Great Smokies Medical Center of Asheville

Archive for August, 2005

Family Constellations

Monday, August 22nd, 2005

by Sheila Saunders, RN, MFT

“Children seldom or never dare to live a happier or more fulfilling life than their parents. Unconsciously they remain loyal to unspoken family traditions, which work invisibly. Family Constellations are a way of discovering underlying consequential family bonds and forces, which have been carried unconsciously over several generations.”

These words of German therapist, Berthold Ulsamer, aptly describe the work developed by Bert Hellinger, renowned German psychoanalyst, psychotherapist, former priest and best-selling author. In working with thousands of family systems, Hellinger has observed a natural order that determines how family dynamics unfold at an unconscious level. Deviations from this natural order in previous generations will affect the lives of successive generations. When this subtle but profound influence is understood, an individual’s suffering is seen in a new light. Then, the same energy that fuels destructive patterns can be shifted to allow for opportunities of growth and change.

Family Constellations are an effective way of revealing unconscious entanglements with the fates of family ancestors. Events such as the premature death of a parent or sibling, the exclusion of a family member, a murder of or by a family member, or victimization of others by a family member can all lead to entanglements, which disturb one’s life and relationships. Severe consequences may result, such as feelings of isolation, depression, mental and physical illness, accidents, and even suicidal thoughts or attempts.

In a workshop setting, clients come with a particular issue they want to address. The issues are often long-standing problems that plague a person’s life, regardless of repeated attempts at change. These conditions arise from the “blind” love of a child towards the family, and are resolved with solutions that allow “enlightened” love to flow. In setting up a family constellation, a client chooses workshop attendees to represent members of his or her family, then places them in relationship to each other, without comment, based on how it “felt” to be in the family. The representatives become a living model of the original family system. In this work, even small movements can provide useful information. Words are kept to a minimum and thus become quite powerful. When the family members are represented by workshop attendees who do not know them or the events that took place, a phenomenon occurs: the representatives begin to notice feelings and thoughts which reflect those of the actual family members.

The best explanation for this phenomenon can be found in the work of renowned author and physicist, Dr. Rupert Sheldrake. This field of energy, called the morphogenetic field, connects people, places and even animals, and has memory and influence. Dr. Sheldrake has documented the existence of this field in a number of books, the most recent of which is entitled “Dogs Who Know When Their Owners Are Coming Home”. Hellinger, having observed the presence of this “knowing field”, learned how to use it to modify previously hidden dynamics, so that the natural order supporting love can be reestablished and love may flow again.

Recent developments have also brought constellations into the realm of the business world in the form of “organizational constellations”. Constellation work is becoming the most rapidly expanding form of therapy in Germany, and is found in more than 80 countries worldwide.

Sheila Saunders is professionally licensed as a Registered Nurse and a Marriage and Family Therapist (MFT). Sheila holds Master’s degrees in Clinical Psychology and Homeopathic Medicine and has worked in the psychiatric field for 24 years, providing group therapy at the former John Bradshaw National Treatment Center in Los Angeles, working in children’s residential treatment, psychiatric hospitals, chemical dependency programs, and most recently as a mediator in Superior Court’s Family Court Services. Sheila has trained in Family Constellations with Bert Hellinger himself, as well as with the most experienced international facilitators. Sheila has focused throughout her career on the gentle but profound effects of a wide variety of alternative treatments. She has found Family Constellations to be the most painless and powerful form of healing yet encountered. Sheila offers Family Constellation workshops, individual sessions and study group support at the Great Smokies Medical Center in Asheville, NC. Workshops may also be arranged in your city. Sheila can be reached at 828-273-5015 or

For more information on family constellations, please
visit Systemic Family Solutions at:

Risk vs. Benefit of Cholesterol-Lowering Drugs

Monday, August 22nd, 2005

by John L. Wilson, Jr., M.D.

The German drug company Bayer AG withdrew its cholesterol-lowering drug Baycol from the market in August, 2001 after it was linked to 31 (now 52 and counting) deaths. An estimated 700,000 people in America were taking Baycol. Many more whose doctors prescribed other closely related drugs in the “statin” family of drugs (including Lipitor, Lescol, Mevacor, Pravachol, and Zocor) are left wondering if they are at risk. 48 million prescriptions were written last year in the US for Lipitor alone. Our television sets are abuzz with marketing of statin drugs, appealing to a huge market of potential customers.

