Optimal Digestive Health: A Complete Guide

Part I

How Your Body Works

1

Redefining the Problem

JERRY STINE

A NEW PERSPECTIVE

If you have digestive illness, this book was written for you, drawn from the experience of people like you. Your experience holds the clues to solving the mystery of your condition. Ultimately the solution will be based on your health history, symptoms, and responses. The details of your situation are the basis for individualizing treatment to fit your unique circumstances and will enhance your opportunities for healing. The promise of this approach is the freedom to lead a rich life, unencumbered by the pain and distress of illness.

This highly individualized approach is an aspect of integrative medicine, which encompasses both mainstream and complementary therapies. The challenges of chronic illness sometimes require additional options. The benefits of nutrition, acupuncture, functional medicine, and other complementary approaches have been confirmed in research and in treatment. Integrative medicine draws from the best of both worlds.

The information in this book is not just theory—it is the result of years of experience of both doctors and patients. The fruits of this knowledge are presented here as specific techniques and therapies. To those of us suffering from gastrointestinal illness, this information can be precious and critical.

TOOLS FOR HEALING

We want to provide you with key tools and concepts that are the basis of integrative medicine. Let’s consider some of the resources that seem to make the greatest difference for patients who are managing chronic health conditions:

An individualized approach.

Nutritional therapy. Using nutrition to adjust the body’s chemistry and promote healing.

Functional medicine and testing. New ways of looking at health that focus on how your body works and new lab tests that expand treatment options.

Integrative treatment. Using different therapies in combination.

Lifestyle. How lifestyle can become a tool for healing.

These approaches and resources offer hope for many complex conditions, from hidden food allergies to chronic illnesses such as Crohn’s disease. This is not to say that all the answers are available yet, but in many cases we can now make real advances toward health by using the latest information and resources.

1. An Individualized Approach

We know intuitively that we’re not all the same. You may function quite differently from those around you and experience reactions to foods or medications that others tolerate without any problem. Although your responses may be unusual, that doesn’t discount their significance. By fully understanding the very individual nature of your responses, you can come to appreciate their importance.

Your physical and mental reactions reflect the status of your body’s chemistry, including your minute-to-minute interaction with the foods you eat and the substances in your environment, such as cigarette smoke. Your biochemistry is essentially the complex interplay that occurs within your body between nutrients, hormones, brain, and immune function, and all the other aspects of your chemistry. Although you have inherited some of these tendencies, other aspects have evolved throughout your life, influenced by your environment and lifestyle.

An important first step in healing involves a deeper understanding of the very individual nature of your physical makeup and your body’s chemistry. In clinical nutrition the uniqueness of each individual is described as biochemical individuality, a term coined by Nobel Prize–winning researcher Roger Williams. He was one of the first to define the wide range of variations in body chemistry that occurs from one person to the next. Your body and chemistry are as individual as your fingerprints and your DNA.

2. Nutritional Therapy

Deficiencies of vitamins or minerals are as individual as any other aspect of health and can be a major cause of illness. You may know, for example, that vitamin C deficiency can cause scurvy, but did you know that a B12 deficiency is an important causal factor in many digestive disorders? These correlations between illness and nutritional deficiencies (and a great many others) have been identified through research. Researchers and physicians have also found that when the missing nutrients are supplied, healing begins to occur.

Nutritional therapy is especially useful in managing chronic illness on a day-to-day basis. Nutrition offers the opportunity to strengthen the body by replenishing depleted resources. In this approach we use the same raw materials that the body uses: foods, vitamins, minerals, amino acids, flora, fiber, and water. New lab tests can guide therapy by identifying deficiencies, and monitor treatment more precisely.

A wide range of nutritional supplements is another of the resources now available to you. These products are skillfully formulated and highly sophisticated, provided through enhanced delivery systems, and better assimilated. As a result an unparalleled level of precision is possible in nutritional prescribing. Using the new lab testing and the incredible range of nutrients currently available, we have additional resources to address the underlying causes of disease.

At this point there is abundant evidence on the effectiveness of nutritional therapy. There are more than 50,000 studies on ascorbic acid (vitamin C) alone. We also have a great deal of research, conducted over long periods of time, on large populations. For example, the Framingham Study has been ongoing for more than 50 years. This research has served to dispel many clinical misconceptions about conditions such as hypertension, glucose intolerance, and diabetes. Our current understanding of cholesterol in all its subtleties also grows out of this work. Recent breakthroughs in research include insight into a number of conditions that can lead to disease:

Insulin resistance (a prediabetic and diabetic condition)

Homocysteine (a risk factor for heart disease, stroke, and dementia)

Microcirculation problems (associated with many chronic conditions)

Although our understanding of these conditions is based on medical research, many of these disorders can be addressed through nutrition (see chapter 38). Since nutrition is one of the cornerstones of an integrative approach, integrative physicians are often among the first to incorporate these clinical strategies.

3. Functional Medicine and Testing

Functional medicine involves another new way of looking at health and illness. This approach applies the concept of biochemical individuality, with a focus on function. This means assessing how well a particular organ or system is functioning—for example, the liver or the adrenal glands. There is an advantage to this approach, because functional testing sometimes identifies problems in organs that might be missed in other types of testing. These tests can also pick up organ malfunction, in some cases before there is manifest disease or a definitive diagnosis. Dysfunction—even subtle dysfunction—can often be detected and defined in detail through functional testing.

By identifying problems in functioning, we can intervene more precisely. When function is restored, healing begins. Balance and healing are promoted by identifying the optimal diet for each individual and by supplementing specific nutrients. Botanicals and/or medications may also be used strategically. Information from testing becomes critically important in developing this individualized nutritional therapy. Functional testing can also guide strategies for prevention, optimal wellness, or antiaging programs.

Functional testing focuses on the kinks, defects, or system failures that underlie any given individual’s particular symptoms. For example, the new lab testing makes it possible to evaluate your specific levels of vitamins, minerals, amino acids, and digestive flora. Tests are also available to measure:

Genetic risk factors for specific diseases

The vitality of your immune system

Markers of inflammation

The levels and interaction of many hormones

Predictors of illness in the digestive tract and elsewhere in the body

The overgrowth of yeast or bacteria, or the presence of other harmful micrbes

The success or failure of digestive processes

These new tests can also define and measure how you respond to stress and the impact of environmental toxins. This testing is now available in affordable, easy-to-use at-home kits, which can be requested from doctors who practice functional medicine. The information from these functional tests makes it possible to target treatment to your specific needs.

