Your Gut’s Feeling for Rheumatoid Arthritis – The Leaky Gut Syndrome

What is a Leaky Gut Syndrome and Why is it Important?
Leaky Gut Syndrome is not a single disease. To begin with, it is a pathological condition that occurs as part of many different diseases and syndromes. As leaky gut syndrome connects apparently unrelated disorders, it is one of the most misunderstood concepts today. It refers to an abnormal increase in the permeability of the intestinal lining. This abnormally large spaces present between the cells of the gut wall allow passage of toxic materials, bacteria, fungi, parasites, undigested protein, fat and other waste not normally absorbed into the bloodstream in the healthy state.

A leaky gut is almost always associated with autoimmune disease (including Rheumatoid Arthritis), hence reversing an autoimmune disease also depends on the healing of the lining of the gastrointestinal tract. What temporary symptomatic relief RA patients find from drugs, the mainstay of treatment, often comes at the price of damaging health with pharmaceutical side effects. Steroids, for instance, are known to cause side effects such as diabetes, osteoporosis, mental instability; Methotrexate (MTX) which was traditionally employed for cancer is infamous for producing liver damage while the newer drugs known as the Biologics e.g. Enbrel, Humira and Remicaide disables a part of our body’s immune system and invites risks of infectious diseases and cancer. These medications are merely symptoms suppression and not able to address the underlying causes of RA. It is important to know that only with understanding of leaky gut phenomenon that one, including his or her health care practitioner, is able to carefully  study, analyse, question and address why such allergies/intolerance and RA develop and determine the appropriate therapies and treatments that are effective and safe to bring our body back into balance.

This gut-joint axis is likely the same mechanism as the gut-brain axis or the gut-skin axis that produce the myriad of symptoms and diseases we are now seeing. In my earlier post – Clueless about Triggers of Rheumatoid Arthritis Flare-ups? Find Out the Culprits with an Elimination Diet – I highlighted how most studies have it wrong when their work are solely focused on researching on antibodies in the blood. The researchers at the University of Oslo, Norway, looked at food-related antibodies that show up in the gut rather than blood of people with RA. Gut health is one of the most important factors for general wellness of our bodies, considering that:

• The gut is responsible for up to 80% of our immune systems
• The gut is responsible for protecting our bodies against pathogenic infections from viruses, bacteria, yeast, parasites and fungi
• The gut is responsible for proper digestion and absorption of vital nutrients
• The gut is also responsible for influencing our happiness through production of natural anti-depressants

Symptoms of Leaky Gut Syndrome
With my RA diagnosis, I gradually came to understand how gastrointestinal health in general, and Leaky Gut Syndrome in particular, contributes to many seemingly unrelated symptoms. If you have many or most of the following symptoms, there is a high likelihood that you are also suffering from leaky gut syndrome that you probably are not even aware of in the first place:

• Joint pains
• Arthritis
• Chronic fatigue
• Chronic depression
• Chronic skin condition
• Abdominal pain, gas or burping
• Constipation
• Food allergies or intolerance
• Parasites/bacterial/viral infection
• Yeast/fungal overgrowth or candida
• Obesity or weight gain
• Muscle pain
• Shortness of breath
• Irritable bowel syndrome (IBS)
• Fibromyalgia (FMS), Multiple Sclerosis (MS) or Hashimoto’s Thyroiditis
• Mood swings, anxiety, confusion, memory loss or brain fog

Triggers and Mediators of Leaky Gut
Imagine, our gastrointestinal tract is the largest organ in the body and two thirds of the immune system lies within these walls. The Leaky Gut Syndrome, through increased permeability of the intestinal lining, triggers inflammation of gut lining when our immune system begins invading altered molecules that pass through this gut lining to get access to our immune system.

When damage occurs to the mucosal barrier of the gut lining, we are increasingly losing a huge part of our immune system that works hard to fight off new invading molecules or proteins. With an over-active immune system, the microvilli of the gut lining becomes damaged, our ability to properly digest food is hence lost, and harmful pathogens can flourish on these undigested food proteins and crowd out beneficial bacteria, resulting in an imbalance in our gut flora. This phenomenon is known as dysbiosis.

