Leaky gut may be a term that you've heard before. If you have an autoimmune disorder or something inflammatory or chronic illness and you've gone searching for root causes or what may have led to it, there's a good chance that leaky gut would've come up on the list. So I want to take a minute and explain what leaky gut is, what the term means, how it relates to problems like autoimmune issues, and then kind of the framework for what we do about it. Every case is a little bit different, so I can't just say specifically what to take and what to do, but I can at least lay out the framework for you so you understand what it takes to get that repaired. Alright, so let's jump right. In your digestive tract, you have cells that line that digestive tract, right? And on one side of the cell you've got what's in your digestive tract, which is either food coming out of your stomach, all the way to poop, moving through your large intestines, and then on the other side of the cell, you've got your bloodstream. So I'm going to use my hand as an example of a cell for just a minute. Okay, so let's say this is the main part of the cell that's lining the digestive tract. These are the VII or the finger-like projections that hang down into the intestines, and what they do is they increase the surface area of the intestines so that you're better able to absorb nutrients from the food that you ate.

(01:36)
There are estimates that the average size adult, which who knows what that is at this point, has almost the surface area of a regulation tennis court in their intestinal track. So massive surface area, mostly because we've got millions of these little vii. So this is a cell that lines your digestive tract. This would be another one. These cells are glued together, okay? I know that's a very awkward position for me to sit in, but these cells are glued together here. Now normally what happens is as food moves through the digestive tract, let's say an amino acid or a mineral or something like that comes in contact with one of the little doorways on this vii. So it knocks on the door and they open a little window in the door and they say, oh, who are you? So they present their papers and it says, oh, you're protein.

(02:28)
You're an amino acid. You're part of a building. Okay, I can see how you would be useful. Here are your papers. I'm going to open the door. You come on in. So that little nutrient now gets into the cell and on its way through the cell, it gets tagged, right? It gets its passport stamped, and then it goes into the bloodstream and gets delivered to wherever it needs to go in the body. That's the general mechanism by which we absorb nutrients, minerals, vitamins, antioxidants, proteins, carbs. Those all come in that way. Now, sometimes these cells get irritated. You've either eaten a food that you have an immune response to or you have dysbiosis. The wrong stuff living in the gut, or the lining of the gut hasn't been well-nourished with the specific nutrients that the actual gut cells need to be healthy. There are a whole host of things that could mess this up.

(03:26)
There are certain chemicals that mess this up. There are medications that mess this up. There are actually hormones like cortisol that can make this worse, right? Stress response kind of stuff, but whatever. There are several mechanisms by which this can happen, but these cells get inflamed, and what happens is instead of being glued together, now they have a little gap. So what happens is some things are still hitting these little control points where they're vetted and they're let in, but other things are slipping right between those cells through that gap and nobody's checking them. They just get right in. It could be a protein, it could be an undigested protein or a poorly digested protein. It could be a bacteria or a virus. It could be a piece of trash that you tried to throw away that's now recycling back into your bloodstream. It could be all kinds of stuff because nobody's checking it.

(04:19)
It's just slipping through the gap and getting into the bloodstream. That's leaky gut. I guess the technical term would be intestinal hyper, because hyper means too much. Hypo means too little, right? Intestinal hyperpermeability, it has become too permeable. It is not selectively permeable. It is now openly permeable. Now, that doesn't mean the entire intestinal tract gets like that. You can have patches where it becomes leaky, not visible to the naked eye. If they do a colonoscopy, they're not going to see anything like that. They can see inflammation, redness, they can see some damage, but they're not going to be able to see if those cells are tightly tucked together or if they have gaps for things to get through. It's not something you can visualize like that. Now, once you have leaky gut, how in the world would that have anything to do with autoimmune disorders?

(05:15)
So you have this risk, right? You have all that stuff in your intestines. Think of your stool, right? It's not pretty stuff. It's got a lot of trash in it. Stinky, it's nasty. You certainly wouldn't take a syringe full of your own stool and inject it into your bloodstream. We would all agree that would make you sick. But when you have leaky gut, you're kind of doing the same thing. So in order to try to protect you against that, about 70% of your immune system surrounds your intestinal tract or surrounds your lower gut, and presumably that's to protect you against all of that potential exposure. Now, let's say you have leaky gut and some undigested proteins are slipping through, or even some normal flora, bad bacteria, yeast and fungus, whatever they're slipping through and they're getting into your bloodstream. Your immune system has to respond to that because we can't have this just floating around the body.

