What is leaky gut? How do I know if I have leaky gut? How can I heal from leaky gut?
These are questions often pondered by the women and men I see in my clinical practice as. naturopath. In this article I want to give you as much information as possible to simplify the concept of leaky gut. And hopefully answer these questions for you.
Leaky gut is now considered to be responsible for (or associated with) a wide range of chronic conditions. Autoimmune conditions, chronic fatigue syndrome, endometriosis and coeliac disease are examples of conditions that can be linked to leaky gut.
Some early studies indicate that leaky gut may also be connected to the onset of conditions such as fibromyalgia, allergies, acne, obesity and arthritis. However, the evidence for these connections are still building.
If your doctor hasn't heard of leaky gut it's because it's a relatively new concept that is slowly gaining an evidence base. Your doctor may be more familiar with the term intestinal hyperpermeability.
Leaky gut explained
The lining of your digestive system is very thin. The single layer of cells that make up the 'gut barrier' are about the thickness of a hair. These cells form the barrier between your digestive system and blood stream. The cells are joined together by tight junctions.
This gut lining is designed to be semipermeable after we have eaten. This allows nutrients to pass from the digestive system in the blood stream for circulation to all our cells. When the tight junctions between cells are compromised, undigested food particles, toxins and bacteria can leaky out of the digestive system and enter the blood stream.
Once foreign substances enter circulation, a chain reaction can trigger bloating, gas, cramps, food sensitivities, fatigue and joint pain. Even the 'healthy' bacteria living in our gut can cause symptoms if they escape the intestines and enter circulation. These substances trigger a cascade of immune activation and inflammation. A wide range of symptoms can be experienced when the gut barrier is compromised.
Symptoms of leaky gut
Here is quite a long list of symptoms that might be caused by gut barrier dysfunction. Remember that you may have leaky gut but you won't necessarily experience all of these:
bloating
abdominal pain
food sensitivities
constipation
diarrhoea
histamine intolerance
hives
seasonal allergies
brain fog
fatigue (or chronic fatigue syndrome)
eczema
depression
anxiety
psoriasis
rosacea
Confused? It can be impossible to diagnose leaky gut from symptoms alone. All of these symptoms can be caused by something else.
how to know if you have leaky gut
Before worrying about leaky gut or making changes to your diet, it's best to do a stool test. There may be other explanations for your symptoms.
I like to investigate gut barrier dysfunction while also trying to uncover other causes for your symptoms such as:
Stool testing for leaky gut is readily available. I have been using the GI map as a diagnostic tool for many years to determine if someone has gut barrier dysfunction. There are 2 main components of leaky gut that I look for:
1. High zonulin levels
High zonulin levels in the stool can be an indicator of gut barrier permeability. Zonulin is a family of proteins that affect the tight junctions. If tight junctions are affected; then toxins, bacteria and food particles can move into the blood stream. This form of leaky gut is also referred to as zonulin-mediated gut permeability.
We know that zonulin levels can be triggered by gluten consumption or gut dysbiosis (microbial undergrowth or overgrowth).
2. Unhealthy mucosal layer
The mucosal layer with the digestive system plays a role in leaky gut by providing protection to the cells forming the gut barrier. The numbers and balance of commensal (or healthy) microbial species will indicate if your mucosal layer is able to perform it's protective role.
Stop wondering! Book in now and I will arrange and interpret the GI map stool test for you.
How did I develop leaky gut?
Good question! Generally speaking, leaky gut is more of a chronic condition that will develop over time. Here is a list of the known risk factors for leaky gut. If you have several of these risk factors, then all the more reason to suspect that leaky gut might be applicable to you:
Post infection from food poisoning or water borne bacteria or parasites.
This is one of the major causes of gut barrier dysfunction and many of the items in the rest of this list can leave you more susceptible to these pathogens. Even if your terrible bout of food poisoning was 25 years ago, I will still want to investigate this.
Candida overgrowth.
Candida is a common yeast that grows in the gut and can overgrow and infiltrate the gut lining. Many women I work with experience recurrent bouts of vaginal thrush (Candida) which can be a clue (although not a certainty) that the Candida is systemic. Candida is very persistent and clever at evading the immune system. It is highly associated with leaky gut.
Over exercising
There is a strong link between over exercising and leaky gut. That link is stress, immune activation and inflammation. Intense physical exercise such as marathons or regular high intensity workouts can come at a price of gut barrier dysfunction.
If you regularly engage in high intensity exercise it's important to supplement with nutrients to support your immune health, your gut health and inflammatory pathways. I recommend seeking out a naturopath or sports nutritionist who specialises in this area.
