Understanding Leaky Gut
Intestinal Permeability or Leaky Gut Syndrome (LGS) may be a major contributor of disease and dysfunction and may account for a very large component of many chronic complaints.
In LGS, the lining of the small intestine becomes inflamed and irritated allowing metabolic and microbial toxins normally kept within the small intestines for passage into the colon to enter the blood stream. In technical terms this is called increased intestinal permeability. This results in involvement of the liver, lymphatic system, and immune response (which includes the endocrine system) to react in a protective response rather than a healing response. Leaky Gut could be implicated as a primary contributor to asthma, food allergies, chronic sinusitis, eczema, urticaria, migraine, irritable bowel, fungal disorders, fibromyalgia, and inflammatory joint disorders including rheumatoid arthritis. It also contributes to PMS, uterine fibroid, breast fibroids, chronic fatigue syndrome and pediatric immune deficiencies.
Leaky Gut Syndrome is a very common problem of modern society in part because of antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs), like Motrin, Advil, Aleve, Vioxx, etc. While this discussion is not going to focus on the pros and cons of antibiotics or NSAIDs, both damage the natural balance the bowel requires to operate optimally.
Antibiotics damage the bowel environment in two ways. The first is by destroying beneficial bacteria. The small intestine and large intestine host over hundreds of different kinds of beneficial bacteria. These bacteria are vital for healthy metabolism and immune response within the intestines. Through their enzyme secretions, bacteria transform metabolic and microbial wastes before they are discharged by the body. These wastes include cellular debris, hormones, chemical wastes, bile, pus, viral toxins, bacterial toxins, etc.
For example, the body creates bile not only as a lubricant to flush wastes out of the liver, but also, by its cold and bitter nature, to detoxify many of the poisons accumulating in the liver. Bile however is extremely caustic to large intestine epithelium. When bile enters the small intestine via the common bile duct, beneficial bacteria break the bile salts down into a less caustic compound, making it safe by the time it reaches the large intestine. Antibiotics destroy these bacteria and thus allow bile salts to enter and damage the large intestine. Perhaps this may explain the high incidence of colon cancer.
Beneficial bacteria also metabolize hormones (ex: estrogen) discharged from the liver into the small intestine. If you lack the bacteria to break down estrogen and the intestinal permeability has been altered, the patient is now reabsorbing estrogens. The extra estrogen binds to sensitive areas such as the breast, uterus, or ovaries, contributing, if not causing, fibroids and tumors. Many forms of premenstrual syndrome are due to relative estrogen excess.
The second way antibiotics damage the intestines is by promoting the growth of Candida and other fungi and yeast. This event, more than any other, precipitates Leaky Gut Syndrome. In a healthy situation the small intestine epithelium maintains tight cell junctions, which contributes to the physical barrier involved in intestinal absorption. In other words the cells are kept close together so nothing can penetrate between them. Candida exudes an aldehyde secretion that causes the cells ling the small intestine (epithelial cells) to shrink. This allows intestinal toxins to pass by the epithelium and enter the tissues and blood. In addition to the physical barrier, there is an important chemical barrier within the mucus that contains immune agents which neutralize any toxin that comes in contact. This mucus-immune barrier remains as the sole defender, which eventually becomes overwhelmed.
Although many people believe Candida itself enters the blood stream allowing it to be deposited elsewhere, such as the brain, unless the immune response is completely depleted, as in AIDS, Candida is quickly destroyed in the blood. The real damage done by Candida is to the intestinal epithelial barrier, allowing the absorption of toxins agents and chemicals, which then enter the blood and affect numerous organs, including the brain.
When the integrity of the intestinal barrier has been compromised, intestinal toxins are not the only pathogens to be absorbed. The barrier, in a healthy state, selectively allows digested nutrients to enter through the small intestine. With leaky gut, nutrients can be absorbed before they are fully digested. The body’s immune response, through specific antigen-antibody markers (the food IgG test), will identify some of these foods as foreign invaders. Every time that particular food contacts the lining of the intestines, an inflammatory immune response is mounted that further damages the epithelial lining. What started as an irritation from yeast with shrinking of the cells has now been complicated with active inflammation every time a particular food is eaten. Food “allergies” become a common secondary contributor to maintaining the leaky gut, even after the yeast is eradicated.
