Gluten & Intestinal Permeability

Gluten & Intestinal Permeability S1 Ep2

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Hi, and welcome to the Goode Health Podcast. I’m your host, Nicole Goode, a registered nutritional therapy practitioner and functional medicine practitioner. Join me as we explore thyroid, brain and fatigue conditions with positivity. From Hashimoto’s to multiple sclerosis, chronic fatigue to adrenal dysfunction.

 

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That’s GOODE, or visit my website  at nicolegoodehealth.com to find out more. 

 

Welcome to today’s episode. So we’re going to jump straight into talking about gluten because in more recent years, it’s become a bit of a hot topic. We’ve always known that people with coeliac need to eliminate gluten from the diet, but more and more people are becoming gluten-free.

 

And what I do see sometimes is that it’s becoming a bit of a trend and people don’t really understand why they’re becoming gluten-free or whether they actually need to be gluten-free. So let’s start by talking about what gluten actually is. So gluten is a mix of proteins that are naturally found in certain grains.

 

Predominantly we’re looking at wheat, barley, and rye. It is the thing that’s responsible for giving dough. Its elasticity and helping it rise during baking. And the gluten consists of two main proteins, so it consists of glutenin and gliadin, and we need to look at the differences between the two. So in terms of structure, glutenin is a complex protein that is composed of long interconnected chains with amino acids.

 

It’s the thing that provides the elasticity and the strength to the gluten structure. Glidden, on the other hand, is a smaller protein. It’s more water soluble, and it’s the thing that gives gluten it’s adhesive properties. The function of glutenin is that it contributes to the viscoelastic properties of the gluten, so it allows it to stretch, it allows it to trap the gases during the fermentation process in baking.

 

And it allows the dough to rise and provides that structure and that texture that we’re used to seeing in baked goods. So things like bread where we see that lovely open structure within the dough. However, when we look at the immunogenicity, so the, the immune response, what we’re primarily talking about there is gliadin, because gliadin is the.

 

Protein that triggers the immune responses in individuals with celiac disease or with non celiac gluten sensitivity. The reason for this is that Glidden contains specific amino acid sequences that can be recognized by the immune system in certain genetically susceptible individuals. So not in everybody.

 

But what it can do is it leads to an immune response, and that immune reaction can cause damage to the small intestine. The glutenin is not involved in the immune response, so it’s specifically the gliadin that we’re talking about when we’re talking about this, this immune reaction. So when we run antibody testing, which we do a lot in clinic, you may see gluten listed, you may see weak listed, you may see gliadin listed.

 

And that is why, it’s because that’s the, that is the protein that we’re actually talking about when we’re talking about these immune responses that can cause issues in certain individuals that we really want to eliminate. So in the context of gluten related disorders, gliadin is the thing that is primarily triggering this adverse reaction.

 

So what foods contain this gluten, because I see people who are gluten-free, who are actually still eating gluten and not realizing that they’re doing so. So the main products we’re looking at, we’re looking at wheat-based products. So we’re looking at things like bread, pasta, cous flour, cakes, cookies, all those lovely baked goods, pastries.

 

We’re looking at barley. So barley is a grain commonly used in your multi-product. So things like, , beer or vinegar. And then we’re looking at rye. So rye breads, rye based cereals, and some alcoholic beverages. So they’re the main three. But then we come across oats and I see a lot of people who have gone gluten-free and they are, some of them are eliminating oats and others are buying gluten-free.

 

But here’s the thing, oats themselves don’t actually contain gluten, so they are actually a naturally gluten-free food. So if you are avoiding gluten, oats are a brilliant food to include in the diet. But they are often processed in facilities that also handle wheat bar rice. So they’re made in factories that deal with other grains and that can lead to possible cross-contamination.

 

Now, if you are celiac, if you have celiac disease, That cross-contamination. So just being made in the same factory can actually be enough to trigger the immune reaction that we’re trying to avoid. So if you’re celiac, you actually need gluten-free oats, not because of the oats themselves, but because of that cross-contamination of the fact that they could have just been made in an environment where they are dealing with other gluten containing grains.

