medical-center-cologne: Intestinal Rehabilitation

Intestinal rehabilitation The gastrointestinal tract and its symbiosis with micro-organisms has been an issue amongst physicians and researchers alike. Usually, intestinal micro-organisms (bacteria and fungi) have been considered to be detrimental to the human host. Recently, research has shown, that the flora plays an important role in the vitality of the human host. In the body, the intestinal mucosa forms the largest contact surface with the outer world (skin 2 M2; lung 100 M2; gut 500 M2). The intestinal tract forms an open functional system with about 300 - 500 M2 active resorption surface for nutrients, water, bile salts and secretions by glands within the gut for protection against micro-organisms and dangerous antigens and toxic material. Also, the gut excretes IgA and waste products into its lumen.

In total, it is estimated that in an average adult, there are about 1000 trillion (10 hoch 15) bacteria living in the gut, mainly in the colon. This is 100 times more than the total amount of cells in the adult human body. The gut flora contributes about 700 grams to the total body weight. At birth, the gut is sterile. The colonisation of the gut is an ongoing process and can be divided into four stages (1):

Phase I: initial colonisation through ingestion of bacteria from the mother during the birth process of mainly aerobic bacteria (E. coli, Enterococcus, etc.);
Phase II: establishment of the early flora from the second week post partum on. Now, the gut is colonised by micro-organisms which break down complex carbohydrates, and aerobic and anaerobic bacteria (Lactobacilli, Bifidobacteria). The newborn will ingest and be colonised mainly by bacteria from the mother though direct contact with the skin and through breastfeeding;
Phase III: colonisation through micro-organisms from food stuffs other than milk. Usually, these bacteria are anaerobe (Eubacterium, Veillonella, Fusobacterium, Megasphaera, Clostridium, etc.). At this stage, the adult situation is achieved. There is being established a kind of equilibrium between many of the various micro-organisms;
Phase IV: stage of the elderly. In the elderly, there is a shift in the equilibrium between the aerobic and the anaerobic bacteria with an increase of the Clostridium species and a decline of the Bifidobacteria. The oxygen use of the aerobic bacteria is so high within the gut that anaerobic bacteria live in symbiosis with aerobic bacteria and further break down of what is left of the foodstuffs.

Robert Gorter, MD, PhD, founder and
director of the Medical Center Cologne

Improvement of Intestinal Mucosa and Flora

In total, it is estimated that in an average adult, there are about 1000 trillion bacteria living in the gut, mainly in the colon.

The development of the gastrointestinal tract and the immune system is highly influenced by the intestinal flora (2-3). Therefore, in cancer, allergies, chronic viral diseases, and other diseases, which are rooted in a malfunctioning of the immune system (immune deficiencies), the content and quality of the intestinal flora are of utmost importance.

Also, the absorption of many vitamins is dependent of the intestinal flora, like Vitamin K, and several of the Vitamin B group (B1, B2, B6, B12), folic acid, biotin, niacin, pantothen acid (4).

With food intake, many potentially infectious microorganisms and detrimental toxins (antigens) enter the gastrointestinal tract. In the submucosal layers of the gut, welldeveloped lymphoid tissue (the Gut Associated Lymphoid Tissue or GALT) is present to prevent invasion of abnormal microorganisms and toxins. In no other organ system, the immune system is so well developed and omnipresent as in the gastrointestinal tract.

The plaques of Peyer are a good example of GALT. Within the lymphocyte population, especially T-lymphocytes in the mucosa and the lamina propria, play an important role in preventing a systemic immune reaction to food antigens (oral tolerance).

In case of food allergies, but also the initiation of allergies over the mucosa, like in hay fever and contact allergies, there is a dysfunction or deficiency of GALT. Therefore, in case of allergies, other than triggered by intake of certain foodstuffs, the intestinal flora should be examined as well.

Under physiological conditions, plasma cells in GALT synthesise and excrete IgA into the lumen of the gut. In contrast to all other classes of immunoglobulins, IgA is resistant to many endogenous and bacterial proteases, and cannot be broken down after it has been excreted into the lumen. IgA works like ?gantibody painting?h and protects the mucosa from invasion of detrimental microorganisms and toxins. In other words, IgA is the ?gfirst line of defence?h (5).

Diet has a definite influence on the functioning of GALT. (see Chapter 7: Orthomolecular Therapy). Therefore, in the Gorter Model, attention is given to diet and intake of trace elements, vitamins and cancer-protective plant substances, like phenols, flavonoids, etc.

