intestinal hyperpermeability, causes and details

Discussion in 'Fibromyalgia Main Forum' started by Catseye, Jan 7, 2009.

  1. Catseye

    Catseye Member

    Sorry about the big words in here, it's one of the most complete scientific explanations I've found for what's happening in our guts - at least most of us. My own conclusion - you can attempt to treat it yourself and waste lots of time and money (unless you get lottery lucky) or you can find someone who will use things like the intestinal hyperpermeability test and a comprehensive digestive stool analysis test to interpret what is happening and what exactly you need to do to fix it. The treatment should consist mostly of dietary changes and supplements. This means you may have a hard time getting medicare or insurance to pay for any of it, I don't know anything about those. I do know that I had one of the worst cases of gut dysbiosis known to man and I've been on the treatment for 9 months now and I'm still not completely healed. I've searched and searched and there is no quick fix for this because you have to eat and the digestive organs are what are damaged. So they have to repair themselves while they are doing their work. It's very difficult and you can't cheat on the diet at all. So, for what it's worth, here's the low down on intestinal hyperpermeability (leaky gut in layman's terms) and the mechanism of action that is causing most of our symptoms:

    From the perspective of function, the contents of the gut lumen lie outside the body and contain a toxic/antigenic load from which the body needs to be protected. Protection is supplied by complex mechanisms which support one another: intestinal secretions (primarily mucus and secretory IgA), the mucosal epithelium, and intramural lymphocytes [1]. This primary, intestinal barrier is supported by the liver, through which all enterically-derived substances must pass before entering the arterial circulation for transport to other tissues and organs. Kupffer cells in the hepatic sinusoids remove absorbed macromolecules by phagocytosis. Hepatic microsomal enzymes alter gut-derived chemical substrates by oxidation and by conjugation to glycine and glutathione(GSH) for excretion into bile and for circulation to the kidneys. The cost of detoxification is high; reactive intermediates and free radicals are generated and anti-oxidants like GSH are consumed [2, 3]. Any compromise of intestinal barrier function increases the production of oxygen radicals and carcinogens by the liver's cytochrome P-450 mixed-function oxidase system. The excretion of oxidation by-products into bile and the reflux of this "toxic" bile into the pancreatic ducts may be the major cause of chronic pancreatic disease.[4, 5]

    Compromised intestinal barrier function can also cause disease directly, by immunological mechanisms.[6-9] Increased permeability stimulates classic hypersensitivity responses to foods and to components of the normal gut flora; bacterial endotoxins, cell wall polymers and dietary gluten may cause "non-specific" activation of inflammatory pathways mediated by complement and cytokines. [10] In experimental animals, chronic low-grade endotoxemia causes the appearance of auto-immune disorders.[11-13]

    Leaky Gut Syndromes are clinical disorders associated with increased intestinal permeability. They include inflammatory and infectious bowel diseases [14-19], chronic inflammatory arthritides [9, 20-24], cryptogenic skin conditions like acne, psoriasis and dermatitis herpetiformis [25-28], many diseases triggered by food allergy or specific food intolerance, including eczema, urticaria, and irritable bowel syndrome [29-37], AIDS [38-40], chronic fatigue syndromes [Rigden, Cheney, Lapp, Galland, unpublished results], chronic hepatitis [41], chronic pancreatitis [4, 5], cystic fibrosis [42] and pancreatic carcinoma. Hyperpermeability may play a primary etiologic role in the evolution of each disease, or may be a secondary consequence of it which causes immune activation, hepatic dysfunction, and pancreatic insufficiency, creating a vicious cycle. Unless specifically investigated, the role of altered intestinal permeability in patients with Leaky Gut Syndromes often goes unrecognized. The availability of safe, non-invasive, and inexpensive methods for measuring small intestinal permeability make it possible for clinicians to look for the presence of altered intestinal permeability in their patients and to objectively assess the efficacy of treatments. Monitoring the intestinal permeability of chronically ill patients with Leaky Gut Syndromes can help improve clinical outcomes.

    < Triggers and Mediators of the Leaky Gut

    Leaky Gut Syndromes are usually provoked by exposure to substances which damage the integrity of the intestinal mucosa, disrupting the desmosomes which bind epithelial cells and increasing passive, para-cellular absorption. The commonest causes of damage are infectious agents (viral, bacterial and protozoan) [43-46], ethanol [47, 48], and non-steroidal anti-inflammatory drugs [20, 49, 50]. Hypoxia of the bowel (occurring as a consequence of open-heart surgery or of shock) [51, 52], elevated levels of reactive oxygen metabolites (biliary, food-borne or produced by inflammatory cells) [53], and cytotoxic drugs [54-56] also increase para-cellular permeability.

    The Four Vicious Cycles

    Cycle One: Allergy
    The relationship between food sensitivities and the leaky gut is complex and circular. Children and adults with eczema, urticaria or asthma triggered by atopic food allergy have baseline permeability measurements that are higher than control levels [57-59]. Following exposure to allergenic foods, permeability sharply increases. Most of this increase can be averted by pre-treatment with sodium cromoglycate [32, 34, 57-59], indicating that release from mast cells of atopic mediators like histamine and serotonin is responsible for the increase in permeability. It appears that an increase in intestinal permeability is important in the pathogenesis of food allergy and is also a result of food allergy.

    Claude Andre, the leading French research worker in this area, has proposed that measurement of gut permeability is a sensitive and practical screening test for the presence of food allergy and for following response to treatment [57]. In Andre's protocol, patients with suspected food allergy ingest 5 grams each of the innocuous sugars lactulose and mannitol. These sugars are not metabolized by humans and the amount absorbed is fully excreted in the urine within six hours. Mannitol, a monosaccharide, is passively transported through intestinal epithelial cells; mean absorption is 14% of the administered dose (range 5-25%). In contrast, the intestinal tract is impermeable to lactulose, a disaccharide; less than 1% of the administered dose is normally absorbed. The differential excretion of lactulose and mannitol in urine is then measured. The normal ratio of lactulose/mannitol recovered in urine is less than 0.03. A higher ratio signifies excessive lactulose absorption caused by disruption of the desmosomes which seal the intercellular tight junctions. The lactulose/mannitol challenge test is performed fasting and again after ingestion of a test meal. At the Hospital St. Vincent de Paul in Paris, permeability testing has been effectively used with allergic infants to determine which dietary modifications their mothers needed to make while breast feeding and which of the "hypoallergenic" infant formulas they needed to avoid in order to relieve their symptoms [60].

    Cycle Two: Malnutrition
    Disruption of desmosomes increases absorption of macromolecules. If the epithelial cells themselves are damaged, a decrease in trans-cellular absorption may accompany the increased para-cellular absorption. Because nutrients are ordinarily absorbed by the trans-cellular route, malnutrition may occur, aggravating strucutural and functional disturbances [61]. Under normal conditions, intestinal epithelium has the fastest rate of mitosis of any tissue in the body; old cells slough and a new epithelium is generated every three to six days [62, 63]. The metabolic demands of this normally rapid cell turnover must be met if healing of damaged epithelium is to occur. When they are not met, hyperpermeability exacerbates [64, 65].

    Correction of nutritional deficiency with a nutrient-dense diet and appropriate supplementation is essential for the proper care of patients with Leaky Gut Syndromes. Specific recommendations are made in the last section of this review. Because of the association between hyperpermeability and pancreatic dysfunction, pancreatic enzymes may also be required.

    Cycle Three: Bacterial Dysbiosis
    Dysbiosis is a state in which disease or dysfunction is induced by organisms of low intrinsic virulence that alter the metabolic or immunologic responses of their host. This condition has been the subject of a recent review article [66]. Immune sensitization to the normal gut flora is an important form of dysbiosis that has been implicated in the pathogenesis of Crohn's disease and ankylosing spondylitis[67-81]. Recent research findings suggest that bacterial sensitization is an early complication of altered permeability and exacerbates hyperpermeability by inducing an inflammatory enteropathy [82, 83]. This has been most studied in the response to NSAIDs. Single doses of aspirin or of indomethacin increase para-cellular permeability, in part by inhibiting the synthesis of protective prostaglandins [20, 49, 50, 84, 85]. Hyperpermeability is partially prevented by pre-treatment with the prostaglandin-E analogue, misoprosterol. Chronic exposure to NSAIDs produces a chronic state of hyper-permeability associated with inflammation, which can not be reversed by misoprosterol but which is both prevented and reversed by the administration of the antibiotic, metronidazole [83, 86]. The effectiveness of metronidazole in preventing NSAID-induced hyperpermeability probably reflects the importance of bacterial toxins in maintaining this vicious cycle. A single dose of bacterial endotoxin, administered by injection, increases the gut permeability of healthy humans [87]. Chronic arthritis can be induced in rats by injection of cell wall fragments isolated from normal enteric anaerobes[88]. Patients with rheumatoid arthritis receiving NSAIDs have increased antibody levels to Clostridium perfringens and to its alpha toxin, apparently as a secondary response to NSAID therap[89].

    There is ample documentation for a therapeutic role of metronidazole and other antibiotics in Crohn's disease and rheumatoid arthritis[90-98]. The mechanism underlying the response has been in dispute. In the case of tetracyclines, one group has asserted that mycoplasma in the joints cause rheumatoid arthritis, others have countered this argument by demonstrating that minocycline is directly immunosuppressive in vitro [99]. Because all patients with arthritis have used NSAIDs, and because NSAID enteropathy is associated with bacterial senisitization, it is possible that the the antibiotic-responsiveness of some patients with inflammatory diseases is a secondary effect of NSAID-induced bacterial sensitization which then exacerbates the Leaky Gut Syndrome. Altering gut flora through the use of antibiotics, synthetic and natural, probiotics, and diet is a third strategy for breaking the vicious cycle in Leaky Gut Syndromes. With regard to diet, patients whose disease responds to vegetarian diets are those in whom the diet alters gut ecology; if vegetarian diets does not alter gut ecology, the arthritis is not improved[100].

