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FUNCTIONAL MEDICINE VERSUS THE TREATMENT OF DISEASE

“The part can never be well unless the whole is well.”

—Plato

OF ALL NATURE’S MIRACLES, the human body is the most amazing. As Thoreau realized, nature works constantly to ensure that your body functions well. Health is our natural state. But the body is complex and intricate—a collection of interweaving systems, each dependent on the others. Although we sometimes talk about the “parts” of our bodies, we are closer to the truth when we think of the body as a whole. At each moment, the body tries to maintain an ideal internal state. The technical term for this process is “homeostasis,” which means “same standing.” Every organism on the planet, from the simplest single-celled amoeba to the human being, relies on this internal mechanism, homeostasis, to sustain life.

Often, though, we subject our bodies to severe stress. If the homeostatic mechanism cannot overcome the forces that threaten it, then the system falls out of balance. In the worst cases, it fails completely. The result is disease (“dis-ease”)—a disruption in the ability of a body system or part to carry out its normal function. By keeping our systems in tune, we can protect ourselves against disease and enjoy the benefits of health.

No matter how old you are or what your current state of health is, you can take steps to help your body function better. You can work better, feel better, and look better—all by taking some basic steps to help your body maintain its optimal homeostasis.

In my years of practice, I found that most of my patients are very good at knowing when something isn’t quite right with their body. But often they feel discouraged because they have visited doctors who tell them that there is nothing wrong. Often, this means that their doctors have been unable to diagnose a specific disease, something that can be looked up in their textbooks or pointed to under a microscope. My perspective is different. I practice what is called functional medicine, an approach pioneered by the nutritional biochemist Jeffrey Bland, Ph.D. In functional medicine, the presence or absence of a disease is secondary to an understanding of the function that prevents a disease or the dysfunction that allows a disease to occur.

A significant difference in the functional approach to health versus the disease-centered approach is that often a body system or an organ can be functioning poorly but be free of disease per se. In these situations, conventional medicine has little to offer to improve the function. Sometimes, a simple correction of diet, proper supplementation, or some lifestyle change can produce dramatic improvements in symptoms more effectively than drugs. Moreover, when prescription or over-the-counter drugs are used to try to suppress the symptoms in a case where no disease process is occurring, they tend to produce side effects and sometimes these side effects can be life-threatening. To illustrate the difference in the approaches, there are many examples to choose from. Perhaps the best examples are simple disorders of digestion.

THE IRRATIONAL APPROACH TO INDIGESTION

The term “indigestion” is often used by patients to describe heartburn, upper abdominal pain, a feeling of gaseousness, difficulty swallowing, a feeling of pressure or heaviness after eating, a sensation of bloating after eating, stomach or abdominal pains and cramps, or fullness in the abdomen. The medical terms used to describe indigestion include functional dyspepsia (FD), non-ulcer dyspepsia (NUD), and gastroesophageal reflux disease (GERD).

These are among the most common diagnoses in North America, and yet several review articles have concluded that “the efficacy of current drugs on the market is limited at best.” “At best” signifies that often these drugs cause more problems than they solve.

Various drugs are used in the treatment of indigestion, FD, NUD, GERD, and irritable bowel syndrome (IBS). My point here is not to show you how ludicrous all these drugs are as a treatment for such functional disorders. Instead, I want to focus on the most popular—acid-blocking drugs. These drugs work, as the term implies, by blocking one of the most important digestive processes, the secretion of hydrochloric acid by the stomach.

Acid-blocker drugs are divided into two general groups. One group consists of the older histamine-receptor antagonist drugs, including Zantac, Tagamet, and Pepcid AC. The other consists of newer and more potent drugs called proton-pump inhibitors (PPIs), including Nexium, Prilosec, Protonix, Prevacid, and Aciphex.

These drugs are a huge business; their total prescription and over-the-counter (OTC) sales are estimated to exceed $13 billion annually. The drug companies love them because they are expensive, don’t produce a true cure, but do tend to suppress symptoms. In short, when people start taking one of these drugs they tend to become dependent on it, and for good reason—it interferes with the body’s natural digestive processes and produces significant disturbances in the gastrointestinal tract. Also, these drugs are typically quite expensive; and as my colleague Jacob Schor, N.D., has noted, “New research on their side effects says that the money spent on acid blocking drugs may be the least of the costs of using them.”

