Tired All the Time? Try Healing Leaky Gut Syndrome for Fatigue Relief

The key to treating leaky gut syndrome is commonly known as the 4R Program among integrative medicine practitioners.

leaky gut syndrome

What's behind your tiredness or fatigue or depression? It could be leaky gut syndrome.

© Johan Larson | Dreamstime.com

Leaky gut syndrome can wreak havoc on your energy and mood, causing you to be tired all the time, depressed, and more. Fortunately, this disorder can be healed through specific, temporary dietary modification and targeted nutritional supplements.

First, however, you need to know what leaky gut syndrome is. We address the condition in Part 1 of this series. You also need to learn how to identify and test for leaky gut; we describe that process in Part 2. Here in Part 3, we’ll get into the options for treating and healing leaky gut syndrome.

By combining a restricted dietary program with nutritional supplements that have been shown in the literature to reduce intestinal inflammation and repair the intestinal lining, you can break the vicious cycle of a leaky gut and finally bring a lasting end to that “tired all the time” feeling.

Healing Leaky Gut Syndrome: The Leaky Gut Diet and 4R Program

The 4R program was developed by Jeffrey Bland, Ph.D., and his associates at the Functional Medicine Institute to promote gastrointestinal health. It is an extremely effective way to address and treat leaky gut syndrome.

The 4R program simplifies the complex interactions in gastrointestinal health by asking four questions:

  1. What needs to be removed?
  2. What needs to be replaced?
  3. Does one need to re-inoculate with probiotics?
  4. Does the intestinal lining need to be repaired?

Step 1 for Healing Leaky Gut Syndrome: Remove

To lower toxic load and reduce inflammation, a special short-term diet in which common allergenic, irritating, and inflammatory foods are temporarily removed is absolutely essential. If you’ve had recent food allergy testing, strict elimination of all your allergic foods is essential for allowing the gut lining to heal. If you have not food allergy testing, that’s okay. Avoidance of foods that commonly inflame and/or cause allergic reactions or food sensitivities (sugars, refined foods, alcohol, additives/preservatives, wheat and all gluten, dairy, eggs, soy, citrus, and corn) will typically do the trick.

This is by no means easy, but it’s doable for a short period of time, and you’ll be amazed at how good you feel after a week or two off these foods. That “tired all the time feeling” will gradually begin to lift. However, if you continue to eat these food culprits during this short-term elimination period, no matter how much you heal your gut otherwise, it will continue to suffer damage.

Keep in mind that you don’t have to deprive yourself of your favorite foods forever; you just have to avoid them long enough to allow proper healing to occur (typically one to two months). The goal is to restore the normal intestinal barrier so that you’re able to eat these foods again.

Step 2 for Healing Leaky Gut Syndrome: Replace

leaky gut syndrome

Supplements can help restore the digestive enzymes and hydrochloric acid required for proper digestion.

In the second stage of healing leaky gut syndrome, you replace digestive secretions by adding back things like digestive enzymes and hydrochloric acid that are required for proper digestion and that may be compromised by diet, drugs, diseases, aging, or other factors. This helps to make sure foods are more thoroughly digested before reaching the lower intestinal tract. A typical supplement product contains the pancreatic enzymes lipase, protease, and amylase along with betaine HCl to enhance stomach acid. The recommended dose is usually 1 to 2 capsules with meals.

Step 3 for Healing Leaky Gut Syndrome: Re-inoculate

By re-inoculating, you provide your gut with beneficial bacteria to reestablish a healthy balance of microflora. The best way to increase the amount good bacteria that live in the gut is by taking a probiotic containing lactobacillus and bifidobacteria. Probiotics have been shown to provide protection against increased permeability by enhancing your immune defenses.

Be aware that probiotic supplements are very susceptible to contamination or loss of potency. For this reason, it’s extra important to seek out a good company that maintains very high standards. Good manufacturers of probiotics include Pharmax, Metagenics, and Xymogen. Take at least 35 billion organisms a day for four weeks and then reduce to 10 billion organisms a day for another month.

