Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion, Fourth Edition (41 page)

In the early 1980s, Orion Truss, M.D., noticed that many of his patients’ other problems resolved when he treated them with Nystatin for fungal problems. Indeed, one patient had a complete reversal of multiple sclerosis. After hearing Dr. Truss lecture on his findings, Abram Hoffer, M.D., a doctor in the field of orthomolecular psychiatry, tried his first yeast protocol on a psychiatric patient who had suffered from depression for many years. One month after initiating Truss’s program, she was mentally and emotionally sound or stable. They met with other doctors, including Sidney Baker, who also began seeing enormous changes in their patients. Soon the word began to spread among integrative clinicians of all sorts. Dr. Abram Hoffer stated that one-third of the world’s population is affected by candidiasis. Typically if
someone’s problem is due to candida, when the person is treated you see remarkable effects; often the person is 80 percent better in just two weeks.

Candida can also colonize in the digestive tract, causing havoc everywhere in the body. Candida colonies produce powerful toxins, such as gliotoxin, aldehydes, and, rarely, alcohol, that are absorbed into the bloodstream and affect our immune system, hormone balance, and thought processes. Candida also lowers immunity by splitting secretory IgA molecules.

The most common symptoms are abdominal bloating, anxiety, constipation or diarrhea (or both), depression, environmental sensitivities, fatigue, feeling worse on damp or muggy days or in moldy places, food sensitivities, fuzzy thinking, insomnia, low blood sugar, mood swings, premenstrual syndrome, recurring vaginal or bladder infections, ringing in the ears, and sensitivities to perfume, cigarettes, or fabric odors. Although these symptoms are the most prevalent, candida has many faces, and many types of symptoms can occur.

Candida infections are usually triggered by use of antibiotics, birth control pills, steroid medications, and consumption of sugar. These drugs change the balance of the intestinal tract, killing the bacteria that keep candida in check, and the fungus quickly takes hold. Candida are like bullies that push their way into the intestinal lining, destroying cells and brush borders. Greater numbers of candida produce greater amounts of toxins, which further irritate and break down the intestinal lining, causing leaky gut. This damage allows macromolecules of partially digested food to pass through. The macromolecules are the perfect size for antibodies to respond to. Your immune system then goes on alert for these specific foods so the next time you eat them, your antibodies will be waiting. The net result is increased sensitivity to foods, other food substances, and the environment. (See
Chapter 4
, “Intestinal Permeability/Leaky Membranes.”)

First begin with a candida diet or the Body Ecology Diet. (Both are described in
Chapter 13
.) Herbs and medications don’t work to permanently rebalance your system unless you change your diet.

Many substances are helpful in killing off candida. Garlic is my personal favorite—eat lots of it raw; women can use it as a vaginal suppository (make sure not to nick the garlic or it can sting!) or take in capsule form. Capryllic acid from coconuts, oleic acid from olive oil, oil of oregano, thyme oil, pau d’arco, olive leaf extract, and grapefruit seed extract are all valuable agents for killing candida. Mathake, a South American herb, has also been found to be extremely effective. While it isn’t necessary to use all these health enhancers, you can buy many of them in combination
products in health-food stores or from health professionals. Remember to take a good probiotic supplement or to eat lots of probiotic-rich foods while you are taking these products.

Typically when I am working with someone, I recommend probiotics and either a single or combination herbal product. If candida is the underlying problem, people feel dramatically better within two weeks. If so, I continue the herbs for 6 to 12 weeks or until no further improvement is noticed. After that I typically recommend a different herb or combination to kill the fungi that didn’t respond to the first one. Many people also choose to use pharmaceutical drugs like Nystatin or Diflucan to treat candidiasis.

When the candida die, protein fragments and endotoxins are released, triggering an antibody response. This can initially produce a worsening of the person’s symptoms and is commonly known as a die-off reaction, or a Herxheimer reaction. To avoid this, it is important to begin therapeutics gently, with small doses, and gradually increase. If your symptoms are still initially aggravated, cut back and increase supplements more gradually. Most people begin to feel dramatically better within two weeks. If you don’t, you’re probably not dealing with a candida problem. Ask your clinician to make therapeutic recommendations.

I recently advised a client to take probiotic supplements for peeling skin and a burning sensation on her feet. Although she scored low on the candida questionnaire (see
Chapter 11
), her symptoms fit those of candida. I advised her to take probiotics slowly, beginning with 5 billion organisms daily and working up gradually to 50 billion to 100 billion organisms. Six days later, she told me her feet were improving, but she had a horrible headache every time she took a teaspoon of probiotics. After she began again more slowly, she was soon relieved of both problems.

Small bowel overgrowth occurs when bacteria in the large intestine travel to the small intestine, often the result of poor HCl production in the stomach or an insufficient amount of pancreatic enzyme function. SIBO is a frequently overlooked contributor to health problems and often underlies such diverse health issues as irritable bowel syndrome, fibromyalgia, restless leg syndrome, and possibly interstitial cystitis.

Dr. Mark Pimentel and his research group reported that 78 percent of people with irritable bowel syndrome had small intestinal bacterial overgrowth (SIBO).
When treated with antibiotics, their symptoms were 75 percent improved or resolved. Other researchers report that about 50 percent of people with irritable bowel syndrome have SIBO. They also report that 78 percent of people with fibromyalgia have SIBO. When the infection is treated, nearly half of them no longer meet the criteria for fibromyalgia. SIBO is also commonly found in people with diabetes, scleroderma, gastric bypass surgeries, interstitial cystitis, restless leg syndrome, diver-ticulosis, Crohn’s disease, celiac disease, strictures in the intestines, poor ileocecal valve function, poor motility, or recent stomach surgery, and it is common in elderly people.
Figure 8.1
shows how stress can lead to changes in the gut mucosa, which in turn leads to changes in the balance of bacteria in the small intestine. This triggers an immune response which stimulates our enteric nervous system (digestive nervous system). All of this results in IBS-like symptoms of gas, bloating, diarrhea, constipation, and/or alternating diarrhea and constipation.

