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This was a difficult post to write as there is so much information about this subject to get your head around, so I have tried to keep it simple (honestly!) and have linked to websites so you can read more if you want to. I am not expert on this and am just trying to make sense of it myself so please look into it yourself rather than relying on this information when trying to solve your digestive problems. I am unsure about the validity of claims made by some websites and the products they promote (enzymes, probiotics and other supplements).
Firstly there are two things to define:
1. What is Leaky Gut Syndrome?
Leaky gut syndrome is not generally recognized by conventional physicians, but evidence is accumulating that it is a real condition that affects the lining of the intestines. The theory is that leaky gut syndrome (also called increased intestinal permeability), is the result of damage to the intestinal lining, making it less able to protect the internal environment as well as to filter needed nutrients and other biological substances. As a consequence, some bacteria and their toxins, incompletely digested proteins and fats, and waste not normally absorbed may “leak” out of the intestines into the blood stream. This triggers an autoimmune reaction, which can lead to gastrointestinal problems such as abdominal bloating, excessive gas and cramps, fatigue, food sensitivities, joint pain, skin rashes, and autoimmunity. The cause of this syndrome may be chronic inflammation, food sensitivity, damage from taking large amounts of nonsteroidal anti-inflammatory drugs (NSAIDS), cytotoxic drugs and radiation or certain antibiotics, excessive alcohol consumption, or compromised immunity. http://www.drweil.com/drw/u/QAA361058/what-is-leaky-gut.html
This is a really good description of how a leaky gut can affect our health and the processes involved as well as some information about what to do about it.
Interestingly it suggests going on an elimination diet for a few weeks to allow things to calm down. I have done this and yes, my symptoms have calmed down, but I have not so far managed to move on to the next stage of reintroducing foods or improving my digestion, despite many attempts. I have been on what is basically an elimination diet for two years! I have put this down to my autonomic nervous system and it’s effects on the gut (it affects the spasms/motility) and is also responsible for my POTS symptoms. It may be that there is more to it and although I did take Kefir for a year (a kind of probiotic) I have not really focussed on these factors recently.
2. What is Gut Dysbiosis?
A frequent disorder (in ME/CFS) is dysbiosis, i.e. the overgrowth of pathogenic bacteria in the intestine… Chronic inflammation of the gut mucosa, resulting from dysbiosis, can lead to the development of leaky gut syndrome.
On Dr Myhill’s site she explains that a positive test demonstrates not enough good bacteria and too much of a bad one:
Prevotella (bacteroides in the upper gut). These ferment to produce hydrogen sulphide. Hydrogen sulphide inhibits mitochondrial function directly. So a positive hydrogen sulphide urine test shows there is a severe gut dysbiosis with overgrowth of prevotella secondary to undergrowth of the goodies!
So, now you understand the basics, I am going to just focus on my personal issues and my plan to deal with this problem (still under construction!). So firstly, based on Dr Myhill’s information what am I doing right and wrong in terms of healing my leaky gut and its bad bacteria?
Things I am doing well:
- Diet: While not Stone Age I have not been eating gluten grains or processed foods.
- Diet: I eat lots of nuts, seeds and vegetables.
- Diet: I also eat fairly small meals and snack quite often as my blood sugar does not seem too stable (possibly due to the high GI foods I can digest).
- Diet: I do eat spicy foods which I read is good for killing bad bugs – good news!
- I have started to take digestive enzymes. These can help me to reintroduce foods that I have struggled to digest previously, and which will hopefully reduce the amount of undigested proteins leaking into my blood stream and therefore reduce bodily inflammation and immune system stress. They can also help to heal the gut wall, they say. See: www.enzymestuff.com
- I take vitamin B12 which is good for stomach acid production (I think I read that somewhere, though maybe not on Dr Myhill’s site!)
- I try to chew well.
Things that I am not doing well:
- I take the contraceptive pill which suppresses the immune system and enourages yeast overgrowth
- I am not on the Stone Age Diet (As a vegetarian I cannot really follow this diet but am not doing everything wrong, see above!). What I have not done brilliantly is that I have struggled to digest a lot of fibrous vegetables and carbohydrates, so my diet has been good for controlling IBS symptoms but been a bit too high GI. I don’t think this is good for weight management, feeling full/energy and I think possibly not great in terms of controlling bad bacteria in the gut (as good bacteria like/need fibre to feed off and break down in colon? I am a little unclear on this).
