Digestive disorders

Health Concerns Herbalist

Avoiding IBD Surgery
By Andrew Gaeddert

Over 60 percent of Crohn’s patients will have surgery, 20 percent of ulcerative colitis patients will go under the knife. Surgery is usually recommended when drugs are not effective for bleeding, fistulas, infections and strictures in the intestines. Oftentimes surgeons and gastroenterologists disagree as to when surgery should be conducted. As the current medications used in the treatment of Crohn’s and ulcerative colitis are more expensive and have more serious side effects, surgeons usually recommend bowel surgery, while gastroenterologists are usually comfortable with using steroids, and other strong acting drugs in order to induce remission. Although colon cancer and perforation require surgery, for most patients surgery is an elective procedure. Even though clients can usually go to the bathroom normally, surgery instills fear in patients. “Fear of the unknown, fear of disfigurement, fear of needing a permanent ileostomy, fear of incontinence with the pouch, fear of death from surgery, fear of changes in interpersonal relations,” said Dr. Stephen Hanauer, chief of gastroenterology and nutrition at the University of Chicago Medical Center.1

Unfortunately, most gastroenterologists are not aware of the benefits of herbal medicine. The herbal formula Isatis Cooling™ has been used for two decades in order to reduce inflammation and cramping. Isatis Cooling treats infections, regulates fluid metabolism, increases blood circulation and removes endotoxins. Isatis Cooling is usually combined with Formula H™ for intestinal bleeding, Colostroplex™ for chronic diarrhea and Quiet Digestion™ or Chzyme™ to help improve digestive function. There are more protocols in my upcoming title, Healing Digestive Disorders, 4th edition.

Notes

  • 1. health.nytimes.com/ref/healthguide/esn-ulcerativecolitisess. html, accessed on 6/25/08.

Chinese Herbal Treatment of Chronic Digestive Disorders: Part One
By Andrew Gaeddert 

Digestive disorders are extremely common in the United States. Many Americans who consume antacids in large quantities do not even consider themselves to be suffering from a chronic digestive disorder. Flatulence, tiredness after eating, heartburn, fullness of the stomach, abdominal bloating, sharp stabbing abdominal pain, diarrhea, constipation, are common signs of chronic digestive disorders. The American dietary habits of eating on the run, consuming cold and raw foods, drinking iced beverages, adults eating a preponderance of dairy products, fondness for sweets, fried foods, and alcohol, are perhaps the greatest contributing factors to digestive disorders.

Proper digestion is necessary for good health. Undigested or incompletely digested food molecules that are absorbed into the system can lead to various diseases and the development of food allergies. Conditions of the small intestine often cause malabsorption syndromes. This article discusses the traditional Chinese medicine (TCM) syndromes and treatment of the following biomedical diseases: ulcerative colitis, Crohn’s disease, peptic ulcers, and irritable bowel syndrome. Symptoms and Syndrome Patterns TCM treatment of diseases is based on the correct differentiation of syndrome patterns. Thus, while the Western diagnosis of some conditions may differ, the TCM pattern may be the same.

For example, Crohn’s disease and ulcerative colitis are biomedically different. Crohn’s disease is characterized by an inflammatory reaction throughout the entire bowel wall; the condition is also known as regional ileitis. The disease can extend over many years with exacerbations and remissions of symptoms that include diarrhea, abdominal pain, anemia, weight loss, fistula formation, and eventually intestinal obstruction. Stools are soft and grayish or brownish, with abundant fecal particles. Any part of the gastrointestinal tract may be involved, but the ileum is the most common site. Current Western treatment is usually long-term antibiotic or steroid therapy.

Ulcerative colitis is characterized by passage of watery stools with mucus and pus. Accompanying symptoms may include abdominal pain, tenderness or colic, as well as intermittent or irregular fever. Serious cases may present hemorrhaging and perforation. Both Crohn’s disease and ulcerative colitis are considered inflammatory bowel diseases (IBD). Males between 15-35 years are most commonly affected. In 15-40% of cases, multiple members of a family are sufferers of Crohn’s disease or ulcerative colitis. Although immune dysfunction is common in IBD, it is unclear if it is the cause or the result of IBD. The actual cause of IBD is unknown. A virus or bacteria may be at fault, or a breakdown of the body’s immune system, or a combination of the two. IBD is not caused by emotional stress, although flare-ups may occur during such times.

