Digestive Health In Early Life Linked To Allergies

dandelionAs a naturopathic physician, I’m always paying close attention to the connection between intestinal health and systemic complaints.  Allergies in particular are something that our profession has recognized as having strong ties to the digestive tract.  When people present to my office complaining of allergies, one of the first things I ask about is whether or not they’re having any digestive symptoms.  I also want to know about their history of antibiotic use, their diet, if they were breastfed as an infant, and whether or not they were born via Caesarean section.  So, what do these birth-related issues have to do with someone’s current allergy symptoms?  Well, we know that allergies are symptoms that result from antibody responses to antigens (dust mites, pollens, mold, etc.) that our body recognizes as foreign. But what your doctors don’t often discuss is why this occurs in the first place.

A recent study done at Henry Ford Health Center suggests that babies born by C-section are five times more likely to develop environmental allergies by age two than children who are born vaginally.  This mainly has to do with the bacterial exposure that occurs when babies pass through the birth canal, vs. if they’re removed via C-section.  Starting in the womb, the intestinal tract of babies is essentially sterile.  As they pass through the birth canal, they are exposed to the entire population of bacteria that resides within their mother’s vaginal and gastrointestinal tract.  This allows their immune system to learn the difference between “good” and “bad” bacteria.  A C-section prevents this critical exposure to bacteria, allowing the body to develop a sensitivity to allergens before the intestinal microbes have a chance to fully develop.

Of course, by the time most of us manifest allergy symptoms, it’s too late to do anything about how we were born!  However, there are still a number of intestinal-related factors that play a role in immune function, and how the immune system may recognize everyday substances as foreign.  But for expecting mothers, if you know you’ll be having a C-section, one of the best measures you can take to protect your child is by breastfeeding.  This will also help to pass on important bacteria that they won’t otherwise be exposed to with formula alone.  You can also supplement with probiotics, which are often formulated as powders with strains that are specific for infants.

For the rest of us, it’s still important to take steps to normalize the microbial environment of the intestines as much as possible when trying to minimize the body’s allergy response.  Ways to do this include consuming more sources of fermented foods, such as yogurt and kefir, and supplementing with mixed strains of probiotics (bifidobacter, lactobacillus, etc.).  You can also look at stool tests to measure the amount of healthy bacteria within your intestinal tract, along with making sure that unwanted microorganisms aren’t present.  The bottom line is that there is much more we can do when it comes to allergies than just loading up with anti-histamines and allergy shots.  The immune system is extremely intelligent and sophisticated, so let’s start giving it a little more credit!

Does Arthritis Originate in the Gut?

I see quite a few patients with rheumatoid arthritis, and other autoimmune arthropathies, and what is the first thing I do?  Give them anti-inflammatory medications?  Give them immune-modulaters?  No!  Chances are, their rheumatologists have already done this.  The first thing I will always do with patients in this category is address their digestive health.  What does digestion have to do with systemic inflammation?  Everything!

If you think about it, the intestines are really the main barrier that separate us from the outside world.  They have to be extremely selective about what they let in and what they keep out.  Immune cells constantly patrol the intestinal barrier, attempting to keep foreign invaders from entering the circulation.  Enzymes and microbes help to break down foods, assuring that only the nutrients we need are allowed to pass through.  We take this whole process for granted, but the level of intricacy at which everything must stay in check is astounding!

When it comes to rheumatoid arthritis, our biggest concern with respect to intestinal health is an increase in permeability (“intestinal hyperpermeability” or “leaky-gut syndrome”).  The causes of this are numerous, but can include stress, food allergies, intestinal inflammation, medications, genetic influences, and exposure to environmental toxins.  Normally, your intestinal cells are bound by “tight junctions”, which are meant to prevent undigested foods from passing through the intestines into the bloodstream.  So, when your body is exposed to substances that are pro-inflammatory, the intestines can usually limit any negative effects with a localized immune response.  However, when various factors (as mentioned above) affect intestinal permeability, antigens are able to bypass the intestinal immune response, allowing them to mobilize throughout the body, causing a systemic inflammatory response.  The body then begins to attack itself because it’s primary defense (the intestinal barrier) has been compromised, forcing other parts of the immune system to become overactive.  Thus, it’s not surprising that a wide range of gastrointestinal and systemic disorders are associated with abnormal intestinal permeability.  According to a 2003 article in the Journal of Gastroenterology and Hepatology, systemic lupus (SLE), juvenile arthritis, eczema, sarcoidosis, psoriasis, inflammatory bowel disease, and a number of other chronic disorders can be linked to intestinal hyperpermeability.

So, what do most doctors instruct their patients with auto-immune disease to do?  Take NSAID medications.  What do these medications do?  Increase intestinal permeability!  They may temporarily relieve the pain, but the approach of using NSAIDs and immune suppressants is not sustainable, and is most likely worsening the long-term prognosis of auto-immune arthropathies.  While a number of respected journals have discussed the link between intestinal hyperpermeability and systemic inflammation, this concept is largely ignored by conventional rheumatologists.  Repairing the gut needs to be the first line of defense when dealing with auto-immune disease.  Otherwise, as long as antigens continue to be able to “slip past” the intestines, it will be impossible for the immune system to regain control of itself.

What should you do if you have an auto-immune disease, or if leaky gut is a potential concern?  If you want a more definitive assessment, there are tests that can be performed to measure the severity of intestinal permeability.  Comprehensive stool testing can also be performed to evaluate the bacterial environment of the intestines, including the overgrowth of any foreign microorganisms that may need to be dealt with.  A doctor who has experience with treating leaky gut will then need to determine which factors are contributing the most, whether it be food allergies, stress, or medications.  Once these underlying obstacles are removed, nutritional interventions which help to initiate intestinal healing can then be implemented.

