VSL#3: A Remedy for Constipation

Probiotics and their efficacy for individuals with SIBO is a controversial topic for which I have been on both sides.  At times, probiotics have worsened my SIBO symptoms and at other times they have been very beneficial.  But no probiotic formula has been as effective for me as VSL#3.  In this post I will discuss research that has been conducted on VSL#3 in regard to improving symptoms of constipation.  VSL#3 has also been studied for a variety of other conditions- I encourage you to search on PubMed for more information.

Having regular bowel movements is extremely important for detoxification because it is a process by which waste is removed from the body.  Alarmingly, it is estimated that as much as 27.1 percent of the US population suffers from functional constipation [1]. Fortunately, low-risk remedies such as probiotics exist to aid in this important detoxification process.  Studies have indicated that administration of VSL#3 can positively impact symptoms of constipation.  It is unclear whether the benefits of VSL #3 probiotic supplementation are temporary or whether they can provide lasting improvement.

VSL#3 contains eight probiotic strains including Streptococcus thermophilus, Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacilus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, and Lactobacilus delbrueckii subsp. bulgaricus.

A 2015 study [2] regarding the efficacy of the probiotic formulation VSL#3 showed positive benefits in individuals with functional constipation selected based on Rome III criteria.  Before administration of the probiotic, lower amounts of bifidobacterium and bacteriodes species were found in the stool of these individuals than in controls.  Seventy percent of individuals with functional constipation noted symptom improvement from administration of the probiotic.  Additionally, participants noted increased frequency of bowel movements from an average of 2.5 +/- 1.3 per week to 6.3 +/- 3.1 per week.  Stool consistency (based on the Bristol Stool Chart) improved from an average of 2.6 +/- 0.7 before treatment to 4.1 +/- 0.9 after the two week probiotic therapy.  Unfortunately, the results were not lasting.  Of the participants who experienced symptom improvement during probiotic administration, 61 percent reported return of hard stools or less frequent bowel movements within one month of the study’s completion.

It appears that VSL#3 may be only a remedy, not a cure.  At a cost of approximately $9-10 per day, administering VSL #3 at the dose utilized in this study may be prohibitive for many individuals.  However, VSL#3 may be an effective and welcomed means of symptom relief for individuals with chronic constipation.  No adverse reactions were noted in the study I analyzed, indicating that these protocols may be safe treatments for promoting elimination and therefore, detoxification.  Of course, it is always recommended that you consult your physician to ensure safety.

References:

[1] Schmier JK, Miller PE, Levine JA, et al. Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model. BMC Public Health. 2014;14:374.

[2] Kim SE, Choi SC, Park KS, et al. Change of Fecal Flora and Effectiveness of the Short-term VSL#3 Probiotic Treatment in Patients With Functional Constipation. J Neurogastroenterol Motil. 2015;21(1):111-20.

Health Update: Goodbye Antimicrobials

It has been a while since I have shared an update on my healing journey.  I am pleased to announce that it has been 5 months since I have taken antimicrobials and over a year since I have taken antibiotics.  Previously, I had been reliant on antimicrobials, prokinetics, and a strict low FODMAP, limited fruit, low sulfur (low thiol, specifically) diet for managing my SIBO.  I could sometimes go two weeks without antimicrobials, but my symptoms would slowly return bringing about a sense of hopelessness.

My decision to abandon antimicrobials was inspired by the results of my Genova Comprehensive Stool Analysis.  The test showed non-existent lactobacillus and bifido bacteria as well as very low microbial diversity.   I attributed this to a variety of factors: heredity, a low FODMAP diet and antimicrobials for an extended period of time, and antibiotic use throughout my lifetime (especially IV Vancomycin to treat Toxic Shock Syndrome at age 17).

Since discontinuing antimicrobials, I have had ups and downs in regard to my symptoms, but the overall trajectory has been positive- I have greatly expanded my diet and have continued to have healthy daily bowel movements (some days are better than others).  I figured it might be helpful to share my current routine with you all to give you a launching pad for ideas to discuss with your physician.

Continue reading

Key Takeaways- NCNM SIBO Symposium 2015

What a wonderful, informative, thought-provoking weekend!  I spent this past weekend at the 2nd Annual NCNM SIBO Symposium learning a myriad of information about digestive conditions- specifically IBS & SIBO.  While listening to the presentations, I kept a keen ear out for information that relates to individuals with chronic relapse, to those with sulfur/thiol intolerance, and additional testing to help reveal underlying causes for SIBO patients.