The most common food allergies are dairy, eggs, gluten grains (wheat, oats, rye), corn, beans (especially soy), and nuts. It is uncommon to have an allergy to meat, rice, millet, vegetables, or fruit. When an IgG antibody to a food are detected, it is important distinguish a real allergy -- that which causes a histamine inflammatory reaction -- from sensitivity, which may cause uncomfortable symptoms, but seldom is damaging. Sensitivities are usually due to low stomach acid or pancreatic enzyme secretion, that is, poor digestion.
In healing the intestinal lining, exposure to a food that stimulates a significant allergy can sabotage the treatment. For example, one may be very good at restricting wheat, dairy and eggs, but if you are allergic to soy and you use soy milk. For this reason, food allergy testing can be a beneficial guideline on what foods to avoid initially.
Source of TOXINS
Metabolic and microbial toxins that enter the bloodstream during leaky gut end up in the liver, which has the job of detoxifying and excreting these byproducts into the bile. The daily metabolic wastes created by normal cell and organ activity keep the liver very active. Any further load from intestinal toxins can saturate the liver’s capacity to detoxify the poisons, and they are returned to the blood circulation. Because the blood must preserve chemical homeostasis, toxic chemicals and physical debris is excreted into the tissue (matrix). Although the lymphatic system attempts to collect and neutralize toxins, if unsuccessful the burden is borne by the liver and the tissue matrix, which then becomes toxic as well.
What started as a gut barrier problem can escalate into a problem of tissue toxicity. When the tissue environment is compromised microbes grow, lymphatics swell, symptoms of inflammation or deposition occur. Over a period of time, the muscles and joints ache, the brain gets a little foggy, the energy production and the body temperature drops, etc. The result can be conditions like fibromyalgia, arthritis, chronic fatigue, genetic mutations and potentially cancer.
The immune system is also stressed. As toxins and foods contact the mucosa, the immune system is activated to neutralize them from entering the body. Normally, much of this work would have been done by beneficial bacteria. With leaky gut more toxins make it to the mucosa where they will be tagged with secretory IgA (sIgA), which attracts macrophages and other white blood cells to neutralize the toxins. Of course if there are too many toxins or undigested, this immune response is overwhelmed and not only do some toxins and allergens enter the body but the immune system is depleted.
A second stress on the immune system with a leaky gut is when the liver and lymphatic system become overwhelmed and as a result, the immune system serves as an overflow.
As more microbes (viruses, bacteria, and fungi) multiply in an unhealthy GI environment, the immune system is unable to keep the microbes in check. As a result opportunistic infections take advantage of a weakened immune system.
The most important organ in resistance to infection is the adrenal gland. Leaky Gut Syndrome slowly diminishes adrenal function. In the early and middle stages, there is actually an adrenal excess, as measured by excess cortisol output. Eventually, cortisol levels drop and exhaustion develops.
Candida grows and thrives when the terrain in the intestines favors it. Just killing Candida is usually not successful, because if the anti-fungal is stopped and the intestinal terrain has not been normalized, the Candida returns. Although antibiotics may be the original cause by killing acid forming bacteria (Lactobacillus bacteria produce lactic acid, for example), if the environment is alkaline, Candida will grow. Antibiotics and chronic illness also reduce stomach acid production, contributing not only to the alkalinity but also impairs digestion. In fact, many people with leaky gut are malnourished, no matter how healthy the food is that they eat.
While lactobacillus supplementation is often recommended to help with leaky gut and Candida overgrowth, most of the lactobacillus sold today does not survive in the intestine, either due to poor terrain or due to being a strain that does not implant in the human intestines.. There are specific Lactobacillus preparations available that do implant and do help establish a healthy intestinal environment.
