April is irritable bowel syndrome (IBS) and autism awareness month. Given that leaky gut syndrome is a causal factor for IBS and autism spectrum disorders and the increasing knowledge about the gut brain axis, I thought my readers may benefit from learning more about leaky gut and the gut brain axis.

I'll discuss the some of the causal factors, symptoms, why it's so important in terms of immune health and the functional approach I use on how to address it.

As a functional nutrition counselor/diet & lifestyle coach, a big focus of my work with clients is on enhancing digestive and intestinal health and integrity. I aim to help educate and support my clients about what's going on in their body and about the gut brain connection so they can better understand that their cognitive and mood issues are related to what's going on in their gut.

Contact me if you'd like to learn about my approach and how I aim to educate, inspire and support you to heal your leaky gut and feel better.

“The gut is not like Las Vegas... What happens in the gut does not stay in the gut.”

Dr. Alessio Fasano

WHAT IS LEAKY GUT SYNDROME?

Leaky gut is a condition in which disruption of the tight junctions of the intestinal barrier leads to enhanced intestinal permeability (EIP), allowing passage of pathogens, toxins, and food particles into systemic circulation, activating an immune response. Leaky gut is characterized by metabolic endotoxemia, dysbiosis, loss of mucosal integrity and intestinal inflammation. To help the gut heal, attention must be focused on the microbial ecosystem, intestinal barrier integrity, and the mucosal barrier while reducing inflammation.

TERMS TO KNOW

Intestinal and mucosal barrier integrity: Intestinal barrier integrity is malleable and multiple mechanisms have been shown to be capable of modulating intestinal permeability. Modulating factors include cytokines, immune cells, and exogenous factors. Mucosal barrier impairment allows gut microbes to easily enter the mucosa, which create intestinal inflammation as a consequence of the host's excessive immune responses to gut microbes.

Metabolic endotoxemia: The innate immune response becomes activated due to persistent low-grade inflammation because of increased circulating endotoxins, primarily lipopolysaccharides (LPS).

Microbial ecosystem: We have over a thousand different species –
bacteria, yeasts, fungi, parasites, archaea - all competing for space and food and nutrients, forming a human organ (the microbiome).

Dysbiosis is a microbial imbalance. Loss of beneficial bacteria, overgrowth of endemic or opportunistic microbial species, overt pathogen infection, or loss of overall microbial diversity.

The microbes themselves (e.g.pathogens, overgrowth) as well as our immune reaction to them can cause damage to the protective intestinal mucosal layer, causing epithelial cell damage in the small intestines. This reversible condition leads to drops in digestive secretions and impaired nutrient absorption.

In the large intestines, this leads to enhanced intestinal permeability (EIP) and susceptibility to systemic inflammation due to translocation of pro-inflammatory debris such as lipopolysaccharides (LPS).

Think of the alimentary canal/digestive tract as a donut hole through your body. It is actually outside of your body.

From mouth to anus is a 25-30 ft. tunnel that is a well-guarded and regulated exchange corridor which is ultimately outside of the systemic body.

It is the entryway for essential nutrition to fuel every cell in the body and the exit path for most toxins and waste – of exogenous (outer) and endogenous (inner) origin. This explains why constipation is a sign of trouble. A toxic build up will effect other systems in the body.

It is guarded by billions of diverse microbes. Our biochemistry is regulated by their behavior and DNA (which transfers genes across species and to humans).

It is home to 2/3+ of the immune system, surveilling our intake, outflow, and microbial balance.

The intestinal epithelium is a one-cell thick semi-permeable interface.

It houses its own nervous system, called the enteric nervous system, which generates neurotransmitters used throughout the body. The enteric nervous system makes 90% of the bodies serotonin and 50% of the bodies dopamine; the pleasure and well-being hormones.

Interestingly, the gut and brain work as an integrated axis, connected via the vagus nerve with 90% of the nerve fibers going from the gut to the brain. Remember, trust your gut feelings!

