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Making Sense of Leaky Gut, IBS, IBD

April 24, 2013

Leaky GutMaking Sense of Leaky Gut, IBS, and IBD
By Trent W. Nichols, MD, and Barry W. Ritz, BS

The intestinal lining is responsible for absorbing nutrients from the foods that we eat and serves as our most important immune barrier, protecting us from potential allergens in undigested foods, as well as microbiological and chemical threats. But sorting through the terminology and the countless catalog pages and store aisles of intestinal health products and digestive aids can be confusing and overwhelming.

In general, the intestinal lining serves two distinct functions: nutrient absorption and immune defense. The gut not only facilitates the digestion and absorption of nutrients from the food we eat, but it also acts as a physical barrier to microbes or undigested food particles that serve as potential allergens, so they don’t go beyond the gut environment and get into the blood stream through the process of translocation. Normal absorption occurs in two ways.

First, cells that line the gut, called enterocytes, selectively absorb nutrients on the side facing the inside of our GI tracts. The nutrients pass through the cells and exit the side of the cells facing the circulatory system’s blood and lymph, sometimes altered or bound to carrier proteins. This is called a transcellular process (through the cells). Our intestinal linings also have tiny porous openings between the cells called tight junctions that allow small nutrients, like many minerals, to pass between the cells and enter the circulatory system directly. This is called a paracellular process (between the cells). If the pore-like structures become damaged and open too wide, toxins and undigested food particles from the gut can flood into the bloodstream causing dozens of ailments. This movement of unwanted substances through the tight junctions is what we call leaky gut.

Leaky gut is a surprisingly common problem with widespread effects. Food allergens and toxins that leak through are carried by the blood to the liver and eventually affect systems throughout the body by aggravating inflammation in the joints, expressing toxins in skin disorders, triggering food sensitivities, and causing “brain fog” or hyperactivity. Managing leaky gut is preventive medicine at its finest. Reducing this toxic load on the liver and body can prevent illness or improve its outcome. Resolving leaky gut can produce very real benefits to total health.

Leaky gut is associated with a wide range of general symptoms, such as fatigue, fevers of unknown origin, abdominal pain, bloating, diarrhea, feelings of toxicity, memory problems, difficulty concentrating, and poor tolerance to exercise.

Leaky gut can cause:
· Attention deficit disorders· Symptoms resembling autism· Chronic and rheumatoid arthritis· Chronic fatigue syndrome· Eczema· Food allergies and intolerances· Inflammatory bowel disease· Irritable bowel syndrome· Joint and collagen problems· Compromised liver function· Malnutrition· Multiple chemical sensitivities· Psoriasis· Skin disorders· Symptoms like schizophrenia

Leaky gut can also be caused by any number of different conditions that cause inflammation (infection), severe trauma (burns or surgery), or many medications (NSAIDs), as well as:
· Aging· AIDS with diarrhea/HIV· Alcoholism· Cancer· Celiac disease· Chemotherapy· Crohn’s disease· Cystic fibrosis· Giardia and other parasites· Chronic hepatitis· Intensive illnesses· Malnutrition· Pancreatitis· Psoriasis· Radiation therapy · Rheumatoid arthritis· Shock or anaphylaxis · Toxic shock syndrome · Ulcerative colitis


Both irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are associated with leaky gut syndrome. Irritable bowel syndrome is a disorder of intestinal function. The condition occurs in the small intestine, colon, or both. It can be characterized by abdominal discomfort, pain, bloating, mucus in the stools, and irregular bowel habits. IBS is typically a gut motility problem, either constipation or diarrhea, or an alteration between these two extremes. It may also involve low-grade inflammation that is not detected in evaluations, but plagues the patient (termed sub-clinical inflammation).

The cause of IBS is not well understood, and IBS is something of a catch-all term. While not considered the cause, stress may exacerbate existing irritable bowel symptoms. Traditional GI tests are necessary to rule out diseases such as cancer, ulcerative colitis, or Crohn’s, but diagnosis of IBS is based entirely on symptoms.

