Leaky Gut Syndrome (LGS), also referred to as increased intestinal permeability, is a rapidly growing condition that is likely influencing the health of many of your patients.
It occurs when the intestinal lining of the digestive tract becomes damaged, allowing unwanted substances to flood into the bloodstream including undigested protein (including gluten), harmful bacteria and other undigested particles. Under normal circumstances, the intestinal lining acts as a barrier to these unwanted substances and is designed to open and close in a very tightly controlled manner, only allowing fully digested particles such as amino acids into the bloodstream. If foreign substances make it into the bloodstream, they will provoke an immune response, which can lead to many inflammatory, debilitating symptoms.
Many individuals are unaware they have LGS but will nonetheless struggle with the health challenges that characterize the condition. Scientific research has found a strong correlation between LGS and many conditions and symptoms, such as those with food allergies/sensitivities, low energy, chronic muscle and joint pain, sluggish metabolism and autoimmune diseases such as Celiac Disease, Lupus, Multiple Sclerosis, Hashimoto's Thyroiditis and Rheumatoid Arthritis. Many in the scientific community believe that LGS precedes autoimmune conditions. If this is true, that means there are at at least 50 million Americans (1 in 5 individuals) who have LGS, a staggering number that surpasses the number of estimated individuals who have diabetes and cancer combined.
The good news is that the intestinal lining can be restored back to health through practical dietary and lifestyle modifications as well as with the help of key supplemental ingredients. A common nutritional approach to helping manage LGS and restore intestinal health is implementing what is known as “the 4R Program.” This program consists of 4 steps that can help restore the intestinal lining as well as improve many other intestinal conditions and symptoms including gas, bloating, diarrhea, constipation and intestinal infections. These steps include: Remove, Replace, Reinoculate and Repair. Below is a brief overview of the 4R Program, including the Aceva products that can provide support during the program. As you will see, Aceva offers multiple product solutions that can help you rehabilitate your patient’s gut and ultimately restore their health and vitality. As you may have heard before, it is believed that all disease begins in the gut! As you continue reading, please keep in mind that although the 4R Program is described in various stages, all 4 stages can be initiated at the same time. In other words, you don’t necessarily complete one stage before moving to the next. Patients may need to remain in some stages longer than others.
Overview of the 4R Program
1. Remove
The first step involves identifying and addressing or removing physical and psychological variables that are contributing to LGS and other intestinal dysfunction. These include:
Mental and Emotional Stress:
Reducing psychological stress is essential in improving intestinal health, as negative thoughts and emotions trigger the production of inflammatory mediators and hormones including cortisol. When the body is under a stress response, the sympathetic nervous system is activated and the body’s resources are directed towards “survival” activities, which results in diverting resources away from the intestinal tract that would normally provide it with protection and nourishment. Practicing meditation, journaling and other mindfulness exercises can lead to a significant reduction in psychological stress, improved digestive health as well as improved quality of life (QOL).
Allergenic Foods:
An elimination diet is performed to remove the most common inflammatory and allergenic foods. This includes all highly processed foods, refined sugar, gluten containing grains, dairy, corn, and soy. Excluding foods that are typically known to cause an immune response include pork, beef, veal, coffee, all grains, chocolate, and most condiments. Allergenic foods are to be avoided for at least one month. This process may take longer for some patients than others, and needs to be individualized depending on each patient. Once sufficient symptom improvement has occurred, one food from a selected food group is added back one at a time and the patient is monitored for symptoms for 2-3 days against the food. If symptoms occur, the patient is to abstain from eating that food, but may reincorporate the foods they do not have experience with back into their permanent diet. Aceva’s Ultimate Body Cleanse (UBC) can be modified to the above criteria to initiate the 4R Program. The UBC diet excludes the most common inflammatory and allergenic foods and will require only a slight modification during some days of the cleanse, such as abstaining from consuming pork, beef, chocolate, coffee and the other foods that are not allowed on the 4R program as well as abstaining from reintroducing foods until the patient’s symptoms have improved significantly (usually between 1-3 months).
