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"Leaky Gut" makes MEDLINE!

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"Leaky Gut" makes MEDLINE!

Posted by
Robert McFerran on September 02, 1999 at 12:35:20:

Sometimes there ARE cracks in the wall.

I almost fell out of my chair when I saw this article suggesting the problems of increased intestinal permeability and the use of the term 'leaky gut'. Not by some foreign medical school with a questionable pedigree but from Loyola University right here in the good old U.S.A.

Enjoy,

Bob

Leaky gut in alcoholic cirrhosis: a possible mechanism for alcohol-induced liver damage.


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Authors:
Keshavarzian A , Holmes EW , Patel M , Iber F , Fields JZ , Pethkar S
Department of Medicine (Division of Gastroenterology), Loyola University Medical School, Maywood, Illinois 60153, USA.
Am J Gastroenterol 1999 Jan;94(1):200-7

Article Number: UI99131455

Abstract: OBJECTIVE: Only 30% of alcoholics develop cirrhosis, suggesting that the development of alcohol-induced liver injury requires one or more additional factors. Animal studies have shown that gut-derived endotoxin is one such factor. Because increased intestinal permeability has been shown to cause endotoxemia, we hypothesized that increased gastrointestinal permeability contributes to the pathogenesis of alcoholic liver disease. This study aimed to measure gastroduodenal and intestinal permeability in alcoholics with and without chronic liver disease and in nonalcoholic subjects with chronic liver disease. METHODS: Gastroduodenal permeability was assessed by measurement of urinary excretion of sucrose after oral administration. Intestinal permeability was assessed by measurement of urinary lactulose and mannitol after oral administration of these sugars. RESULTS: Alcoholics with no liver disease showed a small but significant increase in sucrose excretion. Alcoholics with chronic liver disease demonstrated a marked and highly significant increase in urinary sucrose excretion relative to the controls, to the alcoholics with no liver disease, and to the nonalcoholics with liver disease. Alcoholics with chronic liver disease demonstrated a marked and highly significant increase in both lactulose absorption and in the urinary lactulose/mannitol ratio (alcoholics 0.703 vs controls 0.019, p = 0.01). In contrast, alcoholics with no liver disease and nonalcoholics with liver disease showed normal lactulose absorption and normal lactulose/mannitol ratio. CONCLUSION: Because only the alcoholics with chronic liver disease had increased intestinal permeability, we conclude that a "leaky" gut may be a necessary cofactor for the development of chronic liver injury in heavy drinkers.




Woohoo! Seems as if the party line is developing a case of LGS! ;-) nmi

Posted by
trish on September 02, 1999 at 14:55:11:

In Reply to: "Leaky Gut" makes MEDLINE! posted by Robert McFerran on September 02, 1999 at 12:35:20:

nmi



Re: "Leaky Gut" makes MEDLINE! (Archive under LGS.)

Posted by Walt Stoll on September 03, 1999 at 11:36:23:

In Reply to: "Leaky Gut" makes MEDLINE! posted by Robert McFerran on September 02, 1999 at 12:35:20:

Thanks, Bob!

It really helps to hear that the system is begining to "crack". For such an important concept, it surely took "them" long enough.

Namaste`

Walt



Re: "Leaky Gut" makes MEDLINE! (Archive under LGS.)

Posted by
Robert McFerran on September 03, 1999 at 14:11:05:

In Reply to: Re: "Leaky Gut" makes MEDLINE! (Archive under LGS.) posted by Walt Stoll on September 03, 1999 at 11:36:23:

Hi Walt,

Dr. Ronald Finn once suggested that there are 4 stages in the development of a new medical idea:

1) You are mad
2) I suppose that there might be something to it
3) There could be something in it, but where is the proof?
4) Well, of course, we knew all along.

Leaky gut is going to be a tough one to ever get to stage 4 however. Right now several docs are perceiving leaky gut to be the same as increased intestinal permeability (as diagnosed by the lactulose/mannitol test). This is MUCH too simplistic about what is really going on since the gastrointestinal damage can be anywhere throughout the GI tract (not just isolated to the jejunum where lactulose/mannitol uptake would be most effected).

