The term intestinal permeability aka “Leaky Gut” has made it to mainstream health dialogue in recent years, yet every time I chat with anyone about “Leaky Gut” there is so much confusion around what it is, why you don’t want it, how the gut becomes “leaky” and what you can do about it. So today, let’s break it down a little bit to provide some more clarity on the topic.
Before we talk about “Leaky Gut” specifically, it is worth taking some time to talk about the mucosal barrier.
What is The Mucosal Barrier?
The mucosal barrier is a component of our intestines and is made up of millions of little villi. On the outer most layer of the villi are epithelium cells and each epithelial cell that covers the villi is also covered in thousands of microvilli. Microvilli are finger like projection that constitute what is called the brush border. The brush border is responsible for increasing the surface area for absorption of nutrients from the gut, produces enzymes to break down sugars and aids in fat absorption.
There are special epithelial cells called enterocytes and these cells are responsible for nutrient absorption. Enterocytes have nerves but no blood supply so nutrient absorption happens by diffusion. They are essentially the transport system for food molecules from the intestines into the hepatic portal system, which is the venous system that returns blood from the digestive tract to the liver. Between each enterocyte are what we call “tight junctions” which are the “gates” into general circulation.
The Mucosal Barrier has two main functions
Facilitating nutrition through the hepatic portal system - The hepatic portal system is the venous system that returns blood from the digestive tract to the liver
Acts as a protective layer to restrict offensive substances into general circulation (like antigens or immune complexes)
So, a healthy mucosal barrier is critical for both digestion and gut immunity
Then What is "Leaky Gut"?
“Leaky Gut” happens when the tight junctions in the mucosal barrier “open” allowing harmful substances into general circulation to cause inflammation. This occurs when the intestinal barrier is not functioning properly. When the gut is not functioning properly it cascades to so many other parts of the body. Inflammatory reactions destroy the microvilli and blunt the brush border resulting in poor digestion, nutrient deficiencies, and mood disorders. When the body is in a pro-inflammatory state, white blood cells attack and so “Leaky Gut” can also be a factor in autoimmune disease. As a result, it is VERY important to ensure that your gut is not in an inflammatory state and if it is, it needs to be fixed!
The immune system link is also important to discuss. When there are stressors in the gut it suppresses something called Secretory Immunoglobulin A (SigA) which is the first line of defense against the “bad guys.” SigA is often suppressed when someone is in a Cortisol dominant state and when SigA is suppressed your immune system becomes suppressed.
How Does the Gut Become "Leaky"??
There isn’t one “thing” that causes the gut to become leaky, but in the end it all comes down to lifestyle factors that cause inflammation. Inflammation in the gut can be triggered by an overgrowth of yeast or bacteria in the bowel, pathogens, a poor diet, and the overuse of antibiotics to name a few. Here are a few key contributors to “Leaky Gut”
Overuse of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) like Acetaminophen and Ibuprofen
Too much alcohol
Pathogens in the intestine like H Pylori or Giardia
Crohn’s, Colitis, or IBS
Poor diet and eating foods you are sensitive to
How Can You Tell If You Have "Leaky Gut"?
Some symptoms of “Leaky Gut” include the following, however, keep in mind that it is possible that “Leaky Gut” can be asymptomatic
Diarrhea
Constipation
Intestinal gas and bloating
Hormone imbalances
Fatigue
Mood disorder
The presence of autoimmune disorders
It’s important to watch out for the signs and symptoms of “Leaky Gut”, however there are several reliable lab markers that a health practitioner (such as myself) can run for clients to provide a window into gut function and really provide some answers around the root causes of health complaints.
Zonulin - Zonulin (pre-Haptoglobin 2) is a protein that modulates the permeability of tight junctions between cells of the digestive tract wall. Once triggered, Zonulin plays an important role in the creation of what we think of as gut “leakiness.” If Zonulin levels are elevated, it provides an indication that there is intestinal permeability of the gut.
Non-metabolized sugar molecules (Mannitol/Lactulose)
a. Mannitol is a small molecule and as a result should readily diffuse through the epithelial cells. – Mannitol is readily absorbed and serves as a marker of proper nutrient diffusion to assess the condition of the epithelial cells. If the epithelial cells are healthy, we should see good uptake. Elevated mannitol levels indicate a general increased permeability ie. “leaky gut” because too much diffusion through the cells may be occurring.
b. Lactulose is a larger molecule which will not diffuse and should not be able to pass through the tight junctions. If your tight junctions are working properly, you shouldn’t find much of this in your urine. Elevated levels of Lactulose indicate that these molecules are passing through the intestinal mucosal barrier, which indicates general increased permeability ie “leaky gut.”
So, What's The Big Deal?
You might be thinking, “ok, I have “Leaky Gut,” so what?” Well in all actuality, “Leaky Gut” can be the “cause” of certain health complaints, but it often just a symptom of something much greater happening in the body such as…
Gut dysbiosis – imbalance of “bad” bacteria against “good” bacteria
Presence of pathogens in the intestinal lining
Poor liver detoxification – inability of the liver to flush out waste products
Poor digestion – inability of the body to digest macronutrients and thus absorb nutrients
HPA Axis dysfunction aka hormonal imbalance – elevated or suppressed cortisol and sex hormones such as estrogen and testosterone
Oxidative stress – when there are not enough antioxidants to counteract free radicals in the body
If you are experiencing health complaints, it’s important to see a functional practitioner to help correlate to your symptoms, dig into the root causes (of which intestinal permeability could be one of them) and provide you with insight into the connections to every cell, organ, and tissue in your body.
What Can You Do About It?
If it has been identified that you have “Leaky Gut” or you think you suffer from it, there are a couple of important things you can do to help heal
Diet – remove inflammatory foods including sugar, alcohol, processed foods, and food sensitivities (which often incudes gluten – gluten has been known to inflame the mucosal barrier). Work with a functional practitioner to help you by running lab screenings to identify food sensitivities
Supplements – the use of supplements can help to heal the mucosal barrier. Products that include L-Glutamine, Aloe, Deglycyrrhizinated Licorice and Slippery Elm have been shown to be effective. A good quality probiotic to help heal any dysbiosis in the gut should also be included in every supplement protocol
Test for and eradicate pathogens – work with a functional practitioner to test for any “bad bugs” in the gut. Pathogens excrete toxic substances that inflame the lining of the intestines
Ensure you are minimizing stress and getting enough sleep – cortisol levels impact your immune system and ability to fight inflammation.
Reduce usage of non-steroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen and ibuprofen
Unraveling the mystery of “Leaky Gut” is important so that you understand the inner workings of your body and take control of your health. It can be a big contributor to your health complaints!
If you suspect that you might have "Leaky Gut" feel free to book a FREE 30 min Discovery Call to learn more about how I can help you!
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