In my ever ongoing quest to find answers to my son's multiple symptoms for the past 3-1/2 years which includes: bipolar mania, chronic brown rash on areas of body, prickly heat sensation, muscle/joint pain, bouts of digestive problems, I came across this very interesting article by James A. Ferrel M.D. I strongly believe that his multiple symptoms are interconnected and can be traced back to a root cause of possible toxins. This article appears to support this thought. I hope the article proves to be of use to some on this board. Fondly, Lisa ================================== Leaky Gut Syndrome by James A. Ferrel M.D. Question: What is the Leaky Gut Syndrome (LGS) and how does it cause us harm? Answer: The Leaky Gut Syndrome may be the cause of many "etiology unknown" illnesses. LGS may also explain many of the symptoms patients have that confound and confuse many physicians. In my opinion, it's grossly under-considered as a "mainstream medicine" diagnosis. To understand LGS we need to understand the concept of barrier function. The barrier demarcates the outside environment from the internal environment. The primary function of the barrier is to keep germs and detrimental particles from entering our internal environment. Most people would agree that the skin and what?s under it is internal to us. What is external to the skin is not part of us. Violation of that skin barrier by severe burns, or by penetrating wounds, allow elements of the external environment to enter. Once passed this skin barrier those elements can wreak havoc upon us. This is what happens if we step on a nail and get an inoculated infection. If we weaken the barrier with a burn or physical wound, we create a window of opportunity for germs or unhealthy particles to enter us. This also allows fluids, proteins, electrolytes, cells, etc. (part of us) to exit. Brain, skin, and gut lining epithelium originate from the same embryologic tissue. Often diseases or conditions that affect one affect another. Food allergies can produce skin, neurological, and gut symptoms. For example, allergy to gluten manifests in inflammation of the gut termed celiac disease. The same manifestation in the skin is recognized as dermatitis herpetiformis. Gut lining is generally thinner and more fragile than skin and both are exposed to different environmental challenges. Hence, each tissue will have independent disease manifestations also. Both skin and gut function as barriers. Envision the human body as an odd shaped doughnut. The crust of the doughnut is the barrier. The gut is simply the hole in the doughnut. The doughnut hole is not part of the doughnut; it is part of the outside environment. We are not shaped like a doughnut, but like a doughnut, we have a hole. The mouth is the opening at the top, and at the bottom the opening is the anus. The gut lumen is our ?hole? and its contents are external to us. The two obvious anatomical distinctions between the doughnut hole and the human gut are that: 1.The human gut is irregular in shape, and 2.The crust or surface is variable in organization. These distinctions are due to the gut's other functions of digestion, absorption, and excretion. Because the gut barrier is thin and the contents of the gut is loaded with toxins and germs, our smart bodies have protective immune cells, called polymorphocytes (polys) laden with killer chemicals ready to poison any potential invaders. Polys patrol just inside our gut lining. It is suspected that sometimes these polys release their poisons, generically termed cytokines, inappropriately. This results in inflammation that can sever the cellular attachments of the barrier. Loss of barrier integrity in the gut creates a window of opportunity for toxicity (poisoning). This "window" allows organisms, their toxic products of metabolism, and other particles to enter our interior through the gut lining. Once inside, any foreign material meets our second line of defense, lymphocytes and macrophages. Lymphocytes address the invaders by becoming programmed to make specific antibodies against them. They sense recognition points on the invaders' surfaces. Once released, these antibodies are then programmed to lock onto the surfaces of the invaders and disable them. The combination of invader/antibodies attracts macrophages which engulf and destroy it. Unfortunately, those same beneficial antibodies are suspected of reacting and combining with "friendly tissue" parts of our body, when that healthy tissue is erroneously recognized as foreign. This tissue collateral damage is termed autoimmunity. Leaky Gut (LGS) related autoimmunity is suspected in ANKYALOSING SPONDILITIS, RHEUMATOID ARTHRITIS, et al. with antibodies and inflammatory cytokines that inappropriately damage joint and other tissues, in genetically, and nutritionally deficient, susceptable individuals. MULTIPLE SCLEROSIS could be related to LGS generated antibodies and cytokines attacking the protective myelin sheath of nerve cells in