Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Good Teeth, Gums Reduce Risk of Diseases In Distant Organs

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Why is oral-dental health so important?

Oral cavity is involved in first encounter for foreign bodies and pathogens to the respiratory and gastrointestinal tract.

• Orodental space represents the tip of the spear for most things good and bad (food, drugs, toxins, pathogens) that enter the body especially the gastrointestinal tract.
• Ironically, the status of orodental cavity may reflect the overall health including nutritional and immunological status.
• Orodental changes may be cause of effect or what is happening in the body. 

Orodental flora

Oral cavity is  “dirty”. A variety of bacteria are present including pathogens that have potential for local and body-wide repercussions.

• As many as 500 species are encountered and most of them are not pathogenic.
• In the presence of immune dysfunction, the pathogenic bacteria can become pathogenic manifesting in chronic inflammatory periodontal disease and can then affect the entire body.
• Orodental activities, as simple as chewing, flossing brushing and minor procedures like  scaling result in release of bacteria into blood circulation, although the  bacteremia is usually transient.
• However, the release of bacteria or their toxic product into the circulation have potential to seed another nidus of infection/inflammation setting off a deleterious chain reaction.

 Is localized focus of infection anywhere significant

Poor oral-dental health implies a localized focus of infection.

• The word “localized” may be a misnomer since a localized focus of infection need not have localized effects only.
• Not unlike cancer, metastasis of bacterial infection may occur in the form of bacteremia, release of bacterial toxin into the circulation.
• Metastatic inflammation describes the phenomenon wherein bacterial antigen released into circulation interacts with an antibody resulting in immune complexes that can have their own disease processes. 

Localized focus of infection: A historical perspective

Concept of localized focus of infection is not new; in fact it is rooted in history of medicine since ancient times

• Hippocrates successfully treated a case of arthritis by performing tooth extraction.
• Dr. C.H. Mayo in 1914 declared in Journal of American Medical Association that “root abscesses and pus pockets connecting them are often the source of acute and  chronic rheumatism”. 

Localized orodental infection foci

• Much of  the research has focused on periodontal lesions and their systemic effects beyond oral cavity
• Caries is also increasingly attracting attention in recent times
• WHO considers caries a global health problem 

How does focus of infection including orodental affect body

Diffusion or metastasis of bacteria, toxins and antigens into the body can initiate or worsen a distant and/or generalized illness. Affects can be far away including heart and brain

• Administration of components of normal mouth bacteria (commensal) Porphyromonus gingivalis exacerbates encephalomyelitis in mice.
• An additional concept gaining traction is involvement of RAGE. 

The emerging RAGE concept (Anger at cellular level)

RAGE (Receptor for Advanced Glycation End Products ) has been implicated in multiple disorders.

• Signaling through RAGE has been implicated as a nemesis for diverse pathologies including periodontal disease, cardiovascular diseases, complications of diabetes mellitus including diabetic vasculopathy, Alzheimer disease, cancer, and neurologic conditions.
• An excess of AGEs (Advanced Glycation End Products) has been documented  in numerous organ systems including brain of patients with autism.
• RAGE are plentiful in gums and are  released into circulation when gums are inflamed.
• AGE-RAGE axis has been postulated as the mechanism of a variety of associations of orodental diseases and increased diseases beyond oral cavity including heart, blood vessels and nervous system [Katz et al 2010].

Oral-dental lesions in GI diseases

• Concept of oral-dental lesions in gastrointestinal diseases with far-reaching effects in various parts of the body  is well established.
• Examples include inflammatory bowel disease, Behcet’s disease, celiac disease etc. 

Effects of poor health on oral cavity

In addition to gastrointestinal disorders, aphthous lesions may occur due to immune dysfunction related to infections, malnutrition, allergies, stress and hematological and malignant disorders. More details in upcoming post.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. Do your own due diligence. Talk to your doctor for advice. Ads have potential to generate income for the blogger.

 

 

 

FODMAP diet and foods: Implications in health and disease

Digestion, Health & Nutrition                    Facebook Dr. Anil

FODMAP DIET: ROLE IN IRRITABLE BOWEL, LEAKY GUT AND ALTERATION IN INTESTINAL BACTERIA

What is FODMAP and FODMAP Diet (Gibson and Shepherd 2010)

FODMAP is an acronym applied to group of short chain carbohydrates and sugar alcohols comprised of Fermentable Oligo- Di and Monosaccharides And Polyols

Disease associations: High FODMAP diet have been implicated in the rising tide of a variety of disorders.

