Leaky Gut

Increased intestinal permeability means the gut lining lets more through than usual. It is measurable in research and is found alongside several conditions, but whether it causes them is unresolved.

Gut & Digestive Evidence-Based

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What Is Leaky Gut?

The intestinal lining is a single layer of cells that absorbs nutrients while keeping most bacteria and larger molecules out. Increased intestinal permeability means this barrier lets more through than usual. It is measured in some conditions, such as inflammatory bowel disease13 and untreated celiac disease10, but "leaky gut" is not an established diagnosis, and restoring the barrier has not been shown to improve any disease13.

Healthy intestinal cells are connected by "tight junctions," protein complexes that control what passes between cells. Inflammatory bowel disease, anti-inflammatory painkillers (NSAIDs), strenuous exercise and some food emulsifiers are among the things shown to raise measured permeability13.

Zonulin is a protein that regulates tight junction permeability. In laboratory studies, gliadin, a part of gluten, triggers its release18; one line of research proposes that this pathway contributes to celiac disease and some autoimmune diseases in genetically susceptible people, which remains a hypothesis1.

๐Ÿ”ฌ Intestinal permeability is real and measurable, but the tests are not equally reliable. The lactulose/​mannitol ratio is the better-validated method. Be careful with serum zonulin in particular: the widely used commercial ELISA has been shown not to detect pre-haptoglobin-⁠2, the protein it is meant to measure, and to cross-react with properdin and complement C3. Stool calprotectin measures intestinal inflammation rather than permeability.2
A cross-section of the intestinal lining: healthy cells packed tightly together on one side, and a damaged lining on the other, with wider gaps between cells

Leaky Gut by the Numbers

~70%
of the immune system sits in gut-associated lymphoid tissue, as a 2008 review estimates; a widely repeated approximation rather than a precise measurement3
42 to 75%
of healthy volunteers had abnormal gut permeability after two days of an anti-inflammatory painkiller, depending on the drug9
80%
of people with celiac disease had normal permeability after more than a year on a gluten-free diet10
3ร—
the risk of later Crohn's disease in healthy relatives of patients whose permeability test was abnormal, among 1,420 followed for years11
37ร—
higher permeability ratio in heavy drinkers with liver disease than in controls; heavy drinkers without liver disease tested normal12
Unproven
that restoring the gut barrier improves any gut or whole-body disease, according to a 2019 clinical review13

Symptoms of Leaky Gut

People with increased permeability often report symptoms well beyond the gut. Which way the causation runs is unresolved, so the symptoms below are described as what is seen alongside it, not as what it produces.

SymptomWhat happens
Digestive & Immune Symptoms
Multiple Food Sensitivities (Growing List)The explanation usually offered, that food proteins cross the gut wall and provoke IgG antibodies, is not established, and IgG food panels are not a validated test. True food allergy is a different thing and is tested differently, so symptoms that involve swelling, wheeze or faintness need a doctor rather than an elimination diet.
Bloating, Gas & Digestive DiscomfortBloating has many causes, including SIBO, IBS and food intolerances.
Autoimmune Disease & FlaresIncreased permeability is found alongside Hashimoto's, rheumatoid arthritis, lupus, type 1 diabetes and multiple sclerosis. That it causes autoimmunity is a hypothesis argued from the zonulin pathway1, not a demonstrated sequence.
Allergies, Asthma & Histamine IntoleranceAllergy, asthma and histamine symptoms are sometimes blamed on a permeable gut. That mechanism is not established, and each of these conditions has its own diagnosis and treatment that should not be delayed.
Nutrient Deficiencies Despite Eating WellDeficiencies of iron, B12, folate, zinc or the fat-soluble vitamins despite a good diet are a real finding and a reason to be investigated. Flattened villi specifically mean celiac disease until proven otherwise, which is checked with a blood test and a biopsy, not treated as a permeability problem.
Systemic & Neurological Symptoms
Brain Fog & NeuroinflammationA gut-to-brain inflammation chain has been shown in laboratory models, but not as the cause of brain fog in a person. Brain fog is more often sleep debt, anemia, thyroid disease or depression, all of which are testable.
Depression, Anxiety & Mood InstabilityInflammation and low mood travel together, and permeability markers are raised in some people with depression. Which comes first is unresolved, and no trial has shown that lowering permeability treats depression. Depression is treatable on its own terms and deserves to be treated that way.
Joint Pain & StiffnessJoint pain and stiffness are reported, but the immune explanation offered for them is not established, and morning stiffness lasting over an hour belongs with a clinician, because inflammatory arthritis is treatable and time matters.
Chronic Skin ConditionsSome skin conditions are associated with gut changes in research, but a gut cause is not established. Skin conditions that do not respond to treatment deserve a dermatology review.
Thyroid DysfunctionReported alongside Hashimoto's thyroiditis, as above; whether it contributes is unresolved.

