In this episode, I talk to doctor and preventive physician Vilmos Fux about leaky gut. The interview was conducted as part of the free Online Bowel Congress, here you can find out more about this great congress and get access to all the interviews:
Leaky gut is probably more common than you might think. In this interview, you will find out what causes leaky gut, what symptoms indicate it and, above all, how you can have it diagnosed.
Vilmos Fux emphasizes the importance of a holistic approach to treating leaky gut by explaining which factors all play a role.
Do you have any questions for Dr. Fux? Then feel free to ask them in the comments below the episode, he will be happy to answer them:
[g_podcast id="16463729"]
Julia: I'm delighted that we have a new interview guest, and that is Dr. Vilmos Fux. Welcome, Vilmos, to the interview.
Vilmos: Thank you for the invitation, Julia!
Julia: You are a laboratory physician, but you also have a focus on preventive and nutritional medicine. I think that's a really great combination for our topic, because today we want to talk about leaky gut. I think you really have a great combination of backgrounds.
I'd like to start by asking you: From a conventional medical point of view, does leaky gut even exist or is it a figment of the imagination or an invention of alternative therapists, as is sometimes rumored?
Vilmos: Well, to be honest, in the early years when the term "leaky gut" came up - or "increased intestinal permeability" - many doctors from the field of conventional medicine, other doctors or dieticians or nutritionists who dealt with this topic always accused there was no evidence behind it, no research, no studies, it was all from this alternative medical circle. So they indirectly said that it was all just hocus-pocus anyway and a fashion that had once again gained attention
But that's not the case. So, if you still have any doubts, you only have to look in an online database where you can find all the studies, such asPubmedjust enter the term "leaky gut" or "increased intestinal permeability". You will see how many tens of thousands of papers and studies there are on this topic, which many conventional physicians are publishing and working on. So, it's definitely not a pipe dream. Even the Harvard School keeps publishing information about it. So, at least it has now arrived in conventional medicine. Not, of course, with every doctor. You certainly can't expect that. But for most gastroenterologists at least, if they're doing further training, it's definitely a household name.
Julia: Yes, great. That makes me happy, of course. It really is the case that sometimes you just get attacked, when you say that. But you can confirm it: It really does exist.
Vilmos: It definitely exists. As a laboratory physician, I have to say that I'm always interested in the diagnostic track. Okay, can I test that too? That always sounds quite nice in hypothesis and theory, but I have to somehow prove to the patient that it can be tested, that there are tangible means to say: Okay, are there indications that a patient is affected or not?
Julia: Perhaps we could address this topic right away. How do you diagnose leaky gut anyway? How certain is the diagnosis? If you are diagnosed with it, can you be sure that you actually have it?
Vilmos: Absolutely. Of course, there are markers that may be better than others, but the fact is that most diagnoses are never based on just one parameter. This means that I choose a somewhat broader range of markers that I can test, from different materials. With leaky gut in particular, I determine some things more from the serum, others more from the stool. Then I have to add an intestinal microbiome analysis. We have several options for testing this.
Of course, first and foremost, even as a laboratory physician, I need a correct medical history, either from the patient themselves, so that I know: What symptoms does the patient have? The patient's medication intake, not only because this can have an influence on certain tests, but also because it can give me clues as to which diagnostic route I need to take, whether I need to expand or narrow down. So, it's always important to do this in conjunction with the patient information or at least information from the referring doctor. What does my patient have? What are their symptoms? What is the suspected diagnosis? So that I can build on this, but also provide advice from the laboratory medicine side. Okay, now we have that and the result, but it would also be useful if we could go in this direction.
Now perhaps for the listeners, so that they also know what can be tested: There is a marker called zonulin. Zonulin regulates the tight junctions in leaky gut syndrome. Tight junctions are proteins that we have between the intestinal epithelial cells that regulate precisely. It can happen that certain proteins or foreign proteins from the chyme or bacteria or other toxins pass through the intestinal epithelium - because it is permeable - and then enter the bloodstream, where they can cause problems. We'll talk about that later. But this zonulin regulates precisely whether these tight junctions are tight, as we find in most healthy people, or whether this zonulin is overexpressed and opens these tight junctions, allowing foreign protein components to pass through the intestinal mucosa into the bloodstream.
It has to be said that even in a healthy person, the intestinal mucosa is never 100 percent isolated. It is not like that. It is a semi-permeable membrane, but it should be able to distinguish exactly whether unproblematic proteins or other nutrients - vitamins, electrolytes, etc. - are able to reach the intestinal epithelium. and, of course, can always isolate the problematic substances at the same time. This is at least a super good indication of how we can test whether there is increased intestinal permeability or not. Zonulin can be tested in stool, but also in serum. This means that if there is a leaky gut, we will find increased zonulin. Although it must also be said that the leaky gut cannot be restricted to the intestine alone. We see an overexpression of zonulin in many other autoimmune diseases such as type 1 diabetes, multiple sclerosis or rheumatic diseases.
It's not that it's necessarily causally related - because we still have to wait for better data - but we see that it occurs more frequently in these diseases, that we actually find increased markers for increased intestinal permeability. When we provide nutritional or pharmacological support, we see that the intestinal barrier practically becomes tight again, that the symptoms of these diseases decrease and that autoimmune relapses decrease again, or that the intervals become longer. We can see that this already has an influence.
Then, of course, there are other markers that can be tested. For example, there is alpha-1-antitrypsin, which can be measured in the stool, and this is also an indication of inflammation of the intestinal mucosa and can also be a reliable indicator of increased intestinal permeability.
Julia: And "permeability" always means permeability?
Vilmos: Exactly.
