Are you literally running on empty after the holidays? It’s not only all those high-fat, high-salt, high-sugar celebratory over-indulgence meals, it’s most likely dehydration.

Take the Following Facts to Heart, literally:

Your body is composed of roughly 69 percent water. When you become even mildly dehydrated (even losing as little as two percent of water) here’s what can happen…

1. Mood swings unrelated to other extenuating circumstances.
2. Decreased energy levels and inability to rejuvenate stamina.
3. Cognitive function decreases (brain-fog for example).

The following conditions are caused or accelerated by dehydration and most people do not consider the consequences…

• Diabetics and especially those who are not yet aware they are clinically diabetic. As blood sugar levels rise, your body attempts to eliminate excess glucose through increased urine output—causing more dehydration.
• That female monthly menstrual cycle influences levels of body fluids, estrogen and progesterone swing up-anddown, making hydration even more important. For women who experience heavy periods, it’s not only blood they lose; it’s water as well.
• If you must take prescription medications, be sure and check the list of side-effects before taking. Many meds actually have a diuretic effect—increased urine output puts you at higher risk of dehydration.
• That fight-or-flight response of stress causes your adrenal glands to pump out stress hormones and can lead to chronic adrenal burnout. What most people don’t consider is that the adrenals also produce a hormone called aldosterone, which is responsible in regulating the body’s fluid and electrolyte levels. When chronic adrenal fatigue is present, the body’s production of aldosterone drops—triggering dehydration and low electrolyte levels. Keep in mind that electrolytes are the body’s “electrical system” so it’s no wonder messages get crossed or don’t communicate like in decreased cognitive function (brain-fog).
• Irritable bowel syndrome (IBS) is a very challenging condition because its symptoms include nausea and chronic diarrhea—causing even more dehydration.

The Way I See It…
Hydration is SO easy and readily available…why would you deprive your body of a simple “fuel” to keep it running at optimum health and speed? The old excuse, “I don’t have time to drink all THAT water” is just that, an excuse, not a reason. Trick yourself anyway that works into drinking more water or herbal teas.

I fill four quart-sized decanters each morning with water and/or herbal teas. I work very long hours and by the end of the day, my decanters are empty. However, the trick for me is to drink out of a “fat” straw. My sipper cup has a fat straw inserted and both are made of BPA-free material—no, bpa-free isn’t the total answer but for now at least not as toxic as the soft plastic varieties. I also have a stainless steel water bottle with built-in straw and water filter to avoid buying water in plastic, especially when traveling. When you drink out of a straw, your body craves twice as much water and you consume it with half the amount of effort—try it—it works! Remember that herbal teas and sparkling waters count as water as long as you don’t add anything like sugar. However, you can sweeten tea with a natural no-calorie alternative like Stevia or Lakanto (aka Monk Fruit).

When it comes to carbohydrates, opinions abound. They have been both vilified and promoted as essential dietary components. This dichotomy, however, does not reflect the fact that all carbohydrates are not created equal. Gastroenterologists have coined the term FODMAPs to encompass specific carbohydrates found within many different foods that have greater potential for causing gastrointestinal distress. These carbohydrates can contribute to symptom causation in patients with gastrointestinal disorders such as bloating, irritable bowel syndrome and inflammatory bowel disease.

What are FODMAPs and how do they cause GI symptoms?
The acronym "FODMAPs"– Fermentable Oligo–, Di– and Monosaccharides and Polyols—describes a group of previously unrelated short–chain carbohydrates and sugar alcohols. These include fructose, lactose, fructo– and galacto–oligosaccharides (fructans and galactans) and polyols (such as sorbitol, mannitol, xylitol and maltitol). FODMAPs are poorly absorbed in the small intestine for a variety of reasons. For example, fructose does not move efficiently across the brush border due to poor transport mechanisms across the epithelium.¹ Lactase, the enzyme responsible for metabolizing lactose, is reduced in activity after weaning.² Due to their poor absorption as well as their small size, FODMAPs are osmotically active and increase intestinal water content. They are rapidly fermented by gut bacteria, leading to increased gas production. Greater intestinal water content and gas production leads to bowel distension, which translates into adverse gastrointestinal symptoms such as abdominal pain, bloating and motility changes.³

Where are FODMAPs found?
FODMAPs are found in foods of various shapes and sizes. They can be found in local fast–food joints and packaged foods filled with additives. Processed foods hide FODMAPs well, especially those with added sweeteners. Conversely, they can be found in fresh meals at restaurants and stores catering to health and wellness. Ironically, some of the healthiest foods contain FODMAPs, including certain fruits, vegetables and legumes. Foods with high–FODMAP content include:

• Fruits: mangoes, apples, pears, watermelon, apricot, avocado, blackberry, cherry, lychee, nashi, nectarine, peach, plum, prune, persimmon, canned fruit, fruit juice, dried fruits
• Vegetables: asparagus, beetroot, broccoli, Brussels sprouts, cabbage, eggplant, fennel, garlic, leek, okra, onion, shallots, spring onion, cauliflower, bell pepper, mushroom, sweet corn
• Legumes: baked beans, chickpeas, kidney beans, lentils
• Dairy: milk from cows, goats or sheep, custard, ice cream, yogurt, soft unripened cheeses
• Grains: wheat, rye
• Sweeteners: honey, corn syrup, high–fructose corn syrup, fructose, sorbitol, mannitol, isomalt, maltitol, xylitol

FODMAPs and inflammatory bowel disease
A low–FODMAP diet has been helpful in certain patients with inflammatory bowel disease (IBD). Crohn's disease and ulcerative colitis are chronic inflammatory disorders of the gastrointestinal tract thought to be due to a complex interaction of genes, environmental factors and immune regulation. They are typically treated with anti–inflammatory medication. Patients with IBD often have symptoms due to functional gut disturbance. In these patients, increasing anti–inflammatory therapy is unlikely to be helpful. A pilot study evaluated patients with IBD and concurrent functional gut symptoms. After following the low–FODMAP diet, about half of these patients experienced symptomatic improvement, including decreased abdominal pain, diarrhea and bloating.⁶ The low–FODMAP diet can be considered for IBD patients with concurrent functional gut symptoms.

Is FODMAPs forever?
If your gastroenterologist prescribes a low–FODMAP diet, does this mean you can never eat another FODMAP–containing food again? It's important to remember that FODMAPs do encompass some foods with high nutrient densities. In fact, certain FODMAPs exert prebiotic effects. Prebiotics are nondigestible food ingredients that can lead to improved health. Bacterial fermentation of prebiotics can yield short–chain fatty acids like butyrate, which nourishes the colonic epithelium, favors the growth of beneficial gut bacteria and inhibits the growth of harmful gut bacteria.⁷ Nectarine, garlic, onion, nuts, legumes, rye and wheat are examples of FODMAPs that function as prebiotics.⁸ If you are following a strict low–FODMAP diet, you can obtain prebiotics from non–FODMAP foods such as bananas, kale, chard, brown rice and oatmeal. The low–FODMAP diet should be followed for a period of six to eight weeks, after which foods with the highest nutrient densities should be slowly reintroduced in small quantities with monitoring for tolerance. These foods include fruits, vegetables and legumes.

What steps can you take to decrease FODMAPs in your diet? If you have functional gastrointestinal symptoms and you are prescribed the low–FODMAP diet, it's important to work with both your physician and nutritionist for proper implementation of this diet. If you are generally in good health with occasional gastrointestinal symptoms such as bloating, you may want to keep an eye on your daily FODMAP intake. Studies have shown that even healthy individuals, when fed a high–FODMAP diet, can develop increased gas production.⁹ There are a few steps you can take to decrease dietary FODMAP intake:

1. Cut out FODMAP grains such as wheat and rye. Look for alternatives like quinoa, millet and brown rice.
2. Cut out dairy products. Use nut–based milk substitutes instead.
3. Decrease consumption of packaged foods, particularly ones with long ingredient lists.
4. When enjoying FODMAP fruits, vegetables or legumes, keep a food journal and determine which serving sizes you tolerate best.

1. Gibson, Peter R., and Susan J. Shepherd. "Evidence–based dietary management of functional gastrointestinal symptoms: The FODMAP approach." Journal of Gastroenterology and Hepatology 25.2 (2010): 252–8.
2. Misselwitz, Benjamin, et al. "Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment." United European Gastroenterology Journal 1.3 (2013): 151–9.
3. Shepherd, Susan J., Miranda CE Lomer, and Peter R. Gibson. "Short–chain carbohydrates and functional gastrointestinal disorders." The American Journal of Gastroenterology108.5 (2013): 707–7.
4. "Welcome to IFFGD." International Foundation for Functional Gastrointestinal Disorders. Web. 22 Mar. 2014.
5. Halmos, Emma P., et al. "A diet low in FODMAPs reduces symptoms of irritable bowel syndrome." Gastroenterology 146.1 (2014): 67–5.
6. Gearry, Richard B., et al. "Reduction of dietary poorly absorbed short–chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease—a pilot study." Journal of Crohn's and Colitis 3.1 (2009): 8–14.
7. Mullin, Gerard E. Integrative Gastroenterology. New York: Oxford UP, 2011. Print.
8. Cho, Sungsoo, and Nelson Almeida. Dietary Fiber and Health. Boca Raton, FL: CRC, 2012. Print.
9. Ong, Derrick K., et al. "Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome." Journal of Gastroenterology and Hepatology 25.8 (2010): 1366–73.

