as many of you are aware – gut issues seem very common with bartonella, often leading to sensitivities and even extreme reactivity in some patients to foods, supplements, herbs, medications etc –
this often presents a barrier to treatment and even proper nutrition in some cases.
This ranges from mild gurgling, bloating IBS symptoms etc – to total intolerance to food and feeding only possible through a tube. I suspect the majority of bartonella patients have some degree of this effect, though it may be sub-clinical in some portion of them.
I have often wondered what could be causing such reactivity and theorised that bartonella infecting the gut lining was likely leading to leaky gut - and that this increased gut permeability - which would then let many food molecules and larger food fragments and also bacterial toxins and bacterial fragments and even whole live bacteria into the systemic circulation and thereby cause havoc with the immune system - resulting in the above symptoms.
However exactly how it was doing this and what to do about
it was unclear (other than perhaps to adhere to restrictive diets, as a means of managing symptoms, until treatment of the underlying bartonella infection is successful)
Then the other day by chance I read this study on sleep apnea in Nature scientific reports - where researchers found that sleep apnea was caused leaky gut in humans by causing actual physical damage to the gut lining through hypoxia ( lack of oxygen to the tissues) - and this leaky gut was leading to further downstream effects – including, disturbance of the microbiome inflammation and bacterial dis
location etc
See paper here
https://www.nature.com/articles/s41598-023-27784-0Quote
“ ..studies have found that hypoxia is associated with the existence of certain links, such as in the presence of ischemia, hypoxia-induced intestinal dysfunction, the intestinal mucosa epithelium often necrosis, detachment”The mechanism they described involved mainly caused by HIF-1a (Hypoxia Inducible Factor-1a)
Quote
“Lavie found that oxidative stress upregulated HIF-1α and decreased the expression of epithelial tight junction protein in the duodenum, altering the permeability of the intestinal barrier,”This HIF-1 rang a bell for me as I was sure we had discussions here in the past regarding Bartonella and HIF-1 - so I went back and checked and sure enough - HIF-1 is the same molecule that bart stimulates in infected endothelial cells ( the cells which make up the lining of our blood vessels and capillaries etc) and endothelial cells also make up the gut lining.
See this paper
https://tinyurl.com/2m69sxj2Quote
“Expression of Bartonella adhesin A (BadA) is crucial for bacterial autoagglutination, adhesion to host cells, binding to extracellular matrix proteins and proangiogenic reprogramming via activation of hypoxia inducible factor (HIF)-1.”So basically bartonella directly stimulates the production of the same chemical ( HIF-1) that damages the gut lining in sleep apnea – and this severe leaky gut may be the explanation for the wide array of gut symptoms in bartonella patients
The gut Lining is a very delicate structure, especially in the small intestine – which is the most important site for the interaction of the immune system - it is only 1 cell thick - with extremely fine blood vessels perfusing it – so it make sense that it would be sensitive to microcirculation issues driven by bartonella and changes leading to hypoxia in the tissues would be expected to cause similar damage
see this image of teh fine structures
https://media.sciencephoto.com/image/p5200080/800wm/p5200080-lm_of_blood_vessels_in_villi_of_small_intestine.jpgThis paper documents a similar study in rats (not easy to sample in humans) that shows the sleep apnea type damage to the small intestine is dramatic – including loss of some of the lining!
See this image
https://www.spandidos-publications.com/article_images/mmr/13/5/mmr-13-05-4407-g00.jpgin addition, bartonella further interferes with blood flow via other more mechanical methods – eg by increasing fibrin deposits – by sticking red blood cells together – and thereby blocking the delicate capillaries – and by direct angiogenic physical changes to the blood and lymph vessels
all of which would contribute to hypoxia and magnify the HIF-1 effect
so, it looks like this is the explanation for why people with bart have so many gut-related and therefore immune dysregulation type symptoms – perhaps including things we see here often including MCAS and auto-immunity ( recent studies have found that leaky gut is a prerequisite for most auto-immune diseases )
It also provides a link to other fatiguing illnesses that also tend to have both coagulopathy and gut issues - eg CFS/Fibromyalgia/Hughes syndrome/ sleep apnea/ long COVID – etc
The next question becomes what do about
it …
Whilst this is just a hypothesis linking the facts we know of – it might lead us to consider possible approaches that could potentially provide benefits to both the gut symptoms and the systemic issues – and perhaps also to treatment of bartonella itself by restoring more normal immune function.
In general
• things which reduce inflammation in the gut may help to some degree – as these in turn reduce excessive coagulation - which in turn reduce hypoxia - this is in line with what we often see – eg low carb or low fibre diets often help systemic symptoms, anti-inflammatory herbs or supplements can help to some extent etc
• things which increase blood flow may help – eg anticoagulant type therapies – enzymes like lumbrokinase, nattokinase and bromelain have been used – usually more for systemic benefits – but it could be that they help via helping reduce coagulation products like fibrin in the sensitive gut tissues - and hence reduce gut permeability also.
• Exercise seems to help those that can do it – if done in a careful manner - again possibly by increasing blood flow and oxygenation of tissues – reducing hypoxia
• Hyperbaric oxygen - not something that I have looked into - but I know it has its following in the lyme community – and it could be that this is the mechanism by which its helping – basically switching off the HIF-1 driven effects. Incidentally Babesia although an entirely different organism, also causes blockages in small vessels throughout the body and hence hypoxia – and hence similar effects and outcomes are likely.
• Ozone therapy - again I don’t know much about
it – but I know ozone is 3 oxygen atoms bound together which are unstable and breaks down spontaneously into 2 oxygen atoms ( its more normal form used in the body ) and so again may be a way of oxygenating tissues and switching off the hypoxia reactions.
I thought it was interesting and will be thinking about
how to integrate some aspects of the above into my treatment approaches as I go forward to try to combat leaky gut which I am sure is a part of the reason for the slow and difficult treatment of bartonella - in that much of the immune system is dysregulated by and taken up with dealing with all the leaky gut by products - ad this in turn renders recovery more difficult - so it could well yield a useful way to get a step forward.
i wanted to share it here in case it something others can build on - or at least provide food for thought