by Ali Miller
In attack mode, inflammatory chemical mediators are released from immune cells to battle these compounds. However, many of the compounds that cross the gut-blood barrier in the case of leaky gut are otherwise harmless food compounds that don’t necessitate an attack. In this state the body goes into overreactive mode as a hypervigilant immune response, which drives chronic inflammation and excessive immune reactivity. Studies show that these attacks play a role in the development of autoimmune diseases.
The main culprits of this leaking are gut-damaging chemicals and medications, inflammatory foods, infections, bad bacteria, and toxins. As discussed in Chapter 2, gluten is the number one cause of leaky gut, with abrasive activity of gliadin, a pro-inflammatory compound. Another concern with gliadin is its production of zonulin proteins in gut cells, which unlock tight junctions in the gut lining. In this sense, gluten can cause both inflammatory irritation and, in the role of gatekeeper, drive the opening for more destruction by letting larger particles cross the gut-blood barrier. Here are some symptoms that are associated with leaky gut:
•Brain: Brain fog, depression, ADHD, anxiety
•Skin: Acne, psoriasis, eczema, rosacea, hives, dermatitis
•Thyroid: Hashimoto’s, hypothyroidism, hyperthyroidism
•Colon: Constipation, diarrhea, colitis, Crohn’s, IBS
•Ear, nose, throat: Phlegm, allergies, difficulty swallowing, frequent colds, mucus
•Structural system: Fibromyalgia, arthritis, joint pain, headaches
•Adrenals: Chronic fatigue syndrome, histamine reactivity, panic attacks
•Autoimmune: Multiple sclerosis (MS), neuropathy, Parkinson’s, lupus, chronic inflammatory demyelinating polyneuropathy (CIPD)
Chemicals and Medications that Drive Leaky Gut
Prevention is always the most powerful tool in optimized health! Below are the common irritants and drivers of leaky gut. After reading, take the Anti-Anxiety Diet Leaky Gut Quiz (page 38) to understand the state your gut lining may be in, which will determine the level of intervention and supplementation warranted.
Chlorine. Chlorine in drinking water can be damaging to the gut by sterilizing gut flora. Other commonly consumed chemicals include food additives or preservatives that act as stabilizers, fillers, or emulsifiers. These chemical additives are found throughout processed or even natural products such as almond milk. Food chemicals such as carrageenan, cellulose gum, and polysorbate 80 destroy mucosal membranes and can allow bad bacteria to pass the gut lining, plowing through with damaging effects.
Non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics. These two top drivers of leaky gut are very irritating to the GI tract, causing a separation of gut lining junctions. They can even cause hemorrhaging or bleeding to the intestinal lining, especially if combined with alcohol use. NSAIDs include over-the-counter drugs such as Advil, Aleve, Ibuprofen, and their higher dose counterparts Meloxicam, Celebrex, and Naproxen Sodium, to name a few.
It is important to emphasize the influence of these seemingly harmless drugs, as many people take daily doses of NSAIDs to cope with muscle and joint aches and pains that may be resolved with reduction of inflammatory foods in the diet and support to repair leaky gut. However, instead of reducing the driving causes, they take a drug that provides short-term relief while providing a more long-term hit to the gut lining, which perpetuates the body’s inflammatory response.
Antibiotics. Antibiotics have a less direct but very important role in leaky gut. These drugs sterilize the gut microbiome, including the protective probiotic colonies that seal the gut lining junctions and aid in the further breakdown of foods. When the gut microbiome is weakened through the use of antibiotics, the epithelial gut lining function is compromised. The use of antibiotics also drives imbalance of the microbiome (see Chapter 3).
Unfortunately, like many drugs, we are just starting to see the long-term effects of use. In fact, the first antibiotic, penicillin, did not hit mainstream healthcare until 1939, and since the 1950s it has been increasingly prescribed for both necessary conditions like blood, bone, and organ infection as well as unnecessary conditions like common ear infections, sore throat, and bronchitis, which may have viral influence in which antibiotics serve no beneficial purpose.
