Leaky Gut Syndrome, also known as LGS or increaesd intestinal permeability is a major overlooked cause of autoimmune attack and chronic illness. Did you know that during a typical lifespan 60 tons of food pass through the intestinal tract? Of course, along with food there are also bacteria, viruses, chemicals, and other irritants that pass through the GI tract as well.
The small intestinal cells have small finger-like projections that project into the lumen of the intestines. Because of this feature, it is estimated that the surface area of the small instestine is the size of a tennis court! No wonder our small intestines are designed with a complex arrangement of immune system and physical barriers because a tennis court is a lot of surface to patrol.
The intestine's job is to selectively absorb what is good for us and reject what is bad. Talk about a tough job with such a large surface area. Becase the job is so tough, most of the cells of the digestive tract are replaced every 3-4 days and are protected with a multitude of secretions from the cells such as mucuous, enzymes and immune system substances such as secretory IgA.
So What is Leaky Gut Syndrome or increased intestinal permeability? The cells that make up the lining of the gut is only one cell layer thick and can be easily damaged. Remember that the cells that make up this lining live only for 3-4 days and they have extremely high metabolic activity along with intense nutritional demands. Leaky Gut Syndrome refers to how larger molecules can bypass the protective layer of the gut epithelium (lining) and enter the blood. All material that traverses the digestive tract wall (mucosa) is inspected by the immune system, and it is here that the immune system may have its greatest antigenic exposure. Increased gut permeability can permit exogenous antigens (ones that should have been left to exit in the stool) to enter the systemic circulation. If the antibodies generated towards gut antigens cross-react with the body’s own immunologically similar tissues, the resulting process may manifest itself as an autoimmune disease. It is important to note that the cells of the gut epithelium are joined together by tight junctions (special proteins including zonulin and occludin), so that there are no gaps between the intestinal cells lining the gut. The main way nutrients are suppossed to enter the body is through the epithelial cells to be absorbed. In this way the gut is able to strictly regulate what substances enter the body.
Diagram coutesy of ImmunoSciences Laboratory and Dr. Aristo Vojdani
Some of the signs of LGS are as follows:
chronic joint pain
chronic muscle pain
fuzzy or foggy thinking
confusion, poor concentration
mood swings, nervousness, anxiety
poor immunity, recurrent vaginal infections
bloating, diarrhea or constipation
Several conditions are caused by (in part or fully) Leaky Gut Syndrome, these include:
inflammatory joint disease, arthritis
chronic fatigue syndrome
food allergies and sensitivities
- kidney dysfunction/overload
irritable bowel syndrome
The two most serious consequences of LGS are compromised liver function and autoimmune conditions. These two consequences often lead to a long search for help from traditional doctors as LGS is seldom considered as a causitive factor in most illnesses. Instead the various symptoms are treated with drugs or as conditions worsen, surgery.
The causes of Leaky Gut Syndrome are varied and include:
|The aging process
||AIDS with diarrhea
|Shock or anaphylaxis
|Toxic shock syndrome
||Giardia and other parasites
The good news is that specialized testing to determine if LGS is a potental source of your chronic condition is a STANDARD test that I employ in my initial assesment of those who seek my care and advice.
If LGS is discovered, there is a specific 6 step protocol called the 6R protocol that I employ as part of the designed individualized treatment program. The general outline for the "6R Protocol" is:
- Remove mucosal irritants
- Reduce certain foods in the diet that can thwart the healing process
- Restore normal bowel transit time
- Replace agents for digestive support
- Reinoculate with friendly bacteria
- Repair the mucosal lining
Of course this "6R Protocol" is customized for each individual.
If you would like to obtain a case review and detailed testing for your chronic condition call 586-731-8840 or visit this page of my website for additional information.
If you found value in this article, please use the social sharing icons at the top of this post and please share with those you know who are still suffering with low thyroid symptoms despite having medical managment. Thank you, help me reach more people so they may regain their zest for living!
