There is no doubt that the most important treatment for Celiac Disease and Grain Sensitivity is a gluten-free diet. However, in most cases it takes more than the avoidance of gluten for optimal health to be achieved. There are several Naturopathic treatments available to help restore the health of people with Celiac Disease and Grain Sensitivity. In this week's column we will focus on Intravenous Nutrient Infusions.

Intravenous Nutrient Infusions can be a very important part of treatment for people with compromised digestive systems. This is because, for these people, nutrients from oral supplementation and diet are typically absorbed very poorly into the body. By using the intravenous administration we avoid the compromised digestive system and ensure complete absorption.

Intravenous Nutrient Infusions are not intended to replace optimal nutrition and supplementation. However, they are intended to replenish the body's nutrient status and repair damaged tissue in a relatively rapid manner.

There are 5 main advantages to intravenous nutrient infusions for people with compromised digestion. First of all, the nutrients administered in the IV are 100% absorbed into the bloodstream. This gives the body the best chance to get these nutrients to all the cells of the body. This is extremely important for the damaged and inflamed cells of the intestines as they immediately become infused with the nutrients. This stimulates repair faster and more efficiently than oral supplementation.

Secondly, the dosage administered in the IV can be much higher and more potent than the oral route. For vitamin C, magnesium, and several B vitamins to have a therapeutic effect they must be given in relatively high doses. The high doses can not be achieved in oral supplementation because of the side effects like diarrhea and digestive upset. However, these therapeutic doses can be achieved in the intravenous infusions without adverse effects.

Thirdly, when vitamins, minerals, amino acids, homeopathics and other nutrients are administered intravenously they do not go through the liver before going to the other cells of the body. This is very important because it means the nutrients are not altered. When nutrients are administered orally they must pass through and get processed in the liver before they make to any other cell in the body. This can add burden to the liver and reduce the potency of the nutrients given.

Fourthly, specific nutrients like glutathione, alpha lipoic acid, and homeopathic medicines can be used in combination with the basic vitamins and minerals to support multiple parts of the body in one treatment. There are hundreds of intravenous nutrient infusion formulas that can be used to treat very specific disease processes in the body and support recovery. Intravenous Infusions are not a one size fits all approach.

Lastly, we find Intravenous Nutrient Infusions to be very cost effective over the long run. For people with compromised digestive systems like in Celiac Disease there can be a great deal of time, energy, and money wasted on oral supplements that are not absorbed effectively. A lot of time, energy, and money is also spent on other therapies that are not nearly as effective as Intravenous Infusions. IV therapies can help rapidly repair the digestive system and other tissues of the body so that there is less need for intense oral supplementation and other treatments.

In the next column we will investigate the use of Neural Therapy for the treatment of Celiac Disease and Grain Sensitivity.

Food poisoning bacteria E. coli and Salmonella certainly inflict misery and, in weakened persons, can be deadly. Fortunately, after the nausea and diarrhea run their course, they are not heard from again unless we eat something contaminated.

H. pylori (Helicobacter pylori) also affects the stomach but is more deadly and long-lasting. It can lead to ulcers that claim 9,000 Americans yearly and stomach cancer that kills 11,000. H. pylori is not in the news despite being the world's most common bacterial infection—it stays under the radar because it acts slowly.

You might suspect an H. pylori infection if you have one or more of these issues: heartburn, stinky breath (without a serious gum problem), bloating, stomach pain, or nausea or vomiting an hour or so after a meal. It also interferes with our stomach acid; so you should be concerned if you also have symptoms of stomach acid deficiency listed in my book. (Osteoporosis is one example.) H. pylori is also believed to be involved in migraine headaches, rosacea, one type of arthritis, anemia, B12 deficiency, glaucoma, heart disease, atrial fibrillation, asthma, and morning sickness.

In spite of all those potential clues, doctors do not usually test for H. pylori unless the patient has a raging ulcer. It is too typical in our medical system to just treat each symptom individually with a prescription drug. Third-party payers don't reimburse physicians for the time needed to analyze history and test for an underlying cause, and waiting for the system to change probably isn't a viable option. There is much we can do ourselves though, and prevention is always better than the most enlightened treatment.

H. pylori prevention raises two obvious questions: why don't all people who are exposed become infected? And why do only one in six who harbor H. pylori come down with a diagnosable stomach disease? We know that H. pylori bacteria are transmitted through tainted food or water, so improved sanitation reduces exposure. However, its ability to infect and cause trouble depends largely on the condition of the potential host (that's us).

For example, two-thirds of stomach cancer cases occur in people over age 65. That is when our bodies begin to exhibit the accumulated insults of smoking, alcohol excess, unsatisfactory diet, stress, toxic buildup, and medication usage. (Note that alcohol excess is an H. pylori risk, but moderate alcohol is actually protective—apparently it sterilizes the stomach.) Those who eat the most smoked and highly salted foods, but few fruits and vegetables, are also at higher risk to stomach cancer.

