According to widespread promoters of the topical ‘leaky gut syndrome’, a faulty intestine may be the culprit for an assortment of disorders. Despite the recent popularity of this diagnosis, its existence remains a point of contention between mainstream and holistic doctors, as claims have not been substantiated with research. This places patients at risk of enduring unnecessary physical and financial costs: from expensive and unsubstantiated treatments, to a potential delay in diagnosis of chronic disorders.
Leaky Gut Syndrome (LGS)
The premise of syndrome originates with the term ‘leaky gut’, which indicates an supposed increase in permeability of the mucosal barrier. This single layer of cells controls the absorption of small and large molecules. Ulluwishewa D, Anderson RC, McNabb WC, Moughan PJ, Wells JM, Roy NC. Regulation of tight junction permeability by intestinal bacteria and dietary components. J Nutr. 2011;141:769-776 If the lining is compromised, proponents of LGS claim toxins pass into the bloodstream, consequently stimulating inflammation. Symptoms are proposed to be pervasive:
- Irritable bowel and food intolerances
- Acne and eczema
- Chronic Fatigue
Intestinal structures are complex and dynamic, varying between individuals and stimuli. Importantly, the lining acts as a mechanism of defence for the immune system, with leaky gut often a manifestation of autoimmune disease. However in healthy individuals, human and animal studies conclude that changes in intestinal permeability are insufficient in instigating disease. Odenwald MA, Turner JR. Intestinal permeability defects: is it time to treat? Clin Gastroenterol H. 2013;11:1075-1083 Research does not support a syndrome or attribute the aforementioned symptoms to a leaky gut. Currently, the primary goal of medical treatments is to treat the underlying disorder.
When one diagnosis is represented as culprit of symptoms from autism to skin, it is essential to remain sceptical, from both a patient and professional perspective.
Testing for leaky gut involves measuring the mannitol and lactulose levels in urine. Lactulose is partially absorbed, while mannitol readily passes through intestinal linings. Camilleri M, Nadeay A, Lamsam J, Nord SL, Ryks M, Burton D, Sweetser S, Zinsmeister AR, Singh R. Understanding measurements of intestinal permeability in healthy humans with urine lactulose and mannitol excretion. Neurogastroenterol Moil. 2010;22(1):e15-e26
- High mannitol and low lactulose considered normal range
- High mannitol and high lactulose considered to indicate ‘leaky gut’
Kits range from $100 to $250 from alternative nutritional sites and should be considered with caution. Intestinal motility and permeability varies amongst individuals, and also over time. Similar results are used to identify Crohn’s disease and therefore does not necessarily indicate ‘leaky gut syndrome’.Vilela EG, Torres HG, Ferrari MA, Lima AS, Cunha AS. Gut permeability to lactulose and mannitol differs in treated Crohn’s disease and celiac disease patients and healthy subjects. Braz J Med Biol Res. 2008;41(12):1105-1109 The test also does not distinguish between occasional and prolonged absorption fluctuations, as medications and alcohol can irritate the lining. Despite online availability, interpreting diagnostic results without medical guidance is discouraged.
Treatments: Good or Gimmick…
Alternative practitioners are advocating that a leaky gut is not simply a mechanism of chronic bowel disease, but a more common repercussion of chronic stress or dietary choices. Thus, they advocate that treatment should be aimed at targeted repair of intestinal barrier function. In particular, sugar is blamed for disrupting gut flora and promoting candida overgrowth leading to increased permeability. Gluten and dairy are also considered culprits, with strong promotion of paleo and gluten-free diets and reducing fruit consumption.
Treatments begin with an elimination diet, which is a strict cleanse removing all common allergens followed by digestive aids and supplements. Without a medically guided exclusion or FODMAP diet, be wary of a treatment condemning entire food groups.
Beyond the effort and expense associated with these contemporary diets, patients are at significant risk of nutritional deficiencies.
Supplements often prescribed for treatment range from ordinary probiotics and digestive enzymes, to more obscure options. This may include slippery elm, glutamine, betaine hydrochloride (for stomach acid) and various digestive ‘superfood powders’. Gelatine has also been gaining traction in the media, and is endorsed by Sarah Wilson of I Quit Sugar. Despite the advertisement of costly capsules and powders, natural sources also exist (including bone-broth). These supplements are not medically recognised, because often companies are simply capitalising on the rising fame of the ‘leaky gut’. If you are suffering from the aforementioned symptoms, it is best practice to seek advice from your doctor before embarking on restrictive and expensive remedies.
Patients may receive temporary respite after seeking treatment for LGS, but however this may be linked to an overall change in diet. Minimising dairy, gluten and sugar intake frequently involves a progression to more plant-based, whole-food options. Depending on an individual’s former dietary choices, this alteration can provide health improvements irrespective of any ‘leaky gut’. The danger lies in practitioners attributing this reduction of symptoms to treatment of LGS, but correlation does not equal causation. In particular, Coeliac and Crohn’s disease are intestinal disorders which have severe health risks without management. Vilela EG, Torres HG, Ferrari MA, Lima AS, Cunha AS. Gut permeability to lactulose and mannitol differs in treated Crohn’s disease and celiac disease patients and healthy subjects. Braz J Med Biol Res. 2008;41(12):1105-1109 Symptoms of Coeliac and Crohn’s are often lessened through dietary changes similar to ‘LGS treatments’. Individuals should be aware that this symptomatic relief does not endorse the existence of LGS. Assuming that positive health developments are related to an unsubstantiated syndrome may slow or inhibit diagnosis of these disorders.
Both diagnosis and treatment for chronic illness needs to be prompt and controlled, and must not be confused for a medically-unrecognised alternative.
Leaky Gut Debunked…
At present, intestinal permeability as a syndrome rather than a mechanism of disease is not medically recognised or understood. Practitioners should avoid endorsing LGS without significant evidence-based research supporting the diagnosis. It is simply encouraging expensive, potentially unnecessary supplements and dietary regimes. Most importantly, delaying and disguising the presence of chronic disease puts individuals at risk of life-threatening consequences.
References [ + ]
|1.||⇪||Ulluwishewa D, Anderson RC, McNabb WC, Moughan PJ, Wells JM, Roy NC. Regulation of tight junction permeability by intestinal bacteria and dietary components. J Nutr. 2011;141:769-776|
|2.||⇪||Odenwald MA, Turner JR. Intestinal permeability defects: is it time to treat? Clin Gastroenterol H. 2013;11:1075-1083|
|3.||⇪||Camilleri M, Nadeay A, Lamsam J, Nord SL, Ryks M, Burton D, Sweetser S, Zinsmeister AR, Singh R. Understanding measurements of intestinal permeability in healthy humans with urine lactulose and mannitol excretion. Neurogastroenterol Moil. 2010;22(1):e15-e26|
|4.||⇪ab||Vilela EG, Torres HG, Ferrari MA, Lima AS, Cunha AS. Gut permeability to lactulose and mannitol differs in treated Crohn’s disease and celiac disease patients and healthy subjects. Braz J Med Biol Res. 2008;41(12):1105-1109|