January 23, 2014

Digestion for (not-so) Dummies: Healing a Leaky Gut

We’re in the home stretch, everyone, I promise! Just a couple more posts and we’ll be done with digestion. If you’re new here and want to catch up, you can find the previous posts in this series on digestion here. We’ll finish up our whirlwind tour of the small intestine today, and then all that’s left is the cool, classy colon, also known as the large intestine.

We’ve talked a lot about the small intestine so far: how it works, and all the awful things that can happen when it’s not working properly. So now that we’ve covered compromised intestinal permeability (i.e., a leaky gut), let’s cover some ways to help repair it. ‘Cuz let’s face it: it’s all well and good when your GI tract is functioning well and everything’s going smoothly from top to bottom, but antacids, probiotics, and laxatives wouldn’t be nearly the zillion-dollar moneymaker$ they are if untold numbers of people weren’t experiencing some kind of digestive distress.

The most widely recognized strategy for healing a leaky gut is the “4-R” protocol:

Re-inoculate or Repopulate

The first 3 “R” steps can be done more or less concurrently, although you might want to wait a couple of weeks for the third one. The fourth one definitely needs to be done last.

If wheat is so good for us, 
ya gotta wonder why healing 
diets always have us not eat it.
Remove: This is just what it sounds like. You remove all the things from your diet that might be contributing to or worsening your leaky gut. It’s your basic “elimination diet,” which typically means at least 30 days of NOT consuming the following: gluten, corn, dairy, legumes (beans—soy, in particular, but sometimes all beans), nuts, alcohol, refined sugar, and some protocols call for ditching eggs as well. Many elimination diets remove all grains, not just the gluten grains (so things like buckwheat, millet, amaranth, etc., would also be off limits), but at a bare minimum, gluten’s gotta go. Not negotiable. (If you have a known autoimmune condition, your best bet is to remove nightshades as well. This includes white potatoes, tomatoes, eggplant, all peppers [bell peppers, hot chilies, etc.], and even the seasonings made from peppers, like paprika and chili powder.)

It’s pretty interesting that a diet designed to heal a damaged intestinal lining excludes so many foods normally promoted as good for us, isn’t it? Just sayin’. I'm not implying that grains, beans, and dairy are universally damaging for everyone across the board. I don't believe they are. It's just worth noting that these things can be difficult for many people to digest, so maybe our government nutrition authorities should stop recommending multiple servings of them, daily, for everyone. [/end mini-rant]

Since other factors besides diet can induce a leaky gut, it’s important to try to eliminate those, too. Unfortunately, some of those other things, like stress, are unavoidable. There are also several pharmaceutical drugs (including many that are OTC, like aspirin) that mess with the gut lining. Diet will have the biggest impact, but to whatever extent possible, the “remove” portion of the 4-R protocol should include eliminating or at least minimizing these other players. We can’t eliminate stress altogether, but we can manage it better. And if you have a condition that requires intestine-damaging medication, maybe you can cut your dose down—after consulting with your doctor, of course. And then there’s always the possibility that the condition you’re taking the drugs for in the first place will abate as a result of the elimination protocol. Sweet!

Repair: If we think of the “remove” step as akin to the medical Hippocratic Oath (“First do no harm”), then we can think of the repair step as, “Second, do some good.” That is, now that we’ve taken all the potentially damaging things out of our diet, we need to start putting beneficial things in. This category includes foods and supplements designed to cool the inflammation in the gut and give the body the nutrients it needs to transform the intestinal lining back from being a barren tile floor into the furry, fuzzy shag carpet it’s supposed to be.

You can do a search to find gut-healing elements, but here are just a few: L-glutamine (an amino acid that serves as the enterocytes’ favorite fuel source); marshmallow (the plant, not the stuff you put in s’mores); slippery elm; deglycyrrhizinated licorice (DGL—a fancy way for saying licorice that’s had the compound removed that can be responsible for elevating blood pressure in some people); hydrochloric acid (HCl) supplements (because, remember, if you don’t have enough stomach acid, the small intestine doesn’t stand a chance); and digestive enzymes (to give the small intestine a little break from having to produce all of them on its own). Some of the herbs and supplements come in pill form, some can be taken as teas. 

Of course, we always love healing via real food, and the one major superfood when it comes to healing the gut is bone broth. (I’ll dedicate a whole post to bone broth sometime, but in a nutshell, the reason broth—or, really, stock—is so nourishing to the gut lining is because of the gelatin I talked about here. Note: among culinary nerds like me, “broth” usually refers to liquid simmered with meat/flesh, while “stock” implies the use of bones as well as meat. For this reason, a traditionally simmered stock is usually more nutrient-packed than a broth. [Higher mineral content and usually more gelatin, depending on the types of bones used.]) Two other gut superfoods are coconut oil and garlic (raw garlic is best, if you can handle it). They’re antimicrobial, antifungal, and antiviral, and sometimes small intestinal ailments are the result of bacterial overgrowth or viral infection.

A good stockpot: the gut’s best friend!

Re-inoculate or Repopulate: The “inoculate” or "populate" part of this means inoculate with beneficial bacteria—that is, probiotics (and prebiotics). Since we’re talking about an elimination diet here, it’s probably best if the probiotics don’t come from cultured dairy products like yogurt or kefir. You can use supplements, or better yet, make your own homemade fermented vegetables! Yes! Homemade sauerkraut, kimchi, fermented beets—all good! (You can buy these prepared from the store, but if you go this route, make sure you buy them refrigerated and that the labels indicate the contents are live. Sauerkraut in a can will do nothing to heal your gut. And you really ought to make your own anyway. It’s dirt cheap and fairly easy, whereas the jarred stuff from your health food $tore will co$t you big time. If you happen to live in the DC area, I give lessons!)

