When the Gut Leaks…Inflammation Follows (and Leads)

By Desiree Nielsen, RD

human digestive system

One of the most significant advances in anti-inflammatory theory is the knowledge that inflammation can begin in the gut.

In order to wrap your head around this, you need to understand the importance of your gut to your immune system. Much like your skin, your digestive tract lining is an important barrier between you and the outside world. So much so, that roughly 70% of your immune activity is centered within, and around, that fragile barrier. Fragile because unlike your skin, your digestive tract barrier is only one cell thick. Its job is to strike a delicate balance between access and exclusion, allowing in nutrients and beneficial compounds and keeping out all others.

Your immune system, on the other hand, tows the line between tolerance and action. Tolerance, for nutrients and the trillions of beneficial bacteria that call your gut home; action, against potential toxins and pathogens. Chronic inflammation can be thought of as a loss of this balance: when persistent aggressors such as allergens, dietary stressors, harmful bacteria or environmental toxins are in constant contact with immune tissues, inflammation rages.

We now understand that an imbalance or loss of function in one of these systems can cause the other to falter. If inflammation is present within the gut space, inflammatory messengers may impair gut barrier function on their own.

How does this occur? The most classic example of inflammation damaging the gut is inflammatory bowel disease. While the root cause of inflammation is not yet agreed upon, once present, the inflammation decimates sections of the gut tissue until in some cases, it ceases to function. The gut damage then, in turn, allows substances and bacteria present in the gut to continue to activate the immune system. During a flare up of ulcerative colitis or Crohn’s disease, this vicious cycle makes life very difficult. For Crohn’s disease, sometimes the only way to get the inflammation under control is to remove the damaged portion of the gut.

What about the other way around? The physiology of barrier function and gut permeability is too detailed to fit into one blog post; let it suffice to say that a complex dance between physiology, immunity and microbiology creates the harmonious balance that keeps us healthy. When that dance goes off key, the immune system is presented with foreign stimuli to which it responds with inflammatory action.

Of course, what makes gut barrier dysfunction and inflammation such a hot topic is that they impact many more individuals than previously thought. We used to divide conditions into inflammatory (rheumatoid arthritis) or not (diabetes). However, as our knowledge has grown, so has the list of non-inflammatory conditions with an inflammatory component. On this list is everything from eczema to heart disease, irritable bowel syndrome to anxiety. When other pro-inflammatory factors have already been considered, such as stress, dietary choices and physical activity, we should also look to the gut as another target of our care. One of the key drivers, particularly when gut barrier function is diminished, is the bacteria that live in our colons.

Without a fully functioning gut barrier, bacteria may translocate into the tissues, where the immune system will have to fight to keep bacteria from entering the bloodstream. In addition, should more harmful bacteria be present, endotoxins, substances created by these bacteria, can leach into circulation, stoking the fires of inflammation as they go.

Bacteria may also be the root cause of inflammation and gut barrier dysfunction. Certain harmful bacterial strains may impact the way that gut cells adhere at connection points called tight junctions. Dietary choices, via modulation of the bacterial community or directly, can also increase intestinal permeability – in particular the high calorie, high fat diet so prevalent in our society.

Should you think that gut barrier function is driving inflammation in your own health picture, talk to an integrative medical physician, who can assess your risks and confirm whether gut health should be a therapeutic target for you. Natural treatment remedies such as L-glutamine and omega 3 fatty acids exist but need to be individualized by your care team. Nutrition should always be a part of the treatment strategy – not only to provide the nutrients required for gut repair but also to avoid activating an already inflamed immune system.

Want to get started right away? Start eating these seven anti-inflammatory foods today.

Further Reading:

  1. Bischoff, Stephan C., et al. “Intestinal permeability–a new target for disease prevention and therapy.” BMC gastroenterology 14.1 (2014): 189.