What is intestinal hyper-permeability (aka leaky gut)?
Our digestive tract cleverly allows nutrients to pass through into the bloodstream, while not allowing larger molecules across. It also adjusts to get rid of potential pathogens if they’ve made it through the acidic stomach environment.
But, sometimes things can go wrong, and it doesn’t work the way it should, causing digestive distress, inflammation, allergy, and then other secondary complications. A food you have happily eaten for years is now causing you digestive discomfort - how and why does this happen?
What is intestinal hyperpermeability? And, what can you do about it?
In this article, we cover -
How does the gut barrier work?
What causes intestinal hyperpermeability?
Allergies, food intolerances and autoimmunity
Signs that you might have leaky gut
What about other barriers in the body?
How to fix leaky gut/intestinal hyperpermeability
FAQ’s
How does the gut barrier work?
The wall that separates our small intestines from the bloodstream is only 1 cell thick. Those cells are joined by proteins called ‘tight junctions’, and the whole lining is renewed every 5 days. Nutrients from our food pass through the cells to the other side and into the bloodstream. On the inside of this lining (intestinal epithelium) the cells have tiny finger-like projections called ‘villi’ and the whole lining is coated in a thin layer of mucus. The mucus is important for lubrication, as the first line of defense against pathogens, bacteria, fungi, yeast, and toxins. It is also home to a small number of microbes, regulated by a host of anti-microbial mediators which also serve as a defense of unwanted microbes in the small intestines. One of these is an important immunoglobulin called secretory IgA. On the outside of the lining, is the bloodstream, and a host of immune cells which check everything that crosses over ¹ - kind of like border control at the airport.
As babies, our intestinal lining is more permeable, that is, the tight junctions allow bigger gaps between the cells allowing molecules that prime the immune system to cross over. In babies born prematurely, there is an even greater level of permeability2. The interaction between the immature lining and the immune system can lead to the development of increased allergies and food intolerances. As we grow the lining becomes more stable, with fewer gaps between cells - except in the presence of toxins, pathogens, or other disruptions to the digestive system (3).
The last, and largest section of the gut is the large intestine or colon, which is host to a vast number of species of microbes, and the whole of the colon and its species is referred to as the microbiome.
What causes intestinal hyperpermeability?
The gut is a dynamic environment and a number of factors can disrupt it, such as:
Stress - our body can’t tell the difference between worrying about a job, being bullied, the threat of starvation, or being chased by a saber-toothed tiger. In a stress response the body diverts its resources to surviving an emergency situation also known as ‘fight, flight or freeze’, then returns to ‘rest and digest’ state when the threat has passed. In an ideal world, we would spend 80% of our time in rest and digest and only 20% in fight, flight or freeze - however, that’s not what happens in our modern environment. Instead, we are spending most of our time in a kind of low (or high) level of ongoing stress without it resolving. Our nervous systems are constantly being activated by traffic, noise, drama, illness, or emotions, (and more) and not reverting back to a calm state.
In a stress state, the body responds in the following ways:
Saliva production is reduced, causing a dry mouth
Little or no hydrochloric acid produced in the stomach
Other gastric secretions stop and we lose our appetite
Peristalsis - the wave movement that pushes food through the digestive system is stopped
Migrating motor complex - a stronger wave-like contraction that occurs every 90 mins between meals that has a cleaning function, is stopped
The liver slows the production of bile and releases glucose into the blood for quick energy, while the pancreas secretes glucagon to maintain high blood sugar levels
Breathing becomes shallower to increase oxygenation to the muscles
The eyes dilate to see danger
Cortisol and adrenaline flood the body
The heart rate increases
Brain function alters to become hypervigilant, and reaction times are increased, and aspects of memory, cognition, and learning are reduced 4
All of these actions alter digestion, from not breaking down foods or killing pathogens with saliva, to allowing pathogens to pass through the stomach without being killed by hydrochloric acid. Food is not properly broken down, and nutrients are poorly or not absorbed. Minerals that require an acid environment for absorption are not absorbed. Opportunistic microbes such as H. pylori can proliferate in the stomach, small or large intestines due to the altered pH of those environments. Mucus that is protective of the linings of the gut can be broken down, and inflammation can occur anywhere in the gut. All of these things can contribute to the breakdown of the gut lining.
Toxins in the form of environmental chemicals, pesticides, herbicides (particularly, glyphosate the main component of Roundup), heavy metals, engine exhaust, and chemicals in our workplace, in our living environments or in our personal care or cleaning products, can cause inflammation and/or breakdown of the tight junctions in the gut.
