What Are the Signs of a Leaky Gut?

Leaks are never good news. They mean your car is losing oil, or that rain is falling inside the house. Leaky guts are much the same: Something you want in one place is creeping through to another—and causing issues.

And like the sensor that turns off your dishwasher when it detects water under the machine, a leaky gut might not be the cause of your problems—it might be a silent signal that something else is going on in your intestines, such as Crohn's disease and celiac disease.

Let's dig into what this term really means, what diseases it tends to accompany, plus how to test for leaky gut.

What is a "leaky gut"? (Increased intestinal permeability)

Leaky gut isn't an actual medical diagnosis; it is a term that means increased intestinal permeability, or "hyperpermeability" of the intestinal lining.

In healthy individuals, the gut barrier is a lining that allows nutrients to pass from the digestive tract to the bloodstream. It's like woven cotton fabric, well-packed with tiny gaps that are managed by the cells around them. For those who have leaky gut, the lining is more like muslin or cheesecloth, with larger gaps that allow inflammatory substances, toxins, pathogenic microorganisms, and undigested proteins to pass through and enter circulation.

This can cause inflammation, excess immune reactivity and other health concerns. It's also an indicator that your gut flora, the microorganisms that make up your gut microbiome, may be out of balance.

Leaky gut can accompany chronic diseases, like Crohn's disease, ulcerative colitis and celiac disease. It can also lead to the development of diseases. Whether leaky gut is causing or being caused by another disease, it's not good news.

What are the signs and symptoms of a leaky gut?

This is kind of a trick question, because leaky gut syndrome itself is a silent disorder. On its own, it doesn't feel like anything, so most people don't know they have it until they get tested for it. But it often accompanies some pretty serious gastrointestinal and autoimmune disorders well-known for GI symptoms like abdominal pain and cramping, diarrhea and weight loss—and also fatigue.

• Can be silent or asymptomatic

• May cause discomfort like gas, bloating, diarrhea and constipation

  • Associated condition: Dysbiosis and low levels of good gut bacteria
  • Potential solutions: Increase dietary fiber and probiotics

• Chronic diarrhea, nausea, weight loss, fatigue, anemia, joint pain and ulcers

  • Associated condition: Celiac disease, a serious illness requiring medical diagnosis
  • Potential solutions: Gluten-free diet

• Diarrhea and pain

  • Associated condition: Inflammatory bowel disease (such as ulcerative colitis or Crohn's disease); IBD is a serious autoimmune illness and medical evaluation is essential
  • Potential solutions: Work with a doctor on medical management

• Fatigue and exhaustion

  • Associated condition: Chronic stress (prolonged disease as one example)
  • Potential solutions: Stress management; medical management if disease-caused

If you’re unsure if you have leaky gut, your best option is a test for gut permeability; these range from tests that require drinking a specially formulated liquid solution to simple finger-stick blood tests. If you test positive, this is a strong indicator that leaky gut syndrome may be a concern.

What causes leaky gut? (Risk factors & triggers)

In addition to medical conditions, uncontrolled metabolic issues (blood sugar, insulin resistance, obesity) and some environmental and food allergies can contribute to gut lining permeability. Poor lifestyle choices can also be a factor. These include:

• A diet heavy in ultra-processed foods and added sugar, which can cause inflammation in the gut
• Poor stress management and chronically elevated cortisol levels
• Taking aspirin and other non-steroidal anti-inflammatory drugs like ibuprofen and naproxen consistently for long periods or along with other factors that can compromise the lining of the GI tract
• Extreme exercise (a stressor)

What diseases are associated with leaky gut?

The following diseases and disorders go hand in hand with leaky gut:

1. Celiac disease.

   Celiac disease is an autoimmune disease provoked by gluten in which the lining of the gastrointestinal tract gets eroded by the immune system. Anyone with a celiac disease diagnosis almost certainly has a leaky gut.

2. Inflammatory bowel diseases.

   For example, ulcerative colitis or Crohn's disease. (This is not irritable bowel syndrome.) IBD is an autoimmune disease like celiac, in which the immune system also attacks the gut lining.

3. Autoimmune disease.

   In other autoimmune diseases, the gut lining might also be compromised, allowing large molecules from food to enter circulation and provoke an immune response.

4. Non-alcoholic fatty liver disease (NAFLD).

   There is a high incidence of gut dysbiosis in NAFLD patients. These "bad" bacteria can erode the intestinal wall and contribute to the liver dysfunction that marks NAFLD. (Probiotics that fight the bad bacteria and support the beneficial bacteria in your gut microbiome may help with this condition.)

5. Severe gastrointestinal infections.

   Severe gastrointestinal infection may cause inflammation and intestinal damage and make the gut "leaky." Shigellosis, an infection with Shigella bacteria, is one of the more well-known of these infections, but there are others.

6. Severe illness.

   Severe illness stresses the digestive tract, especially when it requires extensive hospitalization or time in intensive care. Many factors can influence this, from medications, tube feeding and multiple infections to overall tissue loss (sarcopenia). When a person is really ill, all body systems suffer, including the gut.

7. Chemotherapy or radiation to treat cancer.

   The use of chemo or radiation puts cancer patients in a special category of severe illness. Chemotherapy specifically prevents the gut from healing or regenerating itself (as a result of preventing cancer cells from reproducing).

Some gastrointestinal problems, such as small intestinal bacterial overgrowth (SIBO) or microbiome dysbiosis, and even food sensitivities, can cause leaky gut syndrome, but people can have these and not have a problem with a compromised gut lining.