4. Integrative Treatment

In our experience, an integrative approach can be quite useful in the successful management of chronic illness. We’ve observed that some of the patients most successful in coping with chronic illness have involved more than one practitioner in their treatment—for example, an integrative physician, an acupuncturist, a nutritionist, and a conventional physician. We have seen patients who used this approach do very well. These patients tended to be proactive in their use of different therapies. Since every major discipline has its own body of knowledge, treatment protocol, and specific techniques, treatment strategies that include more than one modality can amplify healing. We know that no one therapy provides the whole picture, yet the synergy that can result from this type of approach can be exceptional.

5. Lifestyle

It is clear to many of us that lifestyle is also an important factor in our health. Surprisingly, this is a fairly new perspective (actually it’s the return to an earlier paradigm). For decades lifestyle was considered a minor aspect in the treatment of any illness. Our current appreciation for lifestyle grows out of the wisdom of traditional therapies. Every major healing tradition throughout history has had lifestyle as its foundation and lifestyle was frequently part of overall treatment.

SELF-EVALUATION

At this moment in time and space, the way you experience your life and your health is the result of thousands of interrelated factors. Different aspects of your life, your physical uniqueness, and your lifestyle are all interacting to produce the health you are experiencing.

If you are currently dealing with chronic illness, this may be the ideal time to reassess your situation. A reevaluation offers an opportunity to start over, to describe where you are right now, and to begin putting together a plan for healing. We have chosen the Health Profile below because it’s substantiated by research and provides a reliable basis for self-appraisal. It has been used worldwide in more than one million health assessments.

Approach this self-assessment as if you were evaluating someone else. Note and report everything, no matter how insignificant it seems. Even if a symptom has been with you for a long time, report it. Be honest with yourself and take your time. For the few minutes it takes to do this evaluation, leave behind any preconceptions. A neutral mind-set is also important if you have a genetic predisposition or unresolved illness. You may want to give yourself two scores. To do this, make two columns—one for good days and one for bad days. We encourage you to take yourself seriously—honor your intuitions and observations. You have lived within your body your whole life—no one knows it better than you.

HEAD

___ Headaches

___ Faintness

___ Dizziness

___ Insomnia

___ TOTAL

EYES

___ Watery or itchy eyes

___ Swollen, reddened, or sticky eyelids

___ Bags or dark circles under eyes

___ Blurred or tunnel vision (does not include near- or far-sightedness)

___ TOTAL

EARS

___ Itchy ears

___ Earaches, ear infections

___ Drainage from ear

___ Ringing in ears, hearing loss

___ TOTAL

NOSE

___ Stuffy nose

___ Sinus problems

___ Hay fever

___ Sneezing attacks

___ Excessive mucus

___TOTAL

MOUTH/THROAT

___ Chronic coughing

___ Gagging, frequent need to clear throat

___ Sore throat, hoarseness, loss of voice

___ Swollen or discolored tongue, gums, lips Canker sores

___ TOTAL

SKIN

___ Acne

___ Hives, rashes, dry skin

___ Hair-loss

___ Flushing, hot flashes

___ Excessive sweating

___ TOTAL

HEART

___ Irregular or skipped heartbeat

___ Rapid or pounding heartbeat

___ Chest pain

___ TOTAL

LUNGS

___ Chest congestion

___ Asthma, bronchitis

___ Shortness of breath

___ Difficulty breathing

___ TOTAL

DIGESTIVE TRACT

___ Nausea, vomiting

___ Diarrhea

___ Constipation

___ Bloated feeling

___ Heartburn

___ Intestinal/stomach pain

___ TOTAL

JOINTS/MUSCLES

___ Pain or aches in joints

___ Arthritis

___ Stiffness or limitation of

___ movement

___ Pain or aches in muscles

___ Feeling of weakness or tiredness

___ TOTAL

WEIGHT

___ Binge eating/drinking

___ Craving certain foods

___ Excessive weight

___ Compulsive eating

___ Water retention

___ Underweight

___ TOTAL

ENERGY/ACTIVITY

___ Fatigue, sluggishness

___ Apathy, lethargy

___ Hyperactivity

___ Restlessness

___ TOTAL

MIND

___ Poor memory

___ Confusion, poor comprehension

___ Poor concentration

___ Poor physical coordination

___ Difficulty in making decisions

___ Stuttering or stammering

___ Slurred speech

___ Learning disabilities

___ TOTAL

EMOTIONS

___ Mood swings

___ Anxiety, fear, nervousness

___ Anger, irritability, aggressiveness

___ Depression

___ TOTAL

OTHER SYMPTOMS

___ Frequent or urgent urination

___ Genital itch or discharge

___ Frequent illness

___ TOTAL

TOTAL SCORE ___

The Health Profile was modified with permission from the Immuno Symptom Checklist (ISC) copyrighted 1988 by Immuno Laboratories, Inc., Fort Lauderdale, FL (800) 231-9197. Versions of the ISC has been used by more than one million patients and their physicians worldwide to assist in the evaluation of food allergies and IgG-mediated, delayed food sensitivities.

Scoring the Health Profile

At this point let’s review your scores. The profile can be a useful screening tool and focusing device. The total score can indicate the overall severity of your symptoms, while the individual sections can serve to highlight the problem areas.

A high score of 50 or above may reflect increased intestinal permeability and suggest the need for further testing. There are many causes of hyperpermeability and many associated symptoms throughout the body. Permeability can be checked using a simple at-home test prescribed by your doctor. (See chapters 7 and 17 for further information on this test.)

A high score may also suggest the possibility of food allergies, which can pose a real threat to GI (gastrointestinal) health. Unfortunately food allergies are often difficult to diagnose. Some allergies can cause a direct response in the body, but others cause a delayed reaction and are therefore harder to detect. For additional information on allergies and allergy testing see chapters 8, 16, and 20. If you got a high score on the profile, you will also want to take a look at the candida questionnaire and the parasite questionnaire, both in chapter 2. Remember that all the symptoms on the test can result from any of a number of causes.

