A Note on Choosing Supplements

I recently went to a health talk that my supervising doctor put on at Arizona State University, and one of the attendees brought up this great question. How do you find good quality supplements? I mean, if you walk into a Whole Foods or a Sprouts these days it's like the bread isle on crack. There's 8,000 companies offering 9,000 products, all the while claiming that theirs is the best. But how do you know you're getting what you paid for? Or more importantly, how do you know if you're paying for something you really didn't want?
Functional Medicine practitioners such as myself work with pharmaceutical grade supplements from many different companies. Such companies only sell their products to licensed healthcare professionals. To you out there in the world who just wants some vitamins this may be annoying, but believe me when I tell you it is for your own good. When they say pharmaceutical grade they really mean it... which means two things. On the one hand, you can have a great therapeutic (positive) effect with these supplements. On the other hand, you can do a lot of damage with them if you take them inappropriately... I know- I've made myself sick stimulating the wrong pathway a time or two and I've heard friends' stories after they've done the same. If these products got into the hands of the general public who doesn't know how to use them properly a lot of people would be in a whole world of hurt. I'm not saying that non-pharmaceutical grade supplements aren't effective... Just perhaps not as effective as what we in FM use. The other plus side to going to a doctor for your supplements is that they will run tests (blood, urine, saliva) to ensure that you are taking the right thing.

For those of you who don't want to go to a doctor, there is a more reasonable way to find good quality supplements. Consumer labs is a third party company that tests and reviews different supplements. There is a small subscription fee that goes toward funding the tests that they run, and it is well worth the fee. Not only do they test the supplements for what they claim to contain, but they test for contaminants. For example, their review of vitamin D supplements revealed two products that were contaminated with Lead [1]!

Stay healthy,

Nikki


References:
[1] https://www.consumerlab.com/reviews/vitamin-d-supplements-review/vitamin_d/

Healing the Gut

Yes, my dear followers, there is life after leaky gut syndrome. I recommend doing this protocol while doing an elimination diet. Oftentimes, people say "they went gluten free but didn't feel better", and often times it is because they either were not 100% gluten free OR their gut never got the opportunity to fully recover. In this blog post I am going to give you the tools you need to heal your gut, but I must preface this with a warning: 
                                                                                above all else listen to your body!
While these things work great for most of the cases I have encountered, no two people are alike. I have met people who made their gut problems temporarily worse doing one or more of these things. The key, as with anything in life, is to listen to your body. If something makes you feel worse stop doing it. Furthermore, if one of these things doesn't agree with your body it's a good indication that you should get checked out by a doctor and managed by them rather than a blog. Without proper testing you simply don't know for sure what is going on inside your body, but it has been my personal experience that these things work for most people. For example, some critters like candida actually use glutamine as a substrate for growth, and thus may be exacerbated with supplementation.

The trouble is that you can't walk into a normal doctors office and ask them to help you with your leaky gut. As with much of what I talk about on this blog, 95% of doctors won't know 95% of what you now know, so they will most likely tell you to go home and eat gluten because it's all in your head. Finding a doctor who knows what we know can be a little cumbersome, but it is absolutely crucial if you want to get results and feel better.

If you think your case merits individual management I recommend you do the following:
Go to http://carrickinstitute.org/ and contact them to find a Chiropractic Neurologist near you. This link used to provide a search feature, but the website is currently down. While on the phone, tell the person you specifically would like to find someone who is versed in Functional Medicine as well as neurology. If the people at the institute can not provide this additional information, do not be bashful about calling the individual offices and asking if they do functional medicine, too. You can also try a simple google map search of the phrases "functional medicine" or "functional neurology", but it will not be as effective. There are different flavors of doctors who practice functional medicine, and the flavor dictates the type of treatment they will use. Some doctors are really into heavy metal testing and chelation, which for reasons that will be made apparent in another blog post I do NOT recommend. MDs using functional medicine are good, but may tend toward the use of more pharmaceuticals than many would prefer. The nice thing about going to a DC who does this stuff is that they can not prescribe medications so that route generally is a last resort, in which case they will refer you to an MD. Call me old school, but I think drugs and surgery should be the last resort treatment. Not only that, but finding a DC through the neurology program ensures that the chiropractor will tailor your treatment to what is best for your brain as well as your spine.

