by Eric Bakker B.H.Sc.(Comp. Med.) ND RC Hom. 2003
When I started practice in the early 90's, I was amazed at the number of people encountered who complained of having constipation, diarrhea, increased gas, bloating after eating, fatigue and the many other symptoms of gastrointestinal distress.
It is now the 21st century, and very little has changed, in fact the amount of people seeking natural and non-invasive treatment for gastrointestinal distress along with an increasing amount of many chronic degenerative disorders such as heart disease, diabetes and cancer has increased significantly in the past ten years. So much for an apple a day!
I have generally worked in conjunction with medical practitioners, and when required referred patients with chronic gastrointestinal distress to doctors or gastroenterologists for an initial bowel screen to rule out anything obvious, such as a polyp, hemorrhoid or possibly even bowel cancer. All too often though, the person would come back to me with the diagnosis of NAD (no abnormal diagnosis) - nothing abnormal, no diseases, just "irritable bowel syndrome" (IBS), and the recommendation that they should make dietary changes, increase fiber in their diet and use Metamucil. In most such instances, these changes brought them very little relief. I generally call IBS a "wheelie bin" diagnosis; you just go and dump people in here when you just can't figure them out, and hope that somebody else will collect them and take their problems away with them!
Below I have listed the three major causational factors which come to the rise in gastrointestinal conditions, and are often at the seat of many chronic diseases. If the digestive system functions in optimal health, then the rest of the body can expect excellent health. Dr. Leo Galland has been one of my mentors over the years, and has taught me that if the gut doesn't work, then nothing else generally will. Do you go to your practitioner, whether they be a naturopath or a medical doctor, present with many complaints, and also have a digestive disorder?
In my clinic that is where we stop - we get the digestion working well. Symptomatic treatment is a waste of time generally, until you have overcome your "GI Blues".
Think about your digestive system, do you have any elements of 1, 2, or 3?
1. Fermentation of the digestive system
Fermentation is a disorder of the small intestine, and means that there is a problem with digesting your food efficiently. Instead of digesting starch and dietary sugars, they are used by pathogenic bacterial strains to manufacture your own wine and beer. Many such people feel mentally and physically sluggish as they tend to be toxic with aldehydes and alcohols, blow up with gas and can even feel overheated or flushed at times.
It is a more serious matter, for your small intestine not to function correctly than your large intestine. This is where the digestion and absorption principally takes place. Much of your body's immune system is clustered around the small intestine as well. You can live without your colon, and indeed in some cases of inflammatory bowel disease the colon is removed surgically. You wouldn't last long without your small intestine, however. Unlike your skin, which is well supplied with nerves, the small intestine has a poor nerve supply, making it less likely for to know if there is something wrong.
Fermentation is a common digestive disorder; meaning that food is not being digested efficiently. It has to do with our lifestyle, the foods we eat and the way in which we eat these foods.
The single commonest cause of fermentation in adults is mild to moderate stress.
Fermentation may have its origin partially in hypochlorhydria, under-acidity of the stomach, which is commonly affected by stress.
Can often occur after a major holiday, traveling overseas, recovering from an illness, or having been in hospital on antibiotics.
Most people with fermentation need to alkalinise their diet. A good rule of thumb: 80% alkaline and 20% acid forming foods. You will find several charts and books available, which give you these foods items respectively.
Digestive symptoms include increased or offensive flatus, bloating, bad breath, burping, nausea, indigestion, and increased bowel sounds, gurgling noises, and appetite or bowel changes, itchy anus.
Non-abdominal/digestive symptoms include: body odour, cold hands and/or feet, increased sweating or feeling hot or flushed, irritability/mood swings, apathy, fatigue.
What to do
Fermentation can be detected by way of a simple urine test (Urinary Indican Test) by your practitioner. If this chemical is present, it suggests that you are not digesting foods properly. Once detected, and the level of fermentation and dysbiosis is determined, it is then best treated with a 'kill program'' involving special herbs and nutrients along with a strict diet which excludes all foods containing starch, sugar and yeast. Digestive enzymes may be required with meals the first two to three weeks, and a parasite cleanse as well for a few weeks.
