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Healing Leaky Gut

Posted 4 years ago by Brendan

In our previous post - Leaky Gut and Bloating - we looked at how damage to the mucosal lining of the gastrointestinal (GI) wall and increased permeability, can contribute to a wide range of complaints including bloating. Prolonged leaky gut also seems to be linked with the development of many environmental illnesses including irritable bowel syndrome, inflammatory bowel disease, coeliac disease, asthma, arthritis, autism and so on. This post focuses on what you can do about leaky gut, listing some of the best approaches for helping to heal and maintain a healthy GI lining.

Avoid irritation 

First and foremost, leaky gut is a form of ongoing GI irritation. To allow the mucosa time to heal and restore barrier function, GI irritants should be avoided wherever possible. Just as those with sunburn should cover up to avoid further sun damage, those with a damaged gut need to stop aggrevating the problem before healing can occur. For many with leaky gut, food allergies are a significant source of irritation. Read Food Intolerance and Bloating for more information. The inflammatory changes triggered by eating allergenic or reactive food, only increases GI inflammation, exacerbating permeability further. This creates a vicious cycle, where increasing immune exposure to poorly digested foods only encourages the development of more and more food hypersensitivities. To allow the gut to heal, all reactive foods should be avoided wherever possible.

Primary irritants to avoid: 

  • Sugar
  • Processed carbohydrates 
  • Allergenic or reactive foods 
  • Alcohol 
  • Caffeine 
  • Tobacco 
  • Certain medications (NSAID’s, antibiotics, antacids, pain killers, etc - talk to your doctor about alternatives)
  • Artificial food additives (preservatives, colours, flavours, etc)
  • Environmental contaminants (eat organic wherever possible) 
  • Vinegars 
  • Fermented foods 
  • Fizzy drinks 
  • Dried or canned fruit 
  • Spicy foods

This list is a general guide only*

Image: http://en.wikipedia.org/wiki/Diabetic_diet

Probiotics 

The gut flora plays an essential role in maintaining the health of the GI lining and an effective mucosal barrier. For more about the importance of the gut flora read Good & Bad Bacteria and Probiotics for Bloating. However, with dysbiosis or an imbalance in the concentration of microbes that make up the gut flora, this ability to actively protect against colonisation and damage from pathogenic microorganisms; produce the energy and trophic compounds consumed by mucosal cells to stay healthy and effectively communicate with the immune system about our environment, becomes impaired. 

Aging, stress, illness, poor diet, alcohol, countless lifestyle factors and the use of certain medications like antibiotics, can all contribute to a reduction in the number of beneficial microbes living within the digestive system. With such an imbalance, intestinal permeability appears to increase significantly. Harmful microbes and their toxic waste products not only damage the GI mucosa directly triggering a variety of inflammatory changes that influence permeability, but the production of digestive enzymes, protective mucus and secretory IgA immunoglobulins - all of which are important factors in maintaining an effective mucosal barrier, are also impaired by dysbiosis.

Probiotics are microbial dietary supplements containing the friendly bacteria found within the healthy gut flora. For more read Do Probiotics Work? Used to help re-establish and maintain a healthy gut flora, probiotics are often essential in overcoming leaky gut, with the majority of those experiencing increased intestinal permeability, also experiencing problems with their gut flora. Probiotic supplementation has been shown to enhance mucosal barrier function in both normal and inflammatory bowel conditions including inflammatory bowel disease [1] and irritable bowel syndrome [2], while the use of probiotics in the management of arthritis, autism and other environmental diseases where increased intestinal permeability is often a contributing factors, is an area of ever growing research activity. Reinoculating the bowel with friendly bacteria using a high quality probiotic supplement such as Optibac's For daily wellbeing EXTRA Strength, containing multiple probiotic strains including Lactobacillus acidophilus NCFM which has been proven to improve both the gut flora and mucosal integrity [3], is often the most effective way of helping the gut heal itself.  

