What is Leaky Gut and What Does it Have to Do with Your GI Symptoms, Athletic Performance and Long-Term Food Intolerances?

Just after an incredibly warm, humid and ROUGH marathon in which my gastrointestinal system barely held on to the end, and then subsequently fell completely apart at the finish line. In a prelude to what’s below, I was also stressed out for weeks before that race.

Leaky Gut, also called increased intestinal permeability or gut permeability is when the tight junctions, which are the space between each of the cells that line the small intestine where nutrient absorption occurs, loosen a little and allow larger food particles and bacterial fragments into the bloodstream, potentially setting off an immune response and inflammatory reactions (1).  

If you have a digestive disorder or gut health problems, it’s generally safe to assume you have a leaky gut. Likewise, leaky gut symptoms can present in a wide variety of ways across multiple body systems – not just in the digestive system.  

Leaky Gut is associated with Irritable Bowel Disease (IBD), Crohn’s Disease (CD), multiple sclerosis (MS), rheutamoid arthritis (RA), type 1 diabetes (T1D), asthma, necrotizing enterocolitis, and autism spectrum disorder (2), as well as celiac disease, non-celiac gluten sensitivity, various skin disorders (if your skin has problems–then you have digestive problems), and more (3). However, we haven’t yet determined whether leaky gut is a cause or consequence of these disorders.

The Athlete Component

What is not as well known to a lot of the run long and run harder crowd is that sustained endurance activities, particularly the jostling and pounding that we do as runners, can and will cause a fair bit of leaky gut symptoms. If you consider the anatomy and physiology of this region of the digestive system, it’s easier to see why. Picture a person running a three (or four, or nine) hour marathon or ultra endurance race, or a series of training runs day after day and throughout weeks and months. The race and many of the runs leading up to the race is going to be a hard and a long effort (sometimes both), which we also will sometimes begin without feeling as recovered from the last effort as we’d prefer. Then, while running, we down any number of foods and food-like substances to provide fuel to sustain the effort and to “train the gut.” This fueling on the go is something the digestive and nervous systems are arguably not designed for. We’re “supposed to” be in rest and digest mode while we’re processing those calories. So utilizing them on the go is a stress to the system.

Then there’s the gut itself. At the small intestine, the cells between it and the bloodstream are approximately one cell thick. This is because this is the site where broken down nutrients move through to be transported to the liver and other regions of the body for use. It’s super thin so nutrients can get where they’re supposed to go. But one cell, and the space between it and the next one, is pretty easy to damage with jostling and stress. So even with a perfect diet, a hard long run (or even a hard shorter run) can cause some damage down there. This is why many people have digestive complaints for three to five days after a race or hard effort. That’s exactly how long it takes for the epithelial lining to turnover into completely new cells!

But what makes leaky gut become chronic, thus inviting long-term digestive (or widespread) symptoms?

There are several lifestyle factors that can also lead to and sustain a leaky gut including stress (a BIG one!), lack of sleep, eating inflammatory foods, alcohol, antibiotics, oral contraceptives, prescription medications, exposure to environmental toxins, and frequent use of NSAIDS such as ibuprofen. Likewise, nutrient deficiencies, poor digestion due to digestive enzyme deficiency, overeating in general, wrong ratio of dietary fats, gut microbe dysbiosis and (sometimes hidden) other food allergies can also contribute. Oofda! That’s a lot of factors that can be working against us.

That Villain Gluten and the Bacterial Connection

Dr. Alessio Fasano, a leading scientist who studies celiac disease and related pathologies, discovered an enterotoxin called zonulin a few years ago. Zonulin disassembles the tight junctions in the intestinal lining, allowing pathogens through and thus causing more intestinal permeability. Dr. Fasano’s research team found that zonulin release is primarily triggered by both bacteria and gliadin. Gliadin is part of the gluten protein complex (2.) Hence the reason many of us are either mildly or definitively reactive to gluten-containing foods, at least some of the time.