Causes of Leaky Gut

Increased intestinal permeability is a measurable change with known triggers. Leaky gut as the cause of other diseases is not established, and no disease has been shown to improve simply by restoring the barrier13.

CauseHow It Contributes to Leaky GutWhat Helps
Celiac disease and glutenPermeability is raised in untreated celiac disease and in the first year gluten-free, and trace gluten raises it again10.Celiac blood tests while still eating gluten, and a strict gluten-free diet only once celiac disease is confirmed (conventional care)
Anti-inflammatory painkillers (NSAIDs)Two days of a common NSAID gave abnormal small-intestine permeability in up to 75% of healthy volunteers9.A review of regular NSAID use with your clinician; do not stop a prescribed medicine on your own (conventional care)
AlcoholA single binge raised gut bacterial products in the blood of healthy adults, and heavy drinkers with liver disease had markedly raised permeability12.Drinking less, or not at all (conventional care)
Inflammatory bowel disease and other ulcerating gut diseaseInflammatory or ulcerating gut diseases make the gut leakier. In healthy relatives of people with Crohn's disease, abnormal permeability came before diagnosis, tripling the risk11.Diagnosis and treatment of the bowel condition (conventional care); Saccharomyces boulardii lowered the permeability ratio in one small trial in Crohn's disease in remission8 (Supplement Protocol)
Strenuous exercise and other stress statesA single bout of exercise raises gut damage and permeability markers in healthy people, with damage greater in the heat14; pregnancy and some food emulsifiers also raise permeability13.Exercising in cooler conditions where possible; no supplement is established (Supplement Protocol)

How Leaky Gut Is Diagnosed

Intestinal permeability can be measured in research settings, but no test diagnoses "leaky gut" as a condition.

TestWhat it shows
At-Home Indicators
The Food Reaction JournalKeep a detailed food and symptom diary for 2 weeks. Note every food eaten and symptoms (fatigue, brain fog, bloating, skin reactions, joint pain, mood changes) in the 2 to 4 hours following. If you seem to react to many foods, a food and symptom diary is a useful record to take to a clinician.
The Elimination Diet ScreenA short, structured elimination of foods you suspect, followed by reintroduction one at a time, can show individual triggers. Improvement does not diagnose leaky gut.
Symptoms Worth DiscussingReactions to multiple foods, autoimmune diagnosis, treatment-resistant skin conditions, migratory joint pain, worsening allergies, brain fog, chronic fatigue, anxiety/depression, nutrient deficiencies despite good diet, history of NSAID or antibiotic use, high chronic stress.
Lab & Clinical Tests
Lactulose/​Mannitol Urine TestThe established research measure of intestinal permeability. You drink a solution of lactulose (large molecule) and mannitol (small molecule), then collect urine for 6 hours. A high lactulose-to-mannitol ratio indicates that larger molecules are crossing. It measures permeability; it does not establish that permeability is causing your symptoms. Available through specialist laboratories.
Serum Zonulin TestZonulin is the protein that opens tight junctions. The widely used commercial serum zonulin test does not reliably measure zonulin, so results are hard to interpret; it is not recommended as a test.
Stool DNA TestMeasures calprotectin (intestinal wall inflammation) and secretory IgA (mucosal immune defense). It also reports SIBO-associated bacteria, Candida, H. pylori and parasites, which are worth knowing about in their own right rather than as proven causes of the permeability. Commercial stool panels like this are not validated for diagnosing intestinal permeability; calprotectin on its own is a standard test a regular doctor can order.
Intestinal Antigenic Permeability PanelA commercial antibody panel for barrier proteins; it is not validated as a diagnostic test. Available through specialist laboratories via a practitioner.