Another point I have to make about going to see a doctor and being managed professionally is the quality of supplements you will get. Don't get me wrong, I have gone to Whole Paycheck many times when I am too impatient to wait for my regular supplements to come in... but often times they are not the same. Yes, vitamin D is available at every drug store, but is it a good quality product that you will be able to absorb and use? Many of the supplements doctors like me work with go to great lengths to test their products and ensure that they are optimally absorbed. For example, many of the Apex products I use have been emulsified with things that have been shown in the research to enhance absorption and effectiveness. These products are only available through licensed healthcare professionals, which is both a blessing and a curse. On the down side, it means that these products are not widely available to the public, and it requires people to work with (and pay) a doctor. The blessing side of the story is that these products are strong and not to be taken lightly. I have personally seen what pharmaceutical grade supplements are capable of when they are taken willy-nilly (by myself or other people who still have at least half a clue), so I would hate to see this stuff get into the hands of the general public who doesn't know exactly what they are doing.

Now, let's talk about what you can do today to get that leaky gut of yours back under control!

The "4 R Gut Program" is something that is easily googled, so I won't spend too much time on it... But here's the scoop: the four Rs are in order of importance and the order you should do them in.
Remove the stuff that's causing the problem. This may be a food, a critter, stress, alcohol, or a drug!
Replace the stuff your body should be making, at least for the time being. This may include digestive enzymes such as pancreatic enzymes or stomach acid in the form of Beatine HCl! You need all these things to properly break down your food.
Reinoculate, which is a fancy word for "recolonize your gut with good bugs"... i.e. take a probiotic!
Repair. Help speed up your gut's repair processes by taking supplements such as these and you'll be on your way to a healthy functioning gut in no time!

1. Vitamin D is not only great for your immune system, but it has been shown to increase the expression of tight junction proteins in the gut, which helps to repair the "leaks" between cells [1]
2. L-Glutamine is an amino acid that is preferentially used by the gut epithelial cells as fuel and may not only aid in repair, but prove to be protective to future epithelial damage [2]
3. Herbs that soothe and coat the gut such as licorice root, slippery elm and marshmallow root will help protect the gut while it heals.
4. Antioxidants such as omega-3s, curcumin and resveratrol will help get rid of any residual inflammation that the other Rs and supplements could not tackle.

Less leaky every day,

Nikki


References:
[1] Kong, J. Novel role of the vitamin D receptor in maintaining the integrity of the intestinal mucosal barrier. Am J Physiol Gastrointest Liver Physiol 2008 Jan; 294(1):G208 (PMID 17962355)
[2] Iizuka, Masahiro. Wound healing of intestinal epithelial cells. World J Gastroenterol 2011 May 7;17(17):2161-2171 (PMID 21633524)

A New Way to "Think Pink"

Ah, October. A month for trick or treating, crisp fall weather, carving pumpkins, apple cider, and pink. Yes, October is National Breast Cancer Awareness Month, and of all the months dedicated to a disease this one is the most prominent every year. You couldn't forget this one even if you tried, with all the pink-clad fundraisers and the wide array of pink products that hit the shelves this time of year.

I always thought the idea of having an "awareness month" for a disease such as breast cancer was a little weird. I'm fairly certain that we've all heard of breast cancer, so making us "aware" of the disease seems a bit redundant. Of course the month is really much less about actual awareness and more about fundraising, and therein lies the issue I take with this month.

If you look at the participating products in the "save lids to save lives" list [1] you'll notice that they're not the most healthy products. Actually, they are downright unhealthy. Yoplait yogurt, Totino's pizza rolls, Pillsbury cookies and cinnamon rolls, gummy snacks and cereal are just a few to grace the list... but this begs an important question: What's the point of raising awareness and money for cancer when the very products you buy to support the cause will (probably) give you the disease?? Clearly the people who approved these foods either don't understand human health or are more concerned with lining their pocketbooks than anything else. Call me a cynic, but I think the pink thing is yet another marketing ploy to encourage people to buy these unhealthy products. If you want to give money to cancer research go right ahead, but do yourself a favor and just write Susan Koman a check instead of buying this crap.
Furthermore, why are we raising money for a cure and not talking about prevention? I would be much more on-board with this whole "disease month" thing if they were about prevention. So instead of buying those cinnamon rolls and raising what is likely pennies for research to find a cure, go for a run and make sure you never need a cure.

When I get into practice (soon!) I plan on doing workshops and programs geared toward breast cancer prevention during the month of October, so stay tuned next year. Let's stop thinking in their box (big pharma and it's box of drugs) and create a new one, shall we?