INFLUENCES ON OUR HEALTH

Consider some of the major factors that influence overall health: our genetic heritage, our environment, and our habits.

Genetic Factors

Our genetic heritage is the basis for our uniqueness. We each have our own genetic makeup encoded on the chromosomes of our DNA. However, genetic coding is only one of many influences. The health we each experience is the result of our genetic coding plus thousands of influences from our environment from the moment of our conception.

Recent evidence indicates that we can influence our genetic expression. This refers to the expression of our genetic tendencies and whether risk factors actually become expressed as disease. (For infomation on genetic testing see chapter 17.) We now know that the quality of nutrition affects genetic expression. Research has also shown that, for most people, the strongest influences on health are still environmental factors such as toxic exposure and lifestyle. Although we were brought into the world with a certain genetic code, we can significantly influence our health through our nutrition and lifestyle. Genetics are not destiny.

Influences from Our Environment

The major environmental factors for most people include the quality of food, water, and air; hygiene; physical and emotional stresses; and exposure to toxic substances and microbes.

As we become more conscious of how environmental factors affect us, we are better able to maintain our health by consciously choosing habits that support us. We can begin by focusing on our own immediate environment, educating ourselves about nutrition and water quality. This knowledge can be translated into action by purchasing organic food whenever possible and drinking the cleanest water available. We can lower our exposures at home, because that is where we have the most control. It’s important to make informed choices about cleaning products, pest control, garden and yard spraying, and other details of living that carry subtle risks. (Chapters 9 and 23 on minimizing toxic exposure are particularly important and chapter 26 provides practical information on clearing toxins from the body through detoxification.) Another aspect of coping with our environment involves learning how to minimize the effects of stress in our lives. (See part IV, which offers a variety of resources for stress reduction from mind–body medicine.)

The Importance of Lifestyle and Habits

For anyone with chronic illness, lifestyle is doubly important. The ability to eat and exercise normally is often impaired. Stress is usually higher around all types of issues—work, family, relationships, money. So the challenge is to get good nutrition, exercise, relaxation, and emotional support—at the very time when they are most difficult to obtain. (You’ll find useful information on nutrition in chapters 20, 30, and 31; on exercise in chapter 43; on relaxation in chapter 28; and on expanding your support system in 48 and 49.)

Habits are another important aspect of our lifestyle. Much of our lives is composed of the habits that we have absorbed from our families and the social environment. But habits that work for one person may not work for another. Even habits that seem harmless can compromise our health. Good habits strengthen our vitality. (Resources that can strengthen your self discipline to help you create a healthy lifestyle on a day-to-day basis include exercise, which is discussed further in chapter 43 and meditation, discussed in chapter 45.)

COPING WITH CHRONIC ILLNESS

Unresolved illness can be enormously confusing and frustrating. Consider viewing your situation as a complex puzzle. You may have two or more conditions that coexist. There could be a number of symptoms. A domino effect can occur—the original illness may cause other problems. And even your doctor may not be sure of exactly what is wrong.

If your illness is unresolved, you probably already consider it a mystery. View yourself as a detective. The clues are your symptoms, the results of your lab work, and your responses to treatment. Consider all evidence important, including information on what has been successful and what has not. Even treatments that don’t work provide useful information. Here are some ideas you might find helpful:

Working with Your Practitioner

Work with the most informed and capable healers available to you.

Avail yourself of the relevant testing and explore the suspected causes, step by step.

Become involved in the development of a complete treatment strategy.

Let your physician(s) know how you are responding to therapy so that adjustments can be made. It is as important for your physicians to know what is not working as it is for them to know what is.

If you are seeing more than one practitioner, keep them all informed of what you are doing.

When you see your doctor, ask questions and be sure you understand.

Remember that the best practitioners want to involve you in the healing process.

Developing a Clear History

Review your entire history. The assessment questionnaires in this chapter and in chapter 2 can be part of this process.

Develop and prioritize a list of possible causes.

Maintain a file of the results from your lab work.

Integrate the results of the lab work with the clues from your individual history to develop the most complete understanding possible.

Keep a journal and a record of your progress.

- Record all the circumstances—when, where, how

- Create a list of what has helped and what hasn’t

- Include everything: diet, supplements, drugs and herbs, exercise, stresses, liquid intake, time of day, and seasonal response

- Also create summaries so you can stay focused on your primary successes

Expanding Your Resources

Review the literature at your bookstore, neighborhood library, or medical library.

Continue to adjust and develop your program in response to your progress.

Include lifestyle approaches in your therapy.

Be good to yourself.

Be patient. Not everything you try or every practitioner you see will provide you all the answers, all at once. You may need to explore a number of ideas and see several practitioners before you find all the clues that are required to solve the puzzle of your health situation.

We wish you well.

Jerry Stine is a nutritional consultant and the director of the Lifespan Institute for Antiaging and Functional Nutrition, which he founded in 1987 to develop advanced nutritional programs for life-extension and performance-enhancement. He also founded and directed Health Evaluations, a nonprofit research group with a nutritional consulting clinic and a research lab. For the past 15 years, he has been an independent nutritional counselor with an active private practice and has served as consultant for several respected vitamin manufacturers.

The Lifespan Institute provides nutritional supplements, individual nutritional consultations by phone, and access to a variety of the latest functional testing, including evaluations for allergies, GI health, parasites, adrenal function, oxidative stress, and general screening. For more information, you can reach the institute by phone at (415) 479-3552 or visit its Web site at www.LifespanProducts.com.

2

How Digestion Works

JERRY STINE

OUR INTERNAL ECOSYSTEM

Our bodies are constructed from the products of our digestion—we literally are what we eat. With that in mind, think of the digestive tract as an entire ecosystem, a self-contained environment supporting a community of hundreds of species of bacteria. This ecology consists primarily of friendly bacteria at work, our digestive flora. Without these beneficial bacteria to ferment and digest our food, we can’t have complete digestion or healthy bodies.

