As a naturopathic doctor who treats many people with chronic digestive problems, I get asked this all the time by my patients. People read about it on the Internet and tell me there are some who claim this is a fictional diagnosis.
My answer is YES, leaky gut is real, and people with digestive conditions may or may not have it. If they do, addressing leaky gut can both improve digestive health as well as manage or resolve other health issues related to the underlying leaky gut. This breakdown of normal gut permeability has been linked with chronic skin problems like eczema and psoriasis, arthritis, and a wide variety of inflammatory and other conditions.
As I write this, I saw a patient earlier today who observed that at times when his digestive symptoms flare up, he also gets an itchy rash on his elbows that lasts for a week or so and resolves as his digestive symptoms do. I am suspicious that this connection of symptoms may indicate that he has leaky gut.
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What Is Leaky Gut?
First of all, intestinal permeability is normal and is essential so we can absorb digested proteins, fats and carbohydrates from foods that nourish us, as well as vitamins, minerals and medications. Our intestines, especially the small intestine, have selectively permeable membranes with a variety of mechanisms for choosing what we let in and what we keep out.
In the healthy gut, intestinal cells attach to each other through what are called tight junctions; only very small molecules or water are able to pass through these gaps. Thus, most substances we absorb typically pass through the intestinal cells in a way that controls what we absorb, what we do not, and how our bloodstream and immune system accepts the materials we absorb.
When conditions occur that result in an abnormal increase in gut permeability by breaking down these tight junctions, this allows larger molecules or other substances that we would not normally absorb to enter our bloodstream. We call this Intestinal hyper-permeability or by the common term “leaky gut.”
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What Causes Leaky Gut?A number of environmental factors may lead to an abnormal increase in gut permeability. Among these are chronic alcohol abuse, non-steroidal drugs like Ibuprofen and naproxen (NSAIDs), aspirin, and a number of other drugs, especially chemotherapy drugs for cancer as well as radiation therapies. Antibiotics may aggravate underlying leaky gut. Systemic infections, various intestinal bacterial infections such as food poisoning, parasites and small intestine bacterial overgrowth (SIBO) are all linked with leaky gut, as well as chronic inflammatory gut diseases including Crohn’s disease, ulcerative colitis and celiac disease. Leaky gut is also commonly linked with food allergies and sensitivities.
Other diseases that have been associated with leaky gut include liver cirrhosis, depression, chronic fatigue syndrome, autism, irritable bowel syndrome, diabetes, congestive heart failure, arthritis, eczema and obesity.
How Can I Determine If I Have Leaky Gut?
There are several tests used to detect if leaky gut is present.
The first is called an Intestinal Permeability Assessment. This test involves drinking a solution of mannitol and lactulose followed by collecting a few urine samples at defined time intervals. In a healthy gut, lactulose is poorly absorbed while mannitol is easily absorbed. Both are eliminated through the urine. If mannitol levels in the urine increase while lactulose does not, this suggests that intestinal permeability is normal. However, if lactulose greatly increases as well, this suggests the presence of leaky gut.
The second test is measuring zonulin in the stool or blood. Zonulin is the “glue” that holds intestinal cells together in tight junctions. If zonulin levels are high, this suggests that the body is producing more zonulin to repair damaged gut membranes.
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Finally, my favorite test for leaky gut is a bit indirect. A blood test for food allergies and food sensitivities that measure IgE and IgG antibody reactions to foods may raise my suspicion that leaky gut is present.
Let me give you an example. A few years ago I met with a gentleman who presented with chronic severe dermatitis in various body regions, especially on his hands and forearms. He was a carpenter, thus his rashes affected not only his general health but his work as well. In my workup I ran food allergy/sensitivity tests and found that his immune system was highly reactive to almost all of the foods we tested. While it’s not uncommon to find a few food reactions, probably 90% of the food we tested showed significant reactions. Knowing the connection between dermatitis and leaky gut, I quickly suspected he must have leaky gut as this was the most likely explanation for the many foods causing immune reactions. So we treated his gut to help heal the membranes along with avoidance of his most reactive foods for a period of time. Over the next few months we saw his dermatitis gradually improve and resolve, and subsequent testing showed his foods reactions reduce to only a very few as well.
How Is Leaky Gut Treated?
The first step after determining that leaky gut is present is to determine potential causes that created it in the first place. By understanding and addressing causes, we can remove any irritating influences and the intestinal membrane begins to heal naturally. Removing inflammatory food reactions, decreasing reliance on chronic use of NSAIDs, and reducing inflammation in chronic inflammatory gut diseases are several examples of this. Then the use of probiotics, soothing herbal medicines and other nutritional supplements further promote healing of the intestinal lining, returning it to a state of normal permeability.
Eat a balanced diet. A balanced diet does not have to be a boring diet. As long as you are getting adequate proteins, carbohydrates, vitamins, minerals and fats, that slice of chocolate cake you're craving shouldn't do you too much harm. Enjoy your meals, chew your food properly and eat a variety of foods, including five portions of fruit or vegetables a day. Too much processed food or sugary food can make you feel sluggish.
If you are dealing with any of the conditions mentioned in this article and are looking for other approaches to improving your gut health, and are curious if you may have leaky gut, I am here to help. I do offer 15-minute free phone consultations to briefly discuss your issues and so you can get a sense if my approach is right for you. You can contact me at 415-643-6600 or request a phone consultation .Dr. Carl Hangee-Bauer is SFNM’s founder and Clinic Director and a member of the Gastroenterology Association of Naturopathic Physicians. He has a general naturopathic medical practice and specializes in immune support for allergies, autoimmunity and cancer support, functional gastroenterology and pain management. He has over 30 years of clinical experience using individualized care and treatment plans to provide effective naturopathic based care.
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