Do You Have a “Leaky Gut”?

The term “leaky gut” sounds awfully similar to having, say, a leaky pipe or a leaky faucet. And in a way, it is. “Leaky gut” doesn’t have a whole lot to do with diabetes, but it’s a condition that is being recognized more and more commonly by both alternative and traditional medicinal practitioners, so it’s something that you may want to familiarize yourself with.


What Is It, Anyway?
Leaky gut, or, more formally, “intestinal permeability,” isn’t a disease. Rather it’s a condition in which the lining of the small intestine becomes permeable. A healthy digestive tract breaks down the food that you eat into various sized particles. Glucose, amino acids, vitamins, and minerals are small molecules that are absorbed through the wall of the small intestine. And in healthy individuals, the cells that line the small intestine are tightly joined together. But if you have a leaky gut, spaces form between the cells in the small intestinal wall, letting large molecules (food, bacteria, heavy metals, toxins, and allergens, for example) sneak through. Normally, these large molecules are either digested (in the case of food) or keep right on going through to the large intestine and (hopefully) get excreted. But not if you have a leaky gut.

What’s the Big Deal?
The problem with large molecules slipping through the lining of the small intestine is that it may trigger an immune response in the body. Again, in healthy individuals, an immune response is “normal” because it means that your body can fight off invaders, like viruses, bacteria, and other pathogens that can lead to serious harm. But if molecules that aren’t supposed to slip through the intestinal wall actually DO slip through, it’s thought that the immune response that’s triggered goes into overdrive. This causes an inflammatory response in the body, and inflammation is a precursor to a bunch of health problems, including disease.

What Conditions Are Linked With Leaky Gut?
I should first mention that leaky gut syndrome is regarded with some skepticism by more “mainstream” health-care providers. Most of them don’t argue that leaky gut is a condition, but there remains some doubt as to whether leaky gut is more a consequence of various health problems and diseases as opposed to the actual cause — much like the chicken and the egg situation: which came first? Regardless, conditions that are linked with leaky gut syndrome (either as a cause or an effect) include:

• arthritis
• acne
• psoriasis
• eczema
• depression
• inflammatory bowel diseases (such as Crohn or ulcerative colitis)
• chronic fatigue syndrome
• liver disease
• allergies
celiac disease
• migraines
• asthma

Of course, all of the above conditions can be linked to or triggered by other things, so it’s understandable, in a way, that physicians might struggle with attributing them to an increase in intestinal permeability.

How Do You Know If You Have Leaky Gut?
The other tricky aspect of a leaky gut diagnosis is that symptoms can be rather vague. Not that they’re not real, but more that symptoms can also be linked to other conditions. Symptoms include:

• fatigue
• achy joints and muscles
• abdominal pain
• bloating
• diarrhea
• skin rash
• confusion

These symptoms can be a result of many other conditions, so it’s hard to link them to a leaky gut. But then again, there could be an association.

Most physicians don’t check for leaky gut, let alone diagnose it. There is a test that can be used to diagnose it, called the lactulose/mannitol test, which involves drinking a sugar solution. Urine samples are collected and if high levels of both the lactulose and mannitol show up, it may be indicative of leaky gut. A stool test can also be done. This test checks for bacteria, yeast, and other pathogens. But this test is expensive and likely not covered by insurance. And allergy tests can also be done.

What Causes It?
Again, it’s really not conclusive as to what may cause this condition. But some of the possible culprits include:

• alcohol, which can irritate the lining of the small intestine
• antibiotics, which throw off the balance between good and bad bacteria in the gut
• NSAIDS (non-steroidal anti-inflammatory drugs), such as aspirin, ibuprofen, and naproxen
• prescription corticosteroids, like prednisone and hydrocortisone
• prescription hormone medicines
• enzyme deficiency, such as lactase (needed to digest lactose)
• chemotherapy and radiation therapy
• refined carbohydrate foods (white flour, sugar, soft drinks, and so on)

