For those of us in gastroenterology it is quite satisfying to see the public and, especially, those with celiac and gluten intolerance publically speaking out about this still markedly undiagnosed medical problem.

Indeed, it is the most undiagnosed GI disease by far! 9 out of 10 people with celiac do not know they have it. It is so simple to get the first inkling of the disorder just by looking at your close relatives. If one of them has celiac, your odds are 1 in 21 that you will have it as well. Do you have any GI symptoms at all? A simple blood test is the first and perhaps the only test you will need.

Or are you simply gluten intolerant? If you are on a gluten free diet by choice or at your physician’s direction, then it is likely that you have dysbiosis. And what is dysbiosis? Yogurt and Activia makers have taught us that good bacteria (probiotics) in the gut are very desirable. We gastro doctors fully agree. In addition to probiotics, we all need the prebiotic plant fibers, which the good bacteria, especially those we intentionally take by mouth, are fertilized vigorously so as to proliferate in the bowel. When this happens, some very good health benefits occur.

I personally take some pride in unearthing 2 reports buried in the food literature that showed that Americans get 70-80% of these wonderful prebiotics from wheat. And what happens when wheat is removed from the diet? Yes, the bad bacteria now proliferate and dysbiosis or a bad bacterial mix occurs in the gut with bad health consequences. I published this information in the British Journal of Nutrition in 2010. So, if you are on a gluten free diet, then it is very important that you eat generous portions of gluten free but prebiotic rich foods. You can get this information on my educational web site jacksongi.com.

In addition, our prebiotic product, Prebiotin, can assure you and your gut that the beneficial plant fibers in Prebiotin are working to keep your gut as healthy as possible.

Best wishes for a healthy and symptom-free life both in May and into the future.

Frank W Jackson MD

Were we wrong!!

Dysbiosis  (pronounced dis-by-OSis) It means that the collection of bacteria that everyone has in their gut has shifted from good to bad bacteria. The colon and the gut bacteria are now recognized as a very valuable and healthy organ system. You want to have a good collection of bacteria.

Inflammation  This is bad wherever it occurs in the body. IBS people have low grade inflammation in the wall of the colon, often associated with the dysbiosis, or a bad mix of bacteria as mentioned above. How important is this?

Sensitivity Something we have known for a long time is that IBS patients do have an abnormal sensitivity in the gut. The nerve endings in the gut over react  to any change such as  contraction of the gut wall or too much gas created within the colon. Pain of all types!

A final new finding in the GI research community is that many IBS patients had previous bowel infection of some type. There is not much we can do about what has happened in the past, but it is of interest.

But what can we do?

Diet There is always a bit of trial and error here because no two people or their gut are the same. Nevertheless, what we know is that a high fat and high meat diet is clearly associated with a bad mix of bacteria in the gut. A first step would be to avoid this typical America fast food diet and change the proportions of food on the plate. Less meat, less fat, more veggies and fruit, more whole grains. Probiotics in yogurt or pills may help some. Prebiotics are specialized plant fibers that are proven to enhance the growth of good gut bacteria. Go to our web site, jacksongi.com to learn about them and what foods are rich in them. Prebiotics may have a role to play.

Finally

• There is really no finally for an IBS person as it is a life-long process. However making a conscious effort to change the makeup of the diet may well shift the bacteria complex of the gut from bad to good. This is a positive first step
• In turn, this change could reduce the inflammation in the colon wall
• Reduced inflammation could reduce the sensitivity of the gut wall and lead to fewer and less severe symptoms

References

1. This is a recent general review for physicians that make the points I did above
   The role of diet in the pathogenesis and management of irritable bowel syndrome (Review).
   Int J Mol Med. 2012 May;29(5):723-31. doi: 10.3892/ijmm.2012.926. Epub 2012 Feb 24.
   http://www.ncbi.nlm.nih.gov/pubmed/22366773
2. This article describes the bad make up of gut bacteria in a group of IBS patients who have diarrhea as a dominant symptom
   Alterations in composition and diversity of the intestinal microbiota in patients with diarrhea-predominant irritable bowel syndrome.
   Neurogastroenterol Motil. 2012 Feb 20. doi: 10.1111/j.1365-2982.2012.01891.x. [Epub ahead of print]
   http://www.ncbi.nlm.nih.gov/pubmed/22339879
   
3. This article describes a group of IBS people with constipation as a prime symptom
   Functional dysbiosis within the gut microbiota of patients with constipated-irritable bowel syndrome.
   INRA, UR454 Microbiology Unit, Clermont-Ferrand Research Centre, Saint Genès-Champanelle, France.
   http://www.ncbi.nlm.nih.gov/pubmed/22315951

HOW DOES THIS HAPPEN?