Conventional and Holistic Treatment for Leaky Gut

๐ŸŒฟ HOLISTIC
๐Ÿ’Š CONVENTIONAL
๐ŸŒฟ

Holistic / Functional Approach

Remove likely triggers, eat for a diverse microbiome and investigate diagnosable gut conditions

Primary Strategy
Remove likely dietary triggers, correct nutrient gaps, and add fiber and fermented foods; human evidence that these repair measured intestinal permeability is limited.7
Key Nutrients
L-glutamine, zinc carnosine, DGL licorice, butyrate, vitamin D
Duration
No established timeline; dietary changes that help are usually kept up as ongoing habits.
Outcome
Some people report feeling better; no trial has shown that these measures reduce autoimmune activity

Full Holistic Approach Includes

  • L-Glutamine (5 to 15 g/day fasted): Primary fuel for enterocytes (gut lining cells); tight junction effects are shown mainly in laboratory work
  • Zinc carnosine (75 to 150 mg/day): Studied mainly for the stomach lining; human evidence for the intestinal lining is limited. Zinc carnosine is a chelate: 75 mg of it carries roughly 17 mg of elemental zinc, so do not count it as 75 mg of zinc when adding up your intake.
  • DGL licorice (760 mg before meals): Evidence that it acts on the intestinal lining is lacking. DGL means deglycyrrhizinated: the compound responsible for licorice's effects on blood pressure and potassium has been removed, which is why this form avoids them. Do not substitute whole licorice root or licorice confectionery, which do raise blood pressure and lower potassium.5
  • Slippery elm bark (400 to 500 mg, 3x/day): A mucilage traditionally used for the gut lining; trial evidence is lacking
  • Marshmallow root, a similar traditional demulcent; trial evidence is lacking
  • Butyrate (600 mg/day): Short-chain fatty acid that feeds colon cells; effects on tight junctions are shown mainly in laboratory work
  • Review regular NSAID use with your clinician13, drink less alcohol12 and do not cut out gluten until celiac disease has been tested for15
โš ๏ธ Most of these measures are well tolerated, though some supplements interact with medicines; check with your clinician.

Evidence-Based Supplements for Leaky Gut

These supplements are used for gut symptoms. None has been shown to close a permeable gut in humans, and evidence varies by row.

