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Digestive tract disorders

By Yousry Naguib, Ph.D.
Vitamin Retailer magazine, December 2003

The digestive or gastrointestinal system, also known as the gut, is important for the conversion of food into energy, nutrients, and muscle. The digestive system consists of mouth, esophagus (the tube that passes through the chest and connects the mouth to the stomach), stomach, small intestine, large intestine (colon), rectum, and anus. The stomach leads to the small intestine (small bowel), a narrow long tube, from which most of the food absorption into the blood stream takes place. The small intestine leads to the large intestine (large bowel), which is responsible for forming, storing and expelling waste matter. The waste product passes through the end of the large intestine called the rectum to the anus.
The main digestive problems are Crohn’s disease, indigestion (heart burn), ulcers, lactose intolerance, Celiac disease, irritable bowel syndrome (IBS), flatulence (gas), constipation, and diarrhea.
Constipation is defined as the inability to pass stools. It usually doesn’t signal disease or serious problem. Its cure generally consists of a number of things, including eating foods high in fiber, like bran, whole-grain breads and cereals, fresh fruits and vegetables, drinking enough fluids, and if necessary an over-the-counter stool softener.
According to the American College of Gastrointerology, as many as 50 million Americans suffer from the symptoms of IBS and four out of five sufferers are women,. IBS is a digestive disorder that causes abdominal pain, bloating, gas, diarrhea, and constipation. IBS affects people of all ages, including children. People with IBS tend to have overly sensitive intestines that have muscle spasms in response to food, gas, and sometimes stress. In children, IBS is treated mainly through changes in diet, eating more fiber and less fat.
Crohn’s disease is an inflammatory disease of the gastrointestinal tract that seems to have both genetic and environmental causes, and it is not well understood. Its symptoms include recurrent abdominal pains, fever, nausea, vomiting, and diarrhea which is occasionally bloody. 
Almost half of the world’s population is infected with prevalent bacteria called Helicobacter pylori (H. pylori). H. pylori cause inflammation of the stomach lining, and ulcers. H. pylori begin to colonize the digestive tract at early age and the infected individuals often exhibit no symptoms until a number of years later. Eradication of H. pylori infection with a combination of antibiotics, antacids, and anti-microbial agents often cures the H. pylori associated ulcer. However, the therapy also eliminates “friendly” bacteria necessary for normal function of the gastrointestinal tract, leading to side effects such as bloating, diarrhea, and taste disturbance.
Lactose intolerance is a condition caused by a lack of an enzyme called lactase, which, in turn, causes the body to be unable to digest lactose, a sugar found in milk products. Lactase is normally produced in the small intestine where it breaks lactose down into a form that can be absorbed by the blood. A lack of lactase can cause uncomfortable symptoms for some people. Those who do exhibit the symptoms are said to be lactose intolerant. Thirty to 50 million Americans (adults and children) are lactose intolerant. The disorder affects some populations more than others. Seventy-five percent of all African-Americans and Native Americans are lactose intolerant.
Celiac disease is an inherited digestive disease, which is also known as gluten intolerance. Gluten is a protein that is found in wheat, barley and rye. About one million people in the United States suffer from celiac disease. People with celiac disease should avoid wheat, barley, rye, oat, and kamut.

