Leaky Gut: How to Restore Your Gut and Improve Your Mental Health
So one of the things that I’m really excited about in this world is healing the gut and healing mental health. In this blog we’ll be focusing on leaky gut, a concept you may or may not have heard about before, which is when your digestion allows inflammatory molecules to pass out of the gut and into your bloodstream, causing inflammation throughout your body and even in your brain. This inflammation can lead to a host of illnesses, including IBS, fatigue, chronic pain, autoimmunity, and can play a role in mood imbalances, such as depression and anxiety. We’ll be taking a tour together of gut anatomy 101, what should be happening in the gut and what can go wrong symptoms of a leaky gut, and the relationship between gut health and mental health. And of course, I’ll share some tips for improving your gut health.
Let’s start with inflammationInflammation is one of the major root causes of almost every disease. It also goes hand in hand with a leaky gut. Inflammation has been linked to diabetes, chronic pain, multiple scoliosis, cancer, irritable bowel syndrome, inflammatory bowel diseases like Crohn’s and ulcerative colitis, asthma, allergies, eczema, and perhaps surprisingly to some of you, inflammation can be a root cause of many mental health concerns, which is our focus for today. There are a number of factors that can cause inflammation, and inflammation anywhere in the body can lead to depression and anxiety, especially inflammation in the brain. The thing is, when there’s inflammation in your knee, you feel pain when you go up the stairs. Since there are no pain receptors in the brain, it’s hard to tell when you have brain inflammation, unless you’re looking for the symptoms of it in your mental health.
So where does all this inflammation come from?Well, often it comes from a leaky gut, which we all have some degree of. And it’s the degree of leaking that explains why some of us have symptoms and some don’t. It’s also important to note that folks could have leaky gut for years before developing symptoms. The inflammation and damage can build up under the surface until your body just can’t keep compensating anymore and boom, you’re out of balance, sick, or sad. There was this great study a couple of years back where they took a group of 100 healthy college kiddos, folks with no diagnosed illness, not on any medication, no allergies, et cetera, a control group. When they tested them after a meal, they found that 55% of them had severe leaky gut compared to baseline. That’s staggering. 55% of these young folks had increased inflammation that can stay floating around in your body for up to two weeks. If these healthy young folks had evidence of leaky gut, it’s fair to assume to most folks dealing with chronic health issues also have some degree of leaky gut, including possibly you, my love. But don’t despair, I’m going to explain the science in detail today and we’ll give you everything you need to know to get started on your healing journey.
So let’s talk about the anatomy of our digestive system and what can happen when things go wrong.When we eat, food passes through our body, along with bacteria, viruses, bits of toxins we ingested throughout our day. Our gut lining cells have to make thousands of decisions about which of these particles to let through to our bloodstream and which to keep out. The lining of our gut is just a single cell layer thick, which is completely amazing to me, given that its job is to hold in like, a volcano full of acid, enzymes, food, dead bacteria, viruses, and eventually poop. There’s an immune barrier in the gut lining where about 70% of our body’s immune system lives. That’s right. Most of your immune system is in the gut.
So if you’re getting sick frequently, your gut is the place to look for an answer.These gut immune cells communicate with and directly affect your systemic immune system and your nerves, including your brain, and can therefore have direct effects on your mood and mental health. And then sitting right below this immune layer is that single cell thick protective border, the gut lining. That’s the final frontier that separates what’s in our digestive tract and what’s in our bloodstream. It’s within that protective border where there can be trouble. The tight junction proteins, the glue that holds this lining together can become increasingly permeable. That is things that should not be let into your body like viruses, fungi, bacteria, foods you’re sensitive to, inflammatory particles. All this junk can pass right through into your bloodstream.
This is also called increased intestinal permeability.I like to think of it as a row of little guards at attention in your tummy and in healthy digestion, there’s no space between them. Nothing can get through unless a little guard opens a door and lets the good stuff we need like B vitamins or other nutrients from the gut out into the bloodstream. This is called selective permeability. The guard looks at the particle standing before it and is like, “Oh wait, who are you? You’re apple. Apple, come on through, you’re good.” Or a particle presents itself to the little guard and the guard’s like, “Wait a second, who are you? Who’s this guy? Guys, who’s this guy? This is a virus, be gone.” And it doesn’t let that bad guy through. So when there’s leaky gut, there’s room between those little guardian cells and any old rogue particle can sneak through and can go whizzing around your bloodstream, which is pretty lousy. So when this leaking happens, your immune system throughout your body can see one of those invaders somewhere in your blood and will send signals throughout your body and up your vagus nerve into your brain.
