Low Dose Naltrexone (LDN): The New Treatment You've Never Heard of...

Low Dose Naltrexone (LDN):  The treatment you've never heard of...

Why haven't you heard about this amazing new breakthrough for conditions ranging from autoimmunity to cancer?  Perhaps because as of yet no company has stepped forward with the billions of dollars needed to do a large-scale study on low-dose naltrexone (LDN).  Unfortunately getting FDA-approval for use is not a straightforward process.  With the patent expired, no drug company has been willing to pay such a large sum when they cannot sell the drug exclusively.

However, if you check PubMed, there are currently over 90 studies published on the various uses of LDN, from pain relief, fibromyalgia, Crohn's disease, multiple sclerosis, systemic sclerosis and even cancer.  I have been using this drug in clinical practice with great results for the past several years and I want to tell you about it...

So how does LDN work?

Researchers at The Pennsylvania State University College of Medicine, Hershey, Pennsylvania have discovered the mechanism by which a low dose of the opioid antagonist naltrexone, an agent used clinically (off-label) to treat cancer and autoimmune diseases, exerts a profound inhibitory effect on cell proliferation. We believe that opioid receptor blockade by LDN provokes a compensatory elevation in endogenous opioids and opioid receptors that can function even after LDN is no longer available.

These papers revealed that a short-term opioid receptor blockade with naltrexone (LDN), a general opioid receptor antagonist devoid of intrinsic activity, results in an elevation in production of your own opioids and in response to the blockade. Interference of opioid peptide–opioid receptor interactions for a short time each day (from 4-6 hours) with LDN provided a subsequent window of time (18–20 hours) for the increased levels of endogenous opioids and opioid receptors to elicit a robust functional response: the inhibition of cell proliferation.  In addition many patient report an improved sense of well-being and decrease in overall pain, as one might expect with higher levels of opioid production in the body.

Preliminary Research Abounds for cancer and autoimmune disease

Low dose of the opioid antagonist naltrexone (LDN) is being used clinically off-label to treat cancer and autoimmune diseases, by exerting a profound inhibitory effect on cell proliferation.  LDN is an oral medication, generic, inexpensive, and non-toxic, and has been documented to alter the course of both neoplasias and autoimmune diseases such as Crohn's and multiple sclerosis, making this drug especially attractive as a therapeutic agent.

According to this study in Clinical Rheumatology, Low Dose Naltrexone(LDN) has been demonstrated to reduce symptom severity in conditions such as fibromyalgia, Crohn's disease, multiple sclerosis, and complex regional pain syndrome. They suggest that LDN may operate as a novel anti-inflammatory agent in the central nervous system, via action on microglial cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on opioid receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated.

A study published online in the Cochraine Library in February 2014 discusses using low-dose naltrexone to induce remission in Crohn's Disease.  Although the author conclude there is insufficient evidence to recommend and further research is needed, data from one small study suggests that LDN may provide a benefit in terms of clinical and endoscopic response in adult patients with active Crohn’s disease. Data from two small studies suggest that LDN does not increase the rate of specific adverse events relative to placebo.

In the Journal of Clinical Gastroenterology April 2013, Naltrexone therapy appears safe with limited toxicity when given to children with Crohn’s disease and may even reduce disease activity.

Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome involves glial activation and central sensitization in the central nervous system. This can be a difficult disease to treat and patients suffer greatly with severe chronic pain.   An article in the Journal of Neuroimmune Pharmacology showed positive outcomes of two CRPS patients, after they were treated with low-dose naltrexone, in combination with other CRPS therapies.  Perhaps this is because Low Dose Naltrexone (LDN) is known to antagonize the Toll-like Receptor 4 (TLR4) pathway and attenuate activated microglia.

Link to Fibromyalgia and Autism?

Another article posted online in Discovery Medicine came to the following conclusions:

1. Patients on chronic opioids relate autistically.
2. Autism is a hyperopioidergic disorder.
3. Fibromylagia is a hypoopioidergic disorder.
4. Low opioid tone caused by opioid maintenance or fibromyalgia can usually be reversed with low-dose naltrexone.
5. The increase in the incidence of autism may have been caused by the increase in use of opioids for analgesia during childbirth.

The bottom line is that for disorders that involve low endogenous opioid production, like fibromyalgia and chronic fatigue syndrome, Low Dose Naltrexone may prove to be profoundly beneficial.

