Altered Immunity & The Leaky Gut Syndrome

by Dr Zoltan P Rona MD, MSc

The leaky gut syndrome is a name given to a very common health disorder in which the basic organic defect (lesion) is an intestinal lining which is more permeable (porous) than normal. The abnormally large spaces present between the cells of the gut wall allow the entry of toxic material into the blood stream that would, in healthier circumstances, be repelled and eliminated.

The gut becomes leaky in the sense that bacteria, fungi, parasites and their toxins, undigested protein, fat and waste normally not absorbed into the bloodstream in the healthy state, pass through a damaged, hyperpermeable, porous or "leaky" gut.. This can be verified by special gut permeability urine tests, microscopic examination of the lining of the intestinal wall as well as the bloodstream with phase contrast or darkfield microscopy of living whole blood.

Why is leaky gut syndrome important? The leaky gut syndrome is almost always associated with autoimmune disease and reversing autoimmune disease depends on healing the lining of the gastrointestinal tract. Any other treatment is just symptom suppression. An autoimmune disease is defined as one in which the immune system makes antibodies against its own tissues. Diseases in this category include lupus, alopecia, rheumatoid arthritis, polymyalgia rheumatica, multiple sclerosis, fibromyalgia, chronic fatigue syndrome, Sjogren's syndrome, vitiligo, thyroditis, vasculitis, Crohn's disease, ulcerative colitis, urticaria (hives), diabetes and Raynaud's disease.

Physicians are increasingly recognizing the importance of the gastrointestinal tract in the development of allergic or autoimmune disease. Understanding the leaky gut phenomenon not only helps us with safe and effective therapies to bring the body back into balance. Due to larger than normal spaces between the cells of the gut wall, larger than usual protein molecules are absorbed before they have a chance to be completely broken down as occurs when the intestinal lining is intact. The immune system starts making antibodies against these larger molecules because it recognizes them as foreign, invading substances. The immune system starts treating them as if they had to be destroyed. Antibodies are made against these proteins derived from previously harmless foods. Human tissues have antigenic sites very similar to those on foods, bacteria, parasites, candida or fungi.

The antibodies created by the leaky gut phenomenon against these antigens can get into various tissues and trigger an inflammatory reaction when the corresponding food is consumed or the microbe is encountered.

Autoantibodies are thus created and inflammation becomes chronic. If this inflammation occurs at a joint, autoimmune arthritis (rheumatoid arthritis) develops.

If it occurs in the brain, myalgic encephalomyletis (a.k.a. chronic fatigue syndrome) may be the result.

If it occurs in the blood vessels, vasculitis (inflammation of the blood vessels) is the resulting autoimmune problem. If the antibodies start attacking the lining of the gut itself, the result may be colitis or Crohn's disease.

If it occurs in the lungs, asthma is triggered on a delayed basis every time the individual consumes the food which triggered the production of the antibodies in the first place.

It is easy to see that practically any organ of the body tissue can become affected by food allergies created by the leaky gut.

Symptoms, especially those seen in conditions such as chronic fatigue syndrome, can be multiple and severely debilitating.

The inflammation that causes the leaky gut syndrome also damages the protective coating of the IgA family normally present in a healthy gut. Since IgA helps us ward off infections, with leaky gut problems we become less resistant to viruses, bacteria, parasites and candida.

These microbes are then able to invade the bloodstream and colonize almost any body tissue or organ. When this occurs in the gums, periodontal disease results. If it happens in the jaw, tooth extraction or root canals might be necessary to cure infection.

In addition to the creation of food allergies by the leaky gut, the bloodstream is invaded by bacteria, fungi and parasites that, in the healthy state, would not penetrate the protective barrier of the gut.

These microbes and their toxins, if present in large enough amounts, can overwhelm the liver's ability to detoxify. This results in syndromes such as confusion, memory loss, brain fog, or facial swelling when the individual is exposed to a perfume or to cigarette smoke that he or she has had no adverse reactions to prior to the development of leaky gut syndrome.

Leaky gut syndrome also creates a long list of mineral deficiencies because the various carrier proteins present in the gastrointestinal tract that are need to transport minerals to the blood are damaged by the inflammation process.

For example, magnesium deficiency (low red blood cell magnesium) is quite a common finding in conditions like fibromyalgia despite a high magnesium intake through the diet and supplementation.