There are a number of factors in type 2. Blood pressure, overweight, and lipids in the blood are some of them. But perhaps as important as any is what is happening within the bacterial make up of the gut and colon. When the very best bacteria within the colon are flourishing prodigiously, the health of the colon and its wall is dramatically improved. Bacteria and their breakdown products do not get through and on up to the liver. It is here that these substances induce a fatty liver and even eventually cirrhosis of the liver, a very bad situation. The bottom line is that when the colon bacteria are predominatly bad, the lots of bad things happen, especially for the diabetic person

WHAT TO DO?

Of course, diet is important for every diabetes person. We now know that a shift in diet to one predominately of plant origin is helpful. There are some very beneficial prebiotic fibers in most plants. A high daily dose of these vegetables, fruits and whole grains are a positive first step. Along with this we would recommend a prebiotic supplement such as our Prebiotin, the best prebiotic fiber available. If lipids or cholesterol are part of the Diabetes problem, then Prebiotin Heart Health should be considered. Either way, a type 2 Diabetes person needs to get a substantial amount of prebiotic fibers into the body every day. This will reduce insulin resistance, clean up a fatty liver, lower cholesterol, help in weight loss and in general make management of type 2 Diabetes easier.

Here are some medical references

1. Improving the gut bacteria helps diabetes
   http://www.ncbi.nlm.nih.gov/pubmed?term=the%20therapeutic%20potential%20of%20manipulating %20gut%20microbiota%20in%20obesity%20and%20type%203%20diabetes%20melliyus
2. Insulin resistance and the gut bacteria
   http://www.ncbi.nlm.nih.gov/pubmed/21431853

Part 2 -Prebiotics and Coronary Heart Disease

Our prebiotic formula in Prebiotin Heart Health has a great deal of medical research behind it. By itself it favorably changes the bacterial makeup of lower gut. This results in a wide range of benefits from stronger bones, healthier immune system and an increased ability to lose weight. It likely has a good effect on blood triglyceride for those who need to watch that (link 3 below). Prebiotin by itself contains a good dose of fiber. Together with psyllium and oat bran you get almost half the daily-recommended dose of fiber for the adult person.

Another recently published report showed that changing the gut bacteria makeup in a favorable manner resulted in a greater survival rate when the animals underwent an acute heart attack (link 4 below). Prebiotics and our prebiotic formula specifically have demonstrated the ability to make these changes.

So, the 2nd message this month is to take advantage of prebiotics either in your diet or in a supplement. Prebiotin Heart Health has it all.

Please have a healthy year.

Frank Jackson MD
Jackson GI Medical

1. Dietary patterns are associated with increased risk of coronary heart disease
   http://www.ncbi.nlm.nih.gov/pubmed/22190026
2. Effects of psyllium and oat bran on coronary heart disease risk
   http://www.ncbi.nlm.nih.gov/pubmed/18937894
3. Effects of prebiotics on serum lipids and triglyceride
   http://www.ncbi.nlm.nih.gov/pubmed/12236466
4. Gut bacteria determine severity of heart attack in rats  http://www.ncbi.nlm.nih.gov/pubmed?term=intestinal%20microbiota%20determines%20severity%20of%20myocardial%20infarction%20in%20rats

Frank W Jackson MD
Gastroenterologist
Mechanicsburg PA

Our diet and the foods we consume are obviously the most important part of maintaining a healthy weight and preventing and treating type 2 diabetes. Yet, for those of us that struggle, it is by far the most frustrating of all the things we do. There are hundreds of diet books available and just as many programs, pills and TV commercials that promise an easy solution to this most difficult of all problems. In many of these there is precious little or no science to back up the claims. But science is now entering the picture with some remarkable new discoveries concerning gut bacteria, our diets and how they impact our health and well being. As a physician, I am very impressed that this new research has very practical implications for these patients as well.