A January 2013 article written in Arthritis and Rheumatology concluded that evidence continues to show that low dose naltrexone has a specific and clinically beneficial impact on fibromyalgia pain. The medication is widely available, inexpensive, safe, and well-tolerated.

Motility Agent for Small Intestinal Bacterial Overgrowth (SIBO)

Another novel use of Low Dose Naltrexone has been for aiding motility in SIBO (small intestinal bacterial overgrowth).  Ploesser et al described the use of LDN for aiding the migrating motor complex (MMC) in cleansing the small bowel.  His small study use 2.5mg twice daily in patients with IBS and evidence of SIBO and 4.5mg daily in patients with inflammatory bowel disease.  Approximately 68% of the study patients had improvement in symptoms taking LDN.  According to other research, LDN may have effects on the gut to decrease inflammation, decrease intestinal permeability and stabilize toll like receptors, in addition to aiding motility.

Experimental and Off-label but well tolerated and promising

The use of LDN for chronic disorders is still experimental and considered off-label.  This doesn't stop progressive doctors from prescribing it due to it's safety profile.  The typical dose of LDN is a compounded immediate release tablet from 1.5 to 4.5mg taken at bedtime.   The few reported side effects may be related to opioid blockade at night.  Occasionally patients report anxiety, insomnia, vivid dreaming or nightmares.  There are a portion of patients who already have elevated opioids that may not tolerate the drug. To avoid side effects, I generally start patients on half of intended dose and increase after 7-10 days.  If they still report symptoms, we move the dosing earlier in the day and may still get a beneficial effect.

Low Dose Naltrexone is an oral medication, generic, inexpensive, and non-toxic, and has been documented to alter the course of both neoplasias and autoimmune diseases such as Crohn's and multiple sclerosis, making it an attractive and effective therapeutic agent.

For more on LDN watch my recent interview with Dr. Alex Vasquez ...

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More References:

1. Low Dose Naltrexone Research Trust
2. LDN Clinical Trials 

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6 Signs that SIBO might be the root cause of your IBS

Photo courtesy of www.freedigitalphotos.net

Studies show that over 50% of patients diagnosed with IBS actually have an underlying imbalance called SIBO, or small intestinal bacterial overgrowth. The majority of our gut bacteria should be in the colon. When the bacteria migrate backwards into the small bowel or when there is low stomach acid or poor pancreatic enzyme production, bacteria in the small bowel can overgrow and cause symptoms, such as diarrhea, gas, or bloating.

Six signs you might have SIBO

1. You notice that fiber worsens your constipation
2. You notice an improvement in IBS symptoms when taking antibiotics
3. You feel more gas and bloating when you take probiotics that contain prebiotics
4. You are celiac or gluten intolerant and do not have 100% resolution of symptoms on a gluten-free diet
5. You develop chronic symptoms of gas, bloating, constipation or diarrhea after taking pain medications, like opiates.
6. Your blood work shows chronically low iron or ferratin with no known cause

Top 6 Symptoms of SIBO

1. Abdominal bloating and distention
2. Constipation 
3. Diarrhea
4. Abdominal pain or discomfort
5.  Acid reflux or heartburn
6. Excessive gas or belching

How do I know this isn’t just leaky gut?

While SIBO usually manifests with local GI symptoms, a leaky gut will manifest with systemic complaints that affect the immune system. Keep in mind that is is not uncommon to have both SIBO and leaky gut simultaneously. And very often if you have SIBO for a long period of time, you will develop a leaky gut.

Here are some systemic signs of a leaky gut:

• Multiple food sensitivities
• Skin rashes, acne or rosacea
• Respiratory symptoms, like asthma
• Allergic symptoms or increase in seasonal allergies
• Fatigue
• Brain fog or poor concentration, especially after meals
• Any autoimmune disease
• Joint pain or arthritis
• Headaches or migraines

Remember SIBO can cause leaky gut syndrome but not everyone with SIBO has leaky gut. About half of the patients diagnosed with SIBO will also have leaky gut. Most of the time if SIBO is treated, leaky gut will heal itself!