Irritable bowel syndrome (IBS) is also quite common in the U.S. IBS is not associated with pathologic changes in the intestine, or with inflammation. It is widely believed that emotional fluctuations play a strong role in causing IBS. Also known as spastic colon or nervous indigestion, IBS symptoms include abdominal pain and distention with relief upon bowel movements, constipation, diarrhea, excess mucus production in the colon, and indigestion.

A peptic ulcer, which occurs in the upper gastrointestinal tract, is a circumscribed ulceration of the mucous membrane penetrating through the muscularis mucosa. The most common type of peptic ulcer, a duodenal ulcer, is found in the first few centimeters of the duodenum. Another common form occurs along the lesser curvature of the stomach and is known as a gastric ulcer. The typical pattern of pain in patients with duodenal ulcers is: It is absent upon wakening in the morning, but appears in mid-morning; it is relieved by food, but recurs two to three hours after a meal; pain that awakens the patient at 1 or 2 AM is common. The symptoms of gastric ulcers often do not follow the duodenal ulcer pattern, and eating may cause rather than relieve the pain. Certain drugs, especially aspirin, other nonsteroidal anti-inflammatory drugs, and possibly corticosteroids, predispose to the formation of upper gastrointestinal ulcers that tend to heal when the drug is discontinued.

In diagnosing chronic digestive disorders, parasitic infections, and more importantly, food allergies, must be ruled out. Gastroenterologists generally recommend a low fiber diet, although good nutrition is very important especially for IBD sufferers, since anemia is quite common. Successful treatment of chronic digestive disorders necessitates first treating any parasitic and/or Candida infections that may be present. According to TCM, stress while eating and even returning to work immediately after eating, can cause digestive problems. Many of us Americans tend to be Qi deficient which affects both our energy and our ability to convert foods into energy. Pharmaceuticals as well as recreational drugs may induce stomach yin deficiency.

The root of digestive disorders is usually liver qi invading the spleen/stomach. Stagnant liver qi disrupts the ability of the spleen to transform food into energy. When stagnation of liver qi predominates, constipation with tiny dry stools is a common presentation; while with spleen deficiency, loose stools are. Other symptoms of liver and spleen/stomach qi stagnation include distention, fullness in the upper abdomen that is aggravated after meals or by emotional stress, frequent belching, pain relieved by bowel movements, nausea, regurgitation, and a thin white tongue coating.

Individuals who are in the habit of drinking cold beverages, eating ice cream and raw foods are particularly prone to a cold-dampness pattern. Their symptoms include pain that is relieved by pressure, distention and fullness of the stomach after meals, tiredness, cold limbs, pale tongue with white coating and a weak pulse. A burning pain in the upper abdomen relieved by meals, thirst without the desire to drink much, irritability, red tongue with dry yellow coating, and a rapid pulse all point to yin deficiency pattern. In all chronic digestive disorders food stagnation is present. Chronic dampness precludes complete digestion of food. Overeating, eating too quickly, or eating while emotionally upset can all lead to food stagnation. Symptoms include a sensation of fullness in the stomach, foul breath, sour regurgitation, belching, and insomnia, along with a thick yellow or white tongue coating.

Damp-heat in the large intestine is another common syndrome of chronic digestive disorders. Qi deficiency is also present along with abdominal pain, diarrhea, mucus and blood in the stools, smelly stools, heaviness in the body, fever, anal burning, and a red tongue with a sticky yellow coating. Individuals with this pattern are generally diagnosed as having candidiasis by holistic physicians whether or not tests indicate higher than normal Candida counts. Many cases of candidiasis are iatrogenic because of the overprescribing of antibiotics by Western physicians. When colonies of yeast are established in the mucous membrane, they can survive for years and even decades if the patient’s diet is composed of high sugar, yeast, or fermented foods. Yeast can attach to the wall of the colon, small intestine, or any other part of the gastrointestinal tract, and release toxic byproducts into the circulatory system. These byproducts inhibit the function of T-suppressor cells.