Food allergies and intolerances causing disruption to the microbiome can cause the breakdown of the tight junctions.
Inflammation, either systemic or in the gut can trigger the breakdown of tight junctions
Poor diet - high fat, high refined carbohydrate diets, or diets low in fibre can all cause disruption of the microbiome, and nutrient deficiencies and disturb pH which can disrupt the gut lining.
Medications including over-the-counter anti-inflammatories, and pain medications, PPIs (antacid medications), antibiotics, antihistamines, and many others can cause disruption of the gut lining.
Disruptions to the microbiome, causing dieback of species and the subsequent release of endotoxins can cause inflammation and breakdown of the lining.
Chronic constipation or slow motility can cause a backup of fecal matter in the colon, causing microbial species to colonise parts of the small intestine which usually only has a small number of species - then leading to inflammation and disruption to the gut lining.
Structural abnormalities, surgery, adhesions or scars that cause slow motility and as above cause disruption to the microbes in the small intestines.
Poor hydration can trigger constipation or slow motility. The last stage of producing energy requires hydrogen molecules from water, and without sufficient hydration muscles involved in peristalsis do not have enough energy to function properly. In addition, poor hydration can contribute to constipation as the body recovers moisture from the stool for energy production, brain function, and cellular processes.
Allergies, food intolerances, and autoimmunity
Intestinal hyperpermeability means that large protein molecules can cross into the bloodstream, where they encounter the immune system. These molecules can be from foods, microbes, or other particles and can trigger an immune response to those proteins. If they happen to come from your favourite food, then you can become allergic, or intolerant to (any) food you have eaten - even if you’ve tolerated it for years without issue. When a leaky gut continues over a long period of time, it’s common to accumulate multiple allergies, and the immune system can become dysregulated.
Intestinal hyperpermeability is also strongly associated with autism spectrum disorder, ADHD, Parkinson’s Disease, and Alzheimer’s Disease and a host of other conditions are being researched for links to gut health and microbiome disruption.
It is believed that autoimmune conditions can be triggered into activation, in genetically predisposed individuals, including:
Type 1 diabetes
Multiple sclerosis
SLE - systemic lupus erythematosus (1)
Rheumatoid arthritis
Sjogren’s syndrome
Crohn’s disease
Ulcerative colitis
And, likely other autoimmune conditions (5)
Signs that you might have leaky gut
Chronic diarrhoea, or loose stools
Chronic constipation
Bloating
Gassiness,
Excessively smelly flatulence, or bowel movements
Reflux, burping
Nutritional deficiencies (which will cause seemingly unrelated symptoms like increased pain, moodiness, hormonal changes, joint pain, headaches, poor sleep, exercise intolerance…++)
Increased digestive reactions to foods (even foods you’ve been fine with for ages)
Increased sensitivity to allergens
New allergies
Rashes, eczema or worsening of skin conditions
Joint pain
Brain fog
Headaches
Difficulty concentrating, confusion
Are there other barriers in the body?
Other barriers in the body are also held together with tight junctions, and so there can be a similar barrier dysfunction in more than just the gut. Other barriers that can be affected by a disturbance to the gut microbiome, or other microbiomes in the body are:
Skin
Blood, brain barrier
Lungs
Linings around all organs
All mucous membranes
Usually, the blood, brain barrier is impenetrable to most things, however, when there is inflammation and microbiome disruption this can lead permeability of this barrier leading to headaches, brain fog, confusion, and poor concentration.
How to fix leaky gut/intestinal hyperpermeability
Improving your digestive health is an investment in overall health. Try these simple tips to improve your microbiome and restore intestinal hyperpermeability -
Identify any food intolerances, or foods you are suspicious of
Increase fruit and vegetable intake, eat the rainbow, eat the skins, eat whole foods
Eat organic to reduce pesticide and herbicide loads
Learn meditation and practice daily - even 5 minutes a day can make a big difference to stress resilience and mood regulation
Cut out refined carbohydrates like bread, pasta, biscuits, cakes, and sugar
Cut out fast foods, especially those cooked in oil
Swap your vegetable oil for Extra Virgin Olive oil or Coconut oil
Eat slowly, and mindfully, chewing each mouthful until all food is a paste - remember snakes eat their food whole, then spend days lying around digesting it! Don’t be a snake, chew!
Eat your meals without distractions, no TV, phone, stimulating books, meetings, or conversations - maintain a calm, relaxed state (it’s not called ‘rest and digest’ for nothing!).
If you’ve tried all of these, then seek the help of a professional.