 

For other people though, oats are actually, you don’t need to buy a gluten-free variety. They’re, they’re actually just a naturally gluten-free food. Now, the other areas that we tend to forget about when we’re talking gluten-free are things like processed foods. A lot of processed foods have gluten in even food that you wouldn’t expect to necessarily have gluten, so they may not contain those sort of baked goods that we associate gluten with.

 

But more often than not, processed goods do contain gluten. Things like sources often contain gluten because of the flour and gravy for the same reason, and actually even some packaged soups, which we generally see as a health food. And we wouldn’t necessarily think have glutenin, some of them do. So if you are fully going gluten-free, you do need to be really careful about some of these other foods that can glu gluten.

 

So does everybody really need to avoid gluten to be healthy? So the short answer this is, you know, this is something that I get asked all the time, so, The short answer is no. It’s important to note that gluten is not actually inherently harmful to all people. However, some individuals who have, you know, gluten related disorders such as the celiac or non celiac gluten sensitivity, or maybe a wheat allergy, they need to avoid gluten containing foods.

 

The other area where gluten has become a hot topic, and this is where I’m working with it in clinic all the time, is in autoimmune diseases. And this is due to these links we’ve got with the immune system. So this immune response that we see from the Glidden. So if you fall into one of these categories, it’s likely that you’re gonna have been advised to avoid gluten.

 

So let’s just dig into a little bit into these conditions and what the differences are. So we start with celiac disease. So celiac disease is an autoimmune disorder. It’s triggered by the ingestion of gluten. In individuals who are genetically predisposed to this condition. So when individuals with celiac disease consume gluten containing foods, what happens is the immune system actually mistakenly recognizes the gluten as a threat, and then it launches an immune response.

 

And that’s that autoimmune process beginning. So this immune response leads to inflammation. It can damage the intestine. Specifically, it targets the V, which has small kind of finger-like projections responsible for absorbing nutrients in the gut. So the immune reaction in celiac disease is primarily directed against the glide gliding part of gluten.

 

So the immune system produces antibodies, particularly immunoglobulin A, so IGA antibodies, and also tissue transglutaminase antibodies. So sometimes you’ll see this as T T G, and these can be detected through blood tests. So we can actually test for celiac. The immune response and ongoing inflammation can result in various symptoms including gastrointestinal symptoms, so the ones you’d expect to see.

 

So things like, you know, diarrhea, bloating, abdominal pain. We can also get things like fatigue, weight loss, nutrient deficiencies, even skin rashes, and lots more. And this is where people often get confused because, The response to gluten, given that it’s, you know, it’s something that we eat, it’s something that we consume.

 

Everyone thinks it’s gonna result in gut symptoms, but it’s not necessarily the case. So for some people who are celiacs, they may solely get brain related symptoms, for example. So their symptoms could solely be really bad brain fog, and they may not actually get the gut symptoms at all. Others can get a mix of the gut and brain symptoms or other symptoms.

 

And this is to do with the gut-brain connection, which we can jump into at another time. But the important thing to note is that it’s not necessarily gut issues that we are looking for when we’re talking about gluten in the diet. So it might be, but it’s not necessarily, so the only solution for celiac disease is really strict adherence to a lifelong gluten-free diet.

 

There’s no other option with that. When gluten’s eliminated from the diet, the intestine can heal itself. Symptoms can be controlled, and it’s important. People with celiac disease carefully read all food labels. They really have to make sure that they avoid this cross-contamination. Don’t eat anything by mistake.

 

That could have gluten in where we wouldn’t expect to find it because a lot of the packaged foods and things like that are really guilty of that these days. They all have glutenin when even when it’s not really necessary. And then, you know, we’ve talked about the, the oats and that cross-contamination, and if you, if you have celiac or you think you might be celiac, it’s, it’s most likely that you will know.

