When Probiotics Make You Feel Worse Think SIBO

Clinical and Translational Gastroenterologyvolume 9, Article number: 162 (2018)


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).

Abdominal bloating, gas and distension are common gastrointestinal symptoms that are caused by many conditions including carbohydrate intolerance and small intestinal bacterial overgrowth (SIBO)1. Brain Fogginess (BF) describes a constellation of symptoms comprised of mental confusion, impaired judgment, poor short-term memory, and difficulty with concentration, which is often transient and disabling. Previously, similar symptoms, along with slurred speech and gait disturbances have been described in patients with short bowel syndrome2,3. These patients were found to have metabolic acidosis with elevated levels of D-lactic acid in the serum. Others have described brain fogginess in association with other chronic disorders including postural orthostatic tachycardia syndrome4,5. Recently, probiotic use has been implicated in the production of D-lactic acidosis, both in short bowel syndrome patients and in the first 2 weeks of life in infants who were fed probiotic-containing formula6,7. Typically, D-lactic acidosis is caused by the fermentation of ingested carbohydrate by D-lactic producing bacteria such as lactobacillus and bifidobacterium in the bowel2,3.To read more….