As gut health has such an impact on many health conditions, this webinar covers the issues relating to increased gut permeability, and how to support this issue from a clinical perspective. Kyla discusses the problems you may face with clients dealing with gut issues, concentrating on how to heal a permeable gut (often called leaky gut) through diet and supplements. Gut issues linked to gut permeability including intolerances, gastritis and inflammatory bowel conditions are also be highlighted. Nutritional protocols for healing a leaky gut includes recommended tests to identify specific causes, various aggravating foods to avoid, food and supplements to reduce inflammation, and supplements to support the healing process.

1. Nutritional protocols for gut
permeability
Kyla Williams DipION, BSc, MSc

2. Overview
• What is gut permeability / leaky gut
• Symptoms and health issues relating to increased gut permeability
• Possible causes of gut permeability
• Diagnosing gut permeability
– symptoms
– recommended diagnostic tests to identify specific causes
• Nutritional protocol for healing a leaky gut:
– diet – foods to avoid and foods to reduce inflammation
– supplements to support the healing process

3. Permeable gut vs ‘leaky gut syndrome’
• These terms are often used interchangeably; however they can be
perceived very differently by health professionals
• Controversy exists with the term ‘leaky gut syndrome’
• ‘Leaky gut’ is simply a term used for a permeable gut lining associated
with inflammation
• Nutrition practitioners - the term ‘leaky gut’ is more commonly used
• Medical doctors - may prefer to use the term ‘permeable gut lining’ or
‘inflammed digestive tract’

4. What is gut permeability?
• In a permeable gut lining, the single layer of mucosal cells covering the
digestive tract are damaged:
• Cells become inflamed
• Gaps appear between
the cells
• Food particles and other
toxins may enter directly into the bloodstream

5. A healthy digestive tract
• Closed and closely packed together mucosal
cells lining the digestive tract
• Cells are plumped up, thereby carefully
controlling the absorption of nutrients from food
• Normal tight junction between cells keeps the mucosal barrier intact
• This barrier prevents most large molecules and germs
passing from inside the bowel into the bloodstream

6. An unhealthy permeable gut lining
• Excess inflammation damaging cells and epithelium
• Undigested food particles may pass through gaps
• The immune system may react to this by
creating more inflammation
• Commonly leads to food intolerances – an immune reaction to various
foods which can change over time
• A leaky gut is often an ongoing issue, and frequently undiagnosed

7. The importance of gut health
Nutritional
status – bile,
enzymes etc.
Immune
function – first
line of defence
To balance
hormones
B12 absorption
(intrinsic
factor)
To protect
against food
intolerances

8. Digestive symptoms associated with gut
permeability
• Digestive symptoms are often not a priority to clients
• Clients may want to concentrate on other goals such as
overcoming fatigue (associated with leaky gut)
– diarrhoea
– constipation
– burning sensation in the stomach
– passing a stool shortly after eating
– pain after drinking alcohol or spicy food
– stomach cramps
– gas

9. Other symptoms associated with gut
permeability
• A leaky gut may not only present itself as digestive discomfort
• Other symptoms relating to a leaky gut include:
– hormone imbalances causing mood swings
– headaches
– skin breakouts
– tiredness and fatigue
– joint pains associated with inflammation
and intolerances
– depression and anxiety

10. Health issues linked to gut permeability
• The following conditions may increase gut permeability:
• Inflammatory bowel diseases
– ulcerative colitis
– Crohn’s disease
• Gastritis (inflammation of the stomach – several causes)
• HIV / AIDS
• Type 1 diabetes

11. Causes of a leaky gut
• There are several possible causes of a leaky gut:
– chronic inflammation
– nutritional deficiencies
– fatty acid deficiencies
– improper digestion
–high intake of commonly aggravating foods
– stress
• Other possible causes:
– parasites
– pathogenic bacteria
– yeast infections

12. The role of inflammation in a permeable gut
• Chronic inflammation causes continuous breakdown of cells
• Excess inflammation can damage mucosal cells’ tight junctions
• Inflammation may be a result of an inflammatory diet or medication
• Inflammation exacerbates pain and sensitivity to foods
• Too much inflammation stalls the healing process

13. Nutritional deficiencies and a leaky gut
• Nutrients required for the integrity of the mucosal cells
– zinc
– antioxidants
– protein
– fatty acids
• A leaky gut may also result in nutritional
deficiencies due to inflamed villi and
reduced ability of mucosal cells to absorb
nutrients

14. Fatty acid deficiencies and a leaky gut
• A deficiency in omega-3 fatty acids may increase inflammation
• A low omega-3 index may also reduce fluidity of cell membranes
• Low levels of omega-3 may also shrink cells (less plumped up) leading
to possible gaps between mucosal cells
• Imbalanced ratio of omega-6 to omega-3
fatty acids may lead to inflammation

