September 28, 2009

The Paleo Diet Update v5, #39 – Leaky Gut, Irritable Bowel Syndrome (IBS), and Psychiatric Disease

Filed under: Uncategorized — SL @ 7:47 am

From: Wiley Long – The Paleo Diet <>
Date: 2009/9/26 (26 Sept 2009)
Subject: The Paleo Diet Update v5, #39 – Leaky Gut, Irritable Bowel Syndrome (IBS), and Psychiatric Disease
To: Stephen….. 

  • The Paleo Diet Update
    Loren Cordain, Ph.D.
    Issue: # 2009 – 39 / September 25, 2009


    Hello! Welcome to The Paleo Diet Update. In this update, we discuss newly published research that reveals how to change your diet to prevent many diseases and reverse their symptoms. We also share with you the success stories of people who have lost weight, cured painful conditions, improved athletic performance, improved markers for increased risk of disease, and reversed symptoms of disease.

    Thanks to Maelán Fontes and Pablo Martinez Ramirez, this update is also available in Spanish.

    One of the more common factors seen in multiple diseases is increased gut permeability, which can allow passage of pathogens, bacteria, etc. back into systemic circulation throughout the body. There is scientific evidence that decreasing gut permeability improves several conditions, both physical ailments and psychiatric disorders, such as depression.

    In this issue, we take a look at current research that suggests the gut-brain connection plays an important role in IBS patients suffering from psychiatric diseases. We’ll also show you how to make breakfast without a grain-based product like cereal, a bagel, or toast. Eliminating grain-based products has helped those suffering with IBS and many other illnesses.


    Loren Cordain, Ph.D.

    In This Issue

    Paleo Breakfasts for Champions
        Leaky Gut, Irritable Bowel Syndrome (IBS), and Psychiatric Disease          
               by Maelán Fontes and Pedro Bastos

    Psychiatric disorders are common conditions among IBS patients1. Recent research suggests that the gut-brain connection plays an important role in IBS patients suffering from psychiatric diseases2, 3.

    IBS and psychiatric disorders

    IBS is diagnosed in patients suffering from abdominal pain/discomfort and inconsistency in stool frequency. IBS is included in functional gastrointestinal disorders because organic causes are not present. Currently, it seems to be produced by anomalies in the digestive function, especially motility and sensitivity1. However, it is associated with activation of mucosal immune cells.

    IBS is a common condition affecting between 10-20 percent of the population4. It is more prevalent in women, and is exacerbated by stress5.

    Less than half of IBS patients seek treatment, but of those who do, between 50-90 percent have psychiatric disorders. This includes panic disorder, generalized anxiety disorder, social phobia, post traumatic stress disorder, and major depression2.

    The root of mood disorders

    Current theories suggest that impaired neurotransmitter metabolism, neuroendocrine function, and neural plasticity disrupted by inflammatory and neurodegenerative processes may be at the root of mood disorders. These processes include factors such as low-grade chronic inflammation, oxidative and nitrosative stress, and tryptophan catabolites6, 7.

    One of the mechanisms leading to mood disorders in IBS patients is “bottom-up signalling” from the gut4. This signalling is mediated chiefly by the so-called vagus nerve, which directly connects the gut mucosa with mood-related brain areas4.

    Another mechanism involves the central nerve system (CNS) immune activation, which is induced by peripheral inflammatory substances, namely cytokines. This leads to an inflammatory response, and oxidative and nitrosative stress in the brain6, 7.

    Such immune activation could result from peripheral inflammation. The gut immune system could be the source of this inflammation since the gut associated lymphoid tissue is challenged and activated by countless antigenic and allergenic substances (bacterial and dietary antigens) every day8.

    Increased gut permeability linked to psychiatric conditions

    Scientific evidence shows that decreasing gut permeability improves conditions such as depression and chronic fatigue syndrome9.