All statin drugs are linked to a rare muscle inflammation condition called “myositis” which occurs in about one in a thousand patients, especially if taken with another drug, Lopid (gemfibrizol). Rarely, “rhabdomyolysis” can result, where muscle cells break down to the extent that kidney failure and death can ensue. People taking statin drugs who experience muscle pain and weakness should consult their doctor. The elderly and women seem to be more at risk, and the adverse effects are dose related, meaning the higher the dose, the greater the chance of adverse effects. An elevated blood test, Creatine Phosphokinase (CPK), is an indicator of this muscle damage. A CPK test should be done on all patients who are taking statin drugs.

Statin drugs are “HMG Co-A Reductase Inhibitors”, meaning they block a liver enzyme required for making cholesterol. This same enzyme is also necessary to make Coenzyme Q-10, a very important nutrient essential for energy production in our body, and especially for heart function. Doctors seldom address this other common downside of statin drugs that can be remedied by supplementing Coenzyme Q-10.

For years doctors focused on cholesterol as having a major causative role in heart disease. Because cholesterol is found in arterial plaque, scientists thought that reducing cholesterol levels through low fat diets and drugs would result in less plaque in arteries. The presence of cholesterol in coronary artery plaque no more proves that cholesterol causes heart disease than the presence of a fireman at a fire proves firemen cause fires. In fact, firemen and cholesterol are both on the scene putting out different “fires”. Recent analysis of the Framingham Heart Study data suggests that the “fires” of oxidation, infection, and inflammation, likely due to a resulting increased clotting risk, are better predictors of a future heart attack than are cholesterol levels. Every doctor has seen heart attacks in patients with low or normal cholesterol levels. In fact, too low cholesterol levels pose risks, a fact seldom recognized, much less mentioned to patients. The liver makes 80% of one’s total cholesterol; only 20% is from dietary sources. Cholesterol is the raw material needed by the body to make hormones, including cortisol, estrogen, progesterone, and testosterone. Increased risk of cancer occurrence, mood disorders including depression, suicide, and numerous and varied symptoms of hormone depletion are associated with too low cholesterol.

A balanced cholesterol ratio in the body is the optimal goal. Most people are familiar with “good” (HDL) and “bad” (LDL) cholesterol. Doctors generally agree that having a low ratio of total cholesterol to HDL cholesterol is highly beneficial for cardiovascular health.

I find excellent overall results in cholesterol and triglyceride reduction in my practice from strict reduction of carbohydrates (sugar and starchy foods). Exercise also remains one of the better prescriptions for overall heart health. And, both are very unlikely to be recalled by a pharmaceutical company anytime soon. Unfortunately, lifestyle solutions to health problems are somewhat unpopular in a population desiring quick fixes. There are no drugs that provide a quick fix without risk. It is almost always good advice to not look to drugs as a first line defense for health problems.

Risk of Clot Formation Can be Measured

Monday, August 22nd, 2005

by Eileen M. Wright, M.D.

The ability to form a clot can be life saving, such as after an injury when a person might otherwise bleed to death. Several problems can happen, however, with the complex sequence of events that contribute to clot formation that leave a person at risk for unwanted clots.

Many people know someone who has had a heart attack “out of the blue”. This unfortunate new heart disease victim may have had no identifiable significant risk factors for heart disease, leaving the patient and his or her family wondering why. You may recall the recently publicized warning of the single greatest risk of potentially fatal health complications of air travel: pulmonary embolism, a clot in the lung. And we now have two potentially fatal medical conditions from clot formation in seemingly healthy people.

