Your Most Embarrassing Health Questions Answered by a New York Internist and Gastroenterologist

Many conditions like cancer and diabetes are difficult to talk about with your doctor because of the burden of these diseases and the hardship of the symptoms and treatment. Other ailments are just plain embarrassing. Not to worry, you are not alone in feeling bashful about certain issues you may be experiencing. The good news is, most of these embarrassing conditions are not life threatening and if you have the courage to speak to your doctor, “you will find that your doctor is trained to talk about sensitive issues in a manner that is both considerate and informative,” says New York Based Internist and Gastroenterologist, Dr. Niket Sonpal.

While you are still working up the courage to make an appointment with your doctor, here are the top 5 embarrassing questions you may have with insight from our expert.

I’m still young and I get hemorrhoids. Why is this happening and what can I do?

Though hemorrhoids are more prevalent in adults 40 – 65 years old, young people may still have symptoms associated with hemorrhoids. It is estimated that 75% of the population gets them at some point. Hemorrhoids are common and usually not life-threatening. “What you need to keep in mind is that Hemorrhoids are a symptom of a variety of conditions,” says Dr. Sonpal. “Observe your symptoms and report to your doctor what you feel. Especially in the case of extreme rectal bleeding, lower stomach pain, and unexpected weight loss. These are all symptoms of a more serious condition like colon or rectal cancer, which is most common in people over 40.

I have a cold sore on my mouth, if I perform oral sex on my partner will I transmit to them?

“Yes, it is possible and common for someone with oral herpes to unknowingly transmit the virus to their sexual partner through oral sex,” explains Dr. Sonpal. Using protection is the safest way to prevent this from happening even during oral sex. Herpes is transmitted through skin contact so barriers like condoms are effective in reducing the risk to your partner. Usually, people are more cautious about unplanned pregnancies and diseases transmitted through fluids than they are about oral sex and it’s common for them to have oral sex without condoms. This can lead to, not just the transmission of herpes but other viruses like the previously mentioned HPV. Dr. Sonpal’s advice is to stay tested and don’t be afraid to ask your doctor for the pertinent exams if you know you’ve been exposed. 

Why is my stool green?

Dr. Sonpal explains that, “It can be jarring for people when they experience it the first time but it is rarely related to anything serious. Green is under the umbrella of acceptable stool colors. Most commonly stool will be brown but depending on what you eat you may have occasions where the volume of vegetables you eat affect the color of your poop due to the chlorophyll.”

Other causes can be food coloring, “Children are often exposed to the experience sooner or later because of cereals. Some kids think it’s cool. This is not related to something serious,” says Dr. Sonpal.

Other causes could be medications, coffee, alcohol, and spicy foods. Dr. Sonpal elaborates that if the green stool is not accompanied by diarrhea, nausea, or pain, which could indicate food poisoning, then you shouldn’t worry too much about it. 

Why am I gassier during my period?  

Studies have shown that high percentages of women, with and without Irritable Bowel Syndrome (IBS), complain about increased gas and bloating during their menstruation. “Your body’s hormones are acting up and you may be more sensitive to certain foods than normal,” explains Dr. Sonpal. He recommends avoiding foods high in fiber. These foods tend to increase the bloating as they are meant to keep you full for longer. “If you live a sedentary lifestyle your digestive system might already be slow. Don’t skip out your fitness routine or your late afternoon walk as it can be a key part of keeping your digestive system working during your period, says Dr. Sonpal. He also recommends cutting off the sugary and carbonated drinks which increase the bloat.  

I’m young, why am I having the constant urge to go urinate throughout the day and most of all at night?

This is a tough subject for many people. For older people, it is a sign of aging and they see it as such. The stigma of urinary incontinence keeps them from speaking to their doctors about it until the problem gets out of their control completely. For young people, experiencing urinary incontinence or hyperactive bladder is shocking. We grow up not realizing that these types of issues can affect people at a younger age. Urinary incontinence most commonly affects women and people over 40 but it is totally possible that a person in their 20’s can be dealing with this issue.

