Digestion, Inflammation and Cardiovascular Function

stomach problems

The Fire In The Gut

Many practitioners unfortunately don’t look at the connection between heart disease and digestion, but the relationship is there and there is plenty of research to validate this. If you have been in clinical practice long enough, you will begin to see a relationship between people who have been diagnosed with heart conditions (i.e. high cholesterol, high blood pressure, atherosclerosis, TIA, atrial fibrillation, stroke, etc.) who also have digestive and gastrointestinal health problems.

You can’t “feel” plaque building up in your coronary arteries as it happens, nor can you feel a cardiovascular condition developing, it is generally a silent inflammation. Ironically, the very immune system that is designed to keep us alive can cause damage to the inside of our arteries leading to heart disease. Every single injury triggers an immune response that either becomes appropriate or inappropriate.

Inflammation is clearly not the enemy, yet people generally have a tendency to see inflammation primarily as a disease process, when in fact inflammation is a necessary innate response of our body’s immune system, a process that brings the necessary resources required to a specific area to fight an infection or to heal an injury, including any injury to a blood vessel. Inflammation is a natural process that is vital as part of the body’s healing process. But an inappropriate inflammatory response can be very damaging and even destructive, and many now believe that inappropriate and out of control inflammatory responses indeed underpin most chronic disease today, including heart disease, diabetes and cancer.

If inflammation appears to be uncontrolled, or excessive, then healing the digestive system as a primary measure makes sense before chemically suppressing the healing processes (inflammation) with NSAIDs. Anti-inflammatory medications, such as Voltaren and even aspirin, are multi-billion dollar industries in world-wide sales and exert huge influence on the institutions that train medical doctors, so the focus with conventional medicine when it comes to inflammation is medication to ‘control the fire’.

NSAIDs such as Ibuprofen are Cox-2 inhibitor drugs; they inhibit the enzyme cyclooxygenase-2, a key enzyme that helps stop production of inflammatory-like hormonal compounds such as prostaglandins and various cytokines. Cox-2 helps to fight infections and heal injuries, but the chronic over production can lead to chronic pain and inflammation. Too much production of Cox-2 can also stem from nutritional deficiencies, and a good multi vitamin and omega-3 supplement will often correct these minor imbalances. Drugs like Ibuprofen inhibit Cox-1 and Cox-2, and because Cox-1 helps to maintain the lining of the stomach, GI ulceration occurs in about 25% of users, hence the development of ‘selective’ Cox-2 inhibitor drugs. Did you know that an amazing 65 – 70 million scripts for NSAID drugs are handed out annually in USA? An incredible 80,000 people are hospitalized and more than 8,000 die each year as a consequence of NSAID drugs. When Celebrex was released in America, 10 people died of the drug only 16 weeks after the drug was introduced.

Inflammation feeds upon itself, the fire increases in intensity

Once chronic inflammation begins in the body, especially in the absence of optimal amounts of anti0xidant nutrients to quench it, the inflammation begins to feed upon itself, eventually spiraling out of control. Inflammation in the body can be painful like in fibromyalgia or rheumatoid arthritis, but it can also be silent such as in the development of atherosclerosis (cardiovascular disease). Generally speaking, when chronic ongoing inflammation is present, multiple areas of the body may become under attack and the person may suffer from fatigue along with a host of other complaints. There is good evidence that systemic enzymes help quench this fire and may hold the promise that was first delivered with NSAIDS therapy.

The Good Fats versus The Bad Fats

sunfloweroilAn example of chronic inflammation is when more omega 6 oils than omega 3 oils are consumed in the diet (in a ratio much greater than 1:1), inflammation can slowly by steadily increase. Corn, soy and safflower oils and hydrogenated fats, all commonly used in processed foods and cooking, contain linoleic acid. The body converts linoleic acid to omega 6 including arachidonic acid. The enzyme Cox-2 converts arachidonic acid to prostaglandin E2 and the cytokines IL-1 and IL-6, as well as TNF a, all which are known to produce inflammation. In turn, free radical formation is promoted by these pro-inflammatory cytokines, which then further triggers the production of increasing amounts of pro-inflammatory cytokines. The inflammation feeds upon itself like a fire that has increasing amounts of fuel added to it, this is how chronic inflammation occurs. This similarity of how inflammation in the body can escalate to become chronic systemic inflammation, is like a small fire that has been started in the kitchen of a house that can potentially escalate and destroy the entire house, as the heat builds and consumes all in its path. A small amount of coronary plaque build-up over time can become a major occlusion, forming an unstable plaque that could rupture at anytime, similar the unpredictability of living right over a major fault-line in an earthquake prone city.

