Tag Archives: probiotics

More Butyrate Series, Part 8: Clostridium butyricum and Ulcerative Colitis, Irritable Bowel Syndrome, and Antibiotic Associated Diarrhea

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Clostridium butyricum, a soil-based probiotic used commonly in Asia, colonizes the gastrointestinal (GI) tract of about 10-20% of the human population. Although it does produce butyrate in the GI tract, studies show it creates beneficial effects independently of butyrate too. I do not endorse Clostridium butyricum supplements. I became interested in learning about them because I’m interested in the effect of butyrate on slow colon motility. When I started reading about Clostridium butyricum, it sounded like a nice little probiotic, to the point that I have expanded Part 8 of my Butyrate Series much more than I anticipated in order to elaborate on Clostridium butyricum. (See the first post of Part 8 here.)

I’d like to highlight studies on Clostridium butyricum’s use for GI diseases in this and the next post (or two). Please, remember, I am NOT recommending this probiotic for anyone. I just enjoy reading, researching, and compiling information on niches I am learning about. Do NOT use anything on this blog as medical advice, even if I seem nice, honest, and have certain initials after my name. Anyone on the internet can feed you a line.

By all means, if you think Clostridium butyricum sounds right for you, print off the studies I cite, highlight important points, and hand them to your healthcare provider to see what they think. Although most of the information I have read about Clostridium butyricum, both scientifically and anecdotally, has been positive, I have read tidbits where it made some people worse. (Please pay attention. The Clostridium butyricum probiotics I have found have lactose in them and potato starch, which I know many readers are sensitive to.)

And, as always, please help me with typos or incorrect information. And because it’s more important than anything, be kind and gracious from your heart to all. This world is hurting.  And…now back to science.

Ulcerative colitis

Clostridium butyricum (Bio-Three brand) promoted remission in refractory ulcerative colitis patients, particularly if they started the study with low fecal Bifidobacteria counts.

Twenty refractory ulcerative colitis patients received Bio-Three, nine tablets daily for a month.

  • Nine of the 20 (45%) patients went into remission
  • Two of 20 had a positive response but not full remission
  • In total, 55% had clinical and endoscopic improvement.
  • Nine had no response or worsened. (One of 20 became worse.)
  • 10 of the 20 patients also received 100 grams of “fiber,” which seemed to make no difference in any parameter.
  • Response to the probioitic was not correlated with initial severity of disease symptoms. A person with “terrible” ulcerative colitis symptoms could do–or not do–as well on the probiotic as someone with “mild” symptoms .
  • Patients’ fecal biomes were able to be categorized into three distinct clusters, and those in the clusters with lower Bifidobacteria seemed to respond better to the probiotic and had improved fecal microbiota profiles after therapy.

Source: Clinical effectiveness of probiotics therapy (BIO-THREE) in patients with ulcerative colitis refractory to conventional therapy. Yukiko Tsuda, Yasushi Yoshimatsu, Hiroshi Aoki, Kentaro Nakamura, Masaki Irie, Katsuyuki Fukuda, Nobuo Hosoe, Nobuo Takada, Koji Shirai & Yasuo Suzuki. Scandinavian Journal of Gastroenterology. Vol. 42 , Iss. 11, 2007.

Clostridium butyricum (Bio-Three brand) maintained clinical remission better than placebo did in already controlled ulcerative colitis patients over the course of a year, although the results were not statistically significant.

Of forty-six patients, half received three tablets of Bio-Three three times daily and the other half received placebo doses instead.

  • At three months, the relapse rates in the probiotic therapy group was 0% compared to 17.4% for placebo.
  • At six months, the relapse rate in the probiotic group was 8.7% compared to 26.1% in the placebo group.
  • At 9 months, the relapse rate in the probiotic group was 21.7% compared to 34.8% in the placebo group.
  • At 12 months, the remission rate was 30.5 % in the probiotic group and 43.4% in the placebo group.
  • Fecal flora was analyzed and three clusters of bacterial profiles were identified: cluster I, cluster II, and cluster III. Cluster II has the highest levels of Bididobacteria and benefitted the least from the addition of the probiotic. Cluster I had the lowest level of Bifidobacteria and benefitted the most from the addition of the probiotic, which seems, among other things, to shift the flora to be more consistent with a cluster II bacterial profile. Cluster III was somewhere in the middle for Bifidobacteria.
  • The butyrate to acetate ratio was higher in patients who relapsed. The researchers suggest that the colonic cells are not able to uptake butyrate properly so it persists in the fecal matter.

Source: Yoshimatsu Y, Yamada A, Furukawa R, Sono K, Osamura A, Nakamura K, Aoki H, Tsuda Y, Hosoe N, Takada N, Suzuki Y. Effectiveness of probiotic therapy for the prevention of relapse in patients with inactive ulcerative colitis. World J Gastroenterol. 2015; 21(19): 5985-5994.

[So why not just take Bifido? I think one has to think about the whole climate of the GI tract. Clostridium butyricum would not directly inoculate Bifido. I’d like to think it creates bacteriocins (its own natural antibiotics) and pH changes that can then allow Bifido to properly reproduce and thrive as indicated. Like bringing in hummingbirds by planting geraniums and butterfly bushes. I can put hummingbird food out in winter and bring them, but I haven’t really provided them an environment to prosper. It’s all about cultivating an environment for cure to effect itself–not about taking the magic pill for cure. That’s why food is key.]

Treating ulcerative colitis patients who had food allergies with Clostridium butyricum (420 mg twice daily, brand not mentioned) plus specific immunotherapy for a year reduced the need ulcerative colitis medication.

[Aside: If you have ulcerative colitis, has your healthcare professional suggested food allergy for your consideration?]