Probiotics
            Friendly bacteria, known as probiotic, such as those found in yogurt are becoming increasingly popular, they are used to treat disturbed intestinal microflora, and may help lactose intolerance, and diarrhea. Acidophilus in yogurt, or taken as a tablet, powder, or extract may help bring back beneficial bacteria after a bout of diarrhea.
More than 400 different species of bacteria reside in the human gastrointestinal tract. The most researched ones belong to either the Lactobacillus or Bifidobacterium genera.
Lactobacillus is a genus of bacteria in the family Lactobacteriacae, which are found in the intestinal tract, milk, and fermented products. Acidophilus is a member of lactobacilli. Lactobacillus (L) acidophilus, L. plantarum, L. rhamnosus, and L. casei are common in the human mucosa, from the mouth to the rectum. L. acidophilus is the most common probiotic in yogurt, and is also present in the mouth, digestive tract, and vagina. Probiotics have the ability to survive passage through the gastrointestinal tract, and is usually considered to be non-pathogenic.
Species most frequently used in supplements include Bifidobacterium (B) bifidum, B. longum, B. breve, B. Adolescents, and B. Infantis; Lactobacillus (L) acidophilus, L. bulgaricus, L. thermophilus, L. sporogenes, L. Plantarum, and L. casei GG. Probiotics are usually measured in numbers of organisms per gram. Supplements typically contain 4 billion or more organisms per gram.
Diarrhea is one of the most common health problems in the world, in particular during childhood. Rotavirus and other viruses have been identified as a major cause of acute diarrhea in infants and young children. Antibiotics have also been associated with mild or severe episodes of diarrhea. Non-pathogenic living organisms (such as selected strains of Lactobacillus acidophilus, L. Bulgaricus, Bifidobacterium longum), capable of re-establishing the equilibrium of the intestinal ecosystem, have been used in the prevention of viral or antibiotic associated diarrhea.
The efficacy of the addition of freeze-dried and inactivated Lactobacillus acidophilus LB to oral re-hydration therapy in the treatment of diarrhea in children was demonstrated in a recent placebo-controlled trial. Seventy-three children, of whom 40 were on antibiotics, with acute diarrhea and mild dehydration (50% of the children had rotavirus) received oral re-hydration therapy and either L. acidophilus LB or placebo twice a day for two and half days. L. acidophilus was found to markedly reduce the duration of diarrhea, in particular among children who were not on antibiotics, as compared to placebo [1]. 
Lactobacillus strain GG (Lactobacillus GG, a subspecies of Lactobacillus casei), which comes from a sterile form of the bacteria that grow in the human intestine, administered during acute rotavirus diarrhea has been shown to enhance the immune system and reduce the duration of diarrhea. Thirty-nine infants with acute rotavirus diarrhea were randomly assigned to either fermented milk containing Lactobacillus GG or Pasteurized yogurt (placebo). The Lactobacillus group showed an enhanced concentration of circulating immunoglobulin A (IgA), which correlated with shortened duration of diarrhea [2].
In another study, researchers at the University of Nebraska gave Lactobacillus GG to children on antibiotics for bacterial infections, and to healthy children (placebo). Twenty five percent of placebo-children got diarrhea during the course of the antibiotic treatment compared to just seven percent of the Lactobacillus GG group [3]. The study concluded that Lactobacillus GG reduces the incidence of antibiotic-associated diarrhea in children treated for common childhood infections.
In an Italian study, 63 patients under 4 years old were divided into three groups: the first and second groups suffered an infective diarrhea, and received inactivated L. acidophilus LB and placebo, respectively; the third group had an antibiotic associated diarrhea and were given L. acidophilus LB. L. acidophilus significantly improved symptoms in the first group as compared to the second group, and prevented diarrhea in the third group [4].
Probiotics have been shown to improve lactose digestion by reducing the intolerance symptoms [5]. Research has indicated that bile sensitivity and acid tolerance may be important factors in selecting Lactobacillus acidophilus strain for improving lactose digestion and tolerance. In a randomized double-blind trial, eleven lactose intolerance subjects consumed acidophilus milk containing four different strains (B, N1, E and ATCC 4356) of L. acidophilus. Acidophilus strain N1 was the most effective of the four acidophilus in improving lactose digestion and tolerance [6]. A recent study reported that the ingestion of Lactobacillus acidophilus strain BG2FO4 twice per day for a week failed to treat lactose intolerance [7].
In a recent pilot study, one hundred and twenty H. pylori-positive patients were randomly given either an antibiotic therapy or the same treatment supplemented with Lactobacillus acidophilus GG for 14 days. The Lactobacillus group showed a 60 percent lower risk of bloating and a 70 percent lower risk of diarrhea or taste disturbance than those who received only antibiotics [8]. The L. acidophilus group also showed a significant increase in the eradication rate, suggesting that L. acidophilus could be effective in increasing eradication rates of a standard anti-H. pylori therapy [8].

