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Hindgut Acidosis

Lactic Acid - the hindgut's worst enemy

These days I get so many enquires that all end up relating to hindgut acidosis. It’s so prevalent out there that I’d almost go so far as to say it’s the root cause behind the No.1 cry for help – without question, gut-related issues are right up there at the top, and rightly so - in Functional Medicine, the gut system is top of the pile of the 7-Interconnected-Systems - meet Interconnected-System No. 1 - Assimilation (digestion, absorption, microbiome, and respiration).

One enquiry in particular this last week was all down to a lovely boy’s gut - his whole gut system was in bits, and he was badly suffering as a result, having slowly deteriorated over the previous 5-years. He had both squamous and pyloric stomach/foregut ulcers, plus all the signs that his hindgut was acidic as well, which meant the bit in the middle (small intestine) was also going to be pretty well shot for good measure. All the clues indicated microbiome dysbiosis, aka SIBO (Small Intestinal Bacterial Overload) which as we know inflames the very fragile GI wall membrane and breaks it open, leading to leaky gut and seriously toxic matter leaking into the bloodstream; this then triggers a cascade of autoimmune responses with body-wide pain and inflammation - no different to us humans. Meet Interconnected-System No. 4 - Biotransformation and Elimination (toxicity and detoxification).

Like so many of our 4-legged clients, this boy was yet another case of a whole-body connection syndrome - there were just too many related symptoms and too many connecting factors over his timeline of ‘issues’.

5-years ago ...

... he’d had sarcoid surgery with the accompanying - and necessary - vet meds; the downside was that these would have damaged his gut microbiome and triggered internal stress on his body. And let’s not forget that sarcoids are all about a deviously clever and deeply embedded hidden virus in the body’s cellular tissues, so we also had an exhausted immune system which had been working overtime trying to fight it; hence his overall recovery took much longer than expected, compounding on that internal state of stress his body was already experiencing. Meet No. 2 - Defence and Repair (immune and inflammation).

2-years on ...

... and he was now girthy with belly pain, and he felt slow/unbalanced, a classic sign of impaired digestion meaning poor nutrient absorption, causing fatigued body chemistry deep down at cellular mitochondrial level. No surprise as his small intestinal digestion of all the nutrients (carbs/proteins/fats/minerals) was now disrupted, as was his hindgut fibre digestion - and the hindgut is where the horse's energy comes from. Cue Interconnected-System No. 3 - Energy (energy regulation and mitochondrial function).

Within 2-years of his sarcoid surgery, three of the interconnected systems were already ricocheting off each other, with the original damage to his microbiome from his surgery meds having triggered everything thereafter, because the microbiome is literally the body’s CPU. I'm not disputing that antibiotics weren't absolutely necessary following his surgery, but recent studies are now showing that no organism, whether human or horse, fully recovers their gut function after a course of antibiotics.

Back to the timeline and from hereon this boy’s internal engine started to degrade. His gut function – or lack of it - worsened, and it wasn't long before he was presenting externally with stress, so now his nervous system was involved - No 6 - Communication (endocrine, neurotransmitters and immune messengers). His fight/flight system was now triggered which had released the survival hormones, cortisol and adrenalin, stepping in like the autopilot to take control of the cockpit. And when this happens, cortisol's role - as the stress-managing hormone - is responsible for shutting down energy-sapping body functions in order to get all the blood supply to the where it's needed to stay alive - usually the muscles so they can run fast from a perceived threat. And ... one of those energy-sapping functions is - digestion; I mean, who needs digestion when you’re running from a tiger?! And when you shut down digestion, well … nuff said. The gut’s now well and truly in trouble, as is the body as a whole, because every part of the body depends on a healthy gut function because it’s the life force of the body.

Early 2020 ...

... his sheath was now permanently swollen, and it definitely wasn’t a bean 😉 Two vets later and they were close – one said ‘fatty tissue’, another said ‘muscoskeletal due to … muscle pain’. But neither explained the all-important ‘why’ - probably didn't know the 'why' - and neither could provide a solution. Meet No. 5 - Transport (cardiovascular and lymphatic system), the how/why explained in para no. 6 in the Lactic Acid section below. It was the osteo who said 'ulcers', and here was more of that whole-body connection because what causes pyloric ulcers? Stress.

