Does your gut need a reset?

Yes, I'm Ready

Do you want to start feeling better?

Yes, Where Do I Start?

Do you want to start feeling better?

Yes, Where Do I Start?

Your Guide on How to Use Probiotics for Leaky Gut

Understanding the Role of Probiotics in Healing Leaky Gut Syndrome

Key Takeaways
  • Probiotics are a key approach to healing leaky gut and can repair the gut lining, reduce inflammation, and restore the gut microbiome.
  • Probiotic supplements help reduce symptoms associated with leaky gut syndrome, including bloating, abdominal pain, stool changes, fatigue, and brain fog.
  • It may only take a few weeks to see the beneficial effects of probiotics for leaky gut.
  • Multi-strain probiotics are preferred and should be used alongside an anti-inflammatory diet for best results.

Thinking about trying probiotics for leaky gut? These beneficial bacteria are likely a good place to start, as they work fast to help repair the lining of the gut, can reduce symptoms associated with leaky gut, and will get you back on the road to better health. 

Research shows that probiotics decrease intestinal permeability (leaky gut), which is linked to many chronic health conditions, like obesity, chronic fatigue syndrome, autoimmunity, and irritable bowel syndrome (IBS). 

They can help fix an imbalance of gut bacteria, reduce an overzealous immune response, and put a halt to inflammation — all of which are thought to contribute to leaky gut syndrome. Probiotic supplements are also effective at improving many non-specific health symptoms associated with leaky gut, such as bloating, brain fog, fatigue, and joint pain.

Though many people see relief from their leaky gut symptoms in just a few weeks after starting probiotics, remember that they’re only one piece of the treatment puzzle and work best when implemented with a healthy diet and lifestyle. Let’s take a look at what the research says about probiotics and gut permeability.

What Is Leaky Gut?

Leaky gut syndrome — otherwise called intestinal permeability — occurs when an unhealthy gut environment breaks down the mucosa lining the small intestine. This disruption in the intestinal barrier allows food particles and bacterial toxins to slip through the tight junctions (spaces between the cells) lining the digestive tract [1].

Once these unwelcome intruders get into the bloodstream, the immune system sees them as foreign and initiates an inflammatory response. This inflammation can target many areas of the body and may cause a wide range of symptoms, including digestive complaints, joint pain, fatigue, food sensitivities, and brain fog after meals. 

Who Has Leaky Gut and What Causes It?

While digestive issues like gas, bloating, constipation, and diarrhea are certainly common in those with leaky gut syndrome, it isn’t exclusively associated with gastrointestinal symptoms or conditions. The immune dysfunction seen in leaky gut is linked to numerous chronic health conditions, including [2, 3, 4]:

  • Aging
  • Metabolic syndrome, insulin resistance, and diabetes
  • Elevated cholesterol and triglycerides
  • Obesity/being overweight
  • Inflammatory bowel disease (IBD), like Crohn’s disease and ulcerative colitis 
  • Irritable bowel syndrome (IBS)
  • Polycystic ovary syndrome (PCOS)
  • Celiac disease
  • Chronic fatigue syndrome
  • Non-alcoholic fatty liver disease (NAFLD)
  • Autism and ADHD
  • Gut infections
  • Pancreatitis
  • Autoimmune disease

Leaky gut isn’t a generally recognized diagnosis, but intestinal permeability is widely recognized in the scientific literature. If you have any of these conditions, you may very well have a leaky gut too. 

Below is a summary of symptoms and chronic health problems that may be tied to leaky gut syndrome. Keep in mind that some people may have multiple symptoms that affect several body systems, while others’ symptoms may be limited to just one body system (like the skin).

Body SystemLeaky Gut SymptomsResearch
DigestiveBloating, abdominal pain, IBS, colitis, Crohn’s, IBD[5, 6, 7, 8]
Brain/NeurologicalMental health conditions, such as depression, anxiety, brain fog, and pain syndromes[9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19]
Energy ProductionFatigue (especially after meals), chronic fatigue[14, 20, 21]
JointsJoint pain, inflammation[22, 23, 24]
SkinAcne or skin lesions[25, 26, 27, 28]
Immune SystemAutoimmune disorders, like Hashimoto’s, rheumatoid arthritis, Celiac disease, fibromyalgia, and food allergies[24, 29, 30, 31, 32, 33, 34]
CardiovascularArterial inflammation [35]
BloodHistory of anemia[36, 37]

There are various causes that can disrupt gut health and increase gut permeability, with some of the most common offenders being:

  • A poor diet and inflammatory foods [2]
  • Not enough or poor-quality sleep [38]
  • Alcohol use [39]
  • Chronic stress [40, 41]
  • Antibiotics [42]
  • An imbalance of the gut microbiome (dysbiosis) [29, 43, 44, 45]
  • Use of NSAIDs, aspirin, and other medications [46, 47, 48]
  • Excessive exercise [49]

As there are many factors that can contribute to developing a leaky gut, it’s important to take a holistic approach when healing your digestive tract. One of the most beneficial things you can do to kick-start your gut-healing journey is to start taking probiotic bacteria. 

How Probiotics for Leaky Gut Work

Probiotics are a key part of reversing leaky gut and improving digestive health. They simultaneously work to heal the lining of the gut and help eliminate the cause of leaky gut by reducing intestinal inflammation and restoring healthy bacteria in the gut [50, 51, 52, 53, 54]. 

Research shows that all three categories of probiotics (see below) are successful at reducing the signs of leaky gut. They’re also effective at treating conditions and symptoms linked to increased intestinal permeability, such as:

  • Irritable bowel syndrome (IBS) [55, 56, 57]
  • Inflammatory bowel disease (IBD) [58, 59, 60]
  • Constipation [61, 62, 63]
  • Diarrhea [64, 65, 66]
  • Abdominal pain [67, 68]
  • Bloating [68]

Probiotics may provide relief for non-digestive symptoms associated with leaky gut as well, like brain fog (which often comes on after meals), joint pain, and fatigue [69, 70, 71, 72, 73, 74].

