Talk:Leaky gut syndrome

A Misleading Dichotomy

User:Rslateriii the content you added today was mostly not about the topic of this article. Some was about gut flora and some was about intestinal permeability. Jytdog (talk) 19:21, 31 August 2016 (UTC)

User:Jytdog the content [1] discussing gut flora and intestinal permeability is highly relevant to leaky gut syndrome, and the references I added describe this physiologic principle in much greater detail. The notion that leaky gut syndrome is an entirely unrelated entity is outdated, and painting "leaky gut syndrome" in broad strokes as pseudoscience is increasingly inconsistent with available scientific literature. The statement that "there is currently little objective evidence to support the hypothesis that such increased permeability is the direct cause of any chronic diseases" is an over-generalization, and a quick perusal of PubMed will reveal a myriad of associations between abnormal intestinal permeability and chronic diseases.

Additionally, the above statement from DoctorJoeE that "The two articles were separated... to avoid confusing intestinal permeability (which is real) with leaky gut syndrome (which is hypothetical)" does not adequately take into account that leaky gut syndrome is a poorly-defined entity at this time. I see no reason to perpetuate a false dichotomy between abnormal intestinal permeability and leaky gut syndrome as two fully distinct entities. This seems to be an over-simplification and ignores substantial overlap between two increasingly related topics. Further, the content on the Intestinal Permeability page does not directly mention the human microbiota or the principle of dysbiosis, and this page seemed a more appropriate avenue for connecting those topics.

As it currently stands, this page leaves no room for leaky gut syndrome as a valid scientific hypothesis, and makes no mention that this is an active area of medical research. I was careful to maintain the original statements that leaky gut syndrome is not currently recognized as a distinct medical diagnosis, and that there are no current medically validated tests or treatments for it. That said, researchers believe that further elucidation of leaky gut holds both diagnostic and therapeutic potential -- rather than simply dismissing leaky gut syndrome as quackery, there should at the very least be a mention that research is ongoing. Rslateriii (talk) 22:34, 31 August 2016 (UTC)

Thanks for replying! The problem is that none of the sources you bring actually say that. The sources in the article (which are very high quality per WP:MEDRS) do say that "leaky gut syndrome" is bogus. What you have done is what we call WP:SYN - please read that. Thanks.Jytdog (talk) 23:05, 31 August 2016 (UTC)

Thank you very much for your effort, Rslateriii! You have part of reason and you have used good references, but I think we should clarify concepts.

The best way to understand the need to separate the two concepts ("leaky gut syndrome" and increased intestinal permeability) is reading this summary of an inverview with Alessio Fasano [2], pioneer in the investigation of intestinal permeability and its health implications, and discoverer of zonulin: the term “leaky gut” has been used and abused, mainly by the alternative and complementary medicine network that had, in a visionary fashion, identified leaky gut as a possible mechanism leading to many problems, but most of these statements were not based on factual evidence, to the point in which we went to the extreme to develop an entire field called "leaky gut syndrome" that had very few facts and a lot of fantasies. This is the reason why the traditional medicine establishment has been so skeptical for many years. "Leaky gut syndrome" was into the pipeline of alternative medicine even before the discovery of these doors. But there is no black and white, there are grays, and we have these two camps that saw this topic as either black, it does not exist, it’s bogus, or white and it would explain all the problems of humankind.

Anyway, I think the article is still confusing and should be improved, to make clear what is scientifically proven and I have intention to work on it.

I take this opportunity to ask you, Jytdog, what do you think about using that source on Conceptual basis and background section.

Best regards. --BallenaBlanca (talk) 00:15, 1 September 2016 (UTC)

I am horrified by the ad that popped up when I went to the site. But no, we don't use talks like that; they are not scientific publications. Someone could use it in an article about Fasano to describe his views, but no one can use it to support content about science or medicine. The MEDRS sources say that as of today "leaky gut syndrome" is nonscientific garbage. No responsible scientist should be feeding the hysteria. Jytdog (talk) 00:40, 1 September 2016 (UTC)

Thanks, Jytdog. Yes, it's what I imagined. :D It is only that I like his words "leaky gut syndrome" had very few facts and a lot of fantasies... it would explain all the problems of humankind.. Best regards. --BallenaBlanca (talk) 00:47, 1 September 2016 (UTC)

Thanks; very helpful information! My apologies for the over-reliance on primary sources. Some of the PubMed references I included are review articles, though, which should qualify as secondary sources. I should also point out that the views expressed by the currently used MEDRS sources (specifically Quackwatch and NHS Choices) are a bit overstated on this page. For example, Dr. Barrett makes a specific cautionary note that "Some medical scientists use the term 'leaky gut' for problems associated with abnormal intestinal permeability, but 'leaky gut syndrome' is not one of them." Also, those two sources haven't been updated since 2015, so that information should be amended.

The point I'm trying to make is that drawing a firm line between leaky gut (increased intestinal permeability) and leaky gut syndrome is probably a confusing distinction for the lay public, and this page, in its current state, could be improved to better reflect that leaky gut (abnormal intestinal permeability) is not "nonscientific garbage" - instead, this page could more accurately describe where the established studies for leaky gut stop and the hypothetical theories about leaky gut syndrome start. I would venture to say that members of the lay public are generally unfamiliar with the concept of intestinal permeability, but are more likely to have heard of leaky gut syndrome. If they encounter this article without reading the article about intestinal permeability, a reasonable conclusion to make is that both leaky gut and leaky gut syndrome are pseudoscience. As the old saying goes, this page (in its current state) is throwing the baby out with the bathwater. Rslateriii (talk) 18:15, 1 September 2016 (UTC)

I respectfully disagree. Since the difference between the two is spelled out quite explicitly in the lede, and again in the main content, I don't think such a conclusion would be at all reasonable.