According to Seattle physician, Ralph Golan, M.D. (The New Medicine Guide, Ballantine Books, 1993), a yeast-impaired immune system has less than normal tolerance for ordinarily safe levels of common chemicals such as gasoline and oil fumes, cleaning fluids, and pesticide residues found on supermarket produce. Dr. Golan also notes that an impaired immune system may produce antibodies to the body’s own tissues resulting in autoimmune diseases. Other pharmaceuticals that may lead to candidiasis include cortisone, immunosuppressants, and birth control pills. Patients suffering Crohn’s disease or colitis have a propensity for developing both candidiasis and damp-heat in the intestines. Thus, in addition to following a TCM diet, herbs in a well-balanced formula should be taken for extended periods.

Severe cases of IBD involve blood stasis which is characterized by fixed stabbing pain, a tongue that is purple in the center, dark blood in the stools, and epigastric pain. Because inflammation is a major symptom of IBD, the standard medical treatment is long-term administration of steroids, antibiotics, or sulfa drugs. Surgery is now rare because steroids are almost immediately effective. However, TCM views the use of steroids as harmful to the kidney. And from a Western medicine standpoint, steroids may cause gastrointestinal disorders, and myriad of other problems. Long-term antibiotic use may cause gastrointestinal complaints, fungal overgrowth, and allergic reactions. Sulfa drugs may also lead to gastrointestinal disturbances and allergic skin reactions.

Treatment: Chinese herbs that have an anti-inflammatory action are excellent not only in reducing inflammation, but also in attacking bacteria which may be the cause of flare-ups of IBD. Isatis leaf (da qing ye) and root (ban lan gen) are very effective as they are both antibiotic and antiviral according to Chinese research. They are also cool in nature, and thus are anti-inflammatory. In studies described by Bensky and Gamble in Chinese Herbal Medicine: Materia Medica, 300 patients were administered Isatis and their “fevers would usually disappear entirely within one day, and frequency of bowel movements usually returned to normal within five days” (p. 127). Smilax (tu fu ling) is also an important herb as it clears damp-heat toxin and treats ulcers. According to Michael Murray, N.D., in his Healing Power of Herbs, Smilax is an endotoxin binder (p. 215). Endotoxins are cell wall constituents of bacteria that are absorbed in the gut. If the liver is in dysfunction, the endotoxins may seep into the bloodstream and activate the alternate complement system which plays a critical role in the inflammatory process.

One of the most suitable formulas for treating IBD is Phellostatin because of its antifungal properties, since many IBD patients are also afflicted by candidiasis. The main ingredient is Phellodendron (huang bai) which treats diarrhea and eliminates heat and dampness. The remaining herbs in the formula tonify the Qi, clear heat and dampness, and are anti-inflammatory and antifungal. Phellostatin may be combined with Quiet Digestion. The primary ingredient in the latter formula is Shen Qu which is composed of fermented herbs that are rich in enzymatic activity. For severe cases of gas and bloating, Quiet Digestion may be taken every two hours until the gas subsides. The formula is designed to break down rapidly in the gut for immediate relief. It should be started slowly, one tablet three times per day and then gradually increased to three capsules three times per day after two to three weeks.

Quiet Digestion is taken just before meals in order to help the assimilation of food. It may also be taken after meals when gas-inducing foods are consumed, usually two capsules until the symptoms are alleviated. We recommend combining Quiet Digestion with other formulas when treating chronic digestive disorders, since food stagnation is so common among these cases. For chronic digestive disorders that are accompanied by pain and inflammation, Isatis Cooling is appropriate. In addition to Isatis extract (da qing ye and ban lan gen), its other ingredients tonify the spleen, promote blood circulation, clear dampness and heat, and are anti-inflammatory, antifungal, and antibacterial.

