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Parkland Natural Health Clinic

Colonic irrigation at the Parkland Natural Health Clinic

Parkland Natural Health Clinic is based in the Holborn district of London. Offering colonic irrigation treatment, we are conveniently placed for the City of London and well connected with the London Underground's Central and Piccadilly lines.


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HISTORY OF COLONic irrigation

Colon lavage was first recorded 1500 B.C. in the ancient Egyptian document, Ebers Papyrus which dealt with the practice of medicine. These enemas were described as the infusion of aqueous substances into the large intestine through the anus. Hypocrites (4th and 5th century B.C.), recorded using enemas for fever therapy. Galen (2nd century A.D.), also recognized and was a proponent of the use of enemas. Pare in 1600 A.D., offered the first distinction between colon hydrotherapy and the popular enema therapy of that age.

Colon therapy since the turn of the century has experienced periods of reaction. The factors that contributed mainly to the ambivalence primarily were due to the practice of colon hydrotherapy by the untrained and unskilled, which was very detrimental to its professional growth. When the therapy gained the attention of such physicians as James A. Wiltsie, M.D. and Joseph E.G. Waddinglon, M.D., great value was placed on the therapeutic benefits of this modality. The philosophy attributed to colon therapy by certain physicians of this era was depicted by Dr. Waddington: "Abnormal functioning of the intestinal canal is the precursor of much ill health, especially of chronic disease condition. Restoration of physiolic intestinal elimination is often the first , but too often ignored, important preliminary to eventual restoration of the health in general." Dr. Wiltsie contends that "our knowledge of the normal and abnormal physiology of the colon, and of its pathology and management, has not kept pace with that of many organs and systems of the body. As long as we continue to assume that the colon will take care of itself, just that long will we remain in complete ignorance of perhaps the most important source of ill health in the whole body."

In summary, through misconceptions, misunderstandings and preconceived emotionalism, controversy has prevailed, but accomplished nothing. Historically, we recognize two unequivocal conclusions - First, there is something of value to this modality or it would have been conclusively withdrawn; second, that through lack of professional control and study, colonic irrigation never received the attention and recognition it justly deserves.

Today, with modern technological advancements in colonic irrigation instrumentation, particularly with regard to safety, along with educated and skilled hygienists, colonic irrigation has become a valuable adjunctive modality to the physician in treating disease. At the time of this writing, colon hydrotherapy is still relatively unknown and misunderstood. Combined with sound nutrition, exercise and a positive mental and spiritual outlook, colonic irrigation can play an important role in achieving and maintaining vibrant health.

THEORY OF colonic irrigation

Colonic irrigation is an extended and more complete form of an enema. The concept involves the mechanical process of infusing warm filtered water into the rectum with the objective of cleansing and balancing the colon. This procedure removes fecal material from colon walls and dilutes the bacterial toxin concentration in the large intestine. The therapeutic effects of colon hydrotherapy are improved muscle tone which facilitates peristaltic action and enhances the absorption of nutrients from the cecum and ascending colon while minimizing the absorption of toxic waste material. The cleansing effects of colonic irrigation reduce stagnation and subsequent bacterial proliferation in the colon and maintain harmony of the intestinal flora in promoting optimal health.

Colonic irrigation is not a cure-all, but an important complementary therapy in the overall health care of the client. The colon hygienist may gently manipulate the abdomen during the procedure to enhance the removal of waste material.

The standard enema and colon hydrotherapy treatment both utilize the infusion of aqueous substances into the rectum. A standard enema involves the injection of water (one way) into the colon which is retained and evacuated by the patient. Colonic irrigation is instrument controlled continual bathing of the colon for cleansing and therapeutic purposes. There is no offensive odor or health risk to those in contact with sick patients as with enemas and bed pans and the dignity of the client/patient is maintained. The enema's cleansing ability is limited to the area of the rectosigmoid and shorter periods of time because the body's natural wish to expel material from the rectum. Colonic irrigation extends beyond the natural expulsion area to offer greater cleansing and therapeutic benefits.

