Ask Dr. Etingin: Leaky Gut Syndrome; Weight Gain and Eating Late

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.

Q. My husband insists that if you eat late at night, you’re more likely to put on weight than if you have an earlier dinner. I say it doesn’t matter when you eat—it’s what you eat that matters. Who’s right?

A. You are both right: Timing and content of your meals both play an important part in weight maintenance.

Eating late at night can have a negative effect on your metabolism. Also, if you eat late at night, you may be more likely to struggle with overeating. And, if you are a late-night snacker,  you may be more apt to choose high-calorie, low-nutrient foods, such as chips, ice cream, or cookies.

The content of your diet also impacts your weight. A diet consisting of healthy choices—lean proteins, fruits and vegetables, whole grains, legumes, nuts, seeds, and plenty of water—will help you maintain a healthy weight, even if, sometimes, you eat dinner a little later in the evening.

Ideally, you want to spread your calorie consumption throughout the course of the day and to stop eating two to three hours before sleeping. If you are hungry before bedtime, a small, healthy snack, such berries, nuts, or Greek yogurt, is fine. Just be sure to avoid saturated fat, added sugar, and processed junk food—advice that applies to any time of the day or night.

–Orli R. Etingin, M.D., Editor-in-Chief

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