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Leaky gut became a popular and recognized term only few years ago. In a way, it came into limelight because a lot of patients started having symptoms and problems that did not fit into any existing disease or syndrome description.
These symptoms were similar and patients were connecting them to their diet or foods they eat. Almost all patients had gut dysfunction, so naturally people were seen by gastroenterologists. To add to enigma of the Leaky gut, even the endoscopy and biopsy of the gut was not giving the exact answer to the origin of the problem – the findings of non-specific inflammation were not binging up any specific diagnoses. The first to recognize this new syndrome were natural practitioners, and even they did not know for sure what was causing it. Why the name “leaky gut”? indeed, one of the prominent changes that start other problems in the body is a disruption of the barrier that separates the inner body from the food that travels inside the intestines. In other words, the outside world together with food and drinks may become too close to unprotected internal system of the body. The breach of security, so to say, may then lead to immune system being overwhelmed and dysfunctional, while toxins, pathogens and chemicals can easily enter our lymph and bloodstream and ruin the body.
Laboratory analysis and imaging studies are usually of no help – most of them are normal or slightly abnormal, again shedding no light on the main cause.
One of the main problems associated with leaky gut was severe fatigue and autoimmune conditions, so many of these patients were seen by functional doctors and natural doctors, who found multiple tests and designed many effective treatments for this syndrome.
Another unique feature that is recognized by almost all patients is a negative response (even severe adverse effects) for any conventional medication offered to them in attempt to treat their multiple symptoms.
Causes
What exactly happens in the gut that makes it leaky?
The intestinal barrier is just like skin – both linings function to protect our body from the mechanical damage and harmful intrusions. On the other hand, they regulate the entry and leaving of certain fluids needed for our proper functioning – oils and sweat leaves the body through the skin, nutrients and water are absorbed into the body in the gut.
The mechanism of food digestion is extremely complex and must function properly for us to get all the needed building blocks, vitamins and fluids. On top of the gut epithelium, there are two layers of mucus, the inner and outer layers, that cover the whole intestinal epithelial lining and provide physical protection to separate luminal microorganisms from the epithelium. Organized by its major component, a highly glycosylated gel-forming mucin MUC2, the mucus contains diverse molecules including IgA as well as enzymes and proteins, such as lactoferrin.
Any force that mechanically or chemically will disrupt the mucus and epithelial barrier of the gut will initiate the cascade that can be a start of an endless problem circle. Why would it not heal? Indeed, gut has fastest recovery time and regeneration. If the impact (let’s say you ate one strawberry covered in toxic pesticides and soaked with growth stimulants) is brief and in time and not very destructive, the gut self-heals while you sleep. The daily destruction of the cells producing mucin leads to exhausted repair mechanisms and inability to close defective area.
As we all know, in order to treat a disease well, one needs to know the cause of the problem. In the situation of the Leaky Gut, it seems that this syndrome can actually be an end point of a ‘series of unfortunate events”. Here are proposed reasons why leaky gut develops:
Under-recognized food allergy and sensitivity
Viral and bacterial infections that affect immune system
CMV, Mononucleosis (kissing disease), flu, bacterial infection of the gut (E.Coli, shigella etc.), viral infection of the gut (hepatitis A, enterovirus, viral enterocolitis etc.)
Severe stress or chronic stress, physical or emotional exhaustion
Lifestyle – interrupted sleep pattern, unhealthy diet, substances abuse, and no exercise
Diet – predominance of fast food, pre-packaged, frozen and processed foods
Risk Factors
Risk factors of the Leaky gut have not been identified in research, but have been long suspected by the naturopathic practitioners and functional medicine. Everything that can damage cells can cause it:
Alcohol and certain painkillers
Artificial food ingredients
Pesticides and herbicides used for grain growth
Exposure to heavy metals
Work in chemical industry
Fast food
Unhealthy habits
Absence of regular exercise
Stress and unhappiness
Genetic predisposition for autoimmune diseases
Symptoms
Here is a mystery of the Leaky gut – while the name clearly points to the intestines, almost every system in the body become affected. That poses a significant issue in setting up a right diagnosis. Later we will point just to a couple of diagnoses patients accumulate while searching for an answer to their misery. Although any symptom can come in the course of the Leaky Gut progression, there are still some complains that (when happening together) can point to Leaky Gut diagnosis:
Central nervous symptoms: “brain fog”, short term memory problems, concentration problems, irritability, uncontrolled anger, alternating anxiety/depression bouts, panic attacks. Peripheral neuropathy can present as tingles and numbness
Gastrointestinal symptoms: Chronic diarrhea or constipation, Gas and bloating, Intense cravings for sugar and carbs
Skin problems: rashes, eczema, rosacea, molluscum contagiosum, acne, long healing of wounds, unusual skin infections, mouth ulcers
Autoimmune problems: Joint pain and arthritis, Thyroid conditions, Fibromyalgia
Systemic problems: chronic fatigue, chronic body pains, especially chronic low back pain, muscular weakness, absence of appetite, inability to sleep well
Urinary/reproductive: irritable bladder, interstitial cystitis, inability to conceive, miscarriages, impotence
Allergies and asthma: new onset of severe environmental allergy, bronchial spasm
Complications of leaky gut can be numerous, but surprisingly the worst is an adverse reaction to medications that can lead to severe problems in the body.
