The 5 Key Steps To Healing A Leaky Gut – Live Podcast #399

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Dive deep into the intricacies of gut health as we explore gut inflammation and the phenomenon of a ‘leaky gut'. In this podcast, we'll unravel the connection between the two, discuss their potential health impacts, and provide insights on management, healing, and prevention.

Whether you're experiencing gut-related symptoms or just eager to understand the key to optimal digestive health, this comprehensive guide is for you. Don't forget to like, share, and subscribe for more health insights!

In this episode, we cover:

00:31 – “Leaky Gut”

02:24 – Overreactive Immune System

04:09 – Addressing Food Allergies and Inflammatory Foods

09:12 – Improving the Breakdown and Digestion of Food

12:50 – Improve Gut Lining Inflammation and Hormone Balance

16:49 – Addressing Microbial Imbalances

20:16 – Support from Probiotics and Prebiotics

24:00 – Takeaways

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And we are live! Dr. J here in the house. We're going to be talking all about leaky gut today. The five major steps to heal leaky gut. We're going to talk about it from a functional medicine perspective. Before we dive in, please smash the like button. Love to see your comments down below. We'll have some slides going up here on the screen. So if you guys listen to audio, click the video link down below where you can access the video as well.

All right guys, Dr. J here. We're going to be chatting about leaky gut. I don't love the word “leaky gut”. Leaky gut is an end-byproduct of lots of other issues upstream. Lots of other system issues upstream. Breakdown happening, poor digestion, inflammatory, food choices, inflammation in the body, malabsorption, hormonal stress, gut integrity breakdown, immune stress, and then of course all of the leaky gut downstream is going to happen. There's a manifestation of all of the upstream effects that are manifesting there. And so everything goes from high to low, inside out.

Most people talk about leaky gut like it is its own entity like its happening in and of itself. Like there are no other inputs to it that it's its own thing. And really it's an end result of a lot of other things. If you didn't talk about leaky gut, but you talked about all of these things upstream, that's where the focus should on upstream, patients are going to get better. That's going to be key.

Now, people talk about leaky gut, really what they're talking about is gut permeability, the tight junctions in the gut. The actin-myosin tight junctions, they open up slightly. Undigested food particles can get through there. Again typically, the increase in zonulin protein is a sign that the gut lining is kind of “unzipping” or so to speak. There's a lot of theories where zonulin in the stool doesn't really correlate with gut permeability thing happening. For me it doesn't really matter because we're going upstream at the other underlying issues. We know there's gut permeability, however you wanna test it, however you wanna look at it.

The gut is essentially “unzipping” to a certain degree, allowing undigested food particulate, maybe even endotoxin, maybe even bacteria and yeast, and other things in the gut are making its way into the bloodstream at a microscopic level. It's not sepsis. We're not having tons of E. coli coming in there and creating a sepsis; You die fromm that. But at a microscopic level there's going to be this gut permeability that's going to activate the immune system. Now when the immune system is overactive, it creates a lot of stress, creates a lot of inflammation in the body. Alright the immune cells suck up lots of energy, lots of resources – thats number one. So, you'll going to feel tired, you'll going to feel fatigued.

The more the gut permeability occurs, the more foods that you're eating, the greater chance that you're going to increase the allergenicity to that food. So over time, let's say, if you don't have an allergy to eggs but you're eating eggs every single day, the chance that eggs are going to becomes a food allergy goes up and up and up, and the chance that the reactions for those foods also goes up and up and up. Meaning you can start off with maybe just a little bit of runny nose and then now you have a slight headache and now you have fatigue. And now you have achy joints or brain fog.

So you could see the Amino-reactivity is going to continue to increase because those foods are going to the blood stream, they're not being broken down all the way and the immune system is seeing it, it's creating it and tagging antibodies to go after it and creating more and more inflammation. So that's kind of the vicious cycle that we see with all kinds of foods.

Now, certain foods are going to have a greater inflammation load, greater antigenicity, if you will. So foods are going to be one of the first things that we start with. So when we look at a lot of these things here, we kind of have a flow in how things operate, all right? It's really important to look at things holistically.

