Celiac disease is a condition in which the small intestinal lining becomes damaged as a result of a reaction against a common dietary ingredient, gliadin, a protein in gluten found in wheat, barley and rye. About one percent of the U.S. population is affected by celiac disease, yet most have not been diagnosed. Celiac disease diagnosis is confirmed by biopsy of the small intestine.

Scientists are trying to determine why so many cases of celiac go undiagnosed. A recent study by Colombia University Medical Center has found one reason—improper intestinal biopsy. Celiac disease affects patches of the small intestine, not the entire intestine. Medical recommendations for intestinal biopsy suggest that at least four specimens be taken to ensure that enough areas of the intestine are sampled to detect damage. Researchers used a nationally representative database of over 100,000 individuals who had undergone intestinal biopsy for symptoms like diarrhea, abdominal pain, esophageal reflux, and anemia and found that only 35 percent had the recommended four specimens taken. Most had only two.

In those individuals in whom four specimens were taken, the diagnosis rate for celiac disease more than doubled. “The process of increasing the number of specimens from two to four takes approximately one extra minute during endoscopy,” said Dr. Lebwohl, lead author of the study.

Celiac disease is the most severe form of gluten intolerance, another condition that doesn’t involve intestinal damage—yet! If you are undergoing a biopsy to detect celiac disease, be sure to ask the doctor if they’re taking at least four specimens. If the biopsy comes back negative, however, don’t think you can jump right back into eating gluten. You may have the milder form of gluten sensitivity. A stool test from enterolab.com could help you determine if this is what ails you.

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Renew You Challenge

Let’s start this week off right!

Weekly challenge (I mean, opportunity!) to help set you off on the right foot and in the right direction for bringing health to your week. You could even add it to your calendar. Join us!

Irritable bowel syndrome (IBS) is a common gut disorder characterized by abdominal pain and discomfort, and altered bowel habits—constipation, diarrhea, or usually, alternating between both. People with IBS have a decreased health-related quality of life. Often, they also experience such conditions as fibromyalgia, depression, or even colon cancer.

It is known that women with IBS are less physically active than healthy women, and that women with IBS who do participate in regular physical exercise experience less fatigue or bowel complaints. A study published in the American Journal of Gastroenterology takes this association one step further by testing whether increased physical activity decreases IBS symptoms, and whether it increases quality of life.

As it turns out, regular exercise—20 to 60 minutes of moderate-to-vigorous physical activity 3 to 5 days per week—improved gastrointestinal symptoms and quality of life in people with IBS. The researchers recommend that physical activity be used as a primary treatment modality for IBS. 

I recommend exercise a lot because I believe it should be a part of everyone’s routine. It helps improve gut function, yes, but it also helps improve just about every area of health. So this week, if you or someone you know has IBS and you aren’t getting enough physical exercise, get moving. Find some form of exercise that makes you feel good, and just do it.

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On May 27, 2011 a New York Times article reports that Sherwood Gorbach, a 71 year doctor, has been instrumental in the development of a new antibiotic, Dificid, also known as fidaxomicin, for treating C. difficle (C. diff) diarrhea. Dr. Gorbach spent most of his professional life as professor of medicine and public health at Tufts University. He is also well known in the natural health community as one of the co-inventors of a probiotic known as Lactobacillus GG  (GG stands for Drs. names: Sherwood Gorbach and Barry Golden).  So it is needless to say he is well versed in the use of probiotics.

The discovery and bringing to market of Dificid is no doubt a wonderful event. One reason is there are more antibiotic resistant C. diff strains due to the overuse of Flagyl and Vancocin which have been the mainstays for C. diff treatment. It is important to point out that there are many studies in the medical literature that show the concurrent use of probiotics or probiotic yogurts with antibiotics greatly reduce or prevent C. diff in the first place. ¹ Also, prolonged use of probiotics after a C. diff infection reduces the likelihood of getting recurrent C. diff infections. What a novel concept—why not use probiotics and/or fermented yogurt on a regular basis?  

It turns out that the Dificid, at this point in time being the “new kid on the block,” was shown to be much better than Vancocin in preventing recurrent C. diff. About 25 percent of the Vancocin users had a recurrence compared with only about 15 percent of the Dificid users. Why would this be?  It’s too soon and too new for resistant C. diff strains to develop! What’s more, Dificid like most prescription drugs, has its dark side—namely side effects of nausea, vomiting, abdominal pain and gastrointestinal hemorrhage. Now let’s talk about cost; the drug is likely to be at least as expensive as Vancocin, which costs $1,000 or more for a course of treatment. Optimer, the pharmaceutical company that sells Dificid, is predicted to make about $159 million per year after a few years of selling the drug.

