A comparison of Lactulose Breath Hydrogen Measurements with Gut Fermentation Profiles in Patients with Fungal-type Dysbiosis

J. Nutr. & Env. Med. 2001; 11: 33-42. Eaton, Keith Kenneth, The Princess Margaret Hospital, Osborne Road, Windsor, Berks. SL4 3SJ. Chan,Rebecca. Howard, Mark Andrew. McLaren-Howard, John Michael, Biolab Medical Unit, The Stone House, 9 Weymouth Street, London W1W 6DB. Background. Fungal-type dysbiosis is still an unproven diagnosis. Patients are polysymptomatic, but most have symptoms of irritable bowel. Treatment, using a diet low in fermentable, yeasty and mouldy foods with/or without antifungal drugs, is often rewarding. Patients with the condition also show elevated blood ethanol levels after fasting glucose challenge Because of this a fungal cause has been suggested. These features do not suggest a bacterial overgrowth. Hydrogen generation, on the other hand, is a bacterial fermentation product and would be expected only if a bacterial cause were present. It was therefore decided to compare ethanol and hydrogen production. Methods. Newly referred polysymptomatic untreated adult patients were investigated in a clinic for allergic and environmental diseases. Patients were subjected to two laboratory investigations: a gut fermentation profile which measured ethanol, higher alcohols and short-chain fatty acids, and a lactulose breath hydrogen. These were performed after the initial consultation and reported at the first follow-up visit. 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 ethanol and hydrogen production. Conclusions. If fungal-type dysbiosis is solely due to yeasts, our ethanol positive group should not produce hydrogen, but our 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 fungal-type dysbiosis.