Is "leaky gut" real?

January 25, 2018 7:26 AM

What it says on the tin -- can "gut leaks" cause illness? Or is this pseudoscience?

I've been going to my family doctor for years --literally since I was a kid. Sometimes I see the doctor, sometimes I see a nurse practitioner. I recently went in for back problems (sciatica, I've had an MRI and am consulting with a surgeon, but I wanted to get a prescription for something as I just can't sleep.)

The (new) nurse practitioner gave me the usual check, then gave me a recommendation for a back health book and a prescription for a steroid cream. Ok, so far, so good... but then she comes in with a worksheet about "leaky gut" and how it's affecting my health. According to the sheet, the wall of the intestine weakens and all sorts of toxins get through, causing a number of illnesses.) The only way to fix a leaky gut is to avoid gluten, alcohol, caffeine, etc. (in other words, everything that makes life worth living).

The nurse did not recommend an actual allergy test, nor have I complained about anything close to the symptoms of celiac disease or other intestinal problems.

So... Is "Leaky gut" at all a real thing? And is it time to find a new practice that's a little more science based? I love woo woo stuff, actually, but I can clean my aura myself for free, thank you very much.

posted by kingdead to Health & Fitness (15 answers total)

Wikipedia leads with "Leaky gut syndrome is a hypothetical, medically unrecognized condition.".

Following the citation from that statement to wikipedia leads one to the UK NHS at this page. There's a more info there about what exponents of the theory claim, but concludes there's no current medically sound reason to suspect this.

Seek diagnosis from somewhere else.
posted by nobeagle at 7:37 AM on January 25, 2018 [10 favorites]

If you like your family doctor, it seems like it would be worth contacting her to ask if the practice really supports the idea of "leaky gut" or if this is coming only from the new NP. If the doc might not be aware that the new staff member is handing out these worksheets, that seems like something to bring to her attention.
posted by Kriesa at 8:02 AM on January 25, 2018 [14 favorites]

This is woo. If the walls of your lower intestine weaken you will most likely get colitis, in your upper intestine you will get a peptic ulcer. Alcohol and caffeine are supposed to be absorbed by your small intestine. Toxicity is in the dose.

"Gut" is a totally non-specific term, and like "toxins" is one of those terms that will quickly steer me away from someone's practice.
posted by aspersioncast at 8:17 AM on January 25, 2018 [26 favorites]

There is increasing understanding that stuff that happens in the gut has a lot more effect on the body than previously recognized. Then people start extrapolating and hypothesizing and blaming all ills on something like leaky gut. Coffee is consistently shown to be pretty healthy, providing mild protection from type 2 diabetes, alzheimer's disease, etc. Alcohol has mild health benefits and not so mild health risks. Gluten is a popular topic with little good research. You should make an effort to have a healthy gut. Pro-biotics and pre-biotics are probably sort of good for you and won't hurt you. Or just eat more fiber, soluble and un-. Eat fermented foods like kimchi, fresh sauerkraut, fresh pickles. Mae an effort to avoid sugar; the woo team has been preaching this for some time, and it turns out they were right. Some percentage of alternative medicine gets tested and turns out to have benefits(turmeric) but most of it is shown to be nonsense. Doctors get swayed by popular literature, too. Talk to the doc and see what she has to say.
posted by theora55 at 8:46 AM on January 25, 2018 [7 favorites]

Sounds like something that would go on a medical chart alongside bloaty head.
posted by parm at 8:46 AM on January 25, 2018 [3 favorites]

Leaky gut is a legitimate concern for those with chronic hemorrhoids or tissue splitting around the anus. As a hand-wavey back pain diagnosis, I'd give it side eye so hard. Hope you can find what you need to feel better!
posted by Rube R. Nekker at 9:52 AM on January 25, 2018

I have no doubt whatsoever that this is a collection of symptoms related to something legitimate that may one day be a proven medical diagnosis, such that people who follow guidelines for relieving "leaky gut" find some sort of relief...

But, no. This is not actually A Thing.

Everything you mentioned is also a factor in inflammation, which DOES effect the body in a myriad of ways, some with longer term repercussions. This is currently under medical research. Including the effects of emotional stress on inflammation...

I read a lot and work in the food industry, so customers often present these types of food sensitivites. Y'know. I get it. I think in general what you eat (and especially the pesticides on veg and drugs used on animals) plays a HUGE role in all the mysterious health issues folks experience today. But. Yeah.

IMHO, "leaky gut" is regular folks experiencing something legitimate, but guessing at the cause.
posted by jbenben at 10:02 AM on January 25, 2018 [1 favorite]

Well, "leaky gut" is kind of a real thing, but not the way your nurse practitioner and most people are using it. There are these things called "tight junctions" in your intestinal wall that regulate intestinal permeability. (In people with celiac disease, some studies have found that the tight junctions aren't as tight as they probably should be, leading to greater intestinal permeability and more inflammation.) This is all my understanding as a layperson who likes science. Here are a some scientific journal articles: 1,2, 3. The science on all this is emerging and I bet in 50 years they'll have a real definition, treatments and hopefully a less gross name.

