Gastrointestinal Problems
By Hugo Rodier, M.D.

At the annual meeting of the American Academy of Environmental Medicine held in the fall of 2000, a basic Ayurvedic principle was discussed: "The intestines are the guardian angel of the blood. Blood is the guardian angel of the liver. The liver is the guardian angel of hormones and enzymes. Indeed. You will see the scientific evidence to prove this ancient principle.

Anatomy and Physiology


The G.I. tract enables us to absorb nutrients from Earth to make us who we are, from every tiny atom to every enzyme and chemical substance that makes our body function. It is the way we get energy we need to live, and the main way we eliminate byproducts and toxins we are exposed to daily.

Mouth

This is where it all begins. Chewing our food is vital to begin the process of reducing our food to particles small enough to be absorbed in the intestines. Most people's problems begin right here when, eating in a hurry, they fail to chew at least 12 times before swallowing. The process of chewing also causes digestive enzymes to get ready to do their job from the stomach on down.

Sixty percent of the immune system is found in the G.I. tract

(J. Parenteral Enteral Nutrition, 1999, 23:s7). The tonsils in the throat are the beginning of this system. Because of this association, many systemic, or body diseases are associated with gum disease, which is not adequately emphasized in health care circles. "It is a historical accident that oral and dental diseases are traditionally excluded from the medical curriculum" (J. American Medical Association, 2000, 284:1215). In fact, strokes and preterm deliveries are 2.6 times more likely in someone with periodontal disease (J. Annals ofPeriodontology, 1998, 3:161).
Diabetes has also been associated with gum disease (J. Practical Diabetology, Dec. 2000, 19), as well as with heart disease, which is 2.7 times more likely with gum inflammation.

Esophagus

This muscle takes food down to the stomach. Its powerful contractions contribute to the mechanical breakdown of food. It also keeps stomach acid from coming up, though a serious problem (reflux) can develop, sometimes leading to cancer, ulcers and a narrowing severe enough to block the passage of food.

Stomach

Acid produced by the parietal cells digests food. Attempts to block acid with drugs and antacids in order to heal ulcers will also block the production and absorption of B vitamins because the same parietal cells are in charge of processing these important vitamins.
An ulcer is the breakdown of the buffer layer inside the stomach. Without this carbonate layer, the stomach's own hydrochloric acid becomes harmful. H. pylori bacteria has been associated with the breakdown of this buffer layer, but most people so infected don't have ulcers. While it is true that an infection with this bacteria needs to be treated for an ulcer to heal (testing for this organism is recommended when treating ulcer patients), one cannot conclude that this bacteria is the main factor in ulcer development. H. pylori only takes advantage of a breakdown in the buffer layer, which creates a "raw" surface where the bacteria can easily set up shop and feed itself.
This breakdown is more likely in people with a congenital weakness in the daily renewal of this buffer layer. When a tissue requires such dynamic restructuring, good nutrition is critical. Thus, healing of ulcers requires not only acid blockage, but B-complex supplementation, eradication of H, pylori, nutritional support, and strengthening of the buffer layer.

Duodenum

Most ulcers occur in the duodenum, where they are less likely to become cancerous. The process of digestion continues here, aided by bile salts from the liver and by enzymes that pour into the duodenum from the pancreas.

Pancreas

The pancreas has two functions:
* first, the exocrine production of digestive enzymes (protease, amylase, lipase) to break down proteins, carbohydrates and fats.
* second, the endocrine production of insulin.
Both functions can become problematic, leading to poor digestion and to diabetes, respectively. The latter occurs from a lack of insulin, which is produced by the pancreatic "islets of Langherhans."
Cancer in this organ is serious; patients, on average, live about six months after diagnosis. The endocrine production of insulin is so called because insulin is dumped into (endo) the bloodstream, whereas the digestive enzymes are dumped "outside" (exo) into the duodenum.

Gallbladder stones can block digestive enzymes from reaching the duodenum, since both the gallbladder and the pancreas share the same conduit to the duodenum. This can create a congestion of enzymes in the pancreas, leading to pancreatitis, which is a very painful and sometimes fatal condition. Of course, most pancreatitis is due to direct inflammation of the pancreas by alcohol or pharmaceutical drugs.

Liver

The liver is incredibly complicated. It is best to simplify its function for now, which is mostly the detoxification of toxic products of our own metabolism and the detoxification of foreign chemicals and drugs (xenobiotics). It also helps the process of digestion by producing bile salts, which are stored in the gallbladder. When hormonal signals come from the stomach, the gallbladder constricts to squirt bile into the duodenum in order to digest food, mostly fats. Bile may thicken, eventually turning into stones, which can leave the gallbladder painfully inflamed, particularly after a fatty meal. Most people suffering from this condition are obese and middle-aged.

The thickening of the bile is a warning sign that the patient has a "hyperinsulinemic," or "pre-diabetes," condition. Consequently, it is best to help people process carbohydrates better, lose weight and use nutritional support to break down gallstones so they can pass into the intestines. Surgery may still be necessary for some patients because of severe pain and the possibility of the gallbladder bursting inside the abdomen, which can create a lifethreatening condition.