Let’s take a look at the research on probiotics for leaky gut syndrome.

Probiotics May Decrease Intestinal Permeability

Several clinical studies have shown improvements in intestinal permeability from the use of probiotics.

  • In one study, a marker of intestinal permeability (zonulin) was significantly lower in the group who received a 14-week course of a multi-species probiotic [50].
  • In another clinical trial, oral spore-based probiotic species reduced markers of intestinal permeability compared with placebo [52].
  • In a randomized controlled trial, a seven-day trial of Lactobacillus rhamnosus showed biopsy-confirmed beneficial effects on the genes that regulate intestinal permeability [53].
  • One small study found that probiotics helped to promote intestinal repair in the human gut [52].
  • Another trial found positive effects of probiotics when used to treat intestinal impairment after a GI infection [75].

Probiotics Help Rebalance the Gut Microbiome

Dysbiosis refers to an imbalance in gut bacteria and is likely correlated with a leaky gut. The makeup of the gut microbiome is closely connected to gut barrier integrity [29, 43, 44, 45]. It’s likely that introducing healthy bacteria into the digestive tract through probiotic supplements can help heal intestinal permeability. 

The following research supports the beneficial effects of probiotics on the gut microbiome:

  • A meta-analysis (the highest quality of science) summarizing 18 clinical trials concluded that probiotics are an effective treatment for small intestinal bacterial overgrowth (SIBO) [76]. 
  • In a study of 181 infants, probiotics were as effective as nystatin (a standard antifungal medication) in reducing fungal infection and improving food intolerances [77].
  • Two studies show that probiotics can be more effective than standard antiparasitic drug treatment in Blastocystis hominis and Giardia infections [78, 79].

In summary, we have good science to show that probiotics for leaky gut work well. Even better, probiotics can do this safely and without side effects [80, 81, 82, 83]. 

Using Probiotics for Leaky Gut 

Now that you know how probiotics heal your digestive tract, we can get into the details on what using probiotics for leaky gut actually looks like, including how soon you can expect to see results and which type of probiotic you should use.

Probiotics Can Give Fast Relief

If you think you may have a dysfunctional gut barrier, probiotics for leaky gut can work quickly to get you back on track. I often see in the clinic that patients have less reactivity to foods and more regular stools within one to two weeks of starting probiotic use. 

These results are backed by current research that suggests that probiotics work within one to four weeks to improve leaky gut symptoms and laboratory markers of intestinal permeability [52, 68, 84, 85].

Though probiotics are highly effective in treating gut conditions and symptoms associated with leaky gut syndrome [68], keep in mind that improvements in symptoms after leaky gut treatment aren’t always reflected on laboratory markers [86, 87, 88, 89]. 

This serves as a reminder that lab findings aren’t the end-all-be-all when it comes to recovering from a leaky gut (or any health condition), and the focus should be on how you feel. If you feel better after taking probiotics for leaky gut, chances are you are better.

What Kind of Probiotic Should You Take for Leaky Gut?

To get the most benefit out of your probiotics for leaky gut, we recommend using one from each category of probiotics: 

Category 1: Bifidobacterium and Lactobacillus strains

  • A 2020 systematic review and meta-analysis found that category 1 probiotics can improve blood markers of leaky gut when used with category 3 probiotics [90].
  • Research also shows that Bifidobacterium and Lactobacillus probiotic strains improve leaky gut in those with IBS, in elderly populations, and in endurance athletes [50, 67, 68, 84, 91].

Category 2: Saccharomyces boulardii 

  • This healthy fungus can restore barrier function and has anti-inflammatory effects in the digestive tract [92].
  • Studies show that it improves leaky gut in those with Crohn’s disease, and is beneficial in treating numerous gut conditions and combating gut pathogens [93, 94].

Category 3: Soil-based probiotics (with Bacillus species)

  • These spore-formers can decrease leaky gut and significantly reduce the amount of bacterial toxins in the bloodstream [52, 85, 95].

Using one type is good for gut health, but using all three together is often best for maximum benefit. Multi-strain probiotics are likely more effective than single-strain bacteria in treating certain gut conditions, like IBS and constipation, which are commonly associated with leaky gut syndrome [62, 96, 97].

Think of it this way — each category of probiotics works as one leg of a three-legged stool. Without the other two legs, the stool can’t remain standing.

How to Take Probiotics for Leaky Gut

Try taking a probiotic from each category for three to four weeks, while monitoring your symptoms. If you see improvements, stay on them for a month or two until your symptoms completely resolve or begin to plateau. 

Once you’ve seen sustained improvement, you can begin to slowly reduce your dose until you find the minimum effective dose for you. 

Be sure to select a high-quality probiotic from a manufacturer that stands behind its label claims. For more on how to use probiotics, see our Probiotics Starter Guide.

More Leaky Gut Support

Probiotics are just one part of a leaky gut-healing strategy. It’s especially important to pay attention to lifestyle changes like improving your diet and getting enough sleep. Certain supplements can help too.

Anti-Inflammatory Diet

Eating an anti-inflammatory diet that’s right for your body is a key strategy to improve leaky gut symptoms. An anti-inflammatory diet, such as the Paleo diet, also helps maintain a healthy gut microbiome and intestinal wall. Your main leaky gut diet goal is to reduce gut inflammation by eating healthy, whole foods and to avoid the processed foods that cause gut inflammation. Include clean protein, healthy fatty acids, and fruits, veggies, nuts, and seeds as a source of carbs. Foods like bone broth and curcumin are especially healing for the gut.

Pay attention to the foods your body tolerates and doesn’t tolerate. Everyone is unique in this respect and there’s no one right diet for everyone.

Probiotic Foods for Leaky Gut

While probiotic foods, such as kimchi and kefir, provide general gut health benefits, probiotic foods generally do not have enough colony-forming units (CFUs) to provide a clinical effect on leaky gut or other digestive system disorders. 