To the other point: Fasano is a reputable guy -- and apparently, he is one of a small minority of legitimate researchers who does believe that “leaky gut syndrome” could be real, and may play a role in food allergies, type-1 diabetes, celiac disease, Crohn’s disease, irritable bowel syndrome, and perhaps other digestion-related maladies. But neither he nor anyone else has proved it. Or to put it another way, beliefs are neat, but they should never be confused with scientifically demonstrated facts. If and when Fasano (or somebody else) convincingly demonstrates any of the above, with real data, we will certainly reflect that information in the article. As of now, that has not happened; and unfortunately, as Fasano himself points out, the term “leaky gut” has been used and abused for decades by alternative medicine practitioners who -- based on zero credible evidence -- cite it as the cause of everything from autism to cancer. So public speculation by legitimate scientists like Fasano that "leaky gut syndrome" might be a real phenomenon -- likewise based on no evidence -- serves only to muddy the waters even further. IMHO he should keep his mouth shut until he has some data. DoctorJoeE ^{review transgressions}/_{talk to me!} 19:05, 1 September 2016 (UTC)

Rslateriii is right, the page is confusing, especially for the lay public. It is necessary to clarify the concepts.

DoctorJoeE, I have the impression that you have not understood: Alessio Fasano (who is a pediatrician and researcher, and one of the world's leading authorities in gluten related disorders and autoimmunity) do not defends "leaky gut syndrome" as doctors of alternative medicine pose, he speaks about increased intestinal permeability, which is a real entity. And yes: it has been proven that increased permeability allows passage of macromolecules, favoring the appearance of some systemic disorders. A clear model is celiac disease. Another example: sepsis due to intestinal bacterial translocation. And gradually more evidence are accumulated. As NHS states, currently (on 2015..) there is little evidence, because some cases are proven. The difference is trying to explain all health problems by a leaky gut, which it is unreal and full of fantasies. Best regards. --BallenaBlanca (talk) 19:29, 1 September 2016 (UTC)

Perhaps you should read my post again. I did not say, nor did I mean to imply, that Fasano has defended the "leaky gut syndrome" charlatans. And yes, of course, he is aware -- as am I, along with everybody else interested in intestinal diseases -- that increased intestinal permeability is real, and that it is demonstrable in the presence of some diseases, such as the ones I mentioned. What has not been demonstrated is a cause/effect relationship. That is, the fact that increased intestinal permeability and, say, celiac disease coexist does not prove that one causes the other. (It's easy to draw bad conclusions from good data -- for example, if your headache goes away after you take an aspirin, you would be wrong to conclude that headaches are an aspirin-deficiency disease.) If and when someone does establish cause & effect, then "leaky gut syndrome" will, in a sense, prove to be a real phenomenon -- but not at all in the same way that the charlatans claim -- nor, I'm pretty sure, will it ever turn out to be a magical answer for every idiopathic disease, as the charlatans claim. DoctorJoeE ^{review transgressions}/_{talk to me!} 20:28, 1 September 2016 (UTC)

Yes and in light of the charlatancy (word?) of people trying to make money off of other people who are legitimately suffering, and because of the advocacy of those who are really suffering and believe they have "leaky gut syndrome", this article needs to maintain an extremely bright between 1) "leaky gut sydrome" which is based on an unproven assumption and all the claims within it are pseudoscience; and 2) the interesting and difficult science between done around the relationships among genes, potential toxins, intestinal permeability, and various diseases/conditions, etc. The charlatans and advocates persist in their exploitation/deluston by fuzzifying that line. Jytdog (talk) 20:51, 1 September 2016 (UTC)

Yes, the distinction needs to be clear. Mixing "legitimate" stuff in here won't do that. Alexbrn (talk) 08:53, 2 September 2016 (UTC)

• Bellena you have three of us here saying please don't do what you just did..... Jytdog (talk) 09:14, 2 September 2016 (UTC)

Jytdog, Three people can be wrong...

DoctorJoeE, celiac disease is a weel studied model, in which increased intestinal permeability appears secondary to the abnormal immune reaction induced by gluten (not just coexist) and allows fragments of gliadin protein to get past the intestinal epithelium, triggering an immune response at the intestinal submucosa level that leads to diverse gastrointestinal or extra-gastrointestinal symptoms. Eliminating gluten from the diet leads to normalization of intestinal permeability and the autoimmune process shuts off.

With all due respect, I think Alexbrn also needs to clarify concepts and should be more cautious before editing about these issues. Because of him, basic concept mistakes has been kept on several pages for more than two years, which nobody else noticed, for example:

• His text on Leaky gut, 20 January 2014: [3]
• My correction, 16 August 2016: [4]
• His text on Leaky gut syndrome, 11 September 2014: [5]
• My correction, 17 August 2016: [6]

And now, he reverts my last edit saying (Reverted to revision 737099542 by Jytdog (talk): This blurs the distinction between this fake condition, and legitimate stuff. I think by eliminating this information, he gets exactly the opposite and keeps mixing concepts, or at least not distinguish between what is scientifically proven and what not.

Let's see what Doc James thinks.

Best regards. --BallenaBlanca (talk) 09:40, 2 September 2016 (UTC)

Yes and so can one, and it is more likely.  :( Jytdog (talk) 10:03, 2 September 2016 (UTC)

With respect to "Increased intestinal permeability is a factor in several diseases" the refs are more tentative than that. This paper says "emerging link between obesity and increased intestinal permeability"[7] and this one "Possible links between intestinal permeability and food processing"[8] This is more tentative hypothesis than conceptual basis or background. Doc James (talk · contribs · email) 12:08, 2 September 2016 (UTC)

Precisely what I have been trying to get across, thanks. And BallenaBlanca, I have no idea what a "weel studied model" is, but gluten sensitivity is an entirely different kettle of fish. Don't get me started on the gluten mishugas; 99.9% of people on "gluten-free diets" are not gluten sensitive in the first place. DoctorJoeE ^{review transgressions}/_{talk to me!} 12:51, 2 September 2016 (UTC)

she meant "well"... and she did. But I agree that this content was not what this article needs... Jytdog (talk) 12:58, 2 September 2016 (UTC)

Oops! "Well" :) But not "she", I am a man... :D

Let's see what you think so. I'll make some corrections, adjusting to the source already presente of NHS Choices.

