MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Increased intestinal permeability, also often called leaky gut syndrome, has been popularized by some health practitioners, mainly those of so-called alternative medicine (SCAM). There is insufficient evidence to support its existence and the claim that SCAMs are effective treatments of it is unsubstantiated.

This study aims to describe the health-seeking behavior of Australian adults with suspected increased intestinal permeability (IP). A cross-sectional survey was conducted of 589 Australian adults who have been diagnosed with IP or have suspected (undiagnosed) IP.

The majority (56.2%) of participants with suspected IP reported self-diagnosing their condition, with the majority (56.7%) of these participants preferring to be assessed using an accurate method by a general practitioner or naturopath. On average, Australian adults with suspected IP spent 11.1 (95% CI: 9.5, 12.8) years between first suspecting IP and receiving a formal diagnosis. Over the previous 12 months, participants spent an average of $699 on consultation fees, $2176 on dietary supplements for the treatment of IP, and an average of $287 on the assessment of IP. Furthermore, participants who find it difficult to live on their available household income spent significantly more (mean=$2963) on dietary supplements compared to participants who find it easy to live on their available household income ($1918) (p=0.015).

In terms of the preferred method of treating IP, participants ‘strongly prefer’ the use of dietary products (n=392, 82.2%), followed by lifestyle habits (n=357, 76.5%), and dietary supplements (n=324, 68.6%). On the contrary, 82.8% (n=351) of participants ‘slightly prefer’ the use of medications to treat IP, representing the least preferred method of IP treatment.

The authors concluded that the majority of participants experienced a considerable length of time between first suspecting IP and receiving a diagnosis of IP. The out-of-pocket expenditure associated with the management of IP suggests a financial burden for people with suspected IP. The results of this study provide novel patient-centred considerations that can be used to inform a clinical practice guideline for the management of IP.

I would, however, draw a very different conclusion from these data: patients who think they suffer from IP often fall into the hands of SCAM practitioners who assure them to have a non-existing disease and relieve them of their money by treating them with bogus SCAM.

17 Responses to Increased intestinal permeability: a dodgy diagnosis, diagnosed by dodgy means, and treated by dodgy therapies

  • Wasn’t increased intestinal permability due to inflammatory bowel disease part of the mechanism that Andrew Wakefield proposed for the measles vaccine to cause autism?

    Although in the series of children in his paper none of the bowel biopsies showed inflammatory (or any other) bowel disease, so he had to make that bit up. Also they weren’t all autistic and they hadn’t all had the measles vaccine, and those that had didn’t show any temporal relationship between them, so he had to make that up, too.

  • EE: There is insufficient evidence to support its (IP) existence…

    Having you even looked into it? Just this past year PubMed shows 129 reviews that include the topic, 460 in the last 5 years.

    • I am so glad you mention this.
      I did look into it.
      please show me a couple of studies that show the syndrome is real

      • these are the common tests used for investigation of IP:

        “Currently, a number of non‐invasive tests to measure IP in humans are being used. Urinary recovery of orally administered sugars (ie sucrose, lactulose to mannitol ratio (L/M), lactulose to rhamnose ratio (L/R), sucralose to erythritol ratio (S/E) and sucralose) are widely accepted as markers for IP. Five hour (h) urinary sucrose levels are used as indicator for gastroduodenal permeability, 5‐6 h L/M and L/R as indicators for small intestinal permeability, and 5‐24 h or 0‐24 h S/E as indicators for colon and whole gut permeability respectively.”

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756870/

    • WANT A DECENT SUMMARY OF ALL THOSE REVIEWS?
      Whatever you hear in the media, the fact remains that there is no quality research to support the existence of ‘leaky gut syndrome’. The situation becomes especially dangerous when you consider that the symptoms associated with this disorder are present in a number of other illnesses, so a quick diagnosis of leaky gut is more likely to leave patients untreated for what really ails them.
      https://badgut.org/information-centre/a-z-digestive-topics/leaky-gut-syndrome/

      • EE: Increased intestinal permeability, also often called leaky gut syndrome,

        There is insufficient evidence to support its existence

        BTW: IP and LGS are not the same thing. If you are referring specifically to LGS you should make that clear.

  • In view of comments expressed here and previously in this Blog, I have amended my view/understanding of the role of Increased Intestinal Permeabilitiy.

    Over the years, it was sometimes spoken of as a possible contributing factor in, or complicating aspect of, atopic skin disease.

    In view of what is expressed here, I dug out the books, to see if there is any reference. Sure enough, there isn’t!

    The books I refer to are: “Atopic SKin Disease, A Manual For Practitioners” by Bridgett. Noren and Staughton (Wrightson Biomedical, Petersfield 1996); “Clinical Dermatology 4th Ed”. Rona M. McKie, OUP 1997; “Atopic Dermatitis The Epidemiology, Causes and Prevention of Atopic Eczema” Ed. Hywel Williams, Cambridge University Press 2000.

    The last title above, pertinently has this, on p251:

    “A profusion of poor quality or misleading research is almost as undesirable as no research at all. Although poor quality studies are occasionally useful in generating debate and hypotheses, the general quality of studies which purport to be ‘epidemiological’ studies of Atopic Dermatitis (AD) has been variable. Many studies which the author is asked to peer review for journals still fail to specify how AD was defined, to provide an adequate description of the sampling strategy, or to discuss the possible roles of chance, bias and confounding as alternative explanations for study findings. Such disregard for basic epidemiological principles is likely to result in erroneous conclusions, and it is essential that dermatologists and other clinicians work alongside professional epidemiologists in order to improve aspects of study design and report writing”.

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