Vilmos: Then there are several immune cells that protect a mucous membrane from foreign germs, toxins or even foreign protein components passing through it. We have immune cells that are on the front line to protect us from this. This is immunoglobulin A.
A distinction is made between secretory immunoglobulin A, i.e. immune cells that are secreted by the mucous membrane and are primarily there to protect us from germs and other intruders. This is also something that can be tested to see whether there is increased mucosal permeability or not.
It must also be said that this IgA is reduced in a not insignificant proportion of the population. This means that there is already a deficiency in the first place, and that would mean that if I test this marker now, it would appear inconspicuous because it was already reduced in the first place. So, very important for the participants: if there is anyone who suffers from coeliac disease, for example, i.e. the most severe form of gluten intolerance, it is very often the case that up to 5 percent of those affected have an IgA deficiency. I can't use this test to test for increased mucosal permeability.
Julia: But it always makes sense to take several markers and then look at the whole picture and perhaps not just test one value, but several. Of course, this also requires a therapist who knows how to read the correlations.
Vilmos: Definitely that. You can't expect every doctor to know how to interpret certain laboratory tests. can know. As laboratory physicians, it's more our job to have this consultative role to explain to the referring doctor: Okay, what does the result mean? Are there any other things we can test to rule out or confirm a certain suspected diagnosis?
Julia: Now, I think it's important to perhaps clarify something: How does the suspicion that someone has leaky gut come about in the first place? In other words, what are the symptoms that might make you think that there is leaky gut?
Vilmos: Well, unfortunately, leaky gut is one of those diseases that are known in medicine as chameleon diseases. This is because although it is always the same disease, it can cause an extremely wide range of different symptoms.
In the case of leaky gut in particular, almost every second patient has symptoms outside of the gut, even though they actually have leaky gut in the first place. It is actually the case that leaky gut syndrome can cause almost all possible symptoms. It can therefore affect almost any other organ. This means, for example, that a patient can report allergic skin symptoms, constant itching. However, there may also be people who have calcium absorption disorders, for example, and are prone to osteopenia, the precursor to osteoporosis. It can lead to patients becoming psychiatrically conspicuous, for example reporting mild to severe depression, a drop in performance, that they have somehow not been as productive for some time, become tired earlier, but also have a depressive mood without being able to explain it.
Although the same symptom can also be caused by many other illnesses, you also have to think about the differential diagnosis of leaky gut. And that can be many things.
It can of course also cause intestinal complaints. The most common are flatulence, stool irregularities, diarrhea, but also the opposite, such as constipation, problems in the digestion of certain food components - proteins, fats or carbohydrates.
Sometimes leaky gut is found in combination with other diseases that affect the intestines, especially chronic inflammatory bowel diseases such as ulcerative colitis or Crohn's disease. However, at least according to current data, we do not know whether leaky gut is also causal for these diseases or whether it is just a symptom of them.
In particular - if I can give you a hint - calprotectin is an important diagnostic value for differentiating whether a more serious bowel disease is present, such as chronic inflammatory bowel disease. This is a really super good parameter for distinguishing these serious illnesses from the much more common irritable bowel syndrome.
Julia: Well, calprotectin simply indicates whether the intestinal mucosa is inflamed. Depending on how high it is, you can sort of see how much inflammation there is.
Vilmos: Yes, this is also extremely useful as a progression parameter to assess therapeutic success.
Julia: I also think it's very, very important to check again at some point. I often hear people say: "I used to have this and that. That was elevated." And then I ask: "Yes, and what was it like at the follow-up examination?" - "Oh, we never checked it again." I just think that what you're talking about, looking at a progression, is also very important.
Vilmos: Yes. And if doctors are also listening, by the way: It's also important to be informed. You can't expect the referring doctor to be familiar with all these things. But then just give the lab a quick call. For example, are there things that I need to pay attention to, that I need to comply with before I take the sample? Regardless of whether it's blood serum or a stool test. Because I often see mistakes in laboratory medicine that happen because the so-called "pre-analysis" doesn't fit. In other words, the phase before the test is taken in the first place. It is important that I always have the correct circumstances and that they are always as similar as possible. The result depends on many circumstances. In hormone diagnostics, it is important to know: Okay, how do the hormones behave? And which one should I test in the morning and which one in the evening? Because they behave differently.
It is also very important to know whether patients are taking certain dietary supplements. For example, there is vitamin C, which a relatively large number of people take, especially now in this flu season that we are approaching. In many laboratory tests, this simply has an effect on the measurement procedure - so-called "interferences" - which can lead to false results. But you can't blame the laboratory for this, because it can't know what the patient is taking or not taking, but it can lead to false results, sometimes even false positives.
I recently had a patient whose problem was that he suddenly had massively elevated triglyceride and cholesterol levels, although he had never actually had elevated lipid metabolism parameters before. He wondered whether he had done something wrong with his diet. He had already changed his diet; in this case it was low-carb. I know all about it, so I asked him: "Do you take dietary supplements?" - "Yes, yes, a highly concentrated vitamin C supplement." Then we said: "Okay, don't take it for at least three days and then we'll test it again. Then the values were normal."
I keep hearing that this happens and often doctors in private practice request the test. They often have no way of knowing. It also leads to misdiagnoses, which of course also lead to incorrect interventions. This leads to a rat's tail, even though the initial findings were simply wrong. These are factors that have to be taken into account.
Well, that's why I enjoy my job so much. Laboratory physicians in particular are always accused of not working on patients. We don't operate. We don't administer anesthesia. That's not so "cool", we say. But as a laboratory physician, you have to have extremely broad specialist knowledge. We have to know about blood diseases and coagulation, Hormone diagnostics, stool diagnostics, lots of things. The great thing is that laboratory medicine is the area where the latest findings are always adopted and updated the fastest. There's always so much going on. That's great too.
