摘录

Chapter One Gastrointestinal Tract Health * * * Gastrointestinal function and ecology is at the core of human health. Imbalances can affect overall well-being. Likewise, the structure and functions of the intestines determine total body toxin load and are essential to the process of detoxification. Cleansing and healing the GI tract (especially the colon) provides a base for effective detoxification.     "We are what we eat and assimilate, and not what we eliminate," is really saying that our GI tract function is vital to the process of nourishing our body and controlling toxicity through elimination, a process which truly begins in the colon. Furthermore, we must regularly cleanse the intestinal system to effectively detoxify the body. Specific therapies are discussed throughout this book; in this chapter, I want to provide a basic discussion of the GI tract process and its contribution to overall health--a relationship often overlooked in Western medicine.     In this model (which I call Functional Integrated Medicine), the function, ecology, and permeability of the GI tract are crucial to the health of each patient. Dysbiosis is the term used to describe imbalance of GI function (specifically, incomplete food digestion and assimilation) or its microbial populations. Preventive medicine works with the theory that abnormal function precedes pathology, and hence the GI tract is assessed for dysbiosis. Therefore, to prevent pathology, normal functioning, specifically of the GI tract, must be restored. If this concept of prevention is incorporated into mainstream medicine, we can keep people healthier longer and prevent disease by evaluating and maintaining proper internal function and environment. Fortunately, this shift in thinking is picking up speed around the country.     The GI tract is composed of the mouth and teeth, the esophagus and stomach, the small intestine (duodenum, jejunum, and ileum) and large intestine (colon). Its proper function begins with adequate chewing , which is essential for good nutrition and health. Other digestive organs include the salivary glands, pancreas, gall bladder, GI mucous glands, and liver. Salivary enzymes begin digestion and the process is continued by stomach hydrochloric acid and enzymes, plus the many pancreatic enzymes which are released into the upper small intestine. Finally, the gall bladder releases bile to promote fat digestion. Assimilation of most nutrients occurs in the small intestine; the colon absorbs water, bile salts, and a few other substances in order to prepare the remainder of the colonic contents for elimination.     Regular elimination is also crucial to overall health and control of the level of toxicity in the body--constipation is actually a greater problem than most doctors and patients realize. Hydration, diet, level of physical activity, and stress all affect our eliminative function.     Health and proper functional integrity of the huge mucosal membrane surface area of the GI tract allows the proper assimilation of nutrients. Even minor disruptions such as inflammation or infection may cause abnormal absorption and increased barrier permeability. With increased intestinal permeability, absorption goes out of balance and larger-than-normal molecules get absorbed which can cause allergic reactions and other abnormal immune responses. There is a delicate balance between the assimilation of needed nutrients and the exclusion of toxic substances. Abnormal organisms within the intestinal lumen may produce toxins which can significantly affect mental and physical health. Also, certain pathogens within the GI tract may generate autoimmune reactions in the particularly vulnerable environment of the small bowel, where the majority of our immune cells are located.     Problems of dysbiosis, abnormal GI mucosal permeability, infection, and inflammation are exceedingly common and may cause both gastrointestinal complaints and other health concerns. The GI tract is stressed and otherwise adversely affected by: • refined foods and sugar • excess fatty and rich foods • overeating and failing to chew more than once or twice per mouthful of food • drinking too much with meals, thus diluting our digestive juices and reducing our ability to properly break down food • food chemicals, pesticides, and environmental toxins • the persistent use of alcohol, caffeine, and nicotine • use of prescription, over-the-counter, and recreational drugs • lack of fiber and whole foods, specifically lacking fresh fruits, vegetables, whole grains, and legumes in the diet * * *     The GI tract is especially sensitive to emotional turmoil. A stressful lifestyle may adversely affect motility, digestive enzyme output, and overall function. Over 30 gut hormones have been identified, many of which also act as neurotransmitters. Chemical exposure (specifically ingested chemicals), travel and subsequent parasitic infections, or the overuse of antibiotics can cause intestinal dysfunction and disease. It may take years for the gut to recover from this kind of damage.     