QUIT Your Belly-Aching with Probiotics and Enzymes

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As the old saying goes, the way to a person's heart is through their stomach. Enjoyment of food and the act of eating is central to our individual and collective well-being. Eating well is essential for health. Yet many people suffer from digestive complaints that prevent them From enjoying food and interfere significantly with their overall functioning. As a primary care physician with a diverse patient population, I see gastrointestinal complaints several times per day, and they are a very common cause of acute and chronic health problems in patients of all ages. Some of these patients have conditions easy to diagnose and treat, such as acute gall bladder disease, but most are more complicated, nebulous, difficult to sort out, and may involve a comprehensive and frequently lengthier approach, for long-term symptomatic improvement.

"Indigestion, dyspepsia, irritable bowel syndrome, bloating, belching, flatus, it comes back up, it goes right through me, nothing ever moves through." These are the usual descriptions I hear every day. Most, if not all, are not life threatening but cause distress, absence from work, and many visits to doctors and other health practitioners. People suffering digestive ailments may avoid what they view as trigger foods, such as legumes and members of the broccoli family, when these foods contain the very nutrients and fiber that would otherwise improve their intestinal and overall health, if tolerated digestively. Irritable bowel syndrome, a common and frequently misunderstood motility disorder of the intestines, alone is one of the greatest causes of work loss in the United States. Although prescription medications now exist that can be helpful, many sufferers do not receive or use them, or are seeking a more holistic approach to relief. Botanicals and food supplements, specifically probiotics and plant based digestive enzymes can play a role in that holistic approach, particularly in aiding digestion and by promoting beneficial colonization of the intestinal tract with bacteria that can compete with pathogens.

As always, I urge caution when it comes to self-diagnosis. If you have fever, unexplained weight loss, persistent stool change, especially bloody stools, or if you have severe or persistent abdominal pain, please seek medical care immediately. The vast majority of patients with persistent abdominal complaints however, have already seen not just one, but many practitioners, have been assured their problems are not dangerous, but they are still suffering, still missing work, still seeking a solution. I certainly would never suggest that these practitioners are not competent or that I have a solution when others do not. Indeed, in many instances I find the patient has been noncompliant with a previously recommended strategy that seems sound to me. Lifestyle changes are usually essential and are the hardest things to inspire and enforce, but in a willing patient, I almost always recommend the addition of whole food supplements to my otherwise allopathic approach to their health problem. This article will focus mostly on upper gastrointestinal problems, with the emphasis on digestive enzymes and probiotics, but because probiotics act in the upper and lower gastrointestinal tract, there will be overlap, both anatomically and figuratively in this discussion. For a discussion on colon health and cleansing see my article "A Clean Start" Jan./Feb. 2007 Volume 28, No. 5 issue of totalhealth.

Although the human body can theoretically produce all the essential food digesting enzymes from ingested amino acids, the truth is that for multiple reasons, the endogenous system is chronically challenged and frequently lacking. With age, the essential functions of the stomach, liver, and pancreas begin to wane, leading to relative depletion of endogenous enzymes necessary for digestion of fats, proteins, and carbohydrates. Even in otherwise healthy individuals, these enzymes can be diminished in amount or efficacy by use of antacids, more powerful anti-ulcer medications, antibiotics, or in rare cases from inappropriate use of natural or botanical agents. Thus, even with a diet rich in nutrients, the absorption of those nutrients can be limited by a lack of adequate enzyme activity to fully break down food into molecules accessible to the cells of the digestive tract. Addition of pH neutral, full spectrum plant based digestive enzymes is usually helpful in this population, as is the addition of a digestible probiotic formula to assist digestion and colon health. Products that are goat milk based or pre-fermented in goat's milk have been consistently effective and well tolerated by my patients, and historically worldwide, sol routinely recommend them. This is especially true for probiotic formulations, as those that are cow milk based are so dissimilar from human milk as to be unlikely to benefit the human digestive tract, while goat's milk formulations closely resemble the composition of human milk. Digestive enzyme supplements that contain and/ or are fermented in goat's milk are, in my clinical experience more effective and better tolerated than the other choices on the market.

A good enzyme supplement contains not only back-ups for our endogenous enzymes that are produced and act in the stomach, pancreas, and small intestine, but also contains enzymes our body is not able to produce, to improve the digestion of healthy but otherwise challenging foods, such as cruciferous vegetables and legumes. Endogenous enzymes, such as pepsin, amylase, lipase, trypsin and chymotripsin act over a very narrow pH range and can thus be inactivated or decreased in quantity by commonly used antacids, interactions with other medications, or the changes of aging. Plant based proteases work over a broader pH and are abundant on raw, unprocessed food, but are readily destroyed by cooking, freezing, or pickling, making most of our diets poor in these helpful workers. Enzyme supplements taken with meals overcome this problem. In addition, there are many useful enzymes that are not produced by the body and therefore must come from .the food we eat or from a supplement. Notable examples are alpha galactosidase, which aids in the digestion of the plant sugars in beans, peas, many grains, and vegetables such as broccoli and cabbage, reducing the uncomfortable social side effects of these nutrient giants. Cellulase, xylanase and xylase are exogenous (not made by our bodies) enzymes useful for breaking down the cell wall of plant fibers, making their nutrients available for absorption and assimilation, and reducing the intestinal distress frequently caused by their ingestion. I look for enzyme supplements that contain a full complement of plant based digestive enzymes, not just a few. The inclusion of traditional soothing botanicals such as ginger root, turmeric, cat's claw, and aloe vera as well as natural sources of fiber such as oat, wheat, and barley grasses round out a good enzyme supplement and I look for them when I am choosing a product. Because so many food products in our society contain cow's milk, and lactose intolerance is so common, lactase, and enzymes for breaking down milk proteins are also a must in any dietary enzyme supplement. The consumption of concentrated probiotics, made from sources other than cow's milk will also aid in the digestion of dairy products as well as other nutrients.

For many, our own intestinal flora are altered or depleted by the very same lifestyle that leads to enzyme deficiency, namely the over consumption of cooked and processed foods. A single course of antibiotics may deplete the normal bacteria of a human digestive tract for months, which are hard to replenish without supplements. Therefore, I consider a good probiotic in tandem with a good plant based digestive enzyme supplement to be an important compliment of a wellness program for the gut. The best formulations are either refrigerated, or more conveniently shelf stable, and contain a high concentration of multiple beneficial bacteria, including Lactobacillus (there are several important species), bifidus species, and Streptococcus thermophilus, most commonly found in yogurt. For reasons I have mentioned, I prefer and recommend products extracted from and fermented in goat's milk. The company I like best uses only organic feed and has a reputation for humane treatment of its animals, another consideration when choosing a product.

A holistic approach to digestive and intestinal health, of course includes attention to the health of the whole mind and body. Excessive stress, exposure to toxins, and inadequate sleep, water, and exercise are common reasons for health complaints of all types, but tend to hone in on the gut more often than on other body systems. I feel confident that the nutritional supplements I am recommending are safe for most people, but remember to keep your health practitioners aware of any supplements you are taking. Knowing your history is vital, but understanding your preferences for supplements and how you include them in your health regimen is important for any practitioner who will be involved in caring for your health. As an allopathic physician, I appreciate the respect of my patients for my traditional training and for my interest in an integrated approach to their health care problems. Fixing an unhappy gut is one of my greatest pleasures. When the holistic approach works, and the patient feels well, I feel like I have made my way into their heart, right through their stomach.

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By Joyce Luteyn, M.D.

Illustration by Jeff Ham

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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