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Leaky Gut Cure

After long time in researching and reading lots of medical journals Karen create the most powerful system on the market in curing leaky gut called Leaky Gut Cure. With this new product leaky gut sufferers will now can forget about the discomfort they had to endure until now. Leaky Gut program explains what is leaky gut syndrome, how it affects people, how it is caused by food intolerance and other condition. Leaky Gut Cure also examines the relationship between leaky gut and liver. Leaky gut syndrome is defined by increased permeability of the intestinal mucosa account for endogenous or exogenous toxins. The only place that the Leaky Gut Cure is sold right now is online from the official website. Not only will you get the full Leaky Gut Cure program, but you will also receive a variety of bonus materials to help you with healthier life including a book on supplements, a guide to determining your metabolic type, and even a book on eliminating toxins from your home. Read more...

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Lactose Digestion and Gastrointestinal Function

Lactose is hydrolyzed at the intestinal jejunal brush border by the enzyme lactase into its absorbable monosaccharides glucose and galactose. Lactase activity is robust during infancy and, as is the case in humans and most mammals, declines after weaning. Accordingly, the general pattern of lactase non-persistence is a continuous decline in genetically programmed populations. A shifting pattern of lactose digestion and gastrointestinal function is a result of lactase nonpersistence. The pattern can be described and monitored during three distinct clinical phases. Initially, many reports treated the population studied as a single unit and paid incomplete attention to age-specific considerations. Distinctions between secondary lactose malabsorption due to short-term intestinal injury and primary lactose malabsorption that has a genetic basis were not always made. This introduced additional confounding variables. Differences in an individual's capacity to hydrolyze and tolerate a lactose...

Tracking bifidobacteria in human intestinal samples

Demonstrated by culturing from faecal samples on selective medium which indicated levels of between one and ten percent in adults (Harmsen et al., 2000b), and even up to 90 in infants (Harmsen et al., 2000a). However, these conventional plate counts overestimated bifidobacteria counts by 2 to 10 as a result of underestimation of the total microbial counts by culturing (Mitsuoka, 1990). In addition, it is very challenging to obtain pure cultures of the majority of species in the intestinal microbiota due to the largely anaerobic nature of this community and the paucity of suitable enrichment strategies to stimulate intestinal conditions. Less is known about bifidobacterial numbers in other gastrointestinal sites such as the ileum. Studies are limited to ileostomy patients in which the microbiota differs from those of the healthy distal ileum and these indicated that bifidobacterial counts varied between 0.1 and 10 of the total microbiota. The number of bacteria in the terminal ileum of...

Gastrointestinal Tract

Most patients with AIDS (50 to 98 percent) either present with or later develop diarrhea that is often life-threatening. Gastrointestinal disease in immunocompromised patients is often due to Cryptosporidium, Isospora, Microsporidium, and Cyclospora. The diagnosis of Cryptosporidium is made with a modified Ziehl-Neelsen acid-fast stain or Kinyoun stain of the stool. Many antimicrobial and antidiarrheal agents have been tried without much success in the treatment of cryptosporidiosis. The high rate of recurrence and relapse of this disease is probably related to the underlying immunodeficiency. Isospora belli is another protozoan that can cause significant gastrointestinal disease. As with Cryptosporidium, infection with Isospora occurs after ingestion of oocysts in contaminated food or water and following sexual contact. Symptoms may vary from acute gastroenteritis in immunocompetent individuals to severe, protracted diarrhea in the immunocompromised. Characteristic oocysts can be...

Pharmacokinetic drug interactions

Pharmacokinetic interactions alter the absorption, transport, distribution, metabolism, or excretion of a drug. Corresponding or independent changes in pharmacological response or therapeutic outcome may or may not occur (6,12,17,18). The rate and extent of absorption can be affected by physicochemical factors such as complexation and nonspecific adsorption of the drug and by physiological factors such as gastrointestinal motility, gastrointestinal pH, presence of gastrointestinal disease, gastric emptying time, intestinal blood flow, intestinal metabolism, and inhibition induction of transport proteins (e.g., P-glycoprotein). In infectious diseases, changes in extent are more clinically important than changes in rate of absorption. As safety and effectiveness are concerns in pharmacokinetic interaction studies, the use of exposure rather than rate and extent of absorption concepts is encouraged, because the term exposure expresses more clinical relevance and focuses on the shape of...

Probiotics For Nonruminant Animals

The original application of probiotics in the nonruminant animal was as prophylactics for the prevention of intestinal disease, although they have also found application as treatments to accelerate the reestablishment of the intestinal microflora after illness or antibiotic treatment. 3 They are generally of limited use in the treatment of active infection. The probiotic is defined as a live microbial supplement that enhances gut health or improves gut function. However, wider-ranging improvements on health and growth in nonruminant animals have been reported. These effects are outside the original intention of the probiotic principle, but may arise naturally as a consequence of improved intestinal function. As the intestine constitutes an enormous drain on the energy and protein resources of any animal, 4 any improvement in the efficiency of this organ will have noticeable effects on the overall health and growth of the animal. Many studies have demonstrated that probiotic...

