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In drug medicine, when the symptoms are directly related to the gut,
the treatment strategy consists of symptom suppression with drugs. When the symptoms are
not directly related to the gut, any suggestion of a possible role of a damaged bowel
ecosystem in the cause of symptoms is unceremoniously dismissed. In my view, the most remarkable phenomenon in the entire field of human
biology is this: A vast number of clinical problems that are seemingly unrelated to the
bowel spontaneously resolve when the focus of clinical management turns to all the issues
in bowel ecology. How often do symptoms of persistent debilitating fatigue in young men
and women clear up when an altered state of bowel ecology is restored to normal? How often
do troublesome mood swings subside when therapies focus on the bowel? How often does
arthralgia (pain and stiffness in joints with or without joint swelling) resolve when all
the bowel issues are addressed? How often do we successfully prevent chronic headache;
anxiety; palpitations; incapacitating PMS; recurrent attacks of vaginitis; asthma and skin
lesions by correcting the abnormalities in the internal environment of the bowel? The
answers to these questions will vary widely among physicians. Physicians who regularly neglect the bowel (and those who never
understood the issues of bowel ecology in the first place) will dismiss these questions
with scorn. None of this has been proven with double-blind cross-over studies, they will
strenuously protest. Other physicians who have learned to respect the bowel — as the
ancients did — and care for their patients with a sharp focus on bowel issues will
readily and unequivocally validate my personal (and fairly extensive) clinical experience.
The bowel ecosystem teems with life. Shrouded in metabolic mists, it is
as rich in biologic diversity and as broad in biochemical interrelationships as any other
ecosystem on this planet Earth. The ancients seemed to have an intuitive sense about it.
Death begins in the bowel, they pronounced in more than one way. Leeuwenhoek studied fecal
bacteria during his invention of the microscope in 1719, and, thus, was the first man to
study life in the bowel ecosystem with modern scientific methods. Metchnikoff, the Russian
biologist, who single- handedly developed the concept of the cellular arm of the immune
system, became intensely interested in the aging process in his later years when he moved
to Paris where he served as the head of the Pasteur Institute. He studied the longevity of
Bulgarians and provided strong evidence that certain bowel microbes played important roles
in preserving health and promoting longevity among them. He named the microbe he thought
was most prominent in this field as Lactobacillus bulgaricus. Metchnikoff's work opened
the floodgates of basic research on the bowel flora. A cell looks at the world around it through its cell membrane. It is
this membrane that separates the cell's internal order from external order. Although
molecular host defense mechanisms of both immune and nonimmune types have progressed from
simple single-cell forms to multicellular forms to highly developed complex organisms such
as humans, the fundamental pattern of host defenses has remained the same: The cell
membrane or its counterparts carry the primary responsibility for preserving the biologic
integrity of the organisms. For the professional reader, I discuss at length the energy
and biochemical events which occur at the cell membrane in health and disease in my
monograph, The Agony and the Death of a Cell, published in the 1991 syllabus of the
American Academy of Environmental Medicine. For humans, the gut mucosa is the true counterpart of the cell membrane
of unicellular organisms. From a phylogenetic perspective, the gut mucosa would be
expected to be the primary host defense organ. This indeed is the case when one looks at
health and disease from a holistic perspective. In a biologic sense, man's gut lining is his window to the world around
him. What do we ever get through our skin but a little vitamin D when we get a chance to
bask in the sunshine? What do we get through our lungs? All our ancestors ever received
through their lungs was oxygen. Now we receive — unwillingly and under severe protest
— a heavy load of environmental pollutants. Everything else that enters our biologic
systems enters through the gut lining. It is important to recognize that the mucosal
linings of the mouth, esophagus and stomach essentially are extensions of the gut lining.
The states of health and absence of health are expressions of the dynamics of foods within
the gut ecosystem — the effects on foods of the digestive-absorptive processes as
well as the various life forms in the gut. The ancients seemed to have known this intuitively. We seem to
have taken a very circuitous route to grasp this most fundamental of all aspects of the
immune system. I remember that the hakim (folk-doctor) in my village always prescribed
laxatives for a headache. He prescribed remedies that seemed to work on the bowel for
problems of the skin, joints, liver and other organs. Of course, I, then a medical school
student, found it very amusing. It never occurred to me then why these folk-doctors would
prescribe year after year remedies that couldn't work. More important, from my present
perspective, I never wondered why people accepted those remedies year after year if they
afforded no relief. I was into the science of medicine then. I wasn't into finding out
what worked and what didn't. Nor did I ever doubt the science of my professors who doled
out prescriptions for drugs by the dozens for sheer symptom suppression. That was then.
