Talk:Leaky gut

Citations

(Part discussion moved from from 'leaky gut syndrome.)

Thanks, it seems to me that this subject is not Alt Med as a check on Pubmed shows whilst there are only 12 hits for Leaky gut syndrome, there are 51 for 'leaky gut' including 21 reviews, where as there are 54 reviews for 'bowel permeability and tight junctions' So it seems that the science is there and probably no longer an 'alternative med' subject. However SBOS does not seem appropriate as only one cause among many possible. I will leave it to more experienced to decide. In the meantime the Article needs improvement.

Depression, re PMID 19085093 it is not a Review but as the edit is close to the article wording, it seems to comply with edits that rely on primary sources should only describe the conclusions of the source, In particular, this description should follow closely to the interpretation of the data given by the authors, PMID 18580840 may be better ref as it is secondary source from a reputable publisher will be written by an expert in the field and be editorially or peer reviewed. The author has some 242 pubmed articles on depression. The journal has a formal peer review process satisfactory to NIH, as shown here in 'instructions to authors[1] and published articles are distinct from 'letters to the editor' Peerev (talk) 21:58, 26 April 2009 (UTC)

As far as I'm aware, leaky gut is considered psueoscience. Number of hits on alt med does not prove anything (and 51 is very low for a recognised syndrome. Try searching for "chronic fatigue" and you'll get a lot more!) Both PMID 18580840 and 19085093 are hypotheses. --sciencewatcher (talk) 22:26, 26 April 2009 (UTC)

I said Pubmed not Alt med? Maybe a new Article, Leaky gut or Bowel permability appropriate? From Wiki article its not pseudoscience as it has a testable hypothesis, the fact that there are hypotheses in mainsteam journals attests that. Much of the published science also attests and 75 reviews is not trivial. Hypothesis yes, based on evidence thats why edits were placed in hypotheses section of Article!

Diabetes, PMID 18820210 is again a review in the journal 'Diabetes' ditto. Heart, PMID 18685461 is a review, to which can be added another review PMID 15980032. Hepatitis etc, PMID 18626795 is a review. Somatization and CFS, PMID 19127706 is another review, supported by PMID 19112401, which shows the hypothesis is testable. Peerev (talk) 21:31, 27 April 2009 (UTC)

Ok, it looks like you know more about this than me. Looking at these and other reviews there is genuine research into "leaky gut". The problem is that the "leaky gut syndrome" that is diagnosed by naturopaths isn't the same thing as the leaky gut that we see in the reviews. So you just need to be careful that you separate the "real" leaky gut from the quackery version.

Also, while hypotheses are fine in the hypotheses section, you just need to be careful about two things. First of all, don't give them too much WP:Weight. Generally one sentence max is sufficient for an untested hypothesis. Also you shouldn't be putting in anything too speculative even in the hypotheses section. For example, 19127706, which says "SUMMARY: 'Functional' symptoms, as occurring in CFS and somatization, have a genuine organic cause". That's a bit of a stretch, don't you think? He says "have a genuine organic cause", not "may have a genuine organic cause". Because of this, I'm now a bit suspicious about all of Maes' work. --sciencewatcher (talk) 22:25, 27 April 2009 (UTC)

From his website it seems Maes is a psychiatrist and researcher, this article is in journal 'Curr Opin Psychiatry' so opinion might be operative word? He has four published papers on Leaky gut and depression so it seems he possibly is refering to his own findings? Although not strictly MEDRS I agree with adding the word 'may' as you suggest.

The article title "Leaky gut' already redirects here, so I concur it is probably meant to cover both, but agree needs differentiating? Maybe constrasting these two in the lead might help, PMID 17182488, PMID 16092447. This Google scholar abstract might also be useful rerence [2] unless a better definition is possible, I will attempt a rewording?Peerev (talk) 21:51, 28 April 2009 (UTC)

Yes, just go ahead and improve the article, and I'll not revert unless there is an obvious issue. Sounds like you know what you're doing. --sciencewatcher (talk) 22:19, 28 April 2009 (UTC)

I recommend putting the material on "leaky gut", disruptions of tight junctions, into leaky gut rather than redirect. both articles linking to one another (and elsewhere) as necessary. There's plainly a difference between "leaky gut" per se on the one hand, and "leaky gut syndrome" on the other hand. If I understand the lay of the land correctly, the latter is asserted -- without much if any clear experimental evidence in support to date -- to be related to a cluster of symptoms so as to essentially constitute a defined spectrum disorder (i.e., "leaky gut syndrome") that is considered pseudoscientific. The former ("leaky gut") is still under experimental investigation without much of a clear understanding of its full implications within the medical community. IOW, best to split this new material into the title leaky gut. ... Kenosis (talk) 23:11, 1 May 2009 (UTC)

I've moved the new material over to Leaky gut, where it more appropriately belongs. TBH, it's far too much primary-source material-- please see also WP:Summary style. Nonetheless I've kept the just-added material intact for now at leaky gut, until one or more editors have a chance to deal with it and hopefully it can get sorted out so as not to confuse "leaky gut syndrome" with the more straightforward and far less speculative term "leaky gut". ... Kenosis (talk) 22:45, 3 May 2009 (UTC)