Appendix Information on Recommended Measures Child Health Questionnaire

A comprehensive process of development assured content validity. The internal consistency estimates were high, suggesting that the measure reflects an underlying dimension, QoL. Test-retest reliability was demonstrated in clinically stable patients (ICC 0.92). Correlations between the GIQLI and appropriate measures supported construct validity. Scores on the measure were also able to differentiate groups of gastrointestinal patients with different levels of function, as well as between those with gastrointestinal disease and those who were ostensibly normal. Responsiveness is obviously highest in 25. Dimenas E, Carlsson G, Glise H, Israelsson B, Wiklund I (1996) Relevance of norm values as part of the documentation of quality of life instruments for use in upper gastrointestinal disease. Scand J Gastroenterol Suppl 221 8-13

Metabolism and Excretion of Toxicants

Metabolism Nsaids Liver

Thus, the liver is the richest source of enzymes for metabolizing toxicants, but there is ample evidence that enzyme systems are ubiquitous, which can be rationalized on the basis of the importance of such enzymes in detoxifying various compounds. Intestinal microflora plays an important role in the biotransformation of Intestine (Gut flora)

The role of bacterial gut translocation in multiple organ failure

All the inotropes described above have been studied with regard to their effect on the splanchnic circulation. Gastric mucosal pH can be measured using nasogastric probes and is thought to be a marker of perfusion in this particular vascular bed. A fall in gastric mucosal pH indicates vasoconstriction and reduced perfusion. Compromised perfusion allows breakdown of the mucosal barrier, and gut bacteria pass into the portal circulation. Bacteria and endotoxin come into direct contact with Kupffer cells in the liver, stimulating cytokine production and release. These mediators spill over into the systemic circulation and lead to organ dysfunction. This theory has been demonstrated in animal studies, but the role of bacterial gut translocation in the development of multiple organ failure in humans is still an area of research. There is a great interest in nutrition, immunonutrition, and the effects of various vasoactive drugs on the splanchnic circulation for this reason.

Disease Management

The management of MG includes the administration of acetlycholinesterase inhibitors, thymectomy, chronic immune suppression, and acute immune modulation (plasma exchange, IV immune globulin), when indicated. Muscle weakness usually does not return to normal with the use of these modalities, and there can be great temporal variability in the nature and amount of muscle weakness. Under- or overdosing can cause significant complications. Variability in the amount of muscle weakness can be seen in response to asthma exacerbations, infections, menstruation, pregnancy, emotional stress, hot weather, and other disorders that alter the response to medication, such as renal and gastrointestinal disease.

Oral Cavity and Alimentary Tract

Intestinal motility is reduced with aging as a result of functional changes in the visceral nerves. With decreased transit the residence time of the chyme on the absorptive surfaces is longer, compensating for any senescence in the mucosal uptake itself. The reduction in motility produces the most noticeable and notorious of the manifestations of intestinal health in older persons, namely reduced frequency of defecations.

Absorption Transport and Storage Status Measurement

The contribution of the gut flora to the available pantothenate for humans is unknown, but there is some evidence that bacterial synthesis of the vitamin may be important in animals, especially ruminants, since severe deficiency can only be achieved by using antibiotics or antagonists. Clinical conditions such as ulcers or colitis can adversely affect pantothenate status and excretion rates, and dietary fiber may affect its absorption.

Molecular Biology Microbial

Polymerase chain reaction methods can be used to detect a variety of specific genes in environmental samples without prior cultivation and isolation of microorganisms. They have been applied particularly to virulence determinants (e.g., toxin genes) providing information on pathogen contamination in the food chain. PCR tracking of antibiotic resistance genes in the environment and in human and animal gut bacteria has implications for the debate over the impact of antibiotic use in animal husbandry, which centers on resistance to the antibiotics used in clinical and veterinary medicine. 2. Leser, T.D. Amenuvor, J.Z. Jensen, T.K. Lindecrona, R.H. Boye, M. Moller, K. Culture independent analysis of gut bacteria The pig gastrointestinal tract revisited. Appl. Environ. Microbiol. 2002, 68 (2), 673 690.

Absorption Transport and Storage

Studies with these model systems have shown that the transport of riboflavin at low (e.g., micromolar) concentrations is temperature- and energy-dependent (it is inhibited by inhibitors of ATP production from energy substrates), it becomes saturated as the concentration of riboflavin increases, and it is sodium ion dependent. These characteristics are shared with many other types of small molecules that are actively transported across the gut wall. More specifically for riboflavin, the active transport mechanism involves phosphorylation (to riboflavin phosphate, also known as flavin mononucleotide, or FMN) followed by dephosphorylation, both occurring within the intestinal cells (Figure 1). This latter process is not shared by several other B vitamins, but it is one of a number of common strategies which the gut may use to entrap essential nutrients, and then relocate them, in a controlled manner and direction. A similar strategy is employed at other sites in the body, to ensure...