Acid-blocking drugs will typically raise the gastric pH above the normal range of 3.5, effectively inhibiting the action of pepsin, an enzyme involved in protein digestion that can be irritating to the stomach. Although raising the pH can reduce symptoms, it also substantially blocks a normal body process. The production and secretion of stomach acid are very important not only to the digestive process but also as a protective mechanism against infection. Stomach secretions can neutralize bacteria, viruses, and molds before these can cause gastrointestinal infection. With regard to the digestive process, stomach acid helps initiate protein digestion and it ionizes minerals and other nutrients for enhanced absorption; and without sufficient secretion of hydrochloric acid (HCl) in the stomach the pancreas does not get the signal to secrete its digestive enzymes.

Background of the New Purple Pill

One of the most expensive marketing campaigns in the history of the drug industry was the nearly $500 million spent by AstraZeneca to switch people from its profitable drug Prilosec to the “new purple pill” Nexium. In 2000, Prilosec was the world’s largest-selling prescription drug, with annual sales of more than $6 billion, and it accounted for 39 percent of AstraZeneca’s income. The problem for AstraZeneca was that the patent protection for Prilosec was due to expire in 2001. The loss of patent protection would mean the introduction of generic versions that would be priced significantly lower.

Fortunately for Astra-Zeneca, just before the patent was about to expire, it received FDA approval for Nexium. To protect its profits, AstraZeneca began the $500 million campaign with ads appearing everywhere proclaiming, “Today’s purple pill is Nexium, from the makers of Prilosec.” The company also added 1,300 sales reps to promote the product directly to physicians. As a result, the introduction and promotion of Nexium allowed AstraZeneca to prevent the revenue loss it would have experienced with competition from generics. In 2003, although revenues from Prilosec slid to under $1 billion as many patients and doctors switched to less expensive generic alternatives, sales of Nexium were $3.9 billion. Even when Prilosec did go OTC in 2004, AstraZeneca managed, by “accidental” shortages of the identical OTC version, to keep up sales of the prescription version, which costs six times as much.

Is Nexium better than Prilosec? Here the story gets even more interesting. Chemically, Nexium contains the left-handed version whereas while Prilosec contains both the left-and the right-handed version of the same molecule (omeprazole). There is no real evidence that Nexium is any better, though AstraZeneca seemed to pull the wool over many doctors’ eyes with some cleverly designed clinical trials. Rather than test Nexium versus Prilosec at equivalent dosages, the studies used by AstraZeneca to promote Nexium involved giving subjects with GERD a dosage 40 milligrams (mg) of Nexium but only 20 mg of Prilosec.1, 2 Of course Nexium performed better. Since another study of patients with GERD showed that 20 mg of Prilosec was equal to 20 mg of Nexium, 3 there doesn’t seem to be any real difference between the two other than the cost. Substituting OTC Prilosec for Nexium, Prevacid, and other prescription acid-blockers would cut spending on those medicines by about 50 percent, or almost $7 billion nationally—enough money to pay for health coverage for more than 1 million uninsured Americans—according to a study by the University of Arkansas.4

THE BACTERIAL LINK TO PEPTIC ULCER DISEASE

A corkscrew-shaped bacterium, Helicobacter pylori (H. pylori) is now regarded as the most important factor in the development of peptic ulcers and stomach cancer. The bacterium—one of the few that manage to survive in the acidic environment of the upper digestive tract—seems to burrow under the surface of the stomach lining and attach itself to the underlying cells. There it disrupts the production of the thick protective mucin lining the stomach and intestines and triggers localized inflammation that ultimately leads to the formation of ulcers.

In 2005, Barry Marshall and Robin Warren were awarded the Nobel Prize in Physiology or Medicine for their discovery, in 1979, that H. pylori is a primary factor in peptic ulcer disease and for their subsequent work. As a result, when doctors suspect that peptic ulcer is associated with H. pylori and is not due to other factors (such as side effects of drugs), they typically consider it an infection and treat it with antibiotics.

