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This more of a brain-fog question rather than a paleo question, but I have seen several questions by people dealing with brain fog here so I though that I'd give it a try.

Here is a brief story, I am a healthy 28 year old Male, 6'4" 195lb. About 5 months ago, I was prescribed an antibiotic clindamycin for a skin infection and since then I have been dealing with digestive issues. Abdominal pains, soft stools and occasional diarrhea. I got tested for cdiff 4 times (negative each time) and other infections also came back negative, I have also had blood work which came back completely normal. So, I am assuming that this is a simply a dysbiosis issue. I have been taking probiotics for about 4 months and I have seen some improvement. For the first three months I mostly tried L. Acidophilus (Pearls), B. Infantis (Align) and S. Boulardi (Florastor/Jarrows). About 5 weeks ago I added Jarrows EPS which contains ( L. rhamnosus, L. helveticus, Bifidobacteria Longum, L. Casei, L. Plantarum, Lactococcus Lactis, B. Breve, Pediococcus acidilactici, 5Billion CFU total). At the time, I was also on S. Boulardi (Jarrows). After starting Jarrows EPS, I noticed that I would occasionally have a dazed/brain-foggish feeling along with a slight fatigue. I continued the probiotics for about 2 weeks and then stopped both of them completely. Initially I assumed that this was a die-off/herx reaction but now it has been 3 weeks after stopping the probiotics but I still get the brain fog feeling. I am positive that these brain-fog issues started after starting the probiotic. Nothing else in my diet changed during the period. After getting the brain fog, my GI system does not seem to have changed much.

I had CBC-diff and thyroid testing which was completely normal. My fasting blood sugar level was also normal. I am also drinking a lot of water. I am thinking of getting my B12, B6, Folic Acid, levels tested, but I doubt that these could have dropped off suddenly. My GI told me to wait for a while and see if there is any improvement. Any ideas on what could this be and how should I deal with this. Initially I thought that this was just a matter of time and it would go away on its own, but now about three weeks after stopping the probiotic, I am loosing hope. Is it possible that my antibiotic ravaged gut was ripe for SIBO and the probiotic tipped it over?

Thanks, arbguy

UPDATE 08 Sept Well, the single strain probiotic does not seem to have helped. If only the brain-fog seems to have increased slightly. Also, if I exercise/work out, I seem to have a more intense fog the next day. The duration is making me convinced that this is not a die-off, but something new - SIBO/Candida. I will be visiting my GI this week and I am also planning to see a neurologist. The brain-fog also seems to be increasing my stress/anxiety which is probably feeding it back.

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I think candida die-off can go on for a long time, so I wouldn't entirely rule that out yet. Random other thoughts--Are you in deer tick country? You've been drinking a lot of water, have you also upped your salt and other electolytes along with it? – Happy Now Aug 28 at 0:54
A die-off seems the most plausible explanation as this started soon after starting the probiotic, but it didn't end after stopping the probiotic. Is there a way of knowing whether this is a die-off? Also the fog isn't constant, it is there some days/times and absent on other times, it doesn't seem to be increasing/decreasing with time. I am in NJ, so Lyme disease did cross my mind. I would think it would be extremely unlikely as I haven't been into any wooded/grassy areas or come in contact with animals. I haven't increased my salt and electrolyte intake, I will try to correct that. – arbguy Aug 28 at 5:04
I'm pretty sure a candida die off can continue past when you take probiotics, the hope is that some actually implanted and are working on changing the balance in your gut as they multiply. Our digestion changes as our microbiome changes too, so even though your diet hasn't changed, it is possible that you could be running into some low blood sugar issues or a change in food tolerances/sensitivities as things shift too, (I know, major pain in the ass). You could chug some coconut water or try a glass of water with a pinch of raw salt and see if you can bust through that fog next time it hits. – Happy Now Aug 28 at 7:34

5 Answers

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I had some similar brain-fog and fatigue issues after an infection/antibiotic.

Finally a GI doc diagnosed me with fructose/fructan malabsorbtion (he said about 1% chance after an infection/antibiotics to get it).

It can cause depression by messing with tryptophan so it doesn't go up to make seratonin, I guess (I'm not expert but that's what I understood from what he said.)

The test consists of 4 rounds of fasting and drinking a (glucose/fructose/fructan/lactose) solution and breathing into a balloon every 15-30 min for 2-3 hours.

The treatment is called a low-fodmaps diet. My belching and upset stomach went away about a month into the diet. He said the condition is self-limiting, but could last months to years before gradually getting better.

Not saying that's for sure what you have, but could seek out those tests or experiment with the diet to see if it helps.

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Thanks for the info. I will bring this up with my GI and might experiment with the low-fodmaps diet. Though I doubt I might fructose malabsorption as I have been consuming high-fodmap foods (apples, fruit juices) without any noticeable problems. I will try to observe his more carefully though. – arbguy Aug 28 at 2:23
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I don't have an answer, but I can tell you what probiotics worked for me:

  1. They were from the refrigerated section
  2. They were one or two strain only and I doubled/tripled the dosage
  3. When I tried probiotics with more than one/two strain, I did not notice any effect
  4. I buy pro-biotics that have only one ingredient - the bacteria itself

I think your probiotics may have some additives (they put all kinds of things as fillers) and way too many strain.

Oh, one more thing - it may help you - once I overdosed probiotics (like really really overdosed - I had more than tripled them, they were different strains, and had a huge amount of probiotic foods and also had some beet kvass on the same day). I had a headache, a brain fog and something else - I don't remember - on that day.

After that I did not take probiotics for a couple of days and then restarted decreasing the amount and one strain at a time only. I was fine after a week or so.

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I had previously tried single strain probiotics of medium strength (1-5 Billion CFUs) and had a moderate improvement but without any side effects. I decided to get more aggressive and tried this 8 strain probiotic, which I feel could have caused the brain-fog :(. – arbguy Aug 28 at 16:49
I am not a biologist so I don't know what is going on... but I had that brain fog for one or two days only when ODed it. Just a suggestion - do you want to try single strain again? Maybe if you take it consistently it will kill off the rest of them. (I have read a warning on one probiotic not to mix it with others because it is going to lessen the effect - they will fight with each other maybe?) – VB Aug 28 at 17:34
Most of what I have read says that herx/die-off lasts for a few days. Which is why I am worried that this could be something else. Though some sources, including Happy Now (above) say that it could last longer. I have have actually started a single strain probiotic, one that I had tried earlier with no side effects, about two days ago in the hope that it will crowd out the problematic bacteria. It is too early to tell if it is working. Also, since my brain fog is intermittent, present some times on some days, it will be about a week before I can say if it is lessening or not. – arbguy Aug 28 at 23:27
Good luck and make sure to post an update. I am glad you started a single strain probiotic again, just make sure it is live - some of them are dead. – VB Aug 29 at 4:56
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Are you taking a complete amino acid? It's made a huge difference for me :-)

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No, I am not taking any supplements. After this issue with probiotics, I am worried about potential side effects of any kind of supplements. I am considering taking L-glutamine, as it has been known to heal the gut, but I feel I might be better off getting it naturally from diet, rather than as a supplement. – arbguy Aug 28 at 2:07
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The Dangers of Probiotics: invasive infection, antibiotic resistance There are two possible dangers of probiotics: invasive infection, resistance to antibiotics

Invasive Infection occurs by taking probiotics which then translocate into the blood stream. Probiotics, according to the WHO are "live microorganisms". The reported cases where invasive infection occurs after taking probiotics are low but they exist:

detoxification

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Balls in your mouth

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