I will leave it to others to decide whether split is best. However most material in 'Leaky gut' complies with WP:MEDRS. If however you want please discuss specifics and not generalise. Meanwhile i will add to 'leaky gut'Peerev (talk) 23:24, 3 May 2009 (UTC)

Autism edits

Problem with 'autism' ref's you have now added to lead is they are definately not WP:MEDRS Peerev (talk) 21:45, 4 May 2009 (UTC)Removed such material sourced to media reports , primary studies etc. Peerev (talk) 22:03, 7 May 2009 (UTC)

The Johnson reference includes a research summary, and as such is a secondary source that reviews primary published studies. I've replaced the statement in the lead, and added another research review by Christison. This is too much of a "hot-button" issue subject to widespread popular misconceptions since the Wakefield false alarm. It's appropriately placed the lead because of its wide public exposure. The advanced reader likely will readily discern the difference between "leaky gut" and "leaky gut syndrome", but the layperson, it seems to me, needs to be squared up on the lack of evidence as a cause of autism at the outset of the article. ... Kenosis (talk) 21:45, 8 May 2009 (UTC)

Reincluding material until consensus reached is a breach of BRD, will not be tolerated further. You have a specific view that is not WP:NPOV certainly not for a lead. The cites you have added are not WP:MEDRS and the edit amounts to WP:OR. The Johnson article you have linked to is a consumer website and a nurses information site. From what i can find the Article is not a review and not cited by NIH. PMID 1668583 is not a review but an animal study, PMID 18337276 is a primary source. Media reports are not Medrs either. Find a review cited by NIH that is MEDRS, that says what your edit says, and it will be considered. Peerev (talk) 22:01, 11 May 2009 (UTC)

Leaky Gut in Celiac Disease

An article has appeared on Scientific American magazine that makes a connection between Celiac Disease and a Leaky Gut. It seems like this connection might be more solid than any connection between Leaky Gut and Autism. I have not seen in this Wikipedia article on Leaky Gut any reference to Celiac Disease. I think this should be mentioned. This article discusses two mechanisms that can loosen tight junctions : (1) a toxin called Zot which is produced by bacteria (2) Zonulin, a protein secreted by cells in the body. The article claims that in people with Celiac Disease, Gluten stimulates the production of zonulin, which in turn loosens tight junctions. The loosening of tight junctions causes a leaky gut which enables gluten fragments to cross the intestinal ligning and to come in contact with immune system cells thus generating an immune reaction which damages the intestinal lining cells.

The Article: "Surprises from Celiac Disease" by Alessio Fasano in Scientific American, August 2009

This article also list as a reference two Journal Articles: (1) "Mechanisms of Disease: The Role of Intestinal Barrier Function in the Pathogenesis of Gastrointestinal Autoimmune Diseases" by Alessio Fasano and Terez Shea-Donohue in Nature Clinical Practice Gastroenterology & Hepatology, Vol 2 , No 9, pages 416-422; September 2005. (2) "Diagnosis and Treatment of Celiac Disease" by L.M. Sollid and K.E.A. Lundin in Mucosal Immunology, Vol 2 No.1 Pages 3-7; January 2009.

The first journal article is already listed in the references section of this Wikipedia article. I don't know if the second reference by Sollid includes enough discussion about the roll a leaky gut plays in celiac disease in order to be listed in this WP article. But the Scientific American article is very appropriate and it is written at a level that makes it easy to understand by non-specialists. —Preceding unsigned comment added by Alex Pascual (talk • contribs) 15:52, 27 July 2009 (UTC)

Merger proposal

I propose that Leaky gut syndrome be merged into Leaky gut. I think that the content in the "Leaky gut syndrome" article can easily be explained in the context of "Leaky gut", and the "Leaky gut" article is of a reasonable size that the merging of "Leaky gut syndrome" will not cause any problems as far as article size or undue weight is concerned. There is too much repetition between the two articles to merit them being two separate articles, and they are both discussing virtually the same condition and the same treatments. Not to mention that by now there are over 65 articles on "Leaky gut" in PubMed. Softlavender (talk) 03:22, 14 March 2013 (UTC)

• Support. There are insufficient differences between the articles to warrant two separate articles, which creates an undue WP:CONTENTFORK. The description and treatment in both articles are virtually the same. There are also over 65 articles on Leaky Gut in PubMed. Softlavender (talk) 03:34, 14 March 2013 (UTC)

Result: Merged per consensus and lack of discussion. Softlavender (talk) 06:54, 5 April 2013 (UTC)

References

(moved from "Leaky gut syndrome" Talk page)

Per the requests for references and citations, 150+ drawn upon by Galland, M.D. Res q68 02:29, 9 July 2006 (UTC)

