Leaky What? Intestinal Permeability and its Impacts on Patient Health
“All disease begins in the gut …” – Hippocrates
Over 2,500 years ago, the Greek physician Hippocrates declared, “All disease begins in the gut.” Time has proven him right! There has been an explosion of scientific literature bringing credence to the notion that intestinal health – and in particular, the microbiome – is crucial to the pathogenesis of a myriad of systemic disorders.1
One gut condition, “leaky gut” (a.k.a increased intestinal permeability), is inextricably linked to the status of our microbiome.
Beautifully Designed: The Gut as it Should Be
Before we get started, let’s set the stage with a quick review of the gut barrier function. The intestinal barrier is equipped with four levels to protect the intestine from external stimuli:
- Physical barrier – A single layer of semi-permeable epithelial cells connected by tight junctions, which act like gates to control what passes through.
- Chemical barrier – A mucus layer consisting of mucins and antimicrobial peptides secreted by goblet cells and Paneth cells.
- Immunological barrier –Immune cells in the lamina propria and secreted immune mediators such as cytokines and secretory immunoglobulin A (SIgA).
- Microbial barrier – Commensal bacteria in the intestinal lumen.2
Photo credit: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600953/
Design Disrupted: What is Leaky Gut?
Damage to any of these four barriers is problematic and can ultimately result in disruption or weakening of the tight junctions in the physical barrier; formation of gaps between the epithelial cells; and substances passing through that should not, such as food particles, toxins, and/or microbes. This disrupted balance in the microbiome – known as dysbiosis – plays a significant role in the development of leaky gut.
Dysbiosis is often accompanied by increased pathogenic or opportunistic microorganisms, including gram-negative bacteria that produce lipopolysaccharides (LPS). LPS is one of many pathogen-associated molecular patterns (PAMPs) and is the single most potent immune system stimulant known. PAMPs are found on the surfaces of various microorganisms, such as bacteria, viruses, fungi, and parasites.
PAMPs activate pattern recognition receptors (PRRs) such as TLR4 located on immune cells. PAMPs also induce an immune response, resulting in the release of cytokines, chemokines, and other immune mediators that cause both acute and chronic inflammation.3
To make matters worse, the collateral damage associated with the immune activity which PAMPs initiate results in tissue injury and the production of damage-associated molecular patterns (DAMPs). These DAMPs also bind PRRs and perpetuate inflammation. When this occurs in the gut lining, the result is increased intestinal permeability. PAMPs and DAMPs then enter the bloodstream at increasing levels, contributing to the dysregulation of the immune system and the development of chronic inflammation, and the risk of autoimmune diseases.
Increased intestinal permeability has been linked to various conditions – not only intestinal but also systemic disorders such as diabetes, chronic kidney dysfunction, cancer, and cardiovascular disease.4
Signs, Symptoms, and Testing
Symptoms of leaky gut can vary but may include:
- Bloating
- Gas
- Abdominal pain
- Diarrhea
- Fatigue
- Food sensitivities/allergies
It’s important to note that some patients may not experience classic symptoms. To identify if your patient has a leaky gut, tests such as a lactulose/mannitol test or a zonulin test can be administered to measure intestinal permeability.
Solutions for Leaky Gut
Treatment often involves dietary and lifestyle changes to reduce inflammation and heal the gut lining. This includes balancing the microbiome by removing pathogenic microorganisms and introducing probiotics and digestive support.
Here are 10 tips to share with your patients to improve gut health and reduce inflammation throughout the body:
- Eat a healthy and balanced diet – A diet rich in whole foods, fruits, vegetables, and lean proteins can help support gut health and reduce inflammation. Avoid foods such as processed foods, sugar, gluten, and dairy that can exacerbate the condition.
- Reduce alcohol and caffeine consumption – Alcohol and caffeine can irritate the gut and contribute to leaky gut. Limiting or avoiding these substances altogether is best, especially when healing the gut lining.
- Reduce stress – There is bidirectional communication between the gut and brain. Chronic stress can disrupt gut health and increase inflammation in the body, and vice versa. Practicing relaxation techniques such as meditation and deep breathing can help reduce stress levels and improve gut health.
- Probiotics – Probiotics are beneficial bacteria that can help improve gut health by restoring the balance of good bacteria in the gut. Probiotics can be found in fermented foods such as yogurt, kefir, and sauerkraut and in supplement form.
- Prebiotics – Prebiotic-rich foods such as apples, bananas, asparagus, Jerusalem artichokes, onions, and garlic, and prebiotic supplements feed beneficial bacteria so they can produce important gut-healing compounds like butyrate.
- Rest to digest – To properly digest food, a person needs to be in a rested state. Taking five deep breaths before eating can help your patients get into a relaxed state before they reach for their forks.
- Use digestive enzymes – Taking digestive enzymes can help break down food more effectively, reducing the burden on the gut and preventing undigested food particles from passing through the gut barrier.
- Address food sensitivities – Food sensitivities can contribute to leaky gut and other digestive issues. Identifying and eliminating trigger foods can help reduce inflammation and improve gut health. Also, a leaky gut will often result in food sensitivities to the foods eaten regularly. Recommend a varied diet to prevent sensitives and improve the diversity of nutrients your patients consume.
- Avoid unnecessary antibiotics – Antibiotics can disrupt the balance of bacteria in the gut, resulting in a leaky gut and other digestive issues.
- Balance the microbiome and address problematic biofilms – An unbalanced microbiome can cause a leaky gut. Suggest a bi-annual microbiome detox to address unwanted microbes and restore balance.
- Quality sleep – Getting enough restful sleep is essential for overall health, including gut health. Recommend 7 to 9 hours of sleep per night.
Hippocrates was spot-on when he espoused the importance of gut health. As alternative practitioners, not only are we returning to root-cause medicine identified by our predecessors, we are resurrecting natural therapeutics in the form of botanical medicines and common-sense lifestyle support.
See our Functional Gastrointestinal Protocol sheet for more information about how botanicals can support gut health.