Leaky Gut Syndrome and the Autoimmune Disease Connection
By Dr. Justin Marchegiani
Leaky gut syndrome (gastrointestinal permeability) is a phenomenon that occurs within the intestinal tract where the epithelium tissue’s tight junctions open slightly, allowing undigested food particles and potential bacteria (endotoxin) to make its way into the bloodstream. These compounds are typically only found in the gut, so our immune system goes on high alert when it starts seeing new and unusual things. Our immune system reacts by creating various immune cells called antibodies to inspect what’s going on (and potentially attack)! These antibodies are equivalent to our navy, marine corps, air force, and army; their job is to tag these various particles for destruction. When our immune system attacks some of these foreign proteins (antigens), various organs can get caught up in the scuffle. This accidental tagging is a case of mistaken identity, or the scientific term molecular mimicry.
How Does Molecular Mimicry Work?
There are amino acid sequences on these antigens (foreign particles) that are similar to other tissues in the body. Our immune system reads these antigens by the sequence of its surface proteins. It’s kind of like getting pulled over by a policeman that is out looking for a similar make and model of the car you drive because a suspected criminal was seen driving the same car earlier that day. Foods like gluten can easily cause your immune system to start attacking the thyroid gland, brain, intestinal tract (celiac, Crohn’s, ulcerative colitis), or other nervous-system tissue based on similarity and genetic predisposition. There’s a good deal of research showing that autoimmune disease cannot occur without a leaky gut. This is why people with a chronic illness need to have their gut checked. Click here to get your gut checked!
Gluten and Cross-Reactivity
When these proteins have a similar shape to other proteins, cross-reactivity can occur. These proteins have the ability to bind into other receptor sites, just like with casein and gluten. As you can see by the picture below, the shape of the antigen can be enough to confuse the immune system.
Foods containing things like casein from dairy products can cause the immune system to start attacking the pancreas. Casein can also cross-react with gluten too! Cross-reaction is where the immune system starts responding to other proteins as if they are gluten. This is the reason why some people who only remove some grains from their diet may not recover fully. The consumption of other cross-reactive foods outside of gluten can be enough to prevent your thyroid from healing.
It All Comes Down to Genetics
Wherever the weak link in your genetic chain is, may be the deciding factor regarding what autoimmune condition you express. The tighter you pull your genetic chain, the increased chance those weak links will be exposed and break. The tightness is equivalent to the stress in your life, while the weak link is symbolic of your genetic susceptibility.
Some people may get Hashimoto’s (autoimmune thyroid condition) while others may develop multiple sclerosis or Parkinson’s disease. There tends to be a genetic link regarding what condition you may express. If Parkinson’s or Hashimoto’s runs in your family, this may be a good indicator of what you are predisposed for.
Genetic predisposition is not a death sentence but merely a strong warning you need to heed. I personally have an autoimmune thyroid condition and also have many other autoimmune conditions that run in my family. Because of this, I pay close attention to my diet, emotional stress, physical stress, and chemical stress. The stressors, or allostatic load, in your life have a huge impact on your epigenetics. Your epigenetics control what genes your body expresses, kind of like turning a light switch on or off. So in other words, you have the ability to control what genes you express or don’t express.
So if you have a predisposition toward chronic degenerative autoimmune conditions, it’s really important that you develop other healthy habits that keep those genes from expressing themselves. The more our immune system is fired up, the more inflammation occurs in our body. The additional inflammation and undigested food proteins put additional stress on our detoxification system, causing our liver to have to work harder to filter out all those extra antigens and toxins in our blood stream.
What Causes Leaky Gut?
Inflammation is the underlying cause of leaky gut. Below I will talk more specifically about what the underlying drivers of inflammation are.
Food allergens
All grains, especially gluten-containing grains, such as wheat, barley, rye, oats, spelt, and Kamut, can be hyperallergenic. Other foods can also cross-react with gluten, such as dairy products (especially milk products that are higher in casein) and legumes (soy, beans, and peanuts). Butter, heavy whipping cream, and ghee tend to be OK. Some people who are autoimmune need to avoid everything but ghee. Many of these allergens tend to be a little controversial.
