"Leaky Gut" is Old Technology: Gut Health
“All disease begins in the gut.”
But first, cassette tapes versus MP4
Okay...we don't literally need to go into the technology surrounding the way I listened to music in high school versus today's media world. However, I needed that analogy to make a point that "Leaky Gut" is old science. Current research goes well beyond the limited vision of Leaky Gut. Intestinal Permeability is a term to describe the control of materials passing across the intestinal wall into the body. In cases of an unhealthy gut there are two important distinctions:
Hyper-permeability - integrity of the intestinal wall is lost. Allowing unwanted particles to pass into the body. Even allowing very toxic lipopolysaccharides to be absorbed.
Blunt Brush Boarder - damaged microvilli inhibiting nutrient absorption and proper nutrient breakdown. Most important...microvilli are ferocious immune defenders.
The Intestinal Tract is not part of you
Okay, think of it this way. When you drive thru a tunnel in a mountain, you are not "part of" that mountain. The same goes for the tunnel that runs from our mouth to our anus. Food and consumed products are not part of us until they are absorbed. The job of the digestive tract is twofold. One, it digests and assimilates our consumed foods for absorption. Secondly, as Hippocrates suggests the gut is a massive immune defender! I mean massive. 70% of the body's entire immune system and 80% of plasma cells reside in the gut associated lymphoid tissue (1). The main immunoglobulin (defense fighter) secreted to fight antigens (foreign invader) is referred to as Immunoglobulin A (IgA). Specifically Secretory IgA, the most prominent defender. Those microvilli mentioned above secrete Secretory IgA. In short, having a healthy gut that can breakdown food, provide needed nutrients, and produce defenders is greatly important.
Let's dive deeper to gain a better understanding of the larger picture behind proper gut-dysfunction identification. Proper dysfunction identification allows for effective treatment! Frankly, I'm irritated with the one size fits all "Leaky Gut Protocols" for all that these "experts" are selling.
Gut health treatment is not a one size fits all approach.
In the figure above the Epithelium is highlighted; or epithelial cell. That is the basic cell of the intestinal mucosa. Best way to envision the epithelium is to think of it as single brick. All the bricks are joined tightly together. The space between each brick is referred to as a "Tight Junction". Now envision that the bricks are held "tightly" with mortar. The mortared junctions are to keep unwanted particles from passing in between each epithelium, or brick. You'll notice the bricks have tiny hairs on top, which in the illustration are identified as microvilli. Remember, the microvilli are responsible for further nutrient breakdown with enzymes. Also, the microvilli secrete the famous Secretory IgA (massive defense fighter).
In a healthy gut, those tight junctions are in tact and stay closed unless a large recognized nutrient is needed. Then they will briefly open, then close tightly. It is very important that not all large particles are absorbed, only selective ones. The microvilli breakdown specific proteins and sugars to tiny, absorbable sizes. If a damaging particle is sensed outside the bricks in the tunnel, secretory IgA is secreted to eradicate the enemy. As for the bricks themselves, epithelium? They absorb the tiny amino acids, carbohydrates, and micro-nutrients that the microvilli have broken down further to absorb.
An unhealthy gut can affect the tight junctions, microvilli, and epithelium individually or as a group. Hyper-permeability and Blunt Brush Boarder come back in play now.
Let's begin with the tight junctions. Tight junctions are really mortar that holds the brick tight to the neighboring bricks and only opens on occasion for recognized large particles. Those junctions can loosen allowing unwanted, large particles to flow in freely. These particles can be toxins, poisonous lipopolysaccharides, bugs, undigested foods, and much more. These particles are viewed as foreign and immune helper cells are produced in response. If left untreated, the helper cells actually begin to breakdown the tight junctions. The breakdown is referred to as "Para-cellular Permeability". This is were the term Leaky Gut comes from. But it is only one part of a three part issue. In short, tight junction degradation leads to paracellular permeability. Which creates a chronic inflammatory and immune response.