Julia: Yes, I think so, and it's also important to be able to think in a networked way. And one value alone often doesn't say that much if you don't look at the other values that somehow also play a role. I also find that very, very exciting. You're right about that.
Vilmos: People often forget that 70 percent of diagnoses are actually only based on laboratory diagnostics. So, "only" in quotation marks.
Julia: Yes, exactly. But I think what you explained quite well earlier, that there are actually so many symptoms that can indicate leaky gut and that it's so difficult, shows once again that sometimes it's simply important to test different areas if you can't make any progress. I think for me, the insight from what you listed is that if you have chronic symptoms where you simply can't find a cause, then it would definitely make sense to test for leaky gut. So that's how I would interpret what you said.
Vilmos: Yes. Perhaps another important symptom, because it affects a lot of people: headaches and migraines in particular are often related to these things. I always think it's a shame that people don't even think about it, because it affects a lot of people and it would be relatively easy to help them. Because these are illnesses that cause very severe symptoms.
Julia: Definitely. And, as I can confirm from my own practice, many people who have had their bowels cleaned out say: I no longer have headaches or migraines since I've done this.
Do you know approximately how widespread leaky gut is in the population? So, is it something rare or is it common? Are there any figures?
Vilmos: No, I also looked again, just before our interview, to see if there was anything. There are no major studies that have investigated how common it is in the population. There are not. There are probably population groups where it can occur more frequently.
Julia: Okay.
Vilmos: There are certainly patients in whom you have to think about it more often, and in any case there are symptoms that are completely unclear and do not apply to the most common, let's say, conventional medical illnesses. In any case, patients who have neurological or slightly psychological symptoms and people with autoimmune diseases. These patients should definitely be tested for leaky gut. In any case!
Of course, patients who have irritable bowel syndrome or other intestinal diseases should also be tested.
Julia: Yes, and if you add it all up - whether it's autoimmune diseases or irritable bowel syndrome or things like that, psychological stress, ... I think that means we are already dealing with a relatively large population group where at least a suspicion of leaky gut is justified.
Vilmos: Yes, definitely. Especially when we consider that unfortunately - let me put it this way - a large number of people, or the majority, have little interest in nutrition. This means that we often have a damaged intestine or an irritated, slightly inflamed intestine in a large number of people. I also have to admit that if you're not a specialist or don't spend a lot of time studying it, you don't even know what's healthy etc. anymore. It becomes very difficult. So, someone can be under the misapprehension that they are only eating vegan, but not understand why they are actually worse off than before.
Julia: Yes. Yes, that's right.
Vilmos: I often get the question: What percentage of the population is metabolically healthy now? I would say that at least three quarters of the population is not. And I would venture to say that there are significantly more people with leaky gut. Of course, the degree to which their symptoms are severe or not varies, but if I were to test this, I would probably find a certain degree of inflammation in many people.
Julia: Yes. Would you go so far as to say that one of the main causes of leaky gut is diet? Or that we no longer eat in a way that is perhaps good for our metabolism?
Vilmos: Definitely that. But just to talk about everything that's involved would go beyond our scope.
Julia: Exactly. No, we don't do that.
Vilmos: It's actually the case, as with most illnesses, that it's not just aa factor, but that several risk factors or bad constellations have to come together for it to become a problem. I always say it like this: if someone only has a leaky gut, but the rest of their lifestyle fits ... This also includes no smoking history, regular physical activity, no chronic stress, sufficient sleep. We now also know the influence of sunlight, i.e. healthy chronobiology and circadian rhythms, and how this affects intestinal flora, but also leaky gut. In other words, if my diet is right, but all the other factors are not, then that will always predispose me to developing leaky gut and making it worse. You have to realize that this is a holistic approach. Both in diagnostics, to find out what the cause of the problem is in the first place, but also in the treatment recommendation, you have to take all these factors into account, of course.
Julia: Yes, very good. I like that very much and I can fully endorse it from my practice, so issues like you mentioned, such as chronic stress, for example, or lack of sleep, really do have a direct impact on the gut. But what if we assume that many people's diet is actually not right? Well, I would I would also say that the majority of the population probably eats too much sugar, for example, too much industrially produced food, etc.
Wheat is always an issue when we talk about leaky gut. And again, you hear everything. Some say: "That's completely made up. Wheat is not harmful at all. Wheat is actually important." And then there are people who say: "Wheat always causes leaky gut." Where are you on this spectrum? How harmful do you think wheat actually is?
Vilmos: I always have to look at it in the context of the individual.
But looking at the population as a whole: If we see that many lifestyle factors don't fit for many people, a poor diet can of course become a problem, especially if we consume a lot of certain foods, such as wheat in our countries.
When it comes to diet and lifestyle in particular, we have many building blocks that can cause a problem. For example, if I already have a leaky gut due to chronic stress, poor diet, lack of sleep, lack of light, etc. and I also consume more and more foods that are already problematic per se, they can cause even more problems under these circumstances.
However, it also helps us to understand why these foods are a problem for some people and not for others. In principle, I can't say that wheat is a problem for everyone on the planet. It is not. It depends. Okay, if the circumstances are not right and I consume a lot of it, it can become a problem.
Then I have to differentiate once again that wheat in and of itself will certainly cause a very serious illness in around 1 percent of the population. This is coeliac disease, which again can cause many symptoms in the intestine and outside the intestine.
Then about 0.4 percent of the population will have a wheat allergy, i.e. an intolerance exclusively to wheat, but not to other gluten-rich products.
