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Intestinal
Permeability Leaky Gut
by
Simon Martin
Author's Introduction
Intestinal permeability, or 'leaky gut syndrome' is
receiving increasing attention as the hard-to-deal factor in
patients being treated for food intolerances.
Hyperpermeability is also
associated with Coeliac disease, alcoholism, Crohn's
disease, atopic eczema, chronic giardiasis and intestinal
candidosis.
It has long been known that fibre
in the diet is important for the maintenance of a healthy
gut, but research shows that not all types of fibre have
equally beneficial effects. In looking to repair the damaged
intestine, an important new item can now be added to the
standard prescription of anti-fungals, probiotics and
butyrates. This is FOS, or FructoOligoSaccharide.
The cycle of
inflammation
Leaky gut syndrome has been theoretically
suspected as a major factor in a wide range of food and chemical
sensitivities, arthritis, asthma, headaches, digestive problems of varying
seriousness and chronic fatigue. It was quickly linked to many of the
problems experienced in patients with severe Candida albicans overgrowths,
since it was known that Candida, in its fungal form, can put down 'roots'
into the gut wall, allowing comparatively large molecules to pass through
into the bloodstream.
Whether these are food molecules, bacteria or
chemical toxins, the result would be the same: an immune response by the
body, an attack by antibodies and the start of a cycle of immune response,
inflammation and antibody-antigen reactions.
Intestinal permeability is now respectable,
thanks to the comparatively recent development of a urine-based diagnostic
test.
One laboratory, Diagnos-Tech, uses two molecular
markers – the sugars lactulose and mannitol. Based on recovery of these
markers after a simple urine collection, Diagnos-Tech's data can allow
permeability to be assessed independently of kidney or liver function, or
intestinal transit time.
The test shows intestinal absorptive capacity and
how the mucosal intestinal lining is functioning. "This allows early
detection of mucosal changes in the subclinical stage that precedes patho-histological
changes," says Diagnos-Tech.
The most common factors causing hyperpermeability
to the marker sugars appear to be by defects in the mucosal barrier,
particularly between cell walls, and by inflammation following exposure to
allergens or sensitising agents.
According to Diagnos-Tech, "The
hyperpermeability state encourages permeation of lipid insoluble
macromolecules, polypeptides, polysaccharides, and haptens (incomplete
antigens) from dietary or microbial origin. This may occur in food
sensitivity conditions, or with intestinal Candidosis where yeast
fragments are absorbed intact leading to detectable circulating Candida
antigens."
Depending on the state of the owner's gut and on
the precise type of the liberated molecules, the symptoms that result can
range from local inflammation and smooth muscle spasm (as in asthma and
irritable bowel syndrome) to systemic problems.
Gut permeability and/ or intestinal derangement
have now clinically been demonstrated and reported in standard medical
literature in several conditions.
These include:
Coeliac disease
Alcoholism
Crohn's disease
Food allergies
Atopic eczema
Chronic giardiasis
Chronic intestinal candidosis
A new disease of civilisation
The leaky gut syndrome is prevalent because of
the 21st century lifestyle, says New York MD Dr Sherry Rogers, "and
it can lead to the development of any number of symptoms and diseases.
Unfortunately it is rarely looked for."
In a review article for the Townsend
Letter for Doctors (February/March 1995), Dr Rogers
gives seven results of the preliminary inflammation of the gut.
1. The gut does not properly absorb nutrients,
leading to fatigue and bloating.
2. The absorption of large food particles creates
new food sensitivities and new symptoms with potential new targets for the
storage of antigen antibody complexes such as in the lungs (asthma) or the
joints (arthritis).
3. Damage to the proteins whose job it is to carry
minerals across the gut wall, causing potentially, multiple nutrient
deficiencies.
4. Damage to or breaching of the gut wall's
detoxification capability, leading to new chemical sensitivities and
potential overload of the liver.
5. Interference to the gut's protective coating of
immunoglobulins, resulting in decreased defence against bacteria,
protozoa, viruses and yeasts.
6. Spread of infection due to the 'escape' of
bacteria and yeast from the intestine.