SupplementWhat it is forTypical rangeTimingNotes & cautions
L-GlutaminePrimary fuel for enterocytes (gut lining cells). Stimulates tight junction proteins in laboratory work; human evidence for permeability is limited.5 to 15 g/dayFasted morning; between mealsPowder in water; pharmaceutical-grade
Zinc CarnosineStudied mainly for the stomach lining. In a small crossover trial in 10 healthy volunteers, it prevented the rise in gut permeability caused by an anti-inflammatory painkiller19.75 to 150 mg/day (standardized zinc carnosine)With or between mealsA standardized zinc carnosine form is the most researched form
Saccharomyces boulardiiStudied for microbiome balance; competes with pathogenic organisms that damage the gut lining; produces short-chain fatty acids that fuel colon cells; in one small trial in people with Crohn's disease in remission, it lowered the lactulose/​mannitol ratio over three months, though not back to normal8.250 mg (about 5 billion CFU) to 500 mg (about 10 billion CFU) a dayBetween mealsSafe to take during antimicrobial treatment. Use caution with a weakened immune system or a central line, as bloodstream infections from probiotics have been reported; agree on it with your team.
Curcumin (Turmeric Extract)Downregulates NF-ฮบB, a central regulator of gut wall inflammation, and reduces inflammatory cytokines (IL-⁠6, IL-⁠1ฮฒ, TNF-ฮฑ) that contribute to tight junction breakdown. Trial evidence in humans for reducing intestinal permeability specifically is limited and mostly small.4500 to 1,500 mg/dayWith fat-containing mealsLiver injury has been reported with high-dose, high-absorption curcumin products; stop and seek advice if you notice dark urine or yellowing skin22.
Omega-⁠3 Fish OilEPA and DHA are built into the membranes of gut lining cells; human evidence that they reduce intestinal permeability is limited.2 to 3 g combined EPA+DHA/dayWith mealsThird-party tested for purity; enteric-coated reduces fishy aftertaste. At this dose use fish or algal oil rather than cod liver oil, which also supplies preformed vitamin A, whose adult upper limit is 3,000 mcg a day20. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day24, so check this dose with your clinician first.
Vitamin D3Vitamin D acts on gut lining cells and tight junction proteins in laboratory work; whether supplementing it reduces intestinal permeability in people has not been established. Correcting a deficiency may need a higher initial dose, which is a clinical decision.Set the dose with your clinician; most adults need no blood test firstWith fat-containing mealMonitor serum 25-⁠OH-D with your clinician. Dosing limits: the adult tolerable upper intake level is 4,000 IU/day. The Endocrine Society's 2024 guideline found no clear evidence for an optimal target level; the National Academies (formerly the Institute of Medicine) set sufficiency at 20 ng/mL (50 nmol/L). Any dose above 4,000 IU/day needs a blood test and a clinician, not a self-directed dose.
Vitamin K2 (MK-⁠7)Often paired with vitamin D3; K2 is involved in how the body uses calcium, though supplement benefits for bone and arteries are not established. MK-⁠7 form has the longest half-life, providing consistent activity from a single daily dose.200 to 400 mcg/day (MK-⁠7)With fat-containing meal; same time as D3MK-⁠7 is the superior form (menaquinone-⁠7) vs MK-⁠4 for daily dosing. If you take a blood thinner, clear any vitamin K supplement with the clinician managing it before you start or stop: vitamin K interferes with some anticoagulant medicines, and changing your intake can destabilize your monitoring results. Keeping intake consistent matters more than avoiding it. Not all blood thinners are affected the same way, which is why this is a conversation with your prescriber.
Magnesium GlycinateNeeded for hundreds of enzyme reactions. Magnesium deficiency affects muscle and nerve function, including gut motility.300 to 500 mg/dayBefore bedUsually gentle on the gut. The top of this range is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common. With kidney disease, take it only on your clinician's advice. Count the two magnesium forms together against that limit.
Magnesium CitrateSame as glycinate but with a gentle osmotic laxative effect, useful when constipation is also present. Improves stool frequency and transit time.200 to 400 mg/dayBefore bed or with dinnerUse citrate form when constipation is a prominent symptom; reduce dose if stools become loose. The top of this range is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common. With kidney disease, take it only on your clinician's advice.
Copper BisglycinateCopper is essential for lysyl oxidase, the enzyme that cross-links collagen and elastin in the intestinal wall. Bisglycinate form is well-tolerated and highly bioavailable.2 to 4 mg/dayWith meals; away from high-dose zincWorth considering when taking 50 mg of zinc a day or more for weeks, which can block copper absorption; maintain zinc:copper ratio of ~10:1
Peppermint & Lemon OilEnteric-coated peppermint oil is an antispasmodic that improved overall IBS symptoms and abdominal pain against placebo in pooled trials21; it has not been shown to change intestinal permeability, and evidence for lemon oil is lacking.0.2 mL peppermint (enteric-coated) 2x/dayBefore mealsEnteric-coated capsules only; plain peppermint oil dissolves in the stomach
Prokinetic, Ginger Root or 5-⁠HTPUsed to support gut motility; evidence is limited. No effect on intestinal permeability has been shown.Ginger: 500 to 1,000 mg; 5-⁠HTP: 50 to 100 mgBefore bed on empty stomachDo not take 5-⁠HTP with antidepressants or other serotonin-raising medicines, because of the risk of serotonin syndrome23. Ginger has mild antiplatelet activity, so mention it to your clinician if you take an anticoagulant.

What to Expect Over Time

There is no validated treatment course for increased permeability, and the 4R framework (remove, replace, reinoculate, repair) has not been tested in controlled trials, so this timeline follows its known triggers and related conditions13.

Treatment and supportive care, together
First Weeks

Diagnosable conditions come first: celiac blood tests before any gluten change15, and investigation of bleeding, weight loss or iron deficiency. Drinking less and reviewing regular NSAID use remove two known triggers. New fiber and fermented foods go in slowly.