10 conditions that may predispose you to have SIBO

1. Hypochlorhydria (low stomach acid)
2. Pancreatic insufficiency
3. Decreased motility in small intestine
4. Bowel obstruction
5. Diverticula 
6. Surgical bowel resection or bariatric surgery 
7. Food poisoning (Post infectious IBS)
8. Nerve damage that affects the GI tract
9. Drugs, like opiates 
10. Any disease that slows motility (diabetes, hypothyroid)

Other disorders that may be associated with SIBO

• Rheumatoid arthritis
• Ankylosing spondylitis
• Scleroderma
• Hashimoto’s thyroiditis
• Rosacea
• Restless leg syndrome
• Pancreatic insufficiency
• Liver disease
• Diabetes
• Crohn’s disease
• Celiac disease
• Fibromyalgia
• Kidney failure
• Liver disease
• Diverticulosis

How to Diagnose SIBO

Ask your doctor to order the Lactulose Breath Test (preferred over glucose as it will test the entire small bowel vs. just duodenum). You may also need to check a comprehensive stool analysis and urinary organic acids, which may point in the direction of other dysbiosis but are not directly assessing small bowel bacterial overgrowth

How do we treat SIBO?

1. Diet options

• Paleo diet or autoimmune paleo diet
• Low FODMAP diet
• Specific Carbohydrate Diet
• GAPS Diet
• Avoid all alcohol
• Use caution with probiotics/prebiotics
• Use caution with fermented foods as they can increase histamine
• Homemade Elemental Diet by Dr. Siebecker

2. Antibiotics

• Xifaxan

3. Dr. Jill’s favorite antimicrobial herbs

• Allimed
• Oil of oregano
• Thorne Berberine 500
• Biocidin 

Treating SIBO successfully is not always easy and may involve major dietary changes and medication or herbal treatment for an extended period of time. However, getting the balance of your gut microbes healthy will likely prove to be the most important step in regaining your health and vitality! I know it was in my case… if you haven't read My Story, read more here.

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The Gut Immune System Connection - An Animated Video

The gut mucosa connects with the largest population of immune cells in the body!  Is it any wonder that in functional medicine we assess your gut function as one of the initial steps in cases of allergies, asthma, autoimmune disease, eczema, crohn's disease, ulcerative colitis, IBS, celiac disease, arthritis and more?  

It’s often the first point of exposure to pathogens.   Many microbes use it as a entry point into the rest of the body. The gut immune system therefore needs to be ready to respond to pathogens but at the same time it is constantly exposed to harmless environmental antigens, food particles and commensal microflora which need to be tolerated. Misdirected immune responses to harmless antigens are the underlying cause of food allergies and debilitating conditions such as inflammatory bowel disease. This animation introduces the key cells and molecular players involved in gut immune connection and disease.



By checking your gut's microbial environment and taking a functional medicine approach to health and wellness, we can actually modulate some of the underlying immune dysregulation and eliminate your symptoms!

Nature Immunology homepage: http://www.nature.com/ni/index.html

A Quick Start Guide To Paleo Diet...

You may have heard the recent buzz about Paleo Diet... so what's all the fuss about?

There are far reaching health benefits to eating more like our grandparents would have eaten...   That means real food, not the packaged processed stuff that has become norm in the Standard American Diet, or SAD for short.

The Paleo Diet may be beneficial in reducing your risk of chronic diseases such as diabetes, obesity, heart disease and many autoimmune and inflammatory conditions.   I frequently use the principles of the paleo diet to help patients re-learn how to eat healthy, maintain ideal weight, and feel fabulous!

You shouldn't be surprised to find a lack of packaged foods on the Paleo Diet menu. There were no convenience stores or super-sized grocery chains in the Stone Age.   And if you're one of the 31% of Americans who eats more packaged foods than fresh foods in your daily diet, it could be an adjustment.  What is amazing, however, are the profound benefits to your health that come from these changes.  If you suffer obesity, heart disease, high cholesterol, central weight gain, or autoimmune disease, like Hashimoto's thyroiditis, Crohn's disease, rheumatoid arthritis, or multiple sclerosis, you greatly benefit from eliminated all processed grains & sugar from your diet.  Plus you will not be eating two of the most common food allergens: gluten and dairy.  If you suffer from a leaky gut or gastrointestinal dysbiosis, the Paleo Diet will naturally restore the healthy microbial balance since there are no refined sugars or grains to feed the abnormal bacteria or yeast.

The Paleo Diet is basically this:  No sugar, No flours, No processed foods, No grains, no legumes (lectins), no dairy.  What you CAN eat is lean, clean (organic) unprocessed meats (chicken, fish, turkey, beef, bison, elk, lamb, etc), all fruits and veggies in moderation.  And coconut, nuts & seeds are to be eaten freely in unprocessed state.  If you need to make something special, almond or coconut "flour" can be used.

