Leaky Gut Syndrome
What do health problems like migraines, eczema, psoriasis, asthma, autism, ulcerative colitis and rheumatoid arthritis (and many other autoimmune diseases, including some osteoarthritis) have in common? These conditions are very different, affecting many different parts of the body in many ways.
Some say the common link is Leaky Gut Syndrome (LGS), also called increased intestinal permeability. Leaky Gut sounds more interesting. Regardless of the name used, exactly what is it? Does it really exist? How does it occur and can it affect you? How do you know if you have this? If you?ve got it, how can you get rid of it? This article will attempt to answer these questions.
First, let?s investigate several aspects of your digestive system, primarily your intestinal tract, and the overall state of digestive health in the United States. This will lay the foundation to discuss LGS.
What Happens In Your Intestines?
The intestinal tract is an amazing, unsung part of the human anatomy. What do we know about it? What does it do for us? According to Robert McFerran, author of the upcoming book ARTHRITIS -- Searching for THE TRUTH -- Searching for THE CURE (you can read much of the manuscript on the internet at http://homepages.paradise.net.nz/rwgully/resources/sitemap.htm under the Dietary Theories section):
Over 4 million years of human evolution has provided us with an intestinal tract that:
Has a HUGE surface area - The intestinal tract, while only 20 feet long, has a folding, undulating wall that maximizes surface area. A surface area of over 100 square yards is generated by this design allowing tremendous mechanical, chemical and absorptive efficiency.
Constantly sloughs off tissue along the innermost wall - The stomach, small intestines and colon regenerate their surface once every 12, 14, and 18 hours respectively. This constant renewal of tissue helps to maintain the high level of functionality required by the intestinal tract. Sloughing also makes it more difficult for disease, causing micro-organisms to attach themselves and assists with the efficient processing and excretion of residual wastes.
Devotes 80% of the body?s total complement of t-cells to constant surveillance along the intestinal tract - The tissues of the intestinal tract are delicate and susceptible to damage. If the intestinal wall is compromised pathogens can enter the body. T-cells provide a much needed defense mechanism. They vigilantly wait, responding quickly and aggressively to inactivate and eliminate these intruders.
Maintains a symbiotic relationship with over 500 different types of micro-flora - The lower intestinal tract purposely provides a hospitable environment for bacteria, fungi and other micro-flora. Beneficial micro-organisms stabilize the intestinal environment while aiding vitamin synthesis and processing of wastes. This stable mix of intestinal micro-flora plays a crucial role in protecting the gut from pathogens and parasites.
Let?s look at another source. Elizabeth Lipski, board certified clinical nutritionist and author of the books Digestive Wellness and Leaky Gut Syndrome, has the following comments.
The intestinal wall has a paradoxical function: it allows nutrients to pass into the bloodstream while blocking the absorption of foreign substances found in chemicals, bacterial products, and other large molecules found in food?.?
Current research indicates that 70 percent of the immune system is located in or around the digestive system. Called gut-associated lymphatic tissue, it's located in the lining of the digestive tract and in the intestinal mucus.
The large intestine contains trillions of bacteria. Helpful bacteria, called probiotics, lower the pH of the colon, killing disease-causing microbes. Probiotics also produce vitamins A, B, and K, protect us from illness, enhance peristalsis, and make lactase for milk digestion.
Nutrient absorption, protection from disease this is the essence of activity that keeps us vibrant and healthy. It makes sense that any significant disruption to the digestive process will likely cause problems. For example, how many of us realize that having an inflamed intestinal wall (colitis, etc.) likely means that one is at risk of malnutrition and/or an impaired immune system? In this case, our body's nutrient absorption and health vigilance abilities just aren?t as good.
What happens when the balance between beneficial bacteria and harmful bacteria in the intestines goes out of normal balance (called dysbiosis)? Some feel this is a major factor in the development of the all too common Irritable Bowel Syndrome (IBS). According to Dr. Leo Galland, dysbiosis is closely associated with intestinal permeability and disease. He sites several sources to support his statements in the Bacterial Dysbiosis section at this link.
The Impact Of Stress
When discussing the intestinal tract, we also need to look at stress and the ?fight or flight? response all of us automatically evoke in response to it. When we are at rest, our intestines need a large amount of blood flow to function properly because they are constantly rebuilding tissue. Recall the surface regeneration activity of the intestines.
What do we know in general about stress? How does this relate to intestinal health? Gail Hendrickson, RN, BS, writing for the Discovery Health Channel website (http://health.discovery.com/diseasesandcond/
encyclopedia/3096.html), says the following.
?Acute stress is the reaction to an immediate threat. This is commonly known as the "fight or flight" response. The threat can be any situation that is experienced as a danger. Common stressors include noise, crowding, isolation, illness, hunger, danger and infection. Imagining a threat or remembering a dangerous event can also evoke a stress response.
