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Intestinal health

German: Darmgesundheit

1 The intestinal flora and its influences on the entire organism

The bronchial system and the intestine, if damaged, offer foreign germs (bacteria, viruses, etc.) the ideal access to the entire organism through the large surface of their mucous membrane. In order to preclude this, the mucosa-associated immune system must be intact. A physiological (eubiotic) intestinal flora plays a significant role in the maintenance of the primary immunological defense system.

2 The normal colonization of the intestine

Initial colonization and development of the normal floraUntil birth, the fetus is a sterile organism. It offers microorganisms an ideal colonization potential due to its relatively large surface. During the birth process, the first oral contamination with germs of the maternal vaginal flora occurs, which physiologically mainly consists of lactobacteria and [[bifidobacteria]9. A eubiotic initial colonization presumes a pathogen-free maternal vaginal flora. Physiological vaginal floras are rare and should receive more prominence in prenatal care in future. An abnormal intestinal flora in the infant is already preprogrammed in case of an abnormal vaginal flora. After the initial contact with the vaginal flora follows the contact with the perianal flora, which has a similar composition as the fecal flora, where the portion of oxygen-sensitive germs is clearly reduced. An implantation of most germs of the later flora of small and large intestines occurs through these germs, which are also received through the mouth during birth. In literature, this stage is usually called phase I and is characterized by a certain course of colonization, whereby significant differences can be noted between breast-fed and bottle-fed children.

The flora, which establishes during phase I colonization, stabilizes during the first two weeks and is initially preserved (phase II). The third colonization phase starts with the feeding of additional food and is a critical phase for the intestinal flora, since fibers constitute to a large extent a culture medium for putrefaction germs and therefore can lead to ailments like flatulence and colics, which along with an increased pH value of more than 5.8 indicate dysbiotic intestinal disorders. The survival conditions for the physiologically acidifying flora (lactobacteria, bifidobacteria) are therefore not optimal. As the development of the immune system requires a longer period and the supply of immune globulins through the mother’s milk is no longer ensured, initial contacts with potentially pathogenic germs can lead to very severe diseases and also to severe damages of the mucosa-associated immune system, whereupon allergies, neurodermitis, food intolerances, etc., cannot be excluded in the future.

Phase III, which is the stage of germ flora fed with mixed food, is approximately completed by the age of two. The stomach is barely colonized. A resistant flora, consisting of lactobacteria and a small amount of enterococci, exists only in the small intestine. As a result of the fermentation of carbohydrates by the lactobacteria, the pH value sinks; this in turn prevents the colon flora from ascending into the small intestine. The large intestine is marked by a large biodiversity of bacteria and thereby the most densely colonized area in the intestinal tract. The group of bifidobacteria, which represents, besides eubacteria and bacteroides, the major part of the intestinal flora, is responsible for the acidification of the colon lumen and thereby prevents an unlimited reproduction of putrefying bacteria. The portion of enterococci and E. coli is at the most only 1% of the entire flora. Any persistent increase of fecal coliflora over 1%, along with a significant increase in the pH value, indicates a putrefaction dysbiosis.

3 The intestinal flora of the elderly

The following factors can be considered as causes for age-related alterations of the flora: disorders in the degree of food absorption (damaged dentures, disorders of the gastroduodenal system, etc.), old-age alterations of the intestinal mucosa, tonus reduction and a delayed intestinal passage. Ailments like flatulence, spasms, etc., or secondary diseases can also make it necessary to treat an old-age dysbiosis.

4 Interdependencies between host and intestinal flora

The human body is a habitat for much more than 1012 bacteria (besides viruses, protozoa, bacteriophages, yeasts and other fungi), the major part of which live in the intestinal tract. The interaction between the diverse groups of germs in connection with numerous other factors is called colonization resistance.

5 Interactions with pathogenetic significance

5.1 Colonic flora and cancer diseases, colon carcinoma

It is long-established that steroids which secrete into the intestinal lumen with the bile acid (bile acids and cholesterol), are subject to bacterial conversion and/or decomposition in the colon. As early as 1940, it was assumed that cancer diseases, particularly in the area of the large intestine might be caused by the abnormal decomposition of bile acids. In 1974, Hill and Drasar already published the first data on the statistical correlations between the daily consumption of fat and animal protein and the frequency of colon carcinoma.