    Cycle Four: Hepatic Stress
    The liver of Leaky Gut patients works overtime to remove macromolecules and oxidize enteric toxins. Cytochrome P-450 mixed-function oxidase activity is induced and hepatic synthesis of free radicals increases. The results include damage to hepatocytes and the excretion of reactive by-products into bile, producing a toxic bile capable of damaging bile ducts and refluxing into the pancreas [4, 5]. In attempting to eliminate toxic oxidation products, the liver depletes its reserves of sulfur-containing amino acids [101]. These mechanisms have been most clearly demonstrated in ethanol-induced hepatic disease [47]. Sudduth [102] proposes that the initial insult is the ethanol-induced increase in gut permeability which creates hepatic endotoxemia. Endotoxemia can further increase permeability, alter hepatic metabolism, and stimulate hepatic synthesis of reactive species which are excreted in bile. This toxic bile, rich in free radicals, further damages the small-bowel mucosa, exacerbating hyperpermeability.

    A Practical Approach

    Suspect a pathological increase in gut permeability when evaluating any patient with the diseases listed in Table 1 or the symptoms listed in Table 2. Measure permeability directly using the lactulose/mannitol challenge test. Indirect measures of gut permeability include titres of IgG antibody directed against antigens found in common foods and normal gut bacteria. These tests may be useful but cannot substitute for the direct permeability assay, especially when one is following the response to treatment.

    Table 1

    Diseases Associated with Increased Intestinal Permeability

    * Inflammatory bowel disease
    * Infectious enterocolitis
    * Spondyloarthropathies
    * Acne
    * Eczema
    * Psoriasis
    * Urticaria
    * HIV infection
    * Cystic fibrosis
    * Pancreatic insufficiency
    * AIDS, HIV infection
    * Hepatic dysfunction
    * Irritable bowel syndrome with food intolerance
    * CFIDS
    * Chronic arthritis/pain treated with NSAIDs
    * Alcoholism
    * Neoplasia treated with cytotoxic drugs
    * Celiac disease
    * Dermatitis herpetiformis
    * Autism
    * Childhood hyperactivity
    * Environmental illness
    * Multiple food and chemical sensitivities

    Table 2

    Symptoms Associated with Increased Intestinal Permeability

    * Fatigue and malaise
    * Arthralgias
    * Myalgias
    * Fevers of unknown origin
    * Food intolerances
    * Abdominal pain
    * Abdominal distension
    * Diarrhea
    * Skin rashes
    * Toxic feelings
    * Cognitive and memory deficits
    * Shortness of breath
    * Poor exercise tolerance

    IF ALL COMPONENTS OF THE LACTULOSE/MANNITOL TEST ARE NORMAL, repeat the challenge after a test meal of the patient's common foods. If the test meal produces an increase in lactulose excretion (signifying hyperpermeability) or a decrease in mannitol excretion (signifying malabsorption), specific food intolerances are likely and further testing for food allergy is warranted. Once the patient has been maintained on a stable elimination diet for four weeks, repeat the lactulose/mannitol challenge after a test meal of foods permitted on the elimination diet. A normal result assures you that all major allergens have been identified. An abnormal result indicates that more detective work is needed.

    IF THE INITIAL FASTING MANNITOL ABSORPTION IS LOW, suspect malabsorption. This result has the same significance as an abnormal D-xylose absorption test. Look for evidence of celiac disease, intestinal parasites, ileitis, small bowel bacterial overgrowth and other disorders classically associated with intestinal malabsorption and treat appropriately. After eight weeks of therapy, repeat the lactulose/mannitol challenge. An improvement in mannitol excretion indicates a desirable increase in intestinal absorptive capacity. The lactulose/mannitol assay has been proposed as a sensitive screen for celiac disease and a sensitive test for dietary compliance [46, 103-106]. For gluten-sensitive patients, abnormal test results demonstrate exposure to gluten, even when no intestinal symptoms are present. Monitoring dietary compliance to gluten avoidance by testing small bowel permeability is especially helpful in following those patients for whom gluten enteropathy does not produce diarrhea but instead causes failure to thrive, schizophrenia or inflammatory arthritis [107-115].

    In the case of relatively mild celiac disease or inflammatory bowel disease, mannitol absorption may not be affected but lactulose absorption will be elevated. A recent study published in the Lancet found that the lactulose-mannitol ratio was an accurate predictor of relapse when measured in patients with Crohn's disease who were clinically in remission [116].

    IF THE INITIAL FASTING LACTULOSE IS ELEVATED, OR IF THE INITIAL FASTING LACTULOSE/MANNITOL RATIO IS ELEVATED, consider the possibility of mild inflammatory bowel disease or gluten enteropathy. There are four other primary considerations:

    (A) Exposures. Does the patient drink ethanol, take NSAIDs or any potentially cytotoxic drugs? If so, discontinue them and have the lactulose/mannitol challenge repeated three weeks later. If it has become normal, drug exposures were the likely cause of leaky gut. If it has not, bacterial sensitization may have occurred. This may be treated with a regimen of antimicrobials and probiotics. My preference is a combination of citrus seed extract, berberine and artemisinin (the active alkaloid in Artemisia annua), which exerts a broad spectrum of activity against Enterobacteriaceae, Bacteroides, protozoa and yeasts [117-120].

    If the patient has no enterotoxic drug exposures, inquire into dietary habits. Recent fasting or crash dieting may increase permeability. Counsel the patient in consuming a nutritionally sound diet for three weeks and repeat the test.

    Patients with chronic arthritis may have difficulty stopping NSAIDs. Alternative anti-inflammatory therapy should be instituted, including essential fatty acids, anti-oxidants or mucopolysaccharides[121-125]. Changing the NSAID used may also be helpful. NSAIDs like indomethacin, which undergo enteroheaptic recirculation, are more likely to damage the small intestine that NSAIDs that are not excreted in bile, like ibuprofen [126]. Nabumetone (relafen) is a pro-NSAID that is activated into a potent NSAID by colonic bacteria; the active metabolite is not excreted in bile. Nabumetone is the only presently available NSAID that does not increase small intestinal permeability.

    (B) Infection. The possibilities include recent acute viral or bacterial enteritis, intestinal parasitism, HIV infection and candidosis. Stool testing is useful in identifying these. Repeat the permeability test six weeks after initiating appropriate therapy.

    (C) Food allergy. Approach this probability as described in the section above on food allergy in patients with normal fasting test results. The difference lies in degree of damage; food intolerant patients with abnormal fasting permeability have more mucosal damage than patients with normal fasting permeability and will take longer to heal.

    (D) Bacterial overgrowth resulting from hypochlorhydria, maldigestion, or stasis [41, 127, 128]. This is confirmed by an abnormal hydrogen breath test. Most of the damage resulting from bacterial overgrowth is caused by bacterial enzyme activity. Bacterial mucinase destroys the protective mucus coat; proteinases degrade pancreatic and brush border enzymes and attack structural proteins. Bacteria produce vitamin B12 analogues and uncouple the B12-intrinsic factor complex, reducing circulating B12 levels, even among individuals who are otherwise asymptomatic [129, 130]. In the absence of intestinal surgery, strictures or fistulae, bacterial overgrowth is most likely a sign of hypochlorhydria resulting from chronic gastritis due to Helicobacter pylori infection. Triple therapy with bismuth and antibiotics may be needed, but it is not presently known whether such treatment can reverse atrophic gastritis or whether natural, plant-derived antimicrobials can achieve the same results as metronidazole and ampicillin, the antibiotics of choice.

    Bacterial overgrowth due to hypochlorhydria tends to be a chronic problem that recurs within days or weeks after antimicrobials are discontinued. Keith Eaton, a British allergist who has worked extensively with the gut fermentation syndrome, finds that administration of L-histidine, 500 mg bid, improves gastric acid production in allergic patients with hypochlorhydria, probably by increasing gastric histamine levels [personal communication]. Dietary supplementation with betaine hydrochloride is usually helpful but intermittent short courses of bismuth, citrus seed extract, artemisinin, colloidal silver and other natural antimicrobials are often needed. The first round of such treatment, while the patient is symptomatic, should last for at least twelve weeks, to allow complete healing to occur. Repeat the lactulose/mannitol assay at the end of twelve weeks, while the patient is taking the antimicrobials, to see if complete healing has been achieved. The most sensitive test for recurrence of bacterial overgrowth is not the lactulose/mannitol assay but the breath hydrogen analysis.

    Trophic Therapies

    Many naturally occurring substances help repair the intestinal mucosal surface or support the liver when stressed by enteric toxins. Basic vitamin and mineral supplementation should include all the B vitamins, retinol, ascorbate, tocopherol, zinc, selenium, molybdenum, manganese, and magnesium. More specialized nutritional, glandular and herbal therapies are considered below. These should not be used as primary therapies. Avoidance of enterotoxic drugs, treatment of intestinal infection or dysbiosis, and an allergy elimination diet of high nutrient density that is appropriate for the individual patient are the primary treatment strategies for the Leaky Gut Syndromes. The recommendations that follow are to be used as adjuncts:

    (1) Epidermal Growth Factor (EGF) is a polypeptide that stimulates growth and repair of epithelial tissue. It is widely distributed in the body, with high concentrations detectable in salivary and prostate glands and in the duodenum. Saliva can be a rich source of EGF, especially the saliva of certain non-poisonous snakes. The use of serpents in healing rituals may reflect the value of ophidian saliva in promoting the healing of wounds. Thorough mastication of food may nourish the gut by providing it with salivary EGF. Purified EGF has been shown to heal ulceration of the small intestine [131].