Most people think of allergies as the kinds that close up your throat, like when someone who has a peanut allergy eats peanuts. That type of allergy is known as an IgE-mediated immune response, or in the above peanut example, an anaphylactic response. We tend to know about these allergens in childhood because of some type of traumatic experience that may have included a blocked airway, itching, and/or hives. The allergenic response I am talking about comes from a different part of the immune system. Essentially, a low-grade inflammation that occurs because of a cross-reactivity or an IgA–, an IgG–, or a T-cell–mediated immune response. These types of immune responses can cause leaky gut and contribute to thyroid imbalances, adrenal fatigue, brain fog, weight gain, and other digestive symptoms.
Low stomach acid
We need HCl, or stomach acid, to help break down our proteins and ionize minerals. If we don’t have enough stomach acid, we can’t break down and absorb zinc. If we don’t have enough zinc, this can affect our immune system, sex hormones, and our ability to make stomach acid. As you can see, a downward spiral is occurring that causes our body to break down even faster with no end in sight!
Infections
With inadequate stomach acid, we are also prone to gut infections (bacterial, parasitic, fungal, and viral) and small intestinal bacterial overgrowth (SIBO). Many of these infections produce biotoxins/endotoxins that can affect hormone metabolism and nutrient absorption and can contribute to fatigue of the thyroid and adrenal glands. Chronic infections tend to play a role with autoimmune conditions as well as leaky gut.
How Do We Fix Leaky Gut?
When getting to the bottom of leaky gut, it’s essential to incorporate a 5R program (remove, replace, repair, remove, and reinoculate). Just like baking a cake, the order in which things are done is very important to making the recipe tasting great. Just like when addressing chronic leaky gut autoimmune conditions, the order and how we address the underlying cause is important to preventing relapse as well as to feeling as good as you possibly can during the process. Again, I want to stress that it’s very important to address underlying hormonal imbalances, including adrenal, thyroid, and female hormone issues, before getting to the chronic infection.
I personally find that patients will fall apart during the treatment if this isn’t done. This is dependent on how long the person is sick and how sick the person is, and there are exceptions to every rule. If the person’s hormonal system is not supported adequately when removing the infection, the chance of a die-off reaction is higher. Die-off reactions may feel something like fatigue, headache, nausea, and/or chills. Some people may notice nothing when the infection is being removed while others may have significant die-off reaction symptoms. There are various techniques and herbal medicines that can mitigate die-off or Herxheimer reactions.
The 5R program follows:
Remove
This part’s pretty simple. Remove the foods that are creating inflammation. Some people may need to be on a stricter autoimmune Paleo type of diet. Some may need to remove FODMAPs (a group of carbohydrates the small intestine has trouble absorbing). For others, a clean Paleo diet may be enough. An elimination provocation diet is the easiest way to be specific and avoid expensive and sometimes unnecessary allergy testing.
Replace
People with chronic stress can have low stomach acid. When there’s low stomach acid, there is typically low enzyme and bile salt production as well. It’s always good to work up to a patient’s stomach-acid tolerance so we can ensure the patient is breaking down proteins, fats, and minerals optimally. We need to make sure the building blocks are present, broken down, and absorbed so the person can heal.
Repair
Depending on how stressed or inflamed a patient is, adding additional healing and/or soothing nutrients can be helpful. Sometimes just making the above changes is enough to help facilitate healing. Others may need additional compounds, such as L-glutamine, slippery elm, zinc, aloe vera, and deglycerized licorice.
Remove
This is the place where we remove the infection. As you can see, the infection is one of the last things we address. This helps prevent die-off reactions from overwhelming the detoxification system, immune system, and lymphatic system. I find that removing the infection at the end tends to be the most effective.
Reinoculate
This is where we add the probiotics back in. Many people have a dysbiosis (or SIBO) in the gastrointestinal tract. This is when there is an overwhelming amount of bad bacteria in relationship to good bacteria. Adding in probiotics when there is a high amount of bad bacteria can cause problems, such as gas, bloating, and gastrointestinal pain. Removing the infections and bad bacteria first, allows the good bacteria to flourish. The analogy is weeding the garden before you plant the seeds—you never put seeds into a garden full of weeds.
