Latest / Common Sense Health / The Real Reason You're Bloated: Fermentation and SIBO
Transcript
- Stephen Thomas BSc. Hons: Hello. So I got a question during one of my live streams, you know, a real person, real labs, real story, and they asked me something that I thought was so good that I ended up writing a whole piece about it. And here I am presenting it. And I realized that to answer the question properly, I had to explain something most people have never had explained to them properly. And that's fermentation. Not the trendy version, not the eat your kimchi, it's good for your gut. The actual chemistry. Because once you understand the chemistry, a bunch of stuff that looks contradictory suddenly makes complete sense. So I'm going to do this in two halves. First half is fermentation 101 from scratch, no jargon. And the second half, the advanced part, the lab testing, the antibodies and why a gut problem can show up on a blood test in a way that scares some people half to death. So let's go. Okay. Now everyone's heard fermented goods. Nobody's heard a good definition. So here is. Fermentation is microbial digestion. You take a food, some cabbage, some milk, some grapes, some soybeans, and you introduce microorganisms like bacteria or yeast mould. And those organisms eat the sugars and the starches in that food. There you go, that's it. That's the whole thing. Here's the reaction in its simplest form: a lactic acid bacterium. finds a sugar molecule, glucose, and converts it into lactic acid. So glucose goes in, lactic lactic acid comes out. And that's why sauerkraut is sour. And that's why yogurt is tangy. The sugar is gone. It's been converted into acid. Yeast does have a version of the same trick sugar in, ethanol and carbon dioxide out, and that's beer. That's wine. That's the reason your bread dough rises. The carbon dioxide is what makes it puff up. Now here's the part I want you to lock in because everything else builds on this. Fermentation reduces the sugar content of food mechanically by converting sugar into something else. So sauerkraut has way less sugar than the cabbage it came from. Yogurt has less lactose than the milk it came from. Which is actually why a lot of lactose intolerant people can eat yogurt just fine. Dry wine has basically no sugar left because the yeast ate all of it. So fermentation at the chemical lever level is a sugar removal process. It's a pre-digestion. The microbes did part of the work before you ever took a bite. Now hold on to that because now I'm going to flip it on you. Fermentation is also happening inside your body right now. As you watch this or listen to it, and it's the same chemistry, same sugar conversion, just a different location. And here's the setup: you eat something, most of it gets absorbed in your small intestine. That's the absorption organ. But some carbohydrates resist digestion. Fiber, resistant starch, certain oligosaccharides, sugar alcohols. They pass through the small intestine intact. And land in your large intestine or the colon, where your gut bacteria do to them exactly what the sauerkraut bacteria do to the cabbage. And here's the thing: that's good if you're eating that way, of course. That's supposed to happen. The end products are short-chain fatty acids like butyrate or propionate or acetate. Butyrate is literally the Preferred fuel of the colon cells. Now, obviously, in carnivore you don't have to eat all that stuff because we get butyrate for things like butter. That's why butter is called butter. Now, I'm just going over the whole thing. So this is the version that everyone praises. this is why fiber gets its reputation. Now, consider the other possibility. What if the fermentation isn't happening where it's supposed to? Your small intestine is supposed to be relatively sterile. It's a hallway, not a brewery. Bacteria belong downstream. That's the design, but sometimes they don't stay downstream. The bacteria migrate upward or food sits there too long and ferments in place. And now you've got a fermentation chamber where an absorption chamber should be. And this is the mechanism behind SIBO SIBO, small intestinal bacterial overgrowth. And it's also less discussed but it's got a cousin called CIFO where the fermenters are yeast instead of bacteria. Now here's what happens chemically. You eat a meal with fermentable carbohydrate, like bread or rice or beans or onions or garlic or apples, you know, basically anything with starch or fibre. And normally that moves through quietly. But if it hits a bacterial population in the small intestine, it gets fermented right there, right then. And it produces gas, hydrogen, methane, carbon dioxide, and that gas distends the intestine. That's the bloating. That's the pain. Organic acids, which irritate the lining and