Botanicals provide sound solutions for patients’ gastrointestinal issues.
The father of modern medicine, Hippocrates, once said, “All disease begins in the gut.” That statement couldn’t be truer today. Scientists refer to the gut as the body’s “second brain” as more than half of the body’s nerve cells are located in the gut. Further, approximately 70 percent of the immune system is located in the gastrointestinal (GI) tract, protecting the body from viruses and bacteria.
According to the National Digestive Diseases Information Clearinghouse (NDDIC), approximately 60 to 70 million Americans are affected by all digestive diseases. “GI inflammation is widespread among the American population as evidenced by the growing number of people with gastroesophageal reflux disease, inflammatory bowel disease (IBD) and peptic ulcer,” explained Mandy Kraynik, vice president of Integrative Therapeutics in Wisconsin. “According to the Centers for Disease Control (CDC), these three inflammatory diseases alone affect more than 13 million Americans. However, celiac disease, food allergies and intolerances, and irritable bowel syndrome (IBS) are likely to account for millions more cases of GI inflammation.”
That, in turn, is being reflected in sales of natural ingredients for digestive health, which is one of the fastest growing markets in the United States, according to Tammi Geiger, director of marketing for Wisconsinbased Standard Process. In 2010, the total U. S. market for digestive health ingredients was valued at $265.9 million with an annual growth rate of 18.3 percent. Between 2010 and 2015, the market’s expected annual growth rate (CAGR) is 13.2 percent, with 2015’s expected revenue to reach $495.3 million. 1 “Well-documented studies showing that proper digestive function is interlinked with the immune system and a prerequisite have brought more visibility to this category,” said Geiger.
Finding the Cause
Eating processed food, not getting enough exercise and coping with stress are some factors leading to the population’s GI issues, such as IBS or IBD, with the two most common IBDs being ulcerative colitis and Crohn’s disease, the CDC reports. Both illnesses have one strong feature in common: they are marked by an abnormal response by the body’s immune system, according to David Barton, director of education for Enzymedica in Florida. “An ‘abnormal response’ by the immune system attacking the cells lining the GI tract is one of the main reasons for GI inflammation,” he said. “Normally, the immune cells protect the body from infection. However, the immune systems of people with IBD mistakes food, bacteria and other materials in the intestine for foreign substances and it attacks the cells of the intestines. In the process, the body sends white blood cells into the lining of the intestines where they produce chronic inflammation.When this happens, the patient experiences the symptoms of IBD.2”
IBD is not the only GI inflammation issue that people are dealing with today.While Crohn’s disease and ulcerative colitis remain on the more serious and severe end of the spectrum, less threatening problems, such as heartburn, are becoming a larger topic of concern. “Recent studies have made the news, raising concerns that some conventional approaches to GERD (gastroesophageal reflux disease) and acid reflux, such as antacids and proton pump inhibitors (PPIs), may interfere with optimal mineral absorption, resulting in decreased bone density,” said Beth Baldwin-Lien, ND, medical affairs and education for Connecticut-based Vital Nutrients.
And while heredity may be the cause of GI inflammation in some cases, Stephanie Latter DC, CNS, CCN, owner of Total Life Care Charleston in South Carolina, noted that it most often starts with the diet. “Dietary risk factors include high intakes of total fat, omega-6 fatty acids, refined sugars and meat, while high vegetable and fruit intake decreased the risk for IBD,” she explained. “One study3 even looked at a link between increased consumption of saccharin and sucralose in the increased development of IBD in people due to artificial sweetener’s ability to inhibit non-pathogenic gastrointestinal bacteria.”
Further, Guy Devin, PhD, owner and director of Energetic Insights in Arizona, said he believes that the rise of genetically modified organisms (GMOs) being used in staple food products has played a part in the rise in GI inflammation cases. “Inflammation has perhaps risen 10 to 15 percent per annum over the last five to 10 years,” he said. “This is mainly due to the onslaught of chemicals put in our food. The amount of GMO technology used in soy and wheat, just to name a few, are major contributors to inflammation in the gut. One last key area would be the over prescribing of antibiotics used in food as well as over prescribing of these compounds.”
A Natural Approach
While traditional treatments for GI inflammation can include prescription medications and, in extreme cases, surgery, in recent years Americans have become more health conscious, increasingly opting for natural routes. “Category growth is being driven by rising health care costs and the spending strength of the aging Baby Boomer population and other health conscious consumer cohorts who favor supplements as an affordable way to stay healthy,” said Standard Process’ Geiger. “This shift toward an increasingly health conscious attitude, along with increased research, will help push nutritional products further into the mainstream.”
