Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis, Rao et al, 2018

Indigophoton

Senior Member (Voting Rights)
Abstract
Background

D-lactic acidosis is characterized by brain fogginess (BF) and elevated D-lactate and occurs in short bowel syndrome. Whether it occurs in patients with an intact gut and unexplained gas and bloating is unknown. We aimed to determine if BF, gas and bloating is associated with D-lactic acidosis and small intestinal bacterial overgrowth (SIBO).

Methods
Patients with gas, bloating, BF, intact gut, and negative endoscopic and radiological tests, and those without BF were evaluated. SIBO was assessed with glucose breath test (GBT) and duodenal aspiration/culture. Metabolic assessments included urinary D-lactic acid and blood L-lactic acid, and ammonia levels. Bowel symptoms, and gastrointestinal transit were assessed.

Results
Thirty patients with BF and 8 without BF were evaluated. Abdominal bloating, pain, distension and gas were the most severe symptoms and their prevalence was similar between groups. In BF group, all consumed probiotics. SIBO was more prevalent in BF than non-BF group (68 vs. 28%, p = 0.05). D-lactic acidosis was more prevalent in BF compared to non-BF group (77 vs. 25%, p = 0.006). BF was reproduced in 20/30 (66%) patients. Gastrointestinal transit was slow in 10/30 (33%) patients with BF and 2/8 (25%) without. Other metabolic tests were unremarkable. After discontinuation of probiotics and a course of antibiotics, BF resolved and gastrointestinal symptoms improved significantly (p = 0.005) in 23/30 (77%).

Conclusions
We describe a syndrome of BF, gas and bloating, possibly related to probiotic use, SIBO, and D-lactic acidosis in a cohort without short bowel. Patients with BF exhibited higher prevalence of SIBO and D-lactic acidosis. Symptoms improved with antibiotics and stopping probiotics. Clinicians should recognize and treat this condition.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006167/
 
Interesting. I don't think that antibiotics are necessarily the answer for all of us though, least of all those who are sensitive to medications.

I note that:

"We treated all patients with evidence of SIBO with antibiotics and discontinuation of probiotics, and the rest with dietary advice and stopping probiotics. These measures led to significant improvement of symptoms in 70% of our patients and complete resolution of brain fogginess in 85% of patients, reaffirming that the symptoms were related to D-lactic acidosis and SIBO. Likewise, the group of patients without BF, but with either SIBO or D-lactic acidosis also showed similar degree of improvement in symptoms after antibiotics."

That leaves quite a few who were not helped. I have a feeling that I wouldn't be, having had apparent bad reactions to antibiotics last time I had them (or it may have been to something else).
 
Really interesting to see L-Lactic acidosis present in some SIBO patients too.

Could explain why I had a sky-high serum lactate test (L-lactate) one day but not on repeat - only difference that was obvious was one was before a meal and the other was after.
 
Interesting article, but I have the opposite effect from antibiotics, and probiotics. Antibiotics greatly increase my brain fog; probiotics reduce it. Antibiotics make me dizzy, often cause GI upset, and Increased BF. Probiotics have always helped BF.

What triggers your brain fog? For me it's always been antibiotics, carbohydrates, lack of sleep, too much fibre, and sometimes stress will do this too. Things that help are low carb diet, daily probiotics, and heavy metal chelations. I wouldn't say these chelations would be suitable for severe ME due to reactions to chemicals. And, they do pull out good minerals, which have to be replenished.
 
The ME micorbiome studies are very interesting for me. Ever since the brain fog started, one of the consistent triggers has been GI pain. Once the GI pain reaches a certain level, I get spaced out, or more spaced out.

This is how I describe brain fog - a feeling of looking down a tunnel, disoriented, slowed reaction times, confusion, pressure, feeling of squeezing inside my head, can't figure things out. And, this feels different to me than orthostatic intolerance, which makes me feel faint, lightheaded, weak, and uncoordinated.

Anyone have any other descriptions for brain fog?
 
I wish someone would test brain fog (I don't really like this term) in the following manner:

Pick a dozen or so robustly healthy very articulate and intelligent people who run marathons or triathlons and about 1-5 minutes or so after they complete one of these events ask them to complete some simple cognitive tests both oral and written using language and math.

I don't actually know what the results would look like. But it may be that they have some difficulties doing well. If so, I think this might be what my brain fog looks like.
 
Back
Top Bottom