Could Your Gut Be Leaking? Gut Health Part 2

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Illustration by Michael Burmesch

Could Your Gut Be Leaking?

Having provided an overview of gut health in July’s True Health column, let’s now dive into what can go awry and what we can do about it.

As noted in Gut Health Part I, the GI tract is like a hollow tube going through our body with an opening on either end. When accounting for numerous folds, this hollow space (gut lumen) is actually the largest interface we have with the external environment. The integrity of the gut lining is critical for providing a protective barrier while allowing nourishment—-keeping the “bad” out and allowing the “good” in.  What occurs when the gut barrier function is compromised? Sometimes referred to as “leaky gut,” the GI track becomes like a sieve—overly porous or permeable.  

Here’s how it happens. Any of several triggers damage or inflame the cells lining your gut. Triggers may include: microbiome imbalances (dysbiosis), unhealthy foods, medications, stress, toxins or infections. After many weeks of insult, large molecules that were once kept in the GI tract get through. For example, an inflammatory molecule that tends to “leak” is lipopolysaccharide (LPS—also known as endotoxin) derived from broken down bacteria in the gut. Once LPS gains access to your blood circulation, it can “shower” your body causing low grade, system-wide inflammation.

Overly large molecules derived from under digested food can also get though. Your immune system, constantly surveilling the gut border, sees these large molecules as invaders and may develop antibodies against them. This starts a vicious cycle of food sensitivities which feed into increased gut permeability and can also cause inflammation in other areas of your body. If you are genetically susceptible, this process can contribute to development of autoimmune disorders such as rheumatoid arthritis and thyroiditis. Increased gut permeability has been linked to several health issues including weight gain, migraine headaches, fibromyalgia, mental health issues (depression and anxiety) and several skin conditions to name a few.

Symptoms and Clues

How do we diagnose leaky gut? Often it is based on a constellation of symptoms and findings. The quality of your stool can provide insight, yet many of us don’t know what constitutes “normal.” After all, it’s not a topic that comes up over cocktails, right? So, a “perfect poop” is medium brown, formed but soft, relatively clean (minor soiling of toilet paper) and occurs with relative ease at least once a day. You should feel like you “evacuate.” There are also some tests that can be helpful. Stool testing can identify stealth infections while providing clues on microbiome balance and digestive health. A breath test can be used to assess for small intestine bacterial overgrowth (SIBO). Elevated inflammatory markers on blood testing may also suggest gut health issues.  

So how might you suspect you have suboptimal gut health?  Here are some clues:

• Bloating, diarrhea or constipation
• Heartburn
• Inflammatory skin conditions
• Allergies
• Headaches
• Autoimmune disorder
• Mood disturbance
• Medications (antacids, NSAIDs, antibiotics)
• Do you get “puffy”—especially after eating?

What do we do about it? In Functional Medicine, we talk about the 5 R’s. 

• Remove (offending agents like certain foods or unfavorable organisms)

• Replace (digestive enzymes)

• Reinoculate (probiotics and prebiotics)

• Repair (support gut cell lining and immune system)

• Rebalance (whole body health and lifestyle factors—very importantly consider diet). 

Healing your gut takes a personalized approach and can take time. While this process can be challenging, the impact on your overall health is worth it and hopefully some changes take root as lifelong healthy habits.

Send your questions or indicate topics of interest to bayliss@shepex.com.