I have noticed an increase in particular and important questions lately, from my fellow members in the SIBO Facebook groups: Can I heal a leaky gut while still having SIBO? Which do I focus on treating first?
I really thought it was important to write a post on this topic, not only because there seems to be some confusion and uncertainty around how to treat leaky gut with SIBO, but also because of my personal experiences surrounding leaky gut, that I want you all to learn from!
Looking back, I had many signs of a leaky gut, going back over 10 years ago!
I started having food intolerances when i was just 17 years old (I am 28 now). Sadly, I didn’t think much of it, and continued to eat things I shouldn’t (such as processed foods), as well as the foods that often would give me symptoms (such as diarrhea, indigestion, nausea).
I also had terrible acne as a teen. It started around age 15, getting acne not only on my face but my chest and back, too (a teenager’s dream, right?!). In my teenage desperation to have clear skin and rid myself of embarrassment, I unfortunately went on a damaging and toxic drug: Accutane.
This probably did not help my gut in the least. It did however clear my acne very quickly, but again, having skin issues is a sign your gut is in despair! Rather than covering up the symptoms with drugs, I wish I had the insight back then to take a deeper look into the root cause! Something I sadly relied on my doctor to do, but we all know how that goes…
My food intolerances increased, and eventually I developed an autoimmune illness (again, looking back, that is a HUGE red flag that the gut needs help). Unfortunately I also didn’t know that autoimmune illness was linked to leaky gut (apparently my doctor didn’t either *eye roll*), and I went on more damaging drugs for years, likely further increasing my leaky gut.
I am not beating myself up for not knowing then what I know now (hindsight IS 20/20, right?), however I am sharing my experiences (and yours, too!) in the hopes of saving you and others from common mistakes, and unnecessary suffering. That’s what Hindsighhealth is all about!
Alright, let’s get into it, shall we? To remind you, the big questions are: Can I heal a leaky gut while still having SIBO? Which do I focus on treating first?
The short answers to the questions, in my opinion, are:
– Treat both simultaneously
Let’s start with the basics before we dive into the explanations for my above answers!
What Is Leaky Gut?
Leaky gut occurs due to a malfunction of the intercellular spaces in the gut wall. Tight junctions serve as the gateways between the intestines and control what is allowed to pass into the bloodstream.
Generally, they help keep undigested food proteins, microbes, toxins, and other harmful particles out of the bloodstream. But if a person suffers from a leaky gut, foreign particles will pass through the tight junctions. When these particles enter the bloodstream, the inflammatory reaction can be severe, and when it becomes chronic, autoimmunity can develop.
What is SIBO?
SIBO stands for small intestinal bacterial overgrowth, a condition affecting the small intestine. In simple terms, it occurs when bacteria that normally grow in other parts of the gut (such as the large intestine) start growing in the small intestine.
It can also be caused by the bacteria living in the small intestine becoming imbalanced (due to various factors, read below), certain strains then overgrowing, thus causing negative symptoms.
- Abdominal pain/discomfort
- Bloating and abdominal distention
- Diarrhea (generally associated with hydrogen dominant sibo)
- Constipation (generally associated with methane dominant sibo)
- Gas and belching
- In more severe cases, there may be weight loss and symptoms related to vitamin deficiencies
What Can Cause SIBO to Occur?
SIBO can occur for various reasons. Figuring out why SIBO occured (your root cause!) should be your first step when starting your healing process.
Some common causes (that I also outline in more detail in another post) behind SIBO:
1 – Antibiotic use
2 – Heavy metal toxicity
3 – Low stomach acid
4 – Certain medications that damage the gut
5 – Stress
6 – Impaired MMC
7 – Inflammatory diet
8 – Food poisoning
9 – Slow motility
What Are Some Causes of a Leaky Gut?
There are several known causes of a leaky gut. Let’s put them into four easy to understand categories:
1 – Food
Common inflammatory foods included: Dairy, Gluten, and Sugar. However, inflammatory foods are not always limited to the most common ones.
Because everyone’s microbiome is so unique – essentially like a fingerprint – it can be tricky to know for sure which foods are inflammatory to you and your body. That is why an elimination diet, such as Paleo AIP, is so great!
