NATURAL WAYS TO

DIGESTIVE HEALTH
• Stephen Holt, MD LLD (Hon.) ChB.,
PhD, DNM, DSc, FRCP (C) , MRCP
(UK), FACP, FACG, FACN, FACAM,
KSJ
• Distinguished Professor of
Medicine (Emeritus)
• Scientific Advisor, Natural
Clinician LLC
 INTRODUCTION
• Without efficient digestive function,
general health cannot prevail
• A “rumble” in the guts produces a
“rumble” in the mind and vice versa
• The most common digestive disorders
are functional in origin
• Integrative Medicine cannot impact
“plumbing problems” in the gut
 FUNCTIONAL DIGESTIVE
DISORDERS
• Commonest cause of digestive upset
• A lack of harmony of digestive
function (Claude Bernard)
• Involves the brains of the body and
the “brains” of the gut
• The mind-body or body-mind
• Constitutes about 75% of all GI work
REGION OF GUT DISORDER
Mouth Bruxism
Rumination
Esophagus Globus-Sensation
Functional chest pain
Functional heartburn?
Functional dysphagia
Aerophagia
Stomach and duodenum Non-ulcer dyspepsia

Small Intestines Irritable Bowel Syndrome

Large Intestines Irritable Bowel Syndrome

 RED FLAG SYMPTOMS
• Difficulty in swallowing • Common first symptom of cancer of the
esophagus especially in adults.
• Persistent, new • Abdominal pain must be taken
abdominal pain seriously. It may signal serious
diseases.
• Family history of • These diseases run in families.
bowel cancer,
inflammation or polyps

• Blood in the stool or • Bleeding common among individuals

vomit with cancer or ulcers.
• Change in digestive • Most cancers in the gastrointestinal tract
function in people occur with advancing age.
over the age of 40
years
• Systemic symptoms • Weight loss, fever, joint disease etc.
COMMON ALTERNATIVE INTERVENTIONS

• Nutritional Therapies, Nutraceuticals

• Purging for health (Colonic Therapies)
• Special Food Combinations (Allergies)
• Prebiotic and Probiotic Therapy
• Specific Remedies of Natural Origin
• Lifestyle Change
• Digestive Enzymes
• Gut Detoxification
• Biopharmaceutical Concepts
THE MOUTH: NO MAN’S LAND

• Dentists don’t speak to doctors

and vice versa
• Revolving door phenomenon
• Poor oral health spells disease
• Bacterial translocation
• CVS, respiratory and gut disease
• Concept of oral biocleansing
 GERD: ACID REFLUX
• Mismatch between symptoms and
severity of esophagitis
• Endoscopy indicated in persistent
symptoms or dysphagia
• Oxidative tissue damage contributes to
Barrett’s metaplasia (pre-cancer)
• A peptic stricture may hide cancer
• Dysphagia over the age of 45 years is
cancer until proven otherwise
 GERD: ACID REFLUX
• Obtrusive problems with many
unobtrusive issues
• Laryngitis, globus sensation, asthma
and COPD
• Coexistence of obesity and Metabolic
Syndrome X
• Adverse effects of medication (occult)
• Misdiagnosis
 GERD MANAGEMENT
• Staged intervention strategies
• Lifestyle changes, weight control,
beverages, sleep propped up, exercise
and posture, drugs etc.
• Acid neutralization
• Inhibition of acid secretion
• Mucosal protection
• Rebound phenomena
PUMPING ACID
HOLISTIC NUTRACEUTICAL
APPROACH TO GERD
• Neutralize gastric acid: fava bean flour
(USP standard), sodium bicarbonate (2%
RDI, Na), Ca, Mg
• Natural inhibitors of the proton pump e.g.
ellagic acid: c.f. H+/K+ ATP-ase
• Antioxidants: E, C, green tea, turmeric,
beta carotene: REDOX balance
• Miscellaneous: mastic gum, lecithin, apple
pectin, gastric mucin, Zn
EFFECTS OF ELLAGIC ACID REFERENCES

ANTI-CANCER EFFECTS:
INHIBITION OF CARCINOGENICITY
AND MUTAGENICITY
POWERFUL ANTIOXIDANT
EFFECTS
Ratnoff, O.D., Crum, J.D. (1964) J. Lab. Clin. Med.
63, 359;
Bhargava, U.C., Westfall BA (1968) J. Pharm. Sci.
57, 1728
Constantin A et al. “The dietary anti-cancer agent
ellagic acid is a potent inhibitor of DNA
topoisomerasie in Vitro.” Nutr. Cancer 23 (2): 121-
30, 1995