(06:14)
So some of your immune cells that are monitoring this will see, let's say it's an undigested protein or a poorly digested protein that comes in. So they recognize it and they say, well, that's not a nutrient. That's some sort of organized cell. That must be an invader. So they whip out their iPhone, they take a picture of that cell. Now, the reason that picture is important, it's made of amino acids. We only have a certain number of amino acids to choose from. When we're making things, I'm going to oversimplify this. Let's say we have 20 different colors of amino acids to choose from. Red, green, blue, orange, yellow, come up with 20 colors. So when it takes a picture of that undigested or poorly digested protein coming in, it's going to have a sequence of amino acids to it, right? A color sequence if you will.

(07:04)
So it takes a picture that texts it to all its immune system friends and says, Hey, be on the lookout for this color sequence. We're being invaded. So now you make antibodies specifically targeting that color sequence. That's all good and well, right? Anytime you eat that food, that color sequence comes in, your immune system cleans it up, that's good. But what if you have a protein native already in your own body, one of your own proteins, like a protein in the thyroid or in the pancreas or something like that that already has that same color sequence in it. Now that you've made an antibody to the food that comes in, you have an antibody geared toward that particular color sequence. If you already have that color sequence somewhere in you now that antibody can attack your own tissue, that can lead to an autoimmune issue where you have antibodies to your own native tissue.

(08:00)
That process is called molecular mimicry, and it is presumed to be one of the major pathways to ending up with an autoimmune problem. There are many others, right? You watch my other autoimmune videos and you'll see a list of those, but this is one of the molecular mimicry. Now also, every time you eat that food, you're activating 70% of your immune system. That can lead to a lot of inflammation. So leaky gut can lead to inflammatory problems, systemic issues, issues that are far away from the gut, right? Thyroid issues, whatever. And it can increase inflammation and it can also irritate the intestines. You can get gut symptoms from it. So what do we do about it? Right? Well, there are three main mistakes people make when they try to deal with leaky gut. The first is they just take a bunch of probiotics because they've been told if they get the right balance of bacteria in the gut, that kind of stuff goes away.

(09:02)
Your gut lining will be healthy. You won't have leaky gut. Not necessarily the wrong idea, but just taking a bunch of probiotics in most cases isn't going to fix it. There's a process you have to go through that I'll explain with this framework, and if you don't hit most of the steps in this process, you're not going to get it done. Well, probiotics are one of the steps, one out of five, and without the other four, it's just not likely to work. Alright? So probiotic only, probably not the best approach. Next would be people doing an elimination diet in reverse. So let me explain what I mean. A proper elimination diet is going to be taking everything that could likely be inflammatory out of your diet, letting the whole system calm down, and then one by one, putting them back in to see what you react to.

(09:55)
That's the proper way to do an elimination diet. A reverse elimination diet would be, I'm eating my normal diet, but I'm going to remove this food and if that doesn't make me feel better, then I'm going to remove that food and if that doesn't make me feel better, then I'm going to remove this food. If it's more than one food, you're never going to find it that way. If you remove all of the possibilities, let's say you just fast for three or four days and everything calms down. Let's use eczema as an example. Let's say you fast for three or four days and your eczema gets dramatically better. You've gotten rid of something that's stimulating that response. So you start putting things back in. Let's say you put some beef back in, no change. You put chicken back in, no change. You eat an apple, no change.

(10:41)
You have some lemon, no change. Maybe you have an orange or you have a zucchini, no change. You have cheese, and all of a sudden the eczema gets worse. Take the cheese back out, let it all calm down, move on to the next one. Let's say you put grapes in, you put watermelon in, and then you put pasta in or you put bread in and all of a sudden it blows up again. Take that one out. That's the proper way to do an elimination diet right? Now, there are timeframes for this. There are a certain number of days you have to introduce foods and all that. This is not a video on elimination diets, right? But doing a reverse elimination diet is a big mistake and it's just going to confuse you. And you don't get better, assuming that if there's no diarrhea, you don't have leaky gut so you don't address it.

