Quick answer: Avoid and Annihilate is the first phase of the Leaky Gut Protocol. The goal is to remove factors that may be inflaming or damaging your gut: identify food sensitivities with an elimination diet, address gut infections with your provider, review medications, and reduce everyday toxin exposure from plastics, personal care products, cookware and cleaners.
Key takeaways
Phase one focuses on removing the factors that contribute to gut inflammation so the gut has a chance to recover.
An elimination diet can help identify food sensitivities, and gut infections are best tested for and addressed with your provider.
Reviewing medications such as NSAIDs and antibiotics with your doctor, and reducing everyday exposures from plastics, are also part of this step.
The goal of Phase 1
Remove the factors contributing to gut inflammation and damage, so the gut has a chance to recover. Overview: the four-phase approach.
Step 1: Identify food sensitivities
Food sensitivities can drive gut inflammation. I recommend an elimination diet as part of this protocol (see what is the elimination diet).
The basic steps
Identify common trigger foods to remove, and remove them for the elimination period. Then reintroduce them one at a time (see phased reintroduction), and build a long-term plan based on what you learn.
Step 2: Address gut infections
Harmful bacteria, yeast and parasites can disrupt the microbiome. Work with your provider on testing and treatment.
Step 3: Review medications
NSAIDs can affect the gut lining, and antibiotics can disrupt the microbiome. Talk with your doctor before changing any medication.
Step 4: Reduce toxin exposure
Plastics
Store food in glass or stainless steel, avoid single-use plastics, use a water filter instead of bottled water, and bring your own containers.
Personal care products
Read labels, and avoid triclosan, parabens, phthalates and bisphenols when you can.
The kitchen
Choose organic produce when practical, especially for thin-skinned produce. Cook with stainless steel or cast iron, replace worn non-stick pans and avoid overheating them, and cook at lower temperatures.
Household cleaners
Read labels and choose plant-based brands. Simple vinegar and baking soda cleaners work for many jobs (never mix vinegar with bleach or hydrogen peroxide in the same container).
Why this matters for healthy aging
Reducing the inflammatory load from food triggers and environmental chemicals helps limit the oxidative stress and chronic inflammation that accelerate aging.
When to see a naturopathic doctor
It may be time to see a naturopathic doctor if you have ongoing bloating, gas, diarrhea or constipation, or food reactions that seem to be multiplying. The same is true if you have fatigue, skin flares or joint aches alongside gut symptoms, or if you want a personalized gut plan instead of guessing.
See a medical provider promptly for blood in your stool, black stools, unexplained weight loss, persistent vomiting, severe abdominal pain, fever, or trouble swallowing.
What the research shows
Removing triggers is easier to justify when you can see their effect on the gut. In a 2014 study by Vanuytsel and colleagues, 23 healthy volunteers took a sugar-absorption test under several conditions. The anti-inflammatory drug indomethacin more than doubled the lactulose-to-mannitol ratio (0.071 versus 0.030), a sign of a more permeable small intestine. Public speaking stress also raised it (0.059), mainly in people whose cortisol rose. These were short, single exposures in healthy adults, so they show acute changes rather than long-term harm.
Diet changes can also lower exposure. In a 2014 randomized crossover study by Oates and colleagues, 13 adults ate at least 80% organic or conventional food for 7 days each. Urine levels of organophosphate pesticide breakdown products were 89% lower after the organic week. The study was small and short and measured exposure, not health outcomes, so it supports reducing exposure but does not show what that means for symptoms.
Want help finding the root of your gut symptoms?
A free 15-minute consultation with Dr. Kneessi. No cost, no obligation. In-office in Odenton, MD or by telehealth.
Questions to bring to your clinician
These questions can help you get the most out of your next visit.
Should we test for gut infections or food sensitivities before I start this phase?
Which gut triggers would be most important for me to remove?
How long should I avoid these triggers before reassessing?
What should I eat instead while I am removing triggers?
Frequently asked questions
What is the first step in healing leaky gut?
Removing triggers such as food sensitivities, infections and irritating medications, with guidance.
Do I need to do an elimination diet?
It is part of this protocol, but discuss it with your provider if you have a history of disordered eating.
Which chemicals should I avoid?
Bisphenols, phthalates, parabens and triclosan are common ones to limit.
Is non-stick cookware safe?
Avoid overheating it and replace worn pans; stainless steel and cast iron are good alternatives.
Sources
- Vanuytsel T, van Wanrooy S, Vanheel H, et al. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut 2014. PMID: 24153250. https://pubmed.ncbi.nlm.nih.gov/24153250/
- Oates L, Cohen M, Braun L, et al. Reduction in urinary organophosphate pesticide metabolites in adults after a week-long organic diet. Environ Res 2014. PMID: 24769399. https://pubmed.ncbi.nlm.nih.gov/24769399/
- Bjarnason I, et al. Mechanisms of Damage to the Gastrointestinal Tract From Nonsteroidal Anti-Inflammatory Drugs. Gastroenterology 2018. PMID: 29221664. https://pubmed.ncbi.nlm.nih.gov/29221664/
- Dethlefsen L, Relman DA. Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation. Proc Natl Acad Sci U S A 2011. PMID: 20847294. https://pmc.ncbi.nlm.nih.gov/articles/PMC3063582/
- Rudel RA, et al. Food packaging and bisphenol A and bis(2-ethyhexyl) phthalate exposure: findings from a dietary intervention. Environ Health Perspect 2011. PMID: 21450549. https://pmc.ncbi.nlm.nih.gov/articles/PMC3223004/
- Harley KG, et al. Reducing Phthalate, Paraben, and Phenol Exposure from Personal Care Products in Adolescent Girls: Findings from the HERMOSA Intervention Study. Environ Health Perspect 2016. PMID: 26947464. https://pmc.ncbi.nlm.nih.gov/articles/PMC5047791/
This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before starting supplements or changing medications, especially if you are pregnant, nursing, or managing a health condition.
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