In my research, I came across the work of Dr. Alessio Fasano, a physician and researcher whose work has uncovered the idea that all autoimmune conditions involve some degree of intestinal permeability, also referred to as “leaky gut”. His research led him to discover the three-legged stool of autoimmunity that has revolutionized the way we understand autoimmune disease.
The three legs consist of:

1. Genetic predisposition
2. A triggering event
3. Intestinal permeability

I think we can all agree that we have no control over our genes, and identifying triggering event(s) that initiated your thyroid condition might take quite a bit of time and effort. But addressing leaky gut gives us an actionable pathway to begin healing and puts the power back in our hands, so we can begin the journey toward remission.

What is Leaky Gut?

When functioning as they are designed to function, our healthy human intestines serve the role as both a barrier and a filter. A layer of cells form a mucus barrier, consisting of inter-cellular tight junctions similar to thread fibers that come together to form a piece of cloth. The intestines open and close their tight little junctions to allow nutrients to be absorbed from the food that passes through our gut and blocks the absorption of toxins like partially digested food, pollen, feces, dead cells, and bacteria that we certainly don’t want circulating around our bodies.
But what happens when those intestinal tight junctions become damaged and loose?
Those toxic substances become absorbed into the bloodstream, causing the body to recognize them as foreign invaders. This causes inflammation in the body as it begins to attack the intruders, and eventually leads to autoimmunity.
There are numerous factors that can cause intestinal permeability, and discovering which trigger (or triggers) is damaging your gut is key to restoring its function. These factors include:

• Adrenal fatigue
• Alcohol
• Capsaicin (in “spicy” peppers)
• Dental infections
• Dysbiosis
• Enzyme deficiencies
• Food sensitivities
• Gluten
• Gut infections
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Nutrient depletions
• Psychological stress
• Small intestinal bacterial overgrowth (SIBO)
• Sinus infections
• Strenuous exercise
• Stress
• Surgery or trauma
• Toxins

How Do We Reverse Leaky Gut?

This long list of potential triggers can seem daunting, but the most common triggers that cause leaky gut are stress, food sensitivities, nutrient deficiencies, a deficiency in digestive enzymes, an imbalance of gut bacteria, and intestinal infections (including SIBO).
By addressing and managing stress and then tackling potential gut irritants, we can oftentimes reverse leaky gut and stop autoimmunity in its tracks!
There are four steps to removing some of the triggers and putting an end to leaky gut and its symptoms.

Step 1: Remove Reactive Foods

In some conditions, a single food can act as a trigger and induce intestinal permeability. This is the case with gluten (a protein found in wheat, barley and rye) and Celiac disease. Dr. Fasano estimates that for up to 20 percent of people with autoimmune conditions, the trigger may be gluten, and removing gluten will reverse the autoimmunity.
Even in a person without Celiac disease or any apparent gluten sensitivity, gluten can lead to a leaky gut because it is a protein that is difficult to digest for humans. While some people with chronic diseases go into remission just by removing gluten from their diet, others will need to search for additional “root causes”. These additional food sensitivities are likely to include dairy, soy, and grains, but might also include nuts, seeds, eggs or nightshades (potatoes, tomatoes, bell peppers and eggplant). The Autoimmune Paleo diet can be helpful with this.
I suggest that to discover the food triggers that are causing your leaky gut, begin by eliminating gluten, dairy, soy and grains for a period of 4 weeks. If you begin to feel a relief of gut symptoms after that trial period, you can slowly add each food group back into your diet, one at a time, allowing a few days between foods to see if you get a reaction.
If after eliminating each of these food groups you are still experiencing gut symptoms, it might be time to eliminate a wider group of possible food irritants.
This elimination diet would exclude:

• Caffeine
• Dairy
• Eggs
• Grains
• Legumes
• Nightshades
• Nuts
• Seaweed
• Seeds
• Sugar

It might seem extreme at first glance, but there are still many different delicious and healing foods you can eat while eliminating those that are causing your body harm.