Eighty patients with food allergy (diagnosed by skin testing) associated ulcerative colitis were divided into four groups: placebo, Clostridium butyricum only, specific immunotherapy only (SIT), or Clostridium butyricum with specific immunotherapy together. Using Clostridium butyricum alone or specific immunotherapy alone non-significantly reduced the need for ulcerative colitis medication. However, using the treatments together significantly impacted and reduced the need for medication for ulcerative colitis.

The study also investigated the cellular differences and immune response differences among the placebo group, the food allergy ulcerative colitis group, and the non-food allergy ulcerative colitis group. There were marked, significant differences among the groups, reflecting the significance of food allergy on the cellular response of the body. This study found that food allergy associated ulcerative colitis has unique cellular and immune response differences. [It reinforced in my mind the need for inflammatory bowel patients to modify their diets, especially looking at the top 8 allergenic foods.]

Source: Specific immunotherapy plus Clostridium butyricum alleviates ulcerative colitis in patients with food allergy. Bin La. Fan Yan. Dong Lu. & Zhenlv Lin. Scientific Reports 6, Article number: 25587 (2016).

Taking Clostridium butyricum (Miya-BM, three tablets three times daily) after total proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis seemed to decrease the risk of pouchitis compared to placebo over a two-year period.

Nine patients received the probiotic and eight patients received a placebo; however only seven of the probiotic patients completed the study. Only 1 of the probiotic recipients developed pouchitis, whereas 4 of the placebo patients did. The difference was not statistically significant. Miya-BM was the probiotic. It is the same strain and made by the same manufacturer as the Miyarisan Miyairi CBM 588 I mentioned in the last post. However, the label for the Miyarisan Miyairi CBM 588 tablets that I see have 270 mg compared to the 20 mg mentioned for this study. I’m not sure how to compare that for equivalent dosing among Clostridium butyricum probiotics.

As mentioned in the other studies above, Bifidobacteria increased with use of the Clostridium butyricum. (It also increased in the placebo arm, but the placebo was lactose, which the researchers feel may have allowed Bifidobacteria to increase.) It was also found that Escherichia coli also decreased with Clostridium butyricum use. One last interesting parameter to point out is the effect of Clostridium butyricum on AST and ALT values (“liver function tests”). Clostridium butyricum significantly reduced AST and ALT values compared to placebo.

Source: The effect of Clostridium butyricum MIYAIRI on the prevention of pouchitis and alteration of the microbiota profile in patients with ulcerative colitis. Yasueda, A., Mizushima, T., Nezu, R. et al. Surg Today (2016) 46: 939.

Irritable Bowel Syndrome (IBS)

Although Clostridium butyricum is commonly used in Asia for diverse indications, which I assume includes general symptoms of abdominal discomfort, bloating, and diarrhea (aka, irritable bowel syndrome), I did not readily find irritable bowel studies using Clostridium butyricum. I’ll present what I did find.

A new 2018 study on mice concluded that Clostridium butyricum may exert a beneficial action on visceral hypersensitivity of IBS by inhibiting low grade inflammation of colonic mucous through its action on NLRP6.

NLRP6 is thought to help stabilize the intestinal epithelium to allow repair. In this mouse study, Clostridium butyricum (dose: 1.25×10^9 CFU once daily for 7 days) increased NLRP6 while inflammatory IL-18 and IL-1B were decreased. Inflammatory infiltration into the colonic mucosa was decreased in the mice who received the probiotic. Mice who received Clostridium butyricum had less visceral sensitivity.

Source: Kejia Zhao, Leimin Yu, Xi Wang, Yibo He, Bin Lu; Clostridium butyricum regulates visceral hypersensitivity of irritable bowel syndrome by inhibiting colonic mucous low grade inflammation through its action on NLRP6, Acta Biochimica et Biophysica Sinica, Volume 50, Issue 2, 1 February 2018, Pages 216–223.

In a 2013 Chinese study, two groups of irritable bowel patients received the same dietary information and were maintained on common drug treatments. However, in addition, one group received Clostridium butyricum 500 mg twice a day for a month. At the end of the month, the researchers reported a significant improvement in symptoms of the Clostridium butyricum group.

The study is a Chinese study, and I cannot find it any more than I reference.

Source: http://en.cnki.com.cn/Article_en/CJFDTOTAL-GLYZ201303005.htm.
Zhu Ya-bi, Li Hong-guang, Wang Chang-xiong, Wang Wang-yue. Effects of clostridium butyricum in adjuvant treatment of patients with irritable bowel syndrome. The Chinese Journal of Pharmacology. 2013.

To prevent antibiotic associated diarrhea

In children who required antibiotics, Clostridium butyricum (MIYAIRI) decreased the frequency of antibiotic-associated diarrhea. The probiotic was effective in both prophylactic prevention of diarrhea and also in treatment of antibiotic-associated diarrhea.

Study participants were divided into three groups: antibiotic only, antibiotic with Clostridium butyricum started half-way through the duration of antibiotic, and antibiotic with Clostridium butyricum given at the start of antibiotic dosing. The dose of Clostridium butyricum CBM was 1-4 grams daily of 10^7 CFUs in the form of a dissolvable powder. When the dose was higher than 3 grams, the beneficial effect of the Clostridium butyricum on loose stools was statistically significant: 83% versus 49%. Stool studies also showed that a more normal microbial flora was preserved with concomitant use of the probiotic.

Source: SEKI, H., SHIOHARA, M., MATSUMURA, T., MIYAGAWA, N., TANAKA, M., KOMIYAMA, A. and KURATA, S. (2003), Prevention of antibiotic-associated diarrhea in children by Clostridium butyricum MIYAIRI. Pediatrics International, 45: 86–90.

In a small study of 19 patients being treated for Helicobacter pylori with amoxicillin and clarithromycin, Clostridium butyricum (Miyairi CBM 588) at increasing doses eliminated diarrhea and/or soft stools. (A “regular” dose of 6 tablets of 10^7 CFUs showed a decrease in diarrhea, but a double dose of 12 tablets seemed to prevent diarrhea completely.)