If we say "These supporters say that undigested food particles can pass through the "leaky" bowel wall and into the bloodstream" it seems we are saying that the passage of molecules through the intestinal mucosa is part of the unfounded theory, when it is not. Germs and large molecules can pass through an incompetent intestinal barrier (This barrier is effective at absorbing nutrients, but prevents most large molecules and germs passing from inside the bowel into the bloodstream and potentially causing widespread symptoms.). Is true that the immune system can react to germs, toxins or other substances that have been absorbed into the bloodstream via a porous bowel, but not that this fact cause all the health problems they say ("leaky gut syndrome"). (In some circumstances, this barrier can become less effective and "leaky", although this in itself is not generally thought to be sufficient to cause serious problems. ... This, they say, is linked to a much wider range of health problems, including:...

Also, per WP:SEAOFBLUE we should make a bit clarification about increased intestinal permeability.

I do not know if I expressed myself well, sorry if is not.

Best regards. --BallenaBlanca (talk) 14:42, 2 September 2016 (UTC)

Bellena "leaky gut syndrome" = the entirety of the following: "the bowel wall becomes leaky, stuff gets through, the body raises a systemic inflammatory response, and this causes a whole host of diseases, which can be treated by closing the leaky gut". If you look at different parts of that, yes there is science behind some of the parts. But the whole thing, with its claim of causation and the treatment that flows from the cause, and claiming this with certainty, is bullshit. Actually diagnosing and treating people based on this is not medicine and not science. The people who sell this idea and the diagnoses and the treatments (and the people who sadly suffer and have come to believe and buy) take the parts that are supported with science and claim that they prove that the whole thing is true. This is not OK, and this article is not going to play that game. This may be an entirely different story next year or in five years. But that is the deal now.

Your desire to bring nuance is great; please do that on the articles that deal with science (and please be conservative, not cutting edge; Wikipedia is not cutting edge). This article needs to address the pseudoscience, and do that clearly. Jytdog (talk) 16:01, 2 September 2016 (UTC)

• This article had become a fractured mess, trying to fit it into the standard MEDMOS structure. There was stuff in the lead that was not in the body. I just collapsed it into a brief article, and weeded out the duplications. I think it is much more clear now. Jytdog (talk) 15:56, 2 September 2016 (UTC)

I agree; I think the article is more clear now. I added a bit to the first sentence, which is denoted in bold type: " While increased intestinal permeability is a phenomenon recognized by mainstream science and medicine, claims for the existence of "leaky gut syndrome" as a distinct medical condition are made by practitioners of alternative medicine. " Thoughts? Rslateriii (talk) 17:43, 2 September 2016 (UTC)

Contents not adjusted to or not present on the sources

Jytdog, I agree to collapse the article, now really looks better.

I do not agree with your reasoning ( "leaky gut syndrome" = the entirety of the following: ...) As I said, we must distinguish the proven part (the loss of the protective barrier of the intestine by increased permeability may cause the passage of macromolecules, germs, toxins, antigens... and this can cause immune reactions and health problems) from the not proven theory ("leaky gut syndrome" theory explains a extraordinarily wide range of disorders as a direct cause of an increased intestinal permeability, and therefore may cure them by correcting the intestinal barrier).

We should not build a Wikipedia article based on one or two sources (WP:NPOV), which is what happens now with the article (two sources which match WP:MEDRS and two opinions of renowned persons).

Anyway, even accepting to use only a couple of sources, we can not make "free interpretation" of them, nor distort their content, nor add content referenced with a source in which does not appear any similar text, in order to reflect "what the editor wants" and not what the sources say. And that is what you have done.

I want to make clear that you and I think alike about quacks and pseudoscience. But I can not agree with your approach "This article needs to address the pseudoscience, and do that cleary" Your goal is to make clear that all this is a pseudoscience, but my goal is to be neutral, as required by Wikipedia policies. And in fact, NHS Choices states that there is "little evidence".

I will make some edits, with the exclusive aim of adapting the text to the real content of the sources. I will explain at summary edits.

I still think the article needs a brief explanation about what is increased intestinal permeability (as it has been done at the NHS Choices source), but I will respect the decision to let interested people navigate to wikilinks. Thus, or we explain everything or nothing is explained, because of information out of context what gets is confuse the reader.

Best regards. --BallenaBlanca (talk) 23:39, 3 September 2016 (UTC)

quacks use the "proven part" to justify the whole load of shit they peddle - the theory and all "cures". There is no way we are going to feed quackery here.

the detailed science goes in intestinal permeability; there is no reason to duplicate that here.

No one agrees to add this, Bellena. Let it go. Jytdog (talk) 00:30, 4 September 2016 (UTC)

Yes, this article is about the quackery. The non-quackery stuff goes in the other article. This is distinction we make (as stated in the header) to manage our topic space. Alexbrn (talk) 06:25, 4 September 2016 (UTC)

Alexbrn, you can not simply revert all edits at once. Please, do not treat this matter so lightly. You have to argue.

I will number the edits I'm going to do (again) for adjust the text to the real content of the sources (are nine ten in total). Propose any changes you want, you have to argue it here and provide solid arguments, explaining point by point, step by step. Look closely, please, because there are serious problems, such as texts that are not in the sources and distorted conclusions.

You should not miss neutrality and make "cherry picking", choosing only the parts of the sources that interest you to assert your own position.