Cold water fish, venison, leafy green vegetables, flaxseed and walnuts all yield alpha linolenic acid that converts to omega 3 (which include EPA and DHA). Chronic inflammation is now estimated to underpin more than 80 percent of all chronic disease, including CVD, cancers and diabetes. (Berkley University, UCLA 2013). In an interesting study, when animals were given corn oil (omega 6) instead of fish oil (omega 3) they were found to develop much higher levels of colon cancer especially.

Gum Disease And CRP

People with gum disease have elevated levels of CRP. A 1997 study (University of North Carolina) was the first to link elevated levels of C-Reactive Protein, gum disease and cardiovascular disease. The research found that those with gum disease had significantly elevated levels of bacterial inflammatory components in their bloodstream, which we now call today CICs (Circulating Immune Complexes). It has also been discovered that diuretics can lead to a decreased saliva production, which in turn increases plaque build-up with an increase in Streptococcus mutans, the main bacteria behind plaque and dental caries. Calcium-channel blockers (Amlodipine, Diltiazem) often enlarge gums, leading to bleeding, inflammation and infection, and statin drugs like Atorvastatin (Lipitor) reduce Coenzyme Q 10 levels, one of the best treatments for gum disease.

Leaky Gut Syndrome and Inflammation

The medical diagnosis of leaky gut syndrome (LGS) is controversial. However, the earliest American medical research on LGS dates back to 1929. One of the earliest tests that determined the presence of bowel toxemia and LGS was the Urine Indican Test. Also known as the Obermeyer test, it is an indicator of intestinal toxemia and overgrowth of anaerobic bacteria has been around for over 50 years. Today we can more accurately assess LGS by doing a Complete Digestive Stool Analysis. A 2005 article published in the European Heart Journal linked leaky gut to chronic heart failure. Another paper published in the Acta Gastroenterol Belgium in 2010 stated that LGS contributes to heart disease, obesity and diabetes.

The Celiac Disease and Coronary Artery Disease Link

Recently a link has been established between those who are celiac and coronary artery disease. Celiac patients have almost a two-fold increased risk of coronary artery disease compared with the general population, according to research. The study is the first to look at the association between celiac disease and coronary artery disease, advancing the understanding of how systemic inflammation and autoimmune disease processes might influence the development of cardiovascular disease. Research involving tens of thousands of celiac patients over a three-year period has shown a higher risk of stroke as well when compared to control groups. Have you seen my celiac-related articles yet?

Low-grade inflammation of the digestive system is common in those with celiac disease, causing a continual stream of inflammatory mediators to be spilled into the bloodstream, accelerating the atherosclerosis process and causing eventual coronary artery disease. These more recent findings have now reinforced the idea that chronic inflammation related to dietary proteins can have an adverse role in coronary artery disease and heart health in general. This study again confirms what conventional medicine still believes to be ‘unproven science’, that the digestive tract’s permeability can affect the body’s immune response systemically, leading to chronic disease. You may like to see the page Heart Disease – The Best Blood Tests

The Heart And Gut Connection

A study published in the Diabetes journal in 2007 revealed that a conventional Western diet (high in animal fat and high in sugar) decreases the amount of bifidobacteria in the gut, promoting the intestinal uptake of bacterial cell wall antigens such as lipopolysaccharides (LPS) and peptidoglycans. These bacterial by-products then go on to create major increase of the inflammatory response in the blood, leading to endothelial dysfunction and eventually to atherosclerosis (plaque build-up in the arteries). A diet that is low in animal proteins and contains adequate vegetables, seeds/nuts, soaked legumes, whole grains, and fruit, helps to maintain the optimum balance of beneficial intestinal micro-flora, including many species of bifidobacteria and lactobacilli. In addition, people with diets high in sugar and processed foods are more likely to have yeast infections which promote inflammation.

Helicobacter Pylori May Affect the Heart As Well As the Gut

Although there aren’t many physicians in practice today who would question the fact that H. pylori is the principal cause of stomach ulcers, there is still plenty of skepticism concerning other diseases in which this widespread bacteria may be implicated. One of these is coronary heart disease. Since the mid-1990s, several studies have shown a link between H. pylori infection and the risk for developing heart disease. Among the earliest of these was a case-control study that compared 111 CHD patients with 74 controls who did not have CHD. The results showed that 59% of the men with CHD had evidence of H. pylori infection, compared to a 39% infection rate in the controls. This difference was judged to be significant, based on statistical analysis of the data and controlling for other variables.

