Is ‘Leaky Gut’ a Real Condition?

Leaky gut syndrome has become a household term, but it can be a controversial subject. That's because while a leaky gut—medically known as increased intestinal permeability—is real, the syndrome isn't universally accepted as a medical diagnosis.  

Below, you can find out what the term "leaky gut syndrome" is really referring to, the conditions and symptoms it can be associated with, and what to do if you're concerned you might have it.

Is “leaky gut syndrome” even a real thing?

The concept of a leaky gut begins with the intestinal lining in our stomachs. This barrier is tasked with absorbing water and nutrients from the food we eat while simultaneously preventing bacteria from passing through. It's an enormous area, covering a shocking 4,000 square feet, according to Harvard Health Publishing.

Everyone's intestinal lining is semi-permeable, which means it's designed to let some things in and keep others out. But sometimes this barrier can become compromised. People with increased intestinal permeability—such as those with certain conditions like celiac disease and inflammatory bowel disease (IBD)—have an intestinal lining that lets in more water and nutrients than is ideal.

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As a result of this increased permeability, "pieces of bacteria, toxins, or digested food particles may pass between cells," says Bahar Adeli, MDi, a Philadelphia-based gastroenterologist and spokesperson for the American Gastroenterological Association (AGA). "It's thought to stimulate the immune system, which leads to inflammation as well as possible changes to the microbiome."

Enter: leaky gut. "When the gut has increased permeability, that means the intestines allow more than the usual things to get through and therefore there’s a ‘leak’," says Samantha Nazareth, MD, FACG, a board-certified gastroenterologist based in New York City.

But while it's become a household term, leaky gut syndrome isn't recognized as a medical diagnosis. Instead, it refers to the theory that increased intestinal permeability might not be just a symptom of GI diseases like IBD, but rather an underlying cause that can develop on its own.

So, what are the signs and symptoms of a leaky gut?

There's no current medical diagnosis for leaky gut syndrome, but experts are still learning about the potential causes of increased intestinal permeability. "The causality between a 'leaky gut' and these symptoms has never been proven," says Gail Hecht, MD, a gastroenterologist, Wonderbelly Medical Advisor, and former AGA president. However, these symptoms are sometimes attributed to a leaky gut:

• Bloating
• Gas
• Abdominal pain
• Diarrhea
• Food sensitivities
• Fatigue
• Joint pain
• Skin problems

Also challenging? "These symptoms are nonspecific and can be indicative of various other medical conditions," says Dr. Nazareth. This can make it difficult for your doctor or gastroenterologist to determine what exactly is causing your discomfort and find the correct treatment options to relieve symptoms.

Why can your gut become "leaky"?

We know that people with certain conditions (IBD and celiac disease, to name a few) can have increased intestinal permeability. Some experts think other factors might play a role, too. We're looking at you, chronic stress, poor diet, and unbalanced gut microbiota. "Certain bacterial infections may also irritate or trigger a leaky gut," Dr. Adeli says.

There's an ongoing debate among experts about the cause-and-effect relationship between leaky gut and conditions such as IBD or other autoimmune disorders. Experts are uncertain whether leaky gut precedes and contributes to disease development or occurs as a consequence of another condition. "There's no casual evidence that any one thing is directly contributing to leaky gut, or that if a leaky gut is untreated it will lead to a specific condition," says Dr. Adeli.

The current scientific consensus is that while there are associations between increased intestinal permeability and various conditions, more research is still needed to establish clear, causal links.

What exactly happens during diagnosis and treatment?

Leaky gut isn't an official diagnosis, and doctors don't have a test to reliably measure intestinal permeability. But, researchers are reviewing several different tests, including urine tests, blood tests, and tissue biopsies, all of which might be used to check a person's intestinal permeability in the future. If you have any of the symptoms of a "leaky gut", it's important to let your healthcare provider know. They will likely order a variety of diagnostic exams to determine if you have another GI-related condition that is the primary cause of your symptoms.

If you receive a diagnosis for another condition, treatment will focus on healing those symptoms and the underlying cause of the increased intestinal permeability. And regardless of your diagnosis, taking care of your gut in general is also important. Experts recommend eating more plant-based foods, fermented foods, and fiber and drinking plenty of water throughout the day. It's also important to manage your stress levels and avoid antibiotics unless you absolutely need them.

Health conditions associated with leaky gut

While a leaky gut isn't an official diagnosis, some health conditions can cause increased intestinal permeability, including:

• Inflammatory bowel disease (IBD): People with Crohn’s disease and ulcerative colitis, the two conditions that fall under the umbrella of IBD, cause inflammation in the tissues of their digestive tract. This condition can lead to long-term inflammation and serious complications if untreated.
• Irritable bowel syndrome (IBS): Experts don't know exactly what causes IBS, but the condition can lead to symptoms like abdominal pain, cramping, bloating, and bowel changes. People with IBS have been found to have increased intestinal permeability, research shows.
• Celiac disease: This autoimmune condition causes people to develop an immune response when they eat foods that contain gluten, which leads to symptoms like diarrhea, fatigue, and bloating, and can also increase intestinal permeability.
• Heart disease: Emerging research suggests there's a strong connection between the digestive system and heart health. One study, for example, found that people with chronic heart failure had an increase in large and small bowel permeability, as well as higher amounts of disease-causing bacteria in their gut microbiota.

When to see a healthcare provider about gut concerns

As a general rule, you should be in touch with your provider about any GI discomfort you're experiencing. "I always tell patients that if something concerns you, then it’s time to seek help," says Dr. Nazareth. But these red-flag symptoms are definite signs that a call to your doc is warranted:

• Unintended weight loss
• Blood in your stool
• New abdominal pain
• New IBS-like symptoms

Your provider can order tests to learn what's causing your symptoms and offer treatment options that give you the support you need to feel better.