What Is A Leaky Gut? (And How Can It Cause So Many Health Issues?)

March 15, 2012 in Categories: , , , by

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(Created as a guest post for The Paleo Parents)

One of the fundamental principles of paleolithic nutrition is avoiding foods that damage the lining of the gut.  Essentially, the gut is just a long, wrinkly tube.  Inside this tube, food is digested by enzymes and friendly resident bacteria, breaking down the components of our food to their simplest forms: proteins are broken down into amino acids; carbohydrates are broken down into monosaccharaides; and, fats are broken down into fatty acids.  What can’t be digested by our bodies is excreted as waste.  Amazingly, a single layer of highly specialized cells (called enterocytes) is all that separates the inside of the tube from the outside.  These enterocytes have two very specific jobs:  1) transport the digested nutrients from the “inside-the-gut” side of the cell to the “outside-the-gut” side of the cell; and 2) keep everything else on the inside of the tube.  Immediately outside this tube are two important parts of the digestive system: 1) the resident immune cells of the gut whose job it is to protect against pathogens which might accidentally find their way through the enterocytes; and 2) a network of blood vessels and lymphatic vessels that carry the digested nutrients from our food to the tissues in our body that need them (amino acids and monosaccharaides are transported through the blood while fatty acids are transported through the lymphatic system). 

A “leaky gut” occurs when either the enterocytes are damaged or the proteins that form the tight bond between these cells and hold them together as a solid layer are damaged (or altered).  When this happens, it creates microscopic holes through which some of the contents of the gut can leak out into the blood stream or lymphatic system.  What leaks out isn’t big chunks of food.  Instead, it’s a combination of many different pathogens: incompletely digested proteins, bacteria or bacterial fragments from those friendly bacteria that are supposed to stay inside your gut, or a variety of toxic substances or waste products that would normally be excreted.  When these pathogens leak out, the resident immune cells of the gut recognize them as foreign invaders and mount a response against them (when large quantities of pathogens leak out, other parts of the body, especially the liver, also contribute to the response).  Exactly what leaks out, and how much, determines the precise nature of this immune response. 

 Some pathogenic substances (like bacterial fragments and toxins) cause generalized inflammation by triggering the release of chemicals called inflammatory cytokines (the chemical messengers that circulate in the blood and tell white blood cells to attack).  This type of inflammation has no target so any cell in the body can be an innocent victim.  It is the liver’s job to both control this type of inflammation and to filter out the toxins that may be triggering it.  When the liver is overworked, the toxins build in the body and the inflammation spreads.  This type of inflammation can be a major contributor to health issues ranging from psoriasis and asthma to ADHD and depression.

Other substances (like incompletely digested proteins) cause specific inflammation, which can take the form of an allergy or an auto-immune disease.  An allergy is caused by immune cells creating IgE-type antibodies targeting a part of a protein that is specific to the food it originated from (like an antibody targeting the casein in milk resulting in a milk allergy).  A very similar type of immune response is caused by immune cells creating IgA-, IgM- or IgG-type antibodies targeting a part of a protein that is specific to the food it originated from.  This type of immune response is technically considered a food sensitivity (and not an allergy), and can cause both allergy-type symptoms and symptoms that you might not normally attribute to an allergy, such as: pain, fatigue, and eczema.  It is also the formation of these types of antibodies that can cause auto-immune diseases.  Antibodies target only a short sequence of amino acids, and not all of the amino acids that form an individual protein.  In the case of food allergies and sensitivities, this short sequence of amino acids is still specific to the food it originated from.  But, sometimes the antibodies that form in response to “leaked-out” proteins target a sequence of amino acids that isn’t unique to that protein, but instead is a sequence of amino acids also found in many other normal proteins in the human body.  When this happens, the body attacks itself thinking its own cells are foreign invaders.  For example, an antibody could form against a sequence of amino acids that is found in the insulin-secreting beta cells of the pancreas.  When the body attacks those cells, it causes Type I Diabetes.  An enormous range of autoimmune diseases can be caused in this way, from lupus to celiac disease to Graves’ disease (many of which include genetic susceptibility as confounding factor). 

It is important to know that, for some individuals, a leaky gut can develop slowly over years or decades.  Stress, sleep-deprivation and/or some infections can make matters worse very quickly (and unpredictably).  Once you have a leaky gut, it is only a matter of time before related health conditions begin to crop up.  Depending on the extent of the damage to the gut lining, the exact substances that leak out, and your specific genetics, the inflammation and immune reactions caused by having a leaky gut can add up to any of a huge variety of different health conditions, many of which can be life-threatening.  This is why the gut-friendly, anti-inflammatory paleo diet is known to address so many different health issues:  if your gut is healthy, then so are you.