How does resistance arise

Occasionally, mutations occur spontaneously in bacteria, which render them resistant to one antibiotic or another. Usually the mutation leads to a change in a receptor or binding site such as those just described, rendering the antibiotic ineffective. The changes are usually brought about by point mutations (see Chapter 11) occurring at very low frequency on chromosomal DNA. Bacteria can, however, become resistant much more rapidly by acquiring the mutant resistance-causing gene from another bacterium. This is called transmissable antibiotic resistance it occurs mainly as a result of bacterial conjugation, and is the cause of most of the resistance problems we presently face. Transmissable resistance was first reported in Japan in the late 1950s, when multi-drug resistance in Shigella was shown to have been acquired by conjugation with resistant E. coli in a patient's large intestine. E. coli is known to transfer R (resistance) plasmids to several other gut bacteria including...

Clinical Features And Spectrum

The clinical picture is often multifaceted. In the past, WD was often considered to be a gastrointestinal disease, but it is now established that nearly every organ system can be involved. The course varies in the same extent, so it was suggested that different clinical courses may result from T. whipplei subtypes, identified according to its 16S-23S rDNA. 11 Mostly affected are Caucasian middle-aged

Prediction Of Reactive Metabolite Formation

And almost all drugs have the potential to form a reactive metabolite. One strategy that has been used by the pharmaceutical industry is to screen drug candidates for the production of a reactive metabolite in early metabolic studies by searching for glutathione conjugates. However, not all reactive metabolites form glutathione conjugates and some glutathione conjugates are transported into bile and can be further metabolized by gut bacteria so that they are not detected. In addition, conjugation with glutathione usually leads to an unreactive molecule so that if this pathway is very efficient the drug is unlikely to cause toxicity, at least due to a reactive metabolite.

Fibric acid derivatives Table 132

The fibrates currently marketed in the US are clofibrate, gemfibrozil, and fenofibrate. Fibrates available in other countries include bezafibrate, fenofibrate, ciprofibrate, becla-fibrate, etiofibrate and clinofibrate. In a WHO study clofibrate was shown to reduce modestly (P 0-05) all cardiovascular events. However, increases in non-cardiovascular morbidity and mortality and total mortality occurred.58 In the Helsinki Heart Study, gemfibrozil was associated with a 35 reduction in MIs, particularly in those with elevated levels of plasma LDL-C and triglycerides and low levels of plasma HDL-C. Increases in non-cardiovascular deaths and no reduction in total mortality was observed,59 leading to concerns about the use of fibrates. No fibrate trial has yet shown a significant decrease in total mortality. These agents are approved for use primarily in those with hypertri-glyceridemia. Clofibrate can be toxic in some early studies there was a high mortality rate from malignancy and...

Plant phenolics in human health and as antioxidants

It is evident that plant phenolic compounds constitute one of the most numerous and widely distributed groups of substances with more than 8000 phenolic structures currently known (28). In addition to stress linked phenolics coming only from the shikimate and phenylpropanoid pathways, a number of the phenolic compounds are found in plants, including the flavonoids that contribute to the characteristic flavor and fragrance of vegetables, fruits, tea, and wine. These compounds, which come from phenylpropanoid and polyketide (acetate-malonate) pathways, also have biological properties that are beneficial to human health. Flavonoids such as quercetin and catechin and isoflavonoids, genistein for example, are being investigated for properties which may reduce the incidence of cancer (22,23). Flavonoids and isoflavonoids are a class of phenolic compounds that have appeared sequentially during plant evolution and are simple aromatic compounds generated from both the phenypropanoid and...

Pharmacological Management of Undernutrition

Gynecomastia and hypoglycemia were noted furthermore, the increase in muscle bulk failed to produce a parallel increase in muscle strength. Inadequate data regarding the safety and efficacy of growth hormone administration precludes routine clinical use. Similarly, the role of insulin-like growth factor (IGF-I) in the management of undernutrition is questionable. Although the data suggest that exo-genously administered IGF-I may enhance nitrogen retention, gluconeogenesis, and maintenance of normal gastrointestinal function, evidence-based outcome studies are lacking.

Bacterial interactions

One of the mechanisms by which probiotics may confer a health benefit on the host is the modulation of the intestinal microbiota (Ouwehand et al., 2002b). Accordingly, food supplements such as prebiotics, probiotics and symbiotics are generally developed to improve the population and or the activity of lactobacilli and bifidobacteria within the gut microbiota. One of the most promising properties of dairy propionibacteria, in this context, is their bifidogenic effect. Some strains of P. freudenreichii were shown to enhance the growth of bifidobacteria in vitro and their population in the gut. In this respect, propionibacterial metabolites would best fit to the first definition of probiotics being 'growth promoting factors produced by microorganisms' (Lilly and Stillwell, 1965). The best and first recognised effect of probiotics is the alleviation of lactose intolerance by lactic acid bacteria, mainly Streptococcus thermophilus and Lactobacillus bulgaricus used as yoghurt starters. The...

