LDN and the Leaky Gut Explained
This is Dr Weinstock, there was a question about Low Dose Naltrexone and the leaky gut.
The leaky gut is really best referred to as increased intestinal permeability. Leaky gut, although descriptive, is not as scientific as increased intestinal permeability but you will find references to both if you search PubMed.com to look for articles but it's vastly noticeable when you see just how many more articles are given that term.
Basically, with increased intestinal permeability, the junctions between the epithelial lining cells are disrupted, there are changes in the levels of zonulin and includes – proteins which bind the matrix between the cells and help tie things together, there are other factors involved as well which are more complicated but nonetheless when there’s disruption by drugs such as non-steroidal, heavy alcohol use, or most commonly dysbiosis or bacterial overgrowth then you often will get increased intestinal permeability.
Other factors such as radiation, chemotherapy or other toxic phenomena that will disrupt the gut lining. So what happens underneath the epithelial lining? Well in the submucosa and lamina propria, which are areas beneath the epithelial lining, we have inflammatory cells which are brought into the location because of inflammation that occurs and toxins that try to enter such as bacterial shelled coating such as lipo-polysaccharides or LPS and what this does is attract dendritic cells which then attract mast cells which then with an array of chemicals, as they come out of the mast cells, attracts lymphocytes. The T-cell will secrete microparticles which activates mast cell which then activates the T-cells and B-cells and then we have a vicious cycle; and the T-cell releases cytokines, which are chemicals that cause inflammation and that inflammation will cause more damage to the epithelial lining and a greater increased intestinal permeability.
So if we could do something about the instigator, the mast cell or the T-cell, or even the B-cell which secretes antibodies, then we have hopes of improving intestinal permeability.
There have been no studies to document this theory but it makes sense and when I see patients with irritable bowel syndrome, bacterial overgrowth, and they have extra-intestinal manifestation such as chronic fatigue, muscle aching, I will automatically give them a prescription for LDN and they often get better. With respect to using it to heal the gut lining once again, we need studies to document this and that has not yet been done.
Nevertheless, LDN has a special spot for patients with significant inflammation and alteration in their gut lining integrity.
Answer by Dr Leonard Weinstock website http://gidoctor.net/