by Dr. Leo Galland
Because it is something of a mystery disease that can show itself as a bewildering array of other conditions, you could have Leaky Gut Syndrome and not even realize it.
The reason is that Leaky Gut Syndrome is one of the many concepts in medicine that cuts across the boundary lines of specific diseases.
It is a major example of an important medical phenomenon: distress in one organ causes disease in another.
Conditions that Can Signal Leaky Gut Syndrome
Do you have:
- Chronic fatigue syndrome or fibromyalgia?
Then you may also have Leaky Gut Syndrome, because it causes or contributes to these conditions.
That’s why getting a better understanding of Leaky Gut Syndrome may help you find a more effective solution to your condition.
I am telling you about Leaky Gut Syndrome because it is a vitally important, but often undiagnosed, condition that is key to recovering from many illnesses and regaining robust good health.
An Integrated Approach to Leaky Gut Syndrome
I’ve been evaluating patients for Leaky Gut Syndrome for over twenty years, and have been writing about my integrated approach to this condition. My article “Leaky Gut Syndromes: Breaking the Vicious Cycles” is available at the Foundation for Integrated Medicine website. (1)
Through my clinical experience and further research I came to understand how gastrointestinal health in general, and Leaky Gut Syndrome in particular, contributes to many seemingly unrelated conditions.
To share my knowledge and help my colleagues learn more about this important topic I wrote a chapter titled “Integrative Approach to the Gastrointestinal System” for the textbook Integrative Medicine: Principles for Practice in 2004 and authored the book-length monograph Gastrointestinal Dysregulation: Connections to Chronic Disease, in 2008.
I have found Leaky Gut Syndrome especially relevant for many people with chronic fatigue syndrome.
Scientific Research Connects Leaky Gut with Chronic Fatigue and Depression
Recent research from Belgium confirms my observations about Leaky Gut Syndrome and chronic fatigue syndrome and suggests a treatment plan that can alleviate chronic fatigue and also major depression (2, 3, 4).
The Belgian researchers found that people in their study with either chronic fatigue syndrome or major depressive disorder showed laboratory evidence of Leaky Gut Syndrome, when compared to a healthy control group.
More importantly, they demonstrated that treatment with diet and specific nutrients not only reversed laboratory signs of the Leaky Gut Syndrome, but also improved symptoms of fatigue, malaise and depression (5).
I’ll describe my approach to this condition, and what lessons we can take away from the research from Belgium.
But first, I want to give you some background on Leaky Gut Syndrome and explain why the concept is still so controversial.
What is Leaky Gut Syndrome?
Because it connects apparently unrelated disorders, Leaky Gut Syndrome is one of the most misunderstood concepts in medicine today.
To begin with, Leaky Gut is not a single disease or syndrome; it’s a pathological condition that occurs as part of many different diseases and syndromes. The term refers to an abnormal increase in the permeability of the small intestine. Increased intestinal permeability is a component of many different disorders.
Leaky Gut Syndrome is associated with:
- Inflammatory and infectious bowel diseases (6-12),
- Several types of arthritis (13-18),
- Acne (19),
- Psoriasis, (19),
- AIDS (20),
- Chronic liver disease (21),
- Pancreatic disease (22)
as well as numerous conditions triggered by food allergy, including eczema, hives, and irritable bowel syndrome (29-37).
Why is increased small intestinal permeability such a problem?
The small intestine is the largest organ in your body and two-thirds of your immune system lies within its walls. The small intestine continuously activates itself by sampling the molecules that pass through the intestinal lining.
Leaky Gut Syndrome is increased permeability of this lining, and it alters the molecules which prime your immune system for action by allowing molecules that don’t ordinarily pass through the gut lining to get access to your immune system.
Sometimes, Leaky Gut Syndrome plays a primary role in the evolution of an illness.