And then our level of knowledge is such that we know approximately that for around 5 percent of the population gluten - which we find in higher concentrations in wheat than in rye or spelt - will be a problem without triggering a wheat allergy or coeliac disease. This is known as wheat sensitivity or gluten sensitivity. This means that around 7 percent of the population already have a problem with it.
Then you have to realize that wheat as a grain has a unique structure, that the carbohydrates we find in it break down into simple sugars in the body faster than refined sugar! And that's not all. No matter, even if it's a wholemeal wheat variety. In addition to gluten, wheat also contains other protein components that can also cause problems. And if an intestine is pre-damaged or sensitive or pre-inflamed, it can fuel the inflammation even more, then it's like pouring gasoline over a fire. You can visualize it like that.
Then it is quite interesting that the modern wheat that we have bred up is completely different to the wheat of 50 or 70 years ago. The original principle was like this: The aim was to stop hunger in the world. In other words, it was important to be able to produce a cheap, high-calorie food. However, this brought with it certain problems. After all, it is not that nutritious. But these are other issues that play a role. But what I wanted to say is this: Regardless of gluten and other proteins, wheat contains many other enzymes - inhibitors, for example - that make modern wheat a problem for more people. Just the fact that it can be digested correctly.
We know from animal experiments, for example, that if inflammation is already present, these wheat components can continue to promote or even increase inflammation. Well, these are only animal experiments, but they show us that wheat consumption does something.
So that means, if we want to summarize it now: If I already have illnesses and am struggling with chronic inflammation and it is known that wheat is often a component - in many illnesses now, including cancer - I would recommend that I simply avoid wheat and switch to less inflammation-promoting foods. Thenone inflammatory component is at least reduced or completely eliminated.
Julia: Yes, great. You're actually addressing a point that is very close to my heart, namely that you can't make a blanket statement about whether a food is healthy or unhealthy, it always depends: Who am I talking to? Am I talking to a healthy person or someone who is ill? Or with someone who already has a pre-existing condition? For example, if I'm talking to someone who is chronically stressed, which is also an inflammatory process, then it might not be so good. So, I think that's very, very important and very, very nice, and I think it's almost a great conclusion to our conversation. At the end of the day, it's really about being able to respond to the patient or client as individually as possible and also to look: Who am I dealing with? What are the symptoms? And then to derive measures based on this.
Vilmos: Definitely. You can roughly summarize it like this: I can't recommend a size 43 shoe to everyone in the population, because everyone naturally has different requirements. And it's the same in nutritional therapy or, let's say, holistic medicine, where I have to take a personalized view of the patient and make a diagnosis tailored to them. Find out what is the cause of their problem? And then to optimize or attack a personalized intervention in the form of nutrition and other lifestyle modifications. And I think it's very important to be more aware of this today.
Julia: Yes. Yes, that's right. Finally, I would like to ask you, if someone has been diagnosed with leaky gut, is it curable? Or can we assume that it can be reversed if we take the right lifestyle and nutritional measures and intestinal rebuilding measures?
Vilmos: Yes, definitely. And the great thing is that we can actually test this with the parameters that we have. But the fact is that many patients expect quick results in a short space of time. That's not the case. If I've been doing things for 20 years that have led to inflammation, I can't expect it to go away in a week or two. It's just a process. It can take six to twelve months or even longer.
I always say: the journey is the reward. In other words, getting there is important. Not how quickly I get there. And it's easier for me when I start to change small elements and see certain successes that I can then continue to work on. That also relieves a bit of pressure.
I think we're in such a performance-oriented society that we're always under pressure when it comes to these things - whether it's nutrition, sport or preventive medicine: "So, and from tomorrow I won't do this and this and this and I'll only eat this and this." We go from one extreme to the next and lose the balance in between. It's very important to maintain this.
I always emphasize this in my seminars, of course, and always question whatwhat what I say. I always emphasize that this is ourcurrent state of knowledge. It may change again in a few years, and it certainly will. That's what makes the field so interesting.
Julia: Yes. That's right. Where can listeners and viewers find you? What can they read about you? You've written at least one book.
Vilmos: I've already written two books. One on the subject of grain intolerances and one on the new findings of the fat-protein diet, i.e. the ketogenic diet, independent of epilepsy, where it can still be used, and certain myths and legends that also exist about this form of nutrition, even in conventional medical - if you want to call it that - circles. I also write articles for other blogs and health magazines. From time to time I do interviews, like the one I did with you, or I attend conferences. I would like to do more in this direction in the future. Let's see what comes up.
Julia: Great. Perfect. Thank you very much for the great interview. That was very, very exciting. Is there anything else at the end that you think we should definitely mention or that we have forgotten or that I would like to give the viewers?
Vilmos: No, I think we've given enough information for today. There are often questions from the audience.
Julia: Yes, exactly. You can also post questions below this interview and I would then forward them to Vilmos. Feel free to write in the chat and ask your question. And in addition to the interview, I'll also link to the books if you want to read more.
Thank you very much and take care for now, and I'm sure we'll talk again soon.
Would you like to read more of these exciting interviews about gut health? Then go to the page of the free online Daramkongress www.gruber-ernaehrung.ch/darmkongress, where you can find over 50 exciting interviews with renowned experts on the topic of gut health!
Books by Dr. Vilmos Fux:
KetoInfo: Gluten-free. Soy-free. Knowledge! (together with Daniela Pfeifer)*
and
The clinic of gluten intolerance in adulthood: a retrospective study and new findings*
Now I recommend you subscribe to the podcast so you never miss an episode, and if you like what you hear, I really appreciate a review on iTunes or Apple Podcast. Because these reviews also help other people to find the podcast so that we can spread the knowledge about gut and health more.
https://arktisbiopharma.ch/darmkongress
Leaky gut is probably more common than you might think. In this interview, you will find out what causes leaky gut, what symptoms indicate it and, above all, how you can have it diagnosed.