I’m a woman – why do I have hair on my nipples?

Dr. Sonpal states that, “Hairy nipples are normal for women. Seeing black, wiry hairs growing around the areolas can be surprising, but you’re not alone. The percentage of women who have hairy nipples is unclear, and many women don’t report it to their doctor.

In most cases, hairy nipples aren’t cause for concern. For most people, they’re a normal part of bodily changes.”  You don’t need to remove the dark hairs around your nipples. They won’t cause any issues. However, you can remove them for aesthetic reasons if you choose. Several treatment options may help. One can choose laser hair removal, electrolysis, waxing, trimming etc. Speak with your doctor about what is safest.

Is it supposed to smell “down there?”

“Your vagina and its discharge should have a smell, but it shouldn’t be a bad smell and you shouldn’t be able to smell it from a distance,” says Dr. Sonpal.  He adds, “Vaginal discharge and smells are dependent upon hormonal changes, mood changes, hygiene habits, sexual activity, physical activity and clothing.”  If you’re sweating or you’ve recently had sex, you may notice an odor, but it’s normally nothing to worry about. However, if you experience odor plus itching, burning or irritation, it might be a treatable vaginal infection like bacterial vaginosis or the STI trichomoniasis. “Don’t douche,” cautions Dr. Sonpal. That will just remove the healthy bacteria your body needs to naturally clean your vagina.  

About Dr. Niket Sonpal:

Dr. Niket Sonpal is an Adjunct Assistant Professor at Touro College of Osteopathic Medicine and Clinical instructor at Kingsbrook Jewish Medical Center, Brooklyn who specializes in Gastroenterology. He is a graduate of the Medical University of Silesia – Hope Medical Institute in Poland. After completing his residency in Internal Medicine at Lenox Hill Hospital, he was selected to be the 2013‐2014 Chief Resident at Lenox Hill Hospital–Northshore LIJ Health System. Dr. Sonpal has completed his Fellowship in Gastroenterology & Hepatology at Lenox Hill Hospital and continues his work in the field of medical student and resident test preparation. He now serves as the associate program director for the Internal Medicine Residency Program at Brookdale University medical center.

He is the co‐author for the best-selling Master the Boards: USMLE Step 2 CK, Master the Boards Step 3, And Master the Boards: Internal Medicine. He is also the Chief Operating Officer for Medquest Test Prep, Director of Medical Education for Picmonic Test Prep, and a recognized expert on medical test prep.

5 Key Health Exams Millennials to Get This Year

With more and more millennials skipping out on annual health exams in favor of a quick as needed, visit to an urgent care facility, doctors fear the largest generation in America, may overlook serious health issues. There are 83 million Americans between age 22 and 37 and according to a November 2018 survey by the Kaiser Family Foundation, 45% of those 18-29 and 28% of those age 30-39 do not have a primary care physician. The issue is that health conditions that can be caught early may slip through the cracks. Dr. Niket Sonpal, Adjunct Assistant Professor at Touro College of Osteopathic Medicine in New York City, offers 5 health exams millennials should get this year.

Dr. Sonpal, who at age 36 is a millennial himself, has compassion and understanding when it comes to millennials. “You’re looking at a generation with incredible debt and many don’t have jobs with health insurance,” he says.

In addition to the financial aspect, Dr. Sonpal adds that this is a generation raised on the internet. “When we got sick as kids, our mom searched for answers online. If we went to the doctor, it was a day of missed school and boring waiting rooms. Now as adults, millennials want, fast affordable solutions and often take a DIY approach to health.”

He goes on to say that healthcare has become an expensive hassle millennials choose to avoid. They would much rather facetime or text a doctor as opposed to miss work hours. They prefer to just walk into an urgent care clinic, pay $40 and be done with it, fast. “The problem though is that while this approach may be ok for treating a sore throat or flu, millennials might be missing an opportunity to nip a bigger problem early on.”