These signals, that’s your body screaming there’s an invader, will lead to inflammation.Your brain will experience more inflammation too. These signals will travel back down into your gut, telling your gut and your body as a whole to freak out. This is the gut-brain access. This superhighway between your tummy, your digestion, and your brain, and it’s a huge part of how leaky gut affects your mood. So, how does all this leaky gut business tie back to systemic health and mental health? Part of the answer can be found in the concept of the leaky brain. There’s some exciting new research that shows that leaky gut and having a leaky blood-brain barrier, that is when the bloodstream connects into the brain. There’s a whole set of guardians there, and if they’re asleep on the job, like the ones in your gut may be, particles can leak into the brain, letting more inflammatory compounds in. This can lead to a number of mental health concerns, cognitive decline, and brain fog.
One of the main inflammatory compounds that can cross leaky brain barrier are bacterial coatings.Bacteria shed their outer coatings when they’re done with them, like when you go into your house after being out in the cold, you may drop your sweater at the door. So if you drop a sweater every day, eventually they’ll pile up and if the front door opens, the sweaters could fall out into the hallway. The sweaters that certain bad gut bacteria wear are called lipopolysaccharides, or LPS. And these little stinkers shed their sweaters constantly and they’re all like ugly Christmas sweaters but not the fun ironic ones. They’re inflammatory ugly sweaters and they can pile up. Now, this maybe wouldn’t be a problem unless the door opens and the sweaters fall out into the hallway. That is the bacterial coatings leave the digestive tract when you have leaky gut and make their way into systemic circulation. Think about how annoyed your neighbors would be if there were sweaters all over your shared hallway.
Your body and your brain get super annoyed.AKA inflammation in reaction to being flooded with these lipopolysaccharide, or LPS sweaters, which can also travel to your brain where they can cause more inflammation and can change your brain chemistry, leading to depressed mood and other mental health concerns. I obviously love this topic so I have a whole article about LPS on my website if you want to go back and geek out. So, research shows clear links between inflammation and depression symptoms, and folks with depressed mood have increased inflammatory markers like C-reactive protein, interleukin 6, TNF alpha.
Reducing inflammationWhat’s really fascinating is these same folks have an improvement in mood when their inflammation is reduced. There have been studies where human volunteers, were injected with inflammatory proteins from infectious bacteria. That’s the LPS we’ve been talking about. And those subjects reported that within 20 minutes of receiving the injection of inflammatory molecules, they experienced acute depression symptoms that they did not have before the injection. That is to quite directly say the bacteria made them feel sad. I mean, that’s just wild to me, and it points to this complex relationship between our digestion, the bacteria who call our body home, and our mental health, which it turns out is linked more to our gut than we ever could have imagined even 20 or 30 years ago. It’s also worth noting that these rogue LPS, bacterial sweaters, can lead to what’s called cytokine sickness, an inflammatory response that can look like depression, irritability, erratic mood, anxiety, as well as chronic fatigue. This is such an important reminder that symptoms do not always equal root cause. While some of our symptoms may look like depression, the root cause may actually be something like leaky gut and an inflammatory assault on our brains.
The other thing to remember is that food creates mood.With a leaky gut, potentially inflammatory foods can hit us even harder than other people. Or than ever before in our own lives. Anyone who has kids or works with kids can tell you, what you eat can have immediate changes on your energy and mood. And experiences like acting out, getting sad or weepy, behaving anxiously or getting hyperactive can all be caused by a little bite or two of gluten, sugar, food with red dye in it. And this doesn’t just happen in kids! But because they’re smaller and generally don’t know yet how society wants them to comport themselves, they tend to do what their bodies tell them to while adults mostly hold it in.
