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Understanding Leaky Gut

If you read much about health, you know about controversial diagnoses. The list might start with candida overgrowth, food sensitivities, and toxic mold syndrome and end with adrenal fatigue, heavy metal toxicity, chronic Lyme, and multiple chemical sensitivity syndrome.

Because controversial conditions aren’t routinely covered in medical textbooks, they can easily fly under the radar of your doctor’s medical education. Worse yet, these diagnoses often aren’t accepted as “real” by a majority of conventionally trained physicians. Even today, far too many doctors disbelieve the very existence of hypoglycemia (low blood sugar), fibromyalgia, and chronic fatigue syndrome.

Leaky gut syndrome, also known as intestinal hyperpermeability, is a disorder that never appeared in any medical textbook I ever encountered, and I’ve not seen articles about it in JAMA or the New England Journal of Medicine. I first learned of its existence at an integrative medicine meeting many years ago, and since then I’ve encountered it numerous times in patients with previously undiagnosed chronic conditions. But when I mention leaky gut to gastroenterologists I know professionally, they always respond with a variation of “I read about it somewhere” and end it at that, sort of a last gasp of intellectual curiosity.

Leaky gut was first described in a South African medical journal in the 1980s by a physician dealing with the consequences of intestinal parasites and chronic diarrhea. To this day, most new research on it emerges from medical journals outside the US. Now, decades later, because Stephen Barrett, MD, America’s self-appointed quackbuster, wrote the Wikipedia entry on leaky gut, it’s listed among his other fad diagnoses and referred to as a “dishonest ploy to make money” even as perfectly respectable medical and scientific journals overseas are publishing scholarly reviews of it.

Here’s what happens with leaky gut
In leaky gut disorder, any of several triggers damages the lining of the small intestine, where most food is absorbed. The single most common of these triggering agents is an irritating food. This isn’t necessarily a food allergy, but rather a food sensitivity. Let’s say you’re sensitive to the gluten in wheat. Every time you eat a wheat product it irritates and inflames the lining of your intestine. Ultimately, this constant inflammation damages the protective barrier between the lining of your intestine and your bloodstream.

After weeks or months of this low-level inflammation, the intestinal lining becomes increasingly porous, and large molecules that were once kept away from your bloodstream now leak through. Depending on your individual intestinal lining susceptibility, other irritating triggers include dairy, egg, corn, citrus, soy, and various chemicals, additives, and preservatives. Non-food triggers include NSAIDs like ibuprofen and naproxen, alcohol, intestinal parasites, and candida. Chronic intestinal inflammatory diseases like ulcerative colitis and Crohn’s also often have a leaky gut component.

When your immune system, ever on the alert for foreign invaders like viruses and bacteria, IDs the large molecules (called “macromolecules”) as the enemy it generates antibodies to clear them out of your body. These antibodies attach themselves to the macromolecules, just as they would to a virus or bacteria, creating what’s called an antigen-antibody complex (an antigen is a foreign body that can trigger an immune response).

Now the trouble begins
This antigen-antibody complex circulates through your body, becoming trapped in certain susceptible areas and immediately causing trouble by triggering local inflammation. For example, if caught within the microscopically small blood vessels in your skin, you can get a rash like eczema or psoriasis. Trapped in your lungs, you might develop symptoms of asthma. In your nasal passages, chronic sinusitis; in your joints–especially the small joints in your hands and wrists–joint pain, swelling, and stiffness; in your nervous system, brain fog and symptoms not unlike multiple sclerosis.

On the other hand, in place of localized symptoms you might feel a constellation of symptoms like vague fatigue, brain fog, indigestion, and weight gain from fluid retention. The False Fat Diet, by Elson M Haas, MD, blames much of America’s obesity on undetected leaky gut syndrome, since all this newly generated inflammation causes a lot of fluid retention (hence “false fat”).

Leaky gut diagnosis
Diagnosing leaky gut isn’t difficult, but can only occur if your doctor is willing to recognize and suspect the possibility. Patients who have virtually any chronic symptom to which a doctor has responded “We can’t find anything wrong with you–your tests are normal,” should be on the lookout for leaky gut, even if their docs aren’t.

