Controversial Diagnosis #4: Leaky Gut Syndrome

Leaky gut syndrome, also known as intestinal hyperpermeability, is a disorder that never appeared in any medical textbook I encountered in school. Nor have I 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 lost count of how many times this condition has turned out to be the root cause in patients with previously undiagnosed chronic conditions.

But when I mention leaky gut to the gastroenterologists I know professionally, they respond with a variation of “I read about it somewhere” or “Oh yeah, some patients have asked me about that,” and end it at that, sort of a last gasp of intellectual curiosity.

The Wikipedia article on this condition is transparently under the influence of Stephen Barrett, MD, the retired psychiatrist and founder of the anti-alternative medicine website quackwatch.com, who calls it a fad diagnosis and a “dishonest ploy to make money.”

On the opposite end of this spectrum is the better-credentialed Alessio Fasano, MD, head of Pediatric Gastroenterology and Nutrition at Massachusetts General Hospital.  Over a period of 30 years, Dr. Fasano has authored several hundred papers on the subject and his research has produced newly available diagnostic tests for leaky gut that I’ll discuss later in this Health Tip.

Most recently, using electron microscopy, Australian researchers could actually see examples of leakage in the intestines of patients with Crohn’s disease and ulcerative colitis.

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. Current research now links leaky gut to virtually all autoimmune disorders, including rheumatoid arthritis, lupus, and multiple sclerosis.

Neurophysiologist Dale Bredeson, MD, in his best seller The End of Alzheimer’s has shown the importance of diagnosing and treating leaky gut for all patients who are at risk for Alzheimer’s or are in its early stages. Izabella Wentz, doctor of pharmacy, in her immensely popular book on Hashimoto’s thyroid disease, The Root Cause, places leaky gut front and center. Amy Myers, MD, does the same in her bestseller The Autoimmune Solution.

Here’s what happens with leaky gut
In leaky gut disorder, any of several triggers damages the lining of the small intestine, where food is absorbed. The most thoroughly researched trigger is the chronic inflammation of Crohn’s and ulcerative colitis, but the most common trigger among patients themselves is an irritating food.

All four doctors–Fasano, Bredesen, Wentz, and Myers–hit hard on gluten, which nutritionists call a pro-inflammatory grain. This is neither a gluten allergy nor in most cases celiac disease, but rather a food sensitivity.

Let’s say you’re sensitive to the gluten in wheat. Every time you eat a wheat-containing 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 might include dairy, egg, corn, citrus, soy, and various chemicals (including pesticides), additives, and preservatives. Non-food triggers include alcohol, intestinal parasites, candida, and NSAIDs like ibuprofen and naproxen.

When your body’s immune system, ever on the alert for foreign invaders like viruses and bacteria, identifies the large molecules (called antigens–Greek for “foreign substance”) as the enemy, it generates antibodies to clear them out of your body. These antibodies attach themselves to the antigen, creating what’s called an antigen-antibody complex.

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 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, multiple sclerosis; and in your thyroid, Hashimoto’s.

Dr. Bredesen has shown that these antigen-antibody complexes trigger the production of a protein called amyloid in the brain, the root cause of Alzheimer’s.

On the other hand, instead of specific illness, leaky gut might trigger a constellation of symptoms such as 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”).

But since neither primary care doctors nor gastroenterologists routinely test for leaky gut, what you’ll hear as a patient after you’ve described your symptoms will most likely be “We can’t find anything wrong with you. Your tests are normal.” And when you mention leaky gut, expect to hear “I don’t know anything about that.”

Leaky gut diagnosis
Diagnosing leaky gut isn’t really all that difficult, but can only occur if your doctor is willing to suspect and recognize the possibility. Patients who have virtually any chronic symptom and no positive test results should consider leaky gut.

Find a functional physician (MD, DO, or chiropractic physician) to help you with this protocol:

—Choose the more affordable of two screening tests. The first, available from Genova Diagnostics, is called 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 collect some urine. The liquid contains two forms of sugar, one with a large molecule and the other with a small one. You drink the liquid and mail some of your next-morning urine to Genova. If your results show only the small molecule got through, but not the large, there’s no leak. If both get through, there’s a leak. You have to admit, that’s a pretty cool test.

The second screening test was developed from Dr. Fasano’s research and is the test preferred by Dr. Bredesen. It’s available from Cyrex Laboratories and is called Cyrex Array 2, Intestinal Antigenic Permeability Screen. This requires a blood (serum) specimen. Dr. Fasano discovered that antibodies to certain molecules produced by the intestine followed predictable patterns in patients with leaky gut. The Cyrex Array 2 measures these and the result can diagnose leaky gut.

—Later, to diagnose what’s causing the leak, you want a second test from Genova (also available from 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 correcting your digestion, balancing good and bad bacteria, and clearing any parasites.

—Your physician may also suggest a blood test looking for antibodies to upward of 100 potential trigger foods. Foods that test positive indicate they’re leaking through your intestine and triggering antibody production.

All these tests are available at WholeHealth Chicago. Whether or not they’re covered by your health insurance depends on your policy. On the plus side, prices have dropped considerably when you pay the lab directly. Also, if you have a health savings account, you can cover them from there.

Healing leaky gut
Once you’ve located your leaky gut triggers and eliminated them, your intestine will start to heal itself. However, you can take several steps to speed the process. Our WholeHealth Chicago nutritionists 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:

—UltraGI Replenish, 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).
—Ortho Biotic, an ultra high-potency probiotic.

It’s mildly irritating that almost 40 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