The concept of a “leaky gut” is not new to naturopathic medicine.  Even though it has begun to gain traction in conventional medical journals over the last 10 years, it’s certainly far from being the “standard of care” in rheumatology practices.  If you are suffering from any form of auto-immune inflammation, whether it be inflammatory bowel disease, rheumatoid arthritis, or psoriasis, you seriously need to address the underlying causes that may be affecting your digestive health.  While the connection may not seem obvious at first, healing the gut will be the most important step you can take towards stabilizing any systemic form of inflammation.

 

 

Elderberry and Infections

As many of my patients are already well aware, I often rely upon Elderberry extract, especially in the treatment of influenza and other viral infections. This recent study demonstrates evidence as to why this treatment is effective.

In a study designed to examine the effects of a standardized extract of black elderberry (Sambucus nigra L.) on 3 Gram-positive bacteria and one Gram-negative bacteria responsible for upper respiratory tract infections, as well as two different strains of influenza virus, the extract was found to possess antimicrobial activity against both Gram-positive bacteria of Streptococcus pyogenes and group C and G Streptococci, the Gram-negative bacteria Branhamella catarrhalis, and human pathogenic influenza viruses. The results of this study suggest that elderberry extract such as the one used in this study may be an effective tool for helping to combat various types of upper respiratory tract infections.


Reference: “Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses,” Krawitz C, Mraheil MA, et al, BMC Complement Altern Med, 2011 Feb 25; 11-16. (Address: Institute for Medical Microbiology, Justus-Liebig-University, Frankfurter Strasse 107, 35392 Giessen, Germany. E-mail: Stephan.Pleschka@mikro.bio.uni-giessen.de ).

Flu and Elderberry

I almost universally recommend Elderberry in cases of flu and other viral respiratory infections. Here is some research that demonstrates it’s effectiveness:

According to a recent study, an extract of black elderberry (Sambucus nigra L.) inhibited human influenza virus A (H1N1) infection in vitro. The IC50 value (i.e., the concentration at which the infection was inhibited by 50%) was 252 µg/ml. Two flavonoids isolated from the elderberry extract were found to bind to H1N1 virions and to block the ability of the virus to infect host cells: these flavonoids were 5,7,3′,4′-tetra-O-methylquercetin (Compound 1) and 5,7-dihydroxy-4-oxo-2-(3,4,5-trihydroxyphenyl)chroman-3-yl-3,4,5-trihydroxycyclohexanecarboxylate (Compound 2). Compound 1 and dihydromyricetin (the 3-hydroxyflavonone of Compound 2) were synthesized and shown to inhibit H1N1 infectivity in vitro by binding to H1N1 virions. Compound 1 had an IC50 of 0.13 µg/ml (0.36 µM) for H1N1 infection inhibition, while Compound 3 had an IC50 of 2.8 µg/ml (8.7 µM). The IC50 of the elderberry flavonoids compared favorably with those of oseltamivir (Tamiflu; 0.32 µM) and amantadine (27 µM), which are prescription drugs used to treat influenza.

 

The results of in vitro studies do not necessarily translate into clinical efficacy. In order for a compound to have an antiviral effect in vivo, it must be absorbed intact in amounts sufficient to achieve a virucidal concentration at the site of the infection. No data are available regarding the absorption of the antiviral flavonoids in elderberry, and the capacity of the human body to absorb other naturally occurring flavonoids has been found to be limited. However, in clinical trials, administration of an elderberry extract produced encouraging results in people with influenza-like illness.

 

Forty patients suffering from influenza-like symptoms during an outbreak of influenza B/Panama in 1993 were randomly assigned to receive, in double-blind fashion, a proprietary preparation (Sambucol) containing extracts of Sambucus nigra L. and raspberries (Rubus idaeus L.) or placebo. The dosage was 30 ml per day for children and 60 ml per day for adults, and the treatment was given for three days. Twenty-seven patients completed the trial. After two days of treatment, a higher proportion of patients in the active-treatment group than in the placebo group had experienced significant improvement in symptoms (93% vs. 25%; p value not stated). Symptoms resolved completely after three days in 87% of patients receiving active treatment and in 33% of those receiving placebo.

 

Sixty patients (aged 18-54 years; mean, 30 years) who were suffering from influenza-like symptoms for 48 hours or less were randomly assigned to receive, in double-blind fashion, Sambucol (15 ml 4 times per day during meals) or placebo for five days. The mean time until complete or almost-complete resolution of symptoms occurred was significantly less in the active-treatment group than in the placebo group (3.1 days vs. 7.1 days; 56.3% decrease; p < 0.001). No side effects were reported.

 

Further research with larger numbers of patients in whom the diagnosis of influenza is confirmed by laboratory studies is needed to confirm the results of these preliminary trials. The availability of natural substances should not deter people from taking appropriate precautions for preventing influenza (such as washing hands, keeping family members at home when they are experiencing influenza-like symptoms, and receiving vaccinations when clinically indicated). Nor should the availability of natural substances deter people from seeking medical care and taking medications such as Tamiflu when necessary.

 

Roschek B Jr, Fink RC, McMichael MD, Li D, Alberte RS. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry 2009;70:1255-1261.
2 Zakay-Rones Z, Varsano N, Zlotnik M, Manor O, Regev L, Schlesinger M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med 1995;1:361-369.
Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res 2004;32:132-140.