1. [9] Removed this content not supported by the source: "gastrointestinal disorders are more common in people with autism, and the correlation is often mistaken for causation." Please, copy here where the ref says that.
2. [10] This sentence: “and none have been shown to be safe and effective in clinical trials;” as is included, refers to all listed above, but It does not fit the reference content. The source says: “Thus, the leaky gut cures being sold at a variety of internet sites and alternative medicine stores should be considered with caution. None have been tested in randomized clinical trials”
3. [11] Removed duplicated (already mentioned at the top of the page).
4. [12] Removed text not supported by the current version of the NHS Choices: "the claimed symptoms are generic and there is no medically validated test". Yes, it is true and it is logical and agree. Not a valid diagnosis, no tests. But the fact is that the source does not mention anything about tests.
5. [13] No need to "hide" that "leaky gut" refers to increased intestinal permeability, which may be caused by various conditions and medications. It is necessary for understand the context. So I adjusted to the source, which says "While it's true that some conditions and medications can cause a "leaky" gut (what scientists call increased intestinal permeability)."
6. [14] NHS Choices source says "Leaky gut syndrome" is a proposed condition some health practitioners claim is the cause of a wide range of long-term conditions” “Exponents of "leaky gut syndrome" – largely nutritionists and practitioners of complementary and alternative medicine” The other source by Odenwald et al. says: “The topic is further confused by use of the term “leaky gut syndrome” within the lay and alternative medicine communities, and even by some physicians, and claims that this is responsible for a dizzying array of disorders” So I adjusted to the source: “are mostly made by nutritionists and practitioners of alternative medicine , and also by some physicians.”
7. [15] And now the most problematic issues (7., 8. and 9.). This text: “permitting toxins, microbes, undigested food, or other substances to "leak" into the bloodstream, triggering the immune system” belongs to the description of intestinal permeability and as you proposed, the non-quackery stuff goes in the other article and is enough to keep the wikilink There is a wikilink to intestinal permeability - people can read all about it there. (NOTE: content removed for error on this edit, added back on a further edit
8. [16] This text is not adjusted to the source: “These supporters say that overgrowth of yeast or bacteria in the bowel, a poor diet, and/or the overuse of antibiotics... NHS Choices provides a previous explanation about "leaky gut" and what causes it, and a list of known causes (alcohol, medications, diseases...). The exponents of the theory of "leaky gut syndrome" add more factors. NHS Choices says: “Exponents of "leaky gut syndrome” believe the bowel lining can become irritated and "leaky" as the result of a much wider range of factors, including an overgrowth of yeast or bacteria in the bowel, a poor diet and the overuse of antibiotics.”
9. [17] And NHS Choice says, after listing diseases that are found to cause increased intestinal permeability: This, they say, is linked to a much wider range of health problems, including:...
10. [18] I edited to add edit Nº10: NHS Choices says: "you should be wary of treatments offered by people who claim to be able to "cure" "leaky gut syndrome" as there is little scientific evidence to suggest they are beneficial for many of the conditions they are claimed to help"

Best regards. --BallenaBlanca (talk) 11:00, 4 September 2016 (UTC)

Added back content removed by an error and added several reviews of 2016. Best regards. --BallenaBlanca (talk) 12:13, 4 September 2016 (UTC)

References

BallenaBlanca, I think these are worthwhile revisions. -- Rslateriii (talk) 15:41, 4 September 2016 (UTC)

recent edits turned this back into a confused mess. I fixed it Jytdog (talk) 20:48, 4 September 2016 (UTC)

Restored BallenaBlanca's hard work seeing that Rslateriii and myself agree with the improvements Ballen has made. Best Regards,

Barbara (WVS) (talk) 21:18, 4 September 2016 (UTC)

Barbara you are new to this discussion and if you review the talk page above you will see that there is no consensus for these changes. Please note that misrepresenting the discussion is disruptive and please note that this article is under CAM discretionary sanctions. Jytdog (talk) 21:36, 4 September 2016 (UTC)

Jytdog, I agree with your latest revisions. Some of the prior sentences seemed a bit clunky; I think your edits streamlined them and improved clarity.

What are CAM discretionary sanctions? -- Rslateriii (talk) 23:04, 4 September 2016 (UTC)

Good question. CAM = Complementary and Alternative Medicine (this article is in that category). Basically, since this is one of the areas of WP that editors tend to... disagree more heatedly... in, we are expected to follow WP:s rules of behaviour, dispute resolution etc more rigidly. If we don´t, admins are empowered to deal with disruption quicker and more harshly than otherwise. Something like that. More at WP:AC/DS. Gråbergs Gråa Sång (talk) 06:32, 5 September 2016 (UTC)

Makes sense; thanks! --Rslateriii (talk) 17:09, 5 September 2016 (UTC)

I added a bit to the last sentence of the first paragraph to clarify that the evidence is lacking that directly relates leaky gut syndrome to the many chronic diseases that have been claimed. The prior version could have been interpreted as saying that there is little evidence that "a wide range of factors (such as overgrowth of yeast or bacteria in the bowel, a poor diet, and/or the overuse of antibiotics) cause the intestines to be "leaky", allowing proteins, toxins, bacteria and other matter from inside the intestines to enter the circulation, causing chronic inflammation" - this first half of the hypothesis is generally consistent with the underlying idea of abnormal intestinal permeability. The claims that leaky gut syndrome causes a wide array of chronic diseases (the second half of the hypothesis) is where the hypothesis branches and becomes less substantiated. --Rslateriii (talk) 17:09, 5 September 2016 (UTC)

Thanks, Rslateriii, you have improved it. However, I remain unconvinced. We have to review calmly.

Well, Jytdog, slowly we move forward. But we still need to clarify the points 2. 5. 6. 7. 8. 9.

Let's take a look now at point 6 and your recent edits: (again, remove false distinction about physicians. LGS is not medicine, it is alt med. period) (“"and nutritionists" is not a meaningful distinction; anyone who advocates LGS is alt-med; we don't need to break down the kinds of alt-med practioners”) It is not a "false distinction". The used refs clearly say that it is a theory proposed by health practitioners, especially of alternative medicine, but also physicians. You can not alter the content of the references for the personal goals you want to achieve on this page ” “quacks use the "proven part" to justify the whole load of shit they peddle - the theory and all "cures". There is no way we are going to feed quackery here. the detailed science goes in intestinal permeability; there is no reason to duplicate that here.” The reality is that there is no clear line separating science of unproven facts, and is increasingly more blurred; we must be neutral and accept it, and especially not alter the content of the references. Rememeber, please: Wikipedia:Neutral point of view All encyclopedic content on Wikipedia must be written from a neutral point of view (NPOV), which means representing fairly, proportionately, and, as far as possible, without editorial bias, all of the significant views that have been published by reliable sources on a topic.