Source: Efficacy of Clostridium butyricum preparation concomitantly with Helicobacter pylori eradication therapy in relation to changes in the intestinal microbiota. Kyoto Imase, Motomichi Takahashi, Akifumi Tanaka, Kengo Tokunaga, Hajime Sugano, Mamoru Tanaka, Hitoshi Ishida, Shigeru Kamiya and Shin’ichi Takahashi. Microbiology and Immunology. Volume 52, Issue 3, Version of Record online: 8 APR 2008.

Closing

I’ll have more coming on leaky gut, anxiety, pathogenic gut infections, and more!

Terri

Butyrate Series, Part 8

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Hello! I have not stopped working on and constructing butyrate posts (or other posts, like recipes and homeschooling posts), but I haven’t been able to complete them in a very timely manner. Whew! Homeschooling is hard work! However, I’m ready to start posting the next installment of my Butyrate Series. Let’s look at another way to potentially increase butyrate production in the body. . .

Warning: Writing up what I’ve learned about certain topics is simply a hobby of mine. It’s my entertainment and way to unwind from motherhood, homeschooling, and housework. When you read my writing, I’d like you to enter into an agreement with me: you read it to see what I think I’ve learned, but you do not read it with the thought that I am some expert or that I can possibly help you. I can’t help you. Supplements and treatments discussed enthusiastically on the internet can be dangerous. You, however, armed with knowledge and curiosity, can take the initiative to safely and non-ignorantly make a difference for yourself. This site is not medical advice.

Probiotics to (directly) increase butyrate

The Japanese have used a strain of Clostridium butyricum, a direct butyrate-producing bacteria, as a probiotic since about the 1970s. Savvy health professionals know butyrate best for its gut benefits (healing leaky gut, improving the mucous barrier, and improving motility), but it also has positive effects on the kidneys, brain, and metabolism–not to mention colon cancer prevention. Despite its structural simplicity, the little short chain fatty acid called butyrate truly makes a powerful, all-encompassing health difference.

Personally, my favorite way to increase butyrate in the body is NOT to take supplements– but to eat green bananas, leftover boiled cassava root, and/or leftover potatoes. Aiming to eat whole, real food is always best, but it may not be enough for select problems.  I get that. So I’m curious about all the other ways to increase butyrate.

If you have read any of my butyrate posts, you may remember that I outlined and explored four potential ways to increase the body’s butyrate levels:

  1. Eat butyrate-rich foods, like butter from grass-fed cows.
  2. Eat foods that butyrate-producing bacteria like to metabolize, particularly green bananas, green plantains, refrigerated and then reheated potatoes, beans, lentils, cassava root, and/or rice.
  3. Take butyrate supplements directly.
  4. Take probiotics which contain bacteria known to make butyrate.

Since last writing, I’ve expanded my list of potential butyrate-producing methods that I’d maybe eventually like to write about:

5. Take probiotics which support butyrate-producing bacteria in the GI tract.
6.  Consume prebiotic fibers which enhance butyrate production by GI tract bacteria.
7. Maybe we could somehow upregulate our colonic butyrate importers, such as MCT1 and SMCT1. (1, 2)

My other butyrate posts have waded through points one through three. After quite a gap in my writing due to my work raising four wonderful people in the early stages of life, let’s talk about point number four: probiotics which contain bacteria known to directly make butyrate.

Commercially available butyrate-producing probiotics

The only direct butyrate-producing bacteria (that I found) that we have available as a probiotic for human consumption is Clostridium butyricum. Quite a bit of searching turned up only two different probiotic brands to buy with Clostridium butyricum. (Have you seen any others I’ve missed?) Although both probiotics contain spores of the same species, Clostridium butyricum, they are different strains of the species.

When ingested, the bacterial spores germinate and grow in the intestinal tract, making the short chain fatty acids butyrate and acetate (6). Both strains and brands have studies behind them for various health conditions which I’ll try to discuss in this thread of posts (but not in this post today). Both probiotics can be found on Amazon.

  1. MIYAIRI 588 (CBM 588) Miyarisan Tablets
  • A one-strain probiotic of Clostridium butyricum
  • Manufactured in Japan and distributed there as an over-the-counter medicine
  • Commonly available and used in Asia
  • Available in two strengths: standard and strong. If you look at my citation number 4, you’ll find the recommended dose and much, much more about this probiotic.
  • Other listed ingredients are lactose, corn starch, talc, microcrystalline cellulose, and magnesium stearate
  • History: First isolated from feces by Dr. Chikaji Miyairi in Japan in 1933. CBM 588 is the 588th MIYAIRI strain, isolated from a soil sample in Nagano, Japan in 1963.
  • As mentioned, the probiotic is composed of spores of C. butyricum (rather than “live,” active bacteria), which are then activated in the gastrointestinal tract, making the probiotic quite shelf stable with no refrigeration required. (3, 4)

2. Advanced Orthomolecular Research Probiotic-3

  • A three-strain probiotic which includes Clostridium butyricum TO-A, Enterococcus faecium (same as Streptococcus faecalis) T-110, and Bacillus subtilis TO-A (some places I see the label with Bacillus mesentericus)
  • Only the Clostridium butyricum is the direct butyrate-producing bacteria
  • Also contains lactose, potato starch, polyvinyl alcohol, providone, and sodium stearyl fumarate
  • If I understand correctly, it contains Bio-Three probiotic formula. I believe the “TO-A” implies that the strain was produced by the TOA Pharmaceutical company in Japan (inferred from Bio-Three website). The Bio-Three formulation is used in Japan, and has studies behind it.
  • No refrigeration necessary. As with the Miyairi probiotic, the Clostridium butyricum is in the shelf-stable spore form. (5)

