Leaky gut 101: Is it real? And, how to heal it
This article was medically reviewed by Treta Purohit, MD, Michael Bass, MD, and Idequiz Paez, RD. It was written by Angela Myers.
Leaky gut syndrome, when toxins leak through small holes in the stomach lining, is a bit of a medical mystery. Leaky gut syndrome is a theory. It’s the idea that intestinal permeability is not just a symptom of different kinds of GI (gastrointestinal) diseases but an underlying cause that can develop by itself. Theories like this have some appeal, because they’re one way of explaining various conditions that we haven’t otherwise been able to fully explain yet.
That said, the evidence around “leaky gut syndrome” is lacking. We know that the condition of having intestinal permeability, aka a “leaky gut,” is real, but we don’t know that it’s a disease in itself. For all these reasons, leaky gut is not currently a recognized medical diagnosis. A “leaky gut” is a simplistic term used to describe intestinal permeability, which has been studied when it occurs alongside diseases such as celiac or Crohn’s.
Technically, this syndrome isn’t a diagnosable medical condition. In fact, it’s possible to improve overall gut health with the right treatment plan.
How long that treatment plan takes to work is highly dependent on your lifestyle and any underlying medical conditions. However, there are some scenarios where symptoms perceived as a leaky gut can heal two weeks after starting a new diet. Ahead, discover potential healing timelines, when to see a doctor, and triggers to avoid in order to prevent future flare-ups.
What is leaky gut syndrome?
“Leaky gut syndrome is where the lining of the small intestine becomes damaged, causing undigested food particles, toxins, and bacteria to ‘leak’ through the intestines into the bloodstream,” says Michael Bass, MD, Medical Director and Gastroenterologist at Oshi Health.
The intestinal barrier is a dynamic entity with multiple layers. The first is the lumen, where there’s bila acid, pancreatic and gastric juices, and the second is the microclimate of the intestine. The third and final one is the mucus layer.
This gut lining acts as a barrier between the stomach and bloodstream, but it isn’t airtight. “There are small gaps in the intestinal wall called tight junctions that allow water and nutrients to pass through,” explains Bri Olivieri, RD, a registered dietitian at Oshi Health, “When working correctly, the intestinal barrier controls what can or cannot enter the bloodstream.”
Along with permitting nutrients and water to pass, the barrier should keep harmful bacteria, substances, and pathogens out. When the barrier is weakened, intestinal permeability occurs, and those harmful particles can leak into the gut and bloodstream, causing what is informally called “leaky gut syndrome.”
Again, it’s debated whether leaky gut should be a diagnosable medical condition, but intestinal permeability is definitely real—and related to many GI conditions, including Celiac and Crohns’ disease.
Common symptoms of leaky gut syndrome
The gut is often considered the “second brain” of the body, meaning gut health has a far-reaching impact.
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. These symptoms can include:
- Constipation
- Diarrhea
- Painful indigestion
- Skin problems
- Gas
- Stomach pain
- Bloating
- A lack of energy
- Fatigue
- Brain fog
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.
What causes leaky gut syndrome?
Intestinal permeability syndrome can impact anyone. It’s often seen alongside a diagnosable medical condition. It has, for example, been linked to extra-intestinal diseases, including heart disease, obesity, It’s also common alongside GI conditions, including inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), celiac as well as food allergies,
Some research suggests inflammation can cause intestinal permeability, and many of these underlying conditions have a link to inflammation as well. Yet despite the correlations, not everyone with these conditions will experience what we perceive as a leaky gut.
To make matters more confusing, it is possible to have a leaky gut without an underlying condition. That’s because the most direct cause is external triggers. Dr. Bass says some of the most common triggers are:
- Chronic stress
- Alcohol
- Unhealthy diet
- Food sensitivities
- Bacterial imbalance (dysbiosis)
- Infections
The only way to know for sure if a leaky gut or something else is causing your symptoms is to see a GI specialist. A GI specialist will assess symptoms and diagnose an underlying condition causing what we perceive as leaky gut.
How to address GI symptoms
Because the symptoms we perceive as leaky gut can stem from related conditions and/or external triggers, the best healing approach is one that identifies lifestyle triggers or underlying GI conditions—under the supervision of a GI provider.
Below are some of the most effective treatment options, based on the experience of Oshi’s GI specialists. These options won’t “cure” a leaky gut (there isn’t a cure since it’s not a diagnosable medical condition), but they can manage symptoms and treat any underlying causes.
