To Hans, PC - Dr Gershon's book "The Second Brain"

Hi Hans and PC,
Jackie put me on to this wonderful thought provoking book called “The Second Brain” by Michael D. Gershon, M.D.
The book is all about the enteric nervous system (ENS) or “second brain” as Dr Gershon likes to call it. Dr Geshon is widely regarded as the father of the emerging field of neurogastroenterology. I don’t know if you or PC have already read this book?

As you remember, I initiated the conference topic number 30, “LAF and the Enteric Nervous System” in 2004 but unfortunately this topic went nowhere due to the sheer complexity of the ENS and lack of knowledge by all concerned.
Dr Gershon’s book covers the ENS in great detail with a particular emphasis on nerves and how each organ of the digestive system communicates in various ways with the central nervous system (CNS) and ENS via the vagus nerve. He has written the book with the lay person in mind but it is still very technical.
His goal is to cure functional bowel disease with particular emphasis on Irritable Bowel Syndrome (IBS) suffered by 20% of the population. Hans, I know you suffer from IBS so this book would be of great interest to you. For example, he writes this about IBS:

“There are, for example more nerve cells in segments of gut affected by inflammatory bowel disease. Since nerve cells do not proliferate, how can this happen? Are these additional nerve cells the products of precursors that are retained in the enteric nervous system of adults, or were they preexisiting? Could it be that too many nerve cells in particular regions of the gut is a cause of inflammatory bowel disease?”

So, Hans, you now have two maladies caused by “too many nerve cells”, LAF and IBS. A bit more than coincidental?

About the ENS he states:
“Once I learned that enteric nerve cells talk to gall bladder ganglia, I felt sure that they were also going to make themselves heard in the pancreas”

While reading this book, always in the back of my mind was the question………Can our rouge P cells in our hearts communicate in some way with the ENS through ENS nerotransmitters released in the blood stream? Do P cells have dual capability?

Dr Gershon spends a lot of time explaining the development of the ENS from the foetus onwards and the role of the neural crest. When I was reading this I thought I was reading PC’s neural crest theory for the origin of rouge P cells that he wrote about in one of the old conference topics. Dr Gershon is thinking about the ENS and functional bowel disease along the same lines as PC thinks about P cells. Very interesting indeed. I hope PC reads this book.

Anyway, enough of my ramblings. It’s a good read and very educational for afibbers who think their digestive systems may be linked to their LAF. If you don’t understand about the autonomous nervous system, the ENS, the CNS and the vagus nerve you will definitely know all about it after reading this book.

This is a website about Dr Gershon and his latest research and contact details. As some of us on afibbers have already purchased his book it would be good if he could return the favour and give his opinion regarding the effect the ENS could have on afib.

[cpmcnet.columbia.edu]

Dean

Great report, Dean. I have the book but haven't made much progress in reading, unfortunately. Now after your post, I'm motivated to pick it up and begin again.

Much to contemplate, for sure.

Regards, Jackie

Thanks Dean - I ordered a copy just now.

George

Aloha Dean,

Curious thing about us lone afibbers – we’re always thinking about the why of it. You more than anyone else has touted the GI connection, and the ENS is clearly inextricably entwined with the LAF puzzle.

We did discuss P cells, which are also of neural crest origin, in CR Sessions #35 and #51. Is there a connection between P cells, which are increased in AFers according to Natale et al., and the ENS? I’m afraid that the more I read the more questions I have; so, “The Second Brain” should create a cornucopia of questions.

I have discussed P cells with Prof Haissaguerre and he is lukewarm at best on their presence and/or contribution to AF. He feels that the variation in muscle fiber orientation at the PV-LA junction is sufficient to explain reentry. But this ignores the atrial ectopy arising from the PVs, esp. in LAFers. Perhaps primitive neural crest cells that migrate to this area differentiate into P cells only later when stretched (hypertension, mitral stenosis or regurgitation, CHF, etc.). Just more questions.

