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

Holiday Cinnamon Rolls {gluten + dairy-free + vegan}

At the beginning of advent, William and I had an after-dinner discussion on holiday traditions and the ones that are most important to each of us. One of mine is baking and making gifts of the season to share. My grandma’s Apple Cake, my great grandmother’s Cinnamon Roll Cookies, the stereotypical fruitcake and mince tarts packed with dried fruit and spices that seemingly only me and my dad like. And cinnamon rolls, a new tradition in the past few years. For me, baking during the holidays is more about the joy it brings to others than really wanting or needing to eat all the foods myself. I grew up in an active, ranching family whose busy season happens to be in the winter (“spring” calving usually starts around Christmas, and regardless, animals always need fed first), so some sweet treats after being outside for hours in the cold and dark are always welcome.

After being mostly removed from that lifestyle for more than a decade, I still love to bake and send treats in the mail when I’m not visiting my parents. That’ll be the case this year. And of course, I still bake for myself and William as well. What I’ve found over the years is that most of us have a disjointed relationship to the treats that often come with the holiday season. They bring nostalgic feelings of happy memories, fill the house with comforting scents, and generally taste amazing. And then comes the guilt. We really shouldn’t. It’ll mess with our ‘diet’ or our ‘active lifestyle’ or our ‘new improved body’ we’ve worked so hard for. Or, the high sugar and inflammatory ingredients will hamper our healing process. I’ve been there on all accounts: the guilt, the feeling of needing to control my body, and in recent years, the awareness of hampering my healing.

But the other thing that severely hampers healing is stress. And stressing about every morsel that enters our mouth severely interferes with healing – of any type. We’re going to delve more into intuitive eating and what that really means (intuition versus cravings) here in the coming weeks, but first, let’s pause for the holiday season. Make, bake, and enjoy your favorite treats if you’d like, be mindful about what you really want and enjoy them with all your senses. Continue to chew your food. And generally let go of the guilt.

And if your body is in some stage of healing and you still would enjoy Cinnamon Rolls, these ones are just a bit more nourishing than most, yet still leave room for being slightly decadent, celebratory and delicious.

Happy solstice, yule, Christmas, and holiday season. I hope you enjoy in whatever way you can, and above all, remember to take care of you.

Holiday Cinnamon Rolls {gluten-free + vegan}, makes 4
A few notes on method and ingredients:
– The trick to really good GF bread and pastry is a binder and the best one(s) are a combination of ground chia or flax and psyllium seed husks. Both can usually be found in natural food stores or ordered from herbal companies online.
I’ve only made these with my gluten-free flour mix so any store bought mixes will have different textures/results. Measure flour by weight if you’re substituting. For the frosting, the hemp seeds are optional but provide a little flavor contrast. Just add in the same amount of additional cashews if you’d rather. I’ve tried all types of sugar in these, both in the filling and in the frosting. While I’ve given options, the first one listed is my favorite and first recommendation.
– These can be prepped ahead of time. Prepare them in the evening, and then place the rolls in their pan in the fridge during the rise time overnight. In the morning, let them warm up on the counter while pre-heating the oven. The baking time will likely need to be longer.

Wet Ingredients:
6.5 oz. / 185 ml / 13 Tbs. non-dairy milk
1 1/8 tsp. dry active yeast
1 Tbs. ground chia seeds 
1 Tbs. psyllium seed husk
2 Tbsp. coconut oil, melted
½ Tbsp. apple cider vinegar (or lemon juice)

Dry ingredients:
170 g / 6 oz. / 1 ½ cups gluten-free all-purpose blend
¾ tsp. baking powder
¼ tsp. baking soda
¼ tsp. sea salt
¼ tsp. cardamom, optional

Holiday Spice Filling:
6 Tbs. brown sugar or coconut sugar
¼ tsp. each cinnamon, nutmeg, ginger, and allspice OR 1 tsp. cinnamon
pinch of sea salt
1 Tbsp. coconut oil, melted

Frosting:
¼ cup cashews, soaked
2 Tbs. hemp seeds
2 Tbs. non-dairy milk
1 Tbs. brown rice syrup, honey, or maple syrup
1 tsp. coconut oil
¼ tsp. vanilla extract
a pinch of salt

  1. Warm up the non-dairy milk until lukewarm or at 100 degrees F / 38 degrees C. Whisk in the yeast and allow to froth up for 10 minutes. Add the chia seeds, psyllium, oil and vinegar. Whisk together and set aside so it can thicken a little.
  2. In a large bowl, stir together the dry ingredients. Dump the wet ingredients into the middle of the flour mix and stir with a wooden spoon. Your dough will begin to look scrappy. When this happens, set aside the wooden spoon and start kneading the dough in the bowl with your hands. Knead it lightly until it gets manageable and somewhat smooth.
  3. Roll out the dough on your counter or large cutting board that’s lightly floured. The dough should be easy to roll and not too sticky. Roll it into a large rectangle, a little more than  ¼ inch /3 mm. Combine the spice and sugar filling in a small bowl and spread it out evenly on top of the dough.
  4. Tightly roll the dough up from the short side so you have 4 1 ½-2-inch rolls. Line a small 6-inch or similar cake pan with parchment paper, and then place the rolls inside, cut-side up. Cover lightly with a tea towel, and allow to rise for 1 hour in a warm, non-drafty space in your kitchen. These should rise enough to be touching each other in the pan now. They will not double in size.
  5. Preheat the oven to 375 degrees F. Bake for 15-25 minutes or until the edges have firmed up. (Check after 15 minutes but my oven usually needs the full 25). Place the pan on a wire rack to briefly cool down.
  6. While the rolls are cooling slightly, blend together the frosting in a high-speed blender, and then pour and smooth over the cinnamon rolls. Add a light dusting of cinnamon on top if you’d like.
  7. These taste best when eaten warm and straight out of the oven but can be stored (covered) for about three days.