The common causes of damage are:

1. Dysbiosis or infectious agents – viral, bacterial, protozoan, fungus, yeast, etc
2. Non-steroid anti-inflammatory drugs (NSAIDs), prescription corticosteroids and other cytotoxic drugs
3. Frequent uses of antibiotics, that lead to overgrowth of abnormal flora
4. Over consumption of alcohol and caffeine (strong gut irritants)
5. Chemicals in processed foods (preservatives, dyes, additives, etc)
6. Diets high in refined carbohydrate, trans-fats (omega-6), processed sugar and processed salts
7. Chronic stress – physical, emotional and mental
8. Enzyme deficiencies (e.g. celiac disease, lactase deficiency causing lactose intolerance)
9. Prescription hormones such as birth control pills

How Does Leaky Gut Syndrome Play a Primary Role in Evolution of Disease State?

In RA, it is commonplace that the drugs used to relieve pain and inflammation can further damage the gut lining, even as quick as two weeks of consumption of those rheumatoid drugs. Leaky Gut, in turn, is related to aggravation of the arthritic condition.

At the moment, the precise role of Leaky Gut Syndrome in RA remains unclear, but it appears to be part of a vicious cycle that makes the condition worse from time to time. The relationship between food allergies or intolerance and leaky gut is complex and circular. The allergies or sensitivities may cause a transient increase in intestinal permeability and when this happens very frequently, it further increases the number of food allergies or intolerance, as well as its severity. To the extent that it may activate intestinal immune system’s production of chemicals known as cytokines that spread systematic inflammation, this signifies an important trigger for many RA-related symptoms such as depression, chronic fatigue, swelling, pain, etc.

Mal-absorption of important micro-nutrients also results from the inflammatory process, in which the presence of chemicals that block the absorption of vitamins, phyto-nutrients and essential amino acids. The metabolic demand of a normally rapid cell turnover (usually 3 to 6 days) must be met if healing of damaged gut lining is to occur; but when these are not met due to mal-absorption of nutrients, hyperpermeability will exacerbate.

In short, hyperpermeability initiates a vicious cycle in which allergic sensitization, immune activation, malnutrition and dysfunction occurs. If the signs and symptoms of Leaky Gut are ignored or unrecognized, it promotes continual damage to happen further and eventually, the overwhelmed immune system will start attacking other tissues and organs resulting in other forms of autoimmune diseases. If it attacks nerve tissues, people call it multiple sclerosis; attacks gut or intestine, it’s called Crohn or ulcerative colitis; attacks several organs, it’s called lupus; or if it affects the skins, they call it psoriasis. The list goes on.

Testing for Leaky Gut
Unless specifically investigated, the role of altered intestinal permeability in patients with Leaky Gut often goes unnoticed. While it is not necessary for clinical tests of proving the presence of Leaky Gut Syndrome in patients with RA (since predominantly, RA patients are almost always likely to suffer from Leaky Gut), there are safe, non-invasive and affordable lab tests for measuring the small intestinal permeability available in the market.

The two common lab tests are as follows:

1. Intestinal Permeability Assessment that can be ordered from Genova Diagnostics – This test analyzes urine for  the clearance of two non-metabolized sugars, Lactulose and Mannitol. The patient is required to consume a cocktail of 2 non-digestible sugars. In a healthy gut, Mannitol is easily absorbed while Lactulose is only slightly absorbed. It identifies presence of leaky gut and mal-absorption if Lactulose is easily absorbed.
2. Intestinal Barrier Function Test that can be ordered from BioHealth Diagnostics – This test analyzes saliva or blood serum sample for an assessment of the integrity of the gut’s mucosal barrier, antigen penetration, dysbiosis, leaky gut, mal-absorption, dietary protein sensitivity, intestinal permeability, etc. It also measures the immune antibody response to Candida,bacteria, and dietary proteins. The level of measured antibodies will be able to determine the stage of Leaky Gut Syndrome in the body.

Concluding Remark
If you can accept the notion that Leaky Gut Syndrome – enhanced gut permeability – is the precursor to autoimmune disorders that not only include RA, but other conditions such as MS, Lupus, Type I diabetes and autoimmune hypothyroidism; then you will by now be convinced that optimal health is not possible without healthy intestinal mucosal barrier function. Without interventions, the mucosal immune response will begin to weaken and eventually shut down.

Therefore, if you wish to reverse RA, you must also learn to address the causes of your Leaky Gut Syndrome at its sources and target treatments which usually require several components including avoidance of enterotoxic drugs, allergic foods, elimination of infections and bacteria overgrowth, nutritional dietary supplements and so forth. Each of these components will be discussed in details in the next few posts to follow. So, stay with me and be ready to conquer your Leaky Gut!