Saccharomyces boulardii 

Saccharomyces boulardii is a non-pathogenic probiotic yeast, originally isolated from litchi fruit. Widely recognised as an effective treatment for diarrhea and enteric infections such as Clostridium difficile, S. boulardii cells are understood to produce a range of chemicals that inhibit microbial toxins and virulence factors. Essentially, the presence of S. boulardii makes it difficult for unfriendly invaders to remain within the digestive system. S. boulardii supplementation has been shown to effectively increase the clearance of some particularly pathogenic microbes including E. coli, Giardia, Salmonella, Shigella and Candida from within the GI tract. This leaving friendly microbes such as the bifidobacteria to thrive in the absence of more aggressive invaders [4].

In addition to helping correct and maintain a healthy gut flora, taking S. boulardi also appears to enhance intestinal and mucosal barrier function via the production of trophic compounds consumed by the mucosa; inducing an increased secretion of secretory IgA involved in the immunological maintenance of gut barrier function; inhibition of local inflammatory mediators and enhancement of enzymatic activity within and around the microvilli involved in nutrient absorption [5]

Where leaky gut is associated with chronic dysbiosis, recent antibiotic use or a history of gastrointestinal infection, a course of pure S. boulardii such as Optibac’s For bowel calm in addition to a high strength probiotic like Optibac’s For daily wellbeing EXTRA Strength, does tend to restore the intestinal environment faster than if using probiotic bacterias alone. Similarly, many of those with inflammatory bowel conditions like IBS or IBD, find the combination of probiotic bacterias and S. boulardii more effective than either taken alone. For more on S. boulardii research click here. Safe for both short and long term use, symptomatic improvements - reduced bloating, indigestion, disturbed bowel habits etc, should be noticeable after a two to four week course of treatment but may require longer (especially where there is ongoing exposure to other GI irritation) or even an ongoing maintenance dose for optimal results.

Fructo-Oligosaccharides

Fructo-oligosaccharides (FOS) are a class of indigestible carbohydrates, known to encourage the growth and activity of friendly bacteria within the bowel. Consuming FOS alongside probiotics helps to ensure beneficial bacteria (the bifido bacteria are particularly fond of FOS) are well feed and able to establish themselves within the GI tract. Improved digestion and absorption have also been reported with high FOS intakes. Onions, leeks, garlic and bananas are good sources but the highest concentration is found in Jerusalem artichokes - for a FOS feast recipe, check out Abel & Cole’s Jerusalem artichoke recipe section. Or a number of good probiotics like Optibac’s For daily wellbeing include a therapeutic dose of FOS. Read more about the benefits of FOS here

Glutamine 

Glutamine is a common amino acid found in most protein containing foods. For more on amino acids and protein read Bloating and Protein. Involved in a variety of important roles including the detoxification of ammonia and maintenance of muscle mass, glutamine is one of the most important nutrients for leaky gut. Its ability to move through the bloodstream and cross cell membranes without a transport molecule, makes it the preferred source of fuel for the enterocytes lining the GI tract. These cells can easily pick up glutamine from the blood and convert it to glucose to be used as energy, rather than waiting around for a delivery. This makes glutamine essential for maintaining a healthy mucosal wall [6].

Glutamine also appears to improve the production of protective mucus involved in lubricating the mucosa and secretary IgA immunoglobulins [7]. Several studies have shown a generous supply of glutamine to help correct increased intestinal permeability and poor gut immunity in both critically ill and otherwise healthy individuals. Readily available from pharmacies and health food stores, L-glutamine powder is arguably a better option than capsules considering the relatively large amount required to achieve a therapeutic effect. It's also pleasant tasting and easily added to drinks or smoothies. Excess glutamine can be a problem for some people so talk to a health professional about the best dosage for you.

Image: http://elitefitnessbanff.com/juice-bar/

N-Acetyl-Glucosamine (NAG)

A combination of an amino acid and glucose, NAG is an essential component of the GI mucosa. Involved in the synthesis of glycosaminoglycans, NAG strengthens cell membranes and connective tissue, while also enhancing the production of mucus creating a protective lining on top of epithelial cells. Widely available in capsule form, NAG has been shown to inhibit inflammatory damage to the mucosa while enhancing GI healing in those with IBD [8]. An appropriate therapeutic dose depends on a number of factors so talk to a health professional about what is right for you.  

