by Ami Kapadia, MD
Digestive disorders include Irritable Bowel Syndrome, GERD, and Inflammatory Bowel Disorder to name a few. Where do they come from and why? Infection? Food allergy? Stress? It seems in recent years, the number of people suffering from gastrointestinal disorders continues to increase. It is estimated that 20% of the U.S. population (or around 60 million individuals) suffer from irritable bowel syndrome, or IBS, and an additional 1.4 million individuals suffer from inflammatory bowel disorder, or IBD. Another estimated 7 million suffer from GERD, or gastroesopageal reflux disease.
Sometimes the cause of digestive disorders can seem elusive. While there can be genetic links causing predisposition, there are several environmental factors that may also play a role. In some individuals there seems to be a link with a previous gastroenteritis (prior intestinal infections such as salmonella, e. coli, etc.). Previous antibiotic use can also be a risk factor for the development of intestinal symptoms. For others, the cause of symptoms may be related to food allergy, either along with previous intestinal infections, or as a sole cause. Another related issue seems to be alteration in gut microflora, or a change in the bacteria and other organisms that make up the intestinal ecosystem. We call this “dysbiosis.”
In Part I of this series, I would like to focus on dysbiosis and how it can be related to intestinal symptoms. Dysbiosis is defined as a state of altered microbial ecology that causes or contributes to disease/dysfunction. Organisms of low intrinsic virulence, such as bacteria, yeast and protozoa/parasites, induce disease or dysfunction by altering the nutrition, neuroendocrine and/or immunologic responses of a person.
There are normally around 100 trillion bacterial cells in the human intestinal tract along with a smaller number of yeast colonies (that are kept in check by the bacteria) that are part of our normal flora. These organisms are vitally important to the development and maintenance of a healthy immune system. Some of their “jobs” include: warding off pathogens, decreasing allergic responses, and helping in the excretion of toxins. A fact you may not know is that 80% of the body’s immune system is located in the lining of the small intestine—allowing alterations in the intestinal ecology of bacteria and yeast (=dysbiosis) to have far-reaching impacts on our overall immune system function. When the natural microbial balance is disrupted, illness can result.
You may be wondering what causes dysbiosis? Well, there are many factors. For one, frequent or prolonged antibiotic use can have long-standing effects on the intestinal ecosystem because antibiotics destroy good bacteria as well as the target infection. This fact is becoming increasingly well-known, as probiotics are becoming more commonly used as a method to replace the good bacteria in the intestinal tract. Unfortunately, sometimes probiotics are not enough, and further evaluation and treatment is necessary when intestinal symptoms start after frequent/prolonged antibiotic use.
Other medication related causes of dysbiosis can include use of oral steroids, as well as proton-pump inhibitors or acid-blocking medications. Other infectious causes of dysbiosis involves parasitic infections. While we generally associate parasites with travel abroad, it is possible to pick up a parasite without leaving the country, just by drinking contaminated water or eating contaminated food (at a restaurant, etc.). Finally, it has been shown that stress in and of itself, can cause imbalances in intestinal flora.
Fortunately, there are ways to detect and treat some of these hidden causes of dysbiosis. In many instances, digestive symptoms can be greatly alleviated, if not resolved, with some detective work and the appropriate treatment.
Check back for the next part to this series.
Lebowitz, M and Kapadia, A., “Body Restoration: An Owners Manual” ; 2011.
Galland, L., “ The Four Pillars of Healing”, New York: Random House; 1997.
uptodate.com (topics: IBS, IBD)