Under proper medical supervision Isatis Cooling may be tried as steroids are slowly withdrawn. Underlying the heat and inflammation is deficiency, thus after a course of Phellostatin or Isatis Cooling, Six Gentlemen with cardamon and saussurea (xiang sha liu jun zi wan) may be used to tonify the spleen (especially cold pattern), or Astra Essence, as it is a balanced formula with kidney yin, yang, and blood tonics.

In treating IBS and peptic ulcers, Stomach Caps have proven to be an effective remedy. Based on Ping Wei San (Relieve the Stomach Powder), this formula is modified with bupleurum since many individuals with chronic digestive disorders tend to repress their emotions; it is also included for its anti-inflammatory effect. The other herbs in the formula stimulate digestive enzymes, remove phlegm, treat gas, and remove food stagnation. For stomach yin deficiency pattern, Clearing may be used as it does not contain rehmannia (shu di huang) which some patients cannot tolerate because it is cloying and aggravates the symptoms of chronic digestive disorder.

The above formulas are very effective in treating the complex syndrome patterns that are presented in patients with IBD, IBS, and ulcers. I have been using prepared formulas with much success because they are well tolerated. Sufferers of chronic digestive disorders generally have malabsorption problems, thus herbal teas may not be suitable for these cases. Also, herbal teas are absorbed too quickly to be effective in these patients. Interestingly, persons with digestive conditions are unusually sensitive, and in particular to bitter tastes, so that again, herbal teas may not be well tolerated. Perhaps these individuals would do well to consume more bitter substances as prescribed in the European tradition which encourages taking herbal “bitters” for indigestion. Herbal teas, however, should not be eliminated completely from the therapeutic regimen. I generally advise clients to drink at least three cups of hot peppermint tea daily, because this herb relieves stomach and bowel spasms and alleviates nausea. On occasion I have also administered simple, pleasant tasting herbal decoctions with herbal capsules in order to tonify the Qi and blood. Therefore, by using teas and capsules, patients can consume more herbs (inexperienced practitioners often do not use high enough dosages).

A combination of Fish Oil, FOS, and Antioxidants Decrease Corticosteroid Dose in Ulcerative Colitis Patients  
By Andrew Gaeddert 

In a recent double blind placebo controlled study, 121 subjects with a diagnosis of ulcerative colitis (UC) for at least six months received either a mixture of fish oil, antioxidants, and fructooligosaccharides (FOS) or a placebo. After six months those taking the fish oil mixture were able to reduce their prednisone dosage 35-65percent less than the placebo group. Other improvements such as histological changes were similar in both the active and placebo groups. In addition to having their medications monitored, subjects were evaluated on the basis of endoscopic features, and a DAI scale that evaluated stool frequency, rectal bleeding, appearance of rectal mucosa, and physicians rating for disease activity.1 Patients were instructed to maintain their normal diet. High dose fish oil (10-20g day) has been studied in five randomized clinical trials for UC with mixed results.

Over the past two decades I have treated many patients with ulcerative colitis and Crohn’s disease. While I have not used standard fish oil products, as they are typically difficult to digest, I have begun using EPAQ krill oil with these clients. EPAQ is more easily digested than standard fish oil, and has and has potent anti-inflammatory and antioxidant effects. For high levels of inflammation, I typically administer EPAQ (3 softgels daily) along with Isatis Cooling (9 capsules per day). Isatis Cooling contains anti-inflammatory herbs, ingredients which improve blood circulation and heal ulcers. Isatis Cooling can be combined with either Colostroplex to help heal the intestines and stop diarrhea or Aloe 22 in the event of constipation. For additional protocols and information about herbs and supplements to help people with digestive conditions, see my book Healing Digestive Disorders, 2nd edition.

Notes

  • 1. Sidner DL, Lashner BA, Brzezinski A, et al. An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: A randomized, controlled trial. Clin Gastroenterol Hepatol 2005;3:358-69. http://www.medpagetoday.com/Pulmonary/Asthma/tb/974. http://www.medpagetoday.com/hematologyOncology/BreastCancer/tb1/1139.