Another thing that can help with this third “R” is prebiotics. These are things that serve as food for the probiotics. You might have seen things like inulin and chicory root (or chicory root fiber) on food labels. These are well-known to help maintain a good balance of intestinal flora (the beneficial bacteria). Other things that can feed our good bacteria are starchy carbohydrate plants that have their final digestion in the large intestine, where they serve as food for the bacteria in the colon. (These foods include roots and tubers such as white potatoes, sweet potatoes, yams, parsnips, and yucca.)

Note: This re-inoculate step is crucial if you’ve taken a few rounds of antibiotics. I cannot stress this enough. Antibiotics are a biggie when it comes to inducing a leaky gut. After all, they don’t just kill the bad bugs inside us; they kill the good guys, too. A total carpet bomb (which is an awesome analogy, considering I keep calling the small intestine a shag carpet.) And the way to make sure we repopulate our lower GI tract with the good guys is to load up on probiotic foods (and/or supplements).

Reintroduce: This is the last of the Rs, and the one that will be the most informative for you going forward. Now that you’ve gone at least a month (or longer, if you so desire) without the foods that were the most likely culprits contributing to your leaky gut, and now that you’ve provided that gut with healing nutrients and repopulated the beneficial bacteria that live happily inside your colon, it’s time to re-introduce some of those foods and see what happens. See, with all the effort you put into repairing your gut, said gut should now be in tip-top shape, and any food you react to can be assumed to be a genuine problem for you, rather than simply the result of a leaky gut. So this reintroduction phase is a good way to identify which foods you really should stay away from, and which ones your body does just fine with.

Proceed slowly when you reintroduce.

The key is to introduce the questionable foods one at a time. In other words, if you’ve been on your elimination diet for 30 days, don’t wake up on day 31 and have egg and cheese on a croissant with a soy latte for breakfast. If you feel crappy later on, you won't know whether its because of the wheat, the dairy, or the soy. It’s not even really enough to introduce things one day at a time. Sometimes reactions to food can be delayed a while, so it’s best to wait at least 2-3 days between reintroducing different foods. 
Question: How long does it take to heal a leaky gut?
Answer: It varies. Some people’s bodies are more resilient than others’, and some people’s digestive function has been more severely compromised than others’. So the bad news is, I can’t say exactly how long it would take to heal your gut. (That is, if you suspect it's leaky and want to try this.) But the good news is, most likely you’ll notice an improvement pretty darn quickly--a matter of days, for some people. (Not that you’ll be healed that quickly, but you’ll at least know things are moving in the right direction.)

Why does it happen so fast? Most cells in our body get old, wear out, die, and get replaced by new cells. Some take years to do this, some take months, and some take only days. The cells that line the GI tract—particularly the small intestine—have a very rapid turnover rate. Usually about 3 days. That means that once you remove the foods that might be damaging the intestine, new, healthy, undamaged cells will take their place in just a few days. And when you have healthy, undamaged cells lining your intestine, some of the symptoms you were experiencing as a result of leaky gut start improving, and some might even go away altogether. (After all, that’s really the whole point of this, isn’t it? To not have those symptoms at all.)

For a bit of gee-whiz info, the rapid turnover of the cells in our digestive tract is one of the reasons why people undergoing chemotherapy have so much GI distress. Chemo targets rapidly dividing cells—but just like antibiotics that kill the good bugs along with the bad, chemo doesn’t discriminate between bad rapidly dividing cells (the cancerous ones) and good rapidly dividing cells (like hair follicles and the cells that line the GI tract). With the digestive system under constant attack from chemo, it’s no surprise that patients undergoing that treatment often lose their appetite and/or feel nauseated.

O-KAY! That’s it! We’re finally done with the small intestine! Next up: The large intestine. Large, and in charge! (No, really, it is in charge! Find out why next time.)

Remember: Amy Berger, M.S., NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition.


  1. Question, please!

    "Kathy from Maine" here. I've read about the 4 Rs before, and I'm always confused with the "repair" part. In the second paragraph under that section, you start by saying, "You can do a search to find gut-healing elements, but here are just a few," and then list a bunch.

    Do I pick one and done, or a couple of them, or all of them? If one is good, are four better? I'd love a little guidance, perhaps a sample protocol, like "Take __ mg of ___ in the morning," OR, "Take __ mg of ___, ___mg of ____, and ___ mg of ____ every single day for 30 days."

    I know it's all individual, but I don't even know where to start, and my primary doc is no help as he doesn't believe in such things. I multi-vitamin is about as far as he would go before prescribing something from Big Pharma. Doesn't believe in supplements at all.

  2. Hey Kathy,
    To be honest with you, this isn't my area of expertise. (I know...then why did I write about it? Maybe just trying to be thorough with the digestion series.) You don't need a ton of supplements. The most important thing is that you remove the "offending" foods/substances. That's the big step in terms of cooling the inflammation and calming things down. I think the glutamine is important...maybe 500-1000mg 2-3x/day, between meals. I also like gelatin...you can make homemade gummies using powdered gelatin.
    (Or you could add the gelatin powder to a hot beverage and sip it that way.)