Common Contributors to Leaky Gut

• NSAID drugs (aspirin, ibuprofen, naproxen)

• Other drugs (e.g. steroids, birth control pills, chemotherapy)

• Gut microbial imbalances (LPS) and overgrowths (e.g. Candida)

• Pathogenic microbes

• High blood sugar

• Antibiotics

• Insufficient Vitamin D (very common for those in the northern hemisphere)

• Insufficient zinc

• Loss of commensal bacteria (They provide us with essential nutrients)

• Gluten (increases zonulin, the regulator of intestinal permeability)

• Stress

• Smoking

• Highly processed foods

• Toxins, chemicals, pesticides, food additives, glyphosate 

Symptoms of Leaky Gut and

the Chain of Interconnectedness.

• Digestion and absorption issues lead to anemia, neuropathy, depression, headache.

   

• Motility, microbial, and hormonal issues lead to IBS, constipation, belching, bloating.

• Enhanced gut permeability leads to osteoarthritis, asthma, migraine, chronic fatigue, fibromyalgia, eczema, allergies.

   

• Immune dysregulation causing autoimmune disease dynamics like Hashimoto's thyroiditis, lupus, multiple sclerosis, Crohn's disease, rheumatoid arthritis. (There are over 80 known autoimmune conditions, and for many people it may take years to get a diagnosis. National Institutes for Health report about 25 percent of patients with autoimmune diseases have a tendency to develop additional autoimmune diseases).

   

• The systemic body becomes exposed to what was supposed to be isolated within the intestines (“outside” the body in the donut hole): partially digested food, microbes and their byproducts (especially lipopolysaccharide/LPS), and chemicals. This triggers a heightened immune response and downstream dysfunction from the toxicants.

   

• Enhanced intestinal permeability (EIP) increases the likelihood of food sensitivities and immune reactions to microbial debris (e.g. LPS, bacterial DNA) and also microbial byproducts (e.g. d-lactate, and hydrogen sulfide). Inflammation from LPS is implicated in many chronic inflammatory dynamics and autoimmune diseases.

   

• Small intestinal bacterial overgrowth (SIBO) and intestinal methane overgrowth (IMO) increases the risk of EIP. In particular, hydrogen sulfide gas in the intestines breaks down the protective mucosal layer, encouraging greater permeability.

Functional Approach to Heal the Gut Lining and Barrier Function for Improved Health 

• Work toward optimizing the intestinal mucosal and brush border barrier.

• Avoid antibiotics and animal foods fed them.

• Avoid processed foods. (e.g. emulsifiers and artificial, chemical sweeteners)

• Establish and maintain motility. (poop 1-3 times daily)

• L-glutamine (Those with fibromyalgia and anyone with strong anxiety must use caution to avoid exacerbating glutamate sensitivity)

• Ensure vitamin D sufficiency.

• Mucilaginous herbs are key to support mucosal layer regeneration such as slippery elm, marshmallow, DGL, and aloe. These may not be well-tolerated with small intesitnal bacteria overgrowth (SIBO). Specific foods which naturally soothe the gut lining include okra, chia seed, ground flaxseed, Jerusalem artichokes, legumes (except peanuts), bone broth, collagen/gelatin (easily added to a beverage), konjac (miracle noodles). Bone broth may exacerbate anxiety.

• Supplemental fiber might include pectin, gums (guar, locust bean), FOS (fructooligosaccharides), cellulose. Beware of wheat dextrins.

The gut-brain axis is a bidirectional communication pathway between the gut microbiota and the central nervous system that significantly supports healthy digestion, gastrointestinal comfort, cognitive function, and mood. 

Functional GI disturbances can be seen as disruptions in gut-brain axis activity. When the gut and brain no longer work together seamlessly, unwelcome dysfunctions occur, including psychological challenges and digestive discomforts. Unpleasant episodes of functional GI disruption can involve a variety of issues, including occasional:

• Digestive tract sensitivity and irritation

• Abdominal discomfort

• Gas and/or bloating

• Altered bowel muscle contractions

• Constipation and/or diarrhea

• Anxiousness

• Depressive mood imbalances

• Cognitive function impairment

• Sleep challenges 

Information adapted from the School of Applied Functional Medicines, Essential Gut Course.