• Crohn’s disease
• Celiac disease
• Irritable bowel syndrome
• Chronic fatigue syndrome
• Autism

FODMAPs share thee physiological properties:

• Poor absorption in small intestine
• Osmotically active small molecules
• Rapid fermentation by gut flora: the smaller the length of carbohydrate, faster the fermentation

High luminal FODMAP foods undergo rapid fermentation and create metabolic products that predispose to enhanced intestinal permeability, altered intestinal flora, intestinal gases and predispose to small bowel bacterial overgrowth (SIBO).

Examples of high FODMAP foods/diet include:

• Fructose (fruits, honey, high fructose corn syrup)
• Lactose (diary products)
• Fructo-oligosaccharides or fructans (wheat, onions)
• Galacto-oligosaccharides or galactans ( raffinose and stachyose) contained in legumes, beans, cabbage, onions etc.
• Polyols (sorbitol, mannitol, xylitol, maltitol) contained in apples, pears, plums etc. and low calorie sweeteners. Polydextrose and isomalt are frequently used as artificial sweeteners, are poorly absorbed.

What happens when you ingest high FODMAP diet

• Excess intake and delivery of undigested carbohydrates to the colon renders them subject to bacterial fermentation.
• The metabolic fermentation products including increased organic acids (short chain fatty acids), increased surfactant activity, increased gases (hydrogen, carbon dioxide, methane and hydrogen sulfide) and gut distension injure intestinal barrier by in part causing apoptosis.
• Short chain fatty acids (SCAFAs) excess excess has been shown to increase intestinal permeability in animal models.
• The gas content of gut plays an important role in gastrointestinal symptoms.

Problems occur especially when high FODMAP diet is consumed fast:

The process if rapid, can be especially “explosive”. This occurs when large amounts of undigested carbohydrates are exposed to disproportionately high and potentially pathogenic bacteria in gut e.g. small bowel bacterial overgrowth.

Type of food versus speed

• Oligosaccharides (smaller chain length carbs) and sugars are metabolized at a much faster rate than the longer chain length molecules like dietary soluble fiber.
• The speed of bacterial fermentation and generation of metabolic products varies according to substrate (lactulose >inulin> resistant starch)
• FODMAP elimination diet plan requires global and not individual product restriction.

FOMAP drawbacks

• Low FODMAP diet diminishes access to benefits of prebiotics like fiber
• Effects of high fiber/prebiotics

1. Increased bowel fluid by osmotic effects

2. Increased motility

3. Increased generation of short chain fatty acids that serve as food for colonocytes

4. Increase in beneficial strains of bacteria like bifidobacteria.

FODMAP diet and vegetarians

• Legumes and milk products are a major source of nutrition for vegetarians.
• Since the goal of FODMAP strategy is overall reduction, greater cuts need to be made in other categories in order to accomplish the desired goals.  
• Eat good carbs!

Turning harmful effects of FODMAPs into benefits

• A lower proportion of rapidly fermentable carbohydrates along with greater amount of slowly fermentable carbohydrates have potential for ameliorating harmful effects of FODMAPs and shifting the balance towards benefits.
• For example, ingestion of raw potato starch, guar gum and arabinoxylan causes intestinal injury especially involving enzymatic activities. The deleterious effects of these foods do not occur if they are consumed along with slowly fermentable wheat bran.
• Considering the demonstrated potential health benefits of prebiotics, the harm versus benefits may be individual specific based on diet consumed, gastrointestinal flora, rapidity and amount of bacterial fermentation, and presence of comorbid conditions in the context of genetic susceptibility.

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Disclaimer: Everything on this site is for your information only. Do your own due diligence and consult physician. The ads have potential to generate income for the blogger.

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Cranberry versus antibiotic TMP-SMX for preventing recurrent urinary tract infections or UTI

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Is it better to take antibiotics rather than cranberry to prevent urinary tract infections?

Urinary tract infections including bladder infections are common amongst women. Literature supports the use of Cranberries and cranberry juice for preventing urinary tract infections (UTIs). Cranberry is popular because it is natural and devoid of puported side-effects related to antibiotics expecially over long term.

The study authored by Beerepoot and colleagues from the Academic Medical Center in Amsterdam was published in Archives of Internal Medicine. While the study showed antibiotics to be better at preventing UTI over 1 year, are they really supeior to Cranberry over longer term?

Not so fast! There is a subtext to the overall cost to one's health associated with antibiotic TMP-SMX use which I discuss after the author's conclusions.

Study methods: The study involved 221 premenopausal women with history of recurrent urinary tract infections (UTI). Subjects received either TMP-SMX 480 mg once a day or cranberry capsules 500 mg twice a day for 12 months.