Summary of Common Causes of Leaky Gut Syndrome
- Consumption of allergenic foods
- For infants, premature birth
- Inflammatory Bowel Disease
- Radiation therapy
- Alcohol consumption (depletes N-acetyl glucosamine)
- Non-steroidal anti-inflammatory disease (also depletes N-acetyl glucosamine)
- Secretory IgA deficiency (can be due to zinc or vitamin A insufficiency)
- Oral and parenteral corticosteroids (prednisone, Medrol, cortisone, etc.)
- Eating foods that are not compatible with heritage or blood serotype
- Deficiencies of amino acids that support the gastrointestinal lining (glutamine, arginine, taurine, BCAA, etc.)
- Zinc or vitamin A deficiency
- Digestive tract infections (bacteria, yeast, parasites, viruses)
- Bioflavonoid insufficiency leading to unstable mast cells and subsequent degranulation
- Excessive stress
- Poor digestion
- Excessive sugar leading to yeast and bacterial overgrowth
- HIV infection
Confirming the Diagnosis: Laboratory tests can help confirm and gauge various aspects of Leaky Gut including Candida levels, digestive function, food allergies, etc. Many of the tests are expensive, inconclusive, and not always even accurate. It should be assumed that there are food allergies. If any food allergy is allowed to persist, the intestinal wall will remain inflamed and toxic absorption will continue. Before even considering testing, avoid dairy (cow’s milk, cheese, cottage cheese, yogurt, ice cream) and gluten grains (wheat, rye, oats, spelt, barley). Other relatively common food allergens include eggs; corn (including popcorn, corn syrup, corn oil); and beans (especially soy, lentil and kidney; soy includes tofu, miso, and tamari). Less commonly almonds, peanuts, and garlic are allergenic. Be careful of these ingredients in packaged foods or foods prepared in restaurants.
Many patients feel that certain foods are allergenic because of reactive symptoms. It is important to distinguish “sensitivity” from an immunologic/allergic reaction. Sensitivity to tomatoes or oranges for example may cause discomfort because of an imbalance of digestive acids and enzymes. In contrast, an immune reaction leads to damage to the intestinal lining by initiating an inflammatory reaction, and ironically, are usually without any perceived reaction. Allergy tests can largely be classified as either skin or blood. The traditional skin tests done by Allergists only show reactions that are immediate IgE-based reactions. Most food allergies are delayed reactions, and require testing of the IgG levels through blood serum.
Blood food allergy tests have been helpful even though their accuracy has been questioned. While they may not perfectly predict allergies, they seem accurate based on dramatic improvements in the clinical picture if the foods are avoided. Further, a paper print out of one’s allergies is provides a clear guide to the foods that need to be avoided. There are practitioners who do machine or muscle testing of food allergies, and this is quick and inexpensive. However, they do not seem to distinguish true allergens from sensitivities. There are reliable blood tests for immune reactions but not to food sensitivities as far as I know.
If testing is indicated, assessing the level of Candida infestation helps prioritize treatment. High levels usually warrant specific anti-Candida treatment. Blood antibody tests for Candida is readily available through many reference laboratories but may not identify yeast infections that are localized to the gut (or urogenital tract). It only shows the person for whom candida has been exposed to the blood based antibodies (IgG). Another way to assess yeast is to examine the feces (stool or digestive analysis) with yeast cultures or stains. Both should be done since often times the yeast will not grow in culture but can be seen when searched for by a microscope. In addition, the intestinal environment that promotes yeast often has bacteria and parasites and these add additional avenues to explore. A third technique is to test the urine for metabolites of yeast. Since humans do not make certain chemicals, if these chemicals are seen in a urine specimen one can assume that a bacteria or yeast produced them.