Digestive enzymes
Enzymes are protein molecules produced by living organisms that catalyse chemical reactions of other substances without it being destroyed or altered upon completion of the reactions. Enzymes are responsible for nearly every facet of life and health. Enzymes that are utilized in the digestive system are called digestive enzymes, which include:
Protease - catalyses the splitting of interior peptide bonds in a protein, and it aids in the digestion and utilization of dietary proteins.
Amylase - produced in the pancreas and salivary glands, it aid in the digestion of starch and carbohydrates.
Lipase - catalyses the hydrolysis of fats (monoglycerides, diglycerides and triglycerides) to glycerol and fatty acids.
Invertase (Sucrase) - catalyses the hydrolysis of sucrose to glucose and fructose. Lactase - bearks down the milk sugar lactose. It is useful for individuals suffering from lactose intolerance. It may be beneficial for those suffering from irritable bowel syndrome and other digestive disorders in which a high percentage are adversely affected by dairy products.
Cellulase - digests cellulose fibers into smaller units, it is produced in large amounts by certain fungi and bacteria.
Alpha-galactosidase – catalyses the hydrolysis of alpha-glycosides, including galactose oligosaccharides, galactomannans, and galactolipids. It aids in the digestion of beans
Bromelain - an enzyme from the stem of pineapples breaks down protein and fights inflammation and reduces swelling.
Papain - a protein-digesting enzyme produced by the body. It is used to treat chronic diarrhea and celiac disease, and gastrointestinal discomfort due to intestinal parasites.
The most common digestive enzyme supplements are those extracted from fruits, such as bromelain from pineapple and papain from papayas.

Fibers             
Dietary Fiber stimulates intestinal movement, and helps prevent constipation. There are two types of fiber based on their solubility in water: soluble- and insoluble-fiber. Soluble-fiber is partially digested in the large intestine; it delays gastric emptying, gives a sense of fullness, promotes regularity, and helps lower cholesterol. Insoluble-fiber decreases the transit time of food through the gastrointestinal tract, and enhances regularity.
Psyllium seeds and their husks are rich in soluble fiber and have long been enlisted to ease constipation and digestive system upset [9]. Psyllium seeds are harvested from Plantago psyllium and P. ovata, commonly called plantain. They are commonly added to laxatives.
AlgiumTM is a low molecular weight alginate dietary fiber (marketed by Soft Gel Technologies, Inc.) extracted from kombu (kelp), which has been shown to help facilitate regularity, maintain healthy cholesterol levels. In one study, 18 healthy women consumed a beverage containing 4 grams Algium daily for 3 weeks. The beverage was drunk after breakfast and lunch. During the treatment period, the frequency of bowel movements increased by one and half times [10].

Botanicals
Broccoli contains sulforaphane, which was shown in a study on mice to kill helicobacter pylori, bacteria that cause stomach ulcers and often stomach cancers [11]. Lxatives, such as castor oil, flax seed, psyllium, rhubarb, and senna act to promote evacuation of the bowels.
Carminative herbs, such as peppermint (Mentha spicata), ginger (Zingiber officinale), fennel (Foenicum vulgare), anise (Pimpinella anisum), caraway (Carum carvi), cardamom (Elettaria cardamoum), chamomile (Matricaria recutita), and lemon balm (Melissa officinalis) may ease the pain and discomfort that is associated with constipation. Ginger is primarily used for nausea and vomiting associated with motion sickness. Ginger also helps soothe the digestive tract and may be useful in relieving flatulence. Peppermint helps to reduce nausea and vomiting, and gas pain and indigestion. Peppermint is the most prominent herb used for IBS; its primary ingredient menthol helps to relax the muscles in the small intestine by reducing calcium influx [12].  Fennel helps soothe the digestive tract and relieves stomach bloating and flatulence.
Chamomile calms digestion and relaxes gastrointestinal tract during stress.            Demulcent herbs, such as marsh mallow root (Althaea officinalis), Irish moss (Chondrus crispus), and slippery elm (Ulmus rubra) can help ease heartburn.
Bitter herbs, such as dandelion root (Taraxacum officinale), gentian, barberry, Oregon grape, and aloe (Aloe vera) can relieve constipation and stimulate the secretion of stomach juices to aid in the digestion of foods.
Aloe acts a laxative when used internally. Caution should be exercised when using aloe, over dosage can result in diarrhea, and kidney problems.
Astringent herbs help to reduce fluid and electrolyte loss. They include herbs such as meadowsweet (Filipendula ulmaria), eyebright (Euphrasia), mullein (Verbascum thapsus), and yarrow (Achillea millefolium) [13].
Mastic, a resin from the small tree Pistacia lentiscus, has been shown in a test-tube experiment to kill Helicobacter pylori [14]. In one study, researchers assigned 38 patients with duodenal (intestinal) ulcers to two groups. One group took a gram a day of mastic and the other group took a placebo. Of those taking the mastic, 70% healed, compared with only 22% of the patients taking the placebo. Patients reported no side effects [15].