Four humble herbs with an impressive history for helping people to improve their health and overcome disease include burdock root (Arctium lappa L.), sheep sorrel herb (Rumex acetosella L.), Indian rhubarb root (Rheum officinale L.) and slippery elm bark (Ulmus rubra Muhl.). A traditional herbal formulation made with these four herbs is gaining recognition as a good remedy for treating a wide range of health problems. The below information covers some of the impressive research on these four herbs and helps to shed light on how this synergist blend can afford so many profound health benefits.

BURDOCK ROOT(Arctium lappa L.) Not far from your doorstep, if you look, you can usually find the soft green leaves of burdock, common in most neighborhoods— and based on much scientific and historical data, the root of this plant can dramatically enhance your health by boosting your immune system, improving digestion and thwarting cancer in many different ways. Regularly incorporating burdock root in your daily regime may even be able to increase your lifespan based on anti-aging results found with animals. There are many other documented and accepted health benefits of regularly drinking burdock root tea based on the German Pharmacopoeia, including the relief of gastrointestinal complaints and bone and joint conditions.

Burdock root, also known as gobo or Poor-man’s potatoes, is an important food in Japan known for its many healing properties. Burdock root can safely be eaten as a root vegetable and is popularly eaten by Japanese people and sushi lovers of all nationalities. When grown in loamy soil, the root grows into a very long, creamy colored tap root similar in appearance to a carrot but much longer. It can grow deeper than most root veggies and is known as a good source of trace elements and minerals accessed from deeper soil layers. Unlike carrots and potatoes, burdock root does not contain starch it contains complex carbohydrates called fructo-oligosaccharides (FOS) including 27–45 percent inulin. When people eat starchy roots, this causes a sharp rise in blood sugar and blood insulin levels. But burdock root provides the body with soluble fibers that do not affect blood sugar or blood insulin levels. This makes burdock root and FOS particularly beneficial for diabetics. FOS and inulin have many scientifically documented health benefits including acting as a beneficial prebiotic by feeding beneficial intestinal microflora (BIM) while also eliminating potential gut pathogens, optimizing colonic pH, boosting bone strength through increasing calcium and mineral absorption from food, supporting serum enterolactone and enterodiol concentrations, helping to control blood sugar levels and reducing cholesterol. Other foods that contain inulin include chicory root, onions, Jerusalem artichokes and bananas.

According to Bengmark (2005), researching out of the Institute of Hepatology, University College, London Medical School, U.K., inulin has prebiotic qualities and can affect intestinal immune cells and potentially repair the gut wall and thereby improve overall immune function. Several recent scientific studies have documented significant immune-enhancing effects of inulin and oligofructose.

Taking herbal formulas that contains burdock root, rich in natural oligofructose and inulin, have been found to afford many digestive benefits and favorable results have been shown with a number of digestive disorders according to Tamayo and colleagues (2000).

SHEEP SORREL (Rumex acetosella L.) Sheep sorrel is a common herb found abundantly at roadsides and is otherwise known as sour grass because of its tart leaves. The leaves are popularly used in herbal teas for rejuvenating health and cleansing toxins from the body. Sheep sorrel has powerful phytoestrogen activity (phytoestrogen means plant-estrogen) based on in vitro studies conducted by U.S. hormone researcher, Dr. David Zava in 1998. Sheep sorrel came in tenth out of 150 herbs tested for phytoestrogen activity; the list was headed by soy beans, licorice root and red clover herb, all legumes wellknown for their phytoestrogen activity.

Sheep sorrel is an important component of ESSIAC® tea and products, together with three other herbs, burdock root, slippery elm bark and Indian rhubarb root. Early research on sheep sorrel herb by famed Canadian nurse Rene M. Caisse and R.O. Fisher, M.D., in Ontario in the 1920s and 30s, found that sheep sorrel liquid extract given to mice with artificially induced tumors caused cancerous tumors to markedly regress and disappear. The other herbs in ESSIAC were said to help with cleansing and eliminating the dead cancer cells and other toxins from the system. Nurse Rene Caisse also reputedly had success with treating cancer patients with ESSIAC together with sheep sorrel extract—including one case cured and two cases improved accepted by a Cancer Commission set up by the Canadian Government in the 1939. There are many more anecdotal reports and some well documented cases of success with ESSIAC for dramatically improving people’s health very quickly.