A key protector against H. pylori is sufficient stomach acid. Stomach acid is our first line of defense against invaders but typically declines after age 50. That's coincidentally when the risk of H. pylori infection goes up. Acid-blocking drugs like Nexium and Prilosec purposely deplete stomach acid. Not surprisingly, folks who regularly take that type of drug are at much greater risk for dying of pneumonia! A second line of defense is our beneficial bacteria called probiotics. These good guys compete with the bad guys for space and food and they attack pathogens with natural anti-bacterial chemicals.

Individuals who have healthy gastrointestinal mucous membranes do not become infected with H. pylori, or at least do not develop symptoms. To maintain that important barrier we must not only eat food rich in tissue-repair nutrients, we must also be able to digest and absorb those nutrients. Aiding proper digestion is another key role of friendly bacteria.

In fact, probiotics benefit almost every function in the body directly or indirectly. Our very life depends on the several pounds of good bugs that should live in our gut. They create vitamins (A, B1, B2, B3, B6, B12, K and Biotin); feed the gut lining; help digest food; detoxify dangerous substances; help remove hormone excess; help maintain healthy cholesterol and triglyceride levels; increase the number of immune cells; help cells reproduce normally; reduce inflammation and stimulate cell repair mechanisms. Knowing those fundamental functions, you can imagine the health trouble and potential for infection that ensues if the probiotics become weakened. There is one beneficial bacterial strain, TH10, which has been shown in the laboratory to be especially effective against H. pylori. TH10 is only contained in the probiotic system, Dr. Ohhira's Probiotics.

If you are suspicious that you may have an H. pylori infection, your doctor can use a diagnostic breath test. That type is more meaningful than a blood test, which doesn't indicate if the bug is still active. The standard medical treatment for H. pylori involves strong antibiotics. This is ironic since the general overuse of antibiotics has allowed H. pylori to develop into more resistant strains. The antibiotics also kill our probiotics—a side effect that can produce broad and lasting damage.

If a person is not in grave condition, it makes sense to me that he or she would first try the natural remedies listed below. If antibiotics are necessary, the natural remedies can still be added for their own benefits. At the very least, folks should protect themselves from the unwanted effects of the antibiotics by using probiotics. Probiotic supplements should be taken throughout the course of antibiotics (and after), but taken at a different time of day.

Other natural substances that help fight H. pylori are sulforaphane (found in cruciferous vegetables such as cauliflower, cabbage, kale, and broccoli), turmeric (the familiar yellow spice), mastic gum (a Mediterranean food ingredient from tree resin), ginger, cranberry, vitamin C, berberine (an herb constituent), DGL (a special form of licorice), and zinc carnosine (which also helps heal the GI membranes). Keep in mind the same items used as remedies can also be used for prevention.

More details about H. pylori diagnosis and current medical treatment options can be found on the Helicobacter Foundation website (www.helico.com).

As pointed out in past TotalHealth articles, many fungi and bacteria found in foods are beneficial to health. Whether one is discussing breads, cheeses, fermented tofu, wines, yoghurt, sauerkraut, kimchi or a number of other items, very often it turns out that traditional cooking and preserving techniques involving fungi and bacteria offer many benefits that are lost with modern alternatives.

This having been said, a major benefit of modern food science is the ability to supply beneficial bacteria in concentrated forms. The following discussion is intended to answer questions regarding the class of dietary supplements referred to as probiotics. Readers who wonder why some products have single strains and others offer many, why there often are numbers or other designations after Latin names of the bacteria, what benefits might be expected and how soon, etc., should read on. The species and strains mentioned happen to be ones with which the author is most familiar.

Do different probiotic strains affect the body in different ways? Do people benefit from having more of one strain than another?

The human gut consists of a series of microenvironments. Except for the stomach and the upper two thirds of the small intestine, there are differing bacteria and ratios of bacteria in each of these areas, starting with the mouth. In fact, the human gastrointestinal tract contains a large and diverse population of microorganisms—over 800 different bacterial species comprising nearly 100 trillion living organisms. The composition of this gut flora varies among individuals depending on diet, age, medication (antibiotics), stress, and physiological conditions. Not surprisingly, different probiotics perform different functions and offer different benefits. One big divide, of course, is between the two most important groups of typical probiotic bacterial species, Lactobacilli, found mostly in the lower small intestine and upper large intestine, and Bifidobacteria, found mostly in the large intestine, i.e., the areas of lower pH (meaning more acidic).

