How to Heal a Leaky Gut, Part II

Did you miss my first Leaky Gut Article?! Read more here

So now you may be wondering if you have leaky gut...

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.

Causes of increased intestinal hyperpermeability or "leaky gut":

• Medications (NSAIDS) like ibuprofen and motrin
• Microbial overgrowth or infection
• Parasite infections
• Fungal overgrowth (Candida)
• Ingestion of allergenic foods
• Maldigestion/malabsorption (pancreatic insufficieny or low HCl)
• Radiation therapy or chemotherapy
• Stress
• Aging
• IgA deficiency
• Chronic alcohol intake
• Excessive or strenuous exercise
• Inflammatory bowel disease - Crohn's or Ulcerative colitis

The small and large intestines contains numerous dietary and bacterial products with toxic properties. These include bacteria, bacterial cell wall (LPS), 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:

• 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.
• Avoid alcohol, NSAIDS (ibuprofen, motrin, alleve), and minimize other medications.
• Bentonite clay 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. I also frequently recommend Upgraded charcoal tabs for the same purpose.
• 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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Could These Seven Foods Be Causing Your Weight Gain?!

Food Allergy "Fat"
"Fat" that comes with food sensitivities is a characterized by bloating and fluid retention that many people experience when they ingest these top seven food allergens.  Eating foods that interfere with our body’s chemistry causes tissue swelling, abdominal bloating or even facial puffiness that may have the appearance of real fat. In fact, it’s not unusual for a person to look ten to fifteen pounds heavier due to these nasty reactions.

The foods that people react to most commonly are also the most prevalent in the Standard American Diet (SAD, for short)  They are dairy, wheat, corn, sugar, soy, eggs and peanuts.  Many patients assume they aren’t “allergic” to these foods because they don’t experience the immediate histamine reaction we associate with an allergy, like hives, throat swelling or vomiting.  Another complicating factor is that these type of reactions often cause delayed symptoms, meaning that you may not feel badly for 12-36 hours. This makes such sensitivities extremely difficult to identify, particularly if your sensitivity is to a food that you eat on a daily basis. If you are constantly consuming wheat or dairy, for example, and having a low-grade reaction, you may not recognize this as your body’s distress signals. Instead you might assume they are totally unrelated chronic problems, like a eczema, migraines, fatigue, joint pain, or heartburn.

Virtually any food can cause these reactions — even “healthy” foods like citrus or bell peppers. Typically an individual will develop sensitivities to the foods he or she eats most often. Unfortunately the top seven - dairy, wheat, corn, sugar, soy, eggs, and peanuts - are the basis for most processed foods so most Americans are frequently exposed to them.   If we eat such foods on a daily basis, we may experience a near-constant state of reaction — including bloating and fluid retention. More serious, it may cause inflammation to the lining of the gut, upset your metabolism, create nutritional deficiencies, and blood sugar imbalances.  This can lead to food cravings, low energy, depression and even PMS!

When you eat reactive foods, they enter your bloodstream incompletely digested... as bigger particles that your body doesn’t recognize as food. This not only causes indigestion and gas within the gut, but may trigger release of cytokines and chemicals like adrenaline and histamine that set off an inflammatory response. As fluids rush into afflicted cells and are held in your tissues, swelling and abdominal bloating occur. Due to the fluctuation in endophrins that occurs in this "flight or flight response, you may find that you crave the foods your are most sensitive to.  The only real way to heal the gut is to eliminate these food triggers from your diet.

Elimination Diet to the Rescue!

One of the best ways to determine if you are having food reactions is an elimination diet.  Plan for a minimum of 3 weeks off all of the most common seven food allergens:  dairy, wheat, corn, sugar, soy, eggs and peanuts.  You will not be cured by that time, but you can determine which of these seven you are reacting to by adding them back into your diet one-by-one and seeing which one(s) you have a reaction to.

Another way to find the food culprits is to have your physician test you for IgG food sensitivities.  The elimination diet is the "gold standard" to determine what foods you are sensitive to but some patients prefer to have the data on paper before they start.  I use laboratories like, Genova Diagnostics, Metametrix, and US Biotek for this type of testing. 

Be aware that avoiding staple ingredients like wheat, dairy and corn syrup may require you to limit restaurant and packaged foods and to prepare most of your meals yourself.  I also recommend drinking plenty of water and getting regular exercise. Exercise will stimulate your metabolism and boost your energy level. It will also help flush excess fluids, burn calories and suppress your appetite, allowing you to experience even faster results.  Finding you have hidden food sensitivities may require you to adjust your eating, but when the inches start coming off and you feel better than you have in ages it will be worth all the effort!