Food choices:
Your food choices can affect your gut health and contribute to leaky gut in several ways:
Over eating foods that disagree with you may cause inflammation. Gluten is a good example, however everyone is different and not everyone needs to avoid gluten. I regularly meet people who eat gluten at every meal, for example cereal for breakfast, a sandwich for lunch, and pasta for dinner. I believe that for most people, gluten at every meal is too much gluten and it could be contributing to inflammation and leaky gut.
Under eating foods such as vegetables that contain fibres to nourish a healthy gut microbiome
Eating too often means that your digestive system is often dealing with food, triggering regular immune activation and inflammation
Substances in our food can contribute to leaky gut. Some people are more sensitive than others to pesticides, herbicides, food additives, emulsifiers and sugar. I recommend checking the ingredients in your food and buying organic wherever possible.
Substances on our food can also affect intestinal barrier function. Detergents from dishwashers and insecticides on food preparation surfaces can find a way onto our food and into our digestive systems.
Heavy consumption of alcohol
Alcohol is a toxin. The extent to which alcohol can be harmful to your digestive system cannot be covered in this article. Alcohol puts stress on your liver, gut microbiome and the gut wall. The more alcohol you drink and the amount of time the alcohol stays in your digestive system can negatively influence your gut microbiome.
The occasional glass of wine or beer is not a problem. However drinking more than 1 glass of alcohol per hour can be harmful, and more than 2 to 3 days per week is not recommended.
It's quite common for me to work with women who are consuming 2 to 3 glasses of wine every week night after work and more on the weekend. It's also common to see younger people binge on up to 15 drinks on a Friday or Saturday night. These are habits that can lead you to problems with leaky gut.
Even if you have a heathy diet, and regularly take time to look after yourself and keep fit; heavy consumption of alcohol can be contributing to leaky gut and poor health.
Medications
NSAIDS for pain can be a common cause of leaky gut
antibiotics disrupt the bad and the good bacteria that are keeping the healthy balance and supporting mucous membranes in your digestive system
oral contraceptives affect estrogen levels and may drive Candida growth, a common cause of leaky gut
proton pump inhibitors and other acid reducing medications increase your risk of pathogenic infections
steroids and medications that suppress the immune system can increase your risk of infections that contribute to leaky gut
Stress
Human studies have confirmed that both chronic and acute stress can affect intestinal permeability. This is a disturbing reality because so many of us live in a constant state of fatigue, worry and busyness. Stress causes inflammation which leads to impaired gut barrier function.
What's the connection between leaky gut and other conditions?
Leaky gut and chronic fatigue syndrome
Chronic fatigue syndrome (CFS) is a debilitating and often silent condition that can have an ongoing impact for decades. Working with people with chronic fatigue has brought an awareness to how demoralising this condition can be. Patients report that they have tried many things over many years to improve their energy levels without success. Over time, CFS becomes a silent condition where suffers stop telling friends, family and coworkers what's wrong with them because it's too difficult to discuss.
If you have chronic fatigue it's a very good idea to investigate your gut health. If you have leaky gut, your immune system is on high alert due to the toxins, bacteria and undigested food particles entering your blood stream. Constant immune system activation leads to inflammation and fatigue.
In my experience from working with people with chronic fatigue, they often remember a time when they had food poisoning or a virus many years ago. Leaky gut can be the reason behind the fatigue, muscle soreness, brain fog and joint pain.
leaky gut and endometriosis
Endometriosis is a painful, inflammatory condition that affects 1 in 9 women of childbearing age. Pain can occur with menstruation or at other times of the menstrual cycle, typically when estrogen levels are high.
We know that around 60% or more women who suffer from endometriosis have symptoms that overlap with IBS, or SIBO. This symptom overlap can make it difficult to get a diagnosis of endometriosis, and many women have a delay of several years before they know what the condition is. Unfortunately the delay can lead to growth of more lesions.
Investigations have found that the gut microbiome is altered in around 90% of women with endometriosis, when compared to women without endometriosis. This gut dysbiosis, combined with a leaky intestinal tract can allows toxins, candida and/or bacteria to possibly move into the pelvic area to cause immune activation and inflammation.
If you're interested in how naturopaths (like me) work with endometriosis, you might like to read an update on endometriosis.
leaky gut and autoimmune conditions
Autoimmune occurs when the immune system fails to recognise that it's attacking the persons own body. Whenever I work with someone with any kind of autoimmune condition I begin by investigating their gut health and the possibility of leaky gut. Autoimmune conditions are caused by something that triggered the immune system.