It is also important to maintain proper levels of friendly bacteria within the colon and make sure that their numbers decrease in concentration when progressing up the GI tract into the small intestine or stomach. Overgrowth of abnormal bacteria, fermenting yeasts, and parasites can disturb GI function causing inflammation along the sensitive mucous membrane of the GI tract and thereby adversely affecting the assimilation of food and nutrients.     Abnormal permeability, often called "leaky gut," creates GI imbalance which can lead to systemic disease. Over-assimilation of non-nutrient compounds and under-assimilation of required nutrients may produce deficiencies, as well as allergies and other immune system problems. Inflammation or infection in the GI tract, food allergies, and the overuse of alcohol and non-steroid anti-inflammatory drugs (NSAIDs) can all cause problems in permeability. Disorders such as irritable bowel syndrome, Crohn's disease, rheumatoid arthritis, and HIV infections are frequently associated with leaky gut and permeability problems. A common condition involves fermentation from yeast overgrowth, specifically Candida albicans and other related Candida species, which can lead to a large variety of symptoms and which are often associated with permeability problems.     There are literally billions of microorganisms inhabiting the healthy GI tract. Friendly ones include E. Coli (the bacteria Escherichia coli ), various streptococci, and Lactobacillus acidophilus , as well as Lactobacillus bifidis (Bifidobacteria) , which is predominant in infants and children. However, many other undesirable organisms reside in the GI tract, particularly in the large intestine. These can include yeasts, abnormal bacteria such as Klebsiella (not always pathogenic) and Citrobacter species, a variety of pathogenic parasites that include Giardia lamblia and Blastocystis hominis , and amoebas such as histolytica, hartmani , and coil . HEALING THE GI TRACT     An effective way to think about and heal the gastrointestinal tract has been developed and taught by Jeff Bland, Ph.D., in his nutritional education seminars. It is part of an approach to health care he calls Functional Medicine . Preventive medicine focuses on basic functions within the body, balancing or rebalancing them when they are not right through the use of supportive nutrients and appropriate natural substances. This is similar to OrthoMolecular Medicine , a concept coined by Linus Pauling with whom Dr. Bland worked for a number of years. Currently, Dr. Bland and his team at HealthComm in Gig Harbor, Washington, are working to find better ways to assess, heal, and support GI anatomy and physiology, as a way to remedy illness and generate health.     There have been a number of new tests developed in the last decade which look at digestion and assimilation, GI mucosal surface health, and the presence or absence of appropriate or pathogenic bacteria, yeasts, and parasites. Several licensed laboratories across the country (particularly Great Smokies Diagnostic Lab in Asheville, North Carolina) have led the way in developing very useful, clinically significant tests, which follow. Gastrointestinal Tests Allopathic Medical Tests 1) Upper GI, or the Barium Swallow, X-Ray Study A series of x-rays is taken (viewed with dye) from the mouth to the small intestine. It is useful for identifying anatomical and motility problems as it detects significant problems like gastric or peptic ulcers, hiatal hernias, and tumors within (or pushing into) the upper GI tract. Concerns with this test and the barium enema include the x-ray exposure, constipation from the relatively nontoxic dye (which only rarely causes reactions), and fluid/nutrient imbalance resulting from the enemas and oral purgatives used in preparation for these tests. Cleansing the bowels after the tests by drinking water and taking vitamin C will help counter some of the radiation and toxin exposure. 2) The Barium Enema This rather unpleasant test involves the slow injection of a highly pressurized enema into a cleaned-out colon to examine the area from rectum to small intestine. It is used to diagnose ulcerative colitis in progressed stages, tumors (both benign and cancerous), and misshapen colons, which are often the result of many years of poor diet and constipation. 3) Gastroscopes and Colonoscopes (also Sigmoidoscopes) The gastroscope is a fiberoptic tube that is inserted through the mouth to view the esophagus, stomach, and pyloric area. The colonoscope is inserted through the anus and travels around the colon. Both scopes are used to search out inflammation, polyps, tumors, or ulcers. A less comprehensive test employs the "silver tube" or sigmoidoscope--a rigid instrument used to assess the rectum and sigmoid colon only. The obvious advantage of the scopes for testing is the total avoidance of any exposure to radiation. Biopsies or even complete excisions can be performed utilizing the instruments, often avoiding, or at least postponing, more invasive surgery. These procedures can, however, be quite painful, and doctors often give multiple antipain and tranquilizing drugs, or even general anesthesia from which it may take several days