Human clinical studies with other phytoestrogen-rich foods and herbs, such as flaxseed and red clover, have also produced profound anti-cancer results. For instance, clinical studies with breast cancer patients given muffins containing 50 grams of ground flaxseed daily (flaxseed contains phytoestrogens called lignans in its seed coat) versus placebo muffins (without flaxseed) conducted by Dr. Paul Goss, Dr. Lilian Thompson and colleagues in 2000 at the Princess Margaret Hospital in Toronto, Canada, and a further clinical study conducted by these same researchers with post-menopausal breast cancer patients taking 25 grams of flaxseed daily documented significant anti-cancer effects within 30 to 40 days. A study done with a prostate cancer patient in Australia reported by Dr. Fredrick O. Stevens (1997) and a further randomized, placebo-controlled clinical study with prostate cancer patients conducted by Dr. Jarred and colleagues in England (2002) using red clover isoflavonoid extracts (160 mg/daily for only seven days in the case study and for 30–40 days in the clinical trial) have documented strong anti-cancer effects for red clover isoflavonoid phytoestrogens within days/weeks based on tumorectomies. There were no serious negative side effects noted in any of these studies.

Foods and herbs rich in phytoestrogens, such as flaxseed (lignans), burdock root (isoflavones), burdock seed (lignans), milk thistle seed (lignans), red clover (isoflavones), soybean (isoflaonves), kudzu root (isoflavones), etc., once eaten, are metabolized within the gut by beneficial intestinal bacteria and the isoflavonoids and lignans that they contain significantly increase serum enterolactone and enterodiol concentrations. According to research conducted by the Australian company, Novogen, certain phytoestrogen metabolites function to inhibit anti-apoptosis proteins in cancer cells thereby causing cancer cells to go through apoptosis or programmed cell death without harming normal cells. Simply put, phtoestrogen-rich foods and extracts can cause cancer cells to simply die and be cleansed from the body without causing terrible side effects. Many phytoestrogens have also been shown to stimulate beneficial anti-cancer enzymes. The powerful and safe anti-cancer activity of phytoestrogen-rich foods and herbs may help to explain the myriad anecdotal reports of spontaneous remissions in cancer patients and miracle cancer cures documented over the centuries with various herbs and herbal combinations. More research is needed in this area to clearly define the anti-cancer activity of different phytoestrogens.

Many foods, herbs and supplements contain beneficial phytoestrogens and other natural anti-cancer compounds that help to balance hormones in different ways. Sheep sorrel appears to be one that may have great promise for cancer patients. Further human clinical studies with sheep sorrel are needed to confirm the beneficial estrogen modulating and anti-cancer activity of its phytoestrogens and other active ingredients.

SLIPPERY ELM INNER BARK
(Ulmus fulva Michx. and U. rubra Muhl.) Slippery elm bark has a long history of use as a medicine and also as a food that can be eaten like gruel and is commonly made into lozenges for sore throats and coughs. The inner bark of this tree has been used as folk remedy for treating cancer and other conditions including: respiratory problems, throat irritation, fever, abscesses, dysentery, urinary and kidney inflammations.

Choi and colleagues (2002) at Pusan National University in Korea studied slippery elm bark and found that it exhibited dose-dependent peroxynitrite scavenging activities. According to Langmead and colleagues (2002) at the Academic Department of Adult and Paediatric Gastroenterology, London, U.K., slippery elm bark also exhibited potent antioxidant activity using in vitro tests based on chemiluminescence used to detect herbal effects on generation of oxygen radicals by mucosal biopsies from patients with active ulcerative colitis. These researchers concluded that slippery elm and other herbal extracts merit formal evaluation as novel therapies in inflammatory bowel disease.

Lans, Turner, Khan and Bauer (2007) report the use of Ulmus fulva Michx. in ethnoveterinary medicines used to treat endoparasites and stomach problems in pigs and pets in British Columbia, Canada. The authors note that Ulmus fulva, along with other plants used for this purpose, have mid- to high-level validity for their ethnoveterinary use as anthelmintics (deworming agents).

Five case studies of patients with psoriasis following a dietary regimen including a pinch of slippery elm bark taken daily with meals found relief of symptoms according to Brown and colleagues (2004) at the University of Hawaii at Manoa, Honolulu, U.S. The five psoriasis cases, ranging from mild to severe at the study onset, improved on all measured outcomes over a six-month period.

INDIAN RHUBARB ROOT
(Rheum officinale L.)
Michael Castleman in his book, Medicinal Herbs describes rhubarb (medicinal rhubarbs, Rheum officinale and R. palmatum; and garden rhubarb, R. rhaponticum noted as having similar but less powerful action) as an odd plant: its roots are medicinal; its stems make tasty pies but its leaves are poisonous. He also notes that Chinese physicians have used rhubarb root since ancient times prescribing it externally as a treatment for cuts and burns and internally in small amounts for dysentery while large amounts have powerful laxative action. Formerly, the root was an important drug in many army camps, said to stop dysentry in its tracks. The active ingredients of Indian rhubarb root include emodin and aloe-emodin, rhein and other anthracene derivatives.