REDUCTION OF BLOOD PRESSURE Fiedler, V., Hildebrand, G.H. (1954) Arznelmittel

Forsh 4, 426

INHIBITION OF THROMBOXANE B2 Kimura, Y., Okuda, H., Okuda, T., Arichi, S. (1986)
SYNTHESIS Planta Med. 52, 337

INHIBITION OF ACID SECRETION BY Murakami, S., Kijima, H., Isobe, Y., Muramatsu,
THE STOMACH: BLOCKS GASTRIC M., Aihara, H., Otomo, S., (1991), Planta Med. 57,
PROTON PUMPS 305-308
 UNRESOLVED ISSUES IN ACID
PEPTIC DISEASE
• Holt S, “Over-the-counter Histamines H2-receptor
Antagonists. How will they affect the treatment of
acid-related diseases?” Drugs 47(1): 1-11, 1994
• Removal of acid defense promoting gut infection
e.g. traveler's diarrhea
• Consequences of hypochlorhydria or achlorhydria
• Promotion of gastric cancer? (nitrosamine)
• Drug induced nutrient depletion e.g. Vit. B-12
• Reinforcement of adverse lifestyle by symptom
reduction, with limited effects on the natural
history or clinical course of the disease
 SYMPTOMS AND SIGNS OF
HYPOCHLORHYDRIA
SYMPTOMS
Bloating, belching, burning and
flatulence immediately after meals
A sense of “fullness” after eating
Indigestion, diarrhea or constipation
Multiple food allergies
Nausea after taking supplements
SIGNS
Itching around the rectum; weak,
peeling and cracked fingernails;
dilated blood vessels in the cheeks
and nose
Acne
Iron deficiency, calcium deficiency
Chronic intestinal parasites or abnormal
flora
Undigested food in stool; chronic
Candida infections; functional
symptoms in upper digestive tract;
gas, belching, bloating and
dyspepsia
THE GASTRO DUODENUM
 PEPTIC ULCER DISEASE
• Potent antisecretory drugs put
surgeons out of work, but their legacy
remains with post gastrectomy or
post vagotomy complications (DDD)
• Helicobacter pylori is a miscreant
• Mind-body plays a role: Tidy, H, “The
Incidence of Peptic Ulcer at St.
Thomas’ Hospital” BMJ, 1, 319, 1945
 PEPTIC ULCER

Dr. H Tidy stated in 1945, BMJ:

Psychoneurotic stimuli (mind)
may pull the trigger (referring
to peptic ulcer complications),
but some other hand has
previously loaded the gun.”
 HELICOBACTER PYLORI
• A bug that lies below the layers of
gastric mucus in the antrum
• Switches on acid
• Damages tissue by major
generation of free radicals and
oxidative stress
• Peptic ulcer disability worse in
substance abusers: oxidative stress
 KEY CONCEPT: THE
ANTIOXIDANT APPROACH
• The role of oxidative stress in the
generation of acid peptic disease has
been well defined but ignored as an
important focus of therapeutic intervention
• Oxidative stress promotes tissue injury,
inflammation, metaplasia and cancer in
the upper digestive tract
• All individuals with acid peptic disease
should receive REDOX balanced
antioxidants
NSAID: PUBLIC HEALTH CONCERNS
• Cox inhibition: Cox 1 versus Cox 2
• Onerous side effect profile
• Massive increase in prescription and OTC use
• Holt S, et al. Nonsteroidal anti‑inflammatory drugs
and lower gastrointestinal bleeding. Dig Dis Sci
38:1619-1623, 1993.
• Holt S, et al. Gastric mucosal injury induced by
anti-inflammatory drugs (NSAIDs). Southern
Medical Journal 84, 3:355-360, 1991.
• Holt S, et al. Omeprazole: overview and opinion.
Digestive Diseases and Sciences 36(4):385-93,
1991.
 REDUCING THE BURDEN OF
NSAID DAMAGE
• Reduce NSAID dosage by topical
bone and joint rubs with evidence-
based dietary supplement strategy
• Synergistic formulation of
chondroprotection, herbal Cox-2
inhibition, immune tolerance and
specific anti-inflammatory agents
• Therapeutic tips: “delayed onset”
IRRITABLE BOWELS OR GUTS
• Visceral learning
• About 25M Americans have “The IBS, a
condition that includes the presence of
long lasting (>3m) or intermittent
abnormalities of bowel habit, with or
without lower abdominal pain or
discomfort, not explained by causes
involving any structural or metabolic
changes” c.f. Functional Dyspepsia
 MANAGEMENT OF IBS
• A perfect target for Integrative
Medicine
• Controlled trials reinforce visceral
learning: body-mind approach,
relaxation responses, self hypnosis
• A mixed bag of disorders: benefit of
smooth muscle relaxation, fish oil,
synergistic GI balancing formulae
• Back to Claude Bernard
 COLON CLEANSING

• Synergistic, gentle, herbal,

water-retaining supplements
which facilitate exodus of stool
• Lifestyle change, fiber etc.
• A role for colon hydrotherapy
• Must consider concepts of CDR
 FIBER SUPPLEMENTS
• Soluble and insoluble fibers
• Fiber has predictable effects by
consideration of physicochemical
properties e.g. bran vs. hydrocolloids
• Soluble fibers have intrinsic
metabolic effects
• Fiber must interact with colonic
bacteria to exert its many benefits
 FIBER: THE GLYCEMIC INDEX
• Calculations of the glycemic index of
food are probably a waste of time.

