Leaky Gut: Does It Cause Disease?

Leaky gut syndrome (LGS) is a controversial topic. Some healthcare providers say it's tied to dozens of diseases while others question whether it's anything to worry about.

Proponents treat LGS as a condition. That's where the controversy lies. Meanwhile, a leaky gut, also called increased intestinal permeability, simply describes a known state of the small intestine.

Some practitioners believe healing a leaky gut with a strict diet and nutritional supplements can help control everything from autoimmune diseases to mental disorders.

This article looks at the debate over LGS plus the possible causes, symptoms, and treatments for it.

A Compromised Barrier

Healthcare providers know a gut can be leaky. What's not certain is whether LGS is real and related to a host of medical conditions, as some claim, or whether treating it can provide relief from those conditions.

Your intestines are lined by a layer of cells called epithelial cells. They're normally packed in tight to keep large molecules from slipping between them.

When this lining is damaged, holes and cracks can open up. That allows partially digested foods, toxins, and bacteria to pass through the barrier.

It's established that a leaky gut is common in some digestive disorders such as:

• Celiac disease
• Crohn's disease
• Irritable bowel syndrome (IBS)

Some early research points to its involvement with:

• Autoimmune disease, including lupus, multiple sclerosis, and type 1 diabetes
• Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
• Fibromyalgia
• Arthritis
• Food allergies
• Asthma
• Some mental disorders

The Debate

What's up for debate is whether a leaky gut:

• Constitutes an actual medical condition
• Causes its own symptoms
• Is involved in the development of any medical conditions
• Should be diagnosed and treated

Proponents of LGS are largely healthcare providers who work in complementary or alternative medicine (CAM). They say when large molecules can pass through the gut, it triggers your immune system.

The immune system, they say, sees those molecules as a threat and attacks. They believe that leads to widespread inflammation and myriad possible health conditions.

So far, though, there's no proof a leaky gut is a cause of disease. Many medical professionals believe it's simply a symptom of some conditions, not a cause, and that it doesn't need to be treated.

At this time, there's no evidence that restoring the intestinal barrier can improve digestive conditions or other disorders.

Causes

Until a few decades ago, healthcare providers thought the gut worked normally unless a medical problem directly affected it. They now know that trauma to other parts of the body may cause the gut to react.

LGS proponents believe many things can make the intestinal barrier more permeable. Suggested causes include:

• Food allergies
• Inflammatory bowel diseases (Crohn's disease, ulcerative colitis)
• HIV/AIDS
• Excessive amounts of aspirin or ibuprofen
• Certain antibiotics, especially in high amounts
• Chemotherapy drugs
• Excessive drinking
• Parasitic infections

Proponents believe that combining these potential causes with a genetic predisposition can lead to chronic inflammation and disease. A 2020 study boldly states: "All disease begins in the (leaky) gut."

However, much research needs to be done before the role of a leaky gut is established as a cause of any disease.

Symptoms

Symptoms that proponents attribute to LGS include:

• Rash
• Diarrhea
• Migraines
• Joint pain
• Psychological symptoms

If intestinal barrier problems do cause or contribute to diseases, you'd experience the symptoms of that condition on top of the ones directly caused by a leaky gut.

Treatment

Again, there's no consensus in the medical community about whether a leaky gut or LGS needs to be treated and, if so, how.

Diets

Among healthcare practitioners who do treat LGS, an elimination diet is a common approach. First, you cut out the foods that commonly cause allergies. Then you add them back one by one to see if you react to them.

Some practitioners may run blood and urine tests for food allergies before starting you on the elimination diet. That can narrow down the foods you need to eliminate and shorten the process.

Other diets sometimes suggested for LGS include:

• Low FODMAP diet
• Low sugar diet
• Antifungal diet

Strict elimination diets and other restrictive diets can lead to malnutrition. Be sure to work closely with your provider, and possibly a nutritionist, to make sure you're getting the nutrients you need.

Probiotics and Prebiotics

Probiotic and prebiotic supplements and diets are common choices for treating LGS.

The intestinal tract is a key player in the immune system. Most of the potentially dangerous substances you encounter are in your food. So the gut's immune function is crucial.

Your small intestine plays a key role in immunity. It harbors a host of microorganisms (bacteria and yeast). They're often called the gut microbiome or gut flora.

Your gut microbiome is involved in the immune response and helps carry out digestion. These microorganisms are called probiotics. Common probiotic supplements contain:

• Lactobacillus acidophilus
• Bifidobacterium
• Saccharomyces boulardii

Prebiotics are substances in food that you don't digest, but that provide food for probiotics. Providing lots of prebiotics for your probiotics can help them maintain or regain balance.

High prebiotic foods include:

• Fruit: Nectarines, white peaches, watermelon, pomegranate, grapefruit
• Vegetables: Asparagus, garlic, onion, beetroot, peas, cabbage
• Proteins: Beans, lentils, cashews, pistachios, flaxseed
• Grains: Wheat, oats, barley, rye, wheat bran

Some research suggests that a healthy microbiome helps keep the intestinal barrier healthy and can repair a leaky gut. That's why probiotics and prebiotics are used to treat LGS.

Other Supplements

Other nutritional supplements sometimes suggested for LGS include:

• Fiber: Among many known health benefits, fiber may play a role in healing gut problems and balancing the microbiome.
• Glutamine: A building block of protein, this amino acid plays an important role in the immune system and health of the intestinal barrier.
• Collagen powder: Said to contain amino acids that restore the barrier.

While these supplements may have proven health benefits related to digestion and overall health, they're not proven to improve the conditions some practitioners blame on LGS.

Summary

Increased intestinal permeability, a.k.a. leaky gut, is medically recognized but isn't proven to be a cause of symptoms or disease. Diagnosis and treatment don't have proven benefits.

Even so, proponents of leaky gut syndrome say it's a major cause of or contributor to a wide range of diseases. This opinion is most common among CAM practitioners.

They say food allergies, some conditions, and some drugs can cause LGS. Some preliminary research suggests a possible tie to autoimmune diseases, fibromyalgia, arthritis, and some mental disorders.

Common treatments for LGS, which remain unproven, include identifying and eliminating food allergies, probiotics and prebiotics, and fiber supplements.

A Word From Verywell

If you believe you have leaky gut syndrome, it may be hard to get your healthcare provider to take that diagnosis seriously. That may lead you to consider complementary or alternative practitioners.

If so, involve your regular provider in treatment decisions, even if they don't expect them to work. Their oversight is invaluable when it comes to making sure the treatments are safe when it comes to side effects, drug interactions, and overall health.