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---

Fringe claims

The article is claiming that this syndrome has "inspired" some fringe (and other) kinds of "dietary treatments". Because this is dubious (there is no evidence whatsoever in the linked-to articles) and in the domain of health information I have removed this, but User:Softlavender has twice reinserted it in an unsourced, untagged state. Because this looks highly likely to be fringe misinformation, I think it needs to be deleted immediately. What evidence of verifiability is there? Alexbrn ^{talk|contribs|COI} 09:46, 23 October 2013 (UTC)

If you want citations for information in any article, please put tags. Softlavender (talk) 09:55, 23 October 2013 (UTC)

That's not strictly true. Our policy states there "any material lacking a reliable source directly supporting it may be removed", and in some circumstances (in BLPs for example) editors are required to do so. There is a spectrum, and editors view things differently. My view is that {{cn}} tags are appropriate for uncontentious material, but for anything that encroaches into the area of health information, dubious material needs immediate deletion. Anyway, irrespective of our editorial views about what should and shouldn't be deleted, it is also policy that "The burden of evidence lies with the editor who adds or restores material" (bolding in original) ... which is why I asked for evidence here. Alexbrn ^{talk|contribs|COI} 10:14, 23 October 2013 (UTC)

Oh, it is definitely true. If you've looked into any kind of quackery you'll know that Leaky Gut is a magnet for all types of quacky treatments for IBS, CFS, candida, autism, etc. If you can't find a ref it means you haven't bothered looking :) --sciencewatcher (talk) 15:45, 23 October 2013 (UTC)

There seemed a lot of material out there, but I'm not sure how much is RS; but then we get into how WP:FRINGE applies and whether it's undue to mention it ... but that's the next step :-) Alexbrn ^{talk|contribs|COI} 18:15, 23 October 2013 (UTC)

Yes, the problem is that the entirety of "leaky gut syndrome" is fringe, so perhaps an article from a reputable science magazine might be appropriate. --sciencewatcher (talk) 23:23, 23 October 2013 (UTC)

Oh okay, searching around I see that's right; this wasn't very evident from the article itself, which probably signals a wider neutrality problem here? Alexbrn ^{talk|contribs|COI} 05:36, 24 October 2013 (UTC)

(add) Actually this article is a bit of a disaster, with a load of rather dubious material trying to ride on the coat-tails of the fact that "leaky gut" is (apparently) a thing in real medicine. It was hard to know there was quackery in here because of the lack of mainstream views. Alexbrn ^{talk|contribs|COI} 08:15, 24 October 2013 (UTC)

(add) In fact I'm half-thinking this article was some kind of hoax, with random bits of vaguely-related journal articles copied and pasted together into a jargon-rich confused mess. I'm having a bit of a tidy-up. Alexbrn ^{talk|contribs|COI} 09:58, 24 October 2013 (UTC)

Leaky gut syndrome used to be a different article to Leaky gut, but they were merged a while ago. Leaky Gut Syndrome is definitely fringe/quackery. I'm not sure about Leaky Gut - there seems to be some reasonable research there, although I'm slightly suspicious. It would be good if a medical expert could take a look. --sciencewatcher (talk) 13:42, 24 October 2013 (UTC)

Not sure how much of an "expert" I am, but I am a physician. "Leaky gut" is increased permeability of the intestinal wall, which is a real phenomenon that has actually been observed. The question is whether this "leaking" has any clinical significance. Those who say it does theorize that it may be the cause of numerous diseases, such as psoriasis, arthritis, Crohn's disease, etc., etc. They have also proposed an entity that they call "leaky gut syndrome", which is said to have symptoms including bloating, gas, cramps, food sensitivities, and aches and pains. These are very nebulous symptoms that can be caused by a variety of diseases, or by simple stress and strain. Whether they can also be caused by increased permeability of the intestinal wall is, from an MD’s standpoint, a very gray area. The simple fact is, we don’t know enough about the gut, which is our biggest immune system organ. Obviously there is a lot of room for jumping to unproven conclusion, which then leads to the advocacy of untested treatments and other quackery, as others have pointed out. So in summary, "leaky gut" is real, but whether increased gut permeability leads to psoriasis or arthritis or Crohn's or food sensitivities or "leaky gut syndrome" is an open question -- and that's why I restored the sourced sentence in the lede that says precisely that. It's good that the dubious & unsourced claims are being removed, but we need to be careful not to let the pendulum swing to the other extreme and flat out label it a hoax -- because we don't know that either. NPOV is the key. Cheers, DoctorJoeE ^{review transgressions}/_{talk to me!} 14:44, 24 October 2013 (UTC)

I think the problem with that lede sentence is that it was generalizing the view of a GP (with a history of misconduct) to stand for "doctors", as if this was a live controversy in mainstream medicine. I know this is what newspapers do, but it probably isn't NPOV here, especially since WP:FRINGE applies. Alexbrn ^{talk|contribs|COI} 14:50, 24 October 2013 (UTC)

No, that lede sentence summarized the situation, which is that gut permeability is real, but whether or not it causes disease (or perhaps vice versa, or both) is an open question that has not yet been answered. If your problem is with the source, I will replace it with a scholarly article that makes the same point. DoctorJoeE ^{review transgressions}/_{talk to me!} 16:25, 24 October 2013 (UTC)

