Do You Have A Leaky Gut?
By Eric Madrid MD
The term “leaky gut” has been used by holistic practitioners for several decades. This term is controversial with many conventional medical doctors as leaky gut is not something routinely taught to physicians in medical school. If you ask your doctor information about leaky gut, chances are she will not know what you’re referring to.
However, “increased intestinal permeability” is something that more and more physicians and scientific researchers are beginning to recognize. At the end of this article, you’ll find a list of references supporting the leaky gut—or increased intestinal permeability—theory.
What is Leaky Gut?
About 2,300 years ago, Hippocrates (460 BC-370 BC) believed “All disease begins in the gut”. Science supports this, and focusing on intestinal health is crucial if one wants to improve their overall health.
Leaky gut results when there are abnormal “holes” in your barrier-forming intestinal lining. There are three main purposes for this intestinal barrier:
- To protect the body from toxins and pathogens
- To keep our immune systems healthy
- To support digestion and absorption of vitamins, minerals and other nutrients
Imagine your intestines working like a filter, which keeps out toxins but allows absorption of vitamins, minerals and nutrients into your blood. Now imagine the filter has holes in it, allowing harmful substances to be absorbed. It’s not a good situation.
Failure to recognize the holes or repair the damaged intestinal barrier results in an endless cycle of symptoms, which physicians label as diseases. Once diagnosed, medications will be prescribed and countless referrals to specialists are often advised.
This is seen way too often in my own practice when new patients come to see me. Even though they were under the care of some of the best disease experts, the root cause of their problem was never addressed and appropriately treated. Prescription medications for chronic condition usually minimize symptoms but never fix the root cause of the problem.
Leaky gut results in increased intestinal absorption of toxins, chemicals and proteins into the bloodstream. This increased “antigenic load”—an antigen is a protein that activates the immune system—stresses and confuses the immune system, causing the immune system to form antibodies, which attack one’s own body. This is, by definition, an autoimmune disorder.
In addition, absorption of these toxins negatively affect our body’s main energy producing cells, or mitochondria. These cells become damaged and are unable to generate power. This is referred to as mitochondrial dysfunction. When our cells are unable to produce energy, chronic fatigue and muscle pain ensue.
Leaky gut is common in those with the following diseases. In many cases, it may be the cause:
- Cystic acne
- Chronic fatigue
- Chemical sensitivities
- Chronic allergies
- Chronic pain
- Joint pains/arthritis
- Brain fog
- Cognitive impairment
- Restless leg syndrome
- Eczema and other skin rashes
- Chronic Urticaria
- Hashimoto’s thyroid disease
- Rheumatoid arthritis
- Inability to lose weight
Intestinal Symptoms of Leaky Gut
- Irritable Bowel Syndrome (IBS)
- Acid reflux/heartburn
- Excessive gas production
- Undigested food in stool
Leaky gut, or increased intestinal permeability, is a real condition that produces many real symptoms and problems in those who are afflicted. A PubMed (a search engine for doctors and scientists) search of the scientific literature shows more than 3,700 scientific articles on the subject of “intestinal permeability”.
Causes of Leaky Gut
The causes of a leaky gut are numerous. Our daily choices contribute to either health or diseases, so choose wisely.
Several factors contributing to leaky gut include:
- Poor diet choices (consuming excessive sugar and processed foods while avoiding fruits and vegetables)
- Increased stress levels
- Food sensitivities (dairy, wheat/gluten, corn, soy are common triggers)
- Food allergies
- Recurrent or long-term antibiotic use, which kills the healthy gut bacteria
- NSAIDs (non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, etc.)
