Leaky Gut (Intestinal Permeability) issues show up in many different ways - Bloating, Distention, Stomach pain after meals, excessive gas, Diarrhea, Constipation, SIBO, IBS, Fatigue especially after meals etc. When left unresolved, it almost always manifests as autoimmune and inflammatory type conditions such as acne or eczema, arthritic pain, and even headaches. 

Because Leaky Gut can cause so many different problems in the body, if left unresolved it is associated with neurological symptoms like brain fog.

The Good News:

When you come to Restorative Health Solutions for Leaky Gut, you not only have the peace of mind of good testing, we are identifying and addressing the root cause of your problem, and therefore reducing the chances of it coming back.

On this page Dr. Paul explains in detail, Leaky Gut or Intestinal Permeability, proper testing for leaky gut, how to identify the root cause of the problem and finally, the comprehensive 5 Step Gut Protocol.

COMPREHENSIVE 
5-STEP GUT PROTOCOL
Leaky Gut (Intestinal Permeability) issues show up in many different ways - Bloating, Distention, Stomach pain after meals, excessive gas, Diarrhea, Constipation, SIBO, IBS, Chronic Fatigue especially after meals etc. When left unresolved, it almost always manifests as autoimmune and inflammatory type conditions such as acne or eczema, arthritic pain, and even headaches. 

Because Leaky Gut can cause so many different problems in the body, if left unresolved it is associated with neurological symptoms like anxiety, depression and brain fog.

The Good News:

When you come to Restorative Health Solutions for Leaky Gut, you not only have the peace of mind of good testing, we are identifying and addressing the root cause of your problem, and therefore reducing the chances of it coming back.

On this page Dr. Paul explains in detail, what is leaky gut or intestinal permeability , proper testing for leaky gut, how to identify the root cause of the problem and finally, the comprehensive 5 step gut protocol.

FINDING THE ROOT CAUSE AND FIXING LEAKY GUT, FOR GOOD! 

Helpful Quick Links

Check out the videos below

Complete 5-R Leaky Gut Protocol:

Connection between Leaky Gut and Autoimmune conditions

What are the typical symptoms of Leaky Gut?

IBS Vs IBD Vs SIBO Vs Leaky Gut: What's the difference? How are they typically diagnosed?

COMPREHENSIVE 5-STEP (5-R) GUT PROTOCOL
Finding the root cause, healing leaky gut and making it last!
On this page we explain in detail the steps of this is very effective and successful protocol to help heal leaky gut!

Eight Need-to-Know facts on Leaky Gut:

1. Leaky Gut is commonly referred to as “Intestinal Permeability.” If you search published medical research on Google Scholar for “Leaky Gut,” you'll see 36,000 results. Do the same for “Intestinal Permeability” and 1,340,000 results display! This is important, because some practitioners use the term Intestinal Permeability instead of Leaky Gut and it’s important that you understand they are the same thing!

2. Leaky Gut can wreak havoc on your body and health with or without symptoms directly related to your Gut! Skin rashes, headaches, inflammation, joint pain, fatigue developing allergies, changes in mood.

3. The Gastrointestinal (GI) Tract, or "Gut," houses the vast majority of your immune system, allows you to digest food and absorb nutrients, helps reduce inflammation and aids in keeping your brain healthy.  A healthy gut is one of the most important foundations to build your health on. 

4. What is Leaky Gut?  In your GI tract, you have a protective barrier that prevents foreign substances (antigens) from getting through the intestinal wall and into the bloodstream. These foreign substances or "Antigens" could be undigested food proteins, bacteria/microbes or toxins, or unwanted particles.

5. Unwanted Particles in Your Bloodstream:  
If an Antigen enters your bloodstream, your immune system will mount an immune response, as it doesn’t recognize the Antigen, now considered, "a threat." 
T-cells of the immune system are asked to get rid of the problem. Meanwhile, B-cells are asked to make antibodies, so that if it happens again, the immune system has a planned/automatic response to take out the threat! This, of course, is a mechanism that can cause INFLAMMATION to occur throughout the body.

6. The Many Symptoms of Leaky Gut:
Fatigue
Digestive (bloating, gas, constipation, diarrhea, IBS-like symptoms)
Seasonal Allergies and Multiple Food Allergies/Sensitivities
Skin Reactions/Eczema/Dermatitis/Acne
History of Autoimmune Conditions
Brain Fog-decreased mental processing speed/clarity/focus

7. How to Find out if you have Leaky Gut?
In our opinion, the best way to test for leaky gut is to do an intestinal permeability panel through a reputable lab. The test is a blood test that looks at antibody levels to determine: if you have leaky gut, what type of leaky gut you have and if you have Endotoxemia. 
Briefly, you can have leaky gut where the tight junctions (protein structures that keep the intestinal cells close together) between the cells are Damaged (paracellular) or, you can have leaky gut that damages the intestinal cell itself (transcellular). Having 
Endotoxemia means that bacteria are leaking into 
your bloodstream due to leaky gut.