This is not a matter of opinion or to discuss, is simply reflecting the content of the sources, with neutrality, without biasing. So I will restore it.

And if there is any doubt, in addition to the references cited in the text, these are some examples of the use of the term "leaky gut syndrome" by different scientists:

PMID 15154150
Leaky gut syndrome is a phenomenon of increased intestinal permeability which is thought to be related to and perhaps and etiological factor in a variety of disorders including Crohn’s disease, celiac sprue, chronic fatigue syndrome, and fibromyalgia.

PMID 25810794 [19]

Compromised intestinal mucosal integrity and breakdown of gastrointestinal mucosal barrier function, a condition generically referred to as “Leaky Gut Syndrome”, are associated with starvation, injury, infection, immunosuppression, chemotherapy, and lack of enteral feedings, radiation and other types of stress. Disruption of gut mucosal integrity and barrier dysfunction results in increased permeability to allergens, toxins and pathogens, leading to immunological stress response and inflammation (28, 34). Severe trauma and burn increases intestinal permeability to bacteria and endotoxins leading to sepsis and multiple organ failure (51). A rapid resealing of gut epithelial barrier function following injury under physiological conditions is essential as infection is a major cause of morbidity.

PMID 27114435 [20]

The leaky gut syndrome has received increasing attention in the recent past. The leaky syndrome is simply a phenomenon of passage of lipopolysaccharide or toxins of gram-negative bacteria into the blood stream due to disintegration of intestinal mucosa, which causes bacteremia, endotoxemia, and systemic inflammation. Increased intestinal permeability is known to be associated with several circumstances; the leaky gut syndrome is associated with the long-term use of nonsteroidal anti-inflammatory drug (NSAID), which is an essential pathogenesis of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).1–4 It also contributes to the expression and progression of the alcoholic liver disease and chronic liver disease as well as congestive heart failure.5,6 Moreover, the leaky gut syndrome has been viewed as an important pathogenesis of diabetic mellitus and obesity in relation to insulin resistance

PMID 26604935 [21]

An altered composition of the flora allows the growth of bacterial, viral or fungal pathogen populations and activates a local inflammatory response with alteration of intestinal permeability that will cause the LEAKY GUT SYNDROME. The passage into the circulation of molecules not properly filtered by the bowel causes a systemic inflammatory reaction that can be expressed in various target tissues including the osteo-articular apparatus. This syndrome participates heavily the etiology of osteoporosis also for the mechanism of malabsorption of nutrients

PMID 20664075 [22]
In some circumstances, outside stresses on the host (such as injury, infection, or unhealthy diet) can promote a dysregulation of intestinal mucosal homeostasis, resulting in a “leaky gut” syndrome and translocation of gut bacteria or bacterial products to systemic sites, which further aggravate the host’s health.

PMID 24991549 [23]

Susceptibility to IBD has been associated with the so-called leaky gut syndrome (LGS), in which a decrease in the gut epithelial barrier led to an increase of antigens from food and bacteria from the gut lumen leaking into the body [24]. Also, it is known that excessive bacterial translocation in CD is a key factor in the development of the disease, in which certain genetic mutations affect the autophagy pathway [25]. In fact it has been proposed that antigens belonging to commensal microbiota could interact with the immune system evoking antibody-driven inflammatory responses [26].

PMID 27340433 [24]
Intestinal barrier dysfunction or disruption, known as “leaky gut” syndrome, is characterized by the translocation of macromolecules, bacteria or their toxins to the lamina propria, which is implicated in the pathogenesis of numerous diseases [4]

PMID 23482055 [25]
Chronically increased intestinal permeability (or leaky gut syndrome) allows for the increased translocation of both microbial and dietary antigens to the periphery which can then interact with cells of the immune system.

PMID 26973613 [26]
During infancy and early childhood, these restrictions could contribute to the development of an abnormal microbial population and weaken the first line of the gut barrier (Vaziri et al., 2013). This eventually leads to a “leaky gut syndrome.”

PMID 26462264 [27]
Together, our data further affirm the importance of a balanced gut microflora biodiversity in host immune homeostasis and suggest that prescribing oral antibiotics to patients, especially those with a leaky gut syndrome, have to be carefully weighed if outcomes from postoperative systemic inflammation leading to sepsis are to be improved

PMID 25184418
Taken together, we report the novel finding of a “leaky gut” syndrome including zonulin upregulation in the EAE animal model for human MS. Recent reports showing that IBD patients are at higher risk for MS, while the course of the IBD disease is not influenced by the MS [8], [9], is further supporting a key role of the gut in the modulation of CNS autoimmunity.[28]

PMID 25276205[29]
Liquorice can be used to treat ileitis, leaky gut syndrome, irritable bowel syndrome and Crohn›s disease as it is antispasmodic in the bowels

PMID 17123981 [30]
These mechanisms, including intestinal bacterial overgrowth, are increased permeability of mucosal barrier (leaky gut syndrome) and deficiencies in host immune response.32

PMID 24605015 [31]
Moreover, increased gut permeability in alcoholic liver disease may be aggravated by increased expression of inducible nitric oxide synthase (iNOS) and NF-κかっぱB, which, in turn, enhance the translocation of LPS between tight junctions of adjacent enterocytes[58,59]. This increased gut permeability is also called leaky gut syndrome (LGS).

PMID 26488575 [32]
These findings demonstrate indirectly that matriptase plays a pivotal role in the development of barrier integrity; thus matriptase dysfunction can facilitate the occurence of leaky gut syndrome observed in intestinal inflammatory diseases.