 

If you are, then you really should seek guidance from practitioner who can help support you on that. So then we have this other condition called non celiac gluten sensitivity. Sometimes it’s also called non celiac wheat sensitivity. So, So this is a condition in which individuals experience symptoms similar to celiac disease when they eat the gluten containing foods, but actually they don’t get the characteristic intestinal damage and they don’t get that autoimmune response that we see in Celiac.

 

The exact sort of underlying mechanisms are not very well understood with this, but it’s, it’s believed to be involved with an immune response and possibly some other factors outside of the immune system. So people with non celiac gluten sensitivity can experience much the same symptoms, you know, the abdominal pain, the bloating, the fatigue, the brain fog, all of these sorts of things after consuming gluten.

 

But the immune response differs. And specific markers in the blood are therefore not present. So this is done more on your reaction that what we look at here is your reaction to gluten and whether you, whether you notice these symptoms when we eat gluten and we can use something called an elimination diet for that.

 

If you do have non-celiac gluten sensitivity, again, the solution is to be avoiding those gluten containing foods and that will help to alleviate those symptoms and improve your overall health. But then we do get some people who. Have an immune response to gluten who are not celiac, haven’t necessarily, you know, are not necessarily been told that they’ve got this non celiac gluten sensitivity, but they might have autoimmune disease, so they might have some form of dysfunction with the immune system.

 

And this is where the immune response to gluten comes into play. So the impact of gluten. It’s on the tight junctions in the gut, and it’s associated with increased intestinal permeability. So this is the thing that is commonly referred to these days, you know, in the media or on social media as leaky gut.

 

And it’s an area that is really undergoing a lot of scientific research at the moment. It is now recognized that gluten affects the gut barrier in certain individuals. So we know that that now happens. The exact mechanisms and the extent of that impact us. There’s still a lot of research going on around that area, but we know that gluten contains this protein called glidden, which triggers this immune response in certain individuals.

 

The research suggests that the glidden may interact with certain cells in the gut lining, such as enterocytes. And potentially disrupt these tight junctions that help to maintain the integrity of the intestinal barrier. So the tight junctions, we need them exactly as the names suggest. We need them to keep tight so that they don’t let through too much into the bloodstream.

 

So one proposed mechanism. Is that the glide and peptides can increase the production of a protein called zonulin and zonulin modulates the opening and closing of these tight junctions between the intestinal cells. So we do want these tight junctions to open up sometimes because we want them to allow nutrients through into the bloodstream.

 

But what we don’t want is we don’t want those larger molecules passing through. So excessive production of zonulin can actually lead to the loosening of these tight junctions. They actually open up more, and that potentially lets through more of these large molecules into the bloodstream and increases that intestinal per permeability.

 

Now it is important to note that not everyone experiences the same response to gluten, and that’s why it’s not necessarily the case that everybody needs to to exclude gluten from the diet. Individuals with celiac disease, non celiac sens, gluten sensitivity are believed to be particularly susceptible to these effects.

 

And the same goes for people with any form of immune dysfunction or autoimmune disease because this intestinal permeability activates the immune response. If you don’t have one of these disorders, then gluten may be very well tolerated within your diet, and it may not significantly impact the intestinal permeability.

 

However, the research on the topic is still evolving, and we do need more studies to fully kind of understand the relationship between the gluten, the tight junctions, and the intestinal permeability. But let’s look a little bit more at intestinal permeability and what it is. So in functional medicine, We refer to this as intestinal permeability, but as I said, it’s, it’s, it’s often referred to as leaky gut.

 

You know, in the, it’s become a very common term that a lot of people have heard of, and the, it’s a concept that the, it describes a condition where, The lining of the small intestine becomes more permeable than normal. So the intestinal lining acts as a barrier. It allows nutrients to be absorbed into the bloodstream that that’s what we want that to happen.