Part of the digestive analysis profile includes an assessment of digestion, absorption, inflammation, in addition to cultures for bacteria, yeast, and parasites. For example, chymotrypsin is a digestive enzyme produced by the pancreas that has been suggested as an indicator of pancreatic enzyme function. Traditional Chinese Medicine might call this a stomach-pancreas deficiency with a spleen qi deficiency. From this perspective, lack of Candida and a normal fecal chymotrypsin level one can infer Leaky Gut is unlikely. Another part of a comprehensive digestive test is measurement of fecal secretory IgA (sIgA) as a marker of your intestinal immune system at the site of mucosal lining.
There are tests to determine the intestinal permeability, which is a more precise way of saying leaky gut. By drinking a liquid containing two measurable sugars, one large and one small in size, and then collecting urine for 24 hours, the degree of permeability can be measured. It accurately shows the degree of Leaky Gut. It is helpful in making your case with medical doctors. It does not give any insight into the actual cause, however.
Therapy: Leaky Gut Syndrome may require the following:
- Identify and avoid ongoing dietary irritants to the intestine mucosal lining (food allergies, alcohol, and NSAIDs). Diet is perhaps the hardest path for patients to follow, but this is what determines who gets better and who doesn’t. Patients need to understand that allergenic foods keep the intestines inflamed, allowing toxins to continuously enter the body and perpetuate the process that leads to a leaky gut.
- Candida, bacteria, and parasite overgrowth must be resolved. Diet therapy alone will not eradicate a large overgrowth of Candida, but certain foods will sabotage successful therapy: sugars, refined white flour products (bread, pasta, and pastry), fruit juice and dried fruit. Fresh fruit may or may not be a problem, depending on the severity. Treating Candida can be a big challenge. Funguses are survivors and are difficult to get rid of. Their job is to suck the life out of decaying tissue, so a fundamental imbalance in the vitality and chemistry of the small intestines is often the root cause. Addressing proper pH and restoring vitality via herbs are often mandatory to success. When the Candida levels are high, prescription medicine such as Nystatin, Nizoral, Diflucan, or Sporanox combined with an anti-Candida diet may be necessary to achieve a rapid response. Some of the medications can be toxic to the liver and thus is not without risk. It is not uncommon to need to change the anti-fungal product (either pharmacologic or herbal) every so often to avoid tolerance and adaptation by the yeast or microbe.
- Nutrients and herbs to promote healing of the epithelial lining. If one can stop the irritating factors discussed above, the lining should heal by itself, although slowly. Ginkgo, slippery elm, aloe vera, bioflavonoids such as quercetin, chlorophyll complex, essential fatty acids, antioxidants, and the amino acid glutamine have all been used to heal the intestines. According to Traditional Chinese Medicine, the spleen is responsible for repairing the intestinal lining of the small intestine, and prolonged Leaky Gut easily depletes spleen Qi. This can be noticed with traditional TCM signs and symptoms, or by the Chymotrypsin enzyme level in the feces. If spleen deficiency and liver stagnation coexist there will often be food stagnation, a formula that addresses both may be helpful. If all signs of excess are gone with signs of a weak or small pulse, tonifying the spleen may be required
- Liver support.
- Lymphatic and interstitial fluid mobilization, drainage and detoxification.
- Immune deficiencies need to be supported
- The endocrine system, with particular focus on the adrenals, regulation and support. Pituitary and duodenal support may also play a role.
- Stomach acid, digestive processes, and pancreatic enzyme optimization. Naturopathic approaches often include hydrochloric acid (HCL) and pancreatic enzyme support but these will not rehabilitate the pancreas but will promote efficient digestion while the spleen-pancreas-intestine is recovering.
Prognosis: If you can stay on an appropriate diet, recovery is possible within a few months using the types of therapy indicated above. However, some patients may need up to nine months of treatment for complete recovery if they have depleted their energy reserves. Leaky Gut Syndrome at its heart is auto-toxicity. The need is to rehabilitate the selective barrier of the small intestinal wall, detoxify the body, and restore liver, spleen and kidney functions.
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