The Great Awakening

In retrospect it would have seemed so obvious that bacteria are an important part of life and health. Bacteria have been around long before we humans arrived on the scene. However, these bugs were just discovered and grown in Petri dishes in the late 1800s. Of course, the first rush of research was to identify the bad ones that caused disease and death such as pneumonia and tuberculosis. Then along came antibiotics in the middle of the last century. It was thought that infectious disease would end as drug companies rushed to bring out ever more powerful antibiotics to kill these bad bacteria. Of course, with each new drug, some bacteria developed resistance and so it was a never ending chase. The bad bacteria always won the chase, always slowly becoming resistant to each great new antibiotic. The unfortunate legacy of all this information is that all bacteria were bad, even the ones on our hands and in our mouth.

As the new century came upon us, we learned that we and the bacterial environment in which we live in most cases lived harmoniously together. We now know that most bacteria are simply everywhere in nature from the highest mountains to the deepest ocean. More important than that is the fact almost everywhere we look we find that most bacteria produce benefits where they grow. This makes sense. Why would they not produce a benefit? With a benefit, they can keep growing and flourish. And yes, even produce a benefit for the place or for the person where they grow. And that is exactly what science has found.

One simple example is on the surface of the eye. Science shows that there are a variety of bacteria that normally grow on and so protect the surface of your eye. Yes, your tears, fortunately, are not sterile. Otherwise some bad bacteria would grow there. The ones you have keep the bad ones from finding a home. Another example are the bacteria that grow in and protect our mouth. Most importantly of all they also are found in our intestines where many bacteria quietly grow and in so doing create many health benefits for everyone.

The Gut’s Great Bacteria Factory

A tremendous number of bacteria reside in the gut, especially the large bowel or colon. It was just about 20 years ago that we began to understand the health importance of these bacteria. An astounding revolution then occurred in this entire area of gut bacteria and its relationship to the gut, to the body and to the general health of everyone, especially to those with a weight problem.  This has occurred because of incredible advances in studying the very genes that reside within bacteria.  New genetic probes are now telling us some amazing things about these mostly friendly gut bacteria.  There are well over 1000 species of bacteria in the gut, twice the number that we previously thought.  Remarkably the total number of bacteria in the colon is over 10 trillion, 10 times the number of cells in our entire body. The most important finding in this new revolutionary field of gut bacteria is that most of these intestinal bugs turn out to be our friends. If they are fed properly by the way we eat, a wide variety of health benefits occur, both for the gut and the body.  The colon, in essence, is a true health organ when the large thriving pool of bacteria is of the right mix. The importance of this to those who are overweight, obese, or who have type 2 diabetes has now become clear.

WHAT HAPPENS IN OBESITY AND TYPE 2 DIABETES?

The new research on gut bacteria and the presence of obesity is simply astounding. And this new research has importance for everyone, but especially for those with obesity and type 2 diabetes. In these conditions the colon, where most bacteria live, has a completely different arrangement of bacteria. It is a change that has direct health implications for these people. There is a shift from good types of bacteria which produce health benefits to ones that are not so good, ones that, indeed, cause adverse changes in the colon wall itself.

The good bacteria group is called Bacteriodetes or Good Bacteria for short. The bad group is called the Firmicutes, or the Bad Bacteria. When these latter predominate, changes occur in the wall of the colon.  Some bacteria actually move through the bowel wall and invade the colon itself. Normally, this should not happen. Normally, there is a very strong mucous barrier on the inside surface of the colon that prevents this from happening. So this mucous barrier is weakened and leakage can then occur.  Beyond this, the tight adhesion between the colon wall cells themselves weakens. A true leaky gut ensues whereby various endotoxins or just plain toxins can move through the bowel wall and likely enter the blood and then reach the liver. There are some medical researchers who feel that this may be a major element in the condition known as a fatty liver. A fatty liver is common in obesity and type 2 diabetes. By itself, a fatty liver may progress to very serious liver disease such as cirrhosis.

