help build a healthier nation. Each day of the week focuses on a different aspect of public health, and our focus is Environmental Health.

Why is environmental health important? According to Office of Disease Prevention and Health Promotion (ODPHP) the environment plays a key role to the length and quality of your life. Poor environmental health is not only costly, but very hazardous. Per the ODPHP, 23% of all deaths (26% among children 5 years old or younger) are caused by preventable environmental factors. Therefore, to further understand it’s importance, below are some environmental factors that can affect your health.

  • Outdoor Air Quality
    • Poor air quality can lead to many issues: cancer, respiratory/cardiovascular system damage, and premature death.
  • Surface and Ground Water
    • Minimizing your exposure to contaminated water sources is important to your health as contaminated drinking and recreational waters from chemicals or infectious agents can cause serious illness.
  • Hazardous Substances
    • Substances like nitrogen dioxide from gas cookers or the removal of hazardous waste can filter into your water and air supplies, which when absorbed can be a dangerous health risk (especially for children).
  • Climate
    • Climate can affect air, food, water, disease risk, and mental health. It can increase asthma events and heat-related deaths, but can also impact sea level and cause natural disasters – which may spread diseases and also cause damage to your mental health during recovery periods.
  • Homes and Communities
    • With much time spent either at home, work, or school, your health can be impacted by the space you occupy: Indoor air pollution, inadequate heating or sanitation, or lead-based paint hazards can affect your health.

As you see there are plenty of environmental factors that can impact your health, but the Health Department at the University of Minnesota shared few suggestions on how to live a more sustainable life.

  1. Limit the use of toxic substances and unknown chemicals
  2. Buy organic, fair-trade products
  3. Carpool, bike, or use public transportation to prevent further air pollution
  4. Recycle

While there’s a need for long term sustainability to optimize public health, it’s important to take the initiative to ensure you’re living in a healthy environment. Check your homes, check the products you buy, but most important check in with your doctor to make sure you’re void of any disease risks.

Spring Into Action

It appears winter is behind us (fingers crossed!). Short sleeves, ice cream, and warm nights aren’t the only reasons to get excited for spring. The season also brings surprisingly great health benefits as well.

Of the many benefits that encompass spring, Everyday Health narrowed it down to six things that should excite you and your health.

  1. Extra Daylight
    • Lack of Vitamin D can put your bones at risk, but during the spring you can soak up all the nutrients your body needs. (Remember to take precautions in order to balance healthy sun exposure versus burning.)
    • Extra sunlight serves as a natural mood booster and helps with seasonal depression some people suffer from during the dark fall and winter months.
  2. Healthier Home
    • Spring time means spring cleaning. Not only is it a great calorie burning exercise, but the cleaning of your home, car, office, and other areas can rid you of bacteria that may free you from spring colds and help seize control of your allergies.
  3. Spring-cleaned Diet
    • Around the warmer months you’ll find yourself eating less and going out more.
    • When you do eat, there are more healthy options available since many fresh fruits and vegetables are ripe for the taking.
    • Look for your spring produce at your local farmer’s market.
  4. Outdoor Exercise
    • With warmer temperatures you’re more inclined to explore the outdoors.
    • Studies have shown time outdoors helps with reduced stress and lowering blood pressure.
    • Warmer weather also offers more opportunity for outdoor exercises (e.g. runs, walks, swimming, etc.)
  5. No winter skin
    • Gone are the days of dry skin and with the added vitamin D you’ll surely be moisturized.
  6. Spring Break
    • These are the best times for vacations. Whether near home or getting away, getaways are great ways to manage stress and has been linked to reduced risks of breast cancer and cardiovascular disease.

As you see, there’s plenty to enjoy during these upcoming months, but be sure to keep your health as a priority. Reach out to your doctor if your experiencing any changes during these times, so you make the best of this season.

Healthy and Affordable Shopping

Grocery shopping can seem overwhelming especially as you are getting used to eating and preparing foods in a new way. It can be especially difficult on a budget. My belief is that investing in healthy food is investing in your health. I recently shared some tips with my patients at our R-Health Cherry Hill Healthy Shopping on a Budget event. Here are some of my favorite pieces of advice.

First let’s broadly define “healthy” as there are many controversies.  However, let’s focus on key elements of agreement.  They are: eating whole unprocessed foods, especially fruits, vegetables, nuts and seeds, avoiding empty carbohydrates such as those in sweets and refined flours, avoiding additives including chemicals and added sugar and salt, avoiding pesticides, antibiotics and hormones and getting adequate amounts of healthy fat, protein, and fiber.

Reading labels is empowering! It takes extra time at first, but once you know the products that are right for you, shopping will get faster again.  Not all food labels are helpful in making decisions.  For example, “natural” does not have a clear definition that is regulated by the FDA.  Companies can label their food natural and it still contain high fructose corn syrup for example. Also, beware of Heart-healthy statements as well as they can have plenty of refined carbohydrates that raise your blood sugar and trigger inflammation.  A few things to think about food labels in general.

