# Leaky Gut "Leaky gut" (ie. intestinal permeability) refers to damage to the intestinal barrier resulting in increased passage of food particles into the blood, triggering immune system activation. Evidence suggests that a leaky gut alone may not be enough to cause problems but needs to be combined with immune system dysregulation (which people with ME/CFS have). Symptoms include new or worsening food sensitivities, autoimmune marker elevation and skin inflammation (eczema, rashes, acne, etc.). It may come about as a symptom of a gut disorder such as inflammatory bowel disease or untreated celiac disease. It may also be related to dietary or environmental chemicals such as [[Diet and CFS#Avoid Emulsifiers|emulsifiers]]. Treatment is aimed at restoring the health of the gut lining. Recommendations for treatment: 1. Reduce number of overgrown or unhealthy gut microbiota 2. Slowly increase fiber intake, both in amount and variety 3. Reduce gut inflammation and permeability 4. Consider supplements to help restore the intestinal barrier 5. Recolonize the Gut with Healthy Bacteria # Reduce number of overgrown or unhealthy gut microbiota See [[SIBO]] for more information on testing and treatment. # Recolonize the Gut If gut bacteria have not been exposed to a particular type of fiber for FODMAP then the patient will have increased gastrointestinal discomfort when they eat that food. Gradually increasing the amount and diversity of fiber in the diet can allow time for the microbiome to adapt. Probiotics or fermented foods with live cultures may help. My first recommendation for healthy gut recolonization is with fermented foods. Certain probiotics may also be helpful. # Gut Repair Supplements ### Beta Glucan [[Beta Glucan]] At the level of the intestinal cells it enhances macrophage-mediated tissue repair, accelerating the repair process of ulcers, and improving the repair quality [3] ### Glutamine [[Glutamine]] is the main energy source for intestinal cells. It may reduce inflammation and support tight junction integrity when taken at a dose of 15 g daily. ### Zinc L-Carnosine Zinc L-Carnosine brand name PepZin GI. Anti-inflammatory and antioxidant. There are several studies to support its benefits in restoring gastric lining, healing GI tract, improving taste disorders, improving GI disorders, and enhancing skin and liver. The carnosine aids in absorption of the zinc which plays a key role in repair of the gut lining. Zinc L-carnosine is anti-inflammatory and antioxidant. There are several studies to support its benefits in restoring gastric lining, healing GI tract, improving taste disorders, improving GI disorders, and enhancing skin and liver. Carnosine enhances zinc absorption Zinc plays a key role in repair of epithelial tissue 1. Susan Hewlings, Douglas Kalman. A Review of Zinc-L-Carnosine and Its Positive Effects on Oral Mucositis, Taste Disorders, and Gastrointestinal Disorders. *Nutrients*. 2020;VOL(ISSUE);665.10.3390/nu12030665 ### N-Acetylglucosamine An amino sugar composed of mucin secreted by epithelial cells. Used to promote growth of intestinal bacteria. Showed benefit in mouse codel of UC. "The results overall suggested that NAG or NAG-D supplementation can alleviate inflammation by strengthening the intestinal barrier function and maintaining gut microbiota homeostasis in a DSS-induced colitis mouse model." 1. Sung-In Choi, Young Chul Shin, Joong Su Lee, Yeo Cho Yoon, Ju Myung Kim, Mi-Kyung Sung. N-Acetylglucosamine and its dimer ameliorate inflammation in murine colitis by strengthening the gut barrier function. *Food & Function*. 2023;VOL(ISSUE);8533–8544.10.1039/d3fo00282a ### Pectin Pectin, such as that found in lemon pectin powder, leads to upregulation of regulatory T cells. Pectin is a type of plant-derived polysaccharide, broken down my microbiota into[[ short chain fatty acids]] which then upregulate [[T Regulatory Cells]] and suppress inflammatory function of dendritic cells. Alters ratio of *Firmicutes* to *Bacteroidetes* in gut and lung. Reduce airway inflammation as well as gut inflammation. Has been shown to reduce severity of allergies, although underlying mechanism not yet understood. A polysaccharide broken down into short chain fatty acids which regulates the immune system and reduce inflammation. Pectin has been shown to beneficially alter the microbiome of the lungs as well and reduce airway inflammation and severity of allergies. 1. Frank Blanco-Pérez, Hanna Steigerwald, Stefan Schülke, Stefan Vieths, Masako Toda, Stephan Scheurer. The Dietary Fiber Pectin: Health Benefits and Potential for the Treatment of Allergies by Modulation of Gut Microbiota. *Current Allergy and Asthma Reports*. 2021;VOL(ISSUE);43.10.1007/s11882-021-01020-z ### Licorice [[Licorice]] can help repair mucosal barrier, increase blood flow to the stomach, treat GERD, heal peptic ulcers, reduce gut inflammation, support gut microbiome, treat H. Pylori, and treat oral thrush. ### Mucilaginous Herbs Slippery elm, marshmallow root, aloe vera, etc. Mucilaginous herbs that may protect the mucosa and reduce inflammation. Not well studied.