Step 4 for Healing Leaky Gut Syndrome: Repair

The fourth step, Repair, is extremely important for healing leaky gut syndrome. In order to repair the intestinal lining and support the immune functioning of the gut, you need to provide nutrients that have been studied and shown to help heal the cells of the gut mucosal layer and repair the leaky tight junctions. For nutritional support to help heal the mucosa lining the intestinal wall, a single amino acid, L-glutamine has been shown to both prevent and reverse intestinal mucosal damage from various insults. The recommended dose is at least 1000 mg three times per day between meals.

Butyric acid is another natural compound that has been shown to help repair and regenerate of damaged intestinal cells. Butyric acid is a fatty acid normally made in the lower intestines when bacteria ferment fiber. The recommended dose is 600-1200 mg three times daily with meals. Lastly, the omega-3 essential fatty acids EPA and DHA are recommended at a dose of 1 to 2 grams three times per day to reduce inflammation and promote healthy cell membranes.

Do Your Body a Favor

Following the 4R program for leaky gut syndrome can address the true underlying reason for feeling tired all the time, chronic depression symptoms, irritable bowel, autoimmune diseases, and more. That underlying cause is a leaky gut. Excessive permeability of your intestinal barrier can underlie chronic fatigue and several other chronic health problems. When you devote time to improving the health of your gastrointestinal tract by removing, replacing, re-inoculating, and repairing, you’re doing your whole body a favor. The 4R program can lead to dramatic improvement in fatigue and other symptoms, and sometimes even complete resolution of the problem.

Besides leaky gut syndrome, your “tired all the time” feeling could be due to something as simple as a nutritional deficiency, dehydration, or a statin drug side effect. To learn about other possible answers to the question, “Why am I tired all the time?”  take advantage of our fatigue resources here.


Orli R. Etingin, M.D., editor-in-chief of Weill Cornell Medical College Women’s Nutrition Connection answers a common question about leaky gut syndrome.

Q. My doctor ordered a test for leaky gut syndrome. What is this condition, and what does the test entail?

A. A leaky gut syndrome test will help determine whether you have increased intestinal permeability, a condition in which the lining of your small intestine allows bacteria and undigested food particles to enter your bloodstream. This condition is also called “leaky gut syndrome.”

In a healthy gut, only certain nutrients and molecules can pass through the wall of your intestine into the bloodstream. But, if your intestinal lining becomes too porous, additional substances can “leak” into your bloodstream.

The study of leaky gut syndrome is in its infancy, and it is unclear what causes this condition. It is believed that increased intestinal permeability contributes to conditions such as irritable bowel syndrome, Crohn’s disease, and food allergies. If your doctor has ordered a leaky gut syndrome test, it’s likely that you have symptoms for one of those disorders, such as abdominal pain, gas, and bloating.

The standard test for leaky gut syndrome is often referred to as the “lactulose/mannitol challenge.” For the test, you drink a solution containing two sugars, lactulose and mannitol, that cannot be broken down in your intestines. You’ll then provide a urine sample. Because lactulose molecules are large, urine that shows high levels of lactulose indicates increased intestinal permeability. Mannitol molecules are smaller, and low levels of mannitol in urine suggest poor absorption of small molecules. If the levels of the two sugars are appropriate, your doctor may be able to rule out leaky gut syndrome.

[1] Neurogastroenterol Motil. 2012 Jun;24(6):503-12.

[2] Physiol Rev. 2011 Jan;91(1):151-75.

[3] J Int Soc Sports Nutr. 2012 Sep 20;9(1):45.

[4] Altern Med Rev. 1999 Aug;4(4):239-48.

[5] J Nutr. 2009 Sep;139(9):1619-25.

This article was originally published in 2012 and has been updated

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Kathleen Jade, ND

Dr. Kathleen Jade is a naturopathic physician and served for many years as the Medical Director and Editor-In-Chief of Natural Health Advisory Institute. She has been licensed as a primary … Read More

View all posts by Kathleen Jade, ND

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