Crohn’s disease is a serious chronic intestinal disorder that effects almost a million people in the United States. People who develop Crohn’s disease may have a genetically induced increase in intestinal permeability that creates the inflammation in the bowel. This predisposing leakiness can be found in close relatives of patients with Crohn’s diseases, suggesting that it precedes the development of inflammation.
Leaky Gut Syndrome can occur as a result of another disease.
Celiac disease is an inherited intolerance to gluten, a group of proteins found in wheat, barley and rye. Celiac disease affects about one person in a hundred in North America and often goes undiagnosed, even when people have severe symptoms. The inflammation caused by active celiac disease causes the leaky gut, which in turn causes some of the complications associated with celiac disease.
Leaky Gut Syndrome can also be caused by the treatment for another disease.
In rheumatoid arthritis, for example, the drugs used to relieve pain and inflammation can damage the intestinal lining, leading to Leaky Gut Syndrome within two weeks. Leaky Gut Syndrome, in turn, is associated with aggravation of arthritis.
For most conditions, the precise role of Leaky Gut Syndrome remains unclear, but it seems to be part of a vicious cycle that makes the condition get worse over time. Allergic reactions to food, for example, cause a transient increase in intestinal permeability. If this happens frequently, it may increase the number or severity of food allergies.
In chronic fatigue syndrome and major depressive disorder, Leaky Gut Syndrome activates the intestinal immune system to produce chemicals called cytokines that spread inflammation through your body.
Inflammation is an important trigger for symptoms like fatigue, malaise, pain, and depression.
When should you suspect Leaky Gut Syndrome?
If you have:
- pain in multiple joints
- a chronic skin condition
- chronic diarrhea or abdominal pain,
- chronic fatigue,
- chronic depression,
- a feeling of being infected but your doctor can’t find the infection…
or if you use aspirin or anti-inflammatory drugs on a regular basis, or if you’re a heavy drinker of alcohol.
Recent research in animals has indicated that Leaky Gut Syndrome may also be associated with difficulty losing or gaining weight, but its association with obesity is still under investigation [32, 33].
How can the possibility of Leaky Gut Syndrome be evaluated?
There are only a few laboratories that test for Leaky Gut Syndrome and all require a doctor’s order. Talk to your doctor about what test might be appropriate. High levels of antibodies to common food proteins or to normal intestinal bacteria may indicate increased intestinal permeability. Many research studies have used a challenge test involving a special solution consisting of two sugars, and seeing how much of each appears in urine. A blood test for celiac disease is essential.
Five Steps to Help Heal Leaky Gut Syndrome
Get rid of anything that might be causing or contributing to increased intestinal permeability:
1) Stop drinking alcohol for at least a month.
2) Stop using aspirin, ibuprofen, naproxen and other non-steroidal anti-inflammatory drugs (NSAIDS).
3) Have a stool test for intestinal parasites. There is extensive medical literature on intestinal parasites causing symptoms like fatigue, joint pain and skin disorders, without causing diarrhea. I discuss these in a chapter I wrote titled, “Intestinal Protozoan Infestation and Systemic Illness”, for the Textbook of Natural Medicine, 3rd Edition, in 2005 .
4) Adopt an anti-inflammatory dietary pattern. I explain the benefits of eating to reduce inflammation, and provide a plan to achieve that, in my book, The Fat Resistance Diet. The principles are simple to understand: avoid foods with added sugar and refined starches, made from white flour. Decrease consumption of saturated fat and most vegetable oils, using extra virgin olive oil instead. Eat at least 9 servings of fruits and vegetables a day and at least 4 servings of fish per week.
5) There are dietary supplements that help the small intestine heal and restore its functional integrity. The most important of these are the amino acid L-glutamine and the amino sugar N-acetyl- glucosamine, which are readily available in health food stores.
These are but a few introductory steps toward an integrated approach to this condition. There is a vast amount of scientific literature on Leaky Gut Syndrome, a sample of which appear in the references below from journals such as The Lancet, The British Medical Journal and The Annals of Internal Medicine.
