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Advanced Intestinal Barrier Assessment

Arkansas Nutrition and Natural Healing

Dr. Roger Trubey, Dr.PH, MPH, and Doctor of Integrative Medicine 362 Unger Trail, Mountain Home, Arkansas 72653

Call 501-538-4944

Advanced Intestinal Barrier Assessment

You have heard of leaky gut.  Have you wondered if you have a leaky gut?  The Advanced Intestinal Barrier Assessment will tell you precisely if you have a gut that is damaged and leaky.  And if you do, did you know it can also be an underlying factor not only in in gas and bloating, but also in depression, joint pain and cardiovascular diseases.  And those are just a few of the many, many symptoms and pathologies that are related to excessive gut permeability.  The gut is said to be the gateway to health. It’s where nearly 80% of your immune system lives.  But it may also be the gateway to terrible health problems as well, when it is imbalanced, damaged and leaky.

But what does a leaky gut really mean.  In essence, undigested food particles, pathogenic microbes, toxins etc. are escaping out of the gut and getting directly into the blood where they can translocate to nearly any organ of the body including the brain, thyroid, heart, kidneys, joints, etc.  In these locations they have the potential to ignite inflammation via pro-inflammatory molecules, and when this takes place long-term, they can induce autoimmune disease, or any of the diseases mentioned already

For years clinicians knew something was taking place at the gut level that had seriously strong relationships with tissue damage and organ dysfunction elsewhere, but there was no test to clearly define leaky gut.  


Finally, it was the discovery of Zonulin by Dr. Alessio Fasano, Chair of Pediatric Gastroenterology and Nutrition and Chief of the Division of Pediatric Gastroenterology and Nutrition at MassGeneral Hospital for Children, that discovered the primary key in leaky gut – Zonulin.

Zonulin is the biomarker that is made in the gut and tells the gut lining to open.  It binds to receptors in the gut and tells the tight junctions between cells to open and makes the gut leaky. 

leaky gut


Now there is a purpose to some “leakiness”.  We do want very small molecules like food nutrients to get through but not large molecules like bacteria, that will act as triggers of excessive immune response.  So, when Zonulin is elevated on a blood test, we essentially know that we have created a pathway in the gut that goes from a small alleyway to a 6-lane highway.  It is this factor that led Dr. Fasano to understand that elevated Zonulin was the key to seeing it as one of the primary environmental drivers of autoimmune disease.  In fact, It was to him a near impossibility to have an autoimmune disease without a damaged and leaky gut.

You see we weren’t born with Lupus or rheumatoid arthritis, but when we develop a leaky gut, a deluge of toxins flood into the body and overwhelm it, which then stimulates strong inflammatory responses when these toxins get into specific body tissues.

Once we determine that Zonulin is elevated it can then be treated and the amount reduced to normal levels.  This is a game changer as it will support any individuals return to normal gut function again and go a long way to lessen the autoantibodies involved in autoimmunity and one’s symptoms as well.

It provides us this great advantage to know when and where to start a therapeutic approach and when the treatment approach is complete. Then, it also allows us to potentially be able to return some foods back into the diet that have been previously removed

Knowing one of the major root causes for our inflammation and correcting it provides a significant step in the healing response for so many pathologies that patients are dealing with.



Any condition that has an element of inflammation has a good chance of being rooted in the gut.  And Zonulin is the parameter we are looking at to give us that information.  And when it is elevated, we have the condition necessary to create inflammation leading to reduced health and disease.

One thing that can be done to lower the level of Zonulin is to use immunoglobulins which can come from eggs, colostrum, or bovine serum. They are unique in that they look very similar to Zonulin.  Look at it this way:


So as Zonulin comes back into the normal range we can then know when we can reduce or discontinue the treatment program with the gut barrier now intact. And this will now allow the chance to reintroduce many restricted foods back into the diet

Keep in mind that Zonulin is cited in the medical literature as related to the following:









In essence the Zonulin will tell us how leaky the gut really is and that is such a huge piece of information when I need to know how to guide a patient toward wellness

Diamine Oxidase – DAO

Zonulin gives us incredible insight into whether a gut lining is damaged or leaky, but another parameter, Diamine Oxidase greatly adds to this picture.  DAO is the enzyme responsible for gobbling up and breaking down excess histamine found in the foods we eat.  Histamine is found in many common foods like strawberries, tomatoes and “leftover” foods from a day or two before.  In fact, through bacterial action, the longer we wait to consume these “leftover” foods, the more histamine is present.  So perhaps it is histamine that is the reason for the same cantaloup producing symptoms today that was not seen when consumed fresh yesterday.

In situations like this, when we find a low level of diamine oxidase and correct it, it can be an awesome turning point for many individuals suffering with food reactions and other metabolic disturbances in the body.

DAO is made in the microvilli, the fingertips of the gut lining.  As these microvilli get worn down with gut inflammation, they produce less and less DAO, resulting in higher and higher levels of histamine, leading to elevated levels of inflammation.  And this lining can be broken down by any number of factors that damage the gut.

