|
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'.
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 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.
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, 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.
References:
1. Castro GA, Arntzen CJ. Immunophysiology of the gut: a research
frontier for integrative studies of the common mucosal immune system.
Am J Physiol; 265 (Gastroinest Liver Physiol. 28):G599-610, 2. Castro
GA Immunophysiology of Enteric Parasiticism. Parisitology Today 1989;5-
1: 11-19.
3. Zhang ZJ et al. Supression of diabetes in nonobese diabetic mice by
oral administration of procine insulin. Proc Nat Acad Sci USA 1991;88:10252-6
4. Weiner HL, Mackin GA, Matsui M, et al. Double-blind trial of oral tolerization
with myelin antigens in multiple sclerosis. Science 1993;259:132-4
5. Ciprandi G et al. Pharmacological treatment of Adverse Reactions to
Foods: A comparison of different protocols. Ann Allergy. 1987:58:341.
6. Howard PJ, heading RC. Epidemiology of gastro-esophageal reflux disease.
World J Surg
7. Walker-Smith J.A., Ford P.K., Phillips A.D. The Spectrum of Gastrointestinal
Allergies To Food. Ann Allergy 1984;53:629-636
8. Saavedra-Delagado A.M., Metcalfe D.D. Interactions Between Food Antigens
and the Immune System in the Pathogenesis of Gastrointestinal Diseases.
Ann Allergy 1985;55:694-700.
9. Ciprandi G., Canonica,G.W. Incidence of digestive diseases in patients
with adverse reactions to foods. Annals of Allergy 1988;61:334-336.
10. MacDonald T.T., Spencer J. Evidence that Activated Mucosal T Cells
Play a Role in the Pathogenesis of Enteropathy in Human Small Intestine
J.Exp. Med. 1988;167:1341-1349
11. Jenkins HR, Pincott JR, Soothill JF, Milla PJ, Harries JT. Food allergy:
the major cause of infantile colitis. Arch Dis. Chil. 1984;59:326-329
12. Moon A, Kleinman RE. Allergic gastroenteropathy in children. Ann Allergy
1995;74:5-15
13. Hill Sm, Milla PJ. Colitis caused by food allergy in infants. Arch
Disease in Childhood.1990; 65:132-140
14. Hill Sm, Phillips AD, Mearns M, Walker-Smith JA. Cow's milk sensitive
enteropathy in cystic fibrosis. Arch Disease in Childhood. 1989;64:1251-1255
15. Lothe L, Lindberg T. Jakobsson I. Cows milk formula as a cause of
infantile colic: A double-blind crossover study. Pediatrics 1983;71:268-271
16. Harmatz PR, Bloch KJ. Transfer of dietary protein in breast milk.
Ann Allergy 1988:61-2:21-24 17. Jacobsson I, Lindberg T. Cow's milk proteins
cause infantile colic in breast-fed infants: a double-blind crossover
study. Pediatric 1983;71:286
18. Lynn RB, Friedman LS. Irritable Bowel Syndrome. N. ENG. J Med 1993;329:1940-5
19. Brostroff J. Irritable Bowel Syndrome. N Engl J Med 1994; May 12:1390
20. Jones A.V., McLaughlin P. Shorthouse M. et al. Food intolerance: a
major factor in the pathogenesis of irritable bowel syndrome. Lancet 1982;2:1115
21. Jones Al, Shorthouse M., Workman E. et al. Food intolerance and irritable
bowel. Lancet
22. Nanda R. et al: Food Intolerance and the irritable bowel syndrome.
Gut 1989;30:1099-104.
23. Pagnelii R. et al Intestinal Permeability in irritable bowel syndrome...
Annals of Allergy 64; 377-380
24. Iacono G. Et al Chronic Constipation as a Symptom of Cow milk Allergy.
Jour Pediatrics
25. Gardner MLG. Evidence for, and Implications of, Passage of Intact
Peptides Across the Intestinal Mucosa. 1983 Biochem. Soc Trans 11; 813.