That said, I don't think this has anything to do with your back pain and it was straight up weird that the nurse handed you this. I second the advice to contact your doctor about it and would add the advice to shred or recycle that piece of paper and eat some cinnamon rolls or something in celebration of your non leaky guts.
posted by purple_bird at 11:27 AM on January 25, 2018 [4 favorites]

Here's several Scientific American articles if you feel like reading more than just what some random strangers on the internet have to say.

https://www.scientificamerican.com/article/gut-bacteria-may-exacerbate-depress/

https://www.scientificamerican.com/article/gut-bacteria-may-play-a-role-in-autism/

https://www.scientificamerican.com/article/mental-health-may-depend-on-creatures-in-the-gut/

More...

There's something I eat that causes me to take big bloody diarrhea shits... ... and back pain. I'm not sure what it's called.
posted by humboldt32 at 11:29 AM on January 25, 2018

I should say, I also don't think this is likely to be your problem. Only that it's less woo than some folks here are making out.
posted by humboldt32 at 11:39 AM on January 25, 2018 [1 favorite]

Beware anytime the term "toxins" is used. The legit medical community rarely uses that term. Scratch a "toxin"-sayer and you'll usually find a gourd-waving, incantation-chanting "alternative practitioner."
posted by BostonTerrier at 1:00 PM on January 25, 2018 [3 favorites]

In which a real MD writes about "leaky gut":

Judging from PubMed, if you are going to rely on reality and science as your basis for the diagnosis for leaky gut syndrome, it would be more accurate to say that because of an almost complete lack of supporting basic science and few therapeutic clinical trials showing no effect, virtually no physician who has an understanding of the gastrointestinal physiology gives the disease credence.

Which is why is Leaky Gut a disease diagnosed and treated by naturopaths.

A household name in the ND world. Exclamation mark.

If leaky bowel is treated at The Center for Integrative Medicine of the Cleveland Clinic and promoted by Dr. Oz you know there is little legitimacy. The company you keep, birds of a feather, and all that.

What is leaky gut syndrome? The theory is that tight junctions of the bowel break down and food “wiggles though” into the blood stream and interacts with the immune system. Rather than being exposed to its elemental components, the immune system is presented with large chunks of undigested foie gras, Twinkies, Jiff (objectively the best peanut butter) and beer (am I over sharing?) as well as bacteria, parasites and, of course, toxins. These substances then interact with the immune system in dysfunctional ways to cause a host of symptoms and diseases, from diabetes to multiple sclerosis to autism.

Alterations in intestinal permeability can occur in patients with inflammatory bowel disease, sprue and other diseases. But as is often the case in pseudo-medicines the concept is used with less-than-perfect accuracy until:

The topic is further confused by use of the term “leaky gut syndrome” within the lay and alternative medicine communities, and even by some physicians, and claims that this is responsible for a dizzying array of disorders, including chronic fatigue syndrome, fibromyalgia, allergies, depression, and skin disorders.

posted by mandolin conspiracy at 1:32 PM on January 25, 2018 [3 favorites]

IANAD, but as somebody with lifelong digestive woe and having been to many, many medical professsionals - I do not personally believe that randomly taking probiotics is necessarily a thing to do. There IS evidence that

1. some probiotics are proven to help people with certain conditions
2. of these, they are not all equally well absorbed, depending on brand, quantity, when you take them
3. clearly the gut microbiome and its health are important for humans' quality of life

but if somebody otherwise totally healthy came to me, a layperson, today and said "what probiotic should I take?" I would say "if you feel fine, and your diet is well balanced and your weight and energy and sleep and mood are great - don't take anything. Keep doing that stuff you are doing."

I also believe someday we'll have a much better grasp of this than we do now, which at present seems to be: "This appears to be, uh, safe, because we found it (most of the time) inside a human. So throw this bag of (typically, ingested) bacteria at (your digestive tract) wall and see if it sticks in a way that benefits you".

Here is a link to a clinical guide to treating various conditions with probiotics , with which ones, and their efficacy for said conditions. I don't know much about these particular doctors, but you can follow links next to each probiotic instance to various studies about them.
posted by bitterkitten at 4:53 PM on January 25, 2018 [3 favorites]

In which a real MD writes about "leaky gut":

I can find you "real MDs" who say "leaky gut" is a real thing (though that doesn't mean that every claim about it that random people make on the internet is true). You aren't going to get a definitive yes or no here.

As far as Wikipedia goes, it's not a great source for figuring out if something is woo. The anti-woo prejudice of the people who tend to "win" the editing wars is so strong that real evidence gets dismissed (I know this from subjects I know more about - check the history on the leaky gut page for back and forth editing). I'd consider the NHS page more trustworthy, of course, but if there are good "pro" sources, the Wikipedia page probably won't have them.

For this situation, since you've known this doctor for years, I would ask the doctor. That might reassure you - and it might make you decide you need to leave. I wouldn't leave a medical practice because a nurse practitioner says something questionable. I've had nurses say profoundly stupid things to me that did not reflect what the doctor thought (not a reflection of nurses in general - doctors say stupid things too.)
posted by FencingGal at 9:27 AM on January 26, 2018 [2 favorites]

I know your question is "is leaky gut a real thing"

And the answer is...

It doesnt matter if its real or not. Try the diet, try the help, try eliminating what they suggest. If you feel better it works! If it doesn't, well try something else.

The body is infinitely more complex than our brains or science can possible understand. We have the basics but when it comes to digestive health (microbiome, phages, etc) its just too complex. The only way to know if something works is to try it.
posted by Takeyourtime at 11:14 AM on April 11, 2018