This is the first installment of a three-part series in which I'll be outlining the basics of leaky gut syndrome and how to effectively restore proper gut function.
Gut health has become an incredibly popular topic in the health and wellness world. As research progresses, it is becoming more and more evident that impaired gut function plays a major role in nearly every chronic health conditions, ranging from lower-level issues like headaches and fatigue to autoimmune and neurodegenerative diseases like autism and dementia. So what's it all about? Read on as I break down the basics of gut health, leaky gut, and how you can build a healthy gut for a lifetime of optimal health!
What is leaky gut syndrome?
Leaky gut syndrome, also known as intestinal permeability, is characterized by the loss of proper gut function. The lining of the intestinal tract acts as a filter, effectively controlling which molecules are able to pass through the membrane and into the bloodstream. In a healthy gut, tight cell junctions are able to properly regulate this process, allowing the absorption of nutrients, minerals, and water while blocking the absorption of potentially detrimental molecules. When gut health is damaged, tight cell junctions are lost, creating gaps in the intestinal lining. Function is now compromised, allowing toxins, microbes, and undigested proteins (yes, this is, indeed, just a fancy way of saying poop) to leech into the bloodstream -- gross. Once they reach the bloodstream, the immune systems recognizes these as foreign substances and mounts an attack to keep the body healthy. The chronic presence of these particles causes the immune system to remain on high alert for an essentially indefinite period of time, eventually leading to a number a health issues which I will discuss in just a few paragraphs.
*AC's Analogy* We can think of the gut lining kind of like a screen door (let's assume for this analogy, that you can't just close the regular door, since that would mean no nutrients are being absorbed). When functioning properly, nothing passes through but a nice, fresh breeze. After many months or years of use, the screen starts to break down, holes become a little larger, and you find that flies, mosquitoes, and other insects are able to get into the house and start to be pretty annoying. At this point, most folks would repair or replace the screen. But what if you don't? The holes continue to grow, maybe some mice start getting in, maybe a squirrel. This is obviously a much bigger issue than the insects, but for one reason or another, you continue to let the screen deteriorate. Before you know it, there are raccoons in your bloodstream.
All hyperbole aside, leaky gut syndrome and the ensuing systemic inflammation is a very serious health issue, one that is now being linked to virtually every chronic health issue, particularly autoimmune disorders.
What causes a leaky gut?
The primary cause of leaky gut syndrome is the habitual ingestion of problematic foods such as grains. Gluten is the number one cause of intestinal permeability. As it turns out, gluten intolerance is more than just a fun new way to annoy the servers at your favorite restaurants. While celiac disease is an entirely separate issue, acute reactions to gluten are not the only manifestation of its diabolic powers. Regular ingestion of gluten can cause gut cells to release a protein called zonulin, that is often responsible for the breakdown of the tight cell junctions I mentioned earlier. Does this mean everyone needs to eliminate gluten? Maybe, maybe not, but if you are dealing with any of the common symptoms of leaky gut, avoiding gluten is probably not a bad idea.
Other common causes include infections, toxins (such as mold exposure or pesticides), gut dysbiosis (parasites, Candida, bacterial overgrowth, et al) and even chronic emotional or physical stress (yes, overtraining can cause leaky gut).
What are the common symptoms of leaky gut?
Symptoms of a leaky gut are far-ranging and quite diverse, covering nearly every known chronic health issue. For some healthcare professionals, this creates some skepticism, especially on the allopathic side of medical field, but once you understand the basics of the relationship between intestinal permeability and chronic inflammation, it actually starts to make a whole lot of sense that impaired gut health could be the primary cause of so many chronic issues. Common symptoms include but are not limited to:
Chronic Fatigue: This might be the most common as well as the most overlooked symptom of gut dysfunction, especially in a society where we typically believe that if you aren't exhausted all the time, you aren't working hard enough (sigh). Intestinal permeability causes our immune systems to be constantly elevated which, even at a relatively low level, can eventually lead to adrenal dysfunction, and consistent feelings of fatigue, irritability, and stress. These issues are, unfortunately, accepted as normal in our society, but I can assure you they are not (common does not equal normal).
Gastrointestinal (GI) Issues: Another seemingly obvious symptom with which many folks seem to just learn to live, but excess gas, stomach pain, diarrhea, IBS, constipation, and bloating ARE NOT NORMAL issues for human beings.
Food Sensitivities: non-celiac gluten intolerance gets all the media attention (often with skeptical overtones), but food sensitivities in general are on the rise, clearly showing that humans are experiencing sub-optimal gut health on a very large scale. Healing the gut often eliminates the vast majority of these sensitivities.
Nutrient Deficiencies: If your gut isn't functioning properly, you may also end up experiencing sub-optimal nutrient absorption. Essentially, no matter how well you're eating, if gut function is impaired, you likely aren't absorbing all of those delicious nutrients. In other words, you aren't what you eat, you're the nutrients you absorb. Digestive supplements can help in the short-term, but healing the gut is the only way to truly correct this issue.
Autoimmune Diseases: Most autoimmune diseases are know thought to be "caused" by poor gut health and systemic inflammation ("triggered" is probably more accurate, as the genetic predisposition for these disease must be present in order for sub-optimal lifestyle factors to allow for expression of the gene -- but we'll talk more about that another time).
Headaches, brain fog, arthritis or joint pain, depression, anxiety, and mood disorders, hormonal or thyroid issues, and many others: Due to the promotion of chronic systemic inflammation, there really aren't a lot of health issues that healing a leaky gut cannot help to at least manage. If you're daily life is impacted by any chronic issue, it's possible that you are dealing with some level of intestinal permeability.
How does one heal the gut?