I have scoured through my notes to present to you some of my key takeaways from the presentations:

1) Stress is NOT the trigger/cause of SIBO, but it often plays a role in the manifestation of the condition.
Dr. Pimentel shared that a study has been conducted on soldiers sent overseas to regions such as Afghanistan & Iraq. The study showed that stressful circumstances such as shooting a gun or experiencing a major injury did not correlate with the subsequent development of IBS.  However, patients often indicate that stress exacerbates their IBS/SIBO symptoms and practitioners find that patients who are able to integrate strategies such as yoga, meditation, massage, etc. into their healing journey experience greater improvement than those who do not.  Therefore, it seems that stress does not trigger IBS/SIBO in the first place, but it may worsen symptoms.

2) Finding the right prokinetic often requires experimentation, but here are some tips to lead you in the right direction:

Pharmaceuticals: often required due to greater efficacy than natural options

  • Resolor (prucalopride)– highly effective for individuals with constipation, but contraindicated for those with diarrhea due to invoking slight motility of the large intestine rather than just the migrating motor complex (MMC)
  • Low Dose Erythromycin– frequently used for both IBS-C and IBS-D due to affordability and availability.  Currently, there are no studies on potential impacts on the large intestine commensal flora.
  • Low Dose Naltrexone– potentially beneficial for those with autoimmune conditions, however, many of the physicians did not find it to be a strong enough prokinetic unless combined with other options

Herbals: sometimes used in conjunction with pharmaceuticals

  • Ginger– a remedy traditionally recommended for nausea, ginger is effective at stimulating gastric motility i.e stomach emptying (Ming-Luen, Hu et al 2011) so it may be helpful for individuals with gastroparesis.
  • Iberogast– a combination of herbs that appears to be highly effective for nausea.  This formula has been used for decades in Europe as a remedy for a myriad of digestive complaints ranging from nausea to acid reflux, bloating, constipation, diarrhea, and more.  It was indicated as a safe option during pregnancy.
  • D-limonene– one of the presenters shared this as a prokinetic option, but it did not seem to be widely used among practitioners.  It has been used clinically to dissolve gallstones, provide relief from GERD, and induce phase 1 and 2 liver enzymes which could help protect against cancer (Sun, J. 2007).

3) Biofilm disruptor may be unnecessary in SIBO treatment
Many SIBO experts have not seen an increased benefit when adding a biofilm disrupting agent to their SIBO treatment protocols.  It was expressed, however, that biofilm disruptors may be more beneficial in the treatment of SIFO (small intestine fungal overgrowth) such as with candida albicans.  It was discussed that stool testing may not be reliable for ruling out candida.  One suggestion was that if a stool test is negative for candida, but an antibody test is positive, it could indicate the presence of SIFO specifically in the small intestine.

4) Hormone imbalances and birth control pills may be at play in some SIBO cases
I find it very fascinating that the number of women afflicted with IBS/SIBO far outnumbers the number of men with this condition.  I have suspected that oral contraceptive pills may have played a role in the development/worsening of my GI symptoms.  My friend, Emily, who shares similar skepticism about the connection was brave enough to submit a question to the panel of SIBO experts regarding this issue.  The experts shared that they clinically see hormonal issues and SIBO go hand and hand and that it is certainly possible that oral contraceptive pills could be a factor in SIBO.  I was curious about this issue and stumbled upon a couple of fascinating studies on this issue.  An article titled “Sex Hormones in the Modulation of Irritable Bowel Syndrome” indicates:

“Sex hormones may influence peripheral and central regulatory mechanisms of the brain-gut axis involved in the pathophysiology of IBS contributing to the alterations in visceral sensitivity, motility, intestinal barrier function, and immune activation of intestinal mucosa” (Agata, Mulak et al 2014)


5) Heavy metals as a potential underlying cause of SIBO

I have suspected for a while now that heavy metals (specifically, mercury- due to my high thiol sensitivity & high levels of mercury on my hair test) could be one of my underlying causes, but I never had a scientific explanation until now.  Heavy metal toxicity causes oxidative stress (which my Organix test showed that I have) which can lead to delayed gastrointestinal motility- i.e. constipation (Rana S.V. et al 2014).  One of the biggest controversies with heavy metal testing is how to test the body burden accurately.  At the SIBO symposium, I was able to speak with a Cyrex representative about the Array 11.  It appears that it tests for immune reactions to mercury toxicity (among other toxins) rather than just the presence of the toxin.

