Getting Healthier Now

A Blog About Digestive Health

Tag: arthritis

Probiotics: Larger Doses Making a Big Difference

Lactoferrin for SIBO? It seems to be helping most by lowering my inflammation, and I’ll continue taking it daily, but I’ve noticed it also tends to constipate me, which is a bit of a paradox because while the lactoferrin should help kill pathogens and destroy biofilm, a constipated gut is at continued risk for SIBO.

In an effort to counteract this, and get my gut moving, I’ve gone back to the most basic approach of all: probiotics, and lots of them. I figure I can combine this with the lactoferrin, taking the two of them offset as many hours as possible. Lactoferrin with food, and probiotics between meals.

Why not more of my kefir and sauerkraut? I’ve found “enough” is helpful, but too much of either can make me back slide, and I’m not sure why. Especially when my GI tract is sluggish, I think kefir may worsen SIBO by building more biofilm. If anyone has ever tried cleaning a used kefir mason jar, with its thick accumulation of flora after just a few batches, you know what I’m talking about.

If I could deposit the healthy kefir biofilms exclusively in my colon, that would be another matter, but I’ve tried this, more than a few times. Unfortunately, retention enemas with kefir have given me relief only in acute situations, and longer term use doesn’t seem to address all my symptoms.

Probiotics, on the other hand, generally don’t have a reputation for colonizing our guts. Many see this as a drawback, but in the case of SIBO, I am hoping it’s an advantage. Perhaps these temporary upper gut residents will outcompete small intestinal pathogens without setting up shop and compounding the problem.

Recently I came across an interesting evaluation of some common probiotics on PubMed’s site. Note the section on VSL#3, which is a mixture of gram positive bacteria (which do not contain highly inflammatory lipopolysaccharide). Like many probiotics, VSL#3 is a mixture of flora originally harvested from a healthy human donor.

Take note of what it says about VSL#3 helping to heal the gut barrier function. “Leaky gut” is another term for this, and I’ve no doubt that’s one of my biggest problems.

Barrier function was also assessed using mannitol flux assays and after 4 weeks of VSL#3 treatment, barrier function normalized in these mice. Using the T84 human intestinal epithelial cell line it was further shown that VSL#3 and products secreted by these bacteria enhanced intestinal epithelial barrier function in vitro, and pre-exposure of T84 monolayers to VSL#3 provided a dose-dependent decrease in cellular invasion by the pathogenic bacteria Salmonella enterica serovar Dublin. A subsequent study corroborated these findings and further found that VSL#3 upregulated the expression of several mucins which are postulated to play an important cytoprotective role in host defense against pathogens [21].

The expense is a factor, and the primary reason I’ve never stuck with VSL#3 for very long, but could it be a “poor man’s fecal transplant”? With FMT being very costly in a clinic setting, and since I don’t currently have access to a donor for DIY at home, I’m going to give this a shot. The only difference being I’ll take this probiotic orally in addition to retention enemas.

Speaking of upper gut colonization, would the fact that VSL#3 is human-sourced mean its flora will attach permanently to the wall of the small intestine? Likely, the answer is no. This has something to do with how probiotics are manufactured. For some reason, the adherence of probiotic strains on the gut wall is usually not that good, no matter how the flora was originally harvested.

I began with a retention enema using 8 pills of VSL#3 in about 4 ounces of distilled water, using an empty and rinsed Fleet enema bottle. About 5 minutes later I felt my long-gone sense of smell returning. I noticed a basket of essential oils that had been on my dresser for months. Hard to imagine my nose had been so impaired this wasn’t fragrant to me until now, but that’s indeed the case.

About 20 minutes later, I noticed my tinnitus getting quieter, and my whole body relaxing. My mood improved. Joint pain was lessened, also.

Oral administration of VSL#3 was my next step. I took 8 capsules, 2 doses of 4 each, that first day.

I’ve been taking 4 capsules, 3 times per day, between meals, ever since, and drinking 2 pints of distilled water with each dose. I add trace minerals to my water. I only did the retention enema on day 1, and am hoping I can stop it altogether or reduce to once per week.

Now, three days in to the 12 capsules per day oral protocol, here’s a an intriguing list of symptoms where I’m definitely seeing improvements. It’s worth noting a great many of these issues came about after taking fluoroquinolone antibiotics. How much of being “floxed” is due to altered flora?

I should underscore that probiotics are nothing new for me, and VSL#3 is one I’ve used in the past to stop ulcerative colitis flares, but I’ve never taken it in this quantity, nor have I done it with the same frequency, plus I’m also combining the doses with enough water that my stomach acid is probably being diluted, which means more flora survives to reach the colon.

I also think, subjectively, my symptoms were never this bad in previous years, so I never had this far to “bounce back”.

So many symptoms are linked. Overall, I sense a restoration of my vagal nerve function. Huge relief from a constant stuffy nose (neurological, not from typical blockage), my pulse and BP are nice and low, and my sleep patterns and mood are evening out. No more blazing hot colon, lower back and neck, either.