nutritionally deficient, and genetically vulnerable individuals. In LGS the gut has, as the name implies, a plethora of leaks. This massive leakage material induces our body's immune system to produce large quantities of killer chemicals intended to target the illegal entrants. This huge production effort weakens the immune system by tying up energy and enzymes. In this manner LGS may be a major factor in CHRONIC FATIGUE SYNDROME. The brain may also be affected by the combination of the massive endogenous toxic chemical production of LGS and the exogenous chemical that we take into our bodies. When the brain is thusly affected it is termed an ENCEPHALOPATHY. An encepalopathy may manifest with any combination of cognitive, behavioral, or functional abnormalities. Most of us have been affected by transient encephalopathy (short term "brain fog") or by common transient intoxications, most often self induced with alchohol, or other drugs. It's important to remember that the brain also originates from the same embryologic tissue and shares common vulnerabilities with skin and gut. Celiac disease is now recognized as a multiple system disease that includes the central nervous system, as well as skin and gut. Children with celiac disease may have behavioral, learning, irritability, or concentration problems.. In children whose blood-brain barrier is not yet fully developed, LGS produced endogenous (produced by our body) cytokimes and leakage toxins can more easily affect mentation and thus behavior by direct brain cell toxicity. This mechanism is similar to the brain cell poisoning (toxicity) by exogenous (produced outside our body) chemicals like formaldehyde, methanol, or ethanol. Such chemically toxic children present with varying degrees of encephalopathy. Their behavior and writings will be affected when their brain cells are not functioning optimally. The children with dense or prolonged encephalopathy have increased rate of brain cells dying as a result of the toxicity. The death of the brain cells, along with their neural connections are diffusely distributed unlike a stroke, cerebral paulsy, or brain physical trama. The damage is more difficult to account for by conventional imaging studies and may vary greatly in presentation. These children may be misdiagnosed with AUTISM, ADHD, PSYCHOSIS, or DEPRESSION. They even may go from one wrong diagnosis to another as the brain reestablishes some connections, the toxic load decreases, various inappropriate drug interventions are used, etc. WE ARE SEEING ENTIRELY TOO MANY CHILDREN WITH ENVIRONMENTALLY INDUCED ILLNESSES, INCLUDING LGS MISDIAGNOSED. I strongly believe that something is seriously being "missed," as we are seeing an inordinate number of children (and adults) being diagnosed with mental illness, most often DEPRESSION, and placed on psychoactive drugs. The frequency of occurence statistics don't make any common sense. The drugs often do more harm than good. The momentum for this movement is strong in the mainstream-medicine community. I believe it is powered by the drug companies that make the drugs involved. The good news is that the brain damage involved is diffuse and is more likely to repair itself with time, and good NUTRITION (See my article NUTRITION-MORE THAN JUST A FOOD on this website), if drugs given in misdiagnosis don't exacerbate and prolong the condition, by masking the real cause of the symptoms. Quite often an ENCEPHALOPATHY is misdiagnosed, even in adults. BIPOLAR DISORDER MISDIAGNOSIS is often made as the behavioral changes associated with the ENCEPHALOPATHY often increase or decrease as a reflection of brain function. This often is the case in the MCS (Multiple Chemical Sensitive) patient. The MCS patient's behavior can change quite rapidly upon exposure to chemicals that elicit ACUTE ENCEPHALOPATHIES. With an overload of toxins the brain functions poorly. With episodes of rest, less stress, improved nutrition, exercise, improvement of circadian rythum, etc., the brain functions improve and reflect in better cognition, neurological function, and behavior. The personality, mood, and behavioral changes are the most striking manifestations of the ENCEPHALOPATHY. At close inspection, however, other neurological signs as well as other abnormal signs of other systems of the body (dermatologic, gasto-intestinal, cardiovascular,etc.) may be present. The misdiagnosis is most often brought about when the clinician making the diagnosis fails to carefully listen to the patient or caregiver for the history of chemical exposure and/or gastrointestinal symtoms, and fails to look for concomminant neurological signs of abnormalities. Most often, unfortunately, the naive clinician will focus on the psychiatric signs and discount or ignore the patient as a whole. Most often the misdiagnosis worsens the symtoms as the clinician then inappropriately and naively prescribes strong intervention drugs that further tax the detoxification system. The learning "pearl" for