Dear Dr. Eva,

I am a woman in my 30’s. Over the last few years I have developed a lot of new digestive problems, with bloating, cramps, and diarrhea on and off. My chiropractor thinks I may have leaky gut and suggested some nutritional supplements. When I tried to find information on leaky gut, what I found was vague and contradictory. Can you explain leaky gut?

Thanks,

Gassy

Dear Gassy,

Leaky gut syndrome takes a few minutes to explain, so let me tell you first that there are lots of conditions other than leaky gut that are more likely to be responsible for your problems. The key thing is to think over what else has changed in your life over the past few years. Of course, you have gotten that much older. That could be significant because milk intolerance (lactose intolerance) often starts in adulthood and worsens over time. Maybe you have started on a new medication or supplement which can affect the digestion. Maybe you have made changes in the way you eat. You could have developed a new food allergy to a food you have always eaten previously without problems. Finally, you might be under increased stress at home or at work. All of these factors can cause changes in your digestion. And importantly, all of these are treatable with changes in diet, medication or lifestyle.

A key problem with leaky gut as a diagnosis is that there is no known test to diagnose it and no consistently successful treatment for it.

Leaky gut syndrome is a proposed medical condition which has not been proven to exist.The basic idea of “leaky gut syndrome” is that in this condition, dangerous materials pass through the intestinal lining and cause inflammation which then leads to a wide variety of diseases throughout the body. The diagnosis is usually made by chiropractors and alternative health practitioners, many of whom sell or promote remedies intended to relieve the condition.

The concept of leaky gut syndrome is based on the real physiologic functions of the gut lining. The gut lining, which is just one single cell thick, lines the entire small and large intestine. (Colon is another word for the large intestine.) When it is working properly, the gut lining allows nutrients, electrolytes, water and other helpful substances to pass into the bloodstream while keeping waste products, food   particles, antigens and microorganisms (bacteria, viruses, parasites) inside the gut. The bacteria that are kept inside the gut include both disease-causing bacteria and also the normal bacteria of the intestines.           

Any irritation of the gut lining opens up gaps between the cells of the lining. Irritation can be caused by several different processes. Microorganisms such as cholera and other bacteria, intestinal viruses, and parasites interfere with the connections between the cells of the gut lining. Severe physical stress, such as extensive burns, can also cause damage to the intestinal lining. This damage can let immune-triggering antigens through the lining, resulting in allergic reactions including food allergies. In some people, the immune reaction caused in response to antigens acts as a trigger to start intestinal disease processes, especially autoimmune diseases like celiac disease (gluten enteropathy) and inflammatory diseases like ulcerative colitis and Crohn’s disease.

Some people have a genetic predisposition to intestinal lining injury. However, alcohol use and diet are at least as important as genetics in causing excessive gut lining permeability(“leakiness”). Insufficient consumption of dietary fiber and high intake of sugars and saturated (solid) fats can cause gut inflammation. Age is a factor as well. As people age, the intestinal lining cells get damaged more easily and heal more slowly, and in some cases cannot heal at all.

It has been suggested that increased intestinal permeability plays a role in many  non-gastrointestinal conditions such as autoimmune diseases (lupus, type 1 and 2 diabetes, rheumatoid arthritis, multiple sclerosis), chronic fatigue syndrome, fibromyalgia, arthritis, migraine, allergies, asthma, acne, obesity, and even autism. However, so far there have been no clinical studies in humans showing a connection between any of these diseases and increased intestinal permeability.

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Dr. Eva Hersh, MD
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