Here’s the 'how'. The stomach/foregut’s stress-related ulcers are located in the back of the stomach by the pyloric sphincter, the opening from the stomach to the small intestine, where in the perfect world this area is well protected from the stomach acid by a lovely thick layer of protective gel-like mucus. But - when there’s a permanently switched-on fight/flight response because of stress, the gastric mucus membrane becomes much less well-supplied with blood than usual, and if the gastric mucosa is poorly supplied with blood continually, it stops producing enough of that vital, protective mucus layer.

This means the stomach acid can then infiltrate what's left of the now thinner protective layer and damage the gastric wall membrane, causing red-hot inflammation alongside a heap of red-raw pain, which in turn causes even less protective mucus! So, this self-compounding vicious circle intensifies everything and creates even more stress.

So, what did the vet do? For those of you who know me, you'll know this subject turns me into seething, angry She-Devil – they prescribed an acid-blocking drug, Peptizole, aka a PPI (proton pump inhibitor) to switch off the acid gahhhhh!!! And of course this poor chap got significantly worse because PPIs are 100% absolutely horribly detrimental to a horse’s gut system (that was me being really polite and not letting my potty mouth off on one). Frustrates the 'heck' out of me that these bluddy PPIs are the vets’ go-to for ulcers as they’re So Badly Damaging, but there we go … I could go into the reasons here as to why they’re so bad but it would make this page 12-ft longer than it’s going to be already. Suffice to say it’s all covered on the Ulcers' page in this section if you want to really depress yourself with what happens when horses are fed this gut-wrecking chemical drug.

I’ll now slightly digress and chip in that he was also a bit lame, so he had 4 steroid injections, all around the same time, and no surprise, he got even worse. So now not only did we have Interconnected-System No. 7 involved - Structural integrity (musculoskeletal structure) but No. 4 was pounding along like an out-of-control steam train - Biotransformation and Elimination (toxicity and detoxification). His gut system was already in meltdown, his microbiome was shot, and his immune system barely existed; his liver was already working overtime at having to metabolise all his body's toxicity, and understandably was ready to throw in the towel - frankly I’m surprised he didn’t go into toxic shock – believe me I’ve had many clients who have. We had pylorica ulcers and now also the squamous ulcers, located at the front end of the stomach – this poor boy’s whole gut system was on the final slippery slope to meltdown.

You’ll probably not be surprised to hear that by now this chap was also clearly showing his discomfort – his ‘girthy’ had now progressed to biting, ears back at everything, lots of swinging back glaring at his right side and cow-kicking underneath his belly for good measure. So now we can bring the hindgut back into the conversation because the hindgut – the large intestine - sits definitively on the right side of the horse’s barrel so this is where all the pain is. And when there's pain in the hindgut, it means there's hindgut acidosis.

Hindgut Acidosis

You see a horse swinging his head down his right side to his flanks, usually ears back and nipping at himself? Hindgut acidosis. You see a horse cow-kicking under his belly on the right side? Hindgut acidosis. A horse biting you, and not in a friendly way like a love nibble? Hindgut acidosis. And I speak from experience – our MacAttack, so named because his only job in the world was to bite me and mean it - had long-term hindgut acidosis. I didn’t know this when I adopted him 5-years ago, but he came to me with a buffet of major issues so we were expecting them all to manifest in many ways while we cleaned him up.

When we finally fitted the last piece in the MacAttack jigsaw, we knew we’d got it right because he literally stopped biting overnight. Now when he stalks me in the field it’s to say Hi and let me give him a face rub; now I can grab rug straps under his belly without risking losing an arm - or at the very least an arterial bleed - from a cow-kick. Hindgut acidosis sucks because it burns so it hurts – and not just for the horse but the human who’s nearby 😉

Forward to Spring 2021 ...

... and our client's horse then tipped himself over the edge - he broke through a fence to a grass strip and binged his socks off. Cue faecal water/diarrhoea.

And now we're going to introduce lactic acid bacteria into the whole sorry scenario, because lactic acid is the hindgut's worst enemy, and at the root of all things hindgut acidosis.

The one thing we need to avoid is the risk of lactic acid bacteria arriving in the hindgut, but it'll get there if the front end of the gut system, the stomach/foregut, is out of whack with ulcers/pain/inflammation. These lactic acid bacteria come in naturally from the forage a horse eats - especially if they're fed haylage - but the stomach acid usually deals with them. However, if we've got a disrupted gut system, and especially if a PPI has been prescribed that switches the stomach acid production to Off, the acid wont kill them, so they sneak on through into the small intestine and Boom! - one major enemy of the intestines has now invaded, and trust me when I say it'll wreak havoc.