An increased chance of clot formation can occur after surgery, trauma, stress, toxin exposure, fractures, or infectious illnesses including viral, bacterial, or fungal infections. It is less well known that any chronic infection such as Epstein Barr virus, herpes, and gingivitis can similarly result in the blood flow being chronically more sluggish than desired. Circulation in small vessels can then become obstructed with fibrin, a strand-like substance in the blood involved in clotting, resulting in sluggish blood flow. Since blood cells transport oxygen and waste products, sluggish blood flow in small vessels results in poor oxygenation of tissues and accumulation of waste products. This often leaves tissues unable to heal and leaves a person feeling chronically unwell.

Physicians routinely address clotting abnormalities daily in emergency situations such as heart attacks, strokes, and pulmonary embolisms. Because clues to increased risk for clotting exist prior to actual clot formation, identifying and treating those at risk is now possible before a clot develops. Those wondering if they have this risk must have special blood testing done to assess inherited defects in coagulation. Fortunately, much can be done to treat this condition, and an ounce of prevention is certainly worth a pound of cure. Treatments for increased clot formation risk include taking Vitamin E and EFA (fish oil) supplementation to make platelets less “sticky”, exercise, stress reduction, avoidance of sugar and alcohol in the diet, daily water intake of one ounce for every two pounds of body weight, and taking garlic, which has been shown to be as effective as aspirin in reducing platelet stickiness. The prescription drugs Coumadin or Heparin may be prescribed. Both require periodic monitoring. Diagnosing and treating any underlying condition, such as an infection, that stimulates increased clot formation is also important for long-term treatment success.

If traveling either by air or car, and in particular following a recent infection, sitting with legs bent for an extended period of time can set one up for clot formation, as blood can be trapped and pool in the leg veins. Clots formed in the leg can be fatal when they travel to the lung. Reduce the risk of clot formation by drinking water and taking Vitamin E and fish oil prior to traveling. During travel, do ankle rotations, calf and leg stretches and isometrics frequently. Walk around the aisles of the plane if able, or if traveling by car, stop and get out of the car to walk hourly to increase circulation.

Assessing The Risk of Heart Disease

Monday, August 22nd, 2005

By John L. Wilson, M.D.

According to the American Heart Association, more than 2,600 Americans died of Cardiovascular (Heart) Disease each day in 1998. That is one death every 33 seconds. Considering that Cardiovascular Disease (CVD) has been the leading cause of death in the US since 1900 (except in 1918 when more deaths occurred from an influenza epidemic), it is becoming obvious that the prevention and treatment strategies have fallen short.

Factors that have long been thought to put an individual at risk for CVD include smoking tobacco products, sedentary lifestyle, obesity, high blood pressure, stress, abnormal blood fats including cholesterol and triglycerides, and a family history of heart disease. One’s inherited predisposition to heart disease does not mean that one is fated to get heart disease, as the expression of that genetic predisposition is strongly influenced by lifestyle. Lifestyle modification is critical to successful prevention and intervention of CVD.

For years, elevated cholesterol was the focus of thinking about the cause of CVD, and this decades long oversimplified and largely incorrect belief has been the basis of many ineffective recommendations. The British Medical Journal on March 31, 2001 analyzed 27 separate studies of dietary restriction of cholesterol and fats in reducing CVD risk and found it has no proven effect on total mortality rates.

So if heart disease isn’t a simple plumbing problem, what is it? New research reveals it to be the result of many complex chemical events in the body, that can include clotting, oxidation, inflammation, excess insulin levels, and inborn errors in metabolism that are aggravated by nutritional deficiencies. This more current information on the causes of heart disease has resulted in the development of blood testing that can more accurately identify individuals at risk for heart disease earlier in life, and, importantly, result in very specific interventions to reduce risk. Some of the most important tests are:

1. Lipoprotein (a) [Lp(a)] – Lp(a), a genetic risk factor thought to be the most dangerous of the “bad fats” in the blood stream, does not correlate with cholesterol or triglycerides, so it stands alone as a separate risk factor. Initially defined by Nobel Prize recipient Dr. Linus Pauling, N-acetyl cysteine is the treatment of choice for reducing elevated Lp(a) levels.

2. Fibrinogen – Elevated fibrinogen, involved in the formation of clots and plaque, can detect those at risk for abnormal clot formation. Increasing certain types of dietary fat, eating oily fish, taking Vitamin E, and taking anti-inflammatory natural enzymes may reduce elevated fibrinogen levels.

