How to Heal a Leaky Gut
You can avoid and repair leaky gut by making lifestyle modifications. This means avoiding triggers like gluten, alcohol, NSAIDs, stress, and intense physical activity [R].
1) Lectin Avoidance Diet
Lectins can cause leaky gut. The leaky gut then allows more of the dietary and bacterial antigens (inflammatory agents) to come in contact with the immune system [R, R].
If you feel you are lectin-sensitive, it is best to avoid lectins-rich foods and any other food you are sensitive to.
This means you should eliminate sugars, starches, grains, and other irritating foods.
You can read more about lectins and lectin avoidance diet here.
2) Beneficial Foods
Unsaturated Fat (Omega-3)
It is important to maintain a healthy balance of unsaturated vs. saturated fats, but also omega-3 vs. omega-6 fatty acids.
Western diet typically has an excess of omega-6 and not enough omega-3 fatty acids.
Mice on a high-omega-6 diet develop abnormal gut permeability and chronic low-grade inflammation [R].
On the other hand, mice that received more omega-3 fatty acids have decreased intestinal permeability. Their gut lining also sustains less damage in chemotherapy [R].
Fermented Dairy and Vegetables
Fermented dairy and vegetables are excellent sources of beneficial bacteria. These include yogurt, kefir, sauerkraut, and kimchi.
Yogurt improves intestinal barrier by increasing tight junctions [R].
Yogurt with probiotics prevents the disruption of the intestinal barrier in rats with gut inflammation [R].
Fermented barley and soybean prevent gut barrier dysfunction in mice with IBD-like gut inflammation by increasing tight junction proteins [R].
Fermented soy germ extract also decreases gut permeability in rats with IBD-like inflammation [R].
Finally, kimchi-derived bacteria increase tight junction protein levels in mice [R].
Broccoli Sprouts
Broccoli sprouts protect the intestinal barrier (tested on human cells) [R].
Sulforaphane, found in high amounts in broccoli sprouts, strengthens the gut barrier in mice [R].
3) Stress Management
Managing stress levels is a great way to improve the function of your intestinal barrier and your overall health.
4) A Healthy Circadian Rhythm
A healthy circadian rhythm will also help keep your gut healthy [R].
5) Avoid Alcohol
Even moderate consumption can increase intestinal permeability in susceptible people [R].
6) Moderate Exercise
Non-impact exercise, such as swimming, can be beneficial in moderation.
Swimming increased tight junction protein levels in rats [R].
30 minutes of swimming per day maintains low intestinal permeability in mice. It also prevents chronic stress-induced gut barrier dysfunction [R].
7) Avoid Medications That Cause Leaky Gut
Whenever possible, avoid NSAIDs [R, R, R] and proton pump inhibitors [R, R]. These increase intestinal permeability.
Tylenol, on the other hand, may even decrease intestinal permeability by increasing tight junction proteins in gut cells [R].
8) Vitamins and Minerals
Make sure you are not deficient in vitamins and minerals required for proper gut barrier and immune function. These include vitamin A (retinol), vitamin D, zinc, iron, and the B vitamins.
Vitamin A
Vitamin A lowered intestinal permeability in deficient children (DB-RCT, 79 children) [R].
Vitamin D
Vitamin D maintains the intestinal barrier and, in fact, has been recognized as an intestinal permeability protector [R, R, R].
Vitamin D maintains low intestinal permeability in Crohn’s Disease patients (DB-RCT, 27 patients) [R].
Vitamin D reduces the sensitivity of the intestinal barrier to alcohol in mice [R].
Vitamin B
Niacin (vitamin B3) decreases intestinal permeability in patients with alcohol-induced niacin deficiency [R].
Zinc
Zinc can restore intestinal permeability in Crohn’s disease patients, probably by maintaining tight junctions [R, R].
In 12 Crohn’s disease patients in remission, those receiving zinc (10 patients) had normal gut permeability and did not relapse. Of the remaining two who had increased intestinal permeability, one relapsed [R].
Low levels of zinc improved intestinal permeability in children with diarrhea (DB-RCT, 58 subjects) [R].
9) Supplements
Glutamine
Glutamine is an important nutrient that helps maintain intestinal barrier function [R].