Vilmos Fux emphasizes the importance of a holistic approach to treating leaky gut by explaining which factors all play a role.
Do you have any questions for Dr. Fux? Then feel free to ask them in the comments below the episode, he will be happy to answer them:
[g_podcast id="16463729"]
Julia: I'm delighted that we have a new interview guest, and that is Dr. Vilmos Fux. Welcome, Vilmos, to the interview.
Vilmos: Thank you for the invitation, Julia!
Julia: You are a laboratory physician, but you also have a focus on preventive and nutritional medicine. I think that's a really great combination for our topic, because today we want to talk about leaky gut. I think you really have a great combination of backgrounds.
I'd like to start by asking you: From a conventional medical point of view, does leaky gut even exist or is it a figment of the imagination or an invention of alternative therapists, as is sometimes rumored?
Does "leaky gut" exist?
Vilmos: Well, to be honest, in the early years when the term "leaky gut" came up - or "increased intestinal permeability" - many doctors from the field of conventional medicine, other doctors or dieticians or nutritionists who dealt with this topic always accused there was no evidence behind it, no research, no studies, it was all from this alternative medical circle. So they indirectly said that it was all just hocus-pocus anyway and a fashion that had once again gained attention
But that's not the case. So, if you still have any doubts, you only have to look in an online database where you can find all the studies, such asPubmedjust enter the term "leaky gut" or "increased intestinal permeability". You will see how many tens of thousands of papers and studies there are on this topic, which many conventional physicians are publishing and working on. So, it's definitely not a pipe dream. Even the Harvard School keeps publishing information about it. So, at least it has now arrived in conventional medicine. Not, of course, with every doctor. You certainly can't expect that. But for most gastroenterologists at least, if they're doing further training, it's definitely a household name.
Julia: Yes, great. That makes me happy, of course. It really is the case that sometimes you just get attacked, when you say that. But you can confirm it: It really does exist.
Vilmos: It definitely exists. As a laboratory physician, I have to say that I'm always interested in the diagnostic track. Okay, can I test that too? That always sounds quite nice in hypothesis and theory, but I have to somehow prove to the patient that it can be tested, that there are tangible means to say: Okay, are there indications that a patient is affected or not?
How can you test for leaky gut?
Julia: Perhaps we could address this topic right away. How do you diagnose leaky gut anyway? How certain is the diagnosis? If you are diagnosed with it, can you be sure that you actually have it?
Vilmos: Absolutely. Of course, there are markers that may be better than others, but the fact is that most diagnoses are never based on just one parameter. This means that I choose a somewhat broader range of markers that I can test, from different materials. With leaky gut in particular, I determine some things more from the serum, others more from the stool. Then I have to add an intestinal microbiome analysis. We have several options for testing this.
Of course, first and foremost, even as a laboratory physician, I need a correct medical history, either from the patient themselves, so that I know: What symptoms does the patient have? The patient's medication intake, not only because this can have an influence on certain tests, but also because it can give me clues as to which diagnostic route I need to take, whether I need to expand or narrow down. So, it's always important to do this in conjunction with the patient information or at least information from the referring doctor. What does my patient have? What are their symptoms? What is the suspected diagnosis? So that I can build on this, but also provide advice from the laboratory medicine side. Okay, now we have that and the result, but it would also be useful if we could go in this direction.
Gatekeeper Zonulin
Now perhaps for the listeners, so that they also know what can be tested: There is a marker called zonulin. Zonulin regulates the tight junctions in leaky gut syndrome. Tight junctions are proteins that we have between the intestinal epithelial cells that regulate precisely. It can happen that certain proteins or foreign proteins from the chyme or bacteria or other toxins pass through the intestinal epithelium - because it is permeable - and then enter the bloodstream, where they can cause problems. We'll talk about that later. But this zonulin regulates precisely whether these tight junctions are tight, as we find in most healthy people, or whether this zonulin is overexpressed and opens these tight junctions, allowing foreign protein components to pass through the intestinal mucosa into the bloodstream.
It has to be said that even in a healthy person, the intestinal mucosa is never 100 percent isolated. It is not like that. It is a semi-permeable membrane, but it should be able to distinguish exactly whether unproblematic proteins or other nutrients - vitamins, electrolytes, etc. - are able to reach the intestinal epithelium. and, of course, can always isolate the problematic substances at the same time. This is at least a super good indication of how we can test whether there is increased intestinal permeability or not. Zonulin can be tested in stool, but also in serum. This means that if there is a leaky gut, we will find increased zonulin. Although it must also be said that the leaky gut cannot be restricted to the intestine alone. We see an overexpression of zonulin in many other autoimmune diseases such as type 1 diabetes, multiple sclerosis or rheumatic diseases.
It's not that it's necessarily causally related - because we still have to wait for better data - but we see that it occurs more frequently in these diseases, that we actually find increased markers for increased intestinal permeability. When we provide nutritional or pharmacological support, we see that the intestinal barrier practically becomes tight again, that the symptoms of these diseases decrease and that autoimmune relapses decrease again, or that the intervals become longer. We can see that this already has an influence.
Then, of course, there are other markers that can be tested. For example, there is alpha-1-antitrypsin, which can be measured in the stool, and this is also an indication of inflammation of the intestinal mucosa and can also be a reliable indicator of increased intestinal permeability.
Julia: And "permeability" always means permeability?
Vilmos: Exactly.
