Fratellone Medical Associates

Celiac Disease

Celiac Disease is part of the IBS spectrum. It is a true gluten allergy. It can be diagnosed by biopsy, although nto always conclusive. The serum antibody testing for gliadin, endomyosial, and tranglutaminase is specific and sensitive. IgG allergy testing is preferred for food sensitivity rather than the IgE food sensitivity. IgG is the delayed response whereas the IgE is the immediate response.

As many as one in five Americans has irritable syndrome. One you learn to control the symptoms after some various testing is done, the patient improves. Although IBS can compromise more serious intestinal diseases, as Ulcerative colitis (UC) and Crohn’s Disease, or regional enteritis, IBS doesn’t cause inflammation or changes in bowel tissue that increase your risk for colorectal cancer. Other diseases sometimes associated with IBS include:

  1. Lactose Intolerance
  2. Diveticular Disease
  3. Candidiasis
  4. Celiac Disease

The herbs that can be used dor both irritable bowel syndrome ( IBS) and IBD ( which is Crohn’s and Ulcerative Colitis).

Cat-Nip. Nepeta cataria (also known as catnip, catswort, or catmint) is a plant in the Lamiaceae family. Remember also in the Mint Family is Spearmint, Peppermint and Lemon Balm. Nepeta cataria is mostly used as a recreational substance for feline enjoyment. Roughly two out of every three cats will be affected by the plant. The leaves and the flowers can be used. It is used a gastric nervine, which means used for a person with nervousness and some stomach problem.

Well, then half of the New York City population should be on Catnip. It can be used as a tea or tincture. It can be combined with other herbs. It will not stop your bleeding if you have Crohn’s or Ulcerative colitis but recommended for IBS.

The second herb is Chamomile. I know you know this herb, as many of you readers use is to fall asleep. I have tried it with little success as I was buying it in the supermarket. If you are also, you will need 4 teabags to get a decent night sleep. Yes I said, 4 TEABAGS.

Chamomile or Camomile meaning, “earth-apple” from χαμαί chamai “on the ground” and μῆλον mēlon “apple”, for their apple-like scent, is a common name for several daisy-like plants. These plants are best known for their ability to be made into a tea which is commonly used to help with sleep and can be served with either honey or lemon. Chrysin, a specific flavonoid found in chamomile, has been shown to be anxiolytic in animals and is believed to be at least partially responsible for chamomile’s reputation as a sleep aid. Chamomile is the national flower of Russia. It is known to reduce stress. The flora labelled “chamomile”, all of the family AsteraceaeMatricaria recutita (syn. M. chamomilla), German or blue chamomile, commonly used in tea. There is a Roman type of this herb, which is another herb and family.

A similar herb to Chamomile is Pineapple weed.
I never heard of a Pineapple weed until discussed by my great teacher, 7song Matricaria discoidea, commonly known as pineapple weed and disc mayweed is an annual plant native to North America and Northeast Asia but which has become a cosmopolitan weed. It is in the family Asteraceae. I do not think the name discoidea is correct as in class it was named Matricaria matricaiodes. I found to be listed as the later as discussed in school.

The flowers exude a chamomile/pineapple aroma when crushed. They are edible and have been used in salads (although they may become bitter by the time the plant blooms) and to make herbal tea. Pineapple weed has been used for medicinal purposes, including for relief of gastrointestinal upset, infected sores, fevers, and postpartum anemia.

The difference between using catnip or chamomile for an irritable gut is that catnip is a gastric nervine and can be used for IBS. Catnip does not have anti-inflammatory properties, whereas Chamomile does have anti-inflammatory properties. Therefore if I have a young patient with Crohn’s or Ulcerative colitis, I would use German Chamomile instead of Catnip.

Diarrhea also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and electrolyte imbalances. In 2009 diarrhea was estimated to have caused 1.1 million deaths in people aged 5 and over and 1.5 million deaths in children under the age of 5. This statement is not known but most of us. In the United States, diarrhea is not discussed as it is in developing countries. Diarrhea is an uncomfortable condition that can have many causes. Most cases of diarrhea will go away on its own. However, in some cases, diarrhea can lead to dehydration or be a sign of a more serious problem.