Variations in enema therapy include: The cleansing enema softens the feces and promotes evacuation of the bowel. The retention enema softens the feces and lubricates the lower bowel and rectum. The carminative enema is used primarily to relieve flatus (gas). The nutrient enema provides liquid nutrition for rapid absorption by the colon and rectum.

Colonic irrigation in itself encompasses all of these forms of enema therapy and benefits can be attained. Various prescribed supplemental solutions, i.e., saline, kayxelate, acidophilus, oxygen etc., or others may be implemented through colon hydrotherapy. (As Prescribed by Physician).

Colonic irrigation not only removes impaction, parasites, intestinal flatus and cellular debris, but is thought to cleanse and rejuvenate the portion of the immune system that resides in the intestinal tract (recent European studies indicate a greater portion located in the intestines than previously recognized). In summary, colonic irrigation provides tubular and cellular drainage outwardly from the rectum and inwardly via the portal and mesenteric lymphatic system.

WHY colonic irrigation?

Diseases and functional disturbances of the digestive organs are the most frequently complained about problems today. The health of most organs as well as our overall well-being depends upon how well our bowel (intestine) functions. A change in diet after many years of wrong eating habits does not assure optimal colon health.

Consider these current Medical Facts:

  • Over 400 million dollars are spent annually on laxatives in the U.S.A..

  • Over 70 million Americans suffer from bowel problems.

  • 100,000 people undergo colostomies each year in the U.S.A..

  • Worms outrank cancer as man's deadliest enemy in a worldwide basis!

  • Colon cancer is the second leading cancer killer in the U.S.A..

  • Over 100,000 Americans die annually due to this disease.

These facts demonstrate that the medical profession recognizes the important part which the colon plays in health and disease. In all sickness, the status of the bowel is inquired into as a matter of routine and a laxative or enema prescribed when indicated.

Research has shown that regular use of refined carbohydrates and lack of fiber in the diet increases the transit time of bowel wastes and stimulate putrefaction in the colon. Both of these factors have been linked to constipation and certain bowel disease such as: Diverticulitis, colitis and colon cancer which has a high success rate for cure with surgical management when detected early. The American Cancer Society has provided evidence in recent years which suggests that bowel cancer is caused by environmental agents such as: pesticides and herbicides sprayed on crops, hormones and antibiotics fed to animals and carcinogenic agents in the air we breathe. Periodic cleansing could minimize exposure of these potential carcinogens to the colon wall.

COMMON CONCERNS ABOUT colonic irrigation

LAXATIVES vs. COLONIC IRRIGATION

Laxatives act as chemical irritants and stimulate the muscular walls of the colon to abnormally contract to expel the irritating substances. It is very easy to become dependant upon these drugs and permanently destroy the normal ability of the colon to eliminate naturally on its own accord.

The oral route of administration is the least optimal method of evacuation of the large intestine. Very important digestive processes occurring higher up in the alimentary tract (stomach and small intestine) are interfered with. Most laxatives and other cathartics precipitate dehydration in the patient. Colonic irrigation alternately fills and empties the colon and would improve the hydration status of the patient.

WHAT ABOUT POSSIBLE ELECTROLYTE DEPLETION IN THE COLON?

Electrolytes, or minerals are elements that are responsible for cell function throughout the body, which also carries an electrical charge. When the body is properly nourished with good quality organic foods containing sodium, potassium and magnesium, the electrolyte level of the colon is replenished as part of the diet.

Some Colonic irrigation Devices allow for supplementation (additive) via the rectum (bifidus, saline, kaycelate, acidophilus etc.) and only at the direction of the physician. It is not recommended to use oil of any kind in your colon hydrotherapy device. Coffee enemas should be done by the client at their own home shortly after getting a colon hydrotherapy session at your office. Providing additives without a physician prescription is considered diagnosing, prescribing and treating and is illegal.

WILL THE INTESTINAL FLORA BE DISTURBED BY COLONIC IRRIGATION?

The intestinal flora are billions of microscopic organisms including: bacteria, yeast, fungi and viruses which inhabit the bowel and play a very important role in health and disease. Bacteria synthesize valuable nutrients. Proper balance of these microorganisms is essential to a healthy colon.

