By Michael Ash BSc, DO, ND, DipION
Barbara (name changed) a 55-year-old married mother presented at my practice as a new patient in the middle of a busy day. She explained she was visiting Devon on holiday and the owners of the Caravan Park where she was staying had recommended she attend my practice for advice on a joint problem she had.
She and her husband described how her right hand first finger and back of her hand was hot and painful, with reduced mobility and strength. It would keep her awake at night and over the last few years had been a constant source of irritation and pain.
Her visits to the GP whilst supportive had to date been unsuccessful and the consultants she had been referred to have offered painkillers and anti inflammatory but had been unable to resolve the complaint.
Apart from this affected joint the other joints in her body were without complaint and she was physically active. On questioning I discovered her condition had developed after a hysterectomy, a few years earlier and which as a result of complications an intensive course of antibiotics had been undertaken. Barbara also had a history of irritable bowel syndrome, which had become more pronounced and frequent since the operation. IBS can be a profoundly disturbing condition in which the individual’s life is dictated by the state of their bowels. Natural practitioners recognise that the bowel disruption will normally have a mixed aetiology including stress, poor nutritional status, change in gut ecology and difficulty in handling internally and externally produced toxins. Treating the person as well as the gut is of vital importance in achieving the best outcome.
I explained that the gut has the majority of the immune system attached to it and that within the gut a world exists in which a balance of bacteria has to reside in harmony to break down our food and support our immune function. The gut wall is about the thickness of an eyelid and has to act as both an excluder and permeable barrier to our food. At times the ecological environment can change and the integrity of the gut wall may be compromised allowing small components of food or bacteria or other agents to cross into our blood stream. These provoke an immune response and occasionally some molecular mimicry.
This means that some part of your body may have proteins very similar in make up to those crossing the gut wall and the immune system may attack your own body mistaking it for the external invader, causing an inflammatory response. In effect a leaky gut may allow an immune response that selects a specific joint or organ and causes an inflammatory response. This theory has been postulated as a trigger for rheumatoid arthritis, a systemic autoimmune illness.
I recommended Barbara undertake a programme to restore what I suspected was an imbalance in friendly bacteria and take some specific nutrients to repair the gut wall. In addition I recommended some antioxidants as they are required in the neutralisation of immune activation and support detoxification, which reduces the total burden on the body. The gut wall is able to repair itself quite quickly given the correct nutrients; the ones I used included the following.
To re seed the gut area I included the use of live bacterial supplements (probiotics). Various species, of Lactobacillus and Bifidobacteria are the major organisms involved. Several factors are used to determine whether or not a particular species, subspecies, or strain is suitable as a probiotic: Firstly, the bacteria must maintain its viability under normal conditions of storage for a reasonable amount of time. Secondly, the organism must survive the passage through the acid environment of the stomach, and should stay viable in the presence of intestinal bile acids.
It should also become readily incorporated into the “anaerobic paste”, the thin layer of mucous covering the intestinal cells, and it should become adherent to the intestinal mucosa colonising and remaining there. It should ferment a wide range of carbohydrates. It should produce only l-lactic acid (nor both the d and l isomers) as its major by-product. Finally, it should have an accumulating record of scientifically verified physiological benefits.
This far, a few species have come at the top of their class for providing most or all of these benefits. These include the NCFM-2 strain of Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus rhamnosus and Lactobacillus GG.
To feed the gut wall and facilitate repair I included a spectrum of nutrients in a powder which included L-glutamine is an amino acid, which is the primary source of energy for intestinal mucosal cells. L-glutamine has been shown to be highly effective in helping to restore normal mucosal integrity in patients with increased intestinal permeability or a “leaky gut”. Slippery elm is a soothing herb that ferments in the intestinal area and releases short chain fatty acids such as acetate and butyrate. It also nourishes the villi improving integrity and barrier function. The vitamins ascorbic acid (Vit C), pantothenic acid (B5), vitamin E, and vitamin A/beta carotene all play a significant role in the repair of damage GI mucosa.
N-acetyl glucosamine is a vital component of connective tissue and stimulates the growth of friendly whilst inhibiting unfriendly bacteria. The sulphur amino acids N-acetylcysteine, cysteine and the tripeptide glutathione are critical nutrients, which support detoxification of xenobiotics within the intestinal mucosa and liver and contribute significantly to gut mucosal repair in state of toxic stress. Epithelial growth factor contains agents that assist gastric healing and links with glutamine to maintain structural integrity.
Ensuring an adequate supply of essential fatty acids is also important in the repair of damaged gut mucosa. EFAs also assist in the absorption of minerals and in the function of the immune system.
The body’s liver is a very complex and essential component of maintaining immunity and detoxification. It uses two essential types of enzymes to render chemicals harmless and excrete them through the urine. Both types are dependent on nutrients, and these are grouped together as anti oxidants. These are used in conjunction with antioxidant enzymes to help quench free radical production. Antioxidants impede free radical damage to cells and tissues, providing a metabolic cooling and lubrication system. Anti oxidants is the body’s natural anti toxins and are crucial to homeostasis. A variety of stressful environmental, genetic and behavioural factors have been linked to increased free radical production in the tissues. I included a nutrient source of Vitamins C, E, B vitamins, zinc, selenium, copper, manganese, glutathione, Co Q10, lipoic acid, L-methionine, L-Taurine, Ginkgo biloba, trimethylglycine, and proanthocyanidins. To support Barbara’s immune function and to help diminish free radical mediated inflammation.
The overall quality of the diet, including calories, macro and micronutrient composition, and adequacy of phytonutrient antioxidants is vital in the repair of damaged GI mucosa. At this stage I also excluded from her diet coffee, and alcohol as these require additional enzyme activity in the liver to be broken down and I wanted to rest this area.
Barbara contacted me by phone and mail a couple of weeks later to say that the pain in her hand had gone and that her stomach irritability had also reduced. Quite naturally we were both very pleased with the speed of response, as 4-6 weeks is a more realistic time span.
I am pleased to say that 4 months on Barbara is still free of pain and is enjoying a settled and relaxed digestive tract as well.
Although in this case I did not conduct tests to determine the viability of Barbara’s gut wall or examine the GI environment the outcome based programme proved to be very helpful, and I am confident that this problem should now be fully resolved. Many digestive problems link with other complaints in the body, assessing the functionality and health of the gut is often the first area of interest for the nutritionally orientated clinician. In addition the liver, as the organ principally responsible for detoxification, needs to be considered either as a direct area for treatment or as an adjunct to other strategies.
Nutrition is not an answer to all health problems; however there are rarely areas of health discord that will not respond to some improvement in an individual’s nutritional status, and this is an area in which the holistically orientated practitioner who has trained in nutrition has a distinct advantage over the traditional medic. The concept of a balanced diet being all you need to meet your daily needs is unfortunately inadequate as a practical solution when confronted with a unique individual who needs help.
[boxibt style=”success”]About the Author
Michael Ash BSc, DO, ND, DipION has been in full time private practice since 1982 and currently directs and owns an integrated medicine practice in Devon, where orthodox medicine and complementary medicine practitioners work together to achieve the best for their patients. Originally trained as an Osteopath and Naturopath he has spent the last 10 years pursuing post graduate education in clinical nutrition in the United States and now lectures to practitioners from all disciplines in the UK on how to use nutrition and nutraceuticals to change people’s health for the better. In addition to maintaining a large patient base he regularly writes and broadcasts on health and natural medicine. His philosophy of mixing the best of both styles of medicine with the focus on the patient as an individual keeps him at the forefront of natural medicine in the UK
Phone: 01626 205400