Conclusion: According to many studies, adding a time-tested herbal formula with these humble herbs to your daily menu may bring a boon to your health resulting in many immediately noticeable benefits to your well-being.

Formal clinical trials are warranted to evaluate the real anticancer effects of formulas containing these four herbs. Such clinical studies need to be carefully designed, placebo controlled clinical trials with cancer patients scheduled for tumorectomies but not receiving chemo or radiation, in order to avoid confounding variables from these treatments (i.e. similar in design to studies assessing the anticancer effects of flaxseed and red clover).

For references send a S.A.S.E. to totalhealth.

I've been a pharmacist for 25 years now. Let's face, I know the good, the bad and the ugly drugs. I know we need some of them, and I know that others are not useful, or worse, they are harmful. So today I've decided to share the best remedies that help from head to toe:

Headaches- Taking butterbur (Petasites hybridus) at a dose of 75mg twice daily helps reduce the frequency and intensity of migraines. You can take all the triptan drugs you want (ie Imitrex, Zomig or others) but these drugs usually just reduce pain, sometimes they abort a headache. The butterbur may slash the number of attacks in half. This is HUGE if you have to hold down a job or take care of kiddos. I discussed butterbur and dozens of other solutions my book, Headache Free.

Hypothyroidism- It's impossible to have healthy thyroid function without selenium. Not only will it hinder your ability to make thyroid hormone, it will also stifle your ability to use the hormone inside the cell. There's more about selenium, iodine, B12 and ashwagandha at my website where I archive other articles on thyroid health.

Heart Failure- Niacin (vitamin B3) was found to reduce heart attack and stroke risk in a 2010 study published in the Journal of Cardiovascular Pharmacology and Therapeutics. Doses vary tremendously, so please do nothing until you have your physician's approval. Niacin causes vasodilation (opens vessels) which reduces arterial pressure. I would be remiss if I didn't mention CoQ10 while discussing the heart or heart failure. CoQ10 also lowers blood pressure. I like about 100 to 200 mg daily but again, please always ask your doctor what's right for you.

Digestive disorders- My number one go-to supplement is probiotics. These improve digestion and support a healthy immune system and mood. Digestive enzymes break down the food you eat into absorbable molecules. For heartburn, I recommend slippery elm or marshmallow root. As for nausea and vomiting, ginger tea is gentle and popular. It's a mild blood thinner though, so be careful. And finally peppermint supplements can help with irritable bowel syndrome. The value of peppermint has been discussed many times, even in the British Medical Journal in 2008.

Bone loss- We all know about calcium. But did you know without enough magnesium, vitamin D or K2, you don't even incorporate the calcium into your bones?! So keep in mind the best bone-building supplements contain key minerals, you don't just push one like calcium all by itself. Natural strontium is another over-the-counter mineral used for bone integrity.

Painful knees- Glucosamine sulfate promotes cartilage formation. Collagen is another supplement that reduces pain in the knee joint of osteoarthritis sufferers. A 2012 study in the Annals of Rheumatic Disease found that losing weight helped reduce the amount of cartilage loss while increasing proteoglycan content (squishiness).

Toenail fungus- Apply essential oil of tea tree, and eliminate all sugars. You should also be checked for diabetes if you have a lot of toenail fungus.

Much evidence suggests that gastrointestinal tract problems are on the rise in the modern world with significant health consequences that extend well beyond the gut itself. For instance, autism is increasing, especially in male children, and researchers at MIT and elsewhere point to the GI-tract and disturbances caused by glyphosate and other chemicals used in industrial agriculture as among the causes. Food processing with its emulsifiers and storage techniques likewise may play a role in the upsurge in the prevalence of various inflammatory bowel conditions. Modern over-nutrition and other dietary habits, such as over-consumption of refined carbohydrates and under consumption of omega-3 fatty acids are yet other factors implicated. Researchers trying to uncover patterns underlying contemporary GI-tract issues have been attempting to fit the various known and suspected causes into manageable conceptual models. Recent work suggests that a three-part model involving gut bacteria, gut barrier function ("leaky gut") and inflammation may help with prevention and therapy.¹ The components of the model have emerged from studies of inflammatory bowel disease (IBD, including Crohn's Disease and ulcerative colitis), yet they clearly have application to more ordinary and quite common forms of bowel irritation and discomfort.