Vertical integration of agricultural production

Bacteria can become resistant to the antibiotics used in feed. The US Food and Drug Administration (FDA) concluded in October 2000 that two antibiotics used in poultry had spawned drug resistance (Consumer Reports, 2005b). Soil and waterborne bacteria seem to be acquiring tetracycline resistance genes from bacteria originating in pigs' guts (Ananthaswamy, 2001). Prophylactic feeding of antibiotics to animals can lead to the emergence of resistant strains of gut bacteria, such as Salmonella and hence enhance pathogenic risks.

Population Groups at Risk of Vitamin K Deficiency

Because of the minimal extent of transfer of vitamin K across the placenta, the fetus and newborn infant have much lower circulating vitamin K than adults (typically 30-fold lower). In addition, human milk has a lower concentration of the vitamin than that of most other mammalian species. Although low vitamin K levels have not been found to affect the developing fetus in a functionally deleterious way, it is clear that the newborn, and especially the solely breast-fed infant, is at higher risk of functional deficiency than older infants and adults. In a minority of cases, this can lead to life-threatening or long-term damage associated with intracranial bleeding. Hemorrhagic disease of the newborn (HDN) is classified as early (first 24 h of life), classic (days 1-7), or late (2-12 weeks). Of these, the third category is most likely to involve dangerous intracranial bleeding. Risk factors for HDN include intestinal fat malabsorption and hepatic disease. In Western countries, since the...

Rosmarinic Acid And Medicinal Applications

RA (Fig. 1) is an important caffeoyl ester (phenolic depside) with proven medicinal properties and well-characterized physiological functions. RA is found in substantial quantities in several species in the family Lamiaceae with medicinal uses. Salvia lavandulifolia is used as choleretic, antiseptic, astringent, and hypoglycemic drug in southern Europe and contains high quantities of rosmarinic acid (19). RA-containing Ocimum sanctum (holy basil) is widely used to reduce fevers and against gastrointestinal disease in India. In Mexico, high RA-containing Hyptis verticillata is widely used by Mixtec Indians against gastrointestinal disorders and skin infections (11). In Indonesia and several other parts of the southeast Asia, RA-containing Orthosiphon aristatus is known for its diuretic properties and is also used against bacterial infections and inflammations of the urinary system (14). Salvia cavaleriei, a high RA-containing species, is used in China for treatment of dysentery, boils,...

Drugs used in Parkinsons disease

In the wall of the intestinal tract by monoamine oxidase (MAO) the amine itself cannot be administered. However, L-dopa is rapidly decarboxylated in the brain to dopamine and it was found that high doses of the precursor could reverse many of the symptoms of the disease. Such high doses (up to 10 g were sometimes necessary) caused serious peripheral side effects because up to 95 of the drug was decarboxylated in the peripheral tissues and therefore never reached the brain. To prevent the peripheral catabolism of L-dopa, and to also reduce the dose of the drug that had to be given to produce a beneficial effect, a peripherally acting dopa decarboxylase inhibitor is now routinely combined with the drug. Decarboxylase inhibitors such as carbidopa or benserazide are structural analogues of L-dopa and thereby act as false substrates for dopa decarboxylase. Being charged molecules at physiological pH they cannot cross the blood-brain barrier and thereby permit parenterally administered dopa...

Health Effects of Carbohydrates

High intakes of NSP, in the range of 4-32 gday-1, have been shown to contribute to the prevention and treatment of constipation. Population studies have linked the prevalence of hemorrhoids, diverticular disease, and appendicitis to NSP intakes, although there are several dietary and lifestyle confounding factors that could directly affect these relationships. High-carbohydrate diets may be related to bacterial growth in the gut and subsequent reduction of acute infective gastrointestinal disease risk.

Dairy products and probiotics in childhood disease

3.2.1 Development of the intestinal microbiota in the first years of life - role of breast feeding, prebiotics and infant diet Current data suggest that the intestinal bacterial microbiota undergoes substantial changes in the first year(s) of life and remains relatively stable thereafter, although factors such as acute or chronic intestinal diseases, antibiotic treatment and the composition of the diet influence the composition of the microbiota (Barbut and Petit 2001 Hooper and Gordon, 2001 Nowrouzian et al., 2003 Tannock, 2001 (see Fig. 3.1). Endogenous mechanisms for control of bacterial growth in the intestine include gastric acid production, secretion of gastric, intestinal and pancreatic proteases such as pepsin, trypsin, chymotrypsin or lysozyme, bile-derived detergents, secretion of intestinal bactericidal peptides and IgA (Eckmann, 2005 Fahlgren et al., 2003 Mowat, 2003 Sarker and Gyr, 1992). While the intestine in utero is sterile under physiological conditions, a postnatal...