Etiology of IBS (inflammatory bowel syndrome) is about as clearcut as LAF. Just another thing they appear to have in common. Could P cells communicate with the ENS through neurotransmitters released into the bloodstream? I personally think that the close proximity of epicardial vagal ganglia (also of neural creat origin) with the esophagus is more than coincidental. Rather than communication via hormones perhaps a direct neural reflex arc is involved. You may have heard me mention ‘innocent bystander effect’ several times in past posts (see above CR sessions). Whether this happens in the midbrain or locally near the lower esophagus is a mystery.

The ENS is essentially synonymous with the vagus nerve AKA ‘the wanderer’. Although I believe in a strong correlation between the ENS and LAF, clearly there are many with IBS that don’t have LAF and vice versa. More likely IBS is a potentiator with other factors required for expression of LAF IMHO.

Hello Dean,

Dr. Gershon's book sounds most interesting and I hope I can find the time to read it. I remember briefly looking into the gut/brain/LAF connection when I did the research for my first book. Here are are couple of excerpts from the book that may add to your observations:

"Researchers at the University of Pittsburgh have found that the cardiac control center is located very close to the origin of the vagus nerve in the brain stem. This could explain the link between diverticular disease and atrial fibrillation and opens up the possibility that intestinal problems in general could lead to the activation of the vagus nerve which, in turn, would activate a cascade of central responses perturbing the cardiac rhythm" (page 161)

"Irritable bowel syndrome (IBS) has been linked to an ANS dysfunction, specifically an enhanced vagal response." (page 162)

"In 1993 Swedish researchers reported that patients with Crohn's disease had a sympathetic (adrenergic) dysfunction whilst those with ulcerative colitis had a primarily vagal dysfunction" (page 163)

Actually my IBS has pretty well disappeared. Has this anything to do with my successful PVI? Very interesting question. And by the way inflammatory bowel disease (Crohn's disease and ulcerative colitis) is different from irritable bowel syndrome (IBS) with the former being significantly more serious.

Hans

And where does Leaky Gut caused by antibiotics, etc. fit in here?

Lois

Lois - leaky gut is caused by multiple things. When there is intestinal permeability (leaky gut syndrome), the protein molecules of food enter the blood stream and are viewed by the body as invaders - or antigens. This calls for an anti-body response. In some cases, this response can produce rather severe symptoms. (See Conference Room Session #54 regarding gluten proteins and the body's reaction) as just one example but note specifically the conditions that are a result of that response.

Inflammation is the key issue. Gluten is only one such initiator of the antigen/antibody response.

Following is a post I did back in March '03 that follows along this line. If I were submitting this report today, I'd be making a few changes in brand recommendations for probiotics and digetive enzymes, but this gives the general idea.

It's easy to understand how an irritated gut could be a significant influence over health and our heart when an irritated vagus is involved.

Jackie




Digestive Wellness – What You Need to Know

by Jackie Burgess, RDH


It is well recognized by holistic physicians that proper digestion, absorption, assimilation, and elimination of foods is the key to health. No matter how good, pure, or complete the foods and nutrients consumed are, unless they are broken down so the body can absorb and assimilate them into cells, a person will suffer from malnutrition and enjoy less than optimal health. So says Dr. Jeffrey Bland, noted lecturer and author on health and nutrition. Over 20 million Americans suffer from various digestive disorders which impair their nutrition, he reports[1].

Cardiologist, Stephen Sinatra says, “Sad but true, there are millions of people out there—many of them healthcare providers—who don’t fully appreciate the impact that digestive problems can have on the major diseases that afflict us today. Mainstream medicine, in fact, is ten years behind the times when it comes to understanding how interrelated the body’s organs and functions really are.”