I think there are a few issues here:

• Easy one first: the lede should summarize the body and not contain novel information; so anything new should be added to the body first.
• Yes, I think it would be helpful to have a good source showing that "leaky gut" was, in the mainstream, synonymous with "gut permeability". (But - is it?)
• I don't think characterizing the claims around the adverse causes of "leaky gut" as giving rise "an open question" is neutral. The claim for example, that it causes autism? That seems to be about as open a question as the Wakefield stuff. The NHS site it pretty down on it, implying it is implausible too (if it were true, people who drank a lot of alcohol would have the ill effects claimed, e.g.). Its pseudoscience giving rise to quackery and per WP:FRINGE we need to be careful not to give a false balance here. Alexbrn ^{talk|contribs|COI} 16:56, 24 October 2013 (UTC)

I don't really care about this topic enough to engage in a protracted debate -- but it appears to me that you are falling into the common WP trap of "neutral POV = my POV". I happen to agree with you that this is "pseudoscience giving rise to quackery", but we are not here to push our POV; we are here to write a neutral article. How is the disputed lede sentence "novel information"? I just re-read the article, and it seems to me that it is fair to summarize it by saying that the phenomenon of gut permeability is not in dispute, but the theory that it gives rise to disease, or even a series of nonspecific symptoms, is. And that is exactly what the lede sentence that you took out (twice) says. Perhaps, instead of saying that it's an "open question", you would be amenable to saying that it "lacks credible scientific support"? I agree that we should not create a false balance, but POV pushing is equally inappropriate. That will only fuel the contention of alternative medicine advocates that mainstream medicine rejects anything "new". DoctorJoeE ^{review transgressions}/_{talk to me!} 18:40, 24 October 2013 (UTC)

There's no need to personalize it. I have no POV on leaky gut. A day ago I don't think I'd ever even heard the term. My concern is just to get the article presenting reliable information neutrally. Saying the syndrome "lacks credible scientific support" would look good to me; but I think we do that, in effect, already. (BTW, by "novel information" I meant novel-to-the-lede, but not-in-the-body). Our policy on pseudoscience requires us to describe pseudoscientific things clearly as such; saying the matter is "in dispute" would be less than ideally clear on that point. Alexbrn ^{talk|contribs|COI} 18:51, 24 October 2013 (UTC)

Exactly -- "we say that already" -- which means that it's already in the article body, and therefore appropriate to summarize in the lede. In my view, the most important point to convey in this article is that any discussion of a connection between increased intestinal permeability and pathology of any sort is only at the level of hypothesis, with (as yet) no credible scientific support. DoctorJoeE ^{review transgressions}/_{talk to me!} 20:14, 24 October 2013 (UTC)

Then I think we are in violent agreement :-) It's probably just a matter of wording/sourcing. I am slightly uneasy that I've equated "leaky gut" with "gut permeability" without strong RS backing. Do you know of anything that will suffice here? Alexbrn ^{talk|contribs|COI} 20:43, 24 October 2013 (UTC)

Violent agreement; I like it! I've never cared for imprecise lay terms like "leaky gut", but it seems to be regarded as synonymous with "intestinal wall permeability" in every source I've looked at so far, so I think you're on firm ground there. DoctorJoeE ^{review transgressions}/_{talk to me!} 22:41, 24 October 2013 (UTC)

It appears in a very limited context the term "leaky gut" might be used to refer to general gut permeability; however, in nearly all the material out there it appears to be used in association with the supposed systemic health effects which flow from that, which takes us firmly into fringe territory (which is not to say that investigating it is necessarily fringe, as the evidence needs to be finally settled). The NHS article luckily gives us a reliable steer on this. I think the merger wasn't a great idea, as having a "two-in-one" article complicates the categorization and content in a bad way. I think the small bit of legitimate content could probably be moved to articles about the gut, or about the conditions where there is legitimate treatment, leaving this article to focus on "leaky gut syndrome". I'll raise a query at WT:MED. Alexbrn ^{talk|contribs|COI} 14:47, 24 October 2013 (UTC)

I respectfully disagree. I think it is reasonable that the two be combined, so that we can distinguish one from the other directly, and make the point that gut permeability is a real phenomenon, but whether or not it causes symptomatology is unproven. (See also my response to your reverting my restoration, above.) DoctorJoeE ^{review transgressions}/_{talk to me!} 16:25, 24 October 2013 (UTC)

WT:MED

FYI, I have raised a query about this article at WT:MED. Alexbrn ^{talk|contribs|COI} 15:00, 24 October 2013 (UTC)

Protein losing enteropathy

It was suggested on WTMED that this article should be merged/redirected to the above article. I was unable to find any MEDRS source which explicitly states these two are the same. Google yields some non MEDRS sources linking the two, but suggest need a reliable source to decide what is best. Lesion (talk) 21:07, 24 October 2013 (UTC)

Bias and Skepticism

This article needs extensive revision.