Depletion of glutamine results in a decrease of tight junction proteins and an increase in intestinal permeability [R].
Glutamine has beneficial effects on intestinal integrity in 101 preterm infants and increased intestinal barrier function in 80 malnourished children [R, R].
A study of 51 cancer patients showed that glutamine reduced the chemotherapy-induced increase in intestinal permeability [R].
Glutamine reduced radiation-caused gut injury and maintained gut permeability in rats [R].
Quercetin
Quercetin improves the function of the gut barrier by increasing the assembly of tight junction proteins [R, R].
Myricetin and kaempferol, which are similar flavonoids to quercetin, also improve intestinal barrier function in cell-based studies [R].
These flavonoids are naturally found in fruits, vegetables, nuts, berries, and teas, but are also available as supplements.
Melatonin
Melatonin helps heal the gut barrier.
Melatonin markedly improves gut barrier functions in rats, where the barrier was previously weakened by alcohol or diabetes [R, R, R].
Melatonin reduces elevated gut permeability in mice with IBD-like gut inflammation [R] and in mice treated with NSAIDs [R].
Alcoholics have lower blood melatonin, which correlates with increased intestinal permeability (20 alcoholics and 17 controls) [R].
Lipoic Acid
Lipoic acid supplementation reduces intestinal permeability in post-weaning rats [R].
Ginkgo
Ginkgo biloba helps heal the gut barrier by restoring tight junctions in rats [R].
Curcumin
In rats, curcumin restores intestinal permeability by increasing tight junction proteins [R].
Curcumin helps with NSAIDs-induced increases in gut permeability in rats [R].
Given with antibiotics, curcumin improved intestinal barrier function in mice fed a western diet [R].
Curcumin also protects tight junctions and barrier function in human cells [R].
10) Probiotics
Probiotics help reduce gut leakiness. They strengthen tight junctions and restore the integrity of the intestinal barrier.
plantarum promotes gut barrier repair and increases the stability of tight junctions (10 [R] and 7 healthy subjects [R]).
Fermented milk with probiotics decreased gut permeability in patients with IBS (DB-RCT, 30 subjects) [R]. The probiotics included S. thermophilus, L. bulgaricus, L. acidophilus, and B. longum.
The following probiotics have proven to help heal ‘leaky gut’ in animal and cell studies:
- Lactobacillus rhamnosus GG [R, R, R, R].
- L. acidophilus and Streptococcus thermophilus [R].
- L. plantarum [R, R, R].
- L. paracasei [R].
- L. gasseri [R].
- Bifidobacterium infantis [R].
- L. helveticus and B. longum [R].
- L. plantarum and L. reuteri [R].
- Bacteroides fragilis (improves autism-related symptoms in mice) [R].
- Escherichia coli Nissle 1917 [R].
11) Prebiotics
Prebiotics are fibers that stimulate the growth of beneficial bacteria in the gut.
Inulin-enriched pasta preserves the intestinal barrier and decreases zonulin (20 healthy volunteers) [R].
Prebiotic galactooligosaccharides (GOS) improve intestinal barrier function in rats with pancreatitis [R].
Prebiotics lower intestinal permeability and improve tight-junction integrity in obese and diabetic mice [R].
12) Butyrate
Butyrate is a short chain fatty acid produced by gut bacteria. It strengthens the gut barrier and reduces intestinal permeability [R, R, R, R].
Butyrate helps protect the intestinal barrier in rats with gut inflammation and in mice fed a high-fat diet or exposed to chemotherapy [R, R, R].
13) Drugs
Lubiprostone, a drug used to treat chronic constipation, may improve leaky gut in humans (28 subjects) [R].
The combination of neomycin and bacitracin reduces intestinal permeability in mice [R].
Intestinal permeability decreased after cefotaxime and vancomycin treatment in rats [R].
Tylenol may decrease intestinal permeability since it increases the levels of tight junction proteins in gut cells [R].
THC and CBD oil accelerate the recovery of inflammation-induced intestinal permeability in cells [R].
14) Reduce Inflammation
Addressing inflammation will help heal leaky gut.