Doorman sIgA
Vilmos: Then there are several immune cells that protect a mucous membrane from foreign germs, toxins or even foreign protein components passing through it. We have immune cells that are on the front line to protect us from this. This is immunoglobulin A.
A distinction is made between secretory immunoglobulin A, i.e. immune cells that are secreted by the mucous membrane and are primarily there to protect us from germs and other intruders. This is also something that can be tested to see whether there is increased mucosal permeability or not.
It must also be said that this IgA is reduced in a not insignificant proportion of the population. This means that there is already a deficiency in the first place, and that would mean that if I test this marker now, it would appear inconspicuous because it was already reduced in the first place. So, very important for the participants: if there is anyone who suffers from coeliac disease, for example, i.e. the most severe form of gluten intolerance, it is very often the case that up to 5 percent of those affected have an IgA deficiency. I can't use this test to test for increased mucosal permeability.
Julia: But it always makes sense to take several markers and then look at the whole picture and perhaps not just test one value, but several. Of course, this also requires a therapist who knows how to read the correlations.
Vilmos: Definitely that. You can't expect every doctor to know how to interpret certain laboratory tests. can know. As laboratory physicians, it's more our job to have this consultative role to explain to the referring doctor: Okay, what does the result mean? Are there any other things we can test to rule out or confirm a certain suspected diagnosis?
Julia: Now, I think it's important to perhaps clarify something: How does the suspicion that someone has leaky gut come about in the first place? In other words, what are the symptoms that might make you think that there is leaky gut?
The chameleon disease "leaky gut"
Vilmos: Well, unfortunately, leaky gut is one of those diseases that are known in medicine as chameleon diseases. This is because although it is always the same disease, it can cause an extremely wide range of different symptoms.
In the case of leaky gut in particular, almost every second patient has symptoms outside of the gut, even though they actually have leaky gut in the first place. It is actually the case that leaky gut syndrome can cause almost all possible symptoms. It can therefore affect almost any other organ. This means, for example, that a patient can report allergic skin symptoms, constant itching. However, there may also be people who have calcium absorption disorders, for example, and are prone to osteopenia, the precursor to osteoporosis. It can lead to patients becoming psychiatrically conspicuous, for example reporting mild to severe depression, a drop in performance, that they have somehow not been as productive for some time, become tired earlier, but also have a depressive mood without being able to explain it.
Although the same symptom can also be caused by many other illnesses, you also have to think about the differential diagnosis of leaky gut. And that can be many things.
It can of course also cause intestinal complaints. The most common are flatulence, stool irregularities, diarrhea, but also the opposite, such as constipation, problems in the digestion of certain food components - proteins, fats or carbohydrates.
Sometimes leaky gut is found in combination with other diseases that affect the intestines, especially chronic inflammatory bowel diseases such as ulcerative colitis or Crohn's disease. However, at least according to current data, we do not know whether leaky gut is also causal for these diseases or whether it is just a symptom of them.
In particular - if I can give you a hint - calprotectin is an important diagnostic value for differentiating whether a more serious bowel disease is present, such as chronic inflammatory bowel disease. This is a really super good parameter for distinguishing these serious illnesses from the much more common irritable bowel syndrome.
Julia: Well, calprotectin simply indicates whether the intestinal mucosa is inflamed. Depending on how high it is, you can sort of see how much inflammation there is.
Vilmos: Yes, this is also extremely useful as a progression parameter to assess therapeutic success.
Julia: I also think it's very, very important to check again at some point. I often hear people say: "I used to have this and that. That was elevated." And then I ask: "Yes, and what was it like at the follow-up examination?" - "Oh, we never checked it again." I just think that what you're talking about, looking at a progression, is also very important.
The importance of preanalytics
Vilmos: Yes. And if doctors are also listening, by the way: It's also important to be informed. You can't expect the referring doctor to be familiar with all these things. But then just give the lab a quick call. For example, are there things that I need to pay attention to, that I need to comply with before I take the sample? Regardless of whether it's blood serum or a stool test. Because I often see mistakes in laboratory medicine that happen because the so-called "pre-analysis" doesn't fit. In other words, the phase before the test is taken in the first place. It is important that I always have the correct circumstances and that they are always as similar as possible. The result depends on many circumstances. In hormone diagnostics, it is important to know: Okay, how do the hormones behave? And which one should I test in the morning and which one in the evening? Because they behave differently.
It is also very important to know whether patients are taking certain dietary supplements. For example, there is vitamin C, which a relatively large number of people take, especially now in this flu season that we are approaching. In many laboratory tests, this simply has an effect on the measurement procedure - so-called "interferences" - which can lead to false results. But you can't blame the laboratory for this, because it can't know what the patient is taking or not taking, but it can lead to false results, sometimes even false positives.
I recently had a patient whose problem was that he suddenly had massively elevated triglyceride and cholesterol levels, although he had never actually had elevated lipid metabolism parameters before. He wondered whether he had done something wrong with his diet. He had already changed his diet; in this case it was low-carb. I know all about it, so I asked him: "Do you take dietary supplements?" - "Yes, yes, a highly concentrated vitamin C supplement." Then we said: "Okay, don't take it for at least three days and then we'll test it again. Then the values were normal."
I keep hearing that this happens and often doctors in private practice request the test. They often have no way of knowing. It also leads to misdiagnoses, which of course also lead to incorrect interventions. This leads to a rat's tail, even though the initial findings were simply wrong. These are factors that have to be taken into account.
Laboratory diagnostics - always up to date as a discipline
Well, that's why I enjoy my job so much. Laboratory physicians in particular are always accused of not working on patients. We don't operate. We don't administer anesthesia. That's not so "cool", we say. But as a laboratory physician, you have to have extremely broad specialist knowledge. We have to know about blood diseases and coagulation, Hormone diagnostics, stool diagnostics, lots of things. The great thing is that laboratory medicine is the area where the latest findings are always adopted and updated the fastest. There's always so much going on. That's great too.
