RISK REDUCTION

The most common, preventable causes of increased intestinal permeability are drugs and infections. Aspirin and NSAIDs should not be taken on a daily basis. Most people using NSAIDs daily are trying to relieve chronic headache or joint and muscle pain. Alternative strategies for pain relief are often available. The likelihood of benefit depends upon the location of the pain and the presence or absence of inflammation. Pain control strategies and resources are listed in Appendix IV.

After NSAIDs, alcohol is the drug most likely to destroy normal intestinal permeability. More than one glass of wine or beer is likely to be detrimental.

The body's first line of defense against intestinal infection is the acid produced by a healthy stomach. Stomach acid kills most of the bacteria and parasites that are swallowed along with meals. Strong suppression of stomach acid increases the risk of intestinal infection. The widespread use of antacids is, therefore, a reason for concern, and the FDA's recent decision to make the acid-lowering drugs Tagamet and Pepcid available without a doctor's prescriiption is a terrible disservice to the American people. Most people who take treatments to buffer or reduce stomach acid do not need acid reduction and should avoid it. Tagamet and Pepcid are called H-2 blockers because they block certain effects of histamine in the body. (Conventional "anti-histamines" used for treating symptoms of allergy are called H-1 blockers). They were originally developed for the treatment of ulcers and they made huge profits for the companies which owned them. Doctors soon began using H-2 blockers for relieving stomach pain which was not caused by ulcers (this pain is called "non-ulcer dyspepsia"), even though their efficacy for non-ulcer pain was disputed. The most common cause of non-ulcer dyspepsia, by the way, is taking NSAIDs. If NSAID use were markedly reduced, the frequency of stomach pain and the need for H-2 blockers would also be reduced. Recently, it has become quite clear that most ulcers are triggered by a bacterial infection of the stomach and that antibiotics are superior to H-2 blockers for treating ulcers. As the need for H-2 blockers in the treatment of ulcers just about vanished, the FDA suddenly approved their non-prescriiption use for the treatment of heartburn. The truth is that H-2 blockers are rarely needed to treat heartburn, because heartburn is not caused by excess stomach acid. It is caused by reflux of normal amounts of stomach acid into the esophagus, which occurs when the valve responsible for preventing acid reflux is not working properly. The usual reason for valvular incompetence is dietary. Coffee, alcohol, chocolate and high fat meals prevent the valve from closing properly. Calcium, in contrast, makes it close more tightly.

Almost all people with frequent heartburn can get relief by eating small, low fat meals, chewing a calcium tablet after each, and not eating for four hours before bedtime. Temporary avoidance of coffee, alcohol, and spicy or irritating foods until the heartburn stops is also a good idea. Were these measures followed, the use of H-2 blockers and antacids could be cut by ninety per cent.

A second line of defense against intestinal infection is the normal intestinal bacteria, especially Lactobacilli residing in the small intestine. Antibiotics decimate Lactobacilli. In so doing, they may increase the risk of subsequent intestinal infection. Although antibiotics, when appropriately used, are the most important therapeutic discovery of modern Western medicine, they are often used inappropriately and the effects can be devastating. Whenever I prescribe an antibiotic, I always consider its possible effect on the beneficial intestinal flora. An antibiotic that is rapidly and completely absorbed in the stomach, reaching high levels in the tissues of the body and low levels in the small or large intestine, is least likely to harm intestinal ecology. I also administer Lactobacilli along with the antibiotics. L. plantarum is the only Lactobacillus not harmed by antibiotics and can be taken simultaneously with them.