Leaky Gut Syndrome
This little-known glitch in the body's digestive system could be contributing to a host of poorly understood ailments, from stomach pain to fibromyalgia.
By Catherine Guthrie
Three years ago, Sandy Schottenheimer was, she says, "living on ibuprofen." Her work as a computer programmer left her with severe carpal tunnel syndrome, and doctors recommended drugstore anti-inflammatories to dull the pain. "I popped them like crazy, usually three or four at a time, and often on an empty stomach," she says. After she finally had surgery on her injured wrist two years ago, the 45-year-old thought her troubles were over. The shooting pain in her arm had vanished; but then, during her recovery, she was blindsided by an even more debilitating problem.
Within a week of the surgery, Schottenheimer began having severe abdominal pain, bloating, gas, and more than 20 bouts of diarrhea a day. She'd been diagnosed with irritable bowel syndrome (IBS) years before, but this felt very different. "My gastroenterologist told me it was just IBS, to 'go home and live with it,'" she says.
But she could barely eat or sleep, and she didn't dare leave the house for fear of having another attack. "I went from living on ibuprofen to living in the bathroom," she says.
Schottenheimer spent the next six months in a twilight zone; just going to work was exhausting. She cut back drastically on her exercise regimen and stopped dining out with friends. Instead, she spent much of her time with doctors. Her general practitioner told her the problem was all in her head, while yet another physician said her stomach produced too much acid. Each new appointment felt like another dead end.
Finally, on the recommendation of a friend, Schottenheimer visited a chiropractor who gave her problem a name: leaky gut syndrome.
Leaky what? The syndrome, he told her, is a little-known problem that's believed to contribute to stomach illnesses like inflammatory bowel disease. Also known as increased intestinal permeability, it's been getting more attention lately: Some practitioners think that a leaky gut may trigger or worsen dozens of seemingly unrelated ailments and diseases, including acne, rheumatoid arthritis, asthma, fibromyalgia, and even attention deficit hyperactivity disorder and autism.
"We're seeing intestinal permeability and related conditions more and more frequently," says Parisa Saeedi-Mepham, a naturopathic physician at Bastyr Center for Natural Health in Seattle. "As more research is done, I think we'll find it's more common than people think."
Here's how it's thought to work. Normally, as food travels through the small intestine, tiny molecules of fats, proteins, and starches get absorbed through the walls and into the bloodstream. Larger molecules, which include troublemakers like bacteria, toxins, and partially digested food, are shuffled down to the large intestine and out of the body.
But people with leaky gut syndrome have tiny openings in the walls of their small intestines. This allows the large molecules to leak into the bloodstream, where the immune system attacks them as foreign invaders. Food molecules that get into the blood this way can trigger food allergies; but any large molecules that leak out can cause inflammation, irritating the gut lining and perpetuating the problem.
This chronic inflammation is the suspected link between leaky gut syndrome and more far-reaching conditions, practitioners say. When inflammation flares up in the gut, the immune system fights back to stomp out the flames. Eventually the body's defense system may blow a fuse and start attacking healthy tissue. The result can be autoimmune diseases such as fibromyalgia, chronic fatigue syndrome, and rheumatoid arthritis. As for leaky gut's connection to autism and ADHD, it's possible that some of the toxins absorbed into the bloodstream may aggravate behavioral and developmental problems.
The logical assumption, then, is that treating a leaky gut can be the key to improving these conditions. That was the case for Karina, a 41-year-old psychologist in Melbourne, Australia, who has battled what she now knows to be leaky gut syndrome off and on for ten years. What began as stomach cramps and severe diarrhea escalated over the years into fibromyalgia, joint pain, and chronic fatigue syndrome. She made the rounds of doctors and specialists, only to be told that her symptoms were all "in her mind," that she was clinically depressed, or that they had no idea what was wrong.
At her worst, Karina (who doesn't want her last name used) barely had the strength to go to the grocery store; she had to lean heavily on a cart just to make it down the aisles. "I was so weak I felt as though I'd collapse," she says. "I was convinced I was going to die."
One day while researching her symptoms online, Karina found a site about leaky gut syndrome. Reading the stories of other patients was like seeing her reflection in the mirror for the first time. She went to a doctor and asked to be tested for the syndrome. The result was positive.
When she took the results to the gastroenterologists who'd been treating her, though, they weren't inclined to take it seriously.
Luckily, Karina found a team of integrative physicians who gave her, among other things, anti-inflammatory and antifungal herbs along with large doses of probiotics to restore the natural flora in her gut. Now, four months later, her leaky gut symptoms are gone and the fibro-myalgia is receding, too.
"Leaky gut syndrome underlies many chronic health problems, but you won't find it unless you're looking for it," says Elizabeth Lipski, a nutrition expert in Asheville, North Carolina, and author of Digestive Wellness. "And most physicians aren't looking."
Indeed, Western physicians rarely use the diagnostic test that finally pinpointed the source of Karina's problems. "There have been dozens of scientific publications validating this test," says Leo Galland, an integrative physician and director of the Foundation for Integrated Medicine in Manhattan, "and still mainstream doctors don't know about it and don't use it."
