It sounds like a mouthful, I know. So let me break down the words: metabolism refers to how your body takes food and turns it into energy and building blocks for repair, while eliminating waste (at the cellular level) produced as a byproduct of this process.

As for endotoxemia: endo- is a prefix meaning within the body; tox- means toxins; and -emia means in the blood. So endotoxemia means toxins that are produced inside the body (and the word metabolic implies that they occur as a byproduct of metabolism) that make it into the bloodstream.

There is one specific toxin that is generally referred to in this context, and that is LPS, or lipopolysaccharides. LPS is found in the cell wall of gram negative bacteria (as opposed to gram positive bacteria, whose cell walls have a different composition). Gram negative bacteria can be pathogens, but some normal gut flora is gram negative, as well.

What LPS Does to You

LPS in the bloodstream is associated with inflammation: specifically increased levels of the inflammatory cytokines IL-1, IL-6, and TNF-a.

Inflammation has been correlated with nearly every chronic illness, from diabetes to cancer to neurodegeneration. But more specifically, metabolic endotoxemia seems to be the link between obesity and the risk for cardiovascular disease. 

How LPS Gets Into the Bloodstream: Leaky Gut

As part of the process of absorbing primarily fat and protein, the body produces chylomicrons, which are kind of like soap bubbles: little spheres of fat that surround food particles to be absorbed. Some of those chylomicrons are made of the lipids from LPS-containing cell membranes, which is how the LPS can make it from the gut into the body.

This occurs to a far greater degree in the presence of increased intestinal permeability, or “leaky gut syndrome.” Leaky gut syndrome occurs when the junctions between cells of the small intestine are loose enough to allow food particles (and whatever else might be in the gut) to come in contact with the bloodstream. It can occur as a result of any sort of damage to the intestinal lining—an infection or parasite, yeast overgrowth, food sensitivities, prolonged consumption of inflammatory foods without the building blocks to repair the gut lining, etc.

Researchers have largely concluded that “high fat” meals are responsible for increased metabolic endotoxemia—but they have not made a distinction between healthy and unhealthy fats. For instance, in this study, endotoxemia was associated with a McDonald’s breakfast. In this one, it was associated with processed white bread, plus butter. And in this one, it was associated with general overeating. All of these are inflammatory, and therefore will “loosen” the intestinal barrier. 

Protecting Against Metabolic Endotoxemia

Given the strength of the correlation between endotoxemia and leaky gut, the real treatment is to heal up the gut lining (which will require finding the reason for the increased permeability in the first place, and treating it). A few studies suggest specific ways you can help to heal up the gut lining along the way, though.

  • Omega 3 fatty acids. This study shows that fish oil helps to decrease gram negative commensal flora (like E.coli and enterobacter) and increase gram positive flora (such as bifidobacillus)—and the bifidobacillus helps to heal the leaky gut.
  • Prebiotics. Because they help to feed the good bacteria, probiotics such as inulin also help to lower endotoxemia, according to this study. 
  • Probiotics. Of course, if the food for good bacteria helps to heal up the gut lining, then you’d expect the good bacteria themselves would do so as well. As this study shows, that is indeed the case.
  • Glutamine. As the food for the small intestine, this study suggests that it is effective in helping to restore gut integrity.
  • Antioxidants. This study shows that cocoa (yay chocolate!!) both lowers inflammatory cytokines, and reduces endotoxemia by 40%. And in this study, participants were fed the same McDonald’s breakfast as in the previously mentioned study (a sausage and egg McMuffin), but also given orange juice. Even just the antioxidants from the oranges were enough to lower endotoxemia and inflammation, compared to those who did not have the juice.

I’m not saying that eating whatever you want is ok, as long as you eat chocolate and have orange juice with it. (Sorry.) 🙂 What I am saying, though, is that antioxidants found in nutrient dense foods go a long way to helping to repair damage.

So to recap, how do you treat metabolic endotoxemia? Heal the gut.