It will be difficult if not impossible to heal a leaky gut if you continue to eat known inflammatory foods. Keep this in mind no matter if you are in the beginning stages of healing, or are fully healed. Stay away from those foods, as it is never worth the potential suffering and discomfort it may cause (I have learned this the hard way, on more than one occasion!).
Another point worth mentioning is that a diet lacking in fiber-rich foods causes an imbalance of microbiota. This imbalance – or specifically the lack of beneficial bacteria in your microbiome from a lack of nutrients and fiber – in itself can cause a leaky gut.
This is because part of what makes up the intestinal barrier or tight junctions in our gut, or our bacteria! Without them, intestinal permeability increases, putting us at risk for leaky gut. This is because when we feed our gut bacteria what they need (such as fiber), they produce short-chain fatty acids, which contribute to the health of the intestinal lining and may prevent disease.
As you can see, diet is two-fold: Eating inflammatory foods can contribute to breaking down the cell walls that make up your gut, but also not eating the right things (fiber, a wide range of essential nutrients) can shrink the population of beneficial bacteria that protect our gut lining, as well as leave us vulnerable to gut dysbiosis (which is yet another cause of leaky gut!).
2 – Toxins
Toxins come in the form of medications including NSAIDS (Motrin and Advil), steroids, antibiotics, and acid-reducing drugs (such as PPIs, commonly incorrectly prescribed). Environmental toxins including mercury (I have personal experience with this one!) and other heavy metals, pesticides, and BPAs found in plastic.
3 – Gut infections
As mentioned under “Diet”, having gut dysbiosis (candida, SIBO, H.pylori etc.) can all contribute to a leaky gut. This is because beneficial bacteria help make our intestinal barrier strong, due to their output of short chain fatty acids.
When we have a gut infection or overgrowth, the inflammation caused by this can damage the lining of our gut.
4 – Stress
I have discussed the detrimental effects that chronic stress has on the body (specifically on our digestion), in a previous article. There, I explained how stress can impair the migrating motor complex, and slows down our digestive process, putting us at risk for developing SIBO.
It is also important to note again that stress, specifically chronic stress, can damage the gut, too! This is how it works:
When we’re stressed, a stress hormone called cortisol is released into the bloodstream by the adrenal glands (this one’s for you, fellow adrenal fatigue sufferers). Normal levels of cortisol are also released when you wake up in the morning or exercise. These levels can help regulate your blood pressure and blood sugar levels and even strengthen your heart muscle. In small doses, the hormone can heighten memory, increase your immune system and lower sensitivity to pain.
But prolonged exposure of cortisol/stress on our bodies is quite damaging. This is in part due to the impact cortisol can have on the proteins (such as protein claudin 1 (CLDN1) that help make up the tight junctions of our gut barrier.
That is why stress management is a very important but often overlooked (I know, it isn’t easy at all to address this component of our health) aspect to healing. I urge you to figure out what is causing your stress, and make small steps to improve them.
Some things are out of our control. I get that, too. But there are ways to make your conscious and subconscious reactions to the stressor more productive and healthy.
For example, meditation is a great way to reprogram and train your brain to not spiral out of control when having negative racing thoughts. It teaches you to become better at noticing the thought, acknowledging it, letting it go, and bringing your mind back to being present and mindful of your current environment.
I tend to fixate on negative emotions, by going into a rabbit hole of dark thoughts, raising my anxiety and stress hormone levels. Meditation is difficult (at first) but really shows you how quickly and out-of-control your brain is processing different thoughts. You become hyper aware of just how much anxiety your body must be feeling based on how difficult it is to do something so simple: be present and not let your thoughts take over.
I recommend the app Headspace to help you get into meditation. They offer a free 10-day beginner’s course that guides you through the essentials of meditation and mindfulness. You have the option to start off very slowly. I only did 3 minutes a day at first (and even that was a challenge!).
Why Should I Care If I Have Leaky Gut?
It is a term we are seeing and hearing more and more frequently. It may even be something your doctor won’t acknowledge or has never even heard of. So, you might be wondering why having a leaky gut is such a big deal and why you need to care about it.
Let’s go through the simple yet important process that takes place if/when you have a leaky gut:
Normally, in a healthy gut, the intestinal barrier protects us from all kinds of things. Its main duty is keeping food particles, toxins, antigens and bacteria inside our intestines, and out of our bloodstream.