Step 2: Supplement with Enzymes

Several studies have found that people with chronic diseases and hypothyroidism often have a deficiency in hydrochloric acid, resulting in low levels or even a complete absence of stomach acid.
Digestion is one of the biggest energy-requiring processes of our bodies. When extra effort is required to break down the proteins we eat, it takes a huge toll on our bodies and can often lead to extreme fatigue – a common symptom for those dealing with thyroid and other autoimmune conditions.
A digestive system that is weakened by difficulty with digesting proteins can set off a chain reaction of greater digestive trouble as it struggles to digest the more complex protein molecules found in gluten, dairy and soy. When proteins are poorly digested, we are more likely to become sensitive to them, leading many people with chronic diseases to become sensitive to gluten, dairy and soy, among other foods.
It’s a vicious cycle, but one that can be slowed by supplementing with hydrochloric acid and digestive enzymes, which can assist the body in breaking down these difficult to digest proteins and improving overall intestinal function and vitality. My research and personal experience have led me to recommend a few supplements to help restore proper gut function.
1. Betaine HCL with Pepsin – When I first took Betaine HCL after struggling for a decade with debilitating fatigue, I was amazed at how my energy returned almost overnight! I no longer needed to sleep for 12 hours, and my bloating was significantly reduced. All because I was finally able to digest my food.
Betaine HCl and Pepsin are naturally occurring components of the gastric juices that break down protein bonds in our food to make nutrients and amino acids more bio-available. They are especially important for proper absorption of protein, calcium, B12, and iron. Taking Betaine HCL with Pepsin after every protein-containing meal can assist with digestion and greatly improve energy levels. I recommend the Betaine with Pepsin supplement by Designs for Health.
2. Proteolytic Enzymes – Also known as systemic enzymes, proteolytic enzymes can help bring our immune system back into balance by breaking down pathogens and reducing inflammation that can lead to autoimmunity. In Europe, these systemic enzymes have been studied extensively and have become a popular alternative to pain medications for many inflammatory conditions.
3. Fat Digestive Enzymes – Fat malabsorption is easily overlooked by patients and practitioners alike, but is a common occurrence. Some signs and symptoms of fat malabsorption include greasy, smelly, floating, light-colored stools, gas or belching after eating, diarrhea, dry skin, stomach pain, gallbladder pain (which is on the right side, under the ribs), gallstones, gallbladder removal, nausea, weight loss, hormonal imbalances, and adrenal issues. A low fecal elastase test on functional medicine stool testing can also indicate fat malabsorption.
Potential reasons why a person may have difficulty with fat malabsorption include bile deficiency, pancreatic enzymes deficiency, liver backlog, and small intestinal bacterial overgrowth (SIBO).
The Designs for Health Liver & Gallbladder Support (LV-GB) supplement can help fat digestion in three different ways: it can support the liver’s ability to process fat with milk thistle, give us extra bile via ox bile, and support our bile flow with dandelion, artichoke, and beets. If you have issues with fat malabsorption, this is life-changing support.
4. Vegetable Digestive Enzymes (Plant Enzymes) – Many people with chronic diseases may also have an impaired ability to digest vegetables due to fiber and starch content. In some cases of hypothyroidism, an indigestible ball of plant fiber material known as a phytobezoar has been found to cause bowel obstruction. In the case of poor fiber absorption, undigested vegetables fibers may be found in the stools, and high-fiber meals may cause bloating. A vegetable digestive enzyme that contains fiber-digesting enzymes like cellulase, and/or starch digesting enzymes like amylases, may help with digesting vegetables. I formulated the Designs for Health Plant Enzymes with a specific combination of enzymes, including cellulase and amylase, to help support this digestive process.
5. Broad Spectrum Digestive Enzymes – A broad spectrum digestive enzyme may also be helpful with decreasing symptoms of nutrient deficiencies and increasing energy. Broad spectrum enzymes, like Digestive Enzymes Ultra from Pure Encapsulations, promote optimal digestion of proteins, fats, and carbohydrates. Digestzymes is comprised of a mixture of enzymes, to support enhanced digestion for optimal nutrient bio-availability and absorption.

Step 3: Balance the Gut Flora

The gut is home to trillions of bacteria, and studies have shown that autoimmune disorders can be brought on by an overabundance of the wrong type of bacteria, and can be reversed by an increase in beneficial bacteria. So, you can see how important it is to make sure our gut flora is well balanced.
Gut flora balance is achieved in large part through eating a wide variety of healthy foods, but for those on restrictive diets to help get to the root cause of their autoimmunity, this might be difficult. For that reason, it is often necessary to supplement with fermented foods and probiotics.
Fermented foods – Sauerkraut and similar fermented vegetables are a wonderful source of beneficial bacteria and can help to restore proper gut flora when consumed regularly. Similarly, kefir and yogurt offer an abundance of good bacteria, but should be avoided by those who have been determined to have a sensitivity to dairy. Coconut yogurt and fermented coconut water are great alternatives.
Probiotics – Widely used to rebalance gut bacteria, probiotics can be a powerful tool for those dealing with leaky gut, as they can help restore healthy gut flora by displacing the pathogenic bacteria.
It is important to note that not all probiotics are created equally, and it’s crucial to start slowly and build up from there. As the “good” bacteria begins to take up residence in your intestines and displace the “bad” bacteria, the die-off can sometimes create what’s called a Herxheimer reaction. This can include lethargy, difficulty concentrating, cravings for sweets, diarrhea, rashes, irritability, gas, bloating, headache, nausea, vomiting, congestion, and increased autoimmune symptoms. This type of reaction usually clears within three to five days and leaves the person feeling much better in the end.
There are several different types of probiotics that can be beneficial for those dealing with chronic disease. Lactic acid-based probiotic recommendations include VSL#3, Probiotic Synergy, and Probiomed 50B . Yeast-based probiotics are a safer option for those combating SIBO (small intestine bacterial overgrowth), in which case I recommend Saccharomyces boulardii based probiotics like Floramyces by Designs for Health.
Finally, spore-based probiotics have recently been shown to reduce allergies and asthma, in addition to helping recovery from autoimmune disease and reducing SIBO. I recommend ProbioSpore.

Step 4: Nourish the Gut

Providing nourishing food and supplements is an important last step to give your gut long term support. By adding a few critical nutrients, we can both heal and help prevent leaky gut.
One of the easiest ways to soothe and heal the lining of the gut is to have a delicious cup of bone broth. Bone broth is a traditional food that we hear a lot about these days because it really is one of the most nourishing foods we can feed our bodies.
The reported benefits of bone broth include boosting immunity, relieving joint pain, increasing energy, improving digestion, and giving you a more youthful appearance. Most importantly, for those suffering from leaky gut, the gelatin in bone broth actually helps to seal the junctions in the intestines so they are no longer permeable; and so that toxic substances can no longer pass through the intestinal wall.
Best of all, bone broth is cheap and easy to make and makes a delicious beverage or soup to sip any time of day.
Here’s an easy bone broth recipe that can be thrown together in a slow cooker before bed and enjoyed the next day:
Easy Bone Broth
5 chicken legs
2 cups mixed chopped carrots, onions, and celery
1 tablespoon apple cider vinegar
Sea salt to taste
Purified water
Add all ingredients to a slow cooker and cook overnight, or for 8-24 hours. You’ll wake up to a delicious smell!