Is The Hype About “Leaky Gut” Justified?


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The term “Leaky Gut” has been one of the most commonly used expression in the social media chatter about gut health, inflammatory diets and various remedies of this phenomenon, including probiotics. For the consumer of this information it often implies the presence of holes punched into the gut by bad bacteria releasing them into the gut-associated immune system, into the systemic circulation and into the brain. A recent review article by Maria Aburto and John Cryan from the APC Microbiome Ireland, University College Cork, Ireland provides a masterly discussion of the complexities of the various barriers within the gut microbiome brain system, and of the consequences for gut and brain health when these barriers are compromised. The review article focuses on three major points:

  • Gut and brain barriers are made up from epithelial or endothelial cells, and they have different levels of “permissiveness” under physiological conditions. In other words, the permeability of the barriers is highly variable in a healthy person, and adapted to different physiological states of the organism such as feeding, fasting, stress, exercise.
  • Barriers are dynamic in nature and their function varies across the lifespan.
  • Preclinical studies provide direct evidence of microbial metabolites influencing barrier functioning, linking gut microbial alterations to barrier dysfunction and the subsequent abnormal passage of substances (microbial and non-microbial) along the gut–brain axis. Barrier dysregulation has been shown to be a hallmark of various disorders of the gut and of the brain, and could underlie some of their comorbidities.

The system composed of the gut, its microbiome and the brain serves as a conduit for an ongoing bidirectional dialogue between the gut and the central nervous system. Integral to this bidirectional dialogue are the barriers within this system:

  • the gut epithelial or mucosal barrier
  • the blood-brain barrier
  • the blood-cerebrospinal fluid barrier.

It is important to realize that these barriers are not merely physical blockades, as a simple mechanistic view would suggest; they are dynamic participants in maintaining the body’s homeostasis and their permeabilities are constantly modulated by signals from the gut microbiome and from the brain in a way that is optimized for our health.

“While the gut mucosa prevents gut microorganisms entering the gut wall, it enables a symbiotic interaction with some of these microorganisms.”

The gut mucosa, which lines the gut lumen, forms the first cellular barrier between the host (e.g. us) and gut microorganisms utilizing multiple biological, mechanical mechanisms to prevent the inappropriate contact of the gut microbiota with the gut-based immune system, as well as their translocation into the systemic circulation. While the gut mucosa prevents gut microorganisms entering the gut wall, it enables an ongoing symbiotic interaction with some of these microorganisms. This process is achieved through various components of the gut mucosa that support barrier function and enhance the gut barrier’s role in establishing host–microbiota symbiosis, including mechanical obstacles at the gut epithelial barrier, antimicrobial peptides secreted by specialized epithelial cells, immunoglobulins secreted by gut-based immune cells (secretory IgA) and a gel-like mucus layer produced by so called goblet cells that prevent direct contact of big particles and gut microbes with the epithelial layer.

After the mucosal layer, a second layer of defense is established by the gut vascular barrier, consisting of intestinal endothelial cells surrounding blood vessels in the gut that create a physical barrier preventing the dissemination of bacteria that have breached the epithelial barrier from entering the systemic circulation of the host. Even after microbes and their signaling molecules have entered the systemic circulation, the blood-brain barrier, and the blood-cerebrospinal fluid barrier prevent them from entering the brain. For an excellent discussion of these barriers, the reader is referred to the Aburto review.

These biological interfaces serve as both gatekeepers and facilitators, maintaining a balance by protecting neural tissues from pathogens and toxins, thereby preventing life threatening diseases like meningitis or encephalitis, while selectively allowing essential nutrients and biochemical signals to pass. This selective permeability is a hallmark of their function, demonstrating their dynamic nature. The barriers’ ability to develop and adapt over the lifespan is crucial for both neurological and gastrointestinal development and health.

“The gut is teeming with trillions of microorganisms including bacteria, viruses and fungi that are engaged in a symbiotic relationship with the gut.”

This relationship greatly varies between the different segments within the intestinal tract. These microorganisms are not merely passive inhabitants of the gut; they are active biochemical factories producing metabolites that can significantly influence the integrity and functionality of the gut-brain barriers as well as the flow of communication through the various communication channels making up the brain gut microbiome system. A wealth of preclinical and a smaller number of clinical studies are increasingly revealing that these metabolites have the potential to affect brain health and behavior profoundly in both a positive and negative way. Short chain fatty acids like butyrate are one of the most effective molecules, generated by certain gut microbes from a fiber rich diet supporting a tight gut barrier.

“The early stages of life present critical windows during which the development and modulation of these barriers are especially crucial.”

It is during these periods that the foundation for future health is laid down. Alterations in the gut microbiota and subsequent barrier dysfunction have been implicated in a number of conditions, including a spectrum of often interrelated neurological and gastrointestinal disorders.

One of the primary functions of the gut microbiota is the metabolism of food components that cannot be absorbed intact in the proximal small intestine, creating molecules that are not only beneficial for gut microbial richness and diversity and gut health, but after absorption in the distal small intestine and colon provide a variety of health benefits for the host. The impact of microbial metabolites extends beyond the gut, with SCFAs being one of the most extensively studied. These metabolites are not only influential within the gut itself but also exert significant effects on the brain’s protective barriers. This underscores the far-reaching impact of the gut microbiota on our health and opens new avenues for potential therapeutic interventions.

“Compromised barrier function can be a precursor to or a hallmark of disease.”

For example, a “leaky gut”, characterized by increased permeability of the different barriers, has been suggested to play a role in certain intestinal disorders, such as inflammatory bowel disease and certain forms of irritable bowel syndrome. In the realm of the brain, barrier dysfunction has been proposed as an early indicator of cognitive decline and is connected to a range of neurocognitive and neurodevelopmental disorders, including autism spectrum disorder, depression and schizophrenia.

Understanding brain and gut conditions requires a holistic view that considers them as part of an interconnected system (the brain gut microbiome system) constantly modulated by the gut microbiome. This systemic perspective is vital for developing treatments that address the root causes of these conditions, not merely their symptoms.

“…paradigm shift in the approach to health and disease.”

Delving into the molecular and cellular mechanisms of the gut-brain barriers uncovers potential therapeutic targets that may revolutionize the treatment of neurological and gastrointestinal disorders in the future. Moving beyond the simplistic notion of “leaky gut” to a holistic understanding of barrier dynamics signifies a paradigm shift in the approach to health and disease. The exploration of the gut-brain axis and its barriers provides a snapshot of the intricate interplay between various aspects of our health. The review by Aburto and Cryan emphasizes the importance of an integrative approach that recognizes the interconnectedness of the microbiome, the body’s barriers, and overall well-being.

As research progresses rapidly, we continue to uncover the complexities of the gut-brain connection. This field stands at the forefront of a new frontier in medicine, with the potential to bring about transformative treatments that consider the patient as an integrated whole. The implications for such a holistic or system-based approach to health are vast and could lead to significant advancements in managing and preventing a broad range of diseases. However, awaiting such major scientific breakthroughs, the emerging concept of the brain gut microbiome system including the role of its various barriers is consistent with a range of large epidemiological studies showing the positive interactions between gut and brain health and various lifestyle modifications including diet, exercise, and a positive state of mind.

Emeran Mayer, MD is a Distinguished Research Professor in the Departments of Medicine, Physiology and Psychiatry at the David Geffen School of Medicine at UCLA, the Executive Director of the G. Oppenheimer Center for Neurobiology of Stress and Resilience and the Founding Director of the Goodman-Luskin Microbiome Center at UCLA.