September 18, 2014

Enteroimmunology: A Guide to Prevention and Treatment of Chronic Disease, by Charles Lewis, MD, MPH

Required reading for all naturpathic physicians
An incisive review of the book Enteroimmunology: A Guide to Prevention and Treatment of Chronic Disease, by Charles Lewis, MD, MPH.

A book’s table of contents is often a telling first glimpse of what to expect from the book—not just in terms of content, as the name would imply, but also in terms of style, tone, and personality. So when I opened Enteroimmunology: A Guide to Prevention and Treatment of Chronic Disease, by Charles A. Lewis, MD, MPH, my interest was piqued immediately. With chapter titles like Meteorism, Trots and Foul Winds; Appetite, Satiation and Satiety; and Obesity, Syndrome X and the Company it Keeps, how could it not be?

Enteroimmunology is a field of medicine that focuses on how the enteric immune system’s response to bacteria, toxins (parasitic or food metabolites), and foreign proteins elicits inflammation and influences all other body systems. This book covers enteroimmunology as it relates to such diverse topics as acne, rage, biofilms, interstitial cystitis, diabetes, obesity, cancer, migraines, depression, sleep, osteoporosis, and autoimmune disease. It also covers standard gastrointestinal (GI) conditions: small intestinal bacterial overgrowth (SIBO), dysbiosis, gluten disease, leaky gut, inflammatory bowel disease, and irritable bowel syndrome. The first 7 chapters cover the basics: GI function overview, proteins, fats, carbohydrates, sugar malabsorption (the aforementioned “Meteorism, Trots and Foul Winds”), and the colon and its inhabitants. I enjoyed the overview and learned quite a few more details that are applicable in my daily practice of naturopathic medicine. For example, the thorough table outlining the hormones that affect the GI tract will become a quick, easy reference in my practice. I also appreciate that each chapter is only a few pages but does not lack for depth of information. After the quick overview, the author delves into the nitty gritty of more complicated issues—hyperammonia, enteroimmune depression, leptin resistance, mast cell activation disorder, and leukotriene-associated hypersensitivity.

Naturopathic doctors are trained to have a very good base of knowledge when it comes to the digestive system and how it affects health. We are thoroughly educated in nutrition and how the foods we eat or don’t eat can cause or perpetuate disease states. However, details and intricacies unique to each individual can be very difficult to tease out. As one example, I have a mother and daughter who react to everything. They react to certain foods, most supplements, some herbs, and most synthetic agents. For the mom, her issue is chronic sinus and bronchial issues. Her daughter gets skin reactions from acne to perioral dermatitis. After many years and trying every assessment and treatment I could think of, we’ve achieved a degree of success, but their symptoms still recur intermittently. I felt like I had run out of ways to help them before reading this textbook, which contains at least 8 chapters on immune hypersensitivity. In a brief aside, “Histamine in Pregnancy,” Lewis explains that the placenta creates an increased amount of diamine oxidase (DAO), which is the enzyme that catabolyzes/inactivates histamine. He writes

High DAO levels may explain why some women feel so much better during pregnancy and also explain the reduction in the frequency of migraines and other histamine reactions during pregnancy. High DAO levels lower histamine reactions through much of the pregnancy and protect pregnant women from biogenic amines that otherwise have them not feel so well.

With the mother and daughter I was treating, the daughter had just given birth, and she had not experienced any of her usual hypersensitivities during her entire pregnancy. Perhaps the daughter benefited from the placental DAO, I thought. This idea solidified as I read the very detailed chapter on mast cell activation disorder. After reading and rereading this chapter, I have a few leads on where to go next to address my complicated hyperreactive patients.

Lewis’s book is not a primer on what supplement to recommend but on what the possible causes or maintaining stressors are that perpetuate a state of disease.

This textbook is full of factoids and details that can be applied to daily practice. I found information on carbohydrates that was useful—especially if you utilize the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) or SIBO diets in your practice. Each chapter is short and to the point and includes tables summarizing necessary details and references to other chapters to garner further clarification on difficult points. I also like that the author summarizes every chapter; at the end of the leaky gut chapter is a 20-point list on treating leaky gut, and only a few of the points are about a supplement. Lewis’s book is not a primer on what supplement to recommend but on what the possible causes or maintaining stressors are that perpetuate a state of disease. This is not another book on green pharmacy, but a book that follows the tenets of naturopathic medicine—treat the whole person, find the cause, and use food as your medicine.

In summary, I thoroughly enjoyed this textbook. I look forward to reading it more as I pick up some new tidbits that I can apply to my practice. I also enjoy Lewis’s writing style: He is clear and straightforward, and I can sense that he has plenty of experience behind what he is saying. I enjoy the sense of humor sprinkled throughout the book. This textbook does have its share of typographical errors and forgotten prepositions, but that seems a silly demerit when the content is so exceptional. Every physician should have this insightful book at his or her side—especially those practitioners who follow the tenets of naturopathic medicine.

About the Author

Charles A. Lewis, MD, MPH, is an independent consultant to biomedical and technology companies. He also has more than 20 years in family practice medicine. He received his medical doctorate from Universidad de Technologia de Santiago in the Dominican Republic and his master’s degree of public health from the University of Alabama at Birmingham.

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