If you engaged in the Wheat Belly lifestyle, banished all wheat, grains, and sugars, corrected factors such as vitamin D and omega-3 fatty acids, lost weight, shrunk visceral fat, and experienced other health benefits, yet some abnormality persists despite your efforts, it’s time to consider dysbiosis, SIBO, and their associated endotoxemia.
Modern humans have experienced a dramatic disruption in the composition of their intestinal microbiomes: loss of important species, reductions in healthy metabolites, increase in species ordinarily confined to the colon but ascended up into the small bowel (i.e., SIBO) that exert unhealthy effects.
I’ve previously discussed how such changes in the microbial intestinal landscape can lead to the process of endotoxemia, or the entry of bacterial breakdown products into the bloodstream, the process that explains how and why a change in intestinal microbiome composition can be experienced, for example, as rosacea on the skin, coronary disease in the heart, Parkinson’s disease in the brain and many other conditions far away from the gastrointestinal (GI) tract.
How do you know whether you have experienced a marked unhealthy shift in microbial species in your intestinal microbiome? My personal view is that, if you breathe oxygen and like pepperoni pizza, you have disrupted your microbiome, i.e., have dysbiosis. Dysbiosis is the rule for the majority in the modern world, not the exception. And in some people, dysbiotic microbial species have ascended up into the small intestine, all the way up into the duodenum and stomach. I’ve previously discussed how to recognize some of the telltale signs of small intestinal bacterial overgrowth, SIBO, such as food intolerances and seeing droplets of fat in the toilet from undigested fats and oils. But there are a number of hints that marked microbiome disruption has occurred, measures that you may already have undergone but did not know (nor did your doctor) were markers for dysbiosis, SIBO, and endotoxemia. Among those markers are:
- Any unexplained inflammatory marker—The most common is high-sensitivity C-reactive protein (hs-CRP). You’ve experienced marked improvements in health, yet CRP remains stubbornly elevated above 1.0 mg/dl (the ideal level of 1.0 mg/dl or less). Time to consider dysbiosis, SIBO, and endotoxemia.
- Low free T3—on a thyroid hormone panel. While free T3 can be transiently reduced during weight loss, should it persist at levels at the low end of the lab’s quoted reference range, or fall below, disrupted bowel flora is often the culprit.
- Increased fibrinogen—Fibrinogen is a blood clotting protein that increases with obesity and insulin resistance, but it also can remain increased due to endotoxemia.
- Increased white blood cell (WBC) count—A WBC count of something like 18 thousand indicates severe infection, e.g., a diverticular abscess or pneumonia. But lessers degrees of increase, e.g, 10 or 12 thousand, with an increase in neutrophils, can be suggestive of endotoxemia.
- High blood pressure—Body-wide arterial constriction can be a hallmark of endotoxemia, identified as high blood pressure, systolic, diastolic, or both.
- High blood sugar, high blood insulin—You’ve removed foods that raise blood sugar (wheat, grains, sugars). You addressed common nutrient deficiencies that allow insulin resistance (vitamin D, magnesium, omega-3s, iodine). Yet blood sugar and fasting insulin are higher than optimal. This includes persistently high HbA1c (i.e., any value greater than 5.0%.) Time to consider dysbiosis, SIBO, and endotoxemia.
- Increased AST, ALT—These are liver enzymes that can reflect the process of fatty liver, measured in the blood that typically drop with efforts such as wheat/grain/sugar avoidance and replacement of nutrients that address insulin resistance, i.e., all the elements of the Wheat Belly lifestyle. Should increased AST and ALT persist, however, it can be due to the portal vein (the venous system draining the gastrointestinal tract) endotoxemia that is several-fold worse than systemic endotoxemia. The same applies to GGT.
- Low HDL cholesterol—HDL can serve as a useful index of overall metabolic health. But a persistently Low HDL (that I would define as less than 60 mg/dl) can be a sign of disrupted bowel flora and endotoxemia.
- High triglycerides—Like HDL, triglycerides can likewise serve as an index of overall metabolic health. Triglycerides that remain persistently high (that I would define as greater than 60 mg/dl) can also signal dysbiosis, SIBO, and endotoxemia. (Recall that triglycerides should never be assessed during or in the first 4 weeks after weight loss, as triglycerides are mobilized into the bloodstream during weight loss.)
Some people say “Oh, this is too much! I’ll just accept it.” Not a good idea, as uncorrected dysbiosis, SIBO, and endotoxemia can invite long-term risk for weight gain, obesity, type 2 diabetes, coronary disease, autoimmune conditions, rosacea, diverticular disease, even colon cancer. While corrective action may require patience and efforts that require weeks of months, the benefits can be substantial. But do you see that, with a little understanding and a few crucial steps, you can achieve levels of health that are far superior to the poor excuse for “health” dispensed by the doctor and healthcare system?