Many patients are completely unsatisfied and angry with the conventional healthcare. They continue searching for an explanation of their condition that, in a way can be described as “falling apart”. People develop fear of dying from some sort of enigmatic disease that conventional medicine fails to recognize.
Diseases Associated With Leaky Gut
Celiac Disease
Patients with celiac disease may have a very similar presentation, and it is possible that the changes in their gut is exactly the same as Leaky gut. Is it possible that this is the same disease, only some patients may have a different mutation? We believe it is possible, as patients with Celiac disease respond to exactly same treatments as leaky gut patients, and there is no definitive tests for one or another disease. In a genetic form of celiac disease there are antibodies that can be caught on the blood analysis or biopsy, but they are not necessarily present. Genetic test can identify 2 common chromosome mutations, but there are up to 12 known genes involved and may be even more…
So, at the end – it is all the clinical response to the treatment that makes a difference. Celiac patients need to avoid all glutinous food for entire life, while patients with leaky gut can eat grains most of the time after recovery.
Lyme disease
Lyme disease is a parasitic infection (spirochetes) that starts after the missed tick bite. It is transmitted only by a certain tick (black legged tick) and is pandemic to certain areas only. If the tick was attached more than 24 hours, the parasite can infest the human blood and cause a significant disease that starts with a ‘bull’s eye” specific rash, but then can progress into a true infection. If not treated immediately with antibiotics, the disease may become chronic, or cause chronic dysfunction of the immune system and the whole body.
The most common complain of the chronic Lyme disease patients is chronic debilitating fatigue, which crosses over into a leaky gut presentation. Usually, titers for Lyme disease together with a strong history of a tick and rash in the past, can set a correct diagnosis. Eventually, the treatment is very similar to a leaky gut.
Diabetes
Diabetes is autoimmune disease affecting a pancreatic gland and its hormone glycogen, which creates problem for glucose to enter cells. The result of that is absolutely devastating for the body, causing problems in every organ. Of cause, leaky gut might be a contributor, or just develop by itself and make diabetes worse. Can leaky gut cause diabetes? Most likely yes, but no one knows their relationship.
Increasing evidence, both functional and morphological, supports the concept of increased intestinal permeability as an intrinsic characteristic of type 1 diabetes (T1D) in both humans and animal models of the disease. Often referred to as a “leaky gut”, its mechanistic impact on the pathogenesis of T1D remains unclear. Hypotheses that this defect influences immune responses against antigens (both self and non-self) predominate, yet others argue hyperglycemia and insulitis may contribute to increased gut permeability in T1D.
Gut microbiome
The gut microbiome participates in multiple metabolic processes in the human body and is mainly responsible for regulation of host metabolism.The alterations in function and composition of the gut microbiota have been known to be involved in the pathogenesis of metabolic diseases via induction of epigenetic changes such as DNA methylation, histone modifications and regulation by noncoding RNAs. Induced epigenetic modifications can also be regulated by metabolites produced by the gut microbiota including short-chain fatty acids, folates, biotin and trimethylamine-N-oxide. In addition, studies have elucidated the potential role of these microbial-produced metabolites in the pathophysiology of obesity and diabetes. Hence, this review focuses on the interactions between the gut microbiome and epigenetic processes in the regulation and development of obesity and diabetes, which may have potential as a novel preventive or therapeutic approach for several metabolic and other human diseases.
New research points to a possible link between autism spectrum disorder (ASD) and the gut microbiota as many autistic children have co-occurring gastrointestinal problems. A less integrative gut-blood-barrier is abundant in autistic individuals. This explains the leakage of bacterial metabolites into the patients, triggering new body responses or an altered metabolism. Some other co-occurring symptoms such as mitochondrial dysfunction, oxidative stress in cells, altered tight junctions in the blood-brain barrier and structural changes in the cortex, hippocampus, amygdala and cerebellum were also detected.