3. Homocysteine – When elevated, this sulfur-containing amino acid can be toxic to the body, including coronary arteries. High levels can be addressed with increased intake of vitamins B6, B12, and folic acid.

4. Antioxidant Status – Oxidation can damage the lining of arteries, and one’s ability to offset this damage can be measured in the laboratory. Treatment is lifestyle changes (specifically stopping smoking) and antioxidant nutrients.

5. High Sensitivity C-Reactive Protein (HSCRP) – This inflammatory marker can reveal if there is inflammation occurring in the lining of the coronary arteries, addressing the most recent theories on the origin of CVD that point to an infectious/inflammatory contributing cause.

6. Lipids – Recent research from Harvard suggests the Coronary Risk Ratio (Total cholesterol divided by the “good” cholesterol HDL), combined with HSCRP are the best early predictors of vascular disease.

7. 4-Hour Glucose-Insulin Tolerance Test (GITT) – Excess insulin causes a thickening of the lining of the arteries, setting the stage for CVD. It is also the definitive screen for early detection of diabetes that increases risk for CVD.

8. Ferritin – Hemochromotosis is the medical term for an elevated ferritin, a protein that stores iron. Just as iron can oxidize or rust when left exposed to the elements outside, excess iron is a major source of oxidation inside the body, notably to the blood vessels. We don’t age, we rust! Doctor-supervised blood donation or phlebotomy can often return ferritin levels to normal range.

9. Mineral Adequacy – Imbalances and deficiencies in mineral levels in the body can accelerate the damaging process of hardening of the arteries. Customized supplementation of minerals addresses this contributing cause of heart disease.

A comprehensive CVD risk assessment provides very specific information of exactly where one’s risk is, and provides opportunities for particularly effective prevention and customized early intervention to decrease that risk.

Erectile Dysfunction Likely to Have Physical Cause

Monday, August 22nd, 2005

The life expectancy according to the U.S. Department of Health and Human Services for a U.S. male in 1900 was 47.3 years. As of 1996 it was 73.0 years. This newfound longevity brings with it an opportunity to understand aging and develop medical approaches which can address sexual functioning of an aging man.

A physician who inquires about an aging male patients’ sexual health is finding that erectile dysfunction (ED) is a concern for many. ED is the persistent (greater than six months duration) difficulty in getting or maintaining an erection sufficient for intercourse. The subject of sexual functioning in men has not been adequately addressed in the past in medical schools. Men have their own version of menopause, called andropause, characterized by the decrease of hormones associated with aging. The symptoms of andropause include low energy, depression, lack of stamina, decreased libido, and irritability.

In the recent past, 90% of ED was thought to be caused by psychological factors. Now, 75-90% of ED is known to have a physical cause. (All ED will eventually have a psychological component however, even if it is primarily physically caused.) Healthy sexual functioning in a man has all the complexity of a NASA rocket launch, in that many systems have to coordinate and communicate with each other for liftoff to happen. The nervous, muscular, circulatory, and endocrine (hormonal) systems must all contribute. Not surprisingly, many of the same lifestyle risk factors that contribute to heart disease also contribute to ED. Alcohol and tobacco abuse, dehydration, lack of exercise, obesity, prescription drug use, poor diet, chemical exposures, and declining hormone levels of aging all add up to a greater likelihood of ED becoming a problem for a man.

Both men and women have testosterone and estrogen . . . women just a little bit of testosterone, and men just a little bit of estrogen, if healthy. That small quantity of estrogen in a man is thought to help regulate the production of testosterone, likely plays an important role in sexual arousal, and helps assures the production of healthy sperm. However, a healthy liver is needed to breakdown estrogen in men or it can accumulate to levels than can feminize a man.

Let’s take a closer look at the risk factor of alcohol use. Most men have likely noticed that their sexual ability will decrease after drinking alcohol. Many also know that the liver is often affected in those who abuse alcohol. What they may not know is that a liver already stressed by alcohol is less able to break down estrogen. Gynecomastia, or breast enlargement, in men who drink too much alcohol is common, and the cause is elevated estrogen. Excess estrogen in a man can interfere with healthy erections.