Irritable bowel syndrome (IBS) is a catch-all for common bowel conditions. It currently affects 10–20 percent of the adult population in developed countries. To be sure, the causes of IBS have not been definitively identified and can vary among individuals (food allergies, over-reactive immune system, stress, hormone imbalance, etc.). Symptoms include abdominal pain, flatulence, bloating, change in bowel habits, diarrhea, constipation (or a combination of both), and these often interfere with daily activities and affect the quality of life of the sufferers. Available medications exhibit only limited efficacy and fail to relieve all IBS symptoms over the long term.

Current science no longer views the gastrointestinal system as a simple digestive and disposal apparatus. It is estimated that sixty percent or more of all the macrophages, the first line immune cells of the body, line the GI-tract. Specialized cells in the gut constantly sample its contents in active surveillance for external threats. Microbes in the small and, especially, the large intestine perform a multitude of functions, including aspects of nutrition, such as synthesizing some vitamins and making minerals and other nutrients more available. The intestinal wall controls not only the passage of nutrients and the disposal of bodily wastes, but also regulates immune interaction with the contents of the intestines. GI-tract disturbances can involve any one of the major aspects of gut health or combinations of these. Hence, gut complaints can involve disturbed intestinal microbiome (dysbiosis), disrupted barrier function (leaky gut) and/or improper immune system activation (inflammation).

The Inhabitants of the Gastrointestinal Tract
The microbes present within the body collectively are termed the microbiota. The genomic content (the complete set of genes in the microbiota) is termed the microbiome. Both genetic and environmental factors shape the microbiome. Important early factors are natural birth versus cesarean section, breast-feeding versus formula feeding, and so forth. In adults, dietary habits are highly significant. Vegetarians and meat eaters differ in the make-up of the bacteria in the gut. The amounts and types of fiber in the diet, the amounts and types of carbohydrates and fats, under-nutrition and over-nutrition all matter. So do the level of hygiene and exposure to infections, antibiotics and other drugs.

The human gut consists of a series of micro-environments. Except for the stomach and the upper two thirds of the small intestine, there are differing bacteria and ratios of bacteria in each of these areas, starting with the mouth. In fact, the human gastrointestinal tract contains a large and diverse population of microorganisms — over 800 different bacterial species comprising nearly 100 trillion living organisms. The composition of this gut flora varies among individuals depending on diet, age, medication (antibiotics), stress, and physiological conditions. Not surprisingly, different probiotics perform different functions and offer different benefits. One big divide, of course, is between the two most important groups of probiotic bacteria, Lactobacilli, found mostly in the lower small intestine and upper large intestine, and Bifidobacteria, found mostly in the large intestine, i.e., the areas of lower pH.

For clarity's sake, keep in mind that scientists use a standard genus, species, strain taxonomy in describing bacteria. An example is the probiotic bacterium, Lactobacillus rhamnosus R0011. The genus is Lactobacillus, the species is rhamnosus and the strain is R0011. Dietary supplements properly list all three components of the name because strains even of the same species can exhibit divergent effects in the body.

Broadly speaking, the Lactobacilli act on sugars and starches to create lactic acid, among other things. For instance, L. acidophilus La-14 assists in breaking down lactose (milk sugar) and 15 other carbohydrates and this may improve digestion of dairy products by those individuals who are lactose intolerant. Clinical trials have shown that this strain may improve immune response and bowel regularity. It works especially well in conjunction with another bacteria strain, L. rhamnosus R0011. Interestingly, L. rhamnosus R0011 in conjunction with L. helveticus R0052 in humans enhances the eradication of H. pylori (a cause of stomach ulcers) in combination with conventional medical treatment.

Bifidobacteria, such as B. longum BB536, have been shown to colonize the intestine, stimulate immune response, and promote the growth of other beneficial bacteria. BB536 also decreased the incidence of influenza in seniors. Blood analysis showed significantly higher bactericidal activity of neutrophils and higher NK cell activity at the fifth week of administration compared to pre-administration. There has also been evidence reported that suggests BB536 can help modulate allergies and possess antiallergenic effects. Other bifidobacteria provide their own ranges of benefits.

Increases in certain bacteria and decreases in others— both in absolute numbers and the varieties present—are observed in disturbed gut function. Typically, the more severe the dysfunction, the greater the divergences from normal microbiota. It is unclear to what extent these specific changes are the driving forces for inflammatory and related immune processes and to what extent they reflect the condition, although feedback is highly likely. The finding that certain strains of probiotics reduce excessive inflammation by means of modulation of immune and other responses via the gut is one of the major advances in the knowledge of probiotics in recent years.

