Gut Dysfunction and Chronic Disease : The Benefits of Applying the 4 R ® GI Restoration Program

Each day, the typical healthcare practice is challenged by several cases involving gastrointestinal (GI) complaints. Moreover, many conditions in which symptoms are not localized to the GI but may be systemic often involve an underlying GI dysfunction. For example, research has shown associations between compromised GI function and conditions as varied as rheumatoid arthritis, asthma, metabolic bone disease, and eczema. Therefore, assessment and proper support of GI function may provide benefit for patients with a variety of chronic complaints. The GI system is quite complex, and evaluation of GI function in order to design a therapeutic support program is often a difficult undertaking in a busy practice. A conceptual framework that enables the practitioner to evaluate and target therapies aimed at improving GI function has been developed. Called the 4R® GI Restoration Program, this approach uses the concepts of Remove, Replace, Reinoculate, and Regenerate to provide a focus for evaluation and treatment. The result of this approach is the ability to implement a targeted intervention program involving nutrients, digestive enzymes, and probiotics that promote normalized GI function and optimal health. Gut Dysfunction and Chronic Disease: The Benefits of Applying the 4R GI Restoration Program BY DEANN J. LISKA, PHD AND DAN LUKACZER, ND 558 10/01 Rev. 3/03 ANSR-APPLIED NUTRITIONAL SCIENCE REPORTS Copyright © 2001 by Advanced Nutrition Publications, Inc. 1 Gastrointestinal (GI) complaints are among the leading reasons for seeking out health care and the most common reason for hospitalization. In the United States alone, more than 70 million people suffer some form of serious GI disorder, which can range from mild symptoms to those serious enough to interfere with the patient’s normal life. Commonly encountered GI-related problems are diseases such as gastritis, peptic ulcer, colon cancer, diverticulosis, and inflammatory bowel disease (IBD). Even more common are the so-called “functional” disorders, which include chronic diarrhea, constipation, bloating, and flatulence—often lumped together as irritable bowel syndrome (IBS)—as well as nutrient malabsorption and esophageal reflux. Some diseases and disorders, such as constipation and diverticulosis, are increased significantly in people over 60 years of age and, therefore, are on the rise due to the aging of our population. THE GI–CHRONIC DISEASE CONNECTION The symptoms of these GI diseases and disorders are localized in the gastric and intestinal area, so it is easy to understand why therapeutic support for GI function should be included in the clinical strategy for patients with these complaints. What is surprising to some, however, is that GI dysfunction can underlie many apparently unrelated conditions; that is, disorders in which symptoms are not localized in the GI tract. For example, compromised GI function may result in macromolecules that would normally be excluded from the body instead passing through the intestinal barrier and entering circulation—a condition called intestinal permeability, or “leaky gut”—which can lead to many systemic inflammatory and immune-related symptoms. Leaky gut has been implicated in rheumatoid arthritis, ankylosing spondylitis, eczema, chronic urticaria, and IBD, among other conditions. (For more information on IBD, please refer to the Applied Nutritional Science Report entitled, Nutritional Management of Irritable Bowel Syndrome by James Rouse, N.D.) Small intestinal bacterial overgrowth (SIBO), a condition in which misplaced colonic flora or pathogenic growth has proliferated in the small intestine, is an example of GI dysfunction that can underlie a range of both local and systemic complaints. The presence of SIBO has been documented in patients with conditions as varied as metabolic bone disease, rheumatoid arthritis, IBS, and chronic diabetic diarrhea. SIBO has even been associated with vitamin B12 deficiency in the elderly. 15 In many cases, removal of the bacteria in the small bowel has been shown to result in improved health. For example, in one clinical study with IBS patients, eradication of SIBO and reestablishment of healthy microecology was shown to eliminate symptoms in 48% of the subjects. The normal function of the GI may be compromised even in patients who do not show overt symptoms of GI dysfunction, a fact that may predispose them to other complications. For example, approximately 44% of adults self-medicate for heartburn with antacids or other medications. These drugs function by decreasing or neutralizing the level of stomach acid, and therefore may hinder the adequate digestion of proteins and key nutrients like vitamin B12. Inadequate absorption of vitamin B12 has been associated with neurologic effects, such as senile dementia, and is estimated to affect 10%-15% of people over 60 years old. Furthermore, hypochlorhydria (low stomach acid) also predisposes an individual to exacerbation of bacterial and some parasitic infections. Another example is the use of non-steroidal antiinflammatory drugs (NSAIDs), both by prescription and by self-medication, which can lead to damage in the gastric mucosa. As many as 8% of the global adult population take NSAIDs at any given time, mainly for management of arthritis and inflammatory conditions, and this use is a significant cause of morbidity and mortality. The consumption of NSAIDs has been associated with a high incidence of upper GI complications, including gastric and duodenal ulcers, and GI mucosal lesions and hemorrhage. As can be seen by these and other examples, healthy GI function is key to overall health and its dysfunction is related to myriad diseases and conditions (Table 1). Table 1. Diseases and Conditions Associated with GI Dysfunction Acne rosacea Dermatitis herpetiformis Migraine headaches AIDS/HIV infection Diverticulitis Multiple chemical sensitivities Alcoholism Eczema Pancreatic insufficiency Autism Food allergies Peptic ulcer disease Celiac disease Fibromyalgia Pernicious anemia Childhood ear infections Gastritis Peripheral neuropathies Chronic yeast infections Hemorrhoids Psoriasis/Psoriatic arthritis CFIDS Hepatic dysfunction Rheumatoid arthritis Crohn’s disease Infectious enterocolitis Spondyloarthropathies Cystic fibrosis Irritable bowel syndrome Ulcerative colitis