5.2 Mamma carcinoma

There also exist clear correlations to the fat and protein consumption. Hill assumed that the steroid metabolism of the intestinal flora is also of great significance in the formation of the mamma carcinoma. Intestinal bacteria produce estrogenic steroids from the bile steroids. Estrogens doubtlessly play a prominent role in the formation of the mamma carcinoma. The amount of the steroid substrates in the bile depends on the daily intake of fat.

5.3 Rheumatic diseases

Eicosanoids are formed from the poly-unsaturated fatty acid arachidonic acid and are significantly involved in the inflammation of the joints. Arachidonic acid exclusively reaches the body through food of animal origin. The formation of eicosanoid is an oxidative process, which can be inhibited by non-steroidal antirheumatics, diverse enzymes (metalloproteins) and antioxidants. Besides omega-3 fatty acids and the vitamins C and E, the supplements selen, copper, zinc and iron play an important role as cofactors of pro- and antioxidatively active enzymes.

Numerous studies show that fasting (zero-diet with a daily intake of 2-3 liters of liquid in the form of drinks rich in electrolytes, e.g. vegetable juices, whey or mineral water) in patients with chronic arthritis effects an amelioration of the arthritides already after two days. The withdrawal of food leads to a decrease of the biosynthesis of eicosanoides to one third of the initial value, for which the lack of supplied arachidonic acid from the food might be potentially responsible. The intake of the usual food however causes relapses again.

5.4 The miscolonization of the intestine through foreign germs (dysbiosis)

As mentioned earlier, the physiological flora of the small intestine mainly consists of lactobacteria and enterococci. If the flora of the small intestine is disturbed, there is a risk that germs of the colonic area procure access to the upper areas of the small intestine. A miscolonization of the small intestines by foreign germs always leads to pathological alterations, particularly of the brush border epithelium of the small intestine’s mucous membrane. Due to the related lack of enzyme activity, a disorder of the resorption of important food components (vitamins, carbohydrates, amino acids and minerals) occurs.

5.5 Pathogenesis of a dysbiosis

5.6 Anatomic alterations in the intestinal tract

===Motility disorders=== </br> caused for instance by:

  • Abdominal irradiation
  • Medicines like laxatives
  • Antibiotics (1), etc.

5.7 Other causes

  • Celiac disease and/or sprue
  • Exocrine pancreatic hypofunction (2)
  • Lactose intolerance
  • Stress factors
  • Damaged dentures, etc.

(1) Orally administered antibiotics cause, according to type, quantity and spectrum of efficacy, a certain impairment of the natural intestinal flora, whereas the increase in the pH value forces the growth of putrefaction germs.

(2) An exocrine pancreatic hypofunction may not only be the cause, but also be a temporary epiphenomenon of a dysbiosis, and is absolutely reversible with a change in food habits and an almost eubiotic intestinal flora.

6 Symptoms

The following symptoms, with relative certainty, point to a miscolonization:

  • Chronic diarrheal stools
  • Fatty stools
  • Diaphragmatic elevation (if no other cause can be diagnosed)
  • Sensation of repletion soon after a meal
  • Frequent flatulence often associated with meteorism
  • Disaccharide intolerance
  • Neurological symptoms like feeling of weakness and ataxias.

A bacteriological stool examination can give important clues about a dysbiosis of the small intestine, since often only few or no lactobacteria are detected even if the water content of the stool sample is high, indicating favorable survival conditions for the lactobacteria during the colon passage. As a rule, the dysbiotic colonization of the large intestine also shows a decrease of physiological types of bacteria.

6.1 Nutritional advice

Basically, food should be easily digestible, low in fibers and fat, to go easy on the mostly already damaged intestinal mucosa, and moreover to deprive the abnormal flora of additional nutrients.

===Fry-ups=== Overheating of the fat should be avoided, because it enhances bile production. Some intestinal bacteria can utilize bile and elicit diarrheas through the resulting metabolism products.

===Fats=== Good quality, cold-pressed vegetable oils are suitable for cooking. Butter should not be used for frying. Fresh butter, however, melted over boiled or steamed vegetables, enhances the taste and is easily digestible. Hardened fats (margarine, butter oil, lard and suet) contain long-chain fatty acids and are not recommended, because they put a strain on the gallbladder.