Many prescription drugs and recreational drugs can also contribute to ED. The more commonly implicated drugs are beta-blockers often given for heart disease, diuretics to help the body get rid of excess fluid, and a class of drugs called serotonin reuptake inhibitors used to treat depression. Do not, of course, discontinue prescription medications without consulting your physician.

There is no need to just grin and bear ED. The natural medical approach to treating ED addresses lifestyle modification, which, when combined with the prescribing of natural hormone replacement therapy, can help an aging man regain vitality, an enthusiastic feeling about life, and help restore sexual functioning.

Enzymes: Life’s Labor Force

Monday, August 22nd, 2005

Health Matters July/August 2005 (PDF)

Acid Reigns

Monday, August 22nd, 2005

Health Matters July/August 2005 (PDF)

Lactose Intolerance

Monday, August 22nd, 2005

Lactose intolerance is the inability to digest significant amounts of lactose, the predominant sugar of milk. This inability results from a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine. Lactase breaks down milk sugar into simpler forms that can then be absorbed into the bloodstream. When there is not enough lactase to digest the amount of lactose consumed, the results, although not usually dangerous, may be very distressing. While not all persons deficient in lactase have symptoms, those who do are considered to be lactose intolerant.

Common symptoms include nausea, cramps, bloating, gas, and diarrhea, which begin about 30 minutes to 2 hours after eating or drinking foods containing lactose. The severity of symptoms varies depending on the amount of lactose each individual can tolerate.

Some causes of lactose intolerance are well known. For instance, certain digestive diseases and injuries to the small intestine can reduce the amount of enzymes produced. In rare cases, children are born without the ability to produce lactase. For most people, though, lactase deficiency is a condition that develops naturally over time. After about the age of 2 years, the body begins to produce less lactase. However, many people may not experience symptoms until they are much older.

Between 30 and 50 million Americans are lactose intolerant. Certain ethnic and racial populations are more widely affected than others. As many as 75 percent of all African-Americans and Native Americans and 90 percent of Asian Americans are lactose intolerant. The condition is least common among persons of northern European descent.

Although testing is available that can diagnose lactose intolerance, they require drinking a lactose-loaded beverage, which can cause acute distress to the person drinking it, and can be expensive. Thankfully, once the suspicion of lactose intolerance is raised, simply stopping eating and drinking lactose containing foods and beverages is the treatment of choice. If symptoms go away, then lactose intolerance is very likely the appropriate diagnosis.

Fortunately, lactose intolerance is relatively easy to treat. No treatment exists to improve the body’s ability to produce lactase, but symptoms can be controlled through diet. Young children with lactase deficiency should not eat any foods containing lactose. Most older children and adults need not avoid lactose completely, but individuals differ in the amounts of lactose they can handle. For example, one person may suffer symptoms after drinking a small glass of milk, while another can drink one glass but not two. Others may be able to manage ice cream and aged cheeses, such as cheddar and Swiss but not other dairy products. Dietary control of lactose intolerance depends on each person’s learning through trial and error how much lactose he or she can handle.

For those who react to very small amounts of lactose or have trouble limiting their intake of foods that contain lactose, lactase enzymes are available without a prescription. One form is a liquid for use with milk. A few drops are added to a quart of milk, and after 24 hours in the refrigerator, the lactose content is reduced by 70 percent. The process works faster if the milk is heated first, and adding a double amount of lactase liquid produces milk that is 90 percent lactose free. A more recent development is a chewable lactase enzyme tablet that helps people digest solid foods that contain lactose. Three to six tablets are taken just before a meal or snack.

Lactose-reduced milk and other products are available at many supermarkets. The milk contains all of the nutrients found in regular milk and remains fresh for about the same length of time or longer if it is super-pasteurized. There are several foods that contain much more calcium and much more bio-available calcium per serving than dairy products. Click here for a list of non-dairy sources of dietary calcium.