15. Improper digestion and leaky gut
• Low stomach acid = improper breakdown of proteins
• Low production of bile = improper breakdown of fats
• Low levels of digestive enzymes = larger undigested food particles
Improper
digestion
Undigested
food
particles
Food
passing
through
leaky gut
Possible
intolerances

16. High intake of commonly aggravating foods
• Foods commonly associated with a permeable gut lining:
– gluten
– dairy
– peanuts
– pulses (lentils, beans)
– spicy food
• Foods which an individual has become intolerant to due to IgG
antibody reaction, or other immune reactions

17. Is gluten to blame?
• Gluten - a protein found in grains:
wheat, barley and rye
• It can be very difficult to process in the body and can result in immune
reactions leading to unwanted symptoms such as digestive cramps
• Gluten is one of the most common food intolerances and can
negatively affect symptoms of a leaky gut
• Gluten is not the cause of a leaky gut for everyone
• Small quantities of gluten may be tolerated, although constant intake
of gluten is too much to handle for many people

18. Spicy food
• Spicy food - chilli peppers contain a compound called capsaicin
• Causes irritation to mucosal cells, including the lips, tongue, mouth
and digestive tract
• Leaky gut + chilli = a burning sensation in the stomach and a bout of
diarrhoea

19. Other foods which may aggravate a leaky gut
• Ginger – the spicy / irritating compound is gingerol (related to
capsaicin)
• Raw garlic
• Raw onions
• Although these foods are considered to be anti-inflammatory, they can
also cause irritation to your gut lining if it is already semi-permeable
• Direct contact of such strong foods on already damaged cells can result
in an instant burning sensation in the stomach or intestines

20. Stress and a leaky gut
• Stress can increase stomach acid production
– often leading to gastritis / ulcers
• Stress may reduce ability to digest food by reducing production of
digestive enzymes
• Higher requirements for vitamins and minerals

21. Pathogens – yeast, bacteria and parasites
• Yeast infections such as candida albicans
• Pathogenic bacterial infections,
lack of beneficial bacteria
• Parasites
• Toxins produced by pathogens can cause
further damage

22. Alcohol
• Drinking alcohol in excess, i.e. more than
approximately 3 units in one day,
can cause significant irritation to an already permeable gut
• Alcohol is inflammatory, and therefore is only going to make the
situation worse
• 2-3 units of alcohol may not cause any issue to someone with a
healthy gut lining, but for someone with a permeable gut lining, alcohol
can be very aggravating

23. Medication
•Well known irritants of the bowel lining:
– aspirin
– non-steroidal anti-inflammatory drugs
(nSAIDs) such as ibuprofen
• These medications may cause inflammation of a particular area of the
bowel, which may result in ulcers or a permeable gut lining
• Antibiotics wipe out beneficial bacteria and therefore may result in
infections following treatment
• Birth control pill

24. Diagnosing a leaky gut – symptoms
• Recognise digestive symptoms relating to a leaky gut
– bloating
– diarrhoea
– pain
– stomach cramps after eating
– feeling of ‘sensitivity’ to certain foods such as bread
• Also consider other symptoms
– sinusitis
– eczema
– migraines
– joint pains
–chronic fatigue

25. Diagnosing a leaky gut – tests
• A digestive stool analysis can test secretory IgA (Immunoglobulin A)
levels
• IgA is an antibody used by the immune system to identify and fight off
unwanted objects such as infectious bacteria; this specific type of
antibody is produced in mucosal linings (the gut wall)
• As unwanted undigested food particles may pass through the gut
lining, an immune reaction involving high levels of IgA antibodies may
suggest a permeable gut lining
• Test for food intolerances: if IgG antibodies are produced, a leaky gut is
very likely

26. Protocol: Step 1 – eliminate irritating foods
• Identify any irritating foods and eliminate these from the diet
• Gluten is the most common culprit, although many other foods – such
as peanuts, beans and lentils – can also cause problems in some
individuals
• If a food intolerance test has been carried out:
– eliminate these foods temporarily only, while concentrating on healing the
gut
– intolerances to several foods are likely to develop over time
– simply cutting these foods out is not going to address the cause
– once the gut is properly healed, these intolerances should
disappear

27. Protocol: Step 1 – eliminate irritating foods
• Spicy food should be eliminated (or at least significantly reduced)
during this initial stage for approximately 2-4 months
• Ideally, eliminate alcohol completely for 2-4 months
• Drinking alcohol, even once a week, while trying to heal your gut can
make the healing process twice as long

