Leaky Gut Syndrome: A Primer on Intestinal Permeability

Understanding your intestines

Our "gut" or intestines is a long, continuous tube extending from the mouth to the anus that covers more than 4000 square feet of surface area. It interacts with the outside environment (in the form of food, beverages, medications, etc.), extracts what it needs, and releases what it doesn't. From the bottom of your esophagus to your anus, the intestine is covered in a single layer of cells, called the epithelial barrier.

The epithelial barrier is important for two reasons:

  1. It creates a boundary between the "outside" (.e. the inside of your intestines and all of the external agents traveling through it) and the "inside" (i.e. your bloodstream and organs). The epithelial cells need to be highly selective; if anything that isn't welcome crosses the barrier, it can cause or perpetuate mucosal inflammation. 
  2. It secretes immunoglobulins (antibodies) and other antimicrobials that make up an integral part of your immune system. 

What is leaky gut?

Between the individual cells, lie junctions that serve to pull the cells that serve to pull the cells as tightly towards each other as possible. Certain factors cause these junctions to loosen their hold, thereby weakening the integrity of the epithelial barrier. When there is increased intestinal permeability (a fancy term for leaky gut), external agents (antigens) such as partially digested food, toxins, and bugs enter the bloodstream and have easy access to organ tissues. This invasion of antigens not only adds more burden to the liver, which has to process and eliminate them, but it also causes an imbalance of the inflammatory immune response and eventually leads to chronic inflammation. 

Risk factors

Since the epithelial lining is not meant to be impenetrable, each of us have intestinal permeability to some extent. The more porous your epithelial lining is, however, the higher your chance of experiencing symptoms. Certain genetic and lifestyle factors are associated with a higher degree of permeability; these include:

  • Food sensitivities 
  • Chronic stress 
  • History of gastroenteritis
  • Highly oxidative diet (low in fiber, high in sugar and saturated fats)
  • Heavy alcohol consumption 

Symptoms

The tricky thing with leaky gut syndrome is that since it triggers widespread inflammation, symptoms can show up virtually anywhere in the body. This makes the diagnosis of leaky gut syndrome difficult without a proper assessment or diagnostic testing by a healthcare provider. Some common symptoms include: skin rashes, food sensitivities, gastrointestinal complaints (e.g. gas and bloating), fibromyalgia, thyroid dysfunction, and cognitive impairment. A 2014 literature review showed that chronic intestinal permeability was linked to both intestinal and extra-intestinal (outside the gut) diseases.

  • Extra-intestinal conditions
    • Allergies
    • Infectious (e.g. respiratory) 
    • Acute inflammation (e.g. sepsis, multiple organ failure)
    • Chronic inflammation (e.g. arthritis)
    • Obesity-associated metabolic diseases (non-alcoholic fatty liver disease, diabetes type I and II, cardiovascular disease)
  • Intestinal conditions
    • Gastric ulcers
    • Infectious diarrhea
    • Irritable bowel syndrome
    • Cancer (esophageal, colorectal)

How to fix leaky gut syndrome

Leaky gut syndrome is considered a “grey area” within the medical system because we do not know enough about the gut yet. In fact, some debate remains as to whether or not this condition is real. Regardless of the politics in the various medical fields, if you feel that you may be experiencing symptoms of leaky gut syndrome, it is important to consult with a healthcare provider who can assess your particular condition and recommend appropriate tests and treatments.

The naturopathic approach to treating leaky gut syndrome is the 4 R’s:

  • Remove irritants
    • This is perhaps the most important step of the entire protocol as it decreases the amount of irritating substances that further damage your intestinal lining. Keep in mind that it can take upwards of six months to fully heal the gut.
      • Avoid all grains, legumes, and dairy products as they inhibit the healing process
      • Remove highly oxidative and processed foods; additives found in processed foods tend to be irritating to the gut lining

      • Eliminate caffeine, hot spices, black pepper, and alcohol which can be irritating to the gut lining

      • Decrease refined sugar intake as it increases inflammation
         

  • Replace insufficient digestion

    • Stick to primarily cooked foods, avoiding all raw meat, fish, vegetables, and fruit

    • Increase the amount of bitter vegetables (e.g. bitter melon and dandelion leaves) that you eat to stimulate the liver (an important detoxifying organ)
       

  • Reintroduce normal flora
    • It can be easily assumed that if your gut lining is suffering, then your gut flora (good bacteria) have taken a hit as well. Your health care provider may prescribe a probiotic supplement for you to take temporarily to help restore normal flora.
    • In addition to taking a supplement, you can add probiotic-rich foods to your diet. Examples are: sauerkraut, kombucha, and kimchi
       
  • Repair the intestinal lining
    • If you are working with a healthcare practitioner who is well-versed in intestinal permeability, you may have some supplements recommended to you. Common lining-healing supplements include glutamine, turmeric, N-acetylglucosamine, and zinc.
       

  •   Bonus: RELAX!

    • Set time aside to relax and enjoy your meals, and ensure that you chew your food thoroughly to give your digestive organs a head start

    • Prioritize stress reduction, a regular exercise regimen, and quality sleep

 

 

Resources
·       Leaky gut as a danger signal for autoimmune diseases. Frontiers in Immunology, May 2017.
·       Diseases related to intestinal permeability. BMC Gastroenterology, 2014
·       The intestinal epithelial barrier: a therapeutic target? Nature Review Gastroenterology and Hepatology, November 2017.
·       Alterations in intestinal permeability. GUT, 2006.
 
 

Disclaimer: Information can be empowering, but we all have unique health profiles and needs. Any health-related information contained in this post is intended to be educational and should not be used as a substitute for a visit with your primary care physician. For more information or individualized treatment, feel free to contact me