Protective Immunity

The immune system in our digestive tract performs the tremendous task of distinguishing friend from foe in this internal world, playing traffic cop to more than 500 species of bacteria. Most of these are friendly, but even in a healthy digestive tract small numbers of destructive microbes are always present. We also consume a wide range of bacteria, yeasts, and molds in our food and water; some of these microbes can be harmful if they survive and flourish.

The protective mechanisms of our GI tract are designed to neutralize these common organisms. A significant portion of our immune function is strategically located in the GI tract to keep a favorable balance between the helpful and destructive organisms. This immune function is so vital that 50 percent of the lymph tissue in the body is located in the intestinal lining and 80 percent of all our protective antibodies are produced there. In short, the body devotes an enormous amount of energy to maintaining the proper balance in the digestive system.

When the Balance Is Lost

A number of influences can upset this elegant balance:

Overgrowth of yeast, including candida

Overgrowth of undesirable bacteria

Microscopic parasites

arasites such as worms

Viral illnesses

Poor hygiene

Bad water

Radiation

A starchy diet

Surgery

Too many sweets

Physical injury

Excessive alcohol intake

Stress

Food allergies

Genetic tendencies

Certain medications

Environmental toxins

Frequent use of antibiotics

Friendly Flora

The bacteria in our GI tract number in the trillions. A healthy adult has five to eight pounds of living bacteria in their digestive tract, most of which are beneficial. These bacteria perform an essential part of our digestive function and we are completely reliant on their activities. This huge engine of fermentation produces the nutrients essential to our functioning.

Previously it was thought that the cells lining the GI tract were nourished by our body through the blood supply. However, recent research has shown that it is the beneficial bacteria that nourish the digestive tract (for example, they produce essential short-chain fatty acids). A number of other important nutrients are also available only through the bacterial fermentation of our food. Without the nutrients from these bacteria, there is a loss of function in the lining of the gut. (This can occur whenever we take antibiotics, unless we replenish the bacteria afterward with probiotics.)

Unfriendly Flora

When the flora is compromised or the immune system weakened, destructive bacteria or yeast that happen to be in residence may not be held in check. Then colonies of the harmful organisms (pathogens) can establish themselves in numbers great enough to disturb the intestinal environment and harm the body. This imbalance in the microorganisms of the digestive tract is called dysbiosis.

If the friendly flora are compromised, the intestinal lining can become malnourished, because the supply of vital nutrients is diminished. What’s worse, the destructive microbes produce toxic chemicals that can cause tissue damage in the GI tract and elsewhere in the body. The immune system may then become further impaired.

Nutrient Absorption

The ultimate priority of the GI tract is to contain (and dispel) the substances that are toxic and to admit the nutrients our bodies require. To accomplish this, the gut membrane acts as a selective barrier. This is the single most important activity of the digestive tract. These functions—containing toxins and absorbing nutrients—use an incredible amount of our energy. Digestive activities include regulating and accepting just the nutrients needed and rejecting everything else. And most of the material in the GI tract is rejected—very little is actually absorbed. You can see why the breakdown of these protective systems can cause a toxic condition in the body, a condition referred to as leaky gut; it can also create the potential for illness.

Leaky Gut Syndrome

A form of leakage can occur through the gut lining, compromising the barrier function of the digestive tract. Then some degree of toxins and bacteria can seep into the bloodstream and be passed along to the liver. The leaking of the gut wall—also called leaky gut syndrome or hyperpermeability—can be triggered by a number of factors, including food allergies, certain medications, alcoholism, radiation, chemotherapy, infections including HIV, and severe trauma such as burns. Hereditary tendencies can also play a role in leaky gut. As the gut becomes excessively porous or permeable, the bloodstream begins receiving both nutrients and toxins. All this material is picked up by the blood vessels lining the gut wall and is transported to the liver. The increased load must then be detoxified by the liver. Much of this inappropriately absorbed material is a source of metabolic stress and is potentially damaging to the body.

The Work of the Liver: Detoxification

The liver has the job of sorting out and processing all this material. If the substance is a nutrient the liver processes it into an active form the body can use. If the material is toxic the liver’s job is to neutralize it (to make it less toxic— to detoxify it). This process is essential because even a perfectly healthy gut will release some toxic matter.

The liver is capable of neutralizing an amazing variety of substances in enormous quantities. However, if it is continually overloaded by toxins, detoxification may be incomplete. These toxins can suppress the immune system and compromise its ability to recognize and defend against infection. This excessive load can also directly damage the immune system and the self-repair mechanisms within each cell. Detoxification stress occurs in a feedback loop: The more toxins that are absorbed, the more the liver’s capacity to detoxify can be compromised. At some point, real problems can begin to occur.

CONSEQUENCES OF POOR DIGESTION

The Development of Allergies and Sensitivities

When permeability increases, unprocessed substances can be passed on to the liver, completely undigested. This means that the liver would have to process undigested foods, bacteria, toxic chemicals, or whatever happens to be in the gut. The system could become overwhelmed and release these substances directly into the bloodstream. When this toxic material begins to circulate in the body, the immune system can become triggered, producing allergic responses to foods or other material released from the GI tract. An allergy or a hypersensitivity is typically an overreaction by the immune system, and can cause symptoms anywhere in the body. The food or substance causing the reactions may be relatively innocent—it is actually the overactive response of the immune system that causes the damage.

This dynamic can have a number of causes and result in a wide range of symptoms. For example, eating an allergic food is also a common cause of hyperpermeability and can be such a powerful trigger that permeability can increase within a matter of hours. This is a vicious cycle—hyperpermeability increases the absorption of more toxins and food fragments, which stimulates more allergic responses and amplifies the reactions in a snowball effect.

Innocent Foods and Toxic Effects

There are a number of ways in which problems associated with an overloaded liver can cause additional symptoms. One is the hypersensitization of the immune system just described. Another is direct damage to the body’s tissues caused by the toxic effects of chemicals in food or digestive debris. For example, certain elements in milk or wheat can have direct toxic effects on the nervous or immune system. Specific sensitivities to proteins in wheat have even been implicated in certain forms of schizophrenia.

Autoimmune Disorders

Constant overstimulation of the immune system can also lead to an autoimmune disorder in which the immune system can mistake the tissues of the body for an invader. The white blood cells and T cells may actually attack the body rather than the invasive bacteria or offending substance. This can be a cause of chronic conditions such as asthma, lupus, multiple sclerosis, and rheumatoid arthritis.

