If you’ve ever dealt with persistent bloating, stomach discomfort or diarrhea, you may have wondered whether “leaky gut” could be responsible – especially given how often social media points to it as the cause.
While intestinal permeability is real, “‘leaky gut syndrome’ itself is not currently recognized as an official medical diagnosis,” says Dr. Jason Nagata, a physician at UCSF Benioff Children’s Hospital in San Francisco.
Still, when people talk about “leaky gut,” they are generally referring to this increased intestinal permeability, which is the medical description for how substances pass through the intestinal lining that normally allows nutrients and water to enter the bloodstream while helping keep bacteria and other potentially harmful substances out.
Here’s what can happen when this lining becomes inflamed or injured, allowing substances that would normally be kept out to pass through.
What Is Leaky Gut?
Your intestinal lining is not meant to be completely sealed, but is instead meant to be a selective barrier made of closely connected cells that absorb key nutrients while limiting the passage of anything harmful. “Think of your gut lining like a coffee filter,” say Dr. Ilan Shapiro, medical director of health education and wellness and a physician at AltaMed Health Services in California. “When it works right, it lets the good stuff through and keeps everything else out,” he says, “but when it gets too porous, things slip through that shouldn’t.” When this happens, increased permeability can occur, leading to “conditions like celiac disease and inflammatory bowel disease (IBD),” says Nagata.
This increased permeability is often referred to on social media as “leaky gut,” and is said to be the cause of “reported symptoms like bloating, gas, food sensitivities, joint aches, skin flare-ups like eczema and abdominal discomfort such as diarrhea, constipation, gas or indigestion,” says Shapiro.
Despite such widespread references, the broader idea that increased intestinal permeability develops as its own syndrome and then causes problems throughout the body has not been established. A recent medical review concluded that “leaky gut syndrome” is not an accepted diagnosis as no validated blood, stool or other test can reliably identify it.
It’s also worth noting that increased permeability itself may cause no noticeable symptoms, says Shapiro. And even when symptoms do occur, they are often produced by whatever is actually irritating or injuring the intestine. “Many symptoms attributed to ‘leaky gut’ show up in a lot of other conditions and factors,” he adds. Think constipation, lactose intolerance, infections and medication side effects.
What Causes Leaky Gut?
When increased intestinal permeability does occur, it is thought to be caused by “any conditions that inflame or injure the intestinal lining, including Crohn’s disease, ulcerative colitis, celiac disease, infections and some cancer treatments,” says Nagata.
Other factors that may affect gut health “include chronic heavy alcohol use and diets high in ultra-processed foods,” he says. Research has also documented an association between increased intestinal permeability and the use of nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin and ibuprofen, Nagata adds.
Shapiro says chronic stress can also aggravate digestive symptoms and may affect intestinal permeability through the gut-brain axis, as stress hormones and immune responses can influence digestion and the connections between intestinal cells. “Poor sleep, taking antibiotics over and over again, environmental toxins and even intense endurance exercise can also all mess with your gut lining temporarily,” he adds.
How Is Leaky Gut Treated?
While Shapiro notes there is “no FDA-approved treatment for ‘leaky gut’ specifically” because it is not a recognized medical condition, the best evidence-based approach to related symptoms is for medical providers to “work to identify and treat the underlying problem,” Nagata says.
This means your doctor reviewing your symptoms, diet and medications, plus sometimes also ordering bloodwork, stool testing, imaging or an endoscopy as needed.
From there, treatment depends on the diagnosis.
While persistent or worsening digestive symptoms should be evaluated by a health care professional, Nagata says the most meaningful steps to prevent digestive issues like intestinal permeability include “eating a balanced, fiber-rich diet, limiting excess alcohol and ultra-processed foods, exercising regularly, managing stress and getting enough sleep.”
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