If you suffer from impaired transit, diarrhoea or constipation, bloating and intestinal cramps, you may be afflicted with a condition colloquially known as “leaky gut”.

These symptoms are quite common, being reported in around 30% of the population. the proper medical term for the condition is Irritable Bowel Syndrome (IBS). while sometimes ascribed to psychological factors like stress or anxiety, IBS symptoms are more likely to have a physical origin. very common causes are lactose (milk sugar) or fructose (fruit sugar) intolerance, inflammation of the gut, bacterial overgrowth in the gut, gluten intolerance and type III food allergies. But what most people and physicians do not know is that these symptoms may suggest that you are suffering from leaky gut, a condition that can sometimes can be dangerous because it may cause other illnesses.

Leaky gut can cause an inflammation in the blood and even profound inflammation or auto-immune disorders. Leaky gut may cause chronic fatigue, depression, skin disorders, headaches and heart disorders. New research findings show that leaky gut is even associated with the onset of brain disorders, such as multiple sclerosis, Alzheimer’s and Parkinson’s.

How can we explain the association between leaky gut and these different medical disorders? In our bowel cavity there are many bacteria (collectively called bowel flora). Their number increases from the small intestine to the colon. These bowel flora ensure that food is properly processed and digested. They help to digest cartilage and fibres which we ourselves cannot digest. They are also important for the production of certain vitamins, such as vitamin K.

Hundreds of millions of such bacteria are present in the bowels of a typical adult and they may account for up to one or 1.5 kilogrammes of one’s body weight. there are 300 to 600 different types of gut bacteria. most of them are useful but there are also a few potentially dangerous varieties. Some bacteria contain a very toxic substance, called LPS, that is part of the bacterial wall. When small amounts of bacteria containing this toxic substance enter the bloodstream, our immune system mounts a strong reaction to eliminate the bacteria and the toxic substances contain. But when too many bacteria containing LPS enter the bloodstream a dangerous condition, sometimes life-threatening, may result. for this reason one’s body must be able to defend itself against these “bad” bacteria that are normally present in the bowel.

The primary tool our body uses to keep these bad bacteria under control is “good” bacteria (probiotics), such as milk acid bacteria (lactobacillus). When sufficient numbers of good bacteria are present, the detrimental bacteria cannot develop further. thus, milk acid bacteria function as a type of buffer which _ by virtue of their large numbers _ can catch and contain the bad bacteria. you can give nature a helping hand by taking probiotic pills.

A second line of defence against bad bacteria is the bowel barrier, a thin layer of cells and mucous membranes that is normally impermeable to bacteria, thus contain them in the intestinal cavity. Leaky gut arises when the bowel barrier is interrupted because the sticky substances that hold the cell walls together are disrupted. as a result, gaps arise between the cells and bad bacteria may use these openings to pass from the bowel into the bloodstream. this we call leaky or leaking gut. When bad bacteria penetrate the bloodstream they precipitate an inflammatory reaction and, as a consequence, cause the medical disorders described above.

There are several causes of leaky gut: inflammatory bowel disorders, such as Crohn’s and colitis ulcerosa; infections with yeast, such as Candida; infections with bacteria which cause gastro-enteritis, such as salmonella; long-term or very frequent use of antibiotics; repeated use of painkillers (NSAIDs) or alcohol; long-standing psychological stress; extended physical effort (athletes are particularly prone); and food allergies. In addition, very common conditions, such as lactose and fructose intolerance, may endanger your gut wall and promote leaky gut. A shortage of certain anti-oxidants may also increase the risk of you developing leaky gut. for example, when you have a deficiency of glutamine, painkillers can easily cause a leaky gut. this means that the presence of glutamine, an anti-oxidant, is obligatory in order to preserve a good bowel barrier and thus an adequate defence against the bad bacteria.

We estimate that around 50% of patients with depression, chronic fatigue and IBS also suffer from leaky gut. Phrased differently, leaky gut may play a role in the onset of each of these disorders. Although leaky gut is very frequent and a potentially dangerous condition it remains unrecognised in most cases. the diagnosis of the condition is very simple: one specialised blood and stool test can reveal whether you suffer from leaky gut or not. We would recommend that individuals who suffer from IBS symptoms have their blood and stool tested for leaky gut.

It is also important to identify the trigger factors that have caused leaky gut and IBS in order to eliminate these triggers. it may be necessary, therefore, to examine whether you suffer from lactose or fructose intolerance, small intestine bacterial overgrowth, inflammation of the gut, gluten or other food allergies, etc. Although many patients suffer from IBS and leaky gut due to lactose and fructose intolerance and food allergies, most physicians do not test for these conditions.

Our treatments are based on repairing the gut wall by treating with specific anti-oxidants, such as glutamine and zinc. Probiotics will help to reinstall a better equilibrium between the good and the bad bacteria. A specific diet will also help to repair the leaky gut.

New medications to treat leaky gut are likely to become available in the next few years. These medications are now being developed in the US and in Europe. Some are based on chemical compounds. others come from substances produced by living bacteria that have been found to strengthen the gut wall and repair leaky gut. Effective treatment of leaky gut and IBS also calls for the elimination of trigger factors. Therefore, exclusion diets and sometimes antibiotics or antifungal drugs to eradicate bacteria or yeast may be necessary. By following a proper course of treatment, IBS symptoms such as cramps, diarrhoea, constipation amd bloating will be considerably alleviated and should eventually disappear, while the potential danger posed by a leaky gut will be removed. this treatment will not only address the fatigue, depression, skin problems, etc, but will also prevent these conditions in the future.

Michael Maes, MD, PhD, is a physician based at the TRIA Integrative Wellness and Medical Institute, Piyavate Hospital.

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