Fermentation is generally not that serious a condition as dysbiosis, can be easily rectified, but can escalate into a more serious dysbiosis with fungal overgrowth. It is not generally necessary to use prescriptive antibiotic or antifungal medications at this stage, in fact, they may well be a part of the cause of the gastrointestinal problem initially.
It is important to exclude other causes of abdominal discomfort, such as Helicobacter pylori infection, and any other possible pathologies. See your practitioner for help, H. pylori is difficult to eradicate and even to diagnose correctly, but is achievable in most cases.
2. Dysbiosis- Candida overgrowth
It is the disordered intestinal ecology that actually causes illness, and is described in detail by Dr. Leo Galland as dysbiosis in his book The Four Pillars of Healing. Organisms that are not usually overgrown in the intestines, such as unfriendly bacteria, yeast and protozoa, actually induce disease by altering nutrition patterns in the body. Optimal health requires that the intestinal flora maintain a healthy balance between the more than 400 organisms that usually reside there. Candida albicans is a naturally occuring yeast, becoming increasing implicated in many hard-to solve gastrointestinal cases. Many people who present with chronic dysbiosis and yeast conditions have had symptoms of fermentation, often ranging from minor to a major in the past.
Intestinal dysbiosis is a condition which is extremely common in the New Zealand.
The commonest cause is moderate to chronic on-going stress.
Other causes include fermentation, poor eating habits, moderate to high alcohol (especially beer and wine) consumption, diets high in processed or take-away foods, chronic stress, surgery, drugs such as antibiotics (or consuming foods like commercial poultry containing antibiotics), steroids, the contraceptive pill, and various other pharmaceutical preparations, heavy-metal (mercury, arsenic, cadmium, etc) toxicity pesticide or chemical contamination.
Symptoms connected with dysbiosis and candida overgrowth, Fatigue, often chronic. Skin itching, rashes, tinea. Brain dysfunction such as poor memory, fuzzy head, Recurrent dull headaches, Rapid pulse, palpitations, heart pounding in throat or chest, Dull joint aches, Vaginitis - increased urinary frequency and decreased bladder control, vaginal thrush, which can be chronic and recurrent. Digestive problems -diarrhea, bloating and flatus, gastritis, heartburn, constipation, irritable bowel syndrome.
What to do This condition can generally also be diagnosed by your practitioner either by way of a questionnaire, or by the symptoms you present with in the clinic. Dysbiosis can also be detected by your doctor by way of a serum or stool analysis to candida-antibodies through the conventional pathology labs. Candida overgrowth diagnosis is generally rather easy by way of a questionnaire from your practitioner or as found in the book by Dr. William Crook, entitled "The Yeast Connection" and/or by a CDSA (comprehensive digestive stool analysis). It makes sense to test for Candida if suspected, particularly before employing anything strong to eradicate it.
For mild to moderate cases of dysbiosis or cases of recent origin; the treatment includes a specialised anti-candida diet, anti-fungal nutritional supplements or herbs and a vitamin & mineral supplements. Many excellent books are available, such as the Yeast Connection, by Dr. William Crook. You will find that if you treat vigorously, you will pull out within a month and start to feel good. I recommend that you see a practitioner if this does not happen with you, and you still feel bad.
With heavy dysbiosis, i.e.; systemic candida, or chronic ongoing or recurrent candidiasis, it may be necessary at times to initially be placed by your doctor on a prescriptive agent such as an anti-fungal. Relatively safe antifungal drugs such as Nilstat (Nystatin) used to be part of a prescribed antibiotic drug, preventing fungal (Candida albicans) infestation, until it was decided in America many years ago that doctors could decide themselves when to prescribe an antifungal or an antibiotic drug. Antifungal drugs are at times necessary with recurrent heavy infestations or overgrowths.
Treatment also includes a strict diet temporarily, including the removal of all starchy, sugary and yeasty foods. In severe cases it is best to initially go for the prescriptive anti-fungal medicine for about 7 to 10 days, then follow-up with a natural antifungal program from 3 to 6 weeks.