You can include fermented foods in your diet, but also consider taking a quality probiotic supplement with CFUs in the billions.

Prebiotics for Leaky Gut

Prebiotics are starchy fibers that feed the bacteria in your gut so they can produce important gut-healing compounds, like butyrate. Prebiotics can be included as a supplement, but the best source of prebiotics is a diet rich in fiber. 

Including fruits and vegetables, whole grains and legumes (if tolerated), and nuts and seeds should provide plenty of food for your good bacteria. However, prebiotics should be used with caution, as they can flare digestive symptoms for some. If you want to try a prebiotic supplement, your best bet is to start with a very small dose and increase slowly to tolerance.

Other Key Leaky Gut Supplements

Digestive supports like digestive enzymes and stomach acid support can help encourage gut healing. Several other supplements can also be helpful for resolving leaky gut. 

  • L-glutamine: Supplementation with L-glutamine, an amino acid, can help speed the repair of the intestinal lining, decrease intestinal permeability, and reduce inflammation [98].
  • Vitamin D: Some studies indicate that low vitamin D is associated with greater gut lining permeability and worse outcomes for people with IBD, while increasing vitamin D reduced irritable bowel syndrome (IBS) symptoms [99, 100, 101]. 
  • Deglycyrrhizinated licorice (DGL): Soothing herbs like deglycyrrhizinated licorice (DGL) can help coat and soothe an irritated gut lining [102]. DGL combined with L-glutamine can super-charge your gut-healing protocol.

If changing up your diet and adding in probiotics don’t seem to completely resolve your symptoms, it may be time to add in one of the above gut-healing supplements.

Healing Leaky Gut With Probiotics: The Bottom Line

Probiotics are a key approach to healing leaky gut. They help rebalance your gut flora, restore your intestinal wall, and decrease intestinal inflammation.

These healthy bacteria can work in just a few weeks to give relief for leaky gut symptoms like abdominal pain, brain fog, and stool changes. For the most benefit, you’ll probably want to take a multi-strain probiotic that uses strains from each probiotic category. 

If you have a chronic condition that you suspect may be a result of a leaky gut, feel free to reach out to our functional medicine clinic for help with your journey toward better health. You can also find out more on the huge impact that a healthy gut has on your overall health in my book, Healthy Gut, Healthy You

