The Truth About “Leaky Gut”
This post was previously published in my newsletter, Food Psych Weekly. Sign up to get more like this in your inbox each week, and check out my new Rethinking Wellness newsletter, too!
Welcome back to Food Psych Weekly, the newsletter where I answer your questions about intuitive eating, Health At Every Size, disordered-eating recovery, and how to navigate diet culture without falling into its traps.
I wrote this week’s edition before the horrific shootings in Uvalde and Buffalo, and now, like many people, they’re on my mind all the time. I can only imagine the unspeakable pain those families and communities are facing, made all the more devastating because those deaths were avoidable, or should have been. We shouldn’t live in a country where these things happen and are normalized, and yet we do.
I’ve been seeing some nihilistic takes about how nothing ever changes or ever will change in the wake of mass shootings, and at times I’ve felt that way, too. But though it’s going to be a steep uphill climb to make the systemic changes needed to get some real gun reform in the U.S., I do believe it’s possible. And really, what choice is there but to try? Living in constant fear of gun violence is not “freedom.” There are meaningful ways to take action, even if the change we want to see doesn’t come for years or decades or even in our lifetimes.
This week’s question is from a reader named Laura, who writes:
Hi Christy, I’m a little over 2 years in on my work with intuitive eating/finally leaving the diet culture way of life. It’s been a real struggle at times, but I feel like I’ve finally crested the hardest bits and feeling good about where I’m at with my relationship with food. Cut to: I was recently diagnosed with a raging case of “leaky gut” (I have IBS/digestive issues) and, even with me explaining my disordered eating, she has suggested some food restriction. Ugh. I know my stress has been very high and she wants me to reduce stress and add some supplements, but I’m having a lot of stress around the food restricting!! Any experience or advice with intuitive eating for leaky gut? Thank you.
Thanks, Laura, for that great question. Before I answer, just my usual disclaimer:
These answers are for informational and educational purposes only, aren’t a substitute for individual medical or mental health advice, and don’t constitute a provider-patient relationship.
I’ll be giving fairly quick and unpolished answers here for the foreseeable future because I’m trying to juggle work and caring for a new baby, but hoping this will be a helpful start.
First of all, I want to send you so much compassion for what sounds like a really hard and ongoing effort to find some amount of peace with food. As someone with IBS and other digestive disorders myself (as well as a history of disordered eating), I very much empathize with the pain and suffering those can cause. I want to validate that, and to acknowledge that your symptoms are real, before offering my observations below. In short, I believe that those symptoms have been mislabeled, in a way that sounds like it’s definitely exacerbating your disordered eating.
Unfortunately, the “leaky gut syndrome” diagnosis—which is typically made by complementary and alternative medicine (CAM) practitioners—is a dubious one. Proponents of the supposed syndrome claim that bacteria and toxins “leak” through holes in the intestinal wall, causing a vast array of disparate health conditions, including digestive problems like IBS, psychological issues like depression, and diseases like autoimmune disorders, diabetes, eczema, and more.
Scientific evidence doesn’t support the existence of “leaky gut syndrome,” which at this point is a purely hypothetical condition (CW: weight- and food-stigmatizing language), despite the countless wellness-culture websites and social-media posts proclaiming otherwise.
That said, the supposed syndrome is based on a few kernels of truth. First, our small intestines are semi-permeable membranes that allow nutrients to be absorbed into our bloodstream. If we didn’t have some degree of intestinal permeability, we wouldn’t be able to extract essential nutrients from our food, and we would die. So “intestinal permeability” is real, but it’s perfectly normal.
The second grain of truth in the “leaky gut syndrome” story is that there’s a genuine thing called increased intestinal permeability (aka intestinal hyperpermeability), which is when the intestine becomes more permeable than it otherwise would be. (Confusingly, some researchers and medical doctors refer to increased intestinal permeability in lay terms as “leaky gut,” even though they’re not talking about the hypothetical “leaky gut syndrome” or diagnosing anyone with the supposed condition.) Increased intestinal permeability has been found in certain gastrointestinal disorders such as celiac disease, Crohn’s disease, ulcerative colitis, and potentially some other conditions.
