Digestive and Hormonal Issues
Healthy Gut, Healthy Life
The old adage “what goes in, must come out” describes how many patients perceive their digestive tract, thinking of it simply as a tube that takes in food and expels wastes. Rarely do they recognise that the digestive system is made up of multiple functional layers responsible for its successful operation. Like the layers of a cake or the levels of a building, the functional layers of the gut rely on one another for support, structure and function, whereby a disturbance in one, can impact the others (refer to Figure One). Of these layers, diet, barrier integrity and bacterial balance are foundational components to address in any patient suffering from digestive symptoms. Irrespective of the specific diagnosed condition, formulating a treatment strategy that effectively targets all of these layers can offer significant benefit to your patient’s presenting with gut disorders.
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Figure One: The Functional Layer Model of the GI
Diet Directs Digestion
Diet is often a priority in the acute treatment of any digestive disorder, which makes sense when you consider that the gut is assaulted with approximately half a tonne of food every year. The foods our patients are continuously exposing themselves to, directly influence all of the functional layers of the digestive tract. Consumption of particular foods may elicit both a local and systemic immune response in sensitive individuals. The resultant inflammatory reaction causes damage to what may already be a disturbed and permeable gut, further exacerbating symptoms. This constant irritation can be especially painful in conditions such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) which are characterised by visceral hypersensitivity. Further to this, it is well established that diet can rapidly and significantly alter the composition of the gut microflora.1
While dietary modifications will benefit all patients, the extent of this will be determined by ensuring the most appropriate dietary program is recommended. Figure Two shows the different protocols Practitioners can implement with their patients to help alter their symptoms for the better. The applications of each of the diet have been listed, however these can be adapted for your individual patient.
Figure Two: Dietary Protocols for Digestive Health
|Low FODMAP diet
(Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols)
|Shake It Professional
Weight Management Program
|Gluten free diet||
The Power of Three
Dietary strategies are an invaluable facet of treating digestive symptoms, however, simply removing an offending food is seldom enough. Using coeliac disease as an example, following the removal of gluten, it is likely a patient will subsequently present with leaky gut and require continued effort to heal the intestinal barrier. The barrier layer of the gut is comprised of three different, but interdependent components- the epithelium, mucosal barrier and secretory immunoglobulin A (sIgA). The mucus layer plays a pivotal role in separating host tissue from making direct contact with the microbiome. Within the mucosa is sIgA, an antibody that is pertinent to mucosal immunity through the entrapment and removal of pathogenic bacteria, viruses and toxins. These actions are highly relevant in a range of conditions including IBS, IBD and coeliac disease.
To achieve these benefits, MetaFibre™ and EpiCor® for Gastrointestinal Health contains the novel yeast extract EpiCor®, clinically proven to beneficially support mucosal defence by increasing sIgA. When combined with the prebiotic actions of the resistant maltodextrin,MetaFibre™, this is an ideal formula to maintain the long-term health of the intestinal barrier. For acute intestinal repair, Glutamine and Boswellia (BosPure® Boswellia) for Intestinal Integrity contains ingredients which work via several mechanisms to reduce intestinal inflammation and ultimately attenuate intestinal permeability. These actions help to reduce digestive symptoms rapidly, and compliment MetaFibre™ and EpiCor® for Gastrointestinal Health to comprehensively address all of the components that comprise the intestinal barrier.
Finding the Right Bug for the Job
Further affecting the health of the intestinal barrier, is the intestinal microbiota. Comprising over 1,000 species with a combined weight of approximately one to two kilograms, these ‘bugs’ play a dominant role in not only maintaining the health of the digestive tract but have also proven to influence various chronic diseases. Daily probiotics can help to improve all of the functional layers within the digestive tract, with best results seen when using targeted probiotic strains with demonstrated efficacy.
In cases of IBS and IBD, Lactobacillus plantarum 299v is the first-line probiotic to initiate an anti-inflammatory effect in the gut. It has also been shown to promote mucin synthesis, aiding in the restoration of the mucosal barrier.2 In clinical cases of overgrowth of pathogenic bacteria or candida S. Boulardii and Bi-07 for Management of Dysbiosis is recommended.Saccharomyces cerevisiae (boulardii) is widely researched for its ability to inhibit the growth and adherence of pathogenic bacteria to the gut.3 These benefits are supported byBifidobacterium lactis Bi-07 which has been shown to promote a lower intestinal pH, eliciting an anti-pathogenic effect. These actions make this combination a useful adjunct toLactobacillus plantarum 299v to relieve the symptoms of IBS and IBD. By choosing probiotic strains that are matched to the presenting condition, you can ensure positive results for your patient.
Layering it all Together
As Practitioners, we can view the digestive system, not just as a pathway for carrying food in and out of the body, but as individual functional layers that when addressed holistically can help to alleviate any form of gut dysfunction. Introducing dietary modifications, repairing a damaged intestinal barrier and restoring a healthy microbiome are just three, of the multiple functional layers of the gut pivotal to treatment success. At our finger-tips are effective herbal and nutrient combinations to address all of these functional layers of the digestive system.
