A Comparison of Lactulose Breath Hydrogen Measurements with Gut Fermentation Profiles in Patients with Fungal‐type Dysbiosis

Abstract

Purpose: Fungal-type dysbiosis (FTD) is still an unproven diagnosis. Patients are polysymptomatic, but most have symptoms of irritable bowel. Treatment, using a diet low in fermentable, yeasty and mould-containing foods with or without antifungal drugs, is often rewarding. Patients with FTD show elevated blood ethanol levels after fasting glucose challenge. Because of this most authors suggest a fungal cause. Hydrogen generation is a bacterial fermentation product and would only be expected if a bacterial cause was present. It was therefore decided to correlate ethanol and hydrogen production. Design: Statistical comparison of ethanol producers and non-producers with respect to breath hydrogen and symptomatology. Materials and Methods: The gut fermentation profile was performed by gas-liquid chromatography, and measured ethanol, a number of higher alcohols and short-chain fatty acids. Lactulose breath hydrogen estimations were by gas chromatography. Statistics were calculated using Pearson's rank correlation and the chi-squared test, using Microsoft Excel packages. Results: Two groups were studied. The first produced excess ethanol (n~18) and the second (n~20) did not. Both groups included patients producing hydrogen. There was no statistical correlation between levels of ethanol and hydrogen production. Conclusions: If FTD is solely due to yeasts, our ethanol positive group should not produce hydrogen, solely a bacterial ferment, but the ethanol negative group should. If the conventional view, that yeasts do not produce hydrogen as a fermentation product, is correct, it appears from the commonness of breath hydrogen positives in this series that bacterial fermentation is in some way implicated in FTD.

Gastric Acid Production, Pancreatic Secretions and Blood Levels of Higher Alcohols in Patients with Fungal-type Dysbiosis of the Gut

“…A number of such patients have an excess of urinary b -alanine excretion [5], which again is not present in patients with food intolerance. Other studies have shown that patients with FTD show reduced levels of B vitamins, zinc and magnesium [6], increased gut permeability [4], lowered urinary histidine excretion [7] and a high incidence of elevated breath hydrogen levels [8]. In these studies, there are no signi cant differences between an FTD group and one with food intolerance, although both have a high incidence of abnormality as compared with healthy controls.…”

Yeast metabolic products, yeast antigens and yeasts as possible triggers for irritable bowel syndrome

“…Some tests explore the possibility that intestinal yeasts metabolize an oral glucose load by measuring blood ethanol 1 h after ingestion of a test solution [9,45,46]. These tests have been further developed to include analyses of other alcohols that bacteria, rather than yeast, can produce [6,10]. The test attempts, and has the potential, to identify patients where yeast overgrowth is of sufficient magnitude to produce measurable metabolites in circulation and distinguishes this from bacterial overgrowth, or bacterial dysbiosis [6][7][8]11].…”

“…These tests have been further developed to include analyses of other alcohols that bacteria, rather than yeast, can produce [6,10]. The test attempts, and has the potential, to identify patients where yeast overgrowth is of sufficient magnitude to produce measurable metabolites in circulation and distinguishes this from bacterial overgrowth, or bacterial dysbiosis [6][7][8]11]. Unfortunately, the glucose challenge test is not specific and cannot show that abnormal findings are due to Candida albicans or, for that matter, any other yeast.…”

“…Furthermore, Middleton et al [43] did not reveal an association or a correlation between a group with IBS benefiting from antifungal treatment and microbiological findings of yeasts in stools. Evidence for yeast as a causative factor for symptoms has rather been sought from indirect measurements that look for evidence of yeast metabolites in blood, breath or urine [5,6,10,12,[44][45][46], or that explore yeast allergy/sensitivity [12,44,[47][48][49][50][51][52][53].…”

“…High carbohydrate intake in some of these patients prompted diagnostic labels such as germ-carbohydrate fermentation and intestinal carbohydrate dyspepsia [3] in the early 20th century, while later attempts include descriptions of the candidiasis hypersensitivity syndrome [4] gut fermentation syndrome [5] fungal type dysbiosis [6][7][8][9] and abnormal gut fermentation [10][11][12].…”