As those who have read the Viruses- Friend or Foe section know, for the longest time I thought that viruses had no redeeming qualities. They caused disease and that was the end of the story. I now know this is not the case and that these often-maligned entities are the very thing that are keeping us alive and well at any given moment. But, what can be said about bacteria? In the days of E. coli and Salmonella outbreaks and the ever-present threat of MSRA’s (antibiotic-resistant, flesh eating bacteria), could anyone guess that bacteria play an equally important role in the maintenance of our health?

The fact is that our body is host to millions and millions of bacteria, most of which never disease while others do so only when we have done something to force them into doing harm. Sound familiar? Yes, many bacteria have the same behavior when it comes to disease as our newfound friend, the virus. There is no place in our body that has more bacteria than our intestinal tract. And yet, the healthy pet or person has no sign that these guys are present except for the fact their stool has less than floral odor to it. However, put something into the stomach that doesn’t belong there and we can quickly be made aware of the multitudes of bacteria that reside in that normally dormant environment.

In the dog, we see a condition known as hemorrhagic gastroenteritis (HGE) in which the pet suddenly develops violent diarrhea with what appears to be a large amount of blood. The deep red color is actually derived from a large amount of blood-tinged serum in the feces, resulting from a sudden ulceration of the intestinal tract. It is believed that this damage to the gut’s lining is caused by the release of a toxin by a certain bacteria, Clostridium perfringens, which is a close relative of the bacterium that causes tetanus. Both of these bacteria are known for their powerful endotoxins, with that of Clostridium tentani causing the classic symptom of lock-jaw.

And yet, we find that both organisms can be normal inhabitants of the dog’s body, with the tetanus bacterium living in the mouth of unaffected dogs and sometimes being transmitted to a human through a deep bite wound- thus, the routine of administering tetanus shots to those are dog-bitten. There have been cases of canine tetanus, one of which I saw at my clinic a number of years ago. It was a four month old that had contracted the illness through a damaged and abscessed puppy tooth, something that had been reported in the literature. The combination of the damaged tooth and the immaturity of the patient were apparently the main factors that allowed this resident bacteria to gain a foothold in the unfortunate individual but, at that time, I questioned what other circumstances may have contributed to this once-in-a-career case. I had seen fractured baby teeth many times before but never seen a case of auto-inoculation with tetanus before. There had to be another explanation, perhaps a failed immune system or a mysterious cofactor that no one had thought of previously.

A similar phenomenon occurs in cases of HGE. The Clostridium perfringens organism lies dormant in the intestinal tract for years and suddenly overgrows and releases its toxin. This is a very common and frequently recurrent condition but it was not until I was finally awakened to the importance of food intolerance that I began to see patterns in my patients that would point to the true nature of this frightening and potentially life-threatening illness. As I commonly say to my clients “Whodathunk that the wrong food might actually cause chronic diarrhea?” We as veterinarians are quick to ask whether Fido got into anything weird when Mrs. Jones calls in a panic about her pet’s sudden bout of diarrhea. But oddly enough, the basic diet is one of the last things we fully investigate when this becomes a recurrent or persistent issue. Some will place the pet on a prescription intestinal diet but when that doesn’t work, the client is either referred to a specialist or the pet- and owner- are doomed to long-term symptomatic medication. Once again, I can’t throw stones here because that was my exact routine for the first twenty years of my career. It wasn’t until I had experienced these gastrointestinal issues personally and understood the “leaky gut syndrome” that I realized how much more diligent we needed to be in our investigation of the diet.

The sad fact is that most of the so-called “intestinal formulas” produced by the leaders in the pet food industry contained one or more of the “big 4” trouble foods. It is not uncommon to find corn, soy or even wheat in some of these “bland” diets. For example, one of my best friends called me after years of being out of touch. He had two aged Schnauzers that were having a number of health issues for which Don and his wife could find no solid answers. They had been to a number of the local veterinarians for chronic diarrhea, recurrent pancreatitis, ear infections, and the beginnings of kidney failure. Finally, out of desperation, they went to see a specialist at a veterinary university, who promptly prescribed chicken and Cream of Wheat as the solution to their problems. When this didn’t help, Don did an Internet search for my name and was quite surprised to find that I had a presence on the Internet in this very field of medicine.