So the top five ways we heal the gut, I don't love that term. I'm putting it out there because everyone knows it, they're going on YouTube and Google, they're searching it. I like gut permeability, and gut permeability is just the end result of inflammation in the gut. So really, if I were to label this podcast to be as kind of an alignment with what I think is right, it's just like, how do we get to the root cause of inflammation in the gut? And then the end byproduct, of course, is that gut permeability thing. Again, that's the effect. Let's put our focus on the cause.

So a big thing is addressing the food allergies, and again, antigenicity, antigenic load is going to be a big deal. That's just proteins, foreign proteins coming into the bloodstream, stressing out the immune system. Again, certain foods are going to have a higher antigenicity; they just have more of an inflammatory load. Foods with lectins, phytates, oxalates, foods that are more processed, especially processed sugar, processed grains. Gluten is going to be a big one, right? Alessio Fasano at Harvard showed that even if you're not Celiac, you're not even gluten-sensitive, you're going to have an increase in gut permeability with that gluten protein, that gliadin protein in your bloodstream.

And so we know that in and of itself can create immune reactivity because these foods are now in your bloodstream. They're now going into that bloodstream, and the immune cells are seeing it and tacking it and creating antibodies for it. Now, the more this happens, certain proteins like gluten looks like your thyroid tissue. Certain dairy proteins look like pancreas tissue. Certain proteins can look like myelin or gangliocytes. Different tissues in the body can resemble. And so the more we eat certain foods with this gut permeability, and if we eat other inflammatory foods around it, it's going to create more inflammation, stress, and a greater likelihood you can come down with an autoimmune issue.

I have Hashimoto's. I'm able to keep it mostly in check, keep the antibodies very, very low, just above normal through healthy diet and lifestyle. There's some data showing that eating gluten can raise your antibodies for months at a time. And so the more we can decrease the load of inflammatory foods, grains being a top priority, dairy being a top priority, especially with casein. The casein protein is very immunoreactive. You can have intolerances too, to gluten. You can have gluten intolerance. Intolerance is more of a digestive issue where we're not able to break the protein down. You could have, like in dairy, there's lactose intolerance, but there's also casein allergens. There's also gliadin or gluten allergy. So you could have immunological activity to that protein, but you can also just have intolerances where you're not breaking that protein or that sugar in the form of lactose down.

Podcast 399 Image 1_Dr. Justin Marchegiani

You're going to see lentils or beans could be an issue due to the fact that there's all kinds of phytates and mineral blockers. It's a reason why people market Beano, which is an enzyme to break down the beans because beans are hard to break down. This is the reason why if you look at cookbooks like the Weston A. Price cookbook, they talk about soaking and fermenting your beans or soaking or fermenting your nuts because you can break down a lot of these anti-nutrients and make these foods easier to digest, easier to break down. So, of course, lentils, beans, those types of foods are going to be out of the gates, your legumes, I would say nuts and seeds could be an issue.

Again, like you have your typical paleo diet, which is going to avoid a lot of the most common foods, right? It's going to emphasize on good proteins, animal proteins, good healthy fats, keeping the nuts and seed oils typically at bay, or the excess omega-6 at bay. It's going to focus on some eggs, it's going to focus on fats that are mostly animal-based or good dairy-based fats that are low in lactose, low in casein, like butter or ghee. And then ghee's going to be even better than butter because it's going to be refined, it's going to be more clarified butter, so it's going to have very little lactose and very little casein at all.

And then, of course, you're going to cut out other processed carbohydrates like your grains and your flours. It may allow some safe starches, some squashes, sweet potato, maybe even some white potato. And then, of course, proteins, fats, carbs, and then emphasizing the glycemic approach, right? Emphasizing foods that are more glycemically appropriate, meaning the least amount of sugar breakdown, the better. So emphasizing more vegetables over fruits and starch. And, again, you can refine that based on how active you are or how at a good body weight you are, right? The healthier body weight you're at, and the more active you are, the more you can handle starchy carbohydrates. That's kind of my general rule of thumb.