Although milk and foods made from milk are the only natural sources, lactose is often added to prepared foods. People with very low tolerance for lactose should know about the many food products that may contain lactose, even in small amounts. Food products that may contain lactose include:

* Bread and other baked goods
* Processed breakfast cereals.
* Instant potatoes, soups, and breakfast drinks.
* Margarine
* Lunch meats (other than kosher)
* Salad dressings.
* Candies and other snacks
* Mixes for pancakes, biscuits, and cookies

Some products labeled nondairy, such as powdered coffee creamer and whipped toppings, may also include ingredients that are derived from milk and therefore contain lactose.

Smart shoppers learn to read food labels with care, looking not only for milk and lactose among the contents but also for such words as whey, curds, milk by-products, dry milk solids, casein, sodium caseinate, and nonfat dry milk powder. If any of these are listed on a label, the item contains lactose. Click here for a list of sources of dairy products.

In addition, those with severe lactose intolerance need to know that lactose is used as the base for more than 20 percent of prescription drugs and about 6 percent of over-the-counter medicines. Many types of birth control pills, for example, contain lactose, as do some tablets for stomach acid and gas. A single dose of medication in a lactose base may be tolerated, but add the cumulative effect of multiple daily doses of several prescription drugs that contain lactose, and the effect may be noticeable to a lactose sensitive individual. Lactose intolerance is almost always dose related.

There are other health issues besides lactose intolerance surrounding the use of dairy products, including allergy, the use of bovine growth hormone and its known and unknown impact on human health, and toxic substances in milk including pesticides and herbicides. Cow’s milk is the perfect food-for calves. We recommend the preferred treatment of a known intolerance of any food, including lactose intolerance, is avoidance. Since digestion is a complex process that is critical for good health, a careful approach to avoidance of lactose is the key to reducing symptoms and protecting future health for a lactose sensitive individual.

Irritable Bowel Syndrome (IBS)

Monday, August 22nd, 2005

Irritable bowel syndrome (IBS) is a common disorder of the intestines that leads to crampy pain, gassiness, bloating, and changes in bowel habits. Some people with IBS have constipation (difficult or infrequent bowel movements); others have diarrhea (frequent loose stools, often with an urgent need to move the bowels); and some people experience both. Sometimes the person with IBS has a crampy urge to move the bowels but cannot do so.

Through the years, IBS has been called by many names–colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease. Most of these terms are inaccurate. Colitis, for instance, means inflammation of the large intestine (colon). IBS, however, does not cause inflammation and should not be confused with another disorder, ulcerative colitis.

The cause of IBS is not known, and as yet there is no cure. Doctors call it a functional disorder because there is no sign of disease when the colon is examined. IBS causes a great deal of discomfort and distress, but it does not cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel or to a serious disease such as cancer. Often IBS is just a mild annoyance, but for some people it can be disabling. They may be unable to go to social events, to go out to a job, or to travel even short distances.

The colon, which is about 6 feet long, connects the small intestine with the rectum and anus. The major function of the colon is to absorb water and mineral salts from digestive products that enter from the small intestine. Two quarts of liquid matter enter the colon from the small intestine each day. This material may remain there for several days until most of the fluid and salts are absorbed into the body. The stool then passes through the colon by a pattern of movements to the left side of the colon, where it is stored until a bowel movement occurs.

Colon motility (contraction of intestinal muscles and movement of its contents) is controlled by nerves and hormones and by electrical activity in the colon muscle. The electrical activity serves as a “pacemaker” similar to the mechanism that controls heart function. Movements of the colon propel the contents slowly back and forth but mainly toward the rectum. A few times each day strong muscle contractions move down the colon pushing fecal material ahead of them. Some of these strong contractions result in a bowel movement.

Because doctors have been unable to find an organic cause, IBS often has been thought to be caused by emotional conflict or stress. While stress may worsen many symptoms including IBS symptoms, research suggests that other factors also are important. Researchers have found that the colon muscle of a person with IBS begins to spasm after only mild stimulation. The person with IBS seems to have a colon that is more sensitive and reactive than usual, so it responds strongly to stimuli that would not bother most people.

Ordinary events such as eating and distention from gas or other material in the colon can cause the colon to overreact in the person with IBS. Certain medicines and foods may trigger spasms in some people. Sometimes the spasm delays the passage of stool, leading to constipation. Chocolate, milk products, or large amounts of alcohol are frequent offenders. Caffeine (in coffee, in particular) causes loose stools in many people, but it is more likely to affect those with IBS. Researchers also have found that women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms.

