Parasites, Dysbiosis & Leaky Gut – Part 3

http://www.crohns.net/Miva/education/articles/powerhealing_leogalland.shtml

INTESTINAL PARASITES, BACTERIAL DYSBIOSIS AND LEAKY GUT

EXCERPTS FROM POWER HEALING (RANDOM HOUSE, 1998)
BY LEO GALLAND, M.D.

Just as excessive permeability may have many different effects, it may also have many different causes, each of which may add to the effects of the other. These causes include intestinal infection of any type (viral, bacterial or protozoan), alcohol, and NSAIDs (non-steroidal anti-inflammatory drugs) which increase permeability by decreasing the body's synthesis of beneficial prostaglandins. Allergic reactions to foods also produce an increase in intestinal permeability.

The fate of people treated for chronic arthritis exemplifies the spiral of problems caused by excessive intestinal permeability. Arthritis (inflammation of the joints) is the leading cause of physical disability in industrialized countries.

Some forms of arthritis are preceded by increased intestinal permeability. People with inflammation of the intestine are prone to develop inflammatory arthritis which may continue for many years after the intestinal inflammation is healed. Fragments of intestinal bacteria have been identified in the joints in some cases. In others, antibodies directed against intestinal bacteria may attack the person's own joint tissue, causing an auto-immune reaction.

For most people with chronic arthritis, however, excessive intestinal permeability develops as a result of arthritis and its treatment and may aggravate the arthritis, creating a vicious cycle. People with any type of severe arthritis usually take large doses of NSAIDs on a daily basis to control the pain, stiffness and swelling in their joints; they rapidly develop increased intestinal permeability. Excessive permeability allows bacteria or bacterial antigen to penetrate the wall of the intestine, creating a smoldering inflammation in the intestinal wall (called enteritis), which in turn further increases intestinal permeability. Enteritis develops in seventy per cent of people taking NSAIDs daily for two weeks. The excessive permeability caused by drug-induced enteritis allows fragments of bacteria to enter the circulation, where they cause or aggravate more arthritis.

Much of the research on intestinal permeability and NSAIDs has been conducted with people who suffer from rheumatoid arthritis, an inflammation which affects many joints at the same time and is especially noticeable in the hands. It typically strikes women in their twenties or thirties and lasts for life, crippling thirty per cent of its victims with severe deformities of the affected joints and shortening their life expectancy by ten to fifteen years. Patients with rheumatoid arthritis taking NSAIDs develop antibodies against components of the normal intestinal bacteria. Development of an abnormal or excessive immune response is called sensitization. Sensitization to intestinal bacteria may cause or aggravate arthritis. When patients with rheumatoid arthritis take antibiotics which reduce the numbers of intestinal bacteria, not only does their enteritis clear up, but their arthritis also improves. NSAIDs, the standard treatment for arthritis, by increasing intestinal permeability, create a new problem which aggravates the old one. Increased intestinal permeability explains the beneficial effects of diet for the treatment of rheumatoid arthritis. Fasting and vegetarian diets benefit patients with rheumatoid arthritis. Fasting reduces the excessive intestinal permeability of patients with rheumatoid arthritis while at the same time dramatically improving symptoms. Vegetarian diets alter the bacterial growth in the intestine, acting in a sense like natural, highly selective antibiotics. Those people who respond to vegetarianism with a change in the intestinal bacteria are the ones that benefit. Those people who do not change their intestinal bacteria as a result of changing their diets do not improve their arthritis by becoming vegetarians.

There is a common belief that avoiding specific foods can benefit people with arthritis. One effect of the increased permeability produced by NSAIDs is to increase the absorption of antigens coming from food. People with rheumatoid arthritis frequently become sensitized to food proteins. Their arthritis often improves when they avoid specific foods and then flares up when they consume those foods. I have treated enough patients with rheumatoid arthritis to know that food allergy is not the cause of rheumatoid arthritis. It is part of the cycle of immunologic sensitization, inflammation and increased intestinal permeability that occurs in most patients with severe arthritis. The treatments that are used for chronic arthritis may temporarily relieve pain but they help to maintain the vicious cycle. Perhaps this explains why the long term outlook for patients with rheumatoid arthritis is so bleak and has not been improved by any of the drug therapies developed over the past thirty years. Professor Ann Parke, of the University of Connecticut, voiced an opinion not often heard from rheumatologists, "...maybe NSAIDs have had their day. We should, instead, be striving to maintain the integrity of the gastrointestinal tract in an attempt to prevent the disease at a potential source, rather than treating the complaints and risking perpetuating the disease."

If medicine is to regain its Hippocratic roots, preserving and restoring health, then physicians must learn the science of preserving and restoring normal intestinal permeability. This is not an attempt to "cleanse" the colon with laxatives or enemas or to correct constipation. In the early years of the twentieth century, "auto-intoxication" was a fashionable concept. It was considered to be the cause of chronic fatigue, stomach ulcers, rheumatoid arthritis, high blood pressure, hardening of the arteries, breast cancer and ovarian cysts. The complex regulation of intestinal permeability was not understood and autointoxication was attributed to "intestinal stasis", a fancy term for constipation. In keeping with the spirit of the times, it was treated invasively: enemas for mild cases, colectomy (surgical removal of the large intestine) in severe cases. Even institutions as august as the Mayo Clinic sanctioned colectomies for autointoxication during the first two decades of the twentieth century.

The preservation and restoration of normal intestinal permeability rests on two principles: building resistance and reducing risk. A diet of high nutrient density, described in Chapter...., is the cornerstone for maintenance of intestinal health. The intestinal lining has the fastest growth rate of any tissue in the body. Old cells slough off and a completely new lining is generated every three to six days. The metabolic demands of this normally rapid cell turnover must be met if excess permeability is to be prevented or if healing is to occur. Thorough chewing of food may be important. Saliva contains a substance called epidermal growth factor (EGF) which stimulates growth and repair of tissue. EGF has been used therapeutically to heal the intestine when injured or inflamed.

Essential fatty acids play an important role in maintenance of intestinal integrity. Fish oils limit the intestinal injury caused by toxic drugs and GLA (found in primrose, borage or black currant oils) stimulates production of prostaglandins which help to maintain normal permeability. The principles for EFA supplementation detailed on pages.....should be followed. Merely consuming large quantities of vegetable oils, however, is likely to be harmful to the intestinal lining. High intake of polyunsaturated oils increases the free radical content of bile, producing a toxic bile that may damage intestinal integrity.