Inspired by the need for change,

Nikki

References:
[1] https://savelidstosavelives.com/ParticipatingProducts

Who are we fooling?

The more I see out there in the world the more I realize the world is in need of a serious wake-up call. There are so many companies out there trying to make a buck off of you it's nauseating. I believe probably 90% of the people selling us "food" and nutrition products are not at all interested in our well-being, but just want to take advantage of the current nutrition culture. There is so much confusion surrounding food, supplements, and diets that it's easy to get confused, and that's exactly what companies are banking on.

As I sit in my living room happily eating my hummus and raw veggies for lunch, I am amazed at the commercials I see. When did we as a society decide that gummy vitamins was a good idea, for example? Surely I missed that memo. I would like to go on record as saying that candy is not good for you, not matter how many vitamins they force into those little sugary bear of doom.

Vitamin Water is a classic example of how companies just want to confuse consumers. They are just crossing their fingers we don't do our homework. People are out there thinking "well, water is good for you, so vitamin water must be really good for you!" But if you read the label on those things they are loaded to the brim with sugar... More sugar than a Dunkin Donut's glazed donut, as a matter a fact [1]. At 13 grams of sugar per serving and 2.5 servings per bottle, Vitamin Waters pack a mean 32.5 grams of sugar per bottle. I'm sure all that sugar doesn't interfere with the absorption of those vitamins....
Finally, my personal favorite is protein bars- Particularly the ones that are covered in chocolate. Really? These things are glorified candy bars we've added a little cheap protein powder to in a (successful) attempt to bamboozle consumers. I don't care if that candy bar you're eating has 100 grams of protein, it's still a candy bar.

Michael Pollan said it best when he said "don't buy foods that make health claims". Poor, shy broccoli will never outwardly boast about it's vitamins and fiber... mostly because there's no way to get rich off selling broccoli. If a product has to convince you that it's healthy chances are it's not that healthy. Stick with what we've known about nutrition all out lives: there is no substitute for fruits and vegtables. Learn to love them.


Nikki


References:
[1] http://www.dunkindonuts.com/content/dunkindonuts/en/menu/nutrition/nutrition_catalog.html?nutrition_catalog_hidden=0&nutrition_catalog_needType=Food&nutrition_catalog_selPage=2&nutrition_catalog_perPage=50

Why Gluten? Why now?

I admit it: I hunt for gluten sensitivity. My own friends have scoffed at me "not everybody is gluten sensitive, Nikki"... As if I am somehow insulting their diets by suggesting that others follow my lead into a gluten free life. I know I'm on the hunt for something that relatively few people care about, and I'm okay with that. Somebody has to tell the world about this issue. Maybe I'm just passionate about this topic because going gluten free has helped me so much. Maybe it's because I have trained and read so much about the topic. Or maybe it's because it's a very big issue and nobody else is tackling it. Gluten sensitivity is the elephant in the room.. Will you be one of the few who take notice?
Like Autism, scheptics like to debate weather or not gluten sensitivity (let's call it GS for short) and Celiac Disease (CD) are truly on the rise. It certainly seems like it's becoming more popular, but is it because of a true rise in incidence, or is "going G-free" the newest fad diet?

It's hard to provide real (research) proof that GS is on the rise because we've only started looking at non-celiac gluten sensitivity somewhat recently. However, it does appear that CD is on the rise, and not by a small margin. The most comprehensive study on this topic was done in 2009 [1]. The study compared blood samples from 9,133 healthy young adults from Warren air force base in the 1940s and 50s and compared them to the blood of 12,768 gender matched subjects in present day. The results of the study showed that in the last 50 years, incidence of CD has increased from 1 in every 700 to 1 in every 100 people. Furthermore, upon follow-up the researchers discovered that patients with undiagnosed CD had 4-fold increased risk of death. Since everything you can imagine that would kill you is related to inflammation (cancer, diabetes, heart disease, stroke, autoimmune disease, Alzheimers), it is of no surprise to see that an inflammatory bowel disease like CD can shave years off your life. Sure, it's a hassle to avoid gluten, but wouldn't it be better than setting yourself up for an inflammatory disease later in life?

So why are we reacting to gluten now more than ever before? Wheat isn't that new to us that we should react any differently than we did 50 years ago, right? As with most of the health problems we face today, there is no one cause of this phenomena.