Treating IBS, Crohn’s Disease and Ulcerative Colitis
By Andrew Gaeddert 

In treating a wide range of people with digestive disorders over the past twenty-five years, I can say two of the most important concepts are food stagnation and liver overacting on the spleen. We will discuss these concepts and the use of Quiet Digestion™ in my teleseminar: Treating IBS, Crohn’s Disease, and Ulcerative Colitis.

Quiet Digestion is a combination of two traditional formulas designed to treat intestinal and gastric distress including adnominal pain, cramping, vomiting, bloating, and gas.  In addition, Quiet Digestion is used to improve food, nutrient, and herbal absorption. It can relieve gastroenteritis, hangover, and jet lag.

Importantly, Quiet Digestion and its sister product Chzyme™, are free from additives such as wheat and corn which are often contained in imported products. Chzyme has the same herbal blend as Quiet Digestion with the addition of enzymes to break down fats, carbohydrates, protein, dairy and beans, with peppermint oil to soothe abdominal spasms.

We will also explore a two-pronged approach to help clients with inflammatory bowel disease focusing on both symptomatic relief and controlling the underlying immune system dysfunction. We will discuss a natural supplement that has anti-inflammatory and immunomodulatory effects similar to corticosteroids. We will also discuss probiotics, as well as ancient and modern herbal preparations. Case studies to be discussed are:

  • How a Crohn’s patient was able to avoid surgery
  • A woman whose lab results were controlled with drugs, her symptoms were controlled by herbs
  • The man who had to resort to street drugs to curb his pain
  • The teenager who would not make dietary changes
  • The IBS patient taking 20 supplements 

Gallbladder at Root of Embarrassing Digestive Symptoms
By Andrew Gaeddert

Rebecca, a 62-year-old grandmother, often experienced burping, nausea, intestinal gas, bloating and frequent pain in the upper right side and middle of her abdomen, especially after eating fatty foods. Her discomfort prompted her to see a gastroenterologist, who ordered blood work, abdominal scans and ultrasounds of her gallbladder and liver. The tests showed no abnormalities. Her tongue was red and swollen in the liver and gallbladder area and had a dark yellow coating in the middle. Her pulse was wiry in the liver position and weak in the other positions.

Gallbladder problems are extremely common, affecting more than 20 million Americans each year. Twice as many women as men develop gallstones. Patients are often overweight and middle-aged or older. Risk factors for gallbladder disease include being overweight, having a diet of fatty foods and processed foods, and for women, having high estrogen levels (such as during pregnancy), taking hormone replacement therapy (HRT) and proton pump inhibitors (frequently used to treat gastric ulcer pain). High stress levels can cause gallbladder problems, as can rapid weight loss.

The gallbladder stores bile made by the liver to help digest fatty foods. Bile emulsifies fat, helps with the absorption of fat-soluble vitamins and helps the gastrointestinal tract reabsorb cholesterol. However, in people who eat an excessively fatty diet or who have gastrointestinal issues, including irritable bowel syndrome or gastritis, and especially in those who often use proton pump inhibitors, the bile can concentrate and thicken. The bile duct or gallbladder may then become inflamed and painful. I suggested that Rebecca eliminate fried foods and reduce her intake of sweets, then recommended Chzyme with meals and GB-6™ between meals three times per day. GB-6 is based on an empirical formula from China and is clinically useful in treating and preventing gallbladder stones, gallbladder inflammation and the symptoms of gallbladder disease.

Chzyme is an herbal formula for dampness and food stagnation, with a full spectrum of enzymes to assist in protein, fat and carbohydrate digestion. I also provided Rebecca with information about foods that can cause inflammation and sluggishness in the bile duct such as eggs, pork, citrus fruits and juices, milk, coffee, corn, beans and nuts. I recommended a diet rich in fruits and vegetables and foods that are known to improve bile flow. These include beets, artichokes, dandelion greens, and olive oil. Within two weeks Rebecca felt considerable improvement.

