Do
you have a good idea what microbes in particular cause gas smells? Do
you have any theories as to how someone could smell of gut smells
through their pores/breath?
It is likely that bacterial overgrowth occurs in the small bowel
and the products are absorbed and then emanate from the skin. I
wouldn’t expect that the malodorous products would be absorbed from the
colon. If someone has an overgrowth of Disulfovibrio, there may be a
sulfur smell. If someone has an overgrowth of Pseudomonas sp., the smell
may be sweeter (grape-like), but still sickly sweet. There is a whole
group of sulfur-producing bacteria. Citrobacter freundii produces
sulfur. Additionally, if the person suffers with maldigestion then food
will undergo fermentation and this produces putrefactive compounds such
as putrescine. While blood borne body odor is likely multi-factorial, at
least for some patients, healing the bowel and cleaning up the diet
could provide some relief.
Do
you think with gut-related metabolic body odors, it's likely an enzyme
is saturated? For instance a drug metabolizing enzyme? Any thoughts as
to which one(s)? Any thoughts as to a scenario?
In addition to dysbiosis, I think it could be enzyme saturation or lack
of vitamin and mineral cofactors. Metabolic diseases such as amino
acidurias or organic acidurias have been characterized by strange odors,
especially in the urine. These disorders occur due to lack of an
enzyme, poor function of an enzyme, or low levels of cofactors causing
the enzyme to malfunction. The result is too much of the byproducts,
which can be smelly in high concentrations.
Does leaky gut mean 'leaky small intestine'? Do you think leaky gut or 'leaky colon' is likely a factor?
Leaky gut is often involved in cases of dysbiosis. It could be a factor
in people with blood borne body odor, but I wouldn’t know for sure
without an IgG4 food antibody test. Intestinal permeability, or “leaky
gut,” has been implicated in inflammatory bowel diseases such as Crohn’s
disease, non-alcoholic fatty liver disease, alcoholic liver disease,
food allergy, acute pancreatitis, celiac disease, multi-organ
dysfunction, and autism. According to the leaky gut hypothesis, genetic
predisposition to poor intestinal barrier function, coupled with
stressors such as NSAIDS or alcohol, can result in permeation of the
intestinal mucosa. Antigens and bacteria are then able to cross the
intestinal membrane and enter circulation where the immune system
launches an attack against the antigens.
What kinds of tests would you recommend for a person suffering with blood borne body odor?
Without knowing a detailed history on the patient, I would recommend the GI Effects, the Organix, and the
40 amino acids.
I recommend those lab tests because of the likely involvement of gut
dysbiosis and abnormal SCFAs, vitamin need, and metabolic diseases
involving amino acids and organic acids. I would also recommend
IgG4 Food Antibody testing, especially if the person has gut, skin, or autoimmune symptoms.
Trimethylaminuria
Do you think a
particular type of bacteria are responsible for gut trimethylamine
production? Is it likely the same one thought to cause bacterial
vaginosis (Gardnerella)?
Yes. The more smelly compounds like trimethylamine and hydrogen sulfide
are not products of human metabolism, but they are produced by several
bacteria under certain conditions. They tend to be strict anaerobes that
could dwell in the colon or the vagina.
There
is a 'diagnosis' of 'Secondary TMAU', where the enzyme involved is
deemed fine, but the person has too much trimethylamine. Do you have any
suggestion as to how to kill off the TMA-producing bacteria in
particular?
The first thing to do is lower protein intake and improve protein
digestion to reduce undigested nitrogenous substrates (amino acids) that
must be present to form ammonia. Perhaps water or juice fasting could
be beneficial in these instances as it can change the microbial content
of the gut. If you don’t feed the colonic bacteria, they can’t grow and
produce strange products.
Some
feel that trimethylamine can produce a wide range of odors. Do you
think trimethylamine could cause the wide range of gut smells on its
own?
No. However it can be a component in complex mixtures of products that are responsible for the varying odors among individuals.
Final Questions
What do you think of the quality of probiotics on the market and are there any brands of probiotics you recommend ?
We are impressed with Klaire Labs probiotic and prebiotic formulas. I
also like Custom Probiotics and a high dose probiotic called VSL#3.
Designs for Health has a good probiotic product as well.
Is taking prebiotics on its own a good idea ? And which type of prebiotic do you feel is best ?
Fruits and vegetables are a great source of fiber (prebiotics). Other
ideas are inulin, xylooligosaccharides, larch arabinogalactans, and beta
glucan.
Is there
general treatment advice for 'suspected' dysbiosis or does it vary too
much ? For instance, take nystatin and metronidazole in a 'scorched
earth' policy ?
I think the “4R Protocol” is the most general treatment advice and it’s
comprehensive, but every doctor has a different approach and dysbiosis
treatment should be tailored to the patient.
Treatment using 4 “R” Protocol for Intestinal Health from the
GI Effects Interpretive Guide
Remove offending foods,
medications, gluten (if sensitive) and reduce poor quality fats, refined
carbohydrates, sugars, and fermented foods (if yeast is present).
Consider antimicrobial, antifungal, and/or antiparasitic therapies in
the case of opportunistic/pathogenic bacterial, yeast, and/or parasite
overgrowth (see below for specific recommendations).
Replace what is needed for
normal digestion and absorption such as betaine HCl, pancreatic enzymes,
herbs that aid in digestion such as deglycyrrhizinated licorice and
marshmallow root, dietary fiber, and water.
Reinoculate with favorable
microbes (probiotics such as Lactobacillus sp., Bifidobacter sp., and
Saccharomyces boulardii). To enhance the growth of the favorable
bacteria, supplement with prebiotics such as inulin,
xylooligosaccharides, larch arabinogalactans, beta glucan, and fiber.
Repair mucosal lining by giving
support to healthy intestinal mucosal cells, goblet cells, and to the
immune system. Consider L-glutamine, essential fatty acids, zinc,
pantothenic acid and vitamin C.
Why does the intake of probiotics sometimes produce bloating and gas in some people and not in others?
Not all people react the same to probiotics because it depends on their
microbial populations. When a person has a poor diet (high simple
sugars, low fiber), taking probiotics can produce gas. However, this
usually goes away with time. If the patient increases complex carbs and
decreases simple sugars that often decreases any gas and bloating
brought on by the probiotic. When there are unexplained reactions to
probiotics or prebiotics, it is a good idea to run an Organix test, a GI
Effects test, or food antibody test to identify underlying imbalances.
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