If the carrier protein for magnesium is damaged, magnesium deficiency develops as the result of malabsorption. Muscle pain and spasms can occur as a result. Similarly, zinc deficiency due to malabsorption can result in hair loss or baldness as occurs in alopecia areata.

Copper deficiency can occur in an identical way leading to high blood cholesterol levels and osteoarthritis. Further, bone problems develop as a result of the malabsorption of calcium, boron, silicon and manganese.

The Causes

The leaky gut syndrome is basically caused by the inflammation of the gut lining. This inflammation is usually brought about by the following:

Antibiotics because they lead to the overgrowth of abnormal flora in the gastrointestinal tract (bacteria, parasites, candida, fungi; alcohol and caffeine (strong gut irritants):

foods and beverages contaminated by parasites like giardia lamblia, cryptosporidium, blastocystis hominis and other food and beverage contaminated by bacteria like helicobacter pylori, klebsiella, citrobacter, pseadomoas and other chemicals in fermented and processed food (dyes, preservatives, peroxidized fats);

enzyme deficiencies (e.g. celiac disease, lactase deficiency causing lactose intolerance) NSAIDS (non-steroidal anti-inflammatory drugs) like ASA, ibuprofen, indomethancin, etc);

prescription corticosteroids (e.g. prednisone);

high refined carbohydrate diet - (e.g. candy bars, cookies, cake, soft drinks, white bread);

prescription hormones like birth control pills;

mold and fungal mycotoxins in stored grains, fruit and refined carbohydrates. more common is the fact that many people are suffering from mycotoxicosis (toxic mold poisoning).

The leaky gut syndrome can cause the malabsorption of many important micronutrients. The inflammatory process causes swelling (edema) and the presence of many noxious chemicals all of which can block the absorption of vitamins and essential amino acids. A leaky gut does not absorb the nutrients properly. Bloating, gas and cramps occur as do a long list of vitamin and mineral deficiencies. Eventually, systemic complaints like fatigue, headaches, memory loss, poor concentration or irritability develop.

Prescription broad spectrum antibiotics, especially when taken for extended periods of time, wipe out all the gut friendly bacteria that provide protection against fungi and amoebic (parasitic) infections, help the body break down complex foods and synthesize vitamins like B12 and biotin. Since the friendly bowel flora is killed off, the body now has no local defense against parasites or fungi that are normally held in check. This then quickly develop and these may trigger the signs and symptoms of arthritis, eczema, migraines, asthma or other forms of immune dysfunction. Other common symptoms of this bowel flora imbalance and leaky gut syndrome are bloating and gas after meals and alternating constipation and diarrhea. This set of symptoms is usually labeled as IBS (irritable bowel syndrome) or spastic bowel disease and treated symptomatically by general practitioners and gastroenterologists with antispasmodic drugs, tranquilizers or different types of soluble (pysllium) and insoluble (bran) fiber.

The Leaky Gut and IBS

The mainstream thinking on IBS is that it is caused by stress. Irritable Bowel Syndrome is the number one reason for general practitioner referrals to specialists. In well over 80% of the cases, tests like intestinal permeability test ( a special urine test involving the determination of the absorption rates of two sugars called lactulose and mannitol), CDSA or livecell darkfield microscopy reveal the presence of an overgrowth of fungi, parasites or pathogenic bacteria. The one celled parasite, blastocystis hominis and different species of candida are the most common microbes seen in IBS. The only stress associated with IBS is that which is generated by leaky gut syndrome. If allowed to persist without correct treatment, IBS can progress into more serious disorders like the candidasis syndrome, multiple chemical sensitivities, chronic fatigue syndrome, many autoimmune diseases and even cancer. If treated medically, IBS is rarely cured. To treat it correctly, natural treatments work best and must include the removal of the cause, improvement of gastrointestinal function and healing the lining of the gut.