The science on this is still in its infancy, but the research so far only shows that increased intestinal permeability is correlated with those diseases. Remember the golden rule in statistics: correlation does not equal causation. In fact, researchers generally view increased intestinal permeability as a symptom of these conditions, not a cause.
Because there’s no scientific evidence that increased intestinal permeability causes any disease or symptoms, the so-called “leaky gut syndrome” that some providers diagnose isn’t a recognized medical condition, and there are no validated tests for it. Scientists are currently debating about the validity of different tests to use in further research on intestinal permeability—which, again, is in the early stages and is primarily being conducted on animals, not in large-scale trials of humans. At-home tests or lab tests offered in healthcare providers’ offices claiming to diagnose “leaky gut” should be viewed with extreme skepticism.
Similarly, the treatments for this so-called syndrome are speculative at best. Most of them are just standard Wellness Diet fare: obsessively cut out the foods deemed “bad” in diet and wellness culture, and replace them with “whole” foods and supplements. As the UK’s National Health Service puts it (CW: specific diets mentioned), “There is little evidence that the ‘treatments’ some people claim help to reduce bowel leakiness, such as nutritional supplements and herbal remedies, have any beneficial effect for most of the conditions they supposedly help.”
That doesn’t stop many CAM providers from prescribing tests and treatments for this supposed disorder. A woman named Erin, who I interviewed for my upcoming book, The Wellness Trap, told me how her naturopathic doctor quickly diagnosed her with “leaky gut syndrome” after advising her to undergo “food intolerance” testing. Yet that kind of testing also is often misleading and harmful, as we discussed here several weeks ago.
Unsurprisingly, many people’s relationships with food become very disordered when they receive a diagnosis of so-called leaky gut. For example, Erin’s ND told her she was intolerant to a long list of foods, and she started to see food as dangerous. Looking back now, she recognizes that that’s when she developed orthorexia—a type of eating disorder characterized by an obsession with “healthy” eating.
The same has happened for many of my clients after being diagnosed with “leaky gut syndrome” or other digestive disorders, whether real or invented by wellness culture. At this particular moment in history, gastrointestinal issues often lead healthcare providers (and patients themselves) to default to blaming food and prescribing a restrictive diet. All too often, that knee-jerk response ignores the important role of disordered eating, stress, and trauma in creating those GI problems in the first place for a large number of people.
In writing my new book, I’ve been trying to articulate why it’s so frustrating to me when people are given dubious diagnoses like “leaky gut,” along with the accompanying prescriptions to cut out huge swaths of their menus. My own experience at the intersection of chronic illnesses and disordered eating certainly has something to do with it. As someone with multiple autoimmune conditions and digestive disorders as well as PTSD and a history of an eating disorder, I know firsthand how tempting it is to believe that a diet is the solution to all your symptoms—and how likely dieting is in many cases to worsen both the symptoms and the disordered eating. It also can keep you from getting help for whatever is really causing those symptoms.
What’s more, getting a diagnosis like “leaky gut syndrome” can inadvertently open you up to a world of mis- and disinformation. When social-media and search-engine algorithms pick up on an interest in wellness topics—“leaky gut,” essential oils, green juice, etc.—they tend to lead down a rabbit hole to more extreme pseudoscientific content and even wild conspiracy theories, as I discuss in my upcoming book. If you’ve been searching online for help with your digestive issues (or really anything wellness-related), then I’d recommend being very skeptical of any new wellness-culture content that gets served to you.
So Laura, back to your question: it sounds like the food restrictions that this person prescribed for your “leaky gut” are already causing you a lot of stress, and I think it’s important to listen to that instinct. I don’t know what kind of provider gave you this diagnosis, but I’d suggest getting a second opinion from a gastroenterologist who’s more familiar with disordered eating. You might also consider working with a dietitian who specializes in that field, and see if they can help connect you with a gastroenterologist (and coordinate care with that doctor to help them avoid unintentionally undermining your recovery with diet advice).
I hope that helps give you a place to start, and thanks again for the great question!
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Here’s to avoiding dubious wellness-culture diagnoses,
Christy
P.S. If you want to learn more about how diet culture has influenced the health and wellness world, check out my book, Anti-Diet. It’ll help you recognize and reject the sneaky, modern guises of diet culture that pretend to be all about wellness but are actually just diets by another name, so that you can focus more of your time and energy on the things that truly matter.