If you are concerned about IBS, it is important to realize that normal bowel function varies from person to person. Normal bowel movements range from as many as three stools a day to as few as three a week. A normal movement is one that is formed but not hard, contains no blood, and is passed without cramps or pain. Though three stools a week may be “normal” for some individuals, it is not optimal over a lifetime, as the bowel lining has much increased time for exposure to toxins that are part and parcel of an increasingly contaminated food source. This increased exposure to toxins as a result of less frequent stools can result in increased cancer risk.

People with IBS, on the other hand, usually have crampy abdominal pain with painful constipation or diarrhea. In some people, constipation and diarrhea alternate. Sometimes people with IBS pass mucus with their bowel movements. Bleeding, fever, weight loss, and persistent severe pain are not symptoms of IBS but may indicate other problems.

IBS usually is diagnosed after doctors exclude the presence of disease. To get to that point, the doctor will take a complete medical history that includes a careful description of symptoms. A physical examination and laboratory tests will be done. A stool sample will be tested for evidence of bleeding. The doctor also may do diagnostic procedures such as x-rays or endoscopy (viewing the colon through a flexible tube inserted through the anus) to find out if there is disease. At Great Smokies Medical Center, we rule out several possible causes that could cause symptoms similar to IBS such as chronic bacterial or yeast infections and parasitic infestations through a Comprehensive Digestive Stool Analysis. We also rule out intolerance of food from any cause, including but not limited to food allergy, gluten intolerance, and lactose intolerance. In addition, knowing that IBS can be the result of a disturbance in the autonomic nervous system, we would assess any problem with the sympathetic nervous system (which readies a body for “fight or flight”) through Heart Rate Variability monitoring. We would also do a nutritional assessment, of minerals in particular, to see if the downstream effects of IBS have nutritionally compromised the affected person.

The potential for abnormal function of the colon is always present in people with IBS, but a trigger also must be present to cause symptoms. The most likely culprits seem to be diet and emotional stress. Many people report that their symptoms occur following a meal or when they are under stress. No one is sure why this happens, but scientists have some clues.

Eating causes contractions of the colon. Normally, this response may cause an urge to have a bowel movement within 30 to 60 minutes after a meal. In people with IBS, the urge may come sooner with cramps and diarrhea. For some, the strength of the response can be related to the number of calories in a meal and especially the amount of fat in a meal. Fat in any form (animal or vegetable) can be a strong stimulus of colonic contractions after a meal. Many foods contain fat, especially meats of all kinds, poultry skin, whole milk, cream, cheese, butter, vegetable oil, margarine, shortening, avocados, and whipped toppings. Grains are among the common culprits in those with food allergy accounting for bowel symptoms. Large meals can cause cramping and diarrhea in people with IBS. Symptoms may be eased if you eat smaller meals more often or just eat smaller portions.

Stress may also stimulate colonic spasm in people with IBS. This process is not completely understood, but scientists point out that the colon is controlled partly by the autonomic nervous system. Stress reduction (relaxation) training or counseling and support help relieve IBS symptoms in some people. However, this does not mean IBS is the result of a personality disorder. IBS is at least partly a disorder of colon motility. Whether or not stress is a direct cause of IBS or not, the symptoms of severe IBS can themselves often cause stress in the life of the affected individual.

For many people, eating a proper diet lessens IBS symptoms. Before changing your diet, it is a good idea to keep a journal noting which foods seem to cause distress. Discuss your findings with your doctor. For instance, if dairy products cause your symptoms to flare up, you can try eating less of those foods.

