Leaky gut is becoming a hot topic, and many people are asking questions about what it is and how they can fix it if they have it. In this article, I will go over exactly what leaky gut is, and what evidence-based natural treatments we can use to help resolve it.

Leaky gut is more popular now than ever. This is due, primarily, to the interplay of overuse of antibiotics, a poor diet, food sensitivities, and sometimes even too much exercise(41)!

To put it simply, leaky gut is a disruption of the tight-junction barrier in the intestines.(1) Tight junctions regulate how macromolecules (large molecules) can travel between cells and enter into the body. They are supposed to be very selective in what they let through. When these tight junctions become disrupted, large food molecules like gliadin (from gluten) and bacteria(2) may be able to pass through.

When big molecules get passed the gut barrier that shouldn’t, big problems can occur. One response that can occur is called “molecular mimicry”.(3) Molecular mimicry happens when an antigen is able to get into the bloodstream that shouldn’t have, and it happens to have a similar “structure” as a self-antigen. When the body’s antibodies (or, many times, T-cells) have to attack the antigen to clear it from the blood, those same cells can start attacking the body’s own structures or organs, such as the thyroid(4), joints(5,6), nervous tissue(7), or intestinal cells(8). These reactions can contribute to autoimmune diseases such as thyroiditis, rheumatoid arthritis, multiple sclerosis, and celiac disease, among others.

While it would not be accurate to say that every autoimmune disease is originally caused by a leaky gut and molecular mimicry, we do have enough information to say that for many patients, increased intestinal permeability contributes to the whole body and specific inflammation in autoimmune diseases for many patients. Furthermore, some autoimmune conditions may benefit from diets that limit specific dietary antigens. One study has already shown that a gluten-free diet can benefit many patients with rheumatoid arthritis(6).

While there has also been evidence that having a gluten-free diet does not benefit all autoimmune patients, the most prudent approach is to test to see if the patient does have any food allergies or sensitivities with a blood test, and then see if removing those foods improves symptoms for that patient.

A “leaky gut” or increased intestinal permeability can easily be tested with a mannitol/lactulose test by a functional medicine practitioner or anyone else who is skilled in testing for gut-related issues. This test uses the two different compounds to see how much is getting through a transcellular route (through the cells themselves) and through a paracellular route (between the intestinal cells).

Besides removing any food allergies/sensitivities, giving the patient-specific supplements to help their gut barrier “tighten up” will automatically decrease the number of antigens that can get through the gut lining and cause problems. Additionally, this can lead to a reduction in whole-body inflammation.(9)

The following are some key nutrients that can help to decrease intestinal permeability:

  • MSM (methylsulfonylmethane, the popular joint supplement)
    • This one needs more formal research. Yet, the decrease in allergy symptoms and gut issues tend to support the idea that the sulfur of MSM is being used to increase collagen production in the gut. MSM is part of my protocol for most people with allergy symptoms and increased gut permeability.
  • Niacin(10,11) and Niacinamide
    • While we have evidence that niacin is important for tight junction function, niacinamide does seem to be able to decrease allergy symptoms.(12) Still, niacin would probably be the better choice here, as it also has other anti-inflammatory properties that make it very beneficial for autoimmune diseases such as multiple sclerosis.(13)
    • In my opinion, niacin is highly underutilized as a weapon against gut-related issues.
  • Glycine increases tight junction function.(14) Glycine can be taken as a stand-alone supplement, or you can take gelatin, hydrolyzed collagen, or make/buy bone broth (all have a high amount of glycine as well as some other beneficial amino acids such as proline).
  • Glutamine protects the integrity of intestinal tight junctions.(15)
  • Vitamin D supplementation helped to maintain intestinal permeability in those with Crohn’s disease while the placebo group deteriorated.(31)
  • Zinc is important for tight junction formation, and supplementation can enhance intestinal barrier integrity.(16)
    • Usually 15-30mg of zinc picolinate is enough for most people. It is always beneficial to test your mineral levels before supplementing though, as zinc competes with copper and iron for absorption.
  • Flaxseed and its oil(17)
    • Ground flaxseed can be irritating to some people with IBS or related conditions, so flaxseed oil would be more prudent in that case.
  • Fish oil / Cod liver oil(18,19)
    • The omega 3’s from fish oil (EPA and DHA), as well as the omega 3 from flaxseed oil (ALA), can all be tested by a functional medicine doctor with a blood test to see if you need to supplement. This test will also look at the omega-3/omega-6 ratio, which can help you know if you need to lower your omega-6 intake (from vegetable oils). Omega-6 fats can worsen leaky gut in high amounts.(20,21)
    • Be careful where you buy your fish oil from. Many fish oils are already rancid by the time you consume them, which greatly diminishes the ability for them to help you. Also, many fish oils can have high levels of persistent organic pollutants which are not good to consume over time. You can use Labdoor to help you decide on a fish oil supplement.
  • Curcumin/Turmeric(26)
    • Curcumin can enhance the gut barrier function, as well as decrease intestinal inflammation and circulating endotoxins.
  • Probiotics
    • Probiotics and help synthesis new tight junction proteins, help repair the intestinal mucosa, and protect the gut barrier from damage.(28)
    • Probiotics can be in the form of a pill, yogurt, kombucha, and/or other fermented foods
    • One of my favorite probiotics is apple cider vinegar with the “mother” still in it. These bacteria naturally live in a very acidic environment (i.e. vinegar), so it is more likely that they will survive digestion through the stomach acid make it to the large intestine.
    • Apple cider vinegar also has other beneficial properties such as helping to fight off candida and pathogenic bacteria(29) and has anti-inflammatory properties(30)

