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Disturbed intestinal permeability
• The role of the gut wall is to allow for selective
absorption of nutrients while providing vital protection
against intrusion into the body tissues of harmful
substances from the lumen
• NSAID treatment has adverse effects on enterocyte
mitochondria which may predispose the mucosa to
absorption of bacterial and other large molecules that
provoke a local inflammatory response.
• A similar mechanism may operate in patients with
untreated Crohn's disease, who show abnormally high
- • It is likely that some plant constituents could reduce excessive
- intestinal permeability (Mills and Bone 2000:183).
- – Tannins are likely to have a limited short-term effect at least in the upper
- reaches of the tract and
- – Healing plants with local antiinflammatory activity might effectively
- reduce some types of increased permeability
- • Chamomile
- • Meadowsweet
- • Slippery elm
- • Licorice
- • Calendula
- • Comfrey
- • However, the most promising effect on intestinal permeability is
- likely to lie in changing biliary constituents, using hepatics and
- choleretics (Mills and Bone 2000:183).
• In humans there is a moderately predictable sequence of
colonization after birth and through to adulthood
• There are clear benefits of a healthy bacterial population in
• Anaerobic bacteria in particular are known to be responsible
for considerable secondary digestion and to decrease
intestinal transit time.
- • Normal bacteria have been shown to help protect the gut
- from pathogenic infiltration.
- – Escherichia coli
- – Enterococcus faecalis
- – Bacteroides distasonis
- • Mechanisms are likely to include
- – Modification of bile acids
- – Stimulation of peristalsis
- – Induction of immunological responses
- – Competition for substrates
- – Possible elaboration of various bacteriostatic substances
• The intestinal flora also contributes to non-specific defences
against immunological challenge from dietary antigens by
helping to reduce their uptake across the mucosal barrier.
• Antibiotic use is probably the most widespread impact on
bacterial populations in the gut with an adverse effect on
normal gut flora well established
• Particularly if the antibiotics are poorly absorbed from the gut
or if they are active against anaerobes
- Bile and intestinal flora
- • The relationship of bile products with intestinal flora is
- complex and works in two directions
- – Bile salt metabolites variably stimulate growth in bacterial
- – While anaerobic bacteria act on bile products to produce
- volatile fatty acids that control other pathogenic bacteria
• A particularly revealing insight into the relationship is
seen in the case of bowel cancer.
– There are three known endogenous components that affect
development of colorectal cancer
• colonic bacteria
• the mucus layer
• bile acids
- Bowel flora & bowel cancer
- • The major effects of the bacteria are
- – deconjugation and reduction of bile acids
- – activation of mutagen precursors
- – fermentation and production of volatile fatty acids
- – formation of endogenous mutagens
- – physical adsorption of hydrophobic chemicals
• The mucus layer covering the surface acts as a barrier but
its composition changes in pre-malignant and malignant
– The secretion of protective mucus is elevated by plant cell wall
components in the diet.
– Mucus has some hydrophobic properties and its presence may
alter the effect of bile components and bacterial metabolites on
the gut wall.
- Bowel flora & Breast cancer
- • Bowel bacteria have been linked to Breast cancer.
- • In looking for reasons to explain the epidemiological link between
- high-fibre diets and lower risks of breast cancer, it was found that both
- raising fibre content in the diet and suppressing microflora with
- antibiotics led to reduced intestinal reabsorption of oestrogens and
- lower levels circulating in the blood.
