Multiple Sclerosis, Leaky Gut And IBS Part 1
There are two symptoms that frequently come up when I talk about nutrition and MS with a group of fellow MSers: fatigue and constipation. I have written about these topics here and here. Recently I have encountered several questions about digestive issues and their relationship to MS. Specifically “Leaky Gut” and IBS. Although these topics are related I have broken them into two posts. Also, many of the questions I have received about “Leaky Gut” and IBS have fallen into general categories so I have addressed the questions in this way rather than listing specific questions. First up…”Leaky Gut”. I will address questions about IBS in Part 2 which will be published before the end of April. As it happens, April is IBS Awareness Month so this is a great time to spread awareness about IBS in the MS community!
Show Me The Evidence!!
Before I go any further I want to take this opportunity to emphasize how important it is to evaluate the credibility of health information available on the internet, social media and elsewhere. Students in middle school are required to cite their sources on papers that they write so it should be reasonable to require (at least!!) the same level of citation from providers of health information. What I mean here is that information providers should be citing the source or reference materials for any claims they are making. Dig around a bit to find out about the products, services or service providers you are considering spending money on. The internet is a fabulous tool. It allows people from all over the world to communicate, inform, educate and connect in any number of ways. It is also a great place to sell ideas, products and services. If a particular product is making a claim … investigate it. What are they basing the claims on? Is there any research to support the claims? Go here and here for tools that can help you to evaluate health claims.
What Is “Leaky Gut” Syndrome?
Intestinal permeability is the property that allows fluid and nutrients to exchange between intestines and body tissues. This is a good thing actually. Simply put it is how we obtain water and nutrients from the foods we consume. But in theory it can be bad as well. “Leaky Gut Syndrome” is not a clinical diagnosis (which is why I have used quotation marks around the term), rather it is a term that refers to compromised intestinal barrier function. It is hypothesized that there is link between intestinal barrier dysfunction (“Leaky Gut”) and several diseases including multiple sclerosis, although it is most widely studied in relation to Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS) and Celiac Disease (CD). The role of the gut microbiome in all matters of health is a new and important area of research.But the relationship between the gut and the neuroimmune system is not fully understood. Although much has been learned there are no conclusive findings and much more research is needed in this area.
Intestinal barrier dysfunction (“Leaky Gut Syndrome”) research in the area of Multiple Sclerosis is in the very early stages and has only been studied in mice; it’s relevance in human disease has not been tested.
How Do I Know If I Have a “ Leaky Gut Syndrome” ?
I get this question quite a bit from people emailing with questions about MS. My response is to reply with another question… What makes you think your gut is leaky? I am surprised by the number of people who state that they are not having any actual symptoms but believe that MS itself is a symptom of “Leaky Gut”. Some people attribute all MS symptoms (spasticity, numbness, cognitive issues, fatigue,etc) to “Leaky Gut” and are hopeful that by healing their gut they will rid themselves of these symptoms. To be clear, “Leaky Gut” is not a recognized human health diagnosis and there is no evidence to support the notion that MS is a symptom of “Leaky Gut”. There is also no evidence to support the notion that by healing “Leaky Gut”, MS symptoms will improve. This may change as the research continues, but at this time there is no such evidence.
If you are having GI symptoms like gas, bloating, abdominal pain, diarrhea, constipation I would suggest starting with these specific symptoms. Perhaps you have a recognized condition such as IBS? At least one study finds that IBS occurs more frequently in people with MS. **I will be writing more about IBS in my next blog article so check back for that later this month.**
How Is Leaky Gut Diagnosed?
While measures of intestinal permeability exist, interpretation is complex and can be confounded by variables such as motility and transit time. At this time it remains unclear how the results should be used to guide treatment.
How Do I Heal My “Leaky Gut”?
Currently there is no evidence to support the need to treat “Leaky Gut” or what that treatment might be. There is no evidence that nutritional supplements or herbal remedies promoted to treat or heal “Leaky Gut” will actually “heal” anything. These regimens almost never include information on how to identify when and if your gut has been healed. Some suggest that it is entirely possible to have a “Leaky Gut” and not even know it! Which means you will likely need these supplements indefinitely, right? There is also no evidence to suggest that even if you were able to heal your “Leaky Gut” it would result in healed or cured Multiple Sclerosis or any other medical condition. Products promoted to heal your “Leaky Gut” should be viewed with caution.