Results

1. Mean number of UTIs Cranberry 4.0 vs TMP-SMX 1.8
2. Proportion of women with atleast 1 UTI Cranberry 78% vs TMP-SMX 71%
3. Median time to symptomatic UTI Cranberry 8 months vs TMP-SMX 4 months
4. Antibiotic resistence to E. coli (UTI bacteria) Cranberry 28% vs TMP-SMX 91%

Authors' conclusions: Use of TMP-SMX antibiotic is superior to cranberry for over a period of 12 months at the expense of antibiotic resistence.

My comments

1. The antibiotic group in this study likely had an inherent advantage since the bioavailabilty of active compound in the antibiotic greater than the cranberry capsule group (Clinical significance to be established).
2. The superiority of antibiotic TMP-SMX over 1 year not withstanding, the occurance of more than 90% antibiotic resistence gives me pause and makes me wonder if the results would have reversed if the study was extended over longer term, say 5 years.
3. The long term of use of broad spectrum antibiotic such as TMP-SMX is fraught with dangers, many not well understood including the effect on overall health due to disruption of the bacterial balance and homeostasis in the gut.
4. Many women have moved somewhat past cranberry alone and are using it in combination with mannose.

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Autism, leaky gut and elimination diets

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Autism: Is it linked to leaky gut syndrome? Do elimination diets help?

There has been a lot of “buzz” about the role of increased intestinal permeability (intestinal hyperpermeability) or leaky gut syndrome in the pathogenesis of autism and autistic spectrum disorders or ASD. A leaky gut may allow absorption of larger molecules especially peptides etc. derived from food which then in turn could potentially affect the neurological function manifesting as behavioral problems.

Let’s look at some of the facts:

• Celiac disease that is related to gluten may present with clinical picture of autism.   
• D’Eufemia et al from La Sapienza University in Italy performed a lactulose-mannitol test to evaluate the intestinal permeability in 21 autistic and 40 control kids. The investigators reported that abnormal permeability through a damaged or dysfunctional gut (i.e.leaky gut) was present in 43% of the autistic kids and none of the control children. 
• De Magistris and colleagues from the Second University of Naples, Italy studied alterations in intestinal permeability in kids with autism and their first degree relatives. Abnormal permeability or leaky gut was seen in 37% of kids with autism, as compared to 21% in first degree relatives and only 5% in healthy controls. Faecal calprotectin was increased in 24% of autistic kids, 12% of first degree relatives and none in controls. The investigators concluded that the results support the “leaky gut” hypothesis and measurement of intestinal permeability may identify those kids with autism that  may benefit from elimination diet. In addition, the high prevalence of abnormalities in the relatives indicates that genetic factors involving tight junctions may play a role in the pathogenesis. 
• American Academy of Pediatrics feels that the literature supporting the role of leaky gut in autism is “limited” and that more studies are needed.

If leaky gut plays a role in autism, exclusion of certain foods like gluten and casein with potentially noxious products may help the patients.

• Knivsberg et al. from the Stavanger University College, Norway conducted a randomized controlled trial of effect of gluten free, casein-free diet in kids with autism and found that development of children at the end of 12-months who underwent dietary intervention with gluten-free, casein-free diet was superior to the controls who were on their usual diet. 
• Elder eta l from the University of Florida conducted a double blind cross over trial of casein free, gluten free diet in kids with autistic spectrum disorder. Outcome parameters include autistic symptoms and urinary peptide levels. Overall, there were no differences between the two groups. However, parents of 9 of the 15 kids wanted to continue the diet and reported subjective clinical improvement. 
• A Cochrane database review by Millward and colleagues from the Derbyshire Children’s Hospital in Derby, UK and Literature and Evidence Research Unit at Nottinghamshire Healthcare Trust in Woodbeck, UK conducted a systematic review and meta-analysis of literature on the role of elimination diets in autistic spectrum disorder. The authors identified two randomized controlled trials albeit small. Elimination diet showed benefit in overall autistic traits, social isolation and overall ability to interact. 
• Rossingnol from the International Child Development Resource Center, Melbourne, FL in 2009 gave a grade C recommendation for the use of elimination diets in autistic kids. 
• Since the publication of the above reports, opinions as well as the position statement of American Academy of Pediatrics, another randomized controlled trial has been published. Whiteley et al. from the University of Sutherland in the United Kingdom conducted a 2-stage single blinded randomized controlled trial of gluten free and casein free diet in kids with ASD. Outcome measures included Autism Diagnostic Observation Schedule (ADOS) and the Gilliam Autism Rating Scale (GARS) as markers for  core autism behaviours, Vineland Adaptive Behaviour Scales (VABS) to evaluate the developmental level, along with nd Attention-Deficit Hyperactivity Disorder - IV scale (ADHD-IV) for assessment of  inattention and hyperactivity. Results at 12-months demonstrated a significant improvement in the intervention group on the  ADOS, GARS and ADHD-IV. Results at 24 months showed benefit was sustained at 24 months although the clinical impact showed a plateau.