It links "leaky gut" to "intestinal permeability." "Leaky gut" is an alternative medicine concept that attempts to connect various symptoms with intestinal hyperpermeability. "intestinal permeability" is a well established mechanism of the gut and there are thousands of papers on the subject, as you'll see on pubmed. Many of the papers on intestinal permeability validate some of the claims often made about leaky gut syndrome. It is reasonable to question some of the claims made regarding intestinal hyperpermeability (that it causes autism, for instance), but that it exists and can cause various symptoms has been shown extensively.

A touch of skepticism is appropriate in the absence of evidence, and still more so with contradictory evidence. However, in this instance a well-studied medical subject (intestinal permeability) is being maligned due to it still being under investigation, and its popularization as a catch-all ailment. A properly unbiased article on either leaky gut or intestinal permeability would explain intestinal permeability, mention the experimentally discovered findings, and then bring up the points of contention that have yet to be proven (and may not ever be.)

In its current state, this article feels like a Vatican attack on Galileo's heliocentric model of the solar system. — Preceding unsigned comment added by 172.56.3.119 (talk) 04:20, 16 November 2013 (UTC)

As the opening of the article says, "leaky gut" is a recognized biomedical phenomenon. But the altmed diagnosis of "leaky gut syndrome" is fringe/quackery (as the mainstream sources say) - so that's what Wikipedia says. Alexbrn ^{talk|contribs|COI} 05:58, 16 November 2013 (UTC)

Knowledge as metanarrative vis a vis "mainstream". Interesting. I agree with the comment above; this article reads like it was written by an angry teen rebelling against their parents. Not very becoming. Could be reframed in a big way. — Preceding unsigned comment added by 74.137.23.120 (talk) 03:28, 30 November 2013 (UTC)

The article is a mess, it doesn't differentiate properly between leaky gut and the supposed syndrome, perhaps splitting it in two articles fixes the issues. Interweaving unproven bs in an article about an actual condition doesn't make sense.Feyre (talk) 01:45, 8 December 2013 (UTC)

Agree. The present article is the result of a (bad, IMO) merge: see the discussion in the threads above this one ... Alexbrn ^{talk|contribs|COI} 07:07, 9 December 2013 (UTC)

Having read a lot of the literature on gut permeability and associated conditions, I don't find the NHS article provides a reliable steer. Even in the area of autism, which presumably because of Wakefield every default skeptic gets very nervous about now, there is active research with recently widely reported findings associating leaky gut and the microbiome with autism behaviours (in mice), showing too that specific probiotic treatment was effective. That surprised me, in no small part because of what I must have read on the NHS article some time ago. These findings were highlighted on the NIH Director's Blog in January following a research paper published in Cell in December. Separately, Nature produced a compelling video which shows the mechanism of mucosal wall damage and immune function, perhaps reflecting the subject's topicality. The drift of research suggests to me that leaky gut will be shown to be a bona fide component of various diseases of inflammation/brain signalling and this page will prejudice the casual evidence-based practitioner.Knackeredhack (talk) 13:38, 17 January 2014 (UTC)

If and when the best sources change their view, Wikipedia will follow. But we must avoid having a WP:BALL. Alexbrn ^{talk|contribs|COI} 13:42, 17 January 2014 (UTC)

The best sources would be the Rome Foundation. Better than the NHS article, which seems out of date and journalistic. The notion that dietary intervention somehow constitutes a health fraud seems extreme when a board member of the foundation produced this recent analysis concerning the role of wheat in functional gastroenterological disorders:-

"In fact, in a 2009 evidence-based review, the American College of Gastroenterology IBS Task Force stated, “Patients often believe that certain foods exacerbate their IBS symptoms. There is, however, insufficient evidence that food allergy testing or exclusion diets are efficacious in IBS.”4 This lack of enthusiasm for dietary counseling has increasingly caused healthcare providers to be misaligned with their patients, who are increasingly seeking more holistic solutions for their IBS symptoms. Out of desperation, many patients attempt dietary manipulations, such as the reduction of fatty foods, carbohydrates, gluten, or milk/dairy products or the modification of dietary fiber content after seeking advice from family, friends, or the Internet.5 It should come as no surprise that this disorganized and largely nonvalidated approach can result in frustration for both patients and healthcare providers. Furthermore, the adoption of highly restrictive diets for extended periods of time without appropriate supervision or monitoring can lead to the development of malnutrition.5"

Note the observation of misalignment, not that the patients are wrong to explore their diet. This study looks too at the role intestinal permeability may play and cites currently contradictory evidence. Chey also authored a 2013 introduction to a set of studies on the role of food in functional gastrointestinal disorders, (unfortunately not free as far as I can see) highlighting this is now an active area of research rather than a fringe pre-occupation where little evidence exists, as the NHS article states explicitly. And in contrast to the NHS suggestion which the Wikipedia article still contains that "the theory is vague and currently largely unproven" Chey says in the wheat paper: "In the face of increased intestinal permeability, it is reasonable to hypothesize that environmental factors, such as food antigens, could lead to immune activation or could trigger a low-grade inflammatory response, leading to the generation of symptoms in a susceptible individual." This forms part of a piece with the notion discussed higher up in relation to Michael Maes' work on the gut-brain axis and its role in depression and other "sickness behaviours", which I believe has further research momentum behind it since the reference here in 2009.

