When the Barrier Loosens a Little

When the Barrier Loosens a Little

What we call the outside of the body is the skin. Yet measured by the area where the body meets the outside, skin is not the larger part. Most of that area is inside the gut.

From mouth to anus is a single continuous tube. The tube sits inside the body, but the inside of the tube is not inside the body. It is only a passage for what has been swallowed; it has not yet been taken into the body. The taking in happens at the wall of that tube.

The same is true of the inside of the nose and airways through which breath passes, and blood flows in contact with the inner surface of the vessels. The body has several layers where inside and outside meet like this, and at each of them a wall stands.

This wall is not a solid barrier. It has to let in what is needed and keep out the rest, so it is closer to a wall densely set with doors.

The Seam Stitched Between Cell and Cell

The cells that make up the wall are not simply set side by side. Where cell meets cell, proteins wrap the upper edge like a band and stitch them together. This seam is called a tight junction, and the proteins that serve as the thread are named claudin and occludin.

Outside the seam there is one more layer. A slippery mucus covers it, and mixed into that mucus are antibodies that wrap bacteria so they cannot cling to the wall. The antibody that does this work inside the gut is called secretory IgA.

And this seam is not a structure built once and left. It tightens and loosens according to circumstances. Tension that has been switched on for a long time, shortened sleep, a bout of gastroenteritis that has passed, meals often skipped — all of these lay a hand on that regulation.

More Common Than a Large Breach

When we hear that something has gone wrong with a boundary, it is easy to picture a hole opening somewhere. That is rare. What is actually common is several layers each loosening a little.

The mucus layer thins, the seam does not draw as tight as it used to, and through it things that would ordinarily have passed straight by reach a little further in. Each time, the body makes a small response. When those responses become frequent, digestion, skin and general condition — places that look far apart — show signs of going off together.

Taken one layer at a time, none of it is a disease. That several layers loosened together is the whole of the story.

So People Say This

"They said nothing showed up on the tests."

Some people tell me the endoscopy was clean and the blood work normal, and still their body is not what it was. They are often bloated after eating, the skin flares at trifles, and they do not feel rested even after sleeping. None of it is enough to call a disease.

Split into three — digestive, skin, fatigue — each is inconclusive. Set them on the picture above and they line up as one. The wall has several layers, so when those layers loosen together the signs appear in several places together.

An endoscopy looks at whether the lining is eroded, reddened, or has something protruding. It is a test built to see shapes that can be confirmed by eye. How tightly the seam is drawn is not among the items it looks at. Inflammatory markers in blood only rise once what has happened reaches a certain scale, so at the stage of slight loosening they are usually quiet.

Of course, weight falling on its own, blood in the stool, or fever alongside is a different matter from this story. Then examination comes first.

What I Check

So rather than where it hurts, I look first at when it began to change. Was it after a bout of gastroenteritis? Does it overlap with a period when work piled up? Does it match when meals started being skipped? If the uneasy digestion and the sensitised skin began in the same season, I do not divide them into two matters.

When I use herbal medicine, I do not look at it as topping something up either. I look at the conditions that regulate this boundary. That is why, when someone tells me their digestion is uncomfortable, I do not look only at digestion but deal with the sleep and the tension of that period together. The handles that regulate the boundary are attached there too.

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I take this part as good fortune. If the seam were a structure built once and finished, whatever loosened would simply stay loose; in fact it is made to tighten and release. That means a loosened state is not a fixed circumstance either.

For a body whose several layers have loosened together, regulating those layers as a set is quicker than repairing them one by one. That something is not written on a test sheet does not mean it cannot be read.