Cancer treatments. Cancer treatment, including both the toxic exposure of chemotherapy as well as the sterilizing effects of radiation, can also drive leaky gut. Chemotherapy, in its focus to attack abnormal cells and malignancy, can also hit the epithelial lining of the gut, reducing digestive enzyme production and bloating as well as increasing permeability in the intestines. Radiation has similar outcomes but with more of a mechanical damage from exposure. Both chemotherapy and radiation reduce probiotic activity, as well, which can lead to less protective activity on the lining.
PPIs. Another more commonly prescribed drug category of concern that is now available over the counter is proton pump inhibitors (PPIs), from Nexium and Protonix to the generic omeprazole and pantoprazole. These drugs work to reduce the production of stomach acid. Many people take them for heartburn, reflux, or indigestion; however, often the cause of these conditions is the exact opposite—too little stomach acidity. In fact, stomach acid is supposed to be quite acidic, with a pH of 1 to 2.
Bacterial imbalance, stress, and other drugs can neutralize the stomach acid, causing more bloating and impeding optimal digestive function. When stomach acid gets too low, foods are not properly broken down, which only exacerbates the issue. When these drugs are taken as a response to bloating or acidity in the esophagus often they will resolve the acidity by neutralizing it, but the individual will be prone to vitamin and mineral deficiency as the hydrochloric acid (HCl) levels in the stomach need to be optimized to activate certain enzymes to break down and absorb nutrients. In fact, one of the drivers of B12 deficiency anemia and bone demineralization is associated with use of PPIs. In addition, when B12 levels drop, anxiety peaks, as B12 has calming effects to stabilize mood.
Foods that Drive Leaky Gut
We make over 300 food-related decisions per day. We can choose to consume foods that soothe and heal or that damage and inflame. Food can influence leaky gut by causing structural damage, bacterial imbalance, and the inflammatory process. Foods contributing to leaky gut contain lectins and phytates (primarily in wheat, grains, and legumes), refined processed sugar, excessive carbohydrate, and omega-6 fatty acids from industrialized oils (corn, soy, cottonseed, safflower, to name a few). Familiarize yourself with the foods to remove covered in Chapter 2, Remove Inflammatory Foods.
Infections and Pathogens that Drive Leaky Gut
The presence of pathogenic (bad) bacteria in the gut can cause an imbalance in gastrointestinal lining function. This has been shown to be a primary cause of mortality in poverty-stricken countries where malnourishment is widespread. In fact, research done on the villi of the gut when a pathogen is induced in both healthy and malnourished rats determined that the malnourished state accelerates damage of the gut lining in the presence of a pathogen and that there is greater risk of translocation, which is when the pathogen crosses the gut lining and enters other areas of the body.
Bacteria and infections in the body influence gut integrity on an immunological level. Specific immune T helper cells (Th17, Th22) play a role in maintaining the epithelial lining of the gut via production of interleukin-22 (IL-22), which is optimized in a healthy, balanced gut. When the immune system is distressed it will reduce its production of IL-22, which drives leaky gut. In IL-22 deficient mice, research has shown higher mortality when exposed to Clostridium difficile (C. diff), a known pathogen, as the low levels of IL-22 allow the C. diff to cross the gut barrier, hitting other vital organs and driving dysfunction on a whole-body level.
Toxins and Leaky Gut
Industrialized chemicals in our food, water, air, and households can contribute to gut damage via direct chemical insult as well as sterility of gut biome. The US consumes more GMO crops than the rest of the world, and
we allow many chemical substances in our food system that are banned in other developed nations. Additives, stabilizers, flavor enhancers, and other ingredients are found ubiquitously within the Standard American Diet.