Hidden barriers
Chronic infections can encase themselves in the slime known as biofilms. These biofilms are resistant to antibiotics; therefore, the conventional approach to treating these infections tends to not be as successful. Working with a skilled functional-medicine doctor that can combine the right antimicrobial herbs for your infection with some well-known biofilm busters is an important ingredient to removing the infection in the long run.
What Should I Do Next?
If you’re suffering from an autoimmune condition, fatigue, digestive problems, and/or hormonal imbalances, there is a good chance that leaky gut is playing a part. If you want to take a closer look into what’s causing your health issues, feel free to click here for a complimentary consultation.
Solutions to Small Intestinal Bacterial Overgrowth (SIBO)
By Dr. Justin Marchegiani
I see patients every day walking to my clinic with small intestinal bacterial overgrowth (SIBO) symptoms. Have you ever felt your stomach pooch out after eating certain foods? Do you ever feel like you can’t quite digest your food all the way? Small intestinal bacterial overgrowth can also contribute to leaky gut syndrome!
There are millions of people with SIBO-like symptoms covering them up with medications that don’t fix the underlying problem. SIBO can affect our immune system and compromise our body’s ability to break down food and absorb nutrition.
Below are 5 signs you may have SIBO:
1. Burping or belching
2. Flatulence
3. Indigestion/low nutrient absorption (low B12, proteins, and fats)
4. Diarrhea or constipation
5. Abdominal pain
What Causes SIBO?
1. A lack of stomach acid
When we have low stomach acid, or achlorhydria, our body lacks the ability to activate protein-digesting enzymes in our stomach, called pepsin. We need a low pH (acidic), right around 2, to ensure our body’s optimal digestive capabilities. This is why people on proton-pump inhibitors (drugs that block stomach acid) are at an increased risk for SIBO.
A low pH also provides an inhospitable environment for bad bacteria to grow. When bad bacteria overpopulate the stomach, it’s easy to see the increase in intra-abdominal pressure. This increase in intra-abdominal pressure can open up the esophageal sphincter and allow acids from the stomach to rise up and create irritation or burn the esophageal tissue. Without adequate levels of stomach acid, SIBO is almost certain!
2. Pancreatic insufficiency
Without adequate enzyme production, our body has a difficult time digesting proteins and fats. When our body doesn’t break down these proteins and fats fully, they putrefy, rancidify, and ferment in our intestinal track. This is not good!
HCl is the first important step for enzyme production. Without an acidic pH, the foods that are released from our stomach into our small intestine will not provide enough stimulation to trigger the gallbladder to release bile acids and pancreas to produce protein (trypsin and lipase) and fat-digesting enzymes. Without the crucial release of these enzymes, our body is at an increased risk for small intestinal bacterial overgrowth, or SIBO.
3. Chronic infections
Many infections are opportunistic and are able to take hold of the person’s body because of an accumulation of physical, chemical, and emotional stress. When this happens, we tend to have a decrease in immunoglobulin A (IgA). IgA is a protective mucous membrane barrier that lines our intestinal tract and plays an important role at preventing SIBO. Because 70 to 80% of our immune system is located in the lymphoid tissue in our intestinal tract, this has the ability to throw our immune system out of balance.
Chronic infections can lower stomach acid and decrease our body’s ability to break food down. With low IgA and a lack of stomach acid, our body is a sitting duck for an infection. Bacterial and parasitic infections are known to produce toxins (endotoxin and lithocolic acid) that can actually suppress our immune system. If you’re having chronic SIBO-like symptoms, feel free to click here to see if an infection connection is possible.
Other predisposing factors for SIBO
There are many other risk factors for SIBO, including fibromyalgia and IBS. These other conditions have common threads along with the main causes of SIBO that are above.
When our immune system is compromised by various infections, we have an inability to break down, absorb, and assimilate food due to an increase in physical, chemical, and emotional stress. This accumulation of stress eventually breaks the weak link in your chain. Because the gut is so central to the immune system, so many different conditions have a common link with small intestinal bacterial overgrowth. I would go as far to say that it is impossible to have a chronic disease without some type of gut dysfunction!
What Is SIBO?
SIBO is typically caused by a migration of bacteria from the large intestine making its way back upstream into the small intestine.
“SIBO may be accompanied by both maldigestion and malabsorption. Bacteria in SIBO might significantly interfere with enzymatic, absorptive and metabolic actions of a macro-organism.”
