Clinical Nutrition
By Michael Ash BSc, DO, ND, DipION
Barbara (name changed) a 55-year-old married mother presented
at my practice as a new patient in the middle of a busy
day. She explained she was visiting Devon on holiday and
the owners of the Caravan Park where she was staying had
recommended she attend my practice for advice on a joint
problem she had.
She and her husband described how her right hand first
finger and back of her hand was hot and painful, with reduced
mobility and strength. It would keep her awake at night
and over the last few years had been a constant source of
irritation and pain.
Her visits to the GP whilst supportive had to date been
unsuccessful and the consultants she had been referred to
have offered painkillers and anti inflammatory but had been
unable to resolve the complaint.
Apart from this affected joint the other joints in her
body were without complaint and she was physically active.
On questioning I discovered her condition had developed
after a hysterectomy, a few years earlier and which as a
result of complications an intensive course of antibiotics
had been undertaken. Barbara also had a history of irritable
bowel syndrome, which had become more pronounced and frequent
since the operation. IBS can be a profoundly disturbing
condition in which the individual’s life is dictated
by the state of their bowels. Natural practitioners recognise
that the bowel disruption will normally have a mixed aetiology
including stress, poor nutritional status, change in gut
ecology and difficulty in handling internally and externally
produced toxins. Treating the person as well as the gut
is of vital importance in achieving the best outcome.
I explained that the gut has the majority of the immune
system attached to it and that within the gut a world exists
in which a balance of bacteria has to reside in harmony
to break down our food and support our immune function.
The gut wall is about the thickness of an eyelid and has
to act as both an excluder and permeable barrier to our
food. At times the ecological environment can change and
the integrity of the gut wall may be compromised allowing
small components of food or bacteria or other agents to
cross into our blood stream. These provoke an immune response
and occasionally some molecular mimicry.
This means that some part of your body may have proteins
very similar in make up to those crossing the gut wall and
the immune system may attack your own body mistaking it
for the external invader, causing an inflammatory response.
In effect a leaky gut may allow an immune response that
selects a specific joint or organ and causes an inflammatory
response. This theory has been postulated as a trigger for
rheumatoid arthritis, a systemic autoimmune illness.
I recommended Barbara undertake a programme to restore
what I suspected was an imbalance in friendly bacteria and
take some specific nutrients to repair the gut wall. In
addition I recommended some antioxidants as they are required
in the neutralisation of immune activation and support detoxification,
which reduces the total burden on the body. The gut wall
is able to repair itself quite quickly given the correct
nutrients; the ones I used included the following.
To re seed the gut area I included the use of live bacterial
supplements (probiotics). Various species, of Lactobacillus
and Bifidobacteria are the major organisms involved. Several
factors are used to determine whether or not a particular
species, subspecies, or strain is suitable as a probiotic:
Firstly, the bacteria must maintain its viability under
normal conditions of storage for a reasonable amount of
time. Secondly, the organism must survive the passage through
the acid environment of the stomach, and should stay viable
in the presence of intestinal bile acids.
It should also become readily incorporated into the “anaerobic
paste”, the thin layer of mucous covering the intestinal
cells, and it should become adherent to the intestinal mucosa
colonising and remaining there. It should ferment a wide
range of carbohydrates. It should produce only l-lactic
acid (nor both the d and l isomers) as its major by-product.
Finally, it should have an accumulating record of scientifically
verified physiological benefits.
This far, a few species have come at the top of their class
for providing most or all of these benefits. These include
the NCFM-2 strain of Lactobacillus acidophilus, Lactobacillus
plantarum, Lactobacillus rhamnosus and Lactobacillus GG.
To feed the gut wall and facilitate repair I included a
spectrum of nutrients in a powder which included L-glutamine
is an amino acid, which is the primary source of energy
for intestinal mucosal cells. L-glutamine has been shown
to be highly effective in helping to restore normal mucosal
integrity in patients with increased intestinal permeability
or a “leaky gut”. Slippery elm is a soothing
herb that ferments in the intestinal area and releases short
chain fatty acids such as acetate and butyrate. It also
nourishes the villi improving integrity and barrier function.