The trigger for these changes appears to be the diet. More specifically, when a high meat and saturated fat diet is ingested on a regular basis, there is a shift in the colon bacteria from the Good Bacteria to the Bad Bacteria. As these latter bacteria predominate, increased calories are absorbed through the colon wall. It is important to understand this point clearly. There are a certain number of calories normally produced in the colon by fermentation and the growth of bacteria. However, when the bacteria balance shifts from Good to Bad then there are almost twice as many calories produced by the colon bacteria. Twice as many calories are thereby absorbed. Bad Bacteria in the colon means that more calories seep into your system. This is a major new and now well recognized finding by many researchers.

However, when plant foods are a major part of the diet, then the shift is in the other direction, from the Bad Bacteria to the Good Bacteria. We now know what it is plant food that is so important to the health of the colon and, indeed, to the health of our very bodies. This important and only recently discovered nutrient for our best bacteria is a special type of food fiber.  These unique plant fibers are called Prebiotics.

Prebiotics

A prebiotic is not a probiotic.  Probiotics are live bacteria found in yogurt, other dairy products and pills.  A prebiotic, on the other hand, is a naturally growing plant fiber. These are soluble fibers meaning that they dissolve in water and in so doing nourish the Good Bacteria in the colon. On the other hand, an insoluble fiber, found in wheat and rye, is not fermented by bacteria but rather acts to help form a larger bulkier stool. They do not nourish bacteria.  The best researched of the prebiotics are naturally occurring and are called oligofructose and inulin. These two prebiotics, oligofructose and inulin, are the ones that maximally stimulate the Good Bacteria to thrive and dominate in the gut.  They are the ones that produce so many health benefits.

These two key prebiotics, oligofructose and inulin, are very widespread in many plants throughout the world. They are present in many foods we humans eat such as wheat, onions, garlic, yams, asparagus, bananas, leeks, chicory root, Jerusalem artichoke and even dandelions. Unfortunately, they are not present in large amounts in many of the foods that humans eat on a regular basis. This is where the problem is. For instance,  Prebiotics are not present in French fries or any meat, chicken or even fish. All medical and nutrition experts tell us that we need to be eating from 25 to 35 grams of fiber a day. This means a significant shift in the types of foods we eat. But when this goal is reached on a regular basis, we can be reasonably assured that we are getting enough prebiotic in the diet and that changes are occurring in our gut.

Health Benefits of Prebiotic Fibers

Two major health benefits occur for the overweight and/or type 2 diabetic patient.

Reduced Colon Calorie Absorption

Here is where the new colon and bacteria research is so very surprising and important. We now know that a certain number of calories are generated by bacteria in the colon and are absorbed into the body. What is new is the fact that the calories made and absorbed in an environment of the Bad Bacteria is about twice that of that seen when the Good Bacteria predominate. So, by eating a prebiotic rich diet or even by taking a prebiotic supplement, you can change the makeup of the colon so that fewer calories are absorbed even when eating the same number of total calories. Almost everyone with a weight problem has noted and said that they don’t eat any more than others who are not overweight, but they still can’t lose weight. Now we know why. They are just eating the wrong types of food.

Appetite Hormone Control

New research has shown that your appetite and your sense of fullness are, in part, related to hormones generated in the walls of the gut. These hormones are protein-like substances that enter the blood and then exert an influence on the brain. The hunger hormone is made in the stomach and, of course, helps make one hungry and want to eat. The satiety or fullness hormones are made in the lower bowel and provide a sense of fullness. Prebiotics make these hormones change in the desired direction, providing a drop in the hunger sensation and increase in the sense of fullness. This is just what is desired in the obese and type 2 diabetes person.

There are other now well known health benefits that occur when prebiotics are a major part of the diet. These include:

• Increased absorption of calcium and magnesium through the colon
• Stronger bones
• Enhanced immunity and resistance to intestinal infection
• They may also be some benefit in colon polyps and cancer, and perhaps inflammatory bowel disease as well. Research in these areas is ongoing.

