By: Gail Clayton, R.Ph.
Many diseases are attributed to problems that begin in the digestive system. Digestion is the process whereby our body converts the energy from our food sources to an energy source that we can utilize. Food goes through hundreds of enzymatic reactions to get to the endpoint of energy (ATP) for use. If there is a break down in the process at any step, then illness or disease can result. Gastric acid and pancreatic enzymes aid in the digestive process and help maintain the integrity of the digestive system and aid in the absorption of nutrients from our foods through the intestinal barrier which is the gateway between the outside environment and inside the body. The intestinal epithelial cells are a one cell thick lining that the intestines utilizes to control what is allowed to enter the body from the outside environment by maintaining a “tight junction” between these cells, allowing only nutrients in that are meant to be used by the body and keeping out harmful macromolecules and bacteria. Leaky Gut Syndrome can best be described as an increased permeability of the tight junctions that somehow has lost some of its regulatory control allowing large particles that were once forbidden from entry to now enter the body due to damage of the mucosa. This “leakiness” can be a result of alcohol consumption, NSAID (non-steroidal anti-inflammatory) use, viral, bacterial, yeast, and protozoan infections, and even failure to maintain the proper gastric pH or in producing sufficient pancreatic enzymes.1(425) Chronic oxidative stress, poor quality foods, and cytotoxic drugs will produce reactive oxygen species (ROS) which will also contribute to increasing intestinal permeability.1(425)
The small intestines is 25 feet long that has a lining covered with villi and microvilli and a balance of bacteria and yeast flora that aid digestion. Since 2/3 of immune activity is located in the gut, a wide variety of disorders can be attributed to an activation of the immune system that started in the gut.2 When these foreign macromolecules slip through the damaged intestinal lining, an immune response is triggered allowing undigested food or bacteria to enter the blood stream. This “leakage” can cause the body to react in a number of ways that one would not think is related to the gut.2 Leaky gut is found virtually in all inflammatory bowel disorders and can cause a hypersensitivity to foods and components of the gut flora.1(426)
Because the majority of the immune system lies in the gut, the symptoms of “leaky gut” can be very diffuse and widespread. Once the antigens cross through the tight junctions of the intestinal barrier due to a compromise in the integrity, an immune complex is formed causing an inflammatory response.3 This inflammatory response to certain foods is more of a hypersensitivity to a particular food rather than a true allergy. The more common symptoms of leaky gut are allergies, celiac disease, Chron’s disease, HIV, and malabsorption syndrome.4(43) Other associated diseases include: eczema, psoriasis, food and environmental sensitivities, asthma, bronchitis, AIDS, allergic skin disorders, auto-immune diseases such as fibromyalgia, rheumatoid arthritis, chronic fatigue, Reiter’s syndrome, Sjögren’s syndrome, and skin irritations.1(429-431), 4(43)
Peyer’s patches are a type of lymphoid tissue located all throughout the small intestines in the mucosal tissue that produce immunoglobulins by the B cells. An antibody reaction with food can cause clinical food allergy symptoms.1(430) Most people do not attribute allergic symptoms as being related to gut function, and even Western Medicine practitioners seem to deny the correlation between the two.
CURRENT CONVENTIONAL TREATMENT
Western Medicine is dysfunctional in the way it treats patients with leaky gut symptoms because treatment is based on symptoms only, which means a varied approach of diverse treatments, which does nothing to address the cause. One of the more common symptom of leaky gut is allergies. If a patient were to present to a conventional physician complaining of allergic type symptoms such as rhinitis or even hypersensitivity type reactions such as angioedema or swelling, the common approach is to treat the patient with antihistamines (H1 or H2 blockers) and/or steroids, or if the presenting symptoms are GI distress then a proton pump inhibitor or oral maalox solution is recommended along with the H1 or H2 blocker. For topical rashes such as eczema, psoriasis, or even dermatitis the current approach is to apply topical anti-itch creams such as diphenhydramine or hydrocortisone. For food intolerances, an allergy physician commonly performs skin allergy testing which usually is not very helpful when it comes to food intolerances vs. food allergies. For some of the more serious auto-immune type of symptoms of leaky gut, immune suppressants are commonly prescribed such as methotrexate or Humira or Enbrel to decrease the immune response along with chronic steroid administration. The chronic inflammation that is widespread over the entire body is usually treated with chronic NSAIDs administration. All of these current treatments are palliative at best and do nothing to address the underlying cause of the patient’s suffering.