How is leaky gut diagnosed? (Testing)

A lab test is really the only way to identify excessive intestinal permeability. A convenient and innovative finger stick test with a reliable and comprehensive methodology can help determine if leaky gut syndrome may be a concern. "For those with digestive issues or with many food sensitivities, taking a gut permeability test can help identify if a weakened intestinal barrier may be a potential underlying or exacerbating concern," noted Michael A. Smith, MD, Life Extension's Director of Education. "With many convenient testing options now available, it's an easy first step to take in improving or optimizing gut health."

What lab markers indicate gut permeability?

Look for a gut barrier panel that identifies the following key markers involved with regulating intestinal barrier function:

• Candida albicans.

  Immune system response toward Candida albicans may indicate heightened intestinal permeability and can be an early sign of leaky gut syndrome.

• Zonulin.

  Zonulin is a protein involved with regulation of intestinal permeability through its effects on intestinal tight junctions. Positive reactivity toward zonulin suggests excess gut permeability, typically at an intermediate level of leaky gut syndrome.

• Occludin.

  Occludin is an enzyme involved with stabilization of intestinal tight junctions. Because occludin does not typically enter circulation, detecting reactivity toward occludin suggests a deterioration of the intestinal wall. Typically, it reflects a later stage and/or chronic leaky gut syndrome.

• Lipopolysaccharide (LPS).

  LPS is an extremely inflammatory molecule that comes from certain bacteria. It can trigger a strong inflammatory response, and presence of LPS antibodies may indicate chronic LPS exposure.

Do nutrients help support the intestinal lining?

Yes. A number of nutrients have been studied to support a healthy intestinal lining:

• Vitamin E.

  Vitamin E's ability to help prevent and treat rheumatoid arthritis may be linked to improvement in the gut lining and intestinal barrier.

• Probiotics.

  These health-promoting bacteria help rebalance the gut microbiota and support intestinal health.

• Prebiotics.

  Prebiotic food sources help to fuel the healthy flora in your intestines. They may support better sleep as well as gut health.

• Zinc.

  Zinc is associated with tissue healing and has been proposed for excessive intestinal permeability.

• L-Glutamine.

  In a study, ten active men received glutamine or a placebo before intense exercise, to study gastrointestinal permeability differences post-exercise. Those taking glutamine had decreased gastrointestinal permeability compared to those in the placebo group.

How can you reduce risk factors for leaky gut? (Lifestyle & prevention)

Making healthy choices can help reduce your risk of developing leaky gut.

• Eat a healthy diet.

  Choose a meal plan that is high in fruits, vegetables and legumes, such as the Mediterranean diet. Plant nutrients and high-fiber foods support a healthy microbiome. Just remember to increase your fiber consumption gradually. Too much at once can cause digestive issues. Also, be mindful of any food sensitivities you may have, such as gluten or dairy.

• Manage stress and get enough sleep.

  Regular, restful sleep gives your body the time it needs to recharge and repair the body and your digestive system. Chronic stress damages our health, increasing the risk for serious health concerns and ongoing inflammation.

• Be wary of antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs).

  Specifically, don't take antibiotics for a viral infection. Many sore throats, and much of what we usually think of as colds and flus, are viral infections that aren't helped by antibiotics, and their use may affect your gut health. NSAIDs are also ineffective for viral infections and have been shown to induce gut damage.

• Work up a sweat.

  Exercise is important to overall well-being, weight loss and maintenance, and gut health.

• Support your gut microbiome.

  Live probiotics, prebiotics and targeted nutrients can help promote a healthy gut flora in your intestines.

Frequently asked questions about leaky gut

Can leaky gut be tested with a lab test?

Yes, you can actually test at home with a finger stick test that examines important markers of intestinal barrier function, testing levels of antibody responses to specific compounds—including occludin (a protein), zonulin (an enzyme), Candida (yeast) and LPS (a bacterial component)—that may indicate gut permeability.

Do symptoms like bloating and fatigue mean I have a leaky gut?

No, bloating and fatigue have many causes and may not be associated at all with a leaky gut. Leaky gut syndrome is a silent condition, and it is often present alongside another condition, such as celiac disease, inflammatory bowel disease and more. A lab test is the best way to identify issues with gut barrier permeability.

How long might it take for my gut to heal once causes are addressed?

It depends on the severity of the leaky gut and what caused it. Leaky gut syndrome can have different causes in different people. Even among people dealing with the same cause, severity can vary from person to person.

While it can be difficult to correctly identify the cause of your leaky gut, don’t wait for a diagnosis to start living a gut-friendly lifestyle. Make healthy choices when it comes to diet, sleep, exercise and stress management, and work with a healthcare professional to identify and address any underlying health issues. Removing causes or triggers, and giving your body what it needs for wellness, helps to improve gut health and the integrity of your gut barrier lining.

References

• Actis GC, et al. "Antibiotics and non-steroidal anti-inflammatory drugs in outpatient practice: indications and unwanted effects in a gastroenterological setting." Curr Drug Saf. 2014. https://pubmed.ncbi.nlm.nih.gov/24446890/
• Kou H, et al. "Effect of vitamin E supplementation in rheumatoid arthritis: a systematic review and meta-analysis." European Journal of Clinical Nutrition. April 2022. https://www.nature.com/articles/s41430-022-01148-9
• Marasco G, et al. "Probiotics, Prebiotics and Other Dietary Supplements for Gut Microbiota Modulation in Celiac Disease Patients." Nutrients. September 2020. https://pubmed.ncbi.nlm.nih.gov/32887325/
• "Tips for Being a Safe Patient." CDC. April 2024. https://www.cdc.gov/patient-safety/about/index.html?CDC_AAref_Val=https://www.cdc.gov/patientsafety/features/be-antibiotics-aware-infographic.html