Bottom-line: While there is controversy, my "belief" is consistent with Reichelt and Knivsberg from the Rikshospitalet Medical Centre, University of Oslo in Norway who conclude in Annals of Clinical Psychiatry that a gut-to-brain axis connection in autism is both possible and probable based on the effect of diet on excreted compounds and behavior in conjunction with the clinical data available. Obviously, large studies over time will be needed to resolve the controversy.

More topics below.... or click to Home page            Facebook Anil Minocha

Other topics of interest:

1. Can probiotics strengthen selective intestinal barrier? http://goo.gl/cXmry
2. Autism related to gut bacteria? http://goo.gl/omTSd

Autism treatment strategies at the 12-point treatment program for autism.

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Autism and Gut Bacteria: Are they linked?

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Can antibiotics cure some cases of autism? by Anil Minocha of Shreveport, La

Intestinal bacteria provide numerous health benefits and disruption of this milieu has been associated with many diseases not just inside the gut but in rest of body as well. There is some evidence suggesting autism is associated with impaired gastrointestinal health especially alterations in gut bacteria.

In addition to the fact that some kids provide history of antibiotic use and diarrheal illness prior to onset of the disease, a subset of children develop normally initially before manifesting illness. The spores of the Clostridium bacteria have received special attention in this regard.

Evidence mostly consists of data points, the question is, is it reasonable to conclude that there is a link based on connecting these data points. Some say YES, critics say NO. The proponents frequently cite the following study as one of the pieces of evidence implicating alterations gut bacteria especially clostridia in the pathogenesis of autism.

Sandler and colleagues from the Rush Children’s Hospital at the Rush Medical College in Chicago Illinois performed a study on use of the antibiotic vancomycin patients with autism and published their findings in the study titled ,”Short-term benefit from oral vancomycin treatment of regressive-onset autism” in the Journal of Child Neurology.

Vancomycin is an antibiotic which when given by mouth is works only in the gut since it is not absorbed though the gut into the blood stream.

Hypothesis: Changes in the bacterial flora of the gut may promote increased growth of neurotoxin producing bacteria in the gut with potential to cause manifestations of autism.

Study: Children with antecedent broad-spectrum antibiotic treatment followed by chronic diarrhea along a decline of previously acquired skills, and then frank manifestations of autism were included. 11 children with regressive-onset autism met the inclusion criteria and participated in the study.

Results: Analysis of multiple coded pre- and post-vancomycin assesments including paired videotapes scored by a clinical psychologist blinded to treatment revealed an improvement in 80% of the children. However, the improvement was short-lived and declined post-treatment.

Authors conclusions: While the investigators did not suggest th vancomycin protocol used in the study as an effective therapeutic modality for autism, they concluded that the findings do implicate a possible gut bacteria-brain axis connection.

Dr. Minocha's comment: The literature on role of gut bacteria in autism is controversial and scientific community is divided into two camps. You make the call in consultation with your physician. 

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Kid getting infection from day care center? Try probiotics

Digestion, Health & Nutrition                          Facebook Dr. Anil

There is growing body of literature on benefits of prebiotics and probiotics in reducing risk of infections in elderly as well as in children. Yet, they have not achieved a mainstream acceptance yet for a variety of reasons.

Hojsak and colleagues conducted a randomized, double-blind, placebo-controlled trial to examine the efficacy of Lactobacillus GG (LGG) in preventing gastrointestinal and respiratory tract infections in children attending day care centers. The findings were published in the journal Clinical Nutrition.

281 kids were recruited to the study. Study subjects received 10⁹ colony-forming units(CFU) in a fermented milk product for a period of 3 months. Placebo group was administered the same post-pasteurized fermented milk product.

 

Kids taking LGG suffered fewer respiratory infections and those who did develop respiratory infections had a milder shorter course. However, there was no impact on lower respiratory infections. Similarly there was no effect on frequency or severity of gastrointestinal infections.

                                        Listing of some probiotics on market

Do you or someone you know takes probiotics for prevention on a regular basis? If so what has been your experience. Please share your thoughts.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctort. Please consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Helicobacter pylori and migraine headache

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Helicobacter pylori infection has been implicated in numerous disorders including vasomotor dysfunction in patients with Raynaud's and cardiovascular disease and may be an uncommon or uusual cause of migraine.

