What does your bowel have to do with arthritis, chronic disease, immune disorders, and other maladies? In my view, the most remarkable phenomenon in the entire field of human biology is this: A vast number of clinical problems that are seemingly unrelated to the bowel spontaneously resolve when the focus of clinical management turns to managing the bowel back to health!
In my experience I have found problems of extreme fatigue, mood swings, arthralgia (pain and stiffness in joints with or without joint swelling) resolve when the bowel issues are addressed? How often do we successfully prevent chronic headache; anxiety; palpitations; incapacitating PMS; recurrent attacks of vaginitis; asthma and skin lesions by correcting the abnormalities in the internal environment of the bowel?
Physicians who have learned to respect the bowel - as the ancients did - and care for their patients with a sharp focus on bowel issues will readily validate my personal (and fairly extensive) clinical experience.
The Bowel and the Immune System
Our immune defenses exist as plants in the soil of the bowel contents. The ancients seemed to have known this intuitively. I remember that the hakim (folk-doctor) in my village always prescribed laxatives for a headache. He prescribed remedies that seemed to work on the bowel for problems of the skin, joints, liver and other organs. Of course, I, then a medical school student, found it very amusing. It never occurred to me then why these folk-doctors would prescribe year after year remedies that couldn't work.
More important, from my present perspective, I never wondered why people accepted those remedies year after year if they afforded no relief. I was into the science of medicine then. I wasn't into finding out what worked and what didn't. Nor did I ever doubt the science of my professors who doled out prescriptions for drugs by the dozens for sheer symptom suppression.
That was then. And that was poor Pakistan.
Now I question the science of an average American family practitioner when he prescribes drugs for chronic bowel symptoms. How scientific is his use of antacids for symptoms of burning or pain in the pit of the stomach? How scientific is his use of antispasmodic drugs for abdominal cramps?
How scientific is his use of antidiarrheal drugs for diarrhea? How scientific is his use of steroids for inflammatory bowel disorders? Steroids suppress the immune system.
How scientific is it to further suppress the immune system for problems caused by an errant immune system in the first place?
How scientific is the use of anti-inflammatory agents, anxiolytic drugs, antidepressants, antispastic agents, antihistamines, and, of course, broad-spectrum antibiotics for treating various types of bowel disorders that we - by our own admission - do not understand the causes of?
The Universe of the Bowel
For many years I have studied a host of clinical syndromes in which the symptom- complexes can be related to events occurring in the bowel. As a hospital pathologist, I have had the opportunity to examine more than 11,000 bowel biopsies.
Every time I peered at a bit of bowel through a microscope and saw inflammation - colitis in common jargon - I wondered where and how it might have started. We pathologists know quite a bit about how a damaged bowel looks, but we know little, if anything, about the initial energetic-molecular events that set the stage for tissue damage. What is the cause of ulcerative colitis? Pathologists will tell you it is not known. What is the cause of Crohn's colitis? The answer: unknown. What is the cause of irritable bowel syndrome and spastic colitis? Unknown. What is the cause of microscopic colitis and collagenous colitis? The answer is the same.
Why is it that we do not know the cause of any of these types of colitis? The reason is we search for answers in the damaged structure after the fact rather than in the events preceding the damage. None of these "diseases" can be understood except with ecologic thinking - a Bowel Ecosystem - Bowel Ecology.
LAPs AND TAPs: THE GOOD AND BAD GUYS OF THE BOWEL
LAPs and TAPs are my abbreviations for lactic acid-producing and toxic agents- producing microbes in the bowel. LAPs preserve the normal bowel ecosystem, TAPs disrupt it.
LAPs confer many important host defenses upon the bowel. TAPs are equally versatile in their functions and produce a very large number of noxious substances in the bowel. Not unexpectedly, LAPs-TAPs dynamics are profoundly influenced by food choices.
Bacteria are living beings capable of executing an enormous number of biochemical reactions. Farmers used bacteria and fungi to turn compost into fertilizer long before biologists understood the metabolism of these single-celled bodies. A partial list of such reactions brought about by the normal bowel flora includes production of ammonia, conversion of amino acids into amines and phenols, inactivation of digestive enzymes such as trypsin and chymotrypsin and other enzymes located on the surface of cells lining the gut, deconjugation of hormones such as estrogen and bile acids, denaturation of bile steroids, breakdown of food flavonoids, hydrogenation of polyunsaturated fatty acids in food, utilization of certain amino acids such as B12, conversion of some compounds into carcinogens, and many other enzymatic reactions.
LAPs:
First and foremost, LAPs keep TAPs out. It appears that this essential role is played through different mechanisms that include simple physical crowding out of the potential pathogens as well as production of antimicrobial substances. L. acidophilus produces acidophilin, acidolin and bacterlocin; L. plantartium produces lactolin; L. bulgaricus produces bulgarican; and L. brevis secretes lactobacillin.
Second, they produce many life span molecules. Notable among them are members of the vitamin B complex, especially folic acid and biotin and vitamin K. Lactobacillic acid is an important fatty acid that is produced by some lactic-acid producers and is then converted into essential fatty acids.
Another notable molecule in this context is tryptophan - this is likely to be one of the mechanisms by which yogurt has been reported to be beneficial in cases of chronic anxiety and other conditions.