If for example, food particles enter our bloodstream, because this is not normal, your body, naturally doing its job (more specifically your immune system), will react to it as a foreign invader.
This state of high alert causes your immune system to become overstressed (this alone is not good), and can eventually lead to your own tissues to get caught in the crosshairs. Eventually, if left unchecked, this will develop into full-blown autoimmunity or autoimmune illness, such as Crohns or Ulcerative Colitis.
Yes, that’s right – in case your doctor also doesn’t acknowledge this (mine didn’t!), IBD is linked to leaky gut syndrome.
Your body reacts this way due to something called molecular mimicry. Essentially, your body makes antibodies against these “foreign invaders” that have entered your bloodstream, and attacks its own tissue. That is because these “invaders” look very similar to your own body’s cells.
That is essentially what an autoimmune illness is! Our body is mistakenly attacking itself, causing a whole host of symptoms. Once you have an autoimmune illness, if left untreated, and your leaky gut remains leaky, you are at greater risk for developing yet another autoimmune illness.
Take it from me, having ulcerative colitis. Healing from even just one autoimmune illness can be complicated and take a long time. You certainly do not want multiple! So, if you weren’t concerned about leaky gut before, I really hope you heed this advice before it’s too late.
What Are the Symptoms of a Leaky Gut?
There are a few common symptoms of a leaky gut. The tricky part is, a lot of these symptoms overlap with other health conditions. However, if you have any of them (or even multiple), it can be an indicator and something worth looking further into!
1 – Digestive issues
Bloating, gas, diarrhea, constipation
2 – Food intolerance
Having many food intolerances both physically experienced and/or shown on a food sensitivity test can be an indicator of a leaky gut
3 – Mood imbalances
Anxiety, depression, low mood, anhedonia
4 – Skin issues
Acne, eczema, rashes, hives, etc.
5 – Hormonal imbalances
6 – Autoimmune illness(es)
7 – Chronic fatigue/adrenal fatigue
8 – Brain fog
Trouble concentrating, forming sentences, memory issues
Is There a Test for Diagnosing a Leaky Gut?
Right now, there are three main tests that can help you determine whether you have a leaky gut.
1 – Intestinal Permeability Test (Lactulose/Mannitol Test): measures the ability of lactulose and mannitol (two non-digestible sugars) to pass through the intestinal (gut) lining. The patient drinks a solution containing lactulose and mannitol and provides a urine sample after six hours; the amounts of lactulose and mannitol are measured to determine the presence and degree of leaky gut. This test is available from Genova Diagnostics.
2 – The Zonulin Test:
Measures levels of the zonulin protein present in the stool or blood to indicate the presence and degree of intestinal hyperpermeability. This test may be requested as part of a Food Inflammation Test (FIT) and requires a blood draw; it is available from KBMO Diagnostics.
Zonulin is a protein that opens the spaces between the cells of the intestinal lining. When an individual’s zonulin level increases, the seal (the tight junctions) between the intestinal cells deteriorates, leading to intestinal hyperpermeability, or leaky gut.
By avoiding wheat and gluten, you can ensure your levels of zonulin stay low, and decrease your chances of causing a leaky gut.
3 – Food sensitivity test:
Some doctors or naturopaths might recommend doing a food sensitivity test, also known as an immunoglobulin G (IgG) blood test. This test is controversial because it is usually not very accurate. However, I have found that if you have many intolerances or food sensitivities show up on this kind of test, it can signify that you have a leaky gut. It can mean that your body is overreacting due to being leaky, causing an immune response to several foods.
My food sensitivity test showed several food items that I was “sensitive” to, even though I had no noticeable symptoms whenever consuming those foods. Rather than cut those foods out, I took it with a grain of salt, and decided it was another sign my gut was leaky and needed repair.
Now that we’ve covered some basics on leaky gut, let’s get into more details on answering these important questions.
Can I heal a leaky gut while still having SIBO? Which Do I Focus On Treating First? SIBO or the Leaky Gut?
The complicated nature of this question starts with whether or not SIBO causes leaky gut, or if leaky gut causes SIBO.
As mentioned above, high zonulin levels can cause a leaky gut, and increased levels of zonulin can arise if you have SIBO. So it is very possible that SIBO caused your gut to become leaky!