A proper development of the immune system in the gut and a balanced intestinal flora will add to health, and its maintenance. In case of (chronic) disease, particular attention must be paid to the composition of the various bacterial subpopulations within the gut. In the Gorter Model, prevention medicine also plays an important role.

Therefore, attention is paid to the composition of the intestinal flora as well, as, over time, a misbalanced flora can add to the risk of developing cancer, allergies and chronic disease.

Importance of the Intestinal Flora for the Human host

The development of the gastrointestinal tract and the immune system is highly influenced by the intestinal flora

Micro-organisms have a tremendous flexibility in the physiology of their metabolism, compared to plants and animals. In part, this is due to their tiny dimensions. On average, a bacterium contains less than 100.000 protein molecules.

If, at a given time, certain enzymes are not needed, they are just not produced. Micro-organisms have a tremendous metabolic (anabolic) potential.

A cow of 500 kg produces per day approximately 1 kg than 10.000 kg of protein in the same time. The pH of the intestinal milieu plays an important role in the metabolism and reproduction potentials of micro-organisms.

The optimal pH of the gut (colon) is <7.0. usually="" in="" chronic="" disease="" and="" cancer="" the="" ph="" is="" clearly="">7.0. Therefore, in these cases, the pH of the milieu must be lowered.

This can be brought about by dietary changes, like increasing the intake of fibre and lactulose, and of Lactobacilli, and decreasing the intake of proteins.

Fibre and lactulose are usually plant derived and consist of a mixture of cell membranes and cellulose, which cannot further be broken down by the human digestion processes. A fibre-rich diet lowers blood cholesterol and stimulates peristalsis.

Through increasing gut motility, passage of food rests (faeces) is hastened and thus, toxic substances, among them bile salts, free ammoniac, psychopharmaca and antibiotics, have less contact with the intestinal mucosa. Thus, in this way, it can be understood that fibre rich nutrition lowers the risk of colon cancer (6).

Change of the Milieu

Micro-organisms have a tremendous flexibility in the physiology of their metabolism, compared to plants and animals.

Some of the dietary proteins reach the colon. Here, bacteria, which can break down proteins, are available. Among them are various E. coli and Klebsiella and Proteus species.

Through proteolysis, free ammonia and amines are formed, which make the milieu of the gut more alkaline (ph>7.0).

Therefore, dietary intake of proteins should be modest. Usually, a vegetarian diet is rich in fibre and relatively low in protein.

Bacteria like Bifidobacilli and Lactobacilli lower the pH of the colon and can be an adjunct therapy in the treatment of cancer patients and patients, who received prolonged antimicrobal therapies.

Reduction of Protein Intake

Some of the dietary proteins reach the colon. Here, bacteria, which can break down proteins, are available.

Fundamentally, any immunomodulation through therapeutic intervention only makes sense in diseases, where the cause of the disease lays within the immune system itself, or where through medical interventions (antimicrobal therapies), the intestinal flora has been severely altered.

One parameter is the IgA concentration in the stool (6). Through application of commercially available microbiological preparations, the milieu of the intestinal lumen can be influenced positively, and thus, an effect on GALT can be achieved.

In this context, Saccharomyces boulardii plays a special role in immunomodulation and improvement of the milieu of the intestinal lumen (7,8).

Saccharomyces boulardii can be given prophylactically in case of antimicrobal therapy to prevent diarrhoea, etc., or to treat imbalances of the flora after such a therapy (9).

Immunomodulation Through Microbiological Interventions

Fundamentally, any immunomodulation through therapeutic intervention only makes sense in diseases, where the cause of the disease lays within...

In chronic diseases, the exocrine function of the pancreas can become insufficient.

Often, this condition is late or never diagnosed.

If an insufficiency of the exocrine function of the pancreas is suspected, in the Gorter Model, cancer patients are tested for their pancreas function and substitution of pancreatic enzymes is initiated when an insufficiency has been documented

Pancreas Insufficiency

b>In chronic diseases, the exocrine function of the pancreas can become insufficient. Often, this condition is late or never diagnosed.

Menopausal women frequently request more natural approaches than hormonal substitution for menopausal symptoms. Many women express concern about possible teratogenic effects of long-term hormonal substitution therapies.

The working of Isoflavones (phytoestrogens) has been studied extensively in the treatment of menopausal symptoms in women. Isoflavones show a structural resemblance with normal estrogens(1).