Physiology and function

Nutrients such as proteins, sugars, and fats are metabolized by the liver, but toxins such as various ingested poisons (alcohol, medications, and so on) and gut bacteria translocating through the bowel wall are cleared by the liver as well. Ultimately, the hepatocyte is the core unit of the metabolic machinery. The filtering proportions of sinusoidal endothelial cell, and specialized liver macrophages, Kupffer cells, aid the hepatocyte. The specific role of the hepatocyte is determined by the position of the cell in the hepatic architecture relative to the distance from the portal triad or the hepatic venule. It has become clear that hepatocytes in one area of the liver can be recruited to fulfill tasks in an adjacent area, essentially providing for a continuum, with each hepatocyte capable of providing the full spectrum of necessary functions based on demand. As discussed earlier, the liver produces bile, both as a route to eliminate waste as well as to aid in digestion. One of the...

Finding a competent practitioner

If the treatment you're considering isn't regulated, finding a practitioner is more difficult. You may have to rely on two methods asking friends and acquaintances for references and listening to your gut. It's important not to sign up for anything until you've met with your potential practitioner in person and asked some of the following questions. The answers you get may give you a feeling for whether or not this practitioner is knowledgeable in his or her field.

Adrenocortical Cancer

Most adrenal cancers are greater than 6 cm when they are diagnosed. Those patients who do not present with hormonal symptoms, present because of tumor size or invasion. These tumors are just as likely to become symptomatic because of the large size they can attain in the confines of the relatively small retroperitoneal space or because of their invasion of adjacent structures. These tumor size related symptoms include abdominal pain or pressure, weight loss, hematuria, left varico-cele, dyspnea, or altered gastrointestinal function.

Functional Interactions

Alterations in the GI microflora Alterations in the GI microflora may affect the availability of nutrients produced by the normal gut flora, such as vitamin B12'. Since many drugs are susceptible to bacterial metabolism, changes in the gut flora may also affect drug bioavailability. In certain cases, drug cleavage by intestinal microorganisms is an expected and necessary step for adequate drug action. For example, the anti-inflammatory agent 5-aminosalicylic acid is given as its precursor sulfasalazine, which is converted into the active compound by colonic bacteria. An altered colonic flora will affect the production of the active compound. Drugs can also affect nutrient absorption by directly inhibiting protein synthesis in the enterocyte. Since most transport systems require active protein synthesis and turnover, such inhibition results in a decreased rate of nutrient absorption. Furthermore, certain drugs undergo initial metabolism in the enterocyte, before reaching the...

Neuropeptide Y Receptors

Neuropeptide Y (NPY) is a 36 amino acid neuropeptide that is widely distributed in both the central and peripheral nervous systems. NPY is a member of the pancreatic poly-peptide family, which also includes the structurally related peptides peptide YY (PYY) and pancreatic polypeptide (PP). Neurons containing NPY typically coexpress and cosecrete classical neurotransmitters and or other neuropeptides (e.g., norepinephrine, g-aminobutyric acid, somatostatin, corticotrophin releasing hormone) hence, NPY probably acts in concert with other neurotransmitters and neuro-peptides in either a cotransmitter or modulatory role. As expected from its ubiquitous distribution and colocalization with other neurotransmitters and neuropeptides, NPY has been implicated in a wide variety of physiological effects, including the regulation of body weight, neuronal excitability, circadian rhythms, mood, ethanol consumption, nociception, cognition, endocrine function, cardiovascular function,...

Enteral and parenteral nutrition

The metabolic role of the GI tract in both fasting and stressed states is increasingly recognized. The GI tract can act as a reservoir for bacteria that may cause systemic infections, by allowing bacterial translocation across the gut wall. Gut-derived endotoxin may therefore be the link between GI failure and multiple organ failure in patients without overt clinical evidence of infection. The relationship between GI bacteria, systemic host defences and injury in the development of bacterial translocation is complex. Enteral nutrition (EN) appears to modify antibacterial host defences, blunt the hypermetabolic response to trauma, maintain gut mucosal mass, maintain gut barrier function and prevent disruption of gut flora. This potential benefit acted as a driver for EN in preference to parenteral nutrition (PN). However a number of recent studies comparing (in large randomized controlled trials) EN versus PN have shown that the theoretical benefits do not necessarily translate into...

Documenting a Diagnosis of Food Allergy

Another common problem is the misinterpretation of a sequence of events. For example, a child with an ear infection is given an antibiotic, and 3 days later gets diarrhea, so the parents come to believe the child is allergic to the antibiotic. In fact the cause of the diarrhea is far more likely to be either an underlying viral infection, or a disturbance of the gut flora. Another example is the report of a child who is believed to be allergic to sesame seeds because of reactions occurring after eating buns coated with sesame seeds many such children are in fact not allergic to sesame seeds but are reacting to the egg glaze that has been used as an adhesive for the seed coating. Another common example is the child with asthma who coughs and wheezes after drinking a diluted orange squash drink, with the result that it is believed that the child is reacting to the yellow-orange coloring agent tartrazine. If fact such reactions are more likely to be due to sulfite preservatives in the...