Two FDA-approved prescription medications are available for the treatment of IBS, both limited in use to women only. The first medication for IBS, Lotronex® (alosteron hydrochloride), was approved in 2000, withdrawn the same year for adverse events, and then re-released in 2002 under restricted conditions of use, including specific use in women with severe diarrhea-predominant IBS. Zelnorm™ (tegaserod maleate) was approved in 2002 for the short-term treatment of women whose primary symptom is constipation.

Inflammatory bowel disease is a chronic inflammatory condition divided into two types depending on the location of the inflammation. Ulcerative colitis affects the colon, but just the lining. Crohn’s disease can affect all layers of the intestine and even the entire length of the GI tract from mouth to anus. Again, the cause of IBD is not entirely understood, but autoimmune conditions and allergies, lack of blood supply to the area, abnormal bacterial overgrowth (often related to the overuse of antibiotics), and heredity all seem to play a role.

Current medical therapy […] have been shown to be effective, but long-term use is often complicated by serious side effects. The relation between leaky gut and Crohn’s disease is better established than between leaky gut and either ulcerative colitis or IBS.

Testing for Leaky Gut

Well-established diagnostic tools like colonoscopy or sigmoidoscopy are necessary to rule out serious disease, like chronic inflammation or cancer. Several functional tests can provide additional insight. The comprehensive digestive stool analysis (CDSA) is a simple stool test that gives some twenty different measures, including fat absorption, bacteria and yeast in the colon, and the level of bacterial by-products (both good and bad).

Food allergy testing will identify foods that should be eliminated from the diet in order to break the cycle of inflammation. The intestinal permeability test involves the consumption of a solution of two non-metabolized sugars, lactulose (different from lactose) and mannitol, followed by urine analysis. This test can give an indication of leakiness between the cells of the intestinal lining, as well as altered absorption through the cells.

Look for a doctor who will order these functional tests for you or contact the laboratories directly for assistance (see resources).

Nutrients that heal a leaky gut

In addition to removing food and chemical allergens from diet and environment, as well as reducing stress that might trigger intestinal distress, there are a number of nutrients and supplements that can help heal a leaky gut:

· The most impressive addition to my treatment protocol is a dietary peptide supplement from hydrolyzed white fish. The product is manufactured by Proper Nutrition, Inc. […]. Bioactive peptides act locally on the gut lining as healing factors and may increase protein synthesis. My success with this product led me to design a clinical study on the use of peptides from fish in reducing leaky gut and associated symptoms of IBD.

· Another source of peptides is bovine colostrum that also supplies valuable immune factors. If food allergies are present, consider a form that is lactose-free and casein-free.

· The amino acid L-glutamine is considered the primary energy source of the healing intestinal cell.

· Zinc is essential for growth and wound healing, particularly in cells that turn over rapidly, like those of the intestinal lining.

· Vitamin A is necessary for the maintenance of GI tract integrity, as well as the production of secretory IgA, an antibody that protects the gut lining.

· Antioxidants, like NAC (N-acetyl cysteine) for example, are necessary to reduce oxidative stress to the gut lining. NAC is a synthetic amino acid that helps to replenish glutathione, a very important cellular antioxidant.

· Short-chain fatty acids, the butyrates, are important for the lower portion of the GI tract, particularly the colon. ·

Soothing herbs, like DGL (deglycyrrhizinated licorice), and herbs with anti-inflammatory properties, like boswellia and peppermint, can promote healing. There are many useful herbs.

All of these supplements work to promote intestinal healing. Specific treatment depends on the particular case, as leaky gut is associated with so many different underlying causes.


One Comment
  1. MooHeffer permalink

    I experienced these problems. Came to discover that a doctor with the air force viewed ibs as trash can diagnosis. Little by little, I uncovered the fact that I had intestinal parasites, bacterial disbiosis, and yeast overgrowth, as well as lactose intolerance. What my physician had diagnosed, however, was ibs, and suggested that I consult a shrink, for meds, to deal with the depression, which resulted from chronic illness. The physician and shrink were no better than the intestinal parasites, when it came to bettering my health.

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