Leaky gut...what is it and how do I fix it?

Leaky gut is a general term that describes compromised gut integrity with increased intestinal permeability. There are a variety of factors that can contribute to leaky gut including bacterial or fungal infections, medications, alcohol and conditions such as celiac disease. When the gut junctions become compromised food components are allowed to exit outside of the digestive tract. This can contribute to the development of autoimmune conditions as well as what clients often perceive as being highly sensitive to many foods. Nutrient deficiencies are commonplace when leaky gut occurs.

The path to healing leaky gut lies in determining the underlying cause. Once the offending agents are removed, the path to healing can begin. Diet and healing supplements are key to allowing the gut to heal and allow nutrients to be adequately absorbed. A registered dietitian trained in the field of gastrointestinal nutrition can help guide the client toward the right food and supplement choices to heal a leaky gut.

Glucose or lactulose breath test for SIBO?

A breath test is used to detect the presence of hydrogen or methane-dominant bacteria in the small intestine. The test is conducted by having the patient drink a solution of glucose or lactulose and then breathe into test tubes over a period of 3 hours. The difference in substrate, glucose or lactulose, is that they detect bacterial growth in different areas of the small intestine. Glucose is a sugar that is fermented in the upper (proximal) part of the small intestine; while lactulose is fermented in the lower (distal) part of the small intestine. In my practice, I prefer to do combination glucose and lactulose testing to ensure that the test is highly accurate and avoids any false negatives due to the limitations of using only one test.

Spectrum of Lactose intolerance

Lactose intolerance is not an all or nothing condition. There are different degrees of lactose intolerance. There are also different types of lactose intolerance. The two most common types of lactose intolerance are: 

  • Primary lactose intolerance - deficiency of lactase enzyme that generally develops over time. Certain populations including Asians and African Americans have higher rates of lactose intolerance than other groups.
  • Secondary lactose intolerance - reduced production of lactase enzyme caused by another condition that damages the small intestine, including celiac disease, small intestinal bacterial overgrowth (SIBO), and IBD. After the gut heals, production of lactase enzyme may return.

For those with either type of lactose intolerance, they may find they are still able to tolerate some dairy products. For example, hard aged cheeses are extremely low in lactose and can be tolerated by even the most lactose intolerant. However, cow's milk, yogurt, cottage cheese, ricotta cheese, and cream cheese contain higher levels of lactose. Small amounts cooked into foods may be better tolerated. In addition, lactase enzymes can be taken with higher containing lactose foods to help with digestion.

Because dairy products are a concentrated and convenient source of calcium, those with lactose intolerance need to ensure they are getting adequate calcium from other foods in their diet. Foods such as fortified plant based "milks", calcium enriched tofu, dark green leafy vegetables (kale, collard greens), and nuts like almond are good sources. Consult with a dietitian to ensure your diet is nutritionally adequate.