Traditional Chinese Medicine, TCM, has long asserted that the central tenant to good health is good digestion. According to TCM, when digestion is poor, the qi, or vital energy becomes depleted, and body accumulates substances called "dampness," "heat," or "cold." Symptoms of deficiency of qi manifest as poor energy and sluggishness. Symptoms of dampness, heat, or cold accumulation include abdominal bloating, mental fog, sinus congestion, various skin complaints, joint pain, and numerous other conditions.
In the past few decades, pioneers in allopathic and functional medicine have also started to to notice that poor digestion is correlated with the symptoms described by TCM millennia ago, and are making strides to get to the root cause of these symptoms.
But how could poor diet and digestion impact your sinuses, skin, and joints?
Functional medicine attributes these symptoms to increased intestinal permeability, otherwise controversially coined "leaky gut." In essence, leaky gut is the biologic interpretation of ancient TCM observations. The underlying premise of this theory is that permeability of the gut is on a continuum related to inflammation. Increased inflammation in the GI system results in damage to structures within and between the cells of the gut, resulting in passage of inappropriate molecules into the bloodstream. When your immune system confronts these unsuspected molecules, even if they are not innately harmful compounds, it reacts by mounting a systemic immune response, which can be observed in a myriad of symptoms throughout the body.
What causes increased inflammation of the gut?
Food sensitivities or allergies
Gut microbial imbalance
Exposure to alcohol, toxins, and certain pharmaceutical drugs
Systemic disease
Like most things in medicine, increased intestinal permeability is often multifactorial, which is why functional medicine takes a well-rounded approach to diagnosis and treatment of this condition. Generally, the first steps are to identify food allergies and sensitivities and restore a healthy gut microbiome.
For discovery of food sensitivities, the Gold Standard remains an elimination diet. By eliminating the most common culprits of GI inflammation, and then systematically reintroducing them, the body's response reveals what foods are responsible for your symptoms. Unfortunately, food sensitivity testing (IgG testing) is an imperfect science, and false negative results are common. Therefore, blanket food sensitivity testing is not an optimal solution. However, if an elimination diet yields conflicting results, these tests are invaluable tools for clarification. Ultimately, whether by an elimination diet or testing, uncovering food sensitivities is key for reducing gut inflammation.
In regards to gut microbial imbalance, chronic inflammation in the gut can result in a change in the diversity and ratios of bacteria in your gut, and equally, dysbiosis can be the cause of intestinal inflammation. Furthermore, recent studies show that there is a suspicious correlation between dysbiosis and intestinal permeability. For this reason, probiotics are generally recommended for increased intestinal permeability, and in rare cases, antibiotics may also be prescribed if pathogenic bacteria are discovered on lab testing for severe symptoms. While an excellent tool, probiotics (and antibiotics) are only a short term solution for maintenance of a healthy microbiome. Ideally, once trigger foods are identified and removed from the diet and the gut is healed, the GI microbiome remains in good balance, with the aid of prebiotics as found in a healthy diet full of vegetables and grains.
For optimal intestinal healing, alcohol and other toxins are also removed from the diet, and additional underlying diseases are identified and treated. Treatment of systemic disease impacting gut permeability generally takes patience as you work with a provider you trust, who is invested in the trial and error often required for longterm healing.
Where to begin?
An elimination diet and course of probiotics can certainly be trialed by patients of their own devices, and are cost-effective first steps. Self-guided treatment often makes sense for someone who has mild GI symptoms and is curious and motivated. Several elimination diets can be found through web searches, and often recommend excluding most common trigger foods such as dairy, wheat, soy, and corn for a period of 1-2 months. You may already have an inkling as to what foods cause you to feel more crummy, and can more simply try removing these and see how you feel- you may be surprised by how much more energy you have, or how much easier your digestion feels.
Why might you choose to work with a provider?
If symptoms are more severe, working with a provider can be an invaluable resource, as they guide you through the process of the diet, providing diet plans and more precise food recommendations. They can also identify adjunct lab testing, and help uncover more complex underlying disease processes.
Things to look forward to:
First of all, imagine healing your skin, your joint pain, or your abdominal pain without medications. While these conditions are not strictly caused by poor gut health, in the instances they are, it is incredibly empowering to reclaim your health through your own devices.
For people uncertain if it's worth giving up their favorite foods:
Sometimes symptoms are severe enough the answer is clear. In other cases, if you are mourning the loss of your favorite foods, should they be identified as trigger foods through the elimination diet, know that in some cases, it is possible to heal the gut sufficiently and reintroduce some some of these foods 3-6 months down the line. Essentially, some food sensitivities are transient in the sense that they were not causes of increased gut permeability, but rather victims of it. As other food allergies or intolerances, dysbiosis, toxins, or diseases caused increased permeability, some small molecules of your favorite foods may have snuck through the gaps between the cells and become targets of your immune system. With adequate healing of the lining of the gut, and reduction of inflammation, your body may no longer target these foods, and it it may be possible to reintroduce these foods without a flareup of symptoms.
Jessica Kolahi, PA-C, LA-C, is trained in functional medicine, and can help guide you in uncovering and treating symptoms related to increased intestinal permeability. Book now if you are ready to take the next step.