Intestinal science: answers are forthcoming

Ilse Ferreira Mention the word dysbiosis to the average medical practitioner in South Africa and the likely response would be "don't know the term". And yet, thousands (more likely tens of thousands) of people unwittingly suffer from dysbiosis. What is dysbiosis and what are the implications for health?

Mention the word dysbiosis to the average medical practitioner in South Africa and the likely response would be "don't know the term". This is not the case in Europe, however. 

The term dysbiosis was first used by the Russian scientist Metchnikoff who described it as a state of living with intestinal flora that has harmful effects. He experimented widely in intestinal microbiology and was the first to draw attention to the role of lactobacilli in the intestinal tract. The mechanisms involved, which are now, generations later, coming under the scientific microscope, are more diverse and complex than he could ever have imagined.

Dr Elie Metchnikoff was director of the Pasteur Institute and received a Nobel Prize for his work on the link between the immune system and intestinal flora in 1908.

Humans have more than 400 different species of bacteria and other flora living normally in the intestinal tract. Under normal healthy conditions, a symbiotic relationship exists between man and his intestinal co-habitants. But when this balance is disrupted - either by pathogens or by the absence of "friendly" bacteria - dysbiosis is the result.

Organisms that can cause dysbiosis include protozoan parasites such as Entamoeba species, Giardia lamblia and others, bacteria like Salmonella, Shigella and some strains of Escherichia and Citrobacter, as well as fungi, including Candida Albicans and other Candida species.

Thousands (more likely tens of thousands) of people unwittingly suffer from dysbiosis. The condition is an underlying factor in a wide variety of disease conditions such as allergies, asthma, cancer, depression, eczema, hypoglycaemia (low blood sugar) muscle and joint pain, sinusitis and psoriasis, to name but a few. (Enter here for a list of dysbiosis-related conditions)

Dr Alta Smit of Johannesburg says: "The intestinal tract is highly sensitive to the onslaughts of our modern lifestyle and disharmony can lead to many of our modern disease conditions which cannot be attributed to a single cause." Dr Smit specialises in the treatment of CFS (Chronic Fatigue Syndrome) patients.

"An imbalance in the intestinal tract will interfere with food absorption and cause nutritional shortages, which in turn causes a host of other health problems", according to Jacques Theron, lecturer at Technikon Pretoria. He is currently preparing his doctorate on dysbiosis. "Every micro-organism manufactures toxic by-products which will sweep a path of destruction somewhere in the body. It is more often these by-products, and not necessarily the organism itself, that leads to dysbiosis," he explains.


Although there are slight differences in the descriptions various experts would give of the actual process of dysbiosis, it includes * disharmony of intestinal organisms and fungal overgrowth *putrefaction * allergy and inflammation * malnutrition * hepatic stress * leaky gut syndrome.

Intestinal imbalance leads to fungal overgrowth in almost all instances. Add a sugar, yeast-laden (daily bread) and alcohol diet to this - and the intestinal tract will become a putrid, infected environment leading to systemic infection.

In some experiments patients with Candida Albicans overgrowth, without having consumed a drop of alcohol, tested positive on breathalyser tests! This can be explained by ethanol produced by the yeasty intestinal mix. The putrefaction which is caused mainly by bacteria that decomposes organic substances - especially proteins - has as a nasty neighbour several severely toxic by-products. 

Other causes of putrefaction include the sugar/yeast mix generated by Candida overgrowth, particularly if it is continually topped up with dietary sugars. Putrefaction destroys vital elements like vitamin B, magnesium and zinc. 

Pathogenic bacteria, on the other hand, add their own enzymes to the mix, further complicating normal digestion. Some of the damage that such bacterial overgrowth can cause is produced by the action of bacterial proteases which degrade pancreatic and intestinal brush-border enzymes, thereby creating pancreatic insufficiency, mucosal damage and subsequent malabsorption.

