Pt complaining of brain fog symptoms with fodmap foods

[liquidshadow22]

I'm a psychiatrist and am seeing a patient with a functional GI disorder. The patient is a 30 yo male, who complains of episodic brain fog-impaired concentration, fatigue, poor memory which is episodic lasting a few days at a time and then symptoms improve. Patient is convinced that the symptoms are related to ingestion of fodmap foods - particular offenders include sugar alcohols, inulin fiber, high fructan foods.

In terms of GI symptoms the patient has chronic belching and does notice that abdominal distension occurs around the time the time the cognitive symptoms occur. Pt has a history of appendectomy, cholecystectomy.

Patient has had extensive GI workup - gastric emptying delayed on the emptying scan, small hiatal hernia on upper GI series, negative lactulose, fructose, fructan breath tests, multiple unremarkable endoscopy and colonscopies.

Patient has tried numerous medications without benefit for the symptoms - Reglan, rifaximin, augmentin, antifungal, numerous antidepressants (ssri, elavil, etc), laxatives. Fodmap diet seems to help slightly but does not fix the entire problem.

Any idea what this could be? Is it possible to have D- lactate acidosis from a bowel issue here? Any way the GI tract is responsible for the cognitive symptoms?

The patient does not appear depressed or. Anxious other than the impact on quality of life from the cognitive symptoms. I don't see any other signs of a neurological disorder.

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[cabergoline2]

if he has extensive negative GI workup that showed nothing ,he probably has nothing real...there are studies (very questionable ones) that show brain fog from SIBO with D-lactate being implicated... At the most I would do a hydrogen breath test (in all probability this has already been done)... and he has tried rifaximin/augmentin in any case...

 

[chessknt]

Any history of Covid 19? I have been flooded with PASC patients lately and every single one of them has varying degrees of brain fog they associate with random things like oxygen or inhaler use.

 

[liquidshadow22]

Thanks for replies.

I believe he did have a negative hydrogen breath test as well.

No covid. He states these symptoms have been present for 5 years. States other people can notice when he is particularly tired and at times can barely keep his eyes open despite getting a full night of sleep.

It's pretty strange, I know there is a lot of research on the mind gut connection, microbiome but probably still a lot we don't understand at this point.

 

[cabergoline2]

i am sure celiac has been tested for.. if it has not get that done..also did they do Duodenal biopsies in the EGD ? (will be surprised if he has not had 500 of those by now)
Anyway he low FODMAP cures his brain fog , let him be on it...anything that works...don't care how lol

i am skeptical of a lot of the gut-brain axis -microbiome research... i believe that while there might be something there , the publications so far are very far fetched and not so great evidence wise with questionable statistical methodology... they need more rigorous studies with better designs to prove or disprove stuff...