Leaky Gut Evaluation & Treatment

 1. Evaluation

·     Inflammatory disease (celiac disease, inflammatory bowel disease)

·     A state of hyper-inflammation due to underlying disease may weaken or destabilize the integrity of the gut epithelia. 

·     Infections

·     Infections can play a role in regulating the mucosal barrier. Helicobacter pyloriis a Gram-negative bacterium infecting the human stomach that directly increases epithelial permeability by redistributing TJ protein. Bacterial dysbiosis in SIBO can also disrupt epithelial tight junctions increasing small intestine paracellular permeability, translocation of endotoxin, and induction of proinflammatory cytokines.

·     Vitamin A deficiency

·     Vitamin A-deficient diet alterations within the commensal bacteria, and impairs the intestinal barrier by changing mucin dynamics and expression of defense molecules such as MUC2 and defensin 6

·     Vitamin D deficiency

·     Vitamin D has been recognized as an intestinal permeability protector by inducing the expression of TJ proteins ZO-1 and claudin-1.

·     Chronic kidney disease

·     Heavy influx of circulating urea into the gut disrupts the intestinal barrier and changes the microbial flora.

 

2.    Fiber intake

·     Low-fiber diet has been found to trigger the expansion of mucus-degrading bacteria, including Akkermansia muciniphila and Bacteroides caccae.

·     Meals rich in fiber and fruit have been demonstrated to reduce high fat/high carbohydrate meal-induced increases in plasma LPS levels, the inflammatory response and the expression of TLR2 and TLR4.

·     Fiber leads to increased short chain fatty acid production including butyrate, which if deficiency causes tight junction lesions and intestinal permeability.

 

3.    Western style diet

·     Diets consisting of fast food and processed food have been associated with increased intestinal permeability and depressive symptoms

 

4.    Saturated fat

·     High fat diets are associated with a greater translocation of LPS across the gut wall.

·     A diet high in saturated fat has been shown to greatly decrease Lactobacillus and increase Oscillibacter, changes that correlated with significantly increased permeability in the proximal colon.

 

5.    Alcohol

·     Chronic alcohol consumption is responsible for intestinal barrier dysfunction, alterations on both the quality and quantity of gut microbiota, LPS translocation, and alcoholic liver disease. 

 

6.    Prebiotics and probiotics 

·     Prebiotics and probiotics can be used to reduce intestinal permeability 

o  Prebiotics have stabilizing effects on the intestinal barrier

  • Ex. Benefiber, Prebiotin

o  Probiotic such as Bacteroides fragilispossess the properties to protect the intestinal barrier through targeting different components of the mucosal barrier system. 

  • VSL#3 normalizes colonic physiologic function and barrier integrity, reduction in mucosal secretion of TNFa and IFNy

  

Mu et al. Frontiers in Immunology. 2017

Kelly, et al. Frontiers in Cellular Neuroscience 2015

Fukui, H. World J Hepatol. 2015

Bischoff, et al. BMC Gastroenterol. 2014