The Ruscio Institute has developed a range of high-quality formulations, including a variety of probiotic supplements, to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
  1. Galipeau HJ, Verdu EF. The complex task of measuring intestinal permeability in basic and clinical science. Neurogastroenterol Motil. 2016 Jul;28(7):957–65. DOI: 10.1111/nmo.12871. PMID: 27339216.
  2. Leech B, McIntyre E, Steel A, Sibbritt D. Risk factors associated with intestinal permeability in an adult population: A systematic review. Int J Clin Pract. 2019 Oct;73(10):e13385. DOI: 10.1111/ijcp.13385. PMID: 31243854.
  3. Fasano A. All disease begins in the (leaky) gut: role of zonulin-mediated gut permeability in the pathogenesis of some chronic inflammatory diseases. [version 1; peer review: 3 approved]. F1000Res. 2020 Jan 31;9. DOI: 10.12688/f1000research.20510.1. PMID: 32051759. PMCID: PMC6996528.
  4. Quigley EMM. Leaky gut – concept or clinical entity? Curr Opin Gastroenterol. 2016 Mar;32(2):74–9. DOI: 10.1097/MOG.0000000000000243. PMID: 26760399.
  5. Mujagic Z, Ludidi S, Keszthelyi D, Hesselink MAM, Kruimel JW, Lenaerts K, et al. Small intestinal permeability is increased in diarrhoea predominant IBS, while alterations in gastroduodenal permeability in all IBS subtypes are largely attributable to confounders. Aliment Pharmacol Ther. 2014 Aug;40(3):288–97. DOI: 10.1111/apt.12829. PMID: 24943095.
  6. Michielan A, D’Incà R. Intestinal permeability in inflammatory bowel disease: pathogenesis, clinical evaluation, and therapy of leaky gut. Mediators Inflamm. 2015 Oct 25;2015:628157. DOI: 10.1155/2015/628157. PMID: 26582965. PMCID: PMC4637104.
  7. Lee SH. Intestinal permeability regulation by tight junction: implication on inflammatory bowel diseases. Intest Res. 2015 Jan 29;13(1):11–8. DOI: 10.5217/ir.2015.13.1.11. PMID: 25691839. PMCID: PMC4316216.
  8. Chang J, Leong RW, Wasinger VC, Ip M, Yang M, Phan TG. Impaired intestinal permeability contributes to ongoing bowel symptoms in patients with inflammatory bowel disease and mucosal healing. Gastroenterology. 2017 Sep;153(3):723-731.e1. DOI: 10.1053/j.gastro.2017.05.056. PMID: 28601482.
  9. Karakula-Juchnowicz H, Rog J, Juchnowicz D, Łoniewski I, Skonieczna-Żydecka K, Krukow P, et al. The study evaluating the effect of probiotic supplementation on the mental status, inflammation, and intestinal barrier in major depressive disorder patients using gluten-free or gluten-containing diet (SANGUT study): a 12-week, randomized, double-blind, and placebo-controlled clinical study protocol. Nutr J. 2019 Aug 31;18(1):50. DOI: 10.1186/s12937-019-0475-x. PMID: 31472678. PMCID: PMC6717641.
  10. Maes M, Kubera M, Leunis J-C, Berk M. Increased IgA and IgM responses against gut commensals in chronic depression: further evidence for increased bacterial translocation or leaky gut. J Affect Disord. 2012 Dec 1;141(1):55–62. DOI: 10.1016/j.jad.2012.02.023. PMID: 22410503.
  11. Maes M, Kanchanatawan B, Sirivichayakul S, Carvalho AF. In Schizophrenia, Increased Plasma IgM/IgA Responses to Gut Commensal Bacteria Are Associated with Negative Symptoms, Neurocognitive Impairments, and the Deficit Phenotype. Neurotox Res. 2019 Apr;35(3):684–98. DOI: 10.1007/s12640-018-9987-y. PMID: 30552634.
  12. Wright ML, Fournier C, Houser MC, Tansey M, Glass J, Hertzberg VS. Potential role of the gut microbiome in ALS: A systematic review. Biol Res Nurs. 2018 Oct;20(5):513–21. DOI: 10.1177/1099800418784202. PMID: 29925252.
  13. Nguyen TT, Kosciolek T, Eyler LT, Knight R, Jeste DV. Overview and systematic review of studies of microbiome in schizophrenia and bipolar disorder. J Psychiatr Res. 2018 Apr;99:50–61. DOI: 10.1016/j.jpsychires.2018.01.013. PMID: 29407287. PMCID: PMC5849533.
  14. Maes M, Kubera M, Leunis J-C. The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Neuro Endocrinol Lett. 2008 Feb;29(1):117–24. PMID: 18283240.
  15. Dutta SK, Verma S, Jain V, Surapaneni BK, Vinayek R, Phillips L, et al. Parkinson’s disease: the emerging role of gut dysbiosis, antibiotics, probiotics, and fecal microbiota transplantation. J Neurogastroenterol Motil. 2019 Jul 1;25(3):363–76. DOI: 10.5056/jnm19044. PMID: 31327219. PMCID: PMC6657920.
  16. Maguire M, Maguire G. Gut dysbiosis, leaky gut, and intestinal epithelial proliferation in neurological disorders: towards the development of a new therapeutic using amino acids, prebiotics, probiotics, and postbiotics. Rev Neurosci. 2019 Jan 28;30(2):179–201. DOI: 10.1515/revneuro-2018-0024. PMID: 30173208.
  17. Grigoleit J-S, Kullmann JS, Wolf OT, Hammes F, Wegner A, Jablonowski S, et al. Dose-dependent effects of endotoxin on neurobehavioral functions in humans. PLoS ONE. 2011 Dec 2;6(12):e28330. DOI: 10.1371/journal.pone.0028330. PMID: 22164271. PMCID: PMC3229570.
  18. Buscarinu MC, Romano S, Mechelli R, Pizzolato Umeton R, Ferraldeschi M, Fornasiero A, et al. Intestinal Permeability in Relapsing-Remitting Multiple Sclerosis. Neurotherapeutics. 2018 Jan;15(1):68–74. DOI: 10.1007/s13311-017-0582-3. PMID: 29119385. PMCID: PMC5794695.
  19. Lichtwark IT, Newnham ED, Robinson SR, Shepherd SJ, Hosking P, Gibson PR, et al. Cognitive impairment in coeliac disease improves on a gluten-free diet and correlates with histological and serological indices of disease severity. Aliment Pharmacol Ther. 2014 Jul;40(2):160–70. DOI: 10.1111/apt.12809. PMID: 24889390.
