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Key Messages Intestinal paracellular permeability accounts for the movement of ions and small solutes between the intestinal lumen and the circulation through intercellular tight junctions Studies of the intestinal paracellular transport of large molecules, particulates, and bacteria investigated in cultured epithelially derived cells have to a large extent not been replicated in living organisms Intestinal permeability implying transport through intercellular tight junctions is only one component of the intestinal barrier. The two terms should be used precisely and not interchangeably Many exotoxigenic pathogenic enteric bacteria disrupt the structure and function of the tight junctions, resulting in massive fluid secretion and diarrhea It is unlikely that endotoxin enters the circulation via the paracellular route in undamaged intestinal mucosa M-cells are the most probable entry point of luminal bacteria into the submucosal lymphatics The common assumption that bacterial endotoxins or intact bacteria are transported through the intestine via the paracellular pathway in health or disease is not supported by data obtained in vivo or in vitro in intact mucosa The concept of the leaky gut should be broadened to encompass pathways other than paracellular permeability in the genesis of diseases attributed to endotoxemia References Nagpal R, Yadav H

Physician supervision can help manage side effects and adjust the plan when needed

All authors critically revised and approved the final version of the manuscript

Maintaining Weight Loss After Reaching Your Goal Once you reach your target weight, stopping semaglutide abruptly often results in weight regain

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These might be a good option if you have certain dietary restrictions or food allergies and need to limit specific ingredients commonly found in protein powders, such as casein or whey