Medication will never work for a disease that is so clearly caused by our environment. The environment has to change.

Here I use the word environment in place of the word lifestyle. Using the word “Lifestyle” puts us on the defensive. It places judgement on our culture, our choices and behaviors that have always served us well in the past. These choices have brought us happiness and were good enough for all who have come before us.

I was born and raised in Queens, the son of Greek immigrants. Tradition, culture, religion, family and routine are centered around the kitchen. When the solutions to my own health problems involved changing everything about how I grew up as it relates to food, you could imagine it was a difficult time and it involved difficult choices. I live in the same town as my mother and my brothers; all of the traditions are ever present. My mother has been elbow-deep in dough for over 50 years.

Being told by doctors to keep doing what I have been doing and to “take these pills” just seemed like such an unintelligent choice. I mean flat out ‘stupid.’ Can doctors be stupid? I think so. Their recommendations were absolute quackery. If bowel disease is so clearly based on the environment I create, it’s time to change the environment to one that is acceptable to my genetics and my body. If you don’t understand the above 3 paragraphs, there is no reason to read on. Just plug your symptoms into the symptom tracker on WebMD.com and ask your doctor for the recommended drug. If these words resonate with you, then by all means, read on.

Treatment Rationale for gut disorders: including, but not limited to…

• IBS (irritable bowel syndrome)
• Inflammatory bowel disease
• Crohn’s disease
• Colitis
• Celiac
• Intestinal permeability, “Leaky Gut”
• Gut Dysbiosis

Pre-Phase 1- Get your head in the game.

Before beginning the process of reducing inflammation, it is important to remember that the gastrointestinal system is controlled by the brain / nervous system. This point cannot be overstated and I believe it is the reason many people using a functional approach do not benefit to the level that they should.

When the immune system experiences long term (chronic) stress from any source, mental/emotional, physical, chemical, or immunological, we activate the “protection and defense” portion of the nervous system called the sympathetic system (see my last week’s post for more on this). This is the opposite of what needs to be activated when we want our digestive system to work efficiently. Excess sympathetic tone results in excessive stress hormones and neurotransmitters like cortisol (serum catecholamines) and reduced digestive enzyme production. This results in a thinning of the gut lining from the lower esophagus down to the rectum, creating an environment of continued or worsening permeability or “leaky gut.” This is well documented and nothing new.

What may be new to you, however, is the fact that the excess serum catecholamines or stress hormones like cortisol will inhibit the function and even cause atrophy of the “master gland” in the brain called the hypothalamus. This will result in a long-term inhibition of the brainstem center that activates ⅔ of the GI system, via the largest nerve network in the body called the vagus nerve. Now, I don’t want your eyes to glaze over with too much technical detail, so I won’t go too deep into the weeds.

Whenever there are chronic GI symptoms it is important to activate the vagus system. The vagal nerve and other important brain stem centers can be activated in many ways. It’s a good idea to do at least 3 or more of the following routines daily. Pick the ones that you will with regularity.

1. An experienced practitioner can use electrical stimulation in an office setting with direct current.
2. You can gargle aggressively to the point where your eyes may tear. It may take 30 – 90 seconds of strong gargling several times per day.
3. Along the same thought process as gargling is chanting, singing, and laughing out loud.
4. Deep breathing exercises.
5. Soft tissue massage of the abdomen by an experienced soft tissue practitioner such as a massage therapist.
6. Nightly enema until inflammation is reduced. An enema fits into this section of brain function because the distension of the lower bowel will send a massive barrage of nerve transmission directly to the brain stem. Prepare the enema with the following ingredients:
   1. 5,000 IUs of natural vitamin E
   2. 1 gram of colostrum
   3. 3000-5000 mg of L-glutamine (contraindicated if there is a history of cancer)
   4. ¼ cup of water or brewed organic coffee
   5. 500-1000 mg of reduced glutathione
   6. Phosphatidyl Choline 500mg
7. A not-so-pleasant but very effective way to stimulate the vagus nerve is to use a tongue depressor to stimulate the gag reflex.
8. Improve heart rate variability using devices like the EmWave2.

Reduce/Repair/Maintain.

1. Reduce inflammation. How do you know you have acute or chronic inflammation?

• You know you have inflammation when you have a flare up of symptoms related to abdominal pain associated with eating. Symptoms include nausea, gas and/or bloating, loose stool (or diarrhea), bowel urgency after eating, constipation, reflux, heartburn…virtually any gastrointestinal symptom.
• Blood chemistry analysis can identify inflammatory processes both directly and indirectly.
• IgA and IgG confirmed food sensitivities.
• IgA and IgG confirmed antibody responses to LPS, occludin and zonulin (proteins in the small intestine associated with gut permeability).
• Confirmed diagnosis of colitis and or Crohn’s.
• Sometimes a comprehensive stool analysis is worth doing.

