Normally, the gastrointestinal epithelium (the cells lining your digestive tract) provide a semi-permeable barrier which allows nutrients to be absorbed while preventing larger, potentially toxic, antigenic, or pathogenic molecules or organisms from crossing into the bloodstream. Increased intestinal permeability predisposes the individual to diffusion of antigenic food molecules and translocation of bacteria and/or yeast from the gut to extra intestinal sites including lymph nodes (mesenteric), liver, spleen, and the systemic circulation. This can be secondary to drugs, microbial overgrowth, radiation, stress, alcohol intake, enteral/parenteral nutrition, or injury. Increased intestinal permeability occurs commonly with diseases including inflammatory bowel disease (Crohn’s & ulcerative colitis), rheumatoid arthritis, ankylosing spondylitis, asthma, eczema, food allergies, alcoholism, trauma, and surgery.
To diagnose intestinal hyperpermeability, I use a urine test called the lactulose/mannitol test. These two molecules are water soluble and not metabolized by the body, but are excreted intact in the urine. Lactulose is not well absorbed, and thus should not be present in high amounts in the urine if intestinal permeability is normal. Mannitol is normally well-absorbed and usually present in greater amounts in the urine. Presence of mannitol in the urine measures through the cell absorption while urinary lactulose measures the selective barrier properties of the tight junctions (between cells). If mannitol levels are low, absorption of smaller molecules may be compromised. If lactulose levels are high, it is indicative of increased intestinal permeability to large, potentially antigenic molecules.
To adequately treat abnormal intestinal permeability and the conditions associated with it, treatment focuses on preventing further damage, correcting dysbiosis, and healing inflamed intestinal mucosa. I use a comprehensive treatment plan developed to meet the unique healing requirements of each individual.
