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Ask Dr. Mike: What Is Leaky Gut?

Here you'll find the answers to a wealth of health and wellness questions posed by Healthy Talk fans.

Listen in because what you know helps ensure healthy choices you can live with. Today on Healthy Talk, you wanted to know:

What is leaky gut?

Intestinal permeability happens when the junctions in your gut that control the lining in your small intestine don't work properly. This causes metabolic toxins and undigested food to enter into your blood stream. This can result in numerous unpleasant and vague symptoms like bloating, fatigue, hair loss, heartburn, brittle nails, mood swings, muscle pain and a handful of others. Leaky gut can lead to a variety of other health issues, such as asthma, arthritis, eczema and even obesity.

If you're having gut issues, you should speak to your doctor first to rule out certain autoimmune disorders that affect your gut, like Celiac disease and IBS.

There are some ways you can address your leaky gut, including:

  • Zinc
  • Liquorish extract
  • Milk thistle
  • B vitamins
  • Artichoke extract
  • Fish oils
  • Tart cherry extract
  • Boswellia extract

If you have a health question or concern, Dr. Mike encourages you to write him at This email address is being protected from spambots. You need JavaScript enabled to view it.  or call in, toll-free, to the LIVE radio show (1.844.305.7800) so he can provide you with support and helpful advice.

RadioMD Presents:Healthy Talk | Original Air Date: May 14, 2015
Host: Michael Smith, MD

RadioMD. It's time to ask Dr. Mike. Do you have a question about your health? Dr. Mike can answer your questions. Just email This email address is being protected from spambots. You need JavaScript enabled to view it. or call now 877-711-5211. The lines are open.

MIKE: Two years ago I joined a live, medical on-line forum that WebMD did. It was on gastrointestinal disorders. An update on inflammatory bowel disease, cilia, and that kind of stuff.

I was just really listening and I wasn't really paying attention until another doctor asked the question, "What is leaky gut?" That caught my attention because you have to remember, I have been working in the natural medicine industry for about ten years now, so I think I am a little more familiar with leaky gut that most medical doctors. Naturopathic doctors, chiropractors--they are much more up to date on this concept of leaky gut than an average M.D., but I am better than the average M.D. When I saw that question asked, it caught my attention and I was really curious to see how the moderator for this forum was going to answer the question.

His answer was something along the lines of "Leaky gut means you still have a diagnosis that needs to be diagnosed, or you still have a disease that needs to be diagnosed." It was his way of skirting having to answer the question because he probably really didn't know. That is how a lot of medical doctors see this idea of leaky gut. It's not something that we are really taught in medicine. Although we are a little bit and I'll explain that in a moment. Leaky gut is one of those things where, to a medical doctor, they just need to do a better job at figuring out what the actual disease is.

That is how most medical doctors see this concept of leaky gut. In answering the question, I think we first have to just give a clear cut definition of what leaky gut is. All it is, is hyperpermeability of the gut lining. Obviously, when you bring things into your GI tract--it is a tube for the most part--it digests all of these foods and it brings in the stuff you want and it keeps out the stuff you don't want. There is a very specific type of permeability between the lumen of the gut and bringing stuff into the bloodstream. It is permeable, things do get in, but it is selective.

The gut is a smart tube. It's not just a tube, it's a smart tube. It's permeable, but it's selective in what it allows to permeate into your bloodstream. It has to be. You don't want to bring in toxins and poisons.

It is not a perfect thing. It's not a genius at this, but it is smart. It does keep bad things out, but even in a healthy gut, obviously, toxins and stuff gets in, but that's where you get the liver to detox stuff. But that's the role of the gut, to bring in the stuff that you want, leave out the stuff that you don't want and then that stuff you don't want goes out the other end. That's a pretty simple way to think about it.

Leaky gut is when too much of the stuff that you don't want gets in. It becomes hyper, a high level of permeability to things normally that would have been kept out; now get into your system. That is leaky gut-hyper permeability.

The question becomes – why, then? When that happens, symptoms of leaky gut could be a lot of body aches, muscle aches, joint aches, pain syndromes, are very common in leaky gut. Because inflammation goes up, for instance, more toxins are getting in. That is probably the link. Bloating, gas, all of these things. You could have a lot of digestive symptoms, but you can also have more systemic type symptoms. Food sensitivities go up with leaky gut. Stuff like that. The question is what is causing it.

In one respect, the M.D.s like my colleagues were right. In many cases, there is a reason for it and that should be investigated. For instance, we know that in the context of hyperpermeability, leaky gut, there is a higher risk for inflammatory bowel disease, irritable bowel disease, celiac disease. There needs to be an appropriate work up. If somebody comes in with aches and pains and bloating and gas there are some very basic things that any doctor should do.

Digestive enzymes and a good work up of the bowel itself. Maybe even a scope looking at the lining. Is there some inflammation there that might be causing that? Because you want to rule out some of those major diagnoses. Of course, we don't really know if something like inflammatory bowel disease, like Crone's disease, is causing the hyperpermeability or the hyperpermeability caused the Crone's disease.

That is still a question, we're not really sure which way it goes, but there does need to be a good work up. But once you've ruled out those big diagnoses, the irritable bowel, inflammatory bowel, celiac, ulcer disease, once you've ruled a lot of that stuff out, you are left with just this unknown reason for somebody to have these symptoms that seem to be hyperpermeability. This is where I think medical doctors do a big disservice to patients. Often we don't know what to do at that point.

We don't offer a lot. This is where natural medicine really shines in these kinds of cases. What is leaky gut? It's hyperpermeability. It is caused often by some of these bigger bowel diagnoses. You have to rule those out. If you rule those out and you still have the symptoms of hyperpermeability, here are some things that you can do. Carnosine.

It is a dipeptide of alanine and histidine. Carnosine is very soothing to the gut; it has a healing property to the gut.

About a thousand milligrams a day. There is an herb called picrorhiza. I can never remember if it is a Himalayan herb or an Amazonian herb. I always forget where picrorhiza is naturally from. Picrorhiza is an herb that also has some of those same properties of carnosine. At Life Extension, we have been using picrorhiza for a few years now based on some good, good research in ulcer disease. Licorice extract – also good for the gut lining. Zinc is also very important.

As a matter of fact, there is this complex of zinc and carnosine that the Japanese have been using as a prescription drug for a long time to heal ulcers. If we need to heal the gut, if we need to decrease the inflammation and allow repair and healing to occur so we can decrease the permeability, maybe that zinc/carnosine combination that they use in Japan for ulcers might be appropriate here.

So, there are some things that you can do. Of course, you are going to want to detox as well, because with leaky gut, with hyperpermeability, you're brining a lot of gunk that you don't want. So, it's important to raise antioxidants in your body. It's important to do some liver support products like milk thistle and artichoke extract, and B vitamins and glutathione. Those are all critical to all the different stages or phases of detoxification in the liver.

Support your liver as well. Also, some anti-inflammatories. Your fish oils, your tart cherry extracts, the curcumin, all of those can be done. Boswellia extract—a medicinal plant—is one of my favorites for an anti-inflammatory regimen.

So, what is leaky gut? In very simple terms, it's just things that you don't want to get into your system get in because the gut has lost its ability to be selective in what it allows to permeate in, so it is hyperpermeability. Carnosine, picrorhiza, licorice, zinc, do some detox--those things are going to help with leaky gut.

But make sure you rule out a big diagnosis. This is Healthy Talk on RadioMD. I'm Dr. Mike. Stay well.