So instead of having a tantrum, we might get tense and anxious.Instead of screaming out that we want our mommies, we might get depressed or irritable. We might just lose focus. I will just testify that all of these things, would happen to me with just a few cookies or if I had a second cup of caffeine. Or pretty much any sugar when my gut was super leaky. We are what we eat, and when we have leaky gut, the symptoms of eating foods that cause inflammation are magnified. Societally, we are conditioned to just accept certain kinds of discomfort or pain, certain symptoms, without stopping to listen to our bodies. When you start to pay attention to how your food and the inflammation that food can create affects you, it’s hard to deny the connections between what we eat and how we feel. And the health of our gut has so much to do with what we experience.
So what causes leaky gut?Well, there are a number of factors that can damage the gut lining and can cause leaky gut. Some of the most common are stress and trauma, starting in utero even before we’re born, inflammation and infection, which often go hand in hand, eating foods that you’re sensitive or allergic to, nutrient deficiencies like being low in vitamins A, D, and zinc can also lead to leaky gut. And you don’t have to have wildly low levels of these things. Just being a little low in them can really mess your guts up. Frequent use of non-steroidal anti-inflammatory drugs, that’s the NSAID class of drugs. That’s Advil, Aleve, pills like that. And I know it’s totally normal in our culture for folks to just pop a painkiller, but I want to let you know that these drugs can really do a number on your gut lining.
AntibioticsAnother class of drugs that can really do a number on the gut lining are antibiotics. While antibiotics can be an absolutely amazing lifesaver, antibiotics are made to kill bacteria and living things. So while they’re killing off your strep throat or that nasty infection on a cut on your leg. They also kill off the good bacteria that make up the gut microbiome and protect your stomach lining. And I’m not just talking about the antibiotics we might take, again, if we have an actual infection. I want to remind you that when you buy factory-farmed milk, meat, poultry, dairy, or fish, you’re eating a whole boatload of antibiotics. This is because those animals are fed antibiotics often before they even need them.
The hygiene hypothesisThis is this understanding that in this day and age, we are too clean. We are no longer exposed to dirt, to good bacteria, in the way that our grandmother’s grandmother’s grandmothers were, and it’s hurting us. Again, the link here is through the gut microbiome. If we’re not getting in good bacteria and we’re using hand sanitizer, wipes that advertise that they kill 99.9% of bacteria as though that were like, some really good thing, we are sterilizing our environment to our own detriment. Not all bugs are bad bugs. We need good bacteria for the health of our gut and therefore the health of our whole bodies. I’m not saying not to clean your hands. I’m just saying that I don’t think we need to be murdering every bacteria on earth. So many of them do so many amazing things for us. By creating a constantly sterile environment in our homes is already having negative health outcomes for us and our kids.
So… What can we do about it?I want to start by saying that one of the hardest parts of dealing with leaky gut can be that for a lot of us, your primary care provider may never have even heard of leaky gut. They may have a kneejerk dismissive attitude about it. I know mine did. When I asked about a dozen clinicians whether I could have leaky gut when my IBS, depression, and anxiety were a hot mess in my life. Two or one, they dismissed me and wrote me and this concept of leaky gut off as woo nonsense. And while it was really upsetting for me at the time, I now know how to manage my mind. And I want to urge you not to get bogged down in your thoughts about those clinicians that just don’t get it. I want to urge you not to waste your precious energy being mad at them or even shaking your head at their ignorance. Instead, believe in yourself, the logic of this science, and what your intuition tells you about your own gut health. Move on. Let their negative energy go, find a functional medicine provider, and start doing the work of healing your gut. You have nothing to lose but some seriously lousy symptoms. There’s a simple process we can use to help heal the gut to restore your health and we do that with the four R process.
Remove, replace, reinoculate, and repair.It can take weeks, months, even years to heal your gut so please be patient with your beautiful perfect selves. Your cells are doing the very best they can. There’s no great test out there for leaky gut so keep an eye on your symptoms and to let your body be your guide. Remember that symptoms will ebb and flow. What we’re aiming for here is to lengthen the number of hours, days, weeks, and eventually months between symptom episodes. If you currently have your IBS or depression symptoms daily, your goal may be to only have those symptoms for part of each day. Then as you heal more, every other day. Then every two days, et cetera. This healing is slow and the more you can open your heart to understanding that, the easier it’ll be on you. The other thing I want to make sure to really emphasize before we step into the four R’s is the role that stigma can play in keeping this entire vicious cycle going. When we get worked up, when we get anxious or upset, our cortisol levels spike. And cortisol is one of the stress hormones and is a beautiful thing that literally keeps us alive. In excess though, cortisol can thin mucus membranes. In the case of our gut, picture those guards again standing side by each.