  • Ingredient list: QUICK HINT – look for names you can pronounce and foods you have in your own kitchen.
  • MANY OF THE BEST CHOICES WILL NOT HAVE A LABEL – Think the produce section!
  • Calories: Not all calories are created equal – don’t worry so much about the calorie count, when you are able to get rid of processed foods usually you can trust your body to tell you when you have had enough.
    • Your body processes a Twinkie much differently and with different metabolic effects than a handful of nuts even though they have the same amount of calories.
  • Check the portion size. (Sodium content can be misleading when that tiny can of soup has 2.5 servings!)
  • Watch for fats
    • Buy healthy fats – nuts, seeds, olive oil, etc. and avoid trans fats
    • Foods can be labeled as having 0 gm of fat or trans fats if they have ½ gram or less.
  • Fiber is good for your body, especially for healthy gut bacteria
  • Watch for additives especially sugar and salts
    • New guidelines now ensure labels now contain “added sugars”
    • Try to avoid concentrated natural sugar in high quantities too (e.g. fruit juice or dried fruit)
    • Work on sticking to the recommended limits of no more than 6 tsp of added sugar for women and children and 9 tsp for men per day
    • For salts, much of the sodium and added sugar comes from salts and sugar added to processed foods. This helps the food industry to make the food more addictive. Read labels carefully and cook home-made meals whenever possible.
    • Look for chemical additives or artificial flavors/colors. You might be surprised when you first start reading labels to find how much more is in your can of beans, tomato sauce, or yogurt than you thought.

Saving money on anything usually requires planning ahead.  Look at circulars for sales and make a meal plan for the week.  Look online and in magazines for great ideas for your palate and budget.  Try searching “clean eating on a budget.”  On our grocery trip we toured Aldi.  Not only does this grocery store offer healthy natural (their Simply Nature labels are verified by a third party) and organic options, but surveys show Aldi’s prices on average contain 20% more savings than larger retail stores.  Remember to bring a quarter and your own shopping bags.

Other cost saving tips:  If you have the time, avoid pre-cut servings.  Stock up on nonperishable and frozen items when on sale, and shop frequently for perishable items so they don’t spoil before you can use them.  Try looking above and below eye level, compare store brands, and of course not shopping while hungry are other cost saving tips.

Also know when to invest in organic produce and when to save on conventionally grown produce. According to the Environmental Working Group’s 2017 list below are products to look for.

  • DIRTY DOZENFruits and Vegetables with the most pesticides (Shop organic when possible for these!)
    • Strawberries
    • Apples
    • Peaches
    • Pears
    • Spinach
    • Tomatoes
    • Celery
    • Potatoes
    • Sweet bell peppers
  • CLEAN 15Fruits and Vegetables with the least pesticides (Okay to buy conventionally grown produce for these!)
    • Pineapples
    • Mangoes
    • Papayas
    • Honeydew Melon
    • Kiwi
    • Cauliflower
    • Eggplant
    • Sweet Corn
    • Cabbage
    • Avocadoes

Hopefully this is a good start for your next grocery store trip.  Please feel free to reach out to your R-Health doctor for more information and if you have specific medical conditions for your doctor to get you on the best health and nutrition plan.

Everyday Tips to Relieve Constipation

There comes a point where almost everyone goes through it – constipation. A period of infrequent bowel movements or hard stools.   Constipation can be a very uncomfortable state, especially the longer it lasts. Though not severe, if not taken care of, constipation can cause damage to the veins and skin in your anus, in addition to significant damage to intestines.  Chronic constipation is also a risk factor for colorectal cancer.

Per the Mayo Clinic, there are a few risk factors that may increase your risk of constipation:

  • Older age
  • Women
  • Dehydration
  • Low fiber diet
  • Little to no physical activity
  • Blood pressure medications/treatments
  • Mental health conditions

Luckily our R-Health doctor, Julia Snyder, MD, offers tools to prevent and relieve constipation.

  • Eat a whole foods, high-fiber diet
    • Eat foods in their unprocessed forms without additives (i.e. sugar, salt, flavorings or preservatives)
    • Consider a trial of dairy and gluten free (two food groups that are likely to cause constipation for people)
  • Try adding 2 tablespoons of ground flax seeds to your daily diet for extra fiber
    • Grind the flax yourself every 2 days for an extra healthy fat boost
  • Eat more good fats and try coconut oil
    • g. – wild fatty fish like sardines and salmon, avocados, and olive oil (which lubricates the digestive system)
  • Supplement with magnesium, vitamin C and probiotics
    • Use 200 mg to 1,000 mg of magnesium citrate daily. Gradually increase the dose until you go once or twice a day. If you take too much, you will get loose stools. If that happens, back off a bit.
    • Vitamin C – you can take 2,000 to 4,000 mg in divided doses two or three a day, along with magnesium supplementation. The same principle applies here: If you begin to get loose stools, just back off a bit.
    • Many people who struggle with constipation are often deficient in healthy gut bacteria, so adding probiotics can help – try adding them for one month. The increased fiber in your diet will give them food to eat and they will be happy to stay.  Also add fermented foods/drinks to your diet.  (Fermented vegetables are found in the refrigerated section)
  • Drink about half your weight in ounces of water each day (add more for hot weather or exercise)
    • Try starting off your day with water and lemon (room temperature to warm)
    • Cold drinks slow down the bowels.
    • Try coffee or tea with an apple and walnuts/pecans/almonds for breakfast
  • Exercise regularly
    • Get up and move – just 10-15 minutes of walking a few times a day will make a big difference
    • Try Yoga – the combination of relaxation and movement aids in triggering the bowels to release
  • Give yourself time to go and listen to mother nature’s call!
    • Schedule time in to your morning – just like potty training your little ones!
  • Position yourself correctly
    • Put your feet up on a stool to mimic a squatting position. This allows the muscles to relax and the stool to exit more easily.

 

 

Following these suggestions are sure aids in constipation prevention and management. However, if you have questions, or have frequent constipation, notice blood in your stool, and have severe pain in your bowel and/or experiencing weight loss, be sure to reach out to your R-Health doctor for assistance.