    (2) Saccharomyces boulardii is a non-pathogenic yeast originally isolated from the surface of lichee nuts. It has been widely used in Europe to treat diarrhea. In France it is popularly called "Yeast against yeast" and is thought to help clear the skin in addition to the gut. Clinical trials
    have demonstrated the effectiveness for S. boulardii in the treatment or prevention of C. difficile diarrhea, antibiotic diarrhea and traveler's diarrhea[132, 133]. Experimental data suggest that the yeast owes its effect to stimulation of SIgA secretion[134]. SIgA is a key immunological component of gut barrier function.

    Passive elevation of gut immunoglobulin levels can be produced by feeding whey protein concentrates that are rich in IgA and IgG. These have been shown to be effective in preventing infantile necrotizing enterocolitis[135].

    (3) Lactobacillus caseii var GG is a strain of lactobacillus isolated and purified in Finland. Like S.boulardii, Lactobacillus GG has been shown effective in the prevention of traveller's diarrhea and of antibiotic diarrhea and in the treatment of colitis caused by C. difficile. Lactobacillus GG limits diarrhea caused by rotavirus infection in children and in so doing improves the hyperpermeability associated with rotavirus infection.[136-139] The mechanism of action is unclear. The ability of other Lactobacillus preparations to improve altered permeability has not been directly tested, but is suggested by the ability of live cultures of L. acidophilus to diminish radiation-induced diarrhea, a condition directly produced by the loss of mucosal integrity.

    (4) Glutamine is an important substrate for the maintenance of intestinal metabolism, structure and function. Patients and experimental animals that are fasted or fed only by a parenteral route develop intestinal villous atrophy, depletion of SIgA, and translocation of bacteria from the gut lumen to the systemic circulation. Feeding glutamine reverses all these abnormalities. Patients with intestinal mucosal injury secondary to chemotherapy or radiation benefit from glutamine supplementation with less villous atrophy, increased mucosal healing and decreased passage of endotoxin through the gut wall[140-143].

    (5) Glutathione (GSH) is an important component of the anti-oxidant defense against free radical-induced tissue damage. Dietary glutathione is not well absorbed, so that considerable quantities may be found throughout the gut lumen following supplementation[144]. Hepatic GSH is a key substrate for reducing toxic oxygen metabolites and oxidized xenobiotics in the liver. Depletion of hepatic glutathione is a common occurence in Leaky Gut Syndromes contributing to liver dysfunction and liver necrosis among alcoholics and immune impairment in patients with AIDS. The most effective way to raise hepatic glutathione is to administer its dietary precursors, cysteine or methionine. Anti-oxidant supplementation for Leaky Gut Syndromes should therefore include both GSH and N-acetyl cysteine. Because protozoa are more sensitive to oxidant stress than are humans and because most anti-parasitic drugs and herbs work by oxidative mechanisms, high dose anti-oxidant supplementation should be witheld during the treatment of protozoan infection, especially during treatment with Artemisia.

    (6) Flavonoids are potent, phenolic anti-oxidants and enzyme inhibitors with varied effects depending on the tissues in which they act. Quercetin and related flavonoids inhibit the release of histamine and inflammatory mediators. Taken before eating, they may block allergic reactions which increase permeability. Catechins have been used in Europe to treat gastric ulcerations. The flavonoids in milk thistle (silymarin) and in dandelion root (taraxacum) protect the liver against reactive oxygen species[145].

    (7) Essential fatty acids (EFAs) are the substrates for prostaglandin synthesis. Differential feeding of EFAs can profoundly affect prostanoid synthesis and the systemic response to endotoxin. In experimental animals, fish oil feeding ameliorates the intestinal mucosal injury produced by methotrexate and, additionally, blunts the systemic circulatory response to endotoxin[146]. The feeding of gamma-linolenic acid (GLA), promotes the synthesis of E-series prostaglandins, which decrease permeability. EFAs should be consumed in the most concentrated and physiologically active form to avoid exposure to large quantities of polyunsaturated fatty acids from dietary oils. Consumption of vegetable oils tends to increase the free radical content of bile and to exacerbate the effects of endotoxin[147].

    (8) Fiber supplements have complex effects on gut permeability and bacterial composition. Low fibre diets increase permeability. Dietary supplementation with insoluble fibre, such as pure cellulose, decreases permeability. Dietary supplementation with highly soluble fibre sources, such as fruit pectin or guar gum, has a biphasic effect. At low levels they reverse the hyperpermeability of low residue diets, probably by a mechanical bulking effect which stimulates synthesis of mucosal growth factors. At high levels of supplementation, they produce hyperpermeability, probably by inducing synthesis of bacterial enzymes which degrade intestinal mucins[148-151]. For maximum benefit with regard to intestinal permeability, dietary fibre supplementation should therefore contain a predominance of hypoallergenic insoluble fibre.

    (9) Gamma oryzanol, a complex mixture of ferulic acid esters of phytosterosl and other triterpene alcohols derived from rice bran, has been extensively researched in Japan for its healing effects in the treatment of gastric and duodenal ulceration, thought to be secondary to its potent anti-oxidant activity[152, 153].


    Altered intestinal permeability is a key element in the pathogenesis of many different diseases. Hyperpermeability initiates a vicious cycle in which allergic sensitization, endotoxic immune activation, hepatic dysfunction, pancreatic insufficiency and malnutrition occur; each of these increases the leakiness of the small bowel. Effective treatment of the Leaky Gut Syndromes requires several components: avoidance of enterotoxic drugs and allergic foods, elimination of infection or bacterial overgrowth with antimicrobials and probiotics, and dietary supplementation with trophic nutrients. Direct measurement of intestinal permeability allows the clinician to plan appropriate strategies and to gauge the effectiveness of treatment, using objective parameters.

  2. xchocoholic

    xchocoholic New Member

    Interesting thread ... let me know if you find one for dummies ... : )

    I copied this part in to see if I could understand the treatment options but it's still over my head ...


    Altered intestinal permeability is a key element in the pathogenesis of many different diseases.

    Hyperpermeability initiates a vicious cycle in which allergic sensitization, endotoxic immune activation, hepatic dysfunction, pancreatic insufficiency and malnutrition occur; each of these increases the leakiness of the small bowel.

    Effective treatment of the Leaky Gut Syndromes requires several components: avoidance of enterotoxic drugs and allergic foods, elimination of infection or bacterial overgrowth with antimicrobials and probiotics, and dietary supplementation with trophic nutrients.

    Direct measurement of intestinal permeability allows the clinician to plan appropriate strategies and to gauge the effectiveness of treatment, using objective parameters."

    My doc is saying the same thing. All three of her CFS patients have tested positive for leaky gut ... I had the stool tests and mine came back with leaky gut and candida but no parasites or bad bacteria. I've been treating parasites and bacteria for years with pau d'arco, clove, olive tree leaf and raw garlic so these appear to be easier to get rid of than the candida ...

    Hope this works for you. Marcia

  3. Chootik

    Chootik New Member

    Hi There.

    Do you think this was the reason you couldn't digest a lot of Protein? I remember you saying that you can only eat a chicken drumstick at a time. Well I have the same issue!! I can't do a lot of Protein, forget red meat, fried foods. My heart starts beating, I just feel sick and feel like I'm going to dye or pass out! It really sucks!

    Not sure if it's the liver making me feel this way, or maybe I don't have enough digestive enzymes and can't handle the Protein.

    My question is: When you ate Protein, did you feel the bad feeling right away or did it take a little bit for you to feel bad? The reason is I think if it's a Liver issue, it would take at least a while before we feel bad, cuz the food has to digest a bit and then get to the Liver.

    I'm thinking this could be a stomach problem. Or since my nerves are really messed up and sensative, when my stomach gets full it bothers the Vegas Nerve and the heart starts beating!!

    Either way, I'm sooo tired of all this stuff. I can't wait for it to get fixed!!

  4. MIssAutumn

    MIssAutumn New Member

    Karen, as usual!

    I didn't realize what a mess my gut was until last night. I'm doing the Comprehensive Stool Analyzes for the second time on Monday and had to quit all the supplements for the gut. It's only the second day and I felt it last night. I had one chicken leg and a some asparagus for dinner and right after felt the upset and cramping. I guess all these years I just got use to the feeling. I know now I can probably never have dairy again, that seems to be my food allergy- and will have to take at least the Beta TCP and digestive enzymes and probiotics forever, that's okay.

    It sounds so simple "leaky gut" but when I decided to finally do something on my own (my doctor had been telling me for a few years I had leaky gut but did nothing about it) I could feel the difference within days. Leaky gut does take a long time to get healed and probably is the hardest of all but hopefully the other crud and corruption in my intestines will get healed also with the treatment.

    Thanks again for the research and posting it on the board.
  5. Catseye

    Catseye Member


    I couldn't digest the protein because I didn't have enough stomach acid or enzymes and the reason it made me feel so bad is because the liver was already overworked, along with the kidneys, in detoxifying the poisons that were leaking our from my guts. When these undigested protein and/or fats hit my liver, I would feel like I was dying. I was scared to eat more than a couple of bites of chicken at a time. Now I can eat as much as I want (with the stomach acid supps and enzymes), but I just don't eat much, anyway. And why on earth are you attempting to eat fried foods!!! (smack upside the head from me) You have to eat as healthy as possible! Stick to chicken and meats that aren't fried, veggies that aren't fried, and don't even consider stuff like pizza, french fries, or any of the "American" crappy foods, including hot dogs, etc. Fried means batter and batter means flour. Since you don't have an exact plan of attack, you should go gluten and dairy free just because you may need to anyway - it's not worth the risk. They will cause problems in the intestines and liver and are not even healthy, they are just "yummy" foods. Yummy is no longer a luxury you can afford.

