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Intestinal Permeability

Simon Martin, BioMed Newsletter, Issue 11, May 1995

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 fructo-oligo-saccharide.


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 Civilization
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-protmoting 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. DGL - glycyrrizinised 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'.


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 DGL 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.


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 skepticism of nutritional medicine by orthodox medicine.


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, DGL 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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