About Clostridia and the bacterial species Clostridium butyricum in general

When we are about one month old, different commensal species of Clostridia start to colonize our gastrointestinal (GI) tracts. They are supposed to be there and provide specific and essential benefits to us without causing harm. Since we only typically hear of the toxic Clostridial diseases like botulism, tetanus, and “C. diff.,”  it may sound strange to some of you to know you healthfully have an abundance of clostridium residing in your GI tract! If you think of Clostridia as a “bad” class of bacteria, you might find it even more disturbing and confusing to know that a known pathogen like Clostridium difficile (the culprit in C. diff pseudomembranous colitis) can be part of a normal human gut biome or can actually prevent infection. (6-9)

[Opinionated aside: The fascinating idea that a strain of C. difficile, a bacteria we think of as toxic, can be normal flora supports why I would argue with people that we have to stop oversimplifying health, stop trying to peg things, and start convincing people to do complete overhauls to their modern lifestyles and mindsets to bring the body into rhythm with itself. Don’t just take butyrate supplements and butyrate-enhancing probioitics—investigate your life, eating, habits and make impact changes. Being honest with and scrutinizing oneself often hurts for several months, but if done properly, you move past the pain, and healing and change can begin. Perfection will never be reached in this realm, but progress feels so good to a mind and body.]

Clostridium butyricum is one species of Clostridia bacteria. It is Gram-positive, rod-shaped, and anaerobic. It lives in soil and in the GI tracts of birds and mammals and can be found on the skins of potatoes, Swedes, and even in cream and yoghurt. It ferments starches to produce butyrate. When C. butyricum is exposed to a stressful environment, it can form endospores, an alternative form which allows it to survive the stressful conditions, to later reactivate when exposed to desirable conditions. It is the spores which are used in the probiotic formulation, allowing them to be shelf-stable without refrigeration for several years. (3, 4)

Some of you may have read about the clusters of clostridia and wondered about that. The Clostridia microbiological class (to which C. butyricum belongs) is exceptionally diverse, and even the commonly accepted shared characteristics, such as being rod-shaped (bacillus), anaerobic, and spore forming, have variations and exceptions to the rules. In the attempt to break down, stratify, and classify the types of Clostridia, the species C. butyricum is categorized into what is called “Cluster I Clostridia.” Cluster I Clostridia aren’t common inhabitants of the human gut. Human guts seem to mostly contain butyrate-producing bacteria from Clostridium clusters IV and XIVa rather than cluster I, but some human GI tracts do contain Clostridium butyricum, so clearly it does naturally happen. Fecal studies have found Clostridium butyricum in about 10-20% of its surveys. (6-9)

For all practical purposes, C. butyricum is a non-toxic clostridium species, but there have been reports that it can acquire some of the toxic genes from other clostridia, leading to production of poisonous toxins which may contribute to infant botulism or infant necrotizing enterocolitis. Regarding adults, one case of sepsis from Clostridium butyricum has been reported in an intravenous drug user and one case of antibiotic associated diarrhea has been reported. The complexities of toxin acquisition/production depend on the strain, the host, and interactions with other strains. Some strains of Clostridium butyricum are probiotic and beneficial and other strains show virulence. The probiotic strains mentioned are tested for non-virulence.  (6, 7)

Closing

I’ll cut off this post for today and try to clean up my next writing segment regarding specific uses of the probiotic Clostridium butyricum. I do not have it “polished up” yet, but posting this half will force my hand to get the rest of it tidied up and posted for those interested. I’d like it if you’d point out typos or mis-information to me so I can make corrections. Thanks in advance.

Please keep in mind: I don’t really care about probiotics or bacteria or food. What I really care about is that you grasp your life, your whole life, and tenaciously latch on to the things that are good and real– and that you weed out the things that are bad for you and noxious. I love life. I’ve had my share of challenges, smaller than many, bigger than some. But no matter what, I try to choose to face life HEAD ON with as much transparency as I can. And each new day, each new week, each new stress, shows me how to become more true and real.

The best to you,

Terri F

Citations:

  1. Pedro Gancalves, Fa’tima Martel. Butyrate and Colorectal Cancer: The Role of Butyrate Transport. Current Drug Metabolism. Volume 14, Issue 9, 2013.
  2. Pedro Gonçalves, Fátima Martel. Regulation of colonic epithelial butyrate transport: Focus on colorectal cancer. Biomedical Journal. Volume 1, Issue 3, July–August 2016, Pages 83-91.
  3. Wikipedia site regarding Clostridium butyricum: https://en.wikipedia.org/wiki/Clostridium_butyricum
  4. Clostridium butyricum Miyairi 588 Novel Food Application, public version: C. butyricum MIYAIRI 588 as a novel food supplement.  Probiotic food supplement. Miyarisan pharmaceutical company, LTD. https://acnfp.food.gov.uk/sites/default/files/mnt/drupal_data/sources/files/multimedia/pdfs/clostridiumbutyricumdossier.pdf
  5. Bio-Three website: http://www.bio-three.com/
  6. N.Cassir, S.Benamar, B.La Scola. Clostridium butyricum: from beneficial to a new emerging pathogen. Clinical Microbiology and Infection. Volume 22, Issue 1, January 2016, Pages 37-45. Review. 
  7. Rousseau, Clotilde & Poilane, Isabelle & De Pontual, Loic & Maherault, Anne-Claire & Le Monnier, Alban & Collignon, Anne. Clostridium difficile Carriage in Healthy Infants in the Community: A Potential Reservoir for Pathogenic Strains. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2012. 55. 1209-15.
  8. CS Cummins and JL Johnson. Taxonomy of the Clostridia : Wall Composition and DNA Homologies in Clostridium butyricum and Other Butyric Acid-producing Clostridia. Journal of General Microbiology.   (197 I), 67,33-46
  9. Lopetuso LR, Scaldaferri F, Petito V, Gasbarrini A. Commensal Clostridia: leading players in the maintenance of gut homeostasis. Gut Pathogens. 2013;5:23. doi:10.1186/1757-4749-5-23.

