Leaky Gut Causes and Treatments
What causes the gut to be leaky?
Diet, lifestyle, stress, and environment can all contribute to leaky gut, but 3 factors top the list: foods, pathogenic microorganisms, and medications.
First are foods. The most common irritant to the gastrointestinal tract is gluten—the protein found in wheat, rye, and barley. Other foods that can irritate the lining of the intestines include sugar, dairy, soy, corn, eggs, and any foods that are genetically modified (GMOs).
In my experience, gluten contributes to leaky gut in just about everyone. Ever since the 1990s, I have been recommending patients with IBS go on a gluten-free diet on a trial basis. My colleagues who work in conventional medicine often challenge me that the gluten-free movement is just a fad. I am quick to point out that celiac disease, which is the most severe form of gluten sensitivity, now affects 1 in 100 individuals. That is a rate that has increased from 1 in 3000 some 30 years ago. This is an indisputable fact. How can this be considered a fad? Recently there has been a new group defined as “non-celiac gluten sensitive” individuals who experience a reaction to gluten but do not have actual celiac disease. By some estimates, this group may represent up to 30% of the population, but I believe the incidence is actually higher. A recent study published in the Journal, Gut, found that “non-celiac gluten sensitivity is not imagined”. The study was led by researchers from the Columbia University. Researchers found markers in the blood that indicated a weakened intestinal barrier in those who experienced symptoms such as abdominal pain, bloating, and fatigue after eating wheat—they found biological evidence of leaky gut!
In my experience, nearly 100% of patients who go off gluten on a trial basis end up feeling better and really notice adverse symptoms if they reintroduce gluten into their diet later on. Unfortunately, the only way to know for certain if you are a non-celiac gluten sensitive reactor is to try going gluten-free and see how you feel. There are new functional medicine, cutting edge laboratories that are doing testing to identify the non-celiac gluten sensitive patients-however these tests are not currently accepted by mainstream medicine. In addition to gluten, there are many other digestive irritants in the diet. For example, many experts feel that the introduction of GMO’S over the past few decades has been a major contributing factor in this seeming epidemic of “leaky gut” and associated autoimmune or inflammatory conditions.
Let’s move on to the second important contributing factor to leaky gut: pathogenic microorganisms. This would include pathogenic bacteria such as Clostridium difficile and H. pylori. It also would include pathogenic forms of yeast or parasites. Overgrowth of pathogenic bacteria is more likely to occur after taking an antibiotic because the antibiotic inadvertently kills off the good bacteria, allowing “bad bacteria” to take over. This condition is referred to as dysbiosis and is commonly present along with leaky gut. I often ask my patients, “When was the last time you felt well?” Many times, a course of antibiotics initiated their downward spiral towards poor health.
The third factor that may lead to or perpetuate leaky gut is medications. Anti-inflammatories, such as ibuprofen, would lead that list. I often see a case where someone has a leaky gut from one cause, which then leads to systemic pain and inflammation, which then leads to daily use of ibuprofen, which then feeds back in a vicious cycle to worsen the leaky gut. The medication used to suppress the symptoms actually fans the flames.
Leaky gut treatment
Our protocol to heal a leaky gut is based on a concept that has been used successfully in functional medicine for years—called the “4 R’s.” The 4 R’s protocol involves Removing anything that is making you sick, Replacing anything you are deficient in, Re-inoculating the gut with probiotics, and Repairing any damage to the intestinal lining. The first of the 4 R’s—Remove— involves removing anything that may be causing gut inflammation. First, we recommend eliminating gluten, dairy, soy, corn, sugar and GMO’S—for at least 2 weeks. Other gastrointestinal irritants in the diet might include coffee, alcohol and additives in processed foods. The removal stage should also address any pathogenic microorganisms, such as yeast, bacteria and parasites. We use medications or natural therapies to eradicate these microorganisms. In the case of yeast, for example, an anti-candida diet will virtually starve the yeast. A comprehensive stool analysis may be necessary to identify any harmful organisms that need to be eradicated.
Anti-inflammatory medications such as ibuprofen should be removed. And finally, we recommend any techniques you can incorporate to reduce stress. Stress can be a profound irritant to the gastrointestinal tract, promoting gut inflammation and leaky gut. Always try and eat only when you are in a relaxed state.
The second R—Replace—is accomplished by adding back and replacing anything that will aid in normal digestion or might be lacking because of poor digestive health. For example, we need adequate amounts of hydrochloric acid and digestive enzymes to break down and extract the nutrients from our food. We need to replace any vital nutrients that may become depleted as the result of leaky gut. Nutrient deficiencies can in turn lead to neurotransmitter imbalances which can cause mood disorders. For example, vitamin B6 is required for converting the amino acid tryptophan to the neurotransmitter serotonin. Serotonin deficiency can lead to anxiety and depression.
The third R—Re-inoculate—involves reintroducing good bacteria or probiotics into the gut to establish a balanced gut flora. We need to reestablish a normal terrain or microbiome. This can be accomplished by taking a good probiotic supplement or eating fermented foods, such as kefir, sauerkraut, kombucha tea, kimchi, or miso. In addition, prebiotics are foods that help to feed and nourish good bacteria in much the same way natural fertilizers help your garden grow.
Lastly, the fourth R—Repair—consists of taking specific nutrients to help support and nurture a healthy gut lining.
We have refined a protocol over the past few years that is based on the principles of the 4 R’s. We have treated hundreds of patients with what we refer to as the “leaky gut protocol.” As Hippocrates said some 2000 years ago, “all disease begins in the gut.” I couldn’t concur more, and we tell all our patients that sealing and healing the gut is the starting point on the road to optimal wellness.