Is There Really Such Thing As Leaky Gut?

by Valerie Polley | Jan 15, 2019 | 0 comments

Is There Really Such Thing As Leaky Gut?

Sometime during 2015 I was told I had “leaky gut.” I had no idea what it meant or if it was an actual diagnosis. I had not heard the term in college or any of my time working at Johns Hopkins Hospital. In December 2016, I was accepted and attended the 3-day preceptorship program at the University of Chicago Celiac Disease Center. During a presentation, one of the gastroenterologists talked specifically about “leaky gut” or what is called intestinal permeability. Now, more doctors are seeing leaky gut as an issue. Dr. Alessio Fasano, a gastroenterologist and a world-renowned expert on intestinal permeability is doing much research on this topic.

What is intestinal permeability (leaky gut)?
The intestine is lined with a layer of cells. There are small gaps in the intestinal wall (tight junctions) that allow small molecules (such as water, electrolytes and other nutrients) into the bloodstream to be used by the body. This layer also helps keep harmful substances out of our bloodstream. In someone with “leaky gut” these tight junctions are not working properly. When these gaps become loose, food may not properly break down before they slip through. The gut is now more permeable. This can also allow bacteria and toxins to enter the bloodstream. The body looks at these as invaders and starts an immune and inflammatory response.

Symptoms
When harmful substances get through the intestinal lining into the bloodstream symptoms can include bloating, digestive issues, fatigue, muscle aches and pains, confusion, and skin issues. These invaders tend to target different areas in the body, making symptoms vary from one individual to another.

Link with autoimmune disease
It is thought that leaky gut is a precursor to autoimmune disease. The immune system reacts when the proteins, bacteria, and viruses slip through the junctions. This in turn can trigger an immune response in those that are genetically susceptible. Multiple diseases can arise or be exacerbated due to leaky gut, including Crohn’s disease, celiac disease, Type 1 diabetes, multiple sclerosis, irritable bowel syndrome (IBS), asthma, cancer, food allergies and intolerances, and rheumatoid arthritis.

What contributes to intestinal permeability?
A variety of internal and external irritants can contribute to leaky gut, such as chemicals in processed foods, alcohol, pollutants, radiation & chemotherapy, NSAID use (such as indomethacin, ibuprofen and naproxen), trauma and burns, and viral or parasitic infections.

Testing for leaky gut
The only test used to monitor intestinal permeability is the lactulose-mannitol challenge. This is used mostly in research, but available in some commercial labs.

Dr. Fasano and his colleagues have focused much of their research on zonulin, which is a human protein. Zonulin tends to widen the intestinal cell junctions, which is thought to cause leaky gut. Based on research, people with an autoimmune disease tend to release more zonulin than the average population, making them more prone to leaky gut. Bad gut bacteria and gluten (via gliadin) are two of the most powerful triggers of zonulin release.

Can leaky gut be treated?
This is an area with a large variety of opinions, but some points that are agreed on are:
Removing gluten from the diet. Make sure to get a celiac antibody test prior to going gluten-free to rule out celiac disease.
Monitor for food allergies or any food intolerance. Based on this, treat with the appropriate diet.
Correct nutritional deficiencies.
*Restore healthy bacteria in the gut with a probiotic.

Other suggestions for helping to treat leaky gut:
Encourage whole-foods, anti-inflammatory diet. This could be the Mediterranean or Paleo diet. The Paleo diet appears to be a more popular choice amongst those with leaky gut and those treating leaky gut.
Decrease alcohol intake if consuming.
Decrease intake of NSAIDs.
*L-glutamine (an amino acid)- Thought to help with growth and repair of intestinal lining.
*Zinc (essential trace element)- Thought to help resolve permeability changes.
*Saccharomyces boulardii (nonpathogenic yeast-a probiotic)
*Prior to starting any supplement or vitamin get your physician's approval first.

Future treatments
Larazotide acetate is being studied to help those with celiac disease that follow a gluten-free diet, but continue to have symptoms. This drug is a tight junction regulator, which can help restore the open junctions (“leaky gut”). In celiac disease, exposure to gluten causes these junctions to open, thus leading to an inflammatory reaction. This medication is also being looked at for others that have intestinal permeability for a variety of other reasons. This medication is still currently being studied.

References:
Stewart E.A. CPE Monthly: Leaky Gut Syndrome-Learn About the Causes, Associated Conditions, and Treatments Under Research. Today’s Dietitian. January 2016. Vol. 18 No. 1 P. 46.
Fasano A. Episode 32: Leaky Gut with Dr. Alessio Fassano. PheonixHelix.com

The information in this blog is not a substitute for professional medical advice, examination, diagnosis and treatment. Always seek the advice of your physician or other qualified healthcare provider before altering your diet, starting a new treatment or making changes to an existing treatment.

With summer here, many people are getting excited about upcoming vacations. But for people with digestive issues, symptoms like constipation and bloating are often unwelcome travel companions. Traveling disrupts our body's natural rhythms and daily habits, which can lead to digestive chaos.

This article will help you understand how sudden changes in hydration, diet, and airplane cabin pressure impact the gut, as well as provide practical, evidence-based tips for keeping your gut happy on the road.

