Leaky gut is a controversial subject, and many clinicians refuse to recognize leaky gut as something real. But the science suggests that there is a condition, intestinal permeability, in which food particles and pathogens “leak” across the gut lining, often associated with serious gastrointestinal and systemic illness. In this article, we’ll separate fact from fiction — and provide you with 7 steps to heal leaky gut, or to at least cope with it better.
What is gut health?
Before discussing how leaky gut might occur, understand first how your gut functions. Your gut is home to trillions of bacteria, both good and bad. This home is known as your gut microbiome. There, the bacteria and other substances play a critical role in helping you digest food, absorb nutrients, and maintain a healthy immune system. When your gut is in good health, you're not only more likely to have better and more comfortable digestive functioning, but also higher energy levels, even healthier skin. Learn more: How does a healthy gut affect digestive health?
In fact, research has shown that a healthy gut can even help prevent autoimmune diseases, where the immune system mistakenly attacks healthy cells in the body. This is because a healthy gut can help regulate the immune system and prevent it from becoming overactive.
However, when your gut is out of balance, it can lead to a variety of health problems — and leaky gut may be one of them; or, leaky gut may be a source of the problems. For example, an overgrowth of bad bacteria in the gut can lead to digestive issues such as bloating, gas, and diarrhea. It can also cause inflammation throughout the body, which has been linked to chronic conditions such as heart disease, diabetes, and even cancer. In other words, the health of your gut microbiome is not only critical for supporting a healthy intestinal barrier. but also in preventing inflammation. The relationship is complex and often multi-directional. Learn more: How to lower inflammation.
What is leaky gut syndrome?
While leaky gut is the mainstream term about which you’ve probably heard, the more accurate description is “intestinal permeability” — best described as the large-scale passage of particles directly across the intestinal barrier.
This condition can occur when the tight linkages, called tight junctions (TJs), that bind our intestinal cells together are compromised in some way. TJs are critical for a healthy digestive tract because they allow nutrients and water to cross over our intestines, but keep things like bacteria and viruses out. TJs also play an important role in our immune responses to the things that pass through our digestive tracts, including food particles.
Under healthy conditions, our intestinal cells use specialized vesicles to take in food particles or pieces of cells from our gut microbiomes. These particles are too small to elicit a full-on immune response, but they do “train” our immune systems not to react to them. It’s why healthy people don’t have allergic reactions to everything they eat.
When TJs aren’t functioning as they should, however, particles from our intestines bypass entrance into our cells and can cross directly into the body’s circulation and other tissues, eliciting system-wide inflammation and causing a range of conditions, from food allergies to more serious digestive problems and fatigue. Some particles that get across include lipopolysaccharide (LPS), a molecule produced by certain bacteria that appears to be an important trigger of chronic, low-grade inflammation. Although more research is needed, scientists suspect that LPS triggers inflammation by interacting with a receptor on our own cells, called Toll-like receptor 4 (TLR-4), which promotes the production of pro-inflammatory cytokines. LPS has also been shown to contribute to “leaky gut,” a condition caused by weakened tight junctions in your intestines that has been associated with several chronic diseases, including obesity, diabetes, inflammatory bowel disease (IBD), and more.
Causes of leaky gut
We can’t really say what causes leaky gut, or the compromising of TJs and resulting intestinal permeability, because scientists have yet to determine whether an underlying disease brings on the condition, or whether leaky gut is what causes certain diseases.
Diseases associated with leaky gut include the following:
- Inflammatory bowel diseases (IBD) - Crohn’s disease and ulcerative colitis
- Celiac disease (i.e., gluten sensitivity)
- Irritable bowel syndrome (IBS)
- Chronic fatigue syndrome
Most of these diseases comprise a complex interplay between intestinal permeability, inflammation and disease. Since inflammation seems to be a common driver behind both intestinal permeability and these diseases, clinicians tend to treat intestinal permeability/leaky gut as just another symptom of disease, rather than a cause of disease. And yet, many of these diseases on their own also worsen (as in, possibly cause?) existing intestinal permeability.
There are a number of factors that can contribute to the development of leaky gut.
Underlying disorder: As we just discussed, an underlying disorder, such as Crohn’s disease or celiac disease, could be a cause of leaky gut.
Genetics and family history: Many cases of the diseases associated with leaky gut develop because of genetic factors, although whether such factors are triggered by environmental/lifestyle factors remains under study. Crohn’s disease and colorectal cancer have confirmed genetic links, and recent studies have even confirmed a genetic link between family history and IBS.
An unhealthy gut: While this is a general concept, and probably related to one or more other factors on this list, an “unexplained” (no definitive diagnosis of a disease) unhealthy gut appears highly associated with leaky gut. (We’ll explain what that entails in the next section.)