The vitamins ascorbic acid (Vit C), pantothenic acid (B5),
vitamin E, and vitamin A/beta carotene all play a significant
role in the repair of damage GI mucosa.
N-acetyl glucosamine is a vital component of connective
tissue and stimulates the growth of friendly whilst inhibiting
unfriendly bacteria. The sulphur amino acids N-acetylcysteine,
cysteine and the tripeptide glutathione are critical nutrients,
which support detoxification of xenobiotics within the intestinal
mucosa and liver and contribute significantly to gut mucosal
repair in state of toxic stress. Epithelial growth factor
contains agents that assist gastric healing and links with
glutamine to maintain structural integrity.
Ensuring an adequate supply of essential fatty acids is
also important in the repair of damaged gut mucosa. EFAs
also assist in the absorption of minerals and in the function
of the immune system.
The body’s liver is a very complex and essential
component of maintaining immunity and detoxification. It
uses two essential types of enzymes to render chemicals
harmless and excrete them through the urine. Both types
are dependent on nutrients, and these are grouped together
as anti oxidants. These are used in conjunction with antioxidant
enzymes to help quench free radical production. Antioxidants
impede free radical damage to cells and tissues, providing
a metabolic cooling and lubrication system. Anti oxidants
is the body’s natural anti toxins and are crucial
to homeostasis. A variety of stressful environmental, genetic
and behavioural factors have been linked to increased free
radical production in the tissues. I included a nutrient
source of Vitamins C, E, B vitamins, zinc, selenium, copper,
manganese, glutathione, Co Q10, lipoic acid, L-methionine,
L-Taurine, Ginkgo biloba, trimethylglycine, and proanthocyanidins.
To support Barbara’s immune function and to help diminish
free radical mediated inflammation.
The overall quality of the diet, including calories, macro
and micronutrient composition, and adequacy of phytonutrient
antioxidants is vital in the repair of damaged GI mucosa.
At this stage I also excluded from her diet coffee, and
alcohol as these require additional enzyme activity in the
liver to be broken down and I wanted to rest this area.
Barbara contacted me by phone and mail a couple of weeks
later to say that the pain in her hand had gone and that
her stomach irritability had also reduced. Quite naturally
we were both very pleased with the speed of response, as
4-6 weeks is a more realistic time span.
I am pleased to say that 4 months on Barbara is still free
of pain and is enjoying a settled and relaxed digestive
tract as well.
Although in this case I did not conduct tests to determine
the viability of Barbara’s gut wall or examine the
GI environment the outcome based programme proved to be
very helpful, and I am confident that this problem should
now be fully resolved. Many digestive problems link with
other complaints in the body, assessing the functionality
and health of the gut is often the first area of interest
for the nutritionally orientated clinician. In addition
the liver, as the organ principally responsible for detoxification,
needs to be considered either as a direct area for treatment
or as an adjunct to other strategies.
Nutrition is not an answer to all health problems; however
there are rarely areas of health discord that will not respond
to some improvement in an individual’s nutritional
status, and this is an area in which the holistically orientated
practitioner who has trained in nutrition has a distinct
advantage over the traditional medic. The concept of a balanced
diet being all you need to meet your daily needs is unfortunately
inadequate as a practical solution when confronted with
a unique individual who needs help.
About the Author
Michael Ash BSc, DO, ND, DipION has been in full time private
practice since 1982 and currently directs and owns an integrated
medicine practice in Devon, where orthodox medicine and
complementary medicine practitioners work together to achieve
the best for their patients. Originally trained as an Osteopath
and Naturopath he has spent the last 10 years pursuing post
graduate education in clinical nutrition in the United States
and now lectures to practitioners from all disciplines in
the UK on how to use nutrition and nutraceuticals to change
people’s health for the better. In addition to maintaining
a large patient base he regularly writes and broadcasts
on health and natural medicine. His philosophy of mixing
the best of both styles of medicine with the focus on the
patient as an individual keeps him at the forefront of natural
medicine in the UK
Phone: 01626 205400
Email: eldon@eclipse.co.uk
