Leaky Gut Syndrome

by Dr. Sandra Cabot

If the filtering and/or detoxification systems within the liver are overloaded or inefficient, this will cause toxins, dead cells and microorganisms to build up in the blood stream. This will then increase the workload of the immune system, which will become overloaded and irritated. The immune system will then produce excessive inflammatory chemicals, and in some cases, auto antibodies, because it is in a hyperstimulated state. This may lead to symptoms of immune dysfunction such as allergies, inflammatory states, swollen glands, recurrent infections, chronic fatigue syndrome, fibromyalgia or autoimmune diseases. Some of the more common autoimmune diseases are systemic lupus erythematosus (SLE), sclerosing cholangitis, primary biliary cirrhosis, Hashimoto’s thyroiditis, vasculitis and rheumatoid arthritis.

Immune dysfunction is common in the chemically overloaded environment we live in today, and is exacerbated by nutritional deficiencies inherent in processed and high fat diets. Suppressive drugs are often used to treat symptoms of immune dysfunction.

Simply put, the digestive tract consists of a long tube, which connects the mouth to the anus. After food is swallowed it passes through the oesophagus to the stomach, where it is churned up with acid and stomach enzymes into small particles. This then passes into the small intestine, which is around 20 feet long. The most important function of the small intestine is to digest and absorb nutrients from the food particles that arrive from the stomach. In the upper part of the small intestine, secretions from the liver and gallbladder (bile), and the pancreas (enzymes), are inserted through a small tube (duct), situated near the pancreas gland. Another vital function is to act as a barrier to prevent the re absorption into the blood circulation, of toxins and macromolecules.

When the digestive tract (also known as the intestinal mucosa) is inflamed, you can develop what is called a "leaky gut". This means that large food molecules, endotoxins and xenobiotics can pass straight into the bloodstream and be presented to the liver for detoxification. They should not be in the blood - so the immune system reacts to them, immune complexes are formed and these complexes travel to the liver where they are broken down. This places an enormous burden on the liver, stressing its detoxification capability. As a result these substances may be partially processed and accumulate in the liver and fatty (adipose) tissue. Research in recent years has uncovered the important connection between the health of the human body and the integrity of the gut wall. It is now well established that inflammation of the intestines and a resultant increased permeability of the intestinal mucosal wall has a connection with conditions such as infection, food allergy, Crohn’s disease, coeliac disease, dermatological conditions, colitis, or auto-immune diseases (such as rheumatoid arthritis, ankylosing spondylitis, Reiter’s syndrome, eczema and other ‘allergic’ disorders).

It has also been speculated that the combination of leaky gut and dysfunctional liver detoxification can lead to increased fatty tissue stores of toxic compounds and depressed immune system function.

Causes of Leaky Gut

Some of the most common causes of a leaky gut are: Nonsteroidal anti-inflammatory drugs (NSAID) usage, intestinal infection, dysbiosis, parasites, maldigestion, deficient immunoglobulins, ingestion of allergenic foods, alcoholism, ingestion of toxic chemicals, trauma and endotoxaemia.

Decreased permeability may be caused by chemotherapy, gastroenteritis, irritable bowel syndrome, food allergy, ulcerative colitis, etc. Identifying the cause is an important first step in reversing altered permeability.

How do I know if I have a leaky gut?

It is possible to measure the permeability or 'leakiness' of the gut wall by a simple test available through diagnostic laboratories such as Great Smokies Diagnostic Laboratories or Australian Reference Laboratories in Australia.

How can you improve the integrity of the gut wall?

Treatment of altered intestinal permeability is very important for several reasons. Increased permeability can contribute to, or cause, a wide range of reactions and conditions as noted above. Decreased permeability can cause malabsorption and malnutrition, leading to a wide range of conditions relating to deficiency. Correcting the altered permeability can have an immediate effect on relief of symptoms and a gradual improvement in the underlying condition. There are a number of therapeutic substances, some listed below, which can be used for mucosal support to lower intestinal permeability.