It is also possible that a leaky gut caused your SIBO as well. Just as with chronic parasitic infections, a weakened GI system can also cause an imbalance of bacterial life or dysbiosis.
When there’s a pH change in the GI system, conditions like SIBO can arise. This change in your body’s pH can also cause higher levels of opportunistic bacteria such as H. pylori and E. coli. A GI Map test can help you determine what bacteria might be out of balance so you can target the problem.
Based on the above, we can see that it is difficult to know which came first: Leaky gut or SIBO. However, if you know you are dealing with both issues, I strongly believe treating both at the same time is important.
If you only treat the leaky gut, but still have a bacterial overgrowth, the leaky gut will struggle to heal, or simply get damaged again shortly after.
If you only treat SIBO, but still have a leaky gut, again, you may be able to get rid of the bacterial overgrowth, but it may come back again shortly after, as the opportunistic bacteria will take advantage of the weakened GI system due to the leaky gut.
There is no harm, in my opinion, in treating both simultaneously. Even if you are unsure whether you have a leaky gut, the supplements and changes to your lifestyle that are recommended (discussed below) for leaky gut will only benefit you!
How Do I Treat a Leaky Gut?
The most important first step in healing a leaky gut is figuring out what caused it in the first place! Similarly to how your first step in treating SIBO is figuring out your root cause, the same applies to a leaky gut. If you treat with supplements, but are missing a major contributing factor, such as taking Ibuprofen frequently, or eating inflammatory foods, you will likely struggle to ever treat your leaky gut.
Also remember, it can take anywhere from 6 months to over a year to heal a leaky gut, without any underlying factors (such as an autoimmune disease), so imagine how frustrating it would be to spend all of that effort and time, with little progress, simply because you weren’t aware of your root cause!
For those of us who are lucky to not have any major underlying factors, it can take 2-12 weeks to see a significant improvement in your leaky gut.
Once you have uncovered your root cause(s) to getting a leaky gut, it is then important to address them. For example, if one of your causes is an inflammatory diet, or the Standard American Diet, it would then only make sense to change your diet to one that removes inflammatory foods, and replace it with one that focuses on healing, nutrition and foods you can tolerate.
After you have addressed your root cause, you can then look at supplements to help with healing your gut.
Here is the List of Natural Supplements That Are Proven to Help With a Leaky Gut:
1 – L-Glutamine
Dosage: anywhere between 2 and 5 grams per day is typically a good dose for most people. Powder form is best absorbed compared to capsule form. My naturopath instructed me to take on an empty stomach, in the morning and before bed, as it is better absorbed as opposed to with food.
2 – Marshmallow root
3 – Slippery elm
4 – Collagen
I use collagen peptides
5 – Zinc
There is evidence that zinc plays an important role in gut health. Zinc deficiency can actually alter your gut bacteria (which you know by now, dysbiosis can cause a leaky gut), and supplementing with zinc can also help repair a leaky gut.
Note, zinc can also inhibit or decrease stomach acid. If you have been prescribed PPIs, for H.pylori, gastritis or ulcers, studies show that zinc can be an effective alternative, but it is not conclusive.
6 – Bone broth
Bone broth is an excellent tool to heal a leaky gut. It contains gelatin and collagen (collagen makes up about 30 percent of the protein in your body, as well as many minerals (Calcium, Magnesium. Copper, Iron, Manganese, Phosphorus, Potassium, Sodium, Zinc).
In a mouse model, gelatin supplementation reduced the severity of colitis by strengthening the mucus layer and altering gut microbiota composition.
Note: An acidic medium is necessary to extract these minerals from your meal. When making broth, always add a splash of vinegar or other acids (I use apple cider vinegar) in order to extract the most minerals from the bone.
An important consideration on bone broth: Some people cannot tolerate bone broth, especially at the beginning stages of gut healing. This is due to:
Glutamates are the main excitatory neurotransmitter in the brain. They keep us alert, and are essential for memory and learning. Some people are sensitive to the high amounts of glutamates that might be found in bone broth.
I personally couldn’t drink bone broth at all when I first started healing/when I still had SIBO. It made me feel anxious and nauseous.
A great alternative for those who are glutamate-sensitive is to make meat stock. A significant difference is that the meat stock is not cooked as long as bone broth (meat stock is cooked for about 1-2 hours, bone broth 24-48 hours), but still contains a similar benefit profile.