    You have to stick to whole foods, right out of the ground. And that doesn't mean lots of potatoes with butter and sour cream, either. Root veggies are starches and they can compound intestinal problems also. Start experimenting with spices and eat steamed or roasted veggies. You will acquire a better taste for them as your body starts to get what it needs from them. You can't go back to your old ways of eating, ever, so start the transition now. Eat lots of salads with olive oil and lemon juice. Yes, I am quite aware this is not as yummy as ranch dressing, but these are the things that will get you well. It's a non-yummy climb out of the deep hole we've dug for ourselves because our ignorant doctors steered us wrong and allowed things to get much worse than they already were. We should really all be suing them. It took me too long to figure it out and I couldn't get another doctor to testify against the first doctor, so it's not all that easy. They really back each other up.

    It wouldn't take too long for me to feel bad after eating, maybe 15-30 minutes, hard to remember exactly. I wasn't making enough stomach acid, so the food was probably irritating my stomach lining along with all the other problems it was causing by not being digested properly. Mostly, undigested food will occupy the immune system and congest the liver. It's a common problem. And I'm sure the vagus nerve comes into play because it is what is being pinched in my neck if I don't get regular adjustments from the chiropractor and it affects much of what happens below the neck, including the heart and digestion.

    I just got back from a great vacation in FL and TX. I saw xchocoholic and we had a blast. She picked me up from the airport, and we headed straight for Whole Foods. I think we were there like 4 hours, with a 1/2 hour break in between where we went out to her car and ate and rested. Then right back in to scrounge for items we are allowed to eat without doing any further damage to our intestines/immune system and digestion. That means, sugar free, dairy free, gluten free and natural ingredients. It's not very easy to find things that fit all 4 categories at once. We finally decided on some coconut ice cream with minimal sugar in it. It was a small cheat, but still a cheat. And we bought a bunch of Kombucha tea, a probiotic tea that is bubbly. When all you've been drinking is water for months and months, this stuff tastes like champagne! The grape and strawberry were my favorite flavors, with passionfruit and guava coming in close seconds.

    Then it was like we turned into vampires, we almost grew teeth and everything while we gorged on the ice cream because we don't get such treats very often. I believe that anyone who tried to come between us and our ice cream would have gotten seriously hurt. We were out in the Whole Foods parking lot drinking Kombucha tea and eating lettuce wraps and ice cream. We got some funny looks, we were looking just like we were having a picnic in the car. Afterwards, we went back in for our next kill. We also cheated on coffee while there and even bought unsweetened almond milk and honey to go home and try to make our own frappuccinos. Xchocoholic suggested putting some ice cream in them and how can you say no to that? So we gorged on frappuccinos the next day. Still more cheating, just because of the sugar content even though it was small. It was a huge success, we stayed mostly in line with the intestinal hyperpermeability diet and were completely satisfied. You can make yummy stuff that's healthy, you just need to get creative. But it can get expensive pretty quick.

    Xchocoholic and I also got in our fair share of after Xmas shopping. She got a beautiful optical tree at like 75% off, which we put up and gawked at all night because it was so pretty. It didn't matter that it was after Xmas, we appreciate anything pretty after feeling like we were at the brink of death for so long. We also got scooters at Wal Mart (look in her profile later for photos!) and we must have looked like the happiest scooter people around. We had those things floored, just zooming all over the store. She's the Energizer Bunny (her words) compared to me, who is the Flash, but only for a short while, then I have to rest. Still, I used to be the Incredible Immobile Woman who went from "Catatonia" to "hey, let's go to the beach because every day is Sunday when you're unemployed". She outdid me shopping. We couldn't resist Dillard's and she went in with precise instructions of what to get me and she managed to shop for both of us - she's good! She can keep going and going and going . . . after enough Romaine lettuce wraps! By then, I was pooped out and resting in her car. It was an overall successful shopping experience and successful vacation, too. Best one in years because I felt great and could get around more.

    Now I've got tons of people in my town asking me all kinds of health questions because they all saw me go from being a train wreck, barely able to walk or stand, to being able to stand tall, walk normal and even climb stairs alone. Everybody wants to know what I did to get healthy. So I guess I'll start my own newsletter so I don't have to explain the same thing to everybody over and over. This intestinal hyperpermeability and dysbiosis stuff isn't just a CFIDS thing, it's quite common. We just all develop different diseases from it, not just fibro and cfs. Even the simple things like arthritis can be traced to these in many cases.

    My maid just got back from the doctor. He told her she has a vaginal infection, that it's no big deal, and to just use these suppositories and see him again in 3 months. She has incredibly bad menstrual cramping, back pain, abdominal pain, and she missed a period even though she had her tubes tied. She lives in a country where the water isn't treated. I see it a bit different than her doctor. I see someone who has infections because the immune system is not working properly, which means the guts are most likely infected, too, esp since parasites are rampant in this country. I see this as a beginning of what got me, and I don't see it as "no big deal". I see it as vital that she addresses the problems now before they become bigger. She has also seen me go from having to be fed by hand to doing my own cooking. So she's a bit inclined to listen to me rather than the doctor who blew off all her symptoms as "no son importa". She can't afford Farr, not in this lifetime, but she is eating garlic cloves with me. But she's going to have a problem giving up the high carbs, that's what they live on here.

    A long time ago, I did a post on the garlinase pills that were supposed to preserve the allicin so it was like eating a fresh clove. Well, the garlinase got rid of another strep infection before it started, so I think they definitely do some good. I think I picked up the infection at a doctor's office but I got rid of it with hydrogen peroxide in the ears and the garlic. It bothered me a bit for about 3 days, but these methods I use really work and it never took hold. Everybody should use these whenever they start to "come down with something". If you can catch it early enough, at the first sign of a throat tickle or ear ache, they can be wiped out before they take hold. I gave some to Victoria to use when she doesn't feel like eating the cloves. I'm the only one willing to burn the hell out of my mouth to eat them whenever I think I should. The pills are quite convenient for avoiding the burning.

    rainbow - that's the worst problem of all, the NSAIDs making the intestines worse. I don't know what people in pain are supposed to do. I wonder if morphine works well by itself, but then a person would have to convince a doctor they want it because they don't want to damage their intestines and he'll be like "oh sure, another druggie with a goofy story" and he'll shoot down their request. I never tackled that problem because I didn't have a bunch of pain to contend with. At least not the kind that a pain pill could remedy.


    I think I'll be taking the digestive enzymes and beta tcp forever, too. No biggie, it's just preventative maintenance, once we get cured. You actually had a medical doctor tell you that you had leaky gut? That's incredible, he must be really knowledgeable, unlike most of them. I'm curious as to what his suggestions would be to correct it, did he give you any? I knew about leaky gut, but I way underestimated how difficult it was to fix. And if you're not fixing it, then you are making it worse. So I just made it worse for years before I realized what exactly was happening. I'm much better after 9 months of diet and supps. Actually, my worst symptoms now are all stemming from a deconditioned body. I'm having to google for physical therapy for deconditioned bodies and how to exercise. My back seems to be the worst. I get tired because the back muscles get strained after too much sitting or standing and then they spasm, which is using energy. I'll be even better once I get my poor body a bit more conditioned. It's all a royal pain, but I've got nothing better to do, literally.


    LISALOO New Member

    Thanks for all this will have to read tomorrow

    planning on doing a CSDA next week. Can't wait to see the results![This Message was Edited on 01/15/2009]
  7. Catseye

    Catseye Member

    Here's another excellent article on leaky gut by Leo Galland, MD from his book Power Healing. There is lots you should know in here and it is interesting reading. For anybody who has regular heartburn and takes or is thinking about taking regular heartburn meds, you should be aware of what that will do to your digestion. It is near the end of the article, just after where it says Risk Reduction. This is written more in layman's terms and won't bring on the headache the above article did. And considering this is behind many chronic diseases, it should be memorized and the strategies followed religiously. This isn't just to "cure" an ailment, it is how to stay healthy. Don't pay attention to the name of the disease because most of the major diseases have the same root causes. What the doctor calls it is of no significance. If you think the economy is bad now, just wait until this knowledge is commonplace and the need for many drugs is eliminated. This is the big secret to maintaining health:

    The human intestine maintains within its inner cavity a complex, crowded environment of food remnants and microbial organisms (called "the intestinal flora") from which the body derives nourishment and against which the body must be protected. The relationship between the human host and her army of microbes is described by the Greek word, symbiosis, which means "living together". When symbiosis benefits both parties, it is called mutualism. When symbiosis becomes harmful, it is called dysbiosis. The first line of protection against dysbiosis and intestinal toxicity is strict control of intestinal permeability, the ability of the gut to allow some substances to pass through its walls while denying access to others. The healthy gut selectively absorbs nutrients and seals out those components of the normal internal milieu which are most likely to cause harm, except for a small sampling which it uses to educate and strengthen its mechanisms of immunity and detoxification.

    Bacteria form the largest segment of the intestinal flora. The number of bacteria in the large bowel (about a hundred trillion) exceeds the number of cells in the human body. Intestinal bacteria perform some useful functions, so that our relationship with them is normally one of mutual benefit. They synthesize half a dozen vitamins, supplementing those which are obtained from food. They convert dietary fibre--that part of food which humans cannot digest--into small fatty acids which nourish the cells of the large intestine. They degrade dietary toxins like methyl mercury making them less harmful to the body. They crowd out pathogenic bacteria like Salmonella, decreasing the risk of food poisoning. They stimulate the development of a vigorous immune response. Four-fifths of the body's immune system is located in the lining of the small intestine.