My take on this H. pylori link is that it is another instance in which conventional medicine is obsessed with an infective agent rather than focusing on the host’s defense factors. Here is an analogy: Where there is garbage, there are likely to be flies. You can spray the garbage with insect repellent and control the flies for a little while, but if you take care of the garbage the flies will disappear permanently. The popular treatment of peptic ulcers is antibiotic therapy plus an acid-blocking drug, but the antibiotics are like insect repellent, and taking them in combination with an acid-blocking drug may be extremely dangerous (discussed below). A more rational approach is to focus on eliminating the factors that lead to an overgrowth of H. pylori. Unfortunately, because research focuses on killing the bacteria rather than increasing the health of the intestinal lining, there is little information on factors that protect against H. pylori. Proposed protective factors include maintaining a low pH through proper secretion of stomach acids. But that proposal raises a question: do acid-blocking drugs lead to ulcers? Most experts now agree that they do, because they promote the growth of H. pylori. As a result, the use of acid-blockers as the dominant medical treatment for peptic ulcers for more than 30 years is a classic example of a drug that effectively suppresses symptoms while simultaneously increasing the disease process.

IS TRIPLE THERAPY TRIPLE THE DANGER?

The standard first-line therapy for peptic ulcer now consists of taking an acid-blocking drug along with two antibiotics—amoxicillin and clarithromycin—for ten to fourteen days. It is known as “triple therapy” and is often quite effective in healing peptic ulcers, but it does pose significant risks, and an increasing number of people harbor antibiotic-resistant strains of H. pylori. As a result, the initial treatment fails and the infection requires additional rounds of antibiotic therapy or even stronger measures.

The risks are numerous, but they can be largely prevented with appropriate supplementation (discussed below). The acid-blocking drug removes an important barrier to infection, and the antibiotics kill off the health-promoting bacteria that line the intestines and normally protect the body from infecting organisms. To illustrate this potentially serious combination, researchers gave mice two kinds of live, antibiotic-resistant bacteria for three days. Then they gave the mice a very strong antibiotic (clindamycin) alone or in combination with Protonix, an acid-blocking drug. The results demonstrated that when mice were given both the acid-blocker drug and the antibiotic the infection rate was 75 to 85 percent; this was three times higher than the rate among mice given just the antibiotic.5

This study and many others are showing the importance of maintaining stomach pH and a normal gastrointestinal flora as barriers to infection. One of the major complications of using antibiotics is diarrhea caused by altering the type of bacteria in the colon or by promoting the overgrowth of Candida albicans. One of the most severe forms of antibiotic-induced diarrhea is pseudomembranous enterocolitis (PME). This condition is attributed to an overgrowth of a bacterium (Clostridium difficele), resulting from the death of the bacteria that normally keep this Clostridium under control. Pseudomembranous enterocolitis can be quite serious and even deadly.

The risk of PME seems to be greatly increased if antibiotics are given in combination with acid-blocking drugs. In 1994, prior to the widespread use of the strong acid-blockers like Prilosec and Nexium, only one person in 100,000 developed PME. By 2004, the occurrence rate had jumped to 22 in 100,000. According to a report published in the Journal of the American Medical Association (JAMA), people who take proton-pump inhibitor acid-blocking drugs are three times more likely to develop PME than people not taking these drugs.6 This figure is identical to the increase in infection rate shown in the study with mice.

PROTECTING YOURSELF FROM PME

Probiotics are friendly microflora (bacteria and other organisms) that are vital to our health. Probiotic products include free-dried bacteria available in capsules at health food stores, and also fermented foods such as yogurt, sauerkraut, and kefir. The specific microorganisms found in these products are usually lactobacilli and bifidobacteria species. These bacteria are the major probiotics in the human intestinal tract.

Anytime that you need to take an antibiotic or an acid-blocking drug it is vitally important to supplement your diet with probiotics. This recommendation is especially important if you are undergoing major surgery. Just prior to and after major surgery you will be given antibiotics to reduce the likelihood of an infection. That is very important, but without probiotic supplementation you run the risk of developing not only PME but other gastrointestinal infections as well.

Numerous clinical studies have shown that probiotic supplements produce good results in preventing and treating antibiotic-induced diarrhea.7, 8, 9 Yet, this is an underutilized therapy even though it can prevent significant suffering and even death. Although probiotic supplements are commonly believed ineffective if taken during antibiotic therapy, research actually supports the use of probiotics during such therapy.

