August 6, 2018
Medical College of Georgia at
Augusta University
Probiotic use can result in a
significant accumulation of bacteria in the small intestine that can result in
disorienting brain fogginess as well as rapid, significant belly bloating,
investigators report.
Probiotic use can result in a
significant accumulation of bacteria in the small intestine that can result in
disorienting brain fogginess as well as rapid, significant belly bloating,
investigators report.
In a published study of 30
patients, the 22 who reported problems like confusion and difficulty concentrating,
in addition to their gas and bloating, were all taking probiotics, some several
varieties.
When investigators looked
further, they found large colonies of bacteria breeding in the patients' small
intestines, and high levels of D-lactic acid being produced by the bacteria
lactobacillus' fermentation of sugars in their food, says Dr. Satish S.C. Rao,
director of neurogastroenterology/motility and the Digestive Health Clinical
Research Center at the Medical College of Georgia at Augusta University.
D-lactic acid is known to be
temporarily toxic to brain cells, interfering with cognition, thinking and
sense of time. They found some patients had two to three times the normal
amount of D-lactic acid in their blood. Some said their brain fogginess -- which
lasted from a half hour to many hours after eating -- was so severe that they
had to quit their jobs.
The report in the
journal Clinical and Translational Gastroenterology appears to be the
first time the connection has been made between brain fogginess, bacterial
overgrowth in the small intestine, high levels of D-lactic acid in the gut and
probiotic use, Rao says.
"What we now know is that
probiotic bacteria have the unique capacity to break down sugar and produce
D-lactic acid. So if you inadvertently colonize your small bowel with probiotic
bacteria, then you have set the stage for potentially developing lactic
acidosis and brain fogginess," Rao says.
While probiotics can be
beneficial in some scenarios, like helping a patient restore his gut bacteria
after taking antibiotics, the investigators advised caution against its
excessive and indiscriminate use.
"Probiotics should be
treated as a drug, not as a food supplement," Rao says, noting that many
individuals self-prescribe the live bacteria, which are considered good for
digestion and overall health.
Others have implicated
probiotics in the production of D-lactic acid -- and brain fogginess -- in
patients with a short bowel so their small intestine does not function
properly, and in newborns fed formula containing the popular product. Short
bowel syndrome results in a lot of undigested carbohydrates that are known to
cause small intestinal bacterial overgrowth, or SIBO, and the high levels of
D-lactic acid. Severe liver and kidney problems can produce similar problems.
Whether there was also a
connection when the gut is intact was an unknown. "This is the first
inroad," says Rao.
All patients experiencing
brain fogginess took probiotics and SIBO was more common in the brain fogginess
group as well, 68 percent compared to 28 percent, respectively. Patients with
brain fogginess also had a higher prevalence of D-lactic acidosis, 77 versus 25
percent, respectively.
When brain-foggy patients
stopped taking probiotics and took a course of antibiotics, their brain
fogginess resolved.
Movement of food through the
gastrointestinal tract was slow in one third of the brain foggy patients and
one fourth of the other group. Slower passage, as well as things like obesity
surgery, can increase the chance of bacterial buildup, or SIBO.
"Now that we can identify
the problem, we can treat it," Rao says. Diagnosis includes breath, urine
and blood tests to detect lactic acid, and an endoscopy that enables
examination of fluid from the small intestines so the specific bacteria can be
determined and the best antibiotics selected for treatment.
Normally there is not much
D-lactic acid made in the small intestines, but probiotic use appears to change
that. SIBO, which was present in most with brain fogginess, can cause bacteria
to go into a feeding frenzy that ferments sugars resulting in production of
uncomfortable things like hydrogen gas and methane that explain the bloating.
Probiotics added to that
feeding frenzy the bacterium lactobacillus, which produces D-lactic acid as it
breaks down sugars, The acid get absorbed in the blood and can reach the brain.
All those with brain
fogginess, SIBO and/or D-lactic acidosis, were given antibiotics that targeted
their bacterial population and asked to discontinue probiotics. Those without
SIBO were asked to halt probiotics and stop eating yogurt, which is considered
one of the best sources of probiotics. Those with SIBO and D-lactic acidosis
but no brain fogginess also took antibiotics.
Following treatment, 70
percent of patients reported significant improvement in their symptoms and 85
percent said their brain fogginess was gone. Those without brain fogginess but
with SIBO and high levels of D-lactic acid reported significant improvement in
symptoms like bloating and cramping within three months.
Abdominal pain was the most
common symptom in both groups and before treatment, six of those with brain
fogginess reported a tremendous increase in their abdominal size within just a
few minutes of eating.
All patients received
extensive examination of their gastrointestinal tract, including a motility
test, to rule out other potential causes of their symptoms. They filled out
questionnaires about symptoms like abdominal pain, belching and gas and
answered questions about related issues like antibiotic and probiotic use as
well as food fads and yogurt consumption.
They were given carbohydrates
followed by extensive metabolic testing looking at the impact on things like
blood glucose and insulin levels. Levels of D-lactic acid and L-lactate acid,
which results from our muscles' use of glucose as energy and can cause muscle
cramps, also were measured.
Probiotic use may be
particularly problematic for patients who have known problems with motility, as
well as those taking opioids and proton pump inhibitors, which reduce stomach
acid secretion and so the natural destruction of excessive bacteria.
Probiotics are supposed to
work in the colon and not the small intestines or stomach, Rao says, so
motility issues can result in problems with probiotic bacteria reaching the
proper place. A wide variety of problems, from conditions like diabetes to
drugs like antidepressants and minerals like iron, can slow movement and
increase the possibility that probiotics will remain too long in the upper gut
where they can cause harm, he says.
Probiotics definitely can
help, for example, people who have gastroenteritis, or stomach flu, or are left
with diarrhea and other problems after antibiotics wipe out their natural gut
bacteria, Rao says.
"In those situations, we
want to build up their bacterial flora so probiotics are ideal," he says.
Rao's pursuit of a possible
connection between probiotics, brain fogginess and bloating started with a
memorable patient who developed significant amounts of both problems within a
minute of eating.
"It happened right in
front of our eyes," Rao says of the dramatic abdominal distention. They
knew the woman had diabetes, which can slow motility. When they looked in the
blood and urine at a variety of metabolic compounds, they found the high levels
of D-lactic acid and soon learned the patient used probiotics and regularly ate
yogurt.
Next steps include additional
studies in which the investigators better quantify and characterize the brain
fogginess reported by patients and following patients for longer periods to
ensure their problems remain resolved. Some patients in the current study
required a couple of rounds of antibiotics, Rao notes.
Good food sources of
probiotics include yogurt, sauerkraut, kimchi, kefir and dark chocolate, which
are generally safe because of the small amounts of bacteria present, Rao says.
The 19-foot long small
intestine has been a bit of an understudied organ, likely in part because it's
hard to visualize via the mouth or anus, Rao says. "I think the small
bowel can be a source of huge mystery," Rao says.
Your helpful gut bacteria, or
microbiome, which are essential to things like a well-functioning immune system
and general health, are largely in the large intestine and colon.
Story Source:
Materials provided by Medical College of Georgia
at Augusta University. Note: Content may be edited for style and
length.
Journal Reference:
Satish S. C. Rao, Abdul
Rehman, Siegfried Yu, Nicole Martinez de Andino. Brain fogginess, gas and
bloating: a link between SIBO, probiotics and metabolic acidosis. Clinical
and Translational Gastroenterology, 2018; 9 (6) DOI: 10.1038/s41424-018-0030-7
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