Leaky gut, or intestinal wall hyperpermeability, occurs when the tight junctions between intestinal cells are compromised due to a poor diet, food allergens, stress or other disease processes. This condition allows the passage of bacteria, toxins, and other small molecules that would otherwise be contained in the GI tract, to leak into the bloodstream. Once in circulation, these undesirables trigger the body’s immune system which can lead to wide-spread inflammation (metaflammation) and the erosion of the blood-brain barrier (BBB). The resulting BBB hyperpermeability, or leaky brain, then allows these pathogenic organisms and toxins to enter the brain, causing all types of mental health issues ranging from depression and anxiety to cognitive decline and more severe neurological conditions.
5 Signs of Leaky Gut
- Mental and emotional symptoms: Anxiety, depression, brain fog, other cognitive and emotional symptoms (Harvard Health, 2021)
- Fatigue: Low energy, limited endurance, chronic fatigue, and exercise intolerance (Cleveland Clinic, 2022)
- Digestive upset: Indigestion, pain, burning, gas, bloating, nausea, diarrhea, or constipation (Cleveland Clinic, 2022)
- Food reactivity: Distress after eating certain foods and/or 12+ IgG reactivities (Cleveland Clinic, 2022).
- Body pains: Fibromyalgia, joint pain, stiffness, soreness, and achiness (Harvard Health, 2021).
If you relate with more than 3 of the symptoms from the list above, it is possible you may have a leaky gut. The good news is that you can stop the damage and even reverse the process through a systemic process of identifying the root causes of your symptoms and providing your body the pathway to heal itself.
As a naturopathic physician specializing in mental health, I treat the leaky gut-leaky brain phenomenon every day using a 5-Step approach.
Step 1: Identify the Root Cause(s) of Symptoms.
There are two primary tests that I consider when evaluating the root cause of all suspected leaky gut cases: Intestinal Permeability Assessment (IPA) testing and IgG Food Sensitivity testing.
Test 1: An IPA test directly measures the ability of two sugar molecules, lactulose and mannitol which are consumed in a drink, to permeate the intestinal barrier. In cases of leaky gut, these sugars will leak from the intestines into the bloodstream to be eliminated by the kidneys. Elevated levels in the urine are, therefore, highly indicative of the condition. (GDX IPA, 2022).
Test 2: An IgG test screens for antibody production – in this case, the antibodies are produced in response to the presence of allergenic food proteins. This IgG response reflects a delayed form of hypersensitivity which means that you may not react to food proteins immediately even though you are allergic to them. In fact, in some cases it may take several days for a reaction to occur. So, that cupcake you ate on Monday might not cause problems until Thursday. This makes some food sensitivities tricky to identify. Thankfully, food sensitivity testing is available that can help narrow down what foods might be damaging your gut (GDX, 2022).
Step 2: Remove Obstacles to Healing.
This typically involves tidying up the diet by eliminating your top 3 food triggers (this could mean sensitivities and/or allergies), limiting preservatives, eliminating chemicals and food additives, and emphasizing foods high in prebiotic fibers. Prebiotic fibers are the food your gut microbes need to produce the short chain fatty acids critical to strengthening your intestinal barrier. Foods rich in prebiotic fibers include veggies, legumes, whole grains, and apples. Omega 3 fatty acids, which can be found in fatty fish, krill, flaxseed, chia seeds, and walnuts also provide robust gut-healing support.
Step 3: Give the Mind and Body What it Needs to Heal.
Unmet needs can play a significant role in the development of leaky gut. An audit of workload and other demands, physical activity, recreation, and relationships can offer a lot of insight into what aspects of my four primary lifestyle factors, Connection, Detoxification, Movement, and Rest, are out of balance.
Step 4: Tonify Organ Systems.
Tonification is a word that refers to the increase of strength and energy. In this step, we identify organ systems that are in need of strengthening and energizing. For example, if you suffered from muscle weakness and fatigue, tonification would involve moving your body and gently exercising your muscles.
When suffering from leaky gut and the cognitive problems of leaky brain, we want to focus on solutions that tonify the gut-brain-axis. The gut-brain axis is comprised of five key systems: the gut microbiome, the central nervous system–the brain and spinal cord, the autonomic nervous system –the nervous system responsible for automatic functions such as breathing and heart rate, the enteric nervous system– the nervous system in the gut responsible for digestion and gut-brain communications, and the hypothalamic-pituitary-adrenal axis –a bidirectional feedback loop that communicates with the gut through the vagus nerve (Cain, N., 2022). Tonification of the gut-brain axis may involve use of botanicals, acupuncture, and other holistic methods. Zeroing in on what components need support will get the best results. Individualization is key.