For more information on the difference between meat stock and bone broth, id highly recommend reading this excerpt from the GAPS diet protocol.
Some Lifestyle Changes That Will Help Heal and Avoid a Leaky Gut
Another overlooked but important aspect to gut healing is taking a look at your lifestyle. Both toxic products/chemicals as well as stress can contribute to your gut becoming and staying leaky!
Just to give you an idea on how exposed we are to toxic chemicals: Did you know that women use an average of 200 chemicals on their skin every day?
More than 12,000 chemicals are approved for human use by the FDA. We simply cannot rely on the government to protect us from harmful chemicals. Nor can we assume that what we see on the shelves is safe and has been evaluated by the appropriate departments.
It may be overwhelming, so I recommend starting slow, but replacing your cleaning, body and hair products with more safe and natural ingredients is required if you want to avoid hurting your gut. It is a straight-up fact that the chemicals we use daily are wreaking havoc on our gut microbiome (along with even altering our DNA!
Again, start small. I don't recommend attempting to throw everything away at once. This may leave you overwhelmed with such a big change, so quickly. Like any lifestyle change, the ones that tend to stick are the ones that are manageable and not overly drastic in a short amount of time 😉
I know for myself, it took quite a while for me to get onboard with the idea of throwing away or discontinuing use of some of my products: Will the alternative work just as well? I don’t have time to make my own products! It’s just so much more convenient to go and buy it in the store! How bad can they really be?
But eventually, I just accepted that I need to stop using things that I know are bad for me. I no longer want to support companies who put profit over the health of people and the environment, and I no longer want to pay to poison myself. That may sound dramatic, but that is the absolute truth of the matter.
Working so hard to fix your health and microbiome while still using products that are proven to hurt you and your gut bacteria, just doesn’t make sense.
I will be honest with you guys, because I don’t want to make all of this seem easy – I know it isn’t. I have a couple of products I still have yet to give up, or find good replacements for (I just love my perfume 🙁 ). But I will say I haven’t given up! I recently ordered some essential oils and will attempt to replace that perfume, because again, I can’t be trying to heal my leaky gut, but at the same time continue to use harmful chemicals. It just doesn’t make sense, and I am owning my illogical behavior!
It's best to choose one product, and find a healthier alternative. There are many brands out there that make products that contain NO harmful chemicals, such as BeautyCounter, Way of Will, TruSelfOrganics, and Native. I personally love Native's deodorants, toothpaste and body wash!
There are even tons of websites nowadays that show you how to easily and affordably make your own products such as for cleaning or your body. I recommend The Coconut Mama for great recipes.
Another overlooked aspect to healing our guts is heavy metals. They are in our food, in our water, even in our mouths. Wondering why that candida is so stubborn? Heavy metals could be another factor. Heavy metals suppress your immune system, and may even bind to the candida.
If you go look at your kitchen pot/pan set, I can almost guarantee you are using material that contain PFOAs or PFOs, which are harmful for our health, and have even been shown to possibly alter our microbiomes.
It may seem like an impossible task to avoid exposure to heavy metals, however there are some things we can do to minimize exposure.
1 – Install a water filtration system
I recommend and personally use the AquaTru. According to their website, it is certified to remove 78 toxic chemicals including:
• Chromium 6
• Chlorine and Chloramine
• Pesticides and Fertilizers
• PFOA and PFOS (I’d recommend watching ‘Dark Waters’, or ‘The Devil We Know’, for more info on how harmful and prevalent these chemicals are).
I prefer the AquaTru over the Berkey, because the latter does not remove as many chemicals as the former.
Not only that, but the taste (or lack thereof) of my water is so much better now!
Equally, install a water filter for your bath and/or shower head. I could literally smell the chlorine when I would run my shower or bath. Depending on where you live, the chemicals or heavy metals found in your water will vary. My city even recently sent a letter to my area, informing us that we sit above old lead pipes, and not to drink the water straight from the tap, as it may contain lead (thanks for the info, would have been helpful much sooner!).
You also have the option to purchase water testing kits, to see exactly what is in your water, so you can buy the appropriate water filter, however I have seen mixed reviews as to whether these tests are accurate. That is why I opted for a shower filter that claims to filter out various things like chlorine and heavy metals, and turns hard water soft. I also chose based on reviews that say they noticed a difference by using the filter.