Medication side effects, interactions: An unhealthy, leaky gut can be brought on (or a preexisting gut problem exacerbated by) certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), which can damage the intestinal lining, especially with long-term use. So, too, could antibiotics (which can alter a healthy balance of bacteria in your gut) and other medications.
Dietary factors: As a recent scientific review summarized, diets high in fat and low in fiber appear highly associated with the development or exacerbation of intestinal permeability. And, indeed, celiac disease, IBD and other gut disorders are much higher in Westernized countries (United States, Canada, and Europe) where a high-fat, low-fiber diet is common.
Obesity: Increased body weight may be a leaky gut factor, and it is known to increase the severity of IBS for the afflicted. While further work needs to be done on this association, early findings suggest that obese individuals are more at risk for altered bowel movements and transit of gut contents.
- Mental distress or depression: Feeling stressed, anxious or depressed appears to increase the risk of leaky gut, particularly if associated with IBS. Stress has adverse impacts on several aspects of intestinal function, such as intestinal sensitivity, bowel movement regularity, and immune system activation. Studies have found that people with depression and anxiety often have imbalances in their gut bacteria, a factor explained in part by the “gut-brain connection” — which refers to the fact that your gut and brain are interconnected via the vagus nerve.
Symptoms of leaky gut
The symptoms of leaky gut can vary widely, but some of the most common include bloating, constipation, diarrhea, fatigue, headaches, joint pain, and skin rashes. Learn more: Bowel movements: What’s actually healthy?
Diagnosing leaky gut
There is no one definitive test for diagnosing leaky gut syndrome. However, your doctor may recommend testing for markers of inflammation or allergies, as well as doing a comprehensive stool test to look at the state of your gut microbiome. Other tests include a colonoscopy, a CT scan, or an upper endoscopy to help identify any underlying conditions that may be contributing to your leaky gut syndrome, such as IBD or celiac disease.
To help diagnose what might be bringing on leaky gut, while also potentially treating it, your doctor may also suggest an “elimination diet,” which involves removing certain foods from your diet for a period of time and then reintroducing them one-by-one, to help identify foods that are causing inflammation and aggravating your gut. Common foods that may cause inflammation and worsen leaky gut syndrome include gluten, dairy, soy, and processed foods — and in some cases, FODMAPS foods (see discussion below). By eliminating these foods and then reintroducing them slowly, you can identify which ones are triggering your symptoms and avoid them in the future.
Step-by-step guide to healing leaky gut
Leaky gut syndrome is not a definitive disease, but it may be a factor in or result from any number of disorders, many of which do not have a cure — so cannot be “healed,” per say. You may experience symptoms very differently from another person, which makes a single treatment plan difficult to develop. Therefore, it’s best to work closely with your medical provider on a detailed symptom management plan. Depending on the severity of your symptoms, it’s possible, too, that your provider could recommend various available over-the-counter or prescribed medications. We are not in the business of dispensing medical advice, so what follows is a guide to non-pharmacological strategies for coping with leaky gut, or helping to prevent it in the first place:
Step 1: Reduce your consumption of dietary fats and sugars
Although the mechanisms aren’t fully elucidated, it’s clear that the typical Western diet, so high in unhealthy fats and sugars, is damaging to the intestinal barrier.
High-fat foods: Fats in your gut can reduce bowel motility and keep intestinal gasses inside, inducing bloating.
Simple sugars: Found in foods such as cookies, sugar-sweetened beverages, ketchup and sauces, and even in fruits, vegetables, milk and yogurt, simple sugars are also known to induce gut inflammation.
Reducing fats and sugars, especially those found in processed foods, will pay dividends not only in improving your gut health, but the health of most of your other organ systems (cardiovascular, metabolic, neurological, reproductive, and others). Just be sure to only reduce bad fats (i.e., saturated fats), as healthy fats such as omega-3s and other PUFAs (salmon, avocados, olive oil, nuts) have plenty of health benefits.
Step 2: Up your consumption of high-fiber foods
Eating a diet rich in fiber (including prebiotic fibers) has numerous benefits, including keeping your gut microbiota happy, helping to regulate blood sugar levels, and enhancing nutrient uptake — all of which support gut and overall health and help reduce risk for leaky gut and/or help alleviate its symptoms. In fact, many of the anti-inflammatory and gut barrier-strengthening effects of the gut microbiome are due to the short-chain fatty acids (SCFAs) that are produced by gut bacteria when they break down fiber — carbohydrates that cannot be digested by our own cells. Several research studies have linked increased fiber consumption with healthy TJs, prevention of leaky gut syndrome, and production of intestinal mucus. A balanced diet filled with a variety of multi-colored fruits, vegetables, nuts, seeds and whole grains will not only provide all of the necessary micronutrients for optimal gut health, but will aid in maintaining healthy tight junctions and so helping to prevent or relieve symptoms of leaky gut and other GI disorders.