To Sum Things Up

• Remain on your present weight and/or diabetic control program.
• Add extra prebiotic foods and supplements. Our Prebiotin supplement assures you that you are getting the best prebiotic formula available.
• Reduce red meat and saturated fats in the diet. These are the 2 major factors that promote the growth of Bad Bacteria in the colon.
• Significantly increase the amount of plant based foods in the diet. The goal should be 25-35 grams of plant fiber per day, depending on weight and sex.
• Be sure your physician knows of these dietary changes.
• Our Prebiotin supplment significantly reduces the calories you absorb and favorably changes your appetite hormones

References

1. http://www.ncbi.nlm.nih.gov/pubmed/17183312

This is the landmark study that showed that when the gut was dominated by the bad Firmicute group of bacteria that there was a significant increase in calories produced by the colon bacteria and which were then absorbed into the body

2. http://www.ncbi.nlm.nih.gov/pubmed/20920376

This is a huge 2010 review of research on prebiotics by many experts in the field. They list 12 findings on the effects of prebiotics.

• In the colon good bacteria grow and bad ones do not.
• More regular and easier bowel pattern
• Increased calcium and magnesium absorption
• Enhance bone density
• Better appetite control
• Stronger immune system
• Less leaky bowel
• Fewer bowel infections
• Fewer calories produced in the colon
• Reduce colon cancer risk substances (carcinogens)
• May help in the diet control of inflammatory bowel disease

3. http://www.ncbi.nlm.nih.gov/pubmed/20880099

This scientific article reviews the hormones produced in the wall of the gut that have effects on the sensation of appetite and fullness or satiety in the brain. They are related to prebiotics in the foods we eat or otherwise ingest by supplements.

Plant Fiber and Calories

The research and medical information on these 2 subjects top the list of really new and medically important knowledge. We now have incredibly new techniques to study the thriving bacteria within our gut. We know that when the very best bacteria that confer so many health benefits predominate in the colon, some very good things happen. We also know that the colon bacteria produce a certain number of calories each day. When the bad, unwanted bacteria flourish, twice as many calories are produced. It is as simple as that. Switching to prebiotic rich foods and/or prebiotic supplements makes this happen. You simple turn off the signal for more calorie product by using this simple trick. Prebiotic plant fibers.

Appetite Hormones

This information is also very new. Hormones are proteins, made in the body, that enter the blood stream and can give you signals relating to hunger and feelings of fullness or satiety. There are different hormones produced in the gut wall that do each of these feeling-hunger and fullness. The new research is that prebiotic plant fibers such as are in our Prebiotin shift these signals in the desired direction. So a high soluble plant fiber diet dulls your sense of hunger and increases fullness. A typical high meat and fat diet does the opposite. This is simply chemistry operating in your body based on the types of food you eat and whether you may be taking the right types of prebiotic supplement.

So, make soluble plant fiber a major part of your new diet. Prebiotin is the prebiotic formula that has the most medical research data behind it. Make it part of your New Year’s dietary resolution.

Wishing you the very best and healthiest of New Years to you

Frank W Jackson MD
President
Jackson GI Medical

• Fatty liver
• Type 2 diabetes
• Metabolic syndrome
• Some other chronic liver disease, including non-alcoholic fatty liver disease(NAFLD) and non-alcoholic steatohepatitis (NASH)

Crosstalk in medicine means that the colon and its bacterial content are speaking to the liver. And the conversation is anything but good. Bad things are happening. You really want to stop it. Now, for some back round.

The bacteria residing in everyone’s colon should provide many health benefits, if, and only if, the right bacteria are present and in the right proportions. In the colon there are over 1000 species and simply an astounding total number of bacteria present. The bacterial makeup can shift from the good ones to the bad ones. When this happens, these bad bacteria induce a change in the colon wall. The cells lining the wall weaken and allow bacteria and their contents to easily slip through. This is called a leaky bowel. One other nasty thing occurs. Along with a leaky bowel there is low-grade inflammation.
Both of these things are undesirable.

All the blood that leaves the colon goes directly to the liver. From there it is then passed on into the general circulation. So, the liver acts as a gateway to filter out any bad material that occasionally might be coming from the intestine. After all, you do not want any bacterial products to be let loose into your general blood stream. So, along with its many other functions, the liver does this filtering process and it does it very effectively.

However, when there is a leaky bowel along with inflammation, a huge among of these bacterial materials can leach through the colon wall and reach the liver. The liver is overwhelmed and cannot handle it. A fatty liver ensues. This, in turn, can set up a smoldering inflammatory process which causes fibrous tissue to form. This, in turn, damages the liver and leads to cirrhosis, a very serious outcome. It also causes insulin resistance, which leads to and worsens type 2 diabetes.