The Perfect Storm for Constipation: Fluid and Fiber Drops

One of the biggest contributors to digestive issues like constipation when you're traveling is a change in your normal hydration and fiber intake patterns. Here's how each affects your gut.

Inconsistent Hydration

Disrupted routines often lead to forgetting to drink water. Plus, strict airport security rules mean you can't carry a full water bottle through security checkpoints. Travelers often intentionally avoid drinking to skip using tiny airplane toilets or unfamiliar public restrooms. Finally, plane cabins are incredibly dry, which can quickly lead to dehydration.

The result: When the body is dehydrated, the colon absorbs more water from food waste, leading to hard, dry, and difficult-to-pass stools.

Reduced Fiber Intake

Most people in the United States don't get enough fiber at the best of times, and traveling only makes this worse. Convenience foods at airports, gas stations, and roadside stops are typically highly processed, high in sodium, and low in fiber. Experiencing local cuisines often means prioritizing rich restaurant meals over fresh fruits, vegetables, and whole grains.

Not getting enough fiber quickly contributes to constipation because fiber is essential for adding bulk to stool and keeps things moving through the digestive tract. A sudden drop in fiber stalls peristalsis (the wave-like muscle contractions in the gut), leading to less frequent bowel movements. 

The Combined Effect

The simultaneous drop in both fluid and fiber creates a "logjam" effect in the intestines. Not having enough fluid and fiber slows the movement of waste through your gut. This leads to more water being absorbed from the stool, resulting in hard, difficult-to-pass stool. The traffic jam effect makes acute constipation one of the most common (yet preventable) gut-related travel complaints.

Cabin Pressure and Bloating

Have you ever noticed that you get more bloated during air travel than other forms of travel? No, you're not imagining things. This is due to a law of physics called Boyle's Law. Simply put, this law of physics states that as atmospheric pressure decreases, the volume of a gas naturally increases.

Here's how that works with your gut and air travel. Airplane cabins are pressurized to simulate an altitude of around 6,000 to 8,000 feet. Because of this shift, the gas that's already present in your gut expands during flight. This rapid gas expansion stretches your intestinal walls, leading to pain, cramping, and bloating often referred to as "airplane belly."

Additionally, several common travel habits can aggravate this trapped gas. Drinking carbonated beverages before or during the flight, chewing gum (which leads to swallowing excess air), and remaining stationary for hours on end all trap and intensify the expanding gas.

Tips for a Happy Travel Gut

Fortunately, a few small tweaks to your travel routine can make a huge difference in whether you end up constipated and bloated while traveling.

Pre-Flight and In-Transit Tactics

  • Hydrate on the go: Bring an empty, reusable water bottle through airport security and fill it once you reach the departure lounge (most airports now have water bottle filling stations). Aim for consistent sipping throughout your journey to keep hydrated.
  • Be mindful of foods that can worsen bloating: Avoid fizzy drinks, heavy or fried foods, and gas-producing foods like beans, broccoli, and cabbage, for at least 24 hours before your flight. This can reduce the amount of gas present in your gut, which can reduce the bloating associated with a drop in cabin pressure.
  • Pack smart snacks: Since airport snacks are typically high in sodium and low in fiber, bringing your own high-fiber, travel-friendly snacks can help boost your fiber intake. Consider packing dried chickpeas, almonds, dried fruit, or on-the-go fiber supplements to bridge the gap.

On-Arrival Habits

  • Prioritize fiber: While there's nothing wrong with enjoying the local cuisine wherever you're traveling, try to prioritize fiber at your destination whenever possible. I recommend starting your day with a high-fiber breakfast, such as oatmeal with fruit, nuts, and seeds.
  • Get moving: Try to avoid being sedentary on arrival. Going for a leisurely walk helps stimulate intestinal motility and releases trapped gas (there's a reason a short walk after meals is commonly called a "fart walk"!).
  • Keep a regular sleep schedule: Vacation can throw a serious wrench into your routine, but wherever possible, try to maintain it. Gut issues can be worsened by poor sleep, so sticking to your routine can help support gut comfort on vacation.

Final Thoughts

Travel naturally changes our dietary habits and challenges our digestive system through abrupt changes in cabin pressure, but digestive discomfort doesn't need to ruin your vacation. By being mindful of your fluid and fiber intake, staying active, and making strategic changes in pre-flight eating habits to minimize the effects of cabin pressure changes, you can keep your digestion on track and enjoy every minute of your vacation.

If you're worried about an upcoming trip and need personalized strategies for managing your digestion on vacation, I'd love to help. You can get in touch with me at Blue Tree Nutrition to book your appointment with a registered dietitian.

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Hello, I am

Valerie

My name is Valerie Polley. I am a Indianapolis-based registered dietitian and owner of Blue Tree Nutrition. I consult with clients both local and far away.
I have a bachelor’s degree in nutrition from Purdue University and I have been practicing for 20 years.
I thoroughly enjoy helping clients through their gut health journey. I see a range of GI issues including, but not limited to celiac disease, IBS and SIBO. I also specialize in the FODMAP elimination diet.