While there are some others such as n-acetylglucosamine and intestinal alkaline phosphatase that can help to decrease permeability, I believe that the list above should be focused on as far as supplementation goes. (There is also some preliminary research that n-acetylglucosamine may be able to enhance the survival of candida, which would not be good for individuals who are suffering gut issues due to candida overgrowth.)

As far as diet goes, there are many things that you can do that can help to increase tight junction function.

Foods to add:

  • Virgin Unrefined Coconut Oil.
    • While there haven’t been any studies specifically done on coconut oil to test its ability to decrease intestinal permeability, there are many reasons why it would be a good addition for someone with a leaky gut.
    • One of the ways that a leaky gut can be caused is by candida, a fungus that is usually present in low amounts in the colon. When it is allowed to grow out of control (by taking antibiotics, for example, because these can kill the beneficial bacteria, especially lactobacilli, that usually competes with candida and keeps it in check via hydrogen peroxide production), candida can invade the intestinal mucosa, cause disruption and inflammation of the gut barrier, and even increase the possibilities to develop food allergies/sensitivities (common with leaky gut).(22,23)
    • Candida can be tested for via a stool test by a functional medicine practitioner to either rule it in or out. This will help you focus on the right strategies to heal your individual leaky gut, because treatments specifically for candida overgrowth are different than treatments for a leaky gut due to a low omega-3/omega-6 ratio or reduced levels of niacin, for example.
    • While detailing a treatment protocol for candida overgrowth is beyond the scope of this article, virgin unrefined coconut is one of the effective treatments to help get rid of candida over time via the capric and lauric acid that is in coconut oil.(24)
    • Candida is becoming more of an issue in recent years due to the increase in consumption of refined carbohydrates and lower levels of polyphenols in the diet. Unrefined carbohydrates are loaded with polyphenols, which inhibit the growth of pathogenic bacteria and candida, while refined carbohydrates can easily feed candida.(25)
    • Virgin Unrefined Coconut oil also has many anti-inflammatory properties as a great side effect (due to the abundance of polyphenols present in the unrefined version)!(27)
  • Cooked vegetables / natural fiber
    • While vegetables are beneficial for health in general, some people with impaired intestinal permeability cannot handle raw vegetables very well. For this reason, lightly steamed vegetables are the best way to go for digestive health.
    • Many vegetables also provide a great mix of fiber and polyphenols to the colon. This mixture helps to feed the good bacteria while inhibiting the growth of pathogenic bacteria and fungi. The fiber will get eaten by the good bacteria and produce short-chain fatty acids such as butyrate as a byproduct. These short-chain fatty acids and also help improve the intestinal barrier.(32)
    • It is important to remember that fiber from whole foods like vegetables comes with an abundance of polyphenols. These polyphenols help to modulate the gut microbiome, which will make the fiber even more beneficial. Taking fiber as a stand-alone supplement is devoid of these polyphenols, which means that potentially any type of bacteria, good or not, can eat that fiber and grow. While there definitely are differences between types of fiber, this general principle holds.
  • Spices and herbs
    • We’ve already stressed the importance of polyphenols, but here is where you take out the big guns.
    • Spices / herbs are some of the foods that have the highest polyphenol count. These food ingredients interact with the gut microbiome to promote homeostasis and a reduction in inflammation.(33,34)
    • Try to include foods like garlic, turmeric, marshmallow root, onions, dandelion, ginger, cinnamon, etc. into your diet on a regular basis. You can add these to foods, cook with them, or take them as supplements.
    • Be careful with very spicy herbs such as cayenne, paprika, and sometimes even ginger. While the spicy polyphenols like capsaicin can increase mucous production over time (which is beneficial in the GI tract), starting with large doses can cause trouble for some people. If you choose to try these, start low and go slow so your body has time to adapt.