6.2 Vegetables

Raw, especially stringy, vegetables cannot be solubilized by the intestinal juices, so that the contained vitamins cannot be resorbed. But the putrefying portion of the intestinal flora is able to digest these raw plant parts! Boiled or steamed vegetables can be utilized very well by the human organism. Cabbages (apart from cauliflower, broccoli and tender cabbage turnip) and pulses should be avoided, since they easily cause flatulence.

6.3 Raw vegetarian diets

Leafy salads (corn salad, lettuce, endive, rocket, etc.), chicory, tomatoes, finely grated carrots and sprouts (rich in trace elements) are easy to digest.

6.4 Fruits

Depends on taste and tolerance. It is well-known that stone fruits cause flatulence and therefore should not be eaten in large quantities.

6.5 Cereal products

Coarsely ground whole-wheat bread and all kinds of mueslis should be avoided, since the relatively large pieces of grain bruise the fine epithelial layer of the intestinal mucosa.

6.6 Sugar

Basically, milk sugar and all foods containing milk sugar should be avoided. Food containing cane sugar should also be eaten moderately, since sugar binds calcium and thiamine (vitamin B1) and thereby deprives the body of it. In case of sugar intolerance, honey and maple syrup as well as the monosaccharides glucose and fructose are used as substitutes.

6.7 Animal foods

Light and tender meat like fowls, veal and pork and also fish are preferable. Dark meat like mutton, venison and beef coarse-grained pork is only squeezed while chewing, so that the un-ground fibers are only partly solubilized by the human intestinal juices and can thus be metabolized by the putrefying bacteria of the intestinal tract. Meat and fish should only be slightly fried or steamed. Breaded or grilled meals are not advisable.

6.8 Milk products

Milk is a valuable supplier of minerals, but cannot be digested by many people due to lactose intolerance. Sour milk products (curds, kefir, yoghurt and cheese) are recommendable as they have a positive influence on the acidifying flora of the intestine due to the low pH value, and especially because the lactose is already broken down by the milk acid bacteria they contain and thus does not burden the human organism.

7 The substitution therapy with live microorganisms

Since a long time, clinical experiences have shown that the maintenance of eubiotic conditions is significant for the entire organism. Early on, therefore, one has tried to positively influence the intestinal environment by oral administration of intestinal germs. For a long time, the E. coli strains were considered the most important representatives of the physiological intestinal flora. Other groups of germs were found to be neither diagnostically nor therapeutically significant. As mentioned earlier, it is known today that bacteroides, eubacteria and bifidobacteria have a dominant position among the colonic flora not only in numbers, but also that they are (like the lactobacteria in the small intestine) extraordinarily important for the large intestine.

The emphasis of substitution therapy has meanwhile shifted to the apathogenic groups of germs of lactobacteria and bifidobacteria. After oral substitution, a successful colonization with E. coli is not possible, because complex factors are active that prevent the permanent colonization in the intestine in case of an invasion of serotypes alien to the body. In a substitution with acid tolerant lactobacteria and bifidobacteria, things are different. Lactobacteria belong both to the wall and lumen flora of the small intestine, whereas their association with the mucous membrane of the small intestine is not very distinct, because as non-invasive germs they have an adhering mechanism that clearly differs from that of invasive germs like E. coli.

With the intake of a large amount of live lactobacteria, a part of those bacterial enzymes, which directly or indirectly participate in the development of carcinogen or cocarcinogen compounds, is excreted to a lesser extent through the stool. Initial situation and focus of the treatment should be largely clear. The first one results from a thorough anamnesis, which must also include the food habits of the patient and the result of a detailed analysis of the fecal flora.

Only then is it possible to judge whether a substitution should take place, which microorganisms should be given (and which not!!), and which aiding measures (in terms of diet or medicine) are necessary, admissible or contraindicated. It should not only be the purpose of a fecal flora analysis to discover dysbiotic conditions, but to establish the composition of the symbiotic cultures based on the differential findings of lactobacteria and bifidoflora. Only thus can a therapeutic effect be expected. The result of the bacteriological stool examination often gives important clues with regard to the diet.

The regularly increasing supply of ready-made ingredients and meals by the food industry naturally tempts one to reduce work in the kitchen to a minimum, but it is unsuitable for the conservation, leave alone for the build-up of a physiological intestinal environment. The same applies to eating out frequently.

In order to survive, the body depends on the physiological microorganisms living inside. A constant and balanced interplay of both is of the greatest significance for the well-being and health of human beings as well as animals.

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