Comments

Wonderful post. I am learning, learning, learning about this condition at the ripe age of 54 and trying like crazy to repair the awful damage I have done to myself. I’ve been low carb and traditional for the past year. I am getting there but I know I have another year at least to boost my immune system. Its a slow battle. But I’m fascinated with this topic. I have read the GAPS book which I need to tackle again since it was kind of over my head at the time. But I’m getting there. I wish I knew about this or would have believed in it when my son was younger because he has ADD and is now 23 and won’t give up processed food. Maybe with time I can convince him. Anyway, thank you again.

P. S. I’m leaning more paleo all of the time. My actual question was if you have any feelings about raw milk and it still being banned from paleo eating. I’d like to keep raw milk (on very few occasions) but yogurt and dairy more, all grass fed.

I have signed up today to get your email thanks to your Paleo Parents link.

Thanks Molly! I think that grains and legumes are more damaging to the gut than dairy, so it would be more important to cut those out first (and cut out modern vegetable oils and excess sugars too).

The benefit or harm that might be caused by dairy, especially raw grass-fed dairy, is one of the more contentious issues in the paleo community. I personally believe that milk can be okay for some people and not for others. You won’t really know how good it is for you until you cut it out for a while (at least a month, three would be better) and then try re-introducing small quantities and see how you feel. Myself, I consume grass-fed butter daily and seem to be fine with it, and will very occasionally (like once per month) indulge in a piece of raw, grass-fed cheddar. Generally, I don’t tolerate milk proteins very well.

If you are still eating some grains and legumes, I would worry about getting those out of your diet first. But if you are still dealing with symptoms after a couple of months, it would definitely be worth reconsidering your dairy consumption.

I hope that helps!

I’m concerned that kicking dairy out of my diet will push my calcium and phosphorus levels too low, especially because I am still nursing. What is the consensus in the Paleo world on absorbable forms/ food sources of calcium if I’m not doing dairy? Generally WAPF recommends calcium-rich vegetables in combination with butter to help with absorption. I’m just not sure what to do without dairy for calcium, especially because my teeth and my toddler’s need all the calcium and phosphorus they can get! My gut is in the process of healing, so I know I’m not getting everything out of food that I possibly can right now.

Dairy is a contentious issue. Most people agree that it’s not good for those with leaky guts but that many people benefit from it after healing. As for food sources of calcium, phosphorous and magnesium, I think the best is bone broth. When you boil the bones, add 1-2 Tsp of vinegar to the water which helps to demineralization the bones (which means more minerals in your broth). I boil my bones for 36-48 hours,until they are so soft they are falling apart (you can eat these too, although they don’t have alot of flavor). Other great sources are canned fish where you eat the bones like salmon or sardines. Green veggies beside grass-fed meat ( or cooked in grass-fed tallow) would have the same absorbablility benefit as butter.

I AM SO GLAD you are writing this blog…I have fought this problem now for MANY YRS and just recently read “Wheat Belly” and then decided to check out Jimmy Moore again…wala..found your blog. IT IS REALLY HELPFUL.

Nice article. I have two questions:

“A “leaky gut” occurs when either the enterocytes are damaged or the proteins that form the tight bond between these cells and hold them together as a solid layer are damaged (or altered).”

Why does this happen in the first place?

Also, according to Chris Masterjohn: “As I pointed out in my last gluten post, a recent paper by gluten researcher Dr. Allesio Fasano and colleagues found that intestinal permeability was even lower in people they judged as having non-celiac gluten sensitivity who had been eating gluten under supervision for four months when they compared them to control subjects, whereas those with active celiac disease had greater intestinal permeability.

Likewise, the recent double-blind, placebo-controlled gluten trial found that six weeks of gluten consumption did not cause any change in intestinal permeability in subjects the authors judged as having non-celiac gluten sensitivity.”

So, if non-celiac people don’t usually have a leaky gut, what are the mechanisms that makes gluten harmful to them?