The process of restoring those tight junctions for proper gut function can be long and complicated but it is always rewarding. Committing to the necessary lifestyle changes needed to begin this process is one of the biggest steps you can on your journey to optimal health or in managing chronic disease. Over the course of my own healing process, I have created a five step protocol for effectively healing leaky gut syndrome.
Step one: Eliminate.
Elimination of primary causes is our first step. It also happens to be the most difficult, both in preparation and execution. For starters, due to the complicated nature of the Gut-Brain Axis, it can be tough to identify the root cause of our gut issues. Did the stress initiate the leaky gut, or did the leaky gut initiate the stress? What's more, we often find ourselves stuck in a feed-forward loop in which the symptoms of poor gut health, in one way or another, actually contribute to a continued decrease in gut function, which in turn worsens the symptoms, and so on and so forth. This means that our best option is going to be to take a holistic approach and address many factors at once: diet, exercise, sleep, stress management, and environmental factors all need to be prioritized in this first step. The bottom line: if we don't find and treat the root cause, there is little hope of long-term success.
Now, all of these factors are incredibly individualized, but there are some basics to understand about each.
Sleep is crucial. Not only is it the time when our bodies focus on healing and repair, but getting a good night's rest also provides us the energy and emotional stability to withstand the challenges of an intense healing protocol. The general recommendation for adults is 7-9 hours; if you're working on improving chronic health issues, you definitely want to be closer to 9 than 7.
Exercise is an important part of any healthy lifestyle. However, when dealing with gut dysfunction, high-intensity exercise can actually make our symptoms worse. Stick to plenty of low-level aerobic activity with occasional, short strength training sessions only when energy is high.
Stress management is not a strong suit for most folks in our "go-go-go" society, but for those dealing with chronic fatigue, anxiety, depression, and uncontrolled stress, it needs to be a priority. Stress management can come in many forms, here are some of my favorites: daily gratitude journaling, breathing practices and meditation, long walks in nature, fictional reading, quiet conversations with loved ones, and playing (board or card games, creating art or music).
Environmental factors can also play a role in our healing process, for good or for bad. It's never a bad time to look into optimizing our exposure to harmful toxins in our environment (food, water, air, etc), but it can be downright essential when dealing with more complicated immune issues. Mold toxicity is a big one and awareness has grown quickly in recent years (learn more at survivingmold.com or in this post from Dr. Chris Kresser).
Diet is probably the most important of these lifestyle factors, and it is definitely the most complicated. There are several popular dietary protocols for intestinal healing, and none more so than Autoimmune Paleo (AIP), the Gut and Psychology Syndrome Diet (GAPS), and the Specific Carbohydrate Diet (SCD). SCD utilizes a restriction of, you guessed it, specific forms of carbohydrate. GAPS is the most restrictive of the three, at least initially, and also puts the greatest emphasis on foods that directly contribute to gut healing, such as bone broth and fermented foods; GAPS is also the only diet of the three that puts restrictions on cooking methods. Depending on your symptoms you may also need to experiment with a low-histamine or low-FODMAP diet. While any of these diets can be worthwhile choices, I am going to highlight AIP, as this is the protocol with which I have the most personal experience and have found success in my own healing.
Getting your gut checked for parasites, yeast, SIBO, or dysbiosis is never a bad idea either, though where this falls on the priority list may depend on severity and specificity of your symptoms.
A quick note about AIP/SCD/GAPS and other healing diets...no matter which nutritional approach you choose, keep in mind that these are merely templates from which you may begin your healing process. While nutrition plays a vital role in recovery from gut dysfunction, a more comprehensive approach is often necessary. Furthermore, a generic protocol may work for some, but in most cases, individual specificity is required. I highly recommend working with an experienced health professional.
What is AIP?
"AIP" stands for "Autoimmune Paleo", though it is often referred to as the "Paleo Autoimmune Protocol" or "Paleo AIP" as well, but these all refer to the same dietary protocol. AIP essentially takes the paleo diet one step further; while paleo/primal eaters generally avoid all grains, legumes, vegetable oils, and sometimes dairy, AIP also adds eggs, nuts and seeds, nightshade vegetables, derivative spices of nuts, seeds, and nightshades, and a few other foods and additives to that list. I know what you're thinking, and before you get too worried, AIP is not meant to be a permanent lifestyle change, but rather a temporary healing protocol.
Why utilize AIP?
Aren't there food sensitivity tests I can take instead? The short answer: sort of. Yes, there are tests available, ranging from highly ineffective muscle testing which can be done at many a chiropractic office (for the record, I do believe in chiropractic, but when it comes to muscle testing for allergies without lingual or olfactory components there is little to no evidence of its efficacy -- I'm not telling you not to try it, but be aware of this caveat), to expensive blood tests, the best of which, while helpful and sometimes necessary, are still generally considered inconclusive due to the potential for false negatives. In other words, the most effective way to test for food sensitivities and improve gut health is subjectively, via an elimination diet such as AIP. The general premise is to eliminate all foods which routinely cause gut issues for a minimum of one month or as long as it takes to heal (i.e. when you start feeling really good again). This large-scale elimination simplifies the process and streamlines healing and recovery. Once you've reestablished optimal gut health, you may begin to reintroduce foods one at a time, usually in order of nutrient density and likelihood of gut irritation. Most individuals are eventually able to return the vast majority of foods to their diets (except the original paleo avoidances -- no one needs those), but this is not a casual undertaking, it may take up to a year or more to properly reintroduce all these foods and ingredients to your diet.
Be sure to check out the second installment of my gut health series in which I detail steps two and three: replenish and rest.
Disclaimer: I am not a doctor and although I am a certified health coach, I am not your health coach. This information is given solely for educational purposes and is not meant as diagnosis nor treatment of any medical conditions.
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