Here is something else most doctors don’t know: a detailed analysis of several clinical trials showed that when probiotic supplements are used in a program to eradicate H. pylori, not only is there a reduction in side effects but the eradication rates also improve significantly.10

PRACTICAL RECOMMENDATIONS FOR USING PROBIOTIC SUPPLEMENTS

The intestinal flora plays a major role in the health of the host. Therefore, probiotic supplements can be used to promote overall good health. There are also numerous specific uses for probiotics, based on clinical studies.7

Promotion of proper intestinal environment

Stimulation of gastrointestinal tract and systemic immunity

Prevention and treatment of:

Antibiotic-induced diarrhea

Urinary tract infection

Vaginal yeast infections and bacterial vaginosis

Eczema

Food allergies

Cancer

Irritable bowel syndrome

Inflammatory bowel disease (ulcerative colitis, Crohn’s disease)

Traveler’s diarrhea

Lactose intolerance

Numerous analyses of commercially available probiotic supplements indicate that there is a tremendous range of quality. The quality of probiotic supplements depends on two main factors: (1) the characteristics of the strains contained in the supplement and (2) adequate viability, so that sufficient numbers of bacteria are viable at the point of consumption. Viability at consumption depends on a number of factors, such as proper manufacturing and the hardiness of the strain, as well as packaging and storage of the product in the right amount of moisture and at the correct temperature.

Strains of bacteria can be likened to breeds of dogs. All dogs belong to the genus Canis and the species familiaris. Within this one species is great diversity in size, shape, strength, and other physical characteristics—breeds range from the Saint Bernard to the Chihuahua. A similar division occurs within species of bacteria. Within each species of bacteria there is a multitude of strains. Some probiotic strains are resilient and strong, able to survive passage through the upper gastrointestinal tract and inhibit pathogenic bacteria; others are weak and cannot survive or kill pathogenic bacteria.

Therefore, consumers must utilize products developed and manufactured by companies that have done the necessary research to ensure the viability of their product. There are some very good companies offering high-quality probiotic supplements, but there are also some companies selling products that do not come anywhere close to the claims on the labels. Obviously, the product that I recommend over all others is the one that I developed—Ultimate Probiotic from Natural Factors. But there are many other high-quality probiotic supplements, including Healthy Trinity from Natren, Culturelle® with Lactobacillus GG, and Nature’s Way Primadophilus Optima.

The dosage of probiotic supplements is based solely on the number of live organisms present in the product; therefore, I recommend using products that list the number of live bacteria at expiration rather than at time of manufacture. Successful results are most often attained by taking between 5 billion and 20 billion viable bacteria per day.

BISMUTH—UNDERAPPRECIATED AND UNDERUTILIZED IN ELIMINATING H. PYLORI

Bismuth is a naturally occurring mineral that can act as an antacid as well as against H. pylori. Bismuth preparations are now often prescribed along with triple therapy as a component in quadruple therapy for the eradication of H. pylori. The best-known and most widely used bismuth preparation is bismuth subsalicylate (Pepto-Bismol). However, bismuth subcitrate has produced the best results against H. pylori and in the treatment of non-ulcer-related indigestion as well as peptic ulcers.11 In the United States, bismuth subcitrate preparations are available by prescription through compounding pharmacies (contact the International Academy of Compounding Pharmacists, www.iacprx.org, 1-800-927-4227).

One of the main advantages of bismuth preparations over standard antibiotic approaches to eradicating H. pylori is that whereas the bacteria may develop resistance to various antibiotics, they are very unlikely to develop resistance to bismuth.

The usual dosage for bismuth subcitrate is 240 milligrams (mg) twice daily before meals. For bismuth subsalycilate the dosage is 500 mg—two tablets or 30 milliliters (mL) of standard-strength Pepto-Bismol—four times daily.

Bismuth preparations are extremely safe when taken at prescribed dosages and for less than six weeks at a time. Bismuth subcitrate may cause a temporary and harmless darkening of the tongue, the stool, or both. Bismuth subsalicylate should not be taken by children recovering from the flu, chicken pox, or some other viral infections, as it may mask the nausea and vomiting associated with Reye’s syndrome, a rare but serious illness.