CORE PALEO DIET:

• Meat - GRASS-FED, not grain-fed. Grain causes the same problem in animals as they do in humans.  (bison, elk, buffalo are WONDERFUL red meats to incorporate)
• Fowl - Chicken, duck, hen, turkey…things with wings that (try to) fly.
• Fish - Wild caught fish (mercury and other toxins, like PCBs may be an issue in farmed fish)
• Eggs - Look for Omega-3 enriched eggs raised without hormones or antibiotics from free-range chickens
• Vegetables - As long as they’re not deep-fried, eat as many as you want.
• Oils - Olive oil, coconut oil, avocado oil – think natural.  No soybeans oil or processed oils.
• Fruits - Have natural sugar, and can be higher in calories, so limit if you’re trying to lose weight.
• Nuts - High in calories, so they’re good for a snack, but don’t eat bags and bags of them.
• Tubers - Sweet potatoes and yams.  Higher in calories and carbs, so these are good for right after a workout to replenish your glycogen levels

What's not allowed when following the Paloe diet?

• Grains (including popular cereal grains such as barley, corn, oats, rice, rye and wheat)
• Beans or legumes
• Dairy products
• Refined salt
• Refined sugars or artificial sweetners
• Refined fats
• Canned or processed meats
• Soda and fruit juices
• All chemicals, additives, artificial flavorings, MSG, yeast.

Perhaps the most important thing about Paleo is it encourages you to get back to whole delicious real food!  It will allow you to feel better, lose weight easily and maintain muscle at any age.  I challenge you to give it a try for yourself for 30 days and see if it doesn't change your life!


More Resources for Paleo Diet:

http://paleophysiciansnetwork.com
http://www.marksdailyapple.com
http://www.westonaprice.org/

Healthy Gut = Healthy You!

There is a microbial zoo living inside you, literally trillions of microscopic organisms―more than 10,000 different kinds of them―all co-existing with each other and you.

In fact they outnumber you ten to one and ninety percent of the genetic material, (DNA and RNA) in your body is not yours, it belongs to the bacteria that is located mostly in your gut, but some also live on your skin and even in your nose.

Exactly what those different life forms do has been the subject of some exciting research in recent years, and while a few of these organisms can sometimes wreak havoc with your system, the majority of these little "bugs" are good, helping you digest your food, stay protected from infections, and even keeping your immune system properly regulated to fend off autoimmune diseases like asthma, allergies, and diabetes.

The community of microbes living on and in your body is unique to you – like your fingerprints – and is now being regarded as a key contributor to your overall health.

More and more, science is finding that teeny tiny creatures living in your gut are there for a definite purpose. Known as your microbiome, about 100 trillion of these cells populate your body, particularly your intestines and other parts of your digestive system.

Although some of these bacteria can make you sick, the majority are good, and they work together as to aid your digestive system and keep you well. Beneficial bacteria, better known as probiotics, along with a host of other microorganisms, are so crucial to your health that researchers have compared them to "a newly recognized organ." We now know that your microflora influence your:

• Immune system function
• Brain development, mental health, and memory
• Obesity
• Genetic expression 
• Risk of diseases, including autoimmune disease, cancer, diabetes, and autism

According to the featured article in Time Magazine:

"Our surprisingly complex internal ecology has been a hot topic in medicine lately. Initiatives such as the Human Microbiome Project, an extension of the Human Genome Project, have been working tirelessly to probe potential links between the human microbiota and human health, and to construct strategies for manipulating the bacteria so that they work with us rather than against us.

...They've been linked to a range of nasty conditions, including obesity, arthritis, and high cholesterol. Now, two newer areas of research are pushing the field even further, looking at the possible gut bug link to a pair of very different conditions: autism and irritable bowel disease."

Most people, including many physicians, do not realize that 80 percent of your immune system is located in your digestive tract, making a healthy gut a major focal point in your efforts to achieve optimal health. In fact, the root of many health problems is related to an imbalance of intestinal bacteria.  