With the development of chronic illness an even greater toxic burden is placed on the liver. Under this increased stress, the liver may no longer be able to perform competently. This sets the stage for a whole new arena of possible problems.

Inflammation

Inflammation is a normal consequence of our immune response. Yet if the immune system is continually on hyperalert, inflammation can become chronic. This is often a feature of digestive disorders, and can be caused by many of the stressors we’ve mentioned.

If inflammation continues in the long term, changes in the tissue can occur, degrading resilience and function. Over decades more serious tissue damage can occur, manifesting in conditions such as accelerated aging, diabetes, and cancer. For example, research shows that as many as 40 percent of stomach ulcer cases caused by H. pylori infection go on to become stomach cancer. The body’s attempts to combat infection cause low-level inflammation in the lining of the stomach. If the infection persists, this sets the stage for the development of cancer.

For this reason it is extremely important to resolve inflammation. The best approach is to take it seriously, particularly if it doesn’t seem to be improving or if it recurs.

Challenges to the Immune System: Free Radicals

The chronic overwork of the liver’s detoxification mechanisms, caused by hyperpermeability, sets in motion a series of stresses. The first of these is the increased production of toxic by-products called free radicals. We hear about free radicals in the media, because they have been identified as a major cause of cancer. The assault of free radicals, also referred to as oxidative stress, further overstimulates the liver, causing it to send out signals that can confuse the immune system. These signals may trigger inappropriate reactions in both the immune and neurological systems and cause inflammation. This can occur even in a liver that is still generally functional.

If the liver’s detox mechanisms are held in constant operation, its functions may eventually become compromised. Increased stress on the liver can be caused by even minor but frequent GI complaints, such as chronic constipation or an overgrowth of bacteria or yeast. Continual stress may ultimately compromise the liver’s detoxification capacity. At the same time, free radicals (with the potential to cause cellular damage) could be generated in excessive amounts. Their effects are experienced throughout the body in cell membranes, connective tissue, and genetic material. This oxidative stress can lead to serious chronic illnesses such as Alzheimer’s disease, diabetes, irritable bowel syndrome (IBS), and Parkinson’s disease.

Oxidative stress from free radicals can also cause problems by depleting essential nutrients. This can short-circuit immune function, the activity of the nervous system, and the production of hormones. Over decades these compromises can develop into conditions such as heart disease and cancer. Free radicals have also been identified as a primary cause of aging.

YEAST AND PARASITES

When the delicate balance in the GI tract is lost, an overgrowth of yeast can occur, particularly Candida albicans. Candida is an undesirable species of yeast that is normally found in the gut even when we are healthy, but usually in small numbers. However, when candida develops too large a population (an overgrowth), it can overwhelm the beneficial bacteria, like weeds taking over a garden. An overgrowth can also be caused by certain bacteria or microbes in the gut. Imbalance in the flora has the potential to set in motion the entire sequence of harmful effects we have just described. Candida can cause illness and trigger symptoms anywhere in the body.

Parasites are another cause of digestive disorders that are often overlooked. When we think of parasites we tend to think of worms. Here in the United States, most parasites are single-celled protozoa, so small they can only be seen by microscope. Research by the Centers for Disease Control has found that more than 90 percent of all parasites in 80,000 lab tests were microscopic species. These microbes are a growing public health problem. They are now considered one of the important causes (among many) in some cases of chronic fatigue, arthritis, neurological problems, and immune suppression.

The Possibility of a Yeast Overgrowth of Candida

This is a frequently used questionnaire developed by practitioners to assess the likelihood of a Candida albicans infection.

SECTION A. MAJOR SYMPTOMS

Choose the score that fits your symptoms:

Mild = 4 Moderate = 8 Severe = 12

SECTION B. OTHER SYMPTOMS

Scoring:Mild = 3 Moderate = 6 Severe = 9

SECTION C. MAJOR INFLUENCES—PERSONAL HISTORY

Scoring: Yes = number shown No = zero

Antibiotics and Drugs as Factors

35  ___ Have you taken tetracycline or other antibiotics for one month or longer?

35  ___ Have you taken frequent short courses of other broad-spectrum antibiotics?

15  ___ Have you taken prednisone or other cortisone-type drugs for one month or more?

10  ___ Have you taken birth control pills for more than a year?

Symptoms and Sensitivities

25  ___ Have you had persistent bladder infections or prostatitis, vaginitis, or other reproductive problems?

20  ___ Have you been frequently exposed to high mold environments? Are you sensitive to mold?

20  ___ Do you have severe athlete’s foot, nail or skin fungus, ringworm, or other types of chronic fungus?

20  ___ Have you been treated for internal parasites?

10  ___ Do perfumes, insecticides, or chemicals provoke strong symptoms?

10  ___ Does tobacco smoke really bother you?

Cravings

10  ___ Do you crave or eat lots of starches, such as pastas or breads?

10  ___ Do you crave or consume lots of sweets?

10  ___ Do you crave or consume alcoholic beverages?

    ___ TOTAL SECTION C

    ___ GRAND TOTAL (SECTIONS A, B, & C)

Scores over 100 suggest the possibility of a candida overgrowth. Scores over 175 indicate a high probability of candida and suggest the value of seeing a health care professional.

© 1997, J. Anderson, N. Faass, T. Kuss, J. Ross, and J. Stine.

Scoring the Candida Questionnaire

A high score on the candida questionnaire suggests the possibility of an overgrowth of Candida albicans or other microbes. If your score is over 100, you have a number of symptoms often seen in people with a yeast overgrowth. Additional follow-up with your doctor and with relevant lab work could be very worthwhile. A score over 150 reflects the strong possibility of a problem caused by yeast.

If you find that you have candida, it is important not to view that as the primary problem. An overgrowth typically occurs when the digestive tract is no longer able to protect itself. Other stressors may be causing a suppressed immune function, allowing the candida to proliferate. Factors that promote candida overgrowth include the frequent use of antibiotics, a highly sweet or starchy diet, low levels of stomach acid or digestive enzymes, exposure to toxic chemicals, microscopic parasites, or chronic stress.

