Article on Leaky Gut

[Guest guest]

Hi all,

I think the article below is the one Lynne referenced in her recent message.

I thought I'd repost it for those new to this forum or who may have

otherwise missed it. El

http://www.positivehealth.com/test/articles.asp?i=1748

<http://www.positivehealth.com/test/articles.asp?i=1748 & b=1> & b=1

Natural Approaches to Leaky Gut

by Neil Wootten (more info)

listed in colon health

originally published in issue 111 - May 2005

Leaky Gut sounds a bit messy, but actually it is not at all. It occurs

where there is hyperpermeability of the gut membrane. The gut should,

indeed, be permeable to a certain degree to allow nutrients through.

Ordinarily, the large intestine acts like a one-way protective sieve

that filters out certain food molecules and peptides. In the case of

Leaky Gut, the one-way gate of the gut open too wide, allowing an

increase in peptide molecules and pathogens, which attract certain cells

of the immune system called phagocytes, letting them pass through the

gut wall into the intestine. It is the presence of these phagocytes that

causes an inflammatory reaction in the gut wall.

I liken it to sieving flour. If you are sieving flour for baking, you

need a fine sieve that will allow the fine flour through and keep the

lumps out. This is how the gut operates normally; it allows molecules of

nutrients through, but stops larger molecules and pathogens getting

through into the bloodstream. When the gut becomes too permeable, the

effect is like trying to sieve flour with a colander - many more lumps

get through. This equates to undigested molecules and particles of food,

along with pathogens getting into the body and setting off an immune

reaction. Such foreign bodies, circulating in the blood, will sensitize

the immune system and often cause adverse reactions to food, showing up

as either an allergy or intolerance. These, in turn, can result in a

bewildering array of symptoms those with chronic illnesses may be able

to relate to:

.. Fatigue and malaise

.. Arthritic conditions

.. Painful muscle conditions

.. Fevers of unknown origin

.. Food intolerances

.. Abdominal pain

.. Abdominal distension

.. Diarrhea

.. Skin rashes

.. Toxic feelings

.. 'Brain Fog'

.. Shortness of breath

.. Poor exercise tolerance

Also, whenever this permeability is increased, IBS gets worse.1

How Is It Caused?

Many people suffer from leaky gut and do not realize it. A Leaky Gut can

be caused by anything that damages the lining of the intestine -

infectious microbes, such as bacteria and parasites, a Candida albicans

overgrowth, allergies or even certain prescription drugs, such as

antibiotics and particularly Non-Steroidal Anti-Inflammatory Drugs or

NSAIDs.2 This last is a phenomenon that is a well-known and studied side

effect of NSAIDs. Even single doses of aspirin or of indomethacin

increase cellular permeability, in part by inhibiting the synthesis of

the protective fatty acid prostaglandin. Long-term exposure to NSAIDs

leaves the gut highly inflamed and permeable.

Whatever causes leaky gut, once the condition has developed, it can be

self- perpetuating. The relationship between food sensitivities and the

leaky gut is both complex and circular. In experimental trials reported

in Allergy in 1989, children and adults with eczema, urticaria or asthma

triggered by food allergy show that they have higher gut permeability

than those who don't have these conditions. This indicates that

allergies and food sensitivities may be caused by an over permeable gut.

Interestingly, gut permeability also sharply increases whenever allergic

subjects are exposed to allergenic foods. In all probability what this

indicates is that an increase in intestinal permeability is both

important as a cause of food allergy and also the result of food allergy.

How Does It Affect Us?

There are a number of physical conditions that are well-recognized by

mainstream allopathic medicine as having a relationship to Leaky Gut.

These include inflammatory and infectious bowel diseases, chronic

inflammatory joint diseases,3 skin conditions like acne, psoriasis and

dermatitis,4 and many diseases triggered by food allergy or specific

food intolerance, including eczema, urticaria and irritable bowel

syndrome,5 and even chronic hepatitis.

