Fixing Leaky Gut Helps ME/CFS, and Sometimes Achieves Full Remission In a ME/CFS patient, Michael Maes found that treatment with anti-inflammatories, antioxidants and a leaky gut diet decreased the the leakage of the LPS endotoxin from Gram negative Enterobacteria in the gut, and this was accompanied by a complete remission of ME/CFS symptoms. See this 2007 study by Maes: Normalization of the increased translocation of endotoxin from gram negative enterobacteria (leaky gut) is accompanied by a remission of chronic fatigue syndrome. And in this later 2008 paper, Michael Maes studied 41 ME/CFS patients who he put on "natural anti-inflammatory and anti-oxidative substances, such as glutamine, N-acetyl cysteine and zinc, in conjunction with a leaky gut diet" for a period of 10 to 14 months. Up to 24 patients showed a significant clinical improvement or remission after this protocol, along with attenuation of their IgA and IgM responses to LPS. Maes also published this 2009 review of the evidence for increased LPS translocation through a leaky gut. What Is Leaky Gut Leaky gut involves a dysfunction of the tight junctions that bind together the epithelial cells in the inner lining of the gut. Leaky gut can lead to LPS endotoxin leaking from the intestine into the liver and general circulation where this LPS may trigger inflammatory changes in the liver and other organs. Ref: 1. Some Factors That Cause Leaky Gut: Micro-organisms in the gut increase intestinal permeability. Ref: 1. Lipopolysaccharide (LPS) endotoxin from Gram-negative bacteria increases intestinal permeability. Ref: 1. Clostridium perfringens epsilon toxin increases small intestinal permeability in mice and rats. Ref: 1. Clostridium difficile toxin A increases intestinal permeability. Ref: 1. Enteropathogenic Escherichia coli bacteria disrupt the tight junction barrier function and structure. Ref: 1. Cytomegalovirus can cause increased intestinal permeability. Ref: 1. Mycotoxin ochratoxin A, that can contaminate cereals and animal feed, alters intestinal barrier function. Ref: 1. Blastocystis hominis a protozoan parasite can cause increased intestinal permeability. Ref: 1. IL-1beta causes an increase in intestinal epithelial tight junction permeability. Ref: 1. Nonsteroidal antiinflammatory drug (NSAIDs) increase intestinal permeability. Ref: 1. NSAIDs compromise intestinal permeability in IBS patients to a greater extent than in healthy subjects. Ref: 1. Capsaicin from chili peppers increases leaky gut. Ref: 1. Solanaceae spices (paprika, cayenne pepper) increase gut permeability. Ref: 1. Lectins from beans and vegetables can increase leaky gut; though interestingly, sucrose co-administration reduces the toxic effect of lectins on gut permeability, and intestinal bacterial colonization. Ref: 1. Chloramines (NH2Cl) in tap drinking water compromise tight junctions and so increase gut permeability. Ref: 1. Details on how to remove chloramines from your drinking water given here. Supplements and Drugs That Fix A Leaky Gut: Saccharomyces boulardii preserves the barrier function and modulates the signal transduction pathway induced in enteropathogenic Escherichia coli-infected T84 cells. Ref: 1. Zinc carnosine supplement helps prevent leaky gut occurring. Ref: 1. Colostrum is a powerful means to repair laky gut. In a study on indomethacin-induced gut hyperpermeability, bovine colostrum was able to counter the leaky gut produced by indomethacin (which is an NSAID drug). Ref: 1. Triphala herbal formula (especially the Emblica officinalis component, aka "Indian gooseberry") protects against methotrexate-induced intestinal permeability in rat intestine. Ref: 1. Glutamine supplementation decreases intestinal permeability and preserves gut mucosa integrity in an experimental mouse model. Ref: 1. Curcumin may help decrease intestinal permeability, and may work well with glutamine. Ref: 1. Probiotic bacteria might be beneficial in protecting intestinal epithelial cells from the deleterious effects of pathogenic bacteria. Ref: 1. Lactic acid bacteria probiotics significantly decreased small bowel permeability in IBS-D patients. Ref: 1. Slippery elm bark (Ulmus fulva) may help reduce intestinal permeability. Ref: 1. Berberine attenuates disruption of tight junctions in the intestinal epithelium in a mice model of endotoxinemia. This may possibly have been mediated through down-regulation of NF-kB and myosin light chain kinase pathway. Ref: 1. Low-dose sulfasalazine (500 mg once or twice a day) prevents tight junction disruption induced by TNF-alpha. Ref: 1. Note that the drug sulfasalazine is a potent inhibitor of NF-κB activation, and TNF-alpha-induced increase in intestinal epithelial tight junction permeability requires NF-κB activation, so this explains how sulfasalazine can reduce leaky gut. Ref: 1. If you have diarrhea-predominant irritable bowel syndrome (IBS-D), there is a good chance you have leaky gut, as this is common in IBS-D: This study found that approximately 39% of IBS-D patients had increased intestinal permeability as measured by the lactulose/mannitol test. This study found that colon permeability of IBS-D patients was significantly increased, and interestingly, this degree of colonic permeability correlated with stool frequency (the number of times a day a patient passes stools). This study found that IBS-D patients had increased proximal small intestinal permeability, and this permeability was higher in IBS-D patients with eczema, asthma, or hay-fever. This study found raised levels of serine protease in the colons of IBS-D patients, and discovered that this serine protease causes epithelial barrier dysfunction and increased intestinal permeability; and this study determined that this serine protease came from pancreatic digestive enzyme secretions.