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The second question would be: Do we actually have an inflamed gut or Leaky Gut and how do we know our problems aren't just related to bacterial imbalance?

We tend to separate the IBS sub-types on this board: IBS-C, IBS-D, Leaky Gas, etc as though they are distinct disorders and somehow unique from one another. This also implies that a remedy for one sub-type mightn't be relevant for another.

It could be though that IBS has a varying degree of inflammation for all of us. This means that despite the differences in severity - the cure is the same. Don't eat inflammatory foods. Many of us don't experience diarrhea, and our symptoms are mainly gas / constipation oriented. This doesn't mean that we don't have an inflamed gut; it just means that our inflammation might be at the lower end of the scale and / or that our bacterial byproducts cause constipation-predominant rather than diarrhea-predominant symptoms.

Inflammation means that part of the body becomes red and inflamed, usually due to injury. Colitis, Crohn's Disease and Inflammatory Bowel Disease are the more serious bowel diseases. It's quite possible that IBS is a forerunner to these diseases, especially if the gut inflammation increases.

Allison Siebecker, who works with Mark Pimentel, a leading IBS researcher, believes that 50% of SIBO patients also have Leaky Gut.

Leaky Gut, or intestinal permeability, means that there are gaps between the cells (called enterocytes) that line the gut wall. If these enterocytes become damaged, usually due to a diet high in toxic antinutrients such as lectins, phytates etc then incompletely indigested protein particles can "leak" through the gut lining and into the blood stream. This can set up an immune reaction and food intolerances can increase. This condition can eventually lead to autoimmunity, where the body's antibodies attack its own healthy proteins.

If your food intolerances seem to be increasing then Leaky Gut could be the cause.

I posted here on how damaging grains, flours, legumes & nuts are and how they cause Leaky Gut. The toxic compounds in these foods are lectins, phytates and saponins and these actively damage the gut wall.

http://www.ibsgroup.org/forums/topic/281442-its-not-just-fodmaps-plant-proteins-cause-worse-inflammation/

I found that IBS symptoms improved, literally overnight, when I changed my diet to a combined Paleo Autoimmune diet / low FODMAP diet.

Most commentators on the web recommend fibre as a cure for IBS. This is a half truth at best. Fibre has many different guises and some high fibre foods are quite toxic. Grains, legumes and nuts contain compounds that attack the gut wall. Whole wheat and whole brown rice are possibly the most toxic of all foods. On the other hand low FODMAP vegetables are generally better tolerated because their sugars aren't as fermentable as high FODMAP vegetables. Some people, like myself, tolerate salads very well. The actual level of gut damage will be different for all of us but the remedy is the same. Stop eating inflammatory foods.

Commentators also cite the health benefits of short chain fatty acids (SCFAs) which are the byproduct of bacterial fermentation of fibre in the colon. SCFAs are generally very healthy for the colon as they help to regulate the immune system. These acids promote regulatory T cells and also inhibit the development of T helper cells. In other words, SCFAs are natural anti-inflammatories. SCFAs also help to keep the colon acidic, which makes the colon more inhospitable for pathogens, which prefer a more alkaline environment.

There's no doubt that generally speaking, SCFA's are highly beneficial and that the more fibre we eat, the more diverse our commensal bacterial populations.

However, for some of us, fibre can make our symptoms worse. Vegetables aren't inherently toxic (with the exception of nightshades) however certain high FODMAP vegetables (cabbage, brussel sprouts for example) are indigestible to a certain extent and the fermentation of these by bacteria will increase the production of SCFAs.

The degree of intolerance to vegetables could have a direct correlation to the degree of gut inflammation caused by Leaky Gut. If we do have epithelial damage to our gut wall, then SCFAs might actually be doing more harm than good. If our gut wall is compromised at all, then protein particles are already breaching the gut barrier and entering the blood stream. This means that inflammatory cytokines could be also circulating in our system. These cytokines can down-regulate, or decrease the uptake of SCFAs, so that they are unable to exert their anti-inflammatory effects. Butyrate, one of the principle SCFAs also has a pro-inflammatory component. This means that as a whole, the pro-inflammatory effects dominate. SCFAs then, can exacerbate inflammation, for those who are susceptible to carbohydrate malabsorption, and this is the key. Some of us might be more genetically predisposed to the effects of antinutrients.

