The Ultimate Guide to Leaky Gut

As early as the 1970s, the term “leaky gut” was used by researchers to describe increased intestinal permeability, or the ability of substances to easily pass out of the gut into the bloodstream. These researchers were able to link leaky gut to certain gastrointestinal autoimmune diseases such as celiac disease. Since then, interest in leaky gut has grown and researchers continue to search for ways to target this intestinal permeability in the hopes of treating autoimmune disease.

However, despite this research on intestinal permeability, leaky gut is still not considered a medically recognized disease. In this post, we explain how intestinal permeability can occur and explore everything there is to know about leaky gut. (Source)

What Is Leaky Gut?

Leaky gut is a condition that results from a damaged gut barrier, but what makes up the gut’s barrier and how does this barrier become damaged?

The gut, also known as the gastrointestinal (GI) or digestive tract, consists of a chain of organs that run all the way from the mouth to the anus. The gut’s innermost protective layer, and its first line of defense against pathogens and harmful substances, is the mucosal membrane. 

There are a few ways the mucosal membrane can be compromised and result in leaky gut. One way is for proteins that help support the mucosal barrier to become damaged. These proteins are then unable to support the mucosal barrier properly, resulting in a gut lining that is more susceptible to toxins.

Another is for a cellular pathway to be disrupted. Our cells rely on pathways to communicate across our bodies. For example, a nerve cell must use a cellular pathway to signal to a muscle cell to create movement. When certain pathways are disrupted, membrane cells aren’t able to send the signals needed to maintain the gut barrier. 

In both cases, increased membrane permeability can eventually lead to openings in the gut lining. These openings allow harmful substances and pathogens from the gut to “leak” into the bloodstream. We call this increased intestinal permeability, or leaky gut. 

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Signs and Symptoms of Leaky Gut

It is thought that leaky gut allows bacteria and other substances to escape the gut and travel via the bloodstream to other parts of the body. If this occurs, it might cause an immune response and lead to the development of an autoimmune disease, or make a pre-existing autoimmune disease worse. However, more research is needed to determine whether this causal relationship exists. 

Common symptoms attributed to leaky gut include:

• excessive cramping and gas
• abdominal bloating
• food sensitivities 

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We also know common symptoms of autoimmune diseases that leaky gut may be associated with, such as the following.

Inflammatory Bowel Disease (IBD)

Symptoms include bloody stools, weight loss, diarrhea, and abdominal pain.

Crohn’s Disease 

Symptoms include diarrhea, weight loss, rectal bleeding, fatigue, abdominal pain, and weakness.

Celiac Disease

Symptoms include diarrhea, bloating, constipation, weight loss, and abdominal pain.

Systemic Lupus Erythematosus (SLE)

Symptoms include sensitivity to sun, facial rashes, fever, joint pain, weight loss, fatigue, and kidney and renal issues.

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Causes and Triggers of Leaky Gut

Causes of Leaky Gut

Although it is difficult to pinpoint what exactly causes the lining of the gut to become more permeable, there are a few factors that are thought to contribute to leaky gut. 

Diet

The food you consume greatly affects your gut health, which in turn can affect the health of your intestinal lining. A low-fiber diet can lead to a thinner mucus membrane and increase the permeability of the gut lining. Vitamin D and the vitamin D receptor are also thought to contribute to a pathway that protects the mucosal membrane. However, it is unclear exactly what role they play. Further studies are needed to confirm a positive relationship. (Source)

Prolonged Stress

Chronic mental stress or exposure to a prolonged stressor such as chronic alcohol consumption can negatively affect the community of microorganisms that live in the gut. These microorganisms are important in maintaining intestinal homeostasis.

When prolonged stress disrupts the gut microbiota, the mucosal membrane can be impaired. There is also evidence that prolonged mental stress weakens the immune system. Over time, this may result in decreased removal of toxins in the gut, which in turn damages the gut lining. (Source, Source)

Gut Infections

If you have a stomach infection caused by a bacteria or virus, your gut can be negatively affected. A balanced gut microbiota is important for maintaining the integrity of your intestinal lining. Harmful bacteria caused by an infection can change the composition of your gut microbiota and threaten the integrity of your intestinal lining, increasing your risk of developing leaky gut. (Source, Source)

Triggers of Leaky Gut Flares

Generally, the term flare is used to describe a period during which you experience active symptoms of a given condition, and your condition “flares up.” This is thought to happen with leaky gut.