Step 5: Stimulate The Body’s Natural Healing Capabilities.
The body has an innate ability to heal itself and there are many integrative tools at our disposal that effectively promote that natural healing mechanism. For example, many of us are aware that applying aloe vera gel to a sunburn can soothe the skin and speed up the healing process (Hekmatpou, D, et al, 2019), and the same goes for using certain remedies to heal the gut and brain. Here are my top 3 favorite nutritional supplements for expediting gut healing.
- L-Glutamine: As a powder, glutamine has been clinically shown to soothe gastrointestinal tissue, heal gap junctions, and reduce inflammation (Barekatain, R., et al, 2019).
- Glycyrrhiza glabra: Otherwise known as licorice, glycyrrhiza is a plant that has many medicinal qualities including protecting and healing the intestinal cells and reducing intestinal permeability (Murugan, Sk.K, et al, 2022).
- Psychobiotics and Prebiotics: Psychobiotics are specialized probiotics targeted to support the gut-brain axis. In addition to regulating the immune system, nourishing cells of the intestinal tract, and balancing inflammatory response, psychobiotics and prebiotics have been researched for their efficacy in improving mood, cognition, and overall brain health (Omnibiotic Life, 2022) (Hu, X., Wang, T., Jin, F., 2016).
The naturopathic approach to treating mental health symptoms is by nature a holistic one, with the goal of understanding the root cause and treating the whole person. Whereas conventional psychiatry has a greater tendency to rely on psychoactive medications. Although there is certainly a time and place for these substances, many classically trained medical professionals fail to investigate the physiological mechanisms that may be at the root of psychiatric symptoms. But fortunately, this is changing.
In a recent conversation Dr. David Scheiderer, an integrative psychiatrist in Florida, shares his method of addressing mental health challenges by evaluating the whole person. His personalized approach evaluates not only symptoms but also addresses underlying causes with the ultimate goal of improving mental wellness and quality of life over the long haul.
“My mantra has been, over the years, a personalized treatment for the most personal of all illnesses. No one suffers like those who have mental illness: depression, anxiety, bipolar, mood disorders, degenerative disorders, etc. So, while I want to personalize treatment, at the same time, I need data to guide the appropriate intervention.
For example, we know that inflammation is a component of many mental health disorders and virtually all neurodegenerative conditions–think Alzheimer’s Disease and Parkinson’s Disease . We also know that the progression of many of these conditions starts in the gut, so that’s where I start as well. I want not only to reduce suffering today, I also want to prevent or delay onset of those dreaded neurodegenerative conditions. Then I want to enhance the quality of life and help encourage the pursuit of happiness. Medicines will only help reduce suffering initially. They don’t really accomplish these other things.
Patients who meet the diagnostic criteria for major depression can look very different. Some eat all the time, some don’t eat at all. Some sleep all the time, some don’t sleep at all. Some can’t sit still and some cannot work up the motivation to move.
I always run inflammatory marker tests on all of my patients, because research has revealed a link between inflammation and certain phenotypes of depression, which helps me zero in on specific therapeutic interventions. Whether it be addressing that gut-brain axis by healing and sealing the gut, or selecting the most appropriate psychoactive medication, a patient’s inflammatory state provides a lot of insight.
I use a lot of probiotics (psychobiotics), fish oil, Vitamin D3, and L-methylfolate right on top of the antidepressants when indicated. For inflamed patients, treating the root cause of their dysbiosis with natural remedies seems to work.
I really use this thought process, my unifying theory so to speak, to guide my treatment decisions, whether that be medication, psychotherapy, or the all-important lifestyle changes including diet, exercise, sunshine, and healthy interpersonal relationships.”
It is so encouraging to me, as a naturopathic physician, that more than ever before, my conventionally trained colleagues are embracing a whole-person approach to healthcare. The body has an incredible ability to heal itself given the right environment. And with the unification of traditional holistic wisdom, modern science, and personalized care, deeply restorative healing is possible: gut to brain.
Learn more about healing the gut-brain axis, one bite at a time, with my Gut Psychology Program. Alternative Medicine readers are invited to use a special 15% discount using promo code: ALTMED15
Dr. Nicole Cain has degrees in clinical psychology and naturopathic medicine and is a pioneer in holistic mental health. She has been interviewed as a mental health expert by Forbes, regularly contributes to a mind-body series on Psychology Today. She is currently writing a book about panic and anxiety, and is the founder of the Holistic Wellness Collective, where she teaches how to be your own natural mental health expert. You can find Dr. Nicole on Instagram @DrNicoleCain.