    One important factor that might activate “bottom-up signalling” and CNS immune activation is increased gut permeability or leaky gut (LG)3, 4, 7, 8. LG refers to the gut barrier allowing increased passage of bacterial or dietary antigens from the gut to peripheral circulation6, 8. This might increase the risk of psychiatric disease.

    Lectins8, saponins10, gliadin11, capsaicin, alcohol12, and factors known to increase E. coli and gram-negative bacteria overgrowth (such as certain dietary lectins8) are common in the Western diet, and can produce LG through different mechanisms8, 10, 11.

    The Paleo Diet protects against increased gut permeability and related disorders

    The Paleo Diet can help reduce gut permeability by eliminating foods known to contribute to LG. This includes lectin-containing foods, such as cereal grains and legumes (including peanuts and soybeans)8.

    Gliadin11 is also associated with LG, and it is found in all wheat-derived products (such as bread, pasta, pizzas, bagels, and donuts).

    When LG is a concern, we recommend that solanaceous plants (such as tomatoes, potatoes, eggplant and peppers)10, 13 as well as alfalfa sprouts14, root beer15, amaranth, quinoa, alcohol12, and chilli peppers (which contain capsaicin) also be avoided.

    We further recommend avoiding eggs, at least until LG symptoms subside. Egg white is a source of some membranolytic proteins, such as lysozyme16, that break cell membranes and may contribute to LG.

    Following the Paleo Diet has been shown anecdotally to help IBS and other autoimmune diseases, and many autoimmune diseases present with LG.

    Next time, we’ll take a look at who is at high risk for vitamin D deficiency, and the risk factors for disease associated with this. We'll also share ideas on how to save with grocery store specials.

              Paleo Breakfasts for Champions             by Nell Stephenson
    When converting to a Paleo lifestyle, many people find breakfast to be the most challenging meal to keep Paleo. No doubt, this is probably due to the conditioning we’ve likely all received that a healthy way to start the day is with a grain-based product (cereal, bagel, toast and so on). Many of us view certain foods as being for breakfast, others for lunch and dinner, and others for snacks.

    The first step is to throw that thinking out the window! Food is food no matter what time of day, and the morning is a great time to eat vegetables! I personally, eat veggies and red meat, chicken or fish for breakfast on a typical day.

    But, what should you eat if you’re an athlete preparing for a workout? I change my usual breakfast if I’ve got a big workout to do right away. Rather than the protein and veg-heavy foods I mentioned above, I’ll opt for a starchier (via yam, sweet potato or banana) and easier to digest (like egg whites) combination so that I’m not only well fueled, but I don’t have to wait too long to digest.

    The amount you should consume will be determined by body weight and the intensity and duration of the workout. Experiment a bit and see how much you need to eat based on how you feel during the workout, and change the subsequent meal accordingly. Here are some great ideas for athletes looking for a great way to start the day, pre-workout, while remaining Paleo.

    • Baked yam, hard-boiled egg whites, olive oil, banana, and raw almond butter

    • Homemade smoothie: chilled green tea, egg white protein powder, banana, raw almond butter, and flax seed

    • Baked sweet potato, natural (unsweetened) applesauce, sliced lean turkey breast, and olive oil

    Stick with higher glycemic fruits right before and after a workout. Also, remember to add some table salt because athletes need to replace lost electrolytes. We athletes may need to supplement with electrolyte tabs, depending on the intensity and duration of our workouts, as well as ambient conditions and individual sweat rates.

    Experiment with the above suggestions and make changes to keep it varied. Try pineapple in a smoothie instead of banana, or use baby food banana instead of applesauce.

    Whatever you do, DON’T make the mistake of thinking that you have to resort to non-Paleo foods to support athletic performance. If I can stay Paleo while racing Ironman, and my husband can stick to it while racing 100-mile endurance runs, I think it’s safe to say that Paleo provides 100% of the support needed for endurance racing, or any other athletic endeavor!