Pathogens:
Bacteria, yeast, and other parasites oftentimes play a role in gut-related symptoms and can directly damage the intestinal lining. There are a variety of tests that are available that can identify an intestinal pathogen. Once identified, the pathogen(s) can be addressed and eradicated using natural ingredients and/or medications. Aceva’s Candeva is a comprehensive, herbal formulation designed to help eliminate unwanted pathogens and help restore intestinal health.
2. Replace
In the second step, key digestive secretions that may be lacking are replaced and restored. These secretions include stomach (gastric) acid, bile and digestive enzymes which are essential in breaking down foodstuff so they can be properly absorbed as well as helping to inhibit the growth of pathogens. Dietary approaches to increasing gastric acid include avoiding drinking large quantities of fluid at meals and drinking a small amount of apple cider vinegar (ideally diluted in water). Incorporating digestive bitters into meals such as radicchio and arugula as well as radish, leeks, asparagus and dandelion root tea can help improve bile flow.
Aceva’s Gastro Plus is a unique digestive-enhancing formulation containing supplemental bile acids, hydrochloric acid (betaine HCL) and a comprehensive digestive enzyme complex that is capable of assisting in the breakdown of carbohydrates, fats and proteins. The product is taken before, during or after meals to facilitate the digestive process and enhance nutrient absorption.
3. Reinoculate
Those with LGS and other intestinal dysfunctions suffer from dysbiosis, a condition characterized by insufficient quantities of beneficial probiotic bacteria that normally aid in digestion, nutrient absorption, and “crowd out” pathogenic bacteria in the intestinal tract. The goal of the reinoculation stage, which generally lasts between 6-12 weeks depending on the individual patient/symptom improvement, is to restore these beneficial bacteria.The following variables can aid in this process:
Fermented Foods:
These foods naturally contain live probiotic bacteria (when they are not pasteurized) and include sauerkraut, pickles, kefir and kombucha. Making homemade sauerkraut or pickles is a fun experience and leaves you with a nutrient dense superfood that can help restore intestinal health.
Prebiotics:
Prebiotics are fibers that are non-digestible to human digestive enzymes, but can be metabolized by bacteria in the intestines. When these prebiotic fibers are metabolized, bacterial populations multiply and beneficial compounds are created such as short chain fatty acids that promote human health. It is important to eat a variety of prebiotic fibers to ensure a diverse population of bacteria thrive and survive in the intestinal system. This can be achieved by eating a variety of fruits and vegetables as well as whole plant foods. Keep in mind that some foods contain higher amounts of these fibers. Such foods include artichokes, leeks, onions, bananas, and garlic. Soluble fibers found in sources such as beans, oatmeal and many fruits tend to have more prebiotic activity than non-soluble fiber sources.
Probiotic:
Probiotic bacteria can also be consumed as a supplement. When deciding which product to give your patient, it is extremely important to make sure the product contains a diverse number of acid-resistant bacterial strains that have been clinically proven to provide health benefits. Although it is important to ensure the product contains a sufficient quantity or “potency” of probiotics (typically measured in colony forming units or CFUs), the diversity of the bacterial strains used and their biological activity typically outweigh potency when determining the quality of health outcomes. In addition, some products must be kept refrigerated or the bacteria will not survive or be as biologically active to provide health benefits.
Aceva’s Ultrabiotic is a unique probiotic formulation containing 11 different strains of bacteria as well as well as prebiotic fiber in the form of Fructo Oligo Saccharides (FOS). The bacteria are grown in a non-gmo medium and are monitored closely to ensure the strains do not mature past their “alpha phase” of growth. Bacteria in this phase are more biologically active than when they are allowed to mature into their later stages of growth. The strains of bacteria in Ultrabiotic have been researched in at least 23 studies that showed clinical efficacy in numerous health related conditions.