 

But it also prevents harmful substances from entering the bloodstream. So when the intestinal lining becomes compromised or it becomes damaged, it leads to this intestinal permeability allowing these larger molecules to get through. So if the zonulin is increasing the opening of these tight junctions and allowing the larger molecules through into the bloodstream, we find that things such as undigested food particles or toxins or bacteria can get through into the bloodstream.

 

And then what this does is it triggers an immune response and then it triggers inflammation in the body. So you can see how that’s potentially gonna lead to various health issues such as, you know, autoimmune diseases, digestive disorders, food sensitivities, allergies, even mental health conditions have been linked to this intestinal permeability process.

 

But let’s take a little look at the association between increased intestinal permeability and autoimmune diseases. So, The increased passage of these larger molecules through intestinal permeability into the bloodstream can trigger an immune response. So what we get then is it activates the immune system, which obviously we don’t want to do too much in someone who has an autoimmune disease.

 

We always want to keep the immune system balanced, so we don’t want an underactive immune system because you will get sick all the time, and we don’t want an overactive immune system because you can develop autoimmune diseases. So the presence of these larger molecules in the bloodstream that are not supposed to be there activates the immune system because the immune system has to.

 

Mop up, it has to clean up your system. So it recognizes that these molecules shouldn’t be there. It sees them as foreign invaders, and it is going to mount an immune response against whatever has got through. It then causes production of antibodies. So in response to this perceived threat that your immune system is now seen, the immune system will produce antibodies specific to the molecules that have then crossed that compromised intestinal barrier.

 

And the antibodies are then designed to bind to. And neutralize these foreign substances. So this is the right thing. Your immune system is doing exactly what it should do. It’s just that these molecules shouldn’t be there. They shouldn’t have got through the gut wall and into the bloodstream. So, So we’ve activated the immune system.

 

We’ve caused the production of these antibodies to help mop up your bloodstream. Then what happens is we get an inflammatory response. So again, this is a normal response from your immune system. It’s acting exactly as it should do. The immune system releases various info inflammatory mediators, such as cytokines to help eliminate this perceived threat that the immune system now thinks that you’ve got.

 

And these inflammatory mediators can cause localized inflammation in the gut as well as. Information throughout the body, and this can contribute to systemic inflammation that is so commonly found in autoimmune diseases. So what we get then is this immune system dysregulation. So this ongoing immune response.

 

So you can imagine, you know, if you are eating gluten, if you’ve got somebody who’s eaten gluten, maybe. Every day or every other day, and it’s constantly opening up this gut wall and letting through through into the bloodstream that shouldn’t be there. Your immune system is gonna be switched on all the time trying to mop this up.

 

So this causes this immune system dysregulation, this ongoing immune response, which can lead to this chronic inflammation that is going on all the time within the body. So the dysregulation further perpetuates this inflammation and potentially contributes to the development or exacerbation of autoimmune disease.

 

And then finally we get that tissue damage and the systemic effects. So in some cases, the immune response. Triggered by this intestinal perme. Tea can lead to maybe tissue damage of the gut lining or tissue damage elsewhere in the body, and the chronic inflammation and immune dysregulation. It can also ha, it can have this systemic effect, so it can actually affect various organs and systems in the body.

 

So a flare up of autoimmune disease that you already have, or the triggering of a new autoimmune disease can actually occur. But of course, you’ve gotta have everything at play. So this is why it doesn’t affect everybody. Because you’ve got to have all the genetics at play. You’ve gotta have everything else.

 

In place to develop an autoimmune disease. It’s never as simple as just one thing. So different autoimmune diseases will have, you know, they’ve got varying degrees of association with intestinal permeability. And research is still ongoing into all of these areas and working out exactly how big an association different autoimmune diseases have got.

 

But there’s definitely a link between intestinal permeability, an increased immune function, which causes this increased inflammation, which can lead to the flaring up or development of autoimmune diseases. So, So we know that gluten contributes to this intestinal permeability, but there’s more than just that to consider when we’re looking at this.