 

Slow Guts Need Tenacity

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256px-Pieter_Lastman_-_Jonah_and_the_Whale_-_Google_Art_ProjectTenacity.  Word for the day.  Word for a season.  Word for life.  I can hear mom’s voice even now, “Oh, Terrrr-rrrri.  You have a one-track mind.”  She said it like it was a bad thing!  Pshaw.  But, tenacity got her to buy me some black parachute pants; I think it’s restoring my gut too.  I’ve worked very hard to get this gut moving.  Very.  I’ll be laying out all that I can think of that I tried and how I think it affected my gut and me.  There is no ONE thing that worked for my colon regularity and stool consistency.  Geesh.  What would I have to write about if it was that easy?  I’ve turned down more cookies, cakes, and cheese platters than you can even imagine.  I’ve made myself go to bed early more than I’ve ever made my kids go to bed early.  I’ve attacked my gut on all fronts that I can.  Tenacity.

I’m starting out by writing about the supplements I’ve tried.  That does NOT mean that the supplements are the most important.  Just that I’m postponing talking about acupuncture and gargling and chakras.  I’ve already mentioned vitamin K2 in the last post.  These posts will just keep rolling.  So let’s continue.  Don’t use this as medical advice.  It’s my story.  If it gives you ideas to try, talk about them with your doctor.  Be SAFE.

Iodine

I’ve taken iodine for about two years now. I don’t have much in the way of a reliable iodine source in my diet, so I supplement. Iodine comes to a conventional diet via egg yolks, dairy, seafood, and iodized salt.   Iodine didn’t seem to have any particular impact on MY constipation, although other people have reported to me that when they started taking iodine it did seem to improve their constipation; I experienced other positive benefits from taking iodine. I was able to have my thyroid labs followed to make sure I was safely supplementing. Hypothyroidism (low thyroid) causes constipation. I was never categorized as hypothyroid. However, iodine supplementation did slowly drive my TSH down over time, which was medically interesting to watch.

Bottom line for me: Iodine did not seem to make my constipation better, but it helped other things for me. I think that a TSH needs periodically checked and symptoms need closely monitored if a person is going to take iodine.  In case you’re counting, this is the second supplement I take routinely.

Probiotics and Probiotic Foods

I’ve tried dozens of probiotics. Not A DOZEN—but DOZENS. There is no probiotic that makes my motility improve directly. I’ve tried soil based. I’ve tried VSL. I’ve now tried the Japanese kind. I’ve tried Klaire Labs. I’ve tried pickles, pickle juice, sauerkraut, sauerkraut juice and kimchi. I’ve made my own fermented pickles, sauerkraut, and beets. I’ve tried 24 hour homemade yogurt. I’ve tried homemade coconut yogurt. Tenacity.  There is one probiotic source I haven’t tried, but I’d like to try: Mutaflor. It has studies showing it helps constipation. However, it’s only available in certain countries, and the USA isn’t one of them.

Probiotics aren’t the “cure” for my STC.  I’ve tried many kinds, and I’ve tried driving up the doses.  Tenacity.  In fact, for a couple of months this summer, I even stopped probiotics completely!!!!  I suffered no ill GI effects and my gut still moved! Why did I stop them? I think that I have a mild case of small intestinal bowel overgrowth (SIBO).  (Why not test?  1) I already eat a tailored diet.  2) Things are improving.  3)  I’ve tried antibiotics before for it, and it came right back.  And now, I won’t take antibiotics because I’m nursing.  4)  My case isn’t that bad.)  I now waffle between probiotics and no probiotics.

What is SIBO?  This is where the bacteria from the colon track up into the small intestine in larger numbers and/or with different species than those that should be there. It leads to significant bloating, distention, bowel movement changes, fatigue, and other symptoms. There is a dispute in the SIBO arena about whether one should take probiotics with this disorder. Having no vested interest and an open mind, I could see both sides. So since I’d tried probiotics like crazy for years, I thought I’d try without. (Another aside: I have not always had SIBO symptoms. They started at about age 35. I think it was a result of chronic non-movement of my gut.  I think to effectively treat SIBO, a person HAS to address the underlying issues.)

Bottom-line for me: I tried coming off my probiotic. My gut still moved off the probiotic! However, my gut also moved normally for a couple of months before I got pregnant a couple of years ago and I was ON a probiotic. So for my body, I’m not yet sure whether it prefers a probiotic or not.  LOTS of people swear by probiotics for constipation.  I have been trying to utilize normal portions of Bubbie’s pickles, Bubbie’s sauerkraut, and eating my home-grown produce.

Butyrate

Butyrate has kick-started my gut twice in my life now. In 2013, I started taking it after a big dose of magnesium and immediately I had normal bowel movements daily. I then titrated up resistant starch using potato starch (which leads to natural butyrate production) and came off of the butyrate pills. I then titrated up food sources of resistant starch (green bananas, plantains, cooked and cooled potatoes and rice, raw potato and sweet potato sparingly) and stopped the powder forms of resistant starch.

BINGO. I thought I was a diet-controlled constipetic and the story was over! (I always told God I was going to stop blogging when my constipation was cured.  Never tell God what to do or what you think YOU’RE going to do.  Instead, when you hear “Jump.” from the Big Man, you say, “How high?”  Got it?) But I got pregnant in 2013 and I’ve been chasing GI rainbows ever since. Finally, late this summer of 2015, I decided to get back on butyrate. I took a good dose of magnesium to try to propel that butyrate deep into my intestines (just in case that would help, you know).  BAM.  My gut has been doing pretty well since then. Knock on wood. And I’m working on building back up my food sources of resistant starch again and working on other areas I’ll elaborate on through these posts (like stress management, core strength, etc). THIS IS NOT A SIMPLE QUICK-FIX JOURNEY. You want that? Go somewhere else.  Tenacity.