8. The labs we currently run at RHS to determine if you have Leaky Gut:
Vibrant Labs Intestinal Permeability Panel
Cyrex Labs Array 2 Intestinal Antigenic Permeability Screen
GI Maps Stool Test

 *Now that you know the basics about leaky gut, let's dive into our protocol for healing it! This is perhaps the only way to increase the chances that your symptoms don't recur.*


Our comprehensive protocol for Leaky Gut includes The Five Rs:
 
Remove, Replace, Repair, Reinoculate and Rehab the Brain. 

In this step, the goal is to identify and eliminate the factors causing leaky gut. Removing toxins, identifying underlying infections and dysbiosis and removing the opportunistic bugs, inflammatory food proteins and toxins/chemicals.

This step is all about using specific supplements to help improve digestion and the breakdown of food proteins to their simple elements to minimize inflammation. We add-in digestive enzyme and hydrochloric acid (HCL) support to make sure we're breaking down our food to its simplest components, so it's easily absorbed.

By the time we get to step 3, inflammation should be significantly lowered and, therefore, the immune system should hopefully be calmed down, enough to initiate the healing process. Although healing can start to occur on its own, supplementation is usually needed to be able to speed up the repair. The reason why time can be tough to ensure proper gut repair is because SO many things can cause the barrier in the gut to break down again during that time. In this phase, we start to introduce supplements that have been shown to help restore the protective barrier of the gut.

This section focuses on increasing the population of good bacteria in the gut. This step goes fast, assuming the gut wall is properly repaired in Step 3.

This is crucial in your long-term success in health. Most clinics do not have the neurology background to help their patients with this step, and it's a game changer in making sure your gut . Using the principles of Functional Neurology, Dr. Paul identifies any issues in the gut-brain communication (axis) and helps rehab the brain. Due to the significant communication between the brain and the gut, we apply specific exercises to the brain to help optimize gut function! 

For further details on each step, click the buttons below:

Step 1: REMOVE 

In this phase of the protocol, we ask the question:

  “What is negatively affecting the body and potentially contributing to underlying inflammation?” 

GOAL: Identify and Eliminate 
The Cause of Your Inflammation.
Focus: Eliminating the Factors that are contributing to underlying inflammation and wear-and-tear. 
This list can be quite lengthy, but we try to simplify it 
into the following categories:
  • Food Allergies and food sensitivities
  • Infections (bacterial, yeast/fungi/candida, parasites, viruses,   tick-borne infections)
  • Toxins/chemicals/mold exposure
  • ​Hormone imbalance
  • ​Stress
  • ​Nutritional deficiencies
What Testing Can Be Done To See What 
Specifically Needs To be Removed?

After an in-depth history and examination, we'll decide the testing appropriate for you. We have testing for each main category, but usually recommend investigating the one that seems to be of most importance for your case.

Here are the Tests we use to get more specific answers:

Food Sensitivity Testing
Vibrant Labs Food Sensitivity Panel (IgG, IgA)
Cyrex Labs Array 10-Multiple Food Immune 
Reactivity Panel (IgG, IgA)

Testing To Rule Out Infections
GI MAP Stool Test (looks at pathogens/microbes in the gut, inflammation, secretory IgA, etc)

Comprehensive blood test that includes a CBC with differential (breakdown of white blood cells) and inflammatory markers

Cyrex Array 12-Pathogen Associated Immune Reactivity Screen

Toxin/Chemical/Mold Testing
Cyrex Array 11-Chemical Immune Reactivity Screen
Environbiomics-ERMI test for mold in the home or workplace

Once we know the cause, then what?

If we run a food sensitivity test, you'd simply remove the foods from your diet that test positive. If you don’t end up doing a food sensitivity panel, we still give dietary advice as to what the best diet for you may be. 

When we do testing to rule out active infections (clinical or subclinical), there are many possible scenarios we need to be ready to address. Our point here is that the approach is completely different when we are trying to handle a bacterial infection, viral infection, yeast/fungal infection or parasite infection. 