If we really had a health care system in addition to a sickness care system, probiotics would be taken as seriously (if not more so) than antibiotics in both the prevention—and yes, the treatment—of most all infections. It would be interesting for both Dr Gorbach and the New York Times to tell the more complete story of how Dificid could be avoided, but if truly needed, be complemented with probiotics that would include multiple species and strains of Lactobacillus and Bifidobacteria in a high enough dose to really matter, several hundred billion probiotic bacteria per day.

1. Hickson M, et al., “ Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial.” BMJ. 2007 Jul 14;335(7610):80. Epub 2007 Jun 29.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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There is still a general belief with medical doctors and the public as well that Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) are mostly stress-related psychological disorders. I have personally had many patients who were reluctant to discuss their bowel problems for fear of being labeled a “psych” case. Many practitioners still aren’t aware there can be legitimate causes of disease that come from both mind and body.

With IBS and IBD, as with most discussions, there is often an element of truth on both sides or there would be no controversy. First, let’s look at the validity of the stress factors. People with genetic short serotonin transporter systems react negatively to stress-related increases in cortisol (a stress hormone) than people with normal serotonin transport systems.1 Second, ALL people react to significant stress, which can produce damage to the gut epithelial lining. However, people with a history of IBD generally show more gut lining damage than those without IBD. The damage includes: increased levels of stress hormones, activation and degranulation of mast cells, mitochondrial damage in epithelial cells, and mucosal protein oxidation which can create multiple problems with permeability (leaky gut) and immunity.2 Again, this happens to everyone under stress, but is worse with IBS and IBD because stress can trigger a relapse of either condition.

On the other hand, there are many reports that suggest anywhere from 20 to 60 percent of IBS and IBD patients have had a serious gastrointestinal infection days or weeks before they began having symptoms of chronic bloating, abdominal pain, diarrhea or constipation (or both diarrhea and constipation) that may have lasted years. A study was done on 111 patients with IBS using the lactulose breath test (measures hydrogen and methane gas produced by too many of the wrong bacteria) and 84 percent of patients were positive, which indicates small intestinal bacterial overgrowth (SIBO). Those who were treated with a non-absorbable antibiotic, Neomycin, had a statistically significant improvement both in symptoms, and normalization of the breath test.3 A more recent study4 showed that patients with IBS, but without constipation, treated with rifaximin (a broad spectrum non-absorbable antibiotic) for two weeks provided significant relief of IBS symptoms including: bloating, abdominal pain, and loose or watery stools.

Both of these studies strongly suggest that bacterial overgrowth, which creates a low-grade infection, is a major part of IBS, and can be treated with antibiotics. In addition, I think the standard of care today strongly suggests using probiotics while on antibiotics. This has been shown to lower the incidence of antibiotic associated diarrhea (AAD), and especially Clostridium difficle diarrhea, which can lead to total removal of the colon or even death.

Probiotics alone have been shown to significantly help with IBS. More specifically, probiotics enhance gut barrier function, inhibit pathogen binding and modulate gut inflammatory response. They reduce visceral hypersensitivity associated with both inflammation and psychological stress. More importantly, probiotics can alter colonic fermentation and stabilize the colonic microbiota, show that dietary exposure to pathogens maybe less likely to create another relapse of symptoms.5

Once again we can see that the use of high fiber, essential oils (omegas), probiotics and digestive enzymes (Brenda Watson’s HOPE Formula) can be beneficial in preventing or treating intestinal inflammation—be it IBS or IBD.

1. Way BM. “The Serotonin Transporter Promoter Polymorphism Is Associated with Cortisol Response to Psychosocial Stress.” Biol Psychiat. 2010 Mar 1;67(5):487-92.
2. Farhadi A, et al. “Heightened Responses to Stressors in Patients with Inflammatory Bowel Disease.” Am J Gastro. 2005;100:1796–1804.
3. Pimentel M., et al. “Normalization of Lactulose Breath Testing Correlates With Symptom Improvement in Irritable Bowel Syndrome: A Double-Blind, Randomized, Placebo-Controlled Study.” Am J Gastro. 2003;98:412-19.
4. Pimentel M., et al. “Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation.” N Engl J Med. 2011 Jan;364:22-32.
5. Spiller, R. “Review article: probiotics and prebiotics in irritable bowel syndrome.” Aliment Pharmacog Ther. 2008 Jun;28(4):385-96.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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Most surgeons on call on Thanksgiving or Christmas Day are not surprised when they get called into the ER to see a patient with right upper abdominal pain and tenderness radiating through to the back. There are also no surprises when an abdominal ultrasound shows a dilated gallbladder, possibly with a thickened wall, and gallstones ranging from the size of a pebble to the size of a marble or even an egg. At this point, the appropriate next step would be laparoscopic cholecystectomy, or removal of the gallbladder. This is one of the most common surgical procedures in the Western world today.