References:
Ilchmann-Diounou, H., & Menard, S. (2020). Psychological Stress, Intestinal Barrier Dysfunctions, and Autoimmune Disorders: An Overview. Frontiers in immunology, 11, 1823. https://doi.org/10.3389/fimmu.2020.01823 PMID: 32983091
Šuligoj, T., Vigsnæs, L. K., Abbeele, P. V. D., Apostolou, A., Karalis, K., Savva, G. M., McConnell, B., & Juge, N. (2020). Effects of Human Milk Oligosaccharides on the Adult Gut Microbiota and Barrier Function. Nutrients, 12(9), 2808. https://doi.org/10.3390/nu12092808 PMID: 32933181
Halpern, M. D., & Denning, P. W. (2015). The role of intestinal epithelial barrier function in the development of NEC. Tissue barriers, 3(1-2), e1000707. https://doi.org/10.1080/21688370.2014.1000707 PMID: 25927016
Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI journal, 16, 1057–1072. https://doi.org/10.17179/excli2017-480
De Luca, F., & Shoenfeld, Y. (2019). The microbiome in autoimmune diseases. Clinical and experimental immunology, 195(1), 74–85. https://doi.org/10.1111/cei.13158 PMID: 29920643
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Description text goes hereIt’s very common to develop intolerances to wheat products, or gluten, or the herbicides that they are drenched in. Sometimes, these intolerances have a delayed reaction, and in fact any food intolerance can be delayed by 24-48 hours before symptoms are noticed. This can make it really difficult to tell which foods are the culprits.
Importantly, you shouldn’t cut out good, whole foods from your diet without being sure that it is necessary - this can result in nutritional deficiencies that can cause other problems. There are ways that a naturopath can help you to determine what foods are a problem for you without compromising your nutrition.
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FODMAP diets have become popular and where in the past, they were prescribed ‘for life’, now people are self-prescribing these diets. It’s now recognised that the foods in a FODMAP diet are really essential to supporting a healthy, diverse and abundant microbiome. Foods like garlic and onion have important constituents essential for cardiovascular health, and all of the foods have really important nutrients that are being avoided.
A good treatment strategy is to remove those foods temporarily, while the root cause is being remedied and then to slowly re-introduce the foods. There might be some that will not ever be tolerated again, and therefore genuine allergies, however most intolerances are only temporary, while intestinal impermeability is present and the gut microbiome is disrupted.
Seek the help of qualified practitioner, experienced in helping with gut conditions if you think it’s time to reintroduce FODMAPs.
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Yes, you could…maybe. There are faster and safer ways to do that, though.
There is a lot of helpful information on the internet, mixed in with unhelpful, wrong and downright dangerous information. Sometimes, it’s hard to tell the good from the not so good. Here are some tips in seeking health information on the net:
Use the CRAAP test to discern if it is useful for you:
C - is the information current? Research on gastrointestinal health and the microbiome is growing every day, with 1000’s of new studies being conducted. Whoever you are taking advice from, needs to be up to date with the most current information, and familiar with the past information (including traditional herbal uses from 100’s of years ago) to compare it’s value.
R - is it relevant (to you)? Just because one person with bloating took this ‘thing’ and had relief, doesn’t mean that it will be the same for you. Every human is different, there may be different root causes, you might have different hormones, or triggers.
A - Authority. Is the person giving the information qualified to do so? There are a lot of enthusiastic amateurs, and people selling products who haven’t studied biochemistry, nutrition, herbal medicine, or prescribing. They may understand pharmaceutical drugs, but not be familiar with herbal medicine. Most concerning they may not understand the dangers of interactions between herbs and drugs, food and drugs or herbs and other herbs. Or be aware of how herbs, vitamins or minerals in the wrong form, wrong dosage or taken in the wrong combination can be harmful. Be careful who you listen to, and ask ‘what is their agenda’?
A - Are you sure the information is accurate? In Australia, by law no-one can make a claim to cure anything (nor should they!). Our TGA will not permit practitioners, or any advertising on products to say ‘will’ ‘always’ ‘cure’ or other definitive terms, or make any claims that can’t be substantiated by research. If it doubt, ask for the reference of the study.
P - What is the purpose of the information, what is their agenda? Is it to inform, or sell a product or service, is it a health practitioner, an influencer, a gym instructor, or someone who had success with a particular treatment? This will help to understand what the intent of the information is.
If in doubt, seeking the help of someone who has studied natural health is a great way to let someone else filter all of the information. There are a million different ideas out there for treating every kind of condition, it’s much easier to let someone else do the sorting. text goes here
