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by Joyce Luteyn, M.D.
A CLEAN START
As a family physician,
I see patients of all ages; as we say, "from cradle to grave," but my
average patient is a healthy adult trying to enter middle age with
dignity. They have numerous health concerns or complaints,
which mostly reflect the normal processes of aging, but can in
some cases be ameliorated by lifestyle changes, prescription
medications, and when appropriate, nutritional supplements,
as guided by their health care provider.
Digestive complaints of all varieties are common, their
causes are myriad and often of more than one cause in any
individual's situation. The people frequently complain of multiple
and changing symptoms, making the diagnosis more difficult. Although for the sake of clarity and brevity in this article I am going to chiefly address the lower intestine (colon), it is
important to understand that digestive processes that occur in
the stomach and small intestine are important in the overall
health of the digestive tract, including the colon, and must not
be ignored in evaluating complaints of lower gastrointestinal
dysfunction.
The colon, or the large intestine as it is commonly called is
the last part of the digestive tract. It receives the remains of undigested
food and unabsorbed fluids from the small intestine,
where most nutrient absorption takes place. It is the job of the
colon to reabsorb the right amount of fluid from the residual
food waste, then to package and deliver it into a form that is
easily excreted from the body. Given the intricacies of the absorption
processes of the small intestine, this task would seem
simple, but most of the digestive misery present in people today
lies here, in the toxic waste dump. When I was an intern, I
realized early that any patient admitted without an order for a
"sleeper," or a "pooper"' was a wake-up call waiting to happen.
If this part of the body is not working right, people are unhappy
and will seek my care. I routinely address the bowel health of
my patients at every visit, even if no complaints are present,
and very strongly encourage all of my patients to undergo routine
colon cancer screening as recommended by the American
Cancer Society. This usually means a painless colonoscopy at
age 50, earlier depending on family history. It is a life saving
procedure that all should undertake. This is not a replacement
for preventative colon heath, and a normal colonoscopy should
not preclude complementary treatment for digestive disorders
in order to promote good health and well-being.
The most common problems I encounter in my patients are
constipation, or the difficult infrequent passage of stool. This
causes bloating, abdominal pain and is a major contributor to
the formation of hemorrhoids and other more serious problems
such as diverticulosis and diverticulitis. Diverticuli are
outpocketings in the large intestine that form at weak points
due to years of abnormal pressure on the intestinal wall. These
pockets can act as a trap for undigested food particles and like
appendices, become infected, bleed, or in rare cases require
surgery. Diverticulosis is almost unheard of in less developed
countries where the food is higher in soluble and insoluble fiber
and the normal daily volume of stool is many times what it is in
those with more refined "western diets." Once diverticuli form
they never disappear, but infection of them can be minimized
by keeping the bowels clean, and colonized properly with beneficial
bacteria.
Their formation can be prevented by keeping the pressure
on the colon low, with proper diet, water, fiber, and in many
cases supplements.
Diarrhea, stool urgency, bloating, and inadequate stool
emptying are also common complaints, and seem especially
in women to increase with age. The hormonal effects of menopause,
menses, and birth control pills can affect the natural balance
of good to bad bacteria in the colon, and subsequently the
genital tract, thus increasing problems with flatulence, recurrent
vaginitis, and in some cases recurring bladder infections.
Returning the bowel to normal function by appropriate cleansing
and improvement of the balance of good to bad bacteria
can reduce these problems for many patients. Although proper
diet, avoidance of allergens and toxins, exercise, and adequate
water intake are all necessary for a healthy colon as well a total
body, supplements can be very helpful in
today's busy world to fill in where perfect
living isn't possible.
For colonic health, when upper digestive
problems have been ruled out, I usually
recommend a two step process initially,
followed by a maintenance program
that can be customized to the individual
needs of the person involved. There are
many, many colon cleansing products
and programs available and making a
choice can be difficult. I do not recommend
"colonics" which involve flushing
the colon through the rectum to remove
residuals from the intestine. I have seen
patients develop serious electrolyte and
blood pressure abnormalities as a result
of these often excessively aggressive
treatments. Instead I recommend an oral
bowel cleanser, and am fairly specific in
what I do and do not recommend.
The purpose of a colon-cleansing product
is to remove the superficial layer of
mucoid plaque, which adheres to colonic
walls, including those of outpocketings.