The large intestine is producing bacteria on a daily basis and adherence to proper nutrition will enhance the colon's ability to maintain balance following colon hydrotherapy. The physician may elect to prescribe lacto Bifidus/bacillus culture to facilitate this process and incorporate low fat, cultured, dairy products (yogurt, etc.) into the patient's dietary program.

WHAT ABOUT POSSIBLE CONTAMINATION?

Following a colon hydrotherapy session, the device is thoroughly cleansed and disinfected. A potent germicidal / disinfectant solution is used to properly disinfect the device and its contents are not harmful to the colon environment. When the disinfection is completed, the device is generously cleansed with water clearing the disinfectant solution completely from the device.

The colon hydrotherapy device has several check valves in it to prevent the waste water from returning to the water supply.

In addition, a single-use disposable sterilized packet containing a rectal tube or speculum which is disposed of following each session, ensures against any possible contamination to the client/patient.

INDICATIONS FOR COLONIC IRRIGATION

The history and physical examination of the client would dictate the need for colonic irrigation in the overall treatment plan. Colonic irrigation has been shown to be beneficial for the following conditions:

Acute Fecal Impaction Mucous Colitis

Constipation Fever therapy

Colitis Hyper/Hypothermia

Diarrhea Paraplegics & Quadriplegics (Bowel Training)

Parasitic Infections Prevention

Atonic Colon

Abdominal Distension/Flatulence Preparation for diagnostic

Hemorrhoid (mild to moderate) study of the large intestine

Intestinal Toxemia Barium Enema

Nutrient Supplementation via Rectum Sigmoidoscopy & Colonoscopy

Surgery Diverticulosis

Balance Physiologic Flora of Large Intestine

INDICATIONS UNDER PRESCRIPTION AND DIRECT PHYSICIAN SUPERVISION

Diverticulitis On Site Preparation Following Trauma

Ulcerative Colitis Early Pregnancy (up to 4 mos.)

Crohn's Disease

CONTRAINDICATIONS FOR COLON HYDROTHERAPY

Severe Cardiac Disease Cirrhosis

(uncontrolled Hypertension or Carcinoma of the Colon

Congestive Heart Failure) Fissures/Fistulas

Aneurysm Pregnancy, first & third trimester

Severe Anemias Abdominal Hernia

GI Hemorrhage/Perforation Recent Colon Surgery

Severe Hemorrhoids Renal Insufficiency

PREVENTION

Colon cancer is the second leading cancer killer in the United States.

Colon cancer appears more frequently in women and rectal cancer has higher occurrence in men. Periodic cleansing would minimize the exposure of potential carcinogens to the colon walls, would dilute the toxin concentration in the cecum and facilitate the removal of same. The result is a reduced load on the portal (liver) and lymphatic system allowing the five eliminative organs of the body (skin, lymph, lungs, kidneys, and bowel) to balance the removal of these toxins with their production. When a breakdown in one or more of these systems exist and toxins abound, the potential for disease exists.

Research has shown a definite connection between the nature of the diet and type of flora in the intestines. A diet high in protein results in predominately proteolytic putrefactive bacteria which produce toxic compounds, some of which are absorbed. Alteration of the physiologic flora (balanced) can predispose to the development of 36 of these bacterial toxins. The physiologic (normal) flora is speculated to consist of 30-40% gram negative bacillus and 30% acidophilus. The pathogenic flora consists of streptococcus, staphylococcus, E. coli, bacillus welchi, etc., which are present normally in small numbers. Where conditions exist that alter this proposed balance, the pathogenic flora can flourish and be a source of disease.

Small amounts of proteins, fats, and carbohydrates escaping digestion in the small intestine may be digested by bacterial enzymes which are capable of breaking down (cellulose) and synthesize certain vitamins of the B-complex and vitamin K. The E. Coli bacteria is able to split triglycerides (fatty acids). The products of putrefaction may be absorbed in small quantities by mucosa and transported to the liver, via the blood, where they are detoxified to be excreted by the kidney in the form of sulfates and glucuronide. The material which remains in the colon and is eliminated in the feces contain indole and skatole, mercaptan, hydrogen sulfide and bacterial end products of cystine, which gives the feces an unpleasant odor. The color of the feces is due to bacterial action on stercobilin (bile pigment).