              News and Upcoming Events

    • Chronic stress linked to obesity: The journal Integrative Physiology published a study explaining how chronic exposure to environmental stress may play a role in the development of obesity, through hyperactivation of the hypothalamic-pituitary-adrenocortical (HPA) axis. This study investigated the dynamics of weight gain and the activity of the HPA axis in women who developed weight gain after a stressful event.

    • Paleo Friendly Practicing Physicians and Healthcare Practitioners: If you are a healthcare practitioner recommending the Paleo Diet as part of your practice and would like to be listed on our website, please email, and include a description of your practice and any specialties.

    • Dr. Loren Cordain to speak in Berlin, Germany: October 11th-15th, Dr. Cordain will be presenting information at a round table, open-ended discussion on evolution and disease in Berlin. Please reply to this email for further details.
              Our Recommendations

    • The Paleo Diet Update Archive can get you up-to-date on years of research into how you can use diet to improve your health. For example, here’s a selection from our archive that explains the cause of gallstones. This is from Vol 5 Issue 32 "The Paleo Diet Can Help Prevent Gallbladder Disease".

      “Gallbladder disease is more related to insulin resistance3-5 and chronic consumption of high glycemic load refined carbohydrates than it is related to either fat or cholesterol, such as is found in eggs. Furthermore, cholesterol production by the liver can be more troublesome than exogenous cholesterol consumption.

      Hyperinsulinemia and insulin resistance induce hepatic (liver) cholesterol hypersecretion, and cholesterol hypersaturation of bile as well as gallbladder hypomotility (low movement) are important factors in the formation of gallstones4.”

      The complete archive is available in three zip files for only $99.95.

    • Safe, permanent, inexpensive relief from acne is here. The Dietary Cure for Acne is based on peer-reviewed, scientific research into what causes acne and how to break that cycle.

      This natural cure has none of side effects of acne medicines or cleansers, and it has helped thousands escape the embarrassment and expense of living with acne. Here’s a typical report we get back about how The Dietary Cure for Acne has provided long sought after relief:

      I have suffered intense acne for years and have tried basically every acne medication out there without success, except for Accutane because of the possible side effects.

      After two months of being in the diet, I can see incredible progress in my complexion and continuously see improvements. I cannot express the astounding changes with words: my family and friends are amazed. Again, for this I thank you deeply.

      I have also cherished the changes the diet has brought to different aspects of my life: one of these has been better racquetball performance (I'm a racquetball aficionado).”


      The Dietary Cure for Acne Implementation Program takes The Dietary Cure for Acne to the next level. In the Implementation Program, we will keep you on track, and give you the tools and knowledge to make eating this way easy and hassle-free.

      With this program, you’ll get personal access to our team of experts with live Q&A coaching. You’ll have a detailed plan on what to eat; you’ll learn fast and easy ways to shop for and prep food; and you’ll have a step-by-step program that will make the process easy and guarantee results.

      Another benefit of eating this way is losing excess body fat, so we’ll also discuss why this happens.

      Rosacea, a special kind of acne, has also responded very well to this program. So, we’ll discuss some extra nutritional steps you may want to take if you have rosacea.

      For those who are interested, we’ll also discuss how this diet helps autoimmune diseases and gut permeability.

      Because this is our first time doing this, we have priced The Dietary Cure for Acne Implementation Program at the one-time-only price of $297. There are only six spots still available for this program that starts October 4th at 6:30 pm Mountain. We’re so confident that you’ll love your clear blemish-free skin, and the other improvements you’ll see in the rest of your life, that if you’re not happy with your own results, you’ll get a full refund.

              Follow Up and Feedback

    In this section, we’ll share readers’ concerns and questions about nutrition and the Paleo Diet to help you better understand how to use the diet to optimize your health and fitness.

    We recently received a question concerning how much fish oil should be taken on a daily basis:

    From an evolutionary standpoint, it appears that hunter-gatherers consumed around 1 gram a day of EPA + DHA. This is from Dr. Cordain’s paper titled ”Dietary intake of long-chain polyunsaturated fatty acids during the Paleolithic” published in World Rev Nutr Diet.

