Inflammation is the buzzword these days. Physicians now realise that inflammation in the walls of arteries is probably the most important risk factor in cardiovascular disease, more important even than cholesterol levels. Inflammation is common to many other chronic and debilitating diseases such as rheumatoid arthritis, osteo-arthritis, asthma, acne, eczema, psoriasis, sinusitis, hayfever, Crohn’s disease, ulcerative colitis, etc. In fact, most conditions that are often treated with cortisone fall into this category. Apart from being painful, itchy or disfiguring, inflammatory illness can provoke many vague symptoms that leave one feeling really unwell. In some people low-grade inflammation may even account for difficulty in losing weight.
The integrative approach to treating chronic disease is complex, and requires a multi-faceted approach by practitioners versed in integrative medicine. I believe that the source of inflammation in chronic diseases lies in the gut. The now famous quote ‘Death begins in the colon’ originated with the Russian Nobel Prize- winning biologist Elie Metchnikoff (1845 - 1916), who postulated that the toxic by-products of the bowel bacteria are responsible for many diseases.
The functions of the gut
Research and experience have now confirmed that the gut plays a vital role in chronic ill-health. As the interface between the external environment and the body proper, the intestine fulfils two opposing functions: to allow the absorption of nutrients, and to repel toxic substances.
Let’s explore the protective role that the gut plays in more detail.
There are five layers or barriers, which protect our internal environment from ingested toxins, organisms and allergens:
First layer – bacterial flora
Second layer – internal mucous coating of the intestine
Third layer – enterocytes, which are the lining cells
Fourth layer – lymphoid tissue in the walls of the intestines
Fifth layer – the liver.
The intestine also has non-specific defences, viz. the flow rate (30 minutes to travel 4 metres of small intestine) and desquamation (shedding) of enterocytes (60 million a day). Thus a slow flow rate in constipation allows for greater absorption of harmful substances.
First layer - bacterial flora
Over time the intestine has evolved into a complex functional system, largely dependent on the bacterial flora it contains. 99% of the bulk of stool passed consists of trillions of bacteria, of two types: endogenous flora and transient flora. The endogenous flora is made up of 10 - 20 species, which are dominant, and exist in high concentrations; and a low level of sub-dominant flora, which may multiply in certain disease situations to cause diarrhoea. The transient flora are potentially pathogenic (disease-causing), and include well-known organisms such as Klebsiella, Proteus, Pseudomonas and Staphylococci. While in transit through the gut, they are prevented from expressing their toxicity by the presence of the dominant flora. There are about 300 different species of bacteria in the gut at any one time. The
flora has countless functions, but the three most important are:
(i) assisting in digestion and absorption of nutrients, (ii) co-operation in defence mechanisms, and (iii) production of substances that have a beneficial metabolic role, e.g. metabolism of cholesterol, folic acid.
Second layer - mucous coating
An intact mucous coating lining the inner surface of the intestine traps bacteria, but allows absorption of nutrients.
Third layer - enterocytes
These are cylindrical-shaped cells that line the inner surface of the intestine, which is made up of villi. These villi are finger-like projections, which vastly increase the surface area for absorption of nutrients. Nutrients are absorbed either through the enterocytes, or via the gaps between the cells, which are referred to as ‘tight junctions’. Loss of tight junctions between these enterocytes is the prime factor in the development of a leaky gut.
Fourth layer - lymphoid tissue
This gut-associated lymphoid tissue (GALT) is organised into Peyer’s patches in the walls of the small intestine, and lymphoid follicles in the wall of the colon. This forms the largest concentration of immune tissues in the body (one-third of the whole immune system). It is here that the sentries and patrol militia operate to provide effective defence; recognising and differentiating between harmful invaders and ‘own- side players’, communicating with HQ (the general immune system), neutralising invaders and raising the alarm.
Any increase in the permeability of the gut lining or imbalance in the bowel flora has a powerful impact on the, the body will be subject to repeated infections. If it functions allergies, inflammation and auto-immune diseases.
Diagram of Peyer’s patches
Photograph of Peyer’s patches
Fifth layer - liver
One of the main functions of the liver is to receive and process everything that is absorbed via the intestines and travels to the liver via the portal veins. In a person eating a typical Western diet containing excessive sugars, fats, chemicals, alcohols and free radicals, the liver has to work very hard to detoxify and neutralise harmful substances. If the gut defence systems are compromised, the liver becomes even more overloaded.