Foods to avoid:

This section is the trickiest to give recommendations for because everyone’s body is so different and different people react to different foods. Your best bet for knowing which foods to remove from your diet is to seek out a knowledgeable functional medicine doctor who does up-to-date food allergy and sensitivity testing. (I say “up-to-date” because there are some practitioners who utilize outdated food allergy tests that can have many false-positives due to cross-contamination or be interpreted poorly. For example, IgG4 testing is widely utilized, yet for many people, high IgG4 antibodies to a particular food may just mean that you have been eating a lot of it. IgG4 antibodies can go up as clinical allergy symptoms go down.)

Being hypersensitive to a particular food or multiple foods is correlated with an increase in intestinal permeability.(35) This goes both ways: eating a food that you are hypersensitive to can increase the permeability of the gut even more, and having a leaky gut can promote food hypersensitivities.(3)

Thus, I cannot tell you which foods you may be sensitive to that you should avoid in this article. What I can do is give you some general recommendations that have scientific support for a variety of issues similar to irritable bowel syndrome such as Crohn’s or ulcerative colitis.

  • Reducing calories or losing weight if you are overweight
    • “In summary, a 4-week caloric restriction resulted in significant weight loss, improved gut barrier integrity and reduced systemic inflammation in obese women.”(36)
  • Try the low-FODMAP diet
    • The low-FODMAP diet is a particular type of elimination diet that has been shown to be useful for managing the symptoms of a variety of intestinal issues such as IBS, Crohn’s, and ulcerative colitis.
    • To learn more about the low-FODMAP diet, click here (article in progress)
  • Avoid foods that you are sensitive to via an allergy/sensitivity blood test, or try an elimination diet and slowly add foods back in one by one to determine which are giving you symptoms. (Note: It can take up to a week for symptoms to appear from some foods, so add back foods slowly.)
  • Avoid bad fats, particularly omega-6 fatty acids (37)
    • Check nutrition labels for soybean oil, corn oil, sunflower oil, safflower oil, or cottonseed oil. Avoid fried foods as well, as these are likely cooked in omega-6 fats.
    • Avoid consuming too many saturated fats, as these can increase the ability of lipopolysaccharide (a part of the outer membrane of gram-negative bacteria, also called “endotoxin”) to get from the gut to the bloodstream, which can increase inflammation throughout the body. (40)
  • Avoid refined sugars and carbs
    • Refined sugars and carbs are devoid of beneficial nutrients like fiber and polyphenols. Without these nutrients that help to modulate the gut microbiome, these carbs are able to have free reign to feed whatever in your gut.
    • Sugars from natural sources like fruit will not present such an issue most of the time, as they come with fiber and polyphenols. (38, 39)
      • Remember, this is for whole fruits or fruits that have been completely blending, leaving everything in them. Fruit “juice” has a much higher ratio of sugar to fiber/polyphenols.
      • Some fruits may still be bothersome to some individuals due to the FODMAPs they contain. Read more about FODMAPs here (article in progress).
      • Also, in some conditions, like those who have systemic candida infections, it would be better to reduce sugar to as little as possible. This does not apply to someone with just increased permeability, though.

 

While there are many other treatment options available for irritable bowel syndrome, ulcerative colitis, Crohn’s, other autoimmune conditions, etc., fixing your leaky gut is definitely a foundational step that will help to keep your health in check. Furthermore, following the guidelines of this article will also help to improve your intestinal microbiome, which also has a wide-ranging impact on overall health!

Please leave a comment, questions, or any experiences you have had with this condition below! I would love to hear from you!

