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Many think of the GI tract as the inside of the body, but in actuality it is still outside us. The lining of the gastrointestinal tract protects the inside of our body from the outside: in addition to providing a place for digestion and absorption of nutrients, the GI tract is also responsible for making sure that what finally makes it into our bodies is safe. Protecting our interior is very important, since many substances in the environment, including foods, are quite toxic to us if they enter the blood stream intact.

The GI tract is also a major component of the immune system. Within the wall of the intestine are numerous lymphoid patches. Cells lining the intestine also contain antibody-producing cells, which secrete immunoglobulin A (secretory IgA). This substance protects the intestine by forming a complex with bacteria, preventing them from binding with the intestinal lining. Otherwise, bacteria could pass through the wall of the intestine and enter the lymphatics or blood stream, a process called translocation. People with poor secretory IgA experience numerous infections and food intolerance, a common finding in disorders such as autism.

Particles—both good and bad—enter the body from the GI tract by two basic mechanisms: through cells themselves (transcellular) and between cellular junctions (paracellular). Over 85 percent of passive entry is paracellular. At the site of these tight cellular junctions are channels (pores) which allow small molecules to pass. Like pores in other parts of the body, these channels can open and close as needed. Much of this traffic is controlled by electrical charges from cells.

When these junctions are altered by disease, drugs, or trauma, larger molecules can enter the blood stream, many of which can induce immune reactions. Examples of these diseases include rheumatoid arthritis, asthma, ankylosing spondylitis, food allergies, eczema, pancreatic dysfunction, acute gastritis, celiac disease, HIV infection, burn injury, cystic fibrosis, alcoholism, post-surgical infection, and endotoxemia. Drugs known to alter gut permeability include virtually all nonsteroidal noninflammatory medications (NASIDS), many chemotherapy agents, amphetamine, and cocaine. Cow's milk is also known to induce leaky gut syndrome.

When gut ecology is severely altered, we see increased translocation of bacteria and yeast into the circulatory system. Antibiotics, especially broad-spectrum varieties, can kill beneficial organisms, resulting in an overgrowth of the pathogenic, disease-causing ones. Bacterial translocation is greatly accelerated when antibiotics are combined with cortisone, a common practice.

Once microorganisms enter the blood stream they can seed into numerous organs and tissues, resulting in systemic illness. They can also result in immune suppression, and the formation of autoimmune complexes, which can present as arthritis, muscle weakness or neurological problems. Overgrowths of Candida albicans and Pseudomonas aeroginosa have also been shown to produce immune suppression.443 This would be especially important in those with cancer and chronic infections.

In all cases of increased permeability, the problem is that large polypeptides and proteins are allowed to enter the blood stream where they elicit immune reactions, some of which, by molecular mimicry, can fool the immune system into attacking cells within one's own body.

Chemotherapy also increases gut permeability. Many anticancer agents are very toxic to the rapidly dividing cells lining the GI tract, resulting in chronic diarrhea, blood loss, and increased gut permeability. Two good bacteria, Lactobacillus plantarum and L. reuteri, have been shown to reduce significantly the severity of GI reactions to the chemotherapy agent methotrexate. Radiation of the GI tract, common with cancer treatment, can also cause increased permeability. If uncorrected, it can lead to a prolonged problem lasting years.444

Increased permeability is also common with Crohn's disease and inflammatory bowel diseases. In fact, measures of intestinal permeability are a good way to predict recurrences of Crohn's disease. When permeability is normal during periods of remission, the likelihood of recurrence is smaller.

Food allergies are also associated with increased permeability. Early exposure during infancy to common food allergens such as eggs, milk, and soy can precipitate long term sensitivities to these food products. A similar process can occur when the gut becomes excessively permeable during adulthood, for whatever reason. In fact, food allergies can change as permeability improves. This is not uncommon in autistic children, and in those suffering from yeast overgrowth of the bowel.

Increased gut permeability is common in rheumatoid arthritis, but we cannot tell if it is part of the disease or the result of years of taking NSAIDs. We do know that such patients frequently have antibodies to an organism called Proteus mirabilis. Antibody reactions against this organism are much greater in active disease than quiescent disease. It is also interesting to note that rheumatoid patients who improved after a period of fasting followed by a strict vegetarian diet experienced a fall in Proteus antibodies as well.

While this is not to say that this organism causes rheumatoid arthritis, is has been shown to increase significantly symptoms and accelerate the course of the disease. The same can be said of other autoimmune diseases such as lupus.

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