1) Townsend Letter for Doctors, August/September 1995, p. 63. “Leaky Gut Syndromes: Breaking the Vicious Cycles.” Galland L. Online version available at http://www.mdheal.org/leakygut.htm
2) J Affect Disord. 2007 Apr;99(1-3):237-40.”Increased serum IgA and IgM against LPS of enterobacteria in chronic fatigue syndrome (CFS): indication for the involvement of gram-negative enterobacteria in the etiology of CFS and for the presence of an increased gut-intestinal permeability.” Maes M, Mihaylova I, Leunis JC.
3) Neuro Endocrinol Lett. 2008 Jun;29(3):313-9. “An IgM-mediated immune response directed against nitro-bovine serum albumin (nitro-BSA) in chronic fatigue syndrome (CFS) and major depression: evidence that nitrosative stress is another factor underpinning the comorbidity between major depression and CFS.” Maes M, Mihaylova I, Kubera M, Leunis JC.
4) Neuro Endocrinol Lett. 2008 Feb;29(1):117-24.”The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression.” Maes M, Kubera M, Leunis JC.
5) Neuro Endocrinol Lett. 2008 Dec;29(6):902-10. “Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria.” Maes M, Leunis JC.
6) Gastroenterology, 1989. 97(4): p. 927-31.”Intestinal permeability in patients with Crohn’s disease and their healthy relatives.” Katz, K.D., et al.
7) Br Med J, 1982. 285(6334): p. 20-1. “Intestinal permeability in children with Crohn’s disease and coeliac disease.” Pearson, A.D., et al.,
8) Dig Dis Sci, 1990. 35(5): p. 582-8. “Relationship between intestinal permeability to [51Cr]EDTA and inflammatory activity in asymptomatic patients with Crohn’s disease.” Pironi, L., et al.
9) Gut, 1994. 35(1): p. 68-72. “Intestinal permeability in patients with Crohn’s disease and ulcerative colitis and their first degree relatives.” Munkholm, P., et al.,
10) Ann Intern Med, 1986. 105(6): p. 883-5. “Increased intestinal permeability in patients with Crohn’s disease and their relatives. A possible etiologic factor.” Hollander, D., et al.,
11) Gut, 1992. 33(3): p. 320-3. “Intestinal permeability in patients with Crohn’s disease and their first degree relatives.” Teahon, K., et al.,
12) Parasite. 2008 Sep;15(3):261-5 “Pathophysiology of enteric infections with Giardia duodenalius.” Buret AG.
13) Clin Exp Rheumatol, 1990. 8(1): p. 75-83. “A short review of the relationship between intestinal permeability and inflammatory joint disease.” Rooney, P.J., R.T. Jenkins, and W.W. Buchanan
14)Br J Rheumatol, 1987.26(2): p. 103-7. “Increased intestinal permeability in patients with rheumatoid arthritis: a side-effect of oral nonsteroidal anti-inflammatory drug therapy?” Jenkins, R.T., et al.
15) Clin Exp Rheumatol, 1990. 8(5): p. 523-4.”Reflections on the link between intestinal permeability and inflammatory joint disease.” Mielants, H.
16) Gut, 1991. 32(12): p. 1470-2. “Increased intestinal permeability in ankylosing spondylitis–primary lesion or drug effect?” [see comments]. Morris, A.J., et al.
17) Rheumatol, 1985. 12(2): p. 299-305. “Abnormal bowel permeability in ankylosing spondylitis and rheumatoid arthritis.” Smith, M.D., R.A. Gibson, and P.M. Brooks, J.
18) Rheum Dis Clin North Am, 1991. 17(2): p. 363-71.”Fasting, intestinal permeability, and rheumatoid arthritis.” Skoldstam, L. and K.E. Magnusson
19) Q J Med, 1985. 56(221): p. 559-67. “Small intestinal permeability in dermatological disease.” Hamilton, I., et al.