pour water in. That's the diarrhea, or the alternating constipation and diarrhea, which is even more confusing to live with. You also get osmotic load, undigestive carbohydrates, draw fluid into the gut. By simple osmosis, so you get more bloating. And you get this immune activation. The gut lining responds with inflammation. Inflammation degrades those tight junctions between cells, and the gut gets leakier. And a leaky gut lets bacterial fragments into circulation, which drives more systemic immune activation. So the whole cascade in one line is this: fermentable carbs go in, gas and acid and osmotic load come out. And you get bloating, pain, and a motility chaos in your small intestine, and you get the inflammation. And now I want to explain the thing that confuses nearly everyone. A vegan diet or a high fibre diet is supposed to be good for your gut. And for a lot of people, they claim that it absolutely is. But if you have a small intestinal fermentation problem, a high fibre, high starch. high legume diet is pouring gasoline on the fire. You're delivering the maximum possible substrate to a bacterial population that's already overgrown and already in the wrong place. You're feeding the thing that's hurting you. And legumes are the worst offender because beans contain galacto oligosaccharides and fructons. Carbohydrates basically that humans genuinely cannot digest. And that bacteria Absolutely loves it. Beans and gas isn't a joke unless you're 14 or mentally 14, it's a chemical inevitability. So here's the picture somebody gets healthy, they get sicker, they get told they're imagining it or they need to stick with it, or they should try a different fibre or more fibre, and eventually they give up on the fibre entirely, which is the correct move for them. Now The interesting part, and this is where the person who sent me that question comes in, an animal based diet of meat, fat, organs, maybe eggs and some dairy contains essentially no fermentable carbohydrate, no fibre, no resistant starch, no oligosaccharides, nothing for the small intestinal bacterial population to eat. The bacteria don't necessarily die, by the way, they go dormant. The population shrinks from lack of food, but the symptoms stop. The bloating, the pain, the motility chaos, because the reaction can't run without a reactant. And this is why the carnivore revolution is such a strong signal. It's not that meat is magic sometimes, it's removing the fuel that rem the removes the fire. And I want to be precise here, unlike that last sentence that I messed up, because this matters. If symptoms resolve completely on zero fermentable carbohydrate, that's not a coincidence, and it's not placebo. That's a substantial piece of evidence the fermentable carbohydrate was the driver. That's a testable hypothesis, and the test already ran itself. Okay, because that happened in real person. This is or persons, we have it all the time. This is the part of the live stream question that it was all actually about. And it's the part where I think the most people sort of fail really to understand. My example, and I'm keeping this vague on purpose because it's a real person, you know, and a real story, is someone with a long history of severe pain after eating, alternating bowel habits, like I say, diarrhea and then constipation, significant weight loss and then a complete resolution on a kind of a diet. And somewhere in there, in that period of time, they got some blood work back and two markers came back really high. And a doctor looked at it and just drugged literally. So let's talk about why they might be high, these markers, and why the reason matters more than the number. So marker one was a transglutaminase. transglutaminase is an enzyme. There are several forms, but the one that matters in this context is tissue transglutaminase, which small t capital T G. And it's the auto antigen in celiac disease. The IgA version is the standard celiac screen. That's the one everyone runs, but the IgG version is a different animal. It's usually ordered when someone is IgA deficient, obviously, which is actually common in celiac patients. And it's less specific. It can be positive in celiac disease, but it can also be positive in other autoimmune and inflammatory states. Now, marker two is one I always struggle to pronounce. which comes up as ASCA which is Sacromyces Cervavaceae which is basically the name for brewer's yeast or baker's yeast same organism really now these antibodies ASCA antibodies both IgG and IgA is a classic marker in Crohn's disease and it's part of a panel that helps distinguish Crohn's from ulcerative colitis. So if it's a positive result, it's strongly associated with Crohn's. But, and this is the key word, it's not Crohn specific. It also shows up in celiac