Exploring the Gut-Brain Connection and Photosensitivity

[Nakamova]

There was a particularly elegant study that I think is pertinent to this discussion. Geschwind syndrome is a long list of personality characteristics that were described in the Seventies and were claimed to be present in all patients with temporal lobe epilepsy. The 'symptoms' of the syndrome included deep philosophical thought, hypergraphia, hyperreligiosity, and some thirty other traits. There are still many proponents of Geschwinds, but a group of scientists undertook a massive study, which was intricately described in a book. But the study's methodology was simple to the extreme: They counted how many temporal lobe epilepsy patients had all the traits of Geschwinds, how many had some of them, and how many people without epilepsy had traits of Geschwinds. Since they found no temporal lobe epilepsy patients with all Geschwinds traits, and many temporal lobe epilepsy patients who had none, and many without epilepsy who had several Geschwinds traits, the conclusion that there was no evidence to support Geschwinds was clear.

80% of people suffer from constipation at least once in their lives. IBS affects 3 to 20%, and 5% of Crohns patients suffer from neurological symptoms (epilepsy not specified). Yet only about 5 in 1000 people suffer from epilepsy. The statistics alone are enough to cast aside any concepts of constipation being a precursor to epileptic seizures. If constipation was a precursor to seizure, all 80% of the population who suffered from constipation would have seizures. If Crohns disease was an underlying condition in all with epilepsy, all Crohns sufferers would have epileptic seizures, whereas only 5% suffer from broader neurological symptoms. We don't necessarily even need to look at the etiology of the GI tract issues you've highlighted. The statistics say it all.

Hey kirsten, since epilepsy is an umbrella term for a fairly diverse set of symptoms causes and prognoses, do you think there's a possibility that in some cases gut disturbances may play a contributory role (not necessarily as a primary cause but as a secondary trigger)? I'm thinking of instances where someone with a lowered seizure threshold might be in part triggered by electrolyte imbalance due to malabsorption issues.

There does seem to be a small but statistically significant higher prevalence of ulcers and bowel disorders in people with epilepsy vis-a-vis the general population. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783484/ I realize that this doesn't say anything about primary or secondary causation, or signify an underlying connection. Here's hoping that additional research will shed some light (though with such a diverse population suffering from epilepsy it may be difficult rule in or out a host of other factors.)

For a look at newer research avenues, I recommend the cureepilepsy.org site. See http://www.cureepilepsy.org/research/2013grantees.asp And I know that the plural of anecdote is not data, but I found this particular story on their site carries more scientific weight than many: http://www.cureepilepsy.org/news/story.asp?id=97

 

[Keith]

Nakamova, Verapamil and calcium channels are discussed on page 7 of this thread in relation to gut-brain-eye axis.

I've been informally lobbying CURE to fund research about gut origin of epilepsy including Infantile Spasm as they've yet to receive a funding request to study the relationship. Great organization, it seems, and I'm a longtime fan of their founders, the Axelrods, following David's career since 1983.

 

[kirsten]

Hey kirsten, since epilepsy is an umbrella term for a fairly diverse set of symptoms causes and prognoses, do you think there's a possibility that in some cases gut disturbances may play a contributory role (not necessarily as a primary cause but as a secondary trigger)? I'm thinking of instances where someone with a lowered seizure threshold might be in part triggered by electrolyte imbalance due to malabsorption issues.

Nakamova, I think any seizure sufferer would agree that there are a host of things that lower seizure threshold. In all the research I've seen here, though, the illnesses and diseases in question had a direct impact on the brain, which makes them excellent candidates for occams razor in my view. So, taking your example of electrolyte disturbance, which I have had terrible problems with in the past: on the one hand, low sodium and potassium levels can cause encephalopathy, which of course causes seizures. I would suspect that it could even cause a new seizure focus. Also, when electrolyte imbalances are less severe, one of the typical issues is blood pressure, which again lowers seizure threshold. So it seems that they are secondary triggers, and not a reason to throw out all we know of brain origin in exchange for a view on GI tract toxicity as has been suggested.

 

[Keith]

I've never suggested throwing out what's known about brain origin, but I am strongly suggesting renewed interest in gut origin.

Electrolyte imbalances can be explained via gut origin and are discussed in this thread, especially potassium channels where potassium must be absorbed properly in the small intestine. Relatedly, a lot of potassium is required to manufacture stomach acid, itself required for proper absorption of nutrients such as vitamin B12. Potassium deficiency illustrates a vicious circle.