We had a great reunion conversation but the climax was my attempt to explain why a veterinary specialist would prescribe the number-one canine food allergen for a pet with chronic gastrointestinal issues. “As hard as it is to believe, Don, these guys just don’t know this stuff or think this way.” I went to say that I could understand why the internist did not make the connection between gluten and pancreatitis or kidney failure. He would have to be in-tune with the celiac literature and understand lectins in order to make that leap. But I really could not offer a great explanation as to why this specialist felt compelled to make wheat one of the primary ingredients in an intestinal diet other than stating that this is what I was taught to do thirty years ago. Yes, if Don had been next to me, I could have him the home-prepared diet recipes for various medical conditions found in the back of my internal medicine books which utilized Cream of Wheat in their formulas. But, those books were published thirty years prior, ten years before the pet food industry made that fateful transition from corn-based to wheat-laden diets. Over the past twenty years, pets have become horribly sensitized to wheat and the allergy statistics tell the tale.

So, I instructed Don and Carol to start making their own dog food using chicken, turkey, eggs, vegetables, sweet potatoes and well-cooked Idahos. The response was dramatic. I got a call from Don a short time later with the report that Lucy and Ethel were doing remarkably well and even acting like puppies again. In fact, Carol was so excited to see a normal stool from Ethel that she threatened to send Don an Email picture of one of her latest productions. As crazy as that sounds, people do get excited when a long-term problem finally abates.

This case illustrated three very important points: 1) The body reacts the way it does for very good reason. If we insult it, it will respond appropriately. We may not like the diarrhea, but it occurs for a reason; 2) We can cover up these symptoms with drugs and see major improvements as we do so, even without eliminating the true, underlying cause. But, there will come a time when the drugs stop working; and 3) The appropriate course of action can result in rapid and permanent improvement.

I recently had a case of chronic diarrhea in a cat of two years duration. It had been on antibiotics and gastrointestinal motility drugs all during that time, which allowed the patient to control her diarrhea but never resulted in a formed stool. After taking a history of the diets the owner had utilized during that time, I suspected that the kitty had a rice allergy/intolerance and placed it on a meat-only commercial canned food I stocked at my hospital. We also did a food allergy test due to the chronic nature of the condition and the accompanying skin and ear problems. It typically takes ten days or so to obtain the results from these tests but I called the owner three days after the exam to see how her cat was doing. She excitedly reported that the patient had her first formed stool in over two years after being on the diet for only two days. The diet change had accomplished what years of medication had failed to do and had done so faster than the owner could imagine.

What happened to all of the evil bacteria that were causing all of those chronic problems? How could an organism with such a bad reputation for requiring antibiotics vanish in short order? The truth of the matter is they are not evil, they do not cause our chronic illness, and they are not gone when we are lacking symptoms. Bacteria serve numerous vital functions in our body, including the facilitation of digestion, the production of vitamins, the control of other potential pathogens (e.g. yeast), the escalation of the immune response, and the provision of additional warning signs that we have made a mistake. Once again, the temporary upset of the system becomes a long term illness- or “disease”- when we fail to recognize the underlying insult and halt that action. And how quickly can a long-term issue resolve with proper treatment? In the case of the gastrointestinal tract- the fastest healing tissues in the body- this can occur in matter of days, even after years of symptoms. It only took four days for my long-term heartburn to resolve once I eliminated gluten from my diet.

“But aren’t there bacteria that cause more serious illness and even death?” I am often asked as this point in the lecture. Yes, there are. But like the opportunist viral infections, most of these cases are experienced by those with compromised immune systems, severe trauma, or concurrent illnesses that allow these bacteria to gain their foothold. There is good reason for the elderly pet or person to be the most afflicted in this regard, as they have sustained the most trauma to their organs over time and have suffered the loss of immune competency. However, those conditions that used to be restricted to the elderly are now being reported in young adults, a fact that supports the notion we are doing this tom ourselves. Although we do have mutant strains of bacteria showing up, just as we have different strains of flu viruses, they are changing in response to the same insults that we are throwing at viruses. In fact, there is a virus known as the bacteriophage that affects the bacteria in a similar fashion that other viruses infect tissue cells. These adaptive viruses enable bacteria to “evolve”- adapt to their ever-changing environment- so as to become resistant to our constant insults (e.g. antibiotics, fluoridated water, chemicals, preservatives and other pollutants).