Before developing increased intestinal permeability, changes in the gut microbiota have also been shown to occur, which, given that zonulin release is often triggered by bacteria, suggests that the bacterial change occurs first, and then zonulin release assists the epithelial tight junctions to disassemble, leading the way for subsequent disorders or diseases to develop after sustained leaky gut-inflammatory reactions. It has been suggested that an environmental stimulus, (that list above including stress, gluten, a virus, inflammatory diet, etc.) first causes the change in the gut microbiota (2).

How to Heal

Healing chronic leaky gut often takes a many-pronged approach. We have to remove as many of the things that are causing it as it’s appropriate to. For those of us who aren’t willing to give up endurance athlete lifestyles, that means eating a diet appropriate for the individual, repletion of nutrient deficiencies, and lifestyle tactics (that stress relief component!) become particularly important.

Want to Know More?

A leaky gut is one of the primary categories of digestive imbalances I look for when working with individuals clinically with digestion-related and sometimes widespread symptoms. Often when we’re experiencing chronic GI distress, fatigue, and malabsorption of foods and nutrients, there will be imbalances in several categories, and we begin working on the areas that appear most pertinent. I shared more about this topic in the nervous system’s role in part 1, the immune response and subsequent inflammation in part two, gut microbes and dysbiosis in part three and the importance of chewing our food in part four.

And If you’re tired of dealing with your wonky GI symptoms and fatigue, and would like to get back to feeling and training well, I invite you to reach out to me for more personalized support.

References:
1). Lipski, E. (2012). Digestive Wellness (4th ed). McGraw Hill: New York, NY.
2). Sturgeon, C. and Fasano, A. (2016). Zonulin, a regulator of epithelial and endothelial barrier functions, and its involvement in chronic inflammatory diseases. Tissue Barriers, 4(4). https://doi.org/10.1080/21688370.2016.1251384.
3) Kneessi, R. (2017). NUTR 635: Adverse Reactions to Food. [Lecture]. Maryland University of Integrative Health. Retrieved from: https://learn.muih.edu

What exactly is intuitive eating? Cravings vs. intuition

This is the time of year when it’s common to think about ways to improve our health. And if you are one of the majority that has a long and unsavory history with your relationship to food and/or your body, you just might be thinking more about intuitive eating this year. Or perhaps you assume you’re already eating intuitively by eating what you want when you want to.

For many of us with a history of rigid food beliefs, chronic dieting, or disordered eating behaviors, that step of tuning into and actually honoring our hunger, cravings, and food desires is a BIG start — and leads to less feast and famine mentality, peace around food and less guilt in indulging once in a while. It also can mean finally stepping away from the chronic calorie and macro tracking which tend to fuel the rigid behaviors, and dare I say it, throwing out your scale or having your partner/roommate hide it far away where you just might forget about it for a while – I mean several months, or longer.

One thing I noticed as I became less of a disordered eater and more of an athlete focused on feeling good in my body and recovering from workouts, is that I naturally began honoring my hunger more and focusing less on what my body looked like or what I thought I should be eating. It’s like I opened the fridge, took a look around, and then closed it, thinking nope none of this, a peanut butter sandwich sounds good right nowas well as a couple big handfuls (completely unmeasured and probably ate more than that) of tortilla chips.

And truthfully, I ate two pieces of pie every day for nearly a week around Thanksgiving this year on top of my “normal eating” meals and semi-reduced athletic activity, and I didn’t think about my weight or the scale or calorie tracking once. I also haven’t thought about pie at all in the weeks since then. But is that intuitive eating?

As a nutritionist, I always want the best for every person I work with, and quite honestly, everyone else too. And I always fall back on individualized support. Because for many people that have a long history of not tuning in to their body and hunger signals, the eat what I want when I want it, and maybe that means two slices of pie a day approach is okay with me. It’s a start. But it’s probably more appropriate to call it the honoring your cravings and letting go of guilt and diet-culture beliefs about food approach, rather than truly eating intuitively. I’ll put my pie-eating habits at Thanksgiving into this category.