28. Protocol: Step 2 – test and eliminate
pathogens
• Identify pathogens and eliminate them – usually 3-6 months
• If a digestive stool analysis identifies an infection, such as a bacterial
imbalance or yeast infection:
– supplement with probiotics
– consider other supplements specific to eliminating bacteria (oregano oil,
garlic)
– support immune function (zinc, antioxidants, fermented foods)
– reduce sugar in the diet
• Bacterial infections such as H. pylori may require medical attention
from a doctor and medication

29. Protocol: Step 2 – test and eliminate
pathogens
• If a parasite infection exists, some may be eliminated with
supplements. 6 month course of:
– goldenseal
– oregano oil
– probiotics
• Support liver detoxification
• Some stubborn parasites may require medical attention from a doctor
and medication

30. Protocol: Step 3 – feed your cells
• After all aggravating foods have been eliminated from your diet, it is
important to concentrate on feeding the cells lining your digestive
system
• Cells lining the digestive tract require the amino acid glutamine to be
able to replenish themselves
• The powder form mixed with water is ideal, to maximise exposure to
cells if your digestive system is not strong enough to break down
supplement tablets

31. Protocol: Step 4 – control inflammation
• Keep inflammation down in order to promote healing and reduce pain
• To control inflammation, consider anti-inflammatory foods:
– vegetables
– oily fish (containing omega-3 EPA)
– foods rich in antioxidants
• Limit intake of inflammatory foods:
– grain fed meats (containing omega-6 AA)
– vegetable oils such as refined corn oil and sunflower oil
– refined carbohydrate foods such as sugar and white flour

32. Protocol: Step 4 – control inflammation
• The most potent anti-inflammatory supplement which may help to
calm and soothe the gut lining is omega-3 EPA
• 1000mg omega-3 EPA per day to have a therapeutic effect on reducing
inflammation
• The ratio of omega-6 AA to omega-3 EPA needs to be balanced, e.g.
2:1 ratio
• Omega-3 EPA produces anti-inflammatory eicosanoids

33. Omega-3 EPA to control inflammation
• Pure EPA derived from wild anchovies, sustainable source
• Pharmepa Step 1: 90% omega-3 EPA – 1000mg, (added vitamin E)
• Pharmepa Step 2: 80% omega-3 EPA – 640 mg, GLA – 18mg
(added vitamins B5, D3 & E)
• Adherence to the regime for a minimum of 3 months is required for
therapeutic outcomes
Directions for use
Adults should take
1-2 (Pharmepa Step 1) or
2-4 (Pharmepa Step 2) capsules
daily. Take with food for optimal
absorption.

34. Omega-3 SDA to control inflammation
• Vegetarian options - linseed? algae? hempseed?
• Echium seed oil (as Echiomega) is a source of the
omega-3 fatty acids SDA (stearidonic acid) and ALA.
SDA is the precursor to EPA
• 25-30% of SDA converts to EPA, compared with just
5-8% of ALA – the principal omega-3 in most other
plant-derived oils
• Echiomega, rich in SDA, is the superior choice of
omega-3 for vegetarians and vegans

35. Protocol: Step 4 – control inflammation
• Aloe vera
– soothing properties
– anti-inflammatory
– healing properties
• Liquorice
– soothing, particularly to mucous irritations
– supports immune function
– use deglycyrrhizinated liquorice
• Slippery elm
• Marshmallow root

36. Long term digestive support
• Chew food properly
• Eat sufficient protein and omega-3 fatty acids
• Limit intake of gluten
• Manage stress
• Include supplements on a regular basis where necessary
– Probiotics
– Digestive enzymes

37. References
• Elamin E1, Jonkers D, Juuti-Uusitalo K, van Ijzendoorn S, Troost F, Duimel H, Broers J, Verheyen F, Dekker J,Masclee A. (2012)
Effects of ethanol and acetaldehyde on tight junction integrity: in vitro study in a three dimensional intestinal epithelial cell
culture model. PLoS One, 7(4).
• Rapin JR1, Wiernsperger N. (2010) Possible links between intestinal permeability and food processing: A potential therapeutic
niche for glutamine. Clinics (Sao Paulo), 65(6):635-43.
• Suzuki T. (2013) Regulation of intestinal epithelial permeability by tight junctions. Cell Mol Life Sci, 70(4):631-59.
• van der Hulst RR1, von Meyenfeldt MF, Soeters PB. (1996) Glutamine: an essential amino acid for the gut. Nutrition, 12(11-12
Suppl):S78-81.
• Vazquez-Roque MI1, CamilleriM, Smyrk T, Murray JA, Marietta E, O’Neill J, Carlson P, Lamsam J, Janzow D,Eckert D, Burton
D, Zinsmeister AR. (2013) A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: effects on
bowel frequency and intestinal function. Gastroenterology, 144(5):903-911.

38. www.igennus.com
0845 1300 424
education@igennus.com
Kyla Williams DipION, BSc, MSc
Nutrition Technical Advisor
kylaw@igennus.com