Leaky Gut is also very much associated with Candida. The Candida

organism can metamorphose in the gut, changing from a simple yeast cell

into a much more harmful 'mycelial' fungal form. Under the microscope,

the cell appears to sprout roots and branches; these burrow their way

into the walls of the intestine, and ultimately can spread throughout

the body, with potentially widespread adverse effect. The National

Candida Society notes that up to 16 million people in the UK may be

affected by Candida-related problems.

Increased gut permeability may play a primary role in causing these

diseases, or it may be a consequence of it. But by causing an immune

system reaction, liver dysfunction and pancreatic insufficiency, it

creates a vicious cycle. In most cases, the role of increased intestinal

permeability in these sorts of patients often goes undiagnosed and

unrecognized.

One of the latest and most interesting theories comes from health writer

Susie Cornell, who postulates that Leaky Gut probably plays a central

role in the development of Multiple Sclerosis (MS). In one research

project of 40 MS patients, all were found to have a number of

nutritional deficiencies, even among those taking supplements. The

patients show particular deficiencies of magnesium, manganese, selenium,

zinc and mostly all of the B vitamins. This is quite common with Leaky

Gut patients. Even patients who supplement with these specific nutrients

remain deficient in them.

Because different parts of the intestinal wall absorb different

nutrients, damage to the wall in one area may cause poor absorption of

one particular nutrient, says Cornell. This is why a patient might show

one single deficiency rather than complete malnutrition. The symptoms of

B12 deficiency and magnesium deficiency include fatigue, irritability,

nervous system disorders, tingling and numbness in fingers and toes and

even balance problems. These are among the symptoms that have

collectively been termed 'MS'. You may have noticed that some of these

symptoms are shared with Leaky Gut.

Testing for Leaky Gut

Thankfully, it is a relatively simple exercise to test for Leaky Gut. A

safe, non-invasive and inexpensive method called the Lactulose/Mannitol

test has been developed to measure small intestinal permeability and

also test how well a treatment is working. Claude Andre, the leading

French research worker in this area, says that measuring gut

permeability is a sensitive and practical screening test for detecting

food allergy and responsiveness to treatment.

In Andre's protocol, patients ingest five grams each of the innocuous

sugars lactulose and mannitol. These sugars are not metabolized by

humans, and the amount absorbed is fully excreted in the urine within

six hours. Mannitol, a monosaccharide, is passively transported through

the intestinal cell walls; the average absorption is 14% of the

administered dose. In contrast, the intestinal tract blocks lactulose, a

dissaccharide; less than one per cent of the administered dose is

normally absorbed. The level of both lactulose and mannitol recovered in

urine is then measured.

The normal ratio of lactulose/mannitol recovered in urine is less than

0.03. A higher ratio signifies too much absorption of lactulose and

therefore a gut that 'leaks'. If your test shows you have abnormal

fasting permeability, you have more gut lining damage than patients with

normal fasting permeability and will take longer to heal.

If you come up with a normal Lactulose/Mannitol test result, repeat it

after you've eaten a meal of your most common foods. If the test meal

produces an increase in lactulose excretion (which signifies a leaky

gut) or a decrease in mannitol excretion (signifying malabsorption of

food), it's likely that you have specific food intolerances. Further

testing for food allergy is then warranted. Once you've been maintained

on a stable elimination diet for four weeks, you should repeat the

lactulose/mannitol challenge after a test meal with the foods permitted

on the elimination diet. A normal result will assure you that all major

allergens have been identified. An abnormal result indicates that more

detective work is needed.

In the case of relatively mild celiac disease or inflammatory bowel

disease, your mannitol absorption may not be affected but the lactulose

absorption will be elevated. A recent study published in the Lancet

found that the lactulose/ mannitol ratio was an accurate predictor of a

relapse in patients who'd previously suffered from Crohn's disease.1

If your initial fasting lactulose is elevated, or if the initial fasting

lactulose/mannitol ratio is elevated, your practitioner should also

consider the possibility of mild bowel disease or gluten allergy.

