Gut fermentation in the colon is a normal phenomenon whereby soluble non‐starch polysaccharides are metabolized to short‐chain fatty acids. Abnormal fermentation may be associated with clinical symptoms and is generally assumed to take place in the small bowel. It may be established by ethanol production after a sugar challenge in the fasting subject, which produces maximum production of ethanol 1 hour after sugar challenge. This timing is compatible with the dose acting in the small bowel, but not the large. It was noted that patients with abnormal gut fermentation established by gut fermentation ethanol production tests tended to have low levels of vitamins and minerals, and it was therefore decided to make a prospective study of patients with the condition to determine if this was so. Patients were tested for ethanol production together with standard functional analysis techniques for vitamins B1, B2, and B6 and zinc and magnesium concentrations by sweat analysis using air/acetylene flame atomic absorption. Fifty normal subjects (group A) were analyzed against 30 positive patients by alcohol testing (group B). Statistical analysis, using the Wilcoxon Sum of Ranks test, revealed a remarkable and consistently high difference for vitamins and minerals between the two groups. In group B, 19 of 30 patients had four of five or five of five nutrients abnormal, and no subject with a positive alcohol test had less than two abnormal nutrients. It is concluded that the syndrome that causes abnormal gut fermentation appears to have adverse effects on levels of B vitamins, zinc, and magnesium. As yet it is not clear whether this is a result of malabsorption, over‐utilization, or excessive excretion. The level of ethanol production in this condition is low, but the presence of the nutritional deficits implies that the syndrome may cause quite significant adverse effects on health. More research in this area is required to replicate and extend these studies.
- B vitamins
- gut fermentation