A common view in alternative medicine is that our guts become leaky from our poor diets, and medications we may be taking. According to this theory (which I am not endorsing), the leaky gut allows absorption of toxins and proteins. The latter may activate the immune system, and lead to secondary effects (these effects are often in the eyes of the alternative medicine provider, and may or may not be related to a leaky gut). Indeed, there is evidence that the gut may become leaky, and one may be able to actually measure if they have a leaky gut. However, the clinical relevance of this observation, remains to be well established. In my opinion, it is over subscribed to. Yet, in some cases, a gut restoration program to help restore the normal integrity of the gut barrier may be helpful. The gut restoration program below is a lactose free diet, that is also gluten free. Thus, people withunderlying lactose intolerance and/or gluten enteropathy (a relatively uncommon condition) would be expected to benefit fromthis type of diet.

• Daily multivitamin with trace minerals (e.g. Centrum or Theragram M)
• Replenish "Beneficial Bacteria": those typically used are bifidobacter bifidum, lactobacillus acidophilus and streptococcusthermophillus at doses of ten million cfu twice daily (see Scientific American Article for additional detail on "beneficial bacteria")
• Fructo-oligosaccharides to support the flora noted above. Fructo-oligosaccharides contain 3-10 monosaccharides, with fructose (a 6 carbon sugar like glucose which is commonly found in fruit) being at least two of them. They are found in the following foodstuffs: onion, burdock root, asparagus and rye. More limited forms may be found in: banana, Jerusalem artichoke, sugar maple and Chinese chive.
• Glutamine, a non-essential amino acid which can serve as an important energy source for enterocytes (intestinal cells) due toits easy conversion to the Kreb's cycle substrate, alpha keto-glutarate. It has largely been studied in animal models ofradiation induced intestinal injury, and in TPN (total parenteral nutrition) after surgery. Doses studied in humans have been500-1000 mg three times daily.

Dietary Guidelines

These dietary guidelines are as outlined J Bland's 11/95 paper in Alternative Therapies, which results in a low-lactose, low-fat, gluten-free diet.

• Eliminate Dairy: milk, cheese and creams, including ice cream and frozen yogurt.
• Limit "meat" to poultry, lamb and fish (unless specific allergy known).
• Eliminate gluten containing foods: wheat, oats, barley, or malt. Gluten is found in many common foods: bread, crackers, pasta,cereals, and other flour based foods.
• Rice and corn products are acceptable. Buckwheat and potato flour are also gluten free.

• A Sample Diet (1400 kcal, fat 20% of calories, 91 g protein)
• AM-1 cup cream of rice, 1/2 cup soy milk and banana
• snack- 1 oz almonds or other nut
• lunch- 2 rice cakes, 1/2 oz. tahini & 1 cup chicken/veg/rice soup
• snack- 2 fruit servings
• dinner- 1 boiled potato, 1/2 cup cooked vegetable, 6 oz. of poultry/lamb/fish, small garden salad with vinegar/oliveoil/garlic

Instestinal Bacterial Flora (Gut Microbiota) in the News

• Gut Flora, Inflammation and Cancer, Science, 5 Oct 2012
• Host and Gut Flora Metabolic Interactions, Science, 8 June 2012
• Gut Flora and Immune Interactions, Science, 8 June 2012
• Gut Flora Ecology, Science, 8 June 2012
• Gut Flora Review, Scientific American May 2012
• Gut Microbial Enterotypes (Bacterial Patterns), Science 7 Oct 2011
• Diet and Gut Flora, Science 20 May 2011
• Clostridia and Normal Gut Flora, Science 21 Jan 2011
• Gut Flora and Adaptive Immunity, Science 24 Dec 2010
• Metabolic Syndrome and Gut Flora, Science 9 April 2010
• Gut Flora, Science, 2 Feb 2001
• Gut Flora Manipulation, Science, 2000
• M Cells and intestinal Absorption, Science, 15 August 1997