Broadly speaking, the Lactobacilli act on sugars and starches to create lactic acid, among other things. For instance, L. acidophilus La-14 (La-14 indicates the strain within the particular species) assists in breaking down lactose (milk sugar) and 15 other carbohydrates and this may improve digestion of dairy products by those individuals who are lactose intolerant. Clinical trials have shown that this strain may improve immune response and bowel regularity. It works especially well in conjunction with another bacteria strain, L. rhamnosus R0011. Interestingly, L. rhamnosus R0011 in conjunction with L. helveticus R0052 in humans enhances the eradication of H. pylori (a cause of stomach ulcers) when ingested in combination with conventional medical treatment.

Bifidobacteria, especially such as B. longum BB536 (Morinaga strain), have been shown to colonize the intestine, stimulate immune response, and promote the growth of other beneficial bacteria. BB536 also decreased the incidence of influenza in seniors in trials. Blood analysis showed significantly higher bactericidal activity of neutrophils and higher NK cell activity at the fifth week of administration compared to pre-administration. There has also been evidence reported that suggests BB536 can help modulate allergies and possess antiallergenic effects. Even more recent research is looking at the benefits of this strain in the areas of brain inflammation and dementia.

The finding that certain strains of probiotics reduce excessive inflammation by means of modulation of immune and other responses via the gut is one of the major advances in the knowledge of probiotics in recent years.

Inasmuch as different probiotic species and different strains of the same species often provide different and distinct benefits and also often interact to lead to yet other results, there are good reasons for supplementing with more than one strain and/or species (I refer loosely and not entirely scientifically to "species" here to distinguish also, for instance, Saccharomyces boulardii, which is not another bacterial strain, but instead a probiotic yeast). Similarly, different supplemental probiotics may be more to be desired at certain ages or under particular conditions. No single strain can easily fulfill all these requirements. A mixture of species, therefore, is usually most suitable for supplementation. The most desirable properties of a good probiotic are:

• Compatibility among the strains
• Ability to survive passage through the digestive tract
• Stability under normal gastric conditions
• Resistance to bile salts
• Adherence to intestinal mucosa
• Colonization of the human intestinal tract and/or extended residence time
• Safety with regard to human use
• Production of natural antimicrobial substances
• Antagonism against unfriendly and putrefactive bacteria
• Stability during storage under normal conditions

When purchasing a probiotic supplement, how many different strains should be in supplement and are all the strains in equal parts?

There is no one answer to this question. The probiotic yeast, Saccharomyces boulardii, typically is supplemented by itself before, during and immediately after antibiotic treatment, but otherwise may be supplemented in general with a mixture with bacterial probiotics. As a rule, it is best to supplement at least the two primary species of probiotics, Lactobacilli, found mostly in the lower small intestine and upper large intestine, and Bifidobacteria, found mostly in the large intestine. Three to eight species and/or strains is a common number. Keep in mind that these species and strains must be compatible both in the delivery format and after administered.

What fibers are effective prebiotics?

Let's start by defining the role of prebiotics. According to researchers in the field, "Prebiotics are supplements or foods that contain a nondigestible food ingredient that selectively stimulates the favorable growth and/or activity of indigenous probiotic bacteria. Human milk contains substantial quantities of prebiotics." 1 Some researched prebiotic fibers include trans-galactooligosaccharide, oligofructose, inulin, larch arabinogalactin, resistant starch, pectin, beta-glucans, xylooligosaccharides, and oligofructose-enriched inulin. Recently, scientists have begun to recognize that a number of polyphenols have prebiotic properties, although there as yet is no consensus as to the amounts required for benefits. For instance, proanthocyanidins and other compounds found in grape seed and red wine can positively affect gut microbial health, as can related compounds found in dark/minimally processed chocolate and in cranberries. This is an emerging area of knowledge.

What is the importance of pH in digestive health and how can dietary supplements support a balanced pH?

The degree of acidity or alkalinity of a given region of the gut can be given as its pH. The stomach should have a very low pH (relatively acidic) prior to meals, e.g., a pH of 2 or below, because this is needed to digest proteins and to provide a protective barrier against bacterial invasion of the rest of the gastrointestinal tract. A low pH in the stomach also is required to maintain the tonus of the esophageal sphincter to avoid "heartburn" and other gastrointestinal reflux conditions. The upper small intestine may approach a neutral pH of 6 and slightly above after pancreatic digestive fluids are mixed into foods coming from the stomach; this higher pH is required for the digestion of fats and for the actions of pancreatic enzymes. As foods proceed through the small intestine, the pH should slowly decrease as a result of bacterial action producing lactic and other acids. Short-chain fatty acids produced in the intestines exert a number of health effects. The return to a lower pH in the large intestine is required to produce peristalsis to maintain the proper passage of food through the bowel.

Hydrochloric acid precursor supplements can be taken to improve the production of gastric acid in the stomach. Betain HCl commonly is used for this purpose.

How do enzymes, herbs and botanicals affect acute symptoms like heartburn, indigestion, nausea or diarrhea?