PMID 25409020 [33]
Prolonged and intensive exercise is associated with hyperthermia, splanchnic hypoperfusion, loss of intestinal barrier integrity, and increased intestinal permeability or the so-called ‘leaky gut’ syndrome [22]–[24]

PMID 24678255 [34]
Pathogens, through their activation of a potent signaling molecule called zonulin, induce a breakdown of the tight junctions in cells lining the gut, leading to “leaky gut” syndrome

Best regards. --BallenaBlanca (talk) 19:43, 5 September 2016 (UTC)

Here we are with the WP:WALL. OK, "nutritionists" can stay per the NHS source. The "and physicians" is a bad reading of the source which says "The topic is further confused by use of the term “leaky gut syndrome” within the lay and alternative medicine communities, and even by some physicians, and claims that this is responsible for a dizzying array of disorders, including chronic fatigue syndrome, fibromyalgia, allergies, depression, and skin disorders ". All that says about physicians is that "some physicians" sometimes use the term. The stuff after "including" does not necessarily include "physicians". Removing that. Jytdog (talk) 20:36, 5 September 2016 (UTC)

I agree, this concern (point 6: "also by some physicians") is much more difficult to delineate. Most of the linked articles are written in regards to specific diseases or groups of diseases, but I'm not aware of a consensus in the literature regarding precisely which conditions are potentially associated to abnormal intestinal permeability. Therefore, I agree with Jytdog that we should avoid making a blanket statement that some of the physicians believe all of the conditions are related to leaky gut.

The difficulty is that some physicians believe that some of the following conditions may be related to leaky gut:

3. Neuropsychiatric diseases

5. Immune-Inflammatory and Neuroimmune disease

6. Alcoholic liver disease

7. Critical illness / sepsis

20. perhaps an etiological factor in a variety of disorders including Crohn’s disease, celiac sprue, chronic fatigue syndrome, and fibromyalgia

21. sepsis

22. IBD and IBS; liver disease; insulin resistance and diabetes

23. Osteoarthritis

25. IBD

26. “various diseases” (non-specific)

29. Post-operative sepsis

30. Multiple sclerosis

33. Alcoholic liver disease

34. IBD

(These conditions were numbered in regards to their reference number).

So, perhaps a sentence like: "some physicians believe that some of these diseases may be related to abnormal intestinal permeability, but as of 2016, there is little evidence to support the hypothesis that leaky gut syndrome directly causes the entire array of diseases that have been claimed.” --Rslateriii (talk) 00:21, 6 September 2016 (UTC)

Rslateriii, I like what you propose, but also agree to leave it like is now. It seems enough adding "mostly".

Let's take a look at point 2.

I removed this, to discuss: "None have been adequately tested to determine if they are safe and effective for this purpose, and they may do more harm than good."

In the context, this sentence refers to the sentence above (dietary supplements, probiotics, herbal remedies, gluten-free, low FODMAP, low sugar, or antifungal diets). But the source says: “Thus, the leaky gut cures being sold at a variety of internet sites and alternative medicine stores should be considered with caution. None have been tested in randomized clinical trials” Correct me if I misinterpret. I understand that it refers to "material things" that are being sold (supplements, probiotics, herbal remedies...). A diet is not sold, it is not a thing. And being sold in internet sites and alternative medicine stores, this does not include pharmacies, we can not include (all) probiotics nor (all) suplements in this asseveration. It seems that refers to uncontrolled products.

In addition, the sentences is incorrect and / or outdated, since various types of diets, supplements, probiotics have in fact been tested in randomized trials in various diseases, in order to assess the impact on intestinal permeability and associated symptoms, with diverse results, including some with improvement of symptoms. For this reason, the updated version of NHS Choices has replaced the previous text "There is ... no evidence that so-called "treatments" for "leaky gut syndrome"..." with "There is also little evidence that the "treatments...""

I propose to remove this text and find another better reference; or at least, if we use this same ref, word it adjusted to the content of the source, as for example: None of the products being sold to cure the "leaky gut syndrome" at alternative medicine stores and internet sites have been adequately tested, and they may do more harm than good.

Best regards. --BallenaBlanca (talk) 00:17, 7 September 2016 (UTC)

References

• ""None have been adequately tested to determine if they are safe and effective for this purpose, and they may do more harm than good."[1]" is true and supported by the source. Alt med pushers love to pump up the scant evidence that something ~might~ work. What is important is whether something has been adequately tested to see if it is safe and effective to treat X. No "treatment" for LGS has been shown to be safe and effective. When one is (as described in a MEDRS source) we can of course add that. Until then we are not hyping potentialities. Of course if anybody is aware of a treatment for LGS that has been shown to be safe and effective in adequately powered clinical trials I am all ears. Jytdog (talk) 01:38, 7 September 2016 (UTC)

I have been amazed by your words, Jytdog. I had not included links because I believed that is well known that many studies have been performed. Gluten-free diet and probiotics are the areas with more research, including favorable results and safety. We have, for example, the 2008 Cochrane systematic review, where they have even found favorable effects in three symptoms of autism (overall autistic traits, social isolation,and overall ability to communicate and interact; no outcomes were reported for disbenefits including harms.).

But we are not debating whether or not there are positive results on symptoms and / or intestinal permeability, we are considering whether or not we can say. "None have been adequately tested to determine if they are safe and effective for this purpose, and they may do more harm than good.” refered to special diets, probiotics, and supplements.

Clearly, we can not say this because there are dozens of randomized trials. A small example of a quick search on PubMed: PMID 25004237, PMID 27286693, PMID 25304296, PMID 26853855, PMID 25520366, PMID 27080737, PMID 27367724, PMID 25601299, PMID 25469528, PMID 25244414, PMID 24501384, PMID 24381638, PMID 24150782, PMID 23820246, PMID 23657308, PMID 23357715, PMID 23235200, PMID 23101545, PMID 22992437, PMID 22955359, PMID 22955358, PMID 22872030, PMID 22038507, PMID 23314670,......