OTHER SIDE EFFECTS OF ACID-BLOCKING DRUGS

As a class, these drugs are associated with numerous side effects, but they are for some reason generally regarded as safe and many are now available over the counter. However, because these drugs block a vital bodily function involved in digestion, digestive disturbances are quite common and can include nausea, constipation, and diarrhea. Nutrient deficiencies can appear as a result of impaired digestion. Other possible side effects include allergic reactions, headaches, breast enlargement in men (with Tagamet and Zantac), hair loss, and dizziness. Here are some additional concerns about acid-blockers that you typically will not find on patient handouts from a pharmacy.

WHAT ABOUT ANTACIDS?

Over-the-counter antacids are usually safe and effective when taken occasionally to relieve heartburn, but some important distinctions need to be made:
  • image Be careful not to abuse antacids. Regular use can lead to such side effects as malabsorption of nutrients, bowel irregularities, and kidney stones. Furthermore, although antacids often provide immediate relief, they can produce what is known as acid rebound three or four hours after use. This means that the body will try to overcompensate for the neutralization of gastric acid by secreting even more acid. While this may not be a problem in treating indigestion, it may play a role in delaying the healing of ulcers.
  • image Limit the use of sodium bicarbonate. Many people take sodium bicarbonate (baking soda) for relief of acid indigestion. (Alka-Seltzer is simply ordinary baking soda in a fizzy form.) Although sodium bicarbonate can be useful in the short term, using it often or regularly can increase your sodium intake to unnecessarily high levels. Long-term administration can cause systemic alkalosis (excessively high pH levels throughout the body), leading to such complications as the formation of kidney stones, nausea, vomiting, headache, and mental confusion.
  • image Avoid antacids that contain aluminum. These products (such as Maalox, Rolaids, Digel, Mylanta, and Riopan) have issues of long-term safety due to the aluminum in them. Aluminum may play a role in impairing mental function as well as in diseases of the nervous system including Alzheimer’s disease, Parkinson’s disease, and Lou Gehrig’s disease (amyotrophic lateral sclerosis). Absorption of aluminum is made worse if a meal contains any source of citric acid, such as citrus fruit, juice, or soda pop. In my opinion, there is no reason to use aluminum-containing antacids, because the potential risks far outweigh the short-term benefit.
  • image Follow dosage instructions. It is especially important to avoid taking too much of a magnesium salt such as magnesium oxide, hydroxide, or carbonate. Besides acting as a mild antacid, magnesium salts can exert a laxative effect making diarrhea a definite risk.

THE NATURAL APPROACH TO TREATING INDIGESTION

For a person with chronic indigestion, rather than focusing on blocking the digestive process with antacids, the rational approach is to focus on aiding digestion. Indigestion can be attributed to a great many causes, including not only increased secretion of acid but also decreased secretion of acid and other digestive factors and enzymes. In fact, most nutrition-oriented physicians believe that lack of acid, not an excess, is the true culprit in many patients with indigestion.

The first step is eliminating common dietary causes of GERD and NUD. These causes include overeating, coffee, chocolate, fried foods, carbonated beverages (soft drinks), and alcohol. Another cause is obesity. In many cases, simply eliminating or reducing causative foods or beverages is all that is necessary to completely relieve GERD or NUD. Other tips include decreasing the size of portions at mealtime; chewing food thoroughly; eating in a leisurely manner in a calm, relaxed atmosphere; and not eating within two hours of bedtime.

A number of natural products that can be very effective in relieving GERD and NUD. Although much is said about hyperacidity, a more common cause of indigestion is insufficient secretion of gastric acid. Hypochlorhydria is deficient secretion of gastric acid and achlorhydria is a complete absence of such secretion. Like peptic ulcer disease, achlorhydria and hypochlorhydria have been linked to overgrowth of H. pylori.

Many symptoms and signs suggest impaired secretion of gastric acid, and a number of specific diseases have been found to be associated with insufficient output of gastric acid.