 

Poor diet is one of the big things that we know impacts this intestinal permeability. So a diet that’s high in processed foods, in sugar, in unhealthy fats. If your diet’s low in fiber, Anything that can disrupt the gut microbiome. So if your gut microbiome balance is out, and that is something we regularly test in clinic, all of these things can contribute to intestinal permeability within the diet, chronic stress.

 

So any prolonged stress is also something that can impact the integrity of the intestinal lining. So stress has impacts all around the body far more than what we see, and it can also help with this compromising of the barrier function. And then we have any imbalances in the gut. Microbiota can also.

 

Impact the integrity of the intestinal lining. So if we’ve got a disruption in the balance of beneficial bacteria, or we’ve got some harmful bacteria in the gut that we don’t really want there, all of this can also impact the integrity of the intestinal lining. And then we have certain medications. So some medications such as, , anti-inflammatory drugs, antibiotics, some of these things can also impact the gut lining and in and increase this permeability.

 

So it is associated with gluten, but it’s not necessarily just a gluten problem. There are other things that you could be doing that could be causing this intestinal permeability. So the approach to managing intestinal permeability focuses on, you know, we need to identify and address these underlying causes.

 

And that’s what we do in functional medicine. So here we may look at improving your diet. We may look at managing stress. We might optimize your gut health. We might support the healing of the intestinal lining. And these are all things we can, we can test for. So we can run functional tests to see.

 

Whether we think intestinal permeability is a problem for you, whether these things are going on, we can measure your gut health. We can look at the balance of your microbiome. So all of these things we can do and assess and find the root causes, that’s the key to really dealing with these things. So now you know what intestinal permeability is and how it can impact people and people with certain conditions.

 

But let’s look at some ways that you can support healing of intestinal permeability. So if this is something that you think is a problem for you, then you are gonna wanna try removing that gluten from the diet as well as any other potential triggers. So remember, it’s not just gluten in the diet that we’re looking at.

 

There are other things as well. So you’re gonna want to eliminate those gluten containing foods. You might want to also look at sugar foods. You might wanna increase the fiber in the diet. You might want to look at healthy fats in the diet. And that really then all comes down to following an anti-inflammatory diet.

 

So you want to focus on consuming whole unprocessed foods that are nutrient dense and anti-inflammatory. So typically, you know, we’re talking lots of vegetables, fruits, lean proteins, healthy fats, lots of fiber rich foods. So you really want to address your diet. You also need to address nutrient deficiencies.

 

So if you’ve got nutrient deficiencies, it can actually hinder the gut healing. So you can be doing all the things you need to do to heal the gut, but if you have got nutrient deficiencies, you’re actually gonna struggle to get there. So we need to find these deficiencies and that’s something that I work on a lot in clinic with people.

 

And then we need to address the nutrient deficiencies through appropriate diet changes, or in some cases supplementation. Something else you can do. You can support your digestion and you can optimize your gut health. So you might wanna promote healthy digestion by chewing food thoroughly. You might wanna practice mindful eating, and with a practitioner, you can also look at things like supporting the production of stomach acid or digestive enzymes.

 

You might wanna consider incorporating lots of gut supporting foods, so things like fermented foods, like sauerkraut and kimchi, or bone broths and prebiotic rich foods. And then we need to move beyond diet. So we need to look at things like managing your stress. So chronic stress can negatively impact gut health and it can contribute to intestinal permeability.

 

So you might wanna engage in these stress management techniques. You might wanna look at. Mindfulness meditation, deep breathing exercises, or any activities that promote relaxation in you. So anything you find fun to do on the weekends, what do you enjoy doing? Make sure you’re getting plenty of relaxation in there.

 

1. You’re also gonna wanna make sure that you get good quality sleep. So we need to prioritize A, getting sufficient sleep, and B, getting good quality sleep. So sleep plays a really crucial role in supporting overall immune health, and that includes gut healing. So we can implement sleep routines, we can implement morning routines.

 

We need to make sure that we’re creating the right environment for you to sleep in. So we want it dark, we want it quite cool around 17 degrees. And we want to find any deficiencies as well. So nutrient deficiencies can actually impact your sleep and where necessarily we can use supplemental support to help you get a really good night’s sleep.