Studies by Hong and colleagues demonstrated that eradication of Helicobacter pylori reduces intensity, duration, and frequency of episodes migraine in patients with Hepatitis B related liver cirrhosis. The authors speculated that H. pylori antigens cause intermittent vasospasm of arterioles thus leading to migraine-type attack and the reduction of these vasoactive substances upon eradication provides protection against migraine attacks.

Gasbarrini and colleagues showed that H. pylori is found in 40% of patients with migraine which is similar to controls. However, among infected subjects, a significantly higher prevalence of the more virulent CagA-positive strains was seen among those complaining of migraine with aura as compared to those suffering from migraine without aura (41% vs. 19%, P<0.01) and with controls (41% vs. 17%, P<0.01).

 Yiannopoulou and colleagues argue that H. pylori infection is a probable independent environmental risk factor for migraine without aura, especially in patients that are not genetically or hormonally susceptible to migraine.

Of note, H. pylori has been implicated in numerous non-gastrointestinal disorders. However, the causal relationship has been difficult to establish in most cases.

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 Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Birth control, childhood hygiene, IBD, obesity, premature death

Digestion, Health & Nutrition                          Facebook Dr. Anil

According to Margie Mason of the Associated Press and published in numerous newspapers, some mullahs in Afghanistan are distributing condoms while others are quoting the holy Quran to encourage longer intervals between births.

The Food and Drug Adminsteration is recalling numerous food products because of contamination with the bacteria, various parts of media is reporting. This is used in a variety of soups, sauces, chilis, stews, hot dogs, snacks, dips, and dressings. However, this contamination has not been associated with any episodes of sickness thus far. Per the report, the FDA traced this contamination to Las Vegas-based Basic Food Flavors.

A Population-based study by Klement and colleagues from Israel and published in American Journal of Gastroenterology found that childhood hygiene Is associated With the risk for inflammatory bowel disease. Lacatos states that cold chain hypothesis is providing an even broader platform by linking dietary factors and microbial agents.

Obese children have an increased increased risk of premature death from endogenous. This was reported in the New England Journal of Medicine. Other factors for premature death included  glucose intolerance and hypertension during childhood.

Multiple studies have documented  high prevalence of malnutrition and poor intake in patients who had fallen in hospital. Nutrition assessment nutritional intervention is often neglected but should be undertaken aggressively. Family members beware: Hiesmayr and colleagues report that hospitalised patients eat less food than provided as regular meal and this reduced intake inc reases risk for death in the hospital. 

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Cola fizz, rifaximin, Crohn's, vitamin D, calcium and heart

Digestion, Health & Nutrition                          Facebook Dr. Anil

Coffee may be friendly to the heart. According to news reports, a study found that subjects who drank  four or more cups of coffee each day had an 18 percent lower risk of hospitalization for heart rhythm disturbances.

Cola drinks, whether flat or with fizz, should not be used for hydration in kids with acute gastroenteritis, so say Reece et al in recent Archives of Diseases in Childhood based on clinical as well as laboratory evidence. Majority of children with mild to moderate dehydration can be treated effectively with oral rehydration therapy.

Acute thermal injury from ingestion of extremely hot solid food can be seen in esophagus. The patients present with acute odynophagia. Ulceration and necrosis may be seen on endoscopic evaluation of the esophagus. This was reported by Chung etal. in Journal of Korean Medical Science.

Rifaximin therapy results in clinical improvement in patients with Crohn’s disease as reported by Shafran et al. in Digestive Diseases and Sciences. As such, it may be another option for use for induction and maintainance of remission in Crohn's disease.

Vitamin D deficiency is a growing epidemic and may contribute to multiple ailments including making people more susceptible to Crohn's disease. This was concluded by recently Wang et al as published in the Journal of Biological Chemistry.

Two systemetic reviews on effect of calcium and vitamin D supplementation on heart have been published in recent Annals of Internal Medicine. In accompanying editorial, Guallar and colleagues argue that available evidence in favor of vitamin D supplementation is far more promising than for other vitamin and mineral supplements.

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Anil Minocha Disclaimer: Everything on this site is for your information only. I am not your doctor or pharmacist. Please consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

 

Constipation? Is your colon kinky? Dolichocolon

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Dolichocolon causes constipation-is it true? What is dolichocolon anyway. What is the evidence to support its role in constipation?

The Dolichocolon concept was the brainchild of Arbuthnot Lane and is based on the the theory that kinking of colon leads to constipation. While colon is like a country road with its own twists and turns (and of course each "colonic country road" is different), the Lane theory suggests that gravity leads to unnatural "kinking" or twisting initially in the fixed parts of colon on the left side. It gradually progresses upward and proximally causing elongation and further kinking.

