I've looked into "leaky gut" on multiple occasions during my first year working closely with GI patients. I remember after consulting my 3rd patient that had an extensive list of food allergies/sensitivities, I had to investigate what was going on. WHY are these patients positive for ALL 6 of the common food allergens? And also, why are they not presenting with traditional allergen symptoms (anaphylaxis, itching)? In my investigation, I soon stumbled upon a possible cause: increased intestinal permeability AKA Leaky Gut Syndrome. What I found at that time was that something was causing the tight-junctions between intestinal cells to break down. Without tight-junctions, gaps would form between cells allowing for food particles to enter the bloodstream only to result in immune system response. Immune response to a food = "allergy".
I concluded that I would have to circle around to this conundrum at a later time. But for the time being, I had to recommend the only studied diet for this food allergy/sensitivity condition: The Six Food Elimination Diet. The six food allergens are milk, egg, wheat, soy, fish/shellfish, and peanuts/tree nuts. As you can imagine, compliance with this diet is low.
Besides food allergies/sensitivities, other symptoms of Leaky Gut Syndrome include:
- Diarrhea
- Malabsorption (which can lead to nutritional deficiencies)
- Poor immune system
- Fatigue
- Skin Rashes
- Food Cravings
Fast forward to this past week. After a short discussion with my colleagues about gluten, I revisited the connection between gluten and leaky gut. I've never really taken a side for or against a gluten-free diet (except for celiac patients), until now.
Remember that something was breaking down the tight-junctions causing "leaky gut"? Well zonulin, an inflammatory protein, is the master regulator of inter-cellular tight-junctions. In other words, it regulates "leakiness" by opening and closing the spaces between intestinal cells.
The next question I had was: What increases zonulin?
GLUTEN. Gluten stimulates zonulin release! Also, lectins do as well, but we usually cook foods high in lectins, which disables the action of the lectins (please eat your beans!). Another stimulus for zonulin release is bacteria - harmful bacteria. If your digestive tract senses harmful bacteria, zonulin will break down the tight-junctions, allowing water to enter the colon to flush the body of the bacteria. For all of us that have experienced food poisoning knows what I mean... DIARRHEA.
This picture below demonstrates how gluten disrupts intestinal permeability.
Gluten --> Increases Zonulin --> Zonulin widens the tight-junctions --> flow of food particles enter the blood via the gaps between the intestinal cells --> Autoimmune response to these food molecules (which should normally not be there) --> Inflammation and irritation of the GI tract --> Patient presents positive for food allergies/sensitivities
Gluten --> Increases Zonulin --> Zonulin widens the tight-junctions --> flow of food particles enter the blood via the gaps between the intestinal cells --> Autoimmune response to these food molecules (which should normally not be there) --> Inflammation and irritation of the GI tract --> Patient presents positive for food allergies/sensitivities
So should we all be following a gluten-free diet? No, but a gluten-free diet should be considered for those with GI symptoms such as diarrhea, constipation, and bloating. A therapeutic elimination diet would be beneficial in giving the GI tract a break from the gastric irritant gluten. See below for directions on how to do an elimination diet properly. It's also important to slowly increase prebiotic fiber which will help improve the health of your microbiome (the world of bacteria inside of your GI tract).
If you suspect leaky gut or some gut imbalance, please see your doctor. Could you benefit from removing gluten from your diet? Yes. Do you need to eliminate gluten forever? No, but you should consume anything processed (such as wheat) in moderation.
Can probiotics help? Possibly! Studies suggest that specific strains may improve tight-junctions. There isn't enough research to solidify this claim, but a high-quality probiotic supplement in combination with increase prebiotic fibers is the best place to start to improve overall gastrointestinal health. Two probiotic supplement brands I trust are Metagenics and Garden of Life.
Side Note: NSAIDs, such as ibuprofen and aspirin, can also increase intestinal permeability. But that is for another discussion. I highly recommend limiting the use of NSAIDs as they have been shown to damage the gastrointestinal tract.
30-Day Elimination Diet
Step 1: Remove Gluten for 30 days
Gluten is found in A LOT of commonly eaten foods. Luckily there are plenty of gluten-free options at the grocery store. Once you understand what foods have gluten (wheat, barley, rye, some oats), adjust your mindset to thinking about what you CAN eat. It will make the process much easier.
Note other names for wheat: durum, einkorn, emmer, kamut, spelt
Step 2: Think about the foods you CAN eat
Fresh, whole foods are the way to go. Fruits, vegetables, lentils/beans are a MUST to include because they contain fiber. Fiber is essential to healing the gut and building up a healthful microbiome. Other foods to include are eggs, fish and grass-fed beef, free-range chicken (QUALITY MATTERS when it comes to animal products). It would also be beneficial to include a dietary probiotic such as yogurt or kefir (non-dairy is okay as long as it has the live-cultures).
What about the carbohydrates?! Well, rice will likely become your friend. And gluten-free oatmeal. Other gluten-free options include quinoa, corn, and millet.
Step 3: Reinoculate
It's time to build up that microbiome. It's important to include both prebiotics and probiotics. If you do not like fermented foods, I recommend getting a probiotic supplement. Prebiotic fibers include strawberries, bananas (the greener the better), oats, artichokes, asparagus, garlic, onions, and leeks.
Step 4: Asses how you are feeling
If you are still experiencing gastrointestinal issues, I recommend seeing a gastroenterologist so they may rule out any serious GI condition.
For more information, visit the Mayo Clinic for a good article on Gluten-Free Diet.
