Leaky gut syndrome is one of those “trendy” diagnoses that has polarized the medical community. “The U.S. medical establishment does not recognize it as a legitimate diagnosis, while alternative and complementary doctors tend to look for it in everyone, and blame it for just about everything,” says pioneering researcher Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment at Massachusetts General Hospital For Children in Boston. In his opinion, both are wrong. “It’s wrong to think that it is responsible for so many conditions, but it is also wrong to think that it does not exist,” he says. “The truth is somewhere in between.”
With that in mind, here’s what we know now about what leaky gut is, how to diagnose it, and what to do about it.
What it is: Leaky gut is a condition where the lining of the intestinal tract (usually the small intestine) malfunctions, allowing some contents of the intestines that normally would not pass through this selective barrier to enter the bloodstream. The problem can be with the junctures between cells, or with the cells themselves. Contents that can enter the bloodstream include some bacteria and their toxins, incompletely digested proteins and fats, and wastes that are normally excreted from the body.
What causes leaky gut? The intestinal lining can be altered in many ways: by overgrowth of bacteria, viruses, or microscopic parasites; by use of alcohol, anti-inflammatory drugs or other drugs that damage the intestinal lining; by food allergies or intolerances, exposure to food additives, and nutritional deficiencies that impair the intestines’ ability to repair itself. The condition is both more likely to be recognized these days, and to be more common than ever, Fasano believes. “Our diets have changed dramatically over the past decades, and we are exposed to more chemicals than ever,” he says. The result is changes in our intestines that can lead to leaky gut syndrome.
So what? The big problem with leaky gut is that, once the contents of the digestive tract get into the bloodstream, they can activate the immune system and cause body-wide symptoms, says Dr. Robynne Chutkan, assistant professor of medicine at Georgetown University Hospital and medical director of the Digestive Center for Women, in Chevy Chase, Md. In fact, although this is a controversial theory, there is research to show that autoimmune diseases such as rheumatoid arthritis, multiple sclerosis, Hashimoto’s thyroiditis, psoriasis and others are often preceded by leaky gut, and that people with autoimmune disorders also have a genetic predisposition toward leaky gut, Fasano says. “That’s considered a paradigm shift in thinking about the causes–and potential treatment–for these disorders, and is why there is so much resistance to it in the medical establishment,” he says.
How do you know you have it? Doctors diagnose leaky gut using a combination of symptoms and test results, Chutkan says. They look at symptoms such as: abdominal bloating, excessive gas and cramps, fatigue, food sensitivities, joint pain, skin rashes, inflammatory bowel disease, celiac disease and autoimmune disorders. They may also do a test that requires you to drink a solution of mannitol, a sugar that’s easily absorbed by people with healthy intestinal linings, and lactulose, a sugar that is only slightly absorbed by someone with a healthy intestinal lining. After drinking the solution, urine is collected for six hours and the ratio of mannitol to lactulose in the urine is measured. For someone with a healthy gut, the test shows high levels of mannitol and low levels of lactulose. If high levels of both molecules are found, it indicates a leaky gut condition. If low levels of both molecules are found, it indicates general malabsorption of all nutrients.
How is leaky gut treated? That depends in part on what is causing it in the first place, Chutkan says. If drugs such as anti-inflammatories are involved, other drugs might be substituted. If food sensitivities seem to be a problem, the offending foods will be limited or eliminated. If an overgrowth of bacteria seems implicated, as often is the case, your doctor will work to identify them, and get rid of them with drugs or diet.
To restore the good bacteria that help to police the gut, those with leaky gut syndrome are counseled to eat foods like live culture yogurt, kefir and unpasteurized sauerkraut and pickles, or take probiotic supplements. Cutting back on refined starches and sugar, and steering clear of high protein and high saturated fat diets, as well as eating a good mix of soluble and insoluble fibers, found mostly in vegetables and fruits is also advised. Other dietary measures may include supplements of L-glutamine and N-acetyl- glucosamine, amino acids that intestinal cells can absorb directly and that help healing.