When our digestive system becomes stressed, our ileocecal valve can become loose. The slack in the ileocecal valve makes it easier for bacteria to migrate up the gastrointestinal tract. If more bacteria starts making its way up the GI tract, it makes it harder for the healthy gut bacteria in our small intestine to produce important nutrients, like vitamin K, vitamin D, iron, and various B vitamins.
What Type of Bacteria Is Found in SIBO?
How Do You Test for SIBO?
1. Hydrogen or methane breath test
A solution of glucose or lactulose is consumed. Hydrogen or methane levels are measured after the test, and if hydrogen or methane is found in amounts greater than or equal to 20 ppm, it is considered a positive test for SIBO. Ammonia is a common by-product from the intestinal bacteria. Ammonia has a pH of 11, so it’s easy to see how bacteria can affect intestinal pH!
2. Comprehensive stool test
The pathogenic bacteria mentioned above can be found in the stool by a comprehensive stool analysis. All lab companies are not created equal when it comes to this type of specialized testing. I recommend only using the best companies to ensure that you are getting accurate results. My three favorite lab companies for stool testing are Biohealth Diagnostics, Genova Diagnostics, and Doctors Data. If you are trying to get assessed for SIBO or any other infection, feel free to click here!
3. Organic acid test: This test can look for metabolic by-products of SIBO, including benzoate, hippurate, phenylacetate, phenylpropionate, p-hydroxybenzoate, p-hydroxyphenylacetate, indican, tricarballylate.
How do you treat SIBO?
Conventional Treatment Options
Conventional treatments typically consist of taking specific antibiotics, such as metronidazole and rifaximin. Antibiotics are powerful medicines, and I typically recommend a natural herbal approach first. The herbs tend to be more gentle on the body and don’t have all of the side effects.
Natural Treatment Options
There are many herbal medicines that can help eradicate SIBO. One of my favorites is oil of oregano. Other great herbs include berberine, artemisia, cat’s claw, colloidal silver, and ginger.
Sometimes it’s more than just SIBO causing the problem. If you are having any of the above symptoms, it’s good to get checked by a functional-medicine doctor to make sure there are no other infections driving the problem.
Some of these bacteria use biofilms as a means to protect themselves from the antimicrobials. It can get a little more nuanced when addressing the stubborn infections. Feel free to click here if you need help!
I find many patients do better at making diet and lifestyle changes first and addressing the adrenals and hormonal system second before addressing the gastrointestinal system. When patients go right to the GI system, the side effects tend to be much higher!
Dietary Interventions
FODMAPs: Removing fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) from the diet is also important. These FODMAP sugars can fuel the pathogenic bacteria in the gut, which then leads to more toxic metabolic by-products. Many people notice great improvements in stomach distention, gas, and flatulence after removing these foods from the diet. I personally find a combination of diet, lifestyle, and herbal medicines tend to be the trick to addressing the underlying cause of the problem.
Resistant starch: Adding resistant starch type 2 or 3 into your diet can also help feed the beneficial bacteria in the gut. The beneficial bacteria in the gut produce a short-chain fatty acid called butyrate. Butyrate helps keep the pH in the gut lower, tightens the ileocecal valve, and provides fuel for the cells of the colon. Watch the above video for more information on how resistant starch can help improve your SIBO.
My Favorite Resistant Starch
- Type 2 resistant starch—unripened banana flour by Wedo.
- Type 3 resistant starch—potato flour by Bob’s Red Mill.
Instructions: If you have significant SIBO, start with just 1 tsp of resistant starch and work up to 2 tbs. If you have any significant gas or bloating after taking the resistant starch, half the dose the next day. When in doubt start slow. Gas and bloating are surefire signs that you have SIBO.
I can take 2 tbs of resistant starch two times per day without any symptoms. Some people may have to use herbal medicines to significantly knock down the SIBO before the resistant starch can be tolerated. Make sure you work with your functional-medicine practitioner to support you in the process.
On a low-carbohydrate diet, the E.rectale and the Roseburia bacteria can significantly decline. Adding in resistant starch can help prevent this decline in beneficial bacteria while maintaining a low-carbohydrate eating plan. Some people are carbohydrate sensitive and need to keep their carbohydrates down, and this provides an excellent option to get the best of both worlds.