The beneficial bacteria in your gut has actually been found to help prevent allergies by training your immune system to distinguish between pathogens and non-harmful antigens and respond appropriately – and this may be one reason why they also appear so beneficial in conditions like allergies, asthma, and eczema

 Like it or not, the bugs in your gut have a lot to say about your health!  This is why I frequently test patients gut function for common complaints such as fatigue, migraines, mood disorders, depression, anxiety or insomnia, ecezma, allergies, asthma, autism, and even trouble with concentration & memory.  Getting the gut bugs back into proper balance is critical to your overall health and especially the health of your immune system.  The simplest way to jump start your overall health is pay attention to the gut...  Eliminate sugar and refined flours from your diet and add a high dose probiotic to you regimen.  You'll be well on your way to a happy and helpful intestinal "zoo"!

http://www.health.harvard.edu/healthbeat/the-gut-brain-connection
http://www.mercola.com/
http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/dna-stool-analysis-gi-effects
https://wsunews.wsu.edu/pages/publications.asp?Action=Detail&PublicationID=32253&TypeID=1

Is Leaky Gut Causing Your Eczema or Psoriasis?

How Leaky Gut is linked to Skin Conditions, like Eczema & Psoriasis...

First a little background ... When the body doesn’t tolerate a food or has created antibodies to that food, ingesting it creates a chronic, low-level irritation or inflammation in the gut. Over time, with regular exposure, the irritation worsens and creates spaces between the cells. (Picture the walls of the gut, once tightly knitted together, looking more like swiss cheese!)   This is what is commonly known as, Leaky Gut.  These holes allow bacteria and their toxins, as well as incompletely digested proteins and fats, to “leak” out of the gut and into the bloodstream. Leaky gut syndrome (or increased intestinal permeability), sets the stage for myriad health problems, including rashes and skin problems, like eczema and psoriasis.  The skin is the body’s largest elimination organ so it’s not surprising that it comes under assault when toxins careen through the bloodstream.   A skin rash or eczema is a sign that the body is trying to slough out these toxins.  Some people will also experience increase in acne or be told they have "rosacea".   The body is trying to eliminate the problem the best way it knows how, and unfortunately you may see the nasty effects of leaky gut manifest in skin problems.  In addition, you might also experience gas, bloating, fatigue, sinus congestion, or foggy thinking.  Many other autoimmune conditions are also linked to the underlying problem of leaky gut.

An Elimination Diet Can Heal Your Skin Conditions

An elimination diet is the best way to pinpoint the offending food.   Here's some practical tips and recipes on how to get started.

Don’t know where to start? Foods that are most likely to wreak havoc on the gut include wheat and gluten, dairy products, sugar, soy, eggs, corn and yeast. If you’re highly motivated go off “the big five” for at least 3 weeks: wheat, dairy, sugar, caffeine and alcohol.

Although this isn't easy, you're guaranteed to notice the foods you are reacting to and 90% of patients feel dramatically better after a 3 week elimination plan. You might also consider keeping a food journal. Spend a week or two writing down what you eat and how your body feels in the minutes, hours and days afterward (e.g., an hour after you eat dairy, you feel bloated). It’s about pattern and symptom recognition and connecting the dots which in turn helps you decide which foods to eliminate first.

If you are a "show-me the data" type of person, there are labs that will test the blood for levels of IgG4 against certain foods and may be a predictor of what foods you are the most sensitive to.  In addition, if you have many reactions to a variety of foods, this is almost diagnostic for leaky gut syndrome and you should consult with a functional medicine doctor to start the healing process.

Low SIgA and why it matters to your gut health!

What is SIgA?

IgA is a type of antibody that protects against infections of the mucous membranes lining the mouth, airways, and digestive tract... it is your first line of defense on the mucosal lining and it makes up a majority of your entire immune system.

Some people have a genetic deficiency and present with low levels of SIgA and frequent infections.  Others acquire a low level after their intestinal tract becomes over-run with abnormal microbes.

SIgA helps to shape the composition of the microbes in your gut!

Extraordinary amounts of immunoglobulin A (IgA) are produced in your intestinal mucosa daily, it is known as SIgA and is secreted into the human gastrointestinal tract. SIgA production is driven largely in response to mucosal antigens (bugs or food) encountered by gut-associated lymphoid tissue (GALT).  It is clear that secretory antibodies are directed against at least two broad classes of antigens. The first is associated with enteric pathogens (the "bad guys" or infections) and their virulence factors, or things that the bugs secrete, like toxins.


The second broad class of antigens recognized by SIgA is associated with the intestinal microbes or commensal microflora (the "good" guys, like probiotics). In experimental animal models commensal bacteria are potent inducers of secretory antibodies; in humans, it is estimated that between 25 and 75% of intestinal bacteria are coated with SIgA.  This could explain why one of the most basic ways to improve levels of SIgA is to give a patient probiotics and saccromyces boulardii. 

