Mainstream medicine does not recognize "leaky gut" but in functional and integrative medicine, it is one of the top contributing pathophysiological processes that we consider in many disease processes.
Overview of today's email:
- What is leaky gut
- Can we test for leaky gut?
- Practical clinical tips
- Bonus: Some references to review
1. What is leaky gut
Spoiler: Leaky gut is a misnomer.
Everyone has intestinal permeability - it is how we absorb nutrients!
But the leaky gut that we are referencing is a layman's term for "pathologic gut hyper-permeability," also referenced as LGS (leaky gut syndrome). It was first described in literature in the 1970s
In mainstream medicine, this is not considered a true diagnosis (largely due to the lack of a validated testing or an ICD-10 code.). Yet, there are over 1200 articles on PubMed (with over 400 of these being reviews or meta analyses).
However, even in integrative and functional medicine, it is still unclear if this is considered a condition, a root cause, or a symptom. More research needs to be done.
2. Can we test for leaky gut?
It is easy to get caught up in promoting "test don't guess."
But as clinicians, we have to consider the validity of the testing methods, the sensitivity and specificity, the cost, and if a test will change our treatment plan for a patient.
For those that want the option of a test, the following tests are often cited as useful tests for identifying leaky gut:
- Stool zonulin (*)
- Serum zonulin (*)
- Antibody testing (antibodies to zonulin, LPS, actinomysin) (Cyrex Array 2)
- Lactulose-mannitol testing (the "gold standard" leaky gut test, but not many run this test)
*A brief note on zonulin: it is made by other organs (primarily the liver and the gut), and I currently don't believe that measuring this is helpful.
See below for clinical tips on why I don't often run these tests, and check out this article by Dr. Ruscio on this topic.
3. Practical Clinical Tips
When a patient asks about leaky gut, I generally provide some educational points:
- Leaky gut is controversial in mainstream medicine as a valid diagnosis, and is unique to integrative medicine practitioners
- This diagnosis is often based off symptoms (not test results)
- There are some tests that can be run, but they are hundreds of dollars and don't provide much guidance (so unless someone is really data driven, has extra money to spend, or feels that having a test will motivate them to make changes, I advise against testing)
- When focusing on treatments, the microbiome and mucosal layers should be two of the primary areas of focus, since these are what protect the epithelial gut lining (i.e. the barrier that we suspect is "leaking")...but this lining can theoretically regenerate every 3 days!
Bonus: Some References to Review
I believe it's important to try to be practical and balanced when it comes to application and practice of functional and integrative medicine, and the diagnosis of leaky gut is a great example (I'll take a deeper dive into this in the mentorship, which launches at the end of March!). In the meantime, some resources to review:
Thank you for your time and support - I truly hope I am serving you well!
Next newsletter topic: Candida Overgrowth.
Meg
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