6) The infamous hydrogen sulfide- more to come later this year!
Dr. Pimentel shared a very exciting notice regarding the third type of gas produced in SIBO- hydrogen sulfide.  He promised that there would be more information on sulfate-reducing bacteria sometime this year- perhaps it could be testing?!?  As some of my followers may be aware, the connection between sulfur intolerance and SIBO is one of the areas that I focus much of the content of my blog.  Plan to hear more in the future!

Don’t forget to subscribe to my blog for future updates!

Thanks for reading! =)

Article titles & links to the sources listed above:
Effect of ginger on gastric motility and symptoms of functional dyspepsia
D-Limonene: safety and clinical applications
Relationship of cytokines, oxidative stress, and GI motility with bacterial overgrowth in ulcerative colitis patients
Sex differences in irritable bowel syndrome: do gonadal hormones play a role?

10 Facts About Hydrogen Sulfide

10 Facts About Hydrogen Sulfide:

  1. It can result in rotten-egg-smelling urine, breath, or flatulence.
  2. There is currently no breath test available for detecting hydrogen sulfide SIBO.
  3. A link exists between hydrogen sulfide & ulcerative colitis.
  4. Methane-producing bacteria and sulfate-reducing bacteria both consume hydrogen and may out-compete each other.
  5. Hydrogen sulfide in the brain affects memory and learning.
  6. Flat lining of methane and hydrogen on a lactulose breath test (when symptoms are present) can indicate presence of hydrogen sulfide.
  7. Normal amounts of hydrogen sulfide have beneficial effects such as regulation of inflammation.
  8. But excess levels of hydrogen sulfide is poison to mitochondria (known as the “powerhouse” of cells).
  9. Bacteria responsible for significant production of hydrogen sulfide include enterococcus, streptococcus, and prevotella.
  10. Heavy metals and sulfate-reducing bacteria are double danger (they have a synergistic effect).

References:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155069/
http://www.usc.edu/schools/medicine/departments/psychiatry_behavioralsciences/research/gsc/research/study_sibo.php
http://www.gidoctor.net/client_files/file/Review-of-SIBO.pdf
https://www.gdx.net/core/application-guides/Bacterial-Overgrowth-Application-Guide.pdf
http://www.stlouisgastro.com/client_files/file/chronic-prostatitis-and-small-intestinal-bacterial-overgrowth.pdf
http://www.mecfs-vic.org.au/sites/www.mecfs-vic.org.au/files/Article-DeMeirleir_Presentation_Oct09.pdf

Bacteria Rule Our Health

My Results- Genova GI Effects Comprehensive Stool Profile:

I have been anxiously awaiting my stool test results for a couple of weeks now.  And of course, the day they decide to arrive is the day before a big exam!  At first my mind was completely torn between studying (for my exam) and researching (to interpret my stool test), but I cleverly decided to use researching as a reward for studying.  NERD ALERT! Continue reading

NCNM SIBO Symposium

Have you ever wondered where you can go to find the most up-to-date information regarding SIBO?  Well, I am here to tell you!  The 2nd Annual NCNM SIBO Symposium is coming up the first weekend in June and will be held here in Portland, Oregon.  If you have never been to Portland and would like to visit, here is a great excuse to come!

SIBO Symposium-2015
I am very excited to be attending this year’s event because it will include the world’s leading experts and they will be discussing what they have discovered in the past year.  This year’s event is going to skip over all of the basics that SIBO veterans are already well aware of and go right into the current research and cases.  The topics will be geared toward an advanced audience, but it is open to both physicians and patients.  Interested?  Click here to learn more.

Finding Your Medical Team

Three years ago, I had never visited a naturopathic office.  Today, you would be hard-pressed to get me to visit an allopathic physician because of the negative experiences I have had with the conventional medical model.  I was raised like a typical child living in the United States- I visited the pediatrician once yearly for well-child checks, I got my vaccines, and I was given antibiotics on multiple occasions.  But something not so typical for a child was that I frequented the emergency room every year or two and racked up quite the expense in medical bills before the age of 18 (sorry mom & dad!).  After my visits to the emergency room, I would typically have a follow-up visit with the doctor and be put on some form of antibiotic.  There was never any discussion of lifestyle changes, diet, or underlying causes of my medical ailments.  By the age of 20, I found myself at the gastroenterologist being told that there was nothing they could do for me and I would just have to learn to deal with my embarrassing, painful, and disruptive symptoms.  By the age of 21, I was prescribed a scabies cream by a dermatologist (even though I had a negative test for it) when what I really had was intestinal permeability (leaky gut) causing systemic inflammation and toxins to circulate in my bloodstream, causing itching.