The way to correct this is to change the bacterial make-up of the colon from the bad bacteria to the good ones. When this happens, the bowel wall begins to heal. Bacterial materials do not leave the colon. There is no longer crosstalk between the colon and the liver. The liver has a chance to recover These facts are well summarized in the current reference below.

TREATMENT
The only way to change the bacterial content of the colon from the bad to the good ones is with diet, specifically a diet that contains a large amount of soluble dietary fibers. The standard Westernize diet is very high in red meat and other animal products. It is also very low in fiber, especially the soluble fibers in plants. These are exactly the plant fibers that the good bacteria use to grow and reproduce. When this happens, the bad bacteria are pushed into the back round. Prebiotic soluble fibers are the ones with the most research behind them. Our product, Prebiotin, is 100% prebiotic soluble fiber and, taken daily, can provide much or most of the soluble fiber your body needs. So, go to our High Fiber Diet for full details on this treatment for Fatty Liver. And don’t forget our Prebiotin Prebiotic Fiber to jump start your program.

Reference

http://www.ncbi.nlm.nih.gov/pubmed?term=role%20of%20innate%20immunity%20and%20the%20microbiota%20in%20liver%20fibrosis

• How your diet and the colon bacteria interact is now well understood. If there are lots of fruits, veggies and whole grains in the diet, then the good, health-producing bacteria in the lower gut thrive. On the other hand, if the diet is primarily animal protein and saturated fat based, meaning lots of deep fried foods, then the bad bacteria, called Firmicutes, predominate.
• The presence of these bad bacteria in the gut are associated with and, indeed, appear to be instrumental in increasing the number of calories absorbed from the colon. This type of diet also changes the metabolism of fat cells in the body leading to obesity and diabetes type 2. These are now well known medical facts.
• Now for some new information. As far back as 2004 there were reports in the medical literature relating the exposure of a variety of chemicals, particularly early in life, to subsequent obesity.  (link 1 below).
• In 2007 came another report strongly linking the chemical phthalate to obesity and type 2 diabetes. Phthalate chemicals are very widespread and commonly used in cosmetics, soaps, pesticides, lubricants, plastics and paints. 75% of the US population was found to have phthalates or their derivative in their blood. This too was linked to obesity and/or type 2 diabetes (link 2 below).
• In Feb 2011, the Center for Disease Control and Prevention, a part of the National Institutes of Health, published another amazing study of unwanted chemicals found in the blood or urine of Americans. There were present a variety of 216 different chemicals, including heavy metals such as lead. This is simply mind-boggling. We are all exposed to a staggering array of chemicals used in industry and home products. These include products used in aerosols,  health care products like skin creams and cosmetics, toothpaste and even in factory manufactered and prepared foods and even medicines we ingest.

• This month Nov 2011 comes an article in a well-respected environmental journal. The paraphrased title is “Is There a Relationship Between Environment Chemicals and the Gut Bacteria in causing Obesity and Type 2 Diabetes?” It is an extensive 41-page article with a long list of medical references. In summary it supports the facts that gut bacteria are very important, that these bacteria are exposed to many of the chemicals in our environment, and that there is a likely relationship between these chemically influenced bacteria and obesity and type 2 diabetes (link 3 below).

1. Change your gut bacteria to the good guys. This can be done by gradually changing to a plant based, predominantly fruit, veggie and whole grain diet. Our prebiotic supplement formula, Prebiotin, can help in making this change.
2. Consciously eliminate as many chemicals as possible from your outside and inside environment.
3. Eat fresh foods, preferable organic. Even locally grown veggies, found in your farmers market, may have pesticides on them. Always ask, just to be sure.
4. Avoid to the extent possible factory manufactured foods found in boxes, packages and bottles at your food store. These are usually found in the center aisles.
5. Read food labels. Factory manufactured foods must list all the ingredients. Simple foods like olive oil will list one ingredient. But most labels will have lots of ingredients listed on them. Do you know what each ingredient is? Have you ever heard of some of them? There may be chemicals in the food that produce better shelve life, taste, mouth feel or some other property to benefit the manufacturer. Many of these chemicals are said by the Food and Drug Administration (FDA) and by manufacturer to be safe. But many of these chemicals are not natural. They are manufactured somewhere in a factory. They were approved by the FDA long before we knew anything about the gut bacteria or the huge exposure to chemicals we all face. Now we know that they may interact to cause very serious medical disorders. Simple and natural is always better.
6. Remove as many bottled, canned and boxed chemicals under the sink, in the garage or elsewhere around the house as possible. Keep countertops and other food preparation areas free of detergents and all other such cleaning products.