Some ammonia is formed by bacteria in the intestine, mainly from digestive products of proteins and converted to urea in the liver. In liver disease such as cirrhosis, increased levels of ammonia in the vascular system causes severe neurological symptoms resembling hepatic coma. A low protein diet may ameliorate these symptoms. Cleansing the colon serves to dilute and remove the toxin concentration in the large intestine and respective blood supply.

Observations have been made that a change in diet from high protein to high carbohydrate results in dominance of a non-putrefactive flora. Other evidence has shown that ingestion of fermentable carbohydrates (glucose, fructose, lactose) results in delay of or complete inhibition of the putrefactive process.

The liver is the main detoxification organ of the body. The hepatic (liver) portal vein drains the gastrointestinal tract, gall bladder, pancreas and spleen. The blood retrieved from the stomach and intestines is not returned to the heart but shunted to the liver where portal blood is discharged into sinusoids of the liver which are surrounded by liver cells. In addition to removing, altering, storing, and delivering to the body digested fats, carbohydrates, proteins, vitamins, and minerals, hepatocytes (liver cells) will detoxify any toxins (poisons) present and remove them from the system. The problem arises when toxins are present in too great a number to be adequately handled by the liver. (Phenol and

skatol normally escape liver action) As with any organ or system in the body, the liver has a certain capacity for performing these functions of metabolism. When an unusual burden is placed on any one system, a breakdown occurs that affects the body as a whole. This breakdown results in an increased absorption of toxic substances and if left uncorrected, the body will poison itself (Autointoxification).

Intestinal cleansing is a therapeutic measure which addresses the cause or source of the problem. Other measures which treat only the symptoms will provide only temporary relief of this problem.

Colon hydrotherapy would clean and dilute the toxin load in the large intestine resulting in a reduced burden on the liver and allowing the various eliminative organs of the body in conjunction with a rejuvenated immunological system to restore internal balance and improve the overall health of the individual.

ANATOMY AND PHYSIOLOGY OF THE DIGESTIVE SYSTEM

Every cell in the human body needs carbohydrates, fats, proteins, vitamins, water, and minerals to perform the daily metabolic processes involved in maintaining a living system. Most of these substances are extracted from the food we eat as it passes through the alimentary tract, i.e., the tube that begins with the mouth and ends at the anus. The main function of the alimentary tract is to transfer these materials from the external environment to the internal environment and elimination of food.

Food items are not absorbed in their ingested state. They must be broken down into smaller molecular components before this transfer can occur. This process is called Digestion, and may be through mechanical or chemical means. Absorption refers to the movement of small molecules from the alimentary tract, into the blood and lymphatic vessels.

The anatomy and physiology of the alimentary tract will be discussed in the order that food passes through it. Accessory organs and glands will be discussed when appropriate.

MOUTH

The mouth is the first division of the alimentary tract whose major function is that of getting food into the system. Mechanical breakdown of non-liquid food by chewing (mastication) helps mix food with saliva which, allows for comfortable swallowing, and allows further digestion to reach a more complete state.

Saliva is produced by three paired glands, the parotid, submandibular and sublingual salivary glands. It is 99.5% water; the rest is plasma salts, and proteins (some of which are enzymatic). Following is a list of several functions which have been attributed to saliva: 1) the mucoprotein content aids in lubricating the mouth and in swallowing: 2) the water content acts as a solvent which makes taste possible; 3) its bicarbonate and phosphate buffer systems maintain a slightly acid environment in the oral cavity; 4) its lysozyme component prevents bacterial buildup in the oral cavity; 5) its amylase (ptyalin) content initiates the digestion of carbohydrates. Digestion in the mouth is inefficient at best as amylase works best in neutral or slightly alkaline conditions; plus, food is present in the mouth for only a short period of time. The irregular rough ridges or folds on the hard palate, roof of the mouth, are called rugae.

