Dr Deepak K Agarwal
The writer is senior consultant gasteroenterologist, hepatologist & endoscopist and is running a successful medical centre in Lucknow
A proposed gastrointestinal disorder dubbed ‘leaky gut syndrome’ is currently the topic of numerous debates throughout the medical and natural health communities. Some alternative medicine practitioners claim that leaky gut syndrome is a prevalent problem responsible for ill health in many people. However, most physicians maintain that there is not enough research to prove that it is a legitimate issue.
Intestinal permeability: In some individuals, for a variety of reasons, the physical structure of their intestines is compromised. The tight junctions, which control what materials the intestine absorbs, don’t work properly, allowing larger substances (but still very small) to cross over into the bloodstream. This is known as intestinal permeability. Physicians sometimes find increased intestinal permeability in those who have Crohn’s disease, celiac disease, in individuals receiving chemotherapy, and those who have a high intake of bowel-damaging substances such as aspirin and alcohol. However, intestinal permeability is a symptom of these ailments, not a cause; it does not lead to anything more than inflammation of the bowel walls, and it is not leaky gut syndrome. Furthermore, research shows that increased intestinal permeability sometimes has beneficial effects, such as improving water and nutrient absorption as well as activating the immune system.
The Myth: According to the proponents of leaky gut syndrome, bacteria and toxins enter the bloodstream through these defective tight junctions and wreak havoc throughout the body, causing bloating, gas, cramps, inflammatory bowel disease (IBD), as well as fatigue, food sensitivities, joint pain, moodiness, irritability, sleeplessness, autism, and skin problems like eczema and psoriasis.
Debunked: This is all speculation, as scientific studies do not validate any of these claims. It is extremely dangerous that a TV doctor personality and some otherwise trusted practitioners are diagnosing and treating this baseless ‘syndrome’.
The Myth: Many ‘solutions’ that leaky gut syndrome proponents recommend are based in fad diets, which declare that normal foods cause serious problems in most people. For instance, proponents of leaky gut syndrome recommend that patients avoid any foods with high sugar content (including both processed sugary foods and fresh fruits), claiming that the excess sugar causes an overgrowth of a certain strain of yeast in the GI tract that is responsible for the damage to the intestinal wall. In addition, they say that (unverifiable) sensitivities to gluten or lactose damage the intestine, and they recommend avoiding all dairy products and anything containing gluten.
Debunked: Fruit will not cause yeast to attack your intestines. While a small percentage of the population have symptoms related to gluten and lactose intake, these foods cause no problems for most individuals. Following these practitioners’ instructions is more likely to lead to nutritional deficiencies rather than reduced symptoms. Another issue in this field is that many people in the popular media who support this unverified condition try to sell special products as a treatment for leaky gut syndrome. They offer unproven treatments for a condition that has no medical basis. Additionally, since many of these supplements haven’t been well researched, taking them could cost you a lot of money, do little to reduce your symptoms, and could even be dangerous.
Some patients who try these methods claim to feel better, often very quickly. An individual might report reduced symptoms due to the placebo effect or because of genuine health benefits indirectly related to the treatment. For example, when you eliminate the mentioned whole food groups, you will most likely also be avoiding many related processed foods (e.g., ice cream and pastries) and the additives they contain, while increasing the number of whole foods, such as veggies and rice, that you consume, which tends to make most people feel better anyway. However, this reduction of symptoms could be temporary and could postpone diagnosis of the real cause of symptoms, possibly leading to more complications down the line. Unless you have celiac disease, a food allergy or intolerance, or another ailment that requires drastic dietary changes based on verified research, you should not trust any practitioners who tell you to remove several food groups from your diet, especially healthy foods such as fruits and grains. Another red flag is when someone suggests that the only way to solve your situation is to consume untested and heavily marketed supplements, even if they claim to have a herbal or natural base. Talk to a registered dietitian if you have more questions about what you should be eating.
There is a test available that shows whether an individual has intestinal permeability. It works by measuring levels of two indigestible sugars, mannitol and lactulose, in the urine. Most physicians do not use this test and research shows that it is not very reliable. As we mentioned earlier, there is no evidence that intestinal permeability causes any disease; be wary of anyone who claims that it does. Some unscrupulous individuals are even selling these tests to consumers online. Using this test to diagnose leaky gut syndrome would be like ordering a test to look for blood in the stool of someone with IBD and using a positive test result to ‘prove’ that the bloody stools caused some other mysterious disease that in turn caused the IBD. We already know that bloody stools are a symptom of Crohn’s disease or ulcerative colitis, just as we know that intestinal permeability is a symptom of some diseases such as Crohn’s disease and celiac disease.
Proponents of leaky gut syndrome might also misuse tests that look for bacterial, fungal, or viral infections, or tests that measure immune function, to ‘diagnose’ the disorder, when there is no evidence that the results are in any way related to this baseless ‘syndrome’. The situation becomes especially dangerous when you consider that the symptoms associated with this disorder are present in a number of other illnesses, so a quick diagnosis of leaky gut is more likely to leave patients untreated for what really ails them. It is important to use critical thinking when faced with a potential diagnosis that isn’t backed by scientific evidence. You have to wonder why there are no reliable studies that show evidence of leaky gut syndrome (especially since it supposedly affects so many individuals), why people are so quick to diagnose an unstudied disorder, and why the only way to ‘treat’ this disease is by taking expensive supplements or modifying your diet to remove multiple food groups.
Many practitioners who diagnose patients with leaky gut syndrome claim that a lack of adequate studies does not mean it doesn’t exist. While this could be possible, diagnosing and treating a disease that we don’t have evidence for can be dangerous, which is why the medical community uses such rigorous testing to scientifically support any new diagnoses, medications, or treatment plans before recommending them to patients. If you have any more questions or concerns about ‘leaky gut syndrome’ or intestinal permeability, talk to your medical doctor or gastroenterologist. Although some practitioner might recommend natural products to assist with your physician-prescribed treatment regimens, it’s paramount to leave the diagnosing process to physicians who have training in medicine that is supported by the best scientific research and clinical experience.
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