Poor digestion can set you up for many diseases. Says Dr. Sinatra, “Indigestion is a little recognized symptom of impending heart problems. One of its symptoms, excessive gas, causes bowel distension which presses against organs that have a direct connection with your heart. A heavy meal may shunt so much blood over to the stomach that a person with coronary blockages can be more prone to angina following such a digestive overload[2].”

A thorough understanding of the functional aspects of digestion is best accomplished by reading any of the several recommended books because the topic is so extensive. This article discusses less than optimal digestive functioning and points out its symptoms and consequences. Its goal is to heighten awareness that many chronic conditions or diseases have origins in faulty digestion, absorption and, ultimately, elimination of toxic waste. Scientific evidence exists to support that allergies, all types of arthritis, asthma, chronic fatigue, irritable bowel syndrome, eczema, psoriasis, and migraines, to name a few, have origins in digestive disorders[3,4].

In children, the digestive abuses frequently manifest as allergies and conditions such as colic and ear infections. As we mature, our body adapts and does the best it can with the lifestyle choices we give it.

Eventually, when poor choices are made over cumulative years, conditions develop for which mainstream medicine has little to offer in the way of cure or reversal, but rather we are placated with masking drugs— inhalers for asthma, antihistamines for allergies and steroids and antibiotics when all else fails. These remedies are only cover-ups, they are seldom a cure.

Major contributing factors to digestive ailments are:

• “Leaky gut” syndrome,
• Inadequate digestive enzymes,
• Inadequate stomach acid,
• Imbalance of intestinal flora,
• Inadequate dietary fiber intake,
• Environmental influences such as stress. In fact, along with the skin, the digestive system is the most common expression site of stress-related illnesses[5].


“Leaky Gut” Syndrome
In the process of digestion, food not broken down adequately by chewing, acid in the stomach and digestive enzymes added along the way, arrives in large molecules in the small intestine where absorption of nutrients takes place. The integrity of the intestinal wall can become damaged by incompletely digested food lying in a stagnant state where it putrefies and produces toxins which create intestinal wall inflammation. This inflammation creates tiny tears in the intestinal wall. A compromised intestinal wall allows large, partially digested molecules of fats, proteins and carbohydrates to flow through to the blood stream.

The immune system identifies these large particles as “foreign invaders” and signals for the manufacture of antibodies to the invader-antigens.

Over time, repeated “leaking” of the same food molecule through the intestinal wall causes an allergic reaction often manifesting as sneezing, flushing, coughing, hives, and headache. This is termed the “leaky gut syndrome.” People commonly have these reactions to many foods but fail to make the connection.

It’s interesting to observe the frequency of people in restaurants having reactions like coughing, sneezing and wiping eyes after or during a meal. The problem is exacerbated by habitually eating the same foods daily, weekly, yearly.

In children, food sensitivity can be signalled by ADD (attention deficit disorder), behaviour problems and recurring ear problems[6].

The path to digestive wellness begins with thorough chewing followed by adequate stomach acid production along with enzymes required to breakdown protein, fat and starch, and abundant “good” intestinal bacteria.


Digestive Enzyme Deficiency
When your body doesn’t produce enough enzymes to break down food for proper digestion, instead of nourishing, this food poisons your body. It stagnates in the bowel and becomes toxic—the origin of many illnesses and disease.

Our lifestyles of eating too many cooked, microwaved and irradiated foods kill live enzymes essential to health. Most everyone can benefit from supplemental enzymes; and, especially those over age 50, since this is about the time digestive systems begin to fail to some degree.
Supplementation helps spare the pancreas from overwork.

Some reliable brands to take at the beginning of each meal include[7]:

- Essential Enzymes by Source Naturals
- Mega-Zyme (pancreatic enzymes) and Pro-Gest-Aid (mixed enzymes) by Enzymatic Therapies
- Super Enzymes by NOW
- Cotazym or Zypan (prescription medications).

There is some indication that pancreatic enzymes (especially amylase) work better if the content of the capsule is sprinkled on the food prior to eating rather than swallowing the capsule whole.