PHARYNX, ESOPHAGUS, AND SWALLOWING

There are three stages to swallowing: 1) the voluntary forcing of food from the oral cavity into the pharynx; at this point swallowing becomes a reflex action; 2) the passing of food from the pharynx to the esophagus; pharyngeal nerves stimulate the trachea, eustachian tubes and the posterior opening of the nasopharynx to close while the tongue prevents food from reentering the mouth such that the only place left for the food to go is into the esophagus; 3) the passing of food from the esophagus to the stomach is aided by gravity. Muscular contractions (peristalsis) push food from one end of the esophagus to the other. This occurs through alternate contractions of circular and longitudinal muscles in the esophageal wall.

The last four centimeters of the esophagus is the cardiac sphincter, a muscular valve preventing the stomach contents from reentering the esophagus. Most of the esophagus (about 9 inches) lies within the thoracic cavity and is subject to subatmospheric pressures as are the lungs. The cardiac sphincter lies below the diaphragm and is subject to pressure which is 5 to 10 mm of Hg higher than that of the atmosphere. This higher pressure would force the stomach contents back into the esophagus if the cardiac sphincter were not present.

STOMACH

The stomach is an enlargement of the alimentary tract located inferior to the diaphragm. It is a J-shaped organ and can be divided into four regions: 1) the cardia is the immediate region surrounding the cardiac sphincter; 2) the fundus is the bulbous portion to the left and superior to the cardia; 3) the body is the lower central portion of the stomach; 4) the pylorus is the region adjacent to the pyloric valve which separates the stomach from the small intestine. The outer border of the J-shape is referred to as the greater curvature and the inner border as the lesser curvature.

The stomach serves as a food reservoir, a site for mechanical and chemical digestion, and as an absorption site for alcohol, water, and some salts. Two to three liters of gastric juices (water, salts, mucins, HC1, pepsin, rennin, and perhaps gastric lipase) are secreted by the stomach each day. Secretions arise from gastric glands located in the stomach's mucosal layer. They are composed of chief cells which secrete pepsin and rennin, parietal cells which produce HC1, and mucous cells which secrete mucin.

Pepsin is the major enzyme in the stomach . It is responsible for reducing proteins to proteoses and peptones. It is secreted in an inactive form, pepsinogen, which is activated in the presence of HC1. Rennin acts on the milk protein casein and has a curdling effect on the milk. This enzyme is more highly concentrated in the stomach of infants, than adults. Rennin is present in adults, but not in great amounts. Gastric lipase as the name suggests is found in the stomach, but no evidence is present which suggests that it is produced there. Concentrations are so low that it is now thought to arrive via the pyloric sphincter from the small intestine. In any event it is only capable of breaking down fats to triglycerides. Mucins are secretions from the pyloric mucosa that combine with water to form mucus. This forms a protective barrier against enzymes on the inner lining of the stomach.

Enzymatic secretions are under nervous and hormonal control. Sight, smell and the taste of food will also initiate gastric secretions via vagal nerve stimulation (= Cephalic Phase). Undigested food in the stomach initiates gastric secretions and muscular contractions of the stomach (= Gastric Phase). When food is present in the stomach, gastrin, a hormone of the pyloric mucosa, is released into the blood. It is this hormone that initiates the muscular contractions and secretions mentioned above. As the final mass of partially digested food (i.e., usually this is undigested fats) passes from the stomach to the intestine, the intestine produces a hormone, enterogastrone, which now inhibits gastric movements and secretions (= Intestinal Phase).

The acidity of the stomach (ph = 1.0) is due to a high concentration of HC1. Hydrochloric acid activates pepsinogen. curds milk, plays a minor role in protein digestion (i.e., swells and softens protein), and kills almost all of the bacteria present in the food bolus obtained from the esophagus.

SMALL INTESTINE

The small intestine is approximately twenty-three feet (7m) in length and can be divided into three regions, the duodenum, the jejunum, and the ileum. It begins at the pyloric-valve of the stomach, ends at the ileocecal valve between the ilium and cecum, and has an average diameter of about one inch. The inner absorptive surface area is increased tremendously by millions of fingerlike projections, villi. which are present throughout, and by plicae circulares which are deep circular folds in the mucosa of the intestine.