Let's focus on the bricks; epithelial cells - Those pink cells in the above diagram. Epithelial cells secrete substances, selectively absorb very small nutrients, provide structural protection, and sense the outside environment. The bricks are damn smart! During chronic inflammatory and immune responses our friendly Killer T-Cells go nuts and damage everything in their path. This includes the damn smart epithelium. Two things happen during this process. They become porous too. I know what your saying, "Well, that is Leaky Gut too!!!!". "A porous gut is leaky" Hold on, hold on. There is a different, let me explain. Remember, epithelium absorb useful proteins and sugars for energy and building blocks; amino acids and usable carbohydrates. When the epithelium become diseased, undigested large proteins and sugars are absorbed, not the useful smaller ones. Referred to as "Trans-cellular Permeability".
These proteins or carbohydrates have not been broken down enough to be a usable nutrient and is responsible for nutrient deficiencies. Also, the risk of smaller toxins being absorbed is greater; increasing risk of infection. Both cause a further cascade of inflammation and immune responses. Not to mention, the epithelium looses ability to sense foreign invaders - lost radar. Epithelial damage is much different than just leaking.
PARACELLULAR = THRU TIGHT JUNCTION - ALLOWS LARGE STUFF IN
TRANSCELLULAR = THRU EPITHELIAL CELLS - DEFICIENCIES, LOST RADAR, OTHER THINGS IN
Blunt Brush Boarder will bring it home. On the bricks are the microvilli which secrete the famous Secretory IgA for defense and enzymes to break down foods into vitamins, minerals, and other super small nutrients. When healthy, this is referred to the Brush Boarder. During poor gut health, damage is done not only to the tight junctions and epithelium but the microvilli too. When this happens, microvilli are "blunted" - become atrophied, inflamed, lose viability. Blunt Brush Boarder is damaged microvilli. Damaged microvilli no longer breakdown nutrients for absorption and no longer secrete immunoglobulins against antigens and toxins. This creates malnutrition, illnesses, disease progression, and lost defenses.
As Hippocrates postulated an unhealthy gut compromises our whole body's immune system. This is important because it is substances like Secretory IgA and others that regulate our good bacteria and fight off bad bacteria. When our Jedi Star-fighters are outnumbered, the Storm Troopers win and bacterial imbalance occurs. Sadly, Storm Troopers love to live on microvilli and use them for their Death Star Home. These issues are significant because although nothing is leaking there is severe nutritional deficiency, infection risk, chronic antigen and inflammatory responses, and disease risk.
Our biggest immune system is down!
One or all three of the above problems can affect a person. Para-cellular, Trans-cellular, and Blunt Brush Boarder create their own unique set of conundrums to our health. They should not be viewed as a one issue an longer, nor treated as such. Hopefully I have expressed the importance to change how we look at gut health. Throwing a one size fits all name and treatment plan is not the answer to treating Intestinal Dysfunction. Look below...
...these are the most common seen ailments linked to an unhealthy gut. There is no size fits all approach for the above ailments. Proper gut dysfunction must be identified.
"Leaky Gut" is is old technology.
Dr. A. Fraso in 2012, suggests,"One of the most overlooked functions of the gastrointestinal tract is the tightly controlled antigen trafficking through both the transcellular and paracellular pathways" (2). Dr. A Fraso is best known for current research linking gut health and risk of disease. The triggers responsible for para-cellular, trans-cellular, and Blunt Brush Boarder are implicated in the pathogenesis of such diseases as diabetes, cardiovascular, and cancer (3).
Clinical conditions are not the only issues as a result of gut dysfunction. Millions of people suffer subclinical symptoms and are being mistreated by an ineffective health system. Frequent illnesses, sinus infections, asthma, even depression, anxiety, joint pain, fatigue, sleeplessness, and the inability of weight loss are just some complaints that are correlated to gut health.
I postulate that Hippocrates would appreciate identifying the precise dysfunction(s) would allow for improved and successful treatment.