There is also evidence from mice that secretory antibodies play an important role in shaping the composition of the intestinal microbiota, which in turn can influence your gut's defense against invaders and enhance resistance to the intestinal infections.
  
Profound Role in Intestinal Balance and Your Health

So because SIgA can neutralize the "bad guys" and shape the "good guys" SIgA plays a profound role in intestinal balance and health.  SIgA is the main immunoglobulin in mucus secretions. The intestinal cells produce about 2-3grams of SIgA every day!  And production tends to peak in childhood and start to decline after about sixty years old.

This is our first-line defense against gut pathogens like bacteria, food proteins, parasites, fungi, toxins and viruses. SIgA antibodies prevent micro-organisms, food proteins and cancer-causing substances from binding to the surface of absorptive cells. Effectively, they attach themselves to invading bugs and trap them in mucus to prevent them from going anywhere!

The antibodies also 'tag' foods as acceptable to the body and this suggests why low SIgA levels can be a factor in developing and progressive food allergy and intolerance. Intestinal permeability is also related since, if levels are low, repair of mucosal tissues can be compromised.  This is often referred to as Leaky Gut and can coexsist with low levels of SIgA.

Certain SIgA antibodies have been shown to directly quench bacterial virulence, whereas others help with uptake of SIgA–immune complexes by mucosal dendritic cells and result in down regulation of pro-inflammatory responses normally associated with pathogens and allergic antigens.

In fact it is becoming increasingly evident that human health is inextricably linked to the gut microbiota, intestinal homeostasis, and mucosal immunity. IgA is at the centre of this dynamic. 

Testing your SIgA

Secretory IgA is quite independent of blood IgA levels so just because one is normal, doesn’t mean the other is.   SIgA can be measured in different ways, including stool and saliva. Levels can turn out to be low or high. Stool measurements have traditionally been based on sample extractions from animal models – it is hard to ask a mouse to spit! Salivary samples provide a systemic overview of circulating SIgA.

Ongoing low levels can help to explain why people can’t shift an immune problem like allergies, chronic skin conditions or infections. It can also explain why they find it hard to get rid of a microbial infection, too. Celiacs and those with IBD can have low levels and chronic stress has a major effect on SIgA levels. Certain medications can lower levels – including anti-inflammatories.   Other factors  includeviral infections (like Epstein Barr viruses), poor nutritional status, food allergies, ongoing stress. Interestingly some studies have shown variations in levels with gender and age – male patients often have lower levels.

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Celiac Disease & Gluten Intolerance... What's up with wheat?

Have you been told you have "gluten-intolerance" or worse... that you have celiac disease?  Many people go for years without knowing the connection between gluten and their gastrointestinal symptoms, autoimmune disease (thyroiditis, arthritis, lupus etc), skin disorder (eczema, acne, psoriasis), and even neurological disorders (epilepsy, ADHD, autism, etc) 

What is gluten?

It's a protein found in wheat grain and part of "gluey" proline and glutamine rich proteins known as prolamines. Prolamines are found in all cereal grains, even rice, corn and oats. Gluten ingestion in susceptible individuals is assosiated with the serious neurological and autoimmune reactions often linked to autism spectrum disorder.  

Historically, we can see a large increase in chronic degenerative diseases, like cancer, heart disease, diabetes, and bone loss/tooth decay when societies start to increase intake of grains and especially wheat.  I have seen remarkable improvement in many patient's illnesses, especially skin disorders and autoimmune disease on a grain-free diet.

 Here is a must watch video from Peter Osborne, D.C. that does a very nice job of explaining the differences between gluten intolerance and celiac disease and explaining how this could be contributing to your symptoms...

If you want to know more about YOUR PERSONAL RISK, just ask Dr. Jill about how you can be tested for HLA typing DQ2/DQ8 genes to determine if you are at risk!

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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Leaky Gut - The Syndrome Linked to Many Autoimmune Diseases...

"Leaky Gut" Syndrome

Hyperpermeability or "leaky gut" syndrome is the name given to a very common disorder in which the cells lining the intestines become "leaky" due to inflammation. The abnormally large spaces present between the cells of the gut wall allow the entry of toxic material into the bloodstream that would normally be eliminated.