In the last three years of seeing naturopathic physicians and alternative medicine practitioners, I have learned SO much! I appreciate the time that they take to listen to your entire story and help connect the dots between your various health conditions.  They serve as teachers to put you on a happier, healthier path.  I wanted to share my team of teachers with all of you so that those who live in Portland (& surrounding regions) can take advantage of my research and experiences:

  • Primary Care & Women’s Health: Dr. Erika Siegel, ND, LAc: I originally found Dr. Siegel through a Google search.  I watched a video of her speaking about her approach to medicine and knew that I had to go see her.  She is an exceptional listener, very caring, and knows when she needs to be give you a subtle nudge or a forceful word of wisdom.  I feel very comfortable going to her for my yearly women’s exam and I trust her to guide me in the right direction for all of my health concerns.
  • Gastroenterologist: Dr. Melanie Keller, ND & Functional Medicine Practitioner: Dr. Siegel referred me to Dr. Keller due to the severity of my SIBO.  Dr. Keller is a highly-intelligent SIBO expert who uses evidence-based strategies to repair the GI tract.  I credit her for helping me take control of my symptoms, rather than letting them control me.  She has worked with me to find the root cause of my digestive issues and understand why I have SIBO in the first place.  If your gastroenterologist has told you that there is nothing else they can do for your IBS- go to Dr. Keller!
  • Dermatologist: Dr. Hilary Costello, ND: Dr. Costello is a breath of fresh air in my experience with dermatologists.  She understands the connection between the gut and skin and uses strategies to improve your skin health that do not just involve applying a topical antibiotic (which is what my allopathic dermatologist had me do for acne & itchy skin).  She also does yearly mole checks for those prone to skin cancer and can do minor surgery if she finds anything suspicious.  The facility where she is located is a beautiful spa with a sauna, light room, and soaking pool that can be used to relax and practice self-love after your appointment.
  • Chiropractor: Dr. Louise Paez, DC: If you have ever been to a chiropractor and your body tenses up when they try to crack something, you understand what I mean about not feeling comfortable with what the doctor is doing.  This is the opposite of how I feel with Dr. Paez.  She has a gentle approach that gives me an immediate sense of trust and relief.  She teaches at-home strategies to help you improve posture, reduce pain, and lengthen the amount of time needed between appointments.  She also has a clever insurance biller that helps me get massage coverage at the time of my chiropractic adjustments =)

For those of you who do not live in the Portland area, I have advice for you as well:

  1. Find a primary care physician who listens to you and who you can trust.
  2. Ask your primary care provider who they recommend for various aspects of your health for which you need additional help.
  3. A good practitioner will admit the areas where a specialist is warranted and refer you to those who they trust.
  4. Have any friends who have made instrumental changes in their health?  Ask them who has helped them.
  5. Lastly, since SIBO is such a specialized and under-recognized diagnosis as of now, it may be in your best interest to do a Skype consult with Dr. Melanie Keller.  If you visit her one time in person, you can establish care and she can be your physician.  Can’t come to Portland?  No worries, you can still Skype with her, she just cannot treat you as a patient.

A Self-Love Weekend

The weather in Portland this weekend was gorgeous!  The sunny skies and mild temperature felt much more like Spring than February in the Pacific Northwest.  I took advantage of the wonderful weather this weekend by treating myself to some much needed self-love (a perfect way to celebrate Valentine’s weekend if you ask me).

My Self-Love Activities:

1) Sauna– I recently learned about a place in Portland called Common Ground Wellness Co-Operative.  Located in NE Portland, this serene healing center offers soak and sauna, massage, naturopathic medicine, chiropractic, and acupuncture.  My boyfriend and I attended for a thirty minute soak and sauna session to relax and detoxify.  Unfortunately for me, my boyfriend seemed to be much better at detoxifying than I was.  In fact, this may be the only situation where I will say that I was actually jealous of his superior ability to sweat- he had a sheen of sweat dripping off his body, while my sweat was hardly visible.

As you may have read in some of my previous posts, I have a really distinct fluidy noise in my small intestine and subsequent constipation from eating high thiol foods.  I recently discussed with two of my naturopaths whether my inability to properly metabolize sulfur foods could be due to chronic heavy metal toxicity.  Both of them believed that this explanation fit well with my situation and they referred me to a naturopath who specializes in heavy metal testing and chelation therapy.  While I await my appointment with Dr. Stacey Raffety, it was recommended that I begin regular sauna sessions to help reduce my suspected heavy metal burden.  I prepared for my sauna session by hydrating throughout the day as well as during and after.  I was very impressed by the peaceful and healing atmosphere (although the clothing optional was a tad bit uncomfortable for me) and plan to attend more sauna sessions.