TMAO is a Predictor of Heart Attack and Stroke Risk

meatThe higher the blood levels of trimethylamine-N-oxide (TMAO), the greater the risk for cardiovascular problems. One day, this chemical may even become a major target to allow health care professionals assess a person’s risk of CVD. Researcher Dr. Stanley Hazen (Lerner Research Institute) believes that TMAO assessment will one day accurately predict a person’s risk of heart attack, stroke and even death. Dr. Hazen believes that TMAO assessment predicts heart risk better than most other usual risk factors, including high blood pressure, smoking and blood tests. Choline in egg yolks and carnitine in red meat becomes metabolized into TMAO. This compound formed primarily from animal proteins changes the way cholesterol is metabolized by the body, it becomes more sticky and attaches more readily to blood vessels making it more difficult for the digestive system to get rid of it. People who eat the most meat have the highest levels of TMAO, and regular assessment may help in terms of preventative cardiology. Vegetarians have the lowest levels of TMAO, Dr. Hazen noted.

A three year study into the link of TMAO and heart disease risk was conducted and published in the New England Journal of Medicine (April 2014). TMAO data was collected from more than 4,000 patients over this three year period, and as TMAO levels increased, so did the risk for heart disease, heart attack and stroke. Those with the highest levels of TMAO had 2.5 times the risk for these outcomes compared to those with the lowest levels of TMAO, the study authors reported.

This study has also suggested that probiotics might be able to block excess TMAO production, and that manipulation of beneficial bacteria may hold the key to balancing TMAO levels. My guess is that an enzymatic/probiotic combination dietary supplement may be even more beneficial for those with higher TMAO levels, as the digestive enzymes will facilitate a more complete protein cleavage and absorption in the duodenum, while the probiotic will allow a better fermentation process to occur in the large intestine preventing dysbiosis.

Clearing Out The Inflammation – The Antigenic Load

The body always tries to rid itself of potentially dangerous foreign substances. Antigens come into the body by way of bacteria, yeasts, pollen, viruses and many other potential sources. Various antigen presentations can cause the release of different antibodies (IgE, IgG, IgA and IgM). If the body becomes too imbalanced, antibody production becomes excessive, escalating the inflammatory cascade.

Sources antigen can be for example from:

Excessive antibody production can be very challenging to the immune system. Here are some of the key processes involved in

  • CICs. Antibodies bind to antigens creating CICs. (Circulating Immune Complexes). These complexes can affect all aspects of health including influencing the development and growth of cancer, auto-immunity, infections, joint health, as well as circulatory and heart health.
  • Cytokines. Some increase the inflammatory response (TH1) whereas others help control inflammation (TH2).
  • Cell Debris, damaged proteins are parts of cells that are destroyed by trauma. Blood proteins caused by glycosylation (too much sugar) become oxidised.
  • Fibrin, excess fibrin – a blood clotting protein.
  • Amyloid is a fibrous protein that can increase in the blood and cause neurodegenerative disease.
  • CRP Elevation. CRP increases with inflammation, especially in heart disease and diabetes. The ability of these inflammatory substances to move freely throughout the blood stream is why we can measure levels of inflammatory markers in the blood.
  • ESR Elevation. RBC clumping is noted during inflammation. Rouleaux formation occurs due to increased fibrinogen
  • A2M. Various enzymes in our bodies activate large proteins called A2M (alpha-2-macroglobulins). Activated A2M folds around the inflammatory mediator and aids in the removal of CICs.
  • Macrophage Clean-Up. Balanced cytokine levels can then increase WBCs to the area of inflammation. Macrophages clean up the debris, including cellular debris, too many cytokines, yeasts, viruses, bacteria, pollens, and any excessive CICs that have been captured by the A2M. The liver’s Kupffer cells also engulf and digest A2M.

References:

  • Diabetes. 2007 Jul;56(7):1761-72. E.pub 2007 Apr 24.
  • Greenberger N, Saegh S, and Ruppert R. Urine indican excretion in malabsorption disorders. Gastroenterol 1968;55:204-11. PMID: 4385691.
  • Celiac disease linked to increased risk of coronary artery disease March 29, 2014 American College of Cardiology
  • Mendall MA, Goggin PM, Molinezus N, et al. Relation of Helicobacter pylori infection and coronary artery disease. Brit Heart J 1994;71(5):437-9.
  • Danesh J, Youngman L, Clark S, et al. Helicobacter pylori infection and early onset myocardial infarction: case-control and sibling pairs study. Brit Med J 1999;319(30):1157-62.
  • Niemela S, Karttunen T, Korhonen T, et al. Could Helicobacter pylori infection increase the risk of coronary heart disease by modifying serum lipid concentrations? Heart 1996;75(6):573-5.
  • F.H. Karlsson, et al., “Symptomatic atherosclerosis is associated with an altered gut metagenome.” Nat Commun. 2012 Dec 4;3:1245.
  • S.T. Mayne, “Beta-carotene, carotenoids, and disease prevention in humans.” FASEB J. 1996 May;10(7):690-701.
  • P.D. Cani, et al., “Metabolic endotoxemia initiates obesity and insulin resistance.” Diabetes. 2007 Jul;56(7):1761-72.

 

 

 

 

 

 

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