Agriculture for both consumed crops and industrial crops like cotton, as well as confined animal feeding operations (CAFO) for conventional meat production with use of growth hormone, antibiotics, and mismanaged feces, contribute to chemical toxicity in our water systems. The bisphenol A (BPA) in plastics for food and beverage containers adds insult to injury as a contributor to toxicity and hormone imbalance in the body, driving immune and gut distress.
Volatile chemicals from petrofuels, toxic metals from the mining industry (mercury, lead, asbestos, arsenic, cadmium), and dangerous inhalants in flame retardants and adhesives found in most upholstery and furniture (mattresses, curtains, car seats, to name a few) can all find their way into our air and water systems. Even an individual with an organic and clean diet can be exposed to toxic overload due to the dirty industrialized world we live in. It is estimated that each year, 6 billion pounds of toxic chemicals are released into our environment. Things like arsenic, toxic metals, pesticides, flame retardants, and rocket fuel have all been found in significant levels in most Americans! In fact, according to the Fourth National Report on Human Exposure to Environmental Chemicals, the CDC has found traces of 212 chemicals in typical urinary output, and over 200 different industrial chemicals have been found in the umbilical cords of babies. These toxins can accumulate in the body and negatively impact your overall health.
Your body has the natural ability to rid itself of toxins and waste; however, most of our systems are overwhelmed with far more toxins than the body can get rid of. Excess toxins and waste in the body can lead to symptoms such as:
•Anxiety
•Depression and irritability
•Chronic fatigue
•Skin conditions
•Weight gain
•Joint pain
•Headaches and muscle aches
•Allergies
•Gastrointestinal distress
Stress and Leaky Gut
Stress indirectly causes changes in the microbiome. Research has discovered that lipopolysaccharide (LPS), which is released in the presence of pathogenic bacteria and infection, can drive leaky gut by reducing function of tight junctions of the gut. Emotional and social stress further affect the gut because LPS is released in higher amounts in depressed or anxious individuals. The release of inflammatory chemicals as a response to the leaky gut further drives the anxiety and stress response and perpetuates the cycle. When the parasympathetic fight-or-flight system is turned on from a stress response, it has a significant influence on the intestinal immune system on a bacterial, inflammatory, and gut lining integrity level.
Anti-Anxiety Leaky Gut Quiz
Respond to the following questions with Never, Sometimes, or Often. Give yourself a score of 2 for each Often response, 1 for Sometimes, and 0 for Never. (Where appropriate, use 2 for Yes, 0 for No.)
This quiz will be used as a tool to determine if leaky gut and inflammatory foods are a root cause of your anxiety, requiring additional support such as advanced testing or nutritional supplementation.
The recommendations on the following pages correspond to formulas carried in my clinic. In Supplement Support for the 6 Foundational Rs on page 159, you will find information on dosage, active ingredients, and mechanism of action so you can determine if these formulas are a good fit or find comparable ones that have similar composition.
1. Have you been diagnosed with an autoimmune condition (e.g., Hashimoto’s, rheumatoid arthritis, fibromyalgia, MS)?
Never
Sometimes
Often
2. Do you suffer from acne?
Never
Sometimes
Often
3. Do you suffer from or have a history of other dermatological concerns (e.g., eczema, hives, psoriasis, rosacea)?
Never
Sometimes
Often
4. Do you experience joint or neuromuscular pain?
Never
Sometimes
Often
5. Do you experience bloating?
Never
Sometimes
Often
6. Do you have irregular bowel movements, such as constipation or diarrhea?
Never
Sometimes
Often
7. Do you experience heartburn, reflux, rawness in the stomach, and/or are you on a PPI for heartburn or reflux?
Never
Sometimes
Often
8. Are there foods or additives that you are sensitive to with a digestive, dermatological, or neurological reaction? (If you experience more than three known reactions, give yourself a score of 4.)