See a team of GI specialists
To strengthen overall gut health, you first need to assemble the right support team. Even if some treatment options seem easy to DIY (i.e. reducing stress or changing your diet), they are more effective and require less trial and error with expert guidance.
“When dealing with gastrointestinal symptoms of any type, it is best to consult gastroenterology professionals,” says Olivieri, “A team of GI-focused physicians, nurse practitioners, dietitians, and behavioral health providers can help to determine the best treatment plan.”
For B.H., working with an Oshi GI specialist left him feeling certain of how he was going to manage his symptoms. He reflected, “My treatment plan was explained to me very well, and I feel like I have clear next steps.”
Learn your triggers
Healing symptoms perceived as leaky gut often involves some experimentation. One person’s symptoms may be triggered by a glass or two of wine, while another person may be unaffected by alcohol. However, you won’t know whether alcohol is a trigger for you unless you undergo an elimination diet.
An elimination diet, such as the low FODMAP diet, is the name of the game. FODMAPs are carbohydrates found in a variety of foods, from pasta to chickpeas to mushrooms. They’re even found in some types of alcohol and other beverages.
On the low FODMAP diet, an individual eliminates all FODMAPs for two to four weeks and slowly reintroduces different foods to see which, if any, trigger their GI symptoms. Because this diet can be quite intense (and sometimes confusing), it’s only recommended under the supervision of a GI specialist.
The low FODMAP diet is also temporary, meaning any foods that are not triggering GI symptoms will be reintroduced after you finish the diet. Any triggers and food sensitivities will continue to be avoided after the diet is completed.
Eat the right foods for a leaky gut
Almost every gut health treatment plan will include dietary changes. Usually, these changes focus on restoring healthy gut bacteria and providing the stomach with the nutrients required to heal.
Dr. Bass highlights some of the best foods to heal issues perceived as a leaky gut:
- Probiotics, such as yogurt or miso
- Fermented foods, like kombucha and kimchi
- Fiber-rich foods, including whole grains, lentils, and beans
- Foods high in vitamin A, including leafy greens and many other vegetables
- Foods with a high concentration of omega-3 fatty acids, such as fish and chia seeds
He adds that supplements with L-glutamine, zinc, and omega-3 fatty acids may support gut health as well.
Additionally, some research suggests vitamin D may improve the gut microbiota. Vitamin D supplements are available, though it can also be found in oily fish, mushrooms, egg yolks, and some other foods. Around 30 minutes of direct sun exposure daily (with sunscreen) can boost vitamin D levels too.
Say goodbye to alcohol
For over 30 years, researchers have studied the relationship between alcohol and gut permeability. Long story short: Alcohol increases permeability.
A 2021 study analyzed the impact of eliminating alcohol in a population of patients with alcohol-related liver disease and symptoms perceived as leaky gut. After one week without alcohol, patients experienced improved intestinal barrier function. Even if your symptoms aren’t caused by liver disease, cutting out alcohol often helps.
Fortunately, mocktails and no-alcohol options are increasing in popularity, making it easier to embrace a sober or alcohol-light lifestyle. A registered dietitian can also help you eliminate or reduce alcohol consumption, as well as identify if alcohol is a trigger for you.
Reduce stress
Have you ever felt knots in your stomach during a stressful week at work? Or experienced diarrhea or abdominal pain when caring for a sick family member? Either scenario demonstrates how stress can change our gut microbiome. And those changes sometimes manifest as increased intestinal permeability.
If stress is a factor in your leaky gut syndrome, seeing a gut-brain specialist can help. They can help explain the gut-mind connection and find a customized approach to address your mental health symptoms and relieve stress.
Some approaches they may recommend include:
- Cognitive behavioral therapy for GI conditions
- Mindfulness and meditation
- Breathwork and diaphragmatic breathing
- Gut-directed hypnotherapy
Maintain a diverse diet
Adding the best foods for gut health to your plate is important. But only eating fermented foods and sources of fiber is not the best game plan. Instead, aim to eat diversely, since different foods add novel bacteria to the gut.
“Different types of bacteria produce different byproducts,” explains Olivieri, “This variety is important for a healthy, well-functioning intestinal tract.”
Stay hydrated
“It is very important to pair a high-fiber diet with adequate fluid intake,” explains Olivieri, “Staying hydrated is extremely important when it comes to optimal gut health.” More specifically, water plays an important role in shaping the gut microbiota, and drinking enough water improves overall gut health.
Recommended daily water intake varies depending on your age, gender, and activity level. Generally speaking, most of us should aim for 64 ounces of water or more daily.