Causes of a leaky gut
Many factors in our modern Western lifestyle cause these barriers to become compromised / weakened, and thus increasingly permeable. Among the most important are:
Stress (mental, physical or emotional)
Drugs, especially alcohol, antibiotics, cortisone, hormones and anti-inflammatories
Food intolerances and sensitivities
Environmental pollutants and toxins, including free radicals
Surgery (and the anaesthetic drugs administered)
Altered gut permeability gives rise to allergic and other chronic diseases by making it possible for partially digested food particles, toxic wastes and even bacteria to pass directly into the bloodstream, overwhelming or bypassing the filters and barriers. The immune system springs into action and lymphocytes (white blood cells) form immune clusters around the foreign particles. These clusters circulate to all parts of the body, causing inflammation in one or more tissues or organs, depending on the inherited genetic tendency. One’s inherited weakness determines which inflammatory condition manifests. The constant drain on the immune system can then lead to an immune-suppressed illness.
The burden on the liver is also greatly increased as it attempts to detoxify the blood. Other factors, which further compromise the body, are diminished stomach acid and pancreatic enzymes, which are essential to optimal digestion and breakdown of foods. Lack of these leads to a state of ‘modern malnutrition’. Great quantities of cortisol are released by the adrenal glands when under stress, and this also aggravates the leaky gut syndrome.
Treatment of leaky gut syndrome
The aim of the treatment protocol is to remove obstructions to metabolic processes, and to encourage the body to self-regulate these vital processes. The four pillars of treatment are: remove, replace, reinoculate and repair.
1.1 Parasites, bacteria and fungi: Removal of the latter can be effected with herbal products such as Warburgia, Taheebo or Pau D’Arco, Citricidal, Para 90 etc., or an essential oil product such as Origanum capsules (Pranarom), or Rife Resonator therapy. Usually about 2 weeks’ treatment is needed.
1.2 Dietary toxins, additives, chemicals and foods to which the patient may be sensitive can be avoided by placing the patient on a diet eliminating foods commonly found to be sensitising, such as wheat, dairy, sugar and additives. Occasionally one needs to go further and eliminate soya, gluten and corn as well.
2.1 Insufficient stomach acid and digestive enzymes can be supplemented with products containing Betaine HCl, and digestive enzymes such as DigestCo (Mediherb), Digestizyme (Amipro), etc.
2.2 Nutritional deficiencies, arising from poor digestion, can be corrected with a good functional food (see below).
3.1 Friendly bacteria must be replenished as soon as the parasite cleanse (above) has been completed. This should be ongoing for several months. Use a reliable product such as Reuteri, Intestiflora or Probiflora.
4.1 Gut lining can be repaired with L-Glutamine, MSM and good-quality, pharmaceutical-grade Omega 3 oils.
A good-quality functional food forms the cornerstone of the above regimen, by providing a complete range of nutrients, vitamins, minerals, pre-biotics such as FOS (Fructo-Oligo-Saccharide) and insulin to support the bacteria, L-Glutamine and MSM. The locally produced Target Candida is effective and less expensive, but is based on soya, which may disagree with patients if they are intolerant to it. The imported UltraClear Sustain is excellent and rice-based, but more expensive. UltraInflamX is used when there is inflammation in the body, and UltraClear Plus is for promoting Phase 1 and 2 detoxification pathways in the liver. These products are best used under the supervision of a knowledgeable integrative practitioner.
Liver support and detox
It is important to support the liver through the above programme with herbal products such as Milk Thistle, LivCo (Mediherb), Livotibb, etc. UltraClear Plus and Chlorella both improve detoxification processes in the liver very effectively.
There are some fairly new tests available in South Africa, which can help to rationalise the above protocol and eliminate some of the guesswork. It is worthwhile submitting a stool sample to Synexa Laboratory in Cape Town for analysis of the flora. The results provide therapeutic guidance as to which beneficial bacteria are deficient, and which pathogens detected need elimination. This provides more specific guidance for treating 1.1 and 3.1 above. There are also two food sensitivity tests available, which can be helpful in detecting exactly which foods the patient may be intolerant to. This removes a lot of the dedication and commitment required in following an elimination diet for several months as outlined in 1.2 above. The disadvantages are that the tests are not 100% accurate and are expensive. MDS laboratories in Durban test the patient’s blood sample for 160 foods by means of an immunoglobulin G (IgG)-based testing method (conventional allergy tests use an IgE-based test). ALCAT Laboratory in Gauteng use a test based on measurement of the reaction of white blood cells.
Up to 130 foods and 30 chemical substances can be tested. There is a test available to examine the permeability of the gut wall, but this has not proved to be reliable in practice.
Correction of a leaky gut problem may take from 1 to 3 months to achieve, and is not easy without professional guidance and supervision. It is a fairly intensive and expensive programme to follow for the first 4 - 6 weeks. Once the leaky gut and bowel environment has been corrected, many of the chronic symptoms will improve or disappear. The body may tolerate certain foods again after a period of avoidance, but some foods may prove to be potent triggers to the immune system and have to be avoided in the long term. Having removed the ‘obstacle’ of the leaky gut, the stage is set for further homeopathic or homotoxicological treatment, if needed.