 

 

References:

  1. Lee SH. Intestinal Permeability Regulation by Tight Junction: Implication on Inflammatory Bowel Diseases. Intestinal Research. 2015;13(1):11-18. doi:10.5217/ir.2015.13.1.11.
  2. Clarke TB, Francella N, Huegel A, Weiser JN. Invasive Bacterial Pathogens Exploit TLR-Mediated Downregulation of Tight Junction Components to Facilitate Translocation across the Epithelium. Cell host & microbe. 2011;9(5):404-414. doi:10.1016/j.chom.2011.04.012.
  3. Cusick MF, Libbey JE, Fujinami RS. Molecular Mimicry as a Mechanism of Autoimmune Disease. Clinical reviews in allergy & immunology. 2012;42(1):102-111. doi:10.1007/s12016-011-8294-7.
  4. Benvenga S, Guarneri F. Molecular mimicry and autoimmune thyroid disease. Rev
    Endocr Metab Disord. 2016 Dec;17(4):485-498. doi: 10.1007/s11154-016-9363-2.
    Review. PubMed PMID: 27307072.
  5. Ebringer A, Rashid T. Rheumatoid arthritis is caused by Proteus: the molecular
    mimicry theory and Karl Popper. Front Biosci (Elite Ed). 2009 Jun 1;1:577-86.
    PubMed PMID: 19482674.
  6. Hafström I, Ringertz B, Spångberg A, von Zweigbergk L, Brannemark S, Nylander
    I, Rönnelid J, Laasonen L, Klareskog L. A vegan diet free of gluten improves the
    signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate
    with a reduction in antibodies to food antigens. Rheumatology (Oxford). 2001
    Oct;40(10):1175-9. PubMed PMID: 11600749.
  7. Shor DB, Barzilai O, Ram M, Izhaky D, Porat-Katz BS, Chapman J, Blank M, Anaya
    JM, Shoenfeld Y. Gluten sensitivity in multiple sclerosis: experimental myth or
    clinical truth? Ann N Y Acad Sci. 2009 Sep;1173:343-9. doi:
    10.1111/j.1749-6632.2009.04620.x. PubMed PMID: 19758171.
  8. Barbeau WE, Novascone MA, Elgert KD. Is celiac disease due to molecular
    mimicry between gliadin peptide-HLA class II molecule-T cell interactions and
    those of some unidentified superantigen? Mol Immunol. 1997 May;34(7):535-41.
    Review. PubMed PMID: 9364219.
  9. Bischoff SC, Barbara G, Buurman W, et al. Intestinal permeability – a new target for disease prevention and therapy. BMC Gastroenterology. 2014;14:189. doi:10.1186/s12876-014-0189-7.
  10. Zhong W, Li Q, Zhang W, Sun Q, Sun X, Zhou Z. Modulation of Intestinal Barrier and Bacterial Endotoxin Production Contributes to the Beneficial Effect of Nicotinic Acid on Alcohol-Induced Endotoxemia and Hepatic Inflammation in Rats. Osna N, Kharbanda K, eds. Biomolecules. 2015;5(4):2643-2658. doi:10.3390/biom5042643.
  11. Li SQ, Feng L, Jiang WD, Liu Y, Jiang J, Wu P, Kuang SY, Tang L, Tang WN,
    Zhang YA, Zhou XQ. Deficiency of dietary niacin impaired gill immunity and
    antioxidant capacity, and changes its tight junction proteins via regulating
    NF-κB, TOR, Nrf2 and MLCK signaling pathways in young grass carp
    (Ctenopharyngodon idella). Fish Shellfish Immunol. 2016 Aug;55:212-22. doi:
    10.1016/j.fsi.2016.05.005. Epub 2016 May 13. PubMed PMID: 27181596.
  12. Bekier E, Wyczólkowska J, Szyc H, Maśliński C. The inhibitory effect of nicotinamide on asthma-like symptoms and eosinophilia in guinea pigs, anaphylactic mast cell degranulation in mice, and histamine release from rat isolated peritoneal mast cells by compound 48-80. Int Arch Allergy Appl Immunol. 1974;47(5):737-48
  13. Penberthy WT. Nicotinic Acid-Mediated Activation of Both Membrane and Nuclear Receptors towards Therapeutic Glucocorticoid Mimetics for Treating Multiple Sclerosis. PPAR Research. 2009;2009:853707. doi:10.1155/2009/853707.