I want to urge all millennials women to get women’s wellness exams which is a PAP Smear and breast exam as well as a screening for STD’s and bloodwork. HPV, can lead to cervical cancer so it’s important to monitor dysplasia.

Dr. Sonpal encourages millennials to get these exams out of the at either the start of the year or their birthday month so they can easily remember when they last went to the doctor for these exams.

1. Blood Pressure Screenings

You want to get blood pressure checked out at least once every 2 years and ever year if the top number is 120 to 139 and bottom between 80 to 89. High blood pressure is linked to diabetes which is really hitting millennials hard. According to the CDC, between 2001 and 2015 teen obesity rates rose 30%. “As kids, millennials were part of a supersize culture. Millennials also didn’t spend a lot of time going outside to play until the streetlights came on as Gen X’ers did. This all adds up to diabetes and heart disease if not monitored,” he says.

2. Eye Exams

Millennials were raised on technology and their eyes are reaping the cost of this. It’s estimated that millennials spend over 12 hours per day consuming media with a majority of it on mobile devices on screens held closer to the eye. This leads to “nearsightedness” or “shortsightedness” where the eye weakens and can’t see clearly at a distance. A lot of millennials will find themselves squinting to see things that are further away, they may have dull headaches and find themselves rubbing their eyes frequently. “A lot of millennials are popping ibuprofen for headache associated with eye strain and neck ache from prolonged computer jobs. This then leads to stomach issues,” cautions Dr. Sonpal.

3. IBS and Digestive Screenings

We also need to consider that the food we eat today is full of antibiotics and hormones. Millennials are a generation whose diet was primarily full of processed foods. We see a lot of Celiac Disease (intolerance of gluten). A study in the Journal of the National Cancer Institute, found that from the mid-80s to 2013, the incidence of colon cancer has been rising fastest for people between the ages of 20 and 29, by 2.4 percent per year. “The issue here is that we have millennials self-treating stomach issues that can be the start of something serious. If you’re experiencing chronic stomach pain, see a doctor. Gut health is incredibly important for overall wellbeing,” advises Dr. Sonpal.

4. Mental Health Screening

Millennials are one stressed out generation. According to Psychology Today, suicide rates among young adults have tripled since the 50’s with millennials are reporting a sense of “faking it until they make it.” The problem is they feel disconnected from themselves and wrong for the life they are living. They feel as if they are not enough and then they scroll on their Instagram feeds and see people their age with luxury watches, travel to the Maldives and Dubai and they feel hopeless, stressed and depressed.  They’re popping Xanax and smoking marijuana to take the edge off. The good news is that millennials are willing to discuss their feelings and studies show that this is the first generation who doesn’t see any stigma about seeing a therapist or mentor coach. Sometimes a break up or a layoff can trigger a downward spiral into depression or even drug or alcohol addiction.

5. Annual Exam and Immunizations

It’s recommended that you get the flu shot every year. Another important vaccine is for HPV which was mentioned earlier. Dr. Sonpal points out that the HPV vaccine has expanded coverage and is important to prevent certain types of cancer. Other vaccines may also be recommended depending on your health history. The only way you know is by having a yearly physical.

About Dr. Niket Sonpal:
Dr. Niket Sonpal is an Adjunct Assistant Professor at Touro College of Osteopathic Medicine and Clinical instructor at Kingsbrook Jewish Medical Center, Brooklyn who specializes in Gastroenterology. He is a graduate of the Medical University of Silesia – Hope Medical Institute in Poland. After completing his residency in Internal Medicine at Lenox Hill Hospital, he was selected to be the 20132014 Chief Resident at Lenox Hill Hospital–Northshore LIJ Health System. Dr. Sonpal has completed his Fellowship in Gastroenterology & Hepatology at Lenox Hill Hospital and continues his work in the field of medical student and resident test preparation. He now serves as the associate program director for the Internal Medicine Residency Program at Brookdale University medical center.

