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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Photo courtesy of www.freedigitalphotos.net

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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