Three types of intestinal movements have been described. Peristalsis is a slow, wavelike muscular contraction that pushes chyme through the tube. Rhythmic segmentation involves circular muscle contractions at alternate points around the chyme; this helps mix the chyme and the intestinal juices. Pendular movement involves the alternate contraction of circular and longitudinal muscles in the intestine; this also increases the mixing of chyme and intestinal juices.

Most of the digestion and a majority of the absorption occurs in the small intestine . Acid chyme from the stomach is neutralized in the intestine by pancreatic, liver and intestinal secretions. This occurs such that the ph of the intestine is continually increasing from the duodenum to the ileocecal valve.

Glands of the small intestine (Crypts of Lieberkuhn) are located in its mucosal -layer. The endocrine secretions, enterogastrone, has already been discussed. Other hormones which are indirectly related to digestive activities are secretin, pancreatin, enterocrinin, and cholecystokinin. Chyme entering the small intestine stimulates the secretion of these hormones.

Secretin and pancreatin stimulate the secretion of pancreatic juices, enterocrainin stimulates the secretion of digestive enzymes from the small intestine, and cholecystokinin stimulates both the contraction of the gallbladder and the relaxation of the sphincter of Oddi; this sphincter controls the flow of bile and pancreatic juices from the common bile duct into the duodenum.

The exocrine secretions of the small intestine are digestive in nature. Enterokinase activates pancreatic trypsinogen (inactive trypsin) so that protein digestion may proceed. Trypsin is involved with the final break down of amino acid chains. Weak amylase aids in the break down of complex sugars to disaccharides. Maltage breaks down maltose into glucose.

Sucrase breaks down lactose into glucose and galactose. A final intestinal secretion is released from Brunner's Gland. It is a mucous secretion which protects the intestinal lining from the acid chyme. Besides their digestive and protective qualities, the intestinal juices aid in the transport of undigested material.

LIVER

The liver (figure 7) is the largest organ in the body and is located directly below the diaphragm. It is a multilobular organ, but can be grossly divided into right and left regions. It has several important functions, only one of which is related to digestion. However, several of these functions merit mentioning. They are: 1) heparin production which helps prevent blood from clotting in the vessels, 2) removal of dead and malfunctioning red blood cells from the circulatory System, 3) removal of toxins from the blood. 4) storage of absorbed nutrients, 5) storage of trace metals (copper and iron) and vitamins (A,D,E, and K) which are necessary for daily metabolic activity, and 6) production of bile which aids in the digestion of fats.

Bile, yellow to green in color, is produced by hepatic cells from cholesterol. It is composed of bile salts, bile acids, lipids, and the pigments biliverdin and bilirubin. These pigments are products of red blood cell degradation and must be removed from the circulatory system. If they cannot be removed, the body will develop a pale yellowish tinge to its skin, a condition known as jaundice. Besides its excretory properties, bile is responsible for the emulsification of fats and the partial neutralization of chyme. Fatty acids and glycerol can only be absorbed in the presence of bile salts. Attached to the underside of the liver is the gall bladder, within which excess bile is stored.

THE LIVER AND LYMPHATIC SYSTEM

Much has already been mentioned with respect to the liver and its various functions. Here, concentration will be on the defensive function of the liver, hepatic malfunctions attributed to intestinal toxemia and subsequent infection of other organs due to liver disability.

The liver and the lymphatic system have been designated as the second line of defense against bacteria and their toxins. The first line of defense is naturally the mucosal lining of the alimentary tract. If bacteria or their toxins penetrate the mucosal layer they can enter either 1) the lymphatic system where they may be attacked by various types of bacteriophages or 2) the portal system where they travel directly to the liver. Temporary increases in the toxic load of the portal vein occur during conditions of stasis, dietary insufficiencies and the flu. Any prolongation of this state will damage the detoxifying and bacteriolytic function of the liver. The importance of this function cannot be overlooked once one realized the strategic position of the liver with respect to the circulatory system. All of the "toxic" blood enters the liver for cleansing before it is sent to the rest of the body. At this point, Wiltsie states that anything which will cleanse the colon of bacteria and toxic material should also be beneficial by relieving the liver of some of its duties. He suggests that colon therapy would be advisable for liver and biliary malfunctions.