such clinicians is to strongly suspect a BIPOLAR DEPRESSIVE DISORDER MISDIAGNOSIS in any child or in an adult over 50 years old. These individual's poorly developed (child), or weakened with age (50 or older), blood-brain barriers make them more vulnerable to adverse effects of both exogenous (including drugs) and endogenous chemicals. Also in the older groups, quite often the lifelong bioaccummultion of neuro-toxins and the decline in detoxification enzymes that occur with aging allow for the brain to become more easily affected. Likewise, in the middle age group always rule out illicit drug/alchohol abuse induced encephalopathies. In all age groups, ALLERGY, whether it be food or inhalant type, will weaken the blood brain barrier, mostly around the brain's LIMBIC area. The mechanism of allergy related encephalopathy involves the release of cytokimes from immune cells, such as mast cells, which are induced by the allergy process. The resultant inflammatory process causes "leaks" in the blood brain barrier, allowing chemicals to enter. Most of us are familiar with the lethargy of "spring fever" (a lay term for seasonal allergy). That lethargy/brain fog/out of sorts feeling associated with seasonal allergy is a very mild form of encephalopathy. The limbic area modulates libido and motivation. Since the process often involves the limbic brain, it's no surpise that excessive romantic thoughts and a lazy attitude are part of the clinical presentation of SEASONAL ALLERGY ENCEHALOPATHY. The natural process, in overview, may serve a very necessary teleologic purpose in nature, i.e.- the preservation of the higher animal species. Natural occuring chemicals acting upon the brain, such as fermones, endorphins, and oxytocin powerfully support this natural purpose. Unfortunately, these allergy induced leaks also allow manmade ubiquitous neuro-toxic chemicals, like formaldehyde, VOH's (Volitile Organic Hydrocarbons), or pesticides to enter and poison the neurons. In the more serious leakage cases (allergies plus chemical intoxication) it's like a one-two punch in boxing. The allergy punch lowers the brain's defense and sets up the "knockout" chemical blow. In these cases dramatic, and often life-changing encephalopathies can occur. The limbic region is involved in many other functions such as memory; MOOD; autonomic control of blood pressure, body temperature, hunger, thirst, and sleep. Allergy/chemical induced damage can present with, in assending order of severity: moodiness, sleep disturbance, irritability, depression, and the toxicity induced mixture of complete emotional lability seen in BIPOLAR DISORDER. Such cases are, in my opinion, rarely correctly diagnosed, except by doctors trained in EM (ENVIRONMENTAL MEDICINE). EM doctors almost always incorporate allergy testing and desensitization for inhalant allergies and elimination diet schemes for food related allergies. Of course the EM doctor also works to preserve those brain cells still alive, but still at risk, by enhancement of the body's detoxification processes. Ultimately, eliminating any ongoing toxic chemical exposure is also fundamental to successful treatment. In all such cases of suspected encephalopathies, all clinicians need to look carefully for neurologically or other signs that suggest chemical or allergy related toxicity to rule out encephalopathies! The LGS or other chemical toxicity etiology of patients' symptoms only becomes apparent if, and when, the LGS or toxicity issue is discovered and is resolved. In LGS the weakened gut lining, like a chronic festering skin sore, allows for the colonizing of unnatural microbes. CANDIDA is the main microbe of concern. Not only does Candida produce a plethora of toxins, Candida becomes the main adversary against the body's repair of the leaky gut. Candida thrives in moist, warm places. If our immune system is weak it will entrench itself in the mouth, vagina (a cul-de-sac of the "crust"), or our gut. It looks like cottage cheese. Mouth Candida (thrush) has a typical appearance. It's a mixture of Candida spores, mucus, and inflammatory exudates. If you scrape the "cottage cheese" off the tongue, the tongue will remain inappropriately white. What remains and makes the tongue whiteness appearance persist, is the rizoid form of Candida. Riziods are like roots for the Candida organisms in the gut to anchor to the gut lining. Like spears, the riziods penetrate and make more leaks in the gut. Like tubes they poor in toxins. This Leaky Gut/ Candida phenomenon allows more of the outside environment into our interior. Inside it combines with, invited and uninvited, pharmacologically active chemical guests to potentiate each other in a "polypharmacy of chemical toxicity" in our *ATLAS DRUGGED. *Atlas Drugged is an upcoming book by Dr. Ferrel. Dr. Ferrel is a board certified family physician and a certified nutritional consultant who specializes in preventative and environmental medicine. He currently resides in Phoenix, Arizona.