Stress reduction

Stress management is increasingly being recognised as one of the most important factors in addressing intestinal disorders including leaky gut [9]. With ongoing stress reducing blood flow to the GI tract, affecting the balance of gut flora and inhibiting the secretion of digestive enzymes and protective mucus, the GI wall is deprived of what it needs to maintain an effective barrier [10]. For more on the mind-gut connection and how stress physiological impairs digestion, read Stress and Bloating. Including techniques that help reduce stress into the daily routine (such as yoga, meditation, breathing techniques, self hypnosis, etc), will dramatically help to encourage the healing of leaky gut. Not to mention benefiting every other cell in the body. 

Eat well 

With advanced leaky gut, damage to GI mucosa can be so extreme that it becomes difficult to effectively absorb all of the nutrients available from food. This form of malabsorption can make it difficult for the normal metabolic demands of the intestinal mucosa to be met, let alone the increased demand of healing damaged tissues. Where the diet lacks essential nutrients and vitality to begin with (such as with a diet high in processed or overly refined foods), nutritional deficiencies will often develop in those with a damaged gut. Correcting nutritional deficiencies with a hypoallergenic, nutrient-dense, easy to digest diet and perhaps even nutritional supplements where appropriate, is essential for those with leaky gut. Some of the most important nutrients for helping to heal the gut include Zinc, Vitamin A, Vitamin C and bioflavonoids, Vitamin D, Essential Fatty Acids, Vitamin E and anti-inflammatories such as quercetin. Antioxidant and liver supporting foods like garlic, onion, beets, cruciferous veg, bitter greens and berries also help encourage the detoxification of junk built up in the body as a result of intestinal hyperpearmebility. 

There are plenty of options available if you think bloating or other digestive complaints may be associated with a damaged GI lining or 'leaky gut'. So try out some of the suggestions listed here and you just might find giving your gut some TLC helps you overcome regular digestive complaints like bloating. If you continue to experience uncomfortable symptoms, talk to a health professional with experience in the area about looking deeper into your circumstances and finding the most appropriate treatment options for you.

References
[1] Kennedy, R., et al, 2002, “Mucosal barrier function and the commensal flora”, Gut; 50(3): 441–442.

[2] Zeng, J., et al, 2008, “Clinical trial: effect of active lactic acid bacteria on mucosal barrier function in patients with diarrhoea-predominant irritable bowel syndrome”, Ailmentary Pharmacology and Therapeutics,15;28(8):994-1002. 
[3] Ourwehand, A., et al, 2009, "Influence of a combination of Lactobacillus acidophilus NCFM and lactitol on healthy elderly: intestinal and immune parameters", British Journal of Nutrition, 101;367-375. 
[4] Guillams, T., 2008, "Saccharomyces boulardii in Gastrointestinal Related Disorders", Point Institute of Nutraceutical Research; Dec 2008. 
[5] Guslandi, M. et al., 2003, "A pilot trial of Saccharomyces boulardii in ulcerative colitis", European Journal of Gastroenterology & Hepatology; 15, 697–698.
[6] M. Coëffier, et al. 2010, "Potential for Amino Acids Supplementation during Inflammatory Bowel Diseases", Inflammatory Bowel Diseases, 16(3):518-24.
[7] van der Hulst, R.R., et al., 1993, "Glutamine and the preservation of gut integrity", Lancet, 341(8857)1363-5.
[8] Salvatore, S., et al, 2000, “A pilot study of N-acetyl glucosamine, a nutritional substrate for glycosaminoglycan synthesis, in paediatric chronic inflammatory bowel disease”, Alimentary Pharmacology and Therapeutics, 14(12):1567-79. 
[9] Soderholm, J., & Perdue, M., 2001, “Stress and intestinal barrier function”, Gastrointestinal and Liver Physiology, 280(1)G7-G1. 
[10] Palmer, S., 2000, “Physiology of the stress response”, Centre for Stress Management and City University, London http://www.managingstress.com/articles/physiology.htm

Tell us about your experience with treatments for leaky gut below. What has worked for you and what has not? 


About Brendan O'Loughlin

Brendan is a integrative naturopath, nutritionist and yoga teacher. He has completed training in Naturopathy, Nutrition, Herbal Medicine, Yoga, Iridology and Live Blood Analysis.

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