So, in general, paleo templates are a good focus: good proteins, good fats, carbohydrates, glycemically appropriate. What that means is the carbs that break down faster go into your bloodstream faster. That has hormonal consequences ripple downstream, like insulin, and then cortisol and adrenaline to help balance that out. And so the more you can handle it, the better.

And so an Autoimmune Paleo diet is kind of the next-step up where we may cut out nuts and seeds, cut out eggs, cut out dairy. You know, on a regular paleo diet, we've already cut out all the processed foods, all the refined sugars and grains. We've already cut out some lentils and beans, and maybe some peanuts too, and now we're cutting out nuts and seeds, now we're cutting out eggs, now we're cutting out all dairy, even ghee. Now we're cutting out – I think I hit it all there, and so that's kind of our foundation approach: good protein, good fats, keeping all the inflammatory foods down.

I can't tell you how many times I've seen patients have an issue with nuts or seeds or eggs, and you're like, ‘Hey, these are really healthy foods.' Yeah, they are. And again, if I have an allergy with them, now, is that a for everything? Well, if you heal your gut, if you get the inflammation down, if you improve your digestion, if you improve your microbiome health, you knock down a lot of dysbiotic microbes, you improve the microbiome diversity, you improve motility, can that change over time? Yes, it can, especially if your immune system has had some time without it, so it's been able to adapt and kind of recalibrate. I think you definitely can bring foods back in and try that.

Next, improving the breakdown of digestion. Again, if we're not breaking foods down, improving the breakdown and digestion of foods, so if we're not breaking foods down all the way, the larger the food molecules there are, the greater chance the immune system is going to see these things, tag them, and create some kind of an immune response. And so it's nice to be able to get these foods broken down to smaller pieces. Even healthy foods, right? Beef, chicken – if we don't break them down fully, we're going to have an increased chance of allergenicity. And the immune system is more likely to tag these foods, and you're going to have an immune response. Then you'll make it brain foggy or sleepy or tired and more bloated or more gassy because now your immune system is actually creating a response, a reaction that's negative.

So out of the gates, if you love it, rotate it. So if you're a beef guy and you're eating beef and steaks every day, you gotta rotate it. If you love it, rotate it. Super important that keeps your immune system seeing different foods, so you're less likely to react because you have different foods coming in every day. Also, we're chewing our foods really well. You know, good old adage: 32 chews, one chew for every tooth in your mouth. Now, you don't really have to count that many times. Usually, chewing to like an oatmeal-like consistency is a pretty good rule of thumb. So feel what oatmeal feels like in your mouth. Your food should feel somewhat like that in your mouth.

Chewing your food up very well. You can kind of count it at first, see how long that, you know, maybe that's a minute of chewing, you know, one chew per every second or two, right? Chew, chew, chew. Probably about a minute or so of chewing per bite. That may be a good thing. That may be a good idea to kind of like gauge it or just gauge it based on the texture. How does it feel? Does it feel kind of like an oatmeal-like consistency? Those are a couple of ways that I do it.

Next is not hydrating with our foods, right? Because water has a pH of seven, so when we look at that bile and all of those digestive juices, that should have our pH of around two to three, well, we throw a whole bunch of pH of seven in there. What happens to the overall pH? It starts to go up. And we need to activate those enzymes. Those enzymes are pH sensitive. So we bring those enzymes nice and low. We activate the enzymes by bringing the pH down. So more acid means low pH. Low pH means more enzyme activity. And that includes lipolytic enzymes, which are fat digestive, proteolytic enzymes, which are protein-based, or carbohydrate or amylolytic enzymes to break down carbohydrates. We have to make sure we have good digestive juices.

Podcast 399 Image 2_Dr. Justin Marchegiani

So we do that by one, not hydrating with food and adding a bunch of alkaline or neutral pH. Two, we chew our food up really well, which increases the surface area. It allows the enzymes and the acids to actually work and break these foods down. You know this, like, have you ever just trying to think of an analogy? If you ever took a whole bunch of like towels and you threw them in the laundry and you packed it tight and then you did the laundry, it didn't have enough room for the towels to open up and have the detergent and the water hit it. And so then you pull it out, didn't really clean it, right? Because it was packed so tight. But if you opened that laundry out by making more room in the washing machine, now everything hits it, now it gets clean.

