Fostering Flora: Digestive problems

Digestion has never been a sexy topic. There are only certain places you can discuss it, and only certain people you can discuss it with-unless of course you're a pre-adolescent male, a demographic that is obsessed with it and talks about it to anyone, anytime, because they find it so uproariously funny.

But the rest of us tend to take digestion pretty seriously, because, when it's good, it's practically out of mind. But when it's bad, it doesn't just give you stomach cramps or gas-it can affect your general health. "Digestion is the single most important body component determining health and disease," according to Elson Haas, MD, author of Staying Healthy with Nutrition (Celestial Arts, 1992). Aside from the obvious digestive disturbances, conditions ranging from vaginal infections to cancer, can be traced to imbalances in bacteria that live in the colon. Fortunately, through proper diet and supplementation, it's not difficult to keep these bacteria in balance.

Understanding Digestion

The human digestive system is essentially one large tube that starts in the mouth and ends at the anus. Its purpose is to convert food into usable energy and nutrients, absorb them, and then expel the waste. The system also includes the organs that help this happen, such as the salivary glands, the liver, gallbladder, and pancreas.

Digestion begins in the mouth, where chewing and enzymes in your saliva break down the food enough so that it can travel through the esophagus and into the stomach. There, food is assimilated by hydrochloric acid, hormones, and pancreatic enzymes. When the stomach is finished, it shuttles the resulting mixture into the small intestine, where enzymes, bile, and bacteria digest the food further, and where the walls of the small intestine absorb the nutrients from the food.

When the small intestine has done all it can do, it moves the undigested food-mostly fiber-into the colon. Things get pretty interesting here, as a community of hundreds of different types of bacteria, looking for food, shelter, and an environment to keep their own families alive, break down the fiber, a process called fermentation. And lest we dismiss these selfish little beings as inconsequential, we need to understand that we literally could not survive without them: They provide 10 percent of our daily calories, synthesize vitamins B and K, and fight disease in several ways.

The Good, The Bad, and The Ugly

We've all heard that we need to keep bacteria "in balance." This means that, without enough good bacteria to take care of the bad bacteria, you can develop what naturopathic physicians refer to as "toxic bowel," or dysbiosis, a situation in which the toxins given off by the bad bacteria are absorbed by the colon and produce disease.

Here's how they work: Most of the 400 microorganisms that live in the colon "live together harmoniously in a symbiotic relationship with us, provided the conditions are right and there are enough friendly bacteria," writes Ralph Golan, MD, in his book, Optimal Wellness (Ballantine, 1995). As the "friendly bacteria"-primarily Lactobacillus acidophilus, Lactobacillus bifida, and Streptococcus faecium-feed on carbohydrates in our colon, they produce natural antibiotics that fend off such notorious bacteria as salmonella, staphylococcus, and E. coli. They also can kill Heliobacter pylori, the bacteria that causes ulcers, and the lactic acid they form discourages the growth of other bad guys, most notably Candida albicans, a yeast which can infect our entire bodies and lead to a disease called candidiasis.

Bacteria degrade about half of the fiber we eat, producing short-chain fatty acids (SCFAs). These fatty acids are absorbed by the colon and, among other things, provide an additional 10 percent of calories we wouldn't get otherwise, according to Daniel A. Nadeau, MD, of Bangor, Maine, an endocrinologist, nutritionist, and SCFA researcher. SCFAs also have been shown to possess impressive anticancer activity, particularly in the case of breast cancer, and to enhance the metabolism of glucose in the liver (which is one reason a high-fiber diet is so important for diabetics).

And finally, Golan writes that bacteria helps lower serum cholesterol by producing acetic acid, which inhibits cholesterol synthesis in the liver. Bacteria helps you digest dairy products, promotes regular bowel function, and even metabolizes toxic environmental chemicals. Bacteria in balance also helps nourish an environment which increases the absorption of other nutrients.

It's pretty clear that bacteria play an important role not only in digestive health, but also in our general well-being. Yet most allopathic doctors tend to overlook or dismiss the role of the bowel in disease and probably won't ask you about this during an exam. So how do you know if you have a bacterial imbalance, and what can you do about it?

Keeping 'Em Happy

If you have obvious digestive problems, too many of the bad guys are probably the reason. "Irregular flora and impairment of the digestive system almost always go together," says Nancy White, ND, who has offices in Trumbull and Farmington, Connecticut. "Undigested food, gas, bloating, belching, and heartburn are the most common indications, but if you have frequent vaginal yeast infections, an itchy anus, candidal rashes, or you just feel cloudy and foggy and your stomach aches, you could have an imbalance."

How do you get that balance back? Certain supplements can help, as can a diet of whole grains, beans, fruits, vegetables, nuts, and seeds, perhaps restricting some allergenic foods such as wheat, corn, and dairy products. Experts recommend the following:

1. HIGH FIBER DIETS are the first line of defense. Fiber provides just the right environment for good bacteria. But fiber helps balance bacteria in other ways too, says Suzanne Havala, RD, author of the position paper on vegetarianism for the American Dietetic Association. "The insoluble fiber from vegetables, wheat bran, and whole grains absorb water and add bulk to the stools," says Havala. "This increases transit time, which doesn't permit the overgrowth of the bad bacteria." Havala recommends at least 30 to 40 grams of fiber per day. Remember that animal foods contain no fiber, so "boost your ratio of plant-to-animal foods in your diet to maximize your fiber intake," Havala says. It is actually easier for the body to digest raw foods than cooked or processed foods, so eat more raw fruits and vegetables. This will automatically add fiber. But if you just can't eat that much fiber, consider taking a psyllium fiber supplement. Psyllium provides the type of fiber that fosters the growth of good bacteria.

2. DRINK LOTS OF WATER, herbal teas, and other noncaffeinated, nonsugary drinks, particularly if you've increased your fiber intake or are taking a fiber supplement. Water will help increase transit time.

3. SWITCH TO SOY MILK or rice milk if dairy products are difficult for you to digest.

4. ADD YOGURT OR MILK WITH LIVE ACIDOPHILUS or L. bulgaricus cultures, to your daily diet; however, there are conflicting opinions as to whether these actually help. Acidophilus supplements-tablets, capsules, powders, and

"I ususally automatically prescibe live lactobacillus (acidophilus) for two to four weeks to replenish the good flora if a patient it taking antibiotics," says White. "But I prescribe only live cultures so they will survive digestion in the stomach."

5. FRUSCTOOLIGAOSACCHARIDES (FOS) supplements provide an environment in the colon that fosters the growth of good bacteria.

Supplements to the Rescue

Probiotics are supplements containing live bacteria that can help bring about a healthy balance in your digestive system. These include products that contain Lactobacillus acidophilus, Lactobacillus bulgaricus, bifidobacteria, and others.

Prebiotics are supplements that provide an environment for good bacteria. One variety of prebiotics contains short-chain fructooligosaccharides, called FOS for short. FOS is derived from a glucose molecule and provides an energy source specific to helpful bacteria. (FOS is found naturally in bananas, barley, garlic, onions, rye, and tomatoes.) According to FOS researcher Daniel A. Nadeau, MD, studies show that use of FOS lowers colon cancer risk, eases ulcerative colitis, and increases calcium absorption.