The one thing that hasn’t changed yet, and this is fairly upsetting, is fatigue.

At first I felt strength returning to my legs, and I’d hoped this effect would snowball, but it’s less noticeable now than it was when I first started. Maybe I need to maintain the retention enemas. Another possible explanation for this is lipopolysaccharide being released, as gram positive flora is duking it out with the gram negative ones. If it’s happening in my small intestine, this means more LPS in the bloodstream. Perhaps sorting it all out is just a function of time.

Fatigue is the core of my illness, and Cipro and Levaquin were the triggers for it. I hope as I continue my therapy this will resolve, and it’s clear 3 days of anything gut-related is not enough time to know the longer term potential for healing.

I do hold out lots of hope I can eventually get my energy back, given all the other smaller improvements I’ve seen in the early going. I actually had my housemate take a “before” picture last night, because I’m so shrunken from the SIBO: 6 feet tall and 145 lbs. Underweight is nothing to mess around with, and I know it can significantly impair immunity. I had to do something, and i think i’m finally on the right track.

Have you tried a similar approach, taking large, longer term doses of probiotics? Which type works best for you? And if anyone has figured out a way to “brew” them to reduce the cost, let us know in the comments section below. Thanks.

 

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Conquering Advanced SIBO – Lactoferrin to the Rescue

I’ve probably had small intestinal bacterial overgrowth since childhood, and I’m now in middle age. This is a difficult-to-treat condition where colonic bacteria drifts up, beyond the gateway between the colon and small intestine, known as the ileocecal valve. This happens because the valve is stuck in the “open” position, either due to neurological impairment or constipation, which backs up the entire GI tract and keeps the valve propped open with the fecal stream.

In the early stages people might notice they’re developing rosacea. Most western medical doctors claim there’s no known cause for this skin condition, but in recent years practitioners with a more holistic approach, like Chris Kresser, and others, identified a study from decades ago where common probiotics were proven to be an effective treatment for it. Look for more on this in future GHN blog articles.

Besides rosacea and acne, other early stage SIBO symptoms might include low-grade fatigue, mild mood disturbances and cognitive impairment, minor food intolerances, aches and pains, low-grade, intermittent tinnitus (usually after meals), urinary and sinus infections, ear aches, gingivitis, halitosis, trouble staying warm, mild insomnia, IBS, trouble gaining weight.

Unenlightened doctors were treating my SIBO symptoms, such as sinus infections and prostate problems, with more antibiotics, which was unfortunate considering these drugs (Cipro, for example) likely caused SIBO in the first place. Fluoroquinolones contain fluoride, which binds iodine receptors and (among other things) impairs thyroid function.

SIBO

About six years ago I began to feel my whole gut, from the front around to my lower back, becoming burning hot. I could feel that same heat in my neck. Along with this came increasing brain fog and tinnitus. What’s happening with SIBO is simply upper gut fermentation – a low grade infection of the abdomen. With every single meal consumed, bacteria is fed first, then we get the scraps.

In healthy people the small intestine does have some protective bacteria in low concentrations, but in SIBO the ranks and type of flora resemble the lower gut populations, and these misplaced microbes can cause a lot of damage, by inflaming the small intestinal wall, and running amok systemically, with both toxic byproducts of fermentation and the bacteria themselves in the bloodstream.

This is made even worse when gram-negative bacteria are involved because they boost levels of lipopolysaccharide, a part of their cell membranes, and LPS is one of the most potent triggers of inflammation in our bodies.

Diet plays a role, with the distinct possibility that higher fat consumption fuels the growth of gram-negative bacteria. Paradoxically, this suggests those of us who switched to a higher-fat Paleo approach might be inadvertently increasing inflammation from gram-negative flora and LPS. It’s a  controversial theory, with a lot of strong opinions on all sides, so count on reading more of this in future GHN articles, too.

As SIBO becomes more advanced, think of those 14 feet or so of narrow tubing, the small intestine, where scopes and medicines have trouble penetrating, and how hard it might be to remove these uninvited guests. Bacteria and yeasts, such as candida, build biofilms that act as hardened bunkers against the gut wall. Think of tartar on your teeth, which is also biofilm, and it becomes clear how impossible it might be to cure.

Sadly, SIBO can become “self-worsening” because toxins further impair nerve function, which means the “migrating motor complex“, or MMC – which are peristaltic cleansing waves that normally clear colonic bacteria from the upper gut – this safety mechanism gets even weaker, resulting in more accumulation of bacteria and yeasts, then further inflammation develops.

Another paradox is mounting mineral deficiencies, from malabsorption, yet being unable to take vitamin and mineral supplements without fueling the problem. I am finding magnesium is especially difficult to take when upper gut fermentation is happening.

Later stage SIBO symptoms include crushing fatigue (which I’ve had since my last dose of Levaquin in 2009) to the point where it’s tough to get out of bed. Most people also have wide-ranging food intolerances, loud and constant tinnitus, major brain fog, personality changes (depression/anxiety, cognitive decline), tremors, hormonal problems, cardiovascular issues (tachycardia, hypertension) severe weight loss, and chronic, widespread joint pain.