For Bacteria, we typically use products that contain one or more of the following:
Oregano oil
Thyme oil
Berberine
Olive leaf extract
For Viral infection, we focus on Immune Support and products that have Anti-viral properties:
Glutathione
N-Acetyl Cysteine (NAC)
L-Lysine
Vitamin D, Vitamin A, Vitamin C
Ganoderma
Licorice Root (contraindicated if you have hypertension)

For Yeast/Fungal/Candida-based infections, we prefer:
Grapefruit Seed Extract
Berberine
Oregano Oil
MCT or Coconut Oil

For Parasitic Infections, we have multiple options:
Black Walnut
Chinese Wormwood
Neem
Olive Leaf Extract
Berberine

We apply dietary changes in combination with a personalized supplement protocol for you 
to address any underlying Infection, Dysbiosis (imbalance between the good bugs and bad bugs in the gut) and/or Inflammation. 

Once we feel The Remove Phase has been properly addressed, it's onto Step 2: REPLACE

Step 2: REPLACE 

After the removal phase, we need to evaluate each patient and figure out what and 
how much we need to Replace.

THE GOAL: Rebooting Your Digestion

In this part of the protocol, we're looking to provide digestive enzyme and stomach acid support (hydrochloric acid/HCL, pepsin, etc), especially for those patients with correlating symptoms. To thoroughly investigate this portion of the protocol, we like to begin by diving into the history.

How Do I Know If I Need Digestive Enzymes or HCL?

If someone needs digestive enzyme support, they likely have symptoms such as bloating after eating carbohydrates (sugar, fiber from fruits or veggies, processed food). 

If hydrochloric acid (HCL) support is needed, the symptoms would typically be belching/burping/bloating, sense of fullness during or after meals, offensive breath, difficulty digesting protein (feeling of the food being stuck) and/or heartburn symptoms.
The reason it's so important to have proper digestive enzyme and HCL support is because your food needs to be broken down into its most simple elements in order to absorb everything properly. Without this process, we don’t have optimal absorption of our vitamins, minerals, 
amino acids (from protein), etc.

-----------------------

Are There Any Tests I Can Do To See If I Need Digestive Enzymes or HCL?

For this part of the protocol, we rely heavily on history. 

However, "elastase-1" is a marker that is included in the GI MAP stool test that we commonly run to gather information prior to starting the leaky gut protocol. Elastase-1 is a pancreatic/digestive enzyme marker.  If it's low, the patient is in need of digestive enzymes. 

If high amounts of protein in the stool, you can make the assumption that there isn’t enough HCL to 
break down the protein.

With leaky gut, most patients need some digestive enzyme and/or HCL support before moving onto the next phase.

Once we feel like the replace phase has been properly addressed, we then go onto Step 3: The Repair Phase.

Step 3: REPAIR 

At this point in time, the immune system will likely be calmed down enough to initiate the healing process! 

Although healing can start to occur on its own, supplementation is often needed to speed up the repair. 

How Do I Repair My Leaky Gut?
In this phase, we put a lot of emphasis on supplements that have been shown to promote healing of the barrier system of the gut. However, it's still important for us to address the diet and lifestyle portion of the protocol so we ensure that we aren’t doing things that promote a breakdown of the barrier.

Diet and Lifestyle Factors to consider:
  • Staying on an anti-inflammatory diet
  • Avoiding foods you are sensitive to
  • ​Getting 7-8 hours of good, restful sleep
  • ​Controlling your stress load as much as possible
  • ​Not over-doing the alcohol
  • ​Staying positive and as worry-free as you can
What Supplements Are Typically Recommended During the Repair Phase?

By far the most famous on the list for restoring the GI barrier is L-glutamine. L-glutamine is a non-essential amino acid, which means that the body is able to make it. However, with leaky gut present, the body won’t likely make enough to promote significant healing of the barrier.

Colostrum is an overlooked supplement for leaky gut. The colostrum we use acts like a lint roller to the bacteria/pathogens and toxins of the gut by binding to them and helping the body get rid of them. This supplement can also be used in the remove phase to minimize die-off or herxheimer reactions since it binds to the pathogen or toxin instead of letting it enter circulation and cause a reaction.

Vitamin A and zinc are essential for proper immune function. Vitamin A is also critical for supporting the mucous membrane of the GI tract. Since the mucous membrane of the gut is where your first line of defense lies, then you can see why it is so important for addressing leaky gut and attempting to rebuild the gut.

Deglycyrrhized Licorice Root Extract helps promote a healthy esophageal lining, helps maintain a healthy mucosal surface in the stomach and also supports overall GI health.

