Healthy Gut = Heathy You
Most of us have heard that most of our immune system is located in the gut. It is estimated that 70% of our immune system resides in our gut and is a beautiful balance between the microbes that reside in our gut and our own immune system physiology. So what happens if the gut lining becomes irritated or inflamed by ultra-refined foods, excessive alcohol, or other irritants? The intestinal lining may become somewhat compromised and our immune function can be affected.
Insults to our intestinal lining may reduce our gut’s ability to allow nutrients through and be absorbed while keeping toxins or undigested food within the gut lumen. The intestinal lining acts as a protective barrier keeping what we eat in the intestines for digestion and absorption. The lining is about one cell thick and is susceptible to injury and inflammation from foods we eat as well as environmental and other lifestyle factors. The cells that make up the intestinal lining, known as enterocytes, can become inflamed and then the barrier becomes compromised allowing molecules, microorganisms, undigested food particles and toxins to seep through that should not enter circulation. This can then cause an immune response leading to food sensitivities, inflammation and other symptoms. Intestinal hyperpermeability, also known as “leaky gut” or “leaky gut syndrome” has been implicated as an underlying condition to many inflammatory and autoimmune diseases. The term “leaky gut” is a bit controversial in the medical community but increased intestinal permeability is something that can be measured with certain lab tests.
What causes Excessive Intestinal Permeability?
Although there is no single cause of intestinal permeability there are some common causes that have been identified. These include:
- Chronic stress
- Dysbiosis or imbalance of healthy microbes in the gut
- Environmental contaminants
- Overconsumption of alcoholic beverages
- Use of certain medications
- Poor food choices, standard American diet
- Food and environmental sensitivities
- Lectins for some individuals
- Endurance exercise
Testing for Intestinal Permeability
Most clinicians do not test for leaky gut but instead determine it is a likely problem based on lifestyle and nutrition status. Leaky gut is a symptom and not the root cause of one’s health issues. For example, we can assume it is an issue based on other symptoms such as frequent yeast or bacterial infections, food allergies and sensitivities and chronic stress for example. The following tests can help confirm if your intestinal barrier has been impaired. They are listed in order from least invasive to more invasive options but often clinicians often recommend supplements or medications to optimize the gut without testing based on symptoms.
- Lactulose-mannitol testing (gold standard for testing gut integrity)
- Zonulin-1 or Zonulin antibody testing
- Serum diamine oxidase (DAO)
- Bacterial lipopolysaccharides (LPS)
- Can be indirectly tested through food sensitivity testing – if many foods are reactive, we can assume there is intestinal permeability
- Endoscopy with tissue biopsy or confocal endo microscopy
What Can We Do to Restore Gut Integrity?
There are several steps we can take to heal our gut when we feel we need to. We all go through times in our life when our guts can become inflamed and become permeable. Examples include chronic stress from work or family issues, having to rely on processed foods when traveling, having more treats over the holidays, or drinking more alcohol than usual while on a vacation can all impact gut integrity.
The first step to take is to identify things that may be causing leaky gut and try to eliminate them. Examples include:
- Causes of stress
- Pain medications that injure the gut lining such as over-the-counter NSAIDs
- Environmental toxins, chemicals or other contaminants
- Overconsumption of alcohol
- Poor food choices or food intolerances
- Use of birth control pills
- Steroid medications
- Genetics may play a role
Dietary Changes to Support Gut Health
Cleaning up your diet to include more whole unprocessed foods with a variety of fruits and vegetables is always a great start to improving gut and overall health. Choose organic produce if your budget allows and refer to the Environmental Working Group’s Dirty Dozen list (EWG.org) to identify fruits and vegetables that are highest in pesticides and herbicides that you can prioritize to buy organic. Any foods that you are sensitive to or have trouble tolerating should be eliminated. Choosing healthy fats such as olive oil, avocado oil or coconut oil and avoiding processed seed oils or refined vegetable oil which increase body inflammation. Cutting down on alcohol, sugar and supporting your gut microbes with fiber from whole food sources can also help maintain a healthy gut. Many patients feel better when they take a break from gluten, dairy and sugar while adopting a diet of whole foods that is high in vegetables.
Healing foods help soothe the GI tract.
- Bone broth
- Vegetables and vegetable juices (i.e. cabbage juice)
- Probiotic-rich foods
- Soothing foods know as demulcents. Examples include okra, licorice tea, slippery elm tea or marshmallow root tea
- Elemental (pre-digested) meal supplements for bowel rest
- Medical food meal replacement supplements
Supplements to Support Gut Healing
There are many natural supplements that can help heal the intestinal lining and allow it to resume its function of absorption of nutrients as well as a protective barrier not allowing food or toxins to seep through to circulation. There are many supplements on the market designed to help restore gut integrity and most are combination products that contain several healing components. Some of the most commonly used are listed below.
Digestive enzymes are helpful for gut and digestive health as well. Most of us need digestive enzyme support as we age because of a natural reduction in enzymes that occurs. Supplementing digestive enzymes ensures that the food you eat is broken down and absorbed properly which reduces the risk of indigestion, malabsorption and food sensitivities.
Glutamine (L-Glutamine) is an amino acid that feeds the cells (enterocytes) of the gut lining and promotes repair and maintenance. Start with 1-3 grams daily. Too much Glutamine can cause constipation so be careful not to take too much.
Zinc Carnosinehas been found to help heal the gut lining. Zinc is an important nutrient for healing gastrointestinal tissues and is important to heal wounds on skin as well. A typical dose is about 75mg twice a day.