Julia: Yes, I think so, and it's also important to be able to think in a networked way. And one value alone often doesn't say that much if you don't look at the other values that somehow also play a role. I also find that very, very exciting. You're right about that.
Vilmos: People often forget that 70 percent of diagnoses are actually only based on laboratory diagnostics. So, "only" in quotation marks.
Julia: Yes, exactly. But I think what you explained quite well earlier, that there are actually so many symptoms that can indicate leaky gut and that it's so difficult, shows once again that sometimes it's simply important to test different areas if you can't make any progress. I think for me, the insight from what you listed is that if you have chronic symptoms where you simply can't find a cause, then it would definitely make sense to test for leaky gut. So that's how I would interpret what you said.
Who should be tested for leaky gut?
Vilmos: Yes. Perhaps another important symptom, because it affects a lot of people: headaches and migraines in particular are often related to these things. I always think it's a shame that people don't even think about it, because it affects a lot of people and it would be relatively easy to help them. Because these are illnesses that cause very severe symptoms.
Julia: Definitely. And, as I can confirm from my own practice, many people who have had their bowels cleaned out say: I no longer have headaches or migraines since I've done this.
Do you know approximately how widespread leaky gut is in the population? So, is it something rare or is it common? Are there any figures?
Vilmos: No, I also looked again, just before our interview, to see if there was anything. There are no major studies that have investigated how common it is in the population. There are not. There are probably population groups where it can occur more frequently.
Julia: Okay.
Vilmos: There are certainly patients in whom you have to think about it more often, and in any case there are symptoms that are completely unclear and do not apply to the most common, let's say, conventional medical illnesses. In any case, patients who have neurological or slightly psychological symptoms and people with autoimmune diseases. These patients should definitely be tested for leaky gut. In any case!
Of course, patients who have irritable bowel syndrome or other intestinal diseases should also be tested.
Julia: Yes, and if you add it all up - whether it's autoimmune diseases or irritable bowel syndrome or things like that, psychological stress, ... I think that means we are already dealing with a relatively large population group where at least a suspicion of leaky gut is justified.
Vilmos: Yes, definitely. Especially when we consider that unfortunately - let me put it this way - a large number of people, or the majority, have little interest in nutrition. This means that we often have a damaged intestine or an irritated, slightly inflamed intestine in a large number of people. I also have to admit that if you're not a specialist or don't spend a lot of time studying it, you don't even know what's healthy etc. anymore. It becomes very difficult. So, someone can be under the misapprehension that they are only eating vegan, but not understand why they are actually worse off than before.
Julia: Yes. Yes, that's right.
Vilmos: I often get the question: What percentage of the population is metabolically healthy now? I would say that at least three quarters of the population is not. And I would venture to say that there are significantly more people with leaky gut. Of course, the degree to which their symptoms are severe or not varies, but if I were to test this, I would probably find a certain degree of inflammation in many people.
What is the cause of leaky gut?
Julia: Yes. Would you go so far as to say that one of the main causes of leaky gut is diet? Or that we no longer eat in a way that is perhaps good for our metabolism?
Vilmos: Definitely that. But just to talk about everything that's involved would go beyond our scope.
Julia: Exactly. No, we don't do that.
Vilmos: It's actually the case, as with most illnesses, that it's not just aa factor, but that several risk factors or bad constellations have to come together for it to become a problem. I always say it like this: if someone only has a leaky gut, but the rest of their lifestyle fits ... This also includes no smoking history, regular physical activity, no chronic stress, sufficient sleep. We now also know the influence of sunlight, i.e. healthy chronobiology and circadian rhythms, and how this affects intestinal flora, but also leaky gut. In other words, if my diet is right, but all the other factors are not, then that will always predispose me to developing leaky gut and making it worse. You have to realize that this is a holistic approach. Both in diagnostics, to find out what the cause of the problem is in the first place, but also in the treatment recommendation, you have to take all these factors into account, of course.
Julia: Yes, very good. I like that very much and I can fully endorse it from my practice, so issues like you mentioned, such as chronic stress, for example, or lack of sleep, really do have a direct impact on the gut. But what if we assume that many people's diet is actually not right? Well, I would I would also say that the majority of the population probably eats too much sugar, for example, too much industrially produced food, etc.
Wheat - problematic or harmless?
Wheat is always an issue when we talk about leaky gut. And again, you hear everything. Some say: "That's completely made up. Wheat is not harmful at all. Wheat is actually important." And then there are people who say: "Wheat always causes leaky gut." Where are you on this spectrum? How harmful do you think wheat actually is?
Vilmos: I always have to look at it in the context of the individual.
But looking at the population as a whole: If we see that many lifestyle factors don't fit for many people, a poor diet can of course become a problem, especially if we consume a lot of certain foods, such as wheat in our countries.
When it comes to diet and lifestyle in particular, we have many building blocks that can cause a problem. For example, if I already have a leaky gut due to chronic stress, poor diet, lack of sleep, lack of light, etc. and I also consume more and more foods that are already problematic per se, they can cause even more problems under these circumstances.
However, it also helps us to understand why these foods are a problem for some people and not for others. In principle, I can't say that wheat is a problem for everyone on the planet. It is not. It depends. Okay, if the circumstances are not right and I consume a lot of it, it can become a problem.
Then I have to differentiate once again that wheat in and of itself will certainly cause a very serious illness in around 1 percent of the population. This is coeliac disease, which again can cause many symptoms in the intestine and outside the intestine.