Herbs can help for a variety of reasons. Chamomile is famous for calming properties and typically is taken as an antispasmodic and anti-inflammatory. Peppermint, especially the oil delivered by enteric soft gelatin capsules, is another item for calming the GI-tract. Type "peppermint irritable bowel" into PubMed and there will be 60 or more hits. Again, it is an antispasmodic. Ginger is widely touted—and human trials confirm this—as being good for several forms of nausea. Readers of past TotalHealth articles may recall that the Asian herb/food known as bitter melon, especially in its wild forms, improves various aspects of gastrointestinal health. (Bitter melon is best consumed with small amounts of "warming" herbs such as ginger or turmeric.)

A review published in 2012 concluded, "Amongst the most important we can find [with digestion-enhancing properties] [are] ginger, peppermint, aniseed and fennel, citrus fruits, dandelion and artichoke, melissa and chamomile, but many more have a significant body of experimental data available."²

Pancreatin, which includes trypsin, amylase and lipase, is specifically produced by the body to digest proteins, carbohydrates and fats under the relatively neutral pH conditions found in the stomach at the end of acid digestion and, primarily, in the small intestine. What most people do not realize is that the body tends to conserve digestive enzymes. Long-term use of digestive enzymes can help increase the body's own reserves of these enzymes for better digestion.

Although enzymes can help acutely with indigestion, this may not be the best way of conceptualizing their benefits. Retailers should try to find ways to highlight the contrast between treating the symptoms of poor digestion and actually improving digestion. For instance, as a practical matter, no one has too much acid in the stomach, so quite obviously taking proton pump inhibitors makes worse an underlying condition—too little gastric acid. Blocking acid release may make gastroesophageal reflux disease (GERD) temporarily less painful, but it does not address why GERD exists.

How does "cleansing" support digestive health? What is a safe and effective cleanse?

It is important to distinguish between detoxification and cleansing approaches. Detoxification programs typically focus on the liver and involve the endogenous Phase I and Phase II detoxification systems. Cleansing programs, in contrast, focus on the large intestine and are based on theories of autointoxication from partially digested foods, especially meat and other animal foods, leading to the build-up of mucus and other wastes in the intestines with the absorption of these toxins into the blood.

There is a grain of truth to cleansing theories. A considerable part of the toxins and waste products of the body, such as spent hormones, are eliminated through the bile and thus via the stool. Likewise, it certainly is true that a lack of fiber in the diet and dysbiosis in the gut can lead to toxins being reabsorbed multiple times before being fully excreted from the body. These two pieces fit together because in its detoxification processes, the body binds toxins in a variety of ways, two of which are glucuronidation and sulfation, and then disposes of the toxins via the bile. Without adequate fiber, including fiber that can support the growth of friendly bacteria in the gut, toxins disposed via the bile can be reabsorbed many times before eventually being eliminated from the body. Similarly, without the proper fiber, toxins can influence the health of the cells lining the large intestine. Especially important in this light are synbiotics, meaning combinations of prebiotics (such as fiber) and probiotics that work well together to deliver greater health benefits.

Nevertheless, many of the claims of cleansing programs seem suspect. For instance, the large intestine turns over the cells that make up the intestinal lumen roughly every three days, so claims of a build-up of impacted fecal matter (as opposed to constipation, something entirely different) do not match the evidence.

What can a cleansing program accomplish? First, it can mark a transition to a new general diet. Consuming more fiber (soluble, semisoluble and insoluble) is well established to improve constipation, diverticulosis, some forms of irritable bowel, and to protect against colorectal cancer. How much is needed? Most estimates are 20–35 grams per day rather than the usual American consumption of only 10–15 grams per day. Some health writers suggest consuming herbal gums such as frankincense, myrrh and mastic gum during this period.

Second, dysbiosis is a real issue and a turnover in the make-up of the stool through the addition of fiber and probiotics—a synbiotic approach—can help to change the intestinal milieu. Again, constipation, diverticular disease and forms of inflammatory and irritable bowel can be improved by this combination approach.

The best reason to undertake a cleanse is to transition to a diet higher in vegetables, whole grains, legumes and fiber-rich foods in general. This also should help the system move to a different make-up of intestinal bacteria. A very simple way to accomplish this is to add approximately 10 grams of good quality fiber to each meal and, assuming that one does not have a blocked bile duct, to take supplements that increase the release of bile. These include gentian, artichoke leaf, chicory root, dandelion root and yellow dock. At the same time, a good probiotic should be started to positively influence the composition of the bacteria found in the gut. The first few days of such a cleanse may be a bit uncomfortable and be characterized by unusual gas and bloating, but by the end of one or two weeks things should stabilize. Higher fiber intake from whole fruit (not juice), vegetables, legumes and whole grains should continue.