 

Cause that’s gonna really support that immune system. So. We can also then support gut barrier repair specifically. So there’s certain supplements, so things like glutamine and zinc and quercetin. All of these things can support gut barrier repair and help to reduce that intestinal permeability. However, I would recommend that if you’re gonna look at these supplements, you work with a practitioner as there can be, you know, interactions with other drugs or other supplements or even health conditions who shouldn’t take these particular  supplements.

 

Just because they’re deemed natural, it doesn’t necessarily mean they’re right for you. And this is a mistake quite a lot of people make. They sort of think, you know, supplements because we can go and buy them all over the, over the counter in,  you know, a health food store and because. They are a natural thing as opposed to a medication.

 

People think it’s fine to just take them and there won’t be any adverse effects, but it’s not necessarily true. So you can have side effects to supplements, you can have interactions. So it’s really important that you make sure that you get the right advice when you’re talking about supplements.

 

Something else we can do to support that intestinal permeability is that we can look at the reducing the exposure to toxins, so we can minimize our exposure to environmental toxins and harmful substances because these further contribute to that gut inflammation. So this might involve using things like natural cleaning products.

 

We might move to a more natural personal care products. We might drink filtered water. And we might reduce our exposure to pesticides and chemicals. So these are all things that we can do to help support that gut lining. And then we really need to address gut dysbiosis. So if you’ve got an imbalance of gut bacteria, which is dysbiosis, it can contribute to the intestinal permeability.

 

And a comprehensive stool test can be run to actually assess the health of your gut and to assess the balance of your microbiome. Eating a diverse and varied diet is gonna really help here. So you can do things like aiming for two of each color food a day, so you know all the different colors. Think reds, yellows, greens, blues, whites, oranges, all the different colors of foods.

 

Eat two different ones, two of each different color a day. And then you can buy new foods that you haven’t eaten in a while. So if you, if there’s something you’ve not had for a while, you should make sure that, you know, every time you go to the supermarket, you’re just throwing a couple of those foods that you’ve not eaten in your basket each week.

 

Or you might just switch up the variety of foods. So for example, you might buy purple broccoli instead of green broccoli. You might buy red onion instead of a white onion. So just keep mixing things up. Diversity and variety in your diet are so important, particularly when we’re talking about the health of the gut.

 

You might also want to consider probiotic rich foods for helping with dysbiosis. Or a high quality probiotic supplement as well is something else that can help to support that microbiome. And lastly, you can seek professional guidance. So if you do think that intestinal permeability is something that is having an impact on you, or if you think you’re having reactions when you eat gluten, It really is advisable to work with a healthcare professional, such as a functional medicine practitioner or a registered nutritional therapist who can provide you with personalized guidance and help support and address and heal that intestinal permeability.

 

So remember, healing intestinal permeability. It takes time. It’s not something that’s gonna happen overnight, and everybody’s individual responses may vary. So people react very differently to the things that we can do to help heal the gut. Also remember that none of what we’ve discussed here today should be taken as medical advice, and it’s really important to approach these actions as part of a comprehensive and personalized plan.

 

It’s really important to get to the root causes and the underlying imbalances of what’s going on for you as an individual, and then we can build these personalized plans based on your specific needs and under the guidance of a qualified practitioner. So as you can see, intestinal permeability and it’s linked to gluten is complex and there’s a lot to it.

 

And it doesn’t necessarily mean that every single person needs to avoid gluten, but if this is something that you think is a concern for you and you think that you could be, you know, you could be having a reaction to the gluten or you could be having an immune response to the gluten. It really is important that you get the right advice.

 

It really is important that you start to heal that gut because what we don’t want is any flareups or any development of autoimmune diseases based on this intestinal permeability. So I hope that that has helped you to understand gluten intestinal permeability. Who needs to avoid it, and if you do need to avoid it, how to do so.

 

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