Crohn’s disease
Crohn’s disease is an inflammatory colitis, which is mostly genetic in nature, but the rest is unknown. Just like in Leaky gut, these patients benefit from diet modification and nutritional support. In both diseases there is significant auto-inflammatory component and many organs become involved. The true connection is unknown.
Irritable Bowel Syndrome
Irritable bowel syndrome is a functional disorder of the gut that has bloating, cramps, diarrhea and constipation (at various degree) without a true identifiable cause. Well, this sounds very close to a leaky gut. And, after all, there is no significant difference in real life – just a matter of the diagnosis written in the medical chart.
Food Allergies
True food allergy is almost impossible to miss. All people who have true allergies identify their symptoms precisely in the relation to certain food intake. For example: “When I eat shrimp, my lips get itchy, face becomes red, and then I have vomiting and profuse diarrhea”. All symptoms, although sound similar to the leaky gut, happen only when the culprit food is eaten. In a leaky gut people rarely know which food for sure is responsible, and sometimes they suspect 80% of foods to cause their symptoms.
Vision problems
People who have leaky gut for a prolonged period of time have poor absorption of the minerals and vitamins. In addition to chronic inflammation these patients can develop vision problems that are caused by nutritional and allergy:
Allergic conjunctivitis
Blepharitis
Contact eyelid dermatitis
Cataract
Dry eye syndrome
Age-related macular degeneration (AMD)
Recently, low-grade inflammation, sustained by dysbiosis and a leaky gut, has been shown to contribute to the development of AMD. Given the ascertained influence of the gut microbiota in systemic low-grade inflammation and its potential modulation by macro- and micro-nutrients, a potential role of diet in AMD has been proposed.
Leaky gut in kids
In children the most prominent issue comes from the inflammatory reactions in the central nervous system. One of the most related diseases is attention deficit disorder (ADHD). Another – autism.
Children who have a significant burden of the inflammation in the body become irritable, listless and just not themselves. Anger and discipline problems usually trigger a counselor or social worker at school to contact parents and start a workup into behavioral disorder through a child psychologist. It is important to connect the unusual behavior with other problems to seek the right help. It is interesting that the dietary changes can dramatically change the child’s attitude returning the “normal self” within just few weeks of avoidance of grains, corn and corn syrup.
One of the first symptoms parents get concerned about is allergy to the environment (pets, dust mites, grasses) and to foods. Most develop all assortment of allergic diseases such as:
Eczema
Allergic conjunctivitis
Nasal congestion and ear fluid (Eustachian tube dysfunction)
And asthma
Diagnosis
Leaky gut test does not exist yet. There are many tests that need to be done to rule out other possible diseases before one can say for sure that this is it.
Here is the short list of tests to support Leaky gut disease:
Blood cells
Liver enzymes and bilirubin
Kidney test
Antibody titers for infections
Tests for chronic bacterial infections
Electrolyte and vitamin levels
Thyroid function test and thyroid antibody
TTG and gliadin antibody together with genetic test for Celiac disease
Diabetes test
Allergy skin prick test for environment and foods
Pulmonary function test (PFT)
Cardiac enzymes and ECG, stress test
Ophthalmology exam
Sometimes imaging tests (CT, MRI) can be used to rule out tumors or other problems.
If most of the tests are inconclusive or normal, then specific tests assessing digestive system can be done:
Test for gut microbiome and digestive function (not approved by conventional medicine)
Gut inulin and IgA
Breath test for SIBO (small intestinal bacterial overgrowth)
Test for lactose intolerance
Immunoglobulins
Skin test or patch test for food sensitivities
Test for metal sensitivity
Heavy metal deposits in tissues (not approved by conventional medicine)
Prevention
It is very difficult to predict who will develop Leaky gut and when, if ever. As this is a new disease, it is very likely that our lifestyle and environmental exposures are number one factors responsible. A naturopathic practitioner will give you prevention tips for leaky gut:
A good amount of sunlight a day will raise vit D level in skin which is protective in allergy and many other inflammatory problems
Healthy organic food will not deliver harmful chemicals into your gut that are capable of ruining the brush border of the intestines
Antibiotics kill not only the bad bugs, but also fragile microbes that are essential for our gut health. Try not to take antibiotics for viral illnesses. If you had to take them – then replenish the good bugs by taking probiotics
Antifungals and preservatives in foods, fast freezing salts in fish storage, fillers and artificial food components ( corn syrup, gluten, corn solids, sweeteners, taste enhancers etc.) are harmful to the body and can cause gut permeability
Exercise gives your cells a good boost and increase blood circulation in the body – without exercise an obesity develops that contributes to inflammatory disorders
Having a day off in nature decreases fatigue and anxiety, rejuvenates your body and increases the pheromones – tiny molecules of happiness in the brain that preserve from inflammation and aging
