"Leaky Gut"
By Emily Brown PhD. CNS.
Reviewed by Inna Krieger PhD.
Do you suffer from chronic disease? Chronic joint pain? Low thyroid function? Unresolved autoimmunity? Intestinal pain? Brain fog?
Leaky gut is a primary cause of chronic disease.
Addressing leaky gut doesn’t have to be hard. Overcoming this growing health concern depends on identification of causative factors through diagnostic testing and choosing the appropriate intervention.
In this article I will share one of my favorite evidence-based tests that is available to diagnose leaky gut. I will also share how this test informs intervention and therapy.
The expression “leaky gut” is used to describe a spectrum of problems related to intestinal permeability. Intestinal permeability can be caused by pathogenic bacteria, nonsteroidal anti-inflammatory drugs (aspirin, advil), proton pump inhibitors (pepcid, zantac, prilosec), overgrowth of opportunistic bacteria, alcohol, parasites, immune system dysfunction, dietary sensitivities, or any combination of these factors.1
Causative agents of intestinal permeability
The field standard for evaluating leaky gut is a test by Diagnostics Solutions. This test is called the GI-Map Test.
The GI-Map Test evaluates intestinal permeability by measuring fecal zonulin. Zonulin is a signal peptide that serves to open the tight junctions between co-joined intestinal epithelial cells.2,3
Normal fecal zonulin levels should be around or below 50 ng/mL.5,6 Higher fecal zonulin levels reflect that the tight junctions are frequently open allowing microbes, toxins, and undigested food to enter the bloodstream and encounter the immune system.
The most common causes of high zonulin are gluten and small intestinal bacterial overgrowth (SIBO).8 The GI-Map Test includes diagnostic markers for both gluten and SIBO.
The GI-Map Test marker for reactivity to gluten is anti-gliadin IgA. If this marker is high it means that your immune system is making antibodies against gliadin –the part of wheat that triggers immune reactions in many people. The test measures anti-gliadin IgA antibodies made against total gliadin protein, which likely includes alpha gliadin, beta gliadin, omega gliadin, gluteomorphin, and prodynorphin (personal corresondance with DS lab).
If you have an anti-gliadin IgA level greater than 157 U/L, gluten has a high probability of being a key causative agent of your leaky gut.
Learn more about tight junctions
Nutrients (carbs, fats, protein, vitamins, minerals, and drugs) are absorbed into the body across the intestinal barrier. The intestinal barrier separates your gut from the inside of your body.4 This barrier is a single layer of cells.
There are two paths by which nutrients can move from the gut to the inside of your body. One pathway is called the transcellular route. Nutrients absorbed via the transcellular route will go through the intestinal epithelial cell. This is thought to be the dominant route for absorption.
The second path is called the paracellular route. Nutrients absorbed via the paracellular route will go between one intestinal epithelial cell and its neighbor via a gate.
The gate between intestinal epithelial cells is called a tight junction.4 The tight junctions are negatively charged and thought to transport primarily positively charged molecules. The gates also restrict anything larger than 4.5 angstroms.
Most “leaky gut” occurs due to tight junctions that open too much or that are tricked into letting the wrong substance pass. When this occurs the immune system becomes activated and autoimmunity and inflammation quickly follow.4
The second most common cause of leaky gut is bacterial or fungal overgrowth. The GI-Map Test quantifies commensal, opportunistic and pathogenic bacteria. Click here to view a sample GI-Map Test. If your report shows a high level of an opportunistic or pathogenic bacteria, it is probable that this overgrowth is a contributing factor to your increased intestinal permeability and will need to be addressed. Candida (yeast) and H. Pylori levels are also reported on the GI-Map test and are frequently elevated in intestinal permeability.
There is not a one-size-fits-all solution to leaky gut. Removing foods, drugs, supplements, and alcohol that increase intestinal permeability is a great starting point. Incorporating foods that nourish the gut such as bone broth and high fiber vegetables may also improve gut health.
People that recognize the implications of leaky gut often want to remove the guesswork and confidently disrupt leaky gut. At Nutriplexity we can help you do this. We sit down with you and identify which testing options are necessary to diagnose your leaky gut situation.
Using your own data we then develop a program that will help you overcome your leaky gut. Some examples of interventions include a low FODMAP, Gluten Free, or Candida diet, the antibiotic rifaximin, bacteriophage to kill E. coli, probiotics, specific treatment of intestinal parasites, administration of immunoglobulins, and specific rebalancing of the immune system. Everything is custom. Specific for you.
References
- König J, Wells J, Cani PD, et al. Human Intestinal Barrier Function in Health and Disease. Clin Transl Gastroenterol. 2016;7(10):e196.
- Fasano A, Not T, Wang W, et al. Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease. Lancet. 2000;355(9214):1518-1519.
- Fasano A. Intestinal permeability and its regulation by zonulin: diagnostic and therapeutic implications. Clin Gastroenterol Hepatol. 2012;10(10):1096-1100.
- Wells JM, Brummer RJ, Derrien M, et al. Homeostasis of the gut barrier and potential biomarkers. Am J Physiol Gastrointest Liver Physiol. 2017;312(3):G171-G193.
- Schwiertz A, Spiegel J, Dillmann U, et al. Fecal markers of intestinal inflammation and intestinal permeability are elevated in Parkinson’s disease. Parkinsonism Relat Disord. 2018;50:104-107.
- Malíčková K, Francová I, Lukáš M, et al. Fecal zonulin is elevated in Crohn’s disease and in cigarette smokers. Pract Lab Med. 2017;9:39-44.
- Fasano A. Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiol Rev. 2011;91(1):151-175.
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Hi Emily. Thanks for this article. The Gi-MAP is certainly an interesting tool.
I was wondering if if you know why the medical and scientific community has not yet accepted elevated anti-gliadin IGA antibodies in the stool as a biomarker of NCGS? Are there any issues with the stool test (low specificity, for example) that you know of?