He is the coauthor for the best-selling Master the Boards: USMLE Step 2 CK, Master the Boards Step 3, And Master the Boards: Internal Medicine. He is also the Chief Operating Officer for Medquest Test Prep, Director of Medical Education for Picmonic Test Prep, and a recognized expert on medical test prep.

Instagram “Health Foods” that are Surprisingly Unhealthy or Caloric

From Whole Foods to pricey health food stores, cafes, and coffee shops, certain foods and ingredients have become trendy among health and calorie counting foodies.  Who has not heard of matcha, Acai, cold-pressed juice, and gluten-free baked goods? In a perfect world, wouldn’t it be wonderful if we could find food and drinks that are delicious, healthy and not calorie laden?  While certain Instagram accounts may have you convinced these “magic foods” exist,  Dr. Niket Sonpal is a NYC gastroenterologist and assistant professor at Touro College of Osteopathic Medicine who cautions health enthusiasts to do a deeper dive into what they are eating and imbibing. 

Gluten-Free Baked Goods

Despite the fact that less than one percent of Americans are believed to have celiac disease, customers and food brands alike have gotten caught in the gluten-free food obsession. Dr. Sonpal explains that “To mimic the taste and texture of wheat gluten, companies will use corn, oat, and rice flours, which aren’t necessarily better for you.” One study found that participants who consumed rice-flour-based baked goods had higher levels of metals within their system than the control group, which is linked to rice’s natural arsenic and metal content.

Smoothie Bowls

Their vibrant colors and pleasant toppings give smoothie bowls the appearance of a well-balanced breakfast, but don’t be fooled: they are loaded with sugar. Unlike traditional smoothies that come in useful, portion-controlled bottles, smoothie bowls tend to be larger and have more surface area, which makes it easy to add additional toppings. For example, the Chunky Strawberry Bowl from Jamba Juice contains 590 calories and 58 grams of sugar. 

Acai

Google “acai berry” and a wealth of purported benefits like weight loss and antiaging results will return. Does this trendy health food hail from Brazil really live up to the hype? Dr. Sonpal says that “While the fiber-rich fruit does tout more antioxidant properties than pomegranates and blueberries, many health claims don’t mention that it logs in 247 calories per 100 grams, 26 grams of which are carbohydrates.”  The takeaway?  Unless you are using acai at home and controlling your portions, an acai bowl could cost you almost 600 calories per serving! 

Almond milk

The fact that it’s dairy-free and low in calories has made it the default milk among many people who try to eat healthily. Dr. Sonpal explains that “though unsweetened almond milk, like dairy milk, is a good source of calcium and vitamin D, it’s really low in protein. (Just 1 or 2g protein in a one-cup serving.)

Protein Bars

Protein bars, which are sometimes also energy bars, contain numerous artificial ingredients and have as much nutritional value as a milk chocolate bar. That said, some protein bars can be healthy if they contain healthy, whole, and very few ingredients that make up the bar. Dr. Sonpal cautions, “If you see upwards of 15 ingredients in your protein bar, I would say stay away from it.”

Avocado

If you look at all the salads, grain bowls, and other healthy dishes on Instagram, you’ll probably notice that the people posting them seem to be eating a great deal of avocado. “Avocados are very nutritious and packed with healthy monounsaturated fats and fiber,” says Dr. Sonpal. Many Instagrammers go overboard. “An entire medium avocado contains 250 calories and 23g fat,” Sonpal says. “Keep your serving size to a quarter of a medium avocado, which would be 60 calories and 6g of fat.” 

Veggie Chips

The pieces of actual veggies in veggie chips are so thin and processed that most of the nutrition from the vegetable is gone. “Instead, try whole-grain pretzels, baked corn chips, crackers made with seeds and nuts, or popcorn,” Dr. Sonpal suggests. To keep from turning a bag of chips or box of crackers into a meal, divide them up into sensible portions ahead of time.