IBS and Exercise

The relationship between IBS and exercise is complicated. Exercise does have a well-documented reputation for reducing the results of stress on the body. Since there is a relationship between psychosocial stress and IBS, any activity that reduces stress should help to reduce IBS symptoms. However, this does not always seem to be the case. Intense exercise such as running has been associated with diarrhea symptoms of frequent, loose bowel movements and stomach cramps, a condition called runner’s diarrhea. Suggestions for reducing the likelihood of runner’s diarrhea include: adequate hydration, avoid eating two hours before exercise, avoid caffeine and sweetened beverages – both have the potential for speeding up contractions, avoid eating fatty or gas-producing foods prior to exercise. Try to time your workouts so you exercise at the times when your intestines are quieter.

It’s important to take more rests or back off of the intensity when your body is sending signals that you may be overtraining. Some of the physical symptoms include:

  • A general feeling of fatigue that you can’t shake
  • Sleeping poorly and not having restful sleep
  • Getting sick – picking up colds and other bugs that are going around more frequently than normal due to a weakened immune system
  • Feeling down in the dumps and not motivated to train
  • A decrease in performance – struggling to maintain your normal pace or getting the “dead legs” sensation
  • Injuries, aches and pains

There are many herbal formulas that can relieve IBS symptoms. The most common formula used in our clinic is Chzyme™, which contains peppermint oil that has been shown to reduce abdominal pain and benefit IBS patients in multiple clinical studies. In vitro studies suggest antimicrobial, antioxidant and anti-allergic potential. It has a relaxation effect on gastrointestinal tissue and analgesic effects in the central and peripheral nervous system. In three trials, peppermint oil was considered as effective as smooth muscle relaxants. Chzyme also contains the same herbs as Quiet Digestion™, a Chinese herbal formula with ingredients for food stagnation, bloating, nausea, and intestinal gas. Digestive enzymes are included in Chzyme to aid in the digestion of protein, carbohydrates, and fats.

For clients who have food allergies, heartburn, or reflux, we recommend Enteromend™, a formula with unique DPP-IV activity that has been shown to have anti-inflammatory activity. For clients with diarrhea Colostroplex™ and Source Qi™ can be administered; for chronic constipation Aloe 22™ is recommend.

Nothing Helps My Client With IBS
By Andrew Gaeddert

My client has been suffering from severe bloating, constipation/diarrhea for the past five years. A conventional physician put him on an anti-depressant. Naturopaths advise fiber and probiotics, my client also tried an herbal powder administered by an herbalist…. but nothing seems to work. He tried Cymbalta for a few days and quit because he said “it poisoned my body.” The fiber and probiotics provide marginal relief.

Any change in bowel habits, especially with alternating constipation and diarrhea, must be professionally evaluated. Under most circumstances, an irritable bowel can be assumed and treated while an appropriate workup to exclude more serious conditions is initiated. Serious conditions include malignancy, infection, inflammatory bowel diseases and electrolyte disorders. Though anti-depressants may help some with irritable bowel symptoms, they are to be used only as an adjunct to specific treatment. Fiber helps reduce many symptoms in patients with bowel irritability, and does tend to aid bowel movements. Probiotics may have a role in replenishing bowel flora after protracted antibiotic treatment, and have a role in treating IBS and IBD. As with any natural product, quality is important. For example some commercial fiber products contain additives which compromise digestive function. A popular fiber product recommended by gastroenterologists contains: Aspartame (NutraSweet) and artificial colors.

Some probiotics products are not stored properly and do not contain sufficient quantities of active constituents, and others may contain corn and other allergens. Unfortunately, the herbal powder the aforementioned client picked up was not labeled correctly (the patient said it was unlabeled) and may have improperly identified ingredients, allergens, or even pharmaceutical drugs. All products sold need to have USA contact information on the label.

Health Concerns has several effective options including Chzyme™ which can be taken with meals to reduce bloating and intestinal gas, and Ease 2™ which is often effective in treating alternating constipation and diarrhea. Aloe 22™ is a unique herbal formula for chronic constipation and Colostroplex™ and Source Qi™ are clinically effective solutions for treating chronic diarrhea. For more information see my recently released book, Healing Digestive Disorders, 4th edition.

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