A link is being established now, in recent studies, between rising fasting glucose levels, which I have, systemic inflammation, and metabolic disorders. Is SIBO a common denominator? I wouldn’t be surprised, and indeed, this isn’t a trivial condition that should be left alone.

I did seek conventional medical treatment a few years ago for SIBO. My gastroenterologist wanted me to avoid a “breath test” (patients breathe into a tube and gases are analyzed) because the sugar solution taken prior to the test could have flared my ulcerative colitis. Her caution was sensible. Instead, we just treated for it.

I took a 10 day course of Rifaximin antibiotic, which stays in the gut rather than acting systemically. It worked for the first two days, which my doctor thought was confirmation enough of SIBO. I had a big surge of energy, clarity. It was fantastic. Then on day three the drug had no effect. This is not uncommon, and makes sense considering I’ve got a gut full of antibiotic resistant bacteria. Historically, herbals and fermented foods plus diet and fasting have been more beneficial.

SIBO is insidious – if you didn’t know what was wrong, you might think you were just aging badly, since most people tend to do better when younger. As time goes by, you lose the ability to fight it because your mind is too scattered to do focused self-treatment. Even cooking meals becomes difficult, especially because SIBO can lead to a loss of appetite. Starving it becomes the easy way out – symptoms are reduced when fasting – but any further loss of nutrition compromises an already weak immune system.

So despite my years of struggle with SIBO, including most all the symptoms listed above, I was confused when it flared the last time. This is because it came on strong with pain in my joints. I would wake in the late morning, feeling as if I’d never slept, and my whole body was throbbing. I figured this couldn’t be SIBO, it must have been something entirely different like arthritis. Instead, it was just the worst flare I’d ever experienced.

I started doing a lot of the old fixes, which are quite good: intermittent fasting (I cut out all food after 4pm) to starve the bacteria daily. I took peppermint oil with meals – a surprisingly good antifungal and antibacterial. I boosted my water consumption to about a gallon of distilled water daily, with trace minerals added. I went to 1 cup of coffee in the AM, cut out fibrous vegetables, I added Interfase Plus, to dissolve biofilms.

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The whole time I kept reading, and came across references to bovine-sourced lactoferrin, which is a substitute for the human lactoferrin babies get in breast milk. We adults also have it in our tears, and it can be found throughout the body. Lactoferrin is a bone-builder, a binder of iron (which pulls that fuel away from pathogenic bacteria), it’s also antiviral, used by some people to treat hepatitis C, and a potent antifungal. Throughout the literature, I read of its ability to harm pathogens while protecting, or even nurturing, healthy flora.

This makes lactoferrin a perfect choice for me, because as effective as peppermint oil, olive leaf, or berberine might be, these herbals also kill a lot of good bacteria. I am an avid sauerkraut and kefir-consumer, so I’m putting some flora back, but I don’t want to lose important lower gut microbes that fermented foods cannot replace.

Here’s perhaps the most exciting thing of all: lactoferrin’s interaction with lipopolysaccharide. Very encouraging, to say the least.

My results: it’s been a very exciting few days. The fatigue is still pretty bad, but it’s getting better. I’m finding my mind is clearer, my mood is brighter, and I can at least go for a walk and feel a bit stronger. A few days ago if I ventured out at all, I could hardly get down the block and back.

This makes me wonder how many of us with CFS/ME actually just have advanced SIBO. New science is beginning to understand the “gut-brain axis”, how the brain is linked to a “gut-brain”, our enteric nervous system, and CFS is a condition where that connection is obvious. In this thread “Lisa” did incredibly well with lactoferrin, for a time. For her, it seemed to provide energy as well as clearing the fog.

So far, I’ve had some toxic die-off symptoms (LPS!), but not as much as in the past when using antibiotics (such as the Rifaximin) for SIBO. My joint pain is not entirely gone, but it’s a lot better, same with my sleep patterns.

One very notable fact is I tend to feel more energetic while in motion than I do when I am laying down or sitting. I’ve heard this is a classic hypothyroid symptom, although not often documented, and back to the subject of LPS, I may have found a source of thyroid inflammation. Look for a lot more on this topic in future articles.

My plan from here forward is to reduce the broad spectrum herbal antimicrobials, be more strict about intermittent fasting, eat a lower fat diet with a few more simple carbs to reduce LPS (this is complex – kudos to Paul Jaminet), and continue on taking the lactoferrin. The brands I’m trying are Life Extension and Jarrow. The dose has varied. I started slowly, just two pills a day of Jarrow, but have since gone to 4 of each kind as of today.

I am also still a believer in supplemental iodine, but my dose is lower now, about 2.5mg a day, which is one drop of Lugol’s 2%, and I always take 200mcg a day of selenium to protect my thyroid. I have reduced iodine because if LPS is a factor in my hypothyroidism, I want to heal my SIBO first.

Lactoferrin to the rescue. Let’s see how this goes.

To be continued.