And that was poor Pakistan. Now I question the science of an average American family
practitioner when he prescribes drugs for chronic bowel symptoms. How scientific is his
use of antacids for symptoms of burning or pain in the pit of the stomach? How scientific
is his use of antispasmodic drugs for abdominal cramps? How scientific is his use of
antidiarrheal drugs for diarrhea? How scientific is his use of steroids for inflammatory
bowel disorders? Steroids suppress the immune system. How scientific is it to further
suppress the immune system for problems caused by an errant immune system in the first
place? How scientific is the use of anti-inflammatory agents, anxiolytic drugs,
antidepressants, antispastic agents, antihistamines, and, of course, broad-spectrum
antibiotics for treating various types of bowel disorders that we — by our own
admission — do not understand the causes of? How many different things can the bowel do? It cramps. It obstructs. It
turns and twists. It ulcerates. It bleeds. How does the bowel know when to cramp and when
to obstruct or bleed? And when to turn and twist? For many years I have studied a host of clinical syndromes in which the
symptom- complexes can be related to events occurring in the bowel. As a hospital
pathologist, I have had the opportunity to examine more than 11,000 bowel biopsies during
the last 25 years. Every time I peered at a bit of bowel through a microscope and saw
inflammation — colitis in common jargon — I wondered where and how it might have
started. We pathologists know quite a bit about how a damaged bowel looks, but we know
little, if anything, about the initial energetic-molecular events that set the stage for
tissue damage. What is the cause of ulcerative colitis? Pathologists will tell you it is
not known. What is the cause of Crohn's colitis? The answer: unknown. What is the cause of
irritable bowel syndrome and spastic colitis? Unknown. What is the cause of microscopic
colitis and collagenous colitis? The answer is the same. Why is it that we do not know the cause of any of these types of
colitis? The reason is we search for answers in the damaged structure after the fact
rather than in the events preceding the damage. None of these "diseases" can be
understood except with ecologic thinking. During the early 1980s, my research colleague, Dr. Madhava
Ramanarayanan, and I introduced the micro-elisa assay for allergen-specific IgE
antibodies. This research interest and several subsequent studies gave me important
insights into immune and nonimmune events that inflict tissue injury. It also raised
serious questions about many of the prevailing concepts regarding the role of food and
mold allergy in the causation of numerous bowel disorders. As a clinician, I have cared
for a fairly large number of patients with autoimmune and immunodeficiency syndromes.
These microscopic, immune, molecular, and clinical observations — as disparate as
they appeared in the usual clinical setting — began to take coherent and integrated
forms before me. I began to recognize that events taking place in the bowel were clearly
related to many clinical syndromes that seemed to have nothing to do with the bowel
according to the prevailing concepts of pathogenesis of disease. The single most important
insight into the workings of the human immune and nonimmune defense systems for me has
been this: The integrity of human molecular defenses cannot be preserved except through
preservation of the gut ecology. My clinical work with chronic fatigue states allowed me
to test and validate this fundamental concept with therapies founded on my view of injured
bowel ecosystems.