- Also I do eat things with sugar in, though not huge amounts compared to many people. I don’t actually add it to anything (except honey – yummy!).
- I need to take more vitamin C which can kill off bad bugs
What else can I do heal my Leaky Gut and improve my digestion?
Probiotics: Dr Myhill does not seem very convinced about taking probiotics, and also mentions not to eat sugar when taking Kefir (which she does like, it is a kind of probiotic that you make/grow yourself). (Did I take it for a year for nothing then as I ate sugar?).
This site has lots of information on probiotics.
I have bought two different probiotics and my plan is to have two weeks on a sugar-free diet and take them then for maximum effect (as less sugars for the Candida/yeast to feed on at the same time). I thought if I do it properly I should get some symptoms of die-off (feel terrible!) if I have yeast overgrowth so I should then know if it is an issue I have to take seriously longer term. I have been talking to other people with very bad Candida issues and I don’t think it is a big issue for me as I don’t have any obvious yeast issues. I think perhaps other types of bad bacteria are more the issue, but I will see what the sugar-free diet is like. I am unclear if a sugar-free diet is good for getting rid of other bad bacteria, not just yeast overgrowth. If so it could be a bit confusing.
L-Glutamine – I have bought some of this and have started to take it, but had diarrhea so have stopped for now but will try again.
Systemic enzymes: As well as enzymes to aid digestion, I have also started to take a high protease enzyme between meals as this is supposed to cleanse the blood of toxins that the liver has struggled with, and also reduce inflammation and kill bad bacteria. It seems to be making my stomach ache a bit more. I read to stop for a few days if this is the case then restart, which I have done, but it is still sore. It is often sore though, so perhaps I am misjudging it! There is lots of information on the Enzyme Stuff website as well as the websites of retailers.
Ginger tea is meant to be good for all things tummy – I am grating fresh ginger and making tea with it.
Hypochlorhydria: Stomach acid breaks down food into digestible form, if you don’t have enough then digestion will be very much impaired. It also controls bad bacteria etc. If you think you have low stomach acid then drinking cold water just before or after a meal is bad as it inhibits acid production. More on Hypochlorhydria here and here (the second link is a site about bad breath but has a good summary of the signs, issues and possible solutions to low stomach acid). Both sites mention Betaine HCL, which is an acid supplement. I have decided not to try this as it seems quite risky (being strong acid!) and would talk to my GP before taking it.
I am also trying not to drink too close to eating. I suspect my stomach acid is a bit on the low side and also I don’t want to dilute the action of the enzymes I am taking so it is best to let the food digest before flooding my stomach! (I think common sense needs to be applied with this, especially for someone like me who needs to consume a lot of fluids for other health reasons, but it might be worth experimenting with if digestion is bad). There is some info here and here (see end of first paragraph).
There are various herbal anti-candida, anti-fungal, anti-viral type things you can take but they are either really expensive or seem to have some side effects/controversy so I am holding off on them for now, at least until I am convinced I have candida issues (I am not convinced yet, despite so many sources linking leaky gut with it!).
Additional websites to look at:
http://mdheal.org/leakygut.htm This is an interesting article, though not easy to read or understand in parts. The list of “Trophic Therapies” about a third of the way down in interesting. It also lists tests that are available to help identify specific issues for the individual
This is a quick post, not the one on leaky gut syndrome that I promised you! That is not finished yet. This is just to show how ridiculous the lives of chronically ill people can be! It is no wonder I get so little done in a day and am mentally exhausted! This stuff takes a lot of concentration…
I have started taking digestive enzymes recently as described in my previous post. I have added a high protease (systemic) enzyme to take between meals (to allegedly reduce bodily inflammation and pain among other things). I have also started taking L-Glutamine (though I suspect it has caused diarrhea so I have paused for now to test that, but let’s assume I am taking it. I also read that drinking fluids should be avoided so as not to dilute the enzymes in their very important work, and that if you have low stomach acid the dilution is not good (I don’t know if this applies to me but it could and seems likely) so I should not drink for an hour before meals or two hours afterwards. The protease enzyme is the same rules, but only half an hour before meals is ok. I also take an anti-spasmodic and other medications not related to my digestive issues. I also have in the fridge two probiotics which I plan to start taking soon. I generally need to drink about 4 litres of fluids per day (that’s up to 4x what people usually drink unless it’s hot weather) to help with POTS symptoms.