I have noticed the chlorine smell is now gone, and my hair looks much cleaner after washing, as opposed to without the filter. Win-Win!
2 – Buy Organic
Organic foods are not sprayed with pesticides and harmful chemicals that contain heavy metals. Unfortunately even by buying organic, many foods are still found to contain heavy metals. Buying organic simply reduces the risk of exposure, but does not eliminate it completely.
3 – Pick snacks lower in heavy metals
Apples, unsweetened applesauce, avocados, bananas, beans, cheese, grapes, hard-boiled eggs, peaches, strawberries and yogurt are snacks that were found to be low in heavy metals.
4 – Safely remove amalgam fillings
Unfortunately this is one that hits close to home. Before I was aware of the dangers of amalgam fillings, I had 3 or 4 replaced unsafely (no precautions such as a dental dam, oxygen, etc.) with composite fillings. I was then exposed to toxic mercury vapors that were released during the drilling process.
In case you also weren’t aware (it is not common knowledge unfortunately), mercury in amalgams is dangerous to your health. Mercury in other forms being bad for our health IS common knowledge, yet most medical professionals (i.e western medicine doctors or non-IAOMT dentists) will deny the mercury in amalgams as being unsafe (um, what?).
Little side note: When I was on the hunt for a holistic/IAOMT dentist, I found one that claimed to be a holistic dentist, but then told me he used no safe precautions to remove amalgam fillings. Luckily I found an actual holistic dentist who told me “If a small speck of amalgam ends up going from your mouth, down into the drain of our sink, the city will fine us thousands of dollars, due to the damages it can cause on the water and wildlife. So why would it then be safe to use in your mouth?” I couldn't agree more, Mr. Dentist!
Interesting (but sad) fact: Before scientists understood the toxicity of mercury to humans, it was used in cosmetics, medicines, and in curing felt for hats. In fact, this is where the term “mad hatter” came from. Hat makers often developed physical and mental ailments due to their ongoing mercury exposure.
Shortly after my unsafe removal of amalgams, my health declined and I developed SIBO, adrenal fatigue/thyroid issues, among a whole host of other symptoms. Coincidence? I am beginning to think not.
5 – Replace your cookware with non-PFOA/PTFE material
Personally, after much research (who would have guessed it would be difficult to find alternatives that don’t try to mislead the consumer?) I decided to test out Green Life cookware.
So far I am happy with my purchase and feel good about no longer using toxic cookware.
Tips on Preventing Recurrence of a Leaky Gut
If you follow the advice I have given, as well as the many other resources and information out there on leaky gut, I am confident you will not see a recurrence of leaky gut.
However, if you do happen to have any symptoms in the future, I hope you will learn to be more vigilant and aware of your body and how it is feeling! If you have any strange symptoms, or something is not right, take a moment to reflect on what has changed recently.
Maybe you have been eating things you shouldn’t, or you haven’t been getting adequate sleep. If things are more severe, run some tests. Be proactive so you don’t end up in a bad situation where your life is put on hold, and you have to do more work and spend more money getting out of it!
Both leaky gut and SIBO can have terrible and uncomfortable symptoms that can wreak havoc on our lives in so many ways. I hope the above information helped answer the questions “Can I heal a leaky gut while still having SIBO? Which do I focus on treating first?” !
As you have learned, you would ideally tackle both at the same time, as a leaky gut can both cause SIBO, and be caused by SIBO.
Healing a leaky gut can take some time, depending on your root cause(s), and how well you implement changes to your lifestyle.
I started healing my gut almost two years ago now, and I am still working on it. I have made great progress, being able to tolerate much more food items, and my skin suffers less from acne.
However, unfortunately one of my biggest root causes (mercury toxicity) was only recently discovered. It may take me another year or so (depending on how mercury-toxic I am, and how effectively my body can tolerate the chelation therapy), to fully heal my body and gut.
It may take time, persistence and a lifestyle overhaul, but don’t give up. Getting your life and health back on track is doable. Is there really any other option?!
I am confident that I am making the right paths to healing, and I believe you will, too, with the right information and learning from mine and others’ experiences!
Happy gut healing 🙂