LAPs AND TAPs: THE GOOD AND BAD GUYS OF
THE BOWEL LAPs and TAPs are my abbreviations for lactic acid-producing and toxic
agents- producing microbes in the bowel. LAPs preserve the normal bowel ecosystem, TAPs
disrupt it. In the chapters (from The Canary and Chronic Fatigue) , What Is Chronic
Fatigue? and Where Does It All Begin?, I discuss many elements that increase oxidative
stress on energy and detoxification enzymes. It turns out that almost all these elements
also suppress LAPs and — both directly by inhibiting LAPs and indirectly by other
mechanisms — promote the growth of TAPs. This subject is of enormous significance in
the normal aging process as well as in the accelerated aging process associated with
chronic fatigue states. LAPs confer many important host defenses upon the bowel discussed later
in this section. TAPs are equally versatile in their functions and produce a very large
number of noxious substances in the bowel. Among these are ammonia; phenols; tryptophan
metabolites; vaso-constrictive amines such as histamine, tyramine, agmatine and
cadaverine; certain steroid metabolites; and many toxins — most notably mycotoxins
derived from fungi (yeast). This area has received rather limited investigative
attention, and it is almost certain that future research will uncover a host of as yet
undetected bacterial and fungal toxins and metabolic villains. Finally, the bowel flora
both produce and potentiate some carcinogenic substances. Not unexpectedly, LAPs-TAPs dynamics are profoundly influenced by food
choices. American and British individuals show overgrowth of some TAPs such as bacteroides
and some types of clostridia as compared with Japanese, Indians and Ugandans (Lancet
1:95-100; 1971). It appears likely that these differences are due to an abundance of fats
and beef in the former populations' diet. Bacteria are living beings capable of executing an enormous number of
biochemical reactions. Farmers used bacteria and fungi to turn compost into fertilizer
long before biologists understood the metabolism of these single-celled bodies. A partial
list of such reactions brought about by the normal bowel flora includes production of
ammonia, conversion of amino acids into amines and phenols, inactivation of digestive
enzymes such as trypsin and chymotrypsin and other enzymes located on the surface of cells
lining the gut, deconjugation of hormones such as estrogen and bile acids, denaturation of
bile steroids, breakdown of food flavonoids, hydrogenation of polyunsaturated fatty acids
in food, utilization of certain amino acids such as B12, conversion of some compounds into
carcinogens, and many other enzymatic reactions.
I list below the three genera of LAPs and
several genera of TAPs that most frequently populate the bowel ecosystem.
About 30 species of LAP microbes have been
identified. Some important members of these three groups (L, Lactobacillus; B,
Bifidobacterium; S, Streptococcus) include the following: L. acidophilus Most byproducts of modern technology threaten LAP microbes. In
addition, alcohol, nicotine, various pharmacologic agents, and highly processed and
"preserved" foods have a negative impact on lactic-acid producers. Normal fecal flora in man includes the following: Bacteroidaceae
(Bacteroides and Fusobacteria), Eubacteria, Lactobacilli, Bifidobacteria, Veillonellae,
Acidaminococci, Megasphaerae, Peptococcaceae (Ruminococci, Peptococci and
Peptostreptococci), Clostridia (C. perfrigens and other species), Enterobacteriaceae,
aerobic Lactobacilli, Streptococci, Staphylococci, and yeast and fungi (often used
interchangeably). LAPs: THE GUARDIAN ANGELS OF HUMAN CANARIES The LAPs angels look after human canaries in many ways. First and foremost, LAPs keep TAPs out. It appears that this essential
role is played through different mechanisms that include simple physical crowding out of
the potential pathogens as well as production of antimicrobial substances. L. acidophilus
produces acidophilin, acidolin and bacterlocin; L. plantartium produces lactolin; L.
bulgaricus produces bulgarican; and L. brevis secretes lactobacillin. Second, they produce many life span molecules. Notable among them are
members of the vitamin B complex, especially folic acid and biotin and vitamin K.
Lactobacillic acid is an important fatty acid that is produced by some lactic-acid
producers and is then converted into essential fatty acids. Another notable molecule in
this context is tryptophan — this is likely to be one of the mechanisms by which
yogurt has been reported to be beneficial in cases of chronic anxiety and other
conditions. Third, they play a pivotal role in digestion. Lactose intolerance is a
very common clinical problem. It is often not fully appreciated that a major portion of
lactose ingested in dairy products is actually broken down to simpler sugars by lactase
enzymes produced by lactic acid producers. Lactic acid and lactase producers also play
important roles in protein digestion. This is one of the primary reasons protein
intolerance is so common among individuals with altered states of bowel ecology. Fourth, LAPs actively break down some toxins produced during metabolism
such as ammonia, free phenols and polypeptides. Fifth, LAPs normalize bowel transit time and are effective in
controlling infant and adult diarrhea. Sixth, the antiviral and antifungal roles played by LAPs, having long
been empirically suspected by nutritionists and holistic physicians, have recently been
documented with research studies. Seventh, the cholesterol-lowering effects of fermented milk have been
attributed, among other mechanisms, to orotic acid, which facilitates fat metabolism in
the liver. Eighth, some LAP microbes suppress tumor cells in rats. This factor is not of direct relevance to human canaries — at least not yet, though in time accelerated oxidative damage is likely to increase the incidence of cancer in chronic fatigue states. |
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The
Works of Majid Ali, M.D.