20 April 2012

Part II - Diagnosis and Treatment of Leaky Gut...

So now you've read all about leaky gut and may be wondering if you have it...

Food allergies, toxins, sugar, antibiotics, parasites and stress can wreak havoc with your gastrointestinal system, upsetting the balance in your intestine as well as allowing harmful substances
to enter the system. Gas, bloating, diarrhea, constipation or abdominal discomfort may be the first clue that something is wrong with the digestive tract, but did you know allergies
or even lack of energy and fatigue can often be traced to digestive problems as well?

Normally the gastrointestinal epithelium provides a semi-permeable barrier with allows nutrients to be absorbed while preventing larger molecules from crossing into the bloodstream.   When this lining becomes inflamed or damaged, then the barrier becomes "leaky".  The fallout results in larger, undigested food molecules and other “bad stuff” (yeast, toxins, and all other forms of waste) that your body normally doesn’t allow through, to flow freely into your bloodstream.

Common causes of increased intestinal hyperpermeability or "leaky gut":
  1. Medications (NSAIDS) like ibuprofen and motrin
  2. Microbial overgrowth or infection
  3. Parasite infection
  4. Fungal overgrowth (Candida)
  5. Ingestion of allergenic foods
  6. Maldigestion/malabsorption (pancreatic insufficieny or low HCl)
  7. Radiation therapy or chemotherapy
  8. Stress
  9. Aging
  10. IgA deficiency
  11. Chronic alcohol intake
  12. Excessive or strenuous exercise
  13. Inflammatory bowel disease - Crohn's or Ulcerative colitis
The small and large intestines contains numerous dietary and bacterial products with toxic properties. These include v bacteria, bacterial cell wall particles, peptides, and bacterial antigens capable of inducing antibodies which may cross-react with human tissues.... when these antibodies react, they may form systemic immune complexes which can circulate and deposit in tissues far away from the gut.

Abnormalities of the gut lining barrier lead to increased uptake of inflammatory molecules and pathogenic bacteria. With inflammation & injury to the gut lininng, mucosal absorption of normally-excluded substances increases dramatically.  Intestinal inflammation enhances the uptake and distribution of potentially injurious bacteria and proteins .

"Leaky Gut" is seen in disorders such as:
  • Inflammatory bowel disease (Crohn's & Colitis)
  • Inflammatory joint disease
  • Food allergy
  • Celiac disease
  • Rheumatoid arthritis 
  • Ankylosing spondylitis
  • Reiter’s syndrome
  • Eczema & psoriasis
  • Bipolar, depression and schizophrenia
  • Allergies and asthma
  • Autoimmune thyroiditis
  • Multiple sclerosis
  • Autoimmune liver & gallbladder disease

So how do we test for "Leaky Gut"?

Small molecules (glucose or mannitol) readily penetrate cells and passively diffuse through them. Larger molecules such as lactulose are  normally are normally not able to diffuse through the cell.  If the tight junctions between the cells are functioning properly, they will prevent the lactulose from leaking through.  The  Intestinal Permeability Test directly measures the ability these two sugar molecules—mannitol and lactulose—to permeate the intestinal mucosa.

Mannitol is readily absorbed and serves as a marker of transcellular uptake.   Lactulose is only slightly absorbed and serves as a marker for mucosal integrity (ability of those "tight junctions" to keep out the bad stuff)  The test is a 6 hour urine test that compares ratios of the two substances.

For more info:

Genova Diagnostics Intestinal Permeability Assessment
You will need to contact your functional medicine physician in order to order the test.

Now for some treatment options for this leaky gut!

Nutritional Support
  1. Glutamine, an amino acid, has been shown to reverse intestinal mucosal damage from various insults. Glutamine is the principle fuel used by the upper intestinal tract to repair and heal.
  2. Agents that stimulate protective mucus secretion may also help with the healing.  Some common ones I use are marshmallow root extract and deglycyrrhizinated licorice (DGL) extract.  
  3. Probiotics are essential!  Lactobacillus casei, bifidobacter species, and saccromyces boulardii, a beneficial type of yeast are all important to restore gut health.
  4. Fish oil can be very helpful in the treatment of intestinal inflammation by decreasing inflammatory prostaglandins.  EPA and DHA should be used in the range of 2-4gm daily
  5. Quercetin functions as a natural mast cell stabilizer and decrease release of histmine which contributes to inflammation & injury.  To be effective, quercetin should be used in powder form and taken 3-6gm daily.
  6. Vitamins A and D are critical to supporting secretory IgA function and restoring the mucosal immune system.  Ask your doctor for specific doses...

To Decrease Toxic Load:
  1. Eliminate all known foods that you are sensitive to.  This can be determined through a comprehensive elimination diet or IgG/IgE food tests on the blood.
  2. Avoid alcohol, NSAIDS (ibuprofen, motrin, alleve), and minimize other OTC medications.
  3. Bentonite clay, a colloidal aluminum silicate, is a well-known intestinal adsorbent
    which absorbs numerous toxins, endotoxins and bacteria.  Its value in permeability alterations may result from lowering the toxin load in the lumen, thus facilitating repair.
  4. HCI and digestive enzymes such as plant enzymes, pepsin and pancreatin might help to lessen the antigenic load or toxic molecules being presented on the intestinal lining.
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  1. Fantastic article. Enjoyed part I as well. I bet a lot of folks suffer with this and don't even know it. Failing to address the cause of any condition results in a lot of lost time and money; seems obvious.

  2. Really enjoyed your articles about leaky gut! Thank you for sharing. And thank you for sharing your personal healing story - it's inspiring and motivational. Question - What would you say is the best/most accurate way to diagnose an underlying microbial, fungal, or parasitic infection that may be hindering someone's progress in healing a leaky gut?