It is quite possible to score high on more than one of these questionnaires. These problems are by no means separate from one another—frequently they occur as overlapping conditions. If your scores are high on any of the tests, we encourage you to see your health care professional. Information on candida is included in chapters 15 and 17 on testing and in chapter 21.

Symptoms from Microscopic Parasites

The following questionnaire is designed to assess the possibility of intestinal parasites, particularly the single-celled parasites.

Scoring: 0 = Never 1 = Sometimes 2 = Often 3 = All the time

Scores over 30 suggest the possible presence of microscopic parasites. The most important next step is testing by a lab with special expertise in this field, and treatment by a knowledgeable health care professional.

SOURCE: T. Kuss, Infinity Health Systems, Littleton, Colorado.

Scoring the Questionnaire about Microscopic Parasites

The symptoms described in the questionnaires are associated with any of a number of illnesses. Consequently the scores from the tests point to possibilities, but not to a diagnosis.

A test score above thirty on this questionnaire suggests the possibility of infection by microscopic parasites. They can be extremely difficult to detect and can be difficult to treat. Microscopic parasites can actually suppress the immune system and significantly impair digestion—they can also cause other illnesses almost anywhere in the body.

The incidence of microscopic parasites in the United States is increasing rapidly. If you have had long-term, chronic digestive illness and have not been tested for parasites, this may be the next logical step. Even if you were previously tested, retesting is appropriate since new advances in lab detection are improving doctors’ ability to diagnose this troublesome problem. Undiagnosed infection can underlie many other illnesses. Note that the symptoms from these chronic parasitic infections may not necessarily occur in the digestive tract.

If you think you have a parasitic infection, it may be tempting to undertake self-treatment. It is vitally important not to self-treat if you do have parasites. Many parasitic infections can only be eradicated by a specific drug or drug combination. Herbs can be very useful in combination with prescription drugs and may enhance the effectiveness of the eradication program. However, we advise against relying on the use of herbs alone. Information on lab work for protozoa and parasites is included in chapters 15 and 17 on testing; treatment information appears in chapter 21 on protozoa.

We also want to emphasize that the questionnaires highlight only a few of the many aspects of digestive illness. The scores may indicate the value of lab testing for food allergies, hyperpermeability, candida, or parasites. These relatively simple conditions can play a role in maintaining the chronic nature of more serious digestive disease. We have included these health issues because they are often overlooked in traditional evaluations and treatments. The tests are also useful because very low scores can help to rule out the presence of these problems. Your responses to the questionnaires will assist you in developing strategies to deal with digestive problems.

Biographical information for Jerry Stine appears on page 12.

3

Your Five Protective Barriers

SCOTT ANDERSON, M.D.

THE FIRST PROTECTIVE BARRIER: INTELLIGENCE

Intelligence is the first and most important barrier that guards our health. Although we may think of our brains as the source of our intelligence, we can also define intelligence as the way we live, the way we run our entire lives. It is reflected in our capacity to be proactive—to see positive options and to act on them.

We each have a sphere of influence in which we make choices about our lives. We can choose what we bring into our lives—the people we spend time with, the thoughts we think, and the foods we eat. The more intelligent these choices, the better. Although we often take our diet for granted, it’s important to be very conscious of what we eat, because if we consume only what tempts us, we may not be very healthy. So we should exercise intelligence on behalf of the entire body.

Eating smart means making wise choices about when, how, and where we eat, and all those other little decisions we make when we buy, prepare, and consume food. This may mean planning ahead to bring a healthy snack to work for an energy boost in the afternoon. It should include eating in a relaxed way, perhaps sitting in the sun or a cozy café. Eating smart means paying attention to details such as chewing our food rather than just bolting it down. And it’s wise to know the basics of nutrition.

Anatomy of the Mouth

Why is it so important to chew our food well?

Chewing well mixes our food with saliva to begin digestion and makes it easier to swallow.

Chemicals in our saliva (enzymes) start breaking down the food. The better they’re mixed into the food, the more thoroughly it will be digested.

Our food is moved down the esophagus by waves of muscle contractions (peristalsis) that act as a conveyor belt to the stomach.

Doctors have noticed that people who bolt down their food have a greater tendency toward gastrointestinal problems than those who chew thoroughly. Think of chewing as a time to really taste and savor your food.

THE SECOND BARRIER: STOMACH ACID

Believe it or not, our stomach acid (hydrochloric acid, or HCl for short) is one of the most important self-protections the body provides; it destroys the bad bugs—microbes that are always trying to invade our systems.

Most of us don’t even think about our stomach acid, and when we do, we are more likely to think of it as a problem. But the body invests an enormous amount of energy to produce HCl. If we drew an energy map of the body, the energy used to create this acid would be comparable to the amount of energy it would take to climb Mount Everest. Although we’re used to hearing about the dangers of stomach acid on television, these gastric juices are actually an essential and vital protection to our digestion. Here’s how they work:

Stomach acid basically sterilizes our food. It destroys microbes such as bacteria or yeast seeking to colonize the warm and nutrient-rich folds of the intestines. As our food is mixed with acid in the stomach, the germs are destroyed on contact by burning them with a solution strong enough to literally burn a hole in this book. Germs such as bacteria, microscopic parasites, viruses, and molds can contaminate anything we eat or drink.

Stomach acid begins the process of protein digestion. Stomach juices contain acid and an enzyme called pepsin. This creates just the right chemical conditions for digesting protein.

In the acid mix of the stomach, minerals are processed for absorption. Without enough stomach acid we’d have poor absorption of minerals. In fact, malabsorption of minerals is one of the tip-offs to doctors that a patient may have chronically low stomach acid. The trace mineral deficiencies that may result can be identified through simple lab tests such as hair analysis.

Stomach acid stimulates secretions from the pancreas that are essential to good digestion (enzymes and bicarbonate). The acidity of the food coming out of the stomach signals the pancreas to pour out its juices. When the acid mix comes in contact with the gut wall, this stimulates the next phase of digestion. If the stomach’s output is only mildly acidic, then the pancreas gets a weak signal and the whole digestive process is compromised.