Use of proton-pump inhibitors is one cause of SIBO. If you don’t have acid in your stomach protecting you from bacteria, fungi, and parasites coming in on your food, you are left wide open.

Figure 8.1
SIBO, how it can create IBS-like symptoms.
(Adapted from Wood, Jackie D. Modified from: [2007] “Effects of Bacteria on the Enteric Nervous System: Implications for the Irritable Bowel Syndrome.”
Journal of Clinical Gastroenterology
, 41, S7–S19.)

People with SIBO typically experience it as gas, bloating, diarrhea, and abdominal discomfort. Some people may experience constipation or fatigue. Some people
have frothy, yellow stools (called steatorrhea) and experience fat malabsorption and deficiencies of fat-soluble vitamins (A, D, E, and K). These symptoms are chronic and last for weeks and months, then years. You feel worse when eating carbohydrates and you may need to loosen your pants by the end of the day. From my experience it seems to worsen as the day goes on. What’s happening is that these bacteria are fermenting carbohydrates and sugars in your belly, causing symptoms. The bacteria also produce by-products that are irritating and toxic to your intestines. This can eventually lead to leaky gut and deficiencies of fat-soluble vitamins, B
₁₂
, and iron. Some people lose a lot of weight as a result.

Stool tests can help uncover whether you have a bacterial infection in your colon, but they aren’t accurate at determining whether you have a bacterial infection in your small intestine. The test of choice is a hydrogen breath test, although in my experience it misses many who do have SIBO. You can also determine SIBO by using organic acid testing. Look for D-lactate, indican, and Hippuric acid. Some doctors will just look at your symptoms and treat you without doing testing. You could also experience a lot of gas and bloating from candida, lactose or other carbohydrate intolerance, or too fast a transit time. (See
Chapter 11
for more information on functional testing.)

The current medical treatment for SIBO is antibiotics. The most common ones include Neomycin, Flagyl, Levaquin, Cipro, or Rifaxamin. Rifaxamin is an antibiotic that works locally in the digestive system, so it doesn’t cause systemic problems and has fewer side effects. Dr. Gerard Mullin from Johns Hopkins is using an aggressive herbal therapy for treating SIBO. Whether herbs or pharmaceuticals are used, the goal is to kill bacteria. There are also case history reports showing efficacy of using a combination of peppermint and caraway oils. Typically treatment will resolve the issues. If the SIBO is caused from a problem with obstruction or limitations on how well the muscles in the intestines work, then the person may have to remain on antibiotics continuously.

The other most common medical treatment for SIBO is probiotics. This is in keeping with my “make love, not war” strategy of healing. While this doesn’t always work by itself, it’s worth trying. Probiotics are typically given in large doses, 100 million organisms one to three times daily or more, to bring the intestines back into balance. The best studied of these is VSL-3.

Parasites modulate our immune responses for good or ill. Parasites have evolved alongside of us and have developed strategies for surviving inside of us. In general, parasites cause us harm and we want to eliminate them from our bodies. But in some cases they can be protective and beneficial because they modulate our immune system response, much like probiotic bacteria do. For example, if you have anemia that develops from hookworm, the hookworm also helps you gain resistance to some bacterial infections. TSO pig whipworms are being used and studied to change immune response in people with inflammatory bowel disease and allergy. References in the scientific literature suggest that parasites may be the primary cause of allergies. Parasites cause damage to the lining of the digestive tract, which allows large molecules to enter the bloodstream. This provokes an antigenic response. This theory is revolutionary, and additional research needs to be done to determine just how large a role parasites play in allergies of all types. (See
Chapter 9
for more information on this.) Let’s focus here on parasites that make us sick.

Protozoa are single-celled microbes such as amoebas, leishmania, giardia, plasmodium, and cryptosporidium. Worms, or helminthes, are larger, and typically you can see them. Probably the most common worms in the United States include pinworms, roundworms, flukes, and, less common, tapeworms. Genova Diagnostics Laboratory routinely surveys stool samples for parasites. I had a conversation about this with Patrick Hanaway, M.D., vice president and chief medical officer at Genova Diagnostics Laboratory. In stool samples from people who had symptoms that met the diagnostic criteria for irritable bowel syndrome, parasites were discovered in 23.5 percent of 14 thousand stool samples. The most common ones were Blastocystis hominis (12.5 percent), Dientamoeba fragilis (3.8 percent), Ent-amoeba species (3.4 percent), Endolimax nana (2.2 percent), and Giardia lamblia (0.7 percent).

The symptoms of parasites appear to be like any other digestive problem. Chronic diarrhea is often a sign of a parasitic infection. Other symptoms include pain, constipation, bloating, gas, unexplained weight loss, fatigue, unexplained fever, coughing, itching, rashes, bloody stools, abdominal cramping, joint and muscle aches, irritable bowel syndrome, anemia, allergy, granulomas, nervousness, teeth grinding, chronic fatigue, poor immune response, and sleep disturbances. Parasites play a role in some people who have inflammatory bowel disease. Parasitic symptoms can come and go due to the life cycles of the specific parasite involved. I had one client who went through a 21-day cycle from wellness to headaches, fatigue, constipation, and
diarrhea, to wellness again. If you see a cyclical pattern like this, you can suspect parasites. (See “Parasite Questionnaire” in
Chapter 11
.)