All of the following steps will contribute to reduced inflammation in the gut (we are not making dose recommendations here because they depend on the clinical presentation)

• Drink spring water or any source of non-fluoridated water. Fluoride interferes with energy production by cells and the gut is a very active organ system that requires efficient ATP production.
• Paleo/Autoimmune type diet.
• Resveratrol and Turmeric/Curcumin in a high medicinal dose. The most absorbable forms are liposomal.
• Minimum 3 grams per day of EPA/DHA omega-3 fat. Must be animal source (fish, calamari, krill). Raising EPA levels to 1% of total fatty acid content has been shown to reduce inflammatory cytokine TNF alpha. The same cytokine targeted by the strongest most dangerous drugs used to treat inflammatory bowel and autoimmune diseases.
• Soil-based probiotics. If gas and bloating are an issue that is exacerbated with fermented vegetables or probiotics, then you will not tolerate the probiotics well and should remove them. Get evaluated for SIBO (small intestinal bacterial overgrowth).
• Enemas as described above.
• Intermittent fasting. 16 hours fasting/8 hours non-fasting, 3-7 days per week. This step may have to wait if you have a history of blood sugar dysregulation. Getting blood sugar under control is primary.

2. Repair the barrier between your food and your blood stream. The gut wall is the barrier that keeps out the large undigested food proteins, bacteria, parasites, viruses, and God knows what else is found in our food (additives, preservatives, chemicals, etc.). The gut wall also lets in the nutrition we need so our blood vessels can deliver nutrients.

Simply removing foods that you are sensitive to is not the answer. You will replace those foods with other foods that you will become sensitive to eventually. Repairing the barrier between your food and your blood stream is imperative.
The following supplements will support this process. Dose is dependent on clinical presentation.

• N-Acetyl Cysteine to support detoxification pathways and immune regulating action of glutathione.
• Silymarin or Milk Thistle.
• Bile salt support.
• Methyl donors best found in green vegetables and supplemented with activated folate, methylcobalamin (B12) and other B vitamins. Please note, any B complex may not do, especially if you have an MTHFR defect. Careful blood chemistry analysis by a functional doctor can tell us if we are processing our B vitamins in our diet properly.
• L-Glutamine and DGL (deglycerized licorice). Dose varies greatly. Fuel for replication of intestinal epithelial cells.

3. Maintain: Long-term plan. This can depend on your diagnosis, history, and genetics. Once you’ve healed and restored your health, you are prone to recurrence. A long-term approach is needed to maintain the gains you’ve worked so hard for.

We don’t want to have to get our nutrition from supplement bottles, we want to get it from food.  We want a specific plan for determining what, if any, supplements will need to be used long term. Pill bottles, whether they be pharmaceutical or natural supplements, will never make us healthy. We use them to break chronic metabolic vicious cycles we can measure. Our plan is to get our health from our food and our lifestyle.

The long term action plan is where I believe functional medicine services are most valuable.

It is my experience that it can take 3-12 months (sometimes more) to maximize results. The good news is that the GI tract is a very active organ and the cells replace themselves very quickly. If they replace themselves in a healthy environment, most people will see obvious changes in the first 12 weeks, regardless of how long completion takes, and that kind of positive feedback is enough to keep you going.

Each of the above phases have levels of participation depending on diagnosis, severity and history. For example, each phase can have just a few or as many as a dozen steps. The number of steps you will need can be determined by an experienced provider. We do not recommend that you use this post to self-treat or to self-diagnose. It is a guide, so that when you seek professional help, you have an idea of what a natural long-term healing program should look like.

Why allopathic medicine and functional medicine are so different.

Why are medical breakthroughs so difficult and rare? One of the reasons is that the practice of medicine involves isolating one variable, applying it and comparing it to a control group. For example, medications used to treat bowel diseases like, Crohn’s disease or ulcerative colitis. The medication is designed to inhibit an inflammatory cytokine called TNF alpha. Therefore, the studies are designed to determine if the drug, compared to the controls, is superior to a placebo.

If you have ever been part of a study for a medication, you are warned to avoid adding anything else to your daily routine, including nutritional supplements, changes in diet, or exercise. In other words, continue to live the life that caused your disease and we will see if we can help you with this single intervention.

I recognize why this is done, but it baffles me and I fail to understand the logic behind single interventions in a body that we all know is impacted on so many levels by so many things that we know just by understanding accepted physiology. The idea that a single drug can solve a problem without causing multiple other problems has never really worked well for our society. Yes, this mindset has been used successfully to impact symptoms in the short-term, like pain or congestion, but this way of thinking has been a massive failure for those suffering chronic health problems and disease.

Scientists and researchers spend their careers trying to isolate single variables in order to produce an individual pill, so the idea that someone would make multiple changes to their environment at the same time would make their head explode and, in many ways, negates the value of their work.

When it comes to bowel disorders, there is no data that looks at a multitude of interventions involving diet, supplements, and a lifestyle to treat the disorder. The studies have never been done. However, there is plenty of science and evidence to support each individual step that we discussed here.

Thanks for reading!