All the best – Dr. Johnson – Digging Deeper To Find Solutions
A common misconception among the gluten sensitivity and celiac population (which is estimated to be 1 in 100 to 1 in 166 people in the United States) is you can stop the autoimmune destructive process JUST by avoiding gluten. Unfortunately this is just not true. , 
There is disagreement globally about just how much gluten in food [as cross-contamination or as an additive (remember deamidated gliadin from my last article)] that will promote the continued damage to intestinal mucosa. Some researchers promote 200mg and others as few as 20mg. The "gluten threshold" topic is currently under evaluation by the Codex Alimentarius, the WHO/FAO commission that is in charge of setting food standards at the international level.
Hidden gluten can be found in many manufactured food products in various forms under misleading names, like “modified food starch.” People with celiac disease and gluten sensitivity must learn about all sources of gluten and read food labels thoroughly. In addition if proper testing reveals you have gluten sensitivity or celiac disease, you will also be well served to also be tested for cross reactions to foods that can react with the gluten antibody and avoid any of the foods your testing reveals you are reacting to.
Cross-reactions arise because the cross-reacting antigen shares an epitope in common with the immunizing antigen, or because it has an epitope, which is structurally similar to one on the immunizing antigen. The list of potential cross reating foods are listed below:
Potential Cross Reactive Foods Table
|Alpha-Casein & Beta-Casein
The best strategy to help heal the damage is to combine gluten avoidance, cross reaction food avoidance WITH gluten and casein digestion enzymes (DPP IV enzymes) along with other individualized specific nutritional support that “puts out the fire of inflammation” in the gut.
Typically I will use GlutenFlam(K-52) from Apex Energetics and it contains:
- DPP IV Proteases
- Brush Border Enzymes
- Aloe Vera Extract
In the next few paragraphs a discussion of what each of the ingredients do for those with gluten sensitivity and/or celiac disease is in order. I must warn you - there will be several words you may not recognize in these next few paragraphs. Descriptions of parts of the immune system is complex and has it's own lexicon. I do my best to translate the terms as they come up, though...so forge ahead!
DPP IV enzymes are involved in the break down of proteins, such as gliadin (grain protein) and casein (dairy protein), and in modulation of the immune response. Research has demonstrated that supplementation with DPP IV in trace quantities led to rapid destruction of the gluten peptides and provided therapeutic effects for gluten-sensitive subjects.
Brush border enzymes (amylase, cellulase, invertase, and lactase) can be effective in digesting carbohydrates, proteins, and fats without causing irritation and digestion of the intestinal walls in compromised malabsorption or celiac disease subjects. Heavy dose pancreatic enzymes are NOT suggested with compromised or severe intestinal permeability due to their ability to digest the intestinal wall. This is why before taking ANY supplements you need to consult with a knowledgeable nutritionist - so you don't harm yourself!
The gluten response in the intestinal tract with gluten-sensitive and Celiac disease subjects promotes a severe inflammatory cascade. Several key antioxidant flavinoids have been shown to be specific in quenching this response.
Lycopene and quercetin have demonstrated the ability to prevent macrophage (a Pac-Man type white blood cell) activation induced by gliadin and IFN-gamma (an inflammatory immune signaling chemical).
Gut microflora (bacteria in the gut) reponses trigger tumor necrosis factor-induced intercellular adhesion molecule-1 (ICAM-1) upregulation, and are inhibited by the flavinoid apigenin. when ICAM-1 is increased or upregulated - we are more prone to infection with viruses and it also promotes Leaky Gut Syndrome (also known as intestinal barrier breakdown). The good news is that apigenin helps reduce all of this!
Quercetin has been shown to have a specific activity against antigen-induced histamine secretion in intestinal mast cells. Remember histamine promotes an allergic response, so quercetin can reduce this problem.