Autoimmune thyroid conditions, arthritis, psoriasis, inflammatory bowel disease may all have a leaky gut component to them.
If you have any autoimmune condition, it's a good idea to work with your doctor, or specialist integrative doctor, in combination with a naturopath (like me) who can help you investigate and heal from leaky gut.
you can heal your leaky gut
Your body is an incredible living system that is constantly adjusting and balancing and trying to keep you well. Any small change in your diet and lifestyle can bring large improvements. There isn't one right way to heal leaky gut. Instead there are many small changes you can make to support your body to heal. You can start today. Caring for your digestive system can be easy when you know how.
The tips and recommendations below are separated into the things that contribute to leaky gut that should ideally be removed from your life. And the things that can repair leaky gut and restore your health.
In my clinical practice I like to tackle all of these things in combination, rather than taking a step by step approach.
Remove
1. Remove foods that don't agree with you.
Not all foods suit everyone. Removing harmful foods from your diet can bring about healing and a reduction in symptoms. You may benefit from testing for food biocompatibility, or you may prefer to work with an elimination diet. Keeping a diary of what you are eating and experiencing can be very helpful when trying to decide which foods are bothering you.
I love to use food biocompatibility testing for those who want to fast track the insight to which foods are great for you and which foods to avoid. The advantage of biocompatibility testing is that it can help refine the foods to temporarily eliminate. For instance you may react to most dairy, however butter, cream and maybe some chocolates may be OK for you.
Usually you will have to remove foods that don't agree with you for several months, or up to a year, before introducing them to your diet again. You many discover that there are some foods that just don't sit well with you and are best avoided long term.
The GI map stool test will tell us if gluten is contributing to your leaky gut. If it is, then you should aim to avoid it as much as possible. If gluten is not the culprit, I still recommend that most people cut back the amount they consume daily.
2. Remove processed foods
While you are in the healing phase it's best to avoid foods that are processed such as refined oils, aged meats, refined sugar, soft drinks and fast food. These foods are inflammatory and contain few nutrients to support digestive healing.
3. Remove stress
I know that removing stress from your life is much easier said than done. I've lived the busy working-mum-of-3 lifestyle! I get that sometimes it never ends and if you feel that if you stop for a second that all the balls you are juggling will come crashing down on your head. But if you fully understood the degree to which stress could be contributing to all your health problems, you may take the time to reassess your stress levels and take steps to manage them.
Don't think your stressed? If you regularly have a day that's too busy to allow you to be organised, to cook, to eat well, take time out for exercise, or take time out for a little fun, then possibly you are stressed but not acknowledging it. You might like to read my blog about the 12 habits of healthy women.
Herbal medicine can be helpful here to calm your nervous system and support healthy adrenal function. Some of my favourite anti-stress herbs are skullcap, st. john's wort, withania and schisandra.
4. Remove over exercising
Gentle and moderate exercise is recommended while your gut is healing. Walking, yoga, swimming are a good fit. And lifting weights, but no more than 2 days per week, is what I often recommend to people while they are in the healing phase.
5. Remove medications that may be part of the cycle
You have the choice to seek out alternatives to the medication that might be contributing to your leaky gut. Here are some ideas, but please check with a health professional to decide if these are suitable for you:
NSAIDS - you might try turmeric tablets or fish oils
Oral contraceptive pill - you might learn about natural fertility method, use condoms, talk to your partner vasectomy if appropriate, or look into IUD's
Antibiotics - you can effectively use herbal medicine for most bacterial infections. If you regularly experience urinary tract infections, tonsillitis, or sinus infections, a naturopath (like me) can help you with immune support and herbal alternatives to antibiotics.
Steroids - for all autoimmune conditions, try working with a naturopath or integrative doctor to support, rather than suppress, your immune system. This is the key to reversing your condition.
Acid suppressing medications - try supporting healthy levels of stomach acid with bitters, eat more slowly, eat smaller meals, chew your food, don't eat when you're stressed, eat less of the foods that trigger your reflux, investigate histamine intolerance.
6. remove bacteria, candida or other pathogen
If you're working with me, we will have identified any bugs in your digestive system that might be contributing to the leaky gut by using the GI map stool testing.
Here's the exciting news! Every unwanted bacteria, virus or fungi that we uncover in your gut can be removed by using targeted herbal formulas and/or targeted prebiotic and probiotics. This is something I am really passionate about. After I receive your GI map and other results, I love to mix up an individualised herbal formula to work directly to what is happening in your gut.
