We have talked about leaky gut before on Wellspiration. Specifically throughout our gut series earlier this year, here, here, here, and here. It’s such a big topic though, it warranted another visit because there still seems to be a lot of confusion out there. There is also a lot of misinformation about what leaky gut truly is, what causes it, and how to fix it. Like autoimmune disease, leaky gut is tricky to identify because it is usually accompanied by multiple non-specific symptoms. It’s also not a formal diagnosis, so it’s not recognized by conventional practitioners as a pathological condition. By the end of this however, you should have a better understanding of what leaky gut is, along with some considerations on how to reduce the impact.
What exactly is leaky gut?
When people talk about leaky gut, they are talking about something clinically known as Intestinal Epithelial Barrier Dysfunction, or more commonly, intestinal permeability [5]. To truly understand leaky gut, you need to have a basic knowledge of the anatomy of the gut. Did you know that “the intestinal barrier covers a surface of about 400 m2 and requires approximately 40% of the body’s energy expenditure?” This is according to Stephen Bischoff et al, in the study of “Intestinal Permeability – a new target for disease prevention and therapy [4].” That is a lot of space for something to go wrong. Especially when you consider that the epithelial layer that separates the inside of our body, from the outside world, is only one cell thick.
Going to the clurb
When we refer to the gut here, we are talking about the intestines. Inside the gut, there are two sides: Apical and Basolateral. I think of these like the hot club in town. The apical side is on the street waiting to get in. You can think of the people standing in line like the food you eat and digest. The intestinal barrier is like the red rope outside the club that keeps all the partygoers out.
Only certain things like nutrients, and helpful bacteria are allowed to pass through the velvet ropes. These barriers are known as tight junctions and where they open [3]. These tight junctions act similarly to bouncers. They open and close to let the good stuff in [5]. Once you are inside the “club” you have passed through the ropes and gone into the basolateral layer, or the “club.” Normally the bouncers are really good at their jobs and nothing gets through that shouldn’t. However, when weakened or compromised, they start letting bad things like pathogens, inflammatory molecules, and antigens through. This is where problems begin.
Think of this “lack of security,” as leaky gut. Things that should never be inside the club start getting through. Once something that shouldn’t be inside the body crosses into the basolateral layer, it can easily move into the bloodstream, or “the VIP room,” for analogy purposes. It often starts with a little at a time, and only the smallest molecules. As it increases, it moves into the pathogenic territory of intestinal permeability, where the porousness of the epithelial layer increases and gut integrity is compromised [2]. When someone experiences leaky gut, it occurs on a spectrum. Sometimes it’s irregular and infrequent, but when it reaches the stage of pathogenesis, the epithelial barrier can be largely compromised and it can lead to other major diseases.
Why should you care about leaky gut
As mentioned earlier, when leaky gut becomes pathogenic, it is associated with numerous autoimmune diseases such as “inflammatory bowel disease (IBD), bowel syndrome irritable liver disease (ILD), alcoholic liver disease, nonalcoholic fatty liver disease, steatohepatitis, liver cirrhosis, and collagen diseases [2].” While there isn’t any data showing causation, there is a big enough body of evidence demonstrating correlation. Once unwanted substances start passing into the bloodstream, it can lead to widespread inflammation and trigger allergic reactions, affecting the entire body. It’s theorized this is why people with autoimmune disease develop food sensitivities, intolerances, or even allergies, even though we can’t yet prove that [5]. The consequences of these conditions range from digestive discomfort to more severe systemic issues such as autoimmune diseases and chronic fatigue [3][5].
The role of tight junctions in health and disease
We discussed tight junctions earlier as essential for maintaining the gut’s barrier integrity. While the description is overly simplified, it still helps illustrate the “big rocks” of how the digestive system works. We won’t go into the cells, mucus, and gut-associated lymphoid tissue (GALT), supporting the tight junctions. This is but a humble blog and not a pre-med class. Having said that, through complex chemistry and biology, the tight junctions, et al, regulate what passes into the body’s internal environment. Disruption in tight junction function is a primary contributor to leaky gut, leading to increased intestinal permeability and the associated health issues mentioned above. Understanding and strengthening these junctions can help manage or prevent the progression of leaky gut and its related symptoms [3][4].
Diagnosing leaky gut
As mentioned before, conventional medicine doesn’t recognize “leaky gut,” as a diagnosis. This terminology originates largely from functional medicine and complementary medicine practitioners. Even though it has been largely adopted by patients and the common language, conventional diagnoses are “intestinal permeability” or “intestinal epithelial barrier dysfunction. [4]” Identifying leaky gut involves sophisticated diagnostic approaches that assess intestinal permeability.
