| Inflammatory Conditions and the Gastrointestinal Tract Myron Lezak, M.D. The ever increasing trend toward specialization in western medicine has segregated health care practitioners into ever smaller areas on which tofocus our efforts. This generally works well for acute, severe problemsbut with the chronic afflictions we have, this reductionist approach misses the point: we are more than the sum of our parts. We are rapidlyincreasing our knowledge that health implies not only an excellentfunctioning of all of our parts but that their interrelationship and the relationship toour environment is the key to a healthy existence.As an example of this understanding, I think that it would be worthwhile to look at the relationship of the function of the gastrointestinal tract to the generalized inflammatory conditions of the body that occur as an upregulation of the immune system. These disease processes are referred to as "autoimmune" and occur more commonly in women. The reasons for this are unclear but certainly are partially a reflection of the effects of estrogen on immune system function. For many years it has been recognized that certain inflammatory conditions of the joints (arthritis) have been associated with the bowel inflammatory diseases such as ulcerative colitis and Crohn's Disease. In addition, joint inflammation has been noted after some acute gastrointestinal illnesses such as dysentery and after disruption of bowel integrity when part of the intestine is bypassed for surgery for obesity. Recently, however, much more subtle abnormalities of gastrointestinal function have been related to an over-responding inflammatory response with resulting arthritis, musculo-skeletal problems related to fibromyalgia and additional inflammatory disorders effecting all organ systems including the kidneys, liver and nervous system. The gastrointestinal tract performs the complex functions of digesting and absorbing nutrients into the body while eliminating harmful substances. When this function breaks down as a result of stresses from improper nutrition, toxins and/or emotional factors or illness, a combination of inadequate absorption of nutrients and increased absorption of undesirable elements in the bowel can lead to abnormal immunologic responses that result in inflammatory conditions. Food allergies and sensitivities, ingested toxic products from pesticides and herbicides and processed foods as well as emotional factors that are perceived as "stresses" all play a role in altering gut function and immunity. The result is a breakdown in the balance between normal nutrient digestion and absorption and abnormal permeability of the bowel or a "leaky bowel" that allows abnormal products primarily from the bacteria that inhabit the GI tract and ingested toxins to enter the blood stream. Some of these products are proteins called antigens. In some genetically predisposed individuals with rheumatoid arthritis, antigens from a species of bacteria called Proteus share a structural similarity with antigens on the surface of joints. When these antigens are abnormally "leaked" into the circulation because of a breakdown of the normal barrier function of the Gastrointestinal Tract, the immune system may be activated to attack the joints, resulting in an autoimmune process. A similar relationship with a different bacteria, Klebsiella, exists in some individuals with an inflammatory joint disease of the spine called ankylosing spondylitis. Some other gastrointestinal factors involved in the initiation or potentiation of autoimmunity and an abnormal inflammatory response include the overgrowth of yeast or Candida after antibiotic or steroid treatment. This may lead also to a decrease in absorption of nutrient factors nourishing the joints. Paradoxically, the very medications used to treat arthritis, especially steroids and the nonsteroidal anti-inflammatory drugs such as Ibuprofen, Naproxen and even Aspirin, also serve to make the bowel more "leaky" and thus may perpetuate the very symptoms that are being treated. The newer anti-inflammatory agents referred to as Cox 2 inhibitors (e.g. Celebrex) have somewhat less effect in regard to increasing gastrointestinal permeability. However, these agents do have potential problems in this regard. With this understanding, we can shift our attention from the joints and the other organs involved with the over-active inflammatory response to that of dealing with the whole individual. We can attempt to identify the various factors that have served to put out of balance the intricate relationships of function that create health. Getting the gastrointestinal tract back in balance, thus reestablishing the normal integrity of the bowel and the normal digestive and absorptive functions is a very important first step. This is opposed to conventional medical treatment with steroids and nonsteroidal anti-inflammatory drugs which actually serve to further disrupt GI function. First it is critical to identify and treat any specifically treatable bowel disruption that is playing a role in promoting this upregulated inflammatory process. We have been using with great success a combination of tests and evaluations available from Great Smokies Diagnostic Laboratories that provide us with information regarding GI function as it relates to these inflammatory conditions. The Intestinal Permeability Test gives us an indication of the degree of disruption of the bowel. The Comprehensive Diagnostic Stool Analysis with Parasitology aids us tremendously in assessing digestive and absorptive function, colonic health and the presence of beneficial organisms versus potentially harmful organisms in the GI tract. With this information, we can then make recommendations to remove the offending toxic agents playing a role in this inflammatory reaction. Nutritional support, both in the form of a careful dietary approach and nutritional supplements is also appropriate to restore bowel integrity and promote adequate digestion and assimilation of nutrients. This will also serve to modulate the abnormal immune activity and prevent further damage from the inflammatory response. I advise a whole-foods diet that minimizes processed foods, especially avoiding partially hydrogenated oils and sugar. Organic foods, not treated with herbicides and pesticides are also important considerations. Some dietary factors that in certain sensitive individuals might disrupt integrity include dairy products, wheat products, meat, eggs, and other grains such as oats, corn, rye and barley . A test of specific food sensitivities may be useful. Such an evaluation is available from Great Smokies and is often helpful in assessing the needs for specific dietary limitations. An elimination trial of up to three months with each of these products is worthwhile. Supplements should include the anti-oxidants beta-carotene and a mixed carotenoid complex containing lycopene, lutein and other carotenoids at 15,000 to 25,000 units daily, vitamin E 400 to 800 at IU daily, and vitamin C with at least 2 grams to 3 grams daily. B complex vitamins with vitamin B6 at 50 to 100 mg, folic acid at 800mcg daily, Vitamin B 12 at 500mcg, and vitamin B5 at 50 to 100 mg a day are also warranted. L-Glutamine 500 to 1,000 mg daily, an amino acid which is critically important in maintaining bowel integrity and diminishing the "leaking" of unwanted products into the body is profoundly helpful. N-acetyl cysteine at 500 mg to 1000 mg a day and selenium 200 mcg as precursors to a potent detoxifying and antioxidant system, glutathione peroxidase is also beneficial. Nutrients helpful for the health of cartilage include the minerals zinc 30 mg a day, selenium 200 mcg a day, copper 2 mg a day, and manganese 25 to 50 mg a day as well as glucosamine sulfate 500 to 1,000 mg daily. Taking omega 3 oils, in the form either of fish oil containing EPA and DHA, or flax seed oil daily will act to shift the inflammatory response to a lower gear and maintain a proper balance of immunity. This measure is important and serves as a natural "nonsteroidal anti-inflammatory" program. In addition to the nutrient and supplement approach, the role of chronic stress cannot be overemphasized, This has an effect on hormone levels that influence the inflammatory response and change the underlying immunologic balance. A program of stress reduction combining carefully selected body work - depending on whether specific joints and muscles are involved - and awareness/relaxation programs such as meditation can help greatly with the discomfort and with improving the overallinterrelationships that serve to diminish stress, balance immune function and createwellness. These inflammatory processes are far more common in women than in men. An assessment of hormone status, including estrogen levels and progesterone, as well as the "stress-related" hormones of cortisol and DHEA can also be helpful in determining factors involved with the perpetuation of the inflammatory response. |
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