The most common cause of diarrhea is viral gastroenteritisviral gastroenteritis, a mild viral infection that goes away on its own within a few days. This condition is often called the stomach flu. Viral gastroenteritis often occurs in mini-epidemics in schools, neighborhoods, or families. A common cause is after a trip to a foreign country. Remmeber Montazouma’s Revenge, when returning from Mexico? They occur as a result of eating food or drinking water contaminated with bacteria or parasites. I commonly see diarrhea in patients whom have finished a course of antibiotics. You forgot to take your probiotics, or ‘good bacteria’ or you didn’t eat Activa. I prefer Colibani or Sheep/Goat yogurt. Other medications as laxatives containing magnesium, and chemotherapy for cancer treatment, can also cause diarrhea.

Other medical conditions can also lead to diarrhea. Some of these have been discussed in previous blogs. The range of diseases is a diverse range as Celiac disease , Inflammatory bowel diseases (Crohn’s disease and Ulcerative colitis,

Irratible bowel syndrome (IBS) , Lactose intolerance, Malabsorption syndromes. Some other less common causes of diarrhea are partial removal of the stomach, carconoid syndrome and diabetic complications. Drink plenty of fluid to avoid becoming dehydrated. Start with sips of any fluid other than caffeinated beverages. Milk may prolong loose stools, but also provides needed fluids and nourishment. Drinking milk may be fine for mild diarrhea. For moderate and severe diarrhea, electrolyte solutions available in drugstores are usually best.

Let’s take about a home remedy if you cannot get to the store and get Pedialyte (electrolyte replacement) A siple remedy is mixing one quart of water, 3 teaspoons of sugar and 1 teaspoon of salt. PLEASE do not use honey

PLEASE take probiotics. Another supplement to help the absorption is taking L-glutamine, an amino acid that builds up the villi of the small intestines.

Foods like rice, dry toast, and bananas can sometimes help with diarrhea.
Avoid over-the-counter anti-diarrhea medications unless specifically instructed to use one by your doctor. Certain infections can be made worse by these drugs. When you have diarrhea, your body is trying to get rid of whatever is causing it (contaminated food, virus, etc.). The medicine can interfere with this process.
Get plenty of rest. For chronic disease, please consult a health care professional.
Try adding bulk to your diet to thicken your stool and regulate bowel movements. Such foods include fiber from whole-wheat grains and bran. Psyllium-containing products such as Metamucil or similar products can also add bulk to stools.

Let me say something very important. When should you seek medical advice. One would be blood or pus in your stools , your stools are black, any abdominal pain, lightheadedness, fever, foul smelling or oily stools, recent foreign travel, eaten with someone who has acute diarrhea, starting a new medication or diarrhea lasting more than 5 days.

One herbal remedy would be slippery elm. Others separately would be oatmeal. This is not the gluten free Irish oatmeal (gluten free) I always talk about. The other would be activated charcoal.
I will focus on Slippery Elm. Ulmus rubra, is a species of elm native to eastern North America (from southeast North Dakota, east to southern Quebec, south to northernmost Florida, and west to eastern Texas). It is similar to American Elm in general appearance, but more closely related to the European Wych Elm, which has a very similar flower structure. Other common names include Red Elm, Gray Elm, Soft Elm, Moose Elm and Indian Elm. It has a great history in America. During the Revolutionary War, surgeons used bark poultice as a treatment for gunshot wounds. If you like mucilaginous tea, use three tablespoons of the inner bark in a hot cup of water. This has been traditionally used for sore throats, upset stomach, and diarrhea. I would prefer using elderberry or ginger for my sore throat. I use Aloe vera for gastric irritation and have difficulty swallowing this gelatinous herb. The FDA approved slippery elm as a non prescriptive demulcent in throat lozenges.

