Synopsis of the Small Intestine

The small intestine is a total of twenty-one feet long.  The pyloric sphincter allows the chime (liquefied food) from the stomach to enter the small intestine.  The small intestine has three sections.  The first is the duodenum, the second is the jejunum, and the third is the ileum.

Most digestion and absorption takes place in the small intestine.  Once the chyme enters the duodenum, the hormones secretin and cholecystokinin (CCK) are secreted, which signals the pancreas to secrete enzymes and bicarbonate, and the gallbladder to secrete bile, into the small intestine.

The "enzymes work to convert proteins into amino acids, fats into glycerin and fatty acids, and carbohydrates into monosaccharides (sugars).  These simple molecules are then small enough to pass through the mucosal lining of the intestine into the bloodstream to form building blocks for the body." (Taylor, 2000; p. 69)

Case Study

Jo is a 19 year old Caucasian woman who has been diagnosed with leaky gut.  She has been on several rounds of antibiotics in her life and Crohn's disease runs in her family.  She is 5'8" and weighs 120 pounds.  She eats mostly refined foods, with high amounts of sugars and fats.  She has bouts of diarrhea and constipation, and has a constant ache on her right side.  She has no clue as to what a healthy diet is.

Recommendations

It is important that recommendations address the leaky gut diagnosis and those other problems that are often associated with it, such as insufficient pancreatic enzymes and hydrogen chloride (HCl), bacterial overgrowth, poor dietary habits, food allergies, and possibly parasitic infection.

I would first recommend factors that will support her small intestine's ability to break down (digest) her food.  Pancreatic enzymes would be an important part of her regimen, as well as comfrey and ginger, which promote digestion and stimulate gastric juices.

Secondly, I would want to promote healing of the mucosal layer lining the small intestine.  For healing the mucosal, I would suggest she take soothing and demulcent herbs, such as slippery elm, marshmallow root, and aloe vera juice.  These herbs both soothe and lubricate the mucosal layer, which has a healing effect.

It is important to add HCl supplementation if her stomach acid is low.  When stomach acid is low, the chyme is not acidic enough to signal the duodenum to secrete its hormones, which in turn signal the pancreas to release its enzymes.  She can take HCl supplements or take 1 tablespoon of apple cider vinegar in 8 oz. warm water with meals.

Assuming there is a lack of enzymes in this patient, it is very likely that the undigested sugars have fermented, leading to bacterial overgrowth in the small bowel.  Her past use of antibiotics makes this more likely, as they promote an unhealthy balance of intestinal flora.  To address this condition, I would recommend a combination of grapefruit seed extract and berberine supplements.  They are effective against both Candida (yeast) and bacteria.  Dr. Leo Galland, M.D., also recommends oregano capsules, 500 mg after each meal.  He says "Oregano contains over thirty biologically active ingredients, of which 12 have antibiotic, antiviral, antiparasitic, or antifungal properties."  (Galland, 1997; pg. 202)

This patient needs to improve her diet significantly.  She should strictly eliminate sugars and all starches (Lipski, 2004; p.66).  I would recommend she eat lean organic meals, wild fish, a wide variety of different colored vegetables, and healthy fats.

Alternating diarrhea and constipation is often referred to as irritable bowel syndrome, and is often the result of an irritated small intestine.  As a result, I would advise her to make every effort to avoid ingesting foods that can be irritating to the lining of the small intestine.  Alcohol, sugar, and over-the-counter NSAID's (non-steroidal anti-inflammatory drugs) are know to damage this lining.

She should mainly drink just pure water and herbal teas.  Sodas and fruit juices should be avoided as they can both be irritating as well as perpetuate the bacterial overgrowth that is most likely present.  She should also avoid raw foods because they can be irritating.  During this healing phase, she should eat mainly cooked foods except for the occasional fruit.

Some soothing herbs I mentioned previously can be made up as tea.  This is a good way to gain their healing benefits.

I would also recommend this patient be tested for food allergies, which are often either the consequence of or the cause of leaky gut syndrome.  Foods to which she is allergic must be eliminated from her diet if the lining of her small intestine is to heal.

I think it is also important for her to take a supplement of probiotic bacteria because it can make a big difference in her ability to digest foods.  In his book The Four Pillars of Healing, Dr. Leo Galland, M.D., says "L. acidophilus is well suited to growing in the small intestine, where it is normally one of the dominant species." (Galland, 1997; p. 200).  The daily dose should be between one billion and ten billion viable bacteria a day.  Foods like yogurt and sauerkraut are also good sources of lactobacillus.

The constant pain on her right side may indicate an irritated ileocecal valve.  Many of the previous recommendations should help with this, but she should also avoid hard foods that could be irritating, such as nuts, seeds, chips, and crackers.

I have made recommendations for dietary improvement, supplements and herbs.  In closing, I would liker to say that if the patient can follow through on these suggestions, she will have already made great strides in developing a healthier lifestyle.  I would just encourage her to keep moving in the same direction of increased awareness of what is healthy for her.  This may lead her to more changes in her lifestyle that may further enhance her health.

BIBLIOGRAPHY

Galland, M.D., Leo.  The Four Pillars of Healing.Random House, 1997.
Lipski, Ph.D., Elizabeth.  Digestive Wellness.McGraw Hill, 2005.
Taylor, M.A., Francis.  Allergy Relief and Prevention.Hartley & Marks; 2000.

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