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What exactly is a ‘leaky gut’?

What exactly is a 'leaky gut'? Gut naturopath, gut specialist

Leaky Gut, or more correctly, increased intestinal permeability (IP), is something that is commonly discussed in the blogosphere, and a question that is often raised by my patients. But what does it really mean when your gut is “leaky”? Is this actually really a thing? What exactly is a ‘leaky gut’?

It’s important to note that the intestines are meant to be somewhat permeable for normal function. However, the intestines can also become too permeable, which may become problematic.  Increased IP impacts the intestinal tight junctions between the cells in the digestive tract (enterocytes), making them more “loose/leaky”, which compromises the integrity of the gut wall, causing dysfunction in the gut mucosal barrier. This leads to compounds that should stay in the gut escaping into systemic circulation, which can increase inflammation, immune responses and possibly contribute to certain health issues (1, 2).

There’s been a lot of debate over the years about if leaky gut/IP exists, or if it is a “proper” condition, or if other medical conditions may predispose you to developing IP. However, there has been more research over the last decade confirming its presence, especially regarding certain conditions, which was a topic of a great 2019 systematic review (1).

Conditions that make you more susceptible to developing intestinal permeability

  • Autoimmune disease e.g., coeliac disease, inflammatory bowel disease (IBD) 
  • Liver conditions e.g., non-alcoholic fatty liver disease (NAFLD), liver cirrhosis, chronic liver disease 
  • Diabetes e.g., type 1, type 2 (with chronic liver disease), gestational diabetes 
  • Polycystic Ovarian Syndrome (PCOS)
  • Irritable Bowel Syndrome (IBS) 
  • Food allergies
  • Food hypersensitivity 
  • Autism

(1,3)

Although I see quite a lot of IP in my practice, and it’s important to resolve, I generally find the advice “you probably have a leaky gut” is a little overused in the blogosphere and often touted as the reason behind many gut issues, which is not always the case! In addition, some of the advised treatment suggestions I see online may not properly resolve IP even if you do have it. IP cannot be diagnosed by symptoms alone; in fact, it often doesn’t actually have specific symptoms at all. To illustrate this point, not everyone with ongoing gut issues will automatically have a leaky gut, and furthermore, sometimes people that DO have a leaky gut may have very minimal, if any, gut symptoms. Sounds a bit confusing, doesn’t it?

NBH The Influence of Nutrition on Intestinal Permeability and the Microbiome in Health and Disease Inczefi et al 2022

How do you know if you do have a leaky gut?

Essentially, the only way to know for sure is to specifically test for IP, given you cannot accurately determine if someone has IP from symptoms alone. The gold-standard test for leaky gut, even after over 30 years, is still the lactulose: mannitol IP test (4, 5), which is a special urine test that needs to be ordered by a practitioner – preferably one that has a special interest in all things gut and is trained in how to interpret the test properly ;-).

Any supportive treatment may incorporate specific amino acids, colostrum, probiotics, prebiotics and changes to diet and lifestyle to support healing the intestinal wall and the health of your gut microbiota. Specifics are dependent on how the patient presents and their unique health history. Dose and duration of any interventions is extremely important, so it is best to get proper advice from a suitably qualified health professional.

If you do have a leaky gut, the supportive treatment can take months to resolve things, the cost of which will far outweigh the cost of the test itself, so it’s a worthwhile investment to get the test done before you fork out for months of supplements or a diet overhaul that may not be needed.

As at October 2023, the cost of the lactulose: mannitol IP test is only $149 in Australia (lab costs only, this does not include the cost of your consultations), which is a bargain when compared to other functional testing costs.

If you suspect you. may have IP, get in touch and we can arrange a consult and test if needed! But I hope this information has helped you learn more and find out what exactly is a ‘leaky gut’?

Find our more about managing your gut health.

References

  1. Leech, Bradley & Schloss, Janet & Steel, Amie. (2018). Association between increased intestinal permeability and disease: A systematic review. Advances in Integrative Medicine. 6. 10.1016/j.aimed.2018.08.003.
  1. Camilleri M. Leaky gut: mechanisms, measurement and clinical implications in humans. Gut. 2019 Aug;68(8):1516-1526. doi: 10.1136/gutjnl-2019-318427. Epub 2019 May 10. PMID: 31076401; PMCID: PMC6790068.
  1. Inczefi O, Bacsur P, Resál T, Keresztes C, Molnár T. The Influence of Nutrition on Intestinal Permeability and the Microbiome in Health and Disease. Front Nutr. 2022 Apr 25;9:718710. doi: 10.3389/fnut.2022.718710. PMID: 35548572; PMCID: PMC9082752.
  1. Skinner C, Thompson AJ, Thursz MR, Marchesi JR, Vergis N. Intestinal permeability and bacterial translocation in patients with liver disease, focusing on alcoholic aetiology: methods of assessment and therapeutic intervention. Therapeutic Advances in Gastroenterology. January 2020. 
  1. Vanuytsel T, Tack J, Farre R. The Role of Intestinal Permeability in Gastrointestinal Disorders and Current Methods of Evaluation. Front Nutr. 2021 Aug 26;8:717925. doi: 10.3389/fnut.2021.717925. PMID: 34513903; PMCID: PMC8427160.
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