Right now there are studies out that show that increased intestinal permeability (once again as measured by the lactulose/mannitol test) is higher in persons with auto-immune disease. The problem is that its often even higher in others in their family that have no disease.

Another study looked at the intestinal permeability of folks with confirmed food allergy (defined via elimination diets). The intestinal permeability (measured via the lactulose/mannitol tests) of the folks with food allergy was the same as healthy volunteers that displayed no food allergy. The conclusion was the the lactulose/mannitol test cannot confirm the presence of food allergies.

The idea of 'leaky gut' faces HUGE hurdles as diagnostic labs try to 'sell' various tests to PROVE the presence of leaky gut when they don't really prove anything.

Bob



Re: "Leaky Gut" makes MEDLINE! (Archive under LGS.)

Posted by Walt Stoll on September 03, 1999 at 16:45:54:

In Reply to: Re: "Leaky Gut" makes MEDLINE! (Archive under LGS.) posted by Robert McFerran on September 03, 1999 at 14:11:05:

You're Right, Bob.

Of course, the one thing you can be sure about it that they will never name it "leaky gut syndrome". That would be too easy for people to understand and would be tacit acknowledgement that they had been wrong these past 20 years while they regularly took away the licenses of docs who were quacks for talking about it.

They will come up with a name that has little to do with the problem and because they still have their precious monopoly will probably get away with it. How about IIP? That could be "increased intestinal permeability". All that really matters is saving face and keeping the patient in the dark about it.

Walt



Re: Gastroduodenal permeability

Posted by
Mike Kramer on September 03, 1999 at 19:30:20:

In Reply to: Re: "Leaky Gut" makes MEDLINE! (Archive under LGS.) posted by Robert McFerran on September 03, 1999 at 14:11:05:

Does anyone know if the gastroduodenal permeability test is commercially available? This is the first I've heard of it. My most persevering symptoms are from the upper GI tract. I probably wouldn't take the test even if it were available, since I wouldn be treating myself the same whether the results were positive or negative. But I do find it intriguing that there is evidence that the stomach leaks. Does anyone have any idea of the mechanism of this leakage?

For most of the small intestine I've seen many accounts of how leaks start. But the stomach?



Re: "Leaky Gut" makes MEDLINE! (Archive under LGS.)

Posted by
Robert McFerran on September 03, 1999 at 20:35:30:

In Reply to: Re: "Leaky Gut" makes MEDLINE! (Archive under LGS.) posted by Walt Stoll on September 03, 1999 at 16:45:54:

Walt,

Bullseye!!

You're last comments are exactly the corner that leaky gut will be funnelled into. Even worse it will become another incurable disease for both physicians and their patients to hold onto.

You were the only one who asked me (some 5 years ago)

"Well, why do some folks have leaky gut with the associated food allergies, etc.?"

It was such an OBVIOUS question, yet I would have never thought to ask it (at the time).

I am perplexed to this day why I needed someone else to ask me that simple question.

Thanks again Walt.

Bob




Re: Gastroduodenal permeability

Posted by Walt Stoll on September 04, 1999 at 13:41:52:

In Reply to: Re: Gastroduodenal permeability posted by Mike Kramer on September 03, 1999 at 19:30:20:

Hi, Mike.

If one part of the gut has LGS, the entire gut has it. Where one has the most symptoms depends upon the genetic makeup of that person but the resolution is the same no matter what.

Walt



Re: "Leaky Gut" makes MEDLINE! (Archive under LGS.)

Posted by Walt Stoll on September 04, 1999 at 13:50:45:

In Reply to: Re: "Leaky Gut" makes MEDLINE! (Archive under LGS.) posted by Robert McFerran on September 03, 1999 at 20:35:30:

Thanks, Bob.

I need someone like you (who actually hears what I am saying) to keep me putting stuff out there. Many times I watch people's eyes glaze over and know I am talking to the breeze.

You are my shining student and I thank the stars for your going far beyond what I had to offer you those 5 years ago.

Take a look at the note from Janet about MVP on 9/3/99 (sigh).

Namaste`

Walt



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