I will discuss a few of the proposed mechanisms at play, but it all boils down to three main reasons:

1. Our environment has changed. Let's face it, folks. We're not in Kansas anymore. If you compare our world in 2012 to even twenty or thirty years ago you can tell that change is all around us. GMO food crops are causing immunological and inflammatory changes in our bodies without us even knowing it. We are exposed to numerous chemicals, fertilizers, pesticides, flame retardants, and cleaning chemicals before we even exit the womb. The animals we eat are being raised in CAFOs and dark, crowded chicken coups, fed hormones and antibiotics to the point of near death, and then brought to our dinner table. If that's not an unhealthy environment I don't know what is.

2. We have changed. Children are given more vaccines now than ever before. Our diets are not supplying us with the vitamins and minerals we need to keep us healthy. We don't go outside and play anymore. We've given so many antibiotics it's a wonder any of our gut flora are still alive. We probably all have had a leaky gut at some point in our lives, giving our immune system the perfect opportunity to launch an attack on unsuspecting proteins like gluten. We don't exercise enough. Our chronic stress is frying our brains and our guts. We're not physically as able to process the food we take in, including wheat.

3. The wheat has changed. Not only in the sense of genetically modified wheat, either. Even if the wheat in the field was the same wheat, we do so much stuff after we harvest it now that it's hardly recognizable to the naked eye, let alone the immune system. After being harvested it is not uncommon for crops such as corn and wheat to sit in silos for months or years. During that time, the grains begin to rot, leading to the formation of enterotoxins. Once we get it to the plant to be made into your PopTart it is further modified. Harsh acids and temperatures deaminade gluten so that it becomes more water soluble, making it easier to work with and add it to products. Sure, it's easier to work with in the factory, but do you think your body actually knows what to do with it once you ingest it? Deaminaded gluten can cause some of the most vigorous immune reactions to wheat, but guess what? That's not tested for in the classic celiac panel (but it IS in the Cyrex panel!)

Healthfully yours,

Nikki

[1] Rubio-Tapia, A. Increased prevalence of mortality in undiagnosed celiac disease. Gastroenterology 2009 Jul;137(1):88-93. (PubMed ID 19362553)

Gluten: What You Need to Know

It seems like everywhere you look there's a new gluten free item on the supermarket shelf, a restaurant with a gluten free menu, or a friend "going gluten free". But what's all the fuss over this one little molecule? And why is it becoming increasingly popular to avoid it?
Gluten is the protein found in wheat, barley and rye, and it is what gives many foods their form and texture. Think of it as the "glue" that holds bread products together. Gluten enteropathy, or Celiac Disease (CD), is an autoimmune disease in which the individual reacts to gluten and produce an autoimmune-mediated attack on their intestines. Currently it is estimated that CD affects 1 in every 133 people in the US, with a predilection for Caucasian people and women. More shockingly, it is estimated that 80% of people with Celiac Disease are unaware they have the disease [1]. Diagnosis of CD requires either a positive Anti-gliadin antibody test or Tissue Transglutaminase test, as well as a biopsy of the small intestines showing gross damage to the villi of the intestines. Often times a third test is used, a genetic test that looks for the "Celiac genotype" of either HLA-DQ2 or HLA-DQ8.

Okay, so it makes sense that if you have CD you shouldn't eat gluten. But then there's the real weirdos out there: the 1.6 million Americans who are on a gluten free diet but are not diagnosed with Celiac Disease. Why in the world would people without Celiac Disease go gluten-free?

Because you don't have to be Celiac to have an immunological, and very real reaction to gluten. As a matter of fact, scientists now believe that occult cases of CD account for an astonishingly low number of gluten sensitive individuals. As a matter of fact, research is now showing that those people with enteropathy (disease of the intestinal tract) represents only 1/3 of the patients with neurological manifestations of gluten sensitivity [3]! The vast majority of autoimmune patients are highly sensitive to gluten (and casein) and feel much better when they remove it from their diets. Remember, just because the intestinal tract itself isn't being attacked doesn't mean that the immune system isn't attacking another tissue. In CD it's the gut that gets chewed up, in RA it's the joints, in Hashimoto's it's the thyroid. In any case the immune system reacts to the foreign protein and stimulates an immune attack- it's just a matter of where they send the troops.
The problem is that most doctors have yet to acknowledge that non-celiacs can have a problem with gluten. To them, the "Celiac test" IS "the gluten test", but that is absolutely not true. I have heard countless stories from patients with the same experience: "my doctor said it was all in my head... They said I had no problem with gluten." It's so sad, because these people knew that their bodies did not tolerate gluten, but at the insistence of their ignorant doctors they continued to eat the foods that were contributing to their misery.