So, again, I will remove the sentence.

Best regards. --BallenaBlanca (talk) 07:41, 7 September 2016 (UTC)

Bellena the 2008 cochrane review supports exactly what I wrote: Here is the conclusion: "Research has shown of high rates of use of complementary and alternative therapies (CAM) for children with autism including gluten and/or casein exclusion diets. Current evidence for efficacy of these diets is poor. Large scale, good quality randomised controlled trials are needed." are needed. Meaning "not adequate". Why in the world are you throwing a bunch of primary sources into this discussion? Jytdog (talk) 07:51, 7 September 2016 (UTC)

Bellena I do not understand why you are digging on this quackery. We need to seek some kind of dispute resolution. What do you suggest. Jytdog (talk) 07:59, 7 September 2016 (UTC)

I have been explaining my reasons here. I am sure that we can reach an agreement. I can not support the charlatans and pseudoscience, but I want to let the concepts clear and be neutral, leaving aside my beliefs.

We can ask for more opinions on WikiProject Medicine. Do you agree?

Best regards. --BallenaBlanca (talk) 08:16, 7 September 2016 (UTC)

At the very least, the sentence "None have been adequately tested to determine if they are safe and effective for this purpose, and they may do more harm than good," is a tad redundant. I propose that we either drop "safe" or "they may do more harm than good" - these two statements appear interchangeable to me. I would personally favor dropping the last bit ("more harm than good") for the sake of concision.

Regarding whether these products have been proven effective, I agree with Jytdog - the studies aren't strong enough yet. I found this to be a useful review: Intestinal permeability – a new target for disease prevention and therapy. Here's an excerpt: "Among the diets, some sound promising such as dietary restriction of fat and sugars, or possibly also of poorly absorbed short-chain carbohydrates (FODMAPs). Clearly, more intervention trials are urgently needed now to assess the effects of such substances as preventive or therapeutic agents in different populations and diseases, respectively. For these trials, not only known substances, but also new dietetic components and probiotic agents selected according to their beneficial effects on the gut barrier have to be identified and tested."

This article, along with the many other studies that have been mentioned in this talk (above), all indicate that research is active and ongoing. This was one of my initial contentions with this article - it makes no mention that leaky gut is being studied rather intensively. I don't think this concern has been properly addressed: is there any reason that a sentence or phrase such as "research is ongoing" can't be added to the article? --Rslateriii (talk) 14:47, 7 September 2016 (UTC)

I am fine dropping the "may do more harm than good" and adding PMID 25407511 as a ref. Leaky gut is being studied but the claim Leaky gut actually causes X Y Z, and the offering of treatments based on that claim, are bullshit. Much bullshit is generated by claims of certainty where none exists, and that is exactly what LGS is based on. The ongoing research into the relationships among intestinal epithelium, the intestinal mucosal barrier, gut flora, environmental factors, genes (human and otherwise), and various diseases and conditions is indeed very rich and interesting, but has no place in this article on Leaky Gut Syndrome. Jytdog (talk) 17:30, 7 September 2016 (UTC)

Defining the dispute

I think the dispute we are having centers on the scope of this article.

In my view it should define the pseudoscience idea, say that it is pseudoscience, and that's it. It should have WLs to the articles where actual science and medicine are taking place and those articles should discuss it in as much detail as is appropriate in an encyclopedia. In my view, the article should look pretty much like this.

I think in Bellena's view, the scope should include pretty detailed discussion of the science, especially where it supports the LGS hypothesis; in the article history, this version is an example of maximal expansion so far (not sure if there is more that Bellena wanted to add).

Is that accurate? If so, that is the question we can bring to others for input... Jytdog (talk) 17:38, 7 September 2016 (UTC)

I think I favor the current shorter version, but would be curious to see what others think.

In regards to the prior discussion, I'm not advocating for detailed discussion of the science on this page - but I do think it is worth mentioning that research is being done. I added four words to the end of the first paragraph as an example. I don't think this implies any sort of certainty about the findings of the research; merely that research is ongoing. --Rslateriii (talk) 18:20, 7 September 2016 (UTC)

am trying in this section to identify the core dispute, not so much resolve it at this time... do you agree that this is the core of the matter? If not, how would you define it? Jytdog (talk) 19:31, 7 September 2016 (UTC)

Actually, I think we've made solid progress, and don't have any major objections to the article in its current state. But let's see what BallenaBlanca thinks. --Rslateriii (talk) 20:05, 7 September 2016 (UTC)

Thanks to you both, we really have made solid progress.

My scope is to choose between one of these two options: a) explaining concepts to give the whole picture (as NHS Choices), because the information gives weapons to distinguish charlatans, but currently there is a huge mess of concepts and misinterpretations, or b) keep only the pseudoscience in this article. I agree rule out the option a) and keep wikilinks. What not to do is to mix both, not transmit the idea that the concept of the passage of substances from inside the intestines to the circulation, nor the possible causes of increased permeability, are pseudoscience. As we can read for example at the proposed source, this is not a pseudocience.

