© 2003 by Todd Caldecott, Cl.H., AHG, www.wrc.net/phyto/home.htm
There is an increasing amount of evidence that damage to the intestinal wall plays a role in autoimmune diseases like multiple sclerosis, ankylosing spondylitis, Behcet's syndrome, type one diabetes and rheumatoid arthritis (1,2,3,4,5,6). In some cases these patients will experience problems with digestion, and even if they do not experience overt gastrointestinal disease, when the tissues of the digestive tract are examined by techniques such as colonoscopy they will often display indications of chronic inflammation. Researchers have also noted that in many cases the remission of the autoimmune condition occurs in tandem with the remission of digestive inflammation, and vice versa. These clinical findings lend support to a theory called intestinal permeability syndrome and its role in the pathogenesis of autoimmune disorders.
The theory of intestinal permeability is that some agent or combination of agents initiates an inflammatory response in the digestive tract. Persistent inflammation eventually disrupts the integrity of the mucosal lining of the gut, and tiny perforations allow for molecules larger than usual to pass across this barrier, including molecules from dietary protein and fats, bacteria, parasites and fungi. In response to this infiltration, an immune response is initiated and the body begins to manufacture specific antibodies to these antigens. Unfortunately, human tissues have antigenic sites almost identical to those substances that pass across the permeable intestinal wall. These antibodies then circulate throughout the body to look for more antigens. When an antigen is found, such as a tissue that has similar markers to an exogenous antigen, the antibody initiates an immune response and the tissue begins to be destroyed. This process is called immunological cross tolerance, and is well described in the medical literature. If this process continues unchecked the result is the formation of an autoimmune disease, in which the immune system attacks the host. Factors that directly or indirectly promote intestinal irritation and inflammation include antibiotics, alcohol, caffeine, parasites, pathogenic bacteria, peroxidized fats, some food preservatives and food additives, enzyme deficiencies (e.g. celiac disease, lactose intolerance), NSAIDs, corticosteroids, refined carbohydrates, oral contraceptives and mycotoxins (fungal toxins found in stored grains and dried fruit).
Chronic gut inflammation damages the protective coating of IgA, the antibody that functions to maintain the integrity of the mucous membranes. As a result, the inhibition of a localized immune response allows for a decline of non-specific resistance, and an increased risk of viral, bacterial, fungal and parasite infection. The toxins that are produced by these microorganisms can inhibit liver function, and promote a heightened sensitivity to antigenic triggers such as cigarette smoke and strong perfumes.
Chronic gut inflammation also damages the absorptive capacity of the epithelium, and thus plays an important role in nutrient deficiency. Antibody-mediated destruction of transport proteins will also inhibit the absorption of these nutrients. Thus, conditions such as osteoporosis and fibromyalgia that often display a deficiency of certain minerals such as zinc, calcium and magnesium, can be reasonably linked with increased intestinal permeability. Beyond the impaired absorption of minerals, deficiencies of vitamins, amino acids and essential fatty acids can lead the development of many conditions, and such generalized complaints as fatigue, irritability, poor concentration and headaches.
Achlorhydria (absence of stomach acid) and hypochlorhydria (deficiency of stomach acid) are increasingly recognized as a factor in leaky gut syndrome and autoimmune disorders, as well as many nutrient deficiencies such as Vitamin B12. As we age, the parietal cells in the stomach that secrete hydrochloric acid (HCl) begin to atrophy, and the levels of HCl decline. HCl is absolutely necessary for the activation of an enzyme called intrinsic factor, which then assists in the absorption of vitamin B12, necessary for proper nervous function and the formation of red blood cells. Other common nutrient deficiencies in hypochlorhydria include protein deficiencies, as well as mineral deficiencies such as chromium, copper, iron, magnesium, manganese, molybdenum, selenium and zinc. Apart from aging, the causes of low stomach acid include hereditary factors, chronic stress, and most commonly, the use of antacids and antiulcer medications such as cimetidine and ranitidine. Low stomach acid is difficult to diagnose, and many different techniques exist that can provide some indication. Hypochlorhydria can be inferred by the presence of pernicious anemia, poor gastric motility and poor digestion, seen in the iris as a darkish area around the pupil of the eye, as well as from stool samples in which animal proteins will be poorly digested.
Another factor in the equation is the presence of beneficial bacteria such as Lactobacillus acidophilus and Bifidobacterium bifidum. Research has shown that these friendly bacteria enhance the capacity of the immune cells in the gastrointestinal tract to defend against foreign pathogens. These immune cells maintain an important link to other cells in the immune system, and appear to have a modulating role in immune function. Clinical research has shown that the oral supplementation of friendly bacteria enhances the phagocytic activity of the immune system, and provides sustained immunological protection, both within and without the gastrointestinal tract. Additionally, these bacterium compete with other pathogenic organisms such as Candida albicans and the diarrhea-causing Clostridium difficile.
The key to resolving leaky gut syndrome rests in avoiding the factors which produce the inury, decreasing inflammation, correcting the bowel ecology and eliminating pathogenic organisms, using herbs and supplements to heal the gut wall, and using herbs and beneficial bacteria to promote normal digestion. For more information on treatment strategies used in herbal medicine please check out the autoimmune page.
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