Never
Sometimes
Often
9. Do you experience difficulty concentrating or focusing (i.e., brain fog)?
Never
Sometimes
Often
10. Do you find yourself fatigued or mentally drained after meals?
Never
Sometimes
Often
11. Have you been diagnosed with gastritis or IBD such as Crohn’s, ulcerative colitis, or diverticulitis?
Never
Sometimes
Often
12. Do you have micronutrient deficiency symptoms such as muscle twitches, hair loss, brittle breaking nails, anemia, weakness, shortness of breath, and/or poor immune function?
Never
Sometimes
Often
13. Do you experience ear, nose, and/or throat irritation such as phlegm, mucus, and/or runny nose?
Never
Sometimes
Often
Total Score: ______________________________
Less than 10
Keep gluten out of your diet for at least 12 weeks to further support your gut lining, then limit consumption to two to three times per week, if at all. Consider taking Naturally Nourished Digestaid Enzyme with DPPIV to break down gliadin, when mindfully consuming. Strategically reintroduce gluten after three months using the guidelines in Chapter 2 to reintroduce eliminations. Consume 4 to 6 ounces of bone broth four times per week to continue to support your healthy gut.
Less than 15
Keep gluten out of your diet for six months minimum and consume 4 to 6 ounces of bone broth five to seven times per week to start to repair and soothe your gut. Consider taking 2 to 3 grams of L-glutamine in combination with aloe and DGL, such as the Naturally Nourished GI lining powder, at bedtime to accelerate gut repair and reduce food sensitivity. Take Digestaid Enzyme with DPPIV when dining out to break down gliadin and casein from potential cross contamination. Follow a strategic reintroduction after three months of removing the other four inflammatory foods (while keeping gluten out strictly for six months). Use the guidelines in Chapter 2 to reintroduce eliminations to determine reactivity and if you need to dig deeper on irritants to your gut and body with the MRT blood test.
Greater than 15
In addition to following the supplement recommendations for a score of less than 15, keep gluten out of your diet for 12 months minimum, and the other four inflammatory foods for three months. Use the guidelines in Chapter 2 to reintroduce eliminations after a 1-year period. As this is considered serious risk for leaky gut, it is recommended to run the MRT blood test to learn more about individualized food sensitivity and inflammatory food reactions beyond those eliminated in Chapter 2. Learn more about the Mediator Release Test (MRT) in the Appendix on page 167.
Gut-Blood Barrier and Immune Reactivity
When addressing the root causes of anxiety, gut integrity is a top area of focus. There is strong evidence of depression and anxiety being driven by activation of inflammatory response of the immune system, including release of cytokines and LPS, both of which are released in excess in a state of leaky gut. Secretory IgA (imm
unoglobulin A) is produced in the immune system as a barrier for mucosal membranes. Chronic stress and anxiety can drive imbalance of excess or deficiency. Secretory IgA drops when the immune system is pooped out and an individual is in the “stressed and tired” adrenal insufficiency mode. Elevated secretory IgA is seen when the body is under acute stress from attacking pathogenic bacteria, yeast, or viral influence in the gut. In both cases of too high or too low secretory IgA, leaky gut can be seen, with undesired particles crossing the gut-blood barrier and driving anxiety and mood instability.
Blood-Brain Barrier and Histamines
Histamine is an inflammatory compound made by the immune system in response to allergies in the environment or to gut bacteria action. Histamines can be found actively in certain foods. The role of histamine is to remove the invader from the body rapidly via sneezing, watering eyes, coughing, and other known seasonal allergy responses; however, when histamine builds up in the gut, rapid removal can be more difficult, leading to bloating, GI pain, and bowel irregularity.
Histamine buildup in the blood drives vasodilation, which drives the heart rate to speed up as the body tries to push blood through the canal with less tension. The reaction in the body can first feel like a slump or crash followed by panic and anxiety as tachycardia, or rapid heart rate, hits. Flushing or redness in the skin can further drive anxiety and unease, especially if hives or red marks appear in public.