In fact, Lane was a proponent of colonic resection or a byepass. While initially colonic resection became very popular, it came into disrepute in the early 20th century and now is performed in rare selected cases only.

Lets face it-the concept of dolichocolon or kinking causing a partial bowel obstruction appears simple, straightforward, appealing and plausible (perhaps too simple and straightforward). Furthermore, theoretically speaking, the kinking along with elongation of colon has potential for increased fecal stasis in colon leading to increased water absorption from the fecal contents resulting in "drier" stool and constipation.

However, scientific data to support theoretical concepts above is lacking. At the same time, constipation does not appear to be correlated with colonic length and surgery is not beneficial in cases of colonic "kinks" unless a volvulus is present.

 And click here to read about best toilet posture.

Do you or someone close to you have constipation? What is the cause of constipation in your opinion? Does the Lane's theory of dolichocolon make sense and sound believable to you? Please share your thoughts.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger. 

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Constipation, kinky colon and fecal stasis 

Human milk therapy

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Human milk, lactation,breast feeding: benefits and alternatives

Breast milk feeding is gaining in popularity.

Milk from different sourses

Milk is species specific, and thus human milk is superior to all other milk for consumption by infants. Did you know that human milk is also available at Milk banks?

Human milk and nutrition for baby

Human milk has all essential macronutrients required for growth and development. It has multiple beneficial enzymatic, hormonal and immune components.

Milk contains lactoferrin and lysozyme. Lactoferrin binds iron and reduces nutrients available for the growth of bacteria.

IgA antibodies in human milk have protective functions. Human milk therapy has been shown to reduce infections and the occurance of NEC (necrotising enterocolitis) in kids. In addition, it also has epidermal growth factor which plays an important role in infant growth and development.

Milk and neonates

The neonates have a highly vulnerable intestinal wall which is constantly being bombarded by noxious luminal environment of the intestines. Human milk plays an important role in interactions of the nutritional milieu as well as the intestinal microflora/bacteria with the host (baby). This has important implications for the health and sickness that may affect even extraintestinal systems such as the lungs and brain.

The child/baby may get human milk may be obtained from breast feeding and milk banks.

Last but not the least: The emotional bond that breast feeding builds (and stengthens) between mother and child is priceless.

What are your thoughts on breast feeding? Please feel free to share.

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Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Helicobacter pylori as a lifesaver in cancer: Yes, it is true!

Helicobacter pylori infection of the stomach has been having its ups and downs. We all know that it is implicated in pathogenesis of peptic ulcers (gastric and duodenal ulcer), gastritis and certain forms of cancers. On the other hand, some data has also suggested that the presence of infection is protective against gastroesophageal reflux disease (GERD) or chronic heartburn.

Now comes a study by Dr Meimarakis and colleagues from University Hospitals in Munich, Germany showing the beneficial effect of H. pylori infection in patients who have had curative surgery for stomach gastric cancer (gastric adenocarcinoma).

These investigators studied 166 patients who had surgery for gastric adenocarcinoma between 1992 and 2002. They published their results in the journal Lancet Oncol (2006)

They found that there was 3-fold advantage for H. pylori infected patients with respect to relapse-free and overall survival. For example, the overall survival was 61.9 months in patients positive for H pylori, compared to 19.2 months in patients who did not have H pylori infection.

Considering the problems this infection causes and the advantages it bestows, this celebrity bacteria continues to be a baffling friend and a foe!

Have you been tested or treated for H. pylori infection for any reason? Do any philosophical thoughts come to your mind about this organism, which can be a good, or bad depending upon the situation? At the very least, we should not be killing this poor bug indiscriminately.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

Gas, boating and distention in IBS

Pooling of gas within the digestive tract and difficulty moving it downstream to get rid of it has been implicated in production of bloating and abdominal discomfort including infantile colic. However, the part of bowel involved in intestinal gas retention has not been well defined.

Salvioli and colleagues from the University of Barcelona recently performed a study of small bowel reaction to infusion of fat into the intestine and published their findings in the American Journal of Gastroenterology (August 2006). These investigators studied six patients with irritable bowel syndrome and compared them to healthy controls.

The authors found that in patients with IBS, there is gas retention associated with abdominal distention and distress. They concluded that fat infusion into the bowel inhibits propulsion of gas in the small intestine via reflex inhibition of small bowel transit. This is not accompanied by any significant effects on the colon.

Based on these results and those of some other recent studies, it may be concluded that the origin of bloating and distention symptoms lies in the small intestine.

Do you or someone you know has gas problems? If so, what measures have you taken to feel better?