Treat underlying conditions
Make sure to get an accurate diagnosis and treatment for any potential underlying GI condition you may have, whether that’s irritable bowel syndrome (IBS), Crohn’s disease, or another condition. This will ensure you’re in the best possible position to heal all GI symptoms, not just those sometimes referred to as “leaky gut.”
How long does it take to heal GI symptoms?
When trying out these treatment options, keep in mind that everyone’s healing timeline is different. “The healing process can vary depending on the individual and the severity of the condition, but it typically takes between a few weeks to several months,” explains Dr. Bass.
Sometimes, patients with the same underlying condition and a similar treatment plan heal at different rates. In one study, patients whose GI symptoms stemmed from Crohn’s disease tried a dietary intervention. Within two weeks, 75% of patients saw a reduction in their symptoms. In another study with more participants, all diagnosed with Crohn’s disease and on a dietary intervention as well, the average time to see marked improvements was six weeks.
Signs that your gut is healing include improved digestion, less bloating, fewer food sensitivities, clearer skin, more energy, and reduced brain fog.
Promoting Overall Gut Health
Preventing increased intestinal permeability often looks similar to the healing process: Manage stress, eat a gut-healthy diet, and limit alcohol consumption. However, since GI symptoms perceived as a leaky gut are partially caused by inflammation in the gut, it’s also best to avoid inflammatory triggers.
Some common inflammatory triggers are:
- A high-fat diet, including the typical Western diet
- Ultra-processed foods
- Alcohol
- Smoking
- Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as advil
- Stress
Where possible, opt for a less processed diet, such as the gut-friendly foods mentioned above, and avoid drinking alcohol, smoking, or taking NSAIDs whenever possible. Finding healthier ways to combat stress, such as meditation or regular exercise, may be beneficial as well.
Outlook
We get it: dealing with GI symptoms can be frustrating especially given so much misinformation on chronic gi conditions on the internet. There is much folklore about the leaky gut and its relationship to microbial balance within the gut.
Luckily, that frustration is as curable as GI symptoms, with the right approach under the supervision of experts. The key to healing is often a whole-person approach focused on an individual’s lifestyle and diet, not a medication addressing surface-level symptoms.
If you’re suffering from GI symptoms, search for a GI team that follow this whole-person approach. For N.K., finding such a GI specialist made all the difference. “I wish I had this understanding of my health issues years ago,” she says, “I finally have hope to get my GI problems under control.”
Frequently Asked Questions
How do you know if your leaky gut is healing?
If your gut is healing, your symptoms should decrease in intensity and start to disappear. Many patients also report that as their gut heals, they feel like they have more energy and mental clarity.
What is the fastest way to heal a leaky gut?
Since the symptoms perceived as a leaky gut can be caused by GI conditions, autoimmune diseases, and other underlying conditions, the fastest way to heal varies. Any treatment plan should address the underlying condition and introduce lifestyle changes, such a gut-healthy diet and stress reduction techniques.
Can leaky gut be cured permanently?
Symptoms perceived as a leaky gut can’t be cured permanently. There isn’t a vaccine against it or a prescription someone can take to make it go away. Instead, individuals with these symptoms should seek a diagnosis and treatment plan from a GI specialist. Often, treatment includes lifestyle and dietary changes to better support the gut barrier, decreasing (often eliminating) symptoms.
How long do you need to heal a leaky gut?
The time it takes to heal your gut depends on the underlying condition, the individual, and the treatment plan. Sometimes, GI symptoms can heal in as little as two weeks. For others, it takes a couple months.
What’s the best diet for a leaky gut?
A high-fiber diet is often the best diet for gut health. However, many foods (even ones that are healthy for most people, like asparagus or broccoli) can cause GI symptoms. To determine any hidden triggers, it may be helpful to try the low FODMAP diet, a temporary elimination diet that identifies any carbohydrate groups causing GI symptoms, under the supervision of a registered dietitian.
What are the symptoms of leaky gut?
Common symptoms include diarrhea, constipation, bloating, gas, and stomach pain. Someone may also experience symptoms that span beyond the gut, such as brain fog, fatigue, and skin conditions.
Getting Started with the SIBO Diet
There’s still a lot researchers have to learn about leaky gut syndrome, but one thing is for sure: symptoms perceived as leaky gut impact everyday life and overall health, but they don’t have to. With the right GI specialist and a whole-person approach, symptoms can disappear within a few weeks or months.
If looking for that approach, Oshi Health may be a good option. Oshi provides a supportive team of GI specialists who can help identify what is causing your GI symptoms and the right treatment plan. Schedule an appointment with an Oshi GI specialist today to learn about our whole-person approach.