  14. Li W, Sun K, Ji Y, Wu Z, Wang W, Dai Z, Wu G. Glycine Regulates Expression and
    Distribution of Claudin-7 and ZO-3 Proteins in Intestinal Porcine Epithelial
    Cells. J Nutr. 2016 May;146(5):964-9. doi: 10.3945/jn.115.228312. Epub 2016 Mar
    30. PubMed PMID: 27029941.
  15. Rao R, Samak G. Role of Glutamine in Protection of Intestinal Epithelial Tight Junctions. Journal of epithelial biology & pharmacology. 2012;5(Suppl 1-M7):47-54. doi:10.2174/1875044301205010047.
  16. Valenzano MC, DiGuilio K, Mercado J, et al. Remodeling of Tight Junctions and Enhancement of Barrier Integrity of the CACO-2 Intestinal Epithelial Cell Layer by Micronutrients. Weber CR, ed. PLoS ONE. 2015;10(7):e0133926. doi:10.1371/journal.pone.0133926.
  17. Zhu H, Wang H, Wang S, Tu Z, Zhang L, Wang X, Hou Y, Wang C, Chen J, Liu Y.
    Flaxseed Oil Attenuates Intestinal Damage and Inflammation by Regulating
    Necroptosis and TLR4/NOD Signaling Pathways Following Lipopolysaccharide
    Challenge in a Piglet Model. Mol Nutr Food Res. 2018 May;62(9):e1700814. doi:
    10.1002/mnfr.201700814. Epub 2018 Apr 14. PubMed PMID: 29510469.
  18. Chen J-R, Chen Y-L, Peng H-C, et al. Fish Oil Reduces Hepatic Injury by Maintaining Normal Intestinal Permeability and Microbiota in Chronic Ethanol-Fed Rats. Gastroenterology Research and Practice. 2016;2016:4694726. doi:10.1155/2016/4694726.
  19. Xiao G, Tang L, Yuan F, Zhu W, Zhang S, Liu Z, et al. (2013) Eicosapentaenoic Acid Enhances Heat Stress-Impaired Intestinal Epithelial Barrier Function in Caco-2 Cells. PLoS ONE 8(9): e73571. https://doi.org/10.1371/journal.pone.0073571
  20. Kirpich IA, Feng W, Wang Y, et al. Ethanol and Dietary Unsaturated Fat (Corn Oil/Linoleic Acid Enriched) Cause Intestinal Inflammation and Impaired Intestinal Barrier Defense in Mice Chronically Fed Alcohol. Alcohol (Fayetteville, NY). 2013;47(3):257-264. doi:10.1016/j.alcohol.2013.01.005.
  21. Charlène Alain, Justine Marchix, Sandrine David, Frédérique Barloy-Hubler, Cécile Druart, et al.. Maternal high dietary linoleic acid during gestation and lactation impairs rat offspring gut and metabolic homeostasis. 49. Annual meeting of the european society for paediatric gastroenterology, hepatology and nutrition (ESPGHAN), 2016, Athènes, Greece. 62 – suppl. 1, pp.654, 2016
  22. Yamaguchi N, Sugita R, Miki A, et al. Gastrointestinal Candida colonisation promotes sensitisation against food antigens by affecting the mucosal barrier in mice. Gut. 2006;55(7):954-960. doi:10.1136/gut.2005.084954.
  23. Yan L, Yang C, Tang J. Disruption of the intestinal mucosal barrier in Candida
    albicans infections. Microbiol Res. 2013 Aug 25;168(7):389-95. doi:
    10.1016/j.micres.2013.02.008. Epub 2013 Mar 30. Review. PubMed PMID: 23545353.
  24. Bergsson G, Arnfinnsson J, Steingrímsson Ó, Thormar H. In Vitro Killing of Candida albicans by Fatty Acids and Monoglycerides. Antimicrobial Agents and Chemotherapy. 2001;45(11):3209-3212. doi:10.1128/AAC.45.11.3209-3212.2001.
  25. Shahzad M, Sherry L, Rajendran R, Edwards CA, Combet E, Ramage G. Utilising
    polyphenols for the clinical management of Candida albicans biofilms. Int J
    Antimicrob Agents. 2014 Sep;44(3):269-73. doi: 10.1016/j.ijantimicag.2014.05.017.
    Epub 2014 Jul 6. PubMed PMID: 25104135.
  26. Ghosh SS, He H, Wang J, Gehr TW, Ghosh S. Curcumin-mediated regulation of
    intestinal barrier function: The mechanism underlying its beneficial effects.
    Tissue Barriers. 2018 Jan 2;6(1):e1425085. doi: 10.1080/21688370.2018.1425085.