7. Formation of auto-antibodies due to leaking of
body tissue look-alike antigens: with the possibility of rheumatoid
arthritis, lupus, multiple sclerosis etc have their genesis this way.
As Dr Rogers has said, the 21st century lifestyle
has predisposed many of our patients towards the development of leaky gut
syndrome. If the cause is inflammation, then we have to suspect the
existence of leaky gut in patients with suspicious ecological dietary or
drug profiles.
In ecological terms, we are referring to the
ecology of the colon and its resident bacteria – an estimated 400
different bacterial species so numerous that they outnumber the amount of
tissue cells.
Any sign of abnormal flora suggests an imbalance
that could be causing inflammation: whether this is candida, parasites or
food poisoning organisms such as giardia. Dietary factors ringing alarm
bells include a long-term eating pattern high in sugars such as those in
refined foods and a regular intake of caffeine, the so-called "soft
drinks" and alcohol.
Some individuals may also end up with
inflammation by following practices they think are health-promoting such
as the regular intake of concentrated "fresh" fruit juices,
while others may suffer from food additives or unsuspected sensitivities
to the common allergens such as wheat and the lactose in dairy products.
There is a case for treating anyone with known food or chemical
sensitivities as if they have leaky gut syndrome.
On the drug front, it is by now axiomatic among
many practitioners that any patients who have been treated with
antibiotics will have unbalanced intestinal flora, whether or not they are
yet exhibiting the symptoms. One result of the therapeutic destruction of
the helpful bacteria along with the harmful, is that the potentially
pathogenic bacteria flourish and, by doing so, can directly cause
inflammation of the gut wall.
Another class of drugs suspected of causing gut
inflammation is the ironically titled "anti-inflammatories",
NSAIDs, or non-steroidal anti-inflammatory drugs. Used in cases of chronic
back pain, osteo and rheumatoid arthritis, for migraine, gout,
dysmenorrhoea and in premenstrual syndrome, these drugs are fast becoming
ubiquitous pain-relievers.
Unfortunately, many NSAIDs are non-prescription
drugs freely available over the counter, and as well as aspirin, they have
recently been joined by the more powerful and heavily advertised
ibuprofen-based products.
Irritation of the stomach and/or the intestine is
a standard effect of NSAIDs – while relieving the symptoms of
inflammation elsewhere in the body, they directly contribute to leaky gut
syndrome as they interfere with prostaglandin production, so affecting the
gastrointestinal mucus and leading to acid and enzymatic attacks on the
gut wall.
A new healing
factor
While treatment of leaky gut
syndrome must concentrate on removing the root causes, on
re-establishing internal ecology with antifungals and
probiotics, it is obviously essential that something is done
to encourage the gut wall to heal.
The role of butyrates has already
been established. DGY (deglycyrrizinised) licorice extracts
and the sulphur-derived "vitamin U" (Cabagin) can
also be used, and there is now an additional factor that can
work from within. As a specific food for health-enhancing
intestinal bacteria, it encourages the proliferation of
active endogenous bacteria and leads to the formation of
butyrate on site.
FructoOligoSaccharide (FOS) is a
natural food substance with the properties of a natural
fibre. It occurs in fruits and vegetables. The
FructoOligoSaccharide group of compounds is particularly
rich in plants such as Jerusalem artichokes and dandelions.
Like other forms of fibre, FOS
passes through the stomach and small intestine largely
undigested. However, unlike other fibre supplements, FOS is
an essential growth factor for beneficial intestinal
bacteria.
Once in the colon, FOS is
selectively hydrolysed and fermented by bifidobacteria to
produce acetate and L(+) lactate. The lactate is then
further metabolised by other bacteria to produce butyrate
and propionate. According to BioMed review by Dr Torben
Neesby (Feb 1990), research suggests that the production of
butyrate in the colon could be essential for a healthy and
functioning colonic mucosa. In two reports published in
1981, one group of researchers showed that in patients with
ulcerative colitis, their colonic mucosa were not able to
absorb butyrate at the same rate as those in healthy people,
while the other researchers suggested that low production of
butyric acid in the colon might be a causative factor in the
onset of colitis in susceptible people.
