As a dietitian, I get asked pretty frequently about leaky gut.
“Is it real? What is it exactly? Do I have it?” Can I prevent it?” The term leaky gut has been popping up as a mainstream “diagnosis” for a while now, and the truth is a mix of misunderstanding, myth and fact.
Leaky Gut is a real thing, more scientifically known as intestinal permeability (IP). The idea of a leaky gut is that something; a food, an additive, environmental toxins, or even stress can cause irritation and inflammation in the gut, causing it to become more permeable, or leaky.
This then leads to a series of symptoms (fatigue, headaches, joint pain, GI upset to name a few), a diagnosis based on symptoms or perhaps lab tests and then a protocol to heal the gut. The protocols prescribed often include food elimination diets, supplements, probiotics, and more supplements. Often the protocols lead to some relief, which provides validation.
There are kernels of truth here, but also a lot of misunderstanding which unfortunately may lead to more suffering, long-term food elimination, and spending lots and lots and lots of money on supplements.
The main function of the gut is to provide a barrier from the outside world to the inside world of the human body. Trillions of bacteria live in the body and need to stay in the gut, not float freely into the bloodstream. So, the gut has a very important barrier function. The cells of the gut are called enterocytes. These cells allow things like food proteins, vitamins and minerals access to the body.
Try to picture a tightly fitted picket fence. The posts are all tightly packed next to one another (these are the enterocytes) but you can still see some sunlight or your neighbor’s yard through the pickets. This little bit of room between the cells, allows for substances like water, sodium and tiny sugar molecules to flow between cells. This is called paracellular transport. Leakiness is when more than the normal amount of water, sodium or sugar flows between the cells.
Lucky for us, the body is an amazing thing and we have multiple layers of defense.
The second barrier at the base of the cells is our immune system. When something like bacteria, bacterial toxins, or even food/protein molecules get through (leaks) our white blood cells (WBC) produce an immune response causing some inflammation and many of the symptoms listed above.
The science here is still very new. But we do know that one known cause of intestinal permeability is an acute bacterial infection. If you have experienced food poisoning or been diagnosed with c.diff (an infection of the colon caused by a contagious bacteria), chances are you have had increased intestinal permeability, or leaky gut.
Again, since the science is still new, we do not necessarily know the cause and effect of IP. Diseases like Crohn's Disease, IBS and Celiac Disease are all associated with IP. But what came first? Do these diseases cause IP or is IP causing these diseases? It is not yet clear that permeability itself causes the inflammation. It is especially tricky because intestinal permeability happens to healthy people who don’t experience any symptoms!
So, is Leaky Gut Syndrome real and how do we fix it?
Leaky Gut IS real. It is intestinal permeability associated with other diseases and the symptoms people face are in fact real.
Leaky Gut Syndrome, however, is NOT a medical condition and it is not recognized as a disease we can diagnose. So what do we do? The best protocol is to have the healthiest gut possible. The gut barrier function is supported by the microbiome, so feeding our microbiota things they like to eat is the best plan of action. A diverse, fibrous, plant-heavy diet that you can tolerate, is the first step. Foods like beans, leafy greens, root vegetables, nuts, seeds, fruits are all great options.
What about supplements? Knowing that fiber can be a source of stomach discomfort, many people opt for a supplement instead. But, buyer beware here. Dietary supplements are not regulated in our country so we don’t really know what is in the pills we purchase. Also, taking a fiber supplement daily does not provide the variety that our guts need. Bottom line, feed your guts a variety of foods that you can tolerate!