How to reverse Leaky Gut syndrome

Band-aid treatment with corticosteroids, prescription antibiotics and immunosuppressive drugs may be temporarily life saving for acute episode of pain, bleeding or severe inflammation as occurs in lupus or colitis. In the long run, however, none of these treatments do anything to heal the leaky gut problem. To reverse the leaky gut syndrome the diet must be completely changed to one which is as hypoallergenic as possible. Sugar, white flour products, all gluten containing grains (especially wheat, barley, oats and rye), milk and dairy products, high fat foods, caffeine products, alcohol and hidden food allergies determined by testing must all be eliminated for long periods of time (several years in the more severe cases).
Treatment might also include the use of natural antibiotics: (echinacea, colloidal silver, garlic), antiparasitics cloves, wormwood, black walnut) and antifungal (taheebo, caplytic acid, grapefruit seed extract) depending on the type of infection which shows up on objective tests. It is rare that victims require prescription drugs for these infections and they should be discouraged. The drugs are usually expensive, have unpleasant side effects and are best reserved for life threatening conditions. Leaky gut syndrome patients can help themselves by chewing their food more thoroughly, following the basic rules of food combining, eating frequent small meals rather than three large ones and taking more time with their meals. Gastrointestinal function can be improved with a juice fast or a hypoallergenic diet and supplements like lactobacillus acidophilus and bifidus as well as FOS (fructooligosaccharides) derived from Jerusalem artichoke, chicory, the dahlia plant or burdock root.

Beneficial supplements for leaky gut syndrome.

Natural digestive enzymes - from plant (e.g. bromelain, papain) or pancreatic animal tissues (porcine, bovine, lamb) and aloe vera juice with high MPS concentration (good brands are International Aloe, Earthnet and Royal);

stomach enhancing supplements- betain and pepsin, glutamic acid, stomach bitters, apple cider vinegar; amino acids - L-glutamine, N-acetyl-glucosamine (NAG)

essential fatty acids - milled flax, flax seed oil, evening primrose oil, borage oil, olive oil, fish oil, black current seed oil; soluble fiber - pysillium seed husks and powder, apple and citrus pectin, the rice derived gamma oryzanol;

antioxidants- carotenoids, B complex. vitamin C, E, zinc, selenium, germanium, coenzyme Q10, bioflavinoids, especially quercetin, catechin, hesperidin, rutin and proanthocyanidins (pycnogonals, grape seed extract, pine bark extract, bilberry; herbs

and plant extracts - kudzu, various high chlorophyll containing green drinks like spirulina, chlorella and blue-green algae, burdock, slippery elm, Turkish rhubarb, sheep sorrel, licorice root, ginger root, goldenseal, bismuth and bentonite.

Combination Green Foods - two excellent products are Green Life (bioquest) and Greens+ (Supplement Plus).

Due to the increasing recognition of chronic fatique syndrome, the leaky gut syndrome and multiple chemical sensitivity, a number of supplement companies have been marketing powdered hypoallergenic formulations containing most of the nutrients mentioned above in one convenient package. Some brand names include UltrabalanceB, UltraClear, SustainB, UltraClear PlusB, Pro-Cleanse, Pro-Support, and AntiClear. The products are only available through natural health practitioners like chiropractors, nutritional doctors and naturopaths.

If you suspect you may be suffering from leaky gut syndrome, the most important thing to do is get yourself tested by a natural health care practitioner. A personalized natural program of diet and supplements can then be instituted to help you reverse this debilitating condition.

References:

Gittleman, A L - Guess what came to Dinner - parasites and your health. Garden City Park, NY Avery 1993.
Gottchall, Elain. Breaking the vicious Cycle. Intestinal Health through diet. Kirkton, Ont, Kirkton Press 1994
Martin, Jeanne Marie and Rona, Zoltan P. The complete Candida Yeast Guidebook. Rocklin, California. Prima Books 1996
Robert L et al. The effects of procyandolic oligomers on vascular permeability. A study using quantitative morphology. Pathol Biol. 38.608-616: 1990
Rogers, Sherry A. Finally Healing the immune System. Macrobiotics Today. Sept/Oct 1995 pp 16-20

Useful Laboratory Tests

Most of the pertinent tests require a stool sample, and kits can be provided directly by the practitioner to the patient. Food allergy tests require a serum sample, which is performed by a registered phlebotomist or lab, who gives the spun serum back to the patient to mail.

Low levels do not require aggressive anti-Candida treatment, whereas high levels do. The blood antibody test for Candida is not very useful as it tends to show only in the severely immuno-suppressed, such as AIDS patients. The better Candida tests use a stool sample, and I would recommend either Great Smokies (Asheville) or Diagnos-Techs (Seattle).

There are other tests that are useful. ACHY (anti-chymotrypsin factor) is measured in the stool and is a direct marker for small intestine inflammation; it often indicates food allergies. However, in a chronic case where the immune system has plummeted, the ACHY can look normal. This means that the immune system is too depleted to mount an adequate defense at the site of the mucosal membrane.