• It was concluded that intestinal microflora raise oestrogen levels by
deconjugating bound oestrogens that appear in the bile, thereby
permitting the free hormones to be reabsorbed
• The beneficial effects of a high-fibre diet are likely to be the dominant
factor in women susceptible to breast cancer, especially as there is
evidence that bacterial flora actually enhance some of its wider
- Correction of disturbed bowel flora
- • Correction of disturbed / damaging bowel flora remains
- • There seems little value in the administration of therapeutic
- cultures such as lactobacillus and yoghurt in disturbances
- associated with disrupted gut flora
- • A high bulk diet with reduced simple sugar is more accepted
• As herbalists we can combine the benefits of these dietary
changes with improved hepatic and biliary function and bitter
or aromatic digestive herbs so that food matter is well
prepared in the upper digestive tract
• The value of direct agents on disruptive bowel flora is likely to
- • Fructooligosaccharides have recently been claimed
- to have Prebiotic properties
- – To promote the colonization of the bowel with beneficial
- flora and to be useful in dysbiotic conditions like
- • They are a mixture of oligosaccharides consisting of
- glucose linked to fructose units
• They are widely distributed in plants such as
– Globe artichoke
– Slippery Elm
- • They are not hydrolysed by human digestive enzymes but
- are utilized by intestinal bacteria such as
- – Bifidobacteria
- – Peptostreptococci
- – Klebsiellae
- – Bacteroides fragilis group
• In clinical studies, improvement of faecal microflora was observed on oral
administration of fructooligosaccharides at 8 g and 12.5 g per day; the
population of Bifidobacteria in faeces increased substantially compared
with before the administration.
- Irritable Bowel Syndrome
- • Irritable bowel syndrome is a common gastrointestinal
- disorder that sometimes causes significant discomfort even
- though it is not a serious health threat.
- • The cause of IBS remains unknown.
• IBS is not related to inflammatory bowel diseases, such as
Crohn’s disease or ulcerative colitis
• Typical symptoms include abdominal bloating and soreness,
gas, and alternating diarhoea and constipation.
• People with IBS are more likely than others to have backache,
fatigue, and several other seemingly unrelated problems.
- Medical Treatment
- • Over the counter fibre supplements or laxatives may be used
- to treat constipation
- • The antidiarrheal product (Imodium A-D®) may be used to
- treat episodes of diarrhoea
• Though no prescription medications specifically treat irritable
bowel syndrome, antidepressant and anti-anxiety drugs may
be used for people with mental depression or chronic pain, or
for people who have symptoms that worsen during periods of
• The anticholinergic drug (Levsin®, Levbid®) may be used to
treat colon muscle spasms and abdominal soreness.
- The Brain – Gut connection
- • Greenbaum et al (1987:257) found desipramine (a
- tricyclic antidepressant which selectively blocks
- reuptake of norepinephrine from the neural synapse,
- and also appears to impair serotonin transport)
- improved the symptoms of IBS significantly more
- than atropine, or placebo.
- • This was particularly evident for Diarrhoea
- predominant IBS
Serotonin: A Mediator of the Brain–Gut Connection?
• Kim & Camilleri (2000:2698) reviewed the current information
on Serotonin as a Brain-Gut mediator. They state:-
– ‘It has been estimated that about 95% of serotonin is found
in the GI tract’.
- – ‘Research about gut serotonin lags behind that in brain and,
- similarly, the application of serotonergic agents to gut
- disorders is still in its infancy’.
- – ‘In the past decade, serotonin antagonists have been used in
- chemotherapy-induced emesis, and some serotonin agonists
- are prescribed as prokinetic (accelerating small bowel and
- colonic transit) drugs’.
• ‘In irritable bowel syndrome (IBS), serotonergic
antidepressants have been used in clinical practice,
but they also modulate central cholinergic,
adrenergic, or dopaminergic systems’.
• ‘Selective serotonin agonists and antagonists are
being proposed for treatment of gut disorders,
primarily because of their direct effects on the gut
rather than any central effects’.
- • CONCLUSIONS: The SSRI citalopram significantly improves IBS
- symptoms including abdominal pain, compared to placebo.
- The therapeutic effect is independent of effects on anxiety,
- depression and colonic sensorimotor funciton.
- • CONCLUSIONS FOR HERBALISTS:
- – If it is accepted that Hypericum has a serotonin elevating action then is
- there a potential for incorporating Hypericum into the herbal
- treatment regime for IBS
Dietary changes that may help
• Several trials report that food sensitivities occur in only a
small percentage of people with IBS.
• Researchers have found that standard blood tests used to
evaluate allergies may not uncover food sensitivities
associated with IBS, because IBS food sensitivities may
not be true allergies.
