Four Patterns of Dysbiosis

Leo Galland, M.D., has advanced the idea of four interlocking patterns of bacterial dysbiosis:

1. Putrefaction

This is the Western degenerative disease pattern which results from diets high in fat and meat and low in fiber. This type of diet produces increased concentrations of Bacteroides sp. and induces bacterial urease and beta-glucuronidase activity. These enzymes may then metabolize bile acids to tumor promoters and deconjugate excreted estrogens, raising the plasma estrogen level. The fecal pH may increase as a result of increased ammonia production. Epidemiologic data implicates this type of dysbiosis in the pathogenesis of colon cancer and breast cancer. It is usually corrected by decreasing dietary fat and flesh, increasing fiber consumption and consuming probiotic preparations.

2. Fermentation Excess

This is a condition of carbohydrate intolerance induced by an excess of normal bacterial fermentation usually resulting from small bowel bacterial overgrowth. Abdominal distention, flatulence, diarrhea, constipation and feelings of malaise are commonly described. In small bowel bacterial overgrowth, degradation of intestinal brushborder and pancreatic enzymes by bacterial proteases may cause maldigestion. Fecal short chain fatty acids may be elevated. Patients with fermentation excess are usually intolerant of soluble fiber supplements and often benefit from antimicrobials and a reduction of carbohydrate consumption.

3. Deficiency

Exposure to antibiotics or a diet depleted of soluble fiber may create a deficiency ofnormal fecal flora, including Bifidobacteria, Lactobacillus and E. coli. Direct evidence of this condition is seen in stool cultures when concentrations of any of these organisms are reduced. This condition has been described in patients with irritable bowel syndrome and food intolerance. Deficiency and putrefaction dysbiosis often occur together and respond to the same treatment. Probiotic supplementation as well as fructooligosaccharides are often helpful in reestablishing a normal flora.

4. Sensitization

Abnormal immune responses to components of the normal indigenous intestinal microflora may contribute to the development of inflammatory bowel disease, spondyloarthropathies and other connective tissue diseases or skin disorders such as psoriasis or acne. Endotoxins may activate the alternative complement pathway, and sensitization may complement fermentation excess. Similar treatments may benefit both conditions.

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