What Can You Do?
If you think there’s a possibility that you have leaky gut, have a talk with your doctor. It’s important that you have any symptoms checked out to rule out other conditions or diseases and receive appropriate treatment. And don’t stop taking antibiotics or any other medicines that have been prescribed or recommended to you without checking with your doctor first. Be prepared that your doctor may not be fully supportive of testing you for leaky gut or even diagnosing you with this condition. In the meantime, here are a few steps to take that may be helpful:

• Eat more fruits, vegetables, fish, and healthy fats, like olive oil.
• Cut back on saturated and trans fats.
• Cut back (or even cut out) alcohol and caffeine.
• Cut back on heavily processed foods or foods that contain a lot of preservatives, dyes, and other chemicals.
• Get plenty of fiber in your diet (from fruits, vegetables, etc.).
• Ask your doctor or dietitian about taking a probiotic supplement.

Other dietary supplements are often recommended for leaky gut, but you should discuss the use of these with a health-care professional.

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  • acampbell

    I just wanted to add to the above: A study done at the University of Warwick in England showed that eating a high-fat meal (in people with diabetes) triggered the movement of bacterial endotoxins through the intestinal wall. And eating more frequently during the day compounded this effect. So, high-fat eating and frequent snacking may be culprits in leaky gut syndrome… food for thought!

  • Jim @ Small bowel follow through

    Hey Amy,

    First of, thanks for the article as it is very informative. I work with many people who struggle from IBD and thus have “leaky gut syndrome” as a symptom.

    What I am currently studying and testing is not only the refined carbs that you mentioned but also very specific carbs.

    I have been advising patients to not eat any sort of sugar or complex carbohydrate except for honey. Honey is a disaccharide, which makes it very easy for the intestines to break it down. They may also eat fruits.

    This is suppose to heal the intestines and keep this cycle of constant irritation/inflammation reside.

    Have you any thoughts or research on this? I would love to here another perspective!



  • acampbell

    Hi Jim,

    Unfortunately, the nutritional management of leaky gut syndrome isn’t my speciality. Your advice is interesting. What I don’t understand is why you categorize honey and fruit as complex carbohyrates, when they really are more “simple” carbs due to their chemical makeup. However, if I do come across information, I’ll let you know.

  • Theresa

    Why did you not mention Candida albicans as a culprit? We carry about 3-4 pounds of bacteria and yeast in our gut. A one-time use of antibiotics kills the good microbes in the gut, which actually aid in digestion of food. If not put back probiotically (yogurt, khombucha, sauerkraut, etc.) on a daily basis, the Candida albicans grows and grows. The good guys were needed to keep it in check. Candida albicans goes from a yeast to a pathological fungus. It is insidious and tenacious. It is a parasite at this point and people often don’t know they have it. Western medicine treats symptoms and doesn’t consider Candida albicans overgrowth very often, until it shows up on a culture test.

    The fungus forms tentacles which adhere and tunnel through the small intestinal walls and makes holes (leaky gut). Endoscopy in the small intestine is not a common procedure. People usually just have EGDs and colonoscopies and end the workup there. Those just look at the stomach and the large colon. I am not even sure if looking at the walls is enough. Seeing the jellyfish in stool after treating for Candida on a hunch is a sure-fire way to diagnose having had the bugger. The diet you mention above is a good start.

    If I might add, toxins slip through in leaky gut conditions. This causes toxemia and the liver has trouble dealing with that huge workload. The liver and pancreas (and gallbladder) work together in digestion. When one is backed up, obviously the others are affected. Perhaps the pancreas can’t produce enough insulin to prevent diabetes? Everyone is overtaxed and stressed out (typical american diet, alcohol, drugs, cigarettes, stress, etc.). This becomes one big sloppy mess. Toxins all over, but decompensated ability to clear them. I think treatment starts with diet and detox for a few weeks. Then, improved routine eating patterns. Good health should never be taken for granted.

    As I said, your dietary suggestions look good. I am just befuddled you didn’t mention Candida albicans as a culprit.