Blood pressure issues may also be explained via the gut, something I'd like to learn more about, where pH imbalances caused by gut dysbiosis affect blood pressure. Acidosis may lead to low blood pressure.

Gut imbalances appear as primary triggers.

 

[Keith]

I've been learning about biotin today and how it's made by flora and used by flora to grow. This is a huge subject related to epilepsy, perhaps underappreciated, as is gut origin of seizure in general.

Biotin deficiency is known in epilepsy, but it's seen as a side effect of anticonvulsants. What if it's really a matter of imbalanced flora?
http://www.ncbi.nlm.nih.gov/pubmed/3925859

Studies showing biotin treatment helped stop seizure:
http://www.ncbi.nlm.nih.gov/pubmed/3925859
http://www.neurologyindia.com/artic...e=58;issue=2;spage=323;epage=324;aulast=Joshi
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964795/?report=classic
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509878/

Bacteria use CO2 for growth when biotin is deficient. We know the brain halts seizure by raising CO2 and that low CO2 causes seizure. Biotin is the major cofactor in CO2 metabolism.
http://www.jbc.org/content/188/1/431.long
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3527699/

Now here's where it starts getting interesting regarding imbalanced gut flora as cause of biotin deficiency. Certain groups of bacteria (Bacteroides, although not Prevotella which is also Bacteroides) in our gut flora are known to produce the enzymes needed to make biotin and some people may be deficient in that type of bacteria:
http://www.nytimes.com/2011/04/21/science/21gut.html?_r=0
http://www.nature.com/news/gut-microbial-enterotypes-become-less-clear-cut-1.10276
http://www.nature.com/nature/journal/v473/n7346/full/nature09944.html
http://icds.uoregon.edu/wp-content/uploads/2011/07/arumugam-2011-nature-gut-bacteria.pdf

Magnesium is needed to absorb biotin (I need to learn more about the mechanism/relationship):
http://www.ncbi.nlm.nih.gov/pubmed/11866606

An interesting testimonial about curing hypoglycemia with biotin and magnesium:
http://www.adnuther.com/2011/05/hypoglycemia/

Biotin lowers ammonia and glutamate toxicity in blood and brain:
http://link.springer.com/article/10.1007/BF02347511#page-1

 

[Nakamova]

Gotta love those B vitamins! I find it interesting that the biotin molecule partly contains valeric acid -- a substance also found naturally in the valerian plant. (Valerian tea is often recommended for people with epilepsy or insomnia because of its sedative effects). Also of note: Valeric acid is structurally very similar to valproic acid (the anticonvulsant also known as Valproate/Depakote/Epilim).

 

[MAB]

Gotta love those B vitamins! I find it interesting that the biotin molecule partly contains valeric acid -- a substance also found naturally in the valerian plant. (Valerian tea is often recommended for people with epilepsy or insomnia because of its sedative effects). Also of note: Valeric acid is structurally very similar to valproic acid (the anticonvulsant also known as Valproate/Depakote/Epilim).

That is very interesting! Even when I was a kid I liked reading about nutriution and vitamins. It's amazing how much more we now know 48 years later than we knew when I was 10 yo.

Another thing I have learned is not to swallow a hand full of vitamins/supplements and lie down unless you want to know what a heart attack feels like.

 

[Keith]

Nakamova, amazing you brought up valeric acid as that's what began my recent investigation into biotin. I know of two people with high valerate found in stool testing. Valerate is a salt of valeric acid. One of these people has a seizure disorder and also a brain abscess, so I asked if she was ever diagnosed for helminths (worms make valeric acid!). She said she was and has been treated, but no change yet.

The other person has a gut disorder, so I suggested it could be helminths or, more likely, biotin deficiency as he's not absorbing valeric acid, hence high valerate in stool. I'm not sure if professionals in the field of interpreting stool tests make that connection of valerate to biotin.

Sulfur is also an important part of biotin, so sulfur deficiency may play a role in biotin deficiency. OptiMSM is a pure form of MSM (organic sulfur) which I believe would be helpful for anyone in therapeutic dose with gut disorder for lots of reasons.

Another B vitamin I believe applies strongly in epilepsy is niacinamide, vitamin B3.

 

[KarenB]

Hey guys! Nothing to add...just wanted to pop in and say hi and thanks once again for all the helpful research and support on this particular thread when we were going through the valley of the shadow with dreadful photosensitive seizures that kept us essentially housebound in dim lighting for months. Once we got Jonathan's gut issues cleared up, the photosensitive seizures faded away, and they've been gone over a year now. He had an EEG done in September, and had no reaction to the strobe lights at all! He does still have other mild abnormal activity in his brain when sleeping (the old stuff he's had all along, although no seizures), so apparently there were two different types of epilepsy in one little kid back in 2012 when everything was horrible.