  20. Maes M, Leunis J-C. Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria. Neuro Endocrinol Lett. 2008 Dec;29(6):902–10. PMID: 19112401.
  21. Maes M, Coucke F, Leunis J-C. Normalization of the increased translocation of endotoxin from gram negative enterobacteria (leaky gut) is accompanied by a remission of chronic fatigue syndrome. Neuro Endocrinol Lett. 2007 Dec;28(6):739–44. PMID: 18063928.
  22. Katz KD, Hollander D. Intestinal mucosal permeability and rheumatological diseases. Baillieres Clin Rheumatol. 1989 Aug;3(2):271–84. DOI: 10.1016/s0950-3579(89)80021-4. PMID: 2670255.
  23. Yang L, Wang L, Wang X, Xian CJ, Lu H. A possible role of intestinal microbiota in the pathogenesis of ankylosing spondylitis. Int J Mol Sci. 2016 Dec 17;17(12). DOI: 10.3390/ijms17122126. PMID: 27999312. PMCID: PMC5187926.
  24. Bjarnason I, Williams P, So A, Zanelli GD, Levi AJ, Gumpel JM, et al. Intestinal permeability and inflammation in rheumatoid arthritis: effects of non-steroidal anti-inflammatory drugs. Lancet. 1984 Nov 24;2(8413):1171–4. DOI: 10.1016/s0140-6736(84)92739-9. PMID: 6150232.
  25. Bowe W, Patel NB, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis: from anecdote to translational medicine. Benef Microbes. 2014 Jun 1;5(2):185–99. DOI: 10.3920/BM2012.0060. PMID: 23886975.
  26. Jackson PG, Lessof MH, Baker RW, Ferrett J, MacDonald DM. Intestinal permeability in patients with eczema and food allergy. Lancet. 1981 Jun 13;1(8233):1285–6. DOI: 10.1016/s0140-6736(81)92459-4. PMID: 6112605.
  27. Pike MG, Heddle RJ, Boulton P, Turner MW, Atherton DJ. Increased intestinal permeability in atopic eczema. J Invest Dermatol. 1986 Feb;86(2):101–4. DOI: 10.1111/1523-1747.ep12284035. PMID: 3745938.
  28. Smecuol E, Sugai E, Niveloni S, Vázquez H, Pedreira S, Mazure R, et al. Permeability, zonulin production, and enteropathy in dermatitis herpetiformis. Clin Gastroenterol Hepatol. 2005 Apr;3(4):335–41. DOI: 10.1016/s1542-3565(04)00778-5. PMID: 15822038.
  29. Fasano A. Zonulin, regulation of tight junctions, and autoimmune diseases. Ann N Y Acad Sci. 2012 Jul;1258:25–33. DOI: 10.1111/j.1749-6632.2012.06538.x. PMID: 22731712. PMCID: PMC3384703.
  30. Morris G, Berk M, Carvalho AF, Caso JR, Sanz Y, Maes M. The Role of Microbiota and Intestinal Permeability in the Pathophysiology of Autoimmune and Neuroimmune Processes with an Emphasis on Inflammatory Bowel Disease Type 1 Diabetes and Chronic Fatigue Syndrome. Curr Pharm Des. 2016;22(40):6058–75. DOI: 10.2174/1381612822666160914182822. PMID: 27634186.
  31. Goebel A, Buhner S, Schedel R, Lochs H, Sprotte G. Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. Rheumatology (Oxford). 2008 Aug;47(8):1223–7. DOI: 10.1093/rheumatology/ken140. PMID: 18540025.
  32. Sturgeon C, Fasano A. Zonulin, a regulator of epithelial and endothelial barrier functions, and its involvement in chronic inflammatory diseases. Tissue Barriers. 2016 Oct 21;4(4):e1251384. DOI: 10.1080/21688370.2016.1251384. PMID: 28123927. PMCID: PMC5214347.
  33. Küçükemre Aydın B, Yıldız M, Akgün A, Topal N, Adal E, Önal H. Children with Hashimoto’s Thyroiditis Have Increased Intestinal Permeability: Results of a Pilot Study. J Clin Res Pediatr Endocrinol. 2020 Sep 2;12(3):303–7. DOI: 10.4274/jcrpe.galenos.2020.2019.0186. PMID: 31990165. PMCID: PMC7499128.
  34. Drago S, El Asmar R, Di Pierro M, Grazia Clemente M, Tripathi A, Sapone A, et al. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand J Gastroenterol. 2006 Apr;41(4):408–19. DOI: 10.1080/00365520500235334. PMID: 16635908.
  35. Moludi J, Maleki V, Jafari-Vayghyan H, Vaghef-Mehrabany E, Alizadeh M. Metabolic endotoxemia and cardiovascular disease: A systematic review about potential roles of prebiotics and probiotics. Clin Exp Pharmacol Physiol. 2020 Jun;47(6):927–39. DOI: 10.1111/1440-1681.13250. PMID: 31894861.
  36. Kalach N, Benhamou PH, Campeotto F, Dupont C. Anemia impairs small intestinal absorption measured by intestinal permeability in children. Eur Ann Allergy Clin Immunol. 2007 Jan;39(1):20–2. PMID: 17375737.
  37. Berant M, Khourie M, Menzies IS. Effect of iron deficiency on small intestinal permeability in infants and young children. J Pediatr Gastroenterol Nutr. 1992 Jan;14(1):17–20. DOI: 10.1097/00005176-199201000-00004. PMID: 1573506.
  38. Swanson GR, Burgess HJ. Sleep and circadian hygiene and inflammatory bowel disease. Gastroenterol Clin North Am. 2017 Dec;46(4):881–93. DOI: 10.1016/j.gtc.2017.08.014. PMID: 29173529.
  39. Bode C, Bode JC. Effect of alcohol consumption on the gut. Best Pract Res Clin Gastroenterol. 2003 Aug;17(4):575–92. DOI: 10.1016/S1521-6918(03)00034-9. PMID: 12828956.
  40. Vanuytsel T, van Wanrooy S, Vanheel H, Vanormelingen C, Verschueren S, Houben E, et al. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut. 2014 Aug;63(8):1293–9. DOI: 10.1136/gutjnl-2013-305690. PMID: 24153250.
  41. Karl JP, Margolis LM, Madslien EH, Murphy NE, Castellani JW, Gundersen Y, et al. Changes in intestinal microbiota composition and metabolism coincide with increased intestinal permeability in young adults under prolonged physiological stress. Am J Physiol Gastrointest Liver Physiol. 2017 Jun 1;312(6):G559–71. DOI: 10.1152/ajpgi.00066.2017. PMID: 28336545.