Important notes: Probiotics can also be effective in eliminating or crowding out intestinal pathogens, which is part of the first step “Remove”. Those with conditions such as small intestinal bacterial overgrowth (SIBO) or other intestinal infections may experience a worsening of symptoms when consuming large amounts of prebiotic fibers. For these individuals a low-FODMAP diet may be warranted.
4. Repair
The repair stage of the program focuses on rebuilding the intestinal lining through proper nutrition and may last up to six months or longer. In order for this rebuilding to occur, key nutrients must be consumed and/or supplemented while maintaining an anti-inflammatory diet.. This personalized anti-inflammatory diet will have been established with the “Remove” stage and food reintroductions that took place.
Omega 3 Fatty Acids:
These fatty acids are especially important in promoting an anti-inflammatory environment to allow healing to occur. You can recommend the patient eat cold water fatty fish such as salmon, mackerel and herring to obtain dietary fatty acids. However, many individuals do not obtain sufficient quantities of omega 3 fatty acids in their diet due to not liking the taste and/or concerns of mercury contamination and may require a supplement. Aceva’s Omega 3 Plus makes a great addition to the program to supply these critical omega 3’s. It contains the triglyceride form of omega 3’s, which are up to 51% greater than ethyl ester fish oils. Omega 3 Plus is tested for mercury, lead and other contaminants that are typically found in fish. It is extremely important to ensure omega 3 supplements are manufactured in a way that minimizes oxidation, as taking rancid fatty acids can cause more harm than good. Omega 3 Plus is encapsulated in a nitrogen infused environment to minimize oxidation and maintain potency.
Glutamine:
This is an amino acid that is thought to be the primary compound involved in tissue repair, including the intestinal lining. It promotes growth and repair by coating cell walls, acting as a repellent to irritants such as bacteria and their toxins as well as acts as a building block with other amino acids to rebuild and/or grow new tissue in the body. Although glutamine is regularly consumed in significant quantities in a typical diet, supplemental glutamine is oftentimes needed due to the increased demand for tissue repair that is required during LGS and other intestinal dysfunctions. Aceva’s Muscle Support IG is an excellent option when supplemental glutamine is warranted. It contains a unique combination of L-glutamine and pyridoxal alpha-ketoglutarate (PAK). PAK is the unique ingredient that naturally recycles L-glutamine, so the body can use it over and over. This essential recycling system reduces the need for extremely high glutamine dosing regimens, which can result in cost savings and increased patient compliance.
Herbs such as licorice root extract (DGL), marshmallow root extract and slippery elm can also support intestinal repair. These herbs aid in coating and maintaining the mucosal lining of the stomach and intestines, which can help decrease inflammation and soothe the intestinal tract.
Bone Broth usually makes an excellent addition to an intestinal healing protocol due to containing collagen and the amino acids proline and glycine that aid in repairing damaged cell walls.
Aceva’s 4R Program Protocol
Ultimate Body Cleanse: initiate the program with the cleanse with the modifications stated above
Candeva: take as directed for 1-2 months
Gastro Plus: It is recommended to perform the betaine HCL challenge to determine each individual patient’s needs. If this challenge is not performed, taking 1-3 capsules during or after larger meals should provide sufficient support and may need to be supplemented for at least 3-6 months
Ultrabiotic: take 2-3 capsules daily for 2-3 months
Omega 3 Plus: take 1-2 softgels, twice daily with meals for 4-6 months
Muscle Support IG: take as directed for 4-6 months
** This dosing schedule may need to be modified and is subject to change pending individual patient responses and requirements.
Resources
http://www.chopra.com/articles/heal-your-gut-with-the-4r-program#sm.001virdfh192be7mqhi2bwppdcnar
https://calebscookingcompany.com/autoimmune-diseases-cancer-heart-disease/
https://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html 29.1 million (diagnosed and undiagnosed)
https://bodyecology.com/articles/why_proper_bile_flow_essential_for_getting_rid_of_toxins.php
https://draxe.com/low-stomach-acid/
https://draxe.com/4-steps-to-heal-leaky-gut-and-autoimmune-disease/