20) Gut. 1999 Jul;45(1):70-6 “Small intestinal transit, absorption, and permeability in patients with AIDS with and without diarrhoea.” Sharpstone D, Neild P, Crane R, Taylor C, Hodgson C, Sherwood R, Gazzard B, Bjarnason I.
21) Dig Liver Dis. 2010 Mar;42(3):200-4 “Intestinal permeability in patients with chronic liver diseases: Its relationship with the aetiology and the entity of liver damage.” Cariello R, Federico A, Sapone A, Tuccillo C, Scialdone VR, Tiso A, Miranda A, Portincasa P, Carbonara V, Palasciano G, Martorelli L, Esposito P, Cartenì M, Del Vecchio Blanco C, Loguercio C.
22) J. Pediatr., 1992. 120: p. 696-701. “Correlation of intestinal lactulose permeability with exocrine pancreatic dysfunction.” Mack, D.R., et al.
23) Lancet, 1981. 1(8233): p. 1285-6. “Intestinal permeability in patients with eczema and food allergy.” Jackson, P.G., et al.
24) Digestion, 1989. 42(2): p. 104-9.”Intestinal permeability to 51Cr-labelled ethylenediaminetetraacetate in food-intolerant subjects.” Scadding, G., et al.
25) Lancet, 1981. i: p. 1285-1286. “Intestinal permeability in patients with eczema and food allergy.” Jacobson, P., R. Baker, and M. Lessof
26) Clin Allergy, 1986. 16(6): p. 543-51. “Gastrointestinal permeability in children with cow’s milk allergy: effect of milk challenge and sodium cromoglycate as assessed with polyethyleneglycols (PEG 400 and PEG 1000).” Falth-Magnusson, K., et al.
27) Clin Allergy, 1985. 15(6): p. 565-70. “Gastrointestinal permeability in atopic and non-atopic mothers, assessed with different-sized polyethyleneglycols (PEG 400 and PEG 1000).” Falth-Magnusson, K., et al.,
28) Clin Allergy, 1984. 14(3): p. 277-86. “Intestinal permeability in healthy and allergic children before and after sodium-cromoglycate treatment assessed with different-sized polyethyleneglycols (PEG 400 and PEG 1000).” Falth-Magnusson, K., et al.
29) J Allergy Clin Immunol, 1991. 88(5): p. 737-42. “Identical intestinal permeability changes in children with different clinical manifestations of cow’s milk allergy.” Jalonen, T.
30). J Pediatr Gastroenterol Nutr, 1990. 11(1): p. 72-7. “Modifications of intestinal permeability during food provocation procedures in pediatric irritable bowel syndrome.” Barau, E. and C. Dupont,
31) Ann Allergy, 1990. 64(4): p. 377-80.”Intestinal permeability in irritable bowel syndrome. Effect of diet and sodium cromoglycate administration.” Paganelli, R., et al.
32) Am J Physiol Gastrointest Liver Physiol. 2007 Feb;292(2):G518-25 “Increased intestinal permeability in obese mice: new evidence in the pathogenesis of nonalcoholic steatohepatitis. Brun P, Castagliuolo I, Di Leo V, Buda A, Pinzani M, Palù G, Martines D.
33) Gut. 2009 Aug;58(8):1091-103 “Changes in gut microbiota control inflammation in obese mice through a mechanism involving GLP-2-driven improvement of gut permeability.” Cani PD, Possemiers S, Van de Wiele T, Guiot Y, Everard A, Rottier O, Geurts L, Naslain D, Neyrinck A, Lambert DM, Muccioli GG, Delzenne NM.
34) Textbook of Natural Medicine, 3rd Edition, Volume 2, J. Pizzorno and M. Murray, editors, Churchill Livingstone Elsevier, St. Louis, 2005, pp. 655-660. “Intestinal Protozoan Infestation and Systemic Illness”, Galland L.