What is Intuitive Eating?

I think the best way to share what intuitive eating is is to go back to just basic intuition. We often talk about intuition when we say we have a gut feeling, or “we just know something” and logically, it may not always make a ton of sense. We make these gut-feeling decisions when we choose a job that pushes us out of our comfort zone, or we make a big move, or choose a medical procedure (or opt not to), when it’s not the most logical thing to do.

But how do we “just know” that a food is right for us or is what we need? One of the best ways to begin to learn this is to pay attention to how you feel afterwards. Intuitive eating can best be described as paying attention to and honoring what your body is telling you it wants and needs, rather than what your mind wants or craves.

Signs that Your Body Didn’t Approve the Meal

When you’re done eating and in the three to five hours after, how do feel? How is your energy? Did you get really tired, or alternatively, super stimulated? Did you start to get some of those not-so-optimal digestive symptoms, like bloating, gas, pain, gurgling, reflux, heartburn, nausea, feeling just plain heavy and lethargic, etc.? Were you running to the bathroom or didn’t have a bowel movement today (also known as constipation)? How was your mood? Were you wired, anxious, scattered, fearful or angry, frustrated, short-tempered and snappy? All of those are influenced by what we’re eating and how we’re eating and whether we’re digesting and assimilating foods and nutrients optimally.

If what sounds good is a giant bowl of popcorn for a snack or dessert every day, and then we’re mentally scattered, gassy, constipated, and anxious afterward or the next day, then maybe our craving for popcorn is being influenced by our imbalance, rather than our intuition.

Another example is a desire for particularly salty or spicy foods with lots of onion and garlic. If those are more of what the mind is craving versus what the body is truly desiring, then we might be particularly short-tempered, easily frustrated, have acne or skin rashes, heartburn or nausea, and have loose stools or diarrhea.

One more example goes back to my pie, and in previous life phases, daily ice cream routine. Frequently eating heavy, cold foods often tends to make us feel heavy, lethargic, have sluggish or incomplete bowel movements, feel depressed or have a low mood, promote inflammation, and develop a lot of extra mucus in our sinuses and elsewhere. Many years ago now, I ate ice cream basically daily, and during a certain period, multiple times a day. During the multiple times per day phase, it probably began as my closest interpretation of my intuition–because I was way too light and undernourished, and my brain just simply needed kcals. But after some time, my weight had definitely stabilized and swung back in the direction of my heaviest, and I began to be extremely anxious all the time, craved more sugar (of course), and finally had a major candida outbreak. Candida is a yeast that feeds on sugar! My cravings were coming from the not-so-beneficial organisms in my GI tract – not my intuition.

So it can be a little difficult to graduate to true intuitive eating once we’ve mastered honoring our hunger and shoving off the influences of dieting culture, and are no longer just following cravings and feel like ice cream every day, popcorn and peanut butter on repeat, or grazing all day instead of three solid meals.

Why is all of this even more important? Much of what I write about here is in the realm of digestive health – and/or eating appropriately to fuel our athletic lifestyles. And when I work with individuals, I often encourage them to honor their intuition. But sometimes we need a little more help in deciphering, are we eating enough despite what we think is intuitive eating?, Is that food that I’m craving helping or harming my return to balanced digestion?, Is my daily pie or ice cream habit giving me the calories I need, but encouraging future imbalanced health down the road, and/or already showing signs of imbalance? And admittedly, the more symptoms of imbalanced health that we have (such as some of the above), the more challenging it becomes to self-determine cravings that fuel the imbalance versus eating intuitively that returns us to true, optimal health.

A good way to start to tune in is to keep a little journal of how you felt in the hours after meals for a few days, and see if you have more of the sub-optimal symptoms and moods than you were aware of before. And if you suspect you’re more in the realm of honoring cravings right now and want support in starting to eat more intuitively, feel free to reach out and chat with me in a nutrition consult.