Step 3: Remove trigger foods and toxins
Remove any foods or toxins that could be contributing to inflammation.
Alcohol, caffeine, and even carbonated drinks could be culprits. Avoid them, or at least up your consumption of good old pure water to partially compensate: Good hydration is a key to gut health overall, including leaky gut.
You may also need to eliminate gluten and dairy from your diet. These foods can be difficult to digest and can irritate the lining of the intestines, contributing to leaky gut syndrome. But ask your medical provider about getting tested for these food allergens/triggers; no need to self-diagnose or “guess.”
Discuss with your medical provider, too, any medications you may be taking. As mentioned previously, scientists have established that antibiotics can lead to gut dysbiosis, the clinical name for a gut microbe imbalance, wherein both pathogenic bacteria and good gut bacteria are killed off. Other medications, including ibuprofin, may also contribute to problems associated with intestinal permeability (or leaky gut).
- Your medical provider might also suggest, as we discussed above, trying an “elimination diet.” One such elimination diet focuses on trying to determine if any particular or a few FODMAPs (foods rich in “Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols”) could be causing gut lining irritation. While generally the plant-sourced FODMAPS foods help your “good” gut microbes grow, ultimately helping to reduce GI distress for most individuals, the process can increase gas production in the intestines, increasing flatulence and bloating for some individuals. Excess FODMAPs can also increase the risk of diarrhea by increasing water content in stool. Foods rich in FODMAPs include some of the very plant-based foods we just suggested as beneficial for preventing or treating leaky gut, so it proves that food selection is truly individualized, and quite a balancing act. FODMAP foods include bean and legumes (oligosaccharides); garlic and onions (fructans–oligosaccharides); cruciferous vegetables such as broccoli, cauliflower, cabbage, and kale; and certain fruits such as apples, grapes, watermelon, asparagus (rich in fructose). The aforementioned high-fat and high-sugar processed foods, as well as certain dairy foods (particularly if they contain lactose and you’re lactose-intolerant), are also FODMAPs that could be irritants for you.
Step 4: Rebalance gut bacteria with probiotics
Probiotics are live bacteria that confer health benefits. You can find probiotics in fermented foods such as yogurt, kefir, and sauerkraut; you can also obtain probiotics in over-the-counter supplements (see section below). Probiotics are often referred to as "good" bacteria because they help promote the growth of beneficial bacteria in the gut. In a 10-week study undertaken to determine the influence of dietary intervention on the microbiome and immune system, a fermented food diet (rich in probiotics) was found to increase microbiome diversity and decrease markers of inflammation. Their most medically accepted indication is for relief of gastrointestinal distress (e.g., symptoms such as diarrhea), which may include leaky gut. Their effectiveness depends on the type and quantity consumed.
Step 5: Care for the gut lining with a supplement
There are a number of supplements that claim to help repair the gut lining and reduce inflammation. But be skeptical of any one ingredient; it’s probably not going to be a “magic bullet” digestive fix. It's important to talk to your healthcare provider before starting any new supplements, as some may interact with medications or have side effects. See our 3-step guide: How to buy supplements.
Bear in mind, too, that a supplement is only one small part of an overall dietary regimen and lifestyle modification program. That being said, it’s not always easy, or convenient, or even economical to stick to a healthy, high-fiber diet or follow the other diet and lifestyle recommendations. A dietary supplement focused on gut health may make good sense for you.
Eden’s 3:1 Synbiotic Superblend includes scientifically-backed prebiotics, probiotics, and polyphenols that complement one another and combine to support your gut functioning and comfort while also improving your heart, immune, metabolic and even cognitive health. Learn more: What is a synbiotic?
Specific to intestinal permeability, these Eden’s ingredients have documented benefits:
3-in-1 Synbiotic Superblend
Prebiotics: Resistant potato starch (Eden’s is a formulation called Solnul) bypasses digestive enzymes so that it reaches the colon intact, where it feeds beneficial flora. In human clinical research, resistant potato starch has demonstrated an increase in the total amounts of both a “good” bacteria (Bifidobacterium) and total SCFAs, results associated with improvements in digestion. Locust bean gum is anti-inflammatory, increases TJs, and promotes the growth of beneficial bacteria in the gut. It also improves digestion by decreasing the rate at which the stomach empties, causing you to feel fuller for longer and helping you to avoid overconsumption of those processed fats and sugars that may be exacerbating leaky gut. Guar gum promotes SCFA production by gut microbes and helps normalize the moisture content of stool, with the unique dual-action benefit of relieving both constipation or diarrhea, associated with so many gut disorders. Oat bran promotes the growth of probiotic species (see below) in the gut. Barley beta glucan also promotes the growth of probiotic species in the gut.