HOW MANY BACTERIA IS ENOUGH AND HOW MANY IS TOO MUCH?
Too often the impression is that if one or two billion colony forming units (CFU) of a probiotic species is good, then 50 or 100 billion must be better. Research and real life experience do not always agree with this! There is a strong argument to be made that approximately two billion CFU of any given strain is quite enough for everyday usage if the species and its strain is, in fact, appropriate for the intended purpose. Formulas containing multiple species and multiple strains might supply CFU in the range of 10–15 billion using this reasoning.

Lactobacillus acidophilus is generally considered safe for most people. Gas, upset stomach, and diarrhea are potential side effects in some people (not on antibiotic therapy) who take more than 1 to 2 billion L. acidophilus CFUs daily.³

Supplement shoppers examining probiotic products need to keep in mind that there are many more types of desirable organisms in the gastrointestinal tract than merely Bifidobacilli and Lactobacilli. For instance, according to Tim Spector, professor of genetic epidemiology at Kings College London and director of the British Gut Microbiome project, a "healthy gut is like a perfect English garden. You've got a diversity of microbes of all types, all living together and feeding off each other's by products—nothing is wasted."⁴

Overloading the GI-tract with huge numbers of probiotic bacteria can crowd out the diversity of bacteria that should be found in the gut. The result can be so-called "cleansing" episodes of either or both diarrhea and constipation. Moreover, excess supplementation or supplementation with probiotic strains that do not match a person's constitution, rather than addressing the issues of gas and bloating, actually can increase these. If a probiotic supplement program still continues to cause gas and bloating after two weeks, a different source of probiotics may be found to be more appropriate.

Finally, do not overlook the fact that actual food sources of probiotics often are the best sources. This means real cheeses with live cultures, live yoghurt, real rather than artificially soured sauerkraut, traditionally prepared kimchi and other Asian soured vegetables, traditionally prepared and preserved pickles (all of these will be in the refrigeration section of the store), live sour creams and sour milks, naturally yeast-leavened breads made the traditional way, and so forth and so on. Among other benefits, these foods not only often are more nutritious, but also simply generally taste better.

1. Pediatrics. 2010 Dec;126(6):1217–31.)
2. Int J Food Sci Nutr. 2012 Mar;63 Suppl 1:82–9.)
3. http://umm.edu/health/medical/altmedsupplement/lactobacillus-acidophilus
4. http://www.foodmanufacture.co.uk/Ingredients/Gut-health-governs-obesity-immune-response-and-moods

It looks like we're not the only ones who like the new line of Probium probiotics. In 2014, the 3rd Annual SupplySide CPG Editor's Choice Awards have announced Probium Probiotics Pro-Cran Blend 6B as a finalist with the winners to be announced Oct 6th at SupplySide in Las Vegas.

Not having spoken with the SupplySide Editors I can only guess why they have chosen Probium Probiotics Pro-Cran Blend 6B as a finalist. D-mannose, an ingredient in Probium products, won the Better Nutrition 2010 award for Best of Supplements.

Probium Probiotics Pro-Cran Blend 6B is a terrific supplement for women. With the combination of the timed-release capsule, very high quality of probiotics, D-Mannose and Cranberry extracts you will love the benefits it offers your gut health, digestive system, immune system and urinary tract health.

Key points:

• Contains 6 Billion CFU per Serving of a Proprietary Blend of Lactobacillus acidophilus La14, Bifidobacterium lactis Bl-04, Bifidobacterium bifidum Bb-06 and Bifidobacterium longum Bl-05 along with a Proprietary Blend of Cranberry Fruit Extract, Sunfiber®, FOS and D-Mannose which contains the Equivalent of 752mg of Fresh Cranberry Fruit per Serving
• Other Ingredients - Sunfiber® (Partially Hydrolyzed Guar Gum), Fructooligosaccharides (FOS), Vegetable Powder, Silicon Dioxide and Vegetable Cellulose (Delayed Release Capsules)
• 6 Billion Active Microflora per Serving (1 Veggie Capsule)
• Two Year Shelf Life at Room Temperature
• No Wheat, No Eggs, No Yeast, No Soy, No Sugar, No Salt, No Animal Derivatives, No Maltodextrin, No Magnesium Stearate, No Artificial Flavors or Preservatives
• Gluten Free, Non-Dairy, and Non-GMO
• Kosher Certified
• Made in Wausau, Wisconsin, USA
• Digestive Health**

Suggested Use

As a dietary supplement, take 1 capsule per day, preferably in the morning on an empty stomach or as directed by a healthcare professional.

Much evidence suggests that gastrointestinal tract problems are on the rise in the modern world with significant health consequences that extend well beyond the gut itself. For instance, autism is increasing, especially in male children, and researchers at MIT and elsewhere point to the GI-tract and disturbances caused by glyphosate and other chemicals used in industrial agriculture as among the causes. Food processing with its emulsifiers and storage techniques likewise may play a role in the upsurge in the prevalence of various inflammatory bowel conditions. Modern over-nutrition and other dietary habits, such as over-consumption of refined carbohydrates and under consumption of omega-3 fatty acids are yet other factors implicated. Researchers trying to uncover patterns underlying contemporary GI-tract issues have been attempting to fit the various known and suspected causes into manageable conceptual models. Recent work suggests that a three-part model involving gut bacteria, gut barrier function ("leaky gut") and inflammation may help with prevention and therapy.¹ The components of the model have emerged from studies of inflammatory bowel disease (IBD, including Crohn's Disease and ulcerative colitis), yet they clearly have application to more ordinary and quite common forms of bowel irritation and discomfort.