Modern life frequently results in on-going stressful situations. These may include difficult work or personal situations. Psychological pressures such as relationship problems, loneliness, and financial worries can lead to chronic stress. Physical illness, especially chronic conditions, is another common source of stress?For most people, stress is almost always present. Too much stress can seriously affect physical and mental well being.?
When we experience stress, how do our bodies respond? What can happen in the case of chronic stress? Again from Hendrickson:
?Stress affects the body in many ways, including: ? the release of chemicals called catecholamines from the brain. These are a group of hormones that include adrenaline and epinephrine. ? an increase in heart rate and blood pressure, as the heart and lungs work harder. The rate of breathing also increases and the lungs take in more oxygen. The blood flow increases to get the body ready for added demands. ? dryness of the mouth and throat. Blood flow decreases to areas that are less important for basic survival, including the mouth. This causes dryness of the mouth and difficulty talking and swallowing. ? cool and clammy skin, as blood flow is diverted to vital organs and muscles ? slowing down of digestion of food?Prolonged stress can disrupt the digestive system, irritating the large intestines. This can lead to diarrhea, constipation, abdominal bloating, and cramping?Stress plays an important role in a number of skin conditions, including acne, hives, psoriasis, and eczema.?
McFerran does a nice job of putting chronic stress in context with our body?s intestinal design.
?This design wasn?t by chance. Natural selection forged an intestinal tract finely tuned to balance digestion, elimination, defense and stability. This anatomical structure gave our ancestors an advantage critical for survival. However this design would not be without an Achilles heel. The anatomical design of the intestinal tract would demand more cellular regeneration and blood flow when at rest than any other organ system in the body.
We?ve already seen how persistent stress (either physical or psychological) chronically starves the gut of the blood flow needed for cellular repair. A diet mismatched to inherited metabolic needs compromises (among other things) the amino acid synthesis needed to fuel cellular regeneration throughout the body.
What we witness next is what happens when a physiology that has been built for the past hasn?t had time to evolve as rapidly as change in diet and lifestyle. A collision is imminent and the intestinal tract is poised to be the first casualty. What was designed by nature to give our ancestors an advantage has now become a liability.?
Are we damaging our intestinal function, and our health, through chronic stress overload (among other things)?
Our Digestive Health
How well are we supporting our built in digestive health system? Elizabeth Lipski, in her book Digestive Wellness, sites the following statistics.
?According to a May 1994 study, 69 percent of the people studied reported having at least one gastrointestinal problem within the previous three months.
Except for the common cold, digestive problems are the most common reason people seek medical advice. They are the third largest category of illness in the United States, at a cost of $41 billion.
Constipation plagues our nation. Americans each average over $500 a year on laxatives alone.
Year after year, medications for digestive illness top the pharmaceutical best seller list. Zantac, an ulcer medication, is the best-selling drug of all time, with sales of well over $1 billion annually.?
It's safe to say we are doing something wrong as digestive illness is at epidemic proportions. Can this situation lead to Leaky Gut?
What is Leaky Gut Syndrome?
Leaky gut syndrome, or intestinal permeability, is a condition in which the intestinal lining is more permeable than normal, which means there are unusually large pores or spaces between the cells that make up the intestinal wall. This additional space allows toxic substances such as bacteria, viruses, parasites, and other harmful factors to enter the bloodstream and reach every part of the body. In a healthy gut, these toxins are eliminated.
Does LGS really exist or is it fantasy? Let?s take a look at available information.
One of the better known mainstream articles about LGS was published in Newsweek in November, 1997. It was called ?Gut Reactions.? You can find the article in its entirety at the link below.
While this article presents varying opinions about LGS, it does provide a good layman?s introduction to the subject. Below is a quote from this article supporting the existence of LGS.
Until a few decades ago it was thought that unless a medical problem directly affected the gut, it worked normally. But now physicians know that trauma to other parts of the body causes the gut to react. Dr. Douglas Wilmore, a researcher at Harvard Medical School, showed how intestinal permeability increased in post-operative patients and people with AIDS.
We have a lot to learn about how our digestive system really impacts our health. What other evidence can we find to support the existence of LGS?
There is a test, using the sugars lactulose and mannitol, which measures small intestine ?leakiness. This is commonly used to test permeability in various situations. To see a description of this test, follow this link.
What does medical literature say about LGS? If you search the Medline database for intestinal permeability arthritis, you will find a large number of studies and articles relating to LGS and various types of arthritis. One Medline search site is http://www4.infotrieve.com/newmedline/search.asp. Although LGS has not become accepted by mainstream medicine, you will find several studies/articles here which support the existence of LGS and its association to multiple types of arthritis.