Development of bifidobacteria in the intestine and beneficial effects

Bifidobacteria form part of the normal intestinal microbiota of human infants and adults and are believed to play a beneficial role in maintaining the health of the host. During birth and the first few days of life, bifidobacteria, amongst other intestinal microbes acquired from the mother and the surrounding environment, colonize the infant intestine (Favier et al., 2003). A succession of microbes occurs commencing with aerobes such as enterobacteriaceae, that create reducing conditions favourable to more strict anaerobic bacteria including the bifidobacteria (Franks et al., 1998 Mackie et al., 1999). The changing microbial ecology is coincident with a marked functional and morphological maturation of the infant gut barrier functions and immune system development (Cebra, 1999 Hooper, 2004). The microbiota in breastfed infants is usually dominated by bifidobacteria within a few days, but following a short delay they also reach high numbers in formula-fed infants (Harmsen et al., 2000a...

Range of biomarkers used to investigate health benefits

Key targets for intervention with functional dairy products include gut and oral microbiota, gastrointestinal functions, immunological and defense systems, mucosal systems and integrative functions (e.g., quality of life). Some promising or developing targets include bone and cardiovascular health and mental state performance. Thus, numerous biomarkers related mostly to disease have been exhaustively listed in previous publications (Crews et al., 2001 Saris et al., 2002). The reader is particularly referred to two recent supplements of the European Journal of Nutrition (Asp et al., 2003, 2004). In these supplements, biomarkers presently available for assessing the effects of food components on cardiovascular disease bone health and osteoporosis physical performance and fitness body weight regulation, insulin sensitivity and diabetes risk diet-related cancers mental state and performance gut health and immunity are thoroughly described and discussed.

Postoperative Management

In the acutely ill patient, the development of ileus, stress ulcers, and translocation of gut flora are common complications. Stress ulcers can be prevented by giving sucralfate (1 gevery6-8h). Gut integrity can be maintained by starting early with gastrointestinal feeding and by using enteral rather than parenteral nutrition (Anderson and Vaslef 1997). The caloric needs of 25-35 kcal kg per day and protein of 1.5-2 g kg per day should be met, especially in patients with large wounds, malnutrition, and those on ventilation (Baskin et al. 1990 Anderson and Vaslef 1997).

Route of Nutrition in Malabsorption

Several factors need to be considered when recommending whether oral, enteral, or parenteral nutrition should be used to provide nutrition to the patient with malabsorption, including etiology of malabsorption, severity of gastrointestinal disease, and underlying nutritional and medical condition. Oral nutrition using modified diets as noted previously is the most customary and desirable by physician and patient alike. In cases of mild lactose malabsorption, modification of a regular, healthy diet to avoid foods high in lactose should be sufficient. In cases in which widespread gastrointestinal disease is leading to severe malabsorption, enteral or 'tube' feeding is helpful for two main reasons (i) Use of proprietary formulas specially designed for malabsorption is often indicated, and these formulas may be unpalatable, and (ii) enteral feedings, especially slow continuous 'drip' feedings, make efficient use of nutrient transport kinetics, thereby maximizing residual gastrointestinal...

Future trends

Functional dairy products clearly possess potential to improve intestinal health. Milk as such is a healthy food. Certain lactobacilli strains already have established evidence for their shortening effect in the duration of acute diarrhoea, especially in rotavirus infections. However, vaccination against rotavirus is starting and the need for improved treatment may be reduced. There are still only a few studies on the successful treatment of invasive acute diarrhoea with native lactobacilli, but a promising experimental trial to bind cholera toxin with a genetically modified probiotic strain has recently been published (Focareta et al., 2006). Other intestinal disturbances, such as IBS, are also of interest to many dairy food producers, but this area still needs further studies to prove efficacy. Also a better understanding of the mechanisms and origin of the symptoms would certainly help in the development of effective preventive and treatment agents, including probiotics. In any...


Nutraceuticals are the fastest-growing segment of today's food industry. Indeed, the current lifestyle generates in the consumer an increased interest in the role of diet in health and health promotion. In addition, the diet in some countries is deficient in several vitamins or essential compounds. Bread, as a diary product, is one of the best candidates to become a functional food. For these reasons, baker's yeast producing vitamin precursors or essential fatty acids would be welcome. In the near future, baker's yeast strains producing some prebiotics will be also a reality. As the knowledge of the gut microbiota increases, it will probably become increasingly important to match the modulatory effects of prebiotics to the microbiota present at specific population. These approaches will clearly increase the added value of baker's yeast, contributing to the profitability of the baking industry and improving quality of life and welfare of consumers.

Probiotic Effects

Living microorganisms have long been used as supplements to restore gut health at times of dysfunction. It is clear that different strains from a given microbial group may possess different properties. It is thus important to establish which specific microbial strain may have a beneficial effect on the host even closely related strains can have significantly different or even counteracting effects. Their properties and characteristics should thus be well defined studies using closely related strains cannot be extrapolated to support each other. been shown that changes in intestinal microflora composition precede the development of some allergic diseases, indicating a potential area for probiotic application. LGG given prenatally to mothers and during the first months to infants with a high risk of atopic disease has reduced the prevalence of atopic eczema to about half in the infants receiving the strain. Furthermore, extensively


Although hydrolytic enzymes, esterases and amidases, are named after their major substrates, the same enzyme can often hydrolyze esters, thioesters, and amides therefore, the differentiation between esterases and amidases is sometimes artificial. The highest hydrolytic activity is in the liver, but the enzyme pseudocholinesterase is found in the serum. Gut bacteria also contain hydrolytic enzymes.