Intestinal permeability – a new target for disease prevention and therapy

The barrier assessments are further hindered by the natural variability of this functional entity depending on species and genes as well as on diet and other environmental factors. In the final part, we discuss selected diseases associated with increased intestinal permeability such as critically illness, inflammatory bowel diseases, celiac disease, food allergy, irritable bowel syndrome, and – more recently recognized – obesity and metabolic diseases. All these diseases are characterized by inflammation that might be triggered by the translocation of luminal components into the host. In summary, intestinal permeability, which is a feature of intestinal barrier function, is increasingly recognized as being of relevance for health and disease, and therefore, this topic warrants more attention. A number of different diseases comprising intestinal and extraintestinal diseases have been found to be associated with alterations in the intestinal barrier and increased permeability, respectively (Table ​(Table6).6). Table 6 Diseases related to intestinal permeability Among these, IBD and IBS, critical illness, and – more recently – obesity and metabolic diseases have experienced increasing attention and therefore they will be discuss in this chapter in more detail. Other diseases such as celiac disease need to be mentioned as an example of a disease related to intestinal permeability [175],[176]. The realization that the barrier is so important, raises the question of what can disrupt the barrier. Even though no final conclusions can be drawn, it became more and more evident that besides nutrients acting as down-regulators of tight junctions or as histone deacetylase (HDAC) inhibitors, also viral infections, toxins, hypoperfusion of the gut play a role (Table ​(Table7).7). Lifestyle factors such as living place (farming/country site or urban environment), exercise and drug usage seem to play an important role as well, and they offer new approaches for improving gut barrier function [4],[6]............. Pathogens, as well as usage of antibiotics, might disturb the intestinal mucus layer, either by enhancing mucus degradation, or by inhibiting the normal commensal triggers for mucus production [86]........ Most importantly, malnutrition is associated with increased intestinal permeability, as shown in liver cirrhosis patients, suggesting that nutrients are needed to maintain normal barrier function in the intestine [133]........... Dietetic factors that promote increased intestinal permeability and subsequent translocation of bacteria resulting in inflammatory reactions in the liver, the white adipose tissue, the brain, and other organs trigger metabolic diseases such as insulin resistance. This pathophysiological cascade is now accepted to be of major relevance for the development of metabolic diseases including type II diabetes, cardiovascular diseases and non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) [88]-[93]. Several diseases have been linked to changes in the microbiota populations, or to reduction of the microbiota's diversity, including, atopic diseases, inflammatory bowel disease (IBD), diabetes, obesity, cancer and very recently, even neuropathologies. Some of these pathologies are associated with altered barrier function and increased permeability of the epithelium [6],[7]........... The altered intestinal barrier and the subsequent translocation of small amounts of bacteria or bacterial products is now regarded as one important mechanism causing the low-grade inflammation characteristic for metabolic diseases possibly linked to the subsequent infiltration of organs such as liver, muscle and heart muscle with fat [223]-[226]. Western style diet rich in fat and sugars alters the intestinal barrier in a way resulting in enhanced permeability and elevated endotoxin levels in the portal vein [104],[150],[227]. The result of such alterations is enhanced infiltration of tissues with bacteria and bacterial products and subsequent tissue inflammation and fat accumulation, which can be observed first in the liver and later on in other tissues such as muscle or heart muscle [150],[219],[228]. Also in peripheral blood and in adipose tissue bacteria or bacterial products can be observed following feeding with energy-rich Western style diet, an observation that might enable to define new bacterial biomarkers of intestinal barrier dysfunction in metabolic diseases [89],[214]. However, the two alterations, barrier dysfunction and microbiota alteration, are not necessarily linked, but can occur independently [229]. These findings provide a new concept on the pathophysiology of obesity and metabolic diseases that might offer new therapeutic strategies both at the level of diets and of drugs (Figure ​(Figure77)

So, I propose to remove the content that belows to increased intestinal permeability, and let this...:

Proponents claim that a wide range of factors (such as overgrowth of yeast or bacteria in the bowel, a poor diet, and/or the overuse of antibiotics) cause the intestines to be "leaky", allowing proteins, toxins, bacteria and other matter from inside the intestines to enter the circulation, causing chronic inflammation throughout the body, that results in a wide range of conditions, including chronic fatigue syndrome, rheumatoid arthritis, lupus, migraines, multiple sclerosis, and autism.

...as follows:

Proponents claim that a "leaky gut" causes chronic inflammation throughout the body, that results in a wide range of conditions, including chronic fatigue syndrome, rheumatoid arthritis, lupus, migraines, multiple sclerosis, and autism.

Or, perhaps better, something like this:

Proponents claim that proteins, toxins, bacteria and other matters, which can pass through a "leaky gut" and enter the circulation, cause chronic inflammation throughout the body, that results in a wide range of conditions, including chronic fatigue syndrome, rheumatoid arthritis, lupus, migraines, multiple sclerosis, and autism.

We must let clear that "leaky gut syndrome" is a proposed medical condition sustained mainly by nutritionists and practitioners of alternative medicine that is taking the scientific research and extrapolating it beyond what it should be, ensuring that increased intestinal permeability ("leaky gut") is the direct cause of an incredible amount of health disorders (many more than so far seem to have relationship, the little evidence that NHS Choices mentions) and that they can be cured if the intestinal permeability normalizes (on which there is not evidence for the vast majority of alleged related diseases).

Best regards. --BallenaBlanca (talk) 22:28, 7 September 2016 (UTC)

OK so we it seems that we agree on the more narrow scope? I agree with any of your proposed revisions above. Jytdog (talk) 22:36, 7 September 2016 (UTC)

Yes. I'm glad to reach an agreement. :) Let's see what Rslateriii thinks. Best regards. --BallenaBlanca (talk) 22:48, 7 September 2016 (UTC)

I have chosen the shorter wording. Ok? Best regards. --BallenaBlanca (talk) 23:21, 7 September 2016 (UTC)

All good. hooray! Jytdog (talk) 23:22, 7 September 2016 (UTC)

--BallenaBlanca (talk) 23:27, 7 September 2016 (UTC)

I too prefer the shorter wording; I think separating the pathophysiology of abnormal intestinal permeability from this page decreases potential confusion regarding the overlap between the two.

Also, I'd like to extend my gratitude for the help in orienting me to WP. Although I've been reading articles here since the early 2000s, this is my first time to register and edit anything substantive. The process of revising this page has further increased my respect and appreciation for what I consider to be the most informative website on the planet. Isn't dialectical discourse wonderful? --Rslateriii (talk) 00:17, 9 September 2016 (UTC)

) This was a bit more intense than most and different than most. Mainstream medicine has a much better literature; things get ugliest in WP where the literature is weakest  :) Sorry this was kind of a baptism by fire. Jytdog (talk) 04:41, 9 September 2016 (UTC)