Leaky Gut and Intestinal Hyperpermeability are sooooo different!

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“Leaky Gut Syndrome” is a diagnosis coined by alternative medicinepractitioners in the 1970s.  The syndromewas especially considered in the context of a branch of alternative medicineknown as “environmental medicine”.  Thisfield developed from the 1950s and espoused the theory that many modern chronicdiseases were due to a plethora of toxins in the environment and environmentalallergies¹.   
Leaky Gut was and is said to be caused by damage to the gut lining whichallows abnormal absorption of bacteria, toxins and gut proteins, and leads todevelopment of a very large number of chronic medical conditions.  Diseases that are said to be initiated or worsenedby a Leaky gut include environmental and food allergies, arthritis of severaltypes, eczema, chronic fatigue syndrome, inflammatory bowel disease, pancreaticdisease, migraines, autism, celiac disease and gluten intolerance, andfibromyalgia.
The gut is viewed as one important gateway for toxins and allergensfrom the environment, and constant exposure to these irritants were thought tocause gut pathology, leading to a vicious cycle of gut damage à absorption of toxins, bacteria and abnormally large intraluminalproteins directly into portal and systemic circulation à immune activation and immune-mediated diseases à àdeterioration of gut barrier,  and so on, over and over again.
The pathogenesis of leaky gut is said to include:
·        Altered GI microflora (due to repeatedantibiotic therapy as well as many other drugs and a poor diet).  The intestinal microflora have many criticalfunctions, including detoxifying some xenobiotics, maintaining an intraluminalenvironmental that discourages growth of pathogenic bacterial, maintaining thegut’s tight junctions and barrier function, and dialoguing with the immunetissues of the gut.·        Overgrowth of the yeast, Candida albicans.·        Food allergies (which if not a primary problem,becomes an associated illness once gut permeability is altered)·        Damaged gut mucosal cells become unable todigest food normally, or to detoxify environmental xenobiotics·        Drugs that cause direct damage to the gutmucosa, such as NSAIDs and steroids, hastened the development of ahyperpermeable gut.
Treatment involve any of the following: ·        Changing dietary components to reduceallergenicity·        Supplementing enzymes to improve digestibilityof the food.·        Supplementing probiotics·        Correcting possible nutrient deficiencies with avariety of vitamins and minerals·        Treating yeast overgrowth·        Addressing the quality of fat in the diet toemphasize less inflammatory fatty acids·        Improving gut cell production and turnover withl-glutamine
Just as environmental medicine doctors had reported, many veterinariansusing these methods noted dramatic results when pets were treated using thesame principles. The problem is that “leaky gut” was never documented as acause for these immune mediated diseases, and changes in the gut were not monitoredas patients got better (although these tests are available). 
While the role of leaky gut in such a wide array of chronic diseases isstill considered unproven and under the purview of alternative medicine, “intestinal hyperpermeability” was becoming increasingly recognized by criticalcare specialists in the 1980s as a primary initiator of multiple organdysfunction syndrome and death in critically ill humans ².   And the final results are the same – invasioninto the bloodstream by gut microbes and activation of the immune system – but inthe case of critically ill patients, the course of the problem was more rapidand easier to recognize.
A 1998 review of “intestinal hyperpermeability” -  the approved name for the more acute conditionrecognized by conventional medicine – reviewed the mechanisms behinddevelopment of the condition.  They are:·        Oxidative stress·        Hypoxia·        Tissue acidosis·        Nitric oxide – an cell-signallying molecule thatinfluences circulation, and has been shown to have deleterious effects ifpresent in the gut in abnormally high OR low concentrations.’·        Inflammatory cytokines – which are produced onexposure to luminal antigens and bacteria, which can happen any time thebarrier is breached.·        “Metabolic Inhibition”  - a laboratory condition that causes chemicalchanges in the tight junctions so critical for maintaining the intestinalbarrier. 
When I look at this list, I see mechanisms that are active in chronicdisease as well.  Let’s look at what Iwould consider a typical veterinary patient who is a candidate for managementof a hyperpermeable gut.
This theoretical dog is an 11 year old Labrador with chronicosteoarthritis and a long history of allergic otitis and bad skin.  The dog has eaten the same diet for manyyears, and eats well.  A nonsteroidalanti-inflammatory drug has been administered daily for the past year or so.  And this dog is presented to me foracupuncture to aid in pain control for the arthritis. 
For the past 15 or so years, I’ve handled dogs like this one bydelaying the acupuncture, and recommending the following:1. Change the ingredients in the diet (making it essentially lessallergenic), and make sure that it contains antioxidants in the form ofvegetables and fruits.  If the dog won’teat veggies and fruits, supplement a broad spectrum antioxidant containingVitamins A, E, C, selenium, flavonoids, carotenoids, etc.  2. Supplementing digestive enzymes (not just because of leaky gut,because there are those who believe that old dogs have decreased digestivefunction, especially in the stomach, just as geriatric people with atrophicgastritis do).3. Possibly a probiotic supplement.4. High doses of fish oil5. Massage.
It’s amusing how many people attribute the improvement I see on aregular basis to the massage, because it’s just so hard to believe that dietarychanges can be so effective in pain control!
I’m simply reporting my clinical experience, and I’m not saying this isright for every old arthritic pet.  But Isee that conventional medicine and alternative medicine may be discovering aconvergence in one very important anatomical area and organ function.  The gut is the largest immune organ in thebody.  It contains more neurons than thespinal cord.  It maintains a verydelicate balance between the outside environment and the critical homeostasisinside the body.  And both conventionaland alternative medicine are postulating similar mechanisms for the role of thegut in all disease.  I hope this progresscontinues. 

¹Rogers SA, 1997. Environmental Medicine for Veterinary Practitioners in Complementary and Alternative Veterinary Medicine: Principlesand Practice, Schoen A and Wynn S, Eds. Mosby, St. Louis.
²Fink MP.  Effect ofcritical illness on microbial translocation and gastrointestinal mucosapermeability.  Semin Respir Infect. 1994Dec;9(4):256-60.
³ Unno N, Fink M. Intestinal Epithelial Hyperpermeability. Gastroenterology Clinics of North America 1998; 27(2):289-307).