You may have heard the term “leaky gut” blamed for just about everything from weight gain to eczema to depression. Medical professionals call this condition increased intestinal permeability, but what is it and how do you know if you have it?
“The gut is a very complex system and we’re still learning how it influences health,” says Erika La Vella, DO, a surgeon from Samaritan Weight Management Institute. “Left untreated, we know that a leaky gut can cause gastrointestinal conditions like irritable bowel syndrome, celiac disease and Crohn’s disease, among others.”
A literature review published in the journal The BMJ reported that researchers have connected the health of the gut and the microbiome to other conditions like obesity, allergies, arthritis, mental illness, Parkinson’s disease, autism, liver disease, Type 2 diabetes, cancers and autoimmune diseases like multiple sclerosis and lupus.
How Does a Leaky Gut Develop?
The walls of the intestines are made up of a single layer of cells called enterocytes. These cells are linked together by tight junction proteins that act as gated openings to allow nutrients out of the intestines into the bloodstream. When those tight junctions become damaged, undigested food particles, bacteria and toxins can “leak” out.
The gut is made up of three major parts working together:
- the physical structure of the intestines including the enterocytes and tight junctions;
- the mucosal lining, which acts as a buffer to protect the intestinal cells and keep unhealthy bacteria from getting below the surface;
- healthy bacteria, which digests food.
All systems need to be working properly or it can lead to chronic inflammation and potentially trigger the immune system.
“The body’s largest collection of immune cells are in the gut,” says Dr. La Vella. “When there is increased intestinal permeability, the immune system reacts to these particles by increasing inflammation.”
Causes of Damage
Damage to the tight junctions can be caused by:
- Diet. Notably the standard American diet which is low in fiber and high in sugar and saturated fat, and contributes to poor gut function.
- Stress. The gut cells have receptors for stress hormone (cortisol), damaging tight junctions and believed to be a major contributor to irritable bowel syndrome (IBS).
Damage to the mucosal lining can be caused by:
- A low fiber diet. Fiber feeds gut bacteria which make healing chemicals (short-chain fatty acids) for the cells and immune system. This helps turn off inflammation.
- Taking medications like NSAIDS (commonly used ibuprofen, Aleve and naproxen). These medications poke holes in the mucosal lining leading to ulceration of not only the stomach, but the small intestine as well. This causes the gut to become even more vulnerable to the effects of toxins.
“Leaky gut can happen quickly depending on your diet, medications and stress,” says Dr. La Vella. “The good news is the gut can also heal quickly with stress reduction, eating well and not taking medications that damage the gut or weaken the mucosal lining.”
Symptoms of a Leaky Gut
If you have a leaky gut, you may experience:
- Bloating and gas
- Food sensitivities
- Joint pain
- Weight gain or weight loss
Healing Your Gut Through Diet
Regardless of the cause of a leaky gut, proper nutrition can help you feel better.
“The foods that you eat determine if you are giving your body a chance to heal,” says Dr. La Vella. “Diet is one of the important parts of managing the symptoms of a leaky gut.”
She notes that ultra-processed foods are a common problem because they are low in fiber, high in fat and often contain chemical additives. This combination can harm healthy bacterial growth and damage tight junctions in the intestines.
Dr. La Vella recommends filling up on whole foods from all the food groups including fruits, vegetables, grains, lean protein and cultured dairy. Look for recipes for a Mediterranean-style diet or the DASH diet, which use healthy ingredients prepared in a tasty manner.
Other Diet Recommendations
- Limit or avoid ultra-processed foods like shelf stable bread, sugary breakfast cereals, frozen meals, snack foods like chips or crackers, and instant rice or potatoes. These products are all highly processed and have lost much of their nutritional value.
- Limit or avoid sugar, alcohol and saturated fat — found in animal products like butter, cheese and red meat — which have been shown to decrease the amount of healthy bacteria in the gut.
- Eat plenty of fiber, which feeds healthy bacteria. Fruits, vegetables, legumes, nuts and whole grains are rich sources of fiber.
- Eat fermented foods and cultured dairy, which help populate the gut with beneficial bacteria. Cultured dairy products include traditionally cultured yogurt and kefir, a yogurt-like drink. Common fermented foods include sauerkraut, kimchi and miso. The optimal dose of fermented products is not known, but Dr. La Vella recommends eating some fermented product at every meal. However, she warns that those who aren’t used to eating fermented foods or fiber regularly will experience some gas and bloating as the body adjusts. “Start with a tablespoon a day and work up,” she suggests.
“Bacteria digests the food we eat which is why eating a diet rich in antioxidants and whole foods with plant fiber is critical for health, not just a smaller waistline,” says Dr. La Vella. “Eating a balanced diet to optimize the microbiome is at the heart of my personal and professional practice
Don’t Neglect Sleep
Getting restful sleep each night is another key aspect of gut health. Studies show lack of sleep negatively affects the balance of gut bacteria, the reactivity of the immune system and the integrity of the gut lining. Research published in the International Review of Neurobiology found that the whole body, including the gut microbiome, has a circadian rhythm that is affected by healthy sleep patterns.
Do I Need a Supplement?
According to research published in the journal Frontiers in Immunology, there is some evidence that probiotics can improve the function of your gut and even help reverse leaky gut, but long-term studies are still needed. There is not a single study to date suggesting that probiotics are harmful.
“Probiotic supplements are more like a fertilizer that communicates to your existing gut bacteria. It can regulate the pH and ‘cross-talk’ to other bacteria, increasing short-chain fatty acids — which is the food for the gut cells — and help regulate inflammation and the immune system of the gut,” says Dr. La Vella. “Transitioning away from processed foods and toward whole foods is usually enough to keep your gut healthy.”
Herbal supplements may be helpful in certain situations, but aren’t necessarily a quick fix.
“I think of supplements as medications; there is always a risk and a benefit. I prefer to think about restoring ecosystem balance rather than supplementing to cover up a bad dietary or lifestyle choice,” says Dr. La Vella.
When Should I See a Doctor?
Improving your diet may help you feel better, but a leaky gut sometimes can have other causes, like infection or disease.
In some cases, food sensitivities may be causing your symptoms. If you suspect you may have a food sensitivity, Dr. La Vella recommends working with a doctor to determine your sensitivity.
“It is very safe for anyone to adopt a whole foods diet and you’ll likely start feeling better within a few weeks,” says Dr. La Vella. “If you have ongoing symptoms and are still concerned after making these changes, talk to your doctor. There may be an underlying cause that needs to be treated.”
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