So how does a person find themselves in the operating room on Thanksgiving night? First of all, it didn’t just happen all at once. Gallstone formation takes months or even years. It is believed that low-fiber, high-cholesterol diets high in processed starchy foods contribute to the formation of cholesterol stones. Over-consumption of fatty and fried foods and refined sugar, as well as inadequate intake of vitamins B, C and E, are also factors thought to contribute to gallstone formation. Inadequate water intake and lack of exercise also play a role.

With the above diet, a bacterial imbalance in the gut will develop. The effect in the gut of this imbalance will be increased intestinal permeability (also known as leaky gut). As a result of leaky gut, more toxins are delivered to and processed by the liver. These toxins are sent from the liver to the gallbladder, where they are stored and concentrated along with the bile, which can lead to gallstones.

So how do the holidays fit into this? Very simply – a large meal high in fat and sugar will release the hormone cholecystokinin (CCK) from the duodenum (upper small intestine). CCK triggers the gallbladder to begin contracting and may move the stones into the cystic duct (which drains into the common duct and then into the duodenum) causing gallbladder obstruction, swelling, more inflammation, and severe right upper quadrant pain.

Many people do not realize they have gallstones. They may go years without symptoms and only discover the gallstones in an emergency room visit such as I described above. Other people do experience periodic attacks and are able to recover from them and choose not to have surgery. In either case, it’s prudent to take extra care at major holiday meals. A combination of gravy, ham, buttery mashed potatoes, candied yams and alcohol, followed by pumpkin pie and ice cream is the perfect recipe for a gallbladder stress test. The following recommendations could help you avoid that ER visit this holiday season:

• Eat smaller portions of any high fat, high-sugar foods
• Chew thoroughly
• Eat slowly, taking the time to enjoy the meal and company
• Take digestive enzymes with the meal
• Limit alcohol consumption

Most importantly, as a preventative measure, follow a high-fiber, plant-based, antioxidant-rich diet low in processed foods and saturated fats, fried foods and sugar. In addition to getting regular excise and having regular bowel elimination to reduce toxins, it is important to have a healthy balance of intestinal bacteria. This can be achieved by eating fermented foods (which are naturally high in beneficial bacteria) and taking high-quality probiotic supplements every day.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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As you know from my previous post, April is IBS Awareness Month, and over the next few weeks I’m going to be talking a lot about IBS to help folks get a better understanding of just what it is, what causes it, and what you can do about it—so get ready to love your colon!

First things first, just what is IBS? Irritable bowel syndrome (commonly called IBS) is an intestinal disorder defined largely by its symptoms, which include abdominal cramping, abdominal pain, bloating, gas, and constipation or diarrhea (or both). Based on those symptoms, there are three main types of IBS:

• IBS-C is constipation-predominant IBS, which means it involves constipation-associated symptoms.
• IBS-D is diarrhea-predominant IBS, which means it involves diarrhea-associated symptoms.
• IBS-A, or alternating IBS, involves both constipation- and diarrhea-associated symptoms.

IBS is also one of the most commonly diagnosed disorders today, and as many as 20 percent of Americans have IBS symptoms. However, diagnosing it can be difficult since there are no “biological markers” to look for in a diagnostic test—which essentially means there are no indicators that help doctors distinguish whether you have IBS or something else. So then how do they know if you have it??

An IBS diagnosis is based on certain criteria called the Rome III Criteria, which state that a diagnosis can be made after six months from the first signs of IBS symptoms, with at least three months of recurrent abdominal pain or discomfort in association with two or more of the following conditions:

• Improvement of symptoms with bowel movement
• Onset of symptoms associated with a change in frequency of bowel movements
• Onset of symptoms associated with a change in form of stool

So now that we know a little more about what IBS is, next time we’ll talk about what causes it, so be sure to keep reading!

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Notable News – I can’t tell you how many times I’ve heard that we don’t need our appendix and that it has no function. Now don’t get me wrong, I understand removing the appendix if someone has appendicitis (a potentially fatal inflammation of the appendix) but the appendix isn’t completely useless! Did you know that it actually plays an important role in digestive health?

Recently researchers have determined that the appendix acts as a safe storage area for good bacteria in the body—you know, the kinds that help with digestion and immune function? So after a case of diarrhea, or a bout of antibiotics, both of which wipe out populations of good bacteria, the bacteria hidden in the appendix can actually repopulate the colon and bring balance back to your digestive tract! 

It makes perfect sense, really. The appendix is a narrow tube that sits at the bottom of the first part of the large intestine (also called the cecum). A bacterial infection or antibiotics would easily bypass the appendix because of its small opening, so the beneficial bacteria inside would stay protected. But inside the appendix are still enough bacteria to repopulate the gut when needed… which is pretty important when you consider that chronic dysbiosis (or a lack of enough beneficial gut bacteria) can contribute to infection if bad bacteria reach the appendix and multiply. And what happens then? You guessed it! Appendicitis!

So take it from me, your appendix is important, and so is making sure you take probiotics every day to keep your digestive system in balance!

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