So my point is that you are taking weak and out of date information by quoting the NHS source over the international GI coordinating body The Rome Foundation to discredit the altmed leaky gut industry, though it might have been a reasonable reflection of the official evidenced-based position in 2009. While it's true that altmed lacks rigour, the GI specialists themselves are here acknowledging there is a lot more to diet and have more recently mobilized research into the area, while also noting that it is more complicated than say the altmed/gluten-free proponents would have it. However, by way of example, please note that the Rome Foundation award for the most cited paper of 2013 is a DBRPC study that highlights the role a gluten-free diet can play in non-celiac gut disorders, which further confirms that evidence-based researchers are validating at least in part a role for gluten/wheat in these pathologies. Knackeredhack (talk) 15:03, 20 January 2014 (UTC)

I don't think there's any doubt that the permeability of the gut can be increased by gluten (and a large number of other things). The problem is the claims that this is responsible for a variety of systemic and neurological conditions from multiple sclerosis to autism - or are there good sources taking such things seriously? Alexbrn ^{talk|contribs|COI} 15:19, 20 January 2014 (UTC)

It seems there is plenty of literature which describes the evidenced based move to validate the hypothesis that increased gut permeability plays a role in a range of conditions.This paper from 2012 published by the BMJ and on the Rome Foundation site is a fairly up to date review which shows various neurological disorders may well be related to problems with the gut microbiota in which intestinal permeability and activation of immune system plays a role. It seems the NHS article is anchoring this discussion when what I see is a piece of out of date guidance cautioning people against altmed, which would be fair enough, except that in this case it looks more like altmed is just front-running the evidence-base research hypothesis because diet can be manipulated by trial and error by individuals and non-evidenced based practitioners with results, even if incomplete. The GI community seems to be in a self-confessed catch-up mode. It is surely more complicated than gluten-free. In the case of small intestine bacterial overgrowth which produces the same kind of villous atrophy as celiac disease, and intestinal permeability, and is suspected widely as a cause for much IBS, the role of various starches has been implicated and it looks like the low FODMAP approach is not the final word. So I think the article needs to capture the notion that recent focus on the microbiome as a source of a range of conditions is further highlighting the role intestinal permeability might be playing. The starting point in my own reading has been to actively avoid Altmed sites, so I find it strange to see what I've learnt from PUBMED sources dismissed as fringe theory, when it looks to me to be the thrust of current research, the only problem being that promising studies in this area just need to be validated. Knackeredhack (talk) 17:16, 20 January 2014 (UTC)

References

Supposed Tests/Diagnosis Methods

I have found information from a (M.D.) proponent's perspective on diagnosing/testing for leaky gut. Of course, I recognized it as unscientific and wrote it as such. But seeing as my edit got reverted, I'm guessing Dr. Oz's website is not a reliable source for the believer's perspective? I don't buy any of that stuff, but I saw that the article needed things besides "this isn't an actual condition" in the section; it was already emphasized in the background section.

Perhaps I've been away from Wikipedia too long. What would be considered a reliable source for pulling what proponents of the syndrome say?--Jade Harley (talk) 01:09, 25 November 2013 (UTC)

It's always a tricky to describe "the fringe thing" without giving it undue space; the problem here is trickier because our reliable source (NHS) call LGS "vague" - we wouldn't want to contradict that by stating something specific. We already give about as much information as that source does ... Alexbrn ^{talk|contribs|COI} 04:49, 25 November 2013 (UTC)

I see. In that case, would just a sentence or two mentioning the range of supposed diagnoses and treatments be better?--Jade Harley (pester) 14:22, 25 November 2013 (UTC)

Split proposal

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section. A summary of the conclusions reached follows.

Closing - the result is to split. Alexbrn ^{talk|contribs|COI} 13:00, 17 January 2014 (UTC)

---

I propose that this article be subject to a content split resulting in two target articles:

• Intestinal permeability - about the recognized biomedical phenomenon
• Leaky gut syndrome - about the controversial proposed altmed/fringe condition

As background, note that the current article is the result of a merge of April 2013. Alexbrn ^{talk|contribs|COI} 08:05, 9 January 2014 (UTC)

• Support (as nominator). The article as it stands has a problematic dual nature, combining a recognized phenomenon ("Intestinal permeability") with a pseudoscientific medical condition ("Leaky gut syndrome"). Treating both in one text is difficult not just because they are different topics, but because the requirements of WP:PSCI mean the pseudoscientific nature of Leaky gut syndrome needs to be made explicit, and the wording doing this "contaminates" the legitimate medical topic with commentary which confuses readers. Alexbrn ^{talk|contribs|COI} 08:10, 9 January 2014 (UTC)
• I support this particular split as well, for the same reason, and additionally I would suggest that a search for "leaky gut" return only the disambiguation page. Nakomajoe (talk) 15:18, 9 January 2014 (UTC)Nakomajoe

