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Gut dysbiosis is a term to describe changes in the relative abundance of beneficial and pathogenic bacteria, where excessive Gram-negative bacteria may stick to and cause perforations in the gut barrier wall (intestinal permeability changes) and leak various toxic metabolites [e.g., bile acids, trimethylamine (TMA), and LPS, a cell wall component of Gram-negative bacteria] into systemic circulation [144]

It is not infectious and grows in warm and humid environments

When the degree and duration of intestinal hypoperfusion are severe and long, intestinal reperfusion may aggravate organ damage by excessive activation of polymorphonuclear neutrophils, oxidative stress, and pro-inflammatory mediators and trigger inflammatory responses

it can thus trigger a severe B12 deficiency