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

Gastric ulcer, cancer and endoscopy

Gastric (stomach) ulcers occur frequently and may be cancerous even though they may appear benign during EGD or upper GI endoscopy (upper GI scope). There has been an ongoing debate whether to perform a repeat endoscopy in patients with these ulcers to make sure there is no cancer.

Dr. Hopper and colleagues from United Kingdom examined this issue and published their findings in the journal Gastric Cancer (2006).

These investigators studied 544 patients with apparent benign ulcers of whom 51% underwent a repeat endocopy. Twelve of these ulcers were then found to be cancerous. They compared this group to 296 other patients diagnosed with gastric cancers in this time period. They found that GU cancer group had earlier stage disease and were to survive long term than patients in the comparison cohort.

They concluded that follow up endoscopy of every 50 patients with an apparently benign gastric ulcer will identify 1 patient with cancer. Such an early detection would lead to improved outcome.

Do you have ulcers? Remember gastric ulcers are different from duodenal ulcers since duodenal ulcers rarely are malignant. Most common cause of peptic ulcer disease is the infection with Helicobacter pylori.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

Hazards of sharing toothbrush

Although patients with hepatitis C are advised to take care not to share household and personal items such as razors, nail-scissors or toothbrushes with anyone in family, the data to support these recommendations has been scarce.

Dr. Lock and colleagues from the University of Regensburg in Germany addressed this issue in their recent paper titled,"Hepatitis C - contamination of toothbrushes: myth or reality?" This paper was published in the Journal of Viral Hepatology (September 2006).

These investigators recruited thirty consecutive patients with chronic hepatitis C for the study. None of these patients was taking any antiviral medication.

They investigators collected saliva from the patients before and after brushing teeth for 2 minutes. In addition, toothbrush was rinsed after brushing and the rinsing solution was also analyzed.

The saliva before tooth brushing was positive for hepatitis C RNA in 30% of patients. Hepatitis C positive saliva was seen in 37% of patients after brushing. Interestingly, many of these patients had hepatitis C negative saliva before brushing.

Further more, HCV-RNA was seen in 40% of the toothbrush rinsing water specimens. In half of these patients, the saliva before tooth brushing had been negative for hepatitis C.

In conclusion, this study lends further support to the hypothesis that sharing of household items like toothbrushes may represent an unconventional route of hepatitis C transmission. Although some of the earlier studies had shown conflicting results, the difference in the results may be due to the analytical methods used.

Above study notwithstanding, I wonder how many people in general population (with or without hepatitis C) do share toothbrushes. I would like to know your thoughts.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

A surprise date on colonoscopy

I was asked to perform a colonoscopy on a young female day care worker. She had been complaining of abdominal discomfort, nausea and irregular bowel habit for months. Her physical examination was essentially unremarkable. Our clinical impression was that she probably had irritable bowel syndrome but she had not responded to usual measures.

The colonoscopy prep was poor and made the examination difficult. When the scope reached cecum, we found worms floating around.  This is pinworm or Enterobius vermicularis. The diagnosis was confirmed by microscopy. 

Besides frequently being asymptomatic, the most common manifestation is perianal itching. However, it has potential to cause a wide range of gastrointestinal and nongastrointestinal manifestations, including potentially life-threatening illnesses.

Did you or someone you know had this worm infection as child, or rarely even an adult? Feel free to share your story.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

Clean colon for colonoscopy

Clean colon for colonoscopy for colon cancer prevention

I was explaining to the resident about the importance of a clean colon versus a dirty colon  colonoscopy, and how patients think that the colon is clean and stop the colonoscopy prep prematurely.

Our nurse chimed in, "I tell the patients if you can collect what's coming out in a cup and looks clean enough to drink, only then it is clean". She continued, "I will accept a lemonade but nothing less".

These words may sound gross but are profound and illustrate the misunderstandings patients have about clean colon. When it is "diarrhea" with any brown color to it, be highly skeptical.

Have you had a colonoscopy? What was your experience with the colonoscopy prep?

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger.

Proton pump inhibitors and diarrhea

Clostridium difficile-associated diarrhea usually occurs as a result of antibiotic use and can be potentially life threatening. The role of body defenses especially gastric acid secretion as a risk factor has not been fully elucidated.

Proton pump inhibitors (PPI: Nexium, Prevacid, Protonix, Prilosec, Aciphex) are frequently prescribed for acid reflux, peptic ulcers etc. They act by causing suppression of gastric acid secretion which is an important component of defense mechanism against infections.

Dr. Yearsley and colleagues studied the impact of acid blockade by chronic PPI therapy as a risk factor for development of C. difficile diarrhea and published their findings in the journal Alimentary Pharmacology Therapeutics (August 2006).