Dietary fiber may lessen IBS symptoms in many cases. Beans, fruits, and vegetables are good sources of fiber. Consult your doctor before using an over-the-counter fiber supplement. High-fiber diets give the stool more bulk, which may help to prevent spasms from developing. Some forms of fiber also keep water in the stools, thereby preventing hard stools that are difficult to pass. Click here for more information on types of fiber. Doctors usually recommend that you eat just enough fiber so that you have soft, easily passed, and painless bowel movements. High-fiber diets, particularly cellulose fiber, may initially cause gas and bloating, but within a few weeks, these symptoms often go away as your body adjusts to the fiber. Pectin, a water soluble fiber, is generally better tolerated

Your doctor may prescribe fiber supplements or occasional laxatives if you are constipated. Some doctors prescribe drugs that control colon muscle spasms, drugs that slow the movement of food through the digestive system, tranquilizers, or antidepressant drugs. At GSMC we prefer to first identify any cause of symptoms and remove that cause if possible. It is important to follow the physician’s instructions when taking IBS medications–particularly laxatives, which can be habit forming if not used carefully.

IBS has not been shown to lead to any serious, organic diseases. No link has been established between IBS and inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. IBS does not lead to cancer. Some patients have a more severe form of IBS, and the pain and diarrhea may cause them to withdraw from normal activities. These patients need to work with their physicians to find the best combination of avoidance of contributing causes, medicine, diet, counseling, and support to control their symptoms.

Causes and Treatments of GERD

Monday, August 22nd, 2005

An estimated 60 million Americans suffer from Gastro-Esophogeal Reflux Disease (GERD), 15 million of them with daily episodes. GERD is a condition where digestive fluids from the stomach backwash into the esophagus, the tube that carries food/liquid from the mouth to the stomach and throat. Symptoms may include heartburn, an acidic taste in the back of the mouth, burning under the breastbone, and chest pain that can be confused with the pain of a heart attack. At times patients may have no symptoms other than chronic hoarseness, sore throat, gingivitis, or bad breath.

Conditions that predispose one to GERD include being overweight (which increases the amount of intra-abdominal fat and pressure), presence of a hiatal hernia, wearing tight clothing, overeating, eating rich foods, and drinking alcohol and coffee.

A healthy stomach naturally produces concentrated hydrochloric acid to digest food. pH is a measurement of acidity on a scale from 0-14. The normal pH of the stomach is very acid at 1-2, and the normal pH of the esophagus is slightly alkaline at 7-8. The mucous membranes of the stomach protect the stomach from being digested by hydrochloric acid. The esophagus, however, is not protected from these hydrochloric acid so it can become irritated or damaged by this exposure, resulting in the symptoms of GERD.

Conventional therapies for GERD include treatment with special types of antihistamines, especially Zantac, Tagamet, and Axid, as well as other medications called Proton Pump Inhibitors (PPIs) like Propulsid and Nexia. These drugs decrease stomach acid production. The long-term blocking of stomach acid production, however, is a valid health concern as acid is required for the breakdown of protein, a nutrient needed as a building block of body tissues, and also is required for absorption of minerals essential for health. By prescribing such drug treatments, an assumption is made that GERD symptoms are caused by excess acid production in the stomach, often without testing for the presence of excessive acidity.

GERD is a response to an acid/alkaline imbalance in the stomach, from either excess or deficient stomach acid. The fact that GERD is often caused by inadequate stomach acid production is usually overlooked. Too little stomach acid can trigger the backwash response, especially in older individuals. Studies suggest that 60% of individuals over age 60 make too little hydrochloric acid, with the percentage increasing with advancing age.

Natural therapies for this condition can include a surprisingly effective simple technique of food combining-avoiding starches and sugars (bread, potatoes, pasta, fruit, desserts, etc.) and protein (meat, eggs, fish, etc.) at the same meal. Supplementing hydrochloric acid (HCl) by capsule, always dosed to the size of a meal, has resulted in complete relief of GERD for some patients. Herbal treatments are useful, including a special form of licorice called deglycyrrhizinated licorice, often combined with other herbs such as plantain, slippery elm, and marshmallow root.

Red blood cell or hair analysis often reveals an overall decrease in essential minerals, since stomach acid is critical for the absorption of minerals. Mineral supplementation taken with acidic lemon water can help remedy this deficiency. Delivering specific electrical stimulation to a group of autonomic nerves called the celiac plexus in the upper abdomen that control the functions of the stomach and esophagus can be helpful in reducing the symptoms of GERD.

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