Adequate Stomach Acid
One common cause of poor digestion is an inadequate level of stomach acid. Some symptoms of this condition are:

• Burping,
• Fullness for an extended time after meals,
• Bloating,
• Poor appetite,
• Stomach upsets easily,
• History of constipation,
• Food Allergies,
• Weak, brittle fingernails,
• Rosacea,
• Hair loss in women

An adequate level of stomach acid (gastric acid or hydrochloric acid [HCl]) is essential. The digestive enzyme, pepsin, is activated by HCl. Pepsin breaks down proteins and thereby releases vitamins, minerals and other nutrients into a “digestive soup” which eventually will be absorbed into the blood stream.

Gastric acid (HCl) is a barrier against infection. Bacteria, viruses and fungi inhaled or ingested are normally destroyed in the stomach. It is the first line of defence against food poisoning. Low stomach acid allows bad bacteria to flourish and interfere with nutrient absorption[8].

With all the ads we see on TV promoting antacids to “neutralize excess stomach acid,” it may seem hard to believe that too little acid may be as big a problem as too much. But, symptoms of hypo-acidity often mimic hyper-acidity. Often, the very problem we try to correct, gas and bloating after meals is actually the result of too little HCl and is compounded by what we do—take antacids[9].

Disease conditions caused by low stomach acid include asthma, chronic hepatitis, diabetes, eczema, osteoporosis, thyroid disorders, gallbladder disease, vitiligo, various rheumatic conditions including rheumatoid, lupus, Sjögren’s and weak adrenals[10].

The negative effects of low stomach acid production can be ameliorated by taking betaine hydrochloride capsules with each meal.

Interesting dental note: Hypochlorhydria (low stomach acid) may result in reduced absorption of calcium, magnesium, copper, folic acid and other nutrients related to osteoporosis prevention. Stomach acid production was measured in 79 people aged 16 to 53 years. Those with evidence of alveolar bone loss produced less than half as much HCl as those without alveolar bone loss[11].

Imbalance of Intestinal Flora
There are 400 types of bacteria in the digestive system numbering 100 trillion and weighing about four pounds. They all thrive together in symbiotic or antagonistic relationships and manufacture substances that raise and lower our risk of disease, cancer, immune competence, nutritional status and rate of aging.

Some cause acute or chronic illness and others offer protective and nutritive properties. The latter, the friendly bacteria, are known as intestinal flora or “probiotics” meaning “healthful to life.” It is these bacteria we want to nurture because they, in turn help keep us well[12]. Over-consumption of colas, coffee and alcohol disturbs the acid-base relationship in the bowel and this can also lead to an overgrowth of bad bacteria. Bad bacteria discharge nasty toxins, many of which are carcinogenic. A toxic bowel can initiate a chain of reactions resulting in digestive problems which ultimately lead to immune dysfunction, allergies, skin rashes, osteoporosis, high cholesterol, chronic fatigue, vitamin deficiencies, bad breath and cancer of the colon[13].

Good bacteria help with the absorption of nutrients and are involved in the manufacture of several vitamins. The balance is disrupted by processed foods, excess sugar and carbohydrates, and flour products along with a diet heavy in red meat and saturated fats. Too much animal protein putrefies in the bowel. It actually breaks down into carcinogens inducing the worst cancer-producing chemicals around—phenolic compounds[14].

Antibiotics wipe out all intestinal bacteria—good and bad—and allow an overgrowth of the yeast, Candida. Steroids (like Prednisone), birth control pills and chlorinated water seriously impact the friendly bacteria in a negative manner[15].

Probiotic Supplements
Supplementation with friendly bacteria, called probiotics, helps insure the proper balance in the intestinal flora. Probiotics produce natural chemicals that kill harmful bacteria and prevent many illnesses and fatal diseases. A popular phrase, “death begins in the colon” stems from these facts about bowel physiology. The bowel must have more good bacteria than bad and because of lifestyles and aging, everyone can benefit from daily probiotic supplements[16].