Common Signs and Symptoms of Low Gastric Acidity

   Bloating, belching, burning, and flatulence immediately after meals

   Sense of fullness after eating

   Indigestion, diarrhea, or constipation

   Multiple food allergies

   Nausea after taking supplements

   Itching around the rectum

   Weak, peeling, cracked fingernails

   Dilated blood vessels in the cheeks and nose

   Acne

   Iron deficiency

   Chronic intestinal parasites or abnormal flora

   Undigested food in stool

   Chronic candida infections

   Gassiness in the upper digestive tract

Diseases Associated with Low Gastric Acidity

   Addison’s disease

   Asthma

   Celiac disease

   Dermatitis herpetiformis

   Diabetes mellitus

   Eczema

   Gallbladder disease

   Graves disease

   Chronic autoimmune disorders

   Hepatitis

   Chronic hives

   Lupus erythematosis

   Myasthenia gravis

   Osteoporosis

   Pernicious anemia

   Psoriasis

   Rheumatoid arthritis

   Rosacea

   Sjogren’s syndrome

   Thyrotoxicosis

   Hyper-and hypothyroidism

   Vitiligo

Since not everyone can have detailed gastric acid analysis to determine the need for supplementation, let me offer a practical method of determination to use if you are experiencing any signs and symptoms of gastric acid insufficiency:
  • image Begin by taking one tablet or capsule containing 10 grains (600 mg) of hydrochloric acid (HCl) at your next large meal. If this does not aggravate your symptoms, at every subsequent meal of the same size take one more tablet or capsule. (Two at the next meal, three at the meal after that, then four at the next meal.)
  • image Continue to increase the dose until you reach seven tablets, or when you feel warmth in your stomach, whichever occurs first. A feeling of warmth in the stomach means that you have taken too many tablets for the meal, and you need to take one less tablet for a meal of that size. It is a good idea to try the larger dose again at another meal to make sure that it was the HCl that caused the warmth and not something else.
  • image After you have found the largest dose that you can take at your large meals without feeling any warmth, maintain that dose at all meals of similar size. You will need to take fewer tablets or capsules at smaller meals.
  • image When you take a number of tablets or capsules, it is best to take them throughout the meal.
  • image As your stomach begins to regain the ability to produce the amount of HCl needed to properly digest your food, you will notice the warm feeling again and will have to cut down the dosage.

DIGESTIVE ENZYMES

Lack of digestive enzymes from the pancreas is another functional cause of indigestion. Typically when heartburn, abdominal bloating, abdominal discomfort, and gas occur within the first 15 to 30 minutes after eating, the cause is usually a lack of HCl secretion. If these effects occur after 45 minutes, they usually indicate a lack of pancreatic enzymes. Keep in mind that the secretion of pancreatic enzymes is triggered by the HCl secreted in the stomach. So sometimes taking HCl supplements can lead to improved release of pancreatic enzymes.

Digestive enzyme products are the most effective treatment for pancreatic insufficiency. These preparations can include enzymes from fresh hog pancreas (pancreatin) or vegetarian sources, such as bromelain and papain (protein-digesting enzymes from pineapple and papaya, respectively); and fungal enzymes. I have found that the best results are obtained with multi-enzyme preparations derived from vegetarian sources. They are definitely more resistant to digestive secretions and have a broader range of activity. Simply follow the label instructions for the proper dosage.

A NATURAL CURE FOR PEPTIC ULCERS AND GERD

My all-time favorite natural medicine is a special extract of licorice root known as DGL. (It is short for deglycyrrhizinated licorice, but I tell my patients that it stands for “darn good licorice.”) It is produced by removing glycyrrhetinic acid—a compound that can cause elevations in blood pressure due to sodium and water retention. (Yes, eating too much licorice candy can raise blood pressure.) Because the glycyrrhetinic acid has been removed, DGL does not raise blood pressure.

My fondness for DGL is a result of having used it effectively to treat even the most severe peptic ulcers as well as to relieve the symptoms associated with GERD. In fact, I cannot think of a case in which DGL did not work. Rather than inhibit the release of acid, DGL stimulates the normal defense mechanisms that prevent ulcers. It improves both the quality and the quantity of the protective substances that line the intestinal tract, increases the life span of the intestinal cell, and improves blood supply to the intestinal lining. There is also some evidence that it inhibits the growth of H. pylori.15

Several clinical studies published over the years support my experience. In head-to-head studies, DGL has been shown to be more effective than Tagamet, Zantac, or antacids in both short-term treatment and maintenance therapy for peptic ulcers.16, 17

The standard dosage for DGL is two to four 380-mg chewable tablets taken between meals or twenty minutes before meals. Taking DGL after meals or taking it in a non-chewable form is associated with poor results. The DGL therapy should be continued for at least eight to 16 weeks after there is a full therapeutic response.