NUTRITIONAL DIET PROTOCOL
A functional medicine approach, and the simplest way to treating a patient that presents with symptoms of leaky gut or any illness is to first assess the diet and make necessary changes shifting from refined processed, nutrient poor foods to whole foods that are nutrient dense, which will have a huge impact on changing the way someone feels physically and mentally. Our society has strayed very far away from the way our ancestors ate. Most of the food in the western diet would not be recognizable as food to our great-grandparents, and using food as medicine is the best approach for preventing and treating leaky gut as well as restoring overall general health.
A sufferer of leaky gut must come to a place of readiness for change in their eating and lifestyle habits before real healing can begin. Sometimes being sick and tired and coming to the understanding that their poor diet is the root cause of their woes is all the motivation an individual will need. Once motivated, the first step is to remove nutrient poor foods, poor-quality fats and oils, processed foods, sugary drinks, artificial sweeteners, and any food that doesn’t agree with them.4(28) For highly motivated individuals, this can be achieved rather quickly, however with others a shifting approach to a healthier lifestyle may be the approach they choose. Learning what foods are healthy and how to shop and navigate through the grocery aisles may be a challenge and require extra coaching and education. General guidelines for preventing and restoring a healthy gut include:
- Keeping well hydrated by drinking eight 8oz glasses of filtered water daily can help to keep the enterocytes well hydrated for best nutrient absorption as well as supporting pancreatic secretions of bicarbonate to neutralize gastric acid in the small intestines for maintaining proper digestion.5(29) A good rule of thumb is to drink 1/2 your body weight in ounces of water daily.
- Include fresh foods since they have the greatest enzyme activity for supporting digestion.4(135)
- Eat smaller and more frequent meals, and carry healthy snacks with you.4(136)
- Do not overeat! Eat when hungry, but stop when full.4(135)
- Practice mindful eating. Use mealtime as a way to relax, unwind, and rejuvenate your body and mind.4(137) Chew slowly and savor the flavor!
- Seek out local foods that are in season. These types of foods are generally of a higher quality, fresh and abundant in enzymes and may reduce the amounts of pesticides and herbicides we consume.4(137)
- Include a wide variety of fruits and vegetables from different colors of the rainbow.4(138) Try to eat 9 servings daily!
- Try to eat organic when possible. Organically grown foods are more nutrient dense from the methods used in organic farming to resist pests.1(137) Become familiar with the Environmental Working Group’s “Dirty dozen” and the “Clean Fifteen”9
- Fiber, fiber, and more fiber! Fiber will increase intestinal motility and reduce transit time which will prevent toxic waste products from fermenting in the intestines and provide a substrate for pathogenic bacteria to feed on.4(140) Shoot for a transit time of 24 hours.
For those that have developed many food sensitivities due to leaky gut, identifying and avoiding all foods they are sensitive to for a period of time may allow the healing process to occur. An elimination diet or a 4-day rotation diet may be helpful. A four day rotation is used to allow the body to recover from a food that is consumed as all traces of the food should be cleared from the digestive system within the four day period before it is re-introduced.7Foods are assigned a number according to the biological family it belongs, in which food families are also rotated .6 This principle of this diet is based on the observation that the foods most frequently eaten are the most common foods that an individual will be allergic to.6
This four day rotation sample diet that I have complied in figure 1 has numbers listed next to the food, which indicate the class the food is assigned to (not the quantity that should be consumed). The foods included in this diet are nutrient dense and spread over a four day period so that no two foods from the same class are repeated in the same day, but two foods from the same class may be eaten every other day. If there is a food in the diet that you cannot tolerate you may substitute with another food with the same class assignment from the book, or you may omit that particular food.
This diet is based on the book written by The Environmental Health Center in Dallas, TX, 8345 Walnut Hill Lane, Suite 220, Dallas TX (214)691-8432. To purchase the book please contact The Environmental Health Center in Dallas.