Short Chain Fatty Acids (SCFAs) are fatty acids that are produced by fermentation from bacteria in the gut after ingestion of dietary fiber. The fiber is considered to be a prebiotic that essentially fuels the “good” bacteria of the gut and promotes bacterial diversity.

All of these supplements will each have their part in restoring function in the GI barrier. The goal is for the tight junctions between the cells to heal, tighten back up and pull the cells closer together again so only vitamins, minerals, amino acids and other essential nutrients can pass from the gut into the bloodstream.

At what point do I know my Leaky Gut has been resolved?

After completion of The Leaky Gut Protocol, we typically run this test again to see if your leaky gut markers have normalized or if we still have work to do. 

However, we still have two more phases of the protocol to address before retesting in a typical leaky gut case.

The repair phase of the protocol typically lasts one month, but can last two or more months in the most severe cases. If your Leaky Gut is coming from an autoimmune condition like Crohn’s disease or Ulcerative Colitis, that’s a different story. Our goal in these cases is to improve the lab findings, slow down inflammation and balance the immune system as much as possible.

When The Repair Phase has been properly addressed, we then go onto Step 4: The Reinoculation Phase.

Step 4: REINOCULATE 

With leaky gut, you typically see an imbalance between the good and the bad bacteria. 

FOCUS: Adding back in the “good” bacteria.

 We diversify the population of microbes that live in your gut and contribute towards optimal health.
How Do I Increase the Healthy Bacteria in My Gut?

The good bacteria needs a source of fuel, which comes from dietary fiber. Buy a different combination of plant-based foods each time you go grocery shopping, instead of always eating the same foods over and over again.
For example, if you like salads, mix up what greens you buy. One week you can buy romaine, the next week buy spinach, the next week buy mixed greens, etc. 

By eating a variety of plant-based foods, you will be introducing a lot of fiber into the gut. 

I get tired of eating veggies; what else can I do?

An easy way to get veggies in the diet naturally: chop up a bunch of veggies with a little fruit and make a smoothie. 

Will Eating More Veggies/Fruits Increase Good Bacteria?

Getting the diet right is a HUGE piece to repopulating gut with your good bacteria.  

The best thing you can do through the diet is eat fermented foods that contain a good amount of healthy bacteria. Here is a list of fermented foods:

Kombucha
Kimchi
Sauerkraut
Pickles
Yogurt (preferably dairy-free)
Kefir (preferably dairy-free)

In most cases, we recommend supplementing with a high quality probiotic along with the increase in dietary fiber (from increasing consumption of plant-based foods or by taking a fiber and greens supplement) and taking a SCFA supplement. This combination seems to work really well in repopulating the gut with the good, healthy, friendly bacteria!
When the reinoculation phase has been properly addressed, head to our last phase, Step 5: Brain Rehab.

Step 5:
BRAIN REHAB

You've now learned about the first four R’s of the leaky gut protocol (Remove, Replace, Repair and Reinoculate). Most clinics and physicians practice the 4R Protocol for leaky gut. At RHS, our protocol is complete, with the 5th R: 
Rehab the Brain
The Gut-Brain Axis
Over the last 10 years or so, one of the hottest areas in research has been The Gut-Brain Axis. This research looks into how the brain and the gut are connected, and what happens to the gut if the brain is injured/affected and what happens to the brain if the gut is injured/affected.

One of the biggest topics that has been studied is what happens to the gut after a traumatic brain injury or concussion. These studies, done mainly on rats and mice, show that when a traumatic brain injury or concussion is suffered, the microbiome (all the microbes/bugs in the gut) changes and leaky gut occurs typically within hours of the traumatic brain injury.
The changes they see in the microbiome are negative changes. An imbalance between the good and bad microbes starts to occur. Eventually, the studies show that dysbiosis occurs. Dysbiosis is a term used to describe too many bad/opportunistic bacteria over the good bacteria.

How does the Brain impact the Gut when 
they're so far apart in our body?

In the brainstem, the part of your brain that lies between the brain (cerebral cortex) and the spinal cord, is where your Vagus Nerve originates. The cluster of neurons in the brainstem is referred to the Dorsal Motor Nucleus (DMN). This nucleus is central station that sends and receives information to and from the vagus nerve. Out of the brainstem, the Vagus Nerve branches out and goes to multiple different areas of the body. In Latin, "Vagus" means “the vagabond” or “wanderer” because it's the longest cranial nerve and innervates (nerve supply to an organ or body part) the heart, lungs, and a majority of the abdominal organs including the proximal two-thirds of the gut (stomach, small intestine and the first part of the large intestine).
When a nerve signal is created in the brainstem, the message is sent down the nerve and into the gut to promote function. Here are some of the functions the vagus nerve is responsible for increasing in the gut:
Digestive enzyme output
Blood flow to the gut
Gallbladder contraction-push bile into the GI tract
Gut motility-movement of food through GI tract

Without the vagus nerve, these functions fail. If you don’t have sufficient digestive enzymes, you can’t break down your food optimally. When blood flow is less than optimal to the gut, it’s tough to heal/repair the gut and absorb nutrients efficiently. If the gallbladder doesn’t contract and release bile into the system, it’s tough to break down fats in your diet. When motility is impaired, food is slow to move through the GI tract, which can lead to constipation and subsequent infections of the gut.