Tips for Dealing with Herxheimer or Die-off Reactions

Photo courtesy of www.freedigitalphotos.com

Dealing With Yeast Die-Off (Herxheimer) Reactions

  

Yeast overgrowth can happen in response to improper diet, poor immunity, difficulties in digestion and antibiotic use. Poorly digested food can lead to putrefaction (rotting) and encourages the growth of organisms.  Antibiotic use destroys the normal balance of gut flora and leaves an open field for bad bacteria and fungi to move in.  Hormones and steroids can make this condition worse, too.  Most importantly, over-consumption of simple sugars & refined carbohydrates will feed the yeast.  If the immune system is weakened or there are not enough probiotic ("good" bacteria) to combat the yeast, then it begins to grow unchecked and cause symptoms, such as "leaky gut".

In this blog, I am addressing specific patients who are being treated for fungal dysbiosis (yeast overgrowth), who may experience a worsening of their condition after starting a program for yeast control. This may be very unsettling & discouraging if it is not understood.  It must be addressed effectively in order to avoid worsening symptoms. Here are some strategies to minimize the chances of suffering unnecessarily from a Herxheimer (die-off) reaction.

Common Symptoms of yeast die-off include:

Fatigue, brain fog, gastrointestinal distress such as nausea, gas, bloating, diarrhea or constipation, low grade fever, headache, sore throat, body itch, muscle and joint soreness or pain, flu-like symptoms. Other symptoms include: lethargy, intense sweet cravings, rashes, irritability, joint stuffiness, or muscle pain. In susceptible individuals with pre-existing neurological symptoms such as hyperactivity, irritability, tantrums, and difficulty concentrating, their symptoms may temporarily intensify.

Yeast die-off reactions are not necessarily a sign that yeast treatment is succeeding. It may be an indication that yeast cells are dying in large numbers, and an indicator of the body's toxic overload. At that point, more poisons are being released than the body can adequately cope with at one time and may be a sign the system's elimination pathways (liver, kidneys, & bowels) are overburdened or blocked (as in constipation or liver congestion)

If properly undertaken, treatment for yeast related health problems should not lead to severe yeast die-off reactions.  Patients with elevated heavy metal levels may more problems with “die-off” symptoms

Strategies to minimize discomfort & shorten duration of die-off reactions

·       Reduce the dose of anti-fungals: Some patients may have to stop altogether for a few days. Dr Jill will generally start doses slowly and increasing them over time to help you deal with the possible die-off symptoms

·       Enzymes: Adding enzymes with meals may improve the digestion of foods and limit putrefactive short chain fatty acids with enzymes.  Use pancreatic enzymes, NOT fungal or plant based enzymes.

·       Stay hydrated:  Dr Jill recommend 4-6 fluid ounces of warm water every forty-five minutes, throughout the day.  Mineral water may help, too!

·       Get your sleep:  It is imperative to rest when experiencing yeast die-off reactions – 8-10 hours per night is essential.

·       Neutralize toxins:  There are ways to neutralize fungal toxins. Dr. Jill may recommend molybdenum, biotin, pantethine or liver support to accomplish this.  Activated charcoal may also help.

·       Alkalinize:  You may buffer the toxins by taking alkalizing agents immediately upon experiencing die-off symptoms. Such products as AlkaSeltzer Gold. Drinking mineral water may also help.

·       Antioxidants:  Provide extra antioxidants to quench the oxidative reactions created by the toxins.  Dr Jilll may prescribe vitamin C, Vitamin E or A, alpha lipoic acid or N-acetylcysteine.

·       Sauna & baths:  If you have access to a sauna, begin slowly (15 minutes per session) scrub all skin surfaces with a stiff brush and shower immediately afterwards. Another helpful detox regimen is Epsom salt baths – use 3-4 cups in hot bath and soak for 20min every night.

·       Keep your bowels moving:  You must address any issues with bowel elimination if you have constipation – if you are not eliminating, you will reabsorb any die-off toxins being released! 

More remedies for constipation:

·       Use magnesium citrate 500-1000mg daily or until normal, soft bowel movements 1 or more X daily.  You may also add Ascorbic Acid 5-10grams daily to bowel tolerance.

·       Start every morning with a tall glass of warm water.  8 oz of coffee may also be helpful.

·       Try a few tablespoons of extra virgin olive oil, several times daily on an empty stomach.

·       Mix 2 TBSP of ground flax or chia seed into water & stir , let sit for 10minutes, stir & drink on an empty stomach.

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