• The only practical way to evaluate which foods might
trigger IBS symptoms is to avoid the foods and then
- Herbal Treatment
- • Spasmolytic herbs
- – Viburnum op
- – Dioscorea
- – Matricaria (also mild sedative)
- – Mentha
- • Sedative and nervine tonics
- – Hypericum perforatum
- – Scutellaria
- – Valeriana
- – (Mills & Bone 2000:180)
• Hepatorestoratives & choleretics to improve liver
• Mucilage-containing herbs
– Ulmus, especially if there is constipation.
- • GIT antiseptics to restore normal bowel flora
- – Hydrastis
- – Citrus seed extract
- – Garlic (IBS patients may be intolerant of Garlic)
- • The presence of mucus implies irritation GIT antiinflammatories
- – Filipendula
- – Matricaria
- • Constipation should be treated with gentle herbs
- – Rumex
- – Juglans
- – Taraxacum
Cholecystitis & Gall Stones
• Gallstones are hardened formations, composed primarily of
cholesterol, that develop in the gallbladder.
• The incidence of gallstones increases with age, with family history
being an important risk factor
- • Bitter herbs to improve digestion and gall bladder
- – Artemisia absinthium
- – Gentiana luteum
- – Picrorrhiza kurroa
- – Andrographis
• Choleretic herbs improve bile flow
– Chelidonium majus
– Cynara scolymus
– Taraxacum officinalis
– Silybum marianum
- • Cholegogue herbs improve gallbladder motility
- – Chelidonium majus
- – Cynara scolymus
- – Menta piperita
- • Cholegogue herbs need to be used with caution as increased
- motility in the early stages could lead to an increase in the
- number of attacks
- • Use in combination with spasmolytic herbs to minimise this
• Spasmolytic herbs can help to relieve gallbladder
– Viburnum opulus
– Matricaria recutita
– Mentha piperita
- • Long term use of steroidal saponin herbs
- – Wild Yam
- – Sarsaparilla
- – best avoided as these herbs can increase cholesterol levels
- in bile.
- • Olive oil and lemon juice Gall Bladder flushes are
- best avoided, as the risk of a gall stone getting
- caught in the pancreas and causing acute and life
- threatening pancreatitis is too great.
• Abdominal symptoms after removal of the GALLBLADDER.
• The common postoperative symptoms are often the same as
those present before the operation, such as COLIC, bloating,
NAUSEA, and VOMITING.
• There is pain on palpation of the right upper quadrant and
• The term is often used, inaccurately, to describe such
postoperative symptoms not due to gallbladder removal
- • Acute Pancreatitis is an acute inflammatory condition of
- the Pancreas. Common Causes (90%) are:
- – Gallstones (hence the caution on recommending the olive oil
- Gall Bladder flush)
- – Alcohol
- – Idiopathic
- – Post ERCP (Endoscopic Retrograde CholangioPancre
• When pancreatic insufficiency is severe, malabsorption
may result, leading to deficiencies of essential nutrients
and the occurrence of steatorrhea and diabetes.
• Chronic Pancreatitis is a slow, silent process that
gradually destroys the pancreas and is most often caused
by excessive alcohol consumption (80%).
- • Diabetes mellitus occurs in advanced cases because the
- islets of Langerhans are involved (Haslett etal 2002:802).
- • The blockage of the pancreatic duct by a gall stone causes
- the digestive enzymes to be retained in the pancreas where
- they digest the pancreatic tissue its self (Haslett etal
• The resulting pain is classically epigastric, constant,
radiating through to the back, and relieved by bending
forwards; this is often associated with profuse Vomiting
(Sanders &Kingsnorth 2007:295).
- • Oxygen-derived free radicals cause much of the tissue
- damage in both acute pancreatitis (Schulz etal 1999:2736)
- and chronic pancreatitis (Schoenberg, Birk & Beger
- • Antioxidant levels are found to be low in pancreatitis
- potentially indicating their increased utilization as
- scavengers of free radicals (Van Gossum etal 19961225).
• Combination therapy with selenium, beta-carotene,
methionine, and vitamins C and E was shown to improve
symptoms of chronic and recurrent pancreatitis (Uden etal
• Bagchi etal (1997:179) demonstrated that that Grape seed
extract is a more potent scavenger of oxygen free radicals
than vitamin C and vitamin E.