(11:28)
Another big issue, we've already said, you can have leaky gut without having actual digestive symptoms. So that's the third mistake that people tend to make. What is the framework that we use in functional medicine? And every functional medicine doctor can tell you this framework. They may have their own way of doing it, but the framework is the same. It's one of the very basic tenets of functional medicine, and that was originally a four R program. Now it's a five R program. I'll give you the five rss. I don't think the last one is all that consequential. You'll see why I say that. Now, the five Rs for this are remove, replace, inoculate, repair, and then rebalance. So let me go through what each of those means. Remove is what? Get rid of whatever's offending the system. That may be your elimination diet. That may be doing a lab test for a particular food reaction, like finding that you have antibodies to dairy or antibodies to, I don't know, sorghum or something, right?

(12:36)
And so you take that out. It could be removing the dysbiosis. Like if you do a GI map test and you find out you've got way too much coli in there, or you've got the wrong kind of e coli or you've got c diff in there or something, somebody's going to have to do something to get rid of that bacteria that should not be in there. Remove whatever's offending the system. And that's probably the biggest part of this. And there can be quite a bit of testing surrounding that remove piece because you got to find out what you're removing. So that's a very pivotal piece. Remove replace means you are replacing any digestive enzymes that you might not be making. So this would be taking a digestive aid or taking stomach acid like beane hydrochloride, taking enzymes like pancreatic enzymes. It could even be taking bitters, which I do with a lot of my patients because when you take bitters, it stimulates your digestive tract to make their own enzymes and acid.

(13:36)
And so you're kind of rehabilitating your ability to produce those. So I like doing it that way when I can because we're actually kind of exercising your body's own ability to do that. That's replace. So remove, replace, re inoculate is put the probiotics back in, right? That's the step that we talked about with the probiotics. That's part of this process. There's going to be some collateral damage. You're going to kill off some of the good guys. So put good guys back in and replace 'em as you go along. That also helps set up the right environment for your own natural, normal flora to flourish, right? So remove, replace, re inoculate repair. Think of putting aloe on a sunburn. You want to go into the lining of that digestive tract and you want to heal that, calm it down and repair it. You want to soothe it. That's the repair process. And then rebalance is eat and live in such a manner moving forward that you don't recreate the problem. Now, is that important? Yes. To me, that's not necessarily part of the framework of fixing the problem. That's maintaining the fix after the fact. But at some point years ago, they decided to make it five rs instead of four, and now we're stuck with it. So the fifth R would be rebalance, which would be set up a way of living and eating so that you don't slip back into the same pattern.

(15:02)
So that's the five R program. Now are the supplements and food changes, dietary changes, whatever. Is that different from patient to patient? Yes. That's what I meant earlier when I said, I can't just tell you take three of these and two of these and four of these and do it for six weeks. It's different in every patient. We have to go through a history and a physical. Sometimes we even have to do some lab testing to narrow down the best way to do this. Alright? But that's the framework. Remove, replace, re inoculate, repair, and then rebalance to maintain it from there on out. So that is leaky gut. Kind of start to finish kind of a quick down and dirty explanation of it, but if you suspect you have it, if you've been told you have it, if you know someone with it and you wanted to get clarity on what it is, hopefully this helps clear it up for you.

(15:54)
So anyway, that's leaky gut. If you have any questions, put 'em below the video in my blog and I'll be happy to go through and answer those or make another video to clear up whatever I screwed up on this one. And if you want to have a consult about this or do some testing to figure out how big of an issue this is for you or what your five R program would look like, contact the office. We're happy to set you up with that and get you a consult and get you whatever testing you need so that we can create a program for you and get this under control. Because if you get this under control, that is one less situation that can stimulate inflammatory and autoimmune problems. If you want to get your autoimmune condition under control, this is likely something you are going to have to deal with somewhere in your journey. You're going to have to either make sure you don't have leaky gut or you're going to have to deal with it and get rid of it, one or the other, right? But it is very common for leaky gut to play a major role in your inflammatory or autoimmune problem that you've got going on. So anyway, give us a call at the office. We'll get you all set up. Otherwise, I'll see you on the next video.