1. http://www.niehs.nih.gov/about/assets/docs/feb2011obesityheindel.pdf
2. http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.115-a312b
3. http://www.ncbi.nlm.nih.gov/pubmed?term=dominteractions%20between%20gut%20ecology%20and%20enviormental%20chemicals%20contribute%20to%20obesity%20and%20diabetes%3F

Every Crohns patient wants to know what to eat, how much, and how often.
The bookstore and the web are filled with diets for the Crohns patient. A certain Carbo diet is in vogue right now and some patients swear by it. None of these diets is based on good medical research. Most of them rely only good nutritional intuition or the profit motive. In my previous gastroenterology practice I gave the best advice possible. Get enough calories. Eat lots of protein, meaning animal foods. You should take a multivitamin pill. And yes, we were seeing better and better drug therapies for Crohns. Diet, however, remained in the back round simply because we did not have good research information to get very specific. The Crohns and Colitis Foundation and the Mayo Clinic educational web sites, too, could not and, indeed, even today do not give much information beyond what I say above. But now there is some solid research material and some very provocative advise on what Crohns persons should be putting in their mouth. Read on or be sure to send this to a friend who has or knows someone who has Crohns Disease.

Earlier this year an academic group of physicians did what is called a meta-analysis, meaning they surveyed the entire medical literature on what Crohns people were eating just before they got the disease diagnosed. They looked at over 1000 published articles and found 19 with enough good research and documentation for the following conclusions:

1. Reduce animal protein, especially, meat in the diet. A portion the size of a deck of cards once a day is about right.
2. Fats and vegetable oil. These should be reduced as well. The unexpected and the big news was that people who got Crohns were ingesting lots of vegetable fats. So, reduce the olive and other vegetable oils.
3. Significantly increase the amount of plant food, meaning vegetables, grains and fruit. Fruit, in particular, seemed to be protective.

These above recommendations are based on the best science we have. This research comes from the medical article below (link1).

Food Additives

The other part of nutrition is that of food additives. The increase in the incidence of Crohns disease has paralleled the increase in food additives to prepared, packaged, and bottled foods. The most important of these additives may be the emulsifiers.

Before understanding emulsifiers you need to know some secrets about what is happening within the lower bowel and colon of everyone including Crohns patients. We all have a very large number of bacteria in our colon. They are part of our health make up and should be providing many health benefits. With a solid plant food based diet the bacterial mix swings toward the good side. In Crohns people the bacterial mix is abnormal, meaning there are far more bad types of bacteria than the good ones. The change in diet above helps to swing the bacteria mix back to the good ones that provide so many known health benefits.  In so doing the inflammation may be reduced.

The Mucous Layer

The second big secret is that we all have a very tough layer of thick, tenacious mucous covering the inside lining of the bowel. This is called the mucous layer. It protects us from bacteria invading the bowel wall as happens in a Crohns person.
In research two different emulsifiers have been shown to dissolve this mucous layer in Crohns prone animals and lead to invasion of bacteria with inflammation and infection.

Emulsifiers

An emulsifier is a food additive, frequently chemically made, that does something in the food to which it is added. It may make an emulsion and allow the mixing of oil and water as in salad dressings. It can and often is used to give good mouth feel in ice cream. They have no calories and so they are often used in low calorie foods as a substitute for fat and oil. They may prolong shelf life.

Now back to the mucous layer. In Crohns patients, bad bacteria invade through this mucous lining. An emulsifier from a packaged food may help to emulsify this mucous barrier and in so doing allow bacteria to move through.Research has shown this to occur with the very commonly used emulsifiers carboxy methyl cellulose (link 2) and polysorbate (link 3). There are well over 100 different emulsifiers that can be added to factory prepared foods. You need to read the labels carefully and not buy or eat factory prepared food where there are items on the label that you do not recognize. Assume that they could be emulsifiers. The names of some others are xanthum gum, glycerides, and celluloses. If you want to learn the names of these additives, go to Wikipedia and search for E numbers. Under the 400 series you will find the names of these many emulsifiers.