Dysbiosis inevitably leads to allergy and inflammation. This happens mostly due to leaky gut syndrome. This state exists when the tight junctions between the epithelial cells of the gut lining form openings that allow undigested food particles to escape into the surrounding tissue rather than be carried along to the end of its digestive process. Food allergy increases gut permeability due to the irritation of the lining of the intestinal tract, in turn exacerbating food intolerance. Once this circular path is in place, the gut lining would need fixing.

The body's immune response, which is mostly situated in the gut, as Dr Smit points out, does not remain focused there. Once the immune cells are sensitized in the gut they migrate to other sites in the body where they degranulate and their chemical mediators cause inflammation, far from the site of the original infection. 

Reactive arthritis has been shown to be activated by intestinal infections with Salmonella, Yersinia and other enterobacteria.

The next step in this process is malnutrition, since active transport of nutrients become impaired. Thus, a person who has dysbiosis may have a perceived optimum diet intake - right foods in right quantities - and yet suffer from malnutrition.

Hepatic overload is obvious. The liver is challenged by many more toxic substances it would not normally need to deal with, and in turn it drains the body's energy stores due to its increased workload. 

It is almost needless to say that the body's energy stores would be depleted by all the above processes, which is why dysbiosis plays a factorial role in so many different disease conditions.

Perhaps medical science has become so specialised that it has failed to view disease in its very basic context: starting with the intestinal tract and metabolic functioning.

Metabolic photos

Our Springbok athletes are among those who benefit from the scientific advances in the field of metabolic harmony, which includes dysbiosis, done by the Technikon Pretoria.

"In every living organism, there exists a specific and logical interplay between each of the myriad of vital elements that make up the organism's biochemical nature. With a metabolic assessment we are able to determine exactly what a person, be it an athlete or a patient, requires," says Dr Susan Lehmann, head of Technikon Pretoria's Centre for Molecular Health. She explains: the body's function is like a metabolic symphony. If the metabolism does not function properly, in other words the orchestra is playing false, all the metabolic elements should be tested and balance restored.

An amino acid "photo" is taken from which scientists gain a host of information: which elements are not properly absorbed, for instance. Elements of the energy cycle as well as ten dysbiosis markers form part of the photo.

"Everything works together in an integrated network. For instance, vitamin C can regenerate vitamin E in the body. This regeneration means that if the vitamin C levels are adequate, taking extra vitamin E would be a waste. These co-factors are just as important as the supplemented intake," says Dr Lehmann.

Pretoria's Dr Sterna Franzsen is one of a handful of SA doctors who can perform videomicroscopy blood tests. She explains: "We test live blood, not dried samples as in normal pathological tests. With this test we do analysis of immune functioning on the spot: the size, number and functionality of red and white blood cells can be determined and discussed with the patient. The state of the intestinal tract (leaky gut) as well as the presence of Candida Albicans can also be clearly seen. Presence of various organisms in both the stomach and intestinal tract can be identified, as well as other related metabolic disturbers, such as a lack of stomach acid.

"How many people suffer from dysbiosis and to what extent it plays a role in other diseases are impossible to quantify," says Jacques Theron. But that it plays a major role is indisputable, according to all the experts. The most common symptoms of dysbiosis are abdominal cramps, bloating, abnormal (chronic) fatigue, nausea, diarrhoea/constipation and lactose (milk sugar) intolerance. Even autism, attention deficit disorder and other behavioural problems could be caused by fungal (Candida) overgrowth. 

Treating dysbiosis is not a simple matter. Factors such as the location of the imbalance, (small or large intestine) and the causal factor(s) will determine the correct approach.

Where to next?

"Because dysbiosis decreases the immune systems' ability to protect the body from low virulence disease-causing organisms, chronic problems are given brewing space and remain undiagnosed. With scientific work taking place in the field of microbiology that allows an ever better understanding of dysbiosis, detection and correction will become easier and quicker."

For more information:

Ilse Ferreira (Editor of the medical journal Specialist Forum) 082 330 7596 Jacques Theron Technikon Pretoria (012) 318- 6265


March 2002