Then about 0.4 percent of the population will have a wheat allergy, i.e. an intolerance exclusively to wheat, but not to other gluten-rich products.
And then our level of knowledge is such that we know approximately that for around 5 percent of the population gluten - which we find in higher concentrations in wheat than in rye or spelt - will be a problem without triggering a wheat allergy or coeliac disease. This is known as wheat sensitivity or gluten sensitivity. This means that around 7 percent of the population already have a problem with it.
Then you have to realize that wheat as a grain has a unique structure, that the carbohydrates we find in it break down into simple sugars in the body faster than refined sugar! And that's not all. No matter, even if it's a wholemeal wheat variety. In addition to gluten, wheat also contains other protein components that can also cause problems. And if an intestine is pre-damaged or sensitive or pre-inflamed, it can fuel the inflammation even more, then it's like pouring gasoline over a fire. You can visualize it like that.
Then it is quite interesting that the modern wheat that we have bred up is completely different to the wheat of 50 or 70 years ago. The original principle was like this: The aim was to stop hunger in the world. In other words, it was important to be able to produce a cheap, high-calorie food. However, this brought with it certain problems. After all, it is not that nutritious. But these are other issues that play a role. But what I wanted to say is this: Regardless of gluten and other proteins, wheat contains many other enzymes - inhibitors, for example - that make modern wheat a problem for more people. Just the fact that it can be digested correctly.
We know from animal experiments, for example, that if inflammation is already present, these wheat components can continue to promote or even increase inflammation. Well, these are only animal experiments, but they show us that wheat consumption does something.
So that means, if we want to summarize it now: If I already have illnesses and am struggling with chronic inflammation and it is known that wheat is often a component - in many illnesses now, including cancer - I would recommend that I simply avoid wheat and switch to less inflammation-promoting foods. Thenone inflammatory component is at least reduced or completely eliminated.
Julia: Yes, great. You're actually addressing a point that is very close to my heart, namely that you can't make a blanket statement about whether a food is healthy or unhealthy, it always depends: Who am I talking to? Am I talking to a healthy person or someone who is ill? Or with someone who already has a pre-existing condition? For example, if I'm talking to someone who is chronically stressed, which is also an inflammatory process, then it might not be so good. So, I think that's very, very important and very, very nice, and I think it's almost a great conclusion to our conversation. At the end of the day, it's really about being able to respond to the patient or client as individually as possible and also to look: Who am I dealing with? What are the symptoms? And then to derive measures based on this.
Vilmos: Definitely. You can roughly summarize it like this: I can't recommend a size 43 shoe to everyone in the population, because everyone naturally has different requirements. And it's the same in nutritional therapy or, let's say, holistic medicine, where I have to take a personalized view of the patient and make a diagnosis tailored to them. Find out what is the cause of their problem? And then to optimize or attack a personalized intervention in the form of nutrition and other lifestyle modifications. And I think it's very important to be more aware of this today.
Julia: Yes. Yes, that's right. Finally, I would like to ask you, if someone has been diagnosed with leaky gut, is it curable? Or can we assume that it can be reversed if we take the right lifestyle and nutritional measures and intestinal rebuilding measures?
Vilmos: Yes, definitely. And the great thing is that we can actually test this with the parameters that we have. But the fact is that many patients expect quick results in a short space of time. That's not the case. If I've been doing things for 20 years that have led to inflammation, I can't expect it to go away in a week or two. It's just a process. It can take six to twelve months or even longer.
I always say: the journey is the reward. In other words, getting there is important. Not how quickly I get there. And it's easier for me when I start to change small elements and see certain successes that I can then continue to work on. That also relieves a bit of pressure.
I think we're in such a performance-oriented society that we're always under pressure when it comes to these things - whether it's nutrition, sport or preventive medicine: "So, and from tomorrow I won't do this and this and this and I'll only eat this and this." We go from one extreme to the next and lose the balance in between. It's very important to maintain this.
I always emphasize this in my seminars, of course, and always question whatwhat what I say. I always emphasize that this is ourcurrent state of knowledge. It may change again in a few years, and it certainly will. That's what makes the field so interesting.
Julia: Yes. That's right. Where can listeners and viewers find you? What can they read about you? You've written at least one book.
Vilmos: I've already written two books. One on the subject of grain intolerances and one on the new findings of the fat-protein diet, i.e. the ketogenic diet, independent of epilepsy, where it can still be used, and certain myths and legends that also exist about this form of nutrition, even in conventional medical - if you want to call it that - circles. I also write articles for other blogs and health magazines. From time to time I do interviews, like the one I did with you, or I attend conferences. I would like to do more in this direction in the future. Let's see what comes up.
Julia: Great. Perfect. Thank you very much for the great interview. That was very, very exciting. Is there anything else at the end that you think we should definitely mention or that we have forgotten or that I would like to give the viewers?
Vilmos: No, I think we've given enough information for today. There are often questions from the audience.
Julia: Yes, exactly. You can also post questions below this interview and I would then forward them to Vilmos. Feel free to write in the chat and ask your question. And in addition to the interview, I'll also link to the books if you want to read more.
Thank you very much and take care for now, and I'm sure we'll talk again soon.
Would you like to read more of these exciting interviews about gut health? Then go to the page of the free online Daramkongress www.gruber-ernaehrung.ch/darmkongress, where you can find over 50 exciting interviews with renowned experts on the topic of gut health!
Books by Dr. Vilmos Fux:
KetoInfo: Gluten-free. Soy-free. Knowledge! (together with Daniela Pfeifer)*
and
The clinic of gluten intolerance in adulthood: a retrospective study and new findings*
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