SIBO and Brain Fog Treatment: Can Thiamine Help?

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On one of my recent morning runs, I was enjoying a podcast episode that described one persons journey in treating his SIBO and malnutrition. The actual title of the video involved recovery from SIBO and fibromyalgia, but the reason I clicked on the video was the thumbnail that showed a quite striking change between a very low body weight, young adult, to someone who seemed to put on much more lean mass in a healthy way.

The low body mass picture reminded me of some of my patients who have high levels of inflammation, making them look quite frail. Some of these patients have difficulty with their digestion, and subsequently often start to lose body weight and lean tissue.

As one of the supportive treatments for their digestion, we will often give micronutrient therapy both orally as well as intravenously. Supporting nutrition is often a foundational part of naturopathic principles.

Some patients respond quite rapidly, noticing an improvement in both their cognition as well as often their gut function - despite often these nutrients given intravenously.

Is it improvements in stress adaptation and oxidative stress?

One of the theories I had for these patients was that they were feeling better because the vitamin C, sometimes glutathione, was helping them with oxidative stress. Another common possibility would be that the nutrients were helping them to deal with stress, perhaps from an adrenal adaptive standpoint. While any form of excessive stress can affect us in many ways, once that fight or flight (sympathetic nervous system) gets dominant, then our rest, relax, and digest system may start to suffer.

Supporting the stress-adaptive capability might indirectly help digestion in this way.

SIBO and Brain Fog Treatment

Very frequently, patients with small intestinal bacteria overgrowth describe cognitive difficulties in addition to their digestive symptoms.

Common digestive symptoms might include:

  • bloating
  • diarrhea
  • constipation
  • feeling like food just sits in the stomach
  • sulfur smelling gas
  • bad breath (halitosis)
  • abdominal pain

However, in addition to this, often patients would complain of cognitive impairments, or brain fog. In one article aptly titled Brain fogginess, gas and bloating the researchers described how some cases of SIBO seemed to be associated with an increased amount of D-lactic acid (different from the usual L-lactate produced in increased amounts with exercise) as well as gas and bloating, and brain fog.

In this study, patients with SIBO and D-lactic acid increased levels had improved symptoms, including brain fog, after stopping probiotics and taking appropriate antibiotics.

They concluded that brain fog, gas and bloating, in some people may be linked to probiotics, SIBO and D-lactate levels.

It's not just in that study - most of my patients who have improvements with SIBO tend to have improvements in their cognition (if nothing else seems to be going on).

Thiamine Deficiency and SIBO

The host of the podcast is a nutrition practitioner based out of the UK. Surprisingly to me, one of my patients had also previously been a client of his virtually. EONutrition writes on thiamine quite a bit, and while I do not agree with some of the pages I came across on his website, the page on thiamine was very interesting and an excellent background read.

He took a reverse view of SIBO and nutrient deficiencies than most. I have always assumed that most cases of SIBO caused a nutritional deficiency, but his theory was tha some patients primarily and first off had a micronutrient deficiency (in this case thiamine) and this is what contributed to the development of SIBO.

Some important points:

  • thiamine is essential for energy metabolism
  • important for nerve function and neurotransmitter synthesis
  • deficiencies of thiamine can impair these nerve functions not only in the brain (brain fog) but also in the gut
  • the autonomic nervous system and the vagus nerve, for example, directly affect motility and gut secretions (with low motility being a primary trigger for SIBO)
  • thiamine deficiency may lead to dysfunction in these nerves
  • SIBO might be a symptom of a systemic deficit in energy metabolism and using thiamine might help SIBO without targeting the gut flora

Thus, while the previous article looked at brain fog improving when addressing the microbiome (my experience as well), this practitioner's experience was that thiamine was helping brain fog and SIBO also. This was also my experience, as thiamine is part of the micronutrient treatments I was giving - though I was relating the improvements to adaptions to stress.

SIBO may be a symptom of systemic bioenergetic deficit rather than a primary cause of gut problems, and improving energy metabolism and thiamine status may be an alternate strategy than targeting the gut microbiota directly. A synthetic form of thiamine called benfotiamine is better absorbed than thiamine and can cross the blood-brain barrier

In reality, the mechanism likely does not matter and almost certainly some mechanisms may be more at play for certain patients.

Brain fog and thiamine, and its relative benfotiamine

Thiamine is a vitamin that is essential for energy metabolism and nerve function. Benfothiamine is a synthetic form of thiamine that has better bioavailability and can cross the blood-brain barrier. Deficiency can cause neurological symptoms such as confusion, memory loss, and impaired coordination. It can also affect the gut by disrupting the absorption of nutrients and the balance of bacteria - by affecting the autonomics. Gut dysfunction likely also can affect thiamine absorption. A two way street.

Some studies have concluded that benfotiamine might help cognitive decline in conditions such as Alzheimer's.

I have mainly used benfotiamine as a treatment of neuropathy, in some of my chronic and post-treatment lyme patients. A diabetic neuropathy study summarized its results in this:

benfotiamine in neuropathy

I always used this in conjunction with lipoic acid, although I do not tend to give lipoic acid intravenously.

lipoic acid in neuropathy

Possibility of Benfotiamine in Fatigue, Cognitive Issues in Mold and Mycotoxin patients as well

In a few shared patients who had mold and mycotoxin illness, another practitioner had shared their experience that benfotiamine seemed to help significantly a subset of those who had significant fatigue and brain fog. It would make sense as a cellular energy agent, similar to other mitochondrial supports such as ribose and coq10.

Conclusion

There are almost certainly multiple mechanisms at play when dealing with cognitive impairment, and also when dealing with conditions such as SIBO (small intestinal bacterial overgrowth). Sometimes, testing for deficiencies can be useful, which can be done relatively easily in the urine. Often, given the relative safety of the agent, treatment trials can be done.

Central Sensitivity Syndrome may be one of the conditions that thiamine and other energetic agents could be useful for.

Mycotoxin testing can be useful for assessing if a toxin might be contributing to an increased dependency of this nutrient, if there is suggestive history.