  42. Feng Y, Huang Y, Wang Y, Wang P, Song H, Wang F. Antibiotics induced intestinal tight junction barrier dysfunction is associated with microbiota dysbiosis, activated NLRP3 inflammasome and autophagy. PLoS ONE. 2019 Jun 18;14(6):e0218384. DOI: 10.1371/journal.pone.0218384. PMID: 31211803. PMCID: PMC6581431.
  43. Canakis A, Haroon M, Weber HC. Irritable bowel syndrome and gut microbiota. Curr Opin Endocrinol Diabetes Obes. 2020 Feb;27(1):28–35. DOI: 10.1097/MED.0000000000000523. PMID: 31789724.
  44. El Asmar R, Panigrahi P, Bamford P, Berti I, Not T, Coppa GV, et al. Host-dependent zonulin secretion causes the impairment of the small intestine barrier function after bacterial exposure. Gastroenterology. 2002 Nov;123(5):1607–15. PMID: 12404235.
  45. Ciccia F, Guggino G, Rizzo A, Alessandro R, Luchetti MM, Milling S, et al. Dysbiosis and zonulin upregulation alter gut epithelial and vascular barriers in patients with ankylosing spondylitis. Ann Rheum Dis. 2017 Jun;76(6):1123–32. DOI: 10.1136/annrheumdis-2016-210000. PMID: 28069576. PMCID: PMC6599509.
  46. Utzeri E, Usai P. Role of non-steroidal anti-inflammatory drugs on intestinal permeability and nonalcoholic fatty liver disease. World J Gastroenterol. 2017 Jun 14;23(22):3954–63. DOI: 10.3748/wjg.v23.i22.3954. PMID: 28652650. PMCID: PMC5473116.
  47. Graham DY, Opekun AR, Willingham FF, Qureshi WA. Visible small-intestinal mucosal injury in chronic NSAID users. Clin Gastroenterol Hepatol. 2005 Jan;3(1):55–9. DOI: 10.1016/s1542-3565(04)00603-2. PMID: 15645405.
  48. Bjarnason I, Hayllar J, MacPherson AJ, Russell AS. Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans. Gastroenterology. 1993 Jun;104(6):1832–47. DOI: 10.1016/0016-5085(93)90667-2. PMID: 8500743.
  49. Costa RJS, Snipe RMJ, Kitic CM, Gibson PR. Systematic review: exercise-induced gastrointestinal syndrome-implications for health and intestinal disease. Aliment Pharmacol Ther. 2017 Aug;46(3):246–65. DOI: 10.1111/apt.14157. PMID: 28589631.
  50. Lamprecht M, Bogner S, Schippinger G, Steinbauer K, Fankhauser F, Hallstroem S, et al. Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial. J Int Soc Sports Nutr. 2012 Sep 20;9(1):45. DOI: 10.1186/1550-2783-9-45. PMID: 22992437. PMCID: PMC3465223.
  51. Hoveyda N, Heneghan C, Mahtani KR, Perera R, Roberts N, Glasziou P. A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome. BMC Gastroenterol. 2009 Feb 16;9:15. DOI: 10.1186/1471-230X-9-15. PMID: 19220890. PMCID: PMC2656520.
  52. McFarlin BK, Henning AL, Bowman EM, Gary MA, Carbajal KM. Oral spore-based probiotic supplementation was associated with reduced incidence of post-prandial dietary endotoxin, triglycerides, and disease risk biomarkers. World J Gastrointest Pathophysiol. 2017 Aug 15;8(3):117–26. DOI: 10.4291/wjgp.v8.i3.117. PMID: 28868181. PMCID: PMC5561432.
  53. Mujagic Z, de Vos P, Boekschoten MV, Govers C, Pieters H-JHM, de Wit NJW, et al. The effects of Lactobacillus plantarum on small intestinal barrier function and mucosal gene transcription; a randomized double-blind placebo controlled trial. Sci Rep. 2017 Jan 3;7:40128. DOI: 10.1038/srep40128. PMID: 28045137. PMCID: PMC5206730.
  54. Soifer LO, Peralta D, Dima G, Besasso H. [Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study]. Acta Gastroenterol Latinoam. 2010 Dec;40(4):323–7. PMID: 21381407.
  55. Yuan F, Ni H, Asche CV, Kim M, Walayat S, Ren J. Efficacy of Bifidobacterium infantis 35624 in patients with irritable bowel syndrome: a meta-analysis. Curr Med Res Opin. 2017 Jul;33(7):1191–7. DOI: 10.1080/03007995.2017.1292230. PMID: 28166427.
  56. Tiequn B, Guanqun C, Shuo Z. Therapeutic effects of Lactobacillus in treating irritable bowel syndrome: a meta-analysis. Intern Med. 2015;54(3):243–9. DOI: 10.2169/internalmedicine.54.2710. PMID: 25748731.
  57. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008 May 7;14(17):2650–61. DOI: 10.3748/wjg.14.2650. PMID: 18461650. PMCID: PMC2709042.
  58. Hedin C, Whelan K, Lindsay JO. Evidence for the use of probiotics and prebiotics in inflammatory bowel disease: a review of clinical trials. Proc Nutr Soc. 2007 Aug;66(3):307–15. DOI: 10.1017/S0029665107005563. PMID: 17637082.
  59. Kruis W, Fric P, Pokrotnieks J, Lukás M, Fixa B, Kascák M, et al. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut. 2004 Nov;53(11):1617–23. DOI: 10.1136/gut.2003.037747. PMID: 15479682. PMCID: PMC1774300.
  60. Naidoo K, Gordon M, Fagbemi AO, Thomas AG, Akobeng AK. Probiotics for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD007443. DOI: 10.1002/14651858.CD007443.pub2. PMID: 22161412.
  61. Wen Y, Li J, Long Q, Yue C-C, He B, Tang X-G. The efficacy and safety of probiotics for patients with constipation-predominant irritable bowel syndrome: A systematic review and meta-analysis based on seventeen randomized controlled trials. Int J Surg. 2020 Jul;79:111–9. DOI: 10.1016/j.ijsu.2020.04.063. PMID: 32387213.
  62. Zhang C, Jiang J, Tian F, Zhao J, Zhang H, Zhai Q, et al. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 2020 Oct;39(10):2960–9. DOI: 10.1016/j.clnu.2020.01.005. PMID: 32005532.
  63. Miller LE, Ouwehand AC, Ibarra A. Effects of probiotic-containing products on stool frequency and intestinal transit in constipated adults: systematic review and meta-analysis of randomized controlled trials. Ann Gastroenterol. 2017 Sep 21;30(6):629–39. DOI: 10.20524/aog.2017.0192. PMID: 29118557. PMCID: PMC5670282.