One of the most interesting aspects of this adaption is found in the ability of some bacteria to develop an “L-form”. In this case, the bacteria sheds it outer cell wall and moves to the inside of a cell. Most bacteria remain on the outside of a cell and infect it by attaching to the receptors of that cell, thus creating inflammation in that tissue. Others, such as Clostridial bacteria, produce an endotoxin that causes this inflammation or dysfunction of that particular tissue. But the L-form bacteria, also known as cell wall deficient (CWD) bacteria, are able to move through the cell wall of the host tissue and set up housekeeping inside that cell. Examples of bacteria that are capable of making this fascinating transition are Streptococcus, Borrelia (the Lyme organism), Helicobacter (a stomach resident), and Mycobacterium (one of the bacteria involved in Crohn’s disease).

Now, some clients tell me that this part is way too technical for them, as if I couldn’t tell by the glazed look in their eyes. But I ask them to hand in there for a moment because this rather technical dissertation has a practical application. I assure my clients and readers that I don’t expect them to remember any single trivial fact that I throw at them. I am going for something much bigger- a change in mindset that will transform their way of looking at illness and the symptoms that accompany it. I am also looking to set up a road block between their experiencing a symptom and their reaching for a symptomatic remedy from the medicine chest or the shelves of local pharmacy. To be clear, I am not suggesting that readers simply abandon their prescriptions but I do hope to provide information that may make some drugs less necessary. Remember: I was on five different prescriptions at one time and have not taken a single one of them in over seven years now.

Here’s the short version: Many of these L-form bacteria have been implicated in a wide array of serious and chronic illnesses including Crohn’s Disease, rheumatoid arthritis, Barrett’s esophagus and lower esophageal cancer, Lyme Disease, Chronic Fatigue Syndrome, and Syphilis. There are also veterinary versions of many of these bacteria. Although antibiotics and other symptomatic drugs are used to treat many of these conditions, most sufferers are told that there is no cure for such afflictions. The goal is typically to make the patient as comfortable as possible using the latest pharmaceuticals directed at the bacteria involved in the condition or toward the inflammation, pain, depression, or symptoms associated with that condition. Why can’t we cure these individuals? If it “just a bacterial infection”, why can’t we wipe these guys out like we do a sinus or urinary tract infection?

Amazingly, we have known very little about these odd little entities until just recently. In fact, some of them were literally stumbled upon in the last decade. A very example is called the mycoplasma, a member of the relatively newly designated group called the Mollicutes. Also called PPLO’s or MLO’s, this unusual group of bacteria also lacks a cell wall. Mycoplasma were recently found in the joints of a rheumatoid sufferer after that individual contracted mycoplasmal pneumonia, a relatively common respiratory condition of humans, and was placed on the appropriate antibiotic. Doctors were amazed to find the patient’s rheumatoid arthritis also resolved when the doxycycline was prescribed for the pneumonia. “Hmmm… That’s a three-stroker, John” as Steven Colbert would say to John Stewart of The Daily Show, as he massaged his chin while reflecting on the irony of the statement he had made. But as I tell my clients, I may sometimes do the right thing for the wrong reason but I am happy as long as I do the right thing.

It turns out that many of these intracellular bacteria can be found throughout our body. Helicobacter pylori, for example, is a normal resident of the stomach but moves into the lower esophagus once the initial damage is done by chronic acid reflux. This guy is an “opportunist”…of sorts. I used to leave off the “of sorts” in my lectures until I realized why Helicobacter moves into that damaged area. I used to think it was purely because it wanted to cause disease and was simply waiting for its opportunity, kind of like the incorrect perspective I had on viruses for so long. But now I believe that this bacteria sheds its skin and moves into the cells of this area in order to escape the worsening inflammation as well as the drugs being used to treat Barrett’s esophagus, that precancerous change in the lower esophagus that results from severe and persistent reflux. This invasion does turn up the heat on the fire raging in that area but, once again, inflammation serves a purpose and stimulates the immune system, promotes blood supply and cellular replication, and provides us with warning signs that we have made a mistake. In this way, we can see that Helicobacter is the bridge between phase- one and phase-two of esophageal, gastric and duodenal disorders.