Cold-pressed juices
Cold pressed juices have risen in popularity over the past few years, and with the hefty price tag tacked on to them (one serving of juice can be as much as $12!) one would assume guzzling some would provide you with all the nutrients you could possibly need. Unfortunately for your wallets, and your diets, that is not the case. While made of whole, raw fruits and veggies, the fiber from these foods are often stripped during the juicing process. On top of that, fruits like apples can be added to cut the bitter flavor of leafy greens, which can bump the carbohydrate content up to 20-30 grams of carbs per juice! Dr. Sonpal warns that “because there is no fiber or protein in these juices, guzzling one can cause blood sugar levels to spike too, leaving you right back where you started: hungry and craving something nutrient dense.”

Matcha Lattes

Matcha is one food trend that has taken the center stage. Some restaurants offer matcha pancakes. While matcha is packed with antioxidants and provides detox health benefits that cannot be disputed, ordering up a latte may not be the magic elixir you bargained for.  A 12-ounce matcha latte from a popular coffee chain packs 24 grams of sugar and will set you back 190 calories.

Agave Nectar

Agave syrup is derived from the sweet nectar of the Agave tequila plant and is often perceived as a “natural” alternative to processed cane or beet sugar or other zero-calorie sweeteners. The syrup is touted by manufacturers as a safer sweetener for diabetics because it is lower on the glycemic index (a measurement of how certain foods affect blood sugar levels), Dr. Sonpal says that “no reliable human studies exist reinforcing this claim. Agave syrup is just like any other sweetener- no better, no worse”.

About Dr. Niket Sonpal is a native of Long Island NY and a graduate of the Medical University of Silesia – Hope Medical Institute in Poland. After completing his residency in Internal Medicine at Lenox Hill Hospital, he was selected to be the 2013‐2014 Chief Resident at Lenox Hill Hospital–Northshore LIJ Health System. He is an Adjunct Assistant Professor at Touro College of Osteopathic Medicine and Clinical instructor at Kingsbrook Jewish Medical Center, Brooklyn. Dr. Sonpal has completed his Fellowship in Gastroenterology & hepatology at Lenox Hill Hospital and will continue his work in the field of medical student and resident test preparation. He now serves as the associate program director for the Internal Medicine Residency Program at Brookdale University medical center.

He is the co‐author for the best-selling Master the Boards: USMLE Step 2 CK, Master the Boards Step 3, And Master the Boards: Internal Medicine. He is also the Chief Operating Officer for Medquest Test Prep, Director of Medical Education for Picmonic Test Prep, and a recognized expert on medical test prep.

Real Doctor Tries the Intermittent Fasting Trend and Here’s What Happened

There’s crash dieting, and then there’s intermittent fasting. Crash diets aren’t sustainable and rarely factor in healthy food options. Intermittent fasting on the other hand is gaining attention because people are seeing weight come off, and therefore stay with it. It’s being touted as the go-to way to lose 15, 20 pounds within a month or two. Is it just a popular hashtag or can the weight actually stay off leading millions of people to reach their weight goals? To get clarity, we spoke to Dr. Niket Sonpal who not only is Board Certified in Internal Medicine specializing in Gastroenterology; but lost 6 pounds his first week of intermittent fasting when he decided to do it himself. Here’s what he has to say about intermittent fasting.

What inspired your decision to do intermittent fasting?

I noticed the winter weight became the spring then summer weight and I wanted to take off extra pounds that I noticed had crept on. I was with friends talking about how they lost weight during religious observation and that intermittent fasting was a “thing.” I rolled my eyes. I was skeptical. Then I went online and applied my doctor mind to the concepts I was reading about it and went for it.

There are several ways to go about intermittent fasting. Which way did you do it, when did you start and what was the result? 

