Healing Leaky Gut Syndrome | Symptoms, Tests, Treatments, Supplements, & Diet
What is a Leaky Gut?
The gut encompasses a complex system that starts at the mouth and goes all the way through the entire gastrointestinal tract to the rectum. Requiring a delicate balance of bacteria essential for overall human health and the production of neurotransmitters including serotonin, the gut is sometimes referred to as the body’s “second brain.”
You might have heard of the term “leaky gut,” but maybe you aren't really sure exactly what that means. And while leaky gut may seem like some kind of wacky pseudo alternative science, leaky gut is actually an accepted condition by the mainstream medical community and is known as intestinal permeability. Simply speaking, leaky gut is when the barrier of the intestinal tract becomes disrupted allowing digestive substances (food, waste, etc.) to leak out where it is not supposed to be. When these particles pass through, our immune system is triggered and inflammation is created. More inflammation actually makes the gut more leaky, leading to more and more food intolerances plus systemic inflammation. This is why autoimmune conditions like Hashimoto’s and rheumatoid arthritis are often associated with leaky gut.
What Causes a Leaky Gut?
Leaky gut occurs primarily within the small intestine. Under normal conditions, the walls of the intestines are not permeable, meaning they do not readily allow certain molecules such as digested food, gut bacteria, and waste products to pass through. Instead, they act primarily as a protective barrier keeping compounds and macromolecules inside the small intestines. But let’s take a step back for a moment.
The small intestine is primarily designed for the digestion or the breaking down of food and for the assimilation of nutrients from that food, so that our bodies can then use them. It does this via the cells that line the intestinal wall that are connected via tight junctions. This means the cells of the gastrointestinal mucosa are tightly packed next to each other. But when those junctions are compromised by inflammation or an intestinal disruptor (stress, bacterial imbalance, medications, or certain foods), the junctions weaken, open up, and allow food, bacteria, and waste to permeate the intestinal wall. When the immune system then encounters these particles outside their normal place, it dispatches an immune response causing inflammation. Additionally, the villi—which normally allow small vitamin and mineral particles to pass via diffusion—can also be damaged leading to additional issues such as deficiencies.
See the vicious cycle? The intestinal wall’s tight cell junctions open up allowing unwanted particles to flow out, causing an immune response, and therefore causing more inflammation in the process.
Leaky Gut Symptoms
Common leaky gut symptoms are similar to what you would see with many other digestive issues:
Chronic diarrhea
Constipation
Bloating
Nutritional deficiencies (leaky gut can compromise the villi that line the intestinal wall, which are responsible for the absorption of certain nutrients)
Fatigue headaches
Difficulty concentrating
Skin issues (acne, eczema, psoriasis, unknown rashes, etc.)
Joint pain
Leaky gut has also been associated with irritable bowel syndrome (IBS), inflammatory bowel diseases (IBD) such as Crohn’s and ulcerative colitis, polycystic ovarian syndrome (PCOS), endometriosis, hormonal irregularities, Hashimoto's thyroiditis, and even diabetes. Because inflammation is so heavily involved with leaky gut problems, it can be a cause or an effect of a whole number of health conditions.
How Do I Test For Leaky Gut?
This may seem strange to hear, but I personally believe that everyone has some level of a leaky gut. In fact, if you have been born in the last 100 years, the chances are high that you have some degree of a leaky gut.
But if you definitively want to know whether you have a leaky gut or not and to what extent, there is a way to test for gut permeability. Gut permeability has traditionally been measured by ingesting a non-metabolizable monomeric sugar and observing the degree to which it is adsorbed. This test involves ingesting a pre-measured amount of two different sugars—lactulose and mannitol—both of which are generally not well absorbed by the body. Then about 6 hours following ingestion, we would test your urine. The idea here is that if you don’t have a leaky gut or have very low permeability, these sugars should not show up in your urine (or should be very low). The sugar levels can even tell us your level of intestinal permeability.
How to Treat Leaky Gut
Once we can be sure that you are dealing with a leaky gut and at what level your intestinal permeability is occurring, we want to work to mitigate its effects. When addressing leaky gut, I like to employ what’s called the 4 Rs Approach to GI Health.
The 4 Rs stand for:
Remove
Replace
Re-inoculate
Repair
REMOVE:
This of course involves removing anything that may be disrupting your gut. Medications have been known to be a big gastrointestinal disruptor, and this even includes hormonal birth control, NSAIDS (like ibuprofen, aspirin, and tylenol), etc. Other things to remove might include possible food allergens or food sensitivities, foods with additives or preservatives, and even foods with pesticides. Another thing you can remove from your “diet” is stress. Stress plays a big role in digestion and can cause many digestive problems. It’s not easy to completely eliminate stress in life, especially in our always-on-the-go world, but practicing relaxation and stress-reducing behaviors and techniques can offset your stress . Finally, you may want to test your stool for what is called dysbiosis, which is an imbalance of good bacteria and bad bacteria causing harm within your GI tract. SIBO (small intestinal bacterial overgrowth) is another possibility that I always consider when working with leaky gut. When I suspect SIBO, I will have my patient do a 3-hour lactulose breath test to analyze for both hydrogen- and methane-producing bacteria (unfortunately, a stool test won’t cut it in this case).
REPLACE:
Once we remove some of the main digestive offenders, we want to replace them. Many leaky gut patients have digestive dysfunction in general, so giving them helpful digestive enzymes that help with the breaking down of carbohydrates, fats, and proteins—like lipases, proteases, and HCl—can be very helpful in returning your gut to balance.
RE-INOCULATE:
When we are talking about re-inoculating, we are talking about bringing in the right bacteria and flora, often via probiotics or fermented foods, to help restore your gut health. You can also introduce what are called prebiotics, or essentially bacteria food. These are often found in sources such as fruits, vegetables, and legumes. Timing of the re-incolation phase is so important. Especially in cases when there is dysbiosis or SIBO. If re-inoculation is started before the elimination of an imbalance or pathogenic bacteria, patients will feel worse and complete recovery is often delayed.
REPAIR:
Repairing your gut involves introducing specific nutrients and herbs to your diet to help restore gut mucosa. After eliminating what has been causing problems, introducing helpful enzymes, and incorporating probiotics and prebiotics into your diet, we can also introduce supplements that can help your leaky gut.
Leaky Gut Supplements
Mucosal supportive nutrients are at the top of my list when it comes to a supplemental approach to leaky gut. Here are some of my favorites:
Glutamine:
I like to refer to this as gut cell fuel, creating a strong surface for nutrient absorption.
Zinc Carcinosin:
The particular zinc form is really helpful in bringing down gut inflammation, and happens to also be really helpful for acid reflux and esophagitis.
N-Acetylglucosamine:
This helps with restoring mucosal linings, within the GI tract and elsewhere within the body.
Antioxidants:
When we talk about antioxidants, we are talking about offsetting the effects of free radicals, which cause destruction throughout the body. Some of my favorite antioxidants for the gut are Vitamin C, Selenium Glutathione, and N-Acetylcysteine.
Demulcent herbs:
My favorites are Slippery Elm, Marshmallow, DGL Licorice, and Aloe. They help to soothe inflamed and damaged intestinal tissues. They also have vulnerary actions, meaning they help to heal injured tissues.
I also like to recommend anti-inflammatory herbs like turmeric (the Meriva form) as well as HCl, digestive enzymes, bile, digestive bitters, apple cider vinegar, and patient-specific probiotics. Whatever it is that I recommend or prescribe, it is always very specific to the patient’s symptoms, needs, and health history.
All of my recommended supplements for leaky gut can be accessed through my online dispensary FullScript by clicking here.
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The Leaky Gut Diet and Other Approaches
Now you may be wondering, how do you eat in a way that helps restore a leaky gut? And while recommendations may vary slightly from naturopath to naturopath, there is a basic leaky gut diet that can help.
The leaky gut diet is very similar to an anti-inflammatory diet, which often involves reducing sugars and alcohol, eliminating refined carbohydrates and known food allergens or food sensitivities, and eliminating artificial sweeteners, colors, and preservatives. But it is not all about elimination; a leaky gut diet also encourages eating more organic pesticide-free foods.
With some patients, I find it effective to put them on what is called the GAPS (Gut and Psychology Syndrome) Diet, which involves a very slow step-by-step approach to gut health. Generally speaking, it involves the elimination of all grains, dairy, and beans, but it can involve a more specific approach depending on the patient. It is actually one of my favorite go-tos for restoring gut health, but requires extra discipline that can be challenging for some patients. However, the results make it one I can’t help but favor.
For some severe cases (and especially for my SIBO patients), I sometimes recommend the Elemental Diet, which typically lasts about two weeks. This temporary approach can be very challenging as it involves the patient drinking only a formulation of all the micro and macro nutrients that they would need, but it doesn’t contain anything that would feed any kind of bacteria. During this time, no other food or drink is consumed other than plain filtered water. In most cases, patients will stop supplements and medications unless they are absolutely required. And while very useful and helpful, the Elemental Diet is not something I would recommend anyone try on their own, but rather while working closely with a practitioner.
Book an Appointment
At Simplicity Health Associates in New York City, we help many patients with struggle with a leaky gut and the symptoms of a leaky gut.
Click here to book an appointment online or call (646) 470-8458. You can also email us here.