Although FOS tastes sweet it does
not encourage the growth of yeasts. Its natural sweetness
makes it a welcome addition to strict anti-candida diets,
for example, and as a result scientists are looking at ways
to incorporate it into nutrient-fortified 'functional
foods'.
See also:
High
Dose Enzyme Therapy and Alkalize
for Health
Diet
The diet for healing a leaky gut
should be derived from foods that are well tolerated by the
individual. Any known allergenic foods should be avoided in
the initial stages, especially wheat, rye, barley, rice,
rice syrup, soya, oats, bran, sugar and alcohol. Highly
spiced foods should be excluded from the diet: chillies,
curries, vinegar, pepper, mustard and any other irritant to
the mucus membranes that exacerbates inflammation. Many
herbs recommended for intestinal health, such as cayenne,
pau d'arco and sometimes even goldenseal can actually
aggravate inflamed membranes lining the gut. The diet is
best based upon fresh fruits and vegetables, low in animal
fats and red meats. Use oily fish, chicken and other sea
foods as a source of animal protein. Vegetables high in soft
fibre such as carrots, beetroot, broccoli and swede are
useful as well as apricots, bananas, paw paw, pears,
cherries and mangoes. Drink filtered and bottled water, and
herbal tea as a substitute for coffee, ordinary tea and
drinking chocolate.
Dietary supplements
Dietary supplements can be used to
increase the healing process of the intestinal membranes
along with the necessary changes in diet. Specific nutrients
are known to exert a positive physiological effect upon the
intestinal membranes.
Nutrients such as those mentioned
previously like FOS, butyric acid (as serine butyrate).
Vitamin U and DGY licorice extracts are helpful. Other
factors such as N.A.G. (N. Acetyl Glucosamine), Zinc
ascorbate, magnesium ascorbate and vitamin A have a direct
role in helping to heal the intestinal membranes.
Supplementing with GLA has an anti-inflammatory action which
aids the activity of the other nutrients. Acidophilus,
Bifido bacteria and L. casei are microorganisms that can
help in the overall health of the intestinal tract and
increase the production of essential 'on-site' nutrients
which are required by the mucosal barrier. See also High
Dose Enzyme Therapy
Time to heal
The time it takes for the gut to
repair itself and establish normal function is variable from
one individual to the next. Some practitioners, however,
feel that a minimum of three months is necessary for healing
to take place effectively. Dr Elias Ilyia, Laboratory
director of Diagnos-Tech Laboratories believes that all the
essential factors necessary to manage gut permeability
(leaky gut) are already available to the practitioner.
Dr Ilyia has performed numerous
assays for physicians to determine the presence of leaky gut
and over the past ten years has found the condition to be on
the increase.
He reasons this increase to be
predominantly associated with environmental and dietary
factors. He has, however, actually seen cases of leaky gut
made worse by some treatments and natural products that are
marketed as 'wonder products' for the gastrointestinal
tract. Aloe vera, for example, is a bitter herb that can
gripe sensitive inflamed tissues when taken as a
concentrated liquid. This he sees as an unfortunate
experience as it detracts from a serious subject and further
helps increase the scepticism of nutritional medicine by
orthodox medicine.
Summary
Gut permeability can be classified
as a proven medical condition, for which a clinical test now
exists.
Leaky Gut Syndrome can be a major
factor in a wide variety of disease conditions ranging from
auto-immune diseases to chemical and food sensitivities,
irritable bowel and digestive disorders.
FOS is the fibre of choice in leaky
gut syndrome. It is a growth food source for Bifido
bacterium which is not available to fungi such as candida
albicans or other yeasts organisms in the gut.
Other adjunctive supplements are:
Serine butyrate, DGY licorice extract, N.A.G., Zinc
ascorbate, Magnesium ascorbate,
Vitamin A and GLA.
Careful selection of food groups is
essential during the healing process.
Leaky gut syndrome is an increasing
problem due to '21st Century Diet' and the use of commonly
prescribed drugs such as antibiotics and NSAIDs.
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