    The intake of vegetable omega-6 fatty acids in the Paleolithic was considerably lower than it is in the typical Western diet. During the Paleolithic, 1 gram of DHA + EPA was enough for a healthy person to achieve a 1:1 ratio of omega-6:omega-3.

    In the typical Western diet, however, the omega-6:omega-3 ratio is between 10-15:1. Therefore, we recommend to cut down vegetable omega-6 oils, and increase omega-3 fish oil to 2 grams of EPA + DHA (not all omega-3 is DHA + EPA).

    In the case of an autoimmune and/or inflammatory disease, we recommend you increase this to 4 grams a day of EPA + DHA.

    The bottom line is to eat fish 3 or 4 times a week, and take a supplement of 2 grams a day, at least during the first 4-6 months.

    Although we can't answer every question personally due to the number of letters received, we are very interested in hearing your thoughts, learning about your experiences, and understanding your questions. Many of the questions that we receive will be answered in future newsletters.

    Talk to you next week!

    To your optimum health,

    Wiley Long, M.S., Nutrition and Exercise Science



    1. Garakani A, Win T, Virk S, Gupta S, Kaplan D, Masand PS. Comorbidity of irritable bowel syndrome in psychiatric patients: a review. American journal of therapeutics 2003;10(1):61-7.

    2. Lydiard RB. Irritable bowel syndrome, anxiety, and depression: what are the links? The Journal of clinical psychiatry 2001;62 Suppl 8:38-45; discussion 6-7.

    3. Maes M, Kubera M, Leunis JC. The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Neuro endocrinology letters 2008;29(1):117-24.

    4. Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Alimentary pharmacology & therapeutics 2003;17(5):643-50.

    5. Goehler LE, Lyte M, Gaykema RP. Infection-induced viscerosensory signals from the gut enhance anxiety: implications for psychoneuroimmunology. Brain, behavior, and immunity 2007;21(6):721-6.

    6. Maes M. The cytokine hypothesis of depression: inflammation, oxidative & nitrosative stress (IO&NS) and leaky gut as new targets for adjunctive treatments in depression. Neuro endocrinology letters 2008;29(3):287-91.

    7. Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biological psychiatry 2009;65(9):732-41.

    8. Cordain L, Toohey L, Smith MJ, Hickey MS. Modulation of immune function by dietary lectins in rheumatoid arthritis. The British journal of nutrition 2000;83(3):207-17.

    9. Maes M, Leunis JC. Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria. Neuro endocrinology letters 2008;29(6):902-10.

    10. Francis G, Kerem Z, Makkar HP, Becker K. The biological action of saponins in animal systems: a review. The British journal of nutrition 2002;88(6):587-605.

    11. Lammers KM, Lu R, Brownley J, et al. Gliadin induces an increase in intestinal permeability and zonulin release by binding to the chemokine receptor CXCR3. Gastroenterology 2008;135(1):194-204 e3.

    12. Keshavarzian A, Holmes EW, Patel M, Iber F, Fields JZ, Pethkar S. Leaky gut in alcoholic cirrhosis: a possible mechanism for alcohol-induced liver damage. Am J Gastroenterol 1999;94(1):200-7.

    13. Patel B, Schutte R, Sporns P, Doyle J, Jewel L, Fedorak RN. Potato glycoalkaloids adversely affect intestinal permeability and aggravate inflammatory bowel disease. Inflammatory bowel diseases 2002;8(5):340-6.

    14. Story JA, LePage SL, Petro MS, et al. Interactions of alfalfa plant and sprout saponins with cholesterol in vitro and in cholesterol-fed rats. The American journal of clinical nutrition 1984;39(6):917-29.

    15. Sun HX, Xie Y, Ye YP. Advances in saponin-based adjuvants. Vaccine 2009;27(12):1787-96.

    16. Stevens L. Egg white proteins. Comparative biochemistry and physiology 1991;100(1):1-9.



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