You may have heard of the lactulose-mannitol test, which measures the excretion ratios of these two sugars in urine after ingestion, to determine the selectivity of the intestinal barrier. However, this test is largely unreliable and disproven as a method for diagnosing intestinal permeability [5]. Other test include “in-vitro tissue measurements of intestinal barrier [5].” This means they are done in a test tube rather than inside a human or animal. This has also shown a lot of variability and therefore less promising.
The most promising are two endoscopic measurements of the epithelial layer. These are the confocal endomicroscopy [6] and the endoscopic mucosal impedance [7]. They showed that “food-associated changes during these challenge tests provide some evidence that there can be barrier changes that may indeed support the concept of transient “leakiness” of the gut [5].” Unfortunately, as of now, you can’t walk into a labcorp and request a “leaky gut” test, so we are limited in how we are limited as patients.
Diet and its impact on gut health
It’s no secret that diet plays a pivotal role in the health of the gut barrier. Nutrients that strengthen the gut lining, such as amino acids found in bone broth, and anti-inflammatory foods like mushrooms and hibiscus, can help restore integrity and function [2]. Conversely, foods high in refined sugars and unhealthy fats can exacerbate the symptoms of leaky gut. Tailoring a diet to include gut-friendly foods while eliminating harmful ones can significantly influence the recovery and maintenance of a healthy gut lining [2].
Treatment and clinical implications
While no current treatment can completely cure diseases caused by leaky gut, managing gut health can alleviate symptoms [2]. In some cases, you can significantly reduce disease activity with diet and lifestyle interventions. Treatments may include dietary adjustments, probiotics, and targeted medications, focused on restoring the integrity of the gut barrier. Continued research is essential for developing future therapies that specifically target this critical aspect of gut health [5].
Helping others understand “what is leaky gut”
Even if conventional medicine doesn’t embrace the idea of leaky gut, everyone can benefit from interventions. Simple things can minimize the effects and improve overall health. While the condition can be complex and challenging to manage, integrating a holistic approach that includes dietary changes, lifestyle adjustments, and appropriate medical interventions can provide significant benefits.
Are you struggling with leaky gut or other autoimmune disease symptoms? I can help. As someone who also struggles with autoimmune disease and issues associated with leaky gut, I’ve been there. I’ve also reversed many of my symptoms associated with my autoimmune disease and I’m here to help. Let’s chat so you can start feeling better today. Not ready to take that step, no problem. Check out Wellspiration where we dive into all kinds of topics related to wellbeing and living with autoimmune diease. You can also check out these [A] [B] additional articles specifically, for more leaky gut conversation. Until next time, I’m wishing you abundant health and limitless joy.
Medical Disclaimer:
These statements have not been evaluated by the Food and Drug Administration (FDA). Information provided in this blog post is for educational and informational purposes only and should not be considered as medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, treatment, cure or prevention of any disease. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition.
References
- Campos, M. (2023). Leaky gut: What is it, and what does it mean for you? Harvard Health Blog. https://www.health.harvard.edu/blog/leaky-gut-what-is-it-and-what-does-it-mean-for-you-2017092212451
- Aleman, R. S., Moncada, M., & Aryana, K. J. (2023). Leaky Gut and the Ingredients That Help Treat It: A Review. Molecules, 28(2), 619. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9862683/
- Fasano, A. (2012). Leaky gut and autoimmune diseases. Clinical Reviews in Allergy & Immunology, 42(1), 71-78. https://pubmed.ncbi.nlm.nih.gov/22109896/
- Bischoff, S. C., Barbara, G., Buurman, W., Ockhuizen, T., Schulzke, J. D., Serino, M., et al. (2014). Intestinal permeability – a new target for disease prevention and therapy. BMC Gastroenterology, 14, 189. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253991/
- Camilleri M. (2019). Leaky gut: mechanisms, measurement and clinical implications in humans. Gut, 68(8), 1516–1526. https://doi.org/10.1136/gutjnl-2019-318427
- Fritscher-Ravens, A., Schuppan, D., Ellrichmann, M., Schoch, S., Röcken, C., Brasch, J., Bethge, J., Böttner, M., Klose, J., & Milla, P. J. (2014). Confocal endomicroscopy shows food-associated changes in the intestinal mucosa of patients with irritable bowel syndrome. Gastroenterology, 147(5), 1012–20.e4. https://doi.org/10.1053/j.gastro.2014.07.046
- Katzka, D. A., Ravi, K., Geno, D. M., Smyrk, T. C., Iyer, P. G., Alexander, J. A., Mabary, J. E., Camilleri, M., & Vaezi, M. F. (2015). Endoscopic Mucosal Impedance Measurements Correlate With Eosinophilia and Dilation of Intercellular Spaces in Patients With Eosinophilic Esophagitis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 13(7), 1242–1248.e1. https://doi.org/10.1016/j.cgh.2014.12.032