What UK patients ought to know about a leaky gut test and the NHS

If you are wondering if you’ve got leaky gut and whether you should get a test, read on for an overview of what your options are and possible ways forward.

 

Leaky Gut – The awkward NHS viewpoint

In the UK there are issues to consider with the NHS for those with leaky gut problems, basically the NHS view is one of scepticisim regarding

  1. the existence of leaky gut syndrome.
  2. the possibility of leaky gut being a direct cause of any medical condition.
  3. the effectiveness of any treatment of leaky gut.

See NHS Choices – “Leaky Gut Syndrome” for details on this.
Therefore it can be tricky for the patient who needs help. It’s possible that discussion of your leaky gut concerns with your G.P. may not go well and you are unlikely to get a leaky gut test on the NHS just like that.

Does it exist?

Firstly, in regard to this NHS viewpoint, with thousands of published articles on leaky gut issues there is a lot of scientific literature that is worthy of consideration. The connection between gluten and leaky gut has been explored by Dr Alessio Fasano of the University of Maryland Celiac Research Center. He found that gluten stimulates the body to release a protein called zonulin which opens up the tight junctions in the gut wall increasing intestinal permeability. His study “Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines,” 2006, concluded that this occurs “irrespective of the genetic expression of autoimmunity.” So not just in celiac sufferers.

Correlation does not imply causation?

Not necessarily. The skeptics view regarding the presence of intestinal permeability issues in people with autoimmune conditions is generally that its a side effect of the condition, not a cause. In refuting this, while we cannot simply point to a condition and say “that is caused by leaky gut,” research is now showing that there are links and correlations between intestinal permeability and medical conditions.
The evidence is mounting that leaky gut may be required for an autoimmune condition to develop. For instance,

  • the study “Intestinal Barrier Dysfunction Develops at the Onset of Experimental Autoimmune Encephalomyelitis, and Can Be Induced by Adoptive Transfer of Auto-Reactive T Cells, ” Nouri, 2014, states that “intestinal permeability, often referred to as a “leaky gut”, is playing a pathogenic role not only in development of gastrointestinal disorders like inflammatory bowel disease and celiac disease, but also in systemic autoimmune diseases, like type 1 diabetes “
  • In 2008 a paper in the NeuroEndocrinology Letter, “The Gut Brain barrier in major depression…” detailed a study in which the results showed that leaky gut “plays a role in the inflammatory pathophysiology of depression.”
  • Dr Daniel Hollander’s 1986 study “Increased intestinal permeability in Crohn’s patients and their relatives: an etiological factor ” found that a high level of intestinal permeability was present in a group suffering from Crohn’s AND in a group of their relatives who were genetically susceptible but unaffected by Crohn’s. This suggests that the intestinal defect may not be a by product of the condition, but may contribute towards its development.

Are treatments effective?

The scepticism around treatments is understandable when considering the market for the number of products relating to leaky gut issues that are available for purchase from the local pharmacy, supermarkets, health food stores and online specialists. Everything from supplements for individual vitamins through to actual “leaky gut” labelled products(see the Four R’s treatment program). However, with a bit of digging there are noteworthy clinical studies that suggest real results can be achieved with some supplements.

  • The study “Zinc supplementation tightens “leaky gut” in Crohn’s disease,” Sturniolo, 2001, concludes that zinc supplementation can resolve permeability alterations in patients with Crohn’s disease.
  • The study “Glutamine pretreatment reduces IL-8 production in human intestinal epithelial cells by limiting IκBα Ubiquitination,” Hubert-Buron, 2006, concludes that glutamine decreases the inflammatory response in our gastrointestinal tract cells.
  • The same conclusion with glutamine is drawn in the study “Glutamine prevents cytokine-induced apoptosis in human colonic epithelial cells,” ME Evans, 2003.
  • Considering use of probiotics to restore gut health, their value has been shown in studies such as “L. plantarum prevents enteroinvasive Escherichia coli-induced tight junction proteins changes in intestinal epithelial cells.” Qin, 2009, and “Probiotic Escherichia coli Nissle 1917 inhibits leaky gut by enhancing mucosal integrity.” Ukena, 2007.

Getting a test

Bearing in mind the already mentioned possible difficulties around these issues of leaky gut when seeing your NHS doctor, it goes without saying that the patient may need to go their own way and that can carry significant costs if getting tested.

So what are the testing options for leaky gut?

Lactulose and mannitol testing evaluates nutrient absorption. After an ingestion period the levels are tested in a urine sample, in order to determine how much of these sugars are permeating through the intestinal wall. It shows what is getting through the barrier. Levels can be compared if repeating the test in order to assess healing progress.
A superior option is a test like the Cyrex Intestinal Antigenic Permeability Screen. It assesses damage to gut barrier and proteins. Included is zonulin testing, as previously mentioned, zonulin increases intestinal permeability, so testing for it can be a useful biomarker. This test can flag up gut wall problems ahead of a decline in absorption function, so enabling treatment to begin sooner.
Other testing helps to build up the full picture, such as testing for food sensitivities, bacterial dysbiosis and nutritional deficiencies.

Should i bother?

The next question to consider is “should I be getting tested?” The issue here is that the treatment is the same whether you have a test result or not. Testing can give valuable cause information, it can be a personal preference and cost can be a factor. Some patients benefit from the knowledge of what is actually happening, for instance a test result confirming the impact of gluten may enable the sufferer to understand the need for the strict diet and thus be able to cope with it better. Clarification of cause of leakyness can obviously help, i.e is it a food/gluten issue or bacterial infection? Also tests enable patients to track their progress of treatment giving a representation of effectiveness.

What next?

Regardless of getting tested or not, changes to diet, lifestyle and environment are the solution to fixing your leaky gut. It’s about looking at overall health, not just intestinal health. The four R program will address intestinal issues but lifestyle issues such as sleep and stress along with environmental factors like exposure to toxins are all part of the picture too. The contributing factors and processes of healing are different for everyone, it takes some work, time and patience to get on the right track.

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