“ALL DISEASE BEGINS IN THE GUT.” Hippocrates
Now that you have a better idea of how functional medicine practitioners analyze a patient’s blood work, I want to talk to you about one of the main areas of concern that we have regarding all of our patient’s health, and this of course has to deal with the health of the gastrointestinal tract, or GI tract for short.
Our GI tract is responsible for the following:
- transporting and digesting the food we eat,
- absorbing nutrients from this food and
- expelling the rest as waste.
The primary organs involved in this process are the stomach, small intestine and large intestine.
Under normal circumstances, when food is eaten, our digestive system releases enzymes to break down the food into smaller particles so that they can be absorbed through what is called the intestinal wall. And it is the integrity of this intestinal wall that is a functional medicine practitioner’s primary concern.
The intestinal wall consists of several layers and the one we are really interested in is the most superficial one that comes in contact with the digesting food, and that is the mucosal layer. The mucosal layer is made up of cells that are packed very close together and because of this the spaces between the cells are called tight junctions.
Under normal circumstances, the tight junctions do basically two things:
- they only allow small digesting food particles to pass through this mucosal layer so that they can get into the underlying vascular tissue for the healthy absorption where nutrients can then be used to meet the body’s demands, and
- these tight junctions also serve as a barrier, or a filter, to prevent any large undigested food particles, bacteria, larger proteins and pathogens from passing through them that aren’t essential for nutrient utilization.
Intestinal Permeability…Leaky Gut
Naturally, it is under unhealthy or abnormal circumstances where things start to change for the worse. When our bodies are continually subjected to a poor diet that consists of fast foods, refined sugars, and partially hydrogenated fats, or chronic viruses (hepatitis, Epstein-barr/mono, cytomegalovirus, parvo virus B19 (5th Disease), adenovirus, etc), parasites as well as stress, the integrity of these intestinal tight junctions becomes compromised and the mucosal layer becomes permeable to larger undigested food particles, proteins and pathogens.
This intestinal permeability is what is known as a leaky gut and no one is really immune to developing some level of it. In fact, it is not uncommon for patients to suffer from a leaky gut for several years before even realizing that is what they have.
Sometimes the early symptoms of intestinal permeability (a leaky gut) are digestion related such as:
- gas,
- bloating,
- constipation,
- diarrhea and
- heartburn.
But other times, early symptoms can occur in seemingly unrelated regions of the body farther away, such as:
- in the brain where your mental focus, mood and cognition are affected,
- in the joints where swelling, stiffness and pain occur,
- in the heart where irregular heartbeats or high blood pressure results and
- the skin where eczema and acne develops.
Patients may even experience blood sugar problems, as well as symptoms associated with their thyroid gland such as cold hands and feet, chronic fatigue, loss of outer 1/3 of their eyebrows, weight gain and irritability.
This is because once the intestinal mucosa starts letting in larger food particles or pathogens that are not beneficial to the body, they become immune triggers because there is no intestinal immune tolerance for these substances.
The immune system (Gut Associated Lymphoid Tissue, or G.A.L.T.) located within the intestinal wall then reacts by attacking these foreign invaders (which it is supposed to do) leading to a wide variety of clinical presentations, some of which we just mentioned.
Now the longer the gastrointestinal wall is under attack due to poor diet, medications, chronic viruses, stress and others, the worse the permeability becomes, creating a vicious cycle.
The end result is something known as an auto immune condition, which is basically the loss of self-tolerance, or the inability for the immune system to recognize self-tissue from these foreign or pathogenic organisms, leading to attack upon oneself.
When this happens this self-promoting vicious cycle becomes difficult to unwind unless aggressive dietary and nutritional strategies are employed.
Why Do I Still Have Symptoms When My Lab Tests Are Normal?
Patient’s with early stages of intestinal permeability oftentimes go undiagnosed, misdiagnosed and/or mismanaged because as you have just learned, their blood test results are likely being analyzed using the lab’s pathological ranges and not the functional health ranges, and so they appear normal.
It is not uncommon for these patients to be placed on anti-anxiety medication or to even be told it’s all in their head.
Laboratory Testing is Key Toward Identifying Intestinal Permeability
Fortunately, you may find it comforting to know that there are labs tests that can be ordered to assess your risk for developing intestinal permeability when analyzed with functional blood ranges, not pathological ranges.
The comprehensive blood chemistry panel that we order in our office consists of more than 65 biomarkers and we always take a close look at the following ones to check for early signs of intestinal permeability:
- White Blood Cells (Lymphocytes)
- Total Proteins and Globulin
- Ferritin
- Transferrin
- CRP
- HDL
- Albumin
- 25 Hydroxyvitamin D
- TSH
- Platelets
- Glucose
- HgA1c
Plus, there are even more specific immune tests that we can order through Cyrex Labs to help us identify the damaging route through the intestinal barrier and measure the degree of permeability itself.
As we mentioned earlier, no one is immune from developing some level of intestinal permeability as there are many ways one can acquire it. Therefore, in the next three sections (Part 5 Unstable Blood Sugar, Part 6 Poor Digestion and Part 7 Adrenal Glands and Stress), we are going to explore the three most common mechanisms that lead to this condition as well as talk about the types of symptoms one can experience long before intestinal permeability even develops.
You might be surprised to see some of the very same symptoms you have been suffering with listed there. Perhaps you might even begin to realize where the true underlying cause of your problems are originating from.