Repair and restore
We have to keep in mind that the human digestive system is a complex organ. Everyone has slightly differing biochemistry due to differences in genetics. Therefore the repairing and restoring should also be individual. This should be discussed in detail with your health practitioner.
1. using food as medicine
Eat a wide variety of vegetables and other plant foods such as legumes and lentils to support healthy gut bacteria. Eating this way will support the microbiome and in turn the health of the mucous layer in your gut.
If you find that fruits and vegetables don't agree with you, seek help from a naturopath or nutritionist to heal your digestive system and be able to reintroduce a wide range of fruit and vegetables.
Read my blog about eating more vegetables if you need inspiration. Read about how to eat more plants.
Buying organic, while expensive, means that the food you are eating hasn't been sprayed or dowsed in herbicides or pesticides or artificial fertilisers. Some of these chemicals, such as glysophate, are now being implicated in poor health and leaky gut due to the direct affect on bacteria within our digestive system.
I don't always recommend fermented foods and bone broth. These high histamine foods can be problematic for some people until the initial gut healing work have been completed.
Protein is also important for gut healing because cell repair requires protein. I recommend some protein at every meal.
2. eat at regular meal times
Allow at least 4 hours in between eating. Eating often, and overeating cause increased inflammation and gut barrier stress.
3. herbs and herbal medicine
As a herbalist, I love working with and teaching about herbs! Herbs can be used in food, taken as a supplement, or consumed as a herbal formula made for your individual circumstances.
There is a wide range of gut healing and anti-inflammatory herbs to chose from. Ginger, marshmallow, gotu kola, turmeric, garlic, thyme, clove, fennel, turmeric and rosemary are among my favourites.
Check with me, or a nearby herbalist, to discover which fresh herbs or herbal tinctures are most suitable for you as you heal from leaky gut.
4. Other nutrients or supplements that might be recommended for you
I might also recommend a gut healing powder that contains L-glutamine. L-glutamine is an amino acid that plays a key role in promoting gut healing and maintaining a healthy gut barrier.
Zinc is one of my favourite nutrients for digestive and immune function. Vegetarians and people suffering from stress can be particularly low in this essential nutrient. Zinc in the diet and from supplements can support the tight junctions in the digestive system and contribute to mucosal health.
The best type of prebiotic fibres are those from your diet. You guessed it, I'm talking about fruit, vegetables, lentils, beans and whole grains. However you may have been avoiding foods with fibre due to bloating and cramping. If this is you, then a supplemental prebiotic fibre such as guar gum or PHGG can be a FODMAP friendly fibre to feed your gut microbiome and support intestinal barrier function.
5. support your immune system
I think an essential part of healing is supporting your immune system health. While ever you have leaky gut there is a chance that your immune system might react negatively to toxins, bacteria and/or food particles entering the blood stream.
There are many everyday ways to support your immune system. Prioritise getting enough sleep, getting out in the sunshine and eating protein, fresh fruits and vegetables every day.
It can be a good idea to have a blood test to see if you are low in essential vitamins important for immune such as vitamin B12, vitamin D, as well as iron.
If you're working with me I will often include a medicinal herb such as echinacea or rehmannia for immune modulation within your individualised herbal formula.
6. targeted probiotics
Probiotics are living organisms that can play a role in modulating your gut microbiome. Probiotics can come from foods such as yoghurt, keffir or sauerkraut or from supplements.
I am not a fan of taking any and every probiotic off the counter from the local chemist. I have seen the gut microbiome results from people who have been taking the same probiotic strains for years and years without testing to see how their overall microbiome is affected.
I believe it's important to have an overview of your whole gut health before deciding if probiotics are appropriate in your individual case. I use the GI map stool test to identify any gaps or deficiency in your gut microbiome and determine the necessary probiotic strains to supplement.
The time for healing your leaky gut is now
I hope you now have a clearer understanding of the complex area of gut microbiome and leaky gut. Please reach out if you would like to work with me. I would love to play a part in your healing journey.
Simone :)
Hi! I'm Simone Jeffries. I am a naturopath, nutritionist, herbalist and certified wellness coach. I am also a foodie and an advocate for a whole food diet.
I love to support you with hormonal conditions, histamine intolerance and vaginal imbalances.
I welcome clients to consult with me at my clinic in Manly on Sydney's Northern Beaches, and online from anywhere in Australia.
The information in this blog is from my Bachelor of Health Science degree, experience from working with women in my clinic, and continuing research.
This blog is for information only and not intended to take the place of medical advice. Please seek assistance for any medical concerns.