And yet, it has been established that over 50% of the world’s population are “infected” with Helicobacter pylori and that 80% of those individuals are asymptomatic. How can we call a guy like that a true pathogen? Because my head is now screwed on a bit differently and I now look for the purpose in all things medical, I have to believe that bacteria like this have a positive role beyond what we currently understand. If nothing else, they serve as sentinels or facilitators of inflammation, taking inflammation to new heights in order to get our attention or that of the immune system. If an Internet search is performed, Helicobacter is charged with being the cause of gastric and duodenal ulcers. In my speaking engagements, I like to refer to bacteria and viruses with personal pronouns and shout out things like “No, he’s not! He may make the ulcer deeper and wider so that we finally start paying attention to what we are doing, but he doesn’t cause the ulcer from the get-go.”

What causes the initial ulcer? Inflammation starts the process, just as it does in the skin of dogs with allergies. The infection with bacteria is a secondary event. And as we continue to provide the insults that started the process, the inflammation gets worse as more histamine is dumped out of regional mast cells.

Things escalate as we add drugs to the mix. It turns out that Helicobacter prefers an acid environment. This should be no surprise since he is a normal resident of the stomach and duodenum, the most acid-rich areas of our body. If he liked alkaline surroundings, he would be found somewhere else in the system. The pH of the stomach and upper GI tract is tempered by the bicarbonate in our saliva and the food we ingest so that the optimal acidity is maintained both during eating and between meals. This is yet another great example of the technical perfection found in our bodies. But in steps our man with a plan. Oblivious to the fact that his intolerance to wheat, dairy, soy, corn or an array of secondary food allergens has caused his stomach cells to produce excessive acid, he starts downing the antacids to control the discomfort of heartburn- the warning sign that his stomach so kindly provided. Many will say something like “Man, what did I eat that did this to me” but then not give this profound revelation another thought. Little did they know that they had the solution- albeit momentary- right there in their head. Yes, it was the food that did this. Why do we not pursue this line of thinking?

But Helicobacter says something different in this situation. In effect, he says “What the heck?” as we rapidly turn his house into an alkaline environment, kind of like turning off the heat on a freezing winter day. He dives under the covers and finds a nice cozy little spot in a bed of inflammation caused by the initial reaction to the food. As things progress, he decides he prefers a California King instead of the baby bed he first encountered. He needs more room to expand because things are getting a bit dicey, with all of the inflammation and alkaline rain taking place. The ulcer enlarges and ultimately starts to bleed until a scientist discovers that Helicobacter is “causing” the ulcer and develops antibiotics that kill him in his bed. “Problem solved.” Or is it?

I found out something really interesting about this particular bacterium while I was doing some research on strokes and heart attacks. Researchers had discovered Helicobacter DNA in atherosclerotic (cholesterol) plaques that had formed on the walls of the carotid artery. In fact, in one study, over 50% of the arteries sampled were positive for this normal resident of the stomach.oHow The doctors involved in the study were trying to determine the clinical significance of these bacterial invaders and were questioning whether the presence of Helicobacter in these plaques was a stimulus for the development of the atherosclerosis or a trigger for the release of pieces of the plaque, which would then travel downstream from the site, obstructed that vessel, and result in a stroke.

