What do stomach problems, bloating, fatigue, skin rashes and joint pain have in common? They’re all possible symptoms of leaky gut syndrome. But, there’s a catch: depending on who you ask, leaky gut is either a widespread health crisis or a marketer’s dream.
Welcome to the wellness world’s latest conundrum. It wasn’t that long ago that any mention of gut issues in polite conversation would elicit a TMI warning; now we’re only too happy to talk shit over a glass of kombucha. You’ve probably heard your mate mention leaky gut or seen a blogger talk about it on Instagram, while its long list of symptoms makes it sound like it could be the culprit behind any number of health niggles. Only, your GP has probably never heard of it. So, is leaky gut even a thing?
“It is a very real phenomenon,” confirms Professor Terry Bolin, a gastroenterologist and president of The Gut Foundation. In medical terms, though, it has a far less catchy name – increased intestinal permeability. Quick biology lesson: the lining of the gut is made up of cells that are bound together tightly. In a healthy body, this lining is designed to allow only water and nutrients into the bloodstream. But, if the tight junctions of the gut loosen, larger food particles and bacteria can leak (hence the name) through and float around where they don’t belong, causing problems from inflammation to, in severe cases, malnutrition.
What are the symptoms of leaky gut and what causes it?
Where health practitioners begin to butt heads is over what causes the problem, how it presents and who has it. According to Bolin, who’s been researching increased intestinal permeability for about 20 years, it’s not well known in the wider medical community, which is why the term ‘leaky gut’ might raise your doctor’s eyebrows. He says it’s usually seen in young children in developing countries, who are drinking from a contaminated water supply, or the elderly, who develop small intestinal bacterial overgrowth (too many bacteria in the small intestine) from slow muscle movement in the digestive tract or a sluggish pancreas. It can also affect those with coeliac disease or bowel conditions such as Crohn’s disease or ulcerative colitis.
“People [with leaky gut] might present with fatigue, they might have periodic diarrhoea, they might lose weight... but pain and that sort of thing are not likely,” Bolin says. On the other side of the fence are those who say leaky gut is way more prevalent, triggered by a diet of processed foods, stress and booze. Naturopath Jules Galloway says, “There’s a lot of different things that can contribute to leaky gut, and I think that’s why there are so many points of view, because it’s possible that they’re all correct. The biggest one we see in naturopathy is the good old Western diet. It’s really high in sugars, starchy white carbohydrates, alcohol, processed foods. These are all the things that can place you more at risk.”
Gluten, she adds, is a guilty party, too, because it releases a protein called zonulin, which is known to damage the lining of the gut. It’s what causes leaky gut in coeliacs, but whether it’s responsible for leakiness in those without coeliac disease is still uncertain. Dietitian Marika Day, who specialises in digestive health, says it’s important to understand that leaky gut is more likely a symptom of an underlying issue than a syndrome itself. “What you might experience as a person with intestinal permeability could be related to that leaky gut, or it could be related to the thing that’s causing the leaky gut,” she explains. It’s why there’s such a broad range of symptoms linked to it, she adds, such as food sensitivities and even acne. “Lots of people are like, ‘Oh yeah, that’s me, that’s me.’ But it doesn’t necessarily mean you’ve got leaky gut, because those sorts of symptoms can [be attributed] to so many different things as well.”
How can you test for leaky gut?
So, how can you tell if you have leaky gut? Bolin name-checks a simple test that indicates increased intestinal permeability. It involves taking a solution of two sugars, lactulose and mannitol, which are absorbed differently. “Then you measure the amount of those sugars in the urine and that will give you an indication of what is abnormal,” he explains. “And if you have that abnormality then you can say quite confidently this is leaky gut and there must be a cause for it.” Your GP can refer you to a gastroenterologist who can arrange the test.
How to treat leaky gut?
Because leaky gut has become a buzzword in wellness circles, you’ll find plenty of potential ‘cures’ for it online. But, urges Day, if you’re experiencing gut issues, your first port of call should be to see a doc to rule out underlying conditions such as coeliac disease or inflammatory bowel disease. Then, “if you do feel that you’re experiencing leaky gut, the first thing to address would be lifestyle measures,” she says. “So, things like smoking, alcohol and stress are really big ones that impact the gut. Then the next thing would be to have a high-fibre diet, lots of plant variety, to feed your microbiome and build up that resilience in your gut.”
Galloway adds that healing the intestinal barrier is an important step. She recommends supplements such as slippery elm and glutamine to help ‘close’ those tight junctions. While Day points out that there’s no scientific evidence yet to support the efficacy of oral glutamine supplements in repairing the gut lining, there’s no harm in trying it alongside other lifestyle changes. “Just be really mindful when you see supplements saying that they’re going to cure leaky gut, [as] we actually don’t have a cure,” she warns. There’s still a long way to go in the research, Bolin agrees, noting that the microbiome is likely to play an important role. “We really haven’t reached the top of Mount Everest yet and found out what to do,” he says. We’ll let you know when the answer, um, leaks.