Tag Archives: irritable bowel syndrome

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

Bloating? Check Out FODMAPS.

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Back when I went through pharmacy school, medical school, and then residency, irritable bowel syndrome was very wpid-IMAG1246-1.jpgmysterious. Vague. Did it really exist? Were these patients just neurotic? Over-anxious? We never had much to offer irritable bowel patients. Some fiber. Some Bentyl. Now, it seems the leading irritable bowel doctors are using…drumroll, please…nutritional intervention! I am so happy I learned about food! I mean, I eat it every day, but I had NO idea how it seriously plays a role in my day-to-day function, feeling, and well-being!

For irritable bowel syndrome, researchers discovered that these common food components, called FODMAPS, were messing with some people’s GI tracts! FODMAP foods were removed from patients’ diets, and something like 75% of patients had significant improvement. It wasn’t in their heads after all. How nice. We actually have to believe our patients. Hmmm.

If you Google “FODMAPS”, you’ll find dozens of most excellent resources about it. I kept landing on FODMAP posts when I was trying to figure out my extensive bloating and my new-found classic irritable bowel syndrome symptoms. FODMAP intolerance symptoms include: stomach pains, bloating, gas, diarrhea, and even constipation. FODMAP containing foods are VERY common foods, particularly on a whole foods diet! Things like honey, broccoli, asparagus, dates, and apples have significant FODMAP levels.

When I asked my GI specialist about FODMAPS causing my problem, she kind of seemed scornful (probably my imagination); I was visiting her for chronic constipation. She said, “No. FODMAPS usually cause diarrhea.” Well, that’s not what the internet says, dang it! And now, about 7-8 months after my visit with her, I’m having irritable bowel syndrome symptoms after too many dates, too much avocado, an apple, broccoli, cauliflower. Classic irritable bowel symptoms! I could get tested, and I still might. However, elimination and introduction repeatedly seem to have proved the FODMAP matter in my mind.  I’m wondering, if I have the courage, if removing FODMAPS will further help my GI tract.

FODMAPS is an acronym. Each letter stands for the first letter of a nice, long word:

F=Fermentable When the carbohydrates/sugars listed below make it undigested further down the intestine than they should, bacteria ferment them. Think bubbles and stretch. And bloating and cramps. And diarrhea.
O=Oligosaccharides (fructans and galactans)  Bigger sugars/carbohydrates found in many fruits, vegetables, and legumes. Asparagus, onions, garlic, lentils, and more!
D=Disaccharides (lactose)  Two sugars that are held together (“di”) to make lactose are not cleaved the way they need to be for absorption. Found in milk.
M=Monosaccharides (fructose)  The small intestine just isn’t getting fructose transported across the wall like it should. Found in honey, apples, watermelon, among many others.
a=and
P=Polyols These are kinds of sugar alcohols. Not like the alcohol in wine or beer. Found in apples, avocados, some of the sugar replacements like xylitol (could explain some stomach turning after using Tom’s toothpaste), among other sources.
S=from the s in polyols    Or is it to just make it plural?

These substances are all carbohydrates, some are specifically types of sugar, but not all. They are found in very common foods. If a person’s body doesn’t break them down appropriately and completely like they should, or doesn’t absorb them properly, they travel further down the small intestine and into the large intestine; all the time bacteria is working on them, fermenting them.  Bloating, gas, cramps, diarrhea, foul smelling gas, diarrhea, and even constipation will result.

An individual will have different abilities to absorb different amounts of each FODMAP. A person may be sensitive to one part of the”FODMAP” equation but not the others. For example, a person may tolerate honey great but not avocados. The treatment is to remove FODMAPS for awhile.

GAPS, SCD, Paleo, Whole30, Primal, a whole foods diet, and others will rely heavily on foods that may exacerbate a person’s FODMAP sensitivity. I do the GAPS diet, and I am putting together a list for myself of the vegetables that are both GAPs and FODMAP approved. It is not only vegetables that cause problems, but I lean heavily on vegetables rather than fruits/grains/legumes, so I am interested in those right now. For those interested, check back!

Food has taken this completely sane, practical person and turned her culinary-delights and medical world upside down. Upside down.  Please don’t use any information on this blog for self-diagnosis and treatment.  Find a healthcare provider you trust to discuss things with.

Food counts. It’s not just about your weight. It’s about your function. I would have laughed at you in the face if you suggested a year and a half ago that eggs made me feel blue. Loon. That’s what you’d have been. Eggs do not make people feel sad and irritable. No. They don’t make most people feel that way. But they do make me feel that way. All I’m saying is that we have to be aware. Food is a drug. Take only that which you need and benefits you.

Terri

Posts in the draft bin:  FODMAP/GAPS vegetable list, GAPS testimonial regarding siezures