to recover. Functional GI Tests 4) CDSA--Comprehensive Digestive Stool Analysis This simple assessment has been a medical breakthrough. A stool is collected and mailed overnight to a lab where it is evaluated for digestion of animal proteins, vegetable matter, starch, and fatty acids. Stool pH, intestinal immune function (with the addition of secretory Immunoglobulin A), and the presence of mucus, blood, and certain enzymes are also measured. Culturing is done to locate both normal and abnormal bacteria and yeast or fungus. If any abnormal organisms are detected, sensitivity testing is done with both natural substances (such as garlic, grapefruit seed extract, caprylic acid) and pharmaceutical agents (such as antibiotics and antifungals) to determine which agents kill or inhibit the growth of the detected organism. This allows the practitioner and patient to select the right treatment for their particular condition. This information then gives us a therapy that involves the removal of abnormal organisms, replacement of diminished enzymes or hydrochloric acid, reinoculation with appropriate helpful microorganisms (probiotics), and repair of the GI mucosa. This constitutes the 4R program, which is discussed later in this chapter as "the 5R program," with the addition of rebalancing diet and lifestyle. There are no side effects or medical concerns with the CDSA or the Parasite Study other than the psychological discomfort that some people experience from having to handle their own feces. 5) Parasite Study Certain laboratories specialize in identifying parasitic infections through stool exams. These exams require a loose or a special "purged" stool collection--a watery sample that is observed under a special microscope. (The purging process may cause some diarrhea, but its mildly cleansing effect may have some benefit as well.) These parasitic infections are quite common, even in people who do not travel outside the United States. The lab I currently use is the Institute for Parasitic Diseases (IPD) in Phoenix, Arizona; their findings correlate well with clinical symptoms. I look for parasites in anyone who presents with GI dysfunction (especially pain, gas, bloating, and nausea), allergies, fatigue, insomnia, teeth grinding at night, anxiety, or other psycho-emotional symptoms. 6) Intestinal Permeability This is a simple test that measures the small intestine's ability to absorb needed nutrients and discriminate against harmful substances. After drinking a solution comprised of two sugars (lactulose and mannitol), a urine sample is collected and the levels of these two sugars are measured. Mannitol is normally absorbed at approximately 20%, while lactulose should be absorbed very little, if at all. People with increased intestinal permeability absorb excess lactulose. This suggests that they also inappropriately absorb other larger molecules due to damaged intestinal walls. Such absorption can cause secondary immunologic reactions and subsequent food allergies and intolerance. Working the 5R program will often normalize intestinal permeability. This test and the Breath Test have no side effects at all. The two mostly non-absorbable sugars mentioned above occasionally cause temporarily loose bowels. 7) Breath Test for Small Intestine Bacterial Overgrowth This test measures levels of hydrogen and methane gases in breath samples to assess bacterial overgrowth in the small intestine. Although this problem is more common in the elderly, it should be considered for anyone with gas, bloating, diarrhea, or carbohydrate intolerance. Bacterial overgrowth can compromise health both in the GI tract and throughout the body and can lead to malabsorption, failure to thrive, anemia, weakened immunity, and increased risk of colon cancer (intestinal bacteria may produce additional carcinogens). This test is suggested when the standard 5R approach is not working effectively enough. 8) Detoxification Profile This is a relatively new procedure that tests the detoxification functions of the liver. Our body must be able to metabolize and clear xenobiotics (environmental chemicals), endotoxins (generated from gut flora), and our own biochemicals (including hormones and cholesterol). The Detoxification Profile measures two primary liver pathways: Phase I (oxidation and reduction, such as in caffeine metabolism) and Phase II (glycine, glutathione, and sulfate conjugation, as well as glucuronidation). Each demonstrates the patient's ability or inability to detoxify certain types of chemicals. Test doses of caffeine, aspirin, and acetaminophen are given and then both salivary and urine samples are taken and studied to identify the level of detoxification. The only concern with this test would be any adverse reactions to the testing agents.     I use these tests judiciously whenever I see a patient with gastrointestinal concerns or systemic symptoms correlated with gastrointestinal dysbiosis, inflammation, or toxicity. After gathering information from these tests, I decide upon a course of therapy which is often interdisciplinary in its approach. Detoxification practices--the focus of this book--are an important first step in healing, since many diseases are related to congestion and toxicity from overintake and improper elimination.     