Constipation refers to bowel movements that are infrequent and hard to pass. Constipation is a common cause of painful defecation. Severe constipation includes obstipation and fecal impaction . Constipation is common; in the general population incidence of constipation varies from 2 to 30%.Constipation means different things to different people. For many people, it simply means infrequent stools. For others, however, constipation means hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement. The cause of each of these “types” of constipation probably is different, and the approach to each should be tailored to the specific type of constipation.

Constipation also can alternate with diarrhea. This pattern commonly occurs as part of the irritable bowel syndrome (IBS). At the extreme end of the constipation spectrum is fecal impaction, a condition in which stool hardens in the rectum and prevents the passage of any stool. There was a time as a hospital resident that an elderly patient came to the emergency room with severe constipation. The resident would have to do digital fecal disimpaction. The number of bowel movements generally decreases with age. Ninety-five percent of adults have bowel movements between three and 21 times per week, and this would be considered normal. The most common pattern is one bowel movement a day, but this pattern is seen in less than 50% of people. Moreover, most people are irregular and do not have bowel movements every day or the same number of bowel movements each day.

A medical definition of constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week. There is no medical reason to have a bowel movement every day. Going without a bowel movement for two or three days does not cause physical discomfort, only mental distress for some people. The mental distress is a lot worse than the physical discomfort.

The causes of constipation is numerous. A frequently over-looked cause of constipation is medications. The most common offending medications include:
Narcotic pain medications such as codeine (for example, Tylenol #3), oxycodone (for example, Percocet), and hydromorphone (Dilaudid); The antidepressants such as
amitriptyline (Elavil) and imipramine (Tofranil) ; iron supplements; heart medications as calcium channel blocking agents as cardizem and verapamil; Aluminum-containing antacids .
So do you have to stop these medications to relieve the constipation? This is usually nto necessary providing you add fiber and increased hydration to your diet.

Fiber is important in maintaining a soft, bulky stool. Diets that are low in fiber can, therefore, cause constipation. The best natural sources of fiber are fruits, vegetables, and whole grains.
Although laxatives are a treatment for constipation, it can also be a cause.

The over-use of stimulant laxatives [for example, senna (Senokot), castor oil, and certain herbs]. An association has been shown between the chronic use of stimulant laxatives and damage to the nerves and muscles of the colon, and it is believed by some that the damage is responsible for the constipation. Hormones can affect bowel movements. I usually see the following symptoms in an elderly patient. These include cold hand and feet, hair thinning and hair loss, fatigue, weight gain and constipation. Although not of all these symptoms are necessary I have made the diagnosis. You are suffering from an underactive thyroid ( Hypothyroidism)

The treatment if not overused would be a laxative. I usually tell the patient to increase their dietary fiber and water intake. I ask them to take magnesium oxide 500mg , two at bedtime.Be sure to obtain magnesium oxide, not magnesium taurate, aspartate or orotate. Some people do use Magnesium citrate. Since I love plants,let’s discuss plant /herbal treatments.

The most frequently used herb is Yellow Dock. Curled Dock (Rumex crispus), also known as Curly Dock, Yellow Dock, Sour Dock, Narrow Dock, sometimes as “narrow-leaved dock” (which properly refers to a variant of Sorrel), and ambiguously as “garden patience”, is a perennial flowering plant in the family Polygonaceae, native to Europe and western Asia.

I have much success with Yellow Dock. The only problem I have with Yellow Dock is the bitter taste as the plant matures. Some people use yellow dock as a wild vegetable and add it to their salad. The young leaves should be boiled in several changes of water to remove as much of the oxalic acid in the leaves as possible. Dock leaves are an excellent source of both vitamin A and protein, and are rich in iron and potassium. Curly Dock leaves are somewhat tart due to the presence of high levels of oxalic acid, and although quite palatable, this plant should only be consumed in moderation as it can irritate the urinary tract and increase the risk of developing kidney stones. I have never used it for a uirinary tract infection. I prefer to use a supplement called D-mannose, or the herb, uva ursi and cranberry.