Making the necessary changes to a patient’s diets is the first step for many natural practitioners, according to Dr. Latter, who recommends:
• Removing all inflammatory foods from the diet—including sugar, wheat, corn, cow dairy, night shade vegetables, alcohol and caffeine
• Removing all chemical additives from the diet—such as high fructose corn syrup, trans fats, artificial sweeteners, artificial colors/ dyes and monosodium glutamate
• Avoiding all processed and refined foods
• Increasing consumption of anti-inflammatory foods—such as salmon, walnuts, olive oil, avocados and dark green vegetables (if the patient can tolerate those foods)
• Drinking plenty of water each day—at least eight 8-oz. Glasses daily to facilitate the bowel’s ability to detoxify substances
Adam Killpartrick, DC, director of product development for Innate Response Formulas in New Hampshire, also recommends taking a food allergy test, as a food intolerance or allergy may be the cause of GI inflammation in some cases. “Elimination diet and food allergy testing are incredibly useful in the management of IBD patients,” he said. “These strategies are often the most obvious, but also the most profound. IgG (immunoglobulin G) testing can offer key insight into the foods that are exacerbating the inflammatory response in the gut.”
In addition, Vital Nutrients’ Dr. Baldwin- Lien noted that going gluten-free is becoming more popular with those suffering from GI inflammation. “Gluten-free diets are a major trend right now; while avoiding gluten used to be a therapy recommended only for those diagnosed with celiac disease, more people are taking a look at gluten and other aspects of their diets and assessing how they might be affecting their level of GI inflammation, weight and overall health,” she said.
Stress also can have an effect on inflammation of the gut, so managing stress levels can have a profound effect on inflammation of the gut. Dr. Killpartrick advises practitioners to do everything possible to aid patients with stress reduction. “It sounds so commonplace at this point to say, ‘Decrease your stress.’ It’s something patients read and everywhere,” he explained. “But to elevate yourself to the level of outstanding health care provider, take the time to work with your patients on stress reduction strategies like simple breathing exercises. There have been two small studies4 that have examined the role of acute daily stress in IBD, and suggest a positive association between disease relapse and exacerbation.”
In addition to embracing an antiinflammatory diet and managing stress, introducing nutrients and botanicals that reduce inflammation in the gut can help get the issue under control. Probiotics are nonpathogenic microorganisms that can aid in improving the microbial balance in the GI tract. According to Dr. Latter, probiotics confer their beneficial effects through various mechanisms, including reduced intestinal pH, decreased colonization and invasion by pathogenic organisms, decreased inflammatory markers and midfication of the host immune response.
“Numerous studies suggest that dysbiosis can disrupt the balance of inflammatory mediators and may contribute to intestinal barrier permeability,” said Intergrative Therapeutics’ Kraynik. “Supplementing with probiotics can restore microbial harmony, especially after a course of antibiotics or in the presence of a bacterial, viral or fungal overgrowth. Some strains, such as Lactobacillus rhamnosus, have also been shown to provide direct anti-inflammatory activity in models of IBD.”
Digestive enzymes aid in the complete breakdown of food and assimilation of nutrients. The three primary digestive enzymes are protease, amylase and lipase. “Supplemental enzymes may provide digestive support to those suffering with IBD*,” explained Barton. “Enzymes digest food to its simplest components, proteins to amino acids, carbohydrates to simple sugars, and fats to fatty acids. Once we digest food to its base nutrients, optimal digestion is achieved, which encourages healthy inflammatory responses. In contrast, poor digestion allows undigested proteins to occupy the GI tract in which the immune system reacts by causing abnormal inflammation.”
In 2011, Enzymedica, Inc. launched its Enzyme Science division to provide an exclusive brand of formulas for health care practitioners. The Enzyme Science line features Enzymedica’s proprietary Thera-blend technology in therapeutic formulas designed to meet the specific needs of physicians and health care practitioners. Enzyme Science’s Flex-Mend is a therapeutic enzyme formula taken on any empty stomach to support healthy inflammation.* Its most beneficial activity is due to the proteolytic enzymes hydrolyzing dead/damaged protein structures that may influence an immune response, according to Barton.
Enzycore from Standard Process is a comprehensive blend of microbial enzymes and whole food ingredients designed to support healthy digestion and maximize nutrient absorption. Enzycore contains microbial enzymes for action within a broad range of pH as well as a blend of enzymes that comprehensively break down fats, proteins and carbohydrates. In addition, the product contains L-glutamine as well as kale and beet powder for their trace amounts of lutein and betaine. Enzycore provides support during both gastric and intestinal phases of digestion,* according to the company.
L-glutamine is the most abundant naturally occurring amino acid in the body. But some instances, such as IBD, can dramatically increase the body’s requirement for it. “Because glutamine stores are severely depleted during the inflammatory response in the gut, supplementing with adequate glutamine may be key as deficiency of glutamine has significant negative effects on the integrity of the intestinal wall,” explained Dr. Killpartrick. “Lack of integrity of the GI tract will facilitate further inflammatory responses.”