The gut becomes leaky in the sense that bacteria, fungi, parasites, undigested protein, fat and toxic waste normally not absorbed into the bloodstream in the healthy state, pass through a damaged, hyperpermeable gut membrane. This can be verified by special gut permeability urine tests or microscopic examination of the lining of the intestinal wall.

Common Causes of Leaky Gut

• Infections - fungal overgrowth, parasitic infections
• Drugs like
• NSAIDS, chemotherapeutic agents
• Crohn's disease or Ulcerative Colitis
• Celiac disease
• Chronic alcoholism
• Strenuous exercise
• Food allergies

Leaky Gut and the Connection to Autoimmune Disease

Leaky gut syndrome is almost always associated with autoimmune disease. In fact, reversing symptoms of autoimmune disease depends on healing the lining of the gastrointestinal tract. Any other treatment is just symptom suppression. An autoimmune disease is defined as one in which the immune system makes antibodies against its own tissues. Diseases in this category include lupus, alopecia areata, rheumatoid arthritis, polymyalgia rheumatica, multiple sclerosis, fibromyalgia, chronic fatigue syndrome, Sjogren’s syndrome (dry eyes & dry mouth), vitiligo, thyroiditis, vasculitis, Crohn’s disease, ulcerative colitis, urticaria (hives), type 1 diabetes and Raynaud’s syndrome. Fortunately doctors are beginning to realize the essential role that the gut plays in these disease. Understanding the leaky gut phenomenon helps us see why allergies and autoimmune diseases develop and how to design therapies to restore intestinal integrity and reverse leaky gut.

Inflammation is a key trigger for leaky gut

Inflammation causes the spaces between the cells of the gut wall to become larger than usua. Then protein molecules are absorbed before they have a chance to be completely broken down. The immune system starts making antibodies against these larger molecules because it recognizes them as foreign, invading substances. Antibodies are made against these proteins derived from previously harmless foods. The immune system becomes hyperstimulated and over-reactive to substances that are not necessarily supposed to be dangerous.

Human tissues have proteins & antigens very similar to those on foods, bacteria, parasites, candida or fungi. The antibodies created by the leaky gut phenomenon against these antigens can get into various tissues and trigger an inflammatory reaction in that tissue when the corresponding food is consumed or the microbe is encountered. Autoantibodies are thus created and inflammation becomes chronic. If this inflammation occurs in a joint, autoimmune arthritis (rheumatoid arthritis) develops. If it occurs in the brain, myalgic encephalomyelitis (chronic fatigue syndrome) may be the result. If it occurs in the blood vessels, vasculitis (inflammation of the blood vessels) is the resulting autoimmune problem... and so on.

If the antibodies end up attacking the lining of the gut itself, the result may be colitis or Crohn’s disease. If it occurs in the lungs, asthma is triggered on a delayed basis every time the individual consumes the food which triggered the production of the antibodies in the first place. It is easy to see that practically any organ or body tissue can become affected by food allergies created by the leaky gut. Because the foods can trigger delayed reactions, it can often be very hard to pinpoint the triggering entity.

 
Leaky gut may cause increase risk of infection and sensitivity to environmental chemicals

This ongoing inflammation also damages the protective coating of antibodies normally present in a healthy gut called IgA. Since IgA helps us ward off infections we become less resistant to viruses, bacteria, parasites and candida. These microbes are then able to invade the bloodstream and colonize almost any body tissue or organ. In the clinic we often find patients with leaky gut or autoimmune disease also have microbial infections ongoing in the gut.

Not only can leaky gut create food allergies as the proteins we consume are activating antibodies, but the microbes in the gut can cross over into the blood stream creating a toxic burden that overwhelms the liver's ability to detoxify. Often in severe cases of leaky gut, patients will develop sensitivities to perfume, cigarette smoke or other environmental chemicals. Common complaints are also "brain fog", confusion, poor focus/concentration, or memory loss.

Leaky gut also causes malabsorption and nutritional deficiencies

Finally, leaky gut may contribute to a long list of mineral deficiencies because of the ongoing inflammation and damage to carrier proteins. The most common are iron deficiency, vitamin B12 deficiency, magnesium deficiency which can lead to fatigue, neuropathies or muscle pain. Zinc deficiency due to malabsorption can result in hair loss or baldness as occurs in alopecia areata. Copper deficiency can occur in an identical way leading to high blood cholesterol levels and osteoarthritis. Further, bone problems develop as a result of the malabsorption of calcium, boron, silicon and manganese.

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

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