Most people reading this probably have heard of a leaky gut. But many people don’t truly understand what causes a leaky gut, how to determine if they have it, and how to heal their gut. Many people just assume they have a leaky gut, and then will attempt to repair their gut by drinking bone broth and/or taking gut repair supplements. In the past I have written numerous articles and blog posts on leaky gut syndrome, but since a leaky gut is something that impacts those with Graves’ disease and Hashimoto’s I’ve decided to put together an updated blog post that focuses on five things you should know about a leaky gut.
1. According to the triad of autoimmunity, everyone with Graves’ disease and Hashimoto’s has a leaky gut. The triad of autoimmunity involves a genetic predisposition, an environmental trigger, and an increase in intestinal permeability, which is also known as a leaky gut. It’s common to work with an autoimmune thyroid patient who wonders if they have a leaky gut, although according to this theory, EVERYONE with any type of autoimmune condition has a leaky gut, at least initially. In other words, according to this theory a leaky gut is one of the three factors necessary for autoimmunity to develop, but this doesn’t mean that a leaky gut can’t be healed. In fact, in order to reverse the autoimmune component it is necessary to find and remove the environmental trigger and heal the gut.
2. Gluten causes a leaky gut in everyone. Speaking of environmental triggers, recent evidence shows that gluten causes a leaky gut in everyone. This is a very good argument for everyone with Graves’ disease and Hashimoto’s to avoid gluten while restoring their health, and to also try to your best to avoid it after you have achieved a state of remission. I was diagnosed with Graves’ disease in the fall of 2008, and I achieved a state of remission in 2009. And while I avoid gluten most of the time, I can’t say that I’ve been 100% gluten free since restoring my health. So if gluten causes a leaky gut in everyone, why haven’t I relapsed?
There are a few potential reasons for this. First of all, I do minimize my exposure to gluten. Second, I’m pretty sure that I don’t have Celiac disease or a non-gluten sensitivity. So while gluten causes a leaky gut in everyone, in my case it wasn’t the direct trigger of my Graves’ disease condition. A third reason is luck, as if I were to overindulge in foods with gluten for a prolonged period of time, and at the same time I was exposed to a certain environmental trigger, then there is a very good chance I would relapse. So every time I’m exposed to gluten I’m playing with fire. And to be honest, there is a risk even with a single exposure to gluten. So in no way am I encouraging anyone to consume gluten after getting into remission.
By the way, I think another reason why I haven’t relapsed is because I do a lot of other things to maintain a healthy state. Even though I’m not perfect with the diet, I eat well most of the time. And just like most people, I deal with a lot of stressors, but I’m confident that I do a good job of dealing with them, as I block out time for stress management each day, and I also make sure to get sufficient sleep each night. In addition, I’m always doing things to reduce my toxic load, including doing a 21-day liver detox a few times per year, as well as infrared sauna therapy a few days per week. Don’t get me wrong, as there is always room for improvement, but it’s also important to understand that perfection isn’t necessary to maintain a state of wellness after achieving a state of remission. If this were the case then everyone would eventually relapse.
3. Leaky gut testing is available. Some people aren’t aware that there is testing available to find out if you have a leaky gut. One option is the lactulose-mannitol test, which is a urine test that requires someone to swallow a sugary solution of lactulose-mannitol. Lactulose is a larger molecule, and therefore it’s poorly absorbed in someone who has a healthy gut. As a result, if someone who does this test has high levels of lactulose in the urine then this usually indicates that they have an increase in intestinal permeability.
Cyrex Labs also has a leaky gut test. The name of the test is the Intestinal Antigenic Permeability Screen, also known as their Array #2. This tests for a few different antigens associated with a leaky gut, including actomyosin, occludin/zonulin, and lipopolysaccharides.
I used to recommend leaky gut testing frequently, most commonly the Array #2 from Cyrex Labs. And there are times when I still recommend this test to my patients, but in most cases I assume that the person has a leaky gut. And there are a few reasons why I take this approach. First of all, according to the triad of autoimmunity, everyone with Graves’ disease and Hashimoto’s has a leaky gut. Second, when I used to recommend the Array #2 more frequently I found that most people did test positive. And when someone tested negative I would wonder if the results were accurate since everyone with an autoimmune condition has a leaky gut, at least according to the triad of autoimmunity I mentioned earlier.
Of course there is always the possibility that someone initially had a leaky gut but then took the necessary steps to heal it. So for example, in some people gluten is the sole leaky gut trigger, and if someone has eliminated gluten from their diet, yet hasn’t found and removed the “direct” autoimmune trigger, then conceivably this can cause someone to have a normal leaky gut test, even in the presence of positive autoantibodies. Stated differently, it’s possible to remove the “leaky gut” trigger and heal the gut, yet still have elevated thyroid antibodies if the “direct” environmental trigger hasn’t been removed.
4. A leaky gut can lead to multiple food sensitivities. I’m not a big fan of food sensitivity testing, but there are times when I have had patients order a food sensitivity panel. And it’s common for those who have a leaky gut to have many different food sensitivities. The good news is that healing the gut usually will help to resolve most, if not all of the food sensitivities.
5. In order to heal your gut you need to follow the 5-R protocol. The five components of the 5-R protocol include 1) remove, 2) replace, 3) reinoculate, 4) repair, and 5) rebalance. It is imperative to remove the leaky gut trigger, and while this may sound like common sense, I commonly see people focusing on replacing, reinoculating, and repairing before they find and remove the factor that caused the leaky gut. Admittedly it can be challenging at times to find the leaky gut trigger, and while you can incorporate the different “Rs” of the protocol simultaneously, you won’t heal a leaky gut if you don’t remove the factor that is causing it.
So how can you find the leaky gut trigger? I talk about this in great detail in my book Hashimoto’s Triggers, and the same process of finding and removing triggers also applies to those with Graves’ disease. While many times testing is necessary to find your leaky gut trigger, this isn’t always the case. For example, if gluten is someone’s sole leaky gut trigger, then simply eliminating gluten can allow someone’s gut to heal. If taking a course of antibiotics were the leaky gut trigger, then of course you removed the trigger as soon as you stopped taking the antibiotics.
Sometimes it’s not so simple, and testing may be necessary to find your leaky gut trigger. And even if testing isn’t necessary to detect your “leaky gut trigger”, it very well might be necessary to find your “direct trigger”. If this is confusing to you then I’d recommend reading my blog post on the triad of autoimmunity [1]. It’s also important to keep in mind that someone can have multiple leaky gut triggers. So for example, if someone is eating gluten and has a gut infection, both of these can cause a leaky gut, and thus both of these “leaky gut triggers” would need to be removed in order for the gut to heal.
So let’s summarize this blog post. According to the triad of autoimmunity, everyone with an autoimmune condition has a leaky gut, which of course would include those with Graves’ disease and Hashimoto’s. Although gluten isn’t a “direct” environmental trigger in everyone, it does cause a leaky gut in everyone. A leaky gut can also cause multiple food sensitivities, and while leaky gut testing is available, it’s not something that I commonly recommend to my patients. Finally, in order to heal your gut you need to remove the leaky gut trigger, which is the first “R” of the 5-R protocol.