GI Repair Powder from Vital Nutrients is formulated to provide support for inflammatory bowel conditions, infectious diarrhea and “leaky gut” (or increased intestinal permeability). GI Repair Powder contains L-glutamine, N-acetyl glucosamine, which is a crustacean-derived precursor to the glycosaminoglycan (GAG) molecules of the intestinal mucosa, as well as MSM and rutin to support mucous membrane integrity. The slippery elm bark powder and aloe vera extract in the formula act as demulcents to soothe and coat, while lactoferrin (from New Zealand whey) helps modulate inflammatory activity in the intestine. Zinc carnosine, an amino acid chelate that supports gut repair, has been shown to prevent H. pylori from binding to ulcer sites. According to Vital Nutrients, GI Repair Powder has a very neutral, mild taste, mixes easily in water and is gluten-free.
Meanwhile, Intregrative Therapeutics’ Glutamine Forté delivers a therapeutic level of L-glutamine (5,000 mg [5 g] per serving) in combination with Theracurmin, a novel, water-dispersible form of turmeric with dramatically enhanced curcumin bioavailability.
“Turmeric is a rhizomatous herbaceous perennial plant of the ginger family that has been used for a variety of health ailments in India and China since 700 A.D.,” said Dr. Latter. “The key constituent in turmeric that provides its anti-inflammatory effect is curcurmin. Since turmeric is more bioavailable in the digestive tract, it has been proposed that it is most useful for restoring function in bowel disorders.5 Practitioners can suggest that patients can easily use turmeric in their diets by adding it to vegetables, homemade salad dressings or brown rice dishes. However, in order to achieve a therapeutic dose, turmeric supplementation may be prudent.
“A variety of foods and herbs exist in nature that provide anti-inflammatory effects on the digestive system and human body,” continued Dr. Latter. “In recommending supplements, I prefer to use those made from whole food ingredients to ensure that the patient is receiving all of the nutrition that would be available from eating the foods as opposed to receiving a high dose of just one nutrient.”
Helping patients understand why diet and lifestyle changes are being implemented and how they will affect them in the long run can go a long way in garnering patient cooperation.
“The best way for practitioners to better serve their patients when it comes to GI inflammation is education,” said Dr. Latter. “Because there is a good opportunity to help alleviate some symptoms by small changes in the diet, it is imperative for practitioners to educate their patients on which foods to consume in greater quantities, and which foods should be eliminated completely. Simple is generally best when working with patients, so practitioners can create simple handouts for the patients outlining the anti-inflammatory foods versus the inflammatory foods. Practitioners can also provide their patients with educational materials on natural whole food supplementation that can help improve bowel function.”
“The future of this market is gaining in strength as more people are suffering with inflammatory issues in the body, not only in the GI tract,” concluded Dr. Devin. “We are a society on fire and we must find ways to put that fire out as this inflammation is a silent killer.”
* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
1 U.S. Digestive health Enzymes, Prebiotics & Probiotics Market (2010-2015). Accessed 1/28/2013. Www.marketsandmarkets.com/PressReleases/usdigestive- health-ingredients-market.asp.
2 U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011). Inflammatory bowel disease (IBD). Retrieved from website: www.cdc.gov/ibd/.
3 Qin, X. Etiology of inflammatory bowel disease: A unified hypothesis. World J Gastroenterol 2012 April 21; 18(15): 1708-1722.
4 Garrett VD, Brantley PJ, Jones GN, et al. The relation between daily stress and Crohn’s disease. J Behav Med 1991;14:87, Greene BR, Blanchard EB, Wan CK. Long-term monitoring of psychosocial stress and symptomatology in inflammatory bowel disease. Behav Res Ther 1994;32:217–26.
5 Rajasekaran, S. Therapeutic potential of curcumin in gastrointestinal diseases. World J Gastrointest Pathophysiol. 2011 February 15; 2(1): 1–14.
Healthy Take Aways
Approximately 70 percent of the immune system is located in the GI tract. An ‘abnormal response’ by the immune system attacking the cells lining the GI tract is one of the main reasons for GI inflammation.
According to the CDC, the two most common IBDs are ulcerative colitis and Crohn’s disease.
IgG (immunoglobulin G) testing can offer key insight into the foods that are exacerbating the inflammatory response in the gut.
L-glutamine is the most abundant naturally occurring amino acid in the body. But some instances, such as IBD, can dramatically increase the body’s requirement for it.
FOR MORE INFORMATION:
Enzymedica/Enzyme Science, (888) 918-1118, www.enzymedica.com
Integrative Therapeutics, (800) 931-1709, www.integrativeinc.com
Standard Process Inc., (262) 495-6382, www.standardprocess.com
Vital Nutrients, (888) 328-9992, www.vitalnutrients.net
Botanicals provide sound solutions for patients’ gastrointestinal issues.