It is wise to treat the liver after a course of any drugs, particularly an antibiotic, and place a person on a good liver herbal and nutritional formula from 10 to 14 days. During the natural kill-program, the person supplements with a high-quality pro-biotic twice-daily (don't take these when you take prescriptives, especially an antibiotic, pro-biotics are ok during the natural kill program, just have them several hours away from meals. Take all supplements with meals, unless you are taking liquid herbs, which are best taken about 10 to 15 minutes before a meal. Always take pro-biotic supplements away from meals. The diet can gradually become less restrictive as the symptoms improve. To fully recover digestive function after suffering from candida with IBS, count from 2 to 12 months of treatment, the trick is to be patient and continue with good healthy dietary and lifestyle practices for as long as it takes.
My experience in working with women with dysbiosis, chronic candidiasis or parasitic infections, has taught me that certain tests are beneficial in evaluating gastrointestinal integrity. Hair testing will reveal a pattern if maldigestion and malabsorption are occuring, which are common secondary to dysbiosis. It is necessary at times to examine the flora of the intestine and to establish whether there is yeast, if it has become invasive candidiasis, whether there are any other parasites or if food allergies exist. The CDSA (comprehensive digestive stool analysis) and Food Allergy Panel tests are both very important test, and when correctly utilised with gastrointestinal complaints can add significant value to clinical findings, thereby improving chances of a recovery.
When the relevant tests are completed, dietary changes or various detoxification programmes if applicable can be initiated. At this point also, nutritional deficiencies can be corrected, and natural medicine treatment can begin. Any emotional issues that may have impact, (our point No. 3) such as judgmentalism, anger, depression or stress, will need to be addressed as well if an excellent outcome is expected.
3. Emotional Problems and Stress
Today's NZ society is high-energy as well as being high tech, and stress is ever present in all areas such as occupational, love life, finances, raising a family, violence, traveling in your motor vehicle, and your computer are all examples of known daily stressors that can have negative effects on the health of your digestive system. It is worth noting that the digestive system is intimately tied into our emotional state. Do you ever really feel like eating after you have become angry or upset?
The effect of stress on the digestive system is of epidemic proportions in the world today. Stress often causes a person to abandon regular and healthy eating habits, making them more reliant on fast or take-away meals, or on carbohydrate snacks such as noodles, muffins or biscuits with coffee. They can also become less active and stop exercising due to more hectic lifestyles.
Symptoms of stress on the gastrointestinal system include: heartburn or indigestion, changes in bowel habit causing diarrhea, constipation, appetite problems, and irritable bowel syndrome. Maldigestion and malabsorption eventually occur, leading often to fatigue. Breathing may become altered, (asthma) and shallower as a consequence of stress.
What to do It is important in stress not just to treat the physical manifestations of stress, but to also to allow help through proper stress management or counselling. Good lifestyle recommendations for treating those with stress or burn-out include regular relaxation exercises, yoga, tai chi, meditation, massage swimming and walking.
Nutritionally it is best to seek guidance from your practitioner. There are many specific and effective herbs, minerals and supplements such as amino acids available for stress and burn-out. A natural prescription can be tailored to suit your individual requirements. In most instances, pharmaceutical medicines are not required.
Many people with digestive problems have underlying emotional problems. In order to truely heal, it is necessary to tackle not only the surface manifestation, i.e. the physical symptoms by giving Mylanta or Losec, but also the emotions underpinning the physical complaints. In 1936, Dr. Edward Bach, founder of the Bach Flower Essences said: "There is no true healing unless there is a change in outlook, peace of mind and an inner happiness".
"There is no true healing unless there is a change in outlook, peace of mind and an inner happiness" Dr. Edward Bach
Functional Tests for Gastrointestinal Distress
With today's current epidemic of digestive problems in world, it is almost safe to assume that most people we encounter in clinical practice have digestive complaints to some degree or other until proven otherwise. In some instances, testing can facilitate a diagnosis and offer a treatment where other diagnostic options such as endoscopy, ultrasonography or other forms of imaging failed to dectet any gastrointestinal abnormalities.
Most of the functional tests required range in price. When you realise that the price you have to pay for not being tested in this simple way of submitting a hair sample, a stool sample, or a urine sample, could be very high (i.e. if you have and increased family risk of developing a cancer), you will see the need to be tested in this fashion at least with some regularity. This is preventative medicine at its best!
The 5 tests below are suitable to assess gastrointestinal function and integrity. Some of these tests, including the CDSA, will be outlined in more detail in future editions of Nutritional News.