26. Reinhardt M.C. Macromolecular Absorption of Food Antigens in Health
and Disease. 1984 Ann Allergy.53.597-601.
27. McNeish, A.S.Enzymatic Maturation of the Gastrointestinal Tract and
its Relevance to Food Allergy and Intolerance in Infancy. 1984 Ann Allergy
53: 643.
28. Bienstock J. Mucosal barrier functions. 1984 Nutr reviews 42:3 105-116.
29. Coombs RRA, McLaughlan P. Ann Allergy 1984;53:592.
30. Yates VM, Watikinson G, Kelman A. Further evidence for an association
between psoriasis, Crohn's disease and ulcerative colitis. Br. J Dermat
1982;106:323-330
31. Gardner ML Absorption of intact proteins and peptides. Biol Rev 1984;59:289-331
32. Gardner M.L. Gastrintestinal Absorption of Intact Proteins 1988 Ann
Rev. Nutrition 8:329
33. Walker W.A. Pathophysiology of intestinal uptake and absorption of
antigens in food allergy. Ann Allergy 1987:59,II:7-16
34. Kleiman RE, Bloch KJ, Wlaker WA: Gut induced anaphylaxis and update
of a bystander protein: an amplification of anaphylactic sensitivity.
Pediatr Res 1981:15:598
35. Schrander JP, Dellevoet MD, Arends JW, et al. Small Intestinal muscosa
IgE plasma cells and specific anti-cow milk IgE in children with cow milk
protein intolerance. Ann Allergy 1993; 70:404 36. Castro GA, Powell D.W.
The Physiology of the Mucosal Immune System and the Immune-Mediated Responses
in the Gastrointestinal Tract. Physiology of the Gastrointestinal Tract
. Ed. Johnson R. 1994: 709-750 Raven Press NY.
37. Van Der Meer, S.B., et al. Small Bowel Permeability to Cr-EDTA in
Children With Recurrent Abdominal Pain. ACTA Pediatr. Scand., 1990;422-426.
38. Bjarnson I, Williams P, So A. et al Intestinal Permeability and inflammation
in patients with Rheumatoid Arthritis; effects of non-steroidal anti-inflammatory
drugs. Lancet 1984;ii:711-4
39. Bjarnson I, Zanelli G, Smith T et al. Non-steroidal anti-inflammatory
drugs induced inflammation in humans. Gastroenterology 1987;93:480-9
40. Draper LR, Gyure LA, Hall JG, Robertson D. Effect of alcohol on the
integrity of the intestinal epithelium. Gut 1983;24:399-404
41. Bjarnson I, Ward K, Peters TJ. The leaky gut of alcoholism. Possible
route for entry of toxic compounds. Lancet 1984;:179-82
42. Peters TJ, Bjarnson I. Uses and abuses of intestinal permeability
measurements. Can J Gatroenterol
43. Unsworth DJ, et al IgA anti-gliadin antibodies in Celiac disease.
Clin Exp Immunol. 1981:
44. Keiffer M, et al Wheat gliadin fractions and other cereal antigens
reactive with antibodies in the sera of celiac patients. Clin Exp Immunol.
1982;50:651-60
45. Kelly CP Case records of the Mass General Hosp 30-1994 NEJM 1994;331-6:383-9.
46. Ciclitira PJ, et al Secretion of gliadin antibody by coeliac jejumal
mucosal biopies cultured in vitro. Clin exp. Immunol.1986;64:119-24
47. O'Farrelly C. et al alpha-Gliadin antibody levels: a serological test
for coeliac disease. Br. med Jour
48. Bjarnson I, Peters TJ A Persistent Defect in Intestinal permeability
in Co on the integrity of the intestinal epithelium. Gut 1983;24:399-404
49. Bjarnson I, Ward K, Peters TJ. The leaky gut of alcoholism. Possible
route for entry of toxic compounds. Lancet 1984;:179-82
50. Peters TJ, Bjarnson I. Uses and abuses of intestinal permeability
measurements. Can J Gatroenterol
51. Unsworth DJ, et al IgA anti-gliadin antibodies in Celiac disease.
Clin Exp Immunol. 1981:
52. Keiffer M, et al Wheat gliadin fractions and other cereal antigens
reactive with antibodies in the sera of celiac patients. Clin Exp Immunol.
