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Editor, The Journal of Integrative Medicine
Formerly, Associate Professor of Pathology (adj.), College of Physicians
and Surgeons of Columbia University, NY
Formerly, President of Staff and Chief Pathologist, Holy Name Hospital, Teaneck, NJ
Fellow, Royal College of Surgeons of England - Diplomate,
American Board of Anatomic and Clinical Pathology
Diplomate, American Boards of Environmental Medicine
Past President Capital University of Integrative Medicine

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SEED, FEED AND OCCASIONALLY WEED

A "seed, feed and occasionally weed" holistic approach to the problem of restoring a damaged bowel ecosystem is the centerpiece of my chronic fatigue management.

Seeding is the repopulation of the gut with microflora that have been destroyed by indiscriminate use of antibiotics or crowded out by the unrestrained proliferation of yeast and bacterial organisms such as the Proteus and Pseudomonas species. The "guardian angel bacteria" for bowel ecology belong to the Bifidobacterium and Lactobacillus species. Some other species also play protective roles. In health, these organisms provide the necessary counterbalance to the growth of yeast and pathogenic bacterial organisms. Beyond this, these organisms produce several molecules that play critical roles in our molecular defense systems.

Feeding is the use of some growth factors that the normal bowel flora require to flourish. These include biotin, pantetheine, Vitamin B12 and others. We clinicians have used Vitamin B12 for decades with good clinical results (to the great chagrin of those "academicians" who considered it quackery because they couldn't understand how this vitamin could ever help anybody except those with pernicious anemia). One of the principal mechanisms by which vitamin B12 exerts its myriad beneficial effects is by serving as a "growth hormone" for health-preserving bowel flora. Of course, this vitamin has several other essential roles. It plays a role in the citric acid cycle (the main molecular pathway for energy generation where it facilitates the conversion of methylmalonyl-CoA to succinyl-CoA) and is essential for cell maturation. Further, Vitamin B12 benefits many patients with neuropsychiatric disorders unassociated with anemia or macrocytosis (N Eng J Med 318:1720; 1988).

Occasional weeding is the use of several natural substances that are known to suppress the overgrowth of pathogenic bacteria, viruses and yeasts. During initial treatment, I frequently use oral nystatin or fluoconazole (Diflucan) for short periods of two to three weeks, partly for diagnostic and partly for therapeutic reasons (how a person with one of the ABE states responds to these agents is useful in assessing the degree of damage to bowel ecology). Extensive clinical experience has convinced me that long-term clinical results are far superior when the use of drugs is kept to a minimum.

Nystatin
Simple-minded efforts to "get rid of the yeast" with nystatin and "yeast-free diets" usually yield poor long-term results. Cold hands are associated with "cold bowel." Cold hands and cold bowel are the result of oxidatively-damaged thyroid enzymes (underactive thyroid gland), oxidatively-damaged autonomic nerve cells and fibers (dysautonomia) or an oxidatively- overdriven adrenalin gland (the relentless chatter of the cortical monkey). None of these problems can be effectively managed with yeast-free diets and Nystatin. Of course, there are other essential issues of nutrition, environment, food and mold allergy, and fitness. In the management of battered bowel ecosystems, it is essential to consider the biologic individuality of the patient. It is necessary to adopt an integrated, long-term approach that addresses all relevant issues of bowel flora and parasites, bowel transit time, bowel ischemic patterns, IgE- mediated disorders related to candida and other yeast antigens, malabsorptive dysfunctions, and secondary systemic consequences.