    Bacteria are dangerous tenants, however, so that dysbiosis is a common problem. As powerful chemical factories, bacteria not only make vitamins and destroy toxins, but also destroy vitamins and make toxins. Bacterial enzymes can inactivate human digestive enzymes and convert human bile or components of food into chemicals which promote the development of cancer. Some by-products of bacterial enzyme activity, like ammonia, hinder normal brain function. When absorbed into the body, they must be removed by the liver. People whose livers fail this task, because of conditions like cirrhosis, develop progressive neurologic dysfunction resulting in coma and death. For them, the administration of antibiotics which slow the production of nerve toxins by intestinal bacteria can be life saving.

    The immune reactions provoked by normal intestinal bacteria may be harmful rather than helpful. Inflammatory diseases of the bowel, including ulcerative colitis and Crohn's disease (ileitis), and several types of arthritis have been linked to aberrant immune responses provoked by intestinal bacteria. Two types of aberrancy have been described. First, intestinal bacteria contain proteins which look to the immune system very much like human proteins; they confuse the immune system and may fool the body into attacking itself. Second, fragments of dead bacteria may leak into the wall of the intestine or into the blood stream due to a breakdown in the mechanisms which regulate intestinal permeability. Circulating through the body, bacterial debris is deposited in tissues such as joints, provoking an attack on those tissues by an immune system trying to remove the foreign material.

    Bacterial colonies in the human intestine co-exist with colonies of yeasts, which are no less dangerous, just far fewer in number. Bacterial colonization prevents yeasts from expanding their niche. Frequent or prolonged use of antibiotics decimates bacterial colonies, removing the natural brake on yeast growth. The most obvious effects of yeast overgrowth are local infections, like vaginitis, produced when yeast invade and disrupt cells which line the body's surface. Intestinal yeast infections can cause chronic diarrhea, although most gastroenterologists fail to recognize this. Yeast can also provoke allergic reactions, precipitating asthma, hives, psoriasis or abdominal pain. The occurrence of allergic symptoms or the aggravation of a pre-existing allergy which follows the use of antibiotics should always prompt an investigation into yeast overgrowth as a potential trigger. Neglect of this factor by allergists has left countless patients trapped in a spiral of increasing allergic reactivity, augmented each time antibiotics are prescribed.

    In addition to bacteria and yeast, most of the world's four billion people are also colonized by intestinal parasites. Contrary to popular belief, parasitic infection is not unusual in the U.S. population. It is a common ocurrence, even among those who have never left the country.

    Unlike bacteria, parasites appear to serve no useful function. The part of the immune system which they stimulate does not strengthen the organism to resist serious infection; instead it contributes to allergic reactions, so that parasitic infection increases allergic tendencies. There are two general groups of parasites. The first consists of worms--tapeworms and roundworms--which attach themselves to the lining of the small intestine, causing internal bleeding and loss of nutrients. People infested with worms may have no symptoms or may slowly become anemic. The second category is the protozoa, one-celled organisms like the amoeba which caused John Gerard's colitis. The first protozoa were discovered over three hundred years ago by Antonie van Leeuwenhoek, the most famous of the early microscopists. When the inquisitive Dutchman set about to examine everything in the world that would fit under the lens of a microscope, he found organisms in his own stool that closely match the description later given to Giardia lamblia.

    Giardia is the major cause of day-care diarrhea. Twenty to thirty per cent of workers in day care centers harbor Giardia. Most have no symptoms; they are merely carriers. A study at Johns Hopkins medical school a few years ago demonstrated antibodies against Giardia in twenty per cent of randomly chosen blood samples from patients in the hospital. This means that at least twenty per cent of these patients had been infected with Giardia at some time in their lives and had mounted an immune response against the parasite.

    In 1990 I presented a paper before the American College of Gastroenterology which demonstrated Giardia infection in about half of a group of two hundred patients with chronic diarrhea, constipation, abdominal pain and bloating. Most of these patients had been told they had irritable bowel syndrome, which is commonly referred to as "nervous stomach". I reached two conclusions from this study: (1) Parasitic infection is a common event among patients with chronic gastrointestinal symptoms. (2) Many people are given a diagnosis of irritable bowel syndrome without a thorough evaluation. My presentation was reported by numerous magazines and newspapers, including the New York Times. My office was flooded with hundreds of phone calls from people who were suffering with chronic gastrointestinal complaints. Most of them had been given a diagnosis of Irritable Bowel Syndrome (IBS) by their physicians. The standard treatment for this syndrome had not helped them. All they had received was a label. Many had been told there was no cure. In evaluating these patients, I found that the majority had intestinal parasites, food intolerance or a lack of healthy intestinal bacteria. These conditions were not mutually exclusive. Many patients had more than one reason for chronic gastrointestinal problems. Treating these abnormalities as they occurred in various patients produced remarkably good therapeutic results. A year later, researchers in the Department of Family Medicine at Baylor University in Houston reported findings similar to mine.

    Giardia contaminates streams and lakes throughout North America and has caused epidemics of diarrheal disease in several small cities by contaminating their drinking water. One epidemic, in Placerville, California, was followed by an epidemic of Chronic Fatigue Syndrome, which swept through the town's residents at the time of the Giardia epidemic. Possibly, this epidemic was due to failure of some people to eradicate the parasite. In 1991, my colleagues and I published a study of 96 patients with chronic fatigue and demonstrated active Giardia infection in 46 per cent.

    Sometimes, the intestinal damage produced by giardiasis persists for months after the parasite has been successfully treated. The impairment of digestion and absorption which results from this damage may cause fatigue and other symptoms.

    When I first began presenting the results of my clinical research on parasitic infection, in the mid-1980's, my reports were met with considerable skepticism. The present decade has witnessed an increased awareness of parasitic infection as a common public health problem in the United States, thanks largely to Cryptosporidium, which recently achieved notoriety for contaminating Milwaukee's water supply, causing the largest epidemic of diarrhea in U.S. history, infecting 400,000 people and causing over one hundred deaths. Most municipal water supplies in the U.S. today are home to protozoa like Giardia and Cryptosporidium and one in five Americans drinks water that violates federal health standards. Every year, almost a million North Americans become sick from water-borne diseases; about one per cent die. Further epidemics are inevitable. A recent epidemic occurred in Clark County, Nevada, despite state-of-the-art municipal water treatment.

    How protozoa make people sick is not clear. Some directly invade the lining of the intestine, others provoke an allergic reaction that causes the damage. It appears certain that humans coexist quite readily with their parasites as long as the barrier formed by the intestinal lining remains fully intact, so that the parasites cannot attach to the wall of the bowel. Millions of people throughout the world are carriers of E. histolytica; the organism can be found in stool samples but it does not seem to make them ill. The variability of pathogenic potential recalls Pasteur's challenge to the French Academy: do the causes of disease lie within the microbe or do they lie within the host? When the attachment of a parasite initiates a series of injuries to the intestinal wall that increase its permeability, it generates a cascade of reactions that can shatter a person's health in many different ways. Excessive permeability permits excess absorption of antigens and microbial fragments from the gut, over-stimulating the immune response, fostering allergy and auto-immunity.

    Excess permeability also allows excessive absorption of toxins derived from the chemical activity of intestinal bacteria, stressing the liver. All materials absorbed from the intestine must pass through the liver before entering the body's general circulation. Here, in the cells of the liver, toxic chemicals are destroyed or else prepared for excretion out of the body. The cost of detoxification is high; free radicals are generated and the liver's stores of anti-oxidants are depleted. The liver may be damaged by the products of its own attempts at detoxification. Damage may extend to the pancreas. Free radicals are excreted into bile; this "toxic" bile flows into the small intestine and can ascend into the ducts which carry pancreatic juices, damaging the pancreas, aggravating malnutrition.

    The symptoms produced by excessive intestinal permeability may be limited to the abdomen or may involve the entire body. They may include fatigue and malaise, joint and muscle pain, headache and skin eruptions. The clinical disorders associated with increased intestinal permeability include any inflammation of the large or small intestine (colitis and enteritis), chronic arthritis , skin conditions like acne, eczema, hives or psoriasis, migraine headaches, chronic fatigue, deficient pancreatic function and AIDS . In most cases, it is incorrect to think of excessive permeability as the cause of these disorders. Instead, excess permeability occurs as part of the chain of events which causes disease and aggravates existing symptoms or produces new ones.

    Just as excessive permeability may have many different effects, it may also have many different causes, each of which may add to the effects of the other. These causes include intestinal infection of any type (viral, bacterial or protozoan), alcohol, and NSAIDs (non-steroidal anti-inflammatory drugs) which increase permeability by decreasing the body's synthesis of beneficial prostaglandins. Allergic reactions to foods also produce an increase in intestinal permeability.

    The fate of people treated for chronic arthritis exemplifies the spiral of problems caused by excessive intestinal permeability. Arthritis (inflammation of the joints) is the leading cause of physical disability in industrialized countries.

    Some forms of arthritis are preceded by increased intestinal permeability. People with inflammation of the intestine are prone to develop inflammatory arthritis which may continue for many years after the intestinal inflammation is healed. Fragments of intestinal bacteria have been identified in the joints in some cases. In others, antibodies directed against intestinal bacteria may attack the person's own joint tissue, causing an auto-immune reaction.

    For most people with chronic arthritis, however, excessive intestinal permeability develops as a result of arthritis and its treatment and may aggravate the arthritis, creating a vicious cycle. People with any type of severe arthritis usually take large doses of NSAIDs on a daily basis to control the pain, stiffness and swelling in their joints; they rapidly develop increased intestinal permeability. Excessive permeability allows bacteria or bacterial antigen to penetrate the wall of the intestine, creating a smoldering inflammation in the intestinal wall (called enteritis), which in turn further increases intestinal permeability. Enteritis develops in seventy per cent of people taking NSAIDs daily for two weeks. The excessive permeability caused by drug-induced enteritis allows fragments of bacteria to enter the circulation, where they cause or aggravate more arthritis.

