How do we diagnose leaky gut?

One of the key markers I look at on advanced stool microbiome testing is zonulin.

Zonulin is a protein that regulates the tight junctions between the cells lining your gut. When those junctions loosen, zonulin leaks into the stool, signaling disrupted intestinal permeability — what we commonly refer to as Leaky Gut.

When zonulin is elevated, it tells us something important: the gut barrier is compromised, inflammatory molecules can escape into circulation, the immune system stays on high alert, and systemic inflammation follows.

And that inflammation can show up anywhere in the body.

Let me show you what I mean.

👩⚕️ Five Patients. One Root Cause

Watch my short video which summarizes the different presentations of Leaky Gut!
 

Patient 1: Mysterious Dermatitis

A 76-year-old woman came to see me with a strange, itchy rash on her shins and forearms. A dermatologist had biopsied the rash and labeled it simply “dermatitis.” She was prescribed topical steroids, yet the rash persisted.

We dug deeper and ordered a stool microbiome test, which revealed elevated zonulin — a clear marker of leaky gut.

Three months into a gut-healing protocol focused on repairing intestinal permeability, her rash was already significantly improving.

Patient 2: Severe Eczema

A 29-year-old woman struggling with severe eczema affecting her arms and around her eyes. She noticed immediate flares in response to certain foods.

Her stool microbiome test revealed marked leaky gut, with zonulin levels over 600. Identifying the root cause allowed us to immediately focus on repairing her gut barrier and restoring a healthier gut microbiome.

Patient 3: Autoimmune Disease

A 53-year-old woman with a persistent chest rash that had lasted for years. She tested positive for SSA antibodies, was diagnosed with Sjogren’s syndrome, and was placed on Plaquenil. A prior skin biopsy showed autoimmune-type inflammation.

Her microbiome test revealed leaky gut as well. When the gut barrier breaks down, the immune system can begin reacting to things it was never meant to respond to. Autoimmune disease often begins in the gut long before it appears elsewhere in the body.

Patient 4: Chronic IBS

A 38-year-old woman with chronic IBS-C, bloating, anxiety, and long-standing SIBO. Her symptoms were primarily digestive, yet her testing clearly showed leaky gut.

In her case, chronic bacterial overgrowth and inflammation in the small intestine likely contributed to the breakdown of the gut barrier, making leaky gut both a consequence and a driver of ongoing symptoms.

Patient 5: Allergic Rhinitis

A 16-year-old girl with new-onset nasal allergies and post-nasal drip that seemed out of proportion to her IgE allergy testing. Her stool microbiome test showed leaky gut with a zonulin level of 325, along with dysbiosis and a severely low vitamin D level of 15.

When the gut barrier is compromised, the immune system becomes overly reactive, often leading to histamine intolerance and allergy-type symptoms. In her case, the gut–immune connection was unmistakable.

How do we Treat Leaky Gut?

Watch my short video on healing Gut Inflammation.

Healing leaky gut is not about suppressing symptoms. It is about repairing the gut barrier and restoring balance to the gut ecosystem.

In my practice, this often includes
1) IgG Guard (immunoglobulins) to bind inflammatory triggers and calm immune activation 
2) L-Glutamine to nourish and repair the intestinal lining
3) High-dose probiotics like Probiotic 100 Billion to restore microbial balance
4) Herbal antimicrobials such as Berberine Pro and Oregano Oil when dysbiosis is present.
5) Support Digestion: Digestive Enzyme Pro to improve breakdown of food

Equally important is cleaning up the diet — removing gluten, dairy, sugar, alcohol, and seed oils — and practicing meal spacing to support gut motility.