So it's kind of like the same thing. If we can open up that food, increase the surface area, those enzymes and acids have a much better chance of hitting it and breaking down. So that's a really excellent way to think about it. And again, we may use enzymes, acids, lipolytic enzymes, but also bile acids too. And bile can be really important. Now, technically, bile happens more in the small intestine, but, you know, you can't just throw bile in there, you know, supplementally in the small intestine. It has to go to the stomach first because it goes mouth, esophagus, throat into the stomach. And so we would add it with our food, and it would get mixed in with that stomach acid and start the fat digestive breakdown.

Now, improving the gut lining. So this can be really important if someone has a lot of inflammation in the gut lining or we have, let's say, this leaky gut issue where these enterocytes are separating undigested food or particulate or immunological compounds are happening due to endotoxins or mycotoxins. We have to get that gut lining calmed down. Now, there's amino acid nutrients we can use to help facilitate that. We can use things like glutamine. We can use things like glycine. Glycine is super common in collagen and bone broth. Glutamine is more common in muscle meat. But again, using amino acids are better because they're already broken down. They're kind of in a peptide form or a free amino acid form. You can mix them in water.

So if your digestive system is not working well and you put a whole bunch of heavy food in there, it can sometimes create stress on your tummy. And so using free amino acids can really help calm down that gut lining. And so using the free amino acids are great. Again, we use products like GI Restore, which has glutamine and it'll have an acetyl D-glucosamine, which you get in a lot of seafood, things like the shell, very soothing and healing for the gut lining. We may use DGL licorice, deglycerized licorice. We may use okra pepsin. We may use zinc. Zinc is known and shown to help improve gut permeability. We may use things like DGL, okra pepsin, aloe, ginger, slippery elm. These are kind of in the anti-inflammatory, healing, soothing, mucilaginous herb category. Very helpful, very healing, very soothing. And gets the inflammation down.

Now, when you get the inflammation down, it's so important because the gut lining can be like, it's the equivalent of going out and getting a sunburn. You go out, let's say you have back pain or some shoulder pain, you need a massage, you need some myofascial release, you need an adjustment. But you've got a sunburn. Your back's killing you because of the skin. But you want to go see that therapist or that chiropractor. But then they go to touch you, though, you're like, “Ah, my sun, the sun, that just killed my skin. I can't touch it. I can't even have any input at all.” Well, it's not that the chiropractic adjustment or the massage is bad for you. It's that your skin is so sensitive it cannot handle the input, right? It's the same thing.

The foods in your intestines may be making your gut so inflamed that you can't handle the input of digestive nutrients or heavier proteins or heavier fats or any killing herbs to work on knocking down dysbiosis. And so then we have to really work on getting everything soothed and relaxed in that gut lining. And that's where we add in the glutamine, the glycine, the collagen, the bone broth. I'll do ginger tea with Manuka honey. We'll do lots of heat. We'll maybe even add an elemental diet. Some people will even, this is where we would kind of plug in even a carnivore diet, which is again, the ultimate anti-allergen, or I should say anti-nutrient diet because there's no anti-nutrients from foods. Some people are so sensitive, the anti-nutrients in any vegetable, any fruit, any food can be too much and could set them off. So gut lining support is really important.

Now, I put hormone balance here because hormones play a major role in reducing inflammation. So if you look at your adrenal glands, almost anyone that has some kind of a chronic illness, you're going to see depleted or stressed-out cortisol and/or DHEA levels in the adrenal glands on a test. And that means your ability to heal and have healthy anabolic metabolism goes down. Your ability to manage stress and inflammation goes down. Cortisol is also a glucocorticosteroid, so that means your ability to have energy and to have good blood sugar levels goes down.