So let’s see what a day looks like if I do this properly:
8.30am wake up and take my usual medications with water (most of my glasses of water and cups of tea are 1/3 litre).
9am Get up and have a cup of tea. Take vitamins including zinc (good for digestive/gut health). I really should take more vitamin C too – note to self – it apparently helps kill bad bugs in the gut.
Also put Alpha Stim electrodes on my upper back as I do every day (my pain relief machine).
9.30am take antispasmodic and L-Glutamine
9.45 take digestive enzyme (as it is a veggie capsule I read it needs time to dissolve so to take it a bit before eating, but other places say to take at the same time as food, so I am confused about this one. Let’s say 15 mins is ok for now.
10am take probiotic (type one) and eat breakfast
Also move electrodes on Alpha Stim to anywhere else that hurts or just to another position for upper back/shoulders.
11am change setting on Alpha Stim to CES and put earclips on
12 midday take systemic enzyme and wait half an hour for it to get into my system (think this way round makes sense or I would drink then have to wait an hour?)
Alpha Stim done.
12.30 take usual medications and push fluids for half an hour, perhaps 1 litre.
1pm stop drinking and wait an hour before food
1.30 take antispasmodic and L-Glutamine
1.45 take digestive enzyme assuming it takes time to dissolve
2 – 2.30pm take probiotic (type one) and eat lunch
Go to bed and rest/nap
4.30 wake up and take systemic enzyme
5-5.30pm take usual medications and drink fluids – 1 litre
6pm take antispasmodic and L-Glutamine
6.15 take digestive enzyme
6.30-7pm take probiotic (type one) and eat
9pm drink – not much as getting late and don’t want to be up all night – 1/3 litre
10pm – take usual medications and probiotic (type two). Make way to bed.
So I have only managed to fit in 3 litres of fluids, plus a bit with tablets. I could take a jug and drink more before getting up. This regime also prevents me eating little and often as I prefer and forces me to make sure I have eaten enough in one sitting to last me 4 1/2 hours. This goes against advice for managing IBS and POTS symptoms. I also really like to finish a meal with a cup of tea, but I have known for a long time this is not meant to be good if you have digestive issues.
I have tried the systemic enzyme for a few days and that was fine although my stomach seemed to be getting more sore each morning so I am resting it before starting again as is advised. I am unsure about the L-Glutamine but will try it again in a few days. My plan is to do this properly in a couple of weeks and go sugar-free for that time to see if I get any symptoms of die-off to test for a yeast overgrowth. If I feel fine (normal for me!) than it suggests that yeast is not a big issue for me. The more I read about Leaky Gut Syndrome I suspect it may be an issue, despite being quite skeptical, but I think not too extreme for me. I hope so anyway. Even if I cut out all sugars I will still have to eat the diet that I can currently digest which is not very low GI so there will be sugars present (rice/potato) but it will be reduced and that should trigger some reaction. I think taking the probiotics at this time will maximise their efficacy as the bad bugs will be dying anyway – ha ha evil laugh.
Someone had generously given me some Stevia to use during my sugar-free fortnight. My plan is to make some chocolate biscotti (I have found a recipe) so that I can end meals with something sweet and also sweeten my breakfast as I will have to switch to unsweetened soya milk (yuk!).
Sorry for the lack of links in this post – I really have no energy/time for it. Please leave a comment if anything is unclear – my next post on Leaky Gut Syndrome (coming in a week or two) should clarify it all anyway!
*I do not advise anyone to undertake this strange regmen, I know not how useful it will be, only using myself as a guinea pig, as usual…