Welcome to the lactic acid effect. These lactic acid bacteria ferment sugar, so with all that sugar from a grass binge they've gone to heaven and back! Multiplying like crazy, they overpower and kill off the friendly digesting microbes - cue dysbiosis/SIBO in the microbiome.

Next, the waste product from these bad bugs gorging on all that sugar is lactic acid, which is badbadnotgood, and definitely shouldn’t be in either the small or large intestine because it lowers the pH value to sour – remember, the intestinal environment should be a sterile, pH-neutral one. Also, remember, fermenting shouldn't happen in the small intestine, only enzymatic digestion - fermenting creates gas, and the SI doesn’t cope very well with gas as it’s a very thin tube, so now we’ve got an ever-expanding gas bloat where it doesn’t belong, and it’s very, very uncomfortable.

So, the sour lactic acid environment inflames and splits open the fragile intestinal wall, aka leaky gut, and here we go - a runaway immune system trying desperately to fan the flames, creating a buffet of autoimmune syndromes, and the entire body feeling like it's on fire.

So, Let’s uncover some facts about lactic acid.

Lactic acid – the intestines’ worst enemy

  1. One of the main culprits that causes lactic acid in the hindgut is pectins, which are naturally occurring plant starches. And where do we find a huge concentration of pectins? Our neon-green leafy grass! Those leaf blades are full of pectins with zero cellulose fibre - cellulose fibre is only found in mature, stemmy grass that’s been allowed to seed, i.e. hay or tall, fibrous, standing hay, hence why hay is the best forage we can give our horses. Hence also the main reason why our neon-green grass is so dangerous for our horses. So when our client's boy was in so much trouble after his grass binge, it was all thanks to that overload of green leafy grass pectin hitting his hindgut and creating a whole bunch of pH-lowering, lactic acid by the unfriendly lactic acid bacteria, turning his hindgut environment into a red raw sour burn. And yes - apples and carrots contain pectins too ☹ NB - it's easy to be misled into thinking pectins are good for the gut because this is definitely the case for the human gut. If we don’t have enough pectins in our daily ration, our own gut bacteria start attacking our gut wall, so the saying "an apple a day keeps the doctor away" is bang-on, because apple pectins feed our microbiome and prevent leaky gut. Why? Because us humans naturally have lacto bacteria in our gut microbiome! Look at any human probiotic label and you'll see a host of lactobacillus on the list, including lactobacillus acidophilus - in humans they're meant to be there. But not in horses ...
  2. Another major pectin-offender is beet - sorry to all the beet lovers but it's true, and I speak from experience as I used to feed beet years ago until I learned the facts. Previously thought of as a beneficial fibre feed, beet is actually anything but. Like grass and apple pectin (often found in horse feeds/gut supplements), beet is full of fructose (25%) and pectin-rich. The alleged 'molasses-free' equivalent may be lower in sugar but still contains up to 7% residual sugar in the pulp, and is still full of pectins - and still promoted as safe for laminitics!
  3. The digestion of all starches and those grass sugars (along with proteins/fats) is all meant to be dealt with in the small intestine, but if the digestive function/microbiome of the small intestine is out of kilter, starch and sugar will reach the hindgut, meet lactic acid bacteria and get fermented into lactic acid. This also leads to ...
  4. Colic risk. The general transition time of food digestion in the small intestine is relatively short, so if the small intestinal function has been disrupted with dysbiosis/SIBO, there will be large undigested starch and protein particles due to the short digestion time to digest those larger molecules. Hence they end up in the large intestine, which can lead to colic. So, it’s always good to be mindful of starch levels in feed when a horse’s gut function is compromised - the more complex the starch is, the more chance it’ll end up in the hindgut, and we really, really want to avoid this.
  5. Now to haylage – probably the worst forage we can give to our horses, as the very fermentation process to convert grass to haylage needs … lactic acid bacteria! Just the same as it happens in the gut, the fermentation process lowers the pH so makes it more acidic – my connie, Murf’s, gut literally turns into a projectile, high-pressure faecal water spray within just a few hours of eating haylage. There’s a separate page on the website giving the full gory details of why haylage should be avoided at all costs – it’s literally lethal for our horses.
  6. Remember that swollen sheath, with one vet saying ‘fatty tissue’, and the other saying ‘muscoskeletal due to … muscle pain’. Again, a connecting factor to lactic acid, so the vets were close, but didn’t quite make the connection. Lactic acid can cause the skelelal soft-tissue, i.e. ligaments, tendons and muscles, to feel as if they’re ‘on fire.’ Why? Because when we have dysbiosis/SIBO causing leaky gut, the lactic acid leaks through the permeable gut membrane (leaky gut) into the gut membrane. The liver doesn’t know what to do with it so it gets stored in the cellular tissue where it creates acidic inflammation. Some vets think it’s ‘fatty tissue’ because it can look as if the horse is putting on weight, but it’s actually the lymphatic system sending its fluid – lymph – to the inflammation to urgently try to degrade the lactic acid. So we've now got Interconnected-Systems No 4. Biotransformation and Elimination (toxicity and detoxification) and No. 5 - Transport (cardiovascular and lymphatic system) in the equation.