I KNOW butyrate does NOT work for all people. They’ve told me. More people have told me that butyrate did NOT help them than people have told me that butyrate DOES help them. I’d like to also point out that during pregnancy and post-partum, my gut kind of stopped working and I was on high dose magnesium. Butyrate did not work at this time—even though this summer I tried again and it did! This leads me to suspect that hormones play a huge role in constipation—which I already suspected and this simply pounded into my heat that I need to make sure and learn about this (and hopefully write it up too—although I must say the other day in my research, I saw a new review article that was downplaying hormones…).

Many people write to ask what butyrate I take. I simply tell this as part of my story. Listen. I do not support this brand, other than it has worked best for me out of all the ones I’ve tried. I don’t pretend to think this brand or even butyrate will help you. Heck, it may even set YOU back, while it sets me forward.  I use Body Bio Mag-Cal Butyrate 600 mg (two three times daily, usually, but not always with a meal). If you decide to try this, flash it to your doctor so he/she can make sure it’s going to be fine for you. A commenter, Vicki, has noted that Body Bio has received some reprimands. You may read about this by scrolling down to the comments and looking for an interchange between Vicki and me.  Sometimes, I have a strange feeling that some bottles work better than others.  I don’t know, though.  I have NO proof of that.

Bottom-line: Butyrate has some good evidence supporting its role in promoting gut motility.  I have many posts on that in my butyrate series.  Some people have tried it and found that it helped their food intolerances and gut motility. Others have tried it without success—and with a loss of hard earned cash.  If your’e counting, this is the third, and final, supplement that I currently take routinely.

Magnesium (Natural Calm)

What did I take during pregnancy and post-partum when hormones gripped my gut so tightly? I took three tablespoons of Natural Calm magnesium citrate in a tall glass of water nightly–every night. This is WAY too much magnesium. I am well aware that most of us are magnesium deficient, but this is a lot much! One electrolyte at a high dose is not good for the other electrolytes and their balances.  So even though this got things moving (diarrhea), this is not a good place to live for the rest of my life if I can help it.  Tenacity.

I tried some different forms of magnesium because the taste of this, although the unflavored is really okay, is becoming repulsive after four years or so of using it. The other forms, both topical and oral types of magnesium, just don’t work. And Epsom salts bath, although relaxing, don’t do anything at all for my GI.  This is the only brand of magnesium that has worked for me.  Again, I’ve no vested interest in this supplement, and I’m not saying it will work for you.

At my best right before pregnancy and also the last two months now, I was able to get off of the magnesium.  I still had/have to use it about once a week, and usually at a much lower dose– a heaping tablespoon.  But I only use it when I skip a day or things are too hard.

Bottom-line: Calm magnesium citrate now can keep my gut going (although with diarrhea) through thick and thin. Before I changed my eating and lifestyle four years ago, high dose magnesium did not work. So the fact that it works is great! But I still want off of it entirely! I am currently down to about once a week.  So I guess, if you are a nickel and dime counter, we would call this 3 and 1/2 regular supplements—since I only have to take it as needed and this only about once a week now.

Closing

I am going to stop now.  I have LOTS more to say.  You will be so bored by the time I finish.  You’ll think I talk and think about nothing but moving GI tracts. But, finish I will.  Tenacity.  Get those parachute pants.

Terri

Click here for Slow Guts Need Care, the first post in this series.

 

Probiotic Quiz

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Which probiotic should I take?  HA!  Let me see here…hmmm…let me count…I’ve got at least three kinds in the fridge here somewhere.  No, no, no!  Two in the fridge and Bio-Kult in the cupboard above the stove.  Ah, look!  There are two more half-emptied bottles in the upstairs closet from that course of antibiotics I took three years ago for sinusitis, and…

Back to the question.  Which probiotic?  Even the experts can’t agree on this!  Check out the following contradictory statements regarding Lactobacillus plantarum and Bifidobacterium infantis.

“Meta-Analysis of Probiotic Efficacy for Gastrointestinal Diseases” pooled together many studies on probiotics used in gastrointestinal (GI) diseases and concluded:

“Of the 11 species and species mixtures, all showed positive significant effects except for Lactobacillus acidophilus, Lactobacillus plantarum, and Bifidobacterium infantis.”

(I provide some brief tidbits from this meta-analysis at the end of the post, about what the studies were treating and the strains they looked at.  It’s a good read if you have time.)

However, the American Gastroenterological Association’s website states:

“Probiotics, particularlyBifidobacterium infantis, Sacchromyces boulardii, Lactobacillus plantarum and combination probiotics may help regulate how often people with IBS have bowel movements.”

My 12 years of medicinal training (pharmacy school, medical school, and residency) offered NO education on probiotics.  Basically, in residency, it was good enough to just say, “Go get a probiotic to take with your Levaquin.”  My current probiotic knowledge comes from self-experimentation and reading all those internet help-forums and blogs over the last year.  Tells you how much you should trust my site. By the way, I have tried at least Bio-Kult, a couple of brands of Saccharomyces boulardii, two brands of soil based probiotics, Culturelle, Align, Sustenex, a few brands of Lactobacillus, something from the health food store refrigerator with Bifidobacter and 301 other strains, Activia, homemade yogurt, homemade sour cream, homemade sauerkraut, store-bought kimchi, and both homemade and store-bought fermented pickles.  Whew!  Sadly, although other people may have found their ticket with a probiotic, I don’t think that’s going to be my ride.

How’s Your Probiotic Knowledge?  Take a Probiotic Quiz:

Answer True or False to statements you’ll commonly see across the internet.