Inasmuch as different probiotic species and different strains of the same species often provide different and distinct benefits and also often interact to lead to yet other results, there are good reasons for supplementing with more than one strain and/or species. Similarly, different probiotics may be more to be desired at certain ages or under particular conditions. No single strain can easily fulfill all these requirements. A mixture of species, therefore, is usually most suitable for supplementation.

Mucosal Barrier Function & The Leaky Gut Syndrome
The mucosal barrier of the gut performs many functions, one of which is to separate the contents of the gut from immediate contact with the gut wall and direct access to the body's immune system. Ideally, the contents of the intestines are sampled routinely by specialized cells located in Peyer's patches along the far end of small intestine. Allopathic medicine does not recognize leaky gut syndrome as a distinct condition, yet in IBD it has been demonstrated that the contents of the intestine do, in fact, have direct access to the surface of the intestinal wall and perhaps beyond. Mucus barrier changes may be as much the result of unwanted bacteria (dysbiosis) as a cause. It is possible for substances even to leak into the bloodstream due to defects in the tight junctions that normally characterized the
intestinal wall. Leaky gut can be described as intestinal permeability or intestinal hyperpermeability.

There is little doubt but that leaky gut syndrome involves chronic inflammation. However, controversy arises as to whether this inflammation is a cause or a consequence. Likewise, is the inflammation local or does it prime further inflammation throughout the body leading to or aggravating a host of other conditions, such as allergies?

In IBD, toxemia, meaning the passage of toxins into the blood, is well documented, as are immune system irregularities. The extent of leaky gut in less active and less severe bowel conditions is debated hotly. Nevertheless, indications of intestinal barrier dysfunction and dysbiosis, such as inappropriate immune activation, abdominal pain, flatulence, etc., strongly suggest that leaky gut is, in fact, an aspect of IBS and other less well defined GI-tract issues.

As noted already, available medications have only limited efficacy and fail to relieve IBS symptoms over the long term. Fortunately, there are a number of natural supplements that are documented to help prevent and/or relieve symptoms associated with IBS. For instance, fiber can help with the toxemia issues as well as promote normal intestinal flora. Research has shown that soluble fiber, such as psyllium, can be fermented in the gut and the metabolites may decrease transit time and pressure. Some fibers can increase water retention, thereby increasing the stool mass and, again, reducing transit time. Fiber supplementation in IBS patients promotes significant improvements in constipation and general IBS symptoms.

Similarly, clinical studies have shown the benefits of Lactobacillus and Bifidobacteria species in the treatment of IBS or IBS-like symptoms. This is probably due to their abilities to reduce inflammation, visceral hypersensitivity, and stress responses. Studies have shown that some strains are effective in treating bloating and flatulence while others relieve gastrointestinal pain and irregularity. It has also been reported that effects can vary among individuals. Thus, one may want to try different strains and dosages or a blend of multiple strains and monitor the response.

Another useful supplement is the amino acid L-glutamine to support the health of the cells that make up the enterocytes in the gastrointestinal tract. It not only directly nourishes the mucosal lining of the intestine, but also helps repair it when it is damaged by hypersensitivity, physical stress, or an overreactive immune system. Lglutamine can stimulate the bowel to re-absorb the water from the stool, reducing the number and frequency of bowel movements.

Then there are the everuseful omega-3 fatty acids. Omega-3 fatty acids can replace omega-6 fatty acids in the cell membrane and prevent their harmful effects by reducing the secretion of unwanted prostaglandins and proinflammatory molecules. They also reduce production of platelet aggregators and vasoconstrictors while increasing the secretion of vasodilators and platelet aggregation inhibitors.

Other supplements that have shown the ability to promote improvements in tight junctions include curcumin, boswellia, bile acid supplements and butyric acid supplements.

Immune Function
Both the microbiota and the barrier function aspects of GI-tract health at various points tie into immune function. Therefore, it would seem to be clear that the overall regulation of the immune system necessarily plays a role in the control of immune-related inflammation in the gut. Diet is one of the most significant components involved in what should be a homeostatic system.

Omega-6 fatty acids account for the majority of polyunsaturated fatty acids found in Western diets. Omega-6 fatty acids can stimulate production of harmful prostaglandins and leukotrienes, as well as platelet aggregators and vasoconstrictors. Omega-3 fatty acids, on the other hand, compete with omega-6 fatty acids by replacing omega-6 fatty acids in the cell membranes and provide beneficial effects such as:

1. a reduction in harmful prostaglandin E2 (PGE2) metabolite production,
2. a decrease in thromboxane A2, a strong platelet aggregator and vasoconstrictor,
3. suppressed formation of leukotriene B4, a proinflammatory molecule that is also responsible for leukocyte chemotaxis and adherence, and
4. maintained or increased production of beneficial prostaglandins such as PGI2 and PGI3, protective vasodilators, and inhibitors of platelet aggregation.