References available on request
PERHAPS YOU HAVE ISSUES WITH HORMONAL HEALTH? READ BELOW…
Managing the Master Hormone Oestrogen
The Dance of the Sex Hormones
Hormones are intimately connected to many aspects of health and wellbeing in both men and women. With a multitude of factors influencing the sensitive balance of hormones, we commonly see patients with signs of hormonal imbalance, encompassing PMS symptoms, irregular or heavy periods, infertility, menopausal symptoms, mood swings and weight gain. Hormonal testing can give an invaluable insight into the influence of the various hormones and their metabolites on your patient’s condition, allowing you to formulate specific and effective treatment strategies.
Not All Oestrogens Are Created Equal
Oestrogen is often considered the master hormone, with imbalances in oestrogen and its metabolites having far-reaching impacts on health. Oestrogen exists in three primary forms within the body; oestrone (E1), oestradiol (E2) and oestriol (E3). Each of these exist in differing amounts in the body and have different potencies. E3 is the least potent and forms approximately 60-80% of total oestrogen. E1 and E2 are more potent forms and each ideally equate to 10-20% of the oestrogen balance. In cases of oestrogen dependant pathologies, such as breast cancer, fibroids and endometriosis, there are increased levels of the most potent E2 oestrogen
Moving Oestrogen From A to B
All forms of oestrogen are metabolised through the cytochrome P450 (CYP) enzyme system. This process can occur via one of three hydroxylation pathways in phase I liver detoxification. Figure One contains a summary of oestrogen metabolism and detoxification pathways. CYP1A1/1A2 converts oestrogen to 2-hydroxyoestrogen (2-OH), which undergoes methylation to produce the protective 2-methoxyoestrogen (2-MeO). 2-MeO is a powerfully protective oestrogen; it has been found to have anti-proliferative action, inhibit aromatase and has been tested in clinical trials for treatment of refractory breast cancer.1 The CYP1B1 enzyme is locally active within tissues and converts oestrogen to 4-hydroxyoestrogens (4-OH). The proliferative actions of 4-OH are thought to be contained to nearby tissues.1 CYP2C and CYP3A4 enzymes form the 16-hydroxyoestrogens (16-OH). These are highly metabolically active systemically and are potently proliferative oestrogens.2 Achieving a healthy balance of these oestrogen metabolites is a fundamental treatment goal in the management of hormonal conditions.
Figure One: Oestrogen metabolism and detoxification.
It’s a Balancing Act
Herbs and nutrients effectively support oestrogen detoxification, improving the 2:16-hydroxyoestrogen (2:16 OH) ratio and potentially having anti-carcinogenic effects. Soy isoflavones have been found to increase 2-OH oestrogen levels, therefore, decreasing potently proliferative 16-OH oestrogen that is associated with oestrogen dominant conditions.3 They have also been shown to modulate oestrogen synthesis, decreasing it in conditions associated with high oestrogen and increasing it in low oestrogenic states.4Genistein, the principal isoflavone in soy, has a very similar structure to 17-?-oestradiol, which is the predominant endogenous sex hormone in women. This structural similarity allows genistein to bind to oestrogen receptors (ERs), decreasing ER? activation and blocking the binding of more potent oestrogens thereby exerting a potentially favourable effect in the prevention of hormone-related cancers.5 It is also important to protect the cells of the body from oxidative damage with antioxidants such as Turmeric, Pomegranate and Rosemary. Combining these herbs with soy isoflavones in Healthy Hormone Balance enhances healthy oestrogen metabolism, helps optimise the 2:16 hydroxyoestrogen ratio and increases 2-OH oestrogen metabolism. Healthy Hormone Balance is indicated in cases of oestrogen imbalance, such as uterine fibroids, fibrocystic breast disease, premenstrual syndrome, endometriosis and menopause.
Indole-3-carbinol has been shown to have beneficial effects in oestrogen metabolism, by significantly improving the 2:16 OH ratio within one month of use.6 When used in combination with Rosemary to improve oestrogen biotransformation,7 Indole-3-Carbinol encourages the production of 2-OH, modulates ER-? expression and demonstrates anti-proliferative, anti-inflammatory and antioxidant activities. This may be of clinical relevance in patients with oestrogen-dependent cancers (e.g. prostate, breast and cervical cancers) or those at increased risk. By supporting phase I detoxification of oestrogens, Indole-3-Carbinol may also assist conditions associated with oestrogen excess.
Oestrogen In the Later Years
Even in times of lower oestrogen levels, encouraging healthy oestrogen metabolism and detoxification in your patients remains a priority. As the reproductive years come to a close, ovarian production of oestrogen declines and perimenopause begins. Rehmannia Hot Flush Relief may assist in alleviating symptoms associated with perimenopause. A randomised, controlled trial of the 6-ingredient traditional Chinese herbal formula contained in Rehmannia Hot Flush Relief showed beneficial effects in perimenopausal women. Significant improvements were seen in flushing, perspiration, palpitations, lower back pain and anxiety within two months of treatment. Following treatment, women had markedly reduced follicle-stimulating hormone (FSH) and luteinising hormone (LH) levels and slightly increased oestradiol levels, more reflective of premenopausal levels.8
Restoring balance and harmony to the body, and addressing the individual needs of your patients, takes time. Supporting healthy hormone balance, metabolism and detoxification will not only aid in the management of hormonal symptoms, it also has the potential to reduce proliferation in those at risk. As natural healthcare Practitioners, there are many herbs and nutrients available to restore equilibrium to the endocrine system. The dance of the sex hormones is complex and every patient is unique; yet your potential to restore health is immense.
References available on request.