Elevated cortisol makes little spaces between them.It thins them out so they aren’t shoulder by shoulder and therefore increases leaky gut. One of the hardest parts about having mental and other health concerns is the stigma. Feeling like people are judging you or they just don’t get it, or feeling like you’re being labeled as crazy and written off. I want to empathize with you and send you so much love if that’s a part of your story. I want to say to you that it’s not you, my love, it’s your gut. And it may also be your leaky blood brain barrier. What other people think of you is none of your business. I want to encourage you, as an empowerment step to focus on you and your thoughts and feelings about yourself. You’re not wrong or bad for being sick, whether it be mental health or physical health concerns. You’re just a mammal, mammaling along and doing your best as best you can. Be kind and gentle to you always. And here are the four steps that we will take to help heal the gut.
RemoveIt’s hard to tell what can be causing inflammation in your gut until we reduce what’s going in. So I recommend starting with an elimination protocol for four weeks minimum. Where we pause gluten, dairy, corn, soy, peanuts, caffeine, sugar, and all alcohol. I know that’s an intense list and I know you can do it for 30 days. If you have a lot of gas, bloating, chronic constipation or diarrhea, an autoimmune condition or other serious medical concerns, I highly recommend that you go through this process with the support and guidance of a licensed functional medicine provider who can help guide you through the ups and downs of it all.
I want to talk about the importance of stress in this process.Stress and environmental influences, things that happen to us and shape our lives, even before we’re born, cause biological changes. As well as responses in our bodies and can actually change the number and kind of good and bad bugs in our guts, as well as elevating cortisol, making leaky gut worse. When I talk about an elimination process, I’m not just talking about food. I’m talking about eliminating stress, anxiety, worry. I’m talking about bringing in mindfulness, and reducing tension and anxiety in our bodies by learning to be our own watchers and to manage our minds. The gut-body-mind connection is so deeply linked and I believe that it’s impossible to heal the body without healing the mind. If you’re carrying around old anger, resentment, fear, shame, these things will keep you from healing. They need to be delt with and managed.
ReplaceWhen our gut lining is leaky, we need extra help to digest our food. Many folks feel better when they’re taking medicinal bitters, digestive enzymes, or about a tablespoon or so of apple cider vinegar, well diluted in your water before and with your meals. Please also make sure you’re chewing your food. All the supplements in the world can’t help if you’re eating quickly and swallowing food down that isn’t well chewed. I know it’s so boring and it’s so important.
ReinoculateThat means to add back in the good bacteria that may be missing from your gut lining. I believe deeply in food as medicine and recommend a trial of fermented foods like sauerkraut, beet kvass, non-dairy yogurts and kefir, kombucha, non-soy miso, and kimchi. And there are a couple recipes on my website to some of these fermented foods. If your gut or mental health have really been through it I highly recommend a probiotic supplement with a minimum of five billion CFUs, that stand for colony-forming units, per dose. Containing both lactobacillus and Bifidobacterium species of bacteria.
RepairAgain, I’ll start with food here. Some of the foods that can really help to repair the gut lining are bone broth, organ meats, and lots of vegetables daily. If you have gas and bloating, eat those vegetables well cooked and if you can tolerate raw vegetables, go for it. Having fatty fish once a week and tiny fishes like sardines and anchovies as often as you’d like. Along with organic farm fresh eggs, if those work for you, and lots of good quality fats with each meal. Turmeric is amazing at gut healing and can be mixed into foods and smoothies and curcumin. The active ingredient in turmeric is also powerfully anti-inflammatory.
Your body needs all of this to do the work of repairing your gut and reducing inflammation systemically.My own mental health and gut health improved dramatically when I started eating whole, real foods. And when I started eating little to no processed foods. I know it’s a radical change for so many of us and again, it is so worth it. There are also a number of supplements that can help to heal the gut lining. Please be sure to talk to your licensed healthcare provider before taking any of these. Note that these are the doses for the average non-pregnant adult human. Remember that quality really matters here! Be sure to get your supplements directly from a healthcare provider, a reliable health foods store, or from Fullscript, the Canadian pharmacy I use. So these supplements can be used for about three to six months safely. If you’re not seeing marked improvement after that time, that’s when I would really definitely seek the counsel of a well-trained functional medicine healthcare provider to help you get a really good quality stool test. I use GI Maps in my office myself. No financial connection there, I just love their work.