1982;50:651-60
53. Ciclitira PJ, et al Secretion of gliadin antibody by coeliac jejumal
mucosal biopies cultured in vitro. Clin exp. Immunol.1986;64:119-24
54. O'Farrelly C. et al alpha-Gliadin antibody levels: a serological test
for coeliac disease. Br. med Jour
55. Bjarnson I, Peters TJ A Persistent Defect in Intestinal permeability
in Coeliac Disease demonstrated by a 51Cr EDTA absorption test. Lancet
Feb 12 1983:323-325
56. Mulder CJJ, Tygat GNJ. Celiac disease and related disorders. Netherlands
Jour Med
57. Homes GKT, Prior P, Lane MR, Pope D, Allan RN. Malignancy in celiac
disease -effect of a gluten-free diet. Gut 1989;30:333-8.
58. Braegger C.P., MacDonald T.T. Immune mechanisms in chronic inflammatory
bowel disease. Ann Allergy 1994;72:135-141
59. Voigt AJ, Echave V, Feller JH, et al. Experience with elemental diet
in the treatment of inflammatory bowel disease. Is this primary therapy?
Arch Surg 1973;107:329-33
60. Rocchio MA et al Use of Chemically Defined diets in the Management
of Patients With Acute Inflammatory Bowel Disease. Am Jour Surg.1974;127:469-475
61. O'Morain C, Segal AW, Levi AJ et al Elemental diet as a primary treatment
of acute Crohn's Disease; a controlled trial. Br. Med J 1984:288:1859-62
62. Morin Cl et al Continuous elemental enteral alimentation in the treatment
of children and adolescents with Crohn's disease. J Parent Nutr 1982;6:194-199
63. Saverymuttu S, Hodgson HJF, Chadwick VS. Controlled trial comparing
prednisolone with an antibiotic in active Crohn's disease. Gut 1984:26:994-998
64. Teahon K., Bjarnason I., Pearson A.J., Levi A.J. Ten years experience
with an elemental diet in the management of Crohn's disease. Gut,1990,31;1133-1137
65. Frieri et al. Preliminary investigation on humoral and cellular immune
responses to selected food proteins in patients with Crohn's
66. Knicker W. Non-IgE Mediated and Delayed Adverse reactions to Food
or Additives. Handbook on Food Allergies, Ed Breneman J.C.; Marcel Dekker
Inc. N.Y. 1985.
67. Rowe, A.J. Allergic toxemia and migraine due to food allergy. Calif
West Med, 33:785,1930.
68. Randolph T.G. Allergy as a Causative factor in fatigue, irritability,
and behavior problems in children. Pediat, 31:560,1947.
69. Speer, F. The allergic-tension-fatigue syndrome. Pediat Clin N. Amer,
1:1019,1954.
70. The allergic-tension-fatigue syndrome: Allergy of the Nervous System.
Charles C. Thomas Pub.
71. Landay AL., Jessop C., Lennette ET., Levy JA. Chronic fatigue syndorme:
clinical condition associated with immune activation. Lancet;338(1991):
707-711.
72. Gupta,S. Vayuegula, B. A Comprehensive Immunological Analysis in Chronic
Fatigue Syndrome. Scand J. Immunol 33,319-327 1991.
73. Strauss S.E., Dale J.K., Wright RN, Metcalfe D.; Allergy and the chronic
fatigue syndrome. J. Allergy Clin Immunol;81:5,1; 791-795;1988.
74. Strauss S. History of the Chronic Fatigue Syndrome Reviews of Inf.
Disease 13: sup 1; Jan-Feb '91
75. Bak P., Kan C., Self-Organized Criticality. Sc American Jan '91;46-53.
Related Articles
Leaky
Gut Syndrome
A
Gut Feeling
|
