Dysbiosis is an imbalance in your gut flora caused by too few beneficial bacteria and an overgrowth of bad bacteria, yeast, and/or parasites. The more clinical term that relates to the problem is “Small Intestinal Bacterial Overgrowth” (SIBO), and this term refers to the gut flora that crawled backward into the small intestine from the colon, where it belongs. Over the past ten years, I’ve noticed a dramatic rise in symptoms of dysbiosis in my patients and the people that I work with online in my semi-annual detox. The symptoms of dysbiosis are vague and often go unnoticed, undiagnosed, and even worse, dismissed by your conventional health care clinicians. That needs to change! Here are the top 5 questions that I receive about dysbiosis.
If you have 5 or more of these symptoms, there is a good chance you have dysbiosis.
Q1: How do you know if you have dysbiosis?
- Frequent gas or bloating on most days of the week
- Cramping, urgency, and/or mucus in your poop once per week
- Brain fog, anxiety, or depression
- Food sensitivities
- Missing micronutrients
- Chronic bad breath
- Loose stool, diarrhea, constipation, or a combination
- Diagnosis of Irritable Bowel Syndrome (IBS)
- History of “stomach bugs,” gastroenteritis, and/or food poisoning
- History of prolonged antibiotics such as for acne or sinusitis
- Carbohydrate intolerance, particularly after eating fiber and/or beans
- Fatigue or low energy
- Use of anti-acids for heartburn, reflux, or hiatal hernia?
- Autoimmunity, or an autoimmune condition such as Hashimoto’s thyroiditis, psoriasis, or multiple sclerosis
- Sinus congestion
Scoring: While I have yet to see a validated scale, if you have five or more symptoms, there is a good chance you have dysbiosis. Read on to learn about what it is, why you should care, and what causes it. If you scored four or less symptoms, there’s a good chance that you have normal gut flora, or a mild case of dysbiosis.
The Functional Medicine Approach
Sydney Baker MD, one of the early practitioners of functional medicine, used to say that if you’re sitting on a tack, the solution is to find and remove the tack, not treat the pain. In conventional medicine, the tendency is to throw prescriptions at problems to try to mask symptoms rather than to treat the root cause. In functional medicine, the goal is root cause analysis so that you remove the tack and feel better. Dysbiosis is a common cause of many health problems, from dysestrogenism and breast cancer to irritable bowel syndrome. More on that in a minute. First, let’s run through the most frequently asked questions that I get in my functional medicine practice.
Q2: What does the normal gut flora do for you?
In general, your gut flora, called the microbiota, and their DNA, called your microbiome, are stable in healthy people. But a shift in the microbiota can lead to a permanent imbalance known as dysbiosis. Frankly, I don’t know many people with normal microbiota and microbiome. Maybe three people in the past 10 years, and it’s becoming alarmingly rare.
Your intestinal microbiota are inherited at birth from your mother as you move through the vaginal canal (or not). Later, your diet and lifestyle become more important in their effect on the structure of your microbiota and their diversity. Overall, you microbiota consist of approximately 1014 microbes, which outnumber human cells by 10-fold, and perform several key functions:
- synthesizing vitamin K and other essential nutrients 
- preventing your gut wall from becoming leaky 
- digestion of cellulose
- promoting angiogenesis
- supporting enteric nerve function
- keeping your immune system healthy and recognizing self versus nonself 
- preventing kidney stones 
Q3: What caused my dysbiosis? Or, why did the bad bugs take over?
Abnormal shifts in your gut flora occur with use of antibiotics, illness, stress, aging, lousy dietary habits (sugar, processed foods, eating foods you’re intolerant toward), and other lifestyle issues. 
Q4: What’s so bad about dysbiosis? (Or, why should you care?)
Dysbiosis sets up a sequence of events leading to inflammation, followed by a multitude of vague symptoms (as mentioned at the beginning of this article), and ultimately to problems such as:
- breast cancer 
- colorectal cancer 
- irritable bowel syndrome 
- inflammatory bowel disease 
- autoimmunity 
- metabolic diseases such as obesity,  diabetes,  and gestational diabetes 
- autism 
- other neurological conditions such as Parkinson’s disease 
- how effectively you detoxify endocrine disruptors or xenobiotics 
- plus many other conditions and diseases with linkage still emerging, such as chronic venous insufficiency 
Q5: Is dysbiosis linked to misfiring hormones?
As my 15-year-old daughter is fond of saying: “Hells yes!” I’m a hormone expert, which makes me especially concerned about the role of dysbiosis in potentially causing your hormones to become imbalanced. Here are just a few examples of the problems tied to dysbiosis:
- Creates the type of inflammation that may suppress the control system for making hormones, called the Hypothalamic-Pituitary-Adrenal-Thyroid-Gonadal axis.
- Changes the subset of the microbiome involved in estrogen metabolism, called by Martin Blaser the estrobolome. The estrobolome is one of the levers in the body for your estrogen load.
- Raises beta-glucuronidase activity in the body, which reverses the important estrogen inactivation system in the liver—that means estrogens get recirculated over and over in your body, like bad karma, and raising estrogen levels and thereby estrogenic load. Ultimately, high estrogenic load may increase your risk of estrogen-related conditions, such as diabetes, obesity, breast and prostate cancer. Read more in the next blog post!
How do I fix dysbiosis?
Alas, the solution is not quick or simple. You’d think that perhaps a quick shift in the microbiome might cure you of dysbiosis. But biology is rarely that easy or charitable.  Dysbiosis can be tricky to diagnose and even harder to correct, and your rehab program will depend on the state of your gut and how committed you are to make changes. I’ll write more next time about how to test for and treat dysbiosis. Additionally, you can join my free upcoming webinar where I go into more detail about gut health, leaky gut, and, how to rebuild your digestive system. Remember, eat your probiotic-rich food such as cultured vegetables, sauerkraut, and kimchi–it’s a great way to jump start gut health repair.
Want to learn more? Order Dr. Sara’s new book – about this topic and so much more – entitled, Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years.
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