Sue Shepherd, who developed the low FODMAP diet, believes that SCFAs from high FODMAPs can exacerbate Crohn's Disease (also caused by Leaky Gut).

In her study "Personal view: food for thought - western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis"she refers to the fact that high concentrations of SCFAs increase epithelial permeability and kill the gut cells, if the gut is already damaged, either through alcohol abuse or abuse through a harmful diet.

In this study, she focuses on FODMAPs, and she believes that high FODMAPs - with their high concentrations of short-chain, poorly absorbed carbohydrates - leads to Crohn's Disease.

So what do we do? We need fibre, and should eat as much of it as we can without incurring IBS symptoms such as gas, constipation or diarrhea.

But the first rule of curing IBS is to never increase inflammation. Generally, seafood and meat are safe foods as they don't create SCFAs, however these foods are rich in nutrients. Seafood in particular is high in Omega 3, which is healing for the gut. Meat offal is also very high in nutrients and should be a regular part of your diet, at least twice a week. Fruits are generally unnecessary as vegetables generally have the same nutrients but without the fructose (fruits high in fructose are high FODMAP).

Low FODMAP vegetables such as carrot, pumpkin and green beans tend to be well tolerated. Those with a high degree of inflammation might need to boil their vegetables longer at first to reduce the fibre level.

The real cure to IBS is not allowing inflammation to take hold in the first place. If you believe you do have a compromised gut, then first priority is always to reduce inflammation. You will need a ton of willpower to stick to this diet; it is very hard. Once your symptoms improve you could consider reintroducing certain high FODMAPs that aren't inherently toxic - these are generally the vegetables - cabbage, green peas etc.

Certain foods that are toxic, and that directly damage the gut wall - grains, legumes & nuts should never be reintroduced. High fructose is also toxic so fruit should always be kept to a minimum. In the early stages try none at all and just focus on seafood, meat and the vegetables that you can tolerate.
 

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Hi. Thank you for writing this detailed explanation. I wanted to ask a question. I have developed sensitivity to various foods after a very painful infection. I get intense itching on my body after eating various foods. Could this be due to leaky gut? I also feel feverish. I have severe abdominal pain in upper left abdomen which comes and goes. My pulse also increases to above 90 even when I'm not anxious. Is this all leaky gut or something else? I eat a vegetarian diet. I also have inflammation going through my body. For example swollen gums, sores in mouth etc.
 

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Sorry I can't answer any medical questions. I'm not an expert I just read a lot. IBS is very difficult for vegetarians because meat and seafood provide most of your calories on a healing diet.

Look up PaleoMum for her articles on the autoimmune diet. She's one of the best writers on the web as she's a doctor and she has IBS herself.

http://www.thepaleomom.com/autoimmunity/the-autoimmune-protocol

I think we all have Leaky Gut to a certain extent and itching could be a symptom. Just try the autoimmune diet but it will makes things a lot easier to get your proteins from meat and seafood rather than legumes, grains & seeds which are probably causing your inflammation.
 

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I feel as though you just combined my own thoughts into a post. I am still struggling to find a diet that works. I have gone grain/sugar free, carb free for the most part. I was eating lots of fruit though and still wasn't feeling well at all, now i am doing the GAPS intro diet, which means having bone broth all day long, eating non fibrous vegetables in broth, fermented foods (which I am not doing yet), ginger tea, etc. It's restricting but there are other stages that you move onto once you get your symptoms under control. I figured I would try this just to see if I could figure out some troubling foods once I add them back in.

I still don't know that this is the correct thing to do but I am obviously desperate to ease my symptoms so I thought I would give it a go.

I like the sound of your diet, it makes a lot of sense to me. Just wondering, do you have eggs in your diet?

Thanks for this post, It has given me some insight, and I think I think I may try your idea which involves integrating the paleo and low FODMAPS diet.

- J
 
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