Friday Q&A: on "leaky gut"; artificial sweeteners; anxiety & gastrointestinal woes; & when to take a probiotic & test my microbiome?
You ask the best questions!
It’s Friday Q&A time!
This week is all about gut health. (Next week is a COVID news roundup!)
Check out this week’s newsletter about irritable bowel syndrome and improving your gut health.
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The first question today (about “leaky gut” syndrome) is for all subscribers. The remaining questions (about alternatives to chewing gum, the link between anxiety and GI distress, and biomarkers of a healthy gut) are for paid subscribers.
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Let’s dive in!
What is leaky gut syndrome?
- Ann in Ann Arbor, MI
Great question! I commonly hear from patients whose Google search tells them they might have “leaky gut.”
Here’s what we know: The lining of our intestines is permeable. The delicate membranes from our mouth to our rear ends are resigned to absorb water and essential nutrients—and to prevent toxins and other substances from “leaking” into the bloodstream. Intestinal permeability is a recognized feature of several inflammatory and autoimmune diseases affecting the digestive system, including inflammatory bowel disease and celiac disease.
Here’s where things get murky: Leaky gut syndrome is a condition that some people believe exists, but it is not a recognized medical diagnosis by most medical professionals. The concept of a “leaky gut” is that, for some people, the intestinal lining is overly permeable, allowing toxins and potentially harmful substances into the bloodstream, which can cause inflammation and other health problems.
In the case of various inflammatory gut problems (such as Crohn’s disease, Ulcerative Colitis, or celiac disease), scientists generally consider increased membrane permeability to be a symptom, not a cause. In other words, there is not enough evidence to support the concept of leaky gut syndrome as a standalone diagnosis.
Patients who tell me they think they have “leaky gut” usually are experiencing gas, bloating, and irregular bowel movements for the same reasons I’ve discussed this week. Whether or not we call these symptoms “leaky gut” or irritable bowel is pretty immaterial. What matters most is trying to identify the root cause of the patient’s symptoms; connecting the dots between their laboratory data, colonoscopy history, dietary “inputs,” and emotional state; targeting treatment to the underlying cause when able; and managing the symptoms with a hefty dose of humility (from the doctor’s side) and patience (on the patient’s side). I find that we can usually get to the bottom (😭😆) of these issues!
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In your podcast this week, you talked about how chewing gum and artificial sweeteners can cause gas and bloating. I love chewing gum! It helps me stay focused and it prevents my mouth from getting too dry. Is chewing gum bad for me, and if so, what should I replace it with?