I have mentioned Zonulin already as a primary way we get a leaky gut, when it tells the tight junctions to open, allowing things to flood into the body.   But there is another path to a leaky gut and that being erosion, as happens with the chronic, continual use of non-steroidal anti-inflammatory drugs like aspirin.  These can wear down the gut lining to the point of ulceration.




There are histamine receptors all over the body, eyes, nose gut, skin and even in the brain and any of these tissues will react with inflammation if the histamine is excessive in those tissues.  And in the brain, elevated histamine can contribute to anxiety and depression and worse, ADHD and schizophrenia. 

In the heart we have histamine receptors as well and when the DAO is low, it may result in increased levels of histamine, that contribute to something as uncomfortable as arrythmia.  Treatment for that has been shown to protect against a heart going out of rhythm in some cases.  I suspect the several million individuals with this condition might like to see if their condition would improve if they knew they had an underlying DAO problem.

Likewise, histamine may affect the joints, impairing their flexibility and increasing pain.  Correcting DAO levels when low, may in fact result in less pain and freedom of movement.  Patients may find that even a bountiful intake of beneficial anti-inflammatory supplements, attempting to target that inflammation, will not help when the DAO level is too low.           



In addition to progesterone that drops off before a women’s period, DAO decreases as well.  So, women with PMS symptoms, and headaches that are not responding to progesterone or other traditional support measures, their DAO level needs to be checked.  And when low, correction will often resolve the migraines and other PMS symptoms.  Inflammation may start in the gut, but it does not stay there – any tissue in the body can be a target.

To produce DAO, we need to be getting adequate amounts of Fish oils, Vitamin C, vitamin B6 and copper.  These are the nutrients needed to produce DAO.  When these are not adequate, and just as often because of a genetic variant in the genes designed to produce DAO, we will need to use the specific enzyme as well.  And we know if it is necessary by the Advanced Intestinal Barrier Assessment providing us that information.

So, while we measure DAO in the Advanced Intestinal Barrier Assessment, histamine is also measured and what we want to determine is the relationship between the DAO level and the histamine level. 

You see, one may have lower levels of DAO but if the histamine is also at the bottom of normal, it might then be concluded that their DAO is adequate for them.

Histamine Intolerance

Typical symptoms of histamine intolerance are:


  • headache,
  • diarrhea,
  • migraine,
  • general inflamed,
  • circles under the eyes
  • and runny nose.


Individuals with an inability to break down Histamine may seem to “react to everything,” or improve on antihistamines.


Histamine intolerance might be more obvious with specific food triggers leading to asthma and arrhythmia, hypotension, urticaria (hives), and dysmenorrhea. When DAO or histamine is imbalanced, the main focus of treatment is to increase DAO, reduce histamine, and heal the gut.




Lipopolysaccharides (LPS)

There is a third way for the gut to become leaky – elevated levels of, Lipopolysaccharides or LPS, which are bacterial endotoxins and found in the outer membrane of gram-negative bacteria.  And these are usually pathogenic bacteria.

First, Zonulin tells tight junctions to open up – like a garage door opener – that opens up a way for our gut lining to become leaky

Secondly, one can pound on the garage door and beat it till it breaks apart – that is due to a low DAO and the resulting aftereffects of excessive histamine that cause a leaky gut

Then this third way is to pick and pry at the door to get in – that is lipopolysaccharides, LPS. They can erode and wear down the tight junctions or even break through the cell itself to exit the gut and enter the blood stream







Elevated levels of either LPS IgA, LPS-IgG or LPS-IgE, will increase inflammation, damage the gut lining, and cause leaky gut. These are the three types of antibodies that we make toward lipopolysaccharides.

And when these antibodies are elevated, it tells us that our immune system is strongly reacting to these bacteria in your gut, as they see them as threats to the health of our body, and particularly prone to damaging the gut.

But there is also concern when the levels are very low.  You see, we always have some bacteria in the gut that challenge the lining and the gut should have adequate immune readiness and sensitivity for a healthy response – just not an excessive response

Therefore, Low levels of these antibodies likely suggest that the body has been in a long-term fight and the immune system’s ability to mount any further response is severely compromised.  These are often patients with Inflammatory bowel disease, chronic gut pain or chronic diarrhea.

So, when the LPS is elevated, the immune system is still in the fight and we support it with natural antibiotics like Berberine which helps to kills off the LPS, strengthens the tight junctions, but does not affect the microbiome.

But when these antibodies are at bottom normal or even low, there is a need to go after the infection but also there is a need to support the immune system or to evaluate where the immune imbalance is at using the Lymphocyte Map test.  Using immunoglobulins and other supportive measures is critical when the immune response is faltering and needs nutritional support.


Elevated levels of LPS


When we look at Zonulin, DAO, Histamine, and LPS we have a comprehensive evaluation of leaky gut, damaging factors to the gut lining, indications of pathogenic microbes and an underlying factor in intestinal issues and other metabolic disturbances from the brain to the joints.  All these factors can be measured, tracked and treated by the Advanced Intestinal Barrier Assessment.  These factors are often major players in promoting inflammation that are at the root of so many symptoms and complaints that patients have today

Ask for this test. I believe you will find it extremely helpful.