Leaky Gut Flare Triggers

• Processed foods, as well as food allergens, may cause inflammation of the gut. If you have leaky gut, your gut lining is more permeable and has developed openings that food allergens may pass through. 
• Non-steroidal anti-inflammatory medications, such as aspirin or ibuprofen, can damage the gut lining and allow contaminants to flow from the gut to the bloodstream. Use of these types of drugs may trigger leaky gut flares.
• Radiation treatments and chemotherapy can damage good bacteria in the gut and disrupt the gut microbiota. This imbalance can further damage the gut lining and lead to a leaky gut flare. 
• Excessive alcohol consumption can cause a leaky gut flare because alcohol damages the cells that form the gut lining. There is evidence that people who drink heavily have increased intestinal permeability to the point where large molecules can pass through the gut lining. Excessive alcohol consumption also promotes inflammation in the gut, which may trigger leaky gut flares. 

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Leaky Gut Flare Treatments

Although there are no approved drug treatments to repair the gut lining, you may be able to avoid triggers for leaky gut flares by:

• lowering your consumption of processed foods
• avoiding foods to which you are allergic or sensitive
• limiting use of non-steroidal anti-inflammatories such as aspirin and ibuprofen
• limiting your exposure to radiation, if possible
• lowering your alcohol consumption 

Leaky Gut Risk Factors

History of Disease 

There is evidence of a positive correlation between increased intestinal permeability (leaky gut) and diabetes, liver diseases, and autoimmune conditions such as Crohn’s disease. 

Diet 

High alcohol consumption, high calorie intake, or a high fat diet may lead to leaky gut. However, more research is needed to prove a causal relationship. 

Body Measurements 

A high body mass index (BMI) is weakly correlated with increased intestinal permeability, but BMI is not always an accurate marker of health. Obesity is also positively correlated with increased intestinal permeability.

Biomarkers 

Biomarkers are measurable characteristics that may be helpful in diagnosing diseases. They may be substances, such as toxins, or signs of susceptibility to certain conditions, such as genetic variations. Elevated glucose levels and certain inflammatory protein levels are also weakly associated with leaky gut. 

Age

If you are over 50 years old, you may be at higher risk of developing leaky gut. 

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How Is Leaky Gut Diagnosed?

There is no established medical protocol for the diagnosis of leaky gut. However, there are many different laboratory tests, or assays, that may be performed to look for evidence of leaky gut. Many of these tests are blood or urine tests, but others measure the concentration of specific proteins in the body. (Source)

Lab Tests for Leaky Gut

• Lipopolysaccharide (LPS) Assay 

• Lipopolysaccharide is a bacterial antigen, or substance that stimulates an immune response. With leaky gut, bacterial antigens can move from the gut to other parts of the body. An LPS assay measures the concentration of lipopolysaccharide that has escaped the gut and migrated. This movement is an indication of impaired intestinal barrier function. (Source)

• Tight Junction (TJ) Test 

• Tight junctions are important connections between neighboring epithelial cells in the gut. The intestinal membrane is covered with tight junctions that prevent undigested food and toxins from escaping the gut into the bloodstream. A TJ test measures the level of a protein called claudin that makes up tight junctions. (Source) 

• Butyrate Test 

• A fecal test can be performed to measure the concentration of an important compound called butyrate. Butyrate is produced in the large intestine and helps preserve the intestinal barrier through regulation of tight junctions. If an individual is butyrate deficient, they likely have an impaired intestinal membrane. (Source)

• Zonulin Test 

• Zonulin is an important protein that regulates tight junctions in the epithelial barrier of the gut. Elevated zonulin levels are associated with an increase in intestinal permeability, as well as many chronic inflammatory diseases such as celiac disease and inflammatory bowel disease. Abnormal zonulin levels can be detected using an enzyme-linked immunosorbent assay (ELISA). (Source)

• Calprotectin Test 

• A calprotectin test is a simple fecal test that can be used to check for inflammation in the intestines. Calprotectin is a protein that is involved in the inflammatory response. Since leaky gut can cause inflammation of the intestines and nearby tissue, these inflammatory tests are strong indicators of leaky gut. (Source) 

Treatment of Leaky Gut

There is no medication approved to treat leaky gut. As with leaky gut flares, lifestyle changes may help with leaky gut. You may be able to manage your leaky gut symptoms by: 

• limiting your consumption of foods high in gluten, dairy, and sugar 
• eating raw foods in moderation 
• consuming tea and bone broth

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Leaky Gut Diet

There is no established diet for treating leaky gut, but there are measures you can take to help protect your intestinal barrier. 