Functional genomics

Upon arrival of the post-genomic era, the focus of studies on gut microbiota and its members has shifted from composition and activity to include the study of the functional products of gene expression. Using emerging techniques, such as transcriptomics and proteomics, the molecular activity of the microbiota can be studied in situ on different levels. As explained in the section 'Taxonomy and typing of bifidobacteria colonizing the human intestine', even microbes for which no genome sequence is yet available can be studied using so called smartman arrays, although a complete genome sequence of a related microorganisms will substantially facilitate interpretation of the data. Thus it is now feasible to study the transcriptome of the bifidobacterial community within the intestinal microbiota using bifidobacterial microarrays (Boesten et al., unpublished). Using well-established methods good quality total RNA can be isolated from faecal samples (Zoetendal et al., 2006c). Total RNA...


The syndrome of gastrointestinal ulceration, gastric hypersecretion and diarrhea arising in the presence of a nonbeta islet cell tumor of the pancreas was first described by Zollinger and Ellison in 1955. In the years that followed, the cause of the syndrome was found to be hypersecretion of the peptide hormone gastrin from a neuroendocrine tumor. Over the past four decades the diagnosis and treatment of gastrinomas and the Zollinger-Ellison syndrome have evolved considerably, and study of the pathophysiology of hypersecreting gastrointestinal neuroendocrine tumors has contributed mightily to our understanding of the basic physiology of neuroendocrine control of gastrointestinal function.

Enteral Formulas

Isotonic formulas with fiber These formulas contain soluble and insoluble fibers that are most often soy based. Physiologically, fiber-based solutions delay intestinal transit time and may reduce the incidence of diarrhea compared with nonfiber solutions. Fibers stimulate pancreatic lipase activity and are degraded by gut bacteria into short-chain fatty acids, an important fuel for colonocytes. There are no contraindications for using fiber-containing formulas in critically ill patients.

Coagulation Factors

Coagulation factors may be administered as extracts (factors VIIa, VII and IX) or as fresh frozen plasma (FFP). Vitamin K may be used to increase levels of factors II, VII and IX when there is a deficiency of vitamin K or excess of oral anti-coagulant therapy. Vitamin K2 is produced by gut bacteria. These are reduced by broad-spectrum antibiotics and are deficient in newborn (haemorrhagic disease of the newborn). Desmopressin increases levels of Factor VIII. This may be useful to decrease surgical oozing in mild haemophilia, and in cases of massive transfusion, when clotting factors are reduced.

The Bran Layer

The bran layer is the outer thick-walled structure of the grain. It is rich in B vitamins and phytonutrients such as flavonoids and indoles plus a small amount of protein. It also contains antioxidant compounds including phytoestrogens such as lignans and isofla-vones. These hormonally active compounds, similar to estrogen, may influence sex hormone metabolism and may impact on hormone-related disease. The bran also contains factors that may decrease bioa-vailability of nutrients such as phytic acid, tannins, and enzyme inhibitors. It is also where the bulk of insoluble fiber is found. The insoluble fiber contained within the bran layer has long been recognized to play an important role in intestinal health, by optimizing bowel transit time and increasing fecal weight. But some of the health benefits associated with a high-fiber diet may come from other


In patients with HIV, CMV can cause illness with significant morbidity. Symptomatic infections generally do not occur in patients who are simply HIV positive, but in those with more advanced disease, such as ARC (AIDS-related complex) or AIDS. The most common illness is CMV retinitis, which occurs in more than 10 percent of AIDS patients. Typical complaints are of floaters or of decreased vision. Careful funduscopic examination may reveal characteristic retinal hemorrhages and exudates. Progression to blindness will occur without chronic suppressive therapy with IV ganciclovir or foscarnet. CMV may cause gastrointestinal disease as either an esophagitis or as a colitis. Additionally, CMV can cause an adrenalitis resulting in adrenal insufficiency.


4.5.1 The role of the intestinal microbiota in functional constipation Relatively few studies have investigated the role of the intestinal microbiota in constipation. Using culturing methods, Khalif and colleagues (2005) found that subjects with functional constipation have an aberrant microbiota that presents as a suppression of bifidobacteria and lactobacilli as well as an increased pool of potentially pathogenic micro organisms, such as E. coli and enterobacteria. Patients suffering from severe constipation demonstrated the most pronounced changes. Another study focusing on constipated children revealed increased numbers of bifidobacteria and clostridia in constipation (Zoppi et al., 1998). and Szajewska, 2005). Koebnick and colleagues (2003) investigated the effect of another strain of lactobacilli, L. casei Shirota, in 70 subjects diagnosed with chronic constipation. In comparison to placebo, L. casei Shirota supplementation resulted in improvement in the severity of constipation...