Secretory IgA (SIgA) is a direct marker of the patient?s immune system at the site of mucosal lining of the small intestine, also measured by stool. However, as far as educating the patient and getting compliance, this is a good test for the patient to see.

Candida

Treating Candida can be a big challenge. Funguses are survivors and they are very hard to get rid of. Their job is to suck the life out of decaying tissue, so a fundamental imbalance in the vitality and chemistry of the small intestines is often the root cause. Addressing proper pH and restoring vitality via herbs and dan tian Qi gong, are useful. When the Candida levels are +4 or +5 (on a scale of 1 to 5), it may be necessary to use western prescription medicine, specifically Nystatin. When combined with an anti-Candida diet, Nystatin is usually effective but needs to be taken for four months.

For levels of +3 or below, many natural products will work. The key is to change any anti-fungal product every month, to avoid tolerance and adaptation. Herbally, Huang Lian Jie Du Pian seems to do the trick.

Naturopathic products that work include those made with grapefruit seed extract, oregano oil, undecylenate acid, and berberine herbs. Again, talk to the reps of the various companies (listed at the end of the article) for ideas. For children there are a number of homeopathic nosode products that are quite effective from Professional Health Products (PHP), NutriWest, and others.

Most patients will require supplementation with beneficial bacteria to restore probiosis, the healthy bacterial terrain of the small and large intestine. Supplements combining various strains of lactobacillus are helpful, although quality really can vary depending on the manufacturer. Most should be refrigerated, and taken without food. New evidence points to Lactobacillus Sporogenes as being particularly effective, and a children?s chewable exists. Contact Marcopharma for information.

Liver Patterns. In Leaky Gut, the intestines have been dumping unnatural amounts of microbial or metabolic toxins into the blood, which quickly end up in the liver. This causes stagnation of Qi and blood leading to heat with a reduced ability to clear toxins. It is ultimately the cause of fibromyalgia, because the toxins that the liver cannot neutralized are returned to the blood, then the lymph, and finally the connective tissue.

Prognosis

I had posted a very rushed post two or three weeks ago about my concerns over my husband possibly suffering from leaky gut, got some very helpful responses, but then had to disappear into the neverland of no internet as we made our move to VA. I want to thank you for posting this.

At the time I wrote my post, my husband was desperately ill, and repeated visits with the LLMD provided no viable treatment plan. I pressed for a referral to a gastroenterologist, even tried to talk my hubby into a trip to the ER to expedite receiving care.

Meanwhile, my husband suffered progressively severe bouts of abdominal pain, lost 30 pounds in six weeks despite a high calorie diet, was no longer able to tolerate his abx, and eventually developed an intolerance to most foods. A couple of rounds of Diflucan provided relief early on, but eventually that no longer helped either. His Lyme sx had begun to spiral out of control as well.

I finally got him into an ER in Virginia--where we are now residing--where an abdominal CT scan showed diverticulitis.

He was given a ten day course of Cipro and Flagyl, and is now a new man!

I am so thankful for the dramatic improvement my husband has made, but am still concerned about his long term abx treatment and consequent chronic imbalances in his intestinal flora that may possibly have been the catalyst for his problems. (he had alot of trouble with compliance with respect to probiotics, which I suspect also did not help!)

I want to do whatever possible to prevent a reoccurance of his problems, and I'm still trying to sort out the best way to do that. With him, compliance is still often a problem, I'm afraid. I don't mean to make him sound irresponsible--this last round of problems really scared him, but he is juggling a new job, a busy schedule, an interstate move, business travel, raising five kids with me, and is leery of taking any meds or supplements that may upset his delicate stomach at a time when he can't afford to be sick anymore. Plus..his memory still isn't so hot!

So...thanks again for the valuable information, and if you or anyone else has any advice for me regarding my hubby, I'd love to hear it.

In addition, Most Kefir blows away yogurt in CFU's, has slightly different bacteria, and has cannobolistic "good" yeast that eat up albicans. I have added it as well from time to time, and am trying to make it more of a permanent supplement.

Dont bother with the pills. Many of them are useless (not all). With Stoneyfield Yogurt and Kefir, you absolutely know your getting replacement bacteria. Eat it plain, EVERY NIGHT, without exception.