 

[Nakamova]

Thanks for the update Karen. It's good to hear that Jonathan's doing so well.

 

[Keith]

For all I know, high valerate in stool may indicate biotin excess, not deficiency. Might this be a driving force in microbial overgrowth such as SIBO? Plenty of people have bad reactions to biotin supplements such as acne breakouts and unwanted hair growth.
http://www.ncbi.nlm.nih.gov/pubmed/19540254
http://link.springer.com/article/10.1007/BF01923361
http://www.sciencedirect.com/science/article/pii/S0955286305000926
http://etd.fcla.edu/UF/UFE0000734/lewis_b.pdf

Like any supplement, people should be cautious when taking biotin and begin slowly, if at all. The same is true of probiotics.
http://www.huffingtonpost.com/2013/09/30/biotin-hair-skin-nails_n_4016804.html
http://www.healthcentral.com/chronic-pain/c/question/319998/112015

Biotin is known to increase insulin secretion which is why it's apparently useful in diabetes, both type 1 and type 2. So, I wondered if it would cause hypoglycemia in someone predisposed, but here's a testimonial claiming it helped in reactive hypoglycemia. This may explain an important mechanism of success in use of biotin in epilepsy per studies cited in posts above:
http://paleohacks.com/questions/206226/anyone-have-reactive-hypoglycemia.html

 

[Keith]

This is a packed slideshow detailing gut-brain connection (including the vagus) with hints about how pH balance begins in the gut due to bicarbonate (CO2) release:
http://www.slideserve.com/Leo/secretion-and-small-intestine-function

And here's a friendly video about CO2 transport from a cellular and overall view, but doesn't include focus on the gut:
http://education-portal.com/academy/lesson/carbon-dioxide-transport-in-the-blood.html#lesson

My basic understanding is bicarbonate is released into the gut to buffer acid, hence good levels of gastric acid necessary for health. This bicarbonate enters the bloodstream, bringing plasma to healthy alkaline levels which are then sheared by the blood-brain barrier to bring brain pH to healthy acidic levels. The alkaline blood also translates to healthy intracellular levels of acidity (pH inside the cell). But if blood is too alkaline, then it may also translate to the brain becoming too alkaline via brain stem sensors. We know the brain halts seizure by raising acid. And hyperventilation is used as tool to cause seizure suggesting low CO2 is a cause of seizure.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2673408/

So, health appears to begin with healthy levels of gastric acid. What causes it to be low? Malabsorption in the small intestine of nutrients such as potassium required in large amounts to make gastric acid. This is one reason I like sulfur (OptiMSM in therapeutic dose) because it raises acid in the gut while killing fungi in the small intestine which may be the main problem. It may also lower bacterial counts in the small intestine to good levels. It seems the idea that low gastric acid as caused by microbial overgrowth in the small intestine is taking hold. Adding bicarbonate to the gut (baking soda) seems to have similar function, but may be a band-aid approach, not solving the underlying problem as sulfur might. Sulfur addresses so many more issues including biotin, insulin, glycosaminoglycans and collagen synthesis, itself a part of electrochemistry. Who knew collagen was an important part of the brain? It's not just for skin anymore. For this reason, I think sulfur may be a crucial part of brain repair/plasticity.
http://www.sciencedaily.com/releases/2008/12/081210150713.htm

 

[MaryK]

What an interesting thread. I would only like to add that when I had my first tonic-clonic seizure I also had severe ulcerative colitis along with anxiety. There is another person on this site who had a similar experience. In fact, when I first read his post, I was pretty much like "OMG, someone else" When I think back to my childhood I can remember feeling light-headed, but a neurologist later determined that 'was probably' seizure activity. I should also mention I had a 1 year bout with UC about this same time probably about age 10. I clearly remember, because I could not have treats at the school parties . Shortly after I started having photosensitivity issues about the same time I started my period. Although, my sister whose epilepsy is much less controlled than mine, has never had a gut issue, so I am caught in the middle. On one hand I think there really could be a connection, but it almost seems most on this board would be posting that they had some sort of GI issue when diagnosed. Possibly for me and the other person on this page who had similar presentation/history it is our individual body chemistry or maybe pure coincidence.

