Leaky Gut Syndrome: Symptoms, Diet, Tests & Treatment https://my.clevelandclinic.

org/health/diseases/22724-leaky-gut-syndrome

CORONAVIRUS

Leaky Gut Syndrome

Leaky gut syndrome is a hypothetical condition that’s not currently recognized as
a medical diagnosis. It’s based on the concept of increased intestinal
permeability, which occurs in some gastrointestinal diseases.

Symptoms and Causes Diagnosis and Tests Management and Treatment

OVERVIEW

What is leaky gut syndrome?

Leaky gut syndrome is a hypothetical condition. It’s based on the concept of
relative intestinal permeability.

Intestinal permeability
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Everyone’s guts are semi-permeable. The mucous lining of our intestines is

designed to absorb water and nutrients from our food into our bloodstream.
But some people have increased intestinal permeability or hyperpermeability.
That means their guts let more than water and nutrients through — they “leak”.

Studies have shown that people who have certain chronic gastrointestinal
diseases have leaky guts that let larger molecules through — potentially toxic
ones. Part of the job of your intestinal lining is to act as a barrier to bacteria
and other infectious agents inside the gut. This barrier is an important agent in
your immune system.

“Leaky gut syndrome”

Leaky gut syndrome is a theory that intestinal permeability is not only a
symptom of gastrointestinal disease but an underlying cause that develops
independently. If your intestinal barrier is impaired, it may be letting toxins into
your bloodstream. These toxins may trigger an in�ammatory response that
may manifest as various diseases.

The theory has some appeal as a way of explaining various conditions that we
haven't been able to fully explain yet, but the evidence is lacking. We know that
the condition of having intestinal permeability or a “leaky gut” is real, but we
don’t know that it's a disease in itself, or that it causes other diseases. It’s not
currently a recognized medical diagnosis.

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What disease is associated with leaky gut?

There are diseases that are known to be associated with intestinal
permeability, and there is a lot of speculation about other possible diseases
that might be connected to it.

Known disease associations

Intestinal permeability is a recognized feature of several in�ammatory and
autoimmune diseases affecting the digestive system, including in�ammatory
bowel disease and celiac disease. In these cases, scientists generally
consider it to be a symptom, not a cause. These diseases cause chronic
in�ammation in the intestines, which leads to erosion of the intestinal barrier
gradually over time.

There have been cases where scientists found intestinal permeability in

people before they were diagnosed with these diseases. This has led to some
speculation that intestinal permeability might develop independently from
these diseases, and might even be a contributing cause. But scientists
concluded that intestinal permeability in these cases wasn’t enough to cause
the disease by itself. It was more likely to be an early sign of disease.

Possible disease associations

Many other diseases have been suggested as possible consequences of leaky
gut syndrome. The idea is that “toxins” from your intestines may leak into your
bloodstream and cause an in�ammatory response. Chronic low-grade
in�ammation may, indeed, be a factor in many of these diseases, including
metabolic disorders such as obesity and diabetes, arthritis, chronic fatigue
syndrome, asthma and �bromyalgia. But the rest remains unclear.
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Scientists have measured higher levels of gut bacteria products in the blood in
people with gastrointestinal (GI) diseases that are known to cause intestinal
permeability. In these cases, in�ammation is primarily from other causes,
though bacteria products could make it worse. They’ve also measured it in
liver disease, which is directly related to the gut. Bacteria products traveling
from the gut to the liver via the portal vein could contribute to liver disease, but
is not necessarily the cause of it.

Who does intestinal permeability affect?

The known causes of intestinal permeability involve systematic erosion of the
intestinal lining. This is not a simple feat. Your intestinal lining has many layers
of defense. And while it can be injured temporarily, it is designed to constantly
repair and replenish itself. To actually wear it down enough to penetrate the
lining requires a signi�cant assault. That usually means a chronic disease,
chronic drug use or alcohol abuse or radiation therapy.

The theory of leaky gut syndrome suggests that anything that injures your gut
lining can lead to intestinal permeability if the injury is persistent enough.
Therefore, common everyday factors such as diet and stress may
cumulatively wear down your intestinal lining until it becomes permeable.
Scientists aren’t sure about this, but they do agree that these everyday factors
may cause in�ammation in your gut lining and uncomfortable GI symptoms
for you.

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Erosion of your intestinal lining is one thing, and intestinal permeability is

another. Most people who think they may have a leaky gut have certain
common gastrointestinal symptoms, such as abdominal pain, food
sensitivities, bloating and indigestion. These types of symptoms are common
and may have many possible explanations, and many of them may injure your
intestinal lining. You don’t have to have a leaky gut to experience those effects.

Erosion of the intestinal lining

If your gut lining is under constant assault, eventually it won’t be able to fend
off erosion by chemical irritants, abrasive particles or bacteria inside your gut.
This is what happens in peptic ulcer disease and SIBO (small intestinal
bacterial overgrowth). The wrong kind of bacteria overwhelms the other
bacteria that would usually balance them. The erosive acids and enzymes in
your gut overwhelm the protective mucus that usually neutralizes them.

Erosion of your gut lining will affect your digestion, your immunity, and your
sensitivity to pain in your intestines. And in some cases, it may lead to
intestinal permeability. But it doesn’t have to go that far for you to feel unwell.
If you have gastrointestinal symptoms, these are likely related to the
underlying condition that would be injuring your intestinal lining in the �rst
place. Many gastrointestinal diseases share these same symptoms.