An especially important, and often overlooked, key to better digestion

One of my mentors recently shared a phrase that’s stuck with me, and really helped in my day to day. She shared in an almost offhand way, Rushing is ego. It feeds self-importance. As someone that tends to perpetually feel rushed and scattered and multi-tasks far more than I should, her statement was like a gentle but stern hand on my shoulder. And a reminder that rushing never makes me feel better in any way.

One of the main areas I tend to rush, multi-task and be scattered is when eating. Alone and left to my own devices, I tend to rarely eat without distraction. And when William and I enjoy meals in the evenings together, catching up on our days and eating while talking (quickly) is more the norm. A couple years ago, recognizing a pattern in myself, I started an experiment of several days of eating with no distraction. What I realized from that experiment was that I’ve tended to avoid being alone with my thoughts at meals because it brought awareness to things I didn’t want to feel. A few months later, I reinstated the distraction free eating practice, having lunch every day outside on the patio without technology or (my weakness), things to read. Instead I simply enjoyed my meals, listened to the summer bugs and watched the hummingbird’s daily visit to the pink zinnia. It was lovely and stress-reducing. And a few weeks into that new habit, I noticed my digestion had really improved, and that I’d begun to feel a lot better in my autoimmune pain and other symptoms. And quite noticeably, I was running and recovering really well during that time.

Summer ended and the practice gradually fell away. I went back to distracted eating and well, I’d notice my digestion was off, stress ran higher, and I didn’t tend to enjoy my meals much because I wasn’t paying attention to actually eating them!

Today, I’ve got a short but incredibly substantial tip if you’re struggling with poor digestion, GI pain (whether it’s general or after a tough workout), bloating, excess gas, etc. And it also helps A LOT if you tend to be generally mentally scattered or anxious. It’s one that you don’t have to spend a ton of money on – actually it’s free! It doesn’t take special skills or preparation. And the process of eating your meals and the hours afterward (those poor digestion side effects), will be much more enjoyable.

Are you ready?

For the next few days, try really chewing your food.

And by that I mean, chewing every bite until it’s broken down into a mush. This means you might chew 20-35 times per bite. Yes, really.

That’s going to be tolerated better than it used to…

Before food ever gets to our stomach or small intestine where stomach acids and digestive enzymes contribute to the chemical process of digestion and then nutrient absorption, digestion actually begins in the brain (just thinking about and then smelling food) and in the mouth. Digestive juices, saliva, enzymes, and digestive hormones are released and begin flowing in anticipation of a meal. Then saliva contains enzymes that further initiate digestion. Likewise, mechanical breakdown of food with our teeth is incredibly important so the enzymes, gastric acids, and hormones can then take over further along in the process.

Some people like to count the number of chews per bite, so go ahead if this helps you to establish the practice. Focus on chewing every mouthful until it is liquid.

The father of modern medicine, Hippocrates, is often quoted as saying that all disease begins in the gut. Interestingly and unsurprisingly, most traditional (and much older) medical systems around the world believe the same. For all I know, some wise sage (or perhaps just my wise mentor) also came up with that phrase about rushing and feeding ego’s self-importance. Especially now in mid-December leading up to the holidays — especially now when Covid-rates are increasing stress (again), help your digestion out a little, and actually enjoy your food, by chewing it a little more.

Impaired digestion and subsequent absorption of food is one of the primary categories of digestive imbalances I look for when working with individuals clinically with impaired digestion. Often when we’re experiencing chronic GI distress, fatigue, or anxiety, there will be imbalances in several categories, and we begin working on the areas that appear most pertinent. I shared about the nervous system’s role in part 1 of this topic, the immune response and subsequent inflammation in part two, gut microbes and dysbiosis in part three and I’ll explain remaining categories in future articles.

And If you’re tired of dealing with your wonky GI and would like to get back to feeling and training well, I invite you to reach out to me for more personalized support.