• Understanding factors that control

gastric emptying rate can result in
inference about the glycemic index.

• Slowing gastric emptying slows

glucose absorption – relevance in
acute dosing
FIBER: THE GLYCEMIC INDEX

Holt S, et al
Effect of Gel
Fiber…
Lancet,
March 24th,
1979.
 MECHANISMS OF DIARRHEA
• Exudative diarrhea: infection,
inflammation
• Osmotic diarrhea: lactose,
magnesium
• Secretory diarrhea: cholera,
hormones
• Diarrhea due to motor disturbances:
IBS, post cholecystectomy
 FOOD ADDITIVES
• Recurrent skin rashes,
urticaria, angiodema

• Respiratory disorders

• Attention deficit disorder

 PROBIOTICS
HUMAN FOOD SUPPLEMENTS
• Lactobacillus acidophilus DDS-1
• Lactobacillus brevis
• Lactobacillus bulgaricus
• Lactobacillus casei
• Lactobacillus casei spp Rhamnosus
• Lactobacillus caucasius
• Lactobacillus plantarum
ANIMAL FEED SUPPLEMENTS
• Lactobacillus acidophilus DDS-1
• Lactobacillus plantarum
• Lactobacillus casei
• Steptococcus faecium
• Steptococcus lactis

• Lactobacillus salivarrus

• Bifidobacterium bifidum

• Bifidobacterium longum

• Steptococcus faecium
 PROBIOTICS: BENEFITS
• Assistance with digestion
• Alleviation of digestive disorders, e.g., colitis, IBS, peptic ulcer.
• Enhanced mineral absorptions, especially calcium.
• Enhancement of the synthesis of several vitamins (especially
B complex).
• Protection against pathogenic bacterial infections, e.g., E. coli
infection.
• Reduction of symptoms of lactose intolerance; permits limited
reintroduction of dairy products.
• Reduction of yeast overgrowth (Candidiasis); notable reduction
in vaginal thrush.
• Improvement in immune function; “primes” the gut immune
system.
• Anticancer effects, some good evidence.
• Prevention of Helicobacter pylori infection and its association
with peptic ulcer, dyspepsia and gastric cancer.
• Acne prevention (?)
• Cholesterol reduction, modest and unpredictable.
THE CANDIDA CONTROVERSY

• Candida albicans: innocuous gut

inhabitant or pathogen
• Opportunistic organism with
gliotoxin, which depresses
immunity
• Combined use of prebiosis,
probiosis, enzymes and detox
• Dietary change: sugar elimination
 ORGANIC FOOD
• Favored for enhanced nutrient
density and absence of
organochemicals
• Pesticides and fertilizers are growth
promoters and may contribute to
body toxicity that promotes obesity
TOXIC LIPOGENESIS
• Food contamination: strawberries,
cherries, apricots, grapes etc.
• Economic disadvantages
 PARASITES
• Clever organisms that are not “fooled
by a dose of salts”
• Effective management involves
eradication. Most predictable by the
use of drugs, cleansing inadequate?
• Herbal approaches are variable e.g.
black walnut, grapefruit seed,
wormwood, rosemary, thyme,
marshmallow and citrus peel
 LEAKY GUTS 1
• Damage to tight junctions in the
intestinal lining
• “Chicken and Egg arguments”
• Disease associations: drug usage,
autoimmune disease, gastrointestinal
disease, skin disease, AIDS, etc.
• Causes: drugs (NSAID), infections,
radiation therapy, trauma, TPN
• Dysbiosis: classic lack of harmony
 LEAKY GUTS 2
• Concepts of “CDR,” with focus on “R”
• Glutamine, barrier protomorphogens
• Soluble fiber, e.g. oat beta glucan
• EPA, decrease leukotriene B4, TNF,
reduction in Type 2 prostaglandins
• Flavonoids: Ginkgo, Quercetin, etc
• Probiosis, prebiosis, enzymes, detox
 CONCLUSION
• Without digestive health, general
health will not prevail
• Practitioners of Integrative Medicine
are focused on restoring digestive
harmony as a premonitory to the
management of all disease
• New advances in nutraceutical
technology remain underexplored
• Think digestive health as a baseline