Months 1 to 3

In a 17-⁠week trial in healthy adults, a fermented-food diet steadily increased microbiome diversity and lowered inflammatory markers, though permeability was not measured7. In Crohn's disease in remission, a probiotic yeast lowered the permeability ratio by 3 months8.

Months 3 to 12

In celiac disease, permeability stays raised during the first year gluten-free, so improvement is gradual10.

Long Term

After more than a year gluten-free, 80% of people with celiac disease had normal permeability, and trace gluten raised it again10. Outside such conditions, no trial shows that lowering permeability improves symptoms13.

When to Seek Care

Ask for an urgent appointment for unexplained weight loss, rectal bleeding or bloody diarrhea, or a hard lump in the abdomen16. Call 911 at once if the lips, mouth or throat swell, or breathing becomes difficult, after a food17.

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Supporting Gut Health

Increased permeability is found alongside many conditions; eating for a diverse microbiome is worthwhile on its own terms, and diagnosable conditions deserve their own treatment.

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.6 This page is nutrition education, not medical advice, and it does not replace your doctor. Be clear about what is established here and what is not. Increased intestinal permeability is a real, measurable phenomenon, and it is found alongside a number of diseases. What is not established is that it causes them, or that "leaky gut syndrome" exists as a standalone diagnosis; in most conditions where both are present, the direction of cause is unresolved. Persistent digestive symptoms deserve a medical workup rather than a supplement protocol, particularly if you have blood in the stool, unintentional weight loss or symptoms that wake you at night.