    Epub 2018 Feb 8. PubMed PMID: 29420166; PubMed Central PMCID: PMC5823546.
  27. Intahphuak S, Khonsung P, Panthong A. Anti-inflammatory, analgesic, and
    antipyretic activities of virgin coconut oil. Pharm Biol. 2010 Feb;48(2):151-7.
    doi: 10.3109/13880200903062614. PubMed PMID: 20645831.
  28. Rao RK, Samak G. Protection and Restitution of Gut Barrier by Probiotics: Nutritional and Clinical Implications. Current nutrition and food science. 2013;9(2):99-107.
  29. Yagnik D, Serafin V, J. Shah A. Antimicrobial activity of apple cider vinegar against Escherichia coli, Staphylococcus aureus and Candida albicans; downregulating cytokine and microbial protein expression. Scientific Reports. 2018;8:1732. doi:10.1038/s41598-017-18618-x.
  30. Beh BK, Mohamad NE, Yeap SK, et al. Anti-obesity and anti-inflammatory effects of synthetic acetic acid vinegar and Nipa vinegar on high-fat-diet-induced obese mice. Scientific Reports. 2017;7:6664. doi:10.1038/s41598-017-06235-7.
  31. Raftery T, Martineau AR, Greiller CL, et al. Effects of vitamin D supplementation on intestinal permeability, cathelicidin and disease markers in Crohn’s disease: Results from a randomised double-blind placebo-controlled study. United European Gastroenterology Journal. 2015;3(3):294-302. doi:10.1177/2050640615572176.
  32. Peng L, Li Z-R, Green RS, Holzman IR, Lin J. Butyrate Enhances the Intestinal Barrier by Facilitating Tight Junction Assembly via Activation of AMP-Activated Protein Kinase in Caco-2 Cell Monolayers. The Journal of Nutrition. 2009;139(9):1619-1625. doi:10.3945/jn.109.104638.
  33. Opara EI, Chohan M. Culinary Herbs and Spices: Their Bioactive Properties, the Contribution of Polyphenols and the Challenges in Deducing Their True Health Benefits. Choi CW, ed. International Journal of Molecular Sciences. 2014;15(10):19183-19202. doi:10.3390/ijms151019183.
  34. Prakash UN, Srinivasan K. Beneficial influence of dietary spices on the
    ultrastructure and fluidity of the intestinal brush border in rats. Br J Nutr.
    2010 Jul;104(1):31-9. doi: 10.1017/S0007114510000334. Epub 2010 Feb 24. PubMed
    PMID: 20178671.
  35. Yu LC-H. Intestinal Epithelial Barrier Dysfunction in Food Hypersensitivity. Journal of Allergy. 2012;2012:596081. doi:10.1155/2012/596081.
  36. Ott B, Skurk T, Hastreiter L, et al. Effect of caloric restriction on gut permeability, inflammation markers, and fecal microbiota in obese women. Scientific Reports. 2017;7:11955. doi:10.1038/s41598-017-12109-9.
  37. Scaioli E, Liverani E, Belluzzi A. The Imbalance between n-6/n-3 Polyunsaturated Fatty Acids and Inflammatory Bowel Disease: A Comprehensive Review and Future Therapeutic Perspectives. Int J Mol Sci. 2017;18(12)
  38. Sharma SP, Chung HJ, Kim HJ, Hong ST. Paradoxical Effects of Fruit on Obesity. Nutrients. 2016;8(10)
  39. Klinder A, Shen Q, Heppel S, Lovegrove JA, Rowland I, Tuohy KM. Impact of
    increasing fruit and vegetables and flavonoid intake on the human gut microbiota.
    Food Funct. 2016 Apr;7(4):1788-96. doi: 10.1039/c5fo01096a. PubMed PMID:
    26757793.
  40. Lyte JM, Gabler NK, Hollis JH. Postprandial serum endotoxin in healthy humans is modulated by dietary fat in a randomized, controlled, cross-over study. Lipids Health Dis. 2016;15(1):186.
  41. Janssenduijghuijsen LM, Mensink M, Lenaerts K, et al. The effect of endurance exercise on intestinal integrity in well-trained healthy men. Physiol Rep. 2016;4(20)

Leave a Comment Below!