The flavinoid, luteolin, has demonstrated the ability to prevent lipopolysaccharide-induced NF-kappaB kinase activity in intestinal epithelial (wall) cells and dendritic (brain and nerve) cells as well as TNF-alpha and IL-8 on colon epithelial cells. Lipopolysaccharides (LPS) also known as lipoglycans, are large molecules consisting of a fat joined loosely with a chain of sugar molecules (polysaccharides); they are found in the outer membrane of Gram-negative bacteria, act as endotoxins (toxins within our body) and elicit strong immune responses in animals and humans. NF-kappaB plays a key role in regulating the immune response to infection. On the converse, incorrect regulation of NF-kappaB has been linked to cancer, inflammatory and autoimmune diseases, septic shock, viral infection, and improper immune development. NF-kappaB has also been implicated in processes of synaptic plasticity and memory. In other words this dude named NF-kappaB can help our immune system, but if nudged the wrong way (by LPS) will make our immune system turn against us and promote autoimmunity and damage to our brain - YIKES!
So the good news is that BESIDES avoiding gluten FOR LIFE, you can help keep the inadvertant intake of gluten from keeping you from the recovery you now want, by using specific supplementation including Gluten-Flam (K52). We carry this product in our office dispensary for your convenience.
The next step is to discover what causes Leaky Gut Syndrome, find out if you have it and to what extent and learn what you can do to heal this damage as part of your health recovery. I will discuss this in a future blog post...
If you've had a chronic health challenge for a while such as; diabetes, rheumatoid arthritis, fibromyalgia, autoimmune thyroid, schizophrenia, ADD or ADHD, peripheral neuropathy, chronic fatique, irritable bowel syndrome, can't gain weight, can't lose weight, etc., you may have been tested for gluten sensitivity. That is great as your doctor was thinking out of the box.
More and more doctors are looking for gluten sensitivity and celiac disease as a root cause of many illness. In fact one in about 133 people have this malady and don't know it.
As I have discussed in prior articles, traditional testing for gluten sensitivity is just not adequete and as a result your health suffers. You end up merely having your symptoms treated with various drugs. The real cause continues to wreak havoc on your health and you are left to fall apart as you age. This does not have to be the case.
Recognizing the gap in testing, Dr. Aristo Vojdani has developed special tests to measure sensitivity to the gluten epitopes. Dr. Aristo Vojdani obtained his Ph.D. in the field of microbiology and clinical immunology with postdoctoral studies in tumor immunology at UCLA. Vojdani’s ongoing research, spanning a 40-year career, focuses on the role of environmental factors, such as toxic chemicals, infections and dietary proteins and peptides in complex diseases. An owner of 15 U.S. patents for laboratory assessments, he has published over 120 peer-reviewed articles in scientific journals. Dr. Vojdani is CEO and technical director of Immunosciences Lab., Inc. in Los Angeles, CA, a member of the editorial board of four scientific journals, and a guest editor of six journals.
What are gluten epitopes? How can you get tested for sensitivity to them? Those are the questions that will be answered in this article.
An epitope can be defined as an antigenic determinant which is a small specific portion of an antigen that is recognized by the immune system, driving the the immune system to produce antibodies against it.
The first epitopes that are important to test for are known as gliadin epitopes and consist of:
- alpha gliadin
- beta gliadin
- gamma gliadin
- omega gliadin
Research shows that 50% of children with celiac disease do not respond to alpha gliadin (the most common test for celiac disease as discussed in a previous blog post), but do test positive to a diverse set of gliadin and glutenin peptides, including 6 novel epitopes (Gastroenterology, 2002; 122:1729-1737). Other researchers have confirmed the folly of just testing alpha gliadin (Journal of immunology, 2009; 182:4158-4166). In fact wheat-dependent, exercise induced anaphylaxis (WEDIA) is an allergic reaction provoked by the combination of wheat-ingestion with physical excercise. Among wheat proteins, omega-5 gliadin has been reported as a major allergen in the anaphylaxis.
Gluteomorphin is an epitope that also needs to be tested for immune reactivity. a gluteomorphin is an opioid peptide that is formed during the digestion of the gliadin component of the gluten protein.
When I explain that a patient MUST eliminate wheat and other gluten containing grains from their diet, I have to tell them about possible withdrawal symptoms. Yes, you read that correctly - withdrawal symptoms. Gluteomorphin attaches to the same opiod receptors in the brain that morphine and other opiates do. So "going cold turkey" can lead to the individual feeling worse and developing new symptoms when starting a gluten-free diet. The symptoms can last a few days to several weeks! But if they don't remove gluten from the diet they will never get the chance to regain their health.