One aspect not discussed are food sensitivities and the proliferation of inflammation to the gut. Nor bacterial overgrowth and it's pressure on digestive health. Dr. Rivas, et al., correlated these issues in 2013 (4). This is severely overlooked by practitioners who offer the latest Leaky Gut solution. Often these practitioners are seen live, on social media feeds, offering free seminars on Leaky Gut; and/or, promoting their latest book or supplement. Frankly, this is irresponsible and really ticks me off. What follows is precisely why...
"Caroline" - (name and image have been changed to protect the innocent, but a true case study) - is a woman who's main complaints were fatigue, sleeplessness, lack of energy for exercise, low libido, abdominal bloating, constipation, irregular menses and headaches. She declined an intestinal permeability test, stool pathogen test, and food sensitivity test. The tests she agreed to suggested hypocortisolimia, probable gut dysfunction, and hormone imbalance. There were signs of a deeper immune issue that could not be uncovered with the tests she chose. Caroline participated in a 90-day, self-care holistic protocol and returned. After 90 days, all but her bloating, constipation, and headaches were vastly improved. She was sleeping thru the night, exercising in the morning, indicated that her mood vastly improved too, and presented with improved hormone balance. But the bloating, constipation, and headaches increased in severity. Caroline agreed to run an intestinal permeability, stool pathogen, and mediator release test (food sensitivity). Eureka, we struck gold. She presented with severe Blunt Brush Boarder, H. pylori, a weak parasite, and significant food sensitivities. Omega Fatty Acid containing fish, chicken, avocado, and carrots were listed as remarkable on her food sensitivity test. Why is all this significant, you say? Well, the typical "Leaky Gut" protocol suggests Omega 3 supplements, Glutathione, and bone broth which contains animal collagen (animal protein). Not to mention many would not restrict avocado and carrots. All of which contributed to a heavy antigen overload to Caroline's intestinal health. Although the parasite that was identified may be somewhat harmless in low numbers, it lives on the microvilli of the lumen (Death Star) and contains those lipopolysaccharides - poison. Not eradicating the parasite would have been a failure in her protocol long term, causing continued Blunt Brush Boarder and malnutrition. Lastly, a few of the foods suggested in a "Leaky Gut" protocol can proliferate h. pylori growth; fermented and some acid foods. With these new findings Caroline agreed to a new holistic, self care plan. Caroline's self-care protocol included pathogen eradication, a gut health protocol to sooth Blunt Brush Boarder and epithelial inflammation, and strict nutritional guidelines to avoid excess inflammation.
Caroline and others are precisely why I am passionate in educating those suffering from intestinal discomfort, auto-immune issues, and other clinical issues about gut health. Although I appreciate many bringing light to gut health, knowledge of current testing methods and treatment protocols are what those suffering deserve.
Challenged by health issues? Gut health complaints? Suffering from symptoms listed above? You deserve to heal, you deserve optimal health, and you deserve the most up to date knowledge.
References:
ALLERGY AND GASTROINTESTINAL SYSTEM; CLIN EXP IMMUNOL. 2008 SEP; 153(SUPPL 1):3-6 G VIGHI, ET AL,.
INTESTINAL PERMEABILITY & IT'S REGULATION BY ZONULIN: DIAGNOSTIC & THERAPEUTIC IMPLICATIONS; CLIN GASTROENTEROL HEPATOL. 2012 OCT; 10(10):1096-1100
ZONULIN & IT'S REGULATION OF THE INTESTINAL BARRIER FUNCTION: THE BIOLOGICAL DOOR TO INFLAMMATION, AUTOIMMUNITY & CANCER; PHYSIOL REV. JAN 2011 91(1):151-17
A MICROBIOTA SIGNATURE ASSOCIATED WITH EXPERIMENTAL FOOD ALLERGY PROMOTES ALLERGIC SENSITIZATION AND ANAPHYLAXIS: THE JOUR OF ALL & CLIN IMMUNO. 2013 VOL 131(1): 201-212
