Leaky gut is EVERYWHERE these days. And you CAN NOT ignore it. Because every blog will convince you that you have it… gas and bloating? Tired? Headaches? Sounds like me! The truth is, leaky gut is most definitely a real entity. And it has definitely been associated with many real diseases in the medical literature: infectious diarrhea, inflammatory bowel disease (Crohn’s disease, ulcerative colitis), IBS, small intestinal bacterial overgrowth (SIBO), celiac disease, liver disease, and food intolerances and allergies.
What’s leaking where??
You may think that your skin is the most exposed part of your body to the external environment, but in reality, the gut has a surface area of 200m2 that is constantly exposed to bacteria, food, and digestive products. Where do we NOT want these things to go? Through the wall of the GI tract and into our blood stream. The gut barrier separates out in the bad from the good, so the nutrients get absorbed into the gut wall and any pathogens stay in the gut and get excreted. The gut barrier is made up of your microbiome and mucus layer, then a tight epithelial cell layer, and then within the gut wall there is a micro immune system as the last resort to keep bacteria at bay. When those 4 factors are strong, then you have a tight impermeable gut. BUT when something happens to one of the key players… then things in the GI tract leak into the gut wall and blood stream, activating your immune system and creating inflammation. (Read this for more details)
So how do I stop my gut from leaking?
1. Before you make any moves, make sure you see your gastroenterologist and get checked out for associated diseases such as Celiac disease, Crohn’s Disease, and Ulcerative Colitis. Once you’re cleared—fix that leak!
2. While you’re seeing your GI-- Get checked for a Vitamin A deficiency. Vitamin A-deficient diets cause alterations in the commensal bacteria and impairs the intestinal barrier by changing mucin dynamics and expression of defense molecules
3. Strengthen your microbiome! Key here is prevention- avoid unnecessary antibiotic use. For probiotic sources, natural is always preferred –EAT your probiotics in foods! As for supplements, Lactobacillus and Saccharomyces boulardii have both been shown to reduce intestinal permeability.
4. Avoid alcohol! Ethanol directly disrupts intestinal epithelial tight junction integrity, resulting in endotoxemia, which is suggested to play a key role in alcoholic liver disease ,
5. Avoid a calorie-rich high-fat high-carb Western diet! The Western diet enhances intestinal permeability resulting in metabolic endotoxinemia (toxins in the blood)
6. Avoid sugar, especially fructose! Fructose-induced fatty liver disease is associated with increased intestinal permeability, leading to an endotoxin-dependent activation of liver cells that increase inflammation and fibrosis. Feeding mice a fructose solution was associated with the loss of the tight junction proteins in the small intestine and an increase of bacterial endotoxin in the systemic blood.
7. Make sure your body is making tons of short chain fatty acids, i.e. EAT MORE FIBER!! These organic acids like butyrate are made by microbiome fermentation of undigested dietary carbohydrates (FIBER!) in the colon. Studies have shown that IBD and IBS patients have a reduction of butyrate-producing bacteria, known to improve intestinal barrier function.
8. Prebiotics! Prebiotics have a stabilizing effects on the intestinal barrier and have been found to protects against salmonella infections and against barrier impairment in experimental pancreatitis. See my post on prebiotics for more!
9. Avoid NSAIDs—all non-steroidal anti-inflammatory drugs (NSAIDs) increase small intestinal permeability and cause inflammation
10. Eat more Quercetin! The flavonoid quercetin and its metabolite increase epithelial resistance. It is found in: citrus fruits, apples, onions, parsley, sage, tea, red wine, olive oil, grapes, dark cherries, and dark berries such as blueberries, blackberries, and bilberries
11. Ask your GI doc about Lubiprostone (Amitiza). Lubiprostone improved intestinal permeability in a prospective randomized study.
12. If you’re having infectious diarrhea, talk to your GI about trying a mucosal protector. Sucralfate and bismuth protect the epithelial cells from gastric juice and digestive enzymes. There are also new intestinal barrier modulator drugs and medical foods in the pipeline, such as gelatin tannate and EnteraGam