In the conventional medical community, there's skepticism about whether leaky gut really amounts to a syndrome at all. Jack Di Palma, vice president of the American College of Gastroenterology and a medical professor at the University of South Alabama, in Mobile, thinks it may turn out to be related to certain stomach problems. But, he says, "I am not convinced that a definable syndrome has been described."
Galland, one of the first doctors to draw attention to leaky gut syndrome more than a decade ago, takes a middle position. Although he, like Lipski, feels that it will one day be exposed as a significant health problem contributing to scores of other ailments, he says there just isn't enough research to draw that conclusion yet. For now, he believes the links between leaky gut and many of the problems Lipski cites are still speculative. The people most likely to have leaky gut, he says, are those with Crohn's disease, food allergies, intestinal infections, or AIDS, or those taking high doses of nonsteroidal anti-inflammatory drugs (NSAIDs).
Could you have leaky gut syndrome?
The syndrome with the peculiar name brings on a host of unpleasant symptoms, including gas, bloating, stomach cramps, and diarrhea. Some practitioners will make a diagnosis based simply on a patient's symptoms, but others frown on this approach.
"You can't diagnose leaky gut from symptoms alone," says New York City physician Leo Galland. "If your diagnosis lacks scientific precision, you can call a lot of things leaky gut that aren't." To be certain, you need a clinical test called the lactulose/mannitol challenge, which can be ordered only by a physician.
It's a simple test. You'll be given two types of sugar to eat--one made up of large molecules, the other of small ones. If many of the larger molecules escape into your bloodstream and show up in your urine, the test is positive. For treatment, though, you may need to seek out a naturopath, an integrative physician, or an alternative-minded nutritionist, as many conventional docs are skeptical about the syndrome, unfamiliar with how to treat it, or both. --C.G. | Indeed, overuse of NSAIDs may be the best-documented explanation for how a leaky gut develops. Millions of Americans rely on pills like ibuprofen and naproxen to soothe muscle and joint pain. NSAIDs, when popped daily for weeks, months, and even years, can hinder the gut's ability to heal itself as well as irritate its lining.
In hindsight, Schottenheimer thinks her unbridled use of ibuprofen, especially on an empty stomach, set the stage for leaky gut syndrome. But she believes it was the physical toll of carpal tunnel surgery and the high-dose antibiotics to control a postoperative infection that added up to the last straw.
As a treatment, her alternative practitioner prescribed a low-fiber diet to allow her intestines time to heal, and supplements to aid her digestion. Soon her daily regimen included glutamine, acidophilus, omega-3 fatty acids, and digestive enzymes, along with aloe vera juice and alpha-lipoic acid. Within two weeks, Schottenheimer was feeling better. Six months later, she's nearly symptom-free.
She's still frustrated, though, when she recalls the stream of misdiagnoses from Western doctors. "You have to find someone who is challenged by your case and willing to go the extra mile," she says. "Conventional doctors just don't want to be bothered." 
Catherine Guthrie is a contributing writer.
Mending a Leaky Gut
Most likely, everyone's gut gets a little leaky now and then, says integrative physician Leo Galland. Everything from food allergies to aspirin to stress can irritate its lining. Fortunately, a healthy body repairs itself and moves on, so in most cases no specific treatment is necessary.
But for people with underlying infections, like candida, or chronic ills, like HIV or Crohn's disease, minor damage to the small intestine may go without repair, and the syndrome can become chronic.
While there are no quick fixes for leaky gut syndrome, you can take steps to gradually improve digestion, restore healthy bacteria, and heal microscopic holes in the gut's lining. These will help heal the syndrome, and reduce your chances of a recurrence. Here's what's most commonly recommended.
Chew your chow. By chewing each bite until it turns to liquid, you give your digestive enzymes an easier job to do.
Take food sensitivities seriously. If you know you are sensitive or allergic to some foods, such as gluten or lactose, stop eating them. Certain foods may trigger the body's immune response, which irritates the gut. If you don't know if you have food allergies or sensitivities, consider seeing an allergist or holistic practitioner for testing.
Watch the pills you pop. If you take nonsteroidal anti-inflammatory drugs like ibuprofen frequently, ask your doctor about switching to a more gut-friendly option. One good bet is to try anti-inflammatory herbs such as curcumin, boswellia, and bromelain instead. Galland suggests taking 1,500 milligrams of each, divided into two or three daily doses, on an empty stomach. If you take NSAIDs to treat osteoarthritis pain, joint-strengthening supplements such as glucosamine and chondroitin may help you cut back.
Get friendly with glutamine. This amino acid enables the small intestine to repair microscopic holes. "The small intestine runs on glutamine," says Lipski. She recommends between 5 and 10 grams of powdered L-glutamine a day for people with the syndrome. This is generally considered safe. But if you're sensitive to monosodium glutamate (MSG), you may want to avoid it, as the body converts glutamine into glutamate.
Boost the good belly bugs. If you have leaky gut syndrome, chances are your gut's ratio of good to bad bacteria is out of whack. You can replenish good bugs with a mixed probiotic supplement. Lipski advises taking 2 capsules three times a day.
Don't let low-grade infections get out of hand. If you have an underlying infection, like candida, don't let it fester. When the body is fighting infection, the immune system is always on high alert, which feeds inflammation throughout the body--including the gut. --C.G. | |
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