Fresh Foods

The way to avoid all food additives is to shop fresh. Buy fresh foods, especially the fresh vegetables and fruits. Frozen vegetables and fruits are fine, but, again read the labels.  Avoid the center isles in food stores where these factory made foods are present. Read labels and look up words you do not recognize. Assume they could be emulsifiers. The FDA says that all food additives are safe. However, these decisions were made long before we knew much about the mucous layer of the intestine and how important it is, especially for the Crohns patient.

Prebiotics

A prebiotic is not a probiotic which is a bacteria in yogurt, other dairy products or pills. A prebiotic, on the other hand, is soluble plant fiber that is used by the best bacteria in the gut to promote their growth. When they grow, the bad bacteria do not. They are in a wide variety of plants. Please go my educational web site jacksongi.com to learn more about prebiotics and to search for the Crohns Diet under the Diet section. The Crohns Therapeutic Diet is presented in detail. Our Prebiotin products are a great supplement to your diet.

References

1. Dietary risk of developing inflammatory bowel disease.
   http://www.ncbi.nlm.nih.gov/pubmed/21468064
2. Inflammation of the small intestine after carboxy methyl cellulose ingestion
   http://www.ncbi.nlm.nih.gov/pubmed/18844217
3. Movement of Crohns bacteria across the mucous layer. Effect of the emulsifier polysorbate
   http://www.ncbi.nlm.nih.gov/pubmed/20813719

1. What is the cause of the awful smell of flatus?
2. What causes the smell of stool?
3. Are they the same?
4. Can anything be done about these smells?

The answers are:

1. The foul smell of flatus is almost exclusively due to sulfide gases manufactured within the colon. The bacteria that make these gases, most of which is hydrogen sulfide, are a certain group of bacteria that live in the left side of the colon where there is no acidity. They take hydrogen made by other bacteria in the colon and combine it with sulfate derived from the foods we eat. You end up with hydrogen sulfide that is a gas the jumps out from the bacteria into the otherwise odorless gases in the colon. It is then passed as flatus and the more of these sulfide gases there are, the more awful will be the smell of flatus.
2. The sulfide gases do not cause much smell in stool. This is caused mostly by 2 chemicals called indoles and skatoles. These 2 smelly molecules come from the metabolism within the colon of the amino acid tryptophan. That’s right. Tryptophan is a simple amino acid that is always present in animal protein. It is especially high in meats. The small bowel absorbs most of this amino acid. In the blood it has a sedating effect and is the reason one feels sleepy after a large meal. However, some of the amino acid will escape and end up in the colon where it is acted upon by other bacteria and becomes either an indole or a skatole. The stool will then have a very bad smell.
3. So the sulfide gases and the indoles and skatoles are entirely different.
4. First the sulfide gases. These bacteria in the left side of the colon need a neutral place to grow. No acidity and not too much alkali. When there is acidity within the left colon these bacteria do not grow well and do not produce much sulfide gas. The trick is to increase acidity in the left colon. Prebiotics are special types of plant fiber that are present in many types of vegetables as well as bananas. You can click here to get a lot more information on prebiotics. When these prebiotic type foods are eaten in greater quantities, they reach over to the left colon. They stimulate the best types of bacteria to make lots of acid like substances. These are called short chain fatty acids and they provide many health benefits. A side effect is that they acidify the contents of the colon and these sulfide producing bacteria do not grow and so no sulfide gas is produced. The flatus has no smell. Our dietary supplement product Prebiotin has been shown to do just this. If you take enough Prebiotin, the smell of flatus usually goes away.Now to the smell of stool. If you are a big meat eater, then you will undoubtedly have enough tryptophan reach the colon that the nasty indole and skatole substances will be produced. So, it is pretty simple. Cutting back on animal protein is the best and really the only thing you can do. You do not need to become a vegan. Just cutting back will likely do the trick.

   So, prebiotics and Prebiotin along with a modest reduction in animal protein are the tricks to an odor free GI track.

- By Frank W Jackson MD