Irritable bowel syndrome (IBS) is a catch-all for common bowel conditions. It currently affects 10–20 percent of the adult population in developed countries. To be sure, the causes of IBS have not been definitively identified and can vary among individuals (food allergies, over-reactive immune system, stress, hormone imbalance, etc.). Symptoms include abdominal pain, flatulence, bloating, change in bowel habits, diarrhea, constipation (or a combination of both), and these often interfere with daily activities and affect the quality of life of the sufferers. Available medications exhibit only limited efficacy and fail to relieve all IBS symptoms over the long term.

Current science no longer views the gastrointestinal system as a simple digestive and disposal apparatus. It is estimated that sixty percent or more of all the macrophages, the first line immune cells of the body, line the GI-tract. Specialized cells in the gut constantly sample its contents in active surveillance for external threats. Microbes in the small and, especially, the large intestine perform a multitude of functions, including aspects of nutrition, such as synthesizing some vitamins and making minerals and other nutrients more available. The intestinal wall controls not only the passage of nutrients and the disposal of bodily wastes, but also regulates immune interaction with the contents of the intestines. GI-tract disturbances can involve any one of the major aspects of gut health or combinations of these. Hence, gut complaints can involve disturbed intestinal microbiome (dysbiosis), disrupted barrier function (leaky gut) and/or improper immune system activation (inflammation).

The Inhabitants of the Gastrointestinal Tract
The microbes present within the body collectively are termed the microbiota. The genomic content (the complete set of genes in the microbiota) is termed the microbiome. Both genetic and environmental factors shape the microbiome. Important early factors are natural birth versus cesarean section, breast-feeding versus formula feeding, and so forth. In adults, dietary habits are highly significant. Vegetarians and meat eaters differ in the make-up of the bacteria in the gut. The amounts and types of fiber in the diet, the amounts and types of carbohydrates and fats, under-nutrition and over-nutrition all matter. So do the level of hygiene and exposure to infections, antibiotics and other drugs.

The human gut consists of a series of micro-environments. Except for the stomach and the upper two thirds of the small intestine, there are differing bacteria and ratios of bacteria in each of these areas, starting with the mouth. In fact, the human gastrointestinal tract contains a large and diverse population of microorganisms — over 800 different bacterial species comprising nearly 100 trillion living organisms. The composition of this gut flora varies among individuals depending on diet, age, medication (antibiotics), stress, and physiological conditions. Not surprisingly, different probiotics perform different functions and offer different benefits. One big divide, of course, is between the two most important groups of probiotic bacteria, Lactobacilli, found mostly in the lower small intestine and upper large intestine, and Bifidobacteria, found mostly in the large intestine, i.e., the areas of lower pH.

For clarity's sake, keep in mind that scientists use a standard genus, species, strain taxonomy in describing bacteria. An example is the probiotic bacterium, Lactobacillus rhamnosus R0011. The genus is Lactobacillus, the species is rhamnosus and the strain is R0011. Dietary supplements properly list all three components of the name because strains even of the same species can exhibit divergent effects in the body.

Broadly speaking, the Lactobacilli act on sugars and starches to create lactic acid, among other things. For instance, L. acidophilus La-14 assists in breaking down lactose (milk sugar) and 15 other carbohydrates and this may improve digestion of dairy products by those individuals who are lactose intolerant. Clinical trials have shown that this strain may improve immune response and bowel regularity. It works especially well in conjunction with another bacteria strain, L. rhamnosus R0011. Interestingly, L. rhamnosus R0011 in conjunction with L. helveticus R0052 in humans enhances the eradication of H. pylori (a cause of stomach ulcers) in combination with conventional medical treatment.

Bifidobacteria, such as B. longum BB536, have been shown to colonize the intestine, stimulate immune response, and promote the growth of other beneficial bacteria. BB536 also decreased the incidence of influenza in seniors. Blood analysis showed significantly higher bactericidal activity of neutrophils and higher NK cell activity at the fifth week of administration compared to pre-administration. There has also been evidence reported that suggests BB536 can help modulate allergies and possess antiallergenic effects. Other bifidobacteria provide their own ranges of benefits.