Another factor is the horse’s history - we rarely know what’s gone before with our horse unless we bred them. When a foal is born they don't have an established microbiome - their tiny gut system is beautifully sterile, so the gut microbes need to get to the hindgut – a foal does this by a process known as coprophagia, which is eating faeces, i.e. their mothers'.

The first 4-5 months is crucial for the foal – by eating mum's faeces the foal naturally colonises its hindgut's fibre-fermenting microbes (that reside in the cecum) just as the rest of their intestinal flora forms a stable microbiome. Disturb this process or wean too early, and the foal will end up with lifelong digestive and metabolic problems. If you give a foal antibiotics, or feed it haylage, this will disturb the process of the microbes learning to live in the young gut.

The same principal applies to how the mother has been fed/how healthy her microbiome is, i.e. if she was fed haylage or antibiotics at any time. If so, and therefore by default, if the mother has lactic-acid bacteria in her hindgut, the foal’s immune system will acknowledge the lactic-acid bacteria from its mother’s faeces as ‘normal’, making lactic-acid bacteria a lifelong resident. In other words, if the mother has the wrong microbes, this will be passed on through the generations.

This will dramatically affect the future ability to ferment the cellulose fibre in the hindgut, which will have the direct effect of dramatically affecting the horse’s energy. In these cases, it’s essential to change the feed regime to 24/7 hay which will create a hostile environment for the invader microbes by starving them of their beloved sugar; this will then allow the beneficial microbes to recolonise and outgrow the bad bugs.

This is sadly so widespread these days as so many breeders are feeding haylage to their foals - already we’re seeing foals with metabolic problems, i.e. sweet itch at age 2. Totally a human made problem.

Basically, feed a horse wrong and it creates the wrong microbes which are passed on through the generations. For the last 20-30 years, most scientific research has been focused just on the small intestine, yet the crucial fibre-digesting takes place in the hindgut. Scientists are now realising they’ve strongly neglected the hindgut but are now realising that a healthy hindgut = a healthy metabolism.

The last decade has been the decade of human microbiome research, discovering the connection to so many human-related gut conditions, i.e. IBS, Crones, Celiac, gluten intolerance and so on., so research has intensified and interest has grown – it’s now known that the microbiome manipulates everything! The good news is that as a result, there’s now more research happening on the equine microbiome with the first publications now coming out, and the early realisation that so many horses have disrupted microbiomes at the root cause of many metabolic disturbances, especially in the IR lami-prone horse resulting in colic, faecal water syndromes, trapped gas – all signs of dysbiosis in hindgut. It’s now thought that autoimmune syndromes such as sweet itch/pollen allergies also have their root in a disturbed microbiome, which ultimately, for so many horses, could well have started with not giving the foal the chance to colonise its cecum microbes appropriately

To conclude

So, there we have it - enough of the ramble, and let’s pull this all together. A week ago this poor boy's entire gut system was in meltdown, his whole body felt like it was on fire, and his sheath and inside legs were swollen from lactic-acid storage in his soft-tissue cells.

So, what to do? No question - our Alleviate, Detox and Fortify protocol. Basically we needed to reset him back to his natural state by first stabilising his pain and stress, and getting him off the uber-processed feedbags by switching up his diet/forage management to species-appropriate. Once stabilised, it was then all about cleaning him up from the inside/out with a full body detox. For his ulcers we needed to regenerate the protective mucilaginous layer on his GI tract to then enable the repair of his ulcer damage with our UlsaTonic blend, alongside our GutAminos to start repairing the leaky gut damage to the intestinal membrane.

Our client is completely onboard - she's already got the protocol underway, and removed the offending feedbags from his feedbowl. As for grazing on grass? I think you know the answer to that! He’s been switched to hay, more hay, and nothing but hay, 24/7, 365-days/year 😉

Here’s wishing this lovely chap a happier, stress-free, and certainly more comfy and pain-free future.