- Chronic daily alcohol use (more than 1 drink/day for women and more than 2/day for men)
- Insufficient stomach acid products (occurs from long-term acid reducers)
- Protozoal and parasite infections
- Small intestine bacteria overgrowth (SIBO)
Some labs can test for increased intestinal permeability using a lactulose/mannitol test (Genova Diagnostics and Doctor’s Data) or Zonulin testing (Doctor’s Data, Cyrex labs). These tests may or may not be covered by some insurance carriers. You can also ask your healthcare provider to do blood tests to evaluate you for food sensitivities (IgG) and food allergies (IgE). Allergy testing does not directly check for leaky gut, but certain food sensitivities predispose a person to develop a leaky gut. An evaluation for nutritional status should also be considered. These tests are usually covered by insurance companies. Ask your physician to measure your vitamin D 25-OH, zinc, vitamin B12, iron, ferritin, CBC and CMP.
5Rs to GUT HEALTH
Those who practice functional medicine utilize the “5Rs” for optimizing intestinal health: Remove, Replace, Re-inoculate, Repair and Rebalance.
Remove – Cutout pathogenic organisms and foods to which you are sensitive. For most, this is usually dairy, wheat (gluten) and possibly corn and corn-related products, such as high-fructose corn syrup. Excess sugar and alcohol also damage the gut lining.
Remove artificial sweeteners (aspartame, sucralose) from your diet—they alter gut bacteria and may cause diarrhea and poor digestion by allowing harmful bacteria to flourish. My personal recommendation is a six- week elimination diet. Some recommend 4-6 months of elimination for maximal benefit.
Replace enzymes / HCL (hydrochloric acid) - Supplement with betaine HCL, pancreatic digestive enzymes. Stop/reduce use of acid reducers such a H2 blockers (ranitidine, famotidine) and proton pump inhibitors (omeprazole, esomeprazole, pantoprazole). If you have been on these medications for a long time, you may need to wean off them over several months. Do not stop medications without consulting first with your physician.
Re-inoculate – This is where one re-populates the gut with healthy bacteria. Examples of healthy bacteria include lactobacilli and bifidobacteria. I recommend a probiotic supplement which has between 10- 30 billion units once twice per day. Also, Saccharomyces boulardii, a healthy yeast, can help restore balance. Diet change is the most important thing you can do to improve your gut health. When you feed yourself, you also feed your gut bacteria.
Repair - Dietary changes recommended to help heal leaky gut include the following:
- Drinking bone broth daily, at least 8 ounces twice per day
- Consuming kefir and / or yogurt
- Drinking kombucha tea
- Eating more fermented vegetables such as sauerkraut and kimchi, a staple food in the Korean culture.
- Cooking with coconut oil
- Eliminating grains and processed foods—consume sprouted seeds like chia seeds, flaxseed and hempseed
- Consuming a high plant-based fiber diet, which includes cabbage and avocados.
Rebalance – Make lifestyle changes. Participate in stress reduction activates such as meditation, yoga and daily exercise. Get adequate sleep each night. Also, consider consumptions of a relaxing tea each night before bedtime, an example would be a valerian herbal tea or chamomile tea.
Supplements also play a big role in healing leaky gut. If budget is an issue, choose first from the Primary Supplement list.
- L- Glutamine powder in liquid. Take 5 grams 2-3 times per day for 6-8 weeks
- Probiotics, at least 10 billion units twice per day
- Omega 3 fatty acids (2,000 mg twice per day)
- Quercetin 1,000 mg twice per day for 6-9 weeks
- Licorice, an herbal supplement which helps encourage a healthy gut microbiome. If you have high blood pressure, use the DGL form (Deglycyrrhizinated Licorice)
- Aloe vera juice
- Magnesium chelate 125 mg to 250 mg daily (taking more may result in diarrhea in some)
- Zinc (10-25 mg, usually contained in a quality multi-vitamin)
- Protein shakes for meal replacement. Consider using rice-based protein shake instead of whey and/or soy.
- Boswellia an ayurvedic herb which helps supports intestinal health by reducing inflammation
- Artemisia helps increase good bacteria in the gut.
- The Gut Balance Revolution- Gerard E. Mullin, MD
- The Institute for Functional Medicine, Gastrointestinal Conference attended in 2015 by Dr. Eric Madrid.