We may have to entirely re-think what we term disease as not something

we necessarily catch, but something predominantly under our control,

caused by a chronic breakdown of digestive processes. It may be that

symptoms we group together into a classifiable disease or syndrome may

be no more than the manifestation of one or more nutrient deficiencies,

or the results of a hyperpermeable gut. This would mean that the most

important supplements we take may not necessarily be vitamins and

minerals themselves, but all the digestive enzymes and substances which

ensure that our gut properly absorbs and distributes what we eat.

How To Correct It?

It is quite possible to cure a Leaky Gut with a nutrient dense diet and

appropriate supplements. Many natural substances help repair the

intestinal mucosal surface or support the liver when it becomes

challenged and stressed by toxins.

We have found the swiftest approach, however, to be the use of

Colostrum. Professor Playford of Imperial College and Hammersmith

Hospital conducted trials on indomethacin-induced gut hyperpermeability,

and noted that Colostrum healed leaky gut even while the gut was being

attacked by this NSAID.6 A key growth factor in Colostrum is Epidermal

Growth Factor (EGF), a polypeptide that stimulates growth and repair of

epithelial tissue that is widely distributed in the body. Purified EGF

has been shown to heal ulceration of the small intestine.7 He noted that

the growth factors contained in Colostrum, including EGF, repaired

damage to the gut, and should also work to improve inflammatory and

ulcerative conditions of the gut. Colostrum also contains Secretory IgA,

which is essential to the maintenance of the integrity of the mucosal

lining of the gut.

Vitamin and mineral supplements should include all the B vitamins,

vitamin A, C and E, zinc, selenium, molybdenum, manganese and magnesium.

Because of the association between increased gut permeability and

pancreatic dysfunction, pancreatic enzymes may also be needed. It is

clearly better, if possible, to avoid drugs that damage the gut. This is

not essential if co-dosing with Colostrum, as it heals the gut and keeps

permeability at normal levels.

One would think that beneficial bacteria might have a role to play in

achieving and maintaining normal gut permeability levels. Currently

Lactobacillus caseii var GG, a strain of lactobacillus isolated and

purified in Finland, has been shown to be effective in improving the gut

permeability when this was associated with a rotavirus infection.8

Most practitioners recommend glutamine, the amino acid needed for the

maintenance of intestinal metabolism, structure and function for Leaky

Gut. It has been shown to reverse all the gut abnormalities in patients

fed intravenously. Glutamine also repairs gut lining damage caused by

chemotherapy or radiation,9 although we have found clinically that it is

much slower to take effect than Colostrum.

Supporting the Liver

Because the effects of Leaky Gut greatly increase the load on the liver,

it is vital to support proper liver function. The liver of leaky gut

patients works overtime to remove oversized food molecules and to

oxidize gut toxins, causing increased production of free radicals. This,

in turn, causes damage to liver cells and sends by-products into bile,

producing toxic bile capable of damaging bile ducts and backing up into

the pancreas. Indeed, this may be the cause of chronic pancreatic

disease. In attempting to rectify all this, the liver depletes its

reserves of certain amino acids.10 This is similar to the process that

occurs in liver diseases caused by alcohol.

A lowered level of liver glutathione is a common occurrence in leaky gut

syndromes, and contributes to liver dysfunction and liver necrosis among

alcoholics, and immune impairment in patients with AIDS. The most

effective way to raise liver glutathione is to take its dietary

precursors, cysteine or methionine. A useful supplement to take is

N-acetyl cysteine which helps the body to synthesize glutathione at the

same time as giving protection from the toxins.

Take essential fatty acids (EFAs), particularly gammalinolenic acid

(GLA). In laboratory experiments, fish oil was able to prevent

intestinal mucosal injury produced by methotrexate and protect the body

from the toxins produced in the gut.11 Take these in their most

concentrated and physiologically active form to avoid exposure to large

quantities of polyunsaturated fatty acids.

If you are supplementing with dietary fibre, make sure you are taking

hypoallergenic insoluble fibre and watch the amount, as too much may

increase gut permeability.12

A large proportion of the population have a kind of low-level

dysfunction in the gut, called dysbiosis. This is caused by an imbalance

of non-beneficial (bad bacteria or yeast) organisms which mainly do

their damage by altering the metabolic or immune responses of the body.

