Gut Reactions

Until a few decades ago it was thought that unless a medical problem directly affected the gut, it worked normally. But now physicians know that trauma to other parts of the body causes the gut to react. Dr. Douglas Wilmore, a researcher at Harvard Medical School, showed how intestinal permeability increased in postoperative patients and people with AIDS. He also found that the amino acid glutamine--the fuel intestinal cells use to replace themselves every three to five days--improved the gut's function and helped the overall health of the patient.

To a handful of true believers, leaky-gut syndrome can be the explanation for almost anything that goes wrong in the body. ""When you start looking for it, you see leaky gut in lots of people--even autistic children and people with attention deficit disorder,'' asserts nutritionist Elizabeth Lipski, author of the books ""Digestive Wellness'' (368 pages. Keats Publishing. $14.95) and ""Leaky Gut Syndrome'' (48 pages. Keats Publishing, available December 1997). She thinks, naturally, that traditional medicine isn't moving quickly enough to recognize the significance of this condition. ""There is lots of this information in scientific research,'' she says, ""but it isn't being used fully yet.'' Galland also sees a virtual epidemic of leaky guts, estimating that the syndrome plays a role in 70 percent of people with chronic fatigue syndrome, eight out of 10 aspirin or ibuprofen users, most alcoholics and anyone who is hospitalized. He believes that parasites that can lead to leaky-gut syndrome lurk in most municipal water systems, and recommends that people ""treat your food and water supply as if you were in a Third World country. Boil and filter it, or use bottled water.''

But you still have to eat something, and Galland and others contend that even the most innocuous of foods can create intestinal havoc. One common prescription for leaky-gut syndrome is an elimination diet. An elaborate series of urine and blood tests is used to pinpoint food allergies. Based on the results, whole categories of food, such as dairy products, wheat products or fruits, are banned and then gradually added back over the course of as much as six months while the patient is monitored for reactions. This is what worked so well for Vonelli, though at a high price. ""It took away my Italian heritage,'' Vonelli remembers. ""No more homemade pasta, mozzarella cheese, fresh bread, everything from the good life.''

That all-purpose nutritional standby, fiber, may also play a role in healing problems of the gut. An NIH-funded study from Louisiana State University showed that rats who ate no fiber had abnormal intestinal linings. Glutamine, a nonessential amino acid, also plays a role in maintaining the integrity of the intestinal wall. The research by Wilmore was extended by his wife, physician Judy Shabert, in her book ""The Ul- timate Nutrient, Glutamine'' (224 pages. Avery Publishing Group. $9.95), co-written with Nancy Erlich. She cites a study in which athletes who took glutamine supplements had fewer colds than those who didn't.

But to conclude from these studies that leaky-gut syndrome is widespread, treatable and the cause of all sorts of problems is a leap scientists and most physicians won't make. Peter McNally, a gastroenterologist at Eisenhower Army Medical Center in Augusta, Ga., and a spokesperson for the American College of Gastroenterology, says not enough is known about a leaky gut. McNally uses celiac disease, a wheat allergy that causes a painful skin rash and diarrhea, as an example of a proven relationship between the intestine and disease. ""Finding that skin-to-gut link,'' warns McNally, ""was not easy. It required vigorous science, and this is an area of research that is still in its infancy.''

Cathy Kapika, a professor of nutrition at the Chicago Medical School and a spokesperson for the American Dietetic Association, is also skeptical. ""The gut and glutamine are definitely hot areas of research right now, but saying that a leaky gut is the cause of all of these problems is too simplistic.'' As for strict elimination diets, Kapika recommends using them only as a last-resort diagnosis of food allergies, under close medical supervision; otherwise, they can cause serious malnutrition. But care and maintenance of the gut, an easily abused organ, makes sense in any case. Be alert for allergic reactions to foods that may develop after a sickness or a round of medications. After taking antibiotics, eating yogurt that has live acidophilus can replenish healthy intestinal flora. Cutting down on alcohol, antibiotics and aspirin (as well as not mixing them), and increasing one's fiber intake--Americans typically get about a third of what they should--can go far in maintaining intestinal fortitude.