Intestinal permeability
Some people do have increased intestinal permeability, but it’s di�cult to
separate symptoms of intestinal permeability from the in�ammation that
precedes it. When your gut lining is more permeable, bacteria living in your gut
could cross the intestinal barrier, but we don’t know if this does signi�cant
harm separate from the original disease or injury that caused it. Some studies
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suggest that bacteria products traveling from the gut to the liver may
contribute to liver disease.

SYMPTOMS AND CAUSES

What is the main cause of a leaky gut?

If your intestinal barrier has been breached, it has been under signi�cant
assault, probably for some time. The most direct causes of intestinal
permeability include:

• Chronic in�ammatory states, such as IBD and celiac disease.

• Other diseases that cause intestinal injury, such as HIV/AIDS.
• Chemotherapy and radiation therapies that degrade the intestinal mucosa.
• Chronic overuse of alcohol or NSAIDs, such as aspirin and ibuprofen.
• Food allergies that cause an immune response to certain foods.

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What are the symptoms of a leaky gut?

There are no symptoms associated directly with intestinal permeability. But
intestinal permeability usually follows from injury to your intestinal lining, and
you may have symptoms from that.
For example:

• A burning feeling of ulceration in your gut.

• Painful indigestion from the loss of intestinal mucosa. Ad

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• Diarrhea
• Gas and bloating from fermentation by overgrown bacteria in your gut.
• Low energy from the reduced ability to draw energy from your food.
• Gastrointestinal mucositis from radiation therapy.

DIAGNOSIS AND TESTS

How is intestinal permeability measured?

There is no standard test to measure intestinal permeability directly in
patients, which is one reason why intestinal hyperpermeability is not a current
medical diagnosis. However, there are several kinds of tests currently under
investigation in clinical research to look for evidence of intestinal permeability
in patients. Tests include:

• Urine test. For this test, you drink a solution containing different kinds of
sugars with molecules of different sizes, some of which are not usually
absorbed in the intestines. Then analysts measure the sugar levels in your
urine to see which ones made it through your gut wall.
• Blood test. This test analyzes a sample of your blood for evidence of gut
bacteria in�ltration. Speci�c antibodies and endotoxins are some of the
biomarkers analysts look for.
• Tissue biopsy. This more invasive test examines a sample of your
intestinal tissue in something called an Ussing chamber. The test uses
electrical current to measure ion transport across the intestinal barrier. The
ion transport measurement is parallel to water transport.
• Confocal endomicroscopy. This is an enhanced endoscopy exam that
allows scientists to look at your intestinal lining in high resolution and
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magni�cation. A contrast �uid injected into your vein may show up in your
gut if there is a gap in the lining.

M A N A G E M E N T A N D T R E AT M E N T

What is the fastest way to heal leaky gut?

The only known cure for a leaky gut is to treat the underlying condition that
causes it. Speci�c treatments for IBD, celiac disease and others associated
with intestinal permeability have been shown to repair the intestinal lining in
those who were affected. On the other hand, treatments that target the
intestinal lining independently have not been shown to improve these
diseases or prevent intestinal permeability from recurring.

How can I take care of my gut?

Scientists are continuing to investigate the bene�ts of various therapeutics for
improving the general health and integrity of the gut lining. These therapies
may not be able to mitigate a pathological disease, but they may help mitigate
the effects of everyday factors such as diet, stress and bacterial overgrowth
that can wear on your intestinal lining. They may even help alleviate your
general gastrointestinal symptoms. Therapies include:

• Probiotics. Speci�c probiotics are being tested separately for their ability to
restore gut barrier function. But in general, probiotics may help maintain the
health of your gut lining by preventing overgrowth of the wrong bacteria in
your gut, especially your small intestine.
• Prebiotics. Prebiotics are food for the good bacteria in your gut to help give
them an edge in the �ght. They are usually plant �bers — one more reason Ad

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to eat your veggies.

• Reduce dietary fats and sugars. These encourage the growth of the wrong
kinds of gut bacteria, and they trigger the release of harsh dietary
emulsi�ers that may in�ame your gut.
• Nutrition. A balanced diet, complete with all the necessary macronutrients
and micronutrients (vitamins and minerals) can help fortify your gut.
Vitamin D and an amino acid called L-glutamine may speci�cally help repair
your gut lining.
• Low FODMAP Diet. This speci�c diet is often suggested for people who
have IBS and certain food sensitivities because it systematically eliminates
most of the common food triggers. Using it brie�y may give your gut the
rest it needs to repair, while also clueing you in to which food triggers you
are sensitive to.

A note from Cleveland Clinic

Many people have vague gastrointestinal symptoms, and many times the
causes are frustratingly elusive. In the absence of straight answers, “leaky gut
syndrome” has emerged in the mainstream as a catch-all diagnosis for
general indigestion — and possibly many other conditions. But true intestinal
hyperpermeability is too speci�c and too extreme to explain most people’s
symptoms.

Most people simply have general gut in�ammation — the precursor to

intestinal permeability. This may be due to a speci�c disease, or it may be a
cumulative effect of poor diet, chronic stress and other common factors. Try
reducing these factors. If that doesn’t help, seek medical advice. A quali�ed
gastroenterologist can help you sort through the possible causes of your
speci�c symptoms.

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Last reviewed by a Cleveland Clinic medical professional on 04/06/2022.

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