Here's what you need to know about gluten sensitivity testing and where you can go to get answers.

There are three main problems with traditional Celiac testing that cause gluten-sensitive folks to fall through the cracks.

1. The majority of testing uses the antibody IgA. However secretory IgA is commonly depleted in autoimmune patients, who make up a large percentage of gluten sensitive people. This means that the IgA test can come back low enough to fall into the "negative" range, when in actuality the patients' body was just not making any IgA, let alone IgA against gluten. To combat the risk of false negatives, look for tests that include either IgG or IgM in addition to IgA.

2. Celiac genotype testing is boarder-line useless, but many physicians will not consider you to have CD unless you have the HLA genotype. While 90+% of CD patients are HLA-DQ2 positive, approximately 30% of those of Caucasian decent have this genotype, too! This means that the genotype testing has pretty good sensitivity, but really lousy specificity. That and again, this test is looking for people with occult Celiac Disease, so those who are non-celiac gluten-sensitive would be passed by yet again.

3. The main problem with celiac and gluten testing is that the test only looks for sensitivity against one of the many components of wheat. The anti-gliadin antibody testing used do diagnose CD only tests for Alpha Gliadin- one of 12 or so components of wheat and gluten! Not only that, but most current testing does not test for reactions to wheat versus rye or barley- they assume that the structure is similar enough that they would all produce a positive test result to Alpha-Gliadin.
So what should you do if you believe you are one of the many who have an issue with gluten? The best advise I can give you is to listen to your body!

The cheapest way to find out if you have a food sensitivity is to do a good ol' fashioned food elimination test. That is, cut it out of your diet for a few months, then add it back in and see what happens. We need to re-learn as a species how to listen to our bodies. Back when we were in the bush we would simply know to avoid a food if it made us feel bad. Nobody needed blood tests and peer-reviewed, double blind, placebo controlled trials- it was common sense that your body knew what's best.

I recommend doing an elimination diet with the most common allergens: gluten, dairy, soy, eggs, and peanuts. Give your gut and your immune system a break from these inflammatory foods for a few months with absolutely no cheating. If you can do things to heal your gut (coming in a later post) during that time then all the better. After a few months have passed, slowly start re-introducing foods into your diet, about once every 3-4 days. Recall, it takes the epithelial cells in your gut approximately 3-5 days to regenerate, so it will take you that long to rebound from each new food. As you reintroduce foods, keep an eye out for any symptom: from restless leg syndrome, to gut problems, to pain or insomnia. Remember, the immune system lives in the entire body, so symptoms can pop up anywhere. If you have an autoimmune disease, specifically keep your eyes peeled for symptoms of your disease (ex. joint pain in RA, hypo or hyperthyroidism symptoms in hashimoto's or graves disease, etc). Of course, the entire point of the diet is to avoid the foods that produced any adverse reactions, so listen to your body and stay away from the stuff after that!

For those of you who like to see results that clearly tell you "you can eat this, you can't eat that", you are in luck. A few years ago a lab based out of Phoenix, AZ started running an amazing panel for gluten sensitivity and it is being implemented in functional medicine practices throughout the country. For more information about the lab visit http://www.cyrexlabs.com/. It has been my personal experience with this lab that they are very helpful, and if you ask them they will find you a doctor in your area who runs their tests.

Always in health,

Nikki


References:
[1] http://www.mayoclinic.org/news2012-rst/7008.html
[2] Chart recreated from Datis Kharrazian's seminar notes "Understanding the complexity of gluten sensitivity" 2011
[3] J neurol Neurosurg Psychiatry, 2007:72;560-563. Gluten sensitivity as a neurological illness.