Maintain a Healthy Population of Microorganisms in your Bowel.

It is important to be aware that your bowels may be harboring excessive populations of unfriendly microorganisms such as fungi (most commonly yeasts such as candida albicans), bacteria, viruses and parasites. The term parasite is used to describe a great variety of creatures that vary in complexity from single celled organisms, all the way up to worms that may be several inches or longer. Common disease causing parasites are Giardia lambia, Entamoeba histolytica, Blastocystis hominis and Cryptosporidium, which can be very difficult to detect with routine stool analysis and cultures. When a stool specimen is examined for parasites many of the yeasts that are seen are already dead. Stool cultures therefore often fail to reveal the presence of fungi even when the gut is heavily infected. Some laboratories will examine repeated fresh stool specimens obtained after inducing mild diarrhoea with laxatives and this will increase the chances of detection.

In the US

Great Smokies Diagnostic Laboratory/Genovations™
63 Zillicoa Street
Asheville, NC 28801
USA
Telephone: (828)253-0621

In Australia

Analytical Reference Laboratories
5 Leveson St
North Melbourne, 3051
Email: integrated.medicine@arlaus.com.au

Test for Leaky Gut

Your Doctor can organize a test kit through:

In Australia:
Analytical Reference Laboratories Pty Ltd
Postal - PO Box 279, North Melbourne 3051, Victoria, Australia
Laboratory - Ground Floor, 568 St Kilda Road, Melbourne, 3004.
Telephone: (03) 9529 2922 Facsimile: (03) 9529 2822
Email: info@arlaus.com.au Website: www.arlaus.com.au Est 1974

In USA:
The Great Smokies Laboratories
18A Regent Park Boulevarde, Ashville
North Carolina, USA, 28806
Phone: (828) 285 2223

The test uses two sugars - mannitol (a monosaccharide) and lactulose (a disaccharide). These are water soluble molecules that are not metabolised by the body. Mannitol is readily absorbed, and lactulose is only slightly absorbed. An oral dose containing 5g lactulose, 3g mannitol in 10g of glycerol is given and a timed urine sample is analysed for the ratio of the percentage recovery of lactulose and mannitol.

Clinical Significance

Studies on a wide range of illnesses have demonstrated alterations in the uptake of mono or disaccharides, or both and have correlated these changes with clinical and pathological conditions. These illnesses, which disrupt the structural barrier of the GI tract, often result in pathologic changes in distant organs and tissues.

The permeation of water-soluble molecules through the intestinal mucosa can occur either through cells (transcellular uptake) or between cells (paracellular uptake).

Small molecules (mannitol) readily penetrate cells and passively diffuse through them. Larger molecules such as disaccharides (lactulose) normally are excluded by cells. The ratelimiting barrier in this case is the “tight junction” between cells. Thus, tight junctions help maintain the integrity of the gut wall. The Intestinal Permeability test directly measures the ability of two non metabilised sugar molecules - mannitol and lactulose - to permeate the intestinal mucosa. Lactulose is only slightly absorbed and serves as a marker for mucosal integrity. Mannitol is readily absorbed and serves as a marker for transcellular uptake.

• Low levels of mannitol and lactulose indicate malabsorption.
• Elevated levels of mannitol and lactulose are indicative of general increased permeability and “leaky gut”. Permeability to mannitol may decrease, which is indicative of malabsorption of small molecules.
• The lactulose/mannitol ratio is a useful parameter. An elevated ratio indicates that the effective pore size of the gut mucosa has increased, allowing access (to the body) of larger, possibly antigenic molecules.

Note: Administration of therapeutic substances MUST be carried out under the supervision of a medical practitioner.

Note: Application of this test to children between the ages of 2-12 MUST be conducted under the supervision of a medical practitioner. Separate test kits are available for adults and children.