1.  There is a BEST probiotic.

False.  You can’t fit a square peg into a round hole.  The effectiveness of a probiotic is person dependent, disease dependent, strain dependent, and quality dependent.  That’s a lot of variables to control for.  Your favorite blogger’s probiotic choice probably won’t hurt you, but on the other hand, it may not be the help you were looking for.

One person may do well with a probiotic with just one kind of bacteria whereas another person will do better with a probiotic with many strains of bacteria in it.  Different disease states respond better to different strains of probiotics.  It is helpful to know which strain of species is in your probiotic.  For example, Lactobacillus acidophilus in the above mentioned meta-analysis didn’t benefit the GI diseases looked at, but the specific strain called Lactobacillus acidophilus LB did.  In some cases, knowing the genus (Lactobacillus), species (acidophilus), and strain (LB) becomes very important.  You may want to read up on your condition and choose probiotics with strains that have been found to be effective for that disease state in studies.  And finally, the quality of preparation and handling of the probiotic by the manufacturer and middle-men will make a difference.  If the temperature heats up to a whopping 120 degrees in that semi-truck trailer in the summer, that doesn’t count as “ambient temperatures”, and bacteria will be dying off in the probiotic bottle.

2.  The BEST probiotics need refrigerated.

False.  Bacterial species of different types lie dormant at different temperatures and moisture levels, such as soil based organisms, and do not need refrigerated.  Also, the way the bacteria are processed makes a huge difference.  For example, freeze-dried probiotics don’t need refrigerated, and can lie in a quiescent, viable state for a year or even longer at routine temperatures as long as moisture level is controlled for.  Refrigeration, however, is absolutely necessary for many probiotics, but it still doesn’t imply the probiotic is viable if there were poor handling practices in shipment.  Refrigeration of probiotics will not be harmful, even for the non-refrigerated types.  Refrigeration keeps bacteria in a dormant state, allowing longer shelf-life.  If in doubt, refrigeration is okay.

3.  Probiotics don’t replace your bowel flora.

True (but you must keep reading).  Probiotics don’t permanently replace your bowel flora, but that doesn’t mean they don’t change your bowel flora for the better.  Once you stop taking, say Lactobacillus GG, perhaps you won’t find increased colonies of Lactobacillus GG months later.  But while it was there, the Lactobacillus GG made chemicals to inhibit the growth of other, potentially unwanted, bacteria and yeast.  Plus, it produced acids, like lactic acid, to make the environment more suitable for desirable bacterial strains present in your gut.  Maybe in a way we can say the probiotics allow a “comeback” of the desirables that have been crowded out.  If you add in a form of nutritional rehabilitation (drastically cut back on any sweet intake and grain products), you’ll be even more successful at getting the desirable bacteria back in the game and the undesirables crowded out.  Reminds me of that song line, “Don’t call it a comeback…I’ve been here for years…rockin’ my peers.”  Stupid, I know, but don’t forget I don’t get a dime to write anything.

4.  I OUGHT to be taking a probiotic.

False (but keep reading).  Some people will do very well with the addition of a probiotic.  Their yeast infections will clear up.  Their IBS diarrhea will subside.  Their immunity will strengthen.  However, for every one of these people, you may find somebody who gets very ill on a probiotic.  Any probiotic.  Any dose of probiotic.  Although it would be nice to get some probiotic in that gut, either with food or with supplements, a person can’t bang his or her head against a wall feeling guilty because Natasha Campbell-McBride, MD says probiotics are a cornerstone to treatment.  If you get sick every time you take a probiotic, work on other things.  Like cutting back sugar sources and grain products.  Also, probiotics are controversial in small intestinal bowel overgrowth (SIBO), a condition caused by too many bacteria defying gravity and peristalsis and moving up to take residence in the small intestine, where they wreak havoc.  And lastly, some severe medical conditions, like pancreatitis, can be contraindications (an absolute no-no).

5.  Probiotics should be started out at low doses.

True.  The probiotic can cause a bit of a disturbance in the GI tract.  Some bacteria will die off, some new ones with new metabolites may flourish, and your body may feel uncomfortable from these effects.  So start slowly and work your way up. If the dose calls for 2 capsules twice daily, I start off with just one capsule, see how I do, and adjust up or down from there.   You may even need to break the capsule open and sprinkle a bit on your food and try to increase as you can.  This is my personal opinion, but I give my new probiotic choices about 2-3 weeks before I ditch them and say, “Not gonna’ work for me.”  I figure 2-3 weeks is enough of a trial when I’m bloated and gassy.  If you want to deal with saccharomyces boulardii bloating for 6 weeks, be my guest.

Although starting low can help you tolerate the probiotic better, driving the dose up can be important to achieve desired effects.  The studies mentioned in the meta-analysis above drove the doses up quite high, describing effective doses from 1 million colony forming units to 50 billion colony forming units.  Read your probiotic label.  It should tell you how many CFUs are in each capsule.  For example, my bottle of SCDophilus has 10 billion CFUs per capsule.

6.  A good probiotic will have FOSs (fructo-oligosaccharides).

False.  A probiotic does not need to have FOS as an ingredient.  In fact, I would suggest that you omit the FOS component, particularly initially.  The FOS is an unabsorbable sugar that bacteria enjoy consuming, and the byproduct for you can be gas with its associated cramping.  Ouch.  FOSs are also called “PREBIOTICS” in contrast to the “PROBIOTICS” we are talking about.

Once things are going well with a particular probiotic, if you want to try a similar one with the addition of FOSes, give it a try.  Then, you’ll know if it was the probiotic or the FOSes if there are any side effects.  The FOSes are there to promote the growth of beneficial bacteria.  Not a bad theory, but in practice, maybe not so applicable.  If you eat fruits and vegetables, those are great sources of FOSs for your bacterial flora!