Recommended videos:
[Tom O'Bryan] http://www.youtube.com/watch?v=DjvKrAvolMQ

Recommended websites:
http://www.theglutensyndrome.net/
http://www.glutenfreesociety.org/gluten-free-society-blog/grain-a-double-edged-sword/
[THE lab]  http://www.cyrexlabs.com/
[Great GFDF recipes!]  http://www.nourishingmeals.com/
[An example of how gluten attacks more than the gut]  http://www.livingwithout.com/issues/4_12/ataxia-2366-1.html


The Many Causes of Leaky Gut Syndrome

Last time we introduced the concept of leaky gut syndrome and discussed how the gut works. By now it should be clear that there are a lot of things that go on every minute of every day to ensure normal gut function- your microbes are talking to each other, your immune system is surveying the scene, and your intestinal lining is continually renewing itself. But what happens when one or more things interfere with normal gut function? Gut health is multifaceted it is no surprise that there are numerous things that can increase intestinal permeability (4). The easy way to explain this is that anything that causes inflammation of any kind is going to have an inflammatory effect on the gut... but let's explore a few mechanisms.

  •  Anti-biotic drugs (and herbs) don't just kill the bugs you want to kill- they kill whoever is susceptible to them. Unfortunately, this often includes the "good" microbes that keep your gut healthy. While this may be the least of your concerns if you are on the brink of death from sepsis, it is something to consider when dealing with relatively common ailments such as UTIs, ear infections, and sinus infections. Before you walk out of your doctors office with that anti-biotic script ask yourself "would I be able to shake this bug without this drug?" and "what other effects will this drug have on me?" In my experience, ear infections are almost always viral and thus unresponsive to anti-biotics, UTIs can be killed very quickly with lots of water and some uva ursi, and sinus infections will go away good ol fashioned rest and neti-pot washes.
  • NSAID drugs (non-steroidal anti-inflammatory drugs) such as ibuprofen and advil are notorious for causing stomach ulcers, so it's not a surprise that they damage the rest of the gut lining in the same way. There are multiple mechanisms at play here, including direct irritation of the GI lining by the drug when it is ingested, uncoupling of mitochondrial oxidative phosphorylation, and the inhibition of COX 1 and 2 (1). That last part is especially important. The Cyclooxygenase enzymes aka COX 1 and COX 2 are enzymes responsible for the formation of prostaglandins, or local cellular messengers. NSAIDs are said to be "non-selective COX inhibitors" because they block both enzymes. The sad news is that while blocking COX 2 gets rid of your pain and reduces inflammation, COX 1 is a good guy we really don't want to block. COX 1 is responsible for the formation of anti-inflammatory prostaglandins and actually helps maintain the gut lining. Whoops!
  • Food intolerances are becoming all the more common, the two most common being to gluten and dairy. Exposure to gluten is one of the most potent triggers for zonulin release from the gut lining (which goes hand in hand with increased permeability) even in people without Celiac disease (2).
  • Head injury has been shown to release zonulin, the same molecule that is released from the GI tract when it is injured. This tight junction protein not only closes the gap between epithelial cells in the GI tract, but it plays the same role in maintaining the blood-brain-barrier. When traumatic brain injury was applied to a rodent model in the laboratory setting Santos and colleagues found "significant damages to gut structure and impairment of barrier function" only three hours after injury (3). The authors believe that when zonulin is released from the injured blood-brain-barrier it makes its way to gut via the blood and signals the gut lining to become more permeable, too.
  • Gastrointestinal infections
  • Chronic stress
  • Enviromental toxins
  • Chemotherapy and radiation therapy
  • Autoimmune disease
  • Alcohol
  • Corticosteroids
  • Excessive sugar consumption

With so many things that cause leaky gut syndrome in the world it's a wonder why we don't all have leaky guts. Keep in mind that there are surely other things that cause the gut barrier to break down, but this is a good starter list. Also, people's reactions to the inflammatory stimuli can be much different. For some, stress may be what sends them into a diarrhea-ey downward spiral, for others it may be NSAID use. Everybody has different capacities to handle inflammation based on variations in dietary antioxidant consumption and their body's ability to make its own antioxidants. Either way, I look at this list and am reminded of why I have to eat as clean as humanly possible- you never know what inflammatory thing will try to take you down next!


In health,

Nikki


References:
(1) http://farncombe.mcmaster.ca/document/WallaceBestPractResClinGastroenterol2000141147-159.pdf
(2) Fasano Alessio, Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer, Physiol Rev 2011; 91: 151–175.
(3) Santos Alejandro, Intestinal Permeability to Glucose after Experimental Traumatic Brain Injury: Effect of Gadopentetate Dimeglumine Administration, Nordic Pharmacological Society Basic & Clinical Pharmacology & Toxicology 2008, 103, 247–254.
(4) The Textbook of Functional Medicine 2010 pg 192
(5) Lipski, Elizabeth, Leaky Gut Syndrome 2010 pg 17