This is true. The way I chose, and the way I would imagine most people would try, is the one that calls for 16 hours of fasting with 8 hours of eating time per day. This basically means if your last meal of the day is 8pm you will have your first meal by noon the following day, free to eat until 8pm again. I figured since I sleep most of those hours, it wouldn’t be that tough. The 5-day 2-day option of intermittent fasting, calls for normal eating for 5 days and then strict calorie counting for 2 days (500 calories for women and 600 for men). I didn’t want to be obsessing about calorie counting.

What were the challenges (if any) that you faced when intermittent fasting?

I live across the street from a bagel shop in New York City. I also have delicious New York pizza on every other corner. Cravings and temptation were there for me for sure. When I left my home and smelled those fresh bagels my brain said. “let’s eat.”

Coming at your intermittent fasting as a doctor, what were some things you were thinking about that others must consider too? 

I thought when I would fast. When would be my 8-hour eating period. When we start caloric consumption right when we wake up we do better with weight loss. However, that would mean eating from 7 am until 4pm. This would require a later meal around 3pm. Then I thought, does my lifestyle better allow a 12 noon to 8pm food window?

I also thought about the physiological aspect to what happens to our bodies when we fast intermittently. For one thing, it facilitates weight loss by enhancing hormone function. Insulin levels also lower, plus there’s a rise in noradrenaline. This combination is what helps us to breakdown body fat for energy. While this all reads well on paper there is a lifestyle aspect to it that must be factored in. I’ll add that anyone with a condition should consult with their doctor before going all in on intermittent fasting.

Why do you think it is so difficult for people to fast? What are some of the common symptoms people feel when fasting and what causes them?

When people think of fasting they think of starvation and deprivation. They anticipate they will feel terrible will have a growling stomach, dull headaches, and a bad mood. While these are common symptoms felt at first when fasting, the 16/8 intermittent fasting option allows for food every day. When people see quick results, they stick with it.

What was your diet? What did you cut out and add in? 

I looked at my schedule and my overall daily lifestyle and how food was involved. For people who live very hurried lifestyles, food is typically something that is grabbed fast on the go. When we approach food this way no diet will be sustainable. I realized this would require consistent changes in my behavior. It would also require me to get very mindful about what I was eating during the 8 hours of eating time. I chose to eat what I liked in moderation. So, if two slices of pizza twice per week was the lunchtime norm, I reduced to it to once slice. I still ate pasta just not as often and not as much. I also added in a lot more vegetables, proteins, healthy fats and cut out all fast food and soda. Hey, I’m a doctor, but also a human!

For those thinking about intermittent fasting, how would you advise them to proceed? 

I would explain that at around the 2 to 4-week mark, someone may plateau. When you notice this don’t think this is the most weight you are able to lose. This is normal and if you are also exercising with weight or resistance training you may be building muscle mass. Pay attention to how clothes fit, body fat loss and how weight loss shows beyond the scale. Knowing how over time the body gets used to intermittent fasting and starts to store up all that is eaten, leading to less weight loss, I suggest resetting your body by eating small, healthy meals throughout the day for a week and then resuming the 16/8 intermittent fasting option again.

People may happily think that they can fast and then enjoy a big bowl of pasta or cheeseburger. What kinds of foods should people eat during intermittent fasting?

You can get results without cutting out your favorite foods which means enjoy that burger or pasta, I did! However, you can’t binge on fast food and think you’re going to make any lasting changes. You want to up your vegetable intake. Things like grilled zucchini or eggplant make for great sides to a piece of grilled chicken or steak. Avocados are a good staple for healthy fats and are versatile. There are loads of recipes out there so plan out your food options in advance, so you stick with it.

About the doctor:

Dr. Niket Sonpal is Adjunct Assistant Professor at Touro College of Osteopathic Medicine, Clinical instructor at Kingsbrook Jewish Medical Center, Brooklyn and on the board of the NY‐ American College of Physicians (NYACP). He is completing his Fellowship in gastroenterology at Lenox and has spoken and presented at over 25 national and regional conferences on his research and is a regular participant in national courses.