Probiotics: Bacillus coagulans SC208 has been shown to reduce damage to the gut, according to a 2020 study. Lactobacillus rhamnosus GG and Lactobacillus paracasei LPC-37 have demonstrated an ability to reduce IBS symptoms, some associated with leaky gut, and improve quality of life. The probiotic, Saccharomyces boulardii (a yeast), has also shown promise for relieving symptoms (especially diarrhea) of IBD, another set of disorders (Crohn’s disease and ulcerative colitis) that may include compromised intestinal permeability.
Polyphenols: Green and gold kiwi fruit extracts have been shown to benefit the growth of good bacteria, increase bowel regularity, and ease symptoms of GI distress. Turmeric contains the ingredient, curcumin, which has demonstrated improvement in digestive comfort in patients with IBD.
Step 6: Manage stress, anxiety, depression, and sleep hygiene
There is evidence that treating depression, anxiety, or insomnia and other sleep disorders (such as apnea) — or all of these combined, as they are often related or intertwined — may help reduce the symptoms of an unhealthy gut, including leaky gut. And vice versa, treating a leaky gut may help to improve mood and reduce symptoms of depression and anxiety, and help you sleep better. There are many reasons why this is the case, including malabsorption and alterations to the gut-brain connection. See your medical provider if you are concerned, and you may be referred to a sleep specialist or a behavioral health specialist.
How do you know if you have a sleep problem? You do if you are sleeping less than 7 hours per night, but determining that can be difficult without getting a sleep study done. Your partner may have relevant observations, such as if you sound like you are snoring excessively (which could be sleep apnea) or tossing and turning all night long.
How do you know if you have depression or anxiety? That’s complicated, too. But if you feel that you have developed more than just every-day stress, and stress-relieving practices (such as yoga, meditation, and deep breathing) are no longer bringing you substantive relief, it may be time to at least check in on and attend to your mental health, as so many new and beneficial treatments are available.
Step 7. Watch your weight and exercise regularly
Studies have established links between obesity and other metabolic disorders, marked by undesirable changes in the gut microbiome ecosystem, a phenomenon known as gut dysbiosis. Therefore, it’s generally accepted that maintaining a healthy weight reduces risks of intestinal permeability, while becoming overweight or obese can trigger metaflammation that can impact so many different organ systems, including your gut. The fact that obesity very often results from a diet high in fat and refined carbohydrates and low in fiber (i.e., the typical Western diet), as does compromised intestinal permeability (i.e., leaky gut), is probably no coincidence. The two conditions are related and probably bi-directional.
Considering this link, supporting a healthy gut microbiome with a high-fiber diet (including prebiotic fiber foods), such as the Mediterranean diet, could potentially restore healthy microbes and in turn improve metabolic outcomes that impact weight management, and weight management in turn would benefit gut comfort (i.e., reduce symptoms of leaky gut). How can fiber help you to maintain a healthy weight? As mentioned previously, prebiotic fibers feed beneficial bacteria that produce short-chain fatty acids (SCFAs) within your gut. These SCFAs subsequently promote healthy weight management through improvements in glycemic control and lipid metabolism. Other fibers help delay gastric emptying, which in turn promotes satiety, further helping weight management efforts. Learn more: Can prebiotics help with weight loss?
Sleep hygiene can also impact weight: When you’re deficient in sleep, your circadian rhythm is disrupted, resulting in metabolic dysregulation that has been linked to weight gain.
Exercise (as well as diet) is obviously an important factor in weight management. But exercise independent of weight also has numerous health benefits, including in the gut. For example, exercise can improve lipid profiles by increasing the amount of high-density lipoprotein (the good cholesterol). In addition, exercise improves glucose regulation and can improve mental health. Furthermore, just standing up, and moving, can aid with “keeping things regular” digestively, which can reduce risks of intestinal permeability and its related discomfort. For example, while research is still short of a consensus, many reports have shown that exercises like jogging and cycling can improve the frequency of bowel movements and can help those who might have chronic constipation. Really, any physical movement, and spending less time sitting, can probably help significantly.
It is not uncommon for many of us to experience occasional symptoms of gastrointestinal distress — such as bloating, abdominal pain or other symptoms. While not necessarily a sign that you have a gut disease, these uncomfortable symptoms could represent an early warning sign that you’re suffering from gut inflammation — which could be benign or, if left unchecked, could lead to a compromised intestinal barrier (“leaky gut”) and more serious issues. So if your symptoms persist, the best thing to do is visit your doctor, who can help you get to the bottom of your symptoms and get you on your way to improved gut health. In most cases, the condition isn’t serious, and lifestyle improvements such as a healthier diet (focused on high-fiber fruits, vegetables and healthy fats; and way less on processed fats and sugars), better mental health, enough quality sleep, and daily movement/exercise can go a long way to reducing gut inflammation and preventing a leaky gut. A metabolic supplement is also worth considering; consult with your healthcare provider.