DIGESTION: THE FOOD PROCESSOR

After we’ve eaten, food stays in the stomach for a while. How long depends on the size and content of what we’ve just eaten and how well our digestive equipment is working. During that time (typically at least ninety minutes) food is confined in the stomach under very acidic conditions. Here’s what’s happening when our food is digesting:

The food is being churned in the stomach, grinding it to the consistency of cornmeal

This mixture is cooking in the stomach acid

Germs are being killed

Protein digestion is beginning

Minerals are being processed

When this process has been completed, the food is ready for the next phase of digestion, which takes place in the small intestine. There nourishment from our food will be absorbed by the body, to actually become part of our tissues.

As the stomach sends the food into the small intestine, the food-acid mix needs to be neutralized. If this didn’t occur, the mix would burn the delicate lining of the small gut. By adding bicarb into the mix, the tender lining of the gut (the epithelium) is protected from the chemical burn of digestive acid. This food mixture (called chyme) is about the consistency of liquid oatmeal and contains saliva, stomach acid, pepsin, bicarb, and enzymes.

A Note from the Doctor

As a doctor, when I identify patients who have frequent indigestion, one of the first things I have them try is an over-the-counter supplement of hydrochloric acid, betaine hydrochloride, which they can get from most any health food store. In some cases, just that addition will resolve their digestive problems. If not the next step is to try adding over-the-counter pancreatic enzymes. So my first strategy is to support natural processes in the body that may be weakened, with supplements such as stomach acid and digestive enzymes.

If you have any concerns or questions, be sure to talk about them with your doctor.

When you begin a new supplement, make that the only addition to your diet for at least two weeks so you can more easily identify unwanted effects.

Start by taking only one capsule a day for about four days—just as you start eating.

If it agrees with you, then gradually increase the dose every two to four days until you are taking the recommended dose.

Remember that we’re all different—the nutritional requirements of a 100 pound woman are quite different than those of a growing child of 50 pounds or a man who weighs 200.

—Scott Anderson, M.D.

The Pancreas Takes Center Stage

At this point, the pancreas also makes its contribution. This gland is located near the stomach and is a thin organ about 4 to 6 inches long, shaped like a fleshy leaf. It produces a number of important secretions that help us digest. The major ones include:

Digestive enzymes

Bicarbonate

Insulin (which is secreted into the bloodstream rather than the GI tract)

In this next phase of digestion food is moved into the small gut by the action of the pylorus, a thick muscular ring that acts as the gatekeeper, separating the opening leading out of the stomach from the small gut, which is called the duodenum. The pylorus releases the food mix little by little. If it were to open fully and stay open, the entire contents of the stomach would come flooding out all at once. Instead, the contents of the stomach are released in small squirts, every few seconds or every few minutes. At this point the pancreas secretes more enzymes to continue the digestive process, including:

Lipase to digest fats

Protease for proteins

Amylase for starches

Other enzymes with specialized functions

The Small Intestine: The Source of Our Nourishment

The primary job of the small gut is to absorb nutrients from our food. The breakdown and absorption of proteins and fats and the final digestion and absorption of starches and sugars all occur there.

The small intestine is essentially a tube—25 feet long! Its inner surface is covered with tiny folds that provide the greatest possible surface area for absorption, so we can get the maximum nutrition from our food. If you could unroll and unwrinkle the folds and lay the surface of the tissue out flat, the small gut would be about 60 feet across—at a size of 60 feet wide and 25 feet long, the small intestine has roughly the surface area of a tennis court. The large intestine, in contrast, is only about 5 feet long, with a surface area smaller than the top of a desk.

If you were to view the digestive tract through a videoscope, as gastroenterologists now do, the small intestine has a velvety appearance because its surface is made up of minute folds that are covered with tiny fingerlike structures called villi. The villi themselves are covered with other much smaller hairlike structures (microvilli), which can be seen only through a microscope.

The Incredible Digestive System

In a cubic millimeter of the mucosal lining (smaller than the size of a grain of rice), there are 6 to 9 feet of nerve cell fibers.

Gut reactions are transmitted by nerve impulses that travel through the gut in a matter of seconds.

There are ten times more bacterial cells within the gut than there are cells in our entire body.

Human cells are hundreds of times bigger than bacterial cells.

Although bacteria are microscopic and their DNA is tiny, if we were to take many billions of them and place their DNA end to end, the total length can be huge. For example, there are approximately 75,000 miles of bacterial DNA in a teaspoon of yogurt. And these are the same friendly bacteria that thrive in a healthy digestive tract.

All these structures are exquisitely constructed to absorb nutrients. The villi and microvilli are covered with a layer of protective mucus. The large gut is also lined with mucus, but it has a smooth, glistening surface when seen through the videoscope.

In the small gut the fingerlike villi shrink when chronic irritation is present. As the absorptive area decreases, people usually have problems with malabsorption. In fact, the loss of the villi is one of the findings doctors use to diagnose irritations such as wheat/gluten intolerance (celiac disease, or sprue). If there is infection or irritation, absorption is compromised and the sufferer may lose weight or experience failure to thrive.

After the digested food moves into the colon or large intestine, water is absorbed from the spent food, preparing it to be discarded from the body as stool. Another major function of the colon may be its role as host to a huge population of bacteria, including the friendly flora. Some nutrients are also transferred to the blood here, but the vast majority of absorption has already taken place in the small gut.

THE THIRD BARRIER: THE INNER DEFENSE SYSTEM

We have marvelous safeguards built into our digestive tracts, there to destroy invaders from the outside world, microbes hiding in our food and coming in with our water, waiting to do us harm.

Our protections include microbe fighters (antibodies) concealed in the mucous lining of the gut. Antibodies target antigens, which are anything the body has identified as unknown or potentially harmful. A wide range of substances can be tagged as antigens, from allergenic foods to microbes.

Secretory immunoglobulin A is one of our foremost defenders (sometimes called SIgA). When invading antigens, such as microbes, try to work their way into the folds of the gut, our antibodies attack. Each SIgA molecule resembles a microscopic arrow tipped with a suction cup. Hundreds of these arrows may adhere to the surface of an invader, making it fuzzier and stickier so it will become trapped in the mucous layer.