PEPPERMINT OIL FOR GERD, NUD, AND IBS

Peppermint oil placed in special capsules that are coated (enteric-coated) to prevent their breakdown in the stomach has been shown to be quite helpful in improving gastrointestinal function in individuals with irritable bowel syndrome (IBS). This is a common functional disorder of the large intestine characterized by some combination of the following: (1) abdominal pain; (2) altered bowel function, constipation, or diarrhea; (3) hypersecretion of colonic mucus; (4) dyspeptic symptoms (flatulence, nausea, anorexia); and (5) varying degrees of anxiety or depression.

In several double-blind studies, enteric-coated peppermint oil (ECPO) has been shown to be effective in relieving all symptoms of IBS in approximately 70 to 85 percent of cases within a two to four weeks. In addition, ECPO has benefits in treating NUD and GERD, and in eradicating H. pylori.18

Several clinical studies of patients with IBS used a combination of peppermint oil and caraway oil. The results of these trials indicate that this combination produces better results than peppermint oil alone for symptoms of IBS. Recent studies also indicate the combination of peppermint and caraway oil is more helpful in improving NUD. In one double-blind study, 120 patients with NUD were given either the peppermint and caraway seed oil (ECPO) or cisapride (Propulsid) for four weeks.19 Symptoms of NUD, including pain, were reduced equally in both groups. Positive results were also found in H. pylori–positive individuals.

The significance of this study is enormous. Whereas enteric-coated peppermint and caraway oil is extremely safe at recommended levels, Propulsid was linked to fatal problems with heart rhythm. Once a popular medication for GERD and NUD marketed by Johnson and Johnson, Propulsid was pulled from the market in July 2000 after being linked to 341 reports of abnormalities in heart rhythm. According to the FDA, at least 111 people died as a result of using Propulsid, and nearly 400 developed heart abnormalities. A particularly alarming fact, which came to light after Propulsid was pulled, is that in one study of 58,000 premature babies’ medical records, 20 percent of the babies were found to have been given Propulsid.

The usual dosage of enteric-coated capsules containing peppermint and caraway seed oil is one or two 200-mg capsules up to three times daily between meals. Side effects are rare, but can include allergic reactions (skin rash), heartburn, and—if the dosage is too high—a burning sensation on defecation. There are no known drug interactions.

FINAL COMMENTS

One of the most common digestive issues is constipation, which now affects more than 4 million Americans. The primary reason is lack of dietary fiber. In addition, some people develop unhealthy habits that actually “train” the bowel to become constipated. For example, they ignore the “call of nature” and do not use the toilet as soon as the urge strikes. Other people become dependent on laxatives to produce a bowel movement. Fortunately, it is possible to retrain your body and develop a more regular pattern of bowel movements.

  • image Eat a high-fiber diet, particularly fruits and vegetables.
  • image Drink six to eight glasses of fluids per day.
  • image Identify known causes of constipation, such as not enough fiber in the diet or the use of drugs like diuretics.
  • image Do not repress an urge to defecate; use the toilet as soon as you can.
  • image Sit on the toilet at the same time every day (even when the urge to defecate is not present), preferably immediately after breakfast or exercise.
  • image Exercise at least twenty minutes, three times per week.
  • image Take 3 to 5 grams (g) of a gel-forming fiber supplement (e.g., Metamucil and other psyllium preparations are fine) at night before retiring.

For children with a history of constipation, the first thing I recommend is eliminating milk and other dairy products from the diet. It is well accepted that intolerance to cow’s milk (either an allergy or lactose intolerance) can produce diarrhea. What is not as well known is the fact that cow’s milk intolerance can also lead to constipation and is a major cause of childhood constipation.20 About 70 percent of cases of childhood constipation are cured by eliminating cow’s milk from the diet and substituting soy or rice milk. Kids with constipation who respond to the elimination of milk also experience a decreased symptoms of allergy, including runny nose, eczema, and asthma. My recommendation is that if your child is constipated, start by eliminating cow’s milk and other dairy products while increasing the intake of high-fiber foods, especially pears, apples, and other whole fruits. If this approach is not successful, try barley malt extract available at any health food store. Avoid mineral oil and stimulant laxatives unless they are absolutely necessary.