- Bischoff SC, Barbara G, Buurman W, et al. Intestinal permeability – a new target for disease prevention and therapy. BMC Gastroenterology. 2014;14:189. doi:10.1186/s12876-014-0189-7.
- Mu Q, Kirby J, Reilly CM, Luo XM. Leaky Gut As a Danger Signal for Autoimmune Diseases. Frontiers in Immunology. 2017;8:598. doi:10.3389/fimmu.2017.00598.
- Fukui H. Gut-liver axis in liver cirrhosis: How to manage leaky gut and endotoxemia. World Journal of Hepatology. 2015;7(3):425-442. doi:10.4254/wjh.v7.i3.425.
- Ilan Y. Leaky gut and the liver: A role for bacterial translocation in nonalcoholic steatohepatitis. World Journal of Gastroenterology : WJG. 2012;18(21):2609-2618. doi:10.3748/wjg.v18.i21.2609.
- Exercise, Intestinal Barrier Dysfunction and Probiotic Supplementation Lamprecht M.a,b · Frauwallner A. Lamprecht M (ed): Acute Topics in Sport Nutrition. Med Sport Sci. Basel, Karger, 2013, vol 59, pp 47–56
- Intestinal Barrier Function and the Gut Microbiome Are Differentially Affected in Mice Fed a Western-Style Diet or Drinking Water Supplemented with FructoseJ. Nutr. 2017 147: 5 770-780; first published online March 29, 2017.
- Protective effects of Lactobacillus plantarum on epithelial barrier disruption caused by enterotoxigenic Escherichia coli in intestinal porcine epithelial cells Veterinary Immunology and Immunopathology, Volume 172, April 2016, Pages 55-63 Yunpeng Wu, , Cui Zhu, , Zhuang Chen, , Zhongjian Chen, , Weina Zhang, , Xianyong Ma, , Li Wang, , Xuefen Yang, , Zongyong Jiang,
- Shu X-L, Yu T-T, Kang K, Zhao J. Effects of glutamine on markers of intestinal inflammatory response and mucosal permeability in abdominal surgery patients: A meta-analysis. Experimental and Therapeutic Medicine. 2016;12(6):3499-3506. doi:10.3892/etm.2016.3799.
- Tang Z-F, Ling Y-B, Lin N, Hao Z, Xu R-Y. Glutamine and recombinant human growth hormone protect intestinal barrier function following portal hypertension surgery. World Journal of Gastroenterology : WJG. 2007;13(15):2223-2228. doi:10.3748/wjg.v13.i15.2223.
- Permeability Jian Li, MDBobbi Langkamp-Henken, RD, PhDKim Suzuki, RPHLeroy H. Stahlgren, MD, FACS Glutamine Prevents Parenteral Nutrition-Induced Increases in Intestinal Journal of Parenteral and Enteral Nutrition Vol 18, Issue 4, pp. 303 – 307 First published date: July-02-2016
- Catanzaro D, Rancan S, Orso G, et al. Boswellia serrata Preserves Intestinal Epithelial Barrier from Oxidative and Inflammatory Damage. Deli MA, ed. PLoS ONE. 2015;10(5):e0125375. doi:10.1371/journal.pone.0125375.
- Mannanthendil Kumaran Asha, Debnath Debraj, Shekhar Dethe, Anirban Bhaskar, Nithyanantham Muruganantham & Mundkinajeddu Deepak Effect of Flavonoid-Rich Extract of Glycyrrhiza glabra on Gut-Friendly Microorganisms, Commercial Probiotic Preparations, and Digestive Enzymes Journal of Dietary Supplements Vol. 14 , Iss. 3,2017
- Shawna W, M. TC, Meng L, et al. Artemisia supplementation differentially affects the mucosal and luminal ileal microbiota of diet-induced obese mice. Nutrition (Burbank, Los Angeles County, Calif). 2014;30(0 0):S26-S30. doi:10.1016/j.nut.2014.02.007.