Increases in certain bacteria and decreases in others— both in absolute numbers and the varieties present—are observed in disturbed gut function. Typically, the more severe the dysfunction, the greater the divergences from normal microbiota. It is unclear to what extent these specific changes are the driving forces for inflammatory and related immune processes and to what extent they reflect the condition, although feedback is highly likely. The finding that certain strains of probiotics reduce excessive inflammation by means of modulation of immune and other responses via the gut is one of the major advances in the knowledge of probiotics in recent years.

Inasmuch as different probiotic species and different strains of the same species often provide different and distinct benefits and also often interact to lead to yet other results, there are good reasons for supplementing with more than one strain and/or species. Similarly, different probiotics may be more to be desired at certain ages or under particular conditions. No single strain can easily fulfill all these requirements. A mixture of species, therefore, is usually most suitable for supplementation.

Mucosal Barrier Function & The Leaky Gut Syndrome
The mucosal barrier of the gut performs many functions, one of which is to separate the contents of the gut from immediate contact with the gut wall and direct access to the body's immune system. Ideally, the contents of the intestines are sampled routinely by specialized cells located in Peyer's patches along the far end of small intestine. Allopathic medicine does not recognize leaky gut syndrome as a distinct condition, yet in IBD it has been demonstrated that the contents of the intestine do, in fact, have direct access to the surface of the intestinal wall and perhaps beyond. Mucus barrier changes may be as much the result of unwanted bacteria (dysbiosis) as a cause. It is possible for substances even to leak into the bloodstream due to defects in the tight junctions that normally characterized the
intestinal wall. Leaky gut can be described as intestinal permeability or intestinal hyperpermeability.

There is little doubt but that leaky gut syndrome involves chronic inflammation. However, controversy arises as to whether this inflammation is a cause or a consequence. Likewise, is the inflammation local or does it prime further inflammation throughout the body leading to or aggravating a host of other conditions, such as allergies?

In IBD, toxemia, meaning the passage of toxins into the blood, is well documented, as are immune system irregularities. The extent of leaky gut in less active and less severe bowel conditions is debated hotly. Nevertheless, indications of intestinal barrier dysfunction and dysbiosis, such as inappropriate immune activation, abdominal pain, flatulence, etc., strongly suggest that leaky gut is, in fact, an aspect of IBS and other less well defined GI-tract issues.

As noted already, available medications have only limited efficacy and fail to relieve IBS symptoms over the long term. Fortunately, there are a number of natural supplements that are documented to help prevent and/or relieve symptoms associated with IBS. For instance, fiber can help with the toxemia issues as well as promote normal intestinal flora. Research has shown that soluble fiber, such as psyllium, can be fermented in the gut and the metabolites may decrease transit time and pressure. Some fibers can increase water retention, thereby increasing the stool mass and, again, reducing transit time. Fiber supplementation in IBS patients promotes significant improvements in constipation and general IBS symptoms.

Similarly, clinical studies have shown the benefits of Lactobacillus and Bifidobacteria species in the treatment of IBS or IBS-like symptoms. This is probably due to their abilities to reduce inflammation, visceral hypersensitivity, and stress responses. Studies have shown that some strains are effective in treating bloating and flatulence while others relieve gastrointestinal pain and irregularity. It has also been reported that effects can vary among individuals. Thus, one may want to try different strains and dosages or a blend of multiple strains and monitor the response.

Another useful supplement is the amino acid L-glutamine to support the health of the cells that make up the enterocytes in the gastrointestinal tract. It not only directly nourishes the mucosal lining of the intestine, but also helps repair it when it is damaged by hypersensitivity, physical stress, or an overreactive immune system. Lglutamine can stimulate the bowel to re-absorb the water from the stool, reducing the number and frequency of bowel movements.

Then there are the everuseful omega-3 fatty acids. Omega-3 fatty acids can replace omega-6 fatty acids in the cell membrane and prevent their harmful effects by reducing the secretion of unwanted prostaglandins and proinflammatory molecules. They also reduce production of platelet aggregators and vasoconstrictors while increasing the secretion of vasodilators and platelet aggregation inhibitors.

Other supplements that have shown the ability to promote improvements in tight junctions include curcumin, boswellia, bile acid supplements and butyric acid supplements.

Immune Function
Both the microbiota and the barrier function aspects of GI-tract health at various points tie into immune function. Therefore, it would seem to be clear that the overall regulation of the immune system necessarily plays a role in the control of immune-related inflammation in the gut. Diet is one of the most significant components involved in what should be a homeostatic system.

Omega-6 fatty acids account for the majority of polyunsaturated fatty acids found in Western diets. Omega-6 fatty acids can stimulate production of harmful prostaglandins and leukotrienes, as well as platelet aggregators and vasoconstrictors. Omega-3 fatty acids, on the other hand, compete with omega-6 fatty acids by replacing omega-6 fatty acids in the cell membranes and provide beneficial effects such as:

1. a reduction in harmful prostaglandin E2 (PGE2) metabolite production,
2. a decrease in thromboxane A2, a strong platelet aggregator and vasoconstrictor,
3. suppressed formation of leukotriene B4, a proinflammatory molecule that is also responsible for leukocyte chemotaxis and adherence, and
4. maintained or increased production of beneficial prostaglandins such as PGI2 and PGI3, protective vasodilators, and inhibitors of platelet aggregation.