15) Address chronic infections
Chronic infections can increase gut permeability [R, R, R, R, R], and are best dealt with if possible.
Genetic Factors that Influence Intestinal Permeability
HLA-DQ2.5 and HLA-DQ8.1
HLA-DQ is a protein found on the surface of cells that communicate with the immune system (they present antigens to immune cells).
Two variants, HLA-DQ2.5 and HLA-DQ8.1 increase the risk of celiac disease by about 6-fold [R].
You have HLA-DQ2.5 if you have the following variants:
You have HLA-DQ8.1 if you have the following variants:
Up to 40% of the general population have these variants. However, only about 1% develop celiac disease. This indicates that HLA-DQ2.5 and -DQ8.1 variants are necessary but not sufficient for disease development [R, R, R].
Because of this, the primary value of genetic testing is to rule out celiac disease/gluten intolerance. If you are among the 60% of people who do not carry either of these variants, you are likely (>95%) to not be at risk. That means that you can avoid unnecessary invasive test procedures, such as blood punctures, duodenal biopsies, etc [R].
Apart from celiac disease, having either HLA-DQ2 or HLA-DQ8 increases the risk of type 1 diabetes. Having both of these variants increases the risk even further [R, R].
Women with a history of recurrent pregnancy losses are more often carriers of HLA-DQ2 and DQ8 variants (97 patients and 55 controls) [R].
MYO9B
Myosin IXb (MYO9B) is a protein that helps maintain the intestinal barrier. These MYO9B variants may increase intestinal permeability (study in 1614 Europeans) [R]:
Three of these variants are associated with IBD: rs1545620, rs1457092, and rs2305764 (meta-analysis; 10 studies, 8,975 cases and 9,482 controls) [R].
The rs1545620 and rs2305764 variants are also associated with celiac disease (2717 IBD patients and 4440 controls [R]) (3463 patients and 686 controls [R]).
The association of MYO9B variants with celiac disease was confirmed in other studies [R, R]. However, some also failed to find an association (415 CD patients and 433 controls) [R].
rs2279003, and rs2305764 may increase the risk of type 1 diabetes (316 patients and 706 controls) [R].
rs1457092 was associated with lupus and rheumatoid arthritis (349 lupus patients, 356 arthritis patients, and 345 healthy controls) [R].
NOD2/CARD15
NOD2 (also known as CARD15) functions as an ‘intestinal gatekeeper’’. This protein recognizes bacteria, viruses, and parasites, and activates the immune system. It also helps shape our gut microbiota [R].
These NOD2/CARD15 variants are more often found in people with Crohn’s disease and their relatives (128 patients with Crohn’s disease, 129 first degree relatives, 66 non-related household members, and 96 healthy controls) [R]:
In healthy relatives of Crohn’s disease patients, 40% of those with the 3020insC and 75% of those with both 3020insC and R702W have increased intestinal permeability [R].
3020insC (either rs2066847 or rs5743293), was associated with increased permeability in 75% of multiplex and 61% of the sporadic Crohn’s disease patients (115 patients, 127-first degree relatives including some with sporadic disease, 19 healthy controls) [R].
JAK2
Janus kinase-2 (JAK2) promotes the growth and division of cells, in response to hormones and cytokines (interferon, erythropoietin, leptin, and growth hormone) [R].
IBD patients carrying the JAK2 rs10758669 (C) variant more often have increased intestinal permeability (464 Crohn’s disease patients, 292 ulcerative colitis patients, 508 controls) [R].
MAGI2, MAGI3, and PARD3
MAGI2, MAGI3, and PARD3 are tight junction proteins.
IBD is associated with rs6962966 in MAGI2 and rs1343126 in MAGI3 [R].
rs10763976 in PARD3 and rs6962966 in MAGI2 are associated with both celiac disease and ulcerative colitis [R].
AHR
AHR (aryl hydrocarbon receptor) is a protein that activates detoxification enzymes in response to pollutants and cancer-causing agents. It also plays an important role in activating the immune system [R, R].
AHR rs7796976 (G) increases the risk for disturbed intestinal permeability in Crohn’s disease patients. Smoking can exacerbate this effect (28 IBD patients, 4 controls) [R].
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