Apparently, the jury is still out on that case but, in the meantime, another strange bacterium, Chlamydia pneumoniae, has also been found in similar lesions of blood vessels. Like the mycoplasma, this intracellular bacterium has been classified and reclassified over time, first being deemed a protozoan, then a virus and finally a bacterium. Why the confusion? Because this critter is an obligate intracellular bacterium, which means he can only reproduce inside the cell, just like the members of his previous classifications. They infect other cells by forming a kind of spore which can survive outside the cell for a short period of time until it attaches to the receptors of another cell and imbibed by that cell. Once there, it quickly forms a covering that protects itself from the invader-killing structures called lysosomes. In this little cocoon (inclusion body), it starts to replicate and is later triggered to release its offspring to infect other cells. Researchers report that they don’t really understand the triggers and pathways by which this guy moves from one form to another but Chlamydia have been implicated in venereal diseases in humans and are the leading cause of infectious blindness worldwide. Other species are affected by different members of this group, including cats, mice, hamsters and swine. With that collection of affected species, one would have to wonder whether there has been some transmission between them. We know that a number of viruses and bacteria move between species and I suspect many more than we have formally documented make this transition.

Chlamydia happens to be one of those that do cross species lines. In the cat, this organism causes an upper respiratory condition and conjunctivitis (pink eye), just as it does in humans. Interestingly enough, it usually infects one eye and then can move into the other eye in about three weeks, during which time the infection can be transmitted to the owner, although this is uncommon. But what is both fascinating and relevant is that the infected cat can have recurrences in their lifetime, during which they show the same pattern of infection, starting unilaterally, which is characterized by varying degrees of conjunctivitis. Most don’t have a recurrence of the respiratory condition but this can occur as the organism is known to remain in tissues indefinitely. Because this condition is chronic, latent, and potentially contagious to humans, I began to question whether allergies to cats served a greater purpose. As I mentioned in the section on the development of inhaled allergies, the body knows exactly what it is doing when it forms these sensitivities and the stuffy nose and runny eyes that allergy sufferers develop may be protecting us from more than just the cat’s dander.

If these organisms are so ubiquitous and there is potential for zoonosis (traveling from animals to man), then why are more people not outwardly affected? Or are they? Researchers have now found mycoplasma in the brain of people with chronic fatigue syndrome, fibromyalgia, and Gulf War Syndrome as well as the peripheral nerves of people with ALS (Lou Gehrig’s disease) and the lungs of COPD (chronic obstructive pulmonary disorder). Because they are inside the cell and can cause significant disruption of cellular function, including disorders of the power houses of the cell called mitochondria, they have finally gotten the full attention of the scientific community. In fact, because these Mollicutes can interfere with DNA transcription, their role in the development of cancer is now being investigated.

The results of this study have been reportedly inconclusive but we do know that the mitochondria of the cell are involved in cell growth and differentiation and the DNA of these little power houses show a remarkable resemblance to the genome of bacteria. Thankfully, the DNA of the mitochondria is separate and independent of that found in the nucleus of the cell, where most of our DNA is housed, but it is clear that these bacteria have access to a major component of cellular function. The guys in the ivory towers are busily working to fill in the gaps of our understanding.

And yet, most people have never heard of these guys, just as most have never heard the words “cancer” and “virus” used in the same sentence until the cervical cancer vaccine was introduced. Are those guys in lab coats who are running around in those ivory towers protecting us from a public panic or are they simply waiting ‘til they get their ducks in a row before becoming the harbingers of bad news? Or is it something more than both of these? I hate to be the one to burst the bubble but we have to face the fact that medicine is an inexact science at this point? We have done some regrettable things in the past, all in the name of science- motivated by the spirit of discovery, protected by a veil of secrecy, and covered by the cloak of ignorance. Hey, we make mistakes because we don’t know everything…yet.

But it’s 2009 as I write this and we have made quantum leaps in our technology, all the while remaining relatively ignorant of how the body operates. We’ve been to the moon and placed instruments on far away planets and yet we haven’t grasped how our diets are killing us. That is frightening to me. It’s not the simple fact that we are told to take antacids and antibiotics to kill symptoms and bacteria that serve a greater purpose that concerns me most. It is that these same scientists are using these misunderstood viruses and bacteria in the development of vaccines and the modification of food, both of which have the potential for disastrous results on a global scale. As I study about GMOs (genetically modified organisms) and their use in our foods and the latest line-up of inoculations for pets and their people, it reads like a science fiction novel complete with mad scientists and alien life-forms coming to earth. Have we not learned any more about these earthly microorganisms than we knew about those extraterrestrial beings emanating from the flying saucer that landed in the Saturday matinees of yore?

Apparently not.

DogtorJ