The situation where the immune system begins to react to (and destroy)

normal gut flora is one example that has been implicated in the

development of conditions such as Crohn's disease and ankylosing

spondylitis. Recent research suggests that this kind of gut bacterial

sensitization is an early complication of altered permeability.

Leaky Gut is relatively common, and when one looks at the possible

causes, one can easily understand why. Widely prescribed medications can

cause widespread problems. Yet Leaky Gut is also relatively easy to

diagnose with a simple Lactulose/Mannitol test, and also fairly

straightforward to correct. Once the Leaky Gut is dealt with, one should

find a lessening of a myriad of puzzling symptoms. It is important once

the gut is restored to a normal permeability to avoid the very things

that caused the hyperpermeability in the first place. Equally important

is the consumption of a diet and a supplement regime that will help

maintain the health of the gut wall. Remember, you are not what you eat;

rather you are what you absorb!

References

1. Wyatt J, Vogelsang H, Hubl W, Waldhoer T and Lochs H. Intestinal

permeability and the prediction of relapse in Crohn's disease. Lancet.

5: 341 (8858):1437-9. June 1993.

2. RT, Rooney PJ, DB, Bienenstock J and Goodacre RL.

Increased intestinal permeability in patients with rheumatoid arthritis:

a side-effect of oral nonsteroidal anti-inflammatory drug therapy? Br J

Rheumatol. 26(2): 103-7. April 1987.

3. Rooney PJ, RT and Buchanan WW. A short review of the

relationship between intestinal permeability and inflammatory joint

disease. Clin Exp Rheumatol. 8(1): 75-83. Review. Jan-Feb 1990.

4. Juhlin L and Vahlquist C. The influence of treatment on fibrin

microclot generation in psoriasis. Br J Dermatol. 108(1): 33-7. Jan 1983.

5. PG, Lessof MH, Baker RW, Ferrett J and Mac DM.

Intestinal permeability in patients with eczema and food allergy.

Lancet. 13: 1(8233):1285-6. June 1981.

6. Playford RJ, Mac CE, Calnan DP, Floyd DN, Podas T, W,

Wicks AC, Bashir O and Marchbank T. Co-administration of the health food

supplement, bovine colostrum, reduces the acute non-steroidal

anti-inflammatory drug-induced increase in intestinal permeability. Clin

Sci (Lond). 100(6): 627-33. June 2001.

7. Playford RJ, Woodman AC, P, Watanapa P, Vesey D, Deprez PH,

on RC and Calam J. Effect of luminal growth factor preservation

on intestinal growth. Lancet. 3: 341(8849):843-8. April 1993.

8. Siitonen S, Vapaatalo H, Salminen S, Gordin A, Saxelin M, Wikberg R

and Kirkkola AL. Effect of Lactobacillus GG yoghurt in prevention of

antibiotic associated diarrhea. Ann Med. 22(1): 57-9. Feb 1990.

9. Klimberg VS, Salloum RM, Kasper M, Plumley DA, Dolson DJ, Hautamaki

RD, Mendenhall WR, Bova FC, Bland KI, Copeland EM third, et al. Oral

glutamine accelerates healing of the small intestine and improves

outcome after whole abdominal radiation. Arch Surg. 125(8): 1040-5. Aug

1990.

10. Whitcomb DC and Block GD. Association of acetaminophen

hepatotoxicity with fasting and ethanol use. JAMA. 21: 272(23):1845-50.

Dec 1994.

11. Vanderhoof JA, Blackwood DJ, Mohammadpour H and Park JH. Effect of

dietary menhaden oil on normal growth and development and on

ameliorating mucosal injury in rats. Am J Clin Nutr. 54(2): 346-50. Aug

1991.

12. Gyory CP and Chang GW. Effects of bran, lignin and deoxycholic acid

on the permeability of the rat cecum and colon. J Nutr. 113(11): 2300-7.

Nov 1983.