These investigators performed a case controlled study with 155 C. difficile diarrhea patients. They found that among the C. difficile-associated diarrhea group, 41% had received acid suppression with PPIs 26% of controls. This translates into the fact that chronic PPI therapy almost doubles the risk of C. difficile diarrhea.

Click to read about  How to Stop Heartburn: Simple Ways to Heal Heartburn and Acid Reflux

Take home message: Since antibiotics are the predominant cause of C. difficile associated diarrhea, the risk of concurrent therapy with PPI should be carefully weighed in patients taking antibiotics.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

Irritable bowel syndrome due to water contamination

Irritable bowel syndrome (IBS) is a poorly understood disorder and multiple theories have been postulated to explain this syndrome. Recent studies suggest that a significant number of people develop IBS after a bout of gastrointestinal infection. Dr. Marshall and colleagues from Intestinal Diseases Research Program at the McMaster University in Canada sought to quantify the risk and characterize he risk factors for developing IBS associated with such an infection. They published their findings in the journal Gastroenterology (August 2006).

These investigators studied the development of IBS in subjects 2 years after they had been exposed to contaminated of municipal water supply system. The contaminants in this system included Escherichia coli 0157:H7 and Campylobacter jejuni. They excluded patients with prior history of IBS and inflammatory bowel disease.

The subjects filled out a standardized health questionaire. The subjects were then divided into groups depending upon whether they had developed gastroenteritis or not. Irritable bowel syndrome was diagnosed based on the ROME I criteria.

2069 subjects participated in the study of whom 904 had developed self-reported gastroenteritis while 464 had clinically suspected gastroenteritis. 701 subjects had not developed any gastrointestinal illness as a result of water contamination and were classified as control.

The authors found that IBS had developed in 28% of self-reported gastroenteritis and 36% of clinically suspected gastroenteritis patients. In contrast, IBS was seen in only 10% of subjects who had not developed gastroenteritis as a result of the water contamination. They also found that the IBS as a result of gastrointestinal infection was more likely to be of the diarrhea predominant type and was more likely to occur in younger women.

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger

Probiotics de-stress gut dysfunction

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An article written by Dr. Anil Minocha, Shrevport, La

It is well documented that chronic stress makes the gut barrier hyperpermeable or leaky. This can allow the harmful substances including bacteria to leak across the gut wall and absorbed into the body causing disease.

 Dr. Zareie and colleagues from Hospital for Sick Children, Canada sought to examine if this leakiness of the gut could be prevented by administration of a probiotic regimen in rats under chronic stress.

Study: Chronic psychological stress was induced in rats by a test called water avoidance stress (WAS) which is known to make gut leaky. These rats were subjected to water avoidance stress or sham stress intermittently over a period of days. Animals were given supplementation of probiotics Lactobacillus acidophilus and L. rhamnosus in the drinking water prior to stress. Animals remained healthy for the duration of the study. Rats were sacrificed after the study and the gut as well regional lymph nodes were studied.

Results: Chronic stress caused a intestinal barrier dysfunction (Leaky gut) in both small and large intestine along with increased bacterial stickiness to the lining of the gut wall as well as penetration across the gut wall. Over two-thirds of rats were found to have bacterial translocation to mesenteric lymph nodes.

While probiotic pretreatment alone had no effect on intestinal barrier function in controls, the treatment reduced gut barrier dysfunction; in addition, it completely blocked the bacterial stickiness to the gut wall as well their translocation across the gut wall into the body.

Conclusions: These results further lend support to hypothesis that certain probiotics can prevent chronic stress-induced intestinal abnormalities and, hence have potential to reduce the potential for sicknesses e.g. irritable bowel syndrome and inflammatory bowel disease like Crohn's disease and ulcerative colitis.

Implications in humans: While it may be a big leap to jump to conclusions from a study involving rats, it should be noted that there is evidence suggesting that probiotics help in some patients with irritable bowel syndrome as well as ulcerative colitis in humans.

NOTE: All probiotics are not created equal!

 More topics below or go to   Home Page                             Facebook Anil Minocha

Is toileting posture important? Taking care of business!	Health benefits of probiotics and prebiotics
Celiac sprue	Does zinc reduce risk of pneumonia
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Is fasting good or bad for health	Food triggers for migraine and helpful natural supplements
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Autism and your gut bacteria	Irritable bowel syndrome or IBS

 Home Shreveport Blog Page     Facebook Anil Minocha

Disclaimer: Everything on this site including the blog and the ads are for your information only. I am not your doctor or pharmacist. Please do your own due diligence and consult your health care professional advisor. Dr. Minocha does not offer any opinion as to the ads on this site. The ads have potential to generate income for the blogger