    Much of the research on intestinal permeability and NSAIDs has been conducted with people who suffer from rheumatoid arthritis, an inflammation which affects many joints at the same time and is especially noticeable in the hands. It typically strikes women in their twenties or thirties and lasts for life, crippling thirty per cent of its victims with severe deformities of the affected joints and shortening their life expectancy by ten to fifteen years. Patients with rheumatoid arthritis taking NSAIDs develop antibodies against components of the normal intestinal bacteria. Development of an abnormal or excessive immune response is called sensitization. Sensitization to intestinal bacteria may cause or aggravate arthritis. When patients with rheumatoid arthritis take antibiotics which reduce the numbers of intestinal bacteria, not only does their enteritis clear up, but their arthritis also improves. NSAIDs, the standard treatment for arthritis, by increasing intestinal permeability, create a new problem which aggravates the old one. Increased intestinal permeability explains the beneficial effects of diet for the treatment of rheumatoid arthritis. Fasting and vegetarian diets benefit patients with rheumatoid arthritis. Fasting reduces the excessive intestinal permeability of patients with rheumatoid arthritis while at the same time dramatically improving symptoms. Vegetarian diets alter the bacterial growth in the intestine, acting in a sense like natural, highly selective antibiotics. Those people who respond to vegetarianism with a change in the intestinal bacteria are the ones that benefit. Those people who do not change their intestinal bacteria as a result of changing their diets do not improve their arthritis by becoming vegetarians.

    There is a common belief that avoiding specific foods can benefit people with arthritis. One effect of the increased permeability produced by NSAIDs is to increase the absorption of antigens coming from food. People with rheumatoid arthritis frequently become sensitized to food proteins. Their arthritis often improves when they avoid specific foods and then flares up when they consume those foods. I have treated enough patients with rheumatoid arthritis to know that food allergy is not the cause of rheumatoid arthritis. It is part of the cycle of immunologic sensitization, inflammation and increased intestinal permeability that occurs in most patients with severe arthritis. The treatments that are used for chronic arthritis may temporarily relieve pain but they help to maintain the vicious cycle. Perhaps this explains why the long term outlook for patients with rheumatoid arthritis is so bleak and has not been improved by any of the drug therapies developed over the past thirty years. Professor Ann Parke, of the University of Connecticut, voiced an opinion not often heard from rheumatologists, "...maybe NSAIDs have had their day. We should, instead, be striving to maintain the integrity of the gastrointestinal tract in an attempt to prevent the disease at a potential source, rather than treating the complaints and risking perpetuating the disease."

    If medicine is to regain its Hippocratic roots, preserving and restoring health, then physicians must learn the science of preserving and restoring normal intestinal permeability. This is not an attempt to "cleanse" the colon with laxatives or enemas or to correct constipation. In the early years of the twentieth century, "auto-intoxication" was a fashionable concept. It was considered to be the cause of chronic fatigue, stomach ulcers, rheumatoid arthritis, high blood pressure, hardening of the arteries, breast cancer and ovarian cysts. The complex regulation of intestinal permeability was not understood and autointoxication was attributed to "intestinal stasis", a fancy term for constipation. In keeping with the spirit of the times, it was treated invasively: enemas for mild cases, colectomy (surgical removal of the large intestine) in severe cases. Even institutions as august as the Mayo Clinic sanctioned colectomies for autointoxication during the first two decades of the twentieth century.

    The preservation and restoration of normal intestinal permeability rests on two principles: building resistance and reducing risk. A diet of high nutrient density, described in Chapter...., is the cornerstone for maintenance of intestinal health. The intestinal lining has the fastest growth rate of any tissue in the body. Old cells slough off and a completely new lining is generated every three to six days. The metabolic demands of this normally rapid cell turnover must be met if excess permeability is to be prevented or if healing is to occur. Thorough chewing of food may be important. Saliva contains a substance called epidermal growth factor (EGF) which stimulates growth and repair of tissue. EGF has been used therapeutically to heal the intestine when injured or inflamed.

    Essential fatty acids play an important role in maintenance of intestinal integrity. Fish oils limit the intestinal injury caused by toxic drugs and GLA (found in primrose, borage or black currant oils) stimulates production of prostaglandins which help to maintain normal permeability. The principles for EFA supplementation detailed on pages.....should be followed. Merely consuming large quantities of vegetable oils, however, is likely to be harmful to the intestinal lining. High intake of polyunsaturated oils increases the free radical content of bile, producing a toxic bile that may damage intestinal integrity.

    In addition to a nutrient dense diet, there are several specific dietary resistance factors which warrant careful attention for their ability to preserve normal intestinal integrity and should be part of any program for intestinal detoxification.
    (1) FIBRE

    Fibre is the term that describes remnants of plant cells that are resistant to human digestion. The usual sources are vegetables, cereals, bread, nuts, seeds and fruits. Eating a fibre deficient diet increases intestinal permeability. Although medical researchers have been recommending high fibre diets for about twenty years, and sales of metamucil and other bulk laxatives have gone up, there has been no significant increase in fibre consumption from food and the fibre intake of Americans is far below recommended levels. This is unfortunate, because the fibre found in food is far more complex than the purified powders sold in drug stores.

    There are many different chemical types of fibre, but the most important distinction is between soluble and insoluble fibre. Soluble fibre dissolves in water, forming a thick gel. Fruit pectin, for example, is a highly solube fibre. Psyllium seed, the commonest source of bulk laxatives, contains fibre that is moderately solube. Wheat bran consists of relatively insoluble fibre that is most readily evident as "roughage". Although all fibre adds bulk to bowel movements, the chemical effects of the different types of fibre can be opposite.

    Soluble fibre feeds the intestinal bacteria, which ferment it to produce chemicals called short chain fatty acids (SCFAs). SCFAs have a number of positive effects on the body: they nourish the cells of the large intestine, stimulating healing and reducing the development of cancer. When absorbed from the intestine, they travel to the liver and decrease the liver's production of cholesterol, lowering blood cholesterol levels. Oat bran, for example, contains fibres of moderate solubility; eating oat bran can lower cholesterol levels. Within the intestinal canal, SCFAs inhibit the growth of yeasts and disease-causing bacteria. The effects of soluble fibre are not always beneficial, however. Feeding high levels of soluble fibre supplements like guar gum encourages an overgrowth of the normal intestinal bacteria which deprives the body of vitamin B12 and produces an increase in the concentration of bacterial toxins. Although low fibre diets increase gut permeability, excessive consumption of soluble fibre from supplements can also cause excessive permeability and may create changes in the intestinal milieu that actually enhance the development of stomach or bowel cancer.

    Insoluble fibre does not feed bacteria well and is not readily fermented to SCFAs. Eating wheat bran, which is largely insoluble fibre, has no effect on blood cholesterol levels. Insoluble fibre inactivates intestinal toxins, however, and high intake of insoluble fibre is associated with a decreased risk of colon and breast cancer. Supplements of insoluble fibre as wheat bran or pure cellulose appear to decrease the risk of bowel cancer. Insoluble fibres also inhibit the ability of disease-causing bacteria and parasites to attach themselves to the intestinal wall. Insoluble fibre plays an important role in preventing excess intestinal permeability.

    It should be obvious that humans need a mixture of soluble and insoluble fibres in the diet and that food, not supplements, is the best source. Eating high fibre foods protects against the development of the major degenerative diseases of the modern world--heart disease and cancer--increases longevity and protects against the development of parasitic infection. The best sources of mixed fibres are unrefined cereal grains (oats, brown rice, whole wheat), peas, beans and squash. Among fruits, one gets the most fibre per serving from apples and berries.

    Some high fibre foods contain natural chemicals which help to maintain normal intestinal permeability by unique mechanisms. Carrots, carob, blueberries and raspberries contain complex sugars (oligosaccharides) which interfere with the binding of pathogenic bacteria to the intestinal lining. These have been used in Europe for centuries for the treatment or prevention of diarrhea. Synthetic oligosaccharides are presently being developed as drugs for treating infection. Brown rice is the source of gamma-oryzanol, a group of powerful antioxidants which have been tested extensively in Japan for their ability to heal intestinal and stomach ulcers and alleviate a variety of chronic gastrointestinal complaints. Gamma-oryzanol can be consumed in rice bran or rice bran oil or in pill form. The therapeutic dose is 100 mg three times a day.

    If you become constipated when increasing dietary fibre, you may need more fluid. Drink eight glasses of liquid a day, between meals, not with meals.

    A large body of research over the past ninety years has demonstrated the preventive value of eating foods fermented with Lactobacilli or their cousins, Bifidobacteria. Eating these friendly bacteria prevents intestinal infection due to viruses or pathogenic bacteria and preserves intestinal permeability in the face of infection or other types of injury, can prevent antibiotic-induced diarrhea and travelers diarrhea and can lower serum cholesterol levels. Lactobacilli and Bifidobacteria also show anti-cancer activity, by two mechanisms: they inhibit the growth or activity of cancer-promoting bacteria and some strains actually produce chemicals which inhibit tumor growth.