The epitope named prodynorphin is another opiod that is a basic building block of endorphins. Endorphins ("endogenous morphine") are endogenous (made by the body) opioid peptides that function as neurotransmitters (brain and nerve signaling chemicals). They are produced by the pituitary gland and the hypothalamus in the brain during exercise, excitement, pain, consumption of spicy food, love and orgasm, and they resemble the opiates in their abilities to produce analgesia (pain reduction) and a feeling of well-being (euphoria).
Prodynorphin has been shown to play a central role in many processes in the brain, including how well people feel about themselves, their memories, and their perception of pain. People who don't make enough of prodynorphin are vulnerable to drug addiction, schizophrenia, bipolar disorders, and a form of epilepsy. Gluten sensitivity is known to lead to prodynorphin antibodies and potentially to neurochemical disorders (brain chemical imbalance).
My blood type diet certification through the Institute for Human Individuality has alerted me to the issues related to the next epitope to be discussed; Wheat Germ Agglutinin (WGA). Wheat germ agglutinin is a lectin found in wheat. Lectins have the ability to attach to sugars or carbohydrates on the surface of human cells. What makes us have a particular blood type is the presence of a specific carbohydrate structure on our red blood cells. WGA can cause clumping of human red blood cells, a process called agglutination. The process of agglutination occurs when someone receives the wrong blood type during a blood transfusion. WGA is found in the highest concentration in whole wheat products, including whole sprouted wheat bread and other products.
Of course wheat germ agglutinin is NOT found with traditional gluten testing. It is important to note that WGA can do direct damage to the tissues of the body even if you do not have the genetic tendency to react to gluten - meaning you don't have to have gluten or celiac sensitivity genes to react to WGA. In fact WGA can pass through the blood-brain barrier and attach to myelin and inhibit nerve growth factor. Myelin is the protective sheath on nerves and nerve growth factor is important for the growth and maintenance of neurons. So, if you are so predisposed, wheat can cause brain damage
Anti-WGA antibodies can also cross react with other proteins, which means they may contribute to autoimmunity. Remember autoimmunity means your own immune system attacks your own body tissues. WGA plays a role in the development of celiac disease that is entirely distinct from that of gluten.
Another couple of epitopes to test for are transglutaminase and transglutaminase bound to gliadin. Tissue transglutaminase is an enzyme that removes an amino group from gliadin (deamidation) and adds the remainder of the peptide to the existing protein. When transglutaminase is bound to gliadin a new antigen is formed which has been shown to promote immune activation and is stongly linked to celiac disease.
Hopefully by now you are following the concept that there are many things your body's immune system can react to (antigens) in a way that causes illness. If you don't get tested for these things you will potentially never get well - or worse - have added health challenges or disease to contend with as time marches on.
A few last words are necessary to further clarify one of the epitopes to consider before I end off this blog post.
Deamidated gliadin is the product of acid or enzymatic treatment of gluten often used in the food processing industry. The purpose of deamidating gluten (which is alcohol soluble) to make deamidated gliadin (which is water soluble) is to make the gliadin able to mix with other foods (like milk) without changing the foods' qualities. Unfortunately for us, our immune system is way more activated by deamidated gliadin!
These so-called wheat isolates have been shown in a double-blind, placebo-contolled study to cause problems. In this study, subjects did not react to native wheat flour, but had severe reactions to deamidated wheat isolates. (Journal of Allergy & Clinical Immunology, 2003 Apr;111(4):897-9.)
The extensive use of deamidated wheat isolates in the food industry may be the major cause of hidden food allergies. These isolates are used as food emulsifiers, gelling agents, film formation aids, stretchability agents in meat products, sauces, soups, and as clarifying agents in red wine. Researchers state: "Because food isolates or deamindated gluten are new food ingredients, when allergy to wheat is suspected, immune reaction to wheat isolates should be tested." (European Journal of Inflammationm, 2008. Jan;6(1):1721-1727.)