Great questions. So, no one really knows what starts the leaky gut. It may be a viral infection, stress, genetic susceptibility (like a variation of what happens in celiacs), medications, or a combination of many components of food that break through the mucus lining and allow damage to or alteration of the gut enterocytes. There is far more unknown here than known. Also, small changes in intestinal permeability can cause absolutely no symptoms in one person and huge symptoms in another, depending on how their body reacts to substances that might leak out. And these small changes may or may not be measurable with current techniques. Why one person reacts and another person doesn’t is not understood (but very likely points to partial adaptation to eating grains, see this post http://www.thepaleomom.com/2012/07/why-arent-humans-adapted-to-grains.html).

What is really interesting about the studies that Chris Masterjohn is referring to is that the volunteers with gluten sensitivity has an increase in a tight junction protein called Claudin-4, which might be the body trying to compensate for effects that gluten or other components of wheat is having on the tight junctions or intestinal permeability or could be an indication of a greater adaptation. Also, these patients had activation of the innate immune system (inflammation as opposed to adaptive immunity in which there is antibody formation)in response to eating gluten, but this study was not able to show why/how. The point of this study was really to show that gluten sensitivity is a different entity than celiac disease and point out the need for more studies on gluten sensitivity.

The other limitation of all studies is how the “normal” group is chosen. If Prof. Cordain is right in that gluten causes increased intestinal permeability in the vast majority of people, then it’s hard to find a group of people unaffected to compare against in these studies. This might be why the variability in intestinal permeability measurements was so high in all of the groups in the study.

Researches are just beginning to understand how foods affect our bodies, which means that a diet based on this science (the paleo diet) is likely to evolve as our understanding improves. For now, I think there is far more information pointing to gluten being harmful in the vast majority of people than the contrary.

My husband has battled loose stools for a while now. It is starting to get to the point where he eats something, and almost instantly he has to find a bathroom. He never has any warning beforehand. My question is does leaky gut cause diarrhea? I have been trying to tell him I think that is what he has, but after reading this, I am not sure. He is not paleo, but I really think that he needs to try an elimination diet to get it figured out. Any advice or suggestions?

I think autoimmune disease is originally caused by leaky gut, which allows large foreign proteins to come into the blood. These proteins cause low-grade inflammation through the innate immune system, but do not initially cause autoimmune issues. However, when an infectious agent is encountered, the infection ramps up the adaptive immune system and, because the leaky-gut foreign proteins are present, can cause the immune system to create antibodies to them as well, and to “learn” that these proteins are dangerous. So in the future, any exposure to these foreign proteins causes B cells to ramp up their antibody production and can cause T cells to ramp up as well.

So with autoimmune diseases, the body is not trying to kill its own cells or create problems with its metabolism — it thinks it is fighting a serious infection, signaled by the foreign proteins leaking through the gut, or recognized by the gut-centric immune system. This explains why “just a sip” can cause a flare-up: it doesn’t take a lot to trigger a learned immune response.

This theory seems to fit all/most autoimmune diseases, and when you eliminate *all* foods that trigger an immune response, the auto-immune disease goes into complete remission. Of particular note is that B-cell-created antibodies have a half-life of about 2 weeks, and eating a trigger for an autoimmune issue will usually cause a “flare” for 1-3 weeks. Elsewhere you say that each time you ate a trigger food, you had two weeks of flared lichen planus, and we’ve had similar experiences with our food sensitivities.

Of course, the infectious agent that upregulates the adaptive immune system could be gut bacteria as part of the leaky gut, or a vaccine…

This explains why taking digestive enzymes helps many people with auto-immune issues. The enzymes break down the larger proteins that would trigger an immune response.

If this is all correct, then the cure for auto-immune diseases is to just stop eating foods that trigger an immune response, exactly as you recommend. (And healing a leaky gut would prevent future triggers from being created.)

BTW, a recent study suggests that insulin resistance is an auto-immune disease: http://med.stanford.edu/ism/2011/april/engleman.html

Also, wheat causes leaky gut whenever you eat it — so anytime you get an infection or vaccine and are eating wheat, that can cause it to turn from a low-grade inflammatory food to a trigger for a strong immune response. If you continue to eat it after that, you will have various auto-immune issues, depending on which particular protein sequences were targeted.