    There are numerous species of Lactobacilli and many strains for each species. Some, like Lactobacillus acidophilus, are normal inhabitants of the human digestive tract. Others, like L. bulgaricus, which is a common starter for making yogurt, are not. L. bulgaricus disappears from the intestine within two weeks after yogurt consumption is stopped. Sauerkraut is sour because of L. plantarum, a beneficial organism that is normally found in the human intestine and that stays for a long time after being introduced. Commercially available fermented foods are, unfortunately, unreliable as sources of Lactobacilli, because the lactic acid and hydrogen peroxide which Lactobacilli naturally produce may kill the producers themselves if their concentration becomes excessive. A few years ago, the Annals of Internal Medicine published a study which proved what many women have known for years, that eating yogurt daily can prevent vaginal yeast infections. The researchers were lucky. The batch of yogurt they gave their patients was loaded with living Lactobacillus acidophilus. These organisms not only took up residence in the intestines of the women who ate it, but also colonized the vagina, preventing yeast infection. When the scientists attempted to perform the same experiment a year later, they found that the same brand of yogurt contained no living bacteria.

    The most reliable way to supplement your diet with Lactobacilli is to make your own yogurt or sauerkraut, or to buy nutritional supplements which have been tested by an independent outside laboratory and which list the concentration of viable bacteria found on culture. Lactobacilli are killed by heat, moisture and sunlight. The making of tablets generates heat which lowers the number of viable organisms. Lactobacilli should be freeze-dried, in powder or capsules, in opaque moisture-proof containers, stored in the refrigerator. They should be consumed with meals. The strains which have been most extensively tested for their viability in the human intestine are L.acidophilus strain NCFM-2 and L. plantarum. L. acidophilus is well-suited to growing in the small intestine, where it is normally one of the dominant bacterial species. L. plantarum has growth characteristics which lead it to grow especially well in the large intestine. The daily dose should be between one billion and ten billion viable bacteria. More may cause gastrointestinal irritation.

    "Nutritional yeast" has been used as a dietary supplement for generations, as a source of vitamins and minerals and for treatment of digestive complaints. After treating hundreds of yeast-allergic patients, I was very reluctant to prescribe yeast for anyone, until I discovered a preparation which the French call "Yeast Against Yeast". The yeasts which invade human tissues, causing yeast infection, are mostly members of the genus Candida. The yeast used in baking bread or brewing beer belong to the genus Saccharomyces. Yeast Against Yeast is Saccharomyces boulardii, a microbe which inhabits the surface of many different plants and which was first isolated from lichee nuts in Southeast Asia by French scientists during the 1920's. Saccharomyces boulardii has been used in Europe for decades to treat acute diarrhea and controlled trials have shown it effective in preventing or treating diarrhea brought on by antibiotics. S. boulardii appears to exert its beneficial affects by inactivating bacterial toxins and by stimulating intestinal immune responses. S. boulardii has been available in natural food stores in the United States since 1991. People who are allergic to baker's yeast may also be allergic to S. boulardii, but for most people, including women with chronic Candida infection, Yeast Against Yeast lives up to its name.
    (3) SPICE

    Before they were used as seasoning, culinary herbs and spices were probably used for food preservation. Many varieties have natural antimicrobial activity and can retard spoilage. They are also used to mask the flavor of spoiled food, so I suggest using them at home, where you know the food they flavor is fresh to begin with.

    The world's most extensively studied spice is garlic. Its medicinal use predates recorded history. Garlic is mentioned in the earliest Vedic medical documents, written in India over five thousand years ago. During an epidemic of plague in Marseilles, in 1721, four condemned criminals were enlisted to bury the dead. None of them contracted plague. It seems that they sustained themselves by drinking a cocktail of crushed garlic in cheap wine, which came to be called vinaigre des quatre voleurs (vinegar of the four thieves). In 1858, Louis Pasteur demonstrated garlic's antibiotic activity. The herb was used by Albert Schweitzer for the treatment of amoebic dysentery at his clinic in Africa. Antimicrobial activity of garlic has been repeatedly demonstrated against many species of bacteria, fungi, parasites and viruses. In addition, garlic lowers cholesterol and blood pressure and may protect against cancer. The dose of garlic needed to obtain significant benefit is at least ten grams (about three small cloves) per day.

    Onion, garlic's closest edible relative, has also been widely used for medicinal purposes. Although it lacks the potency of garlic, it can be consumed it much larger quantity, so that its antimicrobial benefits may be equal to those of garlic if consumed regularly.

    Turmeric, a major ingredient in curry powder, is a natural antibiotic that relieves intestinal gas by lowering the numbers of gas forming bacteria, has antifungal activity and has been traditionally used for relieving inflammation. The effective dose is about one gram per day.

    Ginger, which contains over four hundred chemically active ingredients, has long been used for the treatment of digestive complaints. It protects the intestinal lining against ulceration and has a wide range of actions against intestinal parasites. Cinnamon, which I recommend for sweetening the taste of ginger tea, has anti-fungal activity.

    Sage and rosemary contain the essential oil, eucalyptol, which kills Candida albicans, bacteria, and worms. Oregano contains over thirty biologically active iingredients of which twelve have antibiotic, anti-viral, anti-parasitic or anti-fungal effects. As mentioned earlier, thyme has anti-parasitic activity.

    Meals seasoned with these pungent, aromatic herbs, consumed regularly, help protect against intestinal infection. However, heating at 200 degrees (Fahrenheit) for twenty minutes destroys the antibacterial activity of most of these spices. They should be added to food at the end of cooking, just before being eaten.

    NOTE: If high fibre diets, friendly flora, or spicy food give you diarrhea, gas or abdominal bloating, instead of improving digestive function, you may be changing your diet too rapidly, or you may have an allergy to one specific component of the regimen described here. Slow down and try again. Be methodical, making one change at a time. First, cut down on sugar and fat, then switch to whole grains, then add more vegetables. Give yourself a chance to know how each new food you try affects your body. It may take a few days. Then add nutritional supplements, one at a time, allowing yourself three or four days between each change. Experiment with different brands. For some people, one preparation of Lactobacillus will cause diarrhea, but another will not. If you still find that you cannot increase your consumption of fiber or flora without feeling worse, rather than better, you may have an overgrowth of bacteria or yeast in the small intestine which have adapted to using the fibre you are taking to expand their niche, rather than to limit their growth. Bacterial overgrowth of the small intestine is far more common than doctors suspect and most commonly results from a lack of stomach acid or from prior surgery. Yeast overgrowth usually results from taking antibiotics. Resources for dealing with these problems are listed in Appendix III.

    The most common, preventable causes of increased intestinal permeability are drugs and infections. Aspirin and NSAIDs should not be taken on a daily basis. Most people using NSAIDs daily are trying to relieve chronic headache or joint and muscle pain. Alternative strategies for pain relief are often available. The likelihood of benefit depends upon the location of the pain and the presence or absence of inflammation. Pain control strategies and resources are listed in Appendix IV.

    After NSAIDs, alcohol is the drug most likely to destroy normal intestinal permeability. More than one glass of wine or beer is likely to be detrimental.

    The body's first line of defense against intestinal infection is the acid produced by a healthy stomach. Stomach acid kills most of the bacteria and parasites that are swallowed along with meals. Strong suppression of stomach acid increases the risk of intestinal infection. The widespread use of antacids is, therefore, a reason for concern, and the FDA's recent decision to make the acid-lowering drugs Tagamet and Pepcid available without a doctor's prescription is a terrible disservice to the American people. Most people who take treatments to buffer or reduce stomach acid do not need acid reduction and should avoid it. Tagamet and Pepcid are called H-2 blockers because they block certain effects of histamine in the body. (Conventional "anti-histamines" used for treating symptoms of allergy are called H-1 blockers). They were originally developed for the treatment of ulcers and they made huge profits for the companies which owned them. Doctors soon began using H-2 blockers for relieving stomach pain which was not caused by ulcers (this pain is called "non-ulcer dyspepsia"), even though their efficacy for non-ulcer pain was disputed. The most common cause of non-ulcer dyspepsia, by the way, is taking NSAIDs. If NSAID use were markedly reduced, the frequency of stomach pain and the need for H-2 blockers would also be reduced. Recently, it has become quite clear that most ulcers are triggered by a bacterial infection of the stomach and that antibiotics are superior to H-2 blockers for treating ulcers. As the need for H-2 blockers in the treatment of ulcers just about vanished, the FDA suddenly approved their non-prescription use for the treatment of heartburn. The truth is that H-2 blockers are rarely needed to treat heartburn, because heartburn is not caused by excess stomach acid. It is caused by reflux of normal amounts of stomach acid into the esophagus, which occurs when the valve responsible for preventing acid reflux is not working properly. The usual reason for valvular incompetence is dietary. Coffee, alcohol, chocolate and high fat meals prevent the valve from closing properly. Calcium, in contrast, makes it close more tightly.

    Almost all people with frequent heartburn can get relief by eating small, low fat meals, chewing a calcium tablet after each, and not eating for four hours before bedtime. Temporary avoidance of coffee, alcohol, and spicy or irritating foods until the heartburn stops is also a good idea. Were these measures followed, the use of H-2 blockers and antacids could be cut by ninety per cent.

    A second line of defense against intestinal infection is the normal intestinal bacteria, especially Lactobacilli residing in the small intestine. Antibiotics decimate Lactobacilli. In so doing, they may increase the risk of subsequent intestinal infection. Although antibiotics, when appropriately used, are the most important therapeutic discovery of modern Western medicine, they are often used inappropriately and the effects can be devastating. Whenever I prescribe an antibiotic, I always consider its possible effect on the beneficial intestinal flora. An antibiotic that is rapidly and completely absorbed in the stomach, reaching high levels in the tissues of the body and low levels in the small or large intestine, is least likely to harm intestinal ecology. I also administer Lactobacilli along with the antibiotics. L. plantarum is the only Lactobacillus not harmed by antibiotics and can be taken simultaneously with them.