So to recap, you can get deamidated gliadin from the processing of wheat by food processors AND by your own body via the enzymye tissue transglutaminase.
It turns out that antibodies to deamidated gliadin is a better diagnostic test for celiac disease that the conventional gliadin antibody testing.
To make the diagnosis of gluten sensitivity more accurate, 3 different deamidated gliadin peptides should be tested for:
- deamidated 15 mer
- deamidated 17 mer
- deamidated 33 mer
Currently conventional laboratories are only testing for:
- alpha-gliadin antibodies
- tranglutaminase antibodies
Measurement of only these two antibodies will miss many cases of gluten sensitivity immune disorders.
Fortunately I am affiliated with a new advanced laboratory (Cyrex™ Laboratories) and they have a great test known as the Array 3 - Wheat/Gluten Proteome Reactivity & Autoimmunity test. All the items I wrote about in this blog article (and more) are tested via this profile.
So the good news is - even if other lab tests you have had during the search for the cause of your chronic health condition(s) turned up nothing - there is still hope.
Ordering, Questions and Technical Information
Any and all of the current Cyrex™ Arrays 1-4 may be ordered through Dr. Karl R.O.S. Johnson, DC.
If you have further questions, please send your questions to DrJohnson@wellnesschiro.com. I would encourage you to forward this information to any and all that you know.
If you found value in this article, please use the social sharing icons at the top of this post and please share with those you know who are still suffering with chronic condition symptoms despite having medical managment. Thank you, help me reach more people so they may regain their zest for living!
All the best – Dr. Johnson – Digging Deeper To Find Solutions
In the previous blog post, I covered some background information and one of the reasons why gluten sensivity is more prevalent these days, namely inadequate/outdated testing.
Additional reasons why gluten sensitivity and celiac disease are more prevalent include:
- Genetically modified foods (GMO)
- Gluten deamidation
- Gluten storage in bins for long periods of time, leading to enterotoxin contamination
- Hygeine hypothesis
- Leaky Gut Syndrome (LGS)
- Chronic stress - and the resultant breakdown of immune system tolerance
- Poor nutrition
Unless you've had your head in the sand, you probably are aware that Monsanto and other conglomerate companies have been messing with our food supply. They think that changing food via the "better living through chemistry" mindset will make our foods more nutritious or for self-serving purposes make the modified seeds immune to the herbicide chemicals they manufacture. Wheat has been modified over the years to have more protein, which is the most allergenic portion of wheat.
Deamidation is the product of acid or enzymatic treatment of gluten used in the food processing industry. This is accomplished because gliadins are soluble in alcohol and cannot be mixed with other foods (like milk) without changing the food’s qualities. Deamidated gliadin is soluble in water. Our immune system reacts with greater ferver to deamidated gliadin than to gliadin.
The average US storage time for harvested wheat is approximately 2 years! During this storage time the waste products of fungi and mold form which are called enterotoxins. Enterotoxins and be defined as a toxin produced by bacteria that is specific for intestinal cells and causes the vomiting and diarrhea associated with food poisoning. The enterotoxins lead to a leaky gut which triggers an immune reaction to the gluten that is contaminated.
The Hygeine hypothesis theory "proposes that inadequate exposure to infectious organisms leads to immune dysfunction. Under normal circumstances, the immune system is exposed to various viral, bacterial, fungal, or parasitic challenges and becomes properly calibrated to these real threats following successful defenses. Today's public health successes, coupled with the increased use of antibiotics and vaccines, minimize opportunities to mount successful attacks against genuine attackers. IgE is still present, however, and, in the absence of harmful agents, it begins attacking harmless environmental substances.
There is an enormous amount of scientific evidence for this. Children who have had early infections manifest far less atopy, allergy and autoimmune disease". 
Leaky Gut Syndrome LGS is an intestinal condition in which the walls of the intestines are damaged to the point where they no longer function to keep food molecules, bacteria and other unwanted material from entering the blood stream. As a result of the foreign material entering the blood stream, the immune system is activated and intact gluten molecules or any one of the other wheat breakdown products are targeted for destruction, as are the cells of the intestines.