  64. Rogha M, Esfahani MZ, Zargarzadeh AH. The efficacy of a synbiotic containing Bacillus Coagulans in treatment of irritable bowel syndrome: a randomized placebo-controlled trial. Gastroenterol Hepatol Bed Bench. 2014;7(3):156–63. PMID: 25120896. PMCID: PMC4129566.
  65. Majeed M, Nagabhushanam K, Natarajan S, Sivakumar A, Ali F, Pande A, et al. Bacillus coagulans MTCC 5856 supplementation in the management of diarrhea predominant Irritable Bowel Syndrome: a double blind randomized placebo controlled pilot clinical study. Nutr J. 2016 Feb 27;15:21. DOI: 10.1186/s12937-016-0140-6. PMID: 26922379. PMCID: PMC4769834.
  66. Khalighi AR, Khalighi MR, Behdani R, Jamali J, Khosravi A, Kouhestani S, et al. Evaluating the efficacy of probiotic on treatment in patients with small intestinal bacterial overgrowth (SIBO)–a pilot study. Indian J Med Res. 2014 Nov;140(5):604–8. PMID: 25579140. PMCID: PMC4311312.
  67. Francavilla R, Miniello V, Magistà AM, De Canio A, Bucci N, Gagliardi F, et al. A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics. 2010 Dec;126(6):e1445-52. DOI: 10.1542/peds.2010-0467. PMID: 21078735.
  68. Bonfrate L, Di Palo DM, Celano G, Albert A, Vitellio P, De Angelis M, et al. Effects of Bifidobacterium longum BB536 and Lactobacillus rhamnosus HN001 in IBS patients. Eur J Clin Invest. 2020 Mar;50(3):e13201. DOI: 10.1111/eci.13201. PMID: 31960952.
  69. Frändemark Å, Jakobsson Ung E, Törnblom H, Simrén M, Jakobsson S. Fatigue: a distressing symptom for patients with irritable bowel syndrome. Neurogastroenterol Motil. 2017 Jan;29(1). DOI: 10.1111/nmo.12898. PMID: 27401139.
  70. Han CJ, Yang GS. Fatigue in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis of Pooled Frequency and Severity of Fatigue. Asian Nurs Res (Korean Soc Nurs Sci). 2016 Mar;10(1):1–10. DOI: 10.1016/j.anr.2016.01.003. PMID: 27021828.
  71. Chakiath RJ, Siddall PJ, Kellow JE, Hush JM, Jones MP, Marcuzzi A, et al. Descending pain modulation in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Syst Rev. 2015 Dec 10;4:175. DOI: 10.1186/s13643-015-0162-8. PMID: 26652749. PMCID: PMC4674951.
  72. Berstad A, Undseth R, Lind R, Valeur J. Functional bowel symptoms, fibromyalgia and fatigue: a food-induced triad? Scand J Gastroenterol. 2012 Sep;47(8–9):914–9. DOI: 10.3109/00365521.2012.690045. PMID: 22594347. PMCID: PMC3793273.
  73. Nilholm C, Roth B, Ohlsson B. A Dietary Intervention with Reduction of Starch and Sucrose Leads to Reduced Gastrointestinal and Extra-Intestinal Symptoms in IBS Patients. Nutrients. 2019 Jul 20;11(7). DOI: 10.3390/nu11071662. PMID: 31330810. PMCID: PMC6682926.
  74. Hausteiner-Wiehle C, Henningsen P. Irritable bowel syndrome: relations with functional, mental, and somatoform disorders. World J Gastroenterol. 2014 May 28;20(20):6024–30. DOI: 10.3748/wjg.v20.i20.6024. PMID: 24876725. PMCID: PMC4033442.
  75. Sindhu KNC, Sowmyanarayanan TV, Paul A, Babji S, Ajjampur SSR, Priyadarshini S, et al. Immune response and intestinal permeability in children with acute gastroenteritis treated with Lactobacillus rhamnosus GG: a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2014 Apr;58(8):1107–15. DOI: 10.1093/cid/ciu065. PMID: 24501384. PMCID: PMC3967829.
  76. Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017 Apr;51(4):300–11. DOI: 10.1097/MCG.0000000000000814. PMID: 28267052.
  77. Demirel G, Celik IH, Erdeve O, Saygan S, Dilmen U, Canpolat FE. Prophylactic Saccharomyces boulardii versus nystatin for the prevention of fungal colonization and invasive fungal infection in premature infants. Eur J Pediatr. 2013 Oct;172(10):1321–6. DOI: 10.1007/s00431-013-2041-4. PMID: 23703468.
  78. Dinleyici EC, Eren M, Dogan N, Reyhanioglu S, Yargic ZA, Vandenplas Y. Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. Parasitol Res. 2011 Mar;108(3):541–5. DOI: 10.1007/s00436-010-2095-4. PMID: 20922415.
  79. Besirbellioglu BA, Ulcay A, Can M, Erdem H, Tanyuksel M, Avci IY, et al. Saccharomyces boulardii and infection due to Giardia lamblia. Scand J Infect Dis. 2006;38(6–7):479–81. DOI: 10.1080/00365540600561769. PMID: 16798698.
  80. Rinne M, Kalliomäki M, Salminen S, Isolauri E. Probiotic intervention in the first months of life: short-term effects on gastrointestinal symptoms and long-term effects on gut microbiota. J Pediatr Gastroenterol Nutr. 2006 Aug;43(2):200–5. DOI: 10.1097/01.mpg.0000228106.91240.5b. PMID: 16877985.
  81. Rougé C, Piloquet H, Butel M-J, Berger B, Rochat F, Ferraris L, et al. Oral supplementation with probiotics in very-low-birth-weight preterm infants: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2009 Jun;89(6):1828–35. DOI: 10.3945/ajcn.2008.26919. PMID: 19369375.
  82. Tremblay A, Xu X, Colee J, Tompkins TA. Efficacy of a Multi-Strain Probiotic Formulation in Pediatric Populations: A Comprehensive Review of Clinical Studies. Nutrients. 2021 Jun 1;13(6). DOI: 10.3390/nu13061908. PMID: 34206098. PMCID: PMC8226750.
  83. Sheyholislami H, Connor KL. Are Probiotics and Prebiotics Safe for Use during Pregnancy and Lactation? A Systematic Review and Meta-Analysis. Nutrients. 2021 Jul 13;13(7). DOI: 10.3390/nu13072382. PMID: 34371892. PMCID: PMC8308823.
  84. Liu Z-H, Huang M-J, Zhang X-W, Wang L, Huang N-Q, Peng H, et al. The effects of perioperative probiotic treatment on serum zonulin concentration and subsequent postoperative infectious complications after colorectal cancer surgery: a double-center and double-blind randomized clinical trial. Am J Clin Nutr. 2013 Jan;97(1):117–26. DOI: 10.3945/ajcn.112.040949. PMID: 23235200.