Today I woke in so much pain. It was an all-night thing, my stomach, my hands, all the way through my shoulders to my feet. When this happens, I always say that it must be something I’ve eaten. I took leftovers with me today, which I always do, then sat down and decided to pick them apart. I thought I was doing the right things, as Paleo is new to me, so there must be a learning curve. Your site seriously helped. On my plate was (notice I said was – I threw them away) eggplant, green peppers, and tomatoes. As I said before, these were leftovers, from last night’s dinner; also included in that dinner, was paprika and other spices which were included in your nightshade post. While reading through each of your posts, I ended up here, and thought I should comment – “Thank You!” I have suffered from autoimmune disorders/diseases since I was very young. I had many very serious episodes where I was falling down stairs and tripping over things when I was very young. I would often cry, because I was in sooo much pain (before falling down). There would be so much heat radiating from my knees. Nothing could be found wrong with me. In my teens, I ended up with ITP, they eventually removed my spleen. Since, my thyroid has quit working, I suffer from “depression,” that is always the go-to diagnosis. My weight, can get away from me very easily if I do not monitor it at all times; however, when I was younger, I may have weighed a whopping 107 to 117 lbs. Each pregnancy, my hormones seemed to dictate tremendous weight gain, each time within a year I would be back down to my normal weight. Then my thyroid went, I’m sure you can imagine my struggles with that, physical and mental. I quit dairy a long time ago, still had problems. I’ve tried many diets, most recently decided on the Paleo diet. This seems to be working for me. But, as I said before, I’m still learning. Sorry about being histrionic, but I felt as though I should share, and let you know that I will be following your website religiously.

I love that you used the work histrionic in a blog comment! Stress management and sleep are really important for thyroid function, as I’m sure you know, but just want to make sure there’s a focus on lifestyle aspects in addition to diet. :) Good luck with your journey!

Touché on the histrionics Not a lot of experience here in Blogger World, as seen by my using my real name. I’ll change that in a few. Anyway, yes, over the years (many many) I have made significant lifestyle changes. I quit smoking years ago. I was a longtime closet smoker. I’ve tried diet after diet only to give up and go right back to old habits. I exercise regularly, but then again, there are times I fall off that wagon. As to sleep, I’ve always been good at it; unless, my digestive system acts up. That typically will wake me at awful hours. Work can tend to take hold of me and cause a great deal of stress, I’m managing, and whose doesn’t. So, I do believe finding your blog is probably the best thing for me. I will have lots of questions as I read on. Thanks again!

Hi, what do you think when a lot of doctors laughing at the “leaky gut” syndrom? they said that is just a Myth, and never be the true, as the Gut simple can not be leaky. I brought this one to my Doctor, and he is just laughing and .. laughing.. :(

Tons of research? Weird that you don’t cite the papers.

You also state in a previous comment that more is unknown than known. So, which is it?

A careful scientist will try to avoid confirmation bias when seeking out and analyzing research data. I don’t see you holding to that standard.

I agree with you. This is a very old post, written in the first few months after the creation of this blog. While the content is still accurate (explained in great detail in my book which contains 1200 scientific citations), it is a post I have been meaning to come back to, expand on several ideas, and add references to as I do with all of my scientific posts now.

Although I am no scientist,there is one thing I can say is that having the condition is more proof than anything else.Of course it is always possible there is something else going on however, after eating food that is known to disrupt the gut barrier I feel a specific and pretty unique reaction every time.Usually within the hour after eating something like egg whites if it is going to happen, I can feel it go into my bloodstream( and not in the way its supposed to) and my whole body lights up, my pulse and heart rate quickens like my system is on red alert.Following this I will become irritable,tired and have a great deal of brain fog and depression the next day.It not an allergic response its not even like anything but what I would call specifically an autoimmune reaction. If I fall off of those foods for a few weeks and let my stomach heal I can eat them again without a reaction because my stomach lining heals but its only a short period of time before it starts again if I keep eating those foods known to disrupt the gut barrier. I tell ya its an odd ,odd thing!

Hi Sarah, Ive done the autoimmune diet for a number of months and done very well. Upon introducing foods back in I would be great with them for a while but then it seems with time these foods would how do I say, rip my stomach open all over again?It seems my leaky gut really never heals.I will get some healing in,reintroduce new foods, be okay for two to three weeks or so and then be almost back to square one overnight again.What do you think.. does this mean I should just forget reintroducing all together, or should I go for something like two years or so before even thinking about trying new foods? Thanks!

That’s a tough question to answer. Some of the foods are really only problems when consumed frequently (like alcohol, egg whites, coffee…) and reintroduction might be more a question of figuring out how frequently you can indulge without issues. But it could also be that your gut just isn’t ready yet, in which case, more time is needed. I don’t know if you need 6 months or 2 years or 5 years, and there’s really no way to know without experimenting on yourself (sorry that’s such an uninformative answer!)