In autoimmune diseases, such as inflammatory bowel disease, Crohn's disease, and ulcerative colitis, the major contributors to disease development are thought to be proinflammatory mediators that include omega-6 fatty acid, arachidonic acid metabolites, harmful prostaglandins, leukotrienes, and pro-inflammatory cytokines. It has been reported that people who are affected by these diseases have elevated levels of leukotriene B4 and other arachidonic acid metabolites. Interestingly, in clinical studies, omega-3 fatty acid or fish oil supplementation significantly decreased the production of leukotriene B4 and overall leukotrienes in these patients. Omega-3 fatty acid supplementation was also able to induce dramatic improvements in tissue histology, the rate of disease relapse, clinical activity, and steroid-sparing effect after treatment, although responses to supplementation varied among individuals reflecting that there are underlying differences as well as common factors in these diseases.

In all cases, the goal should be to normalize immune function. Scientists understand that the immune system can be overactive as well as underactive and that balance is the key. On the one hand, the immune systems needs vigilante macrophages, natural killer cells and other "soldiers" to be on alert to attack invading organisms before these can take hold in the body. For instance, the cold virus is most successfully combatted if the immune system can react and eliminate it before it has had a chance to multiply. On the other hand, rheumatoid arthritis and other autoimmune diseases in which the body attacks itself afflict millions of Americans. Immune overactivity causes unpleasant side effects, such as allergies and inflammation, and can lead to immune exhaustion and collapse. The answer, therefore, is to balance the body's immune system so that it is neither overactive nor underactive.

Much of this balance is maintained by subsets of helper T cells (Th). There is a ratio between the Th1 subset that is involved mainly in inflammation and the activation of white cells (phagocytes, NK cells, etc.) and the Th2 subset that activates specific B cells. The Th1 and Th2 cells may cross-inhibit function, which means that the more active the one set is, the less active the other set is. Most Americans initially have too much Th1 function and too little Th2. This is one reason that chronic inflammation is so very common in the US. However, the body cannot allow chronic high levels of inflammation, and therefore the immune system begins to shut down as a result. Stimulating more Th1 activity—leading to more inflammation—will never be more than a short term fix if inflammation is not controlled because the body will again attempt to turn off Th1 function in order to reduce the level of inflammation. Hence, there is a common pattern in which chronic immune activation aggravates allergies, IBS, even weight gain, yet at the same time a reduction in immune surveillance allows the development of cancer in later life.

Balancing the immune system is a bit harder than simply stimulating it. Fortunately, there are a few supplements that do this and more. One of the most extensively tested of these supplements is called Moducare®. Developed by Patrick Bouic, Ph.D., head of Immunology at the University of Stellenbosch in South Africa, Moducare® consists of a proprietary blend of phytonutrients called sterols and sterolins. The sterol family of compounds includes fatty substances such as betasitosterol found in saw palmetto. Sterolins are sterols with a glucose (sugar) molecule attached, something that greatly improves absorption into the body. Taken together, sterols and sterolins are more active than when supplemented as single pure substances.

A number of other immune regulators are available. Chamomile extracts (German chamomile) are useful as anti-inflammatories and calm some forms of allergies. Chamomile is particularly interesting because of its calming and immune-regulating effects complement its antioxidant benefits. Another significant immunomodulator is the flower pollen extract sold under names such as Cernitin™. Items already mentioned include turmeric extracts and boswellia extracts, to which can be added quercetin and a number of herbal extracts available as dietary supplements. None of these will be sufficient in the long run, however, without changes in the diet to improve the balance between omega-6 and omega-3 fatty acids or the inclusion of more fiber and consumption of more vegetables and whole fruit.

Some Conclusions
As noted at the outset, GI-tract disturbances can involve any one of the major aspects of gut health or combinations of these. Hence, gut complaints can involve disturbed intestinal microbiome (dysbiosis), disrupted barrier function (leaky gut) and/or improper immune system activation (inflammation). There are strong feedback loops linking these aspects of gut health and therefore solutions to gut issues typically are most successful if all three are addressed together. This means appropriate changes in diet, adoption of probiotic supplementation (either as supplements or via dietary sources), nutrition aimed specifically at improving the health of the cells lining the GI-tract and adopting strategies to reduce inflammation and balance the immune system.

References:

1. Vindigni SM, Zisman TL, Suskind DL, Damman CJ. The intestinal microbiome, barrier function, and immune system in inflammatory bowel disease: a tripartite pathophysiological circuit with implications for new therapeutic directions. Therap Adv Gastroenterol. 2016 Jul;9(4):606 –25.