And so we want to make sure we have good healthy adrenal levels. And if our cortisol rhythm goes up in the morning and down at night, that's healthy. That's good because that gives us energy during the day and relaxation at night. And that cortisol drop at night has an inverse relationship to melatonin. So as cortisol goes down, melatonin can go up, which helps sleep, relaxation, and it also is very anabolic and helps with repair and is a very powerful anti-cancer antioxidant. So if we have that cortisol going up at night, it's going to compete and it's going to knock down that melatonin. So we want to make sure we have good healthy cortisol levels coming down at night so we have good healthy melatonin levels coming up at night, very important.

We're gonna addressing microbial imbalances, this is where we work on knocking down bugs. It can be very helpful to test for this if we have H. pylori, is it just a generalized dysbiosis or SIBO like Citrobacter, Klebsiella, Proteus, Morganella, these are different bacteria. Now, people will talk about SIBO or dysbiosis, I put them in the same camp because when you're doing different stool testing looking at these microbes, guess what? Everything moves its way from the esophagus through the small intestine through the colon. So you got like two, three feet of the esophagus, you got not much in the stomach at all here, maybe a foot from here from the antrum to the fundus, and then when you go down from the small intestine, you have about 21 to 25 feet, and then you have about five feet in the colon.

The entire surface area of the small intestines is the size of a tennis court. So there's a lot of surface area. So when you get a stool sample out the end, everything's mixed in, and so it's hard to know where these microbial imbalances come from. You just have standardized normal ranges of where it should be, and if we see it way out of range, then we just call that kind of a dysbiosis or a generalized dysbiosis, and it's important to know that. Now, you can run SIBO or breath test and look at the gases, the methane or hydrogen gases that are coming out the other side, and that can give you another good window into what's happening from a microbial imbalance standpoint.

We may see just these SIBO bacteria, dysbiotic bacteria like the Klebsiella, Citrobacter, Proteus, Morganella, etc., if they're way out of whack, especially multiple standard deviations out of whack, that tells me there's a problem. If we see things like foodborne pathogens like Salmonella, Campylobacter, E. coli, or the E. coli Shigella, E. coli, or Clostridium difficile, that tells me there's some gut stressors going on there. And you gotta look at the person's symptoms too because it could be just a transient bug that they may have no problem with. If they have symptoms and that's showing up, then it's something you want to knock down from the antimicrobial standpoint.

And then we look at things like yeast, again, yeast is always hard to pick up on the stool test, especially a PCR stool test. So if it's there at any level, for me, it's a concern. Again, I always look at clinical symptoms. I'll see someone with yeast symptoms, they'll have fungal toes, they'll have tinea versicolor rash, they'll have seborrheic dermatitis in their scalp or fungal scalp or dandruff or cradle cap, if you will. They'll have thrush. And so if I see fungal symptoms, I'm treating, no matter what, even if the stool test or organic acid test says it's fine. I'm still going to treat. So it's good to look at things clinically and say, ‘Hey, do we have the topical fungus in the scalp, on the skin, in the mouth, in the nose, vaginal issues, genital issues, on the nails, any issues there?' We're going to treat it.

Now, sometimes you can have a fungal issue that exists topically because of exposure topically or because of walking barefoot or wearing sandals and it may not be indicative of internally in the gut. But it's always good if you're addressing fungus to hit it from both sides, put it between a rock and a hard place. So we'll use good like 10 sulfur soap or we'll use a nice antifungal topical tea tree oil or something a little more natural topical. And then we'll hit it on the inside as well. Really important. And again, you want to know what kind of microbial imbalances are there. So it's good to test, see, is it just a generalized dysbiosis/sibo? Is it yeast? Is it H. pylori? Do we have parasites? Do we have worms? Really nice to know this so we can come up with a comprehensive plan and get a spouse or a partner there. It's good to treat them as well so you're not hot potato making things back and forth.

Support pre and probiotics, really important. So probiotics, again, these are going to be your Bifidobacterium, your Lactobacillus species, Saccharomyces species as well. Very important for modulating the immune system, help with inflammation, massive, huge, huge benefits with probiotics. You can see it help improve mold toxicity, it deactivate some of the mold and makes the mold less reactive, it can help with brain inflammation and brain fog, it can help with motility, all kinds of good benefits. I find using probiotics especially helpful after we've cleared out a lot of bugs. I see a lot of people probiotic intolerant, well, they'll take probiotics or even fermented foods and they get brain foggy, they get gassy, and they're probiotic intolerant, maybe fatigued as well, and they may not be able to handle it.

And so this is where we're going to add in or we're going to work on killing and cleaning out the microbes, we're going to be pulling out the weeds before we add in the seeds, the seeds being the probiotics. And the prebiotics being the fertilizer, that'll be some of the fermentable fibers, whether it's Sun Fiber or healthy, kind of lower FODMAP plant-based fibers, or it could be inulin or chicory root as well to kind of act as the fertilizer to help those probiotic seeds kind of take foothold. We may even add in spore-based probiotics to help potentiate the growth, kind of supercharge the other Bifidobacterium and Lactobacillus species. Now, again, these guys are transient, they're not going to hang out more than a couple of weeks.

Again, the spore-based probiotics will hang out longer. So we want to work in fermented foods into the diet, whether it's some sauerkraut or kimchi, fermented pickles, goat kefir, goat milk as much as we can. A serving a day will be wonderful if we can do that because we know our ancestors evolved with more fermented foods which help potentiate good healthy gut bacterial balance. And with our hyper-sterilization of every food, milk being hyper-pasteurized, everything being pasteurized, we're not getting these healthy bacteria from our food. And so supplementing is going to be super helpful. If you can start adding things back in over time as you get better, you may not need as much probiotic over time. So probiotics and prebiotics can be essential, essentially put you on the right path. And if we can get more of these foods in, then that will help allow less reliance on a lot of probiotic supplements. But if not, we have them.

Next, retesting. I mean, these are my top five, right? But I also like to retest because sometimes microbes can come— other microbes can come up as we clean out that gut lining, other ones that are bedded more in the deep fissures or crypts in that gut lining can kind of come to the surface, and we can see new microbes. It's possible. And also to ensure that we've knocked out the bugs and there's no reinfection during that timeframe. So it's nice to know that and to see that. Now, we may look at inflammation markers. We may look at eosinophils, we may look at calprotectin or IgA or immunological markers that give us a window, are we calming down the immune system? Are we chilling out inflammation? If we get the inflammation down in the gut, it makes a huge difference in your body being able to heal.
You're not wasting all these resources putting out the fire in your gut. Now you have these resources to deal with stress in your life, emotionally, physically, to work on anabolic metabolism, healing muscle, tendons, ligaments. So now your body has more resources to put it to work in your daily life versus dealing with hidden inflammation that you know isn't impacting your life. You know if your gut's just inflamed and it's like having the water on in a guest bedroom in your house and you don't know it, and your water bill is twice as much as it should be, you have all these wasted resources you don't even know what's happening in the background.

Like if you're sitting there and you're feeling stressed because your gut lining is pulling up all these anti-inflammatory resources because you're just sitting there inflamed, well, that stinks. So we want to have as much resources available to you so you can use it in your outward life, dealing with the stress that's already out in front of us, which is already enough in a lot of cases to deal with.

So I hope this helps, guys. I wanted to lay it out for you just like that, have it make a little more sense. Again, when we look at patients, when I look at patients, we individualize the plan. Some patients have to deviate and address things differently. There could be thyroid imbalances to come into play, Hashimoto's. There could be more autoimmune issues like ulcerative colitis or Crohn's which make us have to be a little bit more careful and go a little bit slower and work on inflammation, maybe add an elemental diet, maybe use some fasting approaches or just making sure we use more Instapot and pre-digestive cooking or carnivore.

And again, sometimes hormones can play a big role if you're dealing with a menopausal woman or a woman who's of cycling age but it's very depleted hormones that can play a major role with the immune system and dealing with stress and bumping some of those hormones up and supporting that very helpful. If someone's in a massive fight or flight position like their HPA axis is in overdrive, their amygdala and brainstem are constantly in fight or flight, it sees everything as a threat around them.


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