7.  Side effects of the probiotic are solely due to the bacteria themselves.

False.  If you have (either knowingly or unknowingly, like many people) an intolerance to gluten, soy, or milk, your bad reaction to a probiotic may be due to components used to make the probiotic, not the bacteria itself.  Bio-Kult’s allergy statement says it may contain traces of soy and dairy.  Culturelle’s bacteria are grown with whey, and may contain traces of dairy (although at such low levels it is considered non-immunogenic).  Sustenex Gummy Bears have dairy–it’s no wonder my daughter’s constipation wasn’t budging when I gave her those!

Why take the chance on a bad reaction that will confuse issues you’re trying to work out?  I don’t think it’s worth the money and chance of a reaction to have a product that has soy, dairy, and gluten as potential reactants.  Read those labels!  Look for cellulose type components.  Make sure the probiotic is free of any of those common allergens!  This will really help you narrow down your probiotic choices!

8.  Foods are the best source of probiotics for everybody.

False.  Ideally, our probiotics would come from the food we eat, but some people have such severe food intolerances that they can’t tolerate food-source probiotics.  Yogurt?  Can’t eat dairy.  Sauerkraut or kimchi?  Can’t tolerate the histamine by-products in those.  Coconut kefir?  Coconut products give them diarrhea and headaches.  When food sensitivities are that prevalent, there’s not much choice but to turn to supplements.  If you can tolerate probiotic food sources, the amount of CFUs you eat are reported to be humongous.  However, I’m not talking Activia and canned sauerkraut here.  Anything with added sugar raises a red flag and is totally counterproductive.  Anything that has  been pasteurized will have no, or at least greatly reduced, CFU bacterial numbers.

I have some obsessive-compulsive friends, and they say, “Well, I take a supplement because I just like to know how much I’m getting!”  From Breaking the Vicious Cycle’s website, “Its is often claimed that we can get more good bacteria from taking commercial probiotics. This is not the case and yoghurt is a very low cost source of probiotics. 24hr SCD™ yoghurt has a concentration of 3 billion cfu/ml which means that in just a cup of Yoghurt (236ml) you’ll get 708 Billion beneficial bacteria and that’s about 50 times more than that claimed for a typical 15 billion capsule.”

Besides the CFUs of bacteria in the fermented foods, you also are getting some of their metabolites that benefit the GI tract and your body, such as high levels of bioavailable vitamin C in sauerkraut.

Now Apply Your Knowledge…

1.  Dr. Mercola recommends “Complete Probiotics.”  He thinks its great because it has Lactobacillus acidophilus DDS-1 and 9 other strains, is stable at room temperature, has prebiotics, is free of soy/corn/dairy/wheat/gluten and in a vegetable based capsule.  What do you think?

2.  Dr. Natasha Campbell-McBride recommends the Bio-Kult she helped develop.  It has 14 different strains, is stable at room temperature, and contains soy and milk in trace quantities.  What do you think?

3.  Steve and Jordan recommend GI Pro Health’s “SCDophilus.”  SCDophilus needs refrigerated, is gluten/dairy/soy free in a cellulose capsule, and contains “Lactobacillus acidophilus.”  What do you think?

Enough testing, here are my thoughts on probiotics:

1.  Choose a probiotic with no confounding ingredients.  If you’re not very careful, your probiotic may have soy, wheat, or dairy derivatives which may be accounting for symptoms.  Read all labels closely and opt for vegetable/cellulose based capsules.

2.  Forget the FOSes.  They can cause people a lot of bloating and cramping that may have nothing to do with the introduction of the probiotic.

3.  Know your genus, species, and preferably strain.  Start simple.  Try a one-strain product, and see how that goes.  Branch out from there.

4.  Choose reputable.

5.  Listen to your body.  You may need to start with half a capsule–open and sprinkle–and work up, or you may need 1 every other day.  Titrate up as you can, but if after 2-3 weeks you’re still feeling bad from your probiotic, move on.

6.  Try to incorporate fermented foods, but beware of additives such as sugar or preservatives.  Pasteurization defeats the purpose here, except I have read that Bubbies sauerkraut is so active, they have to heat it up a bit to get it to stop being quite so active!  Their pickles are not pasteurized at all.

7.  Work up the dose.  Know how many CFUs are in the product.  Consider looking at research with the problem your trying to target and replicating the doses they use in their studies with success.

8.  Some probiotics need refrigerated and some don’t.  This is not an indicator of quality–except if it needs refrigerated and somewhere along the line it wasn’t!

From the Meta-Analysis Mentioned Above

The above mentioned meta-analysis looked at

  • pouchitis
  • infectious diarrhea
  • irritable bowel syndrome
  • Helicobacter pylori
  • Clostridium difficile disease
  • antibiotic associated diarrhea
  • traveler’s diarrhea
  • necrotizing enterocolitis

and found that probiotics had a positive significant effect on all of these states except traveler’s diarrhea and necrotizing enterocolitis.

The probiotics looked at were both single-strain products and combined-strain products.

  • VSL #3 which contains
    • 4 Lactobacillus species (L. casei, L. plantarum, L. acidophilus, and L. delbrueckii subsp. bulgaricus)
    • 3 Bifidobacterium species (B. longum, B.breve, and B. infantis)
    • Streptococcus salivarius subsp.
  • Enterococcus faecium
  • Clostridium butyricum
  • Lactobacillus acidophilus combined with Bifidobacterium infantis
  • Bifidobacterium lactis
  • Lactobacillus GG
  • Lactobacillus casei
  • Streptomyces boulardii
  • Lactobacillus acidophilus
    • L. acidophilus LB
    • L. acidophilus with no strain specified
  • Lactobacillus plantarum
  • Bifidobacterium infantis

Lactobacillus without a specified strain, Lactobacillus plantarum, and Bifidobacterium infantis showed no significant effect on the mentioned disease states.  However, Lactobacillus acidophilus LB did.

As always, this is a live performance, and feedback always appreciated.  All the best to you!