What Causes Leaky Gut?
Based on most available literature available, there is no single cause of LGS. According to Elizabeth Lipski, in her book Digestive Wellness, the following items are commonly sited.
Chronic Stress. Prolonged stress changes the immune systems ability to respond quickly and affects our ability to heal. Our body reacts to these stressors by producing less secretory IgA (one of the first lines of immune defense) and less DHEA (an antiaging, antistress adrenal hormone) and by slowing down digestion and peristalsis, reducing blood flow to digestive organs.
Dysbiosis. The presence of dysbiosis contributes to leaky gut syndrome. Candida push their way into the lining of the intestinal wall and break down the brush borders?.and other parasites also irritate the intestinal lining and cause gastrointestinal symptoms. People who have or have had digestive illness or liver problems have an increased tendency to leaky gut syndrome.
Environmental Contaminants. Daily exposure to hundreds of household and environmental chemicals puts stress on our immune defenses and the body's ability to repair. Our immune systems can only pay attention to so many places at one time. Parts of the body far away from the digestive system are affected. Connective tissue begins to break down, and we lose trace minerals like calcium, potassium, and magnesium.
Poor Food Choices. Poor food choices contribute to an imbalance of probiotics and pH. An intestinal tract that is too alkaline promotes dysbiosis. Low-fiber diets cause an increase in transit time, allowing toxic by-products of digestion to concentrate and irritate the gut mucosa. Diets of highly processed foods injure our intestinal lining. Processed foods are low in nutrients and fiber, with high levels of food additives, restructured fats, and sugar. These foods promote inflammation of the GI tract.
Use of Medication. NSAIDs damage brush borders, allowing microbes, partially digested food particles, and toxins to enter the bloodstream. Birth control drugs and steroid drugs also create conditions that help feed fungi, which damage the lining.?
What Can You Do About Leaky Gut?
Okay, let's assume that you may have LGS. How can you make it better? Consider doing the following items. Some are easier to implement than others. This is not a magic bullet approach, but a change of lifestyle. Find a practitioner to assist you if possible.
Learn how to handle stress better. We live in a high stress world, and it's impossible to avoid much of it. Given this, an important thing to address is your reaction to stress. As previously specified, our bodies can have a tough time adapting to todays way of living (McFerran: a physiology that has been built for the past hasn?t had time to evolve as rapidly as change in diet and lifestyle). If you are chronically stressed, it appears that blood flow to your intestinal tract may not be sufficient to maintain a healthy digestive system, a major factor in our overall health.
How can you deal with stress? There are many forms of relaxation techniques available, such as meditation and visualization, that can provide great benefits over time. There is much scientific evidence to support this. A good general introduction to this topic can be seen at this site. http://www.med.unc.edu/medicine/fgidc/relax.htm
Detect and eliminate food sensitivities (not food allergies). There are few true food allergies. However, the existence of food sensitivities and how to detect them are among the most controversial subjects in the field of arthritis. Several physicians recommend eliminating one food at a time and then adding it back to determine possible reactions. As many arthritics can attest, this is method is often not effective.
According to Elizabeth Lipski, author of Leaky Gut Syndrome, There are two main ways to test for food sensitivities: an elimination/provocation diet and blood tests. It's advisable to do both The Elimination/Provocation Test is a low-allergy diet which allows you to feel changes in your body by first eliminating and then reintroducing foods you might be sensitive to. The foods allowed during the elimination test are unlikely to cause food sensitivities. Eliminating the offending foods over several months time gives your digestive system a chance to heal because you are no longer irritating it.
Although this type of approach has been very effective for many, it should be carefully planned. Many say the most difficult part is adding foods back as one must be diligent in monitoring foods eaten and possible reactions over a relatively lengthy time period.
Lipski also recommends selected blood tests to help determine possible sensitivities. Blood tests which quantify antibody reactions are simple, effective ways to screen for food and environmental reactions. Look for a lab which tests for IgG or IgG4 antibodies. Most laboratories also include a list of prepared foods which contain hidden sources of the offending foods, a rotation menu and other educational material to help you in the healing process.
Change your diet. If poor food choices contribute to LGS, it makes sense to consider changing one's diet to a healthier alternative. However, there are many choices out there and everyone seems to be promoting something different. For example, should you eat red meat? How about nightshades, dairy, wheat and soy? Can you go out to restaurants? How do you know what to do?
There are some common elements between many of the diets available today. For example, elimination (or at least major reduction) of processed foods ? organic is preferable, but not always a must - is usually considered essential to aid a return to health. These may seem extreme to most of us, but consider the state of our collective digestive health while following the typical modern, processed food diet.
