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Leaky Gut: Is it real?

Over the last decade, in particular the last few years, the term “leaky gut” has become more prevalent. The confusing thing is, as with many concerning concepts that gain traction- whether you are told to worry about it or not completely depends on who you’re speaking to.

A plethora of supplements, diet plans/challenges and products have been marketed towards “healing” a leaky gut, and I’ve certainly seen clients who have spent a lot of money trying to manage this concern. Is it really something to worry about though?

As always, the answer is likely somewhere in the middle.

First things first, is it a real thing?

Yes…but also kind of no?

“Leaky gut” isn’t a medical term. However, there is a thing called intestinal permeability, which is a real thing. It sounds far less exciting though, and isn’t so easy to say.

The current research in this area is definitely still new and emerging, so there is a lot that isn’t known and yet to be understood, I think this is very important to point out when some are presenting their concerns and approach to leaky gut with much certainty. This includes diagnosing, treating and whether this current spotlight will resolve the concerns associated with it all.

So, what is a “leaky gut”?

The digestive tract not only works by digesting and metabolising food, it also filters the nutrients and compounds that are absorbed into our bloodstream or excreted as waste. Our intestine walls are lined with cells that are linked by tight junctions- small gaps that control what does or does not pass into the bloodstream. When functioning, this permits small particles like water, nutrients and electrolytes entry to the bloodstream, but prevents pathogens, toxins and larger particles from doing so.

When we talk about intestinal permeability or leaky gut, these tight junctions are more permeable- allowing larger particles and other substances to cross the intestinal wall to the bloodstream; this may lead to inflammation, problems with digestion, immune function and disease states. Leaky gut has been linked with conditions such as Coeliac Disease, Type 1 Diabetes, Inflammatory Bowel Disease and Irritable Bowel Syndrome, to name a few.

Here’s the thing though: we don’t know if this is a symptom of these conditions, or a cause exactly. We also don’t know if treating leaky gut will make changes to symptoms or disease progression/risk.

Take away: Leaky gut occurs when the intestinal barrier is weakened, allowing larger particles such as pathogens and toxins to enter the bloodstream. It is not known whether leaky gut is a symptom of a condition, or a cause.

How do you test for it?

Ah-ha! Now, given all of the above, would it just make things a little simpler if there was a way we could monitor or test for leaky gut, to calm any concerns?

Unfortunately, while there is a test used in research contexts (with noted limitations), there are no reliable or accurate tests of leaky gut at present. Yes, this is despite many being promoted online.

I’m all about information and data, but the reason this doesn’t actually concern many practitioners and health professionals at present, is that the diagnosis doesn’t change what you would do next, how to manage your symptoms or answer whether it is the symptom or cause of what is going on. The next steps and approach would be much the same, unless someone is trying to make a bunch of money off of you.

Take away: There is not currently a valid test for leaky gut. Before spending money on a test promised to diagnose this- consider whether it will help you. The fact that one condition is linked with a list of symptoms and diseases does not help to identify why someone feels the way they do, or provide a different solution at present.

What things can worsen your gut permeability?

Again, we are still learning about all the things that contribute to the “leakiness” of one’s gut, but there are some conditions and lifestyle factors to look out for. Spoiler: it isn’t gluten, dairy, sugar or grains.

The factors that can worsen your gut permeability that we know about are:

  • Digestive conditions like Coeliac Disease and Inflammatory Bowel Diseases

  • Microbiome dysbiosis- where the gut microbiome (the fungi, yeast and bacteria in your digestive tract) can be “out of balance” resulting in an overgrowth of more harmful bacteria and/or reduction in health promoting bacteria. A flow on effect of this may be more permeable intestinal walls. This can occur due to typical “western diets” that are high calorie, saturated fat and low fibre, infections, antibiotic use, poor sleep and chronic stress.

  • Excessive alcohol intake has been linked to the disruption of tight junctions and changes to the diversity of gut bacteria.

  • Excessive use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen or aspirin can damage the surface of the intestinal wall and increase its permeability with both short- and long-term use.

  • Major trauma as in severe burns or injuries

  • Radiation and chemotherapy have both been shown to affect intestinal barrier function

Take away: Despite what you may read online, gluten (unless you’re coeliac), dairy, grains or sugar alone do not cause leaky gut. There are many factors to consider including overall dietary patterns, medications, medical conditions and lifestyle factors.

Okay, so can you “heal” a leaky gut?

If you’ve read this far, you’re likely quite invested and looking for answers for yourself or someone else. If nothing else sticks from all my rambling, I want it to be this: the current evidence in this area is still growing, but a good practitioner will guide you with an ethical, practical approach.

If someone is selling you the world, and promises to “heal” this, run. At present, not only can we not diagnose it accurately, nor do we know whether it’s clinically as relevant as suggested, or whether it’s a symptom or a cause, but we also aren’t certain what helps just yet.

What we do know is what encourages the right “balance” of your gut microbiome, avoiding what doesn’t and some emerging nutrients of focus for restoring the intestinal lining.

So, if you are concerned, this is where I would recommend you put your focus on:

  • Working with a health care team to assess your digestive symptoms, rule out anything sinister and manage what is applicable.

  • Following a diverse, plant-rich diet full of whole grains, fruits, nuts, vegetables, legumes and good fats. Minimise your intake of ultra-processed and high saturated/trans fat foods. Reduce intake of alcohol if excessive.

  • Looking at lifestyle factors including stress management, exercise routine, sleep patterns and smoking.

  • Speaking with your team regarding medications that may impact your gut health, modify what you can.

  • Including probiotic-rich foods/drinks like yoghurt, kefir, sauerkraut and sourdough breads.

  • Discussing with your healthcare team whether nutrient deficiencies like zinc and vitamin D, or specific supplements would be worth considering. Note: you should not be walking away with a basket full of products.

Take away: If someone is selling you the world, and promises to “heal” this, run. There is not enough known. We can however address underlying conditions and symptoms, manage lifestyle and dietary factors and make choices which promote positive gut health and reinforce the intestinal wall.

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