Dr. Wolfgang Lutz – original author of the (german text) “Leben Ohne Brot” (now also in english with an american co-author) clearly documented in his thousands of lo-carb healing attempts on patients – that some people take 6 months while others 5 years and some never really totally “recover” but just do better at one level or another. I think you are right Sarah, that the myriad of factors – genetics, damage done, types of foods and on and on affect the eventual outcome.

my partner did brilliantly after a lifetime of neuro-dermatitus after changing to a paleo diet – but upon returning to native switzerland and the creeping in of a little dairy here and there, the dramatic reduction of sunlight in her life (we lived in the desert in the southwest at the time of her best healing) and the substantial increase in stress dealing with creating a new life in her home country (old patterns grabbing hold again…) led to a serious eruption of her autoimmune disorder and we think, the destruction of her intrinsic-factor producing cells in the stomach – pernicious anemia resulting.

it is sooooo complicated a condition – which is why conventional medicine is overwhelmingly clueless – there is not way to get a definitive determination and then shoot the condition down with a magic big-pharma pill.

day by day – is all i can say…..

Thanks Sarah, no you actually helped alot with that answer.That was what I was already suspecting. I think I get so excited about a new food (like egg whites) that I think I start overindulging too much and then that’s what causes me problems. I think if I kept them down to once a week or so it just might work so Ill do some experimenting when I heal up again.

Hi Sarah,

I find your blog so informative, thank you for educating people like me :) I’ve been dealing with food sensitives for years and I had no idea. I constantly had swelling in the ear, throat constriction etc but couldn’t figure out why. Even got allergy test done, nothing showed up ( no food allergies) except for severe environmental allergies.

After suffering from these allergies for quite some time, 3 years back I found out I’m hypothyroid and have Hashimoto’s. I started eliminating foods from my diet. I started with soy, followed by dairy. Going dairy free made an amazing difference, my acne disappeared, so did my heartburn and my digestion improved greatly. I always ate well and worked out, but for some reason I developed a belly. Going off dairy, that spare tire disappeared. I’m pretty sure that it had more to do with inflammation, then anything else.

Now, to my question. I’ve gone egg free and gluten free too, 10 days back. Ever since I went gluten free, I noticed that my stomach started to swell up again, it’s like some kind of inflammation is back. I’m trying to figure out what’s going on. Could you kindly shed some light on this, would really appreciate some input/advice.

Many thanks.

It’s hard for me to know for sure. There’s certainly some adaptation that can take a few weeks when you go gluten-free (it can change how quickly the muscles around your intestines contract, which should normalize again in a few weeks) and change the amount of mucus produced by the cells that line your intestines, which also affects transit time. For me, the most important question is what did you replace those foods with? Are you eating lots of vegetables? fruit? rice? I think it might be a question of what you’re eating more of rather than what you’re not eating. That feeling of a bloated belly can have a lot to do with gut bacteria levels in either your large or small intestine (FODMAPS sensitivity is something to read up on, given that going dairy-free made a difference here) and can also be related to stress (for example if eliminating gluten and eggs means you’re really low carb now, or if you also aren’t getting enough sleep, or if you’re increasing your intake of a food that you’re actually sensitive to). I know none of these are definitive answers, but hopefully this helps.

Thank you, for the reply. I think I will have to look further into my diet and correct it. I’m also thinking I need to look into candida and overgrowth of yeast. I’ve been on a ton of medications in the past most of which were antibiotics and for acid reflux. Thanks again :)

After I did my elimination diet I identified three reactions to different things. The first was an autoimmune reaction to certain foods ie it crossed the barrier and set me off for three days. The second were foods I just couldnt digest well, and the third and actually most frequent were basically pretty much any ingredient that wasnt 100 percent natural. Even the most basic additives like citric acid killed my stomach.I also got the same gnawing, nagging pain from grains, beans and nuts due to lectins I suspect.

After about six or seven months of eliminating all irritants its gotten a little better but its still there when something slips through. Ive found the gluten has been the easiest thing to eliminate, but its all the other stuff that I battle with more. It forces me to stay healthy but my question is, just what causes the aching pain with certain ingredients and foods?Is it that my villi is just maybe still so blunted that it cant digest anything or, do I maybe have sores on my stomach that are sensitive to the fake stuff? It sounds odd I know but that’s what it feels like it aches so bad!