• Consult a health care provider about taking prebiotic and probiotic supplements, which may help repair the gut microbiome and reduce intestinal permeability. One probiotic that may protect the intestinal lining is Bacteroides fragilis. 
• Consider following a diet that can alleviate symptoms of IBS or other autoimmune gastrointestinal diseases, such as the low FODMAPS diet. The low FODMAPS (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet eliminates and then slowly reintroduces these carbohydrates that are difficult for the body to absorb. 

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Holistic Approach to Leaky Gut Treatment

Leaky gut treatment doesn’t begin and end in the intestines. Improvements to your overall health may help reduce inflammation and maintain a healthy gut barrier. 

Reduce Stress 

Stress, even short-term, can have significant and lasting effects on intestinal barrier permeability and gut health. Stress can alter your microbial diversity and is associated with increased intestinal permeability, which puts you at higher risk for developing leaky gut. 

Chronic stress is also generally associated with inflammation that can worsen leaky gut symptoms or cause more leaky gut flares. Stress management is an effective way to reduce the severity of your symptoms and protect your gut health. (Source)

Take Care of Your Mental Health

Mood and mental health conditions are also able to negatively affect your gut. Your mood can influence your gut composition, or the types of good and harmful bacteria living in your gut. If you have low bacterial diversity in your gut, your gut lining is not as healthy. Mental health conditions such as depression can trigger inflammatory responses in your body, which can worsen leaky gut symptoms. (Source)

Improve Your Diet Overall

Finally, your diet plays a large role in gut health. Your gut operates best when it has a rich variety of bacteria and a good balance of macronutrients such as carbohydrates, dietary fats, and proteins. When you have an imbalance of these macronutrients, your gut bacteria are adversely affected. 

Our Western diet, for example, tends to be high in processed foods and refined sugars. This diet is linked to low gut bacterial diversity, which can worsen leaky gut symptoms and increase your risk of developing autoimmune diseases. 

You may also want to consider eating a low gluten diet, as some research suggests gliadin, the part of gluten that can launch an immune response, can increase intestinal permeability. Gluten itself may alter the gut microbiome and, in autoimmune diseases such as celiac disease, the presence of gluten may lead to gut injury. (Source, Source)

Leaky Gut Prognosis

Leaky gut is a new condition in the field of gut research and researchers are not certain of its prognosis. Research indicates that the best way to manage leaky gut long term is to identify any underlying disease.

Once an underlying disease is determined, your leaky gut symptoms can likely be treated using the established treatment plans for that disease. For example, long term treatment options for celiac disease or IBD may prove useful for leaky gut. 

Until health care providers are sure how leaky gut progresses, it is best to manage your leaky gut symptoms using dietary changes and the holistic approach discussed above. (Source)

Potential Complications of Leaky Gut

There are potential complications you may face when treating leaky gut.

• You may have an underlying autoimmune disease, as there is evidence that leaky gut may cause, or is at least linked to, autoimmune diseases such as celiac disease and IBD. (Source)
• You may experience uncertainty when treating your leaky gut, because there are many unanswered questions surrounding intestinal permeability. This makes leaky gut difficult to manage long term if it is not a symptom of a diagnosed autoimmune disease. (Source)
• You may feel overwhelmed managing your gut health. Gut health is critical to managing leaky gut, but gut health is also an interplay between your diet, stress levels, and emotional well-being. (Source)

When Should I Get Medical Care for Leaky Gut?

It is helpful to seek medical evaluation for leaky gut when:

• you experience severe abdominal pain accompanied by 

• fever
• persistent vomiting 
• swollen abdomen
• weight loss
• yellowing of the skin

• you experience symptoms of any autoimmune disease linked to leaky gut, such as IBD, celiac disease, or SLE. Your health care provider will be able to discuss treatment options and ways to manage an autoimmune disease. 

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Where Can I Find the Best Resources About Leaky Gut?

Outside of WellTheory’s Ultimate Guide to Leaky Gut, we recommend looking at:

• The Canadian Society of Intestinal Research to learn about different gastrointestinal conditions and the importance of gut health in managing these conditions.
• The Intestinal Research Journal for in-depth research articles on topics ranging from the importance of microbiome diversity to gut infections to intestinal diseases.
• Gut Microbiota For Health to to read about the relationship between your diet, your gut microbiota diversity, and your overall health. 

What’s the Bottom Line on Leaky Gut?

Although the symptoms and prognosis of leaky gut require further research, there is strong evidence that leaky gut is connected to autoimmune diseases such as celiac disease and IBD. However, because it has not yet been fully established as a medical condition, there are no medically approved treatment options for leaky gut. 

For now, we recommend exploring science-backed diet and lifestyle changes, as well as consulting a health care provider on additional ways to manage your leaky gut symptoms.