Mechanisms
The mechanisms behind leaky gut syndrome in these situations may include changes in
intestinal flora, increased adherence of bacteria to the bowel wall, gut wall inflammation, immune deficiency and changes in circulation. However it is unclear whether the increase in intestinal permeability is a primary or secondary event and not all studies have found these associations.
The part played by bowel flora is not at present clear. Changes in flora could alter the function of enterocytes, their adhesion and, of course, gut transit as well as the production of undesirable immune and inflammatory effects.
For nearly twenty years it has been known that patients with Crohn’s disease, but not
ulcerative colitis, often have evidence of IgG antibodies against candida albicans and saccharomyces cerevisiae. However the presence of these antibodies does not automatically mean that they play a causative role in the disease.
Treatment
As yet there is no specific treatment for LGS but various approaches are considered or are likely to be beneficial:
• Reduce inflammation in the intestinal wall by dietary change and use of anti-
inflammatory medication
• Avoidance of foods to which the person is allergic or
intolerant
• Avoidance of drugs and other causative factors (see previous page)
• Improvements in bowel flora by dietary change and use of probiotic preparations
• Avoidance or limitation of alcohol for at least several weeks
• Zinc supplements have been shown to reduce intestinal permeability in patients with Crohn’s disease. In a small Italian study zinc
sulphate 110 mg three times daily for eight weeks was used in patients who were already in remission. This dose exceeds UK/US safety guidelines and should only be taken with expert advice.
• Other supplements might be helpful. Several B vitamins are essential for the health of the metabolically active enterocytes and a diet rich in omega-3 oils or supple-
ments of fish oils might have an anti-inflammatory effect
• Glutamine supplements have a reputation for being beneficial but this amino acid is only likely to be
deficient (and supplements beneficial) in malnourished or very ill patients such as those with pancreatitis.
It does seem that there is
renewed interest in the function of the gut wall in many gastrointestinal and other diseases. LGS may be a reality for some patients but its importance is as yet unclear. Whether adding this diagnosis to an exisiting gastrointestinal one is of benefit to the patient is also unclear. A degree of healthy scepticism should be combined with a little optimistic interest when considering LGS.
References
1 Millward C. et al. Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD0033498.
2 Cass H. et al. Absence of urinary opioid peptides in children with autism. Arch Dis Child. 2008 Sep;93(9):745-50.
3 Mullin J. et al. Esomeprazole Induces Upper Gastrointestinal Tract Transmucosal Permeability Increase. Aliment Pharmacol Ther. 2008;28(11):1317-1325.
4 Bonet A. et al. Glutamine, an almost essential amino acid in the critically ill patient. Med Intensiva. 2007 Oct;31(7):402-6.
5 Huang XX. Et al. Effects of enteral nutrition supplemented with glutamine and arginine on gut barrier in patients with severe acute pancreatitis: a prospective randomized controlled trial. Zhongua Yi Xue Za Zhi. 2008 Sep 9;88(34):2407-9.
6 Bjarnason I. et al. The leaky gut of alcoholism: possible route of entry for toxic compounds. Lancet. 1984 Jan 28;1(8370):179-82.
7 Sandek A. et al. The emerging role of the gut in chronic heart failure. Curr Opin Clin Nutr Metab Care. 2008 Sep;11(5):632-9.
8 Sturniolo GC. Et al. Zinc supplementation tightens “leaky gut” in Crohn’s disease. Inflamm Bowel Dis. 2001 May;7(2):94-8.
Margaret Moss comments:
'Sulphate is needed to make sulphated glycosaminoglycans (GAGS) for the gut wall. Without adequate sulphate the gut wall is leaky. Without adequate sulphate there is a shortage of digestive enzymes. So food is less efficiently broken down, and the holes in the gut are bigger. That leads to partly broken down food, eg peptides reaching the blood. One peptide is beta casomorphine, which affects the brain.'
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