  85. Han SH, Suk KT, Kim DJ, Kim MY, Baik SK, Kim YD, et al. Effects of probiotics (cultured Lactobacillus subtilis/Streptococcus faecium) in the treatment of alcoholic hepatitis: randomized-controlled multicenter study. Eur J Gastroenterol Hepatol. 2015 Nov;27(11):1300–6. DOI: 10.1097/MEG.0000000000000458. PMID: 26302024.
  86. Ohlsson B. An Okinawan-based Nordic diet improves glucose and lipid metabolism in health and type 2 diabetes, in alignment with changes in the endocrine profile, whereas zonulin levels are elevated. Exp Ther Med. 2019 Apr;17(4):2883–93. DOI: 10.3892/etm.2019.7303. PMID: 30936958. PMCID: PMC6434283.
  87. Riviere AJ, Smith KS, Schaberg MN, Greene MW, Frugé AD. Plasma and fecal zonulin are not altered by a high green leafy vegetable dietary intervention: secondary analysis of a randomized control crossover trial. BMC Gastroenterol. 2022 Apr 12;22(1):184. DOI: 10.1186/s12876-022-02248-3. PMID: 35413837. PMCID: PMC9004007.
  88. Neyrinck AM, Rodriguez J, Zhang Z, Seethaler B, Sánchez CR, Roumain M, et al. Prebiotic dietary fibre intervention improves fecal markers related to inflammation in obese patients: results from the Food4Gut randomized placebo-controlled trial. Eur J Nutr. 2021 Sep;60(6):3159–70. DOI: 10.1007/s00394-021-02484-5. PMID: 33544206. PMCID: PMC8354918.
  89. Damms-Machado A, Louis S, Schnitzer A, Volynets V, Rings A, Basrai M, et al. Gut permeability is related to body weight, fatty liver disease, and insulin resistance in obese individuals undergoing weight reduction. Am J Clin Nutr. 2017 Jan;105(1):127–35. DOI: 10.3945/ajcn.116.131110. PMID: 28049662.
  90. Ramezani Ahmadi A, Sadeghian M, Alipour M, Ahmadi Taheri S, Rahmani S, Abbasnezhad A. The Effects of Probiotic/Synbiotic on Serum Level of Zonulin as a Biomarker of Intestinal Permeability: A Systematic Review and Meta-Analysis. Iran J Public Health. 2020 Jul;49(7):1222–31. DOI: 10.18502/ijph.v49i7.3575. PMID: 33083288. PMCID: PMC7548501.
  91. Chaiyasut C, Sivamaruthi BS, Lailerd N, Sirilun S, Khongtan S, Fukngoen P, et al. Probiotics supplementation improves intestinal permeability, obesity index and metabolic biomarkers in elderly thai subjects: A randomized controlled trial. Foods. 2022 Jan 19;11(3). DOI: 10.3390/foods11030268. PMID: 35159419. PMCID: PMC8834517.
  92. Terciolo C, Dapoigny M, Andre F. Beneficial effects of Saccharomyces boulardii CNCM I-745 on clinical disorders associated with intestinal barrier disruption. Clin Exp Gastroenterol. 2019 Feb 11;12:67–82. DOI: 10.2147/CEG.S181590. PMID: 30804678. PMCID: PMC6375115.
  93. Garcia Vilela E, De Lourdes De Abreu Ferrari M, Oswaldo Da Gama Torres H, Guerra Pinto A, Carolina Carneiro Aguirre A, Paiva Martins F, et al. Influence of Saccharomyces boulardii on the intestinal permeability of patients with Crohn’s disease in remission. Scand J Gastroenterol. 2008;43(7):842–8. DOI: 10.1080/00365520801943354. PMID: 18584523.
  94. Kelesidis T, Pothoulakis C. Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Therap Adv Gastroenterol. 2012 Mar;5(2):111–25. DOI: 10.1177/1756283X11428502. PMID: 22423260. PMCID: PMC3296087.
  95. Du S-X, Jia Y-R, Ren S-Q, Gong X-J, Tang H, Wan-Shui W, et al. The protective effects of Bacillus licheniformis preparation on gastrointestinal disorders and inflammation induced by radiotherapy in pediatric patients with central nervous system tumor. Adv Med Sci. 2018 Mar;63(1):134–9. DOI: 10.1016/j.advms.2017.09.005. PMID: 29120854.
  96. American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009 Jan;104 Suppl 1:S1-35. DOI: 10.1038/ajg.2008.122. PMID: 19521341.
  97. Ford AC, Quigley EMM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547–61; quiz 1546, 1562. DOI: 10.1038/ajg.2014.202. PMID: 25070051.
  98. Shu X-L, Yu T-T, Kang K, Zhao J. Effects of glutamine on markers of intestinal inflammatory response and mucosal permeability in abdominal surgery patients: A meta-analysis. Exp Ther Med. 2016 Dec;12(6):3499–506. DOI: 10.3892/etm.2016.3799. PMID: 28105083. PMCID: PMC5228558.
  99. Luthold RV, Fernandes GR, Franco-de-Moraes AC, Folchetti LGD, Ferreira SRG. Gut microbiota interactions with the immunomodulatory role of vitamin D in normal individuals. Metab Clin Exp. 2017 Apr;69:76–86. DOI: 10.1016/j.metabol.2017.01.007. PMID: 28285654.
  100. Abbasnezhad A, Amani R, Hajiani E, Alavinejad P, Cheraghian B, Ghadiri A. Effect of vitamin D on gastrointestinal symptoms and health-related quality of life in irritable bowel syndrome patients: a randomized double-blind clinical trial. Neurogastroenterol Motil. 2016 Oct;28(10):1533–44. DOI: 10.1111/nmo.12851. PMID: 27154424.
  101. López-Muñoz P, Beltrán B, Sáez-González E, Alba A, Nos P, Iborra M. Influence of vitamin D deficiency on inflammatory markers and clinical disease activity in IBD patients. Nutrients. 2019 May 11;11(5). DOI: 10.3390/nu11051059. PMID: 31083541. PMCID: PMC6567866.
  102. Aly AM, Al-Alousi L, Salem HA. Licorice: a possible anti-inflammatory and anti-ulcer drug. AAPS PharmSciTech. 2005 Sep 20;6(1):E74-82. DOI: 10.1208/pt060113. PMID: 16353966. PMCID: PMC2750414.

Getting Started

Book your first visit


I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!