Urinary Indican Test to determine the presence of indican in the urine, a determination of fermentation. Elevated indole levels are considered to reflect a state of intestinal toxemia caused by protein maldigestion. (or an excessive intake), intestinal overgrowth of anaerobic bacteria. (primarily due to maldigestion)and intestinal mucosal damage.
Intestinal Permeability Test is a simple, reliable test providing valuable information in assessing intestinal health. The person drinks a small solution of two sugars. By assessing the permeation of water-soluble molecules lactulose and mannitol through the intestinal mucosa after testing a urine sample collected after the drink, accurate information is obtained regarding the integrity and function of the lining of the small intestine.
CDSA (comprehensive digestive stool analysis) is a accurate and sensitive determination of not only candida overgrowth, but helps in assessing a wide range of intestinal conditions. The CDSA provides information on the person's ability to digest, metabolise, and absorb nutrients, as well as a full report on all bacterial flora (beneficial, imbalanced and pathogenic), all yeast, and all intestinal parasites (worms, eggs, larva, and protozoa. Chronic bacterial, yeast, or parasitic infections often have adverse effects on the body's metabolic and absorptive processes. The tests even include a sensitivity panel, showing your practitioner what herb, nutrient, or drug the parasites you have are sensitive to.
Food Allergy Test may be critical in some cases, and has helped solve many difficult cases of gastrointestinal distress. This test requires a blood draw and will quickly determine a persons's immune reactivity to 98 foods in 7 different categories, such as all the fruits, grains, vegetables, animal protein foods, grains, etc. The test determines the IgE as well as the IgG antibody levels.
Elemental Analysis of the Hair is a test which we covered recently in a Healthy Options article. The essential nutrient profile on the hair analysis report can easily point to a pattern of an underactive stomach, hypochlorhydria, and is a valuable, low-cost option for the patient to establish the integrity of the digestive and absorptive processes.
Making Sense of it All
Important points to conclude
The treatment of digestive disorders using natural medicine is not difficult, but does take time. Nature requires time to repair and heal a tube almost 30 feet in length.
Functional testing may be required to facilitate diagnosis and improve treatment outcomes.
Remember that the digestive system is under the control of the involuntary nervous system. Adrenaline and nor- adrenaline are hormones which are secreted under stress, they impair the movement of food along the intestines, decrease blood flow to the intestines, impair digestion and absorption by suppressing the production of stomach acid as well as decreasing the production of insulin by the pancreas.
It is important to rest after eating and be aware of how our stress responses, habits and emotions affect our digestion, particularly the stomach.
Diet is most important; the digestion simply will not heal with continued dietary stress. The consumption of pure water, along with appropriate diet changes are necessary, as mentioned earlier: as long as it takes. It is best to work with a practitioner skilled with cases such as yours, call and enquire beforehand.
Exercise which is vigorous and regular is most stimulating to the digestion, the form of exercise is not in itself important. I have found that those who walk the most, have the least bowel congestion.
Some good herbs for the digestive system include aloe vera, slippery elm bark powder, liquorice, gentian, and Milk thistle (St. Mary's thistle). There are many herbs and specific nutrients which have quite specific actions on the digestive system. My recommendations are as usual, for minor self-limiting complaints to try things out yourself, and for more serious or longstanding digestive complaints come in for a checkup.
My favourite herbal combination for a congested liver, leading to constipation - is SPAT - silybum, picorrhiza, artichoke and turmeric. Best taken in small amounts in capsule or if you are game, liquid.
Always work with your qualified and registered naturopath or natural medicine friendly doctor for best results, it is difficult to self-diagnose and treat and expect satisfactory results in chronic cases of gastrointestinal distress. You may have an underlying digestive disorder which needs urgent medical attention, so it always to consult a health-care professional for assessment and treatment or referral to an appropriate provider where required.
References:
The Four Pillars of Healing, Dr. Leo Galland 1997 Random House New York
The Yeast Connection Handbook, William Crook, MD, 1989, Wellness Health, Jackson, Tennessee
Microbiology and Infection Control, Lee & Bishop, 2002 Prentice Hall Victoria Australia
Pathophysiology, Concepts of Altered Health States, Porth, C. 2002, 6th. ed., Lippincott Philadelphia.
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