What is 'leaky gut'?

Did you know that your intestines are about 30 feet long? They’re one of the only things that separate the outside environment from the inside of all of your organs. Think about it, things go in our mouth and then they come out the other side. They never touch anything else inside the body. Pretty cool. Today we’re talking about leaky gut. What is it? There is no gold standard of diagnosis. “Leaky Gut” is a colloquial term that means you may have intestinal permeability or some sort of gut barrier dysfunction. The term is interesting because it’s really descriptive, and quite literal; things leak through from your gut into your bloodstream. It’s implicated in a lot of autoimmune diseases and conditions like autism, obesity, diabetes, celiac disease, Crohn's and ulcerative colitis. When food or other substances leak through into the bloodstream, the body attacks it, creating conditions of overactivity in the person’s immune system. Let’s do a little anatomical review. When you eat you put food into your mouth, it goes down your esophagus, into the stomach. When it leaves your stomach it passes through the first section of the small intestine: the duodenum. After the small intestine, that food passes into the large intestine. We’re going to focus mostly on the small intestine. When we talk about a small intestine, imagine the inside of a pipe. Inside this “pipe” are little fronds called villi. They pull in nutrients and this is how we absorb things. These villi have things like monosaccharides and disaccharides that break down sugar and send it through the barrier and into the bloodstream. What happens when these villi, or these junctions, are open? It leads to a leaky gut. This is due to something called zonulin. In the intestine, zonulin that is like a bouncer at a nightclub. Zonulin is responsible for regulating something called a tight junction. It controls the permeability of these tight junctions between cells in the intestine wall. It's thought that this intestinal barrier is only one cell wide. Think about how infinitesimally small that is and how easy something might leak through. That's a pretty important role. When there is inflammation in the gut, it gets up-regulated, which there's more Zonulin. Instead of keeping those tight junctions close, it opens them up. When food particles permeate that barrier and enter the bloodstream, it's thought that the immune system will attack them like they're invaders that don't belong there. Your immune system is expecting nutrients, but instead it's getting a particle of oat or a piece of milk, or the proteins in milk like casein. So, it starts to attack and you can see how, if that was going on and on and on and on, day after day, that you might get this inflammation and this autoimmune disease component going on. So, how do doctors even treat this? If you went to a gastroenterologist, they're going to try to see what's going on with the inflammation and try to make your symptoms feel better, before they make that assessment. They might put you on a proton pump inhibitor like Prilosec or something like Pepcid, to calm everything down in the gut.

Then they would want to scope it to see what's going on. They will look for inflammation, celiac disease, gastritis or even ulcers. Those are the sorts of things that up-regulate that Zonulin and keep the tight junctions open. Some of the symptoms I see are diarrhea, IBS, bloating and gut pain. Some people go to a gastroenterologist and there's no real explanation after that, not realizing that leaky gut could be a cause. There may be a dysbiosis, which means the microflora are out of balance. Something like a probiotic can help. Most probiotics have two common strains. The first is called bifidobacteria and the other one is called lactobacteria. The bifidobacteria reside in the small intestine and help with digestion and lactobacteria reside in the large intestine. We would definitely want some bifidobacteria to help to recolonize, rebalance and help digestion.

Inflammation can also be quelled by L-glutamine, a common ingredient in supplements that support gut health. L-glutamine is an amino acid that acts like mortar over a bunch of bricks. It creates a mucus layer inside the intestine wall, re-coating it and helping the food move through a lot easier. Another method of identifying leaky gut would be to perform a food sensitivity test. Instead of the results showing a sensitivity to one category like milk or soy, the entire test lights up. We're testing the blood against 96 different foods or 186 different foods and they're all in the red zone. Patients may panic thinking they can’t eat anything anymore, but that is not the case. Those aren’t necessarily sensitivities, it's the zonulin opening those tight junctions, and those are the things that are flowing through to the bloodstream. It's often things that people eat on a regular basis. We go about a method of gut healing, and after six to eight weeks, we start to reintroduce all these foods using something called an elimination diet. We don't eliminate everything, just the biggest offenders. Usually a doctor will have a patient will do a diet diary to keep track of their foods and their symptoms. We work together collaboratively with the testing, diet diary and tracking symptoms to find the foods that are really offensive.

Now if you stop and think about why would you do an elimination diet? If you had somebody who showed up at your door every day, and punched you in the nose, and then did it every day at the same time, the third day or so you would not want to open the door. We don't want those foods punching us in the gut. So, every day, we're adding a little more fuel to that fire; a little more inflammation. If we take that fuel away, it enables that fire to calm down, and for us to heal. There’s one last thing that may be used to treat leaky gut. There are a number of therapies now called peptides. Peptides are a string of proteins and they’re often used for very specific things. There's one called BPC 157. BPC 157 has really good efficacy against gut inflammation and ulcers. As previously mentioned, those are the sorts of conditions inside your intestines that can create the opening of those tight junctions and cause up-regulating of the zonulin to open those tight junctions. The important thing to keep in mind is that each case will have its own conditions and therefore require a unique treatment plan. If you would like to learn more about leaky gut, we are holding an event on May 6th called "Eat Heal Thrive", the event is free with RSVP.

If you have these symptoms and would like to learn more about testing, you can schedule a free 15-minute consultation with Dr. Dan Wool. We have locations in Scottsdale and Tempe. To schedule an appointment, call our office at 480-389-3265.


[Note: This was a cross-post from Chambers Clinic.]

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