Butternut Buckwheat Porridge from Living Ayurveda

About a year ago near the solstice, I wrote the words grounded/focused on a bookmark. The back was painted with a small cross-section of watercolor tulips from a local artist; her cast-offs she’d cut into cards for an intention setting gathering. Grounded and focused were my intentions for how I wanted to feel by the end of this year. Little did we know then what 2020 would entail, but what I did know was that I struggle with being mentally cluttered and scattered, sometimes switching topics mid-sentence in conversation, and often letting my thoughts and ideas run away from me and having nothing to show for it minutes (and sometimes hours) later. I also knew that the internal atmosphere of being grounded and focused wasn’t so much an end goal for months away, but a daily, and sometimes minute by minute practice.

It’s safe to say I have succeeded and failed in my intention, multiple times a day.

But I’ve also been able to add a lot of tools and practices for how to gain a less scattered mind and actions over the years. One of which is continually learning from Ayurveda.

Ayurveda is the indigenous health system of India, and arguably the oldest health system (or one of the oldest) in the world. While I didn’t learn Ayurveda outright in nutrition graduate school, mine was a program that married traditional systems of health with the latest nutritional and medical sciences, and thus incorporating components of Ayurveda in my nutrition classes and clinic was widely accepted – and especially in my herbal classes. In the meantime, as if I didn’t need to study more, I was studying it on the side and incorporating increasingly more aspects of Ayurveda in my own life, helping to get closer to healing many of my GI and autoimmune struggles.

The cluttered and scattered mind is a common feature of imbalanced vata in the body, and like many people in our modern lifestyles, I struggle with this imbalance, a lot. As well as many other high-vata tendencies. Vata is one of the three energies or forces which can be observed in all things, and which are ideally in balance. Pitta and Kapha are the other two energies. Eating foods that support high vata or perhaps foods that support one of the other two doshas that make up our body and mind, is a primary way we can return our ailments to balance, but it’s certainly not the only practice.

So many years ago that I don’t remember, but around the time I first learned of Ayurveda, I discovered Claire’s blog with simple delicious Ayurvedic recipes. Claire has recently released her gorgeous book, Living Ayurveda, which is full of the kind of guidance that helps us achieve a little more balance in our lives. It encourages us to make the connection between time of year and patterns that afflict us (but don’t have to), incorporating building and lightening ingredients in the right ratios in our meals, and recipes that can be adapted depending on the season and our individual doshas or imbalances. Likewise, there are yoga sequences for each season too.

Some of the recipes that I’ve already tried and truly will make again and again include:
Pumpkin Empanadas with Cashew Crema
Shakti Chai
Simple Stewed Apples
and this Butternut Buckwheat Porridge

So many more are on my list – actually all of them really:
Warm Cinnamon Date Shake
Creamy Miso Tahini Dal
Delicata, Wild Rice & Pomegranate Salad
Kitchari Burgers
Fall Harvest Muffins
and most definitely the Yogi Bowl, a variation on something I could eat daily.

Butternut Buckwheat Porridge from Living Ayurveda, serves 2-4
To be completely transparent in portion sizes, I make this recipe as a half batch for one meal. That is a perfect amount for me, as a very active person, to go several hours between breakfast and the midday meal with excellent energy and ‘fuel’. Claire’s suggestions include adding an extra spoonful of ghee for vata support on very dry and cold days, reducing the cinnamon slightly for high pitta (cinnamon in large amounts is quite heating so good for some with high vata and kapha, but less so for others), and taking out the oats and doubling the buckwheat for high kapha. For a completely vegan and/or dairy-free version, I suggest using untoasted sesame oil, especially for vata/kapha, or coconut oil instead.

3 cups water
1/2 cup (untoasted) buckwheat groats or short-grain brown rice
1/2 cup steel-cut oats
1 cup peeled butternut squash, cut into 1-inch cubes
1/4 cup raisins
1 tsp. ghee
1 tsp. ground cinnamon
1/4 tsp. salt
milk of choice and maple syrup, for serving (optional)

  • In a medium pot, combine all ingredients and bring to a boil on high heat. Cover with a lid, reduce heat to medium, and simmer for 30 minutes, until butternut squash is tender and the grains are fully cooked. You might need to stir once or twice during that time. Toward the end, add a splash of water if needed.
  • If using a pressure cooker, reduce the water to 2 1/2 cups and follow instructions for pressure-cooking porridge. Once done, remove from heat and serve hot with a splash of milk of choice and a drizzle of maple syrup on top. I found the milk and syrup is a preference, and I enjoy this without either.