I appreciate what Nakamova said about the B vitamins. I believe I have mentioned it before, but those of us who are on phenobarbital cannot take B6 as it lowers the blood level of phenobarbital, which most neurologists do not know and I found out the hard way.

 

[Keith]

Hi MaryK, what's also interesting is how people can't apparently feel what's going on in their intestines. It may be a brewery and we just don't know without testing. For example, in Celiac disease problems may manifest elsewhere in the body without any gastrointestinal symptoms:
http://www2.luriechildrens.org/ce/online/article.aspx?articleID=248

 

[Gretel]

I am very in love with this topic of discussion. I also have nothing significant, or rather real helpful, to add. But I did want to pop in and say that I myself, also have gut issues and wonder about the gut/brain connection on an almost daily basis.

I have a severe gluten and lactose sensitivity and when I eat gluten, dairy, processed sugar; I have severe digestive issues, joint and muscle pain, fatigue, and even rashes. I also find a tie to my neurological symptoms, like brain fog, migraines, and even cognitive dysfunctions (concentration, depression, anxiety, etc.).

The only thing I really have to add, but it is more of a topic of wonder, is: rather than Epilepsy being more related to Gut issues, but Gut issues being related to Epilepsy.

For example, neurological symptoms are are often a prominent symptom for people with Celiac and Gluten Sensitivity.

For what it's worth, When I was going through the process of finding out whether I had Celiacs Disease, looking on celiac forums you would find a topic like this one on almost every forum.

 

[Keith]

Hi Gretel, are you doing anything in particular to treat your gut problems? What you describe could be something like yeast overgrowth and it quite treatable.

 

[Keith]

An important challenge will be to understand how the flow of CO2 is regulated. On the host side, how is the CO2 spigot controlled, and do CO2 gradients exist in the lumen that help determine community geography? On the bacterial side, how is CO2 imported and sequestered, and how does the competition for CO2 modulate community dynamics?

Eating For Two: How Metabolism Establishes Interspecies Interactions in the Gut
http://www.sciencedirect.com/science/article/pii/S1931312811002952

The mind-body-microbial continuum
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139398/

 

[Janus]

Hi, This SO relates to my seizures. Love the topic. The B-vitamin base of Phosphatidyl- Choline found in Lecithin is a major seizure trigger for me. I have always had mostly temporal lobe absence types but also have a chronic high blood problem that i take varapamil for and it sort-of works. I have more luck with herbs and vitamins. It is ironic that i have this problem as i am very fit, active, and not one pound over weight. A nutrition based vegetarian for 30 years. Docs say I must have just inherited this issue. The epilepsy is not genetic, i have brain damage from a TBI in the mid 1980's. Philosophy and art are my main occupations in early retirement, Misanthropy notwithstanding.
Thanks for the info, you people are fabulous.

 

[Janus]

Oh yeah, What about Co-Q10 ?? I feel it is essential when on BP meds. I also have cholesterol problems at 44 years old, and with my great diet/lifestyle ?? I avoid meds for that like the plague (especially statins) poison on the system.
I had 3 seizures in the last 2 days. Is it because i had egg whites two days ago? I normally avoid eggs at all costs as that is the highest source of natural lecithin. But i thought i was safe with only the 'whites'. I know the yolks is the source. It always is that way; eat lecithin in sufficient quantities (not much) and about 2 days later seize!
What is a poor boy to do? I guess my dreams of being a famous opera singer are over..

 

[Keith]

Janus, you are gem and thanks for bringing up this seizure trigger perhaps based on something I'm just beginning to learn about: cholinergic transmission. How microbial imbalance affects this may not apply to you, but the lessons may be pretty powerful.

I've been wondering/learning about how products of microbes, especially ethanol and acetaldehyde (produced by intracellular fungi, etc.) interfere with acetylcholine in the Krebs cycle and how this also affects CO2. It's very complex stuff I'm not qualified to understand, but I don't see anyone else talking about it in scientific literature!

Here are a few papers about phosphatidylcholine as precursor of acetylcholine:
http://www.ncbi.nlm.nih.gov/pubmed/3316498
http://www.ncbi.nlm.nih.gov/pubmed/7782901
http://www.ncbi.nlm.nih.gov/pubmed/2713682

Previously, we discussed ethanol amplifying insulin secretion leading to hypoglycemia and seizure. But here's another route where ethanol perturbs acetylcholine:
http://link.springer.com/article/10.1007/BF00432267

Which part of your brain was damaged and how might this raised acetylcholine become a trigger?