People who are successful in making significant diet changes consider this a change in lifestyle, not just a diet with the associated temporary connotations. It?s obvious that this step is huge for most people. A new frame of mind, some serious goal setting, and large doses of determination and persistence are required.
One word of advice from some who have been through this: set short-term goals, evaluate your situation at each stage, and move from there. What seems impossible when looked at in a global context may be attainable when broken down into manageable pieces.
Control any parasites associated with LGS. LGS theory says that one?s immune system can become weakened and is often overwhelmed by harmful substances that pass through the intestinal lining. If this is the case, it makes sense that opportunistic bacteria, parasites, yeast, etc, that exist in our intestinal tract have a greater chance of growing out of control and causing additional problems such as additional intestinal damage.
Most successful LGS protocols incorporate antifungals, antibiotics, etc, to deal with these LGS complications as necessary.
Change the ecology of the intestinal tract. The use of prebiotics and probiotics is promoted by many (and indicated by several research studies) as having the ability to improve the balance of good to bad bacteria in the intestinal tract and thus improve health.
Prebiotics are foods that increase the chances of particular good bacteria thriving in the intestinal tract. Some of the best known prebiotics are fructooligosaccharides (FOS).
The field of probiotics is actually about 100 years old. Probiotics the idea that friendly bacteria can suppress the activity of harmful bacteria was proposed by microbiologist Eli Metchnikoff at the Pasteur Institute in Paris. Metchnikoff won a Nobel Prize in 1907 for his research in this area. Many types of yogurt are good sources of probiotics. Others use supplements.
Use nutrients to repair the intestinal mucosal lining and to support your immune system. There are several nutrients that are typically recommended to help repair the intestinal lining. Glutamine is probably the best known.
Other vitamins and minerals can be taken to help one's immune system function and overall health. Many of these are in standard multi-vitamins. This is usually thought to be pretty important in complementing a person?s diet. Often vitamins, minerals, essential fatty acids (EFAs), etc, are customized to the diet one is following.
Exercise. Consider doing light exercise as you are able to strengthen muscles and improve overall well being (and depression levels).
Spirituality. If you have faith in a higher power, don?t hesitate to use it to sustain you and to help handle stress.
About disease modifying arthritis drugs (DMARDs). Many people have the impression that using a natural approach to treating arthritis means that one should totally exclude the use of traditional arthritis medications, particularly DMARDs. However, there may be situations where using a DMARD may make sense to increase the odds of slowing disease progression while waiting for more natural methods to work (according to McFerran, don't expect to see significant sustained LGS improvement for 3-4 months). This is a personal decision between you and your physician.
If you have made it this far, congratulations! This article presents a great deal of information.
Let's summarize. We have reviewed a few basics of the human digestive system, its interaction with the immune system, and the impact of chronic stress on the body.
In modern countries today we see a large amount of digestive illness. Many consider dealing with LGS to be the key to successfully treating these digestive problems and a wide variety of other health problems. We?ve discussed primary causes of LGS along with the major components of an action plan to resolve this serious health issue.
Only you can decide if a reasonable person would conclude that LGS exists, that it can influence arthritis and various other problems, and that you want to take action to do something about it. This article is just the tip of the iceberg in terms of information relating to this topic.
Best of luck in your health journey!
ARTHRITIS -- Searching for THE TRUTH -- Searching for THE CURE by Robert McFerran. Partial manuscript is at http://homepages.paradise.net.nz/rwgully/resources/sitemap.htm under the Dietary Theories section
Digestive Wellness, by Elizabeth Lipski, M.S., C.C.N.
Leaky Gut Syndrome, by Elizabeth Lipski, M.S., C.C.N.
Dr. Leo Galland Leaky Gut Article
Discovery Health Channel Website Stress Article
Article: The BOWEL = The Center of Health
Newsweek Leaky Gut Article
Great Smokies Diagnostic Laboratory Website: Intestinal Permeability Test Description
Introduction to Relaxation Techniques
About Your Digestive System
Digestive System Diagram
The Stress of Life, by Hans Seyle
The Relaxation Response, by Dr. Herbert Benson
Mind as Healer, Mind as Slayer, by Dr. Kenneth Pelletier
Elimination / Provocation Diets
Allergies: The Arthritis Connection, by Dr. John Mansfield (may be out of print)
McFerran?s description of Mansfield?s e-diet: http://homepages.paradise.net.nz/rwgully/theories/mcferran7.htm
Leaky Gut Syndrome, by Elizabeth Lipski
Impact of Processed Foods
Nutrition and Physical Degeneration, by Dr. Westin Price
Comparing Various Popular Diets /Evaluating Dietary Theories
Learn about Probiotics
usprobiotics.org, a site with comprehensive, up-to-date information on activities, research and new developments in the area of probiotics and dairy products