Some reliable brands are:

- DDS-Plus by UAS laboratories. (Acidophilus, Bifidus, FOS – Non-dairy. Refrigerate) and DDS-Junior
- Kyo-Dophilus, Flora Balance, and Healthy Trinity by Natren.

Take them upon arising and between meals so they aren’t subjected to excessive acidity from meal activity.

It is wise, also, to take probiotics whenever taking antibiotics is unavoidable. Obviously, take at different times from the antibiotic. In cases of diarrhea, it is also helpful to take additional doses of probiotics.

Friendly bacteria label names include: for infants and toddlers, bifido bacteria infantis; for children and adults— lactobacillus acidophilus, bifido bacterium bifidus longum, lactobacillus bulgaricus in a base of FOS (fructo-oligosaccharides) a carbohydrate to support bacterial proliferation. FOS is a prebiotic that fertilizes probiotics. Food prebiotics are in barley, wheat, rye, tomato, garlic, onion, bananas and whey.

Just think of gardening. Adding pre-and probiotics to your diet is just fertilizing the good bacteria so they grow healthy and crowd out the bad....just as in fertilizing the lawn to crowd out weeds.

Inadequate Dietary Fiber
The longer between bowel movements, the longer toxins and bile acids accumulate and irritate the lining of the colon causing health problems of the colon such as constipation, appendicitis, diarrhea, diverticular disease, Crohn’s disease, colitis, polyps, colon cancer, irritable bowel syndrome, parasites and hemorrhoids[17].

People on good diets with plenty of water have one to two bowel movements a day; and the transit time (from when first swallowed to exit) should be from 18 to 36 hours. The book, Digestive Wellness, by Elizabeth Lipski, describes how to check transit time and offers remedies for improvement[3].

The recommended daily intake of dietary fiber is between 25 and 30 grams. Pearled barley, beans, oat bran, prunes, tomatoes, and raspberries are good sources of dietary fiber. However, it can be difficult to reach the recommended daily intake through diet alone so a fiber supplement may be necessary.

An economical fiber, whole psyllium husk by NOW Foods sold in health food stores for about $8 for 12 ounces, mixes easily into water, soup or juice. Follow the directions and add to the diet very gradually to become accustomed to the effects. Remember, soluble fiber such as found in oat bran and psyllium binds up cholesterol and sweeps it out of the body.


Conclusion
The digestive process tends to become impaired with age. Poor digestion is associated with many common health problems and many afibbers have reported a connection between digestive problems and the initiation of an afib episode. Healthy digestion can be ensured by proper dietary choices and by judicious supplementation to correct deficiencies in digestive enzymes, stomach acid production, dietary fiber intake, and intestinal flora balance.


References

1. Jeffrey Bland, Digestive Enzymes, Keats Publishing, New Canaan CT. 1993 p. 1
2. Dr. Stephen Sinatra’s HeartSense, May 1998, p. 2, 800/211-7643 $100
3. Elizabeth Lipski, Digestive Wellness, 1996, Keats Publishing, p. 6
4. Ibid. p.6
5. Andrew Weil’s Self Healing, Sept. 98 p 2. $16 800/962-0200
6. Digestive Wellness, p. 101
7. Dr. Stephen Sinatra’s HeartSense, August, 1998, p.6
8. Alan R. Gaby, Preventing & Reversing Osteoporosis, 1994, Prima Publishing, Rocklin, CA p. 183
9. Ibid. p.187
10. Ibid. p. 187; and Digestive Wellness p 120
11. Ibid. p. 187
12. Digestive Wellness, p. 59
13. HeartSense, August 98, p. 6
14. Ibid. p. 8
15. Preventing & Reversing Osteoporosis, p. 183
16. HeartSense, Aug. 98, p 8.
17. Digestive Wellness, p. 54