Ask the Paleo Nurse: Healing a Leaky Gut

I recently asked my Facebook page followers if they would be interested in an "Ask the Paleo Nurse" feature where I take questions from readers and answer them on my blog.  This idea seemed to have a good response, so here it is:  The first "Ask the Paleo Nurse" Q&A!

"What is the best way to heal a leaky gut?"

There is definitely not an easy or single answer to this question.  This entire blog is mostly about healing a leaky gut, so to summarize it all into a few paragraphs is challenging!  But it was the most popular question that I received, so it's obviously something that is on a lot of people's minds.

Leaky gut syndrome is a condition by which the lining of the intestine becomes damaged, leading to increased intestinal permeability.  The intestinal lining is one of the immune system's major lines of defense against infections, toxins, and other threats that are introduced into the body through food and drink.  Normally, the intestinal epithelial cells sit together closely and are joined by tight junctions that form a barrier to prevent unwanted substances from passing through into the bloodstream.  The intestinal barrier can become damaged from a variety of factors, including:

  • A poor diet, such as the standard American diet that is high in processed carbohydrates, excess sugar, and hydrogenated oils
  • Food sensitivities
  • Certain gut-irritating foods, such as grains, legumes, dairy, and alcohol
  • Low stomach acid
  • Chronic stress
  • Hormonal imbalances
  • Certain medications, such as non-steroidal anti-inflammatory drugs, antibiotics, steroids, hormonal contraceptives, and chemotherapy drugs
  • Environmental toxins
  • Infections and parasites
  • Imbalance of the gut flora.

When the lining of the intestine is damaged, the junctions between the cells are widened and begin to allow substances into the bloodstream that usually would not be permitted to pass through the barrier.  These substances include undigested food particles, toxins, microbes, waste, and larger-than-normal macronutrients (carbohydrates, proteins, and fats).  When these substances pass directly into the bloodstream, it provokes an immune response that can lead to food sensitivities, systemic inflammation, autoimmunity, and a variety of diseases.  Conventional medicine recognizes that increased intestinal permeability (leaky gut) exists, but it does not recognize the role that it plays in overall health and the development of disease.

Unfortunately, there is no single best way to heal a leaky gut.  Because so many different causative factors can be involved, healing a leaky gut requires an individualized approach and takes commitment, time, and effort.  Although each plan is unique, there is a general approach that I use to help clients heal a leaky gut:

1.)  Eat a whole food, nutrient-dense diet that excludes foods that irritate the gut:  It is critical to eliminate all processed foods and eat a real food, nutrient-dense diet that eliminates foods that are known to irritate or damage the lining of the gut.  Foods that irritate the intestinal barrier and can lead to inflammation include grains, legumes, dairy products, processed foods, refined sugars, and alcohol.  The Paleo lifestyle is great framework for a whole food, nutrient-dense diet, as it eliminates these irritating and inflaming foods.  I usually start with a Paleo nutrition template and then build upon it to suit the needs of my client.  If a client is having autoimmunity issues, I may recommend the Paleo Autoimmune Protocol.  Sometimes, I have the client do a modified version of the GAPS diet, especially in cases in which the client is experiencing a lot of digestive distress.  With any healing dietary approach to leaky gut syndrome, I do not recommend the popular "80/20" approach to healthy eating because your commitment needs to be 100% in order to allow the lining of the intestine to heal.

2.)  Make sure digestion is working:  You can eat a perfect diet, but if you aren't digesting food appropriately, it is not going to help you much.  You are not just what you eat, but you are what you eat and are able to digest.  Supporting digestion often involves addressing low stomach acid and ensuring healthy liver, gallbladder, and pancreas function.

3.)  Discover and eliminate underlying food sensitivities:  The best way to discover food sensitivities is to eliminate a suspected food for a period of time (I usually recommend at least 30 days) and then try to reintroduce it.  Often, transitioning to a regular Paleo diet will be enough to discover common underlying food sensitivities.  However, if people are still experiencing issues on the Paleo diet, the Paleo Autoimmune Protocol can help to identify additional sensitivities to nightshade vegetables, egg, nuts, seeds, and all dairy (including ghee and butter that is allowed on the Paleo diet).  The GAPS diet is a strict elimination diet that can help to determine sensitivities to many different foods if used appropriately.  In particularly challenging cases in which clients do not respond to elimination techniques, I offer mediated-release testing (MRT), a type of blood testing that is able to pinpoint which foods may be causing a subtle immune response in the body.

4.)  Find ways to reduce and eliminate stress:  Finding methods to reduce and eliminate stress is a priority for healing a leaky gut.  I tell my clients to find a little bit of time every day and spend it doing something that they enjoy doing for themselves.  Prayer, meditation, yoga, moderate exercise, adequate sleep, regular massage, and acupuncture also help with stress relief.

5.)  Consume gut healing foods and nutrients:  If you have a leaky gut, I recommend drinking bone broth daily.  Bone broth is a super food that contains numerous minerals and amino acids that provide the building blocks for replenishing intestinal cells and help to calm inflammation in the digestive tract.  Other gut healing nutrients include Vitamin A, Vitamin U, and L-glutamine.

6.)  Balance the gut flora:  To promote healthy gut flora, I recommend including fermented foods in your diet each day.  At times, it may be appropriate to include a probiotic supplement, but I usually start by recommending a whole food approach first.  For people that have severe gut dysbiosis that does not respond to other approaches, I believe that fecal transplants are worth investigating.

7.)  Discover and eradicate gastrointestinal infections:  Gastrointestinal infections sometimes result from an imbalance of gut bacteria.  They may resolve by following the above recommendations, but occasionally, they need to be specifically addressed.  There are natural, holistic ways of eradicating many of these concerns.  However, if treatment requires conventional medicines, you may need to see a licensed health professional that has the ability to prescribe drugs.

8.)  Consider the use of gut-irritating medications:  Any prescription and over-the-counter medications should be evaluated for their potential to have a negative impact on the intestinal lining.  Before stopping the use of any prescription medication though, you should first consult with the prescriber.

9.)  Reduce exposure to environmental toxins:  There are several steps you can take to reduce the toxins you are exposed to on a daily basis.  A few ideas include replacing conventional cleaning products with homemade or "green" products, using glass food storage containers instead of plastic, buying BPA-free canned products, using a menstrual cup instead of conventional feminine hygiene products, and using other natural beauty and skin care products.

The bottom line is that healing a leaky gut is not a simple process and it does require a multi-faceted approach.  However, if you are committed and willing to put in the time and effort, you will be rewarded with improved health!

Have you used any of these techniques in healing your own leaky gut?  What worked well for you and what did not work?

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P.S.  I'm now writing for the Paleo Movement Online Magazine.  Check out my posts there as well!