A therapeutic regimen often includes dietary changes such as avoiding certain foods or food groups and adding more fresh, high-fiber and low-fat fruits, vegetables, and whole grains. I also address abusive habits and try to motivate my patients to give this therapy a fair chance. Most modern-day abuses--Sugar, Nicotine, Alcohol, Caffeine, and Chemicals--are psychoactive substances which have mental and emotional effects. I believe that giving up at least the habitual use of these SNACCs (as I call them) is extremely important. I also promote chewing your food thoroughly along with regular and systematic undereating. If we make what we eat wholesome and nourishing, we will not only add years to our lives, but life to our years. Choosing the right foods and diet for ourselves, our activity level, and the climate in which we live is the key.     Other lifestyle and therapeutic activities for GI health include: 1. Learning to manage stress. Our sensitive digestive tract works better when we are calm. 2. Setting up an exercise program. Exercise improves digestive functions, stimulates lymphatic flow, and supports immune function. 3. Applying musculoskeletal therapies. This may involve osteopathic or chiropractic realignment of the spine and massage. 4. Using nutritional supplements and herbs. 5. Seeking professional advice on the use of pharmaceutical (or herbal) agents to remove infectious and harmful organisms, including abnormal bacteria, yeasts, and parasites. * * * The 5R Plan     Let me now review the 5R Gastrointestinal Support Plan. This progressive therapeutic program normalizes the function, environment, and tissue health of the GI tract and must be tailored to the individual according to his or her particular evaluation. The five steps are: 1) Rebalance --your diet, your lifestyle, and your life. (This "R" added to Dr. Bland's 4R Plan by my associate, Scott V. Anderson, M.D.) This is important as these areas contribute to health and the state of the digestive tract. Staying away from sugar, refined foods, and irritating substances such as caffeine and alcohol can make a big difference. Learning to deal with stress and developing coping and relaxation skills can help calm the GI tract and support better digestion and assimilation.     Changing habits is not easy. A nutritional counselor, psychologist, or hypnotherapist can help by making us aware of the way old conditioning undermines our new positive health habits. 2) Remove --any offending organisms, particularly pathogenic microflora and/or any food antigens that cause allergic and immunologic reactions.     At this therapeutic level, we evaluate and treat any organisms that do not belong in the human GI tract. These include Giardia lamblia , abnormal types or levels of yeast organisms such as Candida albicans , and bacterial pathogens. Sensitivity testing (finding what therapeutic agents eliminate the specific microbe) can be done on most of these organisms to find the appropriate pharmaceutical or natural medications. Often, there is more than one type of pathogen, and a combination of medications may be needed. Treatments will vary according to the practitioner's training. One useful book is Guess What Came to Dinner by Ann Louise Gittleman; the author discusses the great prevalence of parasitic disease and the best ways, both natural and pharmaceutical, to treat each specific parasite.     We also encourage following an elimination diet that avoids allergenic foods and removes irritating substances such as caffeine, alcohol, refined sugar, and flour. Following a "hypoallergenic" diet involves eliminating common food allergens such as cow's milk, eggs, gluten grains (wheat, rye, barley, and oats), chocolate, coffee, and peanuts. Any food that is consumed regularly or over-consumed should also be eliminated. A diet of fruits, vegetables, rice and beans, fish, and poultry is usually an improvement for most people, producing a reduction of symptoms and an increase in energy. 3) Replace --inadequate amounts of hydrochloric acid (HCl), digestive enzymes, and pancreatic products. Fiber supplementation may also be necessary.     Nutritional substances in this category aid in food breakdown and in its subsequent absorption into the bloodstream for travel to the metabolic factory of the liver. Proper digestion reduces the allergenic and inflammatory effects that occur from larger, more complex molecules.     The CDSA (Comprehensive Digestive Stool Analysis) helps identify digestion weaknesses and guides the practitioner and patient toward the proper replacement support. For instance, enzyme or hydrochloric acid insufficiency is common in people who experience indigestion, gas and bloating, belching and flatulence, and the presence of food particles in the stool. Yeast overgrowth is another problem, and should be ruled out prior to treatment. (Continues...) Excerpted from The Detox Diet by Elson M. Haas. Copyright © 1996 by Elson M. Haas, M.D.. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.