The roots have also been used medicinally as an astringent, tonic, and laxative. Compounds contained in the plant’s roots have been clinically verified to bind with heavy metals such as lead and arsenic and expel them from the body by stimulating biliary function in the liver. I have not used it to remove heavy metals from the body. I commonly use three other herbs as astragalus, cucurmin and hops. I will start adding yellow dock to my metal detoxifying herbs. I know some herbalists that have used yellow dock as a liver (hepaticx) cleanser.

The other commonly used product is Cascara. Did you know that cascara is an herb ?
Well it is. Cascara, Rhamnus purshiana (Cascara Buckthorn, Cascara, Bearberry, and in the Chinook Jargon, Chittam or Chitticum; syn. Frangula purshiana, Rhamnus purshianus) is a species of buckthorn native to western North America from southern British Columbia south to central California, and inland to western Montana.

It is the largest species of buckthorn, occasionally growing up to 15 m tall, though more commonly a large shrub or small tree 5–10 m tall, with a trunk 20–50 cm in diameter. The bark is brownish to silver-grey with light splotching. The leaves are deciduous, alternate, clustered near the ends of twigs; they are oval, 5–15 cm long and 2–5 cm broad with a 0.6–2 cm petiole, dark shiny green on top, fuzzy and paler green below.

The use of cascara is not new. The dried, aged bark of this tree has been used continually for at least 1,000 years by both native and immigrant Americans as a laxative natural medicine, commercially called “Cascara Sagrada”, but old timers call it “chitticum bark”. Cascara Sagrada means “sacred bark” in Spanish.

Cascara Sagrada was accepted in medical practice in the United States in 1877, and by 1890 had replaced the berries of the European Buckthorn (R. catharticus) as a commonly used laxative. It was the principal ingredient in many commercial, over-the-counter laxatives in North American pharmacies until 9 May 2002, when the U.S. Food and Drug Administration issued a final rule banning the use of aloe and cascara sagrada as laxative ingredients in over-the-counter drug products.

Another product used for constipation is Senokot Did you ever think Senna is derived from a plant. Well, senna is derived from a geus of flowering plants.( Senna )Senna ,the sennas, is a large genus of flowering plants in the family Fabaceae, subfamily Caesalpinioideae. This diverse genus is native throughout the tropics, with a small number of species reaching into temperate regions. The number of species is usually estimated to be about 260, but some authors believe that there are as many as 350. The type species for the genus is Senna alexandrina. About 50 species of Senna are known in cultivation.

There are many species of Senna for a variety of purposes. Siamese Senna (S. siamea) leaves can be eaten as a vegetable Senna species make good ornamental plants and are used for landscape gardening. Cassia gum – a commonly-used thickening agent -, despite its name is actually from Chinese Senna (S. obtusifolia) seeds. Another senna, Senna italica ssp. italica (= Cassia obovata), often called “neutral henna”, is used as a hair treatment with effects similar to henna but without the red color.

Sennas have for millennia played a major role in herbalism and folk medicine. Alexandrian Senna (S. alexandrina) was and still is a significant item of trans-national trade Sennas act as purgatives and are similar to aloe and rhubarb in having as active ingredients anthraquinone derivatives and their glucosides. The latter are called sennosides or senna glycosides. Senna alexandrina is used in modern medicine as a laxative; acting on the lower bowel, it is especially useful in alleviating constipation. It increases the peristaltic movements of the colon by irritating the colonic mucosa.

Resveratrol was first isolated from Senna quinquangulata As regards other chemicals, the antiinflammatory compound resveratrol was first isolated from S. quinquangulata,[citation needed] and Siamese Senna The long-standing use of (mainly) Alexandrian Senna is reflected by its presence in many herbal remedies and tonics.
Senna is also the primary ingredient found in most “dieter’s teas”. The combination of acting as a stimulant which reduces a dieter’s appetite, and the laxative properties that cause food to move through their system before as many calories can be absorbed is a combination that can lead to rapid and even dangerous weight loss

The major side effect of taking Senna medication regularly is Melanosis coli, a brown discoloration of the colon wall.