Detoxification
Natural detoxification includes herbs such as dandelion, burdock, sarsaparilla, and red clover, which help to purify the blood by stimulating the body’s detoxification processes. Herbs, such as psyllium and triphala that encourage bowel movement are often included in detoxification formulas. Other laxative herbs, like cascara sagrada and senna can promote dependence and should not be used for long periods.
In a recent study to examine the link between vitamin C levels and infection by Helicobacter pylori, researchers found that the lower the level of vitamin C in the blood, the more likely a person is to develop the infection. Analysis of stored blood samples from participants for Helicobacter pylori and levels of vitamin C revealed that participants with the highest blood levels of vitamin C showed a 25 percent lower prevalence of H. pylori infection.

References
[1] Simakachorn N et al. Clinical evaluation of the addition of lyophilized, heat-killed Lactobacillus acidophilus LB to oral rehydration therapy in the treatment of acute diarrhea in children. J Pediatr Gastroenterol Nutr 2000; 30:68
[2] Kaila M. Enhancement of the circulating antibody secreting cell response in human diarrhea by a human Lactobacillus strain. Pediatric Research 1992; 32:141
[3] Jon Vanderhoof. Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children.  J Pediatr 1999; 135:564
[4] Michielutti F et al. [Clinical assessment of a new oral bacterial treatment for children with acute diarrhea]. Minerva Med 1996; 87:545. Italian
[5] Sanders ME. Summary of conclusions from a consensus panel of experts on health attributes of lactic cultures: significance to fluid milk products containing cultures.
J Diary Sci 1993; 76:1819
[6] Mustapha A et al. Improvement of lactose digestion by humans following ingestion of unfermented acidophilus milk: influence of bile sensitivity, lactose transport, and acid tolerance of Lactobacillus acidophilus. J Dairy Sci 1997; 80:1537
[7] Saltzman JR et al. A randomized trial of Lactobacillus acidophilus BG2FO4 to treat lactose intolerance. Am J Clin Nutr 1999; 69:140
[8] Armuzzi A et al. Effect of Lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during Helicobacter pylori eradication therapy: a pilot study. Digestion 2001; 63:1
[9] Marlett JA, Kajs TM, Fischer MH. An unfermented gel component of psyllium seed husk promotes laxation as a lubricant in humans. Am J Clin Nutr. 2000; 72:784
[10] Kanazawa Y et al. Effect of depolymerized sodium alginate on defecation. Jpn J Nutr 1998; 56:89
[11] Talalay P et al. Sulforaphane inhibits extracellular, intracellular , and anti-biotic-resistant strains of H. pylori and prevents benzo[a]pyrene-induced stomach tumors. Proc Natl Acad Sci USA 2002; 99:7610 
[12] Hills JM. Aaronson PI. The mechanism of action of peppermint oil on gastrointestinal smooth muscle. An analysis using patch clamp electrophysiology and isolated tissue pharmacology in rabbit and guinea pig. Gastroenterology 1991; 101:55
[13] Check Starbuck, J. “3 Herbs for good digestion: Ginger, Peppermint and Aloe.” Better Nutrition (1999): 44-49  
[14] Marone P et al. Bactericidal activity of Pistacia lentiscus mastic gum against Helicobacter pylori. J Chemother. 2001; 13:611
[15] Al-Habbal MJ, Al-Habbal Z, Huwez FU. A double-blind controlled clinical trial of mastic and placebo in the treatment of duodenal ulcer. Clin Exp Pharmacol Physiol. 1984; 11:541

 

 

 

 

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