Most of the products promoted to heal “Leaky Gut” are very expensive. Just this morning I saw a post in my FaceBook feed urging me to read a post that would tell me how to “Heal Leaky Gut and Autoimmune Disease”. Curiosity got the better of me. I clicked the bait and was directed to a page where I was encouraged to purchase a supplement regimen that would …. “Heal Leaky Gut and Auto Immune Disease”. Ugh. And as luck would have it the regimen was on sale! The usual price of $150.00 for a ~1 month supply is (temporarily?) slashed to $109.00. Even at the sale price, that is over $1200 per year for supplements that have no evidence to support efficacy at anything besides generating prosperity for the seller! Could these products be the Emperors New Clothes of supplement regimens?
Many of the claims on food packages and supplements are unsubstantiated. Neither the U.S. Food and Drug Administration (FDA), nor any other federal or state agency, routinely tests nutrition powders and drinks for quality prior to sale. They may or may not contain the amount of active ingredient you are looking for and they may contain ingredients that you might not expect or want (sugar, non-nutritive sweeteners, saturated fat, caffeine, vitamins, minerals or herbs).If you do decide to include one or more of these products in your supplement regimen please share the information with your healthcare team.
Save your money!! If you have even considered spending this much money on supplements to heal a condition that has not even been clearly defined in a clinical sense I urge you to spend some of that money on quality food. Or a yoga class. Or art. Or a vacation. Or donate money to support MS Research. Or do something that brings you JOY. Any of these expenditures will certainly improve your quality of life and health more than the “Leaky Gut Cure” regimens currently promoted on the web and elsewhere.
Feed Your Whole Body… Including Your Gut.
Consuming a balanced diet low in saturated fat, salt and sugar but full of vegetables, fruits, whole grains, beans, nuts, seeds and lean proteins will be beneficial for your whole body including your gut. Aside from supporting optimal overall health, this eating pattern will provide abundant prebiotic fiber which is known to ferment in the gut to produce short chain fatty acids thought to support optimal gut health. Select probiotic foods to keep the gut flora in balance. Check out Consumerlabs.com for information about prebiotic and probiotic supplements.
“Leaky Gut” And Multiple Sclerosis In a Nutshell:
I do not mean to sound so negative here but as a nutrition professional living with this horrible disease I do take it personally when products are targeted at people with MS and other health conditions like cancer. I am very happy that research is investigating this connection and hope it provides some much needed guidance on therapeutic approaches. My answers and opinions on questions regarding “Leaky Gut” are based on the evidence currently available and reported in reference materials including those listed below. Advances have been made (and continue to be made) in understanding the relationship of the gut microbiota and multiple sclerosis and other diseases but it is far from settled science. At present, “Leaky Gut Syndrome” and it’s possible relationship to MS is a theory that has been tested in mice not in humans. Intestinal barrier loss or dysfunction (“Leaky Gut”) alone has not been shown to cause any disease, including MS. There is no evidence to support the need for treatment or what that treatment might be.
I truly hope that in the (near?) future we will have enough information to make evidence based suggestions regarding “Leaky Gut Syndrome” and multiple sclerosis, but we are not there yet. Until then help your gut by taking care of your whole self! Eat a balanced diet. Move your body often. Sleep well. Manage your stress. Honor your self care needs. Beware of people trying to sell hope in an expensive bottle.
Bischoff SC, Barbara G, Buurman W, Ockhuizen T, Schulzke JD, Serino M, Tilg H, Watson A, Wells JM. Intestinal permeability–a new target for disease prevention and therapy. BMC Gastroenterol. 2014 Nov 18;14:189.
Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012 Feb;42(1):71-8.
Maranduba CM, De Castro SB, de Souza GT, Rossato C, da Guia FC, Valente MA, Rettore JV, Maranduba CP, de Souza CM, do Carmo AM, Macedo GC, Silva Fde S. Intestinal microbiota as modulators of the immune system and neuroimmune system: impact on the host health and homeostasis. J Immunol Res. 2015;2015:931574.
Marrie RA, Yu BN, Leung S, et al. The utility of administrative data for surveillance of comorbidity in multiple sclerosis: a validation study. Neuroepidemiology. 2013;40(2):85-92.
Mehrnaz Nouri, Anders Bredberg, Björn Weström, and Shahram Lavasani Intestinal Barrier Dysfunction Develops at the Onset of Experimental Autoimmune Encephalomyelitis, and Can Be Induced by Adoptive Transfer of Auto-Reactive T Cells PLoS One. 2014; 9(9): e106335.
Odenwald MA, Turner JR. Intestinal permeability defects: is it time to treat? Clin Gastroenterol Hepatol. 2013 Sep;11(9):1075-83.