If you scored high in the ‘Intestinal Permeability’ section of the health score quiz, please read this article as it contains some useful information and additional resources that may be of benefit.
The questions or statements posed in this section of the quiz relate to the health of the gut barrier and its integrity.
Symptoms alone are not a diagnosis for intestinal permeability as there are other imbalances that may cause similar symptoms, as a result it is important that if you are looking for a diagnosis in this area then you test and work with a relevant heath professional. It is also important that other red flags be ruled out by your Doctor and if necessary, gastroenterologist.
In this article, we are going to look at:
- Why we need a healthy gut barrier
- What is Intestinal Permeability?
- How is intestinal permeability diagnosed?
- What might cause intestinal permeability in the first place?
- Treatment considerations for intestinal permeability
As well as the recommendations below, you can also get in contact to work with one of our recommended nutrition and functional medicine practitioners, to support you with your overall health and specifically digestive health goals.
Why do we need a healthy gut barrier?
The gut barrier covers around 400 metres squared and utilises around 40% of the body’s energy expenditure. The barrier helps to:
- Protect us from foreign substances and microorganisms that enter the body or already reside in the body
- Helps to regulate water and salt losses
- Allows for appropriate absorption of proteins, fats, carbs, vitamins and minerals
- It is fundamental in the functioning of the immune system
- Much like your skin helps to protect you from the outside environment, the gut barrier serves a similar function. When working well it helps to provide a harmonious relationship between our inner and outer world.
Without a well-functioning barrier this can lead to states of chronic inflammation and immune imbalances.
Classic symptoms of intestinal permeability as you may already be aware of include:
- Changeable stool consistency
- Abdominal pain / bloating
- Joint pain, swelling or arthritic conditions
- Chronic fatigue, both physical and especially mental fatigue and loss of cognitive function
- Sinus and nasal congestion
- Skin conditions like eczema, skin rashes, hives, psoriasis etc
- Increased tendency towards autoimmune conditions
- Increased reactivity to foods that you were previously not intolerant, allergic or sensitive to
- Mood changes and mood disorders
The list of conditions associated with increased intestinal permeability is growing each year and as this dysfunction has become more and more accepted, there has been significantly more time spent researching this area. We are at a point now where the data linking gut permeability to a host of symptoms and conditions, is irrefutable. In the 1980’s there were only around 10 publications a year looking at this area, whereas now the publications associated with intestinal permeability are well over 100 per year.
What is intestinal permeability?
Intestinal permeability goes by a few other names and phrases as well:
- Leaky gut / Leaky gut syndrome
- Intestinal Hyperpermeability / increased intestinal permeability
- Loss of mucosal barrier integrity or function
When the intestinal lining becomes damaged, large particles, toxins and more can enter. As these substances enter it can lead to chronic immune and inflammatory responses. Basically, your body thinks it is under attack and responds as if it were. This can cause a perpetual cycle of invasion, reaction, inflammation, further invasion, reaction, inflammation and so forth.
For some people this breakdown in gut barrier integrity can result in bacteria or bacterial toxins moving into systemic circulation, resulting in more systemic inflammatory and immune load. In some instances, bacteria can move from the gut into other tissues in the body and contribute to other diagnosable conditions. Past research has demonstrated gut pathogens making their way to joints and contributing to the development of certain arthritic conditions.
Ultimately intestinal permeability is a loss of the appropriate function of the barrier between the outside world in our gut and the inside world once things cross the gut barrier. I like to think of the gut barrier as the bouncers on the nightclub door. Their job is to help select the right people to come into the club and prevent the bad guys from getting in. If they are doing a good job then little trouble is likely to kick off inside, however if the doors of the club are left open for anyone and everything all hell can break loose.
What can cause intestinal permeability?
There are many factors that can alter how permeable the intestinal barrier can become, these include:
- Changes in the gut microbiota (general balance of bugs in the gut)
- Small Intestine Bacterial Overgrowth (SIBO)
- Mucus layer alterations, changes in levels of certain immune proteins like Secretory IgA
- Emotional stress and trauma
- Physical stress, for example intensive exercise
- Food sensitivities and allergies
- Generally poor dietary choices
- Very energy rich foods
- Certain medications, especially Non-Steroidal Anti-Inflammatory Drugs
- Specific nutrient deficiencies like vitamin D and vitamin A
When we work with clients, we look to determine what of the above factors may be at play. What we should remember is that intestinal permeability is most likely a symptom of an imbalance or stress elsewhere that if addressed would result in proper gut barrier integrity and a resolution of the symptoms associated to intestinal permeability.
How is intestinal permeability diagnosed?
I believe that intestinal permeability is merely a symptom of imbalances elsewhere, therefore I do not spend a lot of my client’s energy and finances on intestinal permeability testing.
Having said that there are some individuals where I want to see if there is evidence of a breakdown in that barrier and perhaps evidence of immune responses to bacterial toxins (endotoxin/lipopolysaccharides) that may have entered the body.
Markers we assess when looking for Intestinal Permeability
Elevated serum zonulin (blood)
High zonulin in the blood is associated with intestinal permeability. Zonulin is a protein that leads to the breakdown of the tight junctions that hold the gut barrier together.
Elevated Lipopolysaccharides (LPS)
LPS is the immunogenic portion of the outer cell membrane of certain types of bacteria. When high in the blood it means they are passing from the gut into systemic circulation. When it ends up in general circulation it can cause strong immune and inflammatory responses.
Elevated faecal zonulin (stool test)
This is a common marker on many functional stool tests now and helps to indicate if there is a high presence of a protein associated with causing intestinal permeability. It is useful from the perspective that it comes with an overview of the gut microbiome. As a standalone marker, it is not something that I would invest into.
There are other tests available looking at gut permeability, however, to date I have not used other assessments for intestinal barrier screening. For me, it is less important to diagnose intestinal permeability and more important to investigate the underlying causes such as the environmental factors that might be driving it in the first place like stress, diet, medication use, imbalances in the gut microbiome etc.
Treatment considerations for intestinal permeability
I have touched on this above. To start off with, I always look to optimise nutrition and lifestyle factors first.
If symptoms are suggestive of some digestive imbalances and they are not improving with nutrition and lifestyle changes alone, then I may consider stool testing and following a 5R style approach to addressing digestive imbalances.
On top of this I may also look at running a temporary elimination diet with a client to help determine if food is a significant trigger of their symptoms and possible intestinal permeability.
If I was looking for some symptomatic support or if I had evidence of gut permeability, I might consider some supplemental support for the gut barrier, such as:
- Deglycyrrhized Liquorice
- Pre and Probiotics
- Zinc Carnosine
- Marshmallow root
- Slippery Elm Bark
- Vitamin A & D
Please let me stress that just taking supplements for the gut barrier without addressing the root of the issue provides often limited or short-lasting results. You have to determine the cause or contributing factors for long term success.
I hope you have found this content useful. If you feel that you could benefit from additional support in this area, don’t hesitate to get in touch using the enquiry form below.
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- Dr Alessio Fesano MD: The gut is not like Las Vegas
- Dr Alessio Fesano MD: Nutrition, microbe composition and leaky gut: Clinical and Therapeutic consequences
- Intestinal Permeability – A new target for disease prevention and therapy
- Increased Intestinal Permeability and Decreased Barrier Function: Does It Really Influence the Risk of Inflammation?
- Leaky gut as a danger signal for autoimmune disease
- 5R approach to restoring gut health
- Optimising Digestion: How to perform an elimination diet
- Foods that support a healthy digestive system
- Pre & Probiotic foods
- Why SIgA is low and what you can do about it
Tags: digestive health