Dysbiosis (disturbed intestinal flora)

Dysbiosis is an imbalance of the intestinal flora, often caused by medication, stress, but also by malnutrition. Under normal circumstances there are trillions of bacteria in the intestine living in symbiosis. Their tasks include the digestion of indigestible food components such as dietary fibres, the production of short-chain fatty acids and certain vitamins (especially vitamin B12, pantothenic acid) as well as the breakdown of bile dyes and the support of the intestinal defence system. Dysbiosis causes a shift in the balance and an increase in putrefying and/or fermenting bacteria of different genera. In the diagnosis of dysbiosis, stool analyses with subsequent treatment with pro- and prebiotics, nutritional therapeutic measures and, if necessary, intestinal sanitation are the main focus. If left untreated, however, dysbiosis can contribute to the development of chronic diseases and severely restrict the quality of life of the person affected.
 

Dysbiosis can cause various symptoms in the affected person, primarily in the gastrointestinal tract, including increased burping, heartburn, nausea, bloated abdomen, flatulence, foul-smelling stools, alternating diarrhea or constipation, irregularities in bowel movements (too soft, too hard, too often, too rarely), foul-smelling stools, a feeling of fullness, pressure or pain in the abdominal area, intestinal cramps and colic. In addition, complaints such as chronic fatigue, exhaustion, lack of concentration, headaches up to migraines, main problems, food intolerances and increased susceptibility to infections can also occur. The chronic complaints can also have a negative influence on the psyche, often resulting in depressive moods or irritability. The multitude of symptoms often has a negative effect on the quality of life of the affected persons or can greatly reduce it.
 

The different bacteria of the intestinal flora also have different demands on their environment. Depending on the mileu, which results from the pH value, oxygen content and nutritional habits of the person concerned, certain types of bacteria predominate. In the case of dysbiosis, useful (apathogenic) bacterial species such as lactobacteria and bifidobacteria retreat in favour of disease-causing (pathogenic) representatives. In contrast to apathogenic germs, which strengthen the immune system, protect the intestinal mucosa and protect the body from pathogens and toxins, pathogenic representatives produce a number of toxic breakdown products, which then place a heavy burden on the organism and can promote the development of diseases. Dysbiosis may be caused by a number of factors, including the use of certain medicines, malnutrition and prolonged exposure to stress. One of the most serious influences on the intestinal flora are treatments with antibiotics, which can change the composition of the intestinal flora by up to 90 %. Taking them kills not only undesirable bacteria but also useful bacteria as an unintended side effect, which in turn gives pathogenic germs the opportunity to multiply. Other drugs also have a negative influence on the intestinal flora, including so-called gastric acid inhibitors, antidepressants, antihistamines, beta-blockers, statins and ovulation inhibitors. Furthermore, the diet also influences the intestinal flora and leads to an increased occurrence of putrefactive and fermentation bacteria in a diet particularly rich in fat, sugar, carbohydrates and protein. While putrefactive bacteria break down the excess of protein, fermenting bacteria break down the excess of carbohydrates. In both cases, these harmful putrefaction and fermentation processes have strong, negative effects on the digestive system and the entire organism and change the environment in the intestine permanently. 
 

In order to diagnose dysbiosis, first of all the stool of the affected person is analysed with different laboratory medical parameters. Thus, sensitive mass spectrometric methods can be used to diagnose an increased colonization of pathogenic microorganisms in the intestine at an early stage. A disturbed intestinal microflora can also be diagnosed by measuring digestive residues, but also parameters such as α-1-antitrypsin, calprotectin, bile acids, pancreatic elastase, secretory IgA and zonulin, beta-glucuronidase, short chain fatty acids, EPX in stool, histamine in stool, beta-defensin 2, lysozyme, secretory IgA, calprotectin, lactoferrin, alpha-1-antitrypsin, hemoglobin, zonulin, as well as by determination of the flora status. Furthermore, quantitative, bacterial and mycological stool tests are available to determine the aerobic and anaerobic intestinal flora, yeasts, moulds, Clostridium difficile and pH-value. Furthermore, the intestinal microbiome can be examined to determine the frequency of relevant bacterial strains and species, including Firmicutes, Bacteroidetes, Actinobacteria, Proteobacteria, Verrucomicrobia, Euryarcheaota, Fusobacteria, Tenericutes, the description of bacterial diversity, dysbiosis, the FODMAP index, the classification of enterotypes, and the assessment of the risk of metabolic, immunological and neurological diseases. Molecular biological examination of the mucosaprotective flora allows the analysis of the two most important germs for mucosal protection, Akkermansia muciniphila and Faecalibacterium prausnitzii. By measuring short-chain fatty acids by means of head-space GC-MS and subsequent presentation of the determined concentrations mmol/L, as well as the percentage ratio of butyrate, propionate and acetate, the short-chain fatty acids in stool can be determined. 
 

Plant extracts such as ginger and gentian support the digestive processes, increase resistance to unfavourable microorganisms and support the immune system. In addition to secretolytic properties, ginger also has an effective antimicrobial and antiviral spectrum of activity. Gentian contains active ingredients with bactericidal effects that can also be used against antibiotic-resistant strains.

Garlic inhibits the growth of gram-positive and gram-negative bacteria (including Staphylococcus, Streptococcus) as well as fungi and yeasts with the help of the main active ingredient alliin (S-allyl-L-cysteine sulphate). Garlic can also enhance the effectiveness of antimycotics (e.g. Amphotericin B) and inhibit the growth of Helicobacter pylori.

Besides the plant-typical components glabridine and glabrol, liquorice also contains natural salicylic acid for which significant antimicrobial effects have been proven. In addition, polysaccharide fractions of Glycyrrhiza glabra can reduce the ability of Helicobacter pylori, Campylobacter jejuni and Porphyromonas gingivalis to adhere to potential host cells by 60-70%, thus reducing bacterial infection.

L-glutamine plays a central role in the development and maintenance of cell systems. Cells with high division rates, such as the cells of the immune system and the mucosa cells of the small intestine, depend on an adequate supply of the amino acid glutamine. In addition, L-glutamine, as a precursor of glutathione biosynthesis, is a central component for maintaining the antioxidative status. The support of the intestinal flora is important in dysbioses. The intake of probiotics can be beneficial in this case. Lactobacteria such as Bifidobacterium sp. help to bring the intestinal flora back into balance.

One of the most frequent causes of digestive problems in the sense of insufficient breakdown of food components (maldigestion) is a loss of function of the pancreas (pancreatic insufficiency). The complaints that arise from this respond well to the administration of digestive enzymes, as they support the digestion of proteins, carbohydrates and fats and improve digestion. Possible enzymes to support digestive performance include pancreatic enzymes (pancreatin) and vegetable enzymes from pineapple (bromelain) and papaya (papain) as well as lactase, which breaks down lactose.