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

• Oppose-- Better to discuss both on the same page, clearly placing any alt med content in a "Complimentary and alternative medicine section" or somesuch. This would better highlight to readers that part of the topic is mainstream and other parts not. On 2 separate articles, you are assuming that the reader will be aware of and read both articles. Therefore separation might have the opposite effect to what you intended by carrying out this split. You should have sought a more clear consensus than consulting one person to reverse a previous consensus. Lesion (talk) 10:51, 18 January 2014 (UTC)

I didn't "consult one person" - I posted on the Talk page, added the appropriate tags to the articles and waited for a week to see what consensus emerged. Alexbrn ^{talk|contribs|COI} 11:01, 18 January 2014 (UTC)

Granted the previous merge was made by only one person, and you posted on WTMED. The situation here is that Leaky gut is a shorter article than Leaky gut syndrome. To have leaky gut syndrome as a subsection might therefore look odd. Both articles are linked to each other, so this is not so bad. Lesion (talk) 11:13, 18 January 2014 (UTC)

For reference, here is the discussion on WTMED that was not mentioned here: Wikipedia_talk:WikiProject_Medicine/Archive_39#Leaky_gut. Lesion (talk) 10:57, 18 January 2014 (UTC)

• Not sure why the synonym "intestinal permeability" is being used in the literature since arguably this is not pathologic. "Intestinal hyperpermeability" better dennotes abnormality. Lesion (talk) 11:13, 18 January 2014 (UTC)

• Yes, and in fact I haven't moved the content of leaky gut to Intestinal permeability (yet) but left it as a redirect. The terminology around this seems rather confusing. As I see it we now have

• "Intestinal permeability" - a normal phenomenon
• "Intestinal hyperpermeability" - a condition
• "Leaky gut syndrome" - a proposed condition in altmed
• "Leaky gut" - an informal term which might overlap with any of the above

Not sure how best to sort this out in the article naming. Alexbrn ^{talk|contribs|COI} 11:25, 18 January 2014 (UTC)

If 2 articles, "Intestinal hyperpermeability" as the mainstream, and leaky gut syndrome as the CAM...we should follow the sources and my guess is there is no consensus there, as is usual. Lesion (talk) 11:43, 18 January 2014 (UTC)

I don't agree that intestinal permeability is not descriptive of pathology., unless I misunderstand you. It seems clearly part of various conditions under active investigation. Hyperpermeability I've seen less often. The Nature video I posted in the bias section shows clearly the mechanism whereby the integrity of the gut lining breaks down. Altmed is uncoordinated so leaky gut syndrome for them is a catch-all. Altmed dietary recommendations may be inconsistent and untested, but this is a reflection of an oversight in gastrointestinal research programmes highlighted by the Rome Foundation. Diet is where active research is now focused. Monash released their low-FODMAP diet into this context, which has various Altmed imitations not consistent with the formally researched diet. Knackeredhack (talk) 14:19, 20 January 2014 (UTC)

I think it's only potentially pathological when it's increased (or abnormal) intestinal permeability, though the terminology in this area seems far from being agreed. Alexbrn ^{talk|contribs|COI} 14:34, 20 January 2014 (UTC)

The plot thickens

This recent good source

• Thoma YM, Anderson JM, Turner JR (2012). Johnson LR; et al. (eds.). Tight Junctions and the Intestinal Barrier. Vol. 1. Academic Press. pp. 1043–. ISBN 978-0-12-382027-3. {{cite book}}: |work= ignored (help); Explicit use of et al. in: |editor= (help)CS1 maint: multiple names: authors list (link)

introduces the term "leaky gut hypothesis" which is a hypothesis about how the leaky gut relates specifically to Crohn's Disease. Alexbrn ^{talk|contribs|COI} 15:45, 20 January 2014 (UTC)

That highlights very clearly the range of evidence-based research and its long history, but also elaborates the mechanism which gives rise to a range of disorders consequent to the immune response that increased intestinal permeability kicks off. Knackeredhack (talk) 20:05, 20 January 2014 (UTC)

It's a hypothesis it might be implicated in causing Crohn's Disease, which is worth relaying here; it doesn't take in the pseuodo-scientific claims about conditions like MS and autism. Alexbrn ^{talk|contribs|COI} 20:21, 20 January 2014 (UTC)

The claims about multiple sclerosis and autism are not pseudoscientific, but are being actively researched with promising results. I apologise but my attempts to link to papers above seems not to have been successful, but the work of Elaine Hsiao clearly makes the link between microbiota, gut permeability and autism (PMID 24315484). Someone has provided a comment with links to other work in the field concerning other neurological abnormalities including schizophrenia. Hsiao's work was highlighted on the NIH Director's blog (about as official as you can get?) that I referred to and tried to link to above url=http://directorsblog.nih.gov/2014/01/09/creative-minds-can-microbes-influence-mental-health/#more-2460. This TEDx talk at Caltech also highlights how the research may also apply to MS url=http://tedxcaltech.caltech.edu/content/elaine-hsiao. Knackeredhack (talk) 21:24, 20 January 2014 (UTC)