Find an integrative physician to help you with this protocol:

  • Start with one simple screening test available from Genova Diagnostics, uncreatively named “Intestinal Permeability Assessment.” You’re given a small take-home box containing a few ounces of a sweet-tasting liquid and a small plastic container to gather a small amount of urine. The liquid contains two forms of sugar, one with a large molecule and the other with a small molecule. You drink the liquid and mail a portion of your next-morning urine to the lab. If your results show only the small molecule getting through, but not the large, there’s no leak. If both, there’s a leak. You have to admit, that’s a pretty cool test.
  • To diagnose what’s causing the leak, you want a second test from Genova (as well as several other labs), the Comprehensive Stool Digestive Analysis with screen for parasites and candida. This time you’ll send them some stool samples and they’ll evaluate your overall digestive function, check for abnormal bacteria, and look for parasites and candida. Healing leaky gut starts with working toward correcting digestion and clearing parasites.

These two tests are usually covered in part by health insurance, but a third very useful test isn’t covered by any policy I’m aware of, though its out-of-pocket price has dropped considerably. Also, if you have a health savings account, you can cover it from there.

  • The third test determines if your immune system is creating antibodies to any culprit foods, chemicals, molds, and so forth, a total of 116 items for $235, available from ELISA/ACT Biotechnologies.

Healing leaky gut
Once you’ve located your leaky gut triggers and clear them, your intestine will start to heal itself. However, you can also take several steps to speed the process. Our nutritionists at WholeHealth Chicago have created a highly effective nutritional program to quickly heal leaky gut. I’ve seen many patients with undiagnosed chronic ill health simply blossom under this program.

In addition to avoiding trigger foods and clearing parasites or candida, a typical regimen for leaky gut also includes:

  • GI Sustain, the intestinal healing agent and detoxifier formulated by Jeffery Bland, PhD.
  • Glutagenics, by Metagenics, a supplement for intestinal health.
  • Permeability Factors by Integrative Therapeutics, containing additional nutrients for intestinal health.
  • Aloe vera juice (available at most health food stores).
  • Ther-Biotic Complete, an ultra high potency probiotic.

It’s mildly irritating that 20 years after the original description of intestinal hyperpermeability and scores of articles in medical journals worldwide that conventional US physicians, especially gastroenterologists, are so reluctant to explore this condition further. Oh well, who needs ‘em?

Be well,
David Edelberg, MD


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6 comments on “Understanding Leaky Gut
  1. Pete says:

    With the help of a nurse friend I self-diagnosed a Candida problem which I later confirmed with your offices. Utilizing a real/whole food diet while eliminating processed/refined junk foods, industrial grains, and as much sugar as possible, while adding lots of probiotics, I was able to restore health to my gut.

    It is mind-blowing how many symptoms can manifest from chronic inflammation in the gut (which many conventional docs will surely misdiagnose). And the good news is that the food is once again the medicine.

  2. Mark Evans says:

    That test looks fascinating! I want to take it just to put an end my food paranoia.

  3. Carol Diehl says:

    I’m glad for this explanation. However regarding the Wikipedia page that contains misinformation, can’t you add to it? Add the information about European studies? I thought that was what Wikipedia was all about!! would be a big service.

  4. Erin says:

    I recall reading that antibiotics also contribute to leaky gut, but you didn’t mention antibiotics. Is that true?

  5. PR Lundy says:

    Doc, no mention of Dr. Alessio Fasano and his 20 years of research on the subject? PR

  6. KLeister says:

    Thanks for this article; as a person suffering from Ulcerative Colitis for almost 20 years, the conventional medical system is frustrating to say the least – so far, I’ve had the most success with the Specific Carbohydrate Diet (SCD) – I would encourage others suffering with Ulcerative Colitis to give it a try – it’s not an easy diet to follow, but I can tell you that I am seeing a lot of positive effects from it – 2 colonoscopies in 6 months; the first one showed inflammation of the entire colon; the second “markedly improved” with minor inflammataion in the sigmoid colon – for me, that’s huge – good luck to all with gastrointestinal issues in finding what works for you –

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