Leaky Gut, Increased Intestinal Permeability, & Lupus

Known colloquially as “leaky gut,” increased intestinal permeability may be a risk factor for autoimmune diseases, including lupus.

The lining of your intestines acts as a 4000 square foot barrier that walls the gut off from the bloodstream. It only lets small things pass through, like digested nutrients and water molecules. It is able to regulate this process because of a special cellular seal known as “tight junctions.” In a tight junction, the “outer layers of two adjacent cells fuse” together.

“Leaky gut” is what happens when these seals weaken. This is also known as intestinal permeability. The leaks are typically too small for bacteria to pass into the bloodstream. But, some substances can pass flow through the barrier including:

• partially-digested food
• toxins on their way to be excreted
• pieces of bacteria
• smaller microorganisms such as viruses (which feed on the bacteria)

Triggering the immune system

Typically, these substances don’t do damage on their own. But, the body detects them and sees them as signs of an invasion or infection. In response, it “defends itself.”

The immune system jumps into action, ramping up inflammation throughout the body. Inflammation is the body’s way of localizing and eliminating foreign invaders and removing any damaged tissue. However, in autoimmune diseases, the immune system misidentifies healthy cells as foreign invaders — making inflammation dangerous to the healthy tissues in the body.

A review in Frontiers of Immunology describes it well:

“In individuals with a genetic predisposition, a leaky gut may allow environmental factors to enter the body and trigger the initiation and development of autoimmune disease.” 

What causes leaky gut?

Diet, stress, infection, and many medications are linked to leaky gut. Unsurprisingly, all of these factors can change the microbiome in the gut. Changes to the microbiome can damage the gut lining, disrupt the tight junctions, and trigger inflammation.

The gut is full of bacteria, viruses, and other microorganisms which:

• prevent pathogens and unhealthy microbes from settling in the intestine
• release antimicrobial chemicals
• regulate the immune system
• help digest food

Changes to the flora of the intestinal tract

Alcohol, diets high in fiber and low in saturated fat, and stress all alter the microbiome. High-fat and high-additive diets change the microbiome in ways that encourage gut permeability and inflammation, according to studies. 

Research published in 2015 in Autoimmunity Reviews hypothesized that the increasing use of food additives may be responsible for the rise in autoimmune conditions. “Glucose, salt, emulsifiers, organic solvents, gluten, microbial transglutaminase, and nanoparticles are extensively and increasingly used by the food industry, claim the manufacturers, to improve the qualities of food. However, all of the aforementioned additives increase intestinal permeability by breaching the integrity of tight junction paracellular transfer.”

Additional studies have also explored the role of diet on intestinal permeability. A study published in the American Journal of Physiology saw the diet effect in action by giving young soldiers in Norway special rations during a military exercise. 73 people participated in the study. They received normal rations, protein-enhanced rations, or additional carbohydrate supplements during a 4-day cross country ski march. The soldiers volunteered stool (poop) samples before and after the exercise and their microbiomes were investigated. The soldiers were also checked for intestinal permeability via urine samples.

Diet, and the resulting gut microbiota, increased the intestinal permeability following the physiologically-stressful exercise. The researchers concluded that “targeting the intestinal microbiota could provide novel strategies for preserving IP during physiological stress.”

Additional risk factors

Well-known irritants such as aspirin and other non-steroidal-anti-inflammatory painkillers like ibuprofen can also damage the lining between cells. Always speak with your lupus treatment team about medication risk factors.

A long list of diseases can also lead to leaky gut, including:

• Inflammatory bowel disease
• Crohn’s disease 
• Celiac’s disease
• Chronic kidney disease
• HIV/AIDS
• Cystic fibrosis
• Type 1 diabetes
• Sepsis

Medical treatments such as chemotherapy, radiotherapy, immunosuppressants, and abdominal surgery can also cause microbiome and gut damage. Many Lupus Warriors are concurrently battling these diseases and/or undergo these procedures.

Additionally, age can also play a role as the microbiome naturally changes over time. 

Leaky gut on the internet

Leaky gut has a bad reputation from many sources and “leaky gut syndrome” has received push-back from clinicians. It has been used as a way to sell fad diets, herbal remedies, and alternative medicine. The unofficial name “leaky gut” also doesn’t help. Despite this discord, intestinal permeability continues to gain traction in the research.

A 2014 review entitled Intestinal permeability – a new target for disease prevention and therapy noted that “data are accumulating that emphasize the important role of the intestinal barrier and intestinal permeability for health and disease.”

Healing leaky gut

Dr. Alessio Fasano, the director of the Center for Celiac Research and Treatment at Massachusetts General Hospital, shared an interesting analogy on treating leaky gut. It’s like figuring out what is wrong with a broken car, he said. “You don’t know the exact problem until the mechanic lifts the hood, looks around, and tries different things.”

What things can you try? Diet is a great place to start.

• Avoid alcohol
• Decrease intake of processed foods
• Increase fiber intake
• Eat anti-inflammatory foods
  • berries
  • fatty fish
  • broccoli
  • avocados
  • turmeric
  • peppers
• Probiotics

An elimination diet can help identify foods that are personal triggers. You can more information on elimination diets and a full plan here.

Finally, work with your clinicians to identify the treatments that may be impacting your gut microbiome. There aren’t always alternatives, but it doesn’t hurt to ask! These conversations can improve the working dynamic between you and your treatment team.