PMID 24315484 concerns some lab work on mice from which a "connection" between the gut and ASD is proposed. We can't use that here since it's not WP:MEDRS. It doesn't really bear on the line pushed by people selling dietary supplements to "cure" autism. (Update: this systematic review, which we could use, appears to suggest that such a proposed connection is, in any case, not proven.) Alexbrn ^{talk|contribs|COI} 21:37, 20 January 2014 (UTC)

My point is not that people are selling dietary supplements under false pretences, but that is obscuring the view of what is going on in evidence-based medicine ie that intestinal permeability and its regulation by microbes is fully implicated in a range of conditions and these are under investigation. Perhaps this review is more helpful url=http://www.ucc.ie/en/anatomy/news/newsarchive2012/Mind-alteringmicroorganisms.pdf Knackeredhack (talk) 22:22, 20 January 2014 (UTC)

I don't think we are disagreeing then. Any (relevant & reliably sourced) biomedical science can go in the Intestinal permeability article; any quackery and pseudoscience can go to Leaky gut syndrome. Alexbrn ^{talk|contribs|COI} 22:27, 20 January 2014 (UTC)

I think the bifurcation of leaky gut toward intestinal permeability and to leaky gut syndrome seems very apropos. PMID 3607857,PMID 3601973, and PMID 3605358 show the history of the theory and research into gut toxicity and mental health with much reference to intestinal permeability, and highlight that, after a hiatus of many decades where the notion was taboo because of Altmed/colonic irrigation and excessive claims by commercial interests for probiotics, the area is being actively researched since 2000. Particularly ironic is the observation that some attitudes in GI research and practice are still influenced by an out-of-date pseudo-scientific Freudianism. But I guess that's what they learnt in med school.Knackeredhack (talk) 17:31, 22 January 2014 (UTC)

A word to the wise, after further checking the affiliations of the authors, they do seem to be in the "integrative" camp, which I know gets the goat of some skeptics.Knackeredhack (talk) 11:15, 23 January 2014 (UTC)

Incredibly frustrating

This "disambiguation" says in its entirety:

Leaky gut may refer to:

• Intestinal permeability, the phenomenon whereby the intestine wall exhibits permeability
• Leaky gut syndrome, a supposed medical condition promoted by some alternative medicine purveyors

---

From the POV of someone who came here seeking information, I find this incredibly frustrating.

On the one hand, "intestinal permeability" is a recognized phenomenon. Based on the article by that name, as well as the discussion preceding this comment, I get the clear impression that doctors are looking at the condition and studying links to other medical conditions. And moreover, that connections HAVE BEEN found - eg, celiac disease.

On the other hand, when referred to as "leaky gut syndrome", it is disparaged as a "supposed medical condition".

Is it not the same thing, albeit under two different names?

CBHA (talk) 17:42, 31 May 2014 (UTC)

No. There has been a bogus condition used as the basis of health fraud; it is most commonly named "Leaky gut syndrome", is vaguely defined and leads to the sale of bogus remedies. Could this be clearer? Alexbrn ^{talk|contribs|COI} 07:04, 1 June 2014 (UTC)

Thank you. I know that the word syndrome carries a particular connotation that leaky gut alone does not. However, one meaning of gut is intestine, and "highly permeable" translates very easily to "leaky". In most people's experience, someone talking about one of these is also talking about the other.

It seems to me that trying to fence off "leaky gut syndrome" as a term that only a charlatan would use and "intestinal permeability" as a term that only a legitimate doctor or researcher would use is a) doomed to failure and b) highly arbitrary. If a doctor tells a patient that they have a problem with high intestinal permeability, and the patient gives the doctor a blank look, a very likely way of paraphrasing to give the patient some understanding is "leaky gut".

Moreover, the way this distinction is set out here implies that any practitioner who talks about "leaky gut syndrome" is suspect. CBHA (talk) 02:10, 2 June 2014 (UTC)

In my humble opinion (as a practitioner of 33+ years), any practitioner who talks about "leaky gut syndrome" IS suspect. DoctorJoeE ^{review transgressions}/_{talk to me!} 03:21, 2 June 2014 (UTC)

To clarify: I have absolutely no problem with any physician explaining increased intestinal permeability to a patient as a "leaky gut" -- the less "doctor talk" used in conversations with patients, the better. However, there is a chasm dividing "you have a leaky gut" from "you have leaky gut syndrome" -- the former is a legitimately-observed medical condition, while the latter is a totally undocumented non-disease, used only, as far as I can tell, to encourage the sale of highly questionable "cures" for a multitude of diseases to which no link with increased intestinal permeability has ever been credibly demonstrated. So I disagree with you: I don't think distinguishing "leaky gut" from "leaky gut syndrome" is arbitrary or wrong at all. When and if someone in a legitimate lab publishes reproducible evidence that "leaky gut syndrome" is a real disease entity, I will be happy to change my view. I will not be holding my breath. DoctorJoeE ^{review transgressions}/_{talk to me!} 14:36, 2 June 2014 (UTC)

Thanks very much for the feedback. CBHA (talk) 01:55, 3 June 2014 (UTC)