In autoimmune diseases, such as inflammatory bowel disease, Crohn's disease, and ulcerative colitis, the major contributors to disease development are thought to be proinflammatory mediators that include omega-6 fatty acid, arachidonic acid metabolites, harmful prostaglandins, leukotrienes, and pro-inflammatory cytokines. It has been reported that people who are affected by these diseases have elevated levels of leukotriene B4 and other arachidonic acid metabolites. Interestingly, in clinical studies, omega-3 fatty acid or fish oil supplementation significantly decreased the production of leukotriene B4 and overall leukotrienes in these patients. Omega-3 fatty acid supplementation was also able to induce dramatic improvements in tissue histology, the rate of disease relapse, clinical activity, and steroid-sparing effect after treatment, although responses to supplementation varied among individuals reflecting that there are underlying differences as well as common factors in these diseases.

In all cases, the goal should be to normalize immune function. Scientists understand that the immune system can be overactive as well as underactive and that balance is the key. On the one hand, the immune systems needs vigilante macrophages, natural killer cells and other "soldiers" to be on alert to attack invading organisms before these can take hold in the body. For instance, the cold virus is most successfully combatted if the immune system can react and eliminate it before it has had a chance to multiply. On the other hand, rheumatoid arthritis and other autoimmune diseases in which the body attacks itself afflict millions of Americans. Immune overactivity causes unpleasant side effects, such as allergies and inflammation, and can lead to immune exhaustion and collapse. The answer, therefore, is to balance the body's immune system so that it is neither overactive nor underactive.

Much of this balance is maintained by subsets of helper T cells (Th). There is a ratio between the Th1 subset that is involved mainly in inflammation and the activation of white cells (phagocytes, NK cells, etc.) and the Th2 subset that activates specific B cells. The Th1 and Th2 cells may cross-inhibit function, which means that the more active the one set is, the less active the other set is. Most Americans initially have too much Th1 function and too little Th2. This is one reason that chronic inflammation is so very common in the US. However, the body cannot allow chronic high levels of inflammation, and therefore the immune system begins to shut down as a result. Stimulating more Th1 activity—leading to more inflammation—will never be more than a short term fix if inflammation is not controlled because the body will again attempt to turn off Th1 function in order to reduce the level of inflammation. Hence, there is a common pattern in which chronic immune activation aggravates allergies, IBS, even weight gain, yet at the same time a reduction in immune surveillance allows the development of cancer in later life.

Balancing the immune system is a bit harder than simply stimulating it. Fortunately, there are a few supplements that do this and more. One of the most extensively tested of these supplements is called Moducare®. Developed by Patrick Bouic, Ph.D., head of Immunology at the University of Stellenbosch in South Africa, Moducare® consists of a proprietary blend of phytonutrients called sterols and sterolins. The sterol family of compounds includes fatty substances such as betasitosterol found in saw palmetto. Sterolins are sterols with a glucose (sugar) molecule attached, something that greatly improves absorption into the body. Taken together, sterols and sterolins are more active than when supplemented as single pure substances.

A number of other immune regulators are available. Chamomile extracts (German chamomile) are useful as anti-inflammatories and calm some forms of allergies. Chamomile is particularly interesting because of its calming and immune-regulating effects complement its antioxidant benefits. Another significant immunomodulator is the flower pollen extract sold under names such as Cernitin™. Items already mentioned include turmeric extracts and boswellia extracts, to which can be added quercetin and a number of herbal extracts available as dietary supplements. None of these will be sufficient in the long run, however, without changes in the diet to improve the balance between omega-6 and omega-3 fatty acids or the inclusion of more fiber and consumption of more vegetables and whole fruit.

Some Conclusions
As noted at the outset, GI-tract disturbances can involve any one of the major aspects of gut health or combinations of these. Hence, gut complaints can involve disturbed intestinal microbiome (dysbiosis), disrupted barrier function (leaky gut) and/or improper immune system activation (inflammation). There are strong feedback loops linking these aspects of gut health and therefore solutions to gut issues typically are most successful if all three are addressed together. This means appropriate changes in diet, adoption of probiotic supplementation (either as supplements or via dietary sources), nutrition aimed specifically at improving the health of the cells lining the GI-tract and adopting strategies to reduce inflammation and balance the immune system.

References:

1. Vindigni SM, Zisman TL, Suskind DL, Damman CJ. The intestinal microbiome, barrier function, and immune system in inflammatory bowel disease: a tripartite pathophysiological circuit with implications for new therapeutic directions. Therap Adv Gastroenterol. 2016 Jul;9(4):606 –25.