Third, they play a pivotal role in digestion. Lactose intolerance is a very common clinical problem. It is often not fully appreciated that a major portion of lactose ingested in dairy products is actually broken down to simpler sugar by lactase enzymes produced by lactic acid producers. Lactic acid and lactase producers also play important roles in protein digestion. This is one of the primary reasons protein intolerance is so common among individuals with altered states of bowel ecology.
Fourth, LAPs actively break down some toxins produced during metabolism such as ammonia, free phenols and polypeptides.
Fifth, LAPs normalize bowel transit time and are effective in controlling infant and adult diarrhea.
Sixth, the antiviral and antifungal roles played by LAPs, having long been empirically suspected by nutritionists and holistic physicians, have recently been documented with research studies.
Seventh, the cholesterol-lowering effects of fermented milk have been attributed, among other mechanisms, to orotic acid, which facilitates fat metabolism in the liver.
RESTORATION OF BOWEL ECOLOGY
Disruptions of bowel ecology can be arrested and reversed only with a gardener's sense of tending to the soil, nurturing the plants, and respect for the sunshine. That, of course, is the theme of this chapter. The sun-related factors - chronic anger, hostility, conflict, and a sense of being a victim - both slow down the bowel transit time and significantly reduce perfusion in different parts of the alimentary tract. Those anatomically-mediated responses, of course, form the core of the so-called stress response
The Seed-Feed-and-Occasionally-Weed Approach to Restoration of Bowel Ecology
Seeding is the repopulation of the gut with microflora that have been destroyed by indiscriminate use of antibiotics or crowded out by the unrestrained proliferation of yeast and bacterial organisms such as the Proteus and Pseudomonas species.
The "guardian angel bacteria" for bowel ecology belong to the Bifidobacterium and Lactobacillus species. Some other species also play protective roles. In health, these organisms provide the necessary counterbalance to the growth of yeast and pathogenic bacterial organisms. Beyond this, these organisms produce several molecules that play critical roles in our molecular defense systems.
Feeding is the use of some growth factors that the normal bowel flora require to flourish. These include biotin, pantetheine, Vitamin B12 and others. We clinicians have used Vitamin B12 for decades with good clinical results. One of the principal mechanisms by which vitamin B12 exerts its myriad beneficial effects is by serving as a "growth hormone" for health-preserving bowel flora
Occasional weeding is the use of several natural substances that are known to suppress the overgrowth of pathogenic bacteria, viruses and yeasts. During initial treatment, I frequently use oral nystatin or fluoconazole (Diflucan) for short periods of two to three weeks, partly for diagnostic and partly for therapeutic reasons (how a person with one of the ABE states responds to these agents is useful in assessing the degree of damage to bowel ecology). Extensive clinical experience has convinced me that long-term clinical results are far superior when the use of drugs is kept to a minimum.
Simple-minded efforts to "get rid of the yeast" with nystatin and "yeast- free diets" usually yield poor long-term results. Cold hands are associated with "cold bowel." Cold hands and cold bowel are the result of oxidatively-damaged thyroid enzymes (underactive thyroid gland), oxidatively-damaged autonomic nerve cells and fibers (dysautonomia) or an oxidatively-overdriven adrenalin gland. None of these problems can be effectively managed with yeast-free diets and Nystatin. Of course, there are other essential issues of nutrition, environment, food and mold allergy, and fitness. In the management of battered bowel ecosystems, it is essential to consider the biologic individuality of the patient. It is necessary to adopt an integrated, long-term approach that addresses all relevant issues of bowel flora and parasites, bowel transit time, bowel ischemic patterns, IgE-mediated disorders related to candida and other yeast antigens, malabsorptive dysfunctions, and secondary systemic consequences.
Physicians who are not familiar with natural therapies for managing chronic bowel and gastric disorders are in for a pleasant surprise. A very large number of effective natural agents are available to them. Extensive clinical experience has convinced me that for nonlife-threatening, chronic disorders, natural therapies are far superior to the huge array of drugs that are foisted upon us.
Following are important consideration in integrative management of chronic gastric and bowel disorders:
First, all patients should be offered standard drug therapies for acute disorders when any question exists about impending clinical crises or risk of serious complications.
Second, all patients managed with natural agents should be prepared for slow and sustained recovery over weeks and months. It is my practice not to wean my patients off drugs prescribed by other physicians. Rather, my clinical strategy is to go for gentle restoration of bowel and gastric ecologies. The patients sense clinical improvement within several days or some weeks. It is at this time that they ask me if they should begin to reduce the dose of drugs they are taking, and I am only too happy to provide guidance on how to do so gradually.
Third, all patients are required to attend a full-day workshop in which I give detailed information about the devastating impact of internal and external environments on our biology. In addition, nutrition and exercise classes are given by the nursing staff at the institute.
Fourth, all patients must be managed with an overarching philosophy of holistic molecular relatedness in human biology. I repeat this essential point several times at the risk of offending the reader because it is the very essence of the new medicine that the problems of the 21st century call for.
Fifth, and this is of critical importance for the general reader, a self-help approach to health requires guidance from a knowledgeable professional. Safety first. This is the first principle of molecular medicine as it must be for all other types of medicine.
Majid Ali M.D.