Small Intestine

This organ measures about eight yards and has the surface area of several football fields. The surface area is so large because of the thousands of hair-like projections (villi) in the lumen, or space inside. This vast area is necessary to maximize absorption of nutrients and water. A major problem is inflammation of the lining of the intestines, which can create colitis and lead to "leaky gut syndrome" (see below).
There are several forms of colitis. Ulcerative colitis and Crohn's disease (severe colitis) are the most serious because they can lead to cancer and severe inflammation of the large intestine, but the most common is irritable or spastic colitis. It affects 20 percent of people, most of whom continue to suffer because they are diagnosed as stressed and depressed (which is true in some cases) and are treated with drugs to relieve spasms only.
A more logical approach is to decrease inflammation by changing diet and patching up the leakiness (see below). Infectious colitis is caused mostly by viruses but occasionally by bacteria. Infection can be the beginning of the forms of colitis discussed above.

Less common conditions are knotting of the loops of the bowels (intussuseption), the sticking of loops to each other from surgery, tumors, arteriovenous malformations, and intestinal angina. Discomfort that continues needs medical attention.

Large Intestines

The colon's main function is to absorb as much water as possible from excrement and store it until a convenient time for evacuation. Cancer of the colon is the second leading cause of mortality in the United States, a reflection of our poor dietary habits and toxic environment. Consequently, screening with a colonoscopy after age 50 (or 40 if one has a family history of colon cancer) is strongly recommended. Of course, prevention is always preferable.

Other problems besides inflammation and leakiness include diverticulosis (weaknesses in the lining create a ballooning effect in the walls of the colon, which can rupture and create a life-threatening condition), appendicitis (a similar condition from an inflamed appendix, which is part of the immune system), bleeding from polyps (precancerous growths from mutations of the intestinal lining caused by toxic environments and a diet low in fiber), and infections as discussed above.

A Key Point to Remember

The journal Immunology Today published a landmark study in 1994, stating that the immune system (remember, 60 percent of it is found in the G.I. tract), the nervous system and the hormonal system are virtually inseparable! (15:504). This is dramatically important, as you will see.

Our immune system protects us from toxic diets and environmental toxins. This is why our digestive tract developed the dual function of digestion and protection from outside threats.

Dr. Elie Metchnikoff won the Nobel Prize in Medicine in 1908 for his work on probiotics, or friendly bacteria inhabiting our intestines. He said, "Immunity has existed from time immemorial. It is as ancient as disease. The most simple organisms constantly struggle for their existence. They give chase to other organisms for food, and they defend themselves not to become their prey. When the aggressor in this struggle is smaller, it introduces itself into the body of the prey to destroy it by an infection, to absorb the contents of its host and multiply" (Immunity in Infective Diseases, London,1905).

Probiotics have developed a symbiotic relationship with humans. They number about 100 trillion, and their main function is to keep more noxious organisms from colonizing our guts. In other words, they are the forgotten soldiers keeping us from being overcome by constantly mutating pathogens in our toxic environments (American J Clinical Nutrition, February 2001, 73:444s; J Lancet, 2001, 357:1059).

The cells that line the intestines have a very close relationship with the microbes therein. If the "bad guys" predominate, a breakdown in the integrity of the intestinal lining occurs. This is also true in all "mucosal" barriers throughout the body! This inflammation "enhances their penetration across the epithelial (lining) barrier" (American J Clinical Nutrition, February 2001, 73:1124s, 113 1 s). This penetration is known as Leaky Gut Syndrome.

We now know that a shift toward more pathogenic bacteria causes this permeability. Pathogens like Vibrio cholerae have been shown to release a substance called zonulin, which widens the tight junctions between the intestinal cells so that toxins can enter the circulation. Even a less-serious infection like the stomach flu can create this problem for years to come (J. Gut, 2001, 47:804). Later, Irritable Bowel or Spastic Colitis may develop, but because the stomach flu episode happened so long before, the two are not correlated. Irritable Bowel, then, is a disorder of intestinal flora, made worse by stress. It is characterized by spasms of the guts after meals, bloating, cramping, and alternating diarrhea and constipation.

Consequently, if friendly organisms (probiotics) predominate, the intestinal defenses are strengthened. This is a perfect example of how connected we are to the environment we live in. In our culture (as opposed to traditional Native American culture, for example), we see the environment as an enemy that must be conquered and exploited.

Our best approach to disease is to remember the words of Pasteur, best known for discovering these microorganisms: "Le germ n'est rien. Le terrain c'est tout (the germ is not that important... what is, is the "terrain").... If I were to study diseases again, I would concentrate on environmental conditions and the person's resistance ... [which sometimes] form an insufficient barrier against microbial invasion" (The Turning Point, Fritzol Capra, 1982). And where is most of our resistance found? In the gastrointestinal tract! That is why we will return over and over to the concepts of G.I. inflammation and health as we study diseases in this book.