What I find so weird is that just months ago I “thought “I was digesting many of these things fine until I eliminated them and now as you stated in one of your blogs, “it is abundantly clear” when I eat the wrong thing, wow the human body,or MY body for that matter, its just so weird to me. I would think I would have gotten less sensitive after healing but seems many of these sensitivities are here to stay. (although in general I gotta say I feel way better on the autoimmune diet than I have in a while)

To be honest, I’m not really sure what would cause the pain. It could be damage, but it could also be things like autocrine or paracrine release, or even certain hormones. I think it’s still a good idea to listen to your body, but I really can’t tell you what that pain means physiologically.

The increased sensitivity is due to changes in the immune system (the cells that react last longer than the cells that normally restrain the reaction). It should diminish over time (although that can take months and even years for some people).

Thanks, Sarah, with the help of my naturopath I also think I might be dealing with a possible histamine tolerance as well. If so, I guess that might also be contributing to the pain as well. I cant imagine losing any more food but I think until I discover what else might be going on with me the feeling of my immune system being overactive seems to persist.Leaky gut has been pretty hard for me to fully heal but Im gonna keep at it thanks the help from blogs like yours I don’t have to go about it completely blind at least!(:

Thank you for sharing! I did not read the entire thread, so please forgive me if it has already been answered… I’m curious how can leaky gut be confirmed…. is there a specific test?

There is a test called a lactulose-mannitol test that can detect more severe cases. It’s fairly controversial how sensitive the test is and many people believe the false negative rate is high. This can be done in conjunction with stool and urine analysis for gut dysbiosis though (I think it’s the Metametrix Organix test) and those two tests together can be very enlightening for diagnostic purposes.

I’m almost positive I have SIBO/Leaky Gut, but the strange thing is that I was fine before I started following a Paleo food plan. I started eating a Paleo diet in December to clear out the processed food and dairy I was consuming a lot of. I was successful and felt great for a few weeks in terms of better tolerance of my arthritis pain and I lost some weight, but digestion issues came with along with those positives. At first it was constipation, but now, almost three months in, I have extreme bloating (I seriously look six months pregnant), a bacterial vaginal infection, which leads me to believe my body is riddled with bad bacteria right now, and constipation, cramps, the works. I am miserable. I am doing probiotics and kombucha and it helps only a teeny bit. All the research I’ve done for people with SIBO/Leaky Gut say to eat a Paleo Diet … yet that’s what got me in this position! So now what?! I’m tempted to get my doc to prescribe a really strong antibiotic to wipe everything out and start over. The idea of waiting two years to undo what I did to myself with the best of intentions is very frustrating.

You will want to see a qualified practitioner and test for SIBO (or other possible causes of your discomfort). If you test positive, your doctor’s treatment plan may include antibiotics/antifungals and/or herbal supplements like oil of oregano. You can find Sarah’s troubleshooting tips here: http://www.thepaleomom.com/2013/04/how-do-i-know-when-its-working-a-quick-troubleshooting-guide-to-paleo.html and might want to consider the autoimmune protocol: http://www.thepaleomom.com/autoimmunity/the-autoimmune-protocol – Christina, Sarah’s assistant

A few things you could try.

We recently found out we were sensitive to coconut oil, and it was causing us to bloat after every meal. Cutting out coconut oil altogether made a big difference. We are going to try reintroducing it after a couple of weeks, at very low dosage.

Another possibility is that you need more carbs, because the mucosal lining of the gut needs them, and if you don’t have what you need, it can cause gut/digestion issues.

Another is sensitivity to nuts. You could eliminate them altogether, if you haven’t already, and see if that helps.

hi paleo mom. i am struggling to establish whether i should be on on the pale diet or the autoimmune one. after years of IBS-like symptoms, especially bloating, and sustained depression and anxiety and i am now experiencing extreme fatigue that is made much worse by doing ANYTHING that involves any kind of exertion. i recently had an endoscope to explore my extreme reflux that found a 3cm hiatal hernia but what concerned me most was the fact that they could still tell me what i had for breakfast 7 hours later. my stomach was still pretty full and full of acid. i am just at a loss. i am waiting for biopsy results to come back but all they have prescribed until them is PPI’S. i would be so so grateful for any advice. Do you you thin i have leaky gut? many many thanks. clair.

Yes, it does sound like you might benefit from the AIP. If you are not currently Paleo, you may wish to try Paleo for a month or two to see what kind of results you have. If you don’t feel better, that would be a good indication you should try the AIP. – Christina, Sarah’s assistant

Thank you so much for the amazing info you provide in such a simplified way. Really helpful to myself and my family, great work! God Bless!
Lisa Rambo

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