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 to focus our efforts. This generally works
well for acute, severe problems but with the chronic afflictions we have, this
reductionist approach misses the point: we are more than the sum of our parts.
We are rapidly increasing our knowledge that health implies not only an
excellent functioning of all of our parts but that their interrelationship and
the relationship to our 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 that 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 that 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 overall interrelationships
that serve to diminish stress, balance immune function and create
wellness. 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. A salivary test available through
Great Smokies Diagnostic Labs is very helpful for providing this information. It is my experience that this kind of
approach improves the inflammatory picture and provides a basis for improving
general health and the feeling of well-being that we are all entitled to.
An
internist specializing in gastroenterology and the treatment of digestive and
liver disorders, Dr. Lezak is a member of the American Medical Association, the
American Society of Internal Medicine,
Comprehensive
Digestive Stool Analysis
Intestinal
Permeability Test
Comprehensive
Female Hormone Profile
Great
Smokies Diagnostic Laboratory
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