Such as diverticuli and normal colonic
folds. This mucous layer, which is more
pronounced in people with abnormally
slow or rapid colon transit, or in those
with intestinal inflammation acts as a trap
for undigested food particles, abnormal
bacteria and yeast, as well as environmental
toxins. The colon is an excellent barrier
to protect the body from these potential
toxins, but when chronically overloaded,
or diseased, the barrier protection of the
colon can break down and allow them to
enter the blood stream and cause systemic
illness. A good cleansing product works
gently to remove this toxic layer and to
keep it in check over time. It should also
promote the growth of beneficial microbials
in the gut, which is also an important
step in regaining intestinal health.
The cleansing product I recommend
works in multiple ways to promote a
healthy colon. First, it contains a variety
of natural fibers, both water-soluble and
insoluble, which although potentially
available in a perfect diet, are difficult to
ingest in sufficient quantities for good
health. Psyllium husk and seed powder
are naturally occurring highly water-soluble
fibers that promote normalization
of water balance in the bowel. Apple fiber powder binds well with water to add
to this effect and is gentle for those with
sensitive systems. Flax and rice bran are
rich in omega-3 and -6 fatty acids as well
as lignan. Some studies have shown
these ingredients to also lead to reduction
in cholesterol and stabilization of
blood sugar. Inulin, a naturally occurring
fructooligosaccharide (FOS) pre-biotic
and soluble fiber, stimulates the growth
of the beneficial bacteria bifidus, an important
issue when addition of probiotics
is part of the colon health program.
I feel strongly that true bowel stimulants,
such as senna do not belong in a
colon cleanse product. Natural herbs
that promote normal peristalsis are essential
however. Slippery elm bark and
marshmallow root powder have been
used since ancient times to promote
natural peristalsis and to inhibit abnormal
smooth muscle spasms in the
gut. Fennel seed powder and fenugreek
powder have been used historically for
constipation and indigestion. I look for
these ingredients when I am looking for
a cleansing product.
Other important components, usually
derived from whole foods are fermented
goat mineral whey and beet juice powder,
which are alkalizing, and pre-digested
green foods such as wheat, oat, alfalfa
leaf and juice concentrates. Soothing botanicals
should also be an important part
of any bowel/digestive product. Tumeric,
ginger root, and rosemary, as well as
hyssop, and wild oregano, have anti-inflammatory and antispasmodic properties
that can make a colon cleanse product
much easier to tolerate.
Initially, I recommend that those with
long term constipation or slow bowels do
a thorough cleansing at the recommended
rate, or slower if necessary to tolerate
the usual mild increase in gas and bloating
symptoms that may accompany the
stirring up of old debris from the colon.
After the initial phase, lower daily doses,
or intermittent use may be effective.
Those with looser, frequent stools will
still benefit however, although a much
more gradual and gentle program may be
necessary. The additional herbs and nutraceuticals
in a good product should improve
the tolerability of any program for
these more sensitive patients. In either
case, once the colon is cleansed, maintenance
is important and this includes not
only regular use of a colon cleanse product,
but addition of beneficial bacteria.
Most patients with abnormal bowel
motility also have abnormal colonization
of their colon, and therefore their entire
body with excessive concentrations of
deleterious bacterial and fungi, instead
of the good bacteria that promote normal
digestion and metabolism. These
bacteria are generally depleted even in
people without bowel complaints, due to
a diet poor in raw whole foods, and excessive
exposure to antibiotics and overprocessed
foods. Most people eat yogurt
in hope of improving this imbalance, but
commercial yogurts are cow milk based,
and therefore poorly utilized by the human
digestive tract. A good probiotic
should contain multiple beneficial bacteria,
and should be concentrated enough
to make it through the stomach to the
intestines. Shelf stable products, if properly
produced are useful and practical for
most people. In patients with diverticulosis,
I recommend that they take these
products in relatively high doses to promote
a balance of good bacteria over bad
in their diverticuli, thus in theory at least,
reducing the chance of diverticulitis from
an overgrowth of toxic bacteria in the diverticulum.
As uncomfortable as bowel problems
and health are to discuss, they are a very
common cause of physical and social
discomfort for many. Short of mandating
perfect diets, recommending appropriate
supplements for patients suffering from
these problems is a step toward helping
them to achieve improved overall health.
For more information on colon cleansing
products or beneficial probiotic products
used by Dr. Joyce Luteyn, contact
(800) 574-1961, ext 1 or visit www.mtcapra.com.
Joyce Luteyn, M.D., is a
board-certified family practitioner.
She received her
medical degree from the
university of Washington,
and completed a uW
affiliated family medicine
residency in Vancouver,
Washington, in 1997. She
has been in full-time practice for eight years
in Olympia, where she lives with her husband
and two children. Her practice encompasses
the full range of primary care for patients of
all ages.
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