  1. Fasano A. Leaky Gut and Autoimmune Diseases. Clin Rev Allergy Immunol. 2012;42(1):71-⁠78. Springer. The paper identifies zonulin as the only physiologic modulator of intercellular tight junctions described so far, and argues that deregulation of the zonulin pathway in genetically susceptible individuals can permit autoimmune disorders. Its subject is autoimmune disease and celiac disease. ↩
  2. On the limits of serum zonulin testing: Scheffler L, et al. Widely used commercial ELISA does not detect precursor of haptoglobin2, but recognizes properdin as a potential second member of the zonulin family. Front Endocrinol. 2018;9:22. PMC5807381, and Ajamian M, et al. Serum zonulin as a marker of intestinal mucosal barrier function: May not be what it seems. PLoS One. 2019. PLoS One. The commercial assay does not detect pre-haptoglobin-⁠2 and cross-reacts with other proteins, which means a large body of published "serum zonulin" results may not measure zonulin at all. The lactulose/​mannitol dual-sugar ratio remains the better-validated approach. ↩
  3. On the gut's share of the immune system: a 2008 review states that gut-associated lymphoid tissue represents almost 70% of the entire immune system, and that about 80% of antibody-making plasma cells reside there, PubMed 18721321. The figure is widely repeated and different sources state it differently; it conveys that the gut is a major immune organ and should not be read as a precise measurement. ↩
  4. Curcumin's inhibition of NF-ฮบB signaling and downstream inflammatory cytokines is well characterized in laboratory work. Human trial evidence for reducing measured intestinal permeability specifically is limited, and the trials are small. Standard curcumin also has poor oral bioavailability, which is why absorption-enhanced preparations are usually studied. See the NCCIH and Linus Pauling entries in these notes. ↩
  5. Deglycyrrhizinated licorice (DGL) has had glycyrrhizin removed, which is the constituent responsible for licorice's mineralocorticoid effects. Whole licorice and licorice confectionery raise blood pressure and lower potassium through that pathway and can cause serious hypokalemia at sustained intakes, PubMed 42292819; DGL is used precisely to avoid this. The two are not interchangeable. ↩
  6. National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩
  7. Wastyk HC, et al. Gut-microbiota-targeted diets modulate human immune status. Cell. 2021;184(16):4137-⁠4153. PubMed 34256014. A 17-⁠week randomized study in healthy adults, 18 per arm. The high-fermented-food diet increased microbiota diversity and decreased inflammatory markers; in the high-fiber arm the primary outcome, a cytokine response score, was unchanged. The trial did not measure intestinal permeability. ↩
  8. On Saccharomyces boulardii and permeability: in a trial of 34 people with Crohn's disease in remission, randomized to the probiotic or placebo alongside their usual medicines, the lactulose/​mannitol ratio fell by the end of the third month on the probiotic, though complete normalization was not achieved, PubMed 18584523. It has not been shown to do this in people without a diagnosed bowel disease. ↩
  9. On NSAIDs and permeability: in healthy volunteers given two days of different anti-inflammatory painkillers, abnormal lactulose/​mannitol ratios appeared in 42 to 75% depending on the drug, PubMed 11600467. ↩
  10. On celiac disease: intestinal permeability was raised at diagnosis and during the first year of a gluten-free diet, was normal in 80 to 87% of people gluten-free for more than a year, and rose again with trace gluten intake, PubMed 15844719. ↩
  11. On permeability before Crohn's disease: among 1,420 healthy first-degree relatives of people with Crohn's disease followed for a median 7.8 years, an abnormal lactulose/​mannitol ratio at the start was linked to a threefold risk of later diagnosis (hazard ratio 3.03), PubMed 32791132. ↩
  12. On alcohol: heavy drinkers with chronic liver disease had a lactulose/​mannitol ratio of 0.703 against 0.019 in controls, while heavy drinkers without liver disease tested normal, PubMed 9934756; and a single alcohol binge in healthy adults rapidly raised markers of gut bacteria in the blood, PubMed 24828436. ↩
  13. On what is and is not known about leaky gut: a 2019 clinical review found that endurance exercise, NSAIDs, pregnancy and some food emulsifiers raise intestinal permeability and that inflammatory or ulcerating bowel diseases make the gut leakier, but that no such disease is resolved by normalizing the barrier and it is still unproven that restoring barrier function improves any gut or whole-body disease, PubMed 31076401. ↩
  14. On exercise: a meta-analysis of 34 studies in healthy people found a single bout of exercise raised markers of gut damage and permeability, with gut damage greater in hot conditions, PubMed 33201454. ↩
  15. On testing for celiac disease: the NHS advises eating gluten while being tested, and not starting a gluten-free diet until a specialist confirms the diagnosis, NHS. ↩
  16. On urgent bowel symptoms: the NHS advises an urgent appointment for unexplained weight loss, bleeding from the bottom or bloody diarrhea, or a hard lump or swelling in the abdomen, NHS. ↩
  17. On severe allergic reactions: the NHS advises calling emergency services if the lips, mouth, throat or tongue suddenly swell or breathing becomes fast or difficult, NHS. ↩
  18. On gluten and zonulin: in intestinal cell lines and in biopsies of human small intestine, gliadin, a gluten protein, released zonulin and increased permeability; the rise was sustained in tissue from people with celiac disease in remission, and limited and transient in tissue from people without celiac disease. This is laboratory work, not a measurement in people eating gluten, PubMed 16635908. ↩
  19. On zinc carnosine: in a crossover trial in 10 healthy volunteers, five days of an anti-inflammatory painkiller tripled gut permeability on placebo, while no significant rise was seen when zinc carnosine (37.5 mg twice daily) was taken alongside it; the authors called for further studies, and one author had presented data on the product to US regulators, PubMed 16777920. ↩
  20. On cod liver oil: cod liver oil supplements provide vitamin A and vitamin D as well as omega-⁠3s, NIH Office of Dietary Supplements, omega-⁠3, and the adult upper limit for preformed vitamin A is 3,000 mcg a day, NIH Office of Dietary Supplements, vitamin A. ↩
  21. On peppermint oil: in a meta-analysis of 12 randomized trials with 835 adults with IBS, peppermint oil made overall symptom improvement 2.39 times as likely as placebo across seven trials and improved abdominal pain, with side effects no more frequent than on placebo; the trials measured IBS symptoms, not intestinal permeability, PubMed 30654773. ↩
  22. On curcumin and the liver: in seven Italian cases of acute hepatitis linked to turmeric supplements, every case involved a high-bioavailability, high-dose formulation; a systematic review found 23 further published cases, PubMed 32656820. ↩
  23. On 5-⁠HTP and serotonin syndrome: a 2020 review notes that an excess of 5-⁠HTP can cause serotonin syndrome, the overactivity of serotonin that also results from antidepressant medicines and can occasionally be fatal, PubMed 33375373. ↩
  24. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