What IS leaky gut?

Leaky gut is the not-so-new kid on the block,  a stylish term that we hear a lot  along with  “detoxification” “adrenal fatigue”  and “inflammation”. Words that everyone uses without exactly understanding what they mean.

Leaky gut, like all of the above-mentioned phenomenon, is a real-life thing. It very well could be contributing to your symptoms and/or worsening any current disease you have while evading a true conventional diagnosis.

Often these symptoms and diseases go on for long periods of time because it is so difficult to get a diagnosis, and then, to develop an effective clinical approach for the restoration of health. So you are diagnosed with diarrhea, eczema, constipation or colitis, but that doesn’t clarify what the root of the problem is and doesn’t help define a treatment. Or, even more frustrating, typical treatments don’t work, or they don’t work for long.

Scientific terms for leaky gut include increased intestinal permeability and intestinal hyperpermeability. For us to fully understand exactly what this means, let’s review some gastrointestinal and immune basics.

The function of the gastrointestinal system is to break down, assimilate and absorb food into our bodies, and eliminate what we don’t need. The GI tract also is the seat of our immune system, as almost 75% of our immune cells live there. It protects us from infection and pathogens, and plays a crucial role in preventing autoimmune disease. The gut also has major impacts on neuronal and hormonal signalling.

Our teeth, aided by enzymes secreted by salivary glands help us mechanically breakdown and mix our food with digestion-enhancing compounds; our stomach helps churn our food and along with the pancreas and biliary system add acids, enzymes and bile salts to further breakdown food into ever-tinier particles as it is propelled toward the small intestine.

The small intestine is an anatomical wonderland – a tube 15-20 foot long tube that has so many tiny folds in it that, if stretched out, covers an area the size of a tennis court. This greatly aids in the absorption of nutrients but leaves a very large surface area vulnerable to injury. The large intestine absorbs water out of our food and shuttles it to be excreted out of our bodies after we have extracted the macro/micronutrients and water from it.

So when we hear the term “leaky gut” that can sound overly simplistic, because we understand that the “gut” is composed of many structures. However,  in the case of the leaky gut, the small intestine is where all of the action is at – that is the structure that can become “leaky”, or – to be more technically correct – hyperpermeable.

How does this happen? To understand, let’s take a closer look at the structure of the small intestine. The small intestine is a long tube. Food travels in the empty space of the tube. On the other side of the tube is your blood and lymph supply, organs, your internal environment,  – your sacred space. Separating the external environment (your digesting food) from the internal environment (your fiercely protected sacred space) is something called the “brush border”.

The brush border is a one-cell-thick row of cells (called enterocytes) that stand shoulder to shoulder like soldiers, interfacing carefully and quite complexly between your digesting food particles, your immune system and your internal space. This brush border completely lines the entire surface area of the small intestine.  It is through this brush border that food particles are chaperoned from the external world into our bodies to be introduced to the immune system and absorbed to be used.

This introduction to the immune system is critical. The job of the immune system is quite simple: obliterate and destroy anything that is not “self”. Clearly, the food that you eat is not “you”, and needs to be properly introduced to the immune system to prevent an attack by the immune system.

The immune system is a highly evolved, mind-bogglingly complex set of many different cell lines with different jobs, roles and even tissue specificity. Over the course of a lifetime (and research suggests through generations!), our immune system is trained to not go off the deep end in response to foods. This process of training is called tolerization and begins in infancy.

Our gut flora, found downstream in the large intestine, also help modulate immune function and maintain gut integrity, and are  a key player in the digestion and assimilation of nutrients.

All of this results in a system that allows us to digest, absorb and assimilate nutrients without any thought at all from us.

That is, of course, until something goes wrong!

In the case of leaky gut, the gut sustains some type of injury (such as from a virus or trauma), imbalance (as from antibiotic use) or repetitive exposure to an allergenic, inflammatory food component (some very common examples are gluten, dairy, compounds from beans and compounds from the nightshade vegetables) that results in cellular change at the level of the brush border and abnormal inflammatory response from the immune system.

Upon insult, the cells that stand shoulder to shoulder at the brush border separate from one another, creating a hole that grants direct entry to our sacred, protected internal space. This direct entry bypasses chaperoning, formal introductions and gut-flora modulation and deposits partially digested food particles right at the door of the immune system.

The immune system, in response, retaliates and attacks, releasing inflammatory molecules which in turn create more inflammation and signal to other immune cells to come to the area to destroy an invader. Immune cells arrive to the area and pour into the empty space of your intestine, creating antibody against anything and everything they come across.

All of this inflammation actually makes the cells that line the brush border separate even further, and intestinal hyperpermeability – or leaky gut – has manifested.

Leaky gut develops when this process goes chronic, either from lack of recovery to trauma, lack of repletion and restoration of gut function, or continual use of an aggravating food.

Many disorders have increased intestinal permeability as a feature. Celiac disease, non-Celiac gluten intolerance, food allergies/sensitivities, Inflammatory bowel diseases (IBD) such as ulcerative colitis, Crohn’s disease and microscopic colitis feature leaky gut. Other systemic diseases that we find leaky gut present in or exacerbated by include joint disorders,  psoriasis, eczema, migraines, headache,  Reiter’s syndrome, schizophrenia, and any autoimmune condition such as rheumatoid arthritis, autoimmune thyroiditis (Hashimoto’s, Grave’s), multiple sclerosis and lupus (SLE).

The consequences from leaky gut can pop up in any body system, but most common symptoms are found in the gastrointestinal system, the skin, the brain and the joints. Leaky gut often can be a culprit for people who cannot achieve optimal body composition.

Left untreated and unaddressed, leaky gut can lead to nutrient insufficiencies and a shift in the immune system that makes the immune system inappropriately over-reactive. This in turn can lead to increased symptoms, food allergies, a predisposition to autoimmune conditions, and corresponding vulnerability to infections.

From this whirlwind tour into our guts and immune system, we can see that leaky gut is indeed a true physiologic phenomenon with consequences. If you have nagging symptoms that are not responding to treatment and are evading a conventional diagnosis, it may be time to take stock of your gastrointestinal health. Here’s to the happiness of your brush border!



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