They bind selectively to estrogen receptors (2). Especially cardiovascular symptoms and osteoporosis are positively influenced (3,4). Interestingly, in countries with phytoestrogen-rich diets, like in many Asian countries, several forms of cancer are less common than in our western world (5). Also, the intake of Isoflavones improves elevated blood cholesterol and lipid levels (6).

Therefore, in the Gorter Model, menopausal women and women post ovarioectomy, will receive isoflavones in therapeutic doses (usually, an standardized extract of clover and soy isoflavones will be administered).

Womens health - Menopausal Symptomatology

Menopausal women frequently request more natural approaches than hormonal substitution for menopausal symptoms

1. Finegold SM, Sutter VL, Mathisen GE: Normal indigenous intestinal flora. In: Hentges DJ: Human intestinal micro flora in health and disease. Academic Press, New York, London, Paris (1983).

2. Pulverer G, Beuth J, Roszowski W, Burrichter H, et al.: Bacteria of human physiological micro flora liberate immunomodulating peptides. Zbl Bakt (272): 467-476 (1990).

3. Pulverer G, Ko HL, Roszkowski W, Beuth J, Yassin A, Jeljaszewicz J: Digestive tract microflora liberates low molecular weight peptides with immunotriggering activity. Zbl Bakt 272: 318-327 (1990).

4. Rasic JL, Kurman JA: Bifidobacteria and their role. Experientia Supplementum 39(71) Birkhaeuser, Basel, Boston, Stuttgart (1983).

5. Brandt-Zaeg P, Halstensen TS, Kett K: Immunobiology and immunopathology of the human gut mucosa: humoral immunity and intraepithelial lymphocytes. Gastroenterol 97: 1562-1584 (1989).  

6. Bender H: Ballaststoffe in der Ernaehrung: Ihre Eigenschaften und Wirkungen. Pharmazeut Ztg (140): 4383-4390 (1995).

7. Beckmann G, Ruffer A, Sonnenschein B: Wiederaufforstung ?| Symbioselenkung ?| Substitution der Darmflora. Einige kritische Anmerkungen. Naturheilpraxis (50): 780-785 (1997).

8. Friedland T, Seifert J: Untersuchungen zur In-vitro-Wechselwirkung zwischen Saccharomyces boulardii und Enterobakterien. In: Ottenjahn R, Muller J & Seifert J: Oekosystem Darm II. Morphologie, Mikrobiologie, Immunologie, p. 168-177, Springer Verlag, Berlin, Heidelberg, New York (1990).

9. Jahn HU, Ullrich J, Liehr RM, Schieferdecker HL, Riecken EO, Zeitz M: Immunologische und trophische Wirksamkeit von Saccharomyces boulardii beim Menschen. Z Gasteroenterol (31): 527 (1993).  

10. Boneke H, Hotz J: Saccharomyces boulardii bei der Antibiotika-assoziierten Diarhoe. Der Kassenarzt 37(51/52): 26-30 (1997). 1. Setchell KDR, Adlercreutz H: Mammalian ligands and phytoestrogens. Recent studies on their formation, metabolism and biological role in health and disease. In I. Rowland (ed.), Role of the gut flora in toxicity and cancer, London: Academic Press, 315-345 (1988).

2. Shutt DA, Cox RI: Steroid and phytoestrogen binding to sheep uterine receptors in vitro. Endocrinology, 52: 299-310 (1972).  

3. Stonek F, Lass H, Gruber D, Metka M, Huber JC: Comparative doubleblind, cross-over study of efficacy of red clover extract (RCE 40) x placebo in the treatment of menopausal symptoms. University Clinic of Vienna, Department of Gynecological Endocrinology and Reproductive Medicine, AKH, Vienna, Austria (1999).

4. Kuiper GGJM, Lemman JG, Carlsson B, Corton JC, Safe SH, van der Saag PT: Interaction of estrogenic chemicals and phytoestrogens with the estrogen receptor B. Endocrinology, 139(10), 4252-4263 (1998).
5. Adlercreutz H, Gorbach S, Goldin B: Dietary phytoestrogens and the menopause in Japan. Lancet 339: 1233 (1992).

6. Anthony MS, Clarkson TB, Hughes CL, Morgan TM, Burke GL: Soybean isoflavones improve cardiovascular risk factors without affecting the reproductive system of peripubertal rhesus monkeys. J Nutr 126: 43-50 (1996).

References

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