    A key component of risk reduction is maintaining a safe supply of food and drink. Epidemics of giardiasis and cryptosporidiosis from contaminated water and of food poisoning due to Salmonella in chicken or to toxic strains of E. coli in hamburger serve notice that the U.S. food and water supply is not safe. There are guidelines that I give my patients to help them avoid infection when travelling to Asia and Africa. These same guidelines should be applied in the United States, at home or when dining out, because the food in the U.S. may be no safer than in many non-industrialized nations. Although some of these guidelines may seem burdensome, they significantly reduce the risk of acquiring a food- or water-borne infection:

    (1) Always wash your hands carefully with soap and water when returning home from outside and before handling food. Hand- washing is a very effective way to remove pathogens. In day care centers, where Giardia infection can be rampant, the parasite can be found on surfaces, tables and chairs. Handwashing by the staff drastically reduces the frequency of diarrhea. Regular handwashing also protects against catching colds or flu from other people.

    (2) Do not drink tap water that has not been properly filtered or kept at a rolling boil for at least five minutes. Chlorination does not kill the cyst forms of Giardia or Cryptosporidium, which are extremely hardy. The most effective way to remove Cryptosporidium from tap water is to use a reverse osmosis system, which can be mounted under the sink or on a countertop. Reverse osmosis also removes many chemical contaminants from water but is slow and wasteful. To remove Cryptosporidium, a water filter must have pores that are no larger than one micrometer. Water filters that effectively remove Cryptosporidium are certified by the National Sanitation Foundation (NSF), an independent non-profit organization, under their Standard 53 for "cyst removal". No water filter practical for home use will remove bacteria. Have the bacterial concentration in your drinking water tested by an independent laboratory. Call the Water Quality Association at (708) 505-0160 or the American Council of Independent Laboratories at (202) 887-5872 for the name of a certified laboratory near your home.

    The quality of bottled water is completely unregulated. Some bottled water comes from municipal water supplies. To discover the source of any bottled water, call the bottler and request documentation about the nature and purity of the source. Bottled water that comes from municipal water supplies or lakes should be treated by reverse osmosis before being bottled, if it is to be considered safe.

    Avoid using ice unless you feel secure about the purity of the water from which it was made. Remember that automatic icemakers use unfiltered tapwater. Freezing kills most parasites but does not kill bacteria.

    Use pure water for brushing your teeth and rinsing your toothbrush.

    (3) Peel all fruits and vegetables, unless they are to be thoroughly cooked. Wash your hands afterwards. If you cannot peel

    them, soak them for fifteen minutes in a solution made by adding one teaspoon of three per cent hydrogen peroxide to two quarts of water and then rinsing thoroughly with filtered water.

    (4) When eating out, only eat food that has been cooked just before it is served to you. In many restaurants and delicatessens, soups, sauces and stews are frequently stored in large containers, often left uncovered on the floor and reheated in a microwave oven. Microwave cooking does not kill Salmonella and other strains of pathogenic bacteria. It is safest to eat food that is fairly plain and to avoid soup, unless you know how food is handled in the restaurant where you are eating.

    (5) Avoid salad bars. At first glance, salad bars seem like a good place to get healthy food in a hurry. Look again. Some years ago the Wall Street Journal sent a reporter to investigate the cleanliness of salad bars in different parts of the country. Problems were rampant and they lay not only with the restaurant but with the clientele. People are unsanitary in their use of salad bars. They sometimes sample food and put it back. The handles of the serving utensils frequently fall into the food trays, providing an opportunity for contamination.

    (6) Do not eat food that has been prepared by a street vendor.

    (7) Avoid restaurants where there are flies. Flies can spread parasitic cysts and pathogenic bacteria.

    (8) Remember that uncooked meat, fish or poultry are often contaminated with pathogenic bacteria. When preparing your own meals, always keep raw flesh foods away from other food that will be eaten raw, like salad. Cook meat, fish and poultry well and wash your hands after handling them. Also wash the utensils you use to cut them. People have become ill by handling chicken contaminated with Salmonella (as most American chicken is), and then using a contaminated knife or contaminated fingers to prepare other food that was not to be cooked. To kill Salmonella on utensils, soak them in a solution of chlorox for fifteen minutes, then make sure you rinse the chlorox thoroughly away. Do not use dishrags to wipe off kitchen counters, stoves, sinks and tables. Dishrags actually spread germs around. Use recycled paper towels to mop up the bacteria-laden juices from meat, poultry and fish and either use paper towels or sponges to wipe surfaces. Run the sponges through the dishwasher every day to thoroughly remove bacteria.

    Tofu is increasingly popular as a substitute for meat. Tofu that is bought floating in water has high levels of bacterial contamination. Wrapped and sealed tofu is safer. To kill bacteria, tofu should be cooked to an internal temperature of one hundred and sixty degrees.

    (9) Have your pets de-wormed regularly. Wash your hands after handling your pets. Do not let your children crawl on ground where pets are free to roam.

    For people travelling to places where a safe food supply cannot be assured, despite the implementation of all the precautions listed above, I recommend the use of antimicrobial herbs after each meal. My preference is a combination of berberine (the active ingredient in the herb goldenseal) and artemisinin (the most active ingredient in Artemisia annua). This combination can help to prevent or treat bacterial and parasitic infection. These herbs should not be taken by pregnant women, however. The safety profile of artemisinin is high, but it can induce miscarriage.

    There is a novel approach to control of intestinal pathogens, which derives from their need for iron. Virtually all bacteria, except for Lactobacilli and Bifidobacteria, require iron for growth. Animals protect themselves from infection by making chemicals which bind iron, so that the microbes cannot use it. Iron-binding proteins called lactoferrins are concentrated in human milk and are found inside human white blood cells. The high lactoferrin in human milk protects breast-fed infants against intestinal infection. Pure lactoferrin is now available in capsules and has proved to be very useful for the prevention and treatment of intestinal infection, without side effects. It inhibits the growth of pathogenic bacteria and protozoa by starving them for iron, while improving iron absorption by the human host. I recommend that travelers and other people who cannot control the cleanliness of their food supply take one thousand milligrams of lactoferrin at bedtime and the artemisinin-berberine herbal mixture after meals.

    Ulcerative colitis is considered to be a distinct disease entity, which must be separated from other disease entities, especially infectious colitis. Intestinal infections with amebic parasites or certain species of bacteria can produce symptoms and signs indistinguishable from those of ulcerative colitis. The main difference is that antibiotics may cure infectious colitis but have a rather inconsistent effect in ulcerative colitis. Actually, the role of infection in ulcerative colitis, although obscure, is not inconsequential. People with a diagnosis of ulcerative colitis have an increased susceptibility to infections of the large intestine, which aggravate their colitis. Many people who develop the disease in adulthood only acquire ulcerative colitis after contracting a parasitic or bacterial infection. Antibodies directed against the cells which line the large intestine occur in patients with ulcerative colitis, and may also be found in people with chronic forms of infectious colitis. One theory holds that ulcerative colitis is an autoimmune disease provoked by an allergic reaction to micro-organisms in the intestinal tract. Another theory holds that ulcerative colitis may result from toxins produced by intestinal bacteria. Both theories make the boundary between infectious colitis and ulcerative colitis very fuzzy. In addition to the possibility of multiple infectious triggers in ulcerative colitis, the condition may be aggravated by allergic reactions to foods or to the very drugs used to treat mild cases of the disease. Twenty per cent of patients with ulcerative colitis improve by eliminating all milk protein from their diets. Low fat diets may be useful in decreasing the risk of colon cancer, because there is a direct correlation between the development of cancer in ulcerative colitis and the secretion of bile from the liver; the liver secretes bile in response to eating fatty foods.

    Ulcerative colitis is a complex illness that demands a flexibile therapeutic approach. Like all chronic diseases, it is far more clearly understood through its mediators, triggers and antecedents in individual patients than as an abstract disease entity. Conventional drug therapy of ulcerative colitis has as its goal the suppression of the mediators of inflammation. Little attention has been paid to the divergent triggers of different patients. Over the past twenty years I have found some patients in whom ulcerative colitis was profoundly affected by diet, or the composition of the intestinal bacterial flora, or allergic reactions to intestinal yeast, or emotional distress, or the smoking of cigarettes. Each has responded differently to therapies which included diet change, antibiotics or the administration of friendly bacteria like Lactobacilli, but almost all have responded, sometimes with complete remission of symptoms. There are even some patients who develop colitis when they stop smoking cigarettes and who experience a complete remission of colitis when they resume smoking.
    [This Message was Edited on 01/29/2009]
  8. consuegra

    consuegra New Member


    Thanks for this information. I have a phone consult with Dr. Farr next week. Do you have suggestions as to what test results would be most helpful to fax to him? I have CDSA, viral panels, Detoxigenomic, Redlabs and much more.


  9. Catseye

    Catseye Member

    Is it too much to just send everything you've got? They all tell a story and the more you have, the more complete the story. If you're talking dozens of pages, maybe you should ask Farr. He may be able to narrow it down depending on your answers in the symptom questionnaires. What about scanning and emailing, would that work?

  10. maximezara

    maximezara New Member

    Dear Catseye,

    I am also recovering from hyperpermeable gut and a ridiculous assortment of food intolerances, a year of CF, a lifetime of eczema (no more!). My energy is stable so long as I get sufficient sleep and eat right. I am able to eat most foods again, but stay away from gluten, most dairy and sugar, which seem to bring me back down right quick.

    I really appreciate all the information you provide, which is right in line with all I have learned. I am writing a masters thesis on the topic of leaky gut and its association with persistent digestive disorders, and still seeking out excellent research on the topic. I was wondering if you would share the source(s) for the above mentioned information? I see that you have citation numbers but no references listed. It would be really helpful to this work. Also, if you are interested in chatting either online or by phone, I would love to speak with you, as I am compiling clinical data for the thesis, speaking to practitioners with some experience as well as folks like you and me who have been through this and benefitted from a particular health protocol.

    To good health for all,