THE FOURTH BARRIER: THE LIVER

The liver is the Grand Central Station of our metabolism, handling an enormous amount of molecular traffic. The liver is the site of a huge variety of processing, whose vital roles include:

Breaking down nutrients

Filtering out toxins that come in from the gut and breaking them down

Synthesizing important blood components

There are extensive networks of tiny blood vessels around the gut that absorb nutrients from our food. This nutrient-rich blood all flows directly into the larger collecting veins of the portal system and is carried on to the liver. Another network of capillaries comprises the bulk of the liver and surrounds the liver cells. Guarding this system are specialized cells called macrophages, which destroy much of the bacteria that comes in from the GI tract.

All the nutrients and other substances that have been absorbed from our food are processed by the liver and then transported to the rest of the body. Nutrients will be broken down to provide energy and the raw materials from which our body will actually be constructed and maintained. These are the building blocks of muscle, skin, and bone.

The liver also functions somewhat like the oil filter on your car; one of its jobs is to protect the rest of the body from all the debris and gunk that could be harmful. Essentially all the material absorbed from the gut passes through the liver, carried by the bloodstream. The liver cleans the blood before it enters the heart and before it’s pumped throughout the body.

So the liver is the center for toxic cleanup in the body. The majority of the toxins are processed and transformed there. Some substances are exiled: If they don’t measure up, they may get processed out of the body via the bile, in the urine, or in stool. If the liver is required to process too many toxins, an overload may occur. Then the impaired capacity can limit its ability to monitor incoming traffic and filter out harmful substances, like a police force outnumbered by thugs who then get into general circulation.

THE FIFTH BARRIER: FRIENDLY FLORA

The friendly flora are bacteria that have beneficial effects in the body. They are important because they help keep our immune defenses well tuned and provide valuable nutrients such as vitamin K, folic acid, and the essential fatty acid butyrate. This barrier is so central to our well-being that chapter 5 has been devoted to the subject. Read on to learn more about your inner ecology.

OPTIMIZING YOUR FIVE PROTECTIVE BARRIERS

Intelligence. Know as much as you can about your food and make healthy choices of what to put in your mouth. There are many foods available that you would be smart not to eat.

Stomach acid. Know that stomach acid is doing a very important job; avoid antacids and acid-blocking medications. If needed, take supplemental HCl to support this important barrier.

Intestinal lining. Big as a tennis court, this is the delicate velvet surface across which food molecules enter the inner world of your bodily self. Learn as much as you can about how to keep this healthy. (See, for example, chapter 19 for a brief overview of the options.)

Liver. Metabolic Grand Central, the liver chemically transforms and detoxifies all the complex chemistry absorbed from the digestive tract through the intestinal lining. Chapters 9, 23, and 26 have useful information on minimizing toxins, detox, and nutritional support.

Friendly flora. There are ten times as many bacterial cells in your digestive tract as there are in your entire body.

Scott Anderson, M.D., obtained his undergraduate degree in biology from Harvard, a masters degree in genetics (where his thesis focused on human gut microbiology), and his medical degree from the University of Connecticut. During his 20 year career in medicine, he practiced in a variety of clinical settings, including hospitals, outpatient clinics, and medical centers. His areas of focus include preventive, nutritional, and antiaging medicine. Dr. Anderson’s current endeavors include research, writing, and consulting; he can be reached at [email protected].

4

Immune Defenses

MICHAEL ROSENBAUM, M.D.

The digestive tract is the most extensive area of immune activity in the body. Although we typically think of the GI tract as the place where food is digested and then discarded, the GI tract is also a very active immune center. For example, it contains more than 80 percent of our antibody-producing cells.

This immunity is different from the immunity elsewhere in the body in general, an entirely separate immune system that was not really appreciated until recently. It’s considered the largest of our lymph organs, larger than the thymus and all the other lymph nodes scattered throughout our systems.

A MAJOR SYSTEM OF DEFENSES

We are constantly under siege. We coexist with a vast population of microscopic armies consisting of viruses, bacteria, yeast, and parasites. The immune system is our major defense against this constant bombardment. To combat a never-ending horde of enemies, our immunity must be dynamic and ever vigilant.

In the gut, material from the outside environment literally enters the interior of the body as our food and water. They can contain all manner of pathogens. Our trusty immune system is there in the gut to protect us from this outside world inside us.

Our protective barrier is fairly vulnerable. To penetrate the inner gut lining and get into the blood vessels, invaders need only penetrate the mucous barrier and a layer of cells (the epithelium). This is quite different from the skin, for example, which has several protective layers of cells.

There is a lot of internal area to be protected. Consider that the small intestine is on average 25 feet long—more than four times most people’s height. And the large intestine is typically 5 feet long. So you have about 30 feet of GI tract.

Resident bacteria have to be kept under control. In that 30 feet of intestine you have an enormous number of resident bacteria. They’re supposed to be there—they’re normal flora. And it turns out that the normal bacterial population in the human gut is about equal to the number of cells in our entire body.

In the small gut, there are millions of bacteria in each teaspoon of liquid (about a cubic centimeter). In the colon, there are probably at least a trillion. There’s just an incredible amount of normal flora. People have no idea that they carry so much bacteria inside them. And if you take an antibiotic, in a sense you’re probably wiping out almost half the cells in your body. In fact, some antibiotics literally wipe out all the bacteria, harmful and helpful, all at once.

When things are in balance, we have a symbiotic, harmonious relationship with these bacteria. We need the bacteria for so many reasons. They actually produce vitamins such as vitamin K, which helps our blood clot, and folic acid, which is essential to the female reproductive system. They also preserve and maintain a healthy lining of the gut and they tend to crowd out the bad bugs.

There’s rapid turnover. What’s even more amazing is that the gut lining is completely replaced about every five to seven days. These cells work very hard and then they die. If our body can’t keep up with the effort of destroying and replacing them, we could end up with an impaired gut lining. Then we’re subject to intestinal permeability, food allergies, or all kinds of other potential problems.

GUT DEFENSES

Your immune system is a vast military service fighting a never-ending war. The gut marshals several different kinds of defenses to protect us from the outside world that literally comes inside our bodies with food and water. Immune functions can be compared to munitions factories, artillery, hidden attackers, sentries, and even guardsmen that check ID.

Chemical warfare—acid and