Dr. Wiltsie contends that gastrointestinal abnormality almost always preceded liver and spleen infections. Toxins naturally enter the liver in the form of digestive end-products (ammonia, urea, skatol, indole, phenol, etc.). These can be handled. It is the excess that puts the strain on the liver, i.e., pathogens from vicious circles, initiated by other infections.

A competent liver forms an effective barrier between intestinal toxins and general circulation. Liver function may be overtaxed just by material from other focal infections and material that was not removed by the lymphatic system. This could lead to hepatic malfunction which allows intestinal toxins and bacteria to pass through the liver unscathed.

Biliary function was once thought to be independent of liver disease. It is now being looked upon by several physicians as a secondary infection to that of the liver, which is manifested through the circulatory system. Lymph channels common to the bladder and the liver may be another source of disease transmission. Infected bile produced by a diseased liver will eventually be transmitted to the intestine to start the cycle again. Ruffin emphasizes that almost all gallbladder diseases are associated with intestinal disturbances (usually a form of stasis) and liver disorder of one type or another. In other words, he is stressing that if a disorder is found in one of the three, there is likely to be problems with the other two.

A liver which cannot handle toxins from the intestine, other focal infections, including the products of necrosis of its won cells, transfers the burden of detoxification onto another organ, the kidney. Unfortunately, the kidney did not evolve to reduce the amount and kind of toxins that enter the liver, or to detoxify them as efficiently as the liver. What toxins the kidney does remove from the blood often begin to necrose the renal tubules and eventual renal failure ensues. Thus, it should not be surprising that chronic intestinal disorders lead to liver, kidney, heart, artery, joint, and skin disorders as well.

The remaining front in the second line of defense, the lymphatic system, is concerned with the removal of solid materials (i.e., water insolubles) from the intestine. These substances are picked up by the lymphatic system even if the latter is not capable of detoxifying all of them. This leads to a spread of toxins through the lymphatics, several of which travel to the duodenum, stomach, and gall bladder.

Incomplete detoxification by the lymphatic system will allow pathogenic material to enter the circulatory system. With the breakdown of the second line of defense, it is only a short time before intestinal toxemia ensues.

PANCREAS

This organ is located between the greater curvature of the stomach and the duodenum. It is both an endocrine and exocrine gland. It is composed of granular-like epithelial cells forming two masses, 1) the Islets of Langerhans which produce endocrine secretions involved with sugar metabolism and 2) the Acini which secretes digestive enzymes of exocrine origin. Since the pancreas is not part of the small intestine it must transfer its digestive enzymes through the pancreatic duct (Canal of Wirsung) to the common bile duct. The latter enters the small intestine in a small enlarged area called the ampulla of Vater.

Pancreatic juice is composed of 1) trypsinogen, chymotrypsinogen, and procarboxypepsidase, the inactive forms of trypsin, chymotrypsin, and carboxypeptidase respectively; they are responsible for the total breakdown of complex sugars to disaccharides, 2) lipase which reduces fats to fatty acids and glycerol, and 3) bicarbonate ion (HC03-) which raises the ph of the intestine by neutralizing the HC1 from the stomach. All intestinal enzymes are most active at a ph greater than 7.0.

LARGE INTESTINE

The large intestine (figure 8) is the part of the alimentary tract extending from the ileocecal valve to the anus. It is approximately five feet long and has an average diameter of 2 1/2 inches. The large intestine can be divided into five regions: the cecum. ascending, transverse, descending and

sigmoid colon. The cecum. is a blind pouch which receives chyme from the ileum through the ileocecal valve. It has the largest diameter (3 to 3.5 inches) of the large intestine and is the least motile, but does occur in various abdominal positions. A small, wormlike tube, the vermiform appendix is attached to the cecum. Inflammation of this structure is referred to as appendicitis.