In addition to a whole food balanced diet that promotes intestinal health, supplements may be necessary to support the healing of leaky gut. Providing supplements that specifically aid in gut restoration include:
- glutamine 1,000-10,000mg/day8(222)
- zinc carnosine 75-150mg twice daily between meals8(222)
- Gamma-oryzanol 100mg three times daily8(223) (also make sure Omega 3 intake is sufficient)
- Digestive enzymes with meals8(222)
- ImmunoThrive 3 capsules daily.
Immunothrive is a product that I developed containing 5 organic herbs that work synergistically together to support proper imune function. It is a rich souce of active Vitamin A that is required for the immune system in the small intestines. The herbs in Immunothrive have been used for Centuries in Ayurvedic medicine for digestive issues and immune support and has an excellent safety record. It contains a complete array of amino acids and essential fatty acids and is complete with over 90 minerals to provide the nutritional base so that the body has the tools it needs to help recover proper function of the cells, tissues, and organs by balancing the biochemical reactions in the cells.
Healing a leaky gut is not an easy task and cannot be done overnight. Undertaking a gut healing protocol requires a highly motivated individual that is committed to their own healing and recovery and is willing to make the necessary diet and lifestyle changes in order to achieve it. A successful program of restoring gut function incorporates the 4 “R” rules of “Remove, Replace, Restore, and Repair”.1(437) Removing the offending agents such as avoiding foods that are causing an immune response that leads to inflammation allows healing and killing off pathogenic flora. Secondly, replacing the HCl or enzymes needed to aid with digestion. Third, restore the normal flora with probiotics, and lastly repair the intestinal layer with medical food nutrients for repairing the gut lining. I believe the 4 “R” protocol of achieving gut health to be the best strategy, as I have talked and listened to many Functional Medicine practitioners as well as clients of my own give successful testimonies by following this strategy.
1. Lord R, Bralley J. Laboratory Evaluations for Integrative and Functional Medicine. Revised 2nd Edition. Metametix Institute. Duluth GA. 2012.
2. Marston, Wendy. Gut reactions: tiny leaks in the lining of the small intestine may play a role in diseases as diverse as asthma and arthritis. Nov 17,1997: 95+. Opposing Viewpointsin context. http://ic.galegroup.com/ic/ovic/Magazines. DetailsPage/MagazinesDetailsWindow?failOverType=&query=&prodId=&windowstate=normal&contentModules=&display-query=&mode=view&displayGroupName=Magazines&dviSelectedPage=&limiter=&currPage=&disableHighlighting=&displayGroups=&sortBy=&zid=&search_within_results=&p=OVIC&action=e&catId=&activityType=&scanId=&documentId=GALE%7CA19979982&source=Bookmark&u=a22ub&jsid=f86c293c29816583165f01c9682bac6bAccessed 2 Sept. 2015.
3. Chalk C, Chalk A. Probiotics and Allergy: Current Understanding and Application for the PCCP (Primary Care Chiropractic Physician). Jour Chiro Med. Fall 2003. Vol 2(4):131-133. http://ac.els-cdn.com.libproxy.bridgeport.edu/S0899346707600755/1-s2.0-S0899346707600755-main.pdf?_tid=0d81ea70-5278-11e5-9379-00000aab0f01&acdnat=1441311308_ec5d66334328e3ea27573a1cb8edea87. Accessed Sept 3, 2015.
4. Lipski E. Digestive Wellness. 4th Edition. McGraw Hill. NY NY. 2012.
5. Batmanghelidj F. Your body’s many cries for water. Global health Soln, Inc. FAlls Church VA. 2nd Edition. 1997.
6. Maynard B, Bauer S, Carlisle L, etal. Rotational Bon Appetit Cookbook. 2007. Environmental Health Center – Dallas
7. Taylor J, Krondl M, Csima A. Assessing Adherence to a Rotary Diversified Diet, a Treatment for ‘Environmental Illness’. Jour of Amer Dietetic Ass.Dec 1988. Vol 98(12):1439-1444. doi:10.1016/S0002-8223(98)00326-5.
8. Kohlstadt I. Advancing Medicine with Food and Nutrients. 2nd Edition. CRC Press. Boca Raton FL. 2013.
9. Environmental Working Group. EWG’s 2015 Shopping Guide to Pesticides in Produce. http://www.ewg.org/foodnews/summary.php. Accessed Sept 17, 2015.