What supplements work?The supplements are L-glutamine. So L-glutamine, when you see an L before something with a little dash, it means it’s an amino acid. Amino acids are the building blocks of protein, the building blocks of life. So amino acids help give ourselves what they need to regenerate themselves. So I use L-glutamine powder, five to 10 grams of powder in a little water twice daily for about a month.
Some folks really need a second month to help them with that healing process.You can do that any time of day, though it’s optimal to take amino acids on an empty tummy. I get that like, it’s just hard to remember at 10 am or 2 pm when you haven’t just had breakfast or lunch. So do your best. The next thing is zinc. I use zinc to help heal the gut and we take about 25 to 40 milligrams a day. So note that zinc is best absorbed on an empty tummy. But taking zinc without food, if anyone out there has done it, can make you so nauseated. So fine, it’s going to be better absorbed, but I don’t want to get nauseous on the daily so I’m not going to do it. And that’s totally fine, I get to decide do I want to heal my gut just a little faster and be nauseous every day? I vote no on that. So I always take my zinc after a meal. A good quality multivitamin, not some junk from a box store or from the internet is particularly – companies named after rainforests. A really good quality multivitamin can provide the vitamins A, E, C, and selenium that you need in easy form. Again, I believe deeply in food as medicine and we shouldn’t need a multivitamin. But if you have leaky gut, you are not absorbing optimally and it’s really loving to give your body those extra nutrients that it may not be able to get out of your diet in an accessible form.
The next thing is cod liver oil and quality is so vital here.I would hate for you to be taking cheap cod liver oil or some other kind of fish or krill oil from again, your regular pharmacy or a big box store or supermarket. And you might be getting rancid oil, which is really inflammatory and bad for your cells. So I choose cod liver oil versus a different kind of fish oil because it’s a really important ancient, well-recognized traditional food that was held as sacred in many parts of the world. Rosita brand is my absolute go-to, but it is kind of expensive. Next on my list, tied for second are Nordic Naturals and Carlson’s, and those are everywhere. Every health food store has those.
And then the third thing that I use are what’s called the mucilaginous herbs.so those are herbs that make mucilage, which sounds like mucus because it’s the same root. It makes like a snot-like coating within your gut to protect that tender gut lining. And those are the DGL form of licorice, slippery elm, aloe vera, and marshmallow root. And so those are some of the most effective gut-healing herbs. They’re best taken in powder or in extract form and DGL licorice is available as chewables that I love. My preference is the Planetary Herbals one for DGL. Those are best taken before a meal to help coat the gut lining. Every time you might have indigestion or gut upset, you can pop a couple DGL. Try this instead of something like Tums that contains aluminum and that will be much more healing for you.
If we’re not starting with self-love, compassion for self, stress reduction, stigma reduction, and managing our minds, it’s pretty hard for the rest of it to work.So remember to think holistically and think about your whole body, spirit, mind, and soul, when you’re seeking to improve your health. I hope you enjoyed reading me totally nerd out about the gut, leaky gut, and the connection with mental health. It’s really important to me to say it once again. You are so much more than your diagnosis. Empowering ourselves by knowing about our health and being our own best advocate is one of the most feminist, self-loving things we can do in this world. Take good care of yourself, be well, and remember, when one of us heals, we help heal the world.
Thank you for taking the time to read Feminist Wellness. I’m excited to be here and to help you take back your health!
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Victoria Albina, NP, MPH is a licensed and board certified Family Nurse Practitioner, herbalist and life coach, with 20 years experience in health and wellness. She trained at the University of California, San Francisco, and holds a Masters in Public Health from Boston University and a bachelors from Oberlin College. She comes to this work having been a patient herself, and having healed from a lifetime of IBS, GERD, SIBO, fatigue, depression and anxiety.
She is passionate about her work, and loves supporting patients in a truly holistic way - body, mind, heart and spirit. A native of Mar del Plata, Argentina, she grew up in the great state of Rhode Island, and lives in NYC with her partner. A brown dog named Frankie Bacon has her heart, and she lives for steak and a good dark chocolate.