Probiotics are often included in gut healing regimens. A particular strain known as Lactobacillus Plantarum(L. Plantarum) is particularly soothing to the small intestine.
Quercetinis a plant pigment or flavonoid found in many fruits and vegetables. It is often used as a medicine for its antioxidant and allergy lowering properties. Dosage ranges from 500-3000 mg daily. Quality is important since it is difficult to absorb quercetin.
Aloe vera is also a common supplement used to heal leaky gut. It acts as a demulcent coating and soothing the gut to promote healing. Many people use it to heal skin irritations such as minor burns so it makes sense that it can help heal you on the inside as well. Choose a product that has the outer leaf removed.
Deglycyrrhized licoriceis also used to soothe the mucous membranes of the gut to reduce inflammation and pain. This helps promote healing by stimulating production of prostaglandins and cell proliferation. Do not confuse with whole licorice as this can cause an increase in blood pressure. This can be taken in dosages of about 380-400mg 20 minutes prior to meals. Chewable forms of this supplement work best as they are more effective when it mixes with saliva in the mouth before swallowing.
Phosphatidylcholineis a type of fat known as a phospholipid. Phospholipids are used as building blocks by the body to create new cell membranes, central nervous system tissues and has also been found to be helpful in reducing gut permeability by protecting the GI tract. A common dose is 2000-4000 mg daily.
It’s a good idea to discuss adding supplements with your dietitian or healthcare provider to determine which ones are right for you. A consultation by a health practitioner that is familiar with supplements that support gut healing can save you time and money.
Sleep for Healing and Gut Restoration
One of the basic lifestyle changes we recommend to promote healing is prioritizing sleep. Most of us live a busy and fast paced lifestyle that often is stressful. Sleep is sacrificed to get that workout in or to finish the report that’s due. Sleep allows or body to repair itself. Aim to get at least 7-9 hours of sleep each night. If you suffer from insomnia or sleep apnea, work with your doctor to correct any sleep problems.
Intestinal Health and the Mind-Body Connection
Stress management is very helpful in reducing gut issues as well as overall health and resilience. Adopting a mindfulness practice or other meditative technique is often helpful. If you are a spiritual or religious person, you may use prayer as an exercise in mindfulness. Mindfulness is basically synonymous with awareness. Being present in the moment and aware as opposed to letting your thoughts run wild about the past or the future. Calm mind, calm body.
Mindfulness doesn’t need to be sedentary; you can incorporate it into your exercise routine. Go for a walk outside and notice the beauty of nature around you. Practice gratitude for the good things in your life, big or small while you are working out at the gym or even doing chores around the house. If I am reluctantly cleaning my kitchen for the third time in one day, I remind myself how grateful I am to have a home and kitchen to switch my thinking from negative to positive.
Adding calming mind-body exercises such as Yoga, Qi Gong, or Tai Chi are also very healing. Excessive exercise or intense endurance training can increase the stress response and promote intestinal permeability along with other undesirable symptoms.
How do I know if I am at risk for increased intestinal permeability?
You can do a self-assessment of your current health status, diet and lifestyle to determine if this is something you want to explore with your healthcare provider. Are you dealing with an inflammatory or autoimmune condition? Do you drink alcohol in excess of recommendations or daily? Are you on any medications that may have gastrointestinal side effects such as chronic use of over-the-counter pain medications or NSAIDs? Are you chronically stressed? Do you eat the standard American diet of highly processed food that is low in plant fiber? Do you have food sensitivities? Do you suffer from joint pain, skin irritations or headaches? Have you been diagnosed with IBS or an autoimmune disease? Do you have a history of long-term antibiotic use? There are a multitude of factors that can affect our gut health, speak with your dietitian or healthcare provider about any conditions you have been diagnosed with or digestive symptoms you are experiencing to determine if you need to heal your gut and improve overall health.
Healing Bone Broth
This basic bone broth recipe can be made in large batches and used as the liquid base for soups, stews, or can be sipped on its own. The high collagen, vitamin and mineral content is healing for the gut making it a medicinal food. You can make it on a stovetop, slow cooker or Instapot (cooks faster).
- 2-3 pounds chicken, turkey, pork, beef, lamb, or other bones (try to get bones that have lots of connective tissue—feet, knuckles, necks, backs, etc.) Organic if possible.
- 1 tablespoon apple cider vinegar
- 4 cups roughly chopped carrots, onions, and celery (or scraps)
- 2 bay leaves
- 1/2 teaspoon peppercorns
- 1 teaspoon sea salt
- Filtered water
- If using raw bones, preheat oven to 425°F. Layout bones in one layer on a large baking sheet or roasting pan. Bake in preheated oven for 25-30 minutes, or until golden brown
- In a large soup pan or Dutch oven, place the bones, apple cider vinegar, carrots, onions, celery, bay leaves, peppercorns, and salt.
- Fill pot with filtered water until it covers the bones by about an inch. Let mixture rest for 30 minutes.
3. Bring to a simmer over medium-high heat, then reduce heat to as low as your stove will go. You want it to just be barely bubbling. Cover with the lid slightly ajar and cook for 24 hours for poultry bones and 48 hours for red meat bones. If cooking overnight on the stove makes you nervous, you can place the whole pot (covered) in the fridge overnight and restart the cooking time in the morning.
4. When cooking time is up, strain through a fine mesh sieve, and transfer to jars for storing in the fridge or freezer.
5. Once chilled, the broth should be jiggly and have a layer of fat on top. Scrape off the fat and use it for other purposes, if desired.
*This recipe was adapted from https://wholefully.com/bone-broth/
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