Until recently not too many have people heard about or knew someone with gluten sensitivity or even celiac disease. Why does it seem to be so prevalent now? Answering this question requires a bit of discussion and is by no means an in-depth treatise on the subject.
Perhaps it may be important to understand some terms first. I am frequently asked what is the difference between gluten sensitivity, gluten allergy and celiac disease.
Most experts agree that for one to be diagnosed with an allergy, you need to have an immune reaction that includes the antibody named immunoglobulin E (IgE) and the subsequent release of histamine from a class of white blood cells called mast cells. This type of allergic response is immediate and often can be severe. The most severe reaction is called an anaphylactic reaction and can be life threatening. If you have this type of allergy you definitely know it and probably carry an EpiPen® around with you. Some people "grow out" of this type of allergy as they age because the level of IgE diminishes rapidly between the ages of 10 and 30 .
Gluten or other another food sensitivity typically means the sufferer has an immune response with a different set of antibodies. These antibodies are called immunoglobulin A (IgA) or immunoglobulin G (IgG). When you are diagnosed with a gluten sensitivity your testing would show you are reacting to various compounds in wheat, rye, barley. Realizing you have an IgA and/or IgG sensitivity can be more mysterious as there are many symptoms you can have that often are attributed to another cause. The mistaken attribution is commonly due to a delay between the time of ingestion of the food you are sensitive too, or due to the mild nature of a reaction at the time that you just chalk up to "just how you are".
Celiac disease refers to the destruction of your small intestinal cells (called enterocytes) and ofthen the villi and microvilli (which are the finger-like projections of your small intestine cells) by your own immune system. Imagine a piece of shag carpeting rolled up into a tube with the shags facing inward and you have an idea of how the small intestine looks on a microscopic level. Now imagine your immune system has a fleet of lawnmowers that mistakenly mow off all the shags down to nubs. That is celiac disease - and the end point destruction is called total villous atrophy (TVA). Due to the lack of villi you cannot absorb nutrients in sufficient quantity and as a result several other diseases or conditions can develop such as ostoporosis or iron deficiency, depression, abnormal results on liver blood tests and much, much more.
Here is a super important point to take to heart: gluten sensitivity and celiac disease BOTH are permanent intolerances to ingested gluten that results in immunologically mediated inflammatory damage to the small-intestinal cells.
So why is gluten sensitivity seemingly more prevalent these days? First of all, more advanced testing is now available, which makes the diagnosis more accurate with blood tests or with saliva tests. I posted a blog article about this recently and I highly suggest you take a look.
The gold standard for detecting celiac disease used to be a blood test for IgA reaction to alpha gliadin plus 3 biopsies (gliadin is a glycoprotein present in wheat and several other cereals within the grass genus Triticum). The problem with this "gold standard" test is that almost total villous atropy (TVA) was necessary before the test became unequivocally positive. In fact celiac disease patients tend to be 10-15 times more likely to exhibit IgA deficiency in the blood!
Since the advent of better testing (saliva IgA and IgG and testing more that just alpha gliadin) and awareness that gluten sensitivity and celiac disease is more prevalent than previously thought, has led clinicians to look for these disorders in their clinical workup.
In my practice I have found nearly 100% of those patients that come to me with chronic health challenges (such as fibromyalgia, hypothyroidism and balance disorders, etc.) have gluten sensitivity. I have access and use some of the most advanced non-invasive testing availabletoday and as a result, now my chronic condition patients, have found renewed hope for recovering from their illnesses.
Those patients with autoimmune thyroid, fibromyalgia, balance disorders, diabetes, menieres disease, etc. who obtain our battery of tests and are treated with my specialized Johnson Neuro-Metalbolic Therapy program are regaining a zestful life.
Additional reasons for why gluten sensitivity is seemingly more prevalent will be discussed in future blog posts.
1. Croner S (1992). "Prediction and detection of allergy development: influence of genetic and environmental factors". J. Pediatr. 121 (5 Pt 2): S58–63. 10.1016/S0022-3476(05)81408-8.