disease and in other presentations involving intestinal immune activity or activation. So why would both be high at the same time? Well, here's the mechanism that ties this all together, and I think it's the piece that gets missed. When the gut lining is chronically inflamed and permeable, it becomes a very leaky barrier. So bacterial and food antigens can cross into the bloodstream in ways that they shouldn't. Now the immune system sees them, mounts a response, and you get elevated antibodies. Not because the immune system has decided to permanently attack your own body, it's because it's reaching or reacting to a constant stream of antigens leaking through that damaged wall. Now the antibodies may be a symptom of the gut problem, not the cause of it. And that distinction is enormous because it changes the prognosis entirely. If the antibodies are downstream of gut inflammation, then resolving the gut inflammation should let them normalize. If they're a primary autoimmune process, they won't. So they're not the cause, that's the point. The test is simple. Rerun the panel after five or six months of being symptom free is. And if the numbers come down, that's pretty strong evidence the gut was driving the level. And now the thing that I think is genuinely the most important sentence in this whole video, if those results come off a broad IgG food sensitivity panel rather than a targeted celiac or Crohn's work up, how specific it is drops enormously. The IgG to a food can reflect exposure and tolerance as much as pathology. A lot of commercial panels report IgG against dozens of foods. And the results are notoriously noisy. So context is everything. Which which test, what panel, what reference range. So if this pattern pattern describes you or someone you know, here are the questions that you should find actually very useful. Structural questions, not just symptoms questions. One, what test was actually run? Celiac panel or food sensitivity, IgG panel, different tests, different meanings, obviously. Get the exact s the exact test names and the reference ranges. Two, does the antibody picture change on a zero fermentable carb diet? If yes, that tells you something about the mechanism. And three, is there evidence of small bowel involvement? Fecal cow protectin a measure you can do, and some imaging that that can rule out Crohn's or other structural diseases. And four, if the markers normalize, does that change the diagnosis? Because reactive to a gut environment. And permanent autoimmune disease are very different sentences to hear. And these are the conversations for a clinician who can see the full picture. I'm not here to diagnose anyone, but walking in knowing what these markers are and what the mechanism might be means you're not at the mercy of that shrub. So let me bring it all the way back. The confusion about fermented foods comes from two completely different processes, sharing one word, fermentation, as a food product or a food production method. Bacteria pre digest your food, reduce the sugar, create acid, usually beneficial, sometimes not, depending on what else is in the product. And fermentation as an inbody event. Carbohydrate hitting a microbial population in the wrong place, producing gas, acid, and inflammation, often harmful. Consistently missed. And here's the punchline a person can be perfectly fine eating sauerkraut and completely wrecked by lentils. But both involve fermentation. The difference is where it happens and what's doing it. Now the common sense test fails here because common sense treats fermented as one thing. And it's not one thing. It's a chemistry, and chemistry doesn't care about the label on the jar. So thanks to the person in the live stream who asked the question that started this, you know who you are, and honestly, the fact that it took a real person's lapse to make me write this says something about how badly this stuff gets explained. If you want the deeper dive on the testing side, what to ask for, what the markers really mean, what the retest will show you, how it matters, that's coming in another video. So in the meantime, take care of your gut. It's doing more chemistry than you think. And if you enjoyed that, then please consider liking, sharing and subscribing and drop a comment if you would like to as well. What has been your experience with your gut health on carnivore? Has it improved? What about on keto or low carb? Do you still have fermentables in your diet? d have you fallen into the trap of thinking fermentable food is the magic elixir to get rid of your visceral fat? Whatever the comment is, I'll be looking forward to hearing from you and maybe doing a follow-up video on some of the comments as well. Anyway, I hope that was helpful. I'll see you on the next one. I'll be back.