2) Yoga– I attended two yoga classes this weekend- one of them had a focus on stretching, while the other had more of a strength focus.  I find that yoga helps my body to enter a more relaxed state and it also provides the physical benefits of flexibility and muscular strength.  Sometimes, I can even hear my intestines working their magic during yoga classes.

3) Bike Ride– Since moving to a bike-friendly neighborhood six months ago, I have become more accustomed to riding my bike for short trips.  This weekend, I biked a total of 12 miles.  Not only did it feel great to have the endorphin rush of going up a little hill or trying to make it through a light before it turned red, but it was relaxing to be outside enjoying the fresh air.

4) Sun Bathing– you probably already knew that sitting out in the sun allows your body to synthesize Vitamin D, but did you know that your body may also be able to synthesize sulfate through sun exposure?  Due to my inability to tolerate much sulfate from my food, I was pleased to find that there may be a way to get this necessary component into my body while by-passing my digestive tract.  You can read more about the sulfate/sunlight theory here.

What are your self-love activities?  I would love to hear about them in the comments below!

Terry Wahls’ Take On Sulfur Intolerance

If you have not heard of Dr. Terry Wahls’, let me give you a brief intro.  She is a functional medicine practitioner who cured herself from Multiple Sclerosis (MS), a highly-debilitating illness.  Recently, she was the featured guess on Sean Croxton’s Underground Wellness radio show (listen here).  I was intrigued by this episode because I read that sulfate intolerance was one of the issues discussed.  To listen specifically to the sulfur issue, skip to 23:00.

Some key takeaways:

  • People with sulfur intolerance often begin avoiding sulfur veggies (that would be me!!)
  • Dr. Terry Wahls stated that people who cannot handle sulfate actually need more of it. (wait, what?! you want me to feel miserable?)
  • Risk factors for sulfur intolerance: family history of brain, heart, or autoimmune issues.
  • Exposure to glyphosate disrupts glutathione production and sulfur pathways.

I have always been a fan of listening to my body.  When I noticed that sulfur foods caused my small intestine to retain fluid, I reduced my intake of those foods  However, Dr. Wahls qualifications and opinion on this matter make me want to research this issue further so that I am making the best choices for my health.

Interpretation of my Organix Urine Acid Test

In a previous post, I shared an overview of the results of my organix urine acid test (from October 2014) and promised a more comprehensive examination into the meaning of the results.  Here it is!

Category Abnormal Result Significance
Fatty Acid Metabolism Adipate: Very High Fatty acids cannot get into my mitochondria.  May be due to carnitine deficiency.
Suberate: High
Carbohydrate Metabolism Pyruvate: High B vitamin deficiency.
Energy Production Markers Cis-Aconitate: Very Low Amino acid imbalance.
Oxidative Damage & Antioxidant Markers 8-Hydroxy-2-deoxyguanosine: High Oxidative damage potentially due to insufficient antioxidants.

Detoxification

Glucarate: High Indicates that my liver is being overworked by substances that need to get out of my body.
Pyroglutamate: High Indicator of low glutathione levels.
Sulfate: Very High Can indicate severe zinc deficiency.

Explanation for high pyruvate levels:

Cellular respiration is a vital process for human life because it allows humans to generate energy from food.  In glycolysis (the first stage of cellular respiration), glucose is broken down into two pyruvates.  Pyruvate is then converted into acetyl CoA in the next stage of cellular respiration.  However, if there is a deficiency of B vitamins such as thiamin and pantothenic acid, the enzyme that converts pyruvate to acetyl CoA cannot function properly, leading to a buildup of pyruvate.

Putting it all together:

It is clear to me that there is something going on with my ability to generate glutathione.  This is a huge issue because glutathione is known as the body’s “master antioxidant”.  It protects cells from oxidation, aids in detoxification, and supports the immune system.  My negative experiences with high thiol foods and supplements makes me reluctant to take any supplemental glutathione or n-acetyl cysteine.  The next step for me is to try and figure out the WHY behind these markers. Stay tuned for a continuation of healing!

References:

Lord, R. and Bralley, J.  Clinical Applications of Urinary Organic Acids. Part 1: Detoxification Markers.  Alternative Medicine Review.  2008; Vol 13, Num 3, p. 205-215.

Bralley, J., & Lord, R.  Interpreting Urine Organic Acids test results. Retrieved January 17, 2015, from http://www.newtreatments.org/ga.php?linkid=336