How do I know if my Brain needs rehab to help my Gut?

Included in your first appointment is a comprehensive functional neurological examination. This exam looks at various parts of the brain and nervous system to determine what areas are working optimally and what areas need improvement in function.

If areas within the brain and nervous system need to improve in function and/or you have neurological symptoms, then we recommend going through functional neurological rehab. This part of the protocol focuses on giving you specific exercises to stimulate specific areas of the brain or nervous system that need improvement in functioning. To learn more about the gut brain rehab please click the button below:

When you improve function in certain areas of the brain that feed into the same areas that control gut function (vagus), the brain can then  increase the amount of input/signals into the gut to promote optimal gut function. We believe that this piece of the protocol is the most important step in trying to lessen the chance that leaky gut returns. If this part isn’t addressed and you need it, symptoms can start to return within a few months after completing the 4 R protocol. Improved brain function should only help improve gut function and improved gut function should only help brain function. Also, the impact the brain has on the gut may not be as noticeable if the goal is to try and lessen the chances of leaky gut returning instead of drastically reducing symptoms. 


What can you expect in working with Restorative Health Solutions?

At Restorative Health Solutions, we strive to get to the root cause of the symptoms/condition and help patients reach their optimal health. We also guarantee to replace the one-size-fits-all approach with a personalized plan for you! 

How we dramatically lower the recurrence of your symptoms:

1. Our comprehensive 5-step gut health protocol.

2. Our functional medicine and functional neurology combination, which includes rehab to the brain and gut-brain axis.

3.  State-of-the-art lab testing that we use strategically to eliminate the guessing and to get to the root cause of your symptoms.

The result of this approach is that our patients are healthier long-term with much lower recurrence rates of the problem. We find that SIBO patients experience about a 70% recurrence rate, but with our approach we have seen less than 10% of SIBO patients have their symptoms return after the initial symptom-free timeframe.

If you or a loved one are having any symptoms or suspicions of Leaky Gut, or interested in getting a thorough and complete work-up, we’d be happy to help. If you are already working with another doctor or practitioner we're happy to coordinate care with them.  Please don't hesitate to ask questions or to get a second opinion.

We look forward to helping you Restore Your Gut Health, and your quality of life!

Sincerely,

Dr. Paul Deglmann, DC, DACNB, FACFN and Dr. Kyle Warren, DC, CFMP
Owners at Restorative Health Solutions- Edina, MN

Request Free Consultation with Restorative Health Solutions
Before you submit your information, please understand, Dr. Paul does not accept Medical Insurance. However, his service should be covered under your HSA plan. 

FAQs:

Do you offer virtual consultations?
At Restorative Health Solutions we offer both in-person and virtual consultations. Feel free to share your preference with our front desk when you reach out. *We do not work with patients that live outside of the United States.
How much is the 15-minute phone consultation?
Your first phone call is complementary and on us. 
Typically how long are the appointments?
The initial appointment after the first phone call is 1 hour on average. Follow-up visits are usually  30 minutes.
How many visits will I need?
This of course, depends on your unique situation and plan for recovery! Typically, our follow-up visits are every 3-6 weeks in the initial phase of the protocol and every 3-6 months for maintenance or wellness visits. Telehealth options are also available.
Do I need a doctor referral to come see you?
No, you do not! We see people referred by doctors, friends and family, and those that are taking charge of their own health.
I am not sure what tests have been run by my MD already? Will you be willing to talk to them on my behalf?
Yes, absolutely! We routinely look at the previous testing you have already run. Please share as much as you can and we will take it from there.
I am already taking supplements or antibiotics? Can what you do still help me?
Yes, absolutely! Managing your gut microbiome while on Antibiotics is crucial! We can review all your supplements with you. Please note, it's not just about taking the supplements. Taking the right supplements, in the right sequence, and the right way is crucial for long-term improvement. If you do it right, you shouldn't need to be on supplements forever! Bring them for your first visit and we will review them together!

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