The ascending colon, approximately 8 inches long, arises from the cecum on the right side of the abdomen and extends upwards to a position behind the liver. It curves to the left at the hepatic flexure and becomes the transverse colon (approximately 16-20 inches long) which extends across the abdomen. This region exhibits the most colonic movement. It extends inferiorly at the splenic flexure to the level of the iliac crest. This is the descending (approximately 10-12 inches long). The colon turns toward the midline at the iliac crest in a form resembling the letter S. This turning point is the sigmoid flexure and the region is that of the sigmoid colon (approximately 16 inches long). The sigmoid colon empties into the last part of the large intestine, the rectum (approximately 4 to 7 inches long). Three semilunar valves (Valves of Houston) are present in the mucosal layer of the rectum which slows fecal movement through this region. It is not designed to serve as a reservoir, but normally is empty unless defecation is occurring. Generally the descending and sigmoid colon evacuate at the same time. The last two to three inches of the rectum is referred to as the anal canal. Its lining is not of mucus but squamous epithelium. Several blood vessels are present in this region and their inflammation is known as piles or hemorrhoids. An external sphincter muscle is located at the distal end of the canal and an internal sphincter at its proximal end. The former is under voluntary control while the latter is an involuntary muscle. The opening of the anal canal to the exterior is the anus, through which fecal matter is voided. Levator ani muscles assist the above sphincters during defecation.

Intestinal movements are of four types, haustral churning, peristalsis, mass peristalsis, and antiperistalsis. Haustral churning involves the filling, distension and contraction of a haustrum. This moves chyme from one haustrum to the next. Peristalsis is the slow wavelike contractions of the longitudinal and circular muscles which also aids in the forward movement of the chyme. Mass peristalsis refers to strong peristaltic contractions in the sigmoid colon which pushes its contents into the rectum, prior to defecation. Bastedo and others have observed a rare yet fourth type of intestinal movement. It is described as antiperistalsis, i.e., peristaltic contractions in the direction of the cecum. It is hypothesized that this holds back colon contents for a while so that nutrients may be absorbed in the cecum, ascending colon and small intestine. The large intestine is bigger in diameter. It contains several "pockets" (haustra), and it has more longitudinal muscle bands (taeniae coli). The small intestine has villi and plicae circulares which are absent in the large intestine.

Most of the digestion and absorption is complete by the time the chyme reaches the cecum. The major function of the large intestine is the formation and elimination of feces. Feces consists of undigested food residues, intestinal epithelium and mucus, bacteria, and a large amount of water. Ranklin, Bargen and Buie consider the colon to be divisible into right and left halves. The right portion is concerned with digestion and absorption while the left portion is concerned with storage of intestinal debris. The ileocecal valve permits unabsorbed material to enter the cecum and prevents colon bacteria from entering the ileum.

Colon bacteria ferment starches, releasing hydrogen, carbon dioxide and methane gases, and convert any left over protein into amino acids. These products are then converted to indoles and hydrogen sulfide which give the feces its odor. Bilirubin which entered the intestine in the bile is broken down into other pigments by bacteria and is responsible for the normal coloration of feces (i.e., brown). Light, clay colored stools indicate biliary deficiency or blockage. The amount, composition, color and odor of feces depends on the food ingested. A diet consisting of many vegetables will produce a large amount of feces, generally dark yellow. A high protein diet will produce a small amount of very dark feces. In a mixed diet the bulk will vary but the feces should generally be brown. Very black stools indicate upper intestinal pathology. The black is from blood which has traversed a long distance through the intestine.

Bacteria are also involved in the production of several important vitamins which are absorbed by the large intestine and stored in the liver (K and B vitamins). Besides vitamins, the colon absorbs large amounts of water (cecum and ascending colon). Unfortunately, toxins of bacterial metabolism are not prevented from entering the circulatory system as well. These (indol, skatol, cresol, phenol and others) are treated by the liver and excreted by the kidneys. Hydrogen and methane gasses absorbed in the colon are excreted through the lungs. Thus, a very foul breath is often a symptom of a stagnant and fermenting colon. Besides lubrication, mucus is secreted by the large bowel in an effort to mechanically prevent the entrance of toxins into the blood.