After ingestion, the glycones daidzin and genistin are hydrolyzed by gut bacterial glucosidases and by mammalian intestinal lactase phlorizin hydrolase to release the aglycones genistein and daidzein. These may be absorbed or further metabolized. Although most studies suggest that the bioavailabilities of genistein and daidzein are similar, some indicate greater bioavailability for genistein. Daidzein can be metabolized by the gut microflora to form the isoflavan equol (oestrogenic and more potent anti-oxidant than daidzein) or O-desmethylangolensin (O-DMA nonoestrogenic), whereas genistein is metabolized to the nonoestrogenic p-ethyl phenol. In studies, only approximately 35 of subjects are able to convert daidzein to equol. Interindividual variation in the ability to metabolize daidzein to equol could thus influence the potential health protective effects of soya isoflavones. Equol is produced in greater amounts by subjects who consume diets that are low in fat and high in...


Intestinal polyps are intraluminal protuberant tumors characterized by their gross morphological appearance, location(s), number, size, and presence (pedunculated) or absence (sessile) of a stalk. Additional salient features include specific histological features used to discriminate between types and to aid in predicting malignant potential. Extraintestinal manifestations are also associated with specific poly-posis syndromes. Syndromes associated with juvenile polyps are summarized in Table 4. Other intestinal polyposis syndromes are outlined in Table 5. Increased intestinal mucus Diagnosis Presence of adherent organisms on small intestinal rectal biopsy Treatment Travel to endemic areas a risk factor Large intestinal commensal organism Transmission Person-to-person contact Contaminated food water (cysts) Figure 2 Endoscopic view of colonic polyps in a patient with juvenile polyposis col. (Reproduced with permission from Kleinman RE, Gilger MA, Braverman RM, Finegold MS, Hawkins EP,...


MEGALOBLASTIC ANEMIA Dietary deficiency of cobalamin (vitamin B12) or folate is uncommon. A deficiency state leads to megaloblastic anemia. Pernicious anemia is a result of poor absorption of cobalamin or extrinsic factor. Intrinsic factor is produced by the parietal cells of the stomach and combines with cobalamin in the duodenum, enabling its absorption in the small intestine. Pernicious anemia is a result of a lack of intrinsic factor secondary to an autoimmune destruction of the parietal cells of the stomach. Gastric bypass and severe gastrointestinal disease also may result in a decreased production of intrinsic factor and thus absorption of cobalamin. Cobalamin is essential for the production of nucleic acids. Consequently, rapidly dividing cells such as the hematopoetic cells and mucosal lining are affected most. The most common systemic complaints associated with pernicious anemia are fatigue, weakness, shortness of breath, headache, parathesias, and diminished vibratory and...

Medical History

One specific focus of medical history in a nutritional assessment context is the exploration of gastrointestinal function. Conditions such as chronic diarrhea, gastroesophageal reflux, and colonic disorders may be associated with reduced nutrient absorption or food avoidance that result in impaired nutritional status. Past history of gastrointestinal problems and or surgery may also point to current alterations in nutrient digestion or absorption. Other important components of the medical history are history of weight loss or gain, past and present use of medications, use of special foods or formulas, changes in taste or smell, and food allergies and intolerances.

General Strategies

ANTIBIOTICS Antibiotics are indicated in suspected abdominal sepsis and in most patients with localized and all patients with diffuse peritonitis. Endogenous gut flora cause abdominal infections in the GI or GU tract. Primary gynecologic infections, of which PID is the prototype, behave differently and are discussed separately

The live aminal

Muscle tissue of healthy animals is considered essentially sterile, with the exception of lymph nodes (Romans et al., 1994). However, all meat-producing animals harbour large numbers of various microorganisms on their surfaces exposed to the environment, i.e., skin fleece, hooves, and mucosal membranes of the digestory and respiratory tracts, with relatively high microbial concentrations of 106cfu cm2 skin or g faeces, respectively. Pathogenic bacteria excreted in stables may be ingested orally and so reinfection of animals may occur, namely the colonisation of the guts of very young animals with immature gut flora. Use of contaminated feedstuff has been addressed as an important factor, transportation of the animal, insufficient disinfection of transportation vehicles and extended lairage time at the slaughterhouse allow excretion of pathogenic bacteria, and psychogenic stress may release microbes arrested in hepatic mesenteric lymph nodes. Both factors have been addressed as a...

Nutritional Status

Patients should undergo a preoperative nutritional assessment in advance of surgery. Signs and symptoms of malnutrition should be actively sought. Malnutrition leads to a significant increase in the operative death rate. Weight loss of more than 20 percent caused by illnesses such as cancer or gastrointestinal disease results in a higher death rate and a threefold increase in postoperative infection rate. The dietary history should be obtained as well as information that can indicate basic nutritional deficiencies associated with disease states, especially vitamin deficiencies.

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