Intestinal permeability, commonly referred to as “leaky gut,” is a condition that has gained significant attention in the health and wellness community. Maybe you’re not as nerdy as me, but I checked out Pubmed’s trend data to see the prevalence of scientific studies on intestinal permeability in the past 50 years, and I found that in 1974, there was 1 study on intestinal permeability, in 2000, there were 84, and in 2023, there were 705. So, this is clearly something that is becoming both more prevalent and more investigated.  It’s a condition I deal with so often with my functional nutrition clients, so it’s about time we covered it here. This blog post delves deep into the concept of leaky gut, its causes, symptoms, and strategies for managing and improving gut health.

What is Leaky Gut?

Leaky gut, or increased intestinal permeability, occurs when the lining of your small intestine becomes damaged. Normally, the gut lining should only allow small particles like properly digested nutrients to pass through into the bloodstream.  However, the damage allows larger substances like toxins, microbes, and undigested food particles to pass through the gut wall and enter your bloodstream. When this barrier becomes “leaky,” it can cause various health issues.

Imagine your gut lining as a tightly woven net. This net lets beneficial nutrients through while keeping harmful substances out. When the net gets holes, things that shouldn’t pass through, like toxins and partially digested food, can slip into your bloodstream. This can trigger inflammation and potentially lead to health problems like digestive issues, food sensitivities, and even autoimmune diseases.

Here are some key points to understand about leaky gut:

• Barrier Function: The gut lining functions like a barrier or filter. When working correctly, it allows nutrients to enter the bloodstream and keeps out harmful substances. In leaky gut, this barrier is compromised.
• Inflammation: Once harmful substances enter the bloodstream, they can cause inflammation, which may lead to various symptoms and health conditions.
• Common Triggers: Several factors can damage the gut lining, such as poor diet, chronic stress, infections, and certain medications.  We’ll discuss all of these below.

Causes of Leaky Gut

Several factors can contribute to the development of leaky gut:

• Diet: High intake of processed foods, sugar, and alcohol can damage the gut lining. Gluten, in particular, has been shown to increase intestinal permeability in susceptible individuals. Foods rich in additives and preservatives can also disrupt the gut barrier. Moreover, diets low in fiber and high in saturated fats are linked to a decrease in beneficial gut bacteria, which play a crucial role in maintaining gut health. This is why diet is the first intervention we use with clients experiencing gut issues.
• Chronic Stress: Prolonged stress can weaken the immune system and disrupt the gut barrier function. Stress-induced changes in the gut can lead to an imbalance in gut bacteria, which further exacerbates the problem. The gut-brain axis, a complex communication network between the gut and the brain, plays a significant role in this process. This is why stress management is always part of the protocol we design for 1-to-1 clients experiencing gut issues – we simply can’t heal the gut without managing stress.
• Infections: Bacterial, viral, or fungal infections can compromise gut health and lead to increased permeability. Pathogens such as E. coli and Salmonella can directly damage the gut lining, while chronic infections like Candida overgrowth can create persistent inflammation. This is why we use stool tests that discover all of these pathogens in our clients experiencing gut issues.
• Medications: Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics can disrupt gut microbiota and damage the intestinal lining. Antibiotics, while essential for treating infections, can also kill beneficial bacteria, leading to dysbiosis, or microbial imbalance, which is a significant factor in leaky gut development​​. For our clients with a long history of antibiotic use, it often requires a more robust supplement and diet protocol to heal the gut completely.
• Toxins: Exposure to environmental toxins, such as heavy metals, pesticides, and chemicals, can damage the gut lining. These substances can be ingested through contaminated food and water, or absorbed through the skin and respiratory system​. See this post for more about toxins that you can start being aware of in your home.
• Genetic Predisposition: Some individuals may have a genetic susceptibility to increased intestinal permeability. Genetic variations can affect the integrity of the gut lining and the body’s immune response to potential threats​.

Symptoms and Associated Conditions

The symptoms of leaky gut are diverse and can vary widely between individuals, which often makes it hard to recognize or diagnose. Common symptoms include:

• Digestive Issues: Bloating, gas, diarrhea, and irritable bowel syndrome (IBS) are common in those with leaky gut. These symptoms arise from the gut’s inability to properly digest and absorb nutrients due to a compromised barrier​.
• Immune Reactions: Food sensitivities, allergies, and autoimmune conditions such as celiac disease and rheumatoid arthritis can develop from leaky gut. When foreign particles enter the bloodstream, they can trigger an immune response, leading to inflammation and autoimmunity​​.
• Mental Health: Mood swings, anxiety, depression, and brain fog may not seem like gut-related symptoms, but they are! The gut-brain axis plays a crucial role in mental health, and disruptions in gut health can lead to neuroinflammation and altered brain function​.
• Skin Problems: Conditions like eczema, psoriasis, and acne are a direct reflection of gut health. The immune response triggered by leaky gut can manifest in the skin, leading to various dermatological issues. In fact, when we see 1-to-1 clients with skin issues, we automatically think about dietary interventions to fix gut health, and we see fantastic results in helping clients get their skin issues under control by working from the inside!

Diagnostic Approaches

Diagnosing leaky gut can be challenging due to its broad range of symptoms. As functional medicine practitioners, we use a combination of patient history, symptom assessment, and laboratory tests to evaluate intestinal permeability. The truth is that most of the nutrition interventions, which we’ll discuss below, are actually helpful for anyone, so if it is someone with a general sense of dissatisfaction, we’ll likely move forward with dietary and supplement protocols without having specific tests.  In the middle, we may use clues from blood labs, such as an hs-CRP test for inflammation, to clue us in that intestinal permeability is happening.  In more severe cases, we’ll recommend a comprehensive stool analysis, which is a fantastic test that assesses gut microbiota composition and intestinal health markers, and can reveal imbalances in gut bacteria and other issues contributing to leaky gut.  In rare cases, we’ll recommend a lactuose/mannitol breath test, which is technically the gold standard for diagnosis, but is a bit difficult to administer and often is only confirmatory for what we already suspected.

Strategies for Healing and Managing Leaky Gut

• Dietary Adjustments: Adopting an anti-inflammatory diet is crucial for managing intestinal permeability – we want to reduce the inflammation that is already occurring and help calm the gut and immune system from overactivity. Emphasize whole, unprocessed foods, rich in fiber, and include fermented foods to support a healthy microbiome. Consider eliminating gluten, dairy, and alcohol, which are common culprits in promoting gut inflammation. Incorporating foods high in antioxidants and polyphenols, such as berries and green tea, can also help reduce inflammation and support gut health​​.
• Supplementation: Certain supplements can support gut healing:
  • Probiotics: To replenish healthy gut bacteria. Specific strains like Lactobacillus and Bifidobacterium have been shown to improve gut barrier function​. You can see some of my top probiotic recommendations here.
  • L-Glutamine: An amino acid that helps repair the gut lining. L-Glutamine is a key nutrient for enterocytes, the cells lining the gut, and aids in maintaining their integrity​​. You can access my recommendations for l-glutamine and all the below supplements through my Fullscript dispensary here.
  • Zinc: Essential for maintaining gut barrier function, and has been shown to stabilize the gut lining and reduce permeability.
  • Omega-3 Fatty Acids: To reduce inflammation overall, including in the gut lining. These fatty acids have anti-inflammatory properties and support the health of the gut lining​​. More on omega-3s (or fish oil) here.
  • Digestive Enzymes: To aid in the breakdown of food and reduce the burden on the gut. These can help ensure that food is properly digested, reducing the risk of undigested particles entering the bloodstream​.
• Stress Management: Incorporate stress-reducing practices such as yoga, meditation, and regular physical activity to support overall health and gut function. Mindfulness and relaxation techniques can significantly impact the gut-brain axis and reduce the physiological impact of stress on the gut​​. See this post for more on the connection between stress, mental health, and gut health.
• Avoidance of Triggers: Identify and eliminate foods or substances that may exacerbate symptoms. This may involve working with a functional nutritionist to personalize dietary plans. Common triggers include gluten, dairy, and alcohol, but there could be several others​​.
• Gut-Friendly Lifestyle: Adopting habits that support gut health can make a significant difference. This includes adequate sleep, regular physical activity, and staying hydrated. A healthy lifestyle can bolster the immune system and enhance the body’s ability to repair the gut lining​​.
• Regular Monitoring: Regular check-ups and follow-up tests can help monitor progress and make necessary adjustments to the treatment plan. Keeping a symptom diary and tracking dietary changes can provide valuable insights into what works best for individual needs​.

How We Can Help: Functional Nutrition Services

As functional nutritionists, my team and I offer personalized strategies to address leaky gut and other digestive health issues. Through comprehensive assessments and tailored nutrition plans, we aim to restore balance and support long-term wellness – not just make you feel better for a day or a week. If you’re struggling with symptoms of leaky gut or other health concerns, don’t hesitate to reach out for a consultation at this link. Together, we can develop a holistic approach to improve your gut health and overall quality of life!

Now it’s your turn!  Do these symptoms resonate with you?  What could you do today to improve your gut health?

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️ Want to hear about this topic in audio format? → Check out the podcast episode here!