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!

Natural Solutions to Increase Stomach Acid and Improve Digestion

Despite what you may have been led to believe by conventional medicine propaganda, the most common cause of symptoms of heartburn, indigestion, gas, and belching is low stomach acid, not too much (read this post for more information on how low stomach acid is jeopardizing your health).  According to Jonathon Wright, MD (author of "Why Stomach Acid is Good for You"), approximately 90% of Americans produce too little stomach acid.  Low stomach acid impairs digestion and leads to a wide variety of health problems that include:

  • Heartburn
  • GERD
  • Indigestion and bloating
  • Burping or gas after meals
  • Excessive fullness or discomfort after meals
  • Constipation and/or diarrhea
  • Chronic intestinal infections
  • Undigested food in stools
  • Food allergies, intolerances, and sensitivities
  • Acne
  • Chronic fatigue
  • Mineral and nutrient deficiencies (including iron and/or vitamin B12 deficiency)
  • Dry skin or hair
  • Weak or cracked nails
  • Asthma
  • Depression
  • Osteoporosis
  • Any autoimmune disease diagnosis

From a holistic health perspective, bringing the body back into balance often starts by addressing the foundation of digestion.  You are not only what you eat, but what you are able to digest and absorb, and for many, proper digestion can't be brought into balance without first correcting low stomach acid production.   The following are some natural methods to increase stomach acid production and improve digestion:

Eat sitting down and while in a calm, relaxed state:  The process of digestion truly begins in the brain.  The mere sight, smell, or thought of food triggers reflexes in the brain that result in increased stomach acid secretion.  This process occurs through activation of the parasympathetic nervous system, which is responsible for most restorative functions in the body, including that of digestion.  Unfortunately, many of us are living in a perpetual state of activation of the sympathetic nervous system, known as the "fight or flight" response.  We are continuously stressed and pressed for time, which may result in eating hurried meals on-the-go, in the car, at the desk, and often while multi-tasking.  This type of rushing through a meal and lack of focus on what you are eating does not allow for proper activation of the parasympathetic nervous system, which results in less stomach acid secretion.  To take advantage of the maximum secretion of stomach acid, make sure to calm and relax yourself before eating.  If particularly stressed, take a few moments to close your eyes and focus on deep breathing.  Always sit down to eat, if possible at a kitchen or dining table, and eliminate as many distractions as possible.

Chew your food properly:  Mechanical digestion of food begins in the mouth.  While chewing food properly won't necessarily increase stomach acid production, it will make it easier for the process of digestion to continue once in the stomach.  Most people rush through meals so quickly that they gulp down food without chewing adequately and this can put a significant strain on a stomach that is already low in stomach acid.  A good guideline for proper chewing is 20-30 chews per bite.  If you aren't used to proper chewing, this may seem like a lot.  Try putting down your fork in-between bites and counting your chews until you get a feel for adequate chewing.

Eliminate food sensitivities:  Food sensitivities are associated with low stomach acid production.  The best way to tell if you have a sensitivity to a particular food is to eliminate it for a period of time (I usually recommend 30 days) and monitor your symptoms.  If your symptoms improve drastically, and then return when you reintroduce the food, it is likely that you have a sensitivity to that food.  Although it is possible to develop a sensitivity to nearly any food, these are some common food sensitivities:

  • Wheat (and Gluten)
  • Dairy
  • Soy
  • Eggs
  • Nuts
  • Corn
  • A variety of food additives and preservatives
  • Nightshades (especially for those dealing with autoimmune issues)

Following a nutrient-dense, whole food lifestyle, such as Paleo, that eliminates all processed foods, grains, legumes, and dairy will easily remove most of these common food sensitivity culprits from your diet.  The Paleo Autoimmune Protocol, which additionally restricts eggs, nuts and seeds, and nightshades will target the remainder of the common offenders.

Be aware of other stomach irritants:  There are many substances that are irritating to the lining of the stomach and can impact the production of stomach acid or have a direct effect on the function of the lower esophageal sphincter (LES).  Certain foods, such as hot peppers, spicy foods, citrus, tomatoes, caffeine, and alcohol may be problematic.  Medications such as antacids, proton pump inhibitors, and H2 blockers are intended to work by lowering stomach acid or interfering with the natural action of stomach acid.  Also, there are many groups of medications, including non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, bronchodilators, beta-blockers, calcium channel blockers, nitrates, antidepressants, anti-anxiety medications, and anticholinergics that are associated with a weakened LES and/or gut lining irritation.  As with any prescription medication, if you are considering reducing or stopping your use of the medication, you should first discuss it with your prescriber.

The next group of suggestions involve using natural remedies to increase and support stomach acid production.  **WARNING:  If you are currently being treated for gastrointestinal reflux disease, peptic ulcers, Barret's esophagus, or any other serious upper GI disorder, I recommend that you consult with an appropriate holistic health practitioner prior to attempting these remedies on your own. 

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Lemon/Apple Cider Vinegar Water:  To temporarily increase the acidity of the stomach, drink a small amount of fresh lemon juice or apple cider vinegar added to room temperature water about 15-20 minutes prior to eating.  It is important that the water is not too cold because cold water can interfere with the digestion.  If using lemon, squeeze half a lemon in 8 oz. of water.  For apple cider vinegar, add 1 tablespoon in 8 oz. of water.  If consuming apple cider vinegar or lemon juice in water regularly, I recommend drinking it through a straw and brushing your teeth well after in order to protect the enamel of your teeth.

Digestive Bitters:  Another great option for increasing stomach acidity are digestive bitters, which can be found in most health food stores.  Digestive bitters tap into the body's neuro-lingual response that occurs when you taste something bitter.  The bitter taste stimulates increased stomach acid production, as well as other digestive juices.  Follow the dosing directions on the bottle.

Betaine HCL Supplementation:  If you taking any anti-inflammatory medication, such as corticosteroids or NSAIDs (aspirin, ibuprofen, Advil, etc.), it is important that you do not attempt betaine HCL supplementation due to an increased risk of GI bleeding and ulcers.**  Although supplementing with lemon juice in water, apple cider vinegar in water, or digestive bitters can be helpful in mild cases, many people will need something stronger to help bring stomach acid production back into balance.  Betaine HCL supplementation provides the same type of acid produced naturally by the stomach.  It increases the acidity of the stomach to support proper digestion.  Often, by supplementing with betaine HCL for a period of time, the body will gradually shift to a state of balance, the stomach will begin producing adequate amounts of its own acid, and supplementation will no longer be needed.  The dose and length of time needed to supplement with betaine HCL varies for each individual though and some people may require long-term support.  Although betaine HCL can be obtained at most health food stores, I recommend working with an informed holistic health practitioner for best results.

Are you working toward correcting your own low stomach acid in order to restore digestion?  Have you tried any of these techniques and found them helpful?  I would love to hear from you!   

References

Wright, J. & Lenard, L. (2001).  Why Stomach Acid is Good for You:  Natural Relief from Heartburn, Indigestion, Reflux, and GERD. Lanham, Maryland:  The